-
[show abstract]
[hide abstract]
ABSTRACT: Here we present a pediatric case of human papilloma virus associated with dermatopathic lymphadenitis (DL). A 5-year-old boy presented to the pediatric oncology clinic with swelling of the neck and warts on his lower jaw. His blood chemistry and complete blood count were normal, as was chest x-ray. HIV, EBV, CMV, and parvovirus serologies were negative. The patient was investigated for malignancy and lymphoma but no association was found. Histopathologic examination of the lymph node and the lesion revealed DL and verruca vulgaris, respectively.DL represents a benign form of reactive lymph node hyperplasia and described in patients with HIV and EBV infections. It is a rare entity described in patients with human papilloma virus infection. To our knowledge, this is the first report of DL in a patient with human papilloma virus infection.
Journal of Pediatric Hematology/Oncology 05/2013; · 1.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The management of acute respiratory distress syndrome (ARDS) was investigated with the use of heliox in an experimental model.
To investigate whether heliox can be considered a new therapeutic approach in ARDS.
ARDS was designed in Wistar albino male rats, 250-300 g in weight, by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats with ARDS were pressure-controlled ventilated. At the end of 210 min, helium gas was tried. All rats were assigned to two groups: Group 1 (n = 10) was the control group, and was given no treatment; group 2 (n = 7) was given heliox (He: O(2) = 50:50). The heliox group received heliox for 1 h continously. Rats were continued to be kept on a ventilator through the experiment. Two hours after the last inhalation, both lungs of the rats were excised for both histopathological examination and immunohistochemical evaluation.
Histopathological grading were expressed as median interquartile range. Mann-Whitney U-test was used to assess the relationships between the variables.
The infiltation of neutrophils were decreased in rats treated with heliox. Edema in the interstitial and intraalveolar areas was less than that of the control rats. Also, the diminishing of perivascular and/or intraalveolar hemorrhage was apperant. Hyaline membrane (HM) formation decreased in the heliox group compared with the control group. Decreased inducible nitric oxide synthase expression was shown via immunohistochemical examination in the heliox group.
The present study histopathologically indicated the effectiveness of heliox in the decreasing of neutrophil infiltation, interstitial/intraalveolar edema, perivascular and/or intraalveolar hemorrhage and HM formation in ARDS. Besides the known effect of heliox in obstructive lung disease, inhaled heliox therapy could be associated with the improvement of inflamation in ARDS.
Annals of Thoracic Medicine 01/2013; 8(1):46-52. · 1.62 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.
-
Sema Yilmaz,
Nihal Inandiklioglu,
Dincer Yildizdas,
Cansu Subasi,
Arbil Acikalin,
Yurdun Kuyucu, Ibrahim Bayram,
Ali Topak,
Atila Tanyeli,
Gokhan Duruksu,
Erdal Karaoz
[show abstract]
[hide abstract]
ABSTRACT: We hypothesized that bone marrow-derived mesenchymal stem cells (BM-MSCs) would have a possible role in the treatment of acute respiratory distress syndrome (ARDS). ARDS disease model was developed in Wistar albino male rats by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats (n = 8) with ARDS were pressure-controlled ventilated. Isolated and characterized rat (r-) BM-MSCs were labeled with GFP gene, and introduced in the lungs of the ARDS rat-model. After applying of MSCs, the life span of each rat was recorded. When rats died, their lung tissues were removed for histopathological examination. Also the tissue sections were analyzed for GFP labeled rBM-MSCs and stained for vimentin, CK19, proinflammatory (MPO, IL-1β, IL-6 and MIP-2) and anti-inflammatory [IL-1ra and prostaglandin E2 receptor (EP3)] cytokines. The histopathological signs of rat-model ARDS were similar to the acute phase of ARDS in humans. rBM-MSCs were observed to home in lung paranchyma. Although the infiltration of neutrophils slightly decreased in the interalveolar, peribronchial and perivascular area, a notable improvement was determined in the degree of hemorrhage, edema and hyaline membrane formation in rats treated with rBM-MSCs. Also decreased proinflammatory cytokines levels and increased the intensity of anti-inflammatory cytokines were established. Therefore MSCs could promote alveoar epithelial repair by mediating of cytokines from a proinflammatory to an anti-inflammatory response. As a novel therapeutic approach, mesenchymal stem cell treatment with intratracheal injection could be helpful in the management of critically ill patients with ARDS.
Stem cell reviews 07/2012; · 5.08 Impact Factor
-
Journal of Pediatric Hematology/Oncology 04/2011; 33(3):246-7. · 1.16 Impact Factor
-
Journal of Pediatric Hematology/Oncology 03/2011; 33(2):161. · 1.16 Impact Factor
-
[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.
