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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Chronic Lymphocytic Leukemia

I have been diagnosed with CLL AND the following: [ Description_of_disease_and_additional_information ] there are multiple hypodense lesions in the liver, representing presumed cysts. One of these shows some peripheral rim calcification inthe left lobe. Gallbladder removed. The Spleen is massively enlarged measuring at least 20 cm in AP dimension. There is a wedge-shaped hypodense region in the lateral and inferior sasp t of the spleen which may represent a splenic infarct. Mild lymphadenopathy is present in the gastrohepatic ligament, porta hepatis, peripancreatic and celiac axis as well as retroperitoneium around the aorta and IVC. There are mildly distended gas-filled loops of small bowel, although these have a maxiumum caliber of about 2.8 cm, with no definite mechanical bowel obstruction visulaized. No free air is evident. The visualized lung bases and pleural spaces are clear. There are no destructive boy lesions evident. WENT INTO HOSP WITH A KIDNEY STONE ATTACH: tHERE IS A 6 MM MID TO DISTAL URETER IC CALCULUS ON THE RIGHT SIDE CAUSING PROXIMAL hydroureter and periureteric inflammation. There is also mild hydroephrosis and very slight perinephric stranding around the right kidney. The calculus lies just above the level of the inferior right SI joint. [ Prior_treatment ] none, besides Naltraxone 4.5 & Rampiril 2.5 [ Current_treatment_and_medicine ] none report by Dr. C.N. Cooper, Nov. 18/2015, emerg @ Royal Jubilee Hosp. the want to treat me Bendamustine (Treanda) AND Rituximab injection (Rituxan), however, I would like it to be a more natural treatment. The above has been said to give me 6 years, perhaps, pending no further major infections. thereafter, the course to be determined. I m told there is NO CURE for CLL. What s your opinion? Thanks, Donny Redding
Mon, 8 Feb 2016
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Pathologist and Microbiologist 's  Response
Hello and welcome to HCM,
A number of problems are described by you. I will take each problem separately.
Chronic lymphocytic leukemia (CLL) is characterized by lymph node enlargement, liver and spleen enlargement.
The multiple lymph nodes and enlarged spleen that you have mentioned is due to CLL.
CLL is managed with chemotherapy. I suggest you consult your hematologist for management of CLL.
The multiple hypodense lesions in liver need to be assessed for their probable nature.
In case the hypodense lesions are proven to cysts and are asymptomatic, they need to be followed up.
It is not feasible to surgically remove multiple cysts.
The cause of splenic infarct is probable due to massive enlargement of spleen.
Treatment of CLL will help to resolve splenomegaly and enlarged lymph nodes.
A stone is identified in the ureter which is causing dilatation of kidney and ureter leading o hydronephrosis and hydro-ureter.
The stone needs to be managed to prevent the ongoing damage to the kidney.
I suggest you to consult an urologist for clinical assessment and thus management of stone.

Thanks and take care
Dr Shailja Puri




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Suggest Treatment For Chronic Lymphocytic Leukemia

Hello and welcome to HCM, A number of problems are described by you. I will take each problem separately. Chronic lymphocytic leukemia (CLL) is characterized by lymph node enlargement, liver and spleen enlargement. The multiple lymph nodes and enlarged spleen that you have mentioned is due to CLL. CLL is managed with chemotherapy. I suggest you consult your hematologist for management of CLL. The multiple hypodense lesions in liver need to be assessed for their probable nature. In case the hypodense lesions are proven to cysts and are asymptomatic, they need to be followed up. It is not feasible to surgically remove multiple cysts. The cause of splenic infarct is probable due to massive enlargement of spleen. Treatment of CLL will help to resolve splenomegaly and enlarged lymph nodes. A stone is identified in the ureter which is causing dilatation of kidney and ureter leading o hydronephrosis and hydro-ureter. The stone needs to be managed to prevent the ongoing damage to the kidney. I suggest you to consult an urologist for clinical assessment and thus management of stone. Thanks and take care Dr Shailja Puri