The impact of lymph node ratio on overall survival in patients with colorectal cancer

Background

Lymph node metastasis is a predominant prognostic indicator in colorectal cancer. Number of lymph nodes removed surgically was demonstrated to correlate with staging accuracy and oncological outcomes. However, number of lymph nodes removed depends on uncontrolled variables. Therefore, a more reliable prognostic indicator is needed. Calculation of ratio of positive lymph nodes to total number of removed lymph nodes may be an appealing solution.

Materials and Methods

We retrospectively analyzed data of 156 Stage III colorectal cancer patients whom underwent surgery between 2008 and 2015. Patients' demographic characteristics, tumor grade, location, vascular-perineural invasion status, number of removed lymph nodes, and ratio of positive lymph nodes to number of removed lymph nodes were recorded. Spearman correlation analysis was used to determine the correlation coefficient while Kaplan-Meier method and Cox proportional hazard regression model were performed for the prediction of survival and multivariate analysis, respectively.

Results

Number of removed lymph nodes did not correlate with survival, but it was inversely correlated with number of positive lymph nodes. Multivariate analysis showed that ratio of removed positive lymph nodes to the total number of lymph nodes was a significant prognostic factor for survival for a ratio equal or above 0.31 was a poor prognostic indicator (108 months vs. 34 months, hazard ratio: 4.24 [95% confidence interval: 2.15-8.34]; P < 0.019). Tumor characteristics failed to demonstrate any prognostic value.

Conclusions

This study showed that positive lymph node ratio (PLNR) is an important prognostic factor for Stage III colorectal cancer. Although 0.31 can be taken as threshold for "PLNR," prospective trials including larger patient groups are needed to validate its role as a prognostic indicator.

Comparison of local rosmarinic acid and topical dexpanthenol applications on wound healing in a rat experimental wound model

BACKGROUND

The aim of the study was to compare the effects of rosmarinic acid and dexpanthenol in a rat experimental wound model.

MATERIALS AND METHODS

Twenty-four Wistar albino rats weighing 200-250 g were randomly divided into three groups. After 2-cm full-thickness skin defects were created, the wounds were washed with sterile 0.9% NaCl solution. After washing, the control group was left untreated, the second group received 5% dexpanthenol cream, and the third group received 10% rosmarinic acid cream. Before excision, the skin was evaluated macroscopically by measuring the reduction in wound size; after excision, histological examination (epithelisation, inflammation, fibrosis, granulation) was performed.

RESULTS

Macroscopic comparison of the wound sizes showed that group 3 showed a statistically significant difference in wound size reduction compared to the other two groups. Histopathological examination showed that there was no statistically significant difference between the groups. We found that the rosmarinic acid group had greater wound size reduction than the other two groups. However, epithelialisation was detected in fewer cases.

CONCLUSIONS

We believe that rosmarinic acid can be used as a topical cream for wound healing, as it leads to significant reduction in wound size, resulting in fewer scars.

Investigation of antioxidant effects of rosmarinic acid on liver, lung and kidney in rats: a biochemical and histopathological study

BACKGROUND

The aim of the study was to investigate the protective effects of rosmarinic acid in rats exposed to hepatic ischaemia/reperfusion (I/R) injury.

MATERIALS AND METHODS

Thirty-two rats were randomly classified into four groups of 8 rats each: laparotomy without medication, rosmarinic acid (dose of 50 mg/kg via oral gavage) followed by laparotomy, laparotomy followed by hepatic I/R, and hepatic I/R with rosmarinic acid. Serum aspartate aminotransferase, alaninę aminotransferase, and malondialdehyde levels and total oxidant activity and total antioxidant capacity levels of the liver, lung, and kidney were assessed. The histopathologic assessment was also performed.

RESULTS

Rosmarinic acid significantly reduced liver function test parameters and decreased oxidative stress and abnormal histopathologic findings in the liver. The oxidative stress in the lung significantly increased in the I/R group but significantly decreased in the I/R + rosmarinic acid group due to the addition of rosmarinic acid. Rosmarinic acid led to no reduction in oxidative stress in kidney following hepatic I/R injury. There were no statistically significant differences among the groups regarding histopathologic changes in kidney and lung sections.

