Gastric adenocarcinoma metastasis to the parotid gland.
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Adenocarcinoma↗
Biomedical subjects
N Güler
Publications and source records attributed to N Güler.
Prevalence of childhood asthma in Istanbul, Turkey.
In order to determine the asthma prevalence in 6-12-year-old schoolchildren in Istanbul, we issued 2350 questionnaires, according to ISAAC criteria, in six randomly selected city primary schools to be completed at home by parents. A total of 2232 of the questionnaires were completed, an overall response rate of 94.9%, and 2216 questionnaires were taken into consideration. The prevalence of asthma was found to be 9.8% and wheezing 15.1%. To investigate the effect of socioeconomic status on the prevalence of asthma, we evaluated the heating system at home, the place of residence, the educational levels of the mother and father, the number of people living in the house, the sharing of bedrooms, and the annual family income. In conclusion, the prevalence of childhood asthma was not affected by any of these factors. Atopic family history, food allergy, eczema, and frequent otitis media and sinusitis attacks were evaluated and found to be significant in asthma prevalence.
Asthma↗
Maintenance therapy with alpha-interferon following first-line VAD in multiple myeloma.
The aim of this study was to evaluate the response characteristics of vincristine, adriamycin and dexamethasone (VAD) as a first-line chemotherapy and to determine the efficacy of maintenance alpha-interferon (alpha-IFN) in multiple myeloma (MM). Between January 1985 and December 1994, a prospective trial was performed in stage II and III MM patients. The study population received only VAD with no maintenance therapy before 1990 (n=31), and those recruited after 1990 (n=33) were planned to be maintained with alpha-IFN (5 mU, 3 times per wk) during the plateau to a maximum of 2 yr. Median follow-up duration (44 vs. 39 months), time to response (3.4 vs. 3.5 months) and rate of objective response (61.3%, 19/31 and 63.6%, 21/33) were similar in VAD-only and VAD+IFN groups, respectively. The survival analyses revealed higher median progression-free (39.6 vs. 12 months) and overall survival (65+ vs. 24 months) durations in VAD+IFN group compared to VAD-only group. VAD regimen was well tolerated and IFN-related side effects were reversible. These findings denote that IFN maintenance prolongs the duration of response obtained by VAD.
Adolescent↗
Severe autoimmune hemolytic anemia in hairy cell leukemia.
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Anemia, Hemolytic, Autoimmune↗
Comparison of 99mTc(V)-DMSA, 201Tl and 99mTc-MIBI imaging in the follow-up of patients with medullary carcinoma of the thyroid.
Radionuclide scanning with tumour-seeking agents such as pentavalent technetium-99m dimercaptosuccinic acid [99mTc(V)-DMSA], thallium-201 and technetium-99m sestamibi (MIBI) has been reported to be useful in the detection of medullary thyroid carcinoma (MTC). We undertook a study in 14 MTC patients to determine the comparative imaging potential of 201Tl, MIBI and 99mTc(V)-DMSA in the detection of recurrent or metastatic MTC. All patients underwent total thyroidectomy and had persistently elevated serum calcitonin levels after the surgery. Scintigraphic studies were carried out 20 min after the injection of 111 MBq of 201Tl or 555 MBq of MIBI and 2 h following the injection of 370 MBq of 99mTc(V)-DMSA. All scintigraphic findings were correlated with contemporaneous CT or MRI studies. CT, MRI and bone scans showed 42 (26 bone, 16 soft tissue) metastatic sites in 11 of the 14 patients. In the remaining three patients no lesions were detected during diagnostic evaluation. 99mTc(V)-DMSA showed all of the soft tissue metastases but could not show two bone lesions. On the other hand, MIBI imaging was false-negative in 22 (52%) sites and 201Tl was false-negative in 34 (80%) sites. Overall, lesion detection sensitivities for 99mTc(V)-DMSA, MIBI and 201Tl were 95%, 47% and 19% respectively. We conclude that 99mTc(V)-DMSA is clearly superior to MIBI and 201Tl in the follow-up of MTC patients.
Adult↗
Medulloblastoma in a patient successfully treated for immature teratoma of the ovary.
