Bircan Sonmez

Effect of pathologic fractures on survival in multiple myeloma patients: a case control study

BackgroundMultiple Myeloma (MM) is a B cell neoplasm characterized by the clonal proliferation of plasma cells. Skeletal complications are found in up to 80% of myeloma patients at presentation and are major cause of morbidity.Methods49 patients were enrolled with MM admitted to Black Sea Technical University Hospital between 2002–2005. Pathologic fractures (PFs) were determined and the patients with or without PF were followed up minumum 3 years for survival analysis.ResultsPF was observed in 24 patients (49%) and not observed in 25 patients (51%). The risk of death was increased in the patients with PF compared with patients who had no fractures. While overall survival was 17.6 months in the patients with PFs, it was 57.3 months in the patients with no PFs.ConclusionThese findings suggest that PFs may induce reduced survival and increased mortality in the MM patients, however, larger sample size is essential to draw clearer conclusions added to these data.

Effects of Human Amniotic Fluid on Fracture Healing in Rat Tibia

BACKGROUND Human amniotic fluid (HAF), including hyaluronic acid (HA) and several growth factors, has been used experimentally in tendon, nerve, and cartilage regeneration and in bone defects because of its positive stimulating effects on regeneration potential. This study was performed to investigate whether HAF was effective on fracture healing. MATERIALS AND METHODS We created 36 tibial fractures in 20-week-old Wistar rats that were divided into three groups. In group 1, fracture lines were instilled with HAF collected at 18th week of the gestation and, in group 2, fracture lines were instilled with HAF obtained at the end of the gestation. HAF which was collected from different period of gestation was used, because the concentration of HA and growth factors in HAF varies considerably during gestation. Group 3 was used as an operative control group. RESULTS Fracture-healing score was highest in group 1 radiologically at the 3rd and 5th week (P = 0.037, P = 0.018, respectively). In the scintigraphic evaluation, metabolic activity at the fracture site was observed in group 1 more than the others at the 3rd week (P = 0.010). Histologically, the highest scores were obtained from group 1 as compared to other groups at the 3rd and 5th week. In the 5th week, predominant cartilage with some woven bone was observed in group 3, while predominantly woven bone with some cartilage was observed in group 1 (P = 0.036). CONCLUSIONS Our data suggest that HAF had a positive effect on fracture healing in rat tibia, and also this positive effect was observed more in group 1.

The effect of Hirudoid on random skin-flap survival in rats

BACKGROUND One of the main fields of research in flap surgery is to increase the viability of flaps. Many materials have been tested for this purpose. This study shows that topical application of Hirudoid, an organoheparinoid, increases flap survival of dorsal flaps in rats. METHODS Hirudoid was used topically every day in eight of 16 rats in which 10x3-cm dorsal flaps were prepared. The flaps were taken for analysis on the 10th day. Analysis of the flaps was performed using digital measurement and scintigraphy. RESULTS Analysis revealed that the flap necrosis area was smaller in the Hirudoid group compared to the control group. In addition, the area exhibiting radioactive uptake in scintigraphy was greater in the treatment group. CONCLUSION Topical administration of Hirudoid may significantly improve flap survival.

Treatment related changes in antifibrinolytic activity in patients with polycythemia vera

