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PubMed1992

Iliopelvic lymphoscintigraphy as a predictor of early metastatic disease in patients with prostate carcinoma.

Fifty-one patients had iliopelvic lymphoscintigraphy (IPL) as part of the initial assessment of newly diagnosed prostate carcinoma over a 3-year period. Investigations other than IPL showed that all patients had disease confined to the prostate, and they received radiotherapy to the prostate and regional pelvic lymph nodes. Patients with complete absence of activity in an iliac chain on IPL were excluded from the analysis because that finding could have resulted from tumor replacement or a failed injection. Of the remaining 41 patients, 12 had abnormal scintigrams, and 6 (50%) had recurrence within a mean 15-month follow-up period. Of 29 patients with normal scintigrams, 26 (90%) remain disease free over an average 27-month follow-up period.

Aged↗
PubMed1995

CT and MR imaging of the buccal space and buccal space masses.

The authors describe the normal variations in the buccal space and present the range of buccal space pathologic conditions seen on computed tomographic (CT) and magnetic resonance (MR) images. In a series of 50 patients studied with CT and 30 with MR imaging, the visualization and measurement of the normal facial expression and buccinator muscles, parotidomasseteric fascia, parotid duct, accessory parotid tissue, and facial neurovascular bundle were statistically equivalent. The size of the buccal fat pad was statistically the same from side to side within a given patient. Normal lymph nodes were rarely discernible from the facial neurovascular bundles. In a series of 26 patients with unsuspected buccal space masses, salivary gland tumors were the most common masses. Less frequently, benign lesions (eg, hemangioma and dilated parotid ducts) and soft-tissue malignancies (eg, sarcoma) manifested as buccal space masses. Occasionally, a cheek mass of uncertain cause proved to be lymphadenopathy; however, adenopathy is more commonly associated with clinically evident, deeply infiltrating facial neoplasms. Knowledge of the anatomic variations and expected abnormalities of the buccal space is useful for the radiologist interpreting facial CT or MR images.

Adult↗
PubMed2003

Cardiac allograft vasculopathy and dysregulation of the NO synthase pathway.

Cardiac allograft vasculopathy is the most aggressive form of atherosclerosis in humans and is the leading cause of death after the first year of heart transplantation. Endothelial dysfunction is a major contributing factor to the acceleration of coronary vascular disease in these individuals. A reflection of this endothelial dysfunction is the severe impairment in endothelium-dependent vasodilation that occurs early after transplantation. The etiology of this allograft endothelial alteration is multifactorial and may include preexisting atherosclerosis of the graft vessels, reperfusion injury during transplantation, denervation, disruption of the lymphatic system, and acute and chronic immune injury, as well as traditional risk factors for coronary artery disease (hyperlipidemia, diabetes, hypertension, or hyperhomocysteinemia) and pathogens, such as cytomegalovirus. The alteration in endothelial function affects vasomotor tone of the coronary arteries. Evidence indicates that there may be an impairment of endothelial production and/or activity of NO. Because NO is a potent vasodilator, its deficiency would explain the abnormal vasomotor tone in these individuals. In addition, because NO inhibits key processes in vascular inflammation and atherosclerosis, its absence may contribute to the acceleration of transplant vascular disease. Recent studies from our group and others have shed light on the mechanisms of endothelial dysfunction and its importance in cardiac allograft vasculopathy. In addition, the alteration in endothelial function contributes to vascular inflammation and progression of the disease.

Animals↗
PubMed1997

A case of metastatic medullary thyroid carcinoma: early identification before surgery of an RET proto-oncogene somatic mutation in fine-needle aspirate specimens.

