Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait-anxiety.

Several studies have suggested that anxiety may play a role in motion sickness susceptibility (MSS) variability. This study aimed to assess motion sickness susceptibility in healthy subjects and chronic vestibular patients and to investigate its relationship to gender, age and trait-anxiety. Healthy subjects (n=167) and chronic dizzy patients with various vestibulopathies (n=94), aged from 20 to 92 years old, were asked to complete Motion Sickness Susceptibility questionnaire (MSSQ) and trait-anxiety questionnaire (STAI-B). When patients were divided into those who had vestibular loss (n=51) vs. patients without vestibular loss (n=43), the MSSQ scores (mean ± SD) for patients with vestibular loss (18.8 ± 30.9) were lower than healthy subjects (36.4 ± 34.8), who were lower than vestibular patients without vestibular loss (59.0 ± 39.7). These significant differences could not be explained by gender, age, trait-anxiety, or interaction. Women had higher MSS than men, and MSS declined with age for healthy subjects and vestibular patients. The overall relationship between anxiety and MSS scores was weak and only reached significance in healthy subjects. These results support the conclusion that the vestibular system is heavily involved in MSS and that trait-anxiety may play a role in MSS but only in healthy subjects.

[Psychometric properties of a French adaptation of the Tinnitus Handicap Inventory]. / Propriétés psychométriques d'une version française du Tinnitus Handicap Inventory.

INTRODUCTION: Tinnitus is a subjective phenomenon and in the majority of cases it is impossible to objectify it. The patient's self-evaluation using questionnaires and rating scales is the only way to quantify this symptom. Among the most widely used tools is the Tinnitus Handicap Inventory (THI). This questionnaire permits the practitioner to quantify the severity of tinnitus and measure the psycho-emotional and functional components of the tinnitus related handicap. It has been translated and validated in many languages. However, there is no French version of the THI. The reliability of the THI as a powerful clinical tool for tinnitus evaluation, and the lack of a French version of this questionnaire led us to translate it into French. The goal of this study was to validate our French adaptation of the THI (fTHI) for the management of French-speaking tinnitus sufferers. This is also essential for an effective international cooperation. METHODS: The fTHI was presented to a sample of 174 patients (63% men and 34% women) who had consulted our IMERTA Tinnitus Centre from June 2007 to July 2008. All patients reported tinnitus that had persisted for at least six months (average duration: 5.9 ± 4.3 years) as their primary complaint. The mean age of the sample was 54.2 ± 16.4 years, ranging from 22 to 84. The patients did not present any linguistic or mental problems likely to compromise their capacities to answer French questionnaires. During the first visit, before the consultation with the doctor, the patients were asked to complete the fTHI, and to evaluate the clearness of items and the ease of answering the questionnaire. Using rating scales, the patients were also asked to evaluate the severity of tinnitus and its impact on their quality of life. Internal consistency reliability of the fTHI and each sub-scale was evaluated using Cronbach's alpha coefficient (α). The average values, standard errors and correlations between the items, the scores of fTHI and those of the rating scales were calculated using "Statistica 6" software. The level of significance was set at 0.05. The homogeneity was considered to be satisfactory for α greater than 0.8. RESULTS: Ninety-seven percent of the patients answered the totality of the fTHI. Ninety-six percent of them evaluated it as simple, comprehensible and easy to answer. Cronbach's α for the fTHI was 0.90 with item/total correlations (p<0.001) ranging from r=0.21 (item n(o) 19) to r=0.71 (items n(o) 17 and 21). Cronbach's α for the functional sub-scale was 0.80 with item/total correlations (p<0.001) ranging from r=0.38 (item n(o) 24) and 0.69 (item n(o) 4). Cronbach's α for the emotional sub-scale was 0.85 with item/total correlations (p<0.001) ranging from r=0.52 (item n(o) 6) and r=0.78 (item n(o) 21). Cronbach's α for the catastrophic sub-scale was 0.49 with item/total correlations (p<0.001) ranging from r=0.51 (item n(o) 19) and 0.63 (item n(o) 23). The total score of the fTHI is correlated significantly (p<0.001) with the functional (r=0.91), emotional (r=0.90) and catastrophic (r=0.69) sub-scales. Correlations between the fTHI and the rating scales vary between 0.26 (p<0.001) and 0.61 (p<0.001). The highest coefficient of correlation is obtained for the "Total score of fTHI"/"Tinnitus impact on quality of life". CONCLUSIONS: Our results show that the French adaptation of the THI and its sub-scales has good internal consistency reliabilities, comparable to those of the original version. Significant inter-correlations are found between the sub-scales items, even if they represent three distinct factors. In addition, the fTHI is correlated with the self-report rating scales of the tinnitus's impact on the patient's quality of life and the severity of tinnitus. Thus, the fTHI is a psychometrically robust, reliable and valid measure of tinnitus related handicaps and can be used in a clinical setting to quantify the impact of tinnitus on French-speaking patients' quality of life, and to monitor their progress with specific therapies.

