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Öğe Allergic granulomatosis and angiitis in the absence of asthma and blood eosinophilia: a rare presentation of limited Churg-Strauss syndrome(Springer Heidelberg, 2004) Sevinc, A; Hasanoglu, HC; Gokirmak, M; Yildirim, Z; Baysal, T; Mizrak, BAllergic granulomatosis and angiitis, also known as Churg-Strauss syndrome (CSS), is an uncommon vasculitis of unknown etiology. We report a 21-year-old male patient with fatigue, dry cough, and progressive dyspnea. He had no history of asthma or eosinophilia. Thorax computed tomography showed bullous/cystic areas with thin walls in varying sizes (5-15 mm). Histopathological examination of the open lung biopsy revealed granulomatous infiltration with histiocytes and eosinophilic leukocytes. This extremely rare variant of CSS is discussed.Öğe Bilateral transient hearing loss associated with vincristine therapy: Case report(E I F T Srl, 2000) Aydogdu, I; Ozturan, O; Kuku, I; Kaya, E; Sevinc, A; Yildiz, RVincristine, adriamycin, and dexamethasone (VAD) chemotherapy protocol is first-choice treatment in newly diagnosed multiple myeloma patients in many centers. Sudden hearing loss associated with vincristine therapy is a rarely observed event in the VAD protocol. We describe a 69-year old male patient diagnosed with multiple myeloma 7 months ago who developed sudden bilateral hearing loss related to vincristine therapy. This uncommon adverse effect of vincristine is discussed and the literature reviewed.Öğe Bismuth subcitrate nephrotoxicity - A reversible cause of acute oliguric renal failure(Karger, 2002) Sarikaya, M; Sevinc, A; Ulu, R; Ates, F; Ari, FBismuth subcitrate is a known nephrotoxic agent that may lead to acute oliguric renal failure when ingested in toxic doses. We report a 17-year-old girl who was admitted to the emergency room with complaints of nausea, vomiting, and anuria. She had taken 25 tablets containing 300 mg bismuth subcitrate (total 7.5 g). The patient was managed with hemodialysis started a week after ingestion. Bismuth subcitrate nephrotoxicity should be considered in the differential diagnosis of acute renal failure. Copyright (C) 2002 S. Karger AG, Basel.Öğe Blastic natural killer cell leukaemia with skin involvement: a case report(Wiley, 2004) Kaya, E; Ozcan, H; Kuku, I; Dikilitas, M; Sevinc, A; Aydogdu, INatural killer cell leukaemia is generally accompanied by extramedullary involvement. CD4+ natural killer cell leukaemia frequently manifests with cutaneous involvement. The disease pursues a very aggressive course with no long-term survivors reported. We present a patient with CD4+ natural killer cell leukaemia with skin, bone marrow and peripheral blood involvement who is still on remission at the end of 2 years.Öğe Brucellosis in the etiology of febrile neutropenia: Case report(Taylor & Francis Ltd, 2002) Sari, R; Buyukberber, N; Sevinc, A; Bayindir, Y; Buyukberber, SBrucellosis is one of the leading diseases in the differential diagnosis of fever of unknown origin in some parts of the world. It can lead to treatment failure because of slow growth in blood cultures and late appearance of signs and symptoms in patients with febrile neutropenia who were unresponsive to empirical antibiotic treatment. During the last year in our oncology unit adjuvant chemotherapy was given to 3 patients with breast (n=l) and stomach cancer (n=2) and febrile neutropenia was seen after the first course of chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil, etoposide, Adriamycin, and cisplatin) in all 3 patients. Cefepime and amikacin were commenced but the fever continued. Prior to antifungal treatment, the patients were re-evaluated because of the history of unpasteurized milk ingestion without overt signs and symptoms. Serum agglutination tests of brucellosis were performed and were 1:640 in two patients and 1:320 in the third. Brucella melitensis was identified only in one case although multiple blood cultures were taken from all 3 patients. Empiric antibiotic treatment was stopped and streptomycin 1 g/day (10 days), doxycycline 200 mg/day (28 days), trimethoprim 320 mg and sulfamethoxazole 1600 mg/day (28 days) were given. Although neutropenia continued, fever subsided in 3 days. Due to high incidence of brucellosis in some geographic areas, especially in the Middle East, brucellosis should be kept in mind in the differential diagnosis of febrile neutropenia.