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Biomedical subjects

G Janković

Publications and source records attributed to G Janković.

At least 19 recordsLinked to original sources
PubMed2005

[Endoscopic ultrasonography in pancreatic carcinoma].

Even though pancreatic cancer is not such a common diagnosis, its treatment is very expensive and it has a great economic impact to the health system. 5-year survival rates after excessive surgical treatment is only 5%, which imposes more careful selection of patients that have to be surgically treated. According to experience from some medical centers all over the world, EUS is considered as a high sensitive diagnostic method for establishing a diagnosis of pancreatic cancer and evaluation of TNM staging. The main purpose of this survey is to present our experience in using of EUS as a diagnostic method in establishing a diagnosis of pancreatic cancer, as well as to evaluate how reliable this method is in preoperative evaluation if tumor could be successfully resected. We examined the group of 63 patients with pancreatic cancer, which were surgically explored after EUS examination. We wanted to compare TNM status before and after the surgical treatment. All patients were examined by Olympus equipment for endoscopic ultrasound with radial probe working with the frequency of 7,5 and 12 MHz at the Department for Endoscopic Ultrasound of the Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia. Evaluation of pancreatic tumor extension to local organs (pancreas, duodenum, choledochus, stomach, colon and large veins) was performed for all patients. All regional lymph nodes were also explored. Due to low penetration ability of the probe working with the frequency of 7.5 MHz, EUS is not a suitable method for evaluation of M stage (figure 8,9). Patients were divided in different groups, specified by TNM status. For 10 patients resection was estimated as a probably successful solution, but only 8 of them was surgically treated. According to this, our estimation was 79.7% accurate, which is in accordance to results obtained from other medical centers all over the world.

Endosonography↗
PubMed2003

Long-term survival in acute lymphoblastic leukaemia in adults treated according to the LALA 87 protocol.

BACKGROUND: Between January 1989 and July 1995, a prospective study of the therapeutic efficacy of the LALA 87 protocol in adult acute lymphoblastic leukaemia (ALL) has been conducted. METHODS: A total of hundred and twelve patients with ALL have been analysed. The median age of the patients was 40 years (range: 15-65), the gender ratio (M/F) was 66/46, and the morphologic FAB (French-American-British) profile was L1 in 30 (26.9%) patients, L2 in 71 (63.3%) and L3 morphology in 11 (9.8%) of the patients. The LALA 87 protocol includes five phases: induction, consolidation, reinforcement, maintenance and central nervous system (CNS) prophylaxis with intrathecal methotrexate and irradiation. The induction phase comprised daunorubicin 50 mg/m(2) (days 1-3), cyclophosphamide 600 mg/m(2) (days 1 and 8), vincristine 1.5 mg/m(2) (on days 1, 8, 15 and 22) and daily oral prednisone on days 1-21. Maintenance therapy was given for 2 years and consisted of different drugs as reinforcement, daily 6-mercaptopurine and weekly methotrexate. RESULTS: Complete remission (CR) was achieved in 81 (72.3%) of the patients. The causes of induction failure were partial response in 10 (8.9%), and hypoplastic death in 12 patients (10.7%), and 9 were non-responders (8.0%). Of the 81 patients who achieved CR, 62 relapsed (76%). Among the relapsed patients, 9 developed CNS disease in spite of CNS prophylaxis during induction chemotherapy. Median follow-up for the living patients was 110 months. Median disease-free survival (DFS) was 16 months; 19 patients are still in remission with an estimated 10-year DFS (24%). Adverse prognostic factors were >50 years of age, immunologic subtype and cytogenetic profile. CONCLUSION: The results support the strategy of applying more effort and other treatment modalities in the therapy of ALL.

Administration, Oral↗
PubMed2001

Monocytoid B cell lymphoma associated with antibodies to myelin-associated glycoprotein and sulphated glucuronyl paragloboside.

