Allogeneic stem cell transplantation for relapsed primary central nervous system lymphoma: Is it feasible?

Primary central nervous system lymphoma (PCNSL), has an aggressive course and in untreated patients median survival is limited to three months. For relapsed PCNSL, the treatment options are few and results are usually unsatisfactory. Allogeneic Hematopoietic Stem Cell Transplantation (allo-HCT) has been widely used for treatment of relapsed/refractory NHL patients. However there are limited data whether graft versus lymphoma effect can work in PCNSL patients. Here, we present a relapsed refractory PCNSL case treated by allo-HCT.

Effect of radiofrequency on epicardial myocardium after ablation of ventricular arrhythmias from within coronary sinus.

BACKGROUND: Radiofrequency (RF) ablation of idiopathic ventricular arrhythmias (IVA) from the coronary venous system (CVS) has been increasingly performed, but real effect of ablation lesions from CVS on epicardial myocardium has not been studied. OBJECTIVE: To compare effects of RF delivered inside the distal CVS during ablation of IVAs originating from left ventricular summit (LVS) with IVAs ablated from right ventricular outflow tract (RVOT) using cardiac magnetic resonance imaging (CMRI). METHODS: Twenty consecutive patients with IVAs who underwent acutely successful RF ablation at initial appropriate sites, i.e., distal CVS (Group 1, n = 10) or RVOT (Group 2; n = 10) were enrolled. Detailed contrast-enhanced CMRI of each patient was performed 3 months later. Presence and location of scars, distance of CVS to epicardial ventricular myocardium were measured and analyzed. RESULTS: Group 1 consisted of 10 and Group 2 consisted of 10 patients. Three months after the ablation, only three patients in Group 1 had detectable late gadolinium enhancement (LGE) on CMRI while nine out of 10 patients in Group 2 had evident LGE on CMRI (P: 0.02). The mean distance of distal CVS to epicardial anterobasal myocardium was measured to be 8.8 ± 1.6 mm in Group 1. In three cases that had detectable scar on superior anterobasal LV epicardium, the mean distance was 7.4 ± 1.1 mm. CONCLUSIONS: RF delivery inside the CVS is less likely to produce detectable LGE on CMRI compared to RVOT. This may partially explain less than ideal long-term results after ablation of LVS IVAs from within the great cardiac vein/anterior interventricular vein.

Successful Bosutinib Experience in an Elderly Acute Lymphoblastic Leukemia Patient with Suspected Central Nervous System Involvement Transformed from Chronic Myeloid Leukemia.

Managing the blast phase in chronic myeloid leukemia (CML) is challenging because limited data are available for elderly patients. The involvement of the central nervous system (CNS) increases the risk of a poor prognosis. Here, we present an elderly blast phase CML patient with suspected CNS involvement who was successfully treated with bosutinib.

A computational study on the characteristics of airflow in bilateral abductor vocal fold immobility.

OBJECTIVES/HYPOTHESIS: To evaluate airway sufficiency and airflow dynamics in a group of patients who underwent a posterior transverse laser cordotomy (PTLC) procedure. STUDY DESIGN: Mixed methods research, university hospital setting. METHODS: Sixteen patients who underwent a PTLC procedure volunteered to be involved in this study. Dyspnea levels, voice, and glottic opening in indirect laryngoscopy were evaluated subjectively. The airway was evaluated objectively by pulmonary function tests, and glottic areas were measured from axial computed tomography (CT) images. The control group consisted of 63 subjects from the tomography archive. For computational fluid dynamics (CFD) analyses, two subjects from the study group were chosen on the basis of obstruction level, and a normal female subject was selected from the control group. Cartesian coordinates for airway boundaries were determined from axial CT images, and a three-dimensional computational model of the larynx was constructed. Flow simulations were performed with two different flow conditions during inspiration. Comparison of velocity, static pressure, turbulence intensity, and wall shear stress distribution values were made between selected cases and control. RESULTS: Pulmonary data varied widely and did not correlate with the size of the glottic area or dyspnea level. CFD analyses revealed that in addition to obstruction at the glottic level, aerodynamic properties of the larynx are altered due to loss in muscular tonus. Also, the contour of the glottic opening was found to be very important in determining the character of airflow as laminar or turbulent. CONCLUSIONS: Patients have considerable differences in their flow patterns and force distributions during respiration. Patient-specific models may help in evaluation and treatment planning.

Prevalence and types of main and right portal vein branching variations on MDCT.

OBJECTIVE: Our objective was to investigate the prevalence of variant main and right portal vein ramification in a large group of patients. SUBJECTS AND METHODS: The study group consisted of 200 patients who underwent consecutive contrast-enhanced abdominal CT examinations performed with an 8-MDCT scanner. Two observers evaluated both thin axial sections and 3D maximum-intensity-projection and volume-rendered images for branching patterns of the main and right portal veins. RESULTS: Conventional main portal vein anatomy was present in 64.5% of the patients. In 9.5% of the patients, the main portal vein trifurcated into the left portal and right anterior and posterior portal veins. In 23.5% of the patients, the main portal vein divided into a common left portal vein-right anterior portal vein trunk and the right posterior portal vein. Three patients (1.5%) had miscellaneous variations. Twenty-two (16.8%) of 131 patients with conventional main portal vein branching had variant right portal vein branching, most of which was a trifurcation, followed by an abnormally proximal origin of the segment VII vein from the right portal vein. CONCLUSION: Variant main portal vein branching seems to be very frequent. Common right anterior portal vein-left portal vein trunk is far more common than trifurcation. Although less frequent, variations also occur in right portal vein branching.