Subdiaphragmatic stage I & II Hodgkin's disease: long-term follow-up and prognostic factors

PURPOSE

To report long-term follow-up results and to analyze prognostic factors for overall and disease-free survival in patients with subdiaphragmatic Stage I & II Hodgkin's disease.

METHODS AND MATERIALS

From September 1962 to April 1995, 109 patients presented at the M. D. Anderson Cancer Center with subdiaphragmatic Hodgkin's disease. The medical records of these patients were retrospectively reviewed; 22 patients who received no treatment at the M. D. Anderson Cancer Center or who had radiation therapy at other institutions were excluded. The remaining 87 patients formed the basis of this study. The median age of our group was 33 years with a male: female ratio of 3.3:1. The histological subtypes were nodular sclerosis in 21 (24.1%) patients, mixed cellularity in 31 (35.6%), lymphocyte predominance in 33 (37.9%), lymphocyte depletion in 1 (1.1%) and unclassified histology in 1 (1.1%). Of the patients, 32 (36.8%) underwent laparotomy for diagnosis or staging purpose, 74 (85.1%) had lymphangiography, and 35 (40.2%) had computerized tomography of the abdomen and pelvis. Among the patients, 22 (25%) had more than three sites of nodal involvement at presentation, 56 (64.4%) had pelvic or abdominal disease, and 14 (18.4%) had bulky disease that was defined as disease with the largest dimension > or = 7 cm. Stage distribution was IA in 33.3%, IIA in 39.1%, and IIB in 27.6%. Treatment was radiotherapy alone in 60 (69%) patients, chemotherapy and radiation in 23 (26.4%), and chemotherapy alone in 4 (4.6%).

RESULTS

The 10- and 20-year actuarial overall survival rates for all patients were 74.6% and 55.3%, and the corresponding disease-free survival rates were 72.4% and 67.5%, respectively. On univariate analysis, age > 40 years, B symptoms, nodular sclerosis or mixed cellularity histology, and decreased albumin or hemoglobin levels were statistically significant adverse pretreatment factors for overall survival. B symptoms, decreased albumin level, more than 3 sites of disease at presentation, and Stage II were statistically significant negative pretreatment prognostic factors for disease-free survival. Only B symptoms and decreased albumin level predicted worse outcome in both overall and disease-free survivals. On multivariate analysis, age > 40 years, nodular sclerosis and mixed cellularity histology, and decreased hemoglobin levels were three independent risk factors for overall survival. An analysis of the pattern of failure revealed that the majority of the patients with central Stage II disease who did not receive mantle radiation failed in the supradiaphragmatic area. Late complications of radiation were infrequent.

CONCLUSIONS

Long-term follow-up of this group of patients revealed similar overall and disease-free long-term survival, as would be expected from supradiaphragmatic Hodgkin's disease. For patients with central Stage II disease, it is anticipated that supradiaphragmatic radiation therapy would improve the disease-free survival.

[Morphologic changes of red blood cells in various conditions under scanning electron microscope]

To study the changes of RBC in various conditions, blood clots elapsed 6 days in water and air and bloodstains stored in variant time were observed under Scanning Electron Microscope (SEM). The results showed that the morphology of RBC elapsed 6 days in water and air seemed to retain their integrity. They were measured 5, 48-5, 88 microns in diameter, whereas the RBC in the bloodstains stored 14 years were obviously disfigured and some appeared membrane cracking. However, the structure of RBC membrane was well recognized under the SEM. The morphological changes under the SEM and the forensic significance of the RBC were discussed.

[The effects of Chinese medicine herb mixture on cell-mediated immune functions and four kinds of acute-phase reaction proteins in burn patients]

OBJECTIVE

To search for immunomodulators to improve postburn immune function disorder.

METHOD

We studied the Chinese medicinal herbs. On the basis of previous data, we prepared a kind of Chinese medicinal herbal mixture and studied its effects in vivo and in vitro.

RESULT

The mixture could restore the cell-mediated immune response such as the production of interleukin 2 and the T cell proliferative ability, and could also adjust the levels of serum acute-phase reaction proteins, i.e, haptoglobin, prealbumin, transferrin and alpha 1-acid glycoprotein.

