Life expactation and intensity of cancer in brief: Family histories of the patients with myeloproliferative neoplasms

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Background: Thrombosis and bleeding are the most important prognostic factors in myeloproliferative neoplasm (MPN). But there is not a prognostic factor for predicting survival at diagnosis. The determination of the intensity of the cancer incidence in brief- and family histories of patients may help to make a comment on the nature of the MPN. We investigated the effects of the concomitant diseases on survival and cancer intensity in brief- and family histories of the patients with MPN. Methods: Thirty-five (19 female, mean age 59 ±11 years) patients with MPN were enrolled to the study. The diagnosis of the patients were essential thrombocythemia in 19, polycythemia vera in six and primary myelofibrosis in six, and chronic myelocytic leukemia in four. By using Charlson’s concomitant disease index, concomitant disease weight incidence, concomitant state-age relationship, and probability of 10 years survey were investigated. Results: In brief history of the patients, only one (3%) patient had skin cancer. However there were some cancers in family history of 9 patients (26%). These were hematological malignancies in four patients (2 acute myelocytic leukemia and 2 non-Hodgkin’s lymphoma) and solid tumors in five patients (2 breast, 2 colon cancer, one skin and lung cancers). Mean Charlson’s concomitant disease weight index was 1.4±1.5 (0-6), concomitant state-age relationship was 3.2±2 (0-8), and probability of 10 years survey was 63±35% (0-98%). Conclusions: Although our study group is small, Charlson’s concomitant disease index may be used for the determining of life expectancy in MPN. Moreover cancer cluster in family history of these patients was notable.

Macroglossia as a presenting feature of multiple myeloma

Macroglossia has been very rarely reported as a first clinical sign of multiple myeloma.

The effects of desferrioxamine on cisplatininduced lipid peroxidation and the activities of antioxidant enzymes in rat kidneys

Cisplatin-induced nephrotoxicity is associated with an increase in lipid peroxidation and oxygen free radicals in rat kidneys. In this study, the effects of desferrioxamine were compared to vitamin C and E on cisplatin-induced lipid peroxidation and antioxidant enzyme activities in rat kidneys. Rats were divided into five groups, with 15 Wistar rats in each group. In the control group, rats received 1 mL/100 g isotonic saline solution intraperitoneally (i.p.). In Group II, 10 mg/kg cisplatin i.p. was injected to rats. Thirty minutes before the same dosage of cisplatin administration, 100 mg/kg i.p. vitamin C or E was given to rats in groups III and IV, respectively. Rats in Group V received 250 mg/kg desferrioxamine i.p., before the same dose of cisplatin administration. All rats were killed by cervical dislocation after 72 hours. The kidneys were immediately removed and washed in cold saline. Spectrophotometric method was used for all analyses. While catalase, glutathione reductase (GR), and super oxide dismutase (SOD) levels were found to be significantly decreased (P B < 0.001), malondialdehyde (MDA) (P < 0.05) and hydrogen peroxide (H2O2) (P < 0.001) levels were significantly increased in the cisplatin group when compared to the controls. MDA levels were decreased by desferrioxamine (P < 0.005) as well as vitamin C and E (P < 0.05 and P < 0.001, respectively). These three compounds induced a significant increase in SOD levels (P B < 0.05), but only in the vitamin C group, were SOD levels not significantly different than the levels of the controls (P > 0.05). In the desferrioxamine (P < 0.05), vitamin C and E groups (P < 0.001 for both), the cisplatin elevated H2O2 levels were decreased. None of these drugs had any effect on GR and catalase levels (P > 0.05). Desferrioxamine is useful to prevent cisplatin-induced lipid peroxidation, however, vitamin C and E are more effective on antioxidant enzymes than desferrioxamine.

H. pylori positivity and various pathological, endoscopic and clinical features correlated with each other

OBJECTIVE

To investigate the relationship between dyspepsia symptom scores and endoscopic appearances, and histopathological findings and helicobacter pylori positivity in patients having dyspepsia symptom.

METHODS

The study was conducted at the gastroenterology outpatient clinic of Adnan Menderes University, School of Medicine, Aydin, Turkey from April 2012 to July 2012 and comprised patients between 18-65 years of age who were admitted with dyspepsia. Glasgow dyspepsia severity scoring was done with questions posed orally to the patients. In histopathological evaluation of biopsy specimens according to Sydney criteria, chronic inflammation, activity, atrophy, intestinal metaplasia and helicobacter pylori parameters were used. Total number of eosinophils and number of mast cells were recorded.

RESULTS

Of the 60 patients with dyspepsia, 38(63.3%) were female and 22(36.7%) were male. The degree of activation and severity of inflammation increased significantly with increasing helicobacter pylori positivity(r=0.459'p<0.0001; r=0.475'p<0.0001). A significant relationship was found between inflammation, activation and the number of mast cells (p<0.05).There was no relationship between helicobacter pylori intensity and the eosinophil count (r=0.171; p=0.093). There was also a statistically significant correlation between severity of inflammation and activation and the number of eosinophils (r=0.313;p=0.002;r=0.245;p=0.016).

CONCLUSIONS

Mast cell density was seen to have a role in the inflammatory processes of helicobacter pylori infection.

Immunohistochemical evaluation of CD20 expression in patients with multiple myeloma

OBJECTIVE

CD20 expression was reported at different rates in patients with multiple myeloma. The importance of this B-cell antigen for plasma cells is still unknown. This study aimed to investigate CD20 expression of myeloma cells in bone marrow, and any relationship between the stage of disease, isotype and clinical features.

METHODS

Sixty-one patients who were admitted to the hematology clinic of the Adnan Menderes Medical School with the diagnosis of multiple myeloma according to the criteria of the "International Myeloma Working Group" were enrolled in this study. Age, gender, Durie-Salmon stage, history of autologous hematopoietic stem cell transplantation, and the distribution pattern and positivity of CD20 expression on multiple myeloma cells in bone marrow were evaluated. The Mann-Whitney U and chi-square tests were used for statistical analysis with a p-value<0.05 being accepted as statistically significant.

