Epstein-Barr virus association in classical Hodgkin''s disease provides survival advantage to patients and correlates with higher expression of proliferation markers in Reed-Sternberg cells.

Background:Most Epstein–Barr virus (EBV) associatedlymphoproliferative disorders have high proliferation indices. However,classical Hodgkin's disease (cHD) is heterogeneous, with respect toproliferation index of the Reed–Sternberg cell (RS cell), and EBVassociation. Hence, we investigated whether cHD with and withoutEBV-association differ with respect to the proliferation index of the RScells. Further we investigated whether this would have a bearing on patientssurvival. Patients and methods: We investigated 110 cases of cHD for: a) EBVassociation by immunohistochemical demonstration of EBV-latent membraneprotein-1 and EBV encoded nuclear RNA 1 by mRNA in situhybridisation; b) Proliferating cell nuclear antigen (PCNA) expressionin the RS cells. Results:EBV association was noted in 86 of 110 cases(78%). Higher PCNA expression (P = 0.004) and younger age(P = 0.001) correlated independently with EBV association. The 10year relapse free survival (RFS) of EBV+ and EBV– patients were60% and 44%, respectively (P = 0.03). The 10 yearoverall survival (OS) of EBV+ and EBV– patients were 85% and64%, respectively (P = 0.03). EBV association maintained itssignificant impact on RFS and OS within Cox proportional hazard model. Conclusions:Our study suggests that EBV is likely to confer ahigher PCNA expression and also contribute towards maintaining the RS cellsof cHD in cell cycle. Hence, RS cells in EBV associated cHD would be moreresponsive to chemotherapy and radiotherapy associated DNA damage. Thus,EBV-association provides survival advantage to cHD patients treated withstandard chemotherapy and radiotherapy protocols.     

Primary non-Hodgkin’s lymphoma of the bone

Primary non-Hodgkin’s lymphoma of the bone is an unusual entity. Twenty-five patients with diffuse large cell lymphoma of the bone were registered at the Tata Memorial Hospital (TMH) from August, 1991, to May, 2002. Pain at the local site and soft tissue swelling were the commonest symptoms. Involvement of the bones in the lower half of the body was more frequent than the bones in the upper half. Osteolytic lesions and an associated soft tissue mass were the common radiological findings. Nineteen patients received CHOP chemotherapy and five received COP chemotherapy. Twenty-three patients received involved field radiotherapy. The overall response to therapy was 96%. On follow-up, two patients had a nodal relapse. One patient died of progressive disease, and one patient died of cryptococcal meningitis. There were no deaths due to treatment-related toxicity. The mean progression free survival was 9.39 yr and the overall survival was 11.66 yr. The median overall survival has not been reached. At last follow-up, 21 patients were being following up at TMH and are free of disease. Conclusion: Primary bone lymphoma is a malignancy that is highly curable with a combination of chemotherapy and radiotherapy.     

Cytologic features of metastatic nasopharyngeal carcinoma

The aim of the study was to describe the cytologic features of metastatic nasopharyngeal carcinomas (NPC) to lymph node, which would help in arriving at a definite diagnosis, particularly in cases of occult primary with predominant finding of cervical lymphadenopathy. This is a retrospective study over a period of 2 yr (January 2000 to December 2001) and included 15 cases of NPC metastasizing to cervical lymph nodes. All cases had histopathologic diagnosis of primary NPC. Two independent observers studied detailed cytomorphology of these cases. The FNAC smears were cellular and except for three cases revealed predominantly discohesive malignant cells admixed with lymphocytes. Cellular degeneration and naked tumor cell nuclear were seen in all cases. The tumor cells showed mild to moderate nuclear pleomorphism, vesicular chromatin, and scanty cytoplasm with ill-defined cytoplasmic borders. All 15 cases were typed according to the World Health Organization (WHO) classification as types I, II, and III NPCs. There were two cases of type I NPCs, five cases of type II, and eight cases of type III pattern. FNAC of metastatic NPC in lymph node is a valuable diagnostic modality in suggesting the site of origin of the tumor. Furthermore, it is also helpful to exclude residual disease and recurrence in a treated patient with lymphadenopathy.     

Melanin containing cells of the uterine cervix and a possible histogenesis--a case report

A 30 year old nulligravidfemale attended gynaecological OPD for investigation of primary infertility. Local examination revealed presence of a dark pigmented area in the posterior lip of the cervix. The biopsy from cervix showed, squamous metaplasia of the lining epithelium with presence of granules of melanin pigment in the basal layer. Schmorl's stain for melanin and immunohistochemical staining for S-100 and HMB-45 showed strong positivity in these cells. Melanosis of the uterine cervix is usually an incidental finding in females with uterine prolapse in their fifth and sixth decade. The origin of melanin containing cells in the uterine cervix is debatable till date. Amongst the various possibilities for the origin of these cells in the uterine cervix, neural origin is probably more acceptable than epithelial cell origin. The combined expression of melanocytic and Schwanian markers in the index case, suggest a biphasic differentiation of melanin containing cells in the uterine cervix. Although the exact histogenesis and clinical significance of these are still unknown, a long term follow-up is needed to study the nature of these lesions to look for any precursor lesion for development of malignant melanoma.     

Clericuzio‐type poikiloderma with neutropenia in a patient from India

A 9‐year‐old boy presented for evaluation of variegated skin pigmentation. Palms and soles revealed honeycombed hyperpigmented hyperkeratosis. Irregular, firm, skin coloured nodules suggestive of cutaneous calcification were present on both elbows. Total leucocyte count and absolute neutrophil count were 3720/mm3 and 420/mm3 respectively. The neutropenia was not cyclical. Systematic analysis of the whole exome data revealed a homozygous mutation in USB1 gene; chr16:g.58043892TA>‐[1/1]. A final diagnosis of poikiloderma with neutropenia‐ Clericuzio type (PNC) was made. Naegeli Franceschetti Jadassohn, dermatopathia pigmentosa reticularis, PNC and dyskeratosis congenita, all can present with overlapping cutaneous manifestations. Subtle clinical details like thickened nails, hyperextensible joints, calcinosis cutis, characteristic facies and a preceding erythematopapular rash strongly favor the diagnosis of PNC. The index case highlights two novel findings: obliterated dermatoglyphics and mucin deposition (features not described hitherto in PNC).     

新型环糊精衍生物对手性药物的立体选择性研究

目的:用实验证明新型环糊精衍生物单-6-O-苯基氨甲酰基-B-CD(单-6-O-P-B-CD)对普萘洛尔、妥洛特罗以及氯丙那林3种手性药物的手性识别作用要强于β-CD。方法:用一定浓度的单-6-O-P-β-CD和β-CD为手性选择剂,以60 mmol·L-1硼砂(pH 9.25)为运行缓冲液,在分离电压为9.0 kV,检测波长为214nm的条件下,考察了单6-O—P—β—CD和β-CD对3种手性药物对映体的毛细管电泳分离;并用毛细管区带电泳法分别求解了单-6-O—P—β—CD与β—CD和所研究的手性药物形成的配合物的稳定常数。结果:单-6-O—P—β—CD能使所研究的3种手性药物达基线分离,β—CD仅能使上述药物中的普萘洛尔达部分分离(R=0.67)。结论:理论计算和实验结果均表明单-6-O-P—β—CD对所研究的手性药物的手性识别作用要强于β—CD。     

中晚期肝癌肝动脉插管化疗合并碘油栓塞疗效观察

目的 探讨超液化碘油与抗肿瘤药物相混合行肝动脉栓塞化疗治疗不能手术切除及内科静脉化疗不佳的中晚期肝癌的方法和疗效。方法 经股动脉行Seldinger法插管肝动脉超选治疗96例,单次剂量为:丝裂霉素10mg,顺铂60mg,吡柔比星60mg,5-Fu 1500mg,法国产超液化碘油10～20ml。结果 原发性肝癌:治疗前82例甲胎蛋白都有不同程度升高,其高低范围为626～2565ng/ml,通过治疗后数值明显下降,范围在35ng/ml以下并可达到正常水平;转移性肝癌:治疗前甲胎蛋白虽无明显升高,但通过治疗后可显著改善临床症状。二者用CT或术中DSA造影对照,均见病灶明显缩小。82例原发性肝癌中有6例治疗后病灶已全部消失。96例患者生活质量得到提高,生存期延长。结论 对Child B,C级中晚期肝癌患者,抗肿瘤药物吡柔比星与碘油混合乳剂行肝动脉栓塞治疗,绝大多数患者都能耐受,且能控制肿瘤的发展,并有缩小肿瘤的疗效。     

Effect of different doses of Manuka honey in experimentally induced inflammatory bowel disease in rats

To evaluate the effect of different doses of Manuka honey in experimentally induced inflammatory bowel disease in rats. Adult Wistar rats of either sex were used (n = 30). Colitis was induced by a single intracolonic administration of TNBS dissolved in 35% ethanol. The rats (n = 30) were divided into five groups (n = 6) and were treated with vehicle (ethanol), TNBS, Manuka honey (5 g/kg, p.o.), Manuka honey (10 g/kg, p.o.) or sulfasalazine (360 mg/kg, p.o.) body weight for 14 days. After completion of treatment, the animals were killed and the following parameters were assessed: morphological score, histological score and different antioxidant parameters.Manuka honey at different doses provided protection against TNBS-induced colonic damage. There was significant protection with Manuka honey 5 g/kg as well as with 10 g/kg body weight compared with the control (p < 0.001). All the treated groups showed reduced colonic inflammation and all the biochemical parameters were significantly reduced compared with the control in the Manuka honey treated groups (p < 0.001). Manuka honey at different doses restored lipid peroxidation as well as improved antioxidant parameters. Morphological and histological scores were significantly reduced in the low dose Manuka honey treated group (p < 0.001). In the inflammatory model of colitis, oral administration of Manuka honey 5 g/kg and Manuka honey 10 g/kg body weight significantly reduced the colonic inflammation. The present study indicates that Manuka honey is efficacious in the TNBS-induced rat colitis model, but these results require further confirmation in human studies.