Suna Emir - Academia.edu (original) (raw)

Papers by Suna Emir

Research paper thumbnail of Efficacy and safety of intralesional corticosteroid application for hemangiomas

TURKISH JOURNAL OF MEDICAL SCIENCES, 2015

Background/aim: There are different modalities for management of infantile hemangiomas (IHs). In ... more Background/aim: There are different modalities for management of infantile hemangiomas (IHs). In this report, our aim is to evaluate whether intralesional corticosteroid treatment is associated with systemic side effects and whether this is an effective treatment modality for IH. Materials and methods: Six children treated with intralesional corticosteroids for problematic hemangiomas were included in the study. Clinical characteristics, response to treatment, weight, height, blood pressure, morning serum cortisol, and adrenocorticotropic hormone levels were recorded. Results: Each child received intralesional triamcinolone at a dose of 2 mg/kg for 2-5 injections at monthly intervals. Subjects were followed for 1 year. All patients had adrenal suppression following the second or third triamcinolone injections. Five patients demonstrated partial response and one demonstrated no response. Conclusion: Intralesional steroid injection may effectively induce the resolution of hemangiomas, but all the patients in our group had adrenal suppression after treatment. The use of intralesional steroid therapy is not a superior treatment option for hemangiomas. It also has side effects comparable to systemic steroids.

Research paper thumbnail of Radiotherapy for Renal Rhabdoid Tumor: A Case Report and a Review of Literature

Acta Oncologica Turcica

Renal rhabdoid tumor, çok nadir görülen ve kötü sağkalımla seyreden bir hastalıktır.Radyoterapi b... more Renal rhabdoid tumor, çok nadir görülen ve kötü sağkalımla seyreden bir hastalıktır.Radyoterapi bu tumorlerde primer tumore veya cerrahi yatağa, hastalık kontrolü için sıklıkla uygulanmaktadır. Bu vaka takdiminde, 4 aylık renal kitlesi ve yaygın intraabdominal metastazı olan hasta sunulacaktır.Hastaya öncelikle maksimal debulking cerrahi ardından kemoradyoterapi uygulanmıştır. Hastalık progresyon göstermiş ve hasta 3 ay içerisinde kaybedilmiştir.Hastalığı evresine ve hastanın yaşına göre değişik do ve fraksiyonasyonlar uygulanabilmektedir. Doz, fraksiyon ve alan hastaya göre belirlenmelidir.

Research paper thumbnail of NUT Midline Carcinoma of the Lung in a Six-Year-Old Child

Fetal and pediatric pathology, 2017

Nuclear protein of the testis (NUT) midline carcinoma is genetically defined by rearrangement of ... more Nuclear protein of the testis (NUT) midline carcinoma is genetically defined by rearrangement of NUT or by immunohistochemical expression of NUT. A 6-year old child had a NUT midline carcinoma of the lung. Despite aggressive therapy, the child died. NUT carcinoma, which can be diagnosed immunohistochemically, remains an aggressive tumor.

Research paper thumbnail of Evaluation of Serum Trace Element and Vitamin Levels in Children With Cancer in the First 6 Months After Diagnosis

Journal of pediatric hematology/oncology, Jan 5, 2018

Adequate nutrient intake should be provided for the cure of children diagnosed with cancer. The a... more Adequate nutrient intake should be provided for the cure of children diagnosed with cancer. The aim of this study was to evaluate serum trace elements and vitamins of children with cancer at diagnosis and during treatment. Children with newly diagnosed cancer who were admitted to our center were evaluated for serum selenium, iron, ferritin, C-reactive protein, vitamin B12, folate, and 25-OH vitamin D levels at presentation, and at the third and sixth months of cancer treatment. Forty-two children (male/female: 15/27) with a median age of 8 years (range, 2 to 17) were included in the study. Mean serum B12, folate, and iron levels were within normal ranges, but selenium and 25-OH vitamin D were low at presentation and during the 6-month period. Serum ferritin levels were high in all 3 measures, but they decreased significantly at the sixth month (P=0.04). There was no relation between micronutrient deficiency and sex, or primary disease, or stage, or place of residence of the patient....

