Central nervous system metastatic epithelial ovarian cancer. Clinical parameters and prognostic factors: a multicenter study of Anatolian Society of Medical Oncology

Central nervous system (CNS) metastasis is a rare event in the course of late stage epithelial ovarian cancer (EOC); however its incidence is increasing in parallel with prolonged survival of patients. Objective: The authors assessed the clinical parameters and potential prognostic features in patients with CNS metastatic disease. Materials and Methods: Clinical data of the 33 patients from the participating centers were retrospectively collected and analyzed. Median age at the time of CNS metastasis was 57 years. Median time from the diagnosis of primiuy EOC until CNS metastatic disease was 22 months. Nearly half (45.5%) of the patients had single CNS metastatic lesions and all patients in the study group except two received radiotherapy as palliative treatment. Median overall survival (OS) from the time of CNS metastasis was 15 months (0-66). At univariate analysis only number of brain metastatic lesions (p = 0.001) and presence of extracranial disease (p = 0.004) were strongly associated with OS whereas multimodal treatment, size of metastatic lesions, platinum sensitivity, age, grade, and disease stage at presentation were not. Development of CNS metastasis carries a poor prognosis, however patients with single metastatic lesions and only intracranial metastatic disease can have prolonged survival after appropriate palliative management of their disease

Simultaneous occurrence of different follicular neoplasms within the same thyroid gland [Aynı tiroid bezinde farklı foliküler hücre kökenli neoplazilerin birlikteliği]

Purpose: Neoplasms of the thyroid gland are classified according to the cells they originate from and commonly develop from cells of follicular origin. The most common differentiated thyroid cancers (DTC) are papillary and follicular carcinomas. Coexistence of two different histological types of primary follicular thyroid neoplasm is a rare condition. There are previous reports of concomitant medullary and papillary thyroid cancers. However, there is scarce data about the simultaneous occurrence of the two different histological types of primary follicular thyroid tumors and this is the first study on that subject. Material and Method: From January 2007 to September 2014, our institutional database was reviewed for patients who underwent thyroid surgery for various indications. Medical records and cytopathology reports of those patients were examined retrospectively. Simultaneous neoplasms of follicular origin were noted. Results: A total of 3.700 patients were operated. Histopathological examination revealed a benign pattern in 2.686 (73%) patients and a malignant pattern in 1.014 (27%) patients. Among the patients with the diagnosis of DTC, only 20 (1.9%) had a concomitant neoplasm within the same thyroid gland. Discussion: Such simultaneous tumors may be a part of a familial tumor syndrome or an unidentified novel gene mutation playing role in the pathogenesis of more than one type of tumor. Based on the current evidence, the synchronous occurrence of those neoplasms in a given patient is likely coincidental in the literature. Further studies on larger patient population with standardized genetic characterization are needed. © 2016, Galenos Yayincilik. All rights reserved

Perspective of Turkish Medicine Students on Cancer, Cancer Treatments, Palliative Care, and Oncologists (ARES Study): a Study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913–2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15–iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840–841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words “cancer” and “oncologist” meant for the students. The participant students were analyzed in two study groups; “group 1” (n = 1.255) were phases I and II students that had never attended an oncology lesson, and “group 2” (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p < 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of “death” (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students’ understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country. © 2018, American Association for Cancer Education

Perspective of turkish medicine students on cancer, cancer treatments, palliative care, and oncologists (ares study): A study of the palliative care working committee of the turkish oncology group (TOG)

Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913–2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15–iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840–841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words “cancer” and “oncologist” meant for the students. The participant students were analyzed in two study groups; “group 1” (n = 1.255) were phases I and II students that had never attended an oncology lesson, and “group 2” (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of “death” (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students’ understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country. © 2018, American Association for Cancer Education

Effects of alprostadil and iloprost on renal, lung, and skeletal muscle injury following hindlimb ischemia&ndash;reperfusion injury in rats

