Plasma homocysteine, folate and vitamin B12 levels in patients with lung cancer

AIM

Disorders in the metabolism of homocysteine and B vitamins, which are involved in a one-carbon transfer reaction and important for DNA synthesis and methylation, have been hypothesized to be associated with carcinogenesis. The purpose of this study is to evalu-ate the levels of homocysteine, vitamin B12 and folic acid in patients with newly diagnosed lung cancer and determines whether they might be used as an accurate tumor marker for monitoring the patients if they are found to be elevated in lung cancer.

MATERIALS AND METHODS

Forty male patients with lung cancer were included in this study. Age-matched forty healthy males who had not malignant disease or had not received any drug affecting plasma homocysteine levels were selected as control group. Homocysteine, vitamin B12 and folate levels were measured in the samples obtained from the patients and controls.

RESULTS

Mean age of the patients with lung cancer was 58.7 ± 9.9 years. All the patients were cigarettes smokers. Mean daily consumption of cigarettes was 2.0±0.7 packs and mean duration of smoking was 30 ± 11 years. Histologic type of carcinoma was found to be squamous cell carcinoma in 55%, adenocarcinoma - in 35%, and small cell carcinoma - in 10% of the cases. Clinical stage was stage IA in 20%, stage IB - in 20%, stage IIA - in 2.5%, stage IIB - in 10%, stage IIIA - in 12.5%, stage IIIB - in 20%, and stage IV - in 15% of the cases. Mean homocysteine level was 15.3 ± 7.3 µmol/l in the patients with lung cancer while 9.8 ± 2.6 µmol/l in controls. Homocysteine level was significantly higher in the patients with lung cancer compared to control group (p < 0.001). Mean folate level was 4.3 ± 1.8 pg/ml in cancer cases while 6.1 ± 2.3 pg/ml in controls. That is to say, plasma folate levels were significantly lower in cases of lung cancer compared to controls (p < 0.001). There was no significantly difference between groups with regard to B12 levels (mean B12 level was 234 ± 99 and 240 ± 104 ng/ml in the patients with lung cancer and controls, respectively, p = 0.78). Plasma homocysteine, vitamin B12 and folate levels did not show significant difference with respect to histologic type of carcinoma. No significant correlation was found between plasma homocysteine, vitamin B12, folate levels and number of cigarettes smoked per day, duration of smoking, age of the patient, and clinical stage of carcinoma. There was also no correlation between number of cigarettes smoked per day, duration of smoking, age of the patient and clinical stage of carcinoma. A possible inverse correlation between plasma homocysteine, vitamin B12 and folate levels was not observed.

CONCLUSION

In conclusion, high plasma homocysteine and low folate levels could be associated with lung cancer. However, further studies performed on large patient population are needed.

The prevalence of usage of herbal medicines among cancer patients

PURPOSE

To study the prevalence of the usage of herbal medicines among cancer patients.

METHODS

This study was carried out between October 1, 2009 and May 31, 2011, by using face-to-face interviews with cancer patients attending oncology departments (clinics and outpatient clinics, chemotherapy units). A special questionnaire was filled in during the interviews.

RESULTS

Of the patients 68.2% reported usage of herbal medicines, 66% stated that their usage of herbal medicines was based on the media and the Internet as a source and 64% stated that they received information about herbal medicines from relatives and friends. Only 24% of herbal medicines users had consulted or discussed their use with a physician.

CONCLUSION

In Turkey, especially among cancer patients, there is a high prevalence of complementary and alternative medicine (CAM) usage and the most commonly used form of CAM is herbal medicines. This prevalence has also been found to be high in our research as well. Due to the probable side effects and potential drug interactions of herbal agents, all cancer patients should be asked about their use of herbal medicines.

Calculation of pediatric femoral fracture rotation from direct roentgenograms

Background

Radiologic determination of pediatric femoral fracture rotation has been debated. Measuring the antetorsion angle of the fractured femur by computed tomography and comparing it with the opposite side has been the method of choice for this purpose. However, no simple method for direct measurement of femoral fracture rotation exists in the literature. In this study, our aim was to test a mathematical method of measuring the axial plane malrotation from direct roentgenograms.