CONCLUSION

The Chinese herbal mixture showed immune regulatory effects on body defence imbalance and also on acute phase reaction proteins in burn patients.

[Quantitive analysis of 5-hydroxytryptamine levels on edges of incised skin of rats]

To find index for early diagnosis of antemortem wound, the authors used the ICS analysis in a quantitive study of 5-hydroxytryptamine(5-HT) levels on rat's incised-skin antemortem wound in comparison with the postmortem wound inficted at various intervals. The results showed that the 5-HT increased significantly at 5 min, reached a peak at 15 min and decreased at 60 min on antemortem wounds. The 5-HT levels of antemortem groups were prominently high (more than 40%, P < 0.05) as compared with those of postmortem group and the levels of 5-HT on the wounds of postmortem groups were higher (35.77%, P < 0.05) than those of controls as well. The authors suggest that in the cases where the levels of 5-HT are as high as 40% on the edges of the injured skin, the injury should be considered an antemortem wound.

Lymphocytes produce IL-1beta in response to Fcgamma receptor cross-linking: effects on parenchymal cell IL-8 release

Neutrophils mediate tissue injury in response to immune complexes, although the factors that induce their recruitment are incompletely understood. We have reported that lymphocytes may be important regulators of monocyte and macrophage IL-8 release in the presence of immobilized IgG. Since tissue parenchymal cells are important local producers of IL-8 but are not directly stimulated by FcgammaR cross-linking, we hypothesized that lymphocytes may also regulate parenchymal IL-8 release. Supernatants from lymphocytes incubated on immobilized IgG induced primary human fibroblasts and human mesangial cells to produce IL-8 (17 +/- 3.5 and 44 +/- 8 ng/ml, respectively). Fibroblast and mesangial cell IL-8 mRNA levels were similarly increased by the conditioned lymphocyte supernatant. Immobilized anti-human FcgammaRIII, but not FcgammaRI or FcgammaRII Abs, could stimulate this IL-8-inducing activity in lymphocytes, suggesting that FcgammaRIII-bearing lymphocytes were responsible. Supernatants from lymphocytes incubated on immobilized IgG contained 2.2 +/- 0.8 ng/ml of IL-1beta, while enriched monocyte preparations from the same donors incubated on immobilized IgG released only 0.1 +/- 0.04 ng/ml of IL-1beta (p = 0.05). Consistent with the identification of IL-1beta as the lymphocyte factor, fibroblast or mesangial cell IL-8 release induced by the IgG-stimulated lymphocyte supernatants was inhibited by 1) the combination of IL-1R antagonist and soluble type II IL-1R, 2) an IL-1-converting enzyme inhibitor, or 3) anti-IL-1beta but not preimmune Abs. These data suggest that targeted deposits of IgG can stimulate FcgammaRIII-bearing lymphocytes to produce IL-1beta, which induces parenchymal cell IL-8 release.

[A retrospective study of neurogenic pulmonary edema following intracranial injury without open wound]

To find factors that relate to the occurrence of neurogenic pulmonary edema(NPE) following intracranial injury without open wound, thirty-founr autopsies on such cases were studied retrospectively. The rate of NPE in the 34 cases was 41.18%, and it was 44.44% in those aged 10 to 49. The rate of NPE in the persons who died immediately or 0-6 hours after injury was 41.18%, and in those who died 7-48 hours after injury, 41.18% too. The rate of NPE was 69.23% for the cases with only one site of bleeding and 23.81% for ones with multiple sites of bleeding. These findings suggest that the occurrence of NPE is not related with the duration of time after head injury or the location of brain injury, but it is related with the severity of brain injury.

[Study on diagnostic value of analyzing argyrophilic nucleolar organizer regions in benign and malignant pleural effusions]

OBJECTIVE

To evaluate the diagnostic value of argyrophilic nucleolar organizer regions (AgNOR) measurement in benign and malignant pleural effusions.

METHODS

Pleural effusions from 50 patients with proven malignant disease, 30 patients with benign disease were studied using the one-step silver staining method. Six cytologically atypical samples were also included in this study.

