Thrombocytopenia, thrombocytopenia in Intensive Care, APACHE II, Thrombocytopenia and mortality.

TEZ9984Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2012.Kaynakça (s. 79-82) var.XI, 83 s. : tablo ; 29 cm.Amaç: Trombositopeni Yoğun Bakım Ünitelerinde çok yaygın gözlenen klinik bir problemdir. Bu çalışmada Ç.Ü.T.F. Dahiliye Yoğun Bakım Ünitesi’nde trombositopeni sıklığını, trombositopeninin altta yatan nedenlerini, klinik sonuçlarını, mortalite ve morbiditeye olan katkısını saptamayı ve nihayetinde tüm bu sonuçların ışığında trombositopenisi olan yoğun bakım hastalarının yönetimini gözden geçirmeyi amaçladık. Gereç ve Yöntem: Ç.Ü.T.F. Dahiliye Yoğun Bakım Ünitesi’nde Temmuz 2011 ve Ağustos 2012 tarihleri arasında takip edilen 548 hasta incelendi. Bu hastalar içerisinde trombosit sayısı 150.000/uL’nin altında olan 165 hasta çalışmaya dahil edildi. Trombositopeni nedenleri araştırıldı. Trombositopenisi olan hastalar trombosit sayılarına göre 4 gruba (0-19.000/uL, 20-49.000/uL, 50-99.000/uL ve 100-149.000/uL), Acute Phsyiology and Chronic Evaluation (APACHE) II skorlarına göre üç gruba (10-24, 25-34, 35 ve üstü) ayrılarak mortaliteleri, Yoğun Bakımda yatış süreleri, koagülasyon parametreleri, hemoglobin, Beyaz Küre değerleri, trombositopeni gelişme günleri incelendi. Trombositopenisi olan ve trombositopenisi olmayan hastaların mortalite ve Yoğun Bakım yatış süreleri karşılaştırıldı. Bulgular: Çalışma döneminde Dahiliye Yoğun bakım Ünitesinde toplam 548 hasta takip edilmiş olup 165 hastada trombositopeni gözlendi (%30,1). Hastaların 61’i (%37’si) kadın, 104’ü (%63’ü) erkekti. Ortalama yaş 57,2±16,4 (min:18, max:91) idi. Takip edilen hastaların 134’ünün (%81,2) yoğun bakıma kabulü sırasında trombositopenisi varken; 31’inde (%18,8) yoğun bakım takipleri sırasında trombositopeni gelişti. Hastaların 30 (%18)’unda trombositopeni nedeni Sepsis, 18 (%10,9) indetrombositopeni nedeni DİK idi. Yoğun Bakıma kabulün ilk günü hesaplanan ortalama APACHE II skoru 22 idi (min:10, max:42). Çalışma süresince Dahiliye Yoğun Bakım Ünitesinde takip edilen 548 hastanın 288’i (%52,5) exitus oldu. 260 hasta (%47,5) ise servislere devredildi ya da taburcu oldu. Çalışmamızda 165 trombositopenik hastanın 115’i (%69,7), trombositopenik olmayan 383 hastanın 173’ü (%45,1) exitus oldu. Buna göre trombositopenisi olan hastalarda mortalite anlamlı olarak daha fazladır (p=0,020). Ulaşılan en düşük trombosit düzeyi 20.000/uL’nin altında olan 44 hastanın 37’si (%84,1), Ulaşılan en düşük trombosit düzeyi 20 ile 50.000/uL arasında olan 62 hastanın 46’sı (%74,2) ve Ulaşılan en düşük trombosit düzeyi 50.000/uL’nin üstünde olan 59 hastanın 32’si (%54,2 exitus olmuş olup; ulaşılan en düşük trombosit düzeyi düştükçe (trombositopeni derinleştikçe) mortalitenin istatistiksel olarak anlamlı derecede arttığı gözlendi (p=0,003) Ayrıca aynı APACHE II skoruna sahip hasta gruplarında trombosit sayısı düştükçe mortalitenin istatistiksel olarak anlamlı derecede arttığı saptandı. (p=0,002 Sonuç: Ç.Ü.T.F. Dahiliye Yoğun Bakım Ünitesinde Trombositopeninin en sık sebepleri Sepsis ve DİK olup, Trombositopeni mortaliteyi arttıran bir etkendir.Purpose: Thrombocytopenia is a highly common clinical problem encountered in Intensive Care Units. The purpose of the present study is to determine the thrombocytopenia frequency in Ç.