Mild pre-transplant cardiomyopathy may not impair long-term quality of life after bone marrow transplantation.

An 8-year-old child with acute myeloid leukemia (AML), underwent an allogeneic bone marrow transplant (BMT) from his HLA matched sister in spite of having a mild cardiomyopathy. We followed the patient with periodic electrocardiograms (ECG) and echocardiograms which have not worsened, and the patient's quality of life is not compromised 14 years after BMT. Bone Marrow Transplantation (2000) 25, 335-336.

[Extent of endemic Chlamydia trachomatis in the metropolitan area of Buenos Aires (Argentina)]. / Dimensión de la endemia por Chlamydia trachomatis en el área de la ciudad de Buenos Aires (Argentina).

BACKGROUND: In this report we inform laboratory results accumulated over ten years (1986-1995). The number of cases, and the geographic distribution, allow us to present a very reliable data about the dimension of Chlamydia trachomatis urogenital infections in Buenos Aires city and we also compare this profile with the prevalence of Neisseria gonorrhoeae in the same area and period of time. METHODS: Patients were females and males (aged from 15 to 49 years old) attending clinics not specialize in Sexually Transmitted Diseases (STD). Intent to isolation of C. trachomatis was done in McCoy cells culture. Patients for Neisseria gonorrhoeae investigation were a population assisted at the Clinic for STD of an University Hospital (aged from 15 to 75 years old). Study for detection of N. gonorrhoeae was developed by direct and conventional culture technics. RESULTS: 4128 endocervical samples from women with lower genital tract pathology were studied and C. trachomatis infection was detected in 25.6 +/- 4.8%. Over 1206 male urethral samples 29.5 +/- 4.47% shows positive cultures. Except for years 1989 and 1990 in which annual percentage of infected women showed slightly higher percentage over the global average, the results shows a very stable annual values, as it was also found in male patients. Infection in males shows a discrete tendency to be higher compare with values obtained in women. Global results of the evolution of prevalence of N. gonorrhoeae infection shows a very different pattern. Since 1992 we demonstrate a very significant decrease in the number of confirmed cases. CONCLUSIONS: We concluded that patients not attending a STD clinic, reveal a high and very stable endemic level of C. trachomatis lower tract urogenital infections. N. gonorrhoeae in this population is a very sporadic or null finding. Prevalence of Chlamydial infection in STD centers is even higher and also shows an stable profile. In people attending STD clinics N. gonorrhoeae shows a very different kinetics, with an important decrease in prevalence in the last five years.

Cardiac and respiratory function after bone marrow transplantation in children with leukaemia.

Late cardiac and respiratory function changes were evaluated in children surviving disease-free more than 2 years after bone marrow transplantation (BMT) performed for haematological malignancies. Forty-one children received allogeneic and 10 autologous BMT. In all cases studied shortening fraction (SF) was always within normal limits from before BMT up to 4 years after BMT. SF, though still normal, was slightly lower in the group with higher pre-BMT cumulative anthracycline dose. Twenty-eight children underwent respiratory function tests regularly at all scheduled times (pre-BMT, +6 months, +1, +2, +3, +4 years after BMT). Vital capacity and total lung capacity showed a slight continuous decrease which was significant at 4 years after BMT (P = 0.015 and P = 0.003 respectively). The decline of forced expiratory volume in 1 s observed 1 year after BMT (P = 0.002) was roughly maintained over time. However, no children complained of symptoms attributable to respiratory dysfunction, and all indices studied were always within normal limits in almost all patients. So far late cardiac and lung changes following BMT in children seem to be negligible. However, whether such abnormalities could further worsen and impair adult quality of life remains to be ascertained.

Normalization of idiopathic arterial hypertension following cancer immunotherapy with interleukin-2.

It is known that IL-2 cancer immunotherapy is associated with hypotension. The present study was performed to evaluate the influence of low-dose IL-2 subcutaneous therapy on blood pressure in cancer patients with idiopathic hypertension requiring hypotensive therapy. The study included 12 patients, who received IL-2 at 6 million IU/day for at least 4 weeks. Mean values of both systolic and diastolic pressure significantly decreased under IL-2 therapy, and the hypotensive agents were interrupted within 2 weeks in 10/12 patients. Moreover, 6 of them still showed normal blood pressure values without hypotensive therapy after a median follow-up of 6 months. This preliminary study would suggest that low-dose IL-2 subcutaneous therapy may normalize blood pressure values in cancer patients with idiopathic hypertension.