RESULTS

The mean AgNOR count in malignant cells was significantly higher than that in benign mesothelial cells (7.6 +/- 1.4 vs 2.3 +/- 0.7, P < 0.01). The morphological features of AgNOR in malignant cells were mainly of diffuse type (80%), while in benign mesothelial cells, mainly of nucleolar type (90%). Among the six cytologically atypical samples, four were in the malignant range, two were in the benign limits, and these were proved by histopathology.

CONCLUSION

AgNOR study may be useful in differential diagnosis of benign and malignant pleural effusions.

[Analysis and prevention of road traffic fatalities in Sichuan Province]

This is an epidemiological survey of the fatalities from road traffic accidents in Sichuan. All fatal accidents that occurred in Sichuan from January 1994 to December 1994 were analysed. The mortalities per million kilometers of vehicle travel, per 100,000 registered motor vehicles and per 100,000 resident population were 4.35, 42.41 and 3.92 respectively. These figures were compared with international death rates and those reported by other countries. The results showed that Sichuan had higher mortalities per million kilometers of vehicle travel and per 100,000 registered vehicles but lower mortality per 100,000 resident population, compared with some industrialized and rich develeping countries. The majority of the victims were males aged 21 to 40. Road traffic fatalities constituted the leading cause of all accident deaths. The cost of road accidents in Sichuan was estimated to be sixty million Yuan. Further strategies and methods to minimize the rate of such accidents have been suggested.

[Computer simulation of system controlling--application to designing of anti-shock resuscitation therapy for burn injured patient]

The computer simulation of aim-controlling of changes in the circulative plasma volume, plasma protein concentration, hematocrit and electrolytes for five burn injured patients during their shock phase was carried out by using back-propagation algorithm of the simulation system. Based on the aim-controlling, the better resuscitation therapy protocol for the patient was given by computer. The clinical application in five cases of the burns showed that the new method helped us to make individualized clinical anti-shock resuscitation formula for the burn injured patient more reasonable.

[Application of gas chromatography to identification of Clostridium difficile]

With chromatograph produced in our country, the gas chromatograms of fatty acid metabolites of five strains of Clostridium difficile isolated from stool of patients with tumor and one strain for control were compared and analysed by using stainless steel chromatographic column, 15% modified polyethylene glycol stationary phase nitrogen carriergas 140 degrees C column temperature and 190 degrees C detector temperature. The chromatograms of the isolated strains and the control strain were found to be extremely similar. All of them were peaks of acetic, propionic, isobutyric, butyric, isovaleric, valeric, and isocaproic acid. In comparison, the peaks of acetic, butyric, and isocaproic acid were higher, those of the isobutyric and isovaleric acid were medium and those of propionic and valeric acid were lower. Moreover, a low, flat peak appeared at 14th minute and was similar to that of p-cresol reported by Berg et al. The results of our experiment revealed that gas chromatography may be used as a simple, quick method for the identification of Clostridium difficile.

[A clinical study of correlation between ablation depth and corneal subepithelial haze after photorefractive keratectomy]

OBJECTIVE

To assess the correlation between excimer laser ablation depth and corneal subepithelial haze in correction of myopia.

METHODS

The results of 31 cases (62 eyes) of myopic anisometropia on whose both eyes photorefractive keratectomy (PRK) was performed at the same time were analyzed. The bilateral eyes of each patient were divided into two groups: The lower myopic eyes (-9.13 +/- 3.53 D) were in the control group and the higher myopic eyes (-14.10 +/- 4.17 D) in the treatment group. The follow-up periods were 6 to 12 months (mean, 10 months).

RESULTS

There is significant difference (P < 0.05) in the haze between the two groups after PRK.

CONCLUSION

The higher the correction of myopia, the more dangerous the occurrence of the haze following PRK.

