Sema Vural - Academia.edu (original) (raw)

Papers by Sema Vural

uvt.ulakbim.gov.tr

Denenen tüm tedavi protokollerine rağmen, özellikle ileri evrelerdeki nöroblastomun prognozu hale... more Denenen tüm tedavi protokollerine rağmen, özellikle ileri evrelerdeki nöroblastomun prognozu halen iyileştirilememiştir. Ülkemizde de sağ kalım oranlarını yükseltmeye yönelik çalışmalar sürmektedir, ancak yayınlanmış abdominal nöroblastom serisi azdır (1). Türk Pediatrik Onkoloji Grubu 2003 yılında bir protokol oluşturmuştur ve Türkiye'deki birçok merkezin katılımıyla hastalar izlenmektedir. Bu çalışmada abdominal nöroblastomlarla ilgili cerrahi deneyimlerimiz paylaşılmıştır. HASTA ve YÖNTEM 2000-2005 yılları arasında tanı koyularak tedavisi yapılan abdominal nöroblastom vakaları ÖZET Amaç: Ülkemizde yayınlanmış abdominal nöroblastom serisi azdır. Bu çalışmada çocukluk çağındaki abdominal nöroblastomlarla ilgili cerrahi deneyimlerimiz paylaşılmıştır. Hastalar ve yöntem: 2000-2005 yılları arasında tanı koyularak tedavisi yapılan abdominal nöroblastom vakaları incelendi. Tanı yöntemleri, evre, uygulanan cerrahi tedaviler ve sağkalım değerlendirildi. Bulgular: Yaşları 4 ay-8 yaş arasında toplam 23 hasta ameliyat edildi. Hastaların %65'i evre 3 veya 4'tü. İleri evredeki hastaların histolojik tanısı 2000 yılında açık biyopsi (n=6) ya da parsiyel rezeksiyon (n=1) ile koyulurken, daha sonraki yıllarda kalın iğne biyopsisi (n=8) tercih edildi. Bir hastada da kemik iliği ve VMA değeri ile tanıya gidildi. Beş hastaya ilk operasyonda total tümör rezeksiyonu yapıldı. Kemoterapi sonrasında 5 hastaya geç primer total, 5 hastaya parsiyel rezeksiyon yapıldı. Bir hastaya izlemde lokal nüks eksizyonu uygulandı. On sekiz hasta sağkalım açısından değerlendirildi. Sekiz hasta ortalama 17.1 ay içinde kaybedildi (%44.4). Bir hasta tedaviyi terk etmiştir, bir hasta progresyonla evindedir, bir hastanın tedavisi sürmektedir. Yedi hasta (%38.9) tedavilerini tamamlamış ve yaşamaktadırlar. Ortalama izlem süreleri 28.4 aydır. Bunların ikisinde stabil artık kitle bulunmaktadır. Sonuç: Hastalarımız büyük oranda çok geç evrelerde başvurmuşlardır. Uygun hastalarda iğne biyopsisi kullanılmış ve geç primer cerrahiyi teknik olarak kolaylaştırdığı düşünülmüştür.

