Factor VIII:C, epsilon amino-caproic acid or tranexamic acid are prophylactic agents used in preventing hemorrhage pre-operatively in patients with hemophilia A. Although hemophilia A seems to be a factor that avoids the development of acute myocardial infarction (AMI) as it tends to be associated with increased bleeding, it should be kept in mind that prothrombotic agents used pre-operatively for prophylaxis may increase the risk for AMI in the presence of the factor V Leiden mutation. In this report, we discuss the development of AMI following the use of recombinant factor VIII and tranexamic acid for prophylaxis in a patient with known hemophilia before a tooth extraction in conjunction with the relevant literature.
Neoadjuvant systemic chemotherapy is the accepted approach for women with locally advanced breast cancer. Anthracycline- and taxane-based regimens have been extensively studied in clinical trials and consequently are widely used. In this study aimed to research the complete response (pCR) rates in different regimens for neoadjuvant setting and determine associated clinical and biological factors.This study included 63 patients diagnosed with breast carcinoma among 95 patients that had been treated with neoadjuvant chemotherapy between 2007 and 2010. TNM staging system was used for staging. The histologic response to neoadjuvant chemotherapy was characterized as a pCR when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Biologic subclassification using estrogen receptor (ER), progesterone receptor (PR), HER2 were performed. Luminal A was defined as ER+, PR+, HER2-; Luminal B tumor was defined as ER+, PR-, HER2-; ER+, PR-, HER2+; ER-, PR+, HER2-; ER+, PR+, HER2+, HER2 like tumor ER-, PR+, HER2+; and triple negative tumor ER, PR, HER2 negative.Patients median age was 54.14 (min-max: 30-75). Thirty-two patients (50.8%) were premenopausal and 31 (49.2%) were postmenopausal. Staging was performed postoperatively based on the pathology report and appropriated imaging modalities The TNM (tumor, lymph node, metastasis) system was used for clinical and pathological staging. Fifty-seven (90.5%) were invasive ductal carcinomas, 6 (9.5%) were other subtypes. Thirty nine (61.9%) were grade II and 24 (38.1%) were grade III. Seven (11.1%) patients were stage II and 56 (88.9) patients were stage III. The patients were classified for ER, PR receptor and HER2 positivity. Seventeen patients had complete response to chemotherapy. Forty patients (63.5%) were treated with dose dense regimen (cyclophosphamide 600 mg/m2 and doxorubicine 60 mg/m every two weeks than paclitaxel 175 mg/m2 every two weeks with filgrastim support) 40 patients (48%) were treated anthracycline and taxane containing regimens. Thirteen patients (76%) from 17 patients with pCR were treated with the dose dense regimen but without statistical significance (p=0.06). pCR was higher in HER2(-), ER(-), grade III, premenopausal patients.pCR rate was higher in the group that treated with dose dense regimen, which should thus be the selected regimen in neoadjuvant setting. Some other factors can predict pCR in Turkish patients, like grade, menopausal status, triple negativity, percentage of ER positivity, and HER2 expression.
Splenic tumors are rarely seen tumors. Primary non-lymphoid vascular tumors of spleen are hemangioma, lymphangioma, hamartoma, littoral cell angioma, hemangioendothelioma, myoid angioendothelioma and angiosarcoma. Primary splenic epithelioid hemangioendothelioma is very rare tumor among this group. Hemangioendothelioma is generally considered to have a potentially intermediate-borderline malignancy. In the literature review, among splenic hemangioendothelioma cases, rarely of them were reported as primary splenic epithelioid hemangioendothelioma. Its frequency among splenic tumors is 0.3-14%. These tumors do not become in large sizes and have better prognosis. If they become large, they may cause symptoms such as pancytopenia and hemolytic anemia due to splenomegaly and hypersplenism. Early diagnosis and treatment may prevent conditions such as widespread metastasis, splenic rupture and operative complications. In this article, we present clinical and imaging findings of epitheloid splenic hemangioendothelioma with review of other reported cases in the light of literature.
