Allogeneic stem cell transplantation after fludarabine, melphalan and thymoglobulin followed by early withdrawal of prophylactic immunosuppression in patients with acute lymphoblastic leukemia - update of single center study.

Presented are updated results of allogeneic hematopoietic stem cell transplantations (HSCTs) in 25 adult patients with acute lymphoblastic leukemia (ALL) in complete remission (CR) after a reduced intensity conditioning (RIC) combining fludarabine (150 mg/m2) and melphalan (140 mg/m2) with thymoglobulin (4.5 mg/kg or recently 4.0 mg/kg) followed by early initiation of reduction and withdrawal of prophylactic posttransplant immunosuppression. The median post-transplant follow-up was 32 (range, 4-87) months. Stable engraftment of donor's hematopoiesis was achieved in all patients. Acute graft versus host disease (GVHD) as well as the chronic one were equally observed in four cases (16%). Five patients (20%) relapsed with ALL in the median of 9 (range, 3-15) months after HSCT. During the above post-transplant follow-up, 4 recipients (16%) died. Disease progression and posttransplant complications were the cause of death in three (12%) and one (4%) of them, respectively. The probabilities of 2-year event-free (EFS) and overall survival (OS) were 70.3% (95% CI 51.9-88.7%) and 86.1% (95% CI 71.6-100%), respectively. Presented study confirmed our previously reported promising results and this approach may be considered as an alternative to traditional HSCTs performed in high-risk patients with ALL.

Allogeneic stem cell transplantation after fludarabine, melphalan and thymoglobulin followed by early withdrawal of prophylactic immunosuppression could be an effective approach to patients with acute lymphoblastic leukemia.

Presented are results of allogeneic hematopoietic stem cell transplantations (HSCTs) in 13 patients with high-risk acute lymphoblastic leukemia (ALL) in the first complete remission after a reduced intensity conditioning combining fludarabine (150 mg/m2) and melphalan (140 mg/m2) with thymoglobulin (4.5 mg/kg). The immunosuppressive effect of T-cell depletion reducing the risk of graft-versus-host disease (GVHD) and non-relapse mortality was compensated by early initiation of reduction and withdrawal of prophylactic immunosuppression aimed at maintaining effective immunological antileukemic control. The median post-transplant follow-up was 23 (range, 10-65) months. Stable engraftment of donor's hematopoiesis was achieved in all patients. Acute GVHD was observed in two cases (15.4%); the chronic form was not noted. Two patients (15.4%) relapsed with ALL at 3 and 16 months after transplantation. During the above post-transplant follow-up, all 13 recipients were alive, with a probability of 2-year disease-free survival of 76.9% (95% CI 51-100%). Although the results were obtained with a small pilot study group it may be assumed that, given the prognostic risk of most patients and the nearly 2-year median post-transplant follow-up, the approach may be considered as an alternative to HSCTs after traditional myeloablative or reduced conditioning regimens with standard GVHD prophylaxis.

Acute promyelocytic leukemia successfully treated also in elderly patients with significant comorbidities: a 20-year single-center experienc.

UNLABELLED: Acute promyelocytic leukemia is a unique entity among acute leukemias. Introduction of all-trans retinoic acid and, subsequently, arsenic trioxide in its treatment has markedly improved treatment outcomes for this once frequently fatal disease. Improved outcomes have also been observed in elderly patients, including those in whom standard intensive therapy is contraindicated because of comorbidities.In our center, a total of 60 APL patients were treated in 1993-2013, of whom 9 were aged 60 or more years. Although most of them had significant comorbidities at the time of diagnosis, eight achieved complete remission. At the time of the analysis, six patients were alive and in long-term remission; two patients died of causes other than APL. The median follow-up was 59 months.Included is case report of a patient with a high comorbidity score whose treatment was markedly reduced and individualized.Our experience shows that, in APL patients a curative approach is generally tolerated and should always be attempted regardless of age and comorbidities. KEYWORDS: APL - elderly patients - comorbidity.

Region of interest tomography of bigger than detector samples.

For many neutron tomography setups, the maximum sample size for tomography is limited by a comparatively small beam cross section. However, it is not well known outside the medical field that it is possible to perform region-of-interest tomography of sections inside the object that fit into the beam and detector area. Approximately valid reconstruction data appear in a circle with a diameter of approximately the detector width, but with incomplete data and strong artifacts outside that circle. These artifacts can be removed either by mathematical means or by simple geometrical cutting of the reconstructed data, enabling the examination of samples bigger than the detector or beam area.

Development of a subject-standing-type cone-beam computed tomography for chest and orthopedic imaging.

