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Öğe Comparison of tropisetron and granisetron in the control of nausea and vomiting in children receiving combined cancer chemotherapy(Taylor & Francis Inc, 2001) Aksoylar, S; Akman, SA; Ozgenc, F; Kansoy, STropisetron and granisetron are selective serotonin (5-HT3) antagonists that have been proven effective in the prevention of nausea and vomiting in adults and children receiving cancer chemotherapy. This prospective, randomised study was designed to compare the efficacy of the two agents in the prevention of vomiting and nausea in children receiving highly emetogenic chemotherapy for various malignancies. A total of 51 children (mean age: 7.7 +/- 4.8 year) were studied in 133 chemotherapy cycles. In 66 chemotherapy cycles, the children received tropisetron as an antiemetic agent in a dose of 0.2 mg/kg/24 h intravenously and, in 67 cycles, they received granisetron 40 mug/kg/24 h intravenously before cytotoxic drug administration during the days they received chemotherapy. The response per 24 h of chemotherapy was defined as complete (no nausea and vomiting), Partial (1-4 events of vomiting and/or nausea), and failure (more than 4 events of vomiting and/or nausea). Efficacy of antiemetic therapy was evaluated as acute (Day 1) and overall was based on the worst day during the chemotherapy. Complete control of acute vomiting was achieved in 74 % of tropisetron and 88 % of granisetron patients (P = 0.04), and complete control of acute nausea in 56% and 82 % respectively (p = 0.002). Overall response by means of complete control of both vomiting and nausea during the whole therapy period was 29 % of tropisetron group and 55% of granisetron group (p = 0.007). The statistical analysis (depending on the emetogenicity of the chemotherapy cycles) showed increased efficacy of granisetron in highly (grade 3) emetogenic chemotherapy cycles (p = 0.002), whereas there was no difference in the very highly emetogenic cycles (p = 0. 7). Also, granisetron was found to he more effective than tropisetron, especially, in patients heavier than 25 kg (p = 0.02). The adverse reactions were few and mild. There were no differences in the tolerability of the two antiemetic therapy modalities. In conclusion, granisetron was found to be more effective than tropisetron in controlling nausea and vomiting in children receiving highly emetogenic chemotherapy. This increased antiemetic efficacy of granisetron might have been related to maximal dose differences according to body weight.Öğe Concurrent expressions of CD34 and CD133 antigens on stem cells derived from umbilical cord and peripheral blood(Nature Publishing Group, 2005) Kansoy, S; Bayram, N; Kantar, M; Aksoylar, S; Keskinoglu, A; Donmez, A; Cetingul, NÖğe Disseminated Cryptosporidium infection in an infant with hyper-IgM syndrome caused by CD40 deficiency(Mosby-Elsevier, 2003) Kutukculer, N; Moratto, D; Aydinok, Y; Lougaris, V; Aksoylar, S; Plebani, A; Genel, F; Notarangelo, LDWe report the case of an infant with severe respiratory infections, chronic diarrhea, failure to thrive, and disseminated Cryptosporidium parvum infection. Laboratory investigations disclosed a diagnosis of hyper-IgM syndrome caused by CD40 deficiency.Öğe Disseminated Cryptosporidium infection in an infant with hyper-IgM syndrome caused by CD40 deficiency(Mosby-Elsevier, 2003) Kutukculer, N; Moratto, D; Aydinok, Y; Lougaris, V; Aksoylar, S; Plebani, A; Genel, F; Notarangelo, LDWe report the case of an infant with severe respiratory infections, chronic diarrhea, failure to thrive, and disseminated Cryptosporidium parvum infection. Laboratory investigations disclosed a diagnosis of hyper-IgM syndrome caused by CD40 deficiency.