Research paper thumbnail of Accidental cisplatin overdose in a child: successful management with repetitive plasmapheresis and use of chemoprotective agents

The Turkish Journal of Pediatrics

Cisplatin is one of the effective chemotherapeutic agents widely used for many tumor types in chi... more Cisplatin is one of the effective chemotherapeutic agents widely used for many tumor types in children. The most serious complications of cisplatin overdose are nephrotoxicity and ototoxicity. It may lead to life-threatening complications and even death. We report a 13-year-old female patient with osteosarcoma who received a massive cisplatin overdose mistakenly. She was given cisplatin 120 mg/m 2 /day for consecutive two days, instead of one day (total 240 mg/m 2) due to a prescription error. After 12 hours, her cisplatin level was measured as 8,500 ng/ml (normal: 1,000-5,000 ng/ml). She was treated with repeated plasmapheresis combined with use of two chemoprotectants, (N-acetylcysteine and amifostine). On her follow up, renal functions and audiometric tests remained normal. According to our experience with our case, early urgent combined treatment is very important in the management of cisplatin overdose.

Research paper thumbnail of Children Pilomatricoma (Calcifying epithelioma): A case of Atypical Placement

Advanced Techniques in Biology & Medicine

Research paper thumbnail of Risk factors predicting the survival of pediatric patients with relapsed/refractory non-Hodgkin lymphoma who underwent hematopoietic stem cell transplantation: a retrospective study from the Turkish pediatric bone marrow transplantation registry

Leukemia & lymphoma, Jan 2, 2017

We examined outcomes of 62 pediatric patients with relapsed or refractory non-Hodgkin lymphoma (r... more We examined outcomes of 62 pediatric patients with relapsed or refractory non-Hodgkin lymphoma (rr-NHL) who underwent hematopoietic stem cell transplantation (HSCT). The overall survival (OS) and event-free survival (EFS) rates were 65% and 48%, respectively. Survival rates for patients with chemosensitive disease at the time of HSCT were significantly higher than those of patients with chemoresistant disease (69% vs. 37%, p = .019 for OS; 54% vs. 12%, p < .001 for EFS; respectively). A chemoresistant disease at transplantation was the only factor that predicted a limited OS (hazard ratio = 10.00) and EFS (hazard ratio = 16.39) rates. Intensive chemotherapy followed by HSCT could be an effective strategy for treating children with rr-NHL and may offer improved survival for a significant group of pediatric patients, particularly those with chemosensitive disease at transplantation.

Research paper thumbnail of Pediatric bladder/prostate rhabdomyosarcoma: eight cases from a single center

The Turkish Journal of Pediatrics, 2016

In this study, clinical characteristics, treatment modalities and outcome of patients diagnosed w... more In this study, clinical characteristics, treatment modalities and outcome of patients diagnosed with bladder/prostate rhabdomyosarcoma (BP RMS) were evaluated retrospectively. Files of 8 children diagnosed with BP RMS and treated between 2004-2014 were reviewed for clinical characteristics, treatment modalities and outcome. Seven males and one female were diagnosed with BP RMS between 2004-2014. Median age was 33.5 months (range, 2 to 176 months). At presentation the main clinical symptoms were hematuria in 5 patients, and constipation, oliguria and prolonged jaundice in 1 patient each. All patients were non-metastatic and only one had an embryonal histology. Primary resection before chemotherapy was performed on only one patient. Six patients were treated initially with VAC chemotherapy for 12 weeks, two patients were treated PIAV (ifosfamide, cisplatin, doxorubicin, vincristine). Local relapse or progressive disease occurred in 5 of 8 patients, and two of these patients underwent primary or secondary tumor resection without radiotherapy. Three patients developed a local relapse after combination of radiochemotherapy and tumor resection. Radical surgical treatment was performed in 3 patients with local relapse. Only one patient underwent partial cystectomy. Six of 8 patients were alive and under follow-up without disease at a median survival of 53 months (range, 13 to 78 months). BP RMS requires a multidisciplinary treatment approach. There is a general consensus that chemotherapy is the mainstay of treatment in BP RMS, but the method to be used for local control is controversial, and may vary from case to case in this heterogeneous disease.

