One hundred and forty years ago, Armand Trousseau described phlegmasia alba dolens as a sign of internal malignancy. Nowadays, it is commonly believed that the presence malignant tumaor increases the risk of venous thromboembolism (i.e deep vein thrombosis and pulmonary embolism) However, cancer is usually associated with other factors such as old age, extensive surgery,immobility, etc., which may predispose to thromboembolism. The majority of thrombotic events occur in the venous system; the incidence of arterial thrombosis is much lower.Recurrent thromboembolism in cancer patients frequently and diminishes the quality of life of the patients.Furthermore, if the thromboembolism is massive, destipte of early and aggressive treatment, it may result in death. In this article, we review thromboembolic complications in cancer patients.

Iskemik ekstremiteye kemik iligi implantasyonu, endotelyal progenitor hücreler,anjiyogeniksitokinler veya faktörler araciligi ile anjiyogenesisi arttirabilir. Bu çalismada,Buerger hastaligina bagli iskemik ekstremiteli hastalarda otolog kemik iligi-mononükler hücre (KIMH) implantasyonunun yarar ve güvenilirligin arastirdik.
Ankara Üniversitesi Tip Fakültesi'nde iskemik ekstremiteli hastalara otolog KIMH içeren hücre tedavisinin arastirildigi bir klinik çalisma planlandi. KIMH implante edilecek hastalarin seçimi için kriterler; iyilesmeyen ülserler ile birlikte olsun veya olmasin ciddi istirahatagrisitarif edenkritik iskemik bacakli hastalar,sigara birakmaya ragmen alti
aylik süreyle semptomlari düzelmeyen ve iloprost infüzyonuna yanitsiz hastalar,cerrahi veya cerrahi olmayan revaskülarizasyon sansi bulunmayan hastalar olarak belirlendi. Çalismanin birincil sonlanim noktalari, tedavinin güvenilirligi, uygulanabilirligi ve en önemli lezyonun tamamen iyilesmesi olarak belirlendi. Ikincil sonlanim noktalari ise, istirahat agrisinin analjezik ihtiyaci olmadan tamamen iyilesmesi, 12. haftada maksimum yürüme zamaninin(MYZ) degismesi, kol-bacak basinç indeksi(KBBI)ve oksimetre kullanilarak transkütanöz oksijensa ürasyonunun degerlendirilmesi, yeni kollateral damar olusumunun anjiyografik olarak gösterilmesi, talyumlu perfüzyonsintigrafisiyle etkilenen ekstremitede doku perfüzyonunun degerlendirilmesiydi. Hastalardan(ortalama yas 46.7: t 10.3yil) kemikiligi (519: t 45.5 ml) genel anestezi altinda spinailiakaposterior
süperiordanalindi.Sürekli akim hücre ayrim cihazi ile eritrositten arindirma ve volüm azaltilmasindan sonra, eritrositleri %91 oraninda azaltilmis konsantre KIMH(51.5: t 10.1mL)eldeedildi (7.04: t 1.9x 10l/mL totalçekirdeki hücre). Kemik iligi toplanmasindan sonra üç saat içinde KIMH(ortalama12.16: t 4.3 x 108) konsantre iskemik bacagin gastroknemiuskas içine çoklu enjeksiyonla implante edildi. Kontrolamaciyla ayni
metot kullanilarak diger bacaga serum fizyolojik enjekte edildi. Unilateral intramusküler KIMH verilmesi herhangi bir komplikasyona neden olmadi. Öncelikli amaç olan en
önemli lezyonun iyilesmesine üç hastada ulasildi.Hastalarin hepsi az dört hafta takip edildi. Ikincil sonlanim noktasina: 12. haftada MYZ(LlMYZ degisikligi, analjezikihtiyaci olmadan istirahat agrisinin tamamen geçmesine 3 hastada ulasildi. Yirmidört haftalik takibini tamamlamis olan ilk iki hastada kiklinik iyilesme bu süreden
sonra da devamlilikgösterdi. KIM Himplantasyonu öncesi ve üç ay sonrasi yapilan DSA incelemelerinde üç hastada etkilenen arterler boyunca yeni vaskülerkollateralag olusumu gösterildi.
Sunulan çalismanin ön sonuçlari umut vericidir. Sonuç olarak kemik iligi, diger tedavi yöntemlerine yanit vermeyen terminal dönemekstremite iskemisi olan Buerger hastalarinda potansiyel tedavi edici hücreleri barindirmaktadir.