Prevention by L-carnitine of interleukin-2 related cardiac toxicity during cancer immunotherapy.

AIMS AND BACKGROUND: Cardiac toxicity has been observed during IL-2 cancer immunotherapy. Because of its trophic action on the myocardial tissue, the use of L-carnitine has been evaluated during IL-2 therapy in advanced cancer patients with clinically important cardiac diseases. METHODS: The study included 30 cancer patients, who were randomized to treatment with IL-2 alone or IL-2 plus L-carnitine (1000 mg/day orally). IL-2 was injected subcutaneously at a daily dose of 6 million IU for 5 days/week for 4-6 weeks. RESULTS: The percentage of cardiac complications was significantly lower in patients concomitantly treated with L-carnitine than those receiving IL-2 alone (0/15 vs 4/15; P < 0.05), whereas no difference was seen in mean creatine phosphokinase levels on study. CONCLUSIONS: The results would suggest that L-carnitine may be used successfully to prevent cardiac complications during IL-2 immunotherapy in cancer patients with clinically relevant cardiac disorders. Since cardiac metabolism depends mainly on fatty acid oxidation, the stimulatory role of L-carnitine on fatty acid oxidation could explain at least in part its ability to prevent heart disturbances in response to IL-2 administration.

Melatonin response to atrial natriuretic peptide administration in healthy volunteers.

Recent observations have demonstrated that the pineal hormone melatonin (MLT) plays a role in the neuroendocrine control of the cardiovascular system. On the other hand, it has been observed that the cardiac hormone alpha-atrial natriuretic peptide (ANP) may regulate the neuroendocrine functions. The present study was carried out to investigate the possible relationship between cardiac and pineal endocrine functions. Six healthy volunteers were treated on two different occasions with placebo or ANP at a dose of 0.1 mg i.v. as a bolus. An increase of greater than 100% in MLT serum levels was seen in 2/6 subjects. These preliminary results would suggest that ANP may play a role in the regulation of MLT secretion. Further studies will be needed to define better the cardiac-pineal interactions.

Epirubicin in Childhood Acute Lymphoblastic and Myeloid Leukemia in Relapse.

Nineteen children with acute lymphoblastic leukemia (ALL) and 11 with acute non-lymphoblastic leukemia (ANLL) in first or subsequent hematological relapse, and previously exposed to high doses of anthracyclines, were treated with Epirubicin. Eleven patients (7 ANLL and 4 ALL) were treated with Epirubicin as a single drug at the dose of 30 mg/m(2)/day for 3 days a week for 1-3 weeks. 5/7 with ANLL and 0/4 with ALL achieved complete remission (C.R.). Nineteen patients (15 ALL and 4 ANLL) were treated with Epirubicin in combination with Vincristine and Prednisone or Cytosine-arabinoside, Cyclophosphamide and VP-16. 14/15 with ALL and 3/4 with ANLL achieved C.R. One patient previously treated with 750 mg/m(2) of daunornycin developed congestive heart failure (CHF) with a decrease in the cardiac ejection fraction at 11% after receiving 270 mg/m(2) of Epirubicin. No other patients developed CHF. These data are in keeping with the reports in the literature which suggest that Epirubicin is less cardiotoxic than Doxorubicin, while retaining a similar clinical activity.

[Early daunorubicin cardiotoxicity and fatal outcome in a child with acute myeloblastic leukemia (M2)]. / Precoce cardiotossicità da daunorubicina ad esito fatale in un bambino affetto da leucemia mieloblastica acuta (M2).

The authors report a case of fatal Daunorubicin cardiotoxicity on initial phase of therapy for Acute Myeloblastic Leukemia at cumulative doses (225 mg/mq) considered still safe from the current literature. Despite the interruption of therapy and the interventions performed in support of cardiac functionality the patient came to exitus for heart failure 24 hours after the symptoms onset. This example represents a further confirmation of the utility of a steady monitoring with specific tests for the patients undergoing Daunorubicin therapy.

