Senar Ebinc

Life-threatening hypophosphatemia and/or phosphate depletion in a patient with acute lymphoblastic leukemia: a rare case report

Acute severe hypophosphatemia can be life threatening and is associated with mortality and impaired cardiac and respiratory function. Several conditions including decreased absorption or increased urinary phosphate excretion, shifts from the extracellular to intracellular compartments, and phosphate consumption by rapidly proliferating cells are known to induce moderate to severe acute hypophosphatemia. Although hypophosphatemia and/or phosphate depletion in patients with acute or chronic myeloid leukemia have been reported in the literature, hypophosphatemia due to acute lymphoblastic leukemia (ALL) is very rare. We report a case of history of ALL complicated by life-threatening hypophosphatemia manifesting as generalized muscle weakness, fatigue, acute shortness of breath, and difficulty in standing up and walking for 3 days. Serum inorganic phosphate levels were consistently low (0.06 mmol/L). The patient was hospitalized and thought to have a relapsed ALL.Anticancer agents and oral phosphate (660 mg twice daily) were administered. On the second day of treatment, the patient began to improve, and the patient gradually fully recovered within 5 days.We suggested that this hypophosphatemia was induced by a shift of phosphorus into leukemic cells that rapidly replicated in the tissues and excessive cellular phosphate consumption by rapidly proliferating cells. Serum phosphate levels should always be monitored,especially in suspected life-threatening manifestation in relapsed ALL.

The association between serum Dickkopf-1 levels and esophageal squamous cell carcinoma.

Serum Dickkopf-1(DKK-1) is elevated in many malignancies and is an important indicator of malignant potential. However, its significance in esophageal squamous cell cancer (ESCC) has not yet been clarified. We hypothesized a role for DKK-1 in patients with ESCC. The study consisted of 90 ESCC patients and 85 healthy controls. After diagnosis, the level of DKK-1 was measured in the serum samples by enzyme-linked immunosorbent assay and the levels of DKK-1 were much higher in the ESCC patients than in the healthy control group (p < 0.0001). For serum DKK-1, the sensitivity and specificity of the assay were 70 and 80%, respectively. The preoperative serum DKK-1 level was elevated in the ESCC patients. Although serum DKK-1 is not a specific biomarker for ESCC, it might be a useful marker for the diagnosis and treatment of ESCC.

Prevalence of Helicobacter pylori in Patients With Brucellosis

Background Helicobacter pylori infection affects approximately 40 million individuals in Turkey. Our prefecture is an endemic area for H. pylori infection and brucellosis. However, there are no data on the H. pylori prevalence among patients with brucellosis. Objectives The primary aim of the current study was to investigate the link between H. pylori infection and brucellosis. The secondary aim was to determine the seroprevalence of H. pylori infection in healthy individuals. Methods Between May 2010 and May 2011, serum was collected from patients with Brucella infection (n = 111) and healthy individuals (n = 120) and analyzed using an enzyme-linked immunosorbent assay kit. Brucella infection was defined as a positive Wright test or blood culture positivity for Brucella in conjunction with disease symptoms and findings. Results Among the 111 patients with brucellosis, 69% (n = 77) had a seropositivity result for H. pylori IgG. The healthy control subjects had an 87% (n = 104) seropositivity for H. pylori IgG. The serum H. pylori IgG antibody seropositivity was significantly lower in the patients with Brucella infection compared with the control subjects (P < 0.001). Conclusion Our results show that the serum prevalence of H. pylori among the patients infected with brucellosis is significantly lower than that in the control population. A negative correlation between H. pylori infection and brucellosis infection might be hypothesized.

Higher seroprevalence of hepatitis B virus antigen in patients with cystic hydatid disease than in patients referred to internal medicine clinics in Turkey.

Turkey remains an intermediate area for prevalence of hepatitis B virus (HBV) surface antigenemia. The sheep-raising areas of Turkey also pose a high risk for cystic hydatid disease (CHD). Both HBV infection and CHD are major public health issues particularly in eastern parts of Turkey; however, there is no data regarding HBV infection in patients who have had CHD. The aims of this study were to evaluate the association between HBV infection and CHD and suggest ways to reduce HBV infection which is still widespread in Turkey. A retrospective study was conducted with 94 adult patients with active CHD referred to the hepatology department, Yuzuncuyil University School of Medicine from December 2010 to December 2012. All subjects came from rural areas of the region and underwent ultrasonography of abdomen which detected CHD of the liver. All the patients were serologically positive for Echinococcus granulosus. The control group consisted of 500 patients (300 men and 200 women) referred to the internal medicine clinics for other reasons. The patients with CHD and in the control group were tested for the existence of HBs antigen according to the standard procedures. The seroprevalence of HBs antigen was significantly higher in patients with active CHD than those in the control group (12.7% vs 5.2%; P=0.0017). Our data indicate that there is significant association between HBV infection and CHD. All patients with CHD should be screened for HBV infection.

