Evaluation of Periodontal Parameters in Patients with Early Stage Chronic Lymphocytic Leukemia

Svrha rada: Procjenjivao se parodontni status ispitanika s KLL-om u ranom stadiju i uspoređivao s parodontnim statusom zdravih ispitanika u kontrolnoj skupini te analizirala veza između parodontoloških i hematoloških parametara bolesnika s KLL-om. Materijali i metode: Pregledano je 60 ispitanika: 30 oboljelih od KLL-a – u stadiju Rai 0 (ispitna skupina) te 30 zdravih osoba iste životne dobi (kontrolna skupina). Kriteriji za isključivanje bili su: postojanje neke druge sistemske bolesti ili stanja (npr. dijabetes), već provedena parodontna terapija, liječenje antibioticima tijekom posljednja tri mjeseca i uzimanje lijekova. Socijalno-demografski podatci prikupljeni su upitnikom. Ispitanicima s najmanje osam zuba obavljen je kompletan parodontološki pregled i određeni su API, PBI, PPD, REC i CAL. Medicinski podatci oboljelih od KLL-a preuzeti su iz njihove medicinske dokumentacije, a hematološki parametri očitani su iz nalaza krvne pretrage. Rezultati: Skupine su se međusobno razlikovale s obzirom na dob, broj zuba i učestalost odlazaka stomatologu (p 0,05), nego samo za REC (F = 4,601; p 0,05). Zaključak: Rezultati ovog istraživanja pokazali su da su oboljeli od KLL-a imali lošiji parodontni status negoli zdravi ispitanici. Uzročno-posljedična veza između parodontoloških i hematoloških parametara nije dokazana.Objective: To assess periodontal conditions in patients with early stage CLL and to compare it with the periodontal status of age matched healthy controls and to analyze the relationship between periodontal and hematological parameters in CLL patients. Materials and Methods: 60 subjects were examined: 30 patients with CLL Rai 0 (test group) and 30 age-matching healthy individuals (control group). The exclusion criteria were: presence of other systemic disease or condition (e.g. diabetes), history of treatment for periodontitis, use of antibiotics during the last 3 months, use of medications. Socio-demographic data were obtained by means of a questionnaire. Participants with at least 8 teeth underwent a full mouth examination assessing API, PBI, PPD, REC and CAL. Medical data for CLL patients were collected from the patients’ records, while hematological data were obtained from the hemogram. Results: Difference between groups was statistically significant for age, number of teeth and frequency of dental checkups (p0.05), only for REC (F=4.601; p0.05). Conclusion: The results of this study showed that patients with CLL had worse periodontal status compared to healthy subjects. Causal relationship between periodontal and hematological parameters was not proved

T-stanična leukemija velikih granuliranih limfocita – prikaz slučaja

T-cell large granular lymphocytic leukemia (T-LGLL) is an uncommon but probably underdiagnosed disease caused by clonal proliferation of large granular lymphocytes. Diagnosis is typically based on the high number of morphologically characteristic lymphoid cells and finding of an abnormal immunophenotype by flow cytometry. Because of its relatively indolent clinical behavior, observation is often an appropriate therapy. Here we present a case of a 53-year-old male admitted to the hospital because of abdominal pain. Blood examination revealed mild mycrocitic anemia and multiplied lactate dehydrogenase level. Abdominal ultrasound showed splenomegaly of 16 cm, with no lymphadenopathy. Fine needle aspiration of bone marrow revealed hypocellular marrow with 50% of atypical lymphoid cells. There were 81% of atypical medium sized granular lymphocytes with ir-regularly shaped nuclei in peripheral blood, so the cytologic diagnosis was lymphoproliferative proc-ess. Bone marrow biopsy showed nodular and interstitial proliferation of small, partially atypical T lymphocytic cells positive for CD2, CD3, CD5, CD8, granzyme and TIA, and negative for hairy cell markers, CD10, MUM 1, bcl 1, CD4 and CD56. The finding was consistent with T-LGLL. Due to splenomegaly, the patient was treated with cyclosporine and gradually reduced dose of corticoster-oids, leading to regression of splenomegaly and normalization of lactate dehydrogenase level

