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Öğe A case of cervical spine meningioma following etanercept use in a patient with RA(Nature Publishing Group, 2009) Pamuk, Oemer N.; Harmandar, FerdaBackground. a 70-year-old female with active rheumatoid arthritis (RA) was administered etanercept to treat active disease that persisted despite therapy with conventional DMARDs. after 18 months of etanercept therapy, her RA symptoms had improved; however, she developed quadriparesis. she presented to a specialist rheumatology clinic with weakness and numbness in her arms and legs; she also had difficulty in standing up and walking. Investigations. Physical examination, neurological examination, nerve conduction studies, measurement of serum inflammatory markers and autoantibodies, MRI of the cranium and cervical spine, and X-rays of the chest and hands. Diagnosis. the patient underwent neurosurgery to resect a 1 x 2 cm mass in the cervical spine at C6-C7. Histopathologic examination of the excised mass revealed it to be a meningioma. Management. etanercept was discontinued because of a possible association between the drug and development of meningioma; however, shortly afterwards the patient experienced a flare of RA symptoms. High-dose NSAIDs and prednisolone were administered, but the patient died because of gastric perforation. to our knowledge, this is the first report in the literature of meningioma developing following use of tumor necrosis factor inhibitor therapy, and the first to suggest a cause-effect relationship.Öğe Clinical characteristics of haematological malignancy patients diagnosed with leukaemia cutis: Experience of a single centre(Wiley, 2015) Pamuk, Gulsum Emel; Ak, Recep; Tasci, Murat; Harmandar, Ferda; Demir, Muzaffer; Arican, OzerBackground/ObjectivesWe evaluated the clinical characteristics of patients with haematological malignancies at our centre who were diagnosed with leukaemia cutis (LC). In addition, we describe the spectrum of other skin lesions, including, secondary skin malignancies and nonspecific benign skin lesions in haematological malignancy patients. MethodsWe defined 58 skin lesions that developed in 54 inpatients hospitalised in the Department of Haematology, Trakya University Medical Faculty, Turkey. All skin lesions that developed in inpatients between 2006 and 2012 had been evaluated by a dermatologist. The patients' clinical features, skin biopsy results and therapies were obtained from hospital files. The diagnosis of LC was based on clinical features and histopathological examinations of the skin biopsy. ResultsThere were 11 patients with LC. Six (54.5%) had acute myeloblastic leukaemia. In nine patients (82%), LC was present at the initial presentation. Secondary skin malignancy was detected in 11 patients (five basal cell carcinoma, four Kaposi's sarcoma, one squamous cell carcinoma, one malignant melanoma); and malignancy was present in two patients (18%) at the initial presentation. Nonspecific benign skin lesions, the most frequent of which were drug eruptions, were determined in 32 of our patients. LC had a significantly higher likelihood of being present at initial presentation than other skin lesions (P<0.01). The median survival in LC patients was quite short (4.5 months). ConclusionsLC was usually diagnosed at the initial presentation of the patient or during the early course of the disease. Having LC was a poor prognostic factor.Öğe EORTC QLQ-C30 assessment in Turkish patients with hematological malignancies(Springer, 2008) Pamuk, Guelsuem Emel; Harmandar, Ferda; Ermantas, Nilay; Harmandar, Orbay; Turgut, Burhan; Demir, Muzaffer; Vural, OezdenWe aimed to evaluate the prevalences of self-reported anxiety and depression symptoms in hematological malignancy patients and to determine the association between the presence of these disorders and the results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30). One hundred and forty patients with a diagnosis of a hematological malignancy completed the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire. Patients