Prognostic factors in non-metastatic HER2 'low' and HER2 'negative' breast cancer: single institute experience

AIM

Comparison of prognosis and survival in human epidermal growth factor receptor 2 (HER2)-low and HER2-negative patients with early stage or locally advanced, hormone receptor-positive breast cancer.

MATERIAL AND METHODS

In a retrospective single center study, the patients with early stage or locally advanced stage, hormone receptor (HR)-positive [estrogen receptor (ER) ≥ 1% and/or progesterone receptor (PR) ≥ 1%] and HER2 negative or HER2 low invasive breast cancer diagnosis were included. A total of 444 patients were included in the study. Patients were divided into two groups: HER2 negative and HER2 low. There were 235 (53%) patients in the HER2 negative group and 209 (47%) patients in the HER2 low group.

RESULTS

The HER2 low group had significantly longer 5‑year disease-free survival (DFS) than the HER2 negative group. The patients with lower Ki67 (< 20%) also had a longer 5‑year DFS.

CONCLUSION

Nonmetastatic HR+/HER2 low breast cancer patients had better DFS than HR+/HER2 negative ones. The Ki67 level and HER2 low status were independent prognostic factors. Randomized clinical trials are needed in early stage HER2 low breast cancer patients.

Higher TP53 somatic mutation prevalence from liquid biopsy analysis in ever smoker non-small-cell lung cancer patients

OBJECTIVE

Cigarette smoking is a primary risk factor, linked to 80% of LC deaths. TP53, a key gene, is implicated in various cancers, with TP53 alterations in 36.7% of cancers. This research aims to investigate TP53 mutations detected in NSCLC patients by liquid biopsy and explore the relationship between these mutations and smoking history.

MATERIAL AND METHOD

The study enrolled a total of 340 patients diagnosed with non-small cell lung cancer (NSCLC). For sequencing, the Illumina NextSeq 500 system was utilized. The oncogenicity of the variants was assessed according to the ClinGen/CGC/VICC SOP and the variants were categorized into four tiers according to AMP/ASCO/CAP.

RESULTS

The most common mutations were in TP53 (48.7%), followed by EGFR, PIK3CA, and PTEN. Missense mutations were frequent, with TP53 and EGFR having higher rates in ever-smokers. No indels or complex mutations were found in ever-smokers. Patient age ranged from 20 to 86 years. Tier I-II variants were more common in ever-smokers, while Tier III variants were prevalent in never-smokers. TP53 mutations were more frequent in ever-smokers, showing a strong association with smoking. Domain distribution showed differences in PIK3CA. Transversion/transition ratios varied by gene and smoking status.

DISCUSSION

The presence of TP53 mutations is strongly associated with both cigarette smoking and elevated Tv/Ti ratios. The tier status of TP53, EGFR, and PTEN variants does not show a specific domain distribution, but interesting associations are observed between the tier status and domain distribution in PIK3CA variants. Therefore, further comprehensive investigations are needed to explore this entity, as well as the underlying factors contributing to the increased Tv/Ti rates in the TP53 gene. Such research will provide deeper insights into the genetic alterations associated with smoking and tumor heterogeneity, ultimately aiding in the development of targeted therapies.

The effects of Dapagliflozin on monocyte-HDL ratio and neutrophil-lymphocyte ratio among patients with type-2 diabetes mellitus

OBJECTIVE

The present study attempted to explore the effects of starting dapagliflozin for glycemic control in Type-2 diabetes mellitus (DM) patients on the monocyte high-density lipoprotein ratio (MHR) and neutrophil-leukocyte ratio (NLO) as oxidative and inflammation markers.

PATIENTS AND METHODS

We retrospectively investigated the medical files of Type-2 DM patients administered dapagliflozin for at least 12 weeks. Then, we recorded the patients' demographics and compared their pre- and post-treatment biochemical and hemogram parameters.

RESULTS

We retrospectively evaluated the data of 210 patients. The results revealed that the levels of fasting blood glucose (FBG; p < 0.001), hemoglobin A1c (HbA1c; p < 0.001), high-density lipoprotein cholesterol (HDL-c; p = 0.011), triglyceride (p = 0.002), and monocytes (p = 0.019) and MHR (p < 0.001) significantly decreased among the patients following dapagliflozin treatment when compared to the pre-dapagliflozin period.

CONCLUSIONS

MHR is considered a practical, inexpensive inflammation marker for diabetics using dapagliflozin. However, we could not conclude NLR to be a significant inflammation marker, which, in turn, may suggest the need for comprehensive, prospective research.

Gemcitabine-associated digital necrosis in metastatic breast cancer

INTRODUCTION

Gemcitabine is a nucleoside analog antimetabolite used in various malignancies, including metastatic breast cancer. Objective response rates in its use as a single agent in the treatment of metastatic breast cancer are not to be underestimated. Cutaneous, hematological, pulmonary, and vascular side effects are well-known side effects. Venous thromboembolism may occur with antineoplastics, such as platinum compounds. Arterial thromboembolism is rare in cancer, almost rare with chemotherapy. Here, we present a metastatic breast cancer patient who had digital necrosis due to arterial occlusion with gemcitabine monotherapy.

CASE REPORT

A 54-year-old metastatic breast cancer female patient had digital ischemia and necrosis in the left hand's fifth finger after the second course of single-agent gemcitabine as the fourth line setting. Gemcitabine was discontinued, and medical treatment was started. Thrombus was detected in the left subclavian artery digital angiography. Balloon angioplasty and stenting were applied. However, digital amputation had to be performed since tissue necrosis had not regressed despite radiological interventions and medical treatment.

MANAGEMENT AND OUTCOME

Gemcitabine was discontinued. Low molecular weight heparin and acetylsalicylic acid were started. The distal phalanx was amputated due to necrosis during follow-up. Gemcitabine was permanently stopped.

DISCUSSION

Gemcitabine-related vascular events, including arterial thrombosis, may also occur in cancer patients, especially those with higher tumor burden. Therefore, predisposing factors for hypercoagulability and vascular occlusion should be questioned in more detail even before starting antineoplastics which are known to have a lower risk for thrombosis, such as gemcitabine monotherapy.

Uncommon variants detected via hereditary cancer panel and suggestions for genetic counseling

OBJECTIVE

Hereditary cancer syndromes constitute 5-10% of all cancers. The development of next-generation sequencing technologies has made it possible to examine many hereditary cancer syndrome-causing genes in a single panel. This study's goal was to describe the prevalence and the variant spectrum using NGS in individuals who were thought to have a hereditary predisposition for cancer.

MATERIAL AND METHOD

Analysis was performed for 1254 who were thought to have a familial predisposition for cancer. We excluded 46 patients who were carrying BRCA1/2 variants in this study, for focusing on the rare gene mutations. Sequencing was performed using the Sophia Hereditary Cancer Solution v1.1 Panel and the Qiagen Large Hereditary Cancer Panel. The Illumina MiSeq system was used for the sequencing procedure. The software used for the data analyses was Sophia DDM and QIAGEN Clinical Insight (QCITM) Analyze. The resulting genomic changes were classified according to the current guidelines of ACMG/AMP.

