Polymyositis after donor lymphocyte infusion

Chronic graft-versus-host disease (GVHD) is a common long-term complication of allogeneic hematopoietic stem-cell transplantation (HSCT), and is responsible for morbidity, mortality and a decrease in quality of life of patients after SCT. Polymyositis, which usually co-occurs with other manifestations of GVHD, has previously been reported. However, polymyositis as the sole manifestation of chronic GVHD following donor lymphocyte infusion (DLI) is rare. We report a 30-year-old man with Hodgkin's lymphoma who developed acute polymyositis following treatment by DLI 4?months post-allogeneic HSCT. The patient developed fever and generalized myalgia 22?days after a single dose of DLI. Laboratory testing showed elevated muscle enzymes and myopathic abnormalities on electromyographic examination. Muscle biopsy showed features of acute polymyositis, with widespread foci of muscle fiber necrosis associated with infiltration of small mononuclear cells. Twenty-four hours after diagnosis, the patient developed a fatal ventricular arrhythmia. Cardiac involvement may occur in association with polymyositis, but usually occurs in elderly patients after several months of illness. The present case highlights the importance of systematic cardiac evaluation when a diagnosis of polymyositis is initially made to exclude this infrequent presentation of chronic GVHD characteristically associated with some HLA-DR haplotypes.     

Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy

AIM:To compare the bowel cleansing efficacy of same day ingestion of 4-L sulfa-free polyethylene glycol(4-L SF-PEG)vs 2-L polyethylene glycol solution with ascorbic acid(2-L PEG+Asc)in patients undergoing afternoon colonoscopy.METHODS:206 patients(mean age 56.7 years,61%male)undergoing outpatient screening or surveillance colonoscopies were prospectively randomized to receive either 4-L SF-PEG(n=104)or 2-L PEG+Asc solution(n=102).Colonoscopies were performed by two blinded endoscopists.Bowel preparation was graded using the Ottawa scale.Each participant completed a satisfaction and side effect survey.RESULTS:There was no difference in patient demographics amongst groups.4-L SF-PEG resulted in better Ottawa scores compared to 2-L PEG+Asc,4.2 vs4.9(P=0.0186);left colon:1.33 vs 1.57 respectively(P=0.0224),right colon:1.38 vs 1.63 respectively(P=0.0097).No difference in Ottawa scores was found for the mid colon or amount of fluid.Patient satisfaction was similar for both arms but those assigned to 4-L SF-PEG reported less bloating:23.1%vs 11.5%(P=0.0235).Overall polyp detection,adenomatous polyp and advanced adenoma detection rates were similar between the two groups.CONCLUSION:Morning only 4-L SF-PEG provided superior cleansing with less bloating as compared to 2-L PEG+Asc bowel preparation for afternoon colonoscopy.Thus,future studies evaluating efficacy of morning only preparation for afternoon colonoscopy should use4-L SF-PEG as the standard comparator.     

Magnetic resonance imaging of cerebrotendinous xanthomatosis

Cerebrotendinous xanthomatosis is a rare familial sterol storage disease with accumulation of cholestanol and cholesterol particularly in xanthomas, bile and brain. Magnetic resonance imaging is a useful modality for imaging the affected tissues. It contributes to the evaluation and management of the disease.     

5-单硝酸异山梨酯血药浓度测定及其在人的药代动力学

采用气相色谱-电子捕获检测法测定 5-单硝酸异山梨酯的血药浓度。样品经乙醚—正己烷混合溶剂提取,三氟醋酐进行衍生化后,用5% SE-30硅烷化玻璃填充柱分离,以硝酸异山梨酯为内标,⁶³Ni电子捕获检测器检测。此法操作简便,日内、日间误差分别小于4%和6.5%,平均回收率为99.62%±1.19%。在20～800ng·mL^-1血浆浓度范围内呈线性关系(γ=0.9995)。最低检测浓度为2.0ng·mL^-1。应用此法研究了10名健康志愿者单次口服20mg 5-单硝酸异山梨酯片后的药代动力学。     

Convergence of neural systems processing stimulus associations and coordinating motor responses

A sensory-sensory learning paradigm was used to measure neural changes in humans during acquisition of an association between an auditory and visual stimulus. Three multivariate partial least-squares (PLS) analyses of positron emission tomography data identified distributed neural systems related to (i) processing the significance of the auditory stimulus, (ii) mediating the acquisition of the behavioral response, and (iii) the spatial overlap between these two systems. The system that processed the significance of the tone engaged primarily right hemisphere regions and included dorsolateral prefrontal cortex, putamen, and inferior parietal and temporal cortices. Activity changes in left occipital cortex were also identified, most likely reflecting the learned expectancy of the upcoming visual event. The system related to behavior was similar to that which coded the significance of the tone, including dorsal occipital cortex. The PLS analysis of the concordance between these two systems showed substantial regional overlap, and included occipital, dorsolateral prefrontal, and limbic cortices. However, activity in dorsomedial prefrontal cortex was strictly related to processing the auditory stimulus and not to behavior. Taken together, the PLS analyses identified a system that contained a sensory-motor component (comprised of occipital, temporal association and sensorimotor cortices) and a medial prefrontallimbic component, that as a group simultaneously embodied the learning-related response to the stimuli and the subsequent change in behavior.      

Real-time digital angiocardiography using a temporal high-pass filter

A temporal high-pass filtration technique for digital subtraction angiocardiography was studied, using real-time digital studies performed simultaneously with routine cineangiocardiography (cine) for qualitative image comparison. The digital studies showed increased contrast and suppression of background anatomy and also enhanced detection of wall motion abnormalities when compared with cine. This digital technique is compatible with panning the image intensifier during an injection. The digital images are comparable with, and in some cases better than, cine images. Clinical efficacy of this digital technique is currently being evaluated. Real-time display, as well as potential reductions in radiation and contrast material doses, may make digital angiocardiography an attractive technique.     

Bone marrow transplantation for refractory acute leukemia in 34 patients with identical twins

Thirty-four patients aged 4-67 yr (median 17) with acute lymphocytic leukemia (ALL) (18 patients) or acute nonlymphocytic leukemia (ANL) (16 patients) who failed to enter complete remission (CR) or relapsed on conventional chemotherapy were treated with cyclophosphamide (CY), 60 mg/kg/day for 2 days, 1000 rad total body irradiation, and a marrow transplant from a genotypically identical normal twin. Sixteen of the patients received additional chemotherapy within the week before CY. After the transplant, 23 patients received immunotherapy consisting of killed autologous leukemic cells and/or normal twin peripheral blood lymphocytes, 16 as part of a prospectively randomized study. One moribund patient died before engraftment. Nine patients (6 ALL, 3 ANL) continued to have detectable leukemic cells. Twenty-four patients (70%) achieved CR. One of them died of viral hepatitis at 1 mo and another of viral interstitial pneumonitis at 4 mo in CR. Fourteen patients (7 ALL, 7 ANL) relapsed 2-16 mo (median 4) after transplantation. However, 8 patients (24%) (3 ALL, 5 ANL) remain in CR without any maintenance chemotherapy at 29-103 mo (median 80) after the transplant. The end results were not signficantly influenced by the type of leukemia, the immediated pre-CY chemotherapy, or the immunotherapy. The results show that this approach, even when applied to endstage patients with acute leukemia in relapse, causes tolerable morbidity, rare nonleukemic deaths, and frequent remissions, some of which represent cures.