Effect of three surface conditioning methods to improve bond strength of particulate filler resin composites

The use of resin-based composite materials in operative dentistry is increasing, including applications in stress-bearing areas. However, composite restorations, in common with all restorations, suffer from deterioration and degradation in clinical service. Durable repair alternatives by layering a new composite onto such failed composite restorations, will eliminate unnecessary loss of tooth tissue and repeated insults to the pulp. The objective of this study was to evaluate the effect of three surface conditioning methods on the repair bond strength of a particulate filler resin-composite (PFC) to 5 PFC substrates. The specimens were randomly assigned to one of the following surface conditioning methods: (1) Hydrofluoric (HF) acid gel (9.5%) etching, (2) Air-borne particle abrasion (50 microm Al2O3), (3) Silica coating (30 microm SiOx, CoJet-Sand). After each conditioning method, a silane coupling agent was applied. Adhesive resin was then applied in a thin layer and light polymerized. The low-viscosity diacrylate resin composite was bonded to the conditioned substrates in polyethylene molds. All specimens were tested in dry and thermocycled (6.000, 5-55 degrees C, 30 s) conditions. One-way ANOVA showed significant influence of the surface conditioning methods (p < 0.001), and the PFC types (p < 0.0001) on the shear bond strength values. Significant differences were observed in bond strength values between the acid etched specimens (5.7-14.3 MPa) and those treated with either air-borne particle abrasion (13.0-22.5 MPa) or silica coating (25.5-41.8 MPa) in dry conditions (ANOVA, p < 0.001). After thermocycling, the silica coating process resulted in the highest bond values in all material groups (17.2-30.3 MPa).

Administration of granulocyte-colony-stimulating factor for allogeneic hematopoietic cell collection may induce the tissue factor-dependent pathway in healthy donors

The hypercoagulable state caused by the use of recombinant human granulocyte colony-stimulating factor (rhG-CSF) has been cited in anecdotal reports. Since tissue factor (TF) is the main initiator of the coagulation cascade, we examined if rhG-CSF had an inductive effect on the TF-dependent pathway in 18 healthy donors receiving rhG-CSF (10 microg/kg/day x 5 days) for peripheral blood progenitor cell mobilization. After rhG-CSF, there were increases both in TF antigen (TF:Ag) (P=0.01) and TF procoagulant activity (TF:PCA) (P=0.06) plasma levels and in TF:Ag cytofluorimetric expression on CD33 (+) cells (P=0.04). Mean activities of FVIII and vWF also increased significantly. Thrombin time was slightly prolonged (P=0.06) due to significant increases in plasma D-dimer levels. In addition, while FIX activity remained stable, there were marked reductions in mean plasma FX and FII activities and a slight decrease in FVII activity that resulted in a significant prolongation of prothrombin time within normal ranges. In conclusion, the administration of rhG-CSF led to a "prothrombotic state" via stimulation of TF and increased endothelial markers, such as F VIII and vWF. In the light of these findings, the use of rhG-CSF for stem cell mobilization should be undertaken cautiously in healthy donors with underlying thrombotic risk factors.

High-dose thiotepa, melphalan and carboplatin (TMCb) followed by autologous peripheral blood stem cell transplantation in patients with lymphoma – a retrospective evaluation

The purpose of this evaluation was to investigate the efficacy of high-dose chemotherapy with thiotepa, melphalan, and carboplatin (TMCb), and of autologous peripheral blood stem cell (PBSC) infusion in patients with aggressive non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD). A total of 42 patients, 23 with intermediate-grade NHL and 19 with HD, received thiotepa (500 mg/m2), melphalan (100 mg/m2), and carboplatin (1050-1350 mg/m2) followed by autologous PBSC infusion. Of 21 patients with more advanced disease, four had primary refractory disease, one was in complete remission (CR)-2, 11 were in first refractory relapse, and five were beyond first relapse. Of 21 patients with less advanced disease, two were in CR-1, four were in CR-2, and 15 were in first responding relapse. In all, 14 patients (33%) had received prior radiotherapy prohibiting a total-body irradiation (TBI)-based conditioning regimen. The projected 2-year probabilities of survival, event-free survival (EFS), and relapse for all patients were 0.65, 0.60, and 0.21 (0.85, 0.80, and 0.10 for patients with less advanced disease and 0.47, 0.42, and 0.33 for patients with more advanced disease). The probability of nonrelapse mortality in the first 100 days was 0.12. Grade 3-4 regimen-related toxicities (RRT) occurred in five of 42 (12%) patients and death due to grade-4 RRT occurred in only one (2.5%) patient. These preliminary data suggest that 0.42% EFS in this study for advanced disease patients is highly encouraging and high-dose TMCb followed by autologous PBSC transplantation is well tolerated as well as an effective regimen in patients with intermediate-grade NHL or HD, and may be comparable to some previously used regimens including TBI-based regimens.

