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Öğe Akciğer Kanserli Bir Hastada Endobronşiyal Brakiterapi Uygulaması(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2005) Gülbaş, Hülya; Erkal, Haldun Şükrü; Yıldırım, Zeki; Kuzucu, Akın; Serin, MeltemEndobronşiyal brakiterapi, cerrahi tedavinin uygun olmaması nedeni ile radyoterapi uygulanacak olan akciğer kanserli hastalarda endobronşiyal yerleşimli lezyonların kontrol olasılığının arttırılması ya da endobronşiyal yerleşimli lezyonlara bağlı yakınmaların palyasyonunun sağlanması amacı ile tek başına ya da eksternal radyoterapi ile birlikte kullanılabilen bir tedavi yöntemidir. Bu yazıda, Radyasyon Onkolojisi Anabilim Dalı’nda akciğer kanserli bir hastada gerçekleştirilen ilk endobronşiyal brakiterapi uygulaması anlatılmaktadır.Öğe Characteristics of patients who are newly diagnosed with cancer after visiting the emergency department(Drunpp-Sarajevo, 2011) Yucel, Neslihan; Akgun, Feride Sinem; Ertan, Cem; Serin, Meltem; Ozgur, KarciogluThe purpose of this study was to assess clinical characteristics and survival times for patients who presented to a university hospital emergency department with acute problems and were subsequently admitted and diagnosed with cancer. Methods: The patients were 143 individuals who were newly diagnosed with cancer after admission to the emergency department at a university hospital. Medical records were reviewed and data were retrospectively evaluated. Results: The patients included 90 males and 53 females, and the median age was 68 years. At time of diagnosis, 73 patients had locoregional disease and 70 had metastatic disease. Most common primary tumor sites were lung (n = 33), gastric (n = 28), colorectal region (n = 23) and brain (n = 13). Of 143 patients, 33 died of their disease in hospital and 110 were discharged. Most common signs and symptoms were pain (n = 35), bleeding (n = 24) and shortness of breath (n = 23). Medical conditions that necessitated emergency admission were increased intracranial pressure (n = 27), hemorrhage (n = 23), infection (n = 23) and intestinal obstruction (n = 21). The median survival time for the 143 patients total was 6.2 +/- 1.2 months (range, 4.1-8.3 months). Conclusion: Emergency departments play an important role in the diagnosis and treatment of cancer patients, and even in screening for this disease. Individuals with undiagnosed cancer often present an unique set of challenges for emergency physicians because their presentation can range from vague-related symptoms to clear symptoms of malignancy that demand immediate treatment. In order for emergency physicians to be able to diagnose cancer in this patient group, it is important to maximize awareness of the cancer-related symptoms that these individuals may display.Öğe The effects of irradiation on the blood dynamics(Ios Press, 2009) Erkal, Haldun Suekrue; Karakoc, Yunus; Serin, MeltemAim: The present study evaluates the effects of irradiation on the blood dynamics. Materials and methods: Thirty-six volunteers providing written consent participated. A blood sample was transferred into three tubes containing CPDA-1 solution while another blood sample was transferred into three tubes containing heparin. Each tube containing CPDA-1 solution was paired with another tube containing heparin. The first pair was not irradiated, not stored and analyzed immediately (Group 1). The second pair was not irradiated, stored and analyzed at seven days (Group 2). The third pair was irradiated, stored and analyzed at seven days (Group 3). The blood count was performed and the blood viscosity was determined. Results: The mean hemoglobin contents were 126 g/l for Group 1, 128 g/l for Group 2 and 129 g/l for Group 3. For the mean hemoglobin contents, the difference between Group 1 and Group 3 (P < 0.001) and Group 2 and Group 3 (P = 0.01) were significant. The mean red blood cell volumes were 81.8 fl for Group 1, 82.1 fl for Group 2 and 82.3 fl for Group 3. For the mean red blood cell volumes, the difference between Group 1 and Group 2 (P = 0.003) and Group 1 and Group 3 (P = 0.006) were significant. The mean blood viscosities were 2.2 mPa s for Group 1, 2.8 mPa s for Group 2 and 3.2 mPa s for Group 3. For the mean blood viscosities, the difference between Group 1 and Group 2 (P < 0.001), Group 1 and Group 3 (P < 0.001) and Group 2 and Group 3 (P = 0.004) were significant. Conclusion: The present study indicates that the recommended doses of irradiation for the blood products to be used in attempt to prevent the transfusion associated graft versus host disease leads to marked alterations in the blood dynamics and might decrease the viability of the red blood cells following transfusion.