Öğe Cancer antigen 125: Tumor or serosal marker in case of ascites?(Amer Medical Assoc, 2001) Sevinc, A; Sari, R; Buyukberber, S[Abstract Not Available]Öğe Cervico-mediastinal tuberculous lymphadenitis presenting as prolonged fever of unknown origin(Natl Med Assoc, 2004) Bayindir, Y; Sevinc, A; Serefhanoglu, K; But, AProlonged fever of unknown origin (FUO) is a challenging and important medical problem. Tuberculosis is the most frequent cause of FUO, especially in endemic regions, such as developing countries. We present a case of cervico-mediastinal tuberculous lymphadenitis that had been searched and followed up as a prolonged FUO. Especially in endemic areas, tuberculosis should be borne in mind in the differential diagnosis of FUO cases with granulomatous lymphadenitis presenting as prolonged or recurrent fever, even if the cultures and polymerase chain reaction for Mycobacterium tuberculosis are negative.Öğe Complement and immunoglobulin levels in serum and ascitic fluid of patients with spontaneous bacterial peritonitis, malignant ascites, and tuberculous peritonitis(Lippincott Williams & Wilkins, 2002) Yildirim, B; Sari, R; Sezgin, N; Sevinc, A; Hilmioglu, EBackground. We determined complement and immunoglobulin levels in ascitic-fluid and serum of 47 patients with spontaneous bacterial peritonitis, malignant ascites, or tuberculous ascites. Methods. Paracentesis was done to confirm the underlying cause of ascites. Biochemical, hematologic, and microbiologic investigations were also done. Results. The highest serum and ascitic fluid C3 and C4 levels and ascitic fluid IgM, IgA, and IgG levels were found in patients with tuberculosis. Ascitic fluid C3 level was found to be higher in the tuberculous group than in the patients with spontaneous bacterial peritonitis or malignant ascites. Ascitic fluid C4 levels were higher in patients with tuberculosis than in those with spontaneous bacterial peritonitis. Conclusion. We believe that further studies of the in vivo kinetics of immunoglobulins and complement in ascitic fluid of various causes are necessary for a better understanding of the host defense mechanisms of these fluids.Öğe Complete heart block in a patient with Wegener's granulomatosis in remission - A case report(Westminster Publ Inc, 2002) Suleymenlar, G; Sarikaya, M; Sari, R; Tuncer, M; Sevinc, AWegener's granulomatosis is a systemic inflammatory disorder of unknown cause that usually affects the upper and lower respiratory tracts as well as the kidney. Cardiac involvement is rare, although electrocardiographic abnormalities, coronary artery vasculitis, cardiac arrhythmias, and myocardial infarction have been reported in the literature. A 27-year-old female patient with Wegener's granulomatosis in remission is described in whom complete heart block developed in the 13th month of treatment with cyclophosphamide. A temporary pacing was applied and pulse methylprednisolone and cyclophosphamide were commenced. On the ninth day of treatment, normal sinus rhythm was achieved. In conclusion, cardiac rhythm abnormalities should always be kept in mind both in the diagnosis and follow-up of Wegener's granulomatosis.Öğe Cutaneous metastasis of endometrial carcinoma with hemorrhagic nodules and papules(Imr Press, 2005) Baydar, M; Dikilitas, M; Sevinc, A; Senel, S; Senel, F; Aydogdu, IBackground: Endometrium cancer is the fourth most frequent malignancy in women. However, skin metastasis from endometrium cancer is a very rare entity. Case: A 58-year-old multiparous woman postmenopausal for ten years presented with multiple metastatic, nodular, hemorrhagic skin lesions located at the initial surgery and radiotherapy site 14 months after the original diagnosis was made. Combination chemotherapy was instituted, but the patient died after the second cycle of chemotherapy. Conclusion: Although endometrial cancer is one of the most frequent malignancies in women, skin metastasis from endometrial cancer is very rare. In reported cases metastasis from endometrial cancer has been most commonly noted at the initial surgery and radiotherapy site. Therefore, the initial surgical and radiotherapy site must be examined carefully for skin metastasis.