The prognostic impact of comorbidity, nutritional and performance status on patients with diffuse large B cell lymphoma

Background: The aim of the study was to investigate the impact of nutritional status, comorbidity, and performance status on patients with diffuse large B-cell lymphoma (DLBCL). Methods: A retrospective study was conducted on 112 DLBCL patients who were diagnosed at our center between 2009 and 2018. Demographic and disease characteristics and laboratory test results were recorded. Assessments were made using the age-adjusted Charlson comorbidity index (CCI-A) for comorbidity, albumin level for nutritional status, and Eastern Cooperative Oncology Group (ECOG) score for performance status. Results: The mean age of the patients was found to be 62.63 ± 15.16 years. The ECOG score of 65 patients (69.1%) was in the range of 0-1. The mean follow-up time of the patients was determined to be 25.24 ± 25.11 months, and at the end of the follow-up period, 64 patients (57.1%) were survivors. The progression-free survival (PFS), overall survival (OS), and 5-year OS rates of those with CCI-A > 4 were found to be significantly lower than those with CCI-A score ≤4 (P < 0.05). As a result of the Cox-Regression (Backward: LR method) analysis, ECOG and albumin levels were found to be independent risk factors for both OS and PFS (P < 0.05). Conclusion: This study demonstrated that CCI-A, ECOG, and nutritional status are independent prognostic markers for DLBCL patients. Initial evaluation of these patients should include all these parameters, which are easily available at the time of diagnosis

Does blood type have an effect on the course of COVID-19?

Introduction Predictive parameters that can affect the course of this infection have been the main topic of research since the beginning of the COVID-19 (Coronavirus disease 2019) pandemic. Since the discovery of blood groups, the effect of these on infectious diseases has always been of interest. Objectives To analyze the effect of ABO blood group on mortality, hospitalization duration and hematological and cytokine storm parameters in patients with COVID-19. Patients and methods: This retrospective study was conducted on 140 patients diagnosed with COVID-19. Demographic characteristics, laboratory parameters including ABO blood group, complete blood count (CBC) parameters, biochemical tests, cytokine storm parameters, duration of hospitalization, and final status (discharge or death) were recorded. Results: The 140 patients included in the analysis comprised 72 (51.4%) males and 68 (48.6%) females with a mean age of 66.3±14.0 years. . Age and gender, hospitalization duration and mortality rates were similar in all blood group types. Only D-dimer levels were found to be higher in blood group A compared with other blood groups. Conclusion: Although no difference in mortality was determined between groups, the D-dimer level was statistically significantly higher in COVID-19 patients with A blood group. Larger studies are needed to reflect D-dimer levels on the clinical course of infection, and thus on daily practice

Single Centre Experience: Bening and Malign Hematological Patients with COVID-19

Introduction Coronavirus disease 2019 (COVID-19) were declared as pandemic by World Health Organization. With this study, we aimed to define our patients who were followed up with malign or benign hematological diagnoses and diagnosed with COVID-19; determine the distribution of this infection in patient groups and contribute to the literature by creating descriptive statistics with its clinical and demographic features. Patients and methods: It is planned to retrospectively examine patients with a history of COVID-19 who were followed up in Hematology Department of Dışkapı Yıldırım Beyazıt Training and Research Hospital with benign and malignant diagnoses. Results: 88 patients who had COVID-19 infection while being followed in our clinic due to hematological diseases were included in the study. 77 patients had been followed by hematologic malignancies and 11 patients had been followed by benign hematological disease.In the group with malignancy, COVID was found most frequently in patients diagnosed with Philadelphia chromosome negative myeloproliferative neoplasms (22%), nonhodgkin lymphoma (19%) and multiple myeloma (16%). ITP (64%) was the most common disease in patients with benign hematological disorder who had COVID history. 52 (67%) of the malignant cases and 8 (73%) of the bening cases were found to be followed up with the disease in remission. The all patient's most common symptoms at COVID-19 diagnosis were fever (77%), cough (70%) and weakness (65%). 45% of the patients were isolated at home, 48% were required hospitalization. 49% of patients had mild; 27% had moderate and 24% had severe COVID-19 infection. Almost all of the patients in the moderate and severe disease group were followed up in patients diagnosed with malignant hematological disease. 16 (18%) patients received mechanical ventilation and 16 (18%) patients was transferred intensive care unit. All of the patients who were intubated and needed intensive care were diagnosed with malignant hematological disease. 17 patients died due to COVID-19 infection. The mortality rate was 22% in patients with diagnosis of malignant hematological diseases, and 19% when all patients (malignant and bening) were included. Conclusion: In conclusion, the COVID-19 pandemic is a problem all over the world. Determining the course of the disease in certain diagnostic groups is important in the management of both the main disease and the COVID-19 infection. Therefore, the contribution of such recording studies to the literature is important and valuable

