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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.
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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. · 0.63 Impact Factor
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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. · 0.43 Impact Factor
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Journal of Pediatric Hematology/Oncology 04/2011; 33(3):246-7. · 1.16 Impact Factor
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Journal of Pediatric Hematology/Oncology 03/2011; 33(2):161. · 1.16 Impact Factor
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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.
Journal of Pediatric Hematology/Oncology 03/2011; 33(5):e192-4. · 1.16 Impact Factor
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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.
Pediatric Hematology and Oncology 03/2011; 28(4):294-8. · 0.89 Impact Factor
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Pediatric Hematology and Oncology 02/2011; 28(5):444-6. · 0.89 Impact Factor
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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.
Targeted Oncology 12/2010; 5(4):291-4. · 3.61 Impact Factor
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Journal of Pediatric Hematology/Oncology 10/2010; 32(7):574. · 1.16 Impact Factor
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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.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 09/2010; 8(3):237-44.
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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. · 0.66 Impact Factor
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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. · 0.66 Impact Factor
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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. · 0.66 Impact Factor
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ABSTRACT: In recent years, Fms-like tyrosine kinase (FLT) 3 has been the subject of several studies as a prognostic marker.
In this study, the presence of FLT3 mutations in childhood acute leukemias patients and their association with prognosis were investigated.
A total of 120 patients, 80 with acute lymphoblastic leukemia (ALL) and 40 with acute myeloblastic leukemia (AML), were included. Real time polymerase chain reaction methods on a high resolution melting analysis device were used to determine FLT3 mutations.
FLT3/ITD (internal tandem duplication) mutations were found in 6 (7.5%) of the patients with ALL and in 9 (22.5%) of those with AML, whereas no FLT3/TKD (trans kinase domain) mutation was evident in any case. There was no difference between the ALL patients positive and negative for FLT3/ITD with regard to overall survival (OS), event free survival (EFS) and disease free survival (DFS) (p=0.37, p=0.23, p=0.023, respectively). However, in FLT3/ITD positive and negative AML patients, there was a statistically significant difference in OS (p=0.0041), but not EFS and DFS (p=0.09, p=0.095, respectively). A significant difference was found between age and FLT3/ITD positivity (p=0.036).
We found that FLT3/ITD positivity increased with age and that it was associated with decrease in OS in AML patients, providing further evidence that it is an independent factor negatively influencing prognosis.
Asian Pacific journal of cancer prevention: APJCP 01/2010; 11(4):923-7. · 0.66 Impact Factor
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ABSTRACT: Acute myeloblastic leukemia (AML) accounts for 15 to 25 percent of childhood acute leukemias. The most common genetic abnormalities seen in pediatric AML patients are AML1-ETO, PML-RARα and CBFB-MYH11 genes resulting in t(8;21), t(15;17) and inv(16). These genetic defects are seen in approximately 20-25% of AML patients. Objective: We investigated in this study, incidence and prognostic significance of the AML1-ETO, PML-RARα and CBFB-MYH11 genes in children with AML.
The authors analyzed 34 children with AML using the real time-polymerase chain reaction for AML1-ETO, PML-RARα and CBFB-MYH11 genes.
Of the patients, 8.8% were positive for t(8;21), 8.8% for t(15;17) and 3% for inv(16). There were a statistically significant differences between 48 month overall survival rates of the patients positive and negative for t(8;21), t(15;17) and inv(16).
It was concluded that t(15;17), t(8;21) and inv(16) impact on disease prognosis positively, but comprehensive studies with larger patient series are now needed for confirmation.
Asian Pacific journal of cancer prevention: APJCP 01/2010; 11(5):1393-5. · 0.66 Impact Factor
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ABSTRACT: Infection of neutropenic children treated with malignancies is even now the major cause of early morbidity and mortality. Febrile neutropenic attacks without complications are successfully treated with wide-spectrum anti-pseudomonal cephalosporins or carbapenems.
To determine the efficacy and safety of imipenem in the treatment of febrile neutropenia in children with cancer.
Twenty-four patients who had a febrile neutropenic (FN) episodes followed by initiation of empirical imipenem therapy were included in the study.
