1990-1994 yılları arasında Çukurova Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı... more 1990-1994 yılları arasında Çukurova Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalında 73 supratentoriyal astrositoma olgusu, normal beyin dokusunun toleransını aşmayan yüksek radyoterapi dozları ile tedavi edildi. Grade 1,11 astrositomalara median 66 Gy, Grade III,IV astrositomalara 68 Gy eksternal radyoterapi verildi. 13 Grade III,IV astrositoma olgusunda ise total tümör dozu 70 Gy 156 fraksiyon 138 gün hiperfraksiyone radyoterapi (2x1.25 Gy/gün) programı kullanıldı. Olguların %15'ine total rezeksiyon, % 45'ine subtotal rezeksiyon, %40'ına biyopsi yapılmıştı. E/K oranı tüm olgularda 1.4, Grade 1,11 astrositomalarda 1, Grade III,IV astrositomalarda ise 1.8 idi. Olguların %13'ü Grade I, %25'i Grade II, %20'si Grade III, %42'si Grade IV'tür. Olgular 3-76 yaş {ortalama 34, median 32+2.06 (standart sapma 17.67)} arasındaydı. Olgularımızın %28'i takipli, %60'ı ex., %12'si kayıptır. Ortalama takip süresi 76 ay (3-48), median 14±1....
The Effect Of Seizure Type, Age at Onset and Drug Protocols on Prognosis of Juvenile Myoclonic Ep... more The Effect Of Seizure Type, Age at Onset and Drug Protocols on Prognosis of Juvenile Myoclonic Epilepsy Objectives: The aim of this study is to evaulate the effect of age at seizure onset, seizure types, drugs protocols and the duration of treatment delay on prognosis in juvenile myclonic epilepsy (JME). Material and methods: The study included 32 patients (23 women, 9 men; mean age 22.2 ± 4.8 years; range 16 to 37 years) with JME according to ILAE clasification (1989). Clinical characteristics of patients including gender, age at seizure onset, seizure types, duration of delay in the initiation of therapy, treatment protocols, response to therapy, interictal electroencephalography (EEG) and magnetic resonans imaging (MRI) were reviewed. Results: The seizures started at or after 12 years of age in 75 % (n: 24) of the patients. All of our patients had multiple seizures types; 68.7 % (n: 22) of our cases had three types and 31.2 % (n:8) had two types. Thirty one percent were diagnosed as JME and placed on therapy within one year of disease onset, howewer 68.7 % (n:22) of the cases had a delay in the diagnosis and treatment by a mean of 4.5 (1-14) years. The patients were followed up for a mean of 5.4 (1-13) years. In this study we found that 37 % of patients were seizure free and 62.5 % had partially controlled seizures at the end of our follow-up. Conclusion: The prognosis was very good in patiens on monotherapy (p: 0.034), and it was better in patients with disease onset after 12 years of age. On the other hand, prognosis was very good in patiens who had two types of seizures compared to the ones with three types (p:0.001). Seizures were under control in 50 % of patients who did not have any delay in diagnosis and therapy and only in 21.8 % of patients with a delay in the initiation of therapy. ÖZET A m a ç : Bu çal›flmada Juvenil Myoklonik Epilepsili (JME) olgularda, nöbetlerin bafllama yafl›, nöbet tipi, tedaviye bafllamada gecikme ve tedavi protokolünün prognoz üzerindeki etkilerinin araflt›r›lmas› amaçlanm›flt›r. Gereç ve yöntemler: Uluslararas› epilepsi ile savafl derne¤i (ILAE)
ABSTRACT Aim: Non-small cell lung carcinoma (NSCLC) is the leading cause of cancer-related death ... more ABSTRACT Aim: Non-small cell lung carcinoma (NSCLC) is the leading cause of cancer-related death in the world. squamous cell carcinoma (SCC) of the lung is the second most frequent histologic subtype of lung carcinoma. Recently, growth factors, growth factor receptors and signal transduction system related gene amplifications and mutations have been under extensive investigation to estimate the prognosis or to develope indivilualized therapies in SCC. In this study, besides signal transduction molecule (IP3K p110a), we explored the expressions of growth factors/receptors (FGFR1, FGF2) in tumor tissue and also their clinical or prognostic significance in patients with early/advanced diseases of SCC. Methods: From 2005 to 2013, 129 patients (23 early disease, 106 advanced disease) with a histopathological SCC diagnosis were selected from hospital files of Cukurova University Medical Faculty for this study. In 99 patients with sufficient tissue samples, FGFR1, FGF2 and PI3K (p110a) expressions in both tumor and stromal tissue were evaluated with immunohistochemistry by two independent pathologists. Considering survival analysis seperately for patients with both early and advanced stage diseases, the relationship between the clinical features of patients and expressions were evaluated by univariate and multivariate analysis. Results: FGFR1 expression was found to be low in 59 (60%) patients and high in 40 (40%) patients. For FGF2; 12 (12%) patients had high, 87 (88%) patients had low expression, and for IP3K, 31 (32%) patients had high and 66 (68%) patients had low expressions In univariate analysis, survival was significantly associated with stage and performance status (PS) (p Conclusions: Thereis no effective individualized treatment for SCC yet. Therefore, for developing such a treatment in future, it is essential to identify the genetic abnormalities that are responsible for the biological behaviours and carcinogenesis of SCC. Although we could not show the prognostic and predictive significance of FGFR1, FGF2 and IP3K expressions in SCC, we determined the expression rates of FGFR1, FGF2 and IP3K as a reference for Turkish patients. However, we layed emphasis on the fact that pulmonary fibrosis, which is a late complication of radiotherapy at stage III disease, and the scar of tuberculosis could be associated with FGFR1 and FGF2 expressions. Disclosure: All authors have declared no conflicts of interest.
