The predictors of poor outcomes in patients with femoral artery injuries

PURPOSE

This study investigated the predictors of poor outcomes, including limb loss and death, in patients with femoral artery injuries.

PATIENTS AND METHODS

The study included 158 patients aged 2-82 (mean age 28.4 ± 16.5) with femoral arterial injury (common, deep, and superficial femoral artery) that were treated surgically between 2000 and 2010. Isolated venous injuries were excluded. Demographic and clinical data of the patients, including age, gender, admission time, pulse rate and blood pressure, hematocrit value, reason of injury, associated injury, and Mangled Extremity Severity Score (MESS) were recorded.

RESULTS

Of the 158 patients, the death and amputation rates were 5.7% (9) and 5.1% (8), respectively. In logistic regression analysis, four variables (pulse rate, MESS, hematocrit, and bone trauma) were found to be independent predictors for poor outcomes. The Odd's ratios and confidence interval values of these variables were as follows: 7.24 (1.94-26.92), 21.75 (5.41-87.48), 5.93 (3.04-11.54) and 7.46 (2.09-9.56), respectively.

CONCLUSIONS

The MESS value, presence of bone fracture, hematocrit, and pulse rate on admission are predictive risk factors for poor outcomes in patients with femoral artery injury. Therefore, in these patients, prompt intervention by experienced surgeons is crucial for limb salvage and decreased mortality.

Relationship between endothelial dysfunction and prosthetic heart valve thrombosis: a preliminary investigation

AIM

The etiopathogenesis of prosthetic heart valve thrombosis (PHVT) is multifactorial. Since the relationship between PHVT and endothelial function is never studied, we aimed to analyze the role of endothelial function in patients with PHVT.

PATIENTS AND METHODS

Twenty-two patients with PHVT (14 female, 31.8% with atrial fibrillation, mean age 46.0±12.2) and 22 controls with prosthetic heart valves (17 female, 36.4% with atrial fibrillation, mean age 45.7±11.5) were prospectively evaluated. Two groups had similar demographic and echocardiographic characteristics. Endothelial function was evaluated in all patients by the non-invasive measurement of flow mediated dilatation (FMD) of brachial artery. High-resolution ultrasound was used to measure brachial artery diameter at rest, during reactive hyperemia (endothelium-dependent, FMD), and following sublingual administration of nitroglycerin (endothelium-independent, nitroglycerin-mediated vasodilatation, NMD).

RESULTS

Functional capacity at presentation determined as mean NYHA functional capacity class was worse in patients with PHVT than in control group (2.1±0.6 vs. 1.3±0.6; p < 0.0001). FMD was significantly reduced in patients with PHVT compared with control group (4.01±1.52 vs. 8.48±3.37; p < 0.0001). NMD did not differ between two groups (11.77±2.30 vs. 13.38±3.50; p = 0.08). FMD level of < 5.65 predicted prosthetic valve thrombosis with an 82% sensitivity and 77% specificity (area under the curve = 0.888, p < 0.0001).

CONCLUSIONS

This study demonstrated the endothelial dysfunction in patients with PHVT compared with well-matched control group. In this study, we found that patients with PHVT have endothelial dysfunction which might contribute to the development of thrombosis.

Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study

OBJECTIVE

This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study.

PATIENTS AND METHODS

2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed.

RESULTS

The mean age of the patients was determined as 80.3±4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range.

CONCLUSIONS

The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment.

Effects of treatment regimens on survival in patients with malignant pleural mesothelioma

BACKGROUND AND OBJECTIVE

In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy.

PATIENTS

A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010.

RESULTS

Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months.

CONCLUSIONS

The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.      

The association between mean platelet volume and coronary collateral circulation

BACKGROUND

Platelets are important in the pathogenesis of atherosclerotic complications. Higher mean platelet volume (MPV) levels are related to greater in vitro aggregation, and have been identified as an independent risk factor for myocardial infarction, and for death or recurrent vascular events.

AIM

To determine the relationship between MPV and the coronary collateral circulation.

METHODS

The sample consisted of 96 patients with coronary artery disease, and patients were separated into two groups according to their poorly developed or well-developed collateral circulation. Coronary collateral vessels were analyzed according to the Cohen and Rentrop grading system of 0-3.

RESULTS

All analyses were conducted using SPSS 11.5 (SPSS for Windows 11.5, Chicago, IL, USA). Continuous variables were expressed as mean ± SD, and categorical variables were expressed as percentages. Comparison of categorical and continuous variables between the group with well-developed coronary collateral vessels and the group with poorly developed vessels was performed using the chi-squared test and independent samples t-test, respectively. Platelet count and MPV values were similar between the two groups.

