Person: TOKUÇ, AYŞE GÜLNUR
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TOKUÇ
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AYŞE GÜLNUR
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Publication Open Access Ewing Sarcoma of the External Ear Canal(HINDAWI LTD, 2016) BİNNETOĞLU, ADEM; Binnetoglu, Adem; Baglam, Tekin; Tokuc, Gulnur; Binnetoglu, Kiymet Kecelioglu; Gerin, Fatma; Sari, MuratBackground. Ewing sarcoma (ES) is a high-grade malignant tumor that has skeletal and extraskeletal forms and consists of small round cells. In the head and neck region, reported localization of extraskeletal ES includes the larynx, thyroid gland, submandibular gland, nasal fossa, pharynx, skin, and parotid gland, but not the external ear canal. Methods. We present the unique case of a 2-year-old boy with extraskeletal ES arising from the external ear canal, mimicking auricular hematoma. Results. Surgery was performed and a VAC/IE (vincristine, adriamycin, cyclophosphamide alternating with ifosfamide, and etoposide) regimen was used for adjuvant chemotherapy for 12 months. Conclusion. The clinician should consider extraskeletal ES when diagnosing tumors localized in the head and neck region because it may be manifested by a nonspecific clinical picture mimicking common otorhinolaryngologic disorders.Publication Metadata only Outcome of ewing sarcoma in children, twenty years experience from a single center in Turkey(2017-09-01) EKER, NURŞAH; TOKUÇ, AYŞE GÜLNUR; TRUE, ÖMER; EKER N., YILMAZ B., TOKUÇ A. G., ŞENAY R. E., BERK B., DOĞRU Ö.Background/Objectives: Ewing sarcoma (ES) is the second common primary bone malignancy in pediatric patients. Usually, these tumors occur in bone but sometimes they can olsa orginate in soft tissue. These tumors are agressive and treatment involves multidurgs chemotherapy, radiotherapy and surgery. The aim of this study was to determine outcomes of Ewing sarcoma in pediatric patients who was treated in our instution. Design/Methods: This is a retrospective study of 75 pediatric patients with Ewing Sarcoma treated in between 1996 to 2016. Results: During a 20-year period, 75 patients were identified with Ewing Sarcoma in hospital database and their records were analyzed retrospectively. Of the 75 patients, 45 (60%) were males, 30 (40%) were females. The mean age was 10 years (ranging from 1year to 17 years). All of the patients had received the same chemotherapy protocol at presentation. This protocol involved ifosfamide, etoposide, vincristine, doxorubicine, cyclophosphamide and actinomycin. After 3 cycles of chemotherapy, surgery had been performed for most of the patients. Radiotherapy had been performed for the patients who had more than 10% viable cells after pathological examinations. For these patients, chemotherapy had been changed and continued during and after radiotherapy. The second chemotherapy protocol invoved vincristine, cyclophosphamide and topotecan. At the presentation, 22 (29 %) patients had metastatic disease. During the follow up 16 (23 %) patients had relapsed. The 5-year event free survival and overall survival were 46 % and 58,5 %. Metastatic disease at presentation was the significant factor on overall survival. Conclusions: The management of a child or adolescent with Ewing sarcoma is best carried out in a specialized center under the care of a multidisciplinary team, in order to obtain the best outcome for the patient. Early diagnosis is very important because metastatic disease at presentation reduces the overall survival.Publication Metadata only Hodgkin lenfomali olgularımızın değerlendi̇ri̇lmesi̇(2015-04-21) TOKUÇ, AYŞE GÜLNUR; ÖZGEN, ZERRİN; Tokuç A. G., Şenay R. E., Yılmaz B., Özgen Z.Publication Metadata only Investigation of Vitamin D Receptor Gene