Öğe Efficacy of interferon-alpha 2b treatment in children with chronic hepatitis B who have previously undergone therapy for cancer(Wiley, 2000) Kasirga, E; Isenlik, S; Aksoylar, S; Yaprak, I; Kansoy, S; Yuce, GBackground: The aim of the present study was to evaluate the efficacy of treatment with recombinant interferon (IFN)-alpha 2b in 12 children with chronic hepatitis B who had previously undergone therapy for cancer. Methods: Nine children had acute leukemias and the other three children had solid tumors. The mean (+/-SD) age of the children was 8.4 +/- 3.8 years (range 4-16 years). All cases were hepatitis B virus (HBV)-DNA positive and 11 were hepatitis B e antigen (HBeAg) positive. One was anti-HBe positive (mutant strain). Four cases were anti-delta IgG positive. Liver biopsy revealed chronic hepatitis B in 11 patients and cirrhosis in one patient. Interferon-alpha 2b was given at a dose of 5 MU/m(2) three times a week, subcutaneously, for 12 months. Results: Elimination of serum HBV-DNA was obtained in three cases, but a further three patients demonstrated a marked decrease in HBV-DNA levels after therapy. Three of 11 patients seroconverted from HBeAg to anti-HBe. Alanine aminotransferase (ALT) levels returned to normal in three of nine cases in whom the ALT levels were high before treatment. At the end of therapy, the mean histologic activity index score was significantly diminished (P = 0.0039). Conclusions: In conclusion, a 12 month course of IFN-alpha 2b induces some beneficial effects on virologic, biochemical and histologic indices in children with chronic hepatitis B who have previously undergone therapy for cancer.Öğe Evaluation of sponging and antipyretic medication to reduce body temperature in febrile children(Blackwell Science, 1997) Aksoylar, S; Aksit, S; Caglayan, S; Yaprak, I; Bakiler, R; Cetin, FTwo hundred and twenty-four children aged 6 months to 5 years, with rectal temperatures greater than or equal to 39 degrees C (104 degrees F), were randomly treated with sponging alone or with medication including a single oral dose of aspirin 15 mg/kg, or paracetamol 15 mg/kg, or ibuprofen 8 mg/kg. Twenty-three children were excluded from the final analysis because they did not complete the study. Demographic characteristics of the patients were found to be comparable in all groups. Rectal temperatures were recorded every 30 min for a 3 h period. During the first 30 min of intervention, sponging was found to be more effective than all of the three medications. After 60 min, the effects of each medication became superior to sponging with tepid water in reducing body temperature. Twenty-three children were excluded from the final analysis because they did not complete the study. Comparing the effect of the three different medications, it was seen that the antipyretic efficacy of aspirin and ibuprofen were significantly more than paracetamol 3 h after intervention (P < 0.05). For the management of fever over 39 degrees C, it is therefore recommended to give children an antipyretic drug, preferably ibuprofen, and at the same time to begin sponging to provide a rapid and sustained antipyresis.Öğe Experience of the Izmir pediatric oncology group on neuroblastoma: IPOG-NBL-92 protocol(Taylor & Francis Inc, 2003) Olgun, N; Kansoy, SS; Aksoylar, S; Cetingul, N; Vergin, C; Oniz, H; Sarialioglu, F; Kantar, M; Uysal, K; Tuncyurek, M; Kargi, A; Aktas, S; Bayol, U; Karaca, I; Arikan, A; Balik, E; Aktug, TJ; Elmas, N; Kovanlikaya, A; Kinay, M; Anacak, Y; Degirmenci, B; Burak, ZThis multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.Öğe Experience of the Izmir pediatric oncology group on neuroblastoma: IPOG-NBL-92 protocol(Taylor & Francis Inc, 2003) Olgun, N; Kansoy, SS; Aksoylar, S; Cetingul, N; Vergin, C; Oniz, H; Sarialioglu, F; Kantar, M; Uysal, K; Tuncyurek, M; Kargi, A; Aktas, S; Bayol, U; Karaca, I; Arikan, A; Balik, E; Aktug, TJ; Elmas, N; Kovanlikaya, A; Kinay, M; Anacak, Y; Degirmenci, B; Burak, ZThis multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.