IgD myeloma presenting as a testicular tumor: establishment and characterization of an IgD-secreting myeloma cell line.

A 72-year-old man presented with a left testicular tumor and underwent orchiectomy. The tumor was massively infiltrated with myeloma cells bearing monoclonal cytoplasmic IgD lambda. Three months after orchiectomy, he developed huge abdominal masses and subsequently ascites containing numerous myeloma cells. An IgD-secreting myeloma cell line, designated delta-47, was established from the ascites. This cell line expressed CD4 and CD38, but lacked Fc and complement receptors, surface immunoglobulin, CD19, HLA-DR, and PCA-1. CD30 was detected on the cultured cells but not on the ascites tumor cells. Delta-47 cells secreted the same immunoglobulin (IgD lambda) as was found in the patient's serum. The light chain had a molecular weight of 35 kD which was larger than that of the normal light chain. Chromosome analysis of delta-47 revealed an aneuploid karyotype with complex abnormalities including 1q+, 2p+, and 14q+. To our knowledge, this is the only IgD-secreting myeloma cell line and would provide a useful tool for the study of IgD production and IgD myeloma.     

Extramedullary tumor as presentation of leukemia: Establishment of a new human GPIIb- and GPIIIa-positive leukemia cell line

Summary A 25-year-old man noted swelling of the right cervical lymph nodes in October 1983. Diagnosis of malignant lymphoma was made on the basis of pathological examination of biopsies. Despite both chemotherapy and irradiation treatment, blast cells appeared in the peripheral blood and bone marrow in April 1984. Immunophenotypic analysis demonstrated that the blasts in the patient's peripheral blood expressed CD13, CD33, CD41a, and no markers for T or B lymphocytes, suggesting that he had been suffering from megakaryocytic sarcoma. We established a new cell line derived from the blasts in the peripheral blood, designated KH184. KH184 cells expressed glycoprotein (GP) Ib (CD42b) and GPIIb/IIIa (CD41a), while platelet peroxidase (PPO) activity was negative in an ultrastructural study. Both Northern blot and flow cytometric analysis of surface antigens and DNA content revealed that treatment with 12-O-tetradecanoylphorbol 13-acetate (TPA) did not induce the maturation of these cells. Various cytokines such as interleukin 3 (IL-3), interleukin 6 (IL-6), and leukemia inhibitory factor (LIF) had no effect in promoting the growth of KH184 cells. KH184 cells expressing CD41a seem to possess unusual characteristics. KH184 cells, human GPIIb- and GPIIIa-positive leukemia cells, which lack response to TPA-induced differentiaton, provide a new and unique model for the characterization of factors that are implicated in the terminal differentiation of megakaryocytes, and should aid in studies of the mechanism underlying the occurrence of megakaryocytic sarcoma.     

Thyroid dysfunction in systemic lupus erythematosus and rheumatoid arthritis: Its impact as a cardiovascular risk factor

IntroductionThyroid dysfunction and autoantibodies have been frequently associated with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Aim of the workTo assess thyroid function and anti-thyroid antibodies in both diseases and elucidate the effects of the thyroid dysfunction on the clinical parameters, disease activity and cardiovascular risk.Patients and methodsForty SLE and forty RA female patients in addition to twenty controls were included. Free thyroxine (FT3), free triiodothyronine (FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase antibodies (TPOabs), anti-thyroglobulin antibodies (TGabs), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and intima-media thickness (IMT) were measured. Disease activities were assessed in both diseases. In RA patients, the anti-cyclic citrullinated peptide (anti-CCP) was evaluated.ResultsA significantly higher TSH level was found in SLE patients compared to RA patients and controls. No significant difference was present between the RA patients and controls. Anti-TPOabs and anti-TGabs were more frequently detected in SLE (85% and 55%) compared to RA (50% and 37.5%). Abnormal thyroid function tests were detected in SLE, RA patients and controls in 52.5%, 17.5% and 10%, respectively. Subclinical hypothyroidism was the most common abnormality present followed by clinical hypothyroidism then euthyroid sick syndrome in both SLE and RA patients. A positive anti-CCP and high disease activity score (DAS28) in RA were among the strongest independent determinants of cardiovascular disease.ConclusionThyroid dysfunction is frequent in SLE and RA patients. Those with thyroid dysfunction had increased cardiovascular risk.     

Deltamethrin-impregnated bednets as an operational tool for malaria control in a hyper-endemic region of Burundi: impact on vector population and malaria morbidity

Within the framework of the National Malaria Control Programme Burundi, impregnated bednets were promoted through health care facilities, schools and local administration in Nyanza Lac district. The decision to buy a bednet was left to the inhabitants and, as a result, coverage rates between 6 and 65% were observed at sub-district level. Three intervention regions were specified based on the intervention start date. From November 1992 until March 1995, bi-monthly parasitological and entomological surveys were carried out in two areas each of Region 1 and Region 2. After introduction of impregnated bednets in Region 1 the proportions of children under 5 with high parasitaemia were reduced by 42 and 53% in the 2 parasitological survey areas, where the average bednet coverages were 55 and 44% respectively. In the survey areas of Region 2 (control) no significant change occurred during the same period. During the second part of the intervention from September 1994, when intervention was also operational in Region 2, significant decreases in the proportion of high parasitaemia (63 and 42%) among children under 5 years were obtained in both parasitological survey areas of Region 2 (average coverages of 51 and 29%). The positive output of the intervention was maintained and even reinforced in the survey areas of Region 1. Bednets as a tool for malaria control entail specific problems such as coverage, daily use, reimpregnation, and renewal of old and torn nets. Further evaluation has to point out the possible shift of the clinical spectrum and the age-specific admission of malaria cases to assess the long-term benefit of this control method.     

Acid rereflux: a review,emphasizing detection by impedance,manometry, and scintigraphy,and the impact on acid clearing pathophysiology as well as interpreting the pH record

Acid clearing, the interval while intraesophageal pH is <4 after a traditional acid reflux event (RE), is a potential blind spot during pH monitoring, when reflux of acidified gastric contents may occur undetected by the pH probe. This is termed acid rereflux. Acid rereflux comprised 61% (169/262) of acid REs in recumbent postprandial patients with severe GERD in two reports using simultaneous pH monitoring and manometry as well as multichannel intraluminal impedance (MII) in one, and scintigraphy in the other. Acid rereflux events often recurred with short intervals between them. The pH probe alone was insufficient to detect most acid rereflux REs, since expanding pH criteria for an acid RE (>1 unit fall while pH < 4) detected only 35% of acid rereflux REs. When a variety of patients and study conditions was examined, simultaneous manometry–pH monitoring found more frequent acid rereflux in the following situations: (1) patients with vs those without esophagitis; (2) recumbent vs upright posture, and (3) postprandial vs preprandial. Of pathophysiologic importance, acid rereflux in the blind spot is the most common cause of prolonged daytime acid REs in GERD patients. Of clinical importance, the 24-hr pH parameter % acid exposure should be relied upon most in interpreting the 24-hr pH record, because those parameters that relate to RE frequency may be inaccurate due to acid rereflux REs that are not counted. Furthermore, identifying as many REs as possible gives a more reliable indication of the severity of antireflux barrier incompetence, as well as more REs to correlate with patients symptoms that should improve sensitivity of the symptom index. Ambulatory simultaneous pH monitoring and MII will allow these and other roles for acid rereflux to be assessed during the patients normal day.     

Portal vein arterialisation as a technical option in liver transplantation: impact on function,regeneration, and morphology of the liver following hemihepatectomy in pigs

Abstract: Background: Arterialisation of the portal vein has been propagated as a technical variant in liver transplantation. However, the consequences of this unphysiological vascular supply are insufficiently known. Methods: Twenty‐seven healthy pigs were subjected to a left hemihepatectomy and divided into three groups. The first group received complete arterialisation of the portal vein (PVA). In the second group hepatic artery blood flow was also interrupted by dividing the artery (PVA/DHA). Nine animals served as controls (Group C). Results: Early mortality in the PVA/DHA group (6/9) was significantly increased in comparison with the PVA (2/9) and control (2/9) groups (P < 0.05). In the surviving animals, arterialisation (PVA and PVA/DHA) led to significantly faster hepatic regeneration in comparison with control animals, with comparable liver function and with liver size increasing to 278% and 293% vs 134% (P= 0.002) after 3 weeks, in liver … weeks. This was accompanied by enhanced hepatic expression of the proliferation markers MIB‐1(22.4% and 16.7% vs 5.9%, P = 0.002) and PCNA(86% and 68% vs 66%, P = 0.002) one week postoperation. At the same time, the number of apoptotic hepatocytes increased from 1.6% to 2.5% and 2.3% (P= 0.002). No significant difference was found in the collagen content of the liver after 3 weeks. Conclusions: Arterialisation of the portal vein promotes early and enhanced hepatic regeneration without impairing liver function. This technique may therefore be useful in split‐graft liver transplantation, where this aspect would be of particular importance.