The surface expression of CD117 on plasma cells (PCs) from normal individuals and patients with multiple myeloma (MM) has been analysed using triple-stained cells for flow cytometry. In addition, the clinical significance of CD117 expression in MM patients and its possible value for the evaluation of minimal residual disease was explored. A total of 11 healthy volunteers and 56 untreated MM patients were included in the study. The expression of CD117 was analysed by flow cytometry, using simultaneous staining with the MAbs BB4, CD117 and CD38. Cell acquisition was performed in two consecutive steps using a live gate drawn on SSC/CD38 cells and a total of 300,000 events were acquired. For data analysis, the Paint-a-Gate Plus software (Becton Dickinson) was used. PCs were identified according to their strong reactivity for CD38 and their positivity for BB4, as well as by their light scatter distribution. Dilution experiments of CD117+ myelomatous PCs with normal bone marrow (BM) cells were performed in order to assess the sensitivity level of the technique for detection of CD117+ residual PCs. None of the PCs from normal BM samples showed reactivity for the CD117 antigen. In contrast, CD117 antigen was present in 18/56 MM patients (32%), the proportion of positive cells in these cases being as high as 92.1 +/- 9%. Therefore, within PC lineage the c-Kit antigen would be restricted to the myelomatous population and thus could be considered as a 'tumour-associated marker' for monitoring minimal residual disease in about one third of MM patients. Dilution experiments indicate that the detection limit with this marker would be 10(-4) (one myelomatous PC/10(4) normal BM cells). Upon comparing the clinical and haematological disease characteristics of CD117-positive and CD117-negative cases, no significant differences were found.

Adult↗

PubMed1996

[Echocardiographic evaluation of the aortic and pulmonary valve areas in the newborn infant. Normal patterns].

OBJECTIVES: To determine normal values of the aortic and pulmonary functional valve areas in healthy newborn children. MATERIAL AND METHODS: We prospectively studied 32 newborns (17 boys) who were included in the following criteria: healthy parents, normal pregnancy, eutocic delivery, Apgar index 10 at 5 minutes weight between 2.500 and 4.000 kg, normal physical and echocardiographical examinations. The echocardiographical examination was executed during the first 48 hours of life. We used the continuity equation to calculate the aortic and pulmonary functional valve areas. As a reference we used the anatomic (pi r2) aortic and pulmonary valve areas, calculated in the bidimensional images from the distance measured between the two insertion points of the sigmoid valves. RESULTS: We had echocardiographic images and Doppler registrations of excellent quality, in all the newborn children. The functional pulmonary valve area ranged between 0.30 and 0.50 cm2 (mean +/- SD = 0.41 +/- 0.06) and the anatomical one ranged between 0.29 and 0.49 cm2 (mean +/- SD = 0.49 +/- 0.05), without statistical significance and with a correlation index 0.92. The functional aortic valve area ranged between 0.20 and 0.40 cm2 (mean +/- SD = 0.31 +/- 0.05) and the anatomical ranged between 0.21 and 0.36 cm2 (mean +/- SD = 0.29 +/- 0.05), without statistical significance and with a correlation index 0.91. CONCLUSION: There is a good correlation between the functional aortic and pulmonary valve areas, calculated from the continuity equation, and the anatomical ones. These values will be useful in characterizing the critical stenosis of the newborn child with decreased ventricular function, where the transvalvular gradient is inaccurate in the quantification of the obstruction.

Aortic Valve↗

PubMed1996

[Surgical repair of free wall rupture after myocardial infarction].

Between August 1992 and July 1995 five patients with cardiac free wall rupture after acute myocardial infarction underwent surgical treatment in Centro de Cirurgia Torácica do Hospital de S. João. The diagnosis was suggested by the hemodynamic changes and in four patients confirmed with echocardiography and pericardiocentesis. All patients survived and were discharged from the hospital. Medical treatment with inotropic drugs, pericardiocentesis and intraaortic balloon counterpulsation allows hemodynamic stabilization but only early surgery may assure survival.

Adult↗

PubMed1996

[Effect of chemotherapy on hematopoietic stem cells in peripheral blood].

