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Aim: To demonstrate the prognostic importance of glucose-to-lymphocyte ratio (GLR) and uric acid (UA) in patients with metastatic breast cancer (MBC) receiving Cdk 4/6 inhibitors. Materials & methods: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, GLR, UA and CA15-3 were analyzed to assess their prognostic value using Kaplan–Meier curves and Cox regression analysis in 101 patients with MBC, retrospectively. Results: Importantly, both progression-free survival and overall survival were shorter in the group with high neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), GLR and UA. In the multivariate analysis, GLR and UA levels were independent prognostic factors for both progression-free survival and overall survival. Conclusion: In patients with MBC, GLR and UA are independent factors that predict survival times.

Objective: Chemotherapy induced alopecia (CIA) is one of the most common side effects in cancer patients, however; it doesn’t have an effective pharmacological treatment yet. In this study we aimed to research the protective effect of HDDPiW-jSB solution on docetaxel (DTX) -induced rat alopecia model. Material and Methods: Docetaxel (10 mg/kg/week) was administered to the 6-8 months old rats for three weeks. HDDPiW-jSB solution was applied once or twice a week for 4 weeks beginning prior to one week before DTX. Rat hair follicles were evaluated with hematoxylin-eosin and immune-histochemical staining. Results: In the first stage of this study, alopecia was successfully developed by DTX application. In the second stage, application of HDDPiW-jSB solution without DTX, didn’t change the study parameters significantly. In DTX-induced alopecic rat groups’ skin samples, the solution ameliorated the anagen hair follicle count and Bcl-2 values, especially when used as twice a week. Additionally, level of Caspase 3 was decreased. HDDPiW-jSB solution was safe when applied on the skin. Conclusion: Topical HDDPiW-jSB solution could be effective and safe for the protection of DTX-induced alopecia in rat models.

To evaluate the utility of inflammatory prognostic index (IPI), albumin, c-reactive protein (CRP), and lactate dehydrogenase (LDH) as predictive biomarkers of oncologic outcome in metastatic renal cell cancer (mRCC) patients treated with nivolumab.Descriptive study.Manisa Celal Bayar University, Aydın Adnan Menderes University, Bitlis Tatvan State Hospital and Private Hatay Defne Hospital Medical Oncology Clinics, Turkey, from January 2017 to June 2020.Seventy-five mRCC patients treated with nivolumab between January 2017 and June 2020 were enrolled. Several factors were retrospectively investigated, including IPI, CRP, LDH, and albumin level, for their association with progression-free survival (PFS) and overall survival (OS). The IPI was calculated as CRP × NLR/albumin. Univariate and multivariate analyses were performed to assess the prognostic value of relevant factors.When analysed according to the calculated IPI score, it is seen that the group with2.153 has an OS duration of 96.3 months, while the group with ≥2.153 has a shorter time of 42.9 months (p=0.02). In the analysis performed according to albumin level, it was reported that those with low levels (22.8 months) had worse median OS than those with high levels (92.8 months) (p=0.004). According to the cox regression analysis results, it was determined that those with a high IPI score significantly increased the risk of death compared to those with a low score (HR:2.4, p=0.023). However, this significance could not be confirmed in the multivariate analysis. It was analysed that those with low albumin levels significantly increased the risk of death compared to both univariate analysis (HR:3.3, p=0.007) and multivariate analysis (HR:4.4, p=0.003).Those with high IPI scores and low albumin levels were associated with worse median OS. However, only the multivariate analysis analysed albumin level as an independent prognostic variable. Prospective and more extensive research is needed to consolidate the potential prognostic power of these markers.Albumin, Immune checkpoint inhibitor, IPI score, Metastatic renal cell carcinoma, Nivolumab, overall survival, Progression-free survival.

Demirci, Buket/0000-0002-3442-5061; AKSUN, SALIHA/0000-0002-7991-1645; Zeybek, Arife/0000-0003-3656-9947 WOS: 000499254600004 PubMed ID: 31798330 Introduction: The mechanism of oxaliplatin (OXA) induced pulmonary toxi-city is not fully understood. Aim of the study: The present study was designed to investigate the pulmonary toxicity of OXA that has been reported in previous studies. Study design: animal experiments. Material and methods: A total of 40 female Wistar rats were divided into 5 groups. In group 1, 5% glucose was injected intra-peritoneally; then the rats were sacrificed on day 14. OXA was administered in groups 2, 3, 4, and 5; then the animals were sacrificed on day 7 in group 2, day 14 in group 3, day 28 in group 4 and day 48 in group 5. The groups were further categorized as short-term administration and long-term administration groups. Furthermore, tissue glutathione peroxidase (GPX) activity was measured in all rats. Results: The mean GPX activities were 0.66 U/mg in the sham group, 0.74 U/mg in the short-term groups, and 0.74 U/mg in the long-term groups. We found that long-term OXA administration causes pulmonary toxicity resulting in increased intra-alveolar/interstitial macrophages and interstitial pneumonia. Similarly, we found reduced and permanent tissue GPX activity in rats that received OXA in higher doses and for a long term. Conclusions: Long-term OXA therapy causes toxic changes in the lung tissue.

