[Herpesviruses in patients after renal transplantation].

AIM: To estimate graft function after kidney transplantation during active herpesviruses or superinfection Materials and methods. The study included 32 patients (men 21, women 11) with end-stage chronic kidney disease. The median age was 43 years. Cytomegalovirus (CMV), EpsteinBarr virus (EBV) and human herpes virus 6 (HHV-6) DNAs were screened by RT-PCR in the donor's transplant biopsy, and recipients peripheral blood and urine after kidney transplantation (KT) on 0, 1, 2, 4, 6, 12 months. Antiviral antibodies (IgM and IgG) were also screened by Enzyme-linked immunoassay analysis (ELISA) along with PCR. The 500 or less copies of viral DNA per 105 nuclear cells or 1 ml of urine was considered as low, more than 1000 copies high. RESULTS: On the first month after KT CMV DNA was detected in 50% of pts., EBV DNA in 40% and HHV-6 DNA in 33%. During first year after KT two or three viruses simultaneously were found in 12 recipients: CMV, EBV, and HHV-6 were detected in 5 recipients; CMV and EBV in 4 patients; CMV and HHV-6 in 2 pts; EBV and HHV-6 in 1 pt. Graft dysfunction was observed in 9 patients with a high concentration of viral DNA of one, two or three viruses simultaneously. An upraise of the concentration of virus DNA (CMV, EBV and HHV 6) was detected primarily in the urine, while in the blood its concentration was less than 500 cop or undetectable. Renal dysfunction was not observed on the background of low concentrations of viral DNA in urine and blood. However, with an increase of DNA concentration, an impaired graft function in 8 of 12 patients appeared. Low viral DNA level proved to be a background for another virus activation or bacterial/fungal superinfection. CONCLUSION: Graft dysfunction occurs at high viral DNA levels detection during mono-or superinfection. Low viral load can serve as a background for another virus activation and/or bacterial/fungal superinfection.

[Minimal-change glomerulonephritis in chronic lymphocytic leukemia: A clinical case].

Chronic lymphocytic leukemia (CLL) in association with glomerulonephritis (GN) and renal failure is a serious problem in terms of therapy. The paper reports a clinical case of a 64-year-old female patient with Binet stage C CLL accompanied by minimal-change GN complicated by nephrotic syndrome and the development of acute renal failure. GN was diagnosed on the basis of electron microscopic studies of renal biopsy specimens. It was treated with rituximab in combination with bendamustine. The former was intravenously injected in a dose of 375 mg/m2 on day 0 of the cycle; the latter was given in a dose of 70 mg/m2 within the first 2 days; the cycle was repeated 28 days after initiation of the previous cycle. Five cycles could result in complete CLL remission (the follow-up duration was 20 months); nephrotic syndrome was completely abolished and kidney function recovered.

[A case of hemolytic-uremic syndrome with development of catastrophic antiphospholipid syndrome: diagnosis and clinical tactics].

The paper describes a case of practically simultaneous development of the hemolytic-uremic syndrome (HUS) and the catastrophic antiphospholipid syndrome (CAPS) complicated by mesenteric vessel thrombosis and small bowel necrosis. Multimodality treatment comprising volume plasmapheresis, fresh frozen plasma transfusion, hemodialysis, anticoagulant and disaggregant therapy could relieve thrombogenic events, such as pulmonary artery thromboembolism and intestinal necrosis.

[Efficacy of different chemotherapy programs, indications for surgery and radiotherapy in primary mediastinal B-cell lymphosarcoma].

AIM: To evaluate efficacy of treatment of primary mediastinal B-cell lymphosarcoma (PMBLS). MATERIAL AND METHODS: Fifty nine patients with PMBLD were divided into three groups. Group 1 (n = 15) received 8 courses of CHOP, prevention of neuroleukemia and radiotherapy (RT). Group 2 (n = 8)--4 courses of ProMACE-CytaBOM or 1 course of MACOP-B, prevention of neuroleukemia and RT. Group 3 (n = 36)--2 courses of CHOP and 2-3 courses of ESHAP or 3 courses of DexaBEAM, surgical removal of residual mediastinal tumor (RMT), RT. RESULTS: The number of complete remissions in group 1 and 2 was the same (26 and 25%, respectively). Overall 5-year and event-free survivals in groups 1 and 2 were 52 +/- 5 and 13 +/- 5; 62 +/- 5 and 38 +/- 8%, respectively. In group 3 a complete remission was observed in 89% patients (p = 0.01), overall 5-year and event-free survival reached 88 +/- 8 and 85 +/- 7%, respectively. Removal of RMT in time of tumor size stabilization and partial remission (in 12 of 15 cases) led to a complete remission but in progression of the disease (in 3 cases) appeared ineffective. RT resulted in complete remission in 39 of 53 cases, stabilization of tumor growth was in 3 cases, progression--in 10, recurrence--in 1. RT was ineffective in all 4 cases of partial remission. RT use in stabilization of tumor size induced complete remission only in 1 of 7 cases. CONCLUSION: CHOP program is ineffective in PMBLS. Program ProMACE-CytaBOM or MACOP-B is insignificantly more effective than CHOP. Combined therapy is most effective. Surgery is justified in partial remission and tumor growth arrest. RT is indicated in complete remission to achieve its consolidation.

