Acute megakaryoblastic leukemia: experience of GIMEMA trials.

The objective of the study was to evaluate the incidence, characteristics, treatment and outcome of acute megakaryoblastic leukemia (AMeL) in patients enrolled in GIMEMA trials. Between 1982 and 1999, 3603 new consecutive cases of AML aged over 15 years were admitted to GIMEMA trials. Of them, 24 were AMeL. The incidence of AMeL among AML patients enrolled in GIMEMA trials was 0.6% (24/3603). Diagnosis was based on morphological criteria. Out of 11 cytogenetic studies performed two presented chromosome 3 abnormalities. Twelve patients (50%) reached a CR, five (21%) died in induction and seven (27%) were unresponsive. The median duration of CR was 35 weeks (range 10-441). Seven patients underwent transplantation procedures (1 BMT, 4 aBMT, 2 aPBSCT). Four patients died in CR due to chemotherapy-related complications. Comparing the CR rate between AMeL and the other cases of AML enrolled in GIMEMA trials, no differences were observed. These results were mirrored for different age groups. The median survival was 40 weeks. At present, after a follow-up of a minimum of 2 years, only two patients are alive in CR, all the others having died. A 5-year Kaplan-Meier curve shows a disease-free survival of 17% and an actuarial overall survival of 10%. AMeL is a rare form of AML. The CR duration and the overall survival in this group of patients are very poor, even if similar to those observed in other AML. Furthermore, a high number of deaths in CR were observed. On the basis of these data, a specific therapeutic approach, possibly with innovative treatments, should be evaluated.

Plasma cell leukemia: a report on three patients.

Three patients with plasma cell leukemia are reported. Two of them has a previous history of myeloma; the third one started with a plasma cell leukemia. Diagnosis was made from the required presence of 20% plasma cells in the peripheral blood. In all 3 cases, bone marrow aspiration and peripheral blood showed plasma cells strongly positive for acid phosphatase and alpha-naphthyl acetate esterase, and negative for periodic acid-Schiff. The first patient was treated with a polychemotherapy regimen that included vincristine, cyclophosphamide, chlorambucil and prednisone, and the second patient with melphalan and prednisone; the third one, who started with plasma cell leukemia, received total body irradiation at the dose of 600 rad. The results of the therapy and survival time, which was never more than 3 months, are in accord with other reports in the literature.

Therapy of acute nonlymphocytic leukemia in children: a review of 73 patients.

Since 1969, 73 children with acute nonlymphocytic leukemia have been admitted for evaluation and treatment at the Institute of Hematology of the University of Rome. Various drug regimens, basically including daunomycin and/or cytosine arabinoside, were employed both for induction and maintenance treatment. Overall, the incidence of complete remission was 63%. The availability of intensive supportive measures starting in 1974 appears to be the most likely explantation for the higher response rate observed since then. Duration of remission and overall survival were disappointingly short owing to the high frequency of bone marrow relapse. Carefully controlled clinical studies will in the future be necessary to explore better methods of preventing leukemic relapse.

[Special obstetrico-gynecologic hospital structure and local service units. Considerations on the availability and need for ULS 35 and 36]. / Struttura specialistica ospedaliera ostetrico-ginecologica e unità locale dei servizi. Considerazioni sulle disponibilità e necessità delle U.L.S. 35 e 36.

The underlying principles of the national health reform measures and those approved by the Piedmont Region's programmes with regard to social and health reorganisation are recalled. Reference is made to anomalies with respect to local health services No. 35 and No. 36 in the case of obstetrics and gynaecology, there being three maternity departments for 97,251 inhabitants in the area concerned. The main aspects of the division are examined. It is shown that implementation will only be possible if there is a usership capable of feeding every branch of the structure set up. It is suggested that the specialist activities of obstetrics and gynaecology be concentrated at Susa and Avigliana, though oven this division will not ensure a proper flow of users. The position could be improved by better employment of the basic structures, i.e. the consulting surgeries and SAUB out-patient departments.

[Postcoital contraception using a desogestrel-ethinyl estradiol combination]. / Contraccezione post-coitale con una associazione desogestrel-etinilestradiolo.

PIP: Post-coital contraception or rather interception, a term suggested here since it is non-preventive, per definition is applied after the hypothetical time of contraception. Various methods have been proposed for "day after" interventions among which the administration of estro-progestins are the simplest, least expensive and least likely to cause serious side effects. In order to reduce side effects, a trial involving 35 women was conducted at the hospital in Avigliana. A biphasic combination of .150 mg desogestrel + .030 mg ethinyl estradiol was administered in the form of 2 pills within a period of 12 hours or 24 hours after intercourse. 6 tables display age, educational level, occupation, motive, day during menstrual cycle, time after intercourse that treatment was begun. 65.7% of the women were less than 30, 8% less than 20 years old. Almost 80% were treated during their mid-cycles, where the chance of becoming pregnant is greatest, i.e., 20%. Not one pregnancy was observed. It is impossible to ascertain how many conceptions actually did occur due to the nonexistence of methods for determining avoided pregnancies. The only side effects reported were nausea and vomiting of short duration. Menstruation reoccurred within 21 days of treatment for 98%. A small possibility of ectopic pregnancy, however, does exist. Fetal damage from the steroids seems excludable, due to the extremely early period of administration. An increased demand for post-coital interception has been registered for the youngest users, especially among students and employees, which indicate a high or medium high level of education, but it is probably also due to erratic, occasional and inexperienced sexual behavioral patterns, and a lack of knowledge concerning the choice of the right kind of contraception.^ieng

[Neonatal malformations and hormone therapy during pregnancy]. / Malformazioni neonatali e terapia ormonale in gravidanza.

