Splenic lymphoma with villous lymphocytes: case report

We present the case of malignant Non-Hodgkin splenic lymphoma with villous lymphocytes regarded as atypical chronic lymphoid leukemia. This was a 62 years old male patient admitted in the Haematologic Department of Brazzaville Teaching Hospital for an enlarged spleen, anaemia and lymphocytosis. The initial abdominal CT noticed a homogenous splenomegaly and a large retroperitoneal tumour mass measuring 148 X 101mm. The initial count blood cell revealed a lymphocytosis with a lymphocyte count at 82 Giga/l, severe anaemia with a haemoglobin rate at 4.2g/dl, platelet count at 68 Giga/l. Peripheral smear examination showed irregular lymphoid cells with a homogenous distribution, condensed chromatin corresponding to villous lymphocytes. Immunophenotyping showed B lymphoid monotypic population cells positive for CD19, CD 20, and FMC7, moderately positive for CD23 and negative for CD5, CD43 and CD 79b. Therapeutically, combination chemotherapy RCVAD (Rituximab, Vincristin, Daunorubicin, Dexamethasone) give good clinical and haematological response. This report illustrates the need for excellent interdisciplinary collaboration and the interest of the cytology and immunophenotyping in the lymphoid proliferation management

Approaches to the assessment of comorbidity of patients with atherosclerosis of brachiocephalic vessels

The article presents the results of a study of comorbidity of patients with atherosclerosis of the brachiocephalic vessels in dependence of the degree of the stenotic lesion. The results of the assessment of comorbidity indices of comorbidity and rating scales mentioned the above help to conduct assessment of comorbidity and to determine the further prognosis. Patients with unstable atherosclerotic plaques (2,3 and 5 group DAN) have higher rates of comorbidity that requires more careful monitoring and correction further treatment. Correlation analysis showed the existence of dependence of different strength between the all indices. There is a need to create a universal indicator that would help to assess comorbidity of patients with atherosclerosis of BCA for practicing doctors.В статье представлены результаты изучения коморбидности у больных атеросклерозом брахиоцефальных сосудов с разной степенью стенотического поражения. Среди 500 пациентов, находившихся на диспансерном наблюдении у ангионевролога, включено в исследование 100 пациентов с атеросклеротическим поражением брахиоцефальных сосудов и коморбидными заболеваниями. Полученные результаты оценки коморбидности с помощью индексов и оценочных шкал: Система Cumulative Illness Rating Scale (CIRS), Индекс Kaplan-Feinstein (K-F), Индекс Charlson, Индекс коморбидности (ИК), позволили провести комплексную оценку состояния больных и определить дальнейший прогноз течения заболевания. У пациентов с нестабильными атеросклеротическими бляшками (2,3 и 5 группа Динамического Ангионеврологического Наблюдения (ДАН)) выявлены более высокие показатели коморбидности, что требует тщательного наблюдения и коррекции сопутствующей патологии. Существует необходимость создания универсального показателя, который помог бы оценить коморбидность пациентов с атеросклерозом брахиоцефальных сосудов практикующим врачам для контроля сопутствующей патологии, создающей дополнительные риски для больного

ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ БОЛЬНЫХ ДЕСТРУКТИВНЫМ ТУБЕРКУЛЕЗОМ ЛЕГКИХ ПРИ ПАРЕНТЕРАЛЬНОМ И ПЕРОРАЛЬНОМ ПРИМЕНЕНИИ ПРОТИВОТУБЕРКУЛЕЗНЫХ ПРЕПАРАТОВ

Summary. The article contains results of a randomized clinical trial involved 120 patients with cavitating pulmonary tuberculosis. The patients were administered anti-tuberculosis drugs by different routes with the focus on parenteral (lymphotropic and intravenous) administration. The benefit of parenteral administration has been validated as sputum conversion was achieved and lung cavities disappeared much more often including patients with primary drug resistance in comparison to those treated with oral single or combined anti-tuberculosis drugs. The rates of adverse events did not differ significantly in parenteral and oral route of the drug administration. Recommendations have been made on parenteral (lymphotropic and intravenous) administration of anti-tuberculosis drugs in first-diagnosed cavitating pulmonary tuberculosis with high risk of drug resistance of the pathogen.Резюме. В статье приводятся данные рандомизированого клинического исследования 120 больных деструктивным туберкулезом легких при различных методах введения противотуберкулезных препаратов. Особое внимание уделено парентеральному (лимфотропному и внутривенному) введению лекарственных средств. Отмечено и обосновано преимущество парентерального введения противотуберкулезных препаратов, что позволяет в абсолютно большем проценте случаев добиться прекращения выделения микобактерий туберкулеза, в т. ч. у больных с первичной лекарственной устойчивостью, и закрытия каверн в легких, по сравнению с больными, получающими перорально раздельные или комбинированные противотуберкулезные препараты. При этом установлено, что частота побочных реакций при парентеральном методе не имеет существенной разницы по сравнению с пероральным. Приведены рекомендации по парентеральному (лимфотропному и внутривенному) введению противотуберкулезных препаратов у впервые выявленных больных деструктивным туберкулезом легких с высоким уровнем развития лекарственной устойчивости возбудителя

Outcomes and mutational analysis of patients with lower-risk non-del5q myelodysplastic syndrome treated with antithymocyte globulin with or without ciclosporine A

International audienceImmunosuppressive treatment is a disease-modifying therapy for lower-risk myelodysplastic syndromes (MDS). However, IST is relatively rarely used and long-term outcomes of patients are seldom reported. We retrospectively studied outcomes of 20 patients with lower-risk non del 5q MDS with transfusion dependency, with horse or rabbit antithymocyte globulin ± ciclosporine A, and frontline eltrombopag in two of them. IPSS-R was low, intermediate and high in 30%, 55% and 10% of the patients, respectively. Fifty-five percent of the patients had hypocellular bone marrow (BM). Baseline mutations were detected in 31.5% of the patients and were more frequent in patients with normo/hypercellular MDS than in patients with hypocellular MDS. Transfusion independence rate for both red blood cells (RBC) and platelets was achieved in 45% of patients. RBC transfusion duration ≤6 months, B-cell counts >0.2 G/L and, marginally, BM blasts ≤2% were associated with higher transfusion independence rate. Age and cellularity did not influence the response rate. Median transfusion independence duration was 53 months. Cumulative incidence of progression to a more aggressive myeloid disease was 0 in patients without baseline mutations and 33% in patients with baseline mutations (P = .008). Median progression-free and overall survival after treatment onset and median overall survival after loss of transfusion independence were 45.5 months, 68 months and not reached, respectively. In conclusion, antithymocyte globulin ± ciclosporine A results in durable responses in MDS, irrespective of age, in patients with lower-risk disease without B-cell lymphopenia and treated early in the course of the disease