CONCLUSIONS

Our study found that MPV levels are not related to coronary collateral circulation.  

Relation of interatrial duration and p wave terminal force as a novel indicator of severe mitral regurgitation

OBJECTIVES

Interatrial duration is defined as prolonged p wave on electrocardiogram. p waves with a negative terminal phase recorded in V1 enclosing an area of one small square on the electrocardiogram is significantly and strongly correlated with interatrial duration. The aim of study was to investigate whether interatrial duration with p terminal force can be used as reflection of echocardiographic severity of mitral regurgitation.

MATERIALS AND METHODS

Sixty two consecutive patients with mitral regurgitation. were prospectively studied. Age/gender matched 57 subjects who had normal mitral structure and did not have mitral regurgitation. Patients with mitral regurgitation referred to a single cardiac center for echocardiography and who met the entry criteria documented moderate or severe mitral regurgitation with sinus were included. The interatrial duration was defined on the routine 12-lead electrocardiogram (50 mm/s, 10 mm/mV) using the greatest duration of p waves from D2, D3, AVF and V1.

RESULTS

There was a positive correlation between interatrial duration (>/= 110 ms) and effective regurgitant orifice (r = 0.3, p < 0.001). However, left atrial diameter and brain natriuretic peptide were significantly higher in cases with mitral regurgitation. There was also strong correlation between interatrial duration (>/= 110 ms) and p terminal force and left atrial diameter. ROC analysis revealed that interatrial duration of > 110 msec. could predict of severe mitral regurgitation with 88% sensitivity and 100% specificity.

CONCLUSIONS

Severe mitral regurgitation, left atrial diameter was correlated with p terminal force and interatrial duration. Significant interatrial duration (>/= 110 ms) and p terminal force might be considered as novel indicators of severe mitral regurgitation.

Implantable cardioverter defibrillator pocket infection caused by Klebsiella pneumonia

Like any other foreign bodies, implanted cardiac devices can become infected. Staphylococcus aureus and coagulase-negative Staphilococci are the most common causes of infections of pacemaker and defibrillator systems. In this case an implantable cardioverter defibrillator pocket infection caused by an extremely rare microorganism, Klebsiella pneumonia, is presented.

Effect of hypoglycemic drugs on aspirin resistance in patients with diabetes mellitus

BACKGROUND

Aspirin reduces the odds of an arterial thrombotic event in high-risk patients. However, 10%-20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term followup. Aspirin resistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, percutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and diabetes mellitus (DM). The aim of this study was to assess aspirin resistance and to compare it to the use of oral anti-diabetic drugs and insulin in patients with diabetes.

METHODS AND RESULTS

Platelet aggregation was measured after aspirin treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two patient populations were included in the investigation: use of insulin (group 1) and use of oral anti-diabetic agents (OAD) (group 2) in diabetic patients. Platelet aggregation was determined using a multichannel Multiplate analyzer. Among group 1 patients, 4.7% were aspirin non-responders and among group 2 patients, 8.6% were aspirin non-responders. Statistical differences were not found between the groups (p = 0.359).

CONCLUSIONS

This study demonstrated that there was no significant difference in aspirin resistance between type 2 diabetes mellitus patients on insulin treatment and type 2 diabetes mellitus patients on OAD treatment.

Role of Oxidative Stress in the Clinical Outcome of Patients with Multiple Blunt Trauma

OBJECTIVE: This prospective study evaluated serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI), along with the Revised Trauma Score (RTS) and Injury Severity Score (ISS), as predictors of clinical outcome in the early post-traumatic period in patients with multiple blunt trauma (MBT). METHODS: The study included 52 patients admitted to the emergency department with MBT and 40 age-and sex-matched healthy control subjects. RESULTS: The overall MBT patient mortality was 32.7% (17/52). There was no significant association between age and mortality in MBT patients, but there was a negative correlation between mortality and RTS, and a positive correlation between mortality and ISS. TOS levels were significantly higher in nonsurvivors compared with survivors. There was no correlation between TAS or OSI and survival. ISS and RTS showed positive and negative correlations with TOS level, respectively, but neither was significantly related to TAS or OSI. CONCLUSIONS: These findings suggest that TOS, as an early oxidative stress biomarker, may be an objective alternative criterion to the ISS and RTS for managing patients with MBT during the early period following traumatic injury.

