Anterior communicating artery aneurysms: Nonmodifiable morphological parameters associated with rupture risk

BACKGROUND AND PURPOSE

The aim of this study was to investigate the relationship between arterial morphological parameters and the rupture risk of anterior communicating artery (AComA) aneurysms.

METHODS

A hospital database was retrospectively reviewed to identify patients with AComA aneurysms. Morphologic parameters were evaluated on the 3-dimensional computed tomography angiograms. The patients were divided into two groups as ruptured and unruptured. Patient age, sex, morphological parameters such as aneurysm height and weight, neck diameter, aspect ratio (AR), size ratio (SR), bifurcation angle, aneurysm shape, and diameters of the artery were statistically compared between two groups.

RESULTS

Ninety-five AComA aneurysms were analyzed in this study (60 ruptured and 35 unruptured). The aneurysm neck size (p = .005) and the diameter of the A1 segment of the ipsilateral anterior cerebral artery (i-A1) were smaller in the ruptured group than in the unruptured group (p = .001), but AR (p = .001) was higher. The number of patients with irregular shape aneurysm were higher in the ruptured group (p = .006). There was no significant difference between the two groups in terms of age, sex, aneurysm height and weight, bifurcation angle, and SR. Univariate logistic regression analysis showed that i-A1 segment diameter (odds ratio [OR]: -2.070, confidence interval [CI]: 0.030-0.531, p = .005), aneurysm neck diameter (OR: -0.409, CI: 0.491-0.899, p = .008), irregular shape (OR: 1.197, CI: 1.382-7.929, p = .007), and AR (OR: 0.880, CI: 1.315-4.417, p = .004) were significantly correlated with ruptured status. Multivariate regression analysis demonstrated that aneurysm neck diameter (OR: -0.457, CI: 0.410-0.977, p = .039) was the only independent variable for rupture.

CONCLUSION

AComA aneurysm rupture is more likely to occur in aneurysms with smaller i-A1 segment diameter, smaller aneurysm neck diameter, irregular aneurysm shape, and higher AR. Aneurysm neck diameter may be a more important determinant for rupture prediction.

Assessment of the Role of 1,3-β-d-Glucan Testing for the Diagnosis of Invasive Fungal Infections in Adults

Detection of 1,3-β-d-glucan (BDG) in serum has been evaluated for its inclusion as a mycological criterion of invasive fungal infections (IFI) according to EORTC and Mycoses Study Group (MSG) definitions. BDG testing may be useful for the diagnosis of both invasive aspergillosis and invasive candidiasis, when interpreted in conjunction with other clinical/radiological signs and microbiological markers of IFI. However, its performance and utility vary according to patient population (hematologic cancer patients, solid-organ transplant recipients, intensive care unit patients) and pretest likelihood of IFI. The objectives of this article are to provide a systematic review of the performance of BDG testing and to assess recommendations for its use and interpretation in different clinical settings.

Is the middle cerebral artery bifurcation aneurysm affected by morphological parameters of bifurcation?

BACKGROUND

Aneurysm formation is a multifactorial process involving genetic, anatomical and environmental risk factors. A research focusing on the relationship between the presence of aneurysm and the morphology of the arteries will help in the pathogenesis and prediction of intracranial aneurysms. In this study, the relationship between the presence of aneurysm and various morphological parameters of aneurysm-related arteries was evaluated in patients with saccular middle cerebral artery (MCA) bifurcation aneurysm.

MATERIALS AND METHODS

The archival images of 74 patients (62.2% women) were evaluated retrospectively. In this study, the angle between the ipsilateral MCA M1 segment and the dominant truncus (Φ1), the angle between the M1 segment and the recessive truncus (Φ2), and the bifurcation angle (Φ1 + Φ2) were compared. Bilateral internal carotid artery (ICA), MCA M1 segment, dominant and recessive truncus diameters and these diameters ratios were compared with the aneurysmal side and the contralateral side without aneurysm.

RESULTS

When the dominant truncus, recessive truncus angles and bifurcation angle were compared, a significant difference was found on the aneurysmal side (p < 0.0001). In the receiver operating characteristic analysis, when the bifurcation angle of 147.5° was accepted as the limit value, 78.4% sensitivity, 79.7% specificity, 79.5% positive predictive value and 78.7% negative predictive value were determined (area under the curve: 0.85).

CONCLUSIONS

Our study of the morphological features of arteries associated with MCA bifurcation aneurysms showed that the presence of MCA aneurysms was significantly associated with large bifurcation angles.