RESULTS

Thirty patients (48.9%) had positive scores for CD20 with the distribution pattern being most likely interstitial in 55.6% of the cases. There was no statistically significant difference between immunohistochemical positivity for CD20 expression on multiple myeloma cells, immunoglobulin type, and the stage of disease.

CONCLUSION

The combination of immunohistochemical studies with flow cytometry may reveal the importance of CD20 positivity in patients with multiple myeloma more clearly.

Relationship between glycemic control and histochemical myeloperoxidase activity in neutrophils in patients with type 2 diabetes

BACKGROUND

Myeloperoxidase (MPO) is a lysosomal hemoprotein found in the azurophilic granules in neutrophils. Myeloperoxidase plays an important role in oxygen-dependent killing of bacteria, fungi, virus and malignant cells. Diabetes mellitus (DM) is listed among conditions that may lead to secondary MPO deficiency in neutrophils but inconsistent results concerning MPO activity in diabetic patients have been reported in the literature. In this study, we aimed to evaluate the relationship between glycemic control in patients with type 2 DM and MPO activity in neutrophils from a histochemical perspective.

METHODS

The study included 40 patients with type 2 DM with poor glycemic control, 30 patients with type 2 DM with good glycemic control and 31 healthy controls. Peripheral blood smears were analyzed for each patient included in the study. Myeloperoxidase dye was used for staining. Myeloperoxidase ratios in neutrophil were evaluated for proportions of staining with MPO in 100 neutrophils in each smear. SPSS 16.0 version was used for statistical analyses.

RESULTS

Myeloperoxidase ratios in neutrophils were 70 (58.5-80) in type 2 DM patients with poor glycemic control compared to 80 (73.75-90) in those with good glycemic control and 88 (78-92) in healthy controls. The DM group with poor glycemic control was statistically significantly different from the other groups (p < 0.001).

CONCLUSIONS

Poor glycemic control in diabetic patients results in decreased MPO activity in neutrophils histochemically.

Efficacy and tolerability of amifostine in elderly cancer patients

BACKGROUND

Amifostine is a cytoprotective agent used to prevent cisplatin nephrotoxicity. It is associated with dose-limiting acute toxicities of emetic symptoms (nausea and vomiting) and transient hypotension.

OBJECTIVE

The aim of this study was to analyze the efficacy and tolerability of amifostine in elderly cancer patients.

METHODS

This 18-month, prospective, comparative study was conducted at the Department of Internal Medicine, Adnan Menderes University Hospital (Aydin, Turkey). Adult (aged 40-<85 years) hospitalized patients with advanced-stage cancer without comorbid diseases were enrolled. Patients were divided into 2 groups: age <70 years (group 1) and ≥70 years (group 2). All patients were treated with amifostine + cisplatin-based chemotherapy (CT). Amifostine 910 mg/m(2) (maximum, 1500 mg) was administered as a 15-minute IV infusion. Clinical systolic and diastolic blood pressures (SBP and DBP, respectively) were measured at 0 minute (baseline), at 8 and 15 minutes of amifostine infusion, and at 30 minutes after the start of amifostine infusion. In addition to physical examination, chest radiography, electrocardiography, blood chemistry (including serum electrolytes and renal function tests), complete blood count, and complete urinalyses were performed before each CT administration and at the post-CT day of toxicity assessment.

RESULTS

Thirty-five consecutive patients were enrolled (22 men, 13 women; mean [SD] age, 61 [12] years; group 1, n = 22; group 2, n = 13). Patients received a total of 153 CT cycles (median, 4 cycles/patient; group 1, 96 cycles; group 2, 57 cycles). Amifostine caused significant SBP and DBP reductions at 8 minutes of infusion compared with baseline in groups 1 (both P < 0.001) and 2 (P = 0.002 and P = 0.006, respectively). Overall, 20 patients (57.1%) experienced ≥ 1 symptomatic hypotensive episode; these rates were not significantly different between groups 1 (11 cases, 50.0%) and 2 (9 cases, 69.2%). Amifostine infusion was interrupted a similar number of times (6 times in group 1 and 4 times in group 2 [6.3% and 7.0% of administrations, respectively]) due to hypotension, but could be restarted in all. At 15 minutes, mean SBP and DBP values were not significantly different from baseline in either group. The mean baseline SBP values were similar between groups at baseline, and, overall, the differences in mean SBP and DBP values were not significant between groups at any time point. All other toxicities were comparable, and serum creatinine concentrations did not change significantly from baseline with CT in either group.

CONCLUSIONS

In this study of the efficacy and tolerability of amifostine in elderly patients with advanced-stage cancer without comorbid diseases, amifostine was effective in reducing cisplatin-induced nephrotoxicity, with transient systolic and diastolic hypotension being the most prominent adverse effect. All other toxicities were either low grade or preventable. No significant differences in amifostine tolerability or toxicities were observed between the study groups.

Cutaneous metastasis of gallbladder adenocarcinoma in a patient with chronic lymphocytic leukemia: a case report and review of the literature

Skin metastasis of primary gallbladder tumors is extremely rare with a reported incidence of 0.7~9% and it usually involves the thorax, abdomen, the extremities, neck, head region, and scalp. Cutaneous metastasis may occur synchronously or metatochronously. In the present case, the patient had chronic lymphocytic leukemia, which was being treated with an alkylating agent (chlorambucil) when the patient developed skin metastasis from gallbladder adenocarcinoma during post- cholecystectomy follow-up. Given the fact that secondary malignancies occur in chronic lymphocytic leukemia; this clinical setting warrants attention. We aimed to discuss secondary malignancy in chronic lymphocytic leukemia patients and gallbladder adenocarcinoma with skin metastasis, based on a review of the literature and the presented case.

