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OBJECTIVES Our aim was to identify factors associated with overall survival and the efficacy of postrelapse treatment protocols and to determine whether pretransplant consolidation therapy and minimal residual disease status pose a survival benefit. MATERIALS AND METHODS Patients with acute myeloid leukemia who underwent stem cell transplant between 2007 and 2018 were enrolled retrospectively. The effects of pretransplant cytogenetic and minimal residual disease status, pretransplant consolidation therapies, development of graft-versus-host disease, postrelapse treatment protocols, and type of con-ditioning regimens on overall survival were analyzed. RESULTS In 76 study patients, the cumulative overall 1- and 5-year relapse probabilities were 67.8% and 58.7%, respectively. Overall survival rates at 3 and 5 years in patients with and without relapse were 23.5% and 0% and 95.9% and 91.1% (P < .001), respectively. Although mean postrelapse overall survival was better with intensive salvage plus donor lymphocyte infusion, no significant differences were shown versus other therapies (intensive salvage, nonintensive salvage, intensive salvage or nonintensive salvage plus donor lymphocyte infusion, or supportive therapy). Twenty-three patients (30.3%) died during the study period with a median survival of 9.6 months. Patients with favorable, intermediate, and unfavorable cytogenetic status showed overall survival of 46.6 ± 10.4, 54.6 ± 4.4, and 36.9 ± 5.9 months (P = .807). Patients with and without minimal residual disease and patients who received or did not receive consolidation therapy had similar overall survival. Relapse was an independent predictor of overall survival (increased mortality risk of 26.22). Patients who developed graft-versus-host disease showed decreased relapse. CONCLUSIONS Relapse is the most important predictor of overall survival and is associated with poor prognosis. Pretransplant minimal residual status and cytogenetic status showed no effect on relapse rates and overall survival, and consolidation therapy did not improve outcomes.

Aim: To assess the predictive role of hematological indices in the first trimester of pregnancy for gestational diabetes mellitus (GDM) and to compare the progressive changes in these indices between patients with and without GDM in their first and second trimesters. Materials and Methods: Pregnant women screened for GDM in 24-28 gestational weeks and who had CBC test in the first and second trimesters were retrospectively investigated. Platelet mass index (PMI), neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) were calculated. The first trimester hematological indices were compared between normal glycemic patients and the patients with subsequent GDM. The progressive changes of these indices were compared. Results: Three-hundred-sixty-eight women were enrolled and 17.9% had GDM. There was no difference between first trimester hematological indices, except PLR which was lower in GDM group, however, PLR was not an independent predictor. In normal-glycemic pregnant women hemoglobin, hematocrit, lymphocytes, platelets, mean-platelet-volume (MPV), plateletcrit (PCT), platelet-large-cell-ratio (PLCR) and PMI decreased significantly from first trimester to second trimester. White-blood-cells(WBC), neutrophils, nucleated-red-blood-cells(NRBC), immature granulocytes and NLR increased significantly, while no significant changes were detected in red-cell-distribution-width(RDW), platelet-distribution-width(PDW) and PLR. In GDM patients, hemoglobin, hematocrit, lymphocytes, platelets and PMI significantly decreased while WBC, neutrophils, MPV, immature granulocytes and NLR increased from first trimester to second trimester. RDW, PDW, PCT, PLCR, NRBC and PLR did not change. Conclusion: None of the first trimester hematological indices have a predictive ability for subsequent GDM. The progressive changes in MPV can be used as an indicator to assess the development of GDM.

Central venous catheters are commonly used in bone marrow transplantation units and useful for drug administration, supportive treatments, and nutrition. They are used for stem cell infusion and also hemodialysis, hemapheresis, and photopheresis procedures when required during posttransplant period; however, they can sometimes cause severe morbidity and mortality during insertion or removal. While air embolism which may lead to severe neurologic problems is among the rare but severe complications, a meticulous and experienced approach during insertion and removal could significantly decrease this risk. In this case report, we wanted to pull attention to cerebral air embolism which is a rare mechanic complication of central venous catheters.

Aim: To assess the role of simple complete blood count (CBC) in prediction of gestational diabetes (GDM).Materials and Methods: Pregnant women screened for GDM in 24-28 gestational weeks with a 75g-OGTT between January 2018-January 2020 were retrospectively investigated. Patients with a known systemic disease, using aspirin, low-molecular-weight heparin and steroids excluded. The assessed parameters in CBC were hemoglobin, hematocrit, red blood cells, mean corpuscular volume, mean corpuscular hemoglobin concentration, white blood cells (including neutrophils, lymphocytes, monocytes, eosinophils, basophils), platelets, platelet distribution width (PDW), mean platelet volume (MPV), red cell distribution width (RDW), nucleated red blood cell (NRBC), NRBC percentage, plateletcrit (PCT), platelet large cell ratio (P-LCR), immature granulocytes (IG) and IG percentage. Platelet mass index (PMI), neutrophil-to-platelet ratios (NPR) and lymphocyte-to-platelet ratios (LPR) were calculated. These parameters were compared between GDM patients and controls. Regression analysis was performed with the parameters that were significantly correlated with GDM. ROC curve analysis was done in order to find cut-off values.Results: RBC, WBC (all subtypes including immature granulocytes), platelet indices including PMI, NPR and LPR were all similar. Only RDW and NRBC were found to be significantly increased in GDM patients and came out to be independent predictors of GDM with maternal age and screening week. Conclusion: These findings suggest women with GDM may be accompanied with increased RDW and NRBC levels which seem to be independent predictors of this disease and these parameters may be used to monitor and evaluate the development of GDM., Amaç: Basit bir tam kan sayımının (TKS) gestasyonel diyabetus mellitus (GDM) öngörüsündeki rolünü değerlendirmekGereç ve Yöntem: Ocak 2018-Ocak 2020 yılları arasında 24-28. Gebelik haftalarında 75g oral glukoz tolerans testi ile GDM taraması yapılan gebeler retrospektif olarak değerlendirildi. Bilinen sistemik hastalığı olan, aspirin, düşük-molekül-ağırlıklı heparin veya steroid kullanan hastalar elendi. TKS içinde hemoglobin, hematokrit, eritrositler, ortalama korpüsküler hacim ve hemoglobin konsantrasyonu, lökositler (nötrofil, lenfosit, bazofil, monosit, eozinofil dahil), trombositler, trombosit dağılım genişliği, ortalama trombosit hacmi, kırmızı-hücre dağılım genişliği (RDW), çekirdekli kirmizi kan hücreleri (ÇKKH) ve yüzdesi, plateletkrit, trombosit büyük hücre oranı ve immatür granülosit ve yüzdesi mevcuttu. Trombosit kütle indeksi (TKİ), nötrofil-trombosit (NTO) ve lenfosit-trombosit oranları (LTO) hesaplandı. Bu parametreler GDM olan ve olmayan hastalarda karşılaştırıldı. GDM ile anlamlı korelasyon gösteren parametrelerle regresyon analizi yapıldı. Eşik değer hesaplaması ROC eğrisi analizi ile yapıldı.Bulgular: Eritrositler, lökositler (immatür granülosit dahil tüm alt gruplar), TKİ, NTO ve PTO da dahil trombosit indeksleri gruplarda benzerdi. Sadece RDW ve ÇKKH, GDM’li hastalarda anlamlı olarak yüksek olarak bulundu ve bu parametreler yaş ve tarama haftası ile birlikte GDM için bağımsız prediktörler olarak tespit edildi.Sonuç: Bu sonuçlar GDM’li hastalarda RDW ve ÇKKH seviyelerinin artmış olduğunu, bu parametrelerin GDM için bağımsız prediktörler olarak görüldüğünü ve GDM gelişmesinin izleminde ve değerlendirilmesinde kullanılabileceğini göstermektedir.