RESULTS

Pathogenic/likely pathogenic variants were detected in 172 (13.7%) of 1254 patients. After excluding the 46 BRCA1/2-positive patients, among the remaining 126 patients; there were 60 (4.8%) breast cancer, 33 (2.6%) colorectal cancer, 9 (0.7%) ovarian cancer, 5 (0.4%) endometrium cancer, 5 (0.4%) stomach cancer, 3 (0.2%) prostate cancer patients. The most altered genes were MUTYH in 27 (2.1%) patients, MMR genes (MLH1, MSH6, MSH, MSH2, PMS2 and EPCAM) in 26 (2%) patients, and ATM in 25 (2%) patients. We also examined the genotype-phenotype correlation in rare variants. Additionally, we identified 11 novel variations.

CONCLUSION

This study provided significant information regarding rare variants observed in the Turkish population because it was carried out with a large patient group. Personalized treatment options and genetic counseling for the patients are therefore made facilitated.

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy

BACKGROUND

There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based).

METHODS

A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy.

RESULTS

The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months.

CONCLUSION

Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.

Prognostic factors of perioperative FLOT regimen in operable gastric and gastroesophageal junction tumors: real-life data (Turkish Oncology Group)

BACKGROUND

Perioperative FLOT regimen is a standard of care in locally advanced operable gastric and GEJ adenocarcinoma. We aimed to determine the efficacy, prognostic factors of perioperative FLOT chemotherapy in real-life gastric and GEJ tumors.

METHODS

The data of patients who were treated with perioperative FLOT chemotherapy were retrospectively analyzed from 34 different oncology centers in Turkey. Baseline clinical and demographic characteristics, pretreatment laboratory values, histological and molecular characteristics were recorded.

RESULTS

A total of 441 patients were included in the study. The median of age our study population was 60 years. The majority of patients with radiological staging were cT3-4N(+) (89.9%, n = 338). After median 13.5 months (IQR: 8.5-20.5) follow-up, the median overall survival was NR (95% CI, NR to NR), and median disease free survival was 22.9 (95% CI, 18.6 to 27.3) months. The estimated overall survival at 24 months was 62%. Complete pathological response (pCR) and near pCR was achieved in 23.8% of all patients. Patients with lower NLR or PLR have significantly longer median OS (p = 0.007 and p = 0.033, respectively), and patients with lower NLR have significantly longer median DFS (p = 0.039), but PLR level did not affect DFS (p = 0.062). The OS and DFS of patients with better ECOG performance scores and those who could receive FLOT as adjuvant chemotherapy instead of other regimens were found to be better. NLR was found to be independent prognostic factor for OS in the multivariant analysis. At least one adverse event reported in 57.6% of the patients and grade 3-4 toxicity was seen in 23.6% patients.

DISCUSSION

Real-life perioperative FLOT regimen in operable gastric and GEJ tumors showed similar oncologic outcomes compared to clinical trials. Better performance status, receiving adjuvant chemotherapy as same regimen, low grade and low NLR and PLR improved outcomes in real-life. However, in multivariate analysis, only NLR affected OS.

Factors leading to dissemination of cutaneous anthrax: an international ID-IRI study

Background

Although anthrax is a rare zoonotic infection, it still causes significant mortality and morbidity. In this multicenter study, which is the largest anthrax case series ever reported, we aimed to describe the factors leading to dissemination of cutaneous anthrax.

Methods

Adult patients with cutaneous anthrax from 16 referral centers were pooled. The study had a retrospective design, and included patients treated between January 1, 1990 and December 1, 2019. Probable, and confirmed cases based upon CDC anthrax 2018 case definition were included in the study. A descriptive statistical analysis was performed for all variables.

Results

A total of 141 cutaneous anthrax patients were included. Of these, 105 (74%) patients had probable and 36 (26%) had confirmed diagnosis. Anthrax meningitis and bacteremia occurred in three and six patients, respectively. Sequelae were observed in three patients: cicatricial ectropion followed by ocular anthrax (n = 2) and movement restriction on the left hand after surgical intervention (n = 1). One patient had gastrointestinal anthrax. The parameters related to poor outcome (p < 0.05) were fever, anorexia, hypoxia, malaise/fatigue, cellulitis, fasciitis, lymphadenopathy, leukocytosis, high CRP and creatinine levels, longer duration of antimicrobial therapy, and combined therapy. The last two were seemingly the consequences of dissemination rather than being the reasons. The fatality rate was 1.4%.

Conclusions

Rapid identification of anthrax is crucial for prompt and effective treatment. Systemic symptoms, disseminated local infection, and high inflammatory markers should alert the treating physicians for the dissemination of the disease.

Abstract P4-06-05: Can we adapt neoadjuvant rectal (NAR) score besides sytemic immun inflammation index (SII) and prognostic nutritional index (PNI) as prognostic factors to locally advanced breast cancer?

Introduction. Neoadjuvant treatment (NAT) is standard in locally advanced breast (LABC) & rectal cancer (LARC). Neoadjuvant rectal (NAR) score is a novel prognostic factor in LARC. Therefore, NAR score may also have prognostic value in LABC. We aimed to adapt NAR score with inflammatory indices such as systemic immune inflammation index (SII) and prognostic nutritional index (PNI) as prognostic factors in LABC. Material and Methods. 187 LABC patients who had NAT at our center were evaluated retrospectively. The nomogram by Valentini for NAR score was used. Cutoff values for NAR, SII & PNI were defined by ROC analysis. NAR score cut off value was 28.35 with 62.5% sensitivity and 65.4% specificity. Patients were grouped as NAR score low (NAR-L, ≤ 28.35) & high (NAR-H, &gt;28.35) subgroups. Inflammatory indices such as SII (neutrophil (109/L)×platelet (109/L))/lymphocyte (109/L) & PNI (albumin (g/L) + 5× lymphocyte (109/L) were calculated before (bNAT) & after (aNAT) NAT. Cut off values for bNAT & aNAT were as defined as 656 & 687 for SII and 42.5 & 40.5 for PNI. Correlation among pathological features, sentinel lymph node (SLN) & axillary lymph node (ALN) positivity rates and NAR score was evaluated. We also evaluated prognostic significance of SII & PNI. Results. Median follow up was 22 (3-109) months. All patients were female with a median age as 54 (27-79) years. While 116 (62%) patients were in NAR-L group, 71 (38%) were in NAR-H group. Median age was 54 (31-79) years for NAR-L, 54 (27-79) years for NAR-H subgroups. NAR-H group had higher mortality & relaps rates (p=0.009, p=0.009). Patients in NAR-H group had. lower pathological complete response (pCR), more lymphovascular invasion (LVI), perineural invasion (PnI) and higher postoperative ALN (&gt;0.19) positivity rate (p&lt; 0.001, p&lt; 0.001, p&lt; 0.001, p&lt; 0.001) (Table 1). Lower PNI aNAT (&lt;40.5) was a significant poor prognostic factor (p=0.027). Perineural invasion was higher in patients with higher SII bNAT (p=0.027). PNI aNAT was negatively correlated with postoperative ALN positivity rate & mortality (p=0.033, p=0.027). There was a significant decrease in PNI & increase in SII with NAT (p=0.001, p=0.012). Discussion. We consider that NAR score & PNI aNAT can be adapted to LABC as prognostic factors. Patients with higher NAR score (&gt;28.35) & lower PNI aNAT (&lt;40.5) had higher mortality rate. NAR-H group had poorer pathological features & higher SII bNAT group had more PnI. NAT led to significant changes in PNI & SII. Randomized clinical trials are needed in this area.

