scholarly journals The correlation between the level of secretion and the type of monoclonal paraprotein and kidney damage in lymphoproliferative disorders

2019 ◽  
Vol 1 (1) ◽  
pp. 31-40
Author(s):  
Olga Pisarevskaya ◽  
Aleksandra Kotelnikova ◽  
Sergey Kazakov ◽  
Nikolay Potekhin ◽  
Oleg Rukavicyn
Keyword(s):  
Renal Failure ◽  
Stage Iv ◽  
Kidney Damage ◽  
Renal Pathology ◽  
Stage Iii ◽  
Structural Components ◽  
Lymphoproliferative Diseases ◽  
Number Of Patients ◽  
Monoclonal Proteins

Introduction. The course of lymphoproliferative diseases accompanied by the secretion of paraproteins is complicated by damage to the kidneys and the development of renal failure. There is a pathogenetic relationship between the physicochemical properties of monoclonal proteins and renal pathology. Objective: to find out the relationship between the type of monoclonal paraprotein, the level of its secretion and the degree of renal failure in lymphoproliferative diseases. Patients and methods. We analyzed 108 patients with lymphoproliferative diseases in whom secretion of paraprotein was detected. Age from 31 to 86 years (median 62.5 years). Chronic kidney disease (CKD) was diagnosed in 78 out of 108 patients. Results. CKD was diagnosed in patients with multiple myeloma. Stage III CKD was diagnosed in 28 (35.9%) patients, stage IV - in 14 (17.9%), stage V - in 19 (24.4%). 91 patients were diagnosed with concomitant diseases predisposing to the development of renal pathology. In the blood serum of patients with paraproteinemic hemoblastosis in combination with CKD, the vast majority were patients with the secretion of Gκ and Gλ paraproteins, free light chains (FLC). In a significant number of patients, Bens-Jones protein (BJ) in urine was determined. Less commonly, the secretion of paraproteins Dλ, Aλ, Aκ and Mκ was determined. The highest level of pathological proteins of all classes and their structural components and fragments was observed in patients with stage III CKD. A negative correlation of glomerular filtration rate (GFR) with FLCκ in the blood (r = –0.21), GFR with BJκ (r = –0.35), GFR with FLCλ in the blood (r = –0.13), GFR c BJλ, which indicates a tendency to damage the kidneys of FLC and protein BJ. Conclusion. In patients with lymphoproliferative diseases accompanied by monoclonal secretion of paraprotein and kidney damage with the development of CKD, in most cases the blood paraproteins Gκ, Gλ, FLCκ and FLCλ as well as protein BJ in urine, were determined. Paraproteins Aκ, Aλ, Mκ, Mλ, Dλ were determined much less frequently in serum. The highest level of pathological Ig and their structural components was observed in patients with stage III CKD. No association with quantitative level, type of paraprotein, and kidney damage was found. The role of FLC and BJ protein in the development of nephropathy has been confirmed.

scholarly journals The role of paraproteins in kidney damage in patients with lymphoproliferative diseases

2019 ◽  
Vol 14 (3) ◽  
pp. 60-68
Author(s):  
O. N. Pysarevskaya ◽  
A. N. Kotelnikova ◽  
S. P. Kazakov ◽  
N. P. Potekhin ◽  
O. A. Rukavitsyn
Keyword(s):  
Stage Iv ◽  
High Risk Group ◽  
Kidney Damage ◽  
Stage Iii ◽  
Structural Components ◽  
Lymphoproliferative Diseases ◽  
Protective Function ◽  
Temporary Decrease ◽  
Monoclonal Proteins

