Autologous stem cell transplantation (ASCT) in patients with mantle cell lymphoma: a retrospective study of the Spanish lymphoma group (GELTAMO).

Guidelines recommend autologous stem cell transplantation (ASCT) consolidation in first complete or partial response after regimens including rituximab (R) and high-dose AraC (HDAC), but its use beyond that response is questioned. We present a retrospective analysis of 268 patients with MCL who received ASCT. With a median follow-up for survival patients of 54 months, progression-free survival and overall survival for the whole series were 38 and 74 months, respectively, and for patients transplanted in first CR 49 and 97 months, respectively. Patients without CR before transplant were analyzed separately, those who achieved CR after transplantation had better PFS (48 vs 0.03 months, p < 0.001) and OS (92 vs 16 months, p < 0.001) than the remaining. In univariate analysis, first CR at transplant (p = 0.01) and prior rituximab (p = 0.02) were the variables associated with PFS. For OS, the same variables resulted significant (p = 0.03 and p < 0.001, respectively). In multivariate analysis, only the status at transplant (first CR) remained significant. This retrospective study concludes that ASCT consolidation in first CR induces high survival rates. In other stages of disease, the need of ASCT as consolidation may be questioned.

Yebes 40 m radio telescope and the broad band NANOCOSMOS receivers at 7 mm and 3 mm for line surveys.

CONTEXT: Yebes 40m radio telescope is the main and largest observing instrument at Yebes Observatory and it is devoted to Very Long Baseline Interferometry (VLBI) and single dish observations since 2010. It has been covering frequency bands between 2 GHz and 90 GHz in discontinuous and narrow windows in most of the cases, to match the current needs of the European VLBI Network (EVN) and the Global Millimeter VLBI Array (GMVA). AIMS: Nanocosmos project, a European Union funded synergy grant, opened the possibility to increase the instantaneous frequency coverage to observe many molecular transitions with single tunnings in single dish mode. This reduces the observing time and maximises the output from the telescope. METHODS: We present the technical specifications of the recently installed 31.5 - 50GHz (Q band) and 72 - 90.5 GHz (W band) receivers along with the main characteristics of the telescope at these frequency ranges. We have observed IRC+10216, CRL 2688 and CRL 618, which harbour a rich molecular chemistry, to demonstrate the capabilities of the new instrumentation for spectral observations in single dish mode. RESULTS: The results show the high sensitivity of the telescope in the Q band. The spectrum of IRC+10126 offers a signal to noise ratio never seen before for this source in this band. On the other hand, the spectrum normalised by the continuum flux towards CRL 618 in the W band demonstrates that the 40 m radio telescope produces comparable results to those from the IRAM 30 m radio telescope, although with a smaller sensitivity. The new receivers fulfil one of the main goals of Nanocosmos and open the possibility to study the spectrum of different astrophysical media with unprecedented sensitivity.

Agreements and uncertainties in autologous haematopoietic stem cell mobilization and collection. A Spanish consensus document.

Although many experts position statements on autologous stem cell mobilization have been published, there are some aspects that are still under discussion. A Spanish Hematologist expert group was summoned to settle on agreements and uncertainties on PBSCs mobilization, including factors not always considered; as apheresis and cytometry key factors that determine a successful PBSC collection. This document reviews critical factors that define poor mobilizer patients and the tools to better collect the desired stem cells for a successful autologous haematopoietic stem cell transplant.

[Evolution in 18F-FDG-PET of a case of Hodgkin disease, nodular sclerosis variety, after treatment and autotrasplant]. / Evolución, mediante estudios con 18F-FDG, de un caso de enfermedad de Hodgkin tipo esclerosis nodular después de tratamiento y autotrasplante.

