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Hospital de Clinicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2350/7, Porto Alegre, CP 90.030-003, Brazil

The use of highly active antiretroviral therapy (HAART) was associated with a dramatic improvement in the outcome of patients with human immunodeficiency virus (HIV) infection [1, 2]. In this report, we would like to describe the case of a patient with AIDS-related multicentric Castleman’s disease who has also enjoyed a long-lasting complete clinical and pathological remission following the use of HAART alone.

Castleman’s disease belongs to the group of atypical lymphoid proliferations, which are usually confused with the diagnosis of malignant lymphoma. First described in 1956, the typical patient presents with either localized mediastinal lymphadenopathy or a more aggressive form of the disease characterized by diffuse lymphadenopathy and systemic symptoms [3]. The differential diagnosis of Castleman’s disease should include malignant lymphoma, as well as other causes of lymphoma-like syndromes, such as adverse reactions to drugs, autoimmune disorders and viral or bacterial infections.

Until recently, Castleman’s disease was not considered an AIDS-related event, being managed with local surgery, irradiation and cortisteroids. Cytotoxic therapy was reserved only for highly symptomatic patients with refractory disease. Over the past years, however, a newly described AIDS-related multicentric form of Castleman’s disease (MCD) has been recognized. In this aggressive form of the disease, patients develop progressive lymphadenopathy, B symptoms and usually a fatal course [4].

Our patient was a 46 year-old HIV-positive black man who presented with dyspnea, cough, hemoptysis and severe weight loss. He had fever, bibasilar rales and widespread lymphadenopathy. The blood tests were normal, except for a hemoglobin level of 10.7 g/dl. The chest X-ray showed bilateral reticulonodular infiltrates and the computed tomography (CT) scan revealed multiple mediastinal lymph nodes (Figure 1a). The CD4 count was 54 cells/mm³ and the CD4/CD8 ratio was 0.06. A supraclavicular and submandibular lymph node biopsy confirmed MCD. The additional medical work-up ruled out malignant lymphoma, catch-scratch fever, autoimmune or infectious diseases.

Due to the aggressiveness of the disease, combination chemotherapy was offered to the patient, which he refused due to fear of infectious complications. HAART (lamivudine/zidovudine plus indinavir/ritonavir) alone was started and, surprisingly, the patient showed a rapid clinical improvement, with the disappearance of B symptoms within days. By the end of an 18-month follow-up period, the CT scan showed a complete disappearance of the mediastinal lymph nodes (Figure 1b) and a new lymph node biopsy revealed only reactive changes. The CD4 count was 135 cells/mm³ and the viral load was less than 50 copies/ml. The patient remains completely asymptomatic with no evidence of Castleman’s disease following a 24 month follow-up period on HAART alone.

Our report comes as the first in which a complete histologically-proven response for a prolonged period of follow-up is clearly documented in AIDS-related MCD with the use of HAART alone. There are other reports on the clinical outcome of AIDS-related MCD, using a variety of combined therapeutic approaches including antiviral drugs, interferon-, anti-interleukin-6 and chemotherapeutic agents along with HAART. In general, tumor responses are partial and short-lasting, sometimes at the cost of significant clinical toxicity [5–8]. It should be noted that our patient did not develop a clear neoplastic transformation of the disease into a malignant lymphoma after such a long-term follow-up period. Considering the poor treatment results and high risk of infectious complications following cytotoxic therapy in the AIDS population, we postulate that patients with AIDS-related MCD should be first managed with HAART, leaving more aggressive therapeutic approaches for patients at relapse.

REFERENCES

1. Palella FJ Jr, Delaney KM, Moorman AC et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998; 338: 853–860.[Abstract/Free Full Text]

2. Miller V, Staszewski S, Nisius G et al. Risk of new AIDS diseases in people on triple therapy. Lancet 1999; 353: 463–464.[ISI][Medline]

3. Castleman B, Iverson L, Menendez VP. Localized mediastinal lymph-node hyperplasia resembling thymoma. Cancer 1956; 9: 822–830.[CrossRef][ISI][Medline]

4. Oksenhendler E, Duarte M, Soulier J et al. Multicentric Castleman’s disease in HIV infection: a clinical and pathological study of 20 patients. AIDS 1996; 10: 61–67.[ISI][Medline]

5. Lanzafame M, Carretta G, Trevenzoli M et al. Successful treatment of Castleman’s disease with HAART in two HIV-infected patients. J Infect Dis 2000; 40: 90–91.

6. Revuelta MP, Nord JA. Successful treatment of multicentric Castleman’s disease in a patient with human immunodeficiency virus. Clin Infect Dis 1998; 26: 527.[Medline]

7. Scott D, Cabral L, Harrington WJ Jr. Treatment of HIV-associated multicentric Castleman’s disease with oral etoposide. Am J Hematol 2001; 66: 148–150.[Medline]

8. Dupin N, Krivine A, Calvez V et al. No effect of protease inhibitor on clinical and virological evolution of Castleman’s disease in an HIV-1 infected patient. AIDS 1997; 11: 1400–1401.[Medline]

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¹ Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, ² Department of Otolaryngology, Singapore General Hospital, Departments of ³ Diagnostic Imaging, ⁴ Otolaryngology and ⁵ Pathology, KK Women’s and Children’s Hospital, Singapore

Castleman’s disease of the neck is an uncommon benign lymphoproliferative disease that usually presents as homogeneously enhancing enlarged lymph nodes on contrast-enhanced CT scan. We described the appearance of four confirmed cases of Castleman’s disease of the neck on contrast-enhanced CT scan. Three of these presented as a solitary enhancing lymph node and the fourth case presented with multiple bilateral enhancing lymph nodes. A central non-enhancing area was present in two of the three cases that presented as a solitary node. Pathological correlation of one of these cases showed that this was due to a central fibrotic scar. One of the enhancing nodes in the fourth case with multiple and bilateral lympadenopathy also contained a central non-enhancing area. We would like to propose that if a central non-enhancing scar is observed in an enhancing lymph node in the neck on CT scan, Castleman’s disease should be considered as a possible diagnosis.

Castleman’s disease is an uncommon benign lymphoproliferative disorder that is characterized by hypervascular lymphoid hyperplasia [1, 2]. When this condition affects the neck, it usually presents as a solitary neck mass. There are several previous publications on the imaging features of Castleman’s disease of the neck and most of these are single-case reports [1–5]. We would like to describe the appearance of four confirmed cases of Castleman’s disease of the neck on post-contrast CT scan, and to suggest that a central non-enhancing scar, if present, is a useful diagnostic clue of the disease.

Four patients underwent CT scan of the neck as their first line investigation, after presenting with a neck mass. The scan parameters were: 5 mm slice thickness, angle of scan parallel to the hyoid bone, scanning from the level of the external auditory canal to the root of the neck, 20 cm field of view, 135 Kv, 200 mAs and 512 x 512 matrix. All the patients, except in case 2, were given an intravenous bolus dose of 75 ml of non-ionic iodinated contrast agent. The patient in case 2 was given a bolus dose of 50 ml. Scanning for all cases started at 60 s from the onset of contrast injection.

A 33-year-old man presented with a painless, non-tender, mobile, level II lymph node of 1 year’s duration. Endoscopy of the upper aerodigestive tract was normal. CT scan showed an enhancing (136 Hounsfield units) level II lymph node measuring 4.5 cm in the longest diameter on the left side of the neck. A low-attenuation crescentic band was observed in the centre of the mass (Figure 1). The mass was excised and histopathological evaluation revealed Castleman’s disease of the hyaline vascular type

Case 2
A 12-year-old boy presented with a 4 cm non-tender, mobile level III neck lymph node on the left side for a duration of 3 months. Nasopharyngoscopy showed a normal upper aerodigestive tract. CT scan showed a left-sided 4 cm ovoid enhancing (140 Hounsfield units) lymph node at level III. A low-attenuation stellate band was observed in the centre of the mass (Figure 2a). Histology revealed Castleman’s disease of the hyaline vascular type. The gross specimen contained a dense fibrous stroma in a stellate pattern, forming a scar in the centre of the mass (Figure 2b). This correlated very well with the low-attenuation stellate band seen on the CT scan.

Castleman’s disease is an uncommon lymphoproliferative disorder with a characteristic hypervascular lymphoid hyperplasia [1, 2]. First described by Castleman and associates in 1956 [6], it has since come with many synonyms. These include angiofollicular mediastinal lymph node hyperplasia, angiomatous lymphoid hamartoma, lymph nodal hamartoma, follicular lymphoreticuloma and benign giant lymphoma [7]. The many synonyms reflect the uncertainty over its pathogenesis, although most authors would regard Castleman’s disease as a hamartoma or an inflammatory/infective lesion [2, 8].

Histologically, the disease can be divided into two types; the hyaline vascular type and the plasma cell type. The hyaline vascular type makes up about 90% of the cases [1]. Microscopically, the hyaline vascular type is characterized by abnormal small follicles and interfollicular vascularity; consisting of a network of small capillaries with thickened, hyalinized walls radially penetrating the germinal centres from the perifollicular tissue. Follicles characterized by concentric layering of lymphocytes within germinal centres can also be seen. Large fibrotic masses surrounding vessels are often found scattered in the interfollicular areas [7]. The plasma cell type makes up about 10% of the cases [1]. It is characterized microscopically by solid sheets of plasma cells in the interfollicular area. The follicles are usually larger and the prominent interfollicular capillary network characteristic of the hyaline vascular type is usually lacking in the plasma cell type [7].

More than 50% of patients with plasma cell type of Castleman’s disease have systemic manifestations including fever, fatigue, anaemia, hyperglobulinaemia and elevated sedimentation rate. Our patient in case 4 though, did not have any constitutional symptoms. Only about 3% of patients with hyaline vascular type of Castleman’s disease exhibit these features [8]. Most patients with hyaline vascular type of disease are asymptomatic, although they can present with compressive symptoms caused by the mass lesion [1]. Castleman’s disease has no sex predilection and the age of presentation ranged from 8 years to 70 years, although the youngest patient reported was diagnosed at 6 weeks after birth [8].

