KIR2DS1 genotype predicts for complete cytogenetic response and survival in newly diagnosed chronic myeloid leukemia patients treated with imatinib

Natural killer (NK) cells are expanded in chronic myeloid leukemia (CML) patients on tyrosine kinase inhibitors (TKI) and exert cytotoxicity. The inherited repertoire of killer immunoglobulin-like receptors (KIR) may influence response to TKI. We investigated the impact of KIR-genotype on outcome in 166 chronic phase CML patients on first-line imatinib treatment. We validated our findings in an independent patient group. On multivariate analysis, KIR2DS1 genotype (RR=1.51, P=0.03) and Sokal risk score (low-risk RR=1, intermediate-risk RR=1.53, P=0.04, high-risk RR=1.69, P=0.034) were the only independent predictors for failure to achieve complete cytogenetic response (CCyR). Furthermore, KIR2DS1 was the only factor predicting shorter progression-free (PFS) (RR=3.1, P=0.03) and overall survival (OS) (RR=2.6, P=0.04). The association between KIR2DS1 and CCyR, PFS and OS was validated by KIR genotyping in 174 CML patients on first-line imatinib in the UK multi-center SPIRIT-1 trial; in this cohort, KIR2DS1(+) patients had significantly lower 2-year probabilities of achieving CCyR (76.9 vs 87.9%, P=0.003), PFS (85.3 vs 98.1%, P=0.007) and OS (94.4 vs 100%, P=0.015) than KIR2DS1(-) patients. The impact of KIR2DS1 on CCyR was greatest when the ligand for the corresponding inhibitory receptor, KIR2DL1, was absent (P=0.00006). Our data suggest a novel role for KIR-HLA immunogenetics in CML patients on TKI.

Optic nerve cyst associated with optic disk pits

PURPOSE

To report a case with two optic disk pits which were associated with an optic nerve cyst in the same eye.

METHODS

Observational case report.

RESULTS

A 47-year-old patient noted visual impairment in the right eye. On examination the best corrected visual acuity in the right eye was 20/80 and in the left eye was 20/20. Biomicroscopy revealed, in the right eye, a very pale optic disk with two optic disk pits without macular elevation. Magnetic resonance imaging (MRI) revealed a well circumscribed 6 x 6-mm(2) round cystic lesion within the right optic nerve sheath adjacent to the temporal aspect of the right optic nerve at its retrobulbar segment, which compressed and displaced the nerve.

CONCLUSIONS

In the case of an extremely pale optic disk with congenital pits and visual impairment without macular detachment, radiological examination is indicated in order to exclude the possibility of coexisting optic nerve anomalies.

Assessment of intraocular foreign bodies by helical-CT multiplanar imaging

The aim of this study was to examine the effectiveness of helical CT in the assessment of intraocular foreign bodies, evaluating two protocols with different collimation. We performed helical-CT studies in 30 patients. Fifteen patients were examined with 1.5-mm collimation and the other 15 patients with 3.0-mm collimation. All other imaging parameters were identical in both protocols. Multiplanar images were reconstructed. The examinations were reviewed for presence, localization and size of intraocular foreign bodies. We compare our results with the surgical data. We estimate the required examination time. In the first group (collimation 1.5 mm) an intraorbital foreign body was detected in 8 of 15 patients. In 3 of 8 patients an intraocular foreign body (all were metallic) was detected. In the second group (collimation 3.0 mm) an intraorbital foreign body was detected in 9 of 15 patients. In 8 of 9 patients an intraocular foreign body (all were metallic) was detected. Our results were confirmed by surgery in all cases. Examination time was 36 s in the first group and 18 s in the second group. Computed tomography should be considered the imaging modality of choice in the assessment of metallic intraocular foreign bodies and 3.0-mm collimation is optional, because of reduced examination time and radiation exposure.

Perforation of the alimentary tract: evaluation with computed tomography

BACKGROUND

To assess the value of computed tomography (CT) in the diagnosis of perforation of the alimentary tract (AT).

METHODS

During a 4-year period 76 patients with proven AT perforation underwent CT within 1 week before surgery or endoscopy. We retrospectively reviewed these CT scans to determine the signs of AT perforation. There were 41 men and 35 women (28-90 years old). Our goal was to establish the diagnosis of AT perforation and, if this was possible, to identify the site and cause of the AT wall rupture. The CT diagnosis of perforation was based on (a) direct findings of extraluminar air or gastrografin and (b) indirect findings of an abscess or an inflammatory mass surrounding an enterolith in the region of appendix or a bowel wall-related phlegmon or abscess with fluid in the mesentery or surrounding radiopaque foreign body.

