Intravascular lymphomatosis presenting as systemic inflammatory response syndrome

Intravascular lymphomatosis is an unusual form of non-Hodgkin lymphoma characterized by intravascular proliferation of atypical lymphoid cells in multiple organs. It can cause systemic inflammatory response syndrome due to primary release of cytokines by the tumor cells or secondary release of cytokines after vascular occlusion by the tumor cells. It is a potentially fatal condition, because multiorgan failure can ensue due to thrombotic vascular occlusion. This is a very rare condition and most cases are diagnosed post mortem. We present a case of systemic inflammatory response syndrome and subsequent death from multiorgan failure in a patient with intravascular lymphoma.     

Oral glutamine attenuates surgical manipulation-induced alterations in the intestinal brush border membrane

BACKGROUND: Our earlier work has shown that surgical manipulation of the intestine results in oxidative stress and mucosal damage along with alterations in the brush border membrane (BBM). Glutamine feeding is known to offer protection against damage to mucosa under various conditions and this study looked at the effect of oral supplementation of glutamine or glutamic acid in the intestinal BBM alterations after surgical manipulation. MATERIALS AND METHODS: Control and rats pretreated for 7 days with 2% glutamine or glutamic acid or isonitrogenous amino acids, glycine, or alanine were subjected to surgical manipulation of the intestine. BBMs were isolated from the intestine and functional and structural alterations to these membranes were assessed and compared. RESULTS: Surgical manipulation resulted in oxidative stress in the enterocyte BBM and these changes included a decrease in alkaline phosphatase activity and alpha-tocopherol content along with an increase in lipid peroxidation parameters. A decrease in glucose transport by the isolated BBM vesicles suggested functional impairment. Surgical manipulation also resulted in phospholipid degradation possibly mediated by PLA(2) and membrane protease activation. Glutamine or glutamic acid supplementation prevented these changes but not by glycine or alanine. CONCLUSION: This study suggests that oral glutamine or glutamic acid supplementation prior to surgery can offer protection to the intestine and this might prevent postsurgical complications.     

Hypoglycaemic and hypolipidemic effect of ethanolic extract of seeds of Eugenia jambolana in alloxan-induced diabetic rabbits

The hypoglycaemic and hypolipidemic effect of ethanolic extract obtained from seeds of E. jambolana was investigated in alloxan-induced diabetic rabbits. Hypoglycaemic activity was assessed by reduction in fasting blood glucose (FBG) at 90min and also fall in peak blood glucose during glucose tolerance test (GTT) in sub-diabetic and mild diabetic (MD) rabbits, but in severe diabetic (SD) rabbits by reduction in FBG at 90min. Ethanolic extract (100mg/kg body weight) when given orally to sub-diabetic (AR) for 1 day, MD for 7 days and SD for 15 days showed significant fall in FBG at 90min (12% AR, 18.9% MD and 29% SD) and also produced 16.9% fall in peak blood glucose in AR and 21% in MD rabbits during GTT. When administered daily for 15 days to MD and SD rabbits, significant fall in FBG (41.3% MD, 31.6% SD) and glycosylated haemoglobin (GHb) levels (23.3% MD, 26.6% SD) were observed, while serum insulin level showed significant increase (32.8% MD, 26.9% SD). Liver and muscle glycogen content also increased. The ethanolic extract of seeds also exhibited significant hypolipidemic effect as evident from fall in total serum cholesterol (TC)/high density lipoprotein cholesterol (HDL-c) ratio, serum low density lipoprotein cholesterol (LDL-c) levels and decreased activity of HMG-CoA reductase. The histopathological studies of liver, pancreas and aorta in alcoholic extract treated diabetic groups revealed almost normal appearance.     