PURPOSE: To analyze the effect of conventional chemotherapy on haematopoietic progenitor cells (HPC) from peripheral blood (PB). PATIENTS AND METHODS: The present work studies the behaviour of CFU-GM from PB in 47 patients subjected to conventional chemotherapy with the following diagnoses: non-Hodgkin's lymphoma (NHL): 16; Hodgkin's disease (HD): 8; multiple myeloma (MM): 5; acute leukaemia (AL): 8; solid tumor (ST): 10. A total of 57 studies was performed. As controls, 51 samples of PB from healthy subjects were used. Cultures were made in semisolid medium (methylcellulose), using PHA-LCM as stimulant, evaluating the growth of clusters (cl) and colonies (col) on days 7 and 14. RESULTS: Our findings show that in the overall series of patients the number of clusters from days 7 and 14 and of colonies-7--that is the most differentiated progenitor cells--were decreased with respect to the controls while colonies-14 were slightly increased. When the patients were separated by diagnostic groups, the col-14 were found to be increased in ST (p = 0.03) and in AL; in NHL col-14 were the same as in the controls. In the patients with HD all progenitor cells, including col-14 were much lower than the control values (p = 0.005). In order to determine whether the kind or the amount of chemotherapy received might affect these progenitor cells, we have analyzed the cases of NHL, 11 patients treated with moderate chemotherapy versus 12 patients receiving intensive chemotherapy: a stronger degree of growth in the latter, although with no significant differences. On comparing the cases that had received little previous chemotherapy (< 5 courses) against those who had received more than 5 courses growth was seen to be stronger in the patients who had received the fewest courses (p = 0.04). CONCLUSIONS: These results indicate that the HPC from PB are scanty in certain diseases, such as HD and that in all lymphomas the collection of these cells for transplantation purposes should be performed before they have damaged by an excessive number of chemotherapy courses.

Acute Disease↗

PubMed1996

[Activity of various hematopoietic growth factors on acute myeloblastic leukemia blasts].

PURPOSE: Acute myeloblastic leukaemia (AML) cells respond to some extent to the action of haemopoietic growth factors (HGF). This work is aimed to analyse the effect of IL-3, GM-CSF and G-CSF on the proliferative and self-replication capabilities of AML cells and to correlate such response with the morphological and immunological characteristics of the blast cells. PATIENTS AND METHODS: Mononucleated cells from the peripheral blood of 26 AML patients were incubated in liquid medium without serum in presence of IL-3 and GM-CSF alone and in combination with G-CSF. Cell proliferation was evaluated by determination of the increase in the number of cells harvested after incubation with the HGF. The proliferative response was studied in 8 cases by flow cytometry analysis of the cell cycle (number of cells in S-phase). The capability of IL-3 and GM-CSF to induce self-replication of the leukaemic clonogenic cell (CFU-L) was analysed in 9 cases by techniques of replanting on semi-solid medium. RESULTS: Cell proliferation was induced with IL-3 in more cases than with GM-CSF (50% vs 28%); furthermore, the stimulus induced by IL-3 was also more evident, as the number of cells harvested was greater than that corresponding to GM-CSF (2.1 +/- 1.1 x 10(6) cell/mL vs 1.4 +/- 1.4 x 10(6) cells/mL, p = 0.10). Although no clear correlation was seen between the proliferative response to HGF and the immunologic or morphologic subtype of the blast cells, no response to GM-CSF was detected in those cases classified as M2 nor in the CD15-positive leukaemias. A synergistic effect of G-CSF and IL-3 or GM-CSF was found in only 20% of the cases. Both IL-3 and GM-CSF augmented the number of cells in S phase in all the cases analysed; this increase was higher in M1 and M2 with respect to the leukaemias with monocytic component. CONCLUSIONS: IL-3 and GM-CSF induced self-replication of CFU-L in a half of the cases. This effect was not dependent upon the kind of stimulating agent used (IL-3 or GM-CSF), and appeared unrelated to the morphologic or immunologic characteristics of the leukaemia.

Acute Disease↗

PubMed1996

[Transesophageal echocardiography. A critical appraisal. How to avoid false diagnoses].

In this study the authors make a critical appraisal of transesophageal echocardiography. A retrospective analysis was made of the transesophageal echocardiographic performed in the Thoracic Surgery Center of S. João Hospital, Oporto, over a period of approximately five years. The authors report the limitations and complications of this diagnostic tool with particular emphasis on the leading causes of pitfalls. Between October 1990 and December 1995, 1282 examinations were performed in our echocardiographic laboratory, mean age 49.6 +/- 14 years (5-86), 57% of the patients were female and 43% male. A biplane transducer was used in these examinations. Patient absenteeism was 2% and only one major complication occurred in a patient with an aortic dissection. Pitfalls are of special concern with this technology. The new esophagic window over the heart and the high quality of the cardiac images, depicting structures and anatomic details inaccessible, or difficult to be observed by transthoracic echocardiographic, led to the major causes of transesophageal echocardiographic pitfalls. Once recognized, most of the pitfalls can be avoided. In what concerns our experience, examples of the most common pitfalls are illustrated.

Adolescent↗

PubMed1996

[Arterial hypertension in a patient with cardiac tamponade].

An elevated arterial pressure in cardiac tamponade, although not unusual might postpone the diagnosis of pericardial disease. We reported a case of cardiac tamponade, due to neoplastic infiltration of the pericardium, in which the diagnosis was first suspected by the presence of pulsus paradoxus. The patient presented cardiac tamponade and arterial hypertension simultaneously.

Cardiac Tamponade↗

PubMed1995

Evidence for a photocurrent Fano resonance in an artificial nanostructure.

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Journal Article↗

PubMed1995

In vitro autonomous proliferation in ANLL: clinical and biological significance.

In acute non-lymphoblastic leukemia (ANLL) progenitor cells frequently display a certain degree of autonomous growth. The aim of the present work was to analyze the autonomous proliferative capacity of leukemic progenitors in both de novo and secondary to myeloproliferative disorders (MPD) and myelodysplastic syndromes (MDS), acute myeloid leukemias and to correlate with clinical and biological characteristics of the disease. Clonogenic assays with and without leukocyte conditioned medium with PHA (LCM-PHA) were performed and the autonomous proliferation index (API) calculated in a series of 50 patients (34 de novo ANLL, eight secondary to MPD and eight secondary to MDS). Patients were divided into two groups according to their API, low (< or = 0.4) or high (> 0.4). Autonomous growth was observed in 84% of cases studied (82% in de novo ANLL, 75% secondary to MDS and 100% secondary to MPD). The group with the highest API (29 patients) had increased levels of hemoglobin (P = 0.006) and platelets (P = 0.01). A high API was also associated with an immature phenotype of blast cells (P = 0.02). Upon analyzing the de novo ANLL separately we observed that a high API correlated with high Hb values (P = 0.02), a lower rate of complete remission (42% vs 61%) and a lower survival rate (medium of 3 vs 10 months). These findings suggest that the capacity for autonomous proliferation can condition the clinical and biological profile of the disease.

Adult↗

PubMed1995

Acalculous cholecystitis: the use of diagnostic laparoscopy.

Acalculous cholecystitis (AC) carries a high mortality in the critically ill patient. This is partly due to the delay in its diagnosis. Clinical diagnostic examinations are often misleading. The purpose of our study was to evaluate the use of laparoscopy as a diagnostic tool in the evaluation of the critically ill patient suspected of having AC. From May 1993 to January 1994, we evaluated 10 critically ill patients. Mean age was 56 years (range 17-90 years). Nine of the patients were trauma victims (8 blunt, 1 penetrating). The other patient was postcoronary bypass surgery. The laparoscopy was done after a mean of 15 days (range 6-54 days) after ICU admission. All patients were receiving ventilatory support, and all patients had elevated temperatures of greater than 38.5 degrees C. Five patients had abdominal tenderness, and 6 had elevated liver function tests (LFT). Six laparoscopies were done under local anesthesia and IV sedation at the bedside, and 4 were done in the operating room. All patients tolerated the procedure well with no complications. The laparoscopic findings were gangrenous cholecystitis in 2 patients. They both underwent laparoscopic cholecystectomies in the operating room. We elected to drain a very distended gallbladder in 1 patient, who eventually was found to have an empyema of the chest. The other 7 examinations were normal. Six of these patients recovered and were discharged. Our results suggest that laparoscopy can be used in the diagnosis of acalculous cholecystitis. Its positive and negative findings are valuable in the treatment of the critically ill. It can be done safely at the bedside.

