Role of serum concentration of VEGFR1 and TIMP2 on clinical outcome in primary cervical cancer: results of a companion protocol of the randomized, NOGGO-AGO phase III adjuvant trial of simultaneous cisplatin-based radiochemotherapy vs. carboplatin and paclitaxel containing sequential radiotherapy.

OBJECTIVE: Aim of the present study was to analyze the expression-profile of IGF1, IGFBP3, sICAM1, sVCAM1, MMP2, MMP9, TIMP2, VEGFA, VEGFD, VEGFC and VEGFR1 in patients with high-risk FIGO-stage Ib-IIb cervical cancer. METHODS: Serum from 68 cervical cancer patients treated within a phase-III-trial with either simultaneous cisplatin radiochemotherapy or sequential systemic carboplatin and paclitaxel followed by percutaneous irradiation was analyzed by ELISA. Both target expression and correlation with important clinicopathological factors were analyzed following standard statistic procedures. RESULTS: All 68 patients underwent a primary radical hysterectomy with pelvic and/or paraaortic lymphadenectomy. 85.3% of the extirpated tumors had clear surgical margins (R0). Increased levels of VEGFR1, TIMP2 and MMP2 were significantly associated with positive surgical margins (p=0.004, p=0.018 and p=0.004, respectively). High concentration of MMP2 and TIMP2 correlated additionally with an advanced age at time of diagnosis (p=0.001 and p=0.007, respectively). For the cut-off value of 100 pg/ml, an increased VEGFR1 was significantly associated with poor overall (OS) and progression-free (PFS) survival (p=0.017 and p=0.015, respectively). A TIMP2 concentration of lower than 90 ng/ml was significantly associated with poorer OS and PFS (p=0.009 and p=0.043, respectively). In the multivariate analysis, TIMP2 expression in serum was the only independent prognostic factor for OS (p=0.032, HR=6.51, 95% CI=1.17-36.01). CONCLUSIONS: Expression-profile of specific biomarkers associated with tumor invasion, cell migration and angiogenesis seems to be of prognostic value for both OS and PFS in patients undergoing surgery due to primary cervical cancer. Further analyses are warranted to allow an implementation of such markers into clinical practice.

Our experience in eight cases with urinary hydatid disease: a series of 372 cases held in nine different clinics.

OBJECTIVES: Hydatid disease, a parasitic infestation caused by the larval stage of the cestode Echinococcus granulosus, is diagnosed commonly in the east and south-east regions of Turkey. The aim of this study is to emphasize the relatively frequent occurrences of echinococcosis in our region, and to discuss therapeutic options and treatment results according to current literature. METHODS: A retrospective 10-year review of nine different clinics' records of the Research Hospital of the Medical School of Yüzüncü Yil University revealed 372 hydatid disease cases that were localized in various organs and treated surgically (271 cases) or drained percutaneously (99 cases). Hydatid disease was diagnosed by ultrasonography (US) and computed tomography scans (CT) and confirmed histopathologically. RESULTS: The involved organ was lung in 203 cases (131 adults, 72 children), liver in 150, spleen in 9, brain in 2, kidneys in 7 cases and the retrovesical area in 1 case. The urogenital system is involved at a rate of 2.15%. Two hundred and seventy-one cases were treated surgically and 99 percutaneously. Two cases with renal hydatid cyst refused the surgical procedure (one had a solitary kidney with hydatid cyst). Albendazole was administered to 192 patients; 93 patients had open surgical procedure and 99 patients underwent percutaneous procedure. Cysts were excised totally in the open surgical procedure; however, involved kidneys were removed totally (four cases) except one. Cystectomy and omentoplasty was performed in one case. Complications were as follows: in six cases, cystic material was spilled into the bronchial cavity during the dissection and a renal hydatid cyst ruptured and spilled retroperitoneally. CONCLUSION: Hydatid disease is a serious health problem in Turkey. The mainly affected organs are liver and lung. It can be treated surgical or by percutaneous aspiration.

Multicentric tumor of the esophagus and its clinical significance; case report and review of the literature.

