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Infecciones por Papillomavirus/diagnóstico , Lesiones Precancerosas/diagnóstico , Neoplasias Cutáneas/diagnóstico , Adulto , Neoplasias del Ano/diagnóstico , Niño , Condiloma Acuminado/diagnóstico , Femenino , Humanos , Masculino , Neoplasias de Oído, Nariz y Garganta/diagnóstico , Neoplasias del Cuello Uterino/diagnósticoAsunto(s)
Anemia , Adulto , Anciano , Algoritmos , Anemia/diagnóstico , Anemia/terapia , Anemia Hemolítica/diagnóstico , Anemia Hipocrómica/diagnóstico , Anemia Ferropénica/diagnóstico , Anemia Macrocítica/diagnóstico , Transfusión Sanguínea , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Anamnesis , Talasemia/diagnósticoAsunto(s)
Antineoplásicos/efectos adversos , Diarrea/inducido químicamente , Mucositis/inducido químicamente , Neoplasias/tratamiento farmacológico , Vómitos/inducido químicamente , Antineoplásicos/uso terapéutico , Diagnóstico Diferencial , Diarrea/prevención & control , Nutrición Enteral , Humanos , Mucositis/prevención & control , Guías de Práctica Clínica como Asunto , Vómitos/prevención & controlAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Erupciones por Medicamentos/diagnóstico , Receptores ErbB/antagonistas & inhibidores , Neoplasias/tratamiento farmacológico , Quinazolinas/efectos adversos , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Antineoplásicos/uso terapéutico , Cetuximab , Diagnóstico Diferencial , Erupciones por Medicamentos/terapia , Clorhidrato de Erlotinib , Enfermedades del Cabello/inducido químicamente , Enfermedades del Cabello/diagnóstico , Enfermedades del Cabello/terapia , Humanos , Quinazolinas/uso terapéuticoRESUMEN
Paralleling increasing life expectancy, the number of cases of cancer in our population is also on the increase. The question as to whether chemotherapy for the treatment of a tumor in the elderly is appropriate or not, and if so what doses are required, depends in particular on the potentially increased toxicity of the drug in the old patient. The consequence is that alternative substances may have to be sought. When planning treatment, however, additional factors have to be taken into account, such as the possibility of differences in the physiology of the tumor in the elderly, the general state of health of the patient, the presence of concomitant diseases, possible interactions with other medications, and the patient's social environment.
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Antineoplásicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Broncogénico/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Ensayos Clínicos como Asunto , Neoplasias Colorrectales/tratamiento farmacológico , Femenino , Neoplasias Gastrointestinales/tratamiento farmacológico , Estado de Salud , Humanos , Esperanza de Vida , Neoplasias Pulmonares/tratamiento farmacológico , Linfoma/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Mieloma Múltiple/tratamiento farmacológico , Neoplasias/mortalidad , Cuidados Paliativos , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias de la Próstata/tratamiento farmacológico , Calidad de Vida , Factores de Riesgo , Neoplasias de la Vejiga Urinaria/tratamiento farmacológicoRESUMEN
OBJECTIVE: To analyze the results of cytomorphology and immunophenotyping in 54 patients with lymphomatous effusions. STUDY DESIGN: We report the results of cytomorphology and immunophenotyping in 54 patients with lymphomatous effusions. Twenty-three of the 54 had a previous diagnosis of NHL. In the remaining 31 patients, lymphomatous involvement was clinically suspected. RESULTS: Thirty-three lymphomatous effusions were positive for involvement by NHL. Twenty-one of these 33 patients (64%) had a previous diagnosis of NHL. Of the remaining 12 patients with newly diagnosed NHL, 11 had high grade lymphoma, and one had follicular center lymphoma. Twenty effusions were considered to be reactive; only two of these patients had NHL. One effusion revealed involvement by a previously unknown carcinoma. We observed seven false negative results if only one of both methods was considered. A high grade NHL was not diagnosed by immunophenotyping in one case, and six cases of low grade NHL could not be detected by cytomorphology. The combined strategy of cytomorphology and immunophenotyping had a sensitivity of 100% and specificity of 100% in our study, confirmed by follow-up studies. CONCLUSION: Both methods have shown difficulties in the examination of lymphomatous effusions. Cytomorphology has problems distinguishing reactive effusions from low grade NHL. The detection of high grade NHL by immunophenotyping is difficult. However, both methods together offer the advantage of dual staining ability and are most helpful in distinguishing clonal lymphomatous from reactive effusions.
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Inmunofenotipificación/métodos , Linfoma no Hodgkin/diagnóstico , Derrame Pleural Maligno/diagnóstico , Líquido Ascítico/patología , Citodiagnóstico , Femenino , Humanos , Linfoma no Hodgkin/clasificación , Linfoma no Hodgkin/patología , Masculino , Derrame Pleural Maligno/clasificación , Derrame Pleural Maligno/patología , Estudios RetrospectivosRESUMEN
Essential thrombocythaemia (ET) is a relatively benign chronic myeloproliferative disorder that occurs primarily in middle-aged patients. Its clinical course is characterised by thomboembolic and, less frequently, by haemorrhagic complications. Life expectancy of ET is generally of normal length and progression to acute leukaemia is a rare event. About one third of all patients are asymptomatic at diagnosis and many of them remain without complications for years. Therefore, the main challenge for treating patients with ET is to select patients who will benefit from a cytoreductive or antiplatelet therapy, because it is doubtful whether the beneficial effects of therapy outweigh the potential hazards in all cases. For this reason a risk stratification in high and low risk ET patients is essential. The treatment of ET has evolved from alkylating agents to hydroxyurea (HU) or pipobroman and more recently to agents such as IFN-alpha and anagrelide. Aspirin as an antiplatelet therapy is also expected to play a part in the treatment of ET. HU is first-line therapy for elderly patients with high risk ET. In young ET patients without ET related complications and a platelet count << 1000 - 1500 x 10(9)/l abstention from cytoreductive therapy or therapy with low-dose aspirin alone seems to be appropriate. The aim of this review is to address the current treatment practice for ET in adults.
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Trombocitemia Esencial/tratamiento farmacológico , Adulto , Aspirina/uso terapéutico , Humanos , Hidroxiurea/uso terapéutico , Interferón-alfa/uso terapéutico , Pipobromán/uso terapéutico , Pronóstico , Quinazolinas/uso terapéutico , Trombocitemia Esencial/diagnósticoRESUMEN
Immunophenotypic analysis of simultaneous specimens from different sites from the same patient with malignant lymphoma The assumption that immunophenotypic characteristics of different specimens obtained simultaneously from the same patient remain unchanged has rarely been evaluated. Using flow cytometry, we reviewed our experience of 29 patients with non Hodgkin's lymphoma (NHL). From these patients, 60 simultaneous specimens taken from the peripheral blood, bone marrow, effusions, fine needle aspirates from lymph nodes or cerebrospinal fluid were studied. In 26 out of 29 patients, the immunophenotype in the different specimens was identical. In one patient with unclassifiable low-grade B-NHL, immunophenotyping showed additionally a CD38 expression in the effusion which was not seen in the bone marrow. In one patient with mantle cell lymphoma, expression of CD10 in the lymph node was noted which was lacking in the peripheral blood. In the remaining patient with unclassifiable low-grade B-NHL, CD23 expression was noted in the lymph node but not in the peripheral blood. This retrospective study suggests that discordant antigen expression in samples from different body sites within the same patient is a rare event.
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Inmunofenotipificación , Linfoma no Hodgkin/inmunología , Antígenos CD/análisis , Ascitis/inmunología , Ascitis/patología , Biopsia con Aguja , Células Sanguíneas/inmunología , Células Sanguíneas/patología , Células de la Médula Ósea/inmunología , Células de la Médula Ósea/patología , Femenino , Citometría de Flujo , Humanos , Linfoma no Hodgkin/líquido cefalorraquídeo , Linfoma no Hodgkin/clasificación , Linfoma no Hodgkin/diagnóstico , Masculino , Derrame Pleural/inmunología , Derrame Pleural/patología , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVE: Thymic hyperplasia in the anterior mediastinum can occur in healthy children as idiopathic thymic hyperplasia or as a rebound effect after administration of chemotherapy in patients with malignancies. Thymic hyperplasia after chemotherapy is a well-documented phenomenon, particularly in children and less frequently in adults. Both forms of thymic hyperplasia are a diagnostic challenge, and most patients undergo surgical exploration. Fine needle aspiration cytology (FNAC) has supposed to be inadequate to diagnose benign thymic hyperplasia and to separate it from malignant disease. STUDY DESIGN: We report the cytologic findings on eight patients presenting with a mass in the anterior mediastinum that was diagnosed as thymic hyperplasia on FNAC. In five patients the masses developed after chemotherapy. The remaining three patients were healthy children. Three patients underwent ultrasound-guided aspiration; in five cases the procedure was performed under computerized guidance. RESULTS: In all eight patients the cytologic smears showed a mixed population of lymphoid cells. Cytologic diagnosis of thymic hyperplasia was confirmed by immunophenotyping in three patients and by follow-up studies in all of them (median, 68 months; range, 8-113). CONCLUSION: In contrast to previous reports, this study demonstrated the utility of FNAC as a front-line investigative procedure in diagnosing thymic hyperplasia.
