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Öğe Development of second primary multiple myeloma five years after treatment for limited-stage small cell lung cancer: a rare case report(Via Medica, 2021) Eryilmaz, Melek Karakurt; Aykut, Talat; Korkmaz, Mustafa; Karaagac, Mustafa; Araz, Murat; Artac, MehmetIntroduction. The development of a second primary malignancy (SPM) following small cell lung cancer (SCLC) has been previously reported in the literature. Especially smoking-related malignancy coupling is well known. The development of multiple myeloma (MM) in long-term survivors after treatment for SCLC is unknown. Here, we report the first case in the literature who developed MM 5 years after treatment for limited-stage SCLC. Case report. A 67-year-old male patient was diagnosed with limited-stage SCLC. After he received chemotherapy and radiotherapy, he was followed up without medication. He was admitted to the hospital with back pain and dyspnea 5 years after the diagnosis of small cell lung cancer. MRI revealed osteolytic lesions in the vertebrae. Laboratory testing revealed a markedly elevated serum IgA and an elevated serum beta-2 microglobulin level. Serum immunofixation revealed IgA lambda-type M-protein. Lambda excretion in urine immunofixation electrophoresis was observed. Bone marrow aspiration revealed the frequency of plasma cells to be 80% of all nucleated cells. Hence, the final diagnosis revealed IgA lambda free light chain MM. Treatment was given for multiple myeloma. In the follow-up, the patient experienced increased dyspnea and developed bilateral pleural effusion. The cytology sent from thoracentesis sampling was reported as plasmocyte-rich material. The patient fell into a coma and died in an intensive care unit. Conclusion. We presented the development of MM 5 years after treatment in a patient with SCLC who were treated for one year and then followed up with stable findings. It should be kept in mind that a patient with SCLC who is a long-term survivor and presents with back pain may have developed a primary malignancy originating from bone marrow rather than a bone metastasis. Patients should be advised smoking cessation after the treatment and diagnosis of SCLC. Also, the patients with SCLC who are long-term survivors should be closely monitored for the development of SPM.Öğe Nakil poliklinikte takipte olup donör spesifik antikoru pozitifleşen renal transplantasyonlu hastalarda klinik ve biyokimyasal parametrelerin değerlendirilmesi(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2020) Aykut, Talat; Türkmen, KültiginAmaç: Bu çalışmada nakil polikliniğimizde takip ettiğimiz hastaların nakil öncesinde ve nakil sonrası takiplerinde bakılan DSA (Donör Spesifik Antikor) değerlerindeki değişimin, hastaların klinik ve biyokimyasal parametreleriyle ilişkisini değerlendirmeyi amaçladık. Yöntem: Nakil polikliniğinde takipli olan renal nakilli 45 hastanın dosyaları retrospektif olarak incelenerek demografik ve klinik özellikleri, nakil öncesi DSA değerleri, nakil sonrası DSA değerleri, transplantasyon öncesi rutin bakılan biyokimyasal parametreler ve dosyalara not alınmış anamnez bilgileri ile transplantasyon sonrası transplantasyon süreci ile ilgili dosyaya kaydedilmiş bilgiler ve biyokimyasal parametre değerleri kaydedildi. Nakil öncesi bakılan değerler preop, nakil sonrasında kreatinin değerinin stabilleştiği dönemdeki değerler postop ve ileri dönem poliklinik kontrollerinde nakil sonrası DSA bakılan dönemdeki biyokimyasal değerler takip değerleri olarak kaydedildi. İstatistik hesaplamalarında SPSS 25.0 versiyonu kullanıldı. p değeri 0.05’ten küçük ise; istatistik anlamlı kabul edildi. Bulgular: Nakil öncesi 21 hastanın donör spesifik antikoru negatif iken, 24 hastanınki pozitifti. Nakil sonrası 27±18. ayda değerlendirilen hastalardan 23’ünün donör spesifik antikoru negatif, 22’sininki pozitifti. Çalışmamızdaki 45 hastadan 7’sinde (%15.6) rejeksiyon gelişmiştir. Çalışmamızdaki hastalardan 9’unun nakil öncesi DSA değeri pozitifken nakil sonrası DSA değeri negatifleşmiştir. Bu gruptaki hastaların %22 sinde rejeksiyon gelişmiştir. 7’sinin ise nakil öncesi DSA değeri negatif iken nakil sonrası DSA pozitifleşmiştir. Bu hastaların %28 inde rejeksiyon gelişmiştir. 