Autologous stem cell transplantation and stem cell mobilization kinetics in elderly patients with B cell non-Hodgkin lymphoma

As known, the world population is aging and as the life span increases the number of advanced-age lymphomas also shows an upward trend. Autologous hematopoietic stem cell transplantation (HSCT) is the standard treatment modality in chemotherapy-sensitive relapsed or refractory aggressive lymphomas. Increased morbidity and mortality related to both the transplant itself and comorbid diseases can be observed in elderly lymphoma patients. Patients who are 65 years or older and underwent autologous HSCT with B-cell non-Hodgkin lymphoma were retrospectively included in our study. In terms of survival analysis, median follow-up was 34.5 months (8–159) while the overall survival (OS) was 58%. In the univariate analysis of prognostic data in OS, patients who were referred to transplantation with complete response had a statistically significant survival advantage (p = 0.043). In terms of the effect of pre-transplant conditioning regimens on survival, BEAM regimen yielded better results, though not statistically significant. Age, number of chemotherapy cycles received before mobilization and radiation therapy had no significant effect on the CD34 (+) cell count in the final product (p = 0.492, 0.746 and 0.078 respectively). In conclusion, autologous HSCT is a practicable treatment modality that provides survival advantage in suitable advanced-age patients with a diagnosis of B-cell non-Hodgkin lymphoma.     

The predictive effects of the behaviour problem variables on peer victimisation in preschool children

Behaviour problems in young children are fairly common. It has been suggested that approximately 5–14% of preschool children exhibit problem behaviour. There are many reasons for behaviour problems in preschool-aged period children. Researches reveal that link between victimisation and individual differences. However, but still, we do not know the prevalence of the possible precursors of peer victimisation among preschool children. The aim of this study was to investigate the predictive effects the level of behaviour problem variables have on peer victimisation of five to six-year-old children attending preschool education. The sample group of the research included 152 normally developed children selected by simple random sampling method among 5–6 years old children receiving preschool education in the city centre of the province of Çorum in Turkey. The relational survey method was used in this study. The Preschool Behaviour Questionnaire (PBQ) and the Peer Victimisation Scale were used in this study. The PBQ and the Peer Victimisation Scale were completed by the teachers. Results of this study concluded that there was a significant positive relationship between the level of child behaviour problems variables and peer victimisation. In addition, results show that behaviour problems of five to six-year-old preschool children have a significant predictive effect on their peer victimisation.     

Effect of morphine on lower urinary tract discomfort after transurethral resection of prostate under general anesthesia: a randomised clinical study

Background

Lower urinary tract (LUT) discomfort is a common complaint after transurethral resection of the prostate (TURP), and it may lead to agitation and restlessnes. We have evaluated the efficacy of morphine for preventing TURP-related LUT discomfort symptoms.

Methods

This was a prospective randomised study including 60 patients (American Society of Anesthesiologists class I and II) who were scheduled to undergo TURP. The patients were divided into two equally sized groups (group M: morphine, group C: control). A standartized anesthesia method was used. Group M patients received morphine 0.04 mg/kg intravenous (iv) in 100 ml of normal saline followed by an infusion of morphine for 24 h (0.01 mg/kg/h); group C patients received 100 ml normal saline 20 min before the expected extubation time, followed by a normal saline infusion which looked identical to that of the morphine infusion. The incidences and severity of LUT discomfort, postoperative pain, sedation level, postoperative nausea and vomiting (PONV) and respiratory depression were recorded at 0, 1, 2, 6, 12 and 24 h postoperatively.

Results

The incidence of LUT discomfort was lower in group M patients at all time points during the study (p < 0.05) except for 2 h postoperatively, and the severity of LUT discomfort was also lower this group at 0, 12 and 24 h postoperatively (p = 0.001, p = 0.04 and p = 0.02, respectively). Pain (numeric rating scale) scores were lower in group M patients at 0 (p = 0.003) and 6 h (p < 0.001). The need for rescue analgesic was lower in group M patients (19 patients in group C, 10 patients in group M; p = 0.04). The incidence of PONV was higher in group M patients (p = 0.03). The incidence of pruritus, respiratory depression and over-sedation were similar among the groups.