Changes in mononuclear phagocyte microtubules after endotoxin stimulation. II. Changes in microtubule composition

Microtubules are integral components of the cytoskeleton of human cells and are composed of alpha- and beta-tubulin as well as a variable number of microtubule-associated proteins. In monocytes and macrophages, microtubules bind endotoxin and partly regulate endotoxin-induced inflammatory events such as cytokine production. Endotoxin causes a rapid alteration in monocyte microtubule stability. To characterize the effect of endotoxin on mononuclear phagocyte microtubule composition, Western blots and flow cytometry were performed on human monocytes and the monocyte/macrophage-like cell line THP-1. Compared to unstimulated monocytes, monocytes stimulated with endotoxin for 18 h had increased quantities of alpha-, beta-, and tyrosinated alpha-tubulin as well as microtubule-associated protein-2. PMA-differentiated THP-1 cells had increased levels of alpha-tubulin, beta-tubulin, microtubule-associated protein-5, microtubule-associated protein-2, and tau after endotoxin stimulation. These results indicate that endotoxin can alter mononuclear phagocyte microtubules by causing an increase in certain microtubule component proteins.

Changes in mononuclear phagocyte microtubules after endotoxin stimulation. I. Changes in microtubule stability

Microtubules are in a dynamic equilibrium of polymerization and depolymerization. In monocytes and macrophages, microtubules bind endotoxin and partly regulate inflammatory events such as cytokine production. To characterize the morphologic differences between alveolar macrophage and blood monocyte microtubules after LPS stimulation, cells were examined by immunofluorescent microscopy and laser confocal microscopy. Fresh monocytes contained an average of 26 microtubules per cell which significantly increased to 31 microtubules per cell following a 30-min exposure to LPS (P < 0.001). Using a nocodazole-based assay of microtubule dynamic instability, the half-life of fresh unstimulated human monocyte microtubules was approximately 18 s and extended to 26 s following a 30-min exposure to LPS. In vitro maturation of monocytes for 18 h increased microtubule stability but not number. Compared to monocytes, alveolar macrophage microtubules were longer, more numerous, and much more stable. These results suggest that alveolar macrophage microtubules are more numerous and stable than blood monocyte microtubules and that LPS causes an increase in monocyte microtubule number and stability.

Detection of IL-5 and IL-1 receptor antagonist in bronchoalveolar lavage fluid in acute eosinophilic pneumonia

BACKGROUND

Acute eosinophilic pneumonia is an idiopathic cause of respiratory failure, characterized by very high numbers of alveolar eosinophils without significant blood eosinophilia.

OBJECTIVE

The purpose of this study was to determine which cytokines are associated with acute eosinophilic pneumonia.

METHODS

Soluble IL-1 type II receptor and the cytokines IL-1 beta, IL-1ra, IL-3, IL-5, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor-alpha were measured in serum and in bronchoalveolar lavage fluid from two patients with acute eosinophilic pneumonia during both acute and convalescent phases.

RESULTS

Compared with patients with adult respiratory distress syndrome, the patients with acute eosinophilic pneumonia had high bronchoalveolar lavage fluid levels of IL-5, IL-1ra, and soluble type II IL-1 receptor but not IL-1 beta, tumor necrosis factor-alpha, IL-3, or granulocyte-macrophage colony-stimulating factor. Bronchoalveolar lavage fluid levels of IL-5 and IL-1ra fell after resolution of symptoms. In the serum of patients with acute eosinophilic pneumonia, IL-5 was not detectable, and IL-1ra was initially high but fell after corticosteroid treatment.

CONCLUSION

Acute eosinophilic pneumonia is characterized by locally high levels of IL-5, IL-1ra, and soluble type II IL-1 receptor in the alveolar space.

Facial casting as a method to help identify severely disfigured corpses

The authors apply a previously reported method for facial casting of severely disfigured corpses, which allowed a three-dimensional cast to be made. This method involved several stages: face restoration, casting by elastomer, then three-dimensional positive image building. This technique seems to be useful in all cases of severe disfiguration of the face, particularly by trauma.

The improved PAS-ELISA method for the diagnosis of the pathogen for banana mosaic heart rot disease

As a fast and practical immunological test, ELISA has been widely applied both in research and diagnosis of plant viruses [1]. In its research utility, PAS-ELISA has been proven as an effective measure to obtain CMV-free micropropagated plantlets. In large-scale micropropagation of banana plantlets, we have been using it in our Quality Control Department to prepare CMV-free and/or TMV-free germplasm. From large-scale testing, we have found that component(s) in banana tissue can cause a nonspecific reaction which severely interferes with the diagnostic results, making the average optical density (OD490nm) value a much higher false positive, leading to an abnormally high percentage loss of the germplasm prepared. The procedure for preparation of the antigen extract from banana tissue has been modified to eliminate the false positive.

[Statistical analysis of 4,547 burn patients and the mortality in different periods]

4,547 burn patients from 1983-1993 were reviewed by analysing the general data, mortality, and the causes of the death, and the mortality of 606 burn patients in different periods from 1958 to 1993. The purpose was to present some statistical and epidemiological data. The results showed: The incidence of burn injury in children, whose ages were less than 5 years, reached 36.2%, and the causes of burn was mainly thermal injury. The total mortality was 3.2%, and the main cause of the death was burn wound sepsis. No significant difference in the relationship between the mortality and the burn wound area was observed in these burn patients. In different age groups, the size of III degree burn, which accounted for higher mortality, was much different. The incidence of burn wound sepsis, which was the main cause of mortality, was on the increase, as the analysis of 606 burn patients in four different periods from 1958-1963 showed. In regard to the cure rate, the improvement had not been obvious since 1983.

Method for identifying putrefied corpses by facial casting

The authors developed an original method for casting the face of putrefied corpses, which allowed a three-dimensional facial cast of an individual to be made. This method used several stages: face restoration by subcutaneous injections of specific materials, casting by elastomer, then three-dimensional positive image building. This technique enabled the person to be recognized and then identified, and seems to be useful in such difficult cases.

Copper deficiency alters isomyosin types and levels of laminin, fibronectin and cytochrome c oxidase subunits from rat hearts

The relative amounts of cardiac proteins such as laminin, fibronectin, cytochrome c oxidase, and isomyosin types were studied by gel electrophoresis and Western blotting in control and copper-deficient Sprague-Dawley rats of both sexes fed their respective diets from weanling for 3 weeks. Isomyosin types appeared to shift from V1 to greater levels of V3 in copper deficient rats for both genders. Male copper deficient rats had increased cardiac levels of fibronectin, decreased laminin levels, cardiac hypertrophy and anemia. Both male and female rats fed copper-deficient diet had lower levels of cytochrome c oxidase (CCO) subunit IV, and low liver copper, and high heart-to-body weight ratios compared with their respective controls.

Decreased tobacco-glycoprotein-induced lymphocyte proliferation in vitro in pulmonary eosinophilic granuloma

Pulmonary eosinophilic granuloma is a disorder caused by localized collections of proliferating histiocytes in the lung. Little is known about its etiology except that the majority (58 to 97%) of patients are current or ex-smokers, making the potential etiologic role of tobacco products an important area for research. Tobacco glycoprotein (TGP) is a potent immunostimulator that has been isolated from cigarette smoke. TGP-specific lymphocyte proliferation, and cytokine production in vitro, were measured in three patients with pulmonary eosinophilic granuloma in remission and in three closely matched normal subjects with similar smoking histories. One patient with eosinophilic granuloma of bone and a matched control subject were also studied. Peripheral blood mononuclear cells were cultured with TGP, the recall antigen streptokinase (SK), and the mitogen concanavalin A (Con A). All three of the patients with pulmonary eosinophilic granuloma exhibited significant decreases in lymphocyte stimulation to TGP, despite normal responses to SK and Con A. In contrast, the response of the patient with eosinophilic granuloma of bone was higher than her matched control. The mean responses of the patients with pulmonary eosinophilic granuloma to TGP was significantly lower than the mean of nondiseased smokers or of normal nonsmokers. Twenty-four-hour culture supernatants were collected and assayed for cytokine levels (IL-1, IL-2, and IL-6). TGP-stimulated IL-2 production was significantly lower in the patients with pulmonary eosinophilic granuloma than in the normal subjects, confirming the reduced T-cell proliferative response.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective response of multiple myeloma to cyclosporin A

Two patients with advanced multiple myeloma were treated with oral low-dose cyclosporin A. one without other therapy and one in conjunction with chemotherapy to which the patient had been previously unresponsive. Both patients had objective laboratory and clinical responses. In the patient treated with cyclosporin A alone, decreasing serum IL-6 and beta-2-microglobulin levels fell as the clinical response evolved. Cyclosporin A deserves further evaluation in the therapy of multiple myeloma.

