A modified DCF regimen as primary treatment for patients with metastatic gastric cancer

PURPOSE

To retrospectively assess the efficacy and toxity of a modified docetaxel, cisplatin, fluorouracil (mDCF) regimen as primary treatment in patients with metastatic gastric cancer (MGC).

METHODS

mDCF included folinic acid 400 mg/m(2) (day 1) + 5-fluorouracil (5-FU) 400 mg/m(2) i.v. bolus (day 1) + 5-FU 2400 mg/m(2) 46-h infusion (days 1 and 2) + docetaxel 60 mg/m(2) (day 1) + cisplatin 50 mg/m(2) (day 1) and was administered once every two weeks in MGC patients.

RESULTS

Eighty-nine patients (median age 59 years, range 31-79) were enrolled. The median number of courses was 6 (range 2-12), and the total number was 492. The median follow-up duration was 8.6 months (range 2-14). Three (3.3%) patients showed complete response, 21 (23.6%) partial response, 36 (40.4%) stable disease, and progression was observed in 29 (32.6%) patients. The median progression- free survival (PFS) rate was 7 months (95% CI 5.7-8.2), and the median overall survival (OS) rate was 11 months (95% CI 9.7-12.2). The most common toxicity was neutropenia, which was observed in 52 (58.4%) patients.

CONCLUSION

mDCF with reduced drug doses, given every two weeks, is a rather efficient regimen for MGC patients.

Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia

Two cases with quadrupedal locomotion (QL) were presented. In both cases, cognitive and psychiatric functions were normal and, no neurological deficits were observed, except for a sequel paralysis of left leg in Case 2. It was suggested that human QL (1) should not be considered as an epiphenomenon caused by neurodevelopmental malformation and ataxia, but (2) may be considered as a re-emergence of the ancestral diagonal QL, and (3) it may spontaneously emerge in humans with entirely normal brains, by taking advantage of neural networks such as central pattern generators that have been preserved for about 400 million years.

Isolated inferior sagittal sinus thrombosis caused by a rare combination of elevated lipoprotein (a) and iron deficiency anemia

A 21-year-old woman was admitted with right hemiparesis, bilateral papilledema, negative myoclonus of right upper extremity, and bilateral pyramidal findings. An MRI showed no venous flow in the inferior sagittal sinus. Lipoprotein a (Lp [a]) level was high and iron deficiency anemia (IDA) was found. The coexistence of IDA and Lp (a) in patients with cerebral venous thrombosis is a very rare condition in adult patients. These risk factors should be investigated in patients with cerebral venous thrombosis.

The effects of exercise on portal venous system in splenectomized adults

OBJECTIVES

This study was designed to assess the effects of exercise on the portal venous system in splenectomized adults.

BACKGROUND

Splenectomy is a surgical intervention commonly performed at surgery clinics and recognized as a cause of portal vein thrombosis. Intensive exercise increases blood flow to the contracting muscles, causes hypercoagulability and vasoconstriction in the splanchnic area, hence the portal vein diameter, blood flow velocity and discharge decrease.

METHODS

Forty adults participated in this investigation. Subjects were trained to run for twenty minutes on a treadmill at a velocity of 6 km/h and ten-degree elevation. We compared the white blood cell count, portal vein diameter, portal venous blood flow velocity and discharge of splenectomized and healthy adults before and after exercise.

RESULTS

After exercise, the blood leukocyte count was significantly increased and the portal vein diameter was significantly reduced in both groups (p<0.001) but there were no statistically significant differences between the two groups. The portal venous blood flow rate in splenectomy group were significantly lower than in the control group (p<0.001). Furthermore the portal venous blood flow rates in both groups were significantly reduced after exercise (p<0.001).

CONCLUSION

Exercise in splenectomized individuals can cause serious problems in form of decreasing splanchnic flow and increasing blood viscosity. After splenectomy, both healthy individuals and patients with hematologic diseases ought to avoid intensive exercises (Tab. 2, Ref. 16).

Lateralized α-motoneuron excitabilities during lying and standing of healthy individuals in relation to parkinsonian rigidity

OBJECTIVES

To elucidate mechanisms of Parkinsonian rigidity by assessing excitability of alpha-motoneurons innervating right and left soleus muscles in healthy controls and Parkinson's disease (PD) patients with rigidities in the right, left and both legs.

