Conventional therapeutic approaches like chemotherapy, surgery and radiation for cancer and other malignancies have limited success rate. Several factors such as drug resistance, non-penetrability into solid tumors and unwanted toxicity due to non-specific action contribute to treatment failure. To overcome these issues, immunotoxins were developed having a target specific action. Immunotoxins are chimeric cytotoxic proteins which are formed by linking a toxin moiety to intact antibody or its fragment. Bacterial and plant based toxins are used in immunotoxins construction but they have many drawbacks in terms of immunogenicity and non-specific toxicity. Recently, a novel class of immunotoxins of human origin has been introduced. Immunotoxins fight back cancers by targeting the neoplastic cells and cause cells death by inhibiting protein synthesis. They have been categorized into two main classes, chemically conjugated immunotoxins and recombinant immunotoxins. This review summarizes recent advances in immunotoxins development and present a comprehensive illustration of sources and generations of immunotoxins. Moreover, it also highlights future directions to be explored. This review also focuses the limitations in immunotoxins development and its use.
We investigated the cytotoxic effect of nitric oxide (NO) on primary culture of human hematological malignant cells. Sodium nitroprusside (SNP), an NO donor, had cytotoxic effects on the cells of some patients with malignant lymphoma (ML), acute myelocytic leukemia (AML) or chronic myelomonocytic leukemia (CMMoL), but not with multiple myeloma. Cultured cells from the ML patient remained sensitive to SNP after the cells became resistant to anti-cancer drugs. In contrast, the cells from the patients with AML and CMMoL became resistant to SNP while anti-cancer drugs remained effective. In samples of the cells of the patients with ML and AML, the number of CD3 positive lymphoma cell was decreased by SNP and the number of CD33 negative cells and normal B lymphocytes (CD19 positive cells) were increased. In the cells of the patient with ML, apoptosis was induced by SNP. SNP had no effect on lymphocytes of healthy volunteers. These results suggest that SNP had an anti-tumor effect on human hematological malignant cells.
Malignant lymphomas represent approximately 5% of all malignant neoplasm of the head and neck and may involve nodal or extranodal sites. The head and neck region is the second most frequent anatomical site of extranodal lymphomas (after the gastrointestinal tract). Most are non-Hodgkin lymphomas (NHL) of B-cell lineage. Hodgkin's lymphoma (HL) rarely occurs in extranodal site.The aim of the study was to evaluate head and neck manifestation of lymphoma (both HL and NHL) and emphasize diagnostic difficulties of these pathologies.Material and methods. Retrospective review of medical records of patients diagnosed for lymphomas in our department was performed. Authors analyzed demographic data as well as clinical manifestation and diagnostic trials.Results. 9 patients were included to the study. 7 of them suffered from extranodal NHL and 2 of them from HL (one patient - extranodal and one nodal manifestation). There were diagnostic complications in all cases and final diagnosis was made after surgical material analysis.Conclusions. This data demonstrate low sensivity of fine needle aspiration for identification of lymphoma as well as clinical picture is non characteristic.
The present study reports the case of a 40-year-old patient who presented SIADH syndrome due to anaplastic large T-cell lymphoma and antineoplastic drugs.
The aim of the study was to evaluate the function of monocytes in children with leukemias and lymphomas based on the expression of critical costimulatory, activatory and adhesion molecules (CD80, CD86, HLA-DR and CD54 = ICAM-1), estimated with tricolor flow cytometry. In comparison to the control group we found a lower percentage of monocytes with costimulatory molecules (CD80 before and CD86 after lipopolysaccharide stimulation) at the time of diagnosis and of monocytes with HLA-DR molecules after remission induction. We also noted a lower percentage of monocytes with HLA-DR expression in the group with severe or therapy resistant infections. The results of our investigation suggest some defect in costimulation and antigen presentation in lymphoproliferative diseases in children.
Introduction: Nowadays, rituximab is available both as intravenous (IV) and subcutaneous (SC) formulations. The aim of this study is to compare quality of life (QOL) of patients treated in Hematooncology Clinic in Lodz with B-cell nonHodgkin lymphoma (B-NHL) treated with rituximab IV and SC. Material and Methods: In 50 adult patients with B-NHL diagnosis we assessed QOL by three different questionnaries (EORTC QLQ-C30, FACT/ GOG-NTx and EQ-5D). We compared it between patients treated with rituximab IV and SC. Results: In comparison of general condition in EQ-5D-3L and EORTC QLQ-C30 questionnaire patients treated with rituximab SC felt statistically better than with IV administration (p<0.01). In SC group general health was evaluated for 72 while in IV for only 58,1. According to FACT/GOG-NTx questionnaire SC group had significantly better physical well-being. In SC group we observed statistically more complete responses (CR) 21 (88%) versus 17 (65%) in IV group. Moreover, trend was observed in emotional well-being in favor of SC treatment. Discussion: In our study we observed for the first time in the literature statistical difference in frequency of vomiting, nausea, and lack of appetite mentioned from our patients in questionnarie. It is very important that this findings were not published in any other study comparing SC and IV route od administration. Also looking at economic side of SC administration, this type of dosing. As a result it should be preferred form for B-cell lymphoma patients.
