Search

Purpose: To analyze factors that predict the occurrence of chemotherapy-induced myelosuppression and, in particular, the role of the tumor necrosis factor (TNF) ligand-receptor system in lymphoma patients at the beginning of their treatment., Patients and Methods: We investigated the predictive factors for myelosuppression after the first course of chemotherapy in a cohort of 101 consecutive, previously untreated lymphoma patients receiving regimens that include doxorubicin and cyclophosphamide. Plasma samples were tested at baseline by enzyme-linked immunosorbent assay for TNF and its soluble receptors. Univariate and multivariate analyses were performed with a forward regression procedure that included all of the parameters that were found to be significant in the univariate analysis. The dose of chemotherapy and the prophylactic treatment with granulocyte colony-stimulating factor were deliberately included in this model., Results: Sixty-seven patients experienced World Health Organization (WHO) grade 4 neutropenia, and 37 patients experienced febrile neutropenia, which was responsible for WHO grade 2 through 4 infections in 23 patients. In multiparametric regression analysis, the occurrence of grade 4 neutropenia was associated with high doses of cyclophosphamide (odds ratio ¿OR, 19.8; P =.008) and high levels of soluble p75-R-TNF (OR, 8.52; P =.001). The duration of grade 4 neutropenia for more than 5 days was associated with the lack of hematopoietic growth factor administration (OR, 6.76; P =.004) and high levels of soluble p75-R-TNF (OR, 5.84; P =.0023). The occurrence of febrile neutropenia was associated with high doses of cyclophosphamide (OR, 4.7; P =.007), altered performance status (OR, 18.8; P <.0001) and high levels of soluble p75-R-TNF (OR, 3.49; P =.029)., Conclusion: This study indicates that in addition to the dose of chemotherapy and the administration of hematopoietic growth factors, poor performance status and high p75-R-TNF levels can predict the occurrence of chemotherapy-induced myelosuppression in lymphoma patients. This model may help in selecting patients for prophylactic growth factor administration.

Merkel cell carcinoma (MCC) is an uncommon neuro-endocrine tumor of the sun-exposed skin predominantly observed in white patients in the sixth decade of the life. In electron microscopy MCC characteristically contains dense core secretory granules. This tumor expresses both epithelial (keratins of low molecular weight of the simple epithelial type, epithelial membrane antigen) and neuro-endocrine markers (neuron-specific enolase, chromogranin A). The analysis of available literature indicates that MCC has a propensity for involvement of regional lymphatics (12% of patients at the date of initial diagnosis and 50 to 66% afterwards) and for metastases to distant sites (20 to 52%). The prognosis of metastatic disease is poor. The overall survival from the diagnosis of metastases is 6 months. The optimal treatment of locoregional stages should include excision and post-operative radiation. The role of chemotherapy in this tumor is unclear but recent data suggest a high chemosensitivity.

An increased incidence of deep vein thrombosis is reported in cancer patients as compared with general population. Several risk factors for deep vein thrombosis have been identified: venous stasis, direct invasion of venous wall by tumor, and hypercoagulability state by inadequate secretion of procoagulant activities. Reports have suggested that chemotherapeutic agents and hormonal treatment may contribute to this risk. Few papers are available concerning the prophylaxis and curative treatment of deep vein thrombosis in cancer patients and no consensus has been reached yet. This predisposition for deep vein thrombosis should be taken into consideration for perioperative prophylaxis. Efficacy and safety of heparin and antivitamin K in the curative treatment of deep vein thrombosis are discussed but can not be accurately evaluated because of diversity of clinical presentations and mechanism of activation of coagulation. Prospective studies are necessary.

