Abstract | Full Text PDF

Miyelodisplastik sendrom (MDS), klonal bir hastalık olup periferik sitopeni ve apopitozis indüksiyon artışının kısmen sorumlu olduğu patolojik hematopoiezis ile seyreder. Amifostin, sitoprotektif ve antioksidan bir ajan olup, MDS olgularında apopitozisi geciktirerek progenitör hücre yaşam süresini uzatabilmektedir. Bu çalışma, Fransız- Amerikan-İngiliz (FAB) sınıflandırmasına göre 4 MDS- refrakter anemi (MDS-RA), 2 MDS-ring sideroblast ile refrakter anemi (MDS-RARS) ve 3 MDS-artmış blast sayısı ile dirençli anemi (MDS-RAEB) olgusu olmak üzere toplam dokuz olgu ile gerçekleştirilmiştir. Amifostin olgulara 400 mg/m2, beş-altı dakikada intravenöz yolla dört ardışık hafta boyunca ve haftada üç kez uygulanmıfltır. Üç (%33.3) olgunun biri MDS-RA ve ikisi MDS-RARS-tedavi sonrası lökosit, nötrofil ve retikülosit sayılarında belirgin bir artış izlenmiş ve eritrosit transfüzyon gereksinimleri azalmıştır. Klinik yanıt alınan bu olgularda ilacın kesilmesi ile tüm parametreler tedavi öncesi değerlere geri dönmüştür. Amifostin kullanımının MDS-RA ve RARS olgularında sınırlı bir etkinliği olabileceği sonucuna varılmıştır.

Myelodysplastic syndrome (MDS) is a clonal disorder that is characterized by peripheral cytopenia and the induction of apoptosis is thought to be partially responsible for pathological haematopoiesis in MDS. Amifostine is a cytoprotective and antioxidant agent, and it may prolong the survival of progenitor cells in MDS by delaying apoptosis. The study has been carried out with 9 MDS cases. Four of them were diagnosed as refractory anemia (MDS-RA), two as refractory anemia with ring sideroblasts (MDS-RARS) and the remaining three as refractory anemia with excess blasts (MDS-RAEB) according to the French-American-British (FAB) classification. Amifostine was given in a dose of 400 mg/m2, as an IV infusion administered in 5-6 minutes, three times a week for 4 consecutive weeks. Three of the cases (33.3%), two with MDS RARS and one with MDSRA, showed a significant improvement in the number of total leukocyte, neutrophil and reticulocyte counts and a decrease in the requirement of erithrocyte transfusions. In clinically responsive cases, all hematological parameters returned back to pre-treatment values two weeks after the cessation of therapy. We conclude that Amifostine can be used in a selected group of patients with MDS-RA and MDS-RARS.

