Phase II study of gemcitabine plus paclitaxel in metastatic breast cancer patients with prior anthracycline exposure

Chemotherapy provides palliation and modest prolongation of symptom-free survival in metastatic breast cancer. Taxane containing regimens are commonly considered to be among the initials in metastatic setting due to earlier use of anthracyclines in the course of breast cancer. Therefore, we conducted this Phase II study to assess efficacy and safety of gemcitabine plus paclitaxel (GT) combination therapy in anthracycline pretreated metastatic first-line setting. Patients and Methods: The study enrolled 26 women with pathologically confirmed and measurable metastatic breast cancer who were previously treated with anthracycline but no prior chemotherapy for metastatic disease. Twenty six and twenty four patients were eligible for toxicity and efficacy evaluations respectively. Mean age was 47.3 years and median ECOG performance status was 0. Twenty patients (76.9 percent) had visceral metastases, most commonly located in liver and lung. Treatment schedule was as follows: paclitaxel 175 mg/m² was administered intravenously in 3 hours on Day 1 and gemcitabine 1000 mg/m² was administered intravenously in 30 minutes on Day 1 after paclitaxel application, and on Day 8 every 21 days. Results: Objective response rate was 41.7 percent (95 percent CI: 21.9-61.4) with 16.7 percent (95 percent CI: 1.7-31.6 percent) CR, and 25.0 percent (95 percent CI: 7.6-42.3 percent) PR. Median time to progression and overall survival were 9.6 and 14.5 months, respectively. Grade 3-4 toxicity was observed in 34.6 percent (9) patients. Treatment of two patients was discontinued due to toxicity, consisting of Grade 3 hypersensitivity reactions and Grade 4 infections in one patient each. Dose reductions due to myelotoxicity were performed in 4 (15.3 percent) patients. Hematologic toxicities were generally manageable with appropriate dose modifications and supportive care. Conclusion: Gemcitabine and paclitaxel combination regimen is effective and has manageable toxicity profile as first line metastatic setting.     

Comparison of the factors that influence obesity prevalence in three district municipalities of the same city with different socioeconomical status: a survey analysis in an urban Turkish population

BACKGROUND: To evaluate the obesity status, factors and comorbidities related to it in three district municipalities (DM) that compose city center of Bursa with inhabitants of different socioeconomic status. METHODS: A total of 1632 inhabitants >/=18 years of age were interviewed. The number of sample in each DM was obtained proportional to their populations by stratified sampling method. Among 1632, a total of 1543 subjects were included by random sampling and a questionnaire was filled in including demographic, social and behavioral features. RESULTS: The participants living in DM with the highest socioeconomical status (SES) score and level of education had the lowest body mass index (BMI) and body fat percentage (%BF) compared to other DMs. The lowest obesity prevalence (30.8% vs. 36.4% and 39.3%) in that DM was possibly due to younger age, lower female ratio, more active professional, higher percentage of smoking, more consumption of vegetables, olive or corn oil, and less carbohydrate. For the evaluation of the factors that may influence obesity risk, we investigated the effects of these factors in men and women separately with logistic regression model. Sedentary life style and dyslipidemia (DL) in men, being unemployed, having lower level of education and having hypertension (HT) in women and familial obesity in both gender were found to be related to increased obesity risk. CONCLUSIONS: The prevalence of obesity in Bursa is increasing although inhabitants are taking some precautions parallel to their socioeconomical and educational levels. Obesity is becoming a more alarming public health problem in Bursa and Turkey like in most other parts of the world, which forces us to invent new prevention policies. Besides, the results of our study highlight the fact that especially female education requires more attention for decreasing obesity prevalence in coming generations.     

