GÝRÝÞ ve AMAÇ: Ortalama trombosit hacmi (MPV) kýrmýzý kan hücresi daðýlým geniþliði (RDW) testleri rutin tam kan sayýmýnda bulunan basit testlerdir. Ýnflamasyon, MPV ve RDW deðerlerinde deðiþiklikler yapabilir. Bu çalýþmada KRK, adenom ve saðlýklý kontrollerin MPV ve RDW deðerlerini karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: KRK veya irritabl barsak hastalýðý þikayetleri nedeniyle kolonoskopik tarama yapýlan vakalarýn MPV ve RDW deðerleri retrospektif olarak deðerlendirilmiþtir. Kolonoskopi ve histopatolojik bulgularýna göre göre hastalar KRK, adenom ve normal kontrol grubu olmak üzere 3 ayrý gruba ayrýldý. Sonrasýnda adenom grubu displazi ve villöz komponent varlýðýna göre yüksek olasýlýklý prekanseröz ve düþük olasýlýklý prekanseröz olarak 2 alt gruba ayrýldý
BULGULAR: Çalýþmaya ardýþýk toplam 602 hasta alýndý. Bunlardan KRK grubunda (n=130)’si, adenom grubunda (n=241)’si ve normal kolonoskopik bulgularý olan (n=233)’si hasta kontrol grubundaydý. KRK grubunda diðer grublara nazaran hemoglobin, MCV deðerleri daha düþükken trombosit sayýlarý daha yüksek bulundu (P<0.001). MPV ortanca deðerleri KRK, adenom ve kontrol gruplarý arasýnda karþýlaþtýrýldýðýnda sýrasýyla (7,51-7,91-7,90 ve P<0,001). Ayrýca RDW median deðerleri gruplara arasýnda (15,7-14,6-14,4 ve P<0,001) istatistiksel olarak anlamlý bulundu. Adenom alt gruplarý karþýlaþtýrýldýðnda düþük-yüksek olasýlýklý gruplar arasýnda sadece RDW açýsýndan istatistiksel anlamlý fark tespit edildi (14,4-14,8,ve P=0.02). MPV deðerleri açýsýndan gruplar araýnda fark bulunamadý (7,89-8,04 ve P>0.05).
TARTIÞMA ve SONUÇ: Kolonoskopik taramaya alýnacak vakalarda RDW ve MPV deðerleri dikkate alýnmalýdýr.

INTRODUCTION: Mean platelet volume (MPV) and red blood cell distribution width (RDW) are simple tests in routine complete blood count. We aimed to evaluate RDW and MPV values of patients with colorectal carcinoma (CRC) and adenomas and controls.
METHODS: The MPV and RDW values of participitants who undergone colonoscopic examination for CRC screening or irritable bowel syndrome related symptoms were evaluated retrospectively. Patients were divided into three groups according to colonoscopic and histopathologic findings: CRC group, adenoma group and control group. Patients with adenomas then were separated into two subgroups according to dysplasia and villous component as high probable precancerous (HPP) and low probable precancerous (LPP) groups.
RESULTS: A total of consecutive 602 participants were enrolled into the study. There were n=130 patients in CRC, n=241 patients adenoma group and n=233 in control group. The CRC group had lower hemoglobin, MCV values and higher platelet count compared with adenoma group and control group. The median MPV values of CRC group (7.51) were lower than of adenoma group (7.91) and control group (7.90) (P<0.001, for both). The median RDW value of CRC group (15.7) was significantly higher than of adenoma group (14.6) and controls (14.4) (P=0.01, for both). When compared adenoma subgroups, the only different parameter was RDW between LPP and HPP (14.4 vs. 14.8, P=0.02). The MPV values did not differ between groups (7.89 vs. 8.04, P>0.05).
DISCUSSION AND CONCLUSION: The RDW and MPV values should be taken into consideration in patients who undergone colonoscopic screening.

