[Clinical experience with the Infrared Coagulator in the treatment of benign lesions of the oral cavity]

The clinical efficacy of a new medico-surgical device was tested in the treatment of benign lesions of the oral cavity. The Infrared Coagulator was proved to be useful both in terms of reduced bleeding during operations and due to the satisfactory long-term healing of the wound.

Immunohistocytochemical correlation of DAP IV-CD 26 reactivity with immunologic markers of lymphocyte activation in human lymphoid tissues

The topographic distribution of the dipeptidylaminopeptidase IV (DAP IV-CD 26) and II (DAP II) positive T-cell population in six reactive lymph nodes and seven follicular B-cell non-Hodgkin's lymphomas (NHL) was analysed with regard to the distribution of activated T-cells, as visualized by a panel of monoclonal antibodies including Tac-CD 25, HLA-DR, OKT 9-CD 71, ICAM-1-CD 54, LFA-1-CD 11a. For comparative studies serial frozen sections of the lymph nodes were tested by enzyme histochemistry and immunohistochemistry. In addition, cell suspensions obtained from 10 B-NHL and interleukin-2 (IL-2) activated T-cells were investigated by a combined cytochemical and immunological method for simultaneous visualization of DAP IV-CD 26 cytoplasmic activity and surface immunostaining for markers of lymphocyte activation. Both in reactive and lymphomatous lymph nodes the topographic distribution of DAP IV-CD 26+ and DAP II+ lymphocytes was rather similar to that of Tac-CD 25+ lymphocytes. On the contrary, the DAP IV-CD 26 and DAP II distribution pattern substantially differed from that of the other immunologic markers. In a cell suspension of IL-2 activated T-cells, more than 80% of the cells with a blastic morphology were DAP IV-CD 26+; DAP IV-CD 26+ cells coexpressing Tac-CD 25, OKT 9-CD 71, HLA-DR positivity, relative to the total number of DAP IV-CD 26 positive cells, were 90.5%, 70.5% and 87% respectively. Only small (not activated) lymphocytes expressed a focal cytoplasmic DAP II positivity. In cell suspensions from 10 cases of B-NHL the mean percentage of DAP IV-CD 26+ Tac-CD 25+ cells was 75.8. Only a small number of DAP IV-CD 26+ cells coexpressed HLA-DR, the mean percentage being 9.6. The results support the view that DAP IV-CD 26 may be considered as a marker of lymphocyte activation; this marker seems to be restricted to T lymphocytes that reside in the T dependent areas of reactive lymph nodes and to non malignant T-cells surrounding neoplastic follicles of follicular NHL.

Dipeptidylaminopeptidase IV activity in T lymphocyte subsets in B cell non-Hodgkin's lymphomas

The total T cell population and T cell subsets in ten lymph nodes with reactive lymphoid hyperplasia (RLH) and 23 specimens (21 lymph nodes, one stomach, and one small bowel) involved by histologically and immunohistologically diagnosed B cell non-Hodgkin's lymphomas (NHLs) were determined by reactivity with monoclonal antibodies Leu 4-CD3, Leu 3-CD4, and Leu 2-CD8 in cytospin preparations from cell suspensions. T cell populations were also investigated for the coexpression of dipeptidylaminopeptidase IV (DAP IV) activity, which was visualized simultaneously with cell surface immunostaining by a combined cytochemical and immunocytochemical method. The mean absolute percentage of Leu 4-CD3+ (total T) and Leu 3-CD4+ cell populations was significantly lower in B cell NHL cases than in RLH cases (35% v 54%, P less than .001; 29.5% v 44.4%, P less than .01). No difference in the mean absolute percentage of the Leu 2-CD8+ T cell subset was found between the RLH cases and the B cell NHL cases classified as other than category A as described by the Working Formulation (WF) of NHLs. The relative percentage of Leu 4-CD3+ and Leu 2-CD8+ cells coexpressing DAP IV reactivity was lower in B cell NHL cases than in RLH cases (27.3% v 39.5%, P less than .05; 13.5% v 24.4%, P less than .10). There was no difference in the proportion of Leu 3-CD4+ cells expressing DAP IV reactivity between the NHL and RLH groups (34.5% v 36.1%). Since the mean relative percentage of Leu 2-CD8+ cells expressing DAP IV reactivity in the B cell NHL group in the other than category A according to the WF was lower than that of the RLH group (12.5% v 24.4%), and whereas the mean absolute percentage of total Leu 2-CD8+ cells was similar in the two groups (16.6% and 16.6%), a possible defective role of this Leu 2-CD8+ DAP IV+ subset, at least in B cell NHLs in the other than category A according to the WF, may be hypothesized.

