Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP)

BACKGROUND

In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life. One treatment option in such cases is oral immunotherapy (OIT) with foods.

METHODS

We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT.

RESULTS

The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE specific of egg white titer was 38.5kU/l. A double-blind placebo-controlled food challenge with cooked egg white was performed, and if the test proved positive, it was repeated with pasteurized raw egg white. The mean symptoms-provoking dose was 1.26g and 0.55g for cooked egg white and raw egg white, respectively. An IgE specific of ovomucoid titer of <2.045kU/l differentiated those patients that tolerated cooked egg white.

CONCLUSIONS

OIT with egg is regarded as an option in patients with persistent egg allergy. In the previous challenge test, an IgE specific of ovomucoid titer of <2.045kU/l differentiates those patients that tolerate cooked egg white.

Increased incidence of necrotizing enterocolitis associated with routine administration of Infloran™ in extremely preterm infants

We aimed to evaluate the isolation of strains contained in the Infloran™ probiotic preparation in blood cultures and its efficacy in reducing necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in extremely preterm infants. Routine use of probiotics was implemented in 2008. Infants born at <28 weeks gestational age were prospectively followed and compared with historical controls (HC) born between 2005 and 2008. Data on sepsis due to any of the two probiotic strains contained in Infloran and rates of LOS and NEC were analysed. A total of 516 infants were included. During the probiotic period (PC), none of the strains included in the administered probiotic product were isolated from blood cultures. Probiotic administration was associated with an increase in NEC stage II or higher (HC 10/170 [5.9%]; PC 46/346 [13.3%]; P=0.010). Surgical NEC was 12.1% in PC (42/346) versus 5.9% (10/170) in HC (P=0.029). Adjusting for confounders (sex, gestational age, antenatal steroids and human milk) did not change those trends (P=0.019). Overall, clinical LOS and the incidence of staphylococcal sepsis were lower in PC (172/342, 50.3, and 37%, respectively) compared with HC (102/169, 60.3 and 50.9%, respectively) (P=0.038 and P=0.003, respectively). No episodes of sepsis attributable to the probiotic product were recorded. The period of probiotic administration was associated with an increased incidence of NEC after adjusting for neonatal factors, but also with a reduction in the LOS rate.

Radiation dose optimisation for conventional imaging in infants and newborns using automatic dose management software: an application of the new 2013/59 EURATOM directive

Objective: The new 2013/59 EURATOM Directive (ED) demands dosimetric optimisation procedures without undue delay. The aim of this study was to optimise paediatric conventional radiology examinations applying the ED without compromising the clinical diagnosis.

METHODS

Automatic dose management software (ADMS) was used to analyse 2678 studies of children from birth to 5 years of age, obtaining local diagnostic reference levels (DRLs) in terms of entrance surface air kerma. Given local DRL for infants and chest examinations exceeded the European Commission (EC) DRL, an optimisation was performed decreasing the kVp and applying the automatic control exposure. To assess the image quality, an analysis of high-contrast resolution (HCSR), signal-to-noise ratio (SNR) and figure of merit (FOM) was performed, as well as a blind test based on the generalised estimating equations method.

RESULTS

For newborns and chest examinations, the local DRL exceeded the EC DRL by 113%. After the optimisation, a reduction of 54% was obtained. No significant differences were found in the image quality blind test. A decrease in SNR (-37%) and HCSR (-68%), and an increase in FOM (42%), was observed.

CONCLUSION

ADMS allows the fast calculation of local DRLs and the performance of optimisation procedures in babies without delay. However, physical and clinical analyses of image quality remain to be needed to ensure the diagnostic integrity after the optimisation process. Advances in knowledge: ADMS are useful to detect radiation protection problems and to perform optimisation procedures in paediatric conventional imaging without undue delay, as ED requires.

[Pulmonary lobectomy in children: the sooner the better?]

AIM OF THE STUDY

Recommendation of early pulmonary resection in asymptomatic congenital pulmonary airway malformations (CPAMs) is based on the presumed compensatory lung growth during the first months of life. Our aim is to analyze the long-term pulmonary function after lobectomy before and after one year of age using spirometry.

METHODS

We performed a retrospective review of children who underwent pulmonary lobectomy for CPAM between 2001 and 2016. Patients who were old enough (>5 years) to carry out a spirometry were included in the study and were divided into 2 groups (surgery before or after 12 months of age). Pulmonary function testing values were considered normal if they were >80% of predicted.

MAIN RESULTS

Forty-seven patients underwent pulmonary lobectomy for CPAM, 23 of them met the inclusion criteria and prospectively performed a spirometry. Among them, 7 had surgery before and 16 after one year of age (0.1 vs. 2); being both groups comparable in terms of sex, type of CPAM and surgical approach. Time from surgery until pulmonary function testing was longer in patients who had surgery before one year of age (9.1 vs. 4.6 years, p = 0.003). After correcting results by time from surgery until spirometry, a better FEV1/FVC was found in patients who had surgery after one year of age (90% vs. 77%, p = 0.043).

CONCLUSION

Although spirometry may be influenced by many other variables, these preliminary results do not support the current recommendation of performing early lobectomy in CPAMs. Further studies are required in order to resolve the best age to perform pulmonary lobectomy.

Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab

Background:

To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy.

Methods:

Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination.

Results:

The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5–6.6), 9.4 (95% CI, 8.5–10.6), and 14 months (95% CI, 11.8–16) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the derivation set and 4.6 (95% CI, 3.3–8.1), 12.7 (95% CI, 11.3–14.3), and 18.3 months (95% CI, 14.6–24.2) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591–0.631) and 0.673 (95% CI, 0.636–0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index=0.583; P=0.00046) and Japan Clinical Oncology Group prognostic indices (c-index=0.611; P=0.03351).

Conclusions:

We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design.

Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy

OBJECTIVE

To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG.

MATERIAL AND METHODS

We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n=108), re-TURBT (n=153), induction with 27mg of BCG (Connaught strain) (n=87), induction with 81mg of BCG (n=489) or induction with 81mg of BCG+maintenance (n=202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks.

