P067 Bone manifestations of Haematological Malignancies

Background Bone manifestations complicate many haematological malignancies and usually reflect a progression of the disease, affecting the prognosis (1). Because of the diversity of imaging appearances and clinical behavior of this spectrum of disease, diagnosis can be challenging. The Objectives is to describe the characteristics of bone manifestations in hematologic malignancies. Methods A retrospective descriptive study reviewing the medical records of all patients with hematologic malignancies, hospitalized in an internal medicine department. Results Among 70 patients, 39 men and 31 women were enrolled. The mean age was 55 years (15–83 years). Bone manifestations were related to multiple myeloma (28 cases), Hodgkin's disease (16 cases), non-Hodgkin's lymphoma (13 cases), chronic leukaemia (6 cases), acute leukaemia (5 cases) and Waldenström's disease (2 cases). The clinical presentation was dominated by: an alteration of the general condition (45 cases), peripheral lymphadenopathy (28 cases), hepato-splenomegaly (22 cases), diffuse bone pain (21 cases), back pain (16 cases) and night sweats (13 cases). The complete blood count found cytopenia in 47 cases. Patients presented a biologic inflammatory syndrome (58 cases), kidney failure (23 cases) and hypercalcemia (13 cases). Osteolytic lesions were objectified in 13 cases and vertebral collapse in 4 cases. A myelogram was performed in 40 cases, a lymph node biopsy in 25 cases, a bone marrow biopsy (6 cases) and a bone biopsy in 4 patients. The treatment was based on chemotherapy +/- radiotherapy. Therapeutic abstention was indicated in some patients. Conclusion Multiple myeloma and Hodgkin’s disease have shown the most bone manifestations. Knowledge of the different characteristics of hematological malignancies is essential to enable early diagnosis and appropriate treatment.

ORAL HYGIENE STATE AND ITS CORRECTION OPTIONS IN CHILDREN WITH HODGKIN’S DISEASE

The Hodgkin’s disease (lymphogranulomatosis, LGM) stands at the top of the list among malignant lymphomas in children. The highest rate of it occurrence coincides with childhood. LGM is most common at 4-6 and 12-14 years. The scope of scientific clinical research on odontoand parodontopathology is limited among pediatric population. The quantitative and qualitative composition of plaque, its thickness and area is primary pathogenic chain. In turn, unsatisfactory oral hygiene contributes to the development of decay and periodontal and oral mucosal disease in children with LGM. Our research aims to study the oral hygienic condition in patients with LGM during different clinical stages of the underlying disease. In order to reduce the toxic effect of LGM treatment, rational oral hygiene preventive measures shall be implemented. Matherials and methods. A total of 45 patients of both sexes in the 5-15 year age group diagnozed with lymphogranulomatosis (LGM) were examined. 243 healthy age-and-sex-matched children were included in the control group. The patients with lymphogranulomatosis (LGM I) were examined after the initial diagnosis. Group II (LGM II) consisted of patients who had completed the first polychemestry treatment cycle. Group III (LGM III) included patients who had a constant remission period (from over 6 months to 5 years). The oral hygienic condition was studied using the Pahomov’s hygienic index, the simplified oral hygiene index (OHI-S by Greene and Vermilion), the PHP hygiene hygiene efficiency index (Podshadley, Haley, 1968), the modified Turesky index (1970), and API surfaces [6]. The data was statistically analyzed using Student's-Fisher's method. The Pahomov's hygienic index (PHI) in children aged 5-15 with LGM was quite different in the main and control groups (p<0.05). The score of PHI was 2.3 ± 0.05 (p<0.05) in patient group with LGM (LGM I). The Pahomov's hygienic index had increased in the children aged 5-15 diagnozed with LGM. The Pahomov’s index values from the second (LGM II) and third (LGM III) examinations were found to be quite different when compared to the control group of children of the same age (p<0.05). This PHI value was 3.39 ± 0.11 (very poor) after the second examination (LGM II) and was at 2.7 ± 0.10 (poor) during the third examination (LGM II). The satisfactory and unsatisfactory oral hygiene conditions according to the Pahomov’s index were observed in 5-15 year old children with LGM. The satisfactory and unsatisfactory oral hygiene conditions have been established using the Pahomov’s index, Green-Vermilion, Tureski, PHP, API in 5-15 year old children with LGM. The children might have completely given up on tooth brushing due to increased trauma and bleeding gums. Soft plaque is often responsible for dental decay in primary and permanent teeth in children and periodontal diseases. The analysis of the individual oral hygiene condition determined poor level of hygiene skill in patients with LGM compared to somatically healthy children. Hygienic condition and care depend on age, clinical stage of the underlying disease, the course of pathological complications in hard dental and soft oral tissues. Conclusion. Our clinical study established a poor oral hygiene condition by using different groups of dental hygiene indicators in patients with LGM. This condition particularly worsens during chemotherapy, which causes significant changes in periodontal, oral mucous and hard dental tissues. Children have low awareness of oral cavity care requirements or the specifics of selecting hygiene supplies and facilities. In those cases, the dental examination was required for raising awareness and providing oral hygiene control which was carried out among patients at different stages of the Hodgkin’s disease and it remission. Therefore, adopting such measures would provide an opportunity to increase the resistance of hard dental and periodontal tissues.

