Begül Yağcı-Küpeli

Health-related quality of life in pediatric cancer survivors: a multifactorial assessment including parental factors.

Aim: We aimed to evaluate the health-related quality of life (HRQOL) and the effect of associated factors such as cancer type, treatment strategies, sex, age, and parental factors like education and psychopathology in pediatric cancer survivors and make a comparison with healthy children. Patients and Methods: “Pediatric Quality of Life Inventory (PedsQL) 4.0 TM, Generic Core Scale” for children and parents, and “Brief Symptom Inventory” for parents were used. Three hundred and two survivors without major mental or motor deficit and 272 healthy controls of 8 to 18 years of age were enrolled to study. Results: Comparison of scores according to child self-report between survivor and control groups revealed lower points in physical and school subscale of survivor group (P<0.01 and P<0.001, respectively). Female survivors had reported significantly worse HRQOL in physical and emotional subscales of PedsQL than male survivors (P<0.001). Female survivors of ≥16 years of age had reported worse scores in school subscale than females of younger age groups and male survivors of same age group. Parents of control group reported better results in school subscales (P<0.001) and social functioning subscales (P<0.05) than parents of survivor group. Brief Symptom Inventory score had significant effect on child self-report and parent proxy-report of physical functioning (P<0.001), emotional functioning (P<0.001), social functioning (P<0.001), and school subscales (P<0.001) of PedsQL. Significantly better scores of physical functioning subscale in the survivors whose parents are university graduate than the survivors whose parents are primary school graduate were detected (P<0.001). The survivors with central nervous system tumors had reported lower scores in the social, emotional, physical, and school functioning subscales of PedsQL than patients with non-Hodgkin and Hodgkin lymphoma (P<0.001). Child self-report school subscale scores were lower in survivors treated with radiotherapy in combination or as sole therapy than survivors in whom radiotherapy was not given (P<0.001). Conclusions: Our study has provided evidence about less-studied determinants of HRQOL like parental factors such as psychopathology or educational level in childhood cancer survivors. Future research can build on this evidence to obtain additional factors other than well-known medical and treatment-related factors.

Tissue Doppler and myocardial deformation imaging to detect myocardial dysfunction in pediatric cancer patients treated with high doses of anthracyclines

To detect subtle changes in myocardial function in pediatric cancer patients treated with high dose anthracyclines.

Comparison of Sulbactam-Cefoperazone with Carbapenems as Empirical Monotherapy for Febrile Neutropenic Children with Lymphoma and Solid Tumors

Febrile neutropenia (FEN) is a leading complication of intensive chemotherapy. With this prospective randomized study, the authors aimed to compare the effectiveness of sulbactam-cefoperazone (SC) versus carbapenems, as empirical monotherapy in febrile neutropenic children with lymphoma and solid tumors. Febrile neutropenic children (age ≤16 years) hospitalized at the authors’ center for lymphomas or solid tumors between March 2007 and June 2009 were included in the study. Patients randomly received SC or carbapenem. Patients were reevaluated at 72 hours and in case of persistent fever, an aminoglycoside and/or a glycopeptide was added to the antibiotic treatment. When a resistant pathogen was isolated, the antibiotic therapy was modified. Treatment responses was defined as success without modification, overall success, or failure. Two hundred and eight episodes were documented in 128 patients (F/M: 56/72), with a median age of 7 years (0.5–17.4 years). Absolute neutrophil count and duration of neutropenia in patients treated with SC and carbapenems were 133/mm3 (0–500) and 113/mm3 (0–500), and 4 days (1–21) and 5 days (2–20), respectively. In the SC and carbapenem groups, 82 (78.8%) and 84 episodes (80.7%) improved with treatment, whereas 21 (20.2%) and 19 (18.3%) episodes required treatment modification respectively. One patient from each treatment group died according to febrile neutropenia. The overall success rates were 99% in both groups (P = .94). Empiric SC therapy was found to be as effective as carbapenem monotherapy in pediatric febrile neutropenic patients with lymphoma and solid tumors.

An unusual cause of posterior fossa mass: Lhermitte-Duclos disease

Lhermitte-Duclos disease (LDD) (dysplastic cerebellar gangliocytoma) is a rare disorder of unknown pathogenesis, presenting with signs and symptoms resulting from obstruction of cerebrospinal fluid flow and mass effect in the posterior fossa. Magnetic resonance imaging is the diagnostic modality of choice allowing preoperative diagnosis with characteristic findings. Surgery is the choice of treatment. The typical histopathological findings of LDD are characterized by widening of the molecular layer, absence of the Purkinje cell layer and hypertrophy in the granule cell layer. Herein we report an adolescent girl with LDD diagnosed preoperatively by the conventional and advanced MR techniques.

Educational achievement, employment, smoking, marital, and insurance statuses in long-term survivors of childhood malignant solid tumors.

Background/Objective: Survivors of childhood cancer experience many social adaptation problems. We aimed to identify social, educational, and occupational issues of this growing population. Patients and Methods: Survivors treated for childhood malignant solid tumors who were older than 18 years and in remission for at least 3 years were surveyed. The educational achievement, employment, type of habitation, marital status, parenthood, social insurance, and smoking status of the patients were inquired and recorded. Results: Two hundred one patients (126 male patients/75 female patients) were included in the study between 2007 and 2009. The median ages at the time of diagnosis and at the time of study were 10 years (range, 0 to 19 y) and 23 years (range, 18 to 39 y), respectively. The median follow-up duration was 13.5 years (range, 3 to 31 y). Nearly half of the participants were lymphoma survivors. One hundred eleven (55.5%) survivors were high school graduates and 47 (23%) were university graduates. Unemployment rate was 36.8%. Public social insurance rate was 90.5%. Fifty-three (26.4%) survivors had independent habitation. Thirty percent of survivors were married and 7.5% had at least 1 child. Marriage rates were significantly higher in survivors who were older than 23 years, had a follow-up duration of >13 years, had a job, and lived independently (for each parameter P=0.001). University degree was significantly lower in survivors who were treated for central nervous system tumors. Conclusions: Our results have drawn a more marked picture with lower educational achievement and marital rates when compared with the results of large survivorship studies conducted in developed countries. However, they can be interpreted as intriguing when limited resources are taken into account.

Single institution experience on cancer among adolescents 15-19 years of age

Yağcı-Küpeli B, Akyüz C, Yalçın B, Varan A, Kutluk T, Büyükpamukçu M. Single institution experience on cancer among adolescents 15-19 years of age. Turk J Pediatr 2017; 59: 1-5. Adolescent cancers differ from other age groups in terms of cancer types, treatment and outcome. We aimed to present our institutional data on survival of certain types of cancer in adolescents. Hospital files were retrospectively evaluated for distribution of tumor types, clinical features, and overall and event-free survival (OS and EFS) rates in adolescents with malignant tumors. Two hundred ninety-three cases between 15-19 years who were diagnosed with malignant tumor at our department in the last 38 years were included in the study. Mean age was 15.3 and median age was 15 years at time of diagnosis. Male/female ratio was found to be 1.8/1. The most common cancers were non-Hodgkin lymphoma (NHL) (20.5%), Hodgkins lymphoma (HL) (19.8%), central nervous system (CNS) tumors (10.9%), osteosarcoma (10.6%), Ewing sarcoma/primitive neuroectodermal tumors (EWN/PNET (9.9%) nasopharyngeal carcinoma (NPC) (9.6%). Non-compliance to medical treatment was observed in 10.9% of cases with significantly high non-compliance in NHL and osteosarcoma (p=0.02). Overall survival was 57.6% and EFS was 45.7% at a median follow-up time of 8.75 years. In adolescents, lower OS and EFS rates than the younger age group are observed. The most appropriate management plan should be made according to the physical and psychosocial needs of patients in this age group.

Üç yaş altı anaplastik ependimom olgularının tedavisi

Cocukluk cagi ependimomlarinin yaklasik ucte ikisi posterior fossa yerlesimli olup daha az bir kismi supratentorial veya spinal intrameduller yerlesimlidir. Dusuk yas grubu, tam olmayan rezeksiyon ve anaplastik ependimom kotu prognostik kriterlerdendir. Intrakranial anaplastik ependimom hastalarinin cogunda radyoterapi endikasyonu mevcuttur. Kemoterapinin sagkalim uzerine etkisi tartismalidir. Bu calismada anaplastik ependimom tanisini 3 yas altinda alan iki hasta sunulmustur. Her iki olguda da tedaviye kemoterapi ile baslanmis ve 36 ayi doldurduklarinda radyoterapi verilmistir. Daha etkili tedavi yontemleri gelistirilinceye kadar 3 yas altindaki anaplastik ependimom olgularina adjuvan kemoterapi ve sonrasinda radyoterapi uygulanmasi etkili gozukmektedir.

