Publications by authors named "Fatma Betul Cakir"

27 Publications

  • Page 1 of 1

Post- infectious bronchiolitis obliterans in children: Clinical and radiological evaluation and long- term results.

Heart Lung 2021 Jun 4;50(5):660-666. Epub 2021 Jun 4.

Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey.

Background And Objective: This study aims to evaluate clinical and radiological findings and treatment outcomes of the patients with PIBO.

Methods: One hundred fourteen children were enrolled. Initial demographic and clinical findings were evaluated. Pre- and post-treatment clinical and radiological findings were compared.

Results: The median age of the patients at initial pulmonary injury was 7,2 months, the median age at diagnosis was 17.5 months. Persistent wheezing was the most common complaint. Thirty-five patients had mechanical ventilation history. 82,5% of patients had clinical improvement. Bronchiectasis, atelectasis, hyperinflation and air trapping in HRCT improved significantly with treatment. Post-treatment Bhalla scores decreased from 8.3 to 6.5 (p= 0,001). Improvement was observed in radiological and clinical findings after treatment.

Conclusions: This study is one of the largest studies in the literature and one of the few studies that evaluate clinical and radiological outcomes of patients with PIBO.
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http://dx.doi.org/10.1016/j.hrtlng.2021.05.001DOI Listing
June 2021

Is your diagnosis cat scratch disease, not lymphoma?

Pediatr Int 2021 May 17. Epub 2021 May 17.

Department of, Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

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http://dx.doi.org/10.1111/ped.14512DOI Listing
May 2021

Relationships Between Bronchoscopy, Microbiology, and Radiology in Noncystic Fibrosis Bronchiectasis.

Pediatr Allergy Immunol Pulmonol 2021 Jun 14;34(2):46-52. Epub 2021 May 14.

Department of Pediatric Pulmonolgy, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.

Published data on the correlations of bronchoscopy findings with microbiological, radiological, and pulmonary function test results in children with noncystic fibrosis (CF) bronchiectasis (BE) are unavailable. The aims of this study were to evaluate relationships between Bronchoscopic appearance and secretion scoring, microbiological growth, radiological severity level, and pulmonary function tests in patients with non-CF BE. Children with non-CF BE were identified and collected over a 6-year period. Their medical charts and radiologic and bronchoscopic notes were retrospectively reviewed. The study population consisted of 54 female and 49 male patients with a mean age of 11.7 ± 3.4 years. In the classification according to the bronchoscopic secretion score, Grade I was found in 2, Grade II in 4, Grade III in 9, Grade IV in 17, Grade V in 25, and Grade VI in 46 patients. When evaluated according to the Bhalla scoring system, 45 patients had mild BE, 37 had moderate BE, and 21 had severe BE. Microbial growth was detected in bronchoalveolar lavage fluid from 50 of the patients. Forced expiratory volume in 1 s (FEV) and functional vital capacity decreased with increasing bronchoscopic secretion grade ( = 0.048 and  = 0.04), respectively. The degree of radiological severity increased in parallel with the bronchoscopic secretion score ( = 0.007). However, no relationship was detected between microbiological growth rate and radiological findings ( = 0.403). This study showed that bronchoscopic evaluation and especially scoring of secretions correlate with severe clinical condition, decrease in pulmonary function test, worsening in radiology scores, and increase in microbiological bacterial load in patients. Flexible endoscopic bronchoscopy should be kept in mind in the initial evaluation of non-CF BE patients.
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http://dx.doi.org/10.1089/ped.2020.1319DOI Listing
June 2021

Palliative Care in High and Low Resource Countries.

Curr Pediatr Rev 2021 Apr 5. Epub 2021 Apr 5.

Middle East Cancer Consortium, Executive Director, Haifa. Israel.

