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Öğe The Activity of Valproic Acid in the Treatment of Refractory Hyperleukocytosis in a Child with Acute Lymphoblastic Leukemia(TAYLOR & FRANCIS INC, 2013) Kose, Dogan; Koksal, YavuzHyperleukocytosis may be associated with an early morbidity and mortality due to leukostasis. Cytoreductive therapies-such as steroids, hydroxiurea, exchange transfusion, and leukapheresis-have been used for the prevention of leukostasis. Herein, the valproic acid used for the treatment of the hyperleukocytosis did not respond to known therapies in a child; lymphoblastic lymphoma developed bone marrow relapse under the treatment is discussed.Öğe Acute pancreatitis due to pancreatic involvement of Burkitt's lymphoma in a child(AVES, 2015) Erol, Cengiz; Kose, Dogan; Yuksekkaya, Hasan Ali; Koksal, Yavuz[Abstract not Available]Öğe An aggressive parameningeal rhabdomyosarcoma with multiple spinal cord metastases: a case report and review of the literature(SPRINGER, 2017) Yavas, Guler; Karabagli, Pinar; Paksoy, Yahya; Yavas, Cagdas; Karabagli, Hakan; Koksal, YavuzPurpose Spinal cord metastasis from rhabdomyosarcoma (RMS) is extremely rare, with three cases reported to date. Herein, we report an aggressive case of RMS of the infratemporal fossa who which developed spinal cord metastases during treatment. Case presentation A 6-year-old girl presented with an enlarging painless mass around her right ear for 3 months. An enhanced magnetic resonance imaging (MRI) revealed a 5 x x4 x x4.5 5 cm mass on her right infratemporal fossa. A tru-cut biopsy was performed, and histopathologic examination revealed the diagnosis of rhabdomyosarcoma. At the time of the diagnosis, cerebrospinal fluid cytology was negative for malignant cells. The patient underwent induction chemotherapy. There was minimal response to chemotherapy, and the patient underwent curative radiotherapy. However, by 12th fraction of RT, the patient developed a progressive weakness on her lower extremity. Spinal MRI revealed multiple gross masses in different parts of the spinal cord. The local radiotherapy was changed toas craniospinal radiotherapy. However, two 2 weeks after the completion of the RT, the patient developed sepsis and expired because of septic shock. Conclusion Parameningeal RMS is a peculiar subgroup of RMS, which needs an aggressive approach. Despite aggressive approach, meningeal spread is the most important cause of the treatment failure. We should keept in mind that during the treatment, there can be meningeal spread towards to either the brain or spinal cord; therefore, we should follow -up the patients closely from this aspect.Öğe Astroblastoma in a child(SPRINGER, 2008) Unal, Ekrem; Koksal, Yavuz; Vajtai, Istvan; Toy, Hatice; Kocaogullar, Yalcin; Paksoy, YahyaBackground Astroblastoma, an uncommon neuroepithelial tumor, typically presents in young adults as a well-circumscribed cortical or subcortical spherical mass. Astroblastoma may cause a diagnostic problem to anyone unfamiliar with its architectural and histological features. Case history We report the case of a 4-year-old boy who was referred for complaints of progressive deficits of balance and difficulty with walking during the previous 3 months. A large fronto-parietal cystic mass with solid mural nodule was discovered. Total removal of the tumor mass was performed, and a diagnosis of high grade (malignant) variant of astroblastoma was made. Postoperatively, the patient received radiation therapy, for a period of 11 weeks, followed by chemotherapy. He is in a good neurological recovery without any evidence of recurrence for 8 months. Prognosis The best treatment modality for astroblastoma is surgical resection if possible, whereas adjuvant therapy (radiotherapy and/or chemotherapy) can be considered in high-grade astroblastomas, with a close follow-up for all cases.