The changing scene of allogeneic stem cell transplantation for chronic myeloid leukemia—a report from the German Registry covering the period from 1998 to 2004

Due to the recent changes in the indication to allogeneic stem cell transplantation (SCT) in chronic myeloid leukemia (CML), we retrospectively analyzed 1,716 patients with different CML stages who received an allograft from related (n?=?767) or unrelated donors (n?=?938) within the German Registry of Stem Cell Transplantation (DRST) from 1998 to 2004. Myeloablative conditioning was performed in 724/871 cases (83%), dose-reduced conditioning in 147/871 (17%). Annual transplantations were decreasing from 357 to 98 (28%) in the period of study, but the proportion of advanced cases was increasing from 32% (112/346) to 53% (50/94) of all SCTs. Stage of disease, intervals from diagnosis, and patients’ age were independent prognostic parameters, while peripheral stem cells and unrelated transplantation seemed equal to bone marrow/related transplantation. This study demonstrates that allo-SCT still has an important role in advanced CML, which emphasizes the need for optimized transplantation strategies for these high-risk patients.     

Clinical aspects of ballistic peripheral nerve injury: shrapnel versus gunshot

Objectives

Ballistic injuries to peripheral nerves pose special challenges in terms of indications, timing and type of surgical intervention. The aim of the present work was to analyze our experience in the surgical treatment of peripheral nerve ballistic injuries with respect to the mechanism of injury (gunshot versus shrapnel), and identify common and dissimilar prognostic factors in both types of injury.

Methods

This study was conducted on 42 patients totaling 58 nerves. Twenty-two patients (32 nerves) were injured by gunshot and 20 patients (26 nerves) by shrapnel. Median postoperative follow-up was 33 months (range 12 months to 14 years).

Results

Overall postoperative outcome appears to be more favorable for gunshot-wound (GSW) patients than shrapnel-injured patients, especially in terms of neuropathic pain relief (75 % vs. 58 % respectively, p < 0.05). Presence of foreign particles in shrapnel injured patients has a negative impact on the surgical outcome in terms of rate of pain improvement (28 % compared to 67 % in patients with and without foreign particles, respectively). Nerve graft reconstruction, rather than neurolysis, seems to be the more beneficial treatment for shrapnel-induced neuropathic pain (100 % vs. 47 % in improvement rate, respectively). Early surgical intervention (median 2 months after injury) significantly relieved neuropathic pain in 83 % of shrapnel-injured patients compared to 58 % in patients operated later.

Conclusions

This study suggests that shrapnel injury is more destructive for nerve tissue than gunshot injury. Our impression is that early surgical intervention in shrapnel injuries and split nerve grafting (especially when small fragments are recognized in the nerve) significantly improve the patient’s functional activity and quality of life.     

Analysis of outcome for elderly patients after microvascular flap surgery: a monocentric retrospective cohort study

Objectives

Increasingly, aging societies pose a challenge, particularly in the most developed countries. This trend leads to an increasing group of old and very old patients presenting unique requirements and challenges. One of these challenges consists in reassessment and adaption of established treatment strategies for the elderly patients. There is an ongoing discussion taking place among cranio-maxillo-facial surgeons about the appropriate extent of reconstructive flap surgery for old patients.

Materials and methods

This monocentric retrospective cohort study investigated 281 reconstructions with microvascular flaps by comparing the risk for a negative outcome, which was defined as revision, flap loss, and patient death, between three subgroups of elderly patients and younger patients. The three subgroups of elderly patients were defined as—1: young old (65–74 years), 2: old (75–84 years), and 3: oldest old (≥ 85 years). The group of the younger patients was defined by age between 50 and 64 years. Data were obtained within a defined period of 42 months.

Results

Significant correlations with a negative outcome were found for the variables stay on IMC/ICU, multiple flaps, and radiotherapy prior surgery. Our data showed no significant correlation between age and a higher risk for a negative outcome.

Conclusion

Defect reconstruction with microvascular flaps in old patients is not related with a higher risk for a negative outcome.

Clinical relevance

Independently of age, treatment with microvascular flaps is an option for all operable patients, with an indication for oncologic surgery. For optimal therapy planning, individual patient resources and preferences should be considered instead of chronologic age.

     

Optimization of filtering correctors for autopilot control laws with special structures

The paper is devoted to the problem of control law optimization for marine ships, which are steered by autopilots under the action of sea disturbances, mainly determined by bias terms and high‐frequency wave components. The essence of the problem is to find a transfer function of the adjustable corrective item (filter) for the autopilot with a special structure, minimizing the functional, which characterizes the intensity of a ship's rudders action. The correspondent dynamic of a closed‐loop system provides an economical regime of the ship motion, with the aim to reduce general fuel consumption and to prevent the wear of actuator elements. A specialized approach to the filter design is proposed based on the modern H_∞ optimization theory, and its applicability and effectiveness are illustrated by the practical example of autopilot synthesis for a transport ship. Copyright © 2015 John Wiley & Sons, Ltd.     

The evolving practice of intrauterine cervix brachytherapy in Canada: A medical physics perspective

PurposeTo determine the current equipment, technology, and treatment planning methods used in Canadian cancer centers for intrauterine cervix brachytherapy.Methods and MaterialsA questionnaire was developed to survey medical physicists in Canada regarding technical aspects of intrauterine cervix brachytherapy. A response was obtained from one physicist at each radiotherapy facility in Canada.ResultsA total of 32 of the 41 Canadian radiotherapy facilities perform intrauterine brachytherapy. Most (88%) use high-dose-rate brachytherapy. Images used for treatment planning are two-dimensional (2D) X-rays (63%), CT (66%), MRI (13%), and cone beam CT (9%). Patients are moved to another room to obtain images at 66% of the centers. Dose is prescribed to a volume at 28% of centers, and dose–volume histogram information is used in evaluating dose to the organs at risk (47%) and target (31%). Manual optimization was the most common optimization method (81%). A total of 69% of the institutions made significant changes within the past 5 years, and 66% plan major changes within the next 2 years.ConclusionsIntrauterine brachytherapy treatment for cervical cancer is rapidly evolving in Canada, with centers moving toward 3D image-based methods. Often these imaging modalities are not located in the brachytherapy room, so studies on immobilization and verification would be useful. Access to MRI is increasing, but remains low, correlating with a low adoption of volume-based parameters for evaluating target coverage. National treatment guidelines would be useful for centers making the transition from 2D to 3D methods and for encouraging access to MRI.