[Spontaneous Consolidation of Exercise-Induced Bilateral Apophyseolysis of Lesser Trochanter in a Young Ice Hockey Player - Long-Term Follow-up by MRI]. / Spontánní konsolidace ponámahové bilaterální apofyzeolýzy trochanter minor femoris u mladého hokejisty ­ dlouhodobé sledování magnetickou rezonancí.

Exercise-induced bilateral apophyseolysis of lesser trochanter with enthesopathy of iliopsoas muscle is a less frequent cause of the groin pain syndrome in children and adolescents. In a 13-year-old boy, an active ice hockey player, spontaneous consolidation of exercise-induced bilateral apophyseolysis of lesser trochanter and regression of enthesopathy of iliopsoas muscle is documented by a long-term follow-up through MRI. The conservative treatment comprises targeted rehabilitation focusing on the hypertonic muscles, but of equal importance is also comprehensive rehabilitation focusing on correction of the posture and coordination of the muscle groups. It is also necessary to include compensatory exercise in the training plan. Key words: groin pain syndrome, children, apophyseolysis of lesser trochanter, enthesopathy of iliopsoas muscle.

High-dose therapy and autologous stem cell transplantation in patients with diffuse large B-cell lymphoma in first complete or partial remission.

Improved survival has been observed in poor-risk diffuse large B-cell lymphoma (DLBCL) patients treated with high-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) in first complete remission. Retrospective studies have suggested that HDT with ASCT can improve survival also in partial responders but some doubts about the advantage of intensive therapy in such patients still remain. We evaluated retrospectively the results of HDT and ASCT in 55 patients with confirmed DLBCL treated between May 1999 and July 2006. Thirty-six patients (65%) showed partial remission (PR) and 19 patients (35%) reached complete remission (CR) after induction treatment with (44%) or without (56%) concomitant rituximab (R) immunotherapy. After HDT and ASCT, 69% of patients fulfilled the criteria of CR, 22% had unconfirmed CR (CRu), 7% remained in PR and 1 patient (2%) relapsed. Twenty patients in PR after the induction treatment reached CR after ASCT, 12 other PR patients achieved CRu. The 5-year event-free survival (EFS) of the 55 transplanted patients was 76% (95% confidence interval /CI/, 63% to 89%) and the 5-year overall survival (OS) was 85% (95% CI, 73% to 97%). The EFS and OS rates differed significantly only between patients younger than 40 years and older groups (p=0.022 and p=0.046, respectively). On univariate analysis of prognostic factors, EFS and OS were not affected by any of the following: age, sex, stage, subtype of DLBCL, initial lactate dehydrogenase, beta-2-microglobulin and serum thymidine kinase levels, International Prognostic Index (IPI) and age-adjusted IPI scores, induction treatment with or without rituximab and type of primary therapeutic response (CR vs PR). These results show that first-line HDT and ASCT for adults up to the age of 65 years with poor-risk DLBCL is a feasible and effective treatment option even in the era of R-chemotherapy in CR as well as for patients in PR.

[Chemotherapy of BOVAPEC in the primary treatment of Hodgkin's lymphoma intermediate stages]. / Chemoterapie BOVAPEC v primární lécbe stredne pokrocilých stadií Hodgkinova lymfomu.

DESIGN: Chemotherapy of BOVAPEC is the modification of temporary intensified Stanford V protocol, an effective primary treatment of advanced Hodgkin's lymphoma (HL) in spite of limited toxicity. Nitrogen mustard was substituted by less myelotoxic cyclophosphamide and the protocol has been used in the treatment of patients with an intermediate stage of HL. METHODS: The primary treatment with BOVAPEC was started in 62 patients. Complete chemotherapy schedule was administered to 60 patients (97%) and the median of its overall duration was 13 (12-18) weeks. 31 patients (50 %) underwent adjuvant "involved field" radiotherapy (RT). The median of posttherapeutic follow-up was 37 (range 8-85) months. RESULTS: During the treatment, a neutropenia of grade 3 and 4 was observed in 14 patients (23%) but without the development of any serious infectious complications. The manifestation of early non-hematological toxicity did not overcome grade 2.58 patients (94%) achieved the complete remission of HL. A relapse was observed in 11 cases (19%) and estimated five years disease-free survival (DFS) is 72%. The combination of BOVAPEC and RT in primary treatment was associated with higher probability of five years DFS but actually without statistical significance (88% vs. 58%; p = 0.08). CONCLUSION: The BOVAPEC regimen with its acceptable toxicity may represent effective primary therapeutic approach to the patients with the intermediate stage of HL. Adjuvant RT is essential in all patients diagnosed with nodal bulk and/or residual lymphadenomegaly.