RESUMO
We studied 21 dialysis patients who became hypercalcemic without vitamin D or calcium therapy and compared them to 28 dialysis patients who were not hypercalcemic. In the hypercalcemic group, the mean ionized-calcium level was elevated compared to normal subjects (5.4 +/- 0.4 vs. 4.9 +/- 0.1; p less than 0.001), while the ionized-calcium level in the control dialysis patients was below normal (4.5 +/- 0.4 vs. 4.9 +/- 0.1; p less than 0.001). Bone biopsies were performed in all patients. Two thirds of the hypercalcemic patients had low-turnover osteodystrophy (LTO, predominantly osteomalacia), a fraction significantly higher than in the control dialysis patients (13/21 vs. 8/28, respectively; p less than 0.05). The hypercalcemic patients with LTO had markedly elevated surface bone aluminum (63 +/- 24% of all trabecular surfaces). In contrast, the nonhypercalcemic dialysis patients with LTO and all patients with osteitis fibrosa had minimal surface bone aluminum. Hypercalcemic patients with osteitis fibrosa had a significantly lower mean N-terminal parathyroid hormone (PTH) value than did nonhypercalcemic patients with osteitis fibrosa (149 +/- 81 vs. 278 +/- 135 pg/ml, respectively; p less than 0.005). Both mean values were markedly elevated in comparison with those obtained in normal subjects (16 +/- 5 pg/ml). In contrast, patients with LTO, irrespective of the calcium level, had mean PTH values that were not significantly different from those of normal subjects. A PTH level greater than 100 pg/ml was 95% sensitive and 87% specific for osteitis fibrosa, as demonstrated by histomorphometry in nonhypercalcemic dialysis patients. However, this level was only 62% sensitive and 77% specific for a diagnosis of osteitis fibrosa in hypercalcemic dialysis patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Alumínio/metabolismo , Osso e Ossos/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/complicações , Hipercalcemia/metabolismo , Hormônio Paratireóideo/sangue , Diálise Renal , Adulto , Idoso , Osso e Ossos/patologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/patologia , Feminino , Displasia Fibrosa Óssea/complicações , Seguimentos , Humanos , Hipercalcemia/etiologia , Hipercalcemia/mortalidade , Hipercalcemia/patologia , Masculino , Pessoa de Meia-IdadeAssuntos
Furosemida/uso terapêutico , Hipercalcemia/tratamento farmacológico , Solução Salina Hipertônica/uso terapêutico , Adenocarcinoma/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Cálcio/sangue , Feminino , Humanos , Hipercalcemia/etiologia , Hipercalcemia/mortalidade , Hiperparatireoidismo/complicações , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicaçõesRESUMO
As part of epidemiologic studies of human T-lymphotropic virus (HTLV)-I-associated malignancies in Jamaica, the authors evaluated 26 patients with non-Hodgkin's lymphoma for the presence of integrated HTLV-I provirus in their malignant cells. Fifteen of 26 patients had integrated provirus. All 15 also were HTLV-I antibody positive. Eleven patients did not have integrated provirus, and all 11 were antibody negative. All of the antibody-positive cases had onset of their disease in adulthood (age range, 21-57 years) as opposed to the broad age range of negative cases (4-66 years). Clinical features which were more common in provirus positive than negative patients included leukemic phase, skin involvement, and hypercalcemia, which are all features frequently seen in HTLV-I-associated adult T-cell leukemia/lymphoma (ATLL). The presence of skin involvement, circulating malignant cells, abnormal liver function tests, or the presence of two or more of these four features were statistically significantly different between virus-positive and virus-negative cases. Although the survival of positive cases (6 months) was shorter than that of negative cases (9 months), this was not statistically significant. The only significant determinant of survival was hypercalcemia, with those who developed hypercalcemia at some point in their disease course, independent of their HTLV-I status, surviving a mean of 5 months as compared to a mean of 17.5 months in those who never became hypercalcemic. The six HTLV-I-positive lymphomas that underwent cell typing were all primarily OKT4 positive, whereas two HTLV-I antibody-negative cases that were typed were B-cell lymphomas.
