Multidisciplinary Approach to the Diagnosis and Therapy of Mycosis Fungoides

Mycosis fungoides is the most common primary cutaneous T-cell lymphoma, characterized by skin-homing CD4+ T cells derivation, indolent course, and low-grade of malignancy. Mycosis fungoides's classic type typically onsets with cutaneous erythematous patches, plaque, and tumor. In WHO-EORTC classification, folliculotropic mycosis fungoides, pagetoid reticulosis, and granulomatous slack skin are recognized as distinct variants of mycosis fungoides, because of their clinical and histological features, behavior, and /or prognosis. Mycosis fungoides often shows diagnostic difficulties, due to its absence of specific features and lesional polymorphism. A patient's treatment requires staging. In about 10% of cases, mycosis fungoides can progress to lymph nodes and internal organs. Prognosis is poor at advanced stage and management needs a multidisciplinary team approach. Advanced stage disease including tumors, erythroderma, and nodal, visceral, or blood involvement needs skin directed therapy associated with systemic drugs. Skin directed therapy includes steroids, nitrogen mustard, bexarotene gel, phototherapy UVB, and photochemiotherapy, i.e., total skin electron radiotherapy. Systemic therapies include retinoids, bexarotene, interferon, histone deacetylase inhibitors, photopheresis, targeted immunotherapy, and cytotoxic chemotherapy. Complexity of mycosis fungoides associated with long-term chronic evolution and multiple therapy based on disease stage need a multidisciplinary team approach to be treated.

Use of Rituximab in NHL Malt Type Pregnant in I° Trimester for Two Times

Administration of rituximab, one of the basic drugs for the therapy of B-cell lymphoproliferative diseases, during pregnancy has been suspected to cause developmental fetal events, particularly if given during the first trimester of pregnancy. Therefore, use in pregnancy is not permitted. Howe ver, several cases of pregnant women being treated with rituximab are reported herein; an exception is often made in cases with grave illness. We describe an exceptional case of a woman with non-Hodgkin lymphoma of the mucosa-associated lymphoid tissue type where rituximab was given as a single agent without interruption during two consecutive pregnancies. This case can certainly supply important indications on the safety of rituximab.

Reduced Annexin A1 Expression Associates with Disease Severity and Inflammation in Multiple Sclerosis Patients

Chronic neuroinflammation is a key pathological hallmark of multiple sclerosis (MS) that suggests that resolution of inflammation by specialized proresolving molecules is dysregulated in the disease. Annexin A1 (ANXA1) is a protein induced by glucocorticoids that facilitates resolution of inflammation through several mechanisms that include an inhibition of leukocyte recruitment and activation. In this study, we investigated the ability of ANXA1 to influence T cell effector function in relapsing/remitting MS (RRMS), an autoimmune disease sustained by proinflammatory Th1/Th17 cells. Circulating expression levels of ANXA1 in naive-to-treatment RRMS subjects inversely correlated with disease score and progression. At the cellular level, there was an impaired ANXA1 production by CD4⁺CD25^- conventional T and CD4⁺RORγt⁺ T (Th17) cells from RRMS subjects that associated with an increased migratory capacity in an in vitro model of blood brain barrier. Mechanistically, ANXA1 impaired monocyte maturation secondarily to STAT3 hyperactivation and potently reduced T cell activation, proliferation, and glycolysis. Together, these findings identify impaired disease resolution pathways in RRMS caused by dysregulated ANXA1 expression that could represent new potential therapeutic targets in RRMS.

Translating Healthy Living Messages to Postpartum Women and Their Partners After Gestational Diabetes (GDM): Body Habitus, A1C, Lifestyle Habits, and Program Engagement Results From the Families Defeating Diabetes (FDD) Randomized Trial

PURPOSE

The Families Defeating Diabetes intervention evaluated a postpartum healthy living program for women with recent gestational diabetes mellitus (GDM).

DESIGN

Randomized controlled trial.

SETTING

Tertiary centers in London, Calgary, and Victoria, Canada.

PARTICIPANTS

Women with GDM and partners; 46% of eligible maternal participants agreed to participate.

INTERVENTION

Interventional (INT) participants received a healthy living seminar at 3 months; access to a walking group/Website; biweekly e-mails. Control (CON) participants received a contemporary postpartum diabetes prevention handout.

MEASURES

Maternal, partner, and offspring demographics at baseline, 3, and 12 months.

ANALYSIS

Percentages of women losing ≥7% of postpartum weight were compared by χ² testing; body habitus comparisons by analysis of covariance (ANCOVA); maternal A1C comparisons by unpaired t tests; participant outcome associations by Pearson correlation coefficients.

