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Öğe An adult patient with common B-cell acute lymphoblastic leukaemia who presented with pancreatic involvement, description of the second adult case and review of paediatric cases(BMJ Publishing Group, 2014) Pamuk G.E.; Tapan U.; Aksoy S.; Umit H.Pancreatic involvement in acute lymphoblastic leukaemia (ALL) may go unrecognised. There are only a few paediatric cases; nevertheless, presentation with pancreatic involvement in an adult patient with ALL has been reported rarely. Our 52-year-old male patient came to us with abdominal pain, nausea and vomiting; he had pancreatic enlargement on CT. He was diagnosed with common B-cell ALL with pancreatic involvement. The patient obtained haematological remission and the pancreatic enlargement regressed after chemotherapy, but later he had central nervous system and liver relapses. He died 6 months after diagnosis because of progressive pneumonia and chemotherapy-resistant ALL with multiple extramedullary relapses. Copyright 2014 BMJ Publishing Group. All rights reserved.Öğe Antineutrophil cytoplasmic antibody associated vasculitis in one patient with severe aplastic anemia. Description of the first case(2009) Pamuk G.E.; Pamuk O.N.; Ümit E.G.; Puyan F.O.; Öztürk E.; Demir M.[No abstract available]Öğe Chronic lymphocytic leukemia with central nervous involvement in the form of localized mass responding to therapy with fludarabine(2007) Turgut B.; Pamuk G.E.; Turgut N.; Demir M.We report a extremely rare case of involvement of the central nervous system (CNS) in the form of a localized mass by chronic lymphocytic leukemia (CLL). A 69-year-old man was admitted to our hospital with dysartria. Cranial computed tomography (CT) revealed a left frontal mass. He had generalized lymphadenopathy and hepatosplenomegaly. Examination of peripheral blood smear and finding of immunophenotyping of peripheral blood mononuclear cells were consistent with the diagnosis of B-cell CLL. His disease had a agrresive outcome. Cranial RT was applied and then fludarabine plus cyclophosphamide (FC) were begun. After this treatment, peripheral blood lymphocytosis and all the palpable lymph nodes disappeared. Three months after diagnosis, there was nearly complete regression of the mass on cranial magnetic resonance imaging. After six courses of FC, the patient is still alive and he is in complete remission two years after diagnosis. This case shows that CLL might be complicated by brain involvement in the form of a localized mass. Fludarabine seems effective in controlling this form of CLL.Öğe Cutaneous Kaposi sarcoma which developed in a patient with aplastic anaemia using immunosuppressive therapy - Description of the first adult case [1](Academy of Medicine Singapore, 2007) Pamuk G.E.; Kundak T.; Turgut B.; Demir M.; Vural Ö.[No abstract available]Öğe The development of Hodgkin lymphoma in male patient with systemic lupus erythematosus and secondary antiphospholipid syndrome(2007) Pamuk G.E.; Pamuk Ö.N.; Tekgündüz E.; Turgut B.; Demir M.; Çakir N.There are some data that the frequency of malignancy increases in some autoimmune diseases. The development of Hodgkin's lymphoma in patients with systemic lupus erythematosus (SLE) has been reported rarely. Here, we presented a young male SLE patient who had recurrent thrombophlebitis and deep venous thrombosis, secondary antiphospholipids syndrome, and who has been using cyclophosphamide and corticosteroids for 1.5 years for lupus nephritis. After a follow-up of 1.5 years, he developed fever, night sweats and lymphadenopathy. Lymph node biopsy was compatible with mixed-cellular type Hodgkin's lymphoma, and he was in complete hematologic remission after ABVD chemotherapy. Although SLE is a disease which may cause lymphadenopathy and B symptoms, when these symptoms develop in a SLE patient in remission, lymph node biopsy should be taken to rule out the possibility of lymphoma.Öğe The development of pulmonary aspergillosis and pneumothorax in a patient with neutropenic systemic lupus erythematosus and successful treatment of the first case(BMJ Publishing Group, 2014) Pamuk O.N.; Pamuk G.E.; Barutcu E.; Celik A.D.There are reports on patients with systemic lupus erythematosus (SLE) with aspergillosis; however, aspergillosis-related pneumothorax has not been reported in SLE. We present a female patient with active SLE who was administered high-dose steroids, developed an opportunistic bacterial infection and had a cavitary pulmonary lesion. Sputum cultures yielded Aspergillus fumigatus. She was administered voriconazole. She developed dyspnoea and chest X-ray showed pneumothorax. She was placed with an underwater drainage chest tube; the pneumothorax and the pulmonary lesion regressed. Copyright 2014 BMJ Publishing Group. All rights reserved.