We report a case of medulloblastoma as a secondary malignancy in a patient treated for immature teratoma of the ovary (ITO). ITO is a rare but curable tumor of the ovary using combination chemotherapy. There is a great deal of interest in the long-term effects of chemotherapy in these patients. Once regarded as fatal not many series of patients with ITO have been reported with the long follow up as in the present case. This case may start a debate on the susceptibility of central nervous system tumors following chemotherapy in patients with ITO.
Adult↗
Factors influencing the distribution of metastases and survival in metastatic breast carcinoma.
A total of 370 patients with metastatic breast, carcinoma who had been followed at Hacettepe Oncology Department between 1980 and 1991 were retrospectively analyzed for the factors influencing the distribution of metastases and survival. Median age was 47 years. Radical or modified radical mastectomies were performed in 199 (53.8%). Infiltrative ductal carcinoma was the most common pathologic subtype (69.4%). In 191 patients who were evaluated for estrogen receptor (ER) status, 101 (52.9%) were positive and 90 (47.1%) were negative. The distribution of first metastases did not differ between the soft tissue, bone, and visceral sites. The second, third, and fourth metastases were more common in visceral sites (p < 0.05). ER and menopausal status did not affect distribution. Mortality rate was significantly lower in the group having the first metastasis to the bone (p < 0.05). Of interest, first metastases were predominantly found in visceral sites in patients having radical or modified radical mastectomies (p < 0.05). Response to therapy, presence of initial metastases, axillary status, and age were the important factors influencing the overall survival in univariate analysis, whereas response to therapy, ER status, age, and presence of initial metastases were the important factors according to the multivariate analysis.
Adult↗
Comparison of 201Tl, 99Tcm-MIBI and 131I imaging in the follow-up of patients with well-differentiated thyroid carcinoma.
Problems stemming from the withdrawal of TSH suppressing doses of T4 or T3 and false-negative studies associated with 131I scintigraphy have justified the search for other radionuclides in the follow-up of patients with well-differentiated thyroid carcinoma. Although 201Tl and 99Tcm-MIBI (MIBI) have been suggested as alternatives, their role in the detection of residual and recurrent disease has yet to be established. We therefore studied 36 patients who had undergone total or near total thyroidectomy for well-differentiated thyroid carcinoma to determine the imaging potential of 201Tl, MIBI and 131I in the detection of residual or recurrent disease. Eighteen of the 36 patients had undergone 131I ablation. Imaging was performed 20 min following the intravenous injection of 111 MBq 201Tl or 555 MBq MIBI, or 48 h after the oral ingestion of 185 MBq 131I. The overall concordance between the 201Tl, MIBI and 131I scans was 70%. The concordance between thyroglobulin (TG) levels and the 131I scans was 78%; that between the 201Tl and MIBI scans and TG levels was 83%. Among the group of pre-ablative patients, there were six false-negative results with 201Tl and three false-negative results with MIBI. Among the post-ablation group, the 201Tl and MIBI scans were falsely negative in five patients. The 131I scans revealed all known residual or recurrent diseases. In conclusion, 201Tl, MIBI or TG levels should not be used in the place of 131I for the detection of residual or recurrent thyroid cancer. However, in patients who have not had their TSH suppressing doses of T4 or T3 withdrawn, the role of 201Tl and MIBI is debatable.
Adenocarcinoma, Follicular↗
Ifosfamide, mesna and epirubicin as second-line chemotherapy in advanced breast cancer.
The ifosfamide, mesna and epirubicin (IMEpi) combination is administered to 16 patients having advanced metastatic breast carcinoma as second-line chemotherapy. We observed complete response in 6%, partial response in 44% (total overall response rate of 50%), stable disease in 12% and progressive disease in the remaining 38% of the patients. The median remission duration in responders was calculated to be 9.6 months. IMEpi regimen had a tolerable toxicity profile including alopecia, nausea and vomiting, microscopic hematuria, leukopenia and neurotoxicity in which serious complications necessitating discontinuation of the chemotherapy were not encountered. It might be concluded that IMEpi chemotherapy combination is an effective alternative among schedules in the management of patients with stage IV breast carcinoma without serious side effects.
Adult↗
High-dose ifosfamide by infusion with Mesna in advanced refractory sarcomas.