Öğe The effects of methylprednisolone and halofuginone on preventing esophageal and hypopharyngeal fibrosis in delivered radiotherapy(Springer, 2010) Dabak, Hakan; Karlidag, Turgut; Akpolat, Nusret; Keles, Erol; Alpay, Hayrettin Cengiz; Serin, Meltem; Kaygusuz, IrfanIn this study, we assessed the effects of halofuginone and methylprednisolone on hypopharyngeal and esophageal stricture that can develop following radiation to the head and neck of rats. Rats were divided into four groups randomly and 18 Gy radiation was given to the head and neck regions of all rats except the control group. Group 1 (Control Group): No radiation or drugs were administered. Group 2 (Radiation Group): only radiation was applied without any drugs. Group 3 (Halofuginone Group): halofuginone 100 mu g/kg per day was given intraperitoneally. Group 4 (Methylprednisolone Group): methylprednisolone 1 mg/kg per day was administered intramuscularly. In all groups, 90 days after application of radiation, sections of the proximal esophagus and hypopharynx were examined for fibrosis, fibroblast proliferation, vascularization, epithelial atypia, necrosis, polymorphonuclear leukocytes, mononuclear cells, and stenosis index by light microscope and the hydroxyproline levels were assessed biochemically. Fibrosis, epithelial atypia and hydroxyproline levels were found to be significantly higher in the radiation group compared to the control group (P < 0.05). We did not observe fibrosis in either the halofuginone or the control groups. Fibrosis was also significantly lower in the methylprednisolone group than the radiation group (P < 0.05). The differences of the stenosis index scores between the groups were not statistically significant (P < 0.05). Vascularization was similar in all groups. We think that especially halofuginone is a drug that can be used safely to prevent fibrosis due to radiotherapy, but further studies are needed.Öğe Evaluation of oxidant injury induced by irradiation in brain tissues of rats of different ages(Trakya Üniversitesi Tıp Fakültesi Derg.(YA. Balkan Medical Journal, 2009) Uyumlu, Burçin Ayşe; Erkal, Haldun Şükrü; Batçıoğlu, Kadir; Serin, Meltem; Yücel, NeslihanÖz: Amaç: Bu çalışmada, kanser tedavisinde yaygın olarak kullanılan radyoterapinin farklı yaşlardaki ratların beyin dokusunda oluşturduğu oksidatif hasarın değerlendirilmesi amaçlandı. Çalışma Planı: Elli beş Wistar albino tipi erkek rat, 1, 4 ve 12 haftalık (n=10) ve 1 yaş (n=5) olmak üzere dört gruba ayrıldı. Tüm gruptaki ratlara Co-60 cihazı ile 8 Gy tek fraksiyon radyasyon uygulandı. Ratların beyin dokuları homojenize edilerek ikiye ayrıldı. Bir yarısı ile malondialdehid (MDA) ölçümü yapıldı. Diğer yarısından elde edilen süpernatant ile protein miktar tayini yapıldı, süperoksit dismutaz (SOD), katalaz (CAT), glutatyon peroksidaz (GSHPx) aktiviteleri ölçüldü. Bulgular: SOD aktivitesinin 1 haftalık ratlarda anlamlı derecede azaldığı bulundu (p<0.05). GSHPx ve CAT aktivitesindeki azalma 1 haftalık ve 1 yaşındaki ratlarda daha belirgindi. Ergen ve erişkin ratlarda önemli değişmeler olmadı (p<0.05). MDA düzeyinde tüm yaş gruplarında artma gözlendi. En yüksek MDA düzeyi 1 yaşındaki ratlarda gözlendi (p<0.05). Sonuç: Radyoterapide kullanılan iyonize radyasyon antioksidan sistemleri etkilemekte ve doku MDA düzeylerini artırmaktadır. Bu değişiklikler 1 haftalık ve 1 yaşındaki ratlarda daha fazladır. Bu durumun yeni doğan ratlarda henüz birçok sistemin tam olarak yerleşmemiş oluşundan ve 1 yaşındaki ratlarda ise yaşlanmaya bağlı olarak ortaya çıkan fizyolojik kapasitedeki kayıplardan kaynaklandığını söyleyebiliriz.