Does the platelet­to­lymphocyte ratio have a prognostic effect in patients with myelodysplastic syndrome?

INTRODUCTION: Myelodysplastic syndromes (MDS) include various hematologic abnormalities characterized by chronic cytopenia due to disruption in cellular differentiation. This study aims to evaluate the prognostic value of PLR in patients with MDS. MATERIAL AND METHODS: Clinical-laboratory findings and the results of bone marrow biopsies of MDS patients before treatment were recorded. p value of <0.05 was considered statistically significant. SPSS version 20.0 was used for statistical analysis. RESULTS: The study included 62 patients with median follow-up time of 62.8±4.5 months and median age of 68.5 years. In 13 patients, acute leukemia was transformed. In these subjects, a PLR cut-off level of 46 was established for mortality (p=0.015). We found a significant relationship between PLR and multilineage series with the presence of dysplasia (p=0.017). The survival analysis showed a decreased survival in cases with dysplasia in two and/or more series, transformation into acute leukemia, and thrombocytopenia. CONCLUSION: Our study demonstrated that there was a relationship between PLR and MDS with multilineage dysplasia (mld-MDS). PLR is investigated as an inflammatory finding in various hematologic malignancies. Further studies investigating the value of PLR in MDS are needed to determine whether PLR may be a marker of bone marrow dysplasia grading (Tab. 2, Fig. 4, Ref. 32).

In myelodysplastic syndrome cases, what should be the level of ferritin which has prognostic value?

OBJECTIVES: Myelodysplastic syndrome (MDS) is a highly mortal disease in which anemia is unresponsive to treatment. In this study, the effect of basal ferritin values on prognosis and survival was investigated in MDS patients without history of transfusion. METHODS: Data were retrospectively analyzed for 62 MDS cases. The cases were divided into two groups according to ferritin values. RESULTS: The mean survival time was 61.1±4.8 months. During the follow-up period, 34 (54.8%) patients deceased. Median ferritin level was 358ng/mL. The serum ferritin (SF) level associated with mortality was determined as 400ng/mL (ROC area for SF was 0.731 with a cutoff value of 400; sensitivity and specificity were 70.7% and 68.2%, respectively) (P=0.002). There were 29 (46.8%) patients with serum ferritin levels of ≥400ng/mL. Patients with serum ferritin levels≥400ng/mL had low survival rates. Ferritin≥400ng/mL was associated with six times increased mortality (P=0.001). CONCLUSION: Although the acceptable ferritin level at the start of chelation therapy is 1000ng/mL, the fact that 400ng/mL value is associated with survival in our study suggests that it may be useful to start chelation therapy in the early period. Further case studies on the subject are required.

DIAGNOSTIC VALUE OF DUPLEX DOPPLER ULTRASOUND PARAMETERS IN PAPILLARY THYROID CARCINOMA.

CONTEXT: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer due to its high fibrotic content; it can affect the blood flow resistance. OBJECTIVE: To introduce duplex Doppler ultrasonography (DDUS) parameters of papillary thyroid carcinoma (PTC) and their correlation with size. DESIGN: The study was designed as a prospective study. SUBJECTS AND METHODS: Thyroid nodules of the patients who were already scheduled for thyroid surgery either for malignant thyroid nodules or multinodular goiter were evaluated for DDUS parameters. Size, systolic to diastolic flow velocity (S/D) ratio, pulsatility index (PI), and resistive index (RI) of each nodule were recorded. Nodules were diagnosed as PTC or benign nodules based on histopathology. DDUS parameters were compared between PTCs versus benign nodules and micro PTCs (≤ 10 mm) versus large PTCs (> 10 mm). A correlation analysis was performed between the size and DDUS parameters. RESULTS: 140 thyroid nodules (30 PTCs, 110 benign nodules) were obtained. The mean S/D ratio, PI, and RI values were significantly higher in PTC than in benign nodules (p values were 0.0001, 0.0003, and 0.0001 respectively). The optimal cut-off values of S/D (0.732), PI (0.732), and RI (0.738) had accuracy rates of 71%, 69%, and 69%, respectively. There was no statistically significant difference between micro PTC and large PTC with regards to DDUS parameters. The size and DDUS parameters of PTC showed no significant correlation. CONCLUSIONS: PTC has a high resistive flow pattern regardless of its size; however the clinical utility of DDUS to differentiate a PTC from benign nodule is limited.

Stimulated thyroglobulin values above 5.6 ng/ml before radioactive iodine ablation treatment following levothyroxine withdrawal is associated with a 2.38-fold risk of relapse in Tg-ab negative subjects with differentiated thyroid cancer.