The effect of insulin resistance on inflammatory response and oxidative stress in acute cerebral ischemia

OBJECTIVE

Insulin resistance (IR) has effects on inflammation and oxidative stress which have importance in acute stroke. Our aim was to investigate the relationships between IR, inflammation, oxidative stress and stroke severity in acute ischemic stroke patients.

METHODS

We examined the relationships between inflammation, oxidative stress and stroke severity in 75 acute stroke patients with and without IR. Serum levels of oxidative stress markers (nitric oxide (NO), malondialdehyde (MDA), glutathione (GSH)) were measured as well as the cytokines interleukin-6 (IL-6) and interleukin-10 (IL-10).

RESULTS

The levels of IL-10 (13.7±19.11 vs 51.20±89.32 pg/ml, p<0.00) in IR group were significantly reduced. Patients with IR had higher levels of NO (30.26±17.63 vs 22.57±14.5 µmol/L, p=0.04) and IL6 (27.44±57.13 vs 8.68±11.8 pg/ml, p<0.00) and higher NIHSS scores (11.40±5.35 vs 8.81±5.76, p=0.04) when compared with noninsulin resistant group. IL-10 was found negatively correlated with HOMA. Additionally, the parameters with positive correlations with HOMA were NIHSS, IL-6 and NO.

CONCLUSIONS

Inflammation and oxidative stress are more evident in acute stoke patients with insulin resistance which may cause worse stroke severity. Our data also suggest that IL-10 as an antiinflammatory cytokine can be much lower in insulin resistance in acute phase of ischemic stroke. However it can be elevated as an adaptive mechanism in metabolic syndrome as a chronic condition.

A coincidence of renal cell carcinoma and hematological malignancies

Hematological malignancies with renal cell carcinoma (RCC) are rarely seen. We reported here two cases of coincidence of RCC with multiple myeloma (MM) and Hodgkin's disease (HD). A 69-year-old male patient with tumor that was located at the upper pole of left kidney was admitted to our clinic. Partial tumoral resection was performed and stage-I RCC was diagnosed after the histopathological examination of tumor. Moreover, he was diagnosed with IgG kappa stage-IIA MM as a result of bone marrow examination and serum immunofixation electrophoresis. Radiotherapy, combination chemotherapy, and autologous stem cell transplantation (ASCT) were performed. The patient is still alive who achieve a complete remission. A 53-year-old male patient suffered from cervical lymphadenopathy. He has a story of right radical nefrectomy that has been performed 4 years ago. Stage II-B lymphocyte-predominant HD was diagnosed. Combination chemotherapy was started, but relapse occurred 25 months later. ASCT was not planned due to cardiovascular problems and the patient died. Clinicians should keep in mind the coincidence of RCC with MM and HD.

Bone marrow involvement in a patient with alpha heavychain disease: response to tetracycline treatment

A 28-year-old man from East Mediterranean area admitted with abdominal pain, weight loss and diarrhea. Barium x-ray studies showed segmentation, dilatation of bowel loops, mucosal folds thickening and delayed intestinal transit. Histological examination of biopsy specimens revealed villous atrophy and plasmacytic infiltration limited to mucosa and submucosa. Computed tomography showed multiple lymphadenopathy in the abdomen. Serum protein electropheresis and immunoelectropheresis indicated elevated IgA concentration. Bone marrow aspiration and biopsy revealed presence of lymphoplasmacytic infiltration. Immunohistochemical analysis of the intestine, lymph nodes showed positivity for CD45, CD-79, CD-20. After tetracycline treatment the patient's symptoms, abdominal lymphadenopathy and bone marrow infiltration disappeared and IgA concentration decreased to normal levels.

Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia

Hypertriglyceridemia causes acute pancreatitis in 1.3-3.8% of patients. We report here on two cases with severe (triglyceride level >1000 mg/dL) hypertriglyceridemia-induced acute recurrent pancreatitis. Both patients had uncontrolled hypertriglyceridemia and suffered from acute pancreatitis. No cause of secondary hypertriglyceridemia was detected. While stage E pancreatitis (Ranson's score: 2) was diagnosed in the first case, stage D pancreatitis with a null Ranson's score was detected in the second case. Both patients were treated with classical treatment with fluid replacement, analgesic, antibiotics and discontinuation of oral intake. Therapeutic plasma exchange (TPE) with fresh frozen plasma was performed consecutively and with two procedures on the 2nd and 3rd day in the first case. After TPE, while the triglyceride levels decreased from 4408 to 302 mg/dL, the amylase levels dropped from 4234 to 171 IU/L. In the second case, TPE was performed once daily. After TPE, the levels of triglyceride and amylase decreased from 2210 mg/dL and 1618 IU/L to 154 mg/dL and 110 IU/L, respectively. Local and systemic complications due to acute pancreatitis were not observed. Clinical signs and laboratory values improved. At the two-year follow-up of both patients, acute pancreatitis had not recurred with regular fenofibrate treatment. Hypertriglyceridemia should be considered in patients with acute recurrent pancreatitis. Although there is no definitive evidence for early application of TPE in severe hypertriglyceridemia-induced acute pancreatitis yet, therapy with TPE may be of benefit, improving the clinical course.

Takayasu arteritis with intracranial involvement mimicking epilepsy: case report and review of the literature

The symptoms of Takayasu arteritis (TA) are related to end organ ischemia. Here we present a patient with convulsions and intracranial involvement. A 15-year-old young woman was admitted with the complaint of convulsions since one and a half months previously. Her physical examination showed absent pulses and unobtainable blood pressure in both arms. Electroencephalography was normal. An arcus aorto-abdominal aortography, performed for TA prediagnosis, revealed that the subclavian artery ended as a stump at its origin on the right and was occluded by tapering on the left. Arcus aorta was normal. The right renal artery was occluded up to 80-90%. Magnetic resonance imaging of the brain revealed abnormal signal intensity in the deep white matter bilaterally. Cerebral catheter angiography showed focal stenosis of cerebral vessels; it was classified as type V according to the classification of the Takayasu Conference of 1994. A diagnosis of TA was made and 1 mg/kg steroid was given, and after a month methotrexate (15 mg/week) was added. On the tenth treatment day her pulse could be revealed. During the control period she had no convulsion. In young patients TA should be kept in mind as a rare cause in convulsion etiology. Intracranial involvement of TA must be evaluated especially if there is a headache and convulsion.

