Pediatrics international : official journal of the Japan Pediatric Society, 2005
The aim of this study was to detect and investigate the clinical effects of antineutrophil antibo... more The aim of this study was to detect and investigate the clinical effects of antineutrophil antibodies in neonates who had received a blood transfusion or exchange transfusion. Venous blood samples were drawn from 34 neonates at pretransfusion (sample 0), immediately after transfusion (sample 1), 2-3 weeks (sample 2) and 8-12 weeks (sample 3) after transfusion. Ten healthy neonates were in the control group. Antineutrophil antibodies were detected using flow cytometric assay. Antineutrophil antibody was detected in the sera of 20 (58.8%) neonates in the study group. Of these 20 neonates, nine had antineutrophil antibodies in serum samples 0, 1 and 2, which were probably due to the passive transfer of maternal antibodies. Nine neonates had antineutrophil antibodies in serum samples 1 and 2, which were probably due to neutrophil antibodies being present in the donor's blood. In two neonates, antineutrophil antibodies were not detected in samples 0 and 1, but appeared in sample 2, w...
Turkey is located in a geographic area of the world where thalassemia syndromes and abnormal hemo... more Turkey is located in a geographic area of the world where thalassemia syndromes and abnormal hemoglobins are common. In this study we aimed to evaluate the thalassemia syndromes and abnormal hemoglobins in patients from the Aegean region of Turkey. Among the patients admitted to our Pediatric Hematology or Hematology Clinic between January 1997-September 1999, hemoglobin electrophoresis of 3,228 cases investigated for anemia was done using high performance liquid chromatography. Beta thalassemia trait was diagnosed in 21.1%, beta thalassemia major in 0.2%, S-beta thalassemia in 0.37%, Hb D in 0.37%, Hb S trait in 0.32%, Hb E in 0.18%, Hb O-Arab in 0.12%, Hb G-Copenhagen in 0.09%, Hb D-Iran in 0.06%, Hb Lepore in 0.06%, Hb Hasharon in 0.03%. Our results demonstrate that people in the Aegean region of Turkey have a wide spectrum of thalassemia syndromes and abnormal hemoglobins.
Myelodysplastic syndromes (MDS) are rare in children, representing 3% or less of all hematopoieti... more Myelodysplastic syndromes (MDS) are rare in children, representing 3% or less of all hematopoietic malignancies. Cytogenetic abnormalities, such as −7/7q-, +8, and +21 have been reported in 55–80% of children with MDS. Cytogenetic studies have an important impact on diagnosis, treatment selection, and monitoring therapeutic protocols when combined with morphologic data. We report on a pediatric case of MDS with
Objective: Survival rates for childhood acute lymphoblastic leukemia (ALL) have significantly imp... more Objective: Survival rates for childhood acute lymphoblastic leukemia (ALL) have significantly improved and late effects of therapy have been important in the follow-up of survivors. The objective of this study is to identify the endocrinological and cardiological late effects of ALL patients treated in our pediatric hematology unit.
Thrombocytopenia is a common hemostatic abnormality in the newborn infant. The early diagnosis of... more Thrombocytopenia is a common hemostatic abnormality in the newborn infant. The early diagnosis of thrombocytopenia and the underlying primary pathology process play an important role in reducing the risk of severe complications and mortality. We performed a 2-year prospective study of 643 neonates admitted to our neonatology unit to determine the frequency, predisposing factors, and clinical impact of thrombocytopenia. Thrombocytopenia developed in 18.2% of the preterm neonates and 0.8% of the term neonates. Prematurity, sepsis, hypoxia, intrauterine growth retardation, and disseminated intravascular coagulation were identified as predisposing factors for thrombocytopenia. The incidence of complications and mortality were higher in thrombocytopenic infants. Especially the prognosis was worse in cases who had mucosal hemorrhage, without a relation with the degree of thrombocytopenia. The thrombocytopenia occurred by day 2 in 43% of the infants, and resolved by day 8 in 61%. The platelet count nadir occurred by day 2. Since thrombocytopenic infants are at greater risk for bleeding, and the thrombocytopenia itself may have contributed to the high mortality, predisposing factors such as prematurity, infections, hypoxia must be eliminated by providing better care, giving adequate hygiene of both mother and the baby during the prenatal, natal, and neonatal period.