Background. The course of lymphoproliferative diseases, in which the proliferation of a malignant clone is accompanied by the secretion of paraproteins, is often complicated by kidney damage. Perhaps kidney damage is associated with the physicochemical properties of monoclonal proteins.The objective of the study was to determine the relationship between the type of monoclonal paraprotein, its level of secretion, and kidney damage in lymphoproliferative diseasesMaterials and methods. A retrospective analysis of the data of 108 patients with lymphoproliferative diseases accompanied by paraproteinemia and kidney damage was performed. The age of the patients was 31–86 years (median 62.5 years). 78 out of 108 patients were diagnosed with chronic kidney disease (CKD). CKD was diagnosed in accordance with the clinical guidelines of KDIGO 2012.Results. In patients with multiple myeloma, stage III CKD was diagnosed in 28 (35.9 %) cases, stage IV – in 14 (17.9 %), stage V – in 19 (24.4 %). High risk group for CKD included 10 (9.3 %) of 30 patients without CKD. 91 patients were diagnosed with concomitant diseases predisposing to the development of kidney damage. In the group of patients with paraproteinemic hemoblastosis in combination with CKD, the vast majority were patients with the presence of IgGκ and IgGλ blood paraproteins, free light chains (FLC), and Bence-Jones protein (BJ) in the urine. At the same time, patients with the secretion of IgDλ, IgAλ, IgAκ and IgMκ paraproteins were much less common. The highest level of pathological Ig of all classes and their structural components and fragments was observed in patients with stage III CKD, which is also characteristic of other laboratory markers in CKD. A negative correlation of glomerular filtration rate (GFR) with FLCκ in the blood (r = –0.21), GFR with BJκ (r = –0.35), GFR with FLCλ in the blood (r = –0.13), GFR c BJλ, which indicates a tendency to damage the kidneys of FLC and protein BJ.Conclusion. In patients with lymphoproliferative diseases accompanied by monoclonal secretion of paraprotein and kidney damage with the development of CKD, in most cases IgGκ, IgGλ, FLCκ and FLCλ were determined in the blood, and protein BJ in urine. IgAκ, IgAλ, IgMκ, IgMλ, IgDλ paraproteins were determined much less frequently in serum. The highest level of pathological Ig and their structural components was observed in patients with stage III CKD. No association with quantitative level, type of paraprotein, and kidney damage was found. The role of FLC and BJ protein in the development of nephropathy is noted. The results of the study also show that with the development of the disease and kidney damage with subsequent progression of the stage of CKD in patients with lymphoproliferative diseases and proteinemia, there is a tendency to a temporary decrease in proteinuria and a compensatory increase in the number of paraproteins in the blood. This can be considered as one of the compensatory pathophysiological mechanisms of the protective function of the kidneys.

scholarly journals Is there an oligometastatic state in pancreatic cancer? Practical clinical considerations raise the question

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190627
Author(s):  
Marta Scorsetti ◽  
Tiziana Comito ◽  
Davide Franceschini ◽  
Ciro Franzese ◽  
Maria Giuseppina Prete ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Local Treatment ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Free Survival ◽  
Number Of Patients ◽  
Clinical Considerations

Objectives: To evaluate the role of stereotactic body radiotherapy (SBRT) as a local ablative treatment (LAT) in oligometastatic pancreatic cancer. Methods: Patients affected by histologically confirmed stage IV pancreatic adenocarcinoma were included in this analysis. Endpoints are local control (LC), progression-free survival (PFS), and overall survival (OS). Results: From 2013 to 2017, a total of 41 patients were treated with SBRT on 64 metastases. Most common sites of disease were lung (29.3%) and liver (56.1%). LC at 1 and 2 years were 88.9% (95% CI 73.2–98.6) and 73.9% (95% CI 50–87.5), respectively. Median LC was 39.9 months (95% CI 23.3—not reached). PFS rates at 1 and 2 years were 21.9% (95% CI 10.8–35.4) and 10.9% (95% CI 3.4–23.4), respectively. Median PFS was 5.4 months (95%CI 3.1–11.3). OS rates at 1 and 2 years were 79.9% (95% CI 63.7–89.4) and 46.7% (95% CI 29.6–62.2). Median OS was 23 months (95%CI 14.1–31.8). Conclusions: Our results, although based on a retrospective analysis of a small number of patients, show that patients with oligometastatic pancreatic cancer may benefit from local treatment with SBRT. Larger studies are warranted to confirm these results. Advances in knowledge: Selected patients affected by oligometastatic pancreatic adenocarcinoma can benefit from local ablative approaches, like SBRT