CONCLUSIONS

Rosmarinic acid has antioxidant properties and is an effective hepatoprotective agent. However, although rosmarinic acid provides useful effects in the lung by increasing antioxidant capacity and reducing oxidative stress after I/R injury, it does not ameliorate histopathologic changes. These findings suggest that rosmarinic acid is likely to provide favourable outcomes in the treatment of hepatic I/R injury.

Metaplastic carcinoma of the breast: A rare carcinoma with chondroid metaplasia

Metaplastic breast carcinoma accounts for less than 1% of breast malignancies. Huvos et al. first introduced the term metaplastic carcinoma in 1974. It is usually seen together with poorly differentiated ductal carcinoma of the breast. Within its mesenchymal components, undifferentiated connective tissue cells, fibroblasts, osteoblasts and chondroblasts can be found. Metaplastic breast carcinoma is an aggressive disease with a poor prognosis. In this report, a case of a 45-year-old female patient who underwent segmental mastectomy with a diagnosis of metaplastic carcinoma of the breast is presented.

The use of tissue polypeptide specific antigen as a marker in liver diseases

BACKGROUND/AIMS

Tissue polypeptide specific antigen was first defined by Bjorklund in 1957 and is the specific M3 epitope of tissue polypeptide antigen. It is increased in malignant as well as in some benign diseases. The level of tissue polypeptide specific antigen in serum is related mostly with proliferation capacity rather than with tumor mass and cell necrosis. The aim of this study was to evaluate the levels of tissue polypeptide specific antigen and other tumor markers in patients with liver cirrhosis, chronic active hepatitis and hepatoma to determine if tissue polypeptide specific antigen is superior to other tumor markers in hepatoma patients.

METHODS

Thirty-seven patients and 20 controls were included in the study. The patients were divided into three subgroups as cirrhosis, hepatoma and chronic active hepatitis. The levels of tissue polypeptide specific antigen, carcinoembryonic antigen, CA19-9, alpha-fetoprotein and transaminases were determined in all patients.

RESULTS

Tissue polypeptide specific antigen levels were significantly higher in all patients than in the control group (p<0.005) According to Kruskal-Wallis test with regard to subgroups, the differences in mean values of tissue polypeptide specific antigen and alpha-fetoprotein were highly significant (p: 0.0001 for both). There was a low correlation between tissue polypeptide specific antigen and alpha-fetoprotein in the cirrhotic and hepatoma groups, but these were significantly correlated in the chronic active hepatitis group. The correlation coefficient between tissue polypeptide specific antigen and transaminases in all patients was low.

CONCLUSIONS

Our data suggest that tissue polypeptide specific antigen is efficient in determining primary hepatoma patients and also that this marker is specific for proliferation of cells.

Moyamoya syndrome after radiation therapy for optic pathway glioma: case report

We present a 4-year-old girl with neurofibromatosis-1 who developed moyamoya syndrome characterized by bilateral stenosis or occlusion of the distal internal carotid arteries and their branches, leading to the development of an abnormal vascular network. In light of a literature review, the postradiation vasculopathy of the moyamoya type and its relationship with neurofibromatosis-1 are discussed.

Incidence of seizures in pediatric cancer patients treated with imipenem/cilastatin

Proconvulsive tendency of imipenem/cilastatin is one of its well-known side effects. Most studies report incidence rates ranging from 1.5 to 3%. There is no study on the incidence rate among children with systemic malignancies. Eighty-two patients with various malignancies who received imipenem/cilastatin 143 times for neutropenic fever between March 1994 and October 1999 in Department of Pediatric Oncology, Gazi University, were identified. Three of these patients had convulsions attributed to imipenem/cilastatin; 3.6% of the patients had seizure, or 2% of imipenem/cilastatin administrations was followed by a seizure attack.

