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1.
BMC Res Notes ; 14(1): 346, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481515

RESUMO

OBJECTIVE: Studies on the genetic background of patients with multiple myeloma (MM) have been increasing; two important factors considered in such works are uncoupling protein-2 (UCP-2) and nuclear receptor subfamily 3 group C member 1 (NR3C1). We aim to reveal the association of MM with NR3C1 and UCP-2 gene polymorphisms. In this prospective study, 200 patients diagnosed between January 2009 and 2018 and 200 healthy individuals were included. For patients who had undergone autologous stem cell transplantation and control subjects, we statistically compared the CC, GC, and GG genotypes and the C and G alleles of the NR3C1 gene, as well as the AA, AG, and GG genotypes and the A and G alleles of the UCP-2 gene. RESULTS: While the AA genotype was significantly more common in the MM group (p = 0.001), the GG genotype was significantly more common in the control group (p = 0.016). Overall survival was found to be significantly shorter in patients with the UCP-2 GG genotype (p = 0.034). It was also found that having the GG genotype of the UCP-2 gene was a 2.48-fold risk factor for mortality. The fact that overall survival is significantly shorter in MM patients with the UCP-2 GG genotype and its definition as a risk factor for mortality have been put forward for the first time in the literature.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo , Receptores de Glucocorticoides , Proteína Desacopladora 2 , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Mieloma Múltiplo/genética , Mieloma Múltiplo/terapia , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Receptores de Glucocorticoides/genética , Transplante Autólogo , Resultado do Tratamento , Proteína Desacopladora 2/genética
2.
Turk J Haematol ; 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34448556

RESUMO

Objective: To retrospectively evaluate efficacy, safety, survival outcome of single-agent ibrutinib therapy in chronic lymphocytic leukemia patients. Methods: 136 patients (mean(SD) age 64.6(10.3) years, 66.9% were males) who had at least one dose of ibrutinib were included in this retrospective multi-center, non-interventional hospital-registry study conducted at 136 centers across Turkey. Data on patient demographics, baseline characteristics, laboratory findings, leukemia-cell cytogenetics were retrieved. Treatment response, survival outcome including overall survival (OS), progression-free survival (PFS) and safety data were analyzed. Results: Overall, 36.7% of patients had ECOG class 2-3, 44.9 % were in Rai stage 4. FISH revealed presence of del(17p) in 39.8% of patients. Patients received median 2.0 (ranged 0 to 7) lines of pre-ibrutinib therapy. Median duration of therapy was 8.8 months (ranges, 0.4 to 58.0 months). 1-year PFS and OS rates were 82.2% and 84.6%, respectively, median (SE, 95% CI) PFS time was 30.0(5.1, 20.0 to 40.0) months and OS time was 37.9(3.2, 31.5 to 44.2) months. Treatment response (CR or PR), PFS time and OS time were better with 0-2 lines vs. 3-7 lines of prior therapy (p<0.001, p=0.001 and p<0.001, respectively), with ECOG class 0-1 vs. class 2-3 (p=0.006, p=0.011and p=0.001, respectively), with Rai stage 0-2 vs. 3-4 (p=0.002, p=0.001 and p=0.002, respectively. No significant difference was noted in treatment response rates or survival outcome with respect to presence of comorbidity, bulky disease or del(17p). 176 adverse events (AEs) were reported in 74 (54.4%) patients; 46 of 176 AEs were grade 3-4 including pneumonia (n=12), neutropenia (n=11), anemia (n=5), thrombocytopenia (n=5) and fever (n=5). Conclusions: This real-life analysis confirms favorable efficacy and safety profile of long-term ibrutinib treatment, while emphasize the potential adverse impact of poorer ECOG performance status, being heavily treated prior to ibrutinib and advanced Rai stage on patient compliance, treatment response and survival outcomes.

3.
Ann Hematol ; 100(7): 1667-1675, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33988739

RESUMO

The aim of this study is to collect paroxysmal nocturnal hemoglobinuria (PNH) patient data from hematology centers all over Turkey in order to identify clinical features and management of PNH patients. Patients with PNH were evaluated by a retrospective review of medical records from 19 different institutions around Turkey. Patient demographics, medical history, laboratory findings, and PNH-specific information, including symptoms at the diagnosis, complications, erythrocyte, and granulocyte clone size, treatment, and causes of death were recorded. Sixty patients (28 males, 32 females) were identified. The median age was 33 (range; 17-77) years. Forty-six patients were diagnosed as classic PNH and 14 as secondary PNH. Fatigue and abdominal pain were the most frequent presenting symptoms. After eculizumab became available in Turkey, most of the patients (n = 31/46, 67.4%) were switched to eculizumab. Three patients with classic PNH underwent stem cell transplantation. The median survival time was 42 (range; 7-183 months) months. This study is the first and most comprehensive review of PNH cases in Turkey. It provided us useful information to find out the differences between our patients and literature, which may help us understand the disease.