Comparison of PET-CT and bone marrow biopsy in order to evaluate bone marrow involvement in hodgkin and nonhodgkin lymphoma patients

Çalışmamızda yeni tanı Lenfoma hastalarında başlangıç evrelemesi sırasında kemik iliği tutulumunu değerlendirmede PET-BT kullanımının etkinliğinin tespit edilmesi amaçlanmıştır. Hastalar ve Metodlar: Çalışmamızda retrospektif olarak ocak 2010 ve eylül 2016 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesine başvuran Lenfoma tanısı almış olan 104 hastanın dosyaları retrospektif olarak incelendi. Çalışmanın analizleri için SPSS 16.0 paket programı kullanıldı. Kategorik değişkenler frekans ve yüzde oranları şeklinde, sayısal değer alan değişkenler ise ortalama±ss (medyan, min, maks) şeklinde tablo kullanılarak sunuldu. Çalışmamızda hastalar HL ve HDL olarak iki ana başlık altında değerlendirildi. HDL hastaları da klinik seyir ve takiplerine göre agresif ve yavaş seyirli olarak iki alt grup halinde değerlendirildi. 104 hastamızın 24'ü HL 80'i HDL hastasıydı. Bu hastaların 54'ü (% 51,9) erkek, 50'si (%48,1) kadındı. Hastaların evresine göre dağılımları ise; evre I'de 8 (%7,7), evre II'de 21 (%20,2), evre III'de 35 (%33,7) ve evre IV'de 40 (%38.5) hasta mevcuttu. Hastaların 79'u (%76,0) sağ iken 25'i (%24,0) kaybedilmiştir Bulgular: Çalışmamızda hastaların 40'ında (%38,5) KİB'de tutulum saptanırken 64'ünde (%61,5) KİB'de tutulum saptanmamıştır. Tüm hastaların 41'inde (%39,4) PETBT'de kemik iliği tutulumu saptanırken bunların 26'sı (%63,4) yaygın geri kalan 15'i (%36,6) yamalı olarak saptanmıştır. HL hasta grubu değerlendirildiğinde 24 hastanın kemik iliği biyopsisinde 11 (%45,8) hastada tutulum gözlenmemişken 13 (%54,2) hastada tutulum saptanmıştır. Yapılan PET-BT'de ise 10 (%41,7) hastada kemik iliği tutulumu gözlenmemişken kalan 14 (%58,3) hastada tutulum gözlenmiştir. Bu tutulumun 2'si (%14,3) yamalı şekildeyken 12 (%85,7) hastada diffüz bir tutulum şekli tespit edilmiştir. HDL hasta grubunda olan 80 hasta değerlendirildiğinde; kemik iliği biyopsisinde 53 (%66,3) hastada tutulum gözlenmemişken 27 (%33,7) hastada tutulum saptanmıştır. Yapılan PET-BT'de ise 53 (%66,3) hastada kemik iliği tutulumu xiii gözlenmemişken kalan 27 (%33,7) hastada tutulum gözlenmiştir. Bu tutulumun 13'ü (%48,1) yamalı şekildeyken 14 (%51,9) hastada diffüz bir tutulum tespit edilmiştir. Tüm hastalar değerlendirildiğinde PET-BT'nin duyalılığı %80, seçiciliği ise %85,9 olarak gözlenirken HL hastalarında PET-BT ile KİT duyarlılığı %92,3 seçiciliği %81,8 olarak saptanmıştır. HDL tanısı almış 80 hasta değerlendirildiğinde kemik iliği tutulumu kemik iliği biopsisi ile 27 (%33,7) hastada saptanırken 53 (%66,3) hastada gözlenmemiştir. Agresif HDL hastaları için PET-BT'nin duyarlılığı %81.8 seçiciliği %87,75 olarak değerlendirilmiştir. Sonuç: Kemik iliği tutulumunu değerlendirmede PET-BT ekili ancak mükemmel olmayan bir yöntemdir. Non-invaziv olması, kolay uygulanabilir olması, yamalı tutulumları tespit etmekteki başarısı yöntemin artıları olup gelecekteki çalışmalar için umut verici olmaktadırThe aim of our study is to determine the efficacy of PET-CT in evaluating bone marrow involvement during