[Deposition of 51Cr-labeled donor platelets in health and myelosuppressive thrombocytopenias].

AIM: To study the deposition of donor platelets (DP) in myelosuppressive thrombocytopenia (TP) in patients with acute leukemia (AL) or lymphosarcoma (LSA), by using a radionuclide label (51Cr) for DP. SUBJECTS AND METHODS: Complex clinical, hematological and radionuclide studies were conducted in 63 patients divided into 3 groups: 1) 7 healthy volunteers (a control group); 2) 37 patients with AL; 3) 19 patients with LSA. RESULTS: Changes were found in the deposition of labeled DPs used to prevent and treat hemorrhagic syndrome in myelosuppressive TP in patients with AL or LSA. In AL, this function was established to be virtually completely suppressed whereas in LSA, some functional activity of mononuclear phagocytes was preserved. Different degrees of suppression of this function were probably related to the nature of these diseases and particularly due to varying degrees of leukemic infiltration of depot organs. A mechanism for increased consumption of transfused DP in profound TP, one of the causes of which is the myelosuppression as a result of programmed polychemotherapy, cannot be ruled out. CONCLUSION: By and large, the radionuclide labeling technique for DP may be useful in specifying a number of uncertain mechanisms for derangements of the thrombocytic component of hemostasis in oncohematologic diseases.

[The survival and sequestration of transfused donor platelets in cytostatic cytopenias].

AIM: To study the survival and sequestration of transfused donor platelets labeled with 51Cr in patients with acute leukemia (AL). SUBJECTS AND METHODS: Seven donor volunteers and 39 patients with different forms with AL at various stages of polychemotherapy (PCT) were examined. Cytostatic therapy was accompanied by 51Cr-labeled platelet concentrate (PC) transfusions. The patients were on appropriate high-dose (HD) PCT. RESULTS: The duration of donor platelet circulation was 8-10 days in healthy individuals. No platelet hypersequestration was recorded in both the spleen and the liver. Donor platelet survival was shorter in all patients with in a state of cytostatic cytopenia. There was an inverse correlation between the degree of circulation shortening and some clinical and hematological parameters (the bone marrow level of blastemia and blastosis, the XIIa-dependent fibrinolysis parameters). Four variants of radioactivity trends above the spleen and liver were identified. The findings suggest that there is platelet hypersequestration in the spleen, liver, and both organs. In some patients, the above both organs are uninvolved in the hypersequestration processes and the possible mechanism for increased consumption of transfused donor platelets, which is associated with recovery of the HD PCT-damaged vascular endothelium is considered. CONCLUSION: Shortening of transfused donor platelet circulation was found in relation to the level of blastosis. The described procedure may be used as one of the additional methods for evaluating the efficacy of donor PC transfusion and for specifying the pathogenesis of thrombocytopenias in AL patients on programmed HD PCT. A procedure is proposed to time the circulation of 51Cr-labeled platelets, by assessing deposit phenomena and estimating the level of their sequestration in the spleen and liver for the prediction of the efficiency of TC transfusions.

[Diagnosis of early manifestations of myocardial dysfunction at early stages of antitumor treatment in patients with lymphogranulomatosis and lymphosarcomas].

AIM: To comparatively assess the capabilities of currently available instrumental studies in the diagnosis of early cardiac performance changes in patients with lymph tumors at different stages of treatment and to study the myocardial histomorphological pattern in relation to the intensity of the therapy performed (as evidenced by sectional studies). MATERIALS AND METHODS: 44 patients, including 26 with various types of lymphogranulomatosis (LGM) and 18 with lymphosarcomas were examined at different stages of antitumor treatment. Radionuclide equilibrium ventriculography (REVG), echocardiography (EchoCG), and electrocardiography (ECG) were used. Postmortem studies of the myocardial histological pattern were conducted in 20 patients (archive data). RESULTS: No significant pathological REVG, EchoCG, and ECG changes were found in 10 patients examined prior to treatment. In a group of 17 patients receiving a total dose of doxorubicine of 240 +/- 30 mg/m2, there was a significant decrease in diastolic duration, a reduction in diastolic volume, end systolic volume, stroke volume, stroke index, filling fraction over 1/3 diastole. In a group of 17 patients receiving a total dose of doxorubicine of 250 +/- 30 mg/m2 and radiotherapy applied to the mediastinum, the above changes were more marked. There were myocardial histomorphological changes whose magnitude progressed as therapy became more intensive. CONCLUSION. The findings have indicated that by using relatively small cumulative dose of anthracyclines, cardiovascular dysfunction can occur at the early stages of programmed treatment for LGM and lymphosarcomas. REVG has the greatest advantage in their detection.

[Pulmonary extravascular water in patients with acute respiratory failure].

The purpose of the investigation was to study pulmonary extravascular water levels and pulmonary vascular permeability (PVP) in the pathogenesis of acute respiratory failure (ARF)/acute respiratory distress syndrome (ARDS). Twenty-nine patients with ARF/ARDS and 10 healthy volunteers were examined. Central hemodynamics and oxygen transport were explored, by using a Swan-Ganz catheter. Intrathoracic volemic parameters were studied by the transpulmonary thermodilution technique. PVP was assessed by the pulmonary 67Ga-labelled transferrin leakage index. Plasma colloid osmotic pressure (COP) was measured on an osmometer. In most patients with ARF/ARDS, the pulmonary extravascular water index (PEVWI) was found to be higher (mean 16.9 +/- 1.5 ml/kg). At the same time its value was not greater than 10 ml/kg in 7 (24%) of 29 patients. There were no correlations between PEVWI and PaO2/FiO2 and between pulmonary extravascular water and AaDO2. The PVP index (PVPI) measured by transpulmonary thermodilution was 3.2 +/- 0.2, it being normal in 13 (45%) out of 29 patients. The pulmonary 67Ga-transferrin leakage index was higher in all the patients than in healthy individuals (23.2 +/- 2.9 x 10(-3) vs 5.7 +/- 9.9 x 10(-3)) and correlated with PaO2/FiO2 (r = 0.71; p = 0.01). In patients with ARF/ARDS, COP was lower (19.9 +/- 0.7 mm Hg). There were correlations between COP and PEVWI (r = -0.34; p = 0.01), COP and PVPI (r = -0.40; p = 0.044), COP and PaO2/FiO2 (r = 0.35; p = 0.02). PEVWI correlated with the COP-pulmonary wedge pressure gradient (r = -0.45; p = 0.0024). Hypoxemia correlated with intrapulmonary shunt (Qs/Qt). There was no relationship between Qs/Qt and PEVWI in the group as a whole. According to the ratio of Qs/Qt to PEVWI, the patients were divided into 2 groups. Group 1 comprised 11 patients with the ratio < or = 2; Group 2 included 18 patients with the ratio > or = 2, i.e. with an unproportional shunt enlargement as to the severity of pulmonary edema. A correlation between Qs/Qt and PEVWI was found in both groups: r = 0.82; p = 0.001 with the ratio < or = 2 and r = 0.48; p = 0.04 with the ratio > or = 2. Diverse causes of shunt formation were histologically detected. Thus, pulmonary edema was not identified in 24% of patients with ARF/ARDS. Arterial hypoxemia is associated with the increase in the shunt, but, in a portion of patients, the shunt was caused with atelectasis unassociated with pulmonary edema. Increased pulmonary permeability for transferrin is detectable in ARF/ARDS irrespective the severity of pulmonary edema. The pathogenetic features of lung lesions should be taken into account while choosing a treatment for ARF/ARDS.

[Gamma-scintigraphy with Ga-67 citrate in differential diagnosis of residual tumors in lymphogranulomatosis and lymphosarcoma].

AIM: To study informative and diagnostic efficacy of quantitative evaluation of the results of gamma-scintigraphy in patients with lymphogranulomatosis and lymphosarcoma with prevalent mediastinal and pulmonary lesions. MATERIAL AND METHODS: 100 patients with verified lymphogranulematosis were studied: 67 with lymphosarcoma and 33 with mediastinal involvement. The mediastinal tumor monitoring was made before therapy, in complete clinicohematological remission, in progression using a complex of radio-, clinicohematological, histomorphological and radionuclide methods. RESULTS: A comparative analysis of the findings of radiation, radionuclide and histomorphological examinations of the removed residual mediastinal tumor in 10 patients showed that scintigraphic evidence was similar to that of histological findings in most of the examinees. CONCLUSION: A high diagnostic efficacy of a complex of radiation and radionuclide methods with Ga-67 citrate based on estimation of accumulation intensity providing comprehensive information about mediastinal tumor is demonstrated. A comparative analysis was made of the results of radiation, radionuclide and histomorphological examinations of the removed residual lesion of the mediastinum in 10 patients. In most cases, scintigraphic findings coincided with the results of histological studies of biopsies of mediastinal residual lesion.

[Thromboembolism of the pulmonary artery in Willebrand's disease].

AIM: To ascertain risk factors of thromboembolism of the pulmonary artery (TPA) in Willebrand's disease (WD). MATERIAL AND METHODS: We made a retrospective analysis of hospitalizations of WD patients for 10 years. We analysed causes of the patients' admission, interventions, registered maximal levels of factor VIII (FVIII) and Willebrand's factor (FW) in which the interventions were made, cases of TPA. RESULTS: Thirty four patients with WD were hospitalized 45 times. Three patients were treated conservatively because of gastrointestinal bleeding, the rest patients received surgical therapy. All the patients were given FVIII concentrates, cryoprecipitate, fresh-frozen plasma. In the course of the treatment, FW and FVIII levels were determined in 38% cases, FW--in 23%, FVIII--in 27%, coagulation was studied in 12% without test for FVIII and FW levels. Maximal concentration of FW was 72.1 +/- 11.8%, FVIII--125 +/- 15.8%. TPA developed in 2 (4.4%) of 45 patients. In both cases we observed a marked rise of plasmic concentration of FVIII due to therapy (250 and 240%). CONCLUSION: In patients with WD thromboembolic complications risk factors are age, obesity, surgical interventions, immobilization, etc. Simultaneous administration of several drugs containing FW and FVIII was also among the risk factors. Overdosage of FVIII is one of the causes of thrombotic complications in WD. FW and FVIII correlations in FVIII preparations must be considered. Prophylactic heparin therapy is recommended in patients with a high risk of thrombotic complications upon achievement of normal hemostasis.

[Possibility of diagnosis and treatment of thrombotic complications in primary mediastinal B-cell lymphosarcoma]. / Vozmozhnosti diagnostiki i lecheniia tromboticheskikh oslozhnenii pri pervichnoi mediastenal'noi B-kletochnoi limfosarkome.

AIM: Efficacy of the treatment of primary mediastinal B-cell lymphosarcoma depends to a great extent on early diagnosis and treatment policy. In this study we evaluated possibilities of diagnosis and treatment of thrombotic complications of primary mediastinal B-cell lymphosarcoma (PMBL). MATERIAL AND METHODS: 61 patients were examined using roentgenography, computed tomography, chest ultrasound investigation,coagulogram, allelle specific polymerase chain reaction, ultrasound investigation of the jugular, subclavian, brachial veins, vena cava superior to detect mutation of genes II, V factors and methylentetrahydrofolatereductase. RESULTS: In 7 cases prechemotherapy examination detected thrombosis of the internal jugular and subclavian veins. In 4 of 7 cases there was a combined thrombosis of the left internal jugular and subclavian veins, in 3 cases one the vessels was affected with thrombosis. In 2 cases, in the course of polychemotherapy, there was recurrent thrombosis and development of pulmonary artery thromboembolism (PATE). In progression of the disease there was thrombosis of the left subclavian vein (1 case) and PATE (a case). Coagulologically, hypercoagulation syndrome signs were registered. 5 patients with PMBL complicated by thromboses showed gene mutations. CONCLUSION: In PMBL there is a tendency to formation of venous thrombosis and development of PATE. This is explained by tumor process and hereditary factors of thrombogenicity. Therefore, specific antitumor treatment should include anticoagulation therapy.