Öğe Cerebral venous sinus thrombosis in an adolescent with Ewing sarcoma(SPRINGER, 2008) Unal, Ekrem; Yazar, Abdullah; Koksal, Yavuz; Caliskan, Umran; Paksoy, Yahya; Kalkan, ErdalBackground Although thromboembolic complications are common in adult patients with malignant diseases, cerebral venous sinus thrombosis has been rarely described in cancer afflicted pediatric and adolescent population. Case history A 16-year-old adolescent girl referred for complaints of pain and swelling on her left leg. On physical examination, a solid tibial mass was discovered. After the diagnosis of Ewing sarcoma with a tru-cut biopsy, chemotherapy protocol consisting of cisplatin, ifosfamide, adriamycine, and vincristine was started. During the first course of the treatment, the patient expressed headache, diplopia, and ptosis. Contrast-enhanced magnetic resonance (MR) images and MR angiography showed superior sagittal and transverse sinus thromboses. After anticoagulant therapy, the thromboses disappeared within 1.5 months. She received her chemotherapy protocol with the anticoagulant prophylaxis. After a follow-up period of 12 months, she is still in a good neurological recovery without any sequel. Conclusion Children and adolescents with cancer should be monitored closely for thrombotic complications. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment of intracranial thrombosis in childhood cancer, and we review the relevant literature.Öğe Comparison of the Radiologic and Clinical Findings of Adolescents With Breast Complaints(LIPPINCOTT WILLIAMS & WILKINS, 2018) Sekmenli, Tamer; Koksal, Hande; Gunduz, Metin; Bostanci, Hasan; Ciftci, Ilhan; Koksal, YavuzIntroduction:The American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) was developed to guide imaging-based surgical treatment in patients with breast cancer. Studies confirming the BI-RADS did not include adolescents. To evaluate the validity of this classification system in adolescents, we aim to investigate the relationship between the BI-RADS and pathology findings in adolescents. Methods:The medical data of 67 female adolescent patients, aged 12 to 18, referred to our clinic for breast-related complaints between 2013 and 2016 were reviewed retrospectively for demographic data and the results of radiologic and surgical pathologies. Results:The main underlying reasons for the visit at the clinic were fullness, tenderness, pain, and palpable masses. Of the 67 patients, 46 were enrolled in the study. After breast ultrasonography, patients whose complaints had diminished were subtracted from the follow-up. The mean age of the patients was 16 years (12 to 18y). The mean mass diameter size was 3.69 cm (0.9 to 15 cm), and the mean clinical follow-up was 65.3 days (11 to 1095 d). All the patients who were surgically intervened had benign pathology. Of the 21 surgically intervened patients with BI-RADS levels of >= 3, most had fibroadenomas. Conclusions:The BI-RADS classification-based treatment algorithm may not be valid in adolescents. In the present study, all patients with lesions with BI-RADS >= 3 levels had revealed benign pathologies. The BI-RADS classification may show an increased risk. However, to determine the need for a biopsy in adolescents, there is a need for larger-scale pediatric and adolescent studies using the BI-RADS classification.Öğe Constitutive mismatch repair defect syndrome: New insights from whole exome sequencing data and functional studies(ELSEVIER SCIENCE BV, 2016) Caglayan, Ahmet Okay; Omay, Zeynep E. Erson; Koksal, Yavuz; Coskun, Suleyman; Unal, Ekrem; Per, Huseyin; Bilguvar, Kaya[Abstract not Available]Öğe The Correlation between the Level of Doxorubicin-Induced Cardiac Damage and Serum Soluble Fas in an Experimental Rat Model(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2018) Kose, Dogan; Ozdemir, Hulya; Celik, Zeliha Esin; Unlu, Ali; Artac, Hasibe; Koksal, YavuzAim: This study was planned to research the relationship between doxorubicin cardiomyopathy and the soluble Fas (sFas) level. Materials and Methods: Two groups of rats were included in the study. The control group was given physiological saline, while the study group was given doxorubicin. The rats, whose blood samples were taken weekly, were sacrificed and their myocardial tissues were removed. The tissues were examined in terms of morphological changes and surface Fas expression, while the blood samples were examined in