Successful treatment of early relapse of ocular myeloma with bortezomib and steroid after autologous stem cell transplantation

Autologous stem cell transplantation (ASCT) can prolong remission duration, overall and progression free-survival in multiple myeloma (MM). Ocular relapse is rare in MM. Here we present a patient with only ocular relaps and without evidence of bone marrow progression after ASCT. Ig A kappa myeloma, stage IIIA was diagnosed in a 53-year-old man, according to Kyle-Greipp and Durie Salmon. He was treated with three courses of VAD therapy. Then he received high dose melphalan (200 mg/m2), followed by the ASCT. After two months from ASCT, he had bilateral blurry vision, pain, redness in both eyes and diplopia. We detected 5 mm of right-sided proptosis by Hertel exophthalmometry (base 110, 20 mm right eye, 15 mm left eye). Ocular motility of oculus dexter (OD) was restricted in up and lateral gaze. He has diplopia in up gaze. His color vision was 7 of 12 in the right eye and 10 of 12 in the left eye with Ishihara plates. Best corrected visual acuity was 6/10 in the right eye and 7/10 in the left eye. Intraocular pressures were 19 mmHg for OD and 18 mmHg for oculus sinister (OS). Slit lamp biomicroscopy revealed subconjunctival hemorrhages superiorly and temporally in the right eye and bilateral conjunctival hyperemia with chemosis. Fundus examinations of both eyes were unremarkable. Computed tomography and magnetic resonance imaging of orbita revealed a right intraorbital extraconal soft tissue density mass that involved the lacrimal gland and lateral rectus muscle. Prednisolon 1mg/kg/day and bortezomib 1.3 mg/m2 were started (1, 4, 8, 11 days). Eye findings were recovered after one month. Ocular relapse should be considered if there are ocular findings after ASCT for MM. Bortezomib and steroid may be useful for ocular extramedullary relapse of MM (Fig. 2, Ref. 8).

Granulocytic Sarcoma of the Ovotestis: An Association of Myelodysplastic Syndrome and Hermaphroditism

Granulocytic sarcomas are extramedullary tumors (EMD) of malignant myeloid precursor cells. EMD or granulocytic sarcoma of ovary is rare disease. A 15-year-old girl had complaints of abdominal pain and weight loss for 3 months. On physical examination, there were hepatosplenomegaly and a painless mass under the umbilicus. Breast development was grade II. There was no clitoris hypertrophy. Her labia majora were separate and vagina hypoplastic. Hemoglobin level was 9.3 g/dl, white blood cells count 2.8 x 10(6)/1, platelet count 31.6 x 10(9)/1. There were dysplastic features in the blood and bone marrow cells. There were 10 and 22% blasts in the peripheral blood smear and bone marrow, respectively. The levels of serum follicle stimulating and luteinizing hormones were high. An inguinal mass (diameter 9.5 x 7.6) cm was detected on computed tomography. The histopathological diagnosis of this was obtained from laporascopy was composed of ovotestis and there was marked blastic infiltration in this ovotestis which had myeloid markers on flow cytometry. In the immunohistochemical analyses of ovotestis and bone marrow, blasts were positive for LCA, CD-13, CD-33 and CD 68. The cytogenetic analysis of the bone marrow shaved 46 XY karyotype. No response was achieved with combination chemotherapy and the patient died from progressive leukemia. Here we report a rare patient with myelodysplastic syndrome, EMD and hermaphroditism. To our knowledge this is the first case of MDS, EMD and hermaphroditism.

Polycystic ovary syndrome and prolactinoma association

Hyperprolactinemia is the most common pituitary hormone hypersecretion syndrome in both men and women. Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting 5%-10% of reproductive age women. Here, we present a patient with irregular menses, obesity, hirsutism and infertility, and hyperprolactinemia who was diagnosed as PCOS and prolactinoma and admitted to our clinic. Prolactinoma and PCOS association is a rare condition. This 33-year-old woman was admitted to the internal medicine outpatient clinic for irregular menses, obesity, hirsutism and infertility, and hyperprolactinemia. Her laboratory results were as follows: prolactin was 74 ng/mL (normal range:1.8-20.3 ng/mL). Pelvic ultrasonography was correlated with polycystic ovary syndrome. Pituitary MRI showed 6x8 mm microadenoma at left half. Bromocriptine was started with 1.25 mg/day and increased to 5 mg/day. After six months of bromocriptine treatment her prolactin level was normal and no adenoma was detected in pituitary MRI. PCOS and prolactinoma association should be taken into account in PCOS cases with mild hyperprolactinoma.

Is Blastocystis hominis a new etiologic factor or a coincidence in iron deficiency anemia?

Iron deficiency anemia (IDA) is a frequent health problem. Gut parasites such as N. americanus and A. duodenale are known to cause blood loss, but the role of Blastocystis hominis is uncertain. In this study, 212 patients (193 female, 19 male, mean age 41 SD 15 yrs) with IDA were enrolled and 90 persons without IDA (78 female, 12 male, mean age 45 SD 17 yrs). Microscopic examination of stools for B. hominis using the native lugol method was done three times on each subject. If any specimen contained five or more cysts per x400 field, the person was considered positive. B. hominis was found in 48 out of 212 subjects with IDA (22.6%) and in five of 90 (5.6%) subjects without IDA. This difference is highly statistically significant (P < 0.001). Few subjects had other gut parasites and there was no statistical difference in the ir frequencies between IDA and non-IDA subjects. Blastocystis hominis may play a role in the development of IDA either on its own or in conjunction with some other agent.

