Pulmonary ultrasonography in the follow-up of respiratory distress syndrome on preterm newborns. Reduction of X-ray exposure.

PURPOSE: Respiratory distress syndrome (RDS) is the most common cause of respiratory failure in preterm neonates, whose lungs are often immature. The diagnosis and follow-up are based on clinical and radiographic findings. Due to the problem of air artifacts, ultrasonography (US) is not used routinely in the diagnosis of lung diseases. However, when the alveolar air content decreases, as it does in RDS, characteristic patterns appear that can be observed during US lung examinations. The aim of this study was to determine whether the use of chest radiographs in neonates with RDS could be reduced by the routine use of chest US for follow-up examinations. MATERIALS AND METHODS: From April through September 2008, were enrolled all preterm newborns, with very low birth weight (VLBW), consecutive admitted in NICU with clinically and radiologically diagnosed RDS. We performed lung ultrasound examination in this patients. Video-taped US examinations were done every 8-12 h until clinical resolution of the disease was observed. Chest X-rays were performed only in unclear cases. We compared the number of chest radiographs obtained in the NICU during this period and during the preceding six months. RESULTS: 105 serial US lung examinations were performed in 21 preterm infant with clinically and radiologically diagnosed RDS. US lung examinations revealed "comet-tail" artifacts that were compact, diffuse, and symmetrically distributed throughout both lung fields. In 8 cases, the pleural line was also extensively thickened and irregular, and in 7 cases multiple subpleural hypoechoic areas indicative of lung consolidation were observed (mainly on posterior and lateral scans). The mean number of chest radiographs per infant performed in the NICU during the study period was significantly lower than that of the preceding six months (2.6 ± 1 versus 3.8 ± 1.5; p < 0.05). CONCLUSIONS: Chest ultrasound is a valid alternative for the follow-up of VLBW infants with RDS, which can decrease the need for chest X-rays and reduce patient exposure to ionizing radiation.

Analysis of cerbB2 expression using a panel of 6 commercially available antibodies.

Results are presented of a study comparing cerbB2 (neu or Her2) expression as assessed immunohistochemically in breast neoplasia using a panel of 6 commercially available antibodies. The antibodies were examined utilizing conventional formalin fixed paraffin embedded tissue, and compared with molecular analysis of gene amplification. The aim was to determine the practical utility of each antibody, assessing ease of use, specific and non-specific staining characteristics, and expense, thus allowing a specific recommendation as to antibody of choice for immunohistochemical assessment of cerbB2 expression. Reassuringly, amongst the 38 breast lesions (36 carcinomas, 2 fibroadenomas) subjected to immunohistochemically (IHC) with the panel of 6 antibodies (Ab), no gross discrepancy of staining pattern was seen. Of the 38 cases, 10 were positive (26%), where at least one Ab demonstrated clear cytoplasmic membrane staining. Of a total of 45 breast lesions (43 carcinomas, 2 fibroadenomas), including all those examined by IHC, the total number of cases showing cerbB2 amplification by DNA analysis was 14 (31%). Using the DNA amplification as a base line for comparison, one Ab (No. 4) was found to stain 6 of the 14 cases of breast carcinoma that were assessed as showing amplification at the DNA level. Four Abs (1,3,5,6) stained 5 of these cases. However, Abs 3,4 and 6 displayed artefactual cytoplasmic staining (in the absence of membrane staining) that precluded the practical use of these reagents. Therefore, based on additional considerations of cost and ease of use, Ab No. 1 was finally chosen for recommendation from the 6 Ab panel.

B cell chronic lymphocytic leukemia with florid reactive CD4+ T cell lymphocytosis in lymph nodes.

This case is of an unusual florid reactive CD4+ T Cell lymphocytosis involving lymph node (LN) and overshadowing residual B chronic lymphocytic leukemia (CLL). A 65 year old female with a 9 year history of untreated B-CLL presented with weight loss, splenomegaly and lymphadenopathy. B-CLL was confirmed on the basis of peripheral blood lymphocytosis, bone marrow trephine findings and flow cytometry analysis. However, the LN biopsy showed appearances of a diffuse small lymphocytic population mimicking a leukemic T-cell infiltrate. Immunophenotyping and molecular analysis demonstrated the major cell population to be reactive CD4 positive T lymphocytes.

Development of monoclonal antibodies to the human breast carcinoma cell line PMC42.

In an attempt to identify antigens expressed during breast differentiation, three murine monoclonal antibodies, CIBr2, CIBr7, and CIBr18, were produced against the human pleomorphic breast carcinoma cell line PMC42. All three monoclonal antibodies reacted with previously undescribed antigenic determinants on the PMC42 cell line. Antibody CIBr18 reacted only with the immunizing cell line PMC42, whereas antibodies CIBr2 and CIBr7 showed minimal reactivity toward a panel of 34 human leukemia- and solid tumor-derived cell lines. The antigenic determinants detected by the three antibodies were distinct, and each showed variable expression in PMC42 monolayer and organoid cultures. The heterogeneity of staining seen on PMC42 cultures may reflect the fact that this cell line contains up to eight morphologically distinct cell types. Antigen expression correlated with cell type in some instances, whereas in other instances phenotypic subdivision within a cell type was apparent. Antigens recognized by antibodies CIBr7 and CIBr18 were characterized biochemically. In Western blotting, antibody CIBr7 identified a single band of an apparent molecular weight of 38,000 within PMC42 cell lysates. Sodium dodecyl sulfate-polyacrylamide gel analysis of polypeptides immunoprecipitated by antibody CIBr18 from [35S]methionine-labeled PMC42 cell lysates identified two glycoproteins of apparent molecular weights of 115,000 and 120,000, respectively. No biochemical data for the CIBr2 antigen are yet available. All three antigens were detected in human mammary epithelium and some non-breast tissues. The expression of these antigens in normal and neoplastic mammary epithelia is discussed in terms of antigen heterogeneity and changes in antigen expression upon conversion to the malignant state.