[Lenalidomid (Revlimid) in the treatment of multiple myeloma--first experience in the Czech Republic]

The prognosis of multiple myeloma (MM) has substantially improved during last decades due to new, so-called targeted drugs--proteasome inhibitor bortezomib and immunomodulatory drugs (ImiDs), thalidomide and lenalidomide. They could be used in various combinations and/or sequentially thanks to different mechanism of action and toxicity. Both bortezomib and thalidomide are widely used in Czech republic, however, lenalidomide was approved for the treatment of MM (and MDS) at the very latest and its usage is limited due to high costs, as well. According to the results of clinical trials lenalidomide is effective in myeloma refractory to various therapy including other new drugs. First time in the Czech republic the combination of lenalidomide and dexamethasone was given in our center to 2 patients with relapsed myeloma as 7th and 10th line of therapy. Acceptable results of treatment with improved clinical status in the first patient enabled to suspend his therapeutic plasmaferesis. Disease stabilization lasting three months was observed also in the second patient.

[Detection of free light chains--a new method of diagnostics of haematological diseases]

BACKGROUND

To diagnose monoclonal gamopathy, one of the most frequent haematological diseases, we use immunochemical assays, which are based on the detection of paraprotein in serum and/or urine.

METHODS AND RESULTS

The most common laboratory assays we use are SPE (serum protein electrophoresis) and IFE (immunofixation electrophoresis). New method represents the detection of free light chain (FLC) in serum. In our study we compared those three methods (SPE, IFE and FLC) from the point of sensitivity of paraprotein detection. For FLC detection was used Freelite system analyzer (Immunotech Beckman Coulter). We examined 51 patients with diagnosis of multiple myeloma, nonHodgkin's lymphoma, primary amyloidosis and monoclonal gammopathy of undetermined significance.

CONCLUSIONS

Detection of FLC is a valuable method which sometimes could specify diagnosis of MG and make the treatment more accurate.

[Recommendations for early identification of damage to the skeleton by malignant processes, and for early diagnosis of multiple myeloma]

The number of newly diagnosed cases of multiple myeloma in the Czech Republic is about 3-4 per 100 000 persons per year. In the higher age groups, the incidence increases. Multiple myeloma is an illness that reacts well to treatment which can result in periods of remission lasting for years. Some of the patients are even able to return to work. A pre-requisite for successful treatment is early diagnosis and this is usually in the hands of first line physicians. This is the reason why the Czech Myeloma Group, in conjunction with neurologists, orthopedicians and radio diagnosticians has issued the following recommendations for first line physicians containing a more detailed description of the symptoms and the diagnostic pitfalls of the disease. This disease reminds a chameleon for the variety of its symptoms. For the sake of clarification, we shall divide multiple myeloma symptoms into five points, each of which is reason enough to warrant an examination to confirm or rule out a malignant cause of health problems (a negative result does not automatically mean exclusion). If any of the recommended examinations results positive, the diagnostic process must be continued, in which case a general practitioner refers the patient to a specialist health centre. Observing these recommendations should minimize the number of cases of late diagnosis. 1. Bone destruction symptoms. - Unexplained backache for more than one month in any part of spine even without nerve root irritability or without pain in other part of skeleton (ribs, hips, or long bones). - Pain at the beginning of myeloma disease is very similar to benigne common discopathy, however the intensity of backache is decreasing within one months in benigne disease. In the case of malignant process the intensity of bone pain is steadily increasing. - Immediate imaging and laboratory investigation are indicated by resting and night pain in spinal column or in any part of skeleton. - Backache with the sign of spinal cord or nerve compression should be sent for immediate X Ray, and focussed CT/MRI followed by acute surgery if needed. - Osteoporosis especially in men and premenopausal women. 2. Features of changed immunity or bone marrow function. Persistent and recurrent infection, typical is normochromic anaemia, with leucopenia and trombocytopenia. 3. Raised erythrocyte sedimentation rate even increase concentration of total plasma protein. 4. Impaired renal function. Increased level of creatinin or proteinuria, nephrotic syndrome with bilateral legs oedema. 5. Hypercalcemia with typical clinical symptoms (polyuria with dehydratation, constipation, nausea, low level conscience, coma). Every one from these points has to be reason for general medical doctor to start battery of tests: -X-ray of bones focused to painful area (mandatory before physiotherapy, local anaesthesia or other empiric therapy). If plain X-ray does not elucidate pain and symptoms are lasting more than one month, please consider all circumstances and results from laboratory investigation. This patient needs referral to the centre with MRI/CT facilities (CT or MRI is necessary investigation in case of nerve root or spine compression). -Investigation of erythrocyte sedimantion rate (high level of sedimentation of erythrocyte can indicate multiple myeloma). -Full blood count. -Basic biochemical investigation serum and urine: serum urea, creatinin, ionts including calcium, total protein, and albumin CRP (high concentration of total protein indicates myeloma, low level of albumin indicates general pathological process, similary increased concentration of fibrinogen, impaired renal function indicates myeloma kidney, however hypercalcemia is typical for highly aggressive myeloma). -Quantitative screening for IgG, IgM and IgA in serum (isolated raised level one of immunoglobulin with decreased level of the others indicates myeloma). -Common electrophoresis of serum is able to detect monoclonal immunoglobulin level at few gramm concentration. If all the laboratory investigation are in normal level the possibility that the current problems are multiple myeloma origine is smaller, but it does not exclude one of rare variant--non secretory myeloma (undifferentiated plasmocyt lost characteristic feature to produce monoclonal immunoglobulin). If any of tests indicate the possibility of myeloma, patient require urgent specialist referral to department with possibility to make diagnosis of malignant myeloma.