Öğe False-negative scintigraphy with Tc-99m sestamibi in stage IV neuroblastoma(Lippincott Williams & Wilkins, 1999) Ozcan, Z; Erenel, G; Aksoylar, S; Kansoy, S; Burak, Z; Ozkilic, HTc-99m sestamibi, originally developed for myocardial studies, has been used as a tumor-seeking agent. Recently, the agent also was reported to be a functional tracer to predict multidrug resistance-related p-glycoprotein expression in tumor tissue. The current report presents the authors' experience with sestamibi tumor scintigraphy in a neuroblastoma. Although I-131 MIBG tumor imaging and Tc-99m MDP bone scanning accurately demonstrated the extent of the disease, Tc-99m sestamibi showed no accumulation in primary and metastatic foci. Lack of sestamibi uptake was initially thought to be suggestive of failure to respond to chemotherapy because of p-glycoprotein expression. However, the patient responded well to chemotherapy and complete remission was achieved. The failure of Tc-99m sestamibi to detect a neuroblastoma and the lack of sestamibi accumulation in the tumor may not always be related to chemotherapy resistance.Öğe HDR (hypoparathyroidism, sensorineural deafness, renal dysplasia) syndrome presenting with hypocalcemia-induced generalized psoriasis(Walter De Gruyter Gmbh, 2004) Aksoylar, S; Aydinok, Y; Serdaroglu, E; Coker, M; Ozdemir, F; Özkınay, FHDR syndrome is a newly recognized very rare syndrome defined by the combination of hypoparathyroidism, renal dysplasia and sensorineural deafness. Haplo-insufficiency of the GATA3 gene is the underlying mechanism of the HDR syndrome. Here we report a 16 year-old girl with HDR syndrome who presented with generalized psoriasis, which is an unusual presentation. Skin lesions rapidly disappeared after replacement therapy with calcium. It is suggested that generalized psoriasis might have been induced by hypocalcemia due to hypoparathyroidism associated with HDR syndrome.Öğe High-dose acyclovir and pre-emptive ganciclovir in prevention of cytomegalovirus disease in pediatric patients following peripheral blood stem cell transplantation(Nature Publishing Group, 2004) Hazar, V; Kansoy, S; Kupesiz, A; Aksoylar, S; Kantar, M; Yesilipek, ACytomegalovirus (CMV) disease remains an important cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). We evaluated high-dose acyclovir (HDACV) and pre-emptive ganciclovir to prevent CMV disease in 76 children who underwent peripheral blood stem cell transplantation (PBSCT) and were at risk for CMV reactivation and disease ( both recipient and donor seropositive) from May 1998 to April 2003. All received HDACV from day - 9 to 6 months post transplant in conjunction with weekly CMV pp65 antigenemia monitoring. The incidence of antigenemia in this cohort was 19.7%, at a median of 22 days post-PBSCT. The frequencies were 26.4 and 4.4% in allogeneic and autologous groups, respectively ( P = 0.03). Patients with nonmalignant disease had higher CMV antigenemia than those with malignant disease (30.8 vs 8.1%, P = 0.02). Age at PBSCT, sex, graft-versus-host disease (GVHD) prophylaxis regimen and presence of acute GVHD did not affect the risk of CMV antigenemia. No ne of the patients who had positive pp65 antigenemia developed CMV disease during the study period. We conclude that pp65 anti-genemia-guided HDACV and pre-emptive ganciclovir may prevent CMV disease in children undergoing PBSCT.