When reseаrching the biоlоgicаl effects оf diаgnostic ultrasound, which intensity is most commonly used?
Hоdgkin lymphоmа is а B cell lymphоmа that accounts for 10% of lymphomas diagnosed in resource-limited countries. The majority of cases of Hodgkin lymphoma are classic Hodgkin lymphoma with a minority being nodular lymphocyte-predominant lymphoma. Hodgkin lymphoma has a bimodal age distribution occurring most often around 20 years of age or 65 years of age. The risk factors for Hodgkin lymphoma include prior infectious mononucleosis infection, immunocompromised state, history of human immunodeficiency virus infection, or a family history of Hodgkin lymphoma. The most common presentation of Hodgkin lymphoma is nontender lymphadenopathy. In many cases, the lymphadenopathy is chronic and asymptomatic, and the involved lymph node is usually above the diaphragm. Patients may also report pruritus or nonspecific constitutional (B) symptoms, such as fever, night sweats, and weight loss. Physical exam findings include palpable lymphadenopathy(often cervical, axillary, or supraclavicular), hepatomegaly, and splenomegaly. The diagnosis may also be initially suspected when a mediastinal mass is identified on chest X-ray. The diagnosis of Hodgkin lymphoma is confirmed with a tissue biopsy. Excisional biopsy of a peripheral lymph node is the preferred method, but multiple core-needle biopsies may be adequate. The classic finding that is seen on histologic examination of the biopsy is Reed-Sternberg cells. These cells have a bilobed nucleus and prominent nucleoli, which is often described as an owl eyes appearance. The Reed-Sternberg cells are mixed with pleomorphic inflammatory cell infiltrate and express CD30 but do not express CD45 or CD3. Staging is guided by the Ann Arbor staging system with Cotswolds modifications. Stage I Hodgkin lymphoma involves a single lymph node, such as cervical, axillary, inguinal, or mediastinal. Stage II indicates involvement of two or more lymph node regions on the same side of the diaphragm. Stage III involves lymph node regions on both sides of the diaphragm, and stage IV involves one or more extra nodal organs. Patients typically require intravenous contrast-enhanced CT of the neck, chest, abdomen, and pelvis for staging. Hodgkin lymphoma generally has a high cure rate. The management varies depending on the stage of disease, with the goal being to maximize the cure rate while minimizing side effects of treatment. Patients with early-stage disease (stages I or II) are typically treated with a combination of chemotherapy and radiation. Combination chemotherapy alone is typically the treatment for stage III or IV disease. Complications that occur after treatment include additional malignancies (breast, lung, and skin cancers) and cardiovascular disease. Vaccinations should be kept up-to date and annual mammography is recommended in women over 40 or in younger women five to eight years post radiation therapy. Cardiac stress testing, echocardiography, and carotid ultrasound should be performed in patients who are ten years post-treatment. CT scan of the chest is currently under investigation as a routine follow up measure in patients with Hodgkin lymphoma who have been treated to remission. Some experts suggest CT scans of the chest at 6, 12 or 24-month intervals, while other experts do not recommend obtaining CT scans of the chest unless the patient shows signs of relapse. A full body PET scan for use in surveillance of patients in complete remission is not recommended, due to an increased incidence of false-positive results. Serum parathyroid hormone level is not recommended as a specific follow-up laboratory test for Hodgkin lymphoma patients in complete remission. Parathyroid hormone level could be checked if serum calcium levels are not in range or if other clinical signs of parathyroid disease (i.e. bone pain, constipation, depression, increased stone formation) are evident in the patient. A serum thyroid-stimulating hormone should be measured annually in patients who have undergone neck irradiation.