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Biomedical subjects

J J Butler

Publications and source records attributed to J J Butler.

At least 73 records · Page 4Linked to original sources
PubMed1983

Stage III nodular lymphomas. Preliminary results of a combined chemotherapy/radiotherapy program.

Since 1975, all histologic subtypes of Stage III and IIIE nodular lymphoma patients were treated with a combination of radiotherapy and multiple-agent chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo). Fifty-eight patients were treated through 1979. Treatment consisted of two cycles of CHOP-Bleo alternating with sequential radiotherapy to clinically involved regions, and further CHOP-Bleo to a total of ten cycles. Radiotherapy doses ranged between 3000 and 4000 rad delivered in three to four weeks. Forty-six patients completed treatment. In the other 12 patients, treatment was interrupted because of progressive disease in seven, and myelosuppression in five. Overall five-year survival and disease-free survival results were 82% and 47%, respectively. Survival for those patients who completed therapy was 93%. By histopathology, survivals for all patients were: poorly differentiated lymphocytic, 100%; mixed cell, 80%; and histiocytic, 39%. Disease-free figures for all 58 patients were: poorly differentiated lymphocytic, 44%; mixed cell, 65%; and histiocytic, 35%. The extent of abdominal disease influenced five-year survival as follows: 100% for those who had only occult disease at staging laparotomy; 88% for those who were Stage III on the basis of a positive lymphangiogram; and 50% for those who had a palpable mass or required an exploratory laparotomy for symptoms. Five of seven patients with progression during protocol therapy have died. No patients died as a result of myelosuppression. A number of patients developed complications during treatment, none of which were fatal. Eight patients developed herpes zoster, four patients developed transient radiation hepatitis, and four patients had miscellaneous complications.

Age Factors↗
PubMed1983

Large cell lymphoma with microvillus-like projections: an ultrastructural study.

On many of the cells of each of the 10 large cell lymphomas we studied, electron microscopy demonstrating slender peripheral cytoplasmic projections that simulated microvilli. They varied in number, but, when numerous, easily could be misinterpreted as evidence of adenocarcinoma. Immunoperoxidase staining confirmed the presence of monoclonal cytoplasmic immunoglobulin in four of 10 cases. Stains for muramidase were negative in every case. Because nine of the 10 cases were of presumed B-cell lineage, the lymphoma cells are compared to transformed lymphocytes from the follicular centers of reactive lymph nodes.

Adenocarcinoma↗
PubMed1983

Lymphadenopathy in homosexual men. Morbid anatomy with clinical and immunologic correlations.

This is a study of the histopathologic features of lymph nodes removed from eleven young, homosexual men, all of whom presented with lymph node enlargement of more than 3 months' duration, accompanied, in the majority of cases, by fever and weight loss. Reactive follicular and sinusoidal hyperplasia were the main findings in 10 patients. The medullary sinuses were packed with monomorphic round sinusoidal cells associated with neutrophils. In one of the 10 patients, granulomas packed the subcapsular sinuses, especially. Another patient presented with lymphoid-depleted nodes with absent germinal centers and a prominent vascular skeleton; this latter feature made it difficult to distinguish this picture from the nodal form of Kaposi's sarcoma. All patients had a history of sexual promiscuity and used "recreational" drugs. Nine of 10 patients had deficient cellular immunity and inverted T-cell helper/suppressor ratios. The only patient with normal cellular immunity had nodal granulomas. Humoral immunity was normal in all patients.

Adult↗
PubMed1982

Treatment of patients with stages I and II nonmediastinal Hodgkin's disease.

In this study, 95 patients with laparotomy-staged I and II nonmediastinal Hodgkin's disease were treated with involved fields (41 patients), mantle (17), extended fields (26), or involved fields followed by 6 cycles of MOPP (11). Eighty-five patients had upper torso presentations. Seventy had Stage I disease and 25 had stage II. Pathologic findings were nodular sclerosing, 33; mixed cellularity, 41; lymphocyte predominance, 20; and unclassified, one. Five-year overall survivals were excellent regardless of stage, pathologic findings, or treatment: 98% for involved fields or mantle, and 100% for both extended fields and involved fields followed by 6 cycles of MOPP. Corresponding disease-free survivals were 77%, 82%, and 86%, respectively. For patients with upper torso presentations, disease-free figures for the mantle (94%) were better than those for involved fields alone (67%). In addition, regression analysis proved involved fields to be a prognostic factor for a lower disease-free survival. No difference between extended fields or mantle radiotherapy could be detected using this model. Relapses usually occurred in nonirradiated upper torso sites. Only three of the 36 patients treated with involved fields and one of 21 treated with extended fields relapsed in the abdomen alone. Most patients in relapse were salvaged. Rescue treatment was most often radiotherapy and adjuvant combination chemotherapy. Based on this study, the use of mantle radiotherapy is recommended in treating laparotomy-staged I and II patients with nonmediastinal presentations, and the use of extended fields or adjuvant chemotherapy as primary prevention is not recommended.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1982

