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Çocukluk çağı kanserlerinin birçoğunun etyolojisi net açıklanamamıştır. Son çalışmalar, anomalilerin genetik ve çevresel faktörlerin de etkisi ile kanser gelişiminde rol alabileceğini göstermiştir. Bu çalışmanın amacı, maligniteler ve konjenital anomaliler arasındaki ilişkinin araştırılması ve çeşitli kanserlere en sık eşlik eden anomalilerin belirlenmesidir. Çalışmamızda Uludağ Üniversitesi Tıp Fakültesi Çocuk Onkoloji Bilim Dalı'nda takipli, solid tümör veya lenfoması olan 506 hasta incelenmiştir. Hastalardaki malignite dağılımına bakıldığında 135 (%27) hasta sayısı ile lenfomalar birinci sıradadır. Bunu 65 (%13) hasta ile santral sinir sistemi tümörleri ve 63 (%12) hasta ile germ hücreli tümörler takip etmektedir. Hastaların %33.5'inde (n=170) anomali olduğu görülmüştür. Bu 170 hastada, 241 farklı anomali tanımlanmıştır. Bu anomalilerin %30.7'sinin göz, kulak, yüz, boyun anomalileri, %18.25'inin kardiyovasküler sistem anomalileri, %10.78'inin ürogenital sistem anomalileri, %9.12'sinin SSS anomalileri, %7.05'inin kas iskelet sistemi anomalileri, %6.27'sinin sindirim sistemi anomalileri, %2.48'inin solunum sistemi anomalileri, %15.35'inin ise diğer anomaliler grubunun anomalileri olduğu görülmüştür. Hastaların demografik özelliklerine bakıldığında; hastaların %44.6'sı (n=226) kız, %55.4'ü (n=280) erkektir. Hastaların ortalama yaşı 7.34±5.46 yıldır. Doğumdaki ortalama anne yaşı 26.83±5.17, ortalama baba yaşı ise 30.02±5.41'tir. Soygeçmişlerine bakıldığında %20.4'ünde (n=103) annede düşük veya ölü doğum öyküsü olduğu, %28.1'inde (n=142) akrabalarında kanser öyküsü olduğu ve %14.2'sinin (n=72) anne ve babası arasında akrabalık olduğu görülmüştür. Anomalisi olan hastaların %25'inin doğumdaki baba yaşının 35 yaş ve üzeri olduğu görülmüştür (p:0.004). Malignitelerde anomali görülme sıklığı incelendiğinde; SSS tümörü olan hastalarda anomali görülme sıklığı %61.5 (n=40) olarak saptanmıştır (p

Kanser bütün dünyayı etkileyen bir sağlık problemidir. Dünyada her yıl 160,000'den fazla çocuk kansere yakalanmaktadır. Son yıllarda erken tanı ve tedavi olanakları ile birlikte kanser tanısı alan hastaların yaşam oranları artmıştır. Bu açıdan çocuk kanserlerinde erken tanı ve tedavi çok önemlidir. Bu çalışmada lenfoma ve solid tümör tanısı alan çocuklarda ilk yakınma ile kesin tanı konulması arasındaki geçen sürenin değerlendirilmesi amaçlanmıştır. Bu çalışmada 01.01.2005 – 31.12.2014 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları A.D. Çocuk Onkoloji polikliniği ve kliniğine başvuran lenfoma ve solid tümör tanısı alan 759 hasta retrospektif olarak değerlendirildi. Hastanın yakınmalarının başlamasından sonra ilk doktora başvuru süresi, doktora başvurduktan sonra tanı alma süresi ve toplam tanı alma süresinden oluşan, semptomların başlangıcından kesin tanı konuncaya kadar geçen sürelerin tanımlanması amaçlandı. Bu sürelerin yaş, cinsiyet ve tanı gruplarına göre karşılaştırması planlandı.Çalışmamızda tanıda medyan yaş 84 ay erkek/kız oranı 1,2/1 idi. En sık lenfomaların (%22), ikinci sıklıkta SSS tümörlerinin (%18,3) ve üçüncü sıklıkta germ hücreli tümörlerin (%10,8) olduğu görüldü. Kanser tanısı alan hastaların %5,3'ü pratisyen hekim, % 67,5'i çocuk sağlığı ve hastalıkları uzmanı, %3,5'i yandal uzmanı ve %29'u diğer branş hekimlerine başvurmuştu. Doktora ilk başvuru süresi ortanca 15 gün (1-730 gün), kesin tanı merkezine sevk süresi 8 gün (1-1050 gün), onkoloji merkezinde tanı alma süresi 10 gün (1-223 gün) ve toplam tanı süresi 55 gün (3-1254 gün) olarak saptandı. Tanısı Hodgkin-dışı lenfoma (p=0,030), Hodgkin lenfoma (p=0,003), kemik sarkomları (p=0,005), yumuşak doku sarkomları (p=0,009) ve tiroid karsinomu (p=0,001) olan çocuklarda, doktora ilk başvuru süresi 15 günden daha uzun bulundu (p

This study aimed to examine the incidence, clinical characteristics, and outcome of hyperuricemia and tumor lysis syndrome (TLS) in children with non-Hodgkin's lymphoma (NHL) and acute lymphoblastic leukemia (ALL).This retrospective study included data from 327 patients (113 NHL and 214 ALL).Hyperuricemia occurred in 26.5% and 12.6% of the patients with NHL and ALL, respectively. The corresponding figures for TLS were 15.9% and 0.47% (p=0.001). All hyperuricemic NHL patients had advanced disease and renal involvement was present in 53%. All hyperuricemic ALL patients had a leukocyte count50,000 mm3 at the time of diagnosis. Among the hyperuricemic NHL and ALL patients, 96.6% and 66.6% had LDH ≥500 UI/L, respectively. Treatment consisted of hydration and allopurinol; none of the patients received urate oxidase. Among the patients that developed TLS, 26.3% had laboratory TLS, 42.1% had grade I or II TLS, and 31.6% had grade III or IV TLS. Uric acid levels returned to normal after a mean period of 3.5±2.5 and 3.05±0.8 d in NHL and ALL groups, respectively. In all, 7% of the patients with hyperuricemia required hemodialysis. None of the patients died.In this series the factors associated with a high-risk for TLS were renal involvement in NHL and high leucocyte count in ALL. Management with allopurinol and hydration was effective in this group of patients with high tumor burden.AMAÇ: Çalışmanın amacı NHL ve ALL’li çocuklarda hiperürisemi ve TLS sıklığını, klinik özellikleri ve sonuçlarını tanımlamaktır. YÖNTEMLER: Bu retrospektif çalışmada 113 NHL ve 214 ALL’li toplam 327 hastanın verileri değerlendirildi.NHL olgularının %26.5’inde, ALL olgularının %12.6’sında hiperürisemi görüldü. TLS insidansı NHL ve ALL gruplarında %15.9 ve %0.47 bulundu (p=0.001). Hiperürisemi görülen NHL olgularının tümü ileri evrede olup, %53’ünde renal tutulum vardı. Tüm hiperürisemili ALL olgularında tanıda lökosit sayımı 50.000/mm3’den yüksekti. Hiperürisemik NHL grubunun %96.6’sında, ALL grubunun %66.6’sında LDH ≥500 UI/L idi. Tedavide hidrasyon ve allopürinol uygulandı, ürat oksidaz verilen hasta olmadı. TLS gelişen olguların %26.3’ünde laboratuvar TLS, %42,1’inde grade I ve grade II TLS, %31.6’sında grade III ve IV TLS saptandı. Ürik asit düzeyleri NHL ve ALL hastalarında ortalama 3.5±2.5 ve 3.05±0.8 günde normale döndü. Hiperürisemili hastaların %7’sinde hemodiyaliz gerekti. Mortalite olmadı. SONUÇ: Bu seride en yüksek TLS riski renal tutulumu olan NHL olgularında saptandı. Allopürinol ve hidrasyonun tümör yükü yüksek olan bu grupta etkili olduğu gözlendi.

Aim: The objective of this study is to evaluate the febrile neutropenia attacks in the children who have been treated for cancer in our center. Material and Method: Between January 2000 and December 2005, 57 patients with lymphoma and solid organ tumors who, had a total of 206 attacks of febril neutropenia were evaluated retrospectively. Results: The mean absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) levels at the time of febril neutropenia attacks were 296 +/- 342/mm(3), 518 +/- 896/mm(3), 144 +/- 262/mm(3), respectively. The mean C-reactive protein (CRP) level was 7.63 +/- 7.06 mg/dL, Hb level was 8.67 +/- 1.74 g/dL and fever was 38.5 +/- 0.2 degrees C. There were no infection focus in the 57.3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% and 12.1% of the attacks, respectively. Combination of third generation cephalosporins and aminoglycosides were given in 87.8% (n=181) of the attacks. Bacteremia was found in 14.6% (n=30). The rate of isolated gram negative bacteria (60%) was higher than the others. The most common agents isolated were E.coli, Enterobacter cloaca and S.epidermidis in 16.7%, 13.3% and 13.3%, respectively. The success rate of therapy was found as 67.5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteremia. The presence of mucositis prolonged the duration of hospitalization. There were no significant differences between therapy regimens according to success of therapy, bacteremia and duration of hospitalization. The duration of neutropenia was longer in neuroblastoma and brain tumors. The mortality rate was found as 1.45%. Conclusions: The rate of gram negative bacteremia was higher in our study. None of our patients had central venous catheters, so we thought that this could be the reason to the lower rate of isolated gram positive bacteria. The response rate to the treatment was good and mortality rate was low with the empirical treatment by cephalosporin and aminoglycoside combination.

Amaç: Bu çalışmanın amacı solid organ tümörü ve lenfoma nedeniyle kemoterapi ve radyoterapi alan, oral mukozit gelişen ve gelişmeyen hastaların klinik ve demografik özelliklerini karşılaştırmaktır.Yöntem: Değerlendirmeler 1 Mayıs 2012- 31 Mayıs 2013 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Kliniklerinde ve Çocuk Onkolojisi Polikliniğinde gerçekleştirildi. Tüm hastaların yaşı, cinsiyeti, histopatolojik tanısı ve evresi, KT planı, RT alıp almadığı, KT aralıkları kayıt edildi. Çalışma başlangıcında hastaların günlük ağız bakımı alışkanlıklarına ilişkin, anket formunda yer alan sorular yöneltildi. Oral mukozit gelişen hastaların günlük ağız bakımı ve oral mukozite eşlik eden oral alım güçlüğü, yutma güçlüğü, ses kısıklığı, konuşma güçlüğü, bulantı, kusma, karın ağrısı, ishal ve ateş semptomları değerlendirildi ve kaydedildi.Sonuçlar: Çalışmaya alınan hastaların 42?si (%48,3) kız ve 45'i (% 51,7) erkek idi. Hastaların yaş ortalaması 78,8 ± 59,7 ay olarak bulundu. Yaş sınırları 1 ay ile 209 ay arasında değişmekteydi. Hastaların %9,2?si (n:8) bir yaşından küçük olup üç hasta ilk 6 ayda tanı almıştır. Çocukların % 32,2?si (n:28) 1-5 yaş, %19,6?sı (n:17) 6-10 yaş grubunda, % 39?u (n:34) on yaşından büyüktü.Hastaların 24?ünde (%27,4) lenfoma mevcuttu. Lenfomalı olguların 12?sinde (%13,7) non-Hodgkin lenfoma (NHL), 12?sinde (%13,7) HL tanımlandı. NHL tanımlanan 8 hasta B hücreli, 4 hasta lenfoblastik alt grupta idi. Hastaların 18?i (%20,7) santral sinir sistemi tümörü (SSS) tanısı aldı.Bu grupta medulloblastom, ependimom ve pons gliomu tanılı hastalar yer aldı.Olguların 11?i (%12,7) kemik sarkomu, 11?i (%12,7) nöroblastom (NBL), 8?i (%9,2) Wilms tümörü, 5?i (%5,8) rabdomiyosarkom (RMS) tanısı aldı. Malign germ hücreli tümör, retinoblastom (RBL), hepatoblastom (HBL), malign periferik sinir kılıfı tümörü (MPSKT) tanımlanan ikişer hasta (%2,3) çalışma grubunun toplam %9,2?sini oluşturdu. Birer olguda adrenokortikal karsinom ve kolon karsinomu gözlendi (%2,3). Araştırma grubundaki hastaların 38?i (%43,7) RT aldı. İlk değerlendirmede verilen günlük ağız bakımı anket verilerine göre 87 hastanın 61?inin (%70,1) hergün diş fırçaladığı, 3?ünün (%3,4) yemek tuzu (sodyum klorür) veya yemek karbonatı (sodyum bikarbonat) ile gargara ve ağız çalkalama uyguladığı, 5?inin (%5,7) diş fırçalama ve gargarayı birlikte sürdürdüğü belirlendi. Toplam olarak 69?unun (%79,2) günlük ağız bakımı yaptığı saptandı.