Selective transarterial embolization of acute renal hemorrhage: a retrospective study

Introduction: Selective transarterial embolization (STAE) is a minimally invasive treatment method developed as am alternative to surgery for acute renal haemorrhage (ARH). The aim of this study was to evaluate the efficacy and outcome of STAE in ARH patients.Material and methods: The data of patients who underwent STAE with signs of ARH were collected retrospectively. The etiology of renal haemorrhage, localization and type of lesion, embolizing agent used, the amount of contrast material given, duration of fluoroscopy and perioperative and postoperative complications were recorded. Lesions were classified as pseudoaneurysm (PA), arteriovenous fistula (AVF), arterio pelvic fistula (ACF), pathological tumoral vasculature and extravasation.Results: A total of 51 patients were included in the study. The most common symptom was gross hematuria (76.4%) and the most common underlying cause was iatrogenic renal injury (64.7%). Embolizing agents used were n-BCA-iodized oil in 29 patients, coils alone in six patients, coils + n-BCA in four patients, ethanol-iodized oil in three patients, combination of n-BCA-iodized oil and ethanol-iodized oil in two patients, polyvinyl alcohol particles in three patients and covered stent in one patient. Technical success was 100% in all patients and there was no need for reintervention.Conclusions: STAE is a safe, effective and minimally invasive method in emergency treatment of ARH.

Can vessel diameters, diameter ratios, and vessel angles predict the development of anterior communicating artery aneurysms: A morphological analysis

The anterior communicating artery (AcomA) junction is the most common location for cerebral aneurysms. This might because of increased vascular wall stress due to the complex structure of the junction. The aim of this study investigate the effect of morphological parameters in the development of AcomA aneurysms. This retrospective study was approved by the institutional ethics committee. A retrospective analysis of our hospital database was performed to identify patients with AcomA aneurysms. Patients with normal computed tomography angiography (CTA) examinations were enrolled in the study as the control group. The control group was similar to the patient group in gender and age. Morphological parameters (vessel diameters, vessel diameter ratios, and vessel angles) on the same side (ipsilateral) and on the opposite side (contralateral) of the patients with aneurysm, and morphological parameters of the control group were compared. A total of 171 subjects were involved in the study (86 patients with aneurysms and 85 patients in the control group). Multivariate regression analysis revealed that the ipsilateral A1-A2 angle (OR: 0.932; 95% CI: 0.903-0.961; p < 0.001), the ipsilateral A1/A2 vessel diameter ratio (OR: 27.725; 95% CI: 1.715-448.139; p = 0.019), and the contralateral internal carotid artery (ICA)/A1 ratio (OR: 11.817; 95% CI: 2.617-53.355; p = 0.001) were significant morphological predictors for developing an aneurysm. An increased contralateral ICA/A1 ratio, an increased ipsilateral A1/A2 vessel diameter ratio, and a narrow bifurcation angle are significant predictors for developing an aneurysm. Therefore, in patients with clinical risk factors these parameters may be interpreted as additional morphological risk factors for developing an aneurysm.

Single center experience with intralesional bleomycin sclerotherapy for lymphatic malformations

PURPOSE

The purpose of our study was to evaluate the efficacy of percutaneous sclerotherapy using bleomycin in treatment of lymphatic malformations.

METHODS

Between January 2009 and January 2013, ten patients with lymphatic malformations who were admitted to the interventional radiology department were included in this retrospective study. Intralesional bleomycin was administered by percutaneous injection through 21-23 Gauge needles with a dose of 1 mg/kg body weight. Patients were clinically and radiologically assessed at baseline and followed at first and third months after treatment. Response to treatment was measured visually by using photographs and by radiological images. Symptomatic improvement was also evaluated either by patients or parents.

RESULTS

Excellent resolution was obtained visually in 80% of patients with lymphatic malformation. Significant resolution was achieved in 20% of patients. The percentage of radiographic resolution in size and the improvement in symptoms evaluated by patients or parents were similar with visual outcomes. No side effects were recorded except for fever in one patient and transient erythema in another patient.

CONCLUSION

Intralesional bleomycin is a safe and effective treatment for patients with lymphatic malformations.

Evaluation of morphological changes in pharynx with dynamic CT and MRI in snoring patients

BACKGROUND

Identifying the craniofacial abnormalities that cause snoring and the narrowest area of the upper airway creating obstructions can help to determine the proper method of treatment.