terms of sFas level. Results: In the study group, the sFas levels at 2nd-9th weeks were higher than those found at 1st week before administrating the drug, and the increase at 2nd-7th weeks was meaningful. In addition, sFas levels were gradually increased each week during 1st-5th weeks when compared to the values of a previous week, and the increase during the first 4 weeks was meaningful. After the 5th week, the values gradually decreased each week. The mean values of the study group at 1st-8th weeks were higher than those of the control group, and the increases at 2nd-8th weeks were meaningful. The severe forms of interfibrillar hemorrhage, vascular dilatation, myocardial necrosis, inflammatory infiltration, and splitting of muscle fibers occurred with 15, 15, 17.5, 20, and 22.5 mg/kg dose of medicine, respectively. Conclusions: As the tissue injury increased, the increasing cell-surface Fas expression and sFas plasma level at the acute phase of doxorubicin-related cardiotoxicity decreased. The sFas level determined at acute phase may be helpful in predicting the existing injuries and possible late-term problems.Öğe Desmoplastic non-infantile astrocytic tumor with BRAF V600E mutation(SPRINGER JAPAN KK, 2014) Karabagli, Pinar; Karabagli, Hakan; Kose, Dogan; Kocak, Nadir; Etus, Volkan; Koksal, Yavuz[Abstract not Available]Öğe Development of fatty liver in children with non-Hodgkin lymphoma(TURKISH J PEDIATRICS, 2014) Kose, Dogan; Erol, Cengiz; Kaya, Fatma; Koplay, Mustafa; Koksal, YavuzThe aim of this study is to investigate the development of hepatosteatosis in children with non-Hodgkin lymphoma. Twenty-eight patients were evaluated retrospectively for hepatosteatosis by computed tomography. Mild, moderate and severe hepatosteatosis were defined as the difference between the average liver attenuation and the average spleen attenuation, equaling (- 10) - (- 19); (- 20) - (- 29); and >= 30 HU, respectively. "Vaguely" and "obvious" hepatosteatosis were defined as none or mild hepatosteatosis, and moderate and severe hepatosteatosis, respectively. In T-cell lymphoma, obvious hepatosteatosis was determined in 1 of 12 patients (8.3%) at the first evaluation, 8 of 12 patients (66.7%) at the second evaluation and 4 of 12 patients (33.3%) at the third evaluation. In B-cell lymphoma, obvious hepatosteatosis was determined in none of 16 patients at the first evaluation, 2 of 16 patients (12%) at the second evaluation and none of the patients at the third evaluation. In the second evaluation, severe high serum total cholesterol and triglyceride levels were determined in 4 of 5 patients. We observed higher fatty liver ratios, and high triglyceride and cholesterol levels, although the data were obtained from a small number of patients.Öğe Diagnostic Value of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Patient with Adrenal Involvement of Hodgkin Lymphoma(GALENOS YAYINCILIK, 2016) Kose, Dogan; Koksal, YavuzImproved success with the modern management of Hodgkin lymphoma (HL) leaded new method searches to diminish treatment intensities in order to prevent late effects. Sensitivity and specificity of fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is advanced in the determination of malign cell infiltrations in adrenal glands in patients with HL which is a rare finding. A 7.5 year old female patient that was investigated due to pubic hairs and breast development one year ago presented, with complaints of recently developed fever, asthenia, weight loss and night sweating. In her examination, hepatosplenomegaly, phase 2 pubarche and phase 1 thelarche were detected; in FDG PET-CT, advanced lymph node involvement and increased activity in spleen and left adrenal gland were also detected. The patient was diagnosed with HL by biopsy and premature pubarche (PP) by the laboratory values. In the patient, FDG PET-CT that is recorded after the antineoplastic treatment was completely normalized; pubarche and thelarche were completely rested and, normal puberty started when she was 12 years old. The patient has been followed up currently without any problems. In this report, a pediatric HL case with PP and increased activity in left adrenal gland determined by FDG PET-CT, has been presented.