Relationship between NAR score & pathological featuresn (%)pNAR-L (≤ 28.35)NAR-H (&gt;28.35)Mortality40 (17.9)26 (11.0)0.009Relaps7 (6.1)16 (22.5)0.001PCR43(37.1)3(4.2)&lt;0.001LVI35 (30.2)45 (63.4)&lt;0.001PnI26 (22.4)39 (54.9)&lt;0.001SLN21 (31.3)20 (90.9)&lt;0.001ALN17 (23.3)59 (83.1)&lt;0.001

Citation Format: Cemil Yüksel, Mutlu Doğan, Serdar Çulcu, Lütfi Doğan. Can we adapt neoadjuvant rectal (NAR) score besides sytemic immun inflammation index (SII) and prognostic nutritional index (PNI) as prognostic factors to locally advanced breast cancer? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-06-05.

The role of oxidized phospholipids in COVID-19-associated hypercoagulopathy

OBJECTIVE

There is more pronounced hypercoagulation in COVID-19 infection than in other viral lung infections. Oxidized phospholipids (OxPLs) appear in COVID-19-infected lungs due to oxidative stress, after which they promote the induction of tissue factor (TF) expression and inflammatory programmers in monocytes, as well as activate endothelial cells to recruit and bind to monocytes. Therefore, we aimed to demonstrate the role of OxPLs in inflammatory and procoagulant responses in COVID-19 infection.

PATIENTS AND METHODS

Patients with a positive SARS-CoV-2 polymerase chain reaction test and ten healthy donors were included in the study. Peripheral blood was drawn at inclusion for OxPAPC, IFN-γ, and CCL2 serum level measurements. Clinical data were collected from electronic patient medical files. The serum levels of OxPAPC, IFNγ, and CCL2 were measured by immune assays.

RESULTS

Seventy-two patients were included in the study. OxPAPC and CCL2 were higher in the patients than in the controls (<0.003 and 0.011, respectively). INF-γ did not significantly differ between groups. There was no difference between the patients with lung involvement and those without CCL2, INF-γ, and OxPAPC. D-dimer, CRP, and ferritin were higher in the patients with lung involvement. Serum levels of INF-γ and CCL2 were positively correlated with each other (r:0.757, p<0.0001), but no correlation was detected between OxPAPC and INF-γ or CCL2. There was no correlation between OxPAPC and hematologic or biochemical parameters.

CONCLUSIONS

OxPAPC, which is thought to contribute to hypercoagulability, was found to be high in the patients with Covid-19 infection. The role of OxPLs in COVID-19-associated hypercoagulopathy should be investigated further in experimental models and in larger patient groups.

P–641 Pubertal high-fat diet interferes with the ovarian kisspeptin ligand and receptor expressions regulating female fertility

Study question

Does chronic high-fat diet affect ovarian dysfunctions via changing of kisspeptin and kisspeptin receptor expressions?

Summary answer

Ovarian kisspeptin and kisspeptin receptor expressions are significantly affected by the chronic high-fat diet.

What is known already

Regarding the hypothalamic-pituitary-gonadal (HPG) roles of kisspeptin, it appears that it directly stimulates LH secretion from the pituitary, consecutively stimulates ovulation in the female. There are also studies showing that kisspeptins can increase GnRH release, serum FSH, LH, and testosterone (in vivo), and regulate ovulation in women who have reached sexual maturity through the central control of the HPG axis.

Fatty acids can act as nutritional signals that regulate the HPG axis, and elevated levels of circulating saturated fatty acids associated with high-fat diet (HFD)-feeding has been shown to induce ovarian dysfunction. HFD consumption induces ovarian dysfunction in rodents.

Study design, size, duration

4-week-old female rats obtained from Akdeniz University Experimental Animals Unit. Animals were kept in standard conditions; fed with control diet consisting of standard laboratory food (13.5% of total energy from oil) or HFD (60% of total energy from oil) for 8 weeks. Experimental procedures were performed at the age of 12 weeks (250–275 g live weight). Live weights and food consumption of the animals in both groups were calculated weekly and recorded during the experiment.

Participants/materials, setting, methods

At the end of the experimental period, the animals were sacrificed and tissues were obtained. Sections were taken from paraffin-embedded tissues. Immunohistochemical staining for KISS1 and GPR54 were performed in both groups’ ovaries. Tissue collecting, processing, and immunohistochemical staining were performed at the histology and embryology department of Akdeniz University Faculty of Medicine.

Main results and the role of chance

There was a significant increase in body weights of the HFD group during the experiment period compared to the control group.

As a result of immunohistochemical staining, kisspeptin expression is specifically localized to the corpora lutea of the control ovaries. However, kisspeptin expression in the corpora lutea of the HFD ovaries was increased regardless of the ovarian follicles.

KISS1R expression was located in the cytoplasm of oocytes. HFD group also expressed the KISS1R in the oocytes with increasing intensity.

Limitations, reasons for caution

The study design included pubertal age limit of the samples. The functional reproductive period in different mammal species should be considered.

Wider implications of the findings: We suggest that chronic exposure of female rats to a high-fat diet may induce ovarian Kisspeptin expression while kisspeptin receptor expression is not affected in oocytes. Clinical implications should be considered.

Trial registration number

B.30.2.AKD.0.05.07.00/99

Efficacy and Safety of Trastuzumab Emtansine in Her2 Positive Metastatic Breast Cancer: Real-World Experience

AIM

The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment.

METHOD

Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey.

FINDINGS

Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3-4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%).

DISCUSSION

The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC.

IPS-3 Validation in 1012 cases with classical hodgkin lymphoma

The aim of this study is to validate the IPS-3 scoring system as a prognostic indicator in 1012 patients with advanced stage classical Hodgkin Lymphoma (cHL) treated by doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD). According to the IPS-3 scoring system only 3.5 % had high risk and 50.8 % had low risk disease disease and 45.8 % of the cases had intermediate risk disease. Each factors of IPS-7 and IPS-3 scoring systems (age, sex, stage hemoglobin, albumin, lymphocyte count and white cell count) were found to be significant for overall survival (OS) and progression free survival (PFS) according to univariate analyses. Two different multivariate Cox analyses were performed for OS and PFS including the IPS-3/ IPS-7 scoring system parameters. Among 7 risk factors of IPS scoring system, gender and albumin were not found as independent risk factors for both OS and PFS according to cox regression model. But all parameters such as age, stage and hemoglobin those included in IPS-3, were found to be independent significant risk factors for both models obtained for OS and PFS. The results of the study shows that the IPS-3 scoring system can be used as a prognostic indicator in ABVD treated patients in every day practice which is more easily calculate according to the IPS-7.