RESULTS

The mean follow-up was 62±39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003).

CONCLUSIONS

In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance.

Status of Internal Jugular Veins in Patients with Carcinomas of the Head and Neck Area

OBJECTIVE: To assess the status of internal jugular veins (IJV) in patients with head and neck carcinomas.

STUDY DESIGN AND SETTING: This study included 108 IJV of 54 cancer patients who were prospectively evaluated between September 1994 and February 1997. Patency, presence of thrombosis, characteristics of vein wall, compressibility, area of the veins both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were registered in all cases. Also, 30 IJV of 15 normal volunteers were used as a control group. The study was performed in a tertiary care referral center.

RESULTS: Right expiratory flow speed was higher in volunteers ( P = 0.0280), and left basal area was bigger in oncologic patients ( P = 0.0394). No significant changes were found between cancer patients and controls in the remaining parameters ( P > 0.05).

CONCLUSIONS AND SIGNIFICANCE: According to these results, head and neck carcinomas do not seem to affect the ultrasonographic characteristics of IJV. Thus, preoperative evaluation of IJV is not mandatory in these patients.

Clinical outcome following conversion of Girdlestone's resection arthroplasty to total hip replacement: a retrospective matched case-control study

A total of 31 patients, (20 women, 11 men; mean age 62.5 years old; 23 to 81), who underwent conversion of a Girdlestone resection-arthroplasty (RA) to a total hip replacement (THR) were compared with 93 patients, (60 women, 33 men; mean age 63.4 years old; 20 to 89), who had revision THR surgery for aseptic loosening in a retrospective matched case-control study. Age, gender and the extent of the pre-operative bone defect were similar in all patients. Mean follow-up was 9.3 years (5 to 18). Pre-operative function and range of movement were better in the control group (p = 0.01 and 0.003, respectively) and pre-operative leg length discrepancy (LLD) was greater in the RA group (p < 0.001). The post-operative clinical outcome was similar in both groups except for mean post-operative LLD, which was greater in the study group (p = 0.003). There was a significant interaction effect for LLD in the study group (p < 0.001). A two-way analysis of variance showed that clinical outcome depended on patient age (patients older than 70 years old had worse pre-operative pain, p = 0.017) or bone defect (patients with a large acetabular bone defect had higher LLD, p = 0.006, worse post-operative function p = 0.009 and range of movement, p = 0.005), irrespective of the group. Despite major acetabular and femoral bone defects requiring complex surgical reconstruction techniques, THR after RA shows a clinical outcome similar to those obtained in aseptic revision surgery for hips with similar sized bone defects.

Influence of the true number of Bacillus Calmette-Guérin instillations on the prognosis of non-muscle invasive bladder tumors

OBJECTIVES

To analyze if the true number of BCG instillations applied in non-muscle invasive bladder tumors has any influence on their prognosis as well as other tumor and clinical characteristics: age, sex, different protocols, BCG dose, whether primary or recurrent, solitary or multiple, tumor size G3 or Cis.

PATIENTS AND METHODS

A total of 324 high grade NMIBC (15 TaG3, 184 T1G3, 125 Cis) out of 1491 cases included in the CUETO database were analyzed. Following 6 post transurethral resection (RTU) BCG instillations, the patients were scheduled to receive one instillation every two weeks (3-6 times), for a total of 9-12 instillations. One third of the dose (27 mg) (112 cases) or total dose of 81 mg (212 cases). Mean follow-up was 59.6 months. Statistical Analysis: Kaplan-Meier, Cox-regression (uni-multivariate).

RESULTS

A higher level of recurrence (p = 0.032) and progression (P = .013) risk as well as worse Ca-specific survival (P = .005) were obtained if there were fewer than 12 instillations with the Kaplan-Meier and Cox-regression multivariate analysis. A 27 mg (P = .008) dosage and being a female (P < .001) were independent factors for a higher recurrence risk, but not for progression or Ca-specific survival. The remaining characteristics studied were not statistically significant.

CONCLUSIONS

In accordance with the results obtained, we can conclude that the number of BCG instillations applied has some influence on the outcome of high grade NMIBC. The optimum number of instillations as well as their time of application must still be determined. A dose of 27 mg and being a female are predictive factors of recurrence.

Abstract P4-05-04: Proteomic patterns unravel a new luminal-A breast cancer molecular subgroup with prognostic value

Background: Breast cancer is a heterogeneous disease including a variety of entities with different genetic background. Estrogen receptor-positive, HER2 negative tumors (ER+) usually have a favorable outcome, although some patients eventually relapse, which suggests some heterogeneity within this category.

In the last years, proteomic approaches have been incorporated to the study of clinical samples as a way to complement the information provided by gene analysis. Shotgun proteomics allows measuring over 1,000 proteins in clinical samples. In the present study, we combined genomic and proteomic techniques to characterize a set of breast tumors.

Methods: The study population consisted of 102 patients with lymph-node positive breast cancer who had received anthracycline-based adjuvant chemotherapy. Protein extracts from FFPE samples were prepared in 2% SDS buffer and digested with trypsin. SDS was removed from digested lysates, and resulting peptides were analyzed in an Orbitrap Velos. Protein abundance was calculated on the basis of the normalized spectral protein intensity (LFQ intensity) using MaxQuant. A prognostic protein signature was built. Findings were verified using whole genome gene expression data from 1,141 patients included in public repositories. To this purpose, the protein signature was converted to a gene signature. Data analysis was done using MeV, BRBArray Tools, R and Cytoscape software suites and Uniprot (http://www.uniprot.org/) and DAVID (http://david.abcc.ncifcrf.gov) webtools.

