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The article describes a case of Graves' disease treated with methimazole and examines the influence of methimazole-induced alterations of thyroid hormone concentrations during warfarin therapy. A 22-year-old woman presented at our endocrinology outpatient clinic with palpitations, sweating, fatigue, tremors, and diarrhea. She had a pain in her right leg and had difficulty walking. Her thyroid profile was consistent with hyperthyroidism. The patient was treated with warfarin 5 mg once a day for deep vein thrombosis for 2 days. Since a therapeutic range of International Normalized Ratio levels could not be achieved, methimazole was stopped due to drug-drug interaction. Lithium was started instead. A euthyroid state was obtained in 2 weeks together with a therapeutic International Normalized Ratio level. Interactions between warfarin and drugs that alter thyroid hormone concentrations have been reported; however, the extent and significance of the interaction between methimazole and warfarin have been inadequately described. Concomitant therapy with warfarin and antithyroid drugs should be managed by frequent monitoring of both thyroid function and the International Normalized Ratio. Lithium is employed only to provide temporary control of thyrotoxicosis in patients who cannot take thionamide and iodide. The administration of lithium alone or in combination with other drugs is shown to be an effective method of controlling hyperthyroidism when conventional antithyroid drugs show adverse effects or become insufficient. When warfarins are used together with antithyroid medications, adequate anticoagulation may not be obtained due to drug-drug interactions. Lithium can be an alternative drug for antithyroid medication in patients on warfarin therapy.

In this study, we evaluated the effects of XPD/ERCC2, RAD51 and hOGG1 gene polymorphisms on prognosis in Turkish patients with advanced gastric cancer. A total of 31 gastric cancer patients with locally inoperable or distant metastasis and performance status of 0-2 and 29 healthy volunteers as the control group were enrolled in this study. DNA was isolated from serum and then single nucleotide gene polymorphism analyses were done by MassARRAY Analyzer 4 System [Sequenom]. Statistical significance of the observed genotype frequencies was evaluated according to Hardy-Weinberg rule compared to the expected genotype frequencies. Median age was 68 years: 74% male, 26% female in the study group. We determined the XPD/ERCC2 Asp312Asn [rs1799793] single nucleotide gene polymorphism G23591A, RAD51 [rs1801320] single nucleotide gene polymorphism G135C and hOGG1 Ser 326 Cys [rs1052133] single nucleotide gene polymorphism. We could not find any significant association between the genotypes and prognosis in Turkish patients with gastric cancer.Bu çalışmada ileri evre mide kanserli Türk hastalarda XPD/ERCC2, RAD51 ve hOGG1 gen polimorfizminin prognoz üzerine etkisinin olup olmadığını değerlendirdik. Çalışmaya performans durumu 0-2 olan, inoperabl lokal ileri veya uzak metastazlı 31 mide kanseri hastası ile kontrol grubu olarak 29 sağlıklı birey dahil edildi. DNA serumdan izole edildikten sonra tek nükleotid gen polimorfizmi MassARRAY Analyzer 4 System [Sequenom] kullanılarak analiz edildi. Gözlenen genotip frekanslarının istatistiksel değeri beklenen genotip frekanslarına kıyasla Hardy-Weinberg kuralına göre belirlendi. Hasta grubunda ortanca yaş 68 (yıl) ve hastaların %74'ü erkek, %26'sı kadın idi. XPD/ERCC2 Asp312Asn [rs1799793] tek nükleotit gen polimorfizmi G23591A, RAD51 [rs1801320] tek nükleotit gen polimorfizmi G135C ve hOGG1 Ser 326 Cys [rs1052133] tek nükleotid gen poliforfizmi tespit edildi. Mide kanserli Türk hastalarda genotipler ile prognoz arasında anlamlı bir ilişki kuramadık.

Objectives To compare the survival of rst-and second-generation tyrosine kinase inhibitors (TKIs) in patients with rare EGFR exon 18 and exon 20 mutation-positive non-small cell lung cancer (NSCLC). Materials and MethodsWe retrospectively evaluated survival characteristics of 125 patients with EGFR exon 18 and exon 20 mutated NSCLC who received erlotinib or afatinib as rst line treatment between 2012 and 2021 from 34 oncology centres. Since exon 20 insertion is associated with TKI resistance, these 18 patients were excluded from the study.Results EGFR exon 18 mutations were seen in 60%, exon 20 mutations in 16%, and complex mutations in 24% of the patients with NSCLC who were evaluated for the study. There were 75 patients in erlotinib treated arm and 50 patients in afatinib arm. Patients treated with erlotinib had progression-free survival time (PFS) of 8.0 months and PFS was 7.0 months in the afatinib arm (p=0.869), while overall survival time (OS) was 20.0 vs 24.8 months, respectively (p=0.190). PFS of exon 18 mutated arm was 7.0 months, exon 20 mutated arm was 4.3 months, and complex mutation positive group was 17.3 months, and this was statistically signi cant (p=0.036). The longest OS was 32.5 months, seen in the complex mutations group, which was not statistically different than exon 18 and in exon 20 mutated groups (21.0 and 21.2 months, respectively) (p=0.323). ConclusionIn this patient group, especially patients with complex mutations are as sensitive to EGFR TKI treatment similar to classical mutations, and in patients with rare exon 18 and exon 20 EGFR mutation both rst-and second-generation EGFR-TKIs should be considered, especially as rst-and second-line options.

Pituitary abscess is extremely rare and often misdiagnosed as pituitary tumor pre-operatively.We document a case of a 64-year-old lady presented to the outpatient department with complaints of headache and blurring vision of right eye for one month. Based on preliminary investigations, a clinical diagnosis of pituitary adenoma was made and the pituitary gland was surgically excised. Histopathological examination showed Actinomyces infection. This case has been documented due to the extremely rare involvement of the pituitary gland by actinomyces infection. Pituitary abscess is a rare pathology, but it must be considered during evaluating sellar masses, since its prognosis depends on surgical drainage and on the use of specific antibiotics. We report, to our knowledge, the fourth case of Actinomyces israelii infection of the pituitary region.