Lymphomatoid Granulomatosis - Evidence of a Clonal T-Cell Origin and an Association with Lethal Midline Granuloma

Lymphomatoid granulomatosis and lethal midline granuloma areboth characterized histologically by atypical pleomorphic angiocentricinfiltrates. Whether these conditions are malignant lymphoproliferativedisorders remains controversial. Here we report the results of studies carried out in a patientwith coeliac disease, who developed recurrent self-healing subcutaneousnodules with the histological changes of lymphomatoid granulomatosisand an invasive nasal tumour with the histological featuresof lethal midline granuloma. The patient subsequently also developedan erythrophagocytic syndrome. Immunocytochemical labellingof both cutaneous and nasal lesions demonstrated a predominantpopulation of T cells with a CD4-negative CD8-positive phenotype.Analysis of DNA from cutaneous tissue revealed a discrete rearrangementof the ß and T-cell receptor genes. These findings suggest that lymphomatoid granulomatosis is aclonal T-cell lymphoproliferative disorder and its associationwith lethal midline granuloma indicates that both conditionsmay have a common histogenesis.     

Sentinel Lymph Node Biopsy for High-Risk Nonmelanoma Skin Cancers

BACKGROUND Although the utility of the sentinel lymph node biopsy (SLNB) in the staging of melanoma is well established, its usefulness in high-risk nonmelanoma skin cancer (NMSC) is yet to be determined.
OBJECTIVE The objective was to report our experience with patients who underwent SLNB for the staging of a high-risk NMSC.
MATERIALS AND METHODS We identified 13 patients with a high-risk NMSC who underwent SLNB between 1998 and 2006 and conducted a retrospective review of their medical records and tumor pathology. Their status as regards tumor recurrence and survival was obtained when possible.
RESULTS Of 13 patients, 9 had squamous cell carcinoma (SCC), 2 had sebaceous gland carcinoma, 1 had porocarcinoma, and 1 had atypical fibroxanthoma. All SLNB were negative for metastatic disease, but 1 appeared to be a false-negative finding.
CONCLUSION Compared to melanoma, SCC of the skin are much less predictable as regards their tendency to metastasize to the regional lymph nodes. Although the SLNB appears to be a reliable staging procedure for NMSC (especially SCC), the yield may be too low to justify its routine use in this patient population. More data are needed to determine when a SLNB is justified in the management of NMSC.     

A Twin Study of Metabolic Syndrome and Autonomic Tone

Introduction: One possible mechanism of higher cardiovascular mortality associated with the metabolic syndrome (MetS) may be through abnormal modulation in autonomic tone.
Methods and Results: We examined the association between the MetS and autonomic tone as measured by heart rate variability (HRV) among 288 twins from the Twins Heart Study (THS). Of the 288 participants, 151 (52%) had the MetS. The MetS was associated with decreased HRV across all frequency ranges, and each additional MetS risk factor was associated with lower HRV. After adjustment for several potential confounders, very-low frequency (P < 0.001), low frequency (P < 0.001), and total power (P = 0.02) spectra of HRV remained significantly lower in twins with a progressively higher number of MetS components (18–50% decrease comparing twins with 5 risk factors to those with no risk factors). Among 87 twin pairs who were discordant for the number of MetS components, a one-unit increment in MetS components was associated with an 8% smaller very-low frequency (p = 0.03) and a 15% smaller low frequency spectrum (P = 0.002) comparing each twin with his brother.
Conclusion: MetS was associated with lower HRV in a well-characterized sample of middle-aged male twins. This association persisted even after controlling for genetic and shared environmental factors accounted for by comparison within twin pairs. Abnormalities of autonomic tone, as evidenced by lower HRV, may be partly responsible for the higher rate of atrial fibrillation, coronary heart disease, cardiac death, and overall mortality seen in patients with the MetS.     

Generic palliative care

There has recently been a move towards generic palliative care with the extension of the aims, as specified by the WHO (1) to patients with non-malignant diagnoses. Trinity Hospice, London, UK, changed their admissions policy to include any patient with a specialist palliative care need from January 1 1995. The contents of this brief report were first presented as a poster at the EAPC Conference, Barcelona, December 1995.     

QUALITY OF CARE,QUALITY OF LIFE AND THE RELATIONSHIP BETWEEN THEM IN LONG-TERM CARE INSTITUTIONS FOR THE ELDERLY

A stratified randomly selected sample of 28 of all elderly long-term care institutions in the Southampton district was studied including private and local authority residential homes, private nursing homes and NHS geriatric and psychogeriatric wards. The manager was interviewed with a 57-item quality of care questionnaire modified from the methodology of Willcockset al. (1987) covering aspects of regime and environment. To assess quality of life, 10% of residents were randomly selected for a series of structured quality of life interviews and Barthel Index determination. A life-history approach was used to build rapport and increase the authenticity of resident responses. Systematic significant differences in quality of care and quality of life were found between sectors. The correlation coefficients between quality of care and morale and between quality of care and dependency were significant (r=0.526,p<0.01;r=0.508,p<0.01 respectively) although the correlation between morale and dependency (r=0.155,p=0.2) was insignificant. High-quality care may be more difficult to provide in facilities for more disabled residents. This may affect their morale but the relationship between morale and dependency is complex.