Radiological Evaluation of the Healing of Bone Defects Filled with Tricalcium Phosphate (Bioresorb) after Cystectomy of the Mandible

Trikalcijev fosfat -Ca3(PO4)2 - resorbilna je i biokompatibilna kalcijeva fosfatna keramika vrlo velike čistoće s omjerom atoma kalcija i fosfata vrlo sličnim prirodnom koštanom mineralu, pa se u tkivu ponaša poput vlastita koštanog transplantata. Postupno se resorbira tijekom pregradnje kosti i nadomješta novim koštanim tkivom, a u oralnoj se kirurgiji uglavnom primjenjuje kod većih defekata kostiju nakon operacija cista i tumora te u dentalnoj implantologiji. Svrha je rada opisati dva slučaja cijeljenja koštanih defekata čeljusti nakon operacije čeljusnih cista punjenih granulatom beta-trikalcijeva fosfata (Bioresorb Macro Pore - Oraltronics). Postupak je obavljen na hospitaliziranim pacijentima, uz njihovu suglasnost, u Kliničkom zavodu za oralnu kirurgiju Kliničke bolnice Dubrava. Koštani su defekti punjeni potrebnom količinom granulata veličine zrnaca od 1000 do 2000 μm. Rezultati cijeljenja subjektivno su procijenjeni raščlambom kontrolnih snimaka nakon dva, četiri i šest mjeseci te uspoređeni s cijeljenjem slične koštane šupljine koja je nastala nakon što je uklonjena radikularna koštana cista liječena metodom Partsch II i trajnom poslijeoperacijskom sukcijom. Preliminarni rezultati primjene Bioresorb Macro Porea u liječenju velikih cista donje čeljusti pokazali su vrlo dobru prihvatljivost materijala bez komplikacija - znači bez infekcije ili poteškoća s cijeljenjem rana - a obnova koštane strukture bila je završena u razdoblju od četiri i šest mjeseci nakon zahvata. Opisani slučajevi i njihova usporedba s trećim primjerom govore u prilog primjene resorbilnog trikalcijeva fosfata. Može se pretpostaviti da se na taj način brže uspostavlja očekivana građa kosti negoli kod ostalih poznatih metoda.Tricalcium phosphate -Ca3(PO4)2- is a resorbable and biocompatible calcium phosphate ceramic with the ratio of calcium and phosphate atoms very similar to natural bone mineral and consequently in the tissue it behaves like an autogenic bone transplant. It is gradually resorbed during remodelling of the bone and substituted with new osseous tissue. In oral surgery it is mainly used for large bone defects which develop during operations for cysts and tumours and in dental implantology. The purpose of the study was to present two cases of the healing of bone defects after operation of jaw cysts filled with granulate beta-tricalcium phosphate (Bioresorb Macro Pore - Oraltronics). The method was performed on hospitalised patients with their prior consent in the Department of Oral Surgery, University Hospital “Dubrava”. Bone defects were filled with the required amount of granulate, granules 1000 - 2000 µm in size. The results of healing were subjectively evaluated by analysis of radiographs after 2, 4 and 6 months and compared with the healing of a similar cavity after enucleation of a bone cyst treated by Partsch II method with permanent postoperative suctions. The preliminary results of the application of Bioresorb Macro Pore in the treatment of large mandibular cysts showed very good acceptability of the material, with no complications with regard to infection or problematic healing of the wound, and restoration of the bone structure was completed within a period of 4 and 6 months after the operation. The examples presented and their comparison with a third example support the application of resorbable tricalcium phosphate. By this method the anticipated bone structure is achieved faster than by other known methods

Netraumatski obostrani subduralni hematom uzrokovan antiagregacijskom terapijom: Prikaz slučaja i pregled literature