Laryngeal amyloidosis with laryngocele

Both laryngocele and laryngeal amyloidosis are uncommon, and simultaneous occurrences of these entities are extremely rare. A case of laryngeal amyloidosis with laryngocele in which the computed tomography (CT) and magnetic resonance (MR) imaging of the larynx, clearly demonstrating both disease processes, is discussed. Diagnosis is confirmed by histopathologic specimens. Only two cases have been reported in the world literature, and this is the third case of laryngeal amyloidosis associated with laryngocele.

Disturbances in oral and dental structures in patients with pediatric lymphoma after chemotherapy: a preliminary report

OBJECTIVE

The purpose of this study was to evaluate the effects of chemotherapy on oral and dental structures and craniofacial growth in 30 survivors of childhood lymphoma.

STUDY DESIGN

Eruption status, root malformations, premature apexification, agenesis, crown anomalies, soft tissue abnormalities, gingival and periodontal status, enamel defects and discolorations, and craniofacial growth status of the subjects were documented and compared with findings in 20 healthy children who served as controls.

RESULTS

Statistically significant (P < .05) differences between the study and control groups were found for plaque index, enamel hypoplasias, discolorations, and agenesis.

CONCLUSIONS

The results of the study suggest that antineoplastic therapy and/or childhood cancer can result in a higher prevalence of various malformations in teeth. Children treated in the early years of their lives displayed the most severe dental defects, suggesting that immature teeth are at a greater risk of developmental disturbances than fully developed teeth.

Intermediate dose of methotrexate toxicity in non-Hodgkin lymphoma

Methotrexate (MTX) is the chemotherapeutic for which the serum levels can be detected. If the MTX level is detected in time, high toxicity risk can be decreased. In this study, intermediate doses of MTX (1 g/m2) infusions are administered to B-cell non-Hodgkin lymphoma patients between 3 and 13 years old. The toxicity of MTX in accordance with serum levels and the toxicity of other combined drugs are investigated. Blood samples were collected consecutively, and MTX levels were detected by high-performance liquid chromatography. When hematological, gastrointestinal, and renal toxicity scores were compared with the 24-h serum levels of MTX, they showed a significant positive correlation. Hematological toxicity scores increased by Ifosfamide, Etoposide, and Cytarabine combined with MTX without altering the serum levels. Antibiotic combination with MTX has no effect on the toxicity scores. In conclusion, if MTX is combined with other myelosuppressive, hepatotoxic, and nephrotoxic drugs, the measurement of MTX serum levels alone is not a sufficient parameter to show the toxicity.

Arm anthropometry in evaluation of malnutrition in children with cancer

Malnutrition in children with cancer is reported to be relatively uncommon at the time of diagnosis. However, in most studies nutritional status measurement has relied almost exclusively on weight-related indices. This can be misleading, because in children with malignancy, tumor masses can reach more than 10% of total body weight. A controlled study was performed in 62 patients using arm anthropometry to provide a more accurate evaluation of the nutritional status of children with cancer at presentation. Height, weight, midupper arm circumference (MUAC), and triceps skinfold thickness (TSFT) were measured in all patients (40 boys, 22 girls) and controls (18 boys, 13 girls). Weight for height (WFH) of each patient was compared with the national standards. MUAC and TSFT were also interpreted according to the standards developed by A. Roberto Frisancho. The mean ages were 6.5 +/- 3.7 years (range 0.08-13) and 5.7 +/- 4.7 years (range 0.25-15) in patients and control group, respectively. Results showed that although the WFH values for patients were normal, MUAC and TSFT values were significantly less than control values (P < 0.001). Moreover, 27% of patients showed malnutrition (they had MUAC and TSFT below 5th percentile). Patients with intraabdominal solid tumors had significantly lower MUAC and TSFT values than those with extraabdominal solid tumors (P < 0.05). The data strongly indicate that malnutrition is common at the time of diagnosis in children with cancer, and arm anthropometry should replace the use of weight-related indices to identify malnutrition in children.

