BACKGROUND: To assess factors affecting the prolongation of the international normalized ratio (INR) with concurrent warfarin and ciprofloxacin use. METHODS: A retrospective case-control study was performed at a single, 2,000-bed tertiary hospital between January 2007 and December 2009. Thirty-three patients who were on warfarin and ciprofloxacin concurrently were enrolled. Demographics and clinical data were collected from medical records. RESULTS: Nine patients were assigned to the case group (prolonged INR) and 19 patients to the control group (normal INR). Activities of daily living (ADL) and total number of classes of medications taken demonstrated significant differences between the groups (15.33 vs. 7.11, p<0.001; 7.11 vs. 5.47, p=0.041). No bleeding complications occurred during this study. CONCLUSION: As ADL reflects patient performance status and general condition of an individual, we conclude that a poor general condition is associated with coagulopathy in persons concurrently using warfarin and ciprofloxacin.
Activities of Daily Living ; Case-Control Studies ; Ciprofloxacin ; Demography ; Hemorrhage ; Humans ; International Normalized Ratio ; Retrospective Studies ; Tertiary Care Centers ; Warfarin

PURPOSE: To analyze the sonographic, morphologic, and internal echo patterns of endometriomas, and thus determine which ultrasonographic (US) findings assist diagnosis. MATERIALS AND METHODS: One hundred and forty-seven eases of pathologically proven adnexal masses in 130 women were divided into three groups: group I, in which endometriomas were diagnosed at both preoperative US and surgery (true positive) (n=97); group II, in which endometriomas were misdiagnosed at preoperative US, and were confirmed after surgery to be other pathologic entities (false positive) (n=10); group III, in which other adnexal masses were misdiagnosed at preoperative US, but were proven after surgery to be endometriomas (false negative) (n=40). The US findings in these cases were retrospectively reviewed in terms of (a) morphologic type: unilocular, multiseptated, multilobulated, solid and cystic, or mixed; (b) internal echo pattern: homogeneous fine, anechoic, fine septation, or complex; (c) size; (d) wall thickness; (e) the presence or absence of septation; (f) wall nodularity; (g) echogenic wall foci; and (h) a solid area. RESULTS: In group I, the most common morphological type was unilocular cyst (n=63; 65%). In lesions most commonly emitted homogeneous fine echoes (n=76; 78%). In this group, most masses (86%) were less than 10 cm in diameter and the wall thickness in 65% of cases was less than 3 mm. Additionally, internal septation, wall nodularity, focal echogenic wall foci, and a solid area were observed at US. Group II, cases were pathologically confirmed as mucinous cystadenoma (n=3), mucinous cystadenoma with borderline malignancy, hemorrhagic cyst, functional cyst, endometrioid carcinoma, and hematoma. In group III, cases were misdiagnosed as cystadenoma (n=15), hemorrhagic cyst, teratoma, ovarian cancer, functional cyst and ectopic pregnancy at preoperative US. There were no significant differences in size or wall thickness between groups II and III, and group I. At US, groups II and III also showed internal septation, wall nodularity, focal echogenic wall foci, and a solid area, all of which were also apparent in group I. CONCLUSION: The US findings of endometriomas vary: the most common is homogeneous fine internal echoes (79%), found in 85% of unilocular or multiseptated cysts. Their appearance may also be atypical, however: namely solid and cystic or mixed type, with diverse internal echogenicity, and such masses should be differentiated from other adnexal masses such as cystic neoplasm, teratoma, hemorrhagic cyst, functional cyst and ovarian cancer.
Carcinoma, Endometrioid ; Cystadenoma ; Cystadenoma, Mucinous ; Diagnosis ; Diagnosis, Differential* ; Endometriosis* ; Female ; Hematoma ; Humans ; Ovarian Neoplasms ; Ovary ; Pregnancy ; Pregnancy, Ectopic ; Retrospective Studies ; Teratoma ; Ultrasonography

BACKGROUND: Absolute lymphocyte count (ALC) in peripheral blood has recently been reported to be an independent prognostic factor in multiple myeloma (MM). Previous studies indicated that the absolute monocyte count (AMC) in peripheral blood reflects the state of the tumor microenvironment in lymphomas. Neither the utility of the AMC nor its relationship with ALC has been studied in MM. METHODS: The prognostic value of ALC, AMC, and the ALC/AMC ratio at the time of diagnosis was retrospectively examined in 189 patients with MM. RESULTS: On univariate analysis, low ALC (<1,400 cells/microL), high AMC (> or =490 cells/microL), and low ALC/AMC ratio (<2.9) were correlated with worse overall survival (OS) (p=.002, p=.038, and p=.001, respectively). On multivariate analysis, the ALC/AMC ratio was an independent prognostic factor (p=.047), whereas ALC and AMC were no longer statistical significant. Low ALC, high AMC, and low ALC/AMC ratio were associated with poor prognostic factors such as high International Staging System stage, plasmablastic morphology, hypoalbuminemia, and high beta2-microglobulin. CONCLUSIONS: Univariate analysis demonstrated that changes in ALC, AMC, and the ALC/AMC ratio are associated with patient survival in MM. Multivariate analysis showed that, of these factors, the ALC/AMC ratio was an independent prognostic factor for OS.
Diagnosis* ; Humans ; Hypoalbuminemia ; Lymphocyte Count ; Lymphocytes* ; Lymphoma ; Monocytes* ; Multiple Myeloma* ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Tumor Microenvironment