Ü.T.F. Internal Medicine Intensive Care Unit, the underlying causes of thrombocytopenia, clinical results, and the coefficient to the mortality and morbidity as well as to review the management of the intensive care patients with thrombocytopenia in the light of such results. Material and Method: 548 patients monitored by Ç.Ü.T.F. Internal Medicine Intensive Care Unit are examined between July 2011 and August 2012. Within these patients, 165 of them are included in the study with thrombocyte count below 150.000/uL. The causes of thrombocytopeniaare investigated. Patients with thrombocytopenia are divided into 4 groups (0-19.000/uL, 20-49.000/uL, 50-99.000/uL and 100-149.000/uL) based on their thrombocyte count, three groups (10-24, 25-34, 35 and above) based on their APACHE II scores and then their mortality, hospitalization duration in the Intensive Care, coagulation parameters, hemoglobin, White Blood Cell values and thrombocytopenia development days are examined. Mortality and Intensive Care hospitalization durations of the patients with thrombocytopenia and without thrombocytopenia are compared. Findings: A total of 548 patients were monitored in the Internal Medicine Intensive Care Unit during the study period and 165 of them were noted with thrombocytopenia (30,1%). 61 of the patients were female (37%), and 104 of the patients were male (63%). The mean age was 57,2±16,4 (min: 18, max: 91). While 143 of the patients monitored (81,2%) had existing thrombocytopenia during their admittance to the intensive care; 31 of them (18,8%) developed thrombocytopenia during their intensive care monitoring. Sepsis was the cause of thrombocytopenia in 30 of the patients (18%), and DIC was the cause of thrombocytopenia in 18 of the patients (10,9%). The mean APACHE II score calculated on the first day of admittance to the Intensive Care was 22 (min: 10, max: 42). 288 of the 548 patients (52,5%) monitored in the Internal Medicine Intensive Care Unit manifested exitus during the study period. 260 patients (47,5%) were referred to services or discharged. 115 of 165 thrombocytopenic patients (69,7%) and 173 of 383 non- thrombocytopenic patients (45,1%) included in our study manifested exitus. Accordingly, mortality is significantly higher in patients with thrombocytopenia (p=0,020). 37 of 44 patients (84,1%) with lowest thrombocytopenia level achieved below 20.000/uL, 46 of 62 patients (74,2%) with lowest thrombocytopenia level achieved between 20 and 50.000/uL, and 32 of 59 patients (54,2%) with lowest thrombocytopenia level achieved above 50.000/uL developed exitus; it is observed that the mortality statistically significantly increased as the lowest thrombocytopenia level achieved decreased (thrombocytopenia deepened) (p=0,003). Furthermore, it is seen that the mortality statistically significantly increased as the thrombocytopenia count decreased in the patient groups with same APACHE II score (p=0,002). Conclusion: The most common causes of Thrombocytopenia in Ç.Ü.T.F. Internal Medicine Intensive Care Unit are Sepsis and DIC, and Thrombocytopenia is a factor increasing the mortality

