GÝRÝÞ ve AMAÇ: Akciðer kanserinde geliþen sistemik tedavi seçenekleri nedeniyle yaþam süresi uzamakta ve bu nedenle beyin metastazý insidansý da giderek artýþ göstermektedir. Stereotaktik radyocerrahinin tek ve oligo (iki-dört adet) beyin metastazý tedavisinde kullanýlmaya baþlanmasý bu konuda hýzlý bir tedavi alternatifi olmasýný saðlamýþtýr. Takip ettiðimiz akciðer kanserine baðlý beyin metastazlý olgularda retrospektif olarak stereotaktik radyocerrahi tedavisi etkinliðini, stereotaktik radyocerrahi tedavisine yanýtýn difüzyon manyetik rezonans görüntüleme (MRG) ile deðerlendirmenin konvansiyonel MRG’ye ek yararýný ve klinik parametreler arasý iliþkileri deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kliniðimizde akciðer kanseri tanýsý ile takip edilen, Batý Kooperatif Onkoloji Grubu (ECOG) performans statüleri 0-1 ve 1-4 arasý beyin metastazý olan, Ocak 2016 – Aralýk 2017 tarihleri arasýnda stereotaktik radyocerrahi gören 79 olgunun verileri retrospektif olarak incelendi.
BULGULAR: Hastalarýn medyan taný yaþý 59 yýl (43-78) bulundu. Difüzyon MRG’nin tedavi yanýtýný deðerlendirmede ek yararý saptanmadý. Küçük hücreli ve küçük hücreli dýþý akciðer kanseri alt gruplarýnda istatistiksel anlamlý mortalite farký görülmemiþtir. Beyin dýþý diðer organlara metastaz varlýðý tüm sað kalým süresini azaltmýþ ve istatistiksel olarak anlamlý bulunmuþtur (p=0,042).
TARTIÞMA ve SONUÇ: Akciðer kanserine baðlý geliþen beyin metastazlý olgular genetik ve histopatolojik olarak heterojen bir hasta grubundan oluþmaktadýr. Çalýþmamýzda, sadece stereotaktik radyocerrahi uygulanan olgularda, çok deðiþkenli analiz sonucu beyin metastazý dýþý metastaz varlýðýnýn tüm sað kalým süresini olumsuz etkilediðini göstermiþtir.

INTRODUCTION: Due to new systemic treatment modalities, overall survival in lung cancer is increasing. Incidence of brain metastases in lung cancer are more common for this reason. The utilisation of stereotactic radiosurgery for one and oligo (two-four) brain metastases, has provided this treatment strategy as a promt treatment alternative. In this study we aimed to investigate the efficiency of stereotactic radiosurgery in lung cancer patients with brain metastasis, the effectiveness of adding diffusion magnetic resonance imaging (MRI) to conventional MRI for treatment evaluation and the relationship between clinical parameters retrospectively.
METHODS: Seventy-nine lung cancer patients treated between January 2016 and December 2017 in our clinic with stereotactic radiosurgery whose eastern cooperative oncology group (ECOG) performance status were 0-1 and had less than 5 brain metastases, has retrsopectively analysed.
RESULTS: The median age of patients was 59 years (43-78). Diffusion MRI has provided no more benefit for evaluation of treatment. There was no statistically significant mortality difference between subgroups of small cell and non small cell lung carcinoma. The presence of extracranial metastases has shortened the overall survival time significantly (p=0,042).
DISCUSSION AND CONCLUSION: The lung cancer patients with brain metastases have histopathological and genetic heterogenity. Multivariate analysis showed the presence of extracranial metastases had only unfavorable impact on overall survival in our study.

GÝRÝÞ ve AMAÇ: ALK pozitif akciðer kanseri tüm akciðer kanserli olgularý küçük bir bölümünü oluþturur. Özellikle son yýllarda ALK mutasyonu pozitif olgularda hedefe yönelik tedavilerin geliþtirilmesi ile saðkalým sonuçlarýnda belirgin iyileþmeler görülmektedir. Bu çalýþmada da ALK mutasyonu pozitif ve herhangi bir basamakta crizotinib uygulanmýþ akciðer kanserli olgularda klinik özelliklerin ve saðkalým sonuçlarýnýn belirlenmesi amaçlanmýþtýr.

YÖNTEM ve GEREÇLER: Ankara Atatürk Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, Týbbi onkoloji polikliniðine 2014 – 2018 yýllarý arasýnda baþvurmuþ hastalar çalýþmaya dahil edilmiþ ve verileri retrospektif olarak toplanmýþtýr.
BULGULAR: Toplam 48 hasta çalýþmaya dahil edilmiþ olup hastalarýn büyük çoðunluðu metastatik (%86,7) ve sigara içmemiþ (%68,8) hastalardan oluþmaktaydý. Birinci basamakta crizotinib kullanan hastalarda crizotinib ile elde edilen progresyonsuz saðkalým medyan 13,04 ay olarak saptandý. Daha önce bir basamak kemoterapi alan hastalarda ise crizotinib ile PS 16,88 ay olarak bulundu. Tüm grup ele alýndýðýnda metastatik olma zamanýndan itibaren genel saðkalým 37,74 ay olarak saptanmýþtýr
TARTIÞMA ve SONUÇ: ALK mutasyonu pozitif akciðer kanseri olgularýnda saðkalým süresi kemoterapi ile karþýlaþtýrýldýðýnda hedefe yönelik tedaviler ile belirgin olarak artmýþtýr. Bizim çalýþmamýzda da crizotinib ile tek merkez gerçek yaþam verileri ikinci basamak hariç literatürle uyumludur.

INTRODUCTION: Non- small cell lung cancer (NSCLC) with ALK-mutation is a small group of lung cancer. Especially last years, treatment outcomes of NSCLC with ALK-mutation are increased due to developing many new targeted therapies against ALK mutation. In this study, we aim to detect clinical feature and survival outcomes of patients who had ALK mutation positive and treated with crizotinib in any treatment line.
METHODS: The patients who followed in Ankara Atatürk Chest Disease and Chest Surgery Education and Research Hospital, Department of Medical Oncology between 2014-2018 were enrolled. The data of patients were obtained retrospectively.
RESULTS: Totally, 48 patients were enrolled to study and most of these patients were metastatic (86.7%) and non-smoker (68.8%). Median progression-free survival (PFS) of the patients who treated with crizotinib as first-line and second-line (after one-line chemotherapy) were 13.04 months and 16.88 months, respectively. Overall survival of patients who treated with crizotinib in any treatment-line was 37.74 months.
DISCUSSION AND CONCLUSION: In NSCLC with ALK-mutation, superior outcomes are obtained with crizotinib and the other tyrosine kinase inhibitors that targeted to ALK. In our study, real-life data of crizotinib was found as compatible with the previous trial except for second-line treatment

GÝRÝÞ ve AMAÇ: Multipl myelom, plazma hücrelerinin kontrolsüz proliferasyonu ile seyreden hematolojik bir malignitedir. Multipl myelom tedavisindeki çeþitli seçenekler, hastalarýn daha iyi tanýmlanmasý ve tedavilerin standardize edilmesini gerektirmektedir. Bu çalýþmada multipl myelom hastalarýnýn tedavi yanýtlarýnýn deðerlendirilmesi ve klinik bulgularla iliþkisinin araþtýrýlmasý hedeflenmiþtir.
YÖNTEM ve GEREÇLER: 2000-2011 yýllarýnda izlenmiþ olan 151 multipl myelom tanýlý hastanýn klinik ve laboratuar bulgularý ile saðkalým ve tedavi yanýtý verileri retrospektif olarak incelenmiþtir.
BULGULAR: En çok seçilen tedavi melfalan-prednizolon (%45), vinkristin-adriamisin-deksametazon (%21,3) ve vinkristin-adriamisin-deksametazon ardýndan bortezomib (%10) olmuþtur. En az 1 kez remisyon saptanan hastalarýn %22,35’inde ölüm görülmüþtür. Bu oran remisyon saðlanamayan hastalarda %77,35 olarak bulunmuþtur (p=0.000). Evre III hastalýkta daha düþük evrelere göre remisyon oraný anlamlý olarak azalmýþ (p=0.008) ve ölüm riski anlamlý olarak artmýþtýr (p=0.000). Otolog kemik iliði transplantasyonu, nüks riskini (p=0.009) ve ölüm riskini anlamlý olarak azaltmýþtýr (p=0.001). Tedavi þemalarý deðerlendirildiðinde sýrasýyla remisyon oranlarý vinkristin-adriamisin-deksametazon ardýndan bortezomib tedavisiyle %57,9, melfalan-prednizolon ile %33,3, bortezomib ile %29,2, talidomid ile %9,4, lenalidomid ile %23,8 ve vinkristin-adriamisin-deksametazon tedavisiyle %25,7 olarak bulunmuþtur. Remisyon saðlanan 101 hastanýn 23’üne düþük dozlu lenalidomid tedavisi verilmiþ ve 21 hasta otolog kemik iliði transplantasyonuna gönderilmiþtir. Nüks oraný düþük dozlu lenalidomid tedavisi uygulanan hastalarda anlamlý olarak düþük bulunmuþtur (p=0.002, OR: 12,52).
TARTIÞMA ve SONUÇ: En yüksek remisyon oranlarý vinkristin-adriamisin-deksametazon ardýndan bortezomib tedavisi ile saðlanmýþtýr. Otolog kemik iliði transplantasyonu ile daha düþük nüks ve ölüm oranlarý saptanmýþtýr. Düþük dozlu lenalidomid tedavisi uygulanan hastalarda ölüm ve nüks oraný daha düþük bulunmuþtur.

INTRODUCTION: Multiple myeloma is a hematological malignancy which is proceeding with the uncontrolled proliferation of plasma cells. Patients should be determined more definitely and treatments should be standardized to modify various treatment options in multiple myeloma. The aim of this study is to analyse the responses to treatments and the association between clinical features and treatments of multiple myeloma patients.
METHODS: The clinical and laboratuary findings with survival and treatment response data of 151 multiple myeloma patients who have been followed between 2000-2011 were analysed retrospectively.
RESULTS: The most prefered treatments were melphalan-prednisolone (45%), vincristin-adriamicin-dexamethasone (21,3%) and vincristin-adriamicin-dexamethasone followed by bortezomib (10%). Death was observed in 22,35% of the patients that remission was established at least for once. This rate was 77,35% in the patients that remission could not be established (p=0,000). Remission rate was significantly decreased (p=0.008) and death rate was significantly increased (p=0.000) in stage III disease compared with lower stages. Autologous stem cell transplantation, significantly decreased the relapse rate (p=0.009) and death risk (p=0.001). When the treatment protocols were analyzed, remission rate was 57,9% with vincristin-adriamicin-dexamethasone followed by bortezomib, 33,3% with melphalan-prednisolone, 29,2% with bortezomib, 9,4% with thalidomide, 23,8% with lenalidomide and 25,7% with vincristin-adriamicin-dexamethasone, respectively. Maintenance therapy with low dose lenalidomide was administered to 23 of 101 patients that remission was maintained. Autologous stem cell transplantation was administered to 21 patients that remission was obtained. Recurrence rate was significantly lower in patients who were received low dose lenalidomide maintenance therapy (p=0.002) (OR: 12,52).
DISCUSSION AND CONCLUSION: The highest remission rates were obtained with vincristin-adriamicin-dexamethasone followed by bortezomib. Lower recurrence and death rates were established with autologous stem cell transplantation. Recurrence and death rates were found lower in patients that received low dose lenalidomide maintenance therapy.

