Primary lymphoma of the testis

Seventeen patients with initial presentation of lymphoma of the testis were evaluated at the Mayo Clinic between 1969 and 1979. The mean age of the patients was 69 years with 15 of the 17 patients age 60 or older at the time of diagnosis. All histologies were diffuse according to the Rappaport classification with 12 of 17 patients being histiocytic. Eleven patients were classified clinically as Stage I_EA, four as Stage II_EA and two as Stage IV according to the Ann Arbor classification. Eleven of the 15 Stage I_EA and II_EA patients were treated with radiation therapy alone with doses ranging from 2,600 to 4,000 rad. Eight of these 11 Stage I_EA patients experienced recurrence; in five of these eight, the first site of recurrence was Waldeyer's ring and adjacent structures. Four patients were treated initially with chemotherapy (one Stage I_E, one Stage II_E and two Stage IV). In all four patients the lymphoma recurred, in two patients in the central nervous system (CNS). The survival rate at two years was 73% in Stage I_EA patients and 25 % in Stage II_EA patients. There were no survivors at two years in those patients presenting with Stage IV disease.As patients with testicular lymphoma have a relatively high incidence of secondary involvement of Waldeyer's ring and the CNS, careful evaluation of these areas should be performed as part of the routine staging procedures. In view of the high incidence of secondary involvement of distant sites, systemic treatment should be given full consideration in addition to local irradiation as part of the initial treatment of patients with localized disease.     

Nuclear magnetic resonance imaging of the liver: initial experience

Nuclear magnetic resonance (NMR) scans of the liver were obtained in 12 normal volunteers and 32 patients using a whole-body machine developed by Thorn-EMI Ltd., and the results were compared with x-ray computed tomography (CT). Two types of NMR scan, saturation-recovery and inversion-recovery, were performed in order to obtain values for the spin-lattice relaxation time, T1. Although the saturation-recovery scans show little soft-tissue detail, the inversion-recovery scans demonstrated the interlobar fissure, hepatic veins, portal veins, bile ducts, and gallbladder. In comparison with CT (Siemens Somatom 2), both types of NMR scan showed some blurring due to respiratory movement but much less linear artifact across the liver from the air-fluid interface in the stomach. Focal disease within the liver was demonstrated by both CT and NMR, although an area of focal atrophy and another of hepatic infarction were only recognized with NMR. In diffuse disease the pattern varied. In steatosis CT was virtually diagnostic, while NMR showed no specific features. In hemochromatosis, hepatitis, eight cases of cirrhosis, and one of Wilson disease, both techniques showed abnormalities of varying specificity. In two cases of cirrhosis and one of primary biliary cirrhosis, only the NMR scan was abnormal. Nuclear magnetic resonance images are now sufficiently anatomically detailed to permit serious comparisons with technically advanced computed tomography. The information revealed is fundamentally different and can be expected to have some diagnostic utility.     

Pneumococcal pneumonia with bacteraemia

Fourteen cases of pneumococcal pneumonia with bacteraemia have been studied. Thirteen of the patients were older than 50 years and in ten there was evidence of pre-existing disease. Pneumococci of six serotypes were responsible for these infections but type 3 was the commonest and was associated with three of the four fatal cases. The patients who died all had evidence of renal failure. Eight of the ten survivors had prerenal failure which responded to treatment. Hyponatraemia was a common finding. Despite prompt antibiotic treatment and intensive therapy there is still a high morbidity and mortality from this condition.     

The incidence and level of contamination of British fresh sausages and ingredients with salmonellas

A five-tube most probable number (MPN) method, with the pre-enrichment and enrichment stages, was used in a study of the incidence of salmonella contamination of British fresh sausages and the ingredients used in their manufacture. All samples were taken from a large factory in the course of routine production. There was an incidence of 65% contamination of pork (n = 20) and 55% (n = 20) in pork and beef sausages. The incidences of contamination of uncooked ingredients varied from 95% for mechanically recovered meat (n = 20) to 10% for another type of meat. Cooked and/or dried ingredients were rarely contaminated with these organisms, and when contamination occurred, coliforms were also important. The numbers of salmonellas isolated ranged from 7-40 for pork sausages, from 8-24 for beef and pork sausages and from 0.8-378 organisms/g for ingredients. The following salmonella serotypes were isolated (ranked in descending order or incidence): S. derby, S. dublin, S. newport, S. stanley. S. typhimurium, S. heidelberg, S. infantis and S. agona.     

