Early assessment of minimal residual disease in AML by flow cytometry during aplasia identifies patients at increased risk of relapse.

In acute myeloid leukemia (AML), assessment of minimal residual disease (MRD) by flow cytometry (flow MRD) after induction and consolidation therapy has been shown to provide independent prognostic information. However, data on the value of earlier flow MRD assessment are lacking. Therefore, the value of flow MRD detection was determined during aplasia in 178 patients achieving complete remission after treatment according to AMLCG (AML Cooperative Group) induction protocols. Flow MRD positivity during aplasia predicted poor outcome (5-year relapse-free survival (RFS) 16% vs 43%, P<0.001) independently from age and cytogenetic risk group (hazard ratio for MRD positivity 1.71; P=0.009). Importantly, the prognosis of patients without detectable MRD was neither impacted by morphological blast count during aplasia nor by MRD status postinduction. Early flow MRD was also evaluated in the context of existing risk factors. Flow MRD was prognostic within the intermediate cytogenetic risk group (5-year RFS 15% vs 37%, P=0.016) as well as for patients with normal karyotype and NPM1 mutations (5-year RFS 13% vs 49%, P=0.02) or FLT3-ITD (3-year RFS rates 9% vs 44%, P=0.016). Early flow MRD assessment can improve current risk stratification approaches by prediction of RFS in AML and might facilitate adaptation of postremission therapy for patients at high risk of relapse.

[Injury of ICA during endonasal sinus surgery and management by endovascular stent application]. / Verletzung der ACI bei Nasennebenhöhlenoperation und Management durch endovaskuläre Stentapplikation.

BACKGROUND: Injury of the internal carotid artery (ICA) during endonasal sinus surgery is rare but a life-threatening situation for the patient. For adequate treatment endovascular therapy as embolization or balloon occlusion is usually performed although there is a high risk of irreversible neurological deficits. CASE REPORT: We report on a twenty-five-year-old female patient with acute exacerbated chronic polyposis nasi suffering from an injury of the ICA during endonasal sinus surgery. After intraoperative identification of the site of hemorrhage the massive bleeding could temporarily be controlled by a nasal pack. The woman was immediately transferred to a neuroradiological department. After angiographic localization of the vessel defect the bleeding could be stopped by application of a vascular stent without any neurological deficits during or after the procedure. Anatomical characteristics of the ICA in the sphenoid sinus, and recommended emergency treatment and preventive measures are discussed. CONCLUSION: Although vascular stents are difficult to place in the intrasphenoidal course of the ICA, it provides an effective closure of the vascular injury and above all a sufficient cerebral perfusion, therefore, the risk of neurological defects can be reduced.

Association of oligodendroglioma-like cell proliferation and angiomatous vasculature--coincidence or pathogenetically related lesions?

We report a case of an oligodendroglioma associated with a cavernous angioma. The patient, a 20-year-old man with an 8-year history of epileptic seizures, presented an acute onset of headache, nausea, and vomiting. Computerized tomographic scan and angiogram revealed multiple vascular malformations in both hemispheres including a cystic hemorraghic lesion with a perifocal edema attributing to a mass effect. Repeated puncture of the cyst failed to give improvement of elevated intracranial pressure. At surgery, the cyst and the underlying lesion were excised and found to be oligodendrocyte-rich tissue with malformed vascular tissue. Final histological examination revealed an oligodendroglioma associated with a cavernous angioma. As concurrence of oligodendroglioma and vascular malformation is rare, this case raises a broad range of differential diagnoses such as reactive oligodendroglial gliosis due to a vascular malformation, unusual vascularity of an oligodendroglioma as well as other kinds of cerebral tumors or malformations. The diagnostic difficulties as well as the pathogenetic and pathological significance of the concurrence of an oligodendroglioma and cavernous angioma are discussed.

The role of endoscopy in the treatment of acute traumatic anterior epidural hematoma of the cervical spine: case report.

