Allogeneic transplantation for multiple myeloma: further evidence for a GVHD-associated graft-versus-myeloma effect.

We report a series of 37 consecutive patients with multiple myeloma (MM) who received an allograft between 1990 and 2000 at our institution. Median age was 47 years, and nearly 70% of patients were Durie-Salmon stage III. A median of five cycles of chemotherapy were given before transplant, with a median interval between diagnosis and transplant of 9.3 months. We report a nonrelapse mortality rate of 22% with a median follow-up period of 40 months, whereas complete remission (CR) rate at 12 months is estimated at 57%. Treatment failure rate and overall survival at 40 months are estimated at 52% and 32%, respectively. The number of chemotherapy cycles prior to allotransplantation achieved borderline statistical significance as a poor prognosis factor for overall survival (P = 0.05), while the presence of chronic graft-versus-host disease (cGVHD) was significantly correlated with CR achievement (P = 0.036). Our study confirms that early allografting in MM can yield toxicity rates significantly lower than those associated with historical cohorts, and supports the hypothesis that cumulative chemotoxicity has a negative influence on mortality and survival rates. More importantly, our study clearly demonstrates an association between cGVHD and CR and brings further evidence in favor of a graft-versus-myeloma effect.

Adolescent substance use: preliminary examinations of school and neighborhood context.

In considering the influences of microsystems on adolescent substance use, familial and peer contexts have received the most extensive attention in the research literature. School and neighborhood settings, however, are other developmental contexts that may exert specific influences on adolescent substance use. In many instances, school settings are organized to provide educational services to students who share similar educational abilities and behavioral repertoires. The resulting segregation of students into these settings may result in different school norms for substance use. Similarly, neighborhood resources, including models for substance use and drug sales involvement, may play an important role in adolescent substance use. We briefly review literature examining contextual influences on adolescent substance use, and present results from two preliminary studies examining the contribution of school and neighborhood context to adolescent substance use. In the first investigation, we examine the impact of familial, peer, and school contexts on adolescent substance use. Respondents were 283 students (ages 13 to 18) from regular and special education classrooms in six schools. Although peer and parental contexts were important predictors of substance use, school norms for drug use accounted for variance in adolescent use beyond that explained by peer and parental norms. Data from a second study of 114 adolescents (mean age = 15) examines neighborhood contributions to adolescent substance use. In this sample, neighborhood indices did not contribute to our understanding of adolescent substance use. Implications for prevention are presented.

[Intra-observer variability of measurement of posture with three-dimensional digitization]. / Variabilité intra-observateur de la mesure de la posture à l'aide d'un numérisateur tridimensionnel.

A new system based on 3D digitization with magnetic fields has been developed by our research team. The focus of this study was to evaluate the intratester reproducibility of this technique of measurement. Twenty key morphological parameters were used twice to digitize the fourty five female subjects aged 7 to 23 years. The results of variance analysis (ANOVA) for repeated measures showed no statistically significant difference between the two series of measurements for the twenty angles studied. In 56% of the measurements, the difference of the means was less than 1 degree, the greatest being 1.82 degrees. These results confirm the reliability of this new technique of postural evaluation when the measurements are taken by the same tester. Therefore, 3D digitization with magnetic fields could be an interesting alternative to X-Rays for the evaluation of scoliosis.

Quantitation of central activation failure during maximal voluntary contractions in humans.

Muscle fatigue or neuromuscular disease may result in central activation failure during maximal voluntary contractions (MVCs). Superimposition of an electrically stimulated contraction during an MVC has been used to detect central activation failure. To determine the most sensitive means of quantitating central activation failure using this technique, we compared the increment in isometric force from single, double, and high-frequency trains (50 Hz, 500 or 1000 ms) of stimuli of the peroneal nerve imposed during three separate MVCs of the dorsiflexor muscles. Completeness of activation was quantitated with the central activation ratio (CAR) = MVC/(MVC + stimulated force). Comparisons were made of the CARs of three groups of subjects during the three stimulation conditions: 7 healthy subjects, 13 patients with amyotrophic lateral sclerosis, and 5 healthy subjects after fatiguing exercise. For all three groups, the CAR was significantly lower during the train of stimuli condition (means = 0.76-0.89) compared with either the single or double stimuli conditions (means = 0.96-1.00). The results suggest that a superimposed high-frequency train of stimuli is a more sensitive indicator of central activation failure during isometric MVCs compared with either the superimposed single or double stimuli methods.

[3-D evaluation of posture in normal and scoliotic adolescents]. / Evaluation 3-D de la posture chez des adolescents normaux et scoliotiques.