[Gamma-scintigraphy with Ga-67 citrate in differential diagnosis of residual tumors in lymphogranulomatosis and lymphosarcoma].

AIM: To study informative and diagnostic efficacy of quantitative evaluation of the results of gamma-scintigraphy in patients with lymphogranulomatosis and lymphosarcoma with prevalent mediastinal and pulmonary lesions. MATERIAL AND METHODS: 100 patients with verified lymphogranulematosis were studied: 67 with lymphosarcoma and 33 with mediastinal involvement. The mediastinal tumor monitoring was made before therapy, in complete clinicohematological remission, in progression using a complex of radio-, clinicohematological, histomorphological and radionuclide methods. RESULTS: A comparative analysis of the findings of radiation, radionuclide and histomorphological examinations of the removed residual mediastinal tumor in 10 patients showed that scintigraphic evidence was similar to that of histological findings in most of the examinees. CONCLUSION: A high diagnostic efficacy of a complex of radiation and radionuclide methods with Ga-67 citrate based on estimation of accumulation intensity providing comprehensive information about mediastinal tumor is demonstrated. A comparative analysis was made of the results of radiation, radionuclide and histomorphological examinations of the removed residual lesion of the mediastinum in 10 patients. In most cases, scintigraphic findings coincided with the results of histological studies of biopsies of mediastinal residual lesion.

[Possibility of diagnosis and treatment of thrombotic complications in primary mediastinal B-cell lymphosarcoma]. / Vozmozhnosti diagnostiki i lecheniia tromboticheskikh oslozhnenii pri pervichnoi mediastenal'noi B-kletochnoi limfosarkome.

AIM: Efficacy of the treatment of primary mediastinal B-cell lymphosarcoma depends to a great extent on early diagnosis and treatment policy. In this study we evaluated possibilities of diagnosis and treatment of thrombotic complications of primary mediastinal B-cell lymphosarcoma (PMBL). MATERIAL AND METHODS: 61 patients were examined using roentgenography, computed tomography, chest ultrasound investigation,coagulogram, allelle specific polymerase chain reaction, ultrasound investigation of the jugular, subclavian, brachial veins, vena cava superior to detect mutation of genes II, V factors and methylentetrahydrofolatereductase. RESULTS: In 7 cases prechemotherapy examination detected thrombosis of the internal jugular and subclavian veins. In 4 of 7 cases there was a combined thrombosis of the left internal jugular and subclavian veins, in 3 cases one the vessels was affected with thrombosis. In 2 cases, in the course of polychemotherapy, there was recurrent thrombosis and development of pulmonary artery thromboembolism (PATE). In progression of the disease there was thrombosis of the left subclavian vein (1 case) and PATE (a case). Coagulologically, hypercoagulation syndrome signs were registered. 5 patients with PMBL complicated by thromboses showed gene mutations. CONCLUSION: In PMBL there is a tendency to formation of venous thrombosis and development of PATE. This is explained by tumor process and hereditary factors of thrombogenicity. Therefore, specific antitumor treatment should include anticoagulation therapy.

[Morphological, morphometrical, and immunophenotypic characteristics of primary mediastinal B-cell lymphosarcoma]. / Morfologicheskie, morfometricheskie i immunofenotipicheskie kharakteristiki pervichnoi mediastinal'noi B-kletochnoi limfosarkomy.

