Comparison of CD4+ T-cell counts in men and women recently diagnosed with HIV infection in Mexico City, Mexico.
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Adolescent↗
Biomedical subjects
J Guarner
Publications and source records attributed to J Guarner.
Frequency of intestinal parasites in adult cancer patients in Mexico.
Approximately 28% of the Mexican population has intestinal parasites. Oncologic patients receiving chemotherapy should have a coproparasitoscopic study to avoid disseminated parasitic infections. The frequency of intestinal parasites, including Cryptosporidium and Isospora, was evaluated in 100 diarrheic (DS) and 100 formed stools (FS) from adult patients recently diagnosed with cancer, using wet mounts stained with Kinyoun, saccharose and ZnSO4 procedures stained with Lugol's iodine. Seven patients with DS and three with FS had more than one parasite. Pathogenic intestinal parasites were seen in 26% of DS and 15% of FS. Of the frequent parasites, Entamoeba histolytica was found in 12 DS and in 2 FS (p = 0.01), Giardia lamblia in three DS and six FS and Hymenolepis nana in eight DS and 10 FS. Other pathogenic parasites were found only in DS: Cryptosporidium sp. in five patients, Ascaris lumbricoides in two, Strongyloides stercoralis in two and Isospora sp. in one. Cryptosporidium and Isospora were only identified by wet mounts stained with Kinyoun while other parasites were identified by flotation procedures. Since six (3%) of our patients had coccidia, the laboratory must perform special techniques for their detection. In epidemiologic settings where there is a high prevalence of intestinal parasitic infections the coproparasitoscopic studies should be performed and antiparasitic treatment provided before starting chemotherapy.
Adult↗
Chronic myelocytic leukemia in accelerated phase with i(17) (q10) and loss of p53 gene. Case report.
Chronic myelogenous leukemia (CML) is a clonal disorder that presents with a stable period followed by an accelerated phase. The most frequent chromosomal abnormality described is t(9;22). Alterations of chromosome 17, where p53 is located, have been described during transformation. We studied a 23-year-old male who presented with chronic myelogenous leukemia. The karyotype demonstrated 46,XY,t(9;22) (q34;q11) in 12% of mitoses and hyperdiploidy in 43%. Forty-six months later the patient suffered a blast crisis characterized by absolute basophilia; the cytogenetic study demonstrated 48,XY,+8,t(9;22) (q34;q11), +der(22)t (9;22) (q34;q11), +i(17)(q10) in 18% of the mitoses, 46,XY, t(9;22) (q34;q11) in 34% and hyperdiploidy in 23%. Since there was i(17)(q10) during this stage, a retrospective DNA study of the biopsy material before and after the transformation was performed. In the chronic phase, p53 was present in normal amounts, during transformation there was loss of genetic material from the p53 region. The protein product of suppressor gene p53 normally works holding the proliferation of cells. When there is the formation of an isochromosome, genetic material is lost; thus, in this patient, p53 was deleted upon the observation of i(17). Lastly, this case shows how DNA can be extracted from slides; this technique is novel and can be used for retrospective studies when paraffin blocks or fresh tissue are not available.
Adult↗
Ca 15.3 in breast cancer: comparison of two assays and validation in a Mexican population.
Ca 15.3 is a tumor marker used for breast carcinoma, since one epitope is an antigen present in milk fat globules. Serum from 171 patients with breast cancer upon initial presentation was studied for Ca 15.3. In the first 72 cases, the authors compared RIA vs. ELISA using a simple linear regression. On the following 99, only ELISA was performed. With all 171 patients, a clinical association between Ca 15.3 measurement and age, stage and hormone receptors was carried out. Correlation coefficient between RIA and ELISA was 0.85. Of 104 patients below 50 years of age, 88 had normal Ca 15.3 and 16, elevated; 67 were older than 50 years, 46 had normal Ca 15.3 and 21, elevated (p=0.022). Ca 15.3 was elevated in 11% of patients with clinical stages I/II, and 89% in stages III/IV (p=0.0001). The association of Ca 15.3 with hormone receptors was not significant. In conclusion, ELISA and RIA measure Ca 15.3 with comparable results, the first method has the advantage of not using radioactivity. The authors found higher probability of elevated Ca 15.3 in older patients and in those with advanced disease.
