István Benedek and Theodora Benedek
István Benedek and Theodora Benedek
István Benedek, Erzsébet Lázár, Johanna Sándor-Kéri, Szilárd Bíró, Szende Jakab and István Benedek
Hematological conditions can lead to serious disturbances in blood rheology, being frequently associated with increased systemic inflammation and increased risk of bleeding. The imbalance between coagulation and thrombolytic factors in patients with acute coronary syndromes may lead to undesirable outcomes, and the success of emergency coronary angioplasty or by-pass grafting may be altered by increased bleeding in coagulopathies such as hemophilia. This paper intends to review the present knowledge in the field of acute coronary syndromes in subjects with hematological and onco-hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, von Willebrand disease, hemophilia, polycythemia vera, erythrocyte disorders, myelodysplastic syndrome, leukemia, lymphoma or myeloma.
Szende Jakab, Erzsébet Lázár, István Benedek, Judit Beáta Köpeczi, Annamária Pakucs and István Benedek
Multiple myeloma accounts for 10% of the hematologic malignancies and is characterized by a single clone of plasma cells producing a monoclonal protein. The aim of this review is to summarize the current treatment methods of multiple myeloma. In the last 15 years, the incidence of myeloma has increased in patients younger than 65 years, thus treatment became even more important in order to obtain a long lasting remission or plateau phase. The treatment of this disease is complex and focuses not only on increasing the patients’ survival, but also improving their quality of life.
Balázs Oltean-Péter, Szilamér Korodi, István Benedek, Erzsébet Lázár, Johanna Kéri, Annamária Pakucs, István Kovács, Lehel Bordi, Adriana Mitre, Imre Benedek, Theodora Benedek and István Benedek
Recent studies demonstrated that despite restoration of the sinus rhythm, patients with a positive history of atrial fibrillation (AF) are still at risk of thromboembolic events. The primary objective of this study is to identify new imaging-derived biomarkers provided by modern imaging technologies, such as cardiac computed tomography angiography, delayed enhancement magnetic resonance imaging, or speckle tracking echocardiography, as well as hematological biomarkers, associated with the risk of intracavitary thrombosis in patients with AF, in order to identify the imaging-derived characteristics associated with an increased risk of cardioembolic events. Imaging data collected will be post-processed using advanced techniques of computational modeling, in order to fully characterize the degree of structural remodeling and the amount of atrial fibrosis. The primary endpoint of the study is represented by the rate of thromboembolic events. The rate of cardiovascular death, the rate of major adverse cardiovascular events, and the rate of AF recurrence will also be determined in relation to the degree of structural remodeling and atrial fibrosis.
Theodora Benedek, István Kovács and Imre Benedek
Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.
Erzsébet Lázár, Péter Balázs Oltean, Laura Jáni, István Kovács, Tiberiu Nyulas, István Benedek and István Benedek
Hematological conditions and their treatments have an increased risk of cardiovascular events, and invasive interventions have a higher risk of periprocedural complications in this group of patients. The aim of this review was to evaluate the risk of invasive interventions in patients with hematologic disorders and to underline the role of noninvasive cardiovascular screening in patients with hematological disorders such as Hodgkin and non-Hodgkin lymphoma, anemia, hemophilia, thrombocythemia, polycythemia vera, and leukemia. Based on present knowledge in the field, our opinion is that the screening of patients with hematological diseases is very important to reduce the morbidity and mortality due to cardiovascular events. Noninvasive assessments are suitable for this purpose with a significantly lower risk compared to invasive interventions.
István Benedek, István Benedek, Judit Beáta Köpeczi, Johanna Sándor Kéri, Annamária Pakucs, Szende Jakab and Erzsébet Lázár
Plasma cell leukemia (PCL) is one of the most aggressive monoclonal gammopathies, being characterized by the presence of more than 20% of plasma cells in the peripheral blood and an absolute number of these cells of more than 2×109, with different morphology, from young elements to mature cells. The incidence of PCL varies between 2–4% among multiple myeloma (MM) patients. In comparison with MM, PCL appears more often in younger patients. The following article describes the case of a 49-year-old female patient diagnosed with PCL which needed urgent control of the clinical manifestations due to its irreversible complications. Urgent autologous stem cell transplantation is recommended in this group of patients.
Szilárd Bíró, István Benedek, Árpád Bzduch, Johanna Sándor-Kéri, Erzsébet Lázár and István Benedek
In Western countries, chronic lymphocytic leukemia (CLL) is one of the most diagnosed leukemia types among elderly patients. CLL is described as an indolent lymphoproliferative disorder, characterized by the presence of a high number of small, mature B-cells in the peripheral blood smear, with a particular immunophenotype (CD5, CD19, CD23 positive and CD20 dim positive) and accumulation in the bone marrow and lymphoid tissue (e.g., lymph nodes, spleen). The experience of the past decades showed that CLL is clinically very heterogeneous; while some patients present a chronic clinical evolution, with a prolonged survival, in which the treatment can be delayed, others suffer from a more aggressive form, which must be treated early and is associated with many relapses. This observation led to several genomic studies that have mapped the genetic modifications involved in the disease conformations, including del(13q14), del(11q), or trisomy 12. On the other hand, certain genetic mutations such as del(17p13)–p53, NOTCH1 mutation, or ZAP70/CD38 increased expression are associated with worse clinical outcome. In order to apply the right treatment strategy, the RAI and BINET staging systems should be considered, which are based on clinical and laboratory assessment, on genetic mutations that may influence the resistance to chemotherapy, as well as the patient’s age and comorbidities. The aim of this manuscript was to present the therapeutic approaches of CLL, in order to attempt to answer the following question: to treat, or not to treat? This clinical update focuses on the managements of CLL patients in the 21st century.
Árpád Bzduch, István Benedek, Szilárd Bíró, Johanna Sándor-Kéri, Erzsébet Lázár and István Benedek
Acute myeloid leukemia (AML) is a cancerous disease affecting the myeloid line of the bone marrow cells. FLT3, also known as CD135, is a proto-oncogene, which, if mutated, leads to different types of cancer. The protein it encodes presents tyrosine-kinase activity, and its intratandem mutation, FLT3-ITD, leads to uncontrolled proliferation of myeloblasts and worse outcomes in AML patients. There are currently several pharmacological agents that can inhibit the effect of either the proteins with tyrosine-kinase activity or the mutated FLT3 gene. We present the case of a 68-year-old patient, smoker, with a history of arterial hypertension, chronic obstructive pulmonary disease, presenting with headache unresponsive to antalgics, dyspnea after physical exertion, and epistaxis, with onset 2 months prior to his presentation. The patient was diagnosed with AML with positive FTL3 mutation for which conventional induction therapy was initiated. Within the next days, the patient presented several complications related to the disease itself or caused by the treatment, which eventually led to his death.