International Staging System required standardization of biochemical laboratory testing in multiple myeloma

The standardization of biochemical measurement procedures in multiple myeloma is necessary for reliable prognostic stratification of patients in multicentric trials. The new prognostic index International Staging System for multiple myeloma uses only two laboratory markers, albumin and beta-2 microglobulin. Our study compared results of albumin, beta-2 microglobulin and monoclonal immunoglobulin measurements from six centers which provide treatment for multiple myeloma in the Czech Republic and attempted to standardize the analytic procedures. We have found that the measurement of albumin is well standardized and the results from all laboratories were comparable. The measurement of beta-2 microglobulin achieved comparability only after a partial unification of analytical methods. The determination of monoclonal immunoglobulin concentration provided comparable results for concentrations higher than 20 g/l with higher variability for lower values.

Schistosomiasis in einem uterinen Leiomyom

This case report deals with an, in our regions, unusual diagnosis of coincidence of a genital schistosomiasis of a 30-year-old woman, coming from Africa. The female patient presented herself by a specialist because of longer lasting hypermenorrhoe. After clinical examination the patient underwent an operation because of an uterus myomatosus. The histopathological evaluation showed beside a leimyoma an expanded infestation with schistosomiasis haematobium. After pathological diagnosis the patient underwent the standard therapy with a single injection of praziquantel. We report about the clinic, epidemiology, morphology and diagnostic.

[Pilot study of echocardiographic studies using color- and pulsed-wave spectral Doppler methods in blue-crowned amazons (Amazona ventralis) and blue-fronted amazons (Amazona a. aestiva)]

Colour-flow and pulsed-wave spectral Doppler echocardiography was performed on 6 healthy, adult Hispaniolan amazon parrots (Amazona ventralis) and 6 blue-fronted amazon parrots (Amazona a. aestiva) to establish normal reference values. Birds were anesthetized with isoflurane in oxygen and placed in dorsal recumbency. An electrocardiogram was recorded continuously and birds were imaged with a micro-phased-array scanner with a frequency of 7.0 MHz. After assessment of cardiac function in 2-D-echocardiography, blood flow across the left and the right atrioventricular valve and across the aortic valve was determined using color-flow and pulsed-wave spectral Doppler echocardiography. Diastolic inflow (mean value +/- standard deviation) into the left ventricle was 0.17 +/- 0.02 m/s (Hispaniolan amazons) and 0.18 +/- 0.03 m/s (Blue fronted amazons). Diastolic inflow into the right ventricle was 0.22 +/- 0.05 m/s (Hispaniolan amazons) and 0.22 +/- 0.04 m/s (Blue fronted amazons). Velocity across the aortic valve was 0.84 +/- 0.07 m/s (Hispaniolan amazons) and 0.83 +/- 0.08 m/s (Blue fronted amazons). Systolic pulmonary flow could not be detected in any of the birds in this study. No significant differences were evident between the two species examined. Results of this study indicate that Doppler echocardiography is a promising technique to determine blood flow in the avian heart. Further studies in other avian species are needed to establish reference values for assessment of cardiac function in diseased birds.

