Spinal compression due to ossified yellow ligament: a short series of 5 patients and literature review

BACKGROUND: Ossification of ligamentum flavum in the thoracic region causing compressive myelopathy among middle-aged patients is a poorly described entity. CASE DESCRIPTION: Five patients of Indian origin with OYL are described. Their clinical presentations, surgical options, and long-term outcome are presented. Radiologic and clinical follow-up of one of the patient is described over a span of 10 years. CONCLUSIONS: Decompressive laminectomy and excision of the OYL is the commonly performed surgical procedure. A rapid neurologic improvement follows decompression. The persistent spasticity in certain patients is attributed to irreversible changes within the cord. The disease is thought to be progressive in nature. The prolonged follow-up of these patients suggests that the long-term prognosis is poor. Selective racial involvement and variable clinical presentations, with treatment options, are discussed.     

A clinical trial with chimeric monoclonal antibody WX-G250 and low dose interleukin-2 pulsing scheme for advanced renal cell carcinoma

PURPOSE: WX-G250 is a chimeric monoclonal antibody that binds to carbonic anhydrase IX(G250/MN), which is present on greater than 95% of RCCs of the clear cell subtype. The suggested working mechanism of WX-G250 is by ADCC. Because the number of activated ADCC effector cells can be increased by a low dose interleukin-2 pulsing schedule, a multicenter study was initiated to investigate whether WX-G250 combined with LD-IL-2 could lead to an improved clinical outcome in patients with progressive RCC. MATERIALS AND METHODS: A total of 35 patients with progressive clear cell RCC received weekly infusions of WX-G250 for 11 weeks combined with a daily LD-IL-2 regimen. Patients were monitored longitudinally for ADCC capacity. Radiological assessment of metastatic lesions was performed at week 16 and regularly until disease progression. RESULTS: A durable clinical benefit was achieved in 8 of 35 patients (23%), including 3 with a partial response and 5 with stabilization at 24 weeks or greater. Mean survival was 22 months. In general treatment was well tolerated with little toxicity. The number of effector cells increased during treatment but lytic capacity per cell did not increase. ADCC and clinical outcome did not appear to correlate. CONCLUSIONS: WX-G250 combined with LD-IL-2 in patients with metastatic RCC is safe and well tolerated. With a substantial clinical benefit and a median survival of 22 months in patients with metastatic RCC who have progressive disease at study entry combination therapy showed increased overall survival compared to WX-G250 monotherapy. Survival was at least similar to that of currently used cytokine regimens but with a favorable toxicity profile.     

Granulocytic sarcoma of the female genital tract: report of a case with an unusual presentation

Granulocytic sarcoma of the female genital tract is a rare occurrence. A case of a perimenopausal female is presented who reported with a history of menorrhagia with a lump in the abdomen. A diagnosis of fibroid uterus was made but laparotomy findings were suggestive of inoperable ovarian malignancy with metastases. Postoperatively the patient suddenly became very anemic. Hematological investigations and histopathological reports from ovaries, myometrium, endometrium and intraperitoneal deposits all revealed acute myeloid leukemia. The patient received two cycles of chemotherapy but later succumbed to her disease. Extrauterine causes of menorrhagia should be considered before instituting definitive treatment. Preoperative induction chemotherapy may be more successful in cases of granulocytic sarcoma who tend to have a poor prognosis.     

The in vivo radiation response of an experimental tumor: the effect of exposing tumor-bearing mice to a reduced oxygen environment prior to but not during irradiation.

The effect of single or fractionated doses of radiaton on the transplantable KHT sarcoma has been studied in mice which were exposed to a reduced oxygen (O₂) environment prior to but not during irradiation. Tumor-bearing mice were kept in a 12% O₂ environment for a period of time; then their tumors were irradiated locally with a single dose of 2000 rad at a dose rate of 1140 rad/min while the mice breathed air, O₂ or carbogen (5% CO₂:95% O₂). Following irradiation, tumor cell survival was determined using an in vivo lung colony or an in vitro agar colony assay.The results indicate that overnight exposure of tumor-bearing mice (15 hr) to 12% O₂, prior to irradiation of their tumors under air-breathing conditions, leads to a reduction in tumor cell survival by a factor of 3–4 over that found for tumors of air-breathing mice not given a low O₂ pre-treatment. A similar reduction in tumor cell survival is observed for irradiation without prior exposure to the low O₂ environment when the mice are given O₂ or carbogen to breathe instead of air. If the tumors are irradiated while the animals breathe O₂ or carbogen after exposure to 12% O₂, tumor cell survival is reduced to a value ～10 times lower than is obtained in tumors of air-breathing mice not given a low O₂ pre-treatment.During a course of fractionated radiation (seven 500 rad fractions at 24 hr intervals) delivered while the tumor-bearing mice breathed air or carbogen, a 12% O₂ exposure prior to alternate dose fractions was found to lead to significant enhancement of tumor cell killing above that observed when no pre-treatment with 12% O₂ was employed. The reduction in tumor cell survival almost certainly results from a decrease in the number of hypoxic cells in the tumors but the mechanism by which this reduction occurs is not known at present. The decrease may be because of direct killing of hypoxic cells by the low O₂ environment or because of physiological adaptation to the low O₂ environment which persists when the animals are returned to an air atmosphere, leading to an improved O₂ delivery to the tumor. A number of adaptation mechanisms were studied but these shpwed little correlation with the radiobiological effect. Consequently, no clear explanation of the results can be given at present. Regardless of the mechanism, the findings indicate an approach to increasing the effectiveness of radiation treatment of tumors.     

Middle cerebral occlusion in young children

Summary Two cases of acute hemiplegia of apparently obscure aetiology showing middle cerebral artery occlusio, flat presented. Arteritis is suggested as a cause of occlusion. The literature is discussed.