Hepatobiliary scanning in cholecystitis

To validate the use of ^99mTc-PIPIDA in the diagnosis of biliary tract disease, 117 patients with clinical symptoms of acute cholecystitis were prospectively scanned as an initial screening test. The accuracy of the test was evaluated on the basis of surgical pathology in 59 patients. Three groups were defined: cystic duct obstruction, common duct obstruction, and normal scan. The diagnostic accuracy of the test for acute cholecystitis was 97%. Complete common duct obstruction was confirmed at surgery in 12 patients (100%). A normal scan helped to rule out acute cholecystitis. Jaundice did not influence the reliability of the method. Hepatobiliary scanning is an accurate, safe, and rapid diagnostic test for acute cholecystitis.     

Blastoschizomyces capitatus pneumonia in an immuno-competent female

Pulmonary infection due to Blastoschizomyces capitatus is less common. It is an emerging fungal pathogen. We describe a case of Blastoschizomyces capitatus pneumonia in an otherwise healthy female and review the clinical presentation, microbiological characteristics, and treatment for B. capitatus infection.     

European LeukemiaNet criteria for failure or suboptimal response reliably identify patients with CML in early chronic phase treated with imatinib whose eventual outcome is poor

The majority of patients with chronic myeloid leukemia in chronic phase gain substantial benefit from imatinib but some fail to respond or lose their initial response. In 2006, the European LeukemiaNet published recommendations designed to help identify patients responding poorly to imatinib. Patients were evaluated at 3, 6, 12, and 18 months and some were classified as "failure" or "suboptimal responders." We analyzed outcomes for 224 patients with chronic myeloid leukemia in chronic phase treated in a single institution to validate these recommendations. Patients were followed for a median of 46.1 months. At each time point, patients classified as "failure" showed significantly worse survival, progression-free survival, and cytogenetic response than other patients; for example, based on the assessment at 12 months, the 5-year survival was 87.1% versus 95.1% (P = .02), progression-free survival 76.% versus 90% (P = .002), and complete cytogenetic response rate 26.7% versus 94.1% (P < .001). Similarly, the criteria for "suboptimal response" at 6 and 12 months identified patients destined to fare badly, although criteria at 18 months were less useful. The predictive value of some other individual criteria varied. In general, the LeukemiaNet criteria have useful predictive value, but a case could now be made for combining the categories "failure" and "suboptimal response."