2 grubun karşılaştırmasında gruplar arasında anlamlı ilişki bulunamadı ( p=0,608) DSA değişimine göre GFR, kreatinin , sodyum, platelet ve proteinürideki değişim istatiksel olarak anlamlıydı. (p<0.05) Biyokimyasal parametrelerin postop ve takipteki değişim durumları rejeksiyon olan ve olmayan grupta karşılaştırıldı. GFR değişimi ve kreatinin değişimi istatiksel olarak anlamlı bulundu. (p<0.05) Rejeksiyon ile ilişkili bulunan faktörlerin değerlendirilmesi için v binominal lojistik regresyon analizi yapıldı. Takipteki GFR ve nötrofil değerleri bağımsız olarak rejeksiyon ile ilişkili saptandı. Sonuç: Çalışmamıza göre nakil öncesinde DSA pozitifliği veya nakilden sonra DSA pozitifleşen grupta rejeksiyon oranı daha yüksek olsa da istatiksel olarak anlamlı bulunmadı. Tüm çalışmalara rağmen böbrek nakilli hastalarda immünolojik monitorizasyonun HLA antikor gelişimi takibi ile yapılıp yapılamayacağı konusu hala net değildir. HLA antikor gelişimi rejeksiyon için risk olsa da hastaların bir kısmında antikor gelişmesine rağmen greft fonksiyonu normal seyretmektedir. Bu sebeple antikorların titresi, tipi, pozitifleşme zamanı ve uygulanan tedaviler ile olan ilişkileri için daha detaylı çalışmalar gerekmektedir.Öğe Sclerostin and TNF-related weak inducer of apoptosis: can they be important in the patients with glomerulonephritis?(Assoc Medica Brasileira, 2023) Ozer, Hakan; Baloglu, Ismail; Aykut, Talat; Demirci, Mehmet Ali; Aydemir, Fatma Humeyra Yerlikaya; Turkmen, KultiginOBJECTIVE: Sclerostin is a protein produced by osteocytes, kidneys, and vascular cells and has many effects on kidney and vascular structures. Soluble TNF-related weak inducer of apoptosis is a proinflammatory cytokine that may cause glomerular and tubular injury and increase sclerostin expression. This study aimed to investigate serum sclerostin and soluble TNF-related weak inducer of apoptosis levels in patients with glomerulonephritis and the effects they may be associated with.METHODS: This cross-sectional study included 93 patients, 63 of whom were glomerulonephritis and 30 were healthy controls. Serum sclerostin, soluble TNF-related weak inducer of apoptosis, and 24-h urinary protein excretion were measured, and pulse wave velocity was calculated for arterial stiffness.RESULTS: Serum sclerostin and soluble TNF-related weak inducer of apoptosis were higher in glomerulonephritis patients than in the control group, and serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were correlated with both proteinuria and pulse wave velocity. In addition, in the regression analysis, serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were found to be independent predictors of proteinuria in patients with glomerulonephritis.CONCLUSION: This is the first study to show that serum sclerostin and soluble TNF-related weak inducer of apoptosis are elevated in glomerulonephritis patients, and these two markers correlate with arterial stiffness and proteinuria in these patients. Considering the effects of sclerostin and soluble TNFrelated weak inducer of apoptosis in patients with glomerulonephritis, we think these mechanisms will be the target of both diagnosis and new therapies.Öğe Sclerostin and TNF-related weak inducer of apoptosis: can they be important in the patients with glomerulonephritis?(Assoc Medica Brasileira, 2023) Ozer, Hakan; Baloglu, Ismail; Aykut, Talat; Demirci, Mehmet Ali; Aydemir, Fatma Humeyra Yerlikaya; Turkmen, KultiginOBJECTIVE: Sclerostin is a protein produced by osteocytes, kidneys, and vascular cells and has many effects on kidney and vascular structures. Soluble TNF-related weak inducer of apoptosis is a proinflammatory cytokine that may cause glomerular and tubular injury and increase sclerostin expression. This study aimed to investigate serum sclerostin and soluble TNF-related weak inducer of apoptosis levels in patients with glomerulonephritis and the effects they may be associated with.METHODS: This cross-sectional study included 93 patients, 63 of whom were glomerulonephritis and 30 were healthy controls. Serum sclerostin, soluble TNF-related weak inducer of apoptosis, and 24-h urinary protein excretion were measured, and pulse wave velocity was calculated for arterial stiffness.RESULTS: Serum sclerostin and soluble TNF-related weak inducer of apoptosis were higher in glomerulonephritis patients than in the control group, and serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were correlated with both proteinuria and pulse wave velocity. In addition, in the regression analysis, serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were found to be independent predictors of proteinuria in patients with glomerulonephritis.CONCLUSION: This is the first study to show that serum sclerostin and soluble TNF-related weak inducer of apoptosis are elevated in glomerulonephritis patients, and these two markers correlate with arterial stiffness and proteinuria in these patients. Considering the effects of sclerostin and soluble TNFrelated weak inducer of apoptosis in patients with glomerulonephritis, we think these mechanisms will be the target of both diagnosis and new therapies.