RESULTS

Maternal participants were 170 (89 INT and 81 CON) with 63 partners (30 INT and 33 CON); 103 (73 maternal; 30 partners) were lost to follow-up; 57% of maternal participants completed 12 months; 33% INT women (n = 50) lost ≥7% weight versus 25% CON women (n = 47), P = .43. Interventional participant results did not correlate with accession of study elements. Maternal completion was significantly associated with partner involvement, breastfeeding, higher income, and education. Paternal weights correlated significantly with maternal and offspring weights.

CONCLUSION

Families Defeating Diabetes outcomes were not significantly different for INT maternal or paternal participants versus CON participants. Secondary outcomes of future value included statistically significant positive associations between paternal participation, socioeconomic indicators, and maternal study completion, significant correlations between maternal, paternal, and offspring weights as well as insights into study component engagement.

Aortic valve replacement and coronary artery surgery: determinants affecting early and long-term results

BACKGROUND

We studied factors influencing early and late results in patients operated on for aortic valve replacement and coronary artery bypass graft.

METHODS

175 patients were retrospectively analysed over a 10-year period ending in December 2002. There were 135 males and 40 females with a mean age of 62.7 +/- 8.9 years; 109 were in NYHA class III/IV; 45 required an urgent operation, and 103 mechanical valves and 72 biological valves were implanted.

RESULTS

There were 11 operative deaths (6.3 %). Statistical analysis (logistic regression) showed that previous myocardial infarction, poor NYHA class, and low LVEF had a significant effect on early death. There were 52 late deaths at a mean follow-up of 82.7 +/- 38.8 months. Using a Cox survival analysis for any causes, age, urgent operation, low LVEF, and creatinine had a strong impact on unfavourable late outcome.

CONCLUSIONS

A combination of a patient-related factor (age), cardiac-related condition (low LVEF), co-morbid condition (renal dysfunction), and operative cause (urgent operation) is the most important predictor of late clinical outcome for this combined surgical procedure.

Clinical outcome for on-pump myocardial revascularization in patients with mild renal dysfunction

BACKGROUND

Coronary artery disease is the major cause of death in patients with chronic renal failure. We studied the early and long-term outcome of patients with mild chronic renal impairment, preoperative regular diuresis, and normal potassium levels having undergone pump myocardial revascularization.

METHODS

From January 1992 to December 2000, 67 patients with serum creatinine level higher than 1.7 mg/dl and less than 2.5 mg/dl underwent on-pump myocardial revascularization. The patients were divided into 2 groups and treated with renal doses of dopamine in the postoperative or preoperative period, respectively. A homogeneous group of 100 patients was selected as control.

RESULTS

There were no statistically significant differences in mortality and morbidity between the two groups A, while there was a significant difference in cardiac and respiratory complications, ICU stay and LOS between the A and B group in the early and long-term follow-up. Survival at 12-year follow-up is significantly higher in the B group.

CONCLUSIONS

Patients with relatively mild renal insufficiency should be evaluated carefully for open cardiac surgery due to the significant increase in early and long-term morbidity and mortality.

Discrete Subaortic Stenosis: Long-Term Prognosis on the Progression of the Obstruction and of the Aortic Insufficiency

BACKGROUND

We sought to determine the long-term rate of progression of left ventricular outflow tract (LVOT) obstruction and aortic insufficiency (AI) in adult patients operated on for discrete subaortic stenosis (DSS).

METHODS

Between 1975 and 1995, 52 patients underwent surgery for DSS; their mean age was 25.4 +/- 14.8 years. Mean preoperative LVOT gradient was 72.8 +/- 25.7 mm Hg. Excision of the subaortic membrane was carried out in all patients, myectomy of the interventricular septum was additionally carried out in 8 patients (15.4 %), and aortic valve replacement (AVR) was performed in 15 patients (28.8 %).

RESULTS

There were 2 operative deaths (3.8 %). Early postoperative LVOT gradient was 9.7 +/- 6.5 mm Hg. Follow-up ranged from 8.1 to 26.6 years. There were 8 late deaths (16.3 %), and mean LVOT gradient was 13.3 +/- 10.7 mm Hg. Five patients required reoperation for recurrent obstruction; 4 patients had a gradient of more than 30 mm Hg. The AI, in patients who did not undergo aortic valve replacement, did not substantially change during follow-up.

CONCLUSIONS

DSS is a variable, unpredictable and progressive disease; recurrent obstruction may reappear despite the adequacy of surgical excision, and is not related to preoperative gradient. Mild AI remains substantially unchanged and AVR is indicated in severe AI.

Synthesis and biological evaluation of proline derivatives as potential angiotensin converting enzyme inhibitor

The synthesis of a series of proline derivatives (1a-e and 2a-b) as pure isomers is described. These compounds were evaluated in vitro for their ability to inhibit angiotensin converting enzyme (ACE) and compared to the potency of captopril taken as a reference drug. They showed only a weak ACE inhibitory activity.