Surgical excision is the treatment of choice for Castleman’s disease of the neck. There is no reported recurrence for the hyaline vascular type. However, plasma cell type requires closer follow-up after the surgical excision and systemic chemotherapy may be required [8].

Castleman’s disease is usually limited to one site, although a widespread and aggressive form involving lymphadenopathy in several sites with splenomegaly has also been described [9]. The most common site of the localized form is the mediastinum (about 70% of cases). The neck is the next most common [1, 4]. Most of the previously reported cases of Castleman’s disease of the neck were of the hyaline vascular type and these usually present as a solitary mass lesion both on clinical examination and on imaging [1–5, 8]. This was also the observation in our cases, as the patients in case 1 to 3 all presented with solitary neck masses on imaging and were all of the hyaline vascular type. The exception was in case 4 where the patient presented with multiple bilateral lymphadenopathy and the histology was of the plasma cell type. It may be that plasma cell type of Castleman’s disease of the neck has a greater tendency to present as multiple rather than solitary neck masses, although a further study with a larger number of cases would be needed before this impression could be confirmed.

Castleman’s disease of the neck on CT scan has been described as well-circumscribed homogeneous mass lesion with moderate to intense enhancement [1, 3–5, 8]; with the hyaline vascular type having a tendency to enhance more than the plasma cell type, due to the greater vascularity of the former [2, 10]. One case of Castleman’s disease of the neck presenting with ring-enhancement on CT scan has also been described [2]. Unlike pelvic disease where calcification can occur in up to 50% of the cases [10, 11], calcification in the neck disease is uncommon. On MRI of Castleman’s disease of the neck, some authors have described the presence of linear hypointense signals in a stellate or arborizing pattern especially on the T₂ weighted sequences [1, 4, 12]. They attributed these hypointense signals to perivascular lamellar fibrosis or sinus histiocytes and radial fibrosis; and suggested that these hypointense signals could be an important diagnostic clue of Castleman’s disease [1, 4, 12]. In contrast, the appearance of Castleman’s disease of the neck on CT scan has often been described as non-diagnostic [4, 8]. This is because other disease conditions like lymphoma, tuberculosis, metastatic papillary thyroid carcinoma, Kaposi’s sarcoma and Kimura’s disease can also present with enhancing lymph nodes in the neck [13]. Ota and co-authors reported on a case of hyaline vascular Castleman’s disease of the abdomen which had a central stellate fibrotic area within the mass on CT scan [14]. Similar changes have not described before in previous reports of CT appearance of Castleman’s disease of the neck. Crescentic, stellate and rounded areas of non-enhancement were observed in three of our four patients (cases 1, 2 and 4, respectively). Correlation with the gross specimen in case 2 showed that dense fibrous stroma forming a scar was responsible for the appearance, similar to what was reported in Ota’s paper. Although no correlation was made with the gross specimen in cases 1 and 4, we believe that dense fibrous scar could also be responsible for the crescentic and rounded areas of non-enhancement in these two cases, respectively. The absence of a central non-enhancing area in the intraparotid mass of case 3 could possibly be due to an absence of a dense concentration of fibrous tissue. We would therefore like to propose that the presence of a central non-enhancing scar in an enhancing lymph node in the neck on contrast-enhanced CT scan could be an important diagnostic clue of Castleman’s disease.

Received for publication August 20, 2002. Revision received May 9, 2003. Accepted for publication June 23, 2003.

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When her son was born, on Jan. 15, 1996, at 8 pounds, 5 ounces, she knew exactly what she was going to name him: Omoiyanu Ishmael. “It means ‘the miracle child that God hears,’ ” said Ms. Hawkins, sitting up in a hospital bed and inhaling oxygen from a tank in her mother’s co-op apartment in Fort Greene, Brooklyn.

A few minutes later, her 10-year-old miracle, known as Yani, arrived home from Public School 20, the Clinton Hill School. He made a beeline for his mother, embraced her warmly and said with pride, “I got 90 on a test today.”

Ms. Hawkins beamed. “He is my little leader in training,” she said. “He is the smartest.”

Next year, she hopes he will attend Philippa Schuyler Middle School in Brooklyn, a school for the gifted and talented.

The two have lived with Ms. Hawkins’s mother, Lucille Hawkins, 61, in her complex since an electrical fire damaged their apartment on Pacific Street in Brooklyn in August 2005. The co-op has three bedrooms. Also living there is Mrs. Hawkins’s other daughter, Christianna Melissa, 19, whom she adopted at 3 years old.

Mrs. Hawkins, a retired events coordinator for a bank, was also a foster mother for 20 years and adopted a son named Omar, who died of brain cancer when he was 12.

“He died three days before my 30th birthday,” said Ms. Hawkins.

Her eyes welled up, and she wiped away the tears. She said that watching him die — and hoping to be around for her son — has made her fight that much harder to live.

Ms. Hawkins recalled when she first started chemotherapy. “That was the first time I lost my hair,” she said, rolling her eyes and laughing. “I was devastated, oh please. I was bald.”

To be fashionable, she wore fabulous wigs, Ms. Hawkins said. “My mother, she made it funny. She made it not as bad as it could be.”

Ms. Hawkins’s cancer went into remission for most of her 20s, but then returned. She has become weaker and can no longer handle chemotherapy. With care from her mother, her son and two nurses, she takes eight medications a day. She has been using the oxygen since she moved in with her mother after the fire, she said.

“That’s when I started to wear this thing all the time,” she said, lifting a tube going to her nose. “My carbon levels are increasing; my oxygen will decrease if I don’t have this.”

Sitting up in the hospital bed, she pushed a pillow under her right side to cushion an inoperable fluid mass that has grown to the size of a grapefruit. She tires quickly and rarely walks. When she goes out, she uses an old, heavy electric wheelchair.

While the nurses tend to her medical needs, Mattie Williams, a home care attendant, helps with Yani’s care. Ms. Williams’s services are provided by the Brooklyn Bureau of Community Service, one of the seven charitable agencies supported by The New York Times Neediest Cases Fund.

Ms. Williams takes Yani to the park, the library and school events and helps him with his homework. “She is phenomenal,” Ms. Hawkins said.

Ms. Williams began working with the family in the fall of 2005.

Five months later, while the apartment was being fixed, Ms. Hawkins received a past-due rent notice. She owed $455. She also owed $589.06 for an electric bill. “I did not know I still had to pay” the rent for a home that was unlivable, she said.

She was told that she was still responsible for $92 a month, her portion of the subsidized rent, she said. On her income of $558 a month in public assistance, plus $200 in food stamps and $92 in public aid for Yani, she just did not have the money.

Ms. Williams approached the bureau for help, and through the Neediest Cases Fund the outstanding bills were covered. “I am so grateful,” said Ms. Hawkins, who had worked in earlier years, primarily in retail or secretarial jobs.

She is paying the $92 a month rent to remain qualified for subsidized housing. Her apartment has been largely repaired, but she wants to live in her mother’s building and is No. 135 on the waiting list.

Her mother said, “I need to have her near me.”

“But those things we go through,” said Ms. Hawkins, taking everything in stride.

“I am just grateful that God sees fit to bless me day to day,” she said. “He allowed me to have this beautiful child. And he allows me to breathe the breath of life every day. Every day that I take in one, I am glad. But for the grace of God, that could’ve been my last breath just a minute ago.”

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The multicentric form of CD is morphologically identical to the plasma cell variant. Although this type of CD is most common in individuals infected with HIV, reports of this disease have also been described in patients who have undergone renal transplantation or received immunosuppression therapy, such as cyclosporin A.8 The multicentric form is associated with HHV-8 infection. Fever, hepatosplenomegaly, peripheral lymphadenopathy, edema, and pulmonary symptoms, as well as secondary tumors related to HHV-8 infection (eg, Kaposi sarcoma, non-Hodgkin lymphoma, or plasmablastic lymphoma) are common, especially with coexisting HIV disease.2 Like the plasma cell variant, the pathogenesis of multicentric disease stems from high levels of IL-6; however, it is virally mediated.4 Human herpesvirus 8 encodes a viral IL-6 (v-IL-6), which induces endogenous human IL-6 production.4 Multicentric disease follows an aggressive course in patients with HIV and may represent a medical emergency.2 Treatment includes chemotherapy, and the HHV-8 viral load is monitored in conjunction with chemotherapy to assess the effectiveness of treatment.

The etiology of CD is unknown. It has been hypothesized that the 2 variants may represent a continuum of the same disease, that is, the plasma cell variant evolving into the hyaline-vascular variant; however, most investigators consider the 2 variants to be distinct entities.4 Interestingly, Menke et al7 found an aberrant immunophenotypical population of mantle zone B lymphocytes in all the variants of CD.

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Castleman’s disease is a rare lymphoproliferative disorder of uncertain cause characterized by a distinctive pattern of hypervascular lymphoid hyperplasia (1). Although it is usually reported as a solitary mediastinal mass, involvement of other anatomic sites has been reported, with the head and neck being the second most common area (2). We describe a case of hyaline-vascular-type Castleman’s disease located in the retropharyngeal space.

A 34-year-old woman initially presented with a 5-year history of painless swelling on the right side of her oropharynx and a 2-year history of a slightly enlarging mass on the right side of her neck. Her medical history was unremarkable.

Unenhanced CT scans showed a large, well-circumscribed, solid mass in the right retropharyngeal space, which was isodense to the muscle. The mass showed homogeneous, strong enhancement on the contrast-enhanced CT scans

One month later, MR imaging was performed. On the MR images, the mass was located within the right retropharyngeal space, displacing the parapharyngeal fat anteriorly, the pharyngeal mucosal space medially, the styloid process anterolaterally, and the carotid space laterally. It was isointense to the muscle on the T1-weighted images (Fig 1B). There was a nonenhancing linear hypointense signal in an arborizing pattern within the mass on T1- and T2-weighted images (Fig 1C and D). The mass occupied the right retropharyngeal and parapharyngeal space from below the skull base to the hyoid bone level on the contrast-enhanced T1-weighted coronal image (Fig 1E). There was a small lymph node with a 1-cm diameter in the right internal jugular chain just below the main mass.

