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Roos J, Loy T, Ploeger MM, Weinhold L, Schmid M, Mewes M, Prangenberg C, Gathen M. It is (not) always on Friday: inter-hospital patient transfers in orthopedic and trauma surgery. Eur J Trauma Emerg Surg 2023; 49:2605-2613. [PMID: 37599307 PMCID: PMC10728266 DOI: 10.1007/s00068-023-02335-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND While inter-hospital transfers for patients who have suffered major trauma have been well investigated, patient flows for other injured patients, or cases with orthopedic complications, are rarely described. This study aims to analyze the affected collective and to show possible reasons, patterns, and pitfalls to optimize the process in future. MATERIALS AND METHODS In a prospective cohort study, all consecutive transfers to a Level I trauma center in Germany were documented and assessed. Patients suffering a major trauma were excluded. Data on the primary treating hospital, patient characteristics, and differences between emergency and elective surgery were analyzed. RESULTS A total of 227 patients were included; 162 were injured, while 65 had suffered a complication after elective orthopedic surgery or had a complex orthopedic pathology. The most common diagnoses leading to transfer were pathologies of the extremities (n = 62), pathologies of the spine (n = 50), and infections (n = 18). The main reasons stated by the transferring hospitals were a lack of expertise (137 cases) and a lack of capacity (43 cases). There was a significantly higher rate of transfers due to trauma (n = 162) than for orthopedic patients (n = 65), p < 0.0001. CONCLUSION There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery.
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Affiliation(s)
- Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Thomas Loy
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Milena M Ploeger
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Leonie Weinhold
- Institute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Moritz Mewes
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christian Prangenberg
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Teo A, Tan HD, Loy T, Chia PY, Chua CLL. Correction: Understanding antibody-dependent enhancement in dengue: Are afucosylated IgG1s a concern? PLoS Pathog 2023; 19:e1011736. [PMID: 37851611 PMCID: PMC10584112 DOI: 10.1371/journal.ppat.1011736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.ppat.1011223.].
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Teo A, Tan HD, Loy T, Chia PY, Chua CLL. Understanding antibody-dependent enhancement in dengue: Are afucosylated IgG1s a concern? PLoS Pathog 2023; 19:e1011223. [PMID: 36996026 PMCID: PMC10062565 DOI: 10.1371/journal.ppat.1011223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Affiliation(s)
- Andrew Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Medicine, The Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Hao Dong Tan
- School of Biosciences, Faculty of Health and Medicine Sciences, Taylor’s University, Subang Jaya, Malaysia
| | - Thomas Loy
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Po Ying Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Caroline Lin Lin Chua
- School of Biosciences, Faculty of Health and Medicine Sciences, Taylor’s University, Subang Jaya, Malaysia
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Lim PY, Ramapraba A, Loy T, Rouers A, Thein TL, Leo YS, Burton DR, Fink K, Wang CI. A nonstructural protein 1 capture enzyme-linked immunosorbent assay specific for dengue viruses. PLoS One 2023; 18:e0285878. [PMID: 37200264 DOI: 10.1371/journal.pone.0285878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 05/03/2023] [Indexed: 05/20/2023] Open
Abstract
Dengue non-structural protein (NS1) is an important diagnostic marker during the acute phase of infection. Because NS1 is partially conserved across the flaviviruses, a highly specific DENV NS-1 diagnostic test is needed to differentiate dengue infection from Zika virus (ZIKV) infection. In this study, we characterized three newly isolated antibodies against NS1 (A2, D6 and D8) from a dengue-infected patient and a previously published human anti-NS1 antibody (Den3). All four antibodies recognized multimeric forms of NS1 from different serotypes. A2 bound to NS1 from DENV-1, -2, and -3, D6 bound to NS1 from DENV-1, -2, and -4, and D8 and Den3 interacted with NS1 from all four dengue serotypes. Using a competition ELISA, we found that A2 and D6 bound to overlapping epitopes on NS1 whereas D8 recognized an epitope distinct from A2 and D6. In addition, we developed a capture ELISA that specifically detected NS1 from dengue viruses, but not ZIKV, using Den3 as the capture antibody and D8 as the detecting antibody. This assay detected NS1 from all the tested dengue virus strains and dengue-infected patients. In conclusion, we established a dengue-specific capture ELISA using human antibodies against NS1. This assay has the potential to be developed as a point-of-care diagnostic tool.
