Hodgkin's disease in patients with antibodies to human immunodeficiency virus. A study of 22 patients

The experience of 22 Hodgkin's disease (HD) patients with human immunodeficiency virus type I (HIV) antibodies, collected from a cooperative study of six hospitals during 1984-1989 is presented. Young men (average age, 27.6 years) with a high incidence of intravenous drug abuse (86%) were found. The status of the HIV infection at diagnosis of HD was: four patients, acquired immune deficiency syndrome (AIDS); eight patients, persistent generalized lymphadenopathy (PGL); and ten patients, asymptomatic. The natural history of HD was unusual, with a high incidence of B symptoms (81%), advanced Stages III to IV (90%), bone marrow invasion (50%), cytopenias before treatment (45%), opportunistic infections (68%), and aggressive histologies. A decreased response to chemotherapy with poor marrow tolerance and a significant decrease in survival, 18 months, was observed. The AIDS and cytopenias pretreatment were associated with a shorter statistically significant survival, which defines the importance of immunodeficiency in HD prognosis. Complete remission after treatment was a factor that contributed to a longer statistically significant survival. The PGL or asymptomatic patients survived longer but also had a poor course, and five of them had AIDS criteria during evolution. A high incidence of HD in relation to non-Hodgkin's lymphoma (NHL) in patients with HIV infection in the six cooperating hospitals was found. Criteria for considering HD as an AIDS-associated lymphoproliferative disease in our environment are discussed.

Bone marrow biopsy in myelodysplastic syndromes: morphological characteristics and contribution to the study of prognostic factors

Ten characteristics of bone marrow (BM) biopsies in paraffin sections, obtained at diagnosis from patients with myelodysplastic syndromes (MDS) classified according to the FAB criteria, were analysed to identify both the most relevant morphologic data and any possible influence on survival. Agreement between two observers was obtained for 94% of the data. BM cellularity was increased in 63% of the cases and was higher in refractory anaemia with excess of blasts (RAEB). RAEB in transformation (RAEB-t) and chronic myelomonocytic leukaemia (CMML) (P = 0.001). Dysmegakaryopoiesis and dyserythropoiesis were present respectively in 83% and 72% of the cases, with slight differences among the FAB subtypes. Abnormal localization of immature precursors (ALIP) was found in more than half of the cases and somewhat more frequently seen in the RAEB + RAEB-t + CMML group (P = 0.07). Eosinophilia, plasmacytosis and reticulin fibrosis were evident in 26%, 18% and 47% of the cases respectively. Cellularity (P = 0.006), eosinophilia (P = 0.009) and, to some extent, dysmegakaryopoiesis (P = 0.07) bore a certain relationship with survival on univariate analysis. The presence of ALIP was not seen to affect the outcome. Multivariate analysis showed that the cellularity and presence of dysmegakaryopoiesis, in BM biopsy, added significant independent prognostic information to that achieved with age, platelet count and proportion of blast cells in BM aspirate, three variables with proven prognostic value in MDS patients. Using a regression model including these five characteristics we have stratified the patients into low, intermediate and high-risk groups with different survivals (P = 0.00001). The present findings show that BM biopsy is able to provide both morphological characteristics and information about the prognosis of survival, and should thus be included in the initial evaluation of MDS.

Fatal left ventricular perforation during mitral balloon valvoplasty

Percutaneous balloon dilation of left-sided cardiac valves is being performed with increasing frequency. We describe and document the mechanism of injury of left ventricular perforation during mitral balloon valvoplasty. Despite a technically successful surgical repair with hemodynamic restoration, the patient was brain dead. We emphasize (1) the risk and the potentially catastrophic nature of left ventricular perforation during mitral balloon valvoplasty and (2) the need for surgical standby and rapid operative decompression for this complication.

Image deconvolution by a logarithmic/exponential nonlinear joint transform process

We present a nonlinear joint transform processor that uses logarithmic and exponential nonlinearities at the Fourier plane to remove the amplitude distortion effects of a smearing function. The smeared image and the blur function are displayed side by side at the input plane of the system. The exact Fourier phase of the original image is restored in the joint power spectrum from the product of the Fourier transform of the smeared image with the complex conjugate of the Fourier transform of the smearing function. The Fourier amplitude of the original image is recovered by applying the logarithmic nonlinearity to both the joint power spectrum of the smeared image and the blur function, and the Fourier spectrum of the blur function. The amplitude distortion of the joint power spectrum is then removed by subtracting the log of the Fourier spectrum of the blur function from the log of the joint power spectrum. An exponential nonlinearity is then applied to the output of the logarithmic subtraction to implement an inverse logarithmic operation and to recover the Fourier amplitude. An inverse Fourier transform operation will yield the unsmeared image at the output plane of the processor. An analysis of the logarithmic/exponential nonlinear signal processor for image deconvolution is presented. Computer simulation is presented to investigate the performance of the nonlinear processor for a linearly smeared image.

