Prevalence and risk factors of iron overload after hematopoietic stem cell transplantation for childhood acute leukemia: a LEA study.

Data on post-transplant iron overload (IO) are scarce in pediatrics. We conducted a prospective multicenter cohort study (Leucémie de l'Enfant et de l'Adolescent cohort) to determine the prevalence and risk factors of IO in 384 acute leukemia survivors transplanted during childhood. Prevalence of IO (ferritin level ⩾350 ng/mL) was 42.2% (95%CI 37.2-47.2%). Factors significantly associated with IO were: 1) in univariate analysis: older age at transplant (P<0.001), allogeneic versus autologous transplantation (P<0.001), radiation-based preparative regimen (P=0.035) and recent period of transplantation (P<0.001); 2) in multivariate analysis: older age at transplant in quartiles (Odds Ratio (OR)=7.64, 95% CI: 3.73-15.64 for age >12.7 years and OR=5.36, 95% CI: 2.63-10.95 for age from 8.2 to 12.7 years compared to age < 4.7 years), acute myeloid leukemia (OR=3.23, 95% CI: 1.47-7.13), allogeneic graft (OR=4.34, 95% CI: 2.07-9.12 for alternative donors and OR=2.53, 95% CI: 1.2-5.33 for siblings, compared to autologous graft) and radiation-based conditioning regimen (OR=2.45, 95% CI: 1.09-5.53). Graft-versus-host disease was an additional risk factor for allogeneic graft recipients. In conclusion, IO is a frequent complication in pediatric long-term survivors after transplantation for acute leukemia, more frequently observed in older children, those transplanted from alternative donors or with graft-versus-host disease.

[Blunt trauma with bullet-proof vests. Skin lesions are no reliable predictor of injury severity]. / Stumpfes Körperstammtrauma mit ballistischer Schutzweste. Prellmarken geben keine zuverlässigen Hinweise auf innere Verletzungen.

It is well known that so-called bullet-proof vests offer protection against a wide range of penetrating trauma, but their protection against blunt trauma is less well understood. Fast projectiles may result in hematomas and contusions behind the armour. We report a traffic accident involving a young soldier wearing a ballistic protection vest resulting in a right thoracoabdominal blunt trauma leading to a confined liver compression rupture. As nearly no skin marks were detectable, we point out that every emergency department surgeon should be very suspicious if a patient wore a ballistic vest at the time of the accident--there may be no skin marks despite severe intra-abdominal trauma. Our patient recovered following hypotensive ICU treatment, thrombocyte mobilization, and factor VIIa substitution.

Characterization of the NIST seaweed Standard Reference Material.

The National Institute of Standards and Technology (NIST) Standard Reference Material (SRM) for seaweed was developed through an interlaboratory comparison with 24 participants from 16 countries. After evaluating different techniques to calculate certified values for the radionuclides, the median method was found to be the most representative technique. The certified values were provided for 13 radionuclides and information values were given for 15 more radionuclides. Results for the natural decay series showed disequilibrium in both the uranium and thorium series.

Ovarian hyperthecosis in the setting of portal hypertension.

Hepatocellular dysfunction and perturbed portal hemodynamics alter steroid metabolism. Men with liver disease have gynecomastia, although women similarly affected rarely show virilization. We report a 10-yr-old girl with portal hypertension and shunting associated with precocious puberty and ovarian hyperandrogenism. This was one of premature twin girls; neither had clitoromegaly or genital ambiguity. In one child, neonatal respiratory problems led to umbilical vein catheterization with subsequent development of portal hypertension. Pubic hair was first noted at age 6 yr, breasts at 7 yr, and severe acne and clitoromegaly at 10 yr. Baseline sex hormones were elevated: androstenedione (A), 413 ng/dL; testosterone (T), 226 ng/dL; and estradiol (E2), 160 pg/mL. Liver transaminases were within the normal range, however, the coagulation profile was mildly abnormal. Cosyntropin adrenal stimulation revealed no steroidogenic defect. Dexamethasone suppression reduced A and T slightly. LH-releasing hormone stimulation produced a pubertal rise in LH and FSH. Pelvic sonography showed a large right ovary with numerous follicles. Surgical exploration revealed symmetrically enlarged ovaries with dense capsules. Histology of ovarian wedge resections showed hyperthecosis; immunohistochemistry showed stromal cells expressing steroidogenic enzymes and proteins. One month postoperatively, A and T were unchanged from baseline, whereas E2 decreased to 56 pg/mL. A single dose of depot leuprolide acetate significantly reduced T. Subsequent treatment with oral contraceptives reduced T to 50 ng/dL, and cyclical menses occurred. We conclude that precocious puberty and ovarian hyperthecosis were induced in this young girl by elevated circulating levels of sex hormones, a consequence of portasystemic shunting and impaired hepatic steroid metabolism.

Radiographic measurement of prevertebral soft tissue thickness on lateral radiographs of the neck.

PURPOSE: The prevertebral soft tissue measurement is commonly used for assessing prevertebral pathology such as abscesses or hematomas after injury. Very few references concerning the ratio of retrotracheal thickness to C5 diameter are available in the literature. The purpose of this study was to measure the normal soft tissue thickness at the C5 level of the neck and to establish the normal ratio of retrotracheal soft tissue thickness to the diameter of C5 for daily use. DESIGN AND PATIENTS: We measured soft tissue thickness in the neck of 54 normal subjects and calculated the mean and standard deviation. RESULTS AND CONCLUSION: Using mean plus one standard deviation the maximum retrocricoid soft tissue thickness was 0.7xC5 diameter and maximum retrotracheal thickness was 1.0xC5 diameter. Soft tissue thickness that exceeds this limit must be studied further for signs of potential disease.

Abnormal calcification on plain radiographs of the abdomen.

The purpose of this pictorial review is to facilitate recognition and understanding of calcifications seen on conventional radiographs of the abdomen. Calcifications can be categorized by organ system and location in the abdomen. Both common and rare calcifications in the urinary tract, liver, gallbladder, spleen, pancreas, adrenal glands, digestive tract, genital tract, peritoneal cavity, and retroperitoneum are illustrated. Abnormal calcifications in the urinary tract are subcategorized by kidneys, ureters, bladder, and urethra. The density, shape, size, margins, pattern, position, and mobility of calcifications are emphasized for differential diagnoses.

Boehler's angle: a reappraisal.

STUDY OBJECTIVES: To reappraise Boehler's angle and evaluate factors, including centering of the central beam, sex of subjects, and side of the body, that may affect angle measurement. DESIGN: Retrospective clinical review. SETTING: Emergency department, Level I trauma center. TYPE OF PARTICIPANTS: 120 consecutive patients radiographed for ankle injury who had normal bones on the ankle and/or foot radiographs. MEASUREMENTS AND MAIN RESULTS: The mean and SD of Boehler's angle were 30 degrees C +/- 6 degrees (range, 14 degrees to 50 degrees). There was no difference in Boehler's angle between male and female subjects (P greater than .05) or between left and right feet (P greater than .05). Slight variations in central beam location for ankle and foot radiographs had no significant effect on Boehler's angle. CONCLUSION: If 28 degrees is taken as the lower limit of normal for Boehler's angle, 37 cases (31%) would be false-positive "abnormal." The use of 20 degrees as the lower limit may decrease the number of false-positive to three cases (2.5%); using 18 degrees (mean -2 SD) reduces the false-positive rate to less than 1% (one case).

Inverse perspective mapping simplifies optical flow computation and obstacle detection.

We present a scheme for obstacle detection from optical flow which is based on strategies of biological information processing. Optical flow is established by a local "voting" (non-maximum suppression) over the outputs of correlation-type motion detectors similar to those found in the fly visual system. The computational theory of obstacle detection is discussed in terms of space-variances of the motion field. An efficient mechanism for the detection of disturbances in the expected motion field is based on "inverse perspective mapping", i.e., a coordinate transform or retinotopic mapping applied to the image. It turns out that besides obstacle detection, inverse perspective mapping has additional advantages for regularizing optical flow algorithms. Psychophysical evidence for body-scaled obstacle detection and related neurophysiological results are discussed.

Cervical spine flexion patterns.

Lateral projection flexion and extension radiographs of the cervical spine are stress views. They are necessary to evaluate unstable ligamentous injury, which may not be apparent on neutral unstressed films. As there is very little literature on the proper evaluation of these radiographic views, we reviewed 150 consecutive cases from our Emergency Department to define patterns of flexion. Four significantly different patterns emerged. No flexion at any level was seen in 24.7% of patients. A single flexion angle was seen in 24.7% Two flexion angles, usually at consecutive levels, were present in 29.3% of patients, and 21.3% had three or more flexion angles. Correlation with clinical data suggests that attempted flexion with no significant angle or a single angle is abnormal and may indicate soft tissue (ligament or muscle) injury. Three or more flexion angles are thought to represent a normal pattern. The most common pattern, two flexion angles at consecutive levels, has not been previously described. We believe this pattern indicates less than full flexion and can be seen in individuals without significant injury and in those limited by mild soft-tissue injury.

Coracoclavicular and coracoacromial ligament calcification and ossification.

Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification.

Cervical spine annulus vacuum.

Thirty-eight annulus vacuums in 27 patients were analyzed with regard to location, configuration, and associated vertebral abnormalities such as degenerative changes, absent and compressed anterosuperior vertebral body corners, and annulus calcification. It is concluded that most annulus vacuums are a degenerative phenomenon at the attachment of the annulus to bone. These vacuums may be associated with other degenerative changes such as osteophytes and annulus calcification. Vacuums have a strong association with compressed anterosuperior corners. These deformed corners are thought to be early osteophytes and may be related to previous trauma, a vertebra with an absent corner, and/or normal motion. Small annulus vacuums adjacent to vertebral corners with a normal appearance are more likely to result from acute trauma.