Engraftment kinetics and hematopoietic chimerism after reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation.

Reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation (SCT) was introduced several years ago. Although its feasibility has recently been proven, only limited data are available on myelotoxicity, engraftment kinetics, and the significance of hematopoietic chimerism using this novel conditioning regimen. To clarify these open questions, we analyzed 27 patients with various hematological diseases, who received allogeneic SCT preceded by fludarabine/treosulfan conditioning. Further assessment endpoints included graft-vs-host disease (GvHD), mortality, and overall survival (OS). Allogeneic SCT was followed by neutropenia (absolute neutrophil count < or = 0.5 x 10(9)/l) and thrombocytopenia (platelets < or = 20 x 10(9)/l) in all patients. All patients showed stable neutrophil engraftment, and all except one had stable platelet engraftment. Grades II-IV acute GvHD was found in 48% of patients, whereas 52% developed chronic GvHD. The treatment-related mortality on day +100, 1 year after SCT, and at the last follow-up was 11, 26, and 33%, respectively. We found complete chimerism rates of 46, 57, and 72% on days +28, +56, and at the last follow-up or before death, respectively. The underlying malignancy tended to relapse more frequently in patients with mixed chimerism than in those with complete chimerism on day +28 as well as on day +56 (not significant). Additionally, no significant association was found between hematopoietic chimerism and donor type, GvHD, or OS, respectively. We conclude that reduced-intensity conditioning with fludarabine and treosulfan before allogeneic SCT is myeloablative, provides stable engraftment, and leads to complete chimerism in the majority of patients.

Regional kinetic constants and cerebral metabolic rate for glucose in normal human volunteers determined by dynamic positron emission tomography of [18F]-2-fluoro-2-deoxy-D-glucose.

Using dynamic [18F]fluorodeoxyglucose (FDG) positron emission tomography with a high-resolution, seven-slice positron camera, the kinetic constants of the original three-compartment model of Sokoloff and co-workers (1977) were determined in 43 distinct topographic brain regions of seven healthy male volunteers aged 28-38 years. Regional averages of the cerebral metabolic rate for glucose ( CMRglu ) were calculated both from individually fitted rate constants ( CMRglukinetic ) and from activity maps recorded 30-40 min after FDG injection, employing a four-parameter operational equation with standard rate constants from the literature ( CMRgluautoradiographic ). Metabolic rates and kinetic constants varied significantly among regions and subjects, but not between hemispheres. k1 ranged between 0.0485 +/- 0.00778 min-1 in the oval center and 0.0990 +/- 0.01347 min-1 in the primary visual cortex. k2 ranged from 0.1198 +/- 0.01533 min-1 in the temporal white matter to 0.1472 +/- 0.01817 min-1 in the cerebellar dentate nucleus. k3 was lowest (0.0386 +/- 0.01482 min-1) in temporal white matter and highest (0.0823 +/- 0.02552 min-1) in the caudate nucleus. Maximum likelihood cluster analysis revealed four homogeneous groups of brain regions according to their respective kinetic constants: (1) white matter and mixed brainstem structures; (2) cerebellar gray matter and hippocampal formations; (3) basal ganglia and frontolateral and primary visual cortex; and (4) other cerebral cortex and thalamus. Across the entire brain, k1 and k2 were positively correlated (r = 0.79); k1 and k3 showed some correlation (r = 0.59); but no significant linear association was found between k2 and k3. A strong correlation with CMRglu could be demonstrated for k1 (r = 0.88) and k3 (r = 0.90), but k2 was loosely correlated (r = 0.56). CMRglu kinetic ranged from 17.0 +/- 2.45 mumol/100 g/min in the occipital white matter to 41.1 +/- 5.62 mumol/100 g/min in the frontolateral cortex. In most regions the mean values of CMRglu kinetic did not differ significantly from CMRglu autoradiographic. With few exceptions, however, within-region variance was significantly less for CMRglu kinetic than for CMRglu autoradiographic, suggesting greater individual reliability of results obtained by the kinetic approach.

Hypokalemic rhabdomyolysis associated with Bartter's syndrome.

Severe potassium deficiency is an uncommon cause of rhabdomyolysis. We recently treated a 45-year-old patient with myalgia, serious generalized weakness, increased serum creatine kinase and myoglobin level as well as excessive hypokalemia. Histological examination of deltoid muscle biopsy showed rhabdomyolysis. After complete recovery of muscle damage by potassium substitution Bartter's syndrome proved to be the cause of initial and persistent hypokalemia.

[Morphology and distribution of venous openings in the human placenta]. / Morphologie und Verteilung des venösen Ablfusses in der menschlichen Placenta.

A human in situ placenta of the fourth lunar month was totally serial sectioned and light microscopically examined with following results: 1. 252 venous openings had been found. 2. venous drainage takes place over the whole basal plate. 3. the venous openings are scattered in different regions: a) mainly responsible for the venous drainage is a large part of the placenta with most of veins, the so called venous ring, lying between the central part and the marginal lake. b) in the central parts are remarkably less, venous openings as in the venous ring. c) the vessels lie together in groups. 4. only few veins have direct connection with the marginal lake, they have a regulation basin function to equalize the different intervillous blood pressure. 5. there is no topographic relationship between venous openings and plaental septa; although sometimes veins could be found in the near or at the vase of placental septa. 6. the venous endings possess according to their localization different structures: a) in the central parts often narrow, chimney- like endings connected with a venous lake, b) in the venous ring many uncharacteristic forms: broad shaft- like endings, hook- like endings and also multiple openings of one single vein. c) near the marginal lake the vessels run stretched out parallel to the basal plate, partly terraced one upon another. 7. valves do not exist.

Antiviral activity of dipyridamole derivatives.

Among 46 novel pyrimido [5.4-d] pyrimidine derivatives, 26 compounds were found to exhibit antiviral activity as revealed in a test programme against Mengo, Coxsackie B1, fowl plague, vaccinia and pseudorabies viruses, as concerns inhibition of plaque formation and of infectious virus yield. Attempts to disclose structure-activity relationships by discriminant analysis pointed to a possible importance of hydrophobic substitution for the antiviral effectiveness against Mengo virus of the derivatives investigated.