Research progresses in differentiation of benign and malignant vertebral marrow lesions with MR fat quantitative imaging / 中国医学影像技术

Accurate diagnosis of benign and malignant vertebral marrow lesions is crucial for individual treatment strategy and prognosis assessment. The changes of fat content play an important role in the pathological process of vertebral marrow lesions. The research progresses of common MR fat quantitative imaging techniques for differentiation of benign and malignant vertebral marrow lesions were reviewed in this article.

Anemia de Fanconi / Fanconi anemia

Resumen: La anemia de Fanconi es una enfermedad hereditaria con patrón de transmisión autosómico recesivo, asociada con múltiples mutaciones en al menos 20 genes cuyos productos forman parte de los mecanismos de reparación del material genético en las células. Estas mutaciones generan inestabilidad cromosomal que resulta en manifestaciones clínicas muy diversas, las más características son la insuficiencia de médula ósea, anormalidades congénitas y alta predisposición a neoplasias. El diagnóstico clínico de este trastorno es difícil, no sólo por su heterogeneidad, sino también porque es poco sospechado, se necesitan pruebas de laboratorio específicas para poder confirmarlo. De la misma manera, el tratamiento de la enfermedad es difícil porque está enfocado principalmente al manejo de los síntomas y a la prevención de afecciones asociadas, por lo que la anemia de Fanconi debe ser conocida para poder dar a los pacientes el seguimiento correcto.

Abstract Fanconi anemia is a hereditary disease with an autosomal recessive transmission pattern, associated with multiple mutations on at least 20 genes whose products are part of the cell's genetic material repair mechanisms. These mutations produce chromosomal instability, which results in diverse clinical manifestations; the most characteristic is bone marrow failure, congenital abnormalities and a high predisposition to neoplasms. Clinical diagnosis of this disorder is difficult, not only due to its heterogeneity but also because is little suspected, being necessary laboratory test to allow confirmation. In like manner, treatment of the disease is difficult as its mainly focused on symptoms management and prevention of associated conditions, therefore Fanconi anemia needs to be known in order to be able to give patients a correct follow up.

Efeito compensatório do fibrinogênio em paciente com aplasia de medula óssea, choque séptico e trombocitopenia grave guiado por tromboelastometria: relato de caso / Compensatory effect of fibrinogen in a patient with bone marrow aplasia, septic shock, and severe thrombocytopenia guided by thromboelastometry: a case report

RESUMO A transfusão de concentrado de plaquetas é prática comum para prevenção de sangramento espontâneo ou decorrente de procedimentos invasivos; sabe-se que a transfusão de componentes alogênicos do sangue se associa a aumento da mortalidade e piora do desfecho clínico. A força do coágulo é avaliada por meio da tromboelastometria rotacional e determinada pela interação entre plaquetas e fibrinogênio. O efeito compensatório do incremento na concentração sérica de fibrinogênio na força do coágulo, em pacientes com trombocitopenia, tem sido demonstrado em diferentes contextos clínicos, incluindo sepse. Relatamos o caso de uma paciente com trombocitopenia grave, cujo resultado da tromboelastometria rotacional demonstrou efeito compensatório na força do coágulo determinada pelos níveis plasmáticos aumentados de fibrinogênio como reagente de fase aguda em pacientes sépticos. Relatamos o caso de uma paciente de 62 anos com diagnóstico de aplasia de medula óssea admitida a uma unidade de terapia intensiva com choque séptico e trombocitopenia grave. Nas primeiras 24 horas na unidade de terapia intensiva, ela apresentou quadro clínico de insuficiência respiratória aguda e choque. Foi necessário utilizar ventilação mecânica invasiva e fármaco vasoativo. A radiografia de tórax mostrou padrão de lesão pulmonar bilateral. Desta forma, foi solicitada broncoscopia com lavagem broncoalveolar para investigação diagnóstica. Conduziu-se uma tromboelastometria rotacional, e seu resultado mostrou perfil de coagulação normal. Apesar da trombocitopenia grave (1.000/mm3), os níveis de fibrinogênio aumentaram (1.050mg/dL) devido ao choque séptico. A broncoscopia foi realizada sem que subsequentemente ocorresse sangramento ativo. Este caso relata o uso da tromboelastometria como ferramenta diagnóstica em distúrbios da coagulação de pacientes graves, permitindo prevenir o uso desnecessário de transfusões profiláticas de concentrado de plaquetas.

