CA 125 levels in patients with non-Hodgkin lymphoma and other hematologic malignancies.

Cancer antigen (CA 125) is a glycoprotein commonly used as a tumor marker. In this study, CA 125 levels were measured in 149 patients and 26 healthy control subjects. The study group included 69 non-Hodgkin lymphomas (NHL), 25 Hodgkin disease (HD), 20 acute myelocytic leukemia (AML), 14 chronic lymphocytic leukemia (CLL), 12 chronic myelocytic leukemia (CML), and nine multiple myeloma (MM) patients. CA 125 was elevated in 37 of the patients and in none of the control subjects. Average CA 125 level in NHL patients was significantly higher than the controls (56.2 +/- 9.2 U/ml, 7.99 +/- 1.05 U/ml respectively) (P < 0.05). CA 125 levels were significantly higher in NHL patients with abdominal involvement (113.6 +/- 23.4 U/ml), with B-symptoms (72.3 +/- 13.2 U/ml), higher stage of the disease (stages III and IV -75.3 +/- 14.9 U/ml), bulky disease (99.9 +/- 30.4 U/ml) and in those with serosal involvement (103.1 +/- 18.5 U/ml) (P < 0.05 for all). CA 125 levels were also elevated in seven patients with HD and in a patient with CLL with pleural effusion. In conclusion, for patients with NHL, high levels of CA 125 were associated with B-symptoms, advanced stage, bulky disease, abdominal, and serosal involvement. Therefore, CA 125 might be used as a marker to predict prognosis and to detect advanced disease in NHL.

Influence of the refinement of surgical technique and surgeon's experience on the rate of complications after total thyroidectomy for benign thyroid disease.

BACKGROUND: In recent years, many surgeons dealing with endocrine surgery have increasingly performed total thyroidectomy for benign thyroid disease. However, total excision of the thyroid in the treatment of benign lesions has been surrounded by even more controversy than its role in cancer treatment. The complication rate appears to be higher when the operation is done by inexperienced surgeons who have no special skills in endocrine surgery using proper techniques. The aim of this study is to determine whether surgeons experience and the refinement of surgical techniques are associated with postoperative recurrent laryngeal nerve (RLN) palsy or hypocalcemia after total thyroidectomy for benign thyroid disease. METHODS: A total of 68 consecutive patients who underwent total thyroidectomy for benign thyroid disease were reviewed. Twenty-six of these were from between January 1998 and June 1999 (first period) and 42 from between June 1999 and September 2000 (second period). Patients were divided into two subgroups according to different periods and different surgical techniques to identify the RLNs and the parathyroid glands. RLNs function was evaluated pre- and postoperatively by an otolaryngologist, and serum calcium levels were measured at the postoperative follow-up. RESULTS: During the first period of the study, transient hypocalcaemia was determined in 8 (31%) patients. Hypocalcaemia was clinically symptomatic in 5 (19%) patients. Transient RLN palsy developed in 4 (15%) patients. Unilateral permanent RLN palsy due to operative injury was observed in 1 (4%) patient. During the second period, we noted transient hypocalcemia in 11 (26%) patients and symptomatic hypocalcemia in 6 (4%) patients. Serum calcium levels returned to normal within 4 weeks after operation in all patients. Neither transient nor permanent RLN palsy was observed during this period. CONCLUSIONS: Complications of total thyroidectomy can be minimized with increasing experience and the refinement of surgical technique.

Clinical characteristics and genetic screening of an extended family with MEN2A.

MEN-2A is characterized by medullary thyroid carcinoma (MTC) with pheochromocytoma and sometimes parathyroid adenoma. In affected members of the family, the risk of MTC is about 100%. Biochemical screening allows tumors to be detected early but even at this stage treatment is not always curative. Missense mutations in exon 10 and 11 of the RET proto-oncogene are associated with MEN-2A. Early detection of this mutation by DNA analysis allows the identification of the carriers of the gene. We performed genetic screening in 88 members of an extended family with MEN-2A and found 18 members positive for RET mutation (Cys634Gly). Only three of these 18 RET positive cases had a previous diagnosis of medullary cancer and/or pheochromocytoma. Up to now, 12 of the RET positive cases have undergone thyroidectomy. There was extended disease with cervical lymph node metastasis in 6 of them, bilateral medullary microcancer in 3 and c-cell hyperplasia in the remaining 3. Three of the 18 RET positive patients had also pheochromocytoma. Primary hyperparathyroidism was present in only one patient. The mean age of diagnosis of medullary cancer was between 25-50 yr and mean age of death was between 35-95 yr in affected members of the family. The family had many other affected members in other cities in Turkey and in other countries throughout the world from Australia to the Netherlands. So this family is perhaps one of the most extended families with MEN-2A.

Polyserositis as a rare component of polyglandular autoimmune syndrome type II.

Polyglandular autoimmune (PGA) syndromes (types I and II) may affect various endocrine and non-endocrine organs in the body. In the commoner PGA type II, primary adrenal insufficiency, autoimmune thyroid disease and type I diabetes mellitus are the most frequent manifestations. Serositis with pericardial or pleural involvement is not a well known component of the disease. Here, we report a 21-year-old man who first presented with a pleuropericardial effusion and Graves' disease, and who then developed type I diabetes mellitus.

Relationship Between Leptin Levels and Body Indexes in Patients with Haematologic Malignancy.

Leptin is a recently found hormone regulating body weight. In human obesity, this weight-regulating hormone level is in a positive correlation with FMI (fat mass index) and BMI (body mass index). In this study, we aimed to investigate the relation between serum leptin levels and BMI, PF (percentage fat), LMI (lean mass index), FMI and some other parameters of patients with haematologic malignant diseases. Fourty-four patients with haematologic malignant diseases and 25 healthy control group were taken into the study. In the comparison, there were no significant difference between the PF and FMI values of both groups, while the mean BMI and LMI values of the control group were significantly higher than that of the patient group. There was a positive correlation between leptin levels and BMI and FMI among parameters studied in our control group, whereas we couldn't demostrate any such correlation in patient group. We estimate that the alteration may be due to disturbances in the feed back mechanism developing in patient with haematologic malignancy.

Inflammatory Pseudotumor of the Lung Associated with Anemia: A Case Report and Review of the Literature.

Inflammatory pseudotumor of the lung is a benign tumor which is rarely seen. A mass in the left lung was observed in the chest roentgenogram of an 8 year-old boy while investigating for anemia. Preoperative investigations could not render the exact diagnosis. Pneumonectomy was required in exploratris thoracotomy. Histopathologic diagnosis was fibrohistiocytic type of inflammatory pseudotumor. Four months after the operation, anemia was cured without any further treatment.