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Öğe Elevated platelet-monocyte complexes in patients with psoriatic arthritis(Taylor & Francis Ltd, 2009) Pamuk, Guelsuem Emel; Pamuk, Oemer Nuri; Orum, Hueseyin; Arican, Oezer; Turgut, Burhan; Demir, MuzafferWe evaluated platelet and endothelial activation parameters in psoriatic arthritis (PsA), a disease reported to be associated with the development of endothelial dysfunction and increased atherosclerotic complications. Twenty patients with PsA, eight psoriasis and 20 healthy controls were included into the study. The patients' clinical features and acute phase parameters were assessed. In all patients and controls, platelet-monocyte complexes (PMC), platelet-neutrophil complexes (PNC), and basal and ADP-stimulated P-selectin expression were determined with flow cytometry; soluble E-selectin (sE-selectin) and soluble CD40L (sCD40L) were determined with ELISA. Patterns of joint involvement and degrees of skin involvement in PsA patients were assessed. PMC in PsA patients were significantly higher than in the control group (p = 0.02). PNC were not significantly different among the three groups (p values > 0.05). sE-selectin levels in both PsA and psoriasis groups were significantly higher than in healthy controls (p values, respectively, <0.001 and 0.023). Basal and ADP-stimulated CD62P expression and sCD40L level were similar in all groups (p values > 0.05). Polyarticular PsA patients had significantly higher sCD40L than oligoarticular plus spondylitic PsA groups (p = 0.04). sCD40L level was higher in active PsA group than in inactive PsA group (p = 0.03). Groups with limited and extensive skin involvement did not differ significantly in the evaluated parameters. C-reactive protein (CRP) level in PsA patients correlated with sCD40L (r = 0.69, p = 0.012), basal CD62P expression (r = 0.89, p < 0.001) and ADP-stimulated CD62P expression (r = 0.73, p = 0.001). Endothelial activation might be have a role in the pathogenesis of both psoriasis and PsA. Among parameters of platelet activation, only PMC might play a role in the pathogenesis of PsA.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 The evaluation of Kaposi sarcoma patients diagnosed at a single center(Ortadogu Ad Pres & Publ Co, 2007) Pamuk, Guelsuem Emel; Doenmez, Salim; Yesil, Yusuf; Tekguenduez, Emre; Turgut, Burhan; Demir, MuzafferObjective: To determine the general clinical features, treatment modalities and response to treatment in 5 Kaposi sarcoma (KS) patients diagnosed at our center. Material and Methods: Five patients diagnosed with KS at Trakya University Medical Faculty, Department of Internal Medicine, Division of Hematology between October 2001-October 2006 were retrospectively evaluated. Results: KS developed secondary to immunosuppression in four of five patients, one had classical type KS. Four patients were males, and one was female. The diagnoses in patients who used immunosuppressive therapy were aplastic anemia, Hodgkin lymphoma, MDS-RAEB II, and chronic inflammatory demyelinating polyneuropathy (CIDP). We discontinued immunosuppressive therapy and administered vincristine in the aplastic anemia patient. KS lesions disappeared spontaneously although chemotherapy continued in the Hodgkin lymphoma case. KS lesions were present on initial presentation in the patient with MDS-RAEB H; there was prominent progression after chemotherapy and regression was achieved after paclitaxel. KS lesions disappeared spontaneously in the CIDP patient after discontinuation of corticosteroids. In the patient with classical type KS, KS lesions regressed after adriamycin and one persistent big lesion was surgically excised. Conclusion: There was partial or complete improvement of KS lesions after discontinuation of immunosuppressive drugs in some of our patients and with systemic chemotherapeutics in the others. As the diagnosis of this disease requires suspicion in especially early stages, hematologists should consider KS in the differential diagnosis of skin lesions in their immunosuppressive patients and a skin biopsy should be obtained.Öğe The first case of de novo B-cell prolymphocytic leukemia with central nervous system involvement: Description of an unreported complication(Pergamon-Elsevier Science Ltd, 2009) Pamuk, Guelsuem Emel; Puyan, Fulya Oz; Unlu, Ercument; Ozturk, Erman; Demir, Muzaffer[Abstract Not Available]Öğe Frequency of gallstones after renal transplantation and factors that affect gallstone formation(John Wiley & Sons Inc, 2007) Celik, Aykut Ferhat; Altiparmak, Mehmet Riza; Pamuk, Guelsuem Emel; Pamuk, Oemer Nuri; Apaydin, SueheylaBACKGROUND: We investigated the frequency of gallstones (GSs) in our renal transplant recipients and evaluated the effects of various factors on GS formation. METHODS: One hundred and eight-two patients who had undergone renal transplantation at our center in the last 12 years were included in the study. Of these, 163 patients were followed up regularly, of