In this study, we aimed to evaluate the efficacy of specific immunotherapy (SIT) in children mono... more In this study, we aimed to evaluate the efficacy of specific immunotherapy (SIT) in children monosensitized to Alternaria. Sixteen children with bronchial asthma monosensitized to Alternaria were enrolled in the study. Patients were divided into two groups as the immunotherapy group (Group I; 9 patients) and control group (Group II; 7 patients). A significant reduction in bronchial responsiveness to methacholine and Alternaria was found in Group I after one year of SIT (p = 0.03, p = 0.006) in comparison to controls. Specific IgE levels were decreased in the immunotherapy group (p = 0.001). Following allergen provocation, a rise in sputum eosinophil count was found to be lower in the SIT group compared to controls after one year (p = 0.011), and sputum eosinophil cationic protein (ECP) levels did not change in the SIT group, while there was a statistically significant increase in controls. Our results demonstrated that SIT with Alternaria caused clear changes in airway responsivenes...
treatment outcome, and bacteriological resistance of M. tuberculosis isolates. Results: Of the 84... more treatment outcome, and bacteriological resistance of M. tuberculosis isolates. Results: Of the 847 cases, 620 were bacteriologically +ve (548 of 690 pulmonary TB cases and 72 of 157 nonpulmonary cases), with 267 of 548 bacteriologically +ve pulmonary TB (PTB) cases being sputum smear +ve (a further 54 being smear +ve from bronchial washing without having had microscopy of sputum performed prior to surveillance during treatment). Of the 548 cases of bacteriologically proven PTB, 436 completed treatment (422 adequate treatment, 14 irregular treatment) with cure, and there was only one treatment failure. Of the remaining 111, 38 emigrated from Qld and were properly referred to clinicians outside of Qld, while three were lost to follow up. The remaining 70 were either post mortem notifications (11) or deceased before commencing (l) or during TB treatment (58). Of the 58 dying during TB treatment, 16 died due to TB and 42 with TB.
This study was aimed to evaluate the effect of ifosfamide, cisplatin and etoposide (ICE) combined... more This study was aimed to evaluate the effect of ifosfamide, cisplatin and etoposide (ICE) combined chemotherapy in small cell lung cancer (SCLC), and to test the feasibility of adding recombinant human granulocyte colony-stimulating factor (rhG-CSF) to aggressive chemotherapy. Thirty consecutive, previously untreated, patients with SCLC (17 with limited disease and 13 with extensive disease) entered this study. The ICE regimen consisted of ifosfamide (I) 4 g/m2 i.v. with same dose mesna i.v. on first day, cisplatin (C) 25 mg/m2 i.v. on days 1 to 3 and etoposide (E) 100 mg/m2 i.v. on days 1 to 3. A total of 30 MU rhG-CSF i.v. were given from day 7 to 14 if WBC were lower than 3000 x 10(6)/L, neutrophils were lower than 1000 x 10(6)/L. Overall response (OR) rate was 93% with a complete response (CR) rate of 23%. Median survival was 12 months [95% confidence interval (CI): 11-14] and median response duration was 10 months [95% CI: 8-10]. Thirty-seven percent of patients had grade 3 neutropenia, 40% had grade 3 anemia, and 1% had grade 2 thrombocytopenia. Nonhematologic toxicity was mild with nausea and vomiting being the most common. RhG-CSF, which reduced leukopenic nadirs and shortened the neutropenic period, was also well tolerated. This chemotherapy protocol seems to be active, well tolerated and is currently being compared with various conventional chemotherapies.
The rate of intrafamilial transmission of the hepatitis C virus (HCV) was investigated in 90 fami... more The rate of intrafamilial transmission of the hepatitis C virus (HCV) was investigated in 90 family members of 41 index patients with type C chronic liver disease. Antibody to HCV (anti-HCV) was detected by the EIA method (Abbott-Axsym Sys) and Hepatitis C virus RNA, by the polymerase chain reaction (Nested PCR). We also investigated the presence of anti-HCV in 350
Bu calisma 1984-1995 yillari arasinda Cukurova Universitesi Tip Fakultesi Pediatrik Endokrinoloji... more Bu calisma 1984-1995 yillari arasinda Cukurova Universitesi Tip Fakultesi Pediatrik Endokrinoloji ve Metabolizma Poliklinigine basvurup ilk kez fenilketonuri tanisi alarak tedavisi yapilan ve izlenen 22 hastanin, klinik ve laboratuvar olarak son durumlari hakkinda bilgi edinmek, buyume ve gelismelerini, beslenme durumlarini degerlendirmek amaciyla yapildi. Hastalarin dosya kayitlarindan ve son kontrollerinden yaslari, ilk ve son kontroldeki vucut agirligi ve boy persentilleri, vucut agirligi ve boy persentil degisimleri, izlem suresi ve duzeni, diyete uyumlari, cilt ve norolojik bulgularin varligi, mental-motor gerilik derecesi degerlendirilirken, laboratuvarda EEG ve BBT bulgulari incelendi. Olgularin %50' sinde vucut agirligi persentili artarken, %31.8' inde vucut agirligi persentilinde azalma oldugu ve %18.2' sinde degisiklik olmadigi saptandi. Olgularin %45.5'inde boy persentilinde artma, %31.8'inde boy persentilinde azalma oldugu, %22.7'sinde ise degisik...