Lipids during Bufo arenarum oogenesis

Zygote ◽  
2003 ◽  
Vol 11 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Ariana Bruzzone ◽  
Jorgelina Buschiazzo ◽  
Telma S. Alonso
Keyword(s):  
Fatty Acids ◽  
Arachidonic Acid ◽  
Embryo Development ◽  
Stage Iv ◽  
Unsaturation Index ◽  
Stage Iii ◽  
Mitochondrial Population ◽  
Bufo Arenarum ◽  
High Level

The content and composition of phospholipids and triacylglycerols (TAGs) in Bufo arenarum oocytes in stages III and IV of their oogenesis were studied. The total amount of phospholipids in stage IV oocytes is 0.5-fold higher than in stage III oocytes. In both cases, the main phospholipids are phosphatidylcholine (PC) and phosphatidylethanolamine (PE). A striking observation concerns the high level of diphosphatidylglycerol (DPG) in stage III oocytes, which could be indicative of a relatively larger mitochondrial population with respect to other oogenetic stages. A net increase in sphingomyelin content was found during oogenesis. This fact could be related to the role of this phospholipid in the signal transductional pathways. In PC, palmitic (16:0), linoleic (18:2) and oleic (18:1) are the major fatty acids for both types of oocytes, while in PE the main acyl groups are 18:1, 16:0, arachidonic acid (20:4n6) and 18:2. PE is more unsaturated than PC and both phospholipids are more unsaturated in stage III oocytes than in stage IV oocytes. The amount of triacylglycerols is 0.3-fold higher in stage IV oocytes than in stage III oocytes. In both stages, the main fatty acids are 18:2, 18:1 and 16:0. During oogenesis, a significant increase in 18:1 and 18:3n3, and a decrease in 18:2 of TAG were found. The unsaturation index of TAGs from stage IV oocytes is higher than that from stage III oocytes. The TAG increase during oogenesis is consistent with the putative use of these lipids as a source of energy in embryo development.

scholarly journals The Role of Matrix Metalloproteinase9 (MMP9) in Endometriosis

2017 ◽  
pp. 203
Author(s):  
Amalia Amalia ◽  
Nusratuddin Abdullah ◽  
Umar Malinta
Keyword(s):  
Stage Iv ◽  
Stage I ◽  
Stage Iii ◽  
Chi Square ◽  
Cross Sectional ◽  
Significance Level ◽  
Chi Square Test ◽  
Cross Sectional Design ◽  
Metalloproteinase 9

Objective: To investigate the role of MMP-9 expression in endometriosis. Methods: The study was conducted from October 2015 to March 2016, an observational study with cross-sectional design. Samples are all endometriosis patients who underwent laparoscopic surgery in Dr. Wahidin Sudirohusodo Hospital and several other hospitals in Makassar. Samples were stored and fixed in the Grand Medika Histopathology Laboratory Makassar for examination the expression of MMP-9 using immunohistochemical methods. Conducted an analysis of 50 samples, of which 11 samples of stage II, 21 stage III samples, and 18 samples of stage IV. The data obtained and analyzed statistically using Mann Whitney and Chi Square test with a significance level of p <0.05. Results: The results reported rankings mean the expression of MMP-9 in stage I-II = 16.68, stage III-IV 27.99 (p = 0.013). There were differences in the expression of MMP-9 based on the stage. Stage I-II endometriosis had a more positive 2 expression of MMP-9 (45.5%), stage III-IV endometriosis have more positive 3 expression of MMP-9 (59.0%). The results of chi square test (p = 0.043). Conclusion: Higher expression of MMP-9 is significantly associated with higher degree of endometriosis. Keywords: matrix metalloproteinase-9, stages of endometriosis

scholarly journals Presenting features of supraglottic carcinoma of larynx

1970 ◽  
Vol 16 (2) ◽  
pp. 106-112
Author(s):  
Md Anwar Hossain ◽  
SM Tareq Uddin Ahmed ◽  
Md Monjurul Alam ◽  
Kamrul Hassan Tarafder ◽  
Abu Hena Mohammad Parvez Humayun
Keyword(s):  
Respiratory Distress ◽  
Stage Iv ◽  
Stage Iii ◽  
Advanced Stage ◽  
Cervical Lymph Nodes ◽  
Female Ratio ◽  
Presenting Symptoms ◽  
Supraglottic Carcinoma ◽  
Number Of Patients ◽  
Stage Stage