A combined cytochemical and immunocytochemical method for simultaneous visualization of cytoplasmic enzyme reactivity and cell surface antigens in cell suspensions

Immunocytochemical methods were used in combination with enzyme cytochemistry to visualize simultaneously cytoplasmic enzyme reactivity (for dipeptidyl[amino]peptidase [DAP IV], acid phosphatase [AcP], chloroacetyl esterase [CAE]) and cell surface antigens (Leu-3a, Leu-4, Leu-14, Leu-M1, OKT4, OKT8, OKB7) in cytospin preparations from cell suspensions of human reactive lymphoid tissues (four lymph nodes and three tonsils). Different fixative solutions were tested. Enzyme and immunocytochemical reactions were carried out in different orders of sequence to establish which was the better direction for the combination of the two methods. The following immunocytochemical methods were tested: three stages, avidin-biotin complex, peroxidase-antiperoxidase, alkaline phosphatase-antialkaline phosphatase (APAAP) (using both peroxidase and alkaline phosphatase as labeling enzyme). Acetone or buffered formalin acetone gave the best results both for cytochemical and immunologic reactions. DAP IV and AcP reactivities could be visualized only when cytochemical reactions were performed before immunocytochemistry. CAE reactivity could be demonstrated either before or after immunocytochemistry. Cell surface antigens could be demonstrated with most immunocytochemical methods: however, the APAAP method was preferred for its sensitivity and effectiveness when combined with enzyme cytochemistry. By this approach, cells expressing only immunologic markers and cells expressing only cytochemical markers could easily be distinguished from those coexpressing both markers, because cytochemistry and immunocytochemistry could be combined without affecting the reactivity of each marker, and the reaction products did not hamper the interpretation of preparations.

Intermediate lymphocytic lymphoma encompassing diffuse and mantle zone pattern variants. A distinct entity among low-grade lymphomas?

Intermediate lymphocytic lymphoma has been operationally included among low-grade lymphomas, but few clinical data appeared to support definitely such an inclusion. The clinicopathologic features of 13 out of 14 cases of intermediate lymphocytic lymphoma either encompassing diffuse or mantle-zone pattern variants (ILL or MZL, respectively), diagnosed by conventional histology according to established criteria, are reported. Frozen section immunophenotypic analysis was also performed in 10 cases and enzyme studies were done in five. The 14 cases formed 6.9% of 203 non-Hodgkin's lymphomas (NHL) histologically diagnosed over a 2-year period. Among the 13 cases studied, there were nine males (five with ILL and four with MZL) and four females (one with ILL and three with MZL). Median age was 59 years. Splenomegaly (46%), high stage diseases (100%), involvement of bone marrow (92%) and peripheral blood (38%), and diffusion to and/or involvement of extranodal sites (38%), all were common findings at presentation. The 34 low-grade NHL of the total series classified according to the Working Formulation did not significantly differ from the ILL/MZL group in terms of frequency of involvement of bone marrow (69%) and peripheral blood (56%) as well as diffusion to and/or involvement of extranodal sites (26%). In ILL/MZL, therapy modalities were not uniform and the short follow-up time precluded firm conclusions on prognosis. Immunohistology demonstrated that ILL/MZL diagnosed by adequate morphologic criteria is a fairly homogeneous entity, also sharing most of its consistent immunological features with low-grade NHL. Thus, ILL/MZL is a relatively frequent and consistently recognizable clinical and pathological entity that may deserve a distinct place among NHL according to the Working Formulation. Proper clinical studies are needed to establish on a firmer basis the prognosis and optimal treatment of ILL/MZL.

The effect of pre-stretch on mechanical efficiency of human skeletal muscle

The mechanical efficiency of positive work was studied in six subjects performing three different types of exercises. On the first occasion the subjects ran on a motor-driven treadmill at 3.33 m s-1; the second and the third exercises consisted of performing rhythmical vertical jumps for 1 min both in rebound (RJ) and no-rebound (NRJ) conditions. The mechanical efficiency calculated in NRJ, which reflects only the conversion of biochemical energy into mechanical work, was found to be lower than the corresponding observation in RJ, 17.2 vs. 27.8% (P less than 0.001), respectively. These differences could not be explained by only the storage and recoil of elastic energy occurring in RJ compared with NRJ. The calculated extra work delivered 'free' was greater than the potential elastic energy which could be stored within the leg extensor muscles (187 vs. 124 J for each jump, P less than 0.05). It is likely that other factors might be responsible for the extra work found in NRJ. It was suggested that the difference in the length of time to perform positive work between a simple shortening contraction and a stretch-shortening muscular activity could be also responsible for the enhanced efficiency observed in RJ. This suggestion was supported by the high relationship (P less than 0.001) found between the time to perform positive work and the mechanical efficiency measured in jumping and estimated during running.

