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Prognostic value of basal neutrophil lymphocyte ratio in patients with extensive stage small cell lung cancer
Get PDFPurpose: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocytopenia are markers of poor prognosis in lung cancer patients. The aim of this trial is evaluate the prognostic significance of basal NLR, PLR and lymphocytopenia in patients with extensive stage (ES) small cell lung cancer(SCLC).
Materials and Methods: This study was designed as a hospital-based retrospective observational case-series study. A total of 117 patients with extensive stage small cell lung cancer have been treated at four different oncology centers in Turkey between 2011 and 2017. Laboratory results and demographic data were collected.
Results: The median follow-up time was 12 months and 95 (81%) patients died. Progression-free survival (PFS) and overall survival (OS) were estimated, respectively, as 8 and 13 months. 65 (55.6 %) patients had complete response at the end of first line platin-etoposide combination treatment. The cut-off value for NLR and PLR were determined for whole group and patients were dichotomized into high (>= 3.28) and low (= 139.8) and low (< 139.8) PLR groups.. Median OS was lower in patients who had high neutrophil lymphocyte ratio (NLR) (14 versus 12 months respectively).
Conclusion: This study showed that basal NLR may have prognostic biological value in patients with ES SCLC treated with cisplatin + etoposide
Unusual Long Survival with a Giant Invasive Pheochromocytoma of an Incompatible Patient
Get PDFPheochromocytomas (PHEOs) are rare neuroendocrine tumors and about 2-13% of PHEOs are malignant. Predicting malignancy in PHEO cases with invasion but without metastasis is still controversial in the literature. This study presents an unusual long survival with a giant invasive PHEO in an incompatible patient and a review of the literature. In 1989, a 23-year-old female patient was operated for a giant adrenal mass with a pathological final diagnosis of PHEO. Information to the patient's family was provided about the short life span of the patient in the postoperative period because the tumor could not be totally resected. The patient started using regular antihypertensive drugs only after 1994. In 1994, 3700 mBq 131-I-metaiodobenzylguanidine (MIBG) treatment was given. Since then, no specific treatment was administered for PHEO due to patient incompatibility. She was diagnosed with type 2 diabetes mellitus at the age of 40 years and had a cerebrovascular accident due to hypertension at the age of 42. New abdominal computed tomography (CT) showed a right-sided 75 x 37 mm irregular and heterogeneous mass lesion extending inferiorly from the diaphragmatic crus level located in the right adrenal locus compatible with local recurrence. There was no I-123-MIBG uptake. She refused to have advanced workup and further treatment options. Malignant PHEOs reduce overall survival as a consequence of excessive catecholamine release, large tumor burden, and malignancy-related complications. Currently, the treatment of a malignant PHEO still has difficulties for both patients and doctors. Main treatment options for malignant PHEOs are primarily surgical excision. The effect of radionuclide therapy on survival time still remains to be determined. Efforts should be made to identify clinical, biochemical, and pathological criteria for malignancy and to develop new therapies in these patients with malignancy. The clinical course of malignant PHEOs is remarkably variable. Disease-specific survival rate changes from 58 to 88.1% at five years in the literature. Recent discoveries have enhanced new options for treatment, from radionuclide therapy and targeted molecular therapy to immunotherapy. A multidisciplinary approach is needed to individualize treatment in patients with malignant and invasive PHEO
VDR gene FokI polymorphism as a poor prognostic factor for papillary thyroid cancer
Get PDFThis is the first study to investigate the effect of vitamin D receptor (VDR) gene single-nucleotide polymorphisms on the clinicopathologic features of papillary thyroid cancer in Turkey. A total of 165 patients with papillary thyroid cancer and 172 controls were included in this case–control study. VDR gene single-nucleotide polymorphisms FokI (rs2228570), BsmI (rs1544410), ApaI (rs7975232), and TaqI (rs731236) were evaluated using reverse-transcription polymerase chain reaction. VDR gene polymorphisms BsmI, ApaI, and TaqI did not differ between the papillary thyroid cancer group and control group (p > 0.05, each). BsmI, ApaI, and TaqI were not associated with papillary thyroid cancer risk. The VDR gene FokI CT/TT genotype was associated with an increased papillary thyroid cancer risk (CT vs CC: odds ratio = 1.71, 95% confidence interval = 1.15–2.76, p = 0.028; TT vs CC: odds ratio = 2.44, 95% confidence interval = 1.29–4.62, p = 0.005; CT/TT vs CC: odds ratio = 1.88, 95% confidence interval = 1.20–2.96, p = 0.006; CT/CC vs TT: odds ratio = 1.80, 95% confidence interval = 1.05–3.20, p = 0.041). VDR gene polymorphisms were not in linkage disequilibrium. The FokI TT genotype was associated with having T3 and T4, stage III/IV, extra-thyroidal invasion. The FokI CT/TT or TT genotype was associated with developing N1 status, multifocality, tumor size ≥10 mm, and treatment with radioiodine therapy. Persistence/recurrence did not differ between the FokI genotypes. Carriers of the FokI T allele were at an increased risk of more advanced tumor-node-metastasis stage, greater tumor size, multifocality, and extra-thyroidal invasion of papillary thyroid cancer compared with the CC genotype. VDR gene FokI T allele and TT genotype correlated with aggressiveness of papillary thyroid cancer; thus, FokI could be useful as a poor prognostic factor to assess the high risk of papillary thyroid cancer. © The Author(s) 2018
Relationship between Thyroid Volume and Baseline Vitamin D Levels in New-Onset Graves Disease
Get PDFObjective: Serum vitamin D is shown to be decreased and associated with higher thyroid volumes in Graves disease (GD). We aimed to investigate the relationship between thyroid volume and baseline serum vitamin D status in newly diagnosed GD patients.