Clinical and Laboratory Features of CD5-Negative Chronic Lymphocytic Leukemia

Background Chronic lymphocytic leukemia (CLL) usually expresses CD5 antigen. However, 7–20% of patients are CD5 negative. We report here a series of 19 CD5-negative B-CLL cases. Material/Methods We reviewed 19 consecutive CD5-negative B-CLL cases seen in our medical center from 2009 to 2015 and compared them with 105 CD5-positive B-CLL cases. The two groups were compared in terms of clinical parameters, laboratory parameters, and survival characteristics. Results Lymphadenopathy was present in 31.5% of the CD5-negative group and 51.4% of the CD5-positive group (p=0.029). Splenomegaly was present in 42.1% of the CD5-negative group and 16.1% of the CD5-positive group (p=0.029). There was no difference between the groups in terms of Binet A, B, and C stages (p=0.118, p=0.051, and p=0.882, respectively). The median thrombocyte count was 144×109/L and 160×109/L in the CD5-negative and CD5-positive groups, respectively (p=0.044). There was no difference between the two groups in terms of median neutrophil count (p=0.169). The mean lymphocyte count was 43.2±4.0×109/L and 36.7±3.2×109/L in the CD5-negative and CD5-positive groups, respectively (p=0.001). There was no difference between the groups in terms of autoimmune hemolytic anemia and autoimmune thrombocytopenia. In five-year follow-up, 84.2% of CD5-negative patients and 90.5% of CD5-positive patients were alive (p=0.393). Conclusions We found more isolated splenomegaly, less lymphadenopathy, a higher lymphocyte count, and a lower thrombocyte count in the CD5-negative group. There was no difference between the groups in terms of clinical stage, autoimmune phenomena, hemoglobin and neutrophil count, and survival.

Pulmonary Edema and Myocarditis Developing Due to Scorpion Stings

DOI: 10.4328/JCAM.1412 Received: 20.11.2012 Accepted: 11.12.2012 Publihed Online: 11.12.2012 Corresponding Author: Hayriye Gönüllü, Yüzüncü Yıl Üniversitesi, Tıp Fakültesi, Acil Tıp AD, Van, Türkiye. T.: +905057672477 E-Mail: drhayriyegonullu@windowslive.com Özet Akrep sokmalarının birçoğu zararsız olmakla beraber, öldürücü akrep türleri multiorgan yetmezliği, nörotoksisite, kardiyotoksisite ve pulmoner ödeme neden olabilir. Sistemik etkilerin gelişme ihtimaline karşı bu hastalar acil serviste gözlenmelidir. Özellikle pulmoner ödem ve miyokardit gibi ölümcül komplikasyonlar akılda tutulmalıdır. Bu çalışmada acil servise akrep sokması nedeniyle başvuran ve miyokardit ve pulmoner ödem saptanan olgu sunuldu.

Abnormal liver function test in hydatidiform moles: a retrospective study comparing the hyperthyroid state and the euthyroid state

Abstract Introduction: The effect of a hyperthyroid or euthyroid state on liver function tests in patients with hydatidiform moles (HM) is not known. The aim of this study was to determine the effect of hyperthyroidism on liver transaminases in HM. Patients and methods: We retrospectively reviewed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in 80 patients with HM (23 complete moles and 57 partial moles). Results: Of the 80 HM patients, 52 (65%) were euthyroid and 28 (35%) were hyperthyroid. The number of gravida and the levels of serum β-human chorionic gonadotropin (β-HCG), AST, and ALT were significantly higher in the hyperthyroid state than in the euthyroid state (p = 0.033, p = 0.001, p = 0.001 and p = 0.001; respectively). Number of gravida, serum TSH and total T4 were significantly higher in complete HM than partial HM (p < 0.05, p < 0.001, p < 0.05; respectively). Conclusions: Our results demonstrated that HM-related β-HCG may activate thyroid cells via TSH-related signalling, resulting in the release of high levels of FT4, FT3, TT3 and TT4, and a subsequent decrease in TSH.

Restless Legs Syndrome in Multiple Myeloma Patients

Background Restless legs syndrome (RLS) is a common neurological condition characterized by uncomfortable and unpleasant sensations in the legs that are relieved by movement. It is frequently idiopathic, sometimes associated with specific disorders such as malignancies. Because there is no study relevant to RLS in Multiple Myeloma (MM), we aimed to evaluate the frequency of RLS in MM patients during chemotherapy and examined the relationship between presence of RLS and depression and anxiety in these patients. Methods We enrolled a population of 62 adult MM patients for RLS features. RLS was ascertained in MM patients by both the presence of the four essential International RLS Study Group diagnostic criteria and neurological examination. The International RLS Study Group rating scale was used to measure RLS severity. Hospital Anxiety and Depression Scale (HADS) was used to evaluate the levels of depression and anxiety and Short Form-36 (SF-36) to evaluate health related quality of life (HRQOL). Results A total of 62 MM patients were evaluated. Among them 11 were identified by the screening questionnaire to meet the criteria for RLS (17.74%). MM patients with RLS had higher levels of depression (P < 0.01) and anxiety (P < 0.01) and poorer HRQOL compared with those without RLS. Conclusions The frequency of RLS in MM patients is higher than that of expected in the general population. MM patients afflicted by RLS have significantly higher levels of depression, anxiety and poorer HRQOL. Recognition and treatment of RLS in MM patients may be an important target in clinical management and may improve overall health outcomes in these patients.