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    Antithrombotic and Anticoagulant Usage Policies
    (Aves Yayincilik, Ibrahim Kara, 2010) Demir, Muzaffer; Tekguenduez, Emre
    Heparin, heparin-derived compounds and warfarin have been successfully used for the prevention and treatment of venous thromboembolism during last 50 years. Low-molecular-weight heparins are alternative drugs to unfractionated heparin because of pharmacokinetic and pharmacodynamic features nowadays. Warfarin is still a gold standard anticoagulant oral agent. However, there are some limitations of these mentioned drugs. It is needed the new oral and parenteral anticoagulant drugs to solve these limitations. There are several preclinical and clinical studies on efficacy and safety of new drugs such as parenteral FXa inhibitors (idraparinux and idraparinux-biotin complex) and oral FXa inhibitor (rivaroxaban-Xiralto) and oral Flla inhibitor (dabigatran-Pradaxa). Both rivaroxaban and clabigatran are newly approved for short term usage on the prevention of VTE during orthopedic procedures such as hip and knee replacement.
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    Dorsal sural nerve conduction study in vitamin B12 deficiency with megaloblastic anemia
    (Blackwell Publishing, 2006) Turgut, Burhan; Turgut, Nilda; Akpinar, Seval; Balci, Kemal; Pamuk, Guelsuem E.; Tekguenduez, Emre; Demir, Muzaffer
    Peripheral neuropathy is frequently observed in B-12 deficiency. In spite of this, there is little knowledge about peripheral neuropathy in B-12 deficiency because the severity of clinical involvement of the central nervous system clearly outweighs signs and symptoms due to peripheral nervous system involvement. We primarily investigated peripheral neuropathy with dorsal sural conduction study, which is a new method for detection of early peripheral neuropathy, in B-12 deficiency with megaloblastic anemia. Conventional nerve conduction studies and tibial sensory-evoked potential (SEP) recording were also performed. Twenty-eight B-12-deficient patients (15 male, 13 female, mean age 65.8 years) with megaloblastic anemia and 18 age- and sex-matched controls were included in the study. Although dorsal sural sensory nerve action potentials (SNAPs) were not recorded in 15 (54%) of 28 patients, only 9 (32%) of them were found to have polyneuropathy by conventional conduction studies. Furthermore, patients with dorsal sural SNAP had mean lower amplitude, mean longer latency, and slower velocity response when compared with controls. Twenty patients (71%) were diagnosed as having myelopathy by the combination of tibial SEP and neurological findings. Two patients whose dorsal sural SNAPs were not recorded had normal tibial SEP responses; therefore, these patients were considered to have isolated peripheral neuropathy. As a result, we conclude that dorsal sural nerve conduction study is a reliable method for detection of early peripheral neuropathy in B-12 deficiency.
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    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, Muzaffer
    Objective: 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.
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    Preoperative hemostatic evaluation
    (Ortadogu Ad Pres & Publ Co, 2008) Demir, Muzaffer; Tekguenduez, Emre
    Surgical patients may develop hemostatic disorders ranging from unexpected bleeding to pathologic thrombosis, both of which may be potentially life threatening. As surgery is the ultimate test of the hemostatic system, underlying defects of hemostasis may remain asymptomatic and cause excessive, unexpected bleeding during surgery. Therefore, it is desired to know which patient is prone to hemorrhagic complications before surgical procedure. Preoperative evaluation of hemostatic risk includes a carefully taken medical history, physical examination, type and indication of surgery, and targeted laboratory investigations. Obtaining an adequate bleeding history is still of central importance and must include a thorough review of any bleeding episodes, information on the use of current or recent medications affecting hemostasis as well as careful attention to the family history. Physical examination should focus on evidence of bleeding and on identifying systemic disorders like renal and hepatic disease, which are known to increase the bleeding risk of any patient. In the absence of historical risk factors or physical examination findings suggestive of an underlying bleeding tendency, the likelihood of a clinically significant coagulopaty is low. Therefore, the spectrum of preoperative laboratory screening should be based on the results of clinical assessment. A comprehensive and logical preoperative evaluation of hemostasis will minimize bleeding complications. This strategy will also prevent unnecessary, time and money consuming, and occasionally confusing global laboratory investigations of hemostasis. This article focuses on preoperative evaluation of hemostatic risk and laboratory tests used for this purpose.
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    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, Mehmet
    There 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.