Background: COVID-19 may predispose to thromboembolism due to excessive inflammation, hypoxia, and immobilization. We investigated whether these antithrombotic drugs are useful or harmful to tackle COVID-19 and which laboratory parameters are more usable for this purpose. Materials and methods: In our study, patients diagnosed with COVID-19 while using antithrombotic drugs and COVID-19 patients who did not use antithrombotic drugs were compared. Demographic data, laboratory values, clinical results, duration of hospital stay, and mortality were noted and compared. Results: The study was conducted on 236 patients admitted to the emergency department. The mean value of creatine, LDH, PT, NLR, troponin, and ferritin were higher in the drug-using group. Home quarantine and hospitalization rate was 68.8% (n = 33) in antiplatelet users, and 46.2% (n = 6) in the anticoagulant group. Conclusion: The difference between the groups may have been caused by the number of chronic diseases and polypharmacy. The interaction of drugs used for the treatment of COVID-19 with antithrombotic agents is unknown. In addition, as the correlation between COVID-19 and thrombosis is not exactly known, adding antithrombotic drugs to the treatment of the disease is controversial. In our study, the biomarkers used to predict prognosis were worse in COVID-19 patients who continued antithrombotic therapy at the therapeutic dose. In the case of antithrombotic agents, the risks that may arise should always be considered. We recommend monitoring routine blood parameters, especially NLR, LDH, PT, APTT, troponin, and ferritin levels, for the prognosis monitoring of COVID-19 patients who will continue their current antithrombotic therapy

Objective: Castleman disease (CD) is a rare disease also known as angiofollicular lymph node hyperplasia. The two main histological subtypes are the hyaline vascular and plasma cell variants. It is further classified as unicentric CD (UCD) or multicentric CD (MCD) according to the anatomical distribution of the disease and the number of lymph nodes involved. The aim of this multicenter study was to evaluate all cases of CD identified to date in Turkey to set up a national registry to improve the early recognition, treatment, and follow-up of CD. Materials and Methods: Both adult (n=130) and pediatric (n=10) patients with lymph node or involved field biopsy results reported as CD were included in the study. Patients' demographic information, clinical and laboratory characteristics, imaging study results, treatment strategies, and clinical outcomes were evaluated retrospectively. Results: A total of 140 patients (69 male and 71 female) with a diagnosis of UCD (n=73) or MCD (n=67) were included. The mean age was 39 years in the UCD group and 47 years in the MCD group. Female patients were more common in the UCD group. The most common histological subtype was hyaline vascular for both UCD and MCD patients. Asymptomatic patients were more common in the UCD group. Anemia, elevations of acute phase reactants, and hypoalbuminemia were more common in the MCD group. The most commonly used treatment strategies for UCD were surgical excision, rituximab, and radiotherapy, respectively. All UCD patients were alive at a median of 19.5 months of follow-up. The most commonly used treatment strategies for MCD were methyl prednisolone, R-CHOP, R-CVP, and rituximab. Thirteen MCD patients had died at a median of 34 months of follow-up. Conclusion: This study is important in presenting the patient characteristics and treatment strategies for CD from Turkey, with the potential of increasing awareness about CD. Treatment data may help in making decisions, particularly in countries that do not have access to siltuximab. However, larger prospective studies are needed to make definitive conclusions.

Background/aim Thrombocytopenia is a common complication following hematopoietic stem cell transplantation (HSCT). Eltrombopag has been used in thrombocytopenia treatment after HSCT in recent years. Herein, we present our experience of 25 patients treated with eltrombopag for post-HSCT thrombocytopenia. Materials and methods Fifteen autologous hematopoietic stem cell transplantation (AHSCT) and 10 allogenic hematopoietic stem cell transplantation (allo-HSCT) recipients treated with eltrombopag for treatment of prolonged isolated thrombocytopenia (PIT) or secondary failure of platelet recovery (SFPR) in the stem cell transplantation unit of Hacettepe University Hematology Department between 2017 and 2021 were included in the study. The primary endpoint of this study is eltrombopag response in patients diagnosed with PIT or SFPR. Platelet count above 50,000/mm3 for five consecutive days without platelet transfusion was considered as eltrombopag response. Overall survival (OS) analyses were calculated based on the time between HSCT and death from any cause. The patients who were alive at the last follow-up were censored at this time for calculation of OS analyses. Results AHSCT (66.7% (10/15)) and allo-HSCT (50% (5/10)) recipients responded to eltrombopag for the treatment of post-HSCT thrombocytopenia. There was no excess toxicity related to the eltrombopag use. The median response duration of allo-HSCT recipients and AHSCT recipients were 41 (13–104) days and 50 (7–342) days, respectively. There was a statistically significant OS duration difference between the responders and nonresponders in allo-HSCT and AHSCT recipients with p values of 0.005 and 0.02, respectively. Conclusion Eltrombopag is promising for the treatment of thrombocytopenia after AHSCT and allo-HSCT in terms of efficacy and safety.

