GÝRÝÞ ve AMAÇ: Kanser tedavisinde kullanýlan ajanlarýn apoptozu arttýrarak hücre ölümüne yol açtýðý bilinmektedir. Bu çalýþmada akut lenfoblastik lösemili (ALL) çocuklarda BAX gen ekspresyonunu etkileyen G-248A nukleotid polimorfizminin ve apoptozun risk sýnýflandýrýlmasýnda ve tedavi yanýtýnýn deðerlendirilmesindeki önemi araþtýrýldý.
YÖNTEM ve GEREÇLER: Çalýþmada apoptoz indeksi (0-11) yaþ aralýðýndaki, yeni taný 25 ALL’ li hastanýn kemik iliði aspirasyon örneklerinde 0, 3 ve 8.gün Annexin V- FITC kiti kullanýlarak yapýldý. Bax gen polimorfizmi 60 ALL 'li hasta ve 96 saðlýklý kontrol grubunun kan örneklerinde DNA izolasyonu FUJÝ QuickGene 810 otomatik nükleik asit pürifikasyon sistemi ile çalýþýldý.
BULGULAR: Hastalarýn ortalama yaþý 4.9 olup %28' i standart risk, %44'ü orta risk, %28'i yüksek risk grubundaydý. Spontan apoptoz indeksi (AÝ) ile 3.gün AÝ arasýnda anlamlý bir fark ve pozitif korelasyon saptandý ( 18.3±13.7, 19.4±12.7 p= 0,007 r= +0.548). Erken steroid yanýtý kötü olan olgularda 8.gün AÝ anlamlý olarak yüksek gözlendi (p<0.05). Pre-B ALL olgularýnda 0.gün, 3.gün ve 8. gün AÝ anlamlý olarak yüksek bulundu (p<0.05). Hastalarýn %84’ünde CD 10 pozitifliði saptanmýþ olup CD10 ekspresyonu yoðun olan olgularda 3.gün AÝ anlamlý olarak yüksek görüldü (p<0.05). BAX gen polimorfizminin hasta ve kontrol grubunda deðiþiklik göstermediði tespit edildi.
TARTIÞMA ve SONUÇ: Çalýþmamýzda konvansiyonel doz prednisolonun apoptozu belirgin bir þekilde indüklediði ve erken steroid yanýtý kötü olan olgularda 8.gün AÝ yüksekliðinin blast yüküyle iliþkili olduðu düþünüldü. CD10 ekspresyonu yoðun olgularda apoptoz oranýndaki anlamlý artýþýn Pre B ALL’de prognoz açýsýndan deðerli olduðu kanýsýna varýldý.
BAX gen polimorfizminin ALL’nin patogenez, klinik seyir ve prognozdaki etkisinin daha fazla olgu sayýsý ile deðerlendirilmesi ve apoptoz yolaðýnda rol oynayan diðer proteinlerin de araþtýrýlmasýnýn gerekli olduðu düþünüldü.

INTRODUCTION: It is known that the agents used in cancer treatment increase apoptosis and cause cell death. In this study, the importance of G-248A nucleotide polymorphism affecting the BAX gene expression and apoptosis in children with acute lymphoblastic leukemia (ALL) was investigated in the risk classification and the evaluation of the treatment response.
METHODS: Apoptosis index was performed by Annexin V- FITC kit for bone marrow aspiration samples of 25 newly-diagnosed (0-11) years old ALL patients on 0th, 3rd and 8th day. Bax gene polymorphism was studied on blood samples of 60 ALL patients and 96 healthy control group, and DNA isolation was studied by FUJÝ QuickGene 810 automatic nucleic acid purification system.
RESULTS: The mean age of the patients was 4.9, and %28 had a standard risk, %44 had a moderate risk, %28 had high risk. A significant difference and a positive correlation were found between the spontaneous apoptosis index (AI) and the 3rd day AI (18.3±13.7, 19.4±12.7 p= 0,007 r= +0.548). The 8th day AI was found to be significantly higher in patients with poor early steroid response (p<0.05). Apoptosis index; was significantly high on 0th, 3rd and 8th day for PreB ALL cases. 84% of the patients were found to have CD 10 positivity and in cases with intense CD10 expression, AI was significantly higher on the third day (p <0.05). It was determined that the BAX gene polymorphism did not differ in the patient and control groups.
DISCUSSION AND CONCLUSION: In the present study, conventional dose prednisolone was thought to induce apoptosis significantly, and the 8th day AI elevation was associated with blast load in patients with poor early steroid response.It was concluded that the significant increase in apoptosis ratio in cases with intense CD10 expression was a valuable marker in terms of prognosis in Pre B ALL.It was considered necessary to evaluate the effect of BAX gene polymorphism on the pathogenesis, clinical course and prognosis of ALL with more cases, and to investigate other proteins that play a role in the apoptosis pathway.

GÝRÝÞ ve AMAÇ: Bu çalýþmada benign kemik lezyonu sebebiyle profilaktik intramedüller tespit ameliyatý yaptýðýmýz hastalarýn sonuçlarýný sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþmaya 2008-2017 yýllarý arasýnda benign kemik lezyonu nedeni ile küretaj, greftleme ve profilaktik intramedüller tespit ameliyatý yaptýðýmýz 22 hasta dâhil edilmiþtir. Lezyonlar preoperatif dönemde Mirels sýnýflamasýna göre incelenerek patolojik kýrýk riski belirlenmiþtir. Tüm hastalarýn tedavisinde küretaj, greftleme ve intramedüller tespit yöntemi kullanýlmýþtýr. Kontrol muayenelerinde hastalar; eklem hareket açýklýklarýna, aðrý durumuna, lezyonun ve implantýn radyolojik görüntüsüne göre deðerlendirilmiþtir.
BULGULAR: Hastalarýn yaþ ortalamasý 24,8 (aralýk, 7-38) yýldý. Hastalar ortalama 35,8 (aralýk, 13-80) ay takip edildi. Çalýþmaya dâhil edilen 21 hastanýn ilk baþvuru nedeni aðrý olup 2 hastada aðrý fonksiyon kaybýna neden olmaktaydý. Patolojik humerus kýrýðý olan bir hasta akut aðrý ve fonksiyon kaybý ile baþvurdu, iki ay konservatif olarak takip edildi ve ardýndan profilaktik cerrahi yapýldý. Hastalarýn ortalama Mirels skoru 9,3 (aralýk, 9-10)’tü. Takiplerde tüm hastalarýn ekstremite fonksiyonlarý tamdý. Ameliyat sonrasý ortalama VAS 8,09'dan 2,54'e gerilemiþtir.
TARTIÞMA ve SONUÇ: 9 veya daha fazla Mirels skoruna sahip olan iyi huylu kemik lezyonlarý için profilaktik fiksasyonun, olasý patolojik kýrýk riskini azalttýðý, VAS skorlarýný azalttýðý, ayrýca fonksiyon kaybýný önlediði ve daha erken normal aktivitesine geri dönüþe olanak saðladýðý sonucuna vardýk.

INTRODUCTION: In this study, we aimed to present the results of patients who underwent prophylactic intramedullary fixation for benign bone lesions.
METHODS: Twenty-two patients who underwent curettage, grafting and prophylactic intramedullary fixation for benign bone lesions between 2008 and 2017 were included in this study. The lesions were examined according to the Mirels’ classification in the preoperative period and the pathological fracture risk was determined. Curettage, allografting and intramedullary fixation were used in the treatment of all patients. In the follow-up examination, patients were evaluated according to the range of motion, pain, radiological appearance of the lesion and the implant.
RESULTS: The mean age of the patients was 24.8 (7-38) years. The mean follow-up period was 35.8 (13-80) months. The initial complaint of twenty-one patients was pain which caused loss of function in two patients. One patient with pathological humerus fracture was admitted with acute pain and loss of function. He was followed conservatively for two months, then prophylactic surgery was performed. The mean Mirels’ score of the patients was 9.3 (9-10). In the follow-up examination, the range of motion was full in all patients. The mean VAS score decreased from 8.09 to 2.54 postoperatively.
DISCUSSION AND CONCLUSION: We conclude that prophylactic fixation for benign bone lesions which has 9 or more Mirels’ score reduces the risk of impending pathological fractures, reduces VAS scores, and also prevents loss of function and enables to return normal activity earlier.

GÝRÝÞ ve AMAÇ: Metastatik böbrek hücreli kanser (MBHK) sýklýðý giderek artmaktadýr ve temel tedavisi anti-angiogenik tirozin kinaz inhibitörleridir (TKÝ). Sistemik inflamasyonun karsinogenezde önemli bir rollerinden biri de pro-angiogenik faktörlerin salýnýmýný arttýrmaktýr. Biz de bu yazýmýzda TKÝ tedavisi alan MBHK olgularýnda sistemik inflamatuar indekslerinden nötrofil lenfosit oraný (NLO), sistemik immun-inflamasyon indeksi (SII), prognostik nutrisyonel indeks (PNI) ve tedavi sürecinde deðiþen SII deðerlerinin prognostik önemini ortaya çýkarmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýza TKÝ tedavisi alan 28 MBHK hastasý retrospektif olarak dahil edilmiþtir. Kaplan–Meier ve log-rank testleri kullanýlarak klinikodemografik verilerle yaþam süreleri arasýndaki iliþki belirlenmiþtir. NLO (2,73), SII (832) ve PNI (39) için en sensitif ve spesifik deðerler ROC analizi ile saptanýp prognostik önemleri tekli ve multi faktöriyel analizler yapýlarak tespit edilmiþtir
BULGULAR: Yüksek NLO (≥2,73) ve SII (≥832) ile düþük PNI (<39) daha kýsa progresyonsuz yaþam süresi (PYS) ve genel saðkalým (GS) ile iliþkili olup TKI tedavisinin 1. Ayýndaki azalmýþ SII’ye sahip olan hastalarýn ise daha uzun PYS ve GS’ye sahip olduðu tespit edilmiþtir. GS için yapýlan univariate analizlerde ECOG performans durumu, NLR, SII, SII deðiþimi ve PNI prognostik olmakla beraber multifaktöriyel analizlerde sadece SII deðiþimi baðýmsýz prognostik faktördür.
TARTIÞMA ve SONUÇ: TKI tedavisi alan MBHK hastalarýnda tedavi ile azalmýþ SII daha uzun GS için tek baðýmsýz prognostik faktördür.

INTRODUCTION: The frequency of metastatic renal cell cancer (RCC) is increasing and main drugs in management are anti-angiogenic tyrosine kinase inhibitors (TKI). Systemic inflammation has an important role in carcinogenesis and increase the secretion of pro-angiogenic factors. Here prognostic significance of neutrophil lymphocyte ratio (NLR), systemic immune-inflammation index (SII), prognostik nutritional index (PNI) and also change in SII during TKI therapy have been evaluated in cases with RCC treated with TKI
METHODS: Twenty eight cases with RCC treated with TKI were evaluated retrospectively. Kaplan–Meier and log-rank tests were used to detect the association between clinical/demographic findings and survival times. The most sensitive and specific values were found by ROC analysis: Prognostic significance of NLR (2,73), SII (832), SII changes and PNI (39) were detected.
RESULTS: High NLR (≥2,73) and SII (≥832) and low PNI (<39) were found to be associated with shorter PFS and OS. Decreased SII after TKI therapy was found to be associated with longer PFS and OS. In univariate analyses, ECOG performance status, NLR, SII, SII change and PNI were prognostic for OS, whereas in multivariate analyzes only SII change found to be independent factors for OS
DISCUSSION AND CONCLUSION: Decreased SII after TKI therapy was the only independent prognsotic factor in cases with TKI treated with TKI.