RESULTS

There were 65 true-positive and 11 false-negative cases. Levels of perforation were the esophagus (two), stomach (five), duodenum (12), small bowel (15), appendix (six), and colon (36). Causes were peptic ulcer (11), foreign body (five), trauma (seven), iatrogenic (nine), appendicitis (six), diverticulitis (21), Crohn disease (five), AT carcinoma (eight), and ischemia (four). Level and cause were correctly predicted in 55 and 51 instances, respectively. The sensitivity was estimated to 85.5%.

CONCLUSION

CT is a valuable method in the diagnosis of AT perforation. The diagnosis can be established rapidly, without patient preparation and with a high sensitivity.

Comparative study of magnetic resonance angiography, digital subtraction angiography, duplex ultrasound examination with surgical and histological findings of atherosclerotic carotid bifurcation disease

This study was designed in order to determine the diagnostic accuracy in imaging of the extracranial arteries by using magnetic resonance angiography (MRA), digital subtraction angiography (DSA), B-mode duplex ultrasonic examination (DUE) in comparison with the surgical and histological findings of the specimen removed after endarterectomy. The degree of stenosis of the arterial lumen of the surgical specimen was compared with the imaging findings of MRA, DSA and DUE: a) the degree of agreement of stenosis with histologic findings was found in 89% of cases for MRA, in 93% for DSA and 88% for DUE; b) the correlation of morphology of the plaque showed agreement in 91% of the cases with MRA, in 94% with DSA and 87% with DUE; c) the constitution of the plaque was in agreement with DUE findings in 96% of cases. There is no significant difference between the three methods, as far as the estimation of degree of carotid stenosis and morphology of the atheromatous plaque in the carotid arteries. MRA findings are similar with those of DSA and DUE with a high sensitivity and specificity concerning the constitution of the plaque. The combination of MRA and DUE provides all the necessary information concerning the extracranial segments of the cerebral arteries for the preoperative evaluation of patients with carotid disease.

Adjuvant therapy following pancreatic resection for pancreatic duct carcinoma: a prospective randomized study

BACKGROUND/AIMS

This study was made to determine the efficacy of locoregional immunochemotherapy in the treatment of pancreatic ductal carcinoma.

MATERIAL AND METHODS

From November 1991 to June 1996, eighty patients with a diagnosis of pancreatic duct carcinoma underwent pancreatic resection. Patients were divided into two groups, Group A and Group B. Both groups received a standard operative procedure of extended subtotal pancreatectomy with regional lymphadenectomy of the celiac axis, the hepatoduodenal ligament and the superior mesenteric vessels. However, Group B patients had two arterial catheters implanted at the end of the operative procedure: one via the splenic artery, after its ligation near the origin at the celiac axis and directed towards the spleen; the second catheter was implanted into a side arterial branch of the middle colic artery into the superior mesenteric artery.

RESULTS

Group B patients have a significantly greater survival (30 months) compared to Group A patients (16.8 months). The proportion of alive patients between both Groups is much higher for Group's B patients (92% versus 55%). Grading of the tumor, size of the tumor, and presence of positive lymph nodes were seen to be very important factors affecting overall survival in Group A patients, but not in Group B patients. It is impressive that from 25 Group A patients with lymph node involvement, only 8 are presently alive versus 25 alive of 28 total Group B patients with positive lymph nodes.

CONCLUSION

Locoregional immunochemotherapy as an adjuvant modality following pancreatic resection offers impressive advantages in terms of survival regardless of stage, lymph involvement, and tumor size. This therapy deserves further attention and consideration in the treatment of Pancreatic Duct Carcinoma.

Locoregional immuno-chemotherapy transplenic and transtumoral in vivo immunostimulation

The need for adjuvant therapies for treating the cancer patient has stimulated a great deal of research as well as controversy. Much of the current research is investigating chemotherapy and immunotherapy. One aspect of this research is directed at overcoming drug resistance by the target cells. This paper highlights some of the most recent advances in the fields of chemotherapy and immunotherapy, and discusses the effects of multi-drug resistance protein gene expression.

