Sezai Vatansever

Acute Wood or Coal Exposure with Carbon Monoxide Intoxication Induces Sister Chromatid Exchange

Objective: The object of this study was to investigate the genotoxic effect of acute overexposure to combustion products originating from coal or wood stoves in patients presenting with acute carbon monoxide intoxication. Study Design: In a prospective study, we analyzed the frequency of sister chromatid exchange and the carboxyhemoglobin concentration in 20 consecutive patients without a history of smoking or drug use who had been treated in the Emergency Care Unit of Istanbul Medical Faculty due to acute carbon monoxide intoxication. All of these cases were domestic accidents due to dysfunctioning coal or wood stoves. The results were compared with a control group of 20 nonsmoking, nondrug-using healthy individuals matched for age, sex, and absence of other chemical exposure. Results: The mean sister chromatid exchange frequency per metaphase was significantly higher in the study group compared to the control group: 8.11±2.39 vs. 6.33±1.60 (p=0.008). We found that there was no positive correlation between the blood carboxyhemoglobin concentration and sister chromatid exchange frequency. Conclusions: These results suggest that acute exposure to combustion products of wood or coal is genotoxic to DNA. Potential causes of genotoxicity include known mutagenic compounds present in coal or wood smoke and ash, oxygen radicals formed during combustion, as well as hypoxic and reperfusion injury mechanisms initiated by carbon monoxide intoxication. Additional studies on separate carbon monoxide exposure from smoke and ash are needed to understand individual genotoxic contributions and mechanisms.

The Effect of Air Pollution and Meteorological Parameters on Chronic Obstructive Pulmonary Disease at an Istanbul Hospital

In this study, the relation between emergency admissions for chronic obstructive pulmonary disease (COPD) at an Istanbul University Hospital between the years 1997 and 2001 and the meteorological and air pollution parameters has been analysed. Admissions were calculated for each month, and the relations between the number of admissions for each month and the corresponding months meteorological parameters (pressure, temperature, moisture) and the average pollution values (CO, SO2, NO, NO2, PM10) were determined. There were 1586 patients included in this study. COPD admissions had a negative significant correlation with temperature (r =-0.72, p<0.001), a positive significant correlation with pressure (r=0.41, p=0.001) and humidity (r=0.34, p=0.007), and also had a positive significant correlation with SO2 (r=0.64, p<0.001), NO (r=0.40, p=0.002), CO (r=0.57, p<0.001) and PM10 (r=0.27, p=0.03). No significant relationship was found for NO2. When the meteorological and clinical parameters were evaluated, it was found that the only variable related to the COPD admissions was temperature. These results for COPD admissions were found to be considerably higher in seasons other than summer (p <0.001). When summer seasonal values were taken as reference (RR=1), RR=1.24 (95% CI: 1.049–1.475) for autumn, RR=1.86 (95%CI: 1.541–2.115) for spring and RR=2.08 (95% CI: 1.793–2.434) for winter. Air pollution and meteorological parameters should be seen as a widespread public health problem, which can trigger admission and even death due to COPD.

The Effect of Air Pollution and Meteorological Parameters in Istanbul on Hospital Admissions for Acute Coronary Syndrome

It is known that air pollution and meteorological parameters have a negative effect on various respiratory and cardiovascular parameters. In this study, the relationship between emergency hospital admissions for acute coronary syndrome (ACS) and the meteorological and air pollution parameters over the same period were investigated. Some 2889 patients admitted to the emergency internal medicine unit between 1997-2001 were included in this study. The number of patient admissions per month with a diagnosis of ACS were determined and the relationship between meteorological parameters (pressure, temperature, humidity) and mean values of parameters of pollution including carbon monoxide (CO), sulphur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), mass of particles smaller than 10 m (PM10) were investigated. Monthly admission figures for ACS were positively correlated with pressure and negatively correlated with temperature. No relationship between air humidity and admission for ACS was detected. There was also positive correlation between ACS and SO2, CO, NO and PM10levels. The results showed that the most important meteorological parameter that increased the number of admissions for ACS was a decrease in air temperature, and the most important pollution parameter was SO2. Admission for ACS significantly increased in winters and springs in comparison with summers (RR 1.15%95 CI(1.039-1.279); RR 1.16%95 CI(1.046-1.291)). Air pollution and meteorological parameters should be seen as a widespread public health problem, which can trigger admission and even death due to ACS. Greater effort should be expended to further lower air pollution levels.

Adrenocortical Carcinoma: Clinicopathological Features, Prognostic Factors and Outcome

Objective: The purpose of this study was to investigate the clinicopathological characteristics and treatment outcomes of patients with adrenocortical carcinoma (AC). Methods: Twenty-four patients (10 females and 14 males) diagnosed with AC between 1998 and 2009 were evaluated. Clinical features and outcomes were reviewed. Results: Median age was 46.5 years. One (4%) patient was classified as stage I, 10 (42%) were classified as stage II, 8 (33%) were classified as stage III and 5 (21%) were classified as stage IV. Tumor sizes ranged from 3 to 22 cm with a mean diameter of 11 cm. Five patients were locally inoperable at initial diagnosis. In addition to surgery, 2 of 19 patients were treated with an adjuvant cisplatin plus etoposide regimen. Sixteen patients were treated with chemotherapy after recurrence. Median survival time was 18 months. The 1- and 5-year overall survival estimates were 73 and 48%, respectively. Mean survival times for male and female patients were 58 and 12 months, respectively (p = 0.046). Early T stage (p = 0.04), lymph node negativity (p < 0.001), the absence of distant metastases (p < 0.001) and early stage (p < 0.001) were correlated with overall survival. Conclusion: AC is a rare disease with a poor prognosis. There are correlations between gender, stage and survival.

Factors affecting progression-free survival in non-HIV-related Kaposi sarcoma

Abstract Background: Non-HIV related Kaposi sarcoma (NHKS) is a rare indolent neoplasm which is more common around Mediterranean origin. Data concerning factors that influence progression-free survival (PFS) for NHKS are insufficient. The purpose of present retrospective analysis was to distinguish the factors affecting PFS in patients with NHKS. Methods: A hundred and twenty-eight consecutive patients with NHKS who were treated or observed between 1997 and 2014 at Istanbul University Institute of Oncology were included into the study. Treatment response and progression definitions were determined according to different treatment modalities administered at first line. Results: Majority of patients were male (n = 97, 75.8%). Median age of the whole group was 66 years (28–85). Of the patients, 15 patients were immunosuppressant, whereas 113 patients had no disease that caused immunosuppression. Patients were treated with local excision (n = 57, 44.5%), chemotherapy (n = 32, 25.0%) and/or radiotherapy (n = 13, 10.2%) or observed without treatment (n = 26, 20.3%). At a median follow-up of 28 months, 71 (55.5%) patients had progression, while 3 patients (2.3%) died of NHKS. On univariate analysis, patients who had hypertension (HT) had poorer PFS compared with others (19 ± 12 versus 41 ± 22 months; p = 0.03), whereas plaque formation was associated with better outcome (25 ± 9 versus 54 ± 12 months; p = 0.03). In addition, heavy smoking (≥40 pack-years) had a borderline significance regarding better PFS time (23 ± 24 versus 45 ± 38 months, p = 0.06). On multivariate analysis, none of factors evaluated had any impact on PFS. Conclusions: HT was correlated with poorer outcome among NHKS patients. Patients with plaque formation and ≥40 pack-years of smoking had better PFS than others.

An Adolescent in Istanbul with Munchausen's Syndrome

This article presents the treatment period for a 16-year-old girl with Munchausens syndrome. She was initially referred to the hospital with emphysema of the face, which turned out to be due to self-injection of air. She had an eight-month hospitalization period for the diagnosis of her condition. After the diagnosis was established she was treated by our psychiatric team and followed for 21 months successfully without recurrence.

Is it solitary plasmacytoma or nonsecretory myeloma? A must-be-solved dilemma?

Presentation of multiple myeloma with bone lesions is common. It is vital that differentiation between nonsecretory multiple myeloma and plasmocytoma be done and that each disorder be treated accordingly. In this paper, we present a patient with nonsecretory multiple myeloma, who suffered from distal humerus fracture with severe bone destruction, renal failure, hypercalcemia and anemia.

Clinical significance of serum vascular cell adhesion molecule-1(VCAM-1) in colorectal cancer.

550 Background: Vascular cell adhesion molecule-1 (VCAM-1) is a transmembrane glycoprotein, which is expressed on endothelium and contributes in leukocyte adhesion and extravasation during inflammation. It has been demonstrated that VCAM-1 is over-expressed on colorectal cancer (CRC) cells and plays role in metastasis development and angiogenesis. We aimed to compare serum VCAM-1 levels of CRC patients with heathy controls and evaluate its relationship with clinicopathologic parameters, treatment response and overall survival (OS). Methods: The study enrolled 111 patients with histopathologically confirmed CRC followed up between February 2010-September 2013 in Institute of Oncology, Istanbul University and 30 sex- and age-matched healthy controls. Pre-treatment serum VCAM-1 levels were determined by the solid-phase sandwich ELISA method. Results: The cancer localisation was rectum in 40% and colon in 60% of patients. Metastatic disease was present in 51.4%. Forty percent of 40 metastatic patients who rec...

Clinical significance of serum protein and mRNA level of insulin-like growth factor-1 (IGF-1) in patients with hepatocellular carcinoma.

203 Background: The hepatocellular carcinoma (HCC) is one of the most common malignant tumors and the absolute positive and negative markers for HCC are still lacking, and even those characterized by very high sensitivity and specificity do not have an universal diagnostic usefulness. The aim of this study was to assess the usefulness of serum protein and circulating mRNA of insulin-likegrowth factor-1 (IGF-1) as a diagnostic and prognostic tool in HCC. Methods: Fifty-four HCC patients were enrolled into this study. Age and sex matched 20 healthy controls were also included in the study. Serum IGF-1 levels were determined by the solid-phase sandwich ELISA method. Serum IGF-1 mRNA levels were determined by quantitative RT-PCR. Results: The median age at diagnosis was 60 years, range 16–88 years; 48 patients were men. All of patients had cirrhotic history. Fourty-six percent (n=25) of patients had Child-Pugh Score A, 30% (n=16) had Score B or C. All of the patients were preformed with local therapies but no...

Biweekly triplet chemotherapy with gemcitabine, cisplatin and vinorelbine for advanced chemotherapy naïve non-small cell lung cancer.

AIMS AND BACKGROUND To investigate the efficacy and tolerability of biweekly scheduled triplet chemotherapy consisting of gemcitabine, cisplatin and vinorelbine for chemotherapy-naïve advanced non-small cell lung cancer. METHODS AND STUDY DESIGN Patients with stage IIIB/IV non-small cell lung cancer and performance status of 0-2 were eligible. Patients who had brain metastasis and of an older age were also enrolled in the study. The triplet combination chemotherapy consisted of gemcitabine, cisplatin and vinorelbine at the doses of 1000 mg/m(2), 25 mg/m(2) and 50 mg/m(2), respectively, were administered on day 1 and 14, every 28 days, up to 6 cycles. RESULTS Thirty patients were enrolled in the study. Median age was 60 years (range, 42-74). Most of the patients (83%) had metastatic disease and 7 patients (23%) had brain metastasis. In assessing 24 patients for response evaluation, none had complete response. Partial responses were achieved in 18 (60%) patients. Four patients (13%) had stable disease and 2 (7%) progressed. Thirteen percent and 20% of the patients developed severe (grade 3-4) neutropenia and anemia, respectively. Febrile neutropenia, severe thrombocytopenia, hepatic and renal toxicity were not seen. Overall and progression-free survival were 8.15 and 7.15 months, respectively. Patients who had no brain metastasis ( P = 0.069), who had more than 3 courses of chemotherapy (P <0.001), and who had chemotherapy applied without dose reduction (P = 0.018) had better survivals. CONCLUSIONS The biweekly schedule of the triplet chemotherapy combination including gemcitabine, cisplatin and vinorelbine was effective in advanced, mostly metastatic non-small cell lung cancer with acceptable and manageable side effects.