Interleukin-6 levels and HPA axis activation in breast cancer patients with major depressive disorder

An association or a casual link has been proposed between the neuroendocrinological and neuroimmunological changes attributed to either depression or cancer. This study investigated whether breast cancer patients with and without major depression exhibit plasma interleukin-6 abnormalities and dexamethasone suppression test results. Four groups, each consisting of 30 women (1--healthy women, 2--patients with major depression, 3--breast cancer patients without major depression, 4--breast cancer patients with major depression), were compared to each other. Psychiatric evaluations were made by structured clinical interview for DSM-IV. Severity of depression was measured with the Hamilton Depression Rating Scale. Plasma levels of interleukin-6 were measured. A dexamethasone suppression test was applied. Breast cancer patients with major depression had markedly higher plasma levels of interleukin-6 than the other group. All breast cancer patients with depression had abnormal dexamethasone suppression test results. These findings suggest a hypothalamo-pituitary-adrenal axis activation and plasma levels of interleukin-6 and plasma interleukin-6 elevation and plasma levels if interleukin-6 and plasma levels of post cortisol concentrations. Evidence for a casual link or association of major depression with immune and endocrinological activation needs to be investigated further.     

Factors Prognostic of Survival in Patients Awaiting Liver Transplantation for End-Stage Liver Disease

In this study, we investigated possible independent predictive factors for survival, other than MELD score, in patients with cirrhosis. We reviewed the serum sodium, cholesterol, albumin, and platelet levels of 99 patients with cirrhosis and investigated the possible correlation of these parameters with survival period. We found that 77% and 81% of patients with cirrhosis were hypocholesterolemic and hypoalbuminemic, respectively. We noted that the survival time of 6 months in patients with serum sodium levels <125 mM at the time of admission to the study was 27% less than that in patients with sodium levels >130 mM. Patients with cirrhosis and serum sodium levels >130 mM survived for more than 1 year (95% CI). MELD scores of patients with serum sodium levels >130, between 125 and 129, and <125 mM were 15.8 to 19.9, 19.7 to 23.6, and 23.3 to 27.2, respectively (95% CI). In conclusion, we suggest that although all of these parameters are correlated with survival in patients with cirrhosis, the serum sodium level is the most accurate prognostic factor and a valid tool for predicting survival when considered in combination with the MELD score.     

The histopathological evaluation of the effectiveness of melatonin as a protectant against acute lung injury induced by radiation therapy in a rat model

PURPOSE: This study presents the histopathological evaluation of the effectiveness of melatonin as a protectant against acute lung injury induced by radiation therapy. MATERIALS AND METHODS: Thirty-two Wistar rats were divided into four groups. The rats in Group 1 received melatonin and underwent radiation therapy. The rats in Group 2 received no melatonin and underwent radiation therapy. The rats in Group 3 received melatonin and underwent sham radiation therapy. The rats in Group 4 received no melatonin and underwent sham radiation therapy. Melatonin was administered at a dose of 100 mg/kg using an intraperitoneal injection. Radiation therapy was delivered on a Cobalt-60 unit using a single fraction of 18 Gy through an anterior portal covering the right lung in entirety. The rats underwent euthanasia at 6 weeks following radiation therapy. The lungs were dissected and blinded histopathological evaluation was performed. RESULTS: Concerning the right lung, a decrease in intra-alveolar edema and intra-alveolar erythrocytes was observed despite an increase in activated macrophages, intra-alveolar fibrosis, hyaline arteriosclerosis and alveolar wall thickness for the rats in Group 1 as compared to the rats in Group 2. Concerning the left lung, a decrease in alveolar neutrophils and intra-alveolar erythrocytes was evident despite an increase in activated macrophages, hyaline arteriosclerosis and alveolar wall thickness for the rats in Group 1 as compared to the rats in Group 2. CONCLUSIONS: This study puts forward the histopathological evidence regarding the effectiveness of melatonin as a protectant against acute lung injury induced by radiation therapy through restrained inflammation, regrettably at the expense of promoted fibrosis. The effectiveness of melatonin as a protectant against acute lung injury induced by radiation therapy needs to be evaluated further for the unresolved concerns regarding the safety.     

Screening for psychological distress in Turkish cancer patients

The distress thermometer (DT) is a useful measure of psychological distress in cancer patients. Our objective was to investigate distress impact on oncology patients in Turkey and determine the optimal cut-off score on the DT for identifying clinically significant distress. One hundred and eighty two cancer patients completed the DT, Problem List (PL), and Hospital Anxiety and Depression scale (HADS), The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0). The receiver operating characteristic (ROC) curve analyses of DT scores yielded an estimated area under the curve of 0.66 when compared to the HADS cut-off score, suggesting the DT is an effective scale to discriminate between classified cancer patients both with and without clinically significant distress. The DT cut-off score of 4 yielded the optimal combination of sensitivity and specificity. Scores on the DT were moderately correlated to the HADS (p<0.01) and EORTC QLQ-C30. Based on the significant correlations, we conclude that the DT has acceptable criterion validity.     

Efficacy of Sirolimus-Eluting Stents Compared with Paclitaxel-Eluting Stents in an Unselected Population with Coronary Artery Disease: 24-Month Outcomes of Patients in a Prospective Non-randomized Registry in Southern Turkey

Background: The efficacy of drug-eluting stents has been shown in randomized trials, but some controversy exists regarding which stent sirolimus-eluting or paclitaxel-eluting is more effective in unselected Turkish patients. Therefore, we investigated the clinical outcomes of patients who were treated with one type of these drug-eluting stents in the real world.Methods: We created a registry and prospectively analyzed data on a consecutive series of all patients who presented to our institution with symptomatic coronary artery disease between February 2005 and March 2007 and who were treated with the sirolimus- or the paclitaxel-eluting stent. The follow-up period after stent implantation was approximately 24 months. The primary end point was a major cardiac event, and the secondary end point was stent thrombosis. Informed consent was obtained from all subjects, and the study protocol was approved by the local ethical committee.Results: In total, 204 patients were treated with either the sirolimus-eluting stent (n = 103) or the paclitaxel-eluting stent (n = 101). The lesions in the 2 arms of the study were treated similarly by conventional technique. At 24-month follow-up, patients who received the paclitaxel-eluting stent showed significantly higher rates of non-Q-wave myocardial infarction (1.9% vs 5.9%; P: .002), target vessel revascularization (1.9% vs 4.9%; P: .002), coronary artery bypass graft surgery (1.9% vs 6.9%; P: .001), and late stent thrombosis (1.9% vs 3.9%, P: .002).Conclusions: Patients who received the sirolimus-eluting stent showed better clinical outcomes compared with those who had the paclitaxel-eluting-stent.     

Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease

Background and aimEpicardial adipose tissue (EAT), which is thought to be a component of visceral adiposity, is associated with the metabolic syndrome. We aimed to test the hypothesis that echocardiographic EAT thickness can be a marker for the presence and severity of coronary artery disease (CAD).Method and resultsIn all, 150 patients (100 patients with CAD and 50 patients with normal coronary arteries by diagnostic coronary angiography; 65 women, 85 men; mean age 55.7 ± 7.4 years) were enrolled. EAT thickness was measured using 2-D echocardiographic parasternal long- and short-axis views. EAT thickness measurements were compared with angiographic findings.EAT thickness was significantly higher in patients with CAD in comparison to those with normal coronary arteries (6.9 ± 1.5 mm vs. 4.4 ± 0.8 mm; P < 0.001). Furthermore, EAT thickness increased with the severity of CAD (multivessel disease 7.4 ± 1.2 mm vs. single vessel disease 5.7 ± 1.7 mm; P < 0.001). Gensini's score significantly correlated with EAT thickness (r = 0.600, P < 0.001). EAT thickness of ≥5.2 mm had 85% sensitivity and 81% specificity (ROC area 0.914, P < 0.001, 95% CI [0.86–0.96]) for predicting CAD.ConclusionEAT thickness, which is easily and non-invasively evaluated by transthoracic echocardiography, can be an adjunctive marker to classical risk factors for the prediction of CAD.     

Atypical teratoid/rhabdoid tumor of the central nervous system: clinicopathologic and immunohistochemical features of four cases

Background  Atypical teratoid/rhabdoid tumor (AT/RT) is a rare aggressive infantile neoplasm of uncertain origin. This study was performed to assess the clinicopathologic and immunohistochemical features of four AT/RT cases. Case reports  Two cases were male and two were female, and their ages ranged from 8 to 103 months. Tumors were located in the cerebellum (two cases), frontoparietal lobe (one case), and third ventricle (one case). Histopathologically, the tumors were composed of rhabdoid cells and undifferentiated small cells mixed with epithelial or mesenchymal components. However, one of the tumors was composed predominantly of a mesenchymal component mimicking a sarcoma. Immunohistochemically, vimentin (4/4), epithelial membrane antigen (4/4), cytokeratin (3/4), smooth muscle actin (4/4), glial fibrillary acidic protein (4/4), S-100 (4/4), and synaptophysin (1/4) were positive in varying proportions, while desmin and INI-1 were negative in all the cases. All of the patients died within a mean of 14 months due to tumor progression despite the chemotherapy. Only one of our patients lived for 40 months after the diagnosis. In conclusion, AT/RTs are aggressive tumors. They can occur in a variety of locations, such as the third ventricle. Morphologically, a large spectrum can be seen, like predominantly sarcoma in appearance, but immunohistochemistry is helpful in the correct diagnosis.     

