[Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are elevated in peripheral blood plasma of patients with chronic lymphocytic leukemia and decrease after intensive fludarabine-based treatment]. / Bazický fibroblastový rustový faktor (bFGF) a cévní endotelový rustový faktor (VEGF) jsou zvýseny v plazme periferní krve nemocných s chronickou lymfocytární leukemií a klesají po intenzivní lécbe obsahující fludarabin.

Chronic lymphocytic leukemia (CLL) is characterized by extraordinary heterogeneity in terms of clinical course with overall survival ranging from several months to dozens of years. It is currently not possible to accurately predict the future clinical course in an individual patient. Angiogenesis has been recently reported as a potential prognostic factor in various hematological malignancies including CLL. The objective of the present study was to quantify plasma levels of key angiogenic activators vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in patients with CLL and determine their potential change after intensive fludarabine-based treatment. Peripheral blood EDTA plasma concentrations of bFGF and VEGF were measured using comercially available enzyme-linked immunosorbent assay in 73 patients with untreated CLL (43 males, 30 females, median age, 65 years, range 31-88) and 80 healthy donors serving as control group. We found statistically significant increase in concentrations in patients with chronic lymphocytic leukemia compared to the control group (p < 0.0001 for both cytokines). No differences in angiogenic factors were noted between subgroups with low vs. intermediate vs. high-risk stage according to modified Rai staging or males vs. females. In twelve patients who achieved at least partial response after intensive fludarabine-based treatment, levels of bFGF as well as VEGF decreased significantly (bFGF, p = 0.0005; VEGF, p = 0.0068); in addition, they were no more significantly different from controls (bFGF, p = 0.524; VEGF, p = 0.728). Our data showed that key angiogenic activators bFGF and VEGF were elevated in plasma ofCLL patients. Furthemore, treatment with intensive fludarabine-containing regimens resulted in significant decrease of both cytokines. These data suggest that angiogenic cytokines may indeed play a significant role in CLL biology and that treatment with combination of fludarabine, cyclophosphamide +/- rituximab may exhibit antiangiogenic properties. Further studies with longer follow-up are necessary for evaluation of a possible association between angiogenic markers and progression-free survival or overall survival.

[Anagrelide in the treatment of essential thrombocythemia (ET) and other myeloproliferative disorders with thrombocythemia based on data from patient register in the CR]. / Anagrelid v lécbe esenciální trombocytemie a dalsích myeloproliferací s trombocytemií sledovaných v registru pacientu v CR.

Anagrelide hydrochloride is an effective drug used in patients with ET and other myeloproliferative disorders with thrombocythemia to selectively decrease the number of thrombocytes. Indications for use of anagrelide were described in detail in Czech medical literature. Since 2005 data concerning treatment with anagrelide in some medical clinics have been collected in patient register showing course of treatment from 2004, when the medicament obtained marketing authorization from State Institute for Drug Control to be used in the treatment of thrombocythemia in myeloproliferative disorders. Aim of patient register is to monitor medical effect of anagrelide therapy and incidence of adverse effects in patients with ET and other myeloproliferative disorders and subsequent analysis of collected data. At the moment patient register contains data from 154 patients.

[Antithrombin III in various conditions in internal medicine]. / Antitrombin III u nekterých stavu ve vnitrním lékarství.

In a group of 993 patients with serious medical diseases an important deficiency of antithrombin III was found in patients with hepatic insufficiency, pulmonary embolism and with disseminated intravascular coagulation. Acquired antithrombin III deficiency in these conditions develops when the antithrombin production in the liver is low and also in patients with shock syndrome and disseminated intravascular coagulation. Assessment of antithrombin III is of diagnostic and prognostic value in thrombotic and prethrombotic conditions and its results is decisive for adequate substitution. Adequate AT III substitution without concurrent heparin administration in patients with septicaemia and manifestations of DIC improves the prognosis of patients with an increased endothelial resistance.

[Changes in platelet activity in invasive cardiologic procedures]. / Zmeny aktivity desticek pri invazivních kardiologických výkonech.

The authors revealed some changes in the platelet activity in patients with invasive cardiological procedures. Changes of the platelet function were manifested by an enhanced aggregation of platelets in vivo, an increased secretion from alpha granules and increased release of prostaglandin metabolites from platelets and from the vascular wall. Acetylsalicylic acid (ASA) suppressed the formation of circulating platelet aggregates in vivo, but the platelet activity was manifested by another mechanism, independent on ASA. The authors recorded therefore an increase of prostaglandin metabolites and PF4 even in patients who were treated with ASA before the invasive examination.

[Changes in platelet function in patients with arterial hypertension]. / Zmeny destickových funkcí u nemocných s arteriální hypertenzí.

The authors examined some indicators of platelet activity in patients with hypertension stage II (according to WHO). They revealed an increased platelet activity which was manifested by an increased concentration of platelet factor 4 (50.2 +/- 28.2 ng/ml) and thromboxane B2 (49.9 +/- 20.1 pg/ml) in plasma. The increase of indicators of platelet activation associated with hypertension is a molecular marker of activation of haemostasis and according to data in the literature it is an indicator of vascular complications in hypertension. It is not clear whether the increased platelet functions in hypertension is primary or an induced change.

[Bleeding time in incisions in patients with thrombocyte transfusion]. / Vysetrení krvácivosti v rezu u nemocných s prevody trombocytu.

The authors used the Simplate test (Organon Teknika) to examine the bleeding time from an incision in 15 healthy blood donors and found normal values of 3.45 +/- 0.90 min. The authors proved a close correlation between the improvement of the number of platelets in 10 patients with thrombocytopenia, treated with thrombocyte infusions and the improvement of the bleeding time when using the Simplate R test after one hour and after 24 hours following thrombocyte administration. Examination of the bleeding time by means of the Simplate R test (Organon Teknika) was well tolerated by the authors' patients and the test does not produce any side-effects.

Migraine--a haematological disorder?

We analysed 22 patients suffering from migraine to evaluate the possible activation of platelet function utilizing the following methods: platelet factor 4, thromboxane B2 and 6 - keto prostaglandin F 1 alpha levels in platelet poor plasma. Laboratory tests were performed on all patients during headache-free period and the results obtained were compared with those of a normal healthy individuals. The mean results obtained in the patients group during pain-free period indicated a significant activation of platelet function when compared with the normal group.

[Diagnosis and therapy of disseminated intravascular coagulation]. / Poznámky k diagnostice a lécbe diseminované intravaskulární koagulace.

The syndrome of disseminated intravascular coagulation (DIC) is an acquired coagulation disorder which is characterized by a significant activation of haemostasis and the formation of intravascular microthrombi, the consumption of coagulation factors and activation of fibrinolysis. DIC has similar clinical stages and a similar laboratory picture, regardless of the causal factor. The diagnosis of DIC should be based on anamnestic, clinical and laboratory data. The laboratory diagnosis of DIC is possible by using relatively simple tests, which have the character of statim examinations. DIC treatment is based on the principle of treatment of the cause, discontinued consumption of haemostatic material, substitution of lacking factors and restoration of the microcirculation. The possible development of DIC must be taken into account in a number of acute conditions, in particular the development of shock syndrome. The presented article summarizes some views on causes, diagnosis and possible treatment of DIC.

[Treatment of the leukostasis syndrome in chronic lymphadenosis using leukapheresis]. / Syndrom leukostázy pri chronické lymfadenóze, lécený leukaferézou.

The authors draw attention to the leukostasis syndrome which develops in haematological patients in case of enormous leucocyte proliferation. It occurs most frequently in chronic myelosis but may occur also in other types of leukaemia. The diagnosis is not easy. Most frequently disorders of the microcirculation develop in the lungs and brain. These are frequently very urgent clinical situations which can be resolved by leukapheresis. The authors described a patient where during chronic lymphadenosis proliferation of lymphocytes occurred to values of 1432 x 10(9)/l. After leukapheresis and cytostatic treatment rapid improvement of the condition occurred and the leucocyte values were approximately 30 x 10(9)/l. The patient's condition improved for a long period of time and became stabilized.

[Dynamics of retinal changes in relation to treatment of Waldenström's macroglobulinemia]. / Dynamika sítnicových zmen v závislosti na lécbe Waldenströmovy makroglobulinémie.

Authors document with the aid of fluorescent angiography of the retina pathological changes on the retina resulting from hyperviscous syndrome of Waldenstrom macroglobulinemia and their regulation after combined treatment with plasmapheresis and cytostatics.

[The significance of changes in fibrinogen levels during thrombolytic therapy in myocardial infarct]. / Význam zmen koncentrace fibrinogenu pri trombolytické lécbe infarktu myokardu.