Pankreasın Ekstra-Medüller Miyeloid Tümörü: Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Extramedüller miyeloid tümörler (EMMT) miyeloid hücrelerin neoplazileridir. Bu tümörler bütün organlarda oluşabilir fakat bazı lokalizasyonlarda EMMT saptanması nadirdir ve pankreasın EMMT ile tutulumu da nadirdir. Burada allogeneik kök hücre naklinden 4 yıl sonra gelişen pankreas EMMT'ü sunulmuş ve mevcut bilgi gözden geçirilmiştirExtramedullary myeloid tumors (EMMTs) are the tumors of myeloid cells. These tumors may occur in all of the organs of the body, but some localizations are rare. Pancreatic involvement of EMMTs is a rare entity. Here we report a case of EMMT of the pancreas 4 years after allogeneic stem cell transplantation and we review the existing data about EMMTs involving the pancrea

Evaluation of Computed Tomography, Clinical and Laboratory Findings of COVID-19 in Cancer Patients

Aim: The aim of this study was to evaluate the computed tomography (CT), clinical andlaboratory findings of coronavirus disease 2019 (COVID-19) in cancer patients and to comparethe findings between polymerase chain reaction (PCR) positive and negative patients.Material and Methods: Twenty-three cancer patients with positive PCR tests and 22diagnosed as COVID-19 with clinical and radiological findings were included in the study. CTimages of the patients were evaluated simultaneously by two radiologists. Presence ofcomorbid diseases, symptoms and laboratory values were evaluated.Results: The most common CT involvement pattern was peripheral with 88.9% (n=40).Bilateral lung involvement rate was 57.8% (n=26). The most common finding was groundglass opacities (n=38, 84.5%). 35.6% (n=16) of these were accompanied by consolidation.Multifocal involvement was present in 62.2% (n=28) of the cases. The most frequentlyinvolved lobes were lower lobes. Other relatively common findings were septal thickening,subpleural streaking, and air bronchogram. The median neutrophil, lymphocyte, D-dimer,procalcitonin, C-reactive protein and lactate dehydrogenase values of the patients were 2000mm3, 1200 mm3, 1990 ng/mL, 30.7 mcg/L 15.8 mg/dl, 161 IU/L, respectively.Conclusion: Multifocal and bilateral involvement, and ground glass opacities were the mostcommon findings. However, higher rates of septal thickening, which is generally less common,suggest that the findings may be more severe in cancer patients. Most of the inflammatorymarkers were higher in PCR negative cases. Studies with more patients in multiple centers willprovide better comparison of the findings in cancer patients with the general population

Evaluation of Computed Tomography, Clinical and Laboratory Findings of COVID-19 in Cancer Patients

Aim: The aim of this study was to evaluate the computed tomography (CT), clinical andlaboratory findings of coronavirus disease 2019 (COVID-19) in cancer patients and to comparethe findings between polymerase chain reaction (PCR) positive and negative patients.Material and Methods: Twenty-three cancer patients with positive PCR tests and 22diagnosed as COVID-19 with clinical and radiological findings were included in the study. CTimages of the patients were evaluated simultaneously by two radiologists. Presence ofcomorbid diseases, symptoms and laboratory values were evaluated.Results: The most common CT involvement pattern was peripheral with 88.9% (n=40).Bilateral lung involvement rate was 57.8% (n=26). The most common finding was groundglass opacities (n=38, 84.5%). 35.6% (n=16) of these were accompanied by consolidation.Multifocal involvement was present in 62.2% (n=28) of the cases. The most frequentlyinvolved lobes were lower lobes. Other relatively common findings were septal thickening,subpleural streaking, and air bronchogram. The median neutrophil, lymphocyte, D-dimer,procalcitonin, C-reactive protein and lactate dehydrogenase values of the patients were 2000mm3, 1200 mm3, 1990 ng/mL, 30.7 mcg/L 15.8 mg/dl, 161 IU/L, respectively.Conclusion: Multifocal and bilateral involvement, and ground glass opacities were the mostcommon findings. However, higher rates of septal thickening, which is generally less common,suggest that the findings may be more severe in cancer patients. Most of the inflammatorymarkers were higher in PCR negative cases. Studies with more patients in multiple centers willprovide better comparison of the findings in cancer patients with the general population

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naive breast cancer: Real-life practice outcomes

WOS: 000458407200014PubMed ID: 30377778PurposeIn this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients.MethodsThis study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers.ResultsMedian age was 51 (22-82). Median PFS was 28.5months, while median OS was 40.3months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8m vs. 28.5m; p=0.002) and OS (26.7m vs. 40.3m; p=0.009). Patients older than 65years of age (n: 42, 13.2%) had significantly lower OS results (19.8m vs. 40.3m; p=0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure.ConclusionsOur RLP trial included only visceral metastatic, trastuzumab-naive BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date