Low risk stage I endometrial carcinoma: prognostic factors and outcomes

OBJECTIVES

The aim of the study is to evaluate clinical features of patients with low-risk stage I endometrium cancer, who received adjuvant therapy or followed with observation only and to analyse the effects of known prognostic factors in this group of patients.

MATERIALS AND METHODS

A total of 246 patients (median age: 53, range: 31-77) with low-risk stage I endometrial cancer, who were just followed postoperatively (156 patients) or received adjuvant radiotherapy (90 patients) between 1996 and 2007 were reviewed retrospectively.

RESULTS

Local recurrence was detected in four patients, distant metastasis occurred in seven patients, and two patients had both local recurrence and distant metastasis. The 83.3% of recurrences were on the vaginal stump. Five- and ten-year local control (LC) and overall survival (OS) rates are 97.6%, 97.6% and 96.4%, 93.5% in the observation and adjuvant therapy groups, respectively, whereas distant control rates are 96.7% and 96.3%. In multivariate analysis, only age and lymphovascular invasion (LVI) were found to affect OS and disease-free survival (DFS).

CONCLUSIONS

LC and OS rates are high in the low-risk group of patients; however, current adjuvant therapies did not improve the outcomes. Age over 60 years and the presence of LVI have negative effects on outcomes in this group of patients.

Postoperative chemoradiation in patients with localized gastric adenocarcinoma: single center experience

BACKGROUND

5-Fluorouracil (FU)-based chemotherapy (CT) and concurrent 45 Gy radiotherapy (RT) is one of the standard postoperative approaches currently used in gastric carcinoma. The high toxicity rates of this treatment leads to interruption of treatment in the majority of patients. In our study, we investigated the rates of toxicity and treatment discontinuation observed during postoperative FU-based chemoradiotherapy (CRT); retrospectively evaluated the effect of CRT and the other prognostic factors on local and distant control and survival.

PATIENTS AND METHODS

A total of 160 patients consisting of 97 total and 63 subtotal gastrectomy receiving postoperative CRT, have been studied retrospectively.

RESULTS

Patients who had to discontinue the treatment for a median of 6 (range, 3-13) days experienced toxicity during treatment at a rate of 43%. During the 21 (range, 4-68) months of follow-up local recurrences were observed in 8 (5%) patients and distant recurrences were observed in 41 (25.6%) patients. While the 1-3 year overall survival (OS) rates were 75% and 42%, 13-year disease-free survival (DFS) rates were 63% and 42%, respectively. In the univariate analysis for OS and DFS demonstrated statistical significance for below those 60 years of age, D1-D2 dissection type, negative surgical margin, early treatment beginning, the absence of invasion, and early stage disease. D1D2 dissection type, early treatment beginning, age below 60 years and early stage disease significantly improve OS and DFS in multivariate analysis.

CONCLUSIONS

Survival is worse in patients older than 60 years, had late treatment beginning, advanced stage and D0 dissection.

Prognostic factors and treatment outcomes in patients with operated endometrial cancer: analysis of 674 patients at a single institution

PURPOSE

Endometrial carcinoma is the most prevalent gynecologic tumor in developed countries. The aim of the present study was to evaluate the clinical characteristics of the patients with endometrial cancer.

METHODS

Six hundred and seventy-four patients who had received postoperative therapy were retrospectively investigated. Of the cases, 186 were only monitored, whereas 43 received intracavitary radiotherapy (ICRT) and 54 external beam radiotherapy (EBRT). Two hundred and fifty-nine patients received both EBRT plus ICRT. Eight patients received chemotherapy (CT), whereas 24 patients received both CT and EBRT plus ICRT.

RESULTS

Statistical analyses revealed that age, menopausal status, tumor histology, stage, grade, tumor diameter, myometrial invasion, lymphovascular space invasion (LVI), positive cytology of abdominal fluid/washings, omental involvement, adnexal involvement and the type of the therapy significantly affected both the overall survival (OS) and disease- free survival (DFS). Survival was poor in patients over 60 years of age, who had advanced stage (higher than FIGO stage 2a), grade III tumor and myometrial invasion >50%.

CONCLUSION

Age was the most important factor associated with local relapse while survival was affected by age, grade, myometrial invasion and stage.

Aeration efficiency of free-surface conduit flow systems

Dissolved oxygen is a measure of the quantity of oxygen present in water and is one of the best indicators of the health of a water ecosystem. Dissolved oxygen levels in water can be increased by creating turbulent conditions where fine air bubbles are carried into the bulk of the flow. This is achieved by hydraulic structures. A free-surface conduit is a particular instance of this. In the present work, a series of experiments were conducted to investigate the aeration efficiency of free-surface conduit flow systems. The results indicate that free-surface conduit flow systems are very effective for oxygen transfer. At Froude numbers greater than 15, almost full oxygen transfer up to the saturation value was reached. Moreover, from experimental data, a regression equation was obtained with a very high correlation coefficient, showing the effect of various parameters on the aeration efficiency.