Assuntos
Hemoglobinúria Paroxística/epidemiologia , Adolescente , Adulto , Idoso , Aloenxertos , Anticorpos Monoclonais Humanizados/uso terapêutico , Doenças da Medula Óssea/complicações , Substituição de Medicamentos , Feminino , Hemoglobinúria Paroxística/tratamento farmacológico , Hemoglobinúria Paroxística/etiologia , Hemoglobinúria Paroxística/terapia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Avaliação de Sintomas , Trombofilia/etiologia , Resultado do Tratamento , Turquia/epidemiologia , Adulto Jovem
4.
Clin Lab ; 66(9)2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902222

RESUMO

BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematopoietic stem cell disease that may lead to weakness and death of patients, if unrecognized and untreated. Although consensus guidelines were reviewed recently for the diagnostic screening of PNH with multi-parameter flow cytometry (FCM), until now, no study has investigated the efficiency of such clinical indications in older patients. METHODS: Overall, 20 centers participated in the study and a total of 1,689 patients were included, 313 of whom were at geriatric age and 1,376 were aged 18 - 64 years. We evaluated the efficiency of consensus clinical indications for PNH testing using FCM in peripheral blood samples and compared the results of older patients and patients aged 18 - 64 years. RESULTS: PNH clones were detected positive in 7/313 (2.2%) of the older patients. Five (74.4%) of the patients with PNH clones had aplastic anemia, 1 had unexplained cytopenia, and 1 patient had myelodysplastic syndrome (MDS) with refractory anemia. PNH clones were not detected in any older patients who were screened for unexplained thrombosis, Coombs (-) hemolytic anemia, hemoglobinuria, and others (e.g., elevated lactate dehydrogenase (LDH), splenomegaly). We detected PNH clones in 55/1376 (4%) samples of the patients aged under 65 years. Forty-two (76.4%) patients with PNH clones had aplastic anemia, 2 patients had Coombs (-) hemolytic anemia, 3 patients had unexplained cytopenia, 1 patient had MDS with refractory anemia, 1 patient had hemoglobinuria, and 6 (10.9%) had others (e.g., elevated LDH, splenomegaly). PNH clones were not detected in any patients who were screened for unexplained thrombosis. There was no statistical difference between the geriatric population and patients aged 18 - 64 years in terms of clinical indications for PNH screening with FCM (p = 0.49). CONCLUSIONS: Our results showed that the current clinical indications for PNH screening with FCM were also efficient in older patients. We suggest that older patients with unexplained anemia, myelodysplastic syndrome with refractory anemia, and unexplained cytopenia should be screened for PNH with FCM to identify patients who would benefit from treatment.


Assuntos
Anemia Aplástica , Hemoglobinúria Paroxística , Síndromes Mielodisplásicas , Idoso , Teste de Coombs , Citometria de Fluxo , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/diagnóstico , Humanos , Lactente
5.
Transfus Apher Sci ; 58(5): 659-662, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31542336

RESUMO

BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease presenting with variable and various clinical findings. PNH might be overlooked and diagnosis may be delayed due to low awareness about PNH. This is the first multicenter study in Turkey, investigating the efficiency of diagnostic screening of PNH by multiparameter flow cytometry (FCM) according to consensus guidelines. METHODS: We evaluate the efficiency of consensus clinical indications for PNH testing with FCM in 1689peripheral blood samples from 20 centers between January 2014 and December 2017. RESULTS: Overall, at the 20 centers contributing to this study, PNH clone were detected in 62/1689 samples (3.6%) by FCM test. 75.8% (n = 47) of patients with PNH clone had aplastic anemia, 3.2% (n = 2) had Coombs (-) hemolytic anemia, 6.5% (n = 4) had unexplained cytopenia, 3.2% (n = 2) had MDS with refractory anemia, 1.6% (n = 1) had hemoglobinuria and 9.7% (n = 6) had others (elevated LDH, splenomegaly, etc.). In contrast, we detect no PNH clone test in patients who were screened for unexplained thrombosis. CONCLUSIONS: Our study showed that current clinical indications for PNH testing are highly efficient and diagnostic screening of suspected patients for PNH with FCM is recommended. However, advanced screening algorithms are required for patients presenting with unexplained thrombosis and normal complete blood count.


Assuntos
Anemia Refratária , Teste de Coombs , Citometria de Fluxo , Hemoglobinúria Paroxística , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Refratária/sangue , Anemia Refratária/diagnóstico , Feminino , Hemoglobinúria Paroxística/sangue , Hemoglobinúria Paroxística/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Turquia
6.
Transfus Apher Sci ; 57(1): 27-30, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29503132

RESUMO

Thrombotic microangiopathies (TMAs) are rare, but life-threatening disorders characterized by microangiopathic hemolytic anemia and thrombocytopenia (MAHAT) associated with multiorgan dysfunction as a result of microvascular thrombosis and tissue ischemia. The differentiation of the etiology is of utmost importance as the pathophysiological basis will dictate the choice of appropriate treatment. We retrospectively evaluated 154 (99 females and 55 males) patients who received therapeutic plasma exchange (TPE) due to a presumptive diagnosis of TMA, who had serum ADAMTS13 activity/anti-ADAMTS13 antibody analysis at the time of hospital admission. The median age of the study cohort was 36 (14-84). 67 (43.5%), 32 (20.8%), 27 (17.5%) and 28 (18.2%) patients were diagnosed as thrombotic thrombocytopenic purpura (TTP), infection/complement-associated hemolytic uremic syndrome (IA/CA-HUS), secondary TMA and TMA-not otherwise specified (TMA-NOS), respectively. Patients received a median of 18 (1-75) plasma volume exchanges for 14 (153) days. 81 (52.6%) patients received concomitant steroid therapy with TPE. Treatment responses could be evaluated in 137 patients. 90 patients (65.7%) achieved clinical remission following TPE, while 47 (34.3%) patients had non-responsive disease. 25 (18.2%) non-responsive patients died during follow-up. Our study present real-life data on the distribution and follow-up of patients with TMAs who were referred to therapeutic apheresis centers for the application of TPE.


Assuntos
Síndrome Hemolítico-Urêmica/terapia , Troca Plasmática , Proteína ADAMTS13/sangue , Proteína ADAMTS13/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Autoanticorpos/imunologia , Feminino , Seguimentos , Síndrome Hemolítico-Urêmica/imunologia , Síndrome Hemolítico-Urêmica/mortalidade , Síndrome Hemolítico-Urêmica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Turquia
7.
J Infect Dev Ctries ; 10(4): 389-94, 2016 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-27131001

RESUMO

INTRODUCTION: In this study, clinical, laboratory, radiological, and serological examinations of fascioliasis patients were analyzed, and data with a significant impact on differential diagnosis were evaluated. METHODOLOGY: Clinical, radiological, and laboratory findings and treatment responses of a total of 22 fascioliasis patients, treated between October 2009 and September 2014, were evaluated. Nineteen patients were diagnosed with fascioliasis at the invasive phase and three patients at the chronic phase. Patients were followed up for clinical, laboratory, and radiology findings for a period of three months to one year after treatment. RESULTS: The most frequent complaints in both groups were abdominal pain, and the most common physical examination finding was epigastric tenderness. In the performed examination, an eosinophil elevation in whole blood count was detected in 19 patients (100%) in the hepatic phase, and in 2 patients (66.6%) in the biliary phase. The results of the Fasciola hepatica indirect hemagglutination assay (IHA) test ordered in the diagnosis were positive in all patients. Treatment with 10 mg/kg/day triclabendazole for two consecutive days was effective. Live parasites were extracted from patients in the biliary phase with endoscopic retrograde cholangiopancreatography. In the follow-ups, remission in IHA titer and clinical and radiological improvement was achieved in all patients. CONCLUSIONS: If hypereosinophilia is detected by peripheral smear in patients who are admitted with complaints such as abdominal pain, weakness, nausea, myalgia, and weight loss, radiological evaluation and serological tests should be performed and fascioliasis should be considered in the differential diagnosis.