Neuroblastomas and neuroendocrine carcinomas of the nasal cavity: a proposed new classification.

The histologic characteristics of 29 nasal tumors previously diagnosed as neuroblastomas, unclassified carcinomas, or unclassified malignant neoplasms were reviewed. Electron microscopy was performed in 17. Nine tumors were neuroblastomas; six of these were classical neuroblastomas while the other three exhibited olfactory differentiation in addition to the classical neuroblastoma component. Areas of ganglioneuroblastoma were found in the metastasis of one of the three olfactory neuroblastomas. Twenty tumors were classified as neuroendocrine carcinoma because all showed a neuroendocrine pattern with remarkably uniform cells growing from benign glandular epithelium; membrane bound granules were present in the cytoplasm of cells of the ten cases in this group examined by electron microscopy. The mean age of the patients with neuroblastomas was 20 years; survival in this group was 75% at five and seven years, respectively, and 67% at ten years. Recurrences, metastasis, and death occurred within 3 years of diagnosis. There was a low percentage (25%) of multiple recurrences. The metastases were located in cervical lymph nodes, brain and spine. The mean age of the patients with neuroendocrine carcinoma was 50 years. Survival was 100% at five years, 88% at seven years, and 77% at ten years. Recurrences and metastasis in 70% of the cases occurred later than the third year. Multiple recurrences were present in 54% of the cases. The metastases affected lymph nodes, brain and spine in all cases except in one in which lungs and femur were involved. In the latter case adenocarcinoma was also present in addition to the neuroendocrine carcinoma. Three patients died, all more than five years from the time of diagnosis. No correlation was found between staging and prognosis in either group, except for Stage I disease.

Cell Differentiation↗
PubMed1982

The roles of staging laparotomy, chemotherapy, and radiotherapy in the management of localized diffuse large cell lymphoma: a study of 75 patients.

A retrospective study of 75 laparotomy-studied Stage I and II patients with diffuse large cell (histiocytic) lymphoma was conducted to determine the relative contributions of laparotomy, radiotherapy, and combination chemotherapy to their management. The treatment programs were radiotherapy alone, radiotherapy followed by adjuvant chemotherapy, and alternating chemotherapy-radiotherapy. Treatment selection was based on disease presentation, with limited therapy used for favorable patterns and intensive therapy used in prognostically unfavorable settings. Disease-free survival was best in those treated with initial chemotherapy, even though these patients comprised the least favorable prognostic group. A select subset of patients, those with extranodal head and neck disease, obtained good results with radiotherapy alone, but for other presentations this was not a successful approach. Differences in results for the three treatment programs are discussed in relation to future treatment decisions.

Abdominal Neoplasms↗
PubMed1982

Systemic amyloidosis associated with a benign mesenteric lymphoid mass.

This report describes the case of a patient with a mesenteric lymphoid mass with clinical and histologic features suggestive of giant lymph node hyperplasia (GLH) who died as a result of complications related to systemic amyloidosis. To our knowledge, this is only the second case of amyloidosis associated with a benign mesenteric lymphoid mass reported in the literature. The possible relationship of amyloid with GLH will be discussed.

Adult↗
PubMed1982

Reactive lymph node hyperplasia with giant follicles.

Twenty-two cases are presented of patients whose solitary painless, enlarged lymph nodes demonstrated an extreme degree of reactive hyperplasia with giant follicles which were misdiagnosed as lymphoma in 11 (50%) instances. Parotid or submandibular nodes were involved most frequently, and the mass was thought clinically to be a salivary gland tumor in at least one-third of the cases. Occurrence in men predominated (6.3:1) with a median age of 24.5 years (mean, 26.8 years). There were no recurrences during follow-up periods which ranged from 6 months to 15 years. No specific etiologic factors were identified. Microscopically, the enlarged giant follicles involved the entire surface area of the lymph node, frequently assuming a serpentine configuration resulting from coalescence. The description of findings in these exemplary cases is followed by discussion of the histologic differential diagnosis.

