Czynniki ryzyka inkontynencji i epidemiologia nietrzymania moczu

Autorzy scharakteryzowali czynniki powodujące występowanie nietrzymania moczu, podkreślili ich interferencyjne działanie przyczynowe. Szczegółowo zostały omówione takie czynniki jak czynniki predysponujące: płeć, rasa, czynniki genetyczne, anatomiczne, neurologiczne, związane z tkanką łączną, kulturowe, środowiskowe. Przedstawiono znaczenie czynników promujących: otyłość, wykonywany zawód, rekreacja, przebyte operacje, palenie papierosów, przewlekły kaszel, zakażenia dróg moczowych, nieregularne miesiączkowanie, polekowe, dietetyczne, menopauza, oraz czynników dekompensacyjne: wiek, demencja, niedorozwój umysłowy, inne schorzenia, działanie leków, czynniki środowiskowe.The authors have discussed the factors causing urinary incontinence and emphasised their interferential activity. Such pre-disposing factors as: sex, race, genetics, anatomy, neurology, connective tissue issues, cultural and environmental background have been discussed in detail. The significance of the following promoting factors has been presented: obesity, occupation, recreation, surgeries undergone, smoking, chronic cough, urinary tract infections, irregular menstruation, medication effects, diet, menopause, and decompensation factors (age, dementia, mental handicap, other diseases, medication effects, and environmental factors)

Zaburzenia czynności dolnych dróg moczowych u kobiet

Autorzy przedstawili krótki rys historyczny tworzenia i ewolucji definicji niedotrzymania moczu. Scharakteryzowali kliniczne postacie niedotrzymania moczu u kobiet: wysiłkowe nietrzymanie moczu, naglące nietrzymanie moczu, nietrzymanie moczu z przepełnienia, nietrzymanie moczu pozazwieraczowe.The authors have presented a concise historical overview of the origin and evolution of urinary incontinence. They have characterised the clinical forms of urinary incontinence in women: stress incontinence, urge incontinence, overflow incontinence, extra-urethral incontinence

Niedotrzymanie moczu : wprowadzenie do diagnostyki

Autorzy przedstawili rys historyczny badań urodynamicznych, podkreślili znaczenie dobrze zebranego wywiadzie diagnostyce zaburzeń czynnościowych dolnych dróg moczowych. Scharakteryzowali poszczególne składowe postępowania wstępnego. Przypomnieli o istnieniu szeregu kwestionariuszy np. ICIQ-SF, UDI 6SF, Gaudenza, MESA pomocnych w szczegółowej ocenie zaburzeń.The authors have presented the historical background of urodynamic tests and emphasised the significance of wellcollected medical history to the diagnostics of lower urinary tract functional disorders. They have characterised the initial treatment. They pointed out the helpfulness of the questionnaires to be used: ICIQ-SF, UDI 6SF, the Gaudenz Questionnaire, MESA etc

Niedotrzymanie moczu : badanie laboratoryjne i czynnościowe

Autorzy dokonali szczegółowej analizy badań laboratoryjnych i czynnościowych służących diagnostyce nietrzymania moczu. Omówili szczegółowo m.in. Bridge Fluid Test, test kaszlowy, próbę Sanda, test podpaskowy. Jeszcze jednym niezwykle użytecznym narzędziem umożliwiającym ocenę zaburzeń jest dzienniczek mikcji. Dzienniczek mikcji jest szczególnie przydatny w ocenie poliurii (nadmiernej produkcji moczu) oraz nocnej poliurii (nadmiernej produkcji moczu podczas spoczynku nocnego). Autorzy zwrócili uwagę na zasadnicze elementy prawidłowego prowadzenia dzienniczka. Dokonano także omówienia wybranych badań urodynamicznych.The authors have performed a thorough analysis of laboratory and functional examinations used in the diagnostics of urinary incontinence. They have discussed in detail the Bridge Fluid Test, cough test, Sand’s test, pad test, etc. Yet another tool that is very useful in assessing the disorders is a micturition diary. This diary is especially helpful in diagnosing polyuria (excessive urine production) and night polyuria (excessive urine production during sleep). The authors have emphasised the basic elements of keeping such a diary. Furthermore, selected urodynamic tests have been discussed at length

Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia

Background: chronic lymphocytic leukemia (CLL) primarily affects older persons who often have coexisting conditions in addition to disease-related immunosuppression and myelosuppression. We conducted an international, open-label, randomized phase 3 trial to compare two oral agents, ibrutinib and chlorambucil, in previously untreated older patients with CLL or small lymphocytic lymphoma. Methods: we randomly assigned 269 previously untreated patients who were 65 years of age or older and had CLL or small lymphocytic lymphoma to receive ibrutinib or chlorambucil. The primary end point was progression-free survival as assessed by an independent review committee. Results: the median age of the patients was 73 years. During a median follow-up period of 18.4 months, ibrutinib resulted in significantly longer progression-free survival than did chlorambucil (median, not reached vs. 18.9 months), with a risk of progression or death that was 84% lower with ibrutinib than that with chlorambucil (hazard ratio, 0.16; P<0.001). Ibrutinib significantly prolonged overall survival; the estimated survival rate at 24 months was 98% with ibrutinib versus 85% with chlorambucil, with a relative risk of death that was 84% lower in the ibrutinib group than in the chlorambucil group (hazard ratio, 0.16; P=0.001). The overall response rate was higher with ibrutinib than with chlorambucil (86% vs. 35%, P<0.001). The rates of sustained increases from baseline values in the hemoglobin and platelet levels were higher with ibrutinib. Adverse events of any grade that occurred in at least 20% of the patients receiving ibrutinib included diarrhea, fatigue, cough, and nausea; adverse events occurring in at least 20% of those receiving chlorambucil included nausea, fatigue, neutropenia, anemia, and vomiting. In the ibrutinib group, four patients had a grade 3 hemorrhage and one had a grade 4 hemorrhage. A total of 87% of the patients in the ibrutinib group are continuing to take ibrutinib. Conclusions: ibrutinib was superior to chlorambucil in previously untreated patients with CLL or small lymphocytic lymphoma, as assessed by progression-free survival, overall survival, response rate, and improvement in hematologic variables. (Funded by Pharmacyclics and others; RESONATE-2 ClinicalTrials.gov number, NCT01722487.)

Informative Value of Combination of Molecular Genetic and Cytogenetic Diagnostic Methods in Myelofibrosis

Introduction. Myelofibrosis is a rare disease affecting myeloid progenitor stem cells. According to the modern criteria of myelofibrosis diagnostics, the confirmation of the clonality of pathological myeloproliferative process is needed. However, the unique pathognomonic marker for this disease is not revealed. Point missense mutation of JAK2 gene in exon 12 – the JAK2V617F mutation, and karyotype abnormalities are the most frequently found in myelofibrosis patients. In case of additional anomalies the disease prognosis worsens dramatically, in particular, because of higher risk of the transformation to acute leukemia. The purpose of the study was to identify informative combination of molecular genetic and cytogenetic clonal markers for diagnosis and prognosis of myelofibrosis. Materials and research methods. 37 patients were recruited in the study (33 with primary myelofibrosis and 4 with secondary post-polycythemia vera myelofibrosis). Cytogenetic studies were performed for 34 patients. All the patients underwent molecular genetic studies of blood to detect the JAK2V167F mutation. The mutational status of JAK2 gene was reexamined in 10 patients from 1 to 2 years after the initial examination. Results of the investigation and their discussion. The presence of the mutation JAK2V167F was confirmed in 59.5 % of the patients. Chromosomal abnormalities were revealed in 38.2 % of patients. The spectrum of abnormalities included deletions and translocations of chromosome 1, deletions of 5q and 20q, trisomies of chromosomes 3, 8, 9 and 12, monosomies of chromosomes 3, 5, 7, 9, 11, 13, 15 and 17, appearance of іsochromosome 17q, and polyploidy. 4 patients had a complex karyotype. The coincidence of investigated point mutation and karyotype abnormalities was revealed in the total of 8 (21.6 %) patients. The presence of the mutant allele V617F was associated with higher frequency of cytogenetical abnormalities. The complete molecular response to the therapy with hydroxyurea and interferon-α was not achieved in any of the 10 patients who underwent the molecular genetic reexamination. The overall mortality of the patients with JAK2V167F mutation was 27.3 % in 24 months. In the absence of the mutation the mortality rate was slightly lower and constituted 20. 0%. Сytogenetic abnormalities were the only detected clonal markers that allowed to confirm the chronic myeloproliferative process in 13.5 % of patients. Conclusions. Simultaneous cytogenetic analysis and the identification of JAK2V167F mutation increased the rate of clonal confirmation of the pathological process in myelofibrosis patients to 73.0 %, in contrast to 38.2–59.5 % using only one method of investigation. The presence of such cytogenetic anomalies as polyploidy and trisomy of chromosome 9 could result in increase of the copy number of JAK2 gene mutant alleles in pathological cells. The patients having both no detectable level of “wild type” allele of JAK2 gene and considerable quantity of lymphocytes in the blood, could possibly be of higher risk of further transformation of myelofibrosis to acute lymphoid, and not only myeloid leukemia