Assuntos
Fasciolíase/diagnóstico , Fasciolíase/patologia , Dor Abdominal/diagnóstico , Adulto , Idoso , Animais , Anti-Helmínticos/administração & dosagem , Benzimidazóis/administração & dosagem , Diagnóstico Diferencial , Fasciola hepatica/isolamento & purificação , Fasciolíase/diagnóstico por imagem , Fasciolíase/tratamento farmacológico , Feminino , Seguimentos , Testes de Hemaglutinação , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Triclabendazol , Turquia
8.
Genet Test Mol Biomarkers ; 18(6): 403-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24819026

RESUMO

The aim of this study was to explore the association between polymorphisms of five cytokine genes and clinical parameters in patients with Philadelphia-positive (Ph+) chronic myeloid leukemia (CML) treated with imatinib. We analyzed five cytokine genes (interleukin [IL]-6, IL-10, gamma interferon [IFN-γ], transforming growth factor beta-1 [TGF-ß1], and tumor necrosis factor-alpha [TNF-α]) in 60 cases with Ph+ CML and 74 healthy controls. Cytokine genotyping was performed by the polymerase chain reaction-sequence-specific primer. All data were analyzed using the de Finetti program and SPSS version 14.0 for Windows. No significant differences were detected between the CML group and healthy controls with respect to the distributions and numbers of genotypes and alleles in TNF-α, TGF-ß1, IL-10, and IFN-γ. However, the GG genotype associated with high expression in IL-6 was found to be significantly more frequent in CML as compared to controls (p=0.010). The median follow-up time was 49.3 months (range 6.1-168.4) and the median duration of imatinib treatment was 39.5 months (range 5.2-103.4) for these patients. On multivariateanalysis, only IL-10 GCC/GCC highly produced haplotypes were significantly associated with a shorter event-free survival. The relationship between cytokine genotypes/haplotypes and clinical parameters in CML has not been investigated before. Our results suggest that IL-10 may be a useful marker for CML prognosis and theGG genotype of the IL-6 gene may be associated with susceptibility.


Assuntos
Biomarcadores Tumorais/genética , Citocinas/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Feminino , Humanos , Interferon gama/genética , Interleucina-10/genética , Interleucina-6/genética , Masculino , Pessoa de Meia-Idade , Prognóstico , Fator de Crescimento Transformador beta1/genética , Fator de Necrose Tumoral alfa/genética , Adulto Jovem
9.
Transfus Apher Sci ; 48(3): 349-52, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23619327

RESUMO

Therapeutic plasma exchange (TPE), is a procedure, changing pathologic substances in the plasma of patients with replacement fluid. TPE has an increasing list of indications in recent years such as neurological, connective tissue, hematological, nephrological, endocrinological and metabolic disorders. We report our multicenter data about therapeutic plasma exchange in patients with neurological diseases. Six University Hospitals' aphaeresis units medical records about neurologic diseases were reviewed retrospectively. Hundred and fifteen patients and 771 TPE sessions from six aphaeresis units' were included to this study. Of the 115 patients, 53 (46%) were men and 62 (54%) were women. The median age was 50 (range: 5-85) years. Of these patients 58.3% were Guillain-Barre syndrome (GBS), 17.4% were acute disseminated encephalomyelitis (ADEM), 10.4% were chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), 7% were multiple sclerosis, 6.1% were myasthenia gravis (MG) and 0.9% were Wilson disease (WD). The median number of TPE sessions per patient was 5 (range 1-72). Human albumin was used as a replacement fluid in 66% and fresh frozen plasma was used in 34% of cases. TPE was done through central venous catheters in 66%, and peripheral venous access in 34% of patients. Some complications were seen in patients (18.3%) during TPE sessions. These complications were, complications related to catheter placement procedure (8.7%), hypotension (3.5%), hypocalcaemia (3.5%) and allergic reactions (1.7%). The complication ratios were 2.7% in total 771 TPE procedures. TPE procedure was terminated in 6% of sessions depending on these complications. Overall responses to TPE were noted in 89.5% of patients. In conclusion; Therapeutic plasma exchange is an effective treatment option in several neurologic diseases.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Encefalomielite Aguda Disseminada/terapia , Síndrome de Guillain-Barré/terapia , Esclerose Múltipla/terapia , Miastenia Gravis/terapia , Troca Plasmática/métodos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminas/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Transfus Apher Sci ; 48(3): 353-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23602056

RESUMO

UNLABELLED: Thrombotic thrombocytopenic purpura (TTP) is a particular form of thrombotic microangiopathy typically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological abnormalities, and renal dysfunction. TTP requires a rapid diagnosis and an adapted management in emergency. Daily sessions of therapeutic plasma exchange (TPE) remain the basis of management of TTP. Also, TTP is a rare disease that is fatal if it is not treated. TPE has resulted in excellent remission and survival rates in TTP patients. AIM: We aimed to present our experience in 163 patients with TTP treated with TPE during the past 5years from 10 centers of Turkey. PATIENTS AND METHODS: One hundered and sixty-three patients with TTP treated with TPE during the past 5years from 10 centers of Turkey were retrospectively evaluated. TPE was carried out 1-1.5times plasma volume. Fresh frozen plasma (FFP) was used as the replacement fluid. TPE was performed daily until normalization of serum lactate dehydrogenase (LDH) and recovery of the platelet count to >150×10(9)/dL. TPE was then slowly tapered. Clinical data, the number of TPE, other given therapy modalities, treatment outcomes, and TPE complications were recorded. RESULTS: Fifty-eight percent (95/163) of the patients were females. The median age of the patients was 42years (range; 16-82). The median age of male patients was significantly higher than female (53 vs. 34years; p<0.001). All patients had thrombocytopenia and microangiopathic hemolytic anemia. At the same time, 82.8% (135/163) of patients had neurological abnormalities, 78.5% (128/163) of patients had renal dysfunction, and 89% (145/163) of patients had fever. Also, 10.4% (17/163) of patients had three of the five criteria, 10.4% (17/163) of patients had four of the five criteria, and 6.1% (10/163) of patients had all of the five criteria. Primary TTP comprised of 85.9% (140/163) of the patients and secondary TTP comprised of 14.1% (23/163) of the patients. Malignancy was the most common cause in secondary TTP. The median number of TPE was 13 (range; 1-80). The number of TPE was significantly higher in complete response (CR) patients (median 15.0 vs. 3.5; p<0.001). CR was achieved in 85.3% (139/163) of the patients. Similar results were achieved with TPE in both primary and secondary TTP (85% vs. 87%, respectively; p=0.806). There was no advantage of TPE+prednisolone compared to TPE alone in terms of CR rates (82.1% vs. 76.7%; p=0.746). CR was not achieved in 14.7% (24/163) of the patients and these patients died of TTP related causes. There were no statistical differences in terms of mortality rate between patients with secondary and primary TTP [15% (21/140) vs. 13% (3/23); p=0.806]. But, we obtained significant statistical differences in terms of mortality rate between patients on TPE alone and TPE+prednisolone [14% (12/86) vs. 3% (2/67), p<0.001]. CONCLUSIONS: TPE is an effective treatment for TTP and is associated with high CR rate in both primary and secondary TTP. Thrombocytopenia together with microangiopathic hemolytic anemia is mandatory for the diagnosis of TTP and if these two criteria met in a patient, TPE should be performed immediately.


Assuntos
L-Lactato Desidrogenase/sangue , Troca Plasmática/métodos , Púrpura Trombocitopênica Trombótica/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Plasma , Contagem de Plaquetas , Indução de Remissão/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Mol Biol Rep ; 40(2): 1591-7, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23076533

RESUMO

The aim of this work was to report two cases of hypereosinophilic syndrome (HES). FIP1L1-PDGFRA fusion was assessed with two protocols at RNA level. The fusion transcript was found positive at the RNA level with both PCR methods in two cases. In this study, the efficiency of imatinib treatment and a dramatic response in two HES cases with multisystemic involvement showing the characteristics of a chronic myeloproliferative disease were presented. Both cases showed complete responses confirming that imatinib mesylate treatment could be successful even in patients with advanced HES having myeloproliferative disease.