AMAÇ: Bu çalýþmadaki amacýmýz, renal hücreli kanser (RHK) ' in papiller ve þeffaf alt tiplerinin ayýrt edilmesinde difüzyon aðýrlýklý görüntüleme (DAG) ' nin yararlýlýðýný saptamaktýr.
YÖNTEMLER: Papiller tip ve þeffaf hücreli tip RHK ' li toplam 16 olgu retrospektif olarak deðerlenmiþtir. Ýnceleme 3 Tesla alan gücüne sahip manyetik rezonans cihazýnda gerçekleþtirilmiþtir. Renal kitle konturlarý T2 aðýrlýklý görüntülerden de faydalanýlarak sýnýrlanmýþ ve kistik-nekrotik dejenerasyon alanlarý dýþarýda kalacak þekilde elle çizilen ilgi alaný (freehand ROI) kullanýlarak kitlelerin solid komponentlerinin b=50 sn/mm2 ve b=1000 sn/mm2 DAG’lerde görünür difüzyon katsayý (apparent diffusion coefficient =ADC) deðerleri ve ortalama sinyal intensite (SI) deðerleri ile böbreðin normal parankiminin ortalama SI deðerleri ölçülmüþtür. Normal parankimin SI deðerlerinin ölçümü için ROI kortikomedüller bileþkeye yerleþtirilmiþtir.


BULGULAR: Ortalama ADC deðeri papiller RHK’ larda (0.991 ± 0.143×10ˉ³ mm²/sn) þeffaf hücreli RHK’ lardan istatistiksel olarak anlamlý derecede düþüktü (1.296 ± 0.277 × 10ˉ³ mm²/sn) (p<0.05). Ayrýca papiller RHK grubunda, b=1000 sn/mm2 DAG’lerde ölçülen ortalama SI deðerleri (22.8 ± 6.3), normal parankimden (43.4± 14.8); þeffaf hücreli RHK grubunda b=50 sn/mm2 DAG’ lerde ölçülen ortalama SI deðerleri (102± 27.5), normal parankimden (138.8 ± 33) istatistiksel olarak farklýydý (p<0.05).
SONUÇ: Papiller ve þeffaf hücreli kanser subtiplerinin ayýrt edilebilmesinde difüzyon aðýrlýklý görüntüleme faydalý bir yöntem olabilir. Papiller hücreli kanserlerin sýnýrlarý, b=1000 sn/mm2; þeffaf hücreli kanserlerin sýnýrlarý ise b=50 sn/mm2 DAG’lerde daha net olarak seçilebilmektedir. Bulgularýmýzýn desteklenmesi için daha geniþ hasta serisini kapsayan çalýþmalara gereksinim vardýr.

OBJECTIVE: To determine the utility of diffusion-weighted imaging (DWI) in differentiation of papillary and clear cell subtypes of renal cell carcinoma (RCC).
METHODS: A total of 16 patients with papillary RCC and clear cell RCC were enrolled in this retrospective study. Patients underwent MRI with a 3.0-Tesla wholebody system (MAGNETOM Verio, Siemens, Erlangen, Germany) using a standard body matrix coil. Apparent diffusion coefficient (ADC) values and signal intensity (SI) values at b=50 s/mm2 b=1000 s/mm2 DWI of solid components of the renal masses and SI values of normal renal parenchyma were measured. A freehand ROI was drawn around the peripheral margin of the tumor on the diffusion images excluding the cystic or necrotic portions, while referring to the T2-weighted conventional images for verification of lesion boundaries. To measure SI values of normal renal parenchyma, ROIs were placed on the normal corticomedullary junction.
RESULTS: Mean ADC value was statistically significantly lower in papillary RCC (0.991 ± 0.143×10ˉ³ mm²/s) than in that of clear cell RCC (1.296 ±.0.277 × 10ˉ³ mm²/s). For the papillary RCC group, there was statistically significant difference (p<0.05) between mean SI values of normal parenchyma (22.8 ± 6.3) and lesion (43.4± 14.8) at b=1000 s/mm2 DWI; for the clear cell RCC group there was statistically significant difference (p<0.05) between mean SI value of normal parenchyma (138.8 ± 33) and lesion (102± 27.5) at b=50 s/mm2 DWI.
CONCLUSION: For discrimination of papillary and clear cell subtypes of RCC, DWI seems to be a useful method. The boundaries of papillary RCC can be more clearly perceived on b=1000 s/mm2 and that of clear cell RCC on b=50 s/mm2 DWI. However, more extensive research on a larger series of patients are needed to support our findings.