BACKGROUND: Serum thyroglobulin (Tg) is the key parameter used in the follow-up of subjects with differentiated thyroid cancer (DTC). Current guidelines advise its measurement to take place when Thyrotropin (TSH) levels are >30 µU/ml (stimulated Tg) and when TSH < 0.1 µU/ml (suppressed Tg). Although stimulated Tg levels <1 ng/ml have been shown to display excellent prognosis, relapses may occur despite low Tg levels. Recently, very low cut-off levels of stimulated Tg have been proposed for determining the recurrence risk in these subjects. In this study, we aimed to assess the association between ablative stimulated Tg obtained before radioactive iodine ablation therapy (RAI) (ASTg) and late stimulated Tg obtained 6-12 months after primary therapy (LSTg) in a group of subjects with DTC. We also aimed to establish a cut-off level of Tg for recurrence. METHODS: We retrospectively analyzed 393 subjects with low or intermediate risk DTC diagnosed at our institution between January 2000 and December 2010 with a mean follow-up period of 64.4 months (range 14-192 months). All stimulated Tg levels were performed following levothyroxine withdrawal in this study. RESULTS: Histopathological analysis indicated papillary carcinoma in 362 (92.1%) subjects and follicular carcinoma in 31 (7.9%) subjects. Three hundred and twenty-four (82.4%) of our cases were females, and 69 (17.6%) were males. Recurrence occurred in 82 (20.9%) of the subjects. Relapse was significantly more frequently observed in subjects with ASTg ≥ 2 ng/ml; and LSTg ≥ 2 ng/ml. (p = 0.004 and p < 0.001, respectively). In subjects negative for thyroglobulin antibodies (Tg-ab), an ASTg value ≥5.6 ng/ml was established to increase the risk of recurrence by 2.38-fold (p = 0.002), whereas an LSTg ≥ 0.285 ng/ml increased the risk of relapse by 3.087-fold (p < 0.001). CONCLUSION: As a result of this study, we determined that the optimum cut-off level for both ASTg and LSTg may be lower than those previously reported. Using such a lower cut-off may improve sensitivity for detecting relapse.

The predictive value of epidemiological characteristics, clinical and laboratory findings in adult lymphadenopathy etiology.

OBJECTIVE: Our aim was to determine the presence or absence of malignant etiology in the epidemiological, clinical and laboratory results of patients undergoing lymph node biopsies. PATIENTS AND METHODS: This study was carried out between January 2013 and April 2014. We enrolled a total of 150 adult patients who had lymph node biopsies. 73 of these were females (48.7%) and 77 were males (51.3%). The epidemiological characteristics, clinical and laboratory findings were evaluated and compared with the pathological results. RESULTS: Leukopenia (p=0.05) thrombocytopenia (p=0.03) and increased lactate dehydrogenase levels (p=0.01) were found to be associated with the malignancy. In the cervical, submandibular, axillary and inguinal areas lymphadenopathy was generally seem to be benign while the rate of malignancy was higher in the intra-abdominal and supraclavicular regions. In those cases who had a lymph node index of below 2 there was a higher rate of malignancy (p=0.04). In cases which lymphadenopathy accompanied by splenomegaly has been found associated with malignancy (p=0.009). No association with regards to malignancy was found with the erythrocyte sedimentation rate, C-reactive protein and hepatomegaly. CONCLUSIONS: According to the results of the study five variables including cytopenia, lactate dehydrogenase levels, splenomegaly, lymph node index below 2, intra-abdominal and supraclavicular lymphadenopathy were concluded to be the most suitable means of predicting malignant etiology.

The role of diffusion-weighted magnetic resonance imaging in intracranial cystic lesions.

We aimed to define the diffusion-weighted magnetic resonance (MR) imaging features of intracranial cystic lesions and to investigate possible special features for the differential diagnosis. One hundred and twenty patients with intracranial cystic lesions were included in the study. There were 29 arachnoid cysts, eight epidermoid cysts, 34 primary tumors, 18 abscesses, 29 metastases and two hydatid cysts. Echo-planar diffusion-weighted MR imaging was obtained in addition to conventional cranial MR scans. The morphologic features of the cystic portion and the wall of the cyst and signal intensities on diffusion-weighted images were evaluated. All abscesses and epidermoid cysts were hyperintense on diffusion-weighted images. Arachnoid cysts, hydatid cysts, primary tumors, and metastases were hypointense except five cystic tumors. These five primary or metastatic necrotic tumors showed high signal intensity on diffusion-weighted images due to hemorrhage or superinfection. The walls of the cystic tumors were usually hyperintense on diffusion-weighted images in contrast to the wall of the abscesses, which were iso-hypointense. This was a statistically significant finding for the differentiation between tumors and abscesses (p<0.05). Diffusion-weighted MR imaging is a useful technique for the evaluation of the intracranial cystic lesions and provides additional beneficial information to conventional MR imaging. However, the presence of hemorrhage and superinfection of the tumors may cause a signal increase that results in misinterpretetations. In these cases, the appearance of tumor wall may be useful for differentiating abscesses from tumors.

A provisionally unique syndrome with features including "molar tooth" sign and "femoral hypoplasia".

A provisionally unique syndrome with features including "molar tooth" sign and "femoral hypoplasia": The femoral-facial syndrome (FH-UFS) is a rare syndrome of uncertain inheritance comprising hypoplastic femora, microretrognathia, and peculiar facies. We describe a new case with facial dysmorphism, broad chest and widely spaced nipples, shorter right lower limb with femoral hypoplasia and unilateral fibular hemimelia, bilateral absence of 5th metatarsal and toe, and bilateral talipes equinovarus. In addition, a complete agenesis of corpus callosum, cerebellar vermis hypoplasia with molar tooth sign and Dandy-Walker malformation were present. Posterior fossa abnormalities in FH-UFS have not been described in the literature until now, thus extending the clinical spectrum of this entity. Other syndromes characterized by femoral hypoplasia and/or molar tooth sign are also discussed.