Objectives: To find out the presentation of supraglottic carcinoma of larynx.Methods: Fifty cases of supraglottic carcinoma were selected from the in-patient department of Otolaryngology and Head-Neck surgery of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital, Dhaka, during March, 2009 to August, 2009.Results: Among 50 cases in this study male: female ratio 11.5:1 and mean age was 55 years with range 35 years to 80 years. Majority of cases were from the lower socioeconomic group (66%). Regarding habit 94% were smoker, 60% were habituated with chewing betel leaf and betel nuts with or without other ingredient. Only 3 cases (6%) were alcoholic. Most of the cases presented with more than one symptoms and commonest symptoms was change of voice (82%) which was followed by dysphagia (76%), respiratory distress (54%) and neck swelling (42%). 32 (64%) cases had enlarged cervical lymph nodes out of which 27 (84.37%) were homolateral, 4 (12.50%) were bilateral and only 1 (3.12%) was contra-lateral. Vocal cord movement was normal in 23 (46%) cases, impaired in 12 (24%) and fixed in 15 (30%) cases. Most of the cases presented with exophytic lesion 34 (68%) where ulcerative lesion was 16 (32%). (52%) presented with involvement of arytenoid with aryepiglottic folds/vestibule of larynx, 12 cases (24%) had lesion at epiglottis with vestibule/aryepiglottic folds, 8 cases (16%) had lesion at vestibule with false cord, 4 cases (8%) had lesion involving the epiglottis only. Maximum number of patients had T3 lesion (44%) and T2 lesion was 36%. Most of the cases presented at an advanced stage, stage- IV was 42% and stage- III was 36%. Stage- I and stage- II were 6% and 16% respectively. Conclusion: Most common presenting symptoms of supraglottic carcinoma were change of voice, dysphagia and respiratory distress and most of the cases prented in an advanced stage (Stage III and Stage IV). Key words: Supraglottic; personal habit; neck node DOI: 10.3329/bjo.v16i2.6845Bangladesh J Otorhinolaryngol 2010; 16(2): 106-112

The significance of Toll-like receptors in selected nephropathies

2019 ◽  
Vol 55 (2) ◽  
pp. 107-112
Author(s):  
Sebastian Mertowski ◽  
Ewelina Grywalska ◽  
Jarosław Ludian ◽  
Agnieszka Grafka ◽  
Barbara Pęksa ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Inflammatory Reaction ◽  
Inflammatory Mediators ◽  
Modern Society ◽  
Kidney Damage ◽  
Toll Like Receptors ◽  
Molecular Patterns ◽  
Stimulation Of

The diseases associated with kidney damage are an increasingly common problem in modern society and complications of chronic renal failure can result in death. Research conducted by many scientific centers, both Polish and foreign, concern the search for possible factors involved in the pathogenesis of glomerulonephritis. One of the possible causes of nephropathy may include the dysfunction of Toll-like receptors (TLRs), which constitute a “bridge” between innate and acquired response. TLRs are involved in receiving signals related to pathogen associated molecular patterns (PAMPs) as well as receiving information related to the danger associated molecular patterns (DAMP). The stimulation of these receptors activates a cascade of reactions in the course of which various mediators, including pro-inflammatory mediators, are produced. The resulting long-lasting inflammation that develops within the glomerulus may cause kidney damage. In both nephropathies caused by excessive production of antibodies in the IgA class, as well as nephropathy induced by diabetes or lupus, the expression of individual TLRs may indicate an inducer of an inflammatory reaction cascade that leads to kidney damage. This article focuses on literature reports that present current views on the role of TLRs in the pathogenesis of the most common nephropathies.

