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Results for “Dissemination”

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PubMed2005

Down-regulation of CD9 in human ovarian carcinoma cell might contribute to peritoneal dissemination: morphologic alteration and reduced expression of beta1 integrin subsets.

Peritoneal dissemination is one of the main causes of death in cancer patients. Pathophysiology of metastasis has been well investigated, but the mechanism of diffuse spread of tumor colonies in the peritoneal cavity is not fully understood. CD9 is a member of tetraspanin and its down-regulation is known to be involved in poor prognosis. To investigate the significance of the down-regulation of CD9, HTOA, an ovarian carcinoma cell line that highly expressed CD9, was transiently transfected with small interfering RNA (siRNA) against CD9, and CD9-negative cells (HTOA(CD9-)) were purified. HTOA(CD9-) showed altered adhesion patterns on Matrigel, collagen, fibronectin, and laminin compared with those of control siRNA-transfected HTOA (control-HTOA). Flow cytometry and fluorescence cytostainings revealed that the expression levels of integrins beta1, alpha2, alpha3beta1, alpha5, and alpha6 were lower in HTOA(CD9-) than those of control-HTOA. HTOA(CD9-) showed altered expression of junctional and cytoskeletal molecules. By time-lapse video microscopy, control-HTOA showed solid adhesion to extracellular matrix and formed cobblestone pattern, whereas HTOA(CD9-) showed weaker adhesion and were distributed as diffuse spots. To examine whether the expression level of CD9 change during tumor dissemination, HTOA-P, a highly disseminative subclone of HTOA, was established. HTOA-P showed distinctive down-regulation of CD9 at mRNA and protein levels, and showed similar morphologic alteration as HTOA(CD9-) did. These findings indicate that the down-regulation of CD9 may be an acquired event in the process of tumor dissemination. Down-regulated CD9 may attenuate the expression of several integrins and rearrange junctional and cytoskeletal molecules that might contribute to dissemination of ovarian carcinomas.

Adenocarcinoma↗

PubMed1999

Respiratory epithelial ion transport in patients with disseminated bronchiectasis.

The nosological limits between disseminated bronchiectasis and cystic fibrosis (CF) remain unclear. In patients with isolated congenital bilateral absence of the vas deferens, a forme fruste of the CF disease, a normal baseline nasal transepithelial potential difference (PD) but an impaired response to pharmacological interventions have been reported. The purpose of the present study was to explore ion transport in respiratory epithelium from patients with disseminated bronchiectasis. The PD under both baseline and pharmacological interventions was investigated in 13 healthy subjects, six patients with genetically proven CF and 15 patients with disseminated bronchiectasis as confirmed by computed tomography scan. Baseline PD was similar in the control and bronchiectasis groups but, as expected, was significantly more negative in the CF group. Patients with bronchiectasis responded to pharmacological tests (sequential perfusion with amiloride, chloride-free solution, isoprenaline and uridine triphosphate (UTP) similarly to healthy subjects. In contrast, CF patients exhibited an increased response to amiloride and an impaired response to chloride-free solution and isoprenaline. The data show that patients with disseminated bronchiectasis exhibit normal electrophysiological properties in their nasal epithelium. Nasal transepithelial potential difference including pharmacological tests may appear a valuable diagnostic procedure for cystic fibrosis with disseminated bronchiectasis.

Adolescent↗

PubMed2007

Detection of disseminated tumor cells in liver biopsies of colorectal cancer patients is not associated with a worse prognosis.