Assuntos
Benzamidas/uso terapêutico , Síndrome Hipereosinofílica/diagnóstico , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Humanos , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/genética , Mesilato de Imatinib , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Proteínas de Fusão Oncogênica/genética , Polimorfismo de Fragmento de Restrição , Reação em Cadeia da Polimerase em Tempo Real , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Resultado do Tratamento , Fatores de Poliadenilação e Clivagem de mRNA/genética
12.
Int J Hematol ; 88(4): 403-408, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18836791

RESUMO

The etiology of most lymphoproliferative disorders remains unclear, though several hypotheses have been proposed. One of the conjectured mechanisms is infection of a tumor clone by an oncologic virus. Recently, evidence has arisen implicating both hepatitis B and, even more so, hepatitis C viruses in the pathogenesis of lymphoproliferative disease. Based on this information, we surveyed the prevalence of hepatitis B and C virus in patients with lymphoproliferative disease. A total of 334 newly-diagnosed lymphoproliferative disease patients (200 males, 134 females) and 1,014 (133 females, 881 males) healthy controls were randomly recruited from the university blood bank. Serologic evaluation for hepatitis B and C viruses was conducted and confirmed using PCR analyses. Those with hepatitis B and/or C, controls, and subgroups of patients with lymphoproliferative disease were compared using Pearson Chi-square analysis. Among patients with lymphoid tumors, the seropositivity of HbsAg and/or anti-HCV was 8.7% (29/334), and among the controls 6.1% (49/802), however this difference did not achieve statistical significance (P = 0.23, OR: 1.36, 95% CI: 0.82-2.26). We found no significant gender- or age-related differences for either hepatitis B or C seropositivity. There were no significant differences between the seropositivity rates of hepatitis B, C, or both in either NHL or Hodgkin's lymphoma. However, in the diffuse large cell lymphoma and follicular lymphoma subgroups, the HbsAg seropositivity rate was significantly higher than that in the controls (P = 0.017, P = 0.048, respectively), as was the seropositivity rate for hepatitis C in those with diffuse B cell lymphoma versus controls (P = 0.008). We did not identify any significant difference in the combined prevalence of hepatitis B or C seropositivity between patients with lymphoproliferative disorders and controls. However, significant differences were revealed among certain patient subgroups versus the controls. These two viruses could play a role in the development of certain specific lymphoproliferative disorders. Nevertheless, larger epidemiological studies are necessary and should focus, particularly on specific patient subgroups.


Assuntos
Hepacivirus , Vírus da Hepatite B , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Transtornos Linfoproliferativos/epidemiologia , Fatores Etários , Feminino , Anticorpos Anti-Hepatite/sangue , Hepatite B/sangue , Hepatite C/sangue , Humanos , Transtornos Linfoproliferativos/sangue , Transtornos Linfoproliferativos/virologia , Masculino , Prevalência , RNA Viral/sangue , Fatores Sexuais
13.
Hematology ; 13(2): 107-13, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18616878

RESUMO

The use of radiotherapy (RT) with chemotherapy has improved disease free survival and control in primary central nervous system lymphoma (PCNSL). We have encountered three patients with histologically documented central nervous system lymphoma. In all patients pathological diagnosis was B-cell lymphoma. We modified IDARAM regimen to R-IDARAM to enhance and optimize chemotherapeutic components for the treatment of PCNSL. We made three changes: (i) we added rituximab 375 mg/m(2) day 1; (ii) increased dose of MTX from 2 to 3 g/m(2); and (iii) administered two additional courses of R-IDARAM after cranial RT. Following complete staging after course 2, radiotherapy was applied at a dosage of 3600-4140 cGy in conventional schedule (180 or 200 cGy per day) to whole brain (with 3600 cGy to eyes in one case because of eye involvement) and then 2 additional courses of R-IDARAM (totally four courses) chemotherapy regimen were applied. Complete remission (CR) was achieved after first two cycles of R-IDARAM in patient 1 and 3 and after four cycles in patient 2. Currently, three patients have been alive for 29, 10, 15 months respectively. Currently there is no standard treatment modality for PCNSL. Increased dosage of MTX, adding rituximab and consolidation of the IDARAM to R-IDARAM regimen may improve disease control and outcome in PCNSL patients.


Assuntos
Neoplasias do Sistema Nervoso Central/terapia , Linfoma de Células B/terapia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias do Sistema Nervoso Central/diagnóstico , Irradiação Craniana , Citarabina/uso terapêutico , Dexametasona , Humanos , Idarubicina , Imuno-Histoquímica , Linfoma de Células B/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
15.
Tohoku J Exp Med ; 211(3): 285-90, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17347554