Excision of the neck mass was performed via a transcervical approach. A 5 x 8-cm, well-encapsulated, ovoid mass was removed without much difficulty. Histopathologic evaluation revealed Castleman’s disease (giant lymph node hyperplasia) of the hyaline-vascular type (Fig 1F). The mass was thought to arise from the lateral retropharyngeal lymph node. The small lymph node just below the main mass was proved reactive hyperplasia without tumor cells.

In 1956, Castleman et al (3) described a group of patients with large thymoma-like masses in the anterior mediastinum, which they called mediastinal lymph node hyperplasia. The cause of Castleman’s disease is uncertain; it is thought to be inflammatory or hamartomatous in nature (4, 5). Two distinct histologic variants are recognized (4). The most common is the hyaline-vascular type (more than 90% of the cases), which consists of small lymphoreticular follicles distributed within a hypervascular hyalinized stroma. The plasma cell type is less common (fewer than 10% of the cases) and consists of larger lymphoreticular nodules that are separated by sheets of plasma cells and a somewhat less vascular stroma. Patients with the hyaline-vascular-type disease are usually asymptomatic, but they may complain of symptoms caused by the compression of adjacent structures or may present with a palpable mass. Systemic manifestations are commonly seen in the plasma cell type and include fever, anemia, and hyperglobulinemia.

Castleman’s disease is usually limited to one site, although an aggressive multicentric form has been described. The most common site is the mediastinum (approximately 70%). Additional sites of occurrence include the axilla, retroperitoneum, mesentery, vulva, pancreas, pelvis, and neck (1, 4). Fewer than 10% of cases arise in the head and neck (6-11). In our case, the tumor was located within the right retropharyngeal space. It was thought to arise from a retropharyngeal node, probably the lateral group, which is located at the anterolateral aspect of the prevertebral muscle, although a carotid space origin could not be completely excluded. Several cases of Castleman’s disease involving the retropharyngeal or parapharyngeal space, medial to the carotid sheath, as in our case, have been reported (7-9).

The typical CT findings of Castleman’s disease are a well-marginated, homogeneous, and densely enhancing mass (6, 7), although ring enhancement can also be seen (1, 10). The hyaline-vascular variant tends to show more prominent enhancement on CT scans, most likely because of its greater vascularity (1, 10).

Typically, Castleman’s disease appears on MR images as low-to-intermediate signals compared with muscle on T1-weighted images and high signals on T2-weighted images (7, 9). In a few previous reports (12, 13), linear, arborizing, hypointense signals within the mass have been attributed to calcification, fibrous septations, vessels, or sinus histiocytosis. The linear hypointense signals seen on MR images in our case were proved perivascular lamellar fibrosis on pathologic correlation (Fig 1G). These linear hypointense signals could be an important clue to the diagnosis of Castleman’s disease, although they occur infrequently.

The MR imaging differential diagnoses for Castleman’s disease include paraganglioma and schwannoma. Paragangliomas in this area usually displace the internal carotid artery anteriorly because the tumor arises around the vagus nerve. Furthermore, paragangliomas have multiple focal and serpentine areas of low signal intensity, representing vascular flow voids within the mass, especially in large lesions. Schwannomas that arise from the vagus nerve and the sympathetic chain usually displace the internal carotid artery anteriorly because these nerves are posterior to this vessel. Frequently, schwannomas have inhomogeneous signal intensity due to cystic change. These features could be the clue to the differential diagnosis, with Castleman’s disease in the retropharyngeal or parapharyngeal space.

Complete surgical excision is the treatment of choice for Castleman’s disease in the head and neck, with a 100% control rate for the hyaline-vascular type. The plasma cell type, however, requires excision with close follow-up and possible systemic chemotherapy (14). Malignant transformation or association with other malignancies is rare and includes plasmacytoma, malignant lymphoma, and Kaposi’s sarcoma (15). Its malignant potential, although rare, raises suggestions of a relationship with an immune dysfunction or even primary lymphoproliferative disorder (16).

Castleman’s disease is a rare mass, which may involve the retropharyngeal space. On CT scans, it appears as a well-marginated, homogeneously enhancing mass. It has an isointense signal compared with muscle on T1-weighted MR images and a hyperintense signal compared with muscle on T2-weighted MR images, with homogeneous, strong enhancement. Linear hypointense signals in an arborizing pattern may be present within the mass. Castleman’s disease should be considered in the differential diagnosis of masses involving the retropharyngeal space.

1.                    Chaloupka JC, Castillo M, Hudgins P. Castleman disease in the neck: atypical appearance on CT. AJR Am J Radiol 1990;154:1051-1052[Free Full Text]

2.                    Frizzera G. Castleman’s disease: more questions than answers. Hum Pathol 1985;16:202-205[Medline]

3.                    Castleman B, Iverson L, Menendez VP. Localized mediasinal lymph node hyperplasia resembling thymoma. Cancer 1956;9:822-830[Medline]

4.                    Keller AR, Hochholzer L, Castleman B. Hyaline-vascular and plasma-cell types of giant lymph node hyperplasia of the mediastinum and other locations. Cancer 1972;29:670-683[Medline]

5.                    Johnson JT, Oral A, Nalesnik M, Roscoe GJ, Whiteside TL. Giant lymph node hyperplasia: clinical and immunohistologic correlation of an intermediate variant. Ear Nose Throat J 1985;64:249-254[Medline]

6.                    Koslin DB, Berland LL, Sekar BC. Cervical Castleman disease: CT study with angiographic correlation. Radiology 1986;160:213-214[Abstract]

7.                    Freeman SJ, Irvine GH, Glew D. Case report: cervical Castleman’s disease shown by CT and MRI. Clin Radiol 1994;49:721-723[Medline]

8.                    Lanier BJ, Cummings CW. Giant lymphoid hyperplasia presenting as a highly vascularized parapharyngeal mass. Otolaryngol Head Neck Surg 1982;90:426-430[Medline]

9.                    Tuerlinckx D, Bodart E, Delos M, Remacle M, Ninane J. Unifocal cervical Castleman disease in two children. Eur J Pediatr 1997;156:701-703[Medline]

10.                 Nunna SV, Sharma R, Goyal M, Berry M, Gupta SD, Deshpande V. Unusual computed tomography appearance of Castleman disease. Australas Radiol 1997;41:193-195[Medline]

11.                 Gleeson MJ, Cassidy M, McMullin JP. Castleman’s disease: an unusual neck mass. J Laryngol Otol 1988;102:661-662[Medline]

12.                 Glazer M, Rao VM, Reiter D, McCue P. Isolated Castleman disease of the neck: MR findings. AJNR Am J Neuroradiol 1995;16:669-671[Abstract]

13.                 Luburich P, Nicolau C, Ayuso MC, Torra R, Clavero JA. Pelvic Castleman disease: CT and MR appearance. J Comput Assist Tomogr 1992;16:657-659[Medline]

14.                 Sanz C, Sierra J, Cobarro J, Avellaneda R, Montserrat E, Rozman C. An unusual case of Castleman’s disease restricted to the neck. ORL J Otorhinolaryngol Relat Spec 1992;54:331-333[Medline]

15.                 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises (Case 32–1984). N Engl J Med 1984;311:388-398[Medline]

16.                 Williams JL, Kaude JV. Sonographic findings in a case of Castleman disease of the neck. J Ultrasound Med 1986;5:593-594[Medline]

Received November 8, 1999; accepted after revision January 18, 2000.

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Castleman’s disease (angiofollicular lymphoid hyperplasia) is a heterogeneous group of lymphoproliferative disorders of uncertain cause¹. Two pathologic types, hyaline vascular and plasma-cell disease, have been recognized. The plasma-cell variant of Castleman’s disease may be localized or multicentric. Multicentric disease is a systemic lymphoproliferative disorder characterized by lymphadenopathy, hepatosplenomegaly, and constitutional symptoms. Anemia, hypoalbuminemia, and hypergammaglobulinemia are also common. Interleukin-6, a cytokine with pleiotropic effects on the immune system, hematopoiesis, and acute-phase reactions, is a putative growth factor in multiple myeloma and may also be central to the pathophysiology of Castleman’s disease^2,3,4,5,6,7. Administration of a murine anti-interleukin-6 monoclonal antibody (BE-8) was reported to have a transient beneficial effect in one patient with plasma-cell leukemia⁸.

We treated a man who had Castleman’s disease and an elevated serum interleukin-6 concentration with a prolonged course of BE-8 monoclonal antibody. The symptoms and signs of disease resolved, and most of the abnormal laboratory values improved dramatically within a few days, but the abnormalities returned on cessation of therapy. Because of a persistent mesenteric mass, the patient was treated with high-dose dexamethasone. Ultimately, the mass was resected, resulting in a sustained remission of all clinical and biochemical manifestations of the disease.

Methods

BE-8 monoclonal antibody⁹ was administered in a dose of 40 mg given intravenously during a one-hour period daily for 2 days, followed by daily doses of 10 mg given intravenously for 82 days. Serum interleukin-6 concentrations were determined with an enzyme-immunoassay kit (Amgen, Thousand Oaks, Calif.). Tissue sections from the patient were used to study cytokine expression in situ. The sections were fixed with B5 (a mercury-based fixative) and embedded in paraffin. To determine the distribution of cells in the tissue sections, staining was performed with monoclonal antibodies that are reactive with B cells (L26, CD20), T cells (Leu-22, CD43), histiocytes (Ki-M1P), plasma cells (cytoplasmic immunoglobulin), or follicular dendritic cells (S-100). The expression of interleukin-6 by lymphoid cells or histiocytes was determined by immunostaining with rabbit antihuman interleukin-6 antibody (Genzyme, Boston), by means of the avidin-biotin-peroxidase method¹⁰. The anti-interleukin-6 antibody was added at a dilution of 1:100, followed by the addition of biotin-labeled goat antirabbit immunoglobulin (dilution, 1:400). After the tissue sections had been washed, they were incubated with avidin-biotin-peroxidase, and the reaction was developed with diaminobenzidine. The sections were then counterstained with hematoxylin, dehydrated, and cleared as in routine processing. In addition, paraffin sections were immunostained for interleukin-1, -4, -7, -8, and -9; granulocyte colony-stimulating factor; and granulocyte-macrophage colony-stimulating factor, as previously described¹¹.