GÝRÝÞ ve AMAÇ: Bu çalýþmada sinovyal osteokondromatozis nedeniyle kliniðimizde takip ve tedavisi yapýlan 15 hasta deðerlendirilmiþtir.
YÖNTEM ve GEREÇLER: Sinovyal osteokondromatozisli 15 hastanýn (9 erkek, 6 kadýn; ort. yaþ 43; daðýlým 16-72 yaþ), tutulum yerleri sýklýk sýrasýna göre diz (n=6), omuz (n=3), kalça (n=2), dirsek (n=2) ve ayak bileði (n=2) idi. On üç hastaya açýk cerrahi ile total sinovyektomi ve serbest fragman eksizyonu uygulandý. Tanýlar bütün hastalarda histopatolojik olarak doðrulandý. Ýki hasta operasyonu kabul etmedi ve konservatif tedaviye alýndý. Ortalama takip süresi 71 aydý. (daðýlým 12-204 ay).
BULGULAR: On üç hastanýn birinde on altý ay sonra nüks görüldü. Hastaya yeniden total sinovyektomi yapýldý ve sonraki takiplerinde ikinci bir nükse rastlanmadý. Hiçbir hastada malign transformasyon gözlenmedi. Cerrahi sonrasý hastalarýn aðrý þikayetlerinde belirgin düzelme gözlendi. Konservatif tedavi ile takip edilen hastalarda aðrý ve hareket kýsýtlýlýðýnýn devam ettiði görüldü.
TARTIÞMA ve SONUÇ: Çalýþmamýzýn sonucunda diz ekleminin en sýk tutulan eklem olduðu ve görülme sýklýðý açýsýndan cinsiyet farkýnýn olmadýðý görüldü. Hastalarýn cerrahi sonrasý nüks açýsýndan takip edilmesi gerekmektedir. Cerrahi tedavi uygulanamayan hastalarda fizik tedavinin sinoviyal kondromatoziste etkinliði ile ilgili daha fazla çalýþmaya ihtiyaç vardýr. Olgular sýklýkla spesifik olmayan klinik semptomlarla baþvurduðundan aðrý ve þiþlik ile baþvuran hastalarda sinovyal osteokondromatozisin mutlaka akýlda tutulmasý gerekmektedir.

INTRODUCTION: In this study, we evaluated 13 patients who were treated and followed-up for synovial chondromatosis in our clinic.
METHODS: Fifteen patients (9 males, 6 females,; mean age 43 years; range 16 to 72 years) had synovial chondromatosis localized in the knee (n=6), shoulder (n=3), hip (n=2), elbow (n=2), and ankle (n=2). Joint loose bodies were removed together with total synovectomy by open surgery in thirteen patients. Histopathologic confirmation was obtained in all the patients. Two patients refused surgical treatment and were treated conservatively. The mean follow-up period was 71 months (range 12 to 204 month).
RESULTS: One patient developed recurrence sixteen months after surgery, for which repeat total synovectomy was performed in the shoulder and no other recurrences were observed. No malignant transformation was observed in any patient. Symptomatic improvement was obtained in all the patients with treated surgically. Pain and limitation of motion were observed in the patients who were followed up conservatively.
DISCUSSION AND CONCLUSION: As a result of our study, it was found that the knee joint was the most commonly involved joint and there was no gender difference in terms of incidence. All patients must be followed-up with regard to recurrence. Further studies are needed on the efficacy of physical therapy in synovial chondromatosis in patients without surgical treatment. Patients often present with non-specific clinical symptoms. Therefore, synovial osteochondromatosis should be kept in mind in patients presenting with pain and swelling.

GÝRÝÞ ve AMAÇ: Merkezimizde kronik lenfositik lösemi (KLL) tanýsý ile takipte olan hastalarýn genel klinik özellikleri, ilk sýra tedavileri, olgularýn yaþam süreleri ve bu yanýtlara etkili olabilecek faktörleri deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmada 2009-2018 yýllarý arasýnda Eðitim ve Araþtýrma Hastanesi Hematoloji Bölümünde KLL tanýsý ile izlenen 188 hastanýn dosyalarýna ulaþýlabilen 169’u retrospektif olarak deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 169 hastadan 90’ý erkek, 79’u kadýn, median yaþ 65 (min37-max 89) idi. Taný anýnda Rai evrelemesine göre deðerlendirildiðinde evre 0 %33,7 (n: 57), evre I % 17,2 (n: 29), evre II % 40,2 (n: 68), evre III % 2,4 (n: 4), evre IV % 6,5 (n: 11) olduðu tespit edildi. Takip süresi ortalama 42,57 aydý ve bu süreçte 134 hasta (%79,2) hiç tedavi almazken, 35 hasta (%20,7) tedavi aldý. Ýlk sýra tedaviler incelendiðinde tedavi alan 35 hastanýn; 16’si (%45,7) Rituksimab-Fludurabin ve Siklofosfamid (R-FC), 5’i (%14,2) Fludarabin,Siklofosfamid (FC), 3’ü Klorambucil (% 8,5), 5’i Rituksimab-Klorambucil (%14,2), 2’si Rituksimab, Siklofosfamid, Doksorubisin, Vinkristine, ve Prednisone kombinasyonu (R-CHOP) (%5,7), 2’si Rituksimab-Bendamustin (%5,7), 1’i Siklofosfamid, Vinkristine, ve Prednisone kombinasyonu (CVP) ve 1’i CVP (%2,8) aldýðý görüldü. Tedavi almayan hastalarýn ortalama yaþam süresinin 99,4 ay, tedavi alan hastalarýn ortalama yaþam süresinin 89,7 ay olduðu tespit edilmiþtir. Hastalarýn 38’in de (%22,5) mortalite izlendi.
TARTIÞMA ve SONUÇ: Hastalarýmýzýn demografik özelliklerinin diðer çalýþmalarla benzer olduðu görülmüþtür. Tedavi alma durumuna göre sað kalým süresi incelendiðinde yaþam sürelerinin tedavi almayan grupta, tedavi alan gruba göre önemli düzeyde yüksek olduðu tespit edilmiþtir.

INTRODUCTION: We aimed to assess patients with chronic lymphocytic leukemia (CLL) with respect to their general clinical features, first-line treatments, survival time, and factors affecting treatment response.
METHODS: This study retrospectively enrolled 169 patients with available medical records of 188 patients who were under follow-up with CLL at Training and Research Hospital, Department of Hematology between 2009 and 2018.
RESULTS: Among 169 patients enrolled in the study, 90 were male and 79 were female; the study population had a median age of 65 (min 37-max 89) years. An analysis of Rai staging at the time of diagnosis revealed that fifty-seven (33.7%) patients had stage 0 disease; twenty-nine (17.2%) stage 1 disease; sixty-eight (40.2%) stage 2 disease; four (2.4%) patients stage 3 disease; and eleven (6.5%) patients stage IV disease. The mean duration of follow-up was 42.57 months; during that period, 134 (79.2%) patients received no therapy, and 35 (20.2%) patients received therapy. The first-line therapy was administered to 35 patients, of whom 16 (45.7%) received Rituximab-Fludarabin and Cyclophosphamide (R-FC); 5 (14.2%) Fludarabin and Cyclophosphamide (FC); 3 (8.5%) chlorambucil; 5 (14.2%) Rituximab-Chlorambucil; 2 (5.7%) the combination of Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP); 2 (5.7%) Bendamustine; 1 (2.8%) the combination of cyclophosphamide, vincristine, and prednisone (CVP) and 1 (2.8%) Rituximab-CVP. The mean survival time of the untreated patients and treated patients were 99.4 months and 89.7 months, respectively. Thirty-eight (22.5%) patients died.
DISCUSSION AND CONCLUSION: The demographic features of our patients were similar to those reported in previous studies. An analysis of treatment-based survival time revealed that it was significantly longer in the untreated patients than the treated ones.

GÝRÝÞ ve AMAÇ: Philedelphia negatif Ph(-) myeloproliferatif neoplazilerin (MPN) tanýsýnda klinik ve laboratuvar bulgularýnýn yanýnda genetik testler çok önemlidir. Bunlar arasýnda JAK2 genindeki V617F mutasyonu en sýk görülen genomik varyasyondur. Bunlara ek olarak MPL geninde W515L/K mutasyonunun ve CALR genindeki mutasyonlarýn araþtýrýlmasý da önem taþýmaktadýr. Çalýþmamýzda, MPN tanýsý almýþ olan hastalarda retrospektif olarak JAK2 V617F, MPL W515L/K ve CALR mutasyon daðýlýmý ve sýklýðý araþtýrýldý.
YÖNTEM ve GEREÇLER: MPN grubu hastalýk tanýsý ile baþvuran 41 hastanýn JAK2 V617 mutasyonu, MPL W515L/K mutasyonu ve CALR gen mutasyonlarýna yönelik test sonuçlarý retrospektif olarak incelendi. Genetik parametreler real-time PCR cihazý ile analiz edildi.
BULGULAR: Tüm hastalarda JAK2 V617F mutasyon sýklýðý %36, CALR mutasyon sýklýðý %17 olarak bulunurken, MPL W515L/K mutasyonu hiçbir hastada gözlenmedi. MPN’nin alt gruplarýný oluþturan; polisitemi vera, esansiyel trombositoz ve primer myelofibrozis gruplarýnda JAK2 V617F mutasyon sýklýðý sýrasýyla %67, %33 ve %25 olarak bulunurken; CALR mutasyon sýklýðý ise %8, %29 ve %8 olarak bulundu. MPL W515L/K ise hiçbir grupta gözlenmedi.
TARTIÞMA ve SONUÇ: Daha önce yapýlan çalýþmalarda Ph(-) MPN grubu hastalýklarda JAK2 V617F, MPL W515L/K ve CALR mutasyon sýklýðýnýn çok geniþ aralýklarda olduðu bildirilmiþtir. Sonuç olarak, mutasyonlarýn daðýlýmýnda etnisite ve epigenetik faktörlerin yaný sýra sigara, rakým gibi çevresel faktörlerin de etkisinin olduðunu düþünülmektedir.