RESUMO

Cholelithiasis rarely occurs in childhood. Ceftriaxone is a widely used antimicrobial agent in pediatrics due to the broad spectrum. Reversible biliary sludge and/or lithiasis, named as pseudolithiasis, have been reported in patients treated with ceftriaxone. We observed ceftriaxone-associated pseudolithiasis in 8 patients with meningitis. The aim of this study was to report the clinical characteristics of these patients and to evaluate the related factors for the development of ceftriaxone-associated pseudolithiasis in children. The study group consisted of 7 boys and 1 girl. All patients received ceftriaxone 100 mg/kg/day for meningitis. The ultrasonographic evaluation was performed on 5th-10th days after the initiation of the therapy. Biliary sludge was detected in one patient, and gallstone was detected in three patients, while biliary sludge with gallstone was detected in four patients. Six of the cases were diagnosed during summer time. Thus, high temperature may cause loss of fluid, leading to easier formation of sludge. Ceftriaxone treatment was discontinued after sonographic demonstration of pseudolithiasis. Gallbladder sonograms were found to be normal in all patients at the follow-up sonographic examinations performed after 30 days of the diagnosis without specific treatment. Clinicians should screen all pediatric patients living in areas with high temperature and receiving ceftriaxone treatment (over 100 mg/kg) by ultrasonography for biliary sludge or gallstone formation even if they are asymptomatic.


Assuntos
Bile/diagnóstico por imagem , Ceftriaxona/efeitos adversos , Ceftriaxona/uso terapêutico , Colestase/diagnóstico por imagem , Colestase/etiologia , Meningite/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Temperatura , Ultrassonografia
16.
Turk J Gastroenterol ; 17(2): 99-102, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16830290

RESUMO

BACKGROUND/AIMS: The aim of this study was to investigate the effectiveness of plasma exchange therapy in patients with various forms of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. METHODS: During a three-year period, 13 patients with HELLP syndrome were treated with one or two sessions of plasma exchange after delivery. Diagnosis of hemolysis, elevated liver enzymes, and low platelets syndrome was made according to Sibai's criteria, and the severity of illness was categorized according to platelet counts. Among patients, nine were in class-1 and the remaining four were in class-2. Patients with very high levels of aspartate aminotransferase (AST) (>2000 U/L) and lactate dehydrogenase (LDH) (>3000 U/L) were defined as fulminant type (2 cases). RESULTS: Rapid improvement in platelet counts was observed after treatment with plasma exchange. All patients survived except the two fulminant hemolysis, elevated liver enzymes, and low platelets syndrome cases. CONCLUSION: In our study, plasma exchange therapy was effective in patients with severe hemolysis, elevated liver enzymes, and low platelets syndrome, but fulminant cases did not appear to respond to this therapy.


Assuntos
Síndrome HELLP/terapia , Troca Plasmática , Adolescente , Adulto , Aspartato Aminotransferases/sangue , Plaquetas , Feminino , Síndrome HELLP/sangue , Síndrome HELLP/diagnóstico , Síndrome HELLP/mortalidade , Humanos , Lactato Desidrogenases/sangue , Mortalidade Materna , Gravidez , Resultado da Gravidez , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
17.
J Natl Med Assoc ; 98(2): 143-7, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16708498

RESUMO

PURPOSE: The aim of this study is to investigate the effects of HBsAg vaccine and levamisole on virological indicators in naive patients suffering from chronic hepatitis B (CHB) and in healthy carriers of hepatitis B. METHOD: Vaccination and treatment with levamisole were applied to 93 minor patients in total, 43 of them inactive CHB carriers and 50 patients suffering from CHB. RESULTS: 15 (30%) of 50 patients who had high ALT values in the beginning of the study had normal values after treatment. In nine (12%) patients, posttreatment ALT values were higher than pretreatment values, and six (10%) patients showed HBV-DNA loss. In spite of the presence of 50 (54%) HBeAg-positive patients before treatment, 17 (34%) patients proved to be HBeAg-negative after treatment. HBeAg sero-conversion was seen in 10 (20%) cases. In two (2%) patients, HBsAg sero-conversion occurred. CONCLUSION: It was found that treatment with levamisole and vaccine had positive effects on CHB patients and healthy carriers with respect to HBV DNA loss, HBeAg sero-conversion and ALT normalization. The viral load increases and ALT increases that occurred in certain cases were thought to be related to the early immune response. It was determined that combined levamisole and vaccine therapy had no additional positive effect.


