Prognostic factors and treatment of patients with advanced synovial sarcoma: A single-center experience.

BACKGROUND: Synovial sarcoma (SS) is a malignant mesenchymal tumor, which comprises 5%-10% of all the sarcomas. There is insufficient information on prognostic factors and salvage treatments of advanced SS. In this study, we aimed to further clarify the clinicopathological features, prognostic factors, and treatment modalities in advanced SS. MATERIALS AND METHODS: A total of 45 SS patients followed up between 2001 and 2015 at our cancer institute, Department of Medical Oncology, were retrospectively evaluated. Eleven patients were initially metastatic, and remaining patients developed metastasis or became inoperable due to locally advanced disease. Overall survival was evaluated by Kaplan-Meier analysis. RESULTS: The median age of patients was 37 (17-70) years and 60% (n = 26) of them were female. SS was most commonly localized in the lower extremity and abdomen-pelvis (29% and 29%, respectively). Median follow-up time was 33 (6-175) months. Patients were treated with a median of two (1-5) line chemotherapies at metastatic stage. Ifosfamide plus adriamycin (IMA) (49%, n = 22) and cisplatin-etoposide (13%, n = 6) were the most often used chemotherapy regimen as first line in metastatic stage. Partial response was obtained in 32% of the patients treated with IMA chemotherapy. Furthermore, median progression-free survival was 6 (1-123) months. Median survival of metastatic stage at diagnosis or in follow-up was 21 months (14-27) and 21 (12-29) months (P = 0.53), respectively. Most metastatic locations were lung (75%) and bone. Factors influencing survival at metastatic stage were evaluated; statistically significant longer survival was observed in patients with lung metastasis, primary tumor size smaller than 10 cm, patients who underwent surgery for the metastasis, and development-to-metastasis period longer than 12 months. CONCLUSION: Median survival of patients in metastatic stage SS was 21 months. Lung was the most common metastatic site.

Nivolumab for relapsed or refractory Hodgkin lymphoma: real-life experience.

BACKGROUND: Reed-Sternberg cells of classical Hodgkin's lymphoma (cHL) are characterized by genetic alterations at the 9p24.1 locus, leading to over-expression of programmed death-ligand 1 and 2. In a phase 1b study, nivolumab, a PD-1-blocking antibody, produced a high response in patients with relapsed or refractory cHL, with an acceptable safety profile. PATIENTS AND METHODS: We present a retrospective analysis of 82 patients (median age: 30 years; range: 18-75) with relapsed/refractory HL treated with nivolumab in a named patient program from 24 centers throughout Turkey. The median follow-up was 7 months, and the patients had a median of 5 (2-11) previous lines of therapy. Fifty-seven (70%) and 63 (77%) had been treated by stem-cell transplantation and brentuximab vedotin, respectively. RESULTS: Among 75 patients evaluated after 12 weeks of nivolumab treatment, the objective response rate was 64%, with 16 complete responses (CR; 22%); after 16 weeks, it was 60%, with 16 (26%) patients achieving CR. Twenty patients underwent subsequent transplantation. Among 11 patients receiving allogeneic stem-cell transplantation, 5 had CR at the time of transplantation and are currently alive with ongoing response. At the time of analysis, 41 patients remained on nivolumab treatment. Among the patients who discontinued nivolumab, the main reason was disease progression (n = 19). The safety profile was acceptable, with only four patients requiring cessation of nivolumab due to serious adverse events (autoimmune encephalitis, pulmonary adverse event, and two cases of graft-versus-host disease aggravation). The 6-month overall and progression-free survival rates were 91.2% (95% confidence interval: 0.83-0.96) and 77.3% (0.66-0.85), respectively. Ten patients died during the follow-up; one of these was judged to be treatment-related. CONCLUSIONS: Nivolumab represents a novel option for patients with cHL refractory to brentuximab vedotin, and may serve as a bridge to transplantation; however, it may be associated with increased toxicity.