Simultaneous occurrence of the esophageal tumor at multiple sites in a single patient is unusual. Here in, we described a patient had three separate tumoral nodules with ulceration of the esophagus. Thorax CT scan, X-ray and endoscopy revealed the only two tumoral lesion at the lower esophagus. But, the other tumoral lesion at the upper part of the esophagus was detected at operation and histopathologic examination. The aspect of treatment was changed according to this new condition during the operation. We discussed the multicentric tumoral lesions of the esophagus in view of the literature.

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.

[Chest trauma: analysis of 126 cases]. / Gögüs travmasi: 126 olgunun analizi.

To evaluate our experience in chest trauma we review the records of the patients admitted for chest trauma to our service between December 1994 and April 2000. There were 126 patients (113 males, 89.7%), with an age range of 7 to 96 years (mean 35.3). The most frequent cause of chest injury were traffic accidents 48 cases (38%) and 73 cases (57.9%) were victims of blunt trauma. In 36 cases there was a politrauma. Hemo and/or pneumothorax represented the most common thoracic injury (85.7%). Rib fractures were present in 47 cases (36.2% with more than 3 rib fractures). Four patients sustained flail chest and 5 defect of thoracic wall. Six patients were pulmonary contusion and 8 intraparenchymal hematoma. Pleural drainage was performed in 106 cases (8 cases bilateral) and thoracotomy was indicated in 11 (6 cases emergency). Mortality was 6.9% (n:8), of which 4 belonged to politrauma group. Mortality is directly related with politrauma. In the patients of the chest trauma, aggressive diagnostic and therapeutic approaches in association with intensive care follow-up remains one of the most important points to decrease mortality and morbidity rate.

Surgical treatment of hydatid cyst of the lung: review of 30 cases.

Hydatid cyst disease is still a problem in Turkey, especially in the east Anatolian region, as well as in many other places in the world. A retrospective review was made of the surgical treatment of 30 patients with pulmonary hydatid cysts during the last 3 yrs. Nineteen patients were male and 11 female with an average age of 23.5 yrs (range 4-44 yrs). Cystotomy and capitonnage were performed in 28 of the 30 cases (93.4%). The transdiaphragmatic route or simultaneous laparotomy was preferred when the liver was involved. Albendazole was used in four patients with multiple hydatid cyst due to probable recurrence in the postoperative period. Cough and chest pain were the prominent symptoms in the majority of cases. A single lobe was affected in 22 patients. Unilateral multiple foci were present in four patients and bilateral multiple foci in four. Six patients had concomitant liver cysts. Morbidity was low and no mortality was seen. No recurrences were seen on control chest radiographs during the last 2-yr follow-up. In the treatment of hydatid cyst of the lung, conservative surgical methods such as cystotomy and capitonnage still remain the treatment of choice. Medical treatment could be used for prophylactic purposes and in some instances, but the percutaneous aspiration method should not be performed.

Relapsing polychondritis.

In this article, we report on a 40-year-old man with relapsing polychondritis (RP) of the tracheobronchial tree without clinical manifestations of other systems including nasal septum and earlobe cartilage involvement. The illness was diagnosed histologically, and treatment with procaine penicillin was successful. RP is an unusual systemic disorder characterized by widespread inflammation and destruction of cartilage tissues. The main cause is usually autoimmune. In RP various clinical manifestations including nasal chondritis, arthritis, scleritis, damage to tracheal and bronchial cartilage, and aortic, cardiac, and renal involvement may occur. Isolated tracheobronchial involvement is very rare. The diagnosis must be based on a combination of clinical and pathologic features. If diagnosed early, appropriate treatment may prevent life-threatening airway obstruction.

Mediastinal cystic lymphangioma: report of two cases.

Cystic lymphangioma is an extremely rare mediastinal benign tumor characterized by congenitally enlarged lymphatic vessels. It is often diagnosed incidentally because it is only symptomatic when it grows to be very large. We present two cases of mediastinal cystic lymphangioma and review the literature.