Methods: This was a single-center cross-sectional study with a total of 61 new-onset GD patients (n=61, F: 40, M: 21) who were divided into two groups, according to baseline serum vitamin D levels, as Group-1 (vitamin D <20; n: 42) and Group-2 (vitamin D =20; n=19). Thyroid volume (mL) and isthmus measurements (mm) were compared between the two groups.
Results: There was an inverse correlation between the baseline serum vitamin D levels and thyroid volume, thyroid receptor autoantibodies (TRAb), free triiodothyronine (fT3), and parathyroid hormone (PTH) levels (p=0.02, r=-0.31; p=0.005, r=-0.36; p=0.04, r=-0.26; p=0.02, r=-0.32, respectively). Thyroid volume was also correlated with serum free thyroxine (fT4), fT3, TRAb, and thyroid peroxidase autoantibodies (TPOAb; p=0.001, r=0.426; p=0.001, r=0.50; p=0.04, r=0.26; p=0.001, r=0.42, respectively). Low vitamin D and high thyroglobulin antibody (TgAb) levels were significantly associated with thyroid volume based on a regression analysis (p=0.03, odds ratio [OR]: 18.7, 95% confidence interval [CI]: 1.34-260.91 and p=0.04, OR: 16.6, 95% CI: 1.07-255.64, respectively).
Conclusion: Baseline serum vitamin D levels are inversely related with thyroid volumes, fT3, and TRAb levels in new-onset GD. In addition to several advantages, optimization of vitamin D levels would also be beneficial in the surveillance of these patients. However, larger scale studies are required to make further suggestions
A Rare Case of the Urinary Bladder: Small Cell Carcinoma
Get PDFSmall cell carcinoma generally originates from the lungs. However, rarely, it could be observed in organs other than the lungs. Primary small cell carcinoma of the bladder is a rare and aggressive disease and it generally presents itself with metastasis. Although there has not been a consensus on the method of treatment for this rare disease, multimodal treatment is recommended. In this study, we present long-term results of transurethral resection in a patient with non-muscle-invasive primary small cell carcinoma who refused additional treatments
The Role of Diagnostic Approaches to Determine the Treatment
Get PDFThe diagnosis of dermatological diseases requires cytological, dermatoscopic, histopathological examinations, some laboratory tests, and radiology imaging in addition to clinical examination. However, these tests are quite important, not only in time of diagnosis, but also in patient follow ups and determining the therapeutic approach. In this article, the diagnostic tests are reviewed that may help to dermatologists in detecting the treatment of dermatological diseases
Examination of humor styles and mental health status of health services students in vocational schools
Get PDFObjectives: The aim of the study is to determine the humor styles and general mental health of health services students in a vocational school in Turkey.
Methods: This descriptive study was conducted in Turkey in 2013. A total of 354 of health services students from vocational schools agreed to participate in the study. Data were collected from students using a descriptive form, a humor styles questionnaire and a General Health Questionnaire (GHQ 12). Data were analyzed using SPSS 17.0. Descriptive and Pearson tests were used to analyze the study data.
