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Biomedical subjects

D L Sweet

Publications and source records attributed to D L Sweet.

54 records · Page 3Linked to original sources

Multicentric giant lymph node hyperplasia.

A patient with retroperitoneal and axillary lymphadenopathy and splenomegaly was demonstrated histologically to have the hyaline vascular type of giant lymph node hyperplasia, with plasma cell infiltrates in each region. The abdominal lesions were not surgically resectable and did not respond to radiotherapy. The clinical findings included polyclonal gammopathy, high cold agglutinin titers, neuropathy, and bilateral papilledema. All of these abnormalities have persisted three years since the initial diagnosis.

Female↗

Chemotherapy of non-Hodgkin lymphoma: the diffuse types.

Patients with malignant lymphoma, diffuse type, have an unfavorable prognosis when compared to those patients with modular patterns. Prior to the introduction of combination chemotherapy, 50% survival rates for MC-D or PDL-D were about 2 years, HL-D about 1 year. Aggressive combination chemotherapy for advanced MC-D or PDL-D results in complete remission rates of 22-82%, with median survivals of 1-2 years. Patients with localized HL-D are probably curable with radiotherapy alone in 75% of cases. Patients with advanced disease are best treated with intensive combination chemotherapy, achieving a long-lasting complete remission in over one-half of cases, with median survivals now at 1-3 years. Many of these patients are probably cured, central nervous system relapse may now be a concern. The results of treatment of advanced histiocytic lymphoma are now approaching the results reported for advanced Hodgkin disease.

Antineoplastic Agents↗

Hypergranular promyelocytic leukemia (APL): cytogenetic and ultrastructural specificity.

Cytogenetic and ultrastructural findings were important diagnostic indicators of hypergranular promyelocytic leukemia (APL) in a patient whose bone marrow morphology appeared, by light microscopy, to be similar to that in acute myeloblastic leukemia (AML) with maturation. Peripheral blood smears and bone marrow specimens examined by light microscopy showed few cells with the numerous coarse, azurophilic granules typical of APL. Cytogenetic analyses, with several banding techniques, of cells from bone marrow and unstimulated peripheral blood revealed the 15;17 translocation, which has been observed only in APL. A reinterpretation of the reciprocal translocation, based on R banding, suggests that the breakpoints are distal to q24 in No. 15 and at or near the junction of q21 and q22 in No. 17. In addition, the patient had disseminated intravascular coagulation. The characteristic morphology of granules seen in APL was observed in this case only when transmission electron microscopy was used, since the granules were quite small. Since treatment for AML differs from that for APL, identification of the 15;17 translocation and ultrastructural evidence of granules represent valuable diagnostic aids for APL.

Adult↗

Banding studies on chromosomes in diffuse "histiocytic" lymphomas: correlation of 14q+ marker chromosome with cytology.

Chromosomes were studied in cells from tissues primarily involved by diffuse "histiocytic" lymphoma in nine patients. Two of the patients had stage II disease; their tumors were fibrotic and had no mitotic cells. One patient was in stage III, and the remaining six patients had stage IV disease. The modal chromosome number of abnormal cells from these last seven patients was hypodiploid in two, hyperdiploid in four, and near-triploid in one. Complete banding studies of six cases and partial analysis of the seventh indicate that (1) every patient had a distinct cell line with common markers, with a few cells showing minor variants; (2) although certain chromosomes (Nos. 1, 2, 3, 9, 12, and 14) were structurally affected more often than others, no markers with the same banding pattern were noted among them; and (3) the cytologic type of lymphoma could be correlated with the karyotype in all seven patients. When the Lukes and Collins classification was used, three patients whose tumors were composed predominantly of large noncleaved cells showed a 14q translocation leading to the formation of a 14q+ marker chromosome. This marker was not observed in four patients whose tumors had a majority of large cleaved cells. These preliminary results, if confirmed in a larger series of patients, will provide additional evidence that there are consistent chromosome changes associated with specific subtypes of lymphoproliferative disorders analogous to the Ph1 chromosome in chronic myelogenous leukemia.

Chromosome Aberrations↗

Survival of patients with localized histiocytic lymphoma.

Twenty of 65 patients with diffuse histiocytic lymphoma were identified by staging laparotomy as being in pathologic stages (PS) I, I(E), II, II(E). Six of the 20 patients were treated with total nodal, 10 with extended mantle, and four with involved-field radiotherapy. The survival rate and relapse-free survival at five years were 71% and 78%, respectively. All relapses occurred within the first year and were confined to patients with PS II disease and four or more sites of involvement. Accurate pathologic staging identifies patients who are potentially curable with radiotherapy. Further studies are required to determine the treatment necessary to achieve cure in PS II patients with more than four sites of involvement.