A magnificent circumcision carnival in the early 18th century Ottoman period

Circumcision has always been regarded as both an important social event and a milestone of a young man's life in Turkish culture, especially in the Ottoman period. Herein we study an exceptional circumcision festivity which lasted 15 days in the early autumn of the year 1720, for the 4 princes of Sultan III Ahmed, some sons of two high-ranking Ottoman officials and thousands of male children of poor citizens of Istanbul as representing the beneficent of the Sultan. All the organizations of the Empire participated in this huge event, including many shows and a feast, and the preparations were initiated months before. Traditionally, this kind of important social event of Ottoman culture had been described in a literary manner, and Surname-i Vehbi was the special name for the book of this circumcision festivity with 137 colored paintings and a total of 175 pages. The original of this work, which is in the library of Topkapi Palace Museum in Istanbul, was written by Vehbi and illustrated by Levni. The importance of this antique book is that it is the last important example of the illustrated festivity books of Ottoman literature.     

Effectiveness of vardenafil versus papaverine in penile Doppler ultrasonography

PURPOSE: To evaluate erectile dysfunction, penile color Doppler ultrasound is currently considered the best method. But intracavernous injection is invasive and has adverse effects, such as prolonged erection and risk of priapism. In our study we want to evaluate whether vardenafil can be used instead of papaverine in penile Doppler ultrasonography. MATERIALS AND METHODS: A total of 24 patients with erectile dysfunction underwent color Doppler ultrasound before and after intracavernous injection of 60 mg papaverine with genital and audiovisual sexual stimulation. Peak flow and end diastolic velocity were measured in the recorded waveforms obtained 0, 1, 5, 10 and 20 min after injection. The patients also underwent color Doppler ultrasound after a 10-mg oral dose of vardenafil with genital and audiovisual sexual stimulation and at least 5 days after the prior examination. The same parameters were measured at 30, 45, 60, 75 and 90 min after the drug administration. We compared the results with the values obtained after papaverine injection. RESULTS: After oral vardenafil mean peak flow velocity significantly increased starting at 30 min and achieving a maximum value at 60 min. There were no significant differences in the 2 methods in mean peak velocity 1, 5, 10 and 20 min after papaverine injection, and 30, 45, 60, 75 and 90 min after oral vardenafil administration. Although papaverine injection is the gold standard for penile color Doppler ultrasound, it has severe adverse effects such as prolonged erection which we observed in 3 patients (12.5%) and required pharmacological detumescence. After vardenafil no severe adverse effects were observed. CONCLUSIONS: Vardenafil administration achieved increased peak flow velocity comparable to that after intracavernous papaverine injection. With no prolonged erection vardenafil is a safer alternative compared to more invasive intracavernous injection and is also an alternative for patients who fear injections.     

Effects of sildenafil on major arterial blood flow using duplex sonography

PURPOSE: Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Oral use of sildenafil citrate is effective in the treatment of ED. Although the effects of sildenafil citrate have been investigated in several systems, its effect on aortic, superior mesenteric (SMA), and carotid artery blood flow is still unclear. The aim of this study is to investigate the early phase effects of sildenafil citrate on aortic, SMA, and carotid artery blood flow using color duplex sonography (CDS). METHODS: Thirty-four patients with ED (aged 19-71) were included in this study. Peak systolic velocity, end diastolic velocity, and resistance index (RI) in aorta, SMA, and bilateral common and internal carotid arteries were measured at baseline and 45-75 minutes after the administration of sildenafil citrate using CDS. RESULTS: Statistically significant changes were observed in only 3 of 18 parameters: an increase in post drug values of bilateral internal carotid artery peak systolic velocity (Vmax) compared to baseline values and a significant decrease in the RI value of the left main carotid artery after drug administration compared to baseline values. CONCLUSIONS: Sildenafil citrate had no significant effect on aortic and SMA circulation and only caused mild changes in the carotid artery circulation. Although these alterations may be considered clinically insignificant, further studies assessing long-term effects of sildenafil are warranted.     

