Gastric adenocarcinoma under the age of 40; more metastatic, less differentiated.

PURPOSE: Gastric carcinoma is relatively rare under the age of 40 years, and the mean age at presentation is 65 years. Histologically, adenocarcinoma prevails. Previous studies state that gastric adenocarcinoma under 40 is more aggressive. The present retrospective study was undertaken to clarify the clinicopathological characteristics of gastric adenocarcinoma in patients under 40 and to compare their clinical features with the patients over 40 years of age. METHODS: All of the patients with histologically diagnosed gastric adenocarcinoma who had applied to our department from March 2001 to September 2009 were retrospectively evaluated. Patients were stratified according to their age at diagnosis (≤ 40 years; group 1, and > 40 years; group 2). Their clinical, laboratory, and pathological characteristics were analyzed. RESULTS: 251 patients were studied. Sixty-eight percent of those under 40 and 46% over 40 had poorly differentiated histology (p= 0.036). Fifteen (60%) patients under 40 and 73 (32.3%) over 40 had metastatic diseases (p=0.007). CONCLUSION: Younger patients with gastric adenocarcinoma have less differentiated, more advanced and metastatic disease. Patients' complaints, tumor localization, metastatic sites and smoking did not differ significantly between the groups. Controversy for survival parameters still exists.

[The relation of serum interleukin-2 and C-reactive protein levels with clinical and radiological findings in patients with pulmonary tuberculosis]. / Akciger tüberkülozlu hastalarda serum interlökin-2 ve C-reaktif protein düzeylerinin klinik ve radyolojik bulgularla iliskisi.

Immunological events, not the bacilli, are responsible from the tissue damage of tuberculosis. Clarifying the immunological events may lead to the development of new approaches to treatment and defence against tuberculosis disease. In this study we aimed to determine the serum levels of interleukin-2 (IL-2) and C-reactive protein (CRP) in patients with tuberculosis and evaluate the relationship with clinical and radiological findings. The study included 60 patients (mean age: 37 +/- 12 years, all male) with newly diagnosed pulmonary tuberculosis and 23 healthy controls (mean age: 40 +/- 13 years, all male). Admission symptoms, clinical features, demographic data, laboratory investigations and radiological findings were all recorded into the study form. Serum samples which were obtained for determination of IL-2 and CRP levels were preserved at -80 degrees C. While serum IL-2 levels were similar in patients with tuberculosis and healthy controls, serum CRP levels were significantly higher in patients with tuberculosis (p< 0.001). There was a positive correlation between serum IL-2 level and the diameter of cavity (p= 0.012). CRP levels were significantly higher in patients who admitted with fever (p= 0.001) and weight loss (p= 0.024). Serum CRP levels were significantly higher in patients who had involvement of four or more zones (p= 0.029) and multiple cavitary disease (p= 0.001). There was a positive correlation between serum CRP level and the diameter of cavity (p= 0.004). In conclusion, apart from the diameter of cavity, serum IL-2 levels were not correlated with any clinical, laboratory or radiological parameter. Serum CRP levels were a good indicator of disease severity.

A registry-based cohort study of pulmonary tuberculosis treatment outcomes in Istanbul, Turkey.

The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smear- and/or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0%) patients including death (1.8%), treatment default (6.1%), and treatment failure (1.1%). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95% confidence intervals [CI], 3.67-7.91), history of tuberculosis treatment (OR, 3.77; 95% CI, 3.26-4.36), age > 65 years (OR, 2.79; 95% CI, 2.21-3.53), and male gender (OR, 1.91; 95% CI, 1.59-2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95% CI, 27.0-75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95% CI, 8.94-15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95% CI, 6.97-41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95% CI, 8.02-14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.