Recurrent Hodgkin’s Disease Presenting as a Clinically Isolated Cavernous Sinus Syndrome

Background. Hodgkin’s disease involving the central nervous system is uncommon and is usually seen in patients with uncontrolled systemic disease or those who have had multiple episodes of recurrent disease. Common symptoms of intracranial Hodgkin’s disease are motor and/or sensory deficits, headache, papilloedema, coma, and seizures. The rarity of Hodgkin’s disease presenting with intracranial involvement is marked, but patients presenting with cavernous sinus syndrome is even rarer. Despite its rarity, the presence of a cavernous sinus syndrome in a patient with a known history of Hodgkin’s disease warrants full utilization of modern diagnostic techniques in terms of investigation. Case Presentation. A 34-year-old woman, known with previous Hodgkin’s lymphoma and now in remission for the past 7 years, presented with signs and symptoms suggestive of a left cavernous sinus syndrome. She was otherwise systemically well with no other complaints. Extensive investigations revealed no obvious cause for the cavernous sinus syndrome. A CT chest revealed subclinical axillary lymphadenopathy, which on excisional biopsy confirmed recurrent Hodgkin’s disease. The patient’s sole clinical presentation of her recurrent disease was the cavernous sinus syndrome, with no other clinically obvious systemic signs or symptoms to suggest a relapse. This was treated with steroids, and clinical improvement was noted; she was referred to oncology for extensive chemotherapy. Conclusions. Whilst there is a paucity of literature around this topic, it must be remembered by the clinician that cavernous sinus syndrome may be the sole clinical presentation of recurrent Hodgkin’s disease. Even though it is reported that lymphomatous involvement in the brain usually occurs late in the disease process, this case is evidence that cavernous sinus syndrome may precede other systemic signs and symptoms. Recognising this possibility will ensure a rigorous search for Hodgkin’s disease, an early and effective diagnosis, and a better prognosis in affected patients.

A Case Report on Pulmonary Effusion due to Non-Hodgkin’s Disease

Introduction: In patients with non- Hodgkin's disease, pleural effusion is not an unusual finding, with a recorded incidence of up to 20 percent. The effusion can be unilateral or bilateral, and the fluid causes symptoms of dyspnoea, cough, and/or chest pain in most patients. Case Presentation: A 17 years male was admitted in AVBRH with the chief complaint of chest pain since 4 days on one side which radiated to left shoulder, breathlessness from 2 days on walking and cough from 1 month. Patient had no complaint of fever, cold, abdominal pain, vomiting, orthopnia or trauma. The patient had done all necessary investigations by physician order. Therapeutic Intervention, Management and Outcomes: Patient was treated with oxygen therapy, chemotherapy, Thoracentesis and anticoagulant, antibiotics medication. Nursing Management: Administered fluid replacement i.e. RL, oxygen therapy 15 litres per minute, chemotherapy, monitored all vital signs half hourly. Conclusion: Timely treatment and management of Pleural effusion with non-Hodgkin’s disease can bring out successful recovery with limited complications.

Kimura’s disease: an extremely rare case report in an elderly male, followed by Hodgkin’s disease

Kimura disease is a benign rare chronic inflammatory disorder of unknown etiology. The disease is mainly endemic in Asia, cases have been reported in Europe and America. The present case is of a 75 year Indian male who presented with cervical and axillary lymphadenopathy. Ultrasonography was done which showed multiple peritoneal lymph nodes. Peripheral smear showed eosinophilia. Cytomorphology and histopathology showed features of Hodgkin’s disease. S IgE level was raised. 5 years earlier patient had presented with similar complaints of generalized lymphadenopathy, raised IgE level, peripheral eosinophilia. FNAC of cervical lymph node done earlier showed cytomorphology of Reactive Lymphadenitis. Biopsy showed histology of Kimura’s disease.

“If you and I and our Lord . . .”: A qualitative study of religious coping in Hodgkin’s disease

Religious coping and spiritual struggles were qualitatively analyzed in 15 semi-structured interviews with Norwegian Hodgkin’s disease survivors. We asked, How is religious coping expressed in 15 Norwegian Hodgkin’s disease survivors? The analyses were theory-driven, using religious coping and spiritual struggles theories as explorative tools. Especially we focused on coping processes, coping dynamics, coping styles, and coping activities. The analyses show that religiousness functioned as a positive factor in coping with cancer in 14 of the 15 participants, equally distributed as conservational and transformational coping. The combination of the belief in a good, present God, eventually positive divine power, accessible through prayer, and religious support from people around the participants, were the most prominent activities in the religious coping processes. The religious coping had a character of being collaborative for almost all of the participants. Many participants had severe spiritual struggles. For many of the participants, it was difficult not only to be sick, but also to be a survivor. Theories on religious coping and spiritual struggles were useful and adaptable to a Norwegian sample regarding the main dynamics in the religious coping and spiritual struggles processes. The analyses detected a few different religious coping activities in this Norwegian sample compared to those identified in American samples, with the importance of meeting God in nature as the most significant difference.