Clinicomorphological characteristics of Sezary's disease and mycosis fungoides

AIM: To try a combined approach to the study of clinicomorphological and immunophenotypical characteristics of primary cutaneous T-cell lymphomas. MATERIAL AND METHODS: Clinical, histological, genotypic and immunophenotypical parameters were studied in 7 patients (4 male and 3 female, mean age 53.1 +/- 7.8%) with Sezary's disease (SD) and 10 patients (6 male, 4 female, mean age 54.0 +/- 4.0 years) with mycosis fungoides (MF) treated in Hematological Research Center in 1998-2004. RESULTS: Six of seven SD patients had SD stage IV with leukemization, Sezary's cells were found in peripheral blood. Bone marrow and lymph nodes involvement was observed in 5 patients. Morphological signs of transformation into lymphosarcoma were detected in three patients. Skin samples of all the patients showed epidermotropism with lymphoid infiltration of the derma and skin appendages. All the patients had clonal rearrangement of T-cell receptor by gamma-chain. Immunophenotyping (IPT) detected T-cell markers CD45RO, CD43, CD3, CD4 on lymphoid cells. IPT of peripheral blood lymphoid cells was typical for SD in 3 patients. Low density of CD4 and CD2, CD4 and CD5, the presence of CD7 were registered in 1 patient each. The disease history was 3.4 +/- 0.7 years. A lethal outcome was related with septic complications after polychemotherapy. MF history in 10 patients was 10.9 +/- 2.1 years. Stages III and IV were diagnosed in 2 of 10 patients. All the patients had typical pathohistological changes. Polymerase chain reaction test detected clone by rearrangement of gamma-chain of T-cell receptor. In 2 patients IPT detected CD4 absence in the presence of CD8 and CD7. The aberrant clone typical for NK-cells was detected in one case. Two patients died of the disease progression after 7 and 20 years of MF. CONCLUSION: Multiple tests help early diagnosis and conduction of optimal therapy for cutaneous T-cell lymphomas.     

Domestic 1.44 mcm Nd:YAG laser in combined treatment of dacryocystitis complicated by abscess formation

We have treated 12 patients with acute dacryocystitis complicated by abscess formation. All the patients were examined by an ophthalmologist and otolaryngologist. The patients received intravenous antibiotics followed by Nd:YAG laser dacryocystorhinostomy via transcanalicular approach under the endonasal endoscopic control. The treatment resulted in resolution of symptoms and signs of acute dacryocystitis complicated by abscess formation in all the patients. No recurrence of acute dacryocystitis occurred during the median follow-up period of 11 months. Ostium patency defined as the absence of epiphora and observation of irrigated lacrimal fluorescein at the ostium was achieved in 9 patients. Epiphora recurred in 3 cases. Use of Nd:YAG laser reduces the duration of the operation and provides maximal functional and cosmetic results.     

Antiretroviral therapy of acute HIV-infection

AIM: To study efficacy of a short course of highly active antiretroviral therapy (HAART). MATERIAL AND METHODS: Acute HIV infection was verified in 16 infected subjected basing either on seroconversion (by immunoblotting) or a documented negative result 6-12 months before registration of a positive result for HIV antibodies. RESULTS: HAART was given to 12 patients (combivir + nevirapin). The number of CD+ lymphocytes (by median) 1 month after the treatment increased by 185 cells/mcl, 3 months after the treatment--by 215 cells/mcl. After 1-month therapy viral load (median) diminished by 2.02 log10 copy/ml, after 3 months--by 2.31 log10 copy/ml. 71% patients had HIV RNA under 400 copy/ml. Untreated patients showed changes neither in CD4+ lymphocytes number nor in viral load. The study continues. CONCLUSION: HAART is used at the stage of acute infection in the presence of psychic trauma provoked by establishment of HIV-infection diagnosis. Therefore, it is necessary to consult the patients for preparing them for treatment and to maintain compliance.     

Secondary diseases in patients with HIV infection: 15-year follow-up

AIM: To analyse the results of a 15-year study of opportunistic diseases in AIDS patients. MATERIAL AND METHODS: The spectrum of opportunistic diseases were made in AIDS patients in respect to clinical, laboratory and autopsy data for the periods: 1987-1992 (n = 27, 25 deaths--92.6%), 1993-1997 (n = 95, 58 deaths--61.8%), 1998-1999 (n = 70, 28 deaths--40%), 2000-2001 (n = 126, 31 deaths--24.6%), 2002 (n = 80, 32 deaths--40%). RESULTS: The spectrum of opportunistic diseases in AIDS patients was determined for the above time periods and causes underlying these diseases have been determined. CONCLUSION: Among opportunistic diseases associated with HIV infections most prevalent were the following: tuberculosis, cytomegaloviral infections, cerebral toxoplasmosis. Leading modern trends were identified: increasing morbidity of AIDS, tuberculosis, new AIDS cases at late stages with severe opportunistic diseases (2/3 of deaths).     

Effect of Cryopreservation on Semen Sample

There are varied indications of preserving a semen sample for utilization at a later day. However, the freeze-thaw cycle is bound to impart deleterious effect on the fertilizing potential of the sample. 60 semen samples divided into three groups were preserved in this study. On subsequent thawing, after three months it was seen that the yield varied between 66% to 72%. The post thaw percent yield bears a linear relationship with the pre-freeze quality. 5 pregnancies were achieved in the study testifying the preservation of fertilizing ability of the thawed samples. Sub normal semen samples which might be otherwise acceptable in a therapeutic insemination, do not withstand freezing.Key Words: Cryopreservation, Semen     

Effect of short-term Psychiatric Intervention in Cancer Patients

A total of 50 patients undergoing cancer treatment at Malignant Disease Treatment Centre were included in the present study aimed at evaluating the psychological status of cancer patients. All patients filled a specially designed proforma and the following psychological questionnaires : General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, PGI General Well-being Scale and Quality of Life Scale. Analysis of the results showed that 22 (44%) of the cancer patients had psychiatric disorders and this number had reduced to 12 (24%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating Scale for depression. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in cancer patients.Key Words: Cancer, Depression, Psychiatric morbidity     

Laparoscopic Management of Adnexal Masses

Retrospective study of 121 cases of adnexal masses which were managed laparoscopically was carried out. The aim of study was to evaluate the safety and effectiveness of laparoscopic management of adnexal masses. In 120 cases, procedure was completed safely with minimum morbidity. In one case laparotomy had to be done to complete the procedure. In 76 cases cystectomy was done, 26 required salpingo-oophorectomy and 19 required only salpingectomy. Histologic evaluation revealed 30 functional cysts, 36 endometriotic cysts, 11 dermoids, 9 serous cystadenomas, 3 mucinous cystadenomas, 11 parovarian cysts, 19 cases of hydrosalpinx and 2 cases of tuberculosis.Key Words: Adnexal mass, Laparoscopy, Ovarian cyst