Idiopathic adrenal hematoma mimicking neoplasia: A case report

AbstractIntroductionAdrenal haemorrhage is a relatively rare condition. If there is not a specific ethology describing adrenal hematoma, then, this is termed as ‘idiopathic adrenal hematoma’.Presentation of caseWe presented a case of idiopathic adrenal hematoma in this study. A 62-year-old woman was referred to our hospital for evaluation of a 40mm mass in the left upper abdominal cavity. The histopathological findings of the surgical specimen revealed a hematoma with normal adrenal tissue.DiscussionThe incidence of adrenal haemorrhage was found to be 1.1% regarding autopsy results. The Adrenal gland is highly vascular and vulnerable to haemorrhage. Before a surgical operation, it is difficult to diagnose idiopathic adrenal hematomas.ConclusionAn adrenal hematoma should be kept in mind when adrenal masses assessing

The relationship between oxidative stress and preeclampsia. The serum Ischemia-modified albumin levels and thiol/disulfide homeostasis

Objective: Preeclampsia (PE) is a dangerous complication of pregnancy and still a major cause of maternal-fetal morbidity and mortality. Its etiology remains largely unknown, but researchers have suggested oxidative stress-mediated inflammation for the same. The purpose of this study is to investigate the relationship between oxidative stress and PE as well as the usability of oxidative stress indicators such as serum ischemia-modified albumin (IMA) levels and thiol/disulfide balance in the prediction of PE. Materials and Methods: The study included 47 pregnant women with PE and 57 healthy pregnant women. We measured their serum IMA, native thiol, total thiol, and disulfide levels. Additionally, we determined the optimal cutoff values via the receiver operating characteristic curve analysis. Results: There were no differences between the two groups with respect to the maternal age, body mass index, gravida, and parity. The native and total thiol levels were found to be low when the disulfide and IMA levels were high in the patients with PE (p<0.05). When the IMA level was corrected by the albumin level (IMAR), the significant difference between the two groups disappeared. We also found that the native and total thiol concentrations were correlated with the systolic and diastolic blood pressures. The optimal cut-off values calculated for the prediction of PE were as follows: 178.45 µmol/L (with sensitivity of 72% and specificity of 83%) for native thiol, 232.55 µmol/L (with a sensitivity of 75% and specificity of 85%) for total thiol, and 29.05 µmol/L (with sensitivity of 65% and specificity of 72%) for disulfide. Conclusion: The balance of thiol/disulfide may play a role in the pathogenesis of PE and could be used as a biological marker for PE. © 2020 by Turkish Society of Obstetrics and Gynecology Turkish Journal of Obstetrics and Gynecology published by Galenos Publishing House

Comparison of Ultrasonography and Cystoscopy in the Evaluation of Hematuria

Objective:Every day, many patients visit hospital due to hematuria. Ultrasonography and/or cystoscopy are performed in the initial evaluation and management. In this study, we compared ultrasonography and cystoscopy in the evaluation of microscopic or macroscopic hematuria.Materials and Methods:A total of 55 patients, who presented to our clinic with the complaint of hematuria between July 2016 and October 2017, were enrolled in this study. After obtaining informed consent, the patients were directed to urinary ultrasonography and cystoscopy for the evaluation of hematuria.Results:Ultrasonography showed 45 (81.8%) normal bladder and 10 (18.2%) masses, and cystoscopy detected 39 (70.9%) normal bladder and 16 (29.1%) masses in the bladder (p=0.001). Ultrasonography was able to report only 8 (50%) of 16 masses detected via cystoscopy. Two (20%) of 10 masses reported by ultrasonography were not confirmed through cystoscopy. The sensitivity and specificity of ultrasonography in detecting and excluding masses in the bladder were calculated to be 50% and 94.9%, respectively. Ultrasonography failed to detect lesions at the posterior, dome and right side and bladder neck. The cut-off value for blood cell count in urine to refer the patient to a cystoscopy procedure was detected to be 15 with 60% sensitivity and 50% specificity.Conclusion:With low sensitivity, ultrasonography could not offer enough knowledge about the bladder masses as sufficient as cystoscopy

Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion

PURPOSE:We aimed to evaluate the efficacy of multidetector computed tomography (CT) imaging in diagnosis of pleural exudates and transudates using attenuation values. MATERIALS AND METHODS:This retrospective study included 106 patients who were diagnosed with pleural effusion between January 2010 and June 2012. After the patients underwent chest CT, thoracentesis was performed in the first week. The attenuation values of the pleural effusions were measured in all patients. RESULTS:According to Light’s criteria, 30 of 106 patients with pleural effusions had transudates, and the remaining patients had exudates. The Hounsfield unit (HU) value of the exudates (median, 12.5; range, 4–33) was significantly higher than that of the transudates (median, 5; range, 2–15) (P = 0.001). Additionally, when evaluated by disease subgroups, congestive heart failure and empyema were predictable in terms of median HU values of the pleural effusions with high and moderate sensitivity and specificity values (84.6% and 81.2%, respectively; 76.9% and 66.7%, respectively). Compared with other patients, the empyema patients had significantly more loculation and pleural thickening. CONCLUSION:CT attenuation values may be useful in differentiating exudates from transudates. Although there is an overlap in most effusions, exudate can be considered when the CT attenuation values are >15 HU. Because of overlapping HU values, close correlation with clinical findings is essential. Additional signs, such as fluid loculation and pleural thickness, should be considered and may provide further information for the differentiation

Türkiye akademik CAR-T hücre (ISIKOK-19) klinik çalışması ön raporu: Ürün karakterizasyonu ve klinik uygulama sonuçları

Objective: Chimeric antigen receptor T (CAR-T) cell therapies have already made an impact on the treatment of B-cell malignancies. Although CAR-T cell therapies are promising, there are concerns about commercial products regarding their affordability and sustainability. In this preliminary study, the results of the first production and clinical data of an academic CAR-T cell (ISIKOK-19) trial in Turkey are presented. Materials and Methods: A pilot clinical trial (NCT04206943) designed to assess the safety and feasibility of ISIKOK-19 T-cell therapy for patients with relapsed and refractory CD19+ tumors was conducted and participating patients received ISIKOK-19 infusions between October 2019 and July 2021. The production data of the first 8 patients and the clinical outcome of 7 patients who received ISIKOK-19 cell infusions are presented in this study. Results: Nine patients were enrolled in the trial [5 with acute lymphoblastic leukemia (ALL) and 4 with non-Hodgkin lymphoma (NHL)], but only 7 patients could receive treatment. Two of the 3 participating ALL patients and 3 of the 4 NHL patients had complete/ partial response (overall response rate: 72%). Four patients (57%) had CAR-T-related toxicities (cytokine release syndrome, CAR-T-related encephalopathy syndrome, and pancytopenia). Two patients were unresponsive and had progressive disease following CAR-T therapy. Two patients with partial response had progressive disease during follow-up. Conclusion: Production efficacy and fulfillment of the criteria of quality control were satisfactory for academic production. Response rates and toxicity profiles were also acceptable for this heavily pretreated/refractory patient group. ISIKOK-19 cells appear to be a safe, economical, and efficient treatment option for CD19+ tumors. However, the findings of this study need to be supported by the currently ongoing ISIKOK-19 clinical trial.Amaç: Kimerik antijen reseptör T (CAR-T) hücre uygulamaları B-hücreli malignitelerin tedavisinde etkili olmaktadır. CAR-T hücre uygulamalarının sonuçları umut vaadedici olsa da, ticari CAR-T ürünlerinin yükek maliyetleri nedeniyle ulaşılabilirlik açısından ciddi sorunlar yaşanmaktadır. Bu ön raporda, Türkiye’deki ilk akademik CAR-T hücre çalışmasının üretim ve klinik uygulama sonuçları sunulmuştur. Gereç ve Yöntemler: Relaps refrakter CD 19+ hematolojik maligniteli hastalarda ISIKOK-19 T-hücre tedavisinin güvenliği ve etkinliğini değerlendirmek amacıyla yürütülen klinik çalışmaya (NCT04206943) Ekim 2019-Temmuz 2021 tarihleri arasındaki hastalar dahil edilmiştir. Bu raporda ilk 8 hastanın üretim bilgileriyle, ISIKOK-19 hücre infüzyonu yapılan 7 hastanın klinik sonuçları sunulmuştur. Bulgular: Çalışmaya toplam 9 hasta dahil edilmiştir (5 akut lenfoblastik lösemi [ALL] ve 4 non-hodgkin lenfoma [NHL]), ancak sadece 7 hastaya hücre infüzyonu yapılabilmiştir. Hücre infüzyonu alan 3 ALL hastasından 2’sinde ve 4 NHL hastasının 3’ünde tam/kısmi cevap gözlenmiştir (toplam yanıt oranı %72). Dört hastada (%57) CAR-T ilişkili toksisite (sitokin salınım sendromu, immün efektör hücre ilişkili nörotoksisite sendromu ve pansitopeni) tespit edilmiştir. İki hastada ise CAR-T hücre uygulaması sonrası cevapsızlık ve progresif hastalık izlenmiştir. Kısmi cevap veren hastalardan 2’sinde de takip sırasında progresif hastalık tespit edilmiştir. Sonuç: Akademik CAR-T üretimimiz, üretim etkinliği ve kalite kontrol kriterlerinin tam olarak karşılanması açısından tatmin edici sonuçlara sahiptir. Çalışmaya dahil edilen hastaların tedavi yükü hesaba katıldığında tedaviye cevap oranı ve toksisite profili açısından da sonuçlar kabul edilebilir düzeydedir. Bu sonuçlarla, ISIKOK-19 hücrelerinin güvenli, ekonomik ve etkili bir tedavi seçeneği olduğu düşünülebilir. Ancak bu ön sonuçların halen devam eden ISIKOK-19 klinik çalışmasıyla desteklenmesi beklenmektedir