Alper Sevinc

Plasma lipid peroxidation products and antioxidant enzyme activities in patients with type 2 diabetes mellitus

Abstract. Diabetes is associated with a significant increase in thiobarbituric acid reactive substances (TBARS) which are considered as an index of endogenous lipid peroxidation. The human body has a complex antioxidant defense system that prevents the initiation of free radical chain reactions. We measured plasma TBARS levels, superoxide dismutase (SOD) and catalase (CAT) activities and ocmpared their relation to the metabolic control of diabetes and diabetic microangiopathy. Sixty-four patients (19 men), aged 52.35±9.31 years with type 2 diabetes mellitus were included in the study. Thirty-six healthy subjects (12 men), aged 51.02±7.01 years formed the control group. TBARS levels and SOD activity were elevated in the diabetic group when compared with the control group (p<0.001 and p<0.00001, respectively). However CAT activity was significantly decreased in the diabetic group when compared with the control group (p<0.00001). Patients with diabetic nephropathy and retinopathy, but not neuropathy, had elevated TBARS levels but there was no statistically significant difference when compared with diabetic patients without microangiopathy (p>0.05). There was a positive correlation between plasma TBARS levels and SOD activity (r=0.770, p=0.0001) and a negative correlation between plasma TBARS levels and CAT activity (r=0.482, p=0.0001). There was also a negative correlation between SOD and CAT activities (r=−0.609, p=0.0001). We found significantly elevated TBARS levels in diabetic patients. We did not observe any correlation between TBARS levels and blood glucose and HbA1c levels. Elevated TBARS levels and SOD activity and decreased CAT activity may be due to a compensation mechanism of the body.

How to Interpret Serum CA 125 Levels in Patients with Serosal Involvement? A Clinical Dilemma

The clinical utility of tumor markers is limited due to their low specificity. CA 125, an ovarian tumor marker, is a sensitive but nonspecific tumor marker used especially in the follow-up of ovarian cancer for monitoring the efficacy of therapy and for early detection of recurrence. The use of the CA 125 serum assay as a single diagnostic tool is restricted by the fact that the antigen to CA 125 is also produced by normal epithelia (peritoneum, pleura, and pericardium). Since an elevated serum CA 125 level is a marker of ovarian cancer, a laparotomy is the final tool of the physician to clarify the etiology. However, unnecessary operations have been reported in the literature revealing no ovarian pathology (e.g. cirrhosis, tuberculous peritonitis or pancreatic cancer) in such patients. Elevated serum CA 125 levels require a cautious operative planning in patients without a notable tumor mass. A secondary interpretation is needed in case of elevated CA 125 levels whenever serosal (peritoneal, pleural, or pericardial) fluid is present.

The relation between plasma endothelin-1 levels and metabolic control, risk factors, treatment modalities, and diabetic microangiopathy in patients with Type 2 diabetes mellitus

We evaluated the possible relation between plasma endothelin-1 (ET-1) levels and metabolic control, risk factors, treatment modalities, and diabetic microangiopathy, including nephropathy, neuropathy, and retinopathy in patients with Type 2 diabetes and healthy control group. Sixty-eight (39 females and 29 males) patients with Type 2 diabetes and 14 (6 females and 8 males) healthy subjects were included in the study. Plasma ET-1 levels were found to be 10.46+/-1.24 pmol/l in the diabetic group, whereas 7.97+/-0.41 pmol/l in the control group, which was statistically significant (P<.01). We also found elevated plasma ET-1 levels in patients with the least one microvascular complication when compared with the uncomplicated diabetes group (P=.02). Moreover, plasma ET-1 levels of the uncomplicated group was higher than the control group (P<.05). Plasma ET-1 levels were significantly elevated in hypertensive diabetics than normotensive diabetics (t=2.58, P=.012). It was also found to be elevated in diabetic patients with diabetes duration of more than 10 years when compared with patients less than 10 years (P=.02). These findings can be interpreted as the increased damage of microvascular complications in the disease process that may lead to elevated ET-1 levels. Mean plasma ET-1 levels in diabetic patients with a family history of diabetes was found to be higher than patients with no family history of diabetes. Genetical and environmental factors may have an effect on ET-1 level. We also studied the correlations of plasma ET-1 levels on age, sex, fasting blood glucose levels, treatment modalities HbA1c, hyperlipidemia, C-peptide, Body Mass Index, and smoking, but did not find any statistically significant difference. In conclusion, plasma ET-1 levels are well correlated with microangiopathy, hypertension, increased disease duration, and family history of diabetes, but poorly correlated with metabolic control, treatment modalities, age, sex, hyperlipidemia, obesity, and smoking.

