Increased ischemia-modified albumin levels in patients with gastric cancer.

Reactive oxygen species (ROS) are found in the development stages of carcinogenesis. Fifty two patients with gastric cancer and 35 controls were enrolled in this trial. IMA, MDA, Total Oxidant Status (TOS), Total Antioxidant Status (TAS) and Oxidative Stress Index (OSI) were evaluated. There was a significant increase in IMA and MDA levels in the patient group (0.405±0.111, 0.271±0.066; p= 0.0001 and 0.207±0.251, 0.077±0.103; p= 0.004 respectively). TOS was also higher in the patient group but it was not statistically different. TAS was statistically lower and there was significant difference in OSI (0.621±0.394, 0.996±0.37; p=0.0001 and 9.68±18.2, 2.9±3.85; p=0.001 respectively). The areas under receiver operating characteristics curves for the determination of gastric cancer were 0.842 for IMA and 0.708 for MDA. Increased levels of IMA, MDA and oxidative stress index were detected and this condition is associated with the impairment of oxidant-antioxidant balance.

Phenytoin- and cranial radiotherapy-induced toxic epidermal necrolysis treated with combination therapy: systemic steroid and intravenous immunoglobulin.

Toxic epidermal necrolysis (TEN) is a rare dermatological disease that causes serious morbidity and mortality. It may be caused by antibiotics, anticonvulsants, nonsteroidal anti-inflammatory agents, allopurinol, infections, autoimmune diseases, and radiotherapy. A 49-year-old man was admitted to our hospital because of skin changes. Prophylactic phenytoin was administered, and cranial radiotherapy was planned for brain metastases. During these treatments, erythematous lesions and blisters were observed on his scalp, face, neck, the front and back of his body, and his arms. Detachment of the skin, especially on the back, was also observed. TEN was diagnosed, and phenytoin was discontinued. Methylprednisolone 80 mg/day IV and intravenous immunoglobulin 1 g/kg/day were applied for treatment. After 10 days, skin recovery and re-epithelialization were established, temperature decreased, and mucosal hemorrhage ceased. The patient was discharged after 2 weeks.

Clinicopathologic characteristics and BRCA-1/BRCA-2 mutations of Turkish patients with breast cancer.

BACKGROUND: BRCA-1 and BRCA-2 are two major susceptibility genes for breast cancer. Between 30-70 % of hereditary breast cancers are thought to be attributed to mutations in BRCA-1 or BRCA-2. The aim of our study was to investigate the clinicopathologic characteristics and BRCA mutations of patients with breast cancer living in the northeast region of Turkey. MATERIALS AND METHODS: Two hundred eleven patients diagnosed with breast cancer were enrolled in the present study. All patients provided their demographic, environmental, family, and reproductive traits. Patients were screened for mutations of BRCA-1 and BRCA-2 with multiple ligation-dependent probe amplification (MLPA) test. RESULTS: In the present study, the mean age of breast cancer patients was 50.7 years and the mean age at first delivery was 21.8 years. Large genomic rearrangements in BRCA-1 were detected in 4 (1.9 %) patients; 2 of them had exon 21 deletions and the remaining 2 patients had exon 18 and 19 deletions. No BRCA-2 rearrangements were detected in the study population. CONCLUSIONS: Different mutation analyses results were detected in different countries by using different testing techniques. The characteristics and sensitivities of patients as determined by all methods were different in these studies. Due to these factors, BRCA mutation rates were different. This is the first study where MLPA was used to screen BRCA-1 and BRCA-2 mutations in Turkish population (Tab. 1, Ref. 10).

The effect of prenatal factors on the development of colon cancer.

BACKGROUND: There is some evidence that prenatal factors can play a role in the development of colon cancer. Children with an old parent age at the time of birth were observed to develop certain childhood cancers more frequently. OBJECTIVE: This trial was designed to investigate the effects of some prenatal factors on colon cancer risk. Particularly, investigation of the effect of advanced parent age on colon cancer development risk was targeted. MATERIALS AND METHODS: In this study 117 in or out patients diagnosed with colon cancer and 234 control subjects were included. Definitive diagnostic results and dates of diagnosis were determined from pathological reports. Groups were asked for the parent age, smoking habits, sociodemographic, environmental, familial and reproductive traits. The results were compared between the patients and the control group. RESULTS: It was determined that children may have higher risk if mother and father are more than 30 at birth (p = 0.018, p = 0.020). While the mean mother age at birth was 25.6 +/- 5.72 in patients, it was 24.7 +/- 6.90 in the controls. The difference was not statistically significant (p < 0.056). The mean father age at birth was 29.4 +/- 6.58 in patients and 27.4 +/- 7.47 in the controls. The difference was statistically significant (p < 0.001). Smoking of mother was one of the important risk factors of colon cancer (p = 0.044). CONCLUSION: Our data supports that some prenatal factors such as high parental age at birth and mother -smoker may be risk factors for some cancers in children. This is the first study to report that high parental age at birth and exposure to smoke prenatally increase the risk or colon cancer (Tab. 7, Ref. 28).

Bolus fluorouracil induced syncope and pulseless ventricular tachycardia: a case report.

5-fluorouracil is an anti-cancer drug commonly used in oncology practice. Typical side effects are myelosupression, nausea, vomiting, diarrhea and stomatitis. Cardiotoxicity is the other toxicity. Cardiac side effects are ST segment changes, rhythm abnormalities, supraventricular and ventricular dysrhytmias. Pulseless ventricular tachycardia and ventricular fibrillation releated with bolus fluorouracil were not detected in the literature. Here we discussed a 46 year-old male patient that has no known cardiac history. After bolus fluorouracil administration, syncope and pulseless ventricular tachycardia developed in this patient. There are a few explanations about the cardiotoxicity of fluorouracil. One of these is the effect on nitric oxide. It causes a reduction in the levels of endothelial NO and this leads coronary vasospasm. Another explanation is protein kinase C mediated vasospasm. In animal studies toxic myocarditis like lesions were detected with fluorouracil infusions. Finally both myocardit and vasospasm may lead cardiac problems like sudden cardiac deaths. Bolus 5-fluorouracil is as cardiotoxic as 5-fluorouracil infusion and we must be careful about the arrhytmia after the bolus administration.

The effects of E-cadherin and bcl-2 on prognosis in patients with breast cancer.

BACKGROUND: Breast cancer is the most common malignancy in women. Axillary lymph node involvement and tumor size are the most significant prognostic factors in breast cancer. However, more factors are needed for evaluating the prognosis and individualizing the treatment in these patients. Intracellular adhesion molecule E-cadherin, antiapopitotic protein bcl-2, and p53 might have predictive and prognostic properties in breast cancer. OBJECTIVE: We have investigated the effects of E-cadherin, bcl-2, and p53 on disease free survival and overall survival in patients with breast cancer. METHODS: Positivity of aforementioned genes was detected with immunohistochemistry staining. Seventy-six women patients with invasive ductal and lobular breast cancer who had received adjuvant therapy were included in the study. RESULTS: Bcl-2, E-cadherin, and p53 expression in tumor tissue specimens were found in 26.31%, 35.52%, and 9.21%, respectively. Mean duration of follow-up was 93.58 +/- 3.40 months. In multivariate analyses, axillary lymph node presence and C-erb-B2 overexpression were a strong negative prognostic factor of disease free survival and overall survival. E-cadherin and bcl-2 failed to have an effect on disease free survival and overall survival in our study. In addition, p53 overexpression was determined in a limited number of patients. CONCLUSIONS: The results of this study showed that E-cadherin, bcl-2, and p53 did not have any significant prognostic value for our patients. In order to arrive at a decision, we need studies, which include more patients and long follow-up periods (Tab. 2, Fig. 2, Ref. 24).

The effects of VEGF and VEGFR-2 on survival in patients with gastric cancer.

Prognostic criteria of the patients with gastric cancer are of critical importance in their management and follow-up. Angiogenesis is essential for the growth and metastasis of solid tumors. Tumor angiogenesis is a multi-step interactive process, and vascular endothelial growth factor (VEGF) and its receptors have a major role in tumor angiogenesis. Thus, we investigated the effects of VEGF and VEGF receptor-2 (VEGFR-2, KDR) on survival in patients with gastric cancer. We analyzed 51 patients who had undergone total or subtotal gastric resection. The patients were divided into two subgroups according to their VEGF and VEGFR-2 (KDR) expression in resected specimens. There was no significant difference between sex, surgical method, lymph node metastasis, serosal invasion, hematogenous metastasis, chemotherapy status of the two subgroups. Mean follow-up time was 24.22 +/- 15.38 months. We found the survival rates of the patients with VEGF positive tumors to be significantly shorter than those of the patients with VEGF negative tumors. There was no significant difference between the survival rates of VEGFR-2 (KDR) positive and negative patients. It was established that the presence of VEGF expression was significantly associated with the short survival rates in patients with gastric cancer. Analysis of VEGF expression in resected specimens may provide additional guidance in determining the prognosis of such patients. If more extensive studies confirm the significance of VEGF and its receptors in gastric cancer, new therapeutic approaches targeting VEGF and its receptors may be considered in gastric cancer management.

The effects of IL-2, IL-6 and IL-10 levels on prognosis in patients with aggressive Non-Hodgkin's Lymphoma (NHL).