Öğe Elevated alpha-fetoprotein in benign/borderline liver masses in children(KARE PUBL, 2015) Kose, Dogan; Erol, Cengiz; Koksal, YavuzOBJECTIVES The purpose of this retrospective study is to share the data of the patients with high alpha-fetoprotein and benign/borderline liver mass with literature. METHODS Between 2006 and 2012, 5 of our patients were diagnosed with benign/borderline liver mass in connection with high alpha-fetoprotein. RESULTS During the diagnostic procedure, alpha-fetoprotein values of our patients were varying between 123-4905 U/L. While one of the patients diagnosed with hemangioendothelioma was transferred for liver transplantation, the other passed away during the early stages under steroid treatment. After observing malign cells in tissue biopsy, chemotherapy was started for the patient diagnosed with mesenchymal hamartoma and the mass was removed completely. It is currently being monitored and is free of any diseases. Patients, who were diagnosed with hemangioma and focal nodular hyperplasia, were monitored without receiving any treatment. CONCLUSION Since it is possible to observe high alpha-fetoprotein in non-malign liver masses, tissue diagnosis must be confirmed before starting treatment.Öğe Growth-differentiation factor-15 and tissue doppler imaging in detection of asymptomatic anthracycline cardiomyopathy in childhood cancer survivors(PERGAMON-ELSEVIER SCIENCE LTD, 2013) Arslan, Derya; Cihan, Tugba; Kose, Dogan; Vatansev, Husamettin; Cimen, Derya; Koksal, Yavuz; Oran, BulentObjectives: Anthracyclines have led to an increased risk of cardiac morbidity and mortality. Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Tissue Doppler imaging (TDI) also has potential as a clinically useful technique for the assessment of myocardial function. Biochemical markers may be used to detect cardiac damage growth-differentiation factor-15 (GDF-15) and are emerging as a biomarker of cardiac dysfunction. The aim of this study is to assess the value of the plasma levels of GDF-15 and TDI in detecting late myocardial dysfunction in childhood cancer survivors (CCS) who were treated with anthracyclines. Design and methods: Thirty-eight CCS who had completed chemotherapy treatment with anthracyclines were included in this study. Control group consisted of 32 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an M-mode, pulse Doppler and tissue Doppler imaging. However, GDF-15 and cardiac troponin-I (cTnI) were measured. Results: Although, systolic function of the left ventricular was similar in all groups, there were significant differences between parameters of diastolic function of the heart. The mitral valve E wave, E/A ratio, left ventricular E'm wave, and E'm/A'm ratio were different in the patients than in the controls (p = 0.049, p = 0.037, p < 0.0001, p = 0.001, respectively). The tricuspid valve E/A ratio, right ventricular E't wave, and E't/A't ratio in the patients were also different from those of the controls (p = 0.031, p < 0.0001, p < 0.0001, respectively). Mean plasma GDF-15 was significantly higher in patients than healthy controls (p = 0.027). There were no significant differences in cTnI between both groups. Conclusions: Growth-differentiation factor-15 level may be used as a biomarker of anthracycline-induced cardiovascular disease severity in the CCS. (c) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.Öğe High-risk febrile neutropenia and its management in children with solid tumors and lymphoma(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2015) Kose, Dogan; Emiroglu, Melike; Koksal, YavuzBackground/aim: The clinical characteristics and treatment results of febrile neutropenia attacks that occurred in patients with lymphoma and solid tumors were analyzed. Materials and methods: A total of 50 patients with 94 high-risk attacks were evaluated for malignant diseases in this study. Results: The fever etiology was determined as clinical (50%), microbiological (5.31%), clinical-microbiological (5.31%), or unknown (39.3%). A few of the attacks (21.3%) were observed in lymphoma