Results: Students' mean ages was 21.01 +/- 2.26, most participants were women (64.5%), of a moderate socio-economic status (61.9%) and non-smokers (63.8%). The students mean scores for the humor sub-scales are as follows: Affiliative humor 39.63 +/- 8.18, self-enhancing humor 33.64 +/- 9,44, aggressive humor 23.29 +/- 7.67 and self-defecting humor 26.51 +/- 7.87. Most of the students' GHQ scores suggested that participants were at risk of having a mental health disorder (20.6%), while 27.1%were found to be at high risk of having a mental health disorder. A low negative significant correlation between the students self-enhancing humor and general health risk was found.
Conclusion: The study found that students have positive humor styles. Nearly half of the student partisans were found to be at a low risk regarding the development of psychiatric disorders
Scoring systems in prediciting mortality rate of patients applying emergency department
Get PDFObjective: To compare the scoring systems used in intensive care units in terms of predicting the mortality in emergency patients and to determine the most appropriate scoring system for urgent care. Methods: This study was carried out by retrospectively reviewing the files of patients admitted to Ankara Numune Training and Research Hospital emergency medicine clinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admitted to any service of the hospital. This study calculated automatically with the data obtained from the patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHE.), Simplified Acute Physiology Score (SAPS.), Modified Early Warning Score (MEW) and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files were reviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded. The obtained data were entered in SPSS 18 and compared with the scores of APACHE., SAPS., MEW and SOFA. Results: Based on area under the curve analysis, APACE. (0.799; 95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting the patients mortality. However, there was no difference between four scoring system in terms of predicting the mortality. Age (P<0.001, odd's ratio 1.055) pulse (P<0.007, odd's ratio 1.025) and SO2 (P<0.003, odd's ratio 0.952) variables were found to be independent risk factors for mortality. Conclusions: Scores such as APACHE., SAPS., and SOFA, can not be used to make an urgent decision on the first encounter with the patient even though they are successful in predicting mortality. In this case, MEW could be recommended as the most useful system. As a result, the use of scoring systems in emergency departments is useful and necessary. But, multi-centered and large patient group studies are needed
The effect of cold stress on right ventricular function in patients with systemic sclerosis
Get PDFObjective: Pulmonary hypertension and right heart failure are poor prognostic factors in systemic sclerosis (SSc). The effect of cold stress on pulmonary vasospasm was evaluated in some trials but the results were conflicting. The aim of our study was to determine the effect of cold stress on right ventricular (RV) function.
Materials and Methods: Twenty-four patients with SSc and 24 age and sex-matched healthy controls were enrolled in the study. Transthoracic echocardiography (TIE) was performed to all patients at rest and after peripheral cold exposure. Baseline and after cold stress test TIE results were compared between the groups.
Results: Cold exposure induced changes in particularly right venticular function. Pulmonary acceleration time was significantly shortened in the SSc group (118.8 +/- 11.7ms vs 111.3 +/- 13.7ms, P<0.001). Tricuspid annular plane systolic excurison and RV fractional area change were also decreased after cold exposure in the SSc group. (23.3 +/- 1.6mm vs 21.9 +/- 1.9 mm, P<0.001; 46.3 +/- 5.8 vs 44.4 +/- 5.8,P= 0.007, consecutively). Left ventricular (LV) function did not change after cold stress (LV myocardial performance index (0.42 +/- 0.04 vs 0.42 +/- 0.05), P=0.748).
Conclusion: Peripheral cold exposure caused a reduction in right ventricular function indicating pulmonary Raynaud's phenomenon as a possible contributing factor
Bilateral synchronous ovarian tumours: an uncommon case and review of the literature
No full textSynchronous ovarian tumours are rare. Management of these patients can differ from that of patients with uniform tumours. We present a case of synchronous epithelial ovarian cancer and malignant mixed Mullerian tumour in different ovaries, its follow-up and management until death. To our knowledge this is the second case in the English literature to date.
A 61-year-old woman with bilateral adnexal masses underwent complete debulking surgery for ovarian cancer. The final pathology was reported as malignant mixed Mullerian tumour in the right ovary with intact borders and stage 2 grade 3 serous carcinoma in the left ovary. She had a 17-month disease-free interval after 6 cycles of paclitaxel and carboplatin. Recurrence of malignant mixed Mullerian tumour was reported in the pathology after secondary debulking including a partial ileal resection. After 6 cycles of gemcitabine and cisplatin she had a widespread recurrence in the thorax and abdomen. The patient died of disease recurrence at the 25th month after diagnosis.
Coexistence of serous and malignant mixed Mullerian tumour in different ovaries is very rare. The main treatment is complete cytoreduction followed with chemotherapy. Platinum-taxane based chemotherapy resulted in an acceptable disease-free interval in our case, but it is not standard yet. A management protocol may be developed with the increasing number of similar cases in the literature