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Biomedical subjects

C Ustün

Publications and source records attributed to C Ustün.

At least 37 records · Page 2Linked to original sources
PubMed1999

Helicobacter pylori seropositivity in patients with hyperemesis gravidarum.

OBJECTIVE: The aim of this study was to analyze the hypothesis that there was an association between hyperemesis gravidarum (HG) and Helicobacter pylori (HP) infection. METHODS: The study group consisted of 95 pregnant women with HG and 116 asymptomatic pregnant women who were admitted to our hospital between January 1997 and October 1998. Specific serum immunoglobulin G for HP was assayed in the sera of the study group after informed consent was obtained. Chi-square and Student's t-test were used accordingly for statistical analysis of the data. RESULTS: Serologically positive HP infection was detected in 87 of the 95 patients with HG (91.5%) whereas 52 of the 116 asymptomatic gravidas (44.8%) serving as the control group had positive antibody concentrations against HP. The ratio of HP positivity in pregnant women with HG was significantly higher than asymptomatic pregnant women (P < 0.001). The mean index percentages of IgG titers were 73.8 +/- 9.7% in the hyperemesis gravidarum and 25.8 +/- 5.6% control group (P < 0.01). CONCLUSION: HP infection seemed to be significantly associated with hyperemesis gravidarum in our pregnant patient population with hyperemesis gravidarum.

Adult↗
PubMed1999

Hematopoietic stem cell transplantation from non-replicative hepatitis B virus carriers is safe.

BACKGROUND/AIMS: Hepatitis B virus can cause serious problems in individuals undergoing organ transplantation. The aim of this study was to evaluate the hepatic events among HBs-Ag positive recipients and HBs-Ag negative recipients who received products from hepatitis B virus carriers. METHODS: A total of 151 patients received an allogeneic hematopoietic stem cell transplantation at the Department of Hematology-Oncology, University of Ankara, between June 1989 and June 1998. Among these, eight HBs-Ag positive and four HBs-Ag negative recipients received a product from a hepatitis B virus positive donor. The median follow-up period for these 12 patients was 13.2 months. RESULTS: Three of the eight HBs-Ag positive recipients died (one from hepatic failure); of the remainder, two are HBs-Ag negative, two HBs-Ag positive with normal liver injury tests and one HBs-Ag positive with elevated ALT levels. Of the four HBs-Ag negative recipients who received stem cells from a hepatitis B positive donor, two died; none of the patients in this group became HBs-Ag positive after transplantation. CONCLUSION: Hepatitis B virus infection is a common problem in patients being considered for allogeneic hematopoetic stem cell transplantation, especially in areas where hepatitis B virus infection is endemic. We believe that the presence of HBs-Ag positivity is not an absolute contraindication for allogeneic hematopoetic stem cell transplantation unless the hepatitis B virus is in a replication phase.

Adolescent↗
PubMed1999

The comparison of gonadotropin-releasing hormone agonist therapy and intraperitoneal Ringer's lactate solution in prevention of postoperative adhesion formation in rat models.

OBJECTIVE: To evaluate gonadotropin-releasing hormone agonists (GnRH-a) therapy and intraperitoneal Ringer's lactate solution (RL) for the prevention of postsurgical adhesion formation in rat models. STUDY DESIGN: Forty rats were randomized into four groups: Group I was the control; in group II, RL was applied at the surgery; group III and IV received preoperative subcutaneous injections of the GNRH-a leuprolide acetate and only the diluent of the GNRH-a respectively. A standard lesion was created over the uterus of each rat. Adhesions were scored at relaparotomy 3 weeks later. Analysis of variance (Kruskal-Wallis) and Mann-Whitney U-tests were used for the statistical evaluation. RESULTS: The average adhesion scores were 2.7+/-0.26, 1.4+/-0.27, 0.9+/-0.18, and 2.5+/-0.34 in groups I, II, III, and IV respectively. There were significant differences between the scores of groups I and II (P<0.01), groups I and III (P<0.001), groups II and IV (P<0.05), and groups III and IV (P<0.01); but not between the scores of groups II and III, and groups I and IV (P>0.05). CONCLUSION: GNRH-a was successful in reducing postoperative adhesion formation but was not superior to intraperitoneal RL.

Animals↗
PubMed1999

Autoimmune thrombocytopenia in a patient with small cell lung cancer developing after chemotherapy and resolving following autologous peripheral blood stem cell transplantation.

A 46-year-old white male with small cell lung cancer (SCLC) limited to the thorax developed autoimmune thrombocytopenic purpura (AITP), following a cyclophosphamide, paclitaxel and G-CSF-containing regimen for peripheral blood stem cell (PBSC) mobilization. AITP associated with small or non-small cell lung cancer has been reported. We considered that the AITP in this case may be a part of paraneoplastic syndrome, which is frequently seen in patients with SCLC. The patient received HDC and autologous PBSC transplantation (APBSCT) for SCLC and the AITP resolved following transplantation, thus supporting the concept of HDC + APBSCT for the treatment of autoimmune diseases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Treatment of aregeneratoric anemia following an ABO-incompatible allogeneic peripheral blood stem cell transplantation: a case report.

Aregeneratoric anemia (AA) occurs rarely after ABO-incompatible allogeneic peripheral blood stem cell transplantation (alloPBSCT), and its management is generally difficult. Here, we present a 31-year-old white man with myelodysplastic syndrome who developed AA after receiving stem cells from his human leukocyte antigen (HLA) identical, but ABO-incompatible sibling. Because his anti-A antibody titers were high, therapy with conventional doses of erythropoietin and prednisolone failed to treat the AA. Following 8 cycles of plasma exchange and higher doses of erythropoietin and prednisolone as well as danazol administration, anti-A titers decreased, and his anemia improved significantly. In conclusion, to treat and obtain a low titer of antibodies in a patient with AA following an ABO-incompatible alloPBSCT, higher doses of erythopoietin and corticosteroids associated with plasma exchange have to be used.

ABO Blood-Group System↗
PubMed1999

A retrospective comparison of allogeneic peripheral blood stem cell and bone marrow transplantation results from a single center: a focus on the incidence of graft-vs.-host disease and relapse.

To detect the effect of the stem cell source, allogeneic peripheral blood stem cell transplantations (alloPBSCTs) performed between 1995 and 1997 from human leukocyte antigen (HLA)-identical siblings in 40 patients with acute and chronic hematological disorders were compared with a historical group of 40 patients with similar variables who had received allogeneic bone marrow transplants (alloBMTs) between 1993 and 1995. Patients in both groups were identical except that both the recipient and the donor ages were, on average, higher in the alloPBSCT group (26 vs. 36 [p = 0.005] and 27 vs. 32 [p = 0.024], respectively). Patients received similar therapy excluding posttransplant granulocyte colony-stimulating factor administration (97% in alloBMT vs. 12.5% in alloPBSCT). The median time to reach neutrophil counts >0.5 x 10(9)/L and platelet counts >20 x 10(9)/L was 13 and 14 days, respectively, in patients receiving alloPBSCTs compared with 19 and 27 days in patients receiving alloBMTs (p = 0.0014 and p = 0.0002). The alloPBSCT group required similar transfusions of red blood cells or platelets. The incidence of grade II-IV acute graft-vs.-host disease (aGVHD) was similar in both groups. However, chronic GVHD (cGVHD) of all grades developed in 78.1% of patients in the alloPBSCT group after a median follow-up period of 12.5 (range 0.5-34) months. In alloBMT recipients, cGVHD of all grades developed in 21.4% after a median follow-up period of 38 (range 0.5-62) months (p = 0.00001). Day 100 transplant-related mortality was also similar: 20% (8 of 40) in the alloBMT patients and 17.5% (7 of 40) in the alloPBSCT group. Although not statistically significant, a relatively higher relapse rate occurred in the alloBMT group (21.4 vs. 10.7%). The estimated disease-free survival in month 24 was 51.3% for alloBMT and 54.6% for alloPBSCT, and the estimated overall survival in month 24 was 56.1% for alloBMT and 64.6% for alloPBSCT. In conclusion, this retrospective comparison suggests that alloPBSCT from HLA-identical donors is associated with faster engraftment, fewer transfusions, and no greater incidence of aGVHD, but a high incidence of cGVHD.

Adolescent↗
PubMed1999

Differences in liver pathology and clinical outcome between two patients with hepatitis B virus and graft versus host disease.

Our two patients undergoing allogeneic bone marrow transplantation (AlloBMT) had both Hepatitis B virus (HBV) and graft-versus-host disease (GVHD). In the first patient, liver enzymes elevated three months after AlloBMT, and GVHD was diagnosed. Two weeks after the diagnosis of GVHD, HBsAg appeared in his serum. At that time, liver biopsy was not able to discriminate two disorders, but his sequential liver biopsies disclosed GVHD. Despite the patient was treated with cyclosporin A (CsA), he died for chronic GVHD. In contrast to the first patient, the second patient had HBsAg prior to GVHD. His liver enzymes deterioration was detected in the first month after AlloBMT, and reached the highest level in the third month while withdrawing CsA. In the fifth month he developed scleradermatous skin changes, and skin biopsy revealed chronic GVHD, whereas concurrent liver biopsy revealed chronic active hepatitis. This observation showed that immunosuppressive conditions such as GVHD or its prophylaxis may affect the appearance of liver pathology caused by HBV, which depends on the time of GVHD development, and the duration and depth of GVHD prophylaxis.

Adult↗
PubMed1998

Allogeneic peripheral blood stem cell transplantation in acute non-lymphoblastic leukemia.

Unmodified allogeneic peripheral blood stem cell transplantation (alloPBSCT) was performed in 20 consecutive acute non-lymphoblastic leukemia (ANLL) patients from their HLA-identical siblings. There were 11 males and 9 females. Median age was 34 years (range 17-43). Donors were primed with 2.5-15 micrograms/kg/day s.c. granulocyte-colony stimulating factor (G-CSF, Neupogen, Roche). Conditioning regimen was Bu (16 mg/kg) + Cy (120 mg/kg) in 19 patients and high dose Ara-C (3 gr/m2 twice daily for 3 days) for one patient who relapsed after bone marrow transplantation. Eighteen patients were in CR1. CsA + short-term MTX (n = 19) or CsA alone (n = 1) were used for graft versus host disease (GVHD) prophylaxis. The median number of apheresis procedures for each patient was 2 (2-4). A median of 6.5 (3.2-38.2) x 10(8)/kg MNC or 9.4 (2.2-12.4) x 10(6)/kg CD34+ cells were given. Median days to reach granulocyte of > 0.5 x 10(9)/l and platelet of > 50 x 10(9)/l were 12 (10-14) and 15 (11-35) respectively. Day 100 transplant-related mortality was 20 per cent (4/20). Grade 2 to 4 AGVHD was seen in 8 out of 17 (47%) evaluable patients. Severe AGVHD occurred in 3 out of 17 (18%). Clinical CGVHD of all grades developed in 12 out of 17 (70%) evaluable patients. The mean disease-free survival and overall survival were 17 (range: 8-33 months) and 18 months (range: 10-34 months), respectively. In conclusion, alloPBSCT in ANLL is associated with a faster engraftment, no greater incidence of AGVHD, but increased risk of CGVHD.

Acetaminophen↗
PubMed1998

Acquired ichthyosis associated with chronic graft-versus-host disease following allogeneic peripheral blood stem cell transplantation in a patient with chronic myelogenous leukemia.

Acquired ichthyosis (AI) has rarely been described following bone marrow transplantation (BMT). We report a 29-year-old male, who underwent allogeneic peripheral blood stem cell transplantation (alloPBSCT) for chronic myelogenous leukemia, and who developed AI associated with chronic graft-versus-host disease (cGVHD). Both of these disorders were treated successfully with cyclosporin A. We conclude that AI may be related to an autoimmune process on the basis of cGVHD, and dermathopathologic evaluation must be performed in patients with skin changes suggesting AI following allogeneic bone marrow transplantation.

Adult↗
PubMed1998

Effects of Ringer's lactate, medroxyprogesterone acetate, gonadotropin-releasing hormone analogue and its diluent on the prevention of postsurgical adhesion formation in rat models.

Fifty adult female rats were randomly divided into five groups. Before the standard surgical procedure which consisted of creating a lesion with electrocautery over the uterus, leuprolide acetate (LA) together with its diluent, the diluent alone and medroxyprogesterone acetate (MPA) were injected to the third, fourth, and fifth groups, respectively. Ringer's lactate (RL) solution was applied intraperitoneally to the second group at the end of the surgery. Group I received no medication. Relaparotomy was performed 3 weeks later to evaluate the adhesions. The mean adhesion scores were (mean +/- SD) 2.6 +/- 0.7, 1.4 +/- 0.8, 0.9 +/- 0.6, 2.3 +/- 0.8, and 0.8 +/- 0.6 in groups I, II, III, IV, and V, respectively. The postsurgical adhesions were significantly less in the groups treated with RL, LA, and MPA.

