La clínica manda / No disponible

No disponible

Prognostic significance of Bcl-2, tumor-associated macrophages, and total neoplastic and inflammatory lymph node involvement in advanced stage classical Hodgkin's lymphoma.

BACKGROUND: Although Hodgkin's lymphoma (HL) is a curable cancer, current treatment strategies based on risk stratification and response modulation are not precise enough. The predictive power of biological and morphological parameters is controversial, with prognostic models not reaching wide acceptance. PATIENTS AND METHODS: We analyzed the prognostic relevance of 8 parameters in 85 advanced stage classical HL patients, in order to determine whether tissue-based variables could add prognostic value to standard clinical parameters, thus contributing to better risk stratification at presentation. RESULTS: Univariate analysis confirmed 5 indicators of shorter overall survival (OS): Bcl-2 overexpression; increased CD68+ tumor-associated macrophages (TAM); international prognostic score (IPS) > 2; bulky disease; and total lymph node involvement (TLNI) with regard to neoplastic and inflammatory cells. Apart from TLNI, these parameters influenced lower event-free survival (EFS). Multivariate analysis identified 5 independent factors for OS: Bcl-2 overexpression; increased CD68+ TAM; TLNI; IPS > 2; and bulky disease. Increased CD68+ TAM, IPS > 2, and bulky disease affected the EFS. Utilizing the cumulative score of unfavorable prognostic factors for OS, we designed a prognostic model stratifying patients into 4 risk groups (with 0-1, 2, 3, or 4-5 factors), each with progressively reduced OS (p < 0.001). CONCLUSION: Our findings support the combination of tissue-based variables with clinical parameters at diagnosis, identifying patients who are at higher risk of poor outcome.

Promotion of lymphatic integrity by angiopoietin-1/Tie2 signaling during inflammation.

The cutaneous lymphatic system plays a major role in tissue fluid homeostasis and inflammation of the skin. Although several lymphangiogenic factors are known to be involved in the formation of lymphatic vessels, the molecular mechanisms that maintain lymphatic integrity and control the functional drainage of interstitial fluid and resolution of inflammation remain unknown. Here we show that angiopoietin-1 (Ang1) enhances lymphatic integrity and function during inflammation. Ang1 transgenic mice under the control of keratin-14 (K14-Ang1) showed attenuated edema formation and inflammation after UV B (UVB) exposure. After UVB irradiation, blood vascular permeability was inhibited in K14-Ang1 mice compared with wild-type (WT) mice. Moreover, lymphatic vessels of WT mice were markedly enlarged and leaky in inflamed skin, whereas K14-Ang1 mice showed relatively contracted lymphatic vessels together with enhanced lymphatic vascularization. Expression of endothelial-specific tight junction molecules claudin-5 and zonula occludens protein 1 (ZO-1) was strongly down-regulated in the inflamed lymphatic vessels of UVB-exposed WT mice, whereas down-regulation of both claudin-5 and ZO-1 was blocked in UVB-exposed K14-Ang1 mice. In vitro studies revealed that the stability of lymphatic endothelial cells was enhanced in the presence of Ang1, presumably via up-regulation of claudin-5, as well as ZO-1. Claudin-5 knockdown markedly increased the permeability of lymphatic endothelial cells. Overall, our data strongly support the idea that Ang1/Tie2 signaling promotes lymphatic integrity by modulating tight junction molecule expression during inflammation.

[Successful management of a patient with pain and dyspnea from bone metastasis and lymphangitis carcinomatosa after surgery for non-small cell lung cancer (NSCLC) in whom optimal dosages of transdermal fentanyl were determined by titration with fentanyl injection, and oxycodone hydrochloride].

With recent progress in disease-modifying treatments for cancer, patients who have recurrences during a period of several years before entering the terminal stage are encountered frequently. Despite improved life expectancy with cancer therapy, for patients this means prolongation of the period in which various symptoms such as cancer pain and adverse reactions are undergone. In these conditions, although the recognition is not yet sufficient, the importance of palliative care along with disease-modifying treatment is recognized in Japan. We treated a 50s female with pain and dyspnea from bone metastasis and lymphangitis carcinomatosa after surgery for NSCLC in whom the optimal dosages of transdermal fentanyl (Durotep Patch) were determined by titration with fentanyl injection, and oxycodone hydrochloride (OxyContin) in a short period. The dosages after titration were transdermal fentanyl 35 mg, oxycodone hydrochloride 60 mg, and betamethasone 4 mg. Before her death, she was able to stay at home with her family for 3 days without severe symptoms. In the present study we describe the clinical course of this case, the difference of characteristics in these opioids, and the titration method with fentanyl injection.