Palliative Care (PC) is defined by the World Health Organization (WHO) as a support given by multiple disciplines in order to improve the quality of life of both patients and their caregivers, throughout the disease course, from diagnosis to end-of-life. PC aims to prevent and treat symptoms and side effects of the disease and its treatment. PC is well developed in most high income countries; however in most low income settings, where, approximately 80% of patients with cancer requiring PC care for advanced disease live, PC services are still uncommon. Health indicators monitoring global PC development are policy, education, use of medicines, service provision and professional activity. Globally PC development may be categorized as: Group 1 (no known hospice-PC activity), Group 2 (capacity-building activity), Groups 3a Isolated PC provided, 3b Generalized PC provided, 4a hospice-PC services at a stage of integration into regular service provision and 4b hospice-PC services at a stage of advanced integration into regular service provision. Spirituality is an essential element of patient-centered PC. The use of complementary and traditional medicine (CTM) in Middle Eastern countries is widespread. There are wide discrepancies in cancer care and PC in many regions in the world. The Individualized Care Planning and Coordination (ICPC) Model is designed to facilitate the advance care planning with continuity of all the measures like symptom control or emotional, social and spiritual care of both the patient and the family during the disease steps like relapse or end of life.
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http://dx.doi.org/10.2174/1573396317666210405143649DOI Listing
April 2021

Association of Myeloperoxidase Gene Polymorphism With Iron Deficiency Anemia in Turkish Children.

J Pediatr Hematol Oncol 2021 Mar 3. Epub 2021 Mar 3.

Departments of Pediatrics Pediatric Hematology-Oncology, Bezmialem Vakif University, Faculty of Medicine Department of Moleculer Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul Department of Child Endocrinology, Uludağ University Faculty of Medicine, Bursa, Turkey.

This study was performed to investigate the gene polymorphisms of the myeloperoxidase (MPO) enzyme and to determine whether MPO gene polymorphisms influence the response to iron therapy in pediatric patients with iron deficiency anemia (IDA). In this case-control study, 50 Turkish children with IDA and 50 healthy controls were enrolled. Three MPO gene alleles were selected for genotyping in the study: GG, AG, and AA. The relationships of alleles with IDA were analyzed and compared in patients and controls. Pretreatment and posttreatment laboratory parameters and gene polymorphisms were compared in the patient group. There was a significant difference between patients with IDA and controls regarding genotype frequencies of the AA, GG, and AG alleles (P=0.005). However, the AG allele was found to be associated with variations in hemoglobin, red blood cell, hematocrit, mean corpuscular volumes, and mean corpuscular Hb concentrations levels. The frequency of AA, GG, and AG alleles of the MPO gene was potentially associated with changes in iron metabolism and the AG allele led to variations in various hemogram parameters.
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http://dx.doi.org/10.1097/MPH.0000000000002125DOI Listing
March 2021

Surprise diagnosis in an adolescent case with chronic kidney damage: Answers.

Pediatr Nephrol 2021 Jul 11;36(7):1997-1999. Epub 2021 Jan 11.

Bezmialem Vakıf University, Faculty of Medicine, Department of Oncology, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s00467-020-04858-zDOI Listing
July 2021

Surprise diagnosis in an adolescent case with chronic kidney damage: Questions.

Pediatr Nephrol 2021 Jul 11;36(7):1995-1996. Epub 2021 Jan 11.

Department of Oncology, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s00467-020-04850-7DOI Listing
July 2021

Persistent pleural effusion in an infant with an unusual diagnosis: congenital alveolar rhabdomyosarcoma.

Contemp Oncol (Pozn) 2020 3;24(2):132-135. Epub 2020 Jul 3.

Department of Paediatric Haematology and Oncology, Bezmialem Vakif University, Istanbul, Turkey.

Rhabdomyosarcoma (RMS) is a malignant form of neoplasm that originates from skeletal muscle. RMSs can exist anywhere in the human body but are more commonly detected in the neck region and extremities. The alveolar type is one of the subtypes of RMS that has a poor prognosis. Because the clinical manifestation of a tumour can be a painless mass, symptoms might be non-contributary to the diagnosis. Herein, a four-month-old girl was admitted to the emergency department with complaints of respiratory distress without a runny nose, cough, and fever. Recurrent effusions subsided with subsequent tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) was performed to determine the aetiology of the recurrent effusion. The Tru-Cut biopsy obtained during VATS resulted in the diagnosis of alveolar rhabdomyosarcoma. Pleural effusion decreased, and the tube drainage was stopped rapidly after first vincristine, actinomycin-D, and cyclophosphamide chemotherapy cycle. Persistent and recurrent pleural effusions should alert physicians to rule out unusual diagnoses like that of our case.
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http://dx.doi.org/10.5114/wo.2020.97639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403760PMC
July 2020

Cross-sectional study: long term follow-up care for pediatric cancer survivors in a developing country, Turkey: current status, challenges, and future perspectives

Turk J Med Sci 2020 12 17;50(8):1916-1921. Epub 2020 Dec 17.

