Ultrasonography of the gallbladder in patients with hemoblastoses]

A total of 402 patients with acute or chronic leukemia and chronic cholecystitis and 100 healthy controls were exposed to ultrasonic biliography. It was revealed that leukemic infiltration of the bladder wall, increased pressure in the portal system, hypoalbuminemia and the concurrent diseases of the bladder could be the main causes of the alterations in the size and form of the bladder and the width of its walls in hemoblastosis patients. It was stated as well that the thickening of the bladder wall was an obligatory diagnostic criterion for not only chronic cholecystitis but various patterns of hemoblastoses as well. The authors suggested that echolocation of the gall bladder should be done in combination with clinical and morphological verification of the tumor process and its stages that undoubtedly would be of significant value in the choice of therapeutic policy.     

Multiple-organ pathology in septic shock in patients with hemoblastoses

A prospective study of 20 patients with hemoblastosis and septic shock (SS) was carried out by invasive monitoring of the central hemodynamics and oxygen transport, evaluation of biochemical and coagulological parameters, and assessment of the severity of clinical condition by the APACHE II and SOFA scores. Septic shock was effectively treated in 12 patients, 5 of them were discharged from the department (group 1) and 7 died in intensive care wards from various complications (group 2). Eight patients died during the first 2 days from SS resistant to therapy (group 3). Group 2 patients were in need of a longer inotropic support than group 1 patients (5.8 +/- 1.6 vs. 2.7 +/- 0.8 days, p < 0.01). The deficit of bases was more expressed in groups 2 and 3 in comparison with group 1 (-11.3 +/- 3 and -2.7 +/- 9.1 mmol/liter vs. 1.4 +/- 4.4 mmol/liter) and left ventricular stroke index (LVSI) and oxygen delivery were lower. LVSI and base deficit were in linear correlation (rho = 0.4, p < 0.05). XIIa-dependent fibrinolysis was suppressed in all patients, which was more pronounced in group 3 in comparison with groups 1 and 2 (135 +/- 47.4 vs. 103 +/- 27 and 88.3 +/- 42.3). According to SOFA score, the severity of cardiovascular disorders during day 1 of SS was the same in all groups, while starting from day 2 it decreased in patients who survived. Acute respiratory failure was lower in group 1 only on day 1 according to SOFA. More pronounced (according to SOFA) hepatorenal failure was observed in group 2 in comparison with other patients. Organ involvement in hemoblastosis was detected at autopsy in 8 out of 13 cases. Hence, the need in prolonged cardiovascular support of SS patients is associated with development of polyorgan involvement. Fibrinolysis suppression is a frequent early manifestation of hemostasis disorders. Specific neoplastic organ involvement was observed in 61.5% patients with hemoblastosis who died from SS and its complications.     

Cytomegaloviral virus infection in bone marrow transplantation recipients: strategies for prevention and treatment

Cytomegalovirus is major infectious pathogen following allogeneic bone marrow transplantation. In infected recipients, the virus is generally detected between 4 and 10 weeks after transplantation. Historically, CMV disease developed in 30–40% of seropositive recipients, the predominante manifestation being interstitial pneumonitis, which was generally lethal. Therapeutic interventions are discussed with special reference to the use of antiviral therapy for both treatment and prevention of CMV disease. The strategies developed in the bone marrow transplantation population to treat or prevent the development of CMV disease can be extrapolated to other patients groups who are immunosuppressed and at risk for developing clinical manifestations of CMV infection.Presented as an invited lecture at the 4th International Symposium: Supportive Care in Cancer, St. Gallen, Switzerland, 24–27 February 1993     

Clinical picture of tuberculosis with concomitant hemoblastoses

AIM: To study clinical symptoms, course and diagnosis of tuberculosis in patients with hemoblastosis (HB). MATERIAL AND METHODS: 79 patients with tuberculosis and HB were examined. HB was represented by lymphoproliferative diseases (n = 61), acute leukemia (n = 4), chronic myeloproliferative diseases (n = 14). RESULTS: Pulmonary tuberculosis was in 61 (77.2%) patients: in 46 with lymphoproliferative disease (LPD), 4 with acute leukemia (AL) and 11 with myeloproliferative disease(MPD). Generalized tuberculosis was detected in 8 (10.1%) patients (7 with LPD and 1 with MPD) and extrapulmonary tuberculosis was in 10 (12.7%) patients (8 with LPD and 2 with MPD). Infiltrative, disseminated and military tuberculosis of the lungs developed in 55.7, 6.6 and 1.6% HB patients. CONCLUSION: Persistent fever in HB patients may point to developing tuberculosis infection. Fever syndrome and intoxication in patients with HB remission may serve a diagnostic marker of tuberculosis.     

Effectiveness of plasmapheresis on the PF-0.5 blood separator in patients with paraproteinemic hemoblastoses

Plasmapheresis on a Soviet-made PF-0.5 blood cell separator was performed in 20 PPH patients (altogether 33 sessions of plasmapheresis). 1600 to 3300 ml of plasma were removed during one session. Rheopolyglucin was mainly used as plasma-substituting liquid. The procedure was well tolerated by all the patients. After plasmapheresis biochemical indices were within normal. In multiple myeloma paraprotein was decreased by 42%. Waldenstr?m's macroglobulinemia by 47%. Plasma viscosity was decreased 1.2- and 2-fold, respectively. The investigations showed a high efficacy and reliability of plasmapheresis with the help of the Soviet-made PF-0.5.