"Water-lily sign" as a rare finding of spinal hydatidosis

Hydatid disease (HD) is a common parasitic infestation in some developing countries. Hydatid disease may affect many organs in the body, but the most affected are the liver and lungs. Hepatic and pulmonary HD is relatively easier to diagnose because of the frequency of pathognomic features and its order in the differential diagnosis list. When HD is located in uncommon sites, it is difficult to recognize even in endemic areas. The "water-lily sign" is a pathognomic sign for HD and mostly described especially after puncture or percutaneous treatment of the cyst. In this case, we observed the water-lily sign in spinal HD, which was not described before for spinal cases but for soft tissues.     

Prognostic role of pre‐transplantation serum C‐reactive protein levels in patients with acute leukemia undergoing myeloablative allogeneic stem cell transplantation

The aim of this study was to identify indicators of outcome prior to transplantation in allogeneic hematopoietic stem cell transplantation (HCT). Clinical data of 106 patients with acute leukemia were retrospectively analyzed. We examined the role of pre‐conditioning serum C‐reactive protein (CRP) and ferritin levels, HCT‐CI and European Group for Blood and Marrow Transplantation (EBMT) scores on transplant toxicities, transplant‐related mortality (TRM), progression‐free survival (PFS), and overall survival (OS). High pre‐conditioning serum CRP levels showed a positive correlation with higher EBMT scores (p < 0.001), HCT‐CI (p = 0.004), and ferritin levels (p < 0.001). In univariate Cox regression analysis, serum CRP ≥10 mg/L, serum ferritin ≥1500 ng/mL, and HCT‐CI ≥3 had a significant adverse effect on OS. Serum CRP ≥10 mg/L and HCT‐CI ≥3 predicted increased risk of TRM in univariate analysis. Multivariate Cox regression analysis showed that HCT‐CI score ≥3 independently predicted increased risk of TRM and CRP ≥10 mg/L predicted increased risk of disease progression. Although CRP lost its significance on TRM in multivariate analysis, as an inexpensive and readily available serum biomarker of inflammation, the prognostic role of pre‐transplant CRP levels should be analyzed in selected diseases and increased number of patient groups.     

Evaluation of Oxidative Stress Parameters and Urinary Deoxypyridinoline Levels in Geriatric Patients with Osteoporosis

[Purpose] To evaluate the oxidative stress parameters and urinary deoxypyridinoline levels in geriatric patients with osteoporosis. [Subjects and Methods] Eighty geriatric patients aged over 65 years were recruited. Patients were divided into two groups: Group 1 (n=40) consisted of patients with osteoporosis, and Group 2 (n=40) consisted of patients without osteoporosis. Bone mineral density measurements were performed for all patients using DEXA. Oxidative stress parameters were analyzed in blood samples, and deoxypyridinoline levels were analyzed in 24-hour urinary samples. [Results] Compared to Group 2, the total antioxidant status and oxidative stress index levels of Group 1 were not significantly different; however, total oxidant status and 24-hour urinary deoxypyridinoline levels were significantly higher. Pearson correlation coefficients indicated that OSI and urinary deoxypyridinoline levels were not correlated with any biochemical parameters. ROC-curve analysis revealed that urinary deoxypyridinoline levels over 30.80 mg/ml predicted osteoporosis with 67% sensitivity and 68% specificity (area under the curve = 0.734; %95 CI: 0.624–0.844). [Conclusion] Our results indicate that oxidative stress would play a role in the pathogenesis of osteoporosis, and that urinary deoxypyridinoline levels may be a useful screening test for osteoporosis.Key words: Osteoporosis, Oxidative stress index, Deoxypyridinoline     

Investigation of approaches for internal target volume definition using 4-dimensional computed tomography in stereotactic body radiotherapy of lung cancer

The present study was undertaken to investigate the suitability of alternative internal target volume (ITV) delineation strategies based on maximum intensity projection (MIP), average intensity projection (AIP), 2 extreme phases and 4 phases images relative to the ITV_10phase in stereotactic body radiation therapy (SBRT) for lung cancer. The 4-dimensional computed tomography (4DCT) data of 15 lung cancer patients treated with SBRT in our clinic were used. Five different ITVs were generated as follows: merging GTVs from 10 phases (ITV_10Phase); merging GTVs from 2 extreme phases (0%, 50%) (ITV_2Phase); merging GTVs from 4 phases (0%, 20%, 50%, and 70%) (ITV_4Phase); delineating GTV on MIP (ITV_MIP), and delineating GTV on AIP (ITV_AIP). PTV_10Phase, PTV_2Phase, PTV_4Phase, PTV_MIP, and PTV_AIP were generated by adding a 5-mm margin around the related ITV. Volumetric analyses were performed for 4 ITVs and PTVs relative to ITV_10phase and PTV_10phase. SBRT plans made for all PTVs were evaluated for dosimetric effect of alternative ITV delineation strategies. The mean percentage overlap volume (POV) for PTV_2phase, PTV_4phase, PTV_MIP, and PTV_AIP relative to PTV_10phase were 84.2 ± 5.4%, 92.0 ± 2.9%, 82.2 ± 5.7%, and 73.8 ± 9.3%, for lower-lobe tumors, respectively. The mean POV for PTV_2phase, PTV_4phase, PTV_MIP, and PTV_AIP relative to PTV_10phase were 93.2 ± 2.5%, 95.9 ± 1.0%, 87.5 ± 6.7%, and 83.3 ± 6.8% for upper-lobe, respectively. For lower-lobe tumors the mean differences in V20 and MLD for plans based on PTV_2phase and PTV_4phase were <0.5% and <10 cGy, compared with a plan based on PTV_10phase. The use of PTV based on 4 respiratory phases and a 5-mm margin is a safe approach to reduce the workload of target delineation for tumors located in both lower and upper lobes.