Platelet size has diagnostic predictive value for bone marrow metastasis in patients with solid tumors.

Though not very common, solid tumor involvement of the bone marrow (BM) may have serious consequences. Recent studies have shown that mean platelet volume (MPV) is a good indicator for BM disease in the differential diagnosis of thrombocytopenia. We investigated the significance of MPV in the diagnosis of BM metastasis in patients with solid tumors. Patients with histologically-verified solid tumors for whom BM biopsy specimens were available (n = 121) and healthy controls (n = 62) were included in this retrospective study. A total of 183 individuals were analyzed. Of the patients, 61 had a diagnosis of BM metastasis (Group A), 60 did not have BM metastasis (Group B). Group B and C (healthy controls) constituted the control group without BM metastasis (n = 122). The mean MPV was 7.0 +/- 0.8 fl in patients with BM metastasis and 8.4 fl in the control group (P < 0.001). A cut-off point of <7.4 fl was found to have significant predictive value according to receiver-operating characteristics curve analysis. This cut-off point had 85% positive predictive value and 90% negative predictive value in the diagnosis of BM metastasis (odds ratio: 53; 95% confidence interval: 20-135), and a sensitivity of 82.7% and specificity of 89.6%. MPV can be used as a reliable marker to guide the clinician as to the likely presence or absence of BM metastasis in patients with solid tumors.

Biological screening of some Turkish medicinal plant extracts for antimicrobial and toxicity activities.

Screening of antibacterial activity and toxicity of 22 aqueous plant extracts from 17 Turkish plants was conducted. Antibacterial activity was performed with six bacteria including Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus pyogenes, Staphylococcus aureus and Staphylococcus epidermidis. Extracts of Tussilago farfara leaves, Helichyrsum plicatum flowers, Solanum dulcamara aerial parts and Urtica dioica leaves gave the best inhibitory activity against S. pyogenes, S. aureus and S. epidermidis. Of the 22 plant extracts, 20 extracts displayed toxicity (LC50 was <1000 mg L(-1)) in the brine shrimp bioassay. For radish seed bioassay, two different determinations (root length and seed germination) were performed with a comparison between two concentrations (50,000 mg L(-1) and 10,000 mg L(-1)). At low concentration (10,000 mg L(-1)), S. dulcamara aerial parts and Primula vulgaris leaf extracts were observed to inhibit the root length more than the other plant extracts. Also, the most inhibitive plant extract for seed germination was obtained with S. dulcamara aerial parts.

On-line speciation and determination of Cr(III) and Cr(VI) in drinking and waste water samples by reversed-phase high performance liquid chromatography coupled with atomic absorption spectrometry.

A simple, rapid, and selective on-line method for the speciation and determination of Cr(III) and Cr(VI) in aqueous solutions by ion-pairing HPLC coupled with flame atomic absorption spectrometry (FAAS) is described. The composition of the mobile phase has been optimized for better separation. The effects of column temperature, volume of injection loop, fuel flow rate of FAAS, and nebulizer suction rate of FAAS have also been investigated. Separation is accomplished in almost 2.5 min on a 25 cm length C18 column at 40 degrees C. The selectivity of the method has been established by investigating the effect of interfering elements on chromium determination. The detection limit (3sigma) achieved by the method was calculated as 3.7 ng/mL for Cr(III) and 2.0 ng/mL for Cr(VI). The proposed method has been validated by analyzing certified reference material (BCR 544) and successfully applied to the analysis of drinking water and wastewater samples with a relative error below 6%.

Determination of lead and nickel in environmental samples by flame atomic absorption spectrometry after column solid-phase extraction on Ambersorb-572 with EDTA.