Medullary thyroid carcinoma (MTC) management requires determination of the sporadic or familial nature of the disease. RET proto-oncogene mutation analysis in the tumor tissue obtained at surgery and in the peripheral blood identifies somatic vs. germinal mutations. We now report a case of MTC in which a RET somatic mutation at codon 918 was detected in fine-needle aspiration specimens obtained from both the thyroid nodule and two enlarged neck lymph nodes but not in peripheral blood. Therefore, a diagnosis of sporadic MTC was made before surgery. Thus, this approach, by excluding preoperatively multiple endocrine neoplasia disease, permitted immediate thyroidectomy without search for pheochromocytoma. PCR-based genetic analysis in fine-needle aspiration biopsy specimens, therefore, preoperatively identifies genetic abnormalities at an early and easily manageable stage and may well contribute to the management strategy of MTC.

Base Sequence↗
PubMed2006

[Immunohistochemical expression of the E-cadherin-catenin complex in gastric cancer].

BACKGROUND: The E-cadherin/catenin complex plays an essential role in the control of epithelial differentiation. Abnormal expression in tumors correlates with histological grade, advanced stage and poor prognosis. AIM: To evaluate the expression pattern of E-cadherin/catenin complex in gastric carcinoma and analyze their association with tumor clinicopathological features and patient survival. MATERIAL AND METHODS: Inmunohistochemical staining of E-cadherin, alpha and ss-catenin was performed from paraffin specimens of 65 gastric carcinomas. RESULTS: Abnormal expression of E-cadherin, alpha and ss-catenin was demonstrated in 82%, 85% and 88% of gastric carcinomas, respectively. There was a significant correlation between abnormal expression and Lauren pathological classification and depth of infiltration, but not with tumor stage, positive lymph node metastases and survival. CONCLUSION: Abnormal expression of E-cadherin, alpha and ss-catenin occurs frequently in gastric carcinoma and correlates with histological grade.

Cadherins↗
PubMed1998

[Comparison of nuclear accumulation of p53 protein with mutations in the p53 gene on the tissues of human breast cancer].

OBJECTIVE: To compare nuclear accumulation of p53 protein with mutations in the p53 gene on the tissues of human breast cancer. METHOD: Fifty-four invasive ductal carcinomas of breast were analyzed by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) silver stain and strep-avidin-biotin-peroxidase complex (SABC) immunohistochemistry. RESULT: A highly significant association between the presence of p53 gene mutation and nuclear accumulation of p53 protein was found (r = 0.714, P < 0.01). All 22 tumors with p53 gene mutations showed nuclear accumulation of p53 protein. Of the 32 tumors with gene mutations undetected, 9(28%) showed nuclear accumulation of p53 protein. Both p53 mutation protein and p53 gene mutations were prevalent in steroid and progesterone receptors negative tumors (P < 0.05). There was a statistically significant association between the nuclear accumulation of p53 protein and lymph node invasion (P < 0.05). So did p53 gene mutations (P < 0.05). Therefore, p53 abnormalities might be associated with an aggressive phenotype in breast cancer. CONCLUSION: The immunohistochemical detection of nuclear p53 protein accumulation is highly associated with p53 gene mutations in breast cancer tissues. This method is useful for rapid screening of p53 abnormalities. In some cases of slightly positive for p53 nuclear protein we must observe p53 genemutations to avoid the false positive reaction.

Breast Neoplasms↗
PubMed2002

Septic shock secondary to scrub typhus: characteristics and complications.

Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi transmitted by the bite of larval trombiculid mites (chiggers). A prospective study was conducted in septic shock patients in Maharat Hospital, Nakhon Ratchasima Province, Thailand, from 12 November 2001 to 5 January 2002. Of the 51 septic shock patients studied during the 7 week period, 18 (35.3%) were found to have evidence of scrub typhus infection; 3 patients (16.7%) died. In this study, septic shock caused by Orientia tsutsugamushi is the most prominent (35.3%) in endemic area of scrub typhus. Scrub typhus with septic shock patients results in organ failure: respiratory failure, DIC were predominant, followed by renal and hepatic involvement. Two deaths were due to respiratory failure and one death was as a result of combined respiratory and renal failure. Fever was the most common symptom, followed by headache, myalgia and dyspnea; lymphadenophathy and eschar are common signs. Laboratory findings revealed that almost all of the patients had a mild leukocytosis, reduced hematocrit and thrombocytopenia; SGOT, ALP, direct bilirubin (DB), total billirubin (TB), BUN, Cr were elevated; hypoalbuminemia was noted. Urinalysis showed that 88.9% of the patients had albuminuria. 77.8% of patients had abnormal chest X-rays.

Adult↗
PubMed1986

Immunological abnormalities in intravenous drug abusers and relationship to the prolonged generalized lymphadenopathy syndrome in Italy.

The prolonged generalized lymphadenopathy syndrome (PGL) has been considered a prodromal condition to the Acquired immunodeficiency syndrome (AIDS), but the clinical, virological and immunological characteristics of patients who will develop AIDS are not known. We report on the immunological profile of intravenous drug abusers with or without PGL in Northeastern Italy. We found a reduction of lymphocyte-absolute numbers with reversal of the T4/T8 ratio and decreased Leu-11b+ cells. The response to mitogens and natural killer activity are compromised in PGL patients. Neutrophil function is reduced both in drug abusers with or without lymphadenopathy. The serological investigations revealed a high prevalence of antibodies against HTLV III and the Epstein-Barr viruses. The recognition of immune dysfunction in the intravenous drug abusers appears to be important since these patients develop AIDS and these abnormalities may precede AIDS.

AIDS-Related Complex↗
PubMed1988

The in vitro influence of rIL2 on the B-cell dysfunction in patients with persistent generalized lymph node enlargement (PGL) or AIDS.

In AIDS elevated serum Ig levels and autoimmune phenomena indicate that B cells are also involved. The human immunodeficiency virus (HIV) can be cultivated in B cells, and HIV can stimulate B cells. In order to characterize the B-cell dysfunction and conditions for modulating it, functional studies with highly purified B cells were done in four patients with PGL and HIV-positive sera. Data were compared with those from patients with AIDS and normal controls. The experiments consisted of an in vitro study of the differentiation response (IgM/G secretion into culture supernatants) to a T cell-independent polyclonal B-cell activator (PBA) [Klebsiella pneumoniae, KlebsM]. A weak increase in IgM/G levels under stimulatory conditions was characteristic. Addition of recombinant interleukin 2 (rIL2) failed to increase the spontaneous Ig levels. However, coculture experiments using KlebsM and rIL2 resulted in Ig levels like those known from healthy individuals. Patients with frank AIDS did not respond with increased IgG secretion. This indicates that the abnormal B-cell differentiation response to PBAs can be modulated by rIL2 in patients with PGL and partly in AIDS (only IgM).

Acquired Immunodeficiency Syndrome↗
PubMed1984

Lymphadenopathic and oropharyngeal Kaposi's sarcoma in a drug addict with acquired immunodeficiency syndrome. Immunological abnormalities in peripheral blood and lymphoid tissue.

Lymphocyte subsets were analyzed in peripheral blood and lymph nodes from a drug-addict with acquired immunodeficiency syndrome (AIDS) presenting with disseminated lymphadenopathic and oropharyngeal Kaposi's sarcoma. At the onset of disease, hypergammaglobulinemia, increase of OKT8+ T cell subset and reversal of OKT4/OKT8 ratio were found in the blood. At the same time, lymph nodes displayed, besides Kaposi's sarcoma, marked follicular hyperplasia, plasmocytosis and increase of OKT8+/Leu 2a+ T cells within follicular centers. These results are interpreted to indicate that at an early stage of disease the major tissue alterations took place within follicular centers and consisted of both B cell activation and T suppressor cell reaction. These changes correlated with immunological abnormalities observed in peripheral blood. Immunohistochemical investigation of lymphoid tissue may be useful to detect AIDS patients at an early stage.

Acquired Immunodeficiency Syndrome↗
PubMed2002

The expression of murine double minute 2 is a favorable prognostic marker in esophageal squamous cell carcinoma without p53 protein accumulation.

BACKGROUND: Murine double minute 2 (MDM2) is an oncoprotein that inhibits the function of p53 tumor-suppressor protein. Although there have been a few reports on MDM2 gene abnormalities, there has been no investigation into expression of the product of this gene in esophageal squamous cell carcinoma. Thus, the clinicopathological and prognostic significance of the product of the MDM2 gene is as yet unknown. METHODS: MDM2 protein expression status was analyzed in surgically resected materials by immunohistochemical procedures. RESULTS: The expression of MDM2 significantly correlated inversely with tumor size, depth of invasion, lymph node metastasis, lymphatic vessel invasion, and stage of disease. However, the expression of MDM2 correlated with neither p53 protein accumulation status nor Ki-67 labeling index. The prognosis with MDM2-positive status was significantly better than that with MDM2-negative status for patients with p53-negative tumors, but not in those with p53-positive tumors. Moreover, multivariate analysis showed that the expression of MDM2 was an independent prognostic factor in patients with p53-negative tumors. CONCLUSIONS: These findings indicate that MDM2 immunohistochemical analysis may provide useful information concerning the prognosis in esophageal squamous cell carcinoma patients with p53-negative tumors.

Aged↗
PubMed1997

The radiographic prevalence of hilar and mediastinal adenopathy in adult cystic fibrosis.

BACKGROUND: It has been stated that the hilar and mediastinal lymph nodes in adults with cystic fibrosis are invariably enlarged from chronic inflammation. However, until correlation with computed tomography and magnetic resonance imaging became possible, the visualization of this feature on plain chest radiographs received very little attention, and even the advent of these modalities, little has been written on the subject. OBJECTIVE AND METHODS: To determine the frequency of positive radiographic evidence of hilar and mediastinal adenopathy, the chest radiographs of 48 adult patients with cystic fibrosis were reviewed. RESULTS: Adenopathy was found in a total of 25 (52%) of the patients hilar in 22 (46%) and mediastinal in 21 (44%). The adenopathy was chronic and slowly progressive in all of the patients, and in no case did it resolve. The distribution of the adenopathy resembled sarcoidosis in 19 of the 25 patients and lymphoma in another patient. CONCLUSIONS: The diagnosis of adenopathy was thought to be acceptably accurate: among patients for whom CT scans were also available, CT confirmed the radiographic diagnosis of abnormality in 22 of 24 sets of hilar lymph nodes and all 14 sets of mediastinal lymph nodes. When observed on chest radiography, mediastinal adenopathy was invariably widespread throughout the mediastinum. The presence of adenopathy was correlated with more severe pulmonary involvement, as assessed by the Brasfield scoring system. However, the importance of observing adenopathy radiographically lies in allaying concerns about the development of sarcoidosis or systemic lymphatic disease in these patients and preventing unnecessary concern and investigation.

Adolescent↗
PubMed2002

Lymphedema-lymphangiectasia-mental retardation (Hennekam) syndrome: a review.

The Hennekam syndrome is an infrequently reported heritable entity characterized by lymphedema, lymphangiectasia, and developmental delay. Here we add an additional 8 patients, and compare their findings to the 16 cases from the literature. The lymphedema is usually congenital, can be markedly asymmetrical, and, often, gradually progressive. Complications such as erysipelas are common. The lymphangiectasias are present in the intestines, but have also been found in the pleura, pericardium, thyroid gland, and kidney. Several patients have demonstrated congenital cardiac and blood vessel anomalies, pointing to a disturbance of angiogenesis in at least some of the patients. Facial features are variable, and are chiefly characterized, in a typical patient, by a flat face, flat and broad nasal bridge, and hypertelorism. Facial features are thought to mirror the extent of intrauterine facial lymphedema, or may be caused by lymphatic obstruction that affects the early migration of neural crest tissue. Other anomalies have included glaucoma, dental anomalies, hearing loss, and renal anomalies. The psychomotor development varies widely, even within a single family, from almost normal development to severe mental retardation. Convulsions are common. The existence of 10 familial cases, equal sex ratio, increased parental consanguinity rate (4/20 families), and absence of vertical transmission are consistent with an autosomal recessive pattern of inheritance. It seems likely that most (but not all) manifestations of the entity can be explained as sequences of impaired prenatal and postnatal lymphatic flow, suggesting that the causative gene(s) should have a major function in lymphangiogenesis.

Abnormalities, Multiple↗
PubMed1985

Diminished interleukin 2 production and receptor generation characterize the acquired immunodeficiency syndrome.

The Acquired Immunodeficiency Syndrome (AIDS) is a disease found primarily in homosexual men, consisting of opportunistic infections and tumors, and is due to an acquired T-cell defect. In the present report, we studied various T-cell functions which might serve to distinguish homosexuals with a symptom complex including lymphadenopathy from those with AIDS. T lymphocytes from the lymphadenopathy and AIDS patients had markedly depressed proliferative responses in the autologous (auto) and allogeneic (allo) mixed lymphocyte reaction (MLR) compared to healthy homosexuals or heterosexual controls (P less than 0.001). Since proliferation in the MLR depends upon interleukin 2 (IL-2), a T-cell growth factor, we studied the production of and response to IL-2 in various groups of homosexuals and heterosexual controls. IL-2 production was markedly depressed in the lymphadenopathy and AIDS patients, 1.0 and 0.1 U/ml, respectively, compared to the healthy homosexual or heterosexual controls, both 5.0 U/ml (P less than 0.05 and P less than 0.01, respectively). Although the auto MLR of the lymphadenopathy patients rose to control values with the addition of exogenous IL-2, the auto MLR of the AIDS patients did not (P less than 0.01). This lack of responsiveness to IL-2 in the AIDS group was due to their inability to generate IL-2 receptors as shown by the absence of IL-2 absorption by activated cells and the absence of the Tac antigen (IL-2 receptor) on these same cells. The T4+ and T8+ T-cell subsets from the AIDS patients each demonstrated depressed IL-2 production and responsiveness following activation with autologous cells or mitogen, as well as the absence of Tac antigen. The diminished T-cell proliferation in the auto MLR in the lymphadenopathy group is associated with one defect, low IL-2 production, while the depressed proliferation in the AIDS group is associated with two defects, low IL-2 production and a lack of IL-2 receptor generation. These studies demonstrate that IL-2 receptor generation helps distinguish homosexuals with lymphadenopathy from those with AIDS, and that in addition to T-cell defects in the OKT4+ T-cell subset there are significant abnormalities in the OKT8+ T-cell subset in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Deficiency of natural killer activity, but not of natural killer binding, in patients with lymphoadenopathy syndrome positive for antibodies to HTLV-III.

Blood lymphocytes (BL) of eleven patients with lymphoadenopathy syndrome (LAS) were studied for natural killer (NK) activity against the K562 cell line (using both the standard 51Cr release assay and the single-cell cytotoxicity assay on poly-L-lysine-coated coverslips) and for surface phenotype (employing OKT4, OKT8 and Leu7 monoclonal antibodies). A significant reduction in NK activity and in NK active cells was detected, while the percentage of target binding cells was not affected. Furthermore, the OKT4/OKT8 ratio was found to be inverted, and the Leu7+ subpopulation expanded. The patients had high titers of anti-HTLV-III antibodies. This study indicates that defective NK activity in LAS is secondary to an abnormality in the lytic event itself and not in target binding.

Adult↗
PubMed1984

Immunoregulatory subsets of the T helper and T suppressor cell populations in homosexual men with chronic unexplained lymphadenopathy.

Unexplained, generalized lymphadenopathy in homosexual men, which can be a prodrome to the acquired immunodeficiency syndrome, is associated with impaired cell-mediated immunity, a low ratio of T helper-inducer to T suppressor-cytotoxic cells (defined by the T4 and T8 monoclonal antibodies), and hypergammaglobulinemia. We performed double-marker studies on T cells by using a panel of monoclonal antibodies (Ia, T17, TQ1, and Leu-8), which reportedly detect activation or functional subsets of the T4 and T8 T cell populations. The T4:TQ1- or T4:Leu-8- subset, which is the major helper subset for B cell responses, is normally represented in lymphadenopathy patients. A depression in the reciprocal subset, T4:TQ1+ or T4:Leu-8+, accounts for the T4 T cell defect. Similarly, the TQ1 and Leu-8 markers delineate the abnormality of T8 T cells: the T8:TQ1- or T8:Leu-8- subset is elevated, whereas the T8:TQ1+ or T8:Leu-8+ subset is normally represented. We found no evidence of excessive activation of T4 T cells by using the T17 or Ia monoclonal antibodies. We did find an overall increase in Ia-positive T cells; however, this was due to increased T8:Ia+ cells. In functional studies, immunoglobulin production induced by pokeweed was subnormal. Most lymphadenopathy patients had normal T helper cell function when combined with normal B cells. The dampened pokeweed responses could be partially explained by depression of the T4:TQ1+ (or T4:Leu-8+) subset (which has minor help-associated function) and/or greater than expected suppression. However, subnormal pokeweed responses could not be totally explained by immunoregulatory T cell abnormalities because we also found an intrinsic defect in the B cell responses of lymphadenopathy patients.

Acquired Immunodeficiency Syndrome↗
PubMed1980

CT diagnosis of benign mediastinal abnormalities.

Thoracic CT scanning was performed in 49 adult male patients to evaluate a suspected mediastinal mass. A correct diagnosis would have been made in only 20 instances on the basis of conventional chest radiography. Specific diagnoses established by CT included 14 cases of local or diffuse mediastinal fat deposition, five mediastinal cysts, and six anomalies or aneurysms of the great vessels. Four miscellaneous lesions were also clarified. Thoracic angiography would undoubtedly have diagnosed vascular abnormalities, but was obviated in most instances. CT accurately defined anatomic relationships and distinguished vascular from nonvascular masses in the 16 patients who underwent diagnostic thoracotomy or mediastinoscopy. When CT demonstrated a fatty or cystic lesion, no attempt at tissue confirmation was undertaken in all but two of the asymptomatic patients. Clinical follow-up from 6 months to 3 years in conjunction with select correlative radiologic procedures have supported the CT findings in the nonoperated group. CT should be the initial procedure for evaluating most patients with mediastinal abnormalities detected by plain chest radiography. If the patient is asymptomatic and the information provided by CT indicates a benign process, conservative management with careful follow-up is justified.

Adult↗
PubMed2003

Predicting nodal malignancy from clinical data.

OBJECTIVE: A large variety of disorders can lead to lymphadenopathy. It is important and beneficial to patient management to rapidly differentiate between benign and malignant causes. The objective of the study is to identify factors predicting nodal malignancy from readily available clinical data. METHODS: A retrospective study was carried out on patients admitted to Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia between April 1996 and March 2000 with lymphadenopathy, who underwent lymph node biopsy. RESULTS: Univariate analysis suggests 6 variables (age, sex, the presence of other physical signs, abnormal complete blood count, abnormal liver function test and negative Mantoux test) to have independent association with nodal malignancy. The multivariate logistic regression model revealed patients aged more than 40 years, males, generalized lymphadenopathy, presence of other physical signs, abnormal liver function tests and negative Mantoux test to be statistically significantly associated with nodal malignancy (p>0.05). CONCLUSION: The present logistic model can be useful in predicting nodal malignancy using routinely collected clinical data.

Adult↗