Adolescent↗

PubMed1995

[An epidemiological study of bronchial asthma in a population of schoolchildren in the Azores (Faial)].

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Asthma↗

PubMed1995

[Results of a series of 104 consecutive bilateral bone marrow biopsy specimens in lymphoproliferative disorders].

PURPOSE: To establish the incidence of discordance in a series of bilateral bone marrow biopsies (b-BMB) in lymphoproliferative disorders and to determine whether this might lead to changes in the present treatment of each patient. MATERIAL AND METHODS: Between March/1988 and February/1995, 89 patients underwent bilateral bone marrow biopsy (104 b-BMB). Seventy-six underwent one b-BMB; 11 two b-BMB and 2 patients three b-BMB. Sixty-eight b-BMB were done at diagnosis of the disease and 36 for reassessment prior to ABMT. The distribution of the b-BMB by diagnosis was as follows: 54 non-Hodgkin's lymphoma (NHL) -23 low grade NHL and 31 intermediate/high grade NHL-, 44 Hodgkin's disease (HD), 4 multiple myeloma (MM), 1 splenic lymphoma with villous lymphocytes and 1 MM+HD. Specimens were obtained under local anaesthesia with a Jamshidi gauge 8 needle. The biopsies were fixed, decalcified, embedded in paraffin wax and the section cuts were stained (haematoxylin and eosin, Giemsa, Wilder--reticulin--and Masson--collagen--). RESULTS: There was discordance in 5 of the 104 b-BMB (4.8%), but only in four of them was this related to the presence of bone marrow disease, so that incidence falls to 3.8%. Three of them were obtained at diagnosis of the disease (low grade NHL, high grade NHL and HD) and one during reassessment before ABMT. On considering only the specimens that had bone marrow infiltration (19 cases: 14 at diagnosis and 5 in reassessment before ABMT), the absence of concordance in four of them implies that if only unilateral biopsy had been carried out, up to 21% of the cases might have been missed. In one of these patients (HD) this finding led us to replace autologous bone marrow transplantation by autologous peripheral stem cell transplantation. CONCLUSION: On the basis of these data, the use of bilateral bone marrow biopsy specimens may be justified in lymphoproliferative disorders, both at the time of diagnosis and in reassessment prior to ABMT--when the bone marrow was initially infiltrated.

Adult↗

PubMed1994

Anomalous Au/Si barrier modification by a CaF2 intralayer.

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Journal Article↗

PubMed1994

The phenotype of L-CFU and its correlation with the immunological characteristics of the blast cell population in AML.

The membrane phenotype of AML clonogenic cells (L-CFU) was analyzed in 19 AML patients using an in vitro culture technique after a complement-mediated lysis assay employing a panel of six monoclonal antibodies (McAb) -HLA-DR, FMC56 (CD9), FMC27 (CD9), CD14, CD15, CD41a-. Our results show that L-CFU has a heterogeneous but immature phenotype lacking on the expression of differentiation antigens (CD14, CD15, CD41a). In addition, we observed that the L-CFU phenotype is different from that of the whole blast cell population. Interestingly, L-CFU showed a higher expression of HLA-DR antigens with respect to their progeny. Upon analyzing whether the L-CFU phenotype was related to both the morphological and immunological features of AML blast cells, it was observed that, while there is no correlation with the FAB classification, there was a partial relationship between the immunological phenotype of AML blast cells and that of L-CFU. Accordingly, the more immature AML cases showed a more differentiated L-CFU phenotype (HLA-DR+, CD9+, FMC27+) when compared with cases with a more mature blast cell phenotype. These results suggest that those AML cases with a relatively immature myeloblastic phenotype may arise from a progenitor cell that has undergone partial differentiation and that is unable to acquire myeloid differentiation antigens, while those AML cases with mature blast cells might emerge from a very early L-CFU that has the capacity to undergo a greater degree of differentiation.

Antigens, CD↗