[The diagnosis of a hemorrhagic syndrome in chronic myeloleukemia]. / K diagnostike gemorragicheskogo sindroma pri khronicheskom mieloleikoze.

A study was performed of 40 patients with chronic myeloid leukemia. Clinicohematological, radionuclide (51CR), electron-microscopic methods and examinations of plasma and platelet components of hemostasis were applied to elucidate stage-specific relationships between functional-morphological changes in platelets and early manifestations of hemorrhagic syndrome (HS). The latter was directly related to platelets functional activity and their ultrastructure. With HS progression, platelet functions decline, their degeneration becomes more evident in line with growing blood loss from gastrointestinal tract.

[Latent gastro-intestinal hemorrhages as symptoms of hemorrhagic syndrome in acute leukemia]. / Skrytye zheludochno-kishechnye krovotecheniia kak proiavleniia gemorragicheskogo sindroma pri ostrykh leikozakh.

A clinicoradiologic investigation of latent gastrointestinal hemorrhages was conducted in acute leukemia patients with the use of 51Cr. A total of 26 patients suffering from varying forms of leukemia with no external hemorrhages were investigated. Latent gastrointestinal hemorrhages were detected in 50% of the patients. A definite relationship has been revealed between the hemorrhage degree and the leukemic process stage, in acute periods of the disease the volumes of gastrointestinal hemorrhages significantly exceed the permissible volumes. The authors have shown that the method of quantitative determination of latent gastrointestinal hemorrhages with the use of 51Cr, due to its accuracy and informative value, can be recommended for practical use and scientific investigations.

[Quantitative evaluation of latent gastrointestinal hemorrhage in patients with iron deficiency anemia (preliminary report)]. / Kolichestvennaia otsenka skrytykh zheludochno-kishechnykh krovo- techenii u bol'nykh zhelezodefitsitnymi anemiiami (predvaritel'noe soobshchenie).

Radiologic investigation of concealed gastro-intestinal hemorrhage with 51Cr was conducted for its detection and quantitative estimation in 102 patients with iron-deficiency anemia (IDA), loss of blood from the digestive tract was detected in 52 of them. A definite relationship was noted between the volume of hemorrhage and the disease responsible for the development of IDA. Moderate hemorrhage from 2.5 to 15.0 ml/day was detected in chronic inflammatory diseases of the gastro-intestinal tract (GIT): chronic gastritis, colitis. High volumes of hemorrhage are characteristic of diseases attended by gross changes in the digestive tract: polyps, tumors, diverticula, varicosis in GIT. It has been shown that the radiologic method of quantitative estimation of concealed gastro-intestinal hemorrhage with the use of 51Cr is highly sensitive and accurate, that permitted the authors to recommend this method for both practical and scientific investigations.

[Analysis of the causes of post-transfusion complications in the Uzbek SSR]. / Analiz prichin posttransfuzionnykh oslozhnenii v Uzbekskoi SSR.

An analysis has been made of 85 cases of posttransfusion complications recorded in the Uzbek SSR during 10 years (1979-1988). Most of the complications were caused by incompatibility of donor's and recipient's blood with respect to isoserologic systems of red blood cells (55), by transfusion of poor quality solutions (17), and by taking no account of contraindications to transfusion of blood and blood substitutes (13 cases). The main causes of the complications were insufficient competence of physicians in transfusiology, their inattention and disregard of the instructions on transfusion of blood and blood substitutes. The authors have suggested certain organizational measures to improve the quality of training the clinicians in transfusiology.

[Importance of direct roentgeno-radioisotope lymphography in the diagnosis of lymphogenic metastasis]. / Znachenie priamoi rentgenoradioizotopnoi limfografii v diagnostike limfogennykh metastazov.

Using the results of direct x-ray-radionuclide lymphography in 119 patients with malignant tumors of different sites lymphogenic metastases were diagnosed in 68% of the cases as compared to 52% with the use of radiopaque direct lymphography only and 36.5% of the cases detected on clinical examination. This method made it possible to change in 44 out of 119 patients a stage of the disease to a more advanced one.