Positron Emission Tomography (PET) has become a very useful tool for monitoring Hodgkin's disease patients in the last years. When there is suspicion of disease persistence after treatment, this technique makes it possible to evaluate treatment activity of the residual lesions observed in the CT scan. Furthermore, due to the whole body study, new tumor sites, which very often change the therapeutic option, can be detected. We must take into account, however, that 18F-FDG is a very sensitive but not very specific tumor marker, since some inflammatory or infectious conditions may be associated to significant radiopharmaceutical uptakes. Thus, in order to increase specificity it is mandatory to correlate the PET information with the rest of the conventional imaging and clinical data and evolution of the patient. We present the case of a woman with Hodgkin's disease in which 18F-FDG PET was included in the follow-up. Both conditions, tumor and infection, were present in different times of the course. The integration of all the x-ray, clinical, laboratory and metabolic information allowed for a better and correct management of this patient.

Probing non polar interstellar molecules through their protonated form: Detection of protonated cyanogen (NCCNH+).

Cyanogen (NCCN) is the simplest member of the series of dicyanopolyynes. It has been hypothesized that this family of molecules can be important constituents of interstellar and circumstellar media, although the lack of a permanent electric dipole moment prevents its detection through radioastronomical techniques. Here we present the first solid evidence of the presence of cyanogen in interstellar clouds through the detection of its protonated form toward the cold dark clouds TMC-1 and L483. Protonated cyanogen (NCCNH+) has been identified through the J = 5 - 4 and J = 10 - 9 rotational transitions using the 40m radiotelescope of Yebes and the IRAM 30m telescope. We derive beam averaged column densities for NCCNH+ of (8.6 ± 4.4) × 1010 cm-2 in TMC-1 and (3.9 ± 1.8) × 1010 cm-2 in L483, which translate to fairly low fractional abundances relative to H2, in the range (1-10) × 10-12. The chemistry of protonated molecules in dark clouds is discussed, and it is found that, in general terms, the abundance ratio between the protonated and non protonated forms of a molecule increases with increasing proton affinity. Our chemical model predicts an abundance ratio NCCNH+/NCCN of ~ 10-4, which implies that the abundance of cyanogen in dark clouds could be as high as (1-10) × 10-8 relative to H2, i.e., comparable to that of other abundant nitriles such as HCN, HNC, and HC3N.

Efficacy and safety of femoral vascular access for peripheral blood stem cell (PBSC) collection.

Central venous catheters are frequently used in leukapheresis to provide high flow rates. The most common locations are the subclavian or jugular vein, but insertion-related complications and inadequate flow are frequent problems. Experience using femoral venous access is limited, because this has been discouraged due to the high incidence of infectious or thromboembolic complications. We evaluated the safety and efficacy of 108 short-term femoral venous dialysis catheters used for the collection of peripheral blood stem cells (PBSCs). All catheters were placed by a member of the dialysis unit, and they remained in situ for the days needed to reach the target number of CD34+cells. No prophylactic antibiotic or antithrombotic therapy was used. A total of 232 apheresis sessions was performed. The longest duration a catheter remained in situ was 5 days. Most of the patients finished the collection in one or two apheresis sessions. There were no thrombotic or infectious complications, and insertion-related complications or mechanical problems were minimal. Apheresis results were similar to those reported using subclavian or jugular venous access. The short-term use of femoral venous dialysis catheters appears safe and effective for PBSC collection, simplifying the procedure, improving patient comfort, and reducing cost.

Right ventricular late filling termination time and its relation to interstitial collagen content in early transplanted heart: a color M-mode Doppler digital analysis.

BACKGROUND: Histologic changes in cardiac allografts resulting from fibrosis or acute rejection can modify ventricular diastolic function and ventricular inflow characteristics. These abnormalities may be detected by color M-mode Doppler echocardiography which has been shown to be sensitive in assessing ventricular diastolic function. METHODS: Twelve cardiac allograft recipients were prospectively studied with serial color M-mode and single-gated Doppler echocardiography, as well as with endomyocardial biopsy, with a follow-up of approximately 10 weeks. The myocardial interstitial collagen content as evaluated by videodensitometry was compared with right and left ventricular late filling termination times measured in the absence of a severe episode of rejection. RESULTS: A positive and significant correlation was found between the collagen content and the corresponding right ventricular late filling termination time (r = 0.89, p < 0.0001), but no correlation was found with the left ventricular late filling termination time. Moreover, variations in collagen content and variations in right ventricular late filling termination time were also highly correlated (r = 0.91, p < 0.0001). In allograft recipients who had episodes of rejection of grade 3A or greater, both right and left ventricular late filling termination times were significantly increased during rejection. CONCLUSIONS: Measurements of right ventricular late filling termination time by color M-mode Doppler echocardiography performed in the absence of acute rejection can be use to monitor the evolution of interstitial collagen content in cardiac allografts. The early detection of abnormally prolonged late filling termination time could be followed by endomyocardial biopsy to confirm the histologic changes.