Chronic myeloid leukemia following the treatment of rectal adenocarcinoma

Solid tumors may occur in 3% of the patients with chronic myeloid leukemia (CML). Philadelphia (Ph)-positive CML was diagnosed in a 66-year-old man upon a white blood cell count of 58.1 x 10(9)/L. He had no symptoms and physical findings 3 years after treatment for rectal adenocarcinoma. Imatinib mesylate 400 mg/day was started and white blood cell count was lowered to 5.7 x 10(9)/L in 1 month. The patient had received several chemotherapeutic agents such as 5-fluorouracil, irinotecan, raltitrexed, capecitabine, and oxaliplatin. In the literature, there are two reports on CML after the treatment of colorectal carcinoma. The possibility of a relationship between oxaliplatin and/or irinotecan and CML may not be fully excluded. In conclusion, hematological disorders such as CML may emerge in colorectal carcinoma and whole blood counts should be carefully checked. The possibility of a relationship between CML and the chemotherapeutic agents in colorectal carcinoma should be further evaluated.

Cholesterol levels in patients with multiple myeloma

Hypocholesterolemia is seen in solid tumors and some hematological malignancies. We assessed cholesterol levels and the relationship between these levels and types and stages of multiple myeloma (MM) in the patients with MM. One-hundred two patients (60 male and 42 female) of mean age 59 +/- 11 years with MM were enrolled to this study. While 71.6% of the patients were Ig G type, 80.4% of the patients were at stage III. In the control group, there were 71 healthy persons (42 male and 29 female) of mean age 58 +/- 8 years. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in the patients with MM were significantly lower than the controls (p < 0.001). There was no difference for the levels of very-low-density lipoprotein cholesterol and triglyceride between the two groups (p > 0.05). Lipid parameters were not different between Ig types (p > 0.05). The levels of TC and LDL-C in the patients with stage I were higher than those of stages II and III (p < 0.001 and p < 0.005, respectively). The levels of TC and LDL-C in the controls were not higher than the patients with stage I (p > 0.05). HDL-C levels in the patients with stage III were lower than controls (p < 0.001). Hypocholesterolemia are seen in the patients with MM. Hypocholesterolemia may be due to increased LDL clearance and utilization of cholesterol by myeloma cells.

Factor V Leiden G1691A, prothrombin G20210A, and MTHFR C677T mutations in Turkish inflammatory bowel disease patients

BACKGROUND/AIMS

Patients with inflammatory bowel disease (IBD) have an increased risk for thromboembolic complications. We investigated the incidence of factor V Leiden G1691A, methylene tetrahydrofolate reductase (MTHFR) C677T, and prothrombin G20210A mutation in 27 Turkish IBD patients with no history of thromboembolic disease.

METHODOLOGY

Twenty-seven patients, 22 with ulcerative colitis (UC) and 5 with Crohn's disease (CD), and 47 healthy were included to the study. The DNAs were obtained from peripheral blood by using pure polymerase chain kit. Then, factor V Leiden G1691A, which active protein C resistance positive, prothrombin G20210A and MTHFR C677T mutations were investigated in DNA by using LightCycler-Factor V Leiden G1691A mutation, Prothrombin G20210A and MTHFR C677T estimate kits.

RESULTS

The heterozygote factor V Leiden G1691A mutation was detected in 3 (11.1%) patients with IBD and 2 (4.3%) controls (p > 0.05). The homozygote factor V Leiden G1691A mutation was not estimated among patients and controls. Heterozygote prothrombin G20210A mutation was detected in 2 (7.4%) patients with IBD and in 0 (0%) controls (p > 0.05). There was no homozygote prothrombin G20210A mutation in IBD and controls. Heterozygote MTHFR C677T mutation was 10 of 27 (37%) patients with IBD while 15 of 47 (32%) controls (p > 0.05). Homozygote MTHFR C677T mutation was detected in 4 patients (14.9%) with IBD and 3 (6.3%) controls (p > 0.05).

CONCLUSIONS

Our study did not reveal any association between IBD and the most common hereditary thrombophilic factors and these mutations interfere with neither disease manifestations nor the thrombotic complications.

Therapeutic apheresis: Results from a single center in Turkey

BACKGROUND

Therapeutic apheresis (TA) is carried out for a broad spectrum of diseases and syndromes.

AIM

We retrospectively evaluated the results of therapeutic apheresis (TA) including plasma exchange, therapeutic plateletpheresis, and leukapheresis during 2000-2006.

METHODS

A total of 195 procedures were performed in 44 patients (25 male and 19 female, with a mean age of 52+/-15 years). These procedures consist of 165 plasma exchanges, 20 therapeutic plateletpheresis, and 10 leukapheresis. The most common indications were hematological, neurological, and metabolic diseases. Eighty-three percent of plasma exchange, 100% of plateletpheresis and leukapheresis belonged to indication Category I or II, according to the guidelines of the American Society for Apheresis.

RESULTS

While hemoglobin levels significantly increased (p<0.05), platelet counts decreased (p<0.005) after plasma exchange. Hematological parameters did not statistically change significantly with leukapheresis (p>0.05). Platelet counts significantly decreased with plateletpheresis (p<0.001). Total complications were detected in 21% of the procedures. Adverse events (AE) were seen in 17% of the procedures. None of the patients died (Grade-IV) from any complication. AEs occurred in 14% (Grade-I), 1% (Grade-II), and 2% (Grade-III) of the procedures. The most common AEs were nausea/vomiting, hypotension, and abdominal pain.

CONCLUSION

TA, an important procedure in Transfusion Medicine, is safely carried out in our center in several hematological, neurological, and metabolic diseases which are similar to previous reports.