whom 118 were using cyclosporine A (CsA). Abdominal ultrasonography of all patients was performed, and biochemical parameters were also determined. RESULTS: Median duration of patient follow-up was 36 months. GSs were diagnosed in 5 patients (3.1%). Mean age and follow-up duration of the CsA group were lower than those of the non-CsA group (p < 0.05 and p < 0.001, respectively). The frequency of GSs was 3.4% in the CsA group and 2.2% in the non-CsA group (p > 0.05). Median time to detect GS formation in the post-transplantation period was 85 months. The CsA group had a significantly shorter GS-free follow-up period than the non-CsA group (p = 0.008). According to Cox multivariate regression analysis, the only factor that affected GS formation in the post-transplantation period was the use of CsA. CONCLUSION: The use of CsA showed a trend toward increasing the risk of developing a GS sooner in the post-transplant period, particularly for young men.Öğe Increased platelet activation markers in rheumatoid arthritis(Taylor & Francis Inc, 2008) Pamuk, Guelsuem Emel; Vural, Oezden; Turgut, Burhan; Demir, Muzaffer; Pamuk, Oemer Nuri; Cakir, NecatiAtherosclerotic cardiovascular mortality is increased in rheumatoid arthritis (RA) patients. We evaluated the association of inflammatory response with platelet, endothelial, coagulation activation parameters; and subclinical atherosclerosis in RA patients. We included 27 RA patients (21 female; six male) and 19 healthy subjects (14 female; five male). Disease activity score (DAS28) in RA patients was calculated; and patients were divided into two groups as active and inactive. Flow cytometry was used to determine platelet CD62P expression, platelet microparticles (PMP), platelet-monocyte (PMC) and platelet-neutrophil complexes (PNC). Plasma E-selectin, thrombin-antithrombin (TAT) complex, and serum sCD40L levels were determined by ELISA. The intima-media thickness (IMT) of carotid arteries was determined by B-mode ultrasonography. In RA patients, platelet CD62P expression (p< 0.001), PMC (p = 0.037) and sCD40L (p< 0.001) levels were increased when compared to the control group. PNC (p = 0.07) and TAT levels (p = 0.1) were non-significantly higher, and PMP level (p = 0.075) was nonsignificantly lower in RA patients. Soluble E-selectin level was significantly higher in the active RA group than in the inactive RA group (p = 0.009). There was no correlation between carotid IMT and activity markers, the evaluated parameters (p>0.05).The increase in markers of active platelets, CD62P and sCD40L, and PMC levels might be associated with the increased cardiovascular mortality in RA. Nevertheless, none of these parameters were associated with carotid IMT: this suggests that one cross-sectional value might not be a good marker for atherosclerosis.Öğe An increased prevalence of fibromyalgia in iron deficiency anemia and thalassemia minor and associated factors(Springer London Ltd, 2008) Pamuk, Guelsuem Emel; Pamuk, Oemer Nuri; Set, Turan; Harmandar, Orbay; Yesil, NesibeIn this study, we evaluated the prevalence of fibromyalgia (FM) in iron deficiency anemia (IDA) and thalassemia minor (TM) patients and associated factors. In addition, we investigated the prevalence of IDA in outpatients with fibromyalgia, and its effect on clinical findings. The study included 205 IDA, 40 TM patients and 100 healthy controls. FM was diagnosed according to 1990 ACR criteria. Whole blood count, biochemical tests, and serum iron parameters were determined. Pain, fatigue, and FM Impact Questionnaire (FIQ) functional item scores were assessed in FM subjects. In addition, the prevalence of IDA in FM patients diagnosed at the Rheumatology Outpatient Clinic was determined. The prevalences of FM in IDA (17.6%) and TM (20%) groups were higher than in controls (6%; p values 0.006 and 0.025, respectively). When IDA patients with FM were compared to those without FM, it was seen that a higher percentage were females, married, and a higher percentage had history of pica (all p values < 0.05). Serum hemoglobin and iron parameters did not differ between IDA patients with and without FM. IDA was detected in 48 (24.5%) of 196 FM patients. FM patients without IDA had higher sleep disturbance scores (p = 0.012) and longer duration of FM (p = 0.045). FM was a common finding in patients with IDA and TM. FM was associated with female sex and history of pica in IDA patients, and not associated with serum hemoglobin and selected iron parameters. The presence of FM in TM had no association with any of the above-mentioned parameters.