Results: We identified 3,000 protein groups in FFPE breast cancer samples and selected 1,000 that were identified at least in 75% of the samples. Significance Analysis for Microarrays analysis revealed 224 protein groups differentially expressed between ER+ and triple-negative (TN) samples (False Discovery Rate set at &lt;0.001). Hierarchical clustering analyses of protein expression showed that some ER+ samples had a protein expression profile similar to that of TN samples: patients with TN-like tumors had a clinical outcome similar to those with TN disease. Gene ontology analyses unraveled a reduced expression of proteins related with cellular adhesion in the TN-like and the TN groups. A TN-like predictive protein signature was built, converted to a gene signature and evaluated in the whole-genome expression data. The signature had prognostic value in patients with luminal-A breast cancer. This prognostic information was independent from that provided by standard genomic tests for breast cancer, such as MammaPrint, OncoType Dx and the 8-gene Score.

Conclusions: Proteomic profiling showed that cellular adhesion is a differential process between ER+ and TN breast cancer, and is reduced in the TN tumors. A group of ER+ breast tumors with reduced cellular adhesion was identified (TN-like). Patients with this luminal-A, TN-like breast cancer type had a poor outcome. This prognostic information was complementary to that offered by genomic tests such as OncoType.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-05-04.

Analysis of the concordance in the EGFR pathway status between primary tumors and related metastases of colorectal cancer patients:implications for cancer therapy

Patients with metastatic Colorectal Cancer (mCRC), in which primary tumors are KRAS mutated, have no response to anti-EGFR therapy. However, less than half of mCRC patients with KRAS wild-type primary tumors respond to anti-EGFR therapy. Other downstream effectors of the EGFR pathway are being analyzed to fine-tune KRAS predictive value. However, as the primary tumor is the tissue of analysis that determines the use of anti-EGFR therapy in advanced disease, a high concordance in the status of these effectors between primary tumors and related metastases is required. We analyzed the concordances of downstream EGFR effectors in tumoral pairs of primaries and related metastases in a series of KRAS wild-type patients. One hundred seventeen tumoral pairs from patients with CRC were tested for KRAS mutational status. The level of concordance in the presence of KRAS mutations was 91% between the primary tumor and related metastases. The 70 pairs with KRAS wild-type primary tumors were further analyzed for BRAF and PIK3CA mutational status and for EGFR, PTEN and pAKT expression, and the number of concordant pairs was 70 (100%), 66 (94%), 43 (61%), 46 (66%) and 36 (54%), respectively. Our findings suggest that the mutational status of KRAS, BRAF and PIK3CA in the primary tumor is an adequate surrogate marker of the status in the metastatic disease. On the other hand, the immunohistochemical analysis of EGFR, PTEN and pAKT showed a much higher degree of discordance between primaries and related metastases.

A new hierarchical classification for prognosis of hip fracture after 2 years' follow-up

OBJECTIVES

To examine the prognostic value of different profiles of hip fracture patients for recovery of pre-fracture functional level and for post-fracture mortality.

DESIGN

Observational, longitudinal study.

SETTING

University hospital.

PARTICIPANTS

Five hundred and eight patients who received surgery for hip fracture and were followed for 24 months post-fracture. MEASUMENTS: Patients were assessed according to age, number of independent activities of daily living (ADLs) and dementia. The probability of recovery of previous ambulation level and mortality was established at 3, 6, 12 and 24 months post-fracture. Patients were first classified according to the seven different profiles previously established by Penrod. A new patient classification system was then created using different patient groups: persons aged 75 or older were first classified based on the number of independent ADLs they could perform (4, 3-2 and 1-0) and were then subdivided according to age (75-84 years and >84 years) and presence of dementia.

RESULTS

Mean age was 84.5 (SD 6.3) years. Almost all (90.6%) patients walked independently before the fracture. At 24 months' follow-up, the probability of recovery to previous level of ambulation was 73.6%. The new classification into seven groups had higher prognostic value than Penrod's system. Patients under 75 had 95.1% probability of functional recovery and 9.6% of dying. At the other extreme, those over 84 years with 0-1 independent activities of daily living and dementia had 23.9% probability of recovery and 71.4% of dying.

CONCLUSION

Hip fracture patients can be classified into homogeneous groups with different prognostic profiles based on pre-fracture characteristics. This new classification improves Penrod's previous system by establishing groups of patients hierarchically ordered by the probability of recovery and mortality at 3, 6, 12 and 24 months post-fracture.

Activities of daily living after hip fracture: profile and rate of recovery during 2 years of follow-up

SUMMARY

In this study 509 hip fracture patients were followed-up during 24 months measuring their recuperation in activities of daily living. The different activities measured had both different profile and probability of recovery.

INTRODUCTION

Recovery of pre-fracture functional level is a goal of hip fracture treatment. The objective of this study was to measure recovery of previous functional level for ambulation and for the activities of daily living during the 24 months after osteoporotic hip fracture.

METHODS

This is a longitudinal prospective study of the patients admitted to the orthopaedics department of a university hospital for hip fracture and followed up by a geriatrician during three years (2003-2005). Demographic, clinical, functional and treatment data were collected during hospitalisation. Telephone follow-up was made at 3, 6, 12 and 24 months. Data were analysed by survival analysis applying the Kaplan-Meier estimator.

RESULTS

Five hundred and nine patients were included. The mean age was 84.5 (SD 6.3) years. The activities with lower probability of recovery to the previous level at 24 months were climbing stairs, chair/bed transfers, ambulation, dressing, bathing and use of toilet (between 67.5% and 76% recovery). The activities with higher probability of recovery were grooming, feeding and bladder and bowel control (between 86.3% and 95.4%). Recovery of previous performance level for ambulation, chair/bed transfers, use of toilet, feeding, grooming and bladder control occurred primarily during the first 6 months, whereas recovery of bathing, dressing and climbing stairs occurred mainly in the first 12 months after the fracture.

CONCLUSIONS

The activities with lower likelihood of recovery were ambulation, chair/bed transfers, climbing stairs, use of toilet, bathing and dressing. Time of recovery varied by activity; bathing, dressing and climbing stairs were the activities with the longest recovery time.

