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Biomedical subjects

J Guarner

Publications and source records attributed to J Guarner.

53 records · Page 3Linked to original sources
PubMed1987

Primary non-Hodgkin's lymphoma of the heart in two patients with the acquired immunodeficiency syndrome.

We report two cases of primary cardiac lymphoma that developed in patients suffering from the acquired immunodeficiency syndrome. Both cases of lymphoma were histologically aggressive as generally observed in patients with the acquired immunodeficiency syndrome. The lymphoma cells in the center of a tumor nodule obtained from one patient were monoclonal B-cells, whereas those at the periphery showed a polyclonal pattern of staining. It is postulated that this represents a monoclonal lymphoma evolving from a polyclonal B-cell lymphoproliferation analogous to those reported in some cases of lymphoma in immunosuppressed patients infected with Epstein-Barr virus. The lymphoma cells in the other case failed to stain for cytoplasmic immunoglobulins. The possible underlying basis for the increase in incidence of lymphoma in immunodeficiency and the reasons for prevalence of extranodal sites are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Biclonal gammopathy (IgG kappa and IgG lambda) in a patient with non-Hodgkin's lymphoma.

We report a case of non-Hodgkin's malignant lymphoma with biclonal gammopathy (IgG kappa and IgG lambda) involving both serum and urine. Detailed immunologic studies of the tumor disclosed two morphologically indistinguishable clones of cells that were responsible for the production of the two monoclonal immunoglobulins. This, to our knowledge, is the first documented case of a biclonal gammopathy involving a single heavy-chain class with both kappa and lambda light chains in a non-Hodgkin's lymphoma. Lesions resembling lymphomas must not be assumed to be inflammatory simply because the cells express both kappa and lambda antigens.

Aged↗
PubMedDate not supplied

Cytologic detection of Pneumocystis carinii: a comparison of Papanicolaou and other histochemical stains.

Pneumocystis carinii, a common pathogen among immunocompromised patients, has been investigated in cytologic specimens using both the histochemical stains and ultraviolet (UV) fluorescence following Papanicolaou staining. We reviewed 57 pulmonary cytologic specimens obtained from 23 patients and compared the results of specific histochemical stains and Papanicolaou-stained preparations under UV excitation. Specific Pneumocystis fluorescence was observed in 26 of 49 Papanicolaou-stained specimens. Thirty-seven specimens were examined using both histochemical staining and after Papanicolaou UV staining. A comparison of the two techniques showed the Papanicolaou UV technique to have 89% sensitivity and 95% specificity. Cellulosic filters were the most valuable Papanicolaou-stained preparation for Pneumocystis diagnosis. The authors conclude that UV fluorescence of Papanicolaou-stained specimens obtained by noninvasive procedures is a rapid, accurate, and economical method for diagnosing pulmonary Pneumocystis carinii infections.

Biopsy↗
PubMedDate not supplied

A cluster of fulminant myocarditis cases in children, Baltimore, Maryland, 1997.

The true incidence of myocarditis in children is difficult to estimate because many mild cases go undetected. This study describes an unusual cluster of myocarditis cases that occurred in young children living in the greater Baltimore area between May and October 1997. A search of multiple comprehensive databases and interviews with area pediatric cardiologists were conducted to identify unreported cases and determine the background rate of myocarditis in the area. Seven cases of myocarditis were found as well as two with a similar clinical picture and myocardial fibrosis on tissue examination. Six case patients with active myocarditis and one child with fibrosis died. The case children were predominantly black (eight of nine) and male (seven of nine), with no identifiable risk factors. The disease was characterized by a fulminant course with malignant arrhythmias. The greatest number of pediatric myocarditis deaths reported in 1 year prior to 1997 was three. Myocardial tissues were examined using immunohistochemistry, in situ hybridization, and polymerase chain reaction but no etiologic agent was identified. This outbreak is unusual because of both the number of cases and the fulminant course of the disease in this group of children.

Arrhythmias, Cardiac↗
PubMedDate not supplied

An outbreak of plague including cases with probable pneumonic infection, Ecuador, 1998.

During February and March of 1998, 12 sudden deaths were reported among residents of a high-Andean community in Ecuador. All 12 fatalities were members of the same extended family and some had apparent exposure to sick guinea-pigs. Following an initial investigation by public health officials, an additional death was reported in a nearby community in April, also associated with exposure to sick guinea-pigs. Blood samples from humans, dogs, and a rodent were tested for antibody to the F1 antigen of Yersinia pestis by passive haemagglutination assay. Tissue from rodents was subjected to direct fluorescent antibody staining using fluorescein-labelled monoclonal antibody to Y. pestis F1 antigen. Formalin-fixed specimens from the 2 autopsies were evaluated using a 2-step alkaline phosphatase immunoassay with a monoclonal antibody to Y. pestis F1 antigen, and tissues that had not been embedded in paraffin were tested for the presence of DNA encoding the F1 structural antigen by polymerase chain reaction. Serological evaluation of close contacts of the fatalities revealed positive titres to F1 antigen of Y. pestis, the aetiological agent of plague, in 3 contacts from the first community and 1 from the second. Immunohistochemical staining of tissues collected from 2 of the fatalities provided evidence that both had pneumonic plague. Five of 14 dogs found in the communities were seropositive for plague antibody, providing evidence of a recent epizootic plague in the area.