Effectiveness of Ericksonian hypnosis in tinnitus therapy: preliminary results

INTRODUCTION

The present study was performed to evaluate the efficacy of Ericksonian hypnosis in reducing the impact of tinnitus on patients' quality of life.

PATIENTS AND METHODS

A controlled prospective longitudinal study was designed. The severity of tinnitus was assessed with Tinnitus Handicap Inventory (THI) before hypnotherapy and then 1 week, 1 month, 3 months, and 6 months after therapy. Health Survey SF-36 was used to assess health-related quality of life before and after hypnotherapy. Thirty-nine patients with severe idiopathic subjective tinnitus were enrolled in the study.

RESULTS

The mean SD age of the patients was 44.5 +/- 12.5 years, ranging from 21 to 65 years; 48% were female. Mean THI scores assessed at the beginning and 4 times after commencement of therapy were evaluated. The changes in THI scores were significant. Health Survey SF-36 was assessed separately. The greatest increases were seen in physical role followed by emotional role difficulty.

CONCLUSION

The preliminary results of our study demonstrated the effectiveness of Ericksonian hypnosis in the study group.

Family functioning and its clinical correlates in overweight and obese patients

AIM

Our aim is to evaluate the differences in family functioning and anxiety between normal, overweight, and obese subjects.

METHOD

Overweight and obese patients were selected from the outpatient clinic of internal medicine department of a university hospital. Patients were classified into three groups as normal weight (N=82), overweight (N=33) and obese (N=50) patients. The normal weight group included healthy subjects. The individuals were examined by the same psychiatrist (MA). Beck Anxiety Inventory and Family Assessment Device were applied to all groups.

RESULTS

When compared to normal weight patients, obese and overweight patients had significantly higher anxiety scores and higher scores in general functions, problem solving, communication, roles, affective responsiveness, and behavior control dimensions which reflect increased dysfunctions in their families. The total level of dysfunction that patients experience was predicted by alcohol dependence in the family during childhood period, any medical disorder in the current family, anxiety level and body mass index.

CONCLUSION

When treating them clinicians should keep in mind that families of obese and overweight patients may have higher levels of dysfunctions.

Aortic elastic properties in patients with venous thromboembolism

OBJECTIVES

The relationship between venous thrombosis (VT) and atherosclerosis is controversial in recent studies. Aortic elastic properties have a predictive value in detecting early stages of atherosclerosis. The aim of this study is to evaluate the relationship between aortic elastic properties and VT.

METHODS

Elastic properties of aorta in patients with spontaneous VT, without history of known cardiovascular disease and cardiovascular risk factors (n: 31), and in healthy subjects without cardiovascular risk factors (n: 30) were compared. Elastic properties of the aorta were assessed with transthoracic echocardiography.

RESULTS

A significant increase in aortic stiffness index (6.5 ± 1.0 versus 6 ± 0.7, P = 0.03) and a significant decrease in aortic strain and aortic distensibility were found in patients with VT compared with healthy subjects (8.4 ± 7 versus 13 ± 8, P = 0.01, 4.9 ± 4.8 versus 6.5 ± 4.4, P = 0.03, respectively).

CONCLUSIONS

Elastic properties of aorta in patients with spontaneous VT were impaired. These results may support the role of endothelial dysfunction in the pathogenesis of VT.

Serum apolipoprotein C-III in high-density lipoprotein: a key diabetogenic risk factor in Turks

AIMS

We studied determinants of serum apolipoprotein C-III (apoC-III) and whether levels of apoC-III or its fractions predict metabolic syndrome (MetS), Type 2 diabetes and coronary heart disease (CHD).

METHODS

The predictive value of apoC-III, measured by immunoturbimetric immunoassay in 802 tracked individuals of a Turkish general population in determining cardiometabolic risk was assessed over 4.4 +/- 1.2 years' follow-up. Patients with MetS, Type 2 diabetes and CHD at baseline were excluded.

RESULTS

Total apoC-III, as well as both fractions, was significantly, linearly and inversely related to smoking status, positively to alcohol usage and to levels of complement C3. Mid and high tertiles of total or non-high density lipoprotein (HDL) apoC-III predicted significantly and independently incident MetS; they predicted CHD with risk ratios of 1.6 [95% confidence intervals (CI) 1.02-2.5], for 1 sd increment, after adjustments that included HDL cholesterol and body mass index (BMI). The highest tertile of HDL apoC-III was a major independent predictor of new-onset diabetes with a 2.5-fold risk ratio for 1 sd increment (95% CI 1.5-4.0) in combined sexes, after adjustment for waist circumference, HDL cholesterol and other confounders and was a better predictor than waist girth.

