BACKGROUND AND OBJECTIVE: Visual disorders, even blindness, are serious complications of polymyalgia rheumatica (PMR) associated with temporal arteritis. Their early recognition in patients at high risk is essential to avoid the development of such visual disorders. It was the aim of this study to identify these risk factors. PATIENTS AND METHODS: Clinical and laboratory data and biopsy findings in 131 patients (94 women, 37 men; mean age 74 years) with PMR and concomitant temporal arteritis were analysed retrospectively. RESULTS: Visual disorders occurred in 61 of the 131 patients. Temporal artery biopsy was not sufficient to detect those at high risk. But this was possible by identifying a typical clinical pattern in that most patients with visual disorders had severe cerebral symptoms, while they had only minor forms of PMR and few generalized symptoms. There was no correlation between any of the laboratory tests and high risk. CONCLUSIONS: A typical pattern of clinical manifestations can provide early identification of those patients who have PMR associated with temporal arteritis and are at high risk of developing visual disorders.

Aged↗

PubMed1999

[The rare differential diagnosis of a mediastinal space-occupying lesion].

HISTORY AND CLINICAL FINDINGS: Two months before admission a 31-year-old man first noted a painless swelling on the right side of his neck without any associated symptoms. Physical examination revealed a painless right cervical node 4 cm in diameter. INVESTIGATIONS: Magnetic resonance imaging demonstrated a large right-sided cervical tumour which extended into a mediastinal mass 11 cm in diameter. The excised cervical node showed a Hodgkin's lymphoma. Further tests to stage the disease revealed a 1.5 cm tumour in the right testis. Removal of the latter showed a mixed testicular tumour. Mediastinoscopic biopsy confirmed Hodgkin's lymphoma of the mediastinal mass. TREATMENT AND COURSE: Standard chemotherapy of the Hodgkin's lymphoma was undertaken, followed by "extended field" radiation which has so far secured a remission of two years. CONCLUSION: Histological diagnosis is always essential in the case of an unusual tumour location so that a synchronous second tumour may be revealed. If there is a second tumour, exact histological classification with definitive staging of the tumours is necessary to ensure adequate treatment.

Adult↗

PubMed1997

[The synchronous occurrence of acute myeloid leukemia and kidney carcinoma].

HISTORY AND CLINICAL FINDINGS: During the past year a 52-year-old man had developed quarterly bouts of fever, up to 38.5 degrees C, associated with fatigue and arthralgia. The fourth bout continued as undulating periods of fever with markedly impaired general state. Physical examination was unremarkable except for mild generalised lymphadenopathy. INVESTIGATIONS: Extensive imaging and serological studies failed to find an infectious or autoimmunological cause. But computed tomography and angiography revealed a space-occupying lesion in the left kidney, yet the suspected diagnosis of renal carcinoma insufficiently explained the clinical picture. DIAGNOSIS TREATMENT AND COURSE: Haematological tests having shown anaemia (Hb 8.1 g/dl) and blast cells (10%) in the peripheral blood a bone marrow biopsy was performed which indicated acute myeloid leukaemia. Three courses of intensive chemotherapy brought about only partial remission and the patient died 6 months later from a cerebral haemorrhage. An autopsy confirmed both the acute myeloid leukaemia and a renal carcinoma. CONCLUSION: The possibility of synchronous occurrence of two malignancies should always be kept in mind especially if the initially diagnosed tumor cannot explain the clinical symptoms.

Acute Disease↗

PubMed1997

Successful treatment of stage-IIIB seminoma with single-agent carboplatin therapy.

Single-agent carboplatin chemotherapy has recently been introduced into the therapy of limited seminoma. Because of poor compliance due to Down's syndrome we successfully treated a 32-year-old man with relapsed stage-IIIB seminoma with a dose-modified carboplatin monotherapy schedule leading to complete remission even after a follow-up of 4 years.

Adult↗

PubMed1996

Acquired C 1-inhibitor deficiency with angioedema due to pleomorphic immunocytoma in a patient with three malignant tumors: long-term follow-up data and presentation of an additional case.

Two cases of lymphoma-associated acquired C 1-inhibitor deficiency are described. In both patients, C 1-inhibitor deficiency and related symptoms preceded the diagnosis of the underlying neoplasm by several months. C 1-inhibitor deficiency was most likely due to consumption following immunocomplex formation. In both patients, a close relationship between low levels of C 1-inhibitor and tumor relapse was observed during follow-up. These findings indicate that measurement of C 1-inhibitor and complement factor C4 can be used as markers of disease activity in affected patients.

Angioedema↗

PubMed1994

Predominant myocardial sarcoidosis.

Unexpected autopsy findings of a predominantly myocardial sarcoidosis are reported. For a period of two years prior to death, the 42-year-old man suffered from atypical angina pectoris and ventricular arrythmias with episodic ventricular fibrillation. Echocardiography revealed a non-obstructive hypertrophic cardiomyopathia. He succumbed to sudden cardiac arrest. Sarcoidosis granulomas were widespread in the ventricular and atrial myocardium with intensive involvement of the sinus node, atrioventricular node, and the main bundle of His. According to a review of the previous literature on this subject, an obviously deleterious obstructive granulomatous angiitis of the sinus node's central artery was found for the first time.

Adult↗

PubMed1993

Thrombendarteriitis pulmonalis carcinomatosa Ceelen: an immunohistological investigation.

A 65-year-old woman died in sudden right heart failure caused by thrombendarteriitis pulmonalis carcinomatosa Ceelen 16 months after resection of a rectal carcinoma. Autopsy disclosed a complex picture of multiple tumour cell emboli in small pulmonary arteries associated with local thrombosis and thrombus-associated vessel wall reaction. This was characterized by movement of medial muscle cells into the thrombus. In addition, affected vessels showed a prominent perivascular tumour-related infiltration by lymphocytes which are identified immunohistochemically as CD3-reactive T-cells.

Aged↗

PubMed1991

Study of the relationship between immunohistologically demonstrated lymphocytes infiltrating human breast carcinomas and patients' survival.

Eighty-five breast carcinomas were immunostained for CD3-, CD4-, CD8-, CD16-, CD22-, CD38- and CD57-positive lymphocyte subpopulations. The results were related to follow-up data (median follow-up 46 months) of 74 patients regarding overall survival and 73 patients in respect to disease-free survival. Whereas the number of axillary lymph node metastases (P less than 0.01) and the hormone receptor status (P less than 0.01) resulted in significantly different survival curves for overall survival, not one of the lymphocyte subset infiltrats correlated significantly which overall survival. For disease-free survival, pT stage (P less than 0.01) and nodal (P less than 0.01) and hormone receptor status (P less than 0.05) proved to be prognostically important. However, disease-free survival was not influenced by the infiltration of any lymphocyte subset.

Adult↗

PubMed1991

Effects of acute normovolemic hemodilution on splanchnic oxygenation and on hepatic histology and metabolism in anesthetized pigs.

Perioperative hemodilution (HD) has become an accepted means of reducing transfusion requirements. Therefore, the effects of limited (decrease in hematocrit [Hct] from 30 to 20%, "HD1") and severe (decrease in Hct from 20 to 14%, "HD2") acute normovolemic HD with 6% hydroxyethyl starch on splanchnic blood flows (electromagnetic flow probes), O2 uptakes and deliveries, surface O2 tensions (PO2) (Clark-type electrode), hepatic metabolism (organic acids), and hepatic histology (liver biopsies) were studied in nine pigs anesthetized and paralyzed with ketamine/flunitrazepam and pancuronium. HD1 caused significant (P less than 0.05) increases in cardiac output and all splanchnic flows. Only hepatic arterial blood flow increased twice as much as did cardiac output. Except for hepatic arterial O2 delivery, all splanchnic O2 deliveries decreased. Splanchnic O2 extractions increased, and O2 uptakes remained unchanged. There were no changes in mean surface PO2 values or in surface PO2 histograms of liver and small intestine; in portal or hepatic venous pH; and in hepatic uptake of pyruvate and lactate. In contrast, during HD2 (despite further increases in flows and O2 extractions) portal and hepatic venous pH decreased; mean surface PO2 of liver and small intestine decreased; and the liver surface PO2 histogram showed broadening and a shift to the left. However, hepatic uptake of lactate and pyruvate, and splanchnic O2 uptake remained unchanged, and histologic examination did not reveal significant cell injury. These data indicate that in this experimental model limited acute normovolemic HD was well tolerated by the splanchnic organs. After severe HD, gross liver function remained intact, but there was evidence that compensatory mechanisms (increases in flow and O2 extractions) were no longer fully able to counteract the decrease in splanchnic O2 delivery.

