Giriş ve amaç: Hematopoetik Kök Hücre Nakli(HKHN), hematolojik maligniteler, bazı solid tümörlerve immün yetmezlik hastalıkları için en etkili tedavi yöntemlerinden biridir ancak bazıkomplikasyonlara sahiptir. Epileptik nöbetler tekrarlayan anormal nöronal deşarjların neden olduğugeçici santral sinir sistemi işlev bozukluğu sonucu oluşan bilinç, motor ve duysal belirtiler olup HKHNsonrası gözlenen komplikasyonlardan biridir ve prognozu oldukça kötü etkilemektedir. Amacımız,HKHN sırasında gelişen epileptik nöbetlerin sebeplerini ve risk faktörlerini saptamak böylece nöbetgelişimini engelleyerek halihazırda komplikasyon oranı yüksek olan HKHN’in prognozunu olumluyönde etkilemektir. Yöntem ve gereçler: Ekim 2018 ile Ekim 2019 yılları arasında Erciyes Üniversitesi Kemik İliği NakliÜnitesinde nakil amacıyla yatırılırken nöbet geçiren 12 hasta çalışmaya dahil edildi. Hastaların verilerigeriye dönük olarak incelendi. Subakut sklerozan panensefalit tanısı konulan hastalar çalışmaya dahiledilmedi.Bulgular: Dokuz hastaya (%75) Otolog HKHN (OKİT), 3 hastaya (%25) ise Allogeneik HKHN (AKİT)yapıldı. OKİT’lerin %8.2’sinde, AKİT’lerin %5.4’ünde epileptik nöbet gözlendi. Hastaların laboratuvarbulgularında hiçbirinde hipoglisemi, hiponatremi, böbrek ve karaciğer fonksiyon testi bozukluğusaptanmadı. Sekiz hastada (%66.6) hipofosfatemi, 6 (%50)’sında hipopotasemi, 4 (%33.3)’ündehipomagnezemi ve 2 (%16.6)’sinde hipokalsemi gözlendi. Hastaların median toplam ilaç sayısı 8 ± 2.1(6-14) ’dir. Nöbet eşiğini düşüren median ilaç sayısı ise 5.5 ± 1.4 (4-8)’dır. Epileptik eşiği düşürenilaçlardan Flukonazol 9 (%75), Meropenem 7 (%58.3), Metronidazol 6 (%60), İzoniazid 4 (%33.3) veSiklosporin 3 (%25) hastada kullanılmasıyla dikkat çekti. 9 (%75) hastanın beslenme durumu totalparental nutrisyon ile sağlanmaktaydı. bir (%8.3) hastamız exitus oldu.Tartışma ve sonuç: Epileptik nöbet gelişim sebebinin, HKHN sonrası komplike klinik durumda aynıanda var olan ve birbirleriyle etkileşime giren çoklu faktörlerle korele olduğu düşünülmektedir. HKHNsırasında epileptik nöbet geçiren hastalarımızda hipofosfatemi, hipopotasemi gibi elektrolitbozukluklarının sık olduğu ve polifarmasinin özellikle de nöbet eşiğini düşüren ilaç kullanımının fazlaolduğu gözlendi. Bu nedenle bu iki faktörün yakın takip edilmesi epileptik nöbet gelişimini önlemedeen önemli yaklaşım olarak gözlenmektedir.
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Giriş ve amaç: Prostat Kanseri (PK) erkeklerde en sık görülen kanser türüdür. Hastaların tedaviplanında tümörün patolojik derecesinin önemli yeri bulunmaktadır. Çalışmamızda PK tanısı nedeniyleRobot Yardımlı Laparoskopik Radikal Prostatektomi (RYLRP) yapılan hastalarda prostatektomispesmenindeki tümör dereceleri, biyopsi derecelerinden yüksek çıkanlarda, bu artışı öngörmeyiamaçladık.Yöntem ve gereçler: Kliniğimizde Ağustos 2019–Mayıs 2020 tarihleri arasında PK tanısı almış veRYLRP yapılan 109 hastanın bilgileri retrospektif olarak incelendi. Cerrahi işlemler Da Vinci Xi robotsistemi (Intuitive Surgical, Sunnyvale, CA, USA) ile gerçekleştirildi. RYLRP sonrası incelemedekiISUP derecesi, prostat biyopsi derecesine göre artmış olan hastalar grup-1; aynı kalan ya da azalanhastalar ise grup-2 olarak sınıflandırıldı. Bu iki gruptaki hastaların yaş, Prostat Sepsifik Antijen (PSA),prostat hacmi, parmakla rektal muayene (PRM) bulgusu, Nötrofil/Lenfosit oranı (NLO),Trombosit/Lenfosit oranı (TLO) ve AST/ALT (De Ritis) değerleri karşılaştırıldı. Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 64,32±6,20 (46-77) yıl, PSA değeri9,46±10,84 (0,5-86) ng/mL ve prostat hacmi 49,19±25,72 (18-145) mL idi. RYLRP sonrası tümörderecesinde artış 33 (%36,7) hastada tespit edildi, 48 (%53,3) hastada derece aynı kalırken 9 (%10)hastada düşüş mevcuttu. Yaş, PSA, prostat hacmi, PRM’de patolojik bulgu oranı, NLO ve De Ritis oranıgrup 1’de, grup-2’ye göre yüksek bulunsa da bu yükseklik istatistiksel olarak anlamlı değildi (p>0,05).TLO ise Grup-1’de, Grup-2’ye göre anlamlı olarak yüksekti (p=0,026).Tartışma ve sonuç: Çalışmamızda her ne kadar sadece TLO’daki artış istatistiksel açıdan anlamlıolarak bulunsa da prostat hacmi hariç diğer tüm parametreler tümör derecesinde artış saptanan gruptayüksek bulunmuştur.
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Giriş ve amaç: Bu çalışmada 1990 yılında yapılmış Hodgkin lenfoma tezinden yola çıkılarakgünümüzde HL tanı, görüntüleme ve tedavi sindeki güncel gelişim vaka örneklemleri ile incelenecektir.Son 30 yıldaki tedavi endikasyonu değişimleri, radyoterapi tedavi alanlarındaki küçülmeler veradyoterapi doz düşümleri tarihsel süreçler dikkate alınarak karşılaşmalı olarak değerlendirilecektir.Yöntem ve gereçler: Yazarın 1985- 1990 yıları arasında Ankara Numune Hastanesi RadyoterapiKliniğinde tedavisi tamamlanan hastaların demografik ve klinik, özellikleri özetlenecek ve o tarihtekigüncel görüntüleme yöntemleri ve tedavi yaklaşımları, günümüzdeki yaklaşımlarla kıyaslanacaktır.Bulgular: 1985-1990 yılları arasında Ankara Numune Hastanesinde Hodgkin lenfoma tanısı ile tedaviedilen 60 vakanın verileri incelenmiştir. Ortanca yaş 31 olarak bulundu. Evre ve histolojik tip gruplararasında eşit olarak dağılmıştı. Başlangıç tutulum alanlar; servikal-supraklavikular bölge 34 vaka (%56), inguinofemoral 8 vaka (%13), aksiller 7 vaka (%11), mediastinal 5 vaka (%8,2), abdominal 3 vaka (% 5,3), tonsil 2 vaka (%3), primer beyin 1 vaka olarak görüldü. Diafram altı başlayan vakalar totalin% 18 lik bölümüydü. Miks sellüler tip en çok görülen gurubu oluşturdu. Bin dokuz yüz seksenli yıllardaEvre IA ve II A Hodgkin lenfoma da standart tedavi şekli Sub Total Lenfod Işınlama (Mantle, InvertedY) idi. Bu dönemde Hodgkin lenfoma görüntülemesinde kullanılan en gelişmiş yöntem Bi-PedalLenfanjigrafi iken günümüzde FDG PET-CT primer görüntüleme yöntemidir. Bu çalışmada radyoterapialan 58 hastanın 6 sında yineleme olmuştur. Yinelemelerin 4 ü alan dışı, 2 si alan içi olarak raporlanmıştıTartışma ve sonuç: Alan dışı nükslerin fazlalığı ve geniş alan radyoterapi uygulamalarının özellikleçocukluk yaş grubunda oluşturduğu büyüme gelişme gerilikleri, kardiak sorunlar, ikincil kanserlerinartışı gibi yan etkiler araştırmacıları yeni tedavi şekilleri aramaya yöneltmiştir. Günümüzde giderekboyut olarak küçülmüş ve dozu azaltılmış radyoteapi uygulamaları iyi kemoterapi uygulamaları ileeşleştirilmiştir. Hem kemoterapideki iyileşmeler hem de radyoterapi tekniğindeki gelişmeler 5 yıllıkyaşamı %90 seviyelerinin üzerine çıkarırken morbid yan etkiler tarihsel makalelerde anekdot olarakkalmıştır.