AIM: To define histological, cytological, computer-morphometric and immunophenotypical features of primary mediastinal B-cell lymphosarcoma. MATERIAL AND METHOD: The study enrolled 43 patients with primary mediastinal B-cell lymphosarcoma (PMBCL) treated in Hematological Research Center from 1994 to 2002. The examination included morphological and immunophenotypical tests, computer morphometry of the cells by histological sections. RESULTS: PMBCL is represented by a composite population of cells of a giant, large and small size (nuclear areas 76.24 +/- 19.99, 37.77 +/- 8.0 and 17.12 +/- 4.34 mcm2. Three types were identified: giant-cell, large-cell and small-cell. A giant-cell type is represented by large and giant cells comprising, on the average, 44 and 31% of overall number of lymphoid cells. A large-cell type is primarily represented by large lymphoid cells (62% of the lymphoid population). Small-size type is represented by small cells (72% of cells). Frequent histological signs are diffuse sclerosis and focal necrosis. Tumor cells have B-cell nature. In the giant and large cell type more than 70% cells express PCNA, in the small cell type--less than 30%. Expression of activation marker CD30 is observed in 18% cases in the giant and large cell types. CONCLUSION: PMBCL is a morphologically heterogenous disease represented by combination of giant, large and small cells with immunophenotypically B-cell nature characterized in a giant cell and large cell type by prominent but in a small cell and large cell type by insignificant proliferative activity. CD30 expression is observed only in giant cell and large cell types.

[Opportunities of delayed densitometry of "late (fixed) contrast" as a test for tumors in residual mediastinal lesion in primary mediastinal lymphosarcoma after polychemotherapy]. / Vozmozhnosti sposoba otsrochennoi densitometrii "pozdnego (fiksirovannogo) kontrasta", primeniaemogo v kachestve testa opukholi v ostatochnom obrazovanii sredosteniia pri pervichnykh mediastinal'nykh limfosarkomakh posle okonchaniia polikhimioterapii.

AIM: To clarify the potential of delayed densitometry of late (fixed) contrast in differentiation between tumor and fibrosis in residual mediastinal lesion (RML). MATERIAL AND METHODS: Computed tomography (computed tomograph of the third generation COMATOM CR-3 made in Germany, SIEMENS) has examined 12 patients with mediastinal lymphosarcomas after polychemotherapy. All of them had a RML 3 to 6 cm in diameter. RESULTS: CT has detected 8 cases of the tumor and 4 cases of fibrosis. The criteria of the tumor were the following: increased RML density shortly after the contrast medium introduction and 30 min after urographine introduction (p < 0.01); RML density 30 min after introduction of contrast medium was higher than above the aorta (p < 0.01). Fibrosis in RML was stated if RML density before, at the high of concentration and after introduction of the contrast medium was the same (p > 0.01); aortic density was significantly higher of RML density at the height of the contrast (p < 0.01). CONCLUSION: The above method differentiates the tumor with fibrosis in RML with maximal probability. This facilitates further choice of therapeutic policy in secondary resistant form of primary mediastinal lymphosarcoma.

[The 1st results of the combined therapy of recurrent and refractory forms of lymphogranulomatosis (polychemotherapy, radiation therapy and the removal of the residual mediastinal formation)]. / Pervye rezul'taty kombinirovannoi terapii retsidivnykh i refrakternykh form limfogranulematoza (polikhimioterapiia, luchevaia terapiia, udalenie ostatochnogo mediastinal'nogo obrazovaniia).

AIM: To achieve a maximal complete remission rate in patients with recurrent and refractory Hodgkin's disease. To find out a group of patients in whom surgical removal of the residual mediastinal mass would be most effective. MATERIAL AND METHODS: 46 patients with Hodgkin's disease received Dexa-BEAM chemotherapy followed by radiotherapy. Surgical removal of the residual mediastinal mass was made in 12 patients. RESULTS: Second-line Dexa-BEAM therapy produced a 50% complete remission rate. Overall survival was 45.5%, the disease-free survival--43.5%. Removed mediastinal masses were indicative of Hodgkin's disease in 7 cases and fibrosis in 4 cases. CONCLUSION: Dexa-BEAM is an effective program in the treatment of recurrent and refractory Hodgkin's disease. Surgical removal of the residual mediastinal mass with radiotherapy and high-dose chemotherapy improves prognosis in very unfavorable, primary progressive form of Hodgkin's disease.

[Plasma heparin precipitate as a source of fibronectin in the treatment of patients with trophic skin lesions]. / Plazmennyi geparinovyi pretsipitat kak istochnik fibronektina dlia lecheniia bol'nykh s troficheskimi porazheniiami kozhi.

A study with the help of the hard phase enzyme immunoassay has shown that during incubation in the cold of fresh and fresh-frozen donor plasma in the presence of 10 I. U./ml-30 I.U./ml of heparin over 80% of fibronectin with relation to its basal level in the same plasma sample passes to the residue (heparin precipitate). The effectiveness of local use of the preparation of plasmic heparin precipitate (fibronectin concentration of 1 to 1.5 mg/ml) for therapy of patients with heavy trophic skin lesions was substantiated.