Cancer-related secondary lymphoedema due to cutaneous lymphangitis carcinomatosa: clinical presentations and review of literature.

Lymphoedema is a clinical condition caused by impairment of the lymphatic system, leading to swelling of subcutaneous soft tissues. As a result, accumulation of protein-rich interstitial fluid and lymphostasis often causes additional swelling, fibrosis and adipose tissue hypertrophy leading to progressive morbidity and loss of quality of life for the patient. Lymphoedema can be distinguished as primary or secondary. Lymphoedema is a complication frequently encountered in patients treated for cancer, especially after lymphadenoectomy and/or radiotherapy based on destruction of lymphatics. However, although lymphatic impairment is sometimes caused by obstructive solid metastasis, we present three cases of secondary lymphoedema with minor dermatological features without detectable solid metastasis. Sometimes this type of lymphoedema is mistakenly called malignant lymphoedema. All patients were previously treated for cancer without clinical signs of recurrence, presented with progressive lymphoedema and minor dermatological features of unknown origin. Clinical and histopathological examination of the skin revealed diffuse lymphangitis carcinomatosa, leading to secondary lymphoedema and adjustment of the therapeutic approach and prognosis. We reviewed literature on these rare presentations of cancer recurrence and recommend, where appropriate, consulting a dermatologist when discrete skin abnormalities are seen in patients with a history of cancer and developing lymphoedema.

Physical and psychosocial burden due to lymphatic filariasis as perceived by patients and medical experts.

Patients with lymphatic filariasis (LF) face considerable physical, psychological and social disabilities. Morbidity management and control are important components of the Global Programme to Eliminate Lymphatic Filariasis. But information on the various disabilities caused by LF is scanty. We measured the severity levels of seven health states of LF in the physical and psychosocial domains of health from the perspective of patients and medical experts, using a 7-domain 5-level (7D5L) descriptive system. Adenolymphangitis had the highest severity levels in all domains of health followed by lymphoedema grade 4 (L4), lymphoedema grade 3 (L3), hydrocele grade 2 (H2), lymphoedema grade 2 (L2), lymphoedema grade1 (L1) and hydrocele grade 1 (H1). People with higher grades of lymphoedema and hydrocele had more severe psychosocial problems than physical ones. Severity levels assessed by medical experts were lower than those reported by sufferers. These findings indicate that LF has considerable impact on the physical, mental and social domains of health. Morbidity management programmes should be broadened to include counselling, rehabilitation and health education to manage the psychosocial problems caused by LF.

Lymphangitis carcinomatosis of unknown origin presenting as severe pulmonary hypertension.

An apparently healthy 46-year-old woman was admitted because of progressive shortness of breath that had begun 2 months before her admission. Physical examination revealed a patient with respiratory distress, tachycardia, and mild jugular venous distention; otherwise, results were unremarkable. Our investigation revealed hypoxia and severe pulmonary hypertension with signs of right heart dysfunction, but no primary cause was found. The patient died 5 days after admission. Autopsy revealed pulmonary lymphangitis carcinomatosis caused by papillary carcinoma. No primary tumor was found.

Management of disability in lymphatic filariasis--an update.

The global lymphatic filariasis elimination programme incorporates disability management along with transmission control, to ensure 'a visible impact' on those who are already affected by the disease. The common manifestations of lymphatic filariasis like lymphoedema; elephantiasis and hydrocele result from irreversible damage caused to the lymphatics by the adult worms. Only palliative treatment in the form of physical methods and surgery is available for lymphoedema and elephantiasis. Hydrocele can be corrected by surgery. The most distressing aspect of lymphatic filariasis is the attacks of acute adenolymphangitis, which cause considerable short-term and also long-term disability by worsening the lymphoedema. Since each episode prevents the person from attending his work for several days, the economic loss is substantial. The precipitating cause of these attacks is secondary infection, the bacteria entering the tissues through 'entry lesions' in the skin. These episodes can very well be prevented by proper 'local-hygiene' of the affected limbs, which is a simple, effective, cheap and sustainable method that can be carried out even in the patient's house. These subjects and the providers of 'home care' should be trained in foot-hygiene programme, so that the message percolates to various levels in the affected communities, ultimately benefiting the patient.