AIM

To identify the factors that can cause snoring and the areas of the airway that are the most likely to collapse with upper airway imaging.

MATERIAL AND METHODS

Axial pharynx examinations with CT (computerized tomography) and magnetic resonance imaging (MRI) were performed to 38 patients complaining of snoring and 12 patients who did not complain of snoring. The narrowest areas of nasopharynx, hypophraynx, oropharynx, bilateral para-pharyngeal fat pad and para-pharyngeal muscle thickness were measured.

RESULTS

In snoring patients, the narrowest part of the upper airway was the retro-palatal region in the oropharynx, as measured with both imaging methods. When patients with and without snoring were compared, the former that a higher body mass index and neck diameter and a narrower oropharynx area. In dynamic examinations, we determined that as para-pharyngeal muscle thickness increased, medial-lateral airway diameter and the oropharynx area decreased.

CONCLUSIONS

The narrowest section of the airway is the retro-palatal region of the oropharynx, measured both with CT and MRI.

Emergency Endovascular Treatment of a Penetrating Vertebral Artery Injury with Detachable Coils

The surgical approach is difficult and time-consuming in cases of injury to the bony canal segment of the vertebral artery. Diagnosis and treatment should be performed urgently if the patient has active bleeding. We present a patient with a left vertebral artery injury in a stab wound to the neck in whom emergency endovascular treatment was performed with detachable coils because of ongoing gross bleeding.

Comparison of Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Parotid Tumors

OBJECTIVE

The role of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of parotid tumors was investigated.

METHODS

Forty patients with the clinical suspicion of a parotid mass underwent both CT and MRI of the parotid region. Two radiologists independently assessed the CT and MRI results with respect to tumor localization, tumor margin characteristics, and infiltration of surrounding tissue. Histopathologic specimens were obtained in all cases and correlated with the radiologic findings.

RESULTS

The sensitivity and specificity of CT and MRI were nearly the same for tumor location, tumor margin, and tumor infiltration.

CONCLUSION

The 2 imaging techniques provided the same information with respect to the presurgical planning and contribute to the diagnosis and therapy planning of parotid tumors.

Karyotype analyses of ten sections of Trigonella (Fabaceae)

Karyotypes of ten sections of genus Trigonella Linnaeus, 1753 (Fabaceae) from Turkey were investigated. Somatic chromosome numbers of examined species were determined as 2n=14 and 16. The karyotype analyses of the species were carried out and somatic chromosome numbers of Trigonella plicata Boiss., 1872, Trigonella brachycarpa (Fisch.) Moris, 1833, Trigonella rostrata Boiss., 1872, Trigonella lunata Boiss., 1843, Trigonella isthmocarpa Boiss. et Balansa 1856, Trigonella rhytidocarpa Boiss. et Balansa, 1859, Trigonella spicata Sibth. et Sm., 1813, Trigonella cephalotes Boiss. et Balansa 1856, Trigonella capitata Boiss., 1843 and Trigonella gladiata Steven, 1808 were reported for the first time. Two pairs of satellite metaphase chromosomes were observed in Trigonella cariensis Boiss., 1843 and one pair in Trigonella lunata.Moreover, 2 B-chromosomes were found only in Trigonella procumbens Rchb., 1830 among all studied species. The aims of this study are to provide karyological data for a significant pool of the taxa, to show differences among them in the number, size and morphology of somatic chromosomes, to verify previous reports or represent numbers which are different from those cited previously.

Diagnostic value of ultrasonography in temporomandibular disorders

PURPOSE

The purpose of this study was to determine the diagnostic value of ultrasonographic imaging (USI) in temporomandibular disorders.

PATIENTS AND METHODS

USI and magnetic resonance imaging (MRI) were performed in 182 temporomandibular joints (TMJs) of 91 patients who were referred for treatment. After a detailed clinical examination, patients who were clinically diagnosed with TMJ disc derangement were referred to the radiology department for MRI and USI examinations. USI and MRI diagnoses of disc displacement were compared, using clinical diagnosis as the golden standard. The overall agreement between USI and MRI results was evaluated.

