Platelet aggregation is significantly associated with cardiovascular mortality in elderly patients

Background:   The relationship between cardiovascular mortality and platelet function in elderly patients remains unclear.
Methods:   The outcomes for 347 consecutive patients aged 60 or older (mean age 77.5 years; 161 men and 186 women) who were treated without antiplatelet drugs on registration, were retrospectively studied after platelet aggregatability tests. The grading curve (GC) type, as an index of platelet aggregatability, was determined with an aggregometer and adenosine-5'-diphosphate as an agonist. Patients were classified into three groups according to GC type: Group I with suppressed aggregation ( n  = 40); Group II, normal aggregation ( n  = 208); and Group III, increased aggregation ( n  = 99). The mean follow-up was 3.9 years.
Results:   There were three deaths in Group I, 33 in Group II, and 30 in Group III. The mean annual mortality rate was 2.1% in Group I, 4.0% in Group II and 7.5% in Group III. Although the most common cause of death was pneumonia in all three groups, the annual mortality rates due to vascular events were 0.7% in Group I, 0.6% in Group II and 4.2% in Group III. Cox proportional hazards models for vascular death yielded a hazard ratio of 1.5 in the increased GC type.
Conclusion:   These findings indicated that elderly patients with accelerated aggregation had higher mortality rates due to vascular events. Therefore, accelerated aggregation in the elderly suggested not only the progress of arteriosclerosis, but indications of antiplatelet therapy to prevent vascular events.     

Transpleural perfusion with oxygenated perfluorocarbon increases systemic oxygenation

Background and objective:   There is a need for new methods of increasing systemic oxygenation in patients with hypoxia due to potentially reversible pulmonary failure. The goal of this study was to determine if it is possible to increase systemic oxygenation by perfusing the thoracic cavity with oxygenated perfluorocarbon in animals with induced hypoxia.
Methods:   Fifteen Sprague–Dawley rats were intubated, and hypoxia was induced by hypoventilation (room air, respiratory rate <30/min). Inflow and outflow tubes were placed in the thoracic cavity and connected to a perfusion circuit containing a roller pump, warmer and oxygenator. Rats in Group I were not treated during hypoventilation, those in Group II were perfused with oxygenated saline, and those in Group III were perfused with oxygenated perfluorocarbon. Arterial blood gases were collected every 30 min for 180 min. At the conclusion of the experiments, pathological examination of the lungs and parietal pleura was performed.
Results:   PaO₂ in Group III was significantly higher than that in Group I or Group II. PaCO₂ in Group III was significantly lower than that in the other two groups. Histological examination showed no damage to the lungs and parietal pleura in Group III.
Conclusions:   Perfusion of the thoracic cavity with oxygenated perfluorocarbon in an animal model of induced hypoxia resulted in a significant increase in systemic oxygenation without lung damage and might be a useful method for improving systemic oxygenation.     

Nontuberculous Mycobacteria Among Patients Who are Suspected for Multidrug-Resistant Tuberculosis—Need for Earlier Identification of Nontuberculosis Mycobacteria

BackgroundIn this study, we intended to find the prevalence of nontuberculosis mycobacteria (NTM) among patients who are referred as suspected multidrug-resistant tuberculosis (MDR-TB) cases to the only referral center in Iran.MethodsAll patients referred to our center in 2002–2006 as MDR-TB with histories of treatment with standard and CAT II World Health Organization regimens were included in the study. Sputum smear and culture for acid-fast bacilli were performed for all patients 3 times. Sputum polymerase chain reaction was also performed for all patients. Mycobacterial identification was performed via polymerase chain reaction and routine identification tests for all culture-positive cases.ResultsOf the 105 patients in the study, 12 (11.43%) were identified to have NTM infection. The identified mycobacteria were classified in order of prevalence as Chelonae (8 cases), Simiae (2 cases), Aloei (1 case), and Farcinogen (1 case). Based on radiologic findings, most of the cases demonstrated bilateral nodularity (83.3%) and also multifocal bronchiectasis (75%). Notably, cavitary lesions were present in 41.7% of the cases.ConclusionBased on the findings of this study, it is essential that such cases be identified before commencing MDR-TB treatment.     

Treatment of multiple drug-resistant tuberculosis (MDR-TB) in Iran.