ABSTRACT Platelet transfusion is a common practice to prevent spontaneous bleeding or bleeding due to invasive procedures. Transfusion of allogeneic blood components is associated with increased mortality and a worse clinical outcome. The clot strength is assessed by thromboelastometry and determined by the interaction between platelets and fibrinogen. The compensatory effect of high levels of fibrinogen on clot strength in patients with thrombocytopenia has been demonstrated in different clinical settings including sepsis. We report the case of a patient with severe thrombocytopenia whose thromboelastometry showed clot strength that was compensated for by the increase in plasma fibrinogen levels as an acute phase reactant of septic patients. Here, we report a case of a 62-year-old female diagnosed with bone marrow aplasia admitted in the intensive care unit with septic shock and severe thrombocytopenia. During the first 24 hours in the intensive care unit, she presented acute respiratory insufficiency and circulatory shock. The use of invasive mechanical ventilation and norepinephrine was required. Her chest X-ray showed bilateral lung injury. Thus, bronchoscopy with bronchoalveolar lavage was requested. Thromboelastometry was performed and resulted in a normal coagulable profile. Despite severe thrombocytopenia (1,000/mm3), fibrinogen levels were increased (1,050mg/dL) due to septic shock. Bronchoscopy was performed without any active or further bleeding. Here, we report the use of thromboelastometry in the diagnosis of coagulation disorders, preventing unnecessary prophylactic platelet transfusion.

Monoartritis del codo e infarto óseo como presentación inicial de enfermedad linfoproliferativa / Elbow monoarthritis and bone infarction as a form of presentation of B cell lymphoma: case report

We report a 68-year-old woman presenting with pain and swelling in her left elbow. An elbow magnetic resonance with gadolinium evidenced bone marrow infiltration and a bone infarct. Given these findings, a body CT scan was performed which showed multiple mesenteric adenopathies and a large retroperitoneal mass. A lymph node biopsy confirmed a B cell lymphoma. Monoarthritis with no systemic manifestations represents a highly uncommon form of presentation of lymphoma. Moreover it usually affects inferior limbs, particularly in the presence of bone infarction.

Focal osteoporotic bone marrow defects on dental implant treated patients: a 5-year period prevalence study / Defectos focales osteoporóticos de la médula ósea en pacientes tratados con implantes dentales: estudio prevalencia de período a 5 años

Dental implants are considered the most effective treatment for teeth absence. Nevertheless, there are some bone conditions that could affect the osseointegration process, thus affecting the clinical and radiographic success rates. One of these conditions could be the Focal Osteoporotic Bone Marrow Defects. The objective of this study was to describe the 5-year period prevalence of Focal Osteoporotic Bone Marrow Defects (FOBMD) on dental implant treated patients. descriptive retrospective study was conducted. We systematically reviewed the clinical and radiographic data of treated patients in a Dental Implant Unit since January 2010 through December 2014. Once a FOBMD case was found, a detailed questionnaire was applied to the chart looking for demographic, medical and dental characteristics (clinical and radiographic). Also in a sub-sample histological analysis was carried out. Period prevalence (PP) was estimated calculating proportions and 95 % confidence intervals. Statistical analysis was performed using Stata v. 13.2 for Windows (Stata Corp., TX., USA). FOBMD 5-yPP was 9.52 % (CI 95 %: 6.87­13.5 %). We found 42 defects in 34 patients. Within the FOBMD patients, average age was 55.4±11.9 years, 67.64 % being females. Ninety-seven percent of the defects were located in the lower jaw, 79.41 % unilateral, 69.04 % single missed teeth lesions, 71.42 % affecting molar area and 59.52 % located on the right side of the maxillae. Histological analysis revealed inflammatory cells, dystrophic calcifications, hemorrhagic material and fatty cells for all the cases. FOBMD prevalence is low, so it should be considered as a rare condition but showing an exponential growing trend over the time. With no previous epidemiological data, these findings should be considered as a caution during x-ray examinations and treatment planning, in order to avoid surgical or prosthetic complications. Local factors as previous root canal treatments should be considered when elucidating reasons for its appearance.

