Prognostic significance of MRD [minimal residual disease] quantification by PCR in childhood acute leukaemia

Twenty five cases with acute lymphoblastic leukaemia were included in this study. They received induction, intensification and maintenance chemotherapy [Modified Berlin-Frankfurt-Munster BMP 76/79 Protocol], plus prophylactic cranial irradiation to a total dose of 1800 cGy/ 2 weeks/ 10 fractions. MRD quantification was done using real-time PCR. It was found that patients with negative MRD had much better overall and relapse-free survivals than those with positive one, 100% versus 20% and 100% versus 25% at the end of 24 months follow-up. Again, it was found that PCR-MRD levels > 0.01 or more can predict the relapse and the prognosis of those cases was much worse than those with lower levels

Clinical relevance of circulating vascular endothelial growth factor [VEGF] in patients with acute leukemia and non-Hodgkin's lymphoma

Vascular endothelial growth factor [VEGF] is a potent regulatory molecule of the process of new blood vessel formation [angiogenesis]. It is a critical process for tumor growth and metastasis. It might represent a promising therapeutic target in hematologic malignancies. The aim of this study is to assess serum level of VEGF, and its prognostic significance in non-Hodgkin's lymphoma [NHL], acute lymphoblastic leukemia [ALL] and acute myeloid leukemia [AML] patients. VEGF level was assessed in the sera of 47 patients before treatment [NHL; n=20, ALL; n=13, and AML; n=14] and controls [n=13]. Samples were collected again from patients with remission after chemotherapy [25 patients: 10 NHL, 8 ALL and 7 AML patients]. Before treatment serum VEGF levels in NHL and AML patients revealed significant elevation compared with control group [P-values: 0.048 and 0.032 respectively]. On the contrary, a highly significant reduction of serum VEGF was elicited in ALL patients compared with control group [P= 0.009]. After treatment, the serum VEGF levels were significantly reduced nearly to the control values in NHL and AML patients. ALL patients exhibited increasing trend of serum VEGF level in remission approaching control values. In NHL patients the correlation statistics revealed a significant positive correlation between serum VEGF level and serum LDH, uric acid, ESR, B-symptoms, and BM lymphocytes [P- 1 values: 0.007, 0.028, 0.001, 0.003, I and 0.023 respectively]. ALL patients I elicited non-significant correlation between serum VEGF and all other studied parameters. In AML patients, a significant correlation was found between serum VEGF level, and both -ESR [r sr 0.49, P= 0.024] and absoIute neutrophilic count [r = 0.617, P= 0.019]. Serum VEGF levels I showed prognostic information in predicting response to treatment of NHL and AML patients. In ALL patients serum VEGF level could be an early predictor of renewal of normal hematopoiesis after remission induction. Serum level of VEGF may be used to predict clinical outcome and/or monitor treatment of hematologicai malignancy

Congestion index of the portal vein and other predictors of variceal bleeding in portal hypertensive patients

Rupture of esophageal varices is the most common cause of massive, life threatening hemorrhage from the esophagogastric segment and portal pressure is necessary for rupture of varices but not all patients with elevated portal pressure bleed and local factors play a role. This study was designed to clarify the possible contribution of clinical risk factors and en-doscopic findings with portal hemodynamic changes in initiation of variceal bleeding. The study comprised 50 patients with liver cirrhosis and portal hypertension, 30 of them had a history of previous variceal bleeding and the other 20 patients didn't bleed before. After through history taking and clinical examination, liver function tests and complete blood picture were done, abdominal ultrasonography and Doppler study for the portal vein were performed and the congestion index of the portal vein [CI] was calculated and then upper gastrointestinal endoscopy was done. Results showed that mild to moderate splenomegaly, presence of ascites, increase in Child-Pugh score, thrombocytopenia and low prothrombin activity were associated with more variceal bleeding. Also results showed that CI of the portal vein was highly significantly increased in bleeders when compared to non-bleeders. The endoscopic prognostic index [PI] which depends on the size of esophageal varices, presence of gastric varices and congestive gastropathy was highly significantly increased in bleeders than in non-bleeders. Correlation studies showed that CI was positively correlating with Child-Pugh score and PI and it was negatively correlating with platelets count. From the above we can conclude that, for portal hypertensive patients, Echo Doppler of the portal vein which is a cheap and non-invasive technique should be done to select those with high CI to be submitted to endo-scopic screening for large and risky varices who would benefit from the available pharmacological and endoscopic prophylactic therapies

Gastric pull-up after total pharyngolaryngectomy

In this study, 50 patients with hypopharyngeal carcinoma underwent gastric pull-up following total laryngopharyngectomy. The postoperative mortality was 10% and the postoperative morbidity was mainly due to pleural injury, hemorrhage, minor fistulae and mediastinitis. It was found that fistulae occurred in 16% of the cases, hemorrhage in 4% and abdominal wound dehiscence in 4%. The perioperative mortality was 10% in the cases

Cysteine: as a radio-protector against total body irradiation syndromes an experimental study

The radioprotective effect of cysteine on the haemopoietic and gastrointestinal syndromes, was investigated on forty five mature albino rats which divided equally into: two test groups and a control group. The rats of the two test groups were exposed to total body irradiation [2000 cGy]. Cysteine was given intraperitoneally[1 05 mg/gm.] to the rats of the second group, 15 minutes before exposure to the irradiation. Statistical analysis of the blood picture and jejunal crypts mitoses, showed a high significant decrease in the first group with a remarkable significant improvement in the second group [except for Hb concentration and RBCs count]. All these results are supported by the clinical observations, bone marrow cellularity and histopathological findings

Increased tumor necrosis factor [TNF] level in patients with bronchogenic carcinoma with higher values in patients with bone marrow metastasis

TNF is a protein produced by various cell types, mainly monocytes, and has been originally shown to induce necrosis of tumors in vivo. Serum TNF-alpha levels were demonstrated by radioimmunoassay in 17 patients with bronchogenic carcinoma [9 cases with small cell carcinoma and 8 with squamous cell carcinoma]. TNF level was significantly increased in 14 patients [65 +/- 12 ng/L] in comparison with the control group [19 +/- 6 ng/L]. The highest TNF level was encountered in patients with small cell carcinoma, especially in those with bone marrow metastasis [3 cases]. The variation in the TNF level may be due to a variation in immunogenicity of different pathological types or a variation in the TNF receptor numbers of affinity on different cell types. TNF may have a role in the progress of the disease and the bone marrow Involvement

Tumor necrosis factor [TNF] in children with chronic liver diseases

TNF-alpha is a cytokine produced from monocytes and macrophages and has multiple biological activities. Serum TNF levels were determined by radioimmunoassay in 11 children with chronic liver diseases. TNF level was significantly increased in children with chronic liver diseases when compared with reference group [10 healthy children]. There was a significant positive correlation between TNF and liver enzymes [AST and ALT] and a significant negative one between TNF and Hb% and red cell count. TNF production may be related to hepatitis activity or viral replication. Elevations of TNF may contribute in a degree to bone marrow depression in those patients