The Turkish Journal of Pediatrics

SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital

L enfadenopati çocukluk çağında sık karşılaşılan bir klinik bulgudur. Lenf nodu boyutunun beklene... more L enfadenopati çocukluk çağında sık karşılaşılan bir klinik bulgudur. Lenf nodu boyutunun beklenen sınırların üstünde olması ve/veya yapısının bozulması LAP olarak adlandırılır. Lenf nodunun bulunduğu bölgeye göre değişmekle birlikte genellikle 1-1.5 cm'nin, bazı kaynaklara göre 2.5 cm'nin üstünde olan ve/veya yapısı bozulan lenf nod-ları patolojik kabul edilir. LAP, en çok bölgesel veya sistemik akut enfeksiyonlara yanıt olarak görülür ve iyi seyirlidir. Etiyolojisinde kronik enfeksiyonlar, romatolojik hastalıklar ve nadiren çocukluk çağı kanserleri gibi ciddi hastalıklar da yer alabilir. Lenf nodlarında büyüme nedeniyle izlenen hastalar arasındaki kanser sıklığı merkezlere göre farklılık Amaç: Lenfadenopati (LAP) çocukluk çağında sık karşılaşılan bir klinik bulgudur. Çoğunlukla reaktif ve iyi seyirli olup etyolojisinde çocukluk çağı kanserleri nadiren yer alır. LAP nedeniyle izlenen hastalar arasındaki kanser sıklığı merkezlere göre farklılık gösterir. Birinci basamakta hastaların çok az bir bölümü kanser tanısı alırken onkoloji polikliniği gibi referans merkezlerinde sıklık artar. Hastaların kanser riski açısından yeterince değerlendirilmeden sevk edilmesi, referans merkezlerindeki kanser oranını azaltır. Çalışmamızda, LAP nedeniyle çocuk onkoloji polikliniğine gönderilen hastaların klinik, laboratuvar özelliklerinin ve kanser sıklığının araştırılması amaçlandı. Yöntem: Çocuk onkoloji polikliniklerimize Ocak 2014-Aralık 2016 arasında başvuran LAP'lı hastaların kayıtları geriye dönük olarak inceledi. Yaş, cinsiyet, yakınma süresi, uygulanan tedavi, sistemik belirti ve bulgular, lenf nodunun özellikleri, laboratuvar sonuçları kaydedildi; kanser sıklığı hesaplandı. Bulgular: Yaşları 4 ay-17 yaş arasında (ortanca 6 yaş) değişen, 34 kız, 100 erkek 134 hasta çalışma grubunu oluşturdu. Lenf nodlarının %98'i bölgesel, bunların %87'si baş-boyun bölgesinde olup, fizik muayenede boyutları 0.5-5 cm arasında değişiyordu (ortanca 2 cm). Olguların 21'ine (%15.6) biyopsi yapıldı. Patolojik incelemede dört hastada LAP dışı nedenler (perfore epidermal kist, lenfanjiom, pilomatrikoma, ektopik timus) saptandı. Diğer biyopsilerin dokuzu reaktif LAP, dördü lenfadenit, dördü Hodgkin lenfoma tanısı aldı. Kanser tanısı alan tüm hastalarda LAP boyutu 2.5 cm'den büyük ve LAP saptandıktan sonra geçen süre dört haftadan uzundu. Bu olguların üçünde LAP'a sistemik bulgular eşlik ediyordu. Sonuç: Kanser şüphesi ile çocuk onkolojisi polikliniğine gönderilen LAP'lı hastaların yalnızca %3'ü kanser tanısı aldı. Bir referans merkezi için çok düşük olan bu oran, birinci basamak sağlık merkezlerinde izlenebilecek hastaların yeterince değerlendirilmeden ve risk faktörleri gözetilmeden onkoloji polikliniğine yönlendirildiğini düşündürdü.

Journal of cancer research and therapeutics

The national protocol aimed to improve the outcome of the high risk neuroblastoma patients by hig... more The national protocol aimed to improve the outcome of the high risk neuroblastoma patients by high-dose chemotherapy and stem cell rescue with intensive multimodal therapy. After the 6 induction chemotherapy cycles, patients without disease progression were nonrandomly (by physicians' and/or parent's choices) allocated into two treatment arms, which were designed to continue the conventional chemotherapy (CCT), or myeloablative therapy with autologous stem cell rescue (ASCR). Fifty-six percent (272 patients) of patients was evaluated as high risk. Response rate to induction chemotherapy was 71%. Overall event-free survival (EFS) and overall survival (OS) at 5 years were 28% and 36%, respectively. "As treated" analysis documented postinduction EFS of 41% in CCT arm (n = 138) and 29% in ASCR group (n = 47) (P = 0.042); whereas, OS was 45% and 39%, respectively (P = 0.05). Thirty-one patients (11%) died of treatment-related complications. Survival rates of high-risk n...

Turkish Journal of Hematology, 2016

To the Editor, Myelodysplastic syndrome (MDS) comprises a heterogenic group of oncohematological ... more To the Editor, Myelodysplastic syndrome (MDS) comprises a heterogenic group of oncohematological diseases that affect hematopoiesis. Although the precise cause of MDS is unknown, multiple factors are involved, one of the most widely implicated of which is oxidative stress. However, it is unclear whether oxidative stress is a cause of MDS or an effect of other pathological mechanisms. Red blood cells (RBCs) are the first cells exposed to stress stimuli. They are highly vulnerable to free radical accumulation, which leads to the oxidative stress that induces damage in proteins and

Turkish journal of haematology : official journal of Turkish Society of Haematology, Jan 5, 2010