Los implantes dentales se consideran el tratamiento más eficaz para la ausencia dentaria. Sin embargo, hay algunas condiciones óseas que pueden afectar el proceso de osteointegración, lo que afecta a las tasas de éxito clínico y radiográfico. Una de estas condiciones podrían ser los defectos focales osteoporóticos de la médula ósea (DFOMO). El objetivo de este estudio fue describir la prevalencia en un periodo de 5 años de los DFOMO en pacientes tratados con implantes dentales. Se realizó un estudio descriptivo y retrospectivo, con una revisión sistemática de los datos clínicos y radiológicos de pacientes tratados en una unidad de implantes dentales desde enero de 2010 hasta diciembre de 2014. Cuando se encontró algún caso de DFOMO, se aplicó un cuestionario detallado sobre la ficha en busca de características demográficas, médicas y dentales (clínicas y radiográficas). También se realizó un análisis histológico de la submuestra. Se estimó la prevalencia del periodo (PP), el cálculo de proporciones e intervalos de confianza con un 95 %. El análisis estadístico se realizó con el programa Stata v. 13.2 para Windows (Stata Corp, TX., EE.UU.). La prevalencia del periodo para los 5 años de DFOMO fue 9,52 % (IC del 95 %: 6,87 % a 13,5 %). Encontrado 42 defectos en 34 pacientes. Dentro de los pacientes con DFOMO, la edad promedio fue de 55,4±11,9 años, y 67,64 % fueron mujeres. El 97 % de los defectos se encuentraran en la mandíbula. El 79,41 % fue unilateral y 69,04 % con lesiones individuales de pérdidas dentarias; el 71,42 % afectó la zona de los molares y 59,52 % se encontró en el lado derecho del maxilar. El análisis histológico reveló células inflamatorias, calcificaciones distróficas, material hemorrágico y células grasas, en todos los casos. La prevalencia de DFOMO fue baja, por lo que debe considerarse como una enfermedad poco frecuente pero que muestra una tendencia creciente y exponencial en el tiempo. Sin datos epidemiológicos previos, estos resultados deben ser considerados para tener precaución durante los exámenes imagenológicos y la planificación del tratamiento, con el fin de evitar complicaciones quirúrgicas o prótesicas. Los factores locales como tratamientos endodónticos previos deben ser considerados para dilucidar las razones de su aparición.

Paroxysmal nocturnal hemoglobinuria clone in 103 Brazilian patients: diagnosis and classification

Background: Paroxysmal nocturnal hemoglobinuria is an acquired chronic hemolytic ane- mia, which often manifests as peripheral blood cytopenias and thrombosis. Objective: The aim of this study is to describe a Brazilian population of paroxysmal nocturnal hemoglobinuria patients. Methods: One hundred and three paroxysmal nocturnal hemoglobinuria cases were retrospectively reviewed and the clinical presentation, thrombosis, survival, and clone size were assessed. Diagnosis was established by flow cytometry. Results: Fifty-two male and 51 female patients with a median age of 24.1 years (5.5-62 years) were studied. Clinical symptoms included hemoglobinuria (18.4%), infection (46.6%) and thrombosis (16.5%), and 80.6% had pancytopenia. Patients were classified as classic parox- ysmal nocturnal hemoglobinuria (10), paroxysmal nocturnal hemoglobinuria with aplastic anemia (39), and paroxysmal nocturnal hemoglobinuria with subclinical features and aplas- tic anemia (54). There were significant differences in terms of median age, size of clone, clinical symptoms, and peripheral blood cell counts between the three subcategories. The clone size in erythrocytes and granulocytes were respectively 0.04% (range: 0-18%) and 7.3% (range: 0.3-68.7%) in patients with subclinical features and aplastic anemia, 15.8% (range: 0-99.7%) and 63.0% (range: 1.7-99.8%) in patients with aplastic anemia alone, and 82.2% (range: 0-99.85%) and 98.0% (81.3-100.0%) in Classic disease. Statistical differences were identified for platelets (p-value = 0.001), lactate dehydrogenase (p-value = 0.002) and the clone size (p-value < 0.001) in patients who suffered thrombotic events compared to those who did not. Overall survival was 81.7%, with patients with subclinical features and aplastic anemia having lower overall survival (76.5%). Conclusion: This retrospective review of 103 patients over an 11-year period represents the largest collection of paroxysmal...

A Primary Care Approach to Myelodysplastic Syndromes / 가정의학회지

Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies that can extend patients' life expectancy and improve quality of life. Primary care physicians (PCPs) are often involved in the process of diagnosis and follow-up of MDS patients, especially those in low-risk groups. They can therefore play an important role in improving patient care and quality of life by ensuring early referral and participating in supportive management. There is also a shortage of oncologists which increases the importance of the role of PCPs in management of MDS patients. In the face of limited resources, PCPs can improve access and quality of care in MDS patients. This article provides an overview of the common manifestations, diagnostic approaches, and therapeutic modalities of MDS for PCPs, with a focus on when to suspect MDS, when a referral is appropriate, and how to provide appropriate supportive care for patients diagnosed with MDS.

