Predicting survival in locally advanced gastric cancer using prognostic factors - neoadjuvant rectal score and downstaging depth score.

BACKGROUND: Clinical prediction models are needed to accurately predict the prognosis of patients with gastric cancer who have received neoadjuvant therapy and to determine the best treatment strategies. The aim of this study is to determine the role of two prognostic factors, the neoadjuvant rectal (NAR) score and the downstaging depth score (DDS), in predicting survival in patients with gastric cancer who received neoadjuvant therapy and underwent curative gastrectomy. METHODS: We reviewed the medical records of 129 patients who had been diagnosed with primary gastric cancer and underwent radical gastrectomy after receiving neoadjuvant therapy. We calculated the NAR score and DDS values for each patient and conducted a survival analysis to assess the accuracy of these prognostic factors in predicting overall survival. RESULTS: The median overall survival time of the patients was found to be 29 months. Patients with low NAR scores and high DDS had significantly longer overall survival. Univariate analyses based on clinical and laboratory characteristics showed that gender, surgery type, resection type, neural invasion, grade, adjuvant radiotherapy, lymphocyte level, carcinoembryonic antigen (CEA) level, NAR score, and DDS were associated with survival. Moreover, multivariate analyses showed that lymphocyte level, DDS, and NAR score were independent prognostic factors. CONCLUSION: In summary, our research indicates that NAR score and DDS may serve as useful prognostic markers for predicting overall survival in patients with locally advanced gastric cancer who receive neoadjuvant chemotherapy followed by curative surgery. Patients with high DDS and low NAR scores were found to have better prognoses.

Alterations of thymic morphology and antioxidant biomarkers in 60-day-old male rats following exposure to a continuous 900 MHz electromagnetic field during adolescence.

We investigated changes in thymic tissue of male rats exposed to a 900 megahertz (MHz) electromagnetic field (EMF) on postnatal days 22-59. Three groups of six 21-day-old male Sprague-Dawley rats were allocated as: control (CG), sham (SG) and EMF (EMFG) groups. No procedure was performed on the CG rats. SG rats were placed in a Plexiglas cage for 1 h every day between postnatal days 22 and 59 without exposure to EMF. EMFG rats were placed in the same cage for the same periods as the SG rats and were exposed to 900 MHz EMF. Rats were sacrificed on postnatal day 60. Sections of thymus were stained for histological assessment. Oxidant/antioxidant parameters were investigated biochemically. Malondialdehyde (MDA) levels in EMFG increased compared to the other groups. Extravascular erythrocytes were observed in the medullary/corticomedullary regions in EMFG sections. We found that 900 MHz EMF applied for 1 h/day on postnatal days 22-59 can increase tissue MDA and histopathological changes in male rat thymic tissue.

Simple scoring system for prediction of mortality in Fournier's gangrene.

PURPOSE: To create new scoring system for prediction of hospital mortality for patients with Fournier's gangrene(FG). MATERIAL AND METHOD: In total, 84 patients with FG were enrolled into this study. The demographic and clinical characteristics of patients were analyzed retrospectively. RESULTS: The mortality rate was 11.9 %. On multivariate analyses, age >60 years, BUN >40 mg/dl, RDW >14.95 %, albumin level <20 mg/dl and presence of sepsis were significant and independent predictors of mortality. The predictive value of our score for mortality was 95.1 %. CONCLUSION: Our scoring system shows adequate discriminatory function for prediction of mortality in patients with FG. Further larger scale studies can improve the performance of our score.

Calcium level may be a predictive factor for pseudocyst formation after acute pancreatitis.

Pancreatic pseudocysts (PPs) are defined as fluid collections more than 4 weeks old that are surrounded by a nonepithelial wall of fibrous or granulation tissue. Many risk factors have been associated with pseudocyst development but predictive factors remain to be explored. The aim of this study was to investigate the clinical, and biochemical parameters that may predict the development of a PPs after an attack of acute pancreatitis (AP). The medical charts of 102 patients diagnosed with AP were enrolled into the study. Demographic, clinical and laboratory details were recorded at admission and at the 48(th) hour. There were several risk factors on admission and at the 48(th) hour that was predictive of PP formation when evaluated by univariate analysis such as: Alanine aminotransferase level at 48 hrs, calcium level at admission, base excess at 48 hrs, calcium level at 48 hrs, and albumin level at 48 hrs. In multivariate analysis, low calcium level at admission was the only variable that was shown to predict formation of PPs. Lower serum calcium level may be a predictive factor for the development of PPs after AP attack. We advise that patients with calcium levels below 8 mg/dl, after AP should be followed more closely.