Department of Pediatric Oncology, Faculty of Medicine, Ege University, İzmir, Turkey

Aim: The main purpose of this study is to determine the current status of long-term follow-up (LTFU) for childhood cancer survivors and the challenges of LTFU for pediatric cancer survivors at pediatric oncology institutions in Turkey.

Material And Methods: A questionnaire was e-mailed to the directors of 33 pediatric oncology centers (POCs) registered in the Turkish Pediatric Oncology Group (TPOG). Of these 33 active TPOG institutions, 21 participated in the study and returned their completed questionnaires.

Results: Only 1 of the 21 participating centers had a separate LTFU clinic. The remaining centers provided LTFU care for childhood cancer survivors at the pediatric oncology outpatient clinic. Of these centers, 17 (80.9%) reported difficulty in transition from the pediatric clinic to the adult clinic, 14 (66.6%) reported insufficient care providers, and 12 (57.1%) reported insufficient time and transportation problems. As neglected late effects, 16 (76.1%) centers reported psychosocial and getty job problems and 11 (52.3%) reported sexual and cognitive problems. None of the centers had their own LTFU guidelines for their daily LTFU practice

Conclusion: This study was the first to gain an overview of the needs of POCs and the gaps in survivorship services in Turkey. The results from this study will help to develop a national health care system and national guidelines for pediatric cancer survivors.
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http://dx.doi.org/10.3906/sag-1911-193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775715PMC
December 2020

Post-intubation subglottic stenosis in children: Analysis of clinical features and risk factors.

Pediatr Int 2020 Mar;62(3):386-389

Division of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Background: Subglottic stenosis (SGS) is a complication that develops after intubation and is characterized by respiratory distress. The aim was to evaluate patients with post-intubation SGS and to discover the factors contributing to its development.

Methods: A total of 112 patients who had a history of intubation were included. The case group consisted of 50 patients with post-extubation persistent respiratory symptoms for which flexible bronchoscopy (FOB) was conducted and showed SGS. The control group consisted of 62 patient with no post-extubation persistent respiratory symptoms, for whom FOB was not done (n = 54), and who had post-extubation persistent respiratory symptoms and underwent FOB, which did not show subglottic stenosis (n = 8).

Results: No significant differences were detected related to age, gender, and gestational age. The median number of recurrent intubations was 2.5 and 3 in the case group and in control group, respectively (P = 0.14). The median duration of intubation was 20.5 days in the case group, and 6 days in the control group (P < 0.001). The Myer-Cotton classification indicated a degree of obstruction of grade 1 (mild) in 30% (n = 15), grade 2 in 16% (n = 8), grade 3 in 48% (n = 24), and grade 4 in 6% (n = 3) of the case group.

Conclusion: The duration of intubation was found to be a significant risk factor for SGS development. Age at intubation, gender, gestational age, indication of intubation, and the number of recurrent intubations were found to have no significant association. Patients with post-extubation persistent respiratory problems, especially those with prolonged intubations, should be evaluated for SGS.
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http://dx.doi.org/10.1111/ped.14122DOI Listing
March 2020

Nimotuzumab-containing regimen for pediatric diffuse intrinsic pontine gliomas: a retrospective multicenter study and review of the literature.

Childs Nerv Syst 2019 01 11;35(1):83-89. Epub 2018 Nov 11.

Oncology Institute, Istanbul University, Istanbul, Turkey.

Purpose: Nimotuzumab is an IgG1 antibody that targets epidermal growth factor receptor (EGFR). Overexpression of EGFR is detected in some pediatric brain tumors including diffuse intrinsic pontine gliomas (DIPG)s.

Methods: Since May 2010, nimotuzumab, combined with carboplatin or vinorelbine or Temozolomide (TMZ), was administered during progressive disease (PD) after the use of the institutional protocol consisting of radiotherapy (RT) + TMZ and adjuvant TMZ. After May 2012, children with newly diagnosed disease received TMZ during RT, and nimotuzumab and TMZ after RT. Nimotuzumab was given as 150 mg/m/dose once a week for 12 weeks, and then every other week with TMZ until PD. PD patients were switched to nimotuzumab + vinorelbine combination until death.

Results: Nimotuzumab was used in 24 children with DIPG (seven in the PD group, 17 in the newly diagnosed patient group). In the PD group, median survival time was 12 months (7-42 months); 1-year and 2-year overall survival (OS) rates were 42.9 ± 18% and 14.3 ± 13%, respectively. The median survival in this group, after the initiation of nimotuzumab was 6 months (3-8 months). In the newly diagnosed patient group, median survival time was 11 months (3-35 months) and median progression free survival was 4 months (1-21 months). The 1-year OS in this group was 35.3 ± 11% and 2 year OS was 11.8 ± 7%. Nimotuzumab ± chemotherapy was well tolerated with no major adverse effect.

Conclusion: Nimotuzumab-containing regimens are feasible and tolerable; it might be that some patients either with newly diagnosed DIPG or with progressive disease may benefit modestly from nimotuzumab-containing combinations.
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http://dx.doi.org/10.1007/s00381-018-4001-9DOI Listing
January 2019

Testis Involvement in Neuroblastoma: Report of 3 Cases in the Turkish Pediatric Oncology Group-Neuroblastoma Study and Review of the Literature.

J Pediatr Hematol Oncol 2019 01;41(1):13-16

Division of Pediatric Oncology, Oncology Institute, Dokuz Eylul University, Izmir, Turkey.

Background: Neuroblastoma (NB) is the most common extracranial solid tumor of childhood. Primary and secondary testicular involvement is extremely uncommon in neuroblastoma.

Procedure: All children with neuroblastoma treated with the Turkish Pediatric Oncology Group (TPOG)-Neuroblastoma (NB) Study and who had testis involvement either at diagnosis or at relapse were retrospectively evaluated. A review of all cases with neuroblastoma and testis involvement in the literature was done.

Results: There were 3 children with NB documented to have involvement of the testis, 2 at diagnosis, 1 at recurrence, within the 559 cases (0.5%) treated with the Turkish Pediatric Oncology Group (TPOG)-Neuroblastoma Protocol. All had advanced stage. Two were infants. A total of 57 cases of testicular or paratesticular neuroblastoma have been reported in children, and most cases represent metastases as in the 3 cases in our series.

Conclusions: Neuroblastoma should be considered in the differential diagnosis of testicular mass and work-up for neuroblastoma should be done before orchiectomy. Scrotal ultrasonography should be used as the first diagnostic tool and abdominal ultrasonography shall be done additionally. Testis examination should be performed at diagnosis and regularly during follow-up for boys diagnosed with neuroblastoma. Testes may be sanctuary sites when neuroblastoma is metastatic, as is the case in leukemia.
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http://dx.doi.org/10.1097/MPH.0000000000001316DOI Listing
January 2019

Primary Osteosarcoma of the Rib: Distribution of Sex.

J Pediatr Hematol Oncol 2018 08;40(6):490-491

Department of Pediatrics, Division of Pediatric Hematology-Oncology, Bezmialem Vakif University, Istanbul, Turkey.

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http://dx.doi.org/10.1097/MPH.0000000000001126DOI Listing
August 2018

Prediction of outcome in pediatric Hodgkin lymphoma based on interpretation of FDG-PET/CT according to ΔSUV, Deauville 5-point scale and IHP criteria.

Ann Nucl Med 2017 Nov 24;31(9):660-668. Epub 2017 Jul 24.

Department of Nuclear Medicine, Istanbul Faculty of Medicine, Millet cad. ÇAPA, 34093, Istanbul, Turkey.

Objective: Minimizing side effects by using response-adopted therapy strategies plays an important role in the management of pediatric Hodgkin lymphoma (HL); however, the criteria for the definition of adequate or inadequate response are controversial. The aim of this study is to compare different methods of interpretation of F-FDG-PET/CT (PET) in the prediction of disease outcome in order to determine the optimum method in this regard.

Methods: Baseline, interim and post-treatment PET scans of 72 children were interpreted according to revised International Harmonization Project criteria (IHP) and Deauville criteria. Cut-off values for changes in interim and post-treatment FDG uptake (ΔSUV) in the prediction of progression-free survival (PFS) were measured using ROC analysis. Quantitative and visual data were compared with each other in the prediction of PFS.

Results: Mean interim and post-treatment ΔSUV of the primary lesions were 77.4 ± 19.5 and 68.8 ± 30.4% and respective cut-off values were 82 and 73%. However, only post-treatment ΔSUV yielded statistically significant results in the prediction of 3-year PFS (p = 0.043). Interim ΔSUV was further analyzed according to the values reported in the literature (66 and 77%) yet statistically significant results were not reached (p = 0.604 and 0.431). For interim evaluation, IHP criteria was correlated to Deauville criteria (p = 0.002 and p = 0.001) and ΔSUV (p = 0.03), whereas for post-treatment evaluation, significant correlation with ΔSUV (p = 0.04) but marginally significant (p = 0.055 and p = 0.058) correlation with Deauville criteria were achieved. Overall, 1, 3 and 5-year PFS were 95.7 ± 0.2, 89.6 ± 0.4 and 80.8 ± 0.7%, respectively. All methods demonstrated comparable performance in the prediction of 3-year PFS; however, interim PET using Deauville criteria and post-treatment PET using IHP criteria were statistically significant. All methods demonstrated high negative-predictive value but substantially low positive-predictive value.

Conclusions: Deauville criteria are superior to other methods in the prediction of pediatric HL outcome using interim PET data. On the other hand, quantitative evaluation and visual evaluation by IHP can be used reliably at the end of the treatment. In this regard, we report the optimal cut-off value of SUV reduction as 73%.
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http://dx.doi.org/10.1007/s12149-017-1196-xDOI Listing
November 2017

Effects of Malnutrition on Neutrophil/Mononuclear Cell Apoptotic Functions in Children with Acute Lymphoblastic Leukemia.

Nutr Cancer 2017 Apr 20;69(3):402-407. Epub 2017 Jan 20.

d Marmara University Medical Center , Internal Medicine Hematology-Immunology Department , Istanbul , Turkey.

Background: Recent studies claim that apoptosis may explain immune dysfunction observed in malnutrition.

Objective: The objective of this study was to determine the effect of malnutrition on apoptotic functions of phagocytic cells in acute lymphoblastic leukemia (ALL).

Materials And Methods: Twenty-eight ALL patients (13 with malnutrition) and thirty controls were enrolled. Neutrophil and mononuclear cell apoptosis of ALL patients and the control group were studied on admission before chemotherapy and repeated at a minimum of three months after induction of chemotherapy or when the nutritional status of leukemic children improved.

Results: The apoptotic functions of both ALL groups on admission were significantly lower than those of the control group. The apoptotic functions were lower in ALL patients with malnutrition than those in ALL patients without malnutrition, but this was not statistically significant. The repeated apoptotic functions of both ALL groups were increased to similar values with the control group. This increase was found to be statistically significant.

Conclusions: The apoptotic functions in ALL patients were not found to be affected by malnutrition. However, after dietary intervention, increased apoptotic functions in both ALL patient groups deserve mentioning. Dietary intervention should always be recommended as malnutrition or cachexia leads to multiple complications. Enhanced apoptosis might originate also from remission state of cancer.
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http://dx.doi.org/10.1080/01635581.2017.1267778DOI Listing
April 2017

Ceftriaxone-induced hemolytic anemia in a child successfully managed with intravenous immunoglobulin.

Turk J Pediatr 2016 ;58(2):216-219

Division of Pediatric Hematology-Oncology, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey.

Drug-induced hemolytic anemia is an immune-mediated phenomenon that leads to the destruction of red blood cells. Here, we present a case of life-threatening ceftriaxone-induced hemolytic anemia (CIHA) in a previously healthy 3-year-old girl. We also reviewed the literature to summarize the clinical features and treatment of hemolytic anemia. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with high mortality. Our patient had a sudden loss of consciousness with macroscopic hematuria and her hemoglobin dropped from 10.2 to 2.2 g/dl over 4 hours, indicating that the patient had life-threatening hemolysis after an intravascular dose of ceftriaxone who had previously been treated with ceftriaxone in intramuscular form for six days. CIHA is associated with a positive direct antiglobulin test, revealing the presence of IgG in all cases and C3d in most cases. Our patient's direct antiglobulin test was positive for IgG (3+) and for C3d (4+). The case was managed successfully with supportive measures and intravenous immunoglobulin therapy. Ceftriaxone is used very frequently in children; an early diagnosis and proper treatment of hemolytic anemia are essential to improve the patient outcome. The pathophysiological mechanism is the same as for non-drug autoimmune hemolytic anemia. However, there is still no consensus treatment for CIHA. Intravenous immunoglobulin can be used in clinical emergencies, such as our case, or in refractory cases.
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http://dx.doi.org/10.24953/turkjped.2016.02.016DOI Listing
May 2017

A Difficult Case of Hodgkin Lymphoma with Differential Diagnosis of Tuberculosis and Sarcoidosis.

