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PubMed2004

Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms.

OBJECTIVE: To evaluate the role of sonography in evaluation of abnormal axillary lymph nodes identified in patients with otherwise negative or benign findings on mammography. METHODS: For 3 years 2 months, we retrospectively reviewed 30 consecutive cases that had undergone sonographic evaluation for abnormal axillary lymph nodes identified in patients whose mammograms had an American College of Radiology Breast Imaging Reporting and Data System final assessment of 1 or 2. Mammographic and sonographic features of the lymph nodes were analyzed and correlated with the histologic diagnosis in patients undergoing biopsy. Patients who did not undergo biopsy had clinical or imaging follow-up. RESULTS: Twenty of the 30 patients studied had an abnormal sonographic appearance. Biopsy was recommended in 17 of the 20 patients on the basis of an abnormal sonographic appearance. In the remaining 3 patients, there was an underlying cause for lymphadenopathy, and these patients underwent clinical and sonographic follow-up. Eighteen patients underwent biopsy, including 1 patient with normal findings on sonography. Ten of these patients had malignant histologic findings: 6 were metastatic adenocarcinoma; 1, poorly differentiated sarcoma, and 3, lymphoma. The remaining 8 patients had benign histologic findings. The nonbiopsy group had clinical and or imaging follow-up (mean, 17.6 months; range, 6-25 months). The sensitivity (true-positive/true-positive + false-negative) of sonography for assessment of suspected abnormal lymph nodes in the patients studied was 100% (10 of 10); specificity (true-negative/true-negative + false-positive), 50% (10 of 20); positive predictive value (true-positive/true-positive + false-positive) for malignancy based on the presence of 2 or more abnormal sonographic features, 50% (10 of 20); and negative predictive value, 100%. CONCLUSIONS: Sonography is useful in further characterization of isolated abnormal axillary lymph nodes identified on mammography. Sonographic evaluation helps improve the specificity of imaging evaluation in assessment of these lymph nodes.

Adult↗
PubMedDate not supplied

Silicone implants and systemic immunological disease: review of the literature and preliminary results.

Silicone has been utilized as an implant in reconstructive surgery. For years, silicone has been considered to be biologically inert and essentially harmless. Several studies and case reports show that female patients treated with silicone implants developed a systemic disease associated with immunological abnormalities. Removal of the silicone implants was associated with recovery and resolution of the immune abnormalities. Recently, specific antibodies to silicone have been isolated in children with silicone implants. Additionally, immunological abnormalities and high incidence of systemic progressive sclerosis in patients with silicone implants or injections further support the notion that silicone is not biologically inert, and can cause a syndrome of a systemic disease and immunological abnormalities. The specific mechanisms and duration of the latency period is not yet fully understood.

Adult↗
PubMed1979

Thymic deficiency in Down's syndrome.

Children with Down's syndrome (DS) often have small and abnormal thymuses, with lymphocyte depletion, diminution of the cortex, and loss of corticomedullary demarcation--a picture resembling thymic involution. Besides this, they have markedly enlarged Hassall's corpuscles, some surrounded by a sheath of lymphocytes. Patients with DS are known to have increased numbers of respiratory infections; they also have a higher incidence of lymphatic leukemia than do individuals who do not have DS. Studies of cell-mediated (thymic-dependent) immunity demonstrate that children with DS have both diminished numbers of T cells as well as functional deficiency of these cells.

Child↗
PubMed1975

Cellular structure and function in normal and neoplastic lymphoid cells.

In general, the ultrastructure of normal lymphocytes and plasma cells reflects their functional state. Similarly, in pathologic conditions, ultrastructural abnormalities may reflect specific functional derangements of the cells. The identification of some structural abnormalities may be clinically useful, even though their origin and biochemical composition is still obscure.

Bone Neoplasms↗
PubMed1990

Cytophotometrically determined DNA content, mitotic activity, and lymph node metastasis in clinical gastric cancer.