INTRODUCTION: Genetic tests are very important for the diagnosis of Philedelphia negative myeloproliferative neoplasms (MPN), in addition to clinical findings and laboratory results. JAK2 V617F mutation is the most common genomic variaton among these group of diseases. Otherwise, analysis of W515L/K mutation in MPL gene and CALR gene mutations is crucial. In this study, prevalence of JAK2 V617F, MPL W515L/K mutations and, spectrum and prevalence of CALR gene mutations were investigated in MPN patients.
METHODS: Genetic test results of JAK2 V617 mutation, MPL W515L/K mutation and CALR gene mutations of 41 MPN patients were analysed, retrospectively. Genetic parameters were performed with real-time PCR.
RESULTS: While the frequency of JAK2 V617F mutation was 36% and CALR mutation was 17% in all patients, MPL W515L/K mutation was not detected in any patient. In terms of subgroups of MPN; in polycythemia vera, essential thrombocytosis and primary myelofibrosis groups, the incidence of JAK2 V617F mutation was 67%, 33% and 25%, respectively; and the incidence of CALR mutation was 8%, 29% and 8%, respectively. MPL W515L/K was absent in all groups.
DISCUSSION AND CONCLUSION: Previous studies have reported that the frequency of JAK2 V617F, MPL W515L/K and CALR mutations in Ph (-) MPN group diseases is very variable. As conclusion, it is thought that environmental factors such as smoking and altitude have an effect besides epigenetic factors such as ethnicity in distribution of mutations.

GÝRÝÞ ve AMAÇ: Küçük hücre dýþý akciðer kanseri (KHDAK) hastalarýnda, konvansiyonel, birinci basamak sitotoksik kemoterapi (platin çiftler veya platin olmayan çiftler) 7-8 ay ortanca saðkalým platosuna ulaþmýþtýr. Crizotinib tedavisi, PROFILE 1014 ve PROFILE 1007 çalýþmalarýnda standart birinci ve ikinci sýra kemoterapilere kýyasla daha yüksek yanýt oranlarý ve progresyonsuz saðkalým elde etmiþ ve dünya çapýnda ALK-pozitif ileri KHDAK tedavisi için kabul görmüþtür.
YÖNTEM ve GEREÇLER: Bu çalýþmada, crizotinib tedavisi alan, klinik olarak ileri evre ALK-pozitif olan 11 hasta (6 erkek ve 5 kadýn; ortalama yaþ: 50,29 ± 12,72 yýl; yaþ aralýðý 30-66 yýl) retrospektif olarak deðerlendirildi.
BULGULAR: Çalýþmaya toplam 11 hasta alýndý. Ortalama yaþ 50,29 ± 12,72 (daðýlým: 30-66 yýl) idi. Hastalarýn tamamý taný anýnda Evre 4’te idi. Tüm hastalar daha önce platin rejimleri almýþtý. Crizotinib tedavisi altýnda toplam 3 hastada, beyin metastazý, sürrenal metastaz ve primer kitle progresyonu olmak üzere progresyonu gözlendi. Crizotinib tedavisinin 6. ayýnda surrenal metastaz ile progresyonu olan bir hasta öldü. Progresyonsuz saðkalým 25,46 ± 6,56 ay (%95 CI: 12,59-38,33 ay) idi ve genel sað kalým 104,17 ± 13,72 aydý (%95 CI: 77,23-131,04 ay).
TARTIÞMA ve SONUÇ: Hastalarýmýzýn Crizotinib tedavisini iyi tolere ettiði ve ALK-pozitif ileri evre KHDAK olan hastalarda ümit verici etkinlik gösterdiði gözlendi.

INTRODUCTION: Conventional, first-line cytotoxic chemotherapy (platinum doublets or nonplatinum doublets) has reached a plateau of a median survival of 7- 8 months in NSCLC patients. Crizotinib treatment achieve higher response rates and progression free survival compared to standard first-line and second-line chemotherapy in PROFILE 1014 and PROFILE 1007 studies and now accepted worldwide for treating ALK-positive advanced NSCLC.
METHODS: A total of 11 patients (6 males and 5 females; mean age: 50.29 ± 12.72 years; age range 30–66 years) with ALK-positive clinically advanced NSCLC who received crizotinib treatment were retrospectively evaluated in the study.
RESULTS: A total of 11 patients were enrolled in the study. Characteristics of patients are given in Table 1. Mean age was 50.29 ± 12.72 (range: 30–66 years). All patients were at stage 4 at the time of diagnosis and had previously received platin doublet regimens. A total of 3 patients had disease progression under crizotinib treatment, including brain metastasis, surrenal metastasis and primary mass progression. One patient who progressed with surrenal metastasis was died at the 6th month of crizotinib treatment. Progression free survival was 25.46±6.56 months (95% CI: 12.59-38.33 months) and overall survival was 104.17 ± 13.72 months (95% CI: 77.23-131.04 months).
DISCUSSION AND CONCLUSION: Crizotinib was well tolerated and showed promising efficacy in patients with ALK-positive, advanced NSCLC.

GÝRÝÞ ve AMAÇ: Çalýþmanýn amacý, eþ zamanlý ek doz (simultaneous integrated boost, SIB) fraksiyon þemasý ile yoðunluk ayarlý radyoterapi (intensity-modulated radiotherapy, IMRT) ve volümetrik ayarlý ark terapi (volumetric-modulated arc therapy, VMAT) teknikleri kullanýlarak radyoterapi (RT) alan nazofarenks kanseri tanýlý hastalarda, organ eþdeðer doz (organ equivalent dose, OED) kavramý kullanýlarak, belirlenen organlar için RT’ye baðlý ikincil kanser risklerini hesaplamak ve karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Erken evre nazofarenks kanseri tanýlý 5 hastaya ait bilgisayarlý tomografi setleri kullanýlarak, IMRT-SIB ve VMAT-SIB tedavi planlarý oluþturulmuþtur. Her bir hasta için üç ayrý PTV (planning target volume, PTV) tanýmlanmýþ; PTV1, PTV2 ve PTV3. PTV’lere sýrasýyla 52.8 Gray (Gy), 59.4 Gy ve 69.3 Gy tedavi dozu 33 fraksiyonda verilmiþtir. IMRT-SIB ve VMAT-SIB planlarý oluþturulurken, PTV’ler ve risk altýndaki organlar (organs at risk, OARs) için ayný doz hedefleri kullanýlmýþtýr. Planlara ait diferansiyel doz-volüm histogram (dose-volume histogram, DVH) verileri ile Schneider'in “full mechanistic” ve “specific mechanistic sarcoma” modelleri kullanýlarak OED deðerleri ve ikincil kanser geliþim riskini ifade eden aþýrý mutlak risk (excess absolute risk, EAR) deðerleri hesaplanmýþtýr. OED ve EAR’ler beyin sapý, spinal kord, oral kavite, parotis, farenks, submandibular bez, mandibula ve yumuþak doku için hesaplanmýþtýr.
BULGULAR: IMRT-SIB ve VMAT-SIB teknikleri kullanýlarak oluþturulan tedavi planlarýnýn tümünde PTV’ler ve OAR’ler bakýmýndan klinik olarak kabul edilebilir planlar elde edilmiþtir. VMAT-SIB tekniði kullanýlan planlarda, ikincil kanser riski parotis için istatistiksel olarak anlamlý yüksek bulunmuþtur. Ýkincil kanser riskleri hesaplanan diðer organlar için teknikler arasýnda fark bulunmamýþtýr.
TARTIÞMA ve SONUÇ: IMRT-SIB ve VMAT-SIB teknikleri ile RT uygulanan erken evre nazofarenks kanseri tanýlý hastalar için tedavi sonrasý teorik olarak hesaplanan radyasyona baðlý ikincil kanser riskleri çoðu organ (parotis hariç) için benzerdir. Parotis için ise, VMAT-SIB kullanýldýðýnda ikincil kanser riski yüksektir.

INTRODUCTION: To compare intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) in terms of secondary cancer risk after radiotherapy (RT) of nasopharyngeal cancer using the concept of organ equivalent dose (OED).
METHODS: IMRT-SIB and VMAT-SIB plans were generated with identical objective functions for 5 patients with nasopharyngeal cancer of early stage. Three different planning target volumes (PTVs); PTV1, PTV2 ve PTV3 were delineation for each patient and the prescribed doses were 52.8 Gray (Gy), 59.4 Gy and 69.3 Gy delivered in 33 fractions, respectively. Differential dose-volume histograms (DVHs) were used to calculate the OEDs with Schneider’s “full mechanistic” and “specific mechanistic sarcoma” dose-response models. Calculations of OED and excess absolute risks (EAR) were applied to the brain stem, spinal cord, oral cavity, parotid, pharynx, mandibular glands, mandible and soft tissue.
RESULTS: Clinically acceptable plans were achieved for all the IMRT-SIB and VMAT-SIB plans. OED-based secondary cancer risk for parotids was significant higher when VMAT-SIB was used. No significant difference was found in terms of the OED and EAR for other organs, including the brain stem, spinal cord, oral cavity, pharynx, mandibular glands, mandible and soft tissue.
DISCUSSION AND CONCLUSION: The most OED-based secondary cancer risks were similar when IMRT-SIB and VMAT-SIB were applied. However, the second cancer risk for the parotids was slightly higher when VMAT-SIB was used.

GÝRÝÞ ve AMAÇ: Bu çalýþmada kolorektal kanserli hastalarda adjuvan kemoterapi tedavisi sonrasýnda hematolojik parametrelerdeki deðiþiklikleri deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kolorektal kanser tanýsý konan toplam 140 vakada deðerlendirilmiþ ve bu hastalardan 57'sine adjuvan kemoterapi verilmiþtir. Adjuvan kemoterapi sonrasý tam kan sayýmý parametrelerindeki deðiþiklikler deðerlendirildi.
BULGULAR: Katýlýmcýlarýn 67'si (% 47.9) kadýn, 73'ü (% 52.1) erkek idi, yaþ ortalamalarý 62.13 ± 1.11 yýl idi. En sýk görülen tümör yerleþimi rektumdu (% 45.7). Bu hastalardan 57'si adjuvan kemoterapi (% 40.7) aldý, en sýk uygulanan kemoterapi rejimi Mayo rejimi (% 84.2) idi. Olgularýmýzýn % 27.9'unda taný anýnda metastaz vardý. Klinik takip sýrasýnda hastalarýn% 10.7'sinde lokal nüks ve% 7.8'inde metastaz vardý. Hemoglobin (HGB) düzeyleri hem kan transfüzyonu yapýlan hastalarda hem de yapýlmayanlarda anlamlý bir düþüþ gösterdi, ancak bu daha önce transfüzyonu olmayan hasta grubunda daha belirgindi (p = 0.002). Yardýmcý kemoterapiyi takiben, beyaz kan hücresi deðerleri (WBC), ortalama eritrosit hacimleri (MCV) ve trombosit (PLT) seviyelerinin, modifiye edici bileþenlerle (metastaz geliþimi, kemoterapi uygulama süresi, kan transfüzyonu) herhangi bir etkileþim olmadan önemli ölçüde azaldýðý bulundu. (Sýrasýyla p deðerleri 0.002, 0.001 ve 0.001), ayrýca kýrmýzý hücre daðýlým geniþliði (RDW) önemli ölçüde artmýþtýr (p = 0.001).
TARTIÞMA ve SONUÇ: Hgb, MCV, WBC ve trombosit seviyelerinde anlamlý bir azalma ve adjuvan kemoterapi sonrasý RDW'de anlamlý bir artýþ vardý ve bu deðiþiklikler metastaz varlýðýndan veya kemoterapi süresinden etkilenmedi. Kan parametrelerinde bu deðiþikliklerin hastalarýn prognozu ile iliþkisi ileriki çalýþmalarda araþtýrýlmalýdýr.