Changes of arterial arachidonic acid metabolites in hypertensive patients during haemodialysis

It is well known that in haemodialysis patients suffering from oligoanuria, extracellular hypervolaemia develops and this hypervolaemia is the main reason for hypertension occurring in some of the patients. The absence of vasorelaxation during hypervolaemia may be secondary to an increased activity of vasoconstrictor systems and/or a decreased formation of vasodilator agents like prostaglandin E2(PGE2) and prostaglandin I2(PGI2). In the present study, arterial PGE2 and leukotriene C4(LTC4)-like activities and the effect of fluid removal on these arachidonic acid metabolites during haemodialysis were measured in normotensive and hypertensive patients. Plasma PGE2 and LTC4-like activities were significantly different between hypertensive and normotensive patients. PGE2/LTC4 ratio did not change in normotensive patients while it was increased in hypertensive patients after haemodialysis. These results indicate that haemodialysis alters the synthesis of arachidonic acid metabolites especially in hypertensive patients.

The role of plasma arachidonic acid metabolites in the pathogenesis and the prognosis of Henoch-Schönlein purpura

Henoch-Schönlein Purpura (HSP) involve small vessel inflammation. Arachidonate biochemical pathways play an important role in the pathogenesis of vascular inflammation. The aim of this study was to investigate the change in the ratio of plasma arachidonic acid metabolites in the patients with HSP and evaluate the association between clinical activity and prostanoid activity in the acute phase of HSP. Plasma prostaglandin E2 (PGE2)-like activities were found to be 7.2 +/- 0.8 ng/ml in control group (n = 12) while it was 5.3 +/- 0.6 ng/ml in the patients with HSP (n = 12). Plasma leukotriene C4 (LTC4)-like activities were found to be 16.0 +/- 1.1 ng/ml in control while it was 30.9 +/- 4.3 ng/ml in the patients. The differences of LTC4-like activities and the LTC4/PGE2 ratios between the HSP patients and the controls were significant (p < 0.01, p < 0.001 respectively), but no significant difference was found in PGE2-like activities. Plasma LTC4-like activity and LTC4/PGE2 ratio were also significantly increased in the patients with high clinical score (p < 0.05, p < 0.02 respectively). These results suggested that not only cyclooxygenase products but also LTs may play an important role in vascular inflammation. Therefore LTC4/PGE2 ratio must be taken into consideration in the pathogenesis and the prognosis of HSP.

Co-incidence of Guillain-Barré syndrome and spinal cord compression in non-Hodgkin lymphoma

Extradural, radicular and spinal cord compressions are severe neurological complications of lymphomas. Less frequently, involvement of the peripheral nervous system, polymyositis, myasthenia gravis and Guillain-Barré syndrome (GBS) occur. We report a patient with GBS along with a lymphoma of the spinal extradural space where at the beginning the features of GBS outweighed the symptomatology of the extradural spinal mass.

Superoxide dismutase and allopurinol prevent the pressor effects of angiotensin II and histamine in the guinea-pig isolated perfused lung exposed to hypoxia

1. In the guinea-pig isolated perfused lung exposed to hypoxia by infusing N2-gassed Krebs solution, angiotensin II and histamine produced a reduced vasoconstrictor response when compared with the responses obtained in nonhypoxic lung. 2. These reduced vasoconstrictor responses were prevented by prior addition of superoxide dismutase or allopurinol to the medium. 3. These results were taken as evidence for the initiation of the cascade free radical formation in the guinea-pig lung during hypoxia and the primary role of the released intracellular xanthine oxidase. 4. Possible mechanisms of the reduced responses to angiotensin II and histamine and tissue protective activities of allopurinol and superoxide dismutase are discussed.

Neonatal sepsis in Turkey: the comparison between penicillin plus aminoglycoside and ampicillin plus third-generation cephalosporin chemotherapies

Bacterial infections during the neonatal period continue to be a major cause of neonatal morbidity and mortality in developing countries. In this study the etiological and clinical features and treatment regimens of 73 neonates with sepsis and suspected sepsis have been analysed. In contrast to developed countries, staphylococci were found to be still common etiological agents and the treatment regimen of ampicillin plus third-generation cephalosporin was highly effective.