Cardiovascular monitoring of drug-resistant lymphoma patients treated with epoch chemotherapy plus high-dose verapamil in continuous-infusion

High dose Verapamil (VP) infusion has been incorporated into cytotoxic chemotherapy in order to circumvent tumor cell drug-resistance. We have evaluated the cardiovascular side-effects produced by high dose VP associated to EPOCH chemotherapy in 12 patients with chemorefractory lymphoma. Continuous monitoring of right ventricular and pulmonary pressure and cardiac index was performed in three patients by a Swan-Ganz catheter. A slight reduction in cardiac index was observed 6 h after the beginning of VP infusion and was followed by spontaneous recovery within 12 h. First degree atrioventricular (AV) block was detected in 6/12 patients. Premature Ventricular Beats (PVB) occurred in one patient, and promptly disappeared after xylocaine administration. All patients experienced mild and transient hypotension, while severe hypotension was observed only in 1 patient, who promptly recovered when VP administration was discontinued. Hypokalemia was detected in 6 patients possibly as a consequence of transient activation of the renin-angiotensin system.

[Mitral prolapse and the ergometric findings]

In evaluating the significance of arrhythmias and ECG changes during exercise, 42 consecutive patients (pts) with mitral valve prolapse (MVP) underwent a symptom-limited cycloergometer Exercise Stress Test (EST) with load increase of 25 watts every 3 minutes. Eight patients (19%) were positive for anamnestic cardiopalm. The patients were divided in 2 groups, according to echocardiographic evidence of the MPV: group A (12 patients, mean age 32 +/- 13) with prolapse of one mitral leaflet and group B (30 patients, mean age 30 +/- 13) with prolapse of both mitral leaflets. Exercise duration doesn't differ significantly in the two groups. No arrhythmias during EST were found in group A, while arrhythmias were present in 6 patients (20%) in group B. A strong correlation was found between anamnestic cardiopalm and arrhythmias during EST (6/8 = 75%). Three of four patients (75%) with ST impairment during EST, showed at thallium myocardial scintigraphy a non reversible perfusion defect after exercise. These data showed a higher incidence of arrhythmias during EST in patients with MVP of both leaflets and good relationship with symptomatology of cardiopalm.

The effects of maternal exercise on developing rat fetuses

Ten female Sprague-Dawley rats (45.3 days old, s.d. = 3.9) were acclimatised to running on a treadmill at 20 m/min on a 10 degrees incline for 1 hour per day. After mating, one rat from each of 5 pairs continued running on the treadmill at 15 m/min on a 10 degrees incline for 1 hour per day throughout gestation whilst the other rats followed normal laboratory routine. All the rats were weighed daily and at birth the number and weights of all fetuses were measured. In addition, a small piece of diaphragmatic muscle was taken from each of three fetuses from each litter and assessed both histologically and histochemically. The results showed that the maternal rats that did not continue exercising throughout pregnancy produced, on average, approximately 3 more fetuses per litter than the rats that exercised, although this difference was not significant. There was also no difference in mean fetal weight between the two groups and no difference could be demonstrated in the development of the diaphragm muscle.

Total body fat content in a group of professional football players

A hydrostatic weighing method coupled with a closed-circuit helium dilution technique was applied to twenty-nine professional football players of a successful Canadian Football team to obtain body density values. From these results, it was hoped that values for percent body fat could be calculated for each player using Siri's (1956) formula. Unfortunately, the values for body density were so high that for some players negative values for percent body fat were obtained. It has been suggested that these results reflect large skeletal deposits in response to the heavy exercise routines undertaken by the players. Skinfold measurements of the players suggest that there are more fat deposits than their body density values indicate. This casts serious doubt on the use of Siri's (1956) formula with the extremes of body form found in the population and also suggests restricted use of equations based on skinfold measurements for estimating body fat percent.

Body density differences between Negro and Caucasian professional football players

Other workers have shown that the bone density for the average negro is greater than for the average caucasian. This would lead to greater values of body density for the average negro but it is confused because the average negro has a different body form (and consequently different proportions of body components) compared with the average caucasian. This study of body density of a group of professional Canadian football players investigates whether or not to separate negroes from caucasians when considering the formation of regression equations for prediction of body density. Accordingly, a group of 7 negroes and 7 caucasians were matched somatotypically and a comparison was made of their body density values obtained using a hydrostatic weighing technique and a closed-circuit helium dilution technique for measuring lung volumes. The results show that if somatotype is taken into account then no significant difference in body density values is found between negro and caucasian professional football players. The players do not have to be placed in separate groups but it remains to be seen whether or not these results apply to general members of the population.