A randomized,double-blind,placebo-controlled,phase 2 study of RMP-7 in combination with carboplatin administered intravenously for the treatment of recurrent malignant glioma

RMP-7, a bradykinin analog, temporarily increases the permeability of the blood-brain tumor barrier to chemotherapy drugs like carboplatin. We conducted a randomized, controlled trial of carboplatin and RMP-7 versus carboplatin and placebo in patients with recurrent malignant glioma. The primary outcome measure was time to tumor progression (TTP). Adults with recurrent glioblastoma multiforme or anaplastic glioma were randomized in a 1:1 ratio to receive carboplatin and either RMP-7 or placebo. Radiation therapy had failed in all patients, and they may have received prior chemotherapy. Carboplatin (dosed to achieve an area under the curve of 5 mg/ml x time for patients who had received prior chemotherapy, or 7 mg/ml x time for those who had not) was given intravenously every 4 weeks, followed by intravenous infusion of either RMP-7 or placebo (300 ng/kg). TTP, tumor response, neuropsychological assessments, functional independence, and quality of life assessments were analyzed every 4 weeks. There were 122 patients enrolled, 62 in the RMP-7 and carboplatin group and 60 in the placebo and carboplatin group. Median TTP was 9.7 weeks (95% CI, 8.3-12.6 weeks) for the RMP-7 and carboplatin group and 8.0 weeks (95% CI, 7.4-12.6 weeks) for the placebo and carboplatin group. Median survival times were 26.9 weeks (95% CI, 21.3-37.6 weeks) for the RMP-7 group and 19.9 weeks (95% CI, 15.0-31.3 weeks) for the placebo group. No differences were noted for time to worsening of neuropsychological assessments, functional independence, or quality of life assessments. The use of RMP-7 had no effect on the pharmacokinetics or toxicity of carboplatin. At the dose and schedule used in this trial, RMP-7 did not improve the efficacy of carboplatin. Recent preclinical pharmacokinetic modeling of RMP-7 suggests that higher doses of RMP-7 may be required to increase carboplatin delivery to tumor.     

Pulmonary cystic hydatid disease in Ireland

Background Hydatid disease is rare in Ireland and its incidence and prevalence are unknown. Most cases are diagnosed by a combination of clinical findings, morphological features on imaging and by serological testing. Aims We describe an Irish case of pulmonary hydatid disease detected at bronchoscopy by bronchoalveolar lavage, and discuss the diagnosis and treatment of the disorder.     

Synchronous RCC with NHL: A case report.

A 55year old man presented with cervical adenopathy of two months duration.Biopsy of the node showed T-cell lymphoma, which was confirmed by immunohistochemistry. An abdominal CT done for the staging work-up of the lymphoma, revealed a left renal mass which histologically proved to be renal cell carcinoma [RCC], gradeII, stage I. An association between RCC and lymphoma is rare and this case is documented for the synchronous and concurrent occurrence of non-Hodgkin's lymphoma [NHL] of T-cell type and RCC. Key words: RCC, Synchronous, NHL.     

Cryptosporidium and isospora belli diarrhoea in immunocompromised hosts

Cryptosporidium and isospora, two of the intestinal coccidian parasites known to be the causative agents of acute diarrhoea in animals, have now emerged as one of the main causes of prolonged life threatening diarrhoea in immunocompromised patients particularly so in patients with AIDS. Between June 1996 and December 1997, a total of 75 immunocompromised patients presenting with diarrhoea were investigated both for Cryptosporidium and Isospora. The study group consisted of cancer and AIDS patients with history of diarrhoea. Cryptosporidium oocysts were detected in 35 patients (46.7%). One of the faecal samples from an AIDS patient with diarrhoea showed the presence of both Cryptosporidium and Isospora oocysts. To the best of our knowledge, this is the second documented report of Isospora associated diarrhoea in an AIDS patient from India. The various techniques used for demonstration of these parasites were modified acid fast staining, Safranine Methylene-blue staining and direct immunofluorescence test.     

Pet sensitivities in asthmatic children

A history of pet contact and/or apparent clinical sensitivity was obtained in 65 (55%) of 118 unselected asthmatic children. These 65 children were skin tested and their sera examined for specific IgE using the radioallergosorbent test. Those children who had apparent clinical sensitivities had larger skin test reactions and were more likely to have positive specific IgE results than those without apparent sensitivities. Positive skin tests were very common (80%), but the larger the skin test reaction (weal diameter greater than 4 mm diameter) the more likely was there to be a positive history or a positive specific IgE result. Hence a large skin test reaction can provide a helpful pointer to animal allergy of clinical importance. Commercially available animal extracts have limitations for diagnostic tests. A questionnaire survey of 150 day schools emphasized the potential opportunities for contact with animal allergens at school.