INTRODUCTION: Aim: In this study we aimed to evaluate the alterations in hematological parameters due to the adjuvant chemotherapy treatment in patients with colorectal cancer.


METHODS: Material and Method: In a total of 140 cases diagnosed with colorectal cancer were evaluated and among those patients 57 received adjuvant chemotherapy. Alterations in complete blood count parameters after adjuvant chemotherapy were evaluated.
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RESULTS: Results: Among participants, 67 (47.9%) were women and 73 (52.1%) were men with a mean age of 62.13 ± 1.11 years. The most common tumor localization was rectum (45.7%). Among these patients 57 received adjuvant chemotherapy (40.7%), the most frequently implemented chemotherapy regimen was Mayo regimen (84.2%). 27.9% of our cases had metastasis at the time of diagnosis. During clinical follow-up 10.7% of the patients had local relapse and 7.8% had metastasis. Hemoglobin (HGB) levels displayed a significant decrease both in patients who received blood transfusion or not, however this was more evident in the group of patients with no previous transfusion (p=0.002). Following the adjuvant chemotherapy, white blood cell values (WBC), mean erythrocyte volumes (MCV) and thrombocyte (PLT) levels were found to decrease significantly without any interaction with modifying components (metastasis development, chemotherapy implementation duration, blood transfusion) (p values 0.002, 0.001 and 0.001 respectively) while red cell distribution width (RDW) had increased significantly (p=0.001).

DISCUSSION AND CONCLUSION: Conclusion: There was a significant decrease in Hgb, MCV, WBC and platelet levels and a significant increase in RDW after adjuvant chemotherapy and these alterations were not affected by the presence of metastasis or duration of chemotherapy. The association of these alterations in blood parameters with the prognosis of patients should be investigated in further studies

GÝRÝÞ ve AMAÇ: Üretrovezikal anastomoz öncesi posterior rhabdosfinkter rekonstrüksiyonu uygulanmasýnýn özellikle kontinans üzerine etkisi konusunda çalýþmalar mevcuttur. Bu çalýþmada yüksek volümlü robotik cerrahi yapan cerrahlara ait veriler deðerlendirilerek posterior rhabdosfinkter rekonstrüksiyonu uygulanmasýnýn robotik radikal prostatektomi (RARP) sonuçlarý üzerine etkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: RARP prosedürleri üç cerrah tarafýndan gerçekleþtirildi (AFA,AEC,EA). Cerrahlarýn gerçekleþtirdiði ilk 50 operasyon öðrenme eðrisi nedenli çalýþma dýþý býrakýldý. Hastalar grup 1 (posterior rhabdosfinkter rekonstrüksiyonu uygulanan)(n=133) ve grup 2 (posterior rhabdosfinkter rekonstrüksiyonu uygulanmayan)(n=439) olarak 2 gruba ayrýldý. Ortalama hasta yaþý sýrasýyla grup 1’de 63.6±6.5 grup’2 de 63.1±6.9 (p=0.505) ve serum PSA düzeyi grup 1’de 10.9±8.7 grup 2’de 10.1±8.7 (p=0.454) olarak tespit edildi.
Grup 1 ve 2 de sýrasýyla 97 (%72.9) ve 311 (70.8%), hastada bilateral nörovasküler demet(NVB) koruma, 20 (%15.0) ve 72 (%16.4) hastada unilateral NVB koruma ile operasyon uygulandý. Sýrasýyla grup 1 ve grup 2 de 16 (%12.0) ve 56 (%12.7) hastada NVB korunamadý.
BULGULAR: Ortalama prostat aðýrlýðý 65.7±31.7 gr ve 62.2±30.7 gr olarak bulundu(p=0.259). Ortalama konsol süresi, intraoperatif kan kaybý, hastanede yatýþ süresi ve üretral kateter çekim süresi grup1 ve grup 2 için sýrasýyla 143.8±37.4 vs 143.1±37.6 dakika (p=0.886); 93.4±68.3 vs 101.2±72.1 cc (p=0.277); 3.8±1.7 vs 4.2±2.1 gün (p=0.027) ve 8.6±2.9 vs 8.9±3.7 gün (p=0.447), olarak saptandý.
En az 1 yýllýk takip süresi olan hastalardan, erken kontinans (sonda çekilmesini takiben kontinan) oranlarý grup 1(n=103) ve grup 2(n=322) de sýrasýyla %68.9 ve %55.9 olarak bulundu(p=0.019). Postoperatif 1. ay total kontinan hasta sayýsý grup 1 ve grup 2 de sýrasýyla %78.6 and % 72.6 olarak bulundu (p=0.230). Postoperatif 3. ay total kontinan hasta sayýsý grup 1 ve grup 2 de sýrasýyla %90.2 and %87.5 olarak bulundu (p=0.414). Postoperatif 6. ay total kontinan hasta sayýsý grup 1 ve grup 2 de sýrasýyla %95.1 and %94.4 olarak bulundu(p=0.612).
TARTIÞMA ve SONUÇ: Posterior rhabdosfinkter rekonstrüksiyonu uygulanan hastalarda RARP postoperatif erken kontinans kazanýlmasýnda avantaja sahiptir.

INTRODUCTION: There are studies investigating the effect of posterior rhabdosfinkter reconstruction on urinary continent before uretrovesical anastomosis. In this study, we investigated the effect of posterior rhabdosfinkter reconstruction on the results of robotic radical prostatectomy in a high-volume robotic surgery center.
METHODS: Procedures were included by 3 surgeons surgeon (AFA,AEC,EA) after having an experience of >50 cases.Group-1: posterior rhabdosfincter reconstruction suture was performed, n=133.Group-2: posterior rhabdosfincter reconstruction suture was not performed, n=439. Mean patient age and preoperative serum PSA were 63.6±6.5 vs 63.1±6.9 years (p=0.505); 10.9±8.7 vs 10.1±8.7 ng/ml in Groups 1 and 2, respectively (p=0.454).Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing and non-NVB sparing were performed in 97 (72.9%), 20 (15%) and 16 (12%) Group-1 and 311 (70.8%), 72 (16.4%) and 56 (12.7%) in Group-2 patients, respectively.
RESULTS: Mean prostate weights were 65.7±31.7 gr and 62.2±30.7 gr in Groups 1 and 2, respectively (p=0.259).Mean console time, intraoperative blood loss, duration of hospital stay and urethral catheter removal time in Groups 1 and 2 were 143.8±37.4 vs 143.1±37.6 min (p=0.886); 93.4±68.3 vs 101.2±72.1 cc (p=0.277); 3.8±1.7 vs 4.2±2.1 days (p=0.027) and 8.6±2.9 vs 8.9±3.7 days (p=0.447), respectively.Full continence was defined as no pad usage (0 pad/day). Of the available 103 and 322 patients, following removal of the catheter, immediate continence rate was 68.9% and 55.9% in Groups 1 and 2, respectively (p=0.019).On postop 1st-month, 78.6% and 72.6% of the patients in Groups 1 and 2, respectively were fully continent (p=0.230).On postop 3rd-month, 90.2% and 87.5% of the patients in Groups 1 and 2, respectively were fully continent (p=0.412).On postop 6th-month, 95.1% and 94.4% of the patients in Groups 1 and 2, respectively were fully continent (p=0.612).
DISCUSSION AND CONCLUSION: We conclude that, due to our experience RARP procedure with posterior rhabdosphincter reconstruction has an advantage in terms of gaining postoperative early urinary continence.

GÝRÝÞ ve AMAÇ: Baþ ve boyun bölgesinde yerleþimli paragangliomlarýnýn manyetik rezonans, difüzyon aðýrlýklý görüntüleme bulgularýný deðerlendirmek ve görünür difüzyon katsayýsý deðerlerini karþýlaþtýrmak.
YÖNTEM ve GEREÇLER: Çalýþmamýz hastane etik kurul onayý alýnarak yapýldý. Ocak 2011 ile Ocak 2017 tarihleri arasýnda ardýþýk 39 hastanýn (erkek/bayan=7/32; ortalama yaþ±standar sapma=52,9±13,8 yýl, 19–79 yýl) klinik ve görüntüleme bulgularý retrospektif deðerlendirildi. Manyetik rezonans görüntüleri, tümörün lokalizasyonu, büyüklüðü, sinyal intensitesi ve homojenitesi, tuz-biber görünümünün varlýðý, kontrastlanma derecesi, görünür difüzyon katsayýsý deðerleri bakýmýndan deðerlendirildi. Paragangliomlar, baþ (glomus jugulare [13 hasta], timpanikum [2 hasta], jugulotimpanikum [11 hasta]) ve boyun (karotid cisim tümörleri [12 hasta], glomus vagale [1 hasta]) lezyonlarý olarak gruplandýrýldý. Paragangliomlarýn manyetik rezonans-difüzyon aðýrlýklý görüntüleme bulgularý gruplar arasýnda karþýlaþtýrýldý. Görünür difüzyon katsayýsý deðerleri bakýmýndan gözlemciler arasý uyum, sýnýf içi korelasyon katsayýsý kullanýlarak analiz edildi.
BULGULAR: Tuz-biber görünümünün izlendiði paragangliomlarýn boyutlarý, bu görünümün izlenmediði paragangliomlardan daha büyüktü (p<0,001). Baþ bölgesinde yerleþimli olan paragangliomlarýn boyutlarý, boyun bölgesinde yerleþimli olanlara göre daha büyük, T2 sinyalleri daha düþük, difüzyon aðýrlýklý görüntülemedeki sinyalleri ise daha yüksekti (p≤0,033). Paragangliomlarýn ortalama görünür difüzyon katsayýsý deðeri (0,89±0,50×10−3 mm2/s), yerleþim yerlerine göre paragangliomlar arasýnda anlamlý farklýlýk göstermiyordu (p=0,127). Gözlemciler arasý uyum iyi-mükemmeldi (sýnýf içi korelasyon katsayýsý 0,78–0,89).
TARTIÞMA ve SONUÇ: Paragangliomlarýn lokalizasyonlarý, boyutlarý, T2 ve difüzyon aðýrlýklý görüntülerdeki sinyallerini, tuz-biber görünümü göstermelerini etkilemektedir. Konvansiyonel manyetik rezonans görüntüleme bulgularý yanýnda görünür difüzyon katsayýsý deðerleri, paragangliomlarýn diðer baþ-boyun lezyonlarýndan ayýrt edilmesinde yardýmcý olabilir.

