Good Tolerance of Weekly Irinotecan in a Patient with Metastatic Colorectal Cancer on Chronic Hemodialysis

Pharmacokinetic properties of many antineoplastic agents or their metabolites change with organ dysfunction. Unfortunately, chemotherapy doses determined in phase I and II studies in patients with normal hepatic and renal reserves are not usually applicable to those with hepatic and/or renal dysfunction. Considering the high incidence of colorectal adenocarcinoma, it is not unusual for a colorectal cancer patient to be on chronic hemodialysis. We report a patient with metastatic colorectal cancer on chronic hemodialysis who tolerated weekly irinotecan at 50 mg/m2 well without significant toxicity. We briefly discuss therapeutic dose modification in such patients.

Assessment of left ventricular systolic and diastolic dyssynchrony with tissue Doppler echocardiography in patients with heart failure and narrow QRS complex

AIM

Cardiac dyssynchrony is a well known entity in patients with wide QRS complex (>120 ms). Dyssynchrony may also cause ventricular dysfunction in heart failure patients with narrow QRS complexes. In the study, the presence and extent of cardiac dyssynchrony were investigated in patients with heart failure both with narrow and wide QRS complexes using tissue Doppler echocardiography (TDE).

METHODS

Forty-nine patients with heart failure, were included to the study. The first group of 30 patients with a QRS duration of <120 ms (23M; mean age, 64±10.1 years) and the second group consisted of 19 patients with a QRS duration of >120 ms (12M; mean age, 65±11.6 years). In order to examine cardiac synchronization, TDE was performed. Systolic and diastolic intraventricular dyssynchrony and interventricular dyssynchrony were calculated. In order to define systolic and diastolic dyssynchrony, intraventricular delay was accepted as >60 ms, and interventricular delay was accepted as >40 ms.

RESULTS

Left ventricular systolic dyssynchrony was detected in 18 patients (60%) within the narrow QRS group and in 18 patients (94%) within the wide QRS group. Interventricular dyssynchrony was detected in 17 patients (56%) within the narrow QRS group and in 18 patients (94%) within the wide QRS group. For systolic dyssynchrony, correlations existed between intraventricular delay and QRS duration (r=0.48), left ventricular end diastolic diameter (r=0.62), left ventricular end systolic diameter (r=0.61), and EF (r=-0.63). Similarly, correlations existed between interventricular delay and QRS duration (r=0.58), left ventricular end diastolic diameter (r=0.65), left ventricle end systolic diameter (r=0.64), and EF (r=-0.64).

CONCLUSION

The present study suggested that systolic or diastolic dyssynchrony exists despite normal levels of QRS duration.

Single high dose atorvastatin does not ameliorate endothelial function and large arterial stiffness in dyslipidemic patients without atherosclerosis

BACKGROUND

Many studies show that statins have beneficial effects on atherosclerotic risk factors and markers such as flow mediated dilatation (FMD). However, studies on early effects of statins on endothelial function of non atherosclerotic humans are limited.

AIM

The purpose of this study was to determine whether a single high dose of atorvastatin could improve endothelial function and large arterial stiffness in statin naive dyslipidemic non-atherosclerotic patients.

MATERIALS AND METHODS

Thirty statin naïve dyslipidemic non-atherosclerotic patients from Cardiology Outpatient Clinic were enrolled. Arterial stiffness and endothelial function of patients were evaluated by assessing the finger photoplethysmography and the flow-mediated dilatation (FMD) of the brachial artery before and 24 hour after oral administration of 80 mg atorvastatin.

RESULTS

Stiffness indices and FMD 24 hours after administration of 80mg atorvastatin did not differ from baseline measurements (6.89 +/- 1.90 vs. 7.06 +/- 2.37 p : NS and 9.13 +/- 6.07 vs. 9.80 +/- 6.34 p : NS).

CONCLUSIONS

Although it is widely accepted that statins improve endothelial function, evidences of early effect might largely be associated with endothelial injury. Our study suggests that beneficial early effects of statins might not be applicable to patients without atherosclerosis.

