Pregnancy under treatment of imatinib and successful labor in a patient with chronic myelogenous leukemia (CML). Outcome of discontinuation of imatinib therapy after achieving a molecular remission

Because of the teratogenicity data in rats, it is recommended that women treated with imatinib should be aware of the potential teratogenicity of imatinib and effective contraception should be used during imatinib therapy to prevent pregnancy. We describe successful pregnancy and delivery, without any congenital anomaly, in a patient with CML under treatment of imatinib. The fetus had been exposed to imatinib for 8 weeks. The patient remained off treatment during gestation and cytogenetic relapse of CML (5 months after discontinuation of imatinib therapy) developed at seventh month of gestation.     

A Scaffold-Free Multicellular Three-Dimensional In Vitro Model of Osteogenesis

In vitro models of osteogenesis are essential for investigating bone biology and the effects of pharmaceutical, chemical, and physical cues on bone formation. Osteogenesis takes place in a complex three-dimensional (3D) environment with cells from both mesenchymal and hematopoietic origins. Existing in vitro models of osteogenesis include two-dimensional (2D) single type cell monolayers and 3D cultures. However, an in vitro scaffold-free multicellular 3D model of osteogenesis is missing. We hypothesized that the self-inductive ossification capacity of bone marrow tissue can be harnessed in vitro and employed as a scaffold-free multicellular 3D model of osteogenesis. Therefore, rat bone marrow tissue was cultured for 28 days in three settings: 2D monolayer, 3D homogenized pellet, and 3D organotypic explant. The ossification potential of marrow in each condition was quantified by micro-computed tomography. The 3D organotypic marrow explant culture resulted in the greatest level of ossification with plate-like bone formations (up to 5 mm in diameter and 0.24 mm in thickness). To evaluate the mimicry of the organotypic marrow explants to newly forming native bone tissue, detailed compositional and morphological analyses were performed, including characterization of the ossified matrix by histochemistry, immunohistochemistry, Raman microspectroscopy, energy dispersive X-ray spectroscopy, backscattered electron microscopy, and micromechanical tests. The results indicated that the 3D organotypic marrow explant culture model mimics newly forming native bone tissue in terms of the characteristics studied. Therefore, this platform holds significant potential to be used as a model of osteogenesis, offering an alternative to in vitro monolayer cultures and in vivo animal models.     

Thrombotic thrombocytopenic purpura associated with everolimus use in a renal transplant patient

Thrombotic microangiopathy (TMA) in renal transplantation (RTX) generally develops during treatment with calcineurin inhibitors. We present a RTX case that developed TMA under everolimus treatment. A 40-year-old woman received a kidney allograft from her 77-year-old mother. She initially received tacrolimus, mycophenolate mofetil and steroids. She was discharged with a creatinine level of 2.2 mg/dl after treatment for a cellular rejection attack within the first two weeks after transplantation. Later on, tacrolimus was replaced with everolimus. One year later, she presented with fever and increased creatinine level (4 mg/dl), anemia and thrombocytopenia. Her peripheral blood smear revealed signs of microangiopathic hemolysis. Bone marrow examination revealed an increased number of megakaryocytes. We diagnosed the case as TMA and initiated plasma exchange, I.V. pulse steroid treatment and stopped everolimus. This approach improved laboratory and clinic abnormalities. The development of TMA after treatment with everolimus and the exclusion of other possible causes suggested TMA associated with proliferating signal inhibitors (PSIs) in our case.     

Finger pulp reconstruction with free dorsoulnar artery perforator (DUAP) flap

Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly important for optimal handling and sensation. Ideal substitute must provide matching texture, tenacity, and slim subcutaneous fat. This article presents six cases in which fingertip and finger pulp reconstruction were performed via free dorsoulnar artery perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without any complications by the end of at least 3 months follow-up. Free DUAP flap has proved to be a suitable substitute for pulp reconstruction with its thin structure, minimally morbid donor site which is also close to the trauma zone, and possibility for neurotization. It can be especially favorable when splitting the surgical team for a glabrous flap harvest from the foot is not possible.     

Frequency of metastases at the area of the supraretrospinal (level IIB) lymph node in laryngeal cancer

BACKGROUND: Neck dissection is the surgical gold standard for the treatment of patients with cervical lymphatic spread. The purpose of this study was to determine the presence of metastases in the supraretrospinal (level IIB) nodal group and the necessity of routine dissection of level IIB during neck dissection, in patients with squamous cell carcinoma of the larynx. METHODS: Over a 4-year period (between January 2000 and June 2004), the records of patients undergoing laryngectomy and neck dissection were retrospectively evaluated. The numbers of the lymph node and carcinoma metastases at level IIB were recorded. The American Joint Committee on Cancer tumor-node-metastasis classification system was used to classify the primary tumor and neck, and the Memorial Sloan-Kettering Cancer Center classification was used to classify the cervical lymphatic chain. RESULTS: Sixty-three patients with 98 neck dissections were included in the study. Two patients (3.17%) had subglottic lesions, 19 patients (30.15%) had glottic lesions, and 42 patients (66.66%) had supraglottic lesions. In total, 673 lymph nodes were dissected from level II, and 340 were dissected from level IIB. The 11 supraretrospinal lymph nodes of the 340 dissected nodes demonstrated histologic evidence of metastases (3.23%). Six patients (9.52%; 6/63) had metastases at level IIB, and 2 of them also had synchronous metastases at the contralateral level IIB. The patients without palpable lymph nodes at the neck had no metastases at level IIB. CONCLUSION: Our results showed that, if the level IIA shows positive metastatic changes, perioperative pathologic examination by frozen section that includes level IIb could be an alternative approach. This area may not be routinely dissected during the surgical management of laryngeal carcinoma with no palpable lymph nodes.     

The extensor indicis et medii communis

The aim of this study was to examine the existence of the extensor indicis et medii communis in detail. Thirty-one randomly selected adult cadavers (62 upper extremities) were examined for this project (22 males and 9 females between the ages 38 and 87). The muscle was observed in 3 of 62 hands, an incidence of 4.8%. One was in the right and the other two were in the left hands. Mean length and width of the muscle belly were 4.5 +/- 0.8 and 0.8 +/- 0.3 mm, respectively. Although the muscle did not have a junctura tendinum attachment between its two tendons, in one hand, the tendon to the index finger gave a thin slip to the tendon of the extensor digitorum communis for the same finger. Knowledge of variant muscle may be important when one is assessing the traumatized or diseased hand.