The concept 'sexually transmitted diseases' (STD) was introduced in the nineteen sixties and comprises many diseases of varying importance from scabies to HIV infection. The STD family has grown wider and new members will probably join. The starting point of these studies was that patients with HPV infection, attending the STD clinic, appeared to increase in number in the late eighties. HPV was analysed with the Southern blot technique from portio cervix in a female population attending the STD clinic. In this population 8% were HPV-positive. If vulvar/vaginal HPV manifestations were present the figure increased to 34%. Abnormal cytology was found in 13% and if the woman harboured high-risk types of HPV there was also a greater risk of abnormal cytology (Paper I). Different clinical manifestations of HPV infection were examined in men with respect to different types of HPV. Macular lesions seemed mainly to be related to high-risk types to accuminate lesions. Histological dysplasia was correlated to high-risk HPV types (Paper II). The resemblance of acetowhite lesions of the vulva to oral hairy leukoplakia suggested the possibility of EBV as an etiological factor. EBV was demonstrated with PCR in 48% and HPV in 17%. In the group with no acetowhite reactions the correspondings figures were 11% and 42% (Paper III). As these results were unexpected, another group of women with the same clinical manifestations, as well as a control group, were examined. The tendency to find more EBV in the acetowhite lesions was confirmed. HPV was detected equally in both groups (Paper IV). The inclusion criterion was presence of acetowhite, koilocytotic lesions in routine histological examination. When all biopsies were reevaluated, only 8 of 20 demonstrated an evident koilocytosis (Paper IV). A male group with acetowhite penile lesions and a group with no acetowhite reactions were investigated with respect to EBV and HPV. HPV positivity was strongly correlated to acetowhite lesions but not EBV. All lesions demonstrated an evident koilocytosis (Paper IV). The oral mucosa of men with acetowhite, penile lesions more often harboured both EBV and HPV compared to the controls (Paper IV). The portio cervix was examined to detect EBV and HPV, irrespective of clinical manifestations. EBV and HPV was found in 38% and 33%, respectively (Paper V). In patients with acetowhite, koilocytotic and/or dysplastic lesions on the portio cervix EBV was found in 30% and HPV in 51%. EBV was not associated with either acetowhiteness or dysplasia (Paper VI). A group of HPV infected men was investigated concerning psychological complications in connection with their viral, genital infection. Half of the group were anxious about the risk of giving their partner an oncogenic virus, and a fifth of the group had feelings of "dirtiness" and reported a decrease in their sexual desire (paper VII). In view of this, it is concluded that acetowhite, koilocytotic lesions of the penis and the cervix are HPV related. On the vulva, however, HPV seems to have a minor role, whereas EBV might be associated with acetowhite lesions. These and other recent findings suggest EBV to be a possible STD related virus. The oncogenic potential of EBV underlines the importance of further studies. Koilocytosis as a pathognomonic sign of HPV infection has to be reconsidered. Finally, psychological aspects have to be kept in mind in the treatment of patients with HPV infection.

A group of 91 women attending the STD-clinic, Department of Dermatovenereology, Sahlgrenska Hospital, Gothenburg, were screened for EBV DNA and HPV DNA of the cervix with the PCR-technique. Presence of EBV DNA was demonstrated in 35 (38%) women and HPV DNA in 30 (33%) women. Fourteen (15%) women had both EBV DNA and HPV DNA present. Without the colposcope 20 of these women had macroscopic signs of HPV infection on the vulva and/or vagina and 71 had no signs of infection. Presence of EBV DNA was not correlated to clinical signs of HPV infection.

Muco epidermoïd tumors of the lung are rare tumors, derived from the minor salivary gland tissue of the proximal tracheo bronchial tree. We distinguish high grade and low grade malignity tumors. Authors are presenting two cases reports of mucoepidermoid tumors of the lung with a very aggressive behavior and a review of the literature. Attention is drawn to the difficult differential diagnosis with adenosquamous carcinoma of the lung.

The purpose of this study was to demonstrate the prevalence of cervical human papilloma virus (HPV) infection correlated to reason for attending an STD clinic, presence of clinical signs of HPV infection, concomitant infection and abnormal cytology. Samples from the cervical canals of 588 consecutive women attending the STD clinic, Department of Dermato-Venereology, Sahlgrenska Hospital, Gothenburg, were taken with a Cytobrush for detection of HPV DNA with the dot blot/Southern-blot technique. Visible condylomata, i.e. filiform or papular condylomata, were registered. Acetic acid test and colposcopy were not routinely performed. Cytological examination was performed as well as isolation of Chlamydia trachomatis on Mc Coy's cells and culture on Sabouraud agar for Candida albicans. The prevalence of HPV DNA was 8% (48/588). In the group of 233 women attending because of concern about HPV infection, 94 (40%) had visible signs of HPV infection and 30 (13%) were positive for HPV DNA in the cervix. In 355 women attending for other reasons, such as discharge, pruritus or STD check-up, 4 (1%) had visible signs of HPV infection and 18 (5%) were HPV DNA positive. Of 98 women with visible signs of vulvar/vaginal HPV infection, 33 (34%) were HPV-positive in the cervix with a commercial Southern-blot test. Of 490 patients without visible signs of HPV infection, 15 (3%) were HPV-positive in the cervix. In the group of HPV-positive women a positive culture for Candida was demonstrated in 26% (11/43), Compared to 16% (79/504) of the HPV-negative women.(ABSTRACT TRUNCATED AT 250 WORDS)