Biomarkers, Tumor↗
Chemotherapy-associated oral mucosal lesions in patients with leukaemia or lymphoma.
In order to determine the incidence rate of oral lesions associated with chemotherapy, as well as well as its association with clinical and laboratory parameters and potential risk factors, 50 in-patients with non-Hodgkin's lymphoma or leukaemia under chemotherapy were followed from January 1993 to May 1994. Basal and weekly oral examinations were performed. Clinical and laboratory data were registered. Wilcoxon's rank sum test, chi square test, univariate and multivariate logistic regression analyses were used, 36 individuals with leukaemia and 14 with non-Hodgkin's lymphoma were followed for 158 weeks; mean age was 33 years (range 15-85). Oral lesion incidence rate was 45/100 patients-week. Exfoliative cheilitis and infections (herpes and candidosis) were the most common oral complications, followed by haemorrhagic lesions and mucositis. Haemorrhagic lesions correlated with thrombocytopenia (RR = 30.5). Etoposide administration (RR = 8.6), alkylating agents (RR = 15.6), a prior course of chemotherapy (RR = 23.2) and neutropenia (RR = 4.16) were predictors of mucositis. Oral lesions were a common complication in this study, and a possible association of mucositis with several factors is suggested.
Adolescent↗
The use of oral fluid to determine HIV-1 prevalence rates among men in Mexico City.
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Adolescent↗
[Algorithm management for detection of monoclonal gammopathies in serum. Experience of the Instituto Nacional de Cancerología in México].
BACKGROUND: Most patients with multiple myeloma have an abnormal band in the gamma region of protein electrophoresis. AIM: To correlate the clinical diagnosis with patterns of protein electrophoresis. METHODS: Retrospective analysis of all protein electrophoresis or immunoglobulin quantification requested during 1992 and review of clinical charts of patients. RESULTS: During 1992, 553 protein electrophoresis were requested. Of these, 344 were repetitions and 209 came from patients seen for the first time. Among the latter, we found a monoclonal component in 40. Of these 40 patients, 35 had a multiple myeloma, one had a plasmocytoma and four a non-Hodgkin lymphoma. Fourteen patients with diagnosis of myeloma did not have a monoclonal component in protein electrophoresis. These figures resulted in a 71% sensitivity and 97% specificity for monoclonal components in the diagnosis of multiple myeloma. The monoclonal component of patients with myeloma was characterized as IgG in 29 (60%), IgA in 5 (10%) and IgM in one. CONCLUSIONS: A monoclonal component present in a protein electrophoresis has a high diagnostic accuracy for multiple myeloma.
Algorithms↗
The association of Helicobacter pylori with gastric cancer and preneoplastic gastric lesions in Chiapas, Mexico.
BACKGROUND: Helicobacter pylori recently was identified as a risk factor for gastric cancer. Its association with preneoplastic conditions of the stomach, however, is undocumented. METHODS: Gastric biopsy specimens from 245 symptomatic patients were examined for neoplastic and preneoplastic lesions and for gastric H. pylori infection. The sera of 183 subjects were tested by enzyme-linked immunosorbent assay (ELISA) for anti-H. pylori immunoglobulin G. RESULTS: Histologic H. pylori infection, usually accompanied by acute and chronic gastritis, was found in 85.7% of patients. There was a strong association between H. pylori in the tissue and atrophy (relative risk, 15.0; 95% confidence interval, 4.2-56.6), intestinal metaplasia (relative risk, 5.7; 95% confidence interval, 1.9-16.8), and dysplasia or cancer (relative risk, 4.0; 95% confidence interval, 1.1-14.8). The ELISA was 93.2% sensitive and 57.1% specific for histologic infection with a positive predictive value of 96.1%. The overall seroprevalence rate was 86.1%, with no significant difference in rates between patients with cancer precursors and those with normal stomachs. CONCLUSIONS: In this high-risk population, precursor lesions for adenocarcinoma were associated universally with H. pylori infection.
