Spleen sizing by ultrasound scan and risk of pneumococcal infection in patients with chronic GVHD: preliminary observations.

Encapsulated bacteria infections (EBI) can cause severe complications after BMT, usually occurring in patients with chronic GVHD (cGVHD) and attributed to functional hyposplenism. Using ultrasound (US) scan, we measured spleen size in 22 patients transplanted from HLA identical siblings, with or without cGVHD. No patient had received TBI, spleen irradiation or penicillin prophylaxis. Results were correlated with occurrence of EBI during a mean follow-up of 55 months (range 7-93). In the group without cGVHD, the difference between pre- and post-BMT spleen longitudinal diameters was not significant, and no patient developed EBI. In the cGVHD group, post-BMT spleen longitudinal diameters were significantly smaller than those pre-BMT (9.1 ± 1.6 vs 12.3 ± 2.2; P = 0.0005). Out of four patients with cGVHD who showed a major spleen size reduction, two developed a severe infection (an overwhelming sepsis and a pneumococcal meningitis). In our small series, we found a borderline relationship between spleen size reduction and duration of cGVHD (P = 0.06), as well as an increased risk of life-threatening infection in patients with extensive cGVHD and hyposplenism as detected by US scan. We conclude that US scan may be useful to detect spleen size reduction following allogeneic BMT and that penicillin prophylaxis is to be strongly recommended in patients with extensive cGVHD and spleen size reduction, even in those who have not received total body or spleen irradiation

Ultrasound exploration in the work-up of unexplained fever in the immunocompromized host: preliminary observations.

In immunocompromized hosts, febrile episodes have an unknown origin (FUO) in about fifty per cent of cases. In this preliminary study we evaluated the role of abdominal and pleural ultrasound (US) examination for early detection of infectious sites. US exploration was performed in a cohort of 14 consecutive FUO patients early after fever onset, at patients’ bedside, by a hematologist trained in diagnostic ultrasound, and it was repeated at neutrophil recovery. US exploration showed abnormal abdominal findings in 7 and pleural effusion in 3 patients. In all cases but one the abnormality was found at the first US examination. Abdominal and pleural US exploration is a low-cost, easy to use tool for the work-up of FUO in the immunocompromized host that proved to be effective in identifying the infection site in about 50% of patients

Weighted mixed weak-type inequalities for multilinear operators

In this paper we present a theorem that generalizes Sawyer's classic result about mixed weighted inequalities to the multilinear context. Let $\vec{w}=(w_1,...,w_m)$ and $\nu = w_1^\frac{1}{m}...w_m^\frac{1}{m}$, the main result of the paper sentences that under different conditions on the weights we can obtain $$\Bigg\| \frac{T(\vec f\,)(x)}{v}\Bigg\|_{L^{\frac{1}{m}, \infty}(\nu v^\frac{1}{m})} \leq C \ \prod_{i=1}^m{\|f_i\|_{L^1(w_i)}},$$ where $T$ is a multilinear Calder\'on-Zygmund operator. To obtain this result we first prove it for the $m$-fold product of the Hardy-Littlewood maximal operator $M$, and also for $\mathcal{M}(\vec{f})(x)$: the multi(sub)linear maximal function introduced in [LOPTT]. As an application we also prove a vector-valued extension to the mixed weighted weak-type inequalities of multilinear Calder\'on-Zygmund operators.Juan de la Cierva-Formaci\'on 2015 FJCI-2015-2454

Evolution and nucleosynthesis of primordial low mass stars

We discuss in detail the evolutionary properties of low mass stars M< 1 M(Solar) having metallicity lower than Z=10^(-6) from the pre- main sequence up to (almost) the end of the Asymptotic Giant Branch phase. We also discuss the possibility that the large [C,N/Fe] observed on the surface of the most Iron poor star presently known, HE0107-5240, may be attributed to the autopollution induced by the penetration of the He convective shell into the H rich mantle during the He core flash of a low mass, very low metallicity star. On the basis of a quite detailed analysis, we conclude that the autopollution scenario cannot be responsible for the observed chemical composition of HE0107-5240

Ultrasound scan to detect acalculous cholecystopathy in immunocompromised hosts with unexplained fever.

We found a significant prevalence of acalculous cholecystopathy in a group of patients with hematologic malignancies and unexplained fever. Ultrasound scan (US) detected a case of acute cholecystitis, two of gallbladder overdistension and biliary sludge, and one of striated gallbladder wall thickening. US proved effective in early identification of abdominal infection site

Intravenous itraconazole for treating invasive pulmonary aspergillosis in neutropenic patients with acute lymphoblastic leukemia.

Aspergillus infection is associated with a high mortality rate in immunocompromised hosts; more effective drugs for this infection are needed. Oral itraconazole has been studied in neutropenic fungus-infected patients. Using a novel formulation (intravenous) of itraconazole, we successfully treated severe necrotizing pneumonias due to Aspergillus species occurring during a postchemotherapy prolonged aplastic phase in two patients with acute lymphoblastic leukemia

Combined treatment with amphotericin-B and granulocyte transfusion from G-CSF-stimulated donors in an aplastic patient with invasive aspergillosis undergoing bone marrow transplantation.

Granulocyte transfusions from G-CSF stimulated donors were added to standard anti-infective treatment in preparation for and during allogeneic bone marrow transplantation in a young man affected by very severe acute aplastic anemia and invasive aspergillosis. Nine concentrates with a mean neutrophil content of 18.7x109/L (2.6x 108/kg patient b.w.) were transfused before and after marrow infusion. An impressive clinical improvement was noticed after each granulocyte transfusion, although this was not always paralleled by a neutrophil increase in the peripheral blood. Engraftment (N>0.5x109/L and PIt >25x109/L) was verified at +16 and +40 days, respectively. The patient is currently in complete hematological and microbiological remission 14 months after transplantation. Granulocyte apheresis from G-CSF stimulated donors provides a high number of activated neutrophils. At the dose given (300 μg/day) donor tolerance to G-CSF was excellent. This new approach is indicated when life-threatening infections develop in patients exposed to prolonged severe neutropenia

Small bowel infarction by Aspergillus.

Primary gut involvement by Aspergillus is a rare and often fatal complication of intensive antileukemic therapy. We describe the case of an adult patient affected by acute leukemia who developed a small bowel fungal thromboembolism without radiographic evidence of lung involvement during the post-induction aplastic phase. The diagnosis was made histologically at laparotomy performed for small bowel perforation. The patient died a week later in spite of amphotericin-B treatment and neutrophil recovery. Anti- Aspergillus prophylaxis and early introduction of amphotericin-B in the treatment of febrile neutropenia is probably advisable in all cases of AML

Liver nodular regenerative hyperplasia after bone marrow transplant.

We report an unusual liver disease which may occur after bone marrow transplantation, i.e. the collapse of hepatic lobuli followed by regenerative islets: the resulting clinical picture may mimic GvHD or a viral disease, but histology is diagnostic, showing nodular regeneration in the absence of inflammation or fibrosis