Objective: Progression-free and overall survival are better correlated with metabolically active tumor volume (MTV) and total lesion glycolysis (TLG), as compared to the maximum standardized uptake value (SUVmax) in NSCLC patients. In this study, we aimed to evaluate the correlation between the PET-CT parameters and histopathologic tumor regression score in non-small cell lung cancer(NSCLC) patients after treatment with neoadjuvant chemotherapy.(1) Methods: This retrospective study evaluated stage III lung cancer patients who were treated with neoadjuvant chemotherapy followed by surgical resection at a single institution between 2014 and 2018. The 3-dimensional volumes of interest were drawn in primary tumor and largest lymph node on the pretreatment examination and corresponding location on the post-treatment examination to obtain a pre- and post-treatment SUVmax, SUVmean, MTV and TLG. All hematoxylin- and eosin-stained surgery specimens were assessed based on a 4-tiered scale. Results: Patients who had lower than 10% histologic response established higher values of SUVmax, in tumor as compared to good responders in basal PET CT assessment (p:0.014). Patients who established higher than 10% pathologic response showed higher reduction rates in terms of SUVmax (p:0.002), mean tumor volume (p:0.024), and total lesion glycolysis (p:0.009). The overall survival for patients with

Nodal (N) status and molecular subtypes are well-known prognostic factors for breast cancer patients. The aim of the present study was to evaluate whether there was a prognostic role of molecular subtypes for pN3a breast cancer patients in the modern therapeutic era. The present study retrospectively evaluated a total of 521 breast cancer patients who had 10 or more metastatic lymph nodes and received adjuvant systemic therapy at the Oncology Department of four different centers in Turkey between 2000–2015. Patients were divided into four molecular subtypes by immunohistochemical staining. There were no significant differences in relapse rates according to the molecular subtypes (P=0.07). The five year disease free survival rate was 62% for the whole study population, 67% for Luminal A tumors, 53% for Luminal B tumors, 64% for human epidermal growth factor receptor 2-positive tumors and 56% for triple negative tumors. Luminal A patients had a better progression free survival when compared with Luminal B (P=0.026) and triple negative (P=0.07) patients. pT stage (P

Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913–2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15–iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840–841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words “cancer” and “oncologist” meant for the students. The participant students were analyzed in two study groups; “group 1” (n = 1.255) were phases I and II students that had never attended an oncology lesson, and “group 2” (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p < 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of “death” (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students’ understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country. © 2018, American Association for Cancer Education.

Objectives: In this study, we investigated whether mean thrombocyte volume (MPV) and MPV/platelet count ratio have a prognostic significance in advanced NSCLC or not Methods:A total of 496 NSCLC patients at stage IIIB/IV and did not meet exclusion criteria were included in the study. The demographic fetaures (age, gender, smoking habit), clinical characteristics (performance status, weight loss, disease stage, first-line treatment regimen), laboratory tests (levels of hemoglobin, lactate dehydrogenase and calcium as well as MPV, MPV/platelet count ratio and counts of white blood cell, platelet), and histological features (histologic type, tumor grade) were recorded. Results:The MPV levels of all patients were determined as 10.2 {plus minus} 3.4 (range, 6.4-14.1 fL). With ROC curve analysis, the MPV/PC ratio was associated with a sensitivity of 67.8% and a specificity of 84.8% at a cutoff value of 0.47424 for presence of brain metastasis at the time of diagnosis. Univariate analysis showed that OS was significantly shorter in the group with an increased MPV level than in the other group (median OS time 6.8 months vs. 11.5 months, log-rank, P=0.032). Multivariate analysis confirmed that an increased MPV level was an independent poor prognostic factor for OS (HR: 1.704, 95% CI: 1.274 - 3.415, P=0.014). Conclusions: Unlike results of previous studies, the study showed that increased MPV was an important prognostic factor in patients with NSCLC. Hence, an increased MPV level may be used as a prognostic biomarker to estimate for poor overall survival in patients with NSCLC. This article is protected by copyright. All rights reserved.

Objectives: The aim of this study was to analyze high risk breast cancer patients with involvement of five or more axillary lymph nodes with an overall survival of at least five years, and to determine the predictive and prognostic factors by comparing patients by recurrence/metastases status retrospectively. Methods: From a total of 500 patients those were followed up in Adnan Menderes University, Medical Oncology department, 37 were eligible for the study; 23 were disease free and 14 had recurrence/metastases in the follow up period. The patients were analyzed, for demographical (such as age, menopausal status, obesity), anatomical and histological characteristics of tumor (primary tumor’s diameter, stage, grade, Ki-67, hormon receptors and Her-2 status), treatment modalities and prognosis. Results: Both number of metastatic lymph nodes and (metastatic/sampled) lymph node ratio were not significantly different between the recurrence-free and metastatic patients. In the recurrence-free patients both grade 3 (48% vs none, p = 0.03) and p53 negative tumors (64% vs 36%, p = 0.036) were significantly more than metastatic patients. Also in the recurrence free patients as compared to metastatic patients, adjuvant chemotherapy was applied more than 6 cycles (87% vs 43%, p = 0.004), the regimens included more taxane based regimens (91% vs 64%, p = 0.042), aromatase inhibitors were used higher (100% vs 75%, p = 0.019) and the period of tamoxifen treatment in switch regimens were shorter. Conclusion: The results of this study suggested that, high risk breast cancer patients with involvement of five and more nodes that have the predictive factors as grade 3 and/or p53 negative tumors are propably more responsive to adjuvant treatments. Chemotherapy of more than 6 cycles, administering taxane based regimens and aromatase inhibitors in the adjuvant regimens may favourably effect the prognosis.

WOS: 000336834500036, PubMed ID: 24815463, Background: Unlike for fit elderly metastatic colorectal cancer (mCRC) patients, general approaches to initial treatment for the frail older mCRC patients are not clear. Our aim was to evaluate the efficiency and safety of first-line single-agent treatment in one such group. Materials and Methods: We retrospectively evaluated mCRC patients aged 70 or older with an Eastern Cooperative Oncology Group performance score of 2. They had no prior treatment and underwent first-line single-agent capecitabine or other monotherapies until disease progression or unacceptable toxicity. Results: Thirty-six patients were included. Most (n:28, 77.8%) were treated with capecitabine. One patient achieved a complete response and 5 patients had a partial response for an overall response rate of 16.6%. Twelve patients (33.3%) remained stable. Median progression free survival was 5 months (confidence interval (CI), %; 3.59-6.40) and median overall survival was 10 months (95 CI%; 8.1-11.8). Grade 3-4 toxicity was found in 6 patients (16.6%). Febrile neutropenia was not observed and there were no toxicity-associated deaths. Conclusions: Capecitabine is a safe chemotherapeutic agent with moderate activity for first-line treatment of older metastatic colorectal cancer patients with limited performance status.

Background: The clinical course of the neoplasm may vary due to both patient and tumor cell characteristics. Aim: The aim of this study was to research the influence of certain clinical and pathological features on the prognosis of early stage breast cancer. Materials and Methods: This study included 117 women that were treated and followed-up in between the years 2001-2011. The demographic, clinical and histopathological features of the cases were reviewed retrospectively. Statistical analysis: In categorical comparisons between groups, cross-tab statistics were provided and significance levels were estimated using chi-square test. Cox regression analysis, Pearson and Spearman correlation tests, and the Kaplan-Meier test were also used. Results: With an average of 35-months follow-up, the mean disease-free survival of patients was 91 months and the mean overall survival time was 132 months. In the whole study group, the disease-free survival rates were 88, 84, 83 and 52%, while the overall survival rates 95, 94, 83, and 83% within the first, third, fifth and tenth years, respectively. The diseasefree and overall survival rates were decreased with increasing tumor grades, though this was not statistically significant. The presence of lymphovascular invasion, positive staining with Ki67 and postmenopausal status were associated with shorter disease-free and overall survival times. In multivariate analysis, only age and Her2/ neu receptor status influenced the prognosis significantly. Conclusions: In parallel to clinical, histopathological, and immunohistochemical prognostic features in breast cancer, in this study positive Her2/neu receptor status, a previously accepted poor prognostic factor, was found to have positive influence after trastuzumab treatment.

Skin metastasis of primary gallbladder tumors is extremely rare with a reported incidence of 0.7~9% and it usually involves the thorax, abdomen, the extremities, neck, head region, and scalp. Cutaneous metastasis may occur synchronously or metatochronously. In the present case, the patient had chronic lymphocytic leukemia, which was being treated with an alkylating agent (chlorambucil) when the patient developed skin metastasis from gallbladder adenocarcinoma during post- cholecystectomy follow-up. Given the fact that secondary malignancies occur in chronic lymphocytic leukemia; this clinical setting warrants attention. We aimed to discuss secondary malignancy in chronic lymphocytic leukemia patients and gallbladder adenocarcinoma with skin metastasis, based on a review of the literature and the presented case.

Cisplatin (CDDP) is one of the most commonly used antineoplastic agents in current clinical practice. The major toxicities of CDDP are nonhaematological as nephrotoxicity and ototoxicity. Free oxygen radicals are known to play major role in CDDP-induced acute renal failure in rats. α-tocopherol is one of the well-known antioxidant agents. This study was designed to investigate the role of α-tocopherol pretreatment against CDDP-induced lipid peroxidation in rat kidney. Male Wistar rats were divided into three groups and treated as follows: control (saline intraperitoneally), CDDP (10 kg/kg, intraperitoneally), α-tocopherol (200 kg/kg, plus CDDP, intraperitoneally). Rats were sacrificed on third day of the treatment, and kidney tissues were obtained and analyzed. CDDP-treated rats showed high malondialdehyde (MDA) levels (p0.05). In the CDDP plus α-tocopherol group, renal MDA levels were not significantly different from the controls. These data suggest that α-tocopherol may be used to prevent CDDP-induced lipid peroxidation.Sisplatin (CDDP) günlük klinik pratikte en çok kullanılan anti-neoplastik ajanlardandır. CDDP’nin en önemli toksisiteleri, nefrotoksisite ve ototoksisitedir. Sıçanlarda CDDP’ye bağlı, akut renal yetmezlikte serbest oksijen radikallerinin önemli rol oynadığı bilinmektedir. α-tokoferol iyi bilinen antioksidan ajanlardandır. Bu çalışma α-tokoferolün sıçan böbreğinde CDDP’ye bağlı lipid peroksidasyonu önlemedeki rolünü araştırmak için yapılmıştır. Erkek Wistar sıçanları 3 gruba bölünmüştür. 1. kontrol (periton için salin), 2. CDDP (periton için10 mg/kg), 3. α-tokoferol (200 mg/kg) + CDDP, periton içi. Tedavinin üçüncü günü sıçan böbrek dokuları incelenmiştir. CDDP verilen sıçanlarda malonildialdehid (MDA) düzeyleri yüksek bulunmuştur (p0.05). CDDP artı α-tokoferol alan sıçanlarda ise kontrol grubuna göre fark saptanmamıştır. Bu sonuçlar α-tokoferolün CDDP’ye bağlı lipid peroksidasyonu önlemede kullanılabileceğini göstermektedir.

