Medical Advisory Board Research Articles

Hypofractionated Stereotactic Radiation Therapy for Brain Metastases

2011 were included. Neuropsychological assessments administered before and after radiation therapy measured total intelligence quotient (IQ). Parents were given Scales of Independent Behavior (SIB-R), a written questionnaire that assessed functional independence. Results: Median age at diagnosis was 38 months (range, 3 months 20 years). Nineteen (27%) patients had supratentorial ependymoma and 51 (73%) had infratentorial ependymoma. Forty-six (66%) had a gross total resection, and 24 (34%) had a subtotal resection. Thirty seven (53%) had anaplastic histology (WHO grade III); the remainder had classic ependymoma (WHO grade II). At a median follow-up of 46 months, 3year local control, progression free, and overall survival was 83%, 76% and 95%, respectively. Subtotal resection was significantly associated with worse progression-free survival (54% vs 88% for GTR; p Z 0$001) and overall survival (90% vs 97% for GTR; p Z 0$001). Anaplastic histology was observed with worse progression-free survival but did not reach statistical significance (69% vs 83% for classic; p Z 0$509). In a sub-set of patients (n Z 14), mean IQ was 108.5 at baseline and 111.3 after mean 2.05 years of follow-up. In a larger group of patients (n Z 28), overall SIB-R score was 100.1 at baseline and 100.8 after 2.21 years of follow-up. Few patients developed evidence of growth hormone deficiency (GHD), hypothyroidism or hearing loss. Conclusions: Outcomes for children treated with proton radiation compare favorably to the literature. Subtotal resection correlated with inferior outcome. The young age at diagnosis and the proximity of critical structures in patients with ependymoma make proton radiation therapy an ideal radiation modality. Author Disclosure: R. Sethi: None. B.Y. Yeap: None. R. Marino: None. K.J. Marcus: None. P. Caruso: None. M.B. Pulsifer: None. D. Ebb: None. N.J. Tarbell: L. Stock Options; ProCure (no current value to stocks). Q. Leadership; N.T.’s spouse is on the medical advisory board. T.I. Yock: None. S.M. MacDonald: None.

Disease Control Efficacy of Ductal Carcinoma In Situ (DCIS) Treated With Accelerated Partial Breast Irradiation (APBI)

RTOG/EORTC Late Radiation Morbidity systems were used for evaluation of skin, subcutaneous and non-cutaneous toxicities. Median follow-up was 82.5 months (range, 2-104 months). Results: At 4 years, the physician rating of overall cosmesis was good or excellent for 94% of photon patients, compared to 77% of proton patients, with fair or poor results for 6% and 27%, respectively (p Z 0.05). The incidence between the groups were: telangiectasia 11% for photon and 73% for proton patients (p < 0.01); any skin color change, 14% and 60% (p < 0.01); and late atrophy, 19% and 67% (p < 0.01). There were no significant differences between the groups in the incidences of breast pain, edema, fibrosis, fat necrosis, skin desquamation or rib pain or fracture. Patient-reported cosmetic outcomes at 4 years did not significantly differ (good or excellent for 95% of photon patients and 93% of proton patients) (p Z 0.4). There were no differences in breast pain, swelling, skin color or overall satisfaction. Conclusions: Proton 3D-APBI, with a single field used per treatment, led to higher rates of telangiectasia, skin color change and atrophy than treatment with photon or mixed photon and electron plans using 3 or more fields per treatment. Multiple fields per treatment should be used with proton 3D-APBI, similarly to photon 3D-APBI, to minimize the per day integral dose to normal tissue. Pencil beam scanning and other techniques should be explored to reduce proton APBI toxicity. Author Disclosure: S. Galland: None. I.M. Pashtan: None. S.M. MacDonald: None. M. Ancukiewicz: None. M. Specht: None. M.A. Gadd: None. B.L. Smith: None. A. Recht: G. Consultant; medical advisory board of CareCore National, Inc. A.G. Taghian: None.

Late diagnosis of constipation in older people costs £42m a year

Millions of Coronation Street viewers last week watched character Hayley Cropper (pictured alongside husband Roy) being told her pancreatic cancer tumour is inoperable and that she only has up to a year to live. The charity Pancreatic Cancer UK’s medical advisory board worked with the ITV soap opera’s producers on the storyline, and a helpline advertised in the closing credits of the programme was staffed by clinical nurse specialists. The storyline coincides with the publication of Pancreatic Cancer UK’s Every Life Matters report, which claims that reducing the number of pancreatic cancer patients diagnosed as a result of an emergency admission could increase survival rates. Half of all pancreatic cancer diagnoses are made as a result of an emergency presentation to hospital, which means patients are more likely to be at an advanced stage of the disease and are less likely to survive, says the report. The charity is calling on NHS England to instruct the National Institute for Health and Care Excellence to develop a quality standard on pancreatic cancer survival as a matter of urgency. Read Every Life Matters at tinyurl.com/lhqhx7w Soap puts pancreatic cancer in spotlight admissions in England as a result of constipation. The cost to the NHS was £42 million. Its report, The Burden of Constipation in our Ageing Population, says that 80 per cent of care home residents aged over 65 experience chronic constipation. If left untreated it can lead to impaction of hard faecal mass on the colonic wall, resulting in ulceration, lower gastrointestinal bleeding and perforation. Symptoms of untreated constipation include fatigue, nausea, vomiting and abdominal bloating. The report, which states that 80 per cent of community nurses in the UK spend up to half a day a week treating constipation, points out there is no national guidance on managing constipation in adults. It makes seven recommendations for nurses, including routinely using the Bristol Stool Form Scale to classify the form of faeces. Care home staff should suspect and assess constipation in all older residents, says the report, adding that they should use questioning techniques to achieve an accurate diagnosis.

US Hereditary Angioedema Association Medical Advisory Board 2013 Recommendations for the Management of Hereditary Angioedema Due to C1 Inhibitor Deficiency

The treatment of hereditary angioedema (HAE) has undergone dramatic changes as newer medicines have become available in recent years. Optimal care of these patients requires a comprehensive management plan. Although several consensus papers have been published concerning the diagnosis and treatment of HAE, guidelines for a comprehensive management plan have not been developed. To develop state-of-the-art recommendations for the treatment and management of HAE due to C1 inhibitor (C1INH) deficiency in the United States. Members of the US Hereditary Angioedema Association Medical Advisory Board began by reviewing the literature concerning treatment of HAE. Preliminary recommendations were developed based on the literature review, discussions in a face-to-face meeting, and refinements in a series of drafts. Final recommendations reflect the unanimous consensus of the medical advisory board and the US Hereditary Angioedema Association leadership. Recommendations are provided regarding a comprehensive care plan for HAE, including the following: development of an overall management plan, treatment of angioedema attacks, prophylactic treatment, and patient monitoring. A comprehensive individualized management plan developed between an expert HAE physician and the patient, in collaboration with local medical providers and emergency departments, can provide patients with the best opportunity to lead a normal life.

Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser–assisted cataract surgery: Three-month follow-up

To quantify changes in endothelial cell counts and corneal thickness measurements in patients having standard phacoemulsification compared with femtosecond laser-assisted cataract removal. Ruhr University Eye Clinic, Bochum, Germany. Prospective randomized intraindividual cohort study. One eye of each patient had standard phacoemulsification (control group) and the other eye had femtosecond laser-assisted phacoemulsification (study group), both with intraocular lens implantation. Pulsed ultrasound energy was used for phacoemulsification. Noncontact endothelial cell microscopy and corneal pachymetry were performed preoperatively and 1 day, 3 to 4 days, 7 to 10 days, 50 to 60 days, and 90 to 100 days postoperatively. The mean endothelial cell loss was 7.9% ± 7.8% (SD) 1 week postoperatively and 8.1% ± 8.1% 3 months postoperatively in the study group and 12.1% ± 7.3% and 13.7% ± 8.4%, respectively, in the control group. The mean relative change in corneal thickness from the preoperative values was -0.0% ± 1.9% at 1 day, 2.8% ± 1.8% at 1 week, and 3.3% ± 1.7% at 3 months in the study group and -0.9% ± 2.3%, 2.4% ± 1.5%, and 3.2% ± 1.4%, respectively, in the control group. The femtosecond laser did not add to the endothelial damage caused by cataract surgery and might be beneficial in eyes with low preoperative endothelial cell values (eg, cornea guttata cases).

Does cochlear implantation restore music appreciation?

Does cochlear implantation restore music appreciation?

Femtosecond laser–assisted cataract surgery in infants

We describe a technique for performing cataract surgery with a femtosecond laser in infants. Anterior capsulotomy and lens division are performed by the laser. A fluid-filled interface makes it possible to re-dock the laser to the eye for posterior capsulotomy after the eye has been opened for lens aspiration without complications. The integrated 3-dimensional optical coherence tomography also visualizes the posterior capsule, allowing a centered central posterior capsulotomy followed by mechanical anterior vitrectomy. The anterior and the posterior capsule disks are removed without capsule tears. The technique has been performed in 4 infants (ages 2, 4, 7, and 9 months) with congenital cataract. It can enhance the quality of pediatric cataract surgery.

1008 CHARACTER AND TEMPORAL EVOLUTION OF APOPTOSIS IN ACETAMINOPHEN-INDUCED ACUTE LIVER FAILURE

Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins DOI: 10.1097/CCM.0b013e31829791a2 1Department of Hepatology, Imperial College London, London, UK. 2Institute of Liver Studies at King’s College School of Medicine at King’s College Hospital, London, UK. 3Institute of Human Health and Performance, University College London, London, UK. 4Department of Asthma Allergy and Lung Biology, King’s College London, London, UK. 5Division of Critical Care Medicine, University of Alberta, Edmonton, Canada. Drs. Possamai and McPhail are joint first authors and Drs. Wendon, Mitry, and Antoniades are joint senior authors. Supported, in part, by the Imperial National Institute of Health Research Biomedical Research Centre for infrastructure and the King’s College Hospital Research & Development Department and Institute of Liver Studies Histopathology Department for ongoing support and the Medical Research Council UK. Dr. Possamai has received grant funding from the UK MRC. Dr. McPhail received funding from the Wellcome Trust UK as part of a Postdoctoral Training Fellowship [090542] during the production of this article. Dr. Abeles received NIHR-Doctoral Research fellowship from October 2009 to October 2010 and the fellowship had a travel allowance; he also received an EASL young investigator travel grant 2011 and 2012. Dr. Leslie holds multiple operating grants. Dr. Ma has received funding from the National Institutes of Health, Wellcome Trust, and the Howard Hughes Medical Institute. Dr. Shawcross is an advisory board member at Norgine, has given expert testimony for Talbot Walker LLP and Cooperative Legal Services, and has received grant support from HEFCE Clinical Senior Lectureship and Royal Society Grant. She has received payment for lectures from Frontiers in Hepatology and was sponsored to attend the European Association for the Study of the Liver 2011 by Bristol Myers Squibb. Dr. Bernal was a case review consultant for the University of Bordeaux in 2011 and received a speaking fee from the Cardiovascular Society of India in 2011. Dr. Dharwan has consulted for Boherenger Ingelham Cytonet, has received grant support from Astellas, has received payment for lectures from AASLD and EASL, and receives royalties from Oxford University Press. Dr. Heaton is a consultant for Astellas/Novartis and has received payment for lectures and payment for the development of educational presentations from Astellas. Dr. Thursz is a board member for the European Association for Study of the Liver, is a consultant for Abbott Pharmaceuticals, and has received payment for lectures from Gilead, BMS, and Janssen; he has also received travel reimbursements from Merck. Dr. Wendon has consulted for KASE A Kasai-Asai and is on the medical advisory board for Pulsion and Excalenz. Dr. Antoniades has received grant support from EASL Physician Scientist Fellowship Character and Temporal Evolution of Apoptosis in Acetaminophen-Induced Acute Liver Failure

Report of the Eye Bank Association of America Medical Advisory Board Subcommittee on Fungal Infection After Corneal Transplantation

