[Second allogenic bone marrow transplantation after late graft rejection in a patient with severe aplastic anemia]. / Sekundarna alogena transplantacija kostne srzi kod bolesnika sa teskom aplastickom anemijom nakon kasnog odbacivanja primarnog kalema.

Allogeneic bone marrow transplantation (BMT) is the treatment of choice in young patients (pts) with severe aplastic anemia (SAA) who have an HLA identical sibling donor. Late graft rejection to following allogeneic BMT for SAA is a significant clinical problem and is associated with a high risk of mortality. The optimal treatment strategy for patients with late graft rejection after first BMT is still an open question. We report 12-year-old patient with acquired SAA who underwent BMT from his HLA identical sister. BMT was first-line treatment within 3 months of diagnosis. Preparative therapy was Cyclophosphamide (Cy) 200 mg/kg body mass (BM) during 4 days. Graft versus host disease (GVHD) was prevented with Methotrexate (MTX), Methylprednisolone (MPDN) and Cyclosporin A (CsA). After 17 months, during which patient was with normal blood counts and full donor chimaerism, graft rejection occurred. The patient was re-engrafted from the same donor after conditioning with Cy 200 mg/kg BM plus horse antithymocyte globulin (ATG)--2 vials (á 25 mg)/10 kg BM over 4 days. Before the collection, donor's bone marrow was activated with low dose rhGM-CSF (3 micrograms/kg one day). Following a secondary BMT engraftment has sustained. The patient is alive with full donor chimaerism 26 months from secondary transplantation, without acute or chronic GVHD.

[Correlation of cytologic and pathohistologic findings in ultrasonically-guided thin-needle biopsy of abdominal and retroperitoneal organs]. / Korelacija citoloskih i patohistoloskih nalaza biopsija tankom iglom abdominalnih i retroperitonealnih organa pod kontrolom ultrazvuka.

The ultrasonically guided fine needle biopsy is cheap, very sensitive and specific method for the diagnosis of nonpalpable deep-seated lesions. During 1992 in the institute of Radiology of Military Medical Academy in Belgrade 87 biopsies of abdominal and 81 biopsies of retroperitoneal organs were performed for the cytological and histopathologic analysis. Deficient material was obtained in 15.4% of the cases. A good correlation between cytologic and histopathologic findings was observed, with diagnostic concordance in 90.8%. In 9 cases with falsely positive cytological diagnosis at the first examination, the diagnosis of malignancy was later confirmed by other diagnosis procedures. Diagnostic difficulties and the significance of adequate biopsy were particularly stressed.

[Cytologic characteristics of cerebrospinal fluid in patients with serous meningitis caused by enteroviruses, mumps virus or Koch's bacillus]. / Citoloske karakteristike likvora kod bolesnika sa seroznim meningitisom uzrokovanim enterovirusim, mumps virusom i bacilom Koch.

The qualitative and quantitative analysis of the cytogram of cerebrospinal fluid (CSF) was performed in the acute phase of enteroviral meningitis (ENTERO MGT. 31 patients), mumps meningitis (MUMPS MGT, 25 patients) and tubercular meningoencephalitis (TBC ME, 15 patients), to observe the basic characteristics and answer the question whether the cytological response of the central nervous system (CNS) is ethyologically determined. The CSF sediment was obtained in Saykov chamber and was dyed according to Pappenheim. In the group of ENTERO MGT the significant representation of neutrophils with the presence of basophile was observed. The main characteristic of MUMPS MGT was mononuclear response with various morphological forms of lymphocyte cells and neglectable presence of neutrophils. TBC ME was characterized by the neutrophilia in the first 12 days of illness; till the end of the fourth week there was an equal representation of neutrophils and mononuclear cells, followed by a significant lymphocytosis. The cells of the monocytemacrophage system and the plasma-cells were constantly present. It could be concluded that differences in cytological response of CNS between ENTERO and MUMPS group were mainly quantitative and dynamic, probably caused by the various pathogenesic mechanisms of inflammation. The cytological picture of CSF during TBC ME in relation to other two groups had certain qualitative, quantitative and dynamic characteristics which could indicate the diagnosis of the specific meningoencephalitis, making this analysis very useful in the early diagnostics of this illness.

[The role and morphology of thrombocyte concentrates prepared from a buffy coat]. / Prinos i morfologija koncentrovanih trombocita pripremanih iz buffy coat-a.