Stress-shielding of the proximal femur using an extensively porous-coated femoral component without allograft in revision surgery: a 5- to 17-year follow-up study

Revision surgery of the hip was performed on 114 hips using an extensively porous-coated femoral component. Of these, 95 hips (94 patients) had a mean follow-up of 10.2 years (5 to 17). No cortical struts were used and the cortical index and the femoral cortical width were measured at different levels. There were two revisions for aseptic loosening. Survivorship at 12 years for all causes of failure was 96.9% (95% confidence interval 93.5 to 100) in the best-case scenario. Fibrous or unstable fixation was associated with major bone defects. The cortical index (p = 0.045) and the lateral cortical thickness (p = 0.008) decreased at the proximal level over time while the medial cortex increased (p = 0.001) at the proximal and distal levels. An increase in the proximal medial cortex was found in patients with an extended transtrochanteric osteotomy (p = 0.026) and in those with components shorter than 25 cm (p = 0.008). The use of the extensively porous-coated femoral component can provide a solution for difficult cases in revision surgery. Radiological bony ingrowth is common. Although without clinical relevance at the end of follow-up, the thickness of the medial femoral cortex often increased while that of the lateral cortex decreased. In cases in which a shorter component was used and in those undertaken using an extended trochanteric osteotomy, there was a greater increase in thickness of the femoral cortex over time.

[Assessment of a malnutrition screening tool in cancer patients]

40-80% of cancer patients suffer from diverse degrees of malnutrition, depending on tumor subtype, location and staging and treatment strategy. Malnutrition is associated with increased morbidity and mortality in cancer patients. Both the high prevalence and prognostic significance of malnutrition imply the need for accurate malnutrition screening in cancer patients, which could select those patients at risk of nutritional derangements who would benefit from nutritional therapy. Patient-generated subjective global screening (VSG-GP) remains the reference malnutrition screening method, but its complexity and training requirements prevent wider applicability by oncologists. Thus, easier, more clinic-based malnutrition screening tools are required for cancer patients. In this article we propose a basic screening tool based on three items: weight loss, changes in physical activity and decrease in food intake. Two affirmative responses out of the three questions is considered as a positive response, and would prompt expert nutritional assessment.

RESULTS

Our screening interview showed positive correlation with VSG-GP (ROC 0.85, p<0.001) and allowed for a rapid and accurate identification of patients with cancer-related malnutrition.

Concordance of K-Ras status between colorectal cancer (CRC) primaries and related metastatic samples considering clinicopathological features

4053

Background: K-Ras mutations in CRC primaries may predict resistance to anti-epidermal growth factor receptor (EGFR) monoclonal antibodies, but we don´t know its behaviour in metastatic tissue. The aims of this study were: 1) Evaluate the grade of concordance of K-Ras status between primary and related metastatic samples 2) Establish a correlation between k-ras status and individual clinicopathological features Methods: K-ras mutations were retrospectively analysed in primary tumours of 124 patients and 138 related metastatic sites. The primary tumour site was colon in 87 patients and rectum in 37. Sites of metastases were liver (115 samples,83.3%) and lung (23 samples,16.7%). Some patients underwent surgery several times. We analyzed K-Ras point mutations in codons 12 and 13 by direct DNA sequencing from paraffin-embedded tumour and studied its relation with 13 clinicopathological features Results: K-Ras mutation was observed in 42(33.6%) primary tumours and in 52(39.1%) related metastatic sites, being the grade of concordance between primary and metastatic sites of 93% (95% CI: 97.5–88.3%). Discordance was observed in 9 (7%) patients: in 2, K-Ras status was wild type in metastatic site and expressed a mutational pattern in the primary tumour; vice versa, in 7, the mutation status was detected in the metastases meanwhile primary tumour was wild type. We also found statistically significative differences in mutation patterns regarding the site of the metastasic tissue: K-ras mutations were detected in 13 lung samples (61.9%) and in 39 liver samples (34.8%) (p=0.028). Of all the clinicopathological features analyzed we confirmed an increase of mutated K-ras status in tumours which had presented as perforation (p=0.044). No other relation with clinicopathological data was detected Conclusions: With this observational analysis, we confirm the high concordance (superior to 90%) between primary and related metastatic sites in terms of K-Ras status; for the first time, we have reported a higher mutational pattern in lung metastases than in liver disease, founds that may have important relevance regarding clinical/treatment decisions. For the realization of this study we received a grant from Amgen.

No significant financial relationships to disclose.

Survival prediction in terminally ill cancer patients: Description and validation of a new predictive score

9595

Background: Determining an accurate prognosis for terminally ill cancer patients is one of the biggest challenges that confronts a physician. Correct predictions can be done in only 20–40% of all cases. Although the current prognostic scales are helpful, they have significant limitations. Our objective consists of determining the potential indicators that influence the survival of these patients and develop and validate a new predictive model. Methods: A prospective, multicentric and observational study was conducted in 880 terminally ill cancer patients. At first, 40 clinical, demographic and laboratory variables were recorded in 406 patients. A forward stepwise regression method was applied for the multivariate survival analysis. Hence, a predictive model was constructed. Subsequent validation was performed in 474 patients. Results: Median age was 66.4 years (range 18–95). The median overall survival was 21 days in the first 406 patients studied and 19 days in the validation group. A prognostic model with 9 variables was constructed (age, ECOG, the amount of time between initial diagnosis up to being considered terminal phase, nauseas, anorexia, cognitive impairment, lymphocytes, LDH and albumin). Afterwards, to simplify the model, 4 variables that were considered more objective and with greater Odds ratio were selected and assigned one point per each prognostically poor category. We obtained a survival model that discriminates 3 prognostic categories: Good prognoses (score 0) with a median survival of 95 days (44–146), intermediate prognoses (score 1–2) with a median survival of 33 days (26.8–39.2) and bad prognoses (score 3–4) with a median survival of 15 days (11.1–18.9). In the validation group, median survival times were 60 (47.1–72.8), 27 (22.8–31.1) and 11 days (9.2–12.7) respectively. Conclusions: We propose a predictive score model that is objective and easy to use to help in accurately predicting life expectancy in terminally ill cancer patients. Its effectiveness has been validated in a group of independent centers.