The Forkhead box protein M1 (FoxM1) is an important transcription factor having significant roles... more The Forkhead box protein M1 (FoxM1) is an important transcription factor having significant roles in various cellular events. FoxM1 overexpression has been reported to be related with many types of cancer. However, it is not known whether it contributes to oncogenesis of acute lymphoblastic leukemia. Siomycin A, a thiazol antibiotic, is known to inhibit FoxM1 transcriptional activity. In this study, we aimed to determine gene expression levels of FoxM1 in Jurkat cells (T-cell acute lymphoblastic leukemia cell line) and therapeutic potential of targeting FoxM1 by siomycin A alone and in combination with dexamethasone which improves the survival of children with T-cell acute lymphoblastic leukemia (ALL). We also examined the molecular mechanisms of siomycin A and dexamethasone-induced cell death in Jurkat cells. We demonstrated that FoxM1 mRNA is highly expressed in Jurkat cells. Dexamethasone and siomycin A caused a significant reduction in gene expression levels of FoxM1 in Jurkat cells. Targeting FoxM1 by siomycin A and dexamethasone caused a significant decrease in T-ALL cell line proliferation through induction of G1 cell cycle arrest. All these findings suggest a possible role of FoxM1 in T-cell ALL pathogenesis and represent FoxM1 as an attractive target for T-cell ALL therapy.
Dysregulation of microRNA (miRNA) expression contributes to the pathogenesis of several clinical ... more Dysregulation of microRNA (miRNA) expression contributes to the pathogenesis of several clinical conditions. The aim of this study is to evaluate the associations between miRNAs and childhood acute lymphoblastic leukemia (ALL) to discover their role in the course of the disease. Forty-three children with ALL and 14 age-matched healthy controls were included in the study. MicroRNA microarray expression profiling was used for peripheral blood and bone marrow samples. Aberrant miRNA expressions associated with the diagnosis and outcome were prospectively evaluated. Confirmation analysis was performed by real time were significantly dysregulated in ALL patients at day 0. Following a six-month treatment period, the change in miRNA levels was determined by real time RT-PCR and expression of miR-146a, miR-155, miR-181a, and miR-195 significantly decreased. To conclude, these miRNAs not only may be used as biomarkers in diagnosis of ALL and monitoring the disease but also provide new insights into the potential roles of them in leukemogenesis.
Thirty-six patients with Imerslund-Gräsbeck syndrome are presented. The mean ages at presentation... more Thirty-six patients with Imerslund-Gräsbeck syndrome are presented. The mean ages at presentation and diagnosis were 4.7 +/- 3.7 years and 7.2 +/- 4.2 years, respectively. The mean hemoglobin level was 5.8 +/- 2.2 g/dL, the mean cell volume was 104.9 +/- 11.6 fL, the white blood cell count was 4479 +/- 2022/mm3, and the serum vitamin B12 level was 96.9 +/- 73 pg/mL. At diagnosis, 5 of the 36 patients, aged 5 to 16 years, had neurologic symptoms. All the patients had severe megaloblastic changes in bone marrow precursor cells. Proteinuria was detected in 78% of them. Patients with proteinuria had a younger age of onset (P < 0.0001) and diagnosis (P < 0.001) compared with those without proteinuria. In all patients, vitamin B12 excretion unbound to intrinsic factor after a flushing dose of vitamin B12 was lower than normal, and there was no appreciable correction in urinary vitamin B12 excretion after binding of intrinsic factor. The impairment of vitamin B12 absorption studies in Schilling tests; however, showed great variation among patients. Serum haptoglobin values were close to zero in all patients, indicating the presence of that intravascular hemolysis in Imerslund-Gräsbeck syndrome. Variations among patients in the age of presentation, degree of impairment of vitamin B12 absorption, and presence or absence of proteinuria suggest a heterogeneity in etiology of Imerslund-Gräsbeck syndrome at the molecular level.
