[The morphological aspect of the lymph nodes in acquired immunodeficiency (AIDS)].
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Biomedical subjects
Publications and source records attributed to S Leahu.
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A patient with non-cutaneous lymphocytic lymphoma with leukaemic spread is reported. The large majority of the peripheral blood mononuclear cells formed rosettes with sheep erythrocytes (E), had receptors for the Fc portion of IgG (Fc gamma R) and displayed an unusual enzymatic profile. Part of these cells had also labile bound surface membrane IgG. The leukaemic cells were morphologically characterized as large granular lymphocytes (LGL) and consisted of two different types of cells: lymphoid cells and monocytoid cells. The histopathological diagnosis was T-cell lymphoma, pleomorphic type, diffuse. Despite their morphological heterogeneity, all the proliferative cells had the same immunological phenotype, showed normal ADCC activity but no NK activity. After three months, without specific treatment, the surface pattern changed: the cells resembled mature LGL and the NK activity increased. The cytochemical study of the leukaemic cells revealed an enzymatical peculiarity: besides an enzymatic profile characteristic for relatively mature LGL, the cells also displayed peroxidase activity. This unusual aspect--the expression by an individual malignant cell of markers believed to be restricted to a single cellular lineage--might be interpreted as a lineage infidelity or lineage promiscuity. The observation that this lymphoma developed in a patient with a long history of hypogammaglobulinaemia is of particular interest.
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The persistence of contrast medium in the inguinal and retroperitoneal lymph nodes was observed in 104 cases of Hodgkin's disease. Systematic observations were continued until the contrast medium had disappeared completely. The maximum period of observation was 36 months. The following conclusions were reached: a) There is a difference in the behaviour in the contrast medium in normal and abnormal lymph nodes. b) There is a difference in behaviour between various groups of lymph nodes in patients with negative lymphographic findings. c) In patients with positive lymphographic findings the behaviour of the contrast medium varies depending on the histology and radiological appearances of the lymph nodes. An attempt to correlate the persistence of contrast medium with survival time has shown that there is a shorter period of survival in those patients in whom the contrast medium disappeared most quickly from the abnormal nodes. The persistence of contrast medium in the lymph nodes should be borne in mind during treatment planning.
In 88 patients with Hodgkin's disease the clinical value of the general lymphographic picture (lymphodynamic aspects plus nodal patterns) is analysed. The survival times are also reported according to the different pre- and postlymphographic evolution. Histologic types and prelymphographic therapy are correlated with the general lymphographic picture. The predominance of foamy and/or spotty lymphographic patterns of lymph nodes as well as the lymphatic blockages have a severe prognosis (mean intervals between lymphography and exitus 8.3 and respectively 6.2 months). In such cases lymphocytic depletion represents the most frequent histologic type.
To perform the ever increasing number of analyses with a minimum equipment the tendency all over the world is now to replace the classical tests with screening tests. The laboratory of enzymology of the Institute of Internal Medicine has achieved screening tests for the estimation of alkaline phosphatase, of total lactatedehydrogenase and of its fraction I, whose results are in agreement with the reference methods of Bessy-Lowry-Brock and of Lac-Dehystrate-Goedecke in cases of acute and chronic liver diseases, neoplasms, bone diseases (Paget's disease) and myocardial infarction.
The persistence of Lipiodol in various lymph node groups was followed up by systematic lymphographic control. Assuming a certain relationship between the barrier function of the lymph nodes and the persistence of their image on the film the authors have tried to find out whether the duration of Lipiodol persistence may be a test for the estimation of prognosis in Hodgkin's disease. The observation of such cases has shown that Lipiodol is retained for a longer period in the external iliac and lombo-aortic lymph nodes as well as in the pathologic ones, except those with lymphocyte depletion, whereas it is very rapidly eliminated from the inguinal nodes. These findings seem to prove that Hodgkin's disease is more severe in patients in whom the barrier function of the lymph nodes is defective i.e. unable to retain the foreign substances introduced in the organism. These conclusions should be further verified by comparison with other clinical and biologic factors.
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