TOPO1 expression in primary and metastatic GI cancers.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 643-643
Author(s):  
Michael Castro ◽  
Rebecca Feldman ◽  
Sandeep K. Reddy
Keyword(s):  
Metastatic Disease ◽  
Epithelial Mesenchymal Transition ◽  
Stage Iv ◽  
Stage Iii ◽  
Small Bowel Adenocarcinoma ◽  
Exact Test ◽  
Mesenchymal Transition ◽  
Number Of Patients ◽  
Metastatic Setting ◽  
Gi Cancers

643 Background: Irinotecan failed in Stage III colon cancer, but succeeds in Stage IV, to prolong survival. We propose that TOPO1 over-expression is a phenomenon of metastatic disease, and perhaps part of the epithelial-mesenchymal-transition (EMT) associated with metastatic phenotypes. Methods: 5029 colorectal (CRC), 3016 pancreatic, 848 gastric and 309 small bowel adenocarcinoma (SBA) patients were included in the study and tested centrally at a CLIA laboratory (Caris Life Sciences, Phoenix, AZ). A threshold of ≥ 2+ and ≥ 30% (intensity and percent staining) and TOPO1 (1D6) clone was utilized. TOPO1 was examined in primary and metastatic specimens. Two-tailed Fisher’s exact test was performed to test where proportions of positive results were different by subgroup (p ≤ 0.05). Results: See table below. Conclusions: The EMT associated with the transition from primary to invasive metastatic disease appears to include upregulation of TOPO1, in some GI cancers, including CRC, pancreatic and gastric cancer. The paradoxical failure of adjuvant irinotecan in stage III, the epithelial phase of the cancer, may be due to a smaller fraction of patient's whose cancers express this biomarker of response in that setting. A re-examination of irinotecan makes sense for a portion of stage III patients whose cancer expresses high levels of TOPO1 in the primary lesion. The recent superiority with regard to response rate and survival or FOLFOXIRI over FOLFOX alone in the stage IV setting raises renewed interest in whether patients with non-metastatic disease could derive a superior cure rate if suitably selected for FOLFOXIRI with a biomarker approach. At the same time, a large number of patients fail to express TOPO1 in the metastatic setting and perhaps should be spared irinotecan-based approaches including the use of FOLFOXIRI. [Table: see text]

The prognostic role of preoperative serum lactate dehydrogenase (LDH) in patients with resected advanced melanoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21054-e21054 ◽  
Author(s):  
Neil Majithia ◽  
Ana Velazquez Manana ◽  
Yiyi Yan ◽  
Lisa A. Kottschade ◽  
Roxana Stefania Dronca ◽  
...  
Keyword(s):  
Systemic Treatment ◽  
Stage Iv ◽  
Advanced Melanoma ◽  
Stage Iii ◽  
Adjuvant Radiation ◽  
Adjuvant Systemic Treatment ◽  
Upper Limit ◽  
Increased Risk

