[Show abstract][Hide abstract] ABSTRACT: This study evaluates the outcome of 66 pediatric patients with rrHL who underwent autoHSCT. Twenty-nine patients experienced early relapse, and 19 patients experienced late relapse. Of 18 newly diagnosed with HL, 13 were primary refractory disease and five had late responsive disease. At the time of transplantation, only 68% of the patients were chemosensitive. The majority of patients received BCNU + etoposide + ara-C + melphalan for conditioning (45/66), and peripheral blood (56/66) was used as a source of stem cells. After a median follow-up period of 39 months, 46 patients were alive. At five yr, the probabilities of OS, EFS, the relapse rate, and the non-relapse mortality rate were 63.1%, 54.3%, 36.4%, and 9.1%, respectively. The probability of EFS in chemosensitive and chemoresistant patients at five yr was 72.3% and 19%, respectively (p < 0.001). Multivariate analysis showed that chemoresistant disease at the time of transplantation was the only factor predicting limited both OS (hazard ratio = 4.073) and EFS (hazard ratio = 4.599). AutoHSCT plays an important role for the treatment of rrHL in children and adolescents, and survival rates are better for patients with chemosensitive disease at the time of transplantation.
[Show abstract][Hide abstract] ABSTRACT: Observation: Disseminated bacillus Calmette-Guerin infection is an uncommon condition which is usually associated with primary immunodeficiency. It is characterized by multiple and disseminated cutaneous lesions associated with systemic involvement. Here, we describe a case of disseminated bacillus Calmette-Guerin infection in a patient with severe combined immunodeficiency.
[Show abstract][Hide abstract] ABSTRACT: Influenza viruses are common respiratory pathogens in humans and can cause serious infection that leads to the development of pneumonia. In this study, the clinical and laboratory features of 36 patients from Turkey who are hospitalized in intensive care unit due to pandemic influenza A (H1N1) associated pneumonia and respiratory failure were retrospectively evaluated. The most common symptoms were cough and fever. Consolidation (36.1 %) and interstitial changes (30.6 %) were the most frequently identified findings on chest radiographs at the time of admission. Six of the patients (16.7 %) died. Mortality occurred in 3 of 13 patients (23.1 %) with underlying disease, whilst it occurred in only 3 of 23 patients (13 %) who were previously healthy. Mortality was found to be significantly associated only with an elevated lactate dehydrogenase level. A significant relationship was determined only between the presence of lymphopenia and acute respiratory distress syndrome and the need for intensive care treatment. The average time elapsed from the onset of the symptoms until admission was 8.67 ± 2.87 days for the patients died, and 6.0 ± 3.8 days for the patients survived.
Indian Journal of Virology 06/2013; 24(1). DOI:10.1007/s13337-012-0122-z · 0.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Amphotericin B remains the mainstay medical treatment of pulmonary mucormycosis. Optimal dose is not defined. We described a case of pulmonary mucormycosis, which had been treated with 42.55 g (during to 45 weeks) liposomal amphotericin B. In medical literature this case is one of the highest doses of lyposomal amphotericin B administered to a pediatric patient.
Tuberkuloz ve toraks 12/2012; 60(4):375-9. DOI:10.5578/tt.2364
[Show abstract][Hide abstract] ABSTRACT: Acute brucellosis is a zoonotic disease seen in childhood, with non-specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented.
Data for 147 patients, aged 2-16 years, were evaluated retrospectively.
The most frequent complaints and clinical findings were abdominal pain and fever. Other complaints and clinical findings included arthralgia, myalgia, loss of appetite, weakness, sweating, fatigue, headache, arthritis, hepatomegaly, and splenomegaly. Anemia was the most frequent hematological abnormality detected; other abnormalities included leukopenia, thrombocytopenia, and pancytopenia.
Childhood brucellosis can cause non-specific complaints and particularly anemia and leukopenia as hematological abnormalities. It is easily treated, however, with appropriate antibiotics.
Pediatrics International 12/2011; 54(2):215-8. DOI:10.1111/j.1442-200X.2011.03558.x · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Monosymptomatic nocturnal enuresis (MNE) and attention deficit and hyperactivity disorder (ADHD) are multifactorial disorders and biological, social, and psychological factors may play significant roles in the development of both. Children with enuresis display a higher prevalence of ADHD compared to the normal population. This study aimed to evaluate the relationship between MNE and ADHD.
A total of 64 children between the ages of 6 and 13 years who were referred due to primary MNE, their parents, and 42 healthy control cases, were evaluated in terms of attention deficit and hyperactivity by a child psychiatrist using the DSM-IV-2000-TR diagnosic scale.
Of the children with enuresis, 17 had predominantly inattentive type (26.6%), nine had predominantly hyperactive-impulsive type (14.1%), and eight had combined type (12.5%). In the control group, two cases had predominantly inattentive type (4.8%), two cases had predominantly hyperactive-impulsive type (4.8%), and one had combined type (2.4%).
The prevalence of ADHD is higher in children with MNE compared to the normal population. As attention deficit may also negatively effect the treatment of enuresis, children with MNE should be evaluated in terms of attention deficit and those with positive symptoms should be provided with psychosocial support.
International Journal of Psychiatry in Clinical Practice 11/2011; 16(3):229-32. DOI:10.3109/13651501.2011.620129 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Donör granülosit transfüzyonu (DGT), hayatı tehdit eden ciddi bakteriyel veya fungal enfeksiyonu olan nötropenik bir hastaya, yeterli sayı, kalite ve fonksiyonda polimorfo nüveli lökositin verilmesi işlemidir. Son yıllarda, toplama tekniklerindeki önemli gelişmeler ve rekombinant büyüme faktörlerinin kullanılması ile oldukça yüksek dozda granülosit konsantrelerinin toplanabilmesine rağmen, DGT’nun terapötik etkinliği tam olarak kanıtlanamamıştır. Bu amaçla nötropenik hastalarda DGT’un kullanım endikasyonlarını ve etkinliğini belirlemek için geniş çaplı randomize kontrollü çalışmalara ihtiyaç vardır. Bu yazıda, DGT’nun endikasyonları, klinik kullanımı ve toplama teknikleri gözden geçirilecektir.
[Show abstract][Hide abstract] ABSTRACT: Brain natriuretic peptide (BNP) is considered as a prognostic marker in patients with sepsis, but no data are available on BNP in pediatric cancer patients with febrile neutropenia (FN). Twenty-five pediatric cancer patients with FN were included in this study. Serum BNP level was measured. The mean BNP level was 330.8 ± 765.3 pg/mL (5.9-3806 pg/mL). BNP levels of 12 patients were found over the normal level. High BNP levels were related to some conditions of the patients, and these were statistically significant (P < .05). These conditions were required erythrocyte suspension, had pneumonia, time stayed in hospital, and neutropenia time. When regression test was done, required erythrocyte suspension for anemia and had pneumonia were found to be statistically significant. In conclusion, this is one of the first studies on BNP levels in pediatric cancer patients with FN. However, further studies with large sample sizes are needed to confirm the results and provide new data about this issue.
[Show abstract][Hide abstract] ABSTRACT: Initial presentation of Non-Hodgkin Lymphoma (NHL) as primary pleural lymphoma is extremely rare. We report a case with NHL, who was initially presented with pleural effusion and pleural thickening. Our patients at first received intensive treatment of broad spectrum antibiotics for 10 days with no change in the clinical status, and then were diagnosed with T-lymphoblastic lymphoma with the examination of pleural fluid by using cytologic and flow cytometric methods, and treated with LMT89 group B treatment protocol. Our case points out the necessity for considering the NHL within the differential diagnosis of any pediatric patient presenting with sterile pleural effusion and pleural thickening who does not respond to antimicrobial therapy.
[Show abstract][Hide abstract] ABSTRACT: Monoclonal antibodies have provided new promise for patients with B-cell malignancies. Rituximab is a monoclonal antibody against B-lymphocytes that express CD20; it is used for the treatment of patients with relapsed or refractory B-cell non-Hodgkin lymphoma. Very few data are available regarding the treatment of children with non-Hodgkin lymphoma with rituximab. In this article, we reported three children with primary refractory/relapsed B-cell-non-Hodgkin lymphoma, who were successfully treated with a combination of intensive chemotherapy protocol plus rituximab. In all three of our cases, the patients are still in complete remission. Our aim is to emphasize the importance of use of rituximab in the treatment of childhood B-cell non-Hodgkin lymphoma.
[Show abstract][Hide abstract] ABSTRACT: We define the incidence, risk factors, and mortality rates for the occurrence of thrombotic microangiopathy in 50 children who underwent transplants between January 2006 and June 2008 at 2 Turkish pediatric centers.
The diagnosis of thrombotic microangiopathy was done according to the reports of International Working Group in 2007.
