Autoimmune complications in chronic lymphocytic leukemia: a single center experience

Chronic lymphocytic leukemia [CLL] is characterized by the progressive accumulation of B cells with mature appearance and a distinctive immunophenotype in peripheral blood, bone marrow, lymph nodes and other lymphoid tissues. Autoimmune complications are common in CLL and by far the most common manifestation is autoimmune hemolytic anemia [AIHA], followed by immune thrombocytopenia [ITP] and pure red cell aplasia [PRCA]. The study was carried was carried out to see the spectrum of autoimmune complications in patients diagnosed with CLL. This cross sectional study was carried out to describe the clinical presentation, haematological parameters and complications of CLL in patients coming to Shaikh Zayed Hospital [SZH], Lahore over a period of 6 years from June 2002 to July 2008. CLL cases were diagnosed according to the National Cancer Institute [NCI] criteria. The collected data was entered into SPSS version 13 for analysis. Thirty one patients were diagnosed with CLL and in 6 [19.4%] patients the disease was complicated by AIHA and in 1 [3.2%] patient by ITP at presentation. Autoimmune cytopenias were observed in 22% of 31 patients. Autoimmune hemolytic anaemia was more common than ITP, no patients of PRCA were recognized

Surgical experience with cardiac myxomas

Cardiac myxomas are the most common benign intracardiac tumours. We studied the clinical presentation of cardiac myxomas and the morbidity, mortality and recurrence rate following surgery at our institution over a 6 year period. This historical longitudinal study was performed at department of Cardiac Surgery, Armed forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, Pakistan between January 2002 and March 2008 a total number of 8506 cardiac operations were performed. Of these 34 patients [19 males, 15 females] underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made. Complete tumour excision followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 32 patients who survived the surgery, 29 patients were followed up at regular intervals for recurrence. The mean follow-up period was 34 months. Cardiac myxomas constituted 0.40% of the total cardiac operations at our institution. They most commonly occurred in the fourth decade. The commonest location was the left atrium [LA] [79%] followed by the right atrium [RA] [14%]. Only one patient had myxoma in the right ventricle [RV]. Patients with LA myxoma simulated mitral stenosis clinically whereas patients with RA and RV myxomas presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. There were two early deaths. One recurrence was noted at 27 months after surgery. No late deaths were observed in the study. Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity