Cytokine induction after Epstein-Barr virus infection of peripheral T-lymphocytes in vitro

Background: Although the presence of Epstein-Barr virus (EBV) in different T-cell malignancies has been widely reported, there is very few data available for EBV infection of normal T cells. This leads to the lack of knowledge on the early events after T cell infection. Objective: Investigate the early events occurring after normal human peripheral T-cells are infected with EBV in vitro. Methods: T-cells were treated with EBV in vitro. The expression of tumor necrosis factor- α (TNF-α) mRNA were determined using reverse-transcription (RT)-PCR, and the level of TNF-α and interferon- γ (IFN-γ) in the culture supernatant were measured using ELISA. The effect of virus inactivation on cytokine induction from T-cells was also determined. Results: At the beginning of T cell infection by EBV, the expression of several lytic EBV transcripts (BALF5, BcLF1, and BLLF1) were observed using RT-PCR. This indicated the susceptibility of in vitro EBV infection and the entering lytic cycle of EBV-infected T-cells. The interactions of EBV with T-cells lead to induction of inflammatory cytokines, tumour necrosis factor- α (TNF-α) and interferon- γ (IFN-γ), production from the T-cells. Inactivation of the virus by UV irradiation eliminated the TNF-α and IFN-γ induction by EBV, suggesting the involvement in the expression of viral gene(s). Conclusion: This in vitro analysis demonstrated the cytokine induction by EBV after primary infection of T-cells.

Prenatal diagnosis of fetal bladder outlet obstruction at Songklanagarind Hospital: report of 5 cases.

Five cases of fetal bladder outlet obstruction prenatally diagnosed in the Perinatology Unit, Department of Obstetrics and Gynaecology, Songklanagarind Hospital, Songkhla, from January 1990 to September 1999 were reported. Ultrasound findings demonstrated megacystis, various degrees of hydroureter and hydronephrosis and oligohydramnios. Sex could be determined in only four cases and all were male. Chromosome abnormality (trisomy 18) was documented in one case. Postmortem results in three cases established that posterior urethral valves were the cause of obstruction. All cases in our series had poor outcome based on gestational age at first diagnosis, sonographic findings, fetal urinalysis, and chromosome abnormality. Four cases underwent termination of pregnancy and the other resulted in a dead fetus in utero. The outcome of some cases may be improved by using the vesicoamniotic shunt placement procedure that increases the likelihood of fetal survival. Therefore, the recommendation is to establish this procedure at Songklanagarind Hospital in the future.

Granulomatous reaction in peripheral T-cell proliferative disease: a case report.

A 52-year-old male presented with a prolonged fever, anemia, weight loss, hepatosplenomegaly, and elevated serum level of alkaline phosphatase. The patient developed septicemia, metabolic acidosis, and died 3 days after admission. Liver necropsy, tissue showed group C, peripheral T-cell proliferative disease. Epstein-Barr virus genomes were demonstrated in the nuclei of these abnormal T-cell lymphocytes. Granulomatous reaction was observed in the liver and bone marrow. Stains and cultures for mycobacteria and fungi gave negative results. Granulomatous reaction is believed to be induced by cytokines which were released from the T-cell lymphocytes that infiltrated in the liver and bone marrow.

Hepatic peripheral T-cell lymphoma: a spectrum of liver pathology and clinical correlation.

Thirty-two patients with fever of unknown origin, weight loss, anemia, elevated serum levels of alkaline phosphatase and/or lactate dehydrogenase were evaluated. Histopathologic findings of the liver showed T-cell infiltration in the hepatic sinusoids and portal tracts. The cellular morphology varied from mature lymphocyte to malignant lymphoid cells. We divided the cases into four groups on the basis of cellular atypia. Group A and group B showed mature lymphoid cell infiltration, however, only group B had multiple large areas of hepatocellular necrosis. Group C showed atypical lymphoid cell infiltration. In group D, definite malignant lymphoid cell infiltrates were demonstrated. Groups B, C, and D patients had a very poor prognosis. All of them died despite chemotherapy. Group A patients had a better prognosis. Those who had chemotherapy achieved a complete remission. Progression to a higher group occurred in two of six patients with group B lesions and one of seven patients with group C lesions. The EBV-RNA genomes were found increasingly in the higher groups. This study supports the concept that these groups of disease represent a spectrum of peripheral T-cell proliferations.

Zellweger syndrome: first reported case in Thailand and literature review.

We describe an infant boy with facial dysmorphism, profound hypotonia, psychomotor retardation, seizure and hepatomegaly. Biochemical study revealed elevation of very long chain fatty acids and pipecolic acid, consistent with peroxisomal disorder. He died at the age of 4 months. Electron microscopic study demonstrated decreased amounts of peroxisomes in liver and kidneys. The clinical characteristic, accompanied the biochemical and microscopic findings led to the diagnosis of Zellweger syndrome. The recognition of this syndrome is important since it is a fatal disease. The pattern of inheritance is autosomal recessive, hence genetic counseling is necessary. We emphasize that peroxisomal disorder should be included in the differential diagnosis in patients with infantile hypotonia. This patient is the first reported case of Zellweger syndrome in Thailand.

Precancerous lesion and early carcinoma of the pyriform sinus.

Thirty-five specimens from total laryngopharyngectomy clinically diagnosed as squamous cell carcinoma of the pyriform sinus were studied. Patients receiving chemotherapy or radiotherapy were excluded. Pathological examinations revealed 26 (74.3%) precancerous lesions and early carcinoma of the pyriform sinus. Eight out of 26 cases were detected by gross examination. Most pathological findings were carcinoma in situ (CIS). Epithelial changes of the pyriform sinus were not similar to those of the uterine cervix. They usually showed abrupt change, frequently from normal to CIS, mild dysplasia to invasive carcinoma and these lesions can be detected early by physical examination. Because of multifoci of carcinoma, the concept of "multicentric origin" is proposed.

A clinico-pathologic study of ovarian tumors.

A series of 286 patients receiving surgical treatment for ovarian tumors at Song-klanagarind Hospital between January 1987 and June 1990 were reviewed. The most frequent diagnoses by age group were: cancer in 53 per cent of women > or = 50 yrs of age, endometrioma in 63 per cent of women 31-49 yrs of age and benign cystic teratoma in 49 per cent of women < or = 30 yrs of age. Mucinous ovarian tumors were the most common type of epithelial neoplasms. Abdominal pain was the symptom most frequently experienced in patients with benign ovarian tumors. The 95 per cent confidence interval for finding malignancy in women > or = 50 yrs, ascites > 500 ml and size of ovarian tumor > 10 cm was 47-99 per cent.

Lung cavities from Pneumocystis carinii in a patient with systemic lupus erythematosus.

A patient with SLE developed pneumonia due to Pneumocystis carinii. The unusual presentation was the multiple lung cavities. There appeared to be a temporal relationship between the lung infection and reducing steroid intake in this patient.

Fulminant hepatitis, possible virus origin: a report of seventeen cases in southern Thailand.

This report described seventeen patients suffering from fulminant hepatitis and had a rapid fatal course. They were all residents of Southern Thailand. Fourteen cases were recognized between April and August which is the beginning of the rainy season in this part of the country. All age groups were found with males slightly predominant. Clinical manifestation presented with fever and later developed jaundice, convulsion and other central nervous system symptoms, liver failure and acute renal failure. Four cases had pneumonia and another three cases had pleural effusion. Laboratory investigations revealed hyperbilirubinemia, marked increase in serum transaminases, a variable alkaline phosphatase level and electrolytes derangement. HBsAg was positive in only two of fourteen cases. Blood cultures and serological examination for infections were unfruitful. Histopathological changes of the liver were classified into three types; type 1 massive hepatocellular coagulation necrosis; type 2 massive scattered hepatocellular necrosis and type 3 massive bridging hepatocellular necrosis. Electron microscopy of five cases revealed spherical viral-like particles ranging in size 70 to 90 nm in diameter, in the cytoplasm of liver cells. This is believed to be a unique type of fulminant hepatitis, possibly viral in origin, and were clinically and pathologically different from the previously described fulminant viral hepatitis.

Ovarian neoplasms in childhood and adolescents in Songklanagarind Hospital, February 1983-March 1989.

Ovarian tumors in young females under the age of 20 years in Songklanagarind Hospital from February 1983 to March 1989 were evaluated. The total number of patients was 47, with a 4.0 per cent incidence of ovarian tumors in all age groups. Germ cell tumor was the most common tumor (59.6%) and 60.7 per cent were malignant. The chief presenting symptom was abdominal distention or mass, with 17.0 per cent of torsion. Ascites and solid consistency of tumors suggested its malignant potential. Surgery was the treatment for all patients with a conservative approach in the majority of cases and supplemented with chemotherapy and/or radiotherapy in malignant cases.

Intracranial tuberculoma in Thailand: report of a case and review of the literature.

A case of cerebellar tuberculoma in an adult treat at Songkhlanagarind hospital is presented. The total number of well-documented cases in Thailand is 14. The exact incidence is unknown. The epidemiology, clinical and diagnostic features are reviewed.