The significant progress in the treatment of non-Hodgkin lymphomas, translating into prolongation of overall survival results in the manifestation of long-term adverse events, like anthracycline-related cardiotoxicity. Despite the dose-dependent cardiac dysfunction and the presence of risk factors, the increasing probability of cardiotoxicity arises from individual predisposition. Identification of high- -risk patients gives the opportunity to implement the prevention strategies to reduce the incidence of cardiac complications. The study evaluated the utility of biomarkers: N-terminal B-type natriuretic peptide, troponin I and electrocardiography with spatial QRS-T angle assessment, as indicators of individual sensitivity of cardiomyocytes to doxorubicin resulting in myocardial damage. Thirty-five treatment-naïve patients at increased risk of cardiotoxicity, were subjected prospectively during (R)-CHOP treatment to echocardiographic assessment and analysis of biomarkers: TnI and NT-proBNP plasma level and spatial QRS-T assessment before and 24 hours after each cycle of chemotherapy. The analysis of QRS-T angle was consistent with the results of NT-proBNP assessment and allowed to identify, after the first cycle of chemotherapy, patients at increased risk of developing cardiovascular complications, who require thorough echocardiographic analysis and primary cardioprotection implementation. Our data did not reveal the role of TnI in the identification of cardiac events. Our findings, though promising, should be confirmed in a larger group of patients in real-life or clinical trials.
Follicular mucinosis is a rare dermatosis characterized by accumulation of mucin in the follicular epithelium and sebaceous glands. Clinically, it is characterized by the presence of papules or well-circumscribed and infiltrative plaques. In this paper, we report a case of a 15-year-old girl, in which an asymptomatic, erythematous and infiltrative plaque evolved within a few weeks in the forehead region. There was no regression of the lesion with the use of topical glucocorticosteroids and isotretinoinum for 30 days.
Proptosis is a characteristic sign that might suggest the diagnosis of different diseases. Proptosis is characterised by the anterior displacement of the eye and its protrusion. The most commonly associated symptoms of proptosis are deteriorated vision, elevated intraocular pressure and inflammation of periocular tissues. The presented study describes two cases of patients with proptosis and periocular pain. In each case, the primary cause of proptosis was initially incorrectly diagnosed and required in-depth diagnostics. In Patient A extrabulbar optic neuritis caused by Lyme disease was suspected and treated with steroids and antibiotics. Subsequently, Graves’ disease was diagnosed and treated with anti-thymocyte globulin. Complete loss of vision was observed after one month of treatment. Radiotherapy and steroid therapy were introduced. Afterwards, the patient’s vision was restored. Patient B, who was treated for hypothyroidism, was admitted to the hospital with elevated intraocular pressure, double vision, a restricted visual field and proptosis. The primary diagnosis was Graves’ ophthalmopathy (GO). However, after in-depth imaging and pathomorphological studies of a specimen taken from the orbit, B-cell lymphoma was diagnosed. After the introduction of correct treatment, significant improvement was noted. Presented work indicates that in-depth diagnostics are crucial when it comes to the differential diagnosis of GO and a tumor of the orbital cavity.
PL
Wytrzeszcz jest objawem charakterystycznym w różnych jednostkach chorobowych. To przemieszczenie gałki ocznej oraz jej wysunięcie do przodu. Pacjentom z wytrzeszczem najczęściej towarzyszą takie objawy, jak pogorszenie widzenia, wzrost ciśnienia śródgałkowego oraz zapalenie tkanek okołooczodołowych. W pracy opisano dwa przypadki pacjentów z objawami wytrzeszczu oraz bólu okołogałkowego, którego pierwotna przyczyna nie została właściwie rozpoznana i wymagała pogłębionej diagnostyki. U pacjenta A wysunięto podejrzenie pozagałkowego zapalenia nerwu wzrokowego w przebiegu choroby z Lyme, leczonego glikokortykosteroidami i antybiotykami. Następnie rozpoznano chorobę Gravesa i zastosowano leczenie globuliną antytymocytarną. Po miesiącu terapii zaobserwowano całkowitą utratę wzroku. Wdrożono radioterapię i sterydoterapię, uzyskując powrót widzenia. Pacjent B, leczony przewlekle na niedoczynność tarczycy, zgłosił się do szpitala z podwyższonym ciśnieniem śródgałkowym, dwojeniem, ograniczeniem pola widzenia oraz wytrzeszczem. Początkowo diagnostyka wskazywała na oftalmopatię Gravesa (Graves’ ophthalmopathy – GO). Jednak po wykonaniu badań obrazowych oraz patomorfologicznych pobranego z oczodołu wycinka stwierdzono chłoniaka z drobnej komórki B. Po wprowadzeniu leczenia nastąpiła znaczna poprawa. W pracy pokazano, jak ważna w przypadku rozpoznania różnicowego pomiędzy chorobami o etiologii zapalnej i nowotworowej jest pogłębiona diagnostyka.