Research paper thumbnail of Assessment of tumors in children with tuberous sclerosis: a single centre’s experience

Türk Pediatri Arşivi, 2017

Aim: As a result of mutations in TSC1 (9q34) and TSC2 (16p13.3) tumor supressor genes, the mammal... more Aim: As a result of mutations in TSC1 (9q34) and TSC2 (16p13.3) tumor supressor genes, the mammalian target of the rapamycin (mTor) signaling pathway is overactivated in patients with tuberous sclerosis. Abnormal cell proliferation and differentiation is responsible for the growth several different tumors. The aim of this study was to review tumors in our patients with tuberous sclerosis. Material and Methods: Thirty-six patients with tuberous sclerosis were reviewed retrospectively in terms of age, sex, family history, clinical findings, presence of tumors, and treatments. Results: Our study included 36 patients (18/18:M/F) aged between two days and 17 years with a median age of 6 years. There were hypopigmented spots in 30 patients, seizures in 28 patients, and a family history in 11 patients. Tumors related to tuberous sclerosis were renal angiomyolipomas in 21 patients, cardiac rhabdomyomas in 11, subependymal giant cell astrocytomas in seven, and non renal hamartoma in one patient. Everolimus treatment was used in only two patients because of hemodynamic instability. Conclusions: Tuberous sclerosis is a multisystemic disease characterized by the presence of various benign tumors and neurologic disorders. Renal angiomyolipomas, cardiac rhabdomyomas, and subependymal giant cell astrocytomas are commonly observed in patients with tuberous sclerosis. mTOR inhibitors such as everolimus and sirolimus have been increasingly used in the treatment of these tumors. However, the duration and optimal dose of mTOR inhibitors is still controversial and should be used in selected cases.

Research paper thumbnail of Pfapa Sendromlu Bir Çocukta Kolşisin Kullanımı

Turkiye Cocuk Hastalıkları Dergisi, Mar 10, 2012

Research paper thumbnail of Adrenokortikal Karsinom: Olgu Sunumu

Turkiye Cocuk Hastalıkları Dergisi, Mar 1, 2009

... month. His physical examination revealed high blood pressure over 95 percentile for his age, ... more ... month. His physical examination revealed high blood pressure over 95 percentile for his age, streched penis length was above 90 percentile for age, his testes volumes were 5 mL/5mL and he had Taner stage 2 pubic hair. Other ...

Research paper thumbnail of Tumor thrombus in Wilms Tumor

Wilms tumor (WT), also known as nephroblastoma, is the most common renal tumor in children. It ac... more Wilms tumor (WT), also known as nephroblastoma, is the most common renal tumor in children. It accounts for more than 90% of all renal tumors in children. The survival rates have greatly improved over the years, based on the currently available treatment protocols. Most of the patients with WT can expect to be cured of their disease following multimodal therapy (1,2). Multicentre trials have been carried out both in Europe by Society of International Pediatric Oncology (SIOP) and in the United States by National Tumor Wilms Study Group (NTWSG) since 1980's. By using chemotherapy and radiotherapy, in addition to total nephrectomy, the prognosis of WT has improved dramatically to more than 90% in recent years. The management of WT differs in Europe and North America. In Europe, WTs are treated according to the SIOP protocols. Use of preoperative chemotherapy provides tumor reduction prior to surgical resection in this approach. On the other hand, in North America, management of WT is according to the NTWSG regimens which advocate surgery prior to chemotherapy. Inoperable WT constitutes about 28% of total cases of WT. Large size of tumor, involvement of adjacent vital structures, and intracaval tumor thrombus are mostly accepted as inoperable criteria.