OBJECTIVE: Recently, Acinetobacter emerged as an important pathogen and the prevalence of isolati... more OBJECTIVE: Recently, Acinetobacter emerged as an important pathogen and the prevalence of isolation has increased since the last two decades worldwide. Our objective was to see the impact of acinetobacter infection in our hospital; its demographic features, speciation and antibiotic sensitivity and resistance pattern. METHODS: A study of the clinical samples submitted to the microbiology laboratory of a teaching hospital over a period of 2 years (June2001 to June 2003). Identification, speciation and antibiotyping were performed for the isolates of Acinetobacter recovered from infective samples. Clinical demographic characteristics were studied retrospectively. RESULTS: Out of a total 5352 infected samples, 258 (4.8%) were found to be due to Acinetobacter. The organism was responsible for 76 (39.64%) cases of urinary tract infection and 38 (29.45%) cases of wound infection and was most prevalent in the intensive care unit (29.84%). A. baumannii was the most predominant species. A hi...
Objective: We carried out three consecutive projects in our region over the last 15 years in orde... more Objective: We carried out three consecutive projects in our region over the last 15 years in order to assess changes in the prevalence of asthma and allergic diseases and to investigate the relationship between the allergic diseases and possible risk factors. In the last survey, we compared two different questionnaire techniques - the direct parent-reported and the doctor guided-parent reported questionnaires-in determining the risk factors for allergic diseases among school-age children. Materials and Methods: ISAAC questionnaires were given to 5150 school-age children (6-14 years) and 3470 (67.3%) of these were returned. The parents completed a simple two-page written questionnaire about asthma, allergic rhinoconjunctivitis and atopic eczema and a one-page questionnaire about the risk factors. According to the questionnaire results, we constituted an atopic group of 100 children, and 100 children with no allergic symptoms were chosen randomly as the control group. Skin prick test,...
Aim: Certain NF1 patients have short stature due to unclear pathogenesis mechanisms. The aim of t... more Aim: Certain NF1 patients have short stature due to unclear pathogenesis mechanisms. The aim of this study is to investigate endocrinology parameters which could affect height in NF1.Materials and Methods: Clinical data of 48 NF1 patients aged 19 months to 18 years were collected by reviewing medical records. Current physical examination findings including height, weight, and pubertal status were recorded. Serum samples were obtained from all subjects for follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), free T4 (FT4), free T3 insulin-like growth factor (IGF1), and insulin-like growth binding protein3 (IGFBP3) levels.Results: Of the 48 patients, 34 (70%) had height below 50 percentiles. Short stature, defined as height <-2 SD of mean for age and gender, was found in 25% of the patients. Pubertal children with short stature had significantly lower serum median IGF1 level than those with normal height. In the pre-pubertal group, serum median TSH level was significantly higher in those with short stature than those of normal height.Conclusion: Short stature in NF1 might be related to TSH in the pre-pubertal period and to IGF1 after puberty. Investigation of these hormonal pathways in correlation with height appears warranted in children with NF1.
4191 PURPOSE: Erythrocyte apheresis is an effective therapy in the acute and chronic treatment of... more 4191 PURPOSE: Erythrocyte apheresis is an effective therapy in the acute and chronic treatment of sickle cell anemia (SCA). The main goal of erythrocyte apheresis is to improve blood perfusion through reducing Hemoglobin S (HbS) to < %30 and keeping hemoglobin (Hb) at desired level. The aim of this study was to evaluate the effect of the erythrocyte apheresis on immunological parameters in SCA patients with crisis. METHODS Between February 2009 and June 2009, 37 patients (20 female / 17 male) received 44 apheresis treatments at Hemapheresis Unit of Cukurova University School of Medicine, Adana, Turkey. The median age was 22 (Range, 4-56) years and the mean body weight was 51.9±18.6 kilograms. The apheresis procedures were carried out using a Cobe Spectra Cell Separator. A mean of 1.77 body volume calculated red blood cell volumes were exchanged with a mean duration of 125.9±34.9 minutes (Table 1). Sickling negative and leukoreduced packed red cells were used for apheresis treatme...
Spinal anesthesia for caesarean delivery is often associated with hypotension. This study was con... more Spinal anesthesia for caesarean delivery is often associated with hypotension. This study was conducted to evaluate the effects of rapid crystalloid (Lactated Ringer's solution; LRS) or colloid (hydroxyethyl starch; HES) cohydration with a second intravenous access line on the incidence of hypotension and ephedrine requirement during spinal anesthesia for cesarean section. We studied 90 women with uncomplicated pregnancies undergoing elective cesarean section under spinal anesthesia. Intravenous access was established in all patients with two peripheral intravenous lines, the first being used for the baseline volume infusion. Immediately after induction of spinal anesthesia, LRS (Group L) or HES (Group C) infusions were started at the maximal possible rate via the second line in groups L and C respectively. In the third group (Group E), patients received lactated Ringer's solution at a 'keep vein open' rate to maintain the double-blind nature. The incidence of hypote...