e15502 Background: Red cell distribution width (RDW) is an elevated marker in several cancers like breast, colon, prostate and pancreatic cancer at the time of diagnosis. Gastric cancer (GC) is the fifth most common cancer and also third leading cause of cancer deaths.We aimed to determine whether RDW values differ between gastric cancer and healthy subjects, as well as to evaluate association between RDW and other factors. Also, we examined other two important inflammatory markers in GC patients: neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) Methods: This retrospective study included 68 gastric cancer patients and 42 age and sex matched healthy controls. The exclusion criteria involved cardiac disease, chronic obstructive lung disease, thromboembolism, chronic renal failure, hepatic disorders, hypertension, acute and chronic infections, stroke, hematologic disease and other accompanying cancer. Blood samples were retrospectively obtained from computerized patient database. Results: Among 110 subjects; RDW, NLR and PLR were significantly higher in GC patients when compared to healthy subjects (RDW: 44,9 vs 41,4 p < 0.0001, NLR: 3,40 vs 1,90 p < 0.0001, PLR: 245,9 vs 131,1 p = 0.007). There was no statistically significant association between these markers (RDW, NLR and PLR) and stage, histopathological subgroups and metastasis stage at the time of diagnosis. Conclusions: Elevated RDW is a simple, cheap and readily available marker and may be useful in gastric cancer at the time of diagnosis. Also, NLR and PLR can accompany RDW in the assessment of gastric cancer. Key words: gastric, red cell distribution width, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, cancer
e18538 Background: Lung cancer is the leading cause of cancer mortality worldwide. Chemotherapy (CT) is an integral part in the treatment of locally advanced NSCLC (LA-NSCLC) as it improves survival in all subgroups of patients, whether treated with surgery or radiotherapy, as shown in meta-analyses based on individual patient data. In this study, our aim was to overview our data retrospectively in LA-NSCLC patients and to explore which CT regimen is more effective. Methods: One hundred and thirty-two patients were included in this study. Seventy-six of the patients received 60 Gy radiotherapy (RT) and weekly 20 mg/m2 docetaxel and 20 mg/ m2 cisplatin (P) chemotherapy concomitantly. Five patients received P 50 mg/m2 intravenously (IV) on days 1, 8, 29, and 36 and etoposide (E) 50 mg/m2 IV on days 1-5 and 29-33 concurrently with chest RT to 60 Gy. Nine patients received weekly carboplatin AUC 2 and paclitaxel 50 mg/m2 and forty-two patients received only cisplatin 20 mg/m2 concurrently with 60 Gy chest RT. Results: Median age of the dead patients was 61,20±9,96 and 57,70±8,60 for living patients. One hundred and twenty patients were men and the remaining were women. Seventy five patients had adenocarcinoma, forty six patients had squamous cell carcinoma and eleven were nonsmall cell lung carcinoma. Following concomitant CRT, 26 patients (20%) showed complete and 66 patients (50%) showed partial response (total response rate was 70%). The median follow-up was 22 months (range: 8-36 months). The median overall survival was 40 months for stage II patients, 29 months for stage IIIA and 21 months for IIIB patients. Esophagitis in ten (13%) patients, neutropenia in fifteen (9%) patients and pneumonitis in eleven (12%) patients developed as grade III-IV toxicity due to concomitant CRT. Consolidation chemotherapy was given to patients with partial response. Conclusions: There are no clinical trials that have established the optimal regimen for concurrent chemoradiotherapy. In our study; patients were treated with different types of chemotherapy regimens during radiotherapy but the most effective one was cisplatin and docetaxel. This finding should be evaluated in larger clinical trials.
Objective:Periodic mammography, clinical breast examination and breast self-exam (BSE) facilitate getting a therapeutic response and improve disease prognosis, by leading to early diagnosis of the breast cancer.Methods:The study included a total of 618 women working in Çukurova University, Faculty of Medicine, as technician, secretary, staff, midwife and doctor. They answered a 22-items questionnaire consisting of questions about general knowledge, 8 of these were about BSE.Results:While it was statistically significant that the education was not correlated with the age of onset of BSE and timing of BSE, the education was significantly efficient in terms of knowing the aim of the BSE, its frequency, post-menopausal BSE time, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. While it was statistically significant that the profession was not related to age of onset of BSE and knowing the right day of the month on which BSE should be performed, the education was likely to be efficient in knowing the frequency, post-menopausal BSE time, aim of the BSE, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. When the percentage of giving right answers to the questions and educational background and professional groups were compared, it was seen that the difference of the number of right answers and professional groups was significant.Conclusion:Based on our results, we concluded that the education about BSE is warranted in order to increase the likelihood of female healthcare personnel to diagnose breast cancer at an earlier stage, given their role in raising the awareness of the population. Periodic mammography, clinical breast examination and breast self-exam (BSE) facilitate getting a therapeutic response and improve disease prognosis, by leading to early diagnosis of the breast cancer. The study included a total of 618 women working in Çukurova University, Faculty of Medicine, as technician, secretary, staff, midwife and doctor. They answered a 22-items questionnaire consisting of questions about general knowledge, 8 of these were about BSE. While it was statistically significant that the education was not correlated with the age of onset of BSE and timing of BSE, the education was significantly efficient in terms of knowing the aim of the BSE, its frequency, post-menopausal BSE time, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. While it was statistically significant that the profession was not related to age of onset of BSE and knowing the right day of the month on which BSE should be performed, the education was likely to be efficient in knowing the frequency, post-menopausal BSE time, aim of the BSE, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. When the percentage of giving right answers to the questions and educational background and professional groups were compared, it was seen that the difference of the number of right answers and professional groups was significant. Based on our results, we concluded that the education about BSE is warranted in order to increase the likelihood of female healthcare personnel to diagnose breast cancer at an earlier stage, given their role in raising the awareness of the population.
Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe bone disease for which the pathogenetic mechanisms and risk factors are not fully understood. The present study evaluated the data of 652 patients with bone metastasis that had undergone treatment with biphosphonates. Subsequently, 24 patients with BRONJ and 20 control patients without BRONJ that were treated with zoledronic acid were enrolled. It was found that BRONJ occurred in 3.6% of patients. The mean age and the administration of dental treatment were found to be significantly associated with BRONJ development (P=0.049 and P=0.013, respectively). The cumulative dose median in the BRONJ group was found to be significantly higher compared with the cumulative dose average in the control group (P=0.037). In addition, at the time of BRONJ development, improvement in the disease was determined to be better in the BRONJ group than in the control group (P=0.031). The present study determined that age, the existence of dental extraction and the cumulative dose of zoledronate were all important risk factors in BRONJ development.
Increasing amounts of evidence suggest patient-related systemic inflammatory response (SIR) as a powerful prognostic factor in cancer and applicability of SIR as a prognostic factor has been investigated.To evaluate the prognostic significance of SIR, which is among routinely analysed blood parameters in patients with all stages of gastric cancer (GC).A total of 245 patients with gastric cancer who were followed up and treated in four clinics of medical oncology were included in the study. At first admission of the patients, from routinely determined whole blood cell counts in medical oncology clinics, their neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) values were estimated and recorded before initiating chemo- or radiotherapy. A univariate non-parametric analytical method and chi-square test examined the correlation between prognostic factors, and survival rates. Survival curves were estimated using the Kaplan-Meier method.Sixty-eight (27.8%) female and 177 (72.2) male patients (total n=245) were included in the study. When NLR was used as an indicator of SIR, 108 (44.1%) patients were SIR negative and 137 (55.9%) patients were SIR positive. When PLR was used as an indicator of SIR, SIR negativity and positivity were detected in 93(38%) and 152 (62%) patients, respectively. A statistically significant correlation was found between status of lymph node metastasis, stage of the disease and NLR (P=0.001, P=0.017). SIR determined with PLR was found to be correlated with the depth of tumor invasion and stage of the disease (P=0.016, P=0.033). A significant correlation was not detected between PLR and survival (P=0.405).According to our study, parameters of NLR and PLR calculated preoperatively from peripheral blood samples can be used in patients with various sizes of tumours in different disease stages. Still based on our results, NLR calculated during diagnostic workup is a parameter with a prognostic value. In addition, NLR is a determinative factor in the selection of surgical method and chemotherapeutic modalities, which also functions as a potential contributory marker in effective immunotherapeutic strategies.
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