Research paper thumbnail of Gastroduodenal lesions and Helicobacter pylori in children with end-stage renal disease

Pediatric Nephrology, Sep 1, 2000

Research paper thumbnail of Nadir Görülen Bir Klinik Antite: Jukstapapiller Hemanjiyoblastom

Turkiye Klinikleri Journal of Ophthalmology, 2013

Research paper thumbnail of Refugee children with cancer in Turkey

The Lancet Oncology, 2016

Research paper thumbnail of Wilms tumor with intravascular tumor thrombus

Translational pediatrics, 2014

Wilms tumor (WT) is one of the most common solid tumors in children. It is the second most common... more Wilms tumor (WT) is one of the most common solid tumors in children. It is the second most common extracranial solid tumor after neuroblastoma. WT has a strong tendency to invade blood vessels in the form of tumor thrombus, into the renal veins, and inferior vena cava and even into the right atrium. Extension of tumor thrombus along to the renal vein into the inferior vena cava occurs in 4-10% of all patients. Tumor thrombus extending to the right atrium is less reported as 0.7-1%. WT with renal vein thrombus has been reported to be more common in the right kidney because of the shorter right renal vein. Most patients with tumor thrombus are asymptomatic and diagnosis is only made on imaging investigations. Several imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI) and Doppler ultrasonography (USG) can demonstrate intravascular tumor thrombus before surgery. In addition to CT and MRI, Doppler USG is reliable in demonstrating the presence and exte...

Research paper thumbnail of The management of bilateral Wilms tumor

Translational pediatrics, 2014

Wilms tumor (WT) is the most common malignant renal tumor in childhood. Approximately 5-7% of WT ... more Wilms tumor (WT) is the most common malignant renal tumor in childhood. Approximately 5-7% of WT patients present with bilateral disease, either synchronously or metachronously. Bilateral WT usually occurs in younger children and more often in girls. Management of a child with bilateral WT is very challenging. In contrast to unilateral WT, there has not been uniform agreement about the therapeutic strategy in the management of bilateral WT. As surgery is a critical component in the treatment of WT, the aim is to achieve a high cure rate while maintaining adequate long-term renal function in patients with bilateral WT. In the past, radical surgical procedures which lead to the patients on dialysis have been traditionally recommended in these patients. After several multicentre trials, bilateral biopsies followed by pre-operative chemotherapy and then renal salvage surgery have been recommended. The management of bilateral WT has evolved from primary surgical extirpation to kidney-pre...

Research paper thumbnail of The association of consumptive hypothyroidism secondary to hepatic hemangioma and severe heart failure in infancy

Türk pediatri arşivi, 2016

Although hemangiomas are the most common vascular tumors of the liver in infancy, data regarding ... more Although hemangiomas are the most common vascular tumors of the liver in infancy, data regarding hypothyroidism and heart failure related to hepatic hemangiomas are limited. Here, we present a 15- day -old girl who presented with prolonged jaundice at the age of 15 days. Because her TSH level was found to be 74 μIU/mL, she was initially diagnosed with congenital hypothyroidism and L-Thyroxine replacement therapy was initiated. On follow-up examination performed two months later, it was observed that her TSH level was not suppressed and a mass was noticed in the right upper abdomen on physical examination. Abdominal ultrasonography revealed multiple masses with sizes of about 3-3,5 cm covering the whole liver. When evaluated with clinical and radiological appearance, oral methylprednisolone at a dose of 5 mg/kg/day and propranolol at a dose of 2 mg/kg were initiated with a diagnosis of hepatic hemagioma/hemangioendothelioma. Consumptive hypothyroidism due to hepatic hemangioma and co...

Research paper thumbnail of Çocuklarda Ağri: Değerlendi̇rme Ve Yaklaşim

Research paper thumbnail of High-Dose Methylprednisolone Treatment of Hepatic Veno-Occlusive Disease in a Child with Wilms Tumor

Pediatric Hematology and Oncology, Jul 1, 2003

Veno-occlusive disease (VOD) is a rare complication of chemotherapy in children with cancer. In t... more Veno-occlusive disease (VOD) is a rare complication of chemotherapy in children with cancer. In the literature successful treatment of severe VOD has not been well determined. The authors report a 5-year-old boy with Willms tumor whose condition was complicated with VOD while receiving chemotherapy. He was treated successfully with high-dose methylprednisolone. After therapy, the clinical signs of VOD, such as abdominal ascites, oliguria, and jaundice, disappeared without any adverse effects of therapy.