This study aims to determine mortality risk by calculating SNAP-PE-II score, CRIB score and prede... more This study aims to determine mortality risk by calculating SNAP-PE-II score, CRIB score and predetermine the effects of antenatal corticosteroid and surfactant treatment on mortality. The multicenter study was conducted simultaneously in five different centers in four different provinces in Southern Turkey between July 2012 and July 2013. 1668 inborn subjects hospitalized in NICU within the first twelve hours of delivery, meeting with patient selection criteria were included in the study and CRIB and SNAP-PE-II were used to determine mortality. The SNAP-PE-II scoring system was applied to all patients, and the CRIB scoring system was used for 310 newborns with a gestational age of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;32 weeks and weighing &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1500 g. Of the 1668 patients, 188 died (mortality rate, 11.3%). It was demonstrated that &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;cut-off&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; value varied by various centers, which changed specificity and sensitivity of mortality scores. When we compared CRIB and SNAP-PE-II scores, we have shown that SNAP-PE-II significantly predicted mortality stronger (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). It was seen that SNAP- PE II was more predictive on deaths in the group receiving antenatal corticosteroid compared to the group not receiving. SNAP-PE -II scoring system was more predictive than CRIB scoring in determining probabilities of mortality in newborns with a birth weight less than 1500 g, and that assessment of antenatal corticosteroid use in conjunction with SNAP-PE - II predicted mortality better. This article is protected by copyright. All rights reserved.
Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2014
Objective: Postoperative pain management helps early mobilization, reduces postoperative complica... more Objective: Postoperative pain management helps early mobilization, reduces postoperative complications and decreases mortality and morbidity in lower extremity surgery. In this study, we investigated the effect of preoperative pregabalin on postoperative analgesia and opioid related side effects in lower extremity surgery. Material and Methods: After obtaining the institutional review board approval and the written informed consent, ASA I-II 60 patients (18-80 years) who underwent lower extremity surgery were included in the study. The patients were divided randomly into two groups. Group I was given oral plasebo, and Group II oral 150 mg pregabalin one hour before surgery. We performed combined spinal epidural anesthesia to both groups with 10-15 mg 0.5% levobupivacaine and 25 μg fentanyl. In the postoperative period, hemodynamic data, pain scores, sedation levels and side effects were observed and recorded. Results: The demographic characteristics, hemodynamic parameters, duration of surgery of the groups were similar. Postoperative pain scores were lower at 15th, 30th, 60th minutes in the Group II than Group I (p<0.05). The incidence of pruritus was significantly greater in the Group I (p<0.05). There was no statistically significant difference in nausea, pruritus and sedation scale of the groups. Conclusion: Preoperative 150 mg oral pregabalin improves postoperative pain scores, reduces opioid consumption and opioid related side effects.
To investigate the relationship between atopy and hepatitis A virus (HAV) and hepatitis B virus (... more To investigate the relationship between atopy and hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, we studied 42 children who had had HAV infection (Group I), 28 children who had had HBV infection (Group II), and 31 children who were seronegative for both HAV and HBV infection (Control group). Serological tests for HAV and HBV infections (anti-HAV IgG, HBsAg, anti-HBc IgG) and allergic skin tests and specific IgE investigations for the detection of atopy were carried out. In this study, there was no significant divergence in the socio-demographic characteristics among the three groups. The rates of specific IgE positivity in children in the HAV seropositive group (11.9%) and in children in the HBV seropositive group (17.8%) were lower than in the control group (35.4%) (p = 0.03 and p = 0.22, respectively). Also, the number of children with respiratory allergic diseases (allergic rhinitis and/or asthma) both in the HAV seropositive group and in the HBV seropositive gro...
Turkish Journal of Anesthesia and Reanimation, 2015
In our study, the effect of intravenous magnesium sulphate in normal and pre-eclamptic patients o... more In our study, the effect of intravenous magnesium sulphate in normal and pre-eclamptic patients on spinal anaesthesia produced by bupivacaine was investigated. Methods: Sixty-four pregnant (32 normal and 32 pre-eclamptic) were accepted in this study. Pregnants were divided into four groups as patients given intravenous magnesium sulphate and as control. Spinal anaesthesia was induced with 12.5 mg 0.5% hyperbaric bupivacaine. Intraoperative and postoperative haemodynamic variables, sensorial block periods, onset times of sensorial and motor block, maximum sensorial block levels, the time to reach maximum block level, Bromage scores, consumptions of intraoperative analgesic and ephedrine, the quality of anaesthesia, the duration of spinal anaesthesia and magnesium levels in blood and cerebrospinal fluid were measured and recorded. Results: The level of magnesium in blood and cerebrospinal fluid was significantly higher in the group given magnesium in pre-eclamptic patients (p<0.01). Onset of sensory block times were significantly longer in intravenous magnesium group than in groups 1, 2 and 3 (p<0.05). Onset of motor block times were significantly longer and the duration of anaesthesia was shorter in groups given magnesium (p<0.05). Although the quality of anaesthesia was similar, supplemental analgesic consumption was significantly higher in pre-eclamptic pregnants given magnesium sulphate than in pre-eclamptic pregnants who were not given magnesium sulphate (p<0.05). Conclusion: Intravenous magnesium sulphate treatment during the spinal anaesthesia produced by bupivacaine extended the onset of sensory and motor block times, shortened the duration of spinal anaesthesia and therefore led to early analgesic requirement.
Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. ... more Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil-midazolam (RM), and alfentanil-midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration. Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5-16 years (mean 9.20 +/- 3.00 years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure. There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.008). There were no differences between the VAS scores in group AM compared with groups R and RM (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression. Remifentanil, alfentanil, remifentanil-midazolam, and alfentanil-midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group.
