Rolandas Gerbutavicius

A population‐based single nucleotide polymorphism array analysis of genomic aberrations in younger adult acute lymphoblastic leukemia patients

Adult acute lymphoblastic leukemia (ALL) is characterized by a high frequency of abnormal karyotypes some of which are related to outcome. Single nucleotide polymorphism (SNP) array analysis provides a highly sensitive platform to detect large and small genomic aberrations. SNP array profiling data in adult ALL are limited and further systematic studies of this patient group are needed. We performed a population‐based SNP array analysis of genomic aberrations and their influence on survival in 66 Lithuanian 18–65 year old ALL patients diagnosed between 2007 and 2013. Most aberrations were detected in chromosome arm 9p, chromosome arm 6q, chromosome arm 13q, and chromosome 17. The recurrently targeted copy number abnormalities involved several leukemia‐related genes—CDKN2A/B, MLL, IKZF1, PAX5, RB1, TP53, and ETV6. We identified several new recurrent aberrations with possible new target genes: SMARCA4 in 19p13.2, RNASEL in 1q25.3, ARHGEF12 in 11q23.3, and LYL1 in 19p13.2. Aberrations in chromosome 13 and the RB1 gene as well as CDKN2A/B gene status were related to the outcome.

Thrombotic risk assessment in 185 WHO-defined essential thrombocythemia patients: single center experience

Thrombosis risk in essential thrombocythemia (ET) patients can be assessed using different prognostic systems. Conventional risk factors include age more than 60 years and history of previous thrombosis. In addition, other factors such as JAK2 V617F mutations, cardiovascular risk factors, leukocytosis more than 11 × 109/l, thrombophilic factors and platelet count more than 1500 × 109/l are used in different hematology centers as high-risk features for thrombosis. Our study compared different risk model groups for thrombosis in 185 WHO-defined ET patients at the Hospital of Lithuanian University of Health Sciences Kaunas Klinikos. We found that patient distribution in low, intermediate- and high-risk groups varies using different risk stratification models. The biggest difference in risk assignment is evident in patients who are older than 60 years and have no other risk factors and in patients who are younger than 60 years but have other risk factors. This observation suggests that new prospective randomized clinical trials are needed to better stratify patients at risk for thrombosis.

Prognostic factors for positive immune thrombocytopenic purpura outcome after laparoscopic splenectomy

Laparoscopic splenectomy is considered as a second step treatment for ITP patients. The purpose of this study was to determine efficiency of laparoscopic splenectomy for ITP patients and to identify the independent prognostic factors that may predict the positive outcome. Two hundred and thirty nine patient medical records were analyzed retrospectively. The special questionnaire, which included present platelet count, the steroid usage and its dosage, was sent to all patients. The complete response (CR) was defined, when the platelet count was above 130 × 109 /L. The 239 adult patients with a median age of 51.3 (16–93 years) were included in this cohort. The median follow up period was 75 months. 49 patients, who relapsed after steroid treatment, underwent laparoscopic splenectomy. The short term postoperative CR was 71.4% after laparoscopic splenectomy compared to 38.1% in non-splenectomized patients (p < 0.000). The long term CR was 79.5 % in patients after splenectomy compared to 47.4% in non-splenectomized patients (p < 0.018). After univaried analysis three clinical variables were found to be significantly related to splenectomy outcome: disease duration (p<0.007), preoperative platelet count (p<0.049) and platelet count on the third postoperative day (p<0.000). Multiple logistic regression analysis demonstrated, that only platelet count on the 3rd postoperative day > 129 × 109 /L; RR=53.3 95% (CI, 1.888–1517.98) was significant predictor for long-term positive ITP outcome after laparoscopic splenectomy. Splenectomy is effective treatment for ITP. Platelet count > 129 × 109/L on the third postoperative day is the significant predictor of positive long-term outcome after laparoscopic splenectomy.

Thromboelastographic changes during laparoscopic fundoplication

Introduction Thromboelastography (TEG) is a technique that measures coagulation processes and surveys the properties of a viscoelastic blood clot, from its formation to lysis. Aim To determine the possible hypercoagulability state and the effect of antithrombotic prophylaxis on thromboelastogram results and development of venous thrombosis during laparoscopic fundoplication. Material and methods The study was performed on 106 patients who were randomized into two groups. The first group received low-molecular-weight heparin (LMWH) 12 h before the operation, and 6 and 30 h after it. The second group received LMWH only 1 h before the laparoscopic fundoplication. The TEG profile was collected before LMWH injection, 1 h after the introduction of the laparoscope and 15 min after the surgery was completed. Results There was no significant difference in thromboelastography R-time between the groups before low-molecular-weight heparin injection. In group I preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, after the end of surgery and on the third postoperative day. K-time values decreased significantly on the third postoperative day compared with the results before low-molecular-weight heparin injection, and after the operation. In group II, preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, and after surgery. K-time values did not change significantly during or after the laparoscopic operation. Conclusions Our study results demonstrated that the hypercoagulation state (according to the TEG results) was observed during and after laparoscopic fundoplication in patients when LMWH was administered 12 h before the operation together with intraoperative intermittent pneumatic compression. The optimal anticoagulation was obtained when LMWH was administered 1 h before fundoplication.

Venous Stasis and Deep Vein Thrombosis Prevention in Laparoscopic Surgery

Laparoscopic surgery – is one of the most progressive minimal invasive surgery branches. About 25–40% of all abdominal operations are performed laparoscopicaly in our days and this rating is going in ascending order. Laparoscopic operations (cholecystectomy, fundoplication, appendectomy, bypass due to morbid obesity et at.) have rapidly become the operations of choice in abdominal surgery. Several authors reported that deep vein thrombosis (DVT) in the legs developed in 30% of postoperative patients and pulmonary embolism (PE) in 10% of these patients.