Abstract Polycythemia vera (PV) is a clonal myeloproliferative disorder characterized by predominantly excessive erythrocyte production. During the course of the disease, bleeding or thrombosis may be observed. In PV patients, the influence of antifibrinolytic activities on development of thrombohemorrhagic complications remains to be elucidated. In the present study, alterations in antifibrinolytic activity of PV patients and the effects of treatments on these alterations were investigated. Newly diagnosed and therapy-naive 22 PV patients were included. Thrombomodulin (TM), plasmin-alpha 2-antiplasmin complex (PAP), plasminogen activator inhibitor-1 (PAI-1) and thrombin activable fibrinolysis inhibitor antigen (TAFIa) levels were measured in all individuals and after phlebotomy and 5-hydroxyurea (5-HU) therapy in PV patients. TM, PAP, PAI-1 and TAFIa values of the patient group were higher than those of the controls. After phlebotomy, no changes were detected in TM, PAI-1 and TAFIa values, but PAP values decreased. On the contrary, 5-HU treatment resulted in a marked decrease in TM, PAI-1, PAP and TAFIa levels. These findings suggested that the changes in antifibrinolytic activity and endothelial dysfunction might be contributed to formation of intravascular thrombosis in PV patients, even though not clinically overt. 5-HU in addition to phlebotomy affects antifibrinolytic activity and may have an influence on diminishing predisposition of thrombosis.

Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction.

PurposeWe investigated the relationship between scintigraphic infarct size and neutrophil counts after acute myocardial infarction (AMI), which has not been adequately studied with imaging tools. MethodsTwenty-eight consecutive patients with anterior AMI were included in the study. Total white blood cell (WBC), neutrophil counts, creatine kinase-myocardial band (CKMB), and cardiac troponin (cTnT) were obtained at admission and daily during the first 72 h after a patients arrival. Single photon emission computed tomography studies were performed at a median interval of 4 days (range, 3–5 days) after the AMI. The severity scores of perfusion defects were calculated. WBC and neutrophil counts correlated with enzymatic and single photon emission computed tomography infarct size. ResultsLeukocyte and neutrophil counts on admission and first day were positively correlated with peak CKMB, peak cTnT, and scintigraphic infarct size. There were no statistical correlations on the second and third days (P>0.05). The most significant relationship was between basal neutrophil counts and scintigraphic infarct size (r = 0.602, P<0.001). Overall, the correlation coefficients with scintigraphy were better than those with peak CKMB and cTnT levels for both WBC and neutrophil counts. ConclusionMeasuring basal neutrophil counts may be considered as an alternative solution in the prediction of infarct size.

An Unusual Etiology of Erythropoietin Resistance: Hyperthyroidism

Many possible causes of resistance to human recombinant erythropoietin (rh-EPO) have been reported in patients with renal failure. This case presents an unusual cause of erythropoietin-resistant anemia in a patient with chronic renal failure. A 61-year-old male patient who was on chronic hemodialysis program due to diabetic nephropathy for seven months developed erythropoietin resistant anemia. No iron deficiency was revealed by laboratory data, no megaloblastic anemia were found by biochemical investigation, and no inflammatory states including infection or neoplastic diseases were disclosed by abdominal ultrasonography, chest X-ray, bone marrow aspiration and biopsy, or other methods (normal C-reactive protein levels). This hemodialysis patient had epoetin-resistant anemia with primary autoimmune hyperthyroidism. The anti-thyroid therapy was effective not only against the hyperthyroidism but also against his epoetin resistant anemia.

A case of recurrent episodes of acute renal allograft failure caused by renal pedicle tortion.

Background: Acute allograft failure which occur intermittently after renal transplantation caused by graft tortion is a very rare entity. We here report highly unusual case of recurrent episodes of acute allograft dysfunction two years after kidney transplantation secondary to ischemic tubular necrosis caused by tortion of renal pedicle due to rotation of the allograft with body movements. Case Presentation: A 55 year-old male patient with living unrelated kidney transplantation for chronic renal failure caused by autosomal dominant polycystic kidney disease had presented recurrent acute deteriorations in renal functions. All laboratory values were within normal limits except elevated serum creatinine levels, acute tubular necrosis in graft biopsy, and detection of pelvic dilatation in renal ultrasonography from time to time. Changes in axis of graft in nuclear medicine scans taken at different times during the same study made us bring to mind the diagnosis of renal pedicle tortion. Renal blood flow measurements with Doppler ultrasonography in different body positions helped to reach the final diagnosis of mobile kidney right on time. The patient is now well after prompt surgical treatment with nephropexy. Discussion: Unfortunately, tortion of allograft once occurred is associated with very high rate of graft loss due to arterial compromise and infarction and it is very difficult to diagnose without high level of suspicion. We discuss the causes of renal allograft tortion and the measures to prevent its occurrence and the methods to diagnose.