Bone marrow study in patients with Human Immune Deficiency Virus and Acquired Immune Deficiency Syndrome

Introduction: Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) can involve almost any organ system. The study was aimed to assess the various bone marrow abnormalities seen in HIV/AIDS patients with haematologic abnormalities. Materials and Methods: 43 HIV infected patients were included in the study. Baseline haematological investigations included full blood count, CD4 positive lymphocyte counts, and absolute lymphocyte count. Bone marrow aspiration and trephine biopsy were done in all patients. Bone marrows of these patients were carefully evaluated for any abnormalities. HIV positive patients were classified into AIDS group (76%) and non-AIDS (24%) group using National AIDS Control Organisation (NACO) criteria. Results: Normocytic normochromic anaemia was the most common peripheral haematological finding occurring in 72% of patients. The AIDS group had statistically significant lower platelet counts (p=0.004) but no differences in the other parameters. Bone marrow was normocellular in 63.6% in the AIDS group and 100% in the non-AIDS group. Dysplasia was observed in 37.2% of patients, predominantly affecting granulocytic series. Myelodysplasia was statistically associated with a low platelet count. Reduced marrow lymphoid precursors (CD4+) were seen in 37.2% of patients. Conclusions: Bone marrow abnormalities were common in HIV/AIDS patients with haematological abnormalities. The AIDS group had a statistically significant lower platelet count. Myelodysplasia was found in 37.2% of patients with HIV disease and was also statistically associated with a lower CD4+ lymphocyte count.

Effect of Formula Granule of Siwu Drugs on Sex Hormone and Its Receptor in Bone Marrow Depressed Mice / 天津医药

Objective: To investigate the effect of abstracted formula granule of Siwu drugs on the sex hormones and expressions of androgen receptor (AR)and estrogen receptor (ER) in bone marrow depressed mice. Methods: One hundred and eighty mice (90 male and 90 female) were randomly divided into 6 groups. The effects of the formula granule of Siwu on sex hormones and expressions of AR and ER were explored by SABC method in bone marrow of depressed mice. Results: For the male rats, the levels of androgen were increased in male of treatment groups compared with those of model groups (P＜0.05), and the levels of estrogen were decreased in male of treatment groups compared with those of model groups (P＜0.05).For the female rats, the levels of androgen were increased in female of treatment groups compared with those of model groups,but no significant differences (P＞0.05), and the levels of estrogen were decreased in femal of treatment groups compared with those of model groups (P＜0.05). There was a dose dependent manner between treatment groups. Conclusion: The results suggested that formula granule of Siwu drugs may play a role in the hematopoietic function to repair bone marrow depression by improving AR and the balance of estrogen / androgen in mice.

Clinical Study on Acupoint-injecting Method for Marrow Inhibition Caused by Chemical Medications / 针灸推拿医学（英文版）

Purpose:In order to explore the feasibility and efficacy of acupoint-injecting method for marrow inhibition caused by chemical medications. Methods: 110 cases of malignant tumors in the phase of marrow inhibition after arterial chemotherapy were treated by puncturing the acupoints, Zusanli (ST 36), Sanyinjiao (SP 6), Xuehai (SP 10) and Qihai (CV 6) plus injection of 5 mg dexamethasone. Results: Acupuncture treatment and acupuncture plus injection of medications can both effectively improve marrow inhibition after chemotherapy, and the therapeutic effect was better in the group by acupuncture plus acupoint-injecting method. Conclusion: Acupuncture can effectively stimulate the acute and short-term marrow inhibition caused by chemical medications, and acupuncture plus acupoint-injecting method can effectively shorten the treatment time and the lower hemogram phase of peripheral blood. The combination of two therapeutic methods can have remarkable cooperative effect and reduce the medical expenses.