[Bortezomib (Velcade) in relapsed/refractory multiple myeloma--the first experience in the Czech Republic]

BACKGROUND

Multiple myeloma is the second most prevalent and mostly fatal hematologic cancer. Further advances have been made in understanding the mechanisms involved in the myeloma pathogenesis and elucidation of critical signalling pathways as therapeutical targets. Proteasome inhibitors are the example of this new approach and bortezomib is the first agent in this class to enter clinical trials.

METHODS AND RESULTS

In 6 hematological centers in Czech Republic 29 patients with refractory/relapsed myeloma had been treated with bortezomib (Velcade, Millennium Pharmaceuticals) in 2004. The initial dose 1.3 mg/m2 of Velcade was given, in 1 case the dose was adjusted due to pre-existing renal failure to 1 mg/m2. The response was achieved in 17 patients (59%). Four patients had complete, 11 partial and two minor responses. In 5 cases stabilization of disease was observed and 6 patients progressed during the therapy.

CONCLUSIONS

Unfortunately, one patient died immediately after the start of therapy due to sepsis. The most common adverse events were thrombocytopenia, anaemia, neuropathy, gastrointestinal complication, renal failure and fatigue. Grade 4 adverse events occurred in 37.9% of patients (4x thrombocytopenia, 2x gastrointestinal, 2x renal failure, 1x sepsis, leucopenia, hepatopathy and anaemia, respectively). Peripheral neuropathic pain of grade 3 was reported in 4 cases, in one patient therapy had to be interrupted due to this complication. We confirmed promising results of phase II trials.

Echocardiographic examinations of 60 African grey parrots and 30 other psittacine birds

The aim of this study was to establish reference values for the assessment of cardiac function in birds by measuring structures in the heart of healthy psittacine birds; 60 grey parrots, 10 Amazon parrots, 10 cockatoos and 10 Senegal parrots were anaesthetised with isoflurane and examined echocardiographically. The heart was visualised in two planes (vertical and horizontal views). Depending on the quality of the images, several dimensions of the heart could be measured and various parameters calculated. On the basis of these values, it was possible to establish reference values for each parrot genus. Some relative parameters showed no significant difference between the genera, independent of the bird's size.

Pulsed-wave Doppler echocardiography in birds of prey

Pulsed-wave spectral Doppler echocardiography was applied to 111 diurnal and nocturnal raptors of both sexes weighing between 190 and 4200 g. In the first stage, 40 birds were examined without special preparation; in the second stage, 15 birds were examined first when they were not anaesthetised and then when they were anaesthetised; in the third stage, 41 birds were examined after they had been fasted for different periods of time; and finally 15 birds, in which echocardiography had not been possible by using standard (dorsal) restraint and positioning, were examined after being placed in lateral and ventral recumbency. Doppler-derived diastolic inflow into the ventricles was detectable in approximately 80 per cent of the birds weighing between 190 and 2300 g independently of their weight, heart rate and whether they had been anaesthetised or fasted, and aortic blood flow was detected in about 50 per cent of them. It was possible to apply the technique under standard conditions of dorsal recumbency to only one of the birds weighing more than 3000 g and to about 80 per cent of those weighing between 190 and 2300 g. In 11 of 15 birds in which the technique could not be applied under standard conditions, blood flow could be detected in the ventricles and/or the aorta after the birds had been repositioned. No systolic blood flow through the pulmonary artery was detectable in any of the birds.