Case Report

A 27-year-old man saw his physician in March 1987 because of a persistent cough, fatigue, and anemia. He had no history of syphilis or autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus. The physical examination was normal. The patient’s hemoglobin concentration was 7.6 g per deciliter (4.7 mmol per liter), the mean corpuscular volume was 57 microm³, the platelet count was 733,000 per cubic millimeter, the serum iron concentration was 25 µg per deciliter (4.5 µmol per liter), the total iron-binding capacity was 330 µg per deciliter (59 µmol per liter), and the ferritin concentration was 283 ng per milliliter. The bone marrow examination was normal. No specific diagnosis was made, and the patient was followed.

In November 1987, a computed tomographic (CT) scan of the abdomen showed a mesenteric mass measuring 10 by 14 by 4 cm. The patient underwent an exploratory laparotomy in December 1987 with a biopsy of the mesenteric mass and liver and a splenectomy. A histologic examination of the biopsy specimens revealed the plasma-cell variant of Castleman’s disease in the mass and liver; the spleen was normal. The patient was followed with CT scanning but received no systemic therapy. The remaining mesenteric mass and the hemoglobin concentration were stable until July 1990, when the patient was referred to the University of Arkansas Cancer Research Center.

At that time, the patient reported fatigue and had a low-grade fever (temperature, 37.8 °C). The physical examination was normal. A chest roentgenogram revealed no abnormalities, and repeated blood cultures were negative. Abnormal laboratory values included a hemoglobin concentration of 9 g per deciliter (5.6 mmol per liter), a white-cell count of 14,600 per cubic millimeter, a platelet count of 1,360,000 per cubic millimeter, a total serum protein concentration of 8.6 g per deciliter, an albumin concentration of 2.1 g per deciliter with polyclonal hypergammaglobulinemia (3.5 g per deciliter) on serum protein electrophoresis, an alkaline phosphatase concentration of 440 U per liter (7.3 microkat per liter), an interleukin-6 concentration of 45 pg per milliliter, and a C-reactive protein concentration of 16.7 mg per deciliter. Monoclonal plasma cells were not detected by flow-cytometric studies of bone marrow specimens; immunoelectrophoresis of serum and urine samples did not disclose monoclonal gammopathy. On review, the biopsy specimens of the mesenteric mass from December 1987 were interpreted as showing mixed plasma-cell and hyaline vascular variants of Castleman’s disease, and the liver-biopsy specimens were interpreted as normal.

With the approval of the institutional review board and the consent of the patient, he was treated with BE-8 monoclonal antibody for 84 days. His fever and constitutional symptoms improved within 24 hours; however, one to two weeks were required for the hemoglobin concentration to increase and for the platelet count to decrease (Figure 1). The serum interleukin-6 concentration increased markedly during therapy and returned to the base-line value after the treatment had been discontinued; the mesenteric mass did not change. Fever, constitutional symptoms, anemia, thrombocytosis, and other biochemical abnormalities recurred within a few days after the therapy had been discontinued. The patient was then treated with three cycles of dexamethasone at 35-day intervals. During each cycle, an oral dose of 40 mg of dexamethasone was given daily for four days on three occasions, each separated by four days. This treatment had little effect on symptoms, laboratory values, or the mesenteric mass. Approximately two and a half months later, the mass was resected. No clinical or biochemical signs of disease remained after the operation (Figure 1). The mesenteric mass proved to be a mass of lymph nodes and showed mixed hyaline vascular and plasma-cell Castleman’s disease on histologic examination

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The Banner of Love has its roots in a publication called “The Glad Tidings”. It was started early in the century by Elder Wade Hampton Richards, my great-grandfather, assisted by his sons. It published for a number of years, but was a victim of the great Depression.

In about 1933, one of the sons, Elder Hardon G. (”Hard”) Richards, received the opportunity to get out of farming and back into the printing business. He and his family took over a small weekly newspaper which had suffered foreclosure. With a pocketful of one-letter-at-a-time handset type, the family learned the weekly newspaper business, and started from scratch another church publication.

My grandfather, like his father, was not interested in publicizing the religious disagreements of the time. He wanted to publish the good news of the church, and to discuss the great joys of the gospel, as his father had done with “The Glad Tidings.”

My grandmother named the new publication “The Banner of Love” after passages from Songs of Solomon 2:4 and Psalms 60:4.

With this issue, we again dedicate ourselves to the original purposes of this newspaper: to bring the good news to the readers, and avoid the issues that divide and disturb. It is not always easy.

Our worldly training and education is in journalism and law. In those professions, we find ourselves regularly engaged in the issues of the day. In such roles we are trained not to shy away from issues which may be controversial or present a “bad” picture on news. However, our philosophy with the Banner of Love is not of conventional journalism.

With the Banner of Love, we regularly receive articles submitted which may address some ongoing controversies of various churches or groups or assemblies. The publication of such matters was not the originating philosophy of this paper; and we hope to maintain the original goals. We are regularly challenged on this very matter.

We are required to make certain editorial decisions that try our conscious. Our goal is to give our readers good news and not have to worry or have any concern that when they open The Banner of Love, they can enjoy the fruits of the kingdom without being engaged over disputes that detract from that goal.

We make mistakes. When we do, we hope it is because we err on the side of caution. In pursuit of our goal, from time to time we feel compelled to refuse to publish certain articles submitted to us. We know we are privately criticized from time to time because of our conservative, tight philosophy in this regard.

Our philosophy can be explained very simply: the Banner of Love is not a battleground. It is a parade ground for articles of inspiration and explanation of the fruits of the spirit.

With this first issue of the new year, we renew our pledge to three basic philosophies, two civic and one religious:

1. First Amendment. First, we strongly support the civic privileges guaranteed in the First Amendment to the Constitution of the United States. We thus enjoy civil rights that were not guaranteed in the days of Christ: freedom of religion, freedom of speech and press, and the right of assembly. We thus are “guaranteed” the right to enjoy our own religion — even in a time when we witness literally thousands of versions of religious philosophies. With this guaranteed personal civic right comes the corresponding civic duty to respect the rights of other Americans to enjoy the choice of their religious philosophies, or not have a religion at all.

Our rights of free speech protects our many wonderful writers who submit articles for publication to express their personal faith and philosophies. The right of assembly give us a guarantee that we can meet together in groups or in organized churches and worship without government prosecution. Our right of free press gives us the opportunity to present to our readers the Banner of Love without controls or censorship from government. This philosophy allows us to establish our policy of “good news” for our readers.

2. Church and State. To insure these rights are protected and prolonged, we also believe in the philosophy of separation of church and state. We are not all too disturbed by judicial rulings which enforce this concept.

While it may, on the surface, appear as an attack on religion, it is actually a guarantee of religious freedom to insure some unwanted religious philosophy is not forced upon me or my family. In this regard, there is nothing in any judicial ruling which prohibits or unduly limits my personal right to worship or believe as I choose. The only basic restriction is that teachers, or other government-employed individuals cannot require we participate in, or be subjected to, a specific religious event or activity.

No one in our government, has ever stopped any of us from praying to our God whenever and where ever we choose. We should teach this to our children. Each of us has prayed in some unusual places, at unusual times. I have prayed in classrooms, and I have prayed in courtrooms. Nothing stops us from teaching and giving examples of this to our children or to others.

3. Religious Philosophy. Exercising our religious freedom, we believe in the religious doctrine generally outlined in the “Articles of Faith” of the Primitive Baptist Church. We will not restate them today in this column, but are guided by these basic religious concepts in our attempts to write and edit The Banner of Love in accordance with our basic rights of free speech and press.

The most fundamental aspect of this religious philosophy is the doctrine of “sovereign grace” — that being that our Lord is the controller of our eternal fate according to His purpose. (Rom. 8:28). Our eternal destiny is subject to His unconditional love and grace, which was established before each of us was born, or the world formed. (Rom. 9:11; Eph 1:4, 2:8-10; II Tim. 1:7-10; Titus 3:3-8) No man, even ourselves, rises to a level in God’s eyes to be able to earn or justify our own eternal salvation.

Readers of The Banner of Love should expect to see these basic concepts followed in our editorial philosophies.

Finally, we are indebted to our generous writers. We would not have a newspaper without them. The inspiration in our writers is evident and we encourage and pray for their continued support.

We request your prayers that the will of the Lord will be displayed in all our efforts. It is all in His name; all glory to Him.

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Above Ourselves

February 2000

by Don Richards

It gets hard for us humans to understand and comprehend God’s intent for us in this world.

Because of our basic human nature, many things we naturally desire or are inclined to do are exactly opposite of how God instructs us that our actions should be.

We want God to love us, forgive us, and have mercy with us. However, it is not our human nature to feel that same way about all our fellow brethren. We talk about this concept, but it is totally against our nature to follow the practice day in and day out.

The Apostle Paul tells us in the 12^th chapter of Romans that we should honor others above ourselves. Rom 12:10. We know our first love should be toward God. We next should love and honor others, reserving ourselves to third priority. That sounds good in practice, but implementation gets a little tough.

It is not something you can read and put on a shelf or to the back of your mind. To properly follow this guidance, it must be in the forefront of our minds and we should practice it daily.

Let’s go to the heart of this problem. Who is it that you cannot love? It is pretty easy to follow this instruction with our families and friends. That’s pretty easy.

The real problem is addressing our need to love and honor those outside of our family circles. The issue involves those that we dislike, or perhaps those that we really do not know and thus are unconcerned about.

In his sermon on the Mount, in the 5^th chapter of Matthew, Jesus goes right to the point of this basic instruction:

“Love your enemies, bless them that curse you, do good to them that hate you, and pray for them which despitefully use you, and persecute you…” Rom. 12:44.

How many of us have done that today? That is something I do not even want to think about. Sure, I’ve read it, heard it preached, can basically recite it from memory. But do I practice it? No.

I love my family, not my enemies. Jesus responds to that thought:

“For if ye love them which love you, what reward have ye? Do not even the publicans the same?” Matt. 5:46.

This is not an isolated concept in the Bible. It is a prevalent issue. It is taught throughout. Yet, we constantly struggle with it, even though we see the emphasis and re-emphasis of this idea.

If we are smitten on the cheek by an enemy, do we strike back? That is our instinct; most days it is not only an “instinct” but it is an automatic reflex. Yet, Jesus tells us, very clearly, that we should turn the other cheek. Matt. 6:39.

What if someone files a lawsuit against us and goes after the very coat on our backs? Our “instinct” is to countersue and engage in a courtroom battle of name-calling. But what did Jesus tell us if someone sues us for our coat: “let him have thy cloak also.” Matt. 6:40.

What if someone demands of us that we go along with them for a mile on some journey we do not personally want. Jesus advises us to increase it to three miles. Matt. 6:41.

What God has in mind for us is to act above our worldly level as humans. We should elevate ourselves above our corrupt human nature. We are not asked to “love” on the level as humans, but to love on the basis of love that originates from God. A pure love that is merciful and forgiving.

We want revenge to be our jobs. If an enemy has harmed us (or a fellow brother or sister, or friend or co-worker) it is our corrupt human nature to desire to inflict retribution. God may not address the problem as we see it, so we want to handle it as we see best.

But, you know what, revenge is not our jobs. Love is our job. There is no beating around the bush with this issue. The Bible is abundantly clear on this point.

“Recompense no man evil for evil.” (Rom 12:17). “Avenge not yourselves, but rather give place unto wrath… Vengeance is mine; I will repay, saith the Lord.” (Rom. 12:19, Deut. 32:35).

Can we leave our vengeance to the Lord. This is one of the major tests of all time. It is something we do not want to think about, because we do not want to leave it to the Lord, we want to address our enemies, confront them and pay them back. We want to see them suffer, and we are afraid the Lord simply will not handle it as tough as we want it handled.

This is one of the greatest issues we must address day to day. “Love your enemies” is one of the greatest statements of Jesus’ talk on the Sermon on the Mount. Yet we struggle with it daily.

Our job is love. If we put as much effort into love, as we do the effort when we are after vengeance, a lot of evil would disappear.

“If thine enemy hunger, feed him; if he thirst, give him drink; for in so doing thou shalt heap coals of fire on his head.

“Be not overcome of evil, but overcome evil with good.” Rom. 20-21.

It really is an easy lesson to understand. It is taught in very clear terms. We have great difficulty in following it. It takes discipline; it takes rejecting Satan’s all-out efforts at invoking your wrath and vengeance.

Leave vengeance to God. Love your enemies. The goal is good; and the reward is wonderful. Remind yourself of it daily.

The Parts of a Church

March

By Don Richards

Describe for me your family. Describe for me your friend.

Describe for me the parts of your church. Think quickly — tell me about the personalities of your church.

When we are asked to quickly describe such things, the cosmetic things usually come to mind first. We talk about dominant personality, cosmetic looks and the exciting and comely parts.

If you are like me, the first thing that comes to my mind is the pastor. My church has a pastor and another minister. They probably come to mind to mention first. And it has some deacons, whom I would probably name off second. Then I would probably describe the physical building. I probably would add in several of the personalities to whom I am closest.

The Apostle Paul tells us there are lots of parts to a church — and not just the obvious ones, not just the comely ones, not just the obvious ones. And he also tells us that the obvious ones are not the ones on whom the most honor should be bestowed.

As the Apostle Paul is prone to do from time to time in his writings, he explains that he would not have us ignorant. He explains that the church is one body, but not one member — it is many members with a variety of gifts and duties.

The human body is usually best remembered for its face, and its cosmetic appearance. But the face and comely appearance are probably the least important in terms of bodily functions. Some of the most uncomely parts of the body serve much greater and important functions.

In the 12^th chapter of first Corinthians, Paul describes the church. He tells us there are “diversities of gifts, but the same Spirit”. I Cor. 12:4. He tells us there are differences of administration, “but the same Lord.” He discusses “diversities of operations, but it is the same God which worketh all in all.” Verses 5-6.

He continues to describe the various gifts bestowed by the Lord in a church. And how all gifts are necessary to the functioning of the one body.

“For as the body is one, and hath many members, and all the members of that one body, being many, are one body: so also is Christ.” I Cor. 12:12.

The Apostle Paul goes on to use a parable to describe parts of the body, trying to show that all parts are essential for proper functioning; and how proper functioning is lost when one body part is lost. The body of the church is no different.

“But now hath God set the members every one of them in the body, as it hath pleased him?” Verse 18.

“…those members of the body which seem to be more feeble, are necessary. And those members of the body, which we think to be less honourable, upon these we bestow more abundant honour; and our uncomely parts have more abundant comeliness.

“For our comely parts have no need; but God hath tempered the body together, having given more abundant honour to that part which lacked. That there should be no schism in the body; but that the members should have the same care one for another.” I Cor. 12:22-25. We are told that when one member suffers, we all should suffer; and when one member be honoured, all members should rejoice.

The Apostle Paul concludes Chapter 12 and discusses in Chapter 13, the real secret for a complete and peaceful church body: charity. Regardless of the gifts, the riches or the wisdom of an individual member, it is in vain if the member does not have charity — love for each other.

We should rejoice and love all parts of the church — its youth and its elderly; its outspoken and its silent workers; its visible deacons, and its quiet but hard working sisters.

Take a close look at your church. Take a very close look. If you have a good, peace-loving church, then you have all parts of the body. It will include a lot of silent, but faithful workers doing the least favorite duties and not seeking attention. Of course you should have pastors, speakers and singers and public prayers; but you also have a lot of silent prayers, quiet workers, peace makers — all with great respect and fear of the Lord.

Do not be just thankful for the cosmetic parts of your church. Be thankful for all its parts — all its members. It takes them all to be the body of the church. A church is truly blessed when it has all parts, and when each members of the church recognizes the importance of each and all its parts regardless of the uncomely ones.

Charity to each part, and the body will be blessed.

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Whose Feet Have You Washed Lately?

April

by Don Richards

Whose feet have you washed lately?

Many of us are familiar with the teachings of Jesus in the 13^th Chapter of John regarding the washing of the disciples feet. We understand the literal example given by Christ. But do we understand its spiritual lesson? More importantly, do we follow it and practice it?

Whose feet did you wash yesterday?

Following what is known as “the Last Supper” which involved the observation of the feast of the Passover, the 13^th Chapter of John outlines and unusual action by Christ. After supper, Christ girded himself with a towel, poured water into a basin, and began washing his disciples feet.

The disciples were caught off guard by this action, questioning what Jesus was doing. “What I do thou knowest not now; but thou shalt know hereafter.” John 13:7.

Peter at first resisted, but was convinced by Jesus to allow his feet washed.

After Jesus finished he asked: “Know ye what I have done to you? Ye call me Master and Lord: and ye say well; for so I am. If I then your Lord and Master, have washed your feet; ye also ought to wash one another’s feet.”

“For I have given you an example, that ye should do as I have done to you.”

Jesus’s lesson is one of humility and service. Washing of feet was traditionally a menial task, performed by the servants. The disciples were shocked that Jesus performed this on them.

We know from the gospel of Luke (22:24-27) that the disciples had debated who was the greatest among them. Jesus’s lesson in humility was needed by the disciples, and it is needed still by us today.

Based on Jesus’ instruction, the washing of feet became an ordinance of the church. It is not widely practiced among all religions, unlike the communion service (which at the Last Supper preceded Jesus’ washing of feet); but is in fact ridiculed by many people, including some in other religious denominations.

We know the literal washing of feet service to be a solemn, humbling and beautiful religious experience. But our discussion here involves its spiritual meaning.

Jesus wanted us to know that we are not too good to be above performing even the most menial and degrading of tasks in the service of our fellow brethren. How do we measure up on such a guidepost? Do we lower ourselves to performing the most menial and degrading service to others?

If we know, understand and practice these things, then Jesus tells us “happy are ye if ye do them.” John 13:17.

Helping the sick and needy is not always a pleasant physical experience. Their needs are not always at the top of society’s social graces. Yet, our “lowering” of ourselves to help with the most menial tasks in service of our fellow man is one of the most spiritually rewarding experiences we can have and “happy” are we when we do it.

Have you been treated harshly by an enemy? Is there someone you dislike who you wouldn’t be caught dead helping.?

As Jesus told us in the Sermon on the Mount, “Love your enemies, bless them that curse you, do good to them that hate you, and pray for them which despitefully use you, and persecute you.” Matt. 5:44

Can you wash the feet of someone you despise? Can you humble yourself and lower your ego and pride enough to forgive those who use and abuse you — can you wash their feet?

The Apostle Paul tells us to bless those that persecute us and curse them not. We are to “mind not high things, but condescend to men of low estate. Be not wise in your own conceits.” Romans 12:16.

Vengeance is not our job. If your enemy is hungry, feed him; if he thirsts, give him drink. Also, try washing his feet.

By washing your enemy’s feet (in an attitude of love, humility and service), you are pouring coals of fire on his head. Romans 12:20.

This is the hard part for us. Humbling ourselves to the point of performing menial tasks to benefit and serve others, especially our enemies, is not in our human nature. I want revenge — not lowering myself down to the level I think others are at and performing some task which should only be performed by the lowest levels of society.

Washing the feet of others is not easy. It is humbling. Jesus meant it to be that way. And happy are we when we finally lower ourselves to following Jesus’ example.

Whose feet have you washed today?

We should post that message on our bedposts, on our bathroom mirrors, on our desks and in our cars.

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May 2000

Thanks For Your Prayers

We have had a lot of inquiries about the health status of my wife, Melba. She recently was released from the hospital after a 17-day stay for treatment of a rare cancer.

She has been diagnosed with a recurrence of a rare form of malignant cancer known as “thymoma”. We thought it had been eliminated in 1990 and had gone 10 years in apparent total remission.

She has just completed the first of four rounds of very nauseating chemotherapy treatments. The treatments will continue for three days each month through the summer. Our doctors, including those at the M.D. Anderson cancer clinic in Houston, have indicated this treatment is usually very effective against this type of cancer. Our two young children are aware of the seriousness of her condition and are faring quite well under the circumstances.

We have confidence in her physicians, especially “The Great Physician”, and we are very appreciative of all the calls, cards and prayers in her behalf. Thank you.