Various conditioning methods for root canals influencing the tensile strength of titanium posts

Conditioning the root canal is frequently advised to achieve high post-retention when resin composite luting cements are used. However, manufacturers' instructions for this purpose differ widely from one another. The aim of this study was to compare the tensile bond strengths of passive, tapered, titanium root posts that were luted with four different resin composite cements (Compolute Aplicap, Flexi-Flow cem, Panavia 21 EX, Twinlook) in the root canals at three conditions, namely (i) no conditioning, (ii) etching with 37% phosphoric acid, and (iii) etching + bonding agent application. Panavia 21 EX was further tested after using the primer for the post-surface according to the manufacturer's recommendations. The posts luted with zinc phosphate cement (Tenet) acted as the control group. Following endodontic preparation of 140 intact anterior teeth with hand instruments, the post-spaces were prepared using the opening drills of the corresponding size of the posts. The samples were first stored in water at 37 degrees C for 24 h and then thermocycled (5000 cycles, 5-55 degrees C, 30 s). The tensile strength values were measured with the universal testing machine at a crosshead speed of 0.5 mm min(-1). The data were analysed statistically using anova and corrected with Scheffé test due to the significance levels (P < 0.05). The tensile bond strengths of the titanium posts after luting with various cements and thermocycling were affected by the conditioning systems used for the root canals. Tensile bond strengths were the highest with Flexi-Flow (475 +/- 78 N) followed in descending order by Panavia 21 EX (442 +/- 97 N), Twinlook (430 +/- 78 N) and Compolute Aplicap (352 +/- 76 N) after conditioning the root canal. The use of primer on the post improved the tensile bond strength compared with the non-conditioned group for the Panavia 21 EX group (375 +/- 77 N) (P < 0.001). Tensile bond strengths obtained after luting the posts with zinc phosphate cement (414 +/- 102 N) were not significantly different (P < 0.05) than those of resin composite cements. Although the importance of conditioning the root canal was evident for Panavia 21 EX, it was not the case for the other luting cements tested.

In vitro activity of terbinafine and itraconazole against Aspergillus species isolated from otomycosis

The minimum inhibitory concentrations (MIC, microg ml-1) of itraconazole and terbinafine against overall 34 Aspergillus isolates from the external ear canals with otomycosis have been determined with M38-P microdilution method suggested by National Committee for Clinical Laboratory Standards (NCCLS). MIC intervals in 48 h determined by taking MIC-2 value of itraconazole (the lowest drug concentration causing 50% inhibition of visible fungal growth) and MIC-0 value of terbinafine (the lowest drug concentration causing 100% inhibition of visible fungal growth) as a basis have been found as follows: 0.125-1 and 0.06-0.5 microg ml-1 for A. niger (22 strains), 0.06-0.25 and 0.06-0.125 microg ml-1 for A. flavus (10 strains), 0.125 and 0.125-0.5 microg ml-1 for A. terreus (two strains). It has been observed that both of the antifungal agents showed an in vitro activity against all Aspergillus species tested.

Lamivudine prophylaxis for prevention of chemotherapy-induced hepatitis B virus reactivation in hepatitis B virus carriers with malignancies