Anesthesia↗

PubMed1990

Postoperative active specific immunization in colorectal cancer patients with virus-modified autologous tumor-cell vaccine. First clinical results with tumor-cell vaccines modified with live but avirulent Newcastle disease virus.

Sixteen patients with colorectal carcinoma Dukes' Stage B2, C, or D were treated with an autologous virus-modified tumor-cell vaccine after potential curative tumor resection (R0-Resection). An inoculum of 1 X 10(7) cells incubated with 32 hemagglutination units of nonirradiated Newcastle disease virus (NDV) was given intracutaneously up to four times at 10-day intervals. The delayed-type hypersensitivity (DTH) skin reaction was measured. The vaccination was well tolerated. In 11 of 16 patients an increasing reactivity against the vaccine was observed during the vaccination procedure. A challenge test using autologous tumor cells without NDV after the vaccination cycle revealed a specific antitumor sensibilization in 12 patients. The DTH response was not due to bacterial contamination or sensibility to the virus. Histologic examination of the vaccination site showed a dense infiltration of predominantly helper T-lymphocytes. We conclude that in most of the patients treated active, specific immunization led to a specific antitumor sensitivity.

Adult↗

PubMed1987

Immunohistological analysis of lymphocyte subpopulations infiltrating breast carcinomas and benign lesions.

We characterized different subpopulations of infiltrating mononuclear cells using 8 monoclonal antibodies (MAbs) on serial cryosections of breast tissue from 85 cancer patients and 32 samples of benign lesions, and the ABC technique. In general, lymphocytes were found more frequently and more abundantly in cancerous lesions. The infiltrates consisted mainly of T-cells in close contact with malignant cell-nests. T-helper/inducer cells clearly predominated over T-suppressor/cytotoxic cells in neoplastic tissues, whereas in benign tissues the T-helper/suppressor ratios seemed to be well balanced. While a few MAb Leu-7 (HNK-I)-reactive NK cells were found in the stroma of the breast tumors, none could be identified in the noncancerous lesions. The correlation of these data with histology and tumor stage of patients has been evaluated by a quantitative approach using planimetry in an interactive registration system.

Adult↗

PubMed1986

Distribution pattern of lymphocyte subpopulations in human tonsils as analysed by monoclonal antibodies with double immunoenzymatic labeling.

The distribution of B- and T-lymphocytes, T-cell subpopulations, including natural killer cells and monocytes/macrophages, was studied in cryostat sections of human tonsils by the avidin-biotin-peroxidase technique using monoclonal antibodies. A double immunostaining procedure was also developed to detect two types of lymphocytes on one single section simultaneously using horseradish peroxidase and alkaline phosphatase as labeling enzymes. The primary follicles and the germinal centers of the secondary follicles were mainly found to be positive for B-cells. T-cells were predominantly localized in the follicular caps and in the interfollicular areas. The ratio of helper/inducer cells to suppressor/cytotoxic cells was in favour of helper T-cells. Both subpopulations were also predominant in follicular caps and interfollicular areas. The quantity of natural killer cells was very variable and nearly all were localized exclusively in the germinal centers. Monocytes/macrophages were only seen occasionally in the interfollicular areas. The double-immunoenzymatic labeling was useful for the visualization of combinations of antigens, however, without demonstrating the presence of two different surface antigens on one single cell.

Antibodies, Monoclonal↗