[Long-term culture of plasma cells from patients with myeloma and establishment of a permanent cell line]

Multiple myeloma plasma cells are actively dividing cells with the long surviving ability in the ex-vivo culture. In the effort for better understanding of the proliferative potential of malignant myeloma cells and establishment of permanent myeloma cell lines we performed long term cultures of human myeloma cells ex-vivo. During the last two years we cultured 41 bone marrow samples from 39 patients with multiple myeloma. Cells were cultured in the RPMI 1640 culture medium with 15% fetal calf serum at 37 degrees C in 5% CO2 and approximately one third of the culture medium was changed regularly twice a week. Most of the marrows cultures died by apoptosis within 30 days. Four bone marrow samples were cultured for more than 11 months, however, no culture can be qualified as an established cell line. In three cases permanent B-lymphoblastoid cell lines were established (UHKT-55, UHKT-56 a UHKT-57) but secondary immortalization by Epstein-Barr virus was suggested.

CONCLUSIONS

Presented results suggest that myeloma plasma cells can survive and are able to proliferate in the ex-vivo culture for several months up to one year independently on the addition of any external growth factor without spontaneous apoptosis or necrosis. The probability of the establishment of a permanent cell line of plasma cell origin is, however, low. Presence of accessory bone marrow cells was the most important factor for the long-term survival of myeloma cells.

Effect of handling-induced stress on the results of spectral Doppler echocardiography in falcons

In order to evaluate the effects of habituation to handling on the Doppler-derived velocity of diastolic ventricular inflow and systolic aortic outflow, falcons that were accustomed to regular handling were compared with falcons that had been handled very little. The mean heart rate of the frequently handled birds was 111 beats per minute less than the non-habituated birds. All the mean blood flow velocities recorded were much higher in the non-habituated birds than those accustomed to handling. Taking into account the difficulty of objectively quantifying the level of stress suffered by any individual bird, the question is, if meaningful clinical or reference values for Doppler-derived blood flow velocities may be obtained in unsedated or non-anaesthetized birds?

Echokardiographische Untersuchungen bei Psittaciformes

Ziel dieser Studie war, sonographisch darstellbare Strukturen im Herzen von Papageienartigen zu vermessen und – soweit möglich – anatomische sowie physiologische Vergleichswerte aufzustellen. Hierzu wurden 90 Psittaciformes (Graupapageien, Amazonen, Kakadus, Mohrenkopfpapageien) unter Isoflurannarkose untersucht. Abhängig von der Darstellungsqualität ließen sich Herzdimensionen in Systole und Diastole (u. a. die Länge und Breite des linken und rechten Ventrikels, das Interventrikularseptum und die Aortenausstrombahn) vermessen. Außerdem konnten verschiedene funktionelle Parameter (u. a. die Verkürzungsfraktion und die Ejektionsfraktion des linken Ventrikels sowie die systolische Dickenzunahme des Interventrikularseptums) errechnet werden. Viele der errechneten relativen Parameter wie die Verkürzungsfraktionen der Herzkammern, die Relation zwischen der Breite und der Länge der Kammern sowie die Ejektionsfraktion der linken Kammer zeigten konstante körpergrößenund gattungsunabhängige Werte. Die in dieser Studie ermittelten Werte bilden die Grundlage für die Beurteilung der Herzfunktion bei Pagageienartigen mit Verdacht auf eine Herz-Kreislauf-Erkrankung.