We have developed a new clinical evaluation of the human posture based on 3D digitization with magnetic fields. This 3D postural evaluation displays the relative position of the head, the shoulders and the pelvis. The main purpose is to identify key morphological parameters in order to demonstrate significant differences between 2 groups of subjects. Nineteen adolescent control subjects and 22 patients with AIS have been evaluated. The t-tests showed significant statistical differences between the 2 groups for every measurements studied. The 2 most significant were tilt of the shoulders in the postero-anterior plane and the angle of the shoulder-blades vs the shoulders in the transverse plane (p < 0.0005). These results support the value of the 3D postural evaluation as a clinical tool for the evaluation of AIS. This technique is non-invasive and could be used for the clinical follow-up in order to evaluate the postural evolution in scoliotic patients.

[Dorso-lumbal pain and idiopathic scoliosis in adolescence]. / Douleur dorso-lombaire et scoliose idiopathique de l'adolescence.

Current knowledge on the association between back pain and idiopathic scoliosis is often contradictory. The presence, localisation and importance of pain was evaluated for a cohort of 426 adolescents with AIS. Patients were recruited from a scoliosis clinic in a pediatric hospital. A questionnaire and an analogue visual scale graduated from 0 (no pain) to 100 (maximal pain) were used in order to verify more precisely, the importance of the association between AIS and back pain. Chisquare, linear regression and Student T-test were used for statistical analysis. 239 patients with right thoracic and left lumbar curves (RTLL) had a prevalence of pain of 54%. The mean of maximum pain intensity was 49 mm +/- 20. No relation was found between the severity of the scoliosis and back pain. The two groups (with and without pain) were comparable. Cobb angles were about the same for the thoracic and lumbar regions, as well as kyphosis and lordosis, weight, height and age. Risser sign, sex, brace and pelvic tilt were the only variables associated with pain (p < 0.0001). Association between AIS and pain is more frequent than generally reported. Pain appears to be more related with pelvic tilt than severity of the scoliosis.

[Possible relationship between idiopathic scoliosis and morphologic somatotypes in adolescent females]. / Relation possible entre la scoliose idiopathique de l'adolescente et les somatotypes morphologiques.

This retrospective study was conducted to verify the possibility of a relationship between morphological somatotypes and Adolescent Idiopathic Scoliosis (AIS). The sample was composed of 77 adolescent girls presenting Idiopathic Scoliosis. In every case, scoliosis was important enough to necessitate a corrective surgery. The control group (historical type) was taken from an anthropometric study done in 1990 [5]. Morphotypes were evaluated from medical slides with pre-established criteria based on Sheldon's technique [3, 4]. Three somatotype values were obtained: One for ectomorphism, a second for mesomorphism and a third for endomorphism. This classification system is calibrated in a way that the summation of these 3 values necessarily gives 7. AIS patients appear less mesomorphic with a mean value of 1,208 +/- 1.03 than the control group with a mean value of 1,923 +/- 0.89 (Student "t" test: 6,149, p < 0.0001). Based on these results, a relationship between morphological somatotypes and the presence of AIS appears possible. A more elaborate prospective study will be needed to support this hypothesis.

Effects of trandolapril on the sympathetic tone and reactivity in systemic hypertension.

Hemodynamic and autonomic evaluations were carried out after 2-3 weeks of treatment with placebo and at the end of 4 weeks of treatment with an angiotensin converting enzyme (ACE) inhibitor, trandolapril, 2 mg/day in 18 hypertensive patients (average age, 48 +/- 2 years) of either sex. This treatment lowered the mean arterial pressure in the whole group from 112 to 105 mm Hg (p < 0.05) without significant changes in basal heart rate or norepinephrine (NE) and epinephrine plasma levels. Based on daytime ambulatory blood pressure monitoring, the patients were separated into 2 equal groups of 9 patients: the better responders (R), with an average decrease in mean arterial pressure of 12 mm Hg, and the lesser responders (NR), with an average fall of mean arterial pressure of 2 mm Hg. Before treatment, the R group had a higher resting heart rate, a lower cardiac output (-16%), and a higher peripheral resistance (+22%) than the NR group (difference not significant). Moreover, the R group was also observed to have a 33% higher plasma NE level (p < 0.05) in the supine position, associated with a 52% higher NE response to standing (p < 0.05), and a 40% lower number of beta-adrenergic receptors on lymphocytes, suggesting a higher sympathetic tone and reactivity in that group. Following treatment with the ACE inhibitor, heart rate and plasma NE levels were not altered significantly in either group, suggesting a blunting of the baroreflex response concomitant with the lowered blood pressure, especially in the R group.(ABSTRACT TRUNCATED AT 250 WORDS)