Activity and Diabetic Vitreous Hemorrhages

To ascertain the relationship between activity and vitreous hemorrhage, we questioned 72 consecutive diabetic patients presenting with 95 episodes of vitreous hemorrhage. The activity most commonly associated with symptoms of hemorrhage was sleep (36%) followed closely by sitting or lying (26%). Only one of six hemorrhages was associated with activity that could be considered more strenuous than walking. Limiting the activity of diabetic patients does not seem an effective method of preventing vitreous hemorrhage     

Prognostic significance of mediastinal mass in adult Hodgkin's disease

The authors analyzed the prognostic significance of mediastinal involvement with Hodgkin's disease in 169 pathologically stage adults (greater than or equal to 17 years) treated at the Mayo Clinic between 1974 and 1978. Sixty percent of the patients presented with mediastinal disease, evenly divided between those with a mediastinal to thoracic ratio (MTR) less than 0.33 and greater than or equal to 0.33. They were of younger average age and were more likely to have nodular sclerosis histologic subtype than those patients without a mediastinal mass. The median follow-up from diagnosis was 4.1 years with 90% of the patients being followed for 2 or more years. The 5-year disease-free survival (DFS) for the radiation only group was 70% in patients without mediastinal disease, 53% in the less than 0.33 MTR group and 44% in the greater than or equal 0.33 MTR group (P = 0.25). The 5-year survival was 92% in the patients without mediastinal disease, 88% in the less than 0.33 MTR group and 90% in the greater than or equal to 0.33 MTR group (P = 0.70). This lack of significant difference both in the 5-year DFS and survival between the three groups was also seen in the patients taken in toto (169) and in those receiving combined modality treatment (36). However, in early stage (I and II) patients, treated with radiation only, those with a large mediastinal mass had a 5-year DFS (33%) that was significantly worse than both the small mass patients (71%) and those with no mediastinal mass (87%) P less than 0.005). The pattern of relapse in the 40 patients who failed following treatment by radiation only was not affected by an increasing size of mediastinal involvement. At the time of this analysis 27 of the 40 patients who had relapsed following treatment by radiation only (all stages) had remained free from second relapse. The authors do not believe that the current data either support or negate the use of a combined modality approach in the initial treatment of Hodgkin's disease patients presenting with a large mediastinal mass. Only further follow-up will establish whether the treatment of patients, who have relapsed following radiation only, is durable and results in an overall survival comparable to that obtained by using combined modality initially.     

Antigenic stimulation of T lymphocytes in chronic nononcogenic retrovirus infection: equine infectious anemia.

Equine infectious anemia is a chronic disease of horses caused by a nononcogenic retrovirus. Studies were undertaken to determine the types of cells involved in the in vitro lymphoproliferative response to viral antigens and the dynamics of this reaction. It was observed that reactive lymphocytes were present at unpredictable times in the peripheral blood of infected horses. This reaction was shown to be specific for the interaction of equine infectious anemia virus and T lymphocytes. Enriched B-lymphocyte populations did not divide when exposed to equine infectious anemia virus. Macrophages were depleted from the reaction by two methods: adherence to Sephadex and a combination of binding to Sephadex and adherence to complement-coated erythrocytes. Both methods reduced the number of monocytes, but only the combination of Sephadex and complement-coated cells removed the accessory cells needed for lymphocyte proliferation. We conclude that during the chronic stages of equine infectious anemia the number of antigen-reactive T lymphocytes fluctuates within the peripheral blood and that these cells require a complement-binding cell for reaction. The relationship of these cells to the lymphoproliferative stages of this disease is discussed.