Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years' experience of infection in GIMEMA centres.

A retrospective survey was conducted over a 10-year period (1990-99) among 52 haematology divisions in order to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating haematological diseases. The study included 55 patients (18 with non-Hodgkin's lymphoma, 10 with acute lymphoblastic leukaemia, eight with acute myeloid leukaemia, five with chronic myeloid leukaemia, four with chronic lymphocytic leukaemia, four with multiple myeloma, three with myelodys-plastic syndrome, two with myelofibrosis and one with thalassemia) who developed PCP. Among these, 18 (33%) underwent stem cell transplantation; only two received an oral prophylaxis with trimethroprim/sulphamethoxazole. Twelve patients (22%) developed PCP despite protective isolation in a laminar airflow room. The most frequent symptoms were: fever (86%), dyspnoea (78%), non-productive cough (71%), thoracic pain (14%) and chills (5%); a severe hypoxaemia was present in 39 patients (71%). Chest radiography or computerized tomography showed interstitial infiltrates in 34 patients (62%), alveolar infiltrates in 12 patients (22%), and alveolar-interstitial infiltrates in nine patients (16%). Bronchoalveolar lavage was diagnostic in 47/48 patients, induced sputum in 9/18 patients and lung biopsy in 3/8 patients. The diagnosis was made in two patients at autopsy. All patients except one started a specific treatment (52 patients trimethroprim/sulphamethoxazole, one pentamidine and one dapsone). Sixteen patients (29%) died of PCP within 30 d of diagnosis. Multivariate analysis showed that prolonged steroid treatment (P < 0.006) and a radiological picture of diffuse lung involvement (P < 0.003) were negative diagnostic factors

Gain-of-function gene mutations and venous thromboembolism: distinct roles in different clinical settings

Objective To calculate the prevalence of common gain of function gene mutations in patients with different clinical manifestations of venous thromboembolism Design Case-control study Setting Two hospitals in Italy Participants 387 patients with venous thromboembolism and 286 controls Main measures factor V Leiden, factor II A20210, and JAK2 V617F mutations Main results Among patients with deep vein thrombosis in one leg, 23 (20.9%) carried factor V Leiden and factor II A20210 mutations. Similar figures were observed in patients with cerebral vein thrombosis (n=9; 20.0%) and among patients presenting with splanchnic vein thrombosis (n=26; 18.7%). A lower prevalence was obtained in patients with retinal vein thrombosis (n=11; 11.8%). The JAK2 F617 mutant allele was found in 27 patients with splanchnic venous thrombosis (21.1%), and in none of the patients with a thrombotic event in different districts. Thirteen of the 27 JAK2 V617F-positive subjects with splanchnic venous thrombosis were previously known to have a myeloproliferative disease. Three other patients had a diagnosis of myeloproliferative disease after the occurrence of the thrombotic event Conclusion Carriership of factor V Leiden or factor II A20210 mutations identifies an at-risk condition for venous thrombosis in the lower extremities, splanchnic or cerebral vein thrombosis. In patients with splanchnic venous thrombosis, screening for the JAK2 V617F mutation may be useful to recognize patients who should be carefully observed for the subsequent development of overt myeloproliferative disease. Thus, genetic tests may play a different role, various clinical manifestations of venous thromboembolism being associated with distinct risk profiles

A study of monitoring performances with the INSIDE system

The INSIDE collaboration aims to build an on-line hadrontherapy monitoring system, based on a dual-head in-beam PET scanner and a secondary charged particles profiler. In this work preliminary experimental results are presented. The validation of the FLUKA-based Monte Carlo simulation tool is shown together with the expected scanner performances

The INSIDE project: Innovative solutions for in-beam dosimetry in hadrontherapy

The INSIDE project addresses the online dose monitoring in particle therapy issue. The proposed detectors exploit the secondary neutral and charged particles emitted during the treatment by the irradiated volumes. The new detection techniques allow to return and online a measurement of the released dose and the Bragg peak position