Anti-myeloma activity of endogenous and adoptively transferred activated natural killer cells in experimental multiple myeloma model

OBJECTIVE: Despite advances in autologous stem cell transplantation and chemotherapy, multiple myeloma (MM) remains an incurable disease. Due to the role of natural killer (NK) cells in host resistance against several tumors, it is of interest to explore the anti-MM activity of NK cells. For this reason, we aimed to determine if NK cells provide anti-MM activity following interleukin-2 (IL-2) administration, and if ex vivo activated and intravenously administered NK cells prolong survival in MM-bearing C57BL/KaLwRij mice. METHODS: The anti-MM effect of IL-2 was tested by intraperitoneal injection into the 5T33MM-inoculated mice. Subsequently, in vivo effector cell depletions were performed by administration of anti-NK1.1 or anti-CD8 monoclonal antibodies. Finally, magnetically separated and activated NK cells from splenocytes of C57BL/KaLwRij mice were adoptively transferred to tumor-bearing mice in conjunction with IL-2 treatment. RESULTS: IL-2 administration into MM-bearing mice significantly prolonged their survival. This effect was diminished by in vivo depletion of NK cells. Adoptive transfer of activated NK cells showed a significant in vivo anti-MM effect that was dependent on cell dose. Biodistribution of the marked adoptively transferred NK cells correlated with MM cells' homing sites. CONCLUSION: These data suggest that activated NK cells have a promising potential in adoptive immunotherapy for MM.     

A new method for detecting pedicular wall perforation during pedicle screw insertion.

STUDY DESIGN: Sensitivity, specificity, and predictive value analyses of a method that can be used to detect pedicular wall perforation during pedicle screw insertion were assessed. OBJECTIVE: To determine the accuracy of observing the fatty material expelled during pedicle screw insertion for detecting pedicular wall perforations. SUMMARY OF BACKGROUND DATA: Although many methods for safe and accurate insertion of a pedicle screw are described, the rates of misplacement still are high, and complications may occur from improper placement of pedicle screws. Computer-assisted insertion techniques are reported to be very accurate, but these techniques are not yet commonly available. METHODS: In this study, 74 pedicle screw insertions were observed for the material expelled after drilling for the pedicle screw. The outflows of blood and fatty particles were recorded separately. The position of the pedicle screws after surgery was verified by computed tomography. The specificity, sensitivity, positive and negative predictive values, and kappa statistics were assessed. RESULTS: Visible fatty particles were observed during 51 pedicle screw insertions. The histologic analysis showed that the fatty particles were coming from the bone marrow of the corpus. For the observation of fatty particles in detecting perforations along the pedicle screw pathway, the specificity was 98%, the sensitivity 73%, the positive predictive value 84%, the negative predictive value 95%, and the kappa statistic 0.74. CONCLUSIONS: The observation of fatty particles in the blood that comes out after drilling for the pedicle screw may indicate that there is no perforation along the pedicle screw pathway. The observation is easy to perform and does not require any special instruments. Therefore, it can be used alone or in combination with other methods to improve the accuracy of pedicle screw insertion.     

Open fractures of the proximal humerus treated with the Ilizarov method

We followed 12 patients who had been treated with the Ilizarov method for open proximal humeral fractures for more than 3 years. No wound infection occurred. Avascular necrosis and nonunion were each detected in 1 patient. According to Neer's criteria, the outcome was excellent or satisfactory in 8 patients.     

Patient-Partner Satisfaction with Intracavernous Medication Supported with Oral Agents in Selected Cases of Peyronie's Disease

We attempted to find the most adequate treatment option for some selected cases of Peyronie's disease. Between 1993 and 1996, 38 patients with Peyronie's disease and erectile dysfunction were treated with intracavernous medication, supported with oral colchicine and vitamin E. None of the cases had severe angulation of penis and intolerable pain during erection. Quality of sexual life was assessed by CWRU questionnaire. After ten-month follow-up we found improvement in all parameters, in CWRU. The symptoms of 24 cases diminished. The 21 partners examined were also satisfied with the therapy. We conclude that intracavernous medication combined with oral agents is a useful alternative treatment in selected cases of Peyronie's disease.     

