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Autologous stem cell transplantation (SCT) with high-dose melphalan (HDM, 200 mg/m2) is the most effective therapy for multiple myeloma. To determine the feasibility of combining carmustine (300 mg/m2) with HDM, we enrolled 49 patients with previously treated Durie–Salmon stage II/III myeloma (32M/17W, median age 53) on a phase I/II trial involving escalating doses of melphalan (160, 180, 200 mg/m2). The median β2-microglobulin was 2.5 (0–9.3); marrow karyotypes were normal in 88%. The phase I dose-limiting toxicity was grade 2 pulmonary toxicity 2 months post-SCT. Other endpoints were response rate and progression-free survival (PFS). HDM was safely escalated to 200 mg/m2; treatment-related mortality was 2% and grade 2 pulmonary toxicity 10%. The complete (CR) and near complete (nCR) response rate was 49%. With a median post-SCT follow-up of 2.9 years, the PFS and overall survival (OS) post-SCT were 2.3 and 4.7 years. PFS for those with CR or nCR was 3.1 years while for those with stable disease (SD) it was 1.3 years (P=0.06). We conclude that carmustine can be combined with HDM for myeloma with minimal pulmonary toxicity and a high response rate.Leukemia (2006) 20, 345–349. doi:10.1038/sj.leu.2404003; published online 1 December 2005 [ABSTRACT FROM AUTHOR]

Systemic AL amyloidosis (AL) is a disorder in which light chains form fibrillar deposits, leading to organ dysfunction and death. Rarely, AL has been associated with non-Hodgkin's lymphoma (NHL), although this association has not been well characterized. We report a series of six patients with AL associated with NHL, primarily lymphoplasmacytic lymphoma. Organ involvement was variable, with frequent bulky lymphadenopathy and visceral cavity deposits, but no cardiac involvement. Positron emission tomography scans were negative. Bone marrow and lymph node biopsies showed a mixed population of CD20+ lymphoid and CD138+ plasma cells. Serum free light chains were elevated, and correlated with response to therapy. Immunoglobulin light chain variable region (Ig VL) germline gene use was typical for AL, reflecting previously observed correlations between germline gene use and organ tropism. Five patients received rituximab-based therapies with two responses. Two patients underwent autologous stem cell transplantation with one complete haematological response. Four patients survive at 10–132 months from diagnosis. AL with NHL has distinctive clinical features but employs the same Ig VL gene repertoire as AL with clonal plasma cell dyscrasias. Serial serum free light chain levels are useful for tracking response to therapy. Treatments aimed at both lymphoid and plasma cell components appear warranted. [ABSTRACT FROM AUTHOR]

LIFE STAR medical transport helicopters speed patients to trauma centers, but many of the life-saving procedures are performed on board by highly trained flight RTs. [ABSTRACT FROM AUTHOR]

Focuses on bone marrow necrosis (BMN). Symptoms of BMN; Association between primary hepatocellular carcinoma and lymphoblastic lymphoma; Association of therapy related lymphoblastic lymphoma with gene translocations.

Background: Our general surgery residency (46 residents, graduating 6 categoricals per year) offers the opportunity for 2 categorical residents at the end of their second year to choose a 2-year research track. Academic productivity for the remaining categorical residents was dependent on personal interest and time investment. To increase academic productivity within the residency, a mandatory research requirement was implemented in July 2010. We sought to examine the effect of this annual individual requirement., Methods: The research requirement consisted of several components: a curriculum of monthly research meetings and lectures, assigned faculty to act as research mentors, an online repository of research projects and ideas, statistical support, and a faculty member appointed Director of Research. In July 2010, the requirement was applied to all categorical postgraduate year 1-3 residents and expanded to postgraduate year 1-4 in 2011. The research requirement culminated in an annual research day at the end of the academic year. We compared the number of abstract presentations in local, national, and international meetings between the first 2 years of the research program and the 2 years before it. We also compared the total number of publications between the 2 periods, acknowledging that any differences at this point do not necessarily reflect an effect of the research requirement., Results: From July 2008 to June 2010 (Period A), there were 18 podium and poster presentations in local, national, and international meetings, and 30 publications in peer-reviewed journals, whereas between July 2010 and June 2012 (Period B), there were 58 presentations and 32 publications. In Period A 9 of 60 (15%) categorical residents had a podium or poster presentation in comparison with Period B when 23 of 58 (40%) categorical residents had a podium or poster presentation (p < 0.01)., Conclusion: The institution of a mandatory research requirement resulted in a 3-fold increase in scientific presentations in our surgical residency. We believe that the mandatory nature of the program is a key component to its success. We expect to see an increase in the number of publications as a result of this research requirement in the next several years., (© 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.)

