Aplastic anemia is a rare hematologic disorder characterized by hypocellular fatty marrow. Aplastic anemia is diagnosed on the basis of laboratory tests and bone marrow biopsy findings. Biopsy is of fundamental importance for bone marrow assessment, though not representative of the rest of the marrow. Thanks to its exclusive capabilities in the direct visualization of bone marrow, MRI is a noninvasive and relatively rapid method for bone marrow study. The authors report their experience in 3 aplastic anemia patients examined also with MRI at presentation and after marrow transplantation. The dorsolumbar spine was studied with sagittal SE T1-weighted and STIR sequences, while pelvic bones were investigated only with SE T1-weighted sequences in all patients. Two of them were also examined with sagittal scans of the dorsolumbar spine using the chemical shift fat suppression technique. In all three patients, SE T1-weighted images at presentation showed fatty bone marrow infiltration, also confirmed on fat suppression images, and, after transplantation, progressive bone marrow repopulation, with the typical "band" pattern in vertebral marrow. Although MR specificity remains low in the demonstration of bone marrow disorders, the authors believe it to be a useful tool, after accurate clinical and laboratory exams, not only in the diagnosis but also and especially in the follow-up of these disorders.

Adult↗

PubMedDate not supplied

In vitro chemosensitivity of chronic lymphocytic leukemia B-cells to multidrug regimen (CEOP) compounds using the MTT colorimetric assay.

BACKGROUND: Anthracycline-containing regimens have given controversial clinical results in CLL. Therefore, we explored the in vitro behavior of CLL B-cells after exposure to the compounds included in the most frequently used combination therapy regimen (CEOP). METHODS: A 4-day MTT colorimetric assay was used in vitro to test the effect of CEOP regimen drugs, either alone or in combination, on CLL B-cells. All drugs but mafosfamide, tested in place of cyclophosphamide, were used at concentrations corresponding to the in vivo dosage employed in the CEOP regimen. Chlorambucil was also studied since it represents the standard treatment for this disease. RESULTS: Epirubicin, prednisone and vincristine displayed a cytotoxic effect in 15, 13 and 4 out of 30 samples, respectively. Combinations of the same drugs showed a synergistic effect in 6 out of 13 assays. A cytotoxic effect of chlorambucil was detected in 2 out of 5 responders to the combination of CEOP regimen drugs, and in 3 out of 7 non responders. Mafosfamide induced a reduction in cell survival in 60-80% of the samples, depending on its concentration. CONCLUSIONS: The MTT assay is suitable for evaluating the in vitro chemosensitivity of CLL B-cells to multidrug regimen compounds. In the present study 40% of samples were resistant to CEOP regimen components in vitro. The possible role of MTT in predicting the clinical response to the CEOP regimen should still be established by prospective in vitro and in vivo studies.

Adult↗

PubMedDate not supplied

Fractionated infusions of cryopreserved stem cells may prevent DMSO-induced major cardiac complications in graft recipients.

The amount of transfused dimethyl sulfoxide (DMSO) is indicated as the major cause of the cryoprotectant-related toxicity in autologous stem cell recipients, with a high incidence of major cardiac side effects. In this study we tried to discover whether fractionated infusion of the total graft volume could prevent the DMSO-related major cardiovascular side effects. We conclude that continuous cardiac monitoring during and after fractionated infusions of DMSO-containing graft documented no major arrhythmias, with only seven episodes of asymptomatic sinus bradycardia.

Adolescent↗

PubMedDate not supplied

Two consecutive courses of rh-G-CSF-mobilized peripheral blood stem cells for primary marrow alloengraftment failure: case report.

We describe herein a case of bone marrow failure in a 53-year-old patient affected by Ph1-positive chronic myeloid leukemia who received an HLA-identical AB0-mismatched bone marrow transplant from a 56-year-old sibling donor. Hematopoietic recovery after marrow failure was obtained following two consecutive courses of rh-G-CSF-mobilized peripheral blood stem cell infusions. No potential risk factors associated with graft failure, excluding recipient and donor age, were documented, whereas a relatively high number of progenitor cells were necessary to overcome the host-versus-graft barrier in our patient. Therefore we suggest that growth factor-stimulated peripheral blood should be considered as the first choice for allogeneic stem cells in order to avoid primary graft failure with donors over 50 years of age.

Blood Cell Count↗

PubMedDate not supplied

[Echotomography and color-Doppler in the diagnosis of thyroid carcinoma].

Ultrasound examination of the thyroid gland is used extensively in the diagnosis of thyroid carcinoma: it is easy and rapid to perform and widely available. Ultrasound enables easy identification of the image of disease foci within the gland, especially when high frequency probes (7.5-10 MHz) are used. Thyroid nodules are subdivided on the basis of their echostructure into hypoechoic solid, isoechoic solid, and hyperechoic solid, mixed, and liquid. In neoplastic pathologies, a hypoechoic echostructure is not pathognomonic of malignancy but must be regarded with suspicion, especially if it is an isolated nodule in a male patient and continues to grow during suppressive therapy. In fact, thyroid neoplasms evidence a hypoechoic echostructure in 60-70% of the cases, while a hyperechoic echostructure is present in only 2-4%. Only 15-25% of neoplasms appear as isoechoic nodules; a mixed echostructure is rarely (5-10% of the cases) seen. Color-Doppler patterns are classified into four types: I) nodules without internal or perinodular vascularization; II) nodules with vascularization confined to extranodular tissue; III) nodules with significant intra- and perinodular vascularization; IV) increased vascularization (or "thyroid inferno"). The vast majority of thyroid carcinoma (90%) presents type III vascularization. We therefore suggest the routine use of ultrasonography and color-Doppler studies in conjunction with fine-needle aspiration cytology for the diagnostic evaluation of thyroid carcinoma.

Adult↗

PubMedDate not supplied

Diagnostic items and treatment of Plummer's disease: a study on 180 patients.

OBJECTIVE: The aim of this study was to evaluate clinical data of patients who have been undergone to medical, radionuclide, surgical and percutaneous ethanol injection (PEI) treatment of autonomous "hot nodule", to establish the real value of these therapeutical strategies. PATIENTS AND METHODS: The authors analyzed their experience based on 180 Plummer's disease (PD) from January 1990 to December 1997. 49 nodules have been submitted to FNA. RESULTS: The functional stage of PD was partially autonomously in 47 patients, pretoxic nodule in 98 patients and in toxic phase in 35 patients. The more frequent ultrasonographic type has been a solid nodule with abundant intranodular vascularization to color flow duplex Doppler evaluation. The medical therapy has brought to a resolution of the toxic phase in 71.2% of the patients, while 6.4% of the patients developed a recurrent hyperthyroidism. The surgical treatment of the patients with hyperthyroidism has resolved hyperthyroidism symptoms in 87.5% of cases. The therapy with radioactive iodine determined a metabolic normalization in 73.7% of the cases and an hypothyroidism in 89.5% of the cases. Our results, in 12 patients treated with PEI, followed-up through 12 months, have been excellent: total remission in 75% of the patients and no recurrent hyperthyroidism crisis. CONCLUSIONS: It doesn't exist a single therapy to treat the PD. The surgical or radionuclide treatment could be addressed to the big or toxic nodules insensible to pharmacological therapy and the PEI represent a new method to treat the PD because of efficacious, harmless, cheap and practical too.

Adult↗