Conclusion

Based on these results, we conclude that morphine effectively reduces LUT discomfort after TURP at a cost of postoperative nausea and vomiting.     

A dose study of remifentanil in combination with propofol during tracheobronchial foreign body removal in children

Study ObjectiveTo assess the effect of two different remifentanil infusion doses on hemodynamic stability and recovery characteristics in children undergoing tracheobronchial foreign body removal during rigid bronchoscopy.DesignProspective, randomized, clinical comparison study.SettingOperating room of a university hospital.Patients70 ASA physical status 1 and 2 children, aged 3–12 years, presenting for tracheobronchial foreign body removal during rigid bronchoscopy.InterventionsChildren were divided equally into two groups to receive either a 0.1 μg/kg/min (Group R1) or 0.2 μg/kg/min (Group R2) remifentanil infusion. Ten minutes after the remifentanil infusion, 3 mg/kg of propofol and 0.02 mg/kg of atropine were given. Anesthesia was maintained with 0.1 μg/kg/min of remifentanil and 100–250 μg/kg/min of propofol in Group R1 and 0.2 μg/kg/min of remifentanil and 100–250 μg/kg/min of propofol in Group R2. After baseline measurements were recorded, 0.2 mg/kg of mivacurium was given intravenously. Ventilation was maintained with 100% O₂ via a “T” piece connected to the side arm of the bronchoscope.MeasurementsHeart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP), and O₂ saturation (SpO₂) were recorded before (baseline) and after induction, and 1, 3, 5, 10, 15, 20, 25, and 30 minutes after insertion of the rigid bronchoscope into the trachea. Emergence characteristics and complications were noted. Statistical analysis was performed using independent samples t-test, repeated measures, and chi-square test as appropriate.Main ResultsGroups were similar in demographics and duration of bronchoscopy and anesthesia (P > 0.05). In Group R1, HR, SBP, DBP, and MAP increased one minute after insertion of the bronchoscope in Group R1 (P < 0.01). Propofol consumption was significantly higher in Group R1 (63.6 ± 30.1 mg) than Group R2 (39.8 ± 26.6 mg; P < 0.01). Time to spontaneous eye opening was 8.6 ± 1.3 minutes in Group R1 and 6.3 ± 1.1 minutes in Group R2 (P < 0.05). The time to recovery to an Aldrete score of 9 was greater in Group R1 (19.8±3.0 min) than Group R2 (16.1±3.0 min; P < 0.01).ConclusionA remifentanil 0.2 μg/kg/min infusion with propofol provides hemodynamic stability and early recovery in children undergoing foreign body removal during rigid bronchoscopy.     

Effects of low-dose doxycycline and bisphosphonate clodronate on alveolar bone loss and gingival levels of matrix metalloproteinase-9 and interleukin-1β in rats with diabetes: a histomorphometric and immunohistochemical study

Background: Bisphosphonates (BPs) and low‐dose doxycycline (LDD) have been shown to inhibit bone resorption and to improve the levels of proinflammatory mediators and destructive enzymes in gingival tissues, respectively. The purpose of this study is to evaluate the effect of mono and combined BP clodronate and LDD therapies in reducing gingival levels of matrix metalloproteinase‐9 (MMP‐9), interleukin‐1β (IL‐1β), and alveolar bone loss in rats with diabetes. Methods: Fifty adult Wistar rats were divided into five study groups as follows: 1) group 1 = diabetes control; 2) group 2 = diabetes + periodontitis; 3) group 3 = diabetes + periodontitis + LDD; 4) group 4 = diabetes + periodontitis + clodronate; and 5) group 5 = diabetes + periodontitis + LDD + clodronate. LDD and clodronate were given as a single agent or as combination therapy during the 7 days of the post‐experimental periodontitis period. On day 7, the rats were sacrificed, the mobility of the tooth was recorded, and block biopsies were removed. The gingival tissues were analyzed histologically and immunohistochemically for expression of MMP‐9 and IL‐1β. Alveolar bone loss was evaluated morphometrically under a light microscope. Data analysis was performed statistically by Kruskal‐Wallis and post hoc Tukey and Spearman correlation tests. Results: Alveolar bone loss was significantly greater in groups 2 through 5 than group 1 (P <0.05) but was not significantly different among groups 2 through 5 (P >0.05). Animals with periodontitis (group 2) expressed significantly higher levels of MMP‐9 and IL‐1β compared with those without periodontitis (group 1) (P <0.05). MMP‐9 expression was significantly lower in group 3 than groups 1, 2, and 5 (P <0.05). IL‐1β expression was significantly lower in the groups 1, 3, 4, and 5 than 2 (P <0.01) but was not significantly different among groups 1, 3, 4, and 5. Positive correlations were found between alveolar bone loss and density of inflammation (ρ = 0.319, P = 0.021) and between MMP‐9 and IL‐1β (ρ = 0.418, P = 0.002), respectively. Conclusion: Our findings suggest that ligature‐induced periodontitis in animals with diabetes results in significantly higher levels of MMP‐9 and IL‐1β expression in gingiva. The use of mono and combined clodronate and LDD administrations may significantly reduce levels of MMP‐9 and IL‐1β expression. However, drug administration did not affect alveolar bone levels during the study period.     

