Primary malignant lymphoma of the lung: histopathologic and immunologic evaluation of nine cases

Nine primary malignant lymphomas of the lung are described. Seven were localized lesions, and two were diffuse bilateral infiltrations. Histopathologic examination of these lesions suggests that they represent examples of the same entity and that it is a malignant lymphoma rather than a reactive infiltration or "pseudolymphoma." Histologic evidence of lymph node involvement is unusual, even in the presence of mediastinal or pleural infiltration. Immunohistochemical studies demonstrated a monotypic B-cell population in cases in which suitable tumor tissue was available for study (four of nine). Of the other five cases, two had a population of monotypic B lymphocytes in the peripheral blood, and in one of these and in one additional case gastric lymphomas subsequently developed. It is suggested that these lymphomas arise from bronchus-associated lymphoid tissue, which would explain both their histologic features and their tendency to remain localized to the lung for long periods.     

Using graphical representations to enhance the quality‐of‐care for colorectal cancer patients

The study was to enhance adherence to quality‐of‐care guidelines for colorectal cancer (CRC) patients through plotting graphical representations. Rasch analysis was performed to examine the unidimensional measurement of the 13 core indicators. An author‐made Excel module was applied to plot the so‐called Wright map and KIDMAP in education field to report physicians' adherence to the quality‐of‐life guidelines. We found that the scale of the quality‐of‐care guidelines for patients with colon cancer is unidimensional. A total of 15 (3.8%) and 14 (3.5%) persons' response patterns (i.e., Outfit MNSQs >2.0 and 4.0, respectively) are aberrantly dispersed from the majority of sample according to their estimated parameters of persons and indicators. It can be used for investigating the root cause of the 1ow measures and/or the most unexpected aberrant pattern of responses using Rasch analysis once any one indicator of unexpectedly aberrant treatment (p < .05) presents. The Rasch model can deal with these binary and/or missing data frequently seen in clinical settings. We confirm this computer module can contribute to ensuring that hospitals adhere to the treatment guidelines for patients with colon cancer.     

Antigenic and allergenic properties of the storage mite Tyrophagus putrescentiae

The antigens and allergens in the storage mite Tyrophagus putrescentiae, commonly found in grain and hay and sometimes in house dust, were characterized by crossed immunoelectrophoresis and crossed radioimmunoelectrophoresis. Three mite extracts, T. putrescentiae (TP) mite bodies, feces, and a combination of mites, feces, and culture medium (TP + CM) were studied. TP and TP + CM (primarily feces) extracts exhibited 20 and 18 antigens, respectively. By use of serum from two skin test-positive patients, autoradiograms demonstrated TP contained two allergens and TP + CM contained five allergens, three of which probably originated from feces. CM (whole wheat flour) did not stimulate antibody production in rabbits. TP feces shared 10 antigenic determinants with TP and 14 with TP + CM. Two antigens common to TP feces and TP were also shared allergens.     

Further evidence for linkage of Gilles de la Tourette syndrome (GTS) susceptibility loci on chromosomes 2p11, 8q22 and 11q23‐24 in South African Afrikaners

Utilizing DNA samples from 91 Afrikaner nuclear families with one or more affected children, five genomic regions on chromosomes 2p, 8q, 11q, 20q, and 21q that gave evidence for association with GTS in previous case‐control association studies were investigated for linkage and association with GTS. Highly polymorphic markers with mean heterozygosity of 0.77 were typed and resulting genotypes evaluated using single marker transmission disequilibrium (TDT), single marker haplotype relative risk (HRR), and multi‐marker “extended” TDT and HRR methods. Single marker TDT analysis showed evidence for linkage or association, with p‐values near 0.05, for markers D2S139, GATA28F12, and D11S1377 on chromosomes 2p11, 8q22 and 11q23‐24, respectively. Extended, two‐locus TDT and HRR analysis provided further evidence for linkage or association on chromosome 2 with p‐values of 0.007 and 0.025, and chromosome 8 with p‐values of 0.059 and 0.013, respectively. These results provide important additional evidence for the location of GTS susceptibility loci. © 2001 Wiley‐Liss, Inc.     