The submitted work was concerned with two problems: a) investigation of the dynamics of changes of the fibrinogen and fibrin breakdown products after a single dose of streptokinase, b) evaluation of the effectiveness of thrombolysis from changes in the fibrinogen concentration. Two groups of patients were examined with the Q form of acute myocardial infarction who were treated at an intensive care unit. The first group comprised 62 patients (mean age 56.3 years) who were given 1 million units of streptokinase by the i.v. route. The second group comprised 52 patients who were given 1.5 million units of streptokinase. The authors investigated the fibrinogen plasma concentration and the fibrin breakdown product concentration in serum after 3-hour intervals. Concurrently they examined the creatine kinase curve. They proved a significant increase of the fibrinogen and fibrin degradation products before thrombolysis (p less than 0.001). The fibrinogen concentration declined in both groups highly significantly with a maximum after 12 hours. The fibrinogen level reached normal levels in both groups after cca 24 hours. Patients with a high initial fibrinogen level (above 5 g/l) did not attain hypofibrinogenic values during thrombolysis. This phenomenon did not depend on the size of the streptokinase dose. The decline of fibrin breakdown products in both groups declined to baseline values within 24 hours. The authors confirmed that the effectiveness of thrombolysis is influenced among others also by the residual fibrinogen value.

[Preparation of thrombocyte concentrates in the Travenol CS-3000 separator (factors affecting the thrombocyte yield and presence of leukocytes)]. / Príprava trombocytárních koncentrátu separátorem Travenol CS-3000 (faktory mající vliv na výtezek trombocytu a prímes leukocytu).

The authors made 184 thrombocytaphereses for the preparation of thrombocyte concentrates on a Travenol CS-3000 separator. They evaluate indicators on which the thrombocyte yield depends: it was found that the yield is higher in donors with a higher number of platelets and that it increases with the period of separation. The mean thrombocyte yield was 2.91 +/- 0.84 x 10(11). It corresponded to the average lower platelet number of donors--182 x 10(9)/L. In those donors where the number of platelets was higher than 180 x 10(9)/L, the yield was 3.21 x 10(9)/L. The undesirable presence of leucocytes (in 98% lymphocytes) increases in relation to the number of leucocytes in the donor and their decline after separation. It was lower in longer separations. The authors discuss the possibility to increase the thrombocyte yield without contamination with leucocytes.

[Use of the isoradial chamber in the preparation of thrombocyte concentrates using the Travenol CS-3000 separator]. / Vyuzití izoradiální komurky k príprave trombocytárních koncentrátu na separátoru Travenol CS-3000.

During intensive treatment of haemoblastoses it is important to administer repeatedly high-quality platelet concentrates. The authors describe the first results obtained with the use of an isoradial chamber of Travenol Co. for separation on a CS-3000 separator. Using the chamber, they achieved in the first 20 patients a reduction of the separation time by 30 mins. (23%) and the thrombocyte yield was not reduced. The resulting product contained, however, more leucocytes. The chamber can be used to reduce the separation period also under Czechoslovak conditions where donors have smaller numbers of thrombocytes than reported by western authors (the microcomputer of the separator is set for a regime suited for larger thrombocyte numbers).

[Adverse effects of hemapheresis]. / Vedlejsí úcinky hemaferéz.

The authors performed 1252 haemaphereses, incl. 689 plasmaphereses. They divide the side-reactions as follows: Technical reaction: these do not threaten the donor directly; these reactions were recorded in 4.4%. Clinical reactions--total 6.8%. a) early, b) late. The authors recorded one severe reaction during plasmapheresis, there was however, no fatality. The most frequent reactions were: general symptoms, failure to withdraw blood because of poor state of the veins and hypotension. The authors analyze the importance of the observed reactions. They used continual separators where in general the incidence of reactions is smaller. They investigated also late reactions, in particular after development of infections in donors or in the staff working with the separator. Repeated donors were subjected to detailed immunological examination, no abnormalities were, however, recorded.

[Treatment of severely depressed hematopoiesis]. / Lécba tezkých útlumu krvetvorby.

Severe inhibition of haematopoiesis is a serious disease from the prognostic aspect. The authors evaluated a group of 26 patients of whom one survived for more than five years. The mean life span is 154 days. The most frequent cause of death are infectious complications, in particular septicaemia. Investigation of the aetiology of the disease was negative in 46% of the cases, in the remainder drugs were suspected most frequently, in particular antibiotics. It is very important to prevent the development of secondary inhibition of haematopoiesis, in particular by careful indication of myelotoxic drugs. In case of necessity, these drugs should be administered for a short time, in the lowest effective doses with check-ups of the haemogram. Hope for affected patients in future is transplantation of bone marrow and the early administration of antilymphocytic globulin.