Radioembolization of the Spleen: A Revisited Approach for the Treatment of Malignant Lymphomatous Splenomegaly

Intraarterial administration of ⁹⁰Y microspheres to the spleen in patients with malignant lymphoma was mentioned once in the literature in 1973. This case study illustrates the potential indication of selective internal radiotherapy in a heavily pretreated patient with highly refractory disease with a marginal zone lymphoma in leukemic phase and symptomatic splenomegaly. We describe the clinical course of disease; the biological and clinical response to the treatment after radioembolization; and simulation and dosimetry by multimodal imaging via single-photon emission computed tomography and computed tomography. The advantages of radioembolization for the management of lymphomatous splenomegaly are discussed.     

Midterm results of 506 solid trispiked reflection cementless acetabular components for primary total hip arthroplasty

The purpose of this prospective study was to evaluate the outcomes and survivorship of a trispiked, sintered bead-coated titanium shell with a polished inner surface, no screw holes, and an improved locking mechanism. A total of 506 total hip arthroplasties with a minimum 5-year follow-up were available for review at a mean of 7 years (range, 5-11 years). Three sockets (0.6%) were revised for reasons other than aseptic loosening, and 14 (2.8%) polyethylene liners were exchanged. There was no difference in revision rate between non-cross-linked and highly cross-linked liners (P = .4). There were no cases of radiographic loosening. Retroacetabular osteolysis was identified in 2%. The overall 5-year and 10-year Kaplan-Meier survivorship was 97.5% and 97.4%, respectively, whereas survivorship of the shell was 99.8%.     

What Works Best,a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial

Background  

Total hip arthroplasty (THA) has been associated with high survival rates, but debate remains concerning the best fixation mode of THA.     

Gait alterations can reduce the risk of edge loading

Following metal‐on‐metal hip arthroplasty, edge loading (i.e., loading near the edge of a prosthesis cup) can increase wear and lead to early revision. The position and coverage angle of the prosthesis cup influence the risk of edge loading. This study investigates the effect of altered gait patterns, more specific hip, and pelvis kinematics, on the orientation of hip contact force and the consequent risk of antero‐superior edge loading using muscle driven simulations of gait. With a cup orientation of 25° anteversion and 50° inclination and a coverage angle of 168°, many gait patterns presented risk of edge loading. Specifically at terminal double support, 189 out of 405 gait patterns indicated a risk of edge loading. At this time instant, the high hip contact forces and the proximity of the hip contact force to the edge of the cup indicated the likelihood of the occurrence of edge loading. Although the cup position contributed most to edge loading, altering kinematics considerably influenced the risk of edge loading. Increased hip abduction, resulting in decreasing hip contact force magnitude, and decreased hip extension, resulting in decreased risk on edge loading, are gait strategies that could prevent edge loading. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1069–1076, 2016.     

Yttrium-90 Microsphere Radioembolization of the Spleen: A New Approach for the Treatment of Malignant Lymphomatous Splenomegaly

To our knowledge, radioembolization with 90Y-labeled microspheres has never been reported for lymphomatous diseases. A 77-year-old man with marginal zone lymphoma with symptomatic splenomegaly (SM) was treated with 3700 MBb. This procedure is safe and effective and deserves further investigation in lymphomatous or other malignant SM.Full AbstractIntroduction90Y-labeled microsphere (90YRE) is used for the locoregional treatment of hepatic neoplasia. To the best of our knowledge, it has never been reported as a therapeutic approach for lymphomatous diseases.Patients and MethodsA 77-year-old man with marginal zone lymphoma CD20⁺ and CD5, CD10, CD23^? developed a lymphomatous leukemia with symptomatic splenomegaly (SM). After several lines of chemotherapies, he progressed into an aggressive clinical disease with a major enlargement of his spleen responsible for hyperleukocytosis above 200000/μL, anemia requiring regular transfusions, abdominal pain, and anorexia. Palliative irradiation of the spleen with 16 Gy allowed an ephemeral hematologic stabilization. In order to reduce the splenic volume, we performed 90YRE. 3700 MBb of 90Y-labelled microspheres (SIRTEX®) was selectively administered via the splenic artery, which corresponds to a total dose of 36 Gy (calculated from treatment simulation/dosimetry with Technetium-99m—labeled macro-aggregates of albumin). This unusual procedure was safe and led to complete normalization of the blood cell counts.DiscussionRadioembolization is a well-known safe procedure for hepatic neoplasia. A similar procedure has been previously reported years ago with a successful outcome for congestive hypersplenism due to idiopathic cirrhosis. Radioembolization by classical approach and splenectomy is usually complicated by severe morbidity. Irradiation could injure adjacent organs. In our patient, 90YRE was well tolerated with reduction of splenic volume. Despite major medullar infiltration with circulating leukemic cells, the complete normalization of the BCC suggests a major role of the irradiation of lymphomatous cells stored or circulating through the spleen. The response duration was 3 months, and the treatment has recently been repeated.ConclusionThis case report suggests that 90YRE is a safe and effective procedure that deserves further investigation in lymphomatous or other malignant SM. Indeed, this procedure was better tolerated than classical embolization, with impressive results in this highly refractory patient.     

An exploration of group compassion‐focused therapy for personality disorder

Background. People with personality disorders, especially those who also experience high self‐criticism and shame, are known to be a therapeutic challenge and there is a high dropout rate from therapy. Compassion‐focused therapy (CFT) was designed to address shame and self‐criticism specifically, and to develop people's ability to be self‐reassuring and more compassionate to themselves and others. Aims. This study explored how CFT affected self‐criticism and self‐attacking thoughts, feelings, and behaviours, as well as the general symptoms of anxiety, stress, and depression of a personality disordered group within an outpatient group setting, and evaluated the extent of maintenance at a 1‐year follow‐up. A secondary objective was to identify some of the key characteristics that such an intervention would require. This was a pilot study exploring the feasibility, acceptability, and potential value of CFT in treating this difficult population and, as such, was designed as a pre‐randomized controlled trial (RCT) to provide evidence to support applications for funding for an RCT. Methods and design. This study utilized a mixed method combining qualitative and quantitative methods to support a programme evaluation. Eight participants were introduced to the evolutionary‐based CFT model and taken through explorations of the nature of self‐criticism and shame. In subsequent sessions, participants were taught the main compassion‐focused exercises, and any difficulties were addressed. The group was asked to share their personal stories and experiences of practicing self‐compassion and to develop compassionate encouragement for each other. Self‐report measures were administered at the beginning, end, and at a 1‐year follow‐up. Results. This 16‐week group therapy was associated with significant reductions in shame measured by the Others as Shamer Scale (OAS), social comparison on the Social Comparison Scale (SCS) feelings of hating oneself, and an increase in abilities to be self‐reassuring on the Self‐Attacking and Self‐Reassuring Scale (FSCRS), depression and stress measured by the Depression Anxiety and Stress Scale (DASS). There were significant changes on all CORE variables, well‐being, risk, functioning, and problems. Also interesting was that all variables showed a trend for continued improvement at 1‐year follow‐up, albeit statistically non‐significant. A content analysis revealed that patients had found it a moving and very significant process in their efforts to develop emotional regulation and self‐understanding. Conclusion. CFT, delivered in a routine psychotherapy department for personality disorders, revealed a beneficial impact on a range of outcome measures. These improvements were maintained and further changes noted at 1‐year follow‐up. Further research is needed to explore the benefits of CFT using more detailed analysis and RCTs.     

Pulmonary vascular lesions are common in SIV- and SHIV-env-infected macaques

The lack of animal models of HIV-related pulmonary arterial hypertension (HIV-PAH) severely limits investigation of this serious disease. While histological evidence of HIV-PAH has been demonstrated in macaques infected with simian immunodeficiency virus (SIV) as well as with chimeric simian/human immunodeficiency virus (SHIV) containing HIV-1-derived Nef protein, other primate models have not been studied. The objective was to document and describe the development of pulmonary vascular changes in macaques infected with SIV or with SIV containing HIV-1-derived envelope protein (SHIV-env). Lung tissue was obtained at necropsy from 13 SHIV (89.6P)-env-infected macaques and 10 SIV (ΔB670)-infected macaques. Pulmonary arterial pathology, including arterial hyperplasia and the presence of plexiform lesions, was compared to normal monkey lung. Pulmonary artery hyperplasia was present in 8 of 13 (62%) SHIV-env-infected macaques and 4/10 (36%) SIV-infected macaques. The most common histopathological lesions were intimal and medial hyperplasia of medium and large pulmonary arteries. Hyperplastic lesions were predominantly due to smooth muscle cell hyperplasia. This is the first report of pulmonary vascular lesions in SHIV-env-infected macaques and confirms prior reports of pulmonary vasculopathy in SIV-infected macaques. The finding of pulmonary arteriopathy in monkeys infected with SHIV not containing HIV-nef suggests that other factors might also be important in the development of HIV-PAH. This SHIV-env model provides a new means to investigate HIV-PAH.