Aortic dissection and cardiovascular syphilis: report of an observation with transesophageal echocardiography and anatomopathologic findings.

We report the case of a man who had thoracic pain and stroke. Transesophageal echocardiography enabled us to diagnose an intramural hematoma and a saccular aneurysm of the thoracic aorta before he died. Autopsy showed lesions compatible with syphilitic aortitis in the aortic wall. Transesophageal echocardiography and anatomopathologic findings are correlated, and the role of syphilis as a causal factor is discussed.

[Postoperative cardiac insufficiency. The value of enoximone]. / Insuffisance cardiaque postopératoire. Intérêt de l'énoximone.

The authors discuss the physiopathological mechanisms of intra and postoperative cardiac failure and the different means of treatment. A distinction is made between the intra and postoperative periods: the factors which predispose to cardiac failure are different and the immediate postoperative period would seem to be the most dangerous in patients with reduced coronary or contractile reserves. Enoximone is a valuable and effective inotropic agent in this situation.

[Regression of coronary atherosclerosis evaluated by angiography. A review of principal trials and critical study]. / La régression de l'athérosclérose coronaire évaluée par l'angiographie. Revues des principaux essais et étude critique.

The concepts of acceleration of atherosclerosis with fat rich diets and the regression or at least stabilisation of atherosclerosis by suppressing the cholesterol, introducing exercise programmes or administering calcium antagonists or aspirin, have been validated in the animal model. In the clinical situation, repeat coronary angiography has demonstrated that hyperlipidemia and the interval between two investigations are the main factors influencing the progression of atherosclerosis. However, the factors underlying the appearance and progression of atheromatous plaques remain unknown. Interventional trials based on the principle of introducing treatment after reference angiography have been undertaken. The results were assessed after variable time intervals. The general conclusion is that there is a direct relationship between the lowering of plasma cholesterol, the intensity of exercise and the slowing of progression of atherosclerosis as far as can be evaluated by repeat angiography. The data concerning the effect of calcium antagonists is confusing. The main criticism of these trials is the instrument of measurement and the practical significance or even the reality of the observed changes. In the present state of our knowledge, trials of the regression of atherosclerosis can not replace longitudinal studies of the long-term effects of drugs on cardiovascular and general morbidity and mortality.

[Role of antithrombotic agents after myocardial infarction]. / La place des antithrombotiques après un infarctus du myocarde.

Thrombosis is the causal mechanism of myocardial infarction: severe atherosclerotic narrowing, ulceration of the atherosclerotic plaque and disequilibrium between pro and antithrombotic factors, predispose to this complication. Recurrent myocardial infarction is a common complication in the year following an initial event: the risk is higher when the diseased artery has been recanalized in the acute phase. Reocclusion of the recanalized artery without signs of infarction is also a common occurrence. It was therefore logical to have striven over the years to prevent reinfarction and/or rethrombosis after reperfusion. Mechanical methods have not been crowned with resounding success and antithrombotic drugs are the only products associated with real benefits in this prevention. In this article, the authors review the efficacy of aspirin and vitamin K antagonists in the prevention of recurrent myocardial infarction; the data in favour of an efficacy of aspirin in preventing early reinfarction is also analysed; finally, results suggesting a benefit of platelet antiaggregant therapy (Flurbiprofen or aspirin) on the risk of reocclusion after therapeutic recanalisation are also assessed.

[Incidental finding of an isolated thrombus in the left atrium in a young woman with sinus rhythm 5 years after cerebral ischemic accident]. / Découverte fortuite d'un thrombus isolé de l'auricule gauche chez une femme jeune en rythme sinusal 5 ans après un accident ischémique cérébral.

