ABSTRACT
We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P=0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P=0.18), and for grades III-IV was 2.6% vs 11.6% (P=0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P=0.002) and extensive 5% vs 23.6% (P=0.01). OS was 74% vs 76% for BM vs PBSCs (P=0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P=0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P=0.005) respectively. In multivariate analysis, aGvHD II-IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1-5.6, P=0.02) and aGvHD III-IV (HR 8.3 CI 3.4-20.2, P<0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patients.
Subject(s)
Anemia, Aplastic/therapy , Antilymphocyte Serum/administration & dosage , HLA Antigens , Siblings , Stem Cell Transplantation , Acute Disease , Adolescent , Adult , Aged , Allografts , Anemia, Aplastic/mortality , Child , Child, Preschool , Disease-Free Survival , Female , Graft vs Host Disease/mortality , Graft vs Host Disease/prevention & control , Humans , Latin America , Male , Middle Aged , Survival RateABSTRACT
Chiari malformation type I and Poland's syndrome are two rare diseases and their simultaneous presentation had not been previously described in the literature. We report the case of a 27 year old male with history of Poland's syndrome, who referred headache and motor impairment of the intrinsic muscles of the left hand. In a cervical spine MR a Chiari I malformation with syringomyelia from C1 to T2 was found, which was treated by foramen magnum decompression, dural plasty and removal of the posterior arch of the atlas. A discussion of the embryological mechanisms that might be involved in the coexistence of these two entities is presented, emphasizing the role of para-axial mesoderm.
Subject(s)
Arnold-Chiari Malformation/epidemiology , Poland Syndrome/epidemiology , Adult , Arnold-Chiari Malformation/etiology , Arnold-Chiari Malformation/surgery , Comorbidity , Humans , Magnetic Resonance Imaging , Male , Poland Syndrome/etiology , Poland Syndrome/surgeryABSTRACT
La atrición dentaria, el cansancio muscular al levantarse, la movilidad dentaria, la cefalea y la recesión gingival fueron los signos y síntomas más frecuentes. El miedo, la ansiedad y la irritabilidad fueron los síntomas mentales más frecuentes. El tratamiento homeopático fué efectivo en los pacientes con Bruxismo.