Although hepatitis B virus (HBV) reactivation in HBV carriers undergoing immunosuppressive therapy is clearly documented, the role of antiviral prophylaxis in such individuals is still controversial. The aim of this study was to determine the efficacy of lamivudine prophylaxis in HBV carriers with haemato/oncological malignancies, who receive chemotherapy. Eighteen HBV carriers with malignancy, who were candidates for chemotherapy, were enrolled. Eight subjects (three with leukaemia, four with lymphoma and one with multiple myeloma) were enrolled for prophylactic lamivudine therapy. The remaining 10 patients (six with leukaemia, three with lymphoma and one with breast cancer) were not treated with lamivudine and were used as a control. Lamivudine was administered beginning on the same day as the chemotherapy and was maintained for a year after chemotherapy was discontinued. No HBV-related mortality was observed in either group. In the lamivudine-treated group, none of the subjects had clinical, biochemical or serological evidence of HBV reactivation during the time they were receiving chemotherapy and after their chemotherapy was discontinued. In contrast, five of the 10 HBV carriers not receiving lamivudine therapy experienced a reactivation of HBV infection. This reactivation of HBV was observed during the chemotherapy in four with one individual experiencing a HBV activation 12 months after chemotherapy was discontinued. No lamivudine-related major adverse effects were observed. Hence prophylactic lamivudine treatment in HBV carriers with haemato/oncological malignancy receiving chemotherapy prevents chemotherapy-induced HBV reactivation.

The attitude of complete denture wearers towards denture adhesives in Istanbul

The purpose of using denture adhesives is to subjectively benefit denture-wearers with improved fit and comfort of their dentures and to improve their chewing ability and confidence. The purpose of this study was to investigate the approach and thought of complete denture wearers to denture adhesives and to see why they had tried denture adhesive, and their reasons for its current use or non-use through a questionnaire. One hundred and fifteen patients attending the Marmara University, Dental School for new denture treatment were surveyed. In the survey, there were 62 females (54%) and 53 males (46%). Nearly half of these patients (53%) were in the 61-70-year age group with a mean age of 64 years. One hundred and six (92%) patients had never tried denture adhesive. Most patients (73%) who did not use denture adhesives managed their dentures well, but a significant number 101 (87%) did not know that denture adhesives existed. Nine (8%) had tried denture adhesives, and none of the patients were currently using them. Those who ceased using denture adhesive complained mainly that it did not improve the fit and chewing ability significantly. The outcome of this survey demonstrated that the knowledge of the patients is not enough on denture adhesives in Istanbul as it is still generally believed by the practitioners that the prescription of a denture adhesive is a sign of failure of the dentist.

Pulmonary aspiration of nasal secretions in patients with chronic sinusitis and asthma

BACKGROUND

The role of silent aspiration of nasal secretions in the pathogenesis of asthma has often been questioned.

OBJECTIVE

To investigate the presence of pulmonary aspiration of nasal secretions during sleep in patients with chronic sinusitis and asthma and in healthy controls.

DESIGN

Prospective, controlled trial.

SUBJECTS

The study included 13 patients with chronic sinusitis and asthma and 12 healthy controls. The diagnoses were based on history, physical examination findings, radiologic assessments, and pulmonary function test results.

INTERVENTIONS

A radioactive tracer was prepared by diluting 10 mCi of technetium 99m-labeled macroaggregated albumin in 10 mL of physiologic saline. At 10 PM, just before the patients went to sleep, the solution was sprayed into their nostrils. The subjects were examined with a gamma camera to obtain views of the thorax at 8 AM the following morning. The average counts of the lungs and background and the actual lung counts (average lung count minus average background count) were determined.

RESULTS

The average counts of the lungs were significantly greater than the average counts of the background in both the sinusitis-asthma group (P =.001) and the control group (P =.002). The difference in the actual counts of the lungs was not significant between the 2 groups (P =.79).

CONCLUSIONS

The nasal secretions were aspirated into the lungs both in patients with sinusitis and asthma and in healthy adults during sleep, and the relative amounts that were aspirated did not differ significantly between the 2 groups (P =.79). The amount of the aspirated material alone is probably not responsible for the pathogenesis of asthma in patients with chronic sinusitis.