Analyses of cytophotometrically determined DNA content and mitotic rate were carried out in 37 cases of gastric carcinoma to identify biologic significance of DNA abnormalities. Lymph node metastasis was also evaluated by DNA content and mitotic rate. According to the linear regression analysis, there were statistically significant correlations of mitotic rate with DNA variants such as the peak value, the mean value, and the frequency of cells with values exceeding tetraploid or hexaploid chromosome complement. There were significantly higher values for these DNA parameters in patients with lymph node metastasis compared with those without metastasis. Similarly, higher mitotic rates were observed in tumors with metastatic disease. Thus abnormal DNA fractions appear to be indicative of tumors with a high mitotic activity. The quantitative detection of the DNA abnormalities will provide pertinent biologic information required to predict the occurrence of metastasis in patients with gastric cancer.

Cytophotometry↗
PubMed1985

[Value of lymph node biopsy in lymphadenopathies occurring in patients at risk for AIDS].

On the basis of four cases of patients with persistent lymphadenopathy and at risk for acquired immune deficiency syndrome (AIDS), (3 Haitians, one haemophiliac), histopathologic features of lymph node biopsy in AIDS are recalled. Two main types of alterations of lymph node architecture--follicular hyperplasia or lymphoid depletion--can be associated with interfollicular lesions: vascular proliferation, numerous plasma cells, epithelioid reaction that may reflect an infectious process. Alterations of T-cell subsets distribution were also analyzed using immunocytochemical labelling of frozen sections from lymph nodes. In all four cases, T4 (helper)--lymphocytes were markedly depleted, whereas they normally represent the majority of lymph node T cells. They were replaced by prominent T8 (cytotoxic, suppressor)-cells, particularly inside the follicle. T8 lymphocytes are usually rare in this latter area. The fine analysis of these abnormalities is useful in prodromal or mild forms of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Structure and function of the bone marrow and hematopoiesis.

Bone marrow, a well-organized tissue located within the bone cavities, is richly innervated and highly vascularized but devoid of lymphatics. Structurally, it consists of two major cellular elements, the stromal cells (reticular cells--fibroblasts, endothelial cells, adipocytes, and so on) and the parenchymal cells (hematopoietic cells). Functionally, it serves as the primary site for hematopoiesis and as a major reticuloendothelial organ involved in immune responses (cellular and humoral) and removal of senescent and abnormal cells and particulate material. An uncommitted pluripotential hematopoietic stem cell, itself a product of the differentiation of mesenchymal cells of the yolk sac and capable of self-replication, undergoes proliferation and differentiation in an orderly manner, generating immature committed progenitors with uni-, bi-, or trilineage specificity. These committed progenitors also multiply and differentiate in a sequential fashion, ultimately producing mature cells that are released into the circulation. Under steady state conditions, the cell death/loss is balanced by cell production by virtue of regulatory mechanisms that apparently involve (1) cell-cell interaction between marrow cells and (2) production of humoral growth and/or inhibitory factors by stromal and parenchymal cells individually or in concert. Some of these regulators of hematopoiesis have been isolated, purified, molecularly cloned, and characterized. The availability of recombinant growth factors has stimulated clinical trials of these factors as therapeutic agents.

Bone Marrow↗
PubMed1984

B lymphocyte changes in homosexual men with generalized lymphadenopathy.

Studies of B and T lymphocytes were done on homosexual men with generalized lymphadenopathy, homosexuals without any clinical symptoms, and on normal heterosexual controls. In vitro proliferative responses induced by pokeweed mitogen (PWM) and phytohemagglutinin (PHA) were determined, as was the polyclonal plaque-forming cell (PFC) response to PWM. A decreased proliferative response to PWM and PHA was observed in mononuclear cells from patients with generalized lymphadenopathy and in some of the asymptomatic individuals. In addition, the mononuclear cells of these groups showed a reduced PFC response to PWM, which was not due to a kinetic difference. Serum immunoglobulins, particularly IgG, were elevated in most of the patients with generalized lymphadenopathy. T cell changes including reduced T helper/suppressor ratios were observed in most of the symptomatic and in some of the asymptomatic homosexuals. The reduced proliferative and differentiative responses of mononuclear cells to PWM may be compatible with a B cell abnormality, in addition to a previously described T cell dysfunction.

