Chronic myelomonocytic leukemia (CMML) is a type of leukemia, which are cancers of the blood-forming cells of the bone marrow. In adults, blood cells are formed in the bone marrow, by a process that is known as haematopoiesis. In CMML, there are increased numbers of monocytes and immature blood cells (blasts) in the peripheral blood and bone marrow, as well as abnormal looking cells (dysplasia) in at least one type of blood cell.CMML shows characteristics of a myelodysplastic syndrome (MDS); a disorder that produces abnormal looking blood cells, and a myeloproliferative neoplasm (MPN); a disorder characterised by the overproduction of blood cells. For this reason, CMML was reclassified as a MDS/MPN overlap disorder in 2002. For a diagnosis of CMML, the World Health Organization (WHO) states that the blood monocyte count must be >1x109/L, no Philadelphia chromosome or mutations in the PDGFRA or PDGFRB gene should be present, the blast count must be <20% and dysplasia of at least one lineage of myeloid blood cell should be present.Azacitidine is a drug used to treat CMML and is approved by the Food and Drug Administration (FDA) and the European Medicines Agency. Stem cell transplant is also used to treat CMML, and involves the transplantation of donor haematopoietic stem cells into the recipient. Blood transfusion and erythropoietin are used to treat disease associated anaemia. Signs and symptoms
One of the most common signs of CMML is splenomegaly, found in approximately half of cases.
The same phenomenon affects cyclists and exercise bike users, with prolonged pressure on the perineum from the bicycle saddle and the straining of the exercise causing the penis and scrotum to contract involuntarily. An incorrect saddle may ultimately cause erectile dysfunction (see crotch pressure for more information). Individuals with hard flaccid syndrome or other pelvic floor disorders may temporarily have an abnormally small penis. Stretched
Neither age nor size of the flaccid penis accurately predicted erectile length. Stretched length has correlated with erect length in some cases. However, studies have also shown drastic differences between stretched and erect length. One study found that a minimal tension force of approximately 450 g during stretching of the penis was required to reach a full potential erection length. this study also found that tension forces exerted in this study by the urologist were shown to be significantly (P<0.01) lower than 450g. This may account for differences between stretched and erect length. The 2015 study of 15,521 men found that the average length of a stretched flaccid penis was 13.24 cm (5.21 inches) long, which is near identical to the average length of an erect human penis which is 13.12 cm (5.17 inches) long. An 2001 study of about 3,300 men published in European Urology concluded that flaccid stretched length was measured on average to about 12.5 cm (4.9 in). In addition, they checked for correlations in a random subset of the sample consisting of 325 men.