Systemic treatment options for growing teratoma syndrome: A single-center experience with a comprehensive review of the literature

Background

Growing teratoma syndrome (GTS) is a very uncommon phenomena. Given its lower prevalence, there is little data about clinichopathological features and management of GTS. Literature about disease mostly composed of case reports. In this study, we aimed to report patients characteristics and treatment modalities in our center within a relatively large cohort.

Patients and Methods

We retrospectively reviewed the clinical records 21 patients who fulfilled criteria of GTS. Survival analysis was performed by using the Kaplan-Meier method with the Long-rank test. p<0.05 was considered statistically significant.

Results

The median age at diagnosis was 25 (range 17-51). A total of 12 patients could have undergone surgery. Of patients who underwent surgery, 5 patients remained fully disease free, and 7 patients had experienced disease recurrences. Nine patients had unresectable disease, and treated with either platin-based chemotherapy or interferone α2b. Of those, 5 patients eventually had undergone autologous stem cell transplantation (ASCT) with surprisingly promising response rates. One patient had complete response and three patients had partial response. One patient died soon after ASCT due to infectious complication.

Conclusion

GTS is an unique entity with regard to its clinicopathological features and available treatment options as we mentioned in the text. Despite various agents reported to have efficacy in case reports, surgery remains as the mainstay of treatment. According to result of our study, ASCT and platin-based chemotherapy regimens may be feasible options for patients with unresectable disease.

Evaluation of complete blood count parameters, cell ratios, and cell volume indices in mushroom poisonings

OBJECTIVE

Mushroom poisoning is still a significant health-care problem, with the potential to affect blood parameters. The present study analyses the effect of mushroom poisoning on complete blood cell parameters, cell ratios, and cell volume indices and the effect of the mentioned parameters on prognosis/hospital length of stay.

METHODS

The study involved the retrospective assessment of 48 patients who became symptomatic after ingesting mushrooms. Patients who were 18 years and above and who spent at least one day in hospital were included in the study. The control group comprised individuals with similar characteristics to the patient group. The complete blood cell parameters, platelet indices (mean platelet volume, plateletcrit (PCT)), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio levels were compared between the two groups, and these ratios were analyzed for any correlation with length of hospital stay.

RESULTS

NLR was significantly higher and PCT was significantly lower in the mushroom-poisoned group, while all other parameters were similar between the groups. NLR had a positive correlation and PCT had a negative correlation with length of hospital stay.

CONCLUSION

NLR and PCT levels can provide information about prognosis and can aid in the prediction of hospital stay in mushroom-poisoned patients. Further investigations are needed to investigate effects of intoxication on hematological system elements.

Analysis of corneal astigmatism with NIDEK axial length scan in caucasian cataract surgery candidates

Aims and Objectives

The aim of the study was to analyze and quantify the pattern of corneal astigmatism in Caucasian cataract surgery patients using a new optical biometer (axial length [AL] Scan, NIDEK Co., Gamagori, Japan).

Patients and Methods

The datasets of cataract surgery patients acquired between March 1, 2014, and April 15, 2016, were collected and analyzed. The corneal power (flat keratometry, steep keratometry, and mean keratometry), negative cylinder power, and axis of astigmatism were recorded. Keratometry values were optically measured by optical low coherence interferometry (AL-Scan, NIDEK Co., Ltd.,) before cataract extraction.

Results

The study comprised 1233 eyes of 838 consecutive cataract candidates with a mean age of 66.8 ± 10.7 years (range 40-97 years). The mean keratometry value and corneal astigmatism were 43.69 ± 1.61 D and 0.84 ± 0.70 D, respectively. Corneal astigmatism of 1.00 D or greater was found in 344 eyes (27.9%), and 548 eyes (44.4%) had against-the-rule astigmatism. A trend toward decreasing J0 and J45 with age was found by linear regression models. The per-year increase in age was associated with a J0 and J45 decrease of 0.002 D and 0.001D, respectively.

Conclusion

This study provides the distribution of astigmatism axis and power for cataract patients in age subsets from Turkey.

Enhanced degradation of micropollutants by zero-valent aluminum activated persulfate: assessment of toxicity and genotoxic activity

Advanced oxidation of the aqueous Triton™ X-45 (TX-45), iopamidol (IOPA), ciprofloxacin (CIP) and bisphenol A (BPA) solutions via activation of persulfate (PS) with zero-valent aluminum (ZVA) was investigated. The study aimed at assessing the effectiveness of the PS/ZVA process in terms of target micropollutants (MPs) and toxicity abatements in raw surface water (RSW) and distilled water (DW). TX-45, CIP and BPA were completely degraded after 90-minute, 120-minute and 40-minute treatment, respectively, with PS/ZVA in DW, whereas 95% IOPA removal was achieved after 120-minute (MPs = 2 mg/L; ZVA = 1 g/L; PS = 0.25 mM for CIP and BPA; PS = 0.50 mM for TX-45 and IOPA; pH = 3). TX-45 (59%), IOPA (29%), CIP (73%) and BPA (46%) removal efficiencies decreased after 120-minute PS/ZVA treatment in RSW. In DW, Vibrio fischeri toxicities of original (untreated) MPs were found as: CIP (51%) > BPA (40%) > TX-45 (15%) > IOPA (1%), and as BPA (100%) > CIP (66%) > IOPA (62%) > TX-45 (35%) in RSW. Acute toxicities of MPs and their degradation products fluctuated during PS/ZVA treatment both in DW and RSW samples and resulted in different relative inhibition values after 120-minute. The original and PS/ZVA-treated TX-45, IOPA and BPA in DW exhibited neither cytotoxic nor genotoxic effects, whereas CIP oxidation ended up in degradation products with genotoxic effects.

CSF flow patterns in the brain in patients with neuro-Behçet disease and Behçet disease

OBJECTIVE

In the etiopathogenesis of Behcet disease (BD) and Neuro-Behcet disease (NBD), vascular eclipse occurs in both the arteries and veins. The disease affects all vascular structures. The present study evaluates the use of Phase Contrast (PC) Cerebral Spinal Fluid (CSF) Flow Magnetic Resonance Imaging (MRI), a non-invasive technique for measuring CSF dynamics, for determining the level of aqueducts that are influenced in BD and NBD.

PATIENTS AND METHODS

The quantitative evaluation of CSF flow in BD and NBD was performed using images obtained at the level of the cerebral aqueduct on the semi-axial plane. The PC-MRI angiography technique was used.