High-dose sequential (HDS) chemotherapy with blood and marrow cell autograft as salvage treatment in very poor prognosis, relapsed non-Hodgkin's lymphoma.

We tested the feasibility and efficacy of a novel high-dose sequential chemoradiotherapy programme (HDS) in 14 relapsed or refractory non-Hodgkin's lymphoma patients with very poor prognostic features, i.e. transformed histology, marrow invasion, low performance status. This regimen included the sequential administration of high-dose cyclophosphamide (CY) 7 g/m2 followed by high-dose methotrexate (MTX) 8 g/m2 and high-dose VP16 2 g/m2 and finally by total body irradiation (TBI)-melphalan and autograft of bone marrow and peripheral blood progenitor cells. No hemopoietic growth factor support was employed in any phase. There was one treatment-related death during the high-dose phase; three other patients did not complete the programme. All 10 patients concluding the programme achieved complete remission, with four patients in complete clinical remission at a median follow up of 34 months. Median overall survival was 27 months and median failure-free survival (FFS) was 12 months. Twenty-six well comparable patients received conventional salvage therapy during the same period. Their projected median overall survival (8 months) and median FFS (4 months) were shorter than in the HDS group (p = 0.06 for overall survival and p = 0.03 for FFS). Thus, HDS is a feasible programme and may offer superior results than conventional therapy in poor-prognosis NHL patients.

Different suppression of Ph1 positive hemopoiesis induced by intensive chemotherapy in lymphoid and myeloid blast crisis of CML.

BACKGROUND: The suppression of Ph1-positive hemopoiesis is a major goal in the treatment of CML; in this context the CML patients in blast crisis obtaining a complete clinical remission represent a useful model to investigate the behavior of the Ph1-positive and negative clones during bone marrow repopulation after ablative therapy. METHODS: Seven CML patients in blast crisis (four lymphoid and three myeloid) who obtained a complete clinical remission after an intensive polychemotherapy treatment were evaluated by cytogenetic and molecular analysis both in blast and remission phases. Standard cytogenetic and Southern techniques were employed; in addition, minimal residual disease status (MRD) was ascertained by amplification (PCR) of the specific bcr-abl chimeric transcripts. RESULTS: After a single cycle of induction, all lymphoid cases displayed a complete restoration of Ph1-negative hemopoiesis; by contrast, one myeloid blast crisis showed a partial suppression of Ph1-positive hemopoiesis only after two cycles of chemotherapy, and in the remaining two cases the hematological remission was indeed a reversion to the chronic phase. CONCLUSIONS: Ph1-positive chronic clones present in lymphoid blast crisis showed a higher degree of sensitivity to intensive chemotherapy than those present in the myeloid cases. This observation further suggests that the growth properties of the Ph1-positive clones are highly variable from case to case and probably tend to progress during the time-course of the disease.