To investigate the incidence of fungal infections after corneal transplantation to determine whether storage media supplementation with an antifungal should be considered. Adverse reactions reported to the Eye Bank Association of America through the online adverse reaction reporting system between January 1, 2007, and December 31, 2010, were reviewed to identify cases of recipient fungal infection. Data were collected regarding the donor, the donor cornea, recovery and processing, and mate culture and clinical course of the recipients. Thirty-one cases of culture-proven fungal keratitis (n = 14) and endophthalmitis (n = 17) were reported out of 221,664 corneal transplants performed using corneal tissue distributed by domestic eye banks (1.4 cases per 10,000 transplants performed). Although the annual incidence of postkeratoplasty fungal infection has not increased significantly since 2005, a trend toward an increasing rate of fungal infection has been observed. Fungal infections were more commonly reported after endothelial keratoplasty procedures (0.022%) than penetrating keratoplasty procedures (0.012%), but the difference was not statistically significant (P = 0.076). Additionally, no association was found between fungal infection after endothelial keratoplasty and whether the lamellar tissue cut was performed by the surgeon or the eye bank technician. Seventy-three percent (16 of 22) of the fungal cultures performed on the mate corneas were positive, with infection developing in 67% (10 of 15) of recipient eyes (endophthalmitis in 6 eyes and keratitis in 4 eyes). Although a nonsignificant increasing trend in the rate of fungal infection has been observed over the past 6 years, it is not sufficiently compelling to pursue antifungal supplementation of donor storage media.

Predictability of corneal flap thickness in laser in situ keratomileusis using a 200 kHz femtosecond laser

To compare the intended versus the resultant thickness of laser in situ keratomileusis (LASIK) flaps created with a new femtosecond laser and to report the 3-month postoperative refractive outcomes. Wellington Eye Clinic, Dublin, Ireland. Retrospective consecutive case series. A consecutive series of eyes having LASIK flaps created using a Wavelight FS200 femtosecond laser were included in this analysis. Eyes with preoperative spherical equivalent (SE) myopic refractive errors up to -12.00 diopters (D), hyperopic refractive errors up to +5.50 D, and astigmatism up to 6.00 D received primary LASIK. Outcomes included postoperative flap thickness and 3-month postoperative refraction. Outcomes in 431 eyes of 258 patients having LASIK with femtosecond flap creation were assessed. With an intended flap thickness of 120 μm, the mean post-LASIK flap thickness was 120.23 μm ± 13.94 (SD). In 349 of 813 eyes, EX500 optical pachymetry measurements were compared with Scheimpflug pachymetry readings. The mean corneal thickness was 553.52 ± 29.81 μm with optical pachymetry and 553.39 ± 29.12 μm with the Pentacam rotating Scheimpflug camera. In 162 eyes, the flap thickness was measured with optical coherence tomography; the mean was 121.94 ± 10.52 μm. Achieved flap dimensions were as intended. This study provides evidence of the predictability and lower variability of LASIK flaps created using the femtosecond laser. Consecutive patients having LASIK had good, predictable, and stable outcomes at the 3-month mark.

Letter by Heegaard et al Regarding Article, “Sudden Cardiac Arrest and Death Following Application of Shocks From a TASER Electronic Control Device”

The TASER International’s Scientific Medical Advisory Board read with interest the medical expert series from Dr Zipes.1 Complete, balanced, and impartial medical expert testimony are important contributors to advancing medical science. In this series, we believe that Dr Zipes missed or disregarded crucial information. Cases 4 and 5 are examples; there are others. In case 4, video, acoustic, forensic, and probe analysis indicate no contact made between the TASER probe and the suspect’s chest. The emergency medical technician paramedic present documented and testified under oath that both pulse and respirations were present for >8 minutes after electronic control device (ECD) deployment.2 Dr Zipes, as an expert witness in this case, either missed or disregarded this information. For case 5, every medical personnel interpreted …

Editorial introductions

Editorial introductions

Comparison of Blood Graft Cellular Content in Myeloma (MM) Patients and Non-Hodgkin Lymphoma (NHL) Patients Mobilized with Chemotherapy Plus G-CSF with or without Plerixafor