RESULTS

Compared with the clinical diagnosis, MRI showed a sensitivity of 85%, specificity of 62%, and an accuracy of 80% in the detection of internal derangements. The positive predictable value, negative predictive value, and likelihood ratio were 88%, 54%, and 2.29, respectively. Compared with the clinical diagnosis, USI showed a sensitivity of 69%, specificity of 80%, and accuracy of 71% in the detection of internal derangements. The positive predictable value, negative predictive value, and likelihood ratio were 92%, 42%, and 3.45, respectively. Comparing the agreements between the MRI and USI diagnoses of internal derangement, the κ value was found to be 0.36, indicating poor reliability (P < .001).

CONCLUSION

USI, a noninvasive and dynamic imaging method, is a reliable method in evaluating the position of the disc in TMJ disc derangements. Better visualization of joint structures and more reliable results with higher sensitivity and accuracy can be achieved with high-resolution devices (≥12 MHz).

Carcinoma ex pleomorphic adenoma of the minor salivary gland with pulmonary metastasis

Carcinoma ex pleomorphic adenoma is an exceedingly rare neoplasm of the minor salivary gland. Prognostic parameters are recurrence, capsular invasion, and metastasis. We present a case of carcinoma ex pleomorphic adenoma with pulmonary metastasis to emphasize that patients treated for this condition should be investigated for distant metastasis.

Treatment of Multiple Oral and Oropharyngeal Venous Malformations in Maffucci's Syndrome with a Combination of Percutaneous Sclerotherapy and Ligation

Maffucci's Syndrome is an osteochondromatous syndrome with congenital vascular malformations. Major ailments involved are habitual fractures, length discrepancy of the extremities, impediment of the affected parts, extremity overgrowth and pain. The vascular lesions, aside from their mass effects, tend to ulcerate and bleed. Endotracheal intubation is also troublesome in these patients. Malignant tranformation of mesodermal tissue is the major lethal factor in this syndrome. This report describes severe respiratory impairment caused by venous malformations in a young girl. Multiple bunched venous malformations within the tongue, oral cavity and oropharynx were treated with percutaneous sclerotherapy and a simple ligation technique. Airway obstruction was cleared following repetitive treatment sessions.

Lymphopenia and monocytopenia versus MASCC score system in patients with febrile neutropenia

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Background: The purpose of this study was determine the clinical significance of lymphopenia and monocytopenia in terms of its duration and depth in patients with febrile neutropenia (FEN) and MASCC scores parametres. Methods: Sixty-six patients with FEN were prospectively analysed. Recurrent FEN episodes were excluded in this trial. Twenty-four patients had solid tumors, 42 patients had lymphoma-leukemia. Patients with MASCC-scores ≥21 evaluated as low-risk (LR) and the ones with their scores <21 were high-risk (HR). Results: Thirty-six patients had HR and the rest had LR. Lymphocyte count <700/mm3 and monocyte count <100/mm3 were found as 91.6% and 86.6% in HR and in LR groups, respectively.The rate of refractory fever(RF) in HR patients was clearly high.Patients with protracted neutropenia (PN) had higher rate of RF (p = 0.007). Patients with longer duration of neutropenia and monocytopenia tended to have RF (p = 0.052, p = 0.018). The rate of administered AFT was significantly high in HR patients (p = 0.005). AFT was administered to one third of HR patients, but no patient received AFT in LR-group (p < 0.001). In group with neutropenia duration (ND) <10 days, one patient received AFP (p < 0.001). AFT was given to most of the patients who had longer duration of lymphopenia or monocytopenia (respectively; p = 0.002, p = 0.001), and who had leukemia (p = 0.001). The most important parameters effecting the duration of antibiotic therapy (DAT) was found to be ND. DAT >14 days was found more than fourfold in patients PN (p = 0.007). Fifty-five percent out of patients with solid tumor or lymphoma were given <14 days antibiotic therapy. But, most of patients with leukemia had antibiotics >14 days (p = 0.002).The rate of antibiotic therapy >14 days was higher in patients with longer duration of lymphopenia and monocytopenia (respectively; p = 0.073, p = 0.062). The most important parameter that influences on antibiotic modification (AM) was severity of monocytopenia on the first day of FEN. The rate of AM was found in aproximately nine-fold in patients that had monocyte counts ≤100/ mm3 as compared to monocyte ≥100/ mm3 (p = 0.01). Conclusions: The depth of monocytopenia and durations of lymphopenia and monocytopenia were the important parameter influencing antibiotic modification in FEN.

No significant financial relationships to disclose.

Study of mandibular alveolar distraction osteogenesis using a three-dimensional computed tomography measurement method: report of four patients, a preliminary study

OBJECTIVE

This study was conducted to show dimensional and volumetric changes after vertical alveolar distraction osteogenesis using a three-dimensional computed tomography measurement method.