This past month has not been an easy one for our family. My wife, Melba, has been confined to the hospital with a serious illness and related medical complications.

These type of circumstances hit all of us at one time or another. It may be with a child, a spouse, a mother or father or grand parent. Each time some serious illness or disaster hits, there is a great deal of understanding and enlightenment which can occur if we look for it.

In such cases we usually end up praying to God for a specific miracle. Rarely do we see the specific “miracle” for which we asked. But other miracles do occur.

In such circumstances we usually have periods of quiet time to meditate. Sitting in hospitals we get the opportunity to observe what is going on — not only in our lives, but all around us.

The last couple of weeks I was blessed to witness a number of miracles. They did not all involve my wife’s specific medical condition directly, but it is because of her illness that I was more attuned to other situations. God’s accomplishments are abundant. More than we expect. They are not always as we specifically ask; but they are always in ways that we need.

It is amazing how so many things just “conveniently” and “coincidently” occur. But you can “see” the Lord’s hand involved by the fruits of his labors. The Lord works “conveniently” all around us in unexpected miracles. We fail to recognize most of them, and too many times fail to thank him for them.

My faith in my Lord is stronger, not weaker, because of the past few weeks. My love for my wife has grown, and our discussions together as we faced these medical problems has further strengthened our marriage. I have been brought closer to our young children as we attempt to explain the situation with them.

We have been abundantly blessed with the personal time and resources of our friends and pastor. And I have been made aware of “new” friends who were previously only “acquaintances” that I had not realized were very much real “friends”. And I have been made strongly aware of the “depth” of love of other longtime friends.

As the Apostle Paul discussed concerning his “thorn in the flesh”, he three times asked the Lord to remove the distress. The Lord did not directly grant Paul’s request — the thorn was not removed. But the Lord did respond to Paul. The Lord answered: “My grace is sufficient for thee: for my strength is made perfect in weakness.” 2 Cor. 12:7-9. Paul then stated: “Most gladly therefore will I rather glory in my infirmities, that the power of Christ may rest upon me. Therefore, I take pleasure in infirmities, in reproaches, in necessities, in persecutions, in distresses for Christ’s sake: for when I am weak, then am I strong.” 2 Cor. 12:9-10.

We cannot comprehend the wisdom of God. But we should trust Him with all our heart “and lean not unto thine own understanding.” Prov. 3:5. God’s love for us is a mystery to our knowledge (Eph. 3:19), and his ability to accomplish good is abundant, “above all that we ask or think.” Eph. 3:20.

God’s little miracles continue. Look for them, and thank him for them.

MEDICAL UPDATE

The medical condition of my wife, Melba, has continued to fluctuate. At press time, she remained back in the intensive care unit of the hospital, since being readmitted June 8.

She has improved, but it has been very slow. She had developed severe breathing problems, which had to be addressed before she could resume her chemotherapy treatments for her cancer. She is to undergo a total of four chemotherapy treatments, the first of which was completed in mid May with the second about to begin. Our two young children miss their Mom, but appear to be coping well under the circumstances.

Thank you for your inquiries and your continued prayers.

–Don R. Richards

OLDEST CHURCH NEWSPAPER

In our January 2000 issue of the Banner of Love, we commented that the publication was one of the oldest continuing religious publications on record with the U.S. Post Office. The Banner began in 1932 and has been published continuously since.

It remains one of, if not the, oldest such publications in Texas. We were aware of older publications, especially in the northeast United States. However, a reader has graciously contacted us (Earl W. Hall of Austin) to inform us, and provide a copy, of apparently the oldest Primitive Baptist publication in the United States.

The “Sign of the Times” was established in 1832 and is in its 168^th year of publication. Serving Primitive Baptists interests, it is edited by Elder J. R. Williams of Keeling, Virginia and Elder Kenneth R. Key of Greensboro, North Carolina. Subscriptions are $10 per year for the monthly publication. Mailing address is 1012 Bennett Circle, Keeling, Virginia 24566, phone is (804) 792-8758.

It created quite a stir a few days ago when the U.S. Supreme Court ruled that a Texas school cannot conduct a prayer at the start of a football game.

The court’s opinion basically endorsed a similar opinion by the Supreme Court in the early 1960s that held a school cannot officially open the school day with prayer. The 1960 case was pushed by famed atheist Madilyn Murray O’Hair.

The news media has generally assumed that most known Christians are disturbed by the Court’s opinion out of fear that we are removing God’s influence over our school children.

I do not feel quite that disturbed by the ruling. I know I am influenced by the influence my father had on me. And the influence my grandfather had on my father. As many of you know, both my father and grandfather were Primitive Baptist ministers and both established The Banner of Love.

In reading the numerous opinions in the media about the court’s decision, I was reminded of two specific experiences — first was the experience of my father (Elder Afton E. Richards) with his father (Elder Hard G. Richards); and of my personal experiences and discussions with my father.

When the 1960s decision occurred, I was in junior high school and I very vividly remember discussing the issue with my father because the community generally was upset in the same manner as many people today are with this recent court decision. My father then relayed to me a school experience that happened to him involving the concern of his father (my grandfather).

When my father was in school, one of his teachers started requiring a portion of the class day devoted to religious doctrines. Each student was required to discuss religion and be subjected to the teacher’s review and explanation. My grandfather did not care for the practice because he felt the teacher was unconsciously utilizing the opportunity to prostelyze for a particular religion (i.e. the teacher’s religion, even though the teacher’s intent was “good” — that of saving souls). The teacher dismissed my grandfather’s inquiry and required my father to participate.

My grandfather wrote out a script for my father to read at school the next day. It included a strong dose of the Hardshell Baptist doctrine of the Lord’s unconditional, sovereign grace, supported by very pointed scriptural references. My dad read it at school the next day. The teacher discontinued the practice.

That experience greatly influenced my father’s approach to mixing religion and school activities.

The second experience I recall was between my father and I. During my early adult life I worked with my father in the newspaper business. It greatly influenced not only my strong bias in favor of First Amendment constitutional rights, but also my view of separation of church and state.

In a small Texas community the primary news event is the Friday night high school football game. In reporting these ball games, I joined my father in his practice of walking the sidelines, taking pictures and keeping game statistics. It created wonderful memories for me as “quality time” between a father and son.

As was the case with the recent Supreme Court ruling, each game was started with a public prayer over the public address system.

I developed an ongoing private joke with my father based on the pre-game prayer. It was just a private, personal joke between father and son with little meaning at the time; but it was recalled to the forefront of my mind with the recent court decision. My father had great knowledge of the various basic religious doctrines and was very adept at listening to a person speak (in a religious context) and then identify the person’s religion from the context of their speech. As a young man I thought it was somewhat silly and used to tease him about it.

At the start of a football game, after the pre-game prayer ended, my standard routine was to turn to my dad, prod him and smile, and he would quietly mouth to me “Methodist”, or “Catholic”, or “Pentecostal”. He was not making fun of the person’s religion; but he was demonstrating that a person’s religion is subconsciously included in their religious speech. I particularly remember with great fondness our joint laughter at his comment after one pre-game prayer that the person saying the prayer was a “Baptist” trying to save all the “Church of Christ” members. He “read” that in the prayer by the words and context used in the prayer.

I am greatly influenced by those experiences. I know I could do like my grandfather did, and write a very pointed prayer for my son to say at a school event. I would love more children to be exposed to the wonderful doctrine of sovereign grace. However, I also know others could also do the same to my children. In spite of the “good” intentions of people, each of our individual religious preferences are included in our “attempts” at generic speech. My father proved to me many times how a person’s religious doctrine is revealed, even when we do not realize we are doing it.

So, what do we do now to insure that God’s influence stays in our schools?

Who reading this actually believes God’s influence could possibly be kept out of the school if God decides to get in?

Our answer is simple — Pray.

Pray for our schools. Pray for our teachers and the school administrators. Especially, pray for the children. If you know of a problem child (or a problem teacher) at your school, pray specifically for that person. There is not a court in the world that can stop God from entering your school in response to your prayer. Read James 5:16.

Another concern is that we see a lot of people complaining about the absence of prayer in school, but yet we do not see them involved with their children in that school. I do not wish to be too general or global with this, but God will look into the heart to determine an individual’s intent. I view with some suspicion the advocacy of some groups who are publicly adamant about “prayer a public events”, but privately do not actively become involved with their children.

I am reminded of Jesus’ Sermon on the Mount wherein he tells us to avoid the problems of the hypocrites who “love to pray standing …in the corner of the streets” to be seen of men. Matt. 6:5. Their intent is to look good on surface, but lack of substance. Instead, Jesus tells us to enter our closets and “pray to thy Father which is in secret” so that our prayers are rewarded openly. Matt. 6:6.

It is important for us to keep in mind our basic civil constitutional rights in this country. These rights were not disturbed by the Supreme Court. We individually have the First Amendment right of religious expression. The Supreme Court did not touch that right. We can pray anytime and anywhere we get ready. My child can bow his/her head and pray while sitting at a school desk at the start of school. No one can stop my child from praying over his/her meal at lunchtime; and no one can stop me or my child from praying at the start of an athletic event.

It’s my duty to teach my child to pray, and how to pray. I should not have to rely on the school/government to set that example; and in fact, do not want them setting the example. I’d rather our children “let their light so shine” by being seen individually praying over a lunchroom meal or at the start of an athletic event.

If our children are seen privately praying at their school desks, it sets a far greater example of glorifying God to the other children than any “generic” public prayer can do. If our children are not praying in school, it is our own fault.

Look at Daniel’s example. He had a far greater concern than we do about his prayers. A new law specifically prohibited him from praying to his Lord, either in public or in private. Read Daniel 6:5-8. Yet he “let his light so shine” by continuing his personal prayer to his Lord, not out of any intent to be seen of men, but of his personal intent to glorify God. The Lord protected Daniel from a bad law; the Lord will likewise protect our school children.

Remember to pray for our schools.

Teach our children to pray — at school, at home, and any where and any time they desire.

We are all familiar with the concept of a small child being afraid of the darkness. Many of us went through this stage as a child, and witness it again as we raise our own children.

Going to bed each night presents this problem. Our children often request some type of night light or an open closet or open hall door with the light left on.