Methotrexate (MTX) is an essential component of chemotherapy for childhood acute lymphoblastic le... more Methotrexate (MTX) is an essential component of chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both intravenous and most commonly intrathecal routes of MTX have been implicated in acute, subacute, and chronic neurotoxicity syndromes. Subacute MTX neurotoxicity occurs within days to weeks after the intravenous or intrathecal therapy and characterized by a distinct presentation with remarkable clinical resemblance to stroke, including hemiparesis, hemisensory deficits, aphasia, dysarthria, dysphagia, and diplopia. Herein the authors describe the clinical and typical neuroimaging features of a female patient with ALL who presented with subacute MTX neurotoxicity that rapidly progressed to a severe clinical condition in a few hours but eventually resolved completely with dexamethasone and folinic acid. Subacute MTX neurotoxicity is a transient neurological dysfunction that should be considered in patients presenting with stroke-like and various neurological symptoms 10 to 14 days after intrathecal therapy and diffusion-weighted magnetic resonance imaging should be undertaken for the correct diagnosis and exclusion of possible ischemic infarct. Discontinuation of subsequent intrathecal MTX therapies should be considered in severe cases and treatment with dexamethasone and folinic acid may help to resolve the symptoms.
Although veno-occlusive disease of the liver is a well-known complication of high-dose chemothera... more Although veno-occlusive disease of the liver is a well-known complication of high-dose chemotherapy and bone marrow transplantation, it has rarely been observed in children who receive conventional chemotherapy. Most cases in the literature consists of children with Wilms tumor. It has been very uncommon in rhabdomyosarcoma patients until recently, although they commonly receive similar anticancer agents. Here the authors report a 2-year-old boy with rhabdomyosarcoma who developed veno-occlusive disease while receiving VAC (vincristine, actinomycin D, cyclophosphamide) chemotherapy regimen according to the IRS-IV protocol. The patient gradually recovered during 2 weeks with supportive treatment only.
The purpose of the study was to evaluate the plasma levels of tissue factor (TF), an angiogenic m... more The purpose of the study was to evaluate the plasma levels of tissue factor (TF), an angiogenic marker, and tissue factor pathway inhibitor (TFPI), an antiproliferative protein, in the childhood hemangiomas at proliferative and regressive stages. The study included 30 patients with hemangiomas and 30 healthy children. Localization, number, stage, type, duration of growth, and complications of the hemangiomas were determined. Venous blood samples from all individuals were collected into citrated tubes and centrifuged. Supernatant plasma was separated, aliquated, and stored at -70 degrees C until samples could be assayed. Plasma levels of TF and TFPI were measured with quantitative ELISA kits. Plasma TF and TFPI levels did not show any significant difference between the study and control groups. When plasma TF and TFPI levels of the children in the control group and in the study group who were in proliferative and regressive stage were compared to each other, no statistically significant difference could be detected. Plasma TF and TFPI levels of our patients with hemangiomas were not different from healthy children and they did not show any significant difference in proliferative and regressive stages.