Hematol Rep 2015 Jun 8;7(2):5644. Epub 2015 Jun 8.

Bezmialem Vakif University , Istambul, Turkey.

We report here the case of a 14-year-old boy with history of fever, weight loss, and mediastinal lymphadenopathy. The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process. He was diagnosed with Hodgkin's lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy. Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated.
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http://dx.doi.org/10.4081/hr.2015.5644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508547PMC
June 2015

Nontuberculous pulmonary cavitary diseases of childhood.

Pediatr Infect Dis J 2015 Mar;34(3):320-2

From the *Division of Pediatric Pulmonology, Department of Pediatrics; †Department of Pediatrics, Bezmialem Vakif University, Istanbul; ‡Division of Pediatric Pulmonology, Mersin Children's Hospital, Mersin; §Division of Pediatric Hematology & Oncology, Department of Pediatrics; ¶Department of Radiology; and ‖Department of Chest Surgery, Bezmialem Vakif University, Istanbul, Turkey.

We describe the demographic, clinic and radiologic features of nontuberculous cavitary pulmonary diseases in 42 patients with a mean age of 91.1±6.8 months. Infectious etiology was the most common cause (64%), including necrotizing pneumonia (n=15), ruptured hydatid cyst (n=5), lung abscess (n=5) and fungal infection (n=2). Other causes were bronchiectasis, congenital anomalies, foreign body aspiration, sarcoidosis and tumor.
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http://dx.doi.org/10.1097/INF.0000000000000545DOI Listing
March 2015

Desmoplastic infantile ganglioglioma: Report of an unusual case with a cranial defect.

J Pediatr Neurosci 2014 Jan;9(1):48-51

Department of Neurosurgery, School of Medicine, Medipol University, Istanbul, Turkey.

Desmoplastic infantile ganglioglioma (DIG) is a rare tumor that typically occurs in infants under the age of 24 months. These tumors commonly have a good prognosis after surgical resection despite their aggressive radiological appearances. Clinical signs are due to the large size of the tumor and include increased head circumference, bulging fontanel, sunset sign and seizures. We report an unusual DIG case who presented with parietal bulging associated with a bony defect. The patient was thought to have a leptomeningeal cystic formation, but on his cranial magnetic resonance imaging (MRI), we observed a centrally and homogeneously gadolinium-enhanced lesion fixed to the dura by its solid component. A surgical gross total resection was performed, and no residual tumor was observed on follow-up.
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http://dx.doi.org/10.4103/1817-1745.131486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040034PMC
January 2014

Not all that wheezes is asthma or foreign body aspiration: endobrochial inflammatory myofibroblastic tumor.

Indian J Pediatr 2014 Mar 4;81(3):306-7. Epub 2014 Jan 4.

Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, 34093, Turkey,

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http://dx.doi.org/10.1007/s12098-013-1318-yDOI Listing
March 2014

Management of diffuse pontine gliomas in children: recent developments.

Paediatr Drugs 2013 Oct;15(5):351-62

Istanbul University Cerrahpasa Medical Faculty Pediatric Hematology-Oncology, P.C: 34090, Millet Street, Capa, Istanbul, Turkey,

The prognosis for children with diffuse intrinsic pontine gliomas (DIPGs) is dismal. Although DIPGs constitute only 10-15 % of all pediatric brain tumors, they are the main cause of death in this group with a median survival of less than 12 months. Standard therapy involves radiotherapy, which produces transient neurologic improvement. Despite several clinical trials having been conducted, including trials on targeted agents to assess their efficacy, there is no clear improvement in prognosis. However, knowledge of DIPG biology is increasing, mainly as a result of research using biopsy and autopsy samples. In this review, we discuss recent studies in which systemic therapy was administered prior to, concomitantly with, or after radiotherapy. The discussion also includes novel therapeutic options in DIPG. Continuing multimodal and multitargeted therapies might lead to an improvement in the dismal prognosis of the disease.
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http://dx.doi.org/10.1007/s40272-013-0033-5DOI Listing
October 2013

A modified protocol with vincristine, topotecan, and cyclophosphamide for recurrent/progressive ewing sarcoma family tumors.

Pediatr Hematol Oncol 2013 Apr;30(3):170-7

Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Purpose: Topotecan has recently been used in the treatment of pediatric cancer. We evaluated our experience with the modified combination of vincristine, topotecan, and cyclophosphamide (VTC) given in 3 days, in children with recurrent Ewing sarcoma.