METHODS

One group of 45 controls was recruited and 60 PD patients in three groups: rigidities, predominantly in the right, left and both legs. H-reflex (H) and muscle response (M) were recorded from right and left soleus muscles during stimulations of the posterior tibial nerve at the popliteal fossa while lying and standing. The H/M ratio was taken as an index for motoneuron excitability.

RESULTS

Mean H/M ratios were significantly different on the right and left sides, modified by postural changes in controls and PD patients. Analysis of variance showed that in healthy subjects the H/M ratio was: standing>lying (right), lying>standing (left). In right leg rigidity patients, the H/M ratio was greatest during standing, and smallest during lying. In left leg rigidity patients, the H/M ratios on the right and left sides were equally independent of posture. In controls, left H/M>right while lying, <right while standing. In right leg rigidity patients, right H/M>left, but <right in left leg rigidity patients, independent of posture. There was no side difference in patients with rigidity in both legs.

CONCLUSIONS

(i) motoneuron excitability may show side and postural differences in healthy individuals and PD patients; (ii) posture may be associated with lateralized motoneuron excitability in these subjects; and (iii) Parkinsonian rigidity may have spinal motor origins.

[Neurological involvement in brucellosis; clinical classification, treatment and results]

The aim of this retrospective study was to describe and to categorize different clinical pictures of patients with neurobrucellosis in our clinic, and present demographical and laboratory data about the patients. Hospital records of 430 patients with brucellosis between 2003 and 2009, were retrospectively reviewed. Out of 430 patients, 19 (4.4%) had neurobrucellosis. These patients were classified into four groups: Meningitis group (n= 14, 13 cases of subacute/chronic meningitis, one case of acute meningitis), encephalomyelitis group (n= 3, one case of meningoencephalomyelitis, one case of cerebellar abscess and one case of transverse myelitis), polyradicular group (n= 1, Miller-Fisher Syndrome), and others (n= 1, one case of intradural abscess). Ten patients (52.6%) were female, and the mean age of the patients was 48.8 years. About 47.4% of the patients had fever, 26% of the patients had neck stiffness and 5% of the patients were in an unconscious state. Out of 19 patients, 18 underwent lumbar puncture and they had positive brucella antibody test in cerebrospinal fluid (CSF) by standard tube agglutination method. Brucella spp. Were grown in four patient's blood culture and one patient's CSF culture. There were cranial nerve involvement in five cases, the most frequent being the sixth cranial nerve. Out of 19 patients, three recovered with sequela (paraparesis, hearing loss, dementia and sphincter disfunction) and 16 patients recovered completely. Although neurobrucellosis is most frequently presented as subacute/chronic meningitis, it may be associated with different clinical pictures. The classical triad of meningitis (fever, neck stiffness, unconsciousness) is rarely seen in brucellosis-related meningitis. Brucellosis should be kept in mind in patients with unexplained neurological findings particularly in areas where brucellosis is endemic. In addition, a current classification of neurobrucellosis, related to involved location of nervous system, clinical picture and pathogenesis, is needed.

Health-related quality of life of patients with epilepsy in Turkey

The aim of this study was to measure the health related quality of life (HRQOL) of epilepsy patients and to compare it with that of a healthy control group. The evaluation included the effects of the type of seizure, duration of seizure and medical treatment on the quality of life of the patients. The group studied consisted of 221 participants (121 epilepsy patients and 100 healthy control individuals) who completed a sociodemographic data form and who were administered the World Health Organization Quality of Life (WHOQOL-100) scale. The epilepsy patients had statistically lower physical health, psychological well-being, level of independence and global HRQOL than participants in the control group (p<0.05). The analysis of variance showed that the partial epilepsy subgroup had significantly lower averages for all the quality-of-life subfields except for the social relationship dimension. On regression analysis, being married, having a generalized type of seizure and being treated with fewer medications were all related to higher scores on the HRQOL. Epilepsy is a disease that has neurological, psychiatric and psychosocial dimensions that should be evaluated using a multidisciplinary approach.

Use of extracorporeal circulation and selective renal perfusion during the surgical correction of abdominal aortic coarctation

Coarctation of the abdominal aorta is a rare pathology. Stenosis of visceral and renal arteries may present together with coarctation, which requires specific operation techniques. We present the case of a patient with coarctation of the abdominal aorta associated with stenosis of the celiac trunk, the superior mesenteric and the right renal arteries. Distal aortic perfusion by extracorporeal circulation and selective right renal perfusion techniques were used during the operation to protect the spinal cord and kidney against hypoperfusion and ischemia.

Atypical MRI Findings of Synchronous Cerebral Metastasis

Intracranial metastases represent 7% to 17% of all brain tumors. Metastases may appear before, after or synchronously with the primary tumor. Synchronous tumor presentation means that that metastasis is found within two months of primary tumor diagnosis. A 60-year-old man was seen 15 days after the acute onset of confusion and gait disturbance. Results of a neurologic examination revealed disorientation, dysarthria, and left-sided ataxia. Results of nonenhanced computed tomography scanning of the brain were unremarkable. Cerebral magnetic resonance imaging showed multiple miliary, round, small (maximum diameter, 1 cm) lesions located infra- and supratentorially. Gradient-echo magnetic resonance images of these lesions were compatible with hemorrhage and were more pronounced compared with other sequences. Hemorrhagic cerebral metastases were suspected, and the patient was examined for primary tumors. Chest computerized tomography revealed a tumor in the posterior, superior lobe of the right lung; a cervical lymph node biopsy suggested a metastatic carcinoma. Our case illustrates that magnetic resonance imaging findings of synchronous cerebral multiple metastases presenting with neurologic symptoms may be atypical while the results of cerebral computerized tomography are normal. Contrast-enhanced cerebral magnetic resonance imaging, especially gradient-echo magnetic resonance sequences, should always be considered for diagnosing hemorrhagic metastases in patients presenting neurologic findings with a known or unknown cancer.

Rhombencephalosynapsis associated with infantile strabismus

INTRODUCTION

Malformations of the cerebellum have been well-known to coexist with abnormalities of the oculomotor system. Rhombencephalosynapsis (RES) is a rare malformation of the cerebellum of unknown etiology in which the vermis is hypoplastic and the two cerebellar hemispheres are fused. The type of oculomotor disorders associated with RES is not well documented in the literature. Here, two cases are presented. CASE 1: A 15-year-old girl presented with large-angle infantile esotropia and inferior oblique overaction. Slow (3 to 4 cps) rhythmic anteroposterior oscillation movement of the head was observed while walking and left-sided postural tremor was present. CASE 2: An 8-month-old baby girl presented with facial dysmorphism, right esotropia, anisometropia, motor delay and truncal ataxia. Cranial MRI demonstrated RES in both patients.

CONCLUSION

The clinical findings in two children presenting with infantile esotropia and RES may suggest a role of the vermis in ocular alignment. Head nodding in a child with strabismus can be observed only when walking and its presence should prompt neuroimaging.

"Unertan syndrome" in two Turkish families in relation to devolution and emergence of Homo erectus: neurological examination, MRI, and PET scans

"Unertan syndrome" consists of two main symptoms: quadrupedal gait and primitive cognitive abilities including language and conscious experience. To assess the central mechanisms involved in this syndrome, the authors performed MRI and PET scans on affected and unaffected individuals from both families. All affected individuals were also subjected to neurological examination. To assess the integrity of the peripheral and central vestibular system, Barany's caloric test was applied to the affected individuals. Brain MRI and PET scans were performed on normal subjects (n = 7) and patients (n = 7). Right- and left-cerebral and cerebellar areas, including the vermial and callosal areas, were measured on the MRI scans using a computer cursor. Quadrupedal gait, mental retardation, dysartric speech, nystagmus, severe truncal ataxia, hyperreflexia, astasia, and abasia were observed in the affected individuals from both families. Cerebellum and vermis were atrophic in the MRI and PET scans of the first family. In contrast, the brain MRI seemed to be normal in the MRI and PET scans of affected individuals from the second family. The caloric test revealed central vestibular damage in patients from the first family and peripheral vestibular damage in patients from the second family. The results suggest that "Unertan syndrome," discovered in two unrelated families, may be caused by peripheral or central vestibular damage resulting from different genetic defects. Cerebellar hypoplasia may not be a prerequisite for the emergence of this syndrome. Primitive mental abilities may be explained by damage within the vestibulo-cerebellar system, whereas the quadrupedal gait may be due to a genetic defect within the higher brain centers that suppress the atavistic brain networks controlling quadrupedal gait and helped in the emergence of the habitual bipedal gait during human evolution. This retarded development of human locomotion - devolution - may illuminate the brain mechanisms responsible for the transition from quadrupedality to bipedality in human evolution.

Unertan syndrome: a case series demonstrating human devolution

A large family with six individuals exhibiting the Unertan syndrome (UTS) was identified residing in southern Turkey. All of the individuals had mental impairments and walked on all four extremities. The practice of intra-familial marriages suggested that the UTS may be an autosomal recessive disorder, similar to previously described cases. The inferior portions of the cerebellum and vermis were absent as evidenced by MRI and CT scans. The height and head circumference of those affected were within normal ranges. Barany's test suggested normal vestibular system function. The subjects could not name objects or their close relatives. The males (n = 4) could understand simple questions and commands, but answered questions with only one or two sounds. The females (n = 2) were superior to the males with respect to language skills and walking, suggesting an association between walking and speaking abilities. One male exhibited three walking patterns at the same time: quadripedal, tiptoe, and scissor walking. Another male used two walking styles: quadripedal and toe-walking. It is emphasized that there are important differences between the UTS and the disequilibrium syndrome. It is suggested that the inability to walk upright in those affected with the UTS may be best explained by a disturbance in lateral-balance mechanisms, without being related to the cerebello-vestibular system. An interruption of locomotor development during the transition from quadripedality to bipedality may result in habitual walking on all four extremities and is normal in some children. Because quadripedal gait is an ancestral trait, individuals with the UTS, exhibiting a manifestation of reverse evolution in humans, may be considered an experiment of nature, useful in understanding the mechanisms underlying the transition from quadripedality to bipedality during human evolution. The proposed mutant gene or gene pool playing a role in human quadrupedality may also be responsible for human bipedality at the same time. Herein there is no intent to insult or injure; rather, this report is an endeavor to better understand human beings. Supplementary materials are available for this article. Go to the publisher's online edition of International Journal of Neuroscience for the following free supplemental resource(s): video clips.

Subclinical hypothyroidism, hyperhomocysteinemia and dyslipidemia: investigating links with ischemic stroke in Turkish patients

OBJECTIVES

Hyperhomocysteinemia is a risk factor for ischemic stroke. Hypothyroidism may cause hyperhomocysteinemia. To date, no works have examined the association between hypothyroidism and hyperhomocysteinemia in ischemic stroke. We aimed to investigate the roles of hypothyroidism and hyperhomocysteinemia in ischemic stroke, and whether any relationship exists between hypothyroidism and hyperhomocysteinemia in ischemic stroke patients.

METHODS

The study included 249 ischemic stroke patients and 102 patients with no history of stroke. Patients were evaluated for conventional risk factors and levels of homocysteine, thyroid-stimulating hormone, vitamin B12 and folic acid.

RESULTS

Ten (4%) patients in the ischemic stroke group had subclinical hypothyroidism. We did not find any overt or subclinical hypothyroidism in the control group. Hypothyroidism was higher to a statistically significant degree in the ischemic stroke group (p<0.05). Both hyperhomocysteinemia and hypothyroidism were associated with ischemic stroke patients. However, no association was found between hyperhomocysteinemia and hypothyroidism. Ischemic stroke patients with hypothyroidism had lower levels of HDL cholesterol and levels of total cholesterol/HDL-C and LDL-C/HDL-C were higher than those of ischemic stroke patients without hypothyroidism.

DISCUSSION

Hypothyroidism is associated with ischemic stroke. Low HDL cholesterol, high total cholesterol/HDL-C and high LDL-C/HDL-C were associated in ischemic stroke patients with hypothyroidism. Hyperhomocysteinemia was not found to be associated with ischemic stroke patients with hypothyroidism.