Adult↗
Mammary Paget's disease and associated carcinoma. An immunohistochemical study.
Mammary Paget's disease has been said to result from epidermal spread by contiguity of primary intraductal carcinoma. To assess similar identity, we immunostained Paget's cells and underlying intraductal and/or invasive mammary carcinoma in 20 cases for cytokeratins, epithelial membrane antigen, gross cystic disease fluid protein-15, lysozyme, carcinoembryonic antigen, S100 protein, kappa-casein, and alpha-lactalbumin. Steroid receptor immunostain was positive in only one (5%) of the cases of Paget's disease and in two and four (approximately 15%) (for estrogen and progesterone receptor, respectively) of the cases of ductal carcinoma. In 18 patients (90%), the immunohistochemical profile was identical in Paget's cells and associated carcinoma for seven or more antigens. In one patient, there was a definite disparity in the antigenic profile; in another patient, this was dissimilar because of very focal staining in one site. The antigenic similarity between Paget's cells and underlying carcinoma in 18 (90%) of the cases of mammary Paget's disease suggested in favor of their common origin, ie, probably intraepidermal spread of ductal carcinoma. Origin from apocrine/eccrine structures, or multipotent cells in the epidermis, was suggested in a minority.
Biomarkers, Tumor↗
Non-Hodgkin's lymphomas in patients with human immunodeficiency virus infection. Presence of Epstein-Barr virus by in situ hybridization, clinical presentation, and follow-up.
The authors studied all patients with serologic evidence of human immunodeficiency virus (HIV) infection and malignant non-Hodgkin's lymphoma (NHL) that presented at a single hospital from 1982 to 1989. Sixteen patients were identified, all white homosexual men with a mean age of 38.2 years. Lymphoma was the initial presentation of HIV infection in 37.5%. Sixty-two percent of the cases had a high-grade NHL, 31% had intermediate-grade, and 6% (one patient) had a low-grade lymphoplasmacytoid lymphoma. Extranodal involvement was present in 43.7%, with the gastrointestinal tract and liver being the most common sites. Actuarial survival was increased by treatment with methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B). Colorimetric in situ hybridization identified Epstein-Barr virus (EBV) in nine of the 14 cases hybridized. A statistically significant association of EBV with diffuse small noncleaved type (i.e., Burkitt's-like) (six of six) compared with other morphologic types (three of eight) was found (P = 0.025).
Adult↗
Composite Hodgkin's and non-Hodgkin's lymphoma in a patient with acquired immune deficiency syndrome. In-situ demonstration of Epstein-Barr virus.
A 44-year-old man infected with human immunodeficiency virus had Hodgkin's disease, mixed cellularity, and malignant non-Hodgkin's lymphoma, diffuse large cell type. Colorimetric in-situ hybridization showed the Epstein-Barr virus (EBV) genome in the cells of the large cell non-Hodgkin's lymphoma and in the Reed-Sternberg cells and reactive lymphocytes of the Hodgkin's lymphoma. These results suggest that EBV may play a similar causative role in both neoplasms. This colorimetric method of hybridization, yielding results within 8 hours, is applicable to archival material and will be useful in further epidemiologic work associating EBV and lymphoid proliferations and malignancies.
Acquired Immunodeficiency Syndrome↗
Association of Epstein-Barr virus in epithelioid angiomatosis of AIDS patients.
Epithelioid angiomatosis, hemangioma-like vascular proliferations recently described in AIDS patients, has been associated with the cat scratch disease bacillus. Other vascular lesions present in AIDS patients, in particular Kaposi's sarcoma, have been associated with cytomegalovirus (CMV). We investigated the possibility of viral association with epithelioid angiomatosis by analyzing two such lesions, as well as unrelated concurrent skin lesions, for the presence of viral genetic information. Colorimetric in-situ hybridization was performed on formalin-fixed, paraffin-embedded sections using cloned biotinylated probes for CMV, herpes simplex virus, human immunodeficiency virus, and Epstein-Barr virus (EBV). The only virus demonstrated was EBV, and this was only in the two epithelioid angiomatosis lesions. Hybridization signal for EBV was present in the nuclei of endothelial cells and occasional histiocytes. Bacilli were demonstrated within one of the lesions by silver stain. This is the first report associating EBV with this entity, and the first-time demonstration of EBV genetic information in endothelial cells. Our data suggest that these vascular lesions may represent a nonspecific response to infection by many different agents, and that EBV may be involved in the pathogenesis of some of these lesions.