In clinical practice the role of bone marrow evaluation (BM) in the elderly, especially in patients over 75 years old who are referred as middle/advanced old, is not clear. In this study the aim was to assess the indications, results and the contribution of BM aspiration and biopsies to the clinical management and outcomes in patients over 75 years old. All ≥75 years old patients to whom BM evaluation was performed between January 2014 and December 2018 in our clinic were assessed retrospectively. The clinical properties, laboratory, peripheral blood smear and BM aspiration/biopsy results, the applied treatments and the survival outcomes were evaluated. The mean age of the 81 included patients was 80.4±4 (75-95). There was no procedure-related complication. Cytopenias were the most frequent indication. Anemia, leukopenia and thrombocytopenia were detected in 87.6%, 25.9% and 50.6% respectively. Myelodyspastic syndrome (MDS) was the most frequent diagnosis. Multiple myeloma, myeloproliferative diseases and non-Hodgkin lymphoma were the following diagnoses. Aspiration and biopsy showed high correlation. In general the median survival was 69 months in the treated patients and 35 months in non-treated patients. Two-years overall survival was 57% in the treated and 41.7% in non-treated patients. In conclusion in order to diagnose hematological and some non-hematological disorders confined to advanced age, BM evaluation may be performed safely in patients over 75 years old. The indications of BM evaluation is different than childhood and younger adulthood. Treatment of disorders that were diagnosed with this procedure provides a survival benefit. For this reason whenever indicated, in order to diagnose and improve the survival with appropriate treatment, BM evaluation may be offered to patients in this age group., Yaşlı hastalarda, özellikle de orta/ileri yaşlılık olarak tanımlanan ≥75 yaş grubunda kemik iliği değerlendirmenin klinik uygulamalardaki yeri net değildir. Bu çalışmada ≥75 yaşındaki hastalarda yapılan kemik iliği biyopsi ve aspirasyon endikasyonlarının, sonuçlarının ve yapılan kemik iliği incelemesinin klinik yaklaşıma ve sonuçlara katkısının değerlendirilmesi amaçlanmıştır. Ocak 2014- Aralık 2018 yılları arasında kliniğimizde kemik iliği incelemesi yapılan tüm ≥75 yaş hastalar retrospektif olarak değerlendirildi. Hastaların klinik özellikleri ve laboratuvar kan değerleri, periferik yayma, kemik iliği aspirasyon ve biyopsi sonuçları, aldıkları tedaviler ve sağ kalımları değerlendirildi. Çalışmaya dâhil edilen 81 hastanın ortalama yaşı 80,4±4 yıldı (75-95). İşleme bağlı komplikasyon görülmedi. Sitopeniler en sık endikasyondu. Anemi %87,6 oranında görülürken, lökopeni %25,9 ve trombositopeni %50,6 oranında görülmekteydi. En sık konulan tanı miyelodisplastik sendromdu (MDS). Yine multipl miyelom, miyeloproliferatif hastalıklar ve non-Hodgkin lenfoma MDS’yi takip ediyordu. Aspirasyon ve biyopsi yüksek oranda uyum göstermekteydiler. Genel olarak tedavi alan hastalarda ortanca sağ kalım süresi 69 ayken, almayan grupta 35 aydı. Yine 2 yıllık genel sağ kalım tedavi alan hastalarda %57 iken, almayan hastalarda %41,7 idi. Sonuç olarak ≥75 yaş hastalarda, ileri yaşa özgü hematolojik ve bazı non-hematolojik hastalıkların tanısının konulması için kemik iliği incelemesi güvenle yapılabilir. Kemik iliği incelemesinin endikasyonları çocuk ve genç erişkinlerinkinden farklıdır. Bu incelemeyle tanısı konulan hastalıklarda uygulanan tedaviler ile sağ kalım artmaktadır. Bu nedenle endikasyon varlığında, tanının konulması ve uygun tedavinin başlanması yolu ile sağ kalımı arttırmak için kemik iliği incelemesi bu yaş grubuna önerilmelidir.