Polymorphism in Pediatric Patients with Brain Cancer(THIEME MEDICAL PUBL INC, 2017) KOÇ, AHMET; Yilmaz, Baris; Tokuc, Gulnur Ayse; Koc, Ahmet; Yesil, EdanurAim: In recent years, it is believed that Vitamin D may play a protective role in some cancer types. Certain regions of the Vitamin D receptor (VDR) gene may show a genetic difference in structure. The most frequent polymorphisms in this gene are in Taq-1, Fok-1, and Bsm-1 regions. Some adult cancer types are associated with VDR gene polymorphism such as; colorectal carcinoma, breast carcinoma, and prostate carcinoma. Reviewing the medical literature, no such study had been done on children so far. Materials and Methods: We investigated the association of the three most common gene polymorphisms (Taq-1, Fok-1, and Bsm-1 regions) in VDR gene in 32 children with brain tumors and forty control healthy volunteers. Results: We could not find any relationship between childhood brain tumors and VDR gene polymorphism in these three regions. Conclusion: The present results suggest that the Taq-1, Fok-1, and Bsm-1 polymorphism in the VDR gene and pediatric brain cancers have no association.Publication Metadata only Central nervous system tumors(2017-09-01) EKER, NURŞAH; TOKUÇ, AYŞE GÜLNUR; TRUE, ÖMER; YILMAZ B., EKER N., TOKUÇ A. G., DOĞRU Ö., ŞENAY R. E., BERK B.Background/Objectives: Central nervous system (CNS) tumors are the most common solid tumors in childhood. Our instution is the one of the major referral center for pediatric brain tumors in Turkey. We aimed to analyzed children with brain tumors who were diagnosed and treated at our center in this study. Design/Methods: This is a retrospective study of 96 pediatric patients with brain tumors treated in between 2009 to 2017. Sixteen patients were lost to follow-up and 80 patients were included in the analysis. Demographic informations, histologic subtypes, stage at diagnosis, treatment modalities and outcomes were evaluated, retrospectively. Results: Of the 80 patients, 42 (52.5%) were males, 38.5 (47.5%) were females. The mean age was 6.8 ± 4.6 years (ranging from 0.17 years to 15.5 years). The mean duration of follow up was 30 months. Mean survival time was 71.4 months (95% CI: 61.8 - 80.9). The most common localization was the infratentorial area (38.8%). Among all of the patients, gliomas are the most common histologic form (54 %) and 51,3% had grade IV stage for WHO. Five-year overall survival (OS) is 68 %. The most important factor for OS was tumor total resectabity. Total resectable patients OS was 81% vs gross total resection (GTR) was 49.5% vs partial resection was only 28% within 5 years. The children with diffuse infiltrative pontine glioma (DIPG) and atypical teratoid/rhabdoid tumor (AT/RT) had the worst prognosis and these patients died in the first year of their treatment. Conclusions: In developing countries, as the use of molecular studies could not be routinely performed in clinical practice. Brain tumors are relatively common cancers among children.usually the first and the most important step in therapy. Patients with the most complete resection have significantly longer survival despite all of the technological advances.Publication Metadata only Pelvik ve alt ekstemite yerleşimli ewing sarkomlu olgularımızda tedavi sonuçlarımız(2017-04-23) ÖZGEN, ZERRİN; EROL, BÜLENT; TOKUÇ, AYŞE GÜLNUR; EKER, NURŞAH; Özgen Z., Erol B., Tokuç A. G. , Alan Ö., Eker N., Gül D.Publication Metadata only Polisomnografi aracılığıyla tanı alan bir nöroblastom olgusu(2019-10-11) ERGENEKON, ALMALA PINAR; ERDEM ERALP, ELA; GÖKDEMİR, YASEMİN; EKER, NURŞAH; TOKUÇ, AYŞE GÜLNUR; KARADAĞ, BÜLENT TANER; YILMAZ YEĞİT C., ERGENEKON A. P., ERDEM ERALP E., GÖKDEMİR Y., EKER N., TOKUÇ A. G., KARADAĞ B. T.Publication Metadata only Rabdomyosarkom dışı yumuşak doku tümörlerimiz(2019-04-21) TOKUÇ, AYŞE GÜLNUR; EKER, NURŞAH; ŞENAY R. E., TOKUÇ A. G., YILMAZ B., EKER N.