Bone marrow implantation into ischaemic limbs could enhance angiogenesis by supplying endothelialprogeniter cells and angiogenic cytokinesot factors. We investigated efficacy and safety of autologousimplantation of bonemarrow-mononuclearcells (BMMC)in patients with ischaemic limbs due to Buerger's disease. We commence daciinical study to test cell therapy with autologous BMMC in patients with ischaemic limbs at the University of Ankara School of Medicine. In order for the patients to qualify for BMMC implantation, they should have critical limb ischaemia define das ischaemic rest painin a limb with or without non healing ulcers, should not respond to previous iloprost infusions and smoking cessation six months prior to evaluation and should not be candidates for nonsurgicalor surgical revascularisation. Primaryend points were safety andfeasibility of the treatmentand total healing of the most importantlesion. Secondary endpoints were total relief of rest pain without the need for analgesies,change in peak walkingtime (PWT)at 12 weeks, improvements in ankle-brachial pressure index(ABI), transcutaneous oxygen saturation using pulse oximetry(SaO2),angiographic evidence of newcollatera lvesselformation, tissue perfusion in the affected extremity using Thallium perfusions cintigraphyW. hilepatients(meanage46.7: !: 10.3years)were undergeneraal naesthesiaw, eharvested bonemarrow(519: t 45.5mUfromtheposteridilriacspineA. fterredbloodcell(RBCd) epletiaannd volumereduction using a continuous flow cell separator,we achieved 91% RBC depletian and concentrated /~MMC to a final volume and concentration of 51.5: t io.1 mLand7.04: t 1.9 x ioe7/mL total nucleated cells, respectively W.eimplantedBMMC (mean12.16: t 4.3 x ioe8) within three hours after marrow aspiration
by intramuscular injection into the gastrocnemiusmuscle of ischaemic legs. Isotonic saline were injected into the other extremityin as similar fashion as control.
13 Unilateral intramuscular administration of BMMC was not associated with any complications. The primary efficacy end point, total healing of the most importantlesion, was achieved in three patients. All patients were followed up for at least four weeks. The secondary measures; change in PWT(LlPWT)at 12 weeks, total
relief of rest pain without the need of analgesics improved in three patjents. These improvements were sustained for 24 weeks in the first two patients. Digital subtraction angiographic studies before and 3 months after the BMMC implantation showed the presence of a new vascular collateral network across the affected arteries
in three patients. Preliminary results of the presentedstudy are promising. Thus, bone marrow maybe a potential source of cells for Buerger'spatients with end-stage Iimbischaemia refractory to other medical treatment modalities.

HL-60 hücre hattý apoptozis çalýþmak için ilginç bir model teþkil eder. Amacýmýz üç apoptotik gene (BCL-2, BAD and BAX) ait anlatýmlarý gerçek zamanlý kantitatif polimeraz zincir reaksiyonu (PCR) kullanarak saptamaktý. HL-60 hücreleri 1,25 (OH)2D3 (5 x 10-8 M) ile inkübe edildi. RNA porsiyonlarý izole edildi ve cDNA örneklerinde LightCycler analizleri gerçekleþtirildi. Oniki saat sonunda üç gene ait anlatým azalmasý gözledik. Gen anlatým oranlarý BAX için 0.98, BAD için 0.41, BCL-2 için 0.81 idi. Bu çalýþma bu üç genin birlikte anlatým oranlarýný 1,25 (OH)2D3 ile iþlenmiþ HL-60 hücrelerinde erken fazdaki (12 saat) ilk analizini sunmaktadýr. Bilgiler bu apoptozis genlerinin 1,25 (OH)2D3 maruziyetine baðlý olarak anlatým farklýlaþmasýnýn çok erken dönemde yer aldýðýna iþaret etmektedir. Bu optimize edilmiþ strateji benzer apoptotik düzen degiþikliklerinin hýzlý anlaþýlmasýnda kullanýlabilir.