GÝRÝÞ ve AMAÇ: Yazarlar, tek bir merkezde intraoral bölge için gerçekleþtirilen serbest flep rekonstrüksiyonlarýný deðerlendirmeyi amaçlamýþlardýr.
YÖNTEM ve GEREÇLER: Baþ boyun bölgesindeki defektlerin rekonstrüksiyonu için 4 yýllýk süre içinde onbir tane serbest doku nakli gerçekleþtirildi. Hastalar, defekt lokalizasyonu, uygulanan flepler, komplikasyonlar ve hastanede yatýþ süreleri açýsýndan deðerlendirildi.
BULGULAR: Yedi hasta serbest radial önkol flebi ile, iki hasta serbest vertikal rektus abdominis muskulokütan flebi ile, bir hasta serbest transvers rektus abdominis muskulokütan flebi ile bir hasta da serbest fibula osteomuskulokütan flebi ile rekonstrükte edildi. Fleplerin hiçbirinde anastomozda tromboz veya hematom nedeniyle reeksplorasyon yapýlmadý. Flep kaybý görülmedi. Mortalite veya major morbidite ile karþýlaþýlmadý. Ortalama hastanede yatýþ süresi 21.1 gündü (11-25 gün).
TARTIÞMA ve SONUÇ: Aðýz içi defektlerinin rekonstrüksiyonu için multidisipliner yaklaþým desteklenmelidir. Uzun ameliyat süresi, donör alan morbiditesi ve mikrocerrahi baþarýsýzlýðý gibi riskleri olmasýna raðmen serbest doku nakilleri birçok kompleks defektin onarýmýna olanak saðlamaktadýr.

INTRODUCTION: The authors aimed to evaluate the outcomes of free flap reconstructions performed for intraoral region in a single center.
METHODS: Eleven free flaps have been performed for defects of the head and neck over a 4-year period. The patients were evaluated in terms of defects, flaps performed, complications and hospital stays.
RESULTS: Seven patients were reconstructed with radial forearm free flap, one patient was reconstructed with free transverse rectus abdominis musculocutaneous flap, two patients were reconstructed with free vertical rectus abdominis musculocutaneous flap and the remaining one was reconstructed with free fibula osteomusculocutaneos flap. None of the flaps required reexploration for anastomotic thrombosis or hematoma. No flap failure occurred. We did not encounter any mortality or major morbidity. The average hospital stay was 21.1 days with a range from 11 to 25 days.
DISCUSSION AND CONCLUSION: Multidisciplinary approach should be encouraged for the reconstruction of intraoral defects. The versatility of free tissue transfers allows reconstruction of most complex defects; although it carries significant risks, including longer operative times, donor site morbidity, recipient site complications and microsurgical failure, and longer hospital stays.

AMAÇ: Sitotoksik kemoterapi, lokal ileri ve metastatik özefagus kanserinin standart tedavisidir. Biz bu çalýþmada lokal ileri ve metastatik özefagus skuamoz hücreli kanserde birinci basamakta sisplatin ve kýsa süreli infüzyonel 5-florourasil (5-FU) kombinasyonunun yararlarýný ve yan etkilerini deðerlendirdik.
YÖNTEMLER: Bu çalýþmada, retrospektif olarak aralýk 2006 ve temmuz 2013 tarihleri arasýnda sisplatin ve kýsa süreli infüzyonel 5-florourasil (5-FU) kombinasyonu ile tedavi edilen daha önceden tedavi almamýþ lokal ileri veya metastatik özefagus skuamoz hücreli kanserli hastalarý deðerlendirdik. Kemoterapi rejimi olarak sisplatin 75 mg/m2 d1 (1-3-saat infuzyon), kalsiyum lökoverin 60 mg/m2 d1-2 ve 5-FU 500 mg/m2 d1-2 (15-dakika infuzyon) 14 günde bir uygulandý.
BULGULAR: Hastalarýn 14’ü (%51.9) erkek ve 13’ü (%48.1) kadýn olup ortanca yaþ 57 (39-80) idi. ECOG performans skoru 20 (%77) hastada 0 veya 1 iken diðer hastalarda 2 olarak bulundu. Taný anýnda 10 hasta uzak metastaza sahipken 17 hasta lokal ileri hastalýða sahipti. Hastalar medyan 4 kür kemoterapi aldý. Tüm yanýt oraný %44.4’tü. (8 hastada parsiyel yanýt,4 hasta komplet yanýt) ve 7 (%25.9) hasta stabil hastalýða sahipti. Hastalýk kontrol oraný %70.3’tü. Hastalarýn medyan progresyonsuz saðkalýmý 6.2 (%95 CI: 5.13 7.28) ve medyan genel saðkalýmý 11.1 (%95 CI: 7.77-14.5) aydý. Hastalarýn % 40.7’sinde grade 3-4 nötropeni ve % 11.1’inde grade 3-4 trombositopeni saptandý.
SONUÇ: Sisplatin ve kýsa süreli infüzyonel 5-florourasil (5-FU) kombinasyonu ilaç infuzyonu için kateter gerektiren infüzyonel rejime alternative bir tedavi olarak düþünülebilir.

