Prognostic value of nm23 in gastrointestinal stromal tumors

Aim/Background: nm23 is suggested to represent a new class of metastasis suppressor genes. An inverse correlation between nm23 expression level and metastatic potential has been demonstrated in different malignancies. This study evaluated the prognostic value of nm23 in gastrointestinal stromal tumors (GISTs). Methods: Immunohistochemical expression level of nm23 was studied in a total of 32 patients with localized GISTs. The relationship between the expression level of nm23 and patient outcome was investigated. Results: A tumor size of 10 cm or more and a mitotic rate of 10 or more per 50 high-power fields were not significantly associated with the metastasis risk (p=0.60 and 0.55, respectively). Tumors with high expression of nm23 tended to have significantly lower metastatic potential (p= 0.02). The median survival was significantly longer in patients with high expression of nm23 (p=0.007). Conclusion: These results suggest that expression level of nm23 may be considered as a prognostic predictor in GISTs. Future studies with larger patient numbers will be essential to confirm the prognostic significance of nm23 in patients with GIST.     

Erythropoietin exerts neuroprotective effect in neonatal rat model of hypoxic-ischemic brain injury

Hypoxic-ischemic encephalopathy seen in survivors of perinatal asphyxia is a frequently encountered and a major clinical problem for which there is currently no effective treatment. Hematopoietic neuroprotective agents, such as erythropoietin (EPO) may rescue neurons from cell death in this setting. EPO is a cytokine hormone that has neuroprotective effect in vitro and in vivo. In this study, we evaluated the effect of posthypoxic EPO administration in an animal model of neonatal hypoxic-ischemic injury. Our results show that a single intracerebroventricular injection of EPO immediately after hypoxic-ischemic insult in neonatal rat model of hypoxic-ischemia reduced the extent of hypoxic-ischemic brain damage. The mean infarct volume assessed 7 days after hypoxia was significantly smaller in EPO-treated group than in the control group. These findings suggest that EPO may provide benefit after hypoxic-ischemic events in the developing brain, a major contributor to static encephalopathy and cerebral palsy.     

Pulmonary hypertension in dialysis patients

Cardiovascular complications are encountered frequently in end-stage renal disease (ESRD) patients. The study was designed as a prospective cohort study and a total of 105 dialysis patients, 77 hemodialysis and 28 peritoneal dialysis patients, were investigated. All patients had undergone M-Mode Doppler echocardiography every 6 months by which their systolic pulmonary arterial pressures (sPAPs) and left ventricular mass indices (LVMIs) were recorded. Thirty-nine (37.1%) patients had pulmonary hypertension (PHT), that is, a mean sPAP of more than 35 mmHg. The frequency of PHT was higher in peritoneal dialysis patients but the difference was insignificant (p = 0.08). However, the frequency of left ventricular hypertrophy (LVH) was found to be significantly higher in peritoneal dialysis patients than in hemodialysis patients (p = 0.001). When patients with and without PHT were compared, the duration of dialysis (p = 0.02), hemoglobin (p = 0.01), HbA1c (p = 0.03), and serum albumin levels (p = 0.003) were found to be significantly higher in patients with PHT than those without PHT. In conclusion, although nonsignificant, we found a higher prevalence of PHT in peritoneal dialysis patients when compared with hemodialysis patients. This might be due to the significantly higher prevalence of LVH, hence hypervolemia, in peritoneal dialysis patients. The prevention and treatment of PHT in dialysis patients is very important for the improvement of survival in these patients. Hence, the increased prevalence of PHT in ESRD patients necessitates understanding the multiple and interacting factors, such as LVH, serum albumin and hemoglobin levels, and control of diabetes, that might contribute to this pathology in these patients.     

Increased mean platelet volume in cervicocephalic artery dissections

Aim

We aimed to investigate the role of platelets in the pathogenesis of cervicocephalic artery dissections by measuring the mean platelet volume (MPV) and platelet count.

Methods

Thirty-four patients with evidence of cervicocephalic artery dissection were included in the study. Cervicocephalic artery dissection patients were divided into two subgroups as vertebral artery dissections and carotid artery dissections. There were 30 control subjects with similar baseline characteristics. The platelet count and MPV were compared between groups.

Results

The analysis showed a significant difference between the MPV values of the cervicocephalic artery dissection group and the control group (p?<?0.05). However, when we compared subgroups with controls, we found a significantly higher MPV values only in the vertebral artery dissection group. We did not find any significant difference for total platelet count between the cervicocephalic artery dissection groups and controls.

Conclusions

MPV is a marker of platelet function and activation. Increased MPV may be a result of dissection. In addition, it may be a risk factor for dissection-related stroke. Our study supports the notion that platelet reactivity is important in the pathogenesis of the cervicocephalic artery dissections, especially in vertebral artery dissections.     