INTRODUCTION: To evaluate magnetic resonance (MRI) and diffusion weighted imaging (DWI) characteristics of head and neck paragangliomas and to compare the apparent diffusion coefficient values (ADCV) of the paragangliomas.
METHODS: The study was approved by the local ethics committee. We retrospectively reviewed the medical and imaging records of 39 consecutive patients (male/female=7/32; mean age=52.9±13.8 years, range 19–79 years) with paragangliomas between January 2011 and January 2017. All MRI were evaluated for tumor location, size, signal intensity and homogeneity, the presence of salt and pepper (S&P) appearance, contrast enhancement degree, and the ADCV. The paragangliomas were grouped as neck (carotid body tumor [n=12] and glomus vagale [n=1]) and head (glomus jugulare [n=13], tympanicum [n=2],and jugulotympanicum [n=11]) lesions and MRI features were also compared between these groups. Inter-observer agreements for ADCVs were estimated by using the intraclass correlation coefficient.
RESULTS: The paragangliomas showing S&P appearance had larger diameters than those did not (p<0.001). The paragangliomas located in the head had larger diameters and lower T2 signal intensity than those located in the neck (p≤0.023). DWI signal intensity of tumors located in the neck were lower than those located in the head (p=0.033). The mean ADCV of all paragangliomas was 0.89±0.50×10−3 mm2/s, with no significant differences identified among the paragangliomas (p=0.127). Inter-observer reliability was found to be substantial to excellent (intraclass correlation coefficient range, 0.78–0.89).
DISCUSSION AND CONCLUSION: The localization and sizes of paragangliomas affect the presence of S&P apperance, DWI and T2 signal intensity. The addition of ADCV of paragangliomas to conventional MRI findings may increase the accuracy of imaging in distinguishing other head and neck lesions.

GÝRÝÞ ve AMAÇ: Konvansiyonel sitogenetik analiz, çocukluk çaðýnda görülen akut lenfoblastik lösemi (ALL) ve akut myeloid lösemi (AML) hastalarýnda hem taný hem de hastalýk seyrinin izlenmesinde oldukça yol göstericidir. Bazý kromozomal anomaliler spesifik olarak belirli lösemi alt gruplarýnda görülebilmektedir. Ayrýca hastalarýn taþýdýðý sayýsal ve kromozomal anomalilerin bazýlarý iyi prognoz belirteci iken bazýlarý da kötü prognoz belirteçleridir. Sunduðumuz bu çalýþmada kromozomal anomali tespit edilmiþ 10 AML ve 16 ALL olmak üzere toplam 26 pediatrik lösemi hastasýnýn sitogenetik analiz sonuçlarý ile hastalarýn klinik parametreleri arasýndaki korelasyon araþtýrýldý.
YÖNTEM ve GEREÇLER: Hastalara ait konvansiyonel analizler, uyarýlmamýþ kemik iliði örneklerinden, Giemsa-tripsin (GTG bantlama) yöntemi ile elde edilmiþ metafaz kromozomlarýnýn incelenmesi ile oluþturuldu.
BULGULAR: Hem AML hem de ALL hastalarýnda çeþitli yapýsal ve sayýsal anomaliler tespit edilmiþtir. Bu anomaliler literatür ile uyumlu olup, hastalarýn lösemi tipleri ile de uyumluluk göstermiþtir. Kompleks karyotipler AML hasta grubunda, ALL hasta grubundan daha fazla bulunmuþtur. Ayrýca 1 ALL ve 2 AML tanýlý hastada, nadir olarak görülen kromozomal anomaliler tespit edilmiþtir.
TARTIÞMA ve SONUÇ: Günümüzde geliþmiþ moleküler sitogenetik tekniklerin varlýðýna raðmen, konvansiyonel sitogenetik analiz halen oldukça önemli bir yere sahiptir.

INTRODUCTION: Conventional cytogenetic analysis is very helpful in monitoring both the diagnosis and the course of the disease in children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Some chromosomal abnormalities can be seen in specific subgroups of leukemia. In addition, some of the structural and numerical chromosomal abnormalities carried by the patients are good prognosis indicators, while others are bad prognosis indicators. In this study, we investigated the correlation between the cytogenetic analysis results and clinical parameters of the 26 pediatric leukemia patients diagnosed with AML and ALL.
METHODS: Conventional cytogenetic analyzes of patients were made by examining metaphase chromosomes obtained from non-induced bone marrow samples by Giemsa-trypsin (GTG banding) method.
RESULTS: Various structural and numerical anomalies were detected in both AML and ALL patients. These abnormalities were compatible with the literature, and they were also compatible with the types of leukemia of the patients. The complex karyotypes were found more in the AML patients group than in the ALL patients group. In addition, three chromosomal anomalities which are seen very rarely were detected in 1 ALL and 2 AML patients.
DISCUSSION AND CONCLUSION: Despite the presence of advanced molecular cytogenetic techniques, conventional cytogenetic analysis still has an important value.

GÝRÝÞ ve AMAÇ: Hem maspin hem de GLUT-1 ekspresyonu, endometrioid karsinom gibi birçok insan kanserlerini arttýrdýðý gösterilmiþ olmasýna raðmen, bunlarýn uzun dönemde hastalýðýn prognozuyla ilgisi belirlenmemiþtir.Çalýþmamýzýn amacý, malign endometrial dokularda maspin ve GLUT-1'in aþýrý ekspresyonunu araþtýrmak, endometrioid karsinoma gibi neoplastik dokularda progresyondaki rolünü deðerlendirmek, saðkalýmý öngörmedeki rolünü araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya endometrioid adenokarsinomlu 68 hasta ve iyi huylu endometrial dokuya sahip 68 hasta olmak üzere iki grup alýndý. Maspin için immünohistokimyasal boyama nükleer ( çekirdek) olarak kabul edildi. Tümör dokularýnýn ve normal endometriyal dokularýn nükleer boyanmasý, hücre oranlarýna göre þu þekilde skorlandý: negatif boyama <% 25; pozitif boyama % 25 -% 100. GLUT-1 için boyama modeli membranöz olarak kabul edildi. Doku örneklerinde pozitif boyanmýþ tümör hücrelerinin yüzdesi yarý nicel olarak <% 5 negatif boyama ve % 5 -% 100 pozitif boyama ile belirlendi. Takip süresi 6 ila 60 ay arasýnda ve ortalama 53,8 ay idi.Birincil son noktalar tüm nedenlere baðlý ölüm olarak belirlenmiþtir.
BULGULAR: GLUT-1 ve Maspin'in immünohistokimyasal ekspresyonu endometrioid karsinomda belirgin bir þekilde daha yüksekti (p <0.001). Saðkalým ile GLUT-1 arasýnda istatistiksel olarak belirgin bir fark yoktu.Maspin boyalý hastalarda saðkalým oraný düþük olmasýna raðmen istatistiksel olarak anlamlý fark elde edilmedi (p = 0,08). Maspin pozitif olan hastalarda prognoz çok daha kötüdür. GLUT-1, tümörlerin prognozunda ve metastazýnda önemli bir rol oynarken, aþýrý eksprese maspinli dokularda aktivitesi gözlenmedi.
TARTIÞMA ve SONUÇ: GLUT-1, tümör ilerlemesi ve metastazý için önemli bir immün boyama belirteci iken, maspin endometrioid karsinomda prognostik bir parametre olarak daha etkili olduðu tespit edilmiþtir.

INTRODUCTION: Although the expression of both maspin and GLUT-1 have been shown to increase in many human cancers such as endometrioid carcinoma, their long-term prognostic relevance has not yet been established. The aim of our study is to investigate the overexpression of maspin and GLUT-1 in malignant endometrial tissues, to evaluate its role in the neoplastic progression to an endometrioid carcinoma, to establish prognostic clinical parameters and to predict survival.
METHODS: The sample participants comprised of 68 patients with endometrioid adenocarcinoma and 68 patients with benign endometrial tissues. The immunostaining pattern for maspin was accepted as nuclear. Nuclear staining of tumoral tissues and normal endometrial tissues were scored according to cell ratios as follows: negative staining <25%; positive staining 25% - 100%. The linear staining pattern for GLUT-1 was accepted as membranous. The percentage of positively stained tumor cells in the tissue samples were semi-quantitatively determined with negative staining <5% and positive staining 5% - 100%. The follow-up period ranged from 6 to 60 months with a mean of 53,8 months. Primary end points were determined as all-cause mortality.
RESULTS: The immunohistochemical expression of GLUT-1 and Maspin were significantly higher in endometrioid carcinoma (p<0.001). There was no statistically significant difference between survival and GLUT-1. Although the survival in patients with maspin staining was lower, statistical significance was not reached (p=0.08). In patients with positive maspin staining, the prognosis is much worse. While GLUT-1 plays an important role in the progression and metastasis of tumors, its activity was not observed in tissues with overexpressed maspin.
DISCUSSION AND CONCLUSION: While GLUT-1 is an important immunostaining marker for tumor progression and metastasis, maspin has been identified to be more effective as a prognostic parameter in endometrioid carcinoma.

GÝRÝÞ ve AMAÇ: Bu çalýþma, 65 yaþ ve üzerinde metastatik kolorektal kanser (KRK) tanýsý alan hastalarýn genel özelliklerini, performans durumunu, uygulanan tedavileri ve sað kalým oranlarýnýn deðerlendirilmesi amacý ile planlandý.
YÖNTEM ve GEREÇLER: Bu çalýþma Ekim 2010 ile Ekim 2014 tarihleri arasýnda Dr. A.Y. Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi Týbbi Onkoloji Kliniði’nde metastatik evrede 65 yaþ ve üzerinde olan KRK tanýlý 139 hastanýn dosya arþivi taranarak retrospektif olarak yapýldý.
BULGULAR: Hastalarýn ortanca yaþý 73 (65-87) idi. Yaþ aralýðýna göre deðerlendirildiðinde hastalarýn 81’ i (% 58,3) 65-74 yaþ arasýnda, 53’ ü (%38,1) 75-84 yaþ arasýnda, 5’ i (%3,6) 85 yaþ ve üzerinde idi. Çoðunluðunu erkek (% 57) cinsiyet oluþturmaktaydý. Tüm hasta grubu için genel saðkalým (GSK) 12.09 ay (% 95 GA; 9.5-14.64) idi. Yaþ aralýðýna göre ortanca GSK 65-74 yaþ arasý 16.39 ay (% 95 GA;10.3-22.4), 75 yaþ ve üzeri 12.87 ay (% 95 GA; 9.2-16.5 ) (p: 0.906) idi.
TARTIÞMA ve SONUÇ: Kronolojik yaþ tedavi planlamasýnda negatif bir faktör olarak düþünülmemelidir. Taný ve evreleme sonrasýnda hastanýn kiþisel istekleri de gözönüne alýnarak multidisipliner yaklaþým ile tedavi seçenekleri uygulanmalýdýr. Karþýlaþýlabilecek toksisiteler için yakýn ve dikkatli takip yapýlmalý, gerekli durumlarda destek tedaviler uygulanmalýdýr

INTRODUCTION: This study was planned with the aim of assessing general characteristics, performance status, applied treatments and survival rates of patients diagnosed with metastatic colorectal cancer (CRC) over the age of 65 years.
METHODS: This study was conducted between October 2010 and October 2014 at Dr. A.Y. Ankara Oncology Training and Research Hospital, Department of Medical Oncology Clinic. The files in the archives were scanned retrospectively and 139 patients diagnosed with colorectal cancer, who were 65 years or older in the metastatic stage were identified.
RESULTS: The median age of the patients was 73 (65-87). When evaluated according to age range, 81 (58.3%) of the patients were aged between 65-74, 53 (38.1%) were between 75-84 years and 5 (3.6%) were over 85 years old. The majority (57%) were male.
Overall survival was 12.09 months (% 95 GA; 9.5-14.64). According to age range, median OS was 16.39 months between 65-74 years, 12.87 months (% 95 GA; 9.2-16.5 ) (p: 0.906) over 75 years.