cases and 77.7% were observed in patients with solid tumors. Patients who were in remission had 59.6% of the attacks, and 39.4% occurred in patients not in remission. Among the groups tested, 73% (the imipenem/amikacin group) and 47.9% (the piperacillin-tazobactam/amikacin group) of patients were in remission. Glycopeptide addition rates in these groups were 22.2% and 40.8% and antifungal addition rates were 8.8% and 18.3%, respectively. Conclusion: Clinical progress was more problematic in patients who were not in remission during the attacks. This was due to the fact that some patients had other factors that placed them in the high-risk group, as well as increased C reactive protein and procalcitonin values on the first day. Therefore, it may not be accurate to associate the success achieved in the different treatment regimens with antibiotics alone.Öğe Hypothermia in a Child With Hodgkin Disease(LIPPINCOTT WILLIAMS & WILKINS, 2009) Koksal, Yavuz; Caliskan, Umran; Unal, EkremHypothermia is an extremely rare clinical manifestation of unknown origin in Hodgkin disease, which is generally associated with the administration of chemotherapeutic agents. We present hypothermia in a 10-year-old girl with stage IIIB nodular sclerosing type Hodgkin disease, who was previously treated with the diagnosis of immune thrombocytopenic purpura. To the best of our knowledge, this case is the first reported case of hypothermia in Hodgkin disease with combination of previously treated immune thrombocytopenic purpura Lit childhood in the English medical literature.Öğe The Importance of Cystatin-C for Predicting Nephrotoxicity in Children with Acute Leukemia and Non-Hodgkin Lymphoma(AKAD DOKTORLAR YAYINEVI, 2009) Unal, Ekrem; Caliskan, Uemran; Koksal, YavuzDetermination of renal function in patients with childhood cancer by a simple and accurate test is crucial. The aim of this study is to determine the incidence of nephrotoxicity in patients with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL) and evaluate the importance of serum cystatin-C for an early predictor of impairment of renal function. 27 patients (ages varied from 1.5 to 16 years, median age 10 year-old) were enrolled to this study. Serum urea, creatinine, cystatin-C concentrations and calculated creatinine clearances of the patients were determined during the treatment. Twenty (74%) of patients were male and seven (26%) were female. The frequencies of the diagnosis for ALL, AML and NHL were 13 (48.1%), 8 (29.6%) and 6 (22.3%), respectively. The mean values of cystatin C during the treatment were 0.77 +/- 0.3 mg/l, 0.86 +/- 0.5 mg/l and 0.81 +/- 0.3 mg/l, respectively. The values of urea, cystatin-C, and creatinine clearance did not differ statistically by duration of the treatment. We did not observe any renal impairment in our study group by the treatment. Cystatin-C has high values of sensitivity and specificity to predict the glomeruler filtration rate. Therefore cystatin C might be useful for determination glomeruler filtration rate in children with cancer; especially who have difficulties in collecting 24-hours urine sample.Öğe Intracranial metastasis of neuroblastoma: in two different areas at the same time(SPRINGER, 2013) Kose, Dogan; Karabagli, Pinar; Yavas, Guler; Karabagli, Hakan; Koksal, YavuzNeuroblastoma (NB) is the most common extracranial solid malignancy in children. The major cause of death from this cancer is metastasis of tumors, and metastasis can be seen in different areas of the body. Metastasis of NB occurs by hematogenous and lymphatic routes. Generally, brain metastases have been reported in only one area of the brain parenchyma. A 4-year-old male patient was treated in our clinic due to the NB that settled in the intra-abdominal region, but the patient presented with headache and nausea approximately 5 months after completion of the treatment. Whereupon, cranial imaging was performed and two masses were detected in the bilateral frontal lobe, and then the patient underwent surgery. Metastatic NB diagnosis was confirmed histopathologically. The patient's chemotherapy treatment is still ongoing. We report the case of a male patient with two separate metastatic masses in the brain parenchyma, which occurred in two different areas at the same time.