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© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.Purpose: The aim of this study is to evaluate the prevalence of anxiety disorders, its correlation with sociodemographic characteristics, its comorbidities with other psychiatric disorders and its predictors in school-aged children. Methods: This study is part of a representative, multi-centered national study that is planned by the Turkish Association of Child and Adolescent Mental Health to evaluate the prevalence of psychopathology among elementary school students in Turkey between the years 2014–2015. Children are screened via Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version. Impairment is assessed by a 3-point Likert type scale independently by the parent and the teacher. The final sample included 5842 children with the mean age of 8.7 years. Results: The prevalence of any anxiety disorder without considering impairment is 16.7% and considering impairment is 5.2% in children according to our study. We found significant differences for comorbid Attention Deficit Hyperactivity Disorder, Disruptive Behavior Disorder, Mood Disorders, Tic Disorders, Obsessive Compulsive Disorder, Enuresis Nocturna, Encopresis, and Intellectual Disability. Having a history of paternal physical disorder, living in the regions of Marmara, Mediterranean and Black Sea were found to be the main predictors of having childhood anxiety disorders according to the logistic regression analysis. Conclusion: Better understanding of childhood anxiety disorders, comorbid conditions and predictors will result in earlier diagnosis and more appropriate treatment.

Aim: Idiopathic intracranial hypertension (IIH), a disease of obscure origin, is characterized by headache and visual disturbances due to increased intracranial pressure. Recent line of evidence has suggested involvement of inflammation in IIH pathogenesis thus bringing forward anti-glial autoimmunity as a potential contributor of IIH. Glial fibrillary acidic protein (GFAP) is a major astrocytic autoantigen associated with a specific form of meningoencephalitis. Materials and methods: In this study, we investigated the presence of GFAP-antibody in 65 sera (49 obtained during active disease and 16 during remission) and in 15 cerebrospinal fluid (CSF) samples of 58 consecutively recruited IIH patients using cell based assay and indirect immunohistochemistry. Results: GFAP-antibody was found in active period sera of 2 IIH patients with classical symptoms and good treatment response. Two remission period sera obtained at different time points from one of these cases showed lower titers of GFAP-antibody positivity. IgG from positive samples yielded an astrocytic immunoreactivity pattern. None of the CSF samples showed GFAP-antibodies. Conclusions: These results suggest that anti-astrocyte autoimmunity might be present in a fraction of IIH patients. Exact pathogenic significance of this association needs to be further studied. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

OBJECTiVE: The goal of this study was to investigate the efficacy and safety of oral spironolactone in patients with central serous chorioretinopathy (CSC). MATERiALS AND METHODS: In our study, acute CSC patients were divided into two groups: those who received spironolactone 25mg twice a day as the study group, and those who were not treated as the control group. Fundus fluorescein angiography was performed in all patients. Subretinal fluid (SRF) height and central macular thickness (CMT) spectral area were measured by optical coherence tomography as well as subfoveal choroid thickness (CT) in enhanced depth imaging (EDI) mode. The best-corrected visual acuity (BVCA) was measured with the Snellen chart. Side effects of spironolactone were evaluated. RESULTS: There were 31 eyes in the study group and 28 eyes in the control group. The mean follow-up was 2.4±0.5 months. The average SRF height of 240.26±92.89μm in the study group decreased to 26.77±39.52μm (P

Identifying and reporting sexually abused children is one of the most important responsibilities of school counsellors. In this study, we aimed to determine the challenges of reporting child sexual abuse. We used a questionnaire form that was prepared by reviewing the literature about reporting sexual abuse. Participants were asked to state their level of knowledge of child sexual abuse, whether they had encountered such cases, whether they faced any challenges when notifying to authorities, and the possible solutions to problems encountered during this process. Of the school counsellors contacted, 40.9% of the participants stated that they encountered a claim of child sexual abuse at least once, but the majority of them (47.4%) could not report it to judicial authorities because of various reasons; such as being unsure whether the event was really happening, anticipating reactions towards them or school management, and fearing the school’s loss of reputation in the case of disclosure.

Silica impregnated expanded graphite–epoxy composites are developed as bipolar plates for proton exchange membrane (PEM) fuel cells. These composite plates were prepared by solution impregnation, followed by compression molding and curing. Mechanical properties, electrical conductivities, corrosion resistance, and contact angles were determined as a function of impregnated content. The plates show high flexural strength with 5% methyltrimethoxysilane (MTMS) addition (20 MPa) and in-plane conductivity of 131 S cm−1 that meet the DOE target (>100 S cm−1). Corrosion current values as low as 1.09 μA cm−2 were obtained. The contact angle was found to be 80°. Power density of 1 W cm−2 was achieved with custom made expanded graphite–polymer composite plates. High efficiency values were obtained at low current regions.

In this study, the electricity load demand, between 2012 and 2021, has been estimated using the load demand of the electricity generated from hydroelectric power plants in Turkey between 1970 and 2011. Among machine learning algorithms, Multilayer Perceptron, Locally Weighted Learning, Additive Regression, M5Rules and ZeroR classifiers are used to estimate the electricity load demand. Among them, M5Rules and Multilayer Perceptron classifiers are observed to have better performance than the others. ZeroR classifier is a kind of majority classifier used to compare the performances of other classifiers. Locally Weighted Learning and Additive Regression classifiers are Meta classifiers. In the training period conducted by Locally Weighted Learning and Additive Regression classifiers, when Multilayer Perceptron and M5Rules classifiers are chosen respectively, it is possible to obtain models with the highest performance. As a result of the experiments performed using M5Rules and Multilayer Perceptron classifiers, correlation coefficient values of 0.948 and 0.9933 are obtained respectively. And, Mean Absolute Error and Root Mean Squared Error value of Multilayer Perceptron classifier are closer to zero than that of M5Rules classifier. Therefore, it can be said the model performed by Multilayer Perceptron classifier has the best performance compared to the models of other classifiers.

The authors would like to thank all the patients their families and the normal volunteers for their contribution and Prof Nihan Unaltuna-Erginel for her help in DNA management. The authors also thank Sedat Aydın for his help in MRI acquisition, Huseyin Bulut, MD for the psychiatric advice, and Geetika Kalloo for the helpful suggestions on the manuscript. Background: Parkin (PARK2) gene mutations are the predominant cause of autosomal recessive parkinsonism. Characteristic features include: early onset symptoms with slow clinical course, good response to low doses of levodopa, and frequently treatment-induced dyskinesia. Studies using a voxel-based morphometry approach showed a decrease in the gray matter volume of the basal ganglia in mutation carriers during the symptomatic stages. A bilateral, presumably compensatory increase of basal ganglia gray matter value was recently demonstrated in asymptomatic Parkin mutation carriers. Behavioral disorders including: anxiety, psychosis, panic attacks, depression, disturbed sexual, behavioral and obsessive-compulsive disorders have been reported in these patients. Method: A total of 28 Parkinson’s Disease (PD) patients consisting of 10 Young-Onset without Parkin mutations (YOPD), 9 Young-Onset with Parkin mutations (YOPD-p), 9 Late-Onset without Parkin mutations (LOPD) and 32 healthy control subjects were studied with an automated volumetric assessment method to quantify subcortical atrophy. Patients but not controls also underwent a neuropsychological and neuropsychiatric assessment. Results: Results revealed a reduction of bilateral caudate nuclei volumes in YOPD-p patients compared to the YOPD patients while there were no statistically significant differences between other groups. YOPD-p patients showed similar results to other patient groups on neuropsychiatric and neuropsychological evaluation measures. Conclusion: YOPD-p and YOPD patients showed a different pattern of volume changes in basal ganglia. Despite its relatively benign clinical course, carrying the Parkin mutation seems to be associated with greater atrophy in subcortical structures. Failure of compensatory mechanisms, different mutation types and pathophysiologic processes may underlie this diverse pattern of subcortical brain changes. This studywas supported by Istanbul University Research Funds and Istanbul Neuropsychiatry Hospital Research Support Program.

Background and purpose: To evaluate the phenotype and the frequencies of mutations in PRKN, DJ1 and PINK1 genes in patients with Parkinson disease (PD) in Turkey. Methods: Eighty-six patients from 77 PD families participated in the study. Seventy-four families were originating from Turkey, two families from Greece and one family from Bulgaria. All patients underwent detailed neurological examination. PRKN, PINK1 and DJ1 genes were sequenced, and dosage analysis was performed by multiplex ligation-dependent probe amplification. Results: Sixteen patients with PD were found to carry homozygous (n = 14) or compound heterozygous (n = 2) PRKN mutations. We identified exon rearrangements, three point mutations and one new point mutation in exon 2 (p.K27del). In two families, two new PINK1 point mutations (L31X and P416L) were identified. No pathogenic mutations were found in DJ1 gene. Clinical phenotypes of PRKN patients were comparable to previously described features, but only in four of 13 families, the pedigree structure was clearly consistent with an autosomal recessive (AR) mode of inheritance in comparison with nine families where also different pattern of transmission could have been possible. Conclusions: Our data suggest that the PRKN gene mutation is the most frequent form of ARPD in Turkey. The proportion of mutations with regard to the age of onset in our population is in the range of those previously described, but our pedigrees are characterized by high rate of consanguinity, which might explain the high proportion of families with homozygous mutations and of patients in more than one generation. Pathogenic DJ1 mutations do not seem to play a major role in Turkey.

Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The aim of this study was to identify the factors influencing both sputum smear and culture conversion time among patients with new case pulmonary tuberculosis (TB). The study was conducted in a reference hospital in Turkey in which 737 patients with pulmonary TB were hospitalised between January 2000 and 2005. We evaluated 306 (193 men and 113 women) human immunodeficiency virus-negative patients diagnosed with new case pulmonary TB. Factors associated with both sputum smear and culture conversion time (days) were investigated. Patients with diabetes mellitus (DM), cavitary disease, radiologically extensive disease had longer sputum smear and culture conversion time than the other groups. In addition, old age, male sex, smoking and thrombocytosis were found to be significantly associated with sputum smear conversion time. In the logistic regression analysis, the presence of DM and extensive disease were determined as independent factors associated with persistent sputum smear and culture positivity at the end of 2 months. The presence of DM and extensive disease were found to be independent risk factors influencing both sputum smear and culture conversion time in pulmonary TB. Sputum smear and culture examinations should be considered together to assess the poor prognosis.

Breast tuberculosis is a rare form of tuberculosis. Of all the breast diseases treated surgically, tuberculosis is seen in the range between 0.025% and 0.1%. This ratio is higher in undeveloped countries. We presented five cases with breast tuberculosis. Their ages were between 20 and 63 years. All of them had children and were breastfeeding. The cause of admission to the hospital was swelling in four of them and pain in the remainder. All of the lesions were unilateral. One case had received antituberculosis treatment for pulmonary tuberculosis 10 years ago. AAFB was not detected in sputum, breast discharge, urine and tissue culture in all the cases. Diagnosis was made histopathologically from the excisional biopsy material. Caseating granulomatosis was also found in axillary lymph nodes in three cases. Antituberculosis therapy was planned as 2HRZE/4HR for all of the cases. Three of them completed the therapy without any complaints. One case left the hospital without permission. The last one is now undergoing resistant tuberculosis treatment for pulmonary disease without any complaint of her breast. As a conclusion, although tuberculosis of breast is extremely rare, it should be kept in mind particularly in developing and undeveloped countries.

Data that is acquired from different data sources needs too much processing for managing, analyzing and monitoring. Also, you have to fuse and exploit efficiently these data and display the results. Data warehouse consolidates data coming from different data sources. A real time data warehouse is used same purpose as data warehouse, in addition to these, data streams into real time data warehouse on time. Therefore, real time data warehouses can be used in many different areas, such as signal processing, data analysis. In this study, we proposed and implement a real time data warehouse using web services as a prototype.

Cisplatin chemotherapy is associated with neurotoxicity, and oxidative stress might play an important role in the pathogenesis. Mirtazapine may be a preventative agent via its less-known antioxidant properties. The aim of this study was to examine the potential chemoprotective effects of mirtazapine against cisplatin-induced oxidative stress and DNA damage.Twenty-four rats were divided equally into four groups: control; cisplatin (10 mg/kg i.p.); cisplatin plus mirtazapine (10-30 mg/kg, respectively i.p and p.o.); and mirtazapine (30 mg/kg p.o.). The rats were killed at the end of the 14th day of treatment. Brain tissue was examined with regard to antioxidant/oxidant biochemical parameters.Although glutathione (tGSH) and nitric oxide (NO) end product mean scores were found to be statistically higher in the control group when compared with the cisplatin group (72.44% and 61.99% percentage change [PC], respectively), malondialdehyde (MDA), myeloperoxidase (MPO), and 8-hydroxyguanine (8-OH-GUA) mean scores were statistically lower in the control group in comparison with the cisplatin group (-55.48%, -67.99%, and -48.81% PC, respectively; P 0.01). Finally, tGSH and NO end product levels were restored to normal (85.90% and 55.30% PC, respectively), and MDA, MPO, and 8-OH-GUA were significantly reduced by treatment with mirtazapine (-60.50%, -78.59%, and -38.10% PC, respectively; P 0.01).Mirtazapine has chemoprotective effects against cisplatin-induced oxidative stress and DNA damage in the rat brain, which may be attributed to its antioxidant capabilities. It would be useful to investigate whether cisplatin at the desired doses can be given concurrently with mirtazapine.

To evaluate the phenotype and the frequencies of mutations in PRKN, DJ1 and PINK1 genes in patients with Parkinson disease (PD) in Turkey.Eighty-six patients from 77 PD families participated in the study. Seventy-four families were originating from Turkey, two families from Greece and one family from Bulgaria. All patients underwent detailed neurological examination. PRKN, PINK1 and DJ1 genes were sequenced, and dosage analysis was performed by multiplex ligation-dependent probe amplification. Sixteen patients with PD were found to carry homozygous (n = 14) or compound heterozygous (n = 2) PRKN mutations. We identified exon rearrangements, three point mutations and one new point mutation in exon 2 (p.K27del). In two families, two new PINK1 point mutations (L31X and P416L) were identified. No pathogenic mutations were found in DJ1 gene. Clinical phenotypes of PRKN patients were comparable to previously described features, but only in four of 13 families, the pedigree structure was clearly consistent with an autosomal recessive (AR) mode of inheritance in comparison with nine families where also different pattern of transmission could have been possible. Our data suggest that the PRKN gene mutation is the most frequent form of ARPD in Turkey. The proportion of mutations with regard to the age of onset in our population is in the range of those previously described, but our pedigrees are characterized by high rate of consanguinity, which might explain the high proportion of families with homozygous mutations and of patients in more than one generation. Pathogenic DJ1 mutations do not seem to play a major role in Turkey.

Online and offline data is the key to Intelligence Agents, but these data cannot be fully analyzed due to the wealth and complexity and non-integrated nature of the information available. In the field of security and intelligence, there is a huge number of data coming from heterogonous data sources in different formats. The integration and the management of these data are very costly and time consuming. The result is a great need for dynamic integration of these intelligent data. In this paper, we propose a complete model that integrates different online and offline data sources. This model takes part between the data sources and our applications.

WOS: 000306989000006, PubMed ID: 21889254, Background: There are no country-based data focused on aspirin (ASA)-exacerbated respiratory disease (AERD) in Turkey. Objective: To assess the prevalence of AERD in adult patients with asthma. Methods: A structured questionnaire was administered via face-to-face interview by a specialist in pulmonology/allergy at seven centres across Turkey. Results: A total of 1344 asthma patients (F/M: 1081/263: 80.5%/19.5%, mean age: 45.7 +/- 14.2 years) were enrolled. Atopy rate was 47%. Prevalence of allergic rhinitis, chronic rhinosinusitis/rhinitis, and nasal polyposis (NP) were 49%, 69% and 20%, respectively. Of 270 patients with NP, 171 (63.3%) reported previous nasal polypectomy and 40 (25%) had a history of more than three nasal polypectomies. Aspirin hypersensitivity was diagnosed in 180 (13.6%) asthmatic patients, with a reliable history in 145 (80.5%), and oral ASA provocation test in 35 (19.5%) patients. Clinical presentations of ASA hypersensitivity were respiratory in 76% (n = 137), respiratory/cutaneous in 15% (n = 27), and systemic in 9% (n = 16) of the patients. Multivariate analysis indicated that a family history of ASA hypersensitivity (p: 0.001, OR: 3.746, 95% CI: 1.769-7.929), history of chronic rhinosinusitis/rhinitis (p: 0.025, OR: 1.713, 95% CI: 1.069-2.746) and presence of NP (p < 0.001, OR: 7.036, 95% CI: 4.831-10.247) were independent predictors for AERD. Conclusion: This cross-sectional survey showed that AERD is highly prevalent among adult asthmatics and its prevalence seems to be affected by family history of ASA hypersensitivity, history of rhinosinusitis and presence of NP. (C) 2011 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.

Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The aim of this study was to identify the factors influencing both sputum smear and culture conversion time among patients with new case pulmonary tuberculosis (TB). The study was conducted in a reference hospital in Turkey in which 737 patients with pulmonary TB were hospitalised between January 2000 and 2005. We evaluated 306 (193 men and 113 women) human immunodeficiency virus-negative patients diagnosed with new case pulmonary TB. Factors associated with both sputum smear and culture conversion time (days) were investigated. Patients with diabetes mellitus (DM), cavitary disease, radiologically extensive disease had longer sputum smear and culture conversion time than the other groups. In addition, old age, male sex, smoking and thrombocytosis were found to be significantly associated with sputum smear conversion time. In the logistic regression analysis, the presence of DM and extensive disease were determined as independent factors associated with persistent sputum smear and culture positivity at the end of 2 months. The presence of DM and extensive disease were found to be independent risk factors influencing both sputum smear and culture conversion time in pulmonary TB. Sputum smear and culture examinations should be considered together to assess the poor prognosis.

Anaphylactic reaction to meloxicam has never been reported to date. We report 2 cases of meloxicam-induced anaphylactic reaction with no sensitivity to another selective cyclooxygenase 2 inhibitor. A thorough drug allergy work-up should be done before other cyclooxygenase inhibitors are prescribed.