Echinococcus alveolaris: presenting as a cerebral metastasis

Echinococcus multilocularis (EM) is caused by the larval stage of the tapeworm. The main endemic regions for human alveolar echinococcosis are Central Europe, Russia, Turkey, Japan, China, Eastern France, North America. EM is an endemic disease in Turkey and especially common in the eastern Anatolia Region as seen in our case. The liver is the primary focus of the disease, cerebral localization is rare. Cerebral hydatid disease is approximately 5% of alveolar hydatid cases and generally considered to be fatal. Surgical treatment should be considered whenever possible. We present a case of cerebral alveolar hydatid disease that was thought to be cerebral metastasis.     

Electrocardiographic findings of palonosetron in cancer patients

Purpose

Nausea and vomiting are among the major problems occurring during and after the chemotherapy treatments of cancer patients. The recently developed 5-HT₃ antagonists have proved much more effective than former agents. Several studies have shown that these agents cause certain ECG changes. We aimed to evaluate the ECG changes caused by palonosetron, one of the new 5-HT₃ antagonists.

Methods

Our study includes a total of 50 patients diagnosed with solid-organ tumors receiving chemotherapy. The patients were applied 12-lead ECG before palonosetron infusion. Afterwards, subsequent ECGs were applied on the 30th, 60th, and 90th minutes following the infusion of palonosetron. Arterial blood pressure was measured before and after the infusion. PR, QRS, QT, QTmax, QTmin, QTd, Pmax, Pmin, Pd, QTc, QTcmax, QTcmin, and QTcd values were evaluated for each ECG.

Results

We did not detect significant correlations between the systolic and diastolic blood pressures before and after (30?min) palonosetron infusion (p?>?0.05). However, there was a statistically significant decrease in heart rate (p?=?0.000). The evaluation of ECG findings revealed that there was a significant prolongation in PR distance, as shown by the comparisons of 0?min with 30, 60, and 90?min. On the other hand, there was no significant difference in QRS, QT, QTmax, QTmin, QTd, Pmax, Pmin, Pd, QTc, QTcmax, QTcmin, and QTcd values (p?>?0.05).

Conclusion

In this study, we revealed that palonosetron did not cause any severe rhythmic disorders or symptomatic ECG changes. We concluded that it could be safe to administer palonosetron antiemetically.     

Emergency peripartum hysterectomy: our 12-year experience

Objective

The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH).

Methods

We analyzed retrospectively 44 cases of EPH performed at tertiary obstetric center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH, and postoperative follow-up were obtained by analyses of hospital records.

Results

The overall incidence of EPH was 0.48 per 1,000 deliveries during the study period. The most common indications of EPH were abnormal placentation (50 %), uterine atony (36 %) and uterine rupture (9 %). All patients who underwent EPH with abnormal placentation had one or more previous cesarean sections (CS) except one. In our series, 24 cases (54 %) underwent total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %), whereas subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %). Maternal mortality was seen in 2 patients (4.5 %). The causes were disseminated intravascular coagulation in one and adult respiratory distress syndrome in the other patient. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4 and prematurity in 3 patients.

Conclusions

In our series, abnormal placentation was the most common indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.     

Effect of heat shock protein-90 (HSP90) and vascular endothelial growth factor (VEGF) on survival in acute lymphoblastic leukemia: an immunohistochemical study

Background The significance of vascular endothelial growth factor (VEGF) and heat shock protein-90 (HSP90) has received only limited attention especially in acute lymphoblastic leukemia (ALL). In this study, we assessed expressions of HSP90 and VEGF in bone marrow samples of patients with ALL and effect of these expression quantities on the mean overall survival. Patients and methods Using immunohistochemical methods, we assessed expression of HSP90 and VEGF in 22 cases of ALL. Results Expression of HSP90 was detected in 19/22 (86.4%) and 3/22 (13.6%) of patients with ALL, for strongly positive and moderate-weakly positive, respectively. Negative HSP90 expression was not detected in patients with ALL. Expression of HSP90 in patients with ALL and in control group were statistically significant (P < 0.001), however, did not reflect the mean overall survival (P = 0.910). Mean OS was evaluated 992 ± 181 and 724.8 ± 88.2 days for moderate-weak and high HSP90 expression, respectively. VEGF expressions were not significantly different between ALL and control groups (P < 0.087). We did not find any relationship between HSP90 and VEGF expressions in bone marrow specimens of patients with ALL. Conclusion This study demonstrated that HSP90 expression grades in patients with ALL were significantly higher than that in controls and presence of strong HSP90 expression was associated with worse overall survival. VEGF expression in patients with ALL was not different from that in control samples. Determination HSP90 with immunohistochemical method in bone marrow can provide information about prognosis.