GÝRÝÞ ve AMAÇ: Melanom dýþý deri kanseri (MDDK) dünya çapýnda en yaygýn kanser tipidir. Bazal hücreli karsinom (BCC; basal cell carcinoma) ve skuamöz hücreli karsinom (SCC; squamous cell carcinoma) MDDK’lerinin % 99’unu oluþturur ve BCC, SCC’dan 3-5 kat sýk görülür. Burada, MDDK nedeniyle takip edilen hastalarýn demografik verileri ve tedavileri, takip sonuçlarý araþtýrýldý ve bunlar fark ve benzerlik açýsýndan daha önceki veriler ile karþýlaþtýrýldý.
YÖNTEM ve GEREÇLER: Retrospektif olarak, 2014 Ocak- 2018 Ocak tarihleri arasýnda, tek cerrah tarafýndan MDDK nedeniyle takip ve tedavisi yapýlan hastalar incelendi.
BULGULAR: Toplam 251 hasta MDDK nedeniyle tedavi ve takip edildi. Hastalarýn ortalama yaþý 69.9’du. BCC insidansý SCC’nin iki katý bulundu. En fazla tümör lokalizasyonu baþ boyun ve baþ boyun bölgesinde de en sýk lokalizasyon burundu. BCC için 0,5 cm, SCC için 1 cm saðlam cerrahi sýnýrla eksizyon yapýldý. Rekonstrüksiyon seçeneði olarak çoðunlukla lokal flepler kullanýldý (%61.18). 11 hasta opere edilemedi ve opere edilemeyen tümörlerin 4 tanesi göze invazeydi. Vakalarýn %4.43’ünde cerrahi sýnýr pozitif olarak rapor edilirken, 25,82 aylýk takipte sadece 4 hastada nüks gözlendi. 17 hastada baþka bir bölgede yeni bir MDDK gözlendi. Nüks olan hastalarýn 3’ü MDDK nedeniyle öldü.
TARTIÞMA ve SONUÇ: MDDK tanýsý fizik muayene ile çok rahat konulabilmektedir. Biyopsi her vakada gerekli deðildir. Burada, SCC oraný önceki çalýþmalardan farklý olarak beklenenden daha fazla bulundu. Tedavide rekonstrüksiyon seçeneði olarak daha çok lokal flepler tercih edildi. Cerrahi sýnýr pozitif hasta sayýsý (%4.27) ve nüks oraný (%1.31) oldukça az bulundu. Bu da, tedavide flep seçeneðinin tercih edilmesine baðlý tabandan yeterli derinlikte eksizyon yapýlmasýna ve takip süresinin 5 yýldan kýsa olmasýna baðlanabilir.

INTRODUCTION: Non-melanoma skin cancer (NMSC) is the most common type of cancer worldwide. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) constitute 99% of NMSCs, with BCC being 3–5 times more common than SCC. This study analyzed the demographic data, treatment and follow-up of patients with NMSC and compared the results with those of previous studies.
METHODS: Patients who had been followed-up and treated for NMSC by a single surgeon between January 2014 and January 2018 were evaluated retrospectively.
RESULTS: The average age of the 251 patients treated and followed for NMSC was 69.9 years. The incidence of BCC was found to be two times of the SCC. The most frequent tumor localization was the head and neck. Among the head and neck tumors, the incidence of nasal tumors was the highest. Intact surgical margin excisions of 0.5 cm for BCC and 1 cm for SCC were performed. Local flaps were the most common reconstruction option (61.18%). Eleven patients could not be operated on and four of the unoperable tumors were invased to the eye. Positive surgical margins were determined in 4.43% of the patients, but only four patients had disease recurrence during the 25.82 months of follow-up. A new NMSC developed in a different anatomic region in 17 patients. Three of the patients with recurrence died due to NMSC.
DISCUSSION AND CONCLUSION: NMSC is easily diagnosed by physical examination and biopsy is not necessary in every case. The incidence of SCC in our series was higher than reported in previous studies. Local flaps were the preferred reconstruction option. The rates of positive surgical margins (4.27%) and relapse (1.31%) were low. This result can be attributed to adequate depth of the excision from the base through the reconstruction of the defect with flap, and the relatively short (< 5 years) follow-up period.

GÝRÝÞ ve AMAÇ: Akciðer kanseri (AK) en sýk görülen malignitedir ve hala kanser ölümlerinin önde gelen nedenlerinden biridir.Bu çalýþmanýn amacý, sigara kullanýmýnýn ile tümör lokalizasyonu, prognoz ve akut yan etki üzerindeki etkisini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Ankara Atatürk Eðitim Araþtýrma Hastanesi'nde akciðer kanseri tanýsýyla 24.11.11-14.9.16 tarihleri arasýnda küratif torasik radyoterapi verilen 72 hasta retrospektif olarak deðerlendirildi. Primer sonlaným noktalarý, akut yan etki ve genel saðkalýmdýr (OS).
BULGULAR: Altmýþ beþ hasta (% 90,3) erkek, yedi (% 9,7) kadýndý. Tümör lokalizasyonu sað tarafta% 62,5, solda% 37.5 idi. Hastalarýn% 62.5'inde eþzamanlý kemoterapi uygulanmýþtý. Ortanca takip süresi 22 aydýr. Sað akciðer kanseri, KHDAK'de sigara içen hastalarda sol akciðere göre daha yüksek iken (p0,05), bu oran KHAK'de anlamlý deðildi (p0,5). Ayrýca tüm grupta yaþ arttýkça sol akciðer lokalizasyonunda bir artýþ vardý (p0,2). KHDAK'de akut yan etkiler sað akciðerde daha þiddetlidir (p <0,043). KHDAK grubunda, ARP, 50'den fazla sigara içen 5 hastanýn hepsinde geliþti ve bu oran, 50 yýldan az bir süre sigara içen hastalara göre anlamlý derecede yüksekti (p0.044). KHDAK hastalarýnda ARP sað akciðerde belirgin olarak daha fazladýr (p0,05), ancak KHAK'de anlamlý fark yoktu (p = 0,1). OS'de sað ve sol akciðer kanseri arasýnda bir anlamý farklýlýk yoktur.
TARTIÞMA ve SONUÇ: AK sað akciðerde daha sýk görülür. Benzer þekilde, akut pulmoner yan etkiler de KHDAK'de sað tarafta daha sýk gözlenmektedir. Genel saðkalýmda anatomik lokalizasyona göre anlamlý farklýlýk yoktur.

INTRODUCTION: Lung cancer (LC) is the most common malignities and still remain the leading cause of cancer deaths. The aims of this study are to assess the effect of cigarette smoking on the localization and effect of the location of tumors on the prognosis and acute adverse effects.
METHODS: 72 patients that given curative thoracic radiotherapy between 24.11.11-14.9.16 in Ankara Atatürk Educational Research Hospital with diagnosed lung cancer were evaluated, retrospectively. Patients diagnosed with LC and underwent curative radiotherapy (RT) were included. Primer endpoints are the acute adverse effect and overall survey (OS).
RESULTS: : Sixty-five patients (%90,3), were male and seven (%9,7) were female. Tumor localization was 62,5% on the right side and 37.5% on the left side. 62.5% of the patients had concurrent chemotherapy. Median follow-up is 2 years. While the right lung cancer was significantly higher in patients who smoked in NSCLC than in the left lung (p0,05), this ratio was not significant in SCLC (p0,5). There is also an increase in left lung localization with increasing age in all group (p0,2). Acute side effects in NSCLC are more severe in the right lung (p0,043). In the NSCLC group, ARP developed in all 5 patients who smoked more than 50 pct and this ratio is significantly higher than in patients who smoke less than 50 pct year (p0,044). ARP in NSCLC patients is significantly more common in the right lung (p0,05) but there was no significant difference in SCLC (p 0,1). There are no statistically difference in OS between right and left lung cancer.
DISCUSSION AND CONCLUSION: LC is often seen in the right lung. Similarly, the acute pulmonary side effects are also more frequently observed on the right side in NSLC. There are no statistically difference in OS between right and left lung cancer..

GÝRÝÞ ve AMAÇ: Bu çalýþmada adölesan dönemdeki pediatrik onkoloji hastalarýnýn ve ebeveynlerinin, hastalýk tanýsý, tedavi süreci ve alacaðý kemoterapi hakkýnda bilgilendirilmelerinin, çocuk ve ebeveynlerin kaygý düzeylerine etkisinin araþtýrýlmasý hedeflenmiþtir.
YÖNTEM ve GEREÇLER: Çalýþmaya, 2015 ile 2016 yýllarý arasýnda, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi Çocuk Hematoloji-Onkoloji Bölümü’nde yeni taný almýþ, yaþlarý 14-18 arasýnda deðiþen 55 çocuk kanser hastasý ve yaþlarý 30-50 arasýnda deðiþen 58 ebeveyn alýndý. Yatýrýlarak kemoterapi almasý planlanan çocuk ve ebeveynlere, hastalýk ve tedavi hakkýnda bilgi verildi. Hastalýk öncesi rutin hayatlarýndaki genel anksiyete düzeylerini ölçmek için STAI-II (süreklilik anksiyete), hastalýk belirtileri baþlamasýndan kanser taný ve tedavisi konusunda bilgilendirme öncesi ve sonrasý durumsal kaygý durumunu ölçmek için de STAI-I (durumlulukanksiyete) ölçekleri kullanýldý. Yapýlan bilgilendirmenin anksiyete düzeylerine etkisi araþtýrýldý.
BULGULAR: Hastalýk belirtileri baþlamadan önceki rutin hayatlarýnda STAI-II ölçeðiyle deðerlendirilen süreklilik anksiyete düzeylerinin ortancasý hastalarda 38 puan (25-67), ebeveynlerinde 45 puan (26-65) olarak saptandý.(p<0,001). Bilgilendirme öncesi durumsal kaygýyý ölçen STAI-I ortanca puanlarý hastalarda 38 (23-73), ebeveynlerde 48 puan (28-65) olarak bulundu (p: 0.001). Bilgilendirme görüþmesi yapýldýktan sonra STAI-I puanlarýnýn ortancasý hastalarda 38 puan (26-67), ebeveynlerinde 42 puandý (23-68) (p: 0,067). Bilgilendirme öncesi ve sonrasý çocuklarýn kaygý düzeyleri deðiþmezken (p=0,679), ebeveynlerin kaygý düzeylerinde bilgilendirme sonrasýnda istatistiksel olarak anlamlý bir düþüþ gözlendi (p=0,01).
TARTIÞMA ve SONUÇ: Çalýþmamýza katýlan ebeveynlerin rutin hayatlarýndaki genel kaygý düzeyleri hafif-orta düzeyde olup çocuklarýna göre daha kaygýlý olduklarý tespit edilmiþtir. Hastalýk belirtilerinin baþlamasýndan bilgilendirme görüþmesine kadar olan zaman dilimindeki durumsal kaygý düzeylerine bakýldýðýnda ebeveynlerin çocuklara göre daha kaygýlý olduklarý görülmüþtür. Bilgilendirme ebeveynlerin kaygý düzeylerini azaltmýþ, çocuklarýn kaygý düzeylerine ise etkisi olmamýþtýr.