e21054 Background: Up to 50% of patients undergoing resection for advanced melanoma experience recurrence. Identification of preoperative prognostic biomarkers is needed to ascertain risk of relapse and guide postoperative management. Lactate dehydrogenase (LDH) represents a strong prognostic factor in unresectable metastatic (stage IV) melanoma, but its relevance in patients with resected stage III or IV disease remains unknown. Methods: We retrospectively analyzed data from patients with stage III and IV melanoma who had undergone complete resection of disease and received follow-up treatment at Mayo Clinic, Rochester between January 1, 2000 and January 31, 2012. Clinical data were collected from electronic records. Survival data were estimated using the Kaplan-Meier method. Associations of preoperative LDH with time to relapse and death were evaluated using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals. Results: A total of 154 subjects with resectable stage III or IV melanoma were included in the study. Median age at the time of resection was 58; 54 (35.1%) were female. One-hundred sixteen (75.3%) patients were classified as stage III and 38 (24.7%) stage IV. Adjuvant systemic treatment was administered in 75 (48.7%) patients and adjuvant radiation in 32 (20.7%). Median duration of follow-up was 4.0 years. Sixteen (10.3%) patients had preoperative LDH above the upper limit of normal. Each 50-unit increase in LDH was associated with a 15% increased risk of relapse (HR 1.15; p = 0.040) and 23% increased risk of death (HR 1.23; p = 0.001). After adjusting for age, gender, stage, number of sites, adjuvant systemic treatment, and adjuvant radiation, preoperative LDH remained associated with time to death (HR 1.25; p = 0.002). Preoperative LDH greater than the upper limit of normal was associated with increased hazard of death, both with univariate (HR 2.44; p = 0.005) and multivariate (HR 2.17; p = 0.017) analyses. Conclusions: This study supports the role of elevated preoperative LDH as a predictor of inferior outcomes in patients with advanced melanoma. Further study to correlate LDH to outcomes in the era of adjuvant immunotherapy is required.

CAPD in Canada in 1982

1984 ◽  
Vol 4 (2) ◽  
pp. 72-74 ◽  
Author(s):  
Gerald Pose” ◽  
Eric Lam ◽  
Anita Rappaport
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Equal Frequency ◽  
End Stage Renal Failure ◽  
Number Of Patients ◽  
Average Patient ◽  
Using Data ◽  
End Stage

This study examined the role of CAPD in the treatment of end stage renal failure in Canada in 1982, using data obtained from the Canadian Renal Failure Registry. In comparison to 1981, there was an increase in the number of patients on peritoneal dialysis. As of December 31, 1982, equal proportions of patients had started on hemodialysis and peritoneal dialysis. The average patient age was slightly lower for the hemodialysis. The most common reason for discontinuing CAPD was transplantation, followed by peritonitis and other abdominal complications. Over one-half of CAPD patients had no peritonitis; most of the episodes occurred in a minority of patients. In the initial treatment of children, CAPD and hemodialysis were used with equal frequency. At two years the survival of non-diabetic patients on CAPD was similar to that of hemodialysis patients. The Canadian Renal Failure Registry, which was established in 1981, receives data from all 68 dialysis units in Canada (1–2). The Registry has two parts: the first receives data from each centre, and the second concerns data only on patients who were started on treatment after the Registry came into existence, that is, 1981. This report examines the place of CAPD in the overall management of all patients in Canada with end-stage renal failure, and the use and complications of CAPD in patients who started therapy in 1981 and 1982.

The Role of Surgery in Non-Localized Neuroblastoma. Analysis of 59 Cases

1983 ◽  
Vol 69 (4) ◽  
pp. 327-329 ◽  
Author(s):  
Giovanni Cecchetto ◽  
Claudia Luzzatto ◽  
Modesto Carli ◽  
Maurizio Guglielmi ◽  
Luigi Zanesco
Keyword(s):  
Complete Remission ◽  
Primary Tumor ◽  
Multidisciplinary Treatment ◽  
Stage Iv ◽  
Surgical Excision ◽  
Stage Iii ◽  
Complete Surgical Excision ◽  
Stage Iv Disease ◽  
Localized Neuroblastoma

The authors considered 59 stage III and IV neuroblastoma cases, which were observed from January 1967 to June 1979. 13 patients (13/59 = 22%) are surviving in complete remission 3 years after surgery: 9/20 (45%) with stage III and 4/39 (10%) with stage IV disease. The children subjected to complete surgical excision are all alive irregardless of age; the children who were not operated on or subjected to a biopsy, have all died. Of the 33 patients who underwent a reductive excision, 6 (all under 2 years of age) are in complete remission (18%). A better prognosis was found in those patients in whom the site of the primary tumor was at the mediastinal level. These data show the importance of the role of the surgeon in the multidisciplinary treatment of stage III and IV neuroblastomas; our experience is also favorable to the practice of second-look surgery.

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