Of the patients, 10 (41.7%) had solid tumors, while 14 (58.3%) were diagnosed to have acute leukemia. Among all, 5 (20.8 %) and 15 (62.5 %) of the infections were identified microbiologically and clinically, respectively. Fever of unknown origin was observed in 4 (16.7 %) patients. The mean duration of neutropenia was 6.3 -/+ 1.4 (4-8) days in patients with solid tumors, and 9.3 -/+ 7.4 (3-25) days in the group with leukemia. Average time of stay in hospital was 9.0 -/+ 4.1 (4-20) days for patients with solid tumors, and 14.4 -/+ 10.6 (4-33) days for patients with leukemia. FN duration was observed to be significantly longer in patients with an ANC of less than 200/mm3, and in children who were not in remission for the underlying malignant disease. In addition, average time of stay in hospital was observed to be significantly longer in patients who were not in remission for the underlying malign disease. All of the patients were discharged. The success rate of empirical therapy started with imipenem was found be 95.8 %.
Imipenem is effective and safe in the treatment of FN in pediatric cancer patients.
Asian Pacific journal of cancer prevention: APJCP 01/2009; 10(5):921-4. · 0.66 Impact Factor
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ABSTRACT: The aim of nutritional therapy in cancer patients is to prevent weight loss and to improve functional capacity and quality of life. Clinical studies however, have continued to demonstrate that a reduction in body weight loss is difficult to achieve in cancer cachexia. Several studies have shown that supplementation with eicosapentaenoic acid (EPA), an omega-3 fatty acid, has anti-cachectic effects in adult cancer patients. This study evaluated the clinical effects of a protein and energy dense EPA containing nutritional supplement in a group of pediatric cancer patients receiving active chemotherapy treatment.
The study was a prospective, randomized, single center, open-label design. Fifty-two patients diagnosed with pediatric malignant disease and receiving intensive chemotherapy were included. Thirty-three patients received a nutritional supplement containing EPA in addition to their regular food intake. Nineteen control patients did not receive supplementation. Patients were examined and their data (body weight, body mass index, and weight percentile) were recorded regularly once a month for 3 months. A subgroup of patients was evaluated for 6 months.
At 3 months, there were significantly fewer patients in the treatment group as compared to controls that showed losses in body weight (P = 0.001), BMI (P = 0.002), and a negative deviation in weight percentile (P = 0.021). In addition, remission rate was significantly (P = 0.036) higher in the treatment group as compared to controls.
This study demonstrates a decrease in cancer-induced weight loss in pediatric patients fed a protein and energy dense nutrition supplement containing EPA.
Pediatric Blood & Cancer 01/2009; 52(5):571-4. · 1.89 Impact Factor
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ABSTRACT: Background: Reversible posterior leukoencephalopathy syndrome (PRES) is a neurological disorder characterized by signs of posterior cerebral edema upon radiographic examination. Materials and Methods: We retrospectively analyzed the records of nine children with the diagnosis of PRES. Results: Of the nine patients, seven were receiving immunosuppressive therapy and two were acute hypertensive crisis associated with renal disease. Immunosupressive drugs were intrathecal methotrexate in two patients, cyclosporine in two patients, intrathecal cytarabine in one patient, cyclophasphamide in one patient, and intravenous immunoglobulin (IVIg) in another one patient. The most presenting symptoms were seizure, headache, and altered consciousness. Six patients had seizures. Altered consciousness was present in four patients. Headache and nausea or vomiting was present also in six patients. Visual abnormalities were noted in two patients. Magnetic resonance imaging (MRI) studies showed white-matter abnormalities suggestive of edema in the posterior regions of the cerebral hemispheres, but the changes often involved other cerebral areas, the brain stem, basal ganglia or the cerebellum. The patients were treated with antihypertensive medications, and immunosuppressive therapy was withdrawn. In all the patients, the clinical and radiological findings resolved morly completely. Conclusion: Reversible posterior leukoencephalopathy may develop in patients who have renal insufficiency or hypertension or who are immunosuppressed. This syndrome should be recognized immediately and trigger agents can be discontinued to prevent long-term sequelae.
Neurology India. 01/2009;
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ABSTRACT: Neonatal lupus erythematosus (NLE) is a disease primarily characterized by cardiac and/or cutaneous involvement. Hepatic, hematological, neurological and pulmonary involvement are rare manifestations and normally considered as mild and transient complications. But recent studies have shown more frequent hepatic involvement in NLE. We report a two month-old male infant, born to a clinically asymptomatic mother, presenting with significant hepatic involvement and annular, erythematous plaques with hyperkeratotic borders at the eyebrow region and anterior surface of trunk. Both the infant and his mother were positive for anti-Ro (SS-A) and anti-La (SS-B).
The Turkish journal of pediatrics 47(1):63-6. · 0.44 Impact Factor
