Comparison between two fludarabine-based reduced-intensity conditioning regimens before allogeneic hematopoietic stem-cell transplantation: fludarabine/melphalan is associated with higher incidence of acute graft-versus-host disease and non-relapse mortality and lower incidence of relapse than fludarabine/busulfan.

Reduced-intensity conditioning (RIC) regimens are increasingly used in allogeneic stem-cell transplantation (SCT). There are no data whether any of these regimens has advantage and in what setting. We retrospectively analyzed SCT outcomes in 151 patients given fludarabine-based RIC for various hematological malignancies; 72 conditioned with fludarabine and intravenous-busulfan (FB) and 79 with fludarabine and melphalan (FM). FM was more myelosuppressive. Grade III-IV organ toxicity occurred in 31 and 53% of FB and FM recipients (P=0.005) and acute graft-versus-host disease grade II-IV in 33 and 53%, respectively (P=0.01). Non-relapse mortality rate (NRM) was 16 and 40%, respectively (P=0.003). Active disease (HR 2.2, P=0.003) and prior autologous SCT (HR 1.7, P=0.04) predicted inferior overall survival (OS). Among patients transplanted in remission, OS was 72 and 36% after FB and FM, respectively (P=0.03) due to increased NRM with FM. Similarly, patients transplanted in active disease experienced higher NRM with FM, however lower relapse rates resulted in equivalent OS. In conclusion, there are marked differences in outcome between RIC regimens that are theoretically dose-equivalent. The FM regimen is more myelosuppressive and toxic but controls disease better. FB was associated with improved survival in patients transplanted in remission. These observations merit further study in prospective studies.     

An unusual case of a postoperative bone cyst

We describe an unusual case of a postoperative bone cyst resulting from a retained fragment of surgical glove. We highlight some of the problems associated with gloves and suggest ways of safeguarding against similar complications.     

Treatment of conjunctival papillomata with topical interferon Alfa-2b

PURPOSE: Two patients with biopsy-proven conjunctival papillomata exhibited complete resolution after treatment with topical Interferon Alfa-2b (IFNalpha2b). DESIGN: Interventional case reports. METHODS: Two patients with monocular biopsy-confirmed conjunctival papillomata were treated with IFNalpha2b, 1 million units/cc, one drop four times daily until clinical resolution was achieved. RESULTS: (Patient 1) The lesion's size was significantly reduced at 1 month. Complete resolution was noted at the 3-month visit. No recurrences were seen 40 months post-treatment. (Patient 2) The lesion completely resolved after 6 weeks of treatment. No recurrence has occurred 18 months post-treatment. No systemic or local side effect of treatment was noted. CONCLUSIONS: Two sizable conjunctival papillomata resolved using topical IFNalpha2b alone. Interferon is usually not considered effective for large solid tumors without surgical debulking. We realize that this is a limited case series, but these cases may serve as a basis for further investigation.     

Epileptic negative myoclonus in a newborn with hemimegalencephaly

PURPOSE: We report the case of a male newborn with Ohtahara syndrome and right hemimegalencephaly who presented epileptic negative myoclonus in the first days of life. METHODS: Prolonged polygraphic studies were performed, as well as MRI and a full clinical examination. RESULTS: EEG showed a constant and nonreactive pattern of burst suppression. There were several kinds of electro-clinical seizures (generalized myoclonia, short atonias, typical spasm and tonic spasms) at the beginning of the EEG's burst. The periods of EMG silence, lasting less than 300 ms, were associated with stereotyped EEG transients. CONCLUSIONS: Epileptic negative myoclonus can be observed also in neonatal age. The short transient impairment of motor function observed in the newborn seems linked to the slow component of spike-wave discharge, but its mechanism is still not clear.     

Hazard/Risk Assessment of Pyridaben: II. Outdoor Aquatic Toxicity Studies and the Water-Effect Ratio

Outdoor acute aquatic toxicity studies with pyridaben and bluegill sunfish (Lepomis macrochirus) and mysid (Mysidopsis bahia) showed that the 96-h LC50s in site-specific water were significantly greater than in classical laboratory studies. In addition, outdoor acute studies showed that pyridaben degrades rapidly in water, in hours, which supports other laboratory and field studies on the fate of pyridaben in aquatic systems. Chronic toxicity to aquatic organisms is not an issue after application in the field because exposures will be brief. The water-effect ratio (WER) of site-specific to laboratory-water 96-h LC50s for L. macrochirus and M. bahia were 18.5 and 24.5, respectively. The lowest WER was used as an application factor with the laboratory LC50 values of several other aquatic organisms to develop adjusted site-specific LC50 values. Comparison of the distribution of adjusted LC50 values with a distribution of potential environmental exposure concentrations for pyridaben in water indicates minimal acute risk to aquatic organisms. When only acute laboratory data are available, the WER approach is a relevant and realistic means for determining an application factor and for estimating the aquatic hazard/risk assessment of non-persistent pesticides, because it considers a host of factors that affect bioavailability and subsequent toxicity.