Relapse of TEL-AML1--positive acute lymphoblastic leukemia in childhood: a matched-pair analysis.

PURPOSE: The aim of this study was to investigate whether, in relapsed childhood acute lymphoblastic leukemia (ALL), the frequent genetic feature of TEL-AML1 fusion resulting from the cryptic chromosomal translocation t(12;21)(p13;q22) is an independent risk factor. PATIENTS AND METHODS: A matched-pair analysis was performed within a homogeneous group of children with first relapse of BCR-ABL-negative B-cell precursor (BPC) ALL treated according to relapse trials ALL-Rezidiv (REZ) of the Berlin-Frankfurt-Münster Study Group. A total of 249 patients were eligible for this study: 53 (21%) were positive for TEL-AML1, and 196 (79%) were negative. Positive patients were matched for established most-significant prognostic determinants at relapse, time point, and site of relapse, as well as age and peripheral blast cell count at relapse. RESULTS: Fifty pairs matching the aforementioned criteria could be determined. The probabilities with SE of event-free survival and survival at 5 years for matched TEL-AML1 positives and negatives are 0.63 +/- 0.10 versus 0.38 +/- 0.10 (P =.09) and 0.82 +/- 0.09 versus 0.42 +/- 0.19 (P =.10), respectively. These results were confirmed by multivariate analysis, revealing an independent prognostic significance of time point and site of relapse (both P <.001) but not of TEL-AML1 expression (P =.09). CONCLUSION: TEL-AML1 expression does not constitute an independent risk factor in relapsed childhood BCP-ALL after matching for relevant prognostic parameters. It undoubtedly characterizes genetically an ALL entity associated with established favorable prognostic parameters. High-risk therapeutic procedures such as allogeneic SCT should be considered restrictively.

[Ligament repair with PDS (polydioxanone) in chronic insufficiency of the fibular ligament of the upper ankle joint: experimental and clinical experiences]. / Die Bandplastik mit PDS (Polydioxanon) bei der chronischen fibularen Bandinsuffizienz am oberen Sprunggelenk: Experimentelle und klinische Erfahrungen.

From September 1988 till February 1989, 14 patients with chronic ligamentous rupture of the ankle had been operated on using PDS-plasty. Of 12 patients checked in follow-up examination (mean postoperative period 45 weeks), only two showed good or very good results. Most patients had the same signs of chronic instability as preoperatively. Two patients had been reoperated on. Intraoperatively we did not find a biological substitute along the PDS guide line. In an experiment on the rat we examined histological changes and tensile strength at appointed times. Histological data showed no biological substitute of PDS. We also found residues of PDS even after 300 days. After a short time loss of tensile strength occurred. In view of an aseptical necrosis that occurred in our experiments, we must point out the risk of foreign body granulomas.

[Use of gentamicin chains in infected osteosyntheses of long tubular bones]. / Die Anwendung von Gentamicinketten bei infizierten Osteosynthesen der langen Röhrenknochen.

Early and late infections are severe complications after osteosynthesis in closed fractures. Using gentamicin chains is an effective form of local treatment in these cases. The indications for the application and different surgical procedures are described and the authors experiences are given.

[Surgical therapy of medial femoral neck fracture]. / Die operative Therapie der medialen Schenkelhalsfraktur.

During 1986 to 1988 64 patients with the diagnosis acute medial hip fracture have been operated in the University Hospital (Charité) by hip endoprosthesis. Patients up to the age of 75 years have been treated by total hip endoprosthesis. Patients older than 75 years got a femoral head prosthesis. In 92.3% of the patients with femoral head prosthesis no complications were observed. In our hospital we prefer the implantation of the femoral head prosthesis in patients older than 75 years.

[Functional conservative treatment of humerus shaft fracture with the plaster brace]. / Die funktionell-konservative Behandlung der Oberarmschaftfraktur mit dem Gips-Brace.

The functional-conservative treatment of fractures of the humerus shaft is the most efficient method today. It is an uncomplicated and reliable method for outpatient therapy. In our opinion only second degree open fractures and vessel injuries are a contraindication. A few guidelines taken into consideration enable everybody to learn the handling of plaster brace in a short time period. All fractures we treated in this way showed an osseous fracture healing.

[Operative and conservative treatment of fractures of the femur (author's transl)]. / Erfahrungen mid der operativen und konservativen Behandlung der Oberschenkelschaftfrakturen.

82 cases with fractures of the thigh bone were seen at the Surgical Department of the Charité Hospital in Berlin. 5 selected cases were chosen to demonstrate problems of treating these fractures in a different way. Surgical and conservative treatment are no longer adverse. Whereas in compound fractures surgery is the exception, it is the method of choice in fractures of the shaft by intramedullary nailing. Plate-osteosynthesis is only performed in cases which cannot be stabilized by intramedullary nailing. Additional injuries, such as those of skull and brain especially, will complicate surgery in a way, which until now has not been completely elucidated.

[Initial experiences with ambulatory ligament suture of the fresh ligament rupture of the upper ankle joint using local anesthesia]. / Erste Erfahrungen mit der ambulanten Bandnaht der frischen lateralen Bandruptur am oberen Sprunggelenk in Lokalanästhesie.

Reported in this paper is preliminary experience obtained from outpatient suturing in local anaesthesia of recent rupture of fibular ligaments. An indication of this kind is valid for all cases of established rupture of ligaments, with due consideration to be given to individual factors. The method is extensively described. Preliminary short-time results so far recorded from 18 outpatient cases of ligament suturing in local anaesthesia appear to underscore this therapeutic approach as optional in acute situations. Reference is made to early functional therapy to avoid immobilisation damage, and a therapeutic concept is proposed.