OBJECTIVE: Cytotoxic chemotherapy is the basic treatment for locally advanced and metastatic esophageal cancer. We evaluated the benefits and side effects of the first-line short-term infusional 5- Fluorouracil (5-FU) and cisplatin combination regimen in patients with locally advanced and metastatic esophageal squamous cell cancer.
METHODS: We retrospectively reviwed the untreated locally advanced or metastatic squamous cell esophageal cancer patients treated with short-term infusional 5-FU and cisplatin combination between December 2006 and july 2013. Chemotherapy regimen was administered as; cisplatin 75 mg/m2 on day 1 (1-3-h infusion), ca-leucovorin 60 mg/m2 d1-2 and 5-FU 500 mg/m2 d1-2 (15-min infusion) every 14 days.
RESULTS: There were 14 (51.9%) male and 13 (48.1%) female patients. The median age was 57 (range, 39-80) years. Twenty patients had an Eastern Cooperative Oncology Group performance status of 0 to 1 (77%), while the rest had PS of 2 (23%). At first diagnosis, 10 patients had distant metastases and 17 patients had localized disease. In total, 27 patients were treated with a median of four cycles. The overall response rate was 44.4% (8 partial responses, 4 complete responses) and 7 patients (25.9%) had stable disease. The disease control rate was 70.3%. Median progression free survival was 6.2 (95% CI: 5.13 7.28) months and median overall survival was 11.1 (95% CI: 7.77-14.5) months. Among the patients, 40.7% of them had grade 3-4 neutropenia, 11.1% of those patients had grade 3-4 thrombocytopenia.
CONCLUSION: Short-term infusional 5-FU and cisplatin combination regimen can be considered as an alternative treatment to an infusion regimen in which a catheter is necessary for the drug infusion.

Kolon kanseri ve beyin tümörü birlikteliði klinikte karþýmýza Muir-Torre Sendromu, Turcot Sendromu, Cowden Sendromu ya da Gardner Sendromu olarak çýkabilir. Turcot Sendromu multiple adenomatöz kolon polipleri ile santral sinir sisteminin (SSS) primer tümörünün birlikte görüldüðü DNA tamir genlerinde mutasyonlarla seyreden nadir bir hastalýktýr. Biz bu olguda polipozis zemininde geliþen kolon kanseri tanýsýndan üç yýl sonra glioblastome multiforme (GBM) tanýsý alan fakat genetik çalýþmada Turcot Sendromu desteklenemeyen genç bir kadýn hastayý sunduk.

The cooccurrence of colon cancer and brain tumor can be observed as Muir-Torre syndrome, Turcot syndrome, Cowden syndrome or Gardner's syndrome, in clinic. Turcot syndrome which comprises multiple adenomatous colon polyps and central nervous system (CNS) tumor is uncommon disease with mutations in DNA repair genes. We report the case of a young woman who presented with colon cancer that was developed on the ground of polyposis and after three years the patient was diagnosed glioblastoma multiforme (GBM) that couldn't be supported for Turcot Syndrome by genetic studies.

