Computed tomography of mediastinal lymph nodes in nonsmall cell lung cancer. A new approach based on the lymphatic pathway of tumor spread

Computed tomography was used to evaluate mediastinal lymph nodes in 97 patients with nonsmall cell lung cancer. All patients had thorough surgical-pathological determination of mediastinal node status. Twenty-three patients were found to have metastatic lymph nodes. The usual lymphatic pathways of tumor spread into the mediastinum were defined using the node mapping scheme suggested by the American Thoracic Society. We considered mediastinal nodes abnormal when the short axis of the largest mediastinal node in the lymphatic drainage territory of the cancer was greater than or equal to 10 mm and the difference between this node and the largest node in the other territories is greater than 5 mm. The sensitivity was 78%, the specificity 99%, the positive predictive value 95%, the negative predictive value 94%, and the accuracy 94%. Comparing our method to those that used the size criterion alone, the number of false positives was reduced.     

Hepatocellular carcinoma invading the right atrium: clinical, echographic and angiographic study

The authors report the case of a 54 year old woman suffering from hepatocellular carcinoma with tumor growth into right hepatic vein, inferior vena cava and right atrium. On cardiac examination, a pansystolic bruit and a diastolic rumble were audible at the tricuspid focus. Diagnosis was confirmed by inferior vena cavography and two-dimensional echocardiography, which demonstrated a large mobile mass in the right atrium moving to and fro through the tricuspid valve. This case report emphasizes the value of routine cardiac examination during the course of hepatocellular carcinoma.     

Identification of T cell epitopes within a 23-kD antigen (P24) of Toxoplasma gondii.

Among the potentially vaccinating antigens, the products excreted/secreted by the parasite T. gondii have been demonstrated to be excellent candidates. The molecular cloning of one of these antigens (P24) present in excreted/secreted antigens (ESA) has recently been carried out in our laboratory. The recombinant antigen P24 corresponds to a native molecule of 23 kD. We were interested in determining the main epitopes of the P24 antigen eliciting a T lymphocyte response using synthetic peptides derived from the primary structure of P24. Five peptides: 64-79, 88-109, 170-193, 194-208 and 231-250 were synthesized according to their hydrophobicity, mobility and accessibility profiles. The presence of T lymphocyte epitopes in these peptides has been examined in the rat model. The determination of T cell epitopes was carried out using T lymphocytes from infected rats, and from ESA and P24 expression vaccine virus immunized rats. The results showed that the stimulation of T cells with these peptides varied according to the period after Toxoplasma infection. The main T cell stimulation was obtained with the 88-109, 170-193 and 194-208 peptides. When Fisher rats were immunized with ESA, a most significant stimulation was achieved with the 170-193 and 194-208 peptides. In addition, T lymphocytes primed with P24 expressed vaccine virus immunization were more stimulated with the 88-109 and the 194-208 peptides. This study showed that P24-derived peptide-specific T cells were elicited in the three experimental situations, although no antibody response against the 23-kD native antigen was evidenced in the Fisher rat model. However, the native antigen (presented by irradiated parasites) can induce a proliferative response of the 170-193 peptide-specific T lymphocytes, confirming that this peptide contains an important T cell epitope. The adoptive transfer into athymic rats of T helper cells recovered from 170-193 peptide-immunized Fisher rat conferred a significant protection to infected nude rats despite the fact that no antibody production was observed.     

Differential effect of cyclosporin A (CyA) on IgE response: role of CyA-induced suppressor cells

Administration of cyclosporin A (CyA, 30 mg/kg) for the five days following immunization of Brown Norway rats with DNP14-OVA in alum abolished the primary total and specific IgE response, whereas this treatment had no significant effect on the secondary IgE response. On the contrary, with a single injection of CyA on the day of priming, the secondary IgE response only is abolished. The inhibition of the secondary IgE response could be attributed to the induction by a single dose of CyA of nylon wool-adherent spleen cells, as shown by passive transfer experiments. CyA might thus affect the IgE response variously depending on single or repeated administrations.     

Hepatic oil embolism following lymphography: CT diagnosis

Hepatic oil embolism following lymphography is reported in a 68-year-old man admitted for chylous ascites associated with recurrent prostatic carcinoma. Abdominal plain radiography, CT, and ultimately liver biopsy strongly support a direct lymphatic pathway and are against the role of lymphaticovenous anastomoses generally advocated to explain this phenomenon.     

Recombinant human IL-16 inhibits HIV-1 replication and protects against activation-induced cell death (AICD)

The chemoattractant cytokine IL-16 has been reported to suppress lymphocyte activation and to inhibit HIV-1 replication in acutely infected T cells. We have cloned and expressed human IL-16 in Escherichia coli and investigated whether the recombinant protein could regulate the level of lymphocyte apoptosis from HIV-1-infected subjects. After purification and refolding, only 2–10% of the recombinant cytokine was present in a biologically active homotetrameric form. This could explain the need for high concentrations of the bacterially derived IL-16 to induce significant inhibition of HIV-1 replication. Addition of IL-16 to unstimulated peripheral blood mononuclear cell (PBMC) cultures from HIV-1-infected subjects did not modify the observed level of spontaneous lymphocyte apoptosis. In contrast, IL-16 added to PBMC cultures stimulated with anti-CD3, anti-CD95 or dexamethasone reduced significantly the percentage of lymphocytes undergoing AICD. This effect was found to correlate with the ability of the cytokine to decrease CD95 expression on activated CD4⁺ T cells. Comparative studies on PBMC from healthy individuals indicated that the regulation of apoptosis levels by IL-16 is a complex phenomenon and could depend on the nature of the activator used and/or the immune status of lymphocytes tested. The outcome of CD4 cross-linking on T cells by various ligands is discussed in the context of the observed beneficial activities of IL-16 and its potential role in the treatment of HIV disease.