Genetic and biochemical differentiation in Vitis vinifera (Kabarcik) populations grown at different altitudes in Coruh Valley

We examined genetic differences of four Vitis vinifera populations (A, B, C, D) including local Kabarcik cultivar grown along an altitude gradient of 800, 900, 1000, and 1150 m above sea level in the Coruh Valley (800 m: A population; 900 m: B population; 1000 m: C population; 1150 m: D population). Leaf samples were used for both RAPD and fatty acid analysis. A total of 60 individuals with 15 individuals per population were included in this study. RAPD analyses showed various band sizes, which ranged from 250 to 3000 bp. Mean polymorphic locus ratios were determined as 96.29% considering four populations. The highest percentage of polymorphic loci (97.8%) was produced by the highest altitude. Thirty-two different fatty acids were found; linoleic acid was the most common in all four populations. According to the dendograms obtained from statistical analyses of RAPD and fatty acid profiles the populations that were close to each other in terms of geographical distance also were similar genetically.

Genetic diversity in wild sweet cherries (Prunus avium) in Turkey revealed by SSR markers

Wild sweet cherry (Prunus avium) trees are abundant in the northern part of Turkey, including the Coruh Valley. We analyzed 18 wild sweet cherry genotypes collected from diverse environments in the upper Coruh Valley in Turkey to determine genetic variation, using 10 SSR primers. These SSR primers generated 46 alleles; the number of alleles per primer ranged from 3 to 7, with a mean of 4.6. The primer PS12A02 gave the highest number of polymorphic bands (N = 7), while CPSCT010, UDAp-401 and UDAp-404 gave the lowest number (N = 3). Seven groups were separated in the dendrogram, although most of the genotypes did not cluster according to phenological and morphological traits. This level of genetic diversity in these wild sweet cherry genotypes is very high and therefore these trees would be useful as breeders for crosses between cultivated sweet cherry and wild genotypes.

Genetic relationships among wild pomegranate (Punica granatum) genotypes from Coruh Valley in Turkey

The pomegranate has been used traditionally in Coruh Valley in Turkey for a long time; fruits are harvested from wild, semi-domesticated and cultivated trees. In the valley, it occurs in general along with olive trees. We sampled 23 wild-grown pomegranate genotypes sampled from different parts of Coruh Valley and compared them using RAPD primers to determine genetic variability. Eighty-six RAPD primers were used for molecular characterizations, among which 12 gave reliable polymorphic patterns. These primers generated 145 RAPD bands of which 91% were polymorphic. The highest polymorphism ratio was observed with primers OPY06, OPY13, OPBA03, OPBB03, OPBB07, and OPBB09 (100%), while the lowest was with OPBB09 and OPBB10 (75%). The band size was between 250 and 2400 bp. There were five main clusters in the dendrogram; the highest genetic similarity was 0.24 and the lowest was 0.08.

Genetic relationships among turnip (Brassica rapa var. rapa) genotypes

Turnip (Brassica rapa var. rapa) is one of the main vegetables consumed by people living in Eastern Anatolia in Turkey. In this region, farmers obtain their own seeds for production, which results in considerable morphological variability. We examined the genetic variation and relationships among 11 turnip genotypes sampled from diverse environments of the Erzurum region located in Eastern Anatolia in Turkey. Thirty-two Operon RAPD primers were screened; among them, 20 gave reproducible and clear DNA fragments after amplification. The average polymorphism ratio was 90.4%. The genetic distance between turnip genotypes were found to range from 0.302 to 0.733, indicating high genetic variability. Eleven genotypes were divided into three main clusters in a dendrogram; ETS2 and ETS8 genotypes were the most distant. We conclude that RAPD analysis would be useful for genotyping turnip genotypes.

Genetic variation among date plum (Diospyros lotus) genotypes in Turkey

Turkey is one of the most important genetic resources of the date plum, Diospyros lotus, especially in the northeastern part of the country. Authenticating the identity of germplasm resources of D. lotus would be of great value for breeding. We examined the genetic variability of 11 D. lotus genotypes sampled from Coruh Valley in Turkey. One hundred and twenty-eight DNA markers were generated by 12 random primers. The highest polymorphism ratio was observed with the primer OPA-01 (71%) while the lowest was with OPY-01 (36%). The band size was between 350 and 2500 bp for these primers. The percentage of polymorphic bands was 58%, which demonstrated the efficiency of these primers. The similarity between genotypes ranged from 0.48 to 0.76. The RAPD markers permitted us to distinguish all the genotypes.