Acquired progressive spastic paraparesis due to neurobrucellosis: a case report

A 39-year-old man with a 4-month history of transient pins and needles sensations occurring below the waist while walking and difficulty walking presented to our outpatient clinic. He had an approximate 1-year history of bilateral hearing loss, the etiology of which was unknown. His symptoms had been progressive, and there was no significant family history. He demonstrated a spastic gait and required assistance for walking. Deep tendon reflexes were hypertonic; a sensation deficit was defined as originating from the 12th thoracic vertebra. Babinski's sign was positive bilaterally. Sphincter abnormalities were seen in the patient's bladder and bowel functions. Cerebral and spinal magnetic resonance images with contrast media were unremarkable. An analysis of the patient's cerebrospinal fluid was consistent with neurobrucellosis. Owing to spastic paraparesis and hearing loss, the diagnosis of neurobrucellosis was made. Combined antimicrobial therapy was started and continued 6 months. His neurologic condition improved, and he was able to walk without help after 3 months' treatment. Our case illustrates that acquired progressive spastic paraparesis may occur during the course of neurobrucellosis. Neurobrucellosis should be borne in mind when patients present with spastic paraparesis.

Thrombotic Thrombocytopenic Purpura with Reversible Neurological Features: Brain Diffusion MRI with ADC Map, Spect and EEG Findings. A Case Report

Although nervous system involvement is common in thrombotic thrombocytopenic purpura (TTP), abnormalities on computerized tomography, magnetic resonance imaging and electroencephalography are not encountered so frequently and if present, these abnormalities are often reversible. We describe a 39-year-old woman with recurring transient focal neurological findings found to have laboratory findings consistent with TTP. In cerebral diffusion weighted images (DWI), diffuse cortical hyperintensity was noted in right frontal lobe, but the ADC (apparent diffusion coefficient) map was normal. Electroencephalography demonstrated lateralized slowing and repeated DWI showed diffuse cortical hyperintensity in the right hemisphere. SPECT showed luxury perfusion in the right hemisphere areas. The patient's condition resolved with plasmapheresis. Our patient illustrates that diffuse hemispheric involvement can be seen in DWI and EEG, and SPECT may show luxury perfusion after resolution of neurological findings in TTP cases. To our knowledge, this is the first TTP case in which the ADC map was normal.

The adsorption kinetics of the cationic dye, methylene blue, onto clay

In this study, adsorption kinetics of a cationic dye, methylene blue, onto clay from aqueous solution with respect to the initial dye concentration, temperature, pH, mixing rate and sorbent dosage were investigated. In order to understand the adsorption mechanism in detail, zeta potentials and the conductivities of clay suspensions at various pH (1-11) and cation exchange capacity (CEC) were measured. Porosity and BET surface area of clay studied were determined. The results showed that the adsorption has been reached to equilibrium in 1 h. It was found that the amount adsorbed of methylene blue increases with decreasing temperature and also with increasing both sorbent dosage and increasing initial dye concentration. Adsorption capacity decreases with increasing pH, except for the natural pH (5.6) of clay suspensions. The adsorption kinetics of methylene blue has been studied in terms of pseudo-first-order, pseudo-second-order sorption and intraparticle diffusion processes thus comparing chemical sorption and diffusion sorption processes. It was found that the pseudo-second-order mechanism is predominant and the overall rate of the dye adsorption process appears to be controlled by the more than one-step.

Production of granular activated carbon from waste Rosa canina sp. seeds and its adsorption characteristics for dye

An activated carbon was developed from Rosa canina sp. seeds, characterized and used for the removal of methylene blue (basic dye) from aqueous solutions. Adsorption studies were carried out at 20 degrees C and various initial dye concentrations (20, 40, 60, 80, and 100 mg/L) for different times (15, 30, 60, and 120 min). The adsorption isotherm was obtained from data. The results indicate that the adsorption isotherm of methylene blue is typically S-shaped. The shape of isotherm is believed to reflect three distinct modes of adsorption. In region 1, the adsorption of methylene blue is carried out mainly by ion exchange. In region 2 by polarizations of pi-electrons established at cyclic parts of the previously adsorbed methylene blue molecules is occurred. However, it is not observed any change at the sign of the surface charge although zeta potential value is decreased with increase of amount adsorbed. In region 3, the slope of the isotherm is reduced, because adsorption now must overcome electrostatic repulsion between oncoming ions and the similarly charged solid. Adsorption in this fashion is usually complete when the surface is covered with a monolayer of methylene blue. To reveal the adsorptive characteristics of the produced active carbon, porosity and BET surface area measurements were made. Structural analysis was performed using SEM-EDS. The produced active carbon has the specific surface area of 799.2 m2 g-1 and the iodine number of 495 mg/g.