Nazmiye Yüksek

Myocardial Performance Index Combining Systolic and Diastolic Myocardial Performance in Doxorubicin-Treated Patients and Its Correlation to Conventional Echo/Doppler Indices

AbstractThis study was designed to evaluate the utility of myocardial performance index (MPI) in anthracycline cardiotoxicity. The MPI measures the ratio of total time spent in isovolumic activity (isovolumetric contraction time and isovolumetric relaxation time) to the ejection time, thus giving a global index combining systolic and diastolic myocardial performance. In this study, MPI was measured in 35 doxorubicin-treated children (aged 108.5 ± 55.31 months, 23 males and 12 females) in sinus rhythm and 32 age-matched controls, and it was compared with conventional Doppler echocardiographic parameters. The isovolumetric contraction time was prolonged (38.37 ± 24.43 vs 26.37 ± 15.53, p <0.02) and ejection time was shortened (231.91 ± 28.87 VS 256.21 ± 19.55, P <0.001) in doxorubicin-treated patients compared to that in normal children. The isovolumetric relaxation time did not show significant difference between patients and control group (60.11 ± 10.92 vs 61.06 ± 12.12, P > 0.05). MPI was significantly increased in doxorubicin-treated patients compared with that in control groups (0.42 ± 0.07 vs 0.34 ± 0.06, p <0.001), and significant correlation was observed between MPI and fractional shortening, ejection fraction, and left ventricular end diastolic and end systolic diameters (respectively, R = -0.508, P <0.002; R = -0.532, P <0.001; R = 0.467 P <0.005; R=0.606, P <0.001). Also, a weak correlation was found between MPI and duration of the disease and patient ages (R = 0.393, P <0.02; R = 0.379; P <0.02). However, there was no correlation between MPI and cumulative doxorubicin dose (R = 0.311, P > 0.05) and diastolic Doppler parameters in doxorubicin-treated patients. We think that MPI may be a useful parameter in monitoring left ventricular dysfunction in anthracyline-treated patients.

Serum Ca 125 levels in children with acute leukemia and lymphoma

Ca 125 is a tumor marker for the diagnosis and monitoring of ovarian carcinoma. We investigated serum Ca 125 levels in 44 children with leukemia and 59 children with lymphoma at initial presentation and 4 weeks after chemotherapy. Serum Ca 125 levels were measured chemilumimetrically with a sandwich enzyme-linked immunosorbent assay. The incidence of elevated serum Ca 125 levels was significantly higher in children with leukemia (14 children) and lymphoma (26 children) than in the healthy children (2 children). In the patients with non-Hodgkins lymphoma (NHL) who had abdominal involvement and/or serous membrane involvement (ascides, pleural, pericardial effusion) at presentation, serum Ca 125 levels were significantly higher than in the patients without abdominal and/or serosal involvement. Serum Ca 125 levels were impressively increased in the patients with Burkitts lymphoma (BL) in whom abdominal and/or serous membrane involvement were observed more frequently than the other types of lymphoma. The increased serum Ca 125 levels in the patients returned to normal 4 weeks after chemotherapy when they achieved complete remission. In conclusion, serum Ca 125 seems to be a good indicator for serous membrane involvement and it seems to be a promising tumor marker in the assessment of therapeutic response in children with leukemia and NHL.

DOES SERUM SOLUBLE VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS HAVE DIFFERENT IMPORTANCE IN PEDIATRIC ACUTE LEUKEMIA AND MALIGNANT LYMPHOMA PATIENTS

Vascular endothelial growth factor (VEGF) seems to play a central role in angiogenesis-lymphangiogenesis in hematological malignancies. There are limited data related to childhood hematologic malignancies. The aim of the study was to evaluate soluble VEGF (sVEGF) levels in children with acute leukemia and malignant lymphoma (ML) at diagnosis and in remission. The levels of serum sVEGF were measured by enzyme-linked immunosorbent assay (ELISA) in 20 children with acute leukemia, 33 children with different histopathological subtypes of ML, and 20 healthy controls. The levels of sVEGF at diagnosis (range 2 –1040 pg/mL; median 52 pg/mL) was significantly lower than in remission (range 136 –1960 pg/mL; median 630 pg/mL) in acute myeloid leukemia (AML) group (P = .018). The sVEGF levels at diagnosis (range: 2 –640 pg/mL; median 89 pg/mL) was significantly lower compared to remission values (range: 116 –1960 pg/mL; median 136 pg/mL) in patients with acute lymphoblastic leukemia (ALL) (P = .002). In ML group, including Burkitts lymphoma (BL), T-cell non-Hodgkins lymphoma (NHL), and Hodgkins lymphoma (HL), sVEGF levels at diagnosis were higher than remission levels, but there was no statistically significant difference (P >.05). On the other hand, there were significant difference between levels in active disease and control group, ie, BL versus control, T-cell NHL versus control, and HL versus control (P = .008, P = .043, P = .007, respectively). The authors noticed that sVEGF levels showed distinct behavioral pattern in different childhood malignancies at diagnosis and in remission. In acute leukemia and ML patients, VEGF acts through different pathophysiological mechanisms, in both bone marrow (BM) angiogenesis and lymphoid tissue lymphangiogenesis.

