IgG-lambda secreting B-lymphoplasmacytic lymphoma with disseminated cutaneous infiltration: report of a rare case.

We present an 85-year-old female with IgG-lambda lymphoplasmacytic lymphoma (LPL) with disseminated cutaneous infiltration during disease progression, 9 months after initial diagnosis. The patient was voluntarily undertreated, therefore the disease progressed with vast cutaneous involvement. The patient died from severe sepsis and disseminated intravascular coagulation due to acute respiratory bacterial infection, before receiving any kind of treatment.

Effect of angiotensin converting enzyme gene I/D polymorphism and its expression on clinical outcome in acute respiratory distress syndrome.

BACKGROUND: The role of the D allele of the angiotensin-converting enzyme (ACE) gene I/D polymorphism in the clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) remains controversial. Our aim was to assess simultaneously the effect of the ACE I/D polymorphisms as well as the serum and BALF ACE levels on prognosis of patients with ARDS. METHODS: Sixty-nine mechanically ventilated patients with ALI/ARDS were recruited. ACE activity levels both in serum and BALF were assessed by chemical methods. Patients were genotyped for ACE I/D polymorphisms. Time-to-event analysis evaluated the variables associated with the 28-day and 90-day mortality. Finally, we performed a meta-analysis of studies examining the association between ACE I/D polymorphisms and mortality of ALI/ARDS patients. RESULTS: In the multivariable model, age, lung compliance, serum lactate and serum ACE levels were significantly associated with both 28- and 90-day mortality. No significant correlation was found between serum and BALF ACE levels (Spearman's rho=0.054; P=0.66). Serum ACE concentrations were significantly higher (P=0.046) in patients with D/D genotype versus the two other groups combined (I/D and I/I genotypes). The meta-analysis of 6 studies (including ours) provided evidence that D allele is significantly associated with increased mortality in ALI/ARDS patients, yielding a per-allele odds ratio of 1.76 (95% CI: 1.19, 2.59). CONCLUSION: Serum ACE levels appear to be affected by the I/D polymorphism and are correlated with prognosis in patients with ALI/ARDS indicating that further investigation of the clinical significance of the ACE in ARDS might be of value.

Changes in lung tumor shape during respiration.

Evidence that some lung tumors change shape during respiration is derived from respiratory gated CT data by statistical shape modeling and image manipulation. Some tumors behave as rigid objects while others show systematic shape changes. Two views of lung motion are presented to allow analysis of the results. In the first, lung motion is viewed as a wave motion in which inertial effects arising from mass are present and in the second it is a quasistatic motion in which the mass of the lung tissues is neglected. In the first scenario, the extremes of tumor compression and expansion are expected to correlate with maximum upward and downward velocity of the tumor, respectively. In the second, they should occur at end exhale and end inhale, respectively. An observed correlation between tumor strain and tumor velocity provides more support for the first view of lung motion and may explain why previous attempts at observing tumor shape changes during respiration have largely failed. The implications for the optimum gating of radiation therapy are discussed.

Dynamic modeling of lung tumor motion during respiration.

A dynamic finite element model of the lung that incorporates a simplified geometry with realistic lung material properties has been developed. Observations of lung motion from respiratory-gated computed tomography were used to provide a database against which the predictions of the model are assessed. Data from six patients presenting with lung tumors were processed to give sagittal sections of the lung containing the tumor as a function of the breathing phase. Statistical shape modeling was used to outline the diaphragm, the tumor volume and the thoracic wall at each breathing phase. The motion of the tumor in the superior-inferior direction was plotted against the diaphragm displacement. The finite element model employed a simplified geometry in which the lung material fills a rectangular volume enabling two-dimensional coordinates to be used. The diaphragm is represented as a piston, driving the motion. Plots of lung displacement against diaphragm displacement form hysteresis loops that are a sensitive indicator of the characteristics of the motion. The key parameters of lung material that determine the motion are the density and elastic properties of lung material and the airway permeability. The model predictions of the hysteresis behavior agreed well with observation only when lung material is modeled as viscoelastic. The key material parameters are suggested for use as prognostic indicators of the progression of disease and of changes arising from the response of the lung to radiation treatment.

Media thickness measurement of the common carotid artery.

The intima-media thickness (IMT) of the common carotid artery (CCA) is widely used as an early indicator of the development of cardiovascular disease (CVD). It was proposed but not thoroughly investigated that the media thickness (MT), its composition and texture may be indicative for identifying the risk of stroke and differentiating between patients with high and low risk. In this study we present an automated method for segmentation of the media layer and measurement of its thickness in ultrasound images of the CCA. The snakes segmentation method was used, and was evaluated on 100 images against manual segmentation. The mean +/- standard deviation (sd) for the manual and the automated IMT measurements were 0.71+/-0.17 mm and 0.67+/-0.12 mm, and for the manual and the automated MT measurements were 0.25+/-0.12 mm and 0.25+/-0.11 mm respectively. There was no significant difference between the manual and the automated measurements. Further research for validating the proposed technique is required and for evaluating it in a larger sample of subjects.

Alterations of CD43 expression in transfusion-dependent myelodysplastic syndromes.