An experimental methodology for the study of postmortem changes in toxic concentrations of drugs, using secobarbital as an example

Postmortem changes in alcohol and drug concentrations are well known today. The authors used an HPLC assay of barbiturates in postmortem tissue, and developed a rat model in order to evidence postmortem changes in toxics concentrations. Postmortem changes in secobarbital concentrations were evidenced using a rat-secobarbital model. This work emphasizes the difficulty of postmortem toxicology, as concentrations found at the time of autopsy may be different from concentrations at the time of death.

A study on superoxide dismutase activity of some model compounds

The synthesis and characteristics of a binuclear ligand N,N,N',N'-tetrakis (2'-benzimidazolyl methyl)-1,4-diethylene amino glycol ether (EGTB) and its series of coordination compounds containing copper(II), iron(III), and manganese(II) with and without exogenous bridging ligand which was imidazolate ion (Im-), bipyridine (bpy), or 1,10-phenanthroline (phen) are reported. Depending on the redox potentials by cyclic voltammetry, the coordination compounds can act as catalysts for the dismutation of superoxide radicals (O2-). The detection of the rate constant of the reaction of superoxide ion with nitroblue tetrazolium (NBT) which is inhibited by superoxide dismutase (SOD) and its model compounds of the EGTB system has been performed by a modified illumination method. The rate constants kQ of the catalytic dismutation have been obtained.

Increased urine interleukin-1 levels in aging

Our laboratory previously noted an increase in thymocyte mitogenic activity in the urine of many elderly patients. The present study was performed to verify this finding and to determine if this activity was actually due to an increase in interleukin-1 (IL-1). IL-1 levels were measured in the urine of 33 healthy, ambulatory, elderly subjects (ages 83-95 years), using both a murine thymocyte bioassay, measuring activation by the incorporation of tritiated thymidine and an MTT dye reduction assay. There was a significant increase in urine IL-1 in 85% of elderly individuals. In the MTT dye reduction assay, mean elderly urine IL-1 levels were 0.88 U/ml, in comparison with a young control group (ages 23-37 years) in which urine IL-1 levels were very low (mean IL-1 < or = 0.05 U/ml). Urine levels of IL-1 beta were also measured by using a sensitive immunoassay (ELISA) and were found to be significantly increased in the elderly (mean = 57.4 pg/ml), compared to the young (mean = 2.5 pg/ml). In contrast, IL-2 levels in urine were very low, with no difference between the young and the elderly. Mean urine protein and creatinine levels did not differ significantly between young and old, and did not account for the increase in urine IL-1 levels. Although its immunologic significance is not yet understood, this striking increase in IL-1 is an unusual and interesting finding that merits further investigation.

Effects of low copper intake on dimethylhydrazine-induced colon cancer in rats

Rats fed low copper show a high incidence of dimethylhydrazine (DMH)-induced colon tumors compared with rats fed very high Cu. The difference could be due to Cu deficiency in the low group or to Cu toxicity in the high group. In the present study, rats fed low Cu (0.2 ppm) showed greater DMH-stimulated colon tumorigenesis than rats fed adequate Cu (8 ppm). Differences were seen in the number of rats developing tumors (5 of 11 vs 1 of 10), total tumors (7 vs 2), and average tumor mass (1.02 g vs 0.29 g). Low Cu intake did not cause any general DMH toxicity as assessed by body weight gain. To prevent Cu deficiency-induced mortality, low Cu feeding was begun in postweanling rats (weight, about 80 g) housed in groups of five to six, rather than individually. This limited the effects of low Cu feeding to only a moderate Cu deficiency based on several parameters, including three Cu antioxidant enzyme activities. Group-housed rats fed marginal Cu levels (2.5 ppm) showed normal Cu status, and DMH produced only one tumor in 10 rats. In conclusion, high DMH-induced colon tumorigenesis can be found in rats with low activities of Cu antioxidant enzymes.