PIP: The use of pharmacological treatment during pregnancy has always been extremely controversial, especially if the drugs involved are sex hormones, such as diethylstilbestrol. The percentage of congenital malformations attributable to hormonal therapy during pregnancy is 3%; the period of maximum susceptibility to teratogenic agents is between the 3rd-10th week of gestation, or the period of organogenesis. The 1st reported case of congenital malformation due to hormonal therapy during pregnancy goes back to 1957; since then the literature has published more on this subject. One of the most important studies was done in 1977 by Heinonen on a group of 50,282 pregnant women; 1042 had been treated with sex hormones. 19 infants, or 18.2/1000, had cardiovascular defects. Among the remaining 49,240 patients there were 385 cardiovascular malformations, or 7.8/1000. The problem is still far from being resolved; it is up to the individual physician to give the best possible advice, after careful consideration of the clinical situation of every pregnant patient.^ieng

[Analysis of the results and considerations on the organizational aspects of the implementation of the Law 194/78 in a provincial hospital]. / Analisi dei risultati, considerazioni di ordine organizzativo circa la legge 194/78 applicata in un Ente Ospedaliero di provincia.

PIP: Law number 94 legalizing abortion passed in Italy in May 1978. This article reports on the situation of induced abortion in the small provincial hospital of Avigliana, Torino, 1 year after the implementation of the law. The paramedical personnel were supportive of the medical and obstetrical personnel who, not being conscientious objectors, accepted to perform abortions. Every woman was thoroughly checked and counseled prior to the operation by the same doctor who was going to perform the abortion; the procedure was always done under general anesthesia and by vacuum aspiration. There were 66 abortions between June-December 1978, and 115 between January-July 1979. Contrary to expectations the number of deliveries also increased, from 66 during the 1st half to 145 during the 2nd half of operations. More than half the number of patients were referred from the ambulatory clinic within the same hospital, as compared to only 25% during the 1st half; only 7.8% were referred by private physicians, as compared to 30% during the 1st half. Almost 50% of patients were housewives both during the 1st and during the 2nd half; age of patients was, for the great majority, between 24-35; parity was 2 in 43.8% of cases for the 1st half, and in 40% of cases in the 2nd half. The majority of operations was performed within the 1st 8 weeks of pregnancy, and many women came from districts outside that of Avigliana. 34.8% of requests for abortion were because of failure of contraception, and almost 40% for socioeconomic reasons; only 8.2% of requests were motivated by reasons of health. Misinformation about contraceptive practices was widespread among the patients.^ieng

[A case of allergy to a copper-medicated IUD. Etiopathogenetic and clinical aspects]. / Su di un caso di allergia a I.U.D. medicato al rame. Considerazioni etiopatogenetiche e cliniche.

PIP: The use of copper medicated IUDs has replaced the use of inert IUDs, thanks to their increased effectiveness, a Pearl index of 1% as compared to 2.5%. There are very few reported cases of copper allergy due to IUDs; this article presents 1 such case. A 22 year old healthy woman was inserted with a Cu 250 IUD; 1 week after insertion she presented widespread erythematous patches all over her body, excluding her face. Cortisone and antihistamine treatment were ineffective; the IUD was removed, and all symptoms disappeared in less than 20 days; subsequent tests revealed the patient to be allergic to copper sulphate.^ieng

Empiric antibiotic and antifungal therapy for granulocytopenic patients with acute leukemia.

A prospective study was undertaken to determine the effectiveness of an empiric antibiotic treatment employing the combination of a beta-lactam and an aminoglycoside followed in non responders by vancomycin and amphotericin B after 48 and 96 hours respectively. We have evaluated 180 febrile episodes in 102 granulocytopenic leukemic patients. Febrile episodes (44%) were microbiologically documented; 29% were only clinically documented and 27% were possible. In the 180 evaluable episodes treated with a beta-lactam and an aminoglycoside the overall response rate was 61%. In non responders the addition of vancomycin increased the response rate to 83% and the subsequent addition of amphotericin B moved the total responders to 96%. Antibiotic related side effects were minimal. These data suggest the importance of an empiric strategy for treatment of bacterial infections arising in granulocytopenic patients. An early empiric antifungal therapy also appears necessary to control clinically undetected fungal invasion.