SETTING: Masih Daneshvari Hospital, Tehran, Iran, 2000-2002. OBJECTIVE: To evaluate the effectiveness of multiple drug-resistant tuberculosis (MDR-TB) treatment for the first time in Iran. DESIGN: All cases of MDR-TB with complete follow-up data were recruited and results of their treatments were evaluated. RESULTS: MDR-TB treatment was initiated with 5.23 drugs, on average. Isoniazid, amikacin, and ofloxacin were present in the drug regimen of all patients. Average duration of the treatment was 18.5 months (range, 7-36). Over 76% of the patients responded to the treatment (negative smear and culture). Cure and probable cure were documented in seven (41.2%) and four (23.5%) of the patients, respectively. No failure in the treatment occurred when cycloserine was present in the treatment regimen. CONCLUSION: A majority of the MDR-TB patients in Iran can be cured with the use of appropriate treatment regimens. An even greater success could be achieved by providing more second-line drugs.     

Role of intestinal metaplasia subtyping in the risk of gastric cancer in Korea

Background and Aim:  Gastric cancer is believed to develop by a multistage process. Intestinal metaplasia (IM) is regarded as a premalignant condition; it is classified into subtypes I, II and III. The aim of this study was to evaluate whether the subtypes of IM were associated with progression to gastric cancer.
Methods:  The study cohort consisted of 861 subjects, categorized as controls, gastric ulcers, dysplasia and cancer. The IM was scored histologically using the Sydney classification for the antrum and the body of the stomach. The biopsies were stained with high iron diamine and alcian blue (pH 2.5) (HID-AB2.5), and the IM was subtyped as I, II or III.
Results:  The proportion of IM subtypes I, II and III were 14.5%, 47.2% and 38.3% in the antrum, and 28.1%, 57.8% and 14.1% in the body of the stomach, respectively. These distributions did not show significant differences depending on disease or Helicobacter pylori positivity. In cases that were H. pylori -positive, the prevalence of IM subtype II in the cancer and dysplasia groups was higher than in the control group in the body of the stomach ( P  < 0.05). The proportion of IM subtype III in the antrum increased in proportion with age ( P  = 0.036).
Conclusions:  IM subtyping was not found to play a major role in the prediction of gastric cancer development in Korea. IM subtype III was associated with aging, and IM subtype II appeared to be related to gastric carcinogenesis in the presence of H. pylori infection.     

Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse

PURPOSE: The aim of this study was to determine the prevalence, severity, and associations between urinary incontinence and genital prolapse in females after surgery for fecal incontinence or rectal prolapse. METHODS: All patients who underwent surgery for fecal incontinence (Group I) or rectal prolapse (Group II) were compared with a control group of females (Group III) by 43 questions regarding demographic data, past medical and surgical history, and diagnosis and treatment of anal and urinary incontinence and genital and rectal prolapse. The type (stress, urge, and total) of urinary incontinence was determined and graded using an incontinence severity questionnaire (Individual Incontinence Impact Questionnaire). RESULTS: Overall response rate in the three groups of patients was 40.1 percent. The questionnaire was sent to 240 patients operated on for fecal incontinence or rectal prolapse, and 83 of them responded (34.5 percent). The patients were distributed into three groups: Group I consisted of 51 patients (mean age 56.7 +/- 14); Group II consisted of 32 patients (69.7 +/- 11); and Group III consisted of 40 patients (60.5 +/- 16). The prevalence of urinary incontinence in Group I was 27 (54 percent), in Group II was 21 (65.6 percent), and Group III was 12 patients (30 percent; P = 0.003). Genital prolapse was present in 9 (17.6 percent), 11 (34.3 percent), and 5 patients (12.5 percent), respectively (P = 0.03). The prevalence of coexistent urinary incontinence and genital prolapse in both study groups was 22.8 percent (19 patients). There were no statistically significant differences between Groups I and II relative to prevalence, type, and severity of urinary incontinence and genital prolapse, but there were significant differences between the two study groups and the control group. Of the patients in the study group, 67 percent had urinary incontinence before or at the time of surgery. CONCLUSION: There is a higher prevalence and severity of urinary incontinence and pelvic genital prolapse in females operated on for either fecal incontinence or rectal prolapse than in a control group. Therefore, female patients with fecal incontinence or rectal prolapse should be evaluated and treated by a multidisciplinary group of pelvic floor clinicians, including a gynecologist or urologist with special training in female pelvic floor dysfunction and a colorectal surgeon.     