A retrospective comparison of concurrent 5-fluorouracil or oral UFT in postoperative chemoradiation for gastric adenocarcinoma

PURPOSE

5-fluoro-uracil (FU) is a common agent in postoperative chemoradiation in gastric adenocarcinoma. However, FU is not well tolerated in a significant proportion of patients. UFT, a fixed combination of the oral FU prodrug tegafur with uracil, is one of the agents used instead of FU in such cases. We retrospectively compared the toxicity, local and distant control and survival rates with FU or oral UFT during concurrent radiotherapy to assess the role of UFT instead of FU.

PATIENTS AND METHODS

We conducted a retrospective analysis of survival, disease control and toxicity data in 52 patients treated with postoperative chemoradiation following total or subtotal gastrectomy for gastric adenocarcinoma with either FU or UFT between January 2003 and December 2004.

RESULTS

Median follow-up was 20 months (range: 3-59), median survival time was 23 (+/-6.08) months and 1-3 years overall survival (OS) rates were 64.9-39% for all patients. Compared with the UFT regimen, the incidence of treatment interruption was greater with FU (p=0.023), but no significant differences were seen in local control (p=0.40), distant recurrences (p=0.83) and survival rates (p=0.8657) among patients.

CONCLUSION

Concurrent UFT with radiotherapy seems to be a more tolerable and an equally effective regimen in the postoperative treatment of gastric adenocarcinoma when compared to FU.

Male breast cancer: a retrospective analysis

BACKGROUND

To evaluate our results in the treatment of male breast cancer patients with respect to local control (LC), overall survival (OS) and possible prognosis factors for survival.

PATIENTS AND METHODS

Thirty-nine patients with male breast cancer have been retrospectively studied with the trial aim to evaluate the results of our practice. Among them, 94.8% had invasive ductal carcinoma (IDC), 2.6% invasive papillary carcinoma (IPC) and 2.6% invasive lobular carcinoma (ILC) and the distribution according to stage was found to be 12.8, 46.2, 30.7 and 10.3% in Stages I, II, III and IV, respectively. Among the patients, 7.7% received radiotherapy (RT) and hormonotherapy (HT), 22.8% received chemotherapy (CT), 61.8% received chemoradiotherapy (CRT) and HT and 7.7% received HT in addition to surgery.

RESULTS

The distant metastases rate was 36% and the local recurrence rate was 5%. All the local recurrences and the distant metastases had occurred after the first two years. The five-year disease free survival (DFS) and OS rates were 65.8 and 80.1% respectively. In our series, univariate analysis for OS demonstrated statistical significance for lymph node metastases (p=0.00001), stage (p=0.0098) and age (p=0.03); while RT in the treatment modality (p=0.6849), and tumor size (p=0.4439) demonstrated no significance. The presence of lymph node metastases significantly impairs OS (p=0.004) and DFS (p=0.014) in multivariate analysis.

CONCLUSION

Postoperative radiotherapy was important in the management of male breast cancer to improve LC resulting in one local failure, but did not improve OS and DFS in our analysis. The presence of lymph node metastases significantly impaired OS and DFS.

Analysis of patients diagnosed as rectal carcinoma treated with neoadjuvant chemoradiotherapy and radiotherapy alone

14582

Background: Surgery is the standart of the treatment in rectal carcinoma with the help of radiotherapy and chemotherapy applied before or after the operation. Neoadjuvant usage of radiochemotherapy had promising results in randomised trials and in meta-analysis. Methods: We evaluated rectal cancer patients admitted to our center between January 1999-December 2004 retrospectively. Sixty-eight patients were documented. Seventy-five percent of them were male. All of them had adenocarcinoma in histology (19.1% and 5.9% had mucinous and signet ring components respectively). Most of the patients were in Stage II (83.8%). Median 50.4 Gy (45–72 Gy) radiotherapy was delivered in 1.8 Gy fraction dose. Chemoradiotherapy was applied in 86.8% of cases (5-fluorouracil in 35.3% and raltitrexed in 51.5% of them). In operated patients 4 cycle bolus 5-fluorouracil and leucovorin were delivered as adjuvant treatment. Results: Median follow up was 23 months (1–70 months). Downstaging was seen in 54.4 % of cases. In ten (14.7%) patients total response were detected. Six of them (8.8%) were clinically total responders and were not operated. Downstaging was recorded better in 5-fluorouracil group (66.7% versus 37.1%) and it was statistically significant (p< 0.05). Local recurrence and metastasis were seen in 16.2% and 17.6% of the cases respectively. Highest local recurrence rate was seen in T4 stage (42.9%) and highest rate of metastasis was seen in poorly differentiated histology. Regarding all patients; disease free survival and overall survival in three years were 77.7% and 81.4% respectively. There were no statistically significant difference between subgroups of different chemotherapy schedules. Grade I, II and III gastrointestinal system toxicities were seen 16.7%, 48.5% and 15.2% respectively. They were 70.6%, 11.8% when considering Grade I and II hematological toxicities. Conclusions: Neoadjuvant chemoradiotherapy regimens provide downstaging, preserve anal sphincter functions and make easier the surgical approach. In our study 5- fluorouracil seems to be better than raltitrexed but further larger scale randomised trials must be done with different chemotherapeutic agents to state the advantages of neodjuvant chemoradiotherapy in rectal cancer.

No significant financial relationships to disclose.

Retrospective analysis of 105 cases of uterine sarcoma

16079

Background: Currently there is no randomized study based or widely accepted therapeutic modality in uterine sarcomas which are rare tumors forming a heterogeneous group in respect to their pathologic classification. Methods: In our trial, 105 pts. with uterine sarcoma who were referred to our clinic between years 1995–2003 have been retrospectively researched to evaluate the results in this tumor group. 43.8% had Leiomyosarcoma (LMS), 28.6% had Endometrial Stromal Sarcoma (ESS) and 27.6% had a Malign Mullarian Mixed Tumor (MMMT) while the distribution according to the histological subgroups were found to be 58.8% and 41.2% in low + middle grade tumors combined and in high grade tumors respectively. 76.2% had a Total Abdominal Hysterectomy + Bilateral Salphingooverectomy (TAH+BSO), 18.1% had a Total Abdominal Hysterectomy + Bilateral Salphingooverectomy + Lymphadenectomy (TAH+BSO+LND) and 5.7% had a suboptimal surgery as a surgical procedure. 38.1% of the pts. had Radiotherapy (RT), 18.1% had Chemotherapy (CT) and 12.4% had Chemo-radiotherapy (CT+RT) in addition to surgery. Results: The median age of the whole group is 51 (24–87). 55% of our pts. are under 50 years old and 68.5% had an “organ limited disease” ( stages I-II combined). The distant metastases rate is 30% and the local recurrence is 16.2%. All the local recurrences and 90% of the distant metastases have occurred within the first two years. The disease free survival rates at 3 and 5 years are 54.46% and 49.88% ; while the overall survival rates at 3 and 5 years are 54.63% and 51.09% all respectively. The stage is the most important factor effecting on the O.S and 5- year O.S rate is 68.43% in Stage I disease. Conclusions: The aggressive tumor progression pattern and the poor prognosis of uterine sarcomas require adjuvant therapies. The merit of current therapeutic options are still on debate since none of them has proved any specific effects. Planning further multi-center retrospective studies with high number of pts., a more clear description of the prognostic factors and thus the determination of the most appropriate therapeutic option is definitely needed.

No significant financial relationships to disclose.

31 cases with oculoauriculovertebral dysplasia (Goldenhar syndrome): clinical, neuroradiologic, audiologic and cytogenetic findings

Goldenhar syndrome (GS) or oculoauriculovertebral dysplasia (OAVD) is characterized by pre-auricular skin tags, microtia, facial asymmetry, ocular abnormalities and vertebral anomalies of different size and shape. The phenotypical findings of this syndrome are variable due to heterogenous aetiology. For that reason, the physician sometimes faces difficulty when making a definite diagnosis of OAVD. We reviewed the clinical and laboratory findings of 31 patients (15 boys and 16 girls) aged from 1 day to 16 years with the clinical diagnosis of GS. The characteristic features were pre-auricular skin tags (90%), microtia (52%), hemifacial microsomia (77%) and epibulbar dermoids (39%). Vertebral anomalies were noted in 70% of the patients. Cardiac malformations were found in 39% while a genitourinary anomaly was noted in 23% and various central nervous system malformations in 47%. There were 3 pregnancies following an intracytoplasmic sperm injection (ICSI) technique among the 31 patients. Two patients with GS came from the same family. Their relatives had hydrocephaly, myelomeningocele and neural tube defects. It is known that some chromosomal aberrations are seen in GS. We performed chromosome analysis of 29 patients. Among these cases, only one patient with severe mental and motor retardation had a 47,XX,+der(22)t(11,22)(q23; q11 karyotype due to a maternal balanced translocation t(11;22)(q23;q11). This translocation was demonstrated in her sister, brother and maternal uncle. Additionally CATCH 22 analysis in 13 cases with OAVD with a CATCH 22 phenotype revealed no deletion. OAVD patients present with different morphologic features and systemic manifestations. A multidisciplinary approach should be undertaken by departments such as pediatric cardiology, audiology, ophthalmology and plastic surgery when evaluating patients with OAVD. Chromosome analysis should be performed in every patient with Goldenhar syndrome.