Öğe The effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines(Editrice Kurtis S R L, 2004) Sari, R; Sevinc, AThe endocrine and immune changes associated with surgery are well documented, but the interaction between them has not been fully evaluated. We, therefore, investigated the possible effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines. Thirty-five patients were enrolled in the study (26 females and 9 males, aged 42.4 +/- 16.9 yr, who were admitted to General Surgery Clinic for laparascopic cholecystectomy). Serum C-reactive protein, cortisol, thyroid stimulating hormone, free tri-iodothyronine, free thyroxine, tumor necrosis factor-alpha, interleukin-1beta , soluble interleukin-2 receptor, interleukin-6, and interleukin-8 levels were evaluated 6 h before and after the operation. Postoperative cortisol (p = 0.02), TSH (p = 0.034), tumor necrosis factor-alpha (p = 0.003), soluble interleukin-2 receptor (p = 0.004) were found to be significantly higher than their corresponding preoperative levels. However, postoperative serum free thyroxine (p = 0.011), and free tri-iodothyronine levels (p = 0.001) were decreased when compared with preoperative levels, respectively. No significant difference was observed in C-reactive protein, interleukin-1beta, interleukin-6, and interleukin-8 levels. C-rective protein levels did not change in the early period of the surgical stress. Cytokine responses observed in the early period were found to be conflicting. Cortisol is an important marker of surgical stress which also has close relationship with thyroid functions. (C) 2004, Editrice Kurtis.Öğe The efficacy of acetazolamide on visual functions in a patient with choroid metastasis of breast carcinoma(Medicom International, 2001) Sari, R; Camci, C; Kutlu, R; Totan, Y; Sevinc, A; Buyukberber, SBreast carcinoma is the most frequent cancer in women and is the second leading cause of death. Choroid metastasis of breast carcinoma can be found either at presentation or in remission. It is frequently encountered in disseminated breast cancer with multiple organ metastasis. It has been proposed that the oedema-reducing effect of acetazolamide is due to stimulated ion and fluid removal from the retina to the choroid. A 40-year-old female patient on adjuvant chemotherapy for breast cancer was found to have an isolated choroid metastasis. Clinical and radiological remission was achieved after orbital radiotherapy, chemotherapy and acetazolamide treatment. In this case report, we emphasise the possible beneficial effect of acetazolamide in patients with choroid metastasis.Öğe Elevated serum CA-125 levels in hemodialysis patients with peritoneal, pleural, or pericardial fluids(Academic Press Inc, 2000) Sevinc, A; Buyukberber, S; Sari, R; Kiroglu, Y; Turk, HM; Ates, MObjective. Serum CA-125, an ovarian tumor marker, is used especially in the follow-up of ovarian cancer for monitoring the efficacy of therapy and for early detection of recurrence. A number of benign gynecologic as well as benign and malignant nongynecologic conditions are associated with elevated serum CA-125 levels. Malignant and nonmalignant serosal fluids were also found to be associated with high serum levels of CA-125, suggesting that the presence of fluid in the serosal cavities may stimulate its release. Methods. We performed a clinical study in 39 patients (21 females, 18 males) on chronic hemodialysis who were divided into two groups based on the presence of fluid in the serosal cavities (peritoneum, pleura, or pericardium) without clinical and radiologic evidence of neoplasia. There were 26 patients (16 females, 10 males) aged 50.11 +/- 13.86 years (range, 20-76 years) in the serosal fluid-negative group (group 1) and 13 patients (8 females, 5 males) aged 45.30 +/- 18.84 years (range, 17-73 years) in the serosal fluid-positive group (group 2). The control group consisted of 52 healthy volunteers (30 females, 22 males) aged 44.19 +/- 12.59 years (range, 19-68 years). Results. Significantly elevated serum CA-125 levels were found in hemodialysis patients with serosal fluid (P < 0.05) when compared with both the hemodialysis patients without serosal fluid and the control group. There was no statistically significant difference between the control group and the patients without serosal fluids (P > 0.05). Conclusion. Although CA-125 can be considered a reliable tumor marker in patients undergoing hemodialysis, it should be interpreted with caution in patients with serosal fluids. (C) 2000 Academic Press.Öğe Elevated serum CA-125 levels in patients with nephrotic syndrome-induced ascites(Int Inst Anticancer Research, 2000) Sevinc, A; Buyukberber, S; Sari, R; Turk, HM; Ates, MCA-125 is a sensitive, but not a specific, tumour marker especially used in the diagnosis and follow-up of ovarian cancer. Because of the elevated levels of CA-125 encountered during the etiological investigation of nephrotic syndrome (NS) a clinical study was designed to investigate the probable relationship between elevated CA-125 levels in patients with NS, with and without ascites. Twenty-four patients with NS due to non-tumoural pathologies, aged 24 to 56 (15 females and 9 males), were investigated We detected elevated levels of serum CA-125 (275.92 +/- 154.71 U/mL) in 14 (70%) NS patients with ascites (p<0.05). In the other 10 NS patients without ascites (Group 2) and in the control group, consisting of 52 age and sex-marched healthy volunteers, the serum CA-125 levels were found to be 13.60 +/- 5.12 U/mL and 8.50 +/- 5.02 U/mL, respectively (p>0.05). There was no statistically significant difference between the control group and the patients without serosal fluids (p>0.05). We concluded that serum CA-125 levels were elevated in NS patients with ultrasonographically detected ascites in the absence of an ovarian tumour or other diseases known to increase the levels of CA-125.Öğe Elevated serum CA-125 levels: Hepatitis or ascites?(Academic Press Inc, 2000) Sevinc, A; Buyukberber, S; Sari, R[Abstract Not Available]Öğe Follicular thyroid cancer presenting initially with soft tissue metastasis(Oxford Univ Press, 2000) Sevinc, A; Buyukberber, S; Sari, R; Baysal, T; Mizrak, BFollicular thyroid cancer rarely manifests itself as a distant metastatic lesion. We report a case of an otherwise asymptomatic 58-year-old woman with follicular thyroid cancer who initially presented with a soft tissue mass on the right scapular region, An incisional biopsy specimen of soft tissue metastasis showed thyroid follicular neoplasm. Upon this diagnosis, the thyroid gland was re-evaluated by ultrasound, which demonstrated a solitary, hypoechoic nodule in the right lobe, Ultrasonography guided fine-needle aspiration biopsy of the thyroid nodule confirmed follicular neoplasm and the diagnosis of metastatic follicular thyroid cancer was established. The patient refused any type of treatment and left hospital against medical advice. 2.5 years later the patient was admitted to the hospital with giant, sarcoma-like multiple soft tissue masses. On this admission, the serum thyroglobulin level was extremely elevated (3500 ng/ml) and she only accepted to receive chemotherapy, Epirubicin and cyclophosphamide were administered, She received three courses of chemotherapy and is alive with a stable disease after 3 months of follow-up, This case of follicular thyroid cancer is reported because of its uncommon initial presentation with soft tissue metastasis which spread to multiple areas as giant soft tissue masses during follow-up.