Öğe The evaluation of clinical features of chronic lymphocytic leukemia patients followed up at Trakya University Medical Faculty(Turkiye Klinikleri, 2006) Pamuk G.E.; Dönmez S.; Turgut B.; Yeşil N.; Tekgündüz E.; Demir M.; Vural Ö.Objective: To determine the general clinical features, treatment modalities and response to therapy, survival and the importance of prognostic factors that might influence survival in chronic lymphocytic leukemia (CLL) patients diagnosed at our center. Material and Methods: We evaluated 65 CLL patients (39 males, 26 females, median age: 64) followed up at Trakya University Medical Faculty, Department of Internal Medicine, Division of Hematology between 1998 and 2005. Rai staging system was used for clinical staging. Results: At initial diagnosis, 4 cases (6.2%) had stage 0, 14 (21.5%) stage I, 20 (30.8%) stage II, 10 (15.4%) stage III, and 17 (26.2%) stage IV disease. Five patients (7.9%) were asymptomatic at initial presentation. According to Rai stages, 4 were early-stage (Rai 0, I, II) and 3 were advanced-stage (Rai III, IV) patients. Autoimmune hemolytic anemia was detected in 7 (10.8%) and secondary malignancy in 6 (9.2%) CLL patients. When CLL was diagnosed, 23 early Rai stage patients (60.5%) and 22 (80.5%) late Rai stage patients were treated. Best response to first-line therapy (55.6%) was achieved with chlorambucil. The median survival of subjects with early-stage disease at initial diagnosis was 130 months, and that of advanced-stage subjects was 118 months (p= 0.04). Five- and 10-year survival rate was 77% and 49% respectively. Cox multivariable regression analysis showed that having advanced-stage disease at diagnosis (OR: 4.2, p= 0.01) and age >60 years (OR: 5.6, p= 0.036) were independently poor prognostic parameters. Conclusion: The results of this study suggest that advanced-stage disease and age >60 years at initial diagnosis are poor prognostic parameters in CLL patients. Copyright © 2006 by Türkiye Klinikleri.Öğe The evaluation of the clinical features of patients with non-Hodgkin lymphoma(2006) Pamuk G.E.; Harmandar F.; Harmandar O.; Turgut B.; Tekgündüz E.; Demir M.; Vural Ö.The clinical features, histopathological types, treatment modalities and response, and survival analysis were evaluated in our 114 patients with non-Hodgkin lymphoma (NHL). At initial diagnosis, 10% had stage I, 14% stage II, 30% stage III, and 46% stage IV disease according to Cotswold classification. Therapy was administered to 101 (89%) NHL subjects at initial diagnosis. CHOP was given to 57 (56%) and rituximab (R)-CHOP to 17 (17%) cases. The highest rate of complete remission was in R-CHOP group (83%). The median survival of NHL subjects was 52 months. 3-year survival was 54%, 5-year survival was 46%. Survival of very aggressive lymphoma patients (3 months) was shorter than that of aggressive (41 months) and indolent (86 months) patients (p values<0.05). The median survival of stage IV subjects at initial diagnosis (26 months) was shorter than stage I (not reached), stage II (86 months) and stage III (96 months) cases (p values<0.05). Survival of patients with B symptoms, extranodal and bone marrow involvement, unresponsive to first-line therapy, IPI>2 at initial diagnosis was shorter than others (p values <0.05). Cox regression analysis showed that unresponsiveness to first-line therapy (OR:11.6, p=0.001) was an independent poor prognostic factor. It was interesting that combined chemotherapy with rituximab achieved a high rate of complete remission when given as first-line therapy.Öğe Increased adiponectin level in non-Hodgkin lymphoma and its relationship with interleukin-10. Correlation with clinical features and outcome(2006) Pamuk G.E.; Turgut B.; Demir M.; Vural Ö.It was reported that interleukin-10 (IL-10) level increased in non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) patients; moreover this was associated with poor prognosis. In addition, it was stated that adiponectin induced the antiinflammatory cytokine IL-10. We evaluated adiponectin and IL-10 levels in NHL and CLL patients. We included newly diagnosed 28 NHL, 23 CLL patients, and 17 healthy subjects. In NHL patients, adiponectin level was higher than in CLL group and controls (p values <0.05). In CLL group, IL-10 level was lower than in NHL, and control groups (p values <0.05). Adiponectin level had a positive correlation with IL-10 level in the NHL patients (r=0.41, p=0.04). In the NHL group, the median survival of patients with high IL-10 levels was shorter (22 months vs. not reached, p=0.03). Increased IL-10 levels helped to predict poor outcome in our NHL patients. High adiponectin levels and a relationship between adiponectin/IL-10 in newly diagnosed NHL patients might suggest a role for both in the immunodysregulation in NHL.