Castleman hastalýðý (CH), en sýk mediastende asemptomatik kitle olarak görülen lenfoproliferatif bir hastalýktýr. Baþ boyun bölgesinde ise en sýk boyun da görülür. Oral kavite de yerleþimi nadirdir. Tedavisinde cerrahi eksizyon uygulanýr. Bu makalede sað ve sol yanak mukoza altýnda, giderek büyüyen þiþlik þikayeti ile tarafýmýza baþvuran ve histopatolojik tanýsý castleman hastalýðý- plazma hücreli tip olarak raporlanan, non hodgkin lenfoma (NHL) öyküsü olan hasta, literatür eþliðinde sunulmuþtur.

Castleman disease (CD) is a lymphoproliferative disorder that is most frequently seen as an asymptomatic mass in the mediastinum. Among the head and neck region, the neck is the most frequent localization. It is seldom localized in the oral cavity. Surgical excision is the primary choice of treatment. The current study presents a patient with previous non-Hodgkin Lymphoma (NHL) history, who was complaining of a mass gradually increasing in size beneath the right and left buccal mucosa and a histopathological diagnosis of Castleman disease – plasma cell type. The related literature is also reviewed.

Ýris melanomlarýnýn çoðu daha önce var olan iris nevüsleri üzerinden geliþmektedir. Ýris melanomlarýnýn enükleasyon, metastaz ve fonksiyonel kayba neden olma riskleri nedeniyle erken tanýlarý oldukça önemlidir. Ýris nevüsünden melanom geliþimini kestirecek klinik parametrelerin farkýnda olunmasý melanom geliþimi açýsýndan riskli nevüs grubunun belirlenmesini ve iris melanomlarýn erken tespitini kolaylaþtýracaktýr. Bu derlemede iris nevüslerinin ve melanomlarýnýn klinik özellikleri ve ayýrt edici klinik parametreler sunuldu. Böylelikle bu hastalara klinik yaklaþýmda yardýmcý olunmasý amaçlandý.

Most of the iris melanomas arise from pre-existing iris nevi. Early diagnosis of iris melanomas is quite important because of potential risk of enucleation, metastasis and functional loss. Being aware of the clinical parameters predicting the development of melanoma from pre-existing nevus will help determining the hazardous nevus group and early diagnosis of iris melanomas. In this review, clinical features of iris nevi and melanomas and distinguishing clinical parameters were presented. Thus, helping in the clinical management of such patients were aimed.

Primer kardiyak anjiosarkoma, kötü prognozlu nadir bir hastalýktýr. Açýk kardiyak cerrahi operasyon olan ve sað atriumda kardiyak anjiosarkoma tanýsý alan 34 yaþýnda erkek hasta týbbi onkoloji bölümüne baþvurdu. Tümörün tam küratif rezeksiyonu mümkün olmamýþtý ve hastaya postoperatif dönemde 6 siklus kombinasyon kemoterapi rejimen (doksorubisin ve mesna korumasýyla ifosfamid) verildi. Hastada 8 ay boyunca stabil hastalýk mevcuttu, ve progresyon sonrasýnda ikinci sýra kemoterapi (paklitaksel) baþlandý, ancak hasta tanýdan 15 ay sonra kaybedildi. Kardiyak anjiosarkoma olgularýnýn çoðunda küratif rezeksiyonlar mümkün olmadýðýndan daha ileri tedavi seçeneklerine son derece ihtiyaç vardýr.

Primary cardiac angiosarcoma is a rare disease with poor prognosis. A 34-year-old male patient who underwent an open cardiac surgery and diagnosed as cardiac angiosarcoma on the right atrium was admitted to the medical oncology department. Complete curative resection of the tumor was not possible and postoperatively 6 cycles of combination chemotherapy regimen (ifosphamide with mesna protection and doxorubicin) was given. Patient had stable disease for 8 months, and after progression a second-line chemotherapy (paclitaxel) was started but he died after 15 months of diagnosis. Since curative resections are not possible in most of the cardiac angiosarcoma cases, further treatment options are desperately needed.