In Turkish literature there are very few studies regarding multiple primary malignancies (MPM). The aim of this study was to analyze the synchronous and the metachronous malignancies that occurred with a hematologic malignancy. All the patients with a hematologic malignancy were enrolled in this cross-sectional, definitive retrospective study. Data were obtained from the medial records. Patients characteristics including demographic features, treatment protocols and overall survival (OS) were recorded. Among 663 patients with a hematologic malignancy, there were 26 patients with MPMs (3.9%). Synchronous malignancies constitute 0.9% and metachronous malignancies were present in 3%. In men diffuse large B-cell lymphoma (DLBCL) and non-small cell lung carcinoma (NSCLC) and in women breast and acute myeloid leukemia were the most common primary and secondary MPMs respectively. The mean cumulative OS of all patients with MPMs was 246.3±33.4 months and the 5 years-OS was 91.3%. In synchronous MPMs the most frequent concomitant tumors were DLBCL and NSCLC. In metachronous tumors the median time interval between first and second malignancies was 69.5 months (range: 31-312). In four patients there were three MPMs. After radiotherapy three patients developed breast, thyroid and skin cancers and in one patient who received radioiodine for the treatment of thyroid carcinoma, DLBCL had developed. The chemotherapeutic agents applied for the primary malignancies consisted of alkylating agents, antimetabolites, anthracyclines, topoisomerase II inhibitors, monoclonal antibodies and mitotic inhibitors. In 75% of the patients with DLBCL who had received R-CHOP chemotherapy regimen, NSCLC had developed during the follow-up period. In conclusion secondary malignancies with hematologic malignancies are not rare and the clinicians should keep the possibility of secondary malignancies in mind and be suspicious during diagnostic evaluations. Warning with regard to the risk of development of secondary malignancies due to the primary treatment should be given to any patient with a hematologic malignancy. [Med-Science 2020; 9(1.000): 94-9]

Despite recent improvements in the treatment options, adult relapsed/refractory Acute Lymphoblastic Leukaemia (ALL) and lymphoblastic lymphoma (LBL) exhibit poorer cure rates than in childhood. Since, the mainstay difference of childhood multidrug regimens is L-Asparaginase, we sought to salvage adult patients with a protocol containing methotrexate, vincristine, conventional L-asparaginase, and dexamethasone (MOAD). In this study, we aimed to summarize our experience. Methods: Adult patients with relapsed/refractory ALL and LBL followed-up in our institution between 2017 and 2018 were reviewed and those treated with MOAD protocol were retrospectively included in the study. Clinical data, treatment responses, and adverse events were summarised. The protocol featured 28-day cycles of methotrexate 200 mg/m2 intravenously (IV) on days 1 and 15; vincristine 1.4 mg/m2 IV on days 1, 8, and 15; L-asparaginase 10,000 IU/m2 IV twice weekly; and dexamethasone 40 mg IV or orally on days 1–4 and 15–18. Results: A total of eight patients were enrolled, of median age 37 years (range: 21–58 years). Four patients were recovered after transplantation. Complete remission was evident in 38%. Two such patients underwent allogeneic hematopoietic stem cell transplantation after the protocol. Another patient with lymphomatous disease achieved partial remission and underwent successful transplantation. L-asparaginase did not trigger any clinically evident hypersensitivity reaction; the most common adverse events associated with the protocol were hypofibrinogenemia, anemia, and febrile neutropenia. Conclusions: The MOAD protocol was effective and tolerable, enabling to salvage before and after transplantation, particularly in patients with relapsed/refractory T-cell acute lymphoblastic leukemia and lymphoblastic lymphoma.

Our aim was to compare patients with high-risk chronic lymphocytic leukemia referred to our transplant center who underwent allogeneic stem cell transplant with those who did not receive this treatment. Factors compared included demographics, clinical characteristics, and survival rates in the novel targeted therapy era.All 33 patients with high-risk chronic lymphocytic leukemia who were referred to the hematopoietic stem cell transplant center were enrolled in this retrospective, single-center nonrandomized study. Outcomes of patients who received allogeneic stem cell transplant were compared with those of nontransplant patients. Chemoimmunotherapy and ibrutinib were given when indicated. Factors related to overall and progression-free survival were assessed.Thirteen patients underwent allotransplant, and transplant was not done in 20 patients for various reasons. Demographic and clinical features of the transplant and nontransplant groups were similar. The estimated cumulative overall survival was 72.6 ± 15 and 84.3 ± 13 months in the nontransplant and transplant groups, respectively. The 5-year overall and progression-free survival rates in the transplant and nontransplant groups were 57.3%/36.0% and 40%/20.6%, respectively. In the nontransplant group, overall survival of those who used ibrutinib was longer than overall survival in patients in the transplant group who used the same drug, but the difference was not statistically significant. Although not significant, overall survival in patients who did not use ibrutinib was longer in the transplant group than in the nontransplant group. Cox regression analyses showed that transplant, relapse, and Binet stage were independent predictors of overall survival.In patients who do not use ibrutinib, allogeneic stem cell transplant improved survival compared with nontransplant patients. Addition of ibrutinib provided comparable life expectancies, showing that allogeneic stem cell transplant and ibrutinib may have complementary roles. Transplant is still an independent predictor of overall survival.

Background Anemia is a frequent disorder worldwide. Iron deficiency anemia (IDA) is the most common form of anemia. Although oral iron is the first choice for treatment, the efficacy of oral iron preparations may be limited. Ferric carboxymaltose (FCM) is a novel parenteral iron preparation which can rapidly replenish iron stores. The aim of the present study is to investigate the impact of FCM dose on hemoglobin (Hb) and ferritin levels and the frequency of hypersensitivity reactions. Methods This study was conducted with 765 IDA patients between September 1, 2016 and September 1, 2018. He-moglobin (Hb), serum ferritin, transferrin saturation values were examined at the time of diagnosis, Hb and ferritin values at first month. Results Post-treatment Hb and ferritin levels significantly increased. The mean Hb level alteration was 2.43 ± 1.2 g/dL, the median ferritin level alteration was 157.3 ng/mL. The mean Hb level was lower and the mean change in Hb level was higher in higher doses. Allergic reactions were more frequent in higher doses. Conclusions Ferric carboxymaltose is a novel treatment option with a low risk of hypersensitivity reactions and well tolerated even in high doses.