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Enfermedades del Mediastino/diagnóstico , Enfermedades del Mediastino/patología , Hiperplasia del Timo/diagnóstico , Hiperplasia del Timo/patología , Adolescente , Adulto , Biopsia con Aguja , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To evaluate treatment and outcome of 17 pregnancies in nine patients with essential thrombocythaemia (ET) seen at our institution from 1988 to 1998. METHODS: Treatment and outcome of 17 pregnancies in nine ET patients were retrospectively analyzed. RESULTS: Seventeen pregnancies in nine patients with ET resulted in 11 (65%) live births and ended in six (35%) spontaneous abortions. Abortion could not be predicted from ET-associated complications before (p= 0.23) or during (p = 0.39) pregnancy. Maternal complications occurred during six pregnancies (35%): Three major bleedings in two patients with an acquired von Willebrand disease and two minor bleedings in patients treated with low-dose acetylsalicylic acid (ASA) were observed during pregnancy or at term; one patient suffered from transient visual loss while pausing low-dose ASA. Platelet counts prior to pregnancy were significantly higher as compared to the platelet nadir observed during pregnancy (p = 0.0017). Postpartum clinical course was uneventful in all patients. No specific treatment was given during 11 pregnancies. Six women received low-dose ASA during pregnancy followed by low-molecular-weight heparin until the end of the sixth week postpartum in five cases. This treatment was correlated with a favourable outcome (live birth versus abortion) when compared to no treatment (p=0.04). CONCLUSION: Pregnancy in ET can be complicated by first trimester abortion and/or maternal haemorrhage. Our limited observation suggest a positive impact of low-dose ASA during pregnancy followed by low-molecular-weight heparin postpartum on pregnancy outcome in ET; nevertheless, confirmation by prospective documentation is mandatory.
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Complicaciones del Embarazo , Resultado del Embarazo , Trombocitemia Esencial/tratamiento farmacológico , Aborto Espontáneo , Adulto , Aspirina/administración & dosificación , Aspirina/efectos adversos , Aspirina/uso terapéutico , Femenino , Hemorragia/inducido químicamente , Hemorragia/etiología , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Recuento de Plaquetas , Periodo Posparto , Embarazo , Estudios Retrospectivos , Trombocitemia Esencial/sangre , Trombocitemia Esencial/complicaciones , Hemorragia Uterina/complicaciones , Enfermedades de von Willebrand/complicacionesRESUMEN
OBJECTIVE: Extramedullary plasmacytoma is a rare plasma cell neoplasm. It can occur as the sole manifestation of plasma cell neoplasm, as a metastasis from another extramedullary plasmacytoma, as a solitary plasmacytoma of the bone or as a consequence of multiple myeloma. These plasma cell tumors can occur anywhere and have to be differentiated from other neoplasms, infectious processes and chloroma. STUDY DESIGN: We report the findings of fine needle aspiration cytology (FNAC) in 18 patients with extramedullary plasmacytoma. In six patients extramedullary plasmacytoma was the initial presentation of plasma cell neoplasm. In the remaining 12 patients the tumors occurred under or after treatment of plasma cell disease. RESULTS: Eleven lesions were located in the skin, seven in the lymph nodes, one in the liver and another in the spleen. Two patients with known diagnoses of plasma cell disease were thought, before FNAC, to have an infection, and two had a histologic diagnosis of non-Hodgkin's lymphoma. In 13 of 18 patients, cytologic smears showed anaplastic plasma cells. CONCLUSION: FNAC is a front-line investigative procedure in diagnosing extramedullary plasmacytoma.
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Enfermedades Linfáticas/patología , Plasmacitoma/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Femenino , Humanos , Enfermedades Linfáticas/diagnóstico , Masculino , Persona de Mediana Edad , Plasmacitoma/diagnóstico , Neoplasias Cutáneas/diagnósticoRESUMEN
Granulocytic sarcoma (GS) occurs in patients with chronic myeloproliferative disorders as well as in patients with acute myeloid leukemia (AML). These tumorous masses can occur anywhere in the body and have to be differentiated from lymphoma, carcinoma or infectious processes. We report the results of fine-needle aspiration cytology (FNAC) in 26 patients with GS. Seventeen patients suffered from AML and 9 from chronic myeloid leukemia (CML) blast crisis. In 5 patients with AML, GS was the initial presentation of hematological malignancy, in the remaining 21 patients, FNAC confirmed relapse of AML or extramedullary blast crisis of CML. In 8 patients, GS was located in the skin, in 17 in the lymph node and in another patient in the spinal canal. This study demonstrates the clinical utility and diagnostic accuracy of FNAC in the evaluation of GS from multiple sites.
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Biopsia con Aguja , Leucemia Mieloide/diagnóstico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Crisis Blástica/diagnóstico , Carcinoma/diagnóstico , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Humanos , Leucemia Mieloide/patología , Leucemia Mieloide de Fase Acelerada/diagnóstico , Ganglios Linfáticos/patología , Linfoma/diagnóstico , Masculino , Persona de Mediana Edad , Recurrencia , Neoplasias Cutáneas/diagnóstico , Canal MedularRESUMEN
In 40 patients with essential thrombocythaemia (ET) serum erythropoietin (EPO) and thrombopoietin (TPO) concentrations were determined and compared with the EPO and TPO values of a healthy control group. The mean EPO serum concentration for 24 control patients was 9.4 mU/ml +/- 3.7 (range 2-17.9), for 32 untreated ET patients at diagnosis 6.6 mU/ml +/- 7.6 (range 0.5-44.3) and for 8 ET patients treated with cytoreduction 14.1 mU/ml +/- 8.0 (range 4.5-26.1). Serum EPO levels in untreated ET patients at diagnosis were significantly lower compared with serum EPO levels in healthy control patients (p=0.002). Serum EPO levels in treated ET patients were not different from serum EPO levels in healthy controls (p=0.13) but were significantly higher compared with untreated ET patients (p=0.003). Serum TPO levels were determined in 18 of 40 ET patients, the mean TPO serum concentration was 211 pg/ml +/- 109 (range 62,5-345). The mean TPO serum concentration for 10 untreated ET patients at diagnosis was 162 pg/ml +/- 87 (range 62,5-302) and for 8 ET patients who had received cytoreductive treatment 272 pg/ml +/- 106 (range 96-345), respectively (p=0.04). Both serum TPO levels for treated and untreated ET patients were significantly higher (p<0.001) compared with serum TPO levels for healthy controls. The results of our study suggest a difference in the regulation of serum EPO and TPO in patients with ET. While the mean serum EPO level is decreased in untreated ET patients, the corresponding mean serum TPO level is increased. Treatment with cytoreduction, results in normalisation of the mean serum EPO level, whereas the mean TPO serum level remains elevated.
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Eritropoyetina/sangre , Trombocitosis/sangre , Trombopoyetina/sangre , Adolescente , Adulto , Anciano , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Essential thrombocythaemia (ET) is a clonal myeloproliferative disorder associated with an increased risk of both thromboembolic and bleeding complications. Platelet activation plays a crucial role in the pathogenesis of prethrombotic conditions. The platelet surface expression of p-selectin (CD62p) and thrombospondin (TSP) has been shown to correlate with platelet activation. In the present study, we used a flow cytometric assay to study whether the fraction of platelets expressing CD62p and TSP is increased in newly diagnosed ET. Thirty-four patients with newly diagnosed ET and 25 healthy control subjects were investigated. The proportion of platelets expressing the activation-dependent antigens CD62p and TSP was higher in patients with ET (CD62p: 14.7+/-15.0%; TSP: 12.4+/-9.9%) as compared with healthy control subjects (CD62p: 3.0+/-4.0%; TSP: 3.2+/-3.2%; p< 0.001). In ET, there was a linear correlation between platelet surface expression of CD62p and TSP (p<0.0001, r=0.83). At diagnosis of ET, 20 patients were symptomatic and 14 asymptomatic. Compared with asymptomatic ET patients there was no difference in the expression of CD62p (18.3+/-16.2% vs. 14.5+/-13.4%) and TSP (14.4+/-9.8% vs. 12.8+/-9.5%) in symptomatic ET patients. In conclusion, increased expression of platelet neoantigens is present at the diagnosis of ET. Both activation-dependent epitopes CD62p and TSP are increasingly expressed on the platelet surface in newly diagnosed ET patients.