In this study, using flow cytometry, we investigated the autofluorescence emitted by lymphocytes,... more In this study, using flow cytometry, we investigated the autofluorescence emitted by lymphocytes, monocytes and neutrophils exposed to different unconjugated bilirubin concentrations and investigated the relationship between these parameters. Different unconjugated bilirubin concentrations were prepared from a newborn serum with an unconjugated bilirubin concentration of 800 μmol/l. The same concentrations of unconjugated bilirubin have been prepared from pure bilirubin. 10
We aimed to retrospectively evaluate the skin and soft tissue complications secondary to procedur... more We aimed to retrospectively evaluate the skin and soft tissue complications secondary to procedures in acute leukemia patients with and without catheters. Eighty-seven acute leukemia patients (75 acute lymphoblastic leukemia, 12 acute myeloid leukemia ) were included. There were 30 patients with 37 catheter use (6 port, 31 Hickman catheter) and 57 patients without catheter. In patients with catheters, skin and soft tissue complications were seen in 20 (66%) children. The most frequent complication was cellulitis (55%). In the patients without catheter, skin and soft tissue complications were seen in 37 (65%) patients. Cellulitis (37.8%) and extravasation (37.8%) were the most frequent causes. When the frequency of skin and soft tissue complications in patients with and without catheters were compared with each other, there was statistically no significant difference (P=0.792). The duration of chemotherapy was significantly longer in patients who developed skin and soft tissue complications with or without catheters when compared with the duration of the therapy in patients without any skin and soft tissue complications (259.2+/-36.3 and 218.3+/-58.3 d, respectively; P<0.0001). In pediatric leukemia patients, with or without catheters, skin and soft tissue complications are common and these complications may prolong the duration of chemotherapy.
We evaluated the frequency, etiologic factors, outcome, and the comorbid conditions affecting the... more We evaluated the frequency, etiologic factors, outcome, and the comorbid conditions affecting the morbidity and mortality of pulmonary complications in acute childhood leukemia. Sixty-six (40.4%) out of 163 patients developed 79 pulmonary complications. Infectious etiology was the leading cause (92.4%). The most identified infectious agents were Gram (-) bacteria, followed by fungi. Acute respiratory distress syndrome, leukostasis, lymphomatoid granulomatosis, pulmonary edema, and pneumothorax were among the noninfectious causes. The pulmonary complications in the induction and consolidation phase of leukemia therapy were more severe and the mortality rate was higher. Tachypnea, shock, oxygen and mechanical ventilation requirement, disseminated intravascular coagulation, involvement of other organs or systems, cytopenias, requirement of modification in antimicrobial drugs were found to be related with increased mortality risk. The mortality rate of pulmonary complications was 8.9%. Pulmonary infections in the maintenance phase of the therapy were frequently treated with oral antibiotics, and they were generally rapidly taken under control. In conclusion, pulmonary complications are frequent in children with acute leukemia, and early diagnosis and appropriate management are important to avoid mortality owing to pulmonary complications, especially in neutropenic patients receiving induction or consolidation phase of chemotherapy.
A baby centrally cyanosed from birth was investigated for a congenital cardiac defect. Echocardio... more A baby centrally cyanosed from birth was investigated for a congenital cardiac defect. Echocardiography and angiography revealed patent foramen ovale without any other cardiac abnormality. Congenital methaemoglobinaemia was considered as the methaemoglobin level was 27%, suggesting either Hb M or a deficiency of the NADH-cytochrome b5 reductase (cytb5r) enzyme. Measurement of the cytb5r enzyme activity of this patient indicated a
In this report we describe a case of extensive cerebral venous thrombosis in a patient with Evans... more In this report we describe a case of extensive cerebral venous thrombosis in a patient with Evans syndrome. A 19-year-old male patient with Evans syndrome was admitted to the hospital with the complaints of headache, convulsive seizure, and vomiting. The cerebral venous thrombosis including left lateral, left sigmoid, straight sinus, and vena jugularis interna was diagnosed by cerebral magnetic resonance angiography. When the thrombosis developed, he was in hematological remission and he was not receiving any medications except lamivudine for chronic hepatitis B infection. As a genetic prothrombotic risk factor, he had heterozygous prothrombin G20210A gene mutation. His clinical and radiologic findings improved after unfractionated heparin and subsequently with coumadin therapy. On follow-up, cerebral venous thrombosis reoccurred in different localizations, but complete recanalization could be obtained with antithrombotic therapy. We present the case since the association of cerebral venous thrombosis and Evans syndrome is very rare.
Pediatrics international : official journal of the Japan Pediatric Society, 2005
The aim of this study was to detect and investigate the clinical effects of antineutrophil antibo... more The aim of this study was to detect and investigate the clinical effects of antineutrophil antibodies in neonates who had received a blood transfusion or exchange transfusion. Venous blood samples were drawn from 34 neonates at pretransfusion (sample 0), immediately after transfusion (sample 1), 2-3 weeks (sample 2) and 8-12 weeks (sample 3) after transfusion. Ten healthy neonates were in the control group. Antineutrophil antibodies were detected using flow cytometric assay. Antineutrophil antibody was detected in the sera of 20 (58.8%) neonates in the study group. Of these 20 neonates, nine had antineutrophil antibodies in serum samples 0, 1 and 2, which were probably due to the passive transfer of maternal antibodies. Nine neonates had antineutrophil antibodies in serum samples 1 and 2, which were probably due to neutrophil antibodies being present in the donor's blood. In two neonates, antineutrophil antibodies were not detected in samples 0 and 1, but appeared in sample 2, w...
Turkey is located in a geographic area of the world where thalassemia syndromes and abnormal hemo... more Turkey is located in a geographic area of the world where thalassemia syndromes and abnormal hemoglobins are common. In this study we aimed to evaluate the thalassemia syndromes and abnormal hemoglobins in patients from the Aegean region of Turkey. Among the patients admitted to our Pediatric Hematology or Hematology Clinic between January 1997-September 1999, hemoglobin electrophoresis of 3,228 cases investigated for anemia was done using high performance liquid chromatography. Beta thalassemia trait was diagnosed in 21.1%, beta thalassemia major in 0.2%, S-beta thalassemia in 0.37%, Hb D in 0.37%, Hb S trait in 0.32%, Hb E in 0.18%, Hb O-Arab in 0.12%, Hb G-Copenhagen in 0.09%, Hb D-Iran in 0.06%, Hb Lepore in 0.06%, Hb Hasharon in 0.03%. Our results demonstrate that people in the Aegean region of Turkey have a wide spectrum of thalassemia syndromes and abnormal hemoglobins.
Myelodysplastic syndromes (MDS) are rare in children, representing 3% or less of all hematopoieti... more Myelodysplastic syndromes (MDS) are rare in children, representing 3% or less of all hematopoietic malignancies. Cytogenetic abnormalities, such as −7/7q-, +8, and +21 have been reported in 55–80% of children with MDS. Cytogenetic studies have an important impact on diagnosis, treatment selection, and monitoring therapeutic protocols when combined with morphologic data. We report on a pediatric case of MDS with
Objective: Survival rates for childhood acute lymphoblastic leukemia (ALL) have significantly imp... more Objective: Survival rates for childhood acute lymphoblastic leukemia (ALL) have significantly improved and late effects of therapy have been important in the follow-up of survivors. The objective of this study is to identify the endocrinological and cardiological late effects of ALL patients treated in our pediatric hematology unit.
Thrombocytopenia is a common hemostatic abnormality in the newborn infant. The early diagnosis of... more Thrombocytopenia is a common hemostatic abnormality in the newborn infant. The early diagnosis of thrombocytopenia and the underlying primary pathology process play an important role in reducing the risk of severe complications and mortality. We performed a 2-year prospective study of 643 neonates admitted to our neonatology unit to determine the frequency, predisposing factors, and clinical impact of thrombocytopenia. Thrombocytopenia developed in 18.2% of the preterm neonates and 0.8% of the term neonates. Prematurity, sepsis, hypoxia, intrauterine growth retardation, and disseminated intravascular coagulation were identified as predisposing factors for thrombocytopenia. The incidence of complications and mortality were higher in thrombocytopenic infants. Especially the prognosis was worse in cases who had mucosal hemorrhage, without a relation with the degree of thrombocytopenia. The thrombocytopenia occurred by day 2 in 43% of the infants, and resolved by day 8 in 61%. The platelet count nadir occurred by day 2. Since thrombocytopenic infants are at greater risk for bleeding, and the thrombocytopenia itself may have contributed to the high mortality, predisposing factors such as prematurity, infections, hypoxia must be eliminated by providing better care, giving adequate hygiene of both mother and the baby during the prenatal, natal, and neonatal period.