Lung cancer rarely involves the peritoneum without involvement of other metastatic sites. The most common regions of metastasis are the pleura, lung parenchyma, skeletal system, liver, brain, and adrenal glands. Compared with pleural metastasis, peritoneal involvement is rarely encountered in lung carcinoma. Ascites development is often described during late stages of the disease, following diagnosis in patients with serosal involvement other than pleural metastases. Diagnosis is based on histopathological or cytological examination confirmed by the presence of malign cells in the peritoneal fluids. Metastatic involvement of other areas is common and expected in cancer patients in whom peritoneal metastasis develop. There are no pulished reports of lung cancer cases with involvement of only the peritoneum without metastases to other more common regions. Herein we present a rare case of non-small cell lung carcinoma involving the peritoneum. The presented case had an unusual course and relapsed with peritoneal carcinomatosis without involvement of other regions.

Gastrointestinal stromal tumours (GISTs) account for 0.1-3% of all gastrointestinal cancers. Although nausea, emesis, abdominal pain, GIS haemorrhage, and non-specific symptoms associated with metastatic disease are common, asymptomatic cases are not rare. They are located in the stomach in approximately 60-70% of cases, and in the small intestine in 20-30% of cases. Gastrointestinal stromal tumours can be seen synchronously or metachronously with other epithelial cancers. The co-occurrence of colon adenocarcinomas and GISTs in the small intestine is not common. The genetic pathways in the tumourigenesis of two different neoplasms (GIST and colorectal adenocarcinoma) being different was suggested as a probable cause; however; although the number of cases is limited, some researchers have reported that they could not rule out the possibility that this association is not coincidental. Herein we present a patient who was concomitantly diagnosed with a GIST as a result of an ileal lesion biopsy performed during surgery for colon adenocarcinoma.

Background The protective effects of topical mitomycin-C (MMC) have been well documented for tracheal stenosis; however, to the best of our knowledge, the use of heparin as an anti-inflammatory agent to support wound healing in upper airway surgery was not studied before. The aim of this study was to investigate the efficacy of topical heparin for healing of tracheal re-implants in a rabbit's model and its resultant histological changes compared with that of MMC. Methods In a rabbit model ( n = 21), an elliptically shaped portion of the anterior tracheal wall was excised (3–4 tracheal cartilages) under anesthesia and immersed in an isotonic saline solution containing 0.4 mg/mL (0.04%) MMC ( n = 7), heparin (liquemine) 5000 U/mL ( n = 7), or none ( n = 7) for 2 min and then re-implanted. The follow-up period was 2 wk for all animals and then both the larynx and the trachea were excised for histological evaluation. Hematoxylin-eosin (H and E) staining was applied to the excised tissues for microscopic evaluation. Results Compared with controls, the granulation tissue formation score in MMC group ( P = 0.03), and epithelial regeneration and inflammation scores in heparin group ( P = 0.032 and P = 0.022, respectively) were more favorable. The fibrosis index and tracheal lumen ratio values were also more favorable in both MMC ( P = 0.019 and P = 0.0028, respectively) and heparin ( P = 0.023 and P = 0.0021, respectively) groups compared with controls on the 15th d. Conclusions Topical heparin application may have favorable effects on healing of tracheal autografts in a rabbit model. We suggest that heparin therapy should be further researched for the prevention of tracheal stenosis in airway surgery.

The aim of the present study was to examine the frequency and genetic diversity of Blastocystis in cancer patients of a Medical Oncology Department in Aydin, Turkey. Patients' stool samples were examined between January 2013 and February 2014 by both microscopy and culture methods. Culture positive samples were subjected to DNA isolation and Sequence Tagged Site (STS)-PCR analysis. Possible etiological factors and clinical features of Blastocystis infection were also analyzed and compared between Blastocystis infected and non-infected subgroups. Blastocystis was detected in 15 (6.5%) of 232 stool samples by microscopy and in 25 (10.8%) by culture methods. Out of 25 culture positive isolates, the most prevalent subtype was ST3 (59%), followed by ST1 (23%) and ST2 (18%). Blastocystis frequency was higher in the male patients than the females (19% vs. 6.5%, p

Diminished oestrogen receptor (ER) expression in the involved axillary lymph nodes (ALN) in breast cancer compared with the primary tumour has been reported in previous studies. We have assessed a wider spectrum of tumour markers (ER, progesterone receptor (PgR), p53, Ki-67 and HER-2/neu) and compared extent and staining intensities at the primary tumour and the involved ALN on specimens of 22 cases with invasive ductal breast cancer. At the involved ALN, both the quantity of positive staining cells and the staining intensities for ER and PgR were decreased (p 0.05). This study suggested that ALN metastasis might indicate a more unfavourable expression pattern of ER, PgR and Ki-67 in invasive ductal breast cancer.