Lead and nickel were preconcentrated as their ethylenediaminetetraacedic acid (EDTA) complexes from aqueous sample solutions using a column containing Ambersorb-572 and determined by flame atomic absorption spectrometry (FAAS). pH values, amount of solid phase, elution solution and flow rate of sample solution have been optimized in order to obtain quantitative recovery of the analytes. The effect of interfering ions on the recovery of the analytes has also been investigated. The recoveries of Pb and Ni under the optimum conditions were 99 +/- 2 and 97 +/- 3%, respectively, at 95% confidence level. Seventy-five-fold (using 750 mL of sample solution and 10 mL of eluent) and 50-fold (using 500 mL of sample solution and 10 mL of eluent) preconcentration was obtained for Pb and Ni, respectively. Time of analysis is about 4.5 h (for obtaining enrichment factor of 75). By applying these enrichment factors, the analytical detection limits of Pb and Ni were found as 3.65 and 1.42 ng mL(-1), respectively. The capacity of the sorbent was found as 0.17 and 0.21 mmol g(-1) for Pb and Ni, respectively. The interferences of some cations, such as Mn2+, Co2+, Fe3+, Al3+, Zn2+, Cd2+, Ca2+, Mg2+, K+ and Na+ usually present in water samples were also studied. This procedure was applied to the determination of lead and nickel in parsley, green onion, sea water and waste water samples. The accuracy of the procedure was checked by determining Pb and Ni in standard reference tea leaves sample (GBW-07605). The results demonstrated good agreement with the certified values.

Separation and preconcentration of trace manganese from various samples with Amberlyst 36 column and determination by flame atomic absorption spectrometry.

This work assesses the potential of a new adsorptive material, Amberlyst 36, for the separation and preconcentration of trace manganese(II) from various media. It is based on the sorption of manganese(II) ions onto a column filled with Amberlyst 36 cation exchange resin, followed by the elution with 5mL of 3mol/L nitric acid and determination by flame atomic absorption spectrometry (FAAS) without interference of the matrix. Different factors including pH of sample solution, sample volume, amount of resin, flow rate of sample solution, volume and concentration of eluent, and matrix effects for preconcentration were investigated. Good relative standard deviation (3%) and high recovery (>95%) at 100mug/L and high enrichment factor (200) and low analytical detection limit (0.245mug/L) were obtained. The adsorption equilibrium was described well by the Langmuir isotherm model with maximum adsorption capacity of 88mg/g of manganese on the resin. The method was applied for the manganese determination by FAAS in tap water, commercial natural drinking water, commercial treated drinking water and commercial tea bag sample. The accuracy of the method is confirmed by analyzing the certified reference material (tea leaves GBW 07605). The results demonstrated good agreement with the certified values.

Posterior leukoencephalopathy after combination chemotherapy in a patient with lymphoma.

Posterior leukoencephalopathy syndrome is a recently described syndrome involving mainly parieto-occipital gray/white matter of the brain. It occurs secondary to various clinical entities, like hypertension and immunosuppressive therapy. Few cases after combination chemotherapy have been reported. This study describes a 36-year-old woman with primary refractory T-cell lymphoma, who developed central nervous system toxicity due to treatment with intrathecal methotrexate and intravenous ifosfamide, idarubicine and etoposide given as a salvage regimen. Both clinical features as well as magnetic resonance imaging findings were typical for posterior leukoencephalopathy syndrome. The patient died despite anti-hypertensive therapy and haemodialysis. Central nervous system toxicity related to chemotherapeutics and posterior leukoencephalopathy syndrome are discussed briefly.

The use of Agrobacterium tumefacients immobilized on Amberlite XAD-4 as a new biosorbent for the column preconcentration of iron(III), cobalt(II), manganese(II) and chromium(III).