Guillain-Barré syndrome associated with Legionnella infection.

This is the first report of Guillain-Barré syndrome (GBS) related to Legionnella pneumophilia infection. A 13-year-old boy presented with acute dysphagia and dyspnea. He lived in a rural area and had a history of drinking potable deep-hole water. The patient was intubated because of increased respiratory distress. A positive direct fluoresein antigen test confirmed L. pneumophilia infection in BAL. One week after the first admission, acute weakness was noticed including the lower extremities and was more prominent in the distal than the proximal portions. GBS was considered as the initial diagnosis. Tests for all causes known to trigger GBS were negative. Specific serology for L. pneumophilia IgG was positive. He was treated with intravenous immunoglobulins and discharged with minor weakness and difficulty in walking in the second month. On the basis of this case, L. pneumophilia should be included in the etiologic spectrum of GBS.

Magnetic resonance imaging findings in chronic carbon monoxide intoxication.

PURPOSE: To define the cranial magnetic resonance imaging (MRI) features of the chronic stage of carbon monoxide (CO) poisoning in patients with and without neuropsychiatric sequelae. MATERIAL AND METHODS: Eight patients who had neither symptoms nor neurological sequelae and eight patients with neuropsychiatric sequelae were included in the study. Patients aged between 9 to 57 (mean 32.2 years). All patients had been comatose at initial admittance and awoke after normobaric 100% oxygen therapy within 1-7 days. In this study, the patients were being examined with routine cranial MRI between 1 and 10 years (mean 3.4 years) after exposure to CO. RESULTS: The most common finding was bilateral symmetric hyperintensity of the white matter, which was more significant in the centrum semiovale, with relative sparing of the temporal lobes and anterior parts of the frontal lobes on T2-weighted and FLAIR images in all patients. Cerebral cortical atrophy was seen in 10 patients; mild atrophy of cerebellar hemispheres in 8; and vermian atrophy in 11. Corpus callosum was atrophic in one patient. Bilateral globus pallidus lesions were seen in three patients. The lesions were hypointense on T1-weighted images and hyperintense on T2-weighted and FLAIR images. CONCLUSION: Patients with severe CO intoxication may develop persistent cerebral changes independently of their neuropsychiatric findings in the chronic stage. They may present with characteristic MRI findings as described here, even if asymptomatic. The history of CO exposure is therefore helpful for recognizing and interpreting the MRI findings of chronic stage CO intoxication.

Color Doppler ultrasonography findings of bladder tumors: correlation with stage and histopathologic grade.

PURPOSE: To describe color Doppler ultrasonography findings of bladder tumors and to investigate the correlation between these findings with stage and histopathological grade. MATERIAL AND METHODS: Twenty-four patients with bladder tumors were assessed with color Doppler ultrasonography for tumor size, presence of vascularity, vascular pattern, and spectral properties. All patients underwent surgery. Stage and histopathological grades of tumors were determined and compared with color Doppler ultrasonography findings. RESULTS: Presence of vascularity was related to tumor size (P<0.05) and color Doppler signal was detected when tumors reached 24 mm in size. There was no statistically significant relationship between tumor stage and histopathological grade with tumor size, presence and pattern of vascularity, and spectral color Doppler ultrasonography findings (P>0.05). CONCLUSION: The evaluation of vascularity in bladder tumors by color Doppler ultrasonography is not helpful in predicting tumor stage and histopathological grade before surgery.

Characterization of hepatocellular carcinomas with triphasic CT and correlation with histopathologic findings.

PURPOSE: To determine the utility of triphasic CT in the characterization of hepatocellular carcinomas (HCCs) and correlations with histopathologic findings. MATERIAL AND METHODS: Thirty patients with hepatocellular carcinomas were included in the study and triphasic CT examinations were performed. The CT protocol included hepatic arterial, portal venous and late phases. A histopathologic examination was carried out in all but 3 patients, and the diagnosis and degrees of differentiation were determined. RESULTS: Hepatocellular carcinomas were hyperattenuated in 17 (57%) and hypoattenuated in 13 (43%) of the 30 patients in arterial phase images. The lesions were hypoattenuated in 26 (87%) and hyperattenuated in 4 (13%) patients in portal venous phase images. These hyperattenuated tumors were well-differentiated in the histopathologic examinations (P < or = 0.05). Portal vein invasion was seen in 50% of the patients and this relationship was significant in patients whose lesions was greater than 10 cm (P < 0.05). Capsule formation, abnormal internal vessels and necrosis were detected in 57%, 53% and 40% of the patients, respectively. CONCLUSION: Triphasic CT can aid in the histopathologic differentiation of HCCs, in addition to their characterization. Hyperattenuation in PVP images was found to be associated with well-differentiated HCCs and portal vein invasion was more frequent in tumors larger than 10 cm.