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Affiliation(s)
- Pei-Yin Lim
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Appanna Ramapraba
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Thomas Loy
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Angeline Rouers
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Tun-Linn Thein
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Dennis R Burton
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, United States of America
| | - Katja Fink
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Cheng-I Wang
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
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5
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Rouers A, Chng MHY, Lee B, Rajapakse MP, Kaur K, Toh YX, Sathiakumar D, Loy T, Thein TL, Lim VW, Singhal A, Yeo TW, Leo YS, Vora KA, Casimiro D, Lim B, Tucker-Kellogg L, Rivino L, Newell EW, Fink K. Immune cell phenotypes associated with disease severity and long-term neutralizing antibody titers after natural dengue virus infection. Cell Rep Med 2021; 2:100278. [PMID: 34095880 PMCID: PMC8149372 DOI: 10.1016/j.xcrm.2021.100278] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
Prior immunological exposure to dengue virus can be both protective and disease-enhancing during subsequent infections with different dengue virus serotypes. We provide here a systematic, longitudinal analysis of B cell, T cell, and antibody responses in the same patients. Antibody responses as well as T and B cell activation differentiate primary from secondary responses. Hospitalization is associated with lower frequencies of activated, terminally differentiated T cells and higher percentages of effector memory CD4 T cells. Patients with more severe disease tend to have higher percentages of plasmablasts. This does not translate into long-term antibody titers, since neutralizing titers after 6 months correlate with percentages of specific memory B cells, but not with acute plasmablast activation. Overall, our unbiased analysis reveals associations between cellular profiles and disease severity, opening opportunities to study immunopathology in dengue disease and the potential predictive value of these parameters.
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Affiliation(s)
- Angeline Rouers
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- A∗STAR ID Labs, Agency for Science, Technology and Research, Singapore 138468, Singapore
| | - Melissa Hui Yen Chng
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Menaka P. Rajapakse
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Kaval Kaur
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Ying Xiu Toh
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Durgalakshmi Sathiakumar
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Thomas Loy
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- A∗STAR ID Labs, Agency for Science, Technology and Research, Singapore 138468, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore
| | - Tun-Linn Thein
- National Centre for Infectious Diseases, Singapore 308442, Singapore
| | - Vanessa W.X. Lim
- National Centre for Infectious Diseases, Singapore 308442, Singapore
| | - Amit Singhal
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- A∗STAR ID Labs, Agency for Science, Technology and Research, Singapore 138468, Singapore
- Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Singapore 308232, Singapore
- Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore 308442, Singapore
- Lee Kong Chian School of Medicine, Singapore 308232, Singapore
- Tan Tock Seng Hospital, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, Singapore 119228, Singapore
- Saw Swee Hock School of Public Health, Singapore 117549, Singapore
| | - Kalpit A. Vora
- Department of Infectious Diseases and Vaccines Research, Merck, Kenilworth, NJ, USA
| | - Danilo Casimiro
- Department of Infectious Diseases and Vaccines Research, Merck, Kenilworth, NJ, USA
| | - Bing Lim
- Merck Sharp & Dohme Translational Medicine Research Centre, 8A Biomedical Grove, Singapore 138648, Singapore
| | - Lisa Tucker-Kellogg
- Cancer and Stem Cell Biology, and Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Laura Rivino
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore 169857, Singapore
- School of Cellular and Molecular Medicine, University of Bristol, Bristol BS8 1TD, UK
| | - Evan W. Newell
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Katja Fink
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- Corresponding author
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Zhang S, Loy T, Ng TS, Lim XN, Chew SYV, Tan TY, Xu M, Kostyuchenko VA, Tukijan F, Shi J, Fink K, Lok SM. A Human Antibody Neutralizes Different Flaviviruses by Using Different Mechanisms. Cell Rep 2021; 31:107584. [PMID: 32348755 DOI: 10.1016/j.celrep.2020.107584] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/25/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022] Open
Abstract
Human antibody SIgN-3C neutralizes dengue virus (DENV) and Zika virus (ZIKV) differently. DENV:SIgN-3C Fab and ZIKV:SIgN-3C Fab cryoelectron microscopy (cryo-EM) complex structures show Fabs crosslink E protein dimers at extracellular pH 8.0 condition and also when further incubated at acidic endosomal conditions (pH 8.0-6.5). We observe Fab binding to DENV (pH 8.0-5.0) prevents virus fusion, and the number of bound Fabs increase (from 120 to 180). For ZIKV, although there are already 180 copies of Fab at pH 8.0, virus structural changes at pH 5.0 are not inhibited. The immunoglobulin G (IgG):DENV structure at pH 8.0 shows both Fab arms bind to epitopes around the 2-fold vertex. On ZIKV, an additional Fab around the 5-fold vertex at pH 8.0 suggests one IgG arm would engage with an epitope, although the other may bind to other viruses, causing aggregation. For DENV2 at pH 5.0, a similar scenario would occur, suggesting DENV2:IgG complex would aggregate in the endosome. Hence, a single antibody employs different neutralization mechanisms against different flaviviruses.