A subject-standing-type cone-beam computed tomography (CT) with high spatial resolution has been developed as a new three-dimensional imaging modality for subjects standing or sitting naturally on a turntable. A 16-in. X-ray image intensifier and charge coupled device camera acquires a 12-bit 5122-pixel projection at 60 f/s and the rotation period is 4.8 or 9.6 s for 288 or 576 projections, respectively. To reduce image noise, the system controls the X-ray pulse duration and iris-opening area through real-time analysis of the projection image. To improve CT accuracy and eliminate artifacts, the veiling glare of the image intensifier and scattered X-rays are corrected. Human chest and orthopedic studies with about 50 patients were conducted. Three-dimensional images with a spherical field of view with a diameter of 21-25 cm, 0.4- to 0.5-mm voxels and a 512(3) matrix were obtained. In coronal, sagittal and volume rendering images, the surface of arthrosis was visualized smoothly with a resolution higher than that of conventional CT. In the case of gonarthrosis, narrowing of the clearance at the surface of arthrosis was visualized clearly under body-weight burdening, which would be difficult if the subject was lying down.

Inhibition of murine IgE and immediate cutaneous hypersensitivity responses to ovalbumin by the immunomodulatory agent leflunomide.

Leflunomide has been identified as an immunoregulatory and anti-inflammatory compound. Allergic disease is characterized by elevated serum IgE levels, production of allergen-specific IgE and the release of inflammatory mediators from mast cells and granulocytes. Here we demonstrate, using an in vivo murine model, the ability of leflunomide to down-regulate levels of total and allergen-specific serum IgE production. Mice receiving leflunomide (45 mg/kg) orally at the time of primary immunization with ovalbumin adsorbed to aluminium hydroxide adjuvant, showed a reduction in total serum IgE levels of 95%, 41% and 32% following primary, secondary and tertiary immunizations, respectively (P < 0.05). When leflunomide was administered both at the time of primary and subsequent immunizations, reductions in total and specific serum IgE levels of > 80% and > 38%, respectively, were observed (P < 0.05). Administration of leflunomide to mice which had already developed an IgE response resulted in reductions in total and specific serum IgE levels of > 80% and > 45%, respectively (P < 0.05). Following leflunomide treatment, animals failed to develop immediate cutaneous hypersensitivity responses when challenged intradermally with allergen. Down-regulation of immunoglobulin production was not restricted to IgE, since levels of allergen-specific IgG1 and IgG2a in serum were also reduced. The finding of significant reductions in total and allergen-specific IgM suggests that the mechanism of action does not involve selective inhibition of immunoglobulin class switching. A loss in production of the T helper cell-derived B cell differentiation factor IL-5 may account for the reduction in immunoglobulin levels. In adoptive transfer experiments leflunomide did not induce tolerance in allergen-reactive Th2 populations, contrary to animal disease models of transplantation and autoimmunity, where leflunomide was shown to induce tolerance in the effector T cell population.

A comparison of lossless compression methods for medical images.

In this work, lossless grayscale image compression methods are compared on a medical image database. The database contains 10 different types of images with bit rates varying from 8 to 16 bits per pixel. The total number of test images was about 3000, originating from 125 different patient studies. Methods used for compressing the images include seven methods designed for grayscale images and 18 ordinary general-purpose compression programs. Furthermore, four compressed image file formats were used. The results show that the compression ratios strongly depend on the type of the image. The best methods turned out to be TMW, CALIC and JPEG-LS. The analysis step in TMW is very time-consuming. CALIC gives high compression ratios in a reasonable time, whereas JPEG-LS is nearly as effective and very fast.

Can dynamic krypton-81m imaging separate regional ventilation and volume?

This study explores the assumption that 81mKr static images represent regional ventilation. Dynamic acquisition of 81mKr ventilation images permits creation of time-activity curves and the possible separation of the confounding influences of ventilation and volume. By using a two-compartment gas mixing lung phantom, the results demonstrate that both total and tidal 81mKr are closely related to regional ventilation. In 61 children and 15 adult volunteers, there was good agreement between fractional ventilation assessed by total and tidal 81mKr. The dynamic steady-state ventilation image can be analyzed to separate tidally exchanged and resident 81mKr. This may allow regional ventilation to be distinguished from regional volume.

Three-dimensional presentation of the Fourier amplitude and phase: a fast display method for gated cardiac blood-pool SPECT.

The routine clinical use of gated SPECT is inhibited by sophisticated, time-consuming processing techniques. The present paper describes a new technique for the simultaneous three-dimensional presentation of the amplitude and phase of the first Fourier harmonics, with the aim of obtaining detailed information about the ventricular motion in a relatively short time, from each angle of view of three-dimensional space. The method is simple and robust, and processing is automatic. It does not need carefully elaborated techniques for surface determination, because the cardiac surface is merely used as a reference skeleton onto which the functional information of amplitude and phase is mapped. The Fourier analysis before reconstruction results in running times shorter than 15 min and may further open the way for the routine use of gated SPECT.

The effect of milk on ipecac-induced emesis.

A prospective study at two regional poison centers was undertaken in 500 children under six years of age (mean age 2.3 y) to resolve the question of whether milk has an effect on ipecac-induced emesis. When home administration of ipecac was recommended, parents were asked to select either milk or clear fluids. The mean volume of fluid +/- standard deviation administered was 159 +/- 72 mL in the milk group and 161 +/- 77 mL in the clear fluid group (p = 0.79). There was no difference in the onset of vomiting (23.4 +/- 18.5 vs. 23.3 +/- 12.9 min, p = 0.92), number of vomiting episodes (3.5 +/- 1.9 vs. 3.4 +/- 1.8, p = 0.65), or duration of vomiting (45 +/- 73 vs. 39 +/- 54 min, p = 0.31) for the milk group compared with the clear fluid group. Side effects including lethargy and diarrhea occurred with similar frequency in both groups. The substance ingested had no effect on onset of vomiting, vomiting duration or number of vomiting episodes. These findings again demonstrate that milk does not interfere with ipecac-induced emesis.

[The role of SPECT-supported three-phase scintigraphy of red blood cells in the diagnosis of liver hemangioma]. / SPECT-tel támogatott háromfázisú vértartalom szcintigráfia szerepe a májhaemangioma specifikus diagnózisában.

The roles of planar and SPECT 99mTc labeled red blood cell (RBC) scintigraphy in the diagnosis of hepatic cavernous hemangioma were evaluated. Out of the 29 patients with various focal intrahepatic lesions 13 were diagnosed as having hemangiomas: 6 proven by surgery, and 7 proven by maintaining stable clinical course ranging from 6 to 12 month with no change in the size or appearance of the lesion on US. In the 13 patients a total of 16 hemangiomas were found. 12 of these detected by planar imaging, 2 detected by SPECT only. The sensitivity of planar RBC scintigraphy was 75%, the specificity was 100%. Although planar imaging is probably sufficient for all large or superficial hemangioma, delayed SPECT should be used with small (2-3 cm) or deeply seated lesions.

Lethal form of fibuloulnar A/hypoplasia with renal abnormalities.

The present report describes two sibs with lethal acrorenal developmental complex who were products of a nonconsanguinous marriage. Clinical and roentgenologic characteristics did not match any of the known types of fibuloulnar dysostosis. Distinct abnormalities included lethality at birth, facial anomalies, ear anomalies, symmetrical mesomelic shortness of long bones, fibular agenesis, normal vertebrae, oligosyndactyly of phalanges, congenital heart defect, and cystic or hypoplastic kidney. These cases suggest a new lethal form of recessively inherited fibuloulnar dysostosis with renal anomalies.

[Accurate detection of hemangioma of the liver by SPECT]. / Májhaemangioma specifikus kimutatása SPECT-tel.

The hemangioma cavernosum is a frequent, benign tumor of the liver. Generally the hemangioma becomes suspected during the US examination as a secondary result. From the point of view of the differential diagnostics the three-phase blood-pool scintigraphy, a new very sensitive isotope diagnostic method, has a great importance in these cases. The images taken at the beginning, the early and the late-phase show the kind of alteration unambiguously. Since the conventional planar scintigraphy is not always able to detect the small (1-2 cm in diameter) lesions and the lesions surrounded by intact parenchyma, the SPECT has big advantage increasing the resolution of images and introducing the three-dimensional imaging. The authors illustrate the possibility of specific detection of liver hemangioma in a case by SPECT.

[Growth disturbance of the acetabulum by damage to the triradiate cartilage of rabbits].

We made the following two experiments to know how the disturbed triradiate cartilage influences the growth of the innominate bone, particularly that of the acetabulum. Experiment 1: Damage to the anterior and posterior flanges of the triradiate cartilage. Experiment 2: Damage to the structures adjacent to the triradiate cartilage by drilling. As a result of these experiments, in Experiment 1 acetabular dysplasia and thickening of the inner wall of the acetabulum as reported in the past were seen and thickening of the outer cortex of the acetabular edge, irregular arrangement, decreases in number of hypertropic cells in growth plate, diminishing of bone formation, irregular hypertrophies of the trabecula were also noted in the whole acetabulum histologically. In Experiment 2, only the thickening of the inner wall of the acetabulum was seen. As described above the anterior and posterior flanges of the triradiate cartilage participate in acetabular growth and damaging makes the acetabulum small in size. While the femoral head grows normally, incongruity between the two occurs, so dislocation of the femoral head, acetabular dysplasia and thickening of the inner wall of the acetabulum are secondarily produced by the damage of articular cartilage or growth plate.