CONCLUSIONS

Serum total apoC-III or its fractions are linearly and inversely associated with smoking, positively with alcohol usage and serum complement C3. The presumably dysfunctional HDL apoC-III is a stronger predictor of Type 2 diabetes than waist girth in Turks. Non-HDL apoC-III predicts strongly the development of MetS as well as incident CHD, independent of HDL cholesterol, BMI and non-lipid factors. The atherogenicity of apoC-III and dysfunctionality of HDL apoC-III carry huge public health implications in Turks.

Peripheral nervous system involvement in patients with sickle cell disease

BACKGROUND AND PURPOSE

Peripheral nervous system involvement is rare in sickle cell disease (SCD). The aim of this study is to determine the peripheral nerve involvement electrophysiologically in SCD patients without clinically evident neurological signs, symptoms and to determine the relationship between the frequency of sickle cell crisis and peripheral neuropathy.

METHODS

Fifty-one patients with SCD and fifty-one healthy controls were enrolled to the study. Conventional electrophysiological studies of peripheral nerves were performed to all subjects. The data about the frequency of sickle cell crisis were obtained.

RESULTS

Peripheral nervous system involvement was detected in ten (19.6%) patients. Five (9.8%) patients had sensorimotor axonal neuropathy, two (3.9%) sensory axonal neuropathy, one (2%) patient had ulnar sensory neuropathy and two (3.9%) had median sensory neuropathy. Sural nerve sensorial action potential was unobtainable in eight (15.7%) patients and prolonged F latencies were observed in three (5.9%). The frequency of neuropathy was higher in SCD patients when compared with the controls. The frequency of sickle cell crisis was not significantly correlated with peripheral neuropathy.

CONCLUSION

Subclinical peripheral nerve involvement may be seen in SCD patients. Electrophysiological examinations are recommended in routine examination to diagnose early neuropathy in SCD patients without neurologic symptoms.

Association of left ventricular diastolic function abnormalities with aortic elastic properties in asymptomatic patients with type 2 diabetes mellitus. A tissue doppler echocardiographic study

BACKGROUND

The aim of this study was to investigate the association between the aortic elastic properties and the left ventricular diastolic function measured by tissue Doppler echocardiography (TDE) in asymptomatic type 2 diabetes mellitus.

METHODS

Fifty-seven asymptomatic patients with type 2 diabetes (33 women, mean age: 49 +/- 6 years) and 25 healthy control subjects (19 women, mean age: 46 +/- 7 years) were included in the present study. Diastolic filling indices were measured by conventional (CE) and tissue Doppler echocardiography. The aortic elastic properties [Aortic stiffness index (ASI), aortic distensibility and strain] were measured as previous definition.

RESULTS

Compared with control subjects, the ratio of LV diastolic abnormalities measured by CE and TDE were found higher in patients with type 2 diabetes (36% and 73.6%, p = 0.001, respectively, and 52% and 89.4%, p < 0.001, for septal annulus; 48% and 89.4%, p < 0.001 for septal basal respectively). The ASI was significantly higher (p < 0.001), aortic distensibility and aortic strain were also significantly lower in patients with type 2 diabetes than control subjects (p < 0.001 and p < 0.001 respectively). In the regression analysis, Ao distensibility was correlated to age (beta = -0.299, p = 0.004), septal basal Em/Am ratio (beta =0.543, p < 0.001) and HDL-cholesterol (beta = 0.192, p = 0.039). ASI was also correlated only to age (beta = 0.255, p = 0.044), the presence of diabetes mellitus (beta = 0.304, p = 0.009), mitral A wave (beta = 0.322, p = 0.013) and mitral annulus Em wave (beta = -0.505, p < 0.001).

CONCLUSION

The aortic elastic function is impaired in asymptomatic patients with type 2 diabetes. Increased ASI and decreased Ao distensibility are closely associated with diastolic filling indices measured by CE and TDE.

