Radiotherapy-Related Tumour Lysis Syndrome in a Patient with Metastatic Adenocarcinoma of Unknown Origin

ABSTRACT Tumour lysis syndrome (TLS) is a rare but serious complication of cancer treatment. It is generally seen in patients with high tumour load or chemosensitive tumour after chemotherapy and is more common with haematological malignancies like leukaemia and lymphoma when compared to solid tumours. TLS occurring after radiotherapy (RT) in patients with solid tumours is very rare. We aimed to present TLS seen after RT for a vertebral tumoral mass in a patient with metastatic adenocarcinoma of unknown origin. A 78-year-old woman, who was diagnosed with adenocarcinoma of unknown origin, was hospitalized to undergo palliative RT for the vertebral mass. On the 1st day, 4 mg q6hour perioral dexamethasone was started. 300 cGy per session RT started on the 2nd day of hospitalization. After the fifth session of RT (after a total dose of 15 Gy), she developed TLS complicated with acute kidney injury requiring renal replacement therapy and she was successfully treated by haemodialysis. Close monitoring, even in patients with low risk for TLS and early administration of preventive modalities should be kept in mind.

The platelet-to-lymphocyte ratio as an inflammation marker in non-dipper hypertensive patients.

BACKGROUND: Non-dipper hypertensive patients have a higher risk of cardiovascular disease (CVD) than dipper hypertensive patients. Inflammation plays an important role in the pathogenesis and progression of CVD. This study aimed to determine the relationship between the platelet-to-lymphocyte ratio (PLR), and dipper and non-dipper hypertension. MATERIALS AND METHODS: This prospective study included 199 consecutive patients that were diagnosed with primary hypertension. According to ambulatory blood pressure monitoring measurements, non-dipper and dipper group were determined. PLR was determined based on the platelet count and lymphocyte count in the complete blood count. RESULTS: The non-dipper group included 103 patients (74 females and 29 males; mean age: 52.37 ± 10.7 years) and the dipper group included 96 patients (65 females and 31 males; mean age: 48.40 ± 11.1 years). Mean systolic blood pressure was significantly higher in the non-dipper group than in the dipper group (124 ± 15.1 mmHg versus 120 ± 11.2 mmHg, p =0.032) and the median PLR was significantly higher in the non-dipper group than in the dipper group [132.15 (range: 69.64-400) versus 117.0 (range: 53.52-192.26), p = 0.001], whereas the mean white blood cell count (6.86 ± 1.43 × 10³/ µL versus 7.24 ± 1.26 × 10³/µL, p =0.046) and median lymphocyte count [2.09 (range: 0.95-3.92)  × 10³/µL versus 2.24 (range: 0.97-3.98) × 10³/µL, p =0.001) were significantly lower in the non-dipper group. CONCLUSION: Median PLR was significantly higher in the non-dipper hypertensive patients than in the dipper hypertensive patients. We think this finding further supports the role of an increase in inflammatory response in non-dipper hypertension. Hippokratia 2015; 19 (2):114-118.