Treatment of non-Hodgkin's lymphoma with marrow transplantation in identical twins

Eight patients with disseminated non-Hodgkin's lymphoma who failed conventional combination chemotherapy were treated with high-dose chemotherapy, a supralethal dose of total-body irradiation, and a bone marrow transplant from a normal identical twin. Seven patients experienced complete remission. Four of the seven patients (two with diffuse poorly differentiated lymphocytic lymphoma, one with composite lymphoma, and one with diffuse moderately well differentiated lymphocytic lymphoma) remain in complete unmaintained remission 12-126 mo from transplantation. One patient relapsed after 10 mo but was retreated and is alive in unmaintained complete remission 73 mo from transplantation. One patient died of Pseudomonas pneumonia while in complete remission and one patient relapsed and died of progressive lymphoma. These results demonstrate that intensive chemoradiotherapy and twin marrow transplantation can induce frequent and enduring remissions in patients with disseminated non-Hodgkin's lymphoma who have failed conventional therapy.     

A prospective randomised controlled study of the use of ranitidine in patients with gastric cancer

Background—Intestinal metaplasia, whether in the cardia or the distal oesophagus, has been uniformly defined as specialised columnar epithelium, suggesting a relation with Barrett''s oesophagus. It is, however, not clear whether the risk factors associated with intestinal metaplasia are identical at both sites.
Aims—To investigate biopsy specimens obtained below the squamocolumnar junction (SCJ) in relation to endoscopic aspect, gastric histology, and clinical presentation.
Patients and methods—In 423 patients investigated the endoscopic aspect of the SCJ was classified as unremarkable (group I, n=315) or suggestive of Barrett''s oesophagus (group II, n=108). Standardised biopsy specimens from the antrum, corpus, and directly below the SCJ were investigated.
Results—Intestinal metaplasia was detected at the SCJ in 13.4% of group I patients, where it was significantly associated with gastric intestinal metaplasia (odds ratio (OR) 6.96; confidence interval (CI) 2.48 to 19.54) and H pylori (OR 7.85; CI 2.82 to 21.85), and in 34.3% of group II patients where it was significantly associated with reflux symptoms (OR 19.98; CI 6.12 to 65.19), erosive oesophagitis (OR 12.16; CI 3.86 to 38.24), and male sex (OR 6.25, CI 2.16 to 18.14), but not with H pylori or gastric intestinal metaplasia.
Conclusion—This study suggests that the pathogenesis of intestinal metaplasia at the SCJ is not uniform: at an endoscopically unremarkable SCJ it is a sequela of H pylori gastritis, but coexisting with endoscopic features of Barrett''s oesophagus it is associated with male sex and gastro-oesophageal reflux disease.

     

Marrow transplantation for chronic myelocytic leukemia: a controlled trial of cyclosporine versus methotrexate for prophylaxis of graft- versus-host disease

Forty-eight patients with chronic myelocytic leukemia, aged 11 to 47, were treated with high-dose cyclophosphamide and fractionated total body irradiation, followed by infusion of marrow from HLA-identical siblings. They were randomized to receive either methotrexate (MTX) (n = 23) or cyclosporine (CSP) (n = 25) as postgrafting prophylaxis for graft-v-host disease (GVHD). All patients had evidence of sustained hematopoietic engraftment. Seventeen of the 25 patients receiving CSP and 17 of the 23 patients receiving MTX are alive between one and almost four (median, 1.7) years, with an actuarial survival rate at three years of 62% and 66%, respectively (P = .60). Also, with respect to most other parameters studied, the two drugs were identical. The probability of acute GVHD was .42 and .46, respectively (P = .70), that of chronic GVHD, .50 and .63 (P = .44), and that of death from transplant-related causes, .30 and .24 (P = .51). There were no differences in the speed of granulocyte and platelet engraftment (P = .82 and .94, respectively), and the duration of hospitalization was comparable (P = .58). Patients receiving MTX required red cell transfusions for a shorter period of time (P = .02), but had a slightly increased morbidity from early oral mucositis. The leukemia recurrence rates were comparable (P = .60). With the regimens used in this study, we conclude that CSP failed to reduce the incidence of GVHD and improve the survival of patients with chronic myelocytic leukemia when compared to results with standard MTX.     

Analysis of pulse wave velocity in the thoracic aorta by flow-sensitive four-dimensional MRI: reproducibility and correlation with characteristics in patients with aortic atherosclerosis

Purpose:

To measure aortic pulse wave velocity (PWV) using flow‐sensitive four‐dimensional (4D) MRI and to evaluate test–retest reliability, inter‐ and intra‐observer variability in volunteers and correlation with characteristics in patients with aortic atherosclerosis.

Materials and Methods:

Flow‐sensitive 4D MRI was performed in 12 volunteers (24 ± 3 years) and 86 acute stroke patients (68 ± 9 years) with aortic atherosclerosis. Retrospectively positioned 28 ± 4 analysis planes along the entire aorta (inter‐slice‐distance = 10 mm) and frame wise lumen segmentation yielded flow‐time‐curves for each plane. Global aortic PWV was calculated from time‐shifts and distances between the upslope portions of all available flow‐time curves.

Results:

Inter‐ and intra‐observer variability of PWV measurements in volunteers (7% and 8%) was low while test–retest reliability (22%) was moderate. PWV in patients was significantly higher compared with volunteers (5.8 ± 2.9 versus 3.8 ± 0.8 m/s; P = 0.02). Among 17 patient characteristics considered, statistical analysis revealed significant (P < 0.05) but low correlation of PWV with age (r = 0.25), aortic valve insufficiency (r = 0.29), and pulse pressure (r = 0.28). Multivariate modeling indicated that aortic valve insufficiency and elevated pulse pressure were significantly associated with higher PWV (adjusted R² = 0.13).

Conclusion:

Flow‐sensitive 4D MRI allows for estimating aortic PWV with low observer dependence and moderate test–retest reliability. PWV in patients correlated with age, aortic valve insufficiency, and pulse pressure. J. Magn. Reson. Imaging 2012;35:1162‐1168. © 2012 Wiley Periodicals, Inc.     

Transfusion-transmitted babesiosis: a case report from a new endemic area

The seventh documented case of babesiosis transmitted by transfusion is reported. Both the donor and the recipient are residents of Connecticut, where the presence of endemic babesiosis has only recently been established. As the range of Babesia microti, and its vector the Ixodes dammini tick, continues to expand, clinicians and blood bank directors should be aware that cases of transfusion-transmitted babesiosis may occur in newly endemic areas.