A physiologic events' cascade: irritable bowel syndrome may even terminate with chronic gastritis

When specifically asked, about one third of people report recurrent upper abdominal discomfort, and irritable bowel syndrome (IBS) and chronic gastritis (CG) maybe the most frequently diagnosed ones among all. Consecutive patients with upper abdominal discomfort applying to the Internal Medicine Polyclinic were included into the study. IBS was diagnosed according to Rome II criteria and CG was diagnosed histologically. All cases with IBS were compared with the age and sex-matched randomly selected cases without IBS. One hundred and fifty-six patients with IBS and 179 patients without IBS were studied. CG was detected in 72.4% (113 cases) of cases with IBS, and only 36.3% (65 cases) in patients without IBS (p < 0.001). IBS probably is a cascade of many physiological events, being initiated by infection, inflammation, psychological disturbances-like many stresses and eventually leading to dysfunctions of gut and other systems of the body via a low-grade inflammatory process. CG may be one of the terminating points of the physiological events' cascade, IBS. This may explain the high prevalence of IBS in society. Keeping in mind this association will be helpful during prevention, treatment, and follow up of these common pathologies in Primary Health Centers and Internal Medicine and Gastroenterology Polyclinics for physicians.

Practical cut off values to determine body mass index

We tried to understand whether there are significant cut off values simply determining body mass index (BMI). The study was performed in Internal Medicine Polyclinics on consecutive check up patients aged between 15 and 70 years to see possible consequences of excess weight on health and to avoid debility induced weight loss in elders. Insulin using diabetics and patients with devastating illnesses were excluded to avoid their possible effects on weight. Cases were subdivided into three groups according to their body weights as under 65, between 65 and 85, and above 85 kg groups and prevalences of underweight, normal weight, overweight, and obesity were determined. Sensitivity, specificity, and positive and negative predictive values of body weights to determine BMI were calculated. The study included 954 cases (566 females). Sensitivity of 65 kg as a cut off value to detect normal weight was 61.0%, specificity 94.3%, positive predictive value 82.9%, and negative predictive value was 97.6%. Similarly, sensitivity, specificity, and positive and negative predictive values of 65 and 85 kg to detect overweight cases were 71.5%, 63.3%, 56.2%, and 77.1% respectively. So both values were statistically significant to detect normal weight, overweight and obese individuals (p = 0.000 for both). Although BMI is probably a more valuable parameter to show weight status, the cut off values of 65 and 85 kg, as an easier way, have significant places, too.

Host range and infectivity of Heterorhabditis bacteriophora (Heterorhabditidae) from Ukraine

Entomopathogenic nematodes (EPNs) in the genera Steinernema and Heterorhabditis (Rhabditida: Steinernematidae and Heterorhabditidae, respectively) represent a most promising group of pathogens that are lethal to many soil-inhabiting insects. Ukraine has Lagged behind of Eastern European countries in apply studies of entomopathogenic nematodes. Recently, Heterorhabditis bacteriophora were extracted from soils in the Central Forest Steppe areas of Ukraine using Galleria mellonella traps and identified with PCR. Infection were carried out in Laboratory to determine the host range, specificity and virulence of H. bacteriophora ukr. isol. It was shown that this nematode infected a wide range of insect species. Of the 14 tested insects which belong to four orders , all were susceptible to nematode species with mortality ranges from 12 to 96%. Infectivity did differ within each host. The most favorable hosts were Lepidopterans and coleopterans. The virulence of H. bacteriophora was measured by one-on-one bioassay. H. bacteriophora caused 60% mortality at 5 infective juveniles per Galleria mellonella larvae. LD50 values were 3 +/- 1. Nematodes reproduced and completed their cycle with IJ production in all four orders. H. bacteriophora ukr. isoL.. developed preferably in immature insect stage. Percentage of emergence form cadavers that produced progeny were higher for Lepidoptera and Coleopteran species. Progeny production were not related to the biomass of the cadavers. Because of wide range of insect species Heterhorobditis bacteriophora ukr. isol. has potential for control economically important pests in Ukraine. Further studies should be focused at ecological characterization of isolated H. bacteriophora and carrying out survey of entomopathogenic nematodes.

Immunoexpression of HER family, neuregulin, MAPK and AKT in invasive ductal carcinomas of the breast

BACKGROUND

The purpose of this study was to investigate the frequency of expression of the erbB/HER family of growth factor receptors, their ligand neuregulinalpha (NRGalpha) and the most important pathways activated by HER receptors that are mitogen-activated protein kinase (MAPK) and serine/threonine kinase (AKT) in invasive ductal carcinomas of the breast, not otherwise specified (IDC-NOS).

METHODS

59 of the IDC-NOS of the breast were studied for ER, PR, EGFR, c-erbB-2, c-erbB-3, c-erbB-4, neuregulin Ab-3, phospho-AKT, and phospho-p44/42 map kinase using the streptavidin-biotin horseradish method.