Serum CA 125 Levels in Patients with Chronic Heart Failure and Accompanying Pleural Fluid

Malignant and nonmalignant serosal fluids have been found to be associated with high serum levels of CA 125, suggesting that the presence of fluid in the serosal cavities may stimulate its release. In this study, we investigated the relationship between serum CA 125 levels and the presence of pleural fluid in patients with chronic heart failure (CHF). We performed a clinical study in 36 patients with CHF with and without pleural fluid. Patients with CHF were divided into two groups based on the presence of fluid in the pleural cavity. Group 1 included 18 CHF patients (6 females, 12 males) with pleural fluid. Group 2 consisted of 18 CHF patients (7 females, 11 males) without pleural fluid. The control group consisted of 30 healthy volunteers (12 females, 18 males). The serum CA 125 level was determined in all groups. Serum CA 125 levels were found to be 100.0 ± 129.4 U/ml in CHF patients with pleural fluids, whereas they were 36.5 ± 35.2 U/ml in CHF patients without pleural fluid and 8.9 ± 6.1 U/ml in the control group. Significantly high serum CA 125 levels were found in CHF patients with pleural fluids (p < 0.05) when compared with both CHF patients without pleural fluid and the control group. There was also a statistically significant difference in CA 125 levels between patients without pleural fluid and the control group (p < 0.05). We concluded that serum CA 125 levels should be interpreted with caution in patients with CHF in the presence of pleural fluid. Invasive procedures to define the etiology of elevated serum CA 125 levels may be unnecessary in this patient group.

The Use of Complementary Therapies in Cancer Patients : A Questionnaire-Based Descriptive Survey From Southeastern Turkey

Objectives:A study was designed to measure the frequency of complementary therapy (CT) usage in cancer patients in southeastern Turkey. The demographic characteristics associated with the use of CT are sought in patients undergoing or following conventional treatment. Methods:A descriptive survey was performed in a total of 560 cancer patients. Questionnaire-based measures of demographics, expectations, and effects of using different types of CT and perceived benefits were recorded. Result:Demographic characteristics (age, gender, education status, etc.) did not differ among CT users and non-CT users. Three hundred ten patients (55.4%) had used at least one type of CT since the time of the initial diagnosis of cancer. The most frequently used CT method was herbal therapy, and the most commonly used herb was the stinging nettle. The source of information about CT was mainly from friends/family, whereas physicians and nurses played a small part in providing CT-related information. The majority of the patients used CT to benefit more from medical treatment. Only 20.7% of the patients considered themselves not benefiting from using CT. Conclusions:Currently more than half of Turkish patients with cancer use CT in addition to the standard medical approaches. CT usage is not associated with any specific demographic variables. Health professionals should not disregard the reality of CT usage in cancer patients. Because the majority of cancer patients use CT regardless of the medical advice, randomized clinical trials are needed to explore risks and benefits associated with CT modalities in cancer.

Complete Heart Block in a Patient with Wegener's Granulomatosis in Remission: A Case Report

Wegeners granulomatosis is a systemic inflammatory disorder of unknown cause that usually affects the upper and lower respiratory tracts as well as the kidney. Cardiac involvement is rare, although electrocardiographic abnormalities, coronary artery vasculitis, cardiac arrhyth mias, and myocardial infarction have been reported in the literature. A 27-year-old female patient with Wegeners granulomatosis in remission is described in whom complete heart block developed in the 13th month of treatment with cyclophosphamide. A temporary pacing was applied and pulse methylprednisolone and cyclophosphamide were commenced. On the ninth day of treatment, normal sinus rhythm was achieved. In conclusion, cardiac rhythm abnormalities should always be kept in mind both in the diagnosis and follow-up of Wegeners granulomatosis.

The diagnosis of C-kit negative GIST by PDGFRA staining: clinical, pathological, and nuclear medicine perspective.