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Introduction: To evaluate the role of HBME1, PAX8, CD56 and CITED1 in distunguishing benign lesions of the thyroid from malignant tumors and different malignant tumors of the thyroid. Methods: The patients that underwent thyroidectomy between 2007 and 2013 were included to the study. Patients with Nodular Hyperplasia: 22, Folicular Adenoma: 14, Noninvasive Folicular Thyroid Neoplasm With Papillary-Like Nuclear Features: 3, Well Diferentiated Carcinoma, Not Otherwise Specified: 3, Papillary Carcinoma: 22, Papillary Carcinoma Folicular Variant: 12, Minimally Invasive Folicular Carcinoma: 9, Poorly Diferentiated Carcinoma: 4, Anaplastic Carcinoma: 3 were included to the study. HBME1, CITED1, PAX8, CD56 were applied by immunohistochemical method. In statistical analysis, the sensitivity, specificity, positive predictive and negative predictive values of markers were calculated. Results: CD56 (loss of expression), HBME1 was significantly higher in Papillary Carcinoma, Papillary Carcinoma Folicular Variant compared to other malignant neoplasms. The most sensitive markers for malignant tumors were PAX8 and CITED1 (90%, 88%). The most specific markers for malignant tumors were HBME1, CITED1 (97%, 92%). The most sensitive and specific marker for Papillary Carcinoma, Papillary Carcinoma Folicular Variant was HBME1 (100%, 80%). CD56 (loss of expression), CITED1 was the most sensitive markers for Papillary Carcinoma Folicular Variant (86%, 86%). Discussion and conclusion: HBME1 was found an both sensititive and specific marker for Papillary Carcinoma. The cytoplasmic expression of CITED1 was significantly higher in PC compared to other malignant tumors. Nuclear expression of PAX8 was found significantly higher in benign cases compared to malignant tumors. HBME1, CD56 (loss of expression) was found significantly higher in Papillary Carcinoma, Papillary Carcinoma Folicular Variant compared to other malignant tumors.
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Introduction: This study aims to determine the changes in and the factors related to the bone mineral density in patients with bcr/abl-negative chronic myeloproliferative neoplasm (cmpd). Methods: The data of 38 males (52.1%) and 35 females (47.9%) patients diagnosed with cmpd were analyzed retrospectively. The age, gender, diagnosis (polycythemia vera (pv), essential thrombocythemia (et)), jak2v617f mutation positivity, the presence of the cmpd complications and the bone mineral densitometry (bmd) measurements of femur neck and lumbar spine carried out during the diagnosis were recorded for each patient. The patients were divided into four groups: under 65 and over 65 years old for men, premenopausal and postmenopausal status for women. They were also grouped according to the t score of the femur neck and lumbar spine with normal and decreased bone density. Results: Female patients were found to have more bone loss in the lumbar spine (p=0.031). In female patients, the reduction in the lumbar spine bmd was greater in the postmenopausal group (p=0.012). The decrease in bone density in the femur neck was found to be greater in the group above 65 years of age (p=0.01). There was no relationship between bmd and et, pv, jak2v617f mutation positivity, and cmpd complications such as thrombosis and hemorrhage. Discussion and conclusion: according to the results obtained in our study, the presence of cmpd increases bone loss in lomber area in female patients. Therefore, the bmd measurement and calcium-d supportive treatment planning in the premenopausal group are thought to be beneficial in female patients.
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Introduction: Juxtacortical (surface) chondrosarcoma (JCC) is a very rare subtype of chondrosarcoma, mostly seen in young adults. In this study, we aimed to report demographic data and average survival rates of JCC. Methods:In this study we used the latest version of the Surveillance, Epidemiology and End Results (SEER) database, patients were examined under the titles of gender, age, race / ethnic origin, lesion location in the body, degree of tumor differentiation, applied surgeries and follow-up periods. Descriptive statistics were given as mean ± standard deviation, frequency and percentage. Results: A total of 52 patients were included in the study, of which 16 were female and 36 were male (69%), with a mean age of 41.3 ± 20.0 years (range: 8-84 years). When examined for ethnicity, it was found that it was seen most in white race (84.6%).The most common localization of tumor lesions was the lower extremity long bones (50%).Low grade tumor (45% of all tumors) was the most common tumor differentiation. The mean follow-up was 125,5 months (range 4 to 358 months). Discussion: JCC is a very rare type of chondrosarcoma, and often seen as lower grade compared to other types of chondrosarcoma. It's a little more common in men. It tends to settle on the long bones, most commonly on the lower extremity, especially the femoral diaphysis.
