Gain of chromosome 8q is a frequent finding in pleuropulmonary blastoma.

Pleuropulmonary blastomas are rare malignant intrathoracic tumors of early childhood. They appear as a pulmonary- and/or pleural-based mass and their pathogenesis and relationship to other pediatric solid tumors is not well understood. In this study, paraffin-embedded material of five cases of pleuropulmonary blastoma was analyzed for genetic alterations by comparative genomic hybridization and five genetic loci by fluorescence in situ hybridization. Comparative genomic hybridization identified aberrations in all pleuropulmonary blastomas, including four amplifications in three tumors at chromosomes 5q33-34, 11q22.2-ter, 15q25-ter, and 19q11-13.2. The most frequent DNA gains involved 8q11-22.2 (four cases) and 20q (two cases), whereas the most common losses included 9p21-24 (two cases) and 11p14 (three cases). Chromosome 8 gains were confirmed by fluorescent in situ hybridization, resulting in the detection of up to five copies of chromosome 8 centromeres per nucleus. In the two surviving patients, chromosome 8 gains were the only genetic abnormality, suggesting that this might be an early event in pleuropulmonary blastoma carcinogenesis. The identification of new genetic alterations as well as the confirmation of previously reported ones (especially 8q gains) in pleuropulmonary blastoma should help to improve our understanding of both the molecular mechanisms underlying the tumorigenesis of pleuropulmonary blastoma and the relationship of pleuropulmonary blastoma with other pediatric tumors.     

Management of benign lymphoepithelial lesions of the parotid gland in human immunodeficiency virus-positive patients

The diagnosis and radiotherapeutic treatment of these HIV-associated benign lympepithelilial lesions in the parotid gland are discussed. As an example of these lesions, a case is presented involving a 43-year-old HIV-infected man with a 2-year history of enlargements in both parotid glands. After evaluation by computer tomography and cytology, the diagnosis of benign lymphoepithelial lesions was made. Treatment by low-dose radiotherapy (15 Gy) caused regression of both lesions. The lesion on the left regressed completely, but the one on the right side responded only partially . A second course of high-dose radiotherapy (24 Gy) to the right lesion caused regression to a cosmetically acceptable size. Received: 20 March 1998 / Accepted: 1 April 1998     

Atrial volume and function during exercise in health and disease

Background

Although atrial function has prognostic significance in many cardiovascular conditions, changes during exercise have not previously been assessed. The aim of this study was to evaluate left atrial (LA) and right atrial (RA) volume and function during incremental exercise, both in normal individuals, healthy athletes, and in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Fifteen healthy non-athletes, 15 athletes and 15 CTEPH patients underwent multi-slice real-time cardiovascular magnetic resonance imaging at rest and during supine bicycle exercise with simultaneous invasive hemodynamic measurements.

Results

At rest, athletes had larger indexed maximal RA and LA volumes (iRAVmax, iLAVmax) than CTEPH patients and non-athletes, the latter two groups having similar values. CTEPH patients had lower RA and LA emptying functions (EmF) at rest. During exercise, RA volumes (maximum and minimum) increased in CTEPH patients, whilst decreasing in athletes and non-athletes (P?<?0.001). The exercise-induced change in iLAVmax was similar between groups, but iLAVmin did not decrease in CTEPH patients. Thus exercise-induced increases in RAEmF and LAEmF, as seen in normal physiology, were significantly impaired in CTEPH patients. At peak exercise, RA volumes (maximum and minimum) and EmF correlated strongly with RA pressure (R?=?0.70; P?=?0.005; R?=?0.83; P?<?0.001; R?=??0.87; P?<?0.001). On multivariate analysis, peak exercise RAEmF and iLAVmin were independent predictors of VO₂peak in CTEPH patients and together explained 72% of the variance in VO₂peak (ß =0.581 and ß?=??0.515, respectively).

Conclusions

In normal physiology, RAEmF and LAEmF increase with exercise, whereas CTEPH patients have impaired LAEmF and RAEmF, which becomes more apparent during exercise. Therefore, the changes in atrial volumes and function during exercise enable a far better distinction between physiological and pathological atrial remodeling than resting measures of volumes which are prone to confounding factors (e.g. endurance training). Peak exercise RAEmF is a good marker of poor functional state in CTEPH patients.

     

Skin tests predict survival after autologous tumor cell vaccination in metastatic melanoma: Experience in 81 patients

Background:Currently there is no standard adjuvant treatmentfollowing surgical resection of metastatic melanoma. We investigated whethersurgery followed by autologous tumor cell-BCG vaccination was beneficial formalignant melanoma patients. In this study we focus on the prognostic valueof DTH response following vaccination therapy. Patients and methods:Eighty-one patients with AJCC stage III andIV melanoma were selected. Whenever feasible, radical metastasectomy wasperformed. ASI was initiated by the administration of three weeklyintra-cutaneous vaccinations with 10⁷ irradiated autologous tumorcells, starting four weeks after surgery. Depending on the size of DTHresponse to the first three injections, subsequent vaccinations were planned.The first two vaccines also contained 10⁷ BCG organisms as animmune stimulatory adjuvant. Results:Induration as well as erythema correlated strongly withsurvival (P< 0.0001 and P= 0.0004). After radicalmetastasectomy in stage III melanoma patients a five-year survival of48% was observed. In stage IV disease, a five-year survival of34% was seen, after radical surgery had been performed. Whenmacroscopic disease was present at start of vaccination treatment, no clinicalresponses occurred. Apart from transient skin ulceration at the site ofBCG-containing vaccinations, no serious side effects were observed. Conclusions:This study shows that large-scale preparation ofautologous melanoma cell vaccines is feasible, while vaccination results inDTH responses that correlate significantly with survival. ASI seemed to bebeneficial in stage III and stage IV melanoma when given in the adjuvantsetting, while causing only very mild side effects.     

Impact of Percutaneous Coronary Intervention on Outcomes in Patients With Heart Failure: JACC State-of-the-Art Review

Coronary artery disease (CAD) is highly prevalent in patients with heart failure (HF) and accounts for nearly two-thirds of cases. The use of percutaneous coronary intervention (PCI) in HF patients with CAD has markedly increased and has been suggested to be associated with improved outcomes in numerous observational studies. Randomized data comparing the impact of PCI with that of coronary artery bypass graft (CABG) or contemporary guideline-directed medical therapy alone on clinical outcomes and myocardial recovery in patients with HF are lacking. The purpose of this review is to describe the available evidence regarding the impact of PCI in acute HF (in the presence and absence of an acute coronary syndrome), chronic HF with reduced ejection fraction, and HF with preserved ejection fraction. Adequately-powered randomized clinical trials examining the outcomes with PCI in these distinct HF populations are warranted.