Adolescent↗
PubMedDate not supplied

A comprehensive review of the natural history of Helicobacter pylori infection in children.

Across populations of children, Helicobacter pylori prevalence ranges from under 10% to over 80%. Low prevalence occurs in the U.S., Canada, and northern and western Europe; high prevalence occurs in India, Africa, Latin America, and eastern Europe. Risk factors include socioeconomic status, household crowding, ethnicity, migration from high prevalence regions, and infection status of family members. H. pylori infection is not associated with specific symptoms in children; however, it is consistently associated with antral gastritis, although its clinical significance is unclear. Duodenal ulcers associated with H. pylori are seldom seen in children under 10 years of age. H. pylori-infected children demonstrate a chronic, macrophagic, and monocytic inflammatory cell infiltrate and a lack of neutrophils, as compared with the response observed in adults. The effect of H. pylori infection on acid secretion in children remains poorly defined. The events that occur during H. pylori colonization in children should be studied more thoroughly and should include urease activity, motility, chemotaxis, adherence, and downregulation of the host response. The importance of virulence determinants described as relevant for disease during H. pylori infection has not been extensively studied in children. Highly sensitive and specific methods for the detection of H. pylori in children are needed, especially in younger pediatric populations in which colonization is in its early phases. Criteria for the use of eradication treatment in H. pylori-infected children need to be established. Multicenter pediatric studies should focus on the identification of risk factors, which can be used as prognostic indicators for the development of gastroduodenal disease later in life.

Child↗
PubMedDate not supplied

Testing umbilical cords for funisitis due to Treponema pallidum infection, Bolivia.

To establish the frequency of necrotizing funisitis in congenital syphilis, we conducted a prospective descriptive study of maternal syphilis in Bolivia by testing 1,559 women at delivery with rapid plasma reagin (RPR). We examined umbilical cords of 66 infants whose mothers had positive RPR and fluorescent treponemal antibody absorption tests. Histologic abnormalities were detected in 28 (42%) umbilical cords (seven [11%] had necrotizing funisitis with spirochetes; three [4%] had marked funisitis without necrosis; and 18 [27%] had mild funisitis), and 38 [58%] were normal. Of 22 umbilical cords of infants from mothers without syphilis (controls), only two (9%) showed mild funisitis; the others were normal. Testing umbilical cords by using immunohistochemistry is a research tool that can establish the frequency of funisitis due to Treponema pallidum infection.

Antibodies, Bacterial↗
PubMedDate not supplied

Pathologic studies of fatal cases in outbreak of hand, foot, and mouth disease, Taiwan.

In 1998, an outbreak of enterovirus 71-associated hand, foot, and mouth disease occurred in Taiwan. Pathologic studies of two fatal cases with similar clinical features revealed two different causative agents, emphasizing the need for postmortem examinations and modern pathologic techniques in an outbreak investigation.

Disease Outbreaks↗
PubMedDate not supplied

Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States.

From October 4 to November 2, 2001, the first 10 confirmed cases of inhalational anthrax caused by intentional release of Bacillus anthracis were identified in the United States. Epidemiologic investigation indicated that the outbreak, in the District of Columbia, Florida, New Jersey, and New York, resulted from intentional delivery of B. anthracis spores through mailed letters or packages. We describe the clinical presentation and course of these cases of bioterrorism-related inhalational anthrax. The median age of patients was 56 years (range 43 to 73 years), 70% were male, and except for one, all were known or believed to have processed, handled, or received letters containing B. anthracis spores. The median incubation period from the time of exposure to onset of symptoms, when known (n=6), was 4 days (range 4 to 6 days). Symptoms at initial presentation included fever or chills (n=10), sweats (n=7), fatigue or malaise (n=10), minimal or nonproductive cough (n=9), dyspnea (n=8), and nausea or vomiting (n=9). The median white blood cell count was 9.8 X 10(3)/mm(3) (range 7.5 to 13.3), often with increased neutrophils and band forms. Nine patients had elevated serum transaminase levels, and six were hypoxic. All 10 patients had abnormal chest X-rays; abnormalities included infiltrates (n=7), pleural effusion (n=8), and mediastinal widening (seven patients). Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven. With multidrug antibiotic regimens and supportive care, survival of patients (60%) was markedly higher (<15%) than previously reported.

Adult↗
PubMedDate not supplied

[The association between Helicobacter pylori and gastric neoplasia. Epidemiologic evidence].

