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Öğe Acquired Glanzmann thrombastenia due to immune thrombocitopenic purpura(2006) Altintaş A.; Ayyildiz O.; Söker M.; Müftüoğlu E.Glanzmann thrombastenia is a rare otosomal ressesive disease which has normal platelet count and morphology, and impairment of platelet aggregation. There is qualitative or quantitative abnormality in GPIIb-IIIa proteins that have a function of receptor to fibrinogen and Von-Willebrand Factor. Mucocutenous hemorrhage, epistaxis, gingival hemorrhage, and hemorrhage were seen especially in young age. The disease may occur rarely as an acquired. Autoantibodies developed in the course of some disease such as Non-hodgkin's lymphoma, Hodgkin disease, multiple myeloma, in patients who are taking immunusuppressive drugs, and particularly in immune thrombocytopenic purpura. We report here, a patient 42 years-old female, who is diagnosed as Acquired Glanzmann thrombastenia due to immune thrombocytopenia.Öğe Assessment of patients with thrombotic thrombocytopenic purpura(2010) Demir C.; Altintaş A.; Paşa S.; Ali Kaplan M.; Küçükzeybek Y.; Ayyildiz O.Thrombotic thrombocytopenic purpura (TTP) is a severe microvascular occlusive thrombotic microangiopathy characterized by systemic platelet aggregation, organ ischemia, profound thrombocytopenia, and fragmentation of erythrocytes. Unexplained occurrence of thrombocytopenia and anemia should prompt immediate consideration of the diagnosis and evaluation of peripheral blood smear for evidence microangiopathic hemolytic anemia. Excellent remission and survival rates were achieved by therapeutic plasma exchange. We reviewed characteristics and response rates to plasmapheresis of our TTP patients. A total of 25 cases were diagnosed. The parameters of hemoglobin and platelet were analyzed at presentation, as well as the number of plasmapheresis sessions and adjunctive treatment given. We found a response rate of 80 percent to plasma exchange. Response was better in 23 patients who presented with idiopathic TTP. Response was poor in patients with TTP secondary to underlying metastatic carcinoma. Two patients relapsed and one of the relapsed patients died. Plasmapheresis is mandatory and effective for primary TTP. Plasmapheresis may not be effective in all instances, especially if TTP is secondary to underlying disseminated cancer.Öğe Autoimmune hemolytic anemia presented in course of Hodgkin's diseases: Report of two cases(2006) Altintaş A.; Ayyildiz O.; Işikdoğan A.; Atay E.; Müftüoğlu E.Autoimmune hemolytic anemia is a rare disorder that the incidence is approximately 1/100000 in adults. 50-70 % of cases are idiopathic. Recently, the percentages of secondary causes have risen due to detailed investigation and long term follow up. Hematologic and nonhematologic malignancies plays an important role in the etiology and pathogenesis of autoimmune hemolytic anemia that has many other causes. Lenfoproliferative malignencies, especially chronic lenfoid leukemia is the most striking disease. The association of Hodgkin's disease and autoimmune hemolytic anemia is being observed as rare case reports. We discussed two cases of Hodgkin's disease associated autoimmune hemolytic anemia in recent 3 years period. One was presented after therapy and the other was presented prior to therapy.Öğe Cancer and thrombotic thrombocytopenic purpura: Presentation of two cases(Turkiye Klinikleri, 2008) Altintaş A.; Çil T.; Atay A.E.; Kaplan M.A.; Işikdoğan A.; Ayyildiz O.Thrombotic thrombocytopenic purpura (TTP) is a rare and fatal disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurologic disorder, renal function deterioration and fever. TTP may be idiopathic or secondary to autoimmune diseases, drugs, cancer and infections. Clinical findings of TTP are also present in cancer patients with disseminated intravascular coagulation and sepsis. TTP must be considered in the differential diagnosis in the case of concurrent microangiopathic hemolytic anemia and thrombocytopenia with or without leukoerythroblastic blood smear in cancer patients. Here we presented two patients who were followed up in our clinic with TTP secondary to metastatic breast cancer. Copyright © 2008 by Türkiye Klinikleri.Öğe Cladribine treatment outcomes of hairy cell leukemia(2006) Altintaş A.; Ayyildiz O.; Atay A.E.; Çil T.; Müftüoğlu E.Hairy cell leukemia is a rare, clonal, chronic B cell lenfoproliferative disease characterized by splenomegaly and pancytopenia. Purine analogues are first-line choice of therapy. Although effectivity of treatment is established, relapses may occur. In this state, remission may achieved by a new cycle of 2-CdA or alternative modalities. In this report, we represented the results of our patients with HCL that were treated with 2-CdA and followed up in our center.Öğe Cranial involvement in a follicular lymphoma patient with systemic complete remission after Yttrium-90-ibritumomab-tiuxetan treatment: Scientific letter(Turkiye Klinikleri, 2008) Çil T.; Altintaş A.; Paşa S.; Kilinç I.; Işikdoğan A.Non-Hodgkin's lymphoma is a heterogeneous group of lymphoproliferative disorders with varying patterns of behavior and treatment responses. Advances in understanding of tumor biology have made it possible to exploit novel treatment strategies such as monoclonal antibodies and their conjugation with radioimmunotherapy was recommended in patients with first relapse of low-grade lymphomas such as follicular lymphoma after rituximab containing chemotherapy. Treatment with radioimmunotherapy such as yttrium-90-ibritumomab-tiuxetan utilizes a monoclonal anti-CD20 antibody to deliver beta-emitting yttium-90 to the malignant B-cells. Clinical trials have demonstrated its efficacy, which is largely independent of the intrinsic activity of the anti-CD20 antibody. Relapses of nodal lymphomas usually occur in extra lymphoid areas. Central nervous system (CNS) involvement develops in less than 1% of patients with lymphomas. Herein, we are presenting a rare case of CNS involvement of follicular lymphoma in a patient who has achieved systemic complete remission after yttrium-90-ibritumomab treatment. Copyright © 2008 by Türkiye Klinikleri.Öğe Demographical characteristics of the patients with leukemia in Diyarbakir(2003) Işikdo?an A.; Ayyildiz O.; Tiftik N.; Altintaş A.; Müftüo?lu E.The distrubition of leukemias showed variation in various parts of the world. Chronic lymphocytic leukemia is the most common form of leukemia (31% of all leukemias) in western countries, but is rare in Japan. Acute myeloblastic leukemia consist of 80% of adult acute leukemias, whereas acute lymphoblastic leukemia is 20 percent. In this report we analyzed all leukemias according to types, age, sex and peak age. For this reason we analysed 497 leukemia cases followed in our clinic between January 1993-December 1999.Öğe Differential diagnosis of Churg Strauss syndrome: Two cases reports(2007) Altintaş A.; Çil T.; Ayyildiz O.; Şit D.; Müftüoğlu E.Churg-Strauss syndrome (CSS) is characterized by necrotising, eosinophilic-rich granulomatous inflammation of small and medium vessels. Differantial diagnosis with Hypereosinophilic syndrome is crucial. Herein, we presented two patients with eosinophilia and eosinophilia related organ damage and emphasize the clinical properties and differential diagnosis of CSS and Hypereosinophilic syndrome; which has many similarities.Öğe Eosinophilia and related hematological disorders: Review(Turkiye Klinikleri, 2007) Altintaş A.; Özmen Ş.; Ayyildiz O.Eosinophilia is defined by an eosinophile count of >600/mm3; it may be primary or secondary due to the underlying cause. End-organ damage may develop in familial form as well as primary or secondary eosinophilia and it may also develop regardless of a specific cause in severe or mild eosinophilia;. Recently, the pathogenesis of clonal hypereosinophilia is well recognized and different variants are defined. Copyright © 2007 by Türkiye Klinikleri.