Mucormycosis after bone marrow transplantation: report of four cases in thalassemia and review of the literature.

We report four cases of mucormycosis that occurred among 711 patients who underwent BMT for thalassemia, and review 18 additional cases among BMT recipients that were reported in the English-language literature. All these patients were polytransfused and were in advanced phase of disease with severe acquired hemochromatosis. The sites of infection were sinonasal, rhinocerebral-pulmonary, pulmonary and pulmonary-central nervous system. Mucormycosis was the primary cause of death in three of four patients. Two infections were detected within the first 100 days after BMT. Only one of the four patients had partial resolution of sinonasal mucormycosis following aggressive antifungal therapy combined with hyperbaric oxygen treatment.

Ultrasound-computerized tomography in neonatal encephalic pathology.

The echoencephalographic examinations of 127 neonates were analysed to verify the role of US in the study of neonatal cerebral pathology, and to compare it with CT. US was of value in identifying the existence of a cerebral lesion and for follow-up. CT was more reliable for the characterization of the lesion and in establishing the surgical indications.

[Pedicled osteoma of the maxillary sinus. A rare radiological finding?]. / L'osteome pédicule du sinus maxillaire. Une constatation radiologique rare?

Several cases of intrasinus bony densities above pathological dental areas are reported. Common radiological features are outlined (pediculate implantation on the sinusal floor, cortical limits, acute or chronic dental infection). In one case, an histological examination performed at the opportunity of a sinusal operation pointed out osteomatous tissues.

Peptichemio induction therapy in myelomatosis.

Fifteen patients with multiple myeloma, two of whom had plasma cell leukemia, were treated between May 1974 and December 1978. Peptichemio was administered intravenously at doses of 40-80 mg/48 h, courses including 4-17 administrations in association with moderate doses of prednisone (15-50 mg/day) and androstanes at high dosages (250 mg weekly). In two patients PTC was associated with vincristine (VCR) administered on the first day of the course. Eight patients were previously untreated, four had been resistant to melphalan (MPH) and/or cyclophosphamide (CTX), and three had been treated irregularly with one or both of these alkylating agents. The criteria of response to therapy are reported. Out of a total of 15 PTC courses administered we obtained 13 responses, eight complete and five partial; no response was achieved in the other two patients. In the four patients who were resistant to MPH and/or CTX we obtained three responses, which were maintained with the same alkylating agent to which they had been resistant previously. The time needed to obtain a response in 90% of the patients was 6 weeks. Peptichemio was shown to be effective in patients in an advanced stage of the disease, in patients with light-chain myeloma and in those with plasma cell leukemia. The association of VCR potentiated the antitumor effect, but also increased the myelotoxicity. The PTC treatment was well tolerated. It is suggested that PTC be used in induction treatment of myelomatosis and in patients resistant to traditional alkylating agents.

Effect of vincristine on the bone marrow cells of patients with multiple myeloma: a cytomorphologic study.

The cytologic changes induced by vincristine (VCR) on the erythroblasts, the myeloid cells and the neoplastic plasma cells were studied on the bone marrow of 5 patients with plasma cell malignancies. Nine hours after the administration of the drug, the cytocidal effect on the 3 cell types was proportional to the magnitude of the stathmokinetic effect induced in them: marked on the erythroblasts (whose percentage incidence was sharply reduced), more modest on the myeloid cells, and still lower on the plasma cells. Nine days later the plasmocytomatous infiltrate was reduced as compared to before therapy, while the aliquot of hemopoietic cells was restored. At this time the mitotic index of plasma cells, but not that of the hemopoietic cells, was higher than before VCR administration. These findings suggest that the tumor mass reduction by VCR is followed by plasma cell recruitment, which is in progress 9 days after the drug administration. On the contrary, the regeneration of the hemopoietic cells has repopulated the bone marrow and is already exhausted in this lag time. It is hypothesized that VCR administrations given at about 9 day intervals are more and more effective on the recruited plasma cells, owing to the phase S-specificity of the drug. The regeneration of the hemopoietic cells is protected by this time interval.

Morphological and cytochemical studies of circulating Hodgkin's and Reed-Sternberg cells.

Morphological and cytochemical studies of circulating neoplastic cells were carried out in a patient who presented a preterminal leukaemic phase of Hodgkin's disease (HD). Three types of abnormal cells were found in the peripheral blood: abnormal mononuclear cells, Hodgkin's cells and Reed-Sternberg cells. All neoplastic cells were cytochemically negative to Sudan black B, peroxidase and alkaline phosphatase. Some neoplastic cells were positive to PAS and all were positive to acid phosphatase, alpha-naphthylacetate esterase and beta-glucuronidase. The origin of the neoplastic population in HD is discussed.

Cytokinetic studies on circulating neoplastic cells of Hodgkin's disease.

In two patients with advanced Hodgkin's disease the DNA content, the mitotic index and the in vitro tritiated thymidine labeling index of the neoplastic cells found in peripheral blood, bone marrow and, in one case, in ascitic fluid have been determined. Cytologically the tumor cells were classified into three groups: atypical mononuclear cells, Hodgkin (H) cells and Reed-Sternberg (R-S) cells. Two populations with clearly different kinetic features were recognized. The first one was that of atypical mononuclear cells which exhibited diploid DNA content and proliferative activity of moderate degree: tetraploid cells were, however, observed more frequently than expected. The second population grouped together H and R-S cells, had tetraploid modal DNA content and very high proliferative activity. Hodgkin cells had tetraploid or slightly greater DNA content while R-S cells exhibited also DNA values as high as octoploid and sometimes greater. It can be postulated that by endomitosis some atypical mononuclear cells give origin to H cells and that these assume the monstrous features of R-S cells while increasing their DNA content during the DNA synthesis phase.

Iron kinetics and erythropoiesis in Fanconi's anaemia.

Ferrokinetic studies were carried out in 4 patients with Fanconi's anaemia (FA). Experimental data were analysed by means of a mathematical model of iron kinetics in order to obtain a quantitative assessment of effective and ineffective erythropoietic activity, mean red cell lifespan, and non-erythroid iron turnover. The major pathogenetic mechanism of the anaemia appeared to be relative marrow failure, i.e. a reduction in the proliferative capacity of the erythroid marrow. The role of ineffective erythropoiesis was of minor importance. On the basis of the results obtained both the pathogenesis and the natural course of the disease are discussed.