Summary Background: Although 5-fluorouracil (5-FU)-related cardiotoxicity is well known, atrial arrhythmia, as a potentially serious complication has not been studied in detail. The aim of this study was to determine the P max and Pd in the electrocardiograms (ECG) of patients receiving 5-FU treatment. Methods: Twenty-five patients (mean age: 62 years) receiving a 5-FU bolus plus continuous infusion with calcium leucovorin over 48 h and with normal pre-treatment cardiac physical examinations, ECG and echocardiography were enrolled. P maximum (P max), P minimum (P min) and P dispersion (Pd) (maximum minus minimum P wave duration) were measured from the 12-lead ECG at the 0th and 48th hour of the first chemotherapy cycle. Echocardiography was also obtained in all patients at the same times. Results: Clinical cardiotoxicity was observed in two patients. P max and Pd were both significantly longer after 5-FU treatment at the 48th hour (P 0·05). Conclusion: Treatment with 5-FU based regimens may increase Pd and prolong the P max in cancer patients. These alterations may be predictive of patients at risk of atrial arrhythmias during 5-FU treatment.

Background: The pathophysiology of 5-fluorouracil (5-FU) cardiotoxicity is still controversial. The objective of this study was to assess the influence of high-dose leucovorin and infusional 5-FU regimen (HDLV5FU) on cardiac tissues. Methods: We monitored 28 patients (median age 68 years) under HDLV5FU chemotherapy with complete blood counts, cardiac enzymes, C-reactive protein, coagulation tests, Holter electrocardiogram, and conventional echocardiography. Cardiac ultrasonic tissue characterization with integrated backscatter (IBS) analysis was performed in the 16 last enrolled patients. Results: The magnitude of both anterior and posterior cardiac IBS values significantly decreased at the 48th hour of treatment compared to both 0th hour and day 15 (p < 0.003). Cardiac IBS values on the 15th day were not different from the 0th hour. Clinical cardiotoxicity was not observed and other monitored parameters did not change significantly in any patient (p > 0.5 for all). Conclusion: Cardiac IBS analysis suggests that 5-FU might cause reversible subclinical myocardial dysfunction.

Diabetes mellitus (DM) and urinary stone disease (USD) are common diseases in the community. The prevalence of USD has not previously been studied in DM patients.We evaluated 286 diabetics and 111 age-matched controls by means of direct urinary system X-ray, ultrasonography and/or intravenous pyelography. We also examined the history, risk factors and clinical aspects of USD in DM patients.The prevalence of USD (21% vs 8%; p0.05) and the rate of recurrence (2.1 +/- 2.2 vs 1.3 +/- 0.5 stones/case; p0.05) were higher in the diabetics compared to the controls. Family history and male gender were significant risk factors for the development of USD in the DM patients. Increased daily total fluid consumption was not preventive for USD in the DM patients, and the type of fluid consumed did not have an impact on the risk of USD. Alcohol consumption was a significant risk factor for the development USD in the DM patients (odds ratio 3.68; 95% confidence interval 1.29-10.45; p0.05). Crystaluria (10% vs 1%; p0.05) and positive urine culture (8% vs 1%; p0.05) were also more prominent in the diabetics compared to the controls.The results of this study suggest that DM is a risk factor for the development USD.

A 42-year-old woman with locally advanced breast cancer developed headache just after completing adjuvant chemotherapy. Magnetic resonance imaging revealed a mass located in the left subthalamic nucleus (STN) and involving the posterior part of the thalamus and the hypothalamus. The patient refused a radiologically guided biopsy and gamma knife treatment was not financially possible. Palliative whole brain radiotherapy with hormonal therapy was administered. The patient gained 19 kg body weight during 4 months follow up because of hyperphagia. This solitary tumor, either a breast cancer metastasis or a primary tumor, involving the STN is extremely unusual.

Subacute sensory neuronopathy is a paraneoplastic syndrome, which occurs mostly in lung, breast, ovarian malignancies and lymphoma. A 75-yr-old woman who was at the twentieth month of her postoperative follow-up owing to colon adenocarcinoma admitted with subacute sensory neuronopathy. Six months later from the first, neuropathic symptoms liver metastases developed. To the best of our literature review subacute sensory neuronopathy as a preceding sign of recurrence in colon adenocarcinoma has not previously been reported. We conclude that, in the case of subacute sensory neuronopathy without an obvious underlying etiological factor, an occult malignity should always be researched in clinical practice.

Insulinoma is a rare islet cell tumor with typical clinical and biochemical characteristics caused by excessive insulin secretion. The malignant form is characterized by metastases for which a curative resection is rarely possible. Chemotherapy is usually ineffective. We achieved control of serum glucose levels with fluocortolone in a patient with malignant insulinoma and hypoglycemia. We then administered high dose folinic acid and 5-fluorouracil (5-FU) bolus, then 5-FU by continuous in, fusion for 2 consecutive days every 2 weeks (this method is abbreviated as HDLV5FU). The plasma insulin and C-peptide levels remained unchanged and the neoplasm was stable for 4 months with this therapy. According to the authors' literature review, this is the first malignant insulinoma case treated with both fluocortolone and HDLV5FU. Prospective studies are needed to determine more effective treatment modalities for malignant insulinoma.

This study aimed to determine the predictive value of lower extremity deep vein thrombosis (LE-DVT) on first cancer recurrence in patients with stage III colon cancer. A total of 113 eligible patients with stage III colon cancer were divided into two groups according to whether they had LE-DVT. LE-DVT was detected in 29 (26%) patients. Presence of recurrence with distant metastasis had a significant positive correlation with baseline platelet count, baseline mean platelet volume, and the presence of lower extremity deep vein thrombosis. It was concluded that the relation between disease progression and the presence of LE-DVT in stage III colon cancer is independent of other study variables (P=0.031; OR=4.27; 95% CI 1.89-6.71). We hypothesized that the presence of LE-DVT in patients with stage III colon cancer may predict to early cancer recurrence with distant metastasis.

3p deletion which is frequently associated with solitary tumors and hematological malignancies is a chromosomal abnormality. Recently, Janus kinase-2 (JAK2) V617F mutation has an important role in the diagnosis of myeloproliferative disorders, especially in polycythemia vera (PV). We reported the development of gastric cancer in a 75-year-old patient with PV, 3p 12-14 deletion and JAK2 V617F mutation. PV was diagnosed according to the classification of World Health Organization. JAK2 V617F mutation with polymerase chain reaction and 3p12-14 deletion with cytogenetic examination of the bone marrow were detected. We investigated solitary tumors in the patient using computed tomographies of thorax, neck, ear, nose, and throat. However, they were normal. After 2 years, gastric cancer appeared in the patient. In conclusion, cytogenetic examination may be important in both the development and the diagnosis of hematological malignancies and solitary tumors. So the patients should be followed closely.

Trastuzumab treatment does not prevent intracranial seeding and is largely ineffective for established central nervous system metastasis in HER2 overexpressing breast cancer patients. Combination therapy of lapatinib and capecitabine may be an effective treatment option for brain metastasis of HER2-positive breast cancer. We report a patient with breast cancer overexpressing HER-2 where brain metastases were successfully treated with radiation and a combination of lapatinib and capecitabine.

WOS: 000318564100016, PubMed ID: 23475537, Paraneoplastic cerebellar degeneration is a rare non-metastatic complication of malignancies. It presents with acute or subacute onset of ataxia, dysarthria and intention tremor. Paraneoplastic cerebellar degeneration is most commonly associated with malignancies of the ovary, breast and lung. The anti-Yo (anti-Purkinje cells) antibodies that specifically damage the Purkinje cells of the cerebellum are found in the serum and cerebrospinal fluid. Anti-Yo-related paraneoplastic cerebellar degeneration is most commonly found in women with gynecological and breast cancers, but it is reported in other malignancies. Patients with paraneoplastic syndromes most often present with neurologic symptoms before an underlying cancer is detected. We report a case of anti-Yo-related paraneoplastic cerebellar degeneration associated with pleural malignant mesothelioma in a 51-year-old female patient. She presented to our department with a 2-week history after the last chemotherapy of progressive diziness related to head movement, nausea, vomiting, ataxia and unsteady gait. A western blot assay was negative for anti-Hu, anti-Ri, anti-Ma2, anti-CV2 and anti-amphiphysin paraneoplastic antibody markers but positive for anti-Yo. In conclusion, we report a case of paraneoplastic cerebellar degeneration in a patient with pleural malignant mesothelioma because of the rarity of this neurologic presentation after the diagnosis of malignant mesothelioma and of the association with anti-Yo antibodies.

We investigated the long-term effect of trastuzumab, a monoclonal antibody against the Her2 signalling pathway, on QT dispersion in female patients with early-stage breast cancer. A total of 46 eligible patients with early-stage breast cancer were divided into two groups according to whether they were treated with trastuzumab: Group 1 (n = 32, patients with Her2-positive tumours who were treated with trastuzumab) and Group 2 (n = 14, patients with Her2-negative tumours who were not treated with trastuzumab). The both groups were compared using QT interval measurements. Patients with breast cancer treated with trastuzumab after an anthracycline-based regimen exhibited a significantly higher QTd than non-treated patients (0.064 ± 0.023 s vs. 0.051 ± 0.016 s, respectively) (P = 0.034). The mean increases in QTd and QTcd for Group 1 patients after paclitaxel–trastuzumab combination treatment (0.021 ± 0.011 and 0.022 ± 0.014 s, respectively) are significantly different than the mean increases in QT and QTcd after an anthracycline-based regimen (0.005 ± 0.003 and 0.006 ± 0.008 s) in the same group (P = 0.0246), compared with initial measurements. It has been concluded that the relationship between increased QTd measurements and trastuzumab treatment for 12 weeks in an adjuvant setting for patients with early-stage breast cancer is independent from other study variables. We suggested that long-term treatment with trastuzumab significantly prolonged the QT interval and increased QTd in patients with breast cancer.

A 53-year-old woman with advanced-stage ovarian cancer experienced extravasation of paclitaxel into the breast tissue as a result of inappropriate needle insertion and/or dislodgement; it came from a central catheter port (CCP) that was found to be intact under radiological examination with contrast material. The breast became tender and oedematous with erythema, and local warming was observed within a few hours. The patient improved in the next few days during nonsteroidal anti-inflammatory medication and close observation, and the breast healed with thickened and darkened skin and central scarring in the 6th month of follow-up. To the best of our knowledge, extravasation into breast tissue is rare in the literature. Extravasation of vesicant drugs from CCP can cause tissue necrosis; it is therefore essential that ports be carefully assessed and used by experienced staff to lessen the likelihood of such an unpleasant complication.

