Thirty-three patients with multiple myeloma (11 untreated, 15 refractory and seven relapsed patients) have received vincristine and adriamycin infusion therapy with oral dexamethasone (VAD). The median number of course received was five. In addition 16 patients with lymphoid malignancy have received a median of four courses of VAD. Three patients who relapsed after VAD have received further VAD therapy making 52 patient treatments assessable for toxicity. Ten per cent had nausea, 4 per cent vomiting, 4 per cent total alopecia, 25 per cent constipation, 33 per cent paraesthesiae, 8 per cent proximal myopathy, 33 per cent dyspepsia, 23 per cent proven bacteraemia, and 19 per cent chest infections. Infections were not usually associated with neutropenia. Shingles was seen in four patients with myeloma, but none of the patients with lymphoid malignancy. The response rate in myeloma was 9/11, for previously untreated patients, 3/7 for relapsed, and 8/15 for refractory patients. Responses have been seen in other lymphoid malignancies-1/2 patients with relapsed acute lymphoblastic leukaemia had a complete remission. Two out of seven patients with chronic lymphocytic leukaemia achieved a partial remission, and a further three had a clinical improvement. Three out of six patients with non-Hodgkin lymphoma and one patient with macroglobulinaemia achieved a partial remission.

Adult↗

PubMedDate not supplied

Iris involvement in primary intraocular lymphoma: report of two cases and review of the literature.

Non-Hodgkin's lymphoma involves ocular tissues either as a primary tumor or as secondary metastasis from systemic disease. Diagnosis is based on the identification of malignant cells in the eye by biopsy. Although primary intraocular lymphoma cells have been identified in the optic nerve, ciliary body, and iris of a small number of patients by histopathology, these sites of infiltration have rarely been observed on clinical examination. We studied clinical and histopathological findings of two patients with iris infiltration by primary intraocular lymphoma and reviewed the findings of 163 cases reported in the literature.

Biopsy↗

PubMedDate not supplied

Chorioretinal, iris, and ciliary body infiltration by juvenile xanthogranuloma masquerading as uveitis.

Juvenile xanthogranuloma is a benign cutaneous disorder which occasionally involves the eye, orbit, and ocular adnexa in children. Iris and ciliary body manifestations are commonly seen, but retinal and choroidal lesions are exceedingly rare. We report a unique case of retinal, choroidal, iris, and ciliary body infiltration in a 12-year-old patient diagnosed by excisional biopsy of the iris. The diagnosis was confirmed by routine histology and oil-red-o staining. Immunohistochemistry revealed predominantly macrophages, monocytes, and T-helper lymphocytes. Unusual features of this case include the late age at diagnosis, posterior pole involvement, and lack of cutaneous lesions. The presence of cellular adhesion molecules and T lymphocytes implicate a lymphocyte-driven inflammatory process. Apolipoprotein A was the predominant apolipoprotein present within the foamy histiocytes. We also present a critical review of the literature.

Child↗

PubMedDate not supplied

Ocular immunopathology of Behçet's disease.

A patient developed progressive, severe, recurrent bilateral iridocyclitis, retinal vasculitis, and hemorrhagic infarction of the retina that led to blindness despite immunosuppressive therapy. Histopathology of an enucleated blind and painful eye revealed marked nongranulomatous uveitis with a predominantly CD4+ T-lymphocytic infiltration, as well as B-cell and plasma cell aggregation. Extensive expression of adhesion molecules on vascular endothelial cells were found. This finding suggests that adhesion molecules play an important role in the vasculitic process, the trademark of Behçet's disease. The ocular pathology and the therapeutic approach to Behçet's disease are briefly reviewed.

Adult↗

PubMedDate not supplied

Apoptotic and proliferative activities in first trimester placentae.