Abstract 4414 Background:Cellular composition of blood graft collected to support high-dose therapy may have important implications in regard to hematopoietic and immune reconstitution after high-dose therapy. Mobilization method used may have effect on graft composition as well as previous therapy given to the patients. Methods:We have retrospective analyzed by flow cytometry cellular composition of freezed blood grafts in 34 patients with NHL (chemotherapy + G-CSF mobilization 15, add-on plerixafor 19 patients) and compared the observations with those of 17 MM patients mobilized either with low-dose cyclophosphamide + G-CSF (n=12) or with add-on plerixafor (n=5). The analyses were performed from the first graft collected from the chemomobilized patients or from the first draft collected after the plerixafor injection, respectively. Antibodies used included CD34, CD38, CD133 in regard to CD34+ subclasses and CD3, CD4, CD8, CD19 and CD3CD16/CD56 to analyze lymphocyte subsets. In addition, 7-aminoactinomycin D staining was used to assess the amount of nonviable CD34+ and lymphoid cells. Results:In regard to the patients mobilized without plerixafor, MM patients had higher content of CD34+ cells (4.9 vs. 2.0 × 106/kg, p=0.009) as well as lower proportion of more primitive stem cells (0.8 vs. 1.9 % of all CD34+ cells, p=0.075) when compared to NHL patients. The amount of B-lymphocytes was also significantly higher in MM patients (0.5 × 106/kg vs. 0.0, p<0.001). No differences were observed in the total amount of T (CD3+) cells, NK cells or in the proportion of nonviable CD34+ or lymphoid cells. Of the plerixafor treated patients, the amount of B-lymphocytes was higher in MM patients (1.8 × 106/kg vs. 0.0, p<0.001) as well as CD4/CD8 ratio (2.56 vs. 1.0, p=0.004) when compared to NHL patients. Conclusion:As there appears to be differences between MM and NHL patients mobilized with or without plerixafor, it might be advisable to analyze separately effects of mobilization therapy to graft content and post-transplant outcomes in these diseases. Apparently the type and intensity of previous therapy given to the patients (e.g. rituximab) has important effects on graft cellular composition. Disclosures:Jantunen:Genzyme: Has participated in EU Leadership meeting organized by Genzyme as well as Medical Advisory Board meeting organized by Genzyme Other, Honoraria. Silvennoinen:Genzyme: Consultancy.

First Interim Efficacy and Safety Analysis of an International Phase III Randomized Trial in Newly Diagnosed Systemic Peripheral T-Cell Lymphoma Treated with Chemotherapy with or without Alemtuzumab and Consolidated by High Dose Therapy