Method: Children received vincristine (1.5 mg/m(2)/1st day), cyclophosphamide (600 mg/m(2)/day × 2 days) + mesna, and topotecan (1 mg/m(2)/day × 3 days) every 21 days.

Result: A total of 118 courses of VTC were given to 13 patients. One patient received VTC both at first and at second relapse. Thus, 14 relapse episodes in 13 patients were evaluated. After three courses of VTC chemotherapy (CT), two achieved complete response (CR), five achieved partial response, thus an objective response was attained in 7/14 (50%) episodes. Two patients had stable disease and two patients progressed. In three episodes, CR was achieved by surgery before CT. One of them had a second relapse and attained CR with VTC. Median time from diagnosis to relapse was 23 months (5-45 months). Site of relapse was local in four patients, and metastatic in 10 episodes of nine patients. Seven patients are alive, three with no evidence of disease and four alive with disease; six have died of disease. Local treatment was used in 11 episodes. The toxicity of the VTC combination was limited mainly to the hematopoietic system.

Conclusion: In conclusion, the modified VTC protocol in 3 days every 3 weeks seems to be effective and tolerable in children and adolescents with recurrent/progressive Ewing sarcoma.
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http://dx.doi.org/10.3109/08880018.2013.767868DOI Listing
April 2013

False positivity of magnetic resonance imaging under the effect of granulocyte-colony stimulating factor in a child with leukemia.

Contemp Oncol (Pozn) 2013 28;17(3):334-6. Epub 2013 Jun 28.

Istanbul University Istanbul Medical Faculty, Department of Pathology, Istanbul, Turkey.

Granulocyte-colony stimulating factor (G-CSF) increases the proliferation and maturation of committed polymorphonuclear leukocyte precursors, as well as the function of mature polymorphonuclear leukocytes. It has previously been shown in pediatric patients that G-CSF induces reconversion of fatty bone marrow to hematopoietic bone marrow in the pelvis and lower extremities that is detectable by magnetic resonance imaging (MRI). Here, we report a 13-year-old Burkitt leukemia patient with bone pain while he was in remission. He was on G-CSF after cessation of high-dose and low-dose cytarabine chemotherapy. He was suspected to have a leukemia relapse. Pelvic MRI was consistent with leukemic infiltration. However, the pathology of bone marrow biopsy resulted in normal findings. Thus it was suggested that concurrent administration of G-CSF could be the causative agent for both bone pain and false-positive MRI findings. The control MRI after interruption of G-CSF revealed normal findings. In conclusion, radiologists should be informed about the type of therapy, including G-CSF administration, in order to overcome misinterpretation of bone marrow MRI.
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http://dx.doi.org/10.5114/wo.2013.35049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934074PMC
March 2014

Pediatric diffuse intrinsic pontine glioma patients from a single center.

Childs Nerv Syst 2013 Apr 8;29(4):583-8. Epub 2012 Dec 8.

Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty and Oncology Institute, Istanbul University, Istanbul, Turkey.

Background: The prognosis of children with diffuse intrinsic pontine gliomas (DIPG) is dismal. This study aims to evaluate the characteristics and treatment outcome of children with DIPG in a single center.

Methods: We reviewed the outcome of children with DIPG treated at the Oncology Institute of Istanbul University from February 1999 to May 2012.

Results: Fifty children (26 female, 24 male) with the median age of 7 years were analyzed. The median duration of symptoms was 30 days. All patients received radiotherapy (RT). Before the year 2000, 12 patients received only RT. Thirty-eight had concomitant and/or adjuvant chemotherapy with RT. Between 2000 and 2004, 17 patients received cis-platinum or vincristine as sensitizers during RT and CCNU + vincristine combination after RT. Since 2004, 21 patients received temozolomide (TMZ) concomitantly during RT and as adjuvant chemotherapy after RT. The median survival time of all patients was 13 months (1-160 months). Patients receiving RT + TMZ had a significantly higher overall survival than patients with only RT (p = 0.018). Patients receiving RT + chemotherapy other than TMZ also had a significantly higher overall survival than patients receiving only RT (p = 0.013). Patients receiving RT + TMZ + and chemotherapy other than TMZ had a significantly higher survival than patients receiving only RT (p = 0.005).

