Clinicopathologic and immunologic features associated with transformation of mycosis fungoides to large-cell lymphoma.

Mycosis fungoides (MF) can progress to a large-cell malignant lymphoma (LCL). This transformation is associated with a more aggressive biologic behavior and course. We reviewed cutaneous tumors of 36 MF patients and divided them into two groups, one showing histologic evidence of transformation into LCL, another characterized by infiltrates of small- to medium-sized cerebriform cells (nontransformed cases). Biopsies of patches or plaques from early MF stages were available from 34 patients. Twenty of the 36 cases (55.6%) showed transformation to a large-cell variant: nine tumor-stage (T) medium-sized and large-cell pleomorphic, five T immunoblastic, two T large-cell anaplastic, and four unclassified T LCL. Sixteen cases represented nontransformed tumor stage MF. In 23 cases, including both nontransformed (n = 6) and LCL (n = 17) groups, immunohistochemical investigations revealed aberrant patterns of antigen expression (partial loss of one or more T cell-associated antigens) and the presence of activation- and proliferation-associated antigens. Clusters of B-lymphocytes formed a distinctive component of the infiltrate in two nontransformed and nine LCL biopsies. Although survival rates after tumor onset did not significantly differ between the two groups (5-year survival rate 23% for nontransformed patients, 11.1% for LCL patients, p greater than 0.05), overall survival from first biopsy diagnostic of MF showed a statistically significant difference between patients with nontransformed tumor stage MF compared with LCL patients (10-year survival rate 46.6% and 11.2%, respectively, p less than 0.02). The recognition of transformation to LCL in MF should provide a better assessment of future therapeutic approaches.     

Metabolic responses after laparoscopic or open hernia repair

Background: The purpose of a prospective randomized study was to compare the surgical trauma in patients undergoing laparoscopic or open hernia repair. Methods: Postoperative pain, analgesic consumption, and metabolic response to surgery were assessed in 30 patients undergoing laparoscopic (group 1; n=15) or open (group II; n=15; Shouldice repair) unilateral inguinal hernia repair. Both groups were comparable with respect to age, sex, and type and size of inguinal hernia. Results: Postoperative visual analogue scales (VAS) for pain were reduced on mobilization for patients of group I with a significant difference (P=0.02) on the operative day, whereas pain scores at rest and analgesic requirements were similar for both groups. No differences between groups I and II were found in postoperative levels of interleukin-1, interleukin-6, tumor necrosis factor alpha, Creactive protein, fibrinogen, transferrin, alpha-1-antitrypsin, and white blood cells. Postoperative polymorphonuclear (PMN) elastase concentrations remained within normal range in group II but showed a significant increase in patients operated laparoscopically for postoperative days 1 and 2. Conclusions: No major surgical trauma was found after herniorraphy compared to open hernia repair.     

Correlation of arthroscopy with other diagnostic modalities.

In our experience arthroscopy proved to be the most reliable method of evaluating internal derangement of the knee. Among 96 patients who underwent arthrotomy, the arthroscopic diagnosis was confirmed in 96 per cent. The combined anteromedial, anterolateral, and posteromedial approaches consistently demonstrated all intraarticular disorders. We found the posterolateral approach of little benefit.     

Scientific fundamentals of hippo- and riding therapy - a compilation of study results (author's transl)

The article surveys some of the scientific fundamentals of hippo- and riding therapy, and its methods using the characteristic horseback three dimensional rhythmic movement impulses for its therapeutic values, particularly in cerebral palsy. The influence of riding on posture and balance reactions, position of the pelvic, postures of head and trunk as well as rotatory movements was demonstrated in film studies using the cerebral palsied with different syndromes as an example. Electromyographic examinations of antagonistic muscle groups, kinesiologic analyses with the help of a video-recorder, as well as motor tests to evaluate coordination and balance control confirm the practical experience, i.e., that the hippo- and riding therapy has a positive influence on the neuromuscular dysfunction in cerebral movement disorders. A lasting improvement of motor and intellectual abilities was proven by a long-term study which also revealed that motivation was the driving force.     