The authors report the case of a 40 year old woman who had an ischemic stroke. The initial investigation including a complete blood clotting analysis, failed to demonstrate the cause. Five years later, the investigations were completed systematically by transesophageal echocardiography which demonstrated an isolated thrombus localised in the left atrial appendage though the localisation heart was in sinus rhythm and morphologically normal. This case illustrates in the diagnostic yield of transesophageal echocardiography in the investigation of systemic embolism in young patients who have had a cerebral ischemic event of unknown cause, even in the absence of predisposing cardiac cause.

[Quantification of longitudinal myocardial velocities by Doppler tissue imaging during dobutamine echocardiography]. / Quantification des variations de vélocités myocardiques longitudinales par doppler tissulaire au cours de l'échocardiographie sous dobutamine.

Doppler tissue imaging has been suggested to be a valuable method for the diagnosis of myocardial ischaemia during dobutamine echocardiography. The authors studied this mode of investigation in 49 consecutive patients (average age 60 +/- 12 years) referred for dobutamine stress echocardiography and who had undergone coronary angiography. The stress echo was carried out according to a standard protocol (5 to 40 m g/kg/min +/- atropine) with additional acquisition of 3 apical views (4, 2 and 3 chambers) with colour Doppler tissue imaging. Analysis of systolic and diastolic myocardial velocities was performed afterwards from digitised data. The different Doppler tissue parameters were measured in 12 left ventricular segments (excluding the apical segments) for each dosage of dobutamine: peak systolic velocity (S), Q-S duration, systolic velocity time integral (ITVS), peak early diastolic velocity (E), peak end diastolic velocity (A). These parameters were analysed throughout the stress for each segment without significant coronary stenosis to define normal values. ROC curves were constructed to determine threshold values of relative changes of velocity (between maximal dobutamine dosage and basal conditions) to improve detection of ischaemia in a segment with coronary stenosis (vessel diameter reduction > or = 70%). Similar diagnostic performances were observed with different systolic and diastolic parameters. The feasibility of measurement of diastolic velocities was, however, reduced (from 29% to 49%). The diagnostic accuracy of each parameter was the same for each vessel territory. A satisfactory concordance was observed between 2D echocardiography and Doppler tissue imaging for the detection of significant coronary stenosis in an analysis by vascular territory. The authors conclude that analysis of myocardial velocities during dobutamine stress echocardiography is feasible. It may be a useful complement for the detection of coronary stenosis during pharmacological stress echocardiography.

[Valve replacement in aged patients. Risk and remote results]. / Le remplacement valvulaire chez le patient âgé. Risques et résultats éloignés.

A total of 102 patients aged 65 to 78 years underwent valvular replacement between 1975 and 1980. Calcific aortic stenosis was, by far, the commonest lesion (54 cases), followed by mitral stenosis (16 cases), mitral incompetence (14 cases), aortic incompetence (10 cases) and double valve lesions (8 cases). Sixty four patients underwent aortic valve replacement with 7 early deaths (10,9 p. 100). There were 30 mitral valve replacements with 7 deaths (23,3 p. 100) and 8 patients had double valve surgery with 4 deaths (50 p. 100). Aorto-coronary bypass grafting was associated in 25 cases with a 20 p. 100 mortality. Changes in the technique of peroperative myocardial protection have considerably reduced early mortality which has fallen from over 20 p. 100 to 2,9 p. 100 since the use of cardioplegia with local and systemic hypothermia. There was a higher surgical mortality in patients with poor left ventricular function, cardiomegaly and severe symptomatic incapacity. Non-fatal postoperative complications were common (50 p. 100 of survivors). There were 12 late deaths, 75 p. 100 of which were related to cardiovascular causes. The actuarial survival rate was 65,5 +/- 6 p. 100, 5 years after surgery. When operative mortality was excluded, the 5 year survival rate of the operated patients did not differ from that of the general populations of the same age (79,8 p. 100). Only 5 of our patients were lost to follow-up. Of the survivors, 95,5 p. 100 were asymptomatic or improved by at least one functional grade after an average postoperative period of 30 months. The incidence of late haemorrhagic complications in patients on anticoagulants was 11 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

[Morphological study by transesophageal echocardiography and clinical aspects of ruptured chordae tendineae in the elderly]. / Etude morphologique par échocardiographie transoesophagienne et aspects cliniques de la rupture de cordages mitral chez le sujet âgé.