Quantitative Assessment of Magnetic Resonance Imaging for the Noninvasive Evaluation of Bone Marrow Cellularity in Workers with Long-term Exposure to Solvents / 대한산업의학회지

OBJECTIVES: To develop a quantitative and noninvasive method of bone marrow cellularity evaluation in solvent-exposed painters. METHODS: Six painters (mean age 46.5 years, 5 males and one female) with hypocellular marrow, and 132 controls were examined using magnetic resonance imaging (MRI). A full examination of the peripheral blood and a bone marrow biopsy was done on each patient. Signal intensities were measured at the vertebral bodies from T12 to S1 on both the T1- and the T2-weighted image (T1WI and T2WI). Signal indices were calculated by dividing the signal indices of the vertebral bodies by that of the paraspinal muscle and the subcutaneous fat in the same view. RESULTS: The Bone marrow cellularities of the cases painters were between 20.3% and 33.6%. Signal indices based on the muscle at T1WI were greater in the cases of the painters compared to those of the controls (p<0.05, p<0.01). Signal indices based on the muscle at T1WI were significantly higher in older women compared with men (p< 0.05 ) . After adjusting for age and gender, the signal index of cases at S1 based on muscle of T1WI was higher than that of the controls by 0.364. Five of the six cases had a muscle signal index at S1 of T1WI higher than the mean + 1 standard deviation for the same age group and gender. CONCLUSIONS: MR signal indices are influenced by constitutional factors such as fat content, bone density, and the presence of other pathology. However, after adequate adjustment, it can be used as a useful indicator of bone marrow cellularity in a high-risk population.

Comparative study of MR imaging and X-ray in Med-anemia / 中华放射学杂志

Objective To evaluate the diagnostic value of MRI and X ray and to analyze MRI and X ray characteristics in Med anemia Methods MRI was performed in thoracic spine,lumbar spine, sacral spine,pelvis,and superior femurs in 15 patients with pathologically proved Med anemia with T 1WI and T 2WI Seven of them were examined on X ray Twenty volunteers were examined on MR as control group The authors analyzed the manifestations of MRI in the Med anemia, including abnormality of signal intensity of bone marrow,T 1 value,vertebral alteration of size and shaped, spinal cord compression due to epidural extramedullary haematopoiesis, and compared with the findings of bone on X ray Results In the control group, bone marrow showed an inhomogeneous iso signal intensity with band shaped, triangular or motley high signal intensity in the middle or back part of the vertebra, neck of the femur on T 1WI and a homogeneous iso signal intensity on T 2WI in the vertebra, pelvis, and superior femur All cases with Med anemia had low homogenous signal intensity in the bone marrow of the vertebra, pelvis and superior femur on T 1WI but had no alterations on T 2WI The spinal cord was constricted resulting from protruding crushed vertebra with bullet like shape in 4 cases The soft tissue masses, confirmed as extramedullary haematopoiesis by operation, were demonstrated in 4 cases Among 7 cases with X ray examinations, 2 cases showed normal on X ray but abnormal bone marrow on MRI, another 5 cases demonstrated bone alteration including osteoporosis, widening of striations, enlargement of ribs and vertebras T 1 value showed (897 4?75 43)ms in the Med anemia group and (401 5?28 1)ms in the control group with significant statistical difference ( P

Bone marrow MRI in adult patients with untreated acute leukemia and its clinical application value / 中华放射学杂志

Objective To observe bone marrow MR imaging of adult acute leukemia patients in first diagnosis and to reveal the rule of bone marrow infiltration and the role of MRI in diagnosing and predicting the prognosis of untreated acute leukemia adult patients. Methods Fifty-four adult acute leukemia patients received MRI after diagnosis relying on FAB subtype and immunophenotyping including 28 cases with AML and 26 cases with ALL. MR imaging was obtained by the short time inversion recovery and T 1W spin echo technique of pelvis and femur at one time. The examining results of morphology and blood routine were collected at the same time. 15 age-matched volunteers were selected as controls. Results MRI showed that bone marrow of all patients were infiltrated by leukemia cells. The MRI appearance was classified into five patterns based on scope of focus. MRI patters from grade 1 to grade 3 were observed in most of patients with AML and in none with ALL, however, all patients with ALL distributed in grade 4 to grade 5. The distribution of patterns had significant difference between AML and ALL (P

MRI value of differential diagnosis in hematological diseases (a report of 94 cases) / 中华放射学杂志

0.05). Homogenous or inhomogenous high signal in aplastic anemia were detected with decreased T 1 value. Homogenous iso-intensity was revealed in acute pure red cell aplasia with normal T 1 value. Aplastic anemia and acute pure red cell aplasia had a homogenous signal on T 2WI, their T 1 value showed significant difference (P