Dilek Erer,1,* Abdullah &Ouml;zer,1,* H&uuml;seyin Demirtaş,1 İpek Işık G&ouml;n&uuml;l,2 Halil Kara,3 Hande Arpacı,4 Faruk Metin &Ccedil;omu,5 G&uuml;rsel Levent Oktar,1 Mustafa Arslan,6 Ayşeg&uuml;l K&uuml;&ccedil;&uuml;k7 1Department of Cardiovascular Surgery, 2Department of Pathology, Gazi University Medical Faculty, 3Department of Pharmacology, Yıldırım Beyazıt University Medical Faculty, 4Department of Oral and Maxillofacial Surgery, Ankara University Faculty of Dentistry, Besevler, Ankara, 5Department of Physiology, Kırıkkale University Medical Faculty, Kırıkkale, 6Department of Anesthesiology and Reanimation, Gazi University Medical Faculty, Ankara, 7Department of Physiology, Dumlupınar University Medical Faculty, K&uuml;tahya, Turkey *These authors contributed equally to this work Objectives: To evaluate the effects of alprostadil (prostaglandin [PGE1] analog) and iloprost (prostacyclin [PGI2] analog) on renal, lung, and skeletal muscle tissues after ischemia reperfusion (I/R) injury in an experimental rat model.Materials and methods: Wistar albino rats underwent 2 hours of ischemia via infrarenal aorta clamping with subsequent 2 hours of reperfusion. Alprostadil and iloprost were given starting simultaneously with the reperfusion period. Effects of agents on renal, lung, and skeletal muscle (gastrocnemius) tissue specimens were examined.Results: Renal medullary congestion, cytoplasmic swelling, and mean tubular dilatation scores were significantly lower in the alprostadil-treated group than those found in the I/R-only group (P&lt;0.0001, P=0.015, and P&lt;0.01, respectively). Polymorphonuclear leukocyte infiltration, pulmonary partial destruction, consolidation, alveolar edema, and hemorrhage scores were significantly lower in alprostadil- and iloprost-treated groups (P=0.017 and P=0.001; P&lt;0.01 and P&lt;0.0001). Polymorphonuclear leukocyte infiltration scores in skeletal muscle tissue were significantly lower in the iloprost-treated group than the scores found in the nontreated I/R group (P&lt;0.0001).Conclusion: Alprostadil and iloprost significantly reduce lung tissue I/R injury. Alprostadil has more prominent protective effects against renal I/R injury, while iloprost is superior in terms of protecting the skeletal muscle tissue against I/R injury. Keywords: alprostadil, iloprost, ischemia reperfusion injury, rat, renal, lung, skeletal muscl

Effects of lornoxicam and intravenous ibuprofen on erythrocyte deformability and hepatic and renal blood flow in rats

Hande Arpacı,1,* Faruk Metin &Ccedil;omu,2 Ayşeg&uuml;l K&uuml;&ccedil;&uuml;k,3 Bahadır K&ouml;sem,4 Seyfi Kartal,4 Volkan Şıvgın,5 H&uuml;seyin Cihad Turgut,6,* Muhammed Enes Aydın,5 Derya Sebile Ko&ccedil;,5 Mustafa Arslan5 1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, 2Department of Medical Physiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, 3Department of Medical Physiology, Faculty of Medicine, University of Dumlupınar, K&uuml;tahya, 4Department of Anesthesiology and Reanimation, Turgut &Ouml;zal University Hospital, 5Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, 6Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey *These authors contributed equally to this work Background: Change in blood supply is held responsible for anesthesia-related abnormal tissue and organ perfusion. Decreased erythrocyte deformability and increased aggregation may be detected after surgery performed under general anesthesia. It was shown that nonsteroidal anti-inflammatory drugs decrease erythrocyte deformability. Lornoxicam and/or intravenous (iv) ibuprofen are commonly preferred analgesic agents for postoperative pain management. In this study, we aimed to investigate the effects of lornoxicam (2&nbsp;mg/kg, iv) and ibuprofen (30&nbsp;mg/kg, iv) on erythrocyte deformability, as well as hepatic and renal blood flows, in male rats.Methods: Eighteen male Wistar albino rats were randomly divided into three groups as follows: iv lornoxicam-treated group (Group L), iv ibuprofen-treated group (Group İ), and control group (Group C). Drug administration was carried out by the iv route in all groups except Group C. Hepatic and renal blood flows were studied by laser Doppler, and euthanasia was performed via intra-abdominal blood uptake. Erythrocyte deformability was measured using a constant-flow filtrometry system.Results: Lornoxicam and ibuprofen increased the relative resistance, which is an indicator of erythrocyte deformability, of rats (P=0.016). Comparison of the results from Group L and Group I revealed no statistically significant differences (P=0.694), although the erythrocyte deformability levels in Group L and Group I were statistically higher than the results observed in Group C (P=0.018 and P=0.008, respectively). Hepatic and renal blood flows were significantly lower than the same in Group C.Conclusion: We believe that lornoxicam and ibuprofen may lead to functional disorders related to renal and liver tissue perfusion secondary to both decreased blood flow and erythrocyte deformability. Further studies regarding these issues are thought to be essential. Keywords: rat, lornoxicam, iv ibuprofen, erythrocyte deformability, blood flo