Postoperative radiotherapy results in soft tissue sarcomas

19513

Background: Postoperative radiotherapy results with higher local rates than surgery alone. In this trial we have evaluated and studied factors that affects local recurrence rates. Methods: A retrospective clinical study of 125 eligible patients with soft tissue sarcoma diagnosis from SB Okmeydani Educational Hospital-Oncology Department treated between 1998–2002 years was performed. Tumor size, surgery margin histopathologic grade and type were evaluated. At subgroup analysis local recurrense rates were studied in groups with or without postoperative radiotherapy. Results: In 125 patients, 70 were tumor free, 45 were tumor positive or with suspicious margin after the surgery. Subgroup of 25 patients which have tumor size smaller than 5 cm and negative margin had no radiotherapy and had no local recurrens. In an other group of 45 patients which have tumor size larger than 5 cm and tumor negative after excision 18 patients did not have any postoperative radiotherapy and 4 of them (% 22) had local failure. The rest of the 27 patients of this group who had postoperatif radiotherapy had 2 (% 7) local failure. Among 55 patients with positive or suspicious margins; 18 had no postoperative radiotherapy and there were 6 (% 33) local recurrens while the 37 patients with radiotherapy had 7 (% 18) local recurrens rates. Conclusions: In operable soft tissue sarcomas tumor size, hystopathological grade, postoperatif surgery margins are the most important factors which affects local recurrens rates.

[Table: see text]

No significant financial relationships to disclose.

An analysis and epidemiologic study on new cancer patients admitted to our department between 1999–2003

20108

Background: Cancer is one of the most important health problems existing 10.1 millions of new patients and 6.2 millions dead in 2000. 15 millions of new patients will be supposed to be seen in 2020. Method: In this study; between 1999–2003, 41,564 new patients diagnosed as cancer admitted to our center were analyzed. International Classification Disease of Oncology (ICD-O) was used to classify the patients. Basal cell carcinoma and epidermoid carcinoma of the skin were not included. Rest of 41116 patients were reviewed according to their age, sex, diagnosis and coming region. Results: 55.6% of the patients were male. Top five location of the disease can be listed as follows: respiratory system (25.6%), gastrointestinal system (19.2%), breast (15.1%), genitourinary system (11.3%) and lymphoma (4.7%). Analysis according to gender is illustrated in Table . Most cases have come from Marmara Region. While peak incidence was detected between 60–69 years of age in males, it was 50–59 years of age in females. Least comings were seen below 20 years of ages in both sexes. Conclusions: Admission to our department increases gradually while it was 7,020 patients in 1999, it reached to 10,035 person in 2003. General population and population insured by Social Insurance Institution are mostly living in Marmara Region (48.16% of the population are insured by this institution and 41.72% of them reside in Marmara Region). Our department was unique active center in Social Insurance Institution’s order at that time. According to SEER (U.S. Surveillance Epidemiology and EndResults) data in United States (US); although prostate cancer is mostly seen cancer (15%) and lung cancer is recorded in just 13% of cases it is the leading data in our study (22.4%) and prostate cancer is only seen 3.8% of cases. This difference can be explained by effective screening programs in US and prostatic cancer patients mostly prefer to apply the Urology Department in our country. Smoking and environmental conditions may be the reason of high incidence in lung cancer.

[Table: see text]

No significant financial relationships to disclose.

Concomitant chemoradiotherapy with orally used agents in locally advanced gastric carcinoma: Two years results

14127

Background: We designed a prospective study to evaluate tolerability, toxicity and effectiveness of concomitant chemoradiotherapy with oral tegafur-uracil (UFT) and leucovorin in locally advanced gastric carcinoma. 13 patients admitted to our center in 10 months of 2003 (March– December) were included. Methods: Only one of the patients was female (7.7%). Median age was 52 (34–72). All of them were operated with negative surgical margins (53.8% of them have undergone total gastrectomy and rest of them were operated subtotally). All of them have 0 and 1 performance status (ECOG). Their tumor were mostly located in antrum (53.8%). 4 (30.8%) of them in stage II and in stage IIIA, IIIB and IV were as follows: 2 (15.4%), 5 (38.5%) and 2 (15.4%). Median lymph node dissection was 14 (7–31). Median time interval between surgery and treatment was 49 days (25–63). All patients were treated 45 Gy (one patient 39.6 Gy and other patient 50.4 Gy) locoregional radiotherapy (RT) and UFT 300 mg/m2/day + leucovorin 90 mg/day in three times a day during RT. Results: All patients tolerated therapy well (RT was interrupted 3 times just in one patient because of grade III emesis). At the end of median two years follow up; recurrence was seen as metastasis in 4 (30.8%) patients and locoregional in 3 (23.1%). 8 patients (61.5%) died (one of them was not related). Median progression free survival was 17 months (6–34) with 53.8% in one year and 38.5% in two years. Median overall survival (OS) was 24 months (8–34), one and two years OS were 76.9% and 46.2%, respectively. Conclusions: Concomitant chemoradiotherapy with orally used agent (UFT and leucovorin) in locally advanced gastric carcinoma is well tolerated regimen. But to increase survival data by continuing therapy with these agent after chemoradiotherapy must be researched. To answer this question another study was conducted and is going on in our center.

No significant financial relationships to disclose.

A New Method of Bone Marrow Transplantation Leads to Extention of Skin Allograft Survival

Tolerance induction through allogeneic bone marrow transplantation is an alternative method to chronic immunosuppression in maintaining long-term allograft survival. In this article, we introduce a new method of bone marrow allotransplantation, which preserves its natural microenvironment and does not require marrow processing or recipient conditioning. A total of 43 skin graft transplantations were performed in nine experimental groups between isogeneic [Lewis to Lewis (LEW, RT1(1))] and allogeneic [Lewis x Brown Norway (LBN --> F1, RT1(1+n)) to Lewis] rats under 35-day protocol of alphabeta T-cell receptor (TCR) monoclonal antibody (mAb) and cyclosporine (CsA) protocol. Monotherapies combined with "crude" bone marrow transplantation resulted in extended survival up to 21 days under CsA and up to 10 days under alphabeta-TCR mAb protocol. The use of combined protocol of alphabeta-TCRmAb/CsA with crude bone marrow transplantation resulted in the extension of skin allograft survival up to 65 days (P < .05). This new simple method of "crude" bone marrow allotransplantation without recipient conditioning is a promising, minimally invasive technique with a potential for direct clinical application.

Urinary tract infections in unplanned pregnancies and fetal outcome

AIM

Many pregnant women are exposed to antibiotics for urinary tract infections during pregnancy. Our aim is to bring attention to antibiotherapy in unplanned pregnancies.

METHOD

Among the 511 cases followed by our 'Toxicology Information and Follow-up Service' for drug exposure during pregnancy, 101 cases, unaware of their pregnancy, had been prescribed antibiotics and urinary antiseptic drugs in the first trimester of their unplanned pregnancies. The data on the outcome of these pregnancies and the babies were evaluated in this study.

RESULTS

Of the 511 cases, 101 pregnant women were exposed to nine kinds of drugs. Seventy-five cases had healthy babies; two had babies with major malformations; one had a baby with congenital hypothyroidism; five had spontaneous abortions; and eight cases underwent induced abortions. The outcomes of eight pregnancies are unknown. Two pregnancies are still continuing without any problem. One baby had a fetal renal anomaly; however, the physical examination did not reveal any other malformations. The baby died 4 hours after delivery. Another baby had atrial septal defect, a major malformation, and one baby had congenital hypothyroidism.

CONCLUSION

Urinary tract infection is one of the most frequently seen complications of pregnancy. Our study indicated that the possibility of pregnancy should be considered when prescribing antibiotics for urinary tract infections in women of reproductive age.

Pulmonary involvement in rheumatoid arthritis

The primary objective of this investigation was to assess the relationships between clinical characteristics, lung involvement, and frequency of pulmonary involvement in rheumatoid arthritis (RA). Using high-resolution computed tomography (HRCT) and pulmonary function tests (PFT), we prospectively evaluated 52 patients with RA (eight males and 44 females, mean age 53.6 years). The HRCT was abnormal in 35 patients (67.3%), the most frequent abnormalities being reticulonodular patterns, which were found in 22 patients (62.9%), ground-glass attenuation (20%), and bronchiectasis (17%). In this group of patients, PFT results were normal in 13 patients (37%). Titers of rheumatoid factor and erythrocyte sedimentation rate were significantly higher in abnormal HRCT presence. Higher Larsen's score, advanced age, and severe disease were significant risk factors for lung involvement (p<0.001, p<0.01, and p<0.01, respectively) and are suggested by our data to be statistically significant predictors of lung involvement in RA.