Öğe Evaluation of Oxidant Injury Induced by Irradiation in Brain Tissues of Rats of Different Ages(Aves Yayincilik, Ibrahim Kara, 2009) Uyumlu, Ayse Burcin; Erkal, Haldun Suekrue; Batcioglu, Kadir; Serin, Meltem; Yucel, NeslihanObjectives: We aimed to evaluate the age-related changes of oxidative injury in the brain tissues of rats produced by radiotherapy that is widely used on cancer treatment. Study Design: Fifty-five male Wistar albino rats [ages of rats were 1, 4, 12 weeks (n=10) and 1 year (n=5)] were divided into four groups. Irradiation were performed on a Cobalt-60 unit using a single fraction of 8 Gy. The brain tissues were homogenized and divided into two portions. One portion was used for the measurement of the malondialdehyde (MDA). The other portion was used for the measurement of the protein concentration, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSHPx) enzyme activities. Results: The SOD activity decreased significantly in 1-week-old rats (p<0.05). The decreases in GSHPx and CAT activities were more obvious in 1-week and 1-year-old rats than that in others. No significant changes were observed in adolescent and adult rats. The MDA levels of all groups increased. The highest MDA levels were seen in 1-year-old rats (p<0.05). Conclusion: Ionizing radiation used in radiotherapy affected antioxidant systems and increased MDA levels. These changes were more in the 1-week and 1-year-old rats than in others. This can be due to incomplete development of many systems in newborn rats and the loss of physiological capacities associated with aging in 1 -year-old rats.Öğe Evaluation of protective effects of verapamil against lens epithelial tissue injury induced by irradiation in rats(Turkish Journal of Pharmaceutical Sciences, 2010) Batçıoğlu, Kadir; Erkal, Haldun S.; Serin, Meltem; Uyumlu, A. Burçin; Yücel, Neslihan; Yıldırım, Battal; Satılmış, BasriÖz: Bu çalsmada, ratlarda radyasyonla indüklenen lens epitel hücre hasarna karsi verapamilin olası koruyucu etkisini inceledik. Kırk adet dişi Wistar Albino türü rat dört guruba ayrıldı (n=10). Gurup 1’e 20 Gy dozda radyasyon ve 10 mg/kg verapamil uygulandı. Gurup 2’ye 20 Gy radyasyon uygulandı ve verapamil verilmedi. Gurup 3’e 10 mg/kg dozda verapamil verildi, yalancı radyasyon uygulandı. Gurup 4’e verapamil verilmedi ve yalancı radyasyon uygulandı. Tüm guruplarda lens dokular ç ikarldı ve malondialdehit (MDA) ölçümleri yapıldı. Ortalama MDA düzeyleri (nmol/mg prt); Gurup 1 için 5.59, Gurup 2 için 7.04, Gurup 3 için 3.95 ve Gurup 4 için 3.25 olarak belirlendi. Sonuç olarak, radyasyonla indüklenen lens epitel hücre hasarna karsi verapamili koruyucu bir ajan olarak önerebiliriz.Öğe Extraskeletal ewings sarcoma presenting with multifocal intrathoracic mass lesions associated with mediastinal shift(Annals of thoracic surgery, 2006) Kuzucu, Akın; Erkal, Haldun Şükrü; Soysal, Ömer; Serin, MeltemExtraskeletal Ewing’s sarcoma is an uncommon disease that predominantly involves the soft tissues of the trunk or the extremities. This article presents a patient with multifocal intrathoracic mass lesions involving the mediastinum and the lingula associated with mediastinal shift, eventually diagnosed as extraskeletal Ewing’s sarcoma.Öğe False positive 18F FDG uptake in mediastinal lymph nodes detected with positron emission tomography in breast cancer a case report(Case Reports in Medicine, 2013) Uğurluer, Gamze; Kibar, Mustafa; Yavuz, Sinan; Kuzucu, Akın; Serin, MeltemBreast cancer is the most frequently diagnosed cancer among females. It is accepted that lymph node involvement with metastatic tumor and the presence of distant metastasis are the most important prognostic factors. Accurate staging is important in determining prognosis and appropriate treatment. Positron emission tomography with computed tomography detects malignancies using 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG PET CT) with high accuracy and they contribute to decisions regarding diagnosis, staging, recurrence, and treatment response. Here, we report a case of false positive metastatic mediastinal lymph nodes that were diagnosed by 18F-FDG PET CT in a 40-year-old breast cancer patient who had undergone preoperative evaluation. Right paratracheal, prevascular, aorticopulmonary, precarinal, subcarinal, hilar, and subhilar multiple conglomerated mediastinal lymph nodes were revealed in addition to left breast mass and axillary lymph nodes. Mediastinoscopy was performed with biopsy and pathology was reported as granulomatous lymphadenitis. In conclusion, any abnormal FDG accumulation in unusual lymph nodes must be evaluated carefully and confirmed histopathologically.