Adolescent↗

Chronic lymphocytic leukaemia and its relationship to other lymphoproliferative disorders.

Chronic lymphocytic leukaemia is a disorder with variable clinical presentation, but with constant and easily recognizable morphological features. The majority of cases are of B-cell lineage, the cells being characterized by IgM and IgD surface markers. In occasional cases monoclonal gammopathies with idiotypes identical to those of the SIg are produced. Some cases of CLL may be confused with Waldenström's macroglobulinaemia. The clinical and morphological features of certain other lymphoproliferative disorders have been summarized. Finally, a progression of B-cell differentiation along an immunoexpressive spectrum has been described and the relative position of CLL defined. A correlation of cell morphology and function is possible in most cases. The possibility that CLL may terminate in an acute blastic crisis or histiocytic lymphoma is raised. It is emphasized that LPD include a wide range of diseases, some being non-malignant, others of questionable malignancy, and still others being frankly malignant. Clinical, morphological and immunological data are required for diagnosis in some cases.

B-Lymphocytes↗

Avascular necrosis of the femoral head with combination therapy.

Four patients with malignant lymphoma who were treated with multiple courses of combination chemotherapy, consisting of cyclophosphamide, Oncovin, procarbazine, and prednisone (COPP), developed avascular necrosis of the femoral head(s). Disorders usually associated with the development of avascular necrosis were absent. The total prednisone dose received by each patient was small. Avascular necrosis of the femoral head should be considered in the differential diagnosis of bone pain in patients receiving multiple courses of combination chemotherapy.

Adult↗

Malignant lymphoma: implications during the reproductive years and pregnancy.

The malignant lymphomas are reviewed, and involvement of urogenital-ridge derivatives, including the reproductive organs, is summarized. Implications of therapy for pelvic lymphoma are discussed. It is shown by a retrospective analysis that Hodgkin's disease has little effect on fertility, the course of gestation, delivery or fetal wastage and that maternal death is not increased. No adverse effect of pregnancy on the symptoms or longevity of women with Hodgkin's disease can be demonstrated. Women diagnosed in pregnancy as having lymphoma should undergo therapeutic abortion so that proper staging and therapy may be given. Pregnancies over 32 to 34 weeks should be induced. Women previously treated for lymphoma may become infertile as a result of therapy. Those not infertile after therapy should avoid pregnancies since there is a potential risk of malformations and malignancies in the offspring.

Abortion, Induced↗

Consequences of radiotherapy and antineoplastic therapy for the fetus.

The consequences of radiation and antineoplastic therapy on the fetus are summarized. Animal and atom bomb studies clearly demonstrate the carcinogenic effects of radiation. Less information is available on neoplasia and neonatal malformations induced by chemotherapy, but there may be an increased risk. The delayed consequences of radiation and chemotherapy are not well known and require further study.

Abnormalities, Drug-Induced↗

delta 9-Tetrahydrocannabinol as an antiemetic for patients receiving cancer chemotherapy. A pilot study.

We conducted a pilot study to ascertain the potential toxicity and possible efficacy of delta 9-tetrahydrocannabinol (THC) at the oral dose of 5 mg/m2. Over one third of the study population, which consisted of 25 patients, reported significant dysphoric reactions. Four patients (16 per cent) elected not to take THC rather than experience loss of motivation which interfered with their professional life. Paradoxically, on eight occasions nausea seemed to worsen with THC. After the first administration of THC, 18 patients (72 per cent) described less nausea and only two individuals (8 per cent) noted complete resolution of nausea. Two patients reported worsening of their nausea. Eighteen patients noted less vomiting (69 per cent) after the first administration of THC and four patients (15 per cent) reported completed resolution of their vomiting. By the third administration of THC, one of 14 patients (7 per cent) and two of 14 (14 per cent) noted complete alleviation of nausea and vomiting, respectively. Patients who scored high on the Brief Psychiatric Rating Scale, who reported euphoria, or who had psychogenic nausea and vomiting were most likely to have a favorable antiemetic response. The results of this pilot study suggest that orally administered THC is a toxic but transiently effective antiemetic when administered at 5 mg/m2.

Adult↗

Treatment of grade III and IV astrocytomas with BCNU alone and in combination with VM-26 following surgery and radiation therapy.

Twenty-one patients with grade III or IV astrocytomas were assigned randomly to receive either BCNU alone or BCNU and VM-26 after surgery and radiation therapy. Patients surviving radiation therapy and receiving single-agent chemotherapy had a median survival of 14 months while those receiving combination chemotherapy had a median survival of 22 months (P greater than 0.05). None of the patients who failed BCNU-only therapy responded to VM-26. Performance status was not affected by either regimen. Computerized tomographic scanning of the brain was useful only in confirming tumor progression. Two patients died from BCNU-related interstitial pulmonary fibrosis.

Adolescent↗