BACKGROUND: Liver metastases occur frequently in colorectal cancer and are probably caused by disseminated tumor cells having been trapped in the liver. The prognostic significance of hematogenous tumor cell dissemination has already been demonstrated for blood and bone marrow of patients with colorectal cancer. The aim of this study was to investigate the frequency and prognostic significance of disseminated tumor cells in liver biopsies of colorectal cancer patients. METHODS: Liver biopsies from 100 patients with UICC stage I-III colorectal cancer were taken prospectively during resection of the primary tumor. Liver biopsies obtained from 16 patients with benign gastrointestinal diseases served as negative controls. Liver samples from seven patients with liver cirrhosis were additionally taken. Liver biopsies were examined using a reverse transcriptase (RT)-PCR assay to amplify cytokeratin (CK) 20 transcripts. The median follow-up of the patients was 55 months. RESULTS: Disseminated tumor cells were detected in liver samples of 10/100 (10%) patients with UICC stage I-III colorectal cancer. Liver specimens from all seven patients with liver cirrhosis were CK 20-positive, whereas 16 patients with other benign gastrointestinal diseases were all CK 20-negative. There was no correlation between tumor cell detection in liver biopsies and survival of the patients. The only significant prognostic factor on uni- and multivariate analysis was the UICC stage. CONCLUSIONS: This study demonstrates that detection of disseminated tumor cells in liver samples from patients with UICC stage I-III colorectal cancer has no prognostic influence. UICC classification was the strongest prognostic factor in this patient series.

Aged↗

PubMed1998

Treatment and prophylaxis of disseminated Mycobacterium avium complex in HIV-infected individuals.

OBJECTIVE: To review the pathophysiology, epidemiology, treatment, and prophylaxis of disseminated Mycobacterium avium complex (MAC) infection in HIV-infected individuals. DATA SOURCES: A MEDLINE (January 1966-July 1997) and AIDSLINE (January 1980-July 1997) search of basic science articles pertinent to the MAC infection in HIV-infected patients. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: The organism, epidemiology, and pathophysiology of disseminated MAC are discussed for background. A review of clinical trials for the treatment and prophylaxis of disseminated MAC are presented, along with unresolved issues concerning these topics. CONCLUSIONS: The incidence of disseminated MAC has increased dramatically with the AIDS epidemic. The infection can lead to increased morbidity and mortality in HIV-infected patients. Treatment regimens for patients with a positive culture for MAC from a sterile site should include two or more drugs, including clarithromycin. Prophylaxis against disseminated MAC should be considered for patients with a CD4 cell count of less than 50/mm3.

4-Quinolones↗

PubMed2006

Host defence against disseminated Candida albicans infection and implications for antifungal immunotherapy.

The different manifestations of Candida albicans infection are dictated by an underlying defect in the immune response of the host. Protective immunity to disseminated candidiasis, the manifestation of C. albicans infection discussed in this review, has traditionally been ascribed to innate immunity with emphasis on the role of granulocytes. Lately, however, immunological studies have learned that host defence against disseminated candidiasis is based on a complex interplay between innate and cell-mediated immunity. Despite the availability of new antifungal agents, mortality associated with disseminated C. albicans infection remains high. Immunotherapy that augments host defence is an important strategic option in the battle against disseminated candidiasis. Here, the authors review the chronological events in the pathogenesis of disseminated candidiasis that aid in predicting the impact of existing immunotherapy and the development of future immunomodulating strategies.

Adjuvants, Immunologic↗

PubMed2005

Quantitative trait loci that control dengue-2 virus dissemination in the mosquito Aedes aegypti.

The mosquito Aedes aegypti is the most important vector of yellow fever and dengue fever flaviviruses. Ae. aegypti eradication campaigns have not been sustainable and there are no effective vaccines for dengue viruses. Alternative control strategies may depend upon identification of mosquito genes that condition flavivirus susceptibility and may ultimately provide clues for interrupting transmission. Quantitative trait loci affecting the ability of Ae. aegypti to develop a dengue-2 infection in the midgut have been mapped previously. Herein we report on QTL that determine whether mosquitoes with a dengue-2-infected gut can then disseminate the virus to other tissues. A strain selected for high rates of dengue-2 dissemination was crossed to a strain selected for low dissemination rates. QTL were mapped in the F(2) and again in an F(5) advanced intercross line. QTL were detected at 31 cM on chromosome I, at 32 cM on chromosome II, and between 44 and 52 cM on chromosome III. Alleles at these QTL were additive or dominant in determining rates of dengue-2 dissemination and accounted for approximately 45% of the phenotypic variance. The locations of dengue-2 midgut infection and dissemination QTL correspond to those found in earlier studies.

Aedes↗

PubMed2007

Disseminated malignancy misdiagnosed as thrombotic thrombocytopenic purpura: A report of 10 patients and a systematic review of published cases.

BACKGROUND: Patients with disseminated malignancy who present with microangiopathic hemolytic anemia and thrombocytopenia may be misdiagnosed as thrombotic thrombocytopenic purpura (TTP), resulting in inappropriate plasma exchange treatment, a procedure with major risk, and delay of appropriate chemotherapy. PURPOSE: To assess clinical features that may distinguish occult disseminated malignancy from TTP. PATIENTS AND METHODS: We report the 17-year experience of The Oklahoma TTP-Hemolytic-Uremic Syndrome (HUS) Registry (1989-2005) and a systematic review of previously published case reports. RESULTS: Ten of 351 patients in the Oklahoma Registry who were initially diagnosed with TTP and treated with plasma exchange were subsequently discovered to have disseminated malignancy. Only one patient had a history of cancer. In these 10 patients, neurologic abnormalities, hematocrit, platelet count, and serum creatinine were not different from the 133 concurrent patients with idiopathic TTP. Patients with disseminated malignancy had a longer duration of symptoms, more frequent presence of respiratory symptoms, higher lactate dehydrogenase levels, and more often failed to respond to plasma exchange treatment. Diagnosis of malignancy was made by bone marrow biopsy in six patients but not until autopsy in two patients. A systematic literature review identified 19 additional patients, reported from 1965 to 2005, in whom TTP or HUS was initially suspected and systemic malignancy was subsequently discovered. Fourteen different malignant disorders were diagnosed in these 29 patients. CONCLUSIONS: Occult disseminated malignancy may mimic TTP. A search for systemic malignancy, including a bone marrow biopsy, is appropriate when patients with TTP have atypical clinical features or fail to respond to plasma exchange.

Adult↗

PubMed1993

The dissemination of smoking cessation methods for pregnant women: achieving the year 2000 objectives.

The smoking prevalence rate among adult women and pregnant women has decreased only 0.3 to 0.5% per year since 1969. Without a nationwide dissemination of efficacious smoking cessation methods based on these trends, by the year 2000 the smoking prevalence among pregnant women will be approximately 18%. This estimate is well above the US Department of Health and Human Services Year 2000 Objective of 10%. The US dissemination of tested smoking cessation methods could help an additional 12,900 to 155,000 pregnant smokers annually and 600,000 to 1,481,000 cumulatively to quit smoking during the 1990s. Dissemination could help achieve 31 to 78% of the Year 2000 Objectives for pregnancy smoking prevalence. (With dissemination, at best a 15% smoking prevalence during pregnancy, rather than the 10% objective, is likely to be observed.) Our results confirm a well-documented need for a national campaign to disseminate smoking cessation methods.

Adult↗

PubMed1994

Ventricular entry during resection of malignant gliomas: effect on intracranial cerebrospinal fluid tumor dissemination.

The ventricular system is not infrequently entered during the course of maximum cytoreductive surgery for high-grade supratentorial gliomas. It is unclear if ventricular entry during surgery and/or proximity of the tumor to the ventricular system affects cerebrospinal fluid (CSF) tumor dissemination or the patients' overall survival rate. The authors retrospectively reviewed hospital records and neuroradiological studies of 51 patients operated on at the University of Washington between 1987 and 1991. Inclusion in this study necessitated a pathological diagnosis of malignant glioma and the availability of preoperative and postoperative computerized tomography scans or magnetic resonance images. Patients were excluded from the study if they had radiographic evidence of ventricular entry or CSF tumor dissemination prior to referral to the authors' institution. The index operation was defined as the first operation at the University of Washington or (in those patients with ventricular entry) the operation in which the ventricle was entered. Patients were followed until time of death or, in the case of survivors, until February, 1992. The effect of both ventricular entry and the proximity of the tumor to the ventricular system on CSF tumor dissemination and survival rate was assessed using statistical survival methodology. There was no significant difference in time from diagnosis to the index operation between groups compared (Mann-Whitney U-test, p > 0.40). Cerebrospinal fluid dissemination was radiographically documented in 18 patients (35%) following the index operation. This occurrence was not significantly influenced by either ventricular entry during surgery (Mantel-Cox test, p = 0.13), the proximity of the tumor to the ventricular system (p = 0.63), or these two variables combined (p = 0.28). Survival rate following the index operation was not significantly affected by ventricular entry (p = 0.66), proximity of the tumor to the ventricular system (p = 0.61), or these two variable considered in combination (p = 0.44). However, survival rate was significantly decreased once CSF tumor dissemination had occurred (Cox model, p = 0.03).