Just a small light can make a lot of difference. Sometimes, even the presence of a small flashlight is sufficient.

I remember traveling as a small boy in our family car across the high Texas plains. Usually we were returning from some church meeting and it was late on Sunday night when we return. Of course we were usually bored as children, tired, sleepy and homesick as we headed home. Dad used to play games with us to relieve our anxieties. We looked at the lights on the horizon.

We talked about the lights of the upcoming town which we could see from some distance off. Because of the flatness of the plains, we could often see the lights of several towns to our left and right as we drove along. We discussed each single light and what it might represent. It meant there was a farmhouse with real people and other children where we could seek refuge in case of trouble.

We are attracted to light, even a single light because we feel secure in the light from the unknown of the darkness.

It is amazing what a small, single light can achieve to relieve a child’s fears of the darkness. The same concept works all of our adult lives. One small light can mean a world of difference in our times of darkness. Many lights are great; but just one solitary light can mean the difference.

The light can come from strange places. Maybe even you.

Jesus talks to us about the light that is each of us. He does not tell us to hide that light, but to let is shine.

Most of us feel our light is small, and alone it cannot do much good. We look around and we see the big lights that we perceive burns in others. Because it is small, we find ourselves embarrassed or shy about using the light and letting it shine. Instead, we cover it up.

Think about the experiences of our childhood, wherein one small, solitary light to us meant a world of security. One light, regardless of its perceived smallness, made the difference.

In His Sermon on the Mount, Jesus talks to us about our light. Matt. 5:14-16. He compares the lights in each of us to a “city that is set on a hill” — it cannot be hidden. He tells us that when we need light we do not light the single candle and hide it under a basket. Instead, he reminds us that a single candle, set high on the candlestick, will give light to all that are in the house.

With that analogy, we then instructs us in our daily lives: “Let your light so shine before men, that they may see your good works, and glorify your Father which is in heaven.”

Your light may be small, but the Lord put it in you for a purpose. Do not high it under a basket. You need to set that light on a candlestick and let it shine. You do not know what small child is there in the darkness who will get great security from the very light that you think perceive is so small. But for that child who is alone in the darkness, it may be your small light that makes all the difference in a dark world.

And like that solitary farm light in the distance, your solitary light may be used by the Lord provide security to someone without your ever knowing it.

As adults, we remain children in the sight of the Lord. We all need the security that comes from those lights provided by the Lord.

Small lights have made a big difference to me, even in recent days. I thank the Lord for his blessings in each of the people who provided those lights. I pray the Lord will richly bless those lights to let them shine higher and brighter for others to also benefit.

Do not hide your light. Let it shine. You will be blessed and you will greatly ease the insecurity of a child in the darkness.

MEDICAL UPDATE

As an update, my wife Melba was recently released from the hospital after a 35-day stay in the intensive care unit. She remains on oxygen, but it otherwise regaining her strength.

She completed her third treatment of chemotherapy for her rare thymoma cancer; and is scheduled to complete the fourth and final treatment just before Labor Day. We are hopeful her remaining treatment can be done as an outpatient.

–Don R. Richards

 DonCol — August 2000

HEALTH REPORT

The health of my wife Melba has continued to improve, albeit, very slowly. Following her month-long stay in intensive care, she has returned home and continues to undergo chemotherapy treatment for her cancer tumors. She remains on oxygen through a throat tube.

At press time she is undergoing her fourth round of chemotherapy. While it greatly nauseates, sickens and weakens her physically, her mental state has been good based on recent x-ray examinations which indicate the treatment is successful in slowly eradicating the cancer. Last weekend, before this latest treatment round, she was able to attend church (accompanied with a mobile oxygen bottle) for the first time since spring.

My family cannot say enough for the many kind gestures, messages and prayers. Our faith in the Lord continues to strengthen. Thank you.

–Don R. Richards

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Your Problem Should Be My Problem

August

By DON R. RICHARDS

 I really am not interested in your problems.

I do not want to hear about your problems. I have enough problems of my own that I need to solve without focusing on other people’s problems — surely your problems are not as bad as my problems anyway. Taking time to ask about, listen to, or try to solve your problems only takes away from the attention I need to give to my problems, and robs me of that self pity I cherish so much.

Does that sound familiar? Does it sound too close to home?

Most of us have those thoughts. We keep them to ourselves most of the time, but we still think them. It’s our human nature.

As a part of my business, I recently attended a meeting which took place in conjunction with a business seminar. The seminar focused on business “negotiations.”

The leader instructed the attendees in the “art” of negotiations, and getting what you want out of business deals.

One major focus of the seminar intrigued me. A primary virtue of successful negotiators is the ability to get what they want by finding out the weaknesses, needs and goals of their negotiating adversaries. They then try to insure the other side gets satisfied, making compromise much easier. It reminded me of a sermon I heard years ago based on the concept:

That can be a hard concept to accept. How will helping others first get me what I want? That’s what faith is all about.

Jesus gave us the root of this concept in the Sermon on the Mount with the commonly-called “golden rule”. Matt. 7:12, Luke 6:31. Jesus’ entire life is based on service to others above himself.

The Scriptures resonate this theme — the idea of the Good Samaritan, the concept service to others above ourselves.

What do we know about the “Good Samaritan” written about in Luke 10:30-36? We know that as a Samaritan, he was a bitter rival of the Jew who lay distressed in the road. Surely the Samaritan had his own problems. But he went out of his way to help another — even an enemy — placing the interests of that individual above his own interests. The Samaritan interrupted his own schedule and his own problems, and stopped first to help another.

What was Jesus’ instruction given with the Sermon on the Mount? “Go, and do thou likewise.”

Stop for a minute and think about someone you know. What problem does that individual have? What can you do to help that person solve his/her problem?

Do we let ourselves get too busy to help others? Do we let our own problems and troubles cloud our mind to preclude us from considering the problems of others. If we are too busy to help other people with their problems, then we will always have trouble solving our own problems.

Your problem should be my problem. When I help you solve your problem, its amazing how much better and easier it becomes for me to address my own problems.

Read the 13^th Chapter of First Corinthians; it is only 13 verses.

There is “faith, hope and charity, these three; but the greatest of these is charity.”

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A Prophet in His Own Country

September

By DON R. RICHARDS

We have noted with interest that there have been several announcements in recent months about ordinations in various churches. We have not kept count, but it seems there have been announced about an equal number of elders and deacons whom the churches have set aside for those respective offices.

These ordination announcements have caused my mind to ponder the duties created by such ordinations.

A special duty is placed by the church upon both the husband and wife with such an ordination. But the duties of the elder or deacon is not what I want to discuss here today. I want to talk about the duty upon the church, the congregation and the family when it chooses to ordain. This duty is as important as the one on the individual who is ordained.

There is an excellent lesson in the teachings of the gospels regarding Christ’s ministry. Jesus encountered difficulty in the way of skepticism from those around him when he began his ministry. It appears he encountered the most difficulty in his home community among his best acquaintances.

After Jesus had clearly established his ministry, having delivered the Sermon on the Mount (Matt. 5-6-7) and taught the parables to the multitudes (Matt. Chapter 13), Jesus had been away from his home. He returned home to his part of the country at Galilee (where he had been raised) to teach in his own synagogue. (Matt. 13:54, Mark 6:1 and Luke 4:14). He was met with much skepticism and astonishment.

The people in the synagogue who heard him became angry. Who was this to come preach to them? This man was just a local native, merely a carpenter’s son, the son of Mary and the brother of James, Joses and Simon and Judas. Matt. 13:54-55.

They were offended and filled with wrath (Matt 13:57, Mark 6:3, Luke 4:28). They took Jesus and led him out of the synagogue, out of the city and cast him headlong over the hill (Luke 4:29).

Jesus here proclaimed one of his oft-quoted teachings: A prophet is without honor in his own country, among his own kin and in his own house (Matt. 14:57, Mark 6:4, and Luke 4:24). Because of their unbelief, the people missed out on many miracles with which Jesus could have blessed them. Matt. 13:58.

We need to exercise care that we do not make the same mistakes the people in the synagogue made about Jesus. Do we fail to recognize a prophet in our midst because he is local. If we do, we could miss out on many blessings.

We will assume that the ordination service has applied the examination and charge that the Apostle Paul specifies in First Timothy, Chapter 3. After that, the church, the community and the ordained’s kin have the duty to acknowledge the ordained work, and accept the gift, and the teachings, that comes with it.

It’s always hard for me to listen to the preacher admonishing me with the truth of the Word. It is especially hard if the minister is someone I grew up with or am related to (and I am related to a bunch of them — you know who you are). After all, I knew them when . . .

We never like it, but it is so much acceptable to hear the harsh truth when it comes from an out-of-town prophet. We do not like to hear that person we knew as a kid tell us the harsh truth and shepherd the flock.

That is a mistake we often make when we ordain someone. We are all familiar with instances where this has occurred. Too much pressure is on that individual to overcome their past. It becomes much “easier” for them to move to another “country” where their acceptance is made. When we let this happen, like the people in Jesus’ synagogue, we may lose out on the blessings that we otherwise would have received by our acceptance of them.

It is apparent that we see that the Lord has provided talents to an individual because we carefully watch an individual, examine them and call for their ordination. We need to constantly remind ourselves and acknowledge the Lord’s calling after the ordination.

There is a huge responsibility upon an individual who has been ordained as a minister. I do not know of a single elder who takes his office lightly. When a minister studies and feels burdened to labor or deliver a message, we should recognize the prophet, especially when he is at home. We should not miss the blessings because we did not recognize the prophet in his home country.

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Depressed and Lonely

October

By DON R. RICHARDS

Life gets pretty tough when we get lonely, or depressed. We all get this way from time to time.

We may find ourselves lonely when death takes away a spouse, a close family member or a friend. We can find ourselves depressed over a multitude of this world’s problems.

When we get this way, our usual first reaction is to pull away. We want to hide from the world, our family and our friends. As the psychologists analyze it, us men like to retreat into our “caves” and the women retreat into themselves.

It is no fun being lonely or depressed. It is hard to find a good answer when we get ourselves in such a condition. We begin to think we are of no value to anyone — ourselves or others. Yet the Apostle Paul tells us this is not so.