A microorganism Agrobacterium tumefacients as an immobilized cell on a solid support was presented as a new biosorbent for the enrichment of Fe(III), Co(II), Mn(II) and Cr(III) prior to flame atomic absorption spectrometric analysis. Amberlite XAD-4 was used as a support material for column preconcentration. Various parameters such as pH, amount of adsorbent, eluent type and volume, flow rate of sample solution, volume of sample solution and matrix interference effect on the retention of the metal ions have been studied. The optimum pH for the sorption of above mentioned metal ions were about 6, 8, 8 and 6, respectively. The loading capacity of adsorbent for Co(II) and Mn(II) were found to be 29 and 22mumolg(-1), respectively. The recoveries of Fe(III), Co(II), Mn(II) and Cr(III), under the optimum conditions were found to be 99 +/- 3, 99 +/- 2, 98 +/- 3 and 98 +/- 3%, respectively, at the 95% confidence level. The limit of detection was 3.6, 3.0, 2.8 and 3.6ngml(-1) for Fe(III), Co(II), Mn(II) and Cr (III), respectively, by applying a preconcentration factor of 25. The proposed enrichment method was applied for metal ion determination from water samples, alloy samples, infant foods and certified samples such as whey powder (IAEA-155) and aluminum alloy (NBS SRM 85b). The analytes were determined with a relative error lower than 10% in all samples.

Use of Escherichia coli immobilized on amberlite XAD-4 as a solid-phase extractor for metal preconcentration and determination by atomic absorption spectrometry.

A sensitive solid-phase extraction technique (SPE) for the enrichment of Fe(III), Co(II), Mn(II) and Cr(III) prior to atomic absorption spectrometric analysis is described. Escherichia coli immobilized on Amberlite XAD-4 was used as a solid-phase extractor. The effects of the pH, amount of solid-phase, eluent type and volume of the sample solution on the recovery of the metal ions were investigated. The effect of diverse ions was also investigated. The recoveries of Fe(III), Co(II), Mn(II) and Cr(III) under the optimum conditions were found to be 99 +/- 2, 99 +/- 3, 98 +/- 2, 98 +/- 3%, respectively, at the 95% confidence level. The detection limits of the metal ions were found as to be 2.4, 3.8, 1.3 and 1.7 ng ml(-1) for Fe(II), Co(II), Mn(II) and Cr(III) respectively, by applying a preconcentration factor of 25. The proposed enrichment method was applied to the determination of analytes in Atatürk Dam water samples, and alloy samples (RSD < 5%). The accuracy of the method was verified on certified alloy samples (NBS SRM 85b and NBS SRM 59a). The analytes were determined with a relative error lower than 5% in water and alloy samples.

Chronic uterine inversion: preservation of the uterus--case report.

Uterine inversion is a rare and dangerous complication of labor. Although it can be reconstructed successfully with prompt intervention in acute stages, surgical interventions are usually mandatory in sub-acute or chronic phases. In this report we present a case of chronic uterine inversion, that was successfully treated with abdominal surgery.

Determination of iron, manganese and zinc in water samples by flame atomic absorption spectrophotometry after preconcentration with solid-phase extraction onto Ambersorb 572.

A solid-phase extraction method for the preconcentration of Fe, Mn and Zn on a column containing Ambersorb 572 has been developed, and the determination of Fe, Mn and Zn in water using a flame atomic absorption spectrophotometer (FAAS) has been performed. The optimum preconcentration parameters of the procedure have been determined. The effect of the pH, complexing agent, amount of adsorbent, flow rate, concentration and volume of the elution solution and interfering ions on the recovery of the analytes were investigated. The recoveries of Fe, Mn and Zn were 99 +/- 3%, 98 +/- 3% and 99 +/- 3% at the 95% confidence level, respectively, under the optimum conditions. Fe, Mn and Zn were preconcentrated up to 50, 100, 200, respectively. The limits of detection of Fe, Mn and Zn are 2.5, 0.68 and 0.24 micrograms l-1, respectively. The adsorption capacity of the adsorbent was found to be 10.9, 13.1 and 21.5 mg g-1 for Fe, Mn and Zn, respectively. The method has been applied to the determination of these metal ions in tap-water and river-water samples. The precision and the accuracy of the method is very good. The relative standard deviation and the relative error are lower than 4%.