1990-1994 yılları arasında Çukurova Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı... more 1990-1994 yılları arasında Çukurova Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalında 73 supratentoriyal astrositoma olgusu, normal beyin dokusunun toleransını aşmayan yüksek radyoterapi dozları ile tedavi edildi. Grade 1,11 astrositomalara median 66 Gy, Grade III,IV astrositomalara 68 Gy eksternal radyoterapi verildi. 13 Grade III,IV astrositoma olgusunda ise total tümör dozu 70 Gy 156 fraksiyon 138 gün hiperfraksiyone radyoterapi (2x1.25 Gy/gün) programı kullanıldı. Olguların %15'ine total rezeksiyon, % 45'ine subtotal rezeksiyon, %40'ına biyopsi yapılmıştı. E/K oranı tüm olgularda 1.4, Grade 1,11 astrositomalarda 1, Grade III,IV astrositomalarda ise 1.8 idi. Olguların %13'ü Grade I, %25'i Grade II, %20'si Grade III, %42'si Grade IV'tür. Olgular 3-76 yaş {ortalama 34, median 32+2.06 (standart sapma 17.67)} arasındaydı. Olgularımızın %28'i takipli, %60'ı ex., %12'si kayıptır. Ortalama takip süresi 76 ay (3-48), median 14±1....
The Effect Of Seizure Type, Age at Onset and Drug Protocols on Prognosis of Juvenile Myoclonic Ep... more The Effect Of Seizure Type, Age at Onset and Drug Protocols on Prognosis of Juvenile Myoclonic Epilepsy Objectives: The aim of this study is to evaulate the effect of age at seizure onset, seizure types, drugs protocols and the duration of treatment delay on prognosis in juvenile myclonic epilepsy (JME). Material and methods: The study included 32 patients (23 women, 9 men; mean age 22.2 ± 4.8 years; range 16 to 37 years) with JME according to ILAE clasification (1989). Clinical characteristics of patients including gender, age at seizure onset, seizure types, duration of delay in the initiation of therapy, treatment protocols, response to therapy, interictal electroencephalography (EEG) and magnetic resonans imaging (MRI) were reviewed. Results: The seizures started at or after 12 years of age in 75 % (n: 24) of the patients. All of our patients had multiple seizures types; 68.7 % (n: 22) of our cases had three types and 31.2 % (n:8) had two types. Thirty one percent were diagnosed as JME and placed on therapy within one year of disease onset, howewer 68.7 % (n:22) of the cases had a delay in the diagnosis and treatment by a mean of 4.5 (1-14) years. The patients were followed up for a mean of 5.4 (1-13) years. In this study we found that 37 % of patients were seizure free and 62.5 % had partially controlled seizures at the end of our follow-up. Conclusion: The prognosis was very good in patiens on monotherapy (p: 0.034), and it was better in patients with disease onset after 12 years of age. On the other hand, prognosis was very good in patiens who had two types of seizures compared to the ones with three types (p:0.001). Seizures were under control in 50 % of patients who did not have any delay in diagnosis and therapy and only in 21.8 % of patients with a delay in the initiation of therapy. ÖZET A m a ç : Bu çal›flmada Juvenil Myoklonik Epilepsili (JME) olgularda, nöbetlerin bafllama yafl›, nöbet tipi, tedaviye bafllamada gecikme ve tedavi protokolünün prognoz üzerindeki etkilerinin araflt›r›lmas› amaçlanm›flt›r. Gereç ve yöntemler: Uluslararas› epilepsi ile savafl derne¤i (ILAE)
ABSTRACT Aim: Non-small cell lung carcinoma (NSCLC) is the leading cause of cancer-related death ... more ABSTRACT Aim: Non-small cell lung carcinoma (NSCLC) is the leading cause of cancer-related death in the world. squamous cell carcinoma (SCC) of the lung is the second most frequent histologic subtype of lung carcinoma. Recently, growth factors, growth factor receptors and signal transduction system related gene amplifications and mutations have been under extensive investigation to estimate the prognosis or to develope indivilualized therapies in SCC. In this study, besides signal transduction molecule (IP3K p110a), we explored the expressions of growth factors/receptors (FGFR1, FGF2) in tumor tissue and also their clinical or prognostic significance in patients with early/advanced diseases of SCC. Methods: From 2005 to 2013, 129 patients (23 early disease, 106 advanced disease) with a histopathological SCC diagnosis were selected from hospital files of Cukurova University Medical Faculty for this study. In 99 patients with sufficient tissue samples, FGFR1, FGF2 and PI3K (p110a) expressions in both tumor and stromal tissue were evaluated with immunohistochemistry by two independent pathologists. Considering survival analysis seperately for patients with both early and advanced stage diseases, the relationship between the clinical features of patients and expressions were evaluated by univariate and multivariate analysis. Results: FGFR1 expression was found to be low in 59 (60%) patients and high in 40 (40%) patients. For FGF2; 12 (12%) patients had high, 87 (88%) patients had low expression, and for IP3K, 31 (32%) patients had high and 66 (68%) patients had low expressions In univariate analysis, survival was significantly associated with stage and performance status (PS) (p Conclusions: Thereis no effective individualized treatment for SCC yet. Therefore, for developing such a treatment in future, it is essential to identify the genetic abnormalities that are responsible for the biological behaviours and carcinogenesis of SCC. Although we could not show the prognostic and predictive significance of FGFR1, FGF2 and IP3K expressions in SCC, we determined the expression rates of FGFR1, FGF2 and IP3K as a reference for Turkish patients. However, we layed emphasis on the fact that pulmonary fibrosis, which is a late complication of radiotherapy at stage III disease, and the scar of tuberculosis could be associated with FGFR1 and FGF2 expressions. Disclosure: All authors have declared no conflicts of interest.
In this study, we aimed to evaluate the efficacy of specific immunotherapy (SIT) in children mono... more In this study, we aimed to evaluate the efficacy of specific immunotherapy (SIT) in children monosensitized to Alternaria. Sixteen children with bronchial asthma monosensitized to Alternaria were enrolled in the study. Patients were divided into two groups as the immunotherapy group (Group I; 9 patients) and control group (Group II; 7 patients). A significant reduction in bronchial responsiveness to methacholine and Alternaria was found in Group I after one year of SIT (p = 0.03, p = 0.006) in comparison to controls. Specific IgE levels were decreased in the immunotherapy group (p = 0.001). Following allergen provocation, a rise in sputum eosinophil count was found to be lower in the SIT group compared to controls after one year (p = 0.011), and sputum eosinophil cationic protein (ECP) levels did not change in the SIT group, while there was a statistically significant increase in controls. Our results demonstrated that SIT with Alternaria caused clear changes in airway responsivenes...
treatment outcome, and bacteriological resistance of M. tuberculosis isolates. Results: Of the 84... more treatment outcome, and bacteriological resistance of M. tuberculosis isolates. Results: Of the 847 cases, 620 were bacteriologically +ve (548 of 690 pulmonary TB cases and 72 of 157 nonpulmonary cases), with 267 of 548 bacteriologically +ve pulmonary TB (PTB) cases being sputum smear +ve (a further 54 being smear +ve from bronchial washing without having had microscopy of sputum performed prior to surveillance during treatment). Of the 548 cases of bacteriologically proven PTB, 436 completed treatment (422 adequate treatment, 14 irregular treatment) with cure, and there was only one treatment failure. Of the remaining 111, 38 emigrated from Qld and were properly referred to clinicians outside of Qld, while three were lost to follow up. The remaining 70 were either post mortem notifications (11) or deceased before commencing (l) or during TB treatment (58). Of the 58 dying during TB treatment, 16 died due to TB and 42 with TB.
This study was aimed to evaluate the effect of ifosfamide, cisplatin and etoposide (ICE) combined... more This study was aimed to evaluate the effect of ifosfamide, cisplatin and etoposide (ICE) combined chemotherapy in small cell lung cancer (SCLC), and to test the feasibility of adding recombinant human granulocyte colony-stimulating factor (rhG-CSF) to aggressive chemotherapy. Thirty consecutive, previously untreated, patients with SCLC (17 with limited disease and 13 with extensive disease) entered this study. The ICE regimen consisted of ifosfamide (I) 4 g/m2 i.v. with same dose mesna i.v. on first day, cisplatin (C) 25 mg/m2 i.v. on days 1 to 3 and etoposide (E) 100 mg/m2 i.v. on days 1 to 3. A total of 30 MU rhG-CSF i.v. were given from day 7 to 14 if WBC were lower than 3000 x 10(6)/L, neutrophils were lower than 1000 x 10(6)/L. Overall response (OR) rate was 93% with a complete response (CR) rate of 23%. Median survival was 12 months [95% confidence interval (CI): 11-14] and median response duration was 10 months [95% CI: 8-10]. Thirty-seven percent of patients had grade 3 neutropenia, 40% had grade 3 anemia, and 1% had grade 2 thrombocytopenia. Nonhematologic toxicity was mild with nausea and vomiting being the most common. RhG-CSF, which reduced leukopenic nadirs and shortened the neutropenic period, was also well tolerated. This chemotherapy protocol seems to be active, well tolerated and is currently being compared with various conventional chemotherapies.
The rate of intrafamilial transmission of the hepatitis C virus (HCV) was investigated in 90 fami... more The rate of intrafamilial transmission of the hepatitis C virus (HCV) was investigated in 90 family members of 41 index patients with type C chronic liver disease. Antibody to HCV (anti-HCV) was detected by the EIA method (Abbott-Axsym Sys) and Hepatitis C virus RNA, by the polymerase chain reaction (Nested PCR). We also investigated the presence of anti-HCV in 350
Bu calisma 1984-1995 yillari arasinda Cukurova Universitesi Tip Fakultesi Pediatrik Endokrinoloji... more Bu calisma 1984-1995 yillari arasinda Cukurova Universitesi Tip Fakultesi Pediatrik Endokrinoloji ve Metabolizma Poliklinigine basvurup ilk kez fenilketonuri tanisi alarak tedavisi yapilan ve izlenen 22 hastanin, klinik ve laboratuvar olarak son durumlari hakkinda bilgi edinmek, buyume ve gelismelerini, beslenme durumlarini degerlendirmek amaciyla yapildi. Hastalarin dosya kayitlarindan ve son kontrollerinden yaslari, ilk ve son kontroldeki vucut agirligi ve boy persentilleri, vucut agirligi ve boy persentil degisimleri, izlem suresi ve duzeni, diyete uyumlari, cilt ve norolojik bulgularin varligi, mental-motor gerilik derecesi degerlendirilirken, laboratuvarda EEG ve BBT bulgulari incelendi. Olgularin %50' sinde vucut agirligi persentili artarken, %31.8' inde vucut agirligi persentilinde azalma oldugu ve %18.2' sinde degisiklik olmadigi saptandi. Olgularin %45.5'inde boy persentilinde artma, %31.8'inde boy persentilinde azalma oldugu, %22.7'sinde ise degisik...