HL-60 cell line offers an interesting model to study apoptosis. Our aim was to detect the expressions of three apoptotic genes (BCL-2, BAD and BAX) using Real-Time quantitative polymerase chain reaction (PCR). HL-60 cells were incubated with 1,25 (OH)2D3 (5 x 10-8 M). RNA portions were isolated and LightCycler analysis were performed on cDNA samples. 1,25 (OH)2D3 incubated cell portions were compared to nontreated portions. We observed down-regulated levels of three genes at the end of the 12 hours. Gene expression ratios were 0.98 for BAX, 0.41 for BAD, 0.81 for BCL-2. For the first time, this study represents the expression levels of these three apoptosis related genes together during early phase (12 hours) of 1,25 (OH)2D3 treatment of HL-60 cells. Data indicate that expression differences of these apoptosis genes take place so early in exposure to 1,25 (OH)2D3. This optimised strategy would be used in rapid understanding of similar apoptotic deregulations.

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Bu prospektif çalýþlmada anti-D immünglobulin ve intravenöz immünglobulin (IVIG) tedavisi alan 29 hastanýn verisi incelenmiþltir. Daha önceki kortikosteroid ve splenektomi yaklaþýmlarý baþlarýsýz olan 11 hastada anti-D, 18 hastada ise IVIG kullanýldý. IVIG kolunda tam yanýt oranlarý yüksek iken (%55`e karflý %18.1), süre 8 hafta idi. Genel olarak kronik idiyopatik trombositopenik purpurada IVIG baþlarýsý daha önceki verilerle benzer iken, anti-D immünglobulin alan grupta trombosit yanýtýný daha düþlük bulduk.

The aim of this prospective study was to evaluate the data from 29 patients diagnosed as chronic refractory idiopathic thrombocytopenic purpura (ITP) treated with anti-D immunoglobulin and intravenous immunoglobulin G (IVIG). We used anti-D and IVIG in 11 and 18 patients respectively in whom the previous treatments including corticosteroids and splenectomy had been unsuccessful. The complete response rates were significantly higher in IVIG arm (55.5% to 18.1%) with a duration of 8 weeks. The overall efficacy of IVIG in the chronic ITP is similar to previous data, however we found lower platelet responses in patients treated with anti-D that can be attributed to the lower sucess in the splenectomized patients.

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Ayný ailenin iki erkek çocuðunda ataksi telanjektazi (AT) ve Fanconi anemisi (FA) gibi iki farklý tip kromozomal kýrýlma bozukluðu olduðu tanýmlandý. Fenotipik olarak AT tanýsý konulan ilk hastada bulbar konjunktivada telanjektazi, alfa-föto protein yüksekliði, ýgA ve ýgE`nin eksikliði, hücresel immünitenin bozukluðu tanýyý desteklemekteydi. Sitogenetik çalýþmada periferal kan lenfositlerinin iyonize radyasyona karþý hassasiyeti saptandý. Pansitopenisi olan sekiz yaþýndaki erkek kardeþinde immünglobulin, alfa-föto protein deðerleri ve hücresel immünite normal bulundu. Sitogenetik çalýflmada spontan kýrýk gözlenmemesine raðmen diepoksi bütan (DEB) ile hafif, mitomisin-C ile fazla miktarda kromozomal kýrýlma saptandý. Ailenin beþinci erkek çocuðu saðlýklý idi ancak normal hematolojik ve immünolojik bulgulara sahip olan ilk çocukta DEB testinde hafif bozulma varken dördüncü çocukta DEB testi bozuk olarak saptandý. Bilgilerimize göre Türkiye`deki FA ve AT beraberliði olan ilk aile olmasý nedeniyle bu ender durum rapor edildi.

We diagnosed two boys with two different chromosomal instability disorders such as Fanconi anemia (FA) and ataxia-telangiectasia (AT) in the same family. The phenotype of the first sibling supports the diagnosis of ataxia-telangiectasia. He had ataxia, telangiectasias on bulbar conjunctivas, a high level of alpha-fetoprotein, low levels of IgA and IgE, and a defective cell-mediated immunity. Cytogenetic studies of the peripheral lymphocytes revealed a chromosomal sensitivity to ionizing radiation. His 8-years-old brother had pancytopenia but had no ataxia and telangiectasia. He had a normal level of immunoglobulins and alpha-fetoprotein. His cell-mediated immunity was also normal. Cytogenetic studies showed no evidence spontaneus chromosome aberrations; however, there was a mild increase in the rate of diepoxybutane (DEB) and also an increased chromosome aberrations in the mitomycin C (MMC) treated samples than the control. The parent of the boys and 5th child were healty. The first child had normal hematological and immunological features, but he had a mild increase in the rate of DEB. The 4th child had an increased rate of DEB-induced chromosome aberrations. To our knowledge, this is the first family with FA and AT in Turkey and it is reported because of its rarity.

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Lenfomanýn ileri evrelerinde uterus ve serviks infiltrasyonu sýk bulgu ise de, kadýn genital sistem non-Hodgkin-lenfomasý çok nadirdir. Burada 63 yaþýnda postmenopozal kanama ile Ann Arbor Evre IE, primer, difüz, büyük B-hücreli uterus lenfomasý tanýsý konan bir hastayý sunmaktayýz. Hasta CHOP protokolü verilerek tedavi edildi. Primer pelvik NHL, diðer jinekolojik kanserlere benzeyen belirtilerle gelir ve jinekolojik malignitelerin ayýrýcý tanýsýnda düþünülmelidir. Bu olgu kemoterapinin uzak mikroskobik metastazlarý kontrol etmesindeki önemini vurgulamaktadýr.

Although uterus and cervix infiltration is a frequent finding in the later stages of lymphomatous disease, non-Hodgkin’s lymphoma (NHL) of the female genital tract is extremely rare. We present the case of a 63-years- old woman diagnosed with postmenopausal bleeding, Ann Arbor stage IE, primary, diffuse, large B-cell NHL of the uterus. Disease status was monitored with physical examination and imaging studies. We administered chemotherapy according to CHOP protocol (cyclophosphamide, adriamycin, vincristine, and prednisone). Primary pelvic NHL may present symptoms like other more common gynecologic cancers. It should be considered in the differential diagnosis of gynecologic malignancy. Our case emphasizes the importance of chemotherapy that can provide a control of the distant microscopic metastases.

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Kronik eozinofilik lösemi (CEL) nadir görülen ve kronik miyeloid lösemiden farklý miyeloproliferatif bir hastalýktýr. Klonal eozinofil artýþý nedeniyle diðer eozinofili nedenlerinden ayrý ele alýnmasý gereken hematolojik bir malignitedir. Burada hipereozinofili ile seyreden (eozinofil sayýsý: 85.4x109/L) ve takibe alýndýktan dokuz ay sonra blastik transformasyon gösteren bir kronik eozinofilik lösemi olgusu sunmaktayýz. Bu tablonun dalak tutulumu, muhtemel karaciðer tutulumu ve blastik transformasyonla sonlanmasý nedeni ile diðer eozinofili nedenlerinden ayýrdedilmesi gerektiðini düþünüyoruz.

Chronic eosinophilic leukaemia is a rare myeloproliferative disease different from the chronic myeloid leukaemia. It is a haematologic malignancy that must be considered separately from other causes of eosinophilia due to its remarkable clonal eosinophilia. Here, we describe a case with chronic eosinophilic leukaemia which was initially hypereosinophilic (eosinophil count: 85.4 x 109/L) and displayed blastic transformation after a 9 months follow up. We suggest the invasion of spleen, probable invasion of the liver and the blastic transformation of this case must be discerned as a different entity rather than the other causes of eosinophilia.

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