Intra-abdominal Hypertension as a Cause of Oliguric Acute Kidney Injury in a Patient with Chronic Lymphocytic Leukemia.

Acute kidney injury (AKI) is a well-known complication in patients with chronic lymphocytic leukemia (CLL). It could occur via diverse mechanisms such as leukemic infiltration, extrarenal obstruction, tumor lysis syndrome, glomerular diseases, and medication side effects. The incidence of kidney disease at the diagnosis of CLL is about 10%. We report a case of AKI, in a patient with a known history of CLL, due to abdominal compartment syndrome, caused by extremely enlarged intra-abdominal lymph masses. To the best of our knowledge, no case of AKI due to such cause has been reported so far.

Serum Levels of Soluble FLT3 Ligand in Patients with Active Multiple Myeloma Constitute Marker of Bone Marrow Plasma Cell Proliferative Activity.

The FLT3-ligand is a molecule implicated in hematopoiesis. The aim of the present study was to detect any possible connections between serum levels of FLT3-L and multiple myeloma (MM) proliferation markers, such as serum levels of interleukin-6 (IL-6), B-cell activating factor (BAFF), beta-2 microglobulin (B2M), CRP and LDH, as well the percentage of bone marrow infiltration and the plasma cells' proliferation marker Ki-67 PI. We measured the above parameters in 58 patients with active MM. All circulating markers were significantly higher in MM patients compared to controls (p < 0.001 for all cases), and all values were increasing in parallel with disease stage (p < 0.001 for all cases). Positive correlations between FLT3-L were noted with serum levels of BAFF (p < 0.003), IL-6 (p < 0.002), CRP (p < 0.0001), LDH (p < 0.001), and BM Ki-67 PI (p = 0.012), whereas only trends of correlation were noted with the B2M value and the percentage of infiltration. It seems that the increased serum levels of circulating FLT3-L, in parallel with MM activity, reflect their increased presence in the bone marrow microenvironment, probably as an effect of increased angiogenesis and myelosuppression. Consequently, they are potential markers of disease activity.

Mast cells influence the proliferation rate of myeloma plasma cells.

In multiple myeloma (MM), mast cells (MCs) modify bone marrow microenvironment. In order to estimate whether MC density (MCD) in active MM bone marrows relates to the proliferative activity of plasma cells, we estimated in 42 patients MCD, microvascular density (MVD), and the Ki-67 proliferation index (PI) (immunohistochemical expression of tryptase, CD31, and Ki-67). MCD correlated with Ki-67 PI (p < .001), suggesting the important participation of MCs in MM biology and growth; MCs enhance angiogenesis and produce cytokines with growth effects on myeloma cells. Therefore, MCs could be valuable targets for therapeutic interventions.

Kidney organ donation knowledge and attitudes among health care professionals: findings from a Greek general hospital.

Identified barriers of organ donation advancement include lack of knowledge, personal beliefs, and a negative attitude from health professionals. This article reports on current knowledge and attitudes toward kidney donation among nurses and physicians in a Greek general hospital. A previously used questionnaire was applied. More physicians than nurses were donor card holders, with registration rates being lower than expected. Over half of the participants did not consider themselves well informed about registering as a kidney donor. Older nurses differed significantly from younger ones in their willingness to become live donors if an adult required a kidney. Nurses who were blood donors had higher odds ratio of feeling well informed when compared with nurses who were not blood donors. Integrating organ donation issues into undergraduate health science curricula and continuous education interdisciplinary programs is essential in increasing awareness, eradicating negativism, and reversing inertia.

Kidney organ donation: developing family practice initiatives to reverse inertia.

BACKGROUND: Kidney transplantation is associated with greater long term survival rates and improved quality of life compared with dialysis. Continuous growth in the number of patients with kidney failure has not been matched by an increase in the availability of kidneys for transplantation. This leads to long waiting lists, higher treatment costs and negative health outcomes. DISCUSSION: Misunderstandings, public uncertainty and issues of trust in the medical system, that limit willingness to be registered as a potential donor, could be addressed by community dissemination of information and new family practice initiatives that respond to individuals' personal beliefs and concerns regarding organ donation and transplantation. SUMMARY: Tackling both personal and public inertia on organ donation is important for any community oriented kidney donation campaign.

Acute lower limb ischemia as the initial symptom of acute myeloid leukemia.

Although coagulatory system disorders are well recognized in patients with acute leukemia, these usually present with either hemorrhagic complications or thrombosis of small vessels. Large vessel thrombosis is a very rare clinical presentation. We present a patient with previously undiagnosed acute myeloid leukemia (M5), who was referred to our hospital with symptoms of acute ischemia of his right lower limb. Occlusion of the right external iliac artery due to a combination of leucostasis and coagulation disorders was noted and successfully treated with urgent leukapheresis, immediate chemotherapy and surgical thromboembolectomy.