Correlation between symptoms, chest radiographs, pulmonary function tests and severity of emphysema on autopsy lungs in elderly patients

Background:   In general, the clinical features of chronic obstructive pulmonary disease in the elderly are complicated, frequently resulting in undiagnosed disorders. It would be convenient if simple parameters to screen for the disease were developed. The present study investigated the pathological–clinical inter-relationships in emphysema.
Methods:   A total of 121 cases were graded by severity of emphysema into five groups according to the panel grid system. Grades were then compared with various clinical parameters including the severity of respiratory symptoms, characteristics of physical examination, measurements on chest radiographs and airflow obstruction on pulmonary function tests.
Results:   The mean age of patients was 77.1, and 71 cases (58.7%) were male. The severity distribution was as follows: no emphysema 20 (16.5%), and the four grades, ranging from mild to severe, were 65 (53.7%) grade I, 16 (13.2%) grade II, 13 (10.7%) grade III and seven (5.9%) cases were grade IV. Both smoking history (pack-year) and body mass index were significantly correlated with emphysema severity. In addition, both respiratory symptoms and airflow obstruction were sharply and significantly increased in groups III + IV compared with groups I + II. On plain chest radiograph, the ratio of lung length to body height was significantly correlated with the severity of emphysema ( P  < 0.01).
Conclusions:   We conclude that both respiratory symptoms and airflow obstruction are inter-related and demarcate mild emphysema from that showing more than moderate severity. The number of cigarette pack-years, loss of body weight and increased lung length on plain chest radiography might be useful indicators for speculated emphysema severity.     

Outcome of treatment of MDR-TB patients with standardised regimens, Iran, 2002-2006.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) imposes a formidable burden on national health systems. There is still no consensus on the subject, with controversies regarding treatment protocols, treatment outcomes and the various treatment regimens. METHODS: The present study describes Iran's second national cohort for treatment of MDR-TB. The study comprised all documented MDR-TB cases in Iran referred to our centre during the period 2002-2006. All patients received a standardised second-line regimen consisting of ofloxacin, cycloserine, prothionamide and amikacin. Based on drug susceptibility testing results, ethambutol and pyrazinamide were added to the regimen. RESULTS: Forty-three patients diagnosed with MDR-TB, with a mean age of 44.38 +/- 19.05 years, received treatment; of these, 27 (62.8%) were male. Twenty-three were (53.5%) Iranians and the remainder were Afghans. All patients were acquired MDR-TB cases. Of the 43 cases, 25 (58.1%) experienced severe clinically significant adverse effects; 29 (67.5%) had a successful outcome and 14 (32.5%) had a poor outcome (treatment failure in six [14%] and death in eight [18.6%]). Mortality was higher in Iranians (P = 0.039) and in patients whose initial regimen was changed due to adverse drug reactions (P = 0.01). CONCLUSION: Compared with previous studies, our study was able to obtain more favourable outcomes of MDR-TB treatment using a standardised regimen.     

Abnormality of the hepatic vein waveforms in cirrhotic patients with portal hypertension and its prognostic implications

Background and Aim:  We investigated the prognostic significance of changes in the Doppler hepatic vein (HV) waveforms in cirrhotic patients with portal hypertension and the mechanisms of these changes.
Methods:  A total of 103 consecutive patients were included in this study and their HV waveforms were classified into four types: type I, triphasic waveform; type II, biphasic waveform; type III, biphasic waveform with reduced phasic oscillations; and type IV, a flat waveform.
Results:  Type I was observed in 34, type II in 40, type III in 23, and type IV in six patients. The 5-year survival rates were 90%, 89%, 41%, and 0% in type I, II, III, and IV, respectively. Five variables including the Child–Pugh score, albumin, bilirubin, ascites, and HV waveform significantly correlated with the survival in a univariate analysis. A multivariate analysis only identified the HV waveform (type III and IV) to be an independent prognostic value. Even in Child–Pugh class B patients, the 5-year survival rate for type III or IV was as poor as 26% in comparison to 92% for type I or II. In contrast, in Child–Pugh class C patients, the 5-year survival rate for type I or II was as good as 63% in comparison to 25% for type III or IV. Furthermore, the changes in HV waveforms correlated with the extent of hepatic fibrosis, the increase in portal perfusion per liver volume, or the decrease in portal vascular resistance.
Conclusions:  Analyzing the HV waveforms was thus found to be a simple method for accurately assessing the prognosis in cirrhotic patients with portal hypertension.     

Multidrug resistant tuberculosis versus non-tuberculous mycobacterial infections: a CT-scan challenge

IntroductionClinical, laboratory and imaging findings in patients with multidrug resistant-tuberculosis (MDR-TB) and non-tuberculosis mycobacterium (NTM) are similar, and the majority of these patients present with positive smear for Acid Fast Bacilli (ADB) and no response to first line anti-TB treatment, so sputum culture and PCR are necessary, especially in NTM.ObjectiveIn this study we evaluate more details of imaging findings to help earlier diagnosis of pathogens.Materials and methods66 patients with positive smear for AFB and no response to first line anti-TB drugs were divided into two groups by PCR and culture: MDR-TB (43 patients) and NTM (23 patients). Age, sex, history of anti-TB treatment, smoking and CT-scan findings (parenchymal, pleural and mediastinal variables) by details and lobar distribution were analyzed.ResultsMean age of NTM patients was slightly higher (52 versus 45) and there is no significant difference in sex and smoking. In MDR-TB group, history of anti-TB treatment and evidence of chronic pulmonary disease such as calcified and fibrodestructed parenchyma, volume loss and pleural thickening were higher significantly. Cavities in MDR-TB were thick-wall in the background of consolidation, while NTM cavities were more thin-walled with adjacent satellite nodules in same segment or lobe. Prevalence of bronchiectasis was similar in both groups, while bronchiectasis in MDR-TB group was in fibrobronchiectatic background in upper lobes, and in NTM group the distribution was more uniform with slightly middle lobes predominance. Prevalence and distribution of nodular infiltrations were similar more in Tree in Buds and scattered pattern. Calcified or non-calcified lymph nodes and also pleural changes were more frequent in MDR-TB but prevalence of lymphadenopathy was mildly higher in NTM.ConclusionA check-list with multiple variables is helpful for differentiation between the two groups.     

Anti-inflammatory effects of curcumin in a murine model of chronic asthma

BackgroundCurcumin, a dietary pigment responsible for the yellow colour of curry, has been used for the treatment of inflammatory diseases and exhibits a variety of pharmacological effects.MethodsForty-two BALB/c mice were divided into six groups: I, II, III, IV, V, and control group. All groups except the controls were sensitised and challenged with ovalbumin. Group I received nebulised saline in challenge period. Mice in groups II, III, IV, and V were administered curcumin at a dose of 10 mg/kg, curcumin 20 mg/kg, dexamethasone 1 mg/kg, and dimethyl sulfoxide 1 mg/kg, respectively, intraperitoneally once a day for the final 5 days of the challenge period. Animals were sacrificed 24 h after the last drug administration and the airway samples were evaluated histologically by light microscopy.ResultsAll histological parameters in Group III improved similar to Group IV when compared to Group I. In Group II, only thickness of epithelium was significantly lower compared with regard to Group I. All variables except epithelium thicknesses were found to be significantly better in Group III compared to Group II.ConclusionsIn our study, we demonstrated that curcumin administration alleviates the pathological changes of chronic asthma. Curcumin might be a promising therapy for asthma in the future.     

Retreatment management strategies when first-line tuberculosis therapy fails.

SETTING: Public ambulatory centers in northern Lima, Peru. OBJECTIVE: To compare two retreatment strategies in Category I failures. DESIGN: Retrospective cohort study of Category I failures enrolled between February 1997 and October 2001. Strategy A was a nationwide approach, applying a Category II regimen; if that regimen failed, a standardized regimen including second-line drugs was used. Strategy B was a pilot protocol designed to diagnose and treat multidrug-resistant tuberculosis (MDR-TB); this strategy included drug susceptibility testing (DST) and eliminated the Category II regimen. RESULTS: Of 125 patients that Category I failed to cure, 73 entered Strategy A and 52 entered Strategy B. Almost 90% of those with DST results had MDR-TB. Strategy B was three times more likely than Strategy A to cure patients (79% vs. 38%, RR = 2.9, 95% CI 1.7-5.1) and five times more likely to cure patients than the Category II regimen alone (79% vs. 15%, RR 5.2, 95% CI 3.0-9.2). Strategy B also significantly reduced delays to MDR-TB diagnosis and to the initiation of MDR-TB therapy. CONCLUSIONS: Under program conditions, a retreatment strategy based on DST and eliminating the Category II regimen can improve clinical outcomes among Category I treatment failures found to have active, infectious MDR-TB.     

In vitro cytotoxicity of CD8+ T cells in multi-drug-resistant tuberculosis. A preliminary report

Background and objective:   Specific CD8+ T-cell cytotoxicity has been recognized as being involved in the elimination of drug-susceptible tuberculosis (DS-TB). Given that there is currently no information on the cytotoxic effector functions of CD8+ T cells in multi-drug-resistant tuberculosis (MDR-TB), our objective was to analyse the cytotoxic activity, both basal and stimulated, of CD8+ T cells from MDR-TB patients and compare it with that of DS-TB patients, as well as purified protein derivative (PPD)+ and PPD− subjects.
Methods:   Cytotoxic activity of CD8+ T cells from MDR-TB patients, DS-TB patients, PPD+ and PPD− subjects was measured by a colorimetric assay, using H37Rv culture filtrate protein as the antigenic stimulus.
Results:   Twenty-eight subjects were studied (7 MDR-TB patients, 7 DS-TB patients, 7 PPD+ subjects and 7 PPD− subjects). In the presence of the antigenic stimulus, the cytotoxic activity of CD8+ T cells from MDR-TB patients (% lysis) increased from 6.7% to 59.6% ( P  < 0.001). In DS-TB patients lysis increased from 3.2% to 22.5% ( P  < 0.001), whereas in PPD+ subjects it increased from 2.7% to 12.0% ( P  < 0.001) and in PPD− subjects from 1.3% to 3.2% ( P  < 0.001). Basal cytotoxic activity was significantly higher for MDR-TB patients than PPD+ and PPD− subjects ( P  = 0.003), but not compared with that for DS-TB patients ( P  = 0.05). Stimulated cytotoxic activity was highest for MDR-TB patients.
Conclusions:   CD8+ T cells from MDR-TB patients showed an exaggerated cytotoxic activity after antigenic stimulation. Further studies are required to elucidate the role of this response in the immunopathogenesis of MDR-TB.     

Insulin-induced weight gain and cardiovascular events in patients with type 2 diabetes. A report from the DIGAMI 2 study

Aim:  We investigated whether insulin treatment-induced weight gain was accompanied by increased cardiovascular (CV) mortality and morbidity in the second Diabetes Insulin Glucose in Acute Myocardial Infarction (DIGAMI 2) study.
Methods:  We studied the 865 patients who survived during 12 months without any change in their glucose-lowering (GL) therapy. They were divided into four subgroups according to GL treatment: group I, no pharmacological GL treatment (n = 99); group II, oral hypoglycaemic agents (n = 250); group III, new insulin treatment (n = 245) and group IV, insulin before inclusion continued during the first year of follow up (n = 271).
Results:  Patients who started on insulin (group III) experienced an average body weight increase of 2.3 (1.5–3.2) kg during the first year of treatment, whereas weight remained unchanged in groups I, II and IV. The incidence of non-fatal reinfarction was higher in group III compared with the other groups (hazard ratio (HR) = 2.5, p   = 0.011) and CV mortality was higher in group IV (HR = 2.4, p   = 0.003). When the subjects were grouped in quartiles according to maximal body weight increase, those in the lowest quartile experienced the highest CV mortality. Each kilogram increase in weight reduced the risk for CV death with 6%. The incidence of reinfarction did not differ between quartiles.
Conclusions:  Initiation of insulin treatment after myocardial infarction was associated with a significant increase in weight and incidence of reinfarction. The increase in weight did, however, not explain the increased rate of reinfarction.     

Use of Captopril in the Diagnosis of Renal Hypertension

Abstract: 1 . The effects of a single 25 mg oral dose of captopril on blood pressure, heart rate and circulating renin, angiotensin I, angiotensin II, bradykinin and catecholamine levels were examined in untreated patients with essential (n = 10, Group I), accelerated (n = 6, Group II) and renal hypertension (n = 8, Group III) studied on a normal sodium diet .
2 . Mean blood pressure fell only slightly in Group I patients, (113 ± 3 to 109 ± 3 mmHg at 60 minutes) but a greater fall was observed in Group II (153 ± 8 to 135 ± 11 mmHg) and a marked fall in Group III, (136 ± 3 to 114 ± 5 mmHg). There were no significant changes in heart rate in any group .
3 . Plasma angiotensin II levels were significantly reduced 30 minutes after captopril in all three groups and returned toward resting values after four hours. The falls in plasma angiotensin II levels were accompanied by reciprocal increases in blood angiotensin I and plasma renin, but blood bradykinin and plasma catecholamine concentrations remained unchanged .
4 . Resting plasma renin levels showed considerable overlap in the three groups and the mean renin values were not significantly different in the three groups. After captopril a marked rise in plasma renin concentration (>2.5 ng/ml/hr) was observed in seven patients in Group III, including all six patients with renovascular disease. In contrast, none of the patients with essential hypertension and only one patient with accelerated hypertension had such an increase. Determination of the acute renin and blood pressure responses to converting enzyme inhibition with a single oral dose of captopril appears to be useful in identifying patients with renovascular hypertension .     

Changed diastolic function at rest in patients with perfusion defects in exertion myocardial scintigraphy with TI-201

Myocardial perfusion scintigraphy with TI-201 after exercise allows distinction between areas of scar (irreversible defect) and areas of ischemia (reversible defects). Accordingly 4 major groups of patients can be identified: with normal perfusion pattern (Group I); with reversible ischemia (Group II); with scar of previous myocardial infarction (Group III); with both evidence of scar and ischemia (Group IV). Sixty-nine patients (59 m; 10 f; mean age 55.7 +/- 9 years) with suspected or demonstrated ischemic heart disease underwent stress TI-201 myocardial scintigraphy and on the basis of the scintigraphic results were assigned as follows: 11 to group 1, 14 to group II, 31 to group III and 13 to group IV. In order to investigate the behaviour of ventricular diastolic function in these different subsets, all the patients underwent subsequently a radionuclide angiography at rest (both first pass and equilibrium gated blood pool studies), which allowed the assessment of left ventricular ejection fraction (EF), peak filling rate (PFR)--as expression of diastolic function--and regional wall motion pattern. The values of EF and PFR were significantly reduced (p less than 0.05) in the patients with defects of perfusion (Groups II, III and IV) in comparison to the patients with normal perfusion (Group I); abnormal wall motion was found in 0 (I), 8 (II), 22 (III) and 7 (IV) patients. The diastolic function was more frequently altered (PFR less than 2.5 EDV/sec) than the systolic function (EF less than 50%) or regional wall motion, mainly in patients with reversible scintigraphic defects (prevalence of alterations in the groups II and IV: PFR: 78%, EF: 22%, abnormal wall motion: 56%).(ABSTRACT TRUNCATED AT 250 WORDS)     

The Fuenlabrada study: a familial aggregation of ischemic cardiopathy and cardiovascular risk factors

Familial aggregation of coronary heart disease (CHD) and coronary risk factors (CRF) were evaluated by clinical history in adult relatives of children surveyed for CRF. Population was divided into two groups: Group I included 2,153 children without parental history of CHD. Group II included 266 children of 112 families with parental history of early CHD (before 56 years). In 105 cases the patients were the fathers and in 7 cases the mothers. All the patients were admitted to a coronary care unit. Familial aggregation of CHD was 9.7 times more frequent in paternal families of group II (p less than or equal to 0.0001) than in group I; there was no differences in maternal families. Higher prevalence of hyperlipidaemia, blood pressure hypertension, smoking habits, diabetes and obesity in fathers of group II was observed. Children in group II showed increased levels of C-LDL and decreased levels of C-HDL compared with those of group I. The prevalence of CRF was also significantly higher in children of group II, although in the 33% of the children of group II no CRF was detected. Conclusion: a substantial proportion, but not all cases, of familial aggregation of CHD could be explained by known CRF.     