Adult↗

PubMed2003

[Pathogenesis of Trichosporon asahii and strategies for infectious control of disseminated trichosporonosis].

Deep-seated trichosporonosis is a lethal opportunistic infection in immunocompromised patients. Trichosporon asahii and T. mucoides are the most common strains of fungi that cause disseminated trichosporonosis. Thirteen patients were diagnosed with disseminated trichosporonosis over a 20 year period in Oita Medical University Hospital. The majority of them had underlying hematologic malignancies, for which they received cytotoxic chemotherapy resulting in neutropenia. For the rapid diagnosis of this condition, we developed a novel nested-PCR assay that detected DNA specific for Trichosporon asahii and Trichosporon mucoides in the serum of patients with the condition. In a retrospective study using these serum samples, the specific DNA fragment was detected a few days to a few weeks earlier than blood culture. To treat this infection, we studied the efficacy of granulocyte colony-stimulating factor (GCS-F) alone and in combination with antifungal agents against disseminated trichosporonosis in neutropenic mice. The results suggested that GCS-F might be a useful immunomodulator against Trichosporon infections in neutropenic mice and the therapeutic outcome improved when used in combination with fluconazole. Furthermore our experimental animal model demonstrated that disseminated trichosporonosis is induced by immunosuppresion in hosts with latent trichosporonemia which was detectable by the nested PCR but not by blood culture. We found that there is a critical period for the progression of disseminated trichosporonosis after entry of fungi into the bloodstream.

Aged↗

PubMed2003

[Disseminated Fusarium solani infection in patients undergoing hematopoietic stem cell transplantation].

A patient with a hematological malignancy is one example of a type of immunocompromised host, and critical opportunistic infections such as mycosis are not rare during medical treatment for such malignancy. Candidiasis and aspergillosis are typical mycoses and their importance has been recognized widely and great progress attained in their prevention and medical treatment. However, allogenic hematopoietic stem cell transplantation (allo-HSCT) to treat hematological malignancy has spread, and the increase in emerging mycoses such as Fusarium infection is reported. Fusarium spp. are common soil organisms and important plant pathogens, and have been conventionally known as a causative fungus of superficial mycosis in the dermatology and the ophthalmology domain. Reports of profound or disseminated Fusarium infection are found in immunocompromised hosts with such condition as a hematological malignancy or organ transplant, and have shown an upward tendency in recent years. The symptoms of disseminated Fusarium infection are shown in many cases with persistent fever refractory to antibiotics and pneumonia, and this is a highly fatal infection which merges fungemia with multiple organ injury such as that in the lung, liver, spleen, kidney, and the heart. Disseminated Fusarium infection has a high rate of isolation in blood cultures, and the rate of diagnosis while a patient is alive is high compared with aspergillosis, zygomycosis, etc. Despite the administration of anti-fungal drugs following allo-HSCT, two reported cases showing the symptoms of disseminated Fusarium infection finally died. Although definite diagnosis of these cases was made by blood cultures, no medical treatment effect with the anti-fungal drugs was determined. Since the existing antifungals are not expected to cure disseminated Fusarium infection certainly, an early diagnosis and the development of a new antifungal are desired to improve the medical treatment results.

