mFOLFOX-based Chemotherapy Can Augment Survival in Advanced Gastric Cancer Patient with Disseminated Intravascular Coagulation

ABSTRACT Although gastric cancer is a frequent cancer type, disseminated intravascular coagulation is a very rare but serious complication of this disease. We report a 65-year-old man who complained of weight loss, nausea and vomiting, fatigue and dyspnoea for three days. He was diagnosed as having advanced gastric cancer complicated with disseminated intravascular coagulation, which was successfully treated with mFOLFOX chemotherapy regimen. After one cycle of mFOLFOX therapy, thrombocytopenia was improved and serum lactate dehydrogenase levels decreased. Remarkable remission was seen. After 12 cycles of chemotherapy, remarkable remission was seen in the primary tumour and multiple metastatic bone lesions.

Prognostic analysis of patients with operable gastric cancer and tolerability to adjuvant radio-chemo-therapy.

The aim of this study is to evaluate the tolerability and toxicity of adjuvant chemoradiotherapy (CRT) and to analyze the prognosis in patients with operable gastric cancer. The retrospective analysis included 723 patients with operable gastric cancer; stage IB-IV (M0), received adjuvant CRT from 8 Medical Centers in Turkey between 2003 and 2010. The patients' age, sex, tumor localization, Lauren classification, grade and stage of the disease, type of dissection, the toxicity and tolerability status and survival rate were analyzed. All patients were divided into two groups as tolerable group to adjuvant CRT and intolerable group to adjuvant CRT .Among the patient, 73.9% had stage III-IVM0 disease; 61.0% had the intestinal type of gastric cancer, 51.1% had the distal type, and 61.4% had undergone D2 dissections. The number of patients who completed the entire course of the adjuvant CRT was 545 (75.4%).The median follow-up period was 20.8 months (range: 1.5-107 months). Overall Survival (OS) rates were 80% and 52%, while the relapse free survival (RFS) rates were 75% and 48% at 1 and 3 years, respectively.In the univariate analysis of the groups based on the the age defined as <65 or ≥ 65 (p=0.16 / p=0.003), Lauren classification (p=0.004 / p<0.001), localization of tumor (p=0.02 / p=0.04), tumor grade (p=0.06 / p=0.003), disease stage (p<0.001 / p<0.001), type of dissection (p=0.445 / p=0.043), presence or absence of toxicity (p=0.062 / p=0.077) and tolerability of the therapy (p=0.002 / p=0.001). In the cox regression analysis, tumor stage (Hazard Ratio (HR): 0.332; 95% confidence interval (CI): 0.195-0.566; p<0.001), and tolerability (HR: 0.516; 95% CI: 0.305-0.872; p=0.014), were found to be related with the OS. Tumor stage (HR: 0.318; 95% CI: 0.190-0.533; p=<0.001) and tolerability (HR: 0.604; 95% CI: 0.367-0.995; p=0.048) were observed to be statistically significant in terms of the RFS.We have observed that whether a patient can or cannot tolerate adjuvant CRT due to its toxicity is an independent prognostic factor besides the known prognostic factors like tumor stage and Lauren classification. We are of the opinion that the treatment of patients who cannot tolerate adjuvant CRT should be replaced with less toxic adjuvant therapies.

Exfoliative cytology of oral mucosa in kidney transplant patients: a cytomorphometric study.

OBJECTIVES: The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods. METHODS: Smears were obtained from the clinically healthy buccal mucosa and floor of mouth of transplant patients (n = 21) and healthy volunteers (n = 27). Smears from each individual stained by the Papanicolaou method were analyzed using a stereologic method. Nuclear (NV) and cytoplasmic (CV) volumes were evaluated with Stereo Investigator software. RESULTS: CV values were 123,012.71 ± 15,840.96 fL in the floor of the mouth and 133,667.10 ± 26,653.39 fL in the buccal mucosa of the kidney transplant patients. CV values were 133,746.93 ± 14,210.67 fL in the floor of the mouth and 167,797.78 ± 21,007.70 fL in the buccal mucosa of the control group. NV values were 945.68 ± 65.85 fL in the floor of the mouth and 845.15 ± 81.56 fL in the buccal mucosa of the kidney transplant patients and 485.17 ± 18.03 fL in the floor of the mouth and 410.25 ± 52.84 µm(3) in the buccal mucosa of the control group. Significantly higher NV (P = .000) and NV/CV (P = .000) and lower CS (P = .000) values were found in the patient group compared with the control group. CONCLUSION: The findings suggest that there were alterations in oral epithelial cells, detectable by microscopy and cytomorphometry in kidney transplant patients.