Comparison of the non-invasive methods estimating dry weight in hemodialysis patients

BACKGROUND: The treatment of deranged water homeostasis of hemodialysis (HD) patients needs focusing on an accurate assessment of dry weight (DW). However, the correct estimation of post-dialysis DW is still a problem. Echocardiography of inferior caval vein diameter (ICVD) was recently considered as a reliable technique to estimate DWs of HD patients, whereas conductivity measurements and biochemical parameters remain controversial. In this study, we aimed to compare the noninvasive methods estimating DW in HD patients. METHODS: We enrolled 60 patients: 30 hypervolemic (HV) (12 M, 18 F, with a mean age of 41.9 +/- 13.6 years, mean HD duration of 38 +/- 45 months) and 30 normovolemic (NV) patients (19 M, 11 F, with a mean age of 42.2 +/- 14 years, mean HD duration of 62 +/- 51.5 months) according to clinical sign and symptoms as well as the findings on chest x-ray. Furthermore, the DWs of patients were evaluated in post-HD period in terms of echocardiography parameters [ICVD and collapse index (CI) determined by Cheriex], plasma ANP (pANP) levels (RIA), and total body water (TBW) by bioelectrical impedance (BEI). RESULTS: Forty-one of 60 patients had hypervolemic findings (68%) and 19 patients had normovolemia (32%) according to echocardiography parameters. Determination of "hypervolemia" by clinical acumen and pANP levels were not reliable, especially negative predictive values were lower as follows: sensitivity, specificity, positive predictive value, negative predictive values of clinical acumen and pANP levels: 63%, 69%, 87%, 50%, and 67%, 59%, 79%, 43%, respectively. TBW established by BEI did not correlate with ICVD and CI after HD (p > 0.05). The TBW of HV group according to echocardiography parameters was greater than NV group, but the difference was not statistically significant (27.4 +/- 6.6 kg versus 26.4 +/- 5.8 kg, respectively, p > 0.05). However, there was not any difference in the divided BSA values (1.58 +/- 0.2 kg/m2 versus 1.60 +/- 0.2 kg/m2, respectively, p > 0.05). Hypertension was seen in 37 (90%) of the echocardiographically hypervolemic patients, and the blood pressure was kept under control by previously given medication in only 7 (19%) patients. After the dry weight of the patients was corrected echocardiographically to normal limits, the blood pressure of 31 patients (86%) was normalized without antihypertensive treatment, but only in 6 patients remained the necessity of antihypertensive treatment. In addition, in 8 of 11 normotensive patients using antihypertensive drugs, assessment of their clinical and radiological findings showed normovolemia but ICVD > 11.5 mm/m2; however, the need for antihypertensive drugs disappeared when the ICVD reduced to 8-11.5/m2. CONCLUSIONS: Clinical and radiological assessment, pANP levels, and TBW established by BEI appeared to be less valuable in interpreting DW's of HD patients. In accordance with the literature, echocardiography findings have proven to be reliable, and they are important noninvasive tools that can establish an effective and rational antihypertensive treatment.     

The use of recursive partitioning analysis grouping in patients with brain metastases from non-small-cell lung cancer

BACKGROUND: This study evaluates the use of recursive partitioning analysis (RPA) grouping in an attempt to predict the survival probabilities in patients with brain metastases from non-small-cell lung cancer (NSCLC). METHODS: Seventy-two patients with brain metastases from NSCLC treated with radiation therapy were included in the study. Sixty-three patients were male and nine patients were female. Their median age was 57 years and their median Karnofsky performance status was 70. At the time of brain metastases, there was no evidence of the intrathoracic disease in 27 patients and the extrathoracic disease was limited to the intracranial disease in 42 patients. In accordance with RPA grouping, 12 patients were in Group 1, 24 patients were in Group 2, and 36 patients were in Group 3. Radiation therapy was delivered to the whole brain at a dose of 30 Gy in 10 fractions in most of the patients. RESULTS: The median survival time was 7 months for Group 1, 5 months for Group 2 and 3 months for Group 3. The survival probability at 1 year was 50% for Group 1, 26% for Group 2 and 14% for Group 3. CONCLUSIONS: This study presents evidence supporting the use of RPA grouping in an attempt to predict the survival probabilities in patients with brain metastases from NSCLC.