Öğe False Positive 18F-FDG Uptake in Mediastinal Lymph Nodes Detected with Positron Emission Tomography in Breast Cancer: A Case Report(Hindawi Ltd, 2013) Ugurluer, Gamze; Kibar, Mustafa; Yavuz, Sinan; Kuzucu, Akin; Serin, MeltemBreast cancer is the most frequently diagnosed cancer among females. It is accepted that lymph node involvement with metastatic tumor and the presence of distant metastasis are the most important prognostic factors. Accurate staging is important in determining prognosis and appropriate treatment. Positron emission tomography with computed tomography detectsmalignancies using 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG PET CT) with high accuracy and they contribute to decisions regarding diagnosis, staging, recurrence, and treatment response. Here, we report a case of false positive metastatic mediastinal lymph nodes that were diagnosed by 18F-FDG PET CT in a 40-year-old breast cancer patient who had undergone preoperative evaluation. Right paratracheal, prevascular, aorticopulmonary, precarinal, subcarinal, hilar, and subhilar multiple conglomerated mediastinal lymph nodes were revealed in addition to left breast mass and axillary lymph nodes. Mediastinoscopy was performed with biopsy and pathology was reported as granulomatous lymphadenitis. In conclusion, any abnormal FDG accumulation in unusual lymph nodes must be evaluated carefully and confirmed histopathologically.Öğe Histopathological evaluation of melatonin as a protective agent in heart injury induced by radiation in a rat model(Elsevier Gmbh, Urban & Fischer Verlag, 2014) Gurses, Iclal; Ozeren, Murat; Serin, Meltem; Yucel, Neslihan; Erkal, Haldun SukruIntroduction: Melatonin is a hormone which is known to be a powerful cardioprotective agent due to its free radical-scavenging properties. This study was carried out to evaluate whether melatonin administration prior to irradiation would have a protective effect on cardiac histopathological changes in an experimental rat model. Methods: Rats were divided into four groups. Single dose of 18 Gy radiation and sham radiation exposure were used in related groups. 50 mg/kg dose of melatonin were injected intraperitonally 15 min prior to radiation exposure. Analyses and assessments were performed 6 months after radiation exposure. Results: Severe myocardial fibrosis was observed prominently in three regions: the apex, tips of papillary muscles and adjacent to the atrioventricular valves. Inflammation was found to be more in irradiated groups. Increased inflammation and fibrosis were in concordance. The number of mast cells was found to be decreased in irradiated groups. Myocyte necrosis and fibrosis were diminished with melatonin while vasculitis was prevented. Conclusions: Elementary pathological lesions of radiation-induced heart disease (RIHD) are fibrosis, vascular damage, vasculitis and myocyte necrosis. Development of vasculitis was prevented by the use of melatonin. Fibrosis and necrosis were prominently decreased. Prevention of RIHD with the use of melatonin at the long term is encouraging according to the histopathological results. (C) 2014 Elsevier GmbH. All rights reserved.Öğe Larenks karsinomlu iki hastada kondroradyonekroz(Kulak Burun Boğaz İhtisas Dergisi, 2007) Fırat, Yezdan; Kızılay, Ahmet; Fırat, Ahmet Kemal; Serin, Meltem; Erkal, Haldun ŞükrüÖz: Larenkste radyoterapi sonrası görülen nekroz nadir ama ciddi bir komplikasyondur. Lezyonun tümör nüksü veya nekroz olup olmadığının radyolojik ve patolojik bulgularla ayrımı yapılmalıdır. Bu yazıda, evre II ve evre IV larenks karsinomu tanılı, radyoterapi sonrasında nekroz gelişen iki olgu sunuldu. İlk hastaya cerrahi tedaviyi kabul etmemesi nedeniyle 70 Gy dozunda küratif amaçlı; İkinci olguya ise total larenjektomi ve iki taraflı fonksiyonel boyun diseksiyonu sonrasında 46 Gy dozunda adjuvant radyoterapi uygulandı. İlk