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Affiliation(s)
- Shuijun Zhang
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Thomas Loy
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138632, Singapore; School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Thiam-Seng Ng
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Xin-Ni Lim
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Shyn-Yun Valerie Chew
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Ter Yong Tan
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Meihui Xu
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138632, Singapore
| | - Victor A Kostyuchenko
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Farhana Tukijan
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138632, Singapore
| | - Jian Shi
- Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore; CryoEM unit, Department of Biological Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Katja Fink
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138632, Singapore; School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.
| | - Shee-Mei Lok
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; Centre for BioImaging Sciences, National University of Singapore, Singapore 117557, Singapore.
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7
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Ong SM, Teng K, Newell E, Chen H, Chen J, Loy T, Yeo TW, Fink K, Wong SC. A Novel, Five-Marker Alternative to CD16-CD14 Gating to Identify the Three Human Monocyte Subsets. Front Immunol 2019; 10:1761. [PMID: 31402918 PMCID: PMC6676221 DOI: 10.3389/fimmu.2019.01761] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/11/2019] [Indexed: 11/18/2022] Open
Abstract
Human primary monocytes are heterogeneous in terms of phenotype and function, but are sub-divided only based on CD16 and CD14 expression. CD16 expression distinguishes a subset of monocytes with highly pro-inflammatory properties from non-CD16 expressing “classical” monocytes. CD14 expression further subdivides the CD16+ monocytes into non-classical CD14low and intermediate CD14high subsets. This long-standing CD16–CD14 classification system, however, has limitations as CD14 is expressed in a continuum, leading to subjectivity in delineating the non-classical and intermediate subsets; in addition, CD16 expression is unstable, making identification of the subsets impossible after in vitro culture or during inflammatory conditions in vivo. Hence, we aimed to identify the three monocyte subsets using an alternative combination of markers. Additionally, we wanted to address whether the monocyte subset perturbations observed during infection is real or an artifact of differential CD16 and/or CD14 regulation. Using cytometry by time-of-flight (CyTOF), we studied the simultaneous expression of 34 monocyte markers on total monocytes, and derived a combination of five markers (CD33, CD86, CD64, HLA-DR, and CCR2), that could objectively delineate the three subsets. Using these markers, we could also distinguish CD16+ monocytes from CD16− monocytes after in vitro stimulation. Finally, we found that the observed expansion of intermediate (CD14high) monocytes in dengue virus-infected patients was due to up-regulated CD16 expression on classical monocytes. With our new combination of markers, we can now identify monocyte subsets without CD16 and CD14, and accurately re-examine monocyte subset perturbations in diseases.
