Whole-abdomen radiation in patients with advanced ovarian carcinoma after surgery,chemotherapy and second-look laparotomy

Summary Forthy-three patients with ovarian carcinoma were treated with whole-abdomen radiation (moving strip±pelvic radiation), 15 patients had not received prior chemotherapy, and 28 patients were irradiated following chemotherapy and second-look laparotomy. Ten of these had been treated with a variety of chemotherapy regimens (L-PAM, CHAD, Hexa-CAF). Eighteen patients were treated in an ongoing prospective trial with combination chemotherapy consisting of melphalan, cis-platinum, and hexamethylmelamin (HexaPAMP). Thrombocytopenia was the limiting toxicity. A temporary pause in the radiation schedule allowing platelets to recover made it possible to complete treatment in 80% of the patients. The acute toxic effects, which included the expected side effects of radiation therapy on intestine, liver and lung, were not more frequent or more severe in the patients who had received prior chemotherapy than in those who had radiation therapy alone. Thirty-four of 43 patients (stage I, seven patients; stage II, seven patients; stage III, 27 patients; stage IV, two patients) are alive and without evidence of disease 26+ months (range 7 to 64 months) after entering the postsurgical treatment program.Paper presented at the Annual Meeting of the Swiss Society for Oncology, Basel, March 1983     

Detection of the hemoglobin E mutation using the color complementation assay: application to complex genotyping

The color complementation assay (CCA) is a method of allele-specific DNA amplification by which competitive priming and extension of fluorescently labeled oligonucleotide primers determine the color of DNA amplification product. This diagnostic method precludes the need for radioisotopes, electrophoresis, and multiple high-stringency reaction conditions. The multiplicity of mutant globin genes present in Southeast Asians complicates clinical diagnosis and underscores the importance of DNA-based diagnostic methods. We have applied CCA to distinguish beta A and beta E alleles. Competing 15mer primers were a fluorescein-labeled complement to beta A and a rhodamine-labeled complement to beta E, identical except for their central nucleotides. A common unlabeled primer was used to amplify DNA product, the color of which was determined by the perfectly complementary primer. Color photography and spectrofluorometry, as well as a method of black-white photography that we developed to distinguish fluorescein- and rhodamine- labeled DNA, were used to record results. We applied CCA to define the complex genotype of a Thai woman with thalassemia intermedia, 96% HbE, and 4% HbF whose possible genotypes included several permutations of alpha-thalassemia, beta-thalassemia, and beta E genes. zeta-Globin gene mapping of DNA doubly digested with Bg/II and Asp 718 showed the -alpha 3.7/--SEA genotype, and CCA confirmed homozygous beta E/beta E. The CCA is useful for diagnosing the compound hemoglobin genotypes of Southeast Asians and could be applied also to prenatal diagnosis in this population.     

Costimulation and Autoimmune Diabetes in BB Rats

Costimulatory signals regulate T-cell activation. To investigate the role of costimulation in autoimmunity and transplantation, we studied the BB rat model of type 1 diabetes. Diabetes-prone BB (BBDP) rats spontaneously develop disease when 55–120 days of age. We observed that two anti-CD28 monoclonal antibodies (mAb) with different functional activities completely prevented diabetes in BBDP rats. Anti-CD154 mAb delayed diabetes, whereas treatment with CTLA4-Ig or anti-CD80 mAb accelerated disease. Anti-CD86 or anti-CD134L mAbs had no effect. Diabetes resistant BB (BBDR) rats are disease-free, but >95% of them develop diabetes after treatment with polyinosinic-polycytidylic acid and an mAb that depletes Treg cells. In the induced BBDR model, anti-CD154 mAb delayed onset of diabetes, whereas CTLA4-Ig, anti-CD134L or either of the anti-CD28 mAbs had little or no effect. In contrast, blockade of the CD134-CD134L pathway was highly effective for preventing autoimmune recurrence against syngeneic islet grafts in diabetic BBDR hosts. Blockade of the CD40-CD154 pathway was also effective, but less so. These data suggest that the effectiveness of costimulation blockade in the treatment of type 1 diabetes is dependent on both the costimulatory pathway targeted and the mechanism of induction, stage, intensity and duration of the pathogenic process.     

A significant incidental finding on cone beam computed tomography: multiple myeloma

Cone beam computed tomography is widely used in dentistry. Incidental findings are common, with many requiring intervention or monitoring. We present a rare case of previously undiagnosed, asymptomatic multiple myeloma first identified incidentally on cone beam computed tomography and panoramic radiography. This case highlights the diverse range of lesions that may appear on cone beam computed tomography and the importance of radiologic interpretation.     

Assessing the utility of yearly pre-season laboratory screening for athletes on a major professional sports team

Objectives

Professional athletes undergo annual pre-season laboratory screening, although clinical evidence supporting the practice is limited and no uniform set of guidelines on pre-season laboratory screening exists. The aim of this study was to assess the clinical value of annual pre-season laboratory screening tests for a major professional sports team over multiple years.

The difficult diagnosis of cartilaginous tibial eminence fractures in young children

Purpose

Anterior tibial eminence fracture is the main mode of ACL failure in patients with open physes. In young children, purely cartilaginous avulsions of the tibial ACL insertion are possible. The aim of this study was to focus on patients referred for misdiagnosed cartilaginous tibial eminence fractures.

Methods

Ten young patients with cartilaginous tibial eminence fractures were identified in the hospital database. Six of them were misdiagnosed and included in this retrospective case series. Clinical data at the time of injury, radiographs and MRI were analysed in order to evaluate the causes which could have led to inappropriate management.

Results

The patients’ median age at the time of injury was 7 years (5–8.5). The main cause of injury was a low-energy domestic accident (n = 4). Radiographs at the time of injury were normal (n = 4) or showed a very thin ossification (n = 2). The traditional MRI findings of ACL injuries were all negative. On T2 sequences, an epiphyseal fluid signal allowed for a retrospective diagnosis. Cartilaginous tibial eminence fractures were regularly prolonged posteriorly giving a ‘double-PCL sign’ in 4 of the 6 patients. On a median of 6 months (2.5–48) after the injury, patients were referred for repeat giving ways (n = 5) and/or limitation of extension or hyperextension (n = 4). Symptoms were related to non-union, ossification and secondary enlargement of the avulsed fragment.

Conclusions

Post-traumatic knee joint effusions in children aged 9 or younger, even occurring after a low energy trauma and with normal radiographs, should suggest a cartilaginous tibial eminence fracture. Systematic MRI examinations should be mandatory in these patients in whom the avulsed fragment may appear as a double-PCL sign. During follow-up, new radiographs are recommended. A better knowledge of this rare entity should allow us to avoid misdiagnosis and to perform an early refixation of the avulsed fragment.

Level of evidence

III.