Assuntos
Adjuvantes Imunológicos/uso terapêutico , Vacinas contra Hepatite B/uso terapêutico , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B Crônica/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Levamisol/uso terapêutico , Criança , Doença Crônica , Feminino , Humanos , Imunoterapia , Masculino
18.
Turk J Gastroenterol ; 16(4): 188-93, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16547845

RESUMO

BACKGROUND/AIMS: Pathogenesis of chronic hepatitis B and hepatitis B carrier status is related to deficiencies in the immune system. Thus, treatments regulating the immune system are under discussion. The aim of this study was to investigate the effects of HBsAg vaccine and levamisole on lymphocyte subgroups and immunoglobulins in children with chronic hepatitis B and hepatitis B carriers. METHODS: A total of 93 naive children (43 chronic hepatitis B carriers, 50 chronic hepatitis B patients) were treated in three groups with HBsAg vaccine, levamisole or levamisole plus HBsAg vaccine. Levamisole (ketrax) was delivered as 2.5 mg/kg/day per os, three times per week for three months; the vaccine (Gen HevacB) was administered subcutaneously as 20, 30, 40 microg at one-month intervals. Both medications were delivered at same dosages in the combined group. The examinations were performed at pre-treatment and at the end of the third month when the treatment concluded. RESULTS: After treatments, CD3, CD4 and CD4/CD8 significantly increased and CD8 significantly decreased in chronic hepatitis B patient groups, except in the levamisole treated group. IgG and IgA were significantly decreased in all groups of chronic hepatitis B patients. CONCLUSIONS: It was found that HBsAg vaccine induced cellular immunostimulation in children with chronic hepatitis B; however, levamisole did not. The immune cells of hepatitis B carriers did not manifest a significant change in any treatment group. Although there was no change in B-cell, significant decreases were determined in immunoglobulins (IgG, IgA), especially in chronic hepatitis B patients.


Assuntos
Adjuvantes Imunológicos/uso terapêutico , Portador Sadio/virologia , Antígenos de Superfície da Hepatite B/imunologia , Vacinas contra Hepatite B/uso terapêutico , Vírus da Hepatite B/imunologia , Hepatite B Crônica/imunologia , Levamisol/uso terapêutico , Adolescente , Anticorpos Anti-Idiotípicos/imunologia , Complexo CD3/imunologia , Antígenos CD4/imunologia , Relação CD4-CD8 , Portador Sadio/imunologia , Criança , DNA Viral/análise , Quimioterapia Combinada , Feminino , Seguimentos , Vacinas contra Hepatite B/imunologia , Vírus da Hepatite B/genética , Hepatite B Crônica/tratamento farmacológico , Humanos , Imunidade Celular/efeitos dos fármacos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Masculino , Estudos Retrospectivos , Linfócitos T/imunologia , Resultado do Tratamento
19.
Turk J Gastroenterol ; 16(4): 224-7, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16547853

RESUMO

Plummer-Vinson syndrome is known as the association of postcricoid dysphagia, upper esophageal web, and iron deficiency anemia. Although correction of iron deficiency may result in resolution of dysphagia and sometimes disappearance of the webs, dilation therapy is usually necessary to remove webs and relieve dysphagia. We report two cases of Plummer-Vinson syndrome. Both patients presented with significant and longstanding dysphagia, sideropenia, glossitis and koilonychia. Our two patients had occasional choking and aspiration episodes at eating and endoscope did not pass through at the level of the upper esophagus. Patients' esophagograms revealed the presence of webs in part of the post-cricoid region. Both patients were treated with esophageal bougienage or balloon dilation, and iron supplementation. The patients were examined periodically for two years after the initial treatment and found to be in good general condition.


Assuntos
Cateterismo/métodos , Síndrome de Plummer-Vinson/terapia , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Síndrome de Plummer-Vinson/diagnóstico , Índice de Gravidade de Doença
20.
Comput Med Imaging Graph ; 26(5): 357-9, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12204243

RESUMO

A 26 year old woman with ascites was admitted for further investigations. A diagnosis of hydatid cyst disease was suggested on the basis of a combination of abdominal ultrasonography, computerised tomography and latex agglutination tests. This diagnosis was confirmed following surgical intervention. Hydatid cyst disease is a rare cause of ascites and we review the etiology and clinical features of this condition.


Assuntos
Ascite/etiologia , Equinococose Hepática/complicações , Adulto , Ascite/diagnóstico , Equinococose Hepática/diagnóstico , Feminino , Humanos , Fígado/diagnóstico por imagem , Radiografia Abdominal
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