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  • 1
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    German Medical Science; Düsseldorf, Köln
    In:  German Medical Science; VOL: 1; DOC05 /20030904/
    Publication Date: 2003-09-04
    Description: In a series of 46 patients the effects of spinal fusion upon intervertebral height and sagittal alignment in operated and non-operated segments were retrospectively evaluated on digitized radiographs. Data was compared with age- and gender-normalized standard values. The objective was to evaluate the influence of different types of spine fusions primarily upon adjacent segments, particularly in terms of degeneration and sagittal profile of the lumbar spine.Incidence of adjacent segment degeneration (ASD) is still highly controversial. However, not every degeneration adjacent to spinal fusion must be caused by the fusion and responsibility of the fusion for ASD may vary with its range and type.Distortion Corrected Roentgen Analysis (DCRA) was utilized. DCRA is a proven valid, reliable, observer-independent, and accurate tool for assessment of these parameters over time and in comparison with "normal" cohorts. With this method the exact posture of the patients needs not to be known.There was little evidence for serious fusion-related ASD within an average of 40 months follow-up. No difference could be detected for rigid vs. non-rigid fusion and instrumented vs. non-instrumented techniques. Temporary postoperative distraction effects could be detected in operated and non-operated segments. Absolute preoperative values for intervertebral height and vertebral slip were age-related. Retrospectively, the choice of segments for fusion was clearly based upon radiological criteria. Thus we conclude that radiological parameters have an obvious clinical relevance for decision-making and need to be quantified. Within the limitations of this pilot study, true fusion related ASD seems to be infrequent.
    Description: In einer Serie von 46 Patienten wurde der Effekt hinterer Wirbelsäulen-Versteifungseingriffe (Spondylodesen) auf die Höhe des Zwischenwirbelraumes und das sagittale Profil der Lendenwirbelsäule auf digitalisierten Röntgenbildern untersucht. Dabei wurden operierte und angrenzende Bewegungssegmente retrospektiv im Zeitverlauf evaluiert. Die Daten wurden mit alters- und geschlechtsnormierten Standardwerten verglichen. Ziel war es, den Einfluss verschiedener Fusionsverfahren auf den Verschleiß angrenzender Segmente zu quantifizieren.Die Inzidenz sogenannter Anschlussdegenerationen nach Spondylodesen ist stark umstritten. Nicht jede solche Degeneration muß aber auch durch die Spondylodese verursacht sein, Alterungsprozesse sind schwer abgrenzbar.Distorsionskorrigierte Röntgenanalyse (DCRA) kam für diesen Zweck zum Einsatz. DCRA ist ein nachweislich valides, reliables, untersucherunabhängiges und genaues Verfahren zur Messung der genannten Parameter im Zeitverlauf und im Vergleich mit "normalen" Kohorten. Vorteil des Verfahrens ist es, dass die exakte Positionierung der Wirbelsäule im Raum nicht bekannt sein muss.Es fand sich wenig Evidenz für ernsthafte spondylodesebedingte Anschlussdegeneration nach durchschnittlich 40 Monaten Follow-up. Kein Unterschied zeigte sich zwischen Versteifungsverfahren mit rigiden und wenig rigiden Implantaten sowie zwischen Versteifungen mit und ohne Implantaten. Temporäre postoperative Distraktionseffekte bestanden in operierten und angrenzenden Segmenten. Die Absolutwerte für die Höhe des Zwischenwirbelraumes und Wirbelgleiten waren altersabhängig. Retrospektiv zeigte sich, dass für die Wahl des Spondylodeseverfahrens radiologische Kriterien für den Operateur den Ausschlag gaben. Daraus ergibt sich die Notwendigkeit, diese radiologischen Parameter auch zu quantifizieren. DCRA ist hierfür gut geeignet. Im Rahmen der Aussagekraft dieser Pilotstudie erscheint jedoch die fusionsinduzierte Anschlussdegeneration weniger häufig als erwartet.