Use of peripheral blood stem cells to accelerate hemopoietic recovery following autologous bone marrow transplantation.

Twenty-one patients with high risk non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) underwent autologous bone marrow transplantation (ABMT). Nine out of 21 patients received in addition to bone marrow (BM) cells also peripheral blood (PB) cells collected by leucapheresis performed in the recovery phase after high-doses of either cyclophosphamide or etoposide (7 patients), or after ara-C (2 patient). All patients receiving BM + PB cells had ABMT as salvage therapy following extensive relapse or progression of their disease. The addition of PB cells to BM cells allowed a significantly faster recovery after ABMT. Median time to reach WBC greater than 1,000/microL was 14 days versus 20.5 days for patients receiving BM only. Furthermore, a reduced requirement of supportive care and a shorter period of isolation was observed. These results confirm that PB cells combined with BM cells allow a prompt hematopoietic reconstitution after myeloablation. In addition, the data demonstrate the efficacy of PB cells collected after various cytotoxic drugs, even in patients previously exposed to cytoreductive regimens.

HLA class I- like antigen expression on human leukemic cells.

The expression of HLA class I- like molecules was analyzed on human acute and chronic leukemic cells. The presence on leukemic cells of class I- like molecules, absent on the patient's normal lymphocytes, was examined by complement- dependent lymphocytotoxicity using platelet absorbed alloantisera that recognize HLA-linked, 45-12 kd, beta-2-microglobulin associated molecules, selectively expressed on PHA-activated cells. A positive reactivity of the anti- class I- like alloantisera was found in 50% of the acute leukemias (cALL, T-ALL and AML), independently of the lineage of differentiation, while chronic lymphocytic leukemias (B-CLL) were constantly negative. It is suggested that beta-2-microglobulin associated HLA molecules may represent markers of leukemic blast activation and/or maturation state.

Adenosplenomegaly and prognosis in uncomplicated and complicated chronic lymphocytic leukemia. A study of 362 cases.

Presence and size of lymph nodes and spleen, graded from 0 to , in 362 patients with CLL observed from diagnosis were evaluated. Statistical analysis showed a relationship with age, sex, anemia and thrombopenia, leukocytosis, and outlined two different groups: the one without organomegalies , with higher mean age (67 years), female prevalence, and better prognosis; the other with adenosplenomegaly graded ++/ , with lower mean age (57 years), clear male prevalence, and worse prognosis. Survival results were statistically different only between groups 0/+ versus group ++/ . Important chronic diseases were present at diagnosis in approximately 25% of the cases, with a severely reduced survival (median, 27 months), close to that of the cases with anemia and/or thrombopenia (22 months). Therefore it seems that in every prognostic grouping system, complicated cases should be taken into account and grouped with the anemic and/or the thrombopenic ones. The following prognostic groups are proposed: I: low risk: cases without or with adenomegaly and/or splenomegaly + (65% surviving at 100 months); II: intermediate risk: cases with adenomegaly and/or splenomegaly ++/ (median survival, 70 months); III: high risk: cases complicated by chronic diseases, or with anemia and/or thrombopenia (median survival, 25 months).

[Expression of HLA-DR structure and a membrane-specific antigen by a granulocytopoietic line of acute leukemic blast cells]. / Espressione della struttura HLA-DR e di un antigene di membrana specifico per la linea granulocitopoietica sui blasti di leucemia acuta.

Blast cells from peripheral blood of 32 patients with acute leukemia were tested for their ability to react with a monoclonal antibody (D1.B6) specific for HLA-DR surface antigen. In order to evaluate the degree of leukemic cell differentiation a monoclonal antibody (R1.B19) specific for the granulocytopoietic lineage was also employed. The results demonstrated that a considerable proportion of blast cell populations expressed the HLA-DR antigen, while only a small fraction of cells expressed the myeloid antigen.