INTRODUCTION: In this study, it was aimed to investigate the effect of providing information about the diagnosis, treatment process and chemotherapy to adolescent pediatric oncology patients and their parents on the anxiety levels of them.
METHODS: Between 2015 and 2016; fifty-five children aged between 14 and 18 years and their parents (n=55; age: 30-50 years) were included in the study. Children who were planned to receive chemotherapy and their parents were informed about the disease and treatment. STAI-II (continuity anxiety) scale was used to measure the general anxiety levels in pre-disease routine life. STAI-I (state anxiety) was used to measure the state of situational anxiety before and after information about the diagnosis and treatment of cancer. The effect of informing on anxiety levels was investigated.
RESULTS: The median of continuity anxiety levels evaluated with STAI-II scale in the routine life before the onset of the disease symptoms was 38 points (25-67) in patients and 45 points (26-65) in their parents (p <0.001). The mean STAI-I median scores were 38 (23-73) in patients and 48 (28-65) in parents (p: 0.001). After the informative interview the median of the STAI-I scores was 38 points (26-67) in the patients and 42 points in the parents (23-68) (p: 0,067). While the anxiety levels of the children before and after the informations did not change (p = 0.679), a statistically significant decrease was observed in the anxiety levels of the parents (p = 0.01).
DISCUSSION AND CONCLUSION: The general anxiety levels of the parents who participated in our study were mild to moderate in their routine lives and they were found to be more anxious than their children. When we look at the state-related anxiety levels in the period from the onset of disease symptoms to the informative interview, it was observed that parents were more anxious than children. Informing decreased the anxiety levels of the parents and had no effect on the anxiety levels of the children.

GÝRÝÞ ve AMAÇ: Akciðer skuamöz hücreli karsinomlarda (SCC) prognozu belirlemeye yönelik olarak kabul edilmiþ bir histolojik parametre bulunmamaktadýr. Ancak son yýllarda tümör tomurcuklanmasýnýn bu tümörlerin prognozu üzerinde etkili olabileceði yönünde çalýþmalar mevcuttur. Bizim bu çalýþmadaki amacýmýz da, akciðer SCC'da tümör tomurcuklanma oranýný belirlemek ve bu histolojik özelliðin prognostik faktörler ile baðlantýsýný ortaya koymaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya 2011 ile 2016 tarihleri arasýnda Baþkent Üniversitesi Patoloji Anabilim Dalýnda SCC tanýsý alan 36 akciðer rezeksiyon olgusu dahil edildi. Olgulara ait tüm Hematoksilen-eozin boyalý preparatlar deðerlendirildi. Büyük tümör adalarýndan dallanarak, komsu parankime doðru tomurcuklanan ve 5 hücreden az tümör hücresi içeren tümör adalarý tümör tomurcuklanmasý olarak deðerlendirildi ve en çok tomurcuklanma aktivitesi olan alanlar sayýlarak 1 büyük büyütme alanýndaki toplam tümör tomurcuklanma sayýsý (TTS) belirlendi.
BULGULAR: Yapýlan histomorfolojik deðerlendirmede, tüm hastalarda tümör tomurcuklanmasý saptanmýþ olup, 1 büyük büyütme alanýnda (BBA) saptanan ortalama TTS 5,36±3,27'dir. Olgularýn 13 tanesinde (%36,1) TTS 5’in altýnda, 23 tanesinde ise (%63,9) 5 ve 5’in üstündedir. TTS ile pT evresi (p=0,005), lenf nodu metastaz varlýðý (p=0,032), uzak organ metastaz geliþimi (p=0,05) ve TNM evresi (p=0,003) arasýnda istatistiksel olarak anlamlý iliþki saptanmýþtýr. Ortalama yaþam süreleri, 1 BBA'daki TTS 5’in altýnda olanlarda 49±14,6 ay iken, 5 ve 5’in üstünde olanlarda 30,1±17,7 aydýr (p=0,006).
TARTIÞMA ve SONUÇ: Çalýþma sonucunda tümör tomurcuklanmasý ile pT evresi, TNM evresi, lenf nodu metastaz varlýðý, metastaz geliþimi ve hastalarýn ortalama yaþam süreleri arasýnda anlamlý iliþki saptanmýþ olup, tümör tomurcuklanmasýnýn kötü prognoz ile iliþkili olduðu ortaya konmuþtur. Bu bulgu akciðer SCC derecelendirmede tümör tomurcuklanmasýnýn histolojik bir parametre olarak kullanýlabileceðini düþündürmektedir.

INTRODUCTION: For lung squamous cell carcinoma (SCC), there is no histological parameter that have been universally accepted as a prognostic factor. However in recent years, tumor budding (TB) has been recognized as a prognostic factor. In this study, we investigated the ratio of TB in lung SCC and its influence on prognosis.
METHODS: Our study consisted of 36 resected lung SCC, diagnosed at the Baskent University, Department of Pathology, between 2011 and 2016. All haematoxylin and eosin-stained slides were reviewed. TB was defined as small tumor nests composed of less than 5 tumour cells that are branching from big tumor islands to the adjacent paranchyma. They were counted in 1 high-power fields (HPF) in hot spot areas.
RESULTS: In histomorphological evaluation, TB was observed in all patients with the mean number of 5,36±3,27 in 1 HPF. TB was <5/1HPF in 13 cases (36.1%) and ≥5/1 HPF in 23 cases (63.9%). The significant correlation was detected between TB and pT stage (p=0.005), lymph node metastasis (p=0,032), metastasis (p=0,05) and TNM stage (p=0,003). Patients with <5 budding/1 HPF had a mean overall survival of 49±14,6 months, compared with 30,1±17,7 months for those patients whose tumors had ≥5 budding (p=0,006).
DISCUSSION AND CONCLUSION: In conclusion, the significant association was detected between TB and pT stage, TNM stage, lymph node metastasis/metastasis and overall survival. Hence, this study demonstrated that TB is an important predictor of poor prognosis in patients with SCC and it can be used as an histologic parameter in grading of lung SCC.

GÝRÝÞ ve AMAÇ: Günümüzde, etkili kemoterapötik ilaçlar ve teknolojik geliþmeler malign kemik tümörlerinin tedavisinde, hastalarýn çoðunda amputasyon yerine ekstremite koruyucu cerrahi giriþimleri mümkün kýlmýþtýr.
YÖNTEM ve GEREÇLER: Ankara Onkoloji Hastanesi Ortopedi ve Travmatoloji Kliniðinde Ocak 2003 ile Haziran 2016 tarihleri arasýnda femur proksimal primer ve metastatik kemik tümörlerinde proksimal femur tümör rezeksiyon protezi yapýlan 240 hasta çalýþmaya alýnmýþtýr.
BULGULAR: Çalýþmaya alýnan 240 hastanýn 119'u kadýn (%49.6) 121' i erkek (%50.4) hastalardan oluþmaktaydý. Hastalarýn cerrahi zamanýndaki yaþ ortalamasý 53.6 (14-82) yýldý, etkilenen ekstremite 122'sinin ( %50,6) sað, 118'i (%49,4) sol ekstremitesiydi. Hastalarýmýzýn ortalama takip süresi 29.3 ( 1-155) aydý. Hastalarýmýzýn fonksiyonel deðerlendirmesi Kas-Ýskelet Sistemi Tümörleri Derneði (MSTS: Musculoskeletal Tumour Society) skorlama sistemine göre yapýldý. Genel olarak hastalarýmýz ele alýndýðýnda tüm serilerdeki ortalama MSTS skoru % 71,3’tü. Primer kemik tümörü grubunun ortalama MSTS skoru %80,4, metastatik kemik tümörü grubunun MSTS skoru % 67,4' tür.
Femur proksimal rezeksiyon artroplatisinin en önemli komplikasyonu protez dislokasyonudur ve sonuçlarýmýz literatürle benzerdir. Baþarýlý endoprostetik reskonstrüksiyon için iyi bir yumuþak doku örtümü, kapsül onarýmý ve efektif abdüktör mekanizma onarýmý þarttýr
TARTIÞMA ve SONUÇ: Endoprotez rekonstrüksiyonlarý erken dönemde çok iyi fonksiyonel sonuç saðlama avantajlarýna sahipken, orta ve uzun dönemde özellikle genç ve aktif hastalarda mekanik komplikasyonlara yol açmaktadýr.
Ekstremite kurtarýcý cerrahi “önce hayat, sonra konforlu hayat” felsefesinden sapma göstermeden uygulandýðý taktirde yüzgüldürücü sonuçlar vermeye devam edecektir.

INTRODUCTION: Effective chemotherapeutics and technologic developement made limb salvage procedures available instead of amputation in malignant bone tumour therapy.
METHODS: 240 patients treated with the diagnosis of malign bone tumor of proximal femur with proximal femoral resection endoprothesis in Ankara Oncology Hospital between January 2003 and June 2016 are included in this retrospective study.
RESULTS: Among these 240 patients 121(50,4%) were male and 119(49,6%) were female. The mean age in the diagnosis was 53,6(14-82),the affected extremity was left in %50,6(118) and right in %49,4 (122). The mean follow up period was 29,3 months(1-155months). Fonctional evaluation was made by MSTS (Musculoskeletal Tumour Society) scoring system. The overall average MSTS score of patients discussed is %71,3. The avarage MSTS score of the primay malign bone tumors is %80,4, metastasis of the bone tumors is %67,4.
The most important complications of proximal femoral resection arthroplasty is dislocation of the prothesis, and our results are similar to the literature. For a succesful endoprosthetic surgery must have a good soft tissue reconstruction, good capsule repair and effective abductor mechanýsm repair.
DISCUSSION AND CONCLUSION: Although reconstructions by endoprostheses have early stage adventages of excellent functional results, they cause mechanical complications especially in young and active patients in mid and late stages.
Good results may be expected from limb salvage surgery if life precedes comfort in decision making.