Adolescent↗
PubMed1982

Importance of initial mediastinal adenopathy in Hodgkin disease.

The importance of initial mediastinal disease was studied retrospectively in 189 patients with stages I, II, and III Hodgkin disease treated at the M. D. Anderson Hospital and Tumor Institute between 1969 and 1976. Stages I and II patients with mediastinal disease at presentation had an 88% 5 year survival rate compared with a 98% survival rate for those without mediastinal disease. Disease-free survival was 66% versus 78%. Stage III patients with and without initial mediastinal disease showed essentially the same 5 year survival rate (75% versus 78%), but showed a lower disease-free survival of 60% in those with mediastinal disease as compared with 74% in those without mediastinal disease. Because of the prognostic importance of mediastinal disease and its extent at initial presentation, computed tomography is recommended to evaluate patients with low neck or supraclavicular adenopathy in whom there is no obvious mediastinal adenopathy and in all Hodgkin disease patients in whom there is questionable mediastinal disease or suggestion of lung extension on routine radiographs. Treatment plans have been altered to include chemotherapy and low-dose irradiation to the lungs in those patients with mediastinal mass diameters of 7.5 cm or greater, regardless of stage.

Adolescent↗
PubMed1981

Reassessment of prognostic factors in stage IIIA and IIIB Hodgkin's disease treated with MOPP and radiotherapy.

Prognostic factors have been re-evaluated for 88 patients with Stage III Hodgkin's disease to see if they have remained significant on a long-term basis. Treatment had consisted of two cycles of MOPP followed by radiotherapy to the mantle, abdomen, and pelvis; all patients had achieved complete remission. Case material was grouped according to the presence of absence of mediastinal disease. Five-year survivals for Stage IIIA and IIIB patients were 85 and 80%; corresponding disease-free survivals were 76 and 73%. Significant prognostic factors include age, histopathology, and extent of abdominal disease, but the relative importance of these factors differs for the mediastinal and nonmediastinal patients. Modifications of current treatment policy for both mediastinal and nonmediastinal patients are discussed in relation to the prognostic factors.

Adult↗
PubMed1981

Bacterial infection stimulating granulocytic sarcoma of the small bowel.

A 57-year-old white man who had abdominal pain and distension, died after a short hospitalization for increasing ascites, anorexia, and deteriorating mental status. At autopsy, the principal gross finding was a dilated, hyperemic, thickened proximal jejunum that by light microscopy consisted of a transmural infiltrate of large mononuclear cells. Intense naphthol AS-D chloroacetate esterase (NASD) positivity was observed within most of the cells, suggesting granulocytic sarcoma. However, bacterial strains and electron-microscopic examination revealed that the massive jejunal infiltrate was composed of macrophages containing numerous phagocytosed bacteria. Although occasional cells had primary and secondary granules characteristic of myeloid precursors present within their cytoplasm, most cells lacked specific granules. Attempts to reproduce this markedly enhanced NASD result experimentally in peritoneal macrophages of mice were unsuccessful. This case shows that intense NASD cytoplasmic staining may occasionally occur macrophages that have phagocytosed large numbers of bacteria.

Animals↗
PubMed1981

Treatment of stage I and II mediastinal Hodgkin disease. A comparison of involved fields, extended fields, and involved fields followed by MOPP in patients staged by laparotomy.

Three treatment programs for Stage I and II mediastinal Hodgkin disease (established by laparotomy) were compared. Involved-field radiotherapy + MOPP gave a disease-free survival rate of 97%, significantly different from 62% and 55% for involved and extended fields, respectively. Corresponding survival figures of 97%, 88%, and 84% were not significantly different statistically due to salvage with radiotherapy and/or chemotherapy. Among patients given radiotherapy alone, the survival figure of 94% for limited mediastinal disease was significantly better than 63% for extensive mediastinal and hilar disease; corresponding disease-free figures of 72% and 35% were also significantly different. Constitutional symptoms were an important prognostic factor in disease-free survival following the use of involved fields; hilar disease was important only with large mediastinal masses. Most relapses were intrathoracic; MOPP alone salvaged only 47%. Treatment of Stage I and II Hodgkin disease should be based on symptoms, extent of mediastinal disease, and hilar involvement.

Antineoplastic Combined Chemotherapy Protocols↗