Materials and methods

A pediatric femoral shaft fracture model was produced. The bone was secured to a wooden frame that allowed the distal part of the fracture to rotate around an axis. Radiographs were taken at known intervals of rotation ranging from the neutral position to 60° external rotation and to 60° internal rotation in 5° increments of rotation. Five independent, blinded observers measured the radiographs and calculated the fracture rotation according to a standard formula. Calculated rotation values were compared with known rotation values.

Results

Calculated rotation values were close to actual rotation values throughout the arc of rotation. The mean absolute error of five observers for all measurements of external and internal rotation was 3.97° (±0.83). The correlation coefficient between calculated and actual rotation values was 0.9927. The interobserver intraclass correlation coefficient for calculated rotation was 0.997.

Conclusions

Absolute error and correlation coefficient values indicate that this method is accurate and reliable in determining the fracture rotation.

Prognostic significance of the metastatic lymph node ratio for survival in colon cancer

PURPOSE

The metastatic lymph node ratio (LNR) is defined as the number of metastatic lymph nodes divided by the total number of lymph nodes removed. The aim of this study was to investigate the prognostic significance of the metastatic LNR in patients with colon cancer.

METHODS

One-hundred twenty-five patients with stage III colon cancer admitted to the Istanbul University Oncology Institute between 1995 and 2005 were retrospectively evaluated. The median LNR was 0.2, and this figure was accepted as cut-off value in the present study. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Log-rank test was used for intergroup comparisons. The significance level was put at p<0.05.

RESULTS

Of the 125 patients, 58 (46.4%) were males and 67 (53.6%) females with median age 57 years. The mean OS in patients with a LNR <0.2 was 120.5±7.3 months, with a LNR ≥0.2 was 92.8±9.0 months Although clinically significant, the difference between the groups was statistically insignificant (p=0.074). The mean duration of DFS in patients with a LNR <0.2 was 100.6±8.6 months and for those with a LNR ≥0.2 it was 71.7±8.3 months (p=0.017). The 5-year DFS rate in patients with a LNR ≥0.2 was 42.3%; it was 64.1% in those with LNR<0.2. The difference between the groups was statistically significant (p=0.017).

CONCLUSION

The determination of the optimal cut-off value for the LNR in future prospective studies will help defining prognosis with better accuracy in colon cancer patients.

Treatment and clinicopathologic predictors for adenoid cystic carcinomas of the head and neck

PURPOSE

To retrospectively evaluate the management and clinicopathologic predictors of outcome of adenoid cystic carcinoma (ACC) patients treated and followed at our Department.

METHODS

Data on 41 patients treated between 2000 and 2006 at the University of Istanbul, Institute of Oncology, were reviewed. Factors affecting recurrence, distant metastasis and survival were evaluated.

RESULTS

There were 22 (53.6%) major salivary and 19 (46.3%) minor salivary gland tumors. Eighteen patients (43.9%) had solid histologic type tumor. Twenty-one (51%) patients had perineural invasion and 28 (68.2%) high grade tumors. Sixteen (39%) patients had stage I disease, 12 (29.1%) stage II and 13 (31.5%) stage III. Thirty-two patients (78.4%) had radical and 9 (21.9%) partial resection. Thirty-one patients (75.6%) received adjuvant postoperative radiotherapy (RT). Eight patients (19.5%) suffered locoregional relapse and 9 (21%) distant metastases. Two patients (4.8%) died from ACC and 7 (17%) from other causes. The median follow-up was 48 months (range 24-60). Disease free survival (DFS) at 2 and 3 years were 78% and 58%, respectively. Overall survival (OS) at 2 years and 3 years were 87% and 80%, respectively. Median time to locoregional relapse and distant metastasis was 28 and 32 months, respectively. Seven of 9 patients with distant metastasis had solid tumor subtype. Distant metastasis occurred more frequently in patients with tumors of major salivary glands (66%). Sites of distant metastasis were lung alone (n=5), bone alone (n=2) and 2 patients had both lung and bone metastasis. There was no statistically significant relationship between clinical T stage and solid histology with locoregional relapse (p <0.05). Surgical resection type and perineural invasion were significant prognostic factors for locoregional relapse (p=0.03). T stage (p=0.001), grade (p=0.02) and solid histology (p=0.003) were prognostic factors associated with DFS. Prognostic factors associated with OS were grade (p= 0.001), clinical T stage (p=0.02), solid histology (p=0.01), radical excision (p=0.04) and perineural invasion (p=0.001).