GÝRÝÞ ve AMAÇ: Meme Radyoterapisinde tedavinin baþarýsý, hedef volümün doðru ýþýnlamasýna ve hastanýn doðru konumlandýrýlmasýna baðlýdýr. Lazer tabanlý optik yüzey takip sisteminin meme Radyoterapisinde hasta pozisyonlandýrma ve tedavinin her fraksiyonda tekrarlanabilirliði araþtýrýldý. Bu sayede hastaya portal görüntüleme amaçlý uygulanan radyasyonun azaltýlmasý da araþtýrýldý.
YÖNTEM ve GEREÇLER: Catalyst optik yüzey takip sistemi kullanýlarak 3D yüzey görüntüleme ile meme kanserli hastalarda pozisyonlandýrma yapýldý, ardýndan kV tabanlý CBCT ile taramalar yapýlarak iki sistem arasýnda hasta pozisyonunda olan sapmalar belirlendi. 26 Meme kanserli hastaya 475 fraksiyonda lazer tabanlý optik yüzey ve CBCT taramalarý yapýldý. Her bir hastanýn ayrý ayrý ve 475 fraksiyonun tamamý için, ortalama ve maksimum sapma miktarlarý lateral, longitudinal ve vertikal eksenlerde bulundu.
BULGULAR: 475 Fraksiyonda Catalyst ve CBCT deðerleri arasýndaki ortalama farklar lateral eksende; 0.24±0.22 cm, longitudinal eksende; 0.36±0.28 cm, vertikal eksende; 0.22±0.20 cm bulundu. Catalyst ile CBCT deðerleri arasýndaki maksimum farklar lateral eksende; 1.28 cm, longitudinal eksende; 1.54 cm, vertikal eksende; 1.30 cm bulundu. Eðer 26 hasta için sadece Catalyst yüzey takip sistemi kullanýlmýþ olsaydý, klinik hedef volüme 5 mm emniyet marjý verilirse lateral eksende %89.05, longitudinal eksende %74.52 ve vertikal eksende %90.52 güven aralýðý içinde tedavi uygulanabilmektedir.
TARTIÞMA ve SONUÇ: Meme Radyoterapisinde tedavinin tekrarlanabilirliði ve hasta konumlandýrmasýnýn kesin hassasiyetle olmasý büyük öneme sahiptir. Optik yüzey takip sistemi hasta setup’ý için basit, hýzlý, tekrarlanabilir ve doðru bir çözümdür. Rastgele günlük setup hatalarýný en aza indirmek ve hastaya tedavi harici portal görüntüleme amaçlý uygulanan radyasyonu azaltmak için etkin kullanýlabilmektedir. Hasta tedaviye baþladýðý ilk birkaç fraksiyon CBCT ve optik yüzey takip sistemi eþ zamanlý kullanýlmalý aradaki farklarýn az olmasý durumunda, hastanýn tedavisinin tamamý göz önüne alýnarak CBCT sayýsý azaltýlýp optik yüzey takip sistemi kullanýlmalýdýr.

INTRODUCTION: The success of treatment in breast radiotherapy depends on the correct irradiation of the target volume and correct positioning of patient. Patient positioning and repeatability of treatment at each fraction were investigated. In this way, the reduction of radiation implemented to the patient for portal imaging was also investigated.
METHODS: Positioning in breast cancer patients with 3D surface imaging was performed using the Catalyst optical surface guide system. Then, scans with kV-based CBCT were used to determine deviations in the patient position between the two systems. The laser-based optical surface and CBCT scans were performed in 475 fractions.
RESULTS: The mean and maximum deviation amounts for each patient and all of the 475 fractions were obtained in lateral, longitudinal and vertical axes. The mean differences between Catalyst and CBCT values in the 475 fraction were 0.24±0.22cm in the lateral axis, 0.36±0.28cm in the longitudinal axis and 0.22±0.20cm in the vertical axis. The maximum differences between Catalyst and CBCT values were obtained 1.28cm in lateral axis, 1.54cm in longitudinal axis and 1.30cm in vertical axis. If only the Catalyst was used for 26 patients, a margin of 5mm was implemented to clinical target volume, treatment could be performed in lateral axis at 89.05%, in longitudinal axis 74.52% and in vertical axis at 90.52% confidence interval.
DISCUSSION AND CONCLUSION: Reproducibility of the treatment and accurate positioning of the patient are very important in breast radiotherapy. Catalyst system is a simple, fast, repeatable and accurate solution for patient setup. It can be used effectively to minimize random daily setup errors and reduce radiation implemented to the patient for external portal imaging. CBCT and Catalyst should be used simultaneously in the first few fractions. If the deviations between the two systems are low, the number of CBCT should be reduced, taking into account the full treatment of the patient.

GÝRÝÞ ve AMAÇ: Ýnverted papillom (ÝP), sinonazal bölgenin en sýk epitelyal tümörüdür. Nükse yatkýnlýk ve malignite ile iliþkili olmasý açýsýndan önemlidir. Yassý hücreli karsinom (YHK) odaklarýnýn görülme sýklýðý %5-15 arasýndadýr. Genellikle 5-6. dekatta ve erkeklerde 2 kat daha sýk görülür. En sýk lateral nazal duvardan, ikinci sýklýkta maksiller sinüsten köken alýr. En sýk tek taraflý burun týkanýklýðý ile bulgu verir. Tedavisi total/geniþ cerrahi rezeksiyondur.
YÖNTEM ve GEREÇLER: Sinonazal ÝP tanýsýyla 2007-2017 yýllarý arasýnda bir üçüncü basamak saðlýk merkezinde cerrahi yapýlan hastalar çalýþmaya dahil edildi. Hastalar demografik özellikler, belirti ve (klinik ve radyolojik) bulgular, cerrahi, patolojik özellikleri, cerrahi sonrasý komplikasyonlar ve uzun dönem takip sonuçlarý yönünden deðerlendirildi.
BULGULAR: Hastalarýn 12’si erkek (%86), ortanca yaþ 56 (yaþ aralýðý: 36-79) idi. Patolojik incelemede genel olarak HPV (-) olmakla birlikte, 4 sinonazal ÝP hastasýnda YHK, insitu YHK odaðý veya takipte YHK geliþimi (%29) gözlendi.
TARTIÞMA ve SONUÇ: ÝP, benign bir neoplazi olmasýna raðmen malign içerik ve/veya transformasyon açýsýndan önem arz eden bir hastalýktýr. Sonuç olarak, bu durum hastalarýn yakýn takibini gerektirir.

INTRODUCTION: Inverted papilloma (IP) is the most common epithelial tumor of the sinonasal region. It is crucial for predisposition to the recurrence and malignancy. The incidence of squamous cell carcinoma (SCC) foci is between 5% and 15%. It is usually seen in 5-6th decade and 2 times more frequent in males. It commonly originates from the lateral nasal wall, and secondly from the maxillary sinus. The most common finding is the unilateral nasal obstruction. The treatment is total/wide surgical resection.
METHODS: The patients who underwent surgery with the diagnosis of sinonasal IP between 2007-2017 in a tertiary referral center were included in the study. The patients were evaluated in terms of demographic features, signs and symptoms (clinical and radiological), surgical, pathological features, postoperative complications, and long-term follow-up results.
RESULTS: Twelve of the patients were male (86%), the median age was 56 years (range: 36-79 years). Pathological examination was generally HPV (-), and 4 patients with sinonasal IP (%29) had SCC, in-situ SCC focus, or SCC transformation in the follow-up period.
DISCUSSION AND CONCLUSION: Although inverted papilloma is a benign neoplasm, it is an important disease for malignant content and/or transformation. Consequently, the close follow-up is required for these patients.

GÝRÝÞ ve AMAÇ: Hastanemiz Ortopedi ve Travmatoloji Kliniðinde Ocak 2002-Ocak 2015tarihleri arasýnda osteosarkom tanýsý almýþ ve cerrahi tedavisi uygulanmýþ olan 122 hastanýn retrospektif analizi amaçlandý.
YÖNTEM ve GEREÇLER: 81'i erkek(%66.3), 41'i kadýn(%33.7), toplam 122 hasta çalýþmaya dahil edildi.Hastalara iliþkin tüm veriler retrospektif olarak eksiksiz þekilde deðerlendirildi. Hastalarýn %95.9'u opere edildi. Bu hastalardan %72.7’sinde ekstremite koruyucu cerrahi, %27.3'ünde amputasyon uygulandý.
BULGULAR: Ortalama yaþ 23.9 (7-82 yaþ arasý) idi. Hastalarýn %50'si 11-20 yaþ arasý genç gruptu, %66,3 diz çevresi (%50,8i femur distal ve %15.5'i tibia proksimal) yerleþimliydi.Taný anýnda vakalarýn %59 unun Enneking Evre 2B olduðu görüldü. En sýk tümör tipi konvansiyonel osteosarkomdu.
TARTIÞMA ve SONUÇ: Hastanemizde taný almýþ osteosarkom vakalarý incelendiðinde, tümör daðýlýmý ve özelliklerinin dünya literatürü ve türkiyedeki diðer lokal hastane verilerine benzer þekilde olduðu saptanmýþtýr.

INTRODUCTION: It is aimed that a retrospective analysis of 122 patients who were diagnosed with osteosarcoma and underwent surgical treatment between January 2002 and January 2015 at the Orthopedics and Traumatology Clinic of our Hospital.
METHODS: A total of 122 patients (81 males, 41 females) were included in the study. All data were retrospectively and completely evaluated. 95.9% of the patients were operated. 72.7% of these patients, had limb sparing surgery and 27.3% had amputation.
RESULTS: The mean age was 23.9 years (range 7-82 years). 50% of the patients were between 11 and 20 years of age and 66.3% of them were located in the knee (50.8% distal femur and 15.5% proximal tibia). At the time of diagnosis, 59% of cases were found to be Enneking Stage 2B. The most common tumor type was conventional osteosarcoma.
DISCUSSION AND CONCLUSION: When we examined the cases of osteosarcoma which diagnosed in our hospital, the distribution and features of tumor was similar to other cases that is in other hospitalsin our country and the world literature.