ABSTRACT OBJECTIVES: Varicella-zoster virus (VZV) infection may lead to serious complications and... more ABSTRACT OBJECTIVES: Varicella-zoster virus (VZV) infection may lead to serious complications and death in immunocompromised patients. Although there were researches which aim to decrease complications by vaccination and antiviral prophylaxis; there is stil no definitive protocols. In this study, we wanted to determine the frequency and clinical progress of VZV infections in patients with malignant diseases in whom prophylaxis was not used routinely during chemotherapy. METHODS: Datas of 30 patients (12 females, 18 males; median age 6 years; range 1 to 13 years) in pediatric oncology department who were exposed to VZV during their chemotheraphy between January 2001 and December 2004 were retrospectively examined. RESULTS: In 23 of patients there was fever. Skin lesions were widespread, but they were non-hemorhogic or infected and were crusted approximotely in 6.5 days. In one patient liver enzymes were eleveted. In others systemic complications were not seen. Patients taking approximately 8 days of intravenous acyclovir were discharged from hospital without any complication. In our patients VZV infections were benignly progressed. Early treatment with acyclovir might decrease the complications. But in spite of treatment there might be seriously progressed cases. CONCLUSION: In our country where vaccination for VZV is not performed routinely to healthy children; observation of large series with multidisciplinary studies of oncology and infectious diseases clinics may aid us to determine if prophylaxis is needed or not.

Nutrition and Cancer, 2016

This retrospective chart review study aimed to assess vitamin D status and identify risk factors ... more This retrospective chart review study aimed to assess vitamin D status and identify risk factors associated with vitamin D deficiency and bone parameters in children with cancer at admission. The data of 86 (50 males and 36 females) patients between April 2013 and June 2015 were analyzed. Calcium, phosphorus, alkaline phosphatase (ALP), 25(OH)D, age, gender, diagnostic category, body mass index, duration of complaints, and season of blood sampling were recorded. Median age was 7.17 years (range 0.31-17.40) in 29 hematological malignancy and 57 solid tumor patients. According to cut-off level of 20 ng/ml, 63% of children with cancer had vitamin D deficiency at diagnosis with a median 25(OH)D of 16.75 ng/ml. The mean vitamin D value of children &amp;amp;amp;gt;10 years was significantly low in comparison to that observed in younger children [11.83, 95% confidence interval (CI) = = 8.85-14.81 ng/ml vs. 19.81, 95% CI = = 17.02-22.60 ng/ml]. Vitamin D measurement between November and May was a risk factor for vitamin D deficiency (P &amp;amp;amp;lt; 0.05). The frequency of hypocalcemia and hypophosphatemia was not different between two groups of vitamin D. Further longitudinal studies are needed to investigate whether monitoring vitamin D status and supplementation in children with cancer might prevent future complications related to vitamin D deficiency.

Journal of Pediatric Gastroenterology and Nutrition, Nov 1, 2005

The objective of this study was to investigate the effects of ribavirin on bone mineral metabolis... more The objective of this study was to investigate the effects of ribavirin on bone mineral metabolism in patients with chronic hepatitis C who had been treated with interferon and ribavirin. Twenty patients (3 female, 17 male) with chronic hepatitis C were enrolled. Age range was 6 to 15 years (mean+/-SD, 11.15+/- 2.3 years). Thirteen patients received combined interferon alpha-2b and ribavirin therapy (Group 1), and 7 patients received only interferon alpha-2b (Group 2). Both groups were treated for 12 months. Bone mineral density, z-scores and biochemical bone markers were evaluated in both groups before and after treatment. There were no significant differences between the groups in age or gender. Mean lumbar vertebral bone mineral density and mean z-scores in groups 1 and 2 before and after treatment were not significantly different. In both groups, serum and urinary biochemical values and bone markers were all normal and there were no differences between the pretreatment and post-treatment values. Contrary to studies in adults, we did not find any ribavirin-dependent changes related to bone mineral metabolism in our pediatric study groups. Further studies are needed to obtain more detailed information about the effects of ribavirin on bone mineral density.

Tuberculin skin test in children, 2015

Turkiye Klinikleri Gastroenterohepatoloji Dergisi, 2001

Pediatric Blood & Cancer, 2015

World journal of gastroenterology : WJG, Jan 21, 2015

To evaluate the outcome of chronic hepatitis B (CHB) in children with or without malignancies. Tw... more To evaluate the outcome of chronic hepatitis B (CHB) in children with or without malignancies. Twenty four children (15 boys and 9 girls) with malignancies, followed up by the pediatric gastroenterology outpatient clinic for CHB between January 2000 and December 2013, were enrolled in the study (Group 1). Group 2 was formed with twenty five children (11 girls and 14 boys) diagnosed with CHB without malignancies. The data from the patients' records were compared between the two groups. Hepatitis B e antigen (HBeAg)/antiHBe seroconversion was observed in 3 patients (12.5%) in group 1 and 15 patients (60%) in group 2, with annual seroconversion rates of 1.61% and 16.6%, respectively, and the difference was significant (P < 0.01). One patient (6.6%) in Group 1 and 9 patients (53%) in Group 2 showed HBeAg/antiHBe seroconversion after treatment and the difference between the two groups was significant (P < 0.06) Loss of hepatitis B surface antigen was observed in one patient in ...