Acute kidney injury (AKI) is a frequent complication of cardiopulmonary bypass (CPB). The lack of early biomarkers for AKI has impaired our ability to intervene in a timely manner. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is recently demonstrated as an early biomarker of AKI after CPB, increasing 25-fold within 2 h and declining 6 h after surgery. In the present study, we tested whether interleukin-18 (IL-18) is a predictive biomarker for AKI in the same group of patients following CPB. Exclusion criteria included pre-existing renal insufficiency and nephrotoxin use. Serial urine samples were analyzed by enzyme-linked immunosorbent assay for IL-18 in 20 patients who developed AKI (defined as a 50% or greater increase in serum creatinine after CPB) and 35 controls (age, race, and gender-matched patients who did not develop AKI after CPB). Using serum creatinine, AKI was detected only 48–72 h after CPB. In contrast, urine IL-18 increased at 4–6 h after CPB, peaked at over 25-fold at 12 h, and remained markedly elevated up to 48 h after CPB. The performance of IL-18 as demonstrated by area under the receiver operating characteristics curve for diagnosis of AKI at 4, 12, and 24 h after CPB was 61, 75, and 73% respectively. Also, on multivariate analysis, both IL-18 and NGAL were independently associated with number of days in AKI among cases. Our results indicate that IL-18 is an early, predictive biomarker of AKI after CPB, and that NGAL and IL-18 are increased in tandem after CPB. The combination of these two biomarkers may allow for the reliable early diagnosis and prognosis of AKI at all times after CPB, much before the rise in serum creatinine.

Allergen immunotherapy (IT) has encouraging therapeutic outcomes but its safety is still being questioned because of possible severe systemic reactions. The aim of this study was to determine the frequency of systemic reactions (SR), and to identify their correlation with the characteristics of therapy, such as allergen composition and IT schedule, and diagnosis. We analyzed the data of 126 patients who received IT between 2000-2003, and suffered from respiratory allergy or hymenoptera venom anaphylaxis. IT was given by rush, clustered or conventional schedules. The standardized allergen extracts used were grass pollen, house dust mite and hymenoptera venom in 88, 18 and 20 patients, respectively. None of the patients received premedication. A total 4705 injections were administered. One hundred and twenty-three adverse events (AE) (2.6% per injection) were documented in 46 patients. Sixty-one of them were SRs (1.3% SRs per injection) and they were seen in 28 patients. Asthmatics had more tendency to SRs (p=0.05). Rush (1.8%) and clustered (2.8%) IT protocols were associated with a higher rate of SRs (per injection) when compared to conventional schedule (0.9%) (rush vs conventional; p=0.013, clustered vs conventional; p=0.001). The majority of SRs corresponded to grade 3 (49%). Forty-nine (80%) of the 61 SRs were observed during the build-up phase, and mostly with pollen extracts (75.5%). Patients showed more severe SRs during the build-up phase (p0.05). Twenty-six (42.6%) of the SRs were immediate, whereas 35 (57.4%) SRs appeared within 2 hours. Delayed SRs were significantly more frequent in polysensitized patients when compared to monosensitized subjects (p=0.018). Our data indicate that rapid IT regimens and the presence of asthma represent a greater risk for SR development. Since the late SRs occur as frequently as the early ones, we suggest a longer waiting period beyond 30 minutes, especially in polysensitized and asthmatic patients.

43 - ÖZET Yaptığımız çalışmada karaciğerde yer tutan kist hidatikle- rin ultrasonograf ik bulguları ile postoperatif bulgularını muka yese etmeyi ve karaciğer kist hidatiklerinde ultrasonograf inin güvenirlilik derecesini saptamayı amaçladık. Çalışmamız 70 hastayı kapsamaktadır. Ancak, karaciğer operasj'onu geçiren 69 ve medikal tedaviye alınan 1 hasta değer lendirmeye alındı, Preoperatif ultrasonograf i ile 70 olguya kist hidatik tanısı konuldu. Operasyon neticesi kist hidatik tanısı konulan olguların % 91,43 ü kist hidatik, % 5,7 si abse ve % 1,42 si de tümör olarak değerlendirildi 0 Çalışmamızda yırtılma ve enf ekte olmaları halinde kist hidatiğin düzenli konturunun kaybolduğu, internal eko alınmadığı ve tipik kistik yapının solid bir hal aldığı gösterilmiştir. Bu görünümü ile abse ve tümörle karışabileceği kanısına varılmıştır, 70 olgunun % 91,43 ü pozitif, % 8,57 si negatif olması çalışmamızdaki başarı oranının oldukça yüksek bulunduğunu gös termektedir. 45

