[An open-label non-comparative study of the efficacy and safety of melaxen in treatment of sleep disorders in alcohol dependent patients during the period of abstinence].

Forty-five alcohol dependent patients with sleep and mild affective disorders were treated with melaxen (melatonin IR) for 3-weeks. All subjects did not use alcohol for at least 14 days prior the trial. The battery of psychometric scales (a subjective sleep quality questionnaire, the Epworth sleepiness scale, a sleep apnea screening questionnaire, HAM-A, HAM-D, an alcohol consumption questionnaire) was used. Melaxen distinctly improved sleep latency, quality and duration of sleep, breathing during sleep. The drug decreased daily sleepiness and affective disorders, particularly, anxiety. The dosage of melaxen ranged from 3 to 6 mg depending on the respond to the minimal dose.

[Spinal cord injury in multiple myeloma]. / [Porazhenie spinnogo mozga pri mnozhestvennoi mielome]

Myelomic spinal cord damage may be a result of both its compression and vascular disorders (squeezing of an artery, disorders of venous outflow). Diagnosis is based on evaluation of the following signs: normochromic anemia; increase of ESR, total protein and calcium levels; discovery of M-gradient in protein fractions of gamma-zone; multiple regions of destruction in spondylogramme. In doubtful cases magneto-resonance and computer tomography were the most informative. Highly effective was therapy with intensive chemoprogramme including either a range of preparations (alkeran, BGNU, cyclophosphan, adriblastina, prednisolon) or a combination of polychemotherapy with irradiation. The operation was indicated in both insufficiency of conservative therapy and increasing of the symptoms of the damage.

[The significance of lactate dehydrogenase and beta 2-microglobulin levels for the assessment of the prognosis and choice of therapy in multiple myeloma]. / Znachenie urovnia laktatdegidrogenazy i beta 2-mikroglobulina dlia otsenki prognoza i vybora terapii pri mnozhestvennoi mielome.

Serum levels of lactate dehydrogenase (LDG) and beta 2-microglobulin (beta 2-MG) were measured in 164 and 128 patients with multiple myeloma (MM), respectively. High levels of LDG were recordable in 15.4% of patients at diagnosis and 36.8% of terminal stage patients. The frequency of extraosseous foci in untreated patients with high LDG activity made up 36.8%, survival median 19 months. In normal LDG activity the above values were 6.8% and more than 36 months, respectively. The highest LDG level occurred in patients with terminal plasmic cell leukemia. MM with IgD secretion was characterized by a a more frequent rise in LDG concentrations. Normal LDG amounts in active MM were seen in 58 (54.2%) out of 107 patients. beta 2-MG levels exceeded 6 mg/l in 75 of 128 patients with normal creatinine. These patients had a short survival median 24 months. Those patients who had beta 2-MG levels under 6 mg/l have not reached survival median for 36 months of follow-up. The authors hold that beta 2-MG concentrations are of prognostic value in all myeloma secretions and in nonsecretory myeloma as well though their indications are not absolute as 14% had low beta 2-MG levels in high MM activity. Comparative results are presented for 40 high-risk MM patients. Group 1 (20 patients) have received standard chemotherapy. Group 2 (20 patients) have undergone intensive polychemotherapy. Survival median made up 12 and 26 months for group 1 and 2, respectively.

[Liver cirrhosis and lymphoproliferative diseases]. / Tsirroz pecheni i limfoproliferativnye zabolevaniia.

Seven patients suffering from liver cirrhosis combined with lymphoproliferative diseases: chronic lymphoid leukemia (n = 4), lymphosarcoma (n = 3) were placed under observation. Viral etiology of liver cirrhosis was established in 4 patients (HBV markers were revealed in the serum in 2 and in liver tissue in 1) and was assumed in 3 patients (the lack in the anamnesis of other hepatotropic factors; multilobular form of liver cirrhosis). In 5 patients, the lymphoproliferative disease was diagnosed 2-30 years after the appearance of the symptoms of chronic diffuse liver disease. In 2 patients liver cirrhosis and hemoblastosis showed up simultaneously. The role of hepatitis viruses, HBV in particular, in the onset of lymphoproliferative diseases is under discussion.

[The development of multiple myeloma in chronic diffuse liver diseases with a long course of monoclonal immunoglobulinopathy (a description of 2 cases)]. / Razvitie mielomnoi bolezni pri khronicheskikh diffuznykh zabolevaniiakh pecheni, dlitel'no protekavshikh s monoklonal'noi immunoglobulinopatiei (opisanie dvukh nabliudenii).

The authors describe 2 patients with chronic active hepatitis accompanied for many years by stable monoclonal immunoglobulinopathy. In addition to the formation of liver cirrhosis, these patients were diagnosed to have multiple myeloma. Analysis of the authors' and reported data (including those on transformation of liver cirrhosis associated with monoclonal immunoglobulinopathy to hepatocellular carcinoma) makes it possible to regard patients suffering from chronic diffuse liver diseases associated with monoclonal immunoglobulinopathy as a group at risk for paraproteinemic hemoblastosis and hepatocellular carcinoma. The pathogenesis of the development of paraproteinemic hemoblastoses and hepatocellular carcinoma in the indicated group of patients is under discussion.