An Evaluation of P Wave Dispersion, QT, Corrected QT and Corrected QT Dispersion Intervals on the Electrocardiograms of Malnourished Adults

The aim of our study was to investigate P wave dispersion (Pwd), QT, corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) intervals in subjects with malnutrition diagnosed in the pre-anaesthetic assessment, compared to those without malnutrition.

A total of 76 adult patients were included. Main diagnoses, anthropometric measurement, body mass index, electrocardiogram and serum sodium, potassium, chloride, magnesium and calcium levels were recorded for all patients. Pwd, QT and QTd intervals were measured on all electrocardiogram records and QTc and QTcd intervals determined with the Bazett formula. Protein-energy malnutrition was diagnosed with the nutritional risk index.

No statistically significant difference was found between the age, gender and malignant cancer diagnosis rates between patients with malnutrition (group M) and those not suffering from malnutrition (group N) (P >0.05). Serum albumin, total protein, potassium, calcium, magnesium and chloride values of group M were found to be significantly lower than group N (P <0.05). In group M, Pwd, QT, QTc, QTd and QTcd intervals were significantly longer than in group N (P <0.001).

Patients diagnosed with malnutrition during pre-anaesthetic assessment had significantly longer Pwd, QTc and QTcd interval durations than the control group. We attribute such extended Pwd, QTc and QTcd durations in these patients to malnutrition and malnutrition-related electrolyte imbalance.

Serum vitamin D status and bone mineral density in fibromyalgia

OBJECTIVES

To compare serum vitamin D levels and bone mineral density (BMD) values in patients with fibromyalgia and healthy controls.

BACKGROUND

The so far available reports of low levels of vitamin D and low BMD values in patients with fibromyalgia are inconsistent.

METHODS

Serum 25-hydroxyvitamin D (25-OHD) levels and BMD values were measured in thirty women with fibromyalgia and compared with thirty age-matched healthy women. Serum calcium, phosphorus, alkaline phosphatase and parathyroid hormone (PTH) levels were also measured. All participants completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Pain severity was assessed with visual analog scale (VAS).

RESULTS

Mean serum 25-OHD levels did not differ between the groups (fibromyalgia 10.57 +/- 10.46, controls 10.87 +/- 5.52 ng/l; p=0.89); nor did the frequency of vitamin D deficiency (25-OHD < or = 20 ng/l) in each group (fibromyalgia 86.7%, controls 96.7%; p=0.353). Although, mean serum PTH level was found significantly higher in fibromyalgic patients than in controls (p=0.014), only one patient and two of controls had barely elevated PTH levels. There was no relationship between vitamin D level and FIQ score (p=0.707) or HADS (p=0.824) or pain VAS (p=0.414). BMD values in the patients with fibromyalgia were comparable to those in controls at both, the lumbar spine (p=0.866) and femur neck (p=0.61).

CONCLUSION

Neither vitamin D levels nor BMD values are different between women with and without fibromyalgia. In this cross-sectional study, mean serum PTH level was found higher in the fibromyalgic patients than in controls. Nevertheless, in order to confirm the findings of this preliminary study it is still necessary to perform a controlled longitudinal study (Tab. 2, Fig. 2, Ref. 35). Full Text in free PDF www.bmj.sk.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Adenoid hypertrophy in adults: clinical and morphological characteristics

This study compared the aetiology and pathological characteristics of adult and childhood adenoid hypertrophy (AH). Clinical and morphological features and accompanying otolaryngological pathologies were recorded in 40 adults and 23 children undergoing adenoidectomy for obstructive AH. Both AH forms were similar in terms of symptomatology and associated inflammations. There were, however, significant differences in otitis media rate, with effusion and dullness, and retraction in the eardrum both more prevalent in childhood AH. Adult AH was associated with nasal septum deviation in 25.0% of patients. Histopathological features of adenoidal lymphoid tissue were dissimilar in the two groups: numerous lymph follicles with prominent germinal centres was the chief finding in childhood adenoids, whereas adult adenoids showed chronic inflammatory cell infiltration and secondary changes (e.g. squamous metaplasia). These results underline the importance of considering AH as a cause or contributing factor in nasal obstruction and related pathologies in adults and supports the theory that it represents a long-standing inflammatory process rather than being a novel clinical entity.