Enzyme and Immunohistochemistry of Follicular Hyperplasia in AIDS-related Lymphadenopathy

We used a panel of monoclonal and polyclonal antibodies to analyze frozen and paraffin-embedded lymph node biopsy specimens from 25 intravenous drug abusers (IVDA) with acquired immunodeficiency syndrome (AIDS)-related lymphadenopathy histologically characterized by follicular hyperplasia. Our aim was to obtain diagnostic clues to this commonly occurring pattern. Double-labelling immunohistological studies were also performed on selected frozen sections and 13 plastic-embedded specimens were tested by a number of enzyme reactions. Consistent features in IVDA included abnormally high numbers of intrafollicular T-cells, positive for acid phosphatase and beta-glucuronidase, most of which had Leu-2a-positive phenotype; a marked reduction or loss of mantle zone B-cells (positive for surface IgD-IgM and alkaline phosphatase); and disarray of the network of follicular dendritic reticulum cells (DRCs), as revealed with DRC-1 and anti-S-100 protein antibodies or with reaction for 5'-nucleotidase. When present, distinctive intrafollicular clusters of Leu-2a-positive T-cells and mantle zone B-cells were nearly always associated with areas lacking DRCs in some patients. The intrafollicular hypervascularity invariably found in IVDA proved to be of a true capillary nature, as demonstrated by alkaline phosphatase, 5'-nucleotidase, and ATPase reactions. In control tissues, all showing absence of Leu-2a-positive intrafollicular T-cells, most of the above individual changes could be detected, although they were occasional, mild, and never associated within the same follicle. By contrast, combined immunohistological and enzyme histochemical findings in IVDA indicated that in most follicles such changes were marked and very often associated within the same follicle in each case. It can be concluded that on the basis of a combined analysis of lymphoid and non-lymphoid follicular constituents, the histological changes of AIDS-related lymphadenopathy with follicular hyperplastic pattern are further defined and corroborated.

Immunocytochemical evidence of common-ALL antigen in null-ALL

4 cases of acute lymphoblastic leukaemia (ALL), diagnosed as null-ALL by indirect immunofluorescence using monoclonal antibodies, were similarly investigated using a sensitive immunoperoxidase method. The Avidin-Biotin system was employed. The immunoenzymatic results were in agreement with those obtained with immunofluorescence techniques for all antigens except common-ALL (C-ALL). The C-ALL antigen, recognized by the J5 antibody, was detected only by the immunoperoxidase method on cell membranes of the 4 ALL. This paper discusses the possibility of false negative results in testing for C-ALL antigen by conventional indirect immunofluorescence as suggested by refined immunocytochemical screening. Moreover, the ability of the immunoperoxidase system to identify antigens on cell membranes, even at very low density, is discussed. The clinical significance of the presence of C-ALL antigen at weak intensity in cases of null-ALL is also considered.

A two-year survey of mucocutaneous lymph node syndrome in northeastern Italy. Epidemiological and clinical findings

A two-year retrospective survey of cases of mucocutaneous lymph node syndrome (MLNS, Kawasaki disease) was conducted by a collaborative research group in Northeastern Italy (Friuli Venezia-Giulia) by reviewing the records of all patients admitted in the paediatric wards of this area from January 1, 1981 to December 31, 1982. 19 cases of MLNS were identified representing an overall incidence in the two-year period of 14.7 cases per 100,000 children younger than 5 years of age. Seasonal clustering of cases was observed, 17 out of 19 cases occurring either in spring or autumn (P = 0.0004, binomial distribution) and 11 out of 19 cases occurring in spring alone (P = 0.0023). No evidence for direct contact between cases or common source exposure emerged, and no risk factors were identified. The clinical spectrum of the disease was similar to that described elsewhere, carditis, uveitis, arthritis and urethritis being the most frequent complications. One infant died, and in this case coronary artery aneurysms were demonstrated by two-dimensional echocardiography. In the remaining cases recovery was complete without sequelae. This study suggests that MLNS is more frequent than expected and that the real incidence of the disease is probably underestimated. The evidence of seasonal clustering of cases strongly suggests the presence of a yet unidentified exogenous factor playing a role in the etiology of the disease.

Cluster analysis of nutritional and immunological indicators for identification of high risk surgical patients

In spite of the many anthropometric, biohumoral, and immunologic parameters employed in the nutritional assessment of hospitalized patients, it is difficult in clinical practice to evaluate accurately the degree and type of malnutrition and to assess the prognostic significance of this determination. The purpose of this study is to evaluate nutritional status of surgical patients by means of cluster analysis in orderr to identify different nutritional patterns and to evaluate their clinical and prognostic significance. Nutritional assessment of 71 surgical patients was carried out at admission, and the sets of data were evaluated by means of cluster analysis. Four clusters with different nutritional patterns were identified. The incidence of clinical variables (type of disease, postoperative sepsis, palliative procedures, mortality at 6 months, etc.) in each cluster was determined in order to evaluate their clinical and prognostic significance. Cluster 1 showed minor variations of the indicators, including most of the controls presented the lowest incidence of sepsis, palliative procedures, and mortality at 6 months. It was then considered as a reference group representative of the normal nutritional condition at our institution. The other three clusters showed major variations of nutritional indicators and represent poorer risk clinical conditions. Sepsis, palliative procedures and mortality rate were significantly more frequent in these clusters (p less than 0.05, p less than 0.001, p less than 0.05). A different distribution in the clusters was recorded in gastrointestinal tract cancers and other neoplasms. Only the incidence of gastrointestinal tract cancers increases progressively in the clusters with poorer prognosis, suggesting that this type of neoplasia is more frequently associated with major changes of nutritional status.