Thermocapillary convection around gas bubbles: an important natural effect for the enhancement of heat transfer in liquids under microgravity

In the presence of a temperature gradient at a liquid-gas or liquid-liquid interface, thermocapillary or Marangoni convection develops. This convection is a special type of natural convection that was not paid much attention in heat transfer for a long time, although it is strong enough to drive liquids against the direction of buoyancy on Earth. In a microgravity environment, however, it is the remaining mode of natural convection and supports heat and mass transfer. During boiling in microgravity it was observed at subcooled liquid conditions. Therefore, the question arises about its contribution to heat transfer without phase change. Thermocapillary convection was quantitatively studied at single gas bubbles in various liquids, both experimentally and numerically. A two-dimensional mathematical model described in this article was developed. The coupled mechanism of heat transfer and fluid flow in pure liquids around a single gas bubble was simulated with a control-volume FE-method. The simulation was accompanied and compared with experiments on Earth. The numerical results are in good accordance with the experiments performed on Earth at various Marangoni numbers using various alcohols of varying chain length and Prandtl numbers. As well as calculations on Earth, the numerical method also allows simulations at stationary spherical gas bubbles in a microgravity environment. The results demonstrate that thermocapillary convection is a natural heat transfer mechanism that can partially replace the buoyancy in a microgravity environment, if extreme precautions are taken concerning the purity of the liquids, because impurities accumulate predominantly at the interface. Under Earth conditions, an enhancement of the heat transfer in a liquid volume is even found in the case where thermocapillary flow is counteracted by buoyancy. In particular, the obstructing influence of surface active substances could be observed during the experiments on Earth in water and also in some cases with alcohols.

[About type and incidence of heart disease in psittacines kept in captivity in Germany]

It was the aim of the study to get an overview about spectrum and incidence of pathological aberrations in hearts and proximal vessels of psittacines which are kept in captivity in Germany. 107 psittacines which had been sent for routine necroscopy were examined especially for evidence of pathological alterations of the heart and/or the proximal vessels. In 36.4% of these birds macroscopic alterations could be verified. 99.0% of all hearts examined resp. proximal vessels showed at least mild histological alterations. This study allocates that especially noninfectious heart disease is of markedly importance in psittacines and that their evidence is much higher than it might be suspected on the basis of publications.

Morphometry of the heart of budgerigars (Melopsittacus undulatus), Alisterus parrots (Alisterus s scapularis) and common buzzards (Buteo buteo)

In order to establish data and reference values for the thickness of the myocardium and the length of the left and the right ventricle of the avian heart, the hearts of 14 budgerigars (Melopsittacus undulatus), five Alisterus parrots (Alisterus s scapularis) (also known as Australian king parrot) and 10 common buzzards (Buteo buteo) of both sexes were examined according to a standard protocol. In order to compare the results of birds of different sizes all data were related to the size of the bird's body (length of the sternum) and the results of the measurements of the myocardial thickness in relation to the length of the heart. Results of different zones were compared by means of statistical methods within one species. Besides that a comparison between the different species was performed. Only minor significant differences were noted.

Antibody targeting studies in a transgenic murine model of spontaneous colorectal tumors

Monoclonal antibodies (mAbs) have been used to treat malignancies in humans with varying degrees of success. Progress has been hindered by the lack of suitable animal models, which would ideally consist of immunocompetent animals that are tolerant to tumor-associated antigens. Suitable models would allow the study and optimization of anti-tumor immunotherapy. We describe a murine model for the study of immunotherapy in colorectal cancers. Carcinoembryonic antigen (CEA) is a cell-surface glycoprotein that is expressed on normal human intestinal epithelium and that is overexpressed in intestinal tumors. Mice that are transgenic for the human CEA gene (CEA.Tg) were crossed with multiple intestinal neoplasia (MIN) mice. MIN mice carry a germline APC mutation and are prone to the development of intestinal adenomas. The offspring from the MIN x CEA.Tg cross developed intestinal adenomas that were shown by immunohistochemistry to overexpress CEA. Pharmacokinetic studies by using (125)I-labeled anti-CEA mAb PR1A3 showed rapid localization of antibody to tissues expressing CEA, especially the gastrointestinal tract. Macroscopic and microscopic radioautographic analysis of the gastrointestinal tracts from MIN/CEA.Tg mice indicated that PR1A3 targeted and was retained in tumors at levels higher than in areas of normal gut. These results demonstrate the utility of the MIN/CEA.Tg mouse as a model for the study of anti-CEA immunotherapy and, furthermore, demonstrate the efficiency of tumor localization by PR1A3.