Delayed surgical treatment of traumatic hearing loss due to ossicular disruption

OBJECTIVE

Surgical treatment of dislocation and fracture of the middle ear ossicles is recommended to be carried out within months of the initial injury. Here we present 6 patients with traumatic ossicular injury whose surgery was delayed over 1 year. We evaluated the clinical and pathological changes that occurred over time and assessed the surgical outcomes in delayed cases.

METHODOLOGY

Histories of the causative traumas, computerized tomography (CT) and tympanometry findings, pre- and postoperative hearing thresholds, and ossicular damages assessed at the tympanotomies were evaluated.

RESULTS

The time lapse between the trauma and the surgery varied from 1 to 6 years. The resultant hearing losses were moderate or moderately severe, conductive, mixed or sensorineural type. Tympanometry and CT revealed ossicular discontinuity in only two cases. In operations, various types of ossicular abnormalities in the form of absence, displacement, fracture and/or fixation were identified. Continuity and mobility of the ossicular chains were restored with various techniques. Air-bone conduction gap was brought to within 20 dBHL in all cases, and within 10 dB in 3 (50%) of the cases. Gains in the bone conduction were also notable.

CONCLUSION

Trauma to the middle ear may result in an elevation in the air and/or bone conduction thresholds due to ossicular disruption and fixation. Our findings confirmed that tympanotomy is superior to methods such as CT and tympanometry in delineating the type and extent of the traumatic ossicular damage, and usually gives favorable results even in delayed cases.

Blood Flow Indices by Doppler Ultrasonography Vary with Neoadjuvant Chemotherapy but Are Not Related to Plasma VEGF Levels in Locally Advanced Breast Cancer

OBJECTIVE

The aim of our study was to assess the quantity of blood flow to malignant tissue by color Doppler ultrasonography, its correlation with plasma vascular endothelial growth factor (VEGF) levels and response to neoadjuvant chemotherapy of patients with locally advanced and inflammatory breast carcinoma.

METHODS

We measured blood velocity at peak systole (PSV), end-diastolic velocity and resistivity index [RI = (PSV - end-diastolic velocity)/PSV] by Doppler ultrasonography in primary tumors and/or axillary lymph nodes of patients before and after 2-4 cycles of anthracycline-containing neoadjuvant chemotherapy and basal plasma VEGF levels.

RESULTS

Of 21 patients with a median age of 42 years (range 26-68), 16 (76.2%) were premenopausal. Median basal RI was 0.70 (interquartile range 0.68-0.78) and PSV was 24.2 cm/s (interquartile range 18.7-56.6). The median measured VEGF level was 231.5 pg/ml (interquartile range 187.5-345.5). After 2-4 cycles of chemotherapy, 13 patients (61.9%) had partial remission and 8 (38.1%) were stable. Median basal RI (0.70, interquartile range 0.68-0.78) significantly decreased to 0.66 (interquartile range 0.59-073) after chemotherapy (p = 0.043). There was a trend that the greater the shrinkage of the tumor with chemotherapy, the lower the RI (r = 0.70, p = 0.078).

CONCLUSION

The decrease in RI with chemotherapy, which means increased blood flow at diastole of the cardiac cycle into the tumoral tissue, may be related to decreased intratumoral pressure secondary to tumor shrinkage and may reflect a new type of response, that is vascular response.

Intracranial myeloid sarcoma: conventional and advanced MRI findings

Chloroma (myeloid or granulocytic sarcoma) is a rare type of tumour comprising immature granulocytic cells. It generally accompanies acute myeloid leukaemia and, rarely, other myeloproliferative disorders. When presenting as dural-based mass lesions, radiological differential diagnosis includes meningioma, metastasis and lymphoma. There is a limited number of descriptions of chloromas mimicking dural-based masses in the literature. We present preliminary diffusion-weighted MR, perfusion-weighted MR and MR spectroscopy findings of an intracranial myeloid sarcoma.