GEMOX-R regimen is a highly effective salvage regimen in patients with refractory/relapsing diffuse large-cell lymphoma: a phase II study

Objectives:  The prognosis of old or immunocompromised patients with refractory or relapsing diffuse large-cell lymphoma (DLCL) is very poor as the current standard of salvage therapy with autologous stem cell transplantation (ASCT) is not feasible for most of them. New active regimens with an acceptable toxicity profile are needed. We aim to report the results of a phase II trial of the GEMOX-R regimen in DLCL.
Methods:  A total of 32 patients received GEMOX-R regimen in 2-wk intervals if feasible or every 3 wk for a planned six to eight courses.
Results:  Median age of the population was 69 yr. Forty-one percent of the patients were primary refractory and 59% after relapsing. At GEMOX-R, 75% of patients had a stage III–IV and an adjusted International Prognostic Index > 1 was observed in 69%. The response rate was 43% with 34% complete response. Neutropenia and thrombopenia grade III–IV were observed in 43% of the patients and neurotoxicity grade III–IV in 7% of cases. Median follow-up for alive patients was 13 months and the median survival was 9.1 months. At 12 months, the overall survival and progression-free survival were 41% and 29%, respectively.
Conclusions:  GEMOX-R is a new salvage regimen for DLCL with high activity and relatively safe toxicity profile, which can be offered to elderly patients not candidates of ASCT consolidation. The high efficacy of the regimen in this unfavorable population and also in immunocompromised situations warrant further investigation of this regimen in all salvage situations of this type of lymphomas.     

Fine-needle aspiration cytology to distinguish dysplasia from hepatocellular carcinoma with different grades

Background:  Distinguishing dysplasia from hepatocellular carcinoma (HCC) by fine-needle aspiration (FNA) cytology is difficult. The aim of this study was to diagnose HCC and the distinction of liver cell dysplasia from HCC with different grades by interpreting and scoring the cyto-morphological features.
Methods:  Eighty-three cirrhotic patients undertook a sonography-guided FNA and subsequent needle biopsy for the tumor. HCC was confirmed in 68 cases and cirrhosis with dysplasia in 15 cases by pathology and follow-up for longer than 2 years. Eighteen cytological features were scored as degree of one, two or three according to their presence or prominence.
Results:  Two cases of well-differentiated HCC were diagnosed as negative for HCC initially. The sensitivity, specificity, false positive, false negative and accuracy were 97%, 100%, 0%, 3% and 97.6% for FNA cytology in the diagnosis of HCC, respectively. The score of dysplasia was 20.8 ± 1.3 (mean ± SD) and lower than 26.2 ± 3.4 in Edmondson's grade I HCC ( P  < 0.01), 28.9 ± 2.9 in grade II HCC ( P  < 0.01), and 34.9 ± 4.3 in grade III/IV HCC ( P  < 0.01). The score was also significantly lower in grade II HCC than in grade III/IV HCC ( P  < 0.01).
Conclusions:  FNA yielded a high accuracy in the distinction of dysplasia from HCC with different grades. There is a good correlation in cyto-morphological scores of liver cell dysplasia and HCC with different grades. Dysplasia displayed the lowest score and the score increased in order from dysplasia to grade III/IV HCC.     

Prognostic factors in elderly multiple myeloma patients aged 65 years or older: Comparison with nonelderly patients with multiple myeloma

Background:   Although age is a prognostic factor in multiple myeloma (MM), the prognostic factors in elderly MM patients may be different to those in nonelderly MM patients due to the patient's age. The difference in the significance of prognostic factors between elderly MM patients and the nonelderly MM patients was studied.
Methods:   Forty-two elderly MM patients aged 65 years or older were compared with 68 nonelderly MM patients, who were less than 65 years of age. The characteristics of the elderly patients included: aged 65–81 years (median, 72 years); female/male ratio of 22 : 20; 24 IgG type cases, 13 IgA type cases, one non-secretory case and four cases of Bence-Jones type; one case of stage I, 12 cases at stage II and 29 cases at stage III. The prognostic factors were evaluated by means of univariate analysis and Cox's multivariate analysis.
Results:   The median survival time was significantly shorter in the elderly MM patients (24 months) than in the nonelderly patients (50 months) ( P  < 0.01). Of the univariate prognostic factors, corrected serum Ca (cCa), hemoglobin, serum P, bone marrow plasma cell and uric acid were significant prognostic factors in the elderly MM patients, while nine factors including those listed here, were significant in nonelderly controls. Multivariate analysis showed that serum cCa was the only independent prognostic factor ( P  = 0.019) in elderly MM patients, while serum P and bone lesions were significant prognostic factors in nonelderly MM patients.
Conclusion:   Corrected serum c. (cCa) was an independent prognostic factor in elderly MM patients.