RESULTS

Of the 59 tumours, 44 (75%) were ER+, 37 (63%) PR+, four (7%) EGFR+, seven (12%) c-erbB-2+, seven (12%) c-erbB-3+ and 14 (24%) c-erbB-4+alpha. Strong cytoplasmic and/or nuclear immunoexpression was revealed in 17 (29%) cases for NRGalpha, 13 (22%) cases for p-AKT, and nuclear immunoexpression with p-MAPK was found in 17 (29%) cases.

CONCLUSION

The results suggest that high-grade breast carcinomas are not only associated with ER/PR- negativity, but seem to be activated by receptor tyrosine kinase growth factors.

Survival and secondary malignancy rates for adjuvant radiation therapy versus observation in stage I testicular seminoma: A Surveillance, Epidemiology, and End Results (SEER) analysis

5020

Background: The standard adjuvant treatment for men with stage I testicular seminoma remains controversial within the literature. We analyzed survival and secondary malignancy rates in men with stage I seminoma who underwent adjuvant radiation therapy (RT) or observation (OB) following orchiectomy. Methods: Data was obtained from the Surveillance, Epidemiology, and End Results program (SEER) of the U.S. National Cancer Institute from 1973 - 2003. The primary end points were overall survival (OS) and cause-specific survival (CSS). Multivariate Cox regression models were utilized to study the significance of clinical variables: age at diagnosis, laterality of primary disease, race (white, black, American Indian, Asian/pacific islander) and radiation group. Standardized incidence ratios (observed-to-expected [O/E] ratio) and absolute excess risks of secondary malignancies were also assessed for each subgroup. Results: Out of 6,764 patients eligible for analysis, 5,265 were treated with RT and 1,499 with OB. After a median follow up of 7.6 years, the 5-, 10- and 20- year OS rates for the RT versus OB were 97.9 vs. 95.0; 92.2 vs. 92.2; and 83.6 vs. 84.1 (p= 0.005), respectively. The CSS rates for the same time periods were 99.6 vs. 98.7; 99.2 vs. 98.7; and 99.2 vs. 98.7 (p= 0.002), respectively. Adjuvant RT was associated with improved CSS on multivariate analysis with HR 0.37 (CI 0.19–0.70, p= 0.002). Overall, 312 patients developed secondary malignancies which was significantly higher than the endemic rate (O/E 1.43, p<0.05). RT patients had an increased rate of secondary malignancies when compared with the OB population (O/E 1.93, p<0.05). RT population were at excess risk for contralateral testicular, pancreatic, and hematologic malignancies (p<0.05). Conclusions: Within this large United States population analysis, adjuvant RT was associated with improved CSS for men with stage I testicular seminoma. The incidence of secondary malignancies was also found to be significantly increased for the RT group. Further studies are needed to determine if modern RT techniques and field-size reductions may lead to improvements in the therapeutic ratio.

No significant financial relationships to disclose.

Clinical outcome of node-negative (NN) breast cancer (BC) patients

11102

Background: Breast cancer patients (pts) with NN disease have diverse clinical outcomes. An optimal treatment decision- making tool has not been defined for this heterogeneous group. Methods: We identified pts with NN disease who have been treated between 1998–2006 in our department. We recorded the clinical/pathological, treatment characteristics and analyzed their survival outcome. High risk (HR) was defined as having at least one of the following features: age<35 yr-old, pts with grade 3 tumors (tms), ER and PR negative tms, tm size >2 cm. Results: Out of 597 early BC pts, 275 pts with NN disease were identified, 190 pts with HR, 85 with low risk (LR) features.The median age was 51 (26–83). The median follow up was 40 months (4–120 months). 47% pts were premenopausal. 31% pts had breast conserving surgery (BCS).58/29% pts had grade 2/3 tms. 34% pts with BCS or T3 tms received adjuvant radiotherapy. All receptor positive pts received adjuvant endocrine therapy (ET). In the HRNN group, 5% pts had tms>5cm, 51/40% pts had grade 2/3 tms, 43% pts had ER/PR negative tms. In the LRNN group 25/74% pts had grade 1/2 tms, no pt had receptor negative tm. 86%/51% pts received adjuvant chemotherapy (CT) in the HR and LRNN groups. 12%/48% pts received adjuvant ET alone in the HR and LRNN groups. 5pt in the HR and 1 pt in the LR group received no adjuvant systemic therapy due to their comorbidities and/or negative receptor status. So far, 14 pts had relapsed (8 from the HR, 6 from the LR group) and 3 pts died due to BC (1 from the HR, 2 from LR group). The 5-yr DFS was %94 in the HR and was %90 in the LR groups. HRNN pts had %98 and LRNN pts had %95 5-yr OS. Conclusion: It seems that prognostic information based merely on clinical/pathological characteristics might not accurately quantify the risk of recurrence and death, so that the decisions about adjuvant chemotherapy in NN breast cancer patients. Prospective evaluation of the performance of the new genomic prognostic tools compared to traditional prognostic factors is needed in order to more clearly define the HR vs LR subsets of NNBC pts.