Optimal tobramycin dosage in patients with cystic fibrosis--evidence for predictability based on previous drug monitoring

A retrospective analysis of files of patients with cystic fibrosis and pulmonary exacerbations was performed to investigate whether an individual dosage of tobramycin once established by serum level determination allows a reliable prediction of the adequate dosage in a consecutive exacerbation. All patients hospitalized > or = 2 times between May 1997 and September 1998 with pulmonary exacerbation due to Pseudomonas aeruginosa infection susceptible to tobramycin were included. The initial dosage to tobramycin was 5 mg/kg body weight every 12 h followed by drug level determinations to establish the optimal dose. In a consecutive exacerbation the same dosage per kg body weight was used again and drug level determinations were repeated. Sixteen patients (six female = 38%) with a mean age of 24 years (median: 26 years, range: 9-33) were hospitalized for 49 pulmonary exacerbations (2-6 per patient, mean: 3, median: 2.5). During the first episode of tobramycin treatment in the study period all trough levels were < 2 microg/ml (median: 0.6) and the peak levels were 7.1-16.9 microg/ml (median: 11.9). In four patients the peak level was > 12 microg/ml. In 28 consecutive episodes the dosage of tobra myci n was chosen based on optimal results of previous drug level monitoring and in 27 instances (96%) the previously established optimal dose was confirmed. In five consecutive episodes the tobramycin dosage had been increased erroneously and this resulted in abnormally high peak levels in three cases. These findings suggest that a safe and therapeutic tobramycin dosage in an individual patient with cystic fibrosis is predictable based on a previously established optimal dosage.

Two female siblings from Turkey with Langer mesomelic dysplasia (homozygous Leri-Weill dyschondrosteosis syndrome)

Leri-Weill dyschondrosteosis is an autosomal dominant syndrome of which the characteristic features are mild-to-moderate shortness of stature and Madelung deformity of the wrist. The homozygous state of the gene for Leri-Weill syndrome causes Langer mesomelic dysplasia which is characterized mainly by shortening of the long tubular bones, more markedly in the middle than in the proximal and distal segment of the extremities. In this paper, we present two sisters with Langer mesomelic dysplasia (12 years and 6 months of age, respectively), from consanguineous parents. The mother of our cases had Madelung deformity. Father, mother and grandmother also had a slight deformity of both forearms. Unfortunately, despite the well documented case of the older sister with Langer mesomelic type dysplasia, the first and second trimester ultrasonographies of the younger sister were performed by inexperienced staff of a local urban hospital and the prenatal diagnosis of this case was not made. In this paper, we also discuss the prenatal diagnosis of Langer type mesomelic dysplasia.

"Air bubble": a new diagnostic CT sign of perforated pulmonary hydatid cyst

The greatest difficulty in the CT diagnosis of perforated pulmonary hydatid cyst (PPHC) is the increase in the attenuation numbers following infection. Because of the solid density of infected hydatid cysts, the differentiation from an abscess or neoplasm is usually impossible. The aim of this study was to evaluate the value of "air bubble" as a new CT sign in the diagnosis of PPHC. Sixty-five patients (28 men and 37 women) with PPHC were included in the study. As a control group, 55 patients who had malignant (n = 36) or non-malignant (n = 19) pulmonary diseases were also examined. Radiological diagnosis with classical CT findings was made in only 38 of 65 patients (58.5 %) with PPHC. Air bubble sign was positive in 54 of the patients with PPHC (sensitivity 83.1 %) but only 3 of 55 patients in control group (specificity 94.5 %). When we analyzed the CT scans with classical CT findings including air bubble, the diagnosis of PPHC was made in 61 of patients (93.8 %). It is concluded that "air bubble sign" is a valuable CT finding in the diagnosis of PPHC.

Acromesomelic dysplasia associated with mild lumbar spine stenosis

A rare case of acromesomelic dysplasia is reported. The radiological findings were consistent with shortness of all tubular bones, especially those of the forearms. There was also evidence of mild lumbar spine stenosis.

One calyx one ureter

A case of duplication of the renal collecting system in which a single calyx is drained by a single ureter is presented. A second ureter draining a single calyx was not reported in the literature before.

Bilateral Poland anomaly

Bilateral absence of the pectoralis major muscle with accompanying abnormalities of shoulder muscles has been reported in patients without Poland anomaly (PA). However, symmetric absence of pectoralis major muscles, hypoplasia of breasts and nipples with symmetric chest wall deformity and bilateral hand anomaly has not previously been reported. A 6-year-old girl with bilateral absence of pectoralis major muscles and hand involvement and symmetric chest wall deformity is, to our knowledge, the first known case of bilateral Poland anomaly.

Pseudotumor formation in tibia in Gaucher's disease

A very rare case of type 1 Gaucher's disease with pseudotumor formation in the right tibia is presented. In addition to the characteristic radiographic finding of distal femoral flaring (Erlenmeyer flask deformity), a lobulated osteolytic area with surrounding sclerosis was seen in the proximal metaphysis of the right tibia. Adjacent to this pseudotumor appearance was an old pathologic fracture and no significant soft tissue swelling was evident, both of these features being reported for the first time in association with Gaucher's disease.