MATERIALS

Four patients with mandibular alveolar ridge atrophy were evaluated. Three-dimensional computed tomography reconstructions were obtained 2 weeks before and 3 months after the operation. The results of the three-dimensional computed tomography measurements were used for preoperative planning and for quantitative assessment of the mandibular alveolar distraction. The results of the preoperative and postoperative three-dimensional computed tomography measurements were compared statistically using paired t-test.

RESULTS

The increase in distracted mandibular segment volume and surface area, height, and width of each slice after distraction were statistically significant (P < 0.001).

CONCLUSION

In atrophic jaw cases, the dimensions of the present alveolar bone were clearly measured so that the amount of augmentation needed could be estimated. Three-dimensional computed tomography provided better understanding of the effects of distraction osteogenesis on the anterior mandible. Newly formed bone can be viewed as close to its real dimensions after distraction osteogenesis.

The value of three-dimensional computed tomography in diagnosis and management of Jacob's disease

This study reports a case of Jacob's disease characterized with limited mouth opening due to bilateral coronoid hyperplasia forming pseudojoints with zygomatic arches. Magnetic resonance (MR) examination of temporomandibular joint (TMJ) is usually the imaging method chosen in patients with such symptoms. However, the coronoid processes can not be displayed because they are not included in field of view in MR imaging of TMJ. For that reason, these patients may be treated for a misdiagnosis of TMJ disorders. In this study, the aetiology and diagnostic methods of Jacob's disease, the pre-operative/post-operative role of three-dimensional computed tomography and some measurements used in diagnosis were evaluated.

Tuberculosis in stem cell transplant patients

Tuberculosis (TB) is an increasing health problem, and patients undergoing stem cell transplantation (SCT) are at high risk of acquiring TB. Following a review of the medical literature, this article reports the current situation of TB in SCT patients. A PubMed search was undertaken using the keywords 'tuberculosis', 'stem cell transplantation' and 'bone marrow transplantation', and cases with meaningful data for analysis were included. The medical literature contains relatively few data on TB and SCT. Although there is a risk of TB in allogeneic SCT patients, this is less than in solid organ transplant patients, and the risk in autologous SCT patients is similar to the risk in the general population. The incidence of TB in SCT patients is proportional to the incidence of TB in the general population. Evidence favouring TB prophylaxis is not well established. While allogeneic transplantation carries a risk of TB, this is not true for autologous transplantation. Prophylaxis can only be an option for selected patients or countries with high rates of TB.

Evaluation of the effect of transplant-related factors and tissue injury on donor-derived hepatocyte and gastrointestinal epithelial cell repopulation following hematopoietic cell transplantation

The aim of this study was to detect donor-derived hepatocytes and gastrointestinal epithelial cells in recipients of sex-mismatched allogeneic hematopoietic cell transplants, and to assess the effect of tissue injury on the extent of the repopulation. A total of 29 paraffin-embedded biopsy samples were reviewed. Double labeling by immunohistochemistry and fluorescence in situ hybridization was performed. Eighty-nine percent of sex-mismatched samples with histologic evidence of injury demonstrated the presence of donor-derived hepatocytes and gastrointestinal epithelial cells (mean 2.4%). None of the hepatocytes and gastrointestinal epithelial cells in samples obtained from female recipients with female donors showed a Y chromosome signal. The proportion of donor-derived hepatocyte and gastrointestinal epithelial cells in samples with severe graft-versus-host disease was greater than that of samples with mild/moderate graft-versus-host disease (P = 0.09). No relationship between the source of stem cells and the population rate was detected (P > 0.05). We conclude that some recipient hepatocytes and gastrointestinal tract epithelial cells are replaced by donor-derived cells during tissue injury. The severity of tissue injury seems to influence on the extent of this repopulation.

Botulinum Toxin for the Treatment of Temporomandibular Joint Disk Disfigurement: Clinical Experience

Type A botulinum toxin was used for the treatment of symptoms of 26 patients (40 joints) with temporomandibular joint disk disfigurement. In all patients, 0.5 ml (12.5 U) was injected into the lateral pterygoid muscle. The temporalis, medial pterygoid, and masseter muscles were injected if severe tenderness was noted. The data were compared using the Wilcoxon signed rank test and the McNemar test. With the exception of clicking of the right joint, all mean outcome measures showed a significant difference between the preinjection and postinjection assessments. There was a significant difference between the preinjection and postinjection pain scores of the right joint (P=0.0019) and the left joint (P=0.000). Postinjection values of the mouth opening (P=0.002), subjective functional dysfunction (P=0.065), and clicking of the left joint (P=0.001) also showed a statistically significant difference from the preinjection values. In addition, the severity and frequency of headache were reduced after botulinum toxin-A injection into the lateral pterygoid muscle.

Sphenoid sinus mucocele causing third nerve paralysis: CT and MR findings

A 64-year-old woman presented with a 2 week history of ptosis and medial-gaze paralysis of her left eye. Computed tomography scanning of the paranasal sinuses revealed an expansile, homogeneous lesion with no contrast enhancement in the sphenoid sinus. The mass was hyperintense on all MR sequences and there was extension of the mass to the left cavernous sinus and optic canal. Operation revealed a large mucocele. Third nerve palsy disappeared 4 weeks after operation. Because the spread of mucoceles is variable, they may cause different symptoms. Radiological evaluation, especially computed tomography and magnetic resonance imaging, are useful in diagnosis of mucoceles and help to explain the clinical symptoms by showing the spread of the lesion.

Dynamic upper airway soft-tissue and caliber changes in healthy subjects and snoring patients

BACKGROUND AND PURPOSE

The oropharyngeal airways are smaller in those who snore than in those who do not. We sought to determine which soft-tissue component surrounding the airways contributes to upper airway narrowing in those who snore.

METHODS

Ten control subjects and 19 snoring patients underwent CT, with 2-mm-thick axial sections obtained every 0.6 seconds during the respiration cycle at the same oropharyngeal level. We selected two sections with the widest and narrowest parts of the oropharyngeal airway to measure the anteroposterior and lateral dimensions of the airway and the thickness of the bilateral parapharyngeal fat pads, pterygoid muscles, and parapharyngeal walls. Mean values were calculated for each phase. For each subject, differences were calculated by subtracting the values in narrowest phase from those in the widest phase.

RESULTS

Changes in airway dimension (P < .05) and lateral parapharyngeal wall thickness (P < .01) were significantly different between snorers and control subjects. Changes in parapharyngeal wall thickness and transverse oropharyngeal airway diameter changes were significantly related (P < .01) in those who snored but not in control subjects.

CONCLUSION

Airway narrowing predominantly occurs in the lateral dimension in people who snore. Changes in the lateral pharyngeal wall are more important than the parapharyngeal fat pads in airway calibration. Narrowing of the upper airway area at the end of the expirium and the beginning of the inspirium is thought to be the cause of snoring and due to augmented muscle mass and prolonged laxity rather than inadequate activation of the pharyngeal dilating muscles.

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.

Mycobacterial Infection: A Difficult and Late Diagnosis in Stem Cell Transplant Recipients

The Infectious Diseases Working Party of the European Blood and Marrow Transplant Group conducted a survey to obtain information about the frequency, presentation, and treatment of mycobacterial infection (MBI) in stem cell transplant (SCT) recipients. Among 29 centers, MBI was diagnosed in 0.79% of 1513 allogeneic and 0.23% of 3012 autologous SCT recipients during 1994-1998 a median of 160 days after transplantation. The mean interval between first symptoms and diagnosis was 29 days and was still longer for patients with atypical MBI or recipients of corticosteroid therapy. The prevalence of MBI was highest among those who received matched unrelated or mismatched STCs from related donors. Of 31 patients, 20 had tuberculosis, 8 had atypical MBI, and 3 had diagnoses based on histological findings only. Five patients (16%) died, all of whom had received an allogeneic SCT. Because of the increased numbers of unmatched donors and transplantation programs in countries with a high prevalence of tuberculosis, constant vigilance is required to early detect MBI in SCT recipients.

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.

Vancomycin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy

This prospective, double-blind trial assessed whether the addition of a glycopeptide would be able to reduce the time to defervescence in neutropenic patients with cancer who had persistent fever 48-60 h after the initiation of empirical piperacillin-tazobactam monotherapy. Of 763 eligible patients, 165 with persistent fever were randomized to receive piperacillin-tazobactam therapy plus either vancomycin therapy or placebo. Defervescence was observed in 82 (95%) of 86 patients in the vancomycin group and in 73 (92%) of 79 patients in the placebo group (P=.52). The distributions of the time to defervescence were not statistically significant between the 2 groups (estimated hazard ratio, 1.03; 95% confidence interval, 0.75-1.43; P=.75). The number of additional episodes of gram-positive bacteremia and the percentage of patients for whom amphotericin B was empirically added to their therapy regimen were also similar in both groups. This study failed to demonstrate that the empirical addition of vancomycin therapy to the treatment regimen is of benefit to persistently febrile neutropenic patients with cancer.