Ruptured mitral chordae tendinae is a classical complication of myxomatous mitral valves or Barlow's syndrome. This complication is controversial in non-myxomatous mitral valve. Of 91 consecutive patients with mitral valve prolapse examined over an 18 months period by transthoracic and transesophageal echocardiography, 42 (18 women and 24 men) with an average age of 76 +/- 8 years (60-93 years) had ruptured mitral chordae tendinae. The thickness of the anterior mitral leaflet measured at the distal third of the valve by transesophageal echocardiography enabled the identification of two groups of patients; group I: > 3 mm (24 patients), average 4.8 +/- 0.8 mm and group II: < or = 3 mm (18 patients), average 2.6 +/- 0.3 mm. The diameter of the mitral ring and left atrium, the length of the anterior mitral leaflet, the left ventricular end diastolic dimensions and fractional shortening, were measured by transthoracic 2D echocardiography (mitral ring) and M mode (other parameters). Ruptured chordae were detected in only 13 cases (31%) by transthoracic echocardiography; 38% were asymptomatic and a chance finding at transesophageal echocardiography. No significant difference was observed between the two groups with respect to age, gender presence of hypertension, dimensions of the cardiac chambers, fractional shortening or localisation of the prolapse related to the ruptured chordae. Fifty-eight per cent of patients in group I were in NYHA functional classes 3-4 as compared to 16% in group II (p < 0.02). The size of the left atrium was significantly greater in group I, 51 +/- 8 mm vs 38 +/- 7 mm (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Dynamic left ventricular obstruction increased by nitroglycerin in elderly patients with hypertension and concentric left ventricular hypertrophy]. / Obstruction dynamique intraventriculaire gauche aggravée par la nitroglycérine chez les patients hypertendus âgés avec une hypertrophie ventriculaire gauche concentrique.

Left ventricular outflow tract (LVOT) obstruction has been observed in elderly patients with concentric hypertrophic hypertensive cardiomyopathy (HHCM) and no significant valvular disease or regional wall motion abnormalities. In order to determine whether nitroglycerin (NTG) can increase the intraventricular obstruction, we performed echocardiographic (echo) and doppler studies, before and during administration of sublingual NTG (0.8 mg). Twenty patients (n = 20) with long-standing hypertension (19 women and 1 man, mean age 78 +/- 8 yr, mean duration of hypertension 13 +/- 10 yrs were examined. The clinical findings in 17 patients were: angina 5 (29%), dyspnea 9 (53%), syncope or malaise 4 (23%). Electrocardiographic criteria of left ventricular hypertrophy was present in 4 patients and an increased cardio-thoracic ratio (greater than 0.5) in 9 cases. The following echo parameters were determined using M-mode echocardiograms: LV end-diastolic (LVID) and systolic diameter (LVIS), fractional shortening (FS), ventricular septum thickness (IVST), posterior wall thickness (PWT) and the ratio ISVT/PWT (less than 1.3 in all patients). LVM could be calculated in 15 patients and was corrected for body surface area (LVMI). Pulsed and continuous wave Doppler study showed a characteristic late-peaking velocity waveform. We localized the elevated velocities in the LVOT and determined before and during administration of NTG: LVOT peak velocities (V) and peak intraventricular gradients (G) using simplified Bernoulli equation. Results were as follows: [table: see text] Mild mitral regurgitation was observed in 14 patients (70%) and mitral annular calcifications in 11 (55%). Systolic function, as assessed by FS, was normal in all patients. NTG induced a significant acceleration of the LVOT velocities in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical, echocardiographic and Doppler outcome in ischemic right ventricular dysfunction associated with inferior wall infarction]. / Evolution clinique, échocardiographique et Doppler de la dysfonction ischémique ventriculaire droite associée à un infarctus inférieur.