Twenty patients with advanced sarcomas entered a pilot study with ifosfamide (IF) and mercaptoethane sulfonate sodium (Mesna) as a second-line treatment for six planned cycles. All patients had received prior doxorubicin- and cyclophosphamide-based chemotherapies. IF was administered at a dose of 3 g/m2 given as continuous intravenous infusion for 24 hr on day 1-5 with Mesna. In the absence of disease progression, chemotherapy was planned to be repeated every 4 weeks for six consecutive cycles. Following chemotherapy, only 2 patients (11%) achieved partial response with response durations of 6 and 9 months. There was no complete response. When considered for only high-grade tumors, the response rate reached up to 22%. Toxicity was reported for 48 cycles and the dose-limiting toxicities were myelosuppression (22%) and encephalopathy (17%). Chemotherapy protocol was changed after two or three courses in 16 patients with stable or progressive disease. IF/Mesna chemotherapy at this dose and schedule was not found to be very promising in refractory sarcomas as a second-line chemotherapy.
Adult↗
Psychological adjustment of children with mild and moderately severe asthma.
The relationship between the severity and duration of asthma and psychological adjustment was investigated in 29 children with mild and 31 children with moderately severe asthma, who were compared with 60 healthy control children. The severity of asthma was evaluated using the Pearlman-Bierman classification. Psychological adjustment was measured using the Achenbach Child Behavior Checklist (CBCL) and a semi-structured interview. The results of the interviews indicated that regressive symptoms such as clinging, childish behaviour, dependence, and a demanding nature were widespread. Using the illness in the service of achieving other aims was also common in the asthmatic children. CBCL total problem behaviour scores, social competency, and broad band scores were significantly higher in the asthmatic group than the control sample. Problem scores for asthmatic children were significantly correlated with parental friction at home, unsatisfactory relationships with siblings and other health problems in children. However, neither the CBCL total problem scores nor the social competency scores were correlated with the severity and the duration of illness.
Adaptation, Psychological↗
Progressive vertebral blastomycosis mimicking tuberculosis.
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Amphotericin B↗
Intrapleural and intraperitoneal palliative treatment of malignant effusions with mitoxantrone.
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Adult↗
Tumor lysis syndrome following single-dose mitoxantrone.
We report here a 16-year-old boy with pre-B-type acute lymphoblastic leukemia who developed acute tumor lysis syndrome (TLS) following 12 h mitoxantrone infusion. TLS is a distinct clinical entity which has been recognized most frequently with aggressive combination chemotherapy of rapidly proliferating hematologic neoplasms. There have been a few reports of single-agent-induced tumor lysis, but to our knowledge, this is the first case reported with mitoxantrone alone.
Adolescent↗
Combination of docetaxel and doxorubicin as first-line chemotherapy in metastatic breast cancer.
Docetaxel (Taxotere) and doxorubicin have previously demonstrated a significant antitumor activity in patients with metastatic breast cancer. Furthermore, a lack of cross resistance and overlapping toxicities between the two agents have been reported. In a prospective study, docetaxel (80 mg/m2, 1-hr iv infusion) and doxorubicin (60 mg/m2, 1-hr iv infusion) were administered as first-line chemotherapy in metastatic breast cancer patients to evaluate the clinical efficacy and toxicity of the combination. Forty-three patients were enrolled in the study. The median age was 47 years (range, 30-69). The docetaxel-doxorubicin combination was applied with 3-week intervals until progression. Complete response was achieved in 9 (21.4%) of 42 assessable patients and partial response in 24 (57.2%) patients, for an overall response rate of 78.6%. Median response duration was 8 months (3-18 months). Nausea and vomiting (76%), alopecia (64%), neutropenia (35.7%) and mucositis (33%) were the major side effects of the combination. There was one case of cardiac toxicity. In conclusion, the docetaxel-doxorubicin protocol can be considered as an active regimen for the treatment of patients with metastatic breast cancer with acceptable toxicity and a fairly high response rate.
Antibiotics, Antineoplastic↗
Non-Hodgkin's lymphomas of the tonsil: a retrospective analysis of twenty-eight patients with primary tonsillary lymphoma.