[Opinion: turkish in medical communication]

Several problems associated with the use of Turkish in medical, and in particular, radiological communication are addressed in this article. Many words used in medical communication in Turkey have been adapted from European languages. Incorrect spelling and pronounciation of these words occurs quite frequently. A significant proportion of "Turkish" medical vocabulary has been inherited from the former invaders of the Turkish, namely the Persian and Arabic languages. For a rich and living Turkish in medical communication, we must respect our maternal language, prefer the already existing Turkish medical terminology, and try to find and introduce Turkish counterparts for new medical terms.

High-dose thiotepa, melphalan and carboplatin (TMCb) followed by autologous stem cell transplantation in patients with advanced breast cancer: a retrospective evaluation

This study was conducted to evaluate the efficacy of high-dose thiotepa, melphalan and carboplatin (TMCb) regimen in 27 patients undergoing autologous stem cell transplantation (ASCT) for metastatic breast cancer. A total of 27 patients with stage IV breast cancer underwent ASCT following thiotepa (500 mg/m(2)), melphalan (100 mg/m(2)) and carboplatin (1200-1350 mg/m(2)). Of 27 patients, 17 had refractory relapse, eight had responding relapse, and two had no evidence of disease (NED) at the time of transplant. In all, 11 patients had only bone disease, nine had bone plus visceral disease, three had only visceral disease, and two had locoregional recurrent disease. The median time from diagnosis to transplant was 1081 days (range 180-2341). Staging for evaluation of response was performed 4-6 months after transplantation. Five patients were not evaluable (NE) for response because of NED at transplant (n=2) or early death due to transplant-related complications (n=3) (two of viral pneumonia and one of regimen-related toxicity) occurring at a median of 4 days (range 11-46) post-transplant. One of the two patients who was NED at the time of transplant is still NED on day 760 post-transplant. Seven of 15 refractory (47%) and 5/7 (71%) responsive patients with evaluable disease achieved a complete response of all measurable disease or all soft-tissue disease with at least improvement in bone lesions. Of 27 patients (37%),(10) are alive and progression-free, a median of 582 days (range 410-1380) after treatment, 6/17 (35%) with refractory disease and 4/10 (40%) with responsive disease. The probability of progression-free survival (PFS) for all patients was 0.50. The probabilities of PFS at 2 years for patients with refractory (n=17) and responsive (n=10) disease were 0.42 and 0.60, respectively. PFS at 2 years for the 14 patients who were NED or achieved CR/PR(*) following-HDC was 0.67. PFS at 2 years for patients who did not achieve CR/PR(*) following-DHC was 0.33. These preliminary data suggest that high-dose TMCb followed by autologous stem cell transplantation is an effective regimen for patients with advanced breast cancer and may be comparable to some previously used regimens.

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.

Coil-Induced Perforation of Recently Ruptured Cerebral Aneurysm during Embolization. Causes and Avoidance

SUMMARY

Most coil-induced aneurysmal ruptures during endovascular treatment occur in small, recently ruptured aneurysms, and after placement of at least one coil. In cases where the distal part of the microcatheter cannot move back due to its straightness and tightness, the last coil deployed may advance towards the aneurysmal wall through intercircles of deposited coils. To solve this problem, after complete occlusion of the sac is obtained, the microcatheter is slightly withdrawn until the tip of the catheter is placed in the neck, and then the neck is occluded with the appropriate coil.

[The effect of giving information forms about side effects of intravenous iodinated contrast material on the anxiety level of patients]

PURPOSE

We aimed to determine the effect of informing patients about side effects of the contrast material on the level of patients' anxiety.

MATERIALS AND METHODS

Two hundred-ninety seven patients undergoing computed tomography examination were enrolled in the study. Patients were grouped in three categories: (1) patients informed about adverse effects of contrast material and waiting for i.v. contrast material injection, (2) uninformed patients waiting for i.v. contrast material injection, (3) uninformed patients undergoing unenhanced CT examination. All patients were requested to complete a questionnaire including a standard anxiety test. The results were compared statistically.