Adult↗
PubMed1984

Studies in homosexual patients with and without lymphadenopathy. Relationships to the acquired immune deficiency syndrome.

We studied the immunologic function of 19 sexually active homosexual men, ten of whom had persistent lymphadenopathy. Analysis of mononuclear cell populations distinguished homosexuals from heterosexual controls since, as a group, homosexuals had increased percentages of natural killer cells (Leu 7+), decreased helper-inducer T lymphocytes (OKT-4+), increased suppressor/cytotoxic (OKT-8+) T lymphocytes, low OKT-4:OKT-8 ratios, and depressed mitogenic responses. Homosexuals without lymphadenopathy were distinguishable from controls by increased percentages of Ia+ cells, decreased OKT-4+ cells, and decreased OKT-4:OKT-8 ratios. Four had positive findings simultaneously for hepatitis B surface antigen (HBsAg) and surface antibody, and five had positive findings for HBsAg alone. Homosexuals with lymphadenopathy were distinguishable from controls by increased percentages of Leu 7+ cells, increased total lymphocyte numbers per cubic millimeter, decreased percentages of both OKT-4+ and OKT-8+ cells, abnormal OKT-4:OKT-8 ratios, and depressed mitogenic responses. Only histories of larger numbers of sexually acquired diseases, higher numbers of OKT-8+ cells per cubic millimeter, and lower mitogenic responses in homosexuals with lymphadenopathy distinguished this group from homosexuals without lymphadenopathy. Furthermore, none of the nine patients tested in this group was HBsAg positive. We conclude that homosexuals without lymphadenopathy are distinguishable from those with lymphadenopathy by both immunologic and serologic abnormalities.

Acquired Immunodeficiency Syndrome↗
PubMed2000

An analysis of the safety of the single dose, two drug regimens used in programmes to eliminate lymphatic filariasis.

This review of the safety of the co-administration regimens to be used in programmes to eliminate lymphatic filariasis (albendazole + ivermectin or albendazole + diethylcarbamazine [DEC]) is based on 17 studies conducted in Sri Lanka, India, Haiti, Ghana, Tanzania, Kenya, Ecuador, the Philippines, Gabon, Papua New Guinea, and Bangladesh. The total data set comprises 90,635 subject exposures and includes individuals of all ages and both genders. Results are presented for hospital-based studies, laboratory studies, active surveillance of microfilaria-positive and microfilaria-negative individuals, and passive monitoring in both community-based studies and mass treatment programmes of individuals treated with albendazole (n = 1538), ivermectin (9822), DEC (576), albendazole + ivermectin (7470), albendazole + DEC (69,020), or placebo (1144). The most rigorous monitoring, which includes haematological and biochemical laboratory parameters pre- and post-treatment, provides no evidence that consistent changes are induced by any treatment; the majority of abnormalities appear to be sporadic, and the addition of albendazole to either ivermectin or DEC does not increase the frequency of abnormalities. Both DEC and ivermectin show, as expected, an adverse event profile compatible with the destruction of microfilariae. The addition of albendazole to either single-drug treatment regimen does not appear to increase the frequency or intensity of events seen with these microfilaricidal drugs when used alone. Direct observations indicated that the level of adverse events, both frequency and intensity, was correlated with the level of microfilaraemia. In non microfilaraemic individuals, who form 80-90% of the 'at risk' populations to be treated in most national public health programmes to eliminate lymphatic filariasis (LF), the event profile with the compounds alone or in combination does not differ significantly from that of placebo. Data on the use of ivermectin + albendazole in areas either of double infection (onchocerciasis and LF), or of loiais (with or without concurrent LF) are still inadequate and further studies are needed. Additional data are also recommended for populations infected with Brugia malayi, since most data thus far derive from populations infected with Wuchereria bancrofti.

Albendazole↗
PubMedDate not supplied

[Painful shoulder syndrome with drooping after cervical lymphatic dissection].