Chronic Lymphocytic Leukemia in Elderly Patients: Own Experience

Introduction. The annual incidence rate of chronic lymphocytic leukemia (CLL) in Europe is 1­4 per 100 000 population. The disease is more common in older patients. For many years treatment of CLL included single­agent chlorambucil or cyclophosphamide, later ­ a combination of vincristine, cyclophosphamide, prednisolone (COP) alone or with addition of doxorubicin (CHOP) was used. In recent years, the arsenal of antileukemic agents has expanded significantly (fludarabine, cladribine, bendamustine, rituximab and others), a combination of these me­ dications provides a high percentage of complete remissions, but because of its immunosuppressive effect, this treatment cannot be used in all patients. In particular, in patients with comorbidities and older patients. Therefore a considerable attention has been recently paid to the management of the older patients with CLL. The purpose of the study was to analyze the timeliness of CLL diagnosis and management of elderly patients according to data of the Consultative Polyclinics of SI “Institute of Blood Pathology and Transfusion Medicine NAMS of Ukraine”. Results and discussion. 114 CLL patients aged from 61 to 86 were recruited in the study. More than 1/3 of patients were diagnosed with CLL in the late stages of the disease course (III­IV Rai stage), which emphasizes the insufficient wariness for hematological disorders among family doctors and other medical specialists. Results of 2­20 years long observation show that the majority of the patients whose diagnosis was made on early stage (0­I Rai stage) are well and do not require treatment. Indications for initiation of treatment in elderly patients are the same as in younger ones. Short cycles of treatment with chlorambucil in patients aged 66­82 years result in partial remission with good patient condition and satisfactory quality of life with chlorambucil maintenance therapy dura­ tion from 24 to 132 months (at the time this publication was prepared). More aggressive therapy (bendamustine + rituximab and fludarabine + cyclophosphamide) in patients aged 66­79 years is more efficient in terms of obtaining complete remission, but is more toxic and can be used in elderly patients who underwent comprehensive geriatric assessment with preserved renal function and absence of comorbidities. Conclusions. Chlorambucil alone or combined with prednisone should be considered for the first­line therapy of CLL in elderly patients. More aggressive therapies (FC, BR regimens) should be applied at disease progression as treatment of the second line

Single‐agent ibrutinib versus chemoimmunotherapy regimens for treatment‐naïve patients with chronic lymphocytic leukemia: A cross‐trial comparison of phase 3 studies

Chemoimmunotherapy (CIT) and targeted therapy with single‐agent ibrutinib are both recommended first‐line treatments for chronic lymphocytic leukemia (CLL), although their outcomes have not been directly compared. Using ibrutinib data from the RESONATE‐2 (PCYC‐1115/1116) study conducted in patients ≥65 years without del(17p), we performed a cross‐trial comparison with CIT data from published phase 3 studies in first‐line treatment of CLL. Progression‐free survival (PFS), overall survival (OS), and safety data for ibrutinib (median follow‐up 35.7 months) were evaluated alongside available CIT data. CIT regimens included: fludarabine + cyclophosphamide + rituximab (CLL8, CLL10), bendamustine + rituximab (CLL10), obinutuzumab + chlorambucil and rituximab + chlorambucil (CLL11), and ofatumumab + chlorambucil (COMPLEMENT‐1). Median age across studies was 61‐74 years, with older populations receiving ibrutinib, obinutuzumab + chlorambucil, or rituximab + chlorambucil. Median follow‐up varied across studies/regimens (range 14.5‐37.4 months). Among all patients, PFS appeared longer with ibrutinib relative to CIT and OS appeared comparable. Relative to CIT studies that similarly excluded patients with del(17p) (CLL10) or enrolled older/less‐fit patients (CLL11), PFS appeared favorable for ibrutinib in high‐risk subgroups, including advanced disease, bulky lymph nodes, unmutated IGHV status, and presence of del(11q). Grade ≥ 3 infections ranged from 9% (ofatumumab + chlorambucil) to 40% (fludarabine + cyclophosphamide + rituximab), and was 25% with ibrutinib. Grade ≥ 3 neutropenia was 12% for ibrutinib and 26%‐84% for CIT. Although definitive conclusions cannot be made due to inherent limitations of cross‐trial comparisons, this report suggests that ibrutinib has a favorable benefit/risk profile and may potentially eliminate the need for chemotherapy in some patients. Randomized, comparative studies are needed to support these findings