Association between milk production, somatic cell count and bacterial dermatoses in three dairy cattle herds.

OBJECTIVE: To determine the correlations between three bacterial dermatoses in cattle, milk production and bulk-milk somatic cell count (BMSCC). DESIGN: Field observations in three dairy cattle herds. METHODS: Milk production, BMSCC, fertility and all herd diseases were recorded by computerised dairy management systems. Each herd was visited twice weekly and the clinical signs, course of diseases and morbidity and culling rates were noted. Bulk-tank milk was sampled twice monthly and analysed for somatic cell count. Bacteriological and histological examinations were carried out from samples collected from affected animals in the respective herds. RESULTS: The acute exudative form of dermatophilosis was diagnosed only in first-calving cows. The morbidity rate was 53% and the culling rate was 16% of the affected animals. The BMSCC increased by a factor of 2.4 times, and there was an average loss of milk production of 30%/cow/day in affected animals. Ulcerative lymphangitis was diagnosed in first-calving cows (22%) and older cows (15%). The culling rate was 28%. The BMSCC increased by a factor of 17.3 times, and the average loss of milk production was 5.5%/affected animal/day. Papillomatous digital dermatitis (PDD) was diagnosed in first-calving cows (25%) and in older cows (18%). The culling rate was 8%. The BMSCC increased by a factor of two times, and the average loss of milk production was 1.7%/affected animal/day. CONCLUSIONS: The correlations between three skin diseases (ulcerative lymphangitis, dermatophilosis, papillomatous digital dermatitis), milk production and BMSCC have been found to be unfavourable.

Current aspects of bacterial infections of the skin.

The practicing dermatologist is faced with an ever-changing epidemiologic spectrum of cutaneous bacterial diseases. Studies have stated that bacterial skin infections may account for up to 17% of clinical visits. It is hoped that the information presented in this article will enable the practicing dermatologist to provide improved patient care in the diagnosis and management of bacterial infections of the skin.

Unusual mucoid impaction in a case of bronchogenic carcinoma. A case report on mucoid impaction caused by carcinomatous lymphangitis of the bronchial wall distant from the primary lesion.

An unusual mucoid impaction in a case of bronchogenic carcinoma is presented. While mucoid impaction occurred in the upper lobe of the bronchus, the primary site of the adenocarcinoma was found in the lower lobe at autopsy. Mucoid impaction was caused by marked carcinomatous lymphangitis of bronchial wall far distant from the primary lesion. The development of mucoid impaction in the case presented is the first report to the best of our knowledge.

[Diffuse pulmonary carcinomatous lymphangitis. Study of respiratory function in 18 cases]. / Lymphangite carcinomateuse pulmonaire diffuse. Etude de la fonction respiratoire dans 18 cas.

Respiratory function studies were carried out in 18 patients with diffuse and isolated pulmonary lymphangitis (LCP) diagnosed on radiological and cyto-histological grounds. Restrictive ventilatory defects were found in 17 out 18 cases CPT: 75,3% (DS = 5), CV: 56.7% (DS = 14,5). The Tiffeneau coefficient was less than 65% in 50% of cases but the DEM/CV was reduced in 77% of cases, evidence of the great frequency of airflow obstruction. The measure of the (formula; see text) was normal in 5 out of 17 cases, implying the absence of an alveolar neoplastic lesion or obliteration by arteritis or capillaritis in LCP. The alveolar-arterial oxygen gradient on hyperoxia was normal (less than 27 kPa) 14 times out of 18 and slightly increased in 4. Important hypoxaemia at rest was present 17 times out of 18; PaO2: 8 kPa (DS = 1). There was no patient with alveolar hyperventilation: PaCO2: 4.3 kPa (DS = 0.5). On exercise, hypoxaemia remained stable 4 times, improved 5 times and worsened 9 times. A pathophysiological interpretation was given for each disturbance of respiratory function. In conclusion, a characteristic respiratory function profile of LCP is proposed, with a restrictive ventilatory disturbance or moderate mixed picture, a DLCO/VA ratio generally normal, almost constant hypoxaemia at rest and improvement or worsening on exercise. CPT = Mean total lung capacity. CV = Mean vital capacity. DS = Standard deviation.