HIV-assoziiertes Lymphom — ungewöhnliche Ursache einer pathologischen Unterkieferfraktur: Fallbericht und Behandlungsoptionen bei Immundefizienz

Zusammenfassung: Das diffuse großzellige B-Zell-Lymphom (DGBZL) bleibt trotz der Einführung der kombinierten antiviralen Therapie (HAART) ein häufiger maligner Tumor bei HIV-infizierten Patienten. Über 50% dieser Lymphome verlaufen extranodal, davon manifestiert sich die Hälfte in der Kopf-Hals-Region. Bei oralen Manifestationen zählen Schmerzen, Schwellung, Parästhesien und Zahnlockerungen zu den ersten klinischen Symptomen. Im vorliegenden Beitrag wird über einen 52-jährigen Patienten mit einer Fraktur im linken Kieferwinkelbereich bei bekannter HIV-Infektion berichtet. Eine primäre osteosynthetische Versorgung brachte diese nicht zur Ausheilung. Die anlässlich der Revision durchgeführte Biopsie ergab die Diagnose eines primären Lymphoms im Unterkiefer. Eine Konsolidierung der Defektfraktur trat erst nach dessen Vollremission und nachfolgender Rekonstruktion mit freiem kortikospongiösem Beckenkammtransplantat auf. Anhand dieser Kasuistik werden nach Darstellung des Krankheitsbildes die Therapieoptionen bei Unterkieferfrakturen im Rahmen einer Immundefizienz vor dem Hintergrund der verfügbaren Literatur diskutier

Combining gemcitabine, oxaliplatin and capecitabine (GEMOXEL) for patients with advanced pancreatic carcinoma (APC): a phase I/II trial

Background: Gemcitabine remains the mainstay of palliative treatment of advanced pancreatic carcinoma (APC). Adding capecitabine or a platinum derivative each significantly prolonged survival in recent meta-analyses. The purpose of this study was to determine dose, safety and preliminary efficacy of a first-line regimen combining all three classes of active cytotoxic drugs in APC. Patients and methods: Chemotherapy-naive patients with locally advanced or metastatic, histologically proven adenocarcinoma of the pancreas were treated with a 21-day regimen of gemcitabine [1000 mg/m2 day (d) 1, d8], escalating doses of oxaliplatin (80-130 mg/m2 d1) and capecitabine (650-800 mg/m2 b.i.d. d1-d14). The recommended dose (RD), determined in the phase I part of the study by interpatient dose escalation in cohorts of three to six patients, was further studied in a two-stage phase II part with the primary end point of response rate by RECIST criteria. Results: Forty-five patients were treated with a total of 203 treatment cycles. Thrombocytopenia and diarrhea were the toxic effects limiting the dose to an RD of gemcitabine 1000 mg/m2 d1, d8; oxaliplatin 130 mg/m2 d1 and capecitabine 650 mg/m2 b.i.d. d1-14. Central independent radiological review showed partial remissions in 41% [95% confidence interval (CI) 26% to 56%] of patients and disease stabilization in 37% (95% CI 22% to 52%) of patients. Conclusion: This triple combination is feasible and, by far, met the predefined efficacy criteria warranting further investigation

Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin's lymphoma: an analysis from the German Hodgkin Study Group

Background: The optimal treatment of elderly patients with Hodgkin's lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy. Patients and methods: In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older. Results: Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008). Conclusion: Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoide

Single agent rituximab in patients with follicular or mantle cell lymphoma: clinical and biological factors that are predictive of response and event-free survival as well as the effect of rituximab on the immune system: a study of the Swiss Group for Clinical Cancer Research (SAKK)

Background: Predictive factors of rituximab efficacy and its effect on the immune system are still not defined. Patients and methods: Three hundred and six patients with follicular or mantle cell lymphoma received four weekly doses of rituximab (induction) and no further treatment (arm A) or four more doses at 2-month intervals (arm B). Results: Response rate to induction was 44%. Independent predictive factors for response were disease bulk <5 cm, follicular histology, normal hemoglobin and low lymphocyte count. Factors associated with event-free survival (EFS) were having responded to induction, having received not more than one line of therapy, Ann Arbor stage I-III, high lymphocyte count, disease bulk <5 cm, Fc-gamma receptor genotype VV and receiving prolonged treatment. B cells were suppressed by treatment but recovered after a median of 12 months in arm A and 18 months in arm B. The median IgM level after 1 year was normal in arm A but was decreased to 73% of baseline in arm B. We observed 24 serious adverse events, equally distributed between arms. Ten patients receiving induction only and six patients receiving prolonged treatment developed a second tumor. Conclusions: We defined the characteristics predicting response and EFS to rituximab. Prolonged treatment results in longer EFS at the cost of a longer reduction in B cell and IgM levels, but without additional clinical toxicit

An individual patient-data comparison of combined modality therapy and ABVD alone for patients with limited-stage Hodgkin lymphoma