Three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography in carotid artery dissections

A retrospective analysis comparing the three-dimensional time-of-flight MR angiography, MR imaging and transfemoral digital substraction angiography (DSA) in cases of carotid artery dissection was made. During a 2-year period, 12 cases (11 males and 1 female), aged between 16 and 60 years, were submitted to our Hospital with the symptoms of TIA, stroke or cranial nerve palsies and the suspicion of carotid dissection. Transfemoral angiograms were done in other Institutions, while the MRI and MRA were performed in our diagnostic center. Blind interpretation of MR and angiography images was made by two independent radiologists. MR angiography in combination with MR imaging was more accurate than conventional angiography in the diagnosis of carotid artery dissection. Respective sensitivity and specificity were 100% and 100% for MRI with MRA and 91.6% and 100% for conventional angiography. From the analysis of this small series, we can conclude that MR angiography in combination with MR imaging is a reliable noninvasive method for use in diagnosis of extracranial internal carotid artery dissection.

Locoregional chemotherapy versus locoregional combined immuno-chemotherapy for patients with advanced metastatic liver disease of colorectal origin: a prospective randomized study

BACKGROUND/AIMS

This reports presents the results of a prospective randomized controlled study of combined locoregional targeted immuno-chemotherapy for treatment of patients with liver metastasis from primary colorectal malignancies.

MATERIALS AND METHODS

Forty eight patients were randomly assigned into one of two groups. Group A (n = 15) included patients who had post-operatively locoregional chemotherapy and Group B (n = 33) included patients who had combined locoregional immuno-chemotherapy.

RESULTS

Statistical analysis shows a clear superiority in the survival and responses of patients treated with immuno-chemotherapy versus chemotherapy alone. Forty five percent of patients in Group B are alive with a mean survival of 20.3 months, ranging from 13 to 29 months, as opposed to no survivors from Group A and a mean survival of only 9.9 months, ranging from 3.6 to 22.5 months. Additionally, 64% of the immuno-chemotherapy group had a positive response while only 13% of the chemotherapy had such a response.

CONCLUSIONS

Our data supports the value of combined immuno-chemotherapy as a treatment for advanced metastatic liver disease.

[CT-tomometry. Part 1: Inhomogenities of tissues--treatment planning (author's transl)]

By experiments at the CT-total-body-scanner we have related to each other the delta-Nrs., chemical constitution, and density of chemical compounds and of tissues of men. For the bone tissue the relation between delta-Nr., Ca-concentration, and density is given in tabular. The uncertainties of the relations evaluated by experiments are within the acceptable values for the most cases occurring in treatment planning. In the second part we will extend the relations to the application of contrast enhancement in the diagnostic.

[CT-tomometrie. Part 2: Diagnostic--contrast media of iodine (author's transl)]

By experiments the relation is established between delta-Nr. and concentration of iodine in tissue.

[Ganglion recidives of the knee joint. Arthrography and clinic (author's transl)]

56 patients with 59 operated popliteal cysts were controlled clinically and by arthrography. In 14.3% (8 knee-joints) a recidive was found. In 64% the arthrogram showed a tout outline of the joint-capsule. In 30% a small and big bursa was seen. Recessus with long narrow handle can be a potential recidive of ganglion. Clinic and arthrogram allow to make a difference between "recidive" and "ganglion". The clinical recidive may be a new "ganglion".

[Computer tomography of the pelvis. Basics for radiation-therapy, localization and treatment-planning in carcinoma of the prostate (author's transl)]

Computer tomography demonstrates topographic anatomy of the prostate which si important for localization and planning of radiation therapy in carcinoma of the prostate. Additionally, computer tomography detects enlarged regional lymph nodes which allows staging of the disease and individual radiation therapy-planning.

[Differentialdiagnostic of the kneearthrography: bursa--ganglion--capsule rupture (author's transl)]

Based on 600 arthrogramms physiologic recessus is compared with ganglion for differential-diagnostic purposes. The great variance between small and big recessus of the regio genu posterior will be demonstrated. Flexion of the knee joint favour confusion with ganglion. The radiologic and differential diagnostic valuable criteria of the physiologic recessus and ganglion is shown. Finally the characteristics of Baker's cyst as well as posterior capsule rupture are discussed.