Prognosis in monoclonal gammopathy of undetermined significance.

Eighty-seven patients with monoclonal gammopathy of undetermined significance (MGUS) were followed for a period of 1-20 years, median 91 months. Transformation to multiple myeloma occurred in 14 patients of whom seven died as a consequence of the disease. There were 13 unrelated deaths. The actuarial probability of survival was 80% at 10 years and 44% at 15 years and the probabilities of malignant conversion for the same periods were 17% and 30% respectively. The most significant factor influencing the probability of malignant conversion was the increase of monoclonal protein above the level of 30 g/l during the observation period (P<0.001), followed by an increase of M-protein to more than 50% above the baseline level (P=0.02) and a decreased level of uninvolved immunoglobulins (P=0.054).

Prognostic parameters in low-grade non-Hodgkin's lymphomas.

In a group of 73 patients with low-grade non-Hodgkin's lymphomas (LG NHL) a multivariate analysis of the following variables was performed: pathological types following the International Working Formulation, clinical stage, B-symptoms, erythrocyte sedimentation rate, hemoglobin level, white blood cell and lymphocyte count, serum gamma globulin level, serum total lactic dehydrogenase (LDH) level, mitotic and complete remission. The patients with lymphocytic lymphoma manifested the best survival in this group. Low-proliferative lymphomas showed better survival than high-proliferative lymphomas at 3 and 10 years. B-symptoms, serum total LDH level and complete remission were significant independent prognostic factors.

Significance of aneuploidy in non-Hodgkin lymphomas.

The incidence of aneuploidy was determined by flow cytometric analysis in paraffin-embedded tumor samples of 125 patients with non-Hodgkin lymphoma (NHL). There were 48 low-grade (LG) and 77 high-grade (HG) tumors. Aneuploidy was found in 34 (27%) NHL, 15 (31%) LG, and 19 (25%) HG tumors. The analysis of patient survival showed a significantly better survival of patients with LG than HG NHL, but the presence of aneuploidy did not influence the survival on the level of all patients, patients with LG or patients with HG NHL. In patients with LG NHL a tendency of diploid vs. aneuploid patients to survive longer was observed, but only at P = 0.056 significance level.

[Kaposi's sarcoma in patients with kidney transplantation]. / Kaposiev sarkom u bolesnika s transplantiranim bubregom.

An anti-HIV negative patient with cadaveric renal transplant developed Kaposi's sarcoma of the skin and gingiva 10 months after transplantation, taking triple immunosuppression (cyclosporine, azathioprine and prednisone). After reduction of the cyclosporine dose and complete cessation of azathioprine administration, the tumor regressed without rejection of renal transplant. The patient was a carrier of HLA A2 and DR5. When Kaposi's sarcoma was diagnosed serologic tests revealed reactivation of cytomegalovirus (CMV) infection. All this combined with considerable pharmacological immunosuppression, made the patient prone to develop Kaposi's sarcoma, which can regress with adequate reduction of immunosuppression.

Prognostic value of cytophotometric analysis of DNA in lymph node aspirates from patients with non-Hodgkin's lymphoma.

To classify cases of non-Hodgkin's lymphoma in terms of expected clinical behaviour and survival, kinetic parameters measured by cytophotometry were assessed in 62 patients between 1978 and 1987. The influence of the number of cells with increased DNA content (more than 2N) on survival was evaluated. Analyses were carried out on the small samples obtained by needle aspiration biopsy of lymph nodes before treatment, using microdensitometry and Feulgen staining. Patients whose lymphomas contained less than 6% of cells with increased DNA content had a mean survival of 81.3 months and those whose lymphomas contained 6% or more of such cells had a mean survival of 18.5 months. A significant difference in survival using the same criteria was also noticed for patients with both low grade lymphomas and those with intermediate and high grade lymphomas. It is concluded that cytophotometric analysis of lymph node aspirates is of prognostic value in the initial assessment of non-Hodgkin's lymphoma.

[Intensive radiotherapy and polychemotherapy, clinical stage and systemic manifestations of the disease as parameters important in the prognosis for Hodgkin's disease]. / Intenzivna radioterapija i polikemoterapija, klinicki stadij i sistemske manifestacije bolesti kao parametri znacajni za prognozu Hodgkinove bolesti.

In the period from 1961 to 1982, 82 patients (36 females and 46 males) with Hodgkin's disease were treated. The median age was 40 years. According to the way of treatment, the patients were divided into two groups, the first group with 30 patients treated by local x-rays and/or monochemotherapy (treated up to 1971) and the second group with 52 patients treated by aggressive tele-cobalt therapy and/or MOPP polychemotherapy (after 1972). In the first group of patients, complete remission was achieved in 9 cases, partial remission in 15, while there was no remission in 6 cases. In the second group, complete remission was achieved in 40 cases, partial remission in 9, while no remission could be achieved in 3 cases. The difference in the number of remissions achieved between the patients treated up to 1971 and patients treated later is statistically significant (chi 2 = 15.52 p less than 0.0001). The median age was significantly higher in the group of patients treated by aggressive therapy (65:12 months). Seven patients from the first group survived for more than 5 years, 5 being still alive. In the second groups 29 patients survived for more than 5 years, 24 of them being still alive. The difference in survival between these two groups is significant (chi 2 = 11.37; p less than 0.001). There is a significant difference in surviving between patients in different stages of the disease (chi 2 = 27.47; p less than 0.00001). Between the patients without general symptoms (A) and the patients with systemic manifestations (B) the difference in numbers of remissions is statistically significant (chi 2 = 8.44; p less than 0.005). The difference in survival between these two groups of patients is also significant (chi 2 = 16.52; p less than 0.0001).

[Signs of hypercoagulability in hyperlipemic hypertensives]. / Ispitivanje znakova hiperkoagulabilnosti kod hiperlipemicnih hipertonicara.

The correlation between elevated serum lipids, shortened coagulation time, and the accelerated thrombosis measured in vivo was found in experimental animals. Elevated levels of some coagulation factors were found in samples of human hyperlipoproteinemic plasma. Experimental hypertension induced significant rise of serum cholesterol and some coagulation factors also. If thrombosis is important in the genesis of atheroclerosis, these findings could indicate that elevation of plasma lipids may play a role, via the coagulation pathway, in the production of human vascular disease. These findings encouraged us to test the group of patients with rised blood pressure and to correlate their lipid and coagulation status. Statistically significant difference between hyperlipemia and normolipemic hypertonics was seen in level of factors V and VII reduced fibrinolytic activity, decreased antithrombin III, and in higher rate of hypercoagulabilic thromboelastograms.

[Factor XII deficiency - Hageman trait. Report of 2 cases]. / Deficit faktora XII--Hagemanova karakteristika. Opis nasih slucajeva.

For the first time in our literature we have described the two cases of hereditary deficiency of factor XII (Hageman trait), a very rare disorder. It was discovered when a long clotting time was found in our patients during the course of a preoperative evaluation. Abnormal thrombelastogram, with a picture typical for hemophilia, gave as a reason to continue with laboratory investigation. The laboratory findings showed us a very low value of factor XII in one case, and total absence of factor XII in the other.