Joseph M. Kiely

Lymphoma of the spinal extradural space

Ninety‐four patients with lymphoma involving the extradural space with spinal cord compression proven at the time of laminectomy were reviewed. There were about three times as many patients with non‐Hodgkins lymphoma than with Hodgkins disease. The majority of those with Hodgkins disease had a proven histologic diagnosis before the onset of the spinal cord compression syndrome, whereas only 15% of those with non‐Hodgkins lymphoma had previously been so diagnosed. Plain roentgenograms of the spine were suggestive of tumor involvement in less than one‐third of the patients, whereas myelograms were invariably abnormal. As noted by others, the outlook for functional recovery and extended life expectancy is relatively good for patients with this type of cancer, in contrast to reports in the literature regarding prognosis for patients who have metastatic carcinoma with extradural spinal cord compression.

Renal Complications of Lymphoma

Abstract In patients with lymphoma, impairment of renal function may occur as a direct consequence of the tumor either in the form of neoplastic infiltration of the kidney or as bilateral ureteral ...

Pleural effusion in lymphoma.

Pleural effusion in lymphoma is usually, but not invariably, a poor prognostic sign. The presence of underlying parenchymal lung involvement or a chylous type of effusion does not further alter the prognosis, but the presence of malignant cells in the fluid probably shortens survival. Obstruction of lymphatic drainage of the lung and pleura by enlarged mediastinal nodes, with resulting lymphedema of the pleural space, is probably the most common cause of nonchylous pleural effusion. In contrast to patients with metastatic carcinoma, pleural involvement by lymphoma is uncommonly the major factor in fluid formation. Radiation therapy to the mediastinum or to the affected hemithorax is more likely to relieve lymphomatous effusions than is intrapleural therapy or systemic chemotherapy alone.

Myelomonocytic leukemia in Hodgkin's disease

The records of 1,500 patients with Hodgkins disease seen at the Mayo Clinic from 1950 to 1967 were reviewed in search of any later‐developing myelo‐proliferative disorders. No cases of polycythemia vera, agnogenic myeloid metaplasia, or primary thrombocythemia were found in patients with pre‐existent Hodgkins disease. Three case reports of myelomonocytic leukemia (2 manifesting Auer bodies) developing 1 1/2, 5 1/2, and 18 years after the diagnosis of Hodgkins disease are presented. Myelomonocytic leukemia does not appear to represent a transitional stage of Hodgkins disease and is more likely related to therapy of the lymphomatous disease.

Metastatic carcinoma simulating agnogenic myeloid metaplasia and myelofibrosis.

Eight patients with metastatic carcinoma with findings simulating agnogenic myeloid metaplasia and myelofibrosis are reported. All patients had a previous histologic diagnosis of carcinoma and complained of bone pain. All had leukoerythroblastic anemia and reticulocytosis. Splenomegaly, observed in 6 of the 8 patients, was striking in only 2. Bone marrow examination in 6 patients revealed fibrosis in all 6, and carcinoma cells were demonstrable in 4. Osseous roentgenographic changes, observed in all 8 patients, were lytic, blastic, or mixed. Clinical differentiation from agnogenic myeloid metaplasia may be difficult but is possible. Long survival after the onset of myeloid metaplasia with metastatic carcinoma may occur; 3 of our patients were living more than 2 years after onset of the disorder.

Radiochromium-Labeled Lymphocytes in the Rat.

Summary A technic is described for labeling rat lymphocytes, collected from intestinal lymph, with radiochromium without impairing their motility. After intravenous administration, these labeled cells disappeared rapidly from the circulating blood, reappeared to a limited extent within 6 hours, then continued to disappear at a very slow rate (about 1.1% per hour). When the rats intestinal lymphatic trunk was cannulated, 4 to 7% of the labeled lymphocytes appeared in the lymph within 4 days, with maximal lymphatic radioactivity occurring between the 24th and 36th hours.

Thorotrast-induced hepatoma presenting as hyperparathyroidism

Clinical findings mimicking primary hyperparathyroidism were present in a patient with hepatoma, which was diagnosed 27 years after administration of Thorotrast. External scintillation gamma‐ray spectrum analysis during life and autoradiographic studies after death demonstrated the presence of the radioactive contrast medium.

Erythrokinetics in Myxedema

Excerpt Normochromic anemia of modest degree is common in myxedematous patients and may persist for months after institution of thyroid hormone therapy (1-3). The bone marrow tends to be hypocellul...

Short-Term International Medical Service

There are many opportunities for short-term medical service internationally. Prerequisite preparation must include consideration of motivation, flexibility, culturally sensitive health care, and problems in communication and patient approach. Practical considerations require recognizing the importance of choice of locale, lack of materials and equipment, health concerns, travel, and expenses. A reference for opportunities available and a list of articles suggested as supplementary reading are provided.

Reinduction Chemotherapy for Acute Nonlymphocytic Leukemia

Twenty-four patients who had a relapse after successful treatment of acute nonlymphocytic leukemia were re-treated with a chemotherapeutic program similar to that which produced the initial remission. Eight of the nine patients who achieved a second remission had received a three-drug reinduction regimen consisting of cytosine arabinoside, an anthracycline, and 6-thioguanine. An increased duration of initial remission before relapse (more than 26 weeks) predicted a greater likelihood of achieving a second remission.