The nature of small intestinal mucositis: A video-capsule endoscopy study

Background and aims: Alimentary mucositis is a life-threatening side effect in patients receiving conditioning therapy for stem cell transplantation. While oral mucosa can be easily inspected, there are no endoscopic data on small intestinal mucositis. The aim of our study was to investigate small intestinal lesions using video-capsule endoscopy in patients undergoing peripheral blood stem cells transplantation. Materials and methods: We prospectively studied five consecutive patients who underwent peripheral blood stem cells transplantation: three patients (four studies) without concomitant recombinant human keratinocyte growth factor (palifermin) treatment and two patients with palifermin treatment. We performed video-capsule endoscopy studies 7 days after cells infusion, when transplant patients usually have severe abdominal symptoms. Results: In three patients who did not receive palifermin, video-capsule endoscopy revealed extensive confluent ulcerations with bleeding spots in the small intestine. Two patients had lesions in the jejunum and in the ileum. One of them underwent repeat video-capsule endoscopy 6 days later that showed significant healing of the lesions, but still there were diffuse edema of small intestinal mucosa, erosions and scarce ulcerations. In the third patient, the capsule remained in the stomach for 7.5 h but showed duodenal erosions with bleeding spots. Both patients on palifermin treatment had normal examinations. All studies were uneventful. Conclusion: Our data reveal for the first time that small intestinal mucositis in patients undergoing conditioning therapy for peripheral blood stem cells transplantation presents as small intestinal ulcerations and that palifermin treatment prevents these lesions. © 2008 Springer-Verlag

Quetiapine monotherapy in bipolar i disorder: A 1-year stabilization in a woman having undergone bone marrow transplantation

Queatiapine has been used in bipolar mania and most recently in bipolar depression with good results; however, its use in maintenance treatment has not been established yet. A case of a woman suffering from bipolar I disorder who underwent bone marrow transplantation twice because of leukaemia is presented. The use of quetiapine as a monotherapy was efficient and safe and proved to be a good treatment in mood stabilization for 1 year. © 2010 Informa UK Ltd

Involvement of chromosome 13 in myelodysplastic syndromes

We report 2 of 80 cases of myelodysplastic syndromes (MDS) cytogenetically studied, with involvement of chromosome 13. The first case had a t(6;13), and the second had a t(1;13). Abnormalities of chromosome 13 mainly involving loss of band 13q14 have been described in hematologic malignancies. In both our cases band 13q14 did not participate in the deleted segment. © 1991

Myelodysplastic syndromes: Analysis of 131 cases according to the FAB classification

The clinical and haematological findings in 131 patients with myelodysplastic syndromes (MDS), none of which had previously received chemotherapy or radiotherapy, classified according to the FAB criteria, were analysed. The distribution among the 5 subgroups was: RA 31 patients, RAS 19, RAEB 23, CMML 29 and RAEBT 29 patients. There were difficulties in the classification of 24 patients. These included, first, 8 cases with myeloid hyperplasia of the bone marrow (BM) but without mono‐cytosis or excess of blasts of the BM. They were classified as RA. Second, 8 cases with sideroblastosis but with monocytosis or excess of blasts of the BM were classified 3 as RAEB, 2 as CMML and 3 as RAEBT. Finally, 8 cases with absolute monocytosis and BM blasts 15–30% were classified as CMML. 37 of 82 dead patients (45.1%) had transformed to acute non‐lymphoblastic leukaemia (ANLL). The incidence of evolution to ANLL was low for RA and RAS (6.30% and 12.5% respectively), while it was 37.5% for RAEB, 57.1% for CMML and 77.2% for RAEBT. The median survival for each subgroup was: RA 18 months; RAS 25; RAEB 13; CMML 14 and RAEBT 10 months. It is concluded that the FAB classification with some modifications recognises group of MDS with different prognosis. © Munksgaard 198

Treatment of intermediate and advanced stage Hodgkin's disease with modified baseline BEACOPP regimen: a Hellenic Co-operative Oncology Group Study

The purpose of this prospective phase II trial was to investigate the safety and efficacy of a modified baseline BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) regimen in the treatment of intermediate and advanced stage Hodgkin’s disease (HD). From October 1997 to November 2001, 51 consecutive, previously untreated patients with stage IIA (bulky), IIB, III, and IV disease were treated with a modified baseline BEACOPP regimen with the etoposide administered i.v. on day 1 and orally at a dose of 100 mg/m (2), on days 2 and 3. Each patient was scheduled to receive eight courses of BEACOPP with consolidation radiotherapy to bulky (greater than or equal to 5 cm) or residual disease. There were 25 males and 26 females with a median age of 32 yr (16-65 yr); 80.3% of the patients had nodular sclerosis HD, 41% had bulky disease (greater than or equal to 5 cm), 10 were in stage IIA ( bulky greater than or equal to 10 cm), 15 in stage IIB, 19 in stage III, and seven in stage IV. Thirty-seven patients (72.5%) achieved a complete response and 17.6% partial response. No signicant difference in overall response rate was observed between patients with: (i) 0-2 vs. greater than or equal to 3 negative prognostic factors, ( ii) in stage II vs. stages III/IV, LDH level, and bulky disease. With a median follow up period of 39.5 months, actuarial 3-yr survival rate is 82% and time to progression rate 72.5%. Treatment with this combination was well tolerated. Grades 3 and 4 leukopenia and neutropenia occured in 26% and 28% of the patients, respectively, whereas in 16.3% of the patients infection was observed. Support with granulocyte colony-stimulating factor was given to 59% of the patients. No case of secondary MDS/leukemia has been observed. The results of the present study demonstrate that the modified baseline BEACOPP regimen with radiotherapy used in our patients was well tolerated and effective therapy for intermediate and advanced stage HD. Further follow up time is required to evaluate long-term toxicity

Rosuvastatin-induced thrombocytopenia

Rosuvastatin, a statin indicated for patients with primary hypercholesterolemia, mixed dyslipidemia and familial hypercholesterolemia, is well tolerated by most patients. Its most common adverse effects are gastrointestinal derangement, muscle aches and hepatitis. One rare complication of statin treatment is severe thrombocytopenia. The case of a 65-year-old patient who developed severe thrombocytopenia while on rosuvastatin is presented, in addition to a review of the literature. Copyright © 2010 by The Southern Medical Association