The results of quantification and investigation of thrombocyte morphology in 112 concentrated thrombocyte units, prepared from buffy coat of the whole blood taken from the unchosen donors are shown. Immediately after the preparation of units the thrombocyte count was 66.99 +/- 7.04 x 10 cells (contribution of procedure 65.05%), the number of residual leukocytes 70.2 +/- 17.91 x 10 cells and the value of morphological thrombocyte score was 364 +/- 32.1. During the first day of storage on the temperature of 20 +/- 2 degrees C, along with the constant shaking of units the significant decrease of number of morphological score of thrombocyte (p < 0.05) was stated. Beside the mentioned side effects, the units of concentrated thrombocytes prepared in this procedure showed to be therapeutically effective after the storage of 5 days. In contribution to this spoke electronic-microscopic investigations that showed the presence of degenerative changes of thrombocytes during the fourth day of storage. Further improvement of procedure is necessary due to the prolonged preservation of the concentrated thrombocyte units quality.

[Antilymphocyte globulin in the treatment of aplastic anemia]. / Antilimfocitni globulin u lecenju aplasticnih anemija.

Between January 1986 and July 1990, 17 patients with acquired aplastic anemia were treated with ALG or ATG combined with high doses of methylprednisolone. The mean age was 24.3 years (from 4 to 51 years). There were 9 cases with idiopathic etiology of acquired aplastic anemia; in 7 cases aplastic anemia was developed during or after HBsAg infection. In one case aplastic anemia was developed during tuberculous kidney infection. The remission of the disease was achieved in 11 of 17 cases (complete remission in 9-53%, and partial in 2-12% patients). Six (35%) patients did not respond to the treatment with ALG. One patient died of infection and hemorrhagic complications, two weeks after the therapy, without responding to the treatment with ALG. The four year survival rate without recidives was 65% (11/17). Four (23.5%) patients developed clonal diseases: PNH in 2; MDS in 1 and AL in 1 patient, 24, 38, 9 and 6 months after the therapy with ALG, respectively. The age of the patients is a valuable prognostic parameter (all patients under 20 years of age entered the remission), which cannot be said for pretreatment levels of reticulocytes, neutrophils and platelets. In none of the patients adverse effects of ALG were observed. The treatment was conducted in isolated rooms with sterile air circulation. ALG combined with high doses of methylprednisolone, for the majority of patients with aplastic anemia represents a drug of choice and is an appropriate alternative therapy to alogenic bone marrow transplantation, especially for patients with no HLA identical bone marrow donor.

[Clinical study of the therapeutic value of Kybernin in the treatment of antithrombin III deficiency]. / Klinicka studija terapijske vrijednosti Kybernina u lijecenju deficijencija antitrombina III.

Together with a detailed presentation of the physiological role of antithrombin III and a description of the pathological states in which it's acquired deficiency requires substitutional therapy with an antithrombin preparation, this report contains the results of a clinical trial of such a preparation which is in use under the name of Kybernin. Patients with severe diseases and traumas, of a septic nature mostly, were included in the trial. The experimental group includes 20 such patients treated with Kybernin, and the control group had 12 patients who did not receive this preparation. The level of antithrombin III at the time of entering the study was an average of 40.1% in the experimental group, and 53.2% in the control group. The mortality of the treated group was 45%, and in the control group it was 66.7%. Clinical and laboratory results point to a favorable effect of Kybernin therapy in the suppression of disseminated intravascular coagulation.

[Erythrocyte cell aplasia in chronic myeloid leukemia--coincidence or pathogenic link]. / Aplazija eritrocitne loze kod hronicne mijeloidne leukemije--koincidencija ili patogenetska povezanost.

At the Clinic for Hematology of the Military Medical Academy in Belgrade two patients had been treated from November, 1983 to July, 1986, in whom the existence of chronic myelogenous leukemia (CML) was established with negative Ph'-chromosome, as well as the existence of acquired partial erythrocyte aplasia (APEA). In the male patient of 58 years of age and the female patient of 71, APEA was established at the same time as CML. The maladies showed to be refractory to antileukemia (busulfan, hydroxyurea) and immunosuppressive (corticosteroid, androgen) therapy in both of the patients, while in the first patient splenectomy was also without effect on the course of the disease. Serumal inhibitors of erythropoiesis were not registered. After 18 months of disease duration one patient had a blastic transformation of CML into acute myeloblastic leukemia (AML) of the M1 form, and death appeared under the clinical manifestation of sepsis during iatrogenic aplasia of the bone marrow. The other patient died 32 months after start of illness because of intracranial hemorrhage, without signs of HML metamorphosis. In the discussion, previous illnesses are considered--kidney tuberculosis and polyarthralgias--as well as the applied treatment of these illnesses (antituberculotics and nonsteroid antirheumatics) as possible etiological factors in the appearance of APEA. The mutual link between APEA and CML, though exceptionally rare, is possible, and erythroblastopenia can precede or occur simultaneously with CML or during its treatment. APEA is usually the sign of CML terminal metamorphosis into acute leukemia, though it sometimes coexists with CML as an independent malady.