OBJECTIVE AND IMPORTANCE: Epidural hematoma (EDH) of the spine represents an uncommon neurosurgical disorder that sometimes requires emergent surgical decompressive therapy. Traumatic EDH of the cervical spine is exceedingly rare. The hematoma is usually located dorsally in the epidural space. We present one case of acute EDH located ventrally in the cervical spine. Special emphasis is placed on the role of spinal endoscopy in surgical treatment. CLINICAL PRESENTATION: After a fall from a tree, a 69-year-old man with rapidly increasing tetraparesis was referred to our institution. Plain films of the cervical spine revealed nothing abnormal. The results of computed tomography were highly suspicious for EDH. A myelogram and a post-myelographic computed tomographic scan demonstrated the lesion and its extent craniocaudally. INTERVENTION: Emergency decompressive surgery and removal of the hematoma were performed via an anterior approach. Control for total removal of the EDH was achieved using a flexible neuroendoscope providing visualization of the anterior epidural space from the foramen magnum to the T1 level. Surgery was accomplished by vertebral body replacement and anterior plating. CONCLUSION: Spinal endoscopy seems to be a useful tool in the surgical treatment of spinal EDH, providing control of the adjacent levels and allowing the limitation of the extent of bony resection.

[The role of color duplex ultrasound in diagnosis and differential diagnosis of carotid body tumors]. / Die Rolle der Farbduplex-sonographie bei Diagnose und Differentialdiagnose von Glomus-caroticum-Tumoren.

BACKGROUND: Currently the diagnosis of tumorous lesions of the carotid bifurcation is the domain of magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). So far, colour Doppler imaging (CDI) has not been playing an important part in this field. The aim of this study was to define the diagnostic value of CDI in the evaluation of these tumours related to the big arteries and to compare the different imaging techniques. PATIENTS AND METHODS: 6 female patients with suspected tumours of the carotid bifurcation were examined with CDI. Additionally 5 MRI examinations and 3 preoperative diagnostic DSA examinations were performed in the same patients. Pathologically, there were 4 typical carotid body tumours, 1 neuroma of the sympathetic trunk and 1 multifocal paraganglioma of the neck. RESULTS: In carotid body tumours we found a characteristic broadening of the bifurcation with shifting of the internal carotid artery posteriorly and laterally and of the external carotid artery anteriorly and medially. The highly vascularized tumour is surrounded by the arteries. This combination of ultrasound findings was absent in cases of sympathetic neuroma and multifocal paraganglioma. No additional information was achieved with MRI and DSA. CONCLUSION: CDI and MRI evaluation revealed the same diagnostic value in cases of vascularised tumours of the carotid bifurcation. CDI proved to be as accurate as DSA in the imaging of the big arteries and their relationship to the tumour, as well as of the small tumour feeding vessels. Therefore DSA may be omitted as an invasive diagnostic tool in the diagnosis of carotid body tumours.

Marital functioning after cardiac surgery.

Using Barnhill's components of family health functioning, we examined the relationships of spouse anxiety, coping methods, couple responsibility for compliance, and reported compliance with marital couple functioning. Five psychosocial scales were returned by mail by 136 Mended Heart members and spouses from five geographic regions. By multiple regression analysis, confrontive coping strategies and spouse trait anxiety were the two factors predictive of couple marital functioning. When marital functioning scores were examined separately, spouses' confrontive behaviors and patient reported compliance for diet, stress, and smoking prescriptions were predictive of both spouse and patient marital functioning. In addition, spouse marital functioning was predicted by state anxiety and patient compliance, and patient marital functioning by compliance and shared responsibility for compliance. Further studies should evaluate spouse inclusion in rehabilitation programs during hospitalization and convalescence and examine interactional strategies that facilitate confrontive behaviors and patient compliance to promote couple marital functioning after the cardiac event.

Personal adjustments and regimen compliance 1 year after myocardial infarction.