Speciation of Cr(III) and Cr(VI) in water after preconcentration of its 1,5-diphenylcarbazone complex on amberlite XAD-16 resin and determination by FAAS.

A simple and sensitive method for the speciation, separation and preconcentration of Cr(VI) and Cr(III) in tap water was developed. Cr(VI) has been separated from Cr(III) and preconcentrated as its 1,5-diphenylcarbazone complex by using a column containing Amberlite XAD-16 resin and determined by FAAS. Total chromium has also been determined by FAAS after conversion of Cr(III) to Cr(VI) by oxidation with KMnO(4). Then, Cr(III) has been calculated by subtracting Cr(VI) from the total. The effect of acidity, amount of adsorbent, eluent type and flow rate of the sample solution on to the preconcentration procedure has been investigated. The retained Cr(VI) complex was eluated with 10 ml of 0.05 mol l(-1) H(2)SO(4) solution in methanol. The recovery of Cr(VI) was 99.7+/-0.7 at 95% confidence level. The highest preconcentration factor was 25 for a 250 ml sample volume. The detection limit of Cr(VI) was found as 45 mug l(-1). The adsorption capacity of the resin was found as 0.4 mg g(-1) for Cr (VI). The effect of interfering ions has also been studied. The proposed method was applied to tap water samples and chromium species have been determined with the relative error <3%.

Distal oesophageal pH measurement in children during general anaesthesia using the laryngeal mask airway, tracheal tube and face mask.

BACKGROUND: Distal oesophageal pH was measured during controlled ventilation in children with the laryngeal mask airway (LMATM), tracheal tube (TT) and face mask (FM). METHODS: Fifty-six children scheduled for inguinal surgery with a standardized general anaesthetic technique were randomly allocated to receive LMA (n=21), TT (n=18) or FM (n=19). A 14 Fr pH probe was placed into the distal oesophagus and pH values were measured over 1 min at 2-min intervals during the first 20 min of anaesthesia. RESULTS: The median values of pH were 4.4 (3.5-5.5), 4.2 (3.3-4.9), 4.1 (3.2-5.1), 4.1 (3.3-5.0), 4.0 (3.3-4.9), 4.0 (3.4-5.1); 4.2 (3.3-5.1), 4.2 (3.6-5.0), 4.2 (3.5-5.0), 4.2 (3.5-5.2), 4.2 (3.5-5.0), 4.1 (3.5-5.0) and 4.2 (3.6-5.0), 4.2 (3.8-5.8), 4.1 (2.8-5.2), 4.2 (3.3-5.1), 4.2 (3.4-5.1), 4.3 (3.4-5.1) for LMA, TT and FM groups, respectively. CONCLUSION: There was no difference in the median pH values, within and between the groups (P > 0.05). We conclude that there is no difference in gastro-oesophageal reflux, when using a LMA, TT or FM during controlled ventilation in anaesthetized children.

Hypereosinophilia and metastatic anaplastic carcinoma of unknown primary.

The differential diagnosis of eosinophilia may sometimes be difficult. Eosinophilia may occur in a diverse array of conditions from parasitic infestations to malignacies. Idiopathic hypereosinophilic syndrome has also been described. A 65-year-old male patient presenting with eosinophilia of obscure etiology is described in the present report. Three years after the diagnosis of eosinophilia, metastatic anaplastic carcinoma of unknown primary was detected. Differential diagnosis is disscussed briefly. It is stressed that patients with hypereosinophilia of unknown etiology must be screened for malignancy regularly during follow up.

Spectrophotometric determination of some pesticides in water samples after preconcentration with Saccharomyces cerevisiae immobilized on sepiolite.

