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Introduction: Atrial fibrillation (AF) is the most common chronic arrhythmia in the elderly population. In symptomatic patients, restoration and maintenance of sinus rhythm improve quality of life. Unfortunately, AF recurrence still occurs in a considerable number of patients after cardioversion (CV). In this study, we aimed to evaluate the association between vitamin D (VitD) and AF recurrence after electrical or medical CV., Method: A total of 51 patients who underwent CV for symptomatic AF were included in the study. AF recurrence was defined as an AF pattern in 12-lead electrocardiography (ECG) recording after CV within 6 months or ECG Holter recording of AF lasting more than 30 seconds at 6-month follow-up., Results: Mean vitD level was 21.4 ng/ml in our study population. VitD level was lower in the AF recurrence group than in the non-recurrence group (18 ng/ml vs. 26.3 ng/ml, respectively; P=0.001). Additionally, left atrial diameter was larger in the AF recurrence group compared to the non-recurrence group (4.4 vs. 4.1, P=0.025). Patients with AF recurrence were older than patients without AF recurrence, and, although the prevalence of hypertension is higher in the AF recurrence group, there was no statistically significant difference (P=0.107, P=0.867)., Conclusion: In our study, there is a strong association between vitD level and AF recurrence after CV. VitD deficiency might be a predictor of high risk of AF recurrence after CV and vitD supplementation during the follow-up might help the maintenance of sinus rhythm.

Background: Cigarette smoking causes myocardial damage with several mechanisms such as sympathetic nervous system activation, oxidative stress, and endothelial dysfunction. Chronic smokers have an increased risk of morbidity and mortality associated with cardiac events. We aimed to compare the myocardial deformation parameters between chronic smokers and nonsmoker healthy population., Method: Forty-two healthy participants (mean age 33.48 ± 10.00 years) without smoking history, 40 participants (mean age 33.98 ± 9.27 years) who had been smoking were prospectively included. In addition to conventional echocardiographic measurements, global longitudinal strain (GLS) of left ventricle (LV), GLS of right ventricle (RV), left atrial strain, and strain rate were analyzed., Results: Smokers had lower peak early diastolic velocity (E) and E/a (early diastolic velocity/late diastolic velocity) ratio in mitral inflow (70.0 ± 13.9 cm/sec vs 77.1 ± 13.3 cm/sec, P = .023; 1.4 ± 0.4 vs 1.7 ± 0.4, P = .011; respectively). Peak early diastolic velocity of mitral valve septal annulus (Em) and Em/Am ratio (peak early diastolic velocity of mitral valve/late diastolic velocity of mitral valve) (11.0 ± 2.1 cm/sec vs 12.1 ± 2.4 cm/sec, P = .023; 1.2 ± 0.3 vs 1.4 ± 0.4, P = .039; respectively) were lower in smokers. LV GLS and RV GLS were significantly lower in smokers (-17.6% ± 3.01 vs -19.2% ± 2.5; P = .013, -18.9% ± 4.4 vs -21.0% ± 4.5; P = .039; respectively)., Conclusion: Impaired LV and RV deformation were found in chronic smokers in our study. Although there was no statistically significant difference with left ventricular ejection fraction, LV GLS which is the early indicator of LV systolic dysfunction was lower in chronic smokers. The assessment of early harmful effects of smoking on left and right ventricle might be evaluated with speckle tracking echocardiography., (© 2019 Wiley Periodicals, Inc.)

Objective: Heart rate turbulence (HRT) indicates the impairment of cardiac autonomic function. With the literature containing insufficient information on HRT in stable coronary artery disease (CAD), this study aimed to investigate the role of HRT in patients with stable CAD., Methods: The study included 58 patients (mean age: 58.9 ± 10.0 years; 25 male) with documented CAD and demonstrating ventricular premature complexes on Holter monitoring, and a control group of 52 patients (mean age: 55.9 ± 9.3 years; 36 male) with no history of CAD and demonstrating ventricular premature complexes. HRT parameters such as turbulence onset (TO) and slope (TS) were analyzed. Angiographic Gensini score were used to evaluate CAD severity., Results: There was a significant difference in HRT parameters between the 2 groups. TO: 0.47 ± 1.52% vs. -1.61 ± 2.0% (p=0.001) and TS: 4.7 ± 3.0 vs. 6.4 ± 3.7 ms/RR (p=0.009) in patients with CAD and control group respectively. Given also that TO ≥ 0% and TS ≤ 2.5 ms/ RR values are considered abnormal, there was significant difference between the two groups; TO abnormal: 27 patients (46.6%) vs. 7 patients (13.5%), p=0.001, and TS abnormal: 15 patients (25.9%) vs. 4 patients (7.7%), (p=0.004) in CAD patients and control group respectively. A positive correlation was detected between TO and Gensini score (r=0.282, p=0.001) and a negative correlation detected between TS and Gensini score (r=-0.287, p=0.001)., Conclusion: The study demonstrated that HRT variables are impaired in patients with stable CAD when compared to those in the control group, and that these variables also correlate with severity of CAD.

Background: Optimal duration of adjuvant trastuzumab in early breast cancer is an unresolved issue. In this observational study, we compared the outcome of 9 weeks and 1 year adjuvant trastuzumab in early breast cancer patients in Turkey., Methods: Records of 680 patients with HER2-positive early breast cancer who received adjuvant trastuzumab plus chemotherapy were obtained and patients were followed up to compare the disease-free survival (DFS) outcome of 9 weeks versus 1 year trastuzumab., Results: Nine weeks and 1 year trastuzumab was given to 202 (29.7 %) and 478 (70.3 %) patients, respectively. There was a significantly lower rate of patients with negative lymph nodes in the 9-week trastuzumab group. At median 3 years of follow-up from the date of starting trastuzumab, the DFS rates were 88.6 and 85.6 %, respectively (p = 0.670). When adjusted for all the prognostic factors that were significant on univariate analysis, again there was no significant difference in DFS between the groups (HR 0.675; 95 % CI 0.370-1.231; p = 0.200). Cardiac toxicity defined as a ≥15 % decrease in LVEF was significantly higher in the 1-year trastuzumab group (1.88 % versus none for 1-year and 9-week trastuzumab groups, respectively; p = 0.050)., Conclusion: The results of this observational study suggest that DFS outcome of 9 weeks of adjuvant trastuzumab may be comparable to 1 year adjuvant trastuzumab: this needs confirmation by randomized trials.

Thromboembolic obstruction of the renal artery is a serious clinical problem, but rarely diagnosed. The diagnosis is not usually established until irreversible renal parenchymal damage occurs. Here, we present a case of renal artery thromboembolism in a patient who had atrial fibrillation and was treated by selective intra-arterial infusion of tissue plasminogen activator (TPA). A 69-year-old male was admitted to our hospital with a one-hour history of palpitation and epigastric pain. He had inferior myocardial infarction and percutaneous coronary intervention to the right coronary artery two weeks before. Coronary angiogram was performed, and no significant stenosis was detected. One hour later, epigastric pain spread to the left flank region. Spiral computerized tomography showed occlusion of the left renal artery. Emergency abdominal angiography was performed, and selective intra-arterial infusion of TPA was started promptly. The abdominal pain disappeared, and urine output remained adequate. Forty-eight hours later, angiographic follow-up confirmed the complete lysis of the thrombus in the left renal artery. No renal or hemorrhagic complications were observed, and the patient was discharged four days later with normalized renal function on oral anticoagulation.

Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually, it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and arises posteriorly to the aortic root. We report a rare case of a patient with cardiac tamponade due to left ventricular pseudoaneurysm after aortic valve replacement. The subsequent surgical resection was performed successfully.

Constrictive pericarditis is an uncommon cause of heart failure. It is a clinical entity caused by thickening, fibrosis, and/or calcification of the pericardium. We present a 50-year-old female patient who was admitted to our institution with a 6-month history of progressive dyspnea on exertion, abdominal swelling, and lower extremity edema. Her chest X-ray revealed an oblique linear calcification in the cardiac silhouette. Transthoracic echocardiography revealed biatrial enlargement. Left ventricular size and systolic function were normal. Cardiac computed tomography revealed the pericardial thickening (>5 mm) and heavy calcification in left atrioventricular groove. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip, and plateau. Pericardiectomy was performed which revealed a thick, fibrous, calcified, and densely adherent pericardium constricting the heart. The postoperative period was uneventful and was in NYHA functional class I after 3 months.

Kaposi's sarcoma is an unusual tumor principally affecting the skin of the lower extremities. Although the association between Kaposi's sarcoma and renal transplant has been well documented, there are few Kaposi's sarcoma cases in the literature associated with ulcerative colitis or other inflammatory bowel diseases. This report presents a patient with ulcerative colitis who developed Kaposi's sarcoma following treatment with long-term medium-dose azathioprine and additional corticosteroids. Kaposi's sarcoma is a rare complication in inflammatory bowel diseases that may (or may not) be related to immunosuppression. Hence, immunomodulatory agents should be planned carefully in the treatment of inflammatory bowel diseases and avoided if they are not essentially necessary. Cases of colorectal Kaposi's sarcoma complicating inflammatory bowel disease should be managed with a conservative approach and discontinuation of the immunosuppressive treatment.

Deep vein thrombosis (DVT) is a common condition in which the approach to its diagnosis has evolved over the years. Currently, an algorithm strategy combining pre-test probability, D-Dimer testing and compression ultrasound imaging allows for safe and convenient investigation of suspected lower-extremity thrombosis. Patients with low pre-test probability and a negative D-Dimer test result can have proximal DVT excluded without the need for diagnostic imaging. The mainstay of treatment of DVT is anticoagulation therapy, whereas interventions such as thrombolysis and placement of inferior vena cava filters are reserved for special situations. The use of low-molecular-weight heparin (LMW) allows for outpatient management of most patients with DVT. The duration of anticoagulation therapy depends on whether the primary event was idiopathic or secondary to a transient risk factor. More research is required to optimally define the factors that predict an increased risk of recurrent DVT to determine which patients can benefit from extended anticoagulant therapy. DVT is also a serious problem in the antenatal and postpartum period of pregnancy. Thromboembolic complications are the leading cause of both maternal and fetal morbidity and mortality. The incidence of venous thromboembolism during normal pregnancy is six-fold higher than in the general female population of childbearing age. The treatment of DVT during pregnancy deserves special mention, since oral anticoagulation therapy is generally avoided during pregnancy because of the teratogenic effects in the first trimester and the risk of fetal intracranial bleeding in the third trimester. LMW heparin is the treatment of choice for DVT during pregnancy. If acute DVT occurs near term, interrupting anticoagulation therapy may be hazardous because of the risk of pulmonary embolism. In this situation, placement of a retrievable inferior vena cava filter must be considered. However, there is no consensus as to what the appropriate dose should be and whether anti-Xa levels need to be monitored.

Objective: To report an emergency approach of random-start controlled ovarian hyperstimulation (COH) in the late follicular or luteal phase of the menstrual cycle for embryo cryopreservation in patients with cancer., Design: Case series., Setting: Academic tertiary referral centers., Patient(s): Three patients with a diagnosis of breast cancer requiring emergency fertility preservation in the late follicular or luteal phase of the menstrual cycle., Intervention(s): After baseline pelvic ultrasound and hormonal evaluation, random-start COH was commenced immediately on menstrual cycle days 11, 14, or 17 with use of letrozole 2.5 mg/d and recombinant FSH 150 to 300 IU/d. Gonadotropin-releasing hormone antagonist was administered to prevent ovulation in all cases. Ovulation was triggered with either 250 μg of recombinant hCG or 10,000 IU of urinary hCG., Main Outcome Measure(s): Number of oocytes harvested, maturity and fertilization rates, number of embryos frozen., Result(s): Nine to 17 oocytes were harvested, resulting in the freezing of seven to 10 embryos with the mean maturity and fertilization rates of 58.8% to 77.7% and 69.2% to 87.5%, respectively., Conclusion(s): In an emergent setting, ovarian stimulation can be started at a random cycle date for the purpose of fertility preservation without compromising fertilization rates in letrozole cycles., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: We evaluated the value of QT interval dispersion in patients with rheumatic mitral stenosis (MS) in association with echocardiographic parameters and serum N-terminal pro brain natriuretic peptide (NT-proBNP) levels., Study Design: The study consisted of 46 patients (39 women, 7 men; mean age 46.9±9.7 years) with moderate-to-severe rheumatic MS. All patients underwent echocardiographic examination. Blood samples for NT-proBNP were collected immediately after ECG recording. QT interval and QRS complex were measured manually on standard 12-lead surface ECGs. Electrocardiographic and echocardiographic findings and serum NT-proBNP levels were compared with those of a control group consisting of 30 healthy subjects (26 women, 4 men; mean age 46.1±7.3 years)., Results: Compared to controls, serum NT-proBNP levels were significantly higher in MS patients (284.6±206.5 vs. 70.2±9.3 pg/ml, p<0.001). The mean QT interval, QTc interval, and QT dispersion were significantly prolonged in MS patients compared to controls (378±25 vs. 349±21, 420±22 vs. 401±19, and 61±21 vs. 38±15 msec, respectively; p<0.005). QT and QTc dispersions were negatively correlated with mitral valve area (QT: r=-0.311, p=0.03; QTc: r=-0.327, p=0.02), and positively correlated with serum NT-proBNP level (QT: r=0.583, p<0.001; QTc: r=0.637, p<0.001). QTc dispersion was also an independent predictor of serum NT-proBNP level in regression analysis (β=0.330, p=0.03)., Conclusion: Our results indicate that QT dispersion is related to the echocardiographic degree of rheumatic mitral valve disease and serum NT-proBNP levels in rheumatic MS. Being a noninvasive, easy, and inexpensive method, QT dispersion may be used as a complementary tool to the clinical and echocardiographic evaluation of patients with rheumatic MS.

Objectives: Risk stratification in acute coronary syndromes is an important diagnostic tool guiding future therapy. We evaluated the correlation between the AHCPR (Agency for Health Care Policy and Research) risk classification and angiographic morphology in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS)., Study Design: A total of 163 patients hospitalized with the diagnosis of NSTE-ACS were prospectively enrolled. All the patients underwent AHCPR risk analysis followed by coronary angiography. Based on the AHCPR system, the patients were classified as low (n=25, mean age 55±10 years), intermediate (n=55, mean age 58±10 years), and high (n=83, mean age 61±11 years) risk groups., Results: The three groups were similar with regard to gender, age, and coronary heart disease risk factors (p>0.05). Comparison of the high-risk group with intermediate+low-risk group with regard to lesion morphology showed significantly higher rates of complex lesions (31.9% vs. 4.0%, p=0.001), total occlusion (23.2% vs. 0%, p=0.001), and intracoronary thrombosis (13% vs. 2%, p=0.02) in the high-risk group. In univariate analysis, high risk was significantly associated with the presence of complex lesion, total occlusion, intracoronary thrombosis, and TIMI flow

Background: Lymphangiogenesis and angiogenesis are critical processes for tumor growth, invasion, and metastasis, and are crucial for therapeutic strategies. The aim of the present study was to evaluate the clinical significance of lymphangiogenesis and its regulation in gastric carcinomas., Methods: The lymphatic vessel density (LVD) in 65 gastric carcinoma cases was investigated by immunohistochemistry using D2-40 antibody, and evaluated with prognostic parameters. The intratumoral microvessel density (MVD), using CD31 antibody, was assessed and correlated with LVD., Results: D2-40 identified peritumoral lymphatics in all cases, and lymphatic vessel density (LVD) ranged from 3 to 19 (median, 5; mean ± SD, 7.69 ± 4.67). The peritumoral LVD significantly correlated with large tumor size (P=0.0001), lymph node metastasis (P=0.004), visceral organ metastasis (P=0.0001), and TNM stage (P=0.001). Survival was also significantly lower in patients with high LVD tumors than in patients with low LVD tumors (P=0.04). Among various clinicopathologic characteristics, CD31 expression was associated only with lymph node metastasis (P=0.001). However, there was no significant correlation between CD31 and D2-40., Conclusion: Our study showed that lymphangiogenesis plays an important role in the progression of gastric carcinoma. Therefore, D2-40, as an indicator for tumor lymphangiogenesis, may serve as a prognostic marker in gastric carcinoma., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Although breast cancer is the most common disease for women, bilateral breast cancer is a rare situation. Development of a second malignancy which is the most frightening side effect, may be related with genetic predisposition or cancer treatment. Because our case is a survivor of acute lymphoblastic leukemia, development of bilateral breast cancer which occurs rarely in early ages, is discussed with the help of literature.

We present the case of a patient having colonic adenocarcinoma and also incidentally found Hodgkin's lymphoma which involved a single mesenteric lymph node dissected from the sigmoidal resection performed for colonic carcinoma. The disease was confirmed with the removal of right posterior cervical lymph node. Coexistence of colonic carcinoma and lymphoma in the same patient is an uncommon event.

Cancer survivors have a higher risk of new primary cancer, in the same or in another organ, than the general population. We report a 78-year-old women who has metachronous quadruple adenocarcinoma, includes bilateral breast cancer, ovarian cancer and retroperitoneal neuroendocrine carcinoma. The development of second cancer in cancer survivors can be expected but third or higher order malignancies are rare.

Background: We retrospectively evaluated the activity and toxicity of uracil/tegafur (UFT) plus oral folinic acid in combination with vinorelbine (alternating intravenous (IV) on day 1 and oral on day 8) in patients with metastatic breast cancer., Patients and Methods: Treatment consisted of IV vinorelbine 25 mg/m(2) on day 1 and 60 mg/m(2) orally on day 8, and oral UFT 300 mg/m(2) plus leucovorin 60 mg/m(2) on days 1-14 with 21 days interval. All patients were refractory to anthracyclines and taxanes., Results: Partial response (PR) was observed in 3 (9.7%) and stable disease (SD) was observed in 13 (41.9%) patients. Total clinical benefit (PR + SD) of the combination was 51.6%. The median response duration was 3 (range 1-11.8) months. Median overall survival was 9.8 months (95% confidence interval (CI): 7.5-12.1), and median time to progression was 3.4 months (95% CI: 2.3-4.5). The most common toxicities were hematologic, including 4 (12.9%) cases of grade 3 neutropenia and 4 (12.9%) cases of grade 4 neutropenia. Grade 3 diarrhea was reported in 2 (3.2%) patients. 3 (9.7%) patients had hand-foot syndrome. Febrile neutropenia was observed in 1 patient., Conclusions: Although the combination is safe and convenient in clinical practice, it has only moderate activity in metastatic breast cancer patients., (Copyright 2009 S. Karger AG, Basel.)

The publisher regrets that this is an accidental duplication of an article that has already been published in The Breast, 12 (2003) 1-9, doi:10.1016/S0960-9776(02)00214-X. The duplicate article has therefore been withdrawn.

Cyclooxygenase-2 (COX-2) is upregulated in gastric carcinoma, and its increased levels were found to have a prognostic significance in some studies. Both angiogenesis and Helicobacter pylori infection have been reported to be associated with COX-2 expression of gastric cancer in recent studies. In this study, COX-2 expression and its association with CD31 staining, H.-pylori infection, and well-known clinicopathological factors were investigated in 65 gastric cancer patients. COX-2 and CD31 expression assessment was done by immunohistochemical methods. Whartin Starry stain was performed for H.-pylori infection. Of 65 patients, 32 (49%) revealed intense COX-2 immunostaining. Among various clinicopathologic characteristics, COX-2 expression was inversely correlated with tumor size, TNM stage, and lymph node status. Thirty-two (49%) patients revealed intense CD31 immunostaining. Among various clinicopathologic characteristics, CD31 expression was associated only with lymph node metastasis. COX-2 expression was not correlated with CD31 staining and H.-pylori infection. Both COX-2 and CD31 staining had no prognostic significance. In conclusion, we found that COX-2 expression was significantly higher in earlier stages of gastric cancer. It can be suggested that COX-2 expression may be important in the initial development of gastric cancer but not in progression of the disease. Other factors which may be associated with COX-2 in gastric cancer, including angiogenesis and H.-pylori infection, should be investigated in further studies.

Interdigitating dendritic cell tumor (IDCT) is an extremely rare malignancy. It occurs primarily in lymph nodes, but extranodal involvement has also been reported. A 38-year-old woman with IDCT with breast and cervical lymph-node involvement is reported in this paper. To our knowledge, this is the first case of IDCT originating from the breast. In the breast and lymph node, the tumor displayed diffuse sheets, fascicles and storiform growth pattern. It was composed of oval to spindle cells with pale to eosinophilic cytoplasm, ill-defined cell outlines, oval nuclei with vesicular chromatin and prominent eosinophilic nucleoli. Mitotic activity was three per ten high-power fields. The neoplastic cells were intermingled with small mature lymphocytes and plasma cells. Immunohistochemical studies showed that the tumor cells were strongly and diffusely positive for vimentin, CD68, S-100 protein, CD45/leukocyte common antigen and fascin and focally positive for lysozyme, alpha-1 antitrypsin and CD4. Ki-67 labeling index was 10%. The patient was treated with combined therapeutic approaches, including surgery, radiotherapy and chemotherapy. IDCT has the potential for an aggressive clinical course. However, 32 months after the initial diagnosis, the patient is still alive and being followed with a stable tumor burden.

Aims and Background: p53, c-erbB-2 and Ki-67 protein expression and microvessel density (MVD) determined by CD34 antibody were evaluated by immunohistochemistry and their correlation with clinicopathological parameters including estrogen (ER) and progesterone (PR) receptor status and survival were investigated in patients with axillary lymph node-negative infiltrating ductal breast carcinoma., Methods: The study population consisted of 47 patients with axillary lymph node-negative infiltrating ductal breast carcinoma., Results: p53 and c-erbB-2 expression was detected in 36.2% and 31.9% of patients, respectively. Median Ki-67 expression was 10%. There were no statistically significant differences in the distribution of p53, Ki-67 and c-erbB-2 protein expression in relation to the age of the patients or to the size, histological grade or ER and PR status of the tumors. p53 protein expression correlated positively with c-erbB-2 and Ki-67 protein expression (P < 0.05). The mean MVD was 63.65 +/- 29.1 and it correlated positively with histological grade and Ki-67 expression (P < 0.05). Survival analysis revealed that age, tumor size, p53 and c-erbB-2 expression and PR status had no significant prognostic impact, whereas histological grade, proliferative activity and angiogenic activity were significant prognostic factors. Although ER-positive patients had a statistically significant overall survival advantage, the difference in disease-free survival was not significant., Conclusion: In axillary lymph node-negative breast carcinoma the histological grade and the proliferative and angiogenic activity of the tumor could be useful prognostic indicators.

Vascular endothelial growth factor (VEGF) is used to evaluate the angiogenic activity in breast carcinoma. Nitric oxide (NO) and insulin-like growth factor-I (IGF-I) are also implicated in breast tumorigenesis, including angiogenesis. We measured serum VEGF, IGF-I and nitrate+nitrite levels in 38 patients with metastatic and 23 with nonmetastatic breast cancer and in 16 controls. Serum VEGF and IGF-I levels were higher in patients with metastatic disease than in those with nonmetastatic disease or in controls (P<0.001). Serum nitrate+nitrite levels were higher in patients with metastatic and nonmetastatic disease than in controls (P<0.001). Patients with visceral metastasis and local metastasis had higher serum VEGF and nitrate+nitrite levels than patients with bone metastasis (P<0.05). In the metastatic disease group, there was a positive correlation between serum VEGF levels and nitrate+nitrite levels (r=0.436, P<0.05). Within the group with nonmetastatic disease, premenopausal patients had higher serum IGF-I levels than did postmenopausal patients (P<0.001). NO may involve an angiogenic process that is stimulated by VEGF in breast carcinoma. Larger studies are required to clarify these suggestions.

Purpose: Tamoxifen, used in breast cancer treatment, may induce hepatic steatosis. It has been suggested that leptin, which has a relationship with body fat stores, may be involved in the pathogenesis of hepatic steatosis. In this study, we compared serum leptin levels in tamoxifen-treated patients with and without hepatic steatosis., Methods: Thirty-four women with breast cancer receiving tamoxifen were included in the study. Serum samples were obtained from the patients before and 3 months after tamoxifen therapy., Results: Increased hepatic steatosis was detected in 15 of 34 (44%) patients after 3 months of tamoxifen therapy. Serum leptin levels were found to be significantly elevated in patients with increased hepatic steatosis (37.3 +/- 17.7 to 50.5 +/- 22.4 ng/ml, p = 0.023) compared to (48.2 +/- 20.2 to 42.6 +/- 14.9 ng/ml, p > 0.05) after tamoxifen treatment., Conclusion: Leptin may play a role in tamoxifen-induced hepatic steatosis. The exact mechanism involved should be investigated in further studies.

Background: Interleukin-18 (IL-18) is a novel immunoregulatory cytokine that was known previously as interferon-gamma-inducing factor. IL-18 levels can be used as a serum indicator for monitoring the clinical course of patients with hematologic malignancies and gastric carcinoma. Nitric oxide (NO) is a pleiotropic molecule that participates in the multistep processing of carcinogenesis., Methods: In the current study, we measured serum IL-18 and nitrate and nitrite levels in 38 metastatic and 26 nonmetastatic breast carcinoma patients and 16 healthy control subjects. Serum nitrate and nitrite levels were measured as an index of NO generation., Results: The levels of serum IL-18 and nitrate and nitrite were increased significantly in breast carcinoma patients compared with control subjects (P < 0.001). Serum IL-18 levels were significantly higher in the metastatic patients compared with the nonmetastatic patients (P < 0.001). There was no difference in serum nitrate and nitrite levels between metastatic and nonmetastatic patients (P > 0.05). Patients with bone metastasis have higher serum IL-18 levels and lower serum nitrate and nitrite levels compared with patients with liver, lung, and local metastasis (P < 0.001). There was no correlation among serum IL-18, nitrate and nitrite, CA 15-3, and carcinoembryonic antigen levels (P > 0.05)., Conclusions: These findings suggest that serum IL-18 and nitrate and nitrite levels may be useful markers in monitoring metastatic breast carcinoma patients. IL-18 and NO activities in breast carcinoma patients with bone metastasis may be more valuable in the follow-up of these patients., (Copyright 2002 American Cancer Society.)

We investigated whether the glutamergic system plays a role in isolated trachea from control and ovalbumin-sensitized guinea-pigs. Electrical field stimulation induced contractile responses in control group, but electrical field stimulation produced relaxation responses in ovalbumin-challenged guinea-pigs. The responses induced by electrical field stimulation in both groups were completely abolished by tetrodotoxin, but unaffected by hexamethonium. DL-2-amino-5-phosphono-valeric acid (D-AP5) caused a concentration-dependent statistically significant inhibition in the contractile responses to electrical field stimulation50 (EFS50) in control guinea-pigs. But in the ovalbumin-challenged groups, D-AP5 did not cause any significant effect on the relaxation response to frequency of field stimulation (EFS50). N(G)-monmethyl-L-argine caused a significant inhibition in the relaxation effect of EFS50. L- and D-glutamate and N-methyl-D-aspartic acid (NMDA) alone had no effect on the resting tension on the trachea in both groups. Carbachol produced concentration-dependent contractile responses in ovalbumin-challenged groups. These results suggested that responses to electrical field stimulation in control groups might be due to NMDA receptor-mediated release of any substance on prejunctional neurones and, alternatively, NMDA might exert a modulatory effect on any substance at prejunctional level. Also, responses to electrical field stimulation in ovalbumin-challenged guinea-pigs might not be mediated by NMDA but rather by increasing the production of nitric oxide by inducible nitric oxide synthase.

Background: Increased nitric oxide level may play a critical role in the hemodynamic disturbances in patients with cirrhosis. There are few reports investigating the factors related to this increase and their results are controversial. The purpose of this study was to reveal the clinical importance of nitric oxide levels and the possible factors related to this increase in patients with cirrhosis., Methods: Serum and ascites nitrate levels were studied in 50 patients with cirrhosis and 10 control subjects., Results: All cirrhotic patients (groups 2, 3, 4, 5, 6) showed significant increase in serum nitrate levels in comparison with that in control subjects (group 1) (p<0.001). Serum nitrate levels were significantly higher (282.4+/-111.3 micromol/l; p<0.05) in patients with spontaneous bacterial peritonitis (group 2) when compared with those in cirrhotic patients without spontaneous bacterial peritonitis (group 3) (186.4+/-87.6 micromol/l). Ascitic fluid nitrate levels were significantly higher (302.4+/-66 micromol/l; p<0.001) in patients with spontaneous bacterial peritonitis (group 2) when compared with those in cirrhotic patients without spontaneous bacterial peritonitis (group 3) (135.4+/-65.8 micromol/l). Serum nitrate levels were significantly lower in cirrhotic patients without ascites (group 5) when compared with those in cirrhotic patients with ascites (group 3) (98.8+/-52.6 vs. 186.4+/-87.6 micromol/l; p<0.05). No significant differences were found among patients with severe anemia (groups 4, 6) and other cirrhotic patients (group 3) (174.5+/-54.5, 168.8+/-63.8 vs. 186.4+/-87.6 micromol/l; p>0.05). Cirrhotic patients with Child--Pugh B and C scores showed higher serum nitrate levels (179.4+/-81.1, 222.5+/-101.7 micromol/l; p<0.001) than did cirrhotic patients with Child--Pugh A score (85.8+/-59.7 micromol/l)., Conclusion: Our findings suggest that overproduction of nitric oxide in cirrhotic patients may be related to the severity of liver damage and spontaneous bacterial peritonitis but not related to their anemia.

Aims and Background: Breast cancer refractory to known effective agents is one of the major clinical problems frequently encountered in practice. Cisplatin and vinorelbine are known to be active drugs in anthracycline-refractory cases. In this phase II study, the effectiveness and tolerability of cisplatin and vinorelbine was investigated when used in combination as a salvage regimen in the treatment of metastatic refractory breast cancer., Study Design: Twenty-four patients with advanced refractory breast cancer who had been previously treated with a regimen containing doxorubicin were included in the study. Six of the 24 patients also received taxanes after failure of doxorubicin. Cisplatin at 80 mg/m2 on day 1 and vinorelbine at 25 mg/m2 on days 1 and 8 were given every 3 weeks., Results: A total of 98 cycles of chemotherapy was given, with a median of 4/patient. The response rate was 25% (2 [8.3%] complete and 4 [16.7%] partial responses). The median survival rates were 14 months in responders and 5.5 months in nonresponders (P = 0.0282). One complete and one partial response were observed in patients previously treated with paclitaxel (overall response rate, 33%). The median response duration was 12.5 mo (range, 4-21) in complete and 4.5 mo (range, 1.5-13) in the partial response group. Grade 3 and 4 neutropenia occurred in 9 patients, with no toxic deaths. Grade 2-3 nausea and vomiting in 6 patients and grade 1 neuropathy in 1 patient were noted., Conclusions: Although the number of cases is insufficient to indicate that the combination will be effective, it is noteworthy in consideration of anthracycline and taxane refractory cases. A combination of cisplatin and vinorelbine seems to be a reasonable and acceptable choice as an alternative salvage regimen in such cases.