Specific but limited role of new imaging techniques in decision-making about intraabdominal abscesses

Despite the very high accuracy rate of imaging studies (ultrasound, computed tomography, liver-lung-spleen scans and gallium-67 scans) in detecting intraabdominal abscesses, our experience with 80 recent cases indicate that these techniques have not significantly altered traditional methods of decision-making about when and where to drain such abscesses. In only 12.5 percent of cases were such decisions based on special imaging techniques alone, and most of these cases subphrenic abscesses were diagnosed late after surgery. In the remainder, physical examination and routine radiologic studies sufficed, with special imaging techniques primarily corroborating clinical evidence based on these methods. We conclude that the use of special imaging techniques alone in a search for the cause of fever early after abdominal surgery does not provide evidence upon which clinical decisions can be based unless there are already physical signs of an abscess.     

The effect of allopurinol on the degree of early myocardial ischemia

The effect of allopurinol on the size of ischemic injury was evaluated following ligation of the left anterior descending coronary artery (LAD) in 37 open-chest dogs. Heart rate, aortic blood pressure, left ventricular pressure, cardiac ouptut, and total peripheral resistance were continuously monitored. Arterial blood was obtained and analyzed for electrolytes, enzymes, uric acid, total inorganic phosphates, lactate, and pyruvate before and after two hours of LAD ligation. At two hours, the hearts were perfused with fluorescein dye to delineate the flow/no flow areas of the excised cross-section myocardium. Planimetry and section thickness were used to calculate the volume of ischemic myocardium.Heart rate and cardiac output were higher and peripheral resistance was lower at baseline and two hours after ligation in the allopurinol intravenously pretreated dogs than in controls. Uric acid was significantly lower at baseline and two hours after LAD ligation and lower levels of total inorganic phosphate, calcium, and magnesium were present at two hours after ligation. The stained cross-sectioned hearts showed that the control and postligation allopurinol treated animals had respective ischemic areas of 19.42% and 21.56% of the total myocardium below the section of the LAD ligation obtained perpendicular to the long axis of the heart. In contrast, animals pretreated with allopurinol, whether orally or intravenously, showed 14.19% and 12.28% ischemic areas, respectively. The latter represented 36.74% less (p < .005) than in the control group. Postmortem angiographic studies performed on hearts from each group demonstrated collateral connections to the distal LAD in the allopurinol intravenously pretreated group and an absence of open collaterals in the control group.The study suggests that allopurinol pretreatment has a protective effect on the ischemic myocardium. This is probably due to opening of coronary collaterals either by direct vasodilatory action or by maintaining locally high levels of adenosine by enzyme inhibition which in turn acts as a vasodilator.     

Relating literature to medicine: Blending humanism and science in medical education

There is a need to add a humanistic component to scientific aspects of medical education. It must be adequately organized and evaluated to compete successfully in an already overcrowded curriculum. This study reports an educational experiment involving three consecutive freshman classes in a new community-based medical school. A specialist in literature and a psychiatrist teach a two-week course to first-year students in which themes and topics relevant to medical practice are explored through selected readings and patient interviews that are integrated into daily experiential groups. The outcome of the course and similarities and differences between years are explored inrelation to group sessions, class composition, reading assignments, and patient interviews.     

Parental intervention in the treatment of chronic constipation

Chronic constipation was successfully eliminated in a 3-yr-old girl through a regimen combining behavioral and medical treatments. The onset of constipation was at birth. The procedures entailed use of mineral oil to produce reflex defecation concurrent with a token economy established by the parents in the home. After symptom remission, the behavioral- medical interventions were systematically faded. At 39-, 67-, and 93-week follow ups there was no recurrence of constipation and no symptom substitution.