Elastography is a new method of assessment of lymph node consistency. The majority of papers focus on metastases detection of head and neck or breast tumors. The typical desmoplastic reaction in connective tissue stroma in cancer, which is responsible for tissue’s hardening, is seen in lymphoma less frequently. Material and methods: Study of 15 patients with active Hodgkin and non-Hodgkin lymphomas and 16 previously treated patients with no evidence of recurrence. A total of 60 patients suffering from reactive lymphadenopathy was the control group. The size, appearance, vascularity and elastogram of lymph node was analyzed. Results: Type C elastogram correlated strongly with lymph nodes which presented at least three pathologic features in 2D image. Large lymph nodes with long axis diameter over 3 cm may have ‘cheese with holes’ appearance rather than common type C elastogram. Conclusion: According to our simplifi ed sonoelastography scoring system, type C elastogram was present mainly in patients with active lymphoma affecting lymph nodes, which showed all four features that we analyzed using conventional ultrasonography. This elastogram was also present in reactive lymphadenopathies. Distinctive for large lymph nodes in patients with active forms of lymphoma “cheese with holes” appearance, can be considered as equal with type C image, although it is corresponding to type B sonoelastographic map.
PL
Elastografia jest nową metodą pozwalającą ocenić spoistość węzłów chłonnych. Większość prac skupia się na wykrywaniu przerzutów raków okolicy głowy i szyi oraz sutka. Typowa dla raków reakcja desmoplastyczna podścieliska łącznotkankowego, odpowiadająca za wzmożoną spoistość, w chłoniakach występuje rzadziej. Materiał i metoda: Badanie przeprowadzono na grupie 15 pacjentów z aktywną postacią chłoniaka Hodgkina i chłoniaków nie-Hodgkinowskich oraz 16 pacjentów po zakończonym leczeniu i bez cech wznowy. Grupę kontrolną stanowiło 60 osób z odczynową limfadenopatią. Węzły chłonne oceniono pod kątem wielkości, wyglądu, typu unaczynienia oraz wyglądu elastogramu. Wyniki: Elastogram typu C wykazywał silną korelację dodatnią z węzłami chłonnymi prezentującymi co najmniej trzy cechy patologii w obrazie 2D. Duże węzły chłonne przekraczające 3 cm w największym wymiarze zamiast klasycznego elastogramu C mogą prezentować wygląd „sera z dziurami”. Wnioski: Typ C według naszej uproszczonej skali sonoelastograficznej obecny był głównie u chorych z aktywnym chłoniakiem w węzłach wykazujących wszystkie cztery cechy, jakie ocenialiśmy w klasycznym USG, ale obserwowany był także w limfadenopatiach odczynowych. Obraz „sera z dziurami” jest charakterystyczny tylko dla dużych węzłów chłonnych u pacjentów z aktywnymi postaciami chłoniaków i choć odpowiada typowi B mapy sonoelastograficznej, to może być traktowany na równi z obrazem C.
Intussusception is a curious anatomic condition characterized by the invagination of one segment of the gastrointestinal tract into the lumen of an adjacent segment. Once initiated, additional intestinal telescopes into the distal segment, causing the invaginated intestine to propagate distally within the bowel lumen.The aim of the study was to evaluate the clinical manifestation, etiology, and outcome of intussuception at atypical ages.Material and methods. This retrospective study was carried out on patients aged <6 mo or >2 yr with intussusception. Duration of study was from March, 20, 1997 to March, 20, 2008. The places of study were Imam Khomeini and Abuzar referrals hospital. Cases were classified according to age and sex. According to age, patients were <6 mo, 2-10 years, 10-18, and more than 18 years. Age, sex, history, chief complaint, clinical manifestation, sonographic findings, duration of clinical manifestation, method of treatment, outcome, duration of hospital staying, and ICU admission were studied. Data were analyzed with SPSS ver 16 (Chicago, IL, USA) and Epi-info.Results. In this study, 36 cases with diagnosis of intussusception at atypical ages, <6 mo or >2 yr, were included. From all cases, 21 cases (58.3%) were 2 through 10 years and male: female ratio was 2.26:1. Ten cases (27.8%) had history of medical condition. Eighty percent (29 cases) had abdominal pain and 20 cases (58.3%) had vomiting. Abdominal mass was found in 14 cases (38.8%). Sonography was done for 30 (83.3%) of cases and suggesting intussuception in 25 (69.4%) of cases. Intussuception was reduced by hand and performed appendectomy for 10 cases (27.8%). Bowel resection was done for 19 cases (52.8%) and radiological reduction was done for 2 cases (5.6%). Eighteen (50%) cases had anemia. Twenty-five cases admitted to ICU. One (2.8%) patient died (a 65 year old woman). Appendicitis is the most common well defined injury associated with intussusception.Conclusion. This study showed that with advancing age, incidence of intussusception will be decreased. As age increasing, rate of bowel resection will be increased. All cases with appendectomy and reduction by hand had hospital staying 3-10 days. The results of this study was similar to other studies. The most widely used diagnostic procedure for intussusception was sonography.
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