Immuno-isotachophoretic determination of monoclonal immunoglobulin light chains produced by neoplastic B-cells: use in diagnosis, monitoring and detection of residual disease.

We suggest that countercurrent isotachophoresis performed on cellulose acetate membranes (ITP-CAM) should be used for detecting trace amounts of Bence-Jones protein (BJP) in urine of patients with chronic lymphocytic leukemia (CLL), non-Hodgkin's lymphoma (NHL) and related diseases. ITP-CAM allows simultaneous concentration and electrophoretic separation of proteins present in highly diluted solutions, as well as easy immunological detection of separated substances. BJP was found in 24 out of 42 patients with CLL, 33 of 56 with NHL and 3 of 3 with Waldenström macroglobulinemia. Twenty-three patients were followed during the course of chemo- or radiotherapy. In 19 cases the BJP findings correlated well with clinical status. In no case of partial or complete clinical response did BJP completely disappear from the urine.

[Monoclonal immunoglobulinopathy in chronic active hepatitis and liver cirrhosis]. / Monoklonal'naia immunoglobulinopatiia pri khronicheskom aktivnom gepatite i tsirroze pecheni.

The clinico-laboratory and morphological studies were performed to examine and characterize 15 patients with chronic active hepatitis and liver cirrhosis mainly of viral etiology, going in association with monoclonal immunoglobulinopathy. The diagnostic difficulties determined by the syndrome of monoclonal immunoglobulinopathy are demonstrated. The results of a long follow-up (up to 17 years) of the indicated patients' group are provided. A possible role is discussed of hepatitis B virus as a source of long antigenic stimulation in the origin of monoclonal immunoglobulinopathy in chronic diffuse diseases of the liver.

[Local immunity in pathology of the IgA system (IgA subclasses in the saliva of patients with A-paraproteinemia)]. / Sostoianie mestnogo immuniteta pri patologii IgA-sistemy (subklassy IgA v sliune bol'nykh A-paraproteinemiei).

In 39 patients with A-paraproteinemia, the local immunity status was estimated according to the level of IgA subclasses in the saliva and antibody activity of secretory IgA to E. coli and S. Sonnei. Local production of normal IgA was undisturbed only in 12 patients with A-paraproteinemia, since in the saliva of those patients, there was a normal correlation of IgA subclasses and the level of antimicrobial IgA antibodies was the same as in healthy persons. The overwhelming majority of the patients with A-paraproteinemia and all the patients suffering from heavy alpha-chain disease manifested deficiency of local production of normal IgA, which consisted in the impairment of the normal correlation of IgA subclasses in the saliva and in the reduction of sIgA function. A-paraprotein was detected in many samples of the saliva using agar electrophoresis followed by immunoblotting. Secretion was shown to be mainly penetrated by the polymeric forms of A-paraprotein.

[The successful surgical treatment of hypernephroid cancer in 2 patients with multiple myeloma]. / Uspeshnoe khirurgicheskoe lechenie gipernefroidnogo raka u dvukh bol'nykh mnozhestvennoi mielomoi.

The authors related two cases of multiple myeloma BJX and GX combined with hypernephroid cancer. In both cases, the diagnosis of myeloma was supported by morphological examination of the bone marrow and immunochemical identification of monoclonal immunoglobulin. In female patient C, adenocarcinoma developed in the presence of polycystosis in the left kidney operated before. The diagnosis of hypernephroma was established simultaneously with the diagnosis of multiple myeloma BJX, stage III B. The patient was operated on 15 months after institution of polychemotherapy in the presence of myeloma reduction and recovery of nitrogen secretory renal function. The patient survived for 2.5 years after the operation, retaining work fitness for 2 years. She died from terminal exacerbation of myeloma. On autopsy no cancer metastases were detected. In male patient Ch. with myeloma GX, stage II A, hypernephroid cancer of the right kidney was diagnosed 7 months after the diagnosis of myeloma was established. Radical operation resulted in complete somatic and hematological compensation of the patient. The residual mass of myeloma does not manifest itself clinically after 9 courses of polychemotherapy carried out in the preoperative period. It is only detectable by the laboratory tests. The follow-up of the patient is continued.

[Lymphatic tumors with monoclonal immunoglobulin secretion (clinical laboratory comparisons)]. / Limfaticheskie opukholi s sekretsiei monoklonal'nykh immunoglobulinov (kliniko-laboratornye sopostavleniia).

Immunochemistry of proteins of blood serum and urine using novel highly sensitive methods (immunofixed electrophoresis and countercurrent isotachoimmunoelectrophoresis on acetate-cellulose membranes) was performed in 123 patients with lymphatic tumors. Of these, 85 patients had chronic lympholeukemia, 21 lymphocytoma, 9 lymphosarcoma and 8 Waldenström's macroglobulinemia. Monoclonal secretion was detected in 49.6% of the patients on the whole. Isolated secretion of BJ protein turned out to be dominant immunoglobulinopathy in all the clinical groups under study. However, it was observed more frequently in chronic lympholeukemia than in lymphocytomas and lymphosarcomas (respectively 58.4% against 23.8 and 22.2%). Detailed clinico-laboratory comparisons have demonstrated that the patterns of lymphatic tumors with isolated secretion of immunoglobulin L-chains differed from nonsecreting ones in worse prognosis.

[Extracorporeal methods of therapy in lymphatic tumors]. / Ekstrakorporal'nye metody terapii limfaticheskikh opukholei.

The paper is concerned with the use of plasmapheresis, lymphocytapheresis, lymphocytaplasmapheresis and plasma perfusion in patients with tumors of the lymphoid tissue. Based on 976 plasmapheresis sessions given to 161 patients the authors demonstrate its efficacy in the treatment of patients with tumors of the lymphoid tissue associated with secretion of paraprotein whose presence gives rise to such complications as the syndrome of high viscosity, cryoglobulinemia, chronic renal failure, amyloidosis, cold hemolytic disease and other paraproteinemia-induced complications. On abundant material (535 sessions given to 98 patients) the authors review situations in which lymphocytapheresis, lymphocytaplasmapheresis and plasma perfusion may be indicated. Consider approaches to their performance as well as the clinical efficacy of the methods.

[The diagnostic importance of determining minimal amounts of the Bence-Jones protein in the urine of patients with morphologically nondemonstrable lymphatic tumors]. / Diagnosticheskoe znachenie opredeleniia minimal'nykh kolichestv belka Bens-Dzhonsa v moche bol'nykh s morfologicheski nedokazuemymi limfaticheskimi opukholiami.

Urinalysis by the IITP method in 115 patients with lymphatic tumors has shown that in half of them, BJ protein can be identified. The authors' and reported data evidence the lack of BJ proteinuria in normal people and in patients afflicted with other diseases. Since BJ proteinuria was demonstrable with the minimal tumorous mass in successfully treated patients with CLL and LC, the IITP method was used for excluding a morphologically undemonstrable lymphatic tumor in 23 patients with rheumatic diseases, AIHA, and splenomegaly of obscure genesis. Based on the identified BJ protein secretion in the urine, the diagnoses of CLL (I), LC (2), and LS (I) were proved in 4 cases. Later on these diagnoses were supported by the cytologic and histologic findings.

[Determining the level of the rheumatoid factor associated with polyclonal and monoclonal human serum IgA]. / Opredelenie revmatoidnogo faktora, sviazannogo s poliklonal'nym i monoklonal'nym syvorotochnym IgA cheloveka.

The authors studied the activity of the rheumatoid factor (RF) associated with polyclonal and monoclonal IgA contained in the sera of patients with chronic diseases of noninfectious etiology and A-paraproteinemia. IgA-RF-activity was determined by an enzyme immunoassay. In most of the patients' sera IgA had a high level of RF-activity. The frequency of RF-activity detection did not depend on the level of polyclonal IgA but correlated with the level of monoclonal serum IgA. During a study of the chromatographic fractions of sera containing monoclonal IgA, RF-activity was mainly revealed in the fraction of IgA polymers; IgA monomers forming the bulk of serum IgA, demonstrated no RF-activity. The inclination of curves reflecting the correlation between the level of IgA-RF and dilutions of tested sera made it possible to assess function of the affinity of such molecules which was growing with an increase in IgA molecular mass.

[The secretion of monoclonal immunoglobulins in chronic lymphoproliferative diseases]. / Sekretsiia monoklonal'nykh immunoglobulinov pri khronicheskikh limfoproliferativnykh zabolevaniiakh.

Altogether 74 patients (57 with CLL; 12 with lymphocytomas including 7 with generalization of disease; 5 with hairy cell leukemia) were examined to detect the secretion of serum monoclonal immunoglobulins (Ig) and Bence Jones (BJ) protein. Electrophoresis of the serum in agarose gel, radial immunodiffusion and immunoelectrophoresis as well as isotachophoresis with immune development for identification of minimal amounts of BJ protein in urine were employed. Monoclonal Ig in the serum and urine (IgG lambda + BJ lambda and IgA kappa + BJ kappa) were found in 2 CLL patients. BJ protein only was revealed in 40.5% of the examinees (kappa:lambda = 4.5:1). Direct correlation between the level of BJ protein secretion and tumor mass was shown. Effective therapy caused the reduction (but not disappearance) of BJ protein in urine. During a 2-year study BJ protein secretion was undetectable in the group of nonsecreting patients with a large tumor mass. Prospects of the use of the results obtained are under discussion.