[Essential thrombocythemia and miliary tuberculosis].
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Biomedical subjects
Publications and source records attributed to M Rozman.
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In the prognostic evaluations the initial variables, obtained at the time of diagnosis, and the evolutive or time-dependent variables, that appear during the course of the disease, should be clearly differentiated. If this separation is not strictly maintained inaccurate results may be obtained. The errors resulting from the use of an inappropriate methodology are illustrated in the present article on the basis of two series of patients. On the other hand, the advantages and shortcomings of alternative methods, which are valid for prognostic studies with evolutive or time-dependent variables, are discussed. Finally, recommendations are given for the particular instance where the response to therapy in a therapeutic trial is being assessed.
The authors report two cases of chronic lymphocytic leukemia and portal hypertension without an apparent cause. In the first patient, the histopathological study disclosed severe lymphocytic infiltration of the liver with moderate fibrosis of portal spaces. In the second patient, regenerative nodular hyperplasia of the liver was shown to be associated with lymphocytic infiltration. On the basis of these two observations, the authors discuss the mechanisms of portal hypertension in chronic lymphocytic leukemia. It is concluded that there probably is a causal relationship between both disorders, although its pathogenesis may be diverse.
Out of 113 cases of blastic crisis (BC) of Ph'-positive chronic myeloid leukaemia (CML), 13 had extramedullary involvement, this being the first BC manifestation in 5 instances. The median interval between extramedullary BC and bone marrow BC in these last was 2 months. Lymph nodes were the commonest extramedullary site of BC (8 cases), followed by osteoperiosteal and central nervous system (CNS). Lymph node BC occurred as generalised lymphadenopathy in most cases. Osteoperiosteal BC was seen as severe bone pain on osteolytic areas, whereas CNS blast crisis occurred as meningeal leukaemia in one case and chloroma in another. Lymphoid phenotype of blast cells was found in only 2 instances. The median survival of the patients after the onset of extramedullary involvement was 3 months.
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BACKGROUND AND OBJECTIVE: A magnetic resonance (MR) signal shows an inverse correlation with bone marrow cellularity. In this study, we investigated the possibility of estimating the degree of bone marrow cellularity by means of this non-invasive technique. METHODS: In 25 patients with different hematological disorders and homogeneous bone marrow distribution, the percentage of bone marrow cellularity was compared to the MR signal of four middorsal vertebrae in T1 sequence. As internal control, the MR signal of the mid-dorsal spinal cord region was used. The results were expressed as the MR signal ratio (great mean MR signal of four vertebrae/MR signal of the spinal cord). RESULTS: The correlation coefficient (r) between both parameters was -0.93 (p < 0.0001). All observed values fell within the 90% limits of predicted values. The mean difference between observed and predicted bone marrow cellularity was 5.6 (SD 4.0)%. INTERPRETATION AND CONCLUSIONS: The measurement of the MR signal is not easy to standardize since it depends to a large degree on the control employed. The spinal cord proved to be a satisfactory internal control of the MR signal. Within defined conditions, MR can be useful for a rough estimate of bone marrow cellularity in several clinical situations, such as analysis of tumor burden for prognosis of some leukemias and the evaluation of response to therapy in both proliferative and hypoplastic disorders.
The coexistence of chronic myeloid leukemia (CML) and B-cell chronic lymphocytic leukemia (CLL) in the same patient is rare. A 71-year-old woman developed a B-lineage lymphoid blast crisis at 18 months after diagnosis of Ph-positive CML. At this time, a lymphoid cell population with morphologic and immunophenotypic features of CLL was demonstrated. The retrospective review of the tests performed at diagnosis and thereafter disclosed the presence of lymphoid nodules in the initial bone marrow biopsy in the absence of lymphocytosis. Subsequently, there was an appearance of moderate lymphocytosis in the following months. Therefore, diagnosis of CML and coexistent CLL was established. Although a transient remission of blast crisis was achieved, blast cells reappeared two months later and the patient died shortly afterwards. Molecular studies of the immunoglobulin heavy chain gene (IH) rearrangement pattern point to the origin of the diseases in two different cell clones. In addition, previously published cases of simultaneous CLL and CML are reviewed.