Background Treatment options for patients with nonbulky stage IA-IIA Hodgkin lymphoma include combined modality therapy (CMT) using doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) plus involved-field radiation therapy (IFRT), and chemotherapy with ABVD alone. There are no mature randomized data comparing ABVD with CMT using modern radiation techniques. Patients and methods Using German Hodgkin Study Group HD10/HD11 and NCIC Clinical Trials Group HD.6 databases, we identified 588 patients who met mutually inclusive eligibility criteria from the preferred arms of HD10 or 11 (n = 406) and HD.6 (n = 182). We evaluated time to progression (TTP), progression-free (PFS) and overall survival, including in three predefined exploratory subset analyses. Results With median follow-up of 91 (HD10/11) and 134 (HD.6) months, respective 8-year outcomes were for TTP, 93% versus 87% [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.24-0.78]; for PFS, 89% versus 86% (HR 0.71, 95% CI 0.42-1.18) and for overall survival, 95% versus 95% (HR 1.09, 95% CI 0.49-2.40). In the exploratory subset analysis including HD10 eligible patients who achieved complete response (CR) or unconfirmed complete response (CRu) after two cycles of ABVD, 8-year PFS was 87% (HD10) versus 95% (HD.6) (HR 2.8; 95% CI 0.64-12.5) and overall survival 96% versus 100%. In contrast, among those without CR/CRu after two cycles of ABVD, 8-year PFS was 88% versus 74% (HR 0.35; 95% CI 0.16-0.79) and overall survival 95% versus 91%, respectively (HR 0.42; 95% CI 0.12-1.44). Conclusions In patients with nonbulky stage IA-IIA Hodgkin lymphoma, CMT provides better disease control than ABVD alone, especially among those not achieving complete response after two cycles of ABVD. Within the follow-up duration evaluated, overall survivals were similar. Longer follow-up is required to understand the implications of radiation and chemotherapy-related late effects. Clinical trials The trials included in this analysis were registered at ClinicalTrials.gov: HD10 - NCT00265018, HD11 - NCT00264953, HD.6 - NCT0000256

Phase I dose escalation and pharmacokinetic study of pluronic polymer-bound doxorubicin (SP1049C) in patients with advanced cancer

SP1049C is a novel anticancer agent containing doxorubicin and two nonionic pluronic block copolymers. In preclinical studies, SP1049C demonstrated increased efficacy compared to doxorubicin. The objectives of this first phase I study were to determine the toxicity profile, dose-limiting toxicity, maximum tolerated dose and pharmacokinetic profile of SP1049C, and to document any antitumour activity. The starting dose was 5 mg m−2 (doxorubicin content) as an intravenous infusion once every 3 weeks for up to six cycles. A total of 26 patients received 78 courses at seven dose levels. The dose-limiting toxicity was myelosuppression and DLT was reached at 90 mg m−2. The maximum tolerated dose was 70 mg m−2 and is recommended for future trials. The pharmacokinetic profile of SP1049C showed a slower clearance than has been reported for conventional doxorubicin. Evidence of antitumour activity was seen in some patients with advanced resistant solid tumours. Phase II trials with this agent are now warranted to further define its antitumour activity and safety profile

Combination Tones in Violins

In this study we investigate the appearance of combination tones in violins. Most authors in recent times have emphasised that combination tones occur inside the ear exclusively (intra-aural). This assumption will be subjected to scrutiny based on evidence found in an empirical study in which combination tones were measured outside the ear (extra-aural). Measurements were performed in which a violinist played two tones of a particular musical interval simultaneously. This was recorded and subsequently analysed using a Fourier Transformation. In addition to the partial tones of the primary interval, the resulting spectrum showed frequencies corresponding to combination tones. Similar measurements on the viola and violoncello also revealed the existence of extra-aural combination tones. Such frequencies may influence the timbre of simultaneous intervals played on string instruments. In another experiment the violin was excited using an electrodynamic mini-shaker with the aim of localising the origin of extra-aural combination tones. A newly devised tone matrix was used as a theoretical approach which computes all potential combination tones that may occur between any pair of partial tones. The detailed analysis of musical intervals by both the frequency spectrum and the tone matrix shows characteristic mirror and point symmetries in the partial tone structure. The discussion focuses mainly on the audibility of extra-aural combination tones and on ‘the combination tone 1’. This research opens up new perspectives and questions relevant for interpreters, composers, violin makers and violin acousticians

Biological Control of Soil-Borne Diseases of Medicinal and Aromatic Plants: Present Statds

1-6Tagetes minuta, Artimisia annua, Mentha spp, Matricaria chamomile, Geranium, Rosemarinus officinalis, Cymbopogon maritinii, C.flexuosus, Centella asiatica, Catharanthus roseus, etc. are some of the import ant medicinal and aromatic plants grown in India. These plants suffer from a number of soil -borne diseases, viz. collar rot of Mentha caused by &nbsp;Sclerotium rolfsii and Fusarium sp ., Scierotinia rot of Artimisia annua caused by S<span style="mso-bidi-font-style: italic">clerotinia sclerotiorum , stem rot of geranium caused by Rhizoctonia solani, collar rot of Pogostemon cablin and Tagetes sp. caused by Sclerotium rolfsi, etc. These diseases cause the rotting of stem and root system. Chemical management of these diseases is not only quite costly but also harmful. Therefore, attempts have been made to use the indigenous isolates of Triclwderma and Gliocladium spp for the management of these diseases. The nature and mechanism of these biocontrol agents are presented. The results arc quite encouraging and presented in this paper