Pediatric Hematology and Oncology 03/2011; 28(4):294-8. · 0.89 Impact Factor
-
Journal of Pediatric Hematology/Oncology 10/2010; 32(7):574. · 1.16 Impact Factor
-
[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.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 09/2010; 8(3):237-44.
-
[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. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
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
-
[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. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
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
-
[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. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the effectiveness of HFOV in pediatric patients with acute respiratory distress syndrome.
In this retrospective study, we reviewed all 20 pediatric patients, who were consecutively ventilated with HFOV in the pediatric intensive care unit of a tertiary medical center, from January 2006 to February 2007.
A total of 20 patients were enrolled. The median age of the subjects was 70 (3-168) months; 10 were male. All patients received conventional ventilation before HFOV. After initiation of HFOV, there was an immediate and sustained increase in PaO(2)/FiO(2) ratio. The PaO(2)/FiO(2) ratio was elevated and OI was decreased significantly after 10-20 minutes and maintained for at least 48 hours (p= 0.03, both). Thirteen of the 20 patients were successfully weaned. No significant change in the mean arterial pressure and heart rate was noted after HFOV. Overall survival rate was 65%. Of 20 patients, 11 patients suffered from extrapulmonary ARDS (ARDSexp) and 9 from pulmonary ARDS (ARDSp). When HFOV was initiated, there was significant increase in PaO(2)/FiO(2) and decrease in OI in ARDSexp compared to ARDSp (p= 0.03, both). Also mortality rate was significantly lower in patients with ARDSexp (9% vs.66%), (p= 0.01).
In our study, HFOV was effective in oxygenation and seems to be safe for pediatric ARDS patients. HFOV affected ARDSp and ARDSexp paediatric patients differently. However prospective, randomized controlled trials are needed to identify its benefits over conventional modes of mechanical ventilation.
The Indian Journal of Pediatrics 06/2009; 76(9):921-7. · 0.52 Impact Factor
-
[show abstract]
[hide abstract]
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
-
[show abstract]
[hide abstract]
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
-
Pediatrics International 07/2008; 50(3):395-6. · 0.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Leishmaniasis is caused by infection with the hemoparasite Leishmania. The disease is a major public health problem in at least 88 countries, including Turkey. Prolonged fever with anorexia and loss of appetite are the major presenting features of visceral leishmaniasis. It is rarely defined as an etiological cause of hemophagocytic syndrome. The clinical course triggered by leishmania infection and hemophagocytosis may coincide, and this may lead to considerable diagnostic difficulty, especially in young children. In this report, we describe an adolescent boy with visceral leishmaniasis as a rare cause of the hemophagocytic syndrome. This is the first reported association between hemophagocytosis and visceral leishmaniasis in an adolescent.
The American Journal of the Medical Sciences 09/2007; 334(2):139-41. · 1.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this prospectively designed study was to investigate the efficacy of surfactant (S) for acute respiratory distress syndrome (ARDS) in children.
Children with ARDS were included in this study. Surfactant (Survanta, Abbott, USA) was given intratracheally at a dose of 150 mg/kg every 12 h for a total of two doses. During the study period none of the patients received permissive hypercapnia, high frequency ventilation, nitric oxide or ECMO. Peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), ventilation rate, mean airway pressure, tidal volume (TV), Murray index, PaO2/FiO2, ventilation index (VI), oxygen index (OI) and arterial oxygen tension difference (A-aDO2) were measured before and 48 h after surfactant treatment. Duration of mechanical ventilation therapy, duration in paediatric intensive care unit (PICU) and mortality rate were recorded.
Among the 36 children who met the inclusion criteria, 12 were treated with surfactant. The mean age was 72.5+/-56.2 months; 47% of children were male. Infants were ventilated by pressure-controlled ventilators whereas for older children volume-controlled ventilators were used. Sepsis (42%) was the main predisposing factor followed by pneumonia (25%) and malignancy (17%). The baseline characteristics including age, predisposing factors, gender, PIP, PEEP, A-aDO2, PaO2/FiO2, OI, TV, VI and Murray index were similar in the surfactant and non-surfactant (NS) group (p>0.05). There were significant improvements in PIP, PEEP, A-aDO2, PaO2/FiO2, OI, TV, VI and Murray index in the surfactant group after surfactant treatment compared with NS group (p<0.05). Duration of PICU stay and ventilator treatment was longer in NS group (14+/-3.7, 1.8+/-3.2 days vs. 9.2+/-3.1, 8.6+/-1.9 days), (p<0.05). Mortality rate was 42% in surfactant compared with 63% in the NS group, (p>0.05). Children in the surfactant group lived significantly longer (p<0.05).
Modified natural surfactant is an effective treatment option in children with ARDS for improving gas exchange, decreasing the use of ventilatory support and increasing survival time.
Pulmonary Pharmacology & Therapeutics 02/2003; 16(6):327-33. · 2.80 Impact Factor