initial staging in patients with new diagnosed lymphoma. Patients and Methods: In our study we retrospectively reviewed files of 104 patients who applied to Necmettin Erbakan University Meram School of Medicine between January 2010 and September 2016 We used SPSS 16.0 packaged software for analyses of the study. We used tables to provide categorical variables as frequency and percentages and numeric variables as mean±ss (median, minimum, maximum). Patients were evaluated under two main groups as HL and NHL in our study. NHL patients were also further evaluated in two subgroups as aggressive and slow-acting according to clinical course and diseasefollow-up. 24 of our 104 patients had HL and 80 had NHL. 54 (51.9%) of these patients were male and 50 (48.1%) were female. Distribution of the patients according to their stages was; 8 (7.7%) in stage I, 21 (20.2%) in stage II, 35 (33.7%) in stage III and 40 (38.5%) patients in stage IV. Seventy-nine patients (76.0%) were alive while 25 patients (24.0%) were lost during the study. Findings: In our study, we detected that 40 patients (38.5%) had involvement in bone marrow biopsy while there were no signs of disease involvement in other 64 (61.5%) patients. Bone marrow involvement was detected in PET-CT in 41 (39.4%) of all patients, of which 26 (63.4%) were diffuse and the remaining 15 (36.6%) were patchy. When the HL patient group was evaluated, we detected that 11 (45.8%) out of 24 patients had no bone marrow involvement while the rest of the 13 (54.2%) patients had the involvement. Bone marrow involvement was not detected in 10 (41.7%) of the HL patients with PET-CT while 14 (58.3%) of the patients had bone marrow involvement also in PET-CT. When we further investigated the involvements that was detected with PET-CT we found that 2 patients(14.3%) had patchy infiltration of bone marrow while the other 12 (85.7%) patients had diffuse involvement. Whenthe NHL xv patient group which has 80 patients were evaluated, we detected that 53 (66.3%)of the patients had no involvement in bone marrow biopsy while 27 (33.7%) of the patients had involvement. Bone marrow involvement was not detected in 53 (66.3%) of the NHL patients with PET-CT while 27 (33.7%) of the patients had bone marrow involvement in PET-CT. 13 (48.1%) of the patients had patchy involvement while rest of the 14 (51.9%) patients had diffuse involvement. When all patients were evaluated, sensitivity of PET-CT was 80% and selectivity was 85.9%. In HL patients group, sensitivity of bone marrow involvement with PET-CT was 92.3% and selectivity of PET-CT was 81.8%. When 80 patients with NHL were evaluated, bone marrow involvement was detected in 27 patients (33.7%) with bone marrow biopsy while 53 (66.3%) of the patients had no involvement. For aggressive NHL patients, the sensitivity of PET-CT was 81.8% while the selectivity was 87.75%. Conclusion: PET-CT is an effective but an imperfect method for assessing bone marrow involvement. The advantages of this method are it is noninvasive, easy to implement, and succesful at detecting patchy involvement so PET-CT is a promising method for future studie

Fourth versus eighth week surgery after neoadjuvant radiochemotherapy in T3-4/N0+ rectal cancer: Istanbul R-01 study.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.BACKGROUND AND PURPOSE: The optimum duration between neoadjuvant radiochemotherapy and transmesorectal excision in locally advancedrectal cancer has not been defined yet. This randomized study was designed to compare the efficacy of four-week versus eight-week delay beforesurgery. METHODS: One-hundred and fifty-three patients with locally advanced low- or mid-rectum rectal adenocarcinoma were included in this single center prospective randomized trial. Patients were assigned to receive surgical treatment after either four weeks or eight weeks of delay afterchemoradiotherapy. Patients were followed for local recurrence and survival, and surgical specimens were examined for pathological staging and circumferential margin positivity. RESULTS: 4-week and 8-week groups did not differ with regard to lateral surgical margin positivity (9.2% vs. 5.1%, P=0.33, respectively), pathological tumor regression rate (P=0.90), overall survival (5-year, 76.5% vs. 74.2%, P=0.60) and local recurrence rate (11.8% vs. 10.3%, 0.77). Overall survival was better in patients with negative surgical margins (78.8% vs. 53.0%, P=0.04). Local recurrence rate was significantly higher among patients with positive surgical margin (28.5% vs. 9.3%, P=0.02). CONCLUSIONS: Intentional prolongation of the chemoradiotherapy-surgery interval does not seem to improve clinical outcomes of patients with locally advanced rectal cancer. Surgical margin positivity seems to be more important with this regard

Memede Kitlenin Nadir Bir Nedeni: Granüler Hücreli Tümör

Granüler hücreli tümör sıklıkla baş ve boyun bölgesini etkileyen, Schwann hücrelerinden kaynaklanan, nadir bir yumuşak doku tümörü tipidir. Vücutta pek çok farklı organ tutulumu olabilen granüler hücreli tümör, nadir de olsa memede de gözlenebilmektedir. Elli yedi yaşında postmenopozal kadın hastaya sol memede hızlı büyüyen ele gelen ağrısız palpabl kitle nedeniyle dış merkezde eksizyonel biyopsi uygulanmıştı. Biyopsisi memenin granüler hücreli tümörü olarak raporlanan ve cerrahi sınır pozitifliği olan hastaya, geniş sağlam cerrahi sınırlarla reeksizyon yapıldı. Postoperatif takiplerinde bir problem yaşanmayan hasta sorunsuz bir şekilde taburcu edildi. Klinik ve radyolojik olarak meme karsinomuna benzerlik gösteren granüler hücreli meme tümörünün cerrahi tedavisinde lokal nüksü engellemek amacıyla geniş lokal eksizyon yapılmalıdır. Bu olgu sunumunda, granüler hücreli tümörün tanı ve tedavisini güncel literatür bilgisi eşliğinde sunmayı amaçladık

Nadir Bir Batın içi Abse Nedeni, Jejunal Divertikülit Perforasyonu

Jejunal divertikulozis genellikle asemptomatik seyreden çok nadir görülen bir hastalıktır. Obstruksiyon, kanama ve perforasyon gibi divertikülite sekonder oluşan ciddi komplikasyonlar geç tanı konulduğunda yaşamı tehdit edici olabilir. Seksen iki yaşında erkek hasta acil servise karın ağrısı şikayetiyle başvurmuş olup, fizik muayenesi akut batın ve peritonit ile uyumlu idi. Bilgisayarlı abdomen tomografide serbest hava ve apse nedeniyle hastaya perforasyon tanısı konuldu. Eksploratif laparatomi yapılan hastaya ameliyat sırasında peroperatif jejunal divertikülit perforasyonu tanısı konuldu. Segmental ince bağırsak rezeksiyonu ve uçtan uca anastomoz uygulandı. Ameliyat sonrası 25. günde komplikasyonsuz olarak taburcu edildi. Bu olgu sunumunda, gecikmiş tanı nedeniyle jejunal divertikülit perforasyonu olan yaşlı bir hastada nadir bir akut karın nedeninin sunulması amaçlanmıştır