No significant financial relationships to disclose.

A reduced qRT-PCR-based gene expression signature with prognostic value in early breast cancer

Abstract #2030

Background: Gene profiling may improve prognostic accuracy in patients with early breast cancer, but this technology is not widely available. We used commercial assays for qRT-PCR to measure the expression of 83 genes previously found to determine breast cancer prognosis. The objective of our study was to develop a simple molecular signature predicting relapse in early breast cancer with positive hormonal receptors.&#x2028; Methods: 153 patients (age 29-82 years-old) with early breast cancer and a minimum follow-up of 5 years were included. All tumours were positive for hormonal receptors and 38% had positive lymph nodes; 64% of patients received adjuvant chemotherapy (with anthracycline if N+ or high-risk N0). RNA was isolated from tissue slices of formalin-fixed paraffin-embedded samples using the MasterPure RNA Purification Kit (Epicentre Biotech). qRT-PCR amplifications were performed with TaqMan Gene Expression Assays products in an ABI PRISM 7900 HT Sequence Detection System (Applied Biosystems). The reactions were carried out using the TaqMan Low Density Arrays (Applied Biosystems). A supervised analysis was done to identify a prognostic expression signature using BRB Array Tools software. Survival curves were derived from Kaplan-Meier estimates and compared by log-rank test. The association of gene expression and clinical variables with distant metastasis-free survival (DMFS) was analyzed by Cox regression models. SAS 9.1 software package was used for statistical analyses.&#x2028; Results: After a median follow-up of 92 months, 28% of patients relapsed. We defined an 8-gene prognostic signature. The distant metastasis-free survival at 5 years was calculated for this profile. DMFS was 97% -good risk- versus 60% -poor risk, HR 20.3 (95% CI 6.17-67.2), p&lt;0.001. This gene expression profile was highly informative in identifying patients with distant metastasis, even when corrected for traditional prognostic factors in Cox multivariate analysis (HR 20, 95% CI 5.9-67.4). Performance was similar to that of three validated gene profiles. The validity of this signature was verified in an independent cohort obtained at the GEO database.&#x2028; Conclusions: This study identifies a new molecular signature with prognostic utility that outperforms traditional histopathologic prognostic factors. Our 8-gene qRT-PCR assay is suitable for analyzing routine formalin-fixed paraffin-embedded samples in the clinical setting.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2030.

[Impact of cardiopulmonary resuscitation on extremely low birth weight infants]

OBJECTIVE

To examine whether extremely low birth weight (ELBW) infants who undergo Cardiopulmonary Resuscitation (CPR) in the delivery room present poorer survival and greater short-term neurological and general morbidity than those who do not.

METHODS

In a retrospective cohort of 150 ELBW infants born at our hospital between 2000 and 2004, those who needed CPR and those who did not were compared for mortality and short-term general and neurological morbidity. Infants with major birth defects, suspicion of genetic disease and those without a proactive perinatal attitude in the delivery room were excluded. CPR was defined as the administration of chest compressions and/or epinephrine in the delivery room.

RESULTS

150 infants were included, with gestational ages of 23-27 weeks (mean 25.6+/-1.2), birth weight of 425-995 grams (mean 745.2+/-132). Delivery room CPR was given to 32 infants (21.4%). No differences in perinatal characteristics were found except for lower pH and Apgar score and a higher SNAPPE score in infants who underwent CPR. Survival at discharge was similar (62.5% vs 76.3% for those without CPR). Infants who received CPR needed more surfactant, oxygen and higher median airway pressure than infants who did not. Air leaks and coagulopathy were more frequent in CPR infants (p<0.01). Prevalence of bronchopulmonary dysplasia, necrotizing enterocolitis and retinopathy was similar in the two groups. No statistical differences between ELBW infants who needed CPR and those who did not were found in prevalence of intraventricular haemorrhage (IVH) (62.5% vs 52.5%), IVH III (31.2% vs 17.7%), periventricular haemorrhagic infarction (PHI) (18.7% vs 11%) or cystic periventricular leucomalacia (PVL) (15.6% vs 11%). However, in a combined analysis of neurological morbidity (IVH III and/or PVL and/or PHI), significant differences between the two groups were found (46.7% vs 21.6%; p=0.01).

CONCLUSION

This study does not support poorer survival or significant non-neurological morbidity during the neonatal period in ELBW infants who receive CPR. Although the prevalence of individual neurological problems was similar in the two groups, CPR was associated with a clear increase in general neurological morbidity, with a three-times greater risk of brain damage.

[Integrated PET/CT scanner in oncology applications: a radiologic perspective]

OBJECTIVE

To describe our experience with an integrated PET/CT system in the clinical applications in Oncology.

MATERIAL AND METHODS

An integrated PET/CT scanner is an in-line system combining a full-ring detector PET and a multidetector row helical CT in one machine. This is a multidisciplinary technique involving a nuclear medicine physician, a radiologist, a radiopharmacologist, and a physicist, with distinct tasks and working together. The clinical indications for PET scans are determined by the National Health System, which in Madrid is coordinated by Agencia Laín Entralgo, and are performed by a nuclear medicine physician with the help of a radiologist for CT interpretation. The combined PET/CT scans are supervised and interpreted by both a nuclear medicine physician and a radiologist.

RESULTS

Between September 2003 and August 2005, a total of 2459 examinations were performed at our institution: 2200 were PET scans with low-dose noncontrast-CT for attenuation correction (clinical indications approved by NHS), and 259 were combined PET/CT scans with full-diagnostic enhanced-CT (in the setting of research programmes). The overall distribution of clinical indications for the 2459 examinations were: lung cancer 14.7%, solitary lung nodule characterization 7%, lymphoma 23.5%, colon cancer 18.5%, gastric cancer 1.9%, brain tumors 2.6%, head-neck tumors 5.5%, thyroid cancer 5%, breast cancer 4%, unknown origin cancer 4.3%, epilepsy 1.4%, others 11.6%.

