Clinical implications of monosomy 7 in acute nonlymphocytic leukemia

A group of 18 patients with acute nonlymphocytic leukemia and the chromosomal aberration monosomy 7 in their bone marrow cells was compared to a group of control patients with the same disease but normal bone marrow chromosomes. The monosomy 7 group of patients had a higher incidence of fever and infections, and a higher white blood cell and granulocyte count compared to the control group at the time of diagnosis. The clinical difference between the groups continued over the first month of hospitalization. Complete remission was obtained in 12% of the monosomy 7 group and in 59% of the control group. Survival was clearly longer in the control group of patients. Monosomy 7 of the bone marrow in acute nonlymphocytic leukemia is therefore to be considered a bad prognostic sign.     

Cytogenetic and clinical investigations in 76 cases with therapy-related leukemia and myelodysplastic syndrome

Clinical, cytomorphologic, and cytogenetic investigations were carried out in a series of 76 secondary MDS and ANLL. Chromosome abnormalities were more frequent in patients with a history of multiple myeloma or macroglobulinemia (92%) and myeloproliferative disorders (82%) than in patients with previous breast cancer (40%). The secondary hematologic malignancies were mostly a trilineage bone marrow disorder. The most commonly found cytogenetic anomaly was monosomy 7, followed by total or partial loss of chromosome 5. In addition six other chromosomes, i.e., chromosome 3, 8, 9, 12, 17, and 21 seemed to be consistently involved in the pathogenetic mechanisms of secondary leukemia and MDS.     

Simultaneous occurrence of 5q− and 21q− in refractory anemia with thrombocytosis

A 40-yr-old female with refractory anemia and thrombocytosis was shown to possess 5q? and 21q? chromosomal anomalies in the hematopoietic cells. The former anomaly was demonstrated to be a del(5)(q14q32) and the latter to be due to a t(11;21)(q25;q21). A similar translocation was shown to exist in the cells of another patient with essential thrombocytosis. Thus, we tentatively identify the 21q? as being due to a t(11;21).     

Behavior in simulated body fluid of calcium phosphate coatings obtained by laser ablation

Three types of calcium phosphate coatings onto titanium alloy substrates, deposited by the laser ablation technique, were immersed in a simulated body fluid in order to determine their behavior in conditions similar to the human blood plasma. Neither the hydroxyapatite coating nor the amorphous calcium phosphate coating do dissolve and the alpha-tricalcium phosphate phase of the coating of beta-tricalcium phosphate with minor alpha phase slightly dissolves. Precipitation of an apatitic phase is favored onto the hydroxyapatite coating and onto the coating of beta-tricalcium phosphate with minor alpha phase. Onto the titanium alloy substrate reference there is also precipitation but at larger induction times. However, onto the amorphous calcium phosphate coating no precipitate is formed.     

Chronic myeloid leukemia and interferon-alpha: a study of complete cytogenetic responders.

Achieving a complete cytogenetic response (CCgR) is a major target in the treatment of chronic myeloid leukemia (CML) with interferon-alpha (IFN-alpha), but CCgRs are rare. The mean CCgR rate is 13%, in a range of 5% to 33%. A collaborative study of 9 European Union countries has led to the collection of data on 317 patients who were first seen between 1983 and 1997 and achieved CCgRs with IFN-alpha alone or in combination with hydroxyurea. The median time to first CCgR was 19 months (95% CI, 17-21; range, 3-84 months). At last contact, 212 patients were still alive and in continuous CCgR; 105 patients had lost CCgR, but 53% of them were still alive and in chronic phase. IFN-alpha treatment was discontinued permanently in 23 cases for response loss, in 36 cases for chronic toxicity (15 are still in unmaintained continuous CCgR), and in 8 cases because it was believed that treatment was no longer necessary (7 of these 8 patients are still in unmaintained continuous CCgR). The 10-year survival rate from first CCgR is 72% (95% CI, 62%-82%) and is related to the risk profile. High-risk patients lost CCgR more frequently and more rapidly and none survived more than 10 years. Low-risk patients survived much longer (10-year survival probability 89% for Sokal low risk and 81% for Euro low risk). These data point out that a substantial long-term survival in CCgRs is restricted mainly to low-risk and possibly intermediate-risk patients and occurs significantly less often in high-risk patients.     

Discharge planning for complex patients in Spain: the patient/family point of view and teamworking role

The healthcare system is designed to respond to acute care needs and it is an “inappropriate organization” for patients who do not suffer from acute illnesses. The care of chronically ill patients is complex for several reasons: involvement of multiple health professionals, exacerbations over time, presence of co-morbidities, social support needs, etc. The act of discharge is a vital element in continued care process for the patient and it is useful to synthesize all available information. The discharge plan must be prepared from the time of hospital admission and in complex cases a coordinator is required; the case manager. In Spain, there are no widespread-specific programs to improve the discharge process for complex patients. According to available resources and needs there are different programs: Pre-Alt program (to optimize the administrative circuits), liaison nurse, hospital at home, specialized support teams, integrated care services or technology-based discharge support. The optimization of the discharge process is closely related to the health professionals’ working way and teamwork is absolutely essential. Non-technical skills are essential for teamwork. The team must be incorporated values, such as the critical review of procedures, the acceptance of errors (and subsequent learning process), negotiation in cases of discrepancies, etc. Therefore, health organizations should seek out spaces (physical and temporal) so that inter-professional teams could deal with the emotional side of clinical practice (fears, losses, pain, distress and adversity) in order to achieve maximum professional efficiency and efficacy.     

Elliptocytosis and schistocytosis in myelodysplasia: report of two cases

Marked elliptocytosis and schistocytosis are described as unusual manifestations of haematopoietic dysplasia in two patients. The first patient, whose history was negative for inherited haemolytic anaemias, presented these prominent features on his first admission; 22 months later he developed an acute myeloblastic leukaemia. In the second patient, followed since 4 years for an autoimmune thrombocytopenic purpura, elliptocytosis and schistocytosis appeared 17 months before a pancytopenia established. The patient is now on follow-up and is treated for a refractory anaemia. In both cases bone marrow examinations revealed the typical criteria for myelodysplasia and this diagnosis was confirmed by cytogenetic analysis.     

Postoperative mortality after surgery for inflammatory bowel disease in the era of biological agents: A population-based study in Southern Europe

Background: Despite the efficacy of biological agents, surgery is still required for a large percentage of patients with inflammatory bowel disease (IBD).AimsTo assess the postoperative mortality rates and associated risk factors in IBD patients in a population-based setting in the era of biological agents.MethodsThis is a population-based longitudinal study including all patients diagnosed with IBD in Catalonia who underwent intestinal resection or colectomy between 2007 and 2016, identified from the Catalan Health Surveillance System database. Logistic regression was used to calculate the adjusted odds ratio for postoperative in-hospital and 30-day mortality. Data for Crohn's disease (CD) and ulcerative colitis (UC) were analysed separately.ResultsA total of 1,660 interventions for CD (69%) and 738 for UC (31%) were performed at 55 centres. In-hospital and 30-day postoperative mortality rates were 2.1% and 2.5% for CD, and 5.4% and 6.4% for UC, respectively. In the multivariate logistic regression analysis, comorbidity was associated with in-hospital and 30-day postoperative mortality in CD and UC, whereas age was only associated with mortality in CD and a non-laparoscopic surgical approach with UC.ConclusionsIn the era of biologicals, the postoperative mortality rate for IBD depends mostly on co-morbidities and age.