Oxidase activity of ceruloplasmin and some acute phase reactant and trace element concentrations in serum of patients with chronic lymphocytic leukemia.

In the present study, we aimed to investigate the parameters in serum of patients with chronic lymphocytic leukaemia (CLL) and correlate with the cancer stage. The serum concentrations of ceruloplasmin, a-1-acid glycoprotein, albuminumin, transferrin, copper, zinc, manganese, and ceruloplasmin oxidase activity were measured, and compared with those from a healthy control group. The serum from 34 patients with CLL were extracted before chemotherapy. Serum transferrin, albuminumin and Zinc concentrations were lower in patients with CLL while serum a-1-acid glycoprotein, ceruloplasmin, copper concentrations, and ceruloplasmin oxidase activity were higher in CLL patients when compared with the control group. Although serum manganese concentration was lower in CLL groups than in the control group, the difference was not statistically significant. Serum transferrin concentration was lower in the early stage group compared with the advanced stage. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients from the early stage group. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients with advanced stage. In conclusion, increased serum ceruloplasmin oxidase activity, ceruloplasmin, a-1-acid glycoprotein, copper levels and decreased transferrin and albuminumin, unchanged manganese levels are associated with CLL and appear to be a consequence of the disease itself.

Effects of type 2 diabetes mellitus on plasma fatty acid composition and cholesterol content of erythrocyte and leukocyte membranes.

Insulin resistance is a major factor in the pathogenesis of type 2 diabetes mellitus (T2DM) and is related to the fatty acid profile of the plasma membranes. The purpose of the present study was to investigate fatty acid composition and cholesterol content of cell membranes in patients with type 2 diabetes and, thus, to evaluate the possible factors leading to the alteration of plasma membrane fluidity. The study was performed in 20 healthy control subjects and 32 patients with type 2 diabetes. The fatty acid profiles and cholesterol content of the erythrocyte (RBC) and leukocyte (WBC) membranes were determined by a gas chromatographic method. When one considers the membrane constituents increasing fluidity and the ones decreasing it, the diabetics had a membrane composition decreasing fluidity compared to controls. On the other hand, when compared to control subjects, type 2 diabetic patients showed a significantly higher proportion of C16:0 components in erythrocyte and leukocyte membranes and plasma samples (25.4+/-3.1% vs. 31.1+/-4%; 23.3+/-2.4% vs. 29.3+/-5.2%; 27.6+/-3.9% vs. 34.5+/-5.7%; p<0.005, p<0.01 and p<0.005, respectively). Our results suggest that the ratio of saturated:unsaturated fatty acids changes in plasma and cell membranes of patients with type 2 diabetes. This situation may cause, at least in part, RBC-WBC function abnormalities and insulin resistance because of inconvenient membrane fluidity.

Unbiased estimation of tumor regression rates during chemoradiotherapy for esophageal carcinoma using CT and stereology.

SUMMARY. The purpose of the present study is to estimate tumor volumes of 10 patients with esophageal carcinoma on serial CT images that are obtained before and after chemoradiotherapy using a stereological method. In this study, tumor volume was measured using the Cavalieri method of modern design stereology with a combination of three separate stages. Firstly, detailed systematic series of axial CT images of 1-cm thickness were obtained throughout the whole tumor area of each subject and to magnify them all CT images were projected on a screen by overhead projector and then were marked by manually tracing the outline of areas with tumor on serial CT images that are projected onto the screen. Secondly these images were drawn on paper. Finally the images on paper were evaluated with a point-counting method. It was shown in a pilot study analyzed that 100 test points counted on about 6--8 serial slices through for esophagus wall, lumen and wall + lumen are sufficient to secure coefficient of error (CE) on the estimates of volumes as in this study. It was found that tumor volumes before and after radiotherapy for esophagus wall, lumen and wall + lumen was 10.34 cm(3), 1.15 cm(3) and 11.75 cm(3) before and 5.93 cm(3), 1.43 cm(3) and 7.65 cm(3) after radiotherapy, respectively. When only esophagus wall and lumen volumes or wall + lumen volumes before and after radiotherapy were statistically compared, the difference between either esophagus wall (P<0.01) and lumen (P<0.01) volumes or total volumes (P<.1) were significant. It is concluded that CT estimated tumor volumes may be helpful in both evaluating the clinical situation of patients and providing a simple index to assess the efficiency of therapy, prediction of tumor regression rate and minimizing the risk of chemoradiotherapy damage.