A 64-year-old female receiving clopidogrel and aspirin antiaggregation therapy after percutaneous coronary intervention for non-STEMI myocardial infarction developed nontraumatic bilateral subdural hematoma with dizziness, vertigo and headache. Craniotomy had to be postponed because of reduced ADP platelet aggregability. Four days after clopidogrel withdrawal and transfusion of 12 platelet concentrate units, ADP aggregation transiently normalized and bilateral trepanation with hematoma evacuation was performed. The procedure was followed by excellent neurologic and clinical recovery; however, decreased platelet aggregability was recorded by postoperative day 12 despite strict clopidogrel and other platelet inhibitor withdrawal. Suspicion of Glanzmann thrombastenia was excluded by flow cytometry. Two weeks after neurosurgery, the right femoral vein thrombosis was detected by color doppler ultrasonography and therapy with fractionated heparin was initiated, followed by warfarin. The risk and incidence of hemorrhagic complications of antiaggregation and anticoagulation therapy are discussed. Caution is warranted on prescribing this potentially harmful therapy to older patients, generally burdened with other chronic comorbidities.U 64-godišnje bolesnice koja je zbog ne-STEMI srčanog infarkta dobivala aspirin i klopidogrel razvio se netraumatski obostrani subduralni hematom praćen smušenošću, vrtoglavicom i glavoboljom. Kod prijma je utvrđena smanjena agregacija trombocita u ADP testu pa je kraniotomija i dekompresija odgođena za 4 dana. Četiri dana nakon prestanka uzimanja klopidogrela i aspirina te uz transfuziju od 12 doza trombocita prolazno se normalizirala agregabilnost trombocita pa je učinjena obostrana trepanacija i uklonjeni su hematomi. Slijedio je odličan neurološki oporavak. Smanjena agregabilnost trombocita bila je prisutna do 12. poslijeoperacijskog dana. Sumnja na Glanzmannovu trombasteniju isključena je protočnom citometrijom. Četrnaestoga poslijeoperacijskog dana nastala je tromboza desne femoralne vene koja je liječena smanjenim dozama heparina i varfarina. Uz prikaz bolesnice analizira se rizik od krvarenja i tromboze u bolesnika koji uzimaju antitrombocitne lijekove. Preporuča se oprez u starijih bolesnika kod kojih su prisutne i druge teške bolesti, što povećava rizik od krvarenja

Idiopatski asinkroni obostrani segmentalni infarkt testisa - prikaz slučaja

We present an unusual case of sudden onset of pain in the left testis in a patient with a previous medical history of right orchiectomy due to hemorrhagic infarction. A partial orchiectomy was performed with complete removal of the lesion and reconstruction of the testicular parenchyma. Histopathological assessment confirmed segmental testicular infarction without the presence of malignancy. The patient subsequently received anticoagulant therapy.Prikazujemo neobičan slučaj iznenadne pojave boli u lijevom testisu kod bolesnika u kojeg je prethodno učinjena desnostrana orhidektomija zbog hemoragijskog infarkta. Izvršena je djelomična orhidektomija s potpunim uklanjanjem lezije i rekonstrukcijom parenhima testisa. Histopatološkom obradom potvrđen je segmentalni infarkt testisa bez prisutnosti zloćudne bolesti. U bolesnika je nakon toga primjenjena protuzgrušavajuća terapija

Recidivi venske tromboze unatoč “optimalne antikoagulantne terapije” antifosfolipidnog sindroma. Mogu li novi peroralni antikoagulansi riješiti problem ?