Adult↗

PubMed2007

Detection of disseminated pancreatic cells by amplification of cytokeratin-19 with quantitative RT-PCR in blood, bone marrow and peritoneal lavage of pancreatic carcinoma patients.

AIM: To evaluate the diagnostic potential of cytokeratin-19 (CK-19) mRNA for the detection of disseminated tumor cells in blood, bone marrow and peritoneal lavage in patients with ductal adenocarcinoma of the pancreas. METHODS: Sixty-eight patients with pancreatic cancer (n = 37), chronic pancreatitis (n = 16), and non-pancreatic benign surgical diseases (n = 15, control group) were included in the study. Venous blood was taken preoperatively, intraoperatively and at postoperative d 1 and 10. Preoperative bone marrow aspirates and peritoneal lavage taken before mobilization of the tumor were analyzed. All samples were evaluated for disseminated tumor cells by CK-19-specific nested-PCR and quantitative fluorogenic RT-PCR. RESULTS: CK-19 mRNA expression was increased in 24 (64%) blood samples and 11 (30%) of the peritoneal lavage samples in the patients with pancreatic cancer. In 15 (40%) of the patients with pancreatic cancer, disseminated tumor cells were detected in venous blood and bone marrow and/or peritoneal lavage. In the peritoneal lavage, the detection rates were correlated with the tumor size and the tumor differentiation. CK-19 levels were increased in pT3/T4 and moderately/poorly differentiated tumors (G2/G3). Pancreatic cancer patients with at least one CK-19 mRNA-positive sample showed a trend towards shorter survival. Pancreatic cancer patients showed significantly increased detection rates of disseminated tumor cells in blood and peritoneal lavage compared to the controls and the patients with chronic pancreatitis. CONCLUSION: Disseminated tumor cells can be detected in patients with pancreatic ductal adenocarcinoma by CK-19 fluorogenic RT-PCR. In peritoneal lavage, detection rate is correlated with tumor stage and differentiation. In the clinical use, CK-19 is suitable for the distinction between malignant and benign pancreatic disease in combination with other tumor-specific markers.

Biomarkers, Tumor↗

PubMed2002

Reversal of coccidioidal anergy in vitro by dendritic cells from patients with disseminated coccidioidomycosis.

Coccidioides immitis is a pathogenic, dimorphic fungus found in the southwestern United States and is the causative agent of coccidioidomycosis. Extrathoracic dissemination of coccidioidomycosis is associated with a lack of cellular immunity. Dendritic cells (DCs) have been shown to initiate and modulate cellular immune responses. To determine whether DCs could modulate or initiate the immune response in this disease, monocyte-derived DCs were generated from coccidioidal Ag nonresponsive patients with disseminated coccidioidomycosis and healthy nonimmune individuals. DCs generated from both groups demonstrated phenotypes characteristic of DCs and stimulated strong allogeneic MLR. DCs from patients and healthy nonimmune individuals pulsed with the coccidioidal Ag preparation T27K induced lymphocyte proliferation. Mature DCs were much more efficient than immature DCs in these stimulations. Furthermore, restimulation of T27K-primed PBMC with Ag-pulsed DCs generated a C. immitis-specific cellular immune response in PBMC from patients with disseminated coccidioidomycosis as well as healthy nonimmune individuals. These results show that 1) DCs have the capacity to stimulate specific cellular immune responses from patients with disseminated coccidioidomycosis who are nonresponsive to coccidioidal Ag and healthy nonimmune individuals in vitro; 2) DCs can be used to screen coccidioidal Ags as candidates for human vaccine development; and 3) DC therapy may be useful in the treatment of disseminated coccidioidomycosis.

Antigens, Fungal↗

PubMed1999

A randomized trial of three marketing strategies to disseminate a screening and brief alcohol intervention programme to general practitioners.