OBJECTIVE: Recently, Acinetobacter emerged as an important pathogen and the prevalence of isolati... more OBJECTIVE: Recently, Acinetobacter emerged as an important pathogen and the prevalence of isolation has increased since the last two decades worldwide. Our objective was to see the impact of acinetobacter infection in our hospital; its demographic features, speciation and antibiotic sensitivity and resistance pattern. METHODS: A study of the clinical samples submitted to the microbiology laboratory of a teaching hospital over a period of 2 years (June2001 to June 2003). Identification, speciation and antibiotyping were performed for the isolates of Acinetobacter recovered from infective samples. Clinical demographic characteristics were studied retrospectively. RESULTS: Out of a total 5352 infected samples, 258 (4.8%) were found to be due to Acinetobacter. The organism was responsible for 76 (39.64%) cases of urinary tract infection and 38 (29.45%) cases of wound infection and was most prevalent in the intensive care unit (29.84%). A. baumannii was the most predominant species. A hi...
Objective: We carried out three consecutive projects in our region over the last 15 years in orde... more Objective: We carried out three consecutive projects in our region over the last 15 years in order to assess changes in the prevalence of asthma and allergic diseases and to investigate the relationship between the allergic diseases and possible risk factors. In the last survey, we compared two different questionnaire techniques - the direct parent-reported and the doctor guided-parent reported questionnaires-in determining the risk factors for allergic diseases among school-age children. Materials and Methods: ISAAC questionnaires were given to 5150 school-age children (6-14 years) and 3470 (67.3%) of these were returned. The parents completed a simple two-page written questionnaire about asthma, allergic rhinoconjunctivitis and atopic eczema and a one-page questionnaire about the risk factors. According to the questionnaire results, we constituted an atopic group of 100 children, and 100 children with no allergic symptoms were chosen randomly as the control group. Skin prick test,...
Aim: Certain NF1 patients have short stature due to unclear pathogenesis mechanisms. The aim of t... more Aim: Certain NF1 patients have short stature due to unclear pathogenesis mechanisms. The aim of this study is to investigate endocrinology parameters which could affect height in NF1.Materials and Methods: Clinical data of 48 NF1 patients aged 19 months to 18 years were collected by reviewing medical records. Current physical examination findings including height, weight, and pubertal status were recorded. Serum samples were obtained from all subjects for follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), free T4 (FT4), free T3 insulin-like growth factor (IGF1), and insulin-like growth binding protein3 (IGFBP3) levels.Results: Of the 48 patients, 34 (70%) had height below 50 percentiles. Short stature, defined as height <-2 SD of mean for age and gender, was found in 25% of the patients. Pubertal children with short stature had significantly lower serum median IGF1 level than those with normal height. In the pre-pubertal group, serum median TSH level was significantly higher in those with short stature than those of normal height.Conclusion: Short stature in NF1 might be related to TSH in the pre-pubertal period and to IGF1 after puberty. Investigation of these hormonal pathways in correlation with height appears warranted in children with NF1.
4191 PURPOSE: Erythrocyte apheresis is an effective therapy in the acute and chronic treatment of... more 4191 PURPOSE: Erythrocyte apheresis is an effective therapy in the acute and chronic treatment of sickle cell anemia (SCA). The main goal of erythrocyte apheresis is to improve blood perfusion through reducing Hemoglobin S (HbS) to < %30 and keeping hemoglobin (Hb) at desired level. The aim of this study was to evaluate the effect of the erythrocyte apheresis on immunological parameters in SCA patients with crisis. METHODS Between February 2009 and June 2009, 37 patients (20 female / 17 male) received 44 apheresis treatments at Hemapheresis Unit of Cukurova University School of Medicine, Adana, Turkey. The median age was 22 (Range, 4-56) years and the mean body weight was 51.9±18.6 kilograms. The apheresis procedures were carried out using a Cobe Spectra Cell Separator. A mean of 1.77 body volume calculated red blood cell volumes were exchanged with a mean duration of 125.9±34.9 minutes (Table 1). Sickling negative and leukoreduced packed red cells were used for apheresis treatme...
Spinal anesthesia for caesarean delivery is often associated with hypotension. This study was con... more Spinal anesthesia for caesarean delivery is often associated with hypotension. This study was conducted to evaluate the effects of rapid crystalloid (Lactated Ringer's solution; LRS) or colloid (hydroxyethyl starch; HES) cohydration with a second intravenous access line on the incidence of hypotension and ephedrine requirement during spinal anesthesia for cesarean section. We studied 90 women with uncomplicated pregnancies undergoing elective cesarean section under spinal anesthesia. Intravenous access was established in all patients with two peripheral intravenous lines, the first being used for the baseline volume infusion. Immediately after induction of spinal anesthesia, LRS (Group L) or HES (Group C) infusions were started at the maximal possible rate via the second line in groups L and C respectively. In the third group (Group E), patients received lactated Ringer's solution at a 'keep vein open' rate to maintain the double-blind nature. The incidence of hypote...