CONCLUSION

In our experience, the integrated PET/CT system has advantages over the stand-alone PET and/or CT. However, more studies, as the ongoing research programmes at our facility are needed for the diagnostic validation of this technique.

Associations among pollen sensitizations from different botanical species in patients living in the northern area of Madrid

OBJECTIVE

To determinate the existence of associations among sensitizations to antigens produced by pollen grains of different botanical species as assessed by skin prick tests in patients with respiratory disorders.

METHODS

Six hundred twenty nine consecutive patients living in the northern area of Madrid who underwent clinical evaluation because of rhinoconjunctivitis, and/or asthma were studied. All patients were tested with a skin prick test using a battery of inhalants including pollens, dust mites, molds and danders. The exploratory multivariate technique of Multiple Correspondence Analysis was used to compare the homogeneity of sensitizations between groups. Of the 629 patients, 459 (73.0%) had positive skin prick tests to pollen and were selected as the study group.

RESULTS

The most prevalent pollen sensitization was to Gramineae pollen (83.7%) followed by Oleaceae sensitisation (75.8%). Multiple Correspondence Analysis revealed the existence of an association among pollen sensitizations, showing that they clustered two groups: sensitizations to Gramineae, Oleaceae, Cupressaceae, Chenopodiaceae, Plantaginaceae (group I), and sensitizations to Betulaceae, Platanaceae, Compositae (group II). Sensitization to Parietaria was not included in any of the sensitization groups and showed an independent behaviour.

CONCLUSION

Pollen sensitizations in our area cluster into two association groups which have not previously been reported.

Probability of prostate cancer as a function of the percentage of free prostate-specific antigen in patients with a non-suspicious rectal examination and total prostate-specific antigen of 4–10 ng/ml

Our aim was to assess the usefulness of measuring the percentage of free prostate specific antigen (PSA) in serum in relation to reducing the number of prostate biopsies in men with benign prostate examinations and serum PSA levels between 4 and 10 ng/ml. The percentage of free PSA (Immulite) in serum was analyzed prospectively in 500 men, all of whom underwent ultrasound-guided sextant prostate biopsies. Cancer was detected in 21.4% (107/500) of the patients. Using a free PSA cutoff of < or = 23% as a criterion for performing prostate biopsy would have detected 94.4% of cancers, avoided 18.8% of benign biopsies and yielded a positive predictive value of 25.3%. The percentage of free PSA increased with prostate volume. Mean total PSA and mean free percent PSA values increased as patient age increased, influencing the calculation of cutoff values, sensitivity and specificity. PSA density had a sensitivity and specificity not significantly different than the percentage of free PSA. Measurement of the percentage of free serum PSA improves the specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations.

Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of intravesical bacille Calmette-Guérin with a reduced dose of 27 mg in superficial bladder cancer

OBJECTIVES

To determine the efficacy of a three-fold reduced dose (RD, 27 mg) of intravesical bacille Calmette-Guérin (BCG) against the standard dose (81 mg) in patients with superficial bladder cancer, assessing recurrence, progression and differences in toxicity.

PATIENTS AND METHODS

Five hundred patients with superficial bladder cancer (Ta, T1, Tis) were enrolled and randomly assigned to be treated after transurethral resection of all visible lesions with intravesical BCG Connaught strain (weekly x six and thereafter fortnightly x six) either with the standard or RD instillation.

RESULTS

All but one of the 500 patients were evaluable for efficacy and toxicity (252 in the standard arm and 247 in the RD arm). The median follow-up was 69 months (maximum 104); 71 (28%) patients in the standard arm and 76 (31%) in the RD arm developed recurrences; the median time to recurrence has not yet been attained, but at 5 years the mean (sd) percentage of recurrence-free patients was 70.5 (3.12) and 70.4 (3.1) for the standard and RD arms, respectively. In patients presenting with multifocal tumours, the standard dose was more effective against recurrences than the RD (P=0.0151). In those with G3 and high-risk tumours overall, the superiority of the standard dose was marginal (P=0.060 and P=0.082). Twenty-nine (11.5%) tumours in the standard arm and 33 (13.3%) in the RD arm progressed to invasive disease; the median time to progression has not yet been attained, but the percentage of progression-free patients at 5 years was 88.8 (2.23) and 86.9 (2.31) for the standard and RD arms, respectively. The standard dose was more effective than the RD against progression only in patients with multifocal disease (P=0.048). Twelve (4.8%) cystectomies were performed in the standard and 15 (6.1%) in the RD arm. Currently, 106 (21.2%) patients have died, but only 38 (7.6%) from bladder cancer, i.e. 20 (7.9%) in the standard and 18 (7.5%) in RD arm. Overall the disease-specific death rate was lower for those patients who completed the scheduled treatment. The cause-specific survival at 5 years did not differ between the arms (P=0.76) but there was a trend toward better cause-specific survival for patients with multifocal tumours in the standard arm. Toxicity differed between the arms, significantly more patients having no toxicity in the RD arm, and fewer having delayed instillations or withdrawing. However, severe systemic toxicity occurred even in patients treated with the RD, in a similar proportion to those receiving the standard dose.

CONCLUSION

Overall, the RD gave similar results for recurrence and progression but with significantly less toxicity. However, patients with multifocal tumours fared better with the standard dose and there was a trend towards better recurrence rates in patients with high-risk tumours. We recommend continuing to use the standard dose for high-risk tumours, while we consider the reduced dose safe and effective for intermediate-risk lesions and for maintenance schedules.