RESULTS

There is no distinctive difference between BD and NBD that can be distinguished by the aqueduct diameters of both conditions. A clear increase in aqueduct diameter occurred BD and NBD group when compared to the control group. While there were no differences found between the BD group and the control group regarding peak velocity, average velocity, forward flow, reverse flow, net forward flow, and flow, there were distinctive increases in these various factors in the NBD group.

CONCLUSIONS

Using the non-invasive PC-MRI technique, this study found that in BD and NBD patients, changes occurred in CSF flow figures. Increases in CSF parameters were also observed in NBD patients, a finding which may be helpful for future distinction between BD and NBD during diagnosis.

Evaluation of Lymphoma Patients Receiving High-Dose Therapy and Autologous Stem Cell Transplantation: Experience of a Single Center

The aim of this study is to evaluate the results of relapsed or refractory Hodgkin (HL) and non-Hodgkin Lymphomas (NHL) patients who underwent autologous stem cell transplantation supported high-dose chemotherapy (HDC-ASCT). Forty patients who received HDC-ASCT between November 2004 and February 2014 for relapsed or refractory HL and NHL were analysed retrospectively. There were 22 patients with HL and 18 patients with NHL. Thirty-eight patients could be evaluated after transplantation, as two of the patients died in the early post-transplantation period. We identified complete response in 24 patients (63%), partial response in 8 patients (21%), stable disease in 4 patients (11%) and progressive disease in 2 patients (5%). In all patient groups, 5-year overall survival (OS) and event free survival (EFS) were 43 and 40%, respectively; however there was no statistically significant survival difference between HL and NHL patients after ASCT, and 5-year OS and EFS were 47, 40 and 53%, 23%, respectively (p = 0.43, p = 0.76). Chemosensitive relapse had a positive impact on OS (p = 0.02). This study provides evidence for the effectiveness of HDC-ASCT as salvage therapy for patients with relapsed/refractory NHL and HL. Chemosensitive relapse is the most important prognostic factor determining the outcome of the ASCT.

The efficacy of modified docetaxel-cisplatin-5-fluorouracil regimen as first-line treatment in patients with alpha-fetoprotein producing gastric carcinoma

Alpha-fetoprotein producing gastric carcinoma (AFP-PGC) is a rare cancer for which limited data on the clinicopathological features and treatment modalities exist. The aim of this study was to compare the efficacy of modified docetaxel-cisplatin-5-fluorouracil (mDCF) as the first-line chemotherapy regimen in metastatic AFP-PGC and non-AFP-PGC. The patients diagnosed with metastatic gastric cancer who were given mDCF as first-line therapy were retrospectively reviewed. The patients with a basal serum AFP level over 9 ng/ml were defined as AFP-PGC patients. In total, 169 patients (34 with AFP-PGC and 135 with non-AFP-PGC) were included in this study. AFP-PGC patients had more liver metastases than non-AFP-PGC patients (p < 0.001). A decrease in basal AFP levels after three cycles of chemotherapy was significantly different in AFP-PGC group (p = 0.001).Overall disease control rate was 79.4% (partial response [PR] - 44.1%, stable disease [SD] - 35.3%), and 82.2% (complete response - 3%, PR - 36.2%, SD - 43%) in AFP-PGC and non-AFP-PGC patients, respectively. There was no difference between AFP-PGC and non-AFP-PGC groups in overall and progression-free survival rates (11.3 versus 11.4 months and 7.7 versus 7.1 months, respectively). Rates of grade 3-4 hematologic toxicity were 8.8% and 6.7% for neutropenia in AFP-PGC and non-AFP-PGC group, respectively and 5.9% and 7.4% for anemia. In conclusion, mDCF regimen is well-tolerated with acceptable toxicity outcomes in both AFP-PGC and non-AFP-PGC patients. A statistically significant decrease in AFP levels after mDCF regimen indicate that AFP might be considered as a supplemental marker of response to mDCF chemotherapy in AFP-PGC patients. However, further prospective clinical trials are required in this area.

Effectiveness of low-dose oral etoposide treatment in patients with recurrent and platinum-resistant epithelial ovarian cancer

The aim of this study was to evaluate the efficacy and toxicity profile of oral etoposide (50 mg/day, days 1-14, every 3 weeks) in recurrent platinum-resistant epithelial ovarian cancer (EOC). 52 recurrent platinum-resistant EOC patients followed up in four centres between April 2000 and December 2013 were analysed retrospectively. There was response in a total of 21 patients [partial response (PR) and stable disease (SD)], 12 of them used etoposide in second and third, and 9 of them used it in fourth- to fifth-lines of treatment. The overall response rate was 19.2% and clinical benefit rate was 40.4% [PR (19.2%), SD (21.2%)]. Median overall survival (OS) and progression-free survival (PFS) was 9.95 months (95%CI, 0.2-19.7 months) and 3.2 months (95%CI 2.6-3.8 months), respectively. Grade III-IV haematologic and non-haematologic adverse events were observed in 7 (13.4%) patients. We consider that oral etoposide (50 mg/day, days 1-14, every 3 weeks) is an effective treatment with a manageable adverse effect profile in recurrent platinum-resistant EOC patients. Impact statement What is already known on this subject: Oral etoposide is an effective option for recurrent EOC patients at a dose of 50-100 mg/m²/day (1-21 days, every 28 days) regimen. However, it has a high toxicity rate. What the results of this study add: Oral etoposide at a dose of 50 mg/kg (1-14 days, every 21 days) is an effective treatment with a manageable toxicity profile in platinum- resistant ovarian cancer patients when it is used as ≤4th-line palliative setting. What the implications are of these findings for clinical practice and/or further research: We need trials evaluating the effect of low-dose oral etoposide combination with bevacizumab or other chemotherapy agents (irinotecan and gemcitabine) in platinum-resistant EOC patients.

Epidemiological and Molecular Studies on Lumpy Skin Disease Outbreaks in Turkey during 2014-2015

This study was carried out to explore epidemiological and molecular features of lumpy skin disease virus (LSDV) in the Aegean, Central Anatolian and Mediterranean regions of Turkey, to evaluate the risk factors associated with LSDV infection and to investigate the financial impact of LSD and potential role of the Culicoides spp. in the transmission of LSDV. Samples were obtained from 611 cattle, each from different farms, and each clinically suspected to be infected with LSDV during the months of July 2014 and June 2015. Culicoides spp. were trapped from April to June 2015. Genetic characterization of the local LSDV field isolates was conducted by sequencing G-protein-coupled chemokine receptor gene segment. Real-time PCR high-resolution melting analysis was used for distinguishing each type of capripoxviruses. Viral DNA was detected in 448 of the 611 animals and Culicoides midges. Three hundred and ninety-three of the 448 affected farms were surveyed. The morbidity and mortality rates detected were 12.3% and 6.4%, respectively. Phylogenetic analysis showed that the field isolates in this study were clustered together with other Africa and Middle East isolates. Genotyping of isolates from infected cattle has revealed the presence of LSDV. A generalized mixed linear model showed that there were positive associations between LSDV infection, European breeds, small-sized family-type farms and nearness of farm to a lake. The financial cost of disease presence in surveyed cattle farms was estimated to be 72.75 GBP per head. The sequence analysis of the mitochondrial cytochrome oxidase subunit I gene showed that the species of Culicoides in LSDV-positive pools was Culicoides punctatus. Detection of LSDV in Culicoides punctatus suggests that it may have played a role in transmitting LSDV. Furthermore, movement of infected animals into disease-free areas increases the risk of the transmission of LSD. Control strategies for LSDV infection should include consideration of the risk factors identified in this study.