The aim was to determine the validity of the international normalized ratio (IN R) and prothrombin time (PT ) as a monitor for warfarin therapy in patients with lupus anticoagulants and recurrent thrombosis, and to investigate alternative approaches to monitoring warfarin therapy and new treatment options in these patients. A case is described of a 63-year-old female with antiphospholipid syndrome and recurrent venous thrombosis despite optimal adjusted warfarin therapy. In patients with lupus anticoagulants, the IN Rs obtained while receiving warfarin vary and often overestimate the extent of anticoagulation, while PT without receiving warfarin is often prolonged. In conclusion, lupus anticoagulants can influence PT and lead to IN R that does not accurately reflect the true level of anticoagulation. Optimizing of (warfarin) oral anticoagulation therapy could be achieved by individual monitoring of anticoagulation effect with a test that is insensitive to lupus anticoagulants (chromogenic factor X assay). Emerging oral anticoagulants, direct thrombin inhibitors and direct factor Xa inhibitors, such as dabigatran and rivaroxaban, with a predictable anticoagulant response and little potential for food or drug interactions, have been designed to be administered in fixed doses without coagulation monitoring and could be the treatment choice for these patients.Cilj je bio analizirati uzroke neuspjeha “optimalno doziranog” varfarina kod prevencije recidiva duboke venske tromboze u bolesnika s antifosfolipidnim sindromom. Opisuje se slučaj 63-godišnje bolesnice s antifosfolipidnim sindromom i recidivima venske tromboze tijekom uzimanja varfarina. Vrijednosti IN R bile su u terapijskim granicama. Analizirali su se patofiziološki mehanizmi nastanka tromboze i literaturni podaci. Rezultati su pokazali kako u bolesnika s pozitivnim lupus antikoagulans (LA) testom vrijednost PV -IN R ne daje pravu sliku protuzgrušavajućeg učinka varfarina. Aktivnost PV je zbog interferencije često lažno smanjena, iako u času mjerenja bolesnik ne uzima varfarin ili drugi antagonist vitamina K. Zaključak je kako prisutnost LA može interferencijom lažno smanjiti aktivnost u PV testu i rezultirati nalazom IN R koji ne odražava pravo stanje protuzgrušavajuće aktivnosti izazvane varfarinom. U tom bi slučaju umjesto PV testa trebalo mjeriti aktivnost faktora Xa kromogenom metodom koja je neosjetljiva na LA. Drugo moguće rješenje bi u bolesnika s antifosfolipidnim sindromom bila zamjena varfarina novim lijekovima, oralnim inhibitorima trombina i faktora X. Ovi lijekovi u fiksnoj dozi s predvidivim te o hrani i lijekovima uglavnom neovisnim protuzgrušavajućim učinkom imaju djelotvornost i nuspojave uglavnom slične varfarinu, ali ne trebaju kontrole IN R

CAN A REDUCED DOSE OF CYTARABINE BE AS EFFECTIVE AS FULL DOSE IN THE TREATMENT OF PRIMARY DIFFUSE B-CELL LYMPHOMA IN MATRix PROTOCOL?