Can prenatal exposure to a 900 MHz electromagnetic field affect the morphology of the spleen and thymus, and alter biomarkers of oxidative damage in 21-day-old male rats?

We investigated the effects of a 900 Megahertz (MHz) electromagnetic field (EMF), applied during the prenatal period, on the spleen and thymus of 21-day-old male rat pups. Pregnant Sprague-Dawley rats were divided into control and EMF groups. We applied 900 MHz EMF for 1 h/day to the EMF group of pregnant rats. Newborn male rat pups were removed from their mothers and sacrificed on postnatal day 21. Spleen and thymus tissues were excised and examined. Compared to the control group, thymus tissue malondialdehyde levels were significantly higher in the group exposed to EMF, while glutathione levels were significantly decreased. Increased malondialdehyde and glutathione levels were observed in splenic tissue of rats exposed to EMF, while a significant decrease occurred in superoxide dismutase values compared to controls. Transmission electron microscopy showed pathological changes in cell morphology in the thymic and splenic tissues of newborn rats exposed to EMF. Exposure to 900 MHz EMF during the prenatal period can cause pathological and biochemical changes that may compromise the development of the male rat thymus and spleen.

The effects of adjunctive parathyroid hormone injection on bisphosphonate-related osteonecrosis of the jaws: an animal study.

Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) is a serious and challenging complication of chronic BP uptake in patients with osteoporosis who require management of skeletal-related events. The efficiency of adjunctive parathyroid hormone (PTH) injection was evaluated after chronic BP administration that was followed by tooth extraction. BRONJ was not observed in any of the subjects in the control groups, while BRONJ was observed in 66% and 22% of the subjects in the tooth extraction group and the tooth extraction with PTH injection group, respectively. In addition the presence and severity of inflammation was lower in the PTH injected group than in the tooth extraction group, but the difference was not statistically significant (P>0.01). In conclusion, the administration of 30µg/kg/day PTH during a period of 8 weeks had positive effects on the resolution of BRONJ, but further studies are required to verify the effectiveness of PTH in the treatment of BRONJ.

Pontocerebellar hypoplasia associated with nevoid hyperpigmentation and dysmorphic findings: a new subtype?

Pontocerebellar hypoplasia consists of a rare heterogeneous group of congenital neurodevelopmental disorders characterized by hypoplasia and atrophy of the cerebellar cortex, dentate and pontine nuclei, and inferior olives. Lineer nevoid hyperpigmentation is a rare skin condition characterized by whorls and streaks of hyperpigmented macules in a reticulate pattern along Blaschko's lines. Herein we present a three year-old male patient with pontocerebellar hypoplasia associated with nevoid hyperpigmentation on the upper part of the body. Besides he has some dysmorphic features including microcephaly, triangular chin, long philtrum, long hand fingers, flexion contracture in all of the distal phalanges of both hands, and strabismus.

Multiple relapses in extramedullary localization of acute lymphoblastic leukemia.

Extramedullary relapses of acute lymphoblastic leukemia in children and young adults are rare and in most cases are usually related to the central nervous system or testes. We describe a case of a 25-year-old man with an acute lymphoblastic leukemia with multiple extramedullary relapses in the testes, gallbladder, breast, parotid gland and eye at various times (Fig. 5, Ref. 21).

Bilateral breast cancer: a male patient.

Bilateral breast cancer represents less than 2% of male patients with breast cancer. A 63-year old male presented with a mass at right breast and modified radical mastectomy was performed. Pathology was reported as invasive ductal carcinoma. Radiotherapy and tamoxifen was administered following chemotherapy. At the 5th month, a mass was detected at left breast and modified radical mastectomy was performed. Chemotherapy was started postoperatively. BRCA1 and BRCA2 were reported negative. Although male breast cancer is rare, male patients with breast cancer may have cancer at the other breast (Fig. 1, Ref. 5).

Living-donor hepatectomy.

BACKGROUND: Organ transplantation from deceased donors is still far below the need. Because of this deficiency, liver transplantations are performed mostly from live donors in many transplant centers in our country. Living-donor liver transplantation (LDLT) has evolved dramatically over the past decade. The aim of this study was to present our clinical experience with living-donor hepatectomy. METHODS: We retrospectively analyzed all patients who underwent donor hepatectomy between March 2000 and September 2010. We reviewed demographic data, operation type, operation and cold ischemia times, duration of hospital stay, and postoperative complications. RESULTS: During the study period, 140 living donors underwent operations for liver transplantation. We performed 108 right hepatectomies, 17 left hepatectomies, and 15 left lateral hepatectomies. The mean age of the donors was 30.8 years. There was no operative or postoperative mortality. Overall morbidity rate was 13.57% (n = 19). Nine patients had biliary leakages, 4 biliomas; 2 urinary tract infections, and 1 each inferior vena caval injury, pneumonia, portal vein thrombosis, and acute tubular necrosis. Reoperation was not required in any of these patients. CONCLUSIONS: Living-donor liver transplantation is a valuable alternative for patients awaiting a cadaver organ. Live-donor hepatectomy can be performed with low morbidity. The greatest disadvantage of this procedure is the risk of the surgical operation for the individual who will experience no medical benefit from this procedure.

Gynecologic symptoms and sexual function in female kidney allograft recipients.

BACKGROUND: There is little information in the literature about changing menstrual patterns, sexuality, and fertility after kidney transplantation. The purpose of this study was to describe gynecologic symptoms, menstrual characteristics, sexual functions, details of pregnancies and gynecologic care before and after women underwent renal transplantation. METHODS: A detailed Turkish questionnaire was prepared for gynecologic evaluation. Fifty women of reproductive age who underwent renal transplantation took part in this study. The questionnaires were filled out at the time of the postoperative follow-up. RESULTS: The mean age and body mass index of all study participants at the time of interview was 33.9 years (range, 18-52) and 23.5 kg/m(2) (range, 16.5-33.3), respectively. There were no differences between bleeding between periods, heavy period, painful period, and period duration before and after transplantation. Eight women left active working life after grafting on their own accord. Thirteen women ceased sexual activity after transplantation. None of the women reported pregnancy after grafting. A total of 98% of women reported that they were never instructed about regular gynecologic care. CONCLUSION: We found that restrictions in the lives of women with transplanted kidneys included ceasing sexual activity and leaving active working life and that these were due to fear of possible organ damage. Women with transplanted kidneys must be informed about posttransplant sex life and the requirement for regular examinations by a gynecologist. Hence, close collaborations should be formed between patients, primary care physicians, and gynecologists.

Nodular fasciitis of the external auditory canal.

PROBLEM: Nodular fasciitis (NF) is a reactive myofibroblastic proliferation that may be misdiagnosed as a sarcoma because of its rapid growth, rich cellularity, and mitotic activity. NF is uncommon in the auricular region. We describe a case of nodular fasciitis of the external auditory canal in an 8-year-old male. METHODOLOGY: An excisional biopsy was performed, and the pathologic examination was consistent with nodular fasciitis; however, the lesion recurred within a month requiring that a total excision be done. RESULTS: The patient is without recurrence 7 months after the total excision. CONCLUSIONS: Because its histologic features closely mimick a malignant lesion, NF must be considered in the differential diagnosis of a mass originating from the external auditory canal to avoid overly aggressive and functionally debilitating treatment.

Primary biliary cystadenocarcinoma mimicking a complicated hydatid cyst.

Cystadenocarcinoma of the liver is a rare neoplasm that originates from hepatobiliary epithelium. Primary location of this tumor is generally intrahepatic and most cases are in the right hepatic lobe. Herein we present a case of intrahepatic cystadenocarcinoma in a 53-year-old man who had been followed up for 8 years as hydatic cyst disease of the liver. He was admitted to our hospital with jaundice and loss of appetite. Ultrasound and computed tomography showed a cystic lesion that looked like type II cyst hidatic. Thereafter magnetic resonance imaging revealed a cystic lesion associated with biliary tree. On diagnostic laparotomy peritoneal infiltrations were observed and pathologic examination revealed a biliary cystadenocarcinoma and peritonitis carcinomatosa was diagnosed. Unfortunately correct diagnosis was extremely late and no curative management was possible.

Large retroperitoneal schwannoma mimicking ovarian carcinoma: case report and literature review.

