Eighteen Years' Retrospective Review of Colorectal Cancer Cases in Eastern Population.

OBJECTIVE: We aimed to determine the demographic characteristics of colorectal cases and changes in cancer localization according to years in our region. MATERIALS AND METHODS: In the present study, 752 patients diagnosed with colorectal cancer between January 1992 and December 2010 were included. RESULTS: Of all the patients, 427 (56.8%) were males and 325 (43.2%) were females, with a male/female ratio of 1.3/1. The mean age was 56.2±14.9 years. The most commonly encountered complaint at the first application was rectal bleeding (38.4%). The most commonly encountered tumor localizations were in the rectum (55%) and sigmoid colon (18%). In general, tumors were observed to be localized in the right colon at 16.1% and in the left colon at 83.9%. When tumor localizations were compared in the first 10 years of the study with the second 10 years in the present study, it was observed that tumor numbers in the right colon were increased. Cases in our study were diagnosed as Stage IV according to the tumor, node, metastasis (TNM) classification, and liver metastasis was encountered most commonly. CONCLUSION: Although colorectal cancer cases have been most commonly encountered in the rectum, it has been recently determined that right colon tumor percentages were increased. It was defined that they were generally diagnosed at later stages. Therefore, colorectal cancer incidence may be decreased by the widespread use of endoscopic techniques in the determination of precancerous lesions.

Evaluation of the Relationship between Carcinoembryonic Antigen and TNM Stage in Colorectal Cancer.

OBJECTIVE: We aimed to examine the relationship between carcinoembryonic antigen (CEA) levels in the preoperative period and TNM (T: primary tumor, N: lymph node, M: distant metastasis or metastasis) staging in patients with colorectal cancer in our region. MATERIALS AND METHODS: In the present study, 752 cases diagnosed with colorectal cancer between January 1992 and December 2010 we analyzed retrospectively. RESULTS: Data of 752 patients diagnosed with colorectal cancer between 1992 and 2010 were evaluated; of the 752 patients, 427 (56.8%) were males and 325 (43.2%) were females with the mean age of 56.8±14.9 years. CEA levels of 316 cases were measured; 52.2% of the samples were within normal limits. Cases with CEA ≤5 ng/mL were majorly in Stage III, whereas those with CEA >5 ng/mL were predominantly in Stage IV. The TNM stage, tumor diameter, and differentiation levels were defined, and no statistically significant relationship was detected between these parameters and CEA levels. CONCLUSION: While the CEA levels of 52.2% of participating cases were within normal limits, there was no statistically significant relationship between the CEA levels and differentiation level of tumor, tumor diameter, and TNM staging. According to the data, CEA levels may be within normal limits in the majority of patients with colorectal cancer. Therefore, normal levels of CEA will not rule out colorectal cancer diagnosis, and it can be concluded that these patients should be investigated in detail.

Neutrophil-to-lymphocyte ratio as a possible indicator of epicardial adipose tissue in patients undergoing hemodialysis.

INTRODUCTION: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. MATERIAL AND METHODS: Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. RESULTS: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. CONCLUSIONS: Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

Association of hematological indicies with diabetes, impaired glucose regulation and microvascular complications of diabetes.

In recent years, there has been renewed interest in hematological parameters as predictors of endothelial dysfunction and inflammation. The aim of our study is to evaluate the relationship between HbA1c and hematological indices, and to evaluate the relationship between these parameters and microvascular complications of diabetes. Three hundred and seven diabetic patients (124 male, 183 female; mean age 50.8±8.5), and 187 controls (76 male, 111 female; mean age 51.1±10.1) were included in the study. In the diabetic group, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), white blood cell count (WBC), platelet count, platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) were significantly higher than the control group (P<0.05). Diabetic patients were divided into two group according to their HbA1c levels (Group 1; HbA1c <7 (n=82) and group 2; HbA1c ≥7 (n=225)). Mean platelet volume, PCT and PDW levels were significantly increased in group 2. Mean platelet volume was significantly increased in diabetic patients with retinopathy compared to those without retinopathy (P=0.006). The neutrophil to lymphocyte ratio and PLR levels were significantly higher in patients with nephropathy (P=0.004, P=0.004 respectively). There was statistically significant difference of lymphocyte count between patients with and without neuropathy. In correlation analysis, positive correlation between HbA1c and PCT (rs=0.192, P<0.001), HbA1c and PDW (rs=0.305, P<0.001), HbA1c and MPV (rs=0.352, P<0.001) were determined. In binary logistic regression analysis; WBC, PDW and PLR levels were found to be independently associated with diagnosis of diabetes while WBC, MPV, PLR and NLR levels were found to be independently associated with impaired glucose regulation. This study demonstrates that altered hematological indices are closely associated with HbA1c levels in individuals with and without diabetes and some of these parameters are associated with diabetic microvascular complications. These associations may be explained by connection between these easy accessible and inexpensive hematological indices and inflammation, tendency to coagulation and thrombosis in patients with diabetes.

Association of uric acid, atherogenic index of plasma and albuminuria in diabetes mellitus.

BACKGROUND: The associations of serum uric acid (UA), atherogenic index of plasma (AIP) and albuminuria with cardiovascular disease have been shown. Several studies focused on association of serum UA and dyslipidemia, serum UA and renal impairment, dyslipidemia and renal impairment. However, to date, in literature, there have been no studies demonstrating the relationship between these parameters in diabetic patients together. AIMS: We aimed to investigate the association between serum UA, albuminuria and AIP in diabetic patients. METHODS: This was a retrospective study involving data of 645 diabetic patients. The patients were separated into groups according to their serum uric acid and AIP levels. The quantitative urine albumin/creatinine ratio in morning spot urine samples were used for standard albuminuria determination. Serum uric acid levels under 6 mg/dL were considered as normal. AIP was calculated as the logarithmically transformed ratio of triglyceride to high density lipoprotein cholesterol. RESULTS: AIP and albuminuria levels were high in high serum UA group compared to normal UA group. Uric acid and albuminuria tended to increase with increasing AIP. Correlation analysis showed that albuminuria, AIP and UA were significantly correlated with each other. Additionally, in binary logistic regression analysis, AIP was found to be independently associated with high UA levels. CONCLUSIONS: Present study reveals that serum UA, AIP and albuminuria are closely related. Physicians should be aware that patients with concomitant hyperuricemia, albuminuria and high AIP are at increased risk of developing cardiovascular disease. Our study confirms that there is a need for larger prospective studies to determine the mechanisms underlying the association of serum UA, AIP and albuminuria.

Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy.

BACKGROUND: The relationship between diabetic nephropathy, visceral adipose tissue (VAT), and inflammation has been shown. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple, inexpensive, and useful markers to determine inflammation. However, to date, in the literature, there have been no studies demonstrating the relationship between epicardial adipose tissue (EAT), inflammation, and albuminuria. AIMS: We aimed to investigate the association between diabetic nephropathy, NLR, and PLR as inflammatory markers and EAT thickness. METHODS: This was a cross-sectional study involving 200 diabetic patients. The patients were separated into three groups according to their albuminuria levels. The NLR and PLR were calculated from a complete blood count. EAT was measured by transthoracic echocardiography. The estimated glomerular filtration rate (eGFR) was calculated by the modification of diet in renal disease (MDRD) equation. RESULTS: Disease duration, EAT, creatinine, NLR, PLR, absolute neutrophil, lymphocyte, and platelet count tended to increase with increasing albuminuria while the eGFR decreased. When patients were separated into two groups according to NLR and PLR medians, albuminuria levels increased with an increase of the NLR (p = 0.003) and PLR (p = 0.009). A correlation analysis showed that albuminuria was significantly correlated with EAT, disease duration, creatinine, eGFR, PLR, and NLR levels. Additionally, in a binary logistic regression analysis, EAT, NLR, and PLR were found to be independently associated with albuminuria. CONCLUSIONS: Determining various inflammatory cytokines and measuring abdominal VAT in diabetic patients is complex and expensive. Simply measuring EAT and calculating NLR and PLR can predict inflammation and albuminuria in patients with diabetes.