Abstract | Full Text PDF

To evaluate the effect of a combination of nevirapine + stavudine + lamivudine on Haematological and Biochemical values of HIV-1 positive patients in Lagos. Fifty patients who met the enrollment criteria for accelerated clinical trial were studied. Ten millimeters of blood was taken from each patient at first visit for basic haematological and biochemical values. Viral load and CD4 cell counts were also analyzed. All the values were repeated at 12 weeks, and 24 weeks, after patients were placed on drug treatment regimen. All the data were analyzed using Epi-info version 6.4D. The mean erythrocyte sedimentation rate (ESR) results were 53.3 ± 41.8 mm/1 hr, 48.2 ± 40.6 mm/1 hr and 28.6 ± 20.7 mm/1 hr. Haemoglobin (Hb) 123 ± 15 g/L, 124 ± 21 g/L and 132 ± 14 g/L. Packed cell volume 36.8 ± 4.5%, 37.6 ± 4.8%, and 40.3 ± 3.3%. Total white blood cell (WBC) 4.2 ± 1.0, 5.0 ± 1.5 and 4.6 ± 1.0 (baseline, 12 weeks and 24 weeks respectively). Creatinine, 1.2 ± 0.68 g/L, 1.2 ± 0.7 g/L and 1.04 ± 0.3 g/L at (baseline, 12 weeks and 24 weeks respectively). Serum amylase 37.9 ± 15.1 IU/L, 38 ± 23.9 IU/L and 24.3 ± 11.6 IU/L. Triglyceride 95.2 ± 48.3 IU/L, 92.38 ± 54.3 IU/L, and 78.0 ± 35.6 IU/L. Serum bilirubin 0.18 ± 0.09 μmol/L, 0.29 ± 0.28 μmol/L and 0.33 ± 0.24 μmol/L. Alanine transaminase (ALT) 9.9 ± 3.3 IU/L, 15.1 ± 9.0 IU/L and 14.1 ± 9.3 IU/L. Serum aspartate transaminase (AST) 8.2 ± 6.2 IU/L, 9.4 ± 5.2 IU/L and 9.1 ± 6.0 IU/L. On comparison of the results between baseline and 12th week, all parameter were similar except PCV, Hb, serum bilirubin, serum ALT, and total WBC, which were significantly high at 12th week. (p≤ 0.05). On comparison of results between 12th week and 24th week all parameters were similar except Hb and PCV (which were significantly higher at 24th week) while ESR, was significantly lower at 24th week (p≤ 0.05). It was concluded that nevirapine + stavudine + lamivudine combination results in improved haematological values of HIV/AIDS patients. The effect of the drug combination on biochemical parameter in a short period of 24 weeks may not be much. Clinical response and haematological response alone may be used for patient monitoring in a resource poor setting where CD4 count and viral load analysis is impossible.

Abstract | Full Text PDF

Bu çalışma otolog ve allogeneik kök hücre nakli yapılan hastalarda infeksiyöz komplikasyonları değerlendirmek için yapılmıştır. Kök hücre nakli yapılan 1/4 hasta (84 otolog, 30 allogeneik) incelendi. Hazırlama ve birinci ayı içine alan pre-engrafman dönemi erken dönem, birinci yıla kadar engrafman sonrası dönem ise geç dönem olarak tanımlandı. Tüm hastalar nötropenik dönemde antibiyotik profilaksisi ve büyüme faktörü aldılar. Ateşli hastalar imipenem-silastatin veya sefepim + amikasin yada seftazidim + amikasin aldılar. Yüzondört olgunun 90`ında 117 mikrobiyolojik tanımlanmış infeksiyon atağı izlendi. Nakil sonrası dönemde hastaların %79`u en az bir febril epizod gösterdi. Bunların 69 (%59)`u erken, 48 (%41)`i geç dönemde idi. Erken dönemde etken mikroorganizmaların %38.8`i gram-pozitif %51.5`i gram-negatif ve %7.7`si mantar idi. Erken dönemde en sık rastlanan patojenler koagülaz-negatif stafilokok (KNS) ve E. coli idi. Geç dönemde ise etken mikroorganizmaların %44.6`sı gram-pozitif, %44.6`sı gram-negatif ve %6.8`i mantardı. Bu dönemde de KNS ve E. coli en sık rastlanan mikroorganizmalardı. S. aureus`ta %47.4, KNS de ise %86.5 metisilin direnci saptandı. Mikroorganizma izolasyon oranları daha önce bildirilenlerle benzerdir. Ancak viridans streptokok ve mantarlar nispeten düşük bulunmuştur. Bu olgulardaki etken spektrumun bilinmesi ampirik tedavi rejimlerinde antibiyotik seçiminde yol gösterici olmaktadır. Bu nedenle lokal sonuçların bildirimi önemlidir ve her kurumda ampirik antibiyotik başlamadan önce lokal mikrobiyolojik sürveyans sonuçlarının bilinmesi yararlı olur.