Modification of immune response by coats of Myxococcus xanthus myxospores

Treatment with coats of M. xanthus myxospores produced a marked modificatory effect on humoral response, depending on the inoculation model. Also we observed that the percentage of adherent phagocytes and phagocytic index were enhanced after treatment. These results were similar to the effect obtained by M. xanthus myxospores. Data showed that the immune response modifier properties of M. xanthus myxospores are principally present in the coats.

Drosophila Sgs3 TATA: effects of point mutations on expression in vivo and protein binding in vitro with staged nuclear extracts

The Drosophila salivary gland secretion protein gene, Sgs3, has a consensus TATA sequence and gives rise to abundant stage and tissue-specific transcripts. Two TATA point mutations (TAAA and TAGA) reduce transcript levels approximately 50-fold when assayed in transgenic flies. This effect is reflected in vitro, in DNase I footprint and gel retardation assays where we observed TATA-probe-specific complexes that are not seen with TAAA, TAGA or non-specific probes. The binding patterns observed when using nuclear extracts from 0-2- and 0-20-h embryos (Sgs3 inactive) differ from those seen with extracts from third instar salivary glands (Sgs3 active). There are also differences in in vitro binding when using an hsp70 TATA fragment, previously shown to substitute in vivo for the Sgs3 TATA sequence, as probe. Together these observations suggest the possibility that more than one TATA box factor may be present in these extracts. We conclude that a wild-type TATA motif is crucial for the binding of a TATA box factor and all subsequent interactions with other factors bound to the proximal and distal regulatory sequences that are necessary for the normal expression of Sgs3.

[Transitional infiltrating carcinoma of the bladder. Local recurrence and metastases. Analysis of 175 cases treated with radical cystectomy]

Although much has been written on transitional cell carcinoma of the bladder, little has been reported on its metastasis. We reviewed the records of 175 patients, 4 of whom died postoperatively. All patients had been followed until their death and the surviving patients recently evaluated. Sixteen patients were lost after a long follow-up. Most of the metastases were diagnosed within 18 months after the cystectomy. Sixty-one percent of the patients presented bony metastases. The risk of metastasis is greater for sessile tumors, and increases with the degree of vesical wall infiltration, anaplasia and lymph node involvement. Evidence of lymph node involvement is not necessary for metastasis to exist. There were significantly fewer patients who died with metastasis in the patient group that did not receive preoperative radiotherapy in comparison with the other two patient groups. Of the 11 patients who revealed no evidence of tumor in the surgical specimen, 2 metastasized, indicating that metastasis was present prior to cystectomy. Treatment with cytostatic agents is the only effective therapy against distant metastasis. In our view, all patients with a tumor invading perivesical fat or who present lymph node involvement, regardless of tumor stage, should receive chemotherapy after cystectomy as early as patient condition permits.

[Transitional infiltrating carcinoma of the bladder significant in its spread to regional lymph nodes]

We analyzed the course of 170 patients, 136 of whom underwent bilateral lymphadenectomy. Data was obtained to define N of the TNM classification in 126 patients. The remaining patients (10 whose pathologic work-up was unavailable; 32 who did not undergo lymphadenectomy) were classified as Nx. Metastasis was diagnosed during follow-up in 60% of those with positive lymph nodes. In our view, metastasis was already present in these patients prior to the surgical procedure. The survival rate is significantly higher for the patient group without lymphatic spread compared to the group with negative lymph nodes and Nx. Evaluation of the patient group without lymphatic spread revealed a higher survivorship for those who received 2,000 rads (24%) prior to cystectomy compared to those who received 4,500 rads (17%) and those who received no irradiation (12%). However, there is a lower incidence of metastasis for the patient group submitted to surgery alone (50%) compared to those that received preoperative radiotherapy (73% and 67% for those treated with 2,000 and 4,500 rads, respectively). Furthermore, preoperative radiotherapy did not reduce the mortality rate which was 83% for those who received no radiotherapy, 73% for those who received 2,000 rads, and 75% for those who received 4,500 rads. However, it may seem contradictory that a radiation dose of 2,000 rads appears to be more effective in these patients than a dose of 4,500 rads which is theoretically closer to the ideal dose for treatment of node involvement. Patients with positive lymph nodes must be treated with chemotherapy as soon as they have recovered from the surgical procedure since 3 out of 5 patients have undetected micrometastases.

[Infiltrating transitional carcinoma of the bladder. Is the P/T ratio a reliable index to evaluate the effectiveness of preoperative radiotherapy on tumors of the bladder?]

To determine the efficacy of preoperative radiotherapy, we used the following index: change in the clinical relative to the pathological state. We analyzed the series of our department, which was comprised of 175 patients who had undergone radical cystectomy. The P/T ratio was obtained in 138; it dropped in 26 (19%), remained unchanged in 57 (41.3%), and increased in 55 (40%). Analysis of the disease-free interval and survival by Kaplan and Meier's method showed a significantly higher difference for the patient groups with tumor Po + P less than T and P = T than for those with P greater than T, and there were no significant differences between the Po + P less than T and P = T patient groups. However, analysis of the TLE and survival curves for group P = T by comparing the three treatment regimens utilized showed no evidence that preoperative radiotherapy prolongs both parameters. The same finding was observed for the group whose P was greater than T. Evidently, prognosis is good for the group whose P dropped. However, we do not believe that it is ascribably to the beneficial effects of radiotherapy on the tumor. We believe that this is mainly due to the fact that, by definition, patients with more aggressive tumors are excluded. In our series, P3 and P4 tumors are classed under the groups whose P is "equal to" or "greater than".

Induction and repression of the Drosophila Sgs-3 glue gene are mediated by distinct sequences in the proximal promoter

The normal developmental expression of the Drosophila salivary gland secretion protein gene Sgs-3 requires the interaction of a distal and proximal regulatory element. A deletion/replacement analysis of the proximal promoter in stably transformed lines shows that induction of an Sgs-3/Adh fusion gene is normal if sequences from +10 to -50 are replaced by those of the hsp70 gene. Sequences between -98 and -50 are necessary for this expression but there is internal redundancy within this region as two distinct upstream sequences of 18 and 22 bp respectively are sufficient for stage- and tissue-specific expression, albeit at reduced levels. A point mutation at -53 eliminates the ecdysone-mediated repression of the Sgs-3 promoter at pupariation. We report mosaicisms of expression within the salivary gland for a number of stably transformed lines.

Regulatory elements and interactions in the Drosophila 68C glue gene cluster

We reviewed studies on the developmental regulation of the 68C glue gene cluster of Drosophila melanogaster. Extensive transformation analyses of Sgs-3 have shown that four regions necessary for normal expression can be distinguished. The first(+10 to -50) contains the transcription start site and TATA motif. This region can be replaced functionally by corresponding sequences from the hsp70 gene, but it is sensitive to point mutations in the TATA sequence. The second region (-50 to -98) contains more than one upstream sequence that, in combination with the other elements, leads to stage and tissue-specific expression. The third region (centered at -600) contains an element that enhances transcript levels some 20-fold. The final region (between -1.65 and -2.35 kb) contains elements having modest (twofold to threefold) effects on expression, one of which is contained in the coding sequences of Sgs-7, a second member of the cluster.

[Urologic symptoms as first clinical manifestation of tumors of the nervous system. Apropos of 2 cases]

Neurological tumor processes when involving urinary bladder organs or innervation, may give rise to urological symptoms. Depending on the organ or nerve tract affected, and whether such involvement leads to disturbances in the storing or emptying capacity of the bladder, the clinical signs manifested may be extremely varied, simulating different pathological entities that may lead to unnecessary treatment. Two such cases are presented. The symptoms produced and the difficulty in pinning down their origin are discussed. The relevance of urodynamic tests and a permanent attitude of suspicion are highlighted as a key approach to correct diagnosis.

Diaphragmatic elevation in stroke

We compared the relative elevations of the two diaphragms in the supine chest films of 62 patients with recent hemiparesis due to a supratentorial stroke with that of 92 acute coronary patients without neurologic disease. Patients with severe hemiparesis or lesions larger than 40 ml exhibited an excessive elevation of the diaphragm on the paretic side compared with controls. This finding was more common with lesions involving the genu of the internal capsule and/or the near anterolateral area. Measurement of the interdiaphragmatic elevation difference may give information on the location and/or size of the stroke.

Percutaneous double-balloon angioplasty of a stenotic modified Fontan aortic homograft conduit

A 28-year-old woman with pulmonary atresia underwent a modified Fontan procedure that utilized a valved aortic homograft; she developed stenosis of the distal anastomosis between the homograft and the pulmonary artery. Because of the increased risk of reoperation, balloon angioplasty of this stenotic lesion was performed successfully. In the subsequent 11 months she has remained asymptomatic. Balloon angioplasty was a successful alternative to reoperation in this patient.

A distinct congenital motor and sensory neuropathy (neuronal type) with dysmorphic features in a father and two sons. A variant of Charcot-Marie-Tooth disease

A 37-year-old male had clinical and electrophysiological features of hereditary motor and sensory neuropathy (neuronal type) with onset in infancy, as well as histological picture of neurogenic myopathy. Two sons, aged 2 and 3 4/12 years, showed congenital contraction deformities of feet, delayed motor development, and electrophysiological features similar to those of the father. All three also presented laryngeal abnormalities, peculiar facies, short neck, narrow shoulders and protruding chest. The authors conclude that this aggregate of anomalies constitutes a "new" syndrome probably due to an autosomal dominant gene.

Familial simple ectopia lentis. A probable autosomal recessive form

All three sibs from normal and unrelated parents had congenital ectopia lentis without extraocular abnormalities. This pedigree suggests an autosomal recessive form of simple ectopia lentis.