Monocytoid B cell lymphoma (MBCL) is an immunologically and morphologically well-defined low-grade lymphoma with a predilection for lymph nodes of the parotid region. We describe an association of MBCL with anti-myelin-associated glycoprotein (MAG) polyneuropathy in a 53-year-old male. The diagnosis of stage IV MBCL with nodular bone marrow infiltration, Sjögren's syndrome and sensorimotor polyneuropathy was made in October 1996. Serum immunoelectrophoresis demonstrated IgMkappa paraprotein. This was then cross-reacted with epitopes of MAG and sulphated glucuronyl paragloboside (SGPG) on myelin sheaths, and detected by thin layer chromatography and Western blot. Direct immunofluorescence of a sural nerve biopsy showed loss of myelin fibres, segmental demyelinization and IgM deposits on the myelin sheaths. The cerebrospinal fluid was normal. After six cycles of chemotherapy (ChlVPP protocol), all the patient's haematological parameters normalized accompanied by an improvement in neurological signs. The improvement of the polyneuropathy after chemotherapy indicates that the autoimmune anti-MAG and anti-SGPG antibodies resulted from the neoplastic lymphoid proliferation.

Antibodies, Neoplasm↗
PubMed2000

[Toxic megacolon].

Toxic megacolon is a serious complication of inflammatory bowel disease, thus its prevention should be performed thoroughly. In patients with severe colitis refractory to maximal oral and topical therapy or who presents with toxicity, intravenous steroids are obligatory. If there is failure to achieve significant improvement within 7-10 days colectomy or treatment with intravenous cyclosporine or azathioprine are mandatory. In addition to maximal medical therapy as for severe colitis including broad spectrum antibiotics, patients with toxic megacolon should be kept nil per os, with small bowel decompression tube (if a small bowel ileus is present) and rotated into the prone or knee-elbow position frequently (evacuation of bowel gas). Any clinical, laboratory, or radiological deterioration require immediate colectomy. The duration of medical treatment of megacolon is controversial if no significant improvement is noted. Some experts support surgery within 72 hours, others take a more observing position if no toxic symptoms are present, but some advocate surgery within 24 hours.

Humans↗
PubMed1999

Hepatosplenic candidiasis after neutropenic phase of acute leukaemia.

Hepatosplenic candidiasis following granulocytopenic periods is a relatively recently recognised problem in immunocompromised patients, particularly in those with acute leukaemia. We present three patients in whom diagnosis of hepatosplenic candidiasis was suspected on the basis of ultrasonographic (US), computed tomographic (CT) findings and confirmed by laparoscopy and biopsy of liver lesions. All three patients were successfully treated briefly with amphotericin B, followed by a longer period of fluconazole. In one patient laparotomy and surgical evacuation of abscesses was performed. This condition could be more often recognised by careful follow-up of liver function test, C-reactive protein level, ultrasonography, CT and MRI after recovery from chemotherapy-induced neutropenia.

Adult↗
PubMed1999

Primary MALT lymphoma of the kidney.

A primary mucosa associated lymphoid tissue tumor (MALT) of the kidney in a 50-year-old man who suffered from on therapy resistant high blood pressure over 15 years period is presented. A mass in the right kidney (6x5x3 cm) during routine check up was discovered on ultrasonography and confirmed on CT scan and NMR. The patient was submitted to nephrectomy. A mass involving kidney, pyelon and upper part of the ureter was found. Histology showed low grade non-Hodgkin B-cell lymphoma of MALT type. The neoplastic cells were positive for monoclonal antibodies CD20, CD79alpha, surface and cytoplasmic and IgM immunoglobulins and showed light chain restriction (kappa+). After histology was available, a careful staging was performed. The disease was not found anywhere else. It was concluded that the patient belonged to the stage IE of primary kidney MALT lymphoma. Gastroscopy showed signs of chronic superficial gastritis. Urease test was positive and IgG antibodies against Helicobacter pylori in titer 421 were found as well. Except for Helicobacter pylori no additional therapy was given.

B-Lymphocytes↗
PubMed1997

Acute megakaryoblastic leukaemia in a patient with systemic lupus erythematosus.

We describe here a 72-year-old female patient with an acute megakaryoblastic leukaemia (M7 by FAB Classification) and systemic lupus erythematosus (SLE). The patient had not been pretreated with immunosuppressive therapy, which is potentially leukaemogenic. The karyotype displayed multiple, structural and numerical anomalies, suggesting a possible de novo rather than a secondary nature of leukaemia.

Aged↗
PubMed1991

Neutrophil alkaline phosphatase activity in the urinary neutrophils of a patient with chronic myelogenous leukemia.

We report here a patient with Philadelphia chromosome (Ph)-positive chronic myelogenous leukemia (CML) in chronic phase in whom the alkaline phosphatase activity of neutrophils in the peripheral blood was low while at the same time the alkaline phosphatase content of neutrophils present in the urine was elevated. This observation provides independent clinical support for the recent experimental finding that an extrinsic factor (granulocyte colony-stimulating factor) controls alkaline phosphatase expression in human neutrophils.