The present study investigated the efficacy and safety profile of daratumumab monotherapy in 42 patients with relapsed refractory multiple myeloma through a Turkish early access program. the current findings have confirmed the efficacy of daratumumab monotherapy in heavily pretreated patients with refractory multiple myeloma because of the deep and durable responses and favorable safety and tolerability profile. Background: in countries where frontline drug approval is limited to first-generation proteasome inhibitors or immunomodulatory drugs, relapses have been both more frequent and less durable. We investigated real world data on the efficacy and safety of daratumumab monotherapy among patients with relapsed refractory multiple myeloma (RRMM) from Turkey using a prospective early access program. Patients and Methods: A total of 42 patients with RRMM after a minimum of 3 previous lines of proteasome inhibitor/immunomodulatory drug-based treatments were included from 25 centers across Turkey. Daratumumab monotherapy was administered intravenously at a dose of 16 mg/kg weekly (cycles 1-2), on alternate weeks (cycles 3-6), and monthly thereafter. Results: the median daratumumab monotherapy duration was 5.5 months (range, 0.2-28.7 months). the overall response rate was 45.2%, including 14 (33.3%) partial responses, 4 (9.5%) very good partial responses, and 1 (2.4%) complete response. the median duration of response was 4.9 months. the median progression-free survival (PFS) was 5.5 (95% confidence interval, 2.6-8.4 months) with 12- and 18-month PFS rates of 35.7% and 31.0%, respectively. the median overall survival was not reached; the 12- and 18-month overall survival rates were 64.3% and 59.5%, respectively. the depth of response had a significant effect on PFS (log-rank test, P = .026). Overall, of the 76 adverse events reported, 33 (43.4%) were grade >= 3; only 4 (9.52%) were grade 3 infusion-related reactions. No infusion-related reactions or adverse events led to treatment discontinuation. Conclusion: the present findings from our daratumumab early access program have confirmed the efficacy and safety profile of daratumumab monotherapy in heavily pretreated Turkish patients with RRMM., Janssen Pharmaceutica Turkey, The present daratumumab EAP was funded by Janssen Pharmaceutica Turkey. the authors would like to thank to Professor Sule Oktay, MD, PhD, and Cagla Ayhan, MD, from KAPPA Consultancy Training Research Ltd (Istanbul, Turkey), who contributed to the manuscript writing and statistical analyses.

Background Approximately half of patients with relapsed chemosensitive disease achieve robust responses with BEAM (BCNU, etoposide, cytarabine, and melphalan) and autologous stem cell rescue. The scarcity of comparative studies further limits alternative treatment protocols, such as the MITO/MEL (mitoxantrone, melphalan) protocol. Patients and Methods In this retrospective multicenter study, we compared the BEAM and MITO/MEL regimens used before autologous hematopoietic stem cell transplantation (ASCT) in terms of efficacy and side effects in patients with Hodgkin lymphoma. Data met international accreditation rules. Before ASCT, 108 patients received the MITO/MEL, and 34 patients received the BEAM. Results The median follow-up time was 36 months in the MITO/MEL group (range, 3-178) and 23 months in the BEAM group (range, 4-99). After ASCT, the 3-year expected overall survival and disease-free survival rates were 86.1% and 86.1% for the MITO/MEL group and 91.3% and 76.5% for the BEAM group, respectively. Although 50% of patients developed febrile neutropenia attacks in the MITO/MEL group, this rate was 91.1% in the BEAM group. The grade II and higher rates of hepatic, renal, gastrointestinal, and cardiac toxicities were similar in both groups. However, the rate of pulmonary toxicity was determined to be 1.9% in the MITO/MEL group and 29.4% in the BEAM group (P Conclusion The MITO/MEL conditioning regimen seems to be as effective as the BEAM regimen but has better tolerability in terms of pulmonary toxicity and may be used as an alternative option if necessary, depending on the comorbidity status of the patient.

Background Chronic myeloid leukemia (CML) is a disease resulting from BCR-ABL gene fusion. It is possible to monitor treatment by molecular testing for BCR-ABL. The lymphocyte-to-monocyte ratio (LMR) is a commonly used marker associated with prognosis in various neoplasms. This study was performed to evaluate the relevance of absolute lymphocyte count (ALC), absolute monocyte count (AMC), and LMR in predicting molecular response status in patients with chronic phase CML. Methods Samples submitted to our hematology laboratory for BCR-ABL testing between April 2012 and October 2018 were retrospectively reviewed. Concurrent hemogram testing together with the results of quantitative reverse transcriptase-polymerase chain reaction were noted. Data were grouped according to molecular response status and the ALC, AMC, and LMR were compared among patient groups. Results A total of 224 samples from 95 patients were included in the study. Analysis revealed differences between groups when newly diagnosed patients were compared with patients undergoing treatment, regardless of response status. However, analyzing the groups according to molecular response status failed to reveal differences in ALC, AMC, or LMR. Conclusions ALC, AMC, and LMR are not potential biomarkers for predicting molecular response status in patients with chronic phase CML.

Objective/background: Anti-T lymphocyte globulin Fresenius (rATG-F; ATG-Fresenius) and antithymocyte globulin (thymoglobulin), which are included in transplant protocols, are used to reduce the risk of chronic graft-versus-host disease (cGVHD) or suppress allograft rejection. Available clinical studies have been conducted in heterogenous patient populations and with different administration protocols including stem cell sources. Additionally, the pharmacokinetics of ATG is variable, and the clinically effective dose of rATG-F, in particular, is not exactly known. The aim of the study was to investigate the clinical outcomes of acute myeloid leukemia (AML) patients who underwent hemopoietic peripheral stem cell transplantation from full-matched sibling donors and given two different doses of r-ATG-F. Methods: This was a single-center, retrospective chart review conducted between July 2005 and July 2016. Sixty-nine consecutive AML patients who underwent transplant with fludarabine- and busulfan-based conditioning were included in the study. Patients in Group 1 received 15 mg/kg body weight rATG-F to 2013 (n = 46), and Group 2 received 30 mg/kg of rATG-F dose begining in 2013 to reduce to cGVHD (n = 23). Cyclosporine and methotrexate were used to treat acute GVHD (aGVHD) prophylaxis. Outcome parameters were compared between the groups. Results: Although the recommended dose r-ATG-F had led to a decrease in the cumulative incidence of cGVHD (27 [58.7%] vs. 8 [34.8%]; p = .03), it also increased the infection rate at 1 year (3 [6.5%] vs. 4 [17.4%]; p = .02). The two groups were similar in terms of engraftment time, aGVHD, relapse, nonrelapse mortality, and rATG-F-related toxicity. A Cox regression model revealed that aGVHD III–IV was associated with increased nonrelapse mortality at 1 year (hazard ratio = 18.2; 95% confidence interval, 1.667–199.255; p =