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Affiliation(s)
- Siew-Min Ong
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore
| | - Karen Teng
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore
| | - Evan Newell
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore
| | - Hao Chen
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore
| | - Jinmiao Chen
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore
| | - Thomas Loy
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Tsin-Wen Yeo
- National Centre for Infectious Diseases, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Katja Fink
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Siew-Cheng Wong
- Singapore Immunology Network (SIgN), ASTAR Research Entities, Singapore, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
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Hopkins TV, Floyd J, Loy T, Johnston N, Shahab N. Rituximab is an effective treatment in cutaneous histiocyte predominant T-cell rich B-cell lymphoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - J. Floyd
- Univ of Missouri Columbia, Jefferson City, MO
| | - T. Loy
- Univ of Missouri Columbia, Jefferson City, MO
| | - N. Johnston
- Univ of Missouri Columbia, Jefferson City, MO
| | - N. Shahab
- Univ of Missouri Columbia, Jefferson City, MO
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Glaziou P, Bodet C, Loy T, Vonthanak S, El-Kouby S, Sainte Marie FF. Knowledge, attitudes and practices of university students regarding HIV infection, in Phnom Penh, Cambodia, 1999. AIDS 1999; 13:1982-3. [PMID: 10513661 DOI: 10.1097/00002030-199910010-00025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Complete opacification on chest radiographs may be due to collapse of the lung, consolidation, massive pleural effusion, empyema, hemothorax, chylothorax, fibrothorax, and other causes. We report a case of complete opacification of the hemithorax produced by large cell lymphoma, a previously unreported cause of this finding. Diagnosis was complicated by the CT finding of replacement of the lung parenchyma by a soft-tissue mass with an associated small pleural effusion, while bronchoscopy failed to reveal any major airway obstruction. Large cell lymphoma should therefore be added to the differential diagnosis when considering causes of complete opacification of the hemithorax. Both the patient and his brother had the combination of Lowe's syndrome and cancer.
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Affiliation(s)
- J P Higgins
- Department of Internal Medicine, University of Missouri-Columbia 65212
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Wick MR, Loy T, Mills SE, Legier JF, Manivel JC. Malignant epithelioid pleural mesothelioma versus peripheral pulmonary adenocarcinoma: a histochemical, ultrastructural, and immunohistologic study of 103 cases. Hum Pathol 1990; 21:759-66. [PMID: 2193875 DOI: 10.1016/0046-8177(90)90036-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The distinction between malignant epithelioid pleural mesothelioma (MEPM) and peripheral adenocarcinoma of the lung with pleural invasion (PAL) continues to represent a diagnostic challenge in selected cases. In order to provide comparative data on histologic, histochemical, and immunohistochemical features of these neoplasms, we analyzed 51 ultrastructurally categorized MEPMs and 52 PALs with the periodic acid-Schiff-diastase (PAS-D), mucicarmine, and colloidal iron stains, and a panel of immunohistologic reagents. Antibodies to cytokeratin, vimentin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), Leu M1, the B72.3 antigen, blood group isoantigens (BGI), placental alkaline phosphatase, amylase, S100 protein, and Clara cell antigen were used, as applied to paraffin sections with the avidin-biotin-peroxidase complex technique. Ultrastructural studies revealed long, branching microvilli in MEPM cells in all cases, with length-to-diameter ratios (LDR) of 10:1 or more. In contrast, PAL manifested short, nonbranching microvilli with LDR of 8:1 or less. Reactivity with PAS-D and mucicarmine stains was strictly confined to PAL, and hyaluronidase-sensitive colloidal iron-positivity was restricted to MEPM. However, only 63% and 41% of these respective neoplasms demonstrated such histochemical reactivity. Immunohistologic results correlated well with electron microscopic classification. All MEPMs and PALs were reactive for cytokeratin; in addition, the majority of tumors in each group expressed EMA, and a minority were reactive for vimentin. In adenocarcinomas of the lung, Leu M1 was observed in all cases, CEA was apparent in 96%, B72.3 labeled 84%, and BGI were present in 67%; all PALs expressed at least two of these determinants, but none was seen in any mesothelioma. The other markers included in this study also were observed in some PAL cases, but not in MEPM. These findings suggest that immunohistology parallels electron microscopy in efficacy in the diagnostic separation of MEPM and PAL. Using antibodies to Leu M1, CEA, and the B72.3 antigen, reactivity for at least two of these three markers appears to exclude a diagnosis of pleural mesothelioma. The other glycoproteinaceous, oncoplacentofetal, and cytoplasmic antigens we studied can be used to reinforce such a determination, since their distribution is confined to adenocarcinomas.
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Affiliation(s)
- M R Wick
- Department of Pathology, University of Minnesota School of Medicine, Minneapolis
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