DISCUSSION AND CONCLUSION: Advanced age should not be considered as a negative factor in planning treatment. After diagnosis and staging, multidisciplinary approach and treatment options should be applied considering personal wishes of the patient. Close and careful follow-up should be performed for toxicities that may be encountered, and supportive care should be applied when necessary.

GÝRÝÞ ve AMAÇ: Transrektal ultrasonografi kýlavuzluðunda yapýlan prostat biyopsisi (TRUS-B) prostat kanseri tanýsýný koymada kullanýlan altýn standart metottur. Ancak TRUS-B iþleminde kaç kor örnek alýnmasý gerektiði konusu hala tartýþmalýdýr. Bu çalýþmada standart 10 kor ve 12 kor TRUS-B iþlemlerinin kanser saptama oranlarýnýn karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Retrospektif özellikteki bu çalýþmaya prostat spesifik antijen (PSA) yüksekliði veya þüpheli dijital muayene bulgusu nedeniyle 10 kor (Grup-1) veya 12 kor (Grup-2) TRUS-B iþlemi uygulanmýþ hastalar dahil edilmiþtir. PSA>20 ng/ml olan ve daha önce negatif biyopsi öyküsü olan hastalar çalýþma dýþý býrakýlmýþtýr. Gruplarýn kanser tespit edilme oranlarýnýn yaný sýra yaþ, vücut kitle indeksi (VKÝ), serum PSA oranlarý ve prostat hacmi gibi demografik ve klinik verileri karþýlaþtýrýlmýþtýr.
BULGULAR: Çalýþmaya toplam 208 hasta dahil edildi (Grup-1: 98, Grup-2: 110). Çalýþmaya dahil edilen tüm hastalarda kanser tespit edilme oraný %43.2 idi. 10 kor ve 12 kor TRUS-B gruplarý için kanser tespit edilme oranlarý ise benzerdi (sýrasýyla %41.8, %44.5, p=0.694). Bunun yanýnda gruplarýn ortalama VKÝ, ortanca yaþ, prostat hacmi ve PSA deðerleri arasýnda anlamlý fark yoktu. Ateþli üriner sistem enfeksiyonu 12 kor TRUS-B uygulanan hastalarda daha yüksek oranda görülse de aradaki fark istatistiksel olarak anlamlý deðildi (%3.06 ve %4.54, p=0.578).
TARTIÞMA ve SONUÇ: 10 kor prostat biyopsisi, hastadan daha az örnek alýnmasý, benzer kanser tespit etme ve komplikasyon oranlarý nedeniyle 12 kor TRUS-B iþlemine göre daha uygulanabilir bir biyopsi yöntemi gibi görünmektedir.

INTRODUCTION: Transrectal ultrasound-guided prostate biopsy (TRUS-B) is the gold standard method used to diagnose prostate cancer. However, how many samples should be taken in TRUS-B procedure is still controversial. The aim of this study is to compare the cancer detection rates of standard 10-core and 12-core TRUS-B procedures.
METHODS: Patients who underwent 10-core (Group-1) or 12-core (Group-2) TRUS-B operations were included in this retrospective study for prostate specific antigen (PSA) elevation or suspicious digital examination findings. Patients with PSA>20 ng/ml and a history of negative biopsy were excluded from the study. In addition to cancer detection rates of groups, demographic and clinical data such as age, body mass index (BMI), serum PSA ratios and prostate volume were compared.
RESULTS: A total of 208 patients were included in the study (Group-1: 98, Group-2: 110). The rate of cancer detection was 43.2% in all patients included in the study. The rates of cancer detection for 10-core and 12-core TRUS-B groups were similar (41.8%, 44.5%, p=0.694, respectively). Besides, there was no significant difference between the mean BMI, median age, prostate volume and PSA values of the groups. Urinary tract infection with fever was found to be higher in 12 patients with TRUS-B but the difference was not statistically significant (3.06% and 4.54%, p=0.578).
DISCUSSION AND CONCLUSION: The 10-core prostate biopsy appears to be a more applicable biopsy method than the 12-core TRUS-B procedure because of requires less sampling, similar cancer detection and complication rates.

GÝRÝÞ ve AMAÇ: Doz yoðun kemoterapi (AC Q2 × 4 → P Q2 × 4), yüksek riskli meme kanserli hastalarýn adjuvan tedavisinde yaygýn olarak kullanýlmaktadýr. Bununla birlikte, doz yoðun kemoterapi ile üç haftada bir antrasiklin ve siklofosfamidi takiben haftalýk paklitaksel (AC Q3 × 4 → PW × 12) rejimini doðrudan karþýlaþtýran çalýþma yoktur. Ayrýca, antrasiklin ve siklofosfamide haftalýk paklitaksel ilave edildiðinde, doz yoðun AC’ nin (AC Q2 x 4) konvansiyonel AC'den (AC Q3 x 4) daha üstün olup olmadýðý bilinmemektedir. Bu çalýþmada AC Q3 × 4 → P W × 12 rejiminin etkinliðinin ve toksisitesinin deðerlendirmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: 2013 ve 2016 yýllarýnda meme kanseri tanýsý konulan hastalar retrospektif olarak deðerlendirildi. Çalýþmaya lenf nodu pozitif (tümör evresi T1, T2 veya T3 ve nodal evre N1, N2 veya N3) ya da yüksek riskli lenf nodu negatif (T2 veya T3, N0) uzak metastazý olmayan hastalar dahil edilmiþtir.
BULGULAR: Çalýþmaya 150 hasta dahil edildi. Medyan 31 aylýk takip süresinde 13 hastada uzak metastaz geliþti ve 6 hasta vefat etti. Beþ yýllýk hastalýksýz saðkalým ve genel saðkalým oranlarý sýrasýyla % 88.4 ve % 92 idi. Hastalarýn yüzde 38.6'sýnda ciddi nötropeni (grade 3,4) görülürken ciddi bir kardiyotoksisite gözlenmedi.
TARTIÞMA ve SONUÇ: AC Q3 × 4 → P W × 12, lenf nodu pozitif veya yüksek riskli lenf nodu negative erken evre meme kanserli hastalarda etkin ve iyi tolere edilebilir kemoterapi rejimidir.

INTRODUCTION: Dose-dense chemotherapy (AC Q2×4→P Q2×4) is widely used in the adjuvant treatment of high-risk breast cancer patients. However, there is no direct comparison of dose-dense chemotherapy consisting of anthracycline plus cyclophosphamide every three weeks followed by weekly paclitaxel (AC Q3 × 4 → P W × 12) regimen. Moreover, when weekly paclitaxel is added to anthracycline plus cyclophosphamide, it is unknown whether or not dose-dense AC (AC Q2×4) is superior to conventional AC (AC Q3×4). The study aimed to evaluate the efficacy and toxicity of AC Q3 × 4 → P W × 12 regimen.
METHODS: Patients diagnosed with breast cancer from 2013 to 2016 were retrospectively evaluated. The study included women who had histologically-involved lymph nodes (tumor stage T1, T2, or T3 and nodal stage N1, N2, or N3) or high-risk, axillary node-negative disease (T2 or T3, N0) without distant metastases.
RESULTS: This study included 150 patients with breast cancer. After a median follow up period of 31 months, 13 patients had developed distant metastases and 6 patients had died. The estimated 5-year disease-free survival and overall survival rates were 88.4% and 92%, respectively. Severe neutropenia (grade 3, 4) occurred in 38.6%of the patients whereas no severe cardiotoxicity was observed.
DISCUSSION AND CONCLUSION: AC Q3 × 4 → P W × 12 regimen is well-tolerated and effective in patients with node-positive or high-risk node-negative early-stage breast cancer.

GÝRÝÞ ve AMAÇ: Günümüzde kanser tedavisinde modern týptaki geliþmelere raðmen tamamlayýcý ve alterntif tedavi (TAT) yöntemlerine olan ilgi devam etmektedir. Çalýþmamýzýn amacý kemoterapi tedavisi alan hastalarda TAT kullaným oranlarýný, çeþitlerini ve buna etki eden faktörlerin tespit edilmesidir
YÖNTEM ve GEREÇLER: 1 Temmuz-1 Aðustos 2017 tarihleri arasýnda Dýþkapý Yýldýrým Beyazýt Eðitim ve Araþtýrma Hastanesi Týbbi Onkoloji Kliniði ayaktan kemoterapi ünitesinde tedavi alan ve ankete katýlmak isteyen gönüllü hastalara demografik, klinik özelliklerini, TAT kullanýmýný sorgulayan 26 sorudan oluþan anket uygulandý. Anket öncesi hastalardan onam formu alýndý.
BULGULAR: Çalýþmaya katýlmak isteyen 97 hastaya anket uygulandý. Medyan yaþ 60 olarak bulundu (26-84). Hastalarýn 66%’sý kadýn idi. Hastalarýn çoðunluðu ilk/orta okul mezunu (61.5%) ve düþük gelir düzeyinde idi (71.1%). En çok izlenen kanser türü meme kanseriydi (39.2%). Hastalarýn 51.5%’i evre 4 hastalýða sahipti. Hastalarýn büyük çoðunluðu palyatif amaçla tedavi almaktaydý (52.6%). TAT kullananma oraný 21.6% bulundu. Kullanýlan TAT çeþitleri incelendiðinde en sýk ýsýrgan otu ( 9.2%), zerdeçal (4.1%) ve zencefil ( 2.1%) kullanýmý tespit edildi. Hastalarýn 57.2%’ sinin kullandýðý ürünlerden takip eden doktorunun bilgisi yoktu. Hastalarýn 80.9% ‘u bu ürünleri hastalýðýn iyileþme sürecinde fayda göstereceðine inandýðý için kullanýyordu. TAT kullanan hastalarýn 28.5’%’i klinik fayda gördüðünü düþünmekte idi. Düþük gelir düzeyi ile tamamlayýcý tedavi kullanýmý arasýnda istatistiksel olarak anlamlý þekilde iliþki saptandý (p: 0,01).
TARTIÞMA ve SONUÇ: Günümüzde tamamlayýcý tedaviler kanser hastalarý tarafýndan sýklýkla kullanýlan yöntemlerdir. Saðlýk çalýþanlarýnýn TAT kullanýmý açýsýndan dikkatli olmasý ve hastalarla bu açýdan iletiþim içinde olmasý olasý toksisiteleri önlemek açýsýndan oldukça önemlidir.