GÝRÝÞ ve AMAÇ: Ultrasonografi (USG), visseral organlarý, çok yönlü kullaným olanaklarý ile gerçek zamanlý deðerlendirilmesini saðlayan bir görüntüleme tekniðidir. Teþhis ve tedavi katkýlarýnýn yaný sýra, hasta takibinde çok önemlidir ve ayrýca intraoperatif kullaným için fýrsat verir. Bu çalýþma, uzman eðitim programýna dahil edilmesi gereken USG eðitimi modelini tartýþmayý ve asistan doktorlara uygulanan sýnavýn etkinliðini deðerlendirmeyi ve tiroid nodülü, safra taþý ve intraabdominal serbest sývýsý olan hastalarda öðrenme eðrisini deðerlendirmeyi amaçlamaktadýr..
YÖNTEM ve GEREÇLER: Etik kurul onayladýktan sonra, klinik eðitimin bir parçasý olarak radyolog tarafýndan pratik, teorik ve USG' nin hasta baþý kullaným eðitimi verildi.Teorik eðitimden sonra, radyoloðun himayesinde farklý kýdem yýllarýndan seçilen dört cerrahi asistan hasta baþýnda pratik eðitim uygulandý. Ýki aþamalý bir sýnav sistemi belirlendi ve cerrahi asistanlarýnýn deðerlendirilmeleri radyolog tarafýndan yapýldý. Sýnav sonuçlarý istatistiksel olarak deðerlendirildi ve istatistiksel anlamlýlýk düzeyi p <0,05 olarak kabul edildi.
BULGULAR: Tiroid nodülleri için iki test sonucunun istatistiksel olarak anlamlý olduðu onaylandý (p: 0.0560). Ýntraabdominal serbest sývýnýn deðerlendirilmesinin sonuçlarý, baþka bir test yapýlmasýna gerek kalmadan baþarýlý olarak kabul edildi. Safra kesesi taþý için iki test sonucunun istatistiksel olarak hiçbir farký olmadýðý onaylandý (p: 0.5316).
TARTIÞMA ve SONUÇ: USG eðitimi ülkemizde genel cerrahi eðitimi sýrasýnda kýsýtlý merkezin eðitiminin parçasý olabilmektedir. USG eðitiminde kazanýlan deneyimin ve genel cerrahi asistanlarýnýn öðrenme eðrilerinin deðerlendirilmesi ve literatüre sunulmasý faydalý olacaktýr. Eðitim tekniðine dair tartýþmalar baþka merkezlerin bu eðitimi planlayabilmesi için yol gösterici olacaktýr.

INTRODUCTION: Ultrasonography (USG) is an imaging technique that enables real-time evaluation of visceral organs via versatile utilization possibilities. Besides diagnosis and treatment contributions, it is crucial in patient follow-up and it also gives an opportunity of intraoperative usage. This study aims to discuss a model of USG training which should be included in the specialist training program and to evaluate the effectiveness of the examination applied to resident doctors and to evaluate the learning curve on patients with thyroid nodule, bile stone stone and intraabdominal free fluid.
METHODS: After the ethics committee approving, practical, theoretical training and per-patient usage of USG was given by the radiologist as a part of the clinical training. After the training, four surgical assistants selected from different years of residenties were practiced on a patient basis, under possesion of the radiologist. A two-stage examination system was determined and the evaluations of the surgical residents were made by the radiologist and the deficiencies were determined specially for the residents. Statistical significance was considered as the level of p<0.05.
RESULTS: The two test results for thyroid nodules were approved to have made significant progress (p: 0.0560). The results of evaluating the intraabdominal free fluid were regarded as successful without any further testing. The two test results for for gallbladder stone were approved to have no statistically difference (p: 0.5316).
DISCUSSION AND CONCLUSION: USG training might be a part of general surgery resident training program only a few center in our country. The experience gained in USG training and the evaluation of the learning curves of general surgery residents and the presentation of the literature to them will be helpful. Discussions on training techniques will guide other centers to plan this training.

GÝRÝÞ ve AMAÇ: Ýlerleyen yaþla birlikte günlük ihtiyaçlarý karþýlama becerisi azalmaktadýr. Kanser tanýsý ile izlenen yaþlý hastalarýn, gerek hastalýk gerekse uygulanan tedavilerin sonucu olarak günlük yaþam aktiviteleri etkilenmektedir. Çalýþmada, geriatrik kanser hastalarýnýn günlük yaþam aktivitelerini etkileyen faktörlerin deðerlendirilmesi amaçlanmýþtýr.

YÖNTEM ve GEREÇLER: Çalýþmada, Týbbi Onkoloji poliklinikte takip edilen, 65 yaþ ve üzeri hastalar yüz yüze görüþme yöntemi ile deðerlendirildi. Demografik ve hastalýk özellikleri yaný sýra Lawton-Brody enstrümantal günlük yaþam aktivite (EGYA) ölçeðini içeren bir anket uygulandý.


BULGULAR: Çalýþmada, 65 yaþ ve üzeri 129 hasta deðerlendirildi. EGYA skorlarýnýn deðerlendirilmesinde; 75 yaþ altýnda olanlarda, çocuðu olmayanlarda, ilkokul ve üzeri eðitim seviyesine sahip olanlarda EGYA skorlarý daha yüksek saptandý; Çok deðiþkenli analizde; eðitim seviyesi düþük olmasý, düþük EGYA skorlarý ile iliþkili bulundu. (OR: 5.4(%95 GA 1.1-26.2), p= 0.035)

TARTIÞMA ve SONUÇ: Günlük yaþam aktivitelerinin deðerlendirilmesi hastanýn palyatif bakým veya rehabilitasyon ihtiyacýnýn deðerlendirilmesinde ve kognitif/fiziksel iþlevselliðin incelenmesinde kolay ve hýzlý bir deðerlendirme aracýdýr. Özellikle düþük eðitim seviyesine sahip geriatrik kanser hastalar GYA ölçeði ile deðerlendirilip, risk altýnda olanlar çok yönlü geriatrik deðerlendirme yöntemleri ile incelenmelidir.

INTRODUCTION: The ability to meet daily needs decreases with advancing age. As a result of both the disease and the treatments applied to the elderly patients who are followed up with the diagnosis of cancer, daily living activities are affected. The aim of this study was to evaluate the factors affecting activities of daily living in geriatric cancer patients.

METHODS: In this study, patients aged 65 years and older who were followed up in the Medical Oncology outpatient clinic were evaluated. In addition to demographic and disease characteristics, a questionnaire including Lawton–Brody Instrumental Activities of Daily Living Scale (IADL) was applied.

RESULTS: 129 patients aged 65 years and older were evaluated in the study. When the IADL scores were evaluated; it was found that IADL scores were higher in those under 75 years, those who do not have any children, and those with an education equal to or greater than primary school level. In multivariate analysis; low education level was associated with low IADL scores (OR: 5.4(%95 CI 1.1-26.2), p= 0.035).

DISCUSSION AND CONCLUSION: Evaluation of IADL is precious for determining the palliation or rehabilitation needs and cognitive/ physical functionality. Especially patients with low education level should be evaluated with IADL and patient under risk should be further evaluated with multidimensional geriatric assessment tools.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý kalvaryum yerleþimli Langerhans hücreli histiyositozlarýn (LHH) epidemiyolojisi, klinik-radyolojik özellikleri, ayýrýcý tanýsý, histopatolojik karakteristikleri, tedavi stratejilerindeki kilit noktalarý ve takip sonuçlarýný 29 hastalýk bir klinik seriden elde edilen deneyimler ýþýðýnda analiz etmek ve tartýþmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya 2001-2018 yýllarý arasýnda, kafatasý yerleþimli soliter veya multiple LHH nedeniyle kliniðimizde ameliyat edilen tüm hastalar dahil edildi. Hasta epikrizleri, radyolojik görüntüleri, ameliyat notlarý, patoloji sonuçlarý ve takip verileri retrospektif olarak incelendi. Yaþ, cinsiyet, lezyonun yeri ve büyüklüðü, görüntüleme özellikleri, cerrahi rezeksiyonun derecesi, histopatolojik özellikler, adjuvan tedavi, nüks, reoperasyon ve takip sonuçlarýný içeren veriler toplandý.
BULGULAR: Toplam 29 hasta (15 erkek, 14 kýz) tespit edildi. Hastalarýn biri dýþýnda tamamý (%97) çocukluk yaþ grubundaydý. Hastalarýn taný anýndaki yaþ ortalamasý 8,4±7,7 yýldý (ortanca yaþ 8 yýl; aralýk 1-38 yýl). Hastalarýn büyük çoðunluðu cilt altý þiþlik / ele gelen kitle þikayeti ile baþvurdu. Toplam 5 hastada multipl kalvaryal ve/veya diðer organ tutulumlarý tespit edildi. En sýk yerleþim yeri parietal kemik idi. Multiple lezyonlarý olan 3 hastada sadece biyopsi yapýlýrken diðer tüm hastalarda tek veya primer lezyonun total eksizyonu saðlandý. Multipl lezyonlarý ve ek organ tutulumlarý olan olgulara kemoterapi uygulandý. Hastalarýn çoðunda olguda remisyon saðlanýrken, takipte 2 hastada rezidü progresyonu tespit edildi.
TARTIÞMA ve SONUÇ: Benign ve nadir bir kafatasý lezyonu olan LHH olgularýnda cerrahi total eksizyon tek baþýna en etkili ve baþarýlý tedavi yöntemidir. LHH þüphesi olan tüm hastalarda ayýrýcý taný iyi yapýlmalý ve ekstrakalvarial lezyon bakýmýndan tüm vücut taranmalýdýr. Cerrahi olarak total eksizyonun mümkün olmadýðý multipl ve/veya kafa kaidesi yerleþimli olgular ile nüks izlenen olgularda kemoterapötik ajanlar kullanýlabilir.

INTRODUCTION: In this study, our aim was to analyse and discuss epidemiology, clinical and radiologic features, differential diagnosis, histopathologic characteristics, key elements of treatment strategies and follow-up results of Langerhans cell histiocytosis (LCH) in a 29-patient clinical series.
METHODS: All the patients who had been operated for multiple or solitary calvarial LCH between 2001-2018 in our clinic were included in our study. Patient discharge notes, radiologic workup, operation records, patholoy reports and follow-up data were retrospectively evaluated. Age, sex, location and size of the lesion; radiologic features, extent of resection, histopathologic features; adjuvant treatment, recurrence, reoperation and follow-up data were collected.
RESULTS: In total 29 patients (15 male, 14 female) were evaluated. Except one, all patients (97%) were under 18 years of age. Patients’ mean age at the time of diagnosis was 8.4±7.7 years (median 8; range 1-38). Most of the patients admitted with subdermal/palpable mass. In 5 patients there were multiple calvarial and/or other organ involvement. The most common location was parietal bone. In 3 patients with multiple lesions, only biopsy was performed; other patients undergone total extirpation of the primary/solitary lesion. Patients with multiple lesions and other organ involvement had chemotherapy. Most of the patients had a remission whereas two patients developed progression of residue in the follow-up period.
DISCUSSION AND CONCLUSION: Langerhans cell histiocytosis is a benign and rare calvarial lesion, in which total surgical excision is an effective and succesful treatmet. A thorough evaluation of a patient with suspected LCH is needed for differential diagnosis and in order to identify extracalvarial lesions. In cases where total excision is not possible and for patients with multiple and/or skull base involvement chemotherapeutics may be used.

GÝRÝÞ ve AMAÇ: Kolonoskopi, kolorektal hastalýklarýn tarama, taný ve tedavisinde en önemli yöntemdir. Çalýþmamýzda iatrojenik kolon perforasyonunda erken müdahalenin önemine dikkat çekmek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: 2014-2018 yýllarý arasýnda hastanemizde yapýlan 9,840 kolonoskopi iþlemi retrospektif olarak taranmýþtýr.
BULGULAR: Yapýlan 9,840 kolonoskopi sonrasýnda toplamda 5 hastada iatrojenik perforasyon olduðu görülmüþtür. Dört hastada perforasyonun iþlem esnasýnda farkedildiði ve hemen iþlem sonrasýnda müdahale edilerek laparoskopik stapler ile onarým yapýldýðý görülmüþtür. Bir hastanýn ise kolonoskopi sonrasý birinci günde farkedildiði ve Hartman prosedürü uygulandýðý görülmüþtür.
TARTIÞMA ve SONUÇ: Kolonoskopi güvenli bir iþlem olarak tanýmlansa da nadiren komplikasyonlar görülmektedir. Kolonoskopi sonrasýnda görülen en morbid komplikasyon perforasyondur. Literatürde perforasyon oraný %0,005 ile %0,63 arasýnda gösterilmektedir. Çalýþmamýzda literatür ile uyumlu þekilde perforasyon oraný %0,051 olarak tespit edilmiþtir. Perforasyonun erken dönemde tanýnmasý ve müdahale edilmesi hasta morbiditesi açýsýndan çok önemlidir. Erken dönemde taný konmasý durumunda endoskopik onarým, laparoskopik primer onarým gibi morbiditesi daha düþük onarýmlar yapýlabilmektedir. Tanýnýn gecikmesi durumunda ise batýnýn kontamine olmasý nedeniyle Hartman prosedürü gibi daha morbid müdahalelerin yapýlmasý gerekmektedir. Ýatrojenik perforasyon sonrasýnda tedavi yöntemi seçimi; hasta özellikleri, perforasyonun lokalizasyonu, boyutu ve perforasyon sonrasý geçen süreye göre vaka bazlý yapýlmalýdýr.

INTRODUCTION: Colonoscopy is the most important method in the screening, diagnosis and treatment of colorectal diseases. In our study, it was aimed to emphasize the importance of early intervention in iatrogenic colon perforation.
METHODS: 9,840 colonoscopy procedures performed in our hospital between 2014-2018 were retrospectively reviewed.
RESULTS: After 9,840 colonoscopy, total iatrogenic perforation was observed in 5 patients.
In four patients, perforation was noticed during the procedure and immediately after the procedure was performed and repair was performed with laparoscopic stapler. One patient was noticed on the first day after colonoscopy and Hartman procedure was performed.

DISCUSSION AND CONCLUSION: Although colonoscopy is defined as a safe procedure, complications are rarely seen. The most morbid complication after colonoscopy is perforation. The perforation rate in the literature is between 0.005% and 0.63%. In our study, perforation rate was determined as 0,051% in accordance with the literature. Early recognition and intervention of perforation is very important for patient morbidity. In case of early diagnosis, endoscopic repair and laparoscopic primary repair can be performed with lower morbidity. In case of delayed diagnosis, more morbid interventions such as Hartman procedure should be performed because of the contaminated abdomen. Selection of treatment method after iatrogenic perforation; patient characteristics should be based on the location of the perforation, size and time after perforation.

GÝRÝÞ ve AMAÇ: Bu çalýþmada; meme kanseri vakalarýnýn çoðunluðunu oluþturan, lenf nodu tutulumu olmayan hastalarda, meme koruyucu cerrahi sonrasý tüm meme radyoterapisi için en uygun tekniðin araþtýrýlmasý amaçlanmýþtýr. Yaygýn kullanýlan üç boyutlu konformal radyoterapi (3DKRT), uygun maliyetli kabul edilen statik Yoðunluk Ayarlý Radyoterapi (sYART) ve yeni kullanýma giren Volümetrik Ayarlý Ark Terapi (VMAT) dozimetrik olarak karþýlaþtýrýldý.
YÖNTEM ve GEREÇLER: Çalýþmada sIMRT ile tedavi almýþ 16 sað ve 19 sol meme kanseri tanýlý hastanýn bilgisayarlý tomografi(BT) simülasyon kesitleri kullanýldý. Tüm planlamalar Eclipse 10,0 sistemi ile yapýldý. Uygulanan doz total 50Gy/25fraksiyonda, konvansiyonel þema olarak belirlendi. Teknikler hedef volüm ve kritik organ (ipsilateral akciðer, kalp, kontrlateral meme ve kontrlateral akciðer) dozlarý açýsýndan karþýlaþtýrýldý.
BULGULAR: Üç teknik de Hedef Sarýmý(TC) baþarýyla saðlamýþtýr. sYART, 3DKRT’e göre Planlanan Hedef Volüm (PTV) maksimum dozunu (Dmax) düþürmektedir. En iyi PTV doz homojenitesi VMAT ile saðlanmýþtýr. sYART tüm kritik organ dozlarýnda 3DKRT’ye göre düþüþ saðlamaktadýr ve bu düþüþ ipsilateral akciðer ortalama dozu(Dmean), Dmax, 40Gy ve üstü doz alan volüm(V40); kontrlateral meme Dmax ve V5 için istatistiksel olarak anlamlý bulunmuþtur. VMAT diðer iki yönteme göre ipsilateral akciðer Dmax, V20, V30, V40 ve sol meme kanseri hastalarýnda kalp Dmax ve V35’i düþürmüþtür; fakat ipsilateral akciðer Dmean, V5, V10; kontrlateral akciðer ve meme Dmean, Dmax, V5; sað meme ca hastalarýnda kalp Dmax, Dmean, V5, V10; sol meme kanseri hastalarýnda kalp Dmean, V5, V10’u anlamlý yükseltmiþtir.
TARTIÞMA ve SONUÇ: Ýntakt meme radyoterapisi için 3DKRT yerine sYART daha iyi dozimetri saðlamaktadýr, bu sebeple mümkün oldukça tercih edilmelidir. VMAT ile daha homojen doz daðýlýmlarý saðlanýr. Ayrýca VMAT ile ipsilateral kritik organ yüksek dozlarý düþerken, ipsilateral ve kontrlateral kritik organ düþük dozlarý anlamlý artýþ göstermektedir. Bu durumun sonuçlarý uzun takipli klinik çalýþmalar ile incelenmelidir.

INTRODUCTION: The present study aimed to determine the most suitable technique for whole breast radiotherapy after breast conserving surgery in patients without lymph node involvement; those that constitute the majority of breast cancer cases. Three-dimensional conformal radiotherapy (3DCRT), that is widely used, forward planned intensity-modulated radiotherapy (forIMRT), that is accepted to be cost-effective, and volumetric modulated arc therapy (VMAT), that has become available recently, were dosimetrically compared.
METHODS: Computed tomography simulation cross-sections of 16 patients with right breast cancer and 19 patients with left breast cancer, who had been treated with forIMRT, were used in the study. All planning was done using Eclipse 10.0 treatment planning system. A conventional scheme consisting of a total dose of 50Gy given in 25 fractions was used. The techniques were compared in terms of target volume and critical organ (ipsilateral lung, heart, contralateral breast and contralateral lung) doses.
RESULTS: We successfully achieved target coverage (TC) by all three techniques. Forward IMRT led to a higher decrease in planned target volume (PTV) maximum dose (Dmax), in comparison to 3DCRT. The best PTV dose homogeneity was achieved with VMAT. forIMRT resulted in higher reductions in all critical organ doses when compared to 3DCRT, and the decrease was significantly higher in the ipsilateral lung mean dose (Dmean) and Dmax and the volume of ipsilateral lung receiving ≥40Gy (V40), and contralateral breast Dmax and V5. Compared to the other two methods, VMAT led to a greater decrease in Dmax, V20, V30 and V40 of the ipsilateral lung and Dmax and V35 of the heart in left breast cancer patients; but led to a significant increase in Dmean, V5 and V10 of the ipsilateral lung; Dmean, Dmax, and V5 of the contralateral lung and breast, and Dmax, Dmean, V5 and V10 of the heart in right breast cancer patients; and Dmean, V5, and V10 of the heart in left breast cancer patients.
DISCUSSION AND CONCLUSION: forIMRT provides a better dosimetry than 3DCRT for intact breast radiotherapy; therefore, it should be preferred, whenever possible. More homogeneous dose distributions are achieved with VMAT. Additionally, while ipsilateral critical organ high doses decrease by VMAT, ipsilateral and contralateral critical organ low doses show a significant increase. The outcomes of this condition should be studied in clinical studies with long-term follow-up.

GÝRÝÞ ve AMAÇ: Anastomoz kaçaðý aþaðý anterior rezeksiyon sonrasý en ciddi komplikasyondur ve morbidite -mortalite oranlarýný ve hastane kalýþ süresini uzatýr. Bu çalýþmada hastanemiz serisinde saptýrýcý ostomilerin kolorektal anastomozlarda etkinlik ve güvenliðinin retrospektif olarak karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Hastanemizde 2005-2010 yýllarý arasýnda rektum adenokanseri tanýsýyla elektif olarak opere edilerek ekstraperitoneal kolorektal veya koloanal anastomoz yapýlýp saptýrýcý ostomi açýlmýþ tüm hastalarýn dosyalarý geriye dönük olarak incelendi.
BULGULAR: Çalýþmaya toplam 101 hasta alýnmýþtýr. Hastalarýn 29'una (%28.7) neoadjuvan kemoradyoterapi (NAKRT) uygulanmýþtý. Çalýþma grubundaki hastalarýn 33'üne (%32.7) saptýrýcý ostomi uygulanmýþtý. Bu hastalarýn 31'ine (%93,9) ileostomi, ikisine ise kolostomi uygulanmýþtý. NAKRT uygulanmýþ 29 hastanýn 14'üne (%48.2) saptýrýcý ostomi açýldýðý ve bunun da istatiksel olarak anlamlý olarak yüksek olduðu saptandý (p=0.03). BMI <25 olan hastalardan sadece ikisine saptýrýcý ostomi açýlýrken; BMI ≥25 olanlarýn 31’ine saptýrýcý ostomi açýlmýþtý ve aradaki bu fark istatiksel olarak anlamlý bulundu (p=0.0001). Cerrahi alan enfeksiyonu 24 hastada (%23.8) saptanan en sýk komplikasyondu. Stoma açýlan 33 hastanýn 23'ünde (%69.6) stoma iliþkili komplikasyonlarýn geliþtiði gözlendi. Saptýrýcý ostomi açýlan hastalarýn dördünde (%12.2) dehidratasyon bulgularý nedeniyle ek tedaviler uygulandýðý saptandý. Parastomal cilt infeksiyonlarýnýn ileostomi açýlan 31 hastanýn 14'ünde gözlendi (%45).
TARTIÞMA ve SONUÇ: Bu hasta serisinde, NAKRT uygulanan ve BMI ≥ 25 olan hastalarda saptýrýcý ostomi uygulama sýklýðýnýn yüksek olduðu saptanmýþtýr. Primer cerrahi sonrasý en sýk komplikasyon olarak cerrahi alan infeksiyonu 24 hastada (%23.8) saptanmýþtýr. Bu hasta serisinde en sýk rastlanan stoma komplikasyonlarý sýklýk sýrasýyla; deri irritasyonlarý (%42.4), dehidratasyon (%12,1), stoma kanamasý (%6.1), mükokütanöz ayrýþma (%6.1) ve stoma revizyonu (%3) ihtiyacýdýr. Saptýrýcý ostomi uygulanan hastalarda bu komplikasyonlar açýsýndan dikkatli olunmalýdýr.

INTRODUCTION: Anastomotic leakage after low anterior resection is the most serious complication and increases the morbidity and mortality rates and prolonges length of stay. In this study, the effectiveness and safety of diverting ostomies in colorectal anastomosis was compared retrospectively.
METHODS: The charts of all patients with diverting ostomies operated with extraperitoneal colorectal or coloanal anastomosis electively due to rectal adenocarcinoma between 2005-2010 were examined retrospectively.
RESULTS: A total of 101 patients were included in the study. Twentynine (28.7%) patients were given neoadjuvant chemoradiotherapy (NAKRT). Diverting ostomy was applied to 33 of the patients (32.7%) in the study group. Diverting ileostomy was performed to 33 (93.9%) of these patients, colostomy in the remaining two. Diverting ostomy was applied to 14 of 29 patients (48.2%) treated with NAKRT (p = 0.03). While the diverting ostomy was applied in 31 patients with BMI ≥25, it was used only in two patients with BMI <25 (p = 0.0001). Surgical site infection was the most frequent complication in 24 patients (23.8%). Stoma related complications were observed in 23 patients (69.6%). Additional treatments for dehydration were needed in 4 (12.2%) patients. Parastomal skin infections were observed in 14 of 31 patients (45%) with ileostomy
DISCUSSION AND CONCLUSION: In this series of patients, the diverting ostomy applications were found to be more frequent in patients with BMI ≥ 25 and treated with NAKRT. In this series of patients, the most common stoma complications were; skin irritations (42.4%), dehydration (12.1%), stoma bleeding (6.1%), mucocutaneous dehiscence (6.1%) and the need for stoma revision (3%). In terms of these complications care should be taken in patients undergoing diverting ostomy.

GÝRÝÞ ve AMAÇ: Bu çalýþmamýzda onkolojik nedenli mastektomi sonrasý aðrý tedavisi için uygulanmýþ infiltrasyon analjezisi ve pektoral sinir bloðu yöntemlerini, aðrý skorlarý, total analjezik tüketimi ve post anestezi bakým ünitesinden taburculuk süresine etkisi yönünden birbirlerine üstünlüklerini karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Etik kurul izni ve hasta onamlarý alýndýktan, meme kanseri nedeniyle mastektomi uygulanmýþ, 18-80 yaþ arasý 60 hasta çalýþmaya alýndý. Postoperatif analjezi amacýyla pektoral sinir bloðu uygulanmýþ hastalar Grup I, infiltrasyon analjezisi uygulanmýþ hastalar ise Grup II olarak iki gruba ayrýldý. Bütün hastalara intraoperatif tenoxicam 20 mg uygulandý. Hastalarýn operasyon sonrasý aðrýlarý Visual Analog Scala (VAS) ile 1, 6, 12 ve 24. saatlerde deðerlendirildi. VAS deðeri 3 üzeri olan hastalara tramadol 1mg/kg ve gerekirse morfin (0.5-1 mg) uygulandý. Postoperatif ilk 24 saatte tükettikleri toplam analjezik miktarlarý, post anestezik bakým ünitesinde kalýþ süreleri, bulantý-kusma ve diðer yan etki oranlarý kaydedildi, sonuçlar istatistiksel olarak deðerlendirildi.
BULGULAR: Demografik özellikler iki grupta benzerdi. Postoperatif VAS ortalamalarý pektoral sinir bloðu grubunda 1, 6, 12 ve 24. saatlerde infiltrasyon analjezisi grubuna göre anlamlý olarak düþük bulundu. Hastalarýn yirmi dört saatte tükettikleri total analjezik miktarý, bulantý-kusma, diðer yan etki oranlarý ve post anestezi bakým ünitesinde kalýþ süresi pektoral sinir bloðu grubunda anlamlý olarak düþüktü.
TARTIÞMA ve SONUÇ: Çalýþmamýzda onkolojik meme cerrahisi sonrasý aðrý yönetiminde, pektoral sinir bloðu yöntemi infiltrasyon analjezisi yöntemine göre üstün bulundu. Sonuç olarak, meme kanseri nedenli mastektomi sonrasý, pektoral sinir bloðunu etkili bir aðrý yönetimi ve post anestezik bakým ünitesinden erken taburculuk saðladýðý için tavsiye ediyoruz.

INTRODUCTION: In this study, we aimed to compare the superiority of infiltration analgesia and pectoral nerve block methods on pain scores, total opioid consumption and discharge time from post anesthesia care unit (PACU) of patients after oncologic mastectomy.
METHODS: After approval of the ethics committee and patient consent, sixty patients who underwent mastectomy for breast cancer between 18-80 years of age were included in the study. Patients were divided into two groups, who underwent pectoral nerve block for postoperative analgesia as Group I and infiltration analgesia as Group II. Intraoperative tenoxicam of 20 mg was applied to all patients. Postoperative pain was evaluated with Visual Analog Scala (VAS) at the 1st, 6th, 12th and 24th hours. Patients with a VAS of more than 3 were given tramadol 1 mg/kg and morphine (05-1 mg) if necessary. In the first 24 hours postoperatively, total analgesic consumption, discharge time from PACU, rates of nausea, vomiting and other side effects of patients were recorded and results were evaluated statistically.
RESULTS: Demographic characteristics were similar in two groups. Postoperative VAS scores were significantly lower in the pectoral nerve block group at the 1st, 6th, 12th and 24th hours compared to the infiltration analgesia group. The total analgesic consumption, nausea- vomiting rate, and discharge time from PACU were significantly lower in the pectoral nerve block group.
DISCUSSION AND CONCLUSION: In our study, pectoral nerve block method was found superior to infiltration analgesia method on postoperative pain management in oncologic breast surgery. In conclusion, we recommend the pectoral nerve block to supply effective pain management and early discharge time from PACU after mastectomy for breast cancer.

GÝRÝÞ ve AMAÇ: Sigara kullanýmý mesane kanseri riskini 2-4 kat kadar artýrmakla birlikte farklý tütün tipleri ile ilgili bu etki tam olarak kanýtlanamamýþtýr. Bu çalýþmada halk arasýnda “Maraþ otu” olarak bilinen Nicotiana Rustica’nýn mesane kanseri üzerindeki etkisi araþtýrýldý.


YÖNTEM ve GEREÇLER: Kliniðimizde 2014-2019 yýllarý arasýnda mesane tümörü nedeniyle transüretral mesane tümörü (TUR-M) rezeksiyonu gerçekleþtirdiðimiz 98 olgunun verileri retrospektif olarak incelenerek 41 olgu çalýþma kriterlerine uygun bulundu. Olgular düzenli sigara kullanýmý, Maraþ otu kullanýmý ve hiçbirini kullanmayan olarak 3 ayrý gruba ayrýldý. Elde edilen veriler ýþýðýnda gruplar arasý karþýlaþtýrma yapýldý.
BULGULAR: Çalýþmaya uygun bulunan 41 olgunun 29’u (%71) erkek iken 12 tanesi (%29) kadýn idi. Olgularýn yaþ ortalamasý 63 yýl (51-79 yýl) þeklinde hesaplandý. Tüm olgular kullanýlan tütüne göre gruplandýrýldýðýnda; grup 1 sadece sigara kullanan olgular, grup 2 sadece maraþ otu kullanan olgular ve grup 3 ise hiçbir tütün mamülü kullanmayan olgulardan oluþmaktaydý. Olgularýn %51’inde sigara kullaným öyküsü mevcut iken; %15’inde maraþ otu kullanýmý bulunmaktaydý. Maraþ otu kullanan 6 olgunun 5 tanesi günde 5 ten fazla ot kullanmakta iken bunlarýn tümünde T1 tümör izlenmiþ 5 ten az kullanýmý olan tek olgu ise Ta patolojisine sahiptir.
TARTIÞMA ve SONUÇ: Maraþ otu kullanýmý ile mesane kanseri arasýnda iliþki sigara ile mesane kanseri arasýndaki iliþkiye göre zayýf anlamlý kalmýþtýr. Ancak hiçbir tütün ürünü kullanmayan gruba göre anlamlý derecede yüksek izlendi.

INTRODUCTION: It is accepted that smoking increases the risk of bladder cancer by 2-4 times however studies evaluating the relationship between the use of different tobacco types and bladder carcinoma are limited. In this study, the effect of Nicotiana Rustica, known as Maraþ powder, on bladder cancer was investigated.

METHODS: The data of 98 patients who underwent transurethral bladder tumor (TUR-M) resection due to bladder tumor in our clinic between 2014-2019 were evaluated retrospectively and 41 cases were found to be in accordance with the study criteria. Cases were divided into three groups: regular smoking, Maras powder and none. In the light of the data obtained, a comparison was made between the groups.
RESULTS: Of the patients diagnosed with bladder carcinoma, 71% were male and 29% were female. The mean age of the patients was 63 years (51-79 years). When all cases were grouped according to the tobacco used; group 1 consisted only of cases using cigarette, group 2 using only smokeless tobacco, and group 3 consisted of cases using no tobacco products; 51% of these patients smoked and 15% used Maras powder. It was seen that 5 of the 6 patients who used Maras powder used more than 5 herbs per day and all of these cases had T1 tumors; the only one case with Ta pathology which using less than 5 herbs.

DISCUSSION AND CONCLUSION: The relationship between the use of Maras powder and bladder cancer remained poorly significant compared to the relationship between smoking and bladder cancer. However, it was found to be higher than non-tobacco_

GÝRÝÞ ve AMAÇ: Metastatik renal hücreli karsinomda (RHK) yeni geliþtirilen hedefe yönelik tedavilere raðmen halen saðkalým oranlarý düþüktür. En sýk metastaz gözlenen alanlar arasýnda yer alan akciðer, karaciðer ve kemik tutulumu içerisinde, özellikle de kemik metastazý saptanan olgular daha kötü prognoz ile iliþkilendirilmektedir. Çalýþmamýzda RHK’da metastaz odaðýnýn onkolojik sonuçlara etkisini belirlemeyi ve genel saðkalýma etki eden diðer prognostik faktörleri de deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2009-Aralýk 2016 tarihleri arasýnda, taný anýnda metastaz saptanan ve sitoredüktif nefrektomi yapýlan RHK olgularýndan, verilerine tam olarak ulaþýlabilen 35 hasta retrospektif olarak deðerlendirildi. Hastalarýn demografik, patolojik, klinik verileri, nefrektomi sonrasý progresyon durumlarý ve saðkalým verileri kaydedilerek, hastalar kemik metastazý bulunanlar (Grup I) ve sadece visseral organ metastazý olanlar (Grup II) þeklinde iki gruba ayrýldý.
BULGULAR: Hastalarýn ortalama yaþý 59.20 ± 11.72 olup, ortanca 11 (2-90) aylýk takip süresi boyunca 25 (% 71.4) hastada progresyon, 27 (%77.1) hastada ölüm gerçekleþmiþtir. Grup I' de IMDC (p=0.008) ve MSKCC risk skorlarý (p=0.025) Grup II' ye göre daha yüksek bulunurken, yine Grup I' de progresyon (%85.0 vs. %53.3, p=0.04) ve ölüm (%90.0 vs. %60.0, p=0.036) oranlarý anlamlý olarak daha yüksek gözlendi. Öngörülen genel saðkalým süresi, Grup I'de anlamlý olarak daha düþük bulundu (18.60 vs. 43.60 ay, p=0.036). Çok deðiþkenli analizde, IMDC skoru progresyonsuz sað kalýmý öngörmede; Fuhrman derecesi, metastaz odaðýnýn kemik olmasý ve IMDC skoru ise genel saðkalýmý öngörmede baðýmsýz prediktif faktörler olarak bulundu.
TARTIÞMA ve SONUÇ: Kemik metastazlý RHK olgularýnda özellikle de eþlik eden visseral organ metastazý, multipl kemik tutulumu, aksiyel kemik tutulumlarýnda genel saðkalýmýn azaldýðý görülmektedir. Bu hastalarda, beyin dýþýndaki diðer visseral organ tutulumu olan olgulara göre daha kötü prognoz gözlendiðinden, daha yakýn takip gerekmektedir. Ayrýca hayat kalitesini düþüren kemikle iliþkili olay gözlenme oranlarý da daha yüksek olduðundan, uygulanabilecek kemiðe yönelik farklý lokal palyatif tedaviler konusunda daha dikkatli davranýlmalýdýr.

INTRODUCTION: Despite the newly developed targeted therapies in metastatic renal cell carcinoma (RCC), survival rates are still low.The most common metastatic areas are lung, liver and bone. Among these, especially cases with bone metastasis are associated with worse prognosis. In this study, we aimed to determine the effect of metastatic focus on oncologic outcomes in RCC and to evaluate other prognostic factors affecting overall survival.
METHODS: Between January 2009 and December 2016, 35 patients with metastatic RCC who underwent cytoreductive nephrectomy were evaluated retrospectively.Demographic, pathological, clinical data, progression status and survival outcomes after nephrectomy were recorded and the patients were divided into two groups: those with bone metastases (Group I) and those with only visceral organ metastasis (Group II).
RESULTS: The mean age of the patients was 59.20±11.72 years.During the median follow-up period of 11 (2-90) months, 25 patients (71.4%) had progression and 27 patients (77.1%) died.IMDC risk score (p=0.008),MSKCC risk score (p=0.025), progression rate (85.0% vs 53.3%, p=0.04) and mortality rate (90.0% vs 60.0%), p = 0.036) were found to be significantly higher in Group I. The predicted overall survival was significantly lower in Group I (18.60 vs. 43.60 months, p=0.036).In multivariate analysis, IMDC score was found to be independent predictor for progression-free survival. On the other hand, Fuhrman grade, bone involvement and IMDC score were independent predictors for overall survival.
DISCUSSION AND CONCLUSION: It is seen that overall survival decreases especially in the presence of accompanying visceral organ metastasis, multiple or axial bone involvement in RCC with bone metastases.Closer follow-up is required for cases with bone metastasis because these patients have worse prognosis than those with visceral organ involvement except for brain.In addition, the rates of bone-related events are higher in these patients and cause decrease in quality of life.Therefore, different local palliative treatments for bone should be chosen more carefully.

Kolonun malign tümörleri genellikle benign adenomlardan köken almaktadýrlar. Büyük boyutlu ve villöz komponenti olan adenomlarýn malignleþme potansiyelleri diðer adenomlara göre daha fazladýr. Adenomlar genellikle asemptomatikdirler ancak boyutlarý arttýkça kanama, tenesmus, obstruksiyon, intusepsiyon gibi semptomlara neden olabilirler. Villöz adenomlarýn bir kýsmýný oluþturan sekretuar adenomlara baðlý mukuslu diare görülebilir. Sekretuar adenomlar genellikle rektosigmoid bölgede yerleþir ve 4 cm’den büyüktürler. McKittrick-Wheelock sendromu, rektal sekretuar villöz adenoma baðlý olarak geliþen; kronik mukuslu diare, renal yetmezlik ve elektrolit imbalansý triadý ile karþýmýza çýkmaktadýr. Literatürde yaklaþýk olarak 100 civarýnda vaka bildirilmiþtir. Sendroma sebep olan villöz adenom; büyük boyutu ve histolojik tipi nedeni ile invaziv kanser için yüksek risk taþýmaktadýr. Tedavi edilmediði taktirde metabolik kollaps ve malignite gibi yýkýcý sonuçlarý olan bu sendromun sekretuar diare ayýrýcý tanýlarý arasýnda unutulmamasý gerekmektedir. Erken taný ve uygun tedavi ile hayat kalitesinde artma ve belirgin saðkalým avantajý saðlanabilir. Bu olgu sunumunda McKittrick-Wheelock sendromuna sebep olan en büyük boyutlu adenomlardan birinin tespit edildiði ve rektum kanseri tanýsý alan bir hastanýn bilgilerini sunmayý amaçladýk.

Malignant tumors of the colon usually originate from benign adenomas. Adenomas with large size and villous component have higher malignancy potential than other adenomas. Adenomas are usually asymptomatic, but as their size increase, they may cause symptoms such as bleeding, tenesmus, obstruction, intussusception. Mucous diarrhea can be seen due to secretory adenomas that constitute the subgroup of villous adenomas. Secretory adenomas are usually located in the rectosigmoid region and are larger than 4 cm. McKittrick-Wheelock syndrome is characterized by chronic mucous diarrhea, renal failure and electrolyte imbalance due to rectal secretory villous adenoma. Approximately 100 cases have been reported in the literature. Adenoma causing McKittrick Wheelock syndrome carries a hýgh rýsk for the development of ýnvasýve cancer due to its býg sýze and hýstologýc sub-type. This syndrome can be fatal due to the metabolic collapse or possible malignancy however early diagnosis and proper treatment may increase quality of life and serve a significant survival advantage for the patients. The importance of being aware of McKittrick-Wheelock syndrome and the need to include this diagnosis in the work up of patients with secretory diarrhea should be highlighted.In this case report, we aimed to present a patient who was diagnosed with rectal cancer and was diagnosed as one of the largest adenomas causing McKittrick-Wheelock syndrome.

Nodüler tip malign melanom nadir görülen bir malign melanom alt tipidir. Sýklýkla ileri evrede taný alýr ve kötü prognozludur. Bu olgu sunumunda nadir olarak rastlanan, karakteristik cilt bulgularý olan, kemik iliði tutulumu ve yaygýn damar içi pýhtýlaþma tablosunun bir arada bulunduðu bir nodüler tip malign melanom vakasý sunuyoruz.

Nodular type malignant melanoma a rare subtype of malignant melanoma with poor prognosis. It is often diagnosed at advanced stage. In this case report, we present a metastatic malign melanom case with bone marrow involvement and dissemine intravascular haemolysis.

Metastatik meme kanserinde saðkalým sonuçlarý son 20 yýlda iyileþme gösterse de halen kadýnlarda önemli bir morbidite ve mortalite nedeni olmaya devam etmektedir. Son yýllarda geliþtirilen yeni tedavi ajanlarý ile hormon reseptörü pozitif metastatik meme kanserinde ve/veya HER2-pozitif tümörlü hastalarda anlamlý saðkalým artýþlarý saðlanmýþtýr. Kombinasyon veya tek ajanlý tedavide, metastatik üçlü negatif meme kanserinin saðkalýmý açýsýndan bilinen sitotoksik ajanlarla anlamlý bir iyileþme saðlanamamýþtýr. Bu derleme güncel tedavi yaklaþýmlarý ve metastatik meme kanseri için yeni tedavi arayýþlarýna odaklanmýþtýr.

Although, life expectancy of metastatic breast cancer has improved over the last 20 years, it still remains a significant cause of morbidity and mortality in women. New drugs that were developed in recent years have provided significant survival benefits in the treatment of hormone receptor positive and/or HER2-positive breast cancer. Whether in combination or single-agent therapy, no significant improvement were obtained with the known cytotoxic agents in terms of survival of metastatic triple negative breast cancer. This review has focused on the current treatment approaches and the trials seeking challenging treatment options for metastatic breast cancer.

Ülkemizde, saðlýk sistemine yakýn zamanda giren palyatif bakým hizmetleri giderek yaygýnlaþmaktadýr. Aðrý, palyatif bakým ünitelerinde hastalarýn yaþam kalitesini etkileyen en önemli semptomdur. Kanserle iliþkili aðrý, sinir hasarý veya duyu tipi mekanizmasýna dayanarak kolayca kategorize edilebilir, ancak çoðu aðrý aslýnda karýþýktýr. Bu sebeple hasta ve aðrý nedeniyle ilgili güvenilir bilgiler hemen saðlanmalý ve aðrýyý deðerlendirmek için kabul görmüþ aðrý ölçekleri kullanýlmalýdýr. Palyatif onkolojide çeþitli farmakolojik ve invaziv giriþimlerin yaný sýra aðrý tedavisinde etkinliði gösterilmiþ fizyoterapi uygulamalarý da kullanýlmalýdýr. Aðrý tedavisi çok modlu bir yaklaþýmý içerir. Fizyoterapi; terapötik egzersizler, manuel tedavi teknikleri, gevþeme, postüral re-eðitim, pozisyonlama, mobilite, TENS, sýcak veya soðuk uygulama ve masaj gibi birçok yöntemi içerebilir. Ayrýca, aðrý tedavisine aktif katýlým için, hastaya ve ailesine mutlaka eðitim verilmelidir. Bu þekilde palyatif onkolojide aðrý tedavisi daha baþarýlý bir þekilde gerçekleþtirilebilir. Bu derlemenin amacý, palyatif onkolojide aðrý ve fizyoterapisi ile ilgili bilgileri ele almaktýr.

The palliative care services that have recently got into the health system are becoming more common in our country. Pain is the most important symptom that affects the quality of life of the patients in palliative care units. Cancer-related pain can be easily categorized based on nerve damage or sensory-type mechanism, but most pain is actually complicated. Therefore, reliable information on the patient and the cause of pain should be provided immediately, and accepted pain scales should be used to assess pain. Except from the various pharmacological and invasive procedures in palliative oncology, physiotherapy applications that have been shown to be effective in the treatment of pain should also be used. Pain therapy involves a multimodal approach. Physiotherapy can include many methods such as therapeutic exercises, manual therapy techniques, relaxation, postural re-training, positioning, mobility, TENS, hot or cold application and massage. In addition, for active participation in pain therapy, the patient and his / her family should be educated. Pain treatment in palliative oncology can be performed more successfully with these applications. The aim of this review is to determine the knowledge about pain and physiotherapy in palliative oncology.