Öğe The frequency of gallbladder stones in patients width pernicious anemia(Academic Press Inc Elsevier Science, 2001) Aydogdu, I; Sari, R; Ulu, R; Sevinc, ABackground. Ineffective erythropoiesis and intramedullary hemolysis are the two important results of pernicious anemia. Hemolysis is one of the risk factors in the formation of gallbladder stones. Patients and methods. The frequency of gallstones was searched in 59 patients with pernicious anemia and in 54 healthy subjects. Results. Nineteen (32.2%) patients in the pernicious anemia group and three (5.5%) patients in the control group were detected to have gallstones. Pernicious anemia patients with and without gallbladder stones were also compared for mean corpuscular volume, hemoglobin, unconjugated bilirubin, lactic dehydrogenase, and vitamin B12 levels but no statistically significant difference was encountered. Conclusion. Apart from other risk factors, pernicious anemia itself increases the frequency of gallbladder stones. Should patients with pernicious anemia develop upper-abdominal pain or other symptoms referable to biliary tract disease, a high index of suspicion for gallstone-related disease should be maintained. (C) 2001 Elsevier Science.Öğe Gallbladder contractility in patients with cirrhotic versus malignant ascites(Wiley, 2002) Sari, R; Yildirim, B; Sevinc, A; Bahceci, F; Hilmioglu, FPurpose. The aim of this study was to evaluate differences in gallbladder contractility by measuring gallbladder wall thickness, fasting and residual gallbladder volume, and gallbladder ejection fraction in patients with cirrhotic and malignant ascites. Methods, Twenty-four patients (16 women and 8 men) with malignant ascites (2 cervical, 2 colon, 2 stomach, 6 pancreatic, and 12 ovarian carcinomas), aged 59 +/- 12 years, and 26 patients (14 women and 12 men) with cirrhotic ascites, aged 57 +/- 16 years, Were included in the study. After patients fasted overnight for 8 hours, gallbladder wall thickness, fasting gallbladder volume, and gallbladder volume and ejection fraction were measured sonographically at 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after ingestion of a standard liquid test meal. Results. The mean gallbladder wall thickness was higher in patients with cirrhotic ascites than in those with malignant ascites (5.5 +/- 1.5 mm [standard deviation] versus 3.1 +/- 0.6 mm, respectively; p < 0.001). The mean fasting gallbladder volume was also higher in patients with cirrhotic ascites than in those with malignant ascites (27.3 +/- 11.5 cm(3) versus 17.6 +/- 8.9 cm(3); p < 0.05). Patients with cirrhotic ascites had significantly higher mean postprandial gallbladder volumes and ejection fractions than did those with malignant ascites at all times except 10 minutes after the meal (p < 0.05). Conclusions. Our findings suggest that gallbladder contractility is greater in patients with cirrhotic ascites than in patients with malignant ascites. (C) 2002 Wiley Periodicals, Inc.Öğe Gemcitabine-induced erysipeloid skin lesions in a patient with malignant mesothelioma(European Acad Dermatology & Venereology, 2002) Kuku, I; Kaya, E; Sevinc, A; Aydogdu, IGemcitabine is a nucleoside analogue that has shown to have antineoplastic activity in different solid tumours (lung, pancreas, bladder, colon, ovarian, and breast cancer) and malignant mesothelioma. The toxic effects of gemcitabine include myelosuppression, flu-like syndrome, altered liver function tests, bronchospasm, rash, itching, and fever. However, gemcitabine-induced erysipeloid skin reaction was reported in a small number of patients with previous history of radiotherapy or lymphedema. We reported a male patient who developed erysipeloid skin reaction following gemcitabine treatment in the absence of radiotherapy and lymphedema.Öğe Gluten-free diet improves iron-deficiency anaemia in patients with coeliac disease(I C D D R B-Centre Health Population Research, 2000) Sari, R; Yildirim, B; Sevinc, A; Buyukberber, STwo cases of newly-diagnosed asymptomatic coeliac disease with 3 years of unexplained severe iron-deficiency anaemia are presented. Oral iron supplementation had no effect on their serum iron levels and, therefore, had no influence on their anaemia. Upper gastrointestinal endoscopy confirmed normal macroscopic findings, Duodenal biopsies revealed subtotal villous atrophy of the mucosa of the small intestine. A strict gluten-free diet led to an increase in serum iron, resolution of anaemia, and restitution of normal mucosal morphology, Thus, severe iron-deficiency anaemia associated with asymptomatic coeliac disease is responsible to gluten-free diet.
