[Factors of an unfavorable prognosis in patients with B-cell chronic lymphoid leukemia: a retrospective analysis of 206 cases]. / Faktory neblagopriiatnogo prognoza u bol'nykh B-kletochnym khronicheskim limfoleikozom: retrospektivnyi analiz 206 sluchaev.

AIM: To assess factors of an unfavourable prognosis in a group of intermediate risk of B-cell chronic lymphoid leukemia (BCCLL). MATERIAL AND METHODS: 206 BCCLL patients (mean age 55.5 years, male/female = 1.66) entered the study conducted by Hematological Research Center in 1992-2000. RESULTS: Nine patients under 35 years of age did not survive 5 years except one female who achieved a complete remission on fludarabin. The type of bone marrow infiltration (diffuse vs interstitial and nodular), the time of lymphocyte count doubling (under or over 12 months) discriminate the patients by prognosis in the group of intermediate risk: medians of overall survival 65 months vs 148 months and 72 vs 133 months, respectively (p < 0.005 for both curves, log-rank criterion). Survival medians in groups with low (< 50% cells) and high (> 50% cells) expression of CD38+ cells in the group of intermediate BCCLL risk comprise 55 and 106 months (p = 0.005). The type of bone marrow infiltration and time of doubling of lymphocyte count overlap: > 70% patients with a diffuse type of bone marrow infiltration have the time of doubling under 12 months and vice versa while expression of CD38 do not overlap with these values. Combination of two signs (type of bone marrow infiltration and CD38 expression or time og lymphocyte count doubling and CD38 expression) allows more precise identification of prognostically unfavourable groups. Medians of survival for combination of the first two signs (two positive against two negative) comprise 51 months vs 169 months (p < 0.0001), for combination of the latter two signs 55 months vs 106 months was not reached (p < 0.001). Although most patients with a tumor form of BCCLL are referred to stage II, the prognosis in this form is much worse than in stage II, survival medians are 44 and 69 months, respectively (p < 0.05). A mutation status of the genes of a variable region of immunoglobulins enable identification of the group of patients with a relatively benign course of BCCLL (survival medians 61 and 289 months, p < 0.0001). CONCLUSION: In patients under 35 years of age BCCLL runs unfavourably and seems to require intensive polychemotherapy. Usage of a combination of the signs (CD38, time of doubling of lymphocyte count and type of bone marrow infiltration) is a simple and reliable method of identification of prognostically different categories of patients in the group of an intermediate BCCLL risk. Prognosis in patients with a tumor form of BCCLL is unfavourable: medians of survival in patients with a tumor form and stage III-IV are comparable. Mutational status of the genes of immunoglobulin variable region may serve a marker of a long-term prognosis.

[Differential diagnosis of neutropenia in large granulated lymphocyte syndrome and in rheumatoid arthritis]. / Differentsial'naia diagnostika neitropenii pri sindrome bol'shikh granulirovannykh limfotsitov i revmatoidnom artrite.

The paper reports a case of leukemia from large granulated lymphocytes (LGL) in a patient with rheumatoid arthritis and neutropenia, describes current aspects of this leukemia diagnosis including morphological, immunological and molecular-genetic methods, demonstrates other variants of neutropenia development in rheumatoid arthritis.

[Experience in intensive therapy of diffuse peritonitis in children]. / Opyt intensivnoi terapii razlitogo peritonita u detei.

The authors analyze their experience gained in the treatment of diffuse peritonitis in 51 children. The principal components of intensive therapy were effective antibacterial therapy, infusion therapy and parental feeding, prolonged peridural blocking and drug-induced sympathetic blocking, autotransfusions of UV-irradiated blood, and hemoperfusion. The activity of the gastrointestinal tract recovered in all the 51 patients, their clinical and laboratory parameters normalized, and the children were discharged in good condition.

[Complications in ultraviolet irradiation of the blood]. / Oslozhneniia pri ul'trafioletovom obluchenii krovi.

2380 sessions of ultraviolet blood irradiation have been analysed. A DRB-8 lamp was used as a source of irradiation. The complications observed were divided into 2 groups. Group 1 comprised complications associated with the technical performance of the manipulation, their rate being 1.3%. Group II comprised complications developed in ultraviolet blood irradiation. The complications observed in group II were as follows: rigor in 4 cases, hypotension in 2 cases, nasal bleeding in 3 cases, hypoglycemia in 1 patient, bronchospasm in 1 patient and urticaria in 1 patient. To prevent the onset of complications medical care and the oral intake of carbohydrates are recommended for 1.5-2 h after the session. Intramuscular injections are to be avoided for 1.5 h for fear of the appearance of hematomas.