[Non-hodgkin's lymphomas of extranodal localization. Strategies for imaging diagnosis]. / I linfomi non Hodgkin con localizzazione extranodale. Strategia della diagnostica per immagini.

PURPOSE: To evaluate the diagnostic workup proposed by the UICC (International Union against Cancer) Flow charts for diagnosis and staging of lymphomas in developed and developing countries (1998). MATERIAL AND METHODS: Our series consists of 134 patients with early non-Hodgkin's lymphoma (NHL). The patients, 75 men (56%) and 59 women (44%), ranging in age 14-80 years (mean: 56.8), were examined with chest radiography and thoracoabdominal CT. Abdominal US was used only in the follow-up of low-grade NHL. The patients were classified according to the Working Formulation criteria (1981) and staged as proposed by the Ann Arbor Conference guidelines (1971). RESULTS: At diagnosis, 5 patients (3.7%) were in stage I, 32 (23.8%) in stage II, 46 (34%) in stage III and 51 (38%) in stage IV. Extranodal involvement was seen in 59 patients (44%), which was present at disease onset in 49 of them (80%) and developed later on in 10 (20%). Gastrointestinal tract and respiratory system were the most frequent sites of extranodal involvement (15 cases, 25%), followed by liver (12%), genitourinary system (including the ovary), adrenal glands, the craniocervical region, muscles and finally the breast. The parotid gland, thyroid and bone were involved in one case only each. DISCUSSION AND CONCLUSION: In agreement with previous literature reports, our study confirms that the best technique currently available for diagnosis, staging and follow-up of malignant lymphoma is chest-abdomen CT. Indeed, even though extranodal involvement exhibits extremely variable patterns, there are some typical findings at CT, such as homogenous structural hypodensity, low contrast enhancement, frequent plurivisceral involvement and/or local lymph node involvement. Our study followed the 1998 UICC guidelines for cancer diagnosis and staging in developed countries, based on the histology of lymph node biopsy material and on imaging techniques such as CT, MRI and PET. As for developing countries, lymph node biopsy is the most easily available, and thus preferred, examination, while imaging diagnosis features chest radiography and abdominal US.

Alpha and beta cell evaluation in patients with thalassaemia intermedia and iron overload.

Insulin and glucagon secretion were studied during an oral glucose tolerance test and arginine infusion in 11 patients with thalassaemia intermedia, who showed laboratory evidence of iron overload. Mean blood glucose concentrations in patients with thalassaemia intermedia were significantly higher than normal and 3 of 11 patients had impaired glucose tolerance. The principal abnormality appears to be a deficiency in insulin and glucagon from the pancreas in response to oral glucose tolerance and arginine stimulation tests. Several factors, such as iron overload, chronic hypoxia, zinc deficiency and increased catecholamine production secondary to anaemia, might play a part in the pathogenesis of these abnormalities. Each of these factors affect individual cases to a varied degree. Our data emphasize the mildness of carbohydrate defect as compared to the degree of insulinopenia and indicate the necessity for prescribing measures which prevent excessive iron deposition and improve iron excretion in thalassaemic patients with iron overload.

Raised IgE levels in beta-thalassaemia: correlation with splenectomy and hepatitis B virus infection.

IgE values obtained in 117 beta-thalassaemia patients were significantly higher than in age matched normal subjects. In 31 patients (26.5%) IgE levels were above 2 s.d. of normal values for age, but the frequency of IgE with reaginic activity was lower in patients (5.1%) than in controls (11.9%). The highest values were observed in splenectomized patients who were also positive for one or more serological markers of hepatitis B virus infection. The increase of IgE levels was directly correlated with the number of years after splenectomy, and patients with biopsy proven chronic liver disease had higher IgE levels than those without evidence of liver damage. On the other hand, IgE levels were not correlated with the number of transfusions, age, IgG, IgA, IgM levels or T cell subsets and mitogen responsiveness. These results show that beta-thalassaemia patients develop elevated IgE levels to which splenectomy and hepatitis B virus infection contribute in a synergistic manner.

[Hepatitis in thalassemia minor: incidence and evolution]. / Epatite nella talassemia minor: incidenza ed evoluzione.

Incidence, clinical course and outcome of viral hepatitis was evaluated during a 42 mo. study in 118 Thalassaemia minor patients, compared with a paired group of 123 nonthalassaemic subjects, matched for age, sex and number of drug addicts. In the thalassaemics, which account for 13% of residents in our area, acute hepatitis showed to have an incidence of 1.3-1.7 higher than the control group. The acute course was milder and more protracted and the number of evolution into chronicity was more elevated: 19.7% vs. 11.3%, following hepatitis B, and 40.6% vs. 23.7% following NANB hepatitis. However data were statistically significant only as regard as differences between ALT (p less than or equal to 0.05, B-H; p less than or equal to 0.01, NANB-H) and IgM in the group of B hepatitis only (p less than or equal to 0.05) Differences between elongation of course were also significant in both types of hepatitis (p less than or equal to 0.01). Pathogenetic aspects such as depressed cellular immunity and hepatic disorders due to thalassaemia, which may explain the higher incidence of hepatitis and the tendency of evolution into chronicity, are discussed.