Role of pretransplant interferon-alpha(IFN) treatment in the outcome of stem cell transplantation (SCT) from related donors in chronic myelogenous leukemia (CML): results from three Turkish transplant centers

Since transplantation cannot be performed immediately after the diagnosis of chronic myelogenous leukemia (CML), interferon treatment is usually required. This study aims to analyze the effects of interferon-alpha (IFN) treatment on allogeneic stem cell transplantation (SCT) outcome. A total of 106 patients aged 16-47 years and transplanted from HLA-identical sibling donors for CML in chronic phase (CP) were evaluated. In all, 48 had received IFN-alpha for a median duration of 5 months (1-18 months) until a median of 1 month prior to transplantation. Of the patients, 50 have received bone marrow transplant (BMT) whereas 56 have received peripheral blood stem cells (PBSCT) between 1991 and 1999 in three major transplant centers in Turkey. Patient characteristics in both groups were similar. More hematological responders were present in the IFN(+) patients (P=0.0001). No difference was found in engraftment kinetics. The incidences of acute or chronic graft-versus-host disease (GVHD), relapse and graft failure were similar in all patients regardless of stem cell source. Overall survival (OS) and disease-free survival (DFS) at 2 years were similar for both IFN(+) or (-) patients following SCT. With multivariate analysis, pretransplant IFN-alpha use, stem cell source, transplant year and CD34+ cell content were not found to be risk factors for OS. In conclusion, prior IFN exposure did not impair BMT or PBSCT outcome.

The efficacy of two prototype chewing gums for the removal of extrinsic tooth stain

AIM

To compare the potential efficacy of two prototype chewing gums in extrinsic stain removal on natural teeth.

SETTING

Dental school clinics.

DESIGN

Double-blind, two groups, parallel design.

PARTICIPANTS

76 adult volunteers (32m, 44f, mean age: 20.6 years old).

METHODS

Oral hard and soft tissue health was examined. The subjects were randomly assigned to use either Product A (without active ingredients) or Product B (with active ingredients). Each subject was asked to brush their teeth for one minute twice daily (mornings and nights) and chew the gums supplied for 15 min (2 dragees each time), three times daily, once after each meal (breakfast, lunch and dinner) for the entire four-week duration. Dental stain assessment was made on the 12 incisors using the Lobene Stain Index (LSI).

RESULTS

The overall difference between the stain scores after 4-weeks' use of the chewing gums was statistically significant (p<0.01) for both test Product A (10.84) and Product B (7.77) with regard to the mean baseline stain scores (21.57). This difference represented a 48% reduction in stain scores for those subjects using Product A, while the reduction was 64% for the subjects using Product B.

CONCLUSIONS

The results of this in vivo study suggest that chewing gums with and without active ingredients have potential effect on stain removal after regular use for one month.

Fracture reasons in ceramic-fused-to-metal restorations

Ceramic-fused-to-metal restorations are widely used in dentistry with a high degree of general success. Fracture of the ceramic veneers as a result of oral function or trauma is not an uncommon problem in clinical practice. Although fractures of such restorations do not necessarily mean the failure of the restoration, the renewal process is both costly and time consuming and therefore remains a clinical problem. Fractures in the anterior region pose an aesthetic problem but when they are in the posterior, chewing function could also be affected. The published literature reveals that reasons for failures cover a wide spectrum from iatrogenic factors to laboratory mistakes or because of factors related to the inherent structure of the ceramics or simply to trauma.

The effect of disinfectant agents in eliminating the contamination of dental unit water

High concentrations of water-borne organisms cause multiple public health problems. Contamination of water exiting the dental unit water lines could be inhibited with the use of some disinfectants. The purpose of this investigation was to establish the effect of two disinfectants and to test their capacity to eliminate colony forming units (CFU) per mL. Vacuum lines of four chairs were treated for a total of 2 weeks. Two disinfectants (Bio 2000 and Alpron) were used as per manufacturer's instructions. Water samples for hetereothrophic counts from each unit's air/water syringe line were collected before treating the first patient of the day. Baseline, daily, first and second week samples of 10 mL were plated on blood agar plates and eosin ethylene blue agar. For meosifilic bacterial counts, Mueller Hinton agar plates with 1 mL direct and 1/10 were used in sterile serum and CFU were counted. The suspected colonies were further evaluated using API 20E and API 20NE. No Gram(-) opportunistic pathogens were found during the entire observation. Baseline contamination level (>102 CFU mL-1) without use of disinfectants was significantly higher (P < 0.0001) than at both first and second weeks when disinfectants were used. No colony was formed when Bio 2000 was used after both first and second weeks, whereas small number of CFU mL-1 was found at the end of the first week when Alpron (<10) was used. In conclusion, when used daily, both disinfectants prevent the development of bacterial contamination after first and second weeks with no significant differences (P=0.35).

Evaluation of alternative intra-oral repair techniques for fractured ceramic-fused-to-metal restorations

Ceramic fractures are serious and costly problems in dentistry. Moreover, they pose an aesthetic and functional dilemma both for the patient and the dentist. This problem has created demand for the development of practical repair options which do not necessitate the removal and remake of the entire restoration. Published literature on repair techniques for fractured fixed partial dentures, concentrating on the data obtained both from in vitro and in vivo studies, reveals that the repair techniques based on sandblasting and silanization are the most durable in terms of adhesive and cohesive failures compared with those using different etching agents.

Soluble adhesion molecules (sICAM-1, sL-Selectin, sE-Selectin, sCD44) in healthy allogenic peripheral stem-cell donors primed with recombinant G-CSF

BACKGROUND

We analysed the effects of rhG-CSF (Amgen-Roche, USA) on serum changes of four soluble adhesion molecules (SAM) (sICAM-1, sL-Selectin, sE-Selectin and sCD44) in healthy peripheral allogeneic stem-cell transplantation donors and their correlation with acute GvHD and effect on engraftment kinetics.

METHODS

Serum SAM of 15 consecutive healthy HLA identical-sibling donors (median age 30 years, male:female ratio, 7:8) were monitored using a commercial ELISA Kit (Bender Med, Austria) prior to, on the day of first apheresis and 24 h after the cessation of rhG-CSF (10 microg/kg/day s.c. on 5 days) administration. Leukapheresis was started on the fifth day of rhG-CSF administration, using a continuous-flow blood separator (Cobe Spectra, COBE BCT, Inc, Lakewood, CO). Apheresis cycles were continued daily until a target of 4.0 x 10(6) CD34(+) cells/kg was reached.

RESULTS

The results indicate a steady rise of sL-Selectin, sE-Selectin, and sCD44, but not of sICAM-1. Median number of mononuclear cells (MNC) and CD34(+) cells transfused were 7.7x 10(8)/kg and 6.0 x 10(6)/kg, respectively. There was a near-significant correlation between the sL-Selectin levels and CD34(+) cell yield (r = 0.49, 0.06). Median granulocyte and platelet engraftment days were 11 (10-18) and 12 (9-33), respectively. There was a significant inverse correlation between the CD34(+) cell dose and granulocyte levels (r = -0.68, p = 0.022), but not for platelet engraftment. The only correlation between SAM levels and engraftment was for sICAM-1 levels. Increasing sICAM-1 levels were a sign of prolonged neutropenia (r = 0.72, p = 0.011). No correlation between the apheresis day serum levels of adhesion molecules and acute GvHD was documented.

DISCUSSION

Analysis of sICAM-1, sL-Selectin, sE-Selectin and sCD44 levels during allogeneic PBSC apheresis did not reveal any significant effect on engraftment and GvHD, except the correlation of sL-Selectin levels and collected CD34(+) cells. More research and data about the role of not only SAM levels, but also antigenic expression of SAM are required to enlighten leukocyte-endothelial cell interactions and egress of stem cells during G-CSF administration.

Giant cell reparative granuloma originating from the ethmoid sinus

Giant cell granuloma is a reactive osseous proliferation and is histologically benign despite its aggressive clinical course. It usually involves the maxilla and the mandible in the region of the head and neck. It is rare in the ethmoid region. In this paper, an aggressive and recurrent giant cell reparative granuloma, which is recurred in a very short time period, originating from the ethmoid sinus is presented and the criteria for the differential diagnosis are noted in the light of the histological, clinical and biochemical parameters and the literature is reviewed.

Heating-pad burn as a complication of abdominoplasty

As the sensory nerves supplying the abdominal wall are divided during abdominoplasty, sensory changes occur in the abdominal skin after surgery, which are troublesome for some patients. These sensory changes can lead to burn injury in uninformed patients. We report the case of a patient who sustained a second-degree burn to the anterior abdominal skin following the application of a heating pad after an abdominoplasty. This burn healed with conservative treatment. Burn injuries due to sensory loss in the abdominal skin following abdominoplasty must be kept in mind, and patients must be informed about this complication.

