MATILDE regimen followed by radiotherapy is an active strategy against primary CNS lymphomas.

The authors assessed MATILDE chemotherapy followed by response-tailored radiation therapy in 41 patients aged 70 years or younger with primary CNS lymphoma in a Phase II trial. With response rates of 76% after MATILDE and 83% after chemotherapy with or without radiation therapy, this was an active strategy, particularly in low- to intermediate-risk patients (International Extranodal Lymphoma Study Group [IELSG] score). Myelosuppression was the dose-limiting toxicity, with 9.5% of lethal complications. After a median follow-up of 49 months, a plateau in the survival curve (5-year overall survival: 41 +/- 7%) was obtained.

Comparison of the Paracheck-Pf test with microscopy, for the confirmation of Plasmodium falciparum malaria in Tanzania.

Paracheck-Pf is a rapid, qualitative immuno-assay for the detection of Plasmodium falciparum-specific histidine-rich protein-2 in samples of human blood. The assay has now been evaluated, against the usual 'gold standard', microscopy, using blood samples from 1655 individuals in five districts of Tanzania, four of which experience frequent malaria outbreaks. The aim was to verify whether Paracheck-Pf could be a reliable tool for the confirmation of malaria outbreaks in such areas. The overall measurements of the assay's performance were good, with a sensitivity of 90.0%, a specificity of 96.6%, a positive predictive value of 88.9%, and a negative predictive value of 97.0% (with an estimated malaria prevalence of 23.3%). There was, however, marked variation between the study districts, the assay's performance being relatively poor where the test had been stored for 12 months at room temperature (23.5+/-3.5 degrees C). The assay was easy to perform in the field and could clearly be a valuable tool in remote areas and in emergency situations, such as the early detection of malaria outbreaks. The cost of the assay (U.S.$0.62/test at the time of the present study) is sufficiently low that its routine use in the confirmation of P. falciparum malaria might also be cost-effective, particularly in areas where there are no facilities for microscopy and/or where the first-line treatment of malaria is based on relatively expensive artemisinin-based combinations.

Flare and tumor lysis syndrome with atypical features after letrozole therapy in advanced breast cancer. A case report.

Tumor lysis syndrome, which develops after effective therapy of malignant conditions and leads to hyperuricemia, hyperkaliemia, hyperphosphatemia, hypocalcemia and elevated lactate dehydrogenase, is uncommon in solid tumors. In breast carcinoma it can be associated with tamoxifen flare, i.e. a transient increase in symptoms, mainly bone pain, observed shortly after the start of tamoxifen therapy. We report the case of a patient with advanced breast carcinoma involving the pleural space, unresponsive to combined chemotherapy, who experienced rapid worsening after the initiation of letrozole. Her symptoms included shock, bilateral pleural effusion, cardiac tamponade and oliguria. Laboratory parameters disclosed elevated transaminase, lactate dehydrogenase, uric acid and D-dimer blood levels. The patient was in critical condition for nearly 2 weeks. She improved progressively and has remained well and in complete remission for 20 months. This clinical picture suggests increased damage to the pleura (and probably the pericardium) and rapid leakage of tumor products, following the start of endocrine therapy. Letrozole is a non-steroidal aromatase inhibitor which is used in advanced breast cancer, resistant to first-line endocrine/chemotherapeutic treatment. Our review of the literature did not disclose any other descriptions of flare and tumor lysis syndrome after aromatase inhibitor therapy. Moreover, this case was characterized by atypical and complex clinical features. The aim of this presentation is to point out the practical significance, in neoplastic patients, of the differential diagnosis between symptoms due to tumor progression and those associated with anomalous reactions to therapy.

[Unusual case of malaria in Italy]. / Un caso insolito di malaria in Italia.

There is a significant increase in cases of malaria in Italy. The incidence among Italian citizens has remained quite stable since 1990, while the number of cases among foreigners residing in Italy has continued to increase. The clinical manifestations of plasmodium infection can be less evident in these people: they often have only mild complaints for weeks or months. The case of a Senegalese woman with Plasmodium malariae infection is presented. She had been in Italy for 13 months and was 4-month pregnant. Her only symptoms were asthenia and microcytic anemia; she was afebrile. Her anemia was initially believed to be due to iron deficiency: she was treated with iron and folic acid. The anemia worsened, and resolved only after antimalarial therapy with chloroquine.

Marcas cutáneas en recien nacidos / Birthmarks detected in newborns

Presentamos las marcas cutáneas detectadas en 750 recién nacidos durante los meses de mayo y junio de 1995 en el Hospital Materno Perinatal de Lima, Perú, comparando nuestros hallazgos con los de la literatura nacional e internacional

[Occult gastrointestinal hemorrhage. Description of a case with unusual clinical presentation]. / Emorragie gastro-intestinali di origine sconosciuta. Descrizione di un caso con presentazione clinica anomala.

Bleeding from small bowel is a quite rare event and often is a diagnostic challenge to physician and surgeon. We present a case of a patient with an acute massive haemorrhage due to jejunal diverticulosis and with an unusual clinical setting. The site of bleeding was localized by scan with radiotagged erythrocytes, but the diagnosis of jejunal diverticule was evident only at laparotomy. The patient underwent to surgical resection of the affected bowel (40 cm). Although jejunal diverticula are considered a rare source of gastrointestinal haemorrhage, we suggest that this disorder must be considered in all patients with occult gastrointestinal bleeding especially in the elderly.

A pilot study on the effectiveness of cyclosporine in type II mixed cryoglobulinemia.

OBJECTIVE: To evaluate the effect of cyclosporine in the treatment of type II mixed cryoglobulinemia, after the failure of more conventional therapies. METHODS: Two patients with type II mixed cryoglobulinemia associated with chronic HCV infection, purpura, liver disease, and sensitive/motor neuropathy were treated with cyclosporine (2.5 mg/Kg/b.w.), after their failure to respond to treatment with corticosteroid, immunosuppressive drugs, interferon, and plasmapheresis. RESULTS: In both patients an improvement in the clinical manifestations (purpura and peripheral neuropathy), laboratory results (serum transaminases and cryocrit), and liver histology was seen, as well as the disappearance of bone marrow B-cell lymphoproliferation. CONCLUSION: Cyclosporine may be useful in the treatment of type II mixed cryoglobulinemia with prominent autoimmune clinical manifestations, although further studies are needed to better define the selection of patients.