İRİŞ: Yumuşak doku sarkomları, çocuklardaki tüm malignitelerin %6’sını, solid tümörlerin ise %20’sini oluşturur. İskelet kasına farklılaşma yeteneğine sahip mezenkimal hücelerden kaynaklanan rabdomyosarkom (RMS) ve yine primitif mezenkimal dokulardan gelişip heterojen malign hücrelerden oluşan RMS dışı yumuşak doku tümörleri olmak üzere iki grupta incelenir..Çocukluk çağı solid tümörlerinin yaklaşık %3 ünü oluşturan bu nadir tümör grubu en çok 5 yaş altında görülür, lokal invazyon ile lokal rekürrens sıktır ve bu tümörlerin erkeklerde görülme sıklığı 1.2 kat artmıştır. Bu çalışmada, kliniğimizde takip ve tedavi ettiğimiz RMS dışı yumuşak doku sarkomlarımızın özellik ve prognozlarını retrospektif olarak incelemeyi amaçladık MATERYAL-METOT: Çalışmamızda Aralık-2012 ile Ocak-2019 tarihleri arasında merkezimizce tedavi ve takip edilen RMS dışı yumuşak doku sarkom tanılı 17 hasta retrospektif olarak incelenmiştir. BULGULAR: Hastalarımızın yaş ortalaması 97 aydır ve erkek/ kız= 7/10 dur. Patolojik tanıları ; 3 fibrosarkom, 3 synovial sarkom, 2 malign periferik sinir kılıfı tümörü, 2 indiferansiye sarkom, ve birer olgu olarak jüvenil ksantogranülom, lipoblastom, liposarkom, primitif miksoid mezenkimal tümör, iğsi hücreli sarkom, anjiosarkom ile alveoler yumuşak doku sarkomu şeklindedir. Tanı anında tüm sinovial sarkomlu hastalar, bir malign periferik sinir kılıfı tümörü, bir jüvenil ksantogranülom ve bir fibrosarkom tanılı hasta olmak üzere toplamda 6 (%35.2) hastanın metastatik olduğu saptanmıştır. Tedavide 4 (%23.5) hastamıza sadece cerrahi uygulanmış ve ek tedavi gerekmemiştir. Cerrahi ile beraber 6 (%35.2) hastamıza sadece kemoterapi, kalan 7 (%41.1) hastamıza bunlara ek olarak radyoterapi de verilmiştir. Takipte, tedavi kesiminden ortalama 5.3 ay sonra 3 (%17.6) hastamız nüks etmiştir . Halen tedavisi devam etmekte olan 4 hastamız mevcut olup üç hasta ex olmuştur. Ex olanların ikisi başta metastatik olan hastalardır ve nüksten sonra kaybedilmişlerdir. On hastamız tam remisyonda olarak izlenmektedir. SONUÇ: RMS dışı yumuşak doku sarkomları histopatolojik olarak çok geniş bir spektrumdadır. En yaygın alt türler pediatrik yumuşak doku sarkomlarının %10’unu oluşturur. Prognoz hastalığın evresine, tümörün histolojik alt tipine, tümörün büyüklüğüne ve rezeksiyonun derecesine bağlıdır. Metastaz varlığı hastalığı yüksek risk grubuna sokar; bu grubun sağ kalım oranı yaklaşık %15’tir. Bizim hasta grubumuzda da 6 hastanın tanı anında metastatik olduğu görülmüştür. Tedavi planı olarak cerrahi ile beraber kemoterapi ve radyoterapi uygulanan bu hastalardan 2 tanesi takipte nüks sonrasında kaybedilmiştir. Bu bilgi, literatür bilgisi ile uyumludur ancak olgu sayımızın azlığı istatistiksel analizlerimizi zorlaştırmaktadır. Tanı anında tümör çapının >5 cm olduğunun bilinmesi veya rezeke edilemeyen tümöre sahip metastatik olmayan hastalık varlığı RMS dışı yumuşak doku sarkomları orta risk grubuna sokmaktadır ve bu grupta beş yıllık sağ kalım oranı %50 olarak bildirilmiştir. Bizim 17 hastalık serimizden 7 tanesi bu gruba girmektedir ki henüz bu grupta kaybedilmiş vakamız yoktur. Literatür bilgisi, tanı anında tam rezeke edilebilen tümör varlığı ile yine tanı anında metastaz olmaksızın <5 cm boyutundaki kitle boyutunun varlığı hastalığın düşük risk grubuna girdiği şeklindedir. Düşük risk hasta grubunda beş yıllık sağ kalımın %90’larda olduğu belirtilmektedir. Bizim vaka serimizde sadece 4 hasta bu gruba dahil olmuştur. Tedavi olarak sadece cerrahi yapılan bu hasta grubunda tüm hastalarımız yaşamlarına hastalıksız devam etmektedir. Hastanın risk grubu belirlenirken tümörün histolojisinin de önemli olduğu bilinmelidir ve yüksek dereceli tümörlerde prognozun daha kötü olduğu şeklinde literatür bilgisi mevcuttur. Literatürde büyük vaka serilerinde RMS dışı yumuşak doku tümörlerinde histolojik alt tiplere göre ayrıntılı sağ kalım verilebilmektedir ancak bizim az sayıdaki vaka serimizde genel olgu sayısının azlığı, hasta grubunun çok farklı tanılardan oluşması ile birlikte her bir tanıdaki hasta sayısındaki yetersizlik nedeni ile ayrıntılı istatistiksel analiz yapılamamaktadır.Publication Metadata only Post-traumatic stress disorder in mothers of children who have undergone cancer surgery(WILEY, 2017) TOKUÇ, AYŞE GÜLNUR; Cerit, Kivilcim Karadeniz; Cerit, Cem; Nart, Omer; Eker, Nursah; Kiyan, Gursu; Dagli, Tolga; Ekingen, Gulsen; Tokuc, Gulnur; Karaca, Omer; Corapcioglu, FundaBackgroundThe aim of this study was to investigate the rate of post-traumatic stress disorder (PTSD) and associated risk factors among mothers of children who underwent cancer surgery. MethodThis cross-sectional, multi-center study included a total of 60 mothers whose children underwent major thoraco-abdominal surgery and were under follow up in the outpatient setting between February 2016 and May 2016. Clinical Data Form, Hospital Anxiety and Depression Scale (HADS), and Clinician-Administered PTSD scale were used. ResultsOf all participants, 13 (21.7%) were diagnosed with PTSD. These mothers had shorter duration of marriage, longer duration of hospital stay after surgery, and higher HADS scores, compared with the others without PTSD. Thoughts of guilt such as I am being punished or tested were more frequent in mothers with PTSD. Insomnia, irritability, concentration problems, and psychological reactivity were the most common symptoms. ConclusionPost-traumatic stress disorder is a severe disorder that may worsen the daily functioning of mothers and may also have an unfavorable effect on child. It is therefore of utmost importance for clinicians to recognize PTSD and the associated risk factors in order to guide these parents.Publication Metadata only The diagnostic value of soluble urokinase plasminogen activator receptor compared with C-reactive protein and procalcitonin in children with febrile neutropenia(TAYLOR & FRANCIS INC, 2016) KOÇ, AHMET; Sirinoglu, Melis; Soysal, Ahmet; Karaaslan, Ayse; Kadayifci, Eda Kepenekli; Cinel, Ismail; Koc, Ahmet; Tokuc, Gulnur; Yaman, Ali; Haklar, Goncagul; Sirikci, Onder; Turan, Serap; Gelmez, Gulsen Altinkanat; Soyletir, Guner; Bakir, MustafaThe aim of the present study was to determine the diagnostic value of soluble urokinase plasminogen activator receptor (suPAR) in pediatric patients with febrile neutropenia. A prospective case-control study was performed. Patients included 29 children with febrile neutropenia (FN) and 27 control subjects without any infection or immunosuppressive condition. Blood samples were obtained on the day of admission and on the 4th to 7th days of the hospital stay. The median (minimum-maximum) serum levels of suPAR obtained on the first day of the admission were 2.08 (0.93-9.42) and 2.22 (1.08-5.13) ng/mL for the FN group and the control group, respectively. The median serum levels of suPAR in the FN and control groups were not significantly different (P=.053). The mean serum suPAR level was significantly higher in nonsurvivors than in survivors in the FN group (P<.05). In the FN group, the area under the receiver operating characteristics curve (AUCROC) for suPAR was 0.546, but no optimum cutoff value, sensitivity, specificity, negative predictive value (NPV), or positive predictive value (PPV) was obtained. We conclude that suPAR is not useful as a diagnostic biomarker in children with febrile neutropenia; however, persistent high serum suPAR level may predict mortality in FN in children.