INTRODUCTION: Despite recent advancements in modern medicine and in cancer treatment, the interest towards complementary and alternative medicine (CAM) still remains. The aim of our study was to detect rates of CAM use, its kinds and the factor(s) affecting CAM preference in patients receiving chemotherapy
METHODS: A questionnaire consisting of 26 questions on demographics, clinical features, and CAM use was conducted on volunteering patients receiving chemotherapy in the outpatient chemotherapy unit of Dýþkapý Yýldýrým Beyazýt Training and Research Hospital from July 1 to August 1, 2017. Consent was received from the patients prior to the application of the questionnaire.
RESULTS: Ninety-seven volunteering patients replied the questionnaire. Median age was 60 years (26-84). Sixty-six percent of the patients were females. Most patients were primary/junior high school graduates (61.5%) and belonged to the low-income group (71.1%). Most commonly observed cancer type was breast cancer (39.2%). Stage 4 patients made up of 51.5% of the patients. Majority of the patients received palliative treatment (52.6%). CAM use was found 21.6%. Most commonly preferred CAM kinds were stinger (9.2%), turmeric (4.1%) and common ginger (2.1%). The physicians were not aware of the products used in 57.2% of the patients. 80.9% of the patients were using these products for the belief that they would be beneficial in the recovery period of the disease. 28.5% of the patients using CAM thought that these products served a clinical benefit. A statistically significant relation was determined between low income and use of complementary medicine (p: 0,01).
DISCUSSION AND CONCLUSION: Nowadays, complementary medicine is frequently used by cancer patients. It is of vital importance that healthcare workers pay heed to CAM use and be in contact with the patients so as to prevent toxicities

GÝRÝÞ ve AMAÇ: Teröpotik plazma deðiþimi (TPD) hasta plazmasýnýn büyük kýsmýnýn replasman sývýlarýyla deðiþtirilip hastaya geri verildiði bir iþlemdir. TPD iþlemi hematolojik, romatolojik, nörolojik ve toksikolojik hastalýklar olmak üzere bir çok hastalýkta primer tedavi yöntemi ya da tedaviyi tamamlayýcý yöntem olarak kullanýlýr. Günümüzde yoðun bakým ünitelerinde TPD kullaným sýklýðý artmýþtýr. 2010-2017 tarihleri arasýnda reanimasyon yoðun bakýmda TPD uyguladýðýmýz olgularýn klinik özelliklerini sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: Atatürk Eðitim ve Araþtýrma Hastanesi Aferez Ünitesi verileri retrospektif olarak incelenmiþtir. Merkezimizde yapýlan aferez iþlemlerinde Fresenius COM.TEC cihazý kullanýlmýþtýr. Reanimasyon yoðun bakýmda takip edilen toplam 41 olgunun yaþý, cinsiyeti, TPD endikasyonu, TPD sayýsý, Amerikan Aferez Derneði(ASFA) terapötik aferez kategorisi retrospektif olarak incelendi. 171 TPD iþlemi kaydedildi.
BULGULAR: Olgularýn ortanca yaþý 54 (19-88) bulundu. Kadýn erkek oraný 19/22 (%46,3/%53,7) di. Replasman sývýsý olarak 171 iþlemin 100 tanesinde taze donmuþ plazma, 71 tanesinde albümin kullanýlmýþtýr. TPD uygulanan olgular ASFA kategorilerine göre, 8'i kategori 1, 5'i kategori 2, 28'i (68.4%) kategori 3 idi. Suicid nedeniyle 2(%4,9), nörolojik nedenlerle 7 (%17,1), akutkaraciðer yetmezliði-hiperbilluribinemi nedeniyle 14 (%34,1), romatolojik nedenlerle 9 (%22), renal transplant rejeksiyonu nedeniyle 2(%4,9), septik þok nedeniyle de 2(%4,9) olguya TPD iþlemi uygulanmýþtý. Olgularýn ortalama yoðun bakýmda kalýþ süreleri 18,7(min-maks/ 2-68), gün, hospitalizasyon süresi ortalama 27(min-maks/5-110) gündü. TPD öncesi ve sonrasý ortalama hemoglobin (Hgb): 9,3 g/dl (5,3-18) ve 9,7 g/dl (8,2-14,7), trombosit sayýsý: 152.000/mikrol (2000-445.000) ve 167.000 mikrol (10000-480.000), TPD seans sayýsý ortalama 4, ortanca 4 (1-17) olarak saptandý. Ýþlem sýrasýnda mortalite gözlenmedi. Ýzlemleri sýrasýnda 23 hastanýn (%54,8) exitus, 18 hastanýn (% 42,9) sað olduðu belirlendi.
TARTIÞMA ve SONUÇ: Bizim merkezimizde TPD iþlemi en çok ASFA kategori 3 hasta grubunda uygulanmýþtýr. Bu grupta TPD ana tedaviyi destekleyicidir ve olgunun durumuna özgün olarak kullanýlýr. Sonuç olarak; yoðun bakým hastalarýnda TPD endikasyonlarýna bireysel yaklaþým önemlidir ve bilim dallarý arasýndaki multidispliner iletiþim plazmaferez uygulamalarýnýn tamamlayýcý tedavi seçeneði olarak uygulanabilirliðinde artýþa neden olabilecektir.

INTRODUCTION: Therapeutic plasma exchange (TPD) is a procedure in which the majority of patient plasma is replaced with replacement fluids and returned to the patient. TPD procedure is used as a primary treatment or complementary method in many diseases including hematologic, rheumatologic, neurological and toxicological diseases. Nowadays, the frequency of TPD usage in intensive care units has increased. We aimed to present the clinical features of patients undergoing TPD in the reanimation intensive care unit between 2010-2017.

METHODS: The data of the Apheresis Unit of Atatürk Training and Research Hospital were analyzed retrospectively. Fresenius COM.TEC device was used for apheresis operations in our center. Age, sex, indication for TPD, number of TPD, and American Apheresis Association (ASFA) therapeutic apheresis category of 41 patients who were followed in reanimation intensive care unit were retrospectively analyzed. 171 TPD operation evaluated.
RESULTS: The median age of the patients was 54 (19-88) years. The ratio of female to male was 19/22 (46.3% / 53.7%). According to ASFA categories, 8 cases were category 1, 5 cases were category 2, 28 cases (68.4%) were category 3. According to the reasons; TPD was performed in 2 (4.9%) suicid, 7 (17.1%) neurological, 14 (34.1%) acute liver failure-hyperbilluribinemia, 9 (22%) rheumatologic, 2 (4.9%) renal transplant rejection, 2(4.9%) septic shock patients. During the follow-up, it was determined that 23 patients (54.8%) died and 18 patients (42.9%) were alive.
DISCUSSION AND CONCLUSION: In our center, TPD was performed mostly in ASFA category 3 patients. In this group, TPD is supportive of the main treatment and is used specific to the condition of the case. As a result; Individual approach to the indications of TPD in ICU patients is important and multidisciplinary communication between disciplines may increase the applicability of plasmapheresis as a complementary treatment option.

GÝRÝÞ ve AMAÇ: Servikal lenfadenopati, pediatrik hastalarda sýk görülen bir semptomdur. Ek prediktif faktörlerin arttýrýlmasý, malign nedenleri iyi huylu nedenlerden ayýrmak için kritik öneme sahiptir. Bu çalýþmada, servikal lenfadenopatili çocuklarýn deðerlendirilmesinde nötrofil lenfosit oranýnýn klinik önemini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya 18 yaþ altý 86 çocuk hasta dahil edildi. Üç grup oluþturuldu ve kontrol grubu olan grup 1 (30 çocuk) hastanemizde sünnet veya inguinal herni nedeniyle opere edilen hastalardan oluþmaktadýr. Grup 2 çalýþma grubu (30 çocuk) olup kulak burun boðaz ve/veya pediatric hematoloji-onkoloji polikliniklerinde kronik servikal lenfadenopati nedeniyle deðerlendirilen hastalardan oluþmaktadýr. Grup 3 (26 çocuk) ise Hodgkin lenfoma tanýlý hastalardan oluþmaktadýr. Tüm gruplarýn nötrofil-lenfosit oranlarý analiz edilmiþtir.
BULGULAR: Ortalama nötrofil-lenfosit oranlarý açýsýndan grup 1 ve grup 3 (p <0.05) ile grup 2 ve grup3 (p <0.05) arasýnda anlamlý farklýlýk saptanmýþken grup1 ve grup 2 arasýnda anlamlý farklýlýk saptanmamýþtýr (p >0.05). ROC eðrisinde maksimum kombine hassasiyete ve özgüllüðe karþýlýk gelen 1.2 nötrofil-lenfosit oraný deðerine dayanarak bir alýcý ROC analizi yapýldý ve % 40 hassasiyet ve % 33 özgüllük belirlendi.
TARTIÞMA ve SONUÇ: Bu çalýþmada lenfomalý grupta diðer gruplara göre yüksek nötrofil-lenfosit oranlarý ortaya koymaktadýr. Ancak düþük özgüllük ve hassasiyet deðerleri, maligniteyi tespit etmek için parametrenin güvenilir olarak kullanýmýný kýsýtlar.

INTRODUCTION: Cervical lymphadenopathy is a common presenting symptom in pediatric patients. The differentiation of malignant from benign causes and increasing the armamentarium of additional predictive factors is critically important. In this study, we aimed to assess the clinical importance of neutrophil-lymphocyte ratio in the evaluation of children with cervical lymphadenopathy.
METHODS: Eighty-six (n: 86) children (<18 years of age) were the subjects of this study. Three groups were assigned and group 1 as a control patients (n: 30) who underwent circumcision or inguinal hernia repair in our hospital. Group 2 (n=30) as a study group composed of patients who were examined in the otorhinolaryngology and/or pediatric hematology-oncology outpatient clinics due to chronic enlarged cervical lymph nodes. Group 3 (n=26) was composed of patients who were diagnosed with Hodgkin lymphoma. The neutrophil-lymphocyte ratio in the groups were analyzed.
RESULTS: There was significant differences between the mean neutrophil-lymphocyte ratios of group 1 and 3 (p <0.05) and group 2 and 3 (p <0.05) whereas no significant difference was found between group 1 and 2 (p >0.05). A receiver operating characteristic (ROC) curve analysis was performed based on the neutrophil-lymphocyte ratio value of 1.2 corresponded to the maximum combined sensitivity and specificity on the ROC curve and 40% sensitivity and 33% specificity were determined.
DISCUSSION AND CONCLUSION: Present study reveals higher neutrophil-lymphocyte ratio in lymphoma group than the others. However low specificity and sensitivity values restricts the use of a reliable parameter to detect malignancy.

Ýnfantil hemanjioendotelyoma, batýnda kitle veya hepatomegali ile bulgu veren karaciðerin nadir görülen benign vasküler bir tümörüdür. Malign bir lezyon olmadýðý halde klinik olarak çok ciddi semptomlara neden olabilir. Bu nedenle doðru taný, uygun tedavi için çok önemlidir. Bu yazýda multipl hepatik infantil hemanjioendotelyoma tanýlý 6 aylýk bir hastanýn ultrasonografi ve BT bulgularý ile sunulmasý amaçlandý.

Infantile hemangioendothelioma is a rare benign vascular tumor of the liver which generally presenting an abdominal mass or hepatomegaly. Although it is considered a benign lesion it can cause clinically very serious symptoms. Therefore, correct diagnosis is very important for proper treatment. The case of a 6-month-old female patient with multiple hepatic infantile hemangioendotheliomas is reported with ultrasonographic and CT findings.

