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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 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 Fatal valproate overdose in a newborn baby(SAGE PUBLICATIONS LTD, 2007) Unal, Ekrem; Kaya, Ulkuhan; Aydin, KursadValproate is a widely used drug in the treatment of epilepsy in children and adults. However, it is not safe for patients under two years of age, especially during the newborn period. This study presents a case of fatal valproate overdose in a 26-day-old female newborn, who is the youngest patient in the literature.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 The importance of troponin-I as a predictor of cardiac injury caused by carbon monoxide poisoning(TAYLOR & FRANCIS INC, 2007) Unal, Ekrem; Yazar, Abdullah; Oran, Bulent[Abstract not Available]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 Malignant glioblastomatous transformation of a low-grade glioma in a child(SPRINGER, 2008) Unal, Ekrem; Koksal, Yavuz; Cimen, Omer; Paksoy, Yahya; Tavli, LemaThe term of low-grade glioma addresses a favorable clinical outcome with indolent histological features in general consideration; however, recent studies underline the inconsistency, which originates from the accumulation of different histologic subtypes in this terminology. The malignant transformation of a low-grade glioma is unusual but presents a poor prognosis. We report a case of a 12-year-old boy, who was referred for complaints of recurrent seizures. His physical examination was unremarkable, but it was learned that a peripheral mass lesion located on the left posterior parietal lobe-which had been thought to be a low-grade glioma-had been detected on a magnetic resonance imaging 2 years ago at a different hospital. The patient was then treated with valproate and carbamazepine for the seizures and advised to be followed up without any additional diagnostic and therapeutic studies for his suspected low-grade glioma. A recent magnetic resonance imaging study showed enlargements of the mass and surrounding edema with additional necrosis. Surgical excision of the tumor was performed. After the diagnosis of glioblastoma multiforme, the patient received radiation therapy and chemotherapy with a good clinical recovery without any evidence of residue or recurrence at 12-month follow-up. The first line treatment modality in the management of low-grade glioma-especially in suitable patients-is clearly surgery. The gross total resection guarantees the distinguishing of the histological types of the low-grade gliomas and reflects the biologic behavior of these tumors. Observation without surgery must be reserved for selected unoperable cases.Öğe Merkel Cell Carcinoma in a Child(LIPPINCOTT WILLIAMS & WILKINS, 2009) Koksal, Yavuz; Toy, Hatice; Talim, Beril; Unal, Ekrem; Akcoren, Zuhal; Cengiz, MustafaMerkel cell carcinoma, a rare tumor of the skin with aggressive behavior, is usually fatal when advanced disease is present. Merkel cell carcinoma occurs mostly in white race between 60 and 80 years of age, however, it can occur in any races and ages. It is extremely rare in children. We present here a Merkel cell carcinoma in a boy. Its features and treatment modalities were. discussed in the literature light.Öğe Merkel cell carcinoma in a child -- 2(WILEY-LISS, 2007) Unal, Ekrem; Koksal, Yavuz; Toy, Hatice; Talim, Beril; Unal, Ekrem; Akcoren, Zuhal; Cengiz, Mustafa[Abstract not Available]Öğe Mesenchymal hamartoma of the liver mimicking hepatoblastoma(LIPPINCOTT WILLIAMS & WILKINS, 2008) Unal, Ekrem; Koksal, Yavuz; Akcoren, Zuhal; Tavli, Lema; Gunel, Engin; Kerimoglu, UlkuMesenchymal hamartoma of the liver is a cystic benign liver mass occurring in children. Diagnostic confusion with hepatoblastoma may arise when a-feto-protein (AFP) level is elevated. We report an extremely rare case of mesenchymal hamartoma in an 11-month-old boy. Serum AFP was elevated and fine-needle aspiration biopsy suggested the lesion as hepatoblastoma, so he received preoperative chemotherapy. At the end of the preoperative chemotherapy, the tumor size and AFP level decreased. A right hepatectomy was performed. The pathologic examination of the specimen revealed mesenchymal hamartoma. Mesenchymal hamartoma of the liver with increased serum AFP levels may mimic hepatoblastoma if a cytological examination samples only the hepatocellular component of mesenchymal hamartoma. According to our knowledge, this is the first case of the mesenchymal hamartoma of the liver, which showed reduction in serum levels of AFP and involution of the tumor size by preoperative chemotherapy.Öğe Neurological complication of non Hodgkin lymphoma in childhood: experience from a single center in Turkey(SPRINGER, 2014) Kose, Dogan; Paksoy, Yahya; Koksal, Yavuz; Unal, EkremLymphomas are the third most common childhood malignant disease after leukemia and central nervous system (CNS) tumors. Early diagnosis of these complications will reduce mortality and morbidity. In this study we aimed to review the neurological complications of childhood non Hodgkin Lymphoma (NHL). Forty four children with NHL between 2006 and 2012 were investigated retrospectively and 14 cases with neurological complications were identified. The most common symptom was alteration of the consciousness (10 patients, 71.4 %) followed by convulsion (5 patients, 35.7 %), and hallucination (4 patients, 28.5 %); headache, eye pain, neurogenic bladder, speech disability and facial paralysis, and hemiplegia, were less common and each of them was seen in 1 (7.1 %) of the patients. The neurological complications were mostly seen in children with precursor T lymphoblastic lymphoma followed by anaplastic large cell lymphoma. The complications were secondary to medications (Eight patients) infection (two patients); CNS relapse (two patients); or CNS involvement of the primary disease (two patients). Chemotherapy-related neurologic complications were secondary to intrathecal methotrexate, l-asparaginase, vincristine, and ifosfamide Advanced disease and PTLL subtype can be suggested as predictors of neurological complication. The survival rates of neurological complications are fairly good unless it is secondary to involvement of the primary disease. In patients with drug-induced neurological complications, the treatment can be safely re-administered after controlling the neurological complications. Therefore, clinicians managing children with NHL must be informative about neurological complications.Öğe Pilocytic astrocytoma developing at the site of a previously treated medulloblastoma in a child(SPRINGER, 2008) Koksal, Yavuz; Toy, Hatice; Unal, Ekrem; Baysal, Tamer; Esen, Hasan; Paksoy, Yahya; Ustun, M. ErkanBackground After the achieved high cure rates, the survivors of medulloblastoma have come to face other complications associated with treatment regimes. One of these complications is secondary malignant neoplasm (SMN), which is rare but generally fatal. Case history We report a case of an 8-year-old girl in whom a pilocytic astrocytoma developed at the site of previously excised medulloblastoma 26 months earlier. The patient had then received postoperative radiotherapy and chemotherapy for the treatment of medulloblastoma. Twenty-five months after the cessation of treatment, she had no complaint and physical examination was unremarkable, but a mass in the operation region was detected. Surgical excision of the secondary pilocytic astrocytoma was performed with a good clinical recovery without any evidence of residue or recurrence at 9-month follow-up. Conclusion Clinicians must be vigilant for the risk of expected SMNs. Rigorous and prolonged follow-up of patients with central nervous system (CNS) tumors is warrant.Öğe Pituitary-adrenal axis suppression due to topical steroid administration in an infant(WILEY, 2007) Atabek, Mehmet Emre; Pirgon, Ozgur; Unal, Ekrem[Abstract not Available]Öğe Pulmonary arterial pressure in infants with laryngomalacia(ELSEVIER IRELAND LTD, 2006) Unal, Ekrem; Oran, Bulent; Baysal, Tamer; Baspinar, Osman; Keser, Melike; Karaarslan, Sevim; Arbag, HamdiObjective: Persistent upper airway obstruction may lead to increased pulmonary arterial pressure in childhood. Laryngomalacia is one of the most common causes of transient upper airway obstruction by laryngeal blockage in infants. The aim of the study is to evaluate the pulmonary arterial pressures in infants with laryngomalacia during infancy period. Methods: Fifteen infants with laryngomalacia and 30 healthy controls were enrolled into this study. The pulmonary arterial pressures were measured by using Doppler echocardiography. Infants were also evaluated by clinical investigations, telecardiography and electrocardiography. Results: Our results showed that infants with laryngomalacia may have significantly higher pulmonary arterial pressure than healthy subjects. Pressures of patient group were significantly decreased at the end of infancy period. Conclusions:. Increased pulmonary arterial pressure levels due to laryngomalacia are reversible by during developmental process. Therefore, in symptomatic period, evaluation of infants with laryngomalacia by using Doppler echocardiography may be useful for monitoring pulmonary arterial pressure and following up the clinical outcome. (C) 2006 Elsevier Ireland Ltd. All rights reserved.Öğe The real incidence of thyroid carcinoma in childhood(LIPPINCOTT WILLIAMS & WILKINS, 2006) Unal, Ekrem[Abstract not Available]Öğe Refractory cutaneous leishmaniasis in an adolescent: Initial manifestation of type 1 diabetes(W B SAUNDERS CO LTD, 2006) Atabek, Mehmet Emre; Pirgon, Ozgur; Unal, Ekrem[Abstract not Available]Öğe An uncommon extrapulmonary sequestration located in the upper posterior mediastinum associated with the azygos lobe in a child(MOSBY-ELSEVIER, 2007) Koksal, Yavuz; Unal, Ekrem; Aribas, Olgun Kadir; Oran, Bulent[Abstract not Available]