with higher anxiety scores were more frequently inpatients, had higher EORTC general symptom scores, and they had lower cognitive, emotional, social functioning and global quality of life (QoL) scores (all p values < 0.05). Patients with higher depression scores had more frequently active disease and were inpatients; they had higher mean Eastern Cooperative Oncology Group performance scores, EORTC gastrointestinal system and general symptom scores, and significantly lower physical, role, emotional, social and cognitive functioning and global QoL scores (all p values < 0.01). During follow-up, it was observed that survival curves of patients with active disease who had higher HADS depression scores tended to be shorter than those with lower scores (p=0.1). Anxiety and depression are frequent in hematological malignancy patients and associated with poor QoL and performance status. In addition, the presence of self-reported depression might have a predictive value for poor prognosis.Öğe Health-Related Quality of Life in Hematological Malignancy Patients in Northwestern Turkey(Amer Soc Hematology, 2012) Pamuk, Gulsum Emel; Uyanik, Mehmet Sevki; Harmandar, Ferda; Demir, Muzaffer[Abstract Not Available]Öğe Non-Hodgkin lenfoma vakalarımızın klinik özelliklerinin değerlendirilmesi(2006) Harmandar, Orbay; Harmandar, Ferda; Demir, Muzaffer; Turgut, Burhan; Vural, Özden; Tekgündüz, Emre; Pamuk, Gülsüm E.Non-Hodgkin lenfomalı (NHL) 114 hastamızın klinik özellikleri, histopatolojik tipleri, tedavileri ve yanıtları, ve sağkalım analizi değerlendirildi. Tanıda Cotswold’a göre %10’u evre I, %14’ü evre II, %30’u evre III ve %46’sı evre IV’tü. Olguların 101’ine (%89) tedavi uygulandı. 57 olguda (%56) CHOP ve 17 olguda (%17) rituksimab (R)-CHOP verildi. En yüksek tam remisyon oranı R-CHOP grubundaydı (%83). Hastaların medyan sağkalımı 52 aydı. 3 yıllık sağkalım %54, 5 yıllık sağkalım %46 idi. Çok agresif NHL’lilerin sağkalımı (3 ay), agresif (41 ay) ve indolentlerden (86 ay) kısaydı (p’ler <0.05). Tanıda evre IV olguların medyan sağkalımı (26 ay), evre I (ulaşılamadı), evre II (86 ay) ve III (96 ay) olgulardan kısaydı (p’ler <0.05). Tanıda B semptomlu, ekstranodal ve kemik iliği tutulumu saptananlarla, ilk tedaviye yanıtsız, IPI>2 olanların sağkalımları diğerlerinden kısaydı (p’ler<0.05). Cox regresyon analizinde, ilk tedaviye cevapsızlığın (OR:11.6, p=0.001) bağımsız kötü prognostik faktör olduğu saptandı. İlk tedavide rituksimablı kombine kemoterapiyle yüksek tam remisyon oranı dikkat çekiciydi.Öğe Patients with iron deficiency anemia have an increased prevalence of gallstones(Springer, 2009) Pamuk, Guelsuem Emel; Umit, Hasan; Harmandar, Ferda; Yesil, NesibeWe determined the frequency of gallstones (GS) in iron deficiency anemia (IDA) patients and evaluated factors that could affect GS formation-like lipid levels and gallbladder (GB) motilities of the patients. One hundred and eleven IDA patients (88 females, 23 males; median age, 42) and 81 healthy controls (68 females, 13 males; median age, 42) were included into our study. The clinical findings of all IDA patients were recorded down; biochemical values and body mass index (BMI) were determined; and abdominal ultrasonography was performed. In addition, GB emptying was monitored by ultrasound at 30-min intervals for 2 h after a mixed meal in randomly chosen, age-matched 25 IDA patients and 26 controls. Fasting volume (FV), residual volume (RV), and ejection fraction (EF) for all GBs were determined. The frequency of GS plus cholecystectomy was significantly higher in IDA patients (15 cases, 13.5%) than in the control group (five cases, 6.2%, p=0.048). IDA patients with GS plus cholecystectomy were older than those without GS plus cholecystectomy (p<0.001). FV and EF did not differ between IDA and control groups (p>0.05). On the other hand, RV was significantly higher in IDA group than in controls (p=0.035). The frequency of GS in IDA patients was significantly higher than in controls. The increased prevalence of GS in IDA might be explained with impaired GB motility.