The Forkhead box protein M1 (FoxM1) is an important transcription factor having significant roles... more The Forkhead box protein M1 (FoxM1) is an important transcription factor having significant roles in various cellular events. FoxM1 overexpression has been reported to be related with many types of cancer. However, it is not known whether it contributes to oncogenesis of acute lymphoblastic leukemia. Siomycin A, a thiazol antibiotic, is known to inhibit FoxM1 transcriptional activity. In this study, we aimed to determine gene expression levels of FoxM1 in Jurkat cells (T-cell acute lymphoblastic leukemia cell line) and therapeutic potential of targeting FoxM1 by siomycin A alone and in combination with dexamethasone which improves the survival of children with T-cell acute lymphoblastic leukemia (ALL). We also examined the molecular mechanisms of siomycin A and dexamethasone-induced cell death in Jurkat cells. We demonstrated that FoxM1 mRNA is highly expressed in Jurkat cells. Dexamethasone and siomycin A caused a significant reduction in gene expression levels of FoxM1 in Jurkat cells. Targeting FoxM1 by siomycin A and dexamethasone caused a significant decrease in T-ALL cell line proliferation through induction of G1 cell cycle arrest. All these findings suggest a possible role of FoxM1 in T-cell ALL pathogenesis and represent FoxM1 as an attractive target for T-cell ALL therapy.
Dysregulation of microRNA (miRNA) expression contributes to the pathogenesis of several clinical ... more Dysregulation of microRNA (miRNA) expression contributes to the pathogenesis of several clinical conditions. The aim of this study is to evaluate the associations between miRNAs and childhood acute lymphoblastic leukemia (ALL) to discover their role in the course of the disease. Forty-three children with ALL and 14 age-matched healthy controls were included in the study. MicroRNA microarray expression profiling was used for peripheral blood and bone marrow samples. Aberrant miRNA expressions associated with the diagnosis and outcome were prospectively evaluated. Confirmation analysis was performed by real time were significantly dysregulated in ALL patients at day 0. Following a six-month treatment period, the change in miRNA levels was determined by real time RT-PCR and expression of miR-146a, miR-155, miR-181a, and miR-195 significantly decreased. To conclude, these miRNAs not only may be used as biomarkers in diagnosis of ALL and monitoring the disease but also provide new insights into the potential roles of them in leukemogenesis.
Thirty-six patients with Imerslund-Gräsbeck syndrome are presented. The mean ages at presentation... more Thirty-six patients with Imerslund-Gräsbeck syndrome are presented. The mean ages at presentation and diagnosis were 4.7 +/- 3.7 years and 7.2 +/- 4.2 years, respectively. The mean hemoglobin level was 5.8 +/- 2.2 g/dL, the mean cell volume was 104.9 +/- 11.6 fL, the white blood cell count was 4479 +/- 2022/mm3, and the serum vitamin B12 level was 96.9 +/- 73 pg/mL. At diagnosis, 5 of the 36 patients, aged 5 to 16 years, had neurologic symptoms. All the patients had severe megaloblastic changes in bone marrow precursor cells. Proteinuria was detected in 78% of them. Patients with proteinuria had a younger age of onset (P < 0.0001) and diagnosis (P < 0.001) compared with those without proteinuria. In all patients, vitamin B12 excretion unbound to intrinsic factor after a flushing dose of vitamin B12 was lower than normal, and there was no appreciable correction in urinary vitamin B12 excretion after binding of intrinsic factor. The impairment of vitamin B12 absorption studies in Schilling tests; however, showed great variation among patients. Serum haptoglobin values were close to zero in all patients, indicating the presence of that intravascular hemolysis in Imerslund-Gräsbeck syndrome. Variations among patients in the age of presentation, degree of impairment of vitamin B12 absorption, and presence or absence of proteinuria suggest a heterogeneity in etiology of Imerslund-Gräsbeck syndrome at the molecular level.