Effects of Interferon-α-2a on Th3 Cytokine Response in Multiple Myeloma Patients

Aims and background Multiple myeloma cells increase Th3 cytokine response by secreting TGF-β, which causes defective Th1 and Th2 cytokine responses. Therefore, a significant suppression of the immune system is seen in multiple myeloma. Interferon-α (IFN-α) is used in the treatment of multiple myeloma due to its immunomodulatory and anti-tumoral effects. We attempted to define the characteristics of immune cytokine responses and the effects of IFN-α-2a on the immune response in multiple myeloma. Methods Fifteen patients with multiple myeloma and 15 healthy controls were enrolled. IFN-α-2a, 3 million units/day x 3 times/week, was administered subcutaneously to the patients for 2 weeks. Cytokines (TGF-β, IL-1, IL-2, IL-4, IL-10, IFN-γ) were assessed by the ELISA method in sera of the patients in pretreatment and posttreatment periods and in the sera of the controls. Results IL-2 and IL-4 levels in patients, before IFN-α-2a, were lower than the controls, whereas TGF-β levels were higher than the controls. In other words, Th3 cytokine response was increased and Th1 and Th2 cytokine responses were decreased in patients. A short course of IFN-α-2a increased IL-2 levels. Conclusions These findings suggest IFN-α-2a may enhance nonTh3 cytokine responses in multiple myeloma patients.

Could Pyelonephritic Scarring Be Prevented by Anti-Inflammatory Treatment? An Experimental Model of Acute Pyelonephritis

Objectives. This study aimed to demonstrate if the addition of anti-inflammatory treatment to antibiotic therapy shows any superiority to the treatment with antibiotic only. Methods. Forty-nine Wistar rats were divided into 7 groups. Pyelonephritis was performed by E. coli injection to upper pole of kidneys except control group. Group 2 was not treated. Ceftriaxone, ketoprofen, “ceftriaxone + ketoprofen,” methylprednisolone, and “ceftriaxone + methylprednisolone” were given in the groups. The technetium-99m-dimercaptosuccinic acid scintigraphies were performed in 3rd day to detect pyelonephritis and 10th week to detect renal scarring. All kidneys were also histopathologically evaluated. Results. When 3rd day and 10th week scintigraphies were compared, initial 2.00 ± 0.30 point pyelonephritis score resulted in 0.71 ± 0.36 renal scar score in “ceftriaxone + ketoprofen” group (P = 0.039). Initial 2.00 ± 0.43 point pyelonephritis score resulted in 0.86 ± 0.26 renal scar score in “ceftriaxone + methylprednisolone” group (P = 0.041). Renal scar score was declined in “ceftriaxone + ketoprofen” group and “ceftriaxone + methylprednisolone” group compared with no-treatment group on 10th week of the study (P = 0.026, P = 0.044). On histopathological evaluation, it was seen that renal scar prevalence and expansion declined significantly in “ceftriaxone + ketoprofen and ceftriaxone + methylprednisolone” (P = 0.011, P = 0.023). Conclusion. It was evidenced that ceftriaxone treatment in combination with ketoprofen or methylprednisolone declined scar formation in scintigraphic and histopathologic examinations of the kidneys.

FDG-PET in mantle cell lymphoma involving skin

Mehmet Sonmez1, Umit Cobano lu2, Sava Karya ar3, Bircan Sonmez4 1Department of Hematology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey 2Department of Pathology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey 3Department of Nuclear Medicine, Trabzon Numune Training and Research Hospital, Trabzon, Turkey 4 Department of Nuclear Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey