High-dose chemotherapy and stem cell transplantation for patients with stage IV breast cancer without clinically evident disease: correlation of CD34+ selection to clinical outcome

Forty-five patients with metastatic breast cancer without clinically evident disease were treated with thiotepa 750 mg/m2, mitoxantrone 40 mg/m2 and carboplatin 1000 mg/m2 followed by stem cell transplantation to determine the safety and efficacy of CD34+ selection of peripheral blood stem cells. Of these, 15 patients' (group I) stem cells were processed through Baxter Isolex 300 device for CD34+ selection, whereas 30 patients (group II) received unmanipulated stem cells. Toxicity, progression-free survival and survival were compared between these two groups. There was no difference in transfusion requirements, white cell count and platelet recovery and non-hematologic toxicity between the two groups. The survival of patients in group I was 27 months compared to 38 months in group II (P = 0.8). The progression-free survival was 12 months and 13.5 months for group I and group II patients, respectively (P = 0.6). Our results indicate that while there is no adverse effect, there is also no significant advantage of CD34+ selection in terms of progression-free survival and survival in patients with metastatic breast cancer without clinically evident disease. Bone Marrow Transplantation (2000).     

Neonatal anatomical correction of transposition of the great arteries: non-invasive assessment of haemodynamic function up to four years after operation

Intracardiac and great artery blood flow velocities were recorded by pulsed and continuous wave Doppler ultrasound in 18 children aged between eight months and four years (mean 25 months) who had undergone anatomical correction of transposition of the great arteries in the first month of life. Postoperative peak flow velocities across the mitral valve and in the ascending aorta were not significantly different from those in an age matched control population, but tricuspid flow velocities were higher than normal. Aortic regurgitation was detected in only one of the eighteen patients, a markedly lower frequency than that reported after two stage anatomical correction. Peak velocities in the pulmonary artery were higher than normal, and in most cases there was some degree of stenosis of the pulmonary artery at the site of anastomosis.     

Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events

BACKGROUND: Patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) is highly associated with cerebral ischemic events in young patients. The prevalence of PFO and ASA in elderly patients with cerebral ischemic events is not well described. OBJECTIVE: Our study is to evaluate the frequencies of PFO with right-to-left shunt (RLS) and ASA in elderly patients and to determine whether age is a predictor of flow-reversed PFO with RLS in cerebral ischemic events. METHODS: A prospective registry for all consecutive patients with cerebral ischemic events who were evaluated by transesophageal echocardiography (TEE) for the detection of possible cardiac source of embolization was established and maintained in a university hospital. Patients' demographics including age, gender, ethnic origin, cerebrovascular risk factors, and all positive TEE data were collected from July 2000 to August 2001 for statistical analysis. A univariate and multivariate stepwise logistic regression analysis was performed. RESULTS: In older patients the prevalence of PFO with RLS, PFO, and ASA was 25/118 (20%), 28/118 (24%), and 38/118 (32%), respectively, as opposed to younger patients, in whom it was 35/119 (30%), 39/119 (33%), and 38/119 (32%), respectively. Older patients had higher frequencies of hypertension (59; 69%), CAD (25; 21%), and prior history of stroke (23; 20%) as opposed to younger patients. Younger age (<60 years), gender, smoking history, hypertension, hyperlipidemia, CAD, and prior history of stroke were not associated with higher prevalence of PFO with RLS. Patent foramen ovale was associated with ASA (P < 0.001) and LVH (P < 0.019) in patients with TIA and stroke. In multivariate analysis only ASA (P < 0.001) remained significant with PFO, with RLS controlling for age, gender, and LVH. CONCLUSIONS: PFO with RLS and ASA are frequently present in elderly stroke and/or TIA patients and age is not a predictor for PFO. Transesophageal echocardiography should be considered for all stroke and/or TIA patients irrespective of their age.     

Absence of one atrioventricular connexion--a terminologic problem

We present a patient in whom the heart was right-sided, with usual atrial position, absence of the right-sided atrioventricular connexion, and a single outlet via the aorta from a dominant morphologically right ventricle. We use the case to illustrate potential problems in the terminology as used to describe the absence of one atrioventricular connexion. Our case shows why absence of one atrioventricular connexion must be classified according to the side of the missing connexion, and not the anatomy of the atrial or ventricular chambers involved. To simplify the approach to certain hearts, the use of the concept of one concordant or discordant atrioventricular connexion may be justified when the other atrioventricular connexion is absent.     

Treatment of external genital warts in men with imiquimod 2% in cream. A placebo-controlled, double-blind study

OBJECTIVE: The purpose of this double-blind, placebo-controlled study was to evaluate the safety, clinical efficacy and tolerability of imiquimod (2%) in cream to cure external genital warts in males. METHODS: Preselected male patients (n=60) ranging between 18 and 50 years of age (mean 24.2) harbouring 558 lesions (mean 9.3) with clinical, histopathological and polymerase chain reaction (PCR) confirmed diagnosis of human papilloma virus (HPV) infection were randomized to two parallel groups. Each patient was allocated a precoded 25g tube, and instructions on how to apply the trial medication to their lesions at home once daily for three consecutive days per week (max. 12 application in 4 weeks). To evaluate the safety, clinical efficacy and tolerance, patients were exa-mined on a weekly basis. Cure was defined as the total elimination of treated warts with PCR, and Southern blot hybridization confirmed negative HPV DNA. RESULTS: By the end of the treatment, 40% (24/60) patients and 49.8% (278/558) warts were cured. Breaking the code revealed that imiquimod cream had cured 70% (21/30) patients and 86.8% of warts, while placebo healed three subjects and 28 warts (P=0.0001). Eleven patients (18.3%), predominantly in the imiquimod cream group, experienced mild to moderate, non-objective, drug-related side effects with no dropouts. The study was followed up for 18 months from the first day of the treatment, and among the 26 cured patients, one in the imiquimod cream group and two in the placebo had a relapse after 14 months. CONCLUSION: The study demonstrated that 2% imiquimod in cream with mild non-objective side effects is safe, tolerable and significantly more effective than placebo in curing external genital warts in males.