Impact of total marrow/lymphoid irradiation dose to the intestine on graft-versus-host disease in allogeneic hematopoietic stem cell transplantation for hematologic malignancies.

Background and purpose: Graft-versus-host disease (GvHD) is a leading cause of non-relapse mortality in patients undergoing allogeneic hematopoietic stem cell transplantation. The Perugia Bone Marrow Transplantation Unit designed a new conditioning regimen with total marrow/lymphoid irradiation (TMLI) and adaptive immunotherapy. The present study investigated the impact of radiotherapy (RT) doses on the intestine on the incidence of acute GvHD (aGvHD) in transplant recipients, analyzing the main dosimetric parameters. Materials and methods: Between August 2015 and April 2021, 50 patients with hematologic malignancies were enrolled. All patients underwent conditioning with TMLI. Dosimetric parameters (for the whole intestine and its segments) were assessed as risk factors for aGvHD. The RT dose that was received by each intestinal area with aGvHD was extrapolated from the treatment plan for each patient. Doses were compared with those of the whole intestine minus the affected area. Results: Eighteen patients (36%) developed grade ≥2 aGvHD (G2 in 5, G3 in 11, and G4 in 2). Median time to onset was 41 days (range 23-69 days). The skin was involved in 11 patients, the intestine in 16, and the liver in 5. In all 50 TMLI patients, the mean dose to the whole intestine was 7.1 Gy (range 5.07-10.92 Gy). No patient developed chronic GvHD (cGvHD). No dosimetric variable emerged as a significant risk factor for aGvHD. No dosimetric parameter of the intestinal areas with aGvHD was associated with the disease. Conclusion: In our clinical setting and data sample, we have found no clear evidence that current TMLI dosages to the intestine were linked to the development of aGvHD. However, due to some study limitations, this investigation should be considered as a preliminary assessment. Findings need to be confirmed in a larger cohort and in preclinical models.

Chronic use of Datura stramonium cigarettes and late diagnosis of bullous emphysema in a smoker of marijuana and tobacco.

Unconventional inhaled therapy as a treatment for respiratory diseases became very common during the 19th century. Here, we present the case of a 52-year-old patient who smoked Datura stramonium cigarettes, tobacco cigarettes, and cannabis, with only an early diagnosis of asthma. The patient was admitted to our hospital with acute respiratory syndrome, characterized by worsening dyspnea, cough, and an acute episode of dyspnea and chest tightness. The combined chronic use of both D. stramonium cigarettes and cannabis masks the progression of chronic obstructive lung damage due to tobacco cigarette smoking because of the lack of clinical signs and symptoms.

Pulmonary interstitial emphysema and complications: incidence and CT findings in COVID-19.

Background and Objectives: There are scant data available in the published literature providing chest computed tomography (CT) findings on pulmonary interstitial emphysema (PIE), complications and associated parenchymal abnormalities. We report the incidence of PIE and complications by chest CT in patients with COVID-19. Methods: We retrospective analyzed 897 chest CT scans performed with 64-slice CT scanners during the COVID-19 pandemic period from March 2020 to September 2021. Two radiologists and two physicians in training in diagnostic radiology, independently and in consensus, assessed PIE as air within the perilobular (low-attenuation area) and perivascular interstitium such as its complications, parenchymal anomalies and pleural effusion; in addition, the complications of PIE, parenchymal anomalies and pleural effusion were evaluated. Descriptive statistics were used to summarize the data, and the results were expressed as counts and percentages. Results: PIE was revealed in 25 out of 897 patients (2.8%) and associated with pneumomediastinum, subcutaneous emphysema, and pneumothorax in 25 (100%), 16 (64%), and 7 (28%), patients, respectively. Out of 25 patients, 24 patients had ground-glass opacity (GGO), 23 patients had crazy paving, 22 patients had consolidation and 2 patients had pleural effusion. Eighteen out of 25 patients had noninvasive ventilation before CT scan, initially treated with continuous positive airway pressure (positive end expiratory pressure [PEEP] of 10 cmH2O) and subsequently with bilevel positive airway pressure (range PEEP of 8-12 cmH2O). The remaining seven patients had invasive mechanical ventilation via orotracheal intubation (pressure plateau at approximately 25 cmH2O). Six out of 25 (24%) patients died. Conclusion: Chest CT allows the detection of complications associated with PIE and parenchyma abnormalities. The timely detection of PIE and minimal pneumomediastinum could aid the optimization of ventilation modalities and parameters based on patients clinical status therefore potentially reducing complications.

Encrusted cystitis after definitive radiotherapy for cervical cancer: a case report.

PURPOSE: Encrusted cystitis is a rare chronic inflammatory disease characterized by calcified plaques of the bladder, previously altered by varies conditions as urological procedures, caused by urea-splitting bacteria. Only one case has been reported on encrusted cystitis occurring after surgery and radiation therapy for a pelvic neoplasm. We report on encrusted cystitis occurred after definitive radiotherapy for bulky uterine cervix cancer, and examine the doses to the bladder wall and the procedure of radiation treatment performed as a possible cause of the onset of the disease. CASE PRESENTATION: A 52-year-old female developed encrusted cystitis, caused by Corynebacterium spp., after 14 months from definitive chemo-radiotherapy and 2/D brachytherapy treatment for FIGO stage IB2 uterine cervix cancer. For pelvic radiotherapy, the mean bladder dose was 48.47 Gy (range 31.20-51.91); maximal bladder point doses at each brachytherapy insertions were 7.62 Gy, 4.94 Gy and 6.27 Gy at first, second, and third fraction, respectively. Total biological effective dose (BED) at bladder point was 140.05 Gy3. The patient was administered antibiotic therapy with linezolid and urine acidification with vitamin C; dietary norms were also suggested. After therapy, complete remission of symptoms and radiological findings were achieved, and the planned surgery for removing the calcified plaques was not completed. After 5 years from the cervical cancer diagnosis, the patient was disease-free without urinary symptoms. CONCLUSIONS: The high doses administered to the bladder wall and the repeated catheterizations performed at each brachytherapy insertions may have favored the infection and promoted the occurrence of the encrusted cystitis.