Apoptosis and cell proliferation are widely recognized to be important physiological processes which together maintain tissue homeostasis. The apoptotic and proliferative processes in 38 first trimester placentae were quantified using terminal deoxynucleotidyl transferase mediated dUTP nick end-labelling (TUNEL) and an antibody against Ki-67 antigen, respectively. In 14 cases, the estimation of apoptotic index was repeated with sections stained with haematoxylin and eosin by identifying the morphological features of apoptosis. We found that the indices obtained by either method correlated well with each other although a lower rate was obtained with the haematoxylin and eosin stained sections. Apoptosis was found in clusters mainly in syncytiotrophoblasts in association with fibrinoid deposits while proliferating activity was limited to cytotrophoblasts and stromal cells. A significant inverse correlation was observed between the proliferative index and gestational age as well as the apoptotic index. While the extent of apoptosis decreased with advanced gestational age, the correlation was not statistically significant. These findings provide a potential explanation for villous remodelling during trophoblastic invasion in early pregnancy.

Apoptosis↗

PubMedDate not supplied

Relationship between indoor nicotine concentrations, time-activity data, and urine cotinine-creatinine ratios in evaluating children's exposure to environmental tobacco smoke.

The relationship among the three most frequently used environmental tobacco smoke measuring techniques was examined in this study: (1) indoor nicotine concentrations, (2) time-activity data, and (3) urine cotinine levels. Three families that included members who smoked and one family whose members did not smoke were selected from central Taiwan to participate in the study. The children's urine cotinine-creatinine ratios and the nicotine concentrations in the living rooms varied significantly between smokers' and non-smokers' families. The multiple linear regression model indicated that both a child's cotinine-creatinine ratio, established by daily first-urine samples, and the day-averaged urine samples correlated well with the daily butt counts multiplied by the number of hours spent in the living room. It was concluded that daily first urine cotinine-creatinine ratios, as well as day-averaged urine cotinine-creatinine ratios, can predict the environmental tobacco smoke exposure of the previous day.

Adolescent↗

PubMedDate not supplied

Expression of vascular endothelial growth factor in third-trimester placentas is not increased in growth-restricted fetuses.

OBJECTIVE: Vascular endothelial growth factor (VEGF) is considered the growth factor that stimulates vasculogenesis and angiogenesis. Recent studies have demonstrated its role in regulating placental growth and invasion. Its expression can be upregulated by hypoxia. Intrauterine growth restriction (IUGR) is thought to be associated with inadequate placental perfusion, which might result from a failure in the development of the villous vascular network. Our present study was undertaken to examine the relationship between VEGF expression and IUGR in pregnancies with preserved umbilical artery end-diastolic flow. METHODS: VEGF Expression was determined by immunohistochemical analysis of placentas from 17 pregnancies with normal infant birth weight and 17 pregnancies complicated by IUGR. RESULTS: We found no significant differences in the expression of VEGF in villous syncytiotrophoblasts and intermediate trophoblasts in maternal decidua between IUGR and normal pregnancies. However, in both groups there was a strong correlation in the expression of VEGF with villous syncytiotrophoblasts and intermediate trophoblasts. In normal and IUGR pregnancies the infants' Apgar scores at birth were significantly correlated with VEGF staining in both syncytiotrophoblasts and intermediate trophoblasts (P < .05). A strong correlation also was found between cord hematocrit and VEGF staining in villous syncytiotrophoblasts (P < .05), but VEGF staining in intermediate trophoblasts was not correlated with cord hemoglobin or hematocrit. CONCLUSIONS: Our results suggest that VEGF acts in an autocrine and paracrine fashion in both normal and IUGR placentas, and its expression can have an effect on the well being of the infant at birth.

Birth Weight↗

PubMedDate not supplied

Flat preparations of the retinal vessels in Coats' disease.

Flat preparations of the retina were prepared by trypsin digestion in ten cases of Coats' disease. All of the patients were young males with advanced disease leading to enucleation. All eyes showed marked abnormalities in the arterioles, venules, and capillaries. The findings most characteristic of Coats' disease were large aneurysms and thick PAS positive deposits in vessel walls. The aneurysms ranged from 50 to 350 microns and frequently formed large sausage-like or beaded out-pouchings and were sometimes situated on shunt vessels. Other findings frequently seen, but not specific for Coats' disease, were capillary dilatation, small aneurysms, hypocellular vessel walls, and fibrous strands.

Aneurysm↗