Öğe Gastric ring cell carcinoma metastasis to the breast: Two case reports(2009) Çil T.; Altintaş A.; Paşa S.; Işikdoğan A.Metastatic tumors of breast are rare and account only for approximately 2% of all malignant breast cancers. Breast metastasis of stomach's signet ring cell carcinoma (SRCC) is also a very rare condition. Herein, we report two rare cases of gastric SRCC metastasis to the breast. First case is a 63-year-old female patient who was admitted to our clinic with swelling in the left breast and arm with enlarged left axillary lymphadenopathy. She was diagnosed with gastric SRCC a year ago. Second case is a 65-year-old woman diagnosed with gastric SRCC who had undergone total gastrectomy two years ago, and had one-year history of operation for kruckenberg's tumor. This patient was admitted to our clinic with two months history of pain and swelling in the left breast. She was also diagnosed as a gastric SRCC metastasis.Öğe Hairy cell leukemia variant and differantial diagnosis: Case report(2006) Altintaş A.; Işikdoğan A.; Ayyildiz O.Hairy-cell leukemia-variant is an uncommon chronic B cell lymphoproliferative disorder, characterized by splenomegaly and leukocytosis. A variant form of Hairy-cell leukemia has been considered with features intermediate between Hairy-cell leukemia and B-prolymphocytic leukemia. Although there are some cases diagnosed during routine diagnostic tests, most of them admit with abdominal discomfort secondary to massive splenomegaly. A 72-years old female patients with abdominal distention, early satiety, and night sweating for 2 years admitted and a diagnosis variant form of hairy cell leukemia was established. In this report, we discussed clinic and laboratory features of Variant-Hairy cell leukemia.Öğe Hepatitis B virus infection in patient with Hodgkin's and non-Hodgkin's lymphoma and clinical significance(2007) Altintaş A.; Kaplan M.A.; Çil T.; Yilmaz Ş.; Bayan K.; Daniş R.; Ayyildiz O.Hepatitis B virus (HBV) is a hepatotrophic virus that have also a potential to replicate in lymphoid cells. This has led to evaluation of potential association between HBV infection and lymphomas. In this study, we retrospectively determined the HBV surface antigen and anti-HBs antibody in Southeastern region of Turkey where the prevalence of this infection is relatively high. A total of 276 patients were recruited, 203 (73.6%) with non-Hodgkin's lymphoma (NHL) and 73 (26.4%) with Hodgkin's lymphoma (HL), in the period of January 1995 and December 2005. In total, 40 (14.5%) patients were positive for HBsAg. Of them, 12 (16.4%) were in HL group and 28 (13.7%) were in NHL group. Anti-HBs antibody was positive in total of 123 patients [29 (39.7%) in HL and 94 (46.3%) in NHL]. Eleven patients were taken lamivudine prophylaxis (100 mg po / day) in the last two years. Ten were not developed a reactivation, while one with diffuse large-cell NHL reactivated. Besides, one patients with HL who was not taking prophylaxis developed anti-HBcIgM positive with aminotransferase elevations compatible with acute hepatitis. Although HBsAg positivity was higher in lymphoma patients than in general population in our study, for a possible casual association there is need for prospective studies with wider populations. In conclusion, prophylaxis with lamivudine of HBV carriers is important and treatment should be continued until one year after termination of chemotherapy.Öğe Hereditary thrombophilic risk factors in patients with deep venous thrombosis(2007) Altintaş A.; Çil T.; Kaplan M.A.; Yurt M.; Batun S.The prevalence of hereditary risk factors for deep venous thrombosis (DVT) varies greatly in different parts of the world. Factor V Leiden (FVL) and prothrombin G 20210A (FT G20210A) are the most common genetic defects leading to venous thrombosis. The aim of this study was to investigate the frequency of FVL and PT G20210A mutations in adult patient with DVT in our region. Between September 2001 and August 2006, 52 patients with documented venous thrombosis were investigated in our center for the presence of FVL and PT G20210A mutations. Fourteen of 52 patients with thrombosis (%26.9) were detected to have a FVL mutation. The PT G20210A mutation was detected in 6 (%11) of the 52 patients. Our findings reveal that FVL and PT G20210A mutations are significantly higher in patients with DVT than in the healty population in the southeast of Turkey.Öğe Inhibitors in hemophilia A and B in Southeast of Turkey(2006) Altintaş A.; Ayyildiz O.; Çil T.; Söker M.; Müftüoğlu E.Hemophilia A and B are inherited, X chromosome linked coagulation disorders that characterized by clinical signs and symptoms seen in males. The most important treatment related complication was viral infection in the past years, but this problem is overcoming by developing of modern factors concentrate which are available in the market, nowadays. However, developing inhibitor against concentrated factors that used is the most important problem, as in western countries. In this study, we aimed to evaluate the inhibitor developing rate in 73 hemophiliac pediatric and adult patients who have treated and followed up in Dicle University hematology polyclinics in Southeastern Anatolia. 62 (85%) of cases were hemophilia A and 11 (15%) were hemophilia B. Of hemophilia A patients 41 (66.2%) had severe and 17 (27.4%) had moderate disease. The same rates were 7 (63.6%) and 3 (27.3%) in hemophilia B patients, respectively. Only one patient (2.4%) with severe hemophilia A had high titrate of inhibitor positivity (17 BU/ml). Inhibitor was present in any of hemophilia B patients. This rate was lower than previously reported data from community of Turkey. We proposed that the most important cause of this low frequency of inhibitor is using fresh frosen plasma in treatment of those patients with bleeding.Öğe Microchimerism, a dilemma in current medicine(2006) Özmen Ş.; Daniş R.; Altintaş A.; Bayan K.; Yilmaz Ş.Microchimerism refers to presence of a small number of cells, or DNA of one individual harbored in another individual. Many studies indicate that cell trafficking occurs between the fetus and mother during pregnancy and between others after organ transplantation or blood transfusions. These cells or DHA can persist in recipient's blood or tissues for decades, creating a state of physiologic microchimetism. In several recent studies, microchimerism has been shown to have potential roles in pathogenesis of different diseases. However, due to the fact that microchimerism has also been found in healthy individuals and in organs affected by non-autoimmune conditions, an alternative hypothesis has been suggested in which microchimeiic cells are associated with the healing process of a tissue injury as opposed to causing disease. As a conclusion of this review of recent studies, we can say that microchimerism studies yielded more questions than answers.Öğe Patients with Hodgkin's disease: Clinical and pathological evaluation(2006) Altintaş A.; Çil T.; Kaplan M.A.; Atay A.E.; Işikdoğan A.; Büyükbayram H.; Ayyildiz O.Hodgkins' disease accounts 25% of all lymphoid malignancies and 1% of all cancers. In this study, 150 patients with Hodgkins' disease were reviewed retrospectively and compared according to age, gender, histopathologic subtype and stage of disease. 102 (68%) of patients were male and 48 (32%) were female with a median age of 41 (16-73) years. The frequencies of histopathological subtypes, mixed cellularity, nodular sclerosis, lymphocyte-rich and lymphocyte-depletion, were 63 (42%), 37 (24.6%), 25 (16.6%) and 21 (14%), respectively. Histological subtype was not determined in 4 (2.7%) patients. Distribution of patients according to stages were; 18 (12%) patients were in stage I, 35 (23.3%) patients were in stage II, 52 (34.7%) patients were in stage III and 43 (28.7%) patients were in stage IV. Sufficient staging procedure was not performed in two patients. SPSS 11.0 program was used for statistical analyzes. Patients were divided into two groups; older and younger than 40 years age and no statistical significancy was detected between groups. Also there was no significant relation between histopathological subtype and age. In conclusion; Hodgkin disease predominantly seen in males (M/F: 2.1). Mixed celularity HD was the most frequent subtype and 63.7% of our patients were in advanced stage (stage III ve IV).Öğe Retinoic acid syndrome after the first dose of all-trans retinoic acid(2006) Altintaş A.; Paşa S.; Ağgil C.; Tural B.; Ayyildiz O.All-trans retinoic acid (ATRA) was firstly used as a differentiating agent in 1987 in Shanghai for the treatment of acute promyelocytic leukemia (APL). Retinoic Acid Syndrome (RAS) became an important complication of therapy after the administration of ATRA. The frequency of syndrome is 27% and the precise cause is not entirely known. The mortality rate of patients with APL due to this complication is 1%. Symptoms of RAS resembles to sepsis, pneumonia, iatrogenic volume overload and blood transfusion reactions frequently seen in the course of leukemia and may cause confusion in the diagnosis of RAS. Dexamethasone must be administered urgently in the suspicion of RAS since it has a fatal outcome. Herein, we reported an APL patient with white blood cell count of lower than 1000/ml at presentation and complicated with retinoic acid syndrome subsequent to the first dose of all-trans retinoic acid.Öğe Splenectomy in lymphoproliferative disorders(2006) Altintaş A.; Çil T.; Ayyildiz O.Splenomegaly is common in the course of lymphoproliferative disorders. Massive splenomegaly sometimes leads to bulk symptoms and cytopenias. Splenomegaly may also be the primary manifestation of lymphoproliferative disorders. Splenectomy, with an acceptable surgical risk, has the potential to establish the diagnosis of lymphoproliferative disorders in patient with splenomegaly without lymphadenopathy and negative bone marrow findings. Splenectomy in these group patients is performed for either diagnostic or therapeutic reasons. Splenectomy has the potential to relieve bulk symptoms, correct cytopenias, and facilitate aggressive chemotherapy.Öğe Thrombotic thrombocytopenic purpura associated with Graves' disease(2007) Altintaş A.; Çil T.; Ayyildiz O.; Kaplan M.A.; Müftüoğlu E.Thrombotic thrombocytopenic purpura (TTP) is characterized by microangiopathic hemolytic anemia and thrombocytopenia, usually accompanied by fever, renal failure and neurological deficits. TTP usually occurs in previously healthy people, but in a significant number of cases, the syndrome is associated with autoimmune disorders. We report a case of a 53 year old male patient suffering from TTP associated with Graves' disease (GD). After the diagnosis of TTP and Graves' disease plasmapheresis and antithyroid therapy were initiated. After the 15th seans of plasmapheresis, complaints were dissolved and hematologic parameters were recovered. This case draws the reader's attention to a rare condition that TTP associated with GD. Although immune thrombocytopenic purpura (ITP) and pernisious anemia must be initially considered in the event that thrombocytopenia accompanies to GD, TTP is likely in the presence of microangiopathy. The presence of microangiopathic haemolytic anemia and thrombocytopenia is sufficient for the diagnosis of TTP, thus prompt diagnosis and appropriate therapy is crucial for TTP.Öğe An unusual case of fever of unknown origin: Kikuchi-Fujimoto disease(2008) Tüzün Y.; Bayan K.; Altintaş A.; Çil T.; Yilmaz Ş.; Dursun M.Kikuchi-Fujimoto disease (KFD), also called histiositic necrotizing lenfadenitis is a self limited disease, which commonly affects young Asian women. Etiology of KFD is unknown. The disease presents with lymphadenopathy, predominantly in the cervical region, fever, leucopenia and high erythrocyte sedimentation rate. It has occasionally been misdiagnosed as malignant lymphoma. The diagnosis of disease is confirmed by histopathological examination of affected lymph node. Herein, we reported a patient who presented with fever of unknown origin and diagnosed as KFD. We suggest that KFD needs to be considered as one of the differential diagnoses in patients presenting with fever of unknown origin and lymphadenopathy.