The role of urtica dioica (urticaceae) in the prevention of oxidative stress caused by tourniquet application in rats

Tourniquets are used in extremity surgery and provide a relatively bloodless field, thereby minimizing blood loss and helping identify the vital structures. However, they may cause an ischemia-reperfusion injury with potentially harmful local and systemic consequences. Many therapeutic effects such as diuretic, natriuretic, hypotensive, anti-rheumatic, anti-prostatic, and in-vitro anti-oxidant effects of the Urtica dioica (UD) have been determined. In the present study, we aimed to investigate the potential role of UD plant for prevention of oxidative stress in muscle tissues generated by tourniquet application in rats. Wistar rats were used in this study. The UD extract or 1.15% KCl aqueous solution, in which UD leaf samples were homogenized, was given to each group of eight rats once a day for 5 days through an intraesophageal canule. No treatment was applied to untreated group. Tourniquets were applied to the left posterior limb of rats for 1 or 2 h followed by a reperfusion period of 1 h. After the ischemia and reperfusion, the rats were killed with a high dose of anesthetic drug, and malonyldialdehyde (MDA) levels were measured in their tibialis anterior muscles. Basal MDA levels were obtained from tibialis anterior muscles of 8 control rats, which were not exposed to ischemia. MDA levels were lower in the UD-treated rats than those in untreated and KCl-treated rats after either 1 or 2 h of ischemia and 1 h reperfusion. These results indicate that UD has a potential antioxidant effect on ischemic muscle tissues.     

The relationship between frontal sinusitis and localization of the frontal sinus outflow tract: a computer-assisted anatomical and clinical study

OBJECTIVE: To evaluate the relationship between frontal sinusitis and the localization of the frontal sinus outflow tract medial or lateral to the superior attachment of the uncinate process (UP). DESIGN: A retrospective anatomical and clinical study. SETTING: An ear, nose, and throat clinic in i?li Etfal Teaching and Research Hospital, Istanbul, Turkey. PATIENTS: Paranasal sinus computed tomographic scans of 486 sides of the frontal sinuses (hereafter referred to as sides) of 243 patients who had chronic sinusitis were evaluated. In 125 sides (26%), the superior attachment of the UP could not be identified. In the remaining 361 sides (74%), the prevalence of superior attachment of UP types and the presence of frontal sinusitis in each side were recorded. Localization of the frontal sinus outflow tract was determined according to the superior attachment of the UP. Drainage of the frontal sinus to the middle meatus (medial to the superior attachment of the UP [types 1-3]) was classified as group 1, and drainage of the frontal sinus to the ethmoid infundibulum (lateral to the superior attachment of the UP [types 4-6]) was classified as group 2. RESULTS: Frontal sinusitis was found in 125 (35%) of 361 sides. The distribution of frontal sinusitis was 97 (41%) of 237 in group 1 and 28 (23%) of 124 in group 2. Group 1 drainage had a statistically significant presence of frontal sinusitis (chi(2) = 12.11; P<.001). The prevalence of superior attachment of UP types was 63% for type 1/2, 3% for type 3, 12% for type 4, 14% for type 5, and 8% for type 6. CONCLUSIONS: Frontal sinus outflow tract, which is medial to the superior attachment of the UP, is more common than the lateral one. There is a statistically significant relation between the presence of frontal sinusitis and the frontal sinus outflow tract, which is medial to the superior attachment of the UP.     

Delirium and extrapyramidal symptoms due to a lithium-olanzapine combination therapy: a case report

We report an elderly patient who developed severe delirium and extrapyramidal signs after initiation of lithium-olanzapine combination. On hospital admission, serum levels of lithium were found to be 3.0 mM/L which were far above toxic level. Immediate discontinuation of both drugs resulted in complete resolution of most of the symptoms except for perioral dyskinesia which persisted for three more months. We critically discussed the differential diagnosis of lithium intoxication and assessed confounding factors which induce delirium and extrapyramidal signs related with combination therapy of lithium and olanzapine.