This study aims to determine mortality risk by calculating SNAP-PE-II score, CRIB score and prede... more This study aims to determine mortality risk by calculating SNAP-PE-II score, CRIB score and predetermine the effects of antenatal corticosteroid and surfactant treatment on mortality. The multicenter study was conducted simultaneously in five different centers in four different provinces in Southern Turkey between July 2012 and July 2013. 1668 inborn subjects hospitalized in NICU within the first twelve hours of delivery, meeting with patient selection criteria were included in the study and CRIB and SNAP-PE-II were used to determine mortality. The SNAP-PE-II scoring system was applied to all patients, and the CRIB scoring system was used for 310 newborns with a gestational age of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;32 weeks and weighing &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1500 g. Of the 1668 patients, 188 died (mortality rate, 11.3%). It was demonstrated that &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;cut-off&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; value varied by various centers, which changed specificity and sensitivity of mortality scores. When we compared CRIB and SNAP-PE-II scores, we have shown that SNAP-PE-II significantly predicted mortality stronger (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). It was seen that SNAP- PE II was more predictive on deaths in the group receiving antenatal corticosteroid compared to the group not receiving. SNAP-PE -II scoring system was more predictive than CRIB scoring in determining probabilities of mortality in newborns with a birth weight less than 1500 g, and that assessment of antenatal corticosteroid use in conjunction with SNAP-PE - II predicted mortality better. This article is protected by copyright. All rights reserved.
Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2014
Objective: Postoperative pain management helps early mobilization, reduces postoperative complica... more Objective: Postoperative pain management helps early mobilization, reduces postoperative complications and decreases mortality and morbidity in lower extremity surgery. In this study, we investigated the effect of preoperative pregabalin on postoperative analgesia and opioid related side effects in lower extremity surgery. Material and Methods: After obtaining the institutional review board approval and the written informed consent, ASA I-II 60 patients (18-80 years) who underwent lower extremity surgery were included in the study. The patients were divided randomly into two groups. Group I was given oral plasebo, and Group II oral 150 mg pregabalin one hour before surgery. We performed combined spinal epidural anesthesia to both groups with 10-15 mg 0.5% levobupivacaine and 25 μg fentanyl. In the postoperative period, hemodynamic data, pain scores, sedation levels and side effects were observed and recorded. Results: The demographic characteristics, hemodynamic parameters, duration of surgery of the groups were similar. Postoperative pain scores were lower at 15th, 30th, 60th minutes in the Group II than Group I (p<0.05). The incidence of pruritus was significantly greater in the Group I (p<0.05). There was no statistically significant difference in nausea, pruritus and sedation scale of the groups. Conclusion: Preoperative 150 mg oral pregabalin improves postoperative pain scores, reduces opioid consumption and opioid related side effects.
To investigate the relationship between atopy and hepatitis A virus (HAV) and hepatitis B virus (... more To investigate the relationship between atopy and hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, we studied 42 children who had had HAV infection (Group I), 28 children who had had HBV infection (Group II), and 31 children who were seronegative for both HAV and HBV infection (Control group). Serological tests for HAV and HBV infections (anti-HAV IgG, HBsAg, anti-HBc IgG) and allergic skin tests and specific IgE investigations for the detection of atopy were carried out. In this study, there was no significant divergence in the socio-demographic characteristics among the three groups. The rates of specific IgE positivity in children in the HAV seropositive group (11.9%) and in children in the HBV seropositive group (17.8%) were lower than in the control group (35.4%) (p = 0.03 and p = 0.22, respectively). Also, the number of children with respiratory allergic diseases (allergic rhinitis and/or asthma) both in the HAV seropositive group and in the HBV seropositive gro...
Turkish Journal of Anesthesia and Reanimation, 2015
In our study, the effect of intravenous magnesium sulphate in normal and pre-eclamptic patients o... more In our study, the effect of intravenous magnesium sulphate in normal and pre-eclamptic patients on spinal anaesthesia produced by bupivacaine was investigated. Methods: Sixty-four pregnant (32 normal and 32 pre-eclamptic) were accepted in this study. Pregnants were divided into four groups as patients given intravenous magnesium sulphate and as control. Spinal anaesthesia was induced with 12.5 mg 0.5% hyperbaric bupivacaine. Intraoperative and postoperative haemodynamic variables, sensorial block periods, onset times of sensorial and motor block, maximum sensorial block levels, the time to reach maximum block level, Bromage scores, consumptions of intraoperative analgesic and ephedrine, the quality of anaesthesia, the duration of spinal anaesthesia and magnesium levels in blood and cerebrospinal fluid were measured and recorded. Results: The level of magnesium in blood and cerebrospinal fluid was significantly higher in the group given magnesium in pre-eclamptic patients (p<0.01). Onset of sensory block times were significantly longer in intravenous magnesium group than in groups 1, 2 and 3 (p<0.05). Onset of motor block times were significantly longer and the duration of anaesthesia was shorter in groups given magnesium (p<0.05). Although the quality of anaesthesia was similar, supplemental analgesic consumption was significantly higher in pre-eclamptic pregnants given magnesium sulphate than in pre-eclamptic pregnants who were not given magnesium sulphate (p<0.05). Conclusion: Intravenous magnesium sulphate treatment during the spinal anaesthesia produced by bupivacaine extended the onset of sensory and motor block times, shortened the duration of spinal anaesthesia and therefore led to early analgesic requirement.
Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. ... more Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil-midazolam (RM), and alfentanil-midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration. Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5-16 years (mean 9.20 +/- 3.00 years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure. There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.008). There were no differences between the VAS scores in group AM compared with groups R and RM (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression. Remifentanil, alfentanil, remifentanil-midazolam, and alfentanil-midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group.
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