Conclusion: In our series, patients receiving RT + TMZ and also patients receiving RT + chemotherapy other than TMZ had a significantly higher overall survival than patients treated with only RT. Hence, administering chemotherapy during and after RT seems to prolong survival in some DIPG patients.
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http://dx.doi.org/10.1007/s00381-012-1986-3DOI Listing
April 2013

Endobronchial findings of hydatid cyst disease: a report of five pediatric cases.

Pediatr Pulmonol 2012 Jul 13;47(7):706-9. Epub 2011 Dec 13.

Department of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Investigation Hospital, Istanbul, Turkey.

Hydatid disease is still an important public health problem throughout the world. Diagnosis of the disease is generally based on clinical and radiological findings. Evaluation of pulmonary disorders by flexible bronchoscopy (FOB) is a rapidly developing facility, but diagnostic and therapeutic FOB for pulmonary hydatid cysts is still controversial. This study examines the findings of endobronchial hydatid cyst disease in five pediatric patients from Turkey, and clinical experience about this subject is reviewed. All our patients presented with unusual symptoms of the disease, and for all of them, diagnosis had been delayed using current diagnostic methods. As a result of our experience, it can be reported that the endobronchial appearance of the hydatid cyst membrane is whitish-yellow, and it is difficult to differentiate it radiologically from some other common causes of endobronchial lesions in childhood, such as endobronchial tuberculosis, foreign body aspirations, mucous plaques, and granulation scars. The findings of these cases show that, hydatid cyst should also be kept in mind in differential diagnosis of endobronchial lesions. In the diagnosis of pulmonary hydatid cyst in children without typical clinical and radiological findings of the disease, FOB examination is a valuable diagnostic procedure.
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http://dx.doi.org/10.1002/ppul.21615DOI Listing
July 2012

Chronic eosinophilic pneumonia with mucous plugs in a child.

Pediatr Pulmonol 2010 Oct;45(10):1040-2

Sureyyapasa Chest Diseases and Thoracic Surgery Training and Investigation Hospital, Department of Pediatric Pulmonology, Istanbul, Turkey.

Chronic eosinophilic pneumonia is a rare cause of chronic lung disease in children. A 7-year-old girl who attended our clinics with cough and sputum lasting for 5 years, has been evaluated for bilateral alveolar infiltration and ground-glass opacities. Peripheral eosinophilia was detected in total cell blood count. Flexible bronchoscopy showed mucous plugs. Bronchoalveolar lavage fluid and cell block of mucous plugs determined hypereosinophilia. Chronic eosinophilic pneumonia was confirmed after the elimination of other eosinophilic lung diseases and the case was accepted to be idiopathic. She showed a dramatic response to oral corticosteroids. This is the first reported case of chronic eosinophilic pneumonia presenting with mucous plugs in children described to date in the literature.
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http://dx.doi.org/10.1002/ppul.21299DOI Listing
October 2010

Invasive respiratory aspergillosis is a treatable disease with early diagnosis and aggressive therapy.

Pediatr Hematol Oncol 2010 Sep;27(6):422-34

Division of Pediatric Hematology Oncology, Marmara University Medical Center, Istanbul, Turkey.

This study aimed to document outcome of invasive respiratory aspergillosis (IRA) in pediatric malignancy patients. Patients with febrile neutropenia episodes followed between January 2003 and May 2007 were enrolled. Antifungal therapy was added to those who were still febrile on the 5th day of febrile neutropenia treatment. Patients were screened with computerized tomographies. IRA was identified in 22 of 98 patients. There were 13 males and the mean age was 97 months. Proven infection was established in 3, probable in 7, and possible in 12 patients. Liposomal amphotericin B was administered to all patients and was successful in 10 patients. Modifications with caspofungin or voriconazole were done in liposomal amphotericin B failures. The median duration of antifungal therapy was 5.5 months. The median follow-up time was 29 months. There was no evidence of IRA in 12 patients after completion of cancer chemotherapy. Six patients died due to underlying disease, whereas IRA was either in remission or stable disease. Four patients were lost due to IRA. The remission rate for IRA was 82%. Survival at 37 months was 55% (95% confidence interval 25-47 months). The amount of time that absolute neutrophil count after initiation of treatment for IRA remained at zero was found to be an independent prognostic factor on survival (P = .01). These results suggest that early diagnosis and aggressive treatment may increase the successful outcome of IRA.
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http://dx.doi.org/10.3109/08880018.2010.481704DOI Listing
September 2010