    Keywords: FEMALE ; FOLLOW-UP STUDIES ; HUMAN ; LOW BACK PAIN/surgery ; LUMBAR VERTEBRAE/* ; LUMBAR VERTEBRAE/*radiography ; LUMBAR VERTEBRAE/*surgery ; MALE ; ADULT ; MIDDLE AGE ; POSTOPERATIVE COMPLICATIONS ; SPINAL DISEASES/surgery ; SPINAL FUSION/methods ; TREATMENT OUTCOME ; RADIOGRAPHIC IMAGE INTERPRETATION, COMPUTER-ASSISTED ; WEIBLICH ; VERLAUFSSTUDIEN ; MENSCH ; KREUZSCHMERZEN/Chirurgie ; LENDENWIRBEL/* ; LENDENWIRBEL/*Röntgenuntersuchung ; LENDENWIRBEL/*Chirurgie ; MÄNNLICH ; ERWACHSENER ; MENSCHEN IM MITTLEREN ALTER ; POSTOPERATIVE KOMPLIKATIONEN ; WIRBELSÄULENKRANKHEITEN/Chirurgie ; WIRBELFUSION/Methoden ; BEHANDLUNGSERGEBNIS ; RÖNTGENBILDINTERPRETATION, COMPUTERGESTÜTZTE ; ddc: 610
    Language: English
    Type: article
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  • 2
    ISSN: 1432-1076
    Keywords: Erythroleukaemia ; Myeloblastoma ; Spinal cord compression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Severe neurological impairment as the first symptom of acute leukaemia is a rather uncommon finding. We report the case of a 10-month-old infant who presented with acute paralysis of the lower extremities due to cord compression by an epidural tumour composed of malignant erythrocyte precursor cells. Diagnosis of erythroleukaemia (EL) was made by needle biopsy of the spinal epidural mass and confirmed by bone marrow aspiration. Antileukaemic treatment in combination with radiotherapy to the epidural tumour led to haematological remission and neurological recovery with disappearance of the mass lesion as demonstrated by MRI. However, haematological relapse occurred with death of the patient 7 months after diagnosis. This is the first reported case of EL presenting with paraparesis due to an epidural tumour. The clinical symptoms, results of cytogenetic and immunological studies and the clinical course are described.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-8798
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A large number of human haematopoietic cell lines was examined for spontaneous production of interferon. Unconcentrated culture supernatants from 70 out of 71 B-lymphoblastoid cell lines contained considerable amounts of interferon (median titer 22 units per ml); a few lines produced more than 100 units/ml with peak values up to 500 units/ml. In contrast, only one B-lymphoma line out of 18 genuine lymphoma, myeloma, and leukaemia cell lines tested spontaneously produced small amounts of interferon. Following treatment with 5-bromodeoxyuridine (BrdUrd), interferon was produced without further induction in most B-lymphoid cell lines, but not in any of the non-B, non-T, T-lymphoid or myeloid lines examined. Modulation of spontaneous interferon production by chemicals (sodium butyrate, dexamethasone, dimethylsulfoxide, a phorbol ester, and BrdUrd) was studied in more detail in three B-lymphoblastoid and four B-lymphoma cell lines. The patterns of responses observed were different for the action of different chemicals on a given cell line as well as between lymphoblastoid and lymphoma lines in general; furthermore, several lines of evidence suggest that chemicals can differentially influence spontaneous and virus-induced interferon production in a given cell line. The composition of spontaneously produced interferon was analysed using antisera specific for HuIFN-α and HuIFN-β. Interferons produced by untreated as well as BrdUrd-treated lymphoblastoid cells contained more than 95 per cent IFN-α, whereas BrdUrd-treated lymphoma cells produced IFN-α as well as minor amounts (cell lines Namalwa and NC-37) or even over 90 per cent of IFN-β (Daudi).