Right ventricular involvement during inferior wall myocardial infarction does not seem to alter long-term clinical prognosis but its specific outcome has not been clearly studied. We have previously demonstrated that pulmonary regurgitant (PR) flow tracings doppler analysis allows the accurate diagnosis of RV involvement, especially when the pressure half-time of PR was < or = 150 ms and the ratio of the minimal velocity to the maximal velocity was < or = 0.5. We studied 40 patients with acute inferior wall myocardial infarction and with PR flow. Doppler echocardiography was obtained during the first day, before discharge (early control) and between 12 and 24 months follow-up (late control). Among 22 patients with RV involvement defined with PR-derived doppler parameters (RVIPR). 8 had right ventricular enlargement and/or wall motion abnormalities, observed in 6 cases at early control and in 4 at late control. Doppler analysis showed remnant RVIPR parameters in 9 patients at early control and 8 among these at late contorl, with no relation with pulmonary artery pressure or other echocardiographic parameters. No clinical, angiographic or therapeutic data predicted these distinct echocardiographic and doppler patterns and the long-term prognosis was not different. At late control, among 12 RVIPR patients which PR-derived doppler parameters were normal at early control, two patients had still RVIPR pattern at late control and described ischemic recurrence. PR flow doppler analysis is a useful tool for diagnosis and outcome evaluation of RV involvement and shows a remnant diastolic dysfunction in half of the patients with acute RV involvement.

[Dobutamine stress echocardiography; a monocentric experience on 600 consecutive patients. Effect of age]. / Echocardiographie sous dobutamine; expérience monocentrique portant sur 600 patients consécutifs. Influence de l'âge.

The increasing indications of dobutamine stress echo in the investigation of myocardial ischaemia, viability and evaluation of the prognosis of coronary artery disease has made this technique a tool of everyday clinical practice. The authors reviewed the results of 600 investigations in consecutive unselected including patients aged over 75. No significant difference was observed with respect to the causes of interruption of the test between patients aged less than 75 (521 patients) and those older than 75 (79 patients). Attaining the target theoretical maximal heart rate was the commonest reason for stopping the test (47 and 48% respectively). Ventricular arrhythmias were not more common (12 and 10% respectively). Twelve cases of ventricular tachycardia were observed, 8 of which were non-sustained; 9 led to interruption of the test. No cases of ventricular fibrillation were observed. A previous history of cardiac arrhythmias was not associated with a higher frequency of arrhythmia during the test (8% in those with a previous history, 4% in those patients without). Supraventricular arrhythmias were significantly more common in patients over 75 years of age (15 versus 8%, p = 0.046). Dobutamine stress echocardiography' is feasible in a population of unselected patients, including those over 75. Therefore, age does not represent a limitation to the extension of this investigation.

[Simultaneous heart and kidney transplantation using the same donor]. / Transplantations cardiaques et rénales simultanées utilisant le même donneur.

From 1988 to 1991, five cases of combined heart and kidney transplantation using the same donor have been achieved at our institution. All patients were males, 58 +/- 6 (46 to 64). The cardiac condition leading to the cardiac replacement was a dilated cardiomyopathy in one case, end-stage ischemic disease in 3, and failure of a previous cardiac transplantation in one. The renal condition claiming for a graft was a Glomerular nephritis in one, a polycystic disease in 3, and renal failure due to CyA toxicity in one; chronic hemodialysis was mandatory in all patients but one. There were no hospital deaths. The five patients are current survivors, the mean follow-up being 22 +/- 10 months (2-50 months). Five rejection episodes occurred in three patients; two patients have never demonstrated any cardiac rejection. All but one recovered a normal renal function as soon as the 7 th post operative day; only one episode of renal rejection has been detected, easily reversed by corticoids. No simultaneity was ever observed between cardiac and renal rejection episodes. Thus, the detection of rejection must be carried out separately for each graft organ. In four patients, cineangiograms of the coronary vessels were done respectively 12, 30 and 50 months post operatively and revealed a normal coronary bed. Thus, combined heart and kidney transplantation seems to be a realistic approach in properly selected patients in whom cardiac and renal failures cannot be treated by more conventional procedures.