No significant financial relationships to disclose.

Survival outcomes for multiple myeloma over three decades: A Surveillance, Epidemiology, and End Results (SEER) analysis

8019

Background: There is limited data regarding survival outcomes for multiple myeloma in the literature. The purpose of this study was to analyze how patient characteristics and decade of treatment affect overall survival (OS) and cause-specific survival (CSS) for patients within a large United States (US) population database. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results Program (SEER) of the US National Cancer Institute for the years 1973–2003. Patient characteristics (gender, race, age) and year of diagnosis were analyzed by multivariate Cox regression analysis for both OS and CSS endpoints. Results: 40,538 patients were included in the analysis. The mean age at diagnosis was 68.3 (median 69) years. Mean survival for the entire cohort was 41 (median 24) months. Females had better OS than males, hazard ratio (HR) 0.91 (CI 0.89–0.93, P = 0.0001), and CSS, HR 0.96 (CI 0.93–0.98, P = 0.004). There were no significant differences in OS between white and black race (P = 0.34), but black race was associated with improved CSS, HR 0.89 (CI 0.86–0.93, P = 0.0001). Younger age (age <40, 41–60, 61–70, and 71–80) was associated with improved OS and CSS (all P = 0.0001). Early treatment decade (1973–1985) was associated with diminished OS and CSS on multivariate analysis with HR 1.11 (CI 1.08–1.14, P = 0.0001) and HR 1.12 (CI 1.08–1.16, P = 0.001), respectively. Conclusions: This is the largest reported population analysis of survival outcomes for multiple myeloma. It covers three decades of care in the United States. This study reveals that improved OS and CSS are associated with younger age, female gender, and recent decade of treatment. We believe that survival improvement in recent treatment decades may be due to advances in supportive care and/or earlier diagnosis as the standard treatment for myeloma did not significantly change during this time period. Follow up studies may show dramatic improvements in survival outcomes due to modern myeloma therapies in this decade.

No significant financial relationships to disclose.

[Table: see text]

Nephrogenic adenoma of the ureter: case report

Nephrogenic adenoma is a rare metaplastic benign lesion of urothelium in response to genitourinary tract procedures, chronic infection, trauma, urinary calculi and immunosuppressive therapy after renal transplantation. It has been reported to occur throughout the urinary tract especially, in the urinary bladder. We report a case of nephrogenic adenoma arising from the lower end of the right ureter with clinical and radiological features suspicious of carcinoma.

Effect of obesity on P-wave dispersion and QT dispersion in women

OBJECTIVE

The aim of this study was to investigate the effect of obesity on dispersion of P-wave duration and QTc interval in obese women.

METHODS

Forty-two obese women (Body mass index (BMI)=40+/-3 kg/m(2), mean age 45+/-9 years) and compared age-matched (BMI=22+/-1 kg/m(2), mean age 41+/-6 years) twenty-five non-obese women were included in our study. Maximum and minimum P-wave duration, P-wave dispersion (difference between the maximum and the minimum P-wave duration), maximum and minimum QTc interval, and QTc dispersion (the difference between the maximum and the minimum QTc interval) were measured from 12-lead ECG. ECG's were transferred to a personal computer via a scanner and then used for magnification of 400 times by Adobe Photoshop software.

RESULTS

There was significant difference in BMI (40+/-3 vs 22+/-1 kg/m(2), P<0.001, respectively) between obese and non-obese women. Obese women had higher Max. P-wave duration (116+/-11 vs 94+/-14 ms, P<0.001), P-wave dispersion (51+/-15 vs 26+/-11 ms, P<0.001), Max. QTc interval (449+/-38 vs 419+/-30 ms, P<0.001) and QTc dispersion (57+/-23 vs 38+/-15 ms, P<0.001) compared to non-obese women. A significant correlation was found between BMI and Max. P-wave duration (r=0.584, P<0.001), P-wave dispersion (r=0.621, P<0.001), Max. QTc interval (r=0.410, P<0.001), and QTc dispersion (r=0.429, P<0.001). In the linear regression analysis, compared to co-morbidity factors such as age, hypertension, diabetes mellitus and smoking, there was significant association between only BMI and electrocardiographic values (P-wave and QTc dispersion).