Bir hastada birbiri ile iliþkisiz en az iki malignite görülmesi, ‘Multipl Primer Maliginite’ olarak tanýmlanmaktadýr. Diffüz büyük B hücreli lenfoma (DBBHL), NHL’larýn en sýk görülen histopatolojik alt tipidir. DBBHL ile birçok ikincil malignite bildirilmesine raðmen, DBBHL ile pankreas kanseri birlikteliði çok nadir bir klinik tablodur. Biz burada multipl primer malignite olarak, DBBHL remisyonu sonrasý pankreas kanseri tanýsý alan nadir bir olguyu sunduk. Altmýþ sekiz yaþýnda erkek hasta dýþ merkezde DBBHL tanýsý alýp, sekiz kür kemoterapi sonrasý remisyona girmiþ. Kemoterapisi bittikten yaklaþýk beþ ay sonraki kontrollerinde kilo kaybý, karýn aðrýsý, iþtahsýzlýk, genel durum bozukluðu þikayetleri ortaya çýkmýþ. Kliniðimize baþvuran hastada pankreasta kitle ve karaciðerde metastatik lezyon saptandý. Karaciðerdeki lezyonun immünohistokimyasal bulgularý adenokarsinom metaztazý olarak deðerlendirildi. Klinik, patolojik, laboratuar bulgularý ile pankreas kanseri tanýsý konulmuþtur. Primer malignitelerin tedavisi ve takibinde ek bulgular ortaya çýktýðýnda, yeni geliþen ikincil malignitelerin ayýrýcý tanýsýnýn yapýlmasý gerektiðini düþünüyoruz.

The presence of at least two non-related malignancies in one patient is defined as Multiple Primer Maliginity. Diffuse large B-cell lymphoma (DLBCL) is the most common histopathological subtype of NHLs. Although many secondary malignancies have been reported with DLBCL, the association of DBBHL with pancreatic cancer is a very rare clinical entity. We report a rare case of multiple primary malignancies diagnosed as pancreatic cancer after remission of DBBHL. A 68-year-old man was diagnosed with DLBCL in another hospital and was in remission after eight cycles of chemotherapy. Approximately five months after the end of chemotherapy, weight loss, abdominal pain, loss of appetite, general state disorders appeared. The patient was admitted to our clinic with a mass in the pancreas and a metastatic lesion in the liver. Immunohistochemical findings of liver lesion were evaluated as adenocarcinoma metastasis. The patient was diagnosed with pancreatic cancer with clinical, pathological and laboratory findings. We think that differential diagnosis of newly developed secondary malignancies should be made when additional findings appear during the treatment and follow-up of primary malignancies.

Giriþ: Tedavi iliþkili olarak da hematopoietik maligniteler geliþebilmektedir. Biz burada, mide kanseri nedeni ile kemoterapi ve radyoterapi alan bir olguda yaklaþýk 3 yýl sonra geliþen bir akut lenfoblastik lösemi olgusunu bildirdik.
Olgu: Bilinen mide adenokarsinom tanýsý olan hasta subtotal gasrektomi sonrasýnda radyoterapi ile eþ zamanlý haftalýk FUFA (5 Fluoro-urasil/leucoverin) tedavisi almýþ. Yaklaþýk 3 yýl sonra lökositoz tespit edilen hastaya B hücreli akut lenfoblastik lösemi (B-ALL) tanýsý koyuldu. Philedelphia kromozomu t(9;22) RT PCR ile pozitif saptandý. Hasta 12 kür pomp idame + imatinib 600 mg tedavisi verildi. Nüks olan hastaya dasatinib tedavisine geçildi.
Tartýþma: Daha öncesinde kemoterapi almýþ olan hastalarda MDS ve AML haricinde ALL de geliþebileceði akýlda tutulmalýdýr.

Introduction: Hematopoietic malignancies may also develop in relation to treatment. Here, we report a case of acute lymphoblastic leukemia that developed in a patient who received chemotherapy and radiotherapy due to gastric cancer about 3 years later.
Case: A patient with known gastric adenocarcinoma received FUFA (5 Fluoro-uracil / leucoverin) weekly for simultaneous radiotherapy after subtotal gasrectomy. Leukocytosis was detected approximately 3 years later and B cell acute lymphoblastic leukemia (B-ALL) was diagnosed. The Philedelphia chromosome t (9; 22) was positive with RT PCR. The patient was given 12 cycles of POMP maintenance + imatinib 600 mg. The patient who had relapse was started on dasatinib treatment.
Discussion: It should be kept in mind that patients with previous chemotherapy may develop ALL instead of MDS and AML.

GÝRÝÞ: PNH da vücudun sýk tromboz görülmeyen bölgelerinde tromboz görülebilir. Karýn aðrýsý, halsizlik, erektil disfonksiyon, baþ aðrýsý, sýrt aðrýsý, yutma güçlüðü, damar týkanýklýðý veya hemoliz bulgularý görülebilir.
OLGU: 26 yaþýnda erkek hasta halsizlik ve karýn aðrýsý þikayeti ile hastaneye baþvurdu. Hastanýn epigastrik bölgede birkaç aydýr olan yemeklerden baðýmsýz ve kendi kendine gelip geçici tarzda aralýklý olan bir karýn aðrýsý þikayeti de mevcuttu. Hastanýn labaratuvar deðerlerinde: Hemoglobin: Hgb: 10,04 mg/ dL, WBC: 5100/µl, LDH: 964,8 U/L, indirekt bilirubin: 1,3 mg/ dL retikülosit sayýsý: 179 bin, transferrin saturasyonu: % 15,6, kreatin: 0,62 mg/dL, sedimantasyon: 38 mm/saat, CRP: 19,6 INR: 1,22 trombosit: 143 bin, direkt coombs: negatif, indirekt coombs: negatif. Vitamin B12, folik asit ve ferritin düzeyleri ise normal sýnýrlarda idi. Periferik yaymada lenfoplazmositer hücre artýþý mevcuttu, monositlerde artýþ mevcuttu, fragmente eritrosit izlenmedi, atipik hücre veya blast izlenmedi. Non-immün hemolitik anemisi mevcut olan hastaya PNH testi istenildi. PNH testi sonucu: Flow sitometrik analizde granülositlerde %95, monositlerde %96, eritrositlerde %5,9 ( TIP II+ TIP III ) PNH klonunun varlýðýný göstermektedir. Flow sitometrideki beyaz kürelerle eritrositlerin klon büyüklükleri arasýndaki farkýn hemolize ve/veya transfüzyona baglý olabileceði yorumunda bulunulmuþ. d-dimer: 1350 olan hastaya clexan 2x0,6 cc baþlanýldý.Hastaya eculizumab tedavisi baþlanýldý. Eculizumab tedavisi sonrasýnda hastanýn þikayetleri geriledi, semptomlarý duzeldi.
TARTIÞMA: Bizim olgumuzda da olduðu gibi karýn aðrýsý olan bir hastada eþlik eden hemoliz bulgusu varsa mutlaka PNH tanýsý da ayýrýcý tanýda düþünülmelidir. Hastalara hýzlý bir þekilde baþlanacak ekullizumab tedavisi ile tromboembolik riskin de azaltýlmasý saðlanýp saðkalým süresinin uzamasý saðlanabilecektir.

INTRODUCTION: Abdominal pain, fatigue, erectile dysfunction, headache, back pain, dysphagia,renal insufficiency, vascular occlusion or hemolysis might be seen in PNH.
CASE: A 26-year-old male patient presented to the hospital with fatigue and abdominal pain. The patient complained of an abdominal pain that was not related with the meals. He had intermittent abdominal pain in the epigastric region for a few months. Labaratory values were as Hemoglobin: 10,04 mg / dL, WBC: 5100 /, creatinine: 0.62 mg / dL, sedimentation: 38 mm / h, CRP: 19.6, INR: 1.22, platelets: 143 thousand, direct coombs: negative, indirect coombs: negative, LDH: 964,8 U / L, indirect bilirubin: 1,3 mg / dL, reticulocyte count: 179 thousand, transferrin saturation: 15,6 %. Vitamin B12, folic acid and ferritin levels were with in normal limits. Peripheral blood smear showed an increase in lymphoplasmacytic cells, an increase in monocytes, no fragmented erythrocytes and no atypical cells or blasts. PNH test was done by flowcytometry to the patient with non-immun hemolytic anemia. Flowcytometric analysis showed the PNH clone in 95% of granulocytes, in 96% of monocytes and in 5.9% of erythrocytes (Type II + Type III). It has been interpreted that the clonal PNH rate difference between the white cells and erythrocytes in the flow cytometric analysis might be due to hemolysis and/or transfusion. The patient was started to enoxaparine 2x0,6 cc subcutaneously treatment due to the result of D-dimer value which was found as 1350. Eculizumab treatment was started. His symptoms have improved and his complaints have disappeared after eculizumab treatment.
DISCUSSION: If a patient with an abdominal pain had hemolysis as in our case, PNH should be kept in mind. Rapid eculizumab treatment would benefit these patients.

Dentigerous kistler bir odontojenik kist türü olup en sýk üçüncü molar diþ ile iliþkili olarak geliþir. Dentigerous kistler sýklýkla asemptomatiktir ancak bazen enfeksiyon, sinüzit veya kemikte ekspansiyon gibi komplikasyonlara neden olabilir. 22 yaþýnda siyahi erkek hasta, bir haftadýr giderek artan sol taraflý yüz þiþliði, sol yanak aðrýsý ve burun týkanýklýðý þikayeti ile hastanemize baþvurdu. Hastanýn fizik muayenesinde yüzünün sol tarafýnda þiþlik ve palpasyonla maksiller bölgede hassasiyet mevcuttu. Oral muayenesinde sol maksillar 3. molar diþin yeri boþtu. Hastaya paranazal sinüs BT çekildi. BT’de sol maksiller sinüs antrumunu dolduran 26x41 mm boyutlarýnda alveoler proces defekti ile iliþkili kistik lezyon izlendi. Kistin çevresinde ince kalsifiye bir duvar ve içinde anterior duvarda 3. molar diþ mevcuttu. Kistin maksiller sinüsün lateral duvarýný erode ettiði ve komþu yumuþak doku planlarý arasýna yayýldýðý görüldü. Hasta Caldwell-Luc prosedürü ile opere edildi. Ektopik diþ çýkarýldý ve tüm kist içeriði boþaltýldý. Hastanýn kontrolde þikayetlerinin geçtiði görüldü.

Dentigerous cysts are a type of odontogenic cyst that mostly develops in association with the third molar tooth. Dentigerous cysts are often asymptomatic but sometimes might be complicated by infection, sinusitis, or bone expansion. A 22-year-old black male patient was admitted to our hospital with complaints of 1- week progressive left-sided facial swelling, left cheek pain, and nasal obstruction. Physical examination revealed swelling on the left side of the face and tenderness in the maxillary region with palpation. Oral examination showed emptiness at the site of left maxillary third molar tooth. The patient underwent paranasal sinus CT. CT showed a 26x41 mm cystic lesion associated with alveolar process defect in left maxillary sinus antrum. There was a thin calcified wall around the cyst and a third molar tooth in the anterior wall. The cyst eroded the lateral wall of the maxillary sinus and spread adjacent soft tissue plans. The patient was operated with Caldwell-Luc procedure. The ectopic tooth was removed and all cyst contents were evacuated. The patient’s complaints were disappeared at the control.