Carboplatin hypersensitivity in children with glial tumors: a report of two cases -

Pediatrik kanserlerin tedavisinde siklikla kullanilan kemoterapi ajanlarindan biri olan karboplatin, yasami tehdit edici hipersensitivite reaksiyonlarina neden olabilir. Karboplatin hipersensitivitesi protokole ozgu olup, ilacin uzun sureli ve tekrarli dozlarda kullanimi ile iliskilidir. Karboplatin ve vinkristin kombinasyonu pediatrik dusuk gradeli gliomlarin tedavisinde etkin bir sekilde kullanilmaktadir. Ancak, bu protokolun kullanimi sirasinda hipersensitivite reaksiyonlari siklikla gozlenmektedir. Degisen oranlarda basari elde edilen desensitizasyon stratejileri bildirilmistir. Bu stratejilerin basarisiz olmasi durumunda karboplatin tedavisinin kesilmesi soz konusu olabilir. Burada, epinefrin uygulamasi ile tedavi edilen ve hipersensitivite reaksiyonu gelismesi sonrasinda karboplatin tedavilerine devam edilemeyen iki karboplatin hipersensitivitesi olgusu sunulmustur.

Hekimler ve ilaç endüstrisi

Ilac sirketi-hekim iliskilerinin ortaya cikardigi etik sorunlar, gunumuzde bu iliskilerin sik sik mercek altina alinmasina ve elestirilmesine sebep olan bir konudur. Hekimlere verilen kisisel hediyeler, sosyal ve egitsel faaliyetlere saglanan kaynaklar ilac endustrisinde en bilinen pazarlama stratejileri arasindadir. Hekimler bu etkilesime tip ogrenciligi donemlerinden itibaren girmeye baslamaktadir. Hekimin pozisyonu, unvani ve hasta sayisi gibi bazi faktorler bu iliskinin sekillenmesinde etkili olmaktadir. Her ne kadar veriler tersini gosterse de, hekimlerin cogu, ilac endustrisinin kendileri uzerindeki etkisini inkâr etmekte, ya da minimal oldugunu ifade etmektedir. Hekimler ve ilac sirketlerinin ilaclarin etkin kullaniminin tesvik edilmesi, gozlenmesi ve yaratici arastirmalarin yapilmasi gibi bazi ortak cikarlari olmakla birlikte; hekimler oncelikle hasta iyiligi ve bilimsel gelismeye onem verirken, ilac firmalari daha cok ticari kazancla ilgilenmektedir. Bu gorus ayriligi nedeniyle iki taraf arasinda cikar catismasi gorulebilmektedir. Ayrica, bazi pazarlama stratejileri nedeniyle ilac maliyetlerinin artmasi, hastalarda yan etki yapabilecek ilaclarin yanlis veya asiri kullanimi gibi istenmeyen sonuclar ortaya cikabilir ve toplum sagligi tehdit edilebilir. Bu sorunlar uzerine hekim ilac endustrisi iliskilerine bazi duzenlemeler yapilmis ve talimatlar yayinlanmistir. Bu duzenlemelerle birlikte, uygun iliskinin saglanmasi konusunda en onemli gorev hekimlere dusmektedir.

Subcutaneous fat necrosis in a newborn after therapeutic hypothermia: A report of a case

Subcutaneous fat necrosis (SFN) of the newborn is a rare entity seen in newborns with several fetal and maternal risk factors. Lesions of SFN which appear as diffuse swelling, erythematous nodules or plaques are typically located on extremities, trunk, and some parts of the face. A conservative treatment with analgesics is sufficient in most of the cases. Because of the nonspecific appearance of the lesions, SFN can easily be misdiagnosed as hemangioma or other disorders more frequently seen in this age group. Hypercalcemia and other serious complications may be overlooked in the case of misdiagnosis. We present a newborn with SFN, who was treated with hypothermia after asphyxic birth, resolving spontaneously in first 2 months of her life.