Methotrexate (MTX) is an essential component of chemotherapy for childhood acute lymphoblastic le... more Methotrexate (MTX) is an essential component of chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both intravenous and most commonly intrathecal routes of MTX have been implicated in acute, subacute, and chronic neurotoxicity syndromes. Subacute MTX neurotoxicity occurs within days to weeks after the intravenous or intrathecal therapy and characterized by a distinct presentation with remarkable clinical resemblance to stroke, including hemiparesis, hemisensory deficits, aphasia, dysarthria, dysphagia, and diplopia. Herein the authors describe the clinical and typical neuroimaging features of a female patient with ALL who presented with subacute MTX neurotoxicity that rapidly progressed to a severe clinical condition in a few hours but eventually resolved completely with dexamethasone and folinic acid. Subacute MTX neurotoxicity is a transient neurological dysfunction that should be considered in patients presenting with stroke-like and various neurological symptoms 10 to 14 days after intrathecal therapy and diffusion-weighted magnetic resonance imaging should be undertaken for the correct diagnosis and exclusion of possible ischemic infarct. Discontinuation of subsequent intrathecal MTX therapies should be considered in severe cases and treatment with dexamethasone and folinic acid may help to resolve the symptoms.
Although veno-occlusive disease of the liver is a well-known complication of high-dose chemothera... more Although veno-occlusive disease of the liver is a well-known complication of high-dose chemotherapy and bone marrow transplantation, it has rarely been observed in children who receive conventional chemotherapy. Most cases in the literature consists of children with Wilms tumor. It has been very uncommon in rhabdomyosarcoma patients until recently, although they commonly receive similar anticancer agents. Here the authors report a 2-year-old boy with rhabdomyosarcoma who developed veno-occlusive disease while receiving VAC (vincristine, actinomycin D, cyclophosphamide) chemotherapy regimen according to the IRS-IV protocol. The patient gradually recovered during 2 weeks with supportive treatment only.
The purpose of the study was to evaluate the plasma levels of tissue factor (TF), an angiogenic m... more The purpose of the study was to evaluate the plasma levels of tissue factor (TF), an angiogenic marker, and tissue factor pathway inhibitor (TFPI), an antiproliferative protein, in the childhood hemangiomas at proliferative and regressive stages. The study included 30 patients with hemangiomas and 30 healthy children. Localization, number, stage, type, duration of growth, and complications of the hemangiomas were determined. Venous blood samples from all individuals were collected into citrated tubes and centrifuged. Supernatant plasma was separated, aliquated, and stored at -70 degrees C until samples could be assayed. Plasma levels of TF and TFPI were measured with quantitative ELISA kits. Plasma TF and TFPI levels did not show any significant difference between the study and control groups. When plasma TF and TFPI levels of the children in the control group and in the study group who were in proliferative and regressive stage were compared to each other, no statistically significant difference could be detected. Plasma TF and TFPI levels of our patients with hemangiomas were not different from healthy children and they did not show any significant difference in proliferative and regressive stages.