AIMS: To analyze the clinical and therapeutic aspects of patients with primary tonsillary non-Hodgkin's lymphoma. METHODS: Twenty-eight patients with primary tonsillary non-Hodgkin's lymphoma who had been followed in the Hacettepe Oncology Institute between 1974 and 1992 were retrospectively analyzed. Fifteen patients were male, 13 were female. Median age was 55 years. RESULTS: Constitutional symptoms were present in 10 patients (35.7%). Stages according to the Ann Arbor classification were I and II in 12 and 16 patients, respectively. According to the Rappaport classification, poorly differentiated lymphocytic was the most common pathologic subgroup (42.9%). Grades according to the Working Formulation were low, intermediate and high in 3, 22 and 3 patients, respectively. Twenty-two patients had received chemotherapy. Cyclophosphamide, vincristine and prednisone (CVP), and cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) were the regimens most commonly employed. Eighteen patients received radiotherapy to Waldeyer's ring and neck. Eight patients achieved remission with chemotherapy plus radio-therapy, 7 patients with chemotherapy alone, and 5 patients with radiotherapy alone. In addition to the 20 patients who achieved complete remission, 3 patients achieved partial remission; the overall response rate was 82.1%. The response rates and survival attained with the combined modality, chemotherapy, or radiotherapy alone were not statistically different (P > 0.05). The median follow-up was 14 months. Overall and disease-free survival at 5 years were 62.6% and 77.6%, respectively. Pathologic grade was the most important prognostic factor influencing overall survival in the Cox multivariate model. CONCLUSIONS: Poorly differentiated lymphocytic lymphomas were the most common pathologic subtype, and pathologic grade was the most important prognostic factor to influence survival in the present study. Although combined modality treatment did not appear to be superior to chemotherapy or radiotherapy alone, a larger number of patients is needed to draw definite conclusions.
Adult↗
Ifosfamide and etoposide in previously treated patients with advanced breast cancer.
AIMS AND BACKGROUND: Ifosfamide is an active alkylating agent in the treatment of breast cancer, as a first-line therapy and in advanced disease. Since the combination of etoposide with an alkylating agent produces a synergistic and tolerable activity in various malignancies, in the present study, ifosfamide and etoposide were administered to patients with advanced breast cancer to evaluate the response characteristics and the toxicity profile. STUDY DESIGN: The combination of ifosfamide, mesna and etoposide was prospectively administered to 41 previously treated patients with stage IV breast carcinoma. The treatment schedule consisted of ifosfamide, 1500 mg/m2, infused over 24 hrs with 1500 mg/m2 mesna on days 1 to 5 and 120 mg/m2 etoposide, infused over 1 hr on days 1 to 3, to be repeated every 4th week. RESULTS: After a median follow-up of 10 months, an objective response rate of 23% (overall 2.5% complete remission and 20.5% partial remission) and a median response duration of 5.3 months were obtained in 39 assessable patients. The non-responder group consisted of 28.3% stable disease and 48.7% progressive disease. The prior status of chemotherapy was the only significant prognostic factor with an impact on the response rate. The overall toxicity was generally mild, with grade 3 myelotoxicity encountered in 25.7% of patients. CONCLUSIONS: The tolerable side effect profile of the ifosfamide and etoposide combination might be advantageous as regards the quality of life. To improve the rate and/or the duration of response and to clarify the precise role of the ifosfamide-etoposide combination in previously treated advanced breast cancer, further trials are warranted.
Adult↗
Incidence of the type and calcification patterns in patients with elongated styloid process.
We investigated the incidence of elongated styloid process (Eagle's syndrome) using panoramic radiographs taken of 860 patients referred to our clinic. Any styloid process identified was classified according to its length, type and the pattern of calcification. Fifty-nine elongated styloid processes were identified in 32 patients (3.7%), most being bilateral; 24 patients were female and eight were male (female/male ratio: 3:1). The mean age of these patients was 43 +/- 14 years (range: 18 - 78 years). Type I (elongated) was the most frequent type on both sides (42/59); and the most frequent patterns of calcification were partially calcified on the left side (18/59) and completely calcified on the right side (16/59). Only two patients were symptomatic. A corrected differential diagnosis is important to distinguish elongated styloid process from other pathologies with partially overlapping symptoms. We would recommend that clinicians consider the possibility of Eagle's syndrome when both the clinical and radiographic evidence support this diagnosis.
Adolescent↗