EXPRESSION OF MATRIX METALLOPROTEINASE-9 (MMP-9) AND TISSUE INHIBITOR OF MATRIX METALLOPROTEINASE (TIMP-1) IN TISSUES WITH A DIAGNOSIS OF CHILDHOOD LYMPHOMA

Matrix metalloproteinases (MMP) are enzymes involved in the reconfiguration of the microenvironment by means of degrading the extracellular matrix and have more than 20 subgroups containing zinc. Proteins that serve as the inhibitors of these enzymes are called tissue inhibitors of matrix metalloproteinase (TIMP). These enzymes have been shown to be active in a wide range of processes, from wound recovery to fetus development, heart diseases, and spread of malignant diseases. The aim of this study was to investigate whether there is a relationship between the type, stage, and prognosis of childhood lymphoma subjects and matrix metalloproteinase type-9 (MMP-9) and its inhibitor, tissue inhibitor of matrix metalloproteinase type-1 (TIMP-1). Paraffin blocks of childhood patients diagnosed with non-Hodgkin lymphoma (n = 23), Hodgkin lymphoma (n = 14), or reactive lymphadenopathy (n = 12) were retrospectively immunohistochemically stained with MMP-9 and TIMP-1 stains and whether there was a relationship between the degree of staining and the type, tumor stage, and prognosis of the disease was investigated. Moderate and high degrees of MMP-9 staining were detected in 94.6% of the lymphoma patient tissues and a slight TIMP-1 staining was detected in 21.6% of the lymphoma patient tissues. No relationship was observed between the degree of these staining patterns and the type, tumor stage, and prognosis of the disease. This study indicates that the equilibrium between MMP-9 and TIMP-1 is important in lymphomas in addition to all the physiological and pathologic events although MMP-9 and the TIMP-1 staining patterns are not related to the tumor stage, prognosis, and type of the disease. Larger series of patients are needed to determine the prognostic value of MMP-9 and TIMP-1 in childhood lymphoma.

Clinical and epidemiological characteristics of children with germ cell tumors: a single center experience in a developing country

İncesoy-Özdemir S, Ertem U, Şahin G, Bozkurt C, Yüksek N, Ören AC, Balkaya E, Alkan A. Clinical and epidemiological characteristics of children with germ cell tumors: A single center experience in a developing country. Turk J Pediatr 2017; 59: 410-417. Germ cell tumor (GCT) is a rare malignancy accounting for 2-3% of all pediatric tumors. The overall survival rate of children and adolescents with GCT is more than 80% after adopting combined therapy. The aim of this study is to review clinical presentation, management, and outcome in a single-center series with extracranial GCT. Clinical characteristics, pathologic presentations, and survival outcomes of 101 children with GCT, treated at our hospital from 1988 to 2011, were analyzed. Sixty-two of patients were female and 39 of them were male. Fifty-eight (57%) patients had gonadal tumor (24 testicular, 34 ovarian), 43 (43%) extragonadal. Histologically, teratomas were found most frequently (26 mature, 10 immature), followed by yolk sac tumors (n: 33), mixed malignant tumors (n: 13), embryonal carcinoma (n: 10), disgerminoma (n: 8) and seminoma (n: 1). Twenty-six patients were diagnosed as mature teratoma and we excluded them in the evaluation of staging and survival. Five-year overall and relaps-free survival were 80.3% (mean follow-up time: 215.8 months) and 73.4% (mean follow-up time: 176.2 months), respectively. Five-year survival rates were 93.2% and 90.2% in malign GCTs diagnosed after 1999.

A Child with Psoriasis, Hypogammaglobulinemia, and Monosomy 7-Positive Myelodysplastic Syndrome

Namık Özbek1, Arzu Yazal Erdem1, Özlem Arman Bilir1, Fatma Karaca Kara2, Mutlu Yüksek3, Neşe Yaralı1, Meltem Özgüner4, Nazmiye Yüksek5, Bahattin Tunç1 1Ankara Children’s Hematology and Oncology Hospital, Clinic of Pediatric Hematology, Ankara, Turkey 2Ankara Children’s Hematology and Oncology Hospital, Clinic of Biochemistry, Ankara, Turkey 3Bülent Ecevit University Faculty of Medicine, Department of Children’s Immunology, Ankara, Turkey 4Yıldırım Beyazıt University Faculty of Medicine, Department of Histology Embryology, Ankara, Turkey 5Bülent Ecevit University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey