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At least 1,333 records · Page 74Linked to original sources
PubMed1989

CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection.

STUDY OBJECTIVE: To determine if circulating CD4+ lymphocyte counts are predictive of specific infectious or neoplastic processes causing pulmonary dysfunction. DESIGN: Retrospective, consecutive sample study. SETTING: Referral-based clinic and wards. PATIENTS: We studied 100 patients infected with human immunodeficiency virus (HIV) who had had 119 episodes of pulmonary dysfunction within 60 days after CD4 lymphocyte determinations. MEASUREMENTS AND MAIN RESULTS: Circulating CD4 counts were less than 0.200 X 10(9) cells/L (200 cells/mm3) before 46 of 49 episodes of pneumocystis pneumonia, 8 of 8 episodes of cytomegalovirus pneumonia, and 7 of 7 episodes and 19 of 21 episodes of infection with Cryptococcus neoformans and Mycobacterium avium-intracellulare, respectively. In contrast, circulating CD4 counts before episodes of nonspecific interstitial pneumonia were quite variable: Of 41 episodes, 11 occurred when CD4 counts were greater than 0.200 X 10(9) cells/L. The percent of circulating lymphocytes that were CD4+ had a predictive value equal to that of CD4 counts. Serum p24 antigen levels had no predictive value. CONCLUSIONS: Pneumocystis pneumonia, cytomegalovirus pneumonia, and pulmonary infection caused by C. neoformans or M. avium-intracellulare are unlikely to occur in HIV-infected patients who have had a CD4 count above 0.200 to 0.250 X 10(9) cells/L (200 to 250 cells/mm3) or a CD4 percent above 20% to 25% in the 60 days before pulmonary evaluation. Patients infected with HIV who have a CD4 count below 0.200 X 10(9) cells/L (or less than 20% CD4 cells) are especially likely to benefit from antipneumocystis prophylaxis.

Cryptococcosis↗
PubMed1975

Bilateral trephine bone marrow biopsies in lymphoma and other neoplastic diseases.

We have evaluated the usefulness of bilateral rather than unilateral posterior iliac spine trephine biopsies in searching for lymphoma and other neoplastic diseases in the bone marrow. Two hundred and eighty-two patients with these diseases were studied. Tumor was found on only one side in 22% of patients with non-Hodgkin's malignant lymphoma, in 43% of patients with Hodgkin's disease, and in 36% of patients with other neoplastic processes. Thus, the second biopsy yields an additional 11% to 22% of positive biopsies. We conclude that bilateral trephine bone marrow biopsies should be routinely performed when searching for tumor in the bone marrow.

Biopsy, Needle↗
PubMed1999

Orthopaedic oncology for the nononcologist orthopaedist: introduction and common errors to avoid.

A number of the more frequently encountered diagnostic and management errors and pitfalls have been discussed. However, if a physician will recognize his or her own limits and will always consider the diagnostic possibility of a neoplastic process, then appropriate steps can usually be taken, improving the patient's health care. The following chapters will outline the appropriate steps in the evaluation and work-up of patients with suspected tumors, as well as the currently recommended approach for biopsy, treatment, and follow-up.

Adolescent↗
PubMed1999

Cellular response to cancer chemopreventive agents: contribution of the antioxidant responsive element to the adaptive response to oxidative and chemical stress.

Cancer chemopreventive agents can act by inhibiting either the acquisition of mutations or the neoplastic processes that occur subsequent to mutagenesis. Compounds that reduce the rate at which mutations arise, referred to as blocking agents, exert their effects largely through their ability to induce the expression of antioxidant and detoxification proteins. This is achieved by the transcriptional activation of a small number of genes that are co-regulated through the presence of an antioxidant responsive element (ARE) in their promoters. Blocking agents can cause gene induction by producing oxidative and/or chemical stress within the cell and, as the inducible proteins act to ameliorate the metabolic insult, the process represents a form of adaptive response. The transcription factors which mediate this response through the ARE are members of the basic leucine zipper superfamily. The mechanism whereby cells sense and respond to the chemical signal(s) generated by chemopreventive blocking agents is discussed.

Adaptation, Physiological↗
PubMedDate not supplied

Prevention of ovarian cancer.

Chemoprevention trials with OCP and retinoids will be important to determine if these drugs are effective in selected populations. Further work will be critical to understanding the mechanism of action of OCP in preventing ovarian cancer and if this protective effect will be upheld in the high-risk population. Initial results in the Milan study are promising for the retinoids in prevention of ovarian cancer and will be used in chemoprevention trials both alone and in combination with OCP's to determine if there might be an additive effect with these drugs. As yet, little is known about preinvasive changes in the ovary to predict which women are at risk for developing ovarian cancer. We can now identify high-risk women by genetic counseling and testing, yet ultrasound and serum markers are the only modality available to evaluate these women. Research is focusing on developing ways of evaluating women, particularly those at high risk for ovarian cancer, to better understand the neoplastic process in the ovary and thus identify these women prior to their developing advanced ovarian cancer. Research is also focusing on understanding chemoprevention for ovarian cancer so that women can receive the optimal chemopreventive agent when diagnosed as high risk. Prognosis with advanced disease is so poor that early diagnosis and chemoprevention are the only methods at the current time to significantly improve survival in epithelial ovarian cancer.

Female↗
PubMed1976

Aneurysmal bone cyst (a study of 127 cases, 72 with longterm follow up).

127 cases of aneurysmal bone cyst are analysed, seventy two of which were followed up from one to fifteen years after treatment. Statistics on sex, age, site and localisation are reported. Symptoms, radiographic features, histological appearances and differential diagnosis are discussed. In half the cases the cyst was clearly shown to be of subperiosteal origin. The aetiology is unknown, but the pathogenesis seems to consist of a haemorrhagic and hyperplastic (not neoplastic) process which is progressive but has a tendency to become stabilised on reaching a certain point of maturation. Local excision is indicated or, in cases where this is difficult to carry out, radiotherapy. Recurrences occurred in 12 per cent of the cases, always within one year after operation. All cases were eventually cured and there was no evidence of malignant transformation.

Adolescent↗
PubMed1999

Proton MR spectroscopy of the brain.

Over the past five decades, MR spectroscopy has evolved from an analytical chemistry tool to a noninvasive clinical examination on FDA approved equipment with an AMA billing code. While proton MR spectroscopy has dominated current clinical studies, interest in other nucleii has arisen, particularly P-31 for the evaluation of membrane lipids, and C-13 for the evaluation of glutamate neurotransmission and excitotoxicity. Currently, the most common neuroradiological diagnostic indication is the differentation of suspected cerebral neoplasms for post-treatment effects, abcesses, subacute infarcts, demyelinating disease, and other non-neoplastic processes. Recent recommendations for monitoring multiple sclerosis treatment suggest an increasing role for MR spectroscopy in the future.

Brain↗
PubMed1999

Biodiversity and bioseparation of HIV-1 envelope glycoproteins.

Since 1984, studies from almost every branch of modern biology have filled in many gaps in our knowledge of human immunodeficiency virus type 1 (HIV-1). This review focuses on studies of biodiversity and bioseparation of HIV-1 envelope glycoproteins from the vaccine development point of view. It presents an updated picture of different systems for producing either native or recombinant HIV-1 envelope glycoproteins for the preparation of vaccine candidates. The prevention of HIV-1-associated disease is highly relevant to the abrogation of the neoplastic processes associated with this pathogen.

AIDS Vaccines↗
PubMed1999

[Angiogenesis in gynecology and obstetrics].

In current scientific discussion, increasing importance is being given to the clinical significance of the new formation of vessels (angiogenesis) in the course of physiological, inflammatory and neoplastic processes. Angiogenesis is best studied in the growth of malignant tumors, since cancer may be regarded as the most important angiogenesis-dependent disease in terms of social and economic aspects. The significance of angiogenesis in gynecological oncology is as follows: 1) Intratumoral vessel density is an indicator for the emergence and growth of malignant tumours and their precursor lesions, 2) intratumoral vessel density is an independent prognostic factor for solid malignancies and 3) the inhibition of tumor angiogenesis by means of anti-angiogenetic substances causes tumor growth to be suppressed. Angiogenesis also plays an important role in the regulation of the female menstrual cycle. Proliferation of the endometrium and the formation of the corpus luteum in the second half of the menstrual cycle are examples of angiogenesis in the physiological field. The function of angiogenetic factors in the emergence of endometriosis and in female and male infertility are currently under study. In obstetrics, the new formation of blood vessels is significant for the implantation of impregnated blastocysts and for the development and growth of the placenta. Preeclempsia (gestational toxicosis), for instance, is a typical pregnancy-related disease whose pathophysiological mechanism is attributed to a disturbed development and function of small placental vessels. The present paper is an overview of current knowledge and current approaches of research concerning angiogenesis in the field of gynecology and obstetrics. The paper is focused on the clinical significance of angiogenesis.

Angiogenesis Inducing Agents↗
PubMed1976

[Clinicophysiological studies of orbicularis oculi reflex in brain stem diseases].

Orbicularis oculi reflex is consisted of two components; one is early reflex response (R1) which is 14.1 +/- 2.2 msec in latency, and the other is late reflex response (R2) that is 35.0 +/- 8.6 msec in latency (mean +/- 2SD). R1 is observed on the ipsilateral side of stimulation and R2 is visible bilaterally on ipsiand contralateral sides of stimulation. Clinically orbicularis oculi reflex can be recorded easily, however, its clinical and physiological significance has not been clearly solved. Orbicularis oculi reflex was tested on patients with the brain stem lesions of various kinds, and the factors influencing to the reflex pathways were examined, such as the site and the type of lesions, sleep, several anesthetics and the level of consciousness. Results obtained were as follows; 1) both R1 and R2 disappeared or prolonged in latencies by nuclear as well as peripheral facial nerve palsy, since the facial nerve was the final common pathway. 2) on cases of facial sensory disturbance R1 prolonged in latency with concomitant delay of R2 response. 3) both R1 and were attenuated as soon as the alpha rhythmicity of the EEG was disappeared. Administration of thiamylal also attenuated both the R1 and R2, however, ketamine (a dissociative anesthetic) enhanced the R1 in amplitude and suppressed R2. These findings indicated that the R1 and R2 were in some extent regulated from brain stem reticular formation and the orbicularis oculi reflex should be an useful diagnostic measure to detect imparied consciousness. 4) also the reflex should be used to know the extent of neoplastic process in the cerebellar hemisphere to the brain stem. 5) recovery curve of R1 from double shock stimuli (conditioned and test) indicated that this reflex was different from H wave of the spinal cord because of absent refractory period and shorter facilitatory period ranging between 40 to 60 msec.

Adolescent↗
PubMed1999

[Histologic-ultrasonographic correlation of gland asymmetry and "pseudoruptures" of the prostatic capsule].

An histo-ultrasound correlation was carried out between the information obtained with pre-operative transrectal ultrasound and that obtained with the histopathological study of 29 prostate specimens from patients with mean age 63 years (range, 52 to 71 years), who underwent radical cystoprostatectomy for infiltrant neoplasia of the bladder (22/29) and radical prostatectomy for prostate cancer (7/29). The (extrinsic and intrinsic) ultrasound parameters were analyzed focusing in the study of the prostatic capsule or "pseudocapsule". With this comparative, echographic and histological study the concept of capsular "pseudorupture" that results from the presence of (arterial and/or venous) vessels, nerves and fibromuscular folds at the periprostatic fat tissue is introduced. The interruption of the capsular echogram was seen as an indication of tumoral involvement of the capsule, and extracapsular spread. Our results allow us to suggest that this assertion should be reconsidered since these capsular "interruptions", "irregularities" or "pseudoruptures" are present in the normal prostate. Similarly, glandular asymmetry in relation with an heterogenous growth in one lobe in defined to differentiate it from that seen in neoplastic processes.

Aged↗
PubMed1976

[Association of Hashimoto's disease with carcinoma of the thyroid].

The Authors describe a case, which came under their observation, of indifferentiated neoplasia of the thyroid associated with Hashimoto's disease; treated surgically by total thyroidectomy, at a distance of over four years it did not show signs of recurrence. Consideration is also given to pathogenetic and clinical problems, as well as those of surgical therapy, which such a combination between autoimmune thyroditis and a neoplastic process may raise.

Aged↗
PubMedDate not supplied

[A clinico-pathological study of so-called "acute multiple sclerosis" mimicking a brain tumor on the MRI findings].

We are reporting an autopsy case of so-called "acute multiple sclerosis" that was difficult to differentiate from a brain tumor on MRI findings. This case was a 69-year-old man, whose initial symptoms consisted of headache and unsteadiness in walking. Neurological findings included mild ataxia of the left upper extremity and positive Romberg sign. T 2-weighted MRI showed high intensity areas in the posterior limb of the right internal capsule and white matter near the posterior horn of the right lateral ventricle. Although the headache improved, the unsteadiness was exacerbated and the patient became unable to keep standing. Psychiatric symptoms and left hemiparesis were added to the clinical picture. The following MRI proved expansion of the previous lesions and the diffusely enhanced lesion spreading into the contralateral side through the corpus callosum. Stereotaxic biopsy showed the perivascular accumulation of small lymphocytes and a large number of bizarre astrocytes. Primary brain malignant lymphoma was diagnosed and radiation therapy was carried out. However, he developed perforation of the intestinal tract and died. Autopsy findings revealed scattered and disseminated small lesions in the cerebral white matter and the corpus callosum. There were a large number of lipid-laden macrophages, no stainable myelin and preserved axis cylinders in those lesions. Thus, those were interpreted as demyelinting lesions. They were scattered and multiple. This case was radiologically characterised by the diffusely enhanced, expanding butterfly-shaped lesion in bilateral cerebral hemisphere through the corpus callosum, and pathologically proven to be acute demyelination associated with severe perivascular infiltration of inflammatory cells. Multiple sclerosis may mimic neoplastic processes as trans-callosal hyperplastic neuroimage on neuroimaging like the present case.

Acute Disease↗
PubMed1999

[The role of hyperbaric oxygen therapy in radiation-induced digestive disorders. 36 cases].

OBJECTIVES: Study the effect of hyperbaric oxygen on chronic irradiation induced digestive disorders. PATIENTS AND METHODS: A retrospective study was conducted in 36 patients (mean age 66 +/- 11 years) with chronic digestive tract necrosis which had developed a mean 42 months after irradiation therapy. Hyperbaric oxygen therapy was given a mean 17 months after symptom onset: failing healing (n = 9), rectal bleeding (n = 19), profuse diarrhea (n = 9), recurrent anal abscess (n = 1). The severity of the digestive tract radionecrosis was quantified using the Soma-Lent scale. Hyperbaric oxygen therapy was grade 1 (n = 1), grade 2 (n = 11), grade 3 (n = 16), grade 4 (n = 8). RESULTS: Thirty-six patients underwent a mean 67 hyperbaric sessions (100% O2, 2.5 atm, 90 min). Three patients died within one month of the first session due to radiation enteritis, a neoplastic process or another concomitant cause. Immediate outcome after hyperbaric oxygen therapy was cure (n = 3) or improvement (n = 16) in 19 patients (53%) and failure in 17 (47%). Long-term results evaluated in 32 subjects with a mean 52 months follow-up were: cure (n = 9) or improvement (n = 12) in 21 patients (66%) and failure in 11 (34%). Nine patients died within a mean 25 months after the end of the hyperbaric sessions. Death was related to digestive tract radionecrosis in 1 case and neoplasia in 5. CONCLUSION: Hyperbaric oxygen therapy provides clinical relief in 2 out of 3 patients and can be a useful alternative to conventional treatment in patients with chronic radiation-induced necrosis of the digestive tract.

Aged↗
PubMed1999

Issues in cytologic screening and evaluation.

A variety of cytologic specimens may be useful in the screening and evaluation of patients for neoplastic processes. Fine needle aspiration cytology is an example of a cost-effective procedure for mass lesions and may provide a definitive diagnosis for treatment purposes. The sensitivity of a single cytologic procedure varies from 70% to more than 90% depending on specimen type and procurement methods. Communication with the laboratory, including provision of clinical information, is important to ensure proper specimen submission and handling and will also clarify cytologic terminology and appropriate follow-up measures.

Biopsy, Needle↗
PubMedDate not supplied

[Gastric carcinomas of the "bare area". Their anatomo-surgical definition and proposal of an en bloc total gastrectomy].

INTRODUCTION: Regarding the surgical treatment, carcinomas of the gastric proximal third and cardia are considered as an uniform problem. Particularly no difference exists between the gastric tumors of the anterior wall and those of the posterior wall. Nevertheless, cancers of the posterior wall of the proximal third are more difficult to cure and therefore less success has been achieved than with those of the anterior wall. The cause of this different behaviour must consist in an anatomical characteristic, the fact that the posterior wall of the fundus and subcardial portion is not covered by the visceral peritoneum ("bare area"). MATERIAL AND METHODS: Our study group consisted of 22 patients who presented carcinoma of the stomach risen in the area without peritoneal lining. Our treatment of this condition consisted of an operational procedure wherein we removed en bloc the stomach, left pancreas, spleen, and lymph nodes of the compartment I, II and III. In each case we considered the pathological situation, the involvement of the retroperitoneal structures and the condition of the lymph nodes in the compartment III specially, and actuarial statistics. RESULTS: We divided the 22 patients in 4 groups based on the neoplastic involvement of the retroperitoneum. Only in 3 cases (14%) of group 1 the cancer invasion was limited to the gastric muscular layer. In all of the rest, tumor involved the retroperitoneal structures. Postoperative mortality rate was 9%. The five year survival rate was 100% in the 3 cases of group 1 only and 10.5% in all other cases. DISCUSSION: The results show that carcinomas of the "bare area" cause a real jump in the degree of severity of the biological neoplastic process and hence of the prognostic evaluation. When the growth involves the gastric muscular layer, it indicates invasion of the retroperitoneum. Therefore, as with surgical treatment of esophageal carcinoma with the en bloc esophagectomy, we propose an en bloc total gastrectomy which should be performed in every carcinoma arising in the "bare area" because it allows more radical removal than can be obtained from traditional surgical procedures, without risking an increased mortality rate.

Esophagectomy↗
PubMedDate not supplied

Different gastritis features are linked to different gastric neoplasms.

OBJECTIVES: Helicobacter pylori infection induces gastritis, which may evolve to carcinoma or lymphoma. Whether duration of infection and inflammation pattern determine the outcome of the neoplastic process is not known. The aim of this study was to investigate the features of the gastritis associated with neoplasia. METHODS: Gastritis found in association with carcinoma (100 cases) and lymphoma (45 cases) were graded using the Sydney system. RESULTS: In particular in the antrum, gastric carcinomas, in particular of the intestinal type, were associated with a chronic (94%, n = 34/36) atrophic (92%, n = 33/36) gastritis and intestinal metaplasia (81%, n = 29/36). In diffuse type carcinomas inflammation was either absent or mild. An active (64%, n = 16/25), chronic gastritis (100%, n = 25/25) with lymphoid hyperplasia (72%, n = 18/25) was found in marginal zone cell lymphoma. CONCLUSIONS: Our study shows that the (pre)atrophic phases of inflammation are associated with gastric carcinomas. In contrast the active phase of inflammation, characterized by severe activity as well as severe chronicity, is found next to marginal zone cell lymphoma.

Adult↗