Interleukin-1 receptor antagonist gene polymorphism and mortality in patients with severe sepsis

This study aims to determine the influence of the polymorphism within the intron 2 of the interleukin-1 receptor antagonist gene (IL-1RN*) on the outcome of severe sepsis, and to assess its functional significance by correlating this polymorphism with the total production of interleukin-1 receptor antagonist (IL-1Ra) protein determined in stimulated peripheral blood mononuclear cells (PBMC). A group of 78 patients with severe sepsis (51 survivors and 27 nonsurvivors) was compared with a healthy control group of 130 blood donors, and 56 patients with uncomplicated pneumonia. We found a significant association between IL-1RN* polymorphism and survival. Thus, after adjusting for age and APACHE II score, multiple logistic regression analysis showed that patients homozygotes for the allele *2 had a 6.47-fold increased risk of death (95% CI 1.01--41.47, P = 0.04). Besides, compared with patients homozygous or heterozygous for the allele *1, IL-1RN*2 homozygotes produced significantly lower levels of IL-1Ra from their PBMC. Our results suggest that insufficient production of this cytokine might contribute, among other factors, to the higher mortality rate found in severe sepsis patients with the IL-1RN*2 homozygous genotype.

Effect of atmospheric factors on the incidence of Bell's palsy

To assess the possible influence of atmospheric factors on the incidence of Bell's palsy, a retrospective case review of patients seen between 1 January 1992 and 30 June 1996, was designed. The population included all Bell's palsy patients in whom the exact date of onset of paralysis (day, month, year) was known. The following parameters were registered daily by the Spanish National Service of Meteorology throughout the period of survey: temperature, atmospheric pressure and air pollutants (total number of particles and levels of SO2, CO, O3, NO2, NO, CH4 and total organic carbon). The only factor significantly related to Bell's palsy was temperature (P = 0.0164). Lower temperatures were associated with a higher incidence of Bell's palsy. A relationship between atmospheric pressure and/or air pollutants and Bell's palsy was not found.

Comparative cost analysis of autologous peripheral blood progenitor cell and bone marrow transplantation in pediatric patients with malignancies

BACKGROUND AND OBJECTIVES

This study was conducted in order to compare and analyze clinical and economic outcomes of autologous transplantation using bone marrow or peripheral blood as the source of hematopoietic progenitor cells in pediatric patients with malignancies.

DESIGN AND METHODS

We collected clinical information and resource utilization from 131 consecutive autologous transplantations (102 peripheral blood progenitor cell (PBPC) and 29 bone marrow (BM) transplants) at a single institution between January 1989 and December 1998 in children with a variety of malignancies. Multivariable linear regression was used to evaluate the associations between pre-transplantation variables, post-infusion events and overall costs. A cost-effectiveness analysis of transplantation for acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) patients was also performed.

RESULTS

Hematopoietic recovery was faster in the PBPCT group (days to neutrophil and platelet engraftment: 9 and 13, respectively, versus 14 and 21 for BMT, p<0.0001). There were less transfusion, antibiotic and parenteral nutrition requirements and hospital stay was shorter (median 17 days; range 8-38) in the PBPCT group than in the BMT one (median 28 days; range 11-65) (p<0.0001) resulting in a median lower overall cost for PBPCT (US$ 7895) compared to BMT (US$ 11820)(p<0.0001). Major determinants of overall costs for both groups were total body irradiation (TBI)-based conditioning regimen, days of hospitalization and number of transfused platelets. In PBPCT patients, a graft containing > or = 5 x 10(6)/kg CD34+ cells decreased the total cost of transplantation by 27%. Cost-effectiveness was higher for PBPCT than BMT for pediatric AML patients (p<0.0001) whereas in ALL patients the cost-effectiveness of the two transplant strategies was not significantly different.

INTERPRETATIONS AND CONCLUSIONS

We conclude that, compared to BMT, autologous PBPCT in children is associated not only with clinical benefits but also economic advantages.

Factors related to nerve injury and hypocalcemia in thyroid gland surgery

To identify potential risk factors related to complications after thyroidectomy, a study was designed that included 675 patients. Recurrent laryngeal nerve (RLN) paralysis, hypocalcemia, serohematoma, wound infection, and postoperative hemorrhage were evaluated. The rate of paralysis of the RLN was calculated on nerves at risk for hypocalcemia (n = 890) in patients undergoing bilateral procedures or unilateral procedures if they had previously undergone a contralateral operation (n = 321). Multivariate analysis was used to identify the relationships between the variables included in the study. All statistical tests received the same level of significance of 0.05. Permanent hypocalcemia occurred in 2.2% of the patients, whereas unilateral paralysis of the RLN developed in 0.9%. Mortality was 0.1% in this series. The RLN paralysis had a significant relationship with preoperative diagnosis of malignancy (P < 0.03). Likewise, hypocalcemia was related to sex and surgical procedure (P < 0.03). Serohematoma was linked with age (P < 0.001), and hemorrhage was associated with previous radiation of the neck (P < 0.03).

Reproducibility of ultrasonographic measures in internal jugular veins of normal subjects

OBJECTIVE

To assess the reproducibility of ultrasonographic quantitative parameters of internal jugular veins (IJV) in normal subjects.

MATERIAL AND METHODS

Thirty IJV of 15 normal volunteers were prospectively evaluated by means of duplex Doppler ultrasonography (US). Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were registered in all cases. Two measures were performed in each subject.

RESULTS

High reproducibility was encountered in jugular flow (R=0.95) and in area during Valsalva (R=0.90) in the left IJV. Low reproducibility was found in Valsalva flow speed of the left side (R=0.35). The remaining measurements had a good reproducibility (R=0.50-0.75).

CONCLUSIONS

The ultrasonographic parameters of IJV in normal subjects show an adequate grade of reproducibility. Thus, duplex Doppler US can be used as a reliable method for evaluation or comparison of IJV in different situations of future studies.

[Color duplex Doppler ultrasonography in the evaluation of the risk of esophageal varices bleeding in cirrhotic patients]

The risk of variceal bleeding (VB) in patients with cirrhosis and esophageal varices may be determined by the portal pressure gradient. The value of Color Duplex Doppler Ultrasonography (CDDU) in the identification of patients at risk for variceal bleeding has been discussed in the literature. In patients with esophageal varices at risk for bleeding, CDDU did not detect patients who presented variceal bleeding during a mean follow-up of 7 months. However, patients with a low Congestion Index (< 0.05) and a mean upper portal vein velocity of > 9 were at lower risk for variceal bleeding. The Congestion Index was higher in patients with bleeding during the follow-up (0.09 vs. 0.057 (p = 0.03) and the mean portal vein velocity was lower in these patients (10.7 vs. 14).