Primarni limfom središnjeg živčanog sustava rijetki je agresivan non-Hodgkinov limfom. Suvremeni pristup liječenju bolesnika podobnih za intenzivnu imuno-kemoterapiju uključuje faze indukcije i konsolidacije. IELSG32, randomizirano ispitivanje Međunarodne grupe za istraživanje ekstranodalnih limfoma (engl. International Extranodal Lymphoma Study Group) pokazalo je kako u indukcijskoj fazi kombinacija visokih doza metotreksata, citarabina, tiotepe i rituksimaba praćena konsolidacijom autolognom transplantacijom krvotvornih matičnih stanica znatno poboljšava ishode tih bolesnika. Retrospektivno je analizirano sedmero bolesnika s novo dijagnosticiranim primarnim limfomom mozga liječenih od listopada 2018. do veljače 2022. godine koji su primili MATRix protokol kemoterapije s reduciranom dozom citarabina. Primijenjena doza iznosila je 2000 mg/m2 svakih 12 sati trećeg dana ciklusa. Četvrtog dana ciklusa citarabin je izostavljen kod svih bolesnika. Pet bolesnika postiglo je kompletnu remisiju, a jedan parcijalnu remisiju. Kod većine bolesnika na indukcijsku fazu nastavljena je konsolidacija transplantacijom krvotvornih matičnih stanica. Kod jednog bolesnika zabilježena je progresija bolesti tri mjeseca nakon autologne transplantacije krvotvornim matičnim stanicama. Terapijske nuspojave su usporedive i slične s rezultatima IELSG32, s naglaskom da su se hematološke toksičnosti gradusa 4 javljale u malim brojevima. S obzirom na prikazane kliničke slučajeve postavlja se pitanje bi li niža doza citarabina u MATRix protokolu mogla biti jednako učinkovita kao i puna doza u postizanju remisije bolesti primarnog B-velikostaničnog limfoma mozga.Primary diffuse B-cell brain lymphoma is a rare, aggressive non-Hodgkin’s lymphoma. The modern approach to treatment involves two phases, induction and consolidation. IELSG32, a randomized trial by the International Extranodal Lymphoma Study Group, showed that in the induction phase, the combination of high doses of methotrexate, cytarabine, thiotepa, and rituximab followed by consolidation therapy with autologous hematopoietic stem cell transplantation signifi cantly improved outcomes in these patients. We aim here to present characteristics and outcomes of seven patients with newly diagnosed primary central nervous system lymphoma who were treated between November 2018 and February 2022. All of them received the MATRix reduced-dose cytarabine chemotherapy protocol. The dose of cytarabine was 2000 mg/ m2 every 12 hours on the third day of the cycle. On the fourth day of the cycle, cytarabine was completely omitted in all patients. Five patients achieved complete remission and one patient achieved partial remission after completion of the induction therapy at a reduced dose, followed by autologous hematopoietic stem cell transplantation in most patients. One patient had progression of the disease three months after autologous hematopoietic stem cell transplantation. Therapeutic toxicities were similar to IELSG32 results with emphasis on the fact that hematologic toxicities of grade 4 occurred in a low percentage. The above raises a question whether a reduced dose of cytarabine in MATRix protocol be as effective as full dose in achieving disease remission

Use of bendamustin instead of carmustin in autologous stem cell transplantation conditioning – toxicity and infectious complications comparison

Unatrag nekoliko godina u hematologiji i onkologiji globalno sve češći problem postaje prikladna opskrba „starijim i manje zanimljivim“ kemoterapeuticima. Zbog povremene nestašice karmustina, jednog od osnovnih kemoterapeutika pri kondicioniranju prije autologne transplantacije krvotvornih matičnih stanica (ATK S) u oboljelih od limfoma, u našem se centru od 2016. godine on zamjenjuje bendamustinom. U ovom radu retrospektivno analiziramo tijek ATK S-a u 41 bolesnika koji su primili bendamustin u sklopu protokola BeEA M te ga uspoređujemo s tijekom ATK S-a u 40 bolesnika koji su primili karmustin u sklopu protokola BEA M. Medijan oporavka vrijednosti neutrofila (> 0,5 × 109/l) u skupini koja je primila bendamustin iznosio je 11 dana, dok je u skupini kondicioniranoj karmustinom iznosio 10 dana. Medijan oporavka vrijednosti trombocita (> 20 × 109/l) bio je duži kod skupine koja je primala bendamustin (16 prema 13 dana) te su ti bolesnici bili duže ovisni o transfuzijama eritrocita (7 prema 5 dana). Infektivne komplikacije nisu bile češće nakon primjene bendamustina, ali smo nakon primjene karmustina imali veću pojavu mukozitisa II. – III. stupnja (35% prema 12%). Nakon primjene bendamustina zabilježen je jedan slučaj nefrotoksičnosti i kardiotoksičnosti terapije, dok kod primjene karmustina te komplikacije nisu zabilježene. Pri upotrebi bendamustina kod kondicioniranja u naših bolesnika u ovom trenutku nije utvrđena znatnija hematološka toksičnost u odnosu prema karmustinu, ali su prisutni dulji period oporavka vrijednosti trombocita te niža incidencija mukozitisa.Inadequate supply of „old and less interesting“ chemotherapeutic agents is becoming a global issue in hemato-oncology today. In 2016 we were faced with occasional carmustin shortage, one of the most commonly used in autologous transplant conditioning regimens for lymphoma in our centre, so we decided to use bendamustin instead. We performed a retrospective analysis of 41 patients treated at our centre who had received bendamustin within BeEA M protocol and compared them with 40 patients who had received carmustin within BEA M protocol. Both protocols were used as conditioning protocols before autologous stem cell transplantation. Neutrophil recovery median following transplantation (AN C>0,5x109/l) was 11 days in the bendamustin group in comparison to 10 days in the carmustin group.Platelets recovery median following transplantation (PLT>20x109/l) was longer in the bendamustin group (16 vs.13 days) as was blood transfusion dependency (7 vs. 5 days). Infectious complications were not more frequent after bendamustin, but grade II–III mucositis was more frequent in patients who received carmustin (35% vs.12%). Following bendamustin we had one reported case of nephrotoxicity and cardiac toxicity, not reported with carmustin. Bendamustin has shown similar hematologic toxicity compared to carmustin but a longer platelet recovery period and a lower mucositis incidence