Research paper thumbnail of Efficacy and safety of intralesional corticosteroid application for hemangiomas

TURKISH JOURNAL OF MEDICAL SCIENCES, 2015

Background/aim: There are different modalities for management of infantile hemangiomas (IHs). In ... more Background/aim: There are different modalities for management of infantile hemangiomas (IHs). In this report, our aim is to evaluate whether intralesional corticosteroid treatment is associated with systemic side effects and whether this is an effective treatment modality for IH. Materials and methods: Six children treated with intralesional corticosteroids for problematic hemangiomas were included in the study. Clinical characteristics, response to treatment, weight, height, blood pressure, morning serum cortisol, and adrenocorticotropic hormone levels were recorded. Results: Each child received intralesional triamcinolone at a dose of 2 mg/kg for 2-5 injections at monthly intervals. Subjects were followed for 1 year. All patients had adrenal suppression following the second or third triamcinolone injections. Five patients demonstrated partial response and one demonstrated no response. Conclusion: Intralesional steroid injection may effectively induce the resolution of hemangiomas, but all the patients in our group had adrenal suppression after treatment. The use of intralesional steroid therapy is not a superior treatment option for hemangiomas. It also has side effects comparable to systemic steroids.

Research paper thumbnail of Radiotherapy for Renal Rhabdoid Tumor: A Case Report and a Review of Literature

Acta Oncologica Turcica

Renal rhabdoid tumor, çok nadir görülen ve kötü sağkalımla seyreden bir hastalıktır.Radyoterapi b... more Renal rhabdoid tumor, çok nadir görülen ve kötü sağkalımla seyreden bir hastalıktır.Radyoterapi bu tumorlerde primer tumore veya cerrahi yatağa, hastalık kontrolü için sıklıkla uygulanmaktadır. Bu vaka takdiminde, 4 aylık renal kitlesi ve yaygın intraabdominal metastazı olan hasta sunulacaktır.Hastaya öncelikle maksimal debulking cerrahi ardından kemoradyoterapi uygulanmıştır. Hastalık progresyon göstermiş ve hasta 3 ay içerisinde kaybedilmiştir.Hastalığı evresine ve hastanın yaşına göre değişik do ve fraksiyonasyonlar uygulanabilmektedir. Doz, fraksiyon ve alan hastaya göre belirlenmelidir.

Research paper thumbnail of NUT Midline Carcinoma of the Lung in a Six-Year-Old Child

Fetal and pediatric pathology, 2017

Nuclear protein of the testis (NUT) midline carcinoma is genetically defined by rearrangement of ... more Nuclear protein of the testis (NUT) midline carcinoma is genetically defined by rearrangement of NUT or by immunohistochemical expression of NUT. A 6-year old child had a NUT midline carcinoma of the lung. Despite aggressive therapy, the child died. NUT carcinoma, which can be diagnosed immunohistochemically, remains an aggressive tumor.

Research paper thumbnail of Evaluation of Serum Trace Element and Vitamin Levels in Children With Cancer in the First 6 Months After Diagnosis

Journal of pediatric hematology/oncology, Jan 5, 2018

Adequate nutrient intake should be provided for the cure of children diagnosed with cancer. The a... more Adequate nutrient intake should be provided for the cure of children diagnosed with cancer. The aim of this study was to evaluate serum trace elements and vitamins of children with cancer at diagnosis and during treatment. Children with newly diagnosed cancer who were admitted to our center were evaluated for serum selenium, iron, ferritin, C-reactive protein, vitamin B12, folate, and 25-OH vitamin D levels at presentation, and at the third and sixth months of cancer treatment. Forty-two children (male/female: 15/27) with a median age of 8 years (range, 2 to 17) were included in the study. Mean serum B12, folate, and iron levels were within normal ranges, but selenium and 25-OH vitamin D were low at presentation and during the 6-month period. Serum ferritin levels were high in all 3 measures, but they decreased significantly at the sixth month (P=0.04). There was no relation between micronutrient deficiency and sex, or primary disease, or stage, or place of residence of the patient....