Background: Gastrointestinal stromal tumors (GIST) comprise a majority of tumors previously diagnosed as gastrointestinal leiomyomas, leiomyoblastomas, and leiomyosarcomas. Although GIST may be identified by light microscopy, pathologists commonly employ a panel of immunohistochemical markers to confirm the morphological impression including anti-CD34, smoothmuscle actin, desmin, S100, and CD-117. However, in CD- 117 negative cases, it becomes difficult to diagnose GIST. This is of great importance, since the use of imatinib mesylate has led to a dramatic improvement in survival rates of GIST patients besides improved quality of life. Case Report: We report the case of a 67-year-old male patient diagnosed as having chemotherapy-resistant metastatic leiomyosarcoma. We reviewed the specimen for a possible diagnosis of c-kit negative GIST. Plateletderived growth factor receptor-alpha (PDGFRA) immunohistochemical stain was recommended. The specimen was positively stained for PDGFRA. Imatinib mesylate (400 mg/d) was started. The patient showed an excellent response after receiving imatinib treatment which was documented with 18 fluoro-deoxyglucose positron emission tomography and computed tomography (18F-FDGPET/ CT) prior to and after treatment. Conclusion: The importance of diagnosis of c-kit negative GIST is emphasized while stressing the importance of PDGFRA staining besides PET/CT response evaluation.

Association between the Thr431Asn polymorphism of the ROCK2 gene and risk of developing metastases of breast cancer.

The objective of this study was to analyze the genotype distributions and allele frequencies for ROCK2 Thr431Asn and Arg83Lys polymorphisms among breast cancer patients. In this case-control study, 223 patients with breast cancer were recruited and divided into two groups according to metastases (n = 128) and without metastases (n = 95). Genomic DNA from the patients and the control cases (n = 150) was analyzed by real-time PCR using a Light-Cycler. Neither genotype distributions nor the allele frequencies for the Arg83Lys polymorphism showed a significant difference between the groups. Although no marked changes were observed with nonmetastatic group, a statistically significant association was found between the control and metastatic group for the Thr431Asn polymorphism. Although homozygous carriers of the Thr431Thr genotype were more frequent, heterozygous carriers of the Thr431Asn genotype were less frequent among the metastatic patients than among controls. There was also an increase in Thr431 allele (60.5% in patients vs. 51.7% in controls) and decrease in Asn431 allele frequencies (48.3% in control vs. 39.5% in metastatic patients) in metastatic groups (p = 0.036). Our results demonstrate that Thr431Asn polymorphism of the ROCK2 gene could be a risk factor for the metastases of the breast cancer, and may help in predicting the prognosis.

Cytokine concentrations are not predictive of bacteremia in febrile neutropenic patients.

Assay of cytokines and C reactive protein (CRP) in different periods of febrile neutropenia may be helpful for early defining the risk in severe infections. We determined serum interleukin-6 (IL-6), interleukin-8 (IL-8), soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), and CRP in 22 previously untreated patients with various malignancies. Samples were obtained in four different clinical periods of febrile neutropenia; prior to chemotherapy, afebrile neutropenic period after chemotherapy, febrile neutropenic period, and recovery period. When compared to sex-and age-matched group of healthy subjects, IL-6, IL-8, sIL-2R, and CRP levels were found to be elevated in all periods. The highest levels were encountered in the febrile neutropenic period. For predictivity purposes, the afebrile neutropenic period was the most important period. Serum sIL-2R, IL-6, IL-8 and CRP levels were elevated in this period. IL-8 levels showed the most stable elevation through different stages of febrile neutropenia. Serum IL-8 levels were found to have the most reliable and stable elevation in different clinical stages of febrile neutropenia. Nevertheless, IL-8 is not able to discriminate among risk groups and cannot be used as a predictive factor.

Detection of complete response to imatinib mesylate (Glivec ® /Gleevec ® ) with 18F-FDG PET/CT for low-grade endometrial stromal sarcoma

Malignant mesenchymal tumors consist of approximately 10% of uterine tumors. The majority of uterine sarcomas are leiomyosarcoma and endometrial stromal sarcoma (ESS). Surgery, radiotherapy, chemotherapy, and hormonal therapy are used for the treatment of ESS. Imatinib mesylate is indicated in the management of gastrointestinal stromal tumor and chronic myelogeneus leukemia. There is an interest to use imatinib mesylate in the treatment of c-kit positive ESS. We reported a case of 42-year-old female low-grade ESS progressed on chemotherapy and presented with objective response to imatinib mesylate. The treatment response was evaluated with FDG PET/CT. Complete metabolic response was detected. FDG PET, a sensitive method for tumor response evaluation on the basis of tumor metabolism changes, is useful for the evaluation of imatinib treatment in low-grade ESS.