The Apostle, in 2^nd Corinthians, gives us a two-part answer to our depression and loneliness. He tells us we can find comfort in the Lord, and also in our actions to others.

Some of the most important lessons we learn in life are at the hands of experience. If you have lost a loved one, you have a valuable experience which you can use to comfort another person going through the same experience. If you have been through depression, you are perhaps in the best position to comfort and assist someone you know who is going through the same thing.

Doesn’t it always help to know that the person attempting to console you has been through the same misery you are now going through. You accept advice and comfort better from someone you know understands and feels the same pain you are having. We do not accept sympathy as well from someone who has never experienced our kind of pain.

The Apostle Paul confirms this to us, and tells us how we can go about relieving our pain, suffering and depression. His guidance is two-part: We get help from God, and then from our following God’s instruction for us to help others similarly suffering:

“Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort; Who comforteth us in all our tribulations, that we may be able to comfort them which are in any trouble, by the comfort wherewith we ourselves are comforted of God. For as the sufferings of Christ abound in us, so our consolation also aboundeth by Christ.” 2^nd Cor. 1:3-5.

The Apostle tells us that we get help from the Lord in two ways: first, the Lord is there to comfort us as the “Father of mercies.” We should take our troubles, tribulations and sufferings to Him. Secondly, by the mercy and comfort which God gives to us, we should give to each other.

One of the best remedies for any loneliness you have — visit and try to provide companionship to others you see are lonely. In helping them you will help yourself. If you are depressed, or understand the impact of such pain that deep depression can bring, try to carry your understanding to others you see are having the same problem.

As Paul tells us, the comfort you bring to others, will also comfort you. If you have ever suffered, then you can be a help to others who are going through similar problems. In doing so, you will share in the comfort that the Lord will also give to you.

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The Real Spirit of Christmas

November

by Don Richards

The holiday season is upon us again. That means we are supposed to be happy. But we know that is not always the case.

We fake happiness a lot this time of year. We tell everyone we are happy and excited like we were as kids; but usually we feel tremendous stress and pressure — almost always self imposed.

We put pressure and stress on ourselves because we know we must please others — especially in our families. We want to buy the exact correct gifts for our kids, parents and friends. We know we want our house decorated just right (i.e. “perfect”); we absolutely must have the perfect Christmas dinner. Not only do we put pressure on ourselves, we also create stress on those closest to us with our expectations. We “expect” our spouses to meet certain goals, we “expect” certain gifts at Christmas, we “expect” meals to be timely and “complete.”

With the goals we put great pressures on ourselves and those we love. These pressures are primarily based on material desires. Too many times we go to great financial expense to achieve these goals. This in turn puts even greater pressure on us to pay the bills after the holidays.

There are answers to these pressures, if we stop to reflect on the Scriptures, and look at the real spirit of the holidays. Let’s focus our families, not on the material pressures of Ceasar, but on the relief and security of the Lord’s grace and guidance.

Let’s talk about Christmas Day. It is just another day, but we don’t treat it as such. We have such great expectations of what we want that day to be. Instead, let’s treat it as the Lord has instructed:

“This is a day which the Lord hath made; we will rejoice and be glad in it.” Psalm 118:24.

Put the rejoice of the Lord as the primary goal. Think of that first, Make it your primary goal, and you will be guided throughout the day. Approach your family and friends in a spirit of rejoicing in the Lord. Pray the Lord will guide you to keep this thought foremost. You will be amazed at the calmness and security with which you can then approach the tasks at hand. Look first to the Lord, seek his guidance in your approach to your children, your spouse and friends, and the pressures and stress will be relieved.

Christmas Day is just another day — but it is a day made by the Lord, and we should rejoice in it.

Now let’s talk of gift-giving. We all have this great desire to please our family and friends. This is one of the most material aspects of Christmas. Our whole environment is commercialized with the intent to get us to concentrate on gift buying — even when our budgets do not permit. And too many times we expect as much as we give, and we find ourselves disappointed.

Let’s look at three thoughts in this regard to guide us:

1. “Lay not up for yourselves treasures upon earth, where moth and rust doth corrupt, and where thieves break through and steal; But lay up for yourselves treasures in heaven, where neither moth nor rust doth corrupt, and where thieves do not break through nor steal: for where your treasure is, there will your heart be also.” Matt. 6:19-21.

What is more important: whether you get the perfect gift for someone, or whether you clearly establish to someone your love for them? Do you remember every gift your parents gave to you, or do you remember those special times when your mother took time and taught you how to bake cookies, or turkey and dressing?; or when your family met for good fellowship? What do you want your treasures to be — a toy or gift soon forgotten, or those personal times and friendships that we never forget.

Think about this as you approach Christmas.

2. “…Remember the words of the Lord Jesus, how he said, It is more blessed to give than to receive.” Acts. 20:35.

This is a hard concept to accept. It is natural in us to want to receive gifts. It is natural to expect to receive when we give.

The Lord teaches us that we should concentrate on giving, with no thought on whether our gifts are reciprocated. The blessing of the Lord comes with our charity, not with our being recipients. Give your gifts this year with the attitude of no expectation of reciprocation.

Substantial pressure is relieved when we approach our gift giving in this manner. Think about that as you approach Christmas.

3. “Take heed that ye do not your alms before men, to be seen of them: otherwise, ye have no reward of your Father which is in heaven. …That thine alms may be in secret: and thy Father which seeth in secret himself shall reward thee openly.” Read Matt. 6:1-4

The Lord teaches us here to give to the poor and needy without any pretext of receiving public credit. In fact, attempt to provide your charitable giving in secret and anonymously. Your rewards for this are great, because they come from the Lord, not from the admiration of man.

Its okay to make public donations to charity. Businesses, including my personal business, regularly do such activities. But our reward is clear. Our reward for such is from the public — we get the glory of our fellow man (and perhaps even the IRS).

But the real spirit of Christmas comes from anonymous giving to the needy, with no expectation of public recognition. Let the Lord handle the public relations and the press releases, and the IRS tax deductions.

This is an important concept to teach your children. Find someone in need, or a worthy cause; work with your children, family or friends to provide to these individuals or charity. Do it anonymously and teach you children and friends why. Discuss the great personal feelings that come from such actions, with no expectations of publicity.

Enter the Christmas season with these thoughts in mind: First, put the Lord as your priority, not some material desire; second, think about giving without any expectation of receiving a gift; third, give to the needy anonymously.

Try this specific instructions from the Scriptures. See if the pressure and stress of the season are not relieved. See if the real spirit of Christmas is returned to you.

Merry Christmas, and May God Bless

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However, this strategy can only work well in tumors that have adequate levels of oxygen, as Vitamin C Therapy (ascorbate) reacts with oxygen to produce the hydrogen peroxide. Portions of many tumors tend to be low in oxygen (hypoxic), as the blood flow through tumors is often sluggish compared to that which supplies normal tissues; this evidently could compromise the anti-tumor efficacy of vitamin C Therapy (ascorbate). To overcome this problem, Oasis Hospital employs several complementary techniques that can boost the oxygen content of tumors. Ozone autohemotherapy alters the properties of blood so that it is less viscous, its cellular elements are more flexible, and its oxygenated red blood cells surrender oxygen to tissues more readily (rightward shift of dissociation curve); also, it promotes vasodilation by stimulating nitric oxide release by the endothelial lining of small arteries. The net result is more oxygen delivery to the tumor. This strategy involves drawing a small amount of blood, treating it with a mixture of ozone and oxygen, and re-infusing it. Ozone autohemotherapy has been used extensively in Europe, and is known to be safe.

Oasis also has a novel perfluorochemical known as Perftec that is an oxygen carrier; when infused into a patient, it greatly boosts the total oxygen carrying capacity of blood. After Perftec infusion, patients are asked to breathe air that is enriched in oxygen content, so that the circulating Perftec is loaded with optimal amounts of oxygen. The combination of ozone autohemotherapy and Perftec infusion can be expected to improve oxygen availability in hypoxic regions of tumors - which in turn should boost the ability of intravenous Vitamin C Therapy (ascorbate) to generate hydrogen peroxide in tumors

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These references are in PubMed. This may not be the complete list of references from this article.

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—      Fornasiero A, Daniele O, Ghiotto C, Sartori F, Rea F, Piazza M, Fiore-Donati L, Morandi P, Aversa SM, Paccagnella A, et al. Chemotherapy of invasive thymoma. J Clin Oncol. 1990 Aug;8(8):1419–1423. [PubMed]

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—      Fukai I, Masaoka A, Hashimoto T, Yamakawa Y, Mizuno T, Tanamura O, Hirokawa K, Ueda R. An immunohistologic study of the epithelial components of 81 cases of thymoma. Cancer. 1992 May 15;69(10):2463–2468. [PubMed]

—      Pescarmona E, Rendina EA, Venuta F, Ricci C, Ruco LP, Baroni CD. The prognostic implication of thymoma histologic subtyping. A study of 80 consecutive cases. Am J Clin Pathol. 1990 Feb;93(2):190–195. [PubMed]

—      Arceci RJ. Clinical significance of P-glycoprotein in multidrug resistance malignancies. Blood. 1993 May 1;81(9):2215–2222. [PubMed]

—      Grogan TM, Spier CM, Salmon SE, Matzner M, Rybski J, Weinstein RS, Scheper RJ, Dalton WS. P-glycoprotein expression in human plasma cell myeloma: correlation with prior chemotherapy. Blood. 1993 Jan 15;81(2):490–495. [PubMed]

—      Miller TP, Grogan TM, Dalton WS, Spier CM, Scheper RJ, Salmon SE. P-glycoprotein expression in malignant lymphoma and reversal of clinical drug resistance with chemotherapy plus high-dose verapamil. J Clin Oncol. 1991 Jan;9(1):17–24. [PubMed]

—      Sonneveld P, Durie BG, Lokhorst HM, Marie JP, Solbu G, Suciu S, Zittoun R, Löwenberg B, Nooter K. Modulation of multidrug-resistant multiple myeloma by cyclosporin. The Leukaemia Group of the EORTC and the HOVON. Lancet. 1992 Aug 1;340(8814):255–259.

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