Relation between the intestinal flora and diaper dermatitis in infancy

In this study, 40 patients with diaper dermatitis and 20 healthy infants were investigated. Mycological and bacteriological cultures were obtained from affected and healthy skin areas and stool specimens. Candida albicans was isolated simultaneously in 37 out of 40 patients subjected to mycological examination of skin lesions and stool specimen cultures. Of 34 Gram-stained smears from the skin lesions, 27 revealed Candida in hyphal form. In the control group, C. albicans was not grown from the diaper area. No significant difference was observed in the growth of bacteria from the skin with or without lesions (p greater than 0.05). In conclusion, C. albicans-infection originating from the gastrointestinal tract, plays a major role in diaper dermatitis. Thus, a Gram-stained smear can be used as a practical method in early diagnosis.

[Early detection of bacteremia in infancy]

The detection of bacteremia in children less than 24 months of age with fever, is very important, since these patients are at serious risk pyogenic complication. The administration of antibiotics in accordance with the results of cultures is too time consuming. So, several laboratory detection bacteremia must be carried out. In this study, blood cultures, the elevation of white blood cell count, toxic granulation and vacuolization in neutrophils were investigated in 56 children with suspicion of bacteremia. 32 of them were males and 24 females. The positive results were obtained in 41.1% in blood cultures. Positive predictive accuracy were 66.6% and 52.3% for vacuolization and toxic granulation respectively. The presence of these were considered as adjunctive procedures in the early diagnosis of bacteremia.

May-Hegglin anomaly (a presentation of a family)

The May-Hegglin anomaly is a rare autosomal dominant disorder characterized by the presence of large, bizarre, cigar-shaped platelets and Döhle bodies in the leukocytes. This rare anomaly was detected in seven members of a family. It is emphasized that in making a differential diagnosis this disorder must be distinguished from the other mild bleeding disorders.

Acute hemolytic anemia caused by irregular rifampicin therapy

Acute hemolytic anemia characterized by vomiting, diarrhea, vertigo, lumbar pain pallor and high fever due to an irregular and high dose of rifampicin is described in a 13-year-old girl during her treatment for tuberculosis. The presence of rifampicin-dependent antibodies was identified by special tests.

[PPD screening in school children with and without BCG vaccination]

In this work PPD screening has been carried out in BCG vaccinated and unvaccinated school children of various socioeconomical conditions in Sivas. The Immunity and infection ratios in vaccinated children according to being vaccinated one, two, three, four, five and more then five years ago were as follows; 37.7% and 8.4%, 29.4% and 7.3%, 28.5% and 6.0%, 32.3% and 4.2%, 26.0% and 10.9%, 27.3% and 5.5% respectively. There wasn't any significant difference from statistical point of view among these groups (P greater than 0.05). The ratio of tuberculosis++ infection was 26.5% in the unvaccinated group where as in the vaccinated group it was only 6.6%. When the ratios of these groups were compared from the statistical point of view the difference was found to be significant (P less than 0.05).

[Neonatal group B colonization and maternal urogenital and anorectal system carriage]

In pregnant women, the main reservoirs of group B streptococci (GBS) are rectum and urethra. The mother's birth canal and the newborn infant easily contract the organisms from these sites. We studied 100 women and their newborn babies to determine the relation between the maternal carriage and the neonatal group B streptococcal colonization. Vaginal, urethral and rectal swabs obtained from all pregnant women during labor. Within a few minutes after birth and on day 4 of life swab specimens were also taken from the external auditory canal, throat and umbilicus of the infants. The overall maternal carriage rate was found to be 7.00 percent. The frequency of transmission to the neonates was found to be 57.14 percent among maternal carriers. In early neonatal period, the colonization rate of GBS was found to be % 4.0 percent and the infection rate of GBS was found to be 2.0 percent among the newborn population.

[Relationship of gastric aspirate fluid examination to infections in the newborn infant in cases of premature rupture of the membranes]

In fifty newborn babies, gastric aspirate fluids obtained during the one-hour post partum period were examined from the stand point of PML and cultures. A susceptibility to infections (especially lung infections and sepsis) were established in 8 (30.8%) out of 26 cases with EMR more than twelve hours. PML counts of these cases were 13 and more than 13 per high power field. Significant differences were found between the babies with and without EMR, from the point-of-view of PML count in gastric aspirate fluid and the increased incidence of infections (p less than 0.05).