Assessment of hearing via otoacoustic emission in patients that underwent spinal anesthesia

OBJECTIVE

In this study, our aim is to show the differences between the preoperative and postoperative otoacoustic emissions (OAE) value in patients, who underwent spinal anesthesia.

PATIENTS AND METHODS

The presented study was carried out as a randomized, double-blinded, prospective study upon the approval of Ethics Committee of Medicine School, Erciyes University. The study was conducted in accordance with the Helsinki Declaration. The study involved 39 ASA I-II patients (aged 18-65 years), who underwent varicectomy operation in the Cardiovascular Surgery Department. For each of the patients, 3 OAE measurements were performed; the day before surgery, during surgery and the 1st day after surgery.

RESULTS

Significant differences were detected between the 2000 F2 measurements performed before, during and after the surgery (p<0.05). The differences originated from measurements performed before and during surgery. Significant differences were detected among 3000 F1 measurements performed before, during and after surgery (p<0.05). Hearing loss is one of the late complications of spinal anesthesia. In this study, we observed the differences between the preoperative and postoperative OAE values. The incidence of hearing loss detectable with auditory measurements has been reported to vary between 10 and 50%. Of these, 25% is clinically relevant or recognizable. However, it is considered to be a subjective test, because it is influenced from mental, motor and psychological status of the patient. But the management in hearing loss following spinal anesthesia is still controversial. Hearing loss is generally spontaneously resolved within a few days. However, there are case reports of hearing loss lasting for months.

CONCLUSIONS

In this study, we observed differences between some preoperative and postoperative OAE values.

Plasma amino acid profile in autism spectrum disorder (ASD)

OBJECTIVE

In our study, we aimed to reveal pathophysiologic mechanisms in ASD by comparing plasma amino acid levels between patients and healthy controls while considering vitamin B12 and D levels.

PATIENTS AND METHODS

The study included 21 patients aged 2-18 years-old who were followed with a diagnosis autism spectrum disorder (ASD) and 21 age and sex-matched healthy children from our outpatient clinic as control group.

RESULTS

The study included 42 children and adolescents aged 2-18 years-old (19 girls and 23 boys). There were no significant differences in terms of body weight and height between the groups. We found significant differences in levels of ammonium, phosphoethanolamine, histidine, homocysteine, carnosine, methionine, cystathionine, cystine, threonine, 3-methyl histidine and phenylalanine/tyrosine ratio between patient and control groups. Both vitamin B12 and D were significantly lower in the ASD group compared to controls. In the variance analysis with vitamin B12 and D as covariates, significant differences persisted for only phosphoethanolamine (p=0.04), cystathionine (p<0.001), cystine (p=0.006) and threonine (p=0.02).

CONCLUSIONS

Further studies are needed on the amino acids that show variations in children with ASD in order to reveal their role in the etiology and therapeutic use in ASD.

Role of circulating nesfatin-1 in the underweight children with poor appetite

OBJECTIVE

To investigate serum concentration of nesfatin-1 in underweight children who have poor appetite, and its association with anthropometric markers of malnutrition.

PATIENTS AND METHODS

We recruited 50 underweight children and adolescents (aged 2-18 years) who presented with loss of appetite. Thirty age- and sex-matched controls were also included in the study. Fasting serum nesfatin-1 concentrations were measured by using Enzyme-Linked Immunosorbent Assay (ELISA) technique.

RESULTS

Mean nesfatin-1 level was significantly higher in underweight children when compared to controls (p<0.001). There was no correlation between serum nesfatin-1 levels and anthropometrics markers.

CONCLUSIONS

Our results suggest that nesfatin-1 might have an important role in regulation of food intake and pathogenesis of loss of appetite in children.

The contribution of computed tomography to nasal septoplasty

PURPOSE

The aim of this study was to determine the contribution of computed tomography (CT) scanning to nasal septoplasty.

METHODS

The study included 76 patients, on whom septoplasty was planned to be performed because of deviated nasal septum. The patients were divided into 2 groups: those who had a CT scan (group 1, study group) and those who did not have a CT scan (group 2, control group) before septoplasty. Pathologic anatomic structures accompanying deviated septum and surgical interventions performed in addition to septoplasty were determined. The patients were asked the degree of improvement in nasal air passage obstruction, and 2 groups were compared with each other.

RESULTS

Group 1 included 40 patients, and group 2 had 36 patients. In group 1, the pathologic findings determined along with deviated septum were concha bullosa in 14 patients, retention cyst of the maxillary sinus in 2 patients, paradox middle nasal concha in 2 patients, inferior concha hypertrophy in 18 patients, frontal osteoma in 1 patient, antrochoanal polyp in 1 patient, and chronic sinusitis (maxillary, ethmoidal, frontal) in 7 patients. Lateral resection was performed for concha bullosa; out-fracture with submucosal cauterization was performed on the patients with inferior concha hypertrophy, and endoscopic sinus surgery was performed for the patients with chronic sinusitis and antrochoanal polyp.

CONCLUSIONS

Computed tomography is able to recognize some pathologic findings that cannot be found on physical examination and is helpful to decide the location and the type of the surgery. Additional surgical interventions owing to CT performed before the septoplasty are much more helpful to relieve the patient's nasal air passage obstruction.

The Outcome of Patients with Triple Negative Breast Cancer: The Turkish Oncology Group Experience

OBJECTIVE

Triple negative breast cancer (TNBC) is generally considered as a poorer prognostic subgroup, with propensity for earlier relapse and visceral involvement. The aim of this study is to evaluate the outcome of non-metastatic TNBC patients from different centers in Turkey and identify clinical and pathologic variables that may effect survival.

MATERIALS AND METHODS

Between 1993-2007, from five different centers in Turkey, 316 nonmetastatic triple negative breast cancer patients were identified with follow-up of at least 12 months. The data was collected retrospectively from patient charts. The prognostic impact of several clinical variables were evaluated by the Kaplan-Meier and Cox multivariate anayses.