A study was made of 12 patients with head and neck cancer who underwent surgical neck dissection in 1993 to evaluate quantitatively the degree of postoperative shoulder dysfunction after surgical neck dissection. Nerve conduction studies were made of the accessory nerve and the range of motion, strength and position of the shoulder were evaluated. Patients were invited to complete a questionnaire about daily living activities, shoulder pain, shoulder movement and shoulder droop. Our results showed that abnormalities can be found in shoulder and arm function after any type of neck dissection and that these are evident when the accessory nerve is damaged. Subjective questionnaire findings generally coincided with objective postoperative dysfunction.

Aged↗
PubMed1987

Percutaneous drainage of pelvic lymphatic fluid collections in the renal transplant patient.

Seventeen renal transplant patients with pelvic lymphatic fluid collections were treated with percutaneous drainage. Eleven of 16 patients with lymphoceles (69%) were successfully managed without surgery, although seven of these patients required repeat catheter insertions, and three patients developed local infections. The patient with an ovarian cystadenoma was treated with surgery. The mean duration of catheter insertion was ten days for initial drainage and 16 days for repeat drainage. Elevated serum creatinines decreased in 14 of the patients with lymphoceles (88%), including all five patients without pelvocaliectasis, but never returned to baseline in six instances. This observation may reflect the inadequate therapy of frequently encountered concurrent renal parenchymal abnormalities (rejection, cyclosporine toxicity, acute tubular necrosis). While percutaneous management of lymphoceles is technically easy and usually ultimately effective, the interventional radiologist should be prepared for long duration of catheter insertions, repeat interventions, and variable clinical courses. Differentiation of lymphoceles from other fluid collections, such as cystic ovarian neoplasms, may be difficult.

Adult↗
PubMed2002

A possible role of keratinocytes of skin and mucous membranes in prion propagation and transmission.

Prion diseases or transmissible spongiform encephalopathies are lethal neurodegenerative diseases caused by proteinaceous agents that consist of an abnormal form of a host protein designated PrP and are devoid of nucleic acids. In laboratory settings these diseases are usually transmitted by intracerebral or peripheral inoculation. In the field they have been shown to be transmitted by uptake of contaminated food but in most instances the route of transmission remains obscure. Both nervous and lymphatic tissues in peripheral organs have been implicated in the spread and propagation of prions. The exact sites of uptake and initial propagation of the infectious agents have not yet been determined, however. As the expression of PrPc is required for the propagation of the infectious agent the search for peripheral cells positive for PrPc may reveal potential routes of entry and transmission. Recently epidermal and mucosal keratinocytes have been found to express PrPc. These data together with the recent finding that epithelial cells are able to support prion replication in vitro suggest that keratinocytes might play a role in the pathogenesis and/or transmission of prion diseases.

Animals↗
PubMed2004

Molecular and cellular mechanisms associated with autoimmune diseases.

Evidence points to increases in the incidence and prevalence of several autoimmune diseases in the United States. As a result, the cost to public health from clinical management of autoimmune conditions is on the rise. The initiation and progression of autoimmune disturbances involves both genetic and environmental factors. Deficiencies in important proteins that normally participate in maintaining checks and balances within the internal milieu may render an individual prone to developing autoantibodies. Structural abnormalities or decline in normal levels of the pentraxins (serum amylase-P protein, the acute phase proteins, complement, and C-reactive proteins) have been shown to induce autoimmunity. Irregular transmission of information arising from multiple signal transduction pathways typically associated with the serine/threonine cascade routes of mitogen activating phosphorylation kinases, has also been found to induce autoimmunity. The kind of ligand/receptor interactions drives physical recruitment of different signals within the lymphocyte; these links define the quality and quantity of subsequent immune responses. CD95 or the Fas/Apo-1 and its ligand CD95L participate in regulating lymphocyte populations and therefore influence various aspects of immune responses. Mutational abnormalities resulting from synthesis of proteins by the CD95 and/or its ligand CD95L may result in alterations in the apoptotic pathways. Apoptosis may be completely inhibited, activated or partially stimulated. Modulation of apoptosis may lead to accumulation of self-antigens. Subsequently the immune system may be stimulated to react against self-molecules through lymphatic hyperplasia. This process may end up in proliferative disorders and enhanced susceptibility to autoimmune syndromes. This paper deals with mechanisms of autoimmunopathogenesis at the cellular and molecular levels. Emphasis is laid on the role of T and B cell receptor/ligand interactions, functions and malfunctions due to structural and quantitative alterations in T- B- cell clusterof antigen determinants. Genetically susceptible patients who develop spontaneous autoimmune diseases are examined and the etiological factors implicated in the initiation and subsequent dissemination of autoimmune diseases is discussed.

Animals↗
PubMedDate not supplied

MUC1 and MUC2 expression in human gallbladder carcinoma: a clinicopathological study and relationship with prognosis.

Mucins are a group of high molecular weight glycoproteins consisting of a mucin core protein and O-linked carbohydrates. To date, nine apomucins (MUC1-8, and MUC5B) have been identified. Recent studies have demonstrated that MUC1 is expressed in tumors of various human organs, and may function as an anti-adhesion molecule that inhibits cell-to-cell adhesion, inducing tumor metastasis. MUC2 is a major secreted mucin of colon and is known to be expressed in cells showing intestinal metaplasia in the stomach and other organs. MUC2 expression in the mucosal epithelia is an apparently abnormal phenomenon related to the neoplastic process. In this study, we examined MUC1 and MUC2 expression in human gallbladder adenocarcinoma and its clinicopathological significance and relationship with the prognosis of the patients. MUC1 immunoreactivity was detected not only in the cancer cells but also in the cancer stroma. Cytoplasmic MUC1 expression was significantly relation to lymphatic invasion and lymph node metastasis (p < 0.001), and was associated with a poor outcome. In contrast, MUC2 was rarely expressed in gallbladder carcinomas, and its immunoreactivity was detected only in the cancer goblet cells. Overexpression of MUC2 was not significantly related to lymphatic invasion or lymph node metastasis, or prognosis of patients. These observations suggested that MUC1 expression plays a more important role than MUC2 expression in cancer cell growth and metastasis of human gallbladder adenocarcinomas.

Adenocarcinoma↗
PubMedDate not supplied

[Surgical treatment of recurrences after operations for essential varices].

Among our cases of post-operative recurrent varicose veins, we report here only those cases which required further surgery. Thus we were able to carry out a comparative study of a series of 30 patients who were re-operated on between the 16th of March 1959 and the 16th of March 1966, and 44 patients operated on under the same conditions between the 16th of March 1966 and the 16th of March 1974. The causes of recurrence were different in the two groups. Before 1966, they were mainly due to the choice of inefficacious operations. Since 1966, they are due to poor technique in resection of the junction of the femoral vein with the saphenous vein. This was the most common cause, and these failures were favoured by saphenous abnormalities. Associated with stripping of the large vessels, resection of inguinal cavernoma which prolonged the femoro-saphenous junction, was the main stage in these re-operations. It was perfectly efficacious in the treatment of varicose veins but required also resection of inguinal lymph nodes with the cavernoma. Post-operative complications, such as lymphatic fistula and oedema, led us to prefer simple isolation of the cavernoma from the deep veins, but the first and essential stage remains resection of the junction of the femoral and saphenous veins and stripping of accessory trunks.

Female↗
PubMed1989

Facial dysmorphia, parathyroid and thymic dysfunction in the father of a newborn with the DiGeorge complex.

A boy born at full-term died after 14 days from cardiac failure. At autopsy DiGeorge complex was diagnosed. The father was found to have facial dysmorphia and hypocalcaemia. Investigations revealed no cause other than hypoparathyroidism associated with normal serum 1,25-dihydroxyvitamin D concentrations and normal renal handling of phosphate. Immunological tests, performed on two occasions with an interval of 9 months, revealed a decrease in the number of CD8+ lymphocytes, compatible with a partial thymus deficiency. The combination of facial dysmorphia with dysfunction of the thymus and the parathyroid glands can constitute a partial DiGeorge complex. The findings in this family are compared with reports of four other families with DiGeorge complex in two generations. In genetic counseling DiGeorge complex should be considered a heterogenous disorder. Screening of the parents for somatic stigmata, hypocalcaemia, disturbed cellular immunity, cardiac and chromosomal abnormalities is essential.

Adult↗