UNLABELLED: In this article we present a case of retroperitoneal schwannoma localized in the pelvic cavity with complete cystic degeneration, mimicking ovarian carcinoma. CASE: A 25-year-old nulligravid woman was admitted to our gynecology out-patient clinic with the complaint of abdominal distension, right flank pain and pollakiuria. Sonographic study showed a cytic mass containing necrotic areas and filling the whole pelvic cavity. Computed tomography and colonography suggested the possible diagnosis of a right ovarian malign tumor. Laparotomy revealed a retroperitoneal cystic lesion. Microscopic examination of the pelvic mass confirmed the diagnosis of cystic degenerative schwannoma. After six months of initial surgery she is still alive without any evidence of disease. CONCLUSION: In the present case, it is emphasized that it is easy to make an error and misdiagnose a pelvic mass as an ovarian tumor when it is in fact a tumor from another origin. Additonally, clinicians should keep in mind that retroperitoneal schwannoma may mimic cystic ovarian carcinoma even in young women.

Clinical, pathological and radiological evaluation of disseminated Langerhans' cell histiocytosis in a 30-month-old boy.

Langerhans' cell histiocytosis is a rare disease characterized histologically by the proliferation of Langerhans' cells. Oral involvement is frequent and the disease simulates severe localized periodontitis. In this report, we present a case of disseminated Langerhans' cell histiocytosis in a 30-month-old boy who had a mass covering the entire maxillopalatine region and suffered severe periodontal destruction in the posterior maxilla and mandible. We discuss the radiological, histopathological and immunohistochemical findings.

Disseminated peritoneal tuberculosis mimicking advanced-stage endodermal sinus tumor: a case report.

It is well known that peritoneal tuberculosis may mimic advanced-stage epithelial ovarian carcinoma because of similar clinical, radiologic, and laboratory findings. However, disseminated peritoneal tuberculosis mimicking advanced-stage endodermal sinus tumor (ESS) has not been reported previously. An 18-year-old nulliparous woman came with the complaint of pelvic pain and weight loss. Imaging studies demonstrated that she had multiple peritoneal implants and left adnexial mass. Also, laboratory studies showed elevated CA125 and alpha fetoprotein levels suggesting an initial diagnosis of ESS. However, intraoperative frozen section examination showed caseous necrosis, and she was diagnosed as having disseminated peritoneal tuberculosis. Two months after the initial exploration, the patient required liver transplantation because of hepatic failure due to widespread hepatic involvement of the tuberculosis. Concomitant peritoneal and hepatic involvement of tuberculosis may cause false elevation of multiple tumor markers of gynecological cancers and may lead to misdiagnosis and mismanagement of patients. Elevation of these markers should be carefully investigated especially in premenopausal women. To our knowledge, this is the first reported case of peritoneal tuberculosis misdiagnosed as endodermal sinus tumor.

Technical implications of living donor liver transplantation: a single-center experience.

Liver transplantation for end-stage liver disease is the treatment of choice in current surgical practice. However, the shortage of cadaveric organs has limited this treatment option for many years. Living donor liver transplantation (LDLT) may be an option to overcome the organ shortage. In the present series we report a single-center experience with 39 LDLT performed from March 2000 to June 2003. The main indications for LDLT was hepatitis B cirrhosis (11 patients). The recipient hepatectomy was performed with caval preservation. The hepatic vein anastomosis was performed either to recipient hepatic vein or inferior vena cava. The portal vein anastomosis was performed either to the recipient's main or right portal branch. Biliary diversion was performed to the recipient biliary ducts if possible, otherwise to a jejunal loop in Roux-en-Y fashion. The survival rate at the end of one year was 71%. The leading cause of mortality was sepsis in five patients. Biliary complications developed in 20% of the recipients. All bile leaks were from the Roux-en-Y hepaticojejunostomy. Hepatic artery thrombosis was diagnosed in four patients by loss of hepatic blood flow on Doppler ultrasound. LDLT is a major surgical option for end-stage liver disease, particularly for countries with low rates of organ donation. However, there are technical challenges to be overcome such as small vessels from segmental grafts and multiple small bile ducts.

Philadelphia negative, Bcr-Abl positive chronic myeloid leukemia associated with pure red cell aplasia.

Pure red cell aplasia (PRCA) is a rare disorder which is associated with thymoma, viral infections and autoimmune diseases. A few cases of PRCA during the clinical course of CML have been reported and these usually terminate in blastic crisis and death, suggesting a poor prognosis. However, only one case of Philedelphia chromosome negative, Bcr-Abl positive CML associated with PRCA has been reported. Here, we present a second case report of a Philedelphia negative, Bcr-Abl positive CML associated with PRCA who was unresponsive to all the chemotherapeutic regimens. We conclude that the present case supports the idea that the development of PRCA in the course of CML may be a bad prognostic sign.