Çalışma süresince hastaların 46?sında (%52,8) oral mukozit gelişirken 41?inde (%47,2) gelişmedi (Şekil-4). RT sürecindeki hastaların %50?sinde oral mukozit gözlendi.Yorum: Solid organ tümörü ve lenfoma nedeniyle kemoterapi alan çocuk hastalarda da oral mukozite sık (%52,8) rastlanmaktadır. Oral mukozitlerin çoğu (%80,4) ağır seyretmekte ve nüks (%56,5) izlenmektedir. Ancak oral mukozitle ilişkisi net klinik ve demografik özellikler belirlenememiştir. Daha geniş hasta gruplarında, daha kapsamlı prospektif çalışmalara ihtiyaç duyulmaktadır.Anahtar kelimeler: Solid organ tümörü ve lenfoma, kemoterapi, oral mukozit Objective: The aim of this study is to compare the demographic and clinical characteristics of children with and without oral mucositis receiving chemotherapy and radiotherapy for solid organ tumors and lymphoma.Methods: Evaluations were conducted between May 1st, 2012 - May 31st 2013, at Uludag University Pediatrics Department and Outpatient Clinic of Pediatric Oncology Division. All patients' age, gender, histological diagnosis and stage, KT plan, whether they received RT and KT intervals were recorded. At the beginning of the study questions from the questionnaire were asked to the patients about their daily oral care habits. Patients who develop oral mucositis associated with daily oral care and oral ingestion mucosity with difficulty in swallowing, hoarseness, difficulty in speaking, nausea, vomiting, abdominal pain, diarrhea, and fever symptoms were evaluated and recorded.Results: Of the patients, 42 (48.3%) were female and 45 (51.7%) were male. The average age of patients was 78.8 ± 59.7 months. Age limits ranged from 1 month to 209 months. Of all patients 9.2% (n = 8) were 10 years group.In 24 patients (27.4%) there was lymphoma. Twelve patients (13.7%) were diagnosed as non-Hodgkin's lymphoma (NHL) and 12 (13.7%) were diagnosed as HL. Eight of NHL patients were identified as B cell lymphoma and other four patients were identified in lymphoblastic subgroup. Eighteen patients (20.7%) had central nervous system tumors (CNS) identified as medulloblastoma, ependymoma, and pontine glioma. Eleven patients (12.7%) were bone sarcoma, 11 patients (12.7%) were neuroblastoma (NBL), 8 patients (9.2%) were Wilms' tumor and 5 patients (5.8%) were rhabdomyosarcoma (RMS). Two patients with malignant germ cell tumors, 2 with retinoblastoma (RBL), 2 with hepatoblastoma (HBL) and 2 with malignant peripheral nerve sheath tumor (MPNST) were described and they accounted for 9.2% of the study group. Adrenocortical carcinoma in 1 and colon carcinoma was observed in 1 patient (2.3%). In the study group, 38 patients (43.7%) received RT. According to survey results of questionnaire about daily oral care, 61 of 87 patients (70.1%) were toothbrushing every day, 3 patients (3.4%)were mouthwashing with table salt (sodium chloride) or with dining carbonate (sodium bicarbonate) and 5 patients (5.7%) were tooothbrushing and mouthwashing at the same time. A total of 69 (79.2%) patients were applying daily oral care. During the study, 46 patients (52.8%) had oral mucositis and 41 (47.2%) had no oral mucositis (Figure 4). Oral mucositis was observed in 50% of patients in the process of RT.Conclusion: Oral mucositis is frequently (52.8%) developing in children receiving chemotherapy for solid organ tumors and lymphoma. In most of these patients (80.4%) oral mucositis is frequently severe and recurrent (56.5%). However, the casual relationship between oral mucositis and demographic and clinical features are not clearly identified. More comprehensive prospective studies in larger number of patients are needed. Key words: solid organ tumors, lymphoma, chemotherapy, oral mucositis 73

Anemia, which is a common problem in cancer patients, has a negative effect on survival by decreasing the efficacy of chemotherapy and particularly of radiotherapy, as well as impairing the quality of life (QoL) of patients. Recombinant human erythropoietin (rHuEPO) decreases a patient's need for transfusions and increases their QoL. The aim of this study was to evaluate the effect of weekly single-dose EPO treatment on transfusion rates, QoL, and hemoglobin (Hb) levels. In addition, patients were followed up for a long period to assess the impact of EPO treatment on survival. The study was conducted from December 2001 to December 2002 in patients with newly diagnosed lymphoma or solid tumors using a prospective and controlled design. EPO-beta was given as a single dose of 450 U/kg once a week for 12 weeks. The study and control groups included 16 patients each. Hb levels measured in the study group at the 4th, 