CONCLUSION

We concluded that obesity caused significant increase in P-wave and QTc dispersion. Therefore, obese women may not only be under the risk of ventricular arrhythmias, but also they may under the risk of atrial arrhythmias.

HPV DNA frequency and subset analysis in human breast cancer patients' normal and tumoral tissue samples

Viruses are known to be associated with human malignancies, e.g., Epstein-Barr virus, human papillomavirus (HPV) and human T-cell leukemia virus type I. We conducted a prospective study to define the role of HPV in breast cancer. The malignant and normal breast tissue samples of 50 consecutive breast cancer patients were obtained postoperatively. DNA extracted from all tissues was amplified with the polymerase chain reaction using HPV primers. HPV 11, 16, 18, 33 subtypes were searched in HPV-DNA positive samples. Thirty-seven samples (74%) of tumoral breast tissue expressed HPV-DNA, 16 normal breast tissue samples (32%) were positive as well. There was a significant difference in HPV-DNA positivity between normal and tumoral breast tissue samples. HPV 18 was detected in 20 of the HPV-DNA positive tumoral tissue (54.4%) and in 9 of the HPV-DNA positive normal tissue (56.3%). HPV-33 also was detected in 35 (94.6 %) of the HPV-DNA positive tumoral tissue and in 14 (87.5 %) of the HPV-DNA positive normal tissue samples. HPV DNA was significantly associated with breast tumor tissue compared to normal breast tissue. Additional studies looking at HPV and HPV subtypes are needed to clarify the etiological role of the HPV in breast cancer.

A giant adrenal pseudocyst: case report and review of the literature

A 45-year-old woman whose MR images revealed a lobulated, complicated cyst with septations on the superior pole of left kidney underwent retroperitoneoscopic cyst marsupialization. In pathologic examination beneath the atrophic adrenal gland, hyalinized, calcification foci cyst wall without any surrounding epithelium was seen microscopically. It was reported to be "adrenal pseudocyst".

Seroprevalence of hepatitis C in patients with type 2 diabetes mellitus and non-diabetic on haemodialysis

Type 2 diabetes mellitus (DM) has emerged as the commonest cause of end-stage renal disease. Haemodialysis (HD) treatment constitutes a high-risk environment for the transmission of hepatitis C virus (HCV). The aim of this study was to establish a potential relationship between type 2 DM and HCV infection in HD patients. Of the 267 HD patients, 67 (25.1%) had type 2 DM and 200 (74.9%) were with diverse aetiology for end-stage renal disease. The serum markers of HCV infection were tested by a second-generation enzyme-linked immunosorbent assay test for antibodies and by qualitative reverse-transcription polymerase chain reaction technique for viral RNA. The overall prevalence of anti-HCV antibodies and HCV RNA was found to be 12.7% (34/267) and 10.1% (27/267), respectively. Patients with type 2 DM were found to have a higher HCV prevalence compared with non-diabetic patients [20.8% (14/67) vs. 10% (20/200)] (p < 0.05). The mean period on dialysis of anti-HCV-positive patients with type 2 DM was shorter than that observed for anti-HCV-positive non-diabetic patients (43.9 +/- 9.8 months vs. 59.7 +/- 28.4 months) (p < 0.05). This study has shown that although the period on dialysis of diabetic patients are shorter than non-diabetic patients, the prevalence of HCV in HD patients with type 2 DM is higher than that detected in non-diabetic HD patients.

Comparison of xenografting in SCID mice and LIVE/DEAD assay as a predictor of the developmental potential of cryopreserved ovarian tissue

This study compared the predictive value of the LIVE/DEAD fluorescence viability assay to xenotransplantation in SCID mice, regarding the developmental potential of cryopreseved human ovarian tissue for fertility preservation purposes. The thawed ovarian tissue of ten patients was partly examined by LIVE/DEAD viability staining or histologically examined after transplantation and gonadotropin stimulation in 30 SCID mice. The LIVEIDEAD assay showed 87.1 +/- 3.5% (mean +/-SD, n=10) viable follicles (intact oocyte and more than 50% of granulosa cells alive). Histological examination showed follicles in all developmental stages in the transplanted grafts. The total number of follicles found was much lower than with the LIVE/DEAD assay (8.9 +/- 3.1 versus 54.4 +/- 20.0, p < 0.001). If the LIVE/DEAD assay yields > approximately 85% viable follicles, it can be assumed that the follicles in the cryopreserved tissue have maintained their developmental potential. This assay is, therefore, a suitable diagnostic method before an intended retransplantation.