Öğe Letter to the editor: Primary cardiac rhabdomyosarcoma(Wiley-Liss, 2002) Aksoylar, S; Kansoy, S; Bakiler, AR; Ozer, E; Ozgenc, FÖğe Meropenem plus amikacin versus piperacillin-tazobactam plus netilmicin as empiric therapy for high-risk febrile neutropenia in children(Taylor & Francis Inc, 2004) Aksoylar, S; Cetingul, N; Kantar, M; Karapinar, D; Kavakli, K; Kansoy, SThe aim of this study was to evaluate the efficacy and safety of meropenum plus amikacin compared with piperacillin-tazobactam plus netilmicin for initial empirical antibiotic treatment of high-fisk febrile neutropenia in children with cancer. Patients with hematologic malignancy (leukemia or stage III/IV non-Hodgkin lymphoma) who presented with fever and neutrepenia (ANC < 500/mm(3)) and patients with solid tumors who presented with fever and severe. neutropenia (ANC < 100/mm(3)) were considered to be at high risk and eligible,for this study. In this prospective study, 33 patients with 50 febrile neutropenic episodes received iv meropenem (20 mg/kg every 8 h) plus amikacin (15 mg/kg/d in 2 divided doses) (in 31 episodes) or piperacillin/tazobactam (100 mg/4 mg/kg every 8 h) plus netilmicin (7 mg/kg every 24 h) (in 19 episodes). Clinical response was determined at 72 h and at completion of the therapy. The groups were comparable in terms of age, sex, initial ANC, use of growth factors, and classification of the infections. An infection was documented microbiologically in 12 episodes (39%) in the meropenem plus amikacin group and in 8 episodes (42%) in the piperacillin/tazobactam plus netilmicin group. Of the 22 microbiological isolates, 37% were gram-positives, 45 % were gram-negatives, and 18 % were fungi. Most of the clinically documented infections were of lower respiratory tract, gastrointestinal mucosa, or urinary tract origin. The mean duration of neutropenia was 9 days in both groups. Fever persisted for 1-30 days (mean 3 vs. 5 days). The success rate with initial empiric therapy was 52 % in the meropenem plus amikacin and 42 % in the piperacillin/tazobactam plus netmicin g-roup, respectively (p =.5). Total success rate (with or without modification) was 97 % vs. 90 % in the episodes. Three patients died due to infection (I vs. 2 patients). No major adverse effects were, observed in each group. Empirical therapy with meropenem plus amikacin or piperacillin/azobactam plus netilmicin effective and safe in pediatric cancer patients.Öğe Outcome of hematopoietic stem cell transplantation in hyper-IgM syndrome caused by CD40 deficiency(Mosby-Elsevier, 2003) Kutukculer, N; Aksoylar, S; Kansoy, S; Cetingul, N; Notarangelo, LDÖğe Outcome of hematopoietic stem cell transplantation in hyper-IgM syndrome caused by CD40 deficiency(Mosby-Elsevier, 2003) Kutukculer, N; Aksoylar, S; Kansoy, S; Cetingul, N; Notarangelo, LDÖğe Regenerative nodule mimicking hepatocellular carcinoma in a cirrhotic child due to hepatitis B: An imaging dilemma(Wiley, 2004) Ozgenc, F; Aydogdu, S; Aksoylar, S; Elmas, N; Yuce, G; Yagci, RV; Tokat, YViral hepatitis B, post-hepatitic cirrhosis and hepatocellular carcinoma (HCC) is the classical sequence of events in hepatitis B virus (HBV) infected children and serum Alpha-fetoprotein (AFP) and ultrasound (USG) screening is recommended during follow up. We present a 13-yr-old girl with cirrhosis related to chronic HBV infection with normal AFP level and a 4 cm mass appearance by USG. Contrast spiral evaluation computed tomography (CT) study demonstrated a single mass located at 8th segment of the liver. Pre-contrast CT and portal venous phase studies showed heterogeneous liver parenchyma without mass appearance. HCC was suspected based on strong arterial enhancement. Two mediastinal lymphadenopathies, 1 cm under the xyphoid and 2 cm above the pericardium, were detected by thorax CT. Mediastinal exploration was undertaken with living related liver transplant donor in a second operating room. She was transplanted with the right lobe of her ABO compatible mother after evaluation of the lymph nodes revealed reactive histology by frozen section. Histologic evaluation of the explant liver documented cirrhosis with a cirrhotic nodule without histologic malignant evidence. False negative results from screening methods are familiar in the literature; however false positivity of a contrast CT study is rare. The significance of screening methods is discussed.