Effects of atorvastatin on coagulation parameters and homocysteine in patients with primary hypercholesterolemia

BACKGROUND

The mechanism of the antithrombotic action of statins is unclear. We evaluated the effects of atorvastatin on the coagulation parameters and homocysteine levels of patients with primary hypercholesterolemia.

MATERIALS AND METHODS

Forty-four patients with primary hypercholesterolemia were treated with atorvastatin 10 mg/d for 24 weeks at Adnan Menderes University Medical Faculty, Division of Hematology, Aydin, Turkey. We evaluated the effects of atorvastatin on homocysteine; lipid parameters such as total cholesterol, low-density-lipoprotein (LDL) cholesterol, very-low-density-lipoprotein (VLDL) cholesterol, triglycerides, high-density-lipoprotein (HDL) cholesterol, lipoprotein (a), apolipoprotein Al and apolipoprotein B; and coagulation parameters such as fibrinogen, antithrombin-III, protein C, protein S, von Willebrand factor, D-dimer, partial thromboplastin time and prothrombin time; and hematological parameters such as hemoglobin, white blood cell and platelet counts, vitamin B12 and folic acid.

RESULTS

Atorvastatin significantly decreased the levels of total cholesterol, LDL cholesterol (p < 0.001), VLDL cholesterol, triglycerides and apo B (p < 0.001). The level of HDL cholesterol significantly increased with atorvastatin treatment (p < 0.001). Atorvastatin significantly increased the levels of fibrinogen (p < 0.001), but it had no effect on other coagulation factors and homocysteine (p > 0.05). After treatment, while vitamin B12 levels significantly increased (p < 0.05), other hematological parameters were not changed with atorvastatin (p > 0.05).

CONCLUSION

Although there were beneficial effects of atorvastatin on lipid parameters, atorvastatin did not significantly change the level of homocysteine and hematological, and coagulation parameters, with the exception of fibrinogen and vitamin B12 levels.

Treatment of solitary gastric carcinoid tumor by endoscopic polypectomy in a patient with pernicious anemia

Type I gastric carcinoid tumors result from hypergastrinemia in 1%-7% of patients with pernicious anemia. We diagnosed pernicious anemia in a 48-year-old female patient with complaint of fatigue for three months. She had no gastrointestinal symptoms. Endoscopic examination ot the upper gastrointestinal tract revealed atrophic gastritis and a polypoid lesion in the corpus of 3-4 mm in size. Endoscopic polypectomy was performed. Histopathological examination of the specimen revealed positive chromogranin A and synaptophysin stainings compatible with the diagnosis of a carcinoid tumor. Serum gastrin level was increased, urinary 5-hydroxyindoleacetic acid was within the normal range. There was no other symptom, sign, or laboratory finding of a carcinoid syndrome in the patient. No metastasis was found with indium-111 octreotide scan, computed tomographies of abdomen and thorax. Type I gastric carcinoid tumors are only rarely solitary and patients with tumors < 1 cm in size may benefit from endoscopic polypectomy.

Plasma exchange in severe hypertriglyceridemia a clinical study

BACKGROUND

Hypercholesterolemia and hypertriglyceridemia are independent risk factors for atherosclerotic heart diseases. Moreover acute pancreatitis may occur in patients with severe hypertriglyceridemia.

AIM OF THE STUDY

To evaluate the effectiveness of plasma exchange (PE) in patients with severe hypertriglyceridemia.

METHODS

Seven patients with severe hypertriglyceridemia (a triglyceride level of more than 1000mg/dl) were treated with PE. After PE, lipid and hematological parameters and side effects were evaluated.

RESULTS

Triglyceride levels decreased below 1000mg/dl in all patients. The levels of triglyceride and very low-density lipoprotein cholesterol (p<0.05 for both), and total cholesterol (p<0.005) decreased significantly. PE was well-tolerated. Liver and renal functions, hematological parameters, except for an increase in white blood cell counts, did not change significantly.

CONCLUSION

PE may be used safely and effectively in severe hyperlipidemic patients at risk of acute coronary events and acute pancreatitis. Further extended studies may provide more detailed information.

Recovery of splenic infarction with anti-platelet treatments and platelet-apheresis in polycythemia vera

Thrombo-embolic events in coronary and peripheral arteries, and cerebral, pulmonary, portal, hepatic, and deep veins are seen in 27-45% of patients with polycythemia vera (PV). A 79-year-old man was admitted with complaints of pruritus increasing after bath and left upper abdominal pain radiating to left shoulder for two months. On physical examination, ruddy and hyperemic appearances of his face and conjunctiva, tenderness on the left upper quadrant, and splenomegaly were noted. Hemoglobin level was 16.6g/dl, hematocrit 53.8%, white blood cell count 26x10(9)/l, and platelet count 1.032x10(9)/l. Bone marrow aspiration and biopsy revealed hypercellularity, megakaryocytic hyperplasia and dysplasia. The leukocyte alkaline phosphatase score was 190. The levels of serum vitamin B12 and D-dimer were 316 pg/ml and 744 ng/ml, respectively. Arterial O2 saturation was 96%. Red cell mass was measured as 43 ml/kg using radionuclide 51Cr labelled erythrocyte scintigraphy. On cytogenetic analysis, deletion of 20q was found. Computed tomography of whole abdomen showed diffuse splenomegaly and two hypodense areas indicating splenic infarction in 2.5x2 and 3.5x3 cm diameters in subcapsular localization of the spleen. The patient was treated with therapeutic platelet-apheresis, 40 mg/day aspirin, analgesic drugs, and 3g/day hydroxyurea. After 1.5 months, platelet counts dropped to less than 500x10(9)/l and splenic infarcts were not detected on computed tomography. Splenic infarction may be the first evidence of thrombosis in PV. The reduction of platelet counts with platelet-apheresis, anti-platelet drugs, and careful clinical observation may be satisfactory in the treatment of splenic infarction.

Platelet parameters in women with iron deficiency anemia

BACKGROUND

In iron deficiency anemia (IDA), several changes in platelets have been reported. Therefore, a relationship between iron metabolism and thrombopoiesis should be considered. The aim of this study was to evaluate the platelet parameters in women with IDA.

MATERIALS AND METHODS

Eighty-six women of mean age 37 +/- 13 (16-70) years with IDA were enrolled this study. The relationship between serum iron parameters (such as iron, iron-binding capacity, iron saturation and ferritin) and platelet parameters (such as platelet counts, platelet crit, mean platelet volume and platelet distribution width) were evaluated by using Pearson correlation and stepwise logistic regression tests.

RESULTS

Thrombocytosis and thrombocytopenia were noted in 24 (27.9%) and two (2.3%) patients, respectively. Platelet counts were increased when serum iron, iron saturation, ferritin and mean platelet volume were decreased in this study. There was a linear relationship between platelet counts and platelet crit (p<0.001) but inverse relationships between platelet counts and both mean platelet volume and iron saturation (p<0.001, for both). Also there were a linear relationship between platelet distribution width and mean platelet volume (p<0.001) and an inverse correlation between platelet distribution width and mean corpuscular volume (p<0.001). We did not find any correlation between platelet crit and studied iron parameters (p>0.05).

CONCLUSIONS

In IDA, the most important factor affecting platelet counts was iron saturation. These changes in the platelet parameters may be related to low levels of tissue iron. This study suggested that decreased iron saturation might stimulate megakaryopoiesis. Moreover, iron may have an inhibitor effect on platelet counts.

The protective effects of amifostine on adriamycin-induced acute cardiotoxicity in rats

Free oxygen radicals and lipid peroxidation are responsible for adriamycin-induced cardiotoxicity. Amifostine is a scavenger of free radicals and may function as a selective cytoprotective agent. The aim of this study was to investigate the effects of amifostine on adriamycin-induced lipid peroxidation and the levels of protective enzymes in the heart. Male Wistar rats were randomly allocated to three groups: pretreated, untreated, and control (n=10 in each group). Rats were pretreated with an intraperitoneal injection of amifostine (200 mg/kg) 30 min before the injection of adriamycin. The pretreated rats were given an intraperitoneal injection of adriamycin (10 mg/kg) and were sacrificed after 72 h. Likewise, rats received intraperitoneal injection of adriamycin (untreated) or saline (control). The hearts were removed for the analyses of malondialdehyde (MDA), reduced glutathione (GSH) and catalase. MDA levels were increased (p<0.005) in the heart tissues of untreated rats compared to control, while GSH and catalase levels were decreased (p<0.05 and p<0.001, respectively) in untreated animals. In amifostine-preatreated group, MDA levels were lower (p<0.01), and GSH and catalase levels were higher (p<0.05 for both) than the untreated group. GSH levels were even higher in the amifostine-pretreated group compared to control (p<0.01), although catalase levels were significantly lower in the pretreated group (p<0.05). These results indicate that amifostine decreases adriamycin-induced lipid peroxidation and increases the levels of the protective enzymes in the heart tissue. Therefore, amifostine may ameliorate the adriamycin-induced acute cardiotoxicity.

Spondylodiscitis and Streptoccus viridans endocarditis

Infective endocarditis in association with spondylodiscitis is rarely observed. It is sometimes difficult to distinguish between rheumatologic diseases and infective endocarditis. We reported a 61-year-old male with Streptococcus viridans endocarditis suffering from low-back pain as initial symptom. Infective endocarditis was diagnosed according to Duke Criteria. L4-5 spondylodiscitis was revealed on the lumbar magnetic resonance imaging. He responded to antibiotic treatment. Infective endocarditis should be considered in patients with fever and low-back pain due to spondylodiscitis.

Localized extramedullary relapse after autologous hematopoietic stem cell transplantation in multiple myeloma

Extramedullary plasmacytomas are rare manifestation of plasma cell malignancies. After hematopoietic stem cell transplantation HSCT, presentation of localized plasmacytoma with extramedullary growth is very unusual. We report a case of a 56-year-old woman with Dune-Salmon stage IIIA immunoglobulin A-kappa multiple myeloma, which presented 120 days after autologous HSCT with extramedullary plasmacytoma arising from a lymph node in supraclavicular region. The patient had no pretransplant-history related with extramedullary disease. There was no increase of plasma cells in bone marrow or monoclonal protein in urine or serum. Aspiration smears of lymph node revealed a population of plasmacytoid cells at various stages of maturation. The patient was successfully treated with local radiotherapy and has remained progression-free for more than 20 months.

Gastrointestinal lesions and Helicobacter pylori in patients with myeloproliferative disorders

OBJECTIVE

The aim of this study is to investigate the endoscopic lesions, and Helicobacter pylori (H. pylori) positivity in patients with myeloproliferative disorders (MPD).

METHODS

Thirty patients with MPD and 93 controls with functional dyspepsia were enrolled in this study after informed consent obtained between March 2000 and July 2003. The study was held at the Departments of Hematology and Gastroenterology, Adnan Menderes University Faculty of Medicine, Adnan, Turkey. Physical examination, hemogram, peripheral blood examination, upper endoscopic examinations were performed in all patients. Helicobacter pylori positivity was evaluated by rapid urease test, and by histopathological examination of the biopsies obtained from antrum and corpus.

RESULTS

The H. pylori positivity was 46.7% in MPD and 19.4% in control group (p<0.05). The prevalence of gastritis was much higher in MPD patients than control group (p<0.05). There was no gastrointestinal bleeding in control group but 8 patients in MPD group (26.7%; p<0.05).

CONCLUSION

The higher susceptibility of H. pylori infection and high frequency of gastric lesions in patients with MPD suggests a surveillance of these patients. The eradication of H. pylori to avoid probable gastrointestinal problems is advised in MPD patients.

