Lymphocyte subset reconstitution patterns in children with small bowel transplantation induced with steroid-free rabbit anti-human thymocyte globulin

Abstract:  Multiple measurements (n = 212) of lymphocyte subsets in 67 children treated with steroid-free Tacrolimus, and rabbit anti-human thymocyte globulin induction demonstrate early reconstitution of T-cytotoxic and NK cells. Reconstitution of CD4+ cells is complete after the second post-transplant year. During the period at risk for rejection, NK and T-cytotoxic cell counts are significantly higher among Rejectors. During periods at increased risk for EBV viral infection, CD4 counts bear a significant inverse relationship to EBV viral load in a subset of at-risk recipients. Rejection-prone children also demonstrate significantly higher counts of total lymphocytes, Tc and NK cells prior to SBTx, and may illustrate one basis for enhanced baseline immunocompetence.     

Pain reduction in osteoporotic patients with vertebral pain without measurable compression

INTRODUCTION: Non-compression osteoporotic vertebral pain (NCOVP) can also cause pain and severe immobilization, such as typical vertebral compression fracture (VCF). The aim of this study was to evaluate whether patients with NCOVP refractory to medical treatment and severely affecting normal daily activities could be offered therapeutic benefit with percutaneous vertebroplasty. METHODS: We conducted a retrospective review of the records of consecutive percutaneous vertebroplasty procedures performed at our institutions during a 28-month period to define a population of patients who suffered from severe NCOVP. Nine such patients were identified based on physical examination, computed tomography, magnetic resonance (MR) imaging, and bone scans. Initial clinical outcomes were assessed by comparing quantitative measurements of pain (10-point scale) and mobility (5-point scale) 1 day before the operation with those 1 day post-operation. A second follow-up took place between 2 weeks and 1 month after the operation, with a third follow-up between 6 and 10 months post-operative. Biopsy was taken in each case. RESULTS: Each patient demonstrated point tenderness over radiographically normal-shaped vertebra. Every patient showed a low signal on T1W images, and seven cases showed a high signal on T2W images inside the vertebra, indicating bone marrow edema. All patients experienced a reduction in pain and an increase in mobility after percutaneous vertebroplasty, with a mean pain reduction of 7.0 points and an average improved mobility of 2.8 points. Biopsy results indicated necrotic and/or degenerative changes in eight cases. CONCLUSION: The clinical outcomes of our patients suggest that NCOVP, mainly verified by abnormal MR signals and biopsy results, can be successfully treated by percutaneous vertebroplasty.     

Acute leukemia: Diagnosis improved by flow cytometry in addition to morphology

Aims:   Immunophenotyping using flow cytometry (FCM) has become an essential component of acute leukemia (AL) diagnosis. This study evaluated the judicious application of FCM as an adjunct to well-informed morpho-cytochemical assessment in patients with acute leukemia.
Methods:   100 untreated patients with AL were studied using morpho-cytochemistry and immunophenotyping through FCM.
Results:   There were 29 patients with acute myeloid leukemia (AML), 47 with B-acute lymphoblastic leukemia (ALL), 20 with T-acute lymphoblastic leukemia (ALL) and four with biphenotypic acute leukemia (BAL). Morpho-cytochemistry without FCM could provide definite diagnosis only in the AML cases. It failed to provide definite diagnosis in ALL patients. Over half (55%) of ALL patients were given the noncommittal label, AL. The remaining 45% patients were labeled a more definite, probable ALL.
Conclusion:   FCM thus had a role to play in ALL patients to confirm a definite and a probable diagnosis, to define therapeutically and prognostically groups such as B and T lineage ALL and to distinguish AML – M0 from ALL. FCM helps in diagnosing AML cases as well, but is a less essential mode of investigation in this group purely from the perspective of the therapy regime. But its role in defining different subgroups in AML is its major use. While morpho-cytochemistry provides a first-line investigation of great therapeutic value, and more so in AML, it needs to be supplemented by flow cytometry, particularly in ALL.     

Cystic lymphangiomatous hamartoma masquerading as massive ascites

We report a 4-year-old boy presenting with a tense massive ascites and large hydrocele. History and physical examination were unremarkable. Routine laboratory studies were normal. Abdominal ultrasonography revealed massive ascites. Contrast CT was suggestive of a large cyst covering the entire peritoneal cavity. At laparotomy, a large cystic tumor was found extending into the scrotum through the left inguinal ring. Histopathologic examination diagnosed the tumor as a cystic lymphangiomatous hemartoma. Although abdominal lymphangiomas are seen in children, but presenting as massive ascites with hydrocele is very rare.     

Lipodystrophy and metabolic complications of highly active antiretroviral therapy

Objective  

To assess the metabolic drug toxicities of first-line, World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens, to estimate the prevalence of body fat redistribution and to identify associated risk factors.