ABSTRACT
BACKGROUND: Gallium-67 (Ga-67) is widely used in the assessment of patients with lymphoma. Although highly sensitive in Hodgkin's disease and high grade non-Hodgkin's lymphoma (NHL), its sensitivity is reported to be reduced in lower grades of NHL. Several series have suggested that thallium-201 (Tl-201) may be more useful than Ga-67 in the evaluation of low and possibly intermediate grade NHL. AIM: To compare the sensitivity and relative avidities (uptakes) of Tl-201 and Ga-67 in patients with NHL. METHODS: A total of 36 pairs of studies were performed in 33 patients (14 male: 19 female; age range 16-84 years, mean 55 years). All had whole body Ga-67 (400 MBq) and Tl-201 (100-200 MBq) studies (interval 0-three days) which were read by two experienced nuclear medicine physicians blinded to clinical history and results of other investigations. RESULTS: Tl-201 had a higher sensitivity and avidity than Ga-67 in patients with low grade NHL. In contrast, Ga-67 was slightly more sensitive and had a higher avidity in patients with both intermediate and high grade NHL. CONCLUSIONS: We conclude that Tl-201 is more sensitive and avid for low grade NHL than Ga-67 and that consideration should be given to its use in this condition in conjunction with Ga-67 as it may provide complementary information. Routine use in intermediate grade NHL is less convincing as Ga-67 was superior in most cases. Ga-67 is more sensitive than Tl-201 in assessment of high grade NHL.
Subject(s)
Gallium Radioisotopes , Lymphoma, Non-Hodgkin/diagnostic imaging , Thallium Radioisotopes , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Radionuclide Imaging/methods , Sensitivity and Specificity , Statistics, NonparametricABSTRACT
Paraneoplastic pemphigus is a recently described autoimmune disease characterized by painful mucosal ulceration and polymorphous skin lesions in association with an underlying neoplasm. Distinct autoantibodies bind desmoplakin I, desmoplakin II, bullous pemphigoid antigen and an uncharacterized 190 kDa antigen. A case is presented of paraneoplastic pemphigus that developed after radiotherapy for non-Hodgkin's lymphoma in a 53 year old man. Multiple skin biopsies showed a lichenoid reaction without acantholysis. Immunofluorescence and mucosal biopsies were required to establish the correct diagnosis. Corneal opacities resembling lichenoid graft-versus-host disease and retinal haemorrhages, which developed in the patient, have not been previously documented. Despite high doses of immunosuppressive agents and plasmaphoresis, the patient eventually died from respiratory failure.
Subject(s)
Paraneoplastic Syndromes/etiology , Pemphigus/etiology , Radiation Injuries/etiology , Acantholysis/etiology , Acantholysis/pathology , Corneal Opacity/etiology , Corneal Opacity/pathology , Fatal Outcome , Humans , Lymphoma, B-Cell/radiotherapy , Lymphoma, Non-Hodgkin/radiotherapy , Male , Middle Aged , Paraneoplastic Syndromes/pathology , Pemphigus/pathology , Radiotherapy/adverse effects , Retinal Hemorrhage/etiology , Retinal Hemorrhage/pathology , Skin/pathologyABSTRACT
This report describes two patients with epithelioid hemangioendothelioma presenting with multiple tumour nodules in the liver, but without evidence of tumour elsewhere. One patient died in liver failure twelve months after presentation. The other patient has been well for over two years. Histologically the tumours were remarkably similar, being composed of a proliferation of primitive endothelial cells embedded in a myxohyaline stroma, infiltrating central veins, hepatic sinusoids and, to a lesser extent, terminal portal venules. In each case an initial mistaken histological diagnosis of veno-occlusive disease was made.
Subject(s)
Hemangioendothelioma/pathology , Hepatic Veno-Occlusive Disease/pathology , Liver Neoplasms/pathology , Adult , Diagnosis, Differential , Female , Humans , MaleABSTRACT
A series of nine consecutive patients with multiple myeloma and renal failure is presented. All patients were treated with urinary alkalinisation with sodium bicarbonate and/or acetazolamide, diuresis with saline, mannitol and/or furosemide, pulse melphalan and prednisone and, where indicated, allopurinol and aluminium hydroxide. A substantial and sustained improvement in renal function has been achieved in all nine patients. Of five patients with a urea more than 25 mmol/L at presentation, the median survival to date is 64 weeks. Of these patients only one has died --not from renal failure but pneumonia, eighteen months after presentation. The others are alive and well. The results confirm the effectiveness of these measures in both improving renal function and prolonging survival, and suggest a more optimistic prognosis for patients with multiple myeloma and renal failure.
Subject(s)
Kidney Failure, Chronic/etiology , Multiple Myeloma/complications , Adult , Aged , Creatinine/blood , Diuretics/therapeutic use , Female , Humans , Kidney Failure, Chronic/therapy , Male , Melphalan/therapeutic use , Middle Aged , Peritoneal Dialysis , Prednisone/therapeutic use , Prognosis , Time Factors , Urea/urineABSTRACT
A case is presented in which leukostasis, which followed splenectomy for chronic granulocytic leukaemia in metamorphosis, was associated with respiratory failure. The pathophysiology and predisposing factors are discussed.
Subject(s)
Leukemia, Myeloid/complications , Leukocytes , Pulmonary Embolism/etiology , Respiratory Insufficiency/etiology , Aged , Hematocrit , Hemoglobins/analysis , Humans , Leukemia, Myeloid/therapy , Leukocyte Count , Lung/physiopathology , Male , Pulmonary Embolism/physiopathology , Respiratory Insufficiency/physiopathology , SplenectomyABSTRACT
Central nervous system disorders are not uncommon in patients with hyperparathyroidism and hypercalcaemia. Usually these consist of neuropsychiatric disturbances but acute encephalopathies and seizures may occur. A rare manifestation is cerebral infarction. A patient is presented with neuroradiological evidence of infarction caused by cerebral arterial spasm which appears related to hypercalcaemia due to hypervitaminosis D. Arterial spasm is suggested as a possible aetiological factor in focal neurological lesions associated with hypercalcaemia.