BACKGROUND: Research findings are of little benefit to patients or society if they do not reach the audience they are intended to influence. A dissemination strategy is needed to target new findings at its user group and encourage a process of consideration and adoption or rejection. AIM: To evaluate the effectiveness and cost-effectiveness of different marketing strategies for the dissemination of a screening and brief alcohol intervention (SBI) programme to general practitioners (GPs). METHOD: Seven hundred and twenty-nine GPs, one per practice, from the former Northern and Yorkshire Regional Health Authority were randomly assigned to one of three marketing strategies: postal marketing (mailing a promotional brochure to GPs), telemarketing (following a script to market the programme over the telephone), and personal marketing (following the same script during face-to-face marketing at GPs' practices). GPs who took up the programme were asked if they would agree to use it. Outcome measures included the proportions of GPs who took up the programme and agreement to use it. RESULTS: Of the 614 GPs eligible for the study, 321 (52%) took the programme. There was a significant difference in the proportions of GPs from the three marketing strategies who took the programme (82% telemarketing, 68% personal marketing, and 22% postal marketing). Of the 315 GPs who took the programme and were eligible to use it, 128 (41%) agreed to use the programme for three months. GPs in the postal marketing group were more likely to agree to use the programme (55% postal marketing, 44% personal marketing, and 34% telemarketing). Personal marketing was the most effective overall dissemination strategy; however, economic analysis revealed that telemarketing was the most cost-effective strategy. Costs for dissemination per GP were: 13 Pounds telemarketing, 15 Pounds postal marketing, and 88 Pounds personal marketing. CONCLUSION: Telemarketing appeared to be the most cost-effective strategy for dissemination of SBI to GPs.

Alcohol Drinking↗

PubMed2000

Gi and Gq/11 proteins are involved in dissemination of myeloid leukemia cells to the liver and spleen, whereas bone marrow colonization involves Gq/11 but not Gi.

The migration of leukocytes into tissues is regulated by chemokines and other chemotactic factors that act on receptors that signal through Gi proteins. It seems likely that the colonization of tissues during dissemination of hematopoietic tumor cells is similarly regulated. In fact, dissemination of a T-cell hybridoma, a model for T lymphoma, was blocked when Gi proteins were inactivated by the S1 catalytic subunit of pertussis toxin that had been transfected into those cells. Pertussis toxin S1 blocked dissemination of MDAY-D2 murine myeloid leukemia cells to the liver and spleen, as in T-cell hybridoma cells, but it did not prevent bone marrow colonization. In contrast, overexpression of a function-defective mutant of the Gq/11 protein blocked dissemination to the bone marrow and also prevented Gq/11 dissemination to the liver and spleen. This indicates that the influx of these myeloid cells into all tissues requires the Gq/11 protein in addition to the Gi protein in the liver and spleen. (Blood. 2000;96:691-698)

Animals↗

PubMed2000

Experimental study of lymphogenous peritoneal cancer dissemination: migration of fluorescent-labelled tumor cells in a rat model of mesenteric lymph vessel obstruction.

Primary gastrointestinal cancer frequently spreads to the mesentery, omentum and other parts of the peritoneum, and these deposits are generally considered to be induced by intraperitoneal seeding from the primary lesion. However, a few peritoneal metastatic cases or cases with positive intraperitoneal lavage cytology, without serosal infiltration, have been reported. Most of peritoneal dissemination is certainly attended with serosal involvement of gastrointestinal malignancy. Nevertheless, we observe an unusual case of peritoneal dissemination without definite serosal invasion of the malignancy. And peritoneal dissemination is likely to be concomitant with lymph node metastasis in both cases with and without definite serosal invasion. In this study, we examined peritoneal cancer dissemination from the viewpoint of lymphogenous metastasis. For the model of lymphatic invasion, we established an animal experimental model of mesenteric lymph vessel obstruction. With these models, lymphangiographical studies were made on the fourth postoperative day (ten animals each) and we obtained mesenteric lymphangiograms of extensive mesenteric lymph vessels and reflux of lymph distal to the obstruction point from all ten animals. Next, in these experimental models, fluorescent-labelled tumor cells (rat hepatoma cell line, N1-S1) were infused from the mesenteric lymph node distal to the obstruction point on the fourth postoperative day (five animals each), and the migration of these tumor cells was investigated via fluorescent micrography. Subsequently, the fluorescent-labelled tumor cells were revealed in the mesenteric lymph nodes, mesenteric lymph vessels, interstitial tissues of the mesentery, submucosal lymph nodules and mucosal layer of the small intestine. Hence, lymphatic invasion and obstruction may cause extensive peritoneal dissemination via the lymphatic route.

Animals↗

PubMed2001

[A case of glioblastoma associated with dissemination, secondary to intratumoral hemorrhage].

The occasional occurrence of dissemination and tumor-associated hemorrhage from glioblastoma is well known and widely reported in the literature. The authors present a case of cerebral glioblastoma with dissemination possibly caused by intratumoral hemorrhage. Computed tomographic (CT) scan revealed a small hemorrhagic lesion in the right frontal lobe and a sylvian fissure in a 62-year-old man who complained of sudden headache. Four months later, he again presented with neck pain followed by weakness and numbness in the extremities. Magnetic resonance images (MRI) of the cervical spine demonstrated multiple enhanced tumors. After transfer to our institution, a large cystic tumor with ring-like enhancement was found in the right frontal lobe. Progressive neurological deficits prompted an operation on the cervical tumors and a pathological diagnosis of anaplastic astrocytoma with a negative reaction for glial fibrillary acidic protein (GFAP) was made. Intraoperative findings of the second operation for the cerebral tumor disclosed that the tumor extended outside the frontal lobe, growing substantially within the sylvian subarachnoid space and involving middle cerebral artery branches. The results of a pathological study were those consistent with glioblastoma having tumor cells with little positive reaction to GFAP staining. Craniospinal radiation was undertaken as a palliative treatment of the residual tumor. On MRI, multiple nodular dissemination in the lumbo-sacral region was diagnosed. Two months later, the patient suddenly lost consciousness and suffered eye deviation. A CT scan found a large tumor-associated hemorrhage in the right frontal lobe. Emergency evacuation of the hematoma with gross total removal of the residual tumor was performed. He temporarily returned to his preoperative neurological condition but died later due to the recurrent cervical tumor. Dissemination secondary to intratumoral hemorrhage in patients with glioblastoma has not been reported. This rare case shows that hemorrhagic glioblastoma is at risk for dissemination, especially when the hemorrhage occurs in or near the subarachnoid space and tumor cells have a less positive reaction for GFAP staining.

Brain Neoplasms↗

PubMed2002

Comparison of bone marrow studies with blood culture for etiological diagnosis of disseminated mycobacterial and fungal infection in patients with acquired immunodeficiency syndrome.

The role of bone marrow examination in the diagnosis of prolonged fever in patients with human immunodeficiency virus infection remains controversial. This study compared the results of bone marrow examination and blood culture in the evaluation of opportunistic infections in 100 patients with acquired immunodeficiency syndrome who presented with prolonged fever and/or pancytopenia from November 1995 through August 1998. Bone marrow and blood specimens were routinely submitted for bacterial, mycobacterial, and fungal cultures, and histopathological examination of the bone marrow specimens was also performed. A total of 33 cases of disseminated mycobacterial infections and 17 cases of disseminated fungal infections were identified. Fifteen cases of mycobacterial infection and 8 cases of fungal infection were identified by using bone marrow culture. The causative organisms included Mycobacterium avium complex (9 isolates), Mycobacterium tuberculosis (4), Mycobacterium chelonae (1), Mycobacterium kansasii (1), Cryptococcus neoformans (3), and Penicillium marneffei (5). Granulomas were seen in only 8 of 33 disseminated mycobacterial infections, and acid-fast bacilli were detected in only 4 patients. Although bone marrow culture did not provide a significantly higher diagnostic yield than blood culture, bone marrow culture plus histopathological examination had a higher diagnostic yield than blood culture alone for patients with disseminated mycobacteriosis. This study demonstrated that bone marrow examination provides an additional aid in the diagnosis of disseminated mycobacterial or fungal infections in patients with human immunodeficiency virus who had prolonged fever.

AIDS-Related Opportunistic Infections↗