8th, and 12th weeks were significantly higher than the values recorded before the start of chemotherapy. In the control group, Hb levels post chemotherapy were significantly lower than values recorded prior to treatment. The increased Hb levels in the study group were significant at the 8th and 12th weeks of treatment compared to levels measured prior to treatment. In the control group, Hb levels at the 4th and 8th weeks were significantly lower than pretreatment levels. When the percent increase of Hb levels of the study and control groups with respect to treatment week was compared, the difference was statistically significant at the 4th, 8th, and 12th weeks. Although the increase on the performance scale within each group during treatment was significant in both the study and control groups, the increase was more marked in the study group. The percent increase on the performance scale with respect to week of treatment was higher in the study group than in the control group. In EPO treatment group, side effects were seen in 38% of patients, with 19% being local pain in the injection area, 13% local hyperemia, and 6% headache. The mean follow-up period of the study and control group was 7.03 +/- 0.41 (6.0-7.41) and 7.46 +/- 0.45 (6.58-7.83) years, respectively; no statistically significant difference existed between these figures. Overall survival at the end of 7 years of follow-up was 68.8% and 81.3% for the study and control groups, respectively. The use of EPO-beta in lymphoma and solid tumor patients on a once-weekly regimen (450 U/kg) was determined to be effective in increasing Hb levels, decreasing transfusion rates, and improving QoL. This regimen was safe, did not cause serious side effects, and can be recommended because of its high patient compliance and tolerability. An effect of EPO on prognosis was not evident. We could not have an explanation on the effect of EPO treatment on prognosis, as there were low number of patients and advanced-staged patients died earlier. Therefore, a larger number of patients are needed to clarify the effect of EPO treatment on prognosis.

Some children with malignancies initially present with neurologic signs. Cavernous sinus syndrome is a rare manifestation of lymphomas, more commonly reported in adults. A patient presenting with third and fourth cranial nerve palsies was initially thought to manifest Tolosa-Hunt syndrome, but during follow-up a diagnosis of lymphoma without systemic involvement was established. This patient is the youngest, to our knowledge, to be diagnosed with primary cavernous sinus lymphoma. He remains in remission 5 years after chemotherapy. Malignancies (especially non-Hodgkin's lymphoma) should be considered in young children with cavernous sinus syndrome, even without systemic involvement.

Background. There is a risk of viral hepatitis for children with cancer. Both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in countries with high prevalence cause major problems in the management of cancer patients. in this study, we evaluated the incidence and chronicity of HBV and HCV infections in children with malignant diseases receiving chemotherapy. Procedure. One hundred ninety-eight children with cancer (mean age=7.5 +/- 2.5 years) and 100 healthy children as a control group were screened for HBV and HCV. Liver function tests, the number of transfusions, HBV and HCV serology were regularly monitored. In seropositive children, HBV-DNA and HCV-RNA were measured. Chronic hepatitis was defined as having an alanine aminotransferase (ALT) level three times of upper normal limit, positive HBV and HCV antigenemia for longer than 6 months. Liver biopsies were performed in all children with chronic hepatitis. The relationship between the chronic hepatitis and study parameters was statistically analyzed. Results. HBsAg positivity, anti-HCV, and mixed (HBV and HCV) infection were found in 11.6, 5.5, 2% of children, respectively. Most HBV infected children developed chronic hepatitis (48%) while 26 and 21.7% became carriers and immune, respectively. One died of acute fulminant HBV hepatitis. Of HCV infected children, 63.6% also had positive HCV-RNA. Four children with mixed infection (100%) all progressed to chronic hepatitis. In this setting, chronic hepatitis was observed in 22 of 38 infected children (57.8%). The majority had leukemia and lymphoma. Children with HBsAg antigenemia developed chronic hepatitis in shorter time than HCV positive children (median 13 months vs. 51 months, P