Fifty patients (27 male and 23 female; age range, 3 months to 18 years) were included. Patients with malignant and nonmalignant diseases were 13 (26%) and 37 (74%). Myeloablative and nonmyeloablative conditioning regimens were used in 29 (58%) and 21 patients (42%). Bone marrow was used as the source of stem cells in 32 patients (62%) and peripheral blood was used in 18 patients (36%). Thrombotic microangiopathy was seen in 3 of 50 cases (6%). Thrombotic microangiopathy developed in 3 of 18 patients in whom peripheral blood was used as the source of stem cells while none of 32 patients who had bone marrow as the source developed thrombotic microangiopathy (P < .05).
Using peripheral blood as a source of stem cells is a risk factor for development of thrombotic microangiopathy.
[Show abstract][Hide abstract] ABSTRACT: Several studies have suggested that the presence of myeloid antigens is a poor prognostic factor in patients with acute lymphoid leukemia (ALL).
We aimed to assess this possibility in Turkish patients.
Seventy-three children with a diagnosis of ALL-L1 and 38 with ALL-L2 were included. Flow cytometry and fluorescein-isothiocynate conjugated antibodies were used to determined surface antigens on blasts.
Myeloid antigens were positive in 48.4% with ALL-L1 and 60.5% with ALL-L2, the difference not being significant. Overall survival rates of myeloid antigen positive patients at 36, 60, and 72 months were 76%, 58%, and 48%, respectively, comparable to the corresponding 70%, 56%, and 46% in myeloid antigen negative patients (p >0.05).
We did not find any association between myeloid antigen positivity and clinical and laboratory features of ALL.
Asian Pacific journal of cancer prevention: APJCP 01/2010; 11(6):1823-6. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several studies have focused on the immunophenotype of the leukemic population at the time of relapse compared to that observed at diagnosis.
The question of whether differences exist between surface antigens levels on blasts at the time of diagnosis and at relapse in cases of acute lymphoblastic leukemia (ALL) was addressed.
A total of 25 All patients were included. Flow cytometry and fluorescein-isothiocynate conjugated antibodies were used to determined surface antigens levels.
The most frequently detected five antigens were I2 (n=21), CD10 (n=17), CD41 (n=16), CD2 (n=14) and CD7/CD19 (n=13/n=13) at the time of diagnosis and CD41 (n=21), I2 (n=20), CD10 (n=14), CD19 (n=16) and CD2 (n=12) at the time of relapse. There was a significant difference only between CD41 levels at the time of diagnosis and at the time of relapse (p=0.041).
We found changes in antigen expressions at the time of relapse in ALL patients. This condition ought to be evaluated with reference to prognosis of leukemia.
Asian Pacific journal of cancer prevention: APJCP 01/2010; 11(5):1321-4. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chemotherapy related neutropenia developing in oncologic patients is a significant condition and major cause of morbidity and mortality. Febrile neutropenic attacks without complications can be successfully treated with wide-spectrum anti-pseudomonal cephalosporins or carbapenems.
We investigated the efficacy and safety of meropenem in the treatment of febrile neutropenia (FN) in children with cancer.
Twenty four patients who had a febrile neutropenic episodes followed by initiation of empirical meropenem therapy were included in the study.
Of all the patients, 13 (54.2%) had solid tumors, while 11 (45.8%) were diagnosed to have acute leukemia. Among all, 7 (29.2%) and 15 (62.5%) infections were identified microbiologically and clinically, respectively. Fever of unknown origin was observed in 2 (8.3%) patients. The mean duration of neutropenia was 7.2 +/- 3.1 (4-14) days in patients with solid tumors, and 9.3 +/- 4.7 (2-17) days in the group with leukemia. This difference was not statistically significant (log rank, p=0.063). Average time of stay in hospital was 10.1 +/- 6.4 (4-21) days for patients with solid tumors, and 15.9 +/- 11.7 (5-37) days for patients with leukemia (log rank, p=0.041). FN duration was observed to be significantly longer in patients with an absolute neutrophil count (ANC) of less than 100/mm3 and even those with an ANC of less than 200/mm3, and in children who were not in remission for the underlying malign disease (p<0.05). While 22 (91.7%) of the patients were discharged from the hospital, 2 (8.3%) died. The success rate of empirical therapy started with meropenem was 87.5%.
Meropenem is effective and safe for treatment of FN in pediatric cancer patients.
Asian Pacific journal of cancer prevention: APJCP 01/2010; 11(1):123-6. · 2.51 Impact Factor