Short-term follow-up of the nutritional status of children undergoing autologous peripheral blood stem cell transplantation

A prospective longitudinal study was conducted to analyze the evolution of the nutritional status of 34 children (12 girls and 22 boys), aged 1.5-15.8 years (median age 9.06), undergoing autologous peripheral blood stem cell transplantation (PBSCT). The nutritional status was evaluated at baseline, days +1 and +7, discharge, and day +30 by dietary or parenteral intake, anthropometric and laboratory measurements, and nitrogen balance. At baseline, changes in anthropometric (53%) and biochemical measurements (83%) are frequent but mild. The mean caloric intake was normal. Children with normal values for the anthropometric parameters all had an intake > 80% (p < .01). No correlation was found between the anthropometric and biochemical parameters. During transplantation, significant changes (p < .001) were found for energy intake, albumin, transferrin, and nitrogen balance. Fibronectin, prealbumin, and retinol-binding protein showed only a few changes. All but prealbumin recovered on day +30. No correlation was found between the nutritional status and toxicity or infection in children undergoing autologus PBSCT. The changes in the nutritional status observed at the start of transplantation correlated with the nutrional intake. Anthropometric and biochemical changes are complementary. The results may be ascribable to the fact that the patients in this series had mild malnutrition.

Enhanced acute-phase response and oxidative stress in older adults with type II diabetes

OBJECTIVE

To test whether oxidative stress could promote a systemic acute-phase response in elderly patients with type II diabetes.

DESIGN AND METHODS

In a group of 30 older diabetic patients with poor glycemic control, serum levels of lipid peroxides, measured as thiobarbituric acid-reacting substances (TBARS); C-reactive protein (CRP); interleukin (IL)-6 and the soluble form of its receptor (slL-6R), were evaluated at baseline and after 2 and 3 months of therapeutic intervention. Thirty asymptomatic, untreated individuals with abnormal fasting glycemia, but otherwise healthy status, of similar age, sex, and weight served as control group.

RESULTS

At baseline, glycemia (8.83 +/- 0.67mmol/l), HbA1C (8.66 +/- 0.59%), TBARS (8.68 +/- 1.21 micromol/l), CRP (16.05 +/- 3.81 mg/l) IL-6 (5.39 +/- 1.25 pg/ml) and sIL-6R (1425 +/- 492 pg/ml) were significantly higher in diabetic patients than in asymptomatic hyperglycemic individuals (p<0.001). After treatment, glycemia significantly decreased with respect to baseline values (- 9.82% after 60 days and -13.74% after 90 days), as did serum levels of TBARS (-14.05% and -21.89%, respectively), CRP (-32.71% and -43.86%), IL-6 (-23.75% and -40.63%) and sIL-6R (-34.53% and -48.49%, respectively). In diabetic patients, multiple regression showed, at each time, that TBARS and IL-6 were independently correlated with CRP, considering CRP as the dependent variable. Similar correlations were found in asymptomatic hyperglycemic subjects.

CONCLUSION

These results suggest that oxidative stress might be implicated in promoting a state of low-grade systemic inflammation in elderly patients with type II diabetes.

Use of concurrent G-CSF + GM-CSF vs G-CSF alone for mobilization of peripheral blood stem cells in children with malignant disease

There is limited experience in the mobilization of peripheral blood progenitor cells (PBPC) in children and the optimal method for PBPC mobilization is unknown. The present study was conducted to ascertain whether mobilization with G-CSF + GM-CSF (group I) provides some advantage over G-CSF alone (group II) in terms of collected CD34+ cells and hematopoietic recovery following myeloablative conditioning in children with malignancies. An economic analysis was also performed. Each group comprised 21 consecutive patients. The mean number of aphereses was 1.5+/-0.5 in group I and 1.2+/-0.46 in group II (NS). The mean number of CD34+ cells was 3.8 x 106+/-4.03/kg in group I and 4.2+/-5.4 in group II (NS). The mean number of total blood volumes (TBV) processed was 4.4+/-1.5 in group I and 4.3+/-1.5 in group II (NS). The mean duration of the procedure was 276+/-74.1 min in group I and 286.7+/-75.9 min in group II (NS), and the inlet flow was 45.1+/-12 ml/min in group I and 39.5+/-15.1 ml/min in group II (NS). No significant differences in the neutrophil and platelet engraftment probability were observed between the two groups. The mean overall cost of group II was not statistically significant from that of group I (US$ 9521+/-330 vs US$ 10201+/-1028, P = NS). The cost of mobilization was significantly higher in group I than in group II, conditioning regimen costs were similar in both groups and the costs related to the post-transplant period were similar in both groups. We conclude that PBPC mobilization with G-CSF + GM-CSF in children does not enhance hematological recovery in comparison with mobilization using G-CSF alone. However, the combination of G-CSF + GM-CSF does not significantly increase the overall cost of transplantation.

Treatment of fractures of the distal radius with a remodellable bone cement

We performed a prospective, randomised study on 110 patients more than 50 years old with fractures of the distal radius to compare the outcome of conservative treatment with that using remodellable bone cement (Norian skeletal repair system, SRS) and immobilisation in a cast for two weeks.

Patients treated with SRS had less pain and earlier restoration of movement and grip strength. The results at one year were satisfactory in 81.54% of the SRS patients and 55.55% of the control group. The rates of malunion were 18.2% and 41.8%, respectively. There was a significant relationship between the functional and radiological results. Soft-tissue extrusion was present initially in 69.1% of the SRS patients; most deposits disappeared progressively, but persisted in 32.73% at one year.

We conclude that the injection of a remodellable bone cement into the trabecular defect of fractures of the distal radius provides a better clinical and radiological result than conventional treatment.