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0584
    Keywords: Allogeneic bone marrow transplantation (BMT) ; Cytogenetic studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Chromosome studies were performed in 24 patients who underwent allogeneic bone marrow transplantation (BMT) for severe aplastic anaemia (8), chronic myeloid leukemia (5 in chronic, 2 in accelerated phase and 1 in lymphoid blast crisis), acute myeloid leukemia (6), acute lymphoblastic leukemia in relapse (1) and Hodgkin's disease (1). Donor-cell type engraftment was demonstrated in 21 patients: in all 17 sex-mismatched transplants and — as demonstrated by reconstitution with Ph-negative cell populations — in 4 CML patients with a sex-matched donor. Recipient-type mitoses were seen in the bone marrow of 5 cases (1 SAA, 3 CML, 1 AML) after transplantation. They were only observed on one occasion in patients with SAA (4 of 25 on day 33) and AML (44 of 50 on day 14). Despite the continued demonstration of some Ph-positive mitoses in 3 patients with CML up to day 28, 323 and 451 after BMT, respectively, all surviving CML patients are still in complete haematological and clinical remission. So far the significance of these cytogenetically abnormal persisting host cells remains unknown.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0584
    Keywords: Granulocytic sarcoma of the prostate Acute myelogenous leukemia ; AML1/ETO Rearrangement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We describe a 68-year-old patient who developed granulocytic sarcoma of the prostate 9 years after complete remission following successful treatment of acute myelogenous leukemia (FAB, M2). PCR analysis of bone marrow samples in first remission and at the time of relapse detected an AML1/ETO rearrangement typical for AMLs with t (8; 21). The CD 56 antigen was not expressed on the leukemic cells. Systemic chemotherapy led to a short-lasting regression of the tumor, but the patient subsequently developed overt bone marrow relapse and died during chemotherapy. While granulocytic sarcoma as a primary manifestation of AML is well known, as the first manifestation of relapse it appears to be very uncommon.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-0584
    Keywords: Dyskeratosis congenita ; Neutropenia G-CSF
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Dyskeratosis congenita (DC) is a rare congenital X-linked disorder. The major clinical manifestations are abnormal skin pigmentation, nail dystrophy, and leukoplakia of mucosal membranes. About 50% of the patients develop bone marrow failure, which is partly responsible for the poor prognosis. Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) has been administered to some neutropenic patients with DC, but only a moderate stimulation of neutropoiesis has been observed. We report on a patient with DC treated with recombinant human granulocyte-colony-stimulating factor (rhG-CSF). This treatment resulted in a substantial dose-dependent increase in the neutrophil count.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-0584
    Keywords: Key words CLL ; Spontaneous remission ; Immunoglobulin deficiency ; Secondary neoplasia ; Hodgkin's disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We present a 71-year-old patient with chronic lymphocytic leukemia diagnosed 27 years ago. Initially, the disease was staged as Rai II and the patient suffered from secondary immunoglobulin deficiency. Nevertheless, no treatment was necessary at that time. Because of disease progression a single course of chemotherapy was given in 1984. During the following year there was a constant decline of the WBC, accompanied by normalization of the immunoglobulins; both have remained stable ever since that time. However, there was still residual bone marrow infiltration, indicating persisting CLL. In 1993 cervical lymphadenopathy occurred with acute onset. A diagnostic lymphadenectomy revealed Hodgkin's disease of the nodular-sclerosing subtype. The patient was staged as II-III according to the Ann Arbor Classification and underwent radiation therapy. Cytogenetic examination of the bone marrow revealed a normal karyotype with an inversion of chromosome 9. This case demonstrates the rare coincidence of two lymphoproliferative disorders in the same patient. The clinical course and the immunologic findings of this patient are presented, together with a review of the literature.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-0584
    Keywords: CLL ; Spontaneous remission ; Immunoglobulin deficiency ; Secondary neoplasia ; Hodgkin's disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We present a 71-year-old patient with chronic lymphocytic leukemia diagnosed 27 years ago. Initially, the disease was staged as Rai II and the patient suffered from secondary immunoglobulin deficiency. Nevertheless, no treatment was necessary at that time. Because of disease progression a single course of chemotherapy was given in 1984. During the following year there was a constant decline of the WBC, accompanied by normalization of the immunoglobulins; both have remained stable ever since that time. However, there was still residual bone marrow infiltration, indicating persisting CLL. In 1993 cervical lymphadenopathy occurred with acute onset. A diagnostic lymphadenectomy revealed Hodgkin's disease of the nodular-sclerosing subtype. The patient was staged as II–III according to the Ann Arbor Classification and underwent radiation therapy. Cytogenetic examination of the bone marrow revealed a normal karyotype with an inversion of chromosome 9. This case demonstrates the rare coincidence of two lymphoproliferative disorders in the same patient. The clinical course and the immunologic findings of this patient are presented, together with a review of the literature.
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  • 9
    ISSN: 1432-0584
    Keywords: Acute myelogenous leukemia ; Allogeneic marrow transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between February 1982 and April 1995, 62 patients (37 male, 25 female) with acute myelogenous leukemia (AML) with a median age of 32 years (19–51 years) received allogeneic marrow grafts from an HLA-identical sibling (n=60) or an HLA-mismatched family member (n=2). At the time of transplant, 35 patients were in first complete remission (CR), five in second CR, eight were primary refractory, eight were in untreated relapse and six in refractory relapse. The FAB subtypes were as follows: M1 (n=17), M2 (n=13), M3 (n=6), M4 (n=19), M5 (n=6), M6 (n=1). For conditioning most patients were given total body irradiation combined with cyclophosphamide (CY,n=50) or CY and busulfan (n=9). For graft-versus-host disease prophylaxis patients received cyclosporin A (CSA) and methotrexate (MTX) (n=32), MTX alone (n=12), CSA and methylprednisone (n=5), or CSA alone (n=13). As of April 1995, probability of leukemia-free survival projected at 10 years after BMT was 60% for patients transplanted in first CR compared with 10% for patients transplanted beyond first CR. Transplant-related mortality was 11% after BMT in first CR and 39% after BMT beyond first CR. Probability of relapse projected at 10 years after BMT is 32% for patients who received transplants in first CR and 81% for patients who received transplants beyond first CR. Thus, high-dose chemo/radiotherapy followed by allogeneic marrow infusion has a high curative potential for patients with AML who receive transplants in first CR and offers the chance of long-term disease-free survival for some patients with advanced disease.
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  • 10
    ISSN: 1432-0584
    Keywords: Key words Acute myeloid leukemia ; Spontaneous remission ; Hypergammaglobulinemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Spontaneous remissions of acute myeloid leukemia (AML) have been documented in association with infection as well as blood transfusions. Activation of the immune system including an increased number of NK cells and cytokine release have been implicated in the mechanism of this phenomenon. We have observed spontaneous remissions in two patients with AML (one with a t(8;21)-positive M2, one with M5b), both occurring after infection and blood transfusions. The bone marrow showed a reduction of blast cells from 65% to 2% or 40% to 1%, respectively. Remission was accompanied by a marked polyclonal hypergammaglobulinemia in both cases (IgG values of 6420 and 2160 mg/dl, IgA of 802 and 811 mg/dl, respectively). A concomitant increase in bone marrow plasma cells was observed in both patients. Reduction of AML1/ETO PCR positivity from one-step to two-step PCR (approximately 100-fold) was documented in the patient with a t(8;21), while a regression of lymph node and skin leukemic infiltrations occurred in the patient with M5b. One patient relapsed after 4 months, at a time when his serum immunoglobulin levels had markedly decreased. The other patient is in continuous remission after 14 months. These cases suggest a potential role for a humoral immune response in the mechanism of spontaneous remission.
    Type of Medium: Electronic Resource
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