CD43 is a sialylated glycoprotein expressed on the surface of most haemopoietic cells and has been implicated in cell adhesion and signaling. It has previously been shown that CD43 expression is altered in patients with myelodysplastic syndrome (MDS). This raised the question of whether the alteration is associated with transfusions in these patients. We studied the expression of this antigen on peripheral blood leucocytes in two groups of patients with refractory anaemia, 22 transfused and 20 non-transfused. We found decreased expression of CD43 on the monocytes and neutrophils of patients receiving transfusions. Other activation molecules were studied (CD11b, CD18) and were found up-regulated suggesting the existence of activated leucocytes in these patients. The increased levels of soluble vascular cellular endothelial molecule after transfusions in these patients suggested vascular endothelial activation in the absence of infection. Given together, these results show that decreased CD43 in the transfused group of MDS patients is associated with an activated endothelial phenotype.

BOLD responses to stimuli: dependence on frequency, stimulus form, amplitude, and repetition rate.

A quantitative theory is developed for the relationship between stimulus and the resulting blood oxygen level-dependent (BOLD) functional MRI signal. The relationship of stimuli to neuronal activity during evoked responses is inferred from recent physiology-based quantitative modeling of evoked response potentials (ERPs). A hemodynamic model is then used to calculate the BOLD response to neuronal activity having the form of an impulse, a sinusoid, or an ERP-like damped sinusoid. Using the resulting equations, the BOLD response is analyzed for different forms, frequencies, and amplitudes of stimuli, in contrast with previous research, which has mostly concentrated on sustained stimuli. The BOLD frequency response is found to be closely linear in the parameter ranges of interest, with the form of a low-pass filter with a weak resonance at approximately 0.07 Hz. An improved BOLD impulse response is systematically obtained which includes initial dip and post-stimulus undershoot for some parameter ranges. It is found that the BOLD response depends strongly on the precise temporal course of the evoked neuronal activity, not just its peak value or typical amplitude. Indeed, for short stimuli, the linear BOLD response is closely proportional to the time-integrated activity change evoked by the stimulus, regardless of amplitude. It is concluded that there can be widely differing proportionalities between BOLD and peak activity, that this is the likely reason for the low level of correspondence seen experimentally between ERP sources and BOLD measurements and that non-BOLD measurements, such as ERPs, can be used to correct for this effect to obtain improved activity estimates. Finally, stimulus sequences that optimize the signal-to-noise ratio in event-related BOLD fMRI (efMRI) experiments are derived using the hemodynamic transfer function.

Aberrant expression of the major sialoglycoprotein (CD43) on the monocytes of patients with myelodysplastic syndromes.

CD43, a sialylated glycoprotein expressed on the surface of most hematopoietic cells, has been implicated in cell adhesion and signaling. The reduced expression of this antigen in patients with Wiscott-Aldrich syndrome, in which progressive immunodeficiency is a major problem, raised the question whether abnormal expression of this molecule could affect the susceptibility to infections in patients with myelodysplastic syndromes (MDS). We studied the expression of this antigen on the monocytes of ten patients with chronic myelomonocytic leukemia (CMML) and compared the results with 67 patients suffering from other MDS syndromes and with 18 healthy individuals. We chose this series as it plays an important role in MDS patients where in most cases the neutrophils are defective. We also examined the following antigens as indicative of activation and adhesion of the monocytes in these patients: CD11b, CD18, CD35, CD38, CD44, CD69. We found decreased expression of CD43 on the monocytes of the RA, RAS, RAEB, and RAEB-t patients compared with the CMML and controls. The other activation molecules studied were found to be upregulated, suggesting the existence of activated monocytes in these patients. The increased levels of soluble vascular cell adhesion molecule in these patients suggest vascular endothelial activation in the absence of infection. Further experiments are needed to investigate the significance of CD43 downregulation in these patients, its role in cell adherence and tissue migration, and the correlation of the phenomenon to the increased susceptibility to infections observed in these patients.

Activated peripheral blood and endothelial cells in thalassemia patients.

BACKGROUND AND OBJECTIVES: Thalassemia patients have alterations in the expression of some activation and adhesion molecules on peripheral blood lymphocytes. We studied cell surface antigens on peripheral blood cells associated with the activation of these cells and soluble molecules produced by activated endothelium. DESIGN AND METHODS: We investigated the expression of CD11b, CD18, CD35, CD43, CD44, and CD69 on the peripheral blood monocytes, Cd11b, CD18, CD35, CD43, CD44, CD67 on peripheral blood neutrophils and CD38 and CD69 on peripheral blood lymphocytes. We studied 68 transfusion-dependent thalassemics (group A), 10 transfusion non-dependent thalassemics (group B), 18 beta-thalassemia carriers (group C), and 28 normal individuals. Relative fluorescence intensity was used to determine the antigen density. Analysis was performed with an EPICS ELITE flow cytometer. Furthermore, soluble intercelullar adhesion molecule 1 (sICAM-1), soluble vascular adhesion molecule 1 (sVCAM-1), and E-selectin, tumor necrosis factor (TNF) alpha, and interleukin (IL) 1beta were measured in the plasma of patients by enzyme-linked immunometric assay. RESULTS: The expression of CD11b, CD18, and CD69 on the monocytes of group A was significantly greater than in groups B and C and in controls, while CD44 was significantly downregulated in group A. CD11b, CD18, CD35, CD44, and CD67 on the surface of neutrophils and CD38 and CD69 on the surface of lymphocytes were also overexpressed in group A. CD44 was downregulated on the monocytes and upregulated on the neutrophils of the patients compared to controls. The levels of sICAM-1, sVCAM-1, E-selectin, TNF-alpha, and IL-1beta in the serum of patients in groups A and B were higher than those in group C and the controls. CONCLUSION: Endothelial activation markers are significantly increased in thalassemia patients, and activated blood cells circulate in the peripheral blood. These may be related to the vascular complications in these patients and might be useful markers for the follow-up of the vascular disease.