The relationship of attitudes and perceived beliefs of others to regimen compliance and personal psychologic and social adjustments of patients with myocardial infarction was investigated 1 year after the infarction. Eighty-one patients (39 in the experimental group, 42 in the control group) who participated in a prior study on the effect of a nursing intervention on regimen compliance, completed scales that assessed attitudes toward regimen prescriptions (diet, medications, activity, smoking, and stress response), perceived beliefs of others concerning compliance, personal adjustments, and regimen compliance. At 1 year, no differences were found between experimental and control groups for regimen compliance or personal adjustments. There was a significant decrease in mean scores for all variables from the time the patient was in the hospital to 30 days afterward, but no change at 1 year from the 30- or 60-day visit. At 1 year, attitudes were predictive of compliance for all regimen prescriptions. Perceived beliefs of others were predictive of diet, activity, and medication prescriptions.

Influence of a nursing intervention on regimen adherence and societal adjustments postmyocardial infarction.

One hundred three first-time myocardial infarction (MI) patients were randomly assigned to either an experimental or a control condition. Patients completed a cardiac rehabilitation program during hospitalization and were interviewed to assess intentions to follow regimen prescriptions, attitudes toward the prescriptions, coping methods, and the perceived beliefs of others concerning their intentions. Patients were visited at home 30 days after discharge and reassessed on each of the above variables except that their behavior was substituted for intentions and societal adjustment was assessed. The experimental group was given an intervention program which included a discussion of assessment data, identification of problems, and establishment of goals. The assessment was repeated 60 days after discharge. No differences were found between experimental and control groups for either medical regimen adherence or societal adjustment. There was a significant decrease in mean scores for all variables from hospital to 30 days for both groups, but no change from 30 to 60 days. Attitudes and perceived beliefs of others were predictive of adherence, and it was concluded that these variables need to be included in any rehabilitation program.

Indicators of medical regimen adherence for myocardial infarction patients.

This study investigated relationships between demographic and medical variables, attitudes, perceived beliefs of others, and intentions toward medical regimen adherence and actual posthospitalization regimen adherence. During hospitalization, attitudes, perceived beliefs of others, and intentions toward prescribed medical regimen were elicited from 112 persons recovering from a first time myocardial infarction (MI). Six to 9 months posthospitalization, attitudes, perceived beliefs of others, and adherence behaviors were assessed. Multiple regression analysis indicated that, during hospitalization, attitudes and perceived beliefs of others were strong indicators of intentions to adhere to the medical regimen, but they were not indicators of actual adherence posthospitalization. Posthospitalization, attitudes and perceived beliefs of others were strong indicators of actual regimen adherence. Findings indicate rehabilitation plans for the MI patient should be individualized for hospital and home and should include data on health belief variables.

Sinusoidal and postsinusoidal vascular systems in liver cirrhosis.

The morphology of the sinusoidal and postsinusoidal hepatic vein system in liver cirrhosis is shown by postmortem venography, microangiography and micropreparation. The normal angioarchitecture of the sinusoidal and hepatic vein system in lost in cirrhotic alteration of the liver. The hepatic veins are partly stenosed and displaced. Regenerate nodules, pseudolobules and extremely vascularized connective tissue septa, characterize the venous parenchymogram and microangiogram. The size of the regenerate nodules corresponds well to a granulomatous contrast of the parenchyma. The disordered intrahepatic angioarchitecture has clinical significance for hemodynamics and hepatic venous pressure measurement.

[A comparative study between postmortem venography and the pathological anatomy of the liver (author's transl)]. / Vergleichende Studie zwischen postmortaler Venographie und pathologischer Anatomie der Leber.

A barium sulphate-gelatine mixture was injected into the veins in the left lobe of 50 human livers which were then x-rayed. The radiographs were compared with the pathological and anatomical findings and enlargements were studied and compared with the histology. A correlation was found between the venogram and the macroscopic and microscopic changes, particularly in various forms of cirrhosis of the liver. The scope and limitations of hepatic venography were studied with respect to solitary and diffuse liver metastase.