Öğe Initial presentation of an unspecified peripheral T-cell lymphoma as inflammatory polyarthritis and hypereosinophilia(Mattioli 1885 S.p.A., 2016) Pamuk G.E.; Pamuk O.N.; Harmandar F.; Uyanik M.S.; Puyan F.O.; Yesil N.; Dogan O.Summary. Premise: There may be signs of joint and bone involvement in hematologic malignancies, but it is most rare for hematologic malignancies like lymphomas to present with joint symptoms. Patient: A 49-year-old male patient was admitted with rheumatoid arthritis-like symmetrical polyarthritis, morning stiffness, cutaneous vasculitis and hypereosinophilia. Autoantibodies, like rheumatoid factor, anti-citrullinated cyclic peptide, antinuclear antibody, anti-nuclear cytoplasmic antibody, were negative. After 4 months of follow-up, the patient developed a diffuse cutaneous rash and multiple lymphadenopathies. Lymph node biopsy was compatible with peripheral T-cell lymphoma, unspecified. Result: The patient was administered, respectively, CHOP and ICE chemotherapy regimens to which he was refractory. He died from infection and respiratory failure. Conclusion: It should be borne in mind that T-cell lymphomas may have unusual presentations with arthritis and hypereosinophilia. © Mattioli 1885.Öğe Leptin and resistin levels in serum of patients with hematologic malignancies: Correlation with clinical characteristics(2006) Pamuk G.E.; Demir M.; Harmandar F.; Yeşil Y.; Turgut B.; Vural Ö.Aim: To evaluate leptin and resistin levels in patients with various hematologic malignancies. Methods: We included 21 patients with lymphoma, 14 with multiple myeloma (MM), 14 with acute leukemia, 13 with chronic lymphocytic leukemia (CLL), and 25 healthy control subjects into our study. The subjects' body mass indexes (BMI) were calculated; hematological and acute phase response parameters, serum lipid were determined; serum leptin and resistin levels were determined by ELISA. Results: Serum leptin level was significantly increased in CLL and MM groups when compared to the control group (p < 0.01). Resistin level was significantly higher in lymphoma patients than in CLL, acute leukemia and control groups (p < 0.01). In the control group, leptin level was negatively correlated with hemoglobin level (r = -0.44, p = 0.047); and in all patients with hematologic malignancies, leptin level was correlated with BMI (r = 0.32, p = 0.02). Leptin in lymphoma subjects correlated with hemoglobin level (r = 0.64, p = 0.005), resistin level correlated with the platelet count in patients with hematologic malignancies (r = 0.26, p = 0.044). In addition, leptin level had negative correlations with international prognostic score (IPS) in Hodgkin lymphoma (r = -0.9, p = 0.002) and with international prognostic index (IPI) in non-Hodgkin lymphoma (r = -0.77, p = 0.03). In CLL patients, leptin level had a correlation with the poor prognostic marker - CD38 level (r = 0.68, p = 0.03). Conclusion: We found higher leptin levels in MM and CLL patients, and higher resistin levels in lymphoma patients: this fact demonstrates that changes in adipose tissue and metabolism occur in these disease states. Copyright © Experimental Oncology, 2006.Öğe A patient with Fanconi anaemia who presented with isolated thrombocytopenia at older age(2005) Turgut B.; Vural Ö.; Pamuk G.E.; Demir M.; Yetişyi?it T.Fanconi anaemia is a rare autosomal recessive disease characterized by multiple congenital abnormalities, bone marrow failure, and cancer tendency. We report a-22 year-old male patient diagnosed with Fanconi anaemia, who had isolated thrombocytopenia. Initially, we thought that the thrombocytopenia was secondary to infection; but the platelet count did not improve after the infection. He had a special physical appearance, brown pigmentation, left renal ectopia, and L5-vertebral dysplasia. Fanconi anaemia, therefore was considered and the diagnosis was confirmed with diepoxybutane test. This case has warranted that Fanconi anaemia could be presented with isolated thrombocytopenia and could be considered the differential diagnosis of thrombocytopenia. Copyright © Hellenic Society of Haematology.