AbstractAbstract 57 BackgroundThe ACT trial (ACT-1, younger patients aged 18–60 yrs and ACT-2, elderly patients aged >60 yrs) is the first international randomized phase III trial in newly diagnosed primary systemic peripheral T-cell lymphoma (PTCL). It tests, in both younger and elderly patients, the efficacy of the addition of alemtuzumab (ALZ) to 6 courses of bi-weekly CHOP followed, only in younger patients (ACT-1), by high-dose therapy with autologous stem cell rescue. A dose reduction amendment tapering the cumulative ALZ dose from 360 mg (30 mg on days 1 and 2 of CHOP courses 1–6) to 120 mg (30 mg on day 1 of CHOP courses 1–4), respectively, was introduced early on due to two cases of systemic fungal infection (Blood 2011,118;4110). To date, the trial has accrued a total of 186 patients (ACT-1 n=98; ACT-2 n=88). AimHere, we present the results from the first interim efficacy and safety analysis of the ACT-1 trial based on the first 68 randomized patients. ResultsOf the 68 patients, 63 had a complete set of treatment data. The median follow-up was 15 months (range 0.5–42 months). Thirty-two patients belonged to the experimental arm (exp) and 31 to the standard arm (std). Of the 32 patients treated according to exp, 4 received the higher dose of ALZ and 28 the lower. Treatment arms were well balanced with regard to main prognostic features such as age (std: median 53 yrs, range 21–60 yrs; exp: median 50 yrs, range 22–64 yrs; p=0.705), IPI subgroups (std: low 10%, low-intermediate 51%, intermediate-high 29%, high 10%; exp: low 12%, low-intermediate 44%, intermediate-high 19%, high 25%; p=0.392), advanced clinical stage (std: stage III-IV 94%; exp: 97%; p=0.613), performance status ECOG>1 (std: 23%; exp: 28%; p=0.613), elevated LDH (std: 68%; exp: 69%; p=0.932), presence of B-symptoms (std: 68%; exp: 75%; p=0.524), bulky disease (std: 13%; exp: 13%; p=1.0) and bone marrow involvement (std: 39%; exp: 31%; p=0.535). Histological subtypes were also similarly distributed among both treatment arms (std: PTCL-NOS 55%, AILT 23%, other 22%; exp: PTCL-NOS 56%, AILT 28%, other 16%). No cases of anaplastic large cell PTCL (regardless of ALK-protein status) were included. Neither of the treatment cohorts showed significant treatment delay. The median duration of chemotherapy (calculated for 5 bi-weekly cycles of an expected cumulative duration of 70 days) for non-ALZ vs. ALZ-treated patients was 73 vs. 81 days, respectively. No suspected unexpected serious adverse reactions (SUSARs) were reported. Grade 4 leucopenia was more frequent in ALZ-treated patients (std: 24%, exp: 69%; p=0,001), whereas grade 3–4 anemia and grade 3–4 thrombocytopenia were not significantly different between treatment arms (anemia, std: 19%, exp: 31%; p=0,278; thrombocytopenia, std: 20%, exp: 12%, p=0,682). Non-hematological toxicity unrelated to infectious complications was mild and had a similar frequency in both arms. The number of serious adverse events (SAEs) per patient was 0.86 for patients treated at post-amendment ALZ dose levels, representing a significant reduction compared to the pre-amendment value (3.25), and 0.46 for patients treated in the control arm (p=0.002). The frequency of bacterial and fungal infections (grade ≥3) was similar in both treatment arms. ALZ treated patients had more viral events (9/32; 28% vs. 3/31; 10%), mainly (6 out of 9) consisting of asymptomatic cytomegalovirus reactivations. The overall (non-arm specific) 1-year event-free survival (primary end-point), progression-free survival and overall survival were 55% (95% CI: 42%-67%), 54% (95% CI: 42%-67%) and 78% (95% CI: 67%-88%), respectively. ConclusionThe safety profile of the current standard and experimental treatment schedules, as well as the interim outcome results, support a continuation of the trial. A final analysis will be performed in Q2 2015. Disclosures:Jantunen:Genzyme: Has participated in EU Leadership meeting organized by Genzyme as well as Medical Advisory Board meeting organized by Genzyme Other, Honoraria.

Comparison of Post-Transplant Outcomes in Non-Hodgkin Lymphoma (NHL) Patients Mobilized with or without Plerixafor Added to Chemomobilization