Functional MRI in Patients with Intracranial Lesions near Language Areas

We aimed to depict Broca's area and Wernicke's area by word generation and sentence formation paradigms in patients with various intracranial lesions adjacent to language areas using functional MRI technique and to evaluate the ability of functional MRI to lateralize the hemispheric dominance for language. Twenty-three right-handed patients were included in this study. Lesions were classified as low-grade glioma (n=8), high-grade glioma (n=9), metastasis (n=1), meningioma (n=1), arteriovenous malformation (n=2) and mesial temporal sclerosis (n=2). We performed blood-oxygenated-level-dependant functional MRI using a 1.5-T unit. Word generation and sentence formation tasks were used to activate language areas. Language areas were defined as Brodmann 44, 45 (Broca's area) and Brodmann 22 area (Wernicke's area). Laterality index was used to show the dominant hemisphere. Two poorly cooperative patients showed no activation and were excluded from the study. Broca's area was localized in 21 patients (100 %). Wernicke's area, on the other hand, could only be localized in eight of the 21 patients (38 %).The left hemisphere was dominant in 86% of patients while atypical language lateralization (right or bilateral) was demonstrated in 14% of the patients. Bilateral activation areas were shown in 10% of those patients while right cerebral hemisphere was dominant in 4% of the patients. Word generation and sentence formation tasks are especially helpful in localizing Broca's area. Wernicke's area could also be demonstrated in some of the cases. Functional MRI can be used as an important and useful means of demonstrating language areas in patients with lesions adjacent to those areas and depicting the hemispheric dominance.

Morphologic and volumetric analysis of amygdala, hippocampus, fornix and mamillary body with MRI in patients with temporal lobe epilepsy

Our aim was to demonstrate lateralization morphometrically and volumetrically measuring the main limbic structures like hippocampus, amygdala, fornix and mamillary bodies in patients with temporal lobe epilepsy (TLE) and to establish the contribution of each anatomical structure to lateralizing the pathological site. Forty-two patients with complex partial seizures originating from the temporal lobe and 42 control healthy volunteers were included in the study. T2-weighted FSE sequences in axial and oblique coronal planes and T1-weighted SE sequences in the sagittal plane were used. A high-resolution IR sequence was used for the volumetric analysis of amygdala and hippocampus and for the measurement of fornix and mamillary body thickness. Intensity changes and atrophy of limbic structures were observed qualitatively and measurement of these structures was performed quantitatively. Student's t test and Mann-Whitney U-test were used for the statistical analysis. The p values <0.05 was taken as statistically significant. Ten out of 42 patients had intracranial masses and were excluded from the study. Qualitative analysis revealed atrophy in 84% and intensity increase in 60% of cases. Quantitative measurement demonstrated that control cases had a larger hippocampus than the patients ( p<0.001). There was unilateral hippocampal volume loss in 88% and bilateral volume loss in 13% of patients. There was no difference in the volume of amygdala between the groups ( p>0.05). According to the difference in the volumes of the right and left sides, there was unilateral atrophy in 34% of patients. Bilateral atrophy was not observed. There was a significant difference in fornix and mamillary bodies of the patients and control subjects ( p<0.005). In 62.5% of cases, there were abnormalities in the fornix with bilateral involvement in 13% of cases. Mamillary bodies were abnormal in 37% of patients with bilateral involvement in 15%. Lateralization was accomplished in 65% of the patients according to the percentage difference ratios of fornix and in 38% of the patients according to the mamillary bodies. It is important to demonstrate hippocampus atrophy in patients with TLE. In the decision of lateralization of the epileptic side, evaluation of the fornix could be a good and practical solution. However, hippocampal volumetry is an indispensable criterion in demonstrating hippocampal atrophy more accurately. Atrophy of the amygdala and thickness of mamillary bodies have the least importance for lateralization.