RESULTS

Mean age at diagnosis was 49 years (range: 24-82). The majority of the patient group had invasive ductal carcinoma (n: 260, 82.3%) and stage II disease (n: 164; 51.9%). Majority of the patients (87.7%) received adjuvant chemotherapy. 5 year overall survival (OS) and disease-free survival (DFS) rates were 84.6% and 71.6%, respectively. Univariate analysis revealed locally advanced disease (p: 0.001), advanced pathological stage (p: 0.021), larger tumor size (T1&T2 vs T3&T4) (p<0.001), nodal positivity (p: 0.006), and extensive nodal involvement (p<0.001) as significant factors for DFS; whereas, advanced pathological stage (p: 0.017), extensive nodal involvement (p<0.001) and larger tumor size (p: 0,001) and presence of breast cancer-affected member in the family (p=0.05) were identified as prognostic factors with an impact on OS. Multivariate analysis revealed larger tumor size (T3&T4 vs T1&T2) and presence of lymph node metastases (node-positive vs node-negative) as significant independent prognostic factors for DFS (Hazard ratio (HR): 3.03, 95% CI: 1.71-5.35, p<0.001 and HR: 1.77, 95% CI: 1.05-3.0, p=0.03, respectively). Higher tumor stage was the only independent factor affecting overall survival (HR: 2.81; 95% CI, 1.27-6.22, p=0.01).

CONCLUSION

The outcome of patients with TNBC in this cohort is comparable to other studies including TNBC patients. Tumor size and presence of lymph node metastasis are the major independent factors that have effect on DFS, however higher tumor stage was the only negative prognostic factor for OS.

The evaluation of serum N-terminal prohormone brain-type natriuretic peptide, troponin-I, and high-sensitivity C-reactive protein levels in children with congenital heart disease

Although advanced diagnostic and treatment methods are available, congenital heart disease (CHD) holds an important place among the causes of death within the first year of age. Therefore, several prognostic factors are needed for diagnosis and monitoring of these patients. In this study, which includes 66 CHD patients and 38 healthy control children, serum cardiac troponin-I (cTnI), high-sensitivity C-reactive protein (Hs-CRP), and N-terminal prohormone brain-type natriuretic peptide (NT-proBNP) levels were analyzed for their prognostics values. The patient groups were categorized and then evaluated as cyanotic ( n = 16), acyanotic ( n = 50), symptomatic ( n = 23), asymptomatic ( n = 43), and isolated ventricular septal defect (VSD)-isolated atrial septal defect (ASD) groups. Cyanotic group was statistically compared with acyanotic group, symptomatic group with asymptomatic group, and VSD group with ASD group. Between the cyanotic, acyanotic, and control groups; between symptomatic and asymptomatic groups; and between the VSD and ASD groups, significant difference was not showed for age ( p > 0.05). NT-proBNP was found to be significantly higher in the cyanotic group than acyanotic and control group, in the symptomatic group than asymptomatic group; and in the patient group than healthy control group ( p < 0.05). Between the groups of VSD and ASD, significant difference was not showed ( p > 0.05). The same comparison results for TnI and Hs-CRP were not significant ( p > 0.05). TnI and Hs-CRP were only found significantly higher in the patient group than healthy control group ( p < 0.05). Eventually, we think that NT-proBNP, Hs-CRP, and TnI might be used for clinical management and estimation of outcome of these disorders in the future and these also might be able to modify existing strategies, but much more studies are needed.

A male newborn with Simpson-Golabi-Behmel syndrome, presenting with metopic synostosis, anal atresia, and total anomalous pulmonary venous return

Simpson-Golabi-Behmel syndrome is a clinical condition described by Simpson, characterized with multiple congenital anomalies and caused by Glypican 3 (GPC3) mutations of the X-linked gene. Typical findings such as overgrowth, hypoplastic changes of hands and feet, visceromegaly, cleft palate and macrocephalic distinctive facial features and multiple organ anomalies might be observed. GPC3 mutation is claimed to generally cause metopic synostosis. This case was reported because even though a lot of anomalies accompanying Simpson-Golabi-Behmel syndrome had been noticed, combination of metopic synostosis, has not been reported before.

Determination of trace metal ions by AAS in natural water samples after preconcentration of pyrocatechol violet complexes on an activated carbon column

A simple preconcentration method is described for the determination of Cu, Mn, Co, Cd, Pb, Ni and Cr in water samples by flame AAS. Trace metal ions in water were sorbed as pyrocatechol violet complexes on activated carbon column at the pH range of 4-8, then eluted with 1 M HNO(3) in acetone. The effect of major cations and anions of the natural water samples on the sorption of metal ions has been also investigated. The concentration of the metal ions detected after preconcentration was in agreement with the added amount. The present method was found to be applicable to the preconcentration of Cu, Mn, Co, Cd, Pb, Ni and Cr in natural water samples with good results such as R.S.D. from 3 to 8% (N=10) and detection limits under 70 ng l(-1).

Intestinal malignant melanoma presenting with small bowel invagination: a case report

Gastrointestinal tract metastasis of any malignancy is rare. Cutaneous or ocular malignant melanomas are the most common tumors that metastasize to the gastrointestinal tract. Major symptoms of these metastatic lesions are bleeding and obstruction of the gastrointestinal tract. However, malignant melanoma arising in intestinal mucosa causing intestinal obstruction is a rare clinical entity. Herein, we present a case of primary gastrointestinal tract malignant melanoma who presented initially with iron deficiency anemia, which consequently triggered an invagination of jejunal and ileal segments causing obstruction symptoms, three months later.

Ischaemia-modified albumin elevation after percutaneous coronary intervention reflects albumin concentration rather than ischaemia

Background

Percutaneous coronary intervention (PCI) is accepted as a model of myocardial ischaemia in studies of ischaemia markers, especially of ischaemia-modified albumin (IMA). However, there is concern that IMA levels may reflect changes in albumin concentrations rather than myocardial ischaemia also during PCI.

Methods

Twenty-one consecutive patients (17 men and 4 women) undergoing single-vessel percutaneous coronary angioplasty were enrolled in the study. IMA and albumin levels were measured together with myoglobin, creatine kinase 2 and cardiac troponin I, before (Group 1), immediately after (Group 2) and 6 h after (Group 3) the procedure of PCI.

Results

The IMA levels of Group 2 were significantly higher than those of Group 1 and Group 3 ( P < 0.05 for both). However, correction of IMA by multiplying with the (individual albumin concentration of the patient/median albumin concentration of Group 1) ratio gave no statistical differences between the groups ( P > 0.05). There were strong negative correlations between IMA levels and albumin concentrations within individual groups ( r = −0.757, P < 0.001; r = −0.712, P < 0.001; and r = −0.705, P < 0.001 for Group 1, Group 2 and Group 3, respectively).

Conclusion

The results confirm the close dependency of IMA results on albumin concentrations. Therefore, IMA results reflect albumin concentrations rather than myocardial ischaemia also in PCI. This situation and lack of standard reference materials for the albumin cobalt binding assay can lessen the diagnostic performance of IMA.

The frequency of consanguineous marriage in eastern Turkey

The frequency of consanguineous marriage in Eastern Turkey:

OBJECTIVE

The rate of consanguineous marriage (CM) varies depended on different factors such as race, characteristics of population, and religion and moral features in different countries. Gene frequency and genetic structure are changed by CMs. The aim of the present study is to assess the prevalence of CM and its effects on miscarriage, stillbirth, congenital malformation and ratio of newborn death.