Helicobacter pylori (HP) causes chronic gastritis and, together with non-steroidal anti-inflammatory drugs, is considered the most frequent etiologic agent of peptic ulcer. Since there are numerous epidemiologic and pathogenesis studies that demonstrate an association between infection by HP and gastric neoplasias, the World Health Organization declared, in 1994, HP infection a Group 1 carcinogen (a definitive cause of human neoplasias, similar to tobacco). This article reviews the epidemiological evidence supporting the association between HP infection and two gastric neoplasias: adenocarcinoma and B cell lymphoma associated to mucosas (MALT). This article also presents preliminary results of a project performed in the mountainous region of Chiapas, Mexico, in which the decrease of precancerous gastric lesions were studied one year after treatment for HP infection.

Adenocarcinoma↗
PubMedDate not supplied

Vulvar Paget's disease. Cytologic and immunohistologic diagnosis of a case.

An exfoliative smear from the vagina in a case of vulvar Paget's disease extending into the vagina and urethra was cytologically diagnosed as showing a large cell carcinoma. The malignant cells proved to be Paget cells by comparison of the cytologic specimen with subsequent biopsy specimens and by immunohistochemical studies using antibodies for glandular cytokeratin, epithelial membrane antigen, carcinoembryonic antigen and gross cystic disease fluid protein. These studies demonstrated that the Paget cell is probably of apocrine derivation. Exfoliative cytology and immunohistochemistry of exudative vulvar lesions may be helpful in the identification of Paget cells.

Aged↗
PubMedDate not supplied

[Productivity before and after installing a computerized system in a clinical laboratory].

A laboratory information system was installed on January 1991 in the clinical laboratory of the Instituto Nacional de Cancerologia. Our main objective was to speed up the administrative work and integrate its operations under one management. We evaluated the productivity before (1990) and after installing the system (1992), using the parameters proposed by the College of American Pathologists. In 1990 there were 30,764 patients who underwent 191,070 laboratory studies, resulting in 131 tests/clerk/day and 21 patients/clerk/day. In 1992 these figures were 43,679 patients, 245,280 tests, 168 tests/clerk/day and 30 patients/clerk/day. The productivity indexes showed a 41% increase in the number of patients and of 28% in the number of tests. In addition, the laboratory personnel started activities in teaching and research which had been non existent before, i.e. in 1992 they started three research projects and participated in three national or international scientific meetings. In summary, no additional personnel was required even though there was an increase in the workload, basically due to a more efficient organization of the work when using a computerized system.

Cancer Care Facilities↗
PubMedDate not supplied

[Simplified CD4+ T-lymphocyte count in patients with HIV/AIDS in Mexico].

OBJECTIVE: To study the correlation between ALC and CD4 cell counts and to find alternative ways of counting CD4+ T-lymphocytes. MATERIAL AND METHODS: The double positivity for CD3/CD4 antibodies was measured in 175 consecutive HIV-positive patients using flow cytometry; in these cases a difference was made between counting cells that were positive for both antibodies vs those that were positive only to CD4. ALC and CD4 counts were also compared among 500 subjects infected with HIV, using linear regression analysis and comparing the number of dissimilar cases for counts below 200 cells/microliters and ALC counts lower than 1 500 and 2000 cells/microliters. RESULTS: In the 175 cases measured by the CD3/CD4 antibody combination the mean percent was 13.8% and for total CD4 cells 14.2% (p = NS); the mean difference was 0.4% and the median 0.2%. For the 500 patients the mean ALC was 1 700 cells/microliters and the mean CD4 count was 219 cells/microliters; the correlation coefficient was 0.59. CONCLUSIONS: These data suggest a poor correlation of ALC and CD4 cell counts, thus it is impossible to predict CD4 on the basis of ALC. This is the reason why it is necessary to measure CD4 cells separately. The difference between measuring double positive CD3/CD4 cells vs only CD4 positive cells was not significant. Our data suggest that the use of a single CD4 antibody may cut costs and still produce clinically useful information.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Zidovudine plus didanosine in HIV infected asymptomatic patients previously treated with zidovudine].

OBJECTIVE: To evaluate if the combination of AZT/ddl offered any advantages in surrogate markers among HIV infected asymptomatic patients previously treated with AZT for at least six months. METHODS: We used a prospective cohort of 269 asymptomatic HIV patients with CD4+ cell counts between 200 and 500 cells/microL. They were given didanosine (ddl 400 mg/d) in addition to AZT (500 mg/d) and had received AZT monotherapy for an average of 20 months. End points were progression to AIDS, death, or toxicity. RESULTS: Median CD4+ cell count at the start of the combination therapy was 339 cells/microL which increased at three months to 451 and subsequently declined at 6, 12 and 18 months of followup (medians of 392, 360, 307 cells/microL respectively). Five patients progressed to AIDS, six developed toxicity (myelosuppression, hepatitis or pancreatitis) and 26 had minor side effects that required only dose reduction. CONCLUSIONS: The addition of ddl to patients with prolonged ZDV monotherapy can be useful. CD4+ T cell counts showed a significant increase at 3 months with a gradual subsequent decline to below baseline at 18 months. Adverse effect of the drugs, although frequent, did not stop therapy in most patients.

Adolescent↗