This study was performed to assess the incidence of infectious complications in patients undergoing autologous and allogeneic hematopoietic stem cell transplantation (HSCT). The characteristics of microbiologically documented infections in 114 consecutive patients undergoing HSCT (84 autologous, 30 allogeneic) were analyzed. Conditioning and the pre-engraftment period until one month was defined as the early period; the post-engraftment period until one year was defined as the late period. All patients received antibiotic prophylaxis and hematopoietic growth factors during neutropenia. Febrile patients received imipenem-cilastatin or cefepime plus amikacin or ceftazidime plus amikacin. A total of 117 episodes with microbiologically documented infections were seen 90 of 114 patients and 79% of the patients experienced at least one febrile episode during their post-transplant course. Of these episodes, 69 (59%) were in the early period and 48 (41%) were in the late period. In the early period, 38.8% of causative organisms were gram-positive, 51.5% were gramnegative and 7.7% were fungi. The most common pathogens were coagulase-negative Staphylococcus (CoNS) and E. coli in the early period. In the late period, 44.6% of causative organisms were gram-positive, 44.6% were gram-negative and 6.8% were fungi. CoNS and E. coli were also the most commonly isolated agents in this period. Resistance to methicillin was detected in 47.4% of S. aureus and 86.5% of CoNS isolates. The isolation rate was in accordance with previous reports; similar percentages of gram-positive and gram-negative isolates were found in patients undergoing HSCT in both periods. However, a remarkably low rate of viridans streptococci and fungi were observed. The spectrum of pathogens detected in these cases serves as the basis for recommendations on the choice of empiric antimicrobial treatment regimens. Therefore, studies reporting local microbiological findings are necessary. We suggest that local microbiologic surveillance should be known before empiric antimicrobial therapy is started in each institution.

Abstract | Full Text PDF

İntratorasik splenozis, dalak rüptürü veya diyafragma hasarı sonrasında meydana gelebilen nadir bir durumdur. Bu olgu sunumunda, beş yıl önce trafik kazası nedeniyle splenektomi uygulanmış olan 48 yaşındaki kadın hastada gelişen intratorasik splenozis vakasını sunuyoruz. Hastaya sol hemitoraksta kitle tanısıyla, malignite şüphesiyle video yardımlı toraks cerrahisi (VATS) uygulandı ve sol hemitorakstaki lezyon eksize edildi. Histopatolojık inceleme dalak dokusuyla uyumlu bulundu. Sonuç olarak, özgeçmişinde torakoabdominal travmaya bağlı ortaya çıkan diyafragma hasarı veya splenektomı hıkayesi bulunan olgularda intratorasik splenozis akılda tutulması gereken bır tanıdır.

Intrathoracic splenosis is a rare condition that results after rupture of the spleen or diaphragmatic injury. We present herein a case of intrathoracic splenosis of a 48-years-old woman whom splenectomy had been performed 5 years ago after a traffic accident. The patient was operated on with suspicion of malignancy and total resection of the lesion was performed with video-assisted thoracic surgery (VATS). Histopathologic examination confirmed the splenosis diagnosis. Thoracic splenosis should be suspected for the patients with thoracic lesions whom had medical history of thoracoabdominal injury including splenectomy or diaphragmatic injury.

Abstract | Full Text PDF

Kalsinozis kutis, deride kalsiyum fosfat hidroksiapatit kristallerinin birikimi ile karakterize çocukluk çağında nadir görülen bir patolojidir. Derideki kalsifikasyon, distrofik, metastatik, idiyopatik ve iyatrojenik olarak dört ana gruba ayrılabilir. Burada, Burkitt lenfoma tanısı konulan dört yaşında bir erkek olguda indüksiyon tedavisi sırasında gelişen tümör lizis sendromuna sekonder iyatrojenik kalsinozis kutis tablosu sunulmakta ve literatür bilgileri ışığında tartışılmaktadır.

Calcinosis cutis, an uncommon disorder characterized by hydroxyapatite crystals of calcium phosphate deposited in the skin, has been described infrequently in childhood. Cutaneous calcification may be divided into four major categories: dystrophic, metastatic, idiopathic, and iatrogenic. Here, we report an example of iatrogenic type with a 4-year-old boy who diagnosed with Burkitt's lymphoma, and developed calcinosis cutis secondary to a tumour lysis syndrome with induction chemotherapy.

Abstract | Full Text PDF

Abstract | Full Text PDF