CONCLUSION

ACC is a neoplasm in which early diagnosis is important because it is a slow-growing tumor producing diffuse invasion. Distant metastasis and locoregional relapse can be predicted by solid histologic subtype, high grade, type of surgery, perineural invasion and tumor stage. The most frequent sites of metastasis are lung and bone.

Prevalence of Behçet's disease in rural western Turkey: a preliminary report

OBJECTIVES

To study the prevalence of Behçet's disease (BD) in a rural area of Western Turkey.

METHODS

This study was conducted in seven villages in the rural Havsa region which has a total population of 5727. The physicians and medical students visited every household and distributed a questionnaire on the symptoms of rheumatic disorders. One of the questions was whether they had ever suffered from mouth ulcers. If the response was affirmative the proband was examined by a rheumatologist and a dermatologist for other symptoms. The individuals with true aphthous ulcerations had pathergy tests and were invited to the hospital for ophtalmic examinations.

RESULTS

Of the 5203 individuals who participated in this survey, 4861 were 10 years or older. 124 out of 190 individuals who responded positively to the question regarding the presence of mouth ulcers had true aphthous ulcerations. 115/124 underwent a pathergy test and 4 showed positive reactions without any other stigmata of BD, except for folliculitis in one. Among the individuals with a negative pathergy test, 2 had acneiform skin lesions and 1 a genital ulcer. No individual exhibited any ocular symptoms or findings characteristic for BD. Only 1 person with aphthous ulceration, folliculitis and a positive pathergy test was considered to have BD.

CONCLUSION

In this survey, the prevalence of BD was found to be 2: 10,000 (95% confidence interval 0 to 4.3: 10,000). This figure is lower than what has been reported in four previous studies from different regions in Turkey. This finding might be due to ethnic distribution and geographical differences.

Response to nimodipine in caffeine-induced neurotoxicity in cerebellar granular cell culture of rat pups

Methylxanthines (theophylline, theobromine and caffeine) are widely used as central nervous system stimulants and caffeine is used in the treatment of apnea in newborns. Plasma therapeutic concentration of caffeine is around 110 microM. Caffeine diffuses the blood brain barrier easily, increasing oxygen consumption in neurones and leading to cell death. In the present study, 4-7-day-old rats were used to obtain cerebellar granular cell cultures. Caffeine was used 50, 150, 250 and 350 microM concentrations and the most toxic dose for it was found to be 350 microM. Death cell scores were 0.9+/-0.63 for control, 1.1+/-0.63 for 50 microM, 0.89+/-0.47 for 150 microM (P>0.05 for both), 3.84+/-0.8 for 250 microM (P=0.024) and 6.2+/-0. 86 for 350 microM (P=0.001) caffeine concentrations. The role of voltage-dependent calcium channels in caffeine-induced neurotoxicity was tested with the doses of 100 and 200 microM nimodipine 45 min before or after the 350 microM caffeine. Both doses of nimodipine after caffeine administration were found to be ineffective in blocking neurotoxicity. Doses administered 45 min prior to caffeine, reduced death cell score to 0.89+/-0.23 (P=0.000) for 100 microM nimodipine and 2.35+/-0.96 (P=0.000) for 200 microM nimodipine administration into the cultures. A dose-dependent manner of nimodipine in ischemic states is well-known. In the light of these results, nimodipine may be used in the treatment of newborn apneas together with caffeine to prevent neurotoxic side effects of high or repeated doses of it.