Tobacco, alcohol use, and risks of laryngeal and lung cancer by subsite and histologic type in Turkey

Effects of tobacco smoking and alcohol use on risks of cancers of the larynx and lung have been evaluated extensively in industrialized countries. Few studies on the effect of these risk factors have been reported from developing countries. We conducted a case-control study to evaluate risks of laryngeal and lung cancers in men by subsite and cell type in relation to smoking and alcohol drinking in Turkey, a country where smoking and alcohol consumption patterns are different from those in industrialized countries. We identified 832 laryngeal and 1,210 lung cancer cases and 829 controls with information on smoking and alcohol use (amount and duration) and histologic cell type from an oncology treatment center of a Social Security Agency hospital in Istanbul, Turkey, admitted between 1979 and 1984. Both laryngeal and lung cancer showed significant associations with smoking and alcohol drinking, but no monotonic dose-response was obtained for alcohol drinking. Among smokers, the highest risks were observed in the supraglottis region of the larynx (odds ratio [OR] = 4.1) after adjustment for age and alcohol use. Among alcohol drinkers, the highest risks were observed in the glottis region of the larynx (OR = 1.7) after adjustment for age and smoking. In the analysis by the cell type of lung cancer among ever-smokers, small cell type showed the highest risk (OR = 5.4), while it showed no association with alcohol drinking. Cumulative cigarette use (pack-years) and number of cigarettes per day showed stronger associations than years smoked for both cancer sites. The relative risks of joint exposure to smoking and alcohol were 12.2 for laryngeal cancer and 14.1 for lung cancer among heavy smokers and heavy alcohol drinkers. This study provides epidemiologic evidence from Turkey that smoking and alcohol use are associated with risks of cancers of the larynx and lung.

Urethro-vaso-cutaneous fistula in a 5-year-old child

A 5-year-old boy with a 4-year history of urethro-vaso-cutaneous fistula is presented. This is the youngest patient reported to have an acquired urethro-vaso-cutaneous fistula. Fistulography is a convenient method for the demonstration of such entities.

Treatment of hemophilic pseudotumor with low-dose radiotherapy

Hemophilic pseudotumor is one of the most serious complications of hemophilia and is usually treated with extensive surgery. A new treatment approach is radiotherapy. Patients with long-bone pseudotumors are usually treated with high doses of radiotherapy greater than 1500 cGy. We treated a 13-year-old hemophilic boy who had a pseudotumor of the tibia with low-dose radiotherapy (600 cGy). There was no complication during the two-and-a-half-year follow-up. Improvement of both the clinical and radiological status of the patient was noteworthy. We would like to suggest the use of low-dose radiotherapy in patients with hemophilic pseudotumors.

Hepatotoxicity of antituberculosis therapy (rifampicin, isoniazid and pyrazinamide) or viral hepatitis

SETTING

Department of Chest Diseases, Gazi University Faculty of Medicine and Atatürk Chest Diseases Hospital, Ankara, Turkey.

OBJECTIVE

The primary purpose of this study was to assess the contributory role of viral hepatitis in antituberculosis drug hepatotoxicity.

DESIGN

Serologic markers for viral hepatitis were studied in 57 patients who developed acute hepatitis during antituberculosis therapy with rifampicin and isoniazid.

RESULTS

Among 705 adult tuberculous patients, 57 (8.1%) developed acute hepatitis during therapy with rifampicin and isoniazid. Serologic markers confirmed the presence of hepatitis B in 6 (10.5%) and hepatitis C in 4 (7%) of the 57 patients. Acute hepatitis A was not diagnosed in any of the patients.

CONCLUSION

Hepatitis occurring during antituberculosis therapy may not be drug-induced in all patients. Apart from the other factors mentioned above the endemicity of viral hepatitis in developing countries could be responsible for the higher incidence of antituberculosis-drug hepatitis.

Occupational physical activity, socioeconomic status, and risks of 15 cancer sites in Turkey

A multiple-site case-control study of 15 cancers (stomach; colon; rectum; larynx; lung; melanoma; skin; female breast; male breast; cervix; ovary; uterus; prostate; testis; and bladder) was conducted to evaluate their association with occupational physical activity and socioeconomic status (SES). A hospital-based study population (3,486 male cases and 379 female cases, and 2,127 male and 244 female controls) was established in an oncological treatment center in Istanbul, Turkey, from 1979-84. Assessment of physical activity and SES was based on job titles held by the study subjects. Two measures of physical activity were developed based on energy expenditure and 'sitting time' during working hours. Observed risks were adjusted for age, smoking, and SES. Elevated risks were observed among workers who held sedentary jobs for cancers of the colon (odds ratio [OR] = 1.6), rectum (OR = 1.3), melanoma (OR = 1.9), male breast (OR = 1.4), prostate (OR = 5.0), and ovary (OR = 2.0). Cancers of the cervix and uterus showed significantly decreasing risks with decreased activity. Risks of cancers of the colon, rectum, larynx, ovary, and melanoma were enhanced after risks for physical activity indices were adjusted for SES, while the associations between physical activity and cancers of the prostate, cervix, and uterus were weakened after SES adjustment. Risks of melanoma rose significantly with both activity indices after SES adjustment.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer of the male breast: the Turkish experience