Adult patients with sickle cell disease (SCD) are highly susceptible to stem cell transplant complications, including drug toxicity, graft versus host disease (GVHD), and graft rejection due to SCD-related tissue damage, endothelial activation, and inflammation. The scarcity of compatible stem cells for transplantation further limits treatment options, with only 43 cases of adult allogeneic peripheral blood stem cell transplantation (allo-PSCT) from human leukocyte antigen (HLA)-identical sibling donors reported in the international registry for the period 1986-2013. Herein we report remarkable outcomes in a cohort of adult SCD patients who underwent allo-PSCT using a fludarabine (Flu), busulfan (Bu), and anti-T-cell lymphocyte globulin (ATG)-based conditioning regimen in combination with very low dose total body irradiation (TBI), followed by post-transplant cyclophosphamide (Cy) and sirolimus as GVHD prophylaxis. We performed a single-center, retrospective study consisting of 20 consecutive patients (mean age 33.4 years) who underwent allo-PSCT from HLA-matched related donors with a conditioning regimen of Flu 150/Bu 3.2/Cy 29/ATG 30 (Fresenius)/TBI 200 between September 2013 and September 2017. Data were validated by an independent data audit group of the affiliated JACIE-accredited transplantation center. All patients experienced a sustained donor cell engraftment. Full donor chimerism (total cell) occurred within 180 days in all patients. Mean duration of follow-up was 13.8 months (range: 0.3-50 months), with 12 (60%) patients completing 12 months. No non-relapse mortality or graft rejection occurred. Successful treatment was achieved without the presence of graft loss, grade III-IV acute GVHD, extensive chronic GVHD, or other major complications. Allo-PSCT in combination with Flu 150/Bu 3.2/Cy 29/ATG 30(Fresenius)/TBI 200- Cy/Sirolimus therapy yielded encouraging outcomes with no mortality and low incidence of GVHD. Further controlled studies will be necessary to compare transplant protocols and long-term outcomes.

Objective The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (

Background and Objective Assessment of Hemoglobin S trait donors has gained importance together with the increased allogeneic peripheral stem cell transplant activity for sickle cell disease in the regions where the disease is prevalent. Outcomes of Granulocyte-Colony Stimulating Factor (G-CSF) administration are obscure for hemoglobin S trait donors. This study aims at investigating the incidence of hemoglobin S carrier status and outcomes of G-CSF administration among donors who live in Eastern Mediterranean region. Material and Method The cross-sectional, single-center cohort study was performed with 147 donors between January 2013 and March 2017. Prevalence of hemoglobin S trait was estimated and subjects with or without Hemogobin S trait were compared with regard to stem cell characteristics, early and late clinical outcomes after G-CSF administration. Results Eleven out of 147 donors (7.48%) were found as hemoglobin S trait. G-CSF administration was successfully completed and yielded good harvesting results in hemoglobin S trait donors. No statistically significant difference was found between groups with regard to early and late side effects, stem cell characteristics. Blood pressures and QTc values were within normal ranges in both groups. Groups were similar with regard to CD34 values. Conclusion G-CSF seems safe in hemoglobin S trait donors. Their being eligible as donors would increase the chance of the patients for allogeneic stem cell transplantation in high prevalence regions. Further studies are required to reveal the safety profile of G-SCF in hemoglobin S carriers in different regions.

We report a case of isolated tuberculous epididymoorchitis developing in a patient after haematopoietic stem cell transplantation (HSCT). Forty-four-year-old male was admitted to the hospital with scrotal pain and swelling 6 months after an allogeneic HSCT using a fullymatched sibling donor because of his acute myeloid leukemia. There were scrotal tenderness, thickening and erythema on the right side. Brucella standard tube agglutination test was negative. Increased scrotal skin thickening, edema in the right epididymis and increased testicular vascularization were detected on ultrasonography. He was readmitted to our hospital with recurrent scrotal pain after 3 months of partial improvement with oral ciprofloxacin administered for a diagnosis of right epididymoorchitis. Pelvic magnetic resonance imaging revealed bilateral epididymoorchitis and scrotal abscess. Acid fast bacilli were detected on Ehrlich-Ziehl-Neelsen staining of the content of abscesses drained under local anesthesia. Mycobacterium tuberculosis complex was isolated on the 24th day of quadruple anti-tuberculosis therapy. Scrotal fistula developed on the first month of therapy which healed spontaneously after discontinuation of immunosuppressive agents. Full recovery was achieved after six months of antituberculosis therapy. As a result, tuberculous epididymoorchitis should be kept in mind in the presence of chronic epididymoorchitis developing in patients receiving immunosuppressive therapy.

Aim To assess the role of first trimester maternal testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels in prediction of development of gestational diabetes mellitus (GDM). Methods Four hundred and fifty pregnant women were included in this prospective cohort study. All pregnant women with a singleton pregnancy who were not diabetic, had no family history of diabetes, had no history of previous GDM, were of white race and non-smokers were enrolled. Total testosterone and DHEA-S were measured at 11–14 weeks of gestation. The patients were called for routine pregnancy visits and followed accordingly. Forty-two patients did not come to their visits and were excluded. During gestational weeks 24–28, the remaining 408 patients were screened for GDM. The total testosterone and DHEA-S levels were compared between patients with and without GDM. Regression and receiver–operator curve analysis were performed. Results GDM developed in 22 women (5.7%). Compared with women without GDM, first trimester total testosterone levels were higher among women in whom GDM subsequently developed. The DHEA-S level did not differ. Age, total testosterone and body mass index were found to be independent predictors of GDM development. A total testosterone value of 0.45 ng/mL was found to predict development of GDM with a sensitivity of 63.6% and a specificity of 62.7%. Conclusion First trimester total testosterone has a low testing power for GDM screening with low sensitivity and specificity values and cannot be used as a marker alone. It may have a role in combination with other markers.

Although it is presumed to be a curative strategy for intermediate and high risk acute myeloid leukemia (AML), many patients relapse after allogeneic hematopoietic stem cell transplantation. This prompt us to examine the ways to improve the outcomes. We retrospectively evaluated 76 AML patients who were transplanted between 2007-2017 years in our clinic. We tried to identify the factors associated with posttransplant relapse, postrelapse survival and if there was a survival benefit of pretransplant consolidation and minimal residual disease (MRD) negativity. We examined the effect of the acute-chronic graft versus host disease (GVHD) and salvage therapy after the posttransplant relapses. The mean age of the patients was 44.6±1.21 years (ranges 21-67). 42.1% were females and 57.9% were males. 43.3% of the patients were in complete remission (CR) MRD positive state before the transplantation whereas 35.5% were in CR MRD negative and 3.9% were in progressive disease state. In 13 patients who were in CR state, the MRD status were not known. 11 (14.5%) patients were considered as in favorable risk, 52 (68.4%) in intermediate risk and 13 (17.1%) in unfavorable risk with respect to cytogenetic analysis before the transplantation. The donors were HLA compatible relatives (77.6%), HLA compatible non-relatives (10.5%), haploidentical people (9.2%), one HLA incompatible relative (1.3%) and one HLA incompatible nonrelative (1.3%). 74 bone marrow transplantations (97.4%) were allogeneic and the remaining two (2.6%) were autologous. Myeloablative conditioning regimen was applied to 57 patients (75%) and 19 patients got (25%) reduced intensity conditioning regimen. GVHD developed in 51.3% after transplantation and 61.5% of these were chronic extensive. Relapse occurred in 27 patients (35.5%), hematological relapse being the most common (31.6%). The median time for the development of relapse was found to be 5.5 months (range: 1.5-37). The overall probability for the development of a relapse was found to be 48.7% (95% CI: 40.9-56.5)(Figure1A). 23 patients (30.3%) died during the study period with a median survival of 9.6 months (range: 1.6-45). In the studied population the overall survival probability was found to be 52.8% (95% CI: 45.4 - 60.2) [Figure 1B]. 36.4%, 28.8% and 30.8% of the patients with favorable, intermediate and unfavorable cytogenetic status died respectively during the study period. The comparison of the survival probability of the patients with favorable, intermediate and unfavorable cytogenetic status was depicted in Figure 2. The overall survival probability of the patients with favorable, intermediate and unfavorable cytogenetic status were 46.6% (95% CI: 26.2-66.9), 54.6% (95 % CI: 45.9 - 63.2) and 36.9 % (95% CI: 25.4 - 48.5) respectively (p=0.807). MRD status of 60 patients were known. At the end of the study period 75.8% of the CR MRD positive and 70.4% of the CR MRD negative patients remained alive. The comparison of the survival of patients in CR with respect to MRD status is shown in Figure 3. The overall survival probability of CR MRD positive patients was 56.3 % (95% CI: 45.3 - 67.3) and this rate was 52.5 % (95% CI: 40.8 - 64.3) in MRD negative patients (p=0.770) [Figure 3]. Patients who developed GVHD had similar overall survival probability with the patients who did not developed the disease; 47.0% vs 57.2%, p=0.115 (Figure 4A). Even the patients with chronic extensive GVHD had similar overall survival rates with the patients who had none or acute GVHD; 49.3 % vs 58.2%, p=0.27 (Figure 4B). 66.7% of the patients with a progressive disease before the transplantation died during the study period and this rate was 27.1% in the patients with CR (p=0.005). In conclusion the overall survival rate of the transplanted AML patients was 52.8% in the study group. The overall survival did not seem to be affected by pre-transplant MRD status, cytogenetic risk factors and administration of consolidation therapy. The only patients who had significantly worse results were the ones who had progressive disease before the transplantation. From this point it would be logical to make transplantation whenever the patient is in first CR regardless of the MRD status and a matched donor is found so that the toxic effects of the consolidation chemotherapy may be prevented. Disclosures No relevant conflicts of interest to declare.

Multiple myeloma (MM) is a disease of the elderly. It shows rapidly increasing incidence with increased age. Although MM is rare in young people, patients diagnosed before the age of 50 years account for 10% of the overall incidence and approximately 2% are diagnosed before 40 years of age. The aim of the study was to assess the clinical results of the young MM patients diagnosed at the age of ≤45 years. All the MM patients who were ≤45 years old at the time of diagnosis and who were admitted to our clinic between January 2004 and December 2017 were retrospectively assessed. There was a total of 31 patients and 14 (45.2%) of them were females and 17 (54.8%) of them were males. The mean age was 40.4±3.8 years. The most frequent myeloma types were Ig G Kappa (n:12, 38.7%) and Kappa light chain (n: 10, 32.3%). The remaining types were Ig A lambda (n:4, 12.9%), Ig G lambda (n:2, 6.5%), Lambda light chain (n: 2, 6.5%) and non-secretory myeloma (n:1, 3.2%). Before transplantation 12 patients (38.7%) were in complete remission, 11 patients (35.5%) were in very good partial remission, 4 patients (12.9%) were in partial remission state and 4 patients (12.9%) had refractory disease. VAD + VCD protocol was given to 12 (38.7%) patients. 6 (19.8%) patients had VCD, 3 (9.7%) got VCD + VRD, 2 (6.5%) got VAD and 8 (25.8%) got other chemotherapy protocols. Transplantation was done in 26 patients (83.9%). Overall 9 patients (29%) died during the study period. Second or tandem transplantation was performed to 10 patients and 30% (n:3) of these re-transplanted patients died. The overall survival for these patients was estimated to be 70% (95% CI: 64.2-75.8). In conclusion MM in patients younger than 45 years is rare. In these patients Ig G Kappa and Kappa Light chain types are the most frequent types. Heterogeneous of individual patients may exist within these young myeloma patients. For those who are expected to show a poor response to current treatments despite their young age, the efficacy of an alternative therapeutic strategy such as front line allo-HSTC should be further investigated. Disclosures No relevant conflicts of interest to declare.

Terlipressin is a synthetic vasopressin analogue that is used in the treatment of bleeding esophageal varices and hepatorenal syndrome in patients with cirrhosis. Hepatorenal syndrome is a form of renal failure seen in patients with cirrhosis, with fatal outcomes. Ischemic adverse effects related to terlipressin are rarely observed. Herein, two cases who developed ischemic skin necrosis due to terlipressin usage are presented. Terlipressin therapy was started in two cirrhotic patients with presumptive hepatorenal syndrome. During the therapy, ecchymotic and necrotic changes were observed on the scrotal regions of both patients. Skin lesions were relieved after terlipressin therapy. Biopsy results were consistent with ischemia. Even if seen rarely, possible emergence of ischemic complications must be considered.

Eş zamanlı iki taraflı fasiyal paralizi, nadir bir hastalıktır. İdiyopatik veya Lyme hastalığı, Guillain-Barre sendromu, sarkoidoz, viral enfeksiyonlar, sifiliz, pontin gliomlar ve lösemi gibi çeşitli hastalıklarla ilişkili olabilir. Altmış üç yaşında erkek hasta tam kan sayımında aşırı lökositoz ve yüzün sağ tarafında iki haftadır süren güçsüzlük ile hematoloji kliniğine başvurdu. Hastane yatışının yedinci gününde, yüzünün sol tarafında da güçsüzlük gelişti. Hasta iki taraflı fasiyal paralizi tanısı ile Fiziksel Tıp ve Rehabilitasyon kliniğine sevk edildi. Elektroterapi, el masajı ve egzersizden oluşan bir rehabilitasyon programına başlandı. Her iki taraftaki yüz kaslarına haftada üç seans galvanik akım uygulandı. Dört haftalık elektroterapi, günlük masaj ve egzersiz ile 12 seans sonunda, yüzün her iki tarafında da, duyu ve yüz kası kuvveti bakımından anlamlı iyileşme elde edildi. Takip sırasında 12. haftada ilave iyileşme kaydedildi. Bu yazıda, düşük gradlı B hücreli lenfomaya bağlı iki taraflı fasiyal paralizi olan son derece nadir bir olgu ve elektroterapi ve rehabilitasyon teknikleri ile elde edilen iyileşme sunuldu Simultaneous bilateral facial paralysis is an uncommon condition. It may be idiopathic or associated with various disorders including Lyme disease, Guillain-Barre syndrome, sarcoidosis, viral infections, syphilis, pontine gliomas, and leukemia. A 63-year-old male was admitted to the Hematology clinic with a complete blood count showing excessive leukocytosis and a two-week history of right-sided complete facial weakness. On the seventh day of hospitalization, he also developed facial weakness on the left side. The patient with a diagnosis of bilateral peripheral facial paralysis was referred to the Physical Medicine and Rehabilitation department. He was started on a rehabilitation program including electrotherapy, manual massage, and exercise. Galvanic current was applied to the facial muscles of both sides as three sessions per week. After 12 sessions of electrotherapy, daily massage, and exercise for four weeks, a significant improvement was achieved on both sides in terms of sensation and facial muscle strength. Further improvement was noted at 12 weeks during follow-up. In this report, we present an extremely rare case of bilateral peripheral facial paralysis due to B-cell low grade lymphoma and the improvement with electrotherapy and rehabilitation techniques

Background: Cardiac autonomic dysfunction may develop in patients with clinical or subclinical thyroid hormone deficiency. Heart rate variability (HRV) and heart rate turbulence (HRT) are used for evaluating changes in cardiac autonomic functions and also used to provide risk stratification in cardiac and noncardiac diseases. The aim of this study is to evaluate cardiac autonomic functions before and 6 months after thyroid replacement therapy in patients with thyroid hormone deficiency. Methods: Forty hypothyroid patients (mean age 48 ± 13, four male) and 31 healthy controls (mean age 51 ± 12, three male) were included in the study. Twenty-four hour ambulatory electrocardiogram recordings were taken using Pathfinder Software Version V8.255 (Reynolds Medical). The time domain parameters of HRV analysis were performed using the Heart Rate Variability Software (version 4.2.0, Norav Medical Ltd, Israel). HRT parameters, Turbulence Onset (TO), and Turbulence Slope (TS) were calculated with HRT! View Version 0.60-0.1 software. Results: HRV and HRT parameters were decreased in the patient group (SDNN; P < 0.001, SDANN; P < 0.009, RMSSD; P = 0.049, TO; P = 0.035, TS; P < 0.001). After 6 months of thyroid replacement therapy, there were no significant changes observed in either HRV or HRT. Conclusions: Hypothyroidism may cause cardiac autonomic dysfunction. Treating hypothyroidism with L-thyroxine therapy does not effectively restore cardiac autonomic function. HRV and HRT can be used as to help monitor cardiovascular-related risk in this population. Ann Noninvasive Electrocardiol 2011;16(4):344–350

Objective. To examine the effects of linezolid in prevention of adhesion formation in a rat uterine horn model. Design. Prospective randomized study. Setting. University Experimental Animal Research Laboratory Center. Sample. Ninety female Wistar albino rats. Methods. A dose response study was first conducted with 60 Wistar albino rats that were randomly assigned to six equal groups by administering vehicle (control), 5 mg/kg (Group 1), 15 mg/kg (Group 2), 50 mg/kg (Group 3), 100 mg/kg (Group 4), and 150 mg/kg (Group 5) linezolid starting three days before the adhesion inducing operation and continuing for 14 days postoperatively. Adhesion was scored clinically with a scoring system. The minimum effective dose was found to be 100 mg/kg/day. With this dose time response (starting three days before the operation and continuing for seven days), only preoperative and postoperative administration studies were conducted. Main outcome measures. Extent and severity of adhesions. Results. Total adhesion scores in the control and Groups 1 and 2 were significantly higher when compared with Groups 4 and 5, but not with Group 3. There were no significant differences in the adhesion scores between Groups 3, 4, and 5. In time response arm a total of 10 days treatment was not as effective as 17 days treatment. In postoperative and preoperative arms of the study, it was found that administration of linezolid only postoperatively or preoperatively did not affect adhesion formation significantly when compared with the control group. Conclusion. Linezolid was found to reduce intraperitoneal adhesion formation.

Background: The effect of rosiglitazone, an activator of peroxisome proliferator-activated receptor-gamma, on the growth of ectopic uterine tissue was assessed. Methods: Endometriosis was surgically induced in 28 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Four weeks later, rats were randomly grouped and a second laparatomy was performed. The length, width, height and volume of the explants were measured. Rosiglitazone at 0.2 mg/kg/day was orally administered to one group, while vehicle treatment was given to the control group. Four weeks later, rats were sacrificed and ectopic uterine tissues were re-evaluated morphologically and histologically. Scoring system was used to evaluate the preservation of epithelia. Results: One rat in the study group and two rats in the control group died as a result of complications related to surgery. There was a significant difference in post-treatment length, width, height, and spherical volumes between control and rosiglitazone-treated groups. The epithelia were found to be preserved significantly better in the control group when compared with the rosiglitazone-treated group. Conclusion: Rosiglitazone was found to cause regression of experimental endometriosis in rats.

To assess the effect of the peroxisome proliferator-activated receptor (PPAR)-gamma agonist rosiglitazone on the induction of endometriosis in a rat model.Endometriosis was surgically induced in 28 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Group I was assigned as control and no medication was administered. Starting 3 days before the operation and continuing for 4 weeks, 0.2 mg/kg/d rosiglitazone was administered to the study group orally. Four weeks later rats were killed and ectopic uterine tissues were evaluated morphologically and histologically. Scoring systems were used to evaluate preservation of epithelia.Four rats in the study group and one rat in the control group died of complications related to surgery. There was a significant difference in post-treatment spherical volumes (64.00 mm3 [interquartile range (IQR): 354.42] vs 41.60 mm3 [IQR: 37.87], P = .018) and explant weights (77.97 mg [IQR: 431.27] vs 47.24 mg [IQR: 43.01], P = .005) between control and rosiglitazone-treated groups. The epithelia were found to be preserved significantly better in the control group when compared with the roziglitazone-treated group (2.00 [IQR:2.00] vs 0.00 [IQR:2.25], P = .014).Rosiglitazone was found to affect the induction of endometriosis negatively in this experimental rat model and seemed to interfere with the growth and maintenance of the uterine explant.

To assess the role of first trimester maternal testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels in prediction of development of gestational diabetes mellitus (GDM).Four hundred and fifty pregnant women were included in this prospective cohort study. All pregnant women with a singleton pregnancy who were not diabetic, had no family history of diabetes, had no history of previous GDM, were of white race and non-smokers were enrolled. Total testosterone and DHEA-S were measured at 11-14 weeks of gestation. The patients were called for routine pregnancy visits and followed accordingly. Forty-two patients did not come to their visits and were excluded. During gestational weeks 24-28, the remaining 408 patients were screened for GDM. The total testosterone and DHEA-S levels were compared between patients with and without GDM. Regression and receiver-operator curve analysis were performed.GDM developed in 22 women (5.7%). Compared with women without GDM, first trimester total testosterone levels were higher among women in whom GDM subsequently developed. The DHEA-S level did not differ. Age, total testosterone and body mass index were found to be independent predictors of GDM development. A total testosterone value of 0.45 ng/mL was found to predict development of GDM with a sensitivity of 63.6% and a specificity of 62.7%.First trimester total testosterone has a low testing power for GDM screening with low sensitivity and specificity values and cannot be used as a marker alone. It may have a role in combination with other markers.

Overt hypothyroidism is associated with an increased risk for developing cardiovascular disease. We aimed to assess the changes in renal function, serum lipids, vitamin B12, folic acid and homocysteine levels before and after treatment in hypothyroid patients.The study included 54 patients (F/M=47/7) with overt hypothyroidism. All patients were assessed for demographic characteristics such as age, gender, body weight, and body mass index. Fasting blood samples were taken from the patients for analysis of chemical parameters including thyroid stimulating hormone (TSH), free thyroxine (fT4), homocysteine, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), folic acid, and vitamin B12 levels before and after L-thyroxine (LT4) treatment.Homocysteine levels in hypothyroidism (9.67 ± 5.24 mmol/l) were significantly higher than in euthyroid state (8.16 ± 3.38 mmol/L, p=0.038). Glomerular filtration rate (GFR) was lower before treatment. Following LT4 replacement, renal functions significantly improved. After achieving the euthyroid state, folic acid levels significantly increased although vitamin B12 levels were not changed. There was a significant reduction in serum lipid levels after LT4 replacement. It was demonstrated that there was a significant negative correlation between GFR and lipids and a positive correlation with homocysteine and lipids at hypothyroid state. After normalization of thyroid functions, the correlations became non-significant.The hypothyroidism was associated with increased serum homocysteine, lipids, and creatinine concentrations. The improvement of these parameters with LT4 replacement may be associated with the lower risk for atherosclerotic cardiovascular diseases in the patients with hypothyroidism.

Cardiac autonomic dysfunction may develop in patients with clinical or subclinical thyroid hormone deficiency. Heart rate variability (HRV) and heart rate turbulence (HRT) are used for evaluating changes in cardiac autonomic functions and also used to provide risk stratification in cardiac and noncardiac diseases. The aim of this study is to evaluate cardiac autonomic functions before and 6 months after thyroid replacement therapy in patients with thyroid hormone deficiency.Forty hypothyroid patients (mean age 48 ± 13, four male) and 31 healthy controls (mean age 51 ± 12, three male) were included in the study. Twenty-four hour ambulatory electrocardiogram recordings were taken using Pathfinder Software Version V8.255 (Reynolds Medical). The time domain parameters of HRV analysis were performed using the Heart Rate Variability Software (version 4.2.0, Norav Medical Ltd, Israel). HRT parameters, Turbulence Onset (TO), and Turbulence Slope (TS) were calculated with HRT! View Version 0.60-0.1 software.HRV and HRT parameters were decreased in the patient group (SDNN; P0.001, SDANN; P0.009, RMSSD; P = 0.049, TO; P = 0.035, TS; P0.001). After 6 months of thyroid replacement therapy, there were no significant changes observed in either HRV or HRT.Hypothyroidism may cause cardiac autonomic dysfunction. Treating hypothyroidism with L-thyroxine therapy does not effectively restore cardiac autonomic function. HRV and HRT can be used as to help monitor cardiovascular-related risk in this population.

WOS:000241272700042 PubMed: 16997937 BACKGROUND: Effects of rosiglitazone in the prevention of adhesion formation were evaluated. METHODS: Eighty Wistar albino rats were randomly grouped into eight equally sized groups. A 2-cm segment of the antimesenteric surface of the right uterine horn was traumatized to form a standardized lesion, using bipolar cautery. A dose-response study was performed with 0.1, 0.3, 1 and 3 mg/kg/day rosiglitazone. Fifteen days later, adhesions were evaluated clinically and histopathologically. A time-response study was performed with 1 mg/kg/day rosiglitazone (the minimum dose found to significantly affect adhesion formation). Rosiglitazone was given for 7 days post-operatively and results were compared with those of control and the 15-day group (time-response). In all these studies, rosiglitazone was orally administered 3 days before the operation and continued post-operatively. In two further experimental groups, rosiglitazone was only administered pre-operatively or post-operatively. RESULTS: Approximately 1 mg/kg/day rosiglitazone was found to reduce adhesion scores both clinically and histopathologically. Duration of treatment was also found to affect the extent of adhesion formation. However, giving rosiglitazone either just pre-operatively or post-operatively did not significantly reduce adhesion formation. CONCLUSION: Rosiglitazone with peroxisome proliferator-activated receptor (PPAR)-gamma agonist activity reduced the formation of i.p. adhesion possibly by reducing the initial inflammatory response and the subsequent exudation in this study.