Hyperplastic Syndrome Research Articles

THE ROLE OF Β2-MICROGLOBULIN IN ASSESSING THE PROGRESSION OF B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA

Introduction. The primary assessment of β2-microglobulin holds significant value in monitoring the dynamics of oncohematological processes, which can serve as a crucial marker for evaluating the baseline condition of patients with B-cell chronic lymphocytic leukemia. Aim: to analyze the levels of β2-microglobulin in patients experiencing progression of B-cell chronic lymphocytic leukemia. Materials and methods. Twenty six patients with progressive B-cell chronic lymphocytic leukemia (CLL) were examined, comprising 12 males (46%) and 14 females (54%). These patients were designated as Group I. The control group (Group II) included 20 healthy individuals aged 23–43 years, consisting of 11 females (55%) and 9 males (45%). In Group I, disease staging was assessed using the Rai-Binet classification: stage II (B) was observed in 18 patients (69.2%), stage III (C) in 4 patients (15.4%), and stage IV (C) in 4 patients (15.4%). Among patients with progressive CLL, hyperplastic syndrome was evaluated, including lymph node enlargement (≥3 cm in diameter) and hepato- or splenomegaly (liver or spleen extending ≥5 cm below the costal margin). General and biochemical blood analyses were conducted, along with measurements of β2-microglobulin levels. Statistical methods were applied to process and analyze the data. Results. In patients with progression of B-cell chronic lymphocytic leukemia (CLL), hematological analysis revealed anemia (hemoglobin <100 g/L) in 6 patients (23.1%) and thrombocytopenia in 8 patients (30.7%). Leukocytosis with leukocyte levels >100 G/L was observed in 4 patients (15.4%) in Group I. Notably, an inverse correlation was identified between β2-microglobulin levels and hemoglobin levels (r = -0.52; p = 0.02). Biochemical analysis showed a reduction in total serum protein to grade 1 according to CTCAE in 2 patients (7.7%), elevated serum creatinine levels, reaching grade 1 according to CTCAE, were observed in 4 patients (15.4%) in Group I. An inverse correlation was found between β2-microglobulin levels and total serum protein levels (r = -0.44; p = 0.02). A direct correlation was also identified between β2-microglobulin levels and serum creatinine levels (r = 0.65; p = 0.04). In 9 (34.7%) patients of group I, the concentration of β2-microglobulin in blood serum exceeded the level of 5 mg/l. It is important that all 100% (9/9) of patients in this category were found to have hyperplastic syndrome. In addition, 33.3% (3/9) of patients had a combination of lymphadenopathy, splenomegaly, and hepatomegaly (liver +5 cm below the edge of the costal arch), 55.6% (5/9) had a combination of two factors, in 11, 1% (1/9) hyperplastic syndrome was characterized by an increase in the size of peripheral lymph nodes by more than 3 cm. The average level of β2-microglobulin was 6.24 mg/l in patients with progression of B-cell chronic lymphocytic leukemia of group I, of which 9 patients had a level of β2-microglobulin greater than 5 mg/l. Conclusion. The level of β2-microglobulin corresponds to the severity of progression of B-cell chronic lymphocytic leukemia and correlates with the level of anemia, hypoproteinemia, hypercreatinemia, and the severity of hyperplastic syndrome.

MANAGEMENT TACTICS OF PATIENTS WITH HYPERPLASTIC SYNDROME AND ANEMIA

Abstract. The study of this clinical case made it possible to demonstrate the effectiveness of the management tactics of a patient with hyperplastic syndrome and anemia using hormone therapy with Buserelin- Long (an agonist of Hh-RG) for six months, followed by an operative stage (uterine artery embolization). The patient had relief of chronic pelvic pain by the third month of treatment with Buserelin -Long. In the future, the patient did not have a resumption of pain syndrome. During the control examination of the patient six months after the start of treatment, positive dynamics in the treatment of the hyperplastic process was revealed, expressed in a decrease in the size of intramural myomatous nodes, the absence of recurrence of the endometrial hyperplastic process, relief of pain and abnormal uterine bleeding. At the initial treatment of the patient, clinical and laboratory data were revealed confirming her chronic posthemorrhagic iron deficiency anemia. The indicators of clinical and biochemical blood tests reached the limits of reference values during the control examination after 6 months of Buserelin –Long therapy, which indicates the effectiveness of this management tactic in patients with hyperplastic syndrome and anemia. No adverse reactions were detected during treatment. The patient noted the good tolerability of the drug as well as the rapid and effective relief of the manifestations of the disease. Thus, based on the study of this clinical case, we can conclude about the effectiveness of the proposed management tactics for a patient with hyperplastic syndrome and anemia and recommend the use of this type of therapy in patients with similar pathology.

Оценка факторов риска развития поражений печени у больных хронической лимфоцитарной лейкемией в динамике химиотерапии

Актуальность. Лечение В-клеточной хронической лимфоцитарной лейкемии (В-ХЛЛ) сопровождается риском развития поражений печени, что связано с факторами, которые зависят от особенностей пациента, опухоли, и химио­терапией (ХТ). Цель — оценить риск развития и характер нарушений печеночных тестов у больных В-ХЛЛ в динамике ХТ. Материалы и методы. Обследовано 76 больных В-ХЛЛ, из них 44 (57,9 %) мужчины и 32 (42,1 %) женщины. Средний возраст — (66,81 ± 12,50) года. Стадию В-ХЛЛ определяли по классификациям К. Rai (1975, 1987) и J. Binet (1981, 2006). Назначали ХТ по схеме FC (флударабин, циклофосфан). Обследование проводили перед ХТ и после двух курсов FC. Учитывали гиперпластический синдром, гиперлейкоцитоз. Оценивали показатели биохимического анализа крови. Использовали критерии Common Terminology Criteria for Adverse Events (CTCAE), Version 4.02. Результаты. Поздние стадии В-ХЛЛ, ІV по Rai и С по Binet, у больных В-ХЛЛ ассоциируются с ростом риска не получить ответы на ХТ (отношение рисков (RR) 0,53; 95% доверительный интервал (ДИ) 0,31–0,90; р < 0,05). Наличие гиперпластического синдрома сопровождается достоверным риском не достичь ответа на ХТ (RR 0,23; 95% ДИ 0,07–0,80; р < 0,05). Поражение печени чаще регистрируют у больных В-ХЛЛ в III стадии (RR 1,96; 95% ДИ 1,33–2,88; р < 0,05) и IV стадии (RR 2,13; 95% ДИ 1,47–3,08; р < 0,05) по сравнению со ІІ стадией по Rai. У больных В-ХЛЛ риск развития гепатотоксических реакций ассоциируется с низкой эффективностью ХТ, а именно достижением частичного ответа (RR 3,18; 95% ДI 1,93–5,22; р < 0,05) и отсутствием ответа на ХТ (RR 3,71; 95% ДI 2,37–5,81; р < 0,05). Выводы. Риск возникновения поражений печени возрастает у больных В-ХЛЛ IV (С) стадии и ассоциируется с низкой эффективностью ХТ.

229. A call to “Own the Bone”: osteoporosis is a predictor for two-year outcomes after adult spinal deformity surgery

BACKGROUND CONTEXT Osteoporosis (OP) is a common condition affecting nearly 200 million individuals globally. Similarly, adult spinal deformity has a peak prevalence of 65% of the adult population. While bone health is instrumental in orthopaedic surgery, few studies have described the long-term outcomes of osteoporosis following surgery for ASD. PURPOSE We sought to evaluate the impact of OP on two-year postoperative complication rates when compared to patients without OP. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Utilizing the New York State Statewide Planning and Research Cooperative System (SPARCS), we identified all patients who underwent ≥4-level fusion with ICD-9 codes diagnostic for ASD (progressive idiopathic scoliosis and degenerative lumbar disease) from 2009-2011 with ≥2-year follow-up. Patients with osteoporosis (OP) and without OR were identified following exclusions. OUTCOME MEASURES Patient demographics, hospital-related parameters, postoperative complications and reoperations. METHODS Using SPARCS, we identified all patients who underwent ≥4-level fusion with ICD-9 codes diagnostic for ASD (progressive idiopathic scoliosis and degenerative lumbar disease) from 2009-2011 for ≥2-year minimum follow-up. Patients with osteoporosis (OP) and without OP were identified. Any patients with bone mineralization disorders (osteomalacia, rickets, hyperparathyroidism [primary, secondary, tertiary], vitamin D deficiency) and other systemic (fibrous dysplasia, sickle cell disease, renal osteodystrophy) and endocrine disorders (thyroid hypo- or hyperfunctioning disorders, adrenal insufficiency, adrenal hyperplastic syndromes) affecting bone quality or production were excluded, as were patients with surgical indications of trauma, systemic disease, infection, or cancer. The two cohorts were compared for demographics, hospital-related parameters, and 2-year postoperative complications and reoperations. Multivariate binary stepwise logistic regressions was utilized to identify significant predictors of these outcomes (covariates: OP, age, sex, race, and Charlson/Deyo). RESULTS A total of 6,132 patients were identified (OP, n=490 (7.99%); No-OP, n=5,642). OP patients were older (67.6 vs 56.7 years), more often female (83.7% vs 46.2%) and white (84.3% vs 79.1%), and had higher comorbidity scores (Charlson/Deyo: 0.72 vs 0.61), all p CONCLUSIONS Osteoporosis was associated with two-year postoperative complications in ASD patients. Aside from being an etiology of ASD due to vertebral fracture, osteoporosis should be considered as a comorbidity that needs to be optimized and managed perioperatively. Furthermore, this data is a call to every spine surgeon to consider metabolic bone disorders screening prior to any spinal deformity surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Classification and Clinical Implications of Precancerous Lesions in the Stomach

During carcinogenesis, precancers (premalignant lesions) are the morphologically identifiable lesions that precede invasive cancers. In theory, the successful treatment of precancers would result in the eradication of most human cancers. Despite the importance of these lesions, there has been no effort to list and classify all of the precancers. In 2001, the NCI sponsored a workshop on the classification of precancers. When considering all the possible classes of precancers, it is worth noting that not all precancers are neoplastic. In fact, precancers need not progress to cancer, and precancerous lesions often have a high rate of regression. Thus, the following five classes were adopted: 1) acquired microscopic precancers; 2) acquired large lesions with microscopic atypia; 3) Precursor lesions occurring with inherited hyperplastic syndromes that progress to cancer; 4) acquired diffuse hyperplasias and diffuse metaplasias; and 5) currently unclassified entities. In this review paper, precancerous lesions of the stomach are classified and their clinical significance is described.