A 63-year-old man presented with a rare metastatic Merkel cell carcinoma (MCC) involving the lumbosacral spine and causing nerve root compression. Magnetic resonance (MR) imaging revealed an extradural soft tissue mass at the L5-S1 levels. The tumor was subtotally removed and chemotherapy was administered, but he died of multiple metastases from the primary epigastric tumor. Lumbosacral metastatic epidural tumor can manifest as lumbar disc disease symptoms, but MR imaging can non-invasively and rapidly reveal the presence of spinal epidural tumor and any extension to the spinal canal. Extradural MCC metastasis in the lumbosacral area should be considered in the differential diagnosis of radicular symptoms caused by disc herniation.

Imatinib mesylate is a drug that has been approved for treatment of advanced gastrointestinal stromal tumors (GISTs) and patients with leukemia such as chronic myeloid or Philadelphia chromosome-positive acute lymphoblastic. Although it has been described only in one patient with testicular hydrocele and gynecomastia in the literature, several cases of male gynecomastia have been reported with the use of imatinib mesylate in chronic myeloid leukemia (GML). Generally, male mastoplasia resolves after discontinuation of imatinib treatment. We report a 73-year-old male with metastatic GISTs who developed gynecomastia and unilateral testicular hydrocele while receiving imatinib mesylate. Nine months after commencing imatinib treatment, gynecomastia and testicular hydrocele were determined. Hormone analyses requested showed serum testosterone levels below and serum estrogen levels above normal limits. During the first month after discontinuing imatinib mesylate treatment, serum testosterone level was normal and there was a partial regression in gynecomastia and testicular hydrocele. To our knowledge, this is the second report of male gynecomastia following imatinib mesylate treatment of a patient with GIST. In conclusion, male patients who are to receive treatment with imatinib mesylate may be monitored for serum testosterone levels and for other reproductive hormone profiles before initiation of the treatment and their breasts may be examined during follow-up visits.

Thrombotic microangiopathy occurs in 5–10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the patient. On day 5 a laparotomy had to be performed because of acute abdomen due to the rupture of a corpus hemorrhagicum follicle of an ovary. Signet ring cell adenocarcinoma stained with cytokeratin 7 and mucicarmine was seen on ovaries and bone marrow, after the pathological examination. The primary site of tumor could not be investigated, because of the patient’s refusal. Although chemotherapy including cis-platinum, infusional 5-flourouracil, and calcium leucovorin were administered in two courses, she died from respiratory failure. In conclusion, malignancy and bone marrow involvement should be considered when associated with leukoerythroblastic picture and TTP.

Background Clear cell renal cell carcinoma (ccRCC) is the most frequently encountered tumor in the adult kidney. Many factors are known to take part in the development and progression of this tumor. Nuclear factor kappa B (NF-κB) is a family of the genes that includes five members acting in events such as inflammation and apoptosis. In this study, the role of NF-κB (p50 subunit) in ccRCC and its relation to angiogenesis and apoptosis were investigated. Methods Formalin-fixed and paraffin embedded tissue blocks from 40 patients with ccRCC were studied. Expressions of NF-κB (p50), VEGF, EGFR, bc1-2 and p53 were detected immunohistochemically. The relationship of NF-κB with these markers and clinicopathological findings were evaluated. Results The expression of NF-κB was detected in 35 (85%), VEGF in 37 (92.5%), EGFR in 38 (95%), bc1-2 in 33 (82.5%) and p53 in 13 (32.5%) of 40 ccRCC patients. Statistical analyses revealed a significant relation between NF-κB expression and VEGF (p = 0.001), EGFR (p = 0.004), bc1-2 (p = 0.010) and p53 (p = 0.037). There was no significant correlation between NF-κB and such parameters as tumor grade, stage, age and sex. Conclusion The results of this study indicated that in ccRCC cases NF-κB was associated with markers of angiogenesis and apoptosis such as VEGF, EGFR, bc1-2 and p53. In addition, the results did not only suggest a close relationship between NF-κB and VEGF, EGFR, bc1-2 and p53 in ccRCC, but also indicate that NF-κB was a potential therapeutic target in the treatment of ccRCC resistant to chemotherapy.

Solid tumors may occur in 3% of the patients with chronic myeloid leukemia (CML). Philadelphia (Ph)-positive CML was diagnosed in a 66-year-old man upon a white blood cell count of 58.1 x 10(9)/L. He had no symptoms and physical findings 3 years after treatment for rectal adenocarcinoma. Imatinib mesylate 400 mg/day was started and white blood cell count was lowered to 5.7 x 10(9)/L in 1 month. The patient had received several chemotherapeutic agents such as 5-fluorouracil, irinotecan, raltitrexed, capecitabine, and oxaliplatin. In the literature, there are two reports on CML after the treatment of colorectal carcinoma. The possibility of a relationship between oxaliplatin and/or irinotecan and CML may not be fully excluded. In conclusion, hematological disorders such as CML may emerge in colorectal carcinoma and whole blood counts should be carefully checked. The possibility of a relationship between CML and the chemotherapeutic agents in colorectal carcinoma should be further evaluated.