Aged↗
PubMed1990

[Origin of mature granulocytes in the active phase and in remission in various types of acute leukemias].

The problem of provenance of the mature granulocytes in acute myeloblastic leukemia (AML) and in acute lymphoblastic leukemia in their active phase and in remission is still completely unresolved. Mature granulocytes could possibly arise in acute phase of AML from the remaining normal möelopoietic or granulopoietic stem cell or from the very leukemic clone of stem cell which still display, at least partially, the ability to sustain maturation to normal granulocyte level. In ALL, mature granulocyte probably arise from normal granulocyte precursors. In remitted AML, according to opinions of a majority of authors, mature neutrophils descend from normal stem cells. Following the study of 19 patients with AML and 19 patients with ALL, by utilizing the morphological, cytochemical and cytoenzymic properties of granulocytes et the light and electronomicroscopic level the authors have concluded: (1) in comparison with normal granulocytes, granulocytes show in the active AML, hypogranularity as well as a decrease in the activity of all studied enzymes (myeloperoxidase, alkaline and acidic phosphatase and the esterases). (2) In ALL, mature granulocytes do not feature any particular differences in the above pattern as compared with normal granulocytes. (3) In AML remission, the difference between the mature granulocytes and the granulocytes in the active disease is rather slight as compared with the morphological, cytochemical an cytonzymic characteristics. The authors conclude that in a number of patients with AML and in the remitted patients mature granulocytes could possibly originate from the leukemic stem cells which acquired the ability to respond to normal CSF by manner of the gross destruction of the leukemic tumour mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Hereditary factors in the etiology of chronic lymphocytic leukemia].

Leukocyte counts, hemoglobin concentration, PAS positivity index in lymphocytes, leukocyte alkaline phosphatase, karyotype, HLA phenotype as wall as the quality of the cellular and humoral immunity have been studied in 45 patients with chronic lymphocytic leukemia (CLL) and in 103 their closest relatives (sibs, parents). The aim was to detect the possible preleukemic condition in the relatives as a strong propensity towards developing has been previously established in families of patients with CLL. In the CLL patients our studies have confirmed the results of the determination of similar parameters by other authors, namely a higher percentage of PAS+ lymphocytes than normal together with a variety of humoral and cellular immunity disturbances. Regarding the morphological and cytochemical changes in lymphocytes in family members of the CLL patients a higher frequency of PAS+ lymphocytes have been observed: it has been established in over 10 per cent lymphocytes (normally 4-8 per cent) in 31 (30%) examinees and in 14 (13.5%) of these persons the percentage of PAS positivity was equal to that found in CLL patients. Cellular immunity examinations established that in one third of examined E rossete counts counts were lower and in 2 persons the degree of this decrease corresponded to the decrease observed in CLL patients. In one fifth of the examined family members T4:T8 ratio was reduced. In the 13 per cent of the examined M rossete counts were increased, a fact which supports the notion that immunity of B cells exists in relatives of CLL patients. The authors contend that the increased percentage of PAS+ lymphocytes and inadequate functional maturity of the T and B cells in a relatively large number of family members of the CLL patients, intimates that a hereditary disturbance in the lymphocyte make up and their role in the immunity pathways exists and could possibly represent one of the factors implicated in a high frequency of CLL in some families.

Aged↗
PubMed1982

Effects of cytotoxic therapy on hypothalamic-pituitary-adrenal axis response to insulin-induced hypoglycemia in patients with a variety of acute leukemias.

The effect of cytotoxic therapy (including cytosine-arabinoside and thioguanine) on the adrenal response to insulin-induced hypoglycemia has been investigated in 15 newly diagnosed patients with an acute form of leukemia. Hypoglycemia was induced with crystalline insulin (0.15 U kg-1). Cortisol, growth hormone and prolactin were determined by radioimmunoassay at 0, 30, 60, 90 and 120 min during the insulin-tolerance test and also before and after the completion of the therapy. There was a significant impairment of a cortisol response after the completion of the cytotoxic therapy, while no significant changes could be detected in growth hormone and prolactin response. It is concluded that either cortisol synthesis or release mechanism was compromised by the cytotoxic therapy and/or metabolic derangements brought about therewith.

Acute Disease↗