Immunogenicity of and immune response to the human platelet antigen Zwa is strongly associated with HLA-B8 and DR3

In a prospective study the immunogenicity of the Zwa antigen during gestation was investigated. Twenty-six out of 1,211 pregnant women were Zwa negative (2.15%). In 2 out of 23 Zwa negative mothers who delivered Zwa positive children, an antibody to Zwa was detected. To determine the relationship between the immune response of pregnant women towards Zwa and the MHC, the phenotype frequencies of HLA-A, B, C, DR, and complement BF, C2, C4A, C4B allotypes of "non-responders" without detectable Zwa antibodies (N = 20) were compared with a group of "responders", i.e. Zwa negative mothers giving birth to Zwa positive children with typical neonatal alloimmune thrombocytopenia (NAIT; N = 39) and with a normal control population. When compared to the normal control group, "non-responders" showed a significant increase of the DRw6 frequency, whereas in the "responders" group HLA-A1, B8, DR3, and C4A*QO were significantly elevated. If "non-responders" and "responders" were directly compared, only B8 and DR3 remained significantly different. The strongest association with a hypothetical immune response gene appeared to exist with DR3.     

Identification of soluble fibrinogen fibrin monomer complexes by non-enzymatic polymerisation in the tissue

Summary In states of plasmic hypercoagulability and consumption coagulopathy ethanol favours the non-enzymatic polymerization of circulating soluble fibrinogen fibrin monomer complexes (FFMC) in vitro. The ethanolgelation test of Godal and Abildgaard makes use of this phenomenon, called paracoagulation. The present studies show that it is also possible to visualize soluble FFMC by means of ethanol-gelation. In the electron microscope, FFMC, polymerized non-enzymatically by ethanol in the spleen, are characterized by plump or slender mycelioid fibrillar precipitates that show a uniform rhythmic transverse striation, a period-coincidental filamentary arrangement and an average periodicity of 23 nm. The ultrastructure demonstrates these ethanol-induced filaments to be in vitro-polymerized fibrin monomer derivatives. Paracoagulation with ethanol allows the identification of soluble FFMC in the tissue prior to the formation of highly polymerized fibrin-rich microthrombi, the established equivalents of the DIC-syndrome.The electron microscope studies also show the existence of a second type of fibrillary structure in the tissue polymerized by ethanol. This second type lacks the characteristic periodicity of fibrin and the period-coincidental arrangement of the filamentary structures, but is characterized by closely packed or chain-like aligned, irregularly sized spherical bodies. There is some evidence that these spherical bodies in vitro represent non-enzymatically polymerized complexes of fibrin monomers and fibrin degradation products (FDP), the equivalent of a limited local or generalized fibrinolysis in vivo.Suppported by Deutsche Forschungsgemeinschaft — Sonderforschungsbereich 90, CardiovasculÄres System, University of Heidelberg     

Transitional fractures of the distal tibia

INTRODUCTION: The purpose of the study was to determine the outcome after treatment of transitional fractures of the distal tibia, including growth disturbances, osteoarthritis, and/or restriction of the ability to take part in sports. PATIENTS AND METHODS: In a retrospective multicentre study of 72 patients, 50 were evaluated by clinical and 46 by radiographic examination, an average of 7.4 years (standard deviation 5.9) after treatment. Of these 50 patients, initially 20 were treated non-operatively and 30 were treated operatively. The mechanism was mainly supination trauma. RESULTS: There were four revision operations, including two for fracture displacement after earlier non-operative treatment. No patients reported impairment of sports activities. In no case was the range of movement in the upper ankle joint decreased by >10 degrees . Radiographic examination revealed small osteophytes in one case and narrowing of the joint space in two; there was no axial deviation or clinical problems in any of these cases. There were no significant differences between the group treated non-operatively and the group that underwent surgery. The intermediate- to long-term outcome presented was good or very good in both the surgically and conservatively treated patients. Only two of the initially nondisplaced fractures later became displaced. This finding emphasises that operative treatment is not indicated for all nondisplaced fractures. Axial deviations may not occur, because of the little growth potential of the partially closed physis.