RESULTS

The mean anxiety scores calculated by variant analysis were 39.2 +/- 11.7, 42 +/- 10.4, and 38.6 +/- 9.5 in groups 1, 2, and 3, respectively. No statistically significant difference was found between the anxiety scores of the 3 groups.

CONCLUSION

Informing patients about the adverse effects of the contrast material does not affect their anxiety level.

[Case report: Maxillary myxoma]

Maxillary myxoma is a rare benign mesenchymal tumor of unknown etiology. Although odontogenic myxomas are benign and nonmetastasizing tumors, they are locally invasive and have a propensity to recur if incompletely resected. We report a case of odontogenic myxoma involving the anterior part of the maxilla and discuss the role and findings of radiologic imaging.

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.

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.

A randomized trial of assessment of efficacy of leukapheresis volumes, 8 liters vs 12 liters

It is logical to expect that large-volume leukapheresis may be able to collect adequate numbers of PBSC with fewer procedures. To date, there is no agreement on the optimal volume of leukapheresis. Therefore, in this study we compared 8 l volume with 12 l and assessed whether a 50% increase in the blood volume processed would decrease the number of leukaphereses each patient needed to collect > or =2.5 x 10(6) CD34(+) cells/kg in normal mobilizers. PBSC mobilization was done with cyclophosphamide etoposide followed by rhG-CSF in all patients. Forty patients were randomized to undergo 8 l leukaphereses (n = 20 patients) or 12 l leukaphereses (n = 20). The median numbers of leukaphereses required in order to collect > or =2.5 x 10(6) CD34(+) cells/kg in patients processed with 8 l and 12 l were 1 (range 1-5) and 1 (1-4), respectively (P = 0.50). The median number of total nucleated cells (TNC) collected per patient was greater for the 12 l group (7.47 x 10(8)/kg vs 3.90 x 10(8)/kg, P < 0.001), as was the median number of total mononuclear cells (TMNC) (4.26 x 10(8)/kg vs 2.16 x 10(8)/kg, P < 0.001), whereas there was no difference between the two groups for the median number of CD34(+)cells collected per patient (8.94 x 10(6)/kg vs 8.60 x 10(6)/kg, P = 0.85). The TNCs and TMNCs collected per leukapheresis were again greater for the 12 l group (3.64 x 10(8)/kg vs 1.91 x 10(8)/kg, P = 0.001 and 2.17 x 10(8)/kg vs 0.88 x 10(8)/kg, P < 0.001), whereas there was no difference between the two groups for the median number of CD34(+) cells collected per leukapheresis (3.98 x 10(6)/kg vs 3.26 x 10(6)/kg, P = 0.90). This study showed that there is no difference between 8 l and 12 l volumes in regard to collected CD34(+) cells/kg and also the use of a 12 l leukapheresis volume did not decrease the number of leukaphereses performed compared with a 8 l leukapheresis volume. In fact, the use of the larger leukapheresis volume had the disadvantage of adding 60 min to the time the patient was on the machine.

Comparison of cefepime and ceftazidime in combination with amikacin in the empirical treatment of high-risk patients with febrile neutropenia: a prospective, randomized, multicenter study

A total of 208 adult patients with cancer and febrile neutropenia from 5 medical institutions were randomized to receive either cefepime (2 g b.i.d.) or ceftazidime (2 g t.i.d.) in combination with amikacin (15 mg/kg/o.d.). Ninety-seven patients in the ceftazidime (CEZ) group and 98 in the cefepime group (CEF) were evaluable for efficacy. In 68 patients (35%), infection could be documented. The average duration of antibiotic therapy was 11 and 12 d and response rates to the empirical regimen were 36 and 30% for the CEZ and CEF groups, respectively (p > 0.05). The average time of defervescence in responders was 3 d for both groups. Modification of the initial regimen with antivirals and/or azole antifungals raised the number of responders to 44% and 35%, respectively (p > 0.05). Vancomycin was additionally given to 29 patients in the CEZ group and to 27 patients in the CEF group. Twenty-six patients in each group received empirical amphotericin B. Mild, reversible study drug-related side-effects were observed in 12 patients (12%) in the CEZ group and 13 patients (13%) in the CEF group (p > 0.05). Cefepime in combination with amikacin seems to be as effective, safe and tolerable as ceftazidime + amikacin in patients with high-risk neutropenia and fever.