A sensitive and selective method for the preconcentration and determination of carbaryl, chlorpyrifos, linuron, and thiram was developed. The column sorption method was used for the preconcentration studies. Several parameters, such as amount of sorbent, pH, flow rate, volume of elution solution, and interferences, that can influence the retention of pesticides on Saccharomyces cerevisiae immobilized on sepiolite were investigated. Results showed that it was possible to achieve quantitative analysis when the sample pH was in the range 4-6 for carbaryl and thiram, 4-8 for linuron and 6 for chlorpyrifos using 100 mL of sample solution containing 20 microg of pesticide and 5 mL of eluent. Recoveries of carbaryl, chlorpyrifos, linuron, and thiram were 93.2 +/- 0.4%, 97.1 -/+ 0.3%, 98.5 +/- 0.4%, and 96.1 +/- 0.2%, respectively, at 95% confidence level under optimum conditions. The capacity of the sorbent was found to be 41, 28, 35, and 46 mg g(-1) for carbaryl, chlorpyrifos, linuron, and thiram, respectively. Saccharomyces cerevisiae immobilized on sepiolite is suitable for repeated use without loss of capacity up to twenty five cycles. The pesticides studied have been determined in river water with high precision and accuracy.

Local anesthesia for extracorporeal shock wave lithotripsy: a double-blind, prospective, randomized study.

OBJECTIVE: The efficacy of local anesthesia in decreasing intravenous analgesic requirements during extracorporeal shock wave lithotripsy with a second-generation lithotriptor was studied. METHODS: Subcutaneous infiltration was performed before the procedure. Sixty-nine patients (ASA I-II) were randomly allocated into four groups. Lidocaine 1% plus epinephrine (5 microg/ml) were infiltrated subcutaneously in a group of patients with ureteral stones (group UL), and a group with renal stones (group RL). The same amount of saline was administered to a group of patients with ureteral stones (group UC), and a group with renal stones (group RC). RESULTS: Patients with ureteral stones needed higher doses of intravenous analgesic. Neither patients with renal stones nor patients with ureteral stones administered local anesthetic required less intravenous analgesic than patients given placebo. CONCLUSION: Local anesthesia did not decrease the requirement of intravenous doses of analgesics in patients treated with a second-generation lithotriptor (Dornier MPL 9000).

Treatment of advanced soft tissue sarcomas with ifosfamide and doxorubicin combination chemotherapy.

Our objective was to assess the efficacy of a standard dose ifosfamide and doxorubicin containing regimen in the treatment of advanced soft tissue sarcomas. Forty consecutive patients with a median age of 35.5 years were treated. Ifosfamide was administered at a dose of 2.5 g/m(2)/day as 72-hour continuous infusion with mesna at the same dosage and schedule. Doxorubicin was given at the dose of 60 mg/m(2)/day as 2-hour infusion on day 1. Six patients had a complete response (15%), and 9 (22.5%) had a partial response, fourteen patients (35%) stable disease, and 11 (27.5%) did not respond to chemotherapy. The median duration of response was 13 and 5 months for the complete and partial responders, respectively. The median survival was 37 months. Febrile neutropenia was encountered in 9 cases (22.5%). The present ifosfamide and doxorubicin combination is a moderately effective and well-tolerable regimen in the treatment of advanced soft tissue sarcomas.

Flame atomic absorption spectrometric determination of silver after preconcentration on Amberlite XAD-16 resin from thiocyanate solution.

A method of silver preconcentration by using a column containing Amberlite XAD-16 resin and this future determination by a flame AAS after elution is proposed. The effect of the factors such as pH, the nature of complexing agent, sample volume, flow rate, the type and concentration of elution solution on the preconcentration efficiency have been investigated. The influence of some matrix elements on the recovery of silver were also examined. It was found, that the quantitative recovery of thiocyanate complex of silver was obtained from nitric acid solution (pH 2) as 99.20+/-0.07% at the 95% confidence level. A preconcentration factor up to 75 could be obtained. The detection limit of silver was 0.047 mg l(-1). The adsorption of silver onto Amberlite XAD-16 can be formally described by a Langmuir equation with maximum adsorption capacity 4.66 mg g(-1) (0.043 mmol g(-1)). The proposed method was applied to determination of silver in standard alloy with relative error 6.25%.