Abstract 4520 Background:Plerixafor, a CXCR4 antagonist, is used in a combination with G-CSF with or without chemotherapy to enhance mobilization of hematopoietic stem cells (CD34+) from the bone marrow to circulation. Prior studies have shown that plerixafor may mobilize more primitive stem cells and also have impact on other cell populations too. These changes may have impact in engraftment, immunological reconstitution and post-transplant outcome. However, only limited data are available in regard to effects of plerixafor in post-transplant outcomes. Patients and methods:Eighty-nine patients with non-Hodgkin lymphoma (NHL) were included in this study. The patients received disease-specific chemomobilization (most commonly cytarabine based) with G-CSF. In addition, 33 patients (37 %) received plerixafor because of insufficient mobilization, poor collection yields or late mobilization (plerixafor group). Fifty-six patients served as controls (control group). The median age was 58 years in the plerixafor group and 57 years in the control group (p=0.515). The most common histology was diffuse large B-cell lymphoma in both groups. The proportion of patients beyond CR1 or PR1 was significantly higher (55 % vs. 32%, p=0.046) in the plerixafor group. All patients were treated with a single dose (6 mg) of pegfilgrastim after stem cell infusion. Patients were followed after high-dose chemotherapy in regard to haematopoietic engraftment and outcome. Results:The median amount of collected CD34+ cells was 3.5 × 106 CD34+ cells/kg (range 1.3 – 8.9 × 106 CD34+ cells/kg) in the plerixafor group and 4.2 × 106 CD34+ cells/kg (range 1.9 – 18.6 × 106 CD34+ cells/kg) in the control group (p=0.076). The median number of aphaeresis was two (range 1–5) in both groups (p=0.17). The median neutrophil engraftment was 10 days in both groups (range 8–81 days in the plerixafor group and 8–21 days in the control group). The median time to platelet engraftment was 14 days in both groups (range 10–165 days in the plerixafor group and 10–91 days in the control group). The incidence of neutropenic fever was comparable between the groups (71% vs. 76%, p=0.906). The median follow-up time from ASCT was 373 days (range 5–929 days) in the plerixafor group and 518 days (range 81–1175 days) in the control group (p=0.052). No difference in counts of haemoglobin, leucocytes, lymphocytes or platelets were observed at +1, +3, +6, +12 months except for haemoglobin which was significantly higher in the plerixafor group at +3 months. Progression-free survival (PFS) was 72 % in the plerixafor group and 75 % in the control group (p=0.69). Overall survival (OS) was also comparable between the groups (82 % vs. 84 %, p=0.67). Conclusions:The recovery from ASCT and outcome after ASCT seems to be comparable in lymphoma patients whether plerixafor is used or not. Prospective studies including more detailed characterisation of graft cellular content in regard to CD34+ cell subtypes, T-cell repertoire and NK-cells are needed to assess the impact of mobilization method post-transplant outcome. Disclosures:Jantunen:Genzyme: Has participated in EU Leadership meeting organized by Genzyme as well as Medical Advisory Board meeting organized by Genzyme Other, Honoraria.

Spontaneous Rupture of a Left Main Coronary Artery Aneurysm

We report a case of left main coronary artery (LMCA) aneurysm rupture while the patient was hospitalized and immediately after imaging with 2 noninvasive cardiac modalities. An 85-year-old man with history of atrial fibrillation, prostate cancer, hypertension, and hyperlipidemia presented with sudden lightheadedness, chest pressure, and junctional bradycardia (heart rate, 40 bpm). He was admitted to a telemetry bed; warfarin was held and unfractionated heparin was administered. The following day, heparin was held because of supratherapeutic-activated partial thromboplastin times. Transthoracic echocardiogram was performed demonstrating normal ejection fraction, normal wall motion, mild aortic root dilatation, and no pericardial effusion; nothing unusual about the coronary anatomy was noted. Computed tomography coronary angiography to evaluate for coronary artery disease and computed tomography of the chest with contrast to evaluate for pulmonary embolism were performed shortly afterward. Preliminary reports for these studies indicated no pulmonary embolus, mildly aneurysmal thoracic aorta, no thrombus in the left atrial appendage, and <50% stenosis of the left anterior descending ostium. A subsequent final interpretation reported an aneurysmal LMCA (Figure 1). Shortly after returning to his room, the patient developed sudden, severe hypotension and left chest discomfort. Intravenous fluids and vasopressors were administered with minimal effect. Urgent repeat transthoracic ECG showed a new, large pericardial effusion with tamponade (Figure 2). Because of refractory hypotension, emergency pericardiocentesis was arranged. Figure 1. Large left main coronary artery (LCMA) aneurysm on coronary computed tomography angiogram. …

Hemodynamic treatment algorithms should follow physiology or they fail to improve outcome

ICU and High Care Burn Unit, ZNA Stuivenberg, Antwerp, Belgium Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Medical Center, Hamburg, Germany This work was performed at the intensive care unit and High Care Burn Unit, ZNA Stuivenberg, Antwerp, Belgium; and the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Medical Center, Hamburg, Germany. No financial support was used in the connection with this work. Drs. Malbrain and Reuter are members of the Medical Advisory Board of Pulsion Medical Systems. Dr. Reuter received honoraria from Edwards Lifesciences and Pulsion. Dr. Malbrain received honoraria from Pulsion and has stock ownership in Pulsion.