Serial Quantiferon‐TB Gold test results in 279 patients with psoriasis receiving biologic therapy

The risk of active tuberculosis is still a concern in patients receiving biologics. To determine the risk of latent tuberculosis infection (LTBI) reactivation by Quantiferon‐TB Gold (QFT) assay in psoriatic patients treated with biologics in 11 years' follow‐up, along with chest radiography alterations. This retrospective study included 279 patients with plaque‐type and/or pustular, or nail psoriasis who were treated with biologics, and had results for ≥2 LTBI tests. The QFT outcomes were defined according to the baseline and the follow‐up QFT results; seroconversion as from negative to positive, seroreversion as from positive to negative, persistently seronegative as invariantly negative, persistently seropositive as invariantly positive, and other any result was accepted as indeterminate. Demographic features, the presence and the type of any chest X‐ray abnormality was noted during the follow‐up. Of 279 baseline QFT tests, the vast majority were negative (n = 193; 69%), with a less of positive (n = 86; 31%). Ten (5.2%) of 193 patients converted from negative to positive QFT status after starting biologic therapy (P < 0.001) during 11 years' follow‐up. Although these 10 patients exhibited seroconversion of QFT from negative to positive, only one patient was diagnosed with active TB. There was no statistically significant difference among biologics as regards with QFT seroconversion risk (P = .09). This study showed that 5.2% of patients showed seroconversion. Annual QFT testing remains a necessary and mandatory tool to prevent further TB reactivation in psoriasis patients taking biologic therapy although only one patient was diagnosed with active TB in this cohort.     

Contribution of MRI to ultrasound in the diagnosis of fetal anomalies

Purpose:

To evaluate the contribution of MRI to ultrasound (US) in the diagnosis of fetal anomalies.

Materials and Methods:

After informed consent and institutional review board approval, concomitant US and MR imaging were performed for 184 fetuses with suspected anomalies in university hospital. Postnatal final diagnoses were obtained for 183 anomalies in 151 fetuses either by radiological examination, surgery, autopsy, or inspection. The prenatal US and MR diagnoses were compared with respect to postnatal diagnoses. Sign test was used to determine the statistical significance.

Results:

Both ultrasound and MR imaging correctly diagnosed 93 (50%) cases and failed in 12 (7%) cases. Ultrasound was superior in 7 (4%) cases. MR imaging was superior in 71 (39%) cases (P < 0.001). MR contributed to the prenatal diagnosis by the confirmation of the suspected US diagnosis in 13%, by demonstration of additional findings in 31% and by changing the diagnosis in 56% of the cases. The contribution rates were 55% for the central nervous system (CNS) (P < 0.001), 44% for thorax (P = 0.016), 38% for gastrointestinal system (GIS) (P = 0.031) and 29% for genitourinary system (GUS) (P = 0.003) anomalies. In facial, cardiac and extremity‐skeletal system anomalies, there was not a significant contribution of MR imaging over US.

Conclusion:

MR imaging can be used as an adjunct to US in the prenatal diagnosis of fetal anomalies of not only the CNS but also the non‐CNS origin especially those involving the GIS, GUS and thorax. J. Magn. Reson. Imaging 2012;35:882–890. © 2011 Wiley Periodicals, Inc.