Acquired Immunodeficiency Syndrome↗
Ossifying fibromyxoid tumor.
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Diagnosis, Differential↗
Multiple arteriovenous malformations of the small intestine in a patient with protein S deficiency.
The authors report a case of arteriovenous malformations (AVMs) of the small intestine in a young patient with protein S deficiency. These disorders have not been previously reported to occur together. Protein S deficiency may cause thromboses in unusual sites, including the mesenteric veins. Several mechanisms linking protein S deficiency to the occurrence of AVMs in this patient are offered.
Adult↗
Histogenesis of extramammary and mammary Paget cells. An immunohistochemical study.
To define the histogenesis of the Paget cell and possibly identify differences in cells from the two sites, six vulvar and 23 mammary specimens from Paget's disease lesions were studied for immunocytochemical antigens. All vulvar and 21 (91%) mammary lesions were strongly reactive for glandular cytokeratin. All lesions showed immunopositive Paget cells with epithelial membrane antigen (EMA). An apocrine antigen, gross cystic disease fluid protein (GCDFP-15), decorated 66.5% and 56.5% of extramammary and mammary lesions, respectively. All vulvar Paget cells stained for carcinoembryonic antigen (CEA), a frequency significantly greater than the 35% in mammary lesions (p = 0.02). However, CEA is expressed by both eccrine and apocrine sweat glands and their tumors. Vulvar Paget cells were negative for lysozyme, casein, lactalbumin, and S100 protein, compared with 9%, 4%, 4%, and 26% in nipple lesions. S100 protein expression is similar to that in mammary ductal carcinoma (32%). The glandular origin of both extramammary and mammary Paget cells is indicated by the presence of glandular cytokeratin, EMA, and CEA. Approximately 60% of all cases in both sites showed evidence of apocrine derivation (GCDFP-15 positivity). Variable antigen expression suggests possible malignant transformation of pluripotent germinative cells able to differentiate in an apocrine or an eccrine direction, or in both.
Breast Neoplasms↗
Fungal peritonitis caused by Curvularia lunata in a patient undergoing peritoneal dialysis.
The authors present a case of a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) who developed peritonitis with Curvularia lunata and gram negative Enterobacteriaceae. A review of the literature indicates that human infections caused by Curvularia are uncommon despite the ubiquity of the organism in the environment. In this case, the organism was present in the Tenckhoff catheter, lacking attachment to it, but obstructing the flow. Treatment of fungal peritonitis during CAPD is discussed.
Bacterial Infections↗
Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.
To examine the role of sputum examination in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS), we conducted a prospective study of 30 patients with AIDS or suspected AIDS. Sputum was obtained just prior to bronchoscopy by spontaneous cough (20 patients) or by induction with a saline nebulizer (ten patients). Pneumocystis carinii was diagnosed by bronchoalveolar lavage in 13 of the 30 patients; two of these patients had P carinii organisms identified in sputum specimens (sensitivity of sputum, 15.3%; negative predictive value, 60.7%). A cost-analysis study demonstrated that sputum examination is not cost effective when the sensitivity is below 24%. We conclude that P carinii can be diagnosed from expectorated sputum in patients with AIDS, but, because of the test's low sensitivity, it cannot be recommended in the routine evaluation of patients with AIDS and pulmonary complaints.
Acquired Immunodeficiency Syndrome↗
Suicide by hanging. A review of 56 cases.
Fifty-six consecutive cases of suicide by hanging are reviewed. The data provide some evidence for associations between suicide by hanging and youth, incarceration, black males, and clustering. Evidence was noted of low incidence in females, rarity of white female hangings at home, a preference to hang oneself away from home if there have been previous suicide attempts, and possible seasonal trends which may differ from suicide overall. Thus, aside from the method chosen, hanging victims as a group displayed some differences from suicides in general.
Adult↗