Journal of Pediatric Gastroenterology and Nutrition, 2005

The Lancet Oncology, 2016

Annals of surgical …, 2010

Background. The role of surgery has changed substantially over the years in abdominal Burkitt&#x2... more Background. The role of surgery has changed substantially over the years in abdominal Burkitt's lymphoma. Laparot-omy without total excision of the tumor does not have a positive effect on survival, might cause complications, and delays initiation of chemotherapy. Here ...

Turkiye Klinikleri Journal of Pediatrics, 2010

Annals of Saudi Medicine, 2011

Hepatitis B is a disease that is preventable with vaccination. Antibody levels after vaccination ... more Hepatitis B is a disease that is preventable with vaccination. Antibody levels after vaccination may be affected by suppression of the immune system due to cancer therapy. Children with cancer have a high risk of hepatitis B virus (HBV) infection. We aimed to assess the pretreatment immunization status against HBV infection and the rate of continuity of immunization after therapy in children with cancer. Retrospective case review of patients treated from 2004 to 2008. We reviewed the medical records of patients treated in the departments of pediatric hematology and oncology and collected data on immunization history and hepatitis B serology. Anti-HBs antibody titers were compared before and after treatment. This study included 159 (99 males, 60 females) children who had a serologic examination. Antineoplastic therapy had been given for acute leukemia (n=66), non-Hodgkin lymphoma (n=27), Hodgkin lymphoma (n=20), and solid tumors (n=46). Fifty-one patients had not been immunized against HBV prior to the therapy; HBV serology was negative in 49 of these patients and HBsAg was positive in 2 patients. Anti-HBs antibody positivity was present in 99 of 108 patients with an immunization history, whereas no vaccination response was present in 9 patients. The titer of anti-HBs antibody was decreased below the protection level in 33 (33%) patients with positive anti-HBs antibody, whereas the protection level was found to be maintained in 66 (67%) patients. The most significant decrease (63.6%) was observed in leukemia patients. Posttreatment HBsAg and HBV DNA positivity was detected in two of the patients with negative pretreatment serology, whereas no HBV infection developed in the group with positive anti-HBs antibody. This study demonstrated the importance of routine childhood vaccination in reducing the risk of HBV infection in patients with cancer.

Journal of Neuro-Oncology, 2005

Brain is a rare site of metastasis in most extracranial pediatric solid tumors. The aim of this s... more Brain is a rare site of metastasis in most extracranial pediatric solid tumors. The aim of this study is to investigate the incidence, treatment, prognosis of brain metastasis in extracranial pediatric malignant tumors in a single institution and to review the literature. From September 1989 to December 2002, 1100 children &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=16 years of age with extracranial solid tumors including lymphomas were diagnosed and treated in the Division of Pediatric Oncology, Oncology Institute, Istanbul University. Patients with parenchymal metastases in the brain were assessed. Sixteen (10 female, 6 male) of 1100 patients (1.45%) with extracranial solid tumors developed brain metastases. The median age of the patients was 10.5 (1-16) years. The diagnosis was sarcomas in 12 patients: 5 osteosarcomas, 4 Ewing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sarcoma family tumors, 1 rhabdomyosarcoma, 1 clear cell sarcoma of the soft tissue, 1 alveolar soft part sarcoma. Two patients had Wilms&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; tumor and two had germ cell tumors. Four patients (25%) had brain metastasis at diagnosis. Twelve (75%) developed brain metastasis during therapy or relapse at a median duration of 16 (1-70) months from initial diagnosis. All patients had metastases to various sites, mostly lung, at the time the brain metastases were detected. Treatment included surgery, followed by postoperative radiotherapy (RT) and chemotherapy (CT) in 1, S and RT in 1, S in 1, RT and CT in 6, RT in 1, CT in 1 and no treatment in 5. Only one patient with alveolar soft part sarcoma is alive with disease 20 months from diagnosis of brain metastasis. All other patients died at a median time of 2 months (2 days-6 months) from the time of brain metastasis. Children with metastatic cancer who develop headaches or any other neurologic symptom should be investigated for possible brain metastasis. Although, the outcome for these patients is dismal in this series and in the literature; reports of long term survival in a few cases with Wilms&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; tumor, osteosarcoma and alveolar soft part sarcoma who had isolated brain metastasis, suggest that a subset of patients may benefit from therapy.