Oral inflammation and infection in patients with chronic lymphoproliferative disease

Uvod: Bolesnici s kroničnom limfoproliferativnom bolešću podložni su razvoju infekcija zbog imunoloških poremećaja povezanih s bolešću, ali i zbog utjecaja terapije. Stoga je kod ovih bolesnika izuzetno važno minimalizirati bakterijsko i upalno opterećenje iz usne šupljine. Cilj ovog istraživanja bio je procijeniti akumulaciju dentobakterijskog plaka i oralnu upalu kod bolesnika s kroničnom limfoproliferativnom bolešću pomoću aproksimalnog plak indeksa i indeksa krvareće papile te ih usporediti s oralnim statusom ispitanika kontrolne skupine. Materijali i metode: Pregledana su 24 bolesnika s kroničnom limfoproliferativnom bolešću (ispitna skupina) i 28 zdravih ispitanika odgovarajuće dobi (kontrolna skupina). Za svakog ispitanika zabilježeni su aproksimalni plak indeks (API) i indeks krvareće papile (PBI). Rezultati: U ispitnoj skupini srednja vrijednost za API iznosila je 0,81 ± 0,18, a srednja vrijednost za PBI 2,72 ± 0,68. U kontrolnoj skupini srednja vrijednost za API iznosila je 0,69 ± 0,15, a srednja vrijednost za PBI 1,91 ± 0,45. Ispitna skupina se statistički značajno razlikovala od kontrolne skupine prema API (t-test = -2,569; p = 0.013) i PBI (t-test = -5.180; p <0.001). Zaključak: Rezultati ovog istraživanja pokazali su da su bolesnici s kroničnom limfoproliferativnom bolešću imali statistički značajno veće vrijednosti API i PBI od zdravih ispitanika kontrolne skupine, što ukazuje na visoko bakterijsko i upalno opterećenje iz usne šupljine kod ovih bolesnika.Introduction: Patients with chronic lymphoproliferative disease are predisposed to infection due to inherent immune defects related to the primary disease, and as a result of therapy. It is of great importance to minimize infection and inflammation burden from oral cavity in these patients. The aim of this study was to evaluate dentobacterial plaque accumulation and oral inflammation using Approximal Plaque Index and Papilla Bleeding Index in patients with chronic lymphoproliferative disease and to compare it with matched healthy controls. Materials and methods: 24 patients with chronic lymphoproliferative disease (test group) and 28 age matching healthy individuals (control group) were examined. Approximal Plaque Index (API) and Papilla Bleeding Index (PBI) were recorded for each subject. Results: In the test group the mean value of API was 0.81 ± 0.18, and the mean value of PBI was 2.72 ± 0.68. In the control group the mean value of API was 0.69 ± 0.15 and the mean value of PBI was 1.91 ± 0.45. The test group was statistically significant different from the control group according to API (t-test = -2.569; p = 0.013) and PBI (t-test = -5.180; p <0.001). Conclusion: The results of this study showed that patients with chronic lymphoproliferative disease had statistically significant higher values of API and PBI than healthy subjects in the control group, indicating a high infectious and inflammatory burden from the oral cavity in these patients