METHODS

This study was performed in Van region, Eastern Turkey, between September 2005 and April 2006. A total of 650 families from 24 districts chosen in accordance with the number of inhabitants were included in this study. First cousin marriages were accepted as a first degree CMs, sesquialter and second cousin marriages as second degree and marriages between distant relatives were accepted as a third degree CM. Monthly income of the families was classified in accordance with minimum wage determined by government.

RESULTS

Of all families, 224 (34.4%) had CM, and 168 (75%) had first-degree consanguinity. A lower CM rate was found in mothers who graduated from secondary school or upgrading (p < 0.01). However, no relationship was found between CM and fathers' education level. While a low CM rate was found in families who had two or less children (p < 0.01), high rate was observed in families who had five or more children. In addition, a high rate of miscarriage, stillbirth and mental-motor retardation was found in families with CM (p < 0.05). The rate of child mortality between the aged 0-2 years was found to be higher in families with CM (p < 0.01). The higher CM rate was observed in families who married due to pressure or insistence of their families than married voluntarily (p < 0.05).

CONCLUSION

Our study showed that CM rate was very high, 34.4%, in our region Eastern Turkey.

Impact of calcineurin inhibitors on bone metabolism in primary kidney transplant patients

OBJECTIVE

Posttransplant bone disease and bone metabolism markers were investigated in primary kidney transplant recipients receiving calcineurin inhibitor (CNI) based triple immunosuppression. We examined the safety profile and independent potential of CNIs on bone formation and bone resorption. The study also attempted to correct for modifiable and nonmodifiable factors that impact on posttransplantation bone metabolism, such as age, renal function, rejection, steroid dosage, and secondary hyperparathyroidism.

MATERIALS AND METHODS

Serum alkaline phosphatase and osteocalcin were used as indices of bone formation and urinary deoxypyridinoline as a marker for bone resorption. Bone mineral density (BMD) data were assessed in all patients. Osteocalcin and deoxypyridinoline data were correlated with BMD scores to predict the clinical utility and sensitivity of these tests. Sixty-six patients among 300 kidney transplant recipients were enrolled as eligible candidates based upon more than 12 months' posttransplantation follow-up excellent graft function (GFR values >60 mL/min), and intact parathormone levels <100 pg/mL.

RESULTS

Mean follow-up was 1395.3 +/- 179.3 days and 1488.9 +/- 225.1 days for cyclosporine (CsA) and FK506 groups, respectively. Mean values for alkaline phosphatase and osteocalcin were 108.8 +/- 6.0 versus 98.4 +/- 9.7 U/L and 10.1 +/- 1.2 versus 9.8 +/- 1.5 ng/mL for the CsA and FK506 groups, respectively. Both CsA and FK506 caused mild osteoblastic proliferation and matrix mineralization activity, as reflected by increased osteocalcin and alkaline phosphatase levels in 22.6% and 12.5% of patients, respectively. This bone formation activity was counterbalanced by a three-fold increase in urine deoxypyridinoline levels in both groups. Mean deoxypyridinoline levels were, respectively, 13.8 +/- 4.4 versus 11.3 +/- 2.1 nM/mMCr in the CsA and FK506 groups. Thirty-four (68%) patients in the CsA and 10 (62.5%) in the FK506 groups had elevated deoxypyridinoline levels. A strong correlation existed between deoxypyridinoline levels and BMD scores for the CsA group (P < .0001). Despite the presence of relatively greater elevations in deoxypyridinoline and BMD values among CsA-treated patients, there was no significant difference in terms of bone resorption potential of both groups. No correlation existed between iPTH values (<65 pg/mL or among 65 to 98.2 pg/mL) at any time versus osteocalcin, alkaline phosphatase, deoxypyridinoline, or BMD levels. The symptomatic bone disease and fracture rates were 0% in this series.

CONCLUSION

Calcineurin inhibitor-based immunosuppression with low maintenance doses of glucocorticoids induces slight bone formation but relatively potent, clinically relevant bone resorption.

Two-day induction with thymoglobulin in kidney transplantation: risks and benefits

INTRODUCTION

The aim of this study was to develop an induction protocol to reduce allograft rejection with fewer posttransplant infections and malignancies.

METHODS

In this prospective randomized study, a T- and B-cell depletion protocol, consisting of IV thymoglobulin (ATG 5 mg/kg/d) plus methylprednisolone (500 mg/d) plus azathiopurine (2 mg/kg/d), was on days 0 and 1 after renal transplantation. CyA was introduced at day 3.39 among patients undergoing either primary living related (n = 16) or cadaveric (n = 23) transplants excluding recipients of full-HLA-matched sibling, or five- and six-HLA-matched cadaveric donor kidneys. The adequacy of immunosuppression was evaluated by flow cytometric analysis for total, CD3+ (T-cell), and CD19+ (B-cell) lymphocytes.

RESULTS

The acute rejection rate was 6% and 37/39 patients are alive with functioning grafts at an average follow-up of 14.5 months. The overall patient and graft survival rate was 95%. Their mean creatinine value was 1.27 mg/dL. Six patients (16%) required hospitalization due to serious infections. The two deaths were attributed to septicemia and brain abcess caused by unusual agents, namely, Rhodococcus equi and Sporobolomyces. One patient presented with a cutaneous Kaposi sarcoma in the 11th month posttransplant.

CONCLUSION

A Two-day induction protocol with thymoglobulin yields acceptable acute rejection rates among renal transplants. However, caution is necessary for adverse events, particularly atypical bacterial and fungal infections.

[Abdominal gunshot wounds: retrospective analysis of 164 patients]

The medical reports of 164 patients who were operated for abdominal gunshot wounds at Sirnak Military hospital were reviewed retrospectively. One hundred and twenty-nine patients had isolated abdominal injury whereas, 28 had associated thoracic injuries. Seven of these laparotomies revealed no intraperitoneal injury and were considered as non-therapeutic laparotomy. The time for transportation to the emergency department were less than 2 hours in 69% of the patients. The most commonly injured organs were the small bowel in 67, the colon in 63 and the liver in 49 patients. Postoperative complications occurred in 34 patients (20.7%) and mortality rate was 6% (10 patients). In spite of the developing technology and operative techniques, gunshot wounds are still very important with high morbidity and mortality rates.

[Injuries of the extremities caused by high energy gunshots and land-mines]

Hospital records of patients who had extremity injuries caused by high energy gunshots and and land-mines and treated in Sirnak Military Hospital between January 1997 and July 1999 were reviewed retrospectively. Among 236 cases 147 (62.3%) had lower extremity wounds and 89 (37.7%) had upper extremity wounds. The most frequently injured part was hands for the upper extremity and feet for the lower extremity. The most dramatic wounds were caused by stepping on anti personnel mines trapped with anti tank mines. The localization and the extension of the wounds varies with type and power of the gun, the position of the victim at the time of explosion and the distance between the victim and the gun.