Regression of mediastinal Hodgkin disease after therapy: evaluation of time interval

Ninety-one patients with Hodgkin disease of the upper torso who had mediastinal masses were studied to determine the frequency of residual mass and the time required for resolution or stabilization of the mass. In 72 of these patients, radiographs from sufficient intervals were available for determination of the rate of regression. In 62 patients (86%), the mediastinum returned to normal width within 11 months, regardless of the size of the mass. The mediastinum returned to normal in all but one patient with small masses. The intrathoracic relapse rate did not correlate with the regression time of the masses, but relapse occurred more than twice as often in patients with residual mediastinal widening.     

Tubo-ovarian abscesses: CT-guided percutaneous drainage

The results of computed tomographic (CT)-guided percutaneous drainage in eight patients with tubo-ovarian abscesses are reported. Seven patients (88%) recovered without surgery and required no further treatment. One patient had marked clinical improvement but still required a posterior colpotomy. No complications occurred. One patient had a recurrence of symptoms 20 months after the procedure that represented a new infection. The role of CT-guided percutaneous drainage in tubo-ovarian abscesses as well as an analysis of the technical aspects associated with a successful procedure are discussed.     

Cytogenetic features of Hodgkin's disease suggest possible origin from a lymphocyte

Surface marker and gene rearrangement data have supported various hypotheses about the origin of the malignant cell in Hodgkin's disease. Cytogenetic data about this disorder, however, are very scanty. To determine if any chromosomal abnormalities that could add further information to this controversial point are present, we studied tumor samples from 49 patients. Abnormal metaphases were obtained in 18 cases. The most common breakpoints were in 11q23, 14q32, 6q11-21, and 8q22-24. These are common breakpoints in lymphoma and raise the possibility that the malignant cell in Hodgkin's disease may be derived from a lymphocyte. The 11q23 breakpoint is also seen in t(4;11) and t(9;11), which is typical of a type of childhood B-cell acute lymphoblastic leukemia characterized by the presence of aberrant myeloid and monocytic markers. Myeloid and monocytic markers are common in Reed-Sternberg cells.     

Electroconvulsive therapy (ECT) in a patient with a dual-chamber sensing, VDDR pacemaker

BACKGROUND: Because previous case reports involved old pacemaker models, it is unclear whether electroconvulsive therapy (ECT) may interfere with modern pacemaker function. Intracardiac voltages during ECT have not been measured previously. METHOD: We present a 77-year-old man with a dual-chamber sensing VDDR pacemaker who was treated for a major depression with ECT. His pacemaker function was closely monitored throughout the ECT sessions. RESULTS: An intracardiac electrogram showed low noise signals around 2 mV during ECT, which caused oversensing in the atrium. The intracardiac electrogram and pacemaker function normalized immediately after ECT. No arrhythmias or pacemaker malfunction was detected during and after several ECT sessions. CONCLUSION: The presence of a pacemaker should not be a contraindication to receiving ECT. There was no need to convert the pacemaker to a fixed rate pacing or deactivate the pacemaker before ECT. However, careful monitoring for potential pacemaker interference by medical staff experienced in pacemaker management is advised during the first ECT sessions for patients with pacemakers.     

POLYMORPHISMS OF ANGIOTENSIN-CONVERTING ENZYME, ANGIOTENSINOGEN, ANGIOTENSIN II TYPE 1 AND TYPE 2 RECEPTORS AND ENDOTHELIAL NITRIC OXIDE SYNTHASE IN TURKISH RENAL TRANSPLANT RECIPIENTS: A PRELIMINARY STUDY

Immunosuppressive therapy for organ transplant recipients is complicated by high rates of malignant diseases, one of these being Kaposi's sarcoma (KS). We reviewed the records of 1075 patients who underwent kidney transplantation at our center between October 1985 and May 2002. A total of 52 malignant diseases were observed in 50 patients (4.7%), during the post-transplantation period. Kaposi's sarcoma was identified in 16 of these 50 individuals. Of the 16 recipients, six were male and 10 were female. The mean age in the group was 39±9 years (range: 10–62 years). At the time of the KS diagnosis, 14 of the recipients were taking triple-drug immunosuppressive therapy consisting of cyclosporine A, azathioprine, and prednisolone. The other two individuals were receiving azathioprine and prednisolone. The mean time from transplantation to diagnosis with KS was 24±15.2 months (range: 8–74 months). One recipient had concomitant lymphoma and KS. The lesions of seven patients were limited to the skin, five cases involved the skin and gastrointestinal tract, and four patients had disseminated disease. After KS was confirmed, the first-line of treatment was to withdraw cyclosporine A and azathioprine, and taper the prednisolone. The tumors were managed with appropriate surgical and/or medical therapy. At the time of writing, nine individuals were still alive: four had normal renal function and five had lost their grafts as a result of chronic rejection. We have found the combination of immunosuppressive drug withdrawal and chemotherapy to be very effective in patients with limited disease, but the results in cases of generalized disease have been poor.     

Pseudoplatelets: a retrospective study of their incidence and interference with platelet counting

AIMS: Spurious platelet counts can be found in acute leukaemias, as a result of the fragmentation of blood cells. Microscopic examination of a blood smear should be performed to detect the presence of these so called pseudoplatelets. When present, the platelet count should be corrected because of the important clinical consequences that a lower platelet count may have in these patients. METHODS: K(3)EDTA anticoagulated blood was measured on an automated blood cell counter, and a blood smear was made and stained according the May Grünwald-Giemsa method for microscopic observation. A 500 cell/particle differentiation was performed and the automated platelet count was corrected. RESULTS: The incidence of pseudoplatelets in 169 patients with acute leukaemia was studied. Pseudoplatelets were detected in 43 patients (25.4%), and seven patients (4.1%) were re-classified as having a major bleeding risk (platelet count, < 15 x 10(9)/litre). CONCLUSIONS: Platelets should be determined morphologically in patients with acute leukaemia and a routine screening method for the detection of pseudoplatelets should be developed.     

Hyperhomocysteinemia as a risk factor for venous thrombosis.

Classical homocystinuria is associated with arterial vascular diseases and venous thrombosis. In the last decade, several studies have been published indicating that even mild hyperhomocysteinemia is a risk factor for venous thrombosis. The 677C-->T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene is an important cause of mild hyperhomocysteinemia, but this polymorphism does not seem to be a risk factor for venous thrombosis. Studies on the interaction between hyperhomocysteinemia and other thrombotic risk factors are conflicting. Little is known about the pathophysiology of venous thrombosis in hyperhomocysteinemia. Several mechanisms proposed for vascular disease may be applied to venous thrombosis as well. However, up to now there is no satisfying model which might explain a thrombophilic state at plasma homocysteine concentrations in the range of mild hyperhomocysteinemia. The results of a first clinical intervention study are expected in 2002. As the results are pending, clinicians could perform homocysteine measurements in patients with venous thrombosis if screening for thrombophilia is indicated. Vitamin supplementation could be prescribed if homocysteine levels are elevated. However, the patient should be informed about the uncertainty of the benefits of vitamin supplementation.     

A population-based model to describe geometrical uncertainties in radiotherapy: applied to prostate cases

Local motions and deformations of organs between treatment fractions introduce geometrical uncertainties into radiotherapy. These uncertainties are generally taken into account in the treatment planning by enlarging the radiation target by a margin around the clinical target volume. However, a practical method to fully include these uncertainties is still lacking. This paper proposes a model based on the principal component analysis to describe the patient-specific local probability distributions of voxel motions so that the average values and variances of the dose distribution can be calculated and fully used later in inverse treatment planning. As usually only a very limited number of data for new patients is available; in this paper the analysis is extended to use population data. A basic assumption (which is justified retrospectively in this paper) is that general movements and deformations of a specific organ are similar despite variations in the shapes of the organ over the population. A proof of principle of the method for deformations of the prostate and the seminal vesicles is presented.     

Heat shock proteins are therapeutic targets in autoimmune diseases and other chronic inflammatory conditions

Introduction: Exploitation of antigen-specific regulatory T cells (Tregs) as critical regulators in the control of chronic inflammatory diseases is hampered by the obscure nature of most disease-relevant autoantigens. Heat shock proteins (Hsp) are possible targets for Tregs due to their enhanced expression in inflamed (stressed) tissues and there is evidence that Hsp can induce anti-inflammatory immunoregulatory T-cell responses. Areas covered: Recent publications showing that exogenous administration of stress proteins has induced immunoregulation in various models of inflammatory disease have also been shown to be effective in first clinical trials in humans. Now, in the light of a growing interest in T-cell regulation, it is of interest to further explore the mechanisms through which Hsp can be utilized to trigger immunoregulatory pathways, capable of suppressing such a wide and diversified spectrum of inflammatory diseases. Expert opinion: Therapeutic approaches via exploitation of antigen-specific Tregs will benefit from tailor-made combination therapies. Combining current therapeutic approaches with Hsp-specific therapies thereby enhancing natural immune regulation might expedite the entry of antigen-specific regulatory T cells into the therapeutic arsenal of the anti-inflammatory therapeutics.