[Adenopathies in chronic myeloid leukemia (CML). Study of 161 cases]. / Adenopatie nella leucemia mieloide cronica (LMC). Studio su 161 casi.

161 cases of CML have been studied. Clinically significant adenopathies were present in 3,2% of the patients at the moment of diagnosis, and in the subsequent course they appeared in 7% of them. The behaviour of adenopathies showed to be unrelated to: --splenomegaly; --blastic metamorphosis in the peripheral blood or in the marrow (which they often preceded from 3 to 26 months); --hematological sensibility to cytostatic therapy; and furthermore they often acted as the most important clinical and therapeutic problem. From the cyto-histological point of view three features have been observed: 1) blastic metamorphosis in a lymphnode showing features of myeloid metaplasia; 2) blastic invasion in a lymphnode without any sign of myeloid metaplasia; 3) malignant lymphoma. Cytological examination of imprints and ultrastructural studies, besides the usual histological investigations, proved to be useful for the definition of the above mentioned features. In lymphomatous forms, together with the study of the cariotype and the research of the Ph' chromosome, the performance of immunocytological investigations is also necessary.

Chronic lymphoid leukemia. Clinical observations about its natural progression.

223 cases with chronic lymphoid leukemia (CLL) were subjected to a prospective study on the presence of adeno- and splenomegaly at diagnosis and their subsequent variation. Subjects with no initial organ involvement were usually female (76%) and of old age (mean 69.2 years). Adenopathy or combined lymph node and spleen enlargement were inversely proportional to the mean age at diagnosis. Subsequent organ enlargement was noted in 11.7% of patients with no initial organomegaly, splenomegaly in 15% of patients with adenopathy only and adenopathy in 15% of patients with splenomegaly only. Except in the few cases with leukopenia, particularly high leuklocyte levels were noted in patients with splenomegaly (with or without adenopathy). Anemia at diagnosis was not related to the degree of organ enlargement. It is suggested that qualitative and also quantitative differences in organomegaly in CLL merit further study to establish their underlying mechanisms. CLL must be seen as something more complex than the simple mechanical expression of progressive lymphocyte accumulation.

Ocular involvement in leukaemia. Report of three cases.

Three patients with treated acute lymphoblastic leukaemia acquired visual symptoms believed to be caused by ocular infiltration by malignant cells. All three patients had other evidence of systemic disease including bone-marrow involvement at the time. One patient had a previous history of meningeal leukaemia and none had received "prophylactic" cranial irradiation. The ophthalmoscopic appearances were similar in each case and were thought to have been caused by obstruction of axoplasmic flow associated with infiltration of the optic nerve by neoplastic cells. The three patients were treated by local irradiation and two also received intrathecal chemotherapy. Response to treatment was variable but the use of radiotherapy combined with intrathecal cytoxic drugs is probably the best available approach.

[Microbial maps and blood cultures in acute leukemia]. / Mappe microbiche ed emocolture nelle leucemie acute

Microbial maps were performed taking swabs from nose, pharinx, external auditory meatus, groin, vagina, sputum and urine cultures in 69 cases of acute leukaemia, in order: to assess the germs' incidence in an "open ward" department; to eliminate the most dangerous pathogens with local treatment or with a selective therapy without broad-specturm antibiotics; to check, in the 43 cases followed from onset, the changes occurring during the admission and the disease progression; to collect data for comparison with a "sterile" ward. The local decontamination had only a temporary effect. During the course of the disease new, particularly dangerous, pathogens were cultured. Blood cultures were positive in 15% of the patients with fever at the onset of the disease, and in 36.9% of the patients with fever during the disease progression. These values were virtually the same as those observed in the acute stage of C.M.L. (35.7%). In akute leukaemia E. coli (35%) was the most common, followed by P. aeruginosa (20%), Klebsiella (15%), S. alpha haemolyticus (10%) and others. There was little or no relationship between the germs in the maps and those in the blood cultures, though it must be remembered that no stool cultures were examined.