Animals↗
PubMed1998

Acute myeloblastic leukemia associated with hyperleukocytosis and diabetes insipidus.

Two cases with acute myeloblastic leukemia (AML M4-FAB) associated with diabetes insipidus (DI) are presented here. Both patients presented with hyperleucocytosis. One had a white blood cell count (WBC) of 150 x 10(9)/L and the second patient had 200 x 10(9)/L. One of these patients was a 40 year-old male and MRI of the hypophysis showed an infindibuler mass. This patient did not respond to remission induction chemotherapy and reinduction chemotherapy was given. The other patient was a 16-year-old male with a normal CT scan of the head. Both patients had DI with typical clinical and laboratory findings. The first patient died early on during reinduction chemotherapy and the second patient died of intracranial bleeding before induction chemotherapy was given. These findings are consistent with the data in the literature suggesting that the prognosis of AML associated with DI is poor and that these cases generally present with hyperleucocytosis.

Adolescent↗
PubMed1997

Hepatitis B virus infection in allogeneic bone marrow transplantation.

Fourty-four patients who underwent allogeneic bone marrow transplantation (alloBMT) were studied for hepatitis B virus (HBV)-related complications. The mean follow-up period was 15.3 months. Positivity for HBV surface antigen (HBsAg) was observed in 10 patients (22.7%) throughout the study. Four of the 10 patients were HBsAg carriers before alloBMT, while the remaining six became HBsAg(+) after alloBMT. During the follow-up period (from 6 months to 45 months), an elevation in serum ALT activity was observed in the four carriers when immunosuppression was reduced or withdrawn. All of the four HBsAg carriers developed hepatitis, but none of them died of liver failure due to HBV. Only one death due to GVHD and diabetic ketoacidosis was observed in this group. Two of the four carriers received marrow from anti-HBs positive donors and one of them cleared HBsAg from his serum via adoptive immunity 8 months after transplantation. The remaining six patients acquired HBV after alloBMT, but we were unable to demonstrate the source of HBV. Five of them had a moderate increase in serum ALT activity while the other patient had a normal ALT. Two patients seroconverted to anti-HBs spontaneously. Two patients died during the follow-up, one due to intracranial hemorrhage and the other due to GVHD and accompanying pulmonary infection. The rest of the study group (34 patients) remained HBsAg(-) throughout the study. Two of them had an HBsAg(+) donor, but neither developed HBV infection in their follow-up period. The acquisition rate of HBV infection was relatively low in recipients who were positive for anti-HBs compared to those who were negative for anti-HBs (8 vs 19%). Anti-HBs positivity remained for a longer period in recipients who received marrow from anti-HBs positive donors compared to those recipients who had anti-HBs negative donors (median 12 vs 3 months). We think that HBV is a frequent cause of liver dysfunction in alloBMT patients where HBV infection is endemic. Whether the disease is in the form of reactivation of HBsAg-positive recipients, or is acquired from unknown sources in recipients who never had contact with the virus, the course of the disease is not fatal. Silent serologic changes can be demonstrated if viral serologic markers are sought serially. Among them, the disappearance of serum anti-HBs may be important as it increases the risk of HBV contamination in recipients.

Adolescent↗
PubMed1997

A case report of a patient who has pure red cell aplasia and rheumatoid arthritis.

Pure red cell aplasia (PRCA) as an extra-articular manifestation of rheumatoid arthritis (RA) is rare. In the present report a 40-year-old female patient, with a 4-year-history of severe anemia and pain in the small joints of the hands, was diagnosed as having PRCA by bone marrow (BM) examination. Antithymocyte globulin (ATG), methylprednisolone and cyclosporin A (CSA) were used for the treatment of PRCA. The patient's hematological values responded within 6 months but pre-existing arthralgia continued, although with some relief. The patient subsequently fulfilled the criteria for diagnosis of RA at the 16th month. A review of nine published case reports on the coexistence of PRCA with RA revealed the initial diagnosis as RA. In our case, as the initial symptoms and findings were not sufficient for the diagnosis of RA, we therefore conclude that PRCA preceded RA. Although CSA was curative in the treatment of PRCA it could not prevent the full diagnostic features of RA.

Adult↗