Concomitant otomycosis and dermatomycoses: a clinical and microbiological study

Otomycosis tends to recur despite long-term treatment. To our knowledge, there is no study in the English literature concerning the clinical importance of concomitant otomycosis and dermatomycoses. We investigated the presence of dermatomycoses in 52 patients with otomycosis in order to document the clinical and microbiological importance of their coexistence. Dermatomycoses on the feet and/or hands were identified in 19 patients (36.5%). The most common pathogen for otomycosis was Aspergillus niger, while it was Candida albicans for the dermatomycoses. The same pathogenic fungi were isolated from the otomycosis and dermatomycoses in nine of the 19 patients (47.4%). Aspergillus niger was the most common shared pathogen. The pathogens isolated in concomitant dermatomycoses were common pathogens for the fungal infection of the ear ( Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus, Candida albicans). It was concluded that the autoinoculation of the ear canal by pathogenic fungi might be possible in the presence of the untreated dermatomycoses. Dermatomycoses must be investigated in patients with otomycosis and must be treated simultaneously in order to prevent the recurrence of both.

Otomycosis in Turkey: predisposing factors, aetiology and therapy

Otomycosis usually requires long-term treatment and tends to recur. This study was performed on 87 patients with the clinical diagnosis of otomycosis and 20 controls in order to determine the pathogenic agents, predisposing factors and a cost-effective treatment. The predisposing factors included wearing head clothes (74.7 per cent), presence of dermatomycoses (34.5 per cent) and swimming (27.6 per cent). The most common pathogenic fungus was Aspergillus niger (44.8 per cent) in the otomycosis group. The only isolate was Candida albicans in the control group (2.5 per cent). We concluded that administration of four per cent boric acid solution in alcohol and frequent suction cleaning of the ear canal might be a cost-effective treatment for otomycosis since 77 per cent of the patients were treated effectively this way. Eighty per cent of the resistant cases had mixed fungal-bacterial infections, and 50 per cent of them had dermatomycoses. These resistant cases were treated by administration of tioconazole ointment.

In vivo use of all-trans retinoic acid prior to induction chemotherapy improves complete remission rate and increases rhodamine 123 uptake in patients with de novo acute myeloid leukemia

All-trans retinoic acid (ATRA) is used in the treatment of acute promyelocytic leukemia. Because ATRA has effects (increase in apoptosis, suppression of bcl-2), it has also been used for the treatment of other French-American-British (FAB) subtypes of acute myelogenous leukemia (AML). To find out the in vivo and in vitro effects of ATRA in AML, we analyzed 37 patients with de novo AML. Twenty-seven patients received ATRA before remission-induction (RI) treatment (ATRA group). Results were compared to a control group (10 patients) that received induction without ATRA during the same time period. Bone marrow or peripheral blood samples were collected from all patients on d 0 and 4. The immunphenotype, myeloperoxidase (MPO), reac tion and the efflux uptake of rhodamine 123 (Rh123) were analyzed on myeloblasts in these samples. In the myeloblasts from patients treated with ATRA, the uptake of Rh123 was increased significantly (p = 0.026) from d 0 to d 4, and all other parameters remained unaltered. ATRA administration increased the complete remission (CR) rate (88%, 22/25 vs 55%, 5/9) significantly (p = 0.042). Logistic regression analysis revealed that ATRA administration was the important factor in CR, among other potential factors including age, white blood count, bcl-2 expression, and the uptake and efflux of Rh123 (p = 0.05). Estimated disease-free survival and overall survival were similar between these two groups (43% vs 37.5% and 51.2% vs 37.5%, respectively). In conclusion, ATRA treatment prior to RI treatment may improve the CR rate in patients with de novo AML, which seems to be related to its beneficial effect on multidrug resistance.

Ischemic spinal cord injury after aortocoronary bypass operation. A case report

Although spinal ischemia is a very well recognized complication after operation on the thoraco-abdominal and abdominal aorta, it is very rare following coronary artery bypass surgery. A case of a 56-year-old man, who had juxtarenal aortic occlusion and became paraplegic after internal mammary artery grafting for ischemic heart disease is reported. The complete paraplegia was thought to be due to interruption of critical collateral blood supply to the spinal cord.

Allogeneic hematopoietic cell transplantation without myeloablative conditioning for patients with advanced hematologic malignancies

BACKGROUND

The effect of allogeneic hematopoietic cell transplantation (alloHCT) on hematologic malignancies is based on the graft-versus-malignancy effect. Obtaining this effect with reduced toxicity has been possible by non-myeloablative (NMA) alloHCT. Once mixed chimeric status, and host versus graft with graft versus host tolerance are achieved, further strengthening of chimerism and graft-versus-malignancy effect can be obtained by donor lymphocyte infusions (DLIs) when needed.

METHODS

The patient group consisted of 13 patients with advanced hematological malignancies: seven had CML, four of them in blastic-, two in chronic- and the remainder in accelerated-phase; four patients with AML, refractory or in second remission state; one patient with primary refractory secondary AML; and one patient with ALL relapsed after alloHCT. Conditioning regimen consisted of fludarabine 30 mg/m(2)/day for 6 days and anti-T-lymphocyte globulin (ATG) 10 mg/kg/day for 4 days as immunosuppressive. Ara-C or Bu or melphalan were used as the cytoreductive component. All transplants were performed using HLA-identical sibling donors' peripheral blood hematopoietic cells, after priming with filgrastim. Post-transplant GvHD prophylaxis was achieved with CsA alone in 10 patients, and with CsA plus mycophenolate mofetil in the last three patients.

RESULTS

Median follow-up is 3 months (range, 0-20) for all the patients and 6 months (range, 2-15) for the live patients. Donor chimerism was shown in 10 patients, not regarding any pretransplant feature. DLIs were performed in seven patients after transplantation and two of them achieved complete chimeric status and molecular remission. Two CML patients in blastic phase (CML-BP), and the primary refractory secondary AML patient did not respond to procedure. In four patients, drug therapy in conventional doses was added to post-transplant DLIs for their relapsed or refractory diseases. Two patients with AML in second CR, and another CML-BP patient, relapsed or progressed after transplantation. A patient with CML-BP achieved CR and full donor chimerism after transplantation, but developed refractory post-transplant lymphoproliferative disease in the 19th month. Two patients with refractory AML, one patient with relapsed ALL and two patients with CML in chronic phase were in complete chimeric status and free of disease signs. Acute GvHD, Grade II-III, was observed in five patients, and two of them developed secondary progressive chronic GvHD subsequently. We observed one early death in a platelet transfusion refractory blastic phase CML patient due to intracranial hemorrhage. Procedure-related severe toxicity was not observed, either in standard-risk patients or stem-cell donors.

DISCUSSION

Establishing engraftment with donor chimerism was the first successful step in this approach. The second step, which was the result of the graft-versus-malignancy effect, could be seen in most of the patients, but was not sustained in all of them because of the aggressiveness of their malignancy. It can be suggested that the immunotherapeutic efficacy of this approach could be more successful, and with acceptable toxicity, when performed in patients with minimal residual disease. The role of NMA conditioning, and of the treatment in standard disease indications, remains to be determined in further studies.

Bilateral parotid-duct diversion using autologous vein grafts for the management of chronic drooling in cerebral palsy

Chronic drooling is a major problem in patients with cerebral palsy and other neurological dysfunctions. Various treatments, ranging from speech therapy to radical surgery, have been used to overcome this distressing problem, with surgery the most consistently successful. In this study, we used a new surgical technique to manage severe drooling. This involved the dissection of both parotid-duct orifices, and their relocation, via a submucosal tunnel, into the tonsillar pillar using autologous vein grafts. Four patients were treated using this technique together with bilateral submandibular duct rerouting. The results were analysed by subjective judgements of drooling and retrograde sialography at 90 days postoperatively. In all cases, salivary flow was reduced and drooling was significantly improved. Retrograde sialography revealed no signs of obstruction or stricture formation in any of the cases. No postoperative complications occurred. These preliminary results suggest that the bilateral surgical transposition of Stensen's ducts into the tonsillar pillar using autologous vein grafts together with bilateral submandibular duct rerouting can provide effective control of chronic drooling.

Avulsion fractures of both anterior and posterior cruciate ligament tibial insertions

Ipsilateral femur fracture, patellar fracture, and tibial avulsion fractures of anterior and posterior cruciate ligament injuries are reported. We know of no other report of an injury such as this in the literature. We sutured the tibial avulsion fractures by transtibial suturing technique and internally fixated the femur by intramedullary interlocking nailing 2 weeks after the trauma. After 1 year the results were evaluated as very good. Early surgical repair is valuable in these injuries.