Livedoid vasculopathy: fast involution after anticoagulant and hyperbaric oxygen therapy.

The livedoid vasculopathy is a rare condition characterized by the presence of recurrent painful ulcers in distal extremities of lower limbs. Histologically there is thickness of dermal vessels, occlusion of its light by fibrin thrombi associated with minimal inflammatory infiltrate. It might occur as an isolated condition or be associated with an underlying systemic disease, including coagulation and collagen disorders, or neoplasms. Because it is a rare disease there is no consensus for its treatment. We report a case of a 41-year-old man with painful ulcers in the lower extremities. We did not find any associated diseases. The lesions improved dramatically after treatment with anticoagulant and hyperbaric therapy. We concluded that anticoagulation associated with hyperbaric oxygenation may be benefit for the treatment of patients with livedoid vasculopathy. However, further studies should be done with a larger population to confirm our results.

Autologous stem-cell transplantation for multiple myeloma: a Brazilian institution experience in 15 years of follow-up.

OBJECTIVE: To determine the 5-year post-transplant survival of patients with multiple myeloma. METHODS: A retrospective study in patients diagnosed with multiple myeloma submitted to autologous bone marrow transplantation at a Brazilian institution, during the period of 1993 to 2007. RESULTS: Seventy-three patients were evaluated with a median age of 55 years. Survival in 5 years was 75% (2.4 to 60 months). Statistical analysis demonstrated statistical significance for the applied grade of response prior to treatment with autologous bone marrow transplantation (p = 0.01). There was no statistical significance for clinical staging or time of diagnosis (before or after the year 2000). CONCLUSION: Experience in autologous bone marrow transplantation for multiple myeloma at a Brazilian institution demonstrated an evolution consistent with that of medical literature and highlighted the importance of a response to treatment prior to transplantation in the survival of these patients.

Vasculopatia livedoide: rápida involução com câmara hiperbárica e terapia anticoagulante / Livedoid vasculopathy: fast involution after anticoagulant therapy and hiperbaric oxigen therapy

The livedoid vasculopathy is a rare condition characterized by the resence of recurrent painful ulcers in distal extremities of lower limbs. Histologically there is thickness of dermal vessels, occlusion of its light by fibrin thrombi associated with minimal inflammatory infiltrate. It might occur as an isolated condition or be associated with an underlying systemic disease, including coagulation and collagen disorders, or neoplasms. Because it is a rare disease there is no consensus for its treatment. We report a case of a 41-year-old man with painful ulcers in the lower extremities. We did not find any associated diseases. The lesions improved dramatically after treatment with anticoagulant and hyperbaric therapy. We concluded that anticoagulation associated with hyperbaric oxygenation may be benefit for the treatment of patients with livedoid vasculopathy. However, further studies should be done with a larger population to confirm our results.

A vasculopatia livedoide é uma doença que se caracteriza pela presença de úlceras dolorosas recorrentes localizadas nas extremidades distais dos membros inferiores. Histologicamente, apresenta-se com espessamento dos vasos da derme, oclusão de sua luz por trombos de fibrina, associados a um mínimo infiltrado inflamatório. Pode se apresentar isoladamente ou em associação a trombofilias, desordens do colágeno ou doenças neoplásicas. Por ser uma entidade rara, não há consenso sobre seu tratamento. Relatamos o caso de um paciente de 41 anos, do sexo masculino, com úlceras dolorosas de membros inferiores. Nenhum fator associado foi encontrado. Houve dramática regressão do quadro após instituição de terapia anticoagulante concomitante à aplicação de sessões de câmara hiperbárica. Concluímos que a terapia anticoagulante associada a sessões de câmara hiperbárica parece ser benéfica na vasculopatia livedoide; entretanto, sua aplicação em maior número de pacientes faz-se necessária para confirmarmos nossos resultados.

Transplante autólogo em mieloma múltiplo: experiência de um serviço brasileiro em 15 anos de seguimento / Autologous stem-cell transplantation for multiple myeloma: a Brazilian institution experience in 15 years of follow up

Objective: To determine the 5-year post-transplant survival of patients with multiple myeloma. Methods: A retrospective study in patients diagnosed with multiple myeloma submitted to autologous bone marrow transplantation at a Brazilian institution, during the period of 1993 to 2007. Results: Seventy-three patients were evaluated with a median age of 55 years. Survival in 5 years was 75% (2.4 to 60 months). Statistical analysis demonstrated statistical significance for the applied grade of response prior to treatment with autologous bone marrow transplantation (p = 0.01). There was no statistical significance for clinical staging or time of diagnosis (before or after the year 2000). Conclusion: Experience in autologous bone marrow transplantation for multiple myeloma at a Brazilian institution demonstrated an evolution consistent with that of medical literature and highlighted the importance of a response to treatment prior to transplantation in the survival of these patients.

Objetivo: Determinar a sobrevida de pacientes portadores de mieloma múltiplo em 5 anos pós-transplante. Métodos: Estudo retrospectivo em pacientes com diagnóstico de mieloma múltiplo submetidos a transplante autólogo de medula óssea em umainstituição brasileira, no período de 1993 a 2007 . Resultados: Foram avaliados 73 pacientes com mediana de idade de 55 anos. A sobrevida encontrada em 5 anos foi de 75% (2,4 a 60 meses). A análise estatística demonstrou significância estatística para o grau de resposta ao tratamento aplicado previamente ao transplante autólogo de medula óssea (p = 0,01). Não houve significância estatística para o estadiamento clínico ou período de diagnóstico (antes ou após o ano 2000). Conclusão: A experiência na realização de transplante autólogo de medula para mileoma múltiplo, em uma instituição brasileira, demonstrou uma evolução concordante com a literatura médica e destacou a importância da resposta prévia ao transplante na sobrevida desses pacientes.

Hepatic plasmacytosis as a manifestation of relapse in multiple myeloma treated with thalidomide.

Thalidomide and its analogs have been extensively studied in patients with multiple myeloma. We present the case of a 58-year-old female patient with immunoglobulin GA-kappa multiple myeloma who was receiving thalidomide after failing an autologous transplant. She presented with profound asthenia and several space-occupying hepatic lesions, one of which was shown by a CT-guided percutaneous biopsy to be plasmacytoma. The patient then received bortezomib and had a transient response. Because thalidomide may also increase the expression of cytoadhesion molecules in myeloma cells and in the bone marrow microenvironment, it is possible that some patients with multiple myeloma who relapse on thalidomide may present with extramedullary plasmacytomas, as seen in this case. Therefore, whenever symptoms arise in patients with multiple myeloma who are receiving thalidomide, extramedullary plasmacytomas should be considered.