Free oxygen radicals and lipid peroxidation are responsible for adriamycin-induced cardiotoxicity. Amifostine is a scavenger of free radicals and may function as a selective cytoprotective agent. The aim of this study was to investigate the effects of amifostine on adriamycin-induced lipid peroxidation and the levels of protective enzymes in the heart. Male Wistar rats were randomly allocated to three groups: pretreated, untreated, and control (n = 10 in each group). Rats were pretreated with an intraperitoneal injection of amifostine (200 mg/kg) 30 min before the injection of adriamycin. The pretreated rats were given an intraperitoneal injection of adriamycin (10 mg/kg) and were sacrificed after 72 h. Likewise, rats received intraperitoneal injection of adriamycin (untreated) or saline (control). The hearts were removed for the analyses of malondialdehyde (MDA), reduced glutathione (GSH) and catalase. MDA levels were increased (p < 0.005) in the heart tissues of untreated rats compared to control, while GSH and catalase levels were decreased (p < 0.05 and p < 0.001, respectively) in untreated animals. In amifostine-preatreated group, MDA levels were lower (p < 0.01), and GSH and catalase levels were higher (p < 0.05 for both) than the untreated group. GSH levels were even higher in the amifostine-pretreated group compared to control (p < 0.01), although catalase levels were significantly lower in the pretreated group (p < 0.05). These results indicate that amifostine decreases adriamycin-induced lipid peroxidation and increases the levels of the protective enzymes in the heart tissue. Therefore, amifostine may ameliorate the adriamycin-induced acute cardiotoxicity.

Background: The incidence of 5-fluorouracil (5-FU)-related cardiotoxicity seems to be dosage and schedule dependent. It was reported as 1.6–3% with earlier bolus regimens whereas this increased up to 7.6–18% with prolonged (4–5 days) infusion regimens. Knowledge of the cardiotoxicity incidence in patients treated with the widely used de Gramont’s regimen (2 days infusional 5-FU) and the long-term follow-up of affected patients is still limited. Methods: We investigated the incidence and clinical characteristics of the cardiotoxicity of de Gramont’s regimen and long-term follow-up of the affected patients. Results: Nine of a total of 231 patients receiving de Gramont’s regimen experienced cardiac events, revealing an overall incidence of 3.9%. Four (2.5%) cases were receiving de Gramont’s regimen only. Cardiac manifestations were acute coronary syndrome (n = 6), congestive heart failure (n = 2) and atrial fibrillation (n = 1). Cardiotoxicity occurred in the first cycle in eight patients, and in the second cycle in one. The median onset day was day 2. Cardiac symptoms occurred mostly at night time (seven patients) and the onset was a few hours after the bolus part of the regimen in four out of seven patients. After the cardiotoxicity, treatments were continued safely without 5-FU. Conclusions: de Gramont’s regimen has a lower incidence of cardiotoxicity compared with more prolonged 5-FU-based infusion regimens. Nevertheless, patients should still be carefully monitored especially in the first cycles and at night time.

BACKGROUND 5-Fluorouracil (5-FU) cardiotoxicity is a well-known clinical phenomenon whose pathophysiology remains controversial. Cyclic variation of integrated backscatter (CVIBS) assesses acoustic properties of myocardium that may reflect both contractility and structural changes. The aim of this study was to evaluate CVIBS alterations in cancer patients under high-dose leucovorin and infusional 5-FU (HDLV5FU) chemotherapy. METHOD We prospectively evaluated 37 cancer patients under HDLV5FU treatment. Transthoracic echocardiography and CVIBS were performed at the 0th, 48th hours, and on day 15 of the first cycle. The parasternal long-axis view was preferred to obtain the image of integrated backscatter and mainly two regions of interest--interventricular septum (IVS) and posterior wall (PW)--were used. RESULTS Clinical cardiotoxicity was observed in two patients. No significant differences were detected in pre- and posttreatment conventional echocardiography evaluations. However, both the IVS (9.3 +/- 1.0 to 8.1 +/- 1.2 dB, P < 0.001) and PW (9.1 +/- 0.7 to 7.8 +/- 0.9 dB, P < 0.001) CVIBS values significantly decreased in all patients. All values were returned to pretreatment levels (9.2 +/- 0.9 dB in the CVIBS-IVS and 8.9 +/- 0.6 dB in CVIBS-PW, respectively) on day 15 after the treatments. CONCLUSION This study suggests that HDLV5FU may cause acute transient alterations in CVIBS values in the absence of clinical symptoms and signs of cardiotoxicity. The clinical value of CVIBS should be further studied in patients receiving 5-FU-based therapy.

Diffuse metastatic visceral calcification is rare in breast cancer. We report on a 57-year-old woman with breast cancer and hypercalcemia who had diffuse metastatic visceral calcifications on lungs, myocardium, stomach, and thyroid on a (99m)Tc-methylene diphosphonate bone scan. Visceral calcifications were completely resolved 6 months after successful anticancer and zoledronic acid treatments. Bone scanning offers a useful diagnostic tool for both identifying visceral calcification and assessing the response to therapy in chemosensitive malignities with hypercalcemia such as breast cancer.