Cardiac relapses in myeloid leukemia: case report and review of the literature.

Granulocytic sarcoma (GS) is a localized destructive tumor mass composed of immature cells of the granulocytic series, occurring before, concomitantly, or after the overt development of acute or chronic myelogenous leukemia. Although this tumor is known to occur in almost every site of the body, cardiac involvement is rare. We report a case of a 12-year-old female previously treated for 28 months with chemotherapy for acute promyelocytic leukemia, who presented with GS in the left mastoid 3 months after discontinuing treatment. The patient was treated with local radiotherapy only. Thirty months later she presented with heart failure, the result of a right-sided intracardiac mass, while in continuous hematological remission of the primary disease and off therapy. The cardiovascular, hematological, and postmortem findings are described and the literature is reviewed. This is the first clinicopathologic report of GS involving the heart in which the echocardiographic and pathologic findings are detailed.

[Post-infarction aneurysm of the left ventricle. Pre-operative parameters conditioning the surgical risk and remote results]. / Aneurisma post-infartuale del ventricolo sinistro. Parametri pre-operatori condizionanti il rischio chirurgico e i risultati a distanza.

83 patients who underwent resection of postinfarction aneurysms involving the anterior wall of the left ventricle were studied to identify possible determinants of operative outcome, long-term survival and long-term improvement. The indications for aneurysmectomy (either isolated or combined with direct revascularization) were congestive heart failure, angina or life-threatening arrhythmias; six patients were asymptomatic at the time of surgery. Operative mortality rate was 14.4% (11.5% for patients operated more than 60 days following myocardial infarction). The over-all survival rate, at a mean follow-up of 31.5 months (range 2 to 82 months), was 74.39%; 80.88% of patient discharged from hospital, exhibited clinical improvement. Mean values of ejection fraction and excess ejection fraction were significantly higher in the group of operative survivors (31.28 +/- 8.26% and 0.17 +/- 0.08 respectively) than those of surgical deaths (20.25 +/- 8.37% and 0.08 +/- 0.06) (p less than 0.005); the coronary score was significantly lower in the group of survivors (6.81 +/- 2.35 vs 8.33 +/- 2.29) (p less than 0.025). Presence of arrhythmias increased operative mortality (33.3% vs 11.2%, p = 0.05), as did a low cardiac output, impaired contraction of the postero-lateral wall and mitral regurgitation. Long-term survival and improvement were not related to anyone of preoperative parameters taken into consideration: however, a higher percentage of clinical improvement was observed when myocardial revascularization was associated to aneurysmectomy (85% vs. 67.7%).

[Effects of the association of Ca-antagonists with nitroderivatives or betablocking drugs in effort angina pectoris (author's transl)]. / Associazione dei farmaci calcio-inibenti con nitroderivato e beta-bloccante nell'angina pectoris da sforzo.

The effects of the association of calcium antagonists (CAI) with a nitroderivate and a betablocker were studied by means of exercise tests in 8 patients with stable effort angina pectoris. According the statistical model of a latin square 4 x 4, the first 4 patients were tested with the following treatments: placebo, oral; nifedipine (N) 10 mg, oral; N + isosorbide dinitrate (ISDN) 10 mg oral; N + propranolol (Pr) 40 mg, oral. In the second square verapamil 80 mg oral represented the CAI treatment. Compared to placebo, all the treatments produced a significant increase of exercise duration and total work performed before angina. In both the squares the improvement observed after CAI + ISDN was significantly higher than after administration of CAI alone. In both the squares the association of CAI + Pr determined a little, non significant improvement of exercise duration in respect to CAI alone. EKG positivity was delayed by Pr more than angina appearance: hpwever, also this effect was not significant when compared with administration of CAI alone. By the analysis of the changes of heart rate, maximal arterial pressure, ejection time and triple product at the same level of work, a relevant inhibition of myocardial contractility with the adopted doses of CAI can be excluded; the effect of these drugs seems to be due mainly to a decrease of arterial pressure, and, when associated to ISDN, to decreases of arterial pressure and ejection time.