Self-reported changes in the expanded disability status scale score in patients with multiple sclerosis after autologous stem cell transplants: real-world data from a single center.

In order to reset the immune system to baseline function, autologous hematopoietic stem cell transplantation (HSCT) has been performed in patients with multiple sclerosis (MS). After June 2015, 617 new consecutive patients with MS were autografted in our center with non-frozen peripheral blood stem cells. The autografts were performed on an out-patient basis, after conditioning with cyclophosphamide and rituximab. The aim of the study was the assessment of both safety and efficacy of the method. The study's primary co-end-points were recovery of granulocyte and platelet counts and transplant-related mortality. Secondary end-points were overall survival and clinical response (improvement or stabilization of the self-reported expanded disability status scale score). The protocol was registered in ClinicalTrials.gov identifier NCT02674217.0. We included 401 females and 216 males, with a median age of 46 years. A total of 259 patients had relapsing-remitting MS (RRMS), 228 had secondary progressive (SPMS) and 130 had primary progressive (PPMS) multiple sclerosis. All procedures were initially performed on an out-patient basis and only 32 individuals (5%) required hospitalization. One to three aphereses (median 1) were required to harvest at least 1 × 106 /kg viable CD34+ cells. The total number of viable CD34+ infused cells ranged between 1 and 37·83 × 106 /kg (median 5·68). Patients recovered more than 0·5 × 109 /l absolute granulocytes by day 8 (median, range = 2-14), and platelet values were above 20 × 109 /l by day 4 (median, range = 0-11). Eleven individuals required red blood cells and six needed platelet transfusions. To date, there have been no deaths attributable to the transplant, yielding a 30-month overall survival of 100%. Patients have been followed for 3-42 months (median = 12). The overall response rate (decrease or stabilization of the self-reported EDSS score) at 12 months was 78% for all patients (83% in RRMS, 78% in PPMS and 73% in SPMS), while the disability progression-free survival was 82% for all patients (86% in RRMS, 78·5% in SPMS and 78% in SPMS). Changes in the self-reported EDSS score in parallel with neurological improvement were observed in people with all types of MS after HSCT, employing the 'Mexican method'.

Ultrasound evaluation of subdural haematoma.

14 patients with subdural haematoma (SDH) diagnosed by ultrasonography (US) and confirmed by computerized tomography (CT) were reviewed. We describe the morphology of SDH on US and discuss the ultrasound findings which may suggest outcome. SDH appeared as a crescentic mass overlying the cerebral hemisphere and producing medial displacement of the Sylvian fissure, midline shift, ventricular compression, sutural diastasis, changes in the sulcal pattern and echogenicity of the ipsilateral side of the brain. Hydrocephalus was the most common complication. It was the presence of cerebral complications and not the midline shift or ventricular compression which correlated with poor outcome.

Extradural hematoma in neonates.

Six neonates with extradural hematomas (EDH) diagnosed by ultrasound and confirmed by computed tomography scan were reviewed. EDH was seen in term male infants of primigravidas. Predisposing factors were coagulopathy and forceps extraction after prolonged labor. Clinical features were similar to other intracranial hemorrhages, but no deterioration in the level of consciousness was noted. Constant ultrasonographic features include a biconvex, echogenic, intracranial mass adjacent to the inner table of the skull. Ultrasonography was shown to be a reliable tool in establishing the diagnosis, monitoring progress, and detecting complications of EDH. Recovery with conservative management was noted.

Transmission of bovine leukaemia virus in milk.

Nineteen calves born to dams free of bovine leukaemia virus (BLV) did not possess maternally derived precipitating antibody to BLV in their sera after the ingestion of colostrum. Eight of these calves remained serologically negative after being fed milk from BLV-free cows while three (27.3%) of 11 similar calves that had been fed milk from BLV-infected cows developed antibody. Forty-four of 47 calves born to BLV-infected dams acquired maternal antibody to BLV after ingesting colostrum. Two (8.7%) of the 23 calves fed milk from BLV-free cows developed antibody to BLV probably as a result of transplacental or colostrum infection whereas four (16.7%) of the 24 calves fed milk from BLV-infected cows developed antibody. It is concluded that milk transmission of BLV is responsible in part for the high rates of infection encountered in our dairy herds and that calves lacking specific maternal antibody are more susceptible to BLV infection through the ingestion of milk than are calves with maternal antibody.

Transmission of bovine leukemia virus through milk ingestion.

Foi utilizada a prova de imunodifusao para detectar a presenca de anticorpos contra a glicoproteina maior (gp 51) do virus da leucemia bovina (VLB), para avaliar o desenvolvimento da infeccao em bezerros alimentados com leite de vacas livres e infectadas com o virus da leucemia. Os bezerros recem-nascidos receberam o colostro das maes durante cinco dias e depois tres litros de leite, diariamente, por periodos que variaram entre 11 e 49 dias. Todos os animais em experimentacao foram sangrados mensalmente ate os oito meses de idade, para acompanhar o aparecimento dos anticorpos como evidencia da infeccao. O VLB foi transmitido a um dos quatro bezerros (25,0%) sem anticorpos maternos, depois da ingestao de leite de vacas infectadas. Como testemunhos foram utilizados tres bezerros sem anticorpos maternos e 10 com anticorpos maternos que nao adquiriram a infeccao pelo VLB, apos a ingestao de leite de vacas nao-infectadas, por periodos similares. Concluiu-se que o VLB e eliminado no leite de vacas infectadas e se constitui numa fonte de infeccao para bezerros recem-nascidos