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Introduction: It is controversial that cytomegalovirus (CMV) replication is a cause of graft-versus-host disease (GVHD). The aim of this study is to evaluate whether CMV replication causes acute GVHD development or not. Materials and methods: The study is retrospective. Patients diagnosed with acute GVHD with a prior history of allogeneic hematopoietic cell transplantation (allo-HCT) were included in the study. All the included patients were followed-up in the bone marrow transplantation unit between 01/01/2013- 10/31/2019. As the control group, patients without a history of acute GVHD after allo-HCT were included. The data of patients with acute GVHD after allo-HCT and patients with out known acute GVHD were compared. Results: Fifty nine patients with acute GVHD and 178 patients without acute GVHD after allo-HCT were included in the study. Sixteen of the patients with acute GVHD were female and 43 were male. Sixty two of the patients without acute GVHD were female and 116 were male. The average CMVDNA level was found as 1871.0 [821.0-16720.0] copies/ml in patients who had CMV replication in the acute GVHD group. On the other hand, the average of CMV-DNA level was found as 1607.5 [601.0- 119181.0] copies/ml in the non-acute GVHD group. There was no statistically significant difference between the two groups. Discussion: CMV replication does not seem to contribute to acute GVHD development after allo-HCT. Suppression of CMV replication may not prevent acute GVHD development.
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Breast cancer is a heterogenous disease with various morphological, clinical and molecular features. Traditionally, pathologic parameters and clinical stage of the disease are used to determine indication of adjuvant treatment, however these features are not sufficient to identify the patients that need treatment. Prognostic and predictive biomarkers are needed to develop personalized treatments. Predictive factors are indicators of response to a particular treatment. MammaPrint® (Agendia, Amsterdam, the Netherlands), Oncotype DX® (Genomic Health, Redwood City, CA), Prosigna® (Nanostring technologies, Seattle, WA) and Endopredict® (Myriad Genetics) are gene expression profiles that are used to predict the benefit of adjuvant chemotherapy and provide additional prognostic and/or predictive information. In this review, we discuss the role of gene expression signatures in treatment decision of patients with breast cancer.
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Alper GEZDİRİCİ , Ezgi Gökpınar İLİ, Banu DEĞİRMENCİ, Aydeniz Aydın GÜMÜŞ, Gizem ÖZDEMİR, Nihan Alişya ERMAN, Cüneyd YAVAŞ
Objective: In this study, it was aimed to determine the frequency of BRCA1 and BRCA2 variants in patients admitted to our clinic with hereditary breast-ovarian cancer and / or family history and to evaluate them in the light of the literature. Materials and Methods: All patients in our study were selected according to the current NCCN guideline test criteria. The Ion Torrent ™ Oncomine ™ BRCA Research Assay was used to sequence the coding regions of the BRCA1 and BRCA2 genes in our patients. In addition, all patients with copy number changes were confirmed with SALSA® MLPA® Probemix P002 BRCA1 and Probemix P090 BRCA2 (MRC Holland). Results: Variants (pathogenic, likely pathogenic, variants of uncertain clinical significance, and copy number variations) were detected in 39 of the 149 patients included in the study. Novel variants that were not previously described in the literature were detected in two patients, one of the BRCA1 and one of the BRCA2 gene, respectively. Conclusion: In our study, the incidence of BRCA1 and BRCA2 variants was found to be 26.1%. This rate was higher than previous studies conducted in Turkey. Further studies are needed to identify common variants in the Turkish population and to evaluate the patogenity of variants of uncertain clinical significance.
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Aim: Many individuals die due to cancer, and both doctors and researchers work hard to offer accurate illness, diagnostic, and prognosis monitoring, as well as resistance prediction. Methods: A liquid biopsy and hereditary cancer panels were performed on 25 patients to examine the importance, spectrum, and diversity of RET germline and somatic mutations. Most of the patients visited the clinic with the diagnosis of advanced resistant cancers or hereditary cancer (MEN2). Two groups were formed: the first group was germline (n=7, 28%), and the second was somatic (n=18, 72%). For somatic, Tier I-II-III variants; for germline, pathogenic, likely pathogenic, and VUS variants have been included in the study. Results: The mean age was 54.64. There were significantly more female participants (n=14, 56%) than males (n=11, 44%). In the germline group, the most common mutation was ‘RET:c.2410G>A’. Nine mutations were nonsense or frameshift in the somatic group, and the most common mutations were ‘RET:c.2324delinsGAC’ and ‘RET:c.1784A>G’. Nonsense or frameshift RET variants showed a higher incidence in the somatic group. Conclusion: To the best of our knowledge, this is the first research to concentrate on RET mutations in the context of genetic variability between germline and somatic variants. The current study’s results indicate that patients with solid tumors, particularly breast cancer, should undergo RET sequencing to evaluate clinical features and prognosis. Discoveries about the structure and functions of RET gene will lead to more clinically relevant treatment approaches for cancer patients and will play an essential role in improving individual risk prediction, treatment, and prognosis.
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