Non-Hodgkin lymphoma in women: reproductive factors and exogenous hormone use

Few studies of reproductive hormone exposures and non-Hodgkin lymphoma (NHL) have examined NHL subtypes. Associations between reproductive hormonal factors and risk of all NHL and of two predominant subtypes, diffuse large-cell lymphoma (DLCL) (n = 233) and follicular lymphoma (n = 173), were investigated among women (n = 581) in a large, population-based, case-control study (1,591 cases, 2,515 controls). Controls (n = 836) identified by random digit dialing were frequency matched by age and county to incident NHL cases ascertained in the San Francisco Bay Area of California in 1988-1993. Adjusted unconditional logistic regression was used to obtain odds ratios. More than four pregnancies indicated a possible lower risk of all NHL (odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.55, 1.2; p-trend = 0.06) and of DLCL (OR = 0.53, 95% CI: 0.31, 0.90; p-trend = 0.01). Exclusive use of menopausal hormone therapy for > or =5 years was associated with a reduced risk of all NHL (OR = 0.68, 95% CI: 0.48, 0.98) and of DLCL (OR = 0.50, 95% CI: 0.30, 0.85). Oral contraceptive use indicated a lower risk of all NHL (OR = 0.68, 95% CI: 0.49, 0.94), and perhaps DLCL (OR = 0.79, 95% CI: 0.51, 1.2), and of follicular lymphoma (OR = 0.75, 95% CI: 0.46, 1.2). Results suggest that endogenous and exogenous reproductive hormones confer different risks by NHL subtype and are associated with a reduced risk of DLCL in women.     

HIV-infection in childhood]

HIV infection in children is mainly due to vertical transmission. It has turned into a major epidemic in some developing countries. Due to the transfer of maternal antibodies to HIV early, diagnosis in infants is difficult and costly. The disease shows considerable clinical variability. Common classification and staging systems would seem very important in order to compare epidemiological, diagnostic and therapeutic studies. Treatment with anti-retroviral agents in under clinical trial and in combination with intensive supportive measures can significantly improve both survival and quality of life for HIV positive patients. Vaccination against HIV is in its early stages but holds some promise in the long run for the prevention of HIV disease in infants and children.     

Non-Hodgkin lymphoma among Brazilian agricultural workers: A death certificate case-control study

To estimate the non-Hodgkin lymphoma (NHL) mortality risk among agricultural workers in Brazil's southern states, we used death certificates to identify cases of NHL between the ages of 20 and 69 years from residents of nonurban municipalities between 1996 and 2005 (n = 1,317). Controls were randomly selected from those whose underlying cause of death did not include neoplasm or hematological diseases and paired with cases by sex, age, year of death, and state of residence (n = 2,634). Odds of being an agricultural worker among cases and controls were estimated by conditional logistic regression, stratified and adjusted by sex, state, education, and race. An increased risk of death by NHL was observed among agricultural workers 20–39 years old (OR_adj = 2.06; 95% CI 95%, 1.20–3.14). Our results suggest that the young agricultural workers from southern Brazil were more likely to die of NHL compared to nonagricultural workers.     

Misinterpreted lymphadenopathy and thrombocytopenia as unrecognised initial symptoms of an HIV-infection

In a 28-year-old woman and a 30-year-old man with lymphadenopathy, shown by histopathology to be follicular hyperplasia, and in a 40-year-old woman and a 40-year-old man with a thrombocytopenia, HIV-infection was not diagnosed until years later. Three of the four patients did not belong to a 'classical high-risk group' for HIV/AIDS. All patients, meanwhile, suffered from minor or major complications. Moreover, the number of CD4+ cells had decreased to < or = 200/microl before antiretroviral therapy was started. After treatment, all four patients were in reasonable to good condition. An HIV-infection should be considered in every case of reactive lymphadenopathy or thrombocytopenia.     

恶性淋巴瘤患者睡眠障碍的因素分析

目的探讨引起恶性淋巴瘤患者睡眠障碍的因素。方法应用27项睡眠调查表(The27-item Sleep Questionnaire)、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self depressionscale,SDS)、单项社会支持度调查表(the single-item measure of social support,SIMSS)评价39例恶性淋巴瘤患者在治疗过程中的睡眠质量和睡眠时间,并用统计学方法分析心理因素、社会支持度、治疗副反应、自身因素、住院环境对患者睡眠的影响。结果39例恶性淋巴瘤患者的睡眠障碍主要发生于治疗前期,其睡眠质量评分为(3.26±1.19)分,平均睡眠时间为(6.4±0.94)h,并与心理障碍、社会支持度高低、治疗副反应强弱、教育程度、家庭收入、住院环境有关(P<0.05),而与年龄、性别无关(P>0.05)。结论恶性淋巴瘤患者睡眠障碍可受多种因素影响。不同的患者、不同的治疗阶段要采用不同的心理辅导。     

Obesity in HIV-infection: dietary correlates

OBJECTIVE: To describe the prevalence of obesity among a cohort of individuals living with HIV infection, and to determine differences in dietary intake among those subjects who are normal weight, overweight, and obese. DESIGN: A cross-sectional study among participants enrolled in the Nutrition for Healthy Living (NFHL) study. SETTING: Eligible participants included HIV-positive adults living in the greater Boston, MA and Providence, RI, areas. Subjects and Measures of Outcome: In total, 321 (265 males, 56 females) subjects were studied. Body composition measurements, demographic and health data, and fasting blood samples were analyzed. Dietary intake was assessed by three-day food records. Statistical analyses were performed using Statistical Package for Social Science (SPSS). RESULTS: 13% of males and 29% females were found to be obese. Energy intake per kilogram decreased by body mass index (BMI) category for both men and women (p <0.05). Although not different between groups, mean total fat and saturated fat intakes were above recommendations for both men and women in all BMI categories, while total grams dietary fiber decreased as BMI increased. Individuals in all BMI groups had micronutrient intakes below the Dietary Reference Intakes. Serum markers of insulin resistance were significantly different by BMI category among men and women, as well as triglycerides and total cholesterol for the males. CONCLUSIONS: Obesity and diet in individuals living with HIV-infection needs to be addressed, as quality of dietary intake may have future implications regarding cardiovascular disease, metabolic syndrome, and other health risks associated with overweight and obesity.     

Primary HIV-infection: infectious mononucleosis-like presentation with treatment options]

Two patients, men aged 39 and 52 years, are described with a mononucleosis-like syndrome, due to a primary HIV infection. Both patient developed dermatological manifestations. One patient presented with an encephalitis with an inversed CD4/CD8 cell ratio in the cerebrospinal fluid. Primary HIV infection is often missed as a clinical diagnosis. The possible preservation of a strong cellular immune response against HIV itself in case of early start of treatment argues for an immediate intervention with a combination of antiretroviral drugs in this syndrome.     

Stem cell transplantation in patients with low-grade non-Hodgkin lymphoma

Patients with a non-Hodgkin lymphoma of low-grade malignancy have been considered incurable for decades. Several conventional therapies have resulted in an improved disease-free survival but not in a prolonged overall survival. Intensified treatment of relapsed patients with myeloablative conditioning followed by autologous or allogeneic stem cell transplantation (SCT) is being applied more and more. In both forms of SCT the anti-tumour effect of the high-dose chemo- (and radio-) therapy is used; allogeneic SCT has an additional so-called graft-versus-lymphoma effect. Thus allogeneic SCT appears to be a promising and potentially curative treatment for this patient group, despite complications like graft-versus-host disease and higher treatment-related mortality. Early in the course of a low-grade NHL, especially at first relapse, an allogeneic SCT should at least be considered for a patient having an HLA-compatible stem cell donor.     

人免疫缺陷病毒感染者辅助性T淋巴细胞因子变化及机会性感染的临床观察

目的观察人免疫缺陷病毒human immunodeficiency virus,HIV）感染者不同时期及其机会性感染者血清辅助性T淋巴细胞（helper T-Lymphocytes,Th）细胞因子水平的变化规律。方法正常对照组17例。研究组HIV阳性85例（A期17例,B期29例,C期39例）,其中机会性感染31例。用流式细胞仪检测血CD;T和CDs＋T细胞,用酶联免疫吸附技术（enzyme linked immunosorbent assay,ELISA）检测血清白介素-2（interleukin-2,IL-2）、1-干扰素（interferon-1,IFN-γ）、白介素-6（interleukin-6,IL-6）、白介素-10（interleukin-10,IL-10）,数据采用SPSS11．0软件进行统计。结果研究组CD4^＋T细胞（361．85±230．61）10^6／L低于对照组（772．41±161．56）10^6／L（t=6．992,P〈0．01）,IL-2（61．82±63．59）pg／ml低于对照组（111．25±66．14）pg／ml（t=2．907,P〈0．01）,研究组CD8^＋T细胞（713．36±317．59）10^6／L高于对照组（583．24±96．28）10^6／L（t=3．127,P〈0．01）、IL-10（1362．70±869．49）pg／ml高于对照组（818．54±276．22）pg／ml（t=4．704,P〈0．01）和IL-6（1883．14±1058．61）pg／ml高于对照组（1208．52±745．36）pg／ml（t=2．502,P〈0．05）。随着病程进展,IL-2逐渐下降,C期（51．72±62．28）pg／ml和B期（69．02±62．77）pg／m1分别低于对照组,而IL-6、IL-10逐渐上升,C期的IL-6（2040．27±1078．95）pg／ml、IL-10（1472．10±982．03）pg／ml均高于对照组;B期的IL-10（1347．35±780．95）pg／ml高于对照组（818．54±276．22）pg／ml。机会性感染组IL-6（2236．24±1052．42）pg／ml高于无机会性感染组（1680．43±1017．05）pg／ml（t=2．395,P〈0．05）。结论HIV感染者应动态检测血清IL-2、IL-6、IL-10的变化,同时可考虑上调IL-2和下调IL-6、IL-10,调整机体TH1／TI-L2细胞的平衡,以延缓疾病进展。     

恶性淋巴瘤患者医院感染回顾性调查

恶性淋巴瘤患因住院时间长，接受放、化疗及侵袭性操作较多，机体抵抗力差，医院感染发病率高。笔对本院1995年5月-2002年12月间出院的379例恶性淋巴瘤患医院感染情况进行了调查，结果如下。