In this study, using flow cytometry, we investigated the autofluorescence emitted by lymphocytes,... more In this study, using flow cytometry, we investigated the autofluorescence emitted by lymphocytes, monocytes and neutrophils exposed to different unconjugated bilirubin concentrations and investigated the relationship between these parameters. Different unconjugated bilirubin concentrations were prepared from a newborn serum with an unconjugated bilirubin concentration of 800 μmol/l. The same concentrations of unconjugated bilirubin have been prepared from pure bilirubin. 10
We aimed to retrospectively evaluate the skin and soft tissue complications secondary to procedur... more We aimed to retrospectively evaluate the skin and soft tissue complications secondary to procedures in acute leukemia patients with and without catheters. Eighty-seven acute leukemia patients (75 acute lymphoblastic leukemia, 12 acute myeloid leukemia ) were included. There were 30 patients with 37 catheter use (6 port, 31 Hickman catheter) and 57 patients without catheter. In patients with catheters, skin and soft tissue complications were seen in 20 (66%) children. The most frequent complication was cellulitis (55%). In the patients without catheter, skin and soft tissue complications were seen in 37 (65%) patients. Cellulitis (37.8%) and extravasation (37.8%) were the most frequent causes. When the frequency of skin and soft tissue complications in patients with and without catheters were compared with each other, there was statistically no significant difference (P=0.792). The duration of chemotherapy was significantly longer in patients who developed skin and soft tissue complications with or without catheters when compared with the duration of the therapy in patients without any skin and soft tissue complications (259.2+/-36.3 and 218.3+/-58.3 d, respectively; P<0.0001). In pediatric leukemia patients, with or without catheters, skin and soft tissue complications are common and these complications may prolong the duration of chemotherapy.
We evaluated the frequency, etiologic factors, outcome, and the comorbid conditions affecting the... more We evaluated the frequency, etiologic factors, outcome, and the comorbid conditions affecting the morbidity and mortality of pulmonary complications in acute childhood leukemia. Sixty-six (40.4%) out of 163 patients developed 79 pulmonary complications. Infectious etiology was the leading cause (92.4%). The most identified infectious agents were Gram (-) bacteria, followed by fungi. Acute respiratory distress syndrome, leukostasis, lymphomatoid granulomatosis, pulmonary edema, and pneumothorax were among the noninfectious causes. The pulmonary complications in the induction and consolidation phase of leukemia therapy were more severe and the mortality rate was higher. Tachypnea, shock, oxygen and mechanical ventilation requirement, disseminated intravascular coagulation, involvement of other organs or systems, cytopenias, requirement of modification in antimicrobial drugs were found to be related with increased mortality risk. The mortality rate of pulmonary complications was 8.9%. Pulmonary infections in the maintenance phase of the therapy were frequently treated with oral antibiotics, and they were generally rapidly taken under control. In conclusion, pulmonary complications are frequent in children with acute leukemia, and early diagnosis and appropriate management are important to avoid mortality owing to pulmonary complications, especially in neutropenic patients receiving induction or consolidation phase of chemotherapy.
A baby centrally cyanosed from birth was investigated for a congenital cardiac defect. Echocardio... more A baby centrally cyanosed from birth was investigated for a congenital cardiac defect. Echocardiography and angiography revealed patent foramen ovale without any other cardiac abnormality. Congenital methaemoglobinaemia was considered as the methaemoglobin level was 27%, suggesting either Hb M or a deficiency of the NADH-cytochrome b5 reductase (cytb5r) enzyme. Measurement of the cytb5r enzyme activity of this patient indicated a
In this report we describe a case of extensive cerebral venous thrombosis in a patient with Evans... more In this report we describe a case of extensive cerebral venous thrombosis in a patient with Evans syndrome. A 19-year-old male patient with Evans syndrome was admitted to the hospital with the complaints of headache, convulsive seizure, and vomiting. The cerebral venous thrombosis including left lateral, left sigmoid, straight sinus, and vena jugularis interna was diagnosed by cerebral magnetic resonance angiography. When the thrombosis developed, he was in hematological remission and he was not receiving any medications except lamivudine for chronic hepatitis B infection. As a genetic prothrombotic risk factor, he had heterozygous prothrombin G20210A gene mutation. His clinical and radiologic findings improved after unfractionated heparin and subsequently with coumadin therapy. On follow-up, cerebral venous thrombosis reoccurred in different localizations, but complete recanalization could be obtained with antithrombotic therapy. We present the case since the association of cerebral venous thrombosis and Evans syndrome is very rare.
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Papers by Gulersu Irken