Weekly topotecan for recurrent small cell lung cancer - a retrospective anatolian medical oncology group study

Aim: To evaluate efficacy and tolerability of topotecan treatment for recurrent small cell lung carcinoma.Patients and Methods: A total of 62 patients were evaluated retrospectively. Statistical analysis was performedusing GraphPad Instat (version 3.05). Results: DFifty five of patients (89%) were male and 7 (11%) were female.Median age was 56.7±9.3 (34-75). Forty eight of patients (80%) were extensive stage (ES) at the time of diagnosis.Fifty of the patients (80.6 Medical Oncology Clinic) were given median 5.36 cycles of cisplatin-etoposide (2-8 cycles).Time to recurrence was 15.6±6.13 weeks in patients with limited stage (LS) and 6.3±3.82 weeks in extensivestage (ES) (p<0.0001). Overall survival was 14.0±6.08 months in ES and 17.9±6.88 months in LS. The differencebetween two groups was statistically meaningful (p=0.0447). The overall survival of the patients was 14.8±6.43months (4.5-40 months). In terms of survival, there was no difference between males and females (p=0.1171).In 17 (27%) patients who were refractory to topotecan or in whom progression occurred other chemotherapieswere used. Conclusion: Small cell lung cancer is chemosensitive, but recurrences occur in short time. Otherchemotherapy regimens are used in progression. Topotecan is one of them. Patients who were young and in whomrecurrences occur late had given better response to topotecan. Because of the retrospective nature of the study,we couldn’t reach the records exactly and consequently, rate and duration of response couldn’t be calculated.In recurrent SCLC topotecan is one of the treatment choices. But both hematological and non hematologicalside effects should be taken into consideration.     

High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department

Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.     

Treatment of aggressive non-Hodgkin's lymphoma with dose-intensified epirubicin in combination of cyclophosphamide, vincristine, and prednisone (CEOP-100): a phase II study.

Epirubicin is an agent with a lower incidence of cardiotoxicity and myelotoxicity compared with doxorubicin; and it is active in patients with non-Hodgkin's lymphoma (NHL). Our aim was to define the therapeutic efficacy and toxicity of dose-intensified epirubicin in combination with cyclophosphamide, vincristine, and prednisone (CEOP) in patients with diffuse large-cell NHL. Previously untreated patients aged between 15 and 75 years, with at least one measurable lesion, adequate liver, renal, cardiac functions, and no central nervous system involvement were included in the study. The planned chemotherapy regimen CEOP consisted of cyclophosphamide 750 mg/m2, epirubicin 100 mg/m2, and vincristine 1.4 mg/m2 intravenously on day 1 and 100 mg prednisone taken orally on days 1 to 5. Courses were repeated every 21 days. Patients with stage I and II received four cycles of chemotherapy followed by involved-field radiotherapy, and patients with stage III and IV received six cycles of chemotherapy followed by radiotherapy to bulky lymph node sites. Seventy-five patients were enrolled in the study. The complete response rate was 83.8%, and 72 patients were assessable for toxicity. The most common toxicity was myelosuppression; 13.9% of the patients had grade III-IV neutropenia. Severe mucositis, diarrhea, and emesis were uncommon (<10%). At a median follow-up period of 41 months, the 5-year progression-free survival and overall survival rates were 63.5% and 65.3%, respectively. Increasing the dose intensity of epirubicin can yield a similar complete response rate compared with the regimens used in NHL without significantly increasing the toxicity rate associated with chemotherapy. The role of dose-intensive epirubicin should be investigated further in future randomized trials.     

Spontaneous healing of occlusive type F coronary artery dissection

In the presence of resistance to circumferential expansion of atherosclerotic plaques due to mechanical dilation high shear stresses between stiff plaques and normal vessel segments may occur and thus may result in coronary dissection. Limited data are available on the clinical and angiographic outcome of severe (type E, type F) coronary dissections. Herein, we report a case of type F dissection (causing total occlusion) of proximal right coronary artery during balon angioplasty which healed spontaneously. In conclusion, although the type F dissection has worse prognosis due to complete cessation of distal vessel perfusion, the possibility of spontaneous healing should be kept in mind after unsuccessful intervention.