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Plaquetas/metabolismo , Selectina-P/biosíntesis , Activación Plaquetaria , Trombocitemia Esencial/sangre , Trombospondinas/biosíntesis , Aspirina/farmacología , Plaquetas/efectos de los fármacos , Citometría de Flujo , Regulación de la Expresión Génica , Humanos , Persona de Mediana Edad , Selectina-P/genética , Activación Plaquetaria/efectos de los fármacos , Estudios Prospectivos , Trombocitemia Esencial/tratamiento farmacológico , Trombospondinas/genéticaRESUMEN
The purpose of this retrospective study was to evaluate the accuracy of positron emission tomography (PET) using 18-F-fluorodeoxyglucose (FDG) in predicting lymphomatous involvement in the hilar and mediastinal regions in the staging and follow-up of patients with malignant lymphoma. One hundred forty-seven thoracic PET studies in 89 consecutive lymphoma patients were reviewed. Static FDG-PET imaging was performed following application of 270 MBq FDG (mean). Results of FDG-PET were compared with the findings of computed tomography (CT) in all patients and clinical follow-up examination. Eighty-nine of 147 (60%) PET studies showed no FDG uptake in the hilar or mediastinal regions, while 58 (40%) studies did detect FDG uptake in these regions. In 52 of 58 abnormal studies (90%), lymphomatous involvement of the hilar and/or mediastinal regions seen by CT was present. In the remaining six abnormal PET studies (10%), FDG uptake was considered as false-positive because of missing lesions on corresponding CT scans. In four patients false-positive FDG uptake was observed before treatment, in two patients after completion of therapy. In these two patients FDG uptake after therapy was caused by thymus hyperplasia. The remaining four cases before treatment remained unresolved. Sensitivity of FDG-PET was 96%, specificity 94%, positive predictive value 90%, and negative predictive value 98%, respectively. The present study suggests that FDG-PET has potential value in predicting lymphomatous involvement in the hilar and mediastinal regions. FDG-PET may obviate invasive diagnostic procedures in patients with lymphoma.
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Linfoma/diagnóstico por imagen , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias Torácicas/diagnóstico por imagen , Tomografía Computarizada de Emisión/métodos , Adolescente , Adulto , Anciano , Femenino , Fluorodesoxiglucosa F18 , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Radiofármacos , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Noninvasive imaging methods are the cornerstone of the conventional staging of patients with Hodgkin's disease and non-Hodgkin's lymphoma. Gallium-67 scintigraphy has become an important and essential imaging method, especially in the restaging for assessment of residual masses in patients with lymphoma. Magnetic resonance imaging will be used in the future for confirmation of suspect local lesions. Imaging of lymphoma patients with somatostatin receptor scintigraphy will remain a secondary imaging method, which will not be as routine. Positron emission tomography with 18-F-fluorodeoxyglucose (FDG) has made the greatest steps forward and offers, when whole-body FDG-PET is used, the advantage that the entire body of the patient can be imaged. Nodal, extranodal, and bone marrow involvement have been imaged by FDG-PET with great sensitivity and specificity. Perhaps in the future, staging laparotomy for exact staging of lymphoma patients will be unnecessary, and patients will be staged solely with noninvasive staging methods.
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Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/patología , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/patología , Oncología Médica/tendencias , Animales , Humanos , Imagen por Resonancia Magnética , Estadificación de Neoplasias , Radiofármacos , Tomografía Computarizada de EmisiónRESUMEN
Only few cases of Behçet's and hematological malignancies have been reported until now. We recently observed a 39-year-old female patient with Behçet's disease developing a myelodysplastic syndrome (MDS) FAB subtype refractory anemia with excess of blasts in transformation [RAEB-t] with a monosomy 7 after being treated with cyclosporin A and chlorambucil for several years. This case is reported and the occurrence of hematological malignancies and Behçet's disease is reviewed.
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Síndrome de Behçet/tratamiento farmacológico , Cromosomas Humanos Par 7 , Monosomía/patología , Síndromes Mielodisplásicos/tratamiento farmacológico , Adulto , Antineoplásicos Alquilantes/administración & dosificación , Síndrome de Behçet/inmunología , Síndrome de Behçet/patología , Células de la Médula Ósea , Clorambucilo/administración & dosificación , Ciclosporina/administración & dosificación , Resultado Fatal , Femenino , Humanos , Terapia de Inmunosupresión , Inmunosupresores/administración & dosificación , Síndromes Mielodisplásicos/inmunología , Síndromes Mielodisplásicos/patologíaRESUMEN
OBJECTIVE: To determine the aetiology and clinical significance of an elevated platelet count (thrombocytosis) in a large cohort of patients. DESIGN: A retrospective review of the medical records was performed on all patients, who had at least one platelet count > or = 500 x 10(9) L-1. SETTING: Departments of Medicine and Surgery, University of Ulm, Germany. SUBJECTS: A total of 732 patients with thrombocytosis. MAIN OUTCOME MEASURES: Classification of thrombocytosis and thromboembolic complications, and evaluation of laboratory parameters distinguishing between primary and secondary thrombocytosis. RESULTS: Of the total of 732 patients, 89 (12.3%) had primary and 643 (87.7%) had secondary thrombocytosis. Essential thrombocythaemia was observed in 40 of 89 patients (45%) with primary thrombocytosis. The most frequent causes of secondary thrombocytosis were tissue damage (42%), infection (24%), malignancy (13%) and chronic inflammation (10%). Primary thrombocytosis was significantly associated with a higher platelet count and an increased incidence of both arterial and venous thromboembolic complications. In secondary thrombocytosis, thromboembolic events were restricted to the venous system and occurred only in the presence of other risk factors. Mean values of leucocyte count, haematocrit, erythrocyte sedimentation rate, fibrinogen, serum potassium and lactate dehydrogenase were significantly different in primary and secondary thrombocytosis. CONCLUSIONS: The finding of an elevated platelet count on routine blood examination has diagnostic, prognostic and therapeutic implications. It is of clinical importance to distinguish between primary and secondary thrombocytosis, as thrombotic complications occur more frequently in primary thrombocytosis. Unless additional risk factors are present, secondary thrombocytosis is not associated with a significant risk for thromboembolic events.
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Plaquetas , Trombocitosis/sangre , Trombocitosis/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Estudios RetrospectivosRESUMEN
BACKGROUND: Staging of Hodgkin's disease (HD) is accomplished by a variety of invasive and non-invasive modalities. This prospective study was undertaken to investigate the value of whole-body positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) in defining regions involved by lymphoma compared with conventional staging methods in patients with HD. PATIENTS AND METHODS: Fourty-four newly diagnosed patients with HD underwent FDG-PET as part of their initial staging work-up. PET findings were correlated with findings of conventional staging including computed tomography, ultrasound, bone scanning, bone marrow biopsy, liver biopsy and laparotomy. When results of FDG-PET differed to those obtained by conventional methods reevaluation was performed by biopsy, if possible, or magnetic resonance imaging. RESULTS: The results of FDG-PET were compared with three hundred twenty-one conventional staging procedures performed in 44 patients. FDG-PET was positive in 38 of 44 (86%) patients at sites of documented disease. PET detected additional lesions in five cases previously not identified by conventional staging methods. In another case a nodal lesion suspect on CT was negative at FDG-PET and was settled as true negative by biopsy. As a consequence of PET findings five patients had to be upstaged and one patient had to be downstaged, resulting in changes in treatment strategy in all six cases (14%). FDG-PET failed to visualize sites of HD in four patients. In two of our patients a false positive PET result was obtained. CONCLUSIONS: Our data indicate that FDG-PET provides an imaging technique that appears to visualize involved lesions in most patients with HD and is useful in the management of these patients.