Twenty-six patients with male breast cancer who were admitted to the Center of Oncology and Nuclear Medicine, Istanbul, Turkey, between 1980 and 1988, were analyzed retrospectively. Median age was 60 years. Most lesions were infiltrating ductal carcinomas (92%). Of 26 lesions, 9 were staged as stage II (35%), 14 as stage III (54%), and 3 as stage IV (11%). All but five patients underwent unilateral mastectomy (81%). Postoperative treatment consisted of radiation therapy combined with chemotherapy in 11 patients (42%), chemotherapy with or without hormonal therapy in 4 (15%), radiation therapy alone in 10 (38%). Radiation therapy was delivered for a mean total radiation dose of 52 +/- 2 Gy (range 30-60 Gy). Chemotherapy consisted of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in most patients (60%). FAC regimen (5-fluorouracil, Adriamycin, and cyclophosphamide) was given to 6 patients (40%). Six patients were known to have died of breast cancer during follow-up (23%). Fourteen patients were NED (no evidence of disease) at last follow-up (54%). Overall actuarial 5-year survival was calculated to be 37%, and median actuarial survival was 46.6 months. Actuarial 5-year disease-free survival was 27%, and median actuarial disease-free survival was 47.1 months. Only one patient had a local recurrence, and eight patients had 13 distant metastases (31%). Age (P = 0.023), tumor stage (P = 0.055) and nodal status (P = 0.013) were the most significant prognostic factors correlated with the overall survival.

A randomized study comparing cyclophosphamide, doxorubicin, vincristine (CAV) with cyclophosphamide, etoposide, vincristine, methotrexate (CEVM) in patients with small cell lung cancer

This trial was carried out to assess the response rate and survival benefit achieved, if any, by substitution of etoposide for doxorubicin and addition of methotrexate in combination with cyclophosphamide and vincristine in the treatment of 113 patients with small cell lung carcinoma (SCLC). Cyclophosphamide, etoposide, vincristine, methotrexate (CEV-M) yielded a response rate of 75% in localized disease (LD) and 63% in extensive disease (ED), versus 61% in LD and 52% in ED in the cyclophosphamide, doxorubicin, vincristine (CAV) arm. There was also a significant survival benefit for the responders in favor of CEV-M (21.7 +/- 3.8 months of median survival compared to 13.6 +/- 2.8 months in CAV arm) in patients with LD.

Occupational physical activity and colon cancer risk in Turkey

A case-control study of 107 colon cancer cases and 486 controls from an oncological clinic in Istanbul was conducted to examine the association between occupational physical activity and colon cancer in Turkey, where incidence of this disease is low. Only two of the four activity measures showed evidence of an increased colon cancer risk for sedentary jobs (time spent sitting OR = 1.5 and occupational energy expenditure OR = 1.6); neither was statistically significant. Subjects below age 55 showed higher risk associated with sedentary jobs than did the older age group, probably due to their adoption of a more western lifestyle, including dietary habits, less activity, and other factors that may interact to increase the risk of colon cancer.

Hemophilic pseudotumor: a case report

Hemophilic pseudotumor has been defined as a progressive cystic swelling involving muscle which is produced by recurrent hemorrhage and accompanied by roentgenographic evidence of bone involvement. Pseudotumor is a rare complication of hemophilia, and, therefore, we present a case of a six-year-old male hemophiliac with a cyst in the left distal radius.

Tetra-oligodactyly with bilateral aplasia and hypoplasia of long bones of upper and lower limbs: a variable manifestation of the syndrome of ectrodactyly with tibial aplasia

We present, a family manifesting a variation of the syndrome of ectrodactyly with tibial apasia. The principal case in the family showed the most severe bilateral skeletal malformations of this syndrome. The hand changes of this case (tetra-oligodactyly with missing 5th rays) and of a relative (oligodactyly with the last 3 rays being affected) reflected a variable manifestation of "ectrodactyly". Additionally, a review of the relevant literature is presented for further delineation of various aspects of this syndrome.

Post-irradiation osteosarcoma of the iliac bone: a case report

A case of osteosarcoma of the iliac bone developing 12 years after the successful management of childhood rhabdomyosarcoma is presented. The frequency of secondary tumors, mainly bone malignancies, following therapeutic irradiation in the pediatric age-group, and the criteria for the diagnosis of radiation-induced bone sarcoma are discussed.