Effect of femtosecond laser fragmentation of the nucleus with different softening grid sizes on effective phaco time in cataract surgery

To compare the effect of different fragmentation softening grids in femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT). Ruhr University Eye Clinic, Bochum, Germany. Prospective randomized clinical trial. The study evaluated the feasibility of using a femtosecond laser (Catalys Precision Laser System) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Patients had laser refractive cataract surgery with 350 μm fragmentation grids or with 500 μm fragmentation grids. Both groups had phacoemulsification using pulsed ultrasound energy, and the EPT was evaluated. Eighty patients were treated with 350 μm fragmentation grids and 80 patients with 500 μm fragmentation grids. The mean preoperative LOCS III grade was 3.7 ± 0.8 (SD) in the 350 μm group and 3.5 ± 0.8 in the 500 μm group. The mean laser treatment time was 66.4 ± 14.4 seconds in the 350 μm group and 52.8 ± 11.9 seconds in the 500 μm grid group and the mean EPT, 0.03 ± 0.05 seconds and 0.21 ± 0.26 seconds, respectively. The use of the femtosecond laser-assisted system in cataract surgery with 350 μm grid softening led to a statistically significant lower EPT than the 500 μm grid. Dr. Dick is a member of the medical advisory board of Optimedica Corp. No other author has a financial or proprietary interest in any material or method mentioned.

Personal Factors in the International Classification of Functioning, Disability and Health: Prospective Evidence

The goal of this study was to propose a systematic classification of relevant personal factors for describing the background of an individual's life and way of living. The German Society of Social Medicine and Prevention constituted an ICF working group consisting of members from Medical Advisory Boards of Statutory Health Insurances (n = 6) and other institutions (n = 12) in 2009. A two-tier consensus building approach was utilised to construct and document the personal factors, with an initial team of experts compiling the personal factors and a second group of experts, who had not participated in developing the initial proposal, validating the process. The consensus process resulted in personal factors classified into 72 categories and arranged in six chapters as follows: general factors normally unchangeable (chapter 1); a person's inherent physical and mental constitution (chapters 2 and 3); more modifiable factors, such as attitudes, basic skills and behaviour patterns (chapter 4); life situation and socioeconomic/sociocultural factors (chapter 5); and other health factors e.g., prior interventions (chapter 6). We believe the personal factors from this effort to be a good basis for a wider global dialogue on their operationalisation.

South African guidelines for the management of Gaucher disease, 2011

Gaucher disease is an autosomal recessive lysosomal glycosphingolipid storage disorder resulting from a deficiency of lysosomal enzyme acid β-glucosidase (glucocerebrosidase). This partial enzyme deficiency results in accumulation of glycosphingolipid-laden macrophages (Gaucher cells) throughout the liver, spleen, bone marrow, skeleton, lungs and brain (only in types 2 and 3). These guidelines aim to provide a standard of care for patients with Gaucher disease in keeping with international standards, but also realistic for South Africa, and to provide a shared-care model for treating physicians and funders regarding care for these patients. All healthcare professionals involved in the diagnosis and management of Gaucher disease should take note of and implement these guidelines in clinical practice as far as possible. These guidelines were developed through consensus by the Lysosomal Storage Disorder Medical Advisory Board. They are largely based on the UK 2005 National Guidelines for Gaucher Disease, but include new treatment recommendations for enzyme replacement therapy based on subsequent publications. The Southern African Society for Human Genetics (SASHG) (who have endorsed the guidelines) and the National Osteoporosis Foundation of South Africa (NOFSA) provided valuable input. GUIDELINES SPONSOR: Genzyme initiated the project and sponsored the meetings of the Advisory Board and all costs generated by these meetings. It is intended that these guidelines will enable all patients suffering from Gaucher disease to be diagnosed and offered the best possible care available.