Öğe Isolated Scrotal Skin Relapse in a Child with Burkitt Lymphoma(GALENOS YAYINCILIK, 2015) Kose, Dogan; Kivrak, Ali Sami; Ugras, Serdar; Koksal, YavuzBurkitt lymphoma (BL) that is the most rapidly growing human tumor is an aggressive B-cell neoplasia. It generally occurs as an extranodal disease. Its metastasis into extranodal areas is also frequent, however, its cutaneous involvement is rare. An 11-year-old male presented with the complaints of abdominal pain and difficulty in swallowing. The patient was diagnosed with BL by trucut biopsy that was performed for a mass identified in the left upper abdominal quadrant and B-cell Non-Hodgkin's lymphoma (NHL) BFM 95 treatment protocol was applied. The patient applied again for the complaint of right scrotal swelling 1.5 months after the completion of therapy. On physical examination, right scrotal edema and redness were identified. The patient was diagnosed with relapsed BL by biopsy taken from scrotal skin and LMB-Group C treatment protocol was applied. The patient came again with the complaints of abdominal swelling and pain 20 months after the completion of therapy. On physical examination, a mass was detected in the left mid-upper quadrant of the abdomen. The result of biopsy was reported as BL again and COPM (cyclophosphamide, vincristine, prednisolone, and methotrexate) treatment protocol and rituximab were started. However, central nervous system (CNS) relapse developed and the patient was lost. This case was presented because isolated scrotal skin relapse has not been reported in the literature.Öğe Kluver-Bucy syndrome in a boy with non-Hodgkin lymphoma(TAYLOR & FRANCIS INC, 2007) Unal, Ekrem; Koksal, Yavuz; Baysal, Tamer; Energin, Meltem; Aydin, Kursad; Caliskan, UmranKluver-Bucy syndrome is a rare neurobehavioral condition characterized by visual agnosia, excessive oral tendency, hypermetamorphosis, placidity, altered sexual behaviors, and changes in dietary habits. The authors report a case of Kluver-Bucy syndrome in a 10-year-old boy with non-Hodgkin lymphoma after intratechal methotrexate administration. He was treated by risperidone without any sequels.Öğe Left ventricular diastolic function evaluated with tissue Doppler imaging in children with familial Mediterranean fever(SPRINGER LONDON LTD, 2009) Baysal, Tamer; Peru, Harun; Oran, Bulent; Sahin, Tahir Kemal; Koksal, Yavuz; Karaaslan, SevimThe aim of this study was to assess the left ventricular diastolic function using conventional echocardiography and tissue Doppler imaging in children with familial Mediterranean fever. This study included 29 (13 males and 16 females) patients and 30 healthy subjects as controls. Body mass index was calculated and arterial blood pressure was monitored. After an overnight fast, venous blood samples were taken and serum amyloid A protein, C-reactive protein, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol levels were measured. A complete 2-dimensional, M-mode, pulse wave Doppler, and pulse wave tissue Doppler echocardiographic examination was performed. There were no significant differences between the groups regarding age, body mass index values, systolic and diastolic blood pressures, heart rates, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol. Serum levels of inflammatory markers were higher in patients' group (C-reactive protein and serum amyloid A protein levels were 10.84 mg/dl, 22.32 mg/l in patients' group, respectively, and 4.11 mg/dl, 3.65 mg/l, respectively, in the healthy controls.) Peak mitral A wave, E and A wave ratio differed significantly in both groups. There were statistically significant differences regarding parameters observed by tissue Doppler imaging such as E'm, A'm, E'm, and A'm ratio between patients' group and controls. Tissue Doppler imaging provided additional information on left ventricular diastolic function. While systolic functions were in normal range, some of the diastolic function parameters were impaired in patients with familial Mediterranean fever during childhood.