Research paper thumbnail of Accidental cisplatin overdose in a child: successful management with repetitive plasmapheresis and use of chemoprotective agents

The Turkish Journal of Pediatrics

Cisplatin is one of the effective chemotherapeutic agents widely used for many tumor types in chi... more Cisplatin is one of the effective chemotherapeutic agents widely used for many tumor types in children. The most serious complications of cisplatin overdose are nephrotoxicity and ototoxicity. It may lead to life-threatening complications and even death. We report a 13-year-old female patient with osteosarcoma who received a massive cisplatin overdose mistakenly. She was given cisplatin 120 mg/m 2 /day for consecutive two days, instead of one day (total 240 mg/m 2) due to a prescription error. After 12 hours, her cisplatin level was measured as 8,500 ng/ml (normal: 1,000-5,000 ng/ml). She was treated with repeated plasmapheresis combined with use of two chemoprotectants, (N-acetylcysteine and amifostine). On her follow up, renal functions and audiometric tests remained normal. According to our experience with our case, early urgent combined treatment is very important in the management of cisplatin overdose.

Research paper thumbnail of Children Pilomatricoma (Calcifying epithelioma): A case of Atypical Placement

Advanced Techniques in Biology & Medicine

Research paper thumbnail of Risk factors predicting the survival of pediatric patients with relapsed/refractory non-Hodgkin lymphoma who underwent hematopoietic stem cell transplantation: a retrospective study from the Turkish pediatric bone marrow transplantation registry

Leukemia & lymphoma, Jan 2, 2017

We examined outcomes of 62 pediatric patients with relapsed or refractory non-Hodgkin lymphoma (r... more We examined outcomes of 62 pediatric patients with relapsed or refractory non-Hodgkin lymphoma (rr-NHL) who underwent hematopoietic stem cell transplantation (HSCT). The overall survival (OS) and event-free survival (EFS) rates were 65% and 48%, respectively. Survival rates for patients with chemosensitive disease at the time of HSCT were significantly higher than those of patients with chemoresistant disease (69% vs. 37%, p = .019 for OS; 54% vs. 12%, p < .001 for EFS; respectively). A chemoresistant disease at transplantation was the only factor that predicted a limited OS (hazard ratio = 10.00) and EFS (hazard ratio = 16.39) rates. Intensive chemotherapy followed by HSCT could be an effective strategy for treating children with rr-NHL and may offer improved survival for a significant group of pediatric patients, particularly those with chemosensitive disease at transplantation.

Research paper thumbnail of Pediatric bladder/prostate rhabdomyosarcoma: eight cases from a single center

The Turkish Journal of Pediatrics, 2016

In this study, clinical characteristics, treatment modalities and outcome of patients diagnosed w... more In this study, clinical characteristics, treatment modalities and outcome of patients diagnosed with bladder/prostate rhabdomyosarcoma (BP RMS) were evaluated retrospectively. Files of 8 children diagnosed with BP RMS and treated between 2004-2014 were reviewed for clinical characteristics, treatment modalities and outcome. Seven males and one female were diagnosed with BP RMS between 2004-2014. Median age was 33.5 months (range, 2 to 176 months). At presentation the main clinical symptoms were hematuria in 5 patients, and constipation, oliguria and prolonged jaundice in 1 patient each. All patients were non-metastatic and only one had an embryonal histology. Primary resection before chemotherapy was performed on only one patient. Six patients were treated initially with VAC chemotherapy for 12 weeks, two patients were treated PIAV (ifosfamide, cisplatin, doxorubicin, vincristine). Local relapse or progressive disease occurred in 5 of 8 patients, and two of these patients underwent primary or secondary tumor resection without radiotherapy. Three patients developed a local relapse after combination of radiochemotherapy and tumor resection. Radical surgical treatment was performed in 3 patients with local relapse. Only one patient underwent partial cystectomy. Six of 8 patients were alive and under follow-up without disease at a median survival of 53 months (range, 13 to 78 months). BP RMS requires a multidisciplinary treatment approach. There is a general consensus that chemotherapy is the mainstay of treatment in BP RMS, but the method to be used for local control is controversial, and may vary from case to case in this heterogeneous disease.