Objectives: The aim of this study was to determine the effects of whey proteins on methotrexate (MTX)-induced brain and small intestine damage. Materials and Methods: 30 Sprague Dawley rats (200-300 g) were divided into four groups: Control, control + whey, MTX, and MTX+whey. MTX was administered at 20 mg/kg (single dose) intraperitoneally to the MTX group rats, and 2 mg/kg of whey protein were administered by oral gavage for 10 days to the whey groups. Lipid peroxidation, glutathione, and nitric oxide (NO) levels, as well as glutathione-Stransferase and superoxide dismutase activities were measured in the brain and small intestine. SDS-polyacrylamide gel electrophoresis of the brain and intestine tissues were also carried out. Results: While MTX treatment caused oxidative damage in the brain and small intestine, whey protein administration ameliorated MTXinduced oxidative stress. MTX administration did not change the brain’s NO level, while an increase in intestinal NO level was detected. Conclusion: MTX induced oxidative stress in the brain and small intestine changed the protein metabolism in these tissues regardless of reduced food intake. Consecutive 10-day administration of whey proteins has shown its therapeutic effect on MTX-induced brain and small intestine oxidative damage

IV ÖZET Amaç: Nisan 1997-Ocak 1999 tarihleri arasında supratentoryal yerleşimli malign glial tümörlerde konvansiyonel RT ile akselere hiperfraksiyone RT ve eş zamanlı sisplatinin toksisite, tolerabilite, progresyonsuz sağ kalım ve genel sağkahm açısından karşılaştırmaktır. Materyal ve Metod: Supratentoryal yerleşimli malign glial tümör tanısı almış Karnosfky performans statüsü %30'dan büyük 39 hasta faz II randomize çalışmaya dahil edildi. Hastalar iki gruba bölündü. İlk grup (n:20) 60 Gy konvansiyonel RT ve ikinci grup (n: 19) 48 Gy akselere hiperfraksiyone RT ve sisplatin uygulandı. Yaşları 10 ile 70 arasında olan 27 hasta erkek, 12 hasta kadındı. Hastalar fizik muayene, rutin hematolojik ve biyokimyasal test, CT ve idrar kreatin klerensi ile değerlendirildiler. Bulgular: Median takip süresi 25 haftaydı ve genel sağkahm ve progresyonsuz sağkalım 1 ve 2.grupta sırasıyla 24'e karşın 12 hafta ve 25'e karşın 25 haftaydı. n.grupta progresyonsuz sağkalım istatistiksel olarak anlamlı bulundu. Genel sağkahmda ise I. ve n. Grup arasında fark yoktu. Tek değişkenli analiz grup İT de tümör histolojisi ve cinsiyetin, grup I'de tümör histolojisinin pregresyonsuz sağkalıma, genel sağkalıma ise grup I'de tümör histolojisi grup İT de ise tümör çapının istatistiksel olarak anlamlı etki ettiğini gösterdi. Hiçbir hastada tedaviye ara verecek akut toksitite görülmedi. Geç toksisite oranı ise düşüktü. Toksisiteler kabul edibelir ve tolerabl olup tedaviye bağlı ölüm görülmemiştir. Sonuç: Bu çalışmada akselere hiperfraksiyone RT ve sisplatinin progresyonsuz sağkalım üzerine konvansiyonel RT'ye istatistiksel olarak üstün olduğu gösterilmiştir. Yaşam süresi kısa olan bu hastalarda akselere hiperfraksiyone RT ve sisplatin hastanın hastanede kalma süresini kısaltarak daha kaliteli bir yaşam sunmaktadır. Beyin tümörlerinin tedavisinde RT ve kemoterapi konusunda birçok çalışma vardır. Ancak genel sağkalım hale kötüdür ve RT ve kemoterapi ve radyo kemoterapi kombinasyonları için daha ileri araştırmalara ihtiyaç vardır. SUMMARY The Compare of Conventional RT with Accelerated Hiperfractioned RT and concomitant Cisplatin in Supratentorially Located Malign Glial Tumors Purpose: To compare, toxicity, tolerability, disease free and total survival differencies between in conventional RT versus accelerated hiperfractioned RT and concomitant cisplatin in supratentorially located malign glial tumors. Material and Methods: Between April 1997 and January 1999 39 patients with supratentorially located malign glial tumors whose karnofsky performance status had been greater than %30 were entered in two a randomized trial. Patients divided in two groups. First group (n=20) received 60 Gy conventional RT and second group (n=19) received 48 Gy accelerated hiperfractioned RT and cisplatin. Twenty-seven of the patients were male and twelve patients were female, whose ages were varied from 10 to 70. Patients evaluated with physical examination, routine haemotology and biochemistry profile, compoterized tomography and urine creatinine clerens. Results :Median follow-up duration was 25 weeks and total median and disease free survival were 24 versus 12 weeks and 25 versus 25 weeks respectively in group 1 and 2. In group 11, a stastistically significant median disease free survival was found. No significant differencies between groups I and II in median total survival was found. One way variance analysis showed that tumor histology and gender had statistically significant effect on median disease free survival in group II and tumor histology m group I. Also tumor histology in group I and tumor diameted in group II had a significant effect on total survival. None of the patients expericed acute toxicity that would require any drop out. The rate of late toxicities was low. Toxicities were accepttable, tolerable and no treatment related death occured in either treatment groups. Conclusion: In this study there is a statistically significant superiority of accelerated hiperfractioned RT and cisplatin treatment over conventional RT for disease free survival was evidenced. In this patients with short time total survival accelerated hiperfractioned RT and cisplatin treatment achieves shorter hospitilization period and more quality life. There are many trials about RT and chemotherapy in the treatment of brain tumors. However survival is still poor and we need further investigations about radiotherapy and chemotherapy and radiochemotherapy combinations. 54

IV ÖZET Amaç: Beyin metastazlı hastalarda iki değişik radyoterapi fraksiyonunun palyasyon ve sağkalıma etkisini araştırmak. Gereç ve Yöntem: Nisan 1997-Kasım 1998 tarihleri arasında beyin metastazı tanısı almış, Karnofsky performans statusu(KPS) %50'den büyük olan, kranial metastazı rezeke edilmemiş 40 olgu başvuru sırasına göre randomize edilerek 300cGy/10fraksiyon veya 200cGy/20 fraksiyon ile tedavi edilmiştir. Olguların 30'u %75'i (30/40) erkek %25'i (10/40)kadm olup yaşlan 14-69 arasında değişmekteydi. Primer tümöre göre dağılım %55 akciğer, %15 meme, %12,5 primeri bilinmeyen, %5 koryokarsinom, %5 tiroid, %2,5 larinks ve %2,5 malign melanom ve %2,5 nazofarinks kanseri şeklindedir. Bütün hastalara 16mg/gün kortikosteroid başlanmıştır. Olgular, yakınma ve nörolojik bulgularda sağlanan palyasyon oranı, sağkalım ve tedavinin yan etkileri yönünden değerlendirildi. Ayrıca tedavi öncesi Karnofsky Performans Durumu(KPS), Eastern Cooperative Oncology Group (ECOG) performans durumu ve Nörolojik fonksiyon durumu(NFC) gibi prognostik faktörlerin sağkalıma etkisi araştırılmıştır. Tedavi başında, tedavi sonu l.,3. ve 6. aylarda yapılan kranial CT veya MRI ile kranial hastalık objektif olarak ve aynı zamanda nörolojik muayene ile sübjektif olarak değerlendirildi. Bulgular: Medyan sağkalım, I.grupta 4,3 ay ve Hgrupta 5,8 ay bulundu. Semptomlardaki düzelme, lokal kontrol, NFC ve ECOG performans durumlanndaki düzelme süreleri ve genel sağkalımlan açısından tedavi şemaları arasında istatistiksel fark saptanmadı. Ancak 200cGy/20 fraksiyon grubunda hastalıksız sağkalımdaki düzelme veKPS'deki düzelme 300cGy/10 fraksiyon grubuna göre istatistisel olarak anlamlı olmak üzere daha iyi bulunmuştur(p=0.0399 ve p=0.014). Tek değişkenli analizde KPS£70 olması(p=0.0449),ECOG70, EC0G

Amaç: Evre IEl-A ve III-B küçük hücre dışı akciğer kanserlerinde hiperfraksiyone radyoterapi ile simültane kemoterapi şemasını, normo&aksiyone radyoterapi ile simültane kemoterapi şeması ile toksisite, tolerabilite, hastalıksız ve total sağkalım açısmdan karşılaştırmak. Gereç ve Yöntem: Nisan 1997-ocak 1999 tarihleri arasında, evre III-A ve III-B küçük hücre dışı akciğer kanserine sahip, Karnofsky performans durumu % 70'in üzerinde, son iki ayda kilosunun % 5 'inden daha fazlasını kaybetmemiş ve önceden herhangi bir tedavi görmemiş olan, toplam 40 hasta çalışmaya dahil edilmiştir. Hastalar iki gruba ayrılmıştır. Birinci guruba (n=20), 69.6 Gy hiperfraksiyone radyoterapi ile simültane cisplatin (50 mg/m2, tedavinin 1. ve 21. günlerinde), etoposide (150 mg, tedavinin 1, 2, 3. ve 21, 22, 23. günlerinde) kemoterapisi, ikinci guruba (n=20) 60 Gy normofraksiyone radyoterapi ile simültane aynı kemoterapi şeması uygulanmıştır. Kemoterapi, radyoterapinin bitiminden sonra 4 kür daha uygulanarak her iki tedavi grubunda da toplam 6 küre tamamlanmıştır. Olguların 37 tanesi erkek (% 92.5), 3 tanesi bayan (% 7.5) olup, yaşlan 33 ile 69 arasında değişmekteydi. Histopatolojik tümör tipine göre dağılım, % 70 skuamöz hücreli, % 15 adeno, % 2.5 büyük hücreli ve % 12.5 diğer küçük hücre dışı akciğer kanseleri şeklindedir. Olguların değerlendirilmesinde, fizik muayene, hemogram, biokimyasal testler, akciğer radyogramı, kompüterize tomografi ve biolojik tümör belirleyicileri kullanılmıştır. Bulgular: îki gurup arasında cevap oranlan belirgin derecede farklıydı. Median sağkalım, I. grupta 13 ay, II. grupta 10.5 ay olup, istatistiksel olarak anlamlı bir fark olduğu gözlemlenmiştir (P=0.02). Median hastalıksız sağkalım I. grupta 11.5 ay, ikinci grupta 8.5 ay olarak saptandı (P0.05). Histopatolojik tümör tipine göre her iki gurupta genel sağkalım süreleri karşılaştınldığmda, I. gruptaki skuamöz histolojiye sahip hastalar lehine istatistiksel olarak anlamlı bir farkın olduğu gözlenmiştir (P0.05). Also there was, a statistically significant total survival advantage for patients with squamous cell hystology in group I than patients with same hystology in group II (P

ÖZET Baş Boyun Kanserlerinin Değişik Tekniklerle Radyoterapisi Esnasında Radyasyon Dozlarının Gözlere Etkisinin Değerlendirilmesi Bu çalışmada Atatürk Üniversitesi Tıp Fakültesi Yakutiye Araştırma ve Uygulama Hastanesi Radyasyon Onkolojisi Anabilim Dalı'nda baş boyun kanserli hastaların radyoterapisi esnasında, gözlerin almış olduğu total doz, rando-fantom yardımı ile tespit edilmiştir. Bu çalışmada sekiz değişik türde baş boyun kanseri radyoterapisinin sonuçlan araştırılmıştır. (Larenks, orofarenks, oral cavity, nazofarenks, parous, maxiller sinüs, orbita ve tiroid). Radyoterapi protokolü olarak, Atatürk Üniversitesi Yakutiye Araştırma ve Uygulama Hastanesi Radyasyon Onkolojisi Anabilim Dalı'nda uygulanan protokol dikkate alınmıştır. Ölçümler rando-fantomda yapılmıştır. Araştırmanın sonucu olarak larenks, orofarenks, oral cavity ve tiroid kanserlerinin radyoterapisi esnasında gözlerin almış olduğu dozlar, katarakt oluşturmak için gerekli olan 400 cGy'lik total dozun altında çıkmıştır. Nazofarenks, parous, maxilller sinüs ve orbita kanserlerinin radyoterapisi esnasında gözlerin almış olduğu dozlar, katarakt oluşturmak için gerekli olan 400 cGy'lik dozun üstünde çıkmıştır. Bu sonuçlardan anlaşılacağı gibi, nazofarenks, parous, maxiller sinüs ve orbita kanserlerinin radyoterapisi sonucu hastalarda komplikasyon olarak gözlerde katarakt oluşması beklenen bir sonuç olduğu anlaşılmıştır. SUMMARY The Evaluation of The Effect of The Radiation Dose on The Eyes During Radiotherapy of Head and Neck Cancers by Different Technics The evaluation of the effect of radiation dose on the patient eyes during the radiotherapy of head and neck cancer was made with rando-phantom at the Radiation Oncology Service of the Yakutiye Hospital of Atatürk University. To carry out this study, radiotherapy of 8 different head and neck cancers were put in observation (Larynx, oropharynks, parous, nasopharynx, maxillary sinus, orbita and thyroid). The radiotherapy protocol was made in respect of the application of the Radiation Oncology Service of the Yakutiye Hospital of Atatürk University protocol. The measurements were made by rando-phantom. At the end of the research, it was observed that during the radiotherapy of the larynx, oropharynx, oral cavity and thyroid cancers, the total radiation dose on the eyes was below vaules causing cataract (below 400 cGy). During the radiotherapy of the nasopharynx, parous, maxillory sinus and orbital tumours the total radiation dose on the eyes was above at 400 cGy causing cataract. As a result, it appears that the radiotherapy of the nasopharynx, parous, maxillary sinus and orbital cancers is a cause of complication of cataract for the patient eyes. 33