Importance: Today's general surgery interns are faced with increased duty hour restrictions and stringent competency-based supervision milestone requirements (ie, from direct to indirect supervision). Working within these constraints, we instituted a unique 2-month intern curriculum (boot camp) incorporating knowledge-based, experiential, and practical components., Objectives: To describe our curriculum and the effect on resident performance and teaching faculty and nursing staff perceptions., Design: All interns underwent a 2-month (July and August 2011) boot camp curriculum consisting of two 2½-hour knowledge-based and procedural skills (SimMan) didactic sessions per week and completion of 25 core intensive introductory American College of Surgeons Fundamentals of Surgery web-based self-study modules, followed by a standardized patient clinical skills assessment., Setting: Integrated general surgery residency program at the University of Connecticut School of Medicine, Farmington., Participants: Postgraduate year 1 general surgery categorical and preliminary residents., Main Outcomes and Measures: We used several assessment tools, including an intern boot camp survey, clinical skills assessment scores, intern American Board of Surgeons In-Training Examination scores, and nursing staff and teaching faculty surveys of intern performance and aptitudes compared with the previous year's interns. Data were analyzed by independent group t test, χ2 tests of proportions, and Fisher exact test for small sample cross tables., Results: In total, 84% (91 of 108) of intern respondents agreed or strongly agreed with the usefulness, relevance, and execution of the boot camp. Compared with the previous year's interns, the nursing staff agreed or strongly agreed that the cohort interns were better at patient assessment, collaboration, and effective communication and provided compassionate and respectful patient care. More than 40% (7 of 17) of surveyed teaching faculty agreed or strongly agreed that the cohort interns demonstrated better patient care and procedural skills and self-confidence compared with the previous year's interns. The clinical skills assessment scores after the 2-month boot camp paralleled the scores typically seen at the end of the previous 2 internship years (P > .25 for all). The proportion of nondesignated and categorical interns pursuing careers in general surgery scoring in the top quartile on the American Board of Surgery In-Training Examination increased from 7% (2 of 28) to 50% (5 of 10) compared with the previous 2 internship years (P = .01)., Conclusions and Relevance: Recent changes in intern duty hours and supervision rules mandate that residency training programs must institute a competency-oriented curriculum to provide interns with the necessary knowledge and practical skills to attain clinical competence.

We previously reported that three risk factors (RF): initial remission duration <1 year, active B symptoms, and extranodal disease predict outcome in relapsed or refractory Hodgkin lymphoma (HL). Our goal was to improve event-free survival (EFS) for patients with multiple RF and to determine if response to salvage therapy impacted outcome. We conducted a phase II intent-to-treat study of tailored salvage treatment: patients with zero or one RF received standard-dose ifosfamide, carboplatin, and etoposide (ICE); patients with two RF received augmented ICE; patients with three RF received high-dose ICE with stem cell support. This was followed by evaluation with both computed tomography and functional imaging (FI); those with chemosensitive disease underwent high-dose chemoradiotherapy and autologous stem cell transplantation (ASCT). There was no treatment-related mortality. Compared to historical controls this therapy eliminated the difference in EFS between the three prognostic groups. Pre-ASCT FI predicted outcome; 4-year EFS rates was 33% vs. 77% for patients transplanted with positive versus negative FI respectively, P = 0.00004, hazard ratio 4.61. Risk-adapted augmentation of salvage treatment in patients with HL is feasible and improves EFS in poorer-risk patients. Our data suggest that normalisation of FI pre-ASCT predicts outcome, and should be the goal of salvage treatment.