Primary central nervous system diffuse large B-cell lymphoma in the immunocompetent: Immunophenotypic subtypes and Epstein-Barr virus association.

INTRODUCTION: Primary central nervous system diffuse large B-cell lymphoma (PCNSL DLBCL) in the immunocompetent is an uncommon tumor that has an activated B-cell immunophenotype resembling germinal center exit B cells. They also differ from primary central nervous diffuse large B-cell lymphomas in the immunocompromised as they show no association with the Epstein-Barr virus. OBJECTIVE: To determine if immunophenotypic subtyping of PCNS DLBCL from Asian subcontinent are also different similar to its systemic counterpart is unclear, as there are only limited studies from Asia, and none from India. MATERIAL AND METHODS: The immunohistochemical profile of 24 South Indian patients with primary central nervous system diffuse large B-cell lymphoma was studied using germinal center markers - CD10 and Bcl-6, and activation markers - MUM1 and CD138, which are markers for late/post germinal centre B cells. Insitu hybridization for EBV genome and LMP1 by immunohistochemistry was carried out in all cases to determine association with EBV. RESULTS: Centroblastic morphology and uniform activated B-cell phenotype with positivity for MUM1 was seen in 91.6% of tumors. Co-expression of Bcl-6 and MUM1 was evident in 50%, which is more frequent than in systemic diffuse large B-cell lymphomas. All cases were negative for Epstein-Barr virus using EBER in-situ hybridization and LMP1 immunohistochemistry. CONCLUSION: Primary diffuse large B-cell lymphoma in the immunocompetent is a distinct clinicopathological entity with centroblastic morphology, a uniform activated B-cell immunophenotype that is not associated with the Epstein-Barr virus regardless of geographic origin.

Polycyclic alkaloids via transannular Mannich reactions.

The tricyclic compound , representing the framework of the cylindricine and lepadiformine alkaloids, was prepared in a single operation via the first example of a transannular Mannich reaction involving a macrocyclic diketoamine .

A new route to furanoeremophilane sesquiterpenoids. Synthesis of (+/-)-6[small beta]-hydroxyeuryopsin.

The naturally occurring furanoeremophilane 6[small beta]-hydroxyeuryopsin was synthesized by a novel route which involved Stille coupling of a 2-furylstannane with a cyclohexylmethyl bromide, followed by intramolecular formylation of the furan to complete the tricyclic nucleus of the sesquiterpenoid.

Management of glass intraocular foreign bodies.

PURPOSE: To describe the results of management of glass intraocular foreign bodies (IOFBs). METHODS: A total of 51 eyes of 43 patients that sustained penetrating injury with glass IOFB were studied retrospectively. A total of 23.5% had IOFB only in the anterior segment; the rest had IOFB in the posterior segment alone or in both the anterior and posterior segments. Six eyes were followed conservatively despite IOFB in a functional eye. Removal of IOFB was combined with repair of retinal detachment (where present) using internal tamponade with gas or silicone oil or buckle. RESULTS: After a mean follow-up of 16.8 months, 66.7% of eyes recovered better than 6/60 (20/200) vision and 75.6% had attached retina. On univariate analysis, scleral entry wound, posterior segment IOFB, larger size of IOFB, and retinal damage were found to be associated with poor anatomic outcome. Lower presenting visual acuity, hyphema, retinal damage, subretinal hemorrhage, detached retina, and larger IOFB were associated with a poor functional result. Multivariate analysis identified retinal damage caused by the foreign body as the only factor significantly associated with poor anatomic as well as functional outcome. CONCLUSIONS: Glass IOFBs are caused in a majority of cases by blast injury. Bilaterality is not uncommon. Presence of retinal damage is predictive of poor functional and anatomic results. Overall results are modest with modern vitreoretinal surgical techniques.

Repair of pharyngo-cutaneous fistula using a bipedicled tubed flap.

The successful closure of a large pharyngo-cutaneous fistula by a bipedicled tubed flap is described. This procedure is technically simple and reliable. An advantage of this method is that both lining and covering are obtained in the same flap.

The role of fibreoptic nasopharyngoscopy in nasopharyngeal carcinoma (NPC).

With the introduction of the flexible fibreoptic nasopharyngo-laryngoscope, we have a sophisticated instrument for examination of the nasopharynx and larynx. It is also useful for obtaining biopsies from the nasopharynx and has many advantages over other methods. The most important is that it is possible to take biopsies from selected sites under direct visualization and the biopsy results are therefore more reliable.

Pseudocysts of the auricle.

Pseudocyst of the auricle is a distinct clinical entity with certain characteristic features. These cysts occur more frequently in Chinese and develop spontaneously, without trauma or infection. The cysts contain clear yellow coloured fluid. A simple but effective method of treatment is described.

Cementifying fibroma of the ethmoidal sinus.

An interesting case of cementifying fibroma of the ethmoidal sinus is presented. This benign tumour, in this unusual site, tends to behave in an aggressive manner and radical surgery is necessary. Recurrence is frequent.

Hyperparathyroidism with osteitis fibrosa cystica in the maxilla.

In hyperparathyroidism, skeletal changes occur in 13 per cent of severe and long-standing cases (Smith, 1979). These skeletal changes vary from generalized demineralization of bone in early cases to resorption of bone marrow and replacement by fibrous tissue with cystic changes, the latter being termed osteitis fibrosa cystica or brown tumour. These cystic tumours are rare and usually occur in the long bones. Osteitis fibrosa cystica rarely presents in the maxilla as the initial symptom of hyperparathyroidism.

Intravenous albumin administration for prevention of spinal hypotension during cesarean section.

Five percent albumin in Ringer's lactate with 5% dextrose solution (D5RL) (15 ml/kg) was prophylactically infused preanesthetically over 15 to 20 minutes to prevent hypotension during spinal anesthesia in 46 patients undergoing elective cesarean section. Apgar scores and the incidence and severity of hypotension were compared to results obtained in 41 patients who were given D5RL solution without albumin (15 ml/kg). The incidence of hypotension was significantly less in patients given 5% albumin than in patients hydrated with D5RL alone. Mean arterial pressure decreased up to 18 torr from control values in patients hydrated with D5RL but mean arterial pressure did not change significantly in patients given 5% albumin. The Apgar scores, both at 1 minute and 5 minutes, were significantly higher (p < 0.01) in infants born of mothers given albumin than in infants whose mothers were given D5RL solution. Prophylactic administration of 5% albumin in D5RL solution is an effective method for prevention of spinal hypotension.

Malignant lymphoma of the faucial tonsil.

Ten cases of malignant lymphoma of the faucial tonsil treated in the R.U.H., Bath, during 1965--1975 are reviewed. Dysphagia and irritation in the throat are predominant symptoms. Enlarged tonsil is the commonest feature. Radiotherapy is the treatment of choice and the prognosis has improved considerably with modern supervoltage radiotherapy.