Research paper thumbnail of Assessment of tumors in children with tuberous sclerosis: a single centre’s experience

Türk Pediatri Arşivi, 2017

Aim: As a result of mutations in TSC1 (9q34) and TSC2 (16p13.3) tumor supressor genes, the mammal... more Aim: As a result of mutations in TSC1 (9q34) and TSC2 (16p13.3) tumor supressor genes, the mammalian target of the rapamycin (mTor) signaling pathway is overactivated in patients with tuberous sclerosis. Abnormal cell proliferation and differentiation is responsible for the growth several different tumors. The aim of this study was to review tumors in our patients with tuberous sclerosis. Material and Methods: Thirty-six patients with tuberous sclerosis were reviewed retrospectively in terms of age, sex, family history, clinical findings, presence of tumors, and treatments. Results: Our study included 36 patients (18/18:M/F) aged between two days and 17 years with a median age of 6 years. There were hypopigmented spots in 30 patients, seizures in 28 patients, and a family history in 11 patients. Tumors related to tuberous sclerosis were renal angiomyolipomas in 21 patients, cardiac rhabdomyomas in 11, subependymal giant cell astrocytomas in seven, and non renal hamartoma in one patient. Everolimus treatment was used in only two patients because of hemodynamic instability. Conclusions: Tuberous sclerosis is a multisystemic disease characterized by the presence of various benign tumors and neurologic disorders. Renal angiomyolipomas, cardiac rhabdomyomas, and subependymal giant cell astrocytomas are commonly observed in patients with tuberous sclerosis. mTOR inhibitors such as everolimus and sirolimus have been increasingly used in the treatment of these tumors. However, the duration and optimal dose of mTOR inhibitors is still controversial and should be used in selected cases.

Research paper thumbnail of Pfapa Sendromlu Bir Çocukta Kolşisin Kullanımı

Turkiye Cocuk Hastalıkları Dergisi, Mar 10, 2012

Research paper thumbnail of Adrenokortikal Karsinom: Olgu Sunumu

Turkiye Cocuk Hastalıkları Dergisi, Mar 1, 2009

... month. His physical examination revealed high blood pressure over 95 percentile for his age, ... more ... month. His physical examination revealed high blood pressure over 95 percentile for his age, streched penis length was above 90 percentile for age, his testes volumes were 5 mL/5mL and he had Taner stage 2 pubic hair. Other ...

Research paper thumbnail of Tumor thrombus in Wilms Tumor

Wilms tumor (WT), also known as nephroblastoma, is the most common renal tumor in children. It ac... more Wilms tumor (WT), also known as nephroblastoma, is the most common renal tumor in children. It accounts for more than 90% of all renal tumors in children. The survival rates have greatly improved over the years, based on the currently available treatment protocols. Most of the patients with WT can expect to be cured of their disease following multimodal therapy (1,2). Multicentre trials have been carried out both in Europe by Society of International Pediatric Oncology (SIOP) and in the United States by National Tumor Wilms Study Group (NTWSG) since 1980's. By using chemotherapy and radiotherapy, in addition to total nephrectomy, the prognosis of WT has improved dramatically to more than 90% in recent years. The management of WT differs in Europe and North America. In Europe, WTs are treated according to the SIOP protocols. Use of preoperative chemotherapy provides tumor reduction prior to surgical resection in this approach. On the other hand, in North America, management of WT is according to the NTWSG regimens which advocate surgery prior to chemotherapy. Inoperable WT constitutes about 28% of total cases of WT. Large size of tumor, involvement of adjacent vital structures, and intracaval tumor thrombus are mostly accepted as inoperable criteria.

