ABSTRACT
BACKGROUND: Lymphomas of the ocular adnexa are heterogeneous and demonstrate a wide range of clinical, histological, immunohistochemical and molecular genetic characteristics. AIM: The aim of this article is to give an overview of the interdisciplinary diagnostics and individually adapted lymphoma subtype-based therapy. DIAGNOSTICS: Depending on the lymphoma localisation, i.e. whether in the eyelid, the conjunctiva or in the orbit, a photograph or a radiological scan is required to record the tumor extent. Visual function is more likely to be impacted when the lymphoma arises in the posterior orbit, close to the optic nerve and imaging diagnostics are therefore necessary. Histological investigations are essential for confirming the lymphoma diagnosis and give information about the particular subtype, which in turn will determine subsequent patient management, Clinical staging investigations for determining the systemic extent of the lymphoma manifestation (e.g. imaging, blood analyses as well as bone marrow biopsy) are mandatory. THERAPY: External beam radiation, local and systemic chemotherapy or in some cases antibiotics are treatment options after surgical excision in isolated ocular adnexal lymphoma. The TNM classification of the American Joint Committee on Cancer or the Ann Arbor staging system, as well as the guidelines of the German Society of Hematology and Medical Oncology are all tools to aid the choice of the appropriate individually adapted therapy for systemic disease, which includes psycho-oncological care.
Subject(s)
Eye Neoplasms/diagnosis , Eye Neoplasms/therapy , Lymphoma/diagnosis , Lymphoma/therapy , Chemoradiotherapy/methods , Conjunctival Neoplasms/diagnosis , Conjunctival Neoplasms/therapy , Diagnosis, Differential , Diagnostic Imaging/methods , Eyelid Neoplasms/diagnosis , Eyelid Neoplasms/therapy , Humans , Ophthalmologic Surgical Procedures/methods , Orbital Neoplasms/diagnosis , Orbital Neoplasms/therapy , Treatment OutcomeABSTRACT
Hypercalcemia in malignancies is a frequent complication, mostly affecting patients with solid tumors or multiple myeloma. Calcium elevation is induced by direct bone infiltration of a tumor mass or through calcium liberation from the skeleton by a humoral mediator. The latter mechanism is referred to as humoral hypercalcemia of malignancy (HHM). Frequent mediators of HHM are parathyroid hormone-related peptides (PTHrP). We report a patient with chronic lymphocytic leukemia and hypercalcemia induced by PTHrP. In contrast to solid tumors and myeloma, PTHrP-induced HHM is very rare in low-grad lymphoma including chronic lymphocytic leukemia. Therapeutical approaches consist of cytoreductive treatment and calcium-lowering therapy with bisphosphonates.
Subject(s)
Hypercalcemia/etiology , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Parathyroid Hormone-Related Protein/blood , Diphosphonates/therapeutic use , Humans , Hypercalcemia/drug therapy , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Male , Middle AgedSubject(s)
Acute Kidney Injury/diagnosis , Carcinoma, Bronchogenic/diagnosis , Hypercalcemia/diagnosis , Lung Neoplasms/diagnosis , Paraneoplastic Syndromes/diagnosis , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Biopsy , Bone Density Conservation Agents/administration & dosage , Carcinoma, Bronchogenic/complications , Carcinoma, Bronchogenic/therapy , Diphosphonates/administration & dosage , Emergencies , Fatal Outcome , Fluid Therapy , Hemodiafiltration , Humans , Hypercalcemia/etiology , Hypercalcemia/therapy , Ibandronic Acid , Lung/pathology , Lung Neoplasms/complications , Lung Neoplasms/therapy , Male , Middle Aged , Palliative Care , Paraneoplastic Syndromes/etiology , Paraneoplastic Syndromes/therapy , Parathyroid Hormone/analysis , Parathyroid Hormone-Related Protein/analysisABSTRACT
OBJECTIVES: Infections with multidrug-resistant microorganisms (e.g. Pseudomonas aeruginosa and Staphylococcus aureus) cause immense complications in wound care and in the treatment of immunosuppressed patients. Like most antimicrobial peptides, histones are relatively small polycationic proteins located in each eukaryotic nucleus, which naturally supercoil DNA. The aim of this study was to investigate the in vitro and in vivo activity of histone H1.2 in infected burn wounds and its potential toxicity. METHODS: To characterize the antimicrobial properties of histone H1.2 against potential causative organisms of burn wound infections, the in vitro radial diffusion assay and modified NCCLS microbroth dilution MIC assay were carried out. Haemolytic and cytotoxic properties were determined in human red blood cells and primary human keratinocytes. In vivo antimicrobial activity was tested in an infected rat burn model with P. aeruginosa (ATCC 27853). All results were compared with the naturally occurring broad-spectrum antimicrobial peptide protegrin-1 and with antibiotics clinically used against the corresponding bacteria. RESULTS: Human histone H1.2 exerted good antimicrobial activity against all tested microorganisms without significant haemolytic activity. Surprisingly, histone H1.2 showed cytotoxicity with an LD50 of 7.91 mg/L in primary human keratinocytes. The in vivo burn model data revealed a significant three-fold higher reduction in bacterial counts within 4 h compared with carrier control. CONCLUSIONS: These findings indicate that histone H1.2 is a potential candidate for use as a local and, because of its low haemolytic activity, systemic antimicrobial agent. However, further investigations are needed to specify the cytotoxicity and the dose-response relationship for histone H1.2.
