[Long-term survival in multiple myeloma]. / Dlhodobé prezitie pri mnohopocetnom myelóme.

The authors present the results of 23-year protocol studies of survival with multiple myeloma, focused on problems of perspective long-term survival. Of 535 diagnosed patients between 1970 and 1990 the authors checked regularly and treated 475. In addition to 60 latent forms where treatment was administered only when clinical symptoms developed or after progression of laboratory signs, to all patients treatment was administered according to protocols (monotherapy-cyclophosphamide prednisone in 1970-1975 only to 30 patients, the remainder had combined treatment--COPP, VMCP, MOCCA); in the third stage of the disease MOCCA treatment is better. The median of survival of patients after VMCP treatment (in stage II) MOCCA (in stage III) is more than 90 months, 15% survive for more than 10 years. The authors emphasize the importance of combined intensive treatment of patients for the prognosis of survival. Long-term experience revealed that patients achieve an objective response in 85%, while the risk of leukaemic and cancerogenic complications is low (1.1%). The therapeutic effect and survival period are favourably affected by immunomodulation treatment (Interferon, proteolytic enzymes, thymus factor).

Prognostic value of plasma-cell immunophenotype in patients with multiple myeloma.

A review is given of the prognostic significance of immunophenotyping of blood lymphoplasmocytic cells. From a group of 250 patients followed from 1981 through 1991 a subgroup of 70 patients (followed 1986 through 1991) were phenotyped at 6-month intervals by immunofluorescence tests with monoclonal antibodies for cytoplasmic immunoglobulin, kappa-lambda index, CD71, CD10, CD20, CD38, and HLA-DR receptors. In course of a longitudinal study it was found that prognostic significance for shortened survival can be derived from the presence of circulating CD10, CD71, and CD20 positive undifferentiated cells in peripheral blood. There was a correlation between increase of CALLA positive and CD71 positive cells. Further, an increase of undifferentiated clone occurred during transition of the disease to an aggressive phase. The median survival of the total group of 250 patients treated by the VMCP/MOCCA protocol, according to statistical analysis, was 90 months, the median survival of the aggressive stage with plasmoblastic and lymphoplasmocytic cell type, respectively, was only 12 months. The significance of phenotypization in the prognostic evaluation of variant heterogenous myeloma types is stressed.

[Immunotyping of medullary and circulatory cells for prognostic evaluation of plasmacytoma]. / Imunotypizácia drenových a cirkulujúcich buniek pri prognostickom posúdení plazmocytómu.

The authors discuss the prognostic impact of immunophenotyping of circulating lymphoplasmatic cells in the peripheral blood stream in patients with generalized plasmocytoma. From a group of 250 patients followed up from 1981 to 1991 they selected a sub-group of 70 patients where they evaluated in 1986-1991 after six-month intervals the phenotype of medullary and circulating cells. They used the method of immunofluorescent detection of the presence of cytoplasmic Ig, the kappa-lambda index and phenotyping of antigens CD 9, CD 10, CD 20, CD 38, HLA-DR by monoclonal antibodies. In a longitudinal investigation of the survival period they revealed that the finding of circulating cells with signs of non-differentiation (presence of antigen CD 10 detected by antibody CALLA, presence of antigens B 1 (CD 20), CD 9 on circulating lymphocytes) has a prognostic meaning suggesting shorter survival. There was a direct correlation between the increase of CALLA positive cells and CD 9 positive cells. The authors found also that release of the clonus with signs of immaturity was present when the disease developed into the aggressive stage. While the group of 250 patients had according to statistical analyses, when treated according to protocol VMCP/MOCCA, a median survival of 90 months, the median survival of the aggressive stage (with the plasmoblast and lymphoplasmocytic type resp.) was only 12 months. The authors emphasize the prognostic importance of immunological typing of heterogeneous plasmocytoma populations.

Preservation surgery of the spleen.

Authors point out possibilities of preservation of the spleen or its parts in injuries and some diseases, especially non-parasitic cysts. Review is completed by a case report of successful management of a splenic pseudocyst by partial resection.

[Splenectomy in hairy cell leukemia]. / Splenektómia pri vlasatej leukémii.

Splenectomy was performed in five patients with hairy cell leukemia at the Surgical Department of the Hospital with Policlinic, Bezrucova, Bratislava, over the years 1982-1987. One of the patients died 3 years after operation due to progression of the disease, the other four patients have been surviving for 2-7 years following surgery without relapse of the disease. The presented results, compared with the world literature, justify splenectomy to be advocated as the primary therapeutic procedure in hairy cell leukemia.

[Long-term results of surgical treatment of portal hypertension]. / Dlhodobé výsledky chirurgickej liecby portálnej hypertenzie.

Large number of contradictory operative surgeries refer best to embarrasments, existed on this section of surgery. Today, from the amount of operative surgeries prevail the endoscopic sclerotization of the gastroesophageal varices. On basis of retrospective study of 48 portosystemic shunts was showed, that 28 operated patients survive average 8.1 year, till now 4 patients of them are alive, within 8-14 years. In 7 cases of azygoportal deconexion by Torres-Dengi, average time of survive was 2.5 year. There experiences led the authors to elaborate an algorithm of treatment of portal hypertension, where the postosystemic shunts are the portosystemic shunts are the effective palliative operative surgery in indicated cases.

[Ultrastructure of the red pulp of the spleen in various thrombocytopenias]. / Ultrastruktúra cervenej pulpy sleziny pri niektorých trombocytopéniách

The authors describe 10 cases of samples of spleen tissue obtained from patients with various thrombocytopenias which had been subjected to electron microscopical examinations. In splenomegalies associated with liver cirrhoses a certain proportion of platelets accumulated in the spleen, whereas others were ingested by macrophages. No significant polymorhism of the platelets was observed. In cases of idiopathic thrombocytopenic purpura marked polymorphism of the platelets as regards size and structure was observed. The platelets also showed a concoisuous relation to the polymorphonuclear laucotytes. The alterations of the inner structure of the platelets could not be regarded as specific, because they were also found in lymhogranuloma.