[Treatment possibilities of proximal femoral and femoral neck fractures--a concept for selection of procedure]. / Behandlungsmöglichkeiten bei proximalen Femur- und Femurhalsfrakturen--ein Konzept zur Auswahl des Verfahrens.

The authors treated 115 fractures of the proximal part of the femur and its neck. Most of these fractures were treated surgically. Indications, surgical technique, complications and results are dealt with. Guidelines for adequate treatment of each fracture type are established.

[Follow-up results of ligament replacement by PDS in chronic lateral ligament instability of the upper ankle joint]. / Nachuntersuchungsergebnisse der Bandplastik mit PDS bei der chronischen fibularen Bandinsuffizienz des oberen Sprunggelenks.

From September 1988 till February 1989 we have operated on 14 PDS-ligament replacements of the ankle in patients with chronic lateral instability. Only one patient had an excellent clinical result with a stable ankle. Ten of twelve patients had poor results at follow-up. 2 patients had been reoperated on. We did not find biological substitute along the PDS guide line. This suggested the opinion, the PDS-ligament replacement of the ankle can't realize the expectations.

[Supination and inversion trauma of the ankle joint--experimental study of the value of arthrography]. / Das Supinations-Inversions-Trauma am Sprunggelenk--experimentelle Studie zur Aussagefähigkeit der Arthrographie.

Arthrographic results obtained from the upper ankle bone are presented on the basis of anatomic specimens. They are considered as providing experimental evidence to practice related criteria for assessment of arthrography.

[Tibial shaft fracture. Forms of therapy and their complications]. / Die Unterschenkelschaftfraktur. Therapieformen und deren Komplikationen.

The rate of complications in treatment of lower leg fractures has continued to be high, which calls for critical appraisal of possible therapeutic approaches. The effectiveness of both conservative and surgical treatment has been shown by a prospective study which covers a period from 1984 to 1988. An analysis of 166 cases proved helpful in providing guidelines for therapy of closed and open lower leg fractures. Conditions and prerequisites are expounded for the use of various surgical techniques, and hints are given on how to reduce complications.

[Fractures of the extremities with open soft tissue injury. Complications and treatment concept]. / Extremitätenfrakturen mit offener Weichteilverletzung. Komplikationen und Behandlungskonzept.

In the history and also in the present time the open fractures of the extremities have a high rate of complications after the operative treatment. In our extract we will point the problems in this treatment. Also we want to show the effective ways to sink the complications. We describe the differences in the treatment of the open and closed fractures. With regard of the methods the osteosynthesis, the technique of the operative treatment and the after treatment of open fractures of the extremities we give directions for the universal and special treatment.

[Complications of the treatment of leg fractures]. / Komplikationen bei der Behandlung von Unterschenkelfrakturen.

From 1976 to 1980 168 patients suffering from closed (n = 148) and open (n = 20) fractures of the lower leg were treated. Complications following operative (5.0%) as well as conservative (2.67%) treatment are mostly caused by early and late infections.

Low grade malignant non-Hodgkin's lymphomas and peripheral pleomorphic T-cell lymphomas in childhood--a BFM study group report.

Non-Hodgkin's lymphomas (NHL) are classified as low or high grade malignant lymphomas of either B or T cell origin. Cells of low grade malignant NHL (LG-NHL) of B cell type represent either follicular or postfollicular, cells of LG-NHL of T cell type postthymic maturation stages in the lymphoid differentiation pathway. LG-NHL often fail to undergo long-term complete remission or cure in adults, no matter what type of conventional therapy is applied. In three pediatric therapy studies frequency and probability of continuous complete remission (pCCR) were studied for LG-NHL and peripheral pleomorphic T-cell lymphomas (PTCL). Of 432 evaluated patients only six children (1.4%) were qualified as LG-NHL. LG-NHL of T cell type were diagnosed in three children (one T-zone lymphoma, two PTCL of small cell type), LG-NHL of B cell type in another three cases. Two children presented with nodular type of centroblastic/centrocytic lymphoma (CB/CC), one with lymphoplasmocytoid type of immunocytoma (IC). In addition to the two patients with low grade malignant PTCL, there have been also four children with high grade malignant PTCL. The analysis showed that there was not significant difference for event free survival of children with LG-NHL and HG-NHL, respectively (pCCR: 0.63 and 0.82, p = 0.29). In contrast, when comparing high and low grade PTCL versus all other types of childhood NHL (non-PTCL), a significant difference seems to exist (pCCR for PTCL: 0.44, for non-PTCL: 0.83; p = 0.02). However, for further concisive conclusions more patients are needed for evaluation.

Alterations in function and phenotype of monocytes from patients with septic disease--predictive value and new therapeutic strategies.

Recently we described the predictive value of the proportion of HLA-DR+ peripheral blood monocytes for the clinical outcome of septic disease in immunosuppressed patients (allograft recipients) and surgical patients mostly with peritonitis as septic focus (following perforation of gastrointestinal tract). The experiments described here show that the loss of HLA-class II antigen expression and other phenotypical abnormalities of monocytes from septic patients with fatal outcome are associated with functional defects (antigen presentation, formation of reactive oxygen species, cytokine secretion). The picture of phenotypical and functional defects of monocytes was termed "immunoparalysis" (leading parameter: loss of HLA-DR antigen expression less than 20%). Interferon-gamma as well as GM-CSF normalized in vitro the surface antigen expression on monocytes derived from septic patients with "immunoparalysis". However, sera from patients with "immunoparalysis" prevented the cytokine-mediated effects on HLA-DR antigen expression. The inhibitory activity in septic sera was not dialysable. In order to remove such factors we started a plasmapheresis study in septic patients selected for "immunoparalysis". The preliminary data of this clinical trial suggest an improved survival rate.