Research paper thumbnail of Gastroduodenal lesions and Helicobacter pylori in children with end-stage renal disease

Pediatric Nephrology, Sep 1, 2000

Research paper thumbnail of Nadir Görülen Bir Klinik Antite: Jukstapapiller Hemanjiyoblastom

Turkiye Klinikleri Journal of Ophthalmology, 2013

Research paper thumbnail of Refugee children with cancer in Turkey

The Lancet Oncology, 2016

Research paper thumbnail of Wilms tumor with intravascular tumor thrombus

Translational pediatrics, 2014

Wilms tumor (WT) is one of the most common solid tumors in children. It is the second most common... more Wilms tumor (WT) is one of the most common solid tumors in children. It is the second most common extracranial solid tumor after neuroblastoma. WT has a strong tendency to invade blood vessels in the form of tumor thrombus, into the renal veins, and inferior vena cava and even into the right atrium. Extension of tumor thrombus along to the renal vein into the inferior vena cava occurs in 4-10% of all patients. Tumor thrombus extending to the right atrium is less reported as 0.7-1%. WT with renal vein thrombus has been reported to be more common in the right kidney because of the shorter right renal vein. Most patients with tumor thrombus are asymptomatic and diagnosis is only made on imaging investigations. Several imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI) and Doppler ultrasonography (USG) can demonstrate intravascular tumor thrombus before surgery. In addition to CT and MRI, Doppler USG is reliable in demonstrating the presence and exte...

Research paper thumbnail of The management of bilateral Wilms tumor

Translational pediatrics, 2014

Wilms tumor (WT) is the most common malignant renal tumor in childhood. Approximately 5-7% of WT ... more Wilms tumor (WT) is the most common malignant renal tumor in childhood. Approximately 5-7% of WT patients present with bilateral disease, either synchronously or metachronously. Bilateral WT usually occurs in younger children and more often in girls. Management of a child with bilateral WT is very challenging. In contrast to unilateral WT, there has not been uniform agreement about the therapeutic strategy in the management of bilateral WT. As surgery is a critical component in the treatment of WT, the aim is to achieve a high cure rate while maintaining adequate long-term renal function in patients with bilateral WT. In the past, radical surgical procedures which lead to the patients on dialysis have been traditionally recommended in these patients. After several multicentre trials, bilateral biopsies followed by pre-operative chemotherapy and then renal salvage surgery have been recommended. The management of bilateral WT has evolved from primary surgical extirpation to kidney-pre...

Research paper thumbnail of The association of consumptive hypothyroidism secondary to hepatic hemangioma and severe heart failure in infancy

Türk pediatri arşivi, 2016

Although hemangiomas are the most common vascular tumors of the liver in infancy, data regarding ... more Although hemangiomas are the most common vascular tumors of the liver in infancy, data regarding hypothyroidism and heart failure related to hepatic hemangiomas are limited. Here, we present a 15- day -old girl who presented with prolonged jaundice at the age of 15 days. Because her TSH level was found to be 74 μIU/mL, she was initially diagnosed with congenital hypothyroidism and L-Thyroxine replacement therapy was initiated. On follow-up examination performed two months later, it was observed that her TSH level was not suppressed and a mass was noticed in the right upper abdomen on physical examination. Abdominal ultrasonography revealed multiple masses with sizes of about 3-3,5 cm covering the whole liver. When evaluated with clinical and radiological appearance, oral methylprednisolone at a dose of 5 mg/kg/day and propranolol at a dose of 2 mg/kg were initiated with a diagnosis of hepatic hemagioma/hemangioendothelioma. Consumptive hypothyroidism due to hepatic hemangioma and co...

Research paper thumbnail of Çocuklarda Ağri: Değerlendi̇rme Ve Yaklaşim

Research paper thumbnail of High-Dose Methylprednisolone Treatment of Hepatic Veno-Occlusive Disease in a Child with Wilms Tumor

Pediatric Hematology and Oncology, Jul 1, 2003

Veno-occlusive disease (VOD) is a rare complication of chemotherapy in children with cancer. In t... more Veno-occlusive disease (VOD) is a rare complication of chemotherapy in children with cancer. In the literature successful treatment of severe VOD has not been well determined. The authors report a 5-year-old boy with Willms tumor whose condition was complicated with VOD while receiving chemotherapy. He was treated successfully with high-dose methylprednisolone. After therapy, the clinical signs of VOD, such as abdominal ascites, oliguria, and jaundice, disappeared without any adverse effects of therapy.