olguda bilgisayarlı tomografi, ikinci olguda manyetik rezonans görüntüleme ile radyolojik inceleme yapıldı. Her iki olgudan alınan çok sayıda biyopsinin patolojik inceleme sonucu, malignansiye ait bulguya rastlanmayan koagülasyon nekrozu şeklinde idi. İlk hasta Chandler sınıflandırması evre IV radyonekroz olarak kabul edildi ve larenksin fonksiyonunu kaybetmesi nedeniyle total larenjektomi uygulandı. Histopatolojik incelemede malign hücreye rastlanmadı ve tüm kesitlerde yaygın fibroz ve koagülasyon nekrozu ile karşılaşıldı. Diğer hasta ise lokal debridman ve konservatif yaklaşımla tedavi edildi. Başlık (İngilizce): Chondroradionecrosis in two patients with laryngeal carcinoma Öz (İngilizce): Postradiotherapy necrosis in the larynx is a rare but serious complication. It must be differentiated from tumor recurrence with radiological and histopathological studies. Herein, we presented two patients with stage II and stage IV larynx carcinoma who developed chondroradionecrosis following radiotherapy. The first patient did not accept surgical treatment and was treated with curative radiotherapy at a dose of 70 Gy. The other one received adjuvant radiotherapy at a dose of 46 Gy following total laryngectomy and bilateral functional neck dissection. The two patients were evaluated with computed tomography and magnetic resonance imaging, respectively. Pathologic examination of multiple biopsies taken from both cases showed coagulation necrosis without malignancy. The first patient had grade IV radionecrosis according to the Chandler classification and underwent total laryngectomy because of nonfunctional larynx. Histopathologically, there were no malignant cells, but widespread fibrosis and coagulation necrosis. The other patient was treated with conservative treatment and local debridement.Öğe Soliter sternum metastazı saptanan nazofarenks kanserli bir hastada sternum rezeksiyonu, polipropilen ağ ve metilmetakrilat yama kullanılarak rekonstrüksiyon ve adjuvant radyoterapi uygulaması(2005) Kuzucu, Akın; Soysal, Ömer; Serin, Meltem; Erkal, Haldun ŞükrüNazofarenks kanserlerinin sternum metastazları oldukça nadir olarak görülmektedir. Cerrahi tekniklerde sağlanan gelişmeler, sternum rezeksiyonu ve rekonstrüksiyonunun sternum metastazlarında bir tedavi seçeneği olarak gündeme gelmesine yardımcı olmaktadır. Bu yazıda, soliter sternum metastazı saptanan nazofarenks kanserli bir hastada sternum rezeksiyonu, polipropilen ağ ve metilmetakrilat yama kullanılarak rekonstrüksiyon ve adjuvant radyoterapi uygulaması sunulmaktadır.Öğe Soliter Sternum Metastazı Saptanan Nazofarenks Kanserli Bir Hastada Sternum Rezeksiyonu, Polipropilen Ağ ve Metilmetakrilat Yama Kullanılarak Rekonstrüksiyon ve Adjuvant Radyoterapi Uygulaması+(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2005) Kuzucu, Akın; Soysal, Ömer; Serin, Meltem; Erkal, Haldun ŞükrüNazofarenks kanserlerinin sternum metastazları oldukça nadir olarak görülmektedir. Cerrahi tekniklerde sağlanan gelişmeler, sternum rezeksiyonu ve rekonstrüksiyonunun sternum metastazlarında bir tedavi seçeneği olarak gündeme gelmesine yardımcı olmaktadır. Bu yazıda, soliter sternum metastazı saptanan nazofarenks kanserli bir hastada sternum rezeksiyonu, polipropilen ağ ve metilmetakrilat yama kullanılarak rekonstrüksiyon ve adjuvant radyoterapi uygulaması sunulmaktadır.Öğe Wilms’ Tümörlü Bir Çocukta Radyoterapi Sırasında Yineleyen Anestezi Uygulamaları(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2005) Erdem, Tuba Berra; Erkal, Haldun Şükrü; Erdoğan Öztürk; Özgen, Ünsal; Serin, MeltemRadyoterapi uygulamalarının doğruluğu, güvenilirliği, yinelenebilirliği ve başarısı açısından hastaların uygulamalar sırasında hareketsiz kalmaları ve bu şekilde gerçekleştirilen tedaviye uyum sağlamaları büyük önem taşımaktadır. Anestezi yaklaşımları, dört yaş altındaki çocuklarda radyoterapi uygulamalarının başarısına önemli ölçüde katkıda bulunmaktadır. Bu yazıda, Wilms’ tümörü tanısı almış üç yaşında bir kız çocuğunda İnönü Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı’nda intravenöz sedasyon altında gerçekleştirilen radyoterapi uygulaması anlatılmakta ve çocuklarda radyoterapi uygulamalarında anestezi yaklaşımları gözden geçirilmektedir.