Functional and morphological cardiac changes in myeloproliferative disorders (clinical study)

PURPOSE

Cardiac involvement is not well defined in myeloproliferative disorders (MPD). The purpose of this study was to evaluate the cardiac involvement by transthoracic echocardiography in MPD.

MATERIALS AND METHODS

The study groups were 36 patients (mean age: 58+/-15 years, 20 female and 16 male) with MPD and 30 age-matched healthy controls. MPD group included 15 essential thrombocythemia (ET), eight chronic phase chronic myelogenous leukemia (CML), seven idiopathic myelofibrosis (MF) and six polcythemia vera patients.

RESULTS

Valvular regurgitations were present in 14 patients (39%) and eight controls (27%), (P>0.05). Mitral regurgitation (MR) was more prominent in CML compared to controls (P=0.044). The rates of annular calcifications, valvular thickening, and vegetation like lesions were not different between MPD and control groups. Pulmonary hypertension (PHT) was present in six (17%) patients, but none of the controls (P=0.021). The rates of PHT in CML and MF were significantly higher than controls (P<0.05). The rate of PHT was not different in-between MPD patients with and without thromboembolic events, however, in MPD cases with thromboembolic events PHT was more common compared to controls (P=0.037).

CONCLUSION

This study showed that valvular lesions were not more prevalent in MPD. PHT was the most prominent cardiac pathology in MPD (especially in CML, MF and thromboembolic events subgroups) compared to controls. Further evaluation of the cardiac changes in MPD subgroups with extended studies including trans-oesophageal echocardiography and longer follow-up periods would be appropriate.

A New Perspective on Cardiotoxicity of 5-Fluorouracil

BACKGROUND

The pathophysiology of 5-fluorouracil (5-FU) cardiotoxicity is still controversial. The objective of this study was to assess the influence of high-dose leucovorin and infusional 5-FU regimen (HDLV5FU) on cardiac tissues.

METHODS

We monitored 28 patients (median age 68 years) under HDLV5FU chemotherapy with complete blood counts, cardiac enzymes, C-reactive protein, coagulation tests, Holter electrocardiogram, and conventional echocardiography. Cardiac ultrasonic tissue characterization with integrated backscatter (IBS) analysis was performed in the 16 last enrolled patients.

RESULTS

The magnitude of both anterior and posterior cardiac IBS values significantly decreased at the 48th hour of treatment compared to both 0th hour and day 15 (p < 0.003). Cardiac IBS values on the 15th day were not different from the 0th hour. Clinical cardiotoxicity was not observed and other monitored parameters did not change significantly in any patient (p > 0.5 for all).

CONCLUSION

Cardiac IBS analysis suggests that 5-FU might cause reversible subclinical myocardial dysfunction.

Oral versus intramuscular cobalamin treatment in megaloblastic anemia: a single-center, prospective, randomized, open-label study

BACKGROUND

Cobalamin (vitamin B12) deficiency, the most common cause of megaloblastic anemia, is treated with intramuscular (IM) cobalamin. It has been suggested by some investigators that oral (p.o.) cobalamin treatment may be as effective in the treatment of this condition, with the advantages of ease of administration and lower cost.

OBJECTIVE

This study assessed the effects and cost of p.o. versus i.m. cobalamin treatment in patients with megaloblastic anemia due to cobalamin deficiency.

METHODS

This was a 90-day, prospective, randomized, open-label study conducted at the Division of Hematology, Department of Internal Medicine, Adnan Menderes University Research and Practice Hospital (Aydin, Turkey). Patients aged > or =16 years with megaloblastic anemia due to cobalamin deficiency were randomized to receive 1000-microg cobalamin p.o. once daily for 10 days (p.o. group) or 1000-microg cobalamin i.m. once daily for 10 days (i.m. group). After 10 days, both treatments were administered once a week for 4 weeks, and after that, once a month for life. Patients were assessed for the presence of reticulocytosis between treatment days 5 and 10 until it was detected. Therapeutic effectiveness was assessed by measuring hematologic parameters on days 0, 10, 30, and 90 and serum vitamin B12 concentration on days 0 and 90. The Mini-Mental State Examination was used before and after the B12 therapy for cognitive function assessment and 125-Hz diapozone was used for vibration threshold testing. Neurologic sensory assessment, including soft-touch and pinprick examinations, was used to identify neuropathy at baseline and study end. Tolerability was assessed using laboratory tests and patient interview. Cost was assessed using the cost of the study drug and of the injection.

RESULTS

Sixty patients completed the study 26 in the p.o. group (16 men, 10 women; mean [SD] age, 60 [15] years) and 34 in the i.m. group (17 men, 17 women; mean [SD] age, 64 [10] years). Reticulocytosis was observed in all patients. In the p.o. group, at days 30 and 90, all hematologic parameters changed significantly versus day 0 (mean hemoglobin levels increased [both P<0.001]; mean corpuscular volume decreased [both P<0.001]; mean white blood cell count increased [day 30, P<0.01; day 90, P<0.001]; and mean platelet count increased [both P<0.001]). The mean serum vitamin B12 concentration increased significantly from day 0 to 90 (P<0.001). These hematologic parameters and the recovery patterns were similar between the 2 groups. Neurologic findings included sensitive peripheral neuropathy in 9 patients (15.0%), alteration of cognitive function (loss of memory, impaired concentration) in 7 patients (11.7%), and loss of sense of vibration in 5 patients (8.3%). Neurologic improvement was detected in 7 of 9 patients (77.8%) in the p.o. group and 9 of 12 patients (75.0%) in the i.m. group at day 30.

CONCLUSIONS

In this study of patients with megaloblastic anemia due to cobalamin deficiency, p.o. cobalamin treatment was as effective as i.m. cobalamin treatment. P.o. treatment also was better tolerated and less expensive compared with IM treatment. However, because of the small sample size and the short term of this study, further long-term studies are needed to determine the efficacy of p.o. cobalamin treatment.