The association of intracranial aneurysms and sickle cell disease (SCD) has been described in the English-language literature. Treatment strategies have included angiography and craniotomy. However, with advancement of non-operative interventions, much controversy surrounds the treatment of these patients. Endovascular embolization has been used in many patients with cerebral aneurysms, but it had been reported in the literature in only two sickle cell patients. The authors present a case of endovascular embolization of multiple intracranial aneurysms in a patient with sickle cell anemia with good outcome. Am.
Introduction: Chronic Lymphocytic Leukemia (CLL) is the most frequent adult leukemia in western countries. It is known to have a heterogeneous clinical course, some patients presenting an indolent disease while others have an aggressive disease requiring prompt treatment. Therefore, an individualized approach, especially in early clinical stage patients is necessary. Recent studies suggest that the biological markers LPL and ADAM-29 could be useful to predict prognosis in CLL patients: LPL being associated with an unfavorable prognosis while ADAM-29 to favorable one. Aims: to evaluate the expression of LPL (L), ADAM-29 (A) and the L/A ratio in CLL patients in regard to Binet clinical stage and progression free survival (PFS). Patients and Methods: thirty CLL patients followed at UNIFESP/EPM and HSPE were studied. RNA extraction was done by the TRIZOL method followed by c-DNA synthesis. c-DNA was amplified by PCR using LPL and ADAM-29 specific primers. T-Student’s exact test was used to compare the genes frequencies and Kaplan Meyer analysis to evaluate PFS. The results were considered statistically significant when p<0.05. Results: Of the 30 CLL patients studied (16M/14F, median age of 67 years, varying from 38 to 64 years) 19 (63,3%) were early clinical stage (Binet A), 8 (26,7%) Binet B and 3 (10%) Binet C. In the Binet A group LPL was negative in 52.63% of the patients and ADAM-29 positive in 63.15% with relation LPL-/ADAM29+ (or L/A=0) in 52.63% (10/19). In contrast among Binet B and C patients 90% (10/11) presented relation LPL+/ADAM-29- (or L/A=1). Those who were LPL+ or ADAM-29- or L/A=1 had a shorter PFS when compared to those LPL-or ADAM-29+ or L/A=0 (p<0.05). Patients, even those in early clinical stages (Binet A and B), when LPL+, ADAM- and L/A=1 constitute a group with an unfavorable prognosis with a short DFPS (p<0.05). Conclusion: Our study shows that patients with a positive expression of LPL, negative for ADAM-29 and with L/A=1 have unfavorable prognosis independent of clinical stage. Analyzing Binet A and B together, we identified a subgroup LPL+, ADAM- and L/A=1 with a poor outcome. Thus, the expression profile of these genes could be useful to identify Binet A and B patients with an unfavorable prognosis, contributing to the decision making process to begin therapy in an individualized manner. (Support–FAPESP proc n. 05/57792-0)
Introduction: Chronic Lymphocytic Leukemia (CLL) is the most frequent leukemia in adults of western countries. Its clinical course is variable with some patients presenting an indolent disease while others have an aggressive disease requiring prompt treatment. Biomarkers to identify patients with poor prognosis, especially in early clinical stages, are being studied. Increase of angiogenesis, as an apoptosis deregulator, has been associated to poor prognosis in some malignant diseases such as Multiple Myeloma and Non-Hodgkin Lymphoma. Expression of Vascular Endothelial Growth Factor (VEGF) in CLL cells seems to have an unfavorable impact on prognosis, even though only a few studies have addressed this issue. AIMS: to analyze the expression of VEGF and its relation to Binet clinical stage, mutation status of IgVH and event free survival. Patients and Methods: 52 CLL patients diagnosed at UNIFESP and HSPE were studied. VEGF expression was evaluated on blood samples stained with Biotinylated Human VEGF (R&D Systems) monoclonal antibody and acquired with FACScalibur® and analyzed CellQuest® software. The expression of VEGF was considered positive when its mean fluorescence intensity was >200. IgVH mutation of 25 cases status was also studied by sequencing of the amplified samples by RT-PCR using VH family specific primers. The sequences were analysed with lg Blast® software and considered mutated (M) when there was a germline homology of 98% or greater and those displaying homology <98% were classified as unmutated (UM). Fisher’s exact test was used to compare results and Kaplan Meyer analysis to evaluate progression free survival (PFS). Differences were considered significant if p<0.05. Results: Of the 52 CLL patients (28M/24F, median age of 67 years varying between 38–78 years) 29 (56%) were Binet A, 17 (33%) Binet B and 6 (11%) Binet C. Twenty nine were VEGF+ and 23 VEGF−. Binet A patients were more frequently VEGF− than Binet B+C ones (p=0,002). In the whole population, VEGF+ patients presented shorter PFS when compared to VEGF− (p=0.004). Additionally, even early clinical stage patients (A+B), VEGF+ patients had an adverse prognosis with shorter PFS than those who were VEGF− (p=0.023). As for IgVH mutation status, of the 25 analyzed patients VEGF− were predominantly M while VEGF+ NM (p=0.043), and this difference was also seen when A+B patients were analysed (p=0.031). Conclusion: Our study shows that VEGF expression is associated with an adverse prognosis in CLL patients, even in those in early clinical stages (A+B). FC analysis of VEGF showed to be feasible and easily executable and could be evaluated as surrogate of IgVH mutation status in additional studies with a greater series of patients. (support: FAPESP proc.no.05/57792-0).
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