Öğe Might platelet-leucocyte complexes be playing a role in major vascular involvement of Behcet's disease? A comparative study(Lippincott Williams & Wilkins, 2010) Pamuk, Guelsuem Emel; Pamuk, Omer Nuri; Orum, Hueseyin; Demir, Muzaffer; Turgut, Burhan; Cakir, NecatiWe determined platelet-leucocyte complexes, which play roles in the thrombosis-inflammation relationship, in Behget's disease patients with and without major vascular involvement (MVI) and in healthy controls. We included 36 Behget's disease patients (22 male, 14 female, mean age: 34.4 +/- 8.3 years) and 20 healthy individuals (14 male, six female, mean age: 31.8 +/- 4.4 years). Whole blood count, CRIP and ESR were determined in both groups. Clinical data about the patients were obtained from medical charts. Individuals with hypertension, diabetes, coronary artery disease, and smokers were excluded. Behcet's disease patients with MVI were taken as a separate group (8 male, 5 female, mean age: 37 +/- 8 years). MVI was defined as the presence of pulmonary arterial aneurysm, deep venous thrombosis, vena cava inferior or superior thrombosis, or venous sinus thrombosis. Flow cytometry was used to determine platelet-monocyte complexes (PMC), platelet-neutrophil complexes (PNC), basal and adenosine diphosphate (ADP)-stimulated platelet CD62P expression. Behget's disease patients with MVI had significantly higher PNC than Behcet's disease patients without MVI and healthy controls (P values=0.01). PMC levels in Behcet's disease patients with MVI were significantly higher than in healthy controls (P=0.01). The groups were similar in basal and ADP-stimulated platelet CD62P expression (P values >0.05). Basal and ADP-stimulated CD62P expression, PMC and PNC were not significantly different between active Behget's disease versus inactive Behget's disease patients. The evaluated parameters were similar in Behget's disease patients with and without uveitis, and pathergy-positive and pathergy-negative groups. Our results might suggest that the formation of PMC and PNC might play a role in thrombosis and MVI of Behget's disease. Blood Coagul Fibrinolysis 21:113-117 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.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.Öğe The simultaneous diagnosis of Kaposi sarcoma and MDS RAEB-II in a human immunodeficiency virus-negative patient(Springer, 2009) Pamuk, Guelsuem Emel; Aydogdu, Erkan; Turgut, Burhan; Demir, Muzaffer[Abstract Not Available]Öğe Successful treatment of severe gastrointestinal bleeding after chemotherapy in acute myeloblastic leukemia with recombinant activated factor VII Report on one case and review of other uses in acute leukemias(Humana Press Inc, 2010) Pamuk, Guelsuem Emel; Tasci, Murat; Ozturk, Erman; Demir, MuzafferHemorrhage is a frequent complication in patients with acute leukemias as a result of chemotherapy-induced myelosuppression. Gastrointestinal bleeding in thrombocytopenic patients carries a high mortality. Patients are generally managed with red blood cell, platelet suspensions, and fresh frozen plasma; and sometimes with pharmacologic and endoscopic interventions. If these therapeutic measures fail, patients might be treated with hemostatic drugs, one example of which is recombinant activated factor VII (rFVIIa). This drug is recommended for all kinds of bleeding in hemophiliacs with inhibitors; it is also being used for the treatment of bleeding in thrombocytopenia and platelet function disorders. We present our 44-year-old female patient who had gastrointestinal system bleeding after remission induction therapy for acute myeloid leukemia. Thrombocytopenia was refractory to apheresis platelets; and gastrointestinal bleeding could be controlled only after the administration of a single dose (35 mu g/kg, total dose 2.4 mg) of rFVIIa. Our experience indicates that rFVIIa might be a novel treatment alternative in massive bleeding in leukemic patients with thrombocytopenia or platelet function disorders.Öğe Systemic antineutrophil cytoplasmic antibody vasculitis in a patient with chronic lymphocytic leukemia -: Quite a rare diagnosis(Pergamon-Elsevier Science Ltd, 2007) Pamuk, Guelsuem Emel; Uyanik, Mehmet Sevki; Demir, Muzaffer; Tekguenduez, Emre; Turgut, Burhan; Soy, MehmetThere might be rheumatic manifestations of malignant diseases, especially those of the hematological type. Until now, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in chronic lymphocytic leukemia (CLL) has been reported on only very few occasions. Here, we present our patient with Rai stage II CLL who came to us with constitutional symptoms. She turned out to have hematuria with dysmorphic erythrocytes and developed hemoptysis. She had pulmonary-renal syndrome and was diagnosed with p-ANCA positive microscopic polyangiitis. She is currently using prednisolone and cyclophosphamide and undergoing regular hemodialysis. Constitutional symptoms in patients with hematological malignancies should make the physicians consider systemic vasculitis after exclusion of disease-related complications. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Vanishing bile duct syndrome in a patient with Hodgkin's lymphoma and asymptomatic hepatitis B virus infection(Univ Catholique Louvain-Ucl, 2009) Umit, Hasan; Unsal, Gulbin; Tezel, Ahmet; Soylu, Ali Riza; Pamuk, Guelsuem Emel; Turgut, Burhan; Demir, Muzaffer[Abstract Not Available]