The aim of this study was to investigate serum levels of IL-2, IL-6 and IL-10 in the pretreatment period and to determine if high IL-2, IL-6, IL-10 levels correlate with the outcome in patients with Non-Hodgkin's Lymphoma (NHL) in the post treatment period. Forty-three patients with the diagnosis of aggressive NHL were included in our study. In all cases initial treatment consisted of CHOP. Patients who failed initial therapy and relapsed from CR were treated with the ESHAP regimen or autologous bone marrow transplantation. The median follow-up duration was 127 weeks (20-228 weeks). There was a negative relationship between the failure-free survival and IL-2 levels (p<0.01). IL-2 levels were negatively correlated with overall survival (p<0.02). There was no relationship between the failure-free survival and IL-6 and IL-10 levels. IL-6 and IL-10 levels did not affect overall survival. In conclusion, in patients with lymphoma, the immune system tries to control the progression of tumor thus leading to high IL-2 levels.

The in-vitro effects of medroxyprogesterone acetate on acidic pH induced apoptosis of periferal blood mononuclear cells.

Medroxyprogesterone acetate (MPA) which has a steroid structure, is widely used in oncology practice in the treatment of the cachexia of cancer and to reduce hematologic toxicity in patients receiving chemotherapy. However, the mechanisms of MPA on these effects are unclear. In this study, we investigated the effects of two different doses of MPA (10(-5) and 10(-6) M/L) on acidic pH induced apoptosis of periferal blood mononuclear cells (PBMC) derived from 10 healthy volunteers. Compared with the control group, we found that MPA at the dose of 10(-5) M/L had a negative effect on apoptosis (32.88 +/- 4.61 and 20.7 +/- 1.53% respectively, p < 0.05), a positive effect on cell count of PBMC (1395 +/- 151 x 10(3) and 1100 +/- 139 x 10(3) respectively, p < 0.05) and no effects on cell viability and its proliferation. More comprehensive trials are needed to clarify this effect of MPA.

The effects of dexamethasone on leukemic cells derived from patients with AML.

This study was performed to investigate the effects of dexamethasone on acute myelocytic leukemia (AML) cells. The study has been designed to investigate the in vitro effects of dexamethasone on the proliferative capacity, maturation and apoptosis of leukemic cells derived from patients with AML. Dexamethasone induced leukemic cell apoptosis and decreased cell count compared to the control. The percentage of cellular maturation increased in the dexamethasone groups compared to the control groups. Proliferative capacity of the cells was similar in all groups. These effects of dexamethasone on leukemic cells may be related to activation of the genes which stimulate apoptosis and maturation. More comprehensive studies are needed to evaluate the apoptotic effect of dexamethasone on AML cells.

Blood coagulation and fibrinolytic activity in hypothyroidism.

The influence of hypothyroidism on haemostasis is controversial; both hypocoagulable and hypercoagulable states have been reported. Hypothyroidism has been associated with atherosclerosis; a hypercoagulable state in addition might represent a risk factor for thromboembolic disease. The aim of the present study was to investigate the markers of endogenous coagulation and vascular endothelial cell function and to evaluate the relationship between serum lipid profile, thyroid hormones and haemostatic parameters in hypothyroid patients. We investigated various haemostatic parameters in 20 patients with hypothyroidism and compared them with 20 euthyroid controls. The relationship between serum thyroid hormones and the haemostatic parameters was examined. The plasma levels of fibrinogen, AT III and PAI-1 were significantly increased in hypothyroid patients compared with the control group, whereas factors VIII and X activity was decreased. We showed that free T3 levels correlated with factor IX activity. Free T4, FT3 and TSH did not correlate with fibrinogen, vWF, AT III, t-PA, or PAI-1. aPTT correlated inversely with t-PA activity and positively with protein C activity. Anti-Tg correlated inversely with FV. There was a positive correlation between triglycerides and protein C. Protein S correlated inversely with high density lipoprotein cholesterol. We found a hypofibrinolytic state in patients with hypothyroidism. Our results suggest that the risk of developing thrombosis and ultimately myocardial infarction via high PAI-1 levels may be increased in patients with hypothyroidism, a result in line with recent epidemiological data. However, thyroid hormones may play a role at different levels of the complex haemostatic system.

Respiratory distress due to endotracheal aspergilloma in an immunocompromised lymphoma patient: case report.

A 54-year old woman, intensively treated for aggressive, relapsed lymphoma had symptoms of severe dyspnea and hoarseness. The diagnosis of endotracheal aspergilloma was made by sputum culture, bronchoscopy and biopsy. The lesions consisted of endotracheal aspergilloma associated with tracheal obstruction due to the mass effect. The patient improved dramatically after removal of the mass.

Endogenous granulocyte colony-stimulating factor (G-CSF) levels in chemotherapy-induced neutropenia and in neutropenia related with primary diseases.

Granulocyte-colony stimulating factor (G-CSF) and granulocyte macrophage colony-stimulating factor (GM-CSF) are being administered to patients with neutropenia. However, little is known about the endogenous levels of both factors in these patients. We measured the endogenous G-CSF levels in patients with chemotherapy-induced neutropenia (n=15, study group A), in patients who had not received chemotherapy with neutropenia caused by a number of primary diseases (n=14, study group B) and in healthy volunteers (n=15, control group). Both the study groups and the control group did not show any clinical or laboratory findings of infection. The G-CSF levels were elevated in patients following chemotherapy and in patients who had neutropenia without chemotherapy, but the mean G-CSF levels in patients with chemotherapy-induced neutropenia were significantly higher than in patients with primary diseases. The levels of endogenous G-CSF were also higher in both neutropenic groups, compared to the control group. In conclusion, endogenous G-CSF levels in chemotherapy-induced neutropenia were significantly higher than non-chemotherapy related neutropenia and controls. This may be explained as G-CSF synthesizing bone marrow stromal cells may be more affected in primary disease related neutropenia than in chemotherapy induced neutropenia.

Prevalence of diabetes, obesity and hypertension in a Turkish population (Trabzon city).

OBJECTIVE: The objectives of this study were to determine the prevalence of diabetes mellitus in Trabzon city, Turkey, using standardized diagnostic criteria, and to evaluate associated factors. METHODS: A total of 3000 eligible study subjects were selected. Of those, 2646 subjects participated in the study. Individuals aged > or =20 years were selected from their family health cards and were invited to the health station. Anthropometric and demographic data were obtained for each subject. Plasma glucose was measured by an autoanalyser. People without previously diagnosed diabetes were categorized according to WHO diagnostic criteria as follows. Diabetes: a fasting plasma glucose (FPG)> or =140 mg/dl or 2-h plasma glucose > or =200 mg/dl after a 75-g oral glucose load. RESULTS: The overall prevalence of diabetes in those > or =20 years of age was 6.0% (n=160). Among diabetic subjects, 69 were newly diagnosed diabetes mellitus. Age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) and FPG were higher in diabetic subjects than in non-diabetic subjects. The prevalence of diabetes showed significant association with increased age (P<0.0001). The overall prevalence of obesity was 19.2%. The combined prevalence of both overweight and obesity was 60.6%. The prevalence of obesity was 27.4% among women and 10.7% among men (P<0.0001). Prevalence of diabetes increased with degree of obesity (P<0.0001). The rate of obesity in diabetic subjects was 35.6%. In the study population as a whole, the prevalence of obesity increased with age, being highest in the 50-59 years age group, but lower again in the 60+ age group. Prevalence of SBP> or =140 mmHg was 12.0% and of DBP> or =90 mmHg was 8.2%.

Thyroid function tests in pregnant women with and without goiter in the eastern Black Sea region.

Maternal thyroid function was investigated in 29 pregnant women with goiter and 51 pregnant women without goiter in the eastern Black Sea region of Turkey, which is an endemic goiter area. Ten women with goiter and 10 healthy women without goiter were used as controls in the study. In all of the pregnant women, increased concentrations of total and free thyroxine, total and free tri-iodothyronine and thyroxine-binding globulin were found. Serum thyroid-stimulating hormone levels showed a decrease in pregnant women without goiter compared with non-pregnant women without goiter.

Does nimesulide induce gastric mucosal damage? "A double-blind randomized placebo-controlled trial".

BACKGROUND/AIMS: In this study, it was aimed to examine the effect of nimesulide, a selective inhibitor of cox-2 enzyme, to the gastric mucosa and to correlate its effect with aspirin. METHODOLOGY: This study was planned as double-blind, randomized and placebo-controlled. Mean age of voluntary persons (n = 32) was 42.3 +/- 2.7. Divided into 3 groups of volunteers were given randomized placebo (n = 10), aspirin (n = 10) (500 mg aspirin, Bayer) and nimesulide (n = 12) (100 mg mesulid, Pfizer) with 50 mL of water after 12 hours fasting period at 08.00 am. Gastroduodenoscopy was performed to the volunteers 3 hours after each therapy. RESULTS: Endoscopic scores of groups were; placebo: 0.20 +/- 0.13, aspirin: 2.8 +/- 0.46, nimesulide: 1.41 +/- 0.51. Lesion scores both in the aspirin group when compared with nimesulide and placebo groups (P < 0.00002, < 0.03), and in the nimesulide group when compared with the placebo group (P < 0.01) were significantly high. The positivity of Helicobacter pylori of groups was found; 67% in placebo, 72% in aspirin, 71% in nimesulide and there was no statistically significant difference in the groups. CONCLUSIONS: It was shown that nimesulide causes significantly serious gastric mucosal lesion when compared with placebo. The lesion score of nimesulide was found less than aspirin. According to the findings, nimesulide should be given carefully just as other analgesics due to the probability of causing gastric lesion.