Assuntos
Deltaretrovirus/isolamento & purificação , Linfoma não Hodgkin/epidemiologia , Provírus/isolamento & purificação , Anticorpos Antivirais/análise , DNA Viral/análise , Deltaretrovirus/imunologia , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/imunologia , Doença de Hodgkin/microbiologia , Doença de Hodgkin/mortalidade , Humanos , Hipercalcemia/mortalidade , Jamaica , Leucemia Linfoide/epidemiologia , Leucemia Linfoide/imunologia , Leucemia Linfoide/microbiologia , Leucemia Linfoide/mortalidade , Leucemia Mieloide Aguda/epidemiologia , Leucemia Mieloide Aguda/imunologia , Leucemia Mieloide Aguda/microbiologia , Leucemia Mieloide Aguda/mortalidade , Linfadenite/epidemiologia , Linfadenite/imunologia , Linfadenite/microbiologia , Linfadenite/mortalidade , Linfoma não Hodgkin/imunologia , Linfoma não Hodgkin/microbiologia , Linfoma não Hodgkin/mortalidade , Provírus/imunologiaRESUMO
As part of epidemiologic studies of human T-lymphotropic virus (HTLV)-I-associated malignancies in Jamaica, the authors evaluated 26 patients with non-Hodgkin's lymphoma for the presence of integrated HTLV-I provirus in their malignant cells. Fifteen of 26 patients had integrated provirus. All 15 also were HTLV-I antibody positive. Eleven patients did not have integrated provirus, and all 11 were antibody negative. All of the antibody-positive cases had onset of their disease in adulthood (age range, 21-57 years) as opposed to the broad age range of negative cases (4-66 years). Clinical features which were more common in provirus positive than negative patients included leukemic phase, skin involvement, and hypercalcemia, which are all features frequently seen in HTLV-I-associated adult T-cell leukemia/lymphoma (ATLL). The presence of skin involvement, circulating malignant cells, abnormal liver function tests, or the presence of two or more of these four features were statistically significantly different between virus-positive and virus-negative cases. Although the survival of positive cases (6 months) was shorter than that of negative cases (9 months), this was not statistically significant. The only significant determinant of survival was hypercalcemia, with those who developed hypercalcemia at some point in their disease course, independent of their HTLV-I status, surviving a mean of 5 months as compared to a mean of 17.5 months in those who never became hypercalcemic. The six HTLV-I-positive lymphomas that underwent cell typing were all primarily OKT4 positive, whereas two HTLV-I antibody-negative cases that were typed were B-cell lymphomas. (AU)
Assuntos
Humanos , Deltaretrovirus/isolamento & purificação , Linfoma não Hodgkin/epidemiologia , Provírus/isolamento & purificação , Anticorpos Antivirais/análise , DNA Viral/análise , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/imunologia , Doença de Hodgkin/microbiologia , Doença de Hodgkin/mortalidade , Hipercalcemia/mortalidade , Deltaretrovirus/imunologia , Jamaica , Leucemia Linfoide/epidemiologia , Leucemia Linfoide/imunologia , Leucemia Linfoide/microbiologia , Leucemia Linfoide/mortalidade , Leucemia Mieloide Aguda/epidemiologia , Leucemia Mieloide Aguda/imunologia , Leucemia Mieloide Aguda/microbiologia , Leucemia Mieloide Aguda/mortalidade , Linfadenite/epidemiologia , Linfadenite/imunologia , Linfadenite/microbiologia , Linfadenite/mortalidade , Linfoma não Hodgkin/imunologia , Linfoma não Hodgkin/microbiologia , Linfoma não Hodgkin/mortalidade , Provírus/imunologiaRESUMO
Of 95 patients consecutively diagnosed with non-Hodgkin lymphoma, 52 (55%) had antibodies to human T-cell leukemia-lymphoma virus, type I. Antibody positivity was strongly associated with skin involvement, leukemia, and hypercalcemia (p less than 0.02). Two patients had systemic opportunistic infections. Neither meningeal nor lung infiltration was detected, and lymph node infiltration was diffuse in all patients. Of 36 patients who received immunophenotypic classifications, 30 had diseases that affected the T-cell system, and the cells of all tested patients with these diseases showed the helper/inducer (T4) phenotype. Twenty-seven of these thirty-six patients were found to have adult T-cell leukemia-lymphoma, and of the 27, 24 had antibodies to HTLV-I. The median duration of survival in patients with adult T-cell leukemia-lymphoma was 17 weeks, but a subgroup of 9 patients had indolent courses and a median survival of 81 weeks, which suggests that the disease has differing expression with courses that range from smoldering and indolent to acute and rapidly fatal. Hypercalcemia was the most important prognostic determinant of adult T-cell leukemia-lymphoma.
Assuntos
Infecções por Deltaretrovirus/epidemiologia , Linfoma não Hodgkin/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Infecções por Deltaretrovirus/mortalidade , Infecções por Deltaretrovirus/patologia , Feminino , Humanos , Hipercalcemia/mortalidade , Infecções/mortalidade , Jamaica , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosRESUMO
Of 95 patients consecutively diagnosed with non-hodgkin lymphoma, 52(55 percent) had antibodies to human T-cell leukemia-lymphoma virus, type I. Antibody positively was strongly associated with skin involvement, leukemia, and hypercalcemia (p<0.02). Two patients had systemic opportunistic infections. Neither meningeal nor lung infiltration was detected, and lymph node infiltration was diffuse in all patients. Of 36 patients who received immunophenotypic classifications, 30 had diseases that affected the T-cell system, and the cells of all tested patients with these diseases showed the helper/inducer (T4) phenotype. Twenty-seven of these thirty-six patients were found to have adult T-cell leukemia-lymphoma, and of the 27, 24 had antibodies to HTLV-I. The median duration of survival in patients with adult T-cell leukemia-lymphoma was 17 weeks, but a subgroup of 81 weeks, which suggests that the disease has differing expression with courses that range from smoldering and indolent to acute and rapidly fatal. Hypercalcemia was the most important prognostic determinnant of adult T-cell leukemia-lymphoma.(AU)