Background/aim: The disease caused by SARS-CoV-2 was named as COVID-19. There is as yet insufficient information about the effects of HSCT on the clinical course of COVID-19. In the present study, we aimed to investigate the clinical course of COVID-19 in patients who had undergone HSCT. Materials and methods: We analyzed baseline characteristics, clinical course and findings of COVID-19, hospitalization and death rates, overall survival, and case fatality rates of HSCT recipients diagnosed with COVID-19 retrospectively. Results: 57.6% of the patients underwent AHSCT, and 42.4% underwent allo-HSCT. 60.6%, 27.3%, and 12.1% of the patients had mild, moderate, and severe COVID-19 or critical illness, respectively. Overall, 45.5% were hospitalized, 12.1% required intensive care, and 9.1% necessitated invasive mechanical ventilation. The total CFR was 9.1% in HSCT recipients, 22.2% in patients with active hematologic malignancy, and 4.2% in patients without active hematologic malignancy. Conclusion: It can be concluded that mortality of HSCT recipients is lower in patients whose primary disease is in remission compared to ones that are not in remission. Further studies with larger group patients are needed in order to delineate the effects of COVID-19 on HSCT patients.

BACKGROUND:Autologous stem cell transplantation (ASCT) is one of the standard treatments of choice for eligible multiple myeloma (MM) patients. Herein, we aimed to analyze MM patients at our center and compare the clinical outcomes of single and double ASCT patients.MATERIALS AND METHODS:Patients who were diagnosed as having MM and had undergone single or double ASCT in our clinic between the years 2003 and 2020 were retrospectively examined.RESULTS:In this study, the median time of second ASCT is approximately 3.6 years from the first ASCT. Overall survival (OS) duration of the single and double transplanted groups was 4,011 ± 266 vs 3,526 ± 326 days, respectively (p: 0.33). Progression-free survival (PFS) duration of the single and double transplanted groups was 2,344 ± 228 vs 685 ± 120 days, respectively (p: 0.22). Disease assessment after ASCT stable or progressive disease, partial remission, and very good partial or complete remission (CR) in single and double ASCT groups was 62/44/105 and 8/4/5, respectively (p: 0.22).CONCLUSION:The present study points out that the second ASCT treatment option for MM patients may not be effective as suggested, especially in the era of novel MM drugs, since our results come from the past data that novel drugs were not exist. In conclusion, we found no benefit with second ASCT in MM patients in terms of PFS and OS or CR rates, and the novel anti-myeloma drugs might decrease the need for a second transplant.

Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China; and spread all over the world. Reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 usually returns to negative in 20 days post-infection, but prolonged positivity has been reported up to 63 days. A case whose viral shedding lasted 60 days is reported from China. Herein we report a patient with a history of autologous stem cell transplantation (ASCT) for lymphoma whose RT-PCR test remained positive for SARS-CoV-2 for 74 days. The prolonged RT-PCR positivity, despite convalescent plasma infusion, may suggest that the given antibodies may be ineffective in terms of viral clearance. In patients with hematological malignancies or immunosuppression, such as ASCT, may lead to prolonged viral shedding, and strict isolation is warranted for long-term SARS-CoV-2 infection control.

During the ongoing COVID-19 pandemic due to the SARS-CoV-2 virus of which evidence-based medical paradigms cannot be easily applied; difficult clinical decisions shall be required particularly in the 'difficult-to-treat' cases of high risk group with associated comorbidities. Convalescent immune plasma therapy is a promising option as a sort of 'rescue' treatment in COVID-19 immune syndrome, where miraculous antiviral drugs are not available yet. In this report, we aim to convey our experience of multi-task treatment approach with convalescent immune plasma and anti-cytokine drug combination in a COVID-19 patient with extremely challenging comorbidities including active myeloid malignancy, disseminated tuberculosis and kidney failure.

Acute myeloid leukemia (AML) usually seen in the elderly. The quest for effective, tolerable and durable response for the treatment of elderly or frail patients with AML resulted venetoclax combination. The aim of this study was to present here the experience and data for the use of venetoclax in combination with azacitidine in elderly or frail and unfit patients with relapse/refractory AML treated outside of a clinical trial. We retrospectively analyzed 30 consecutive elderly (≥ 65 years old) or frail patients with relapse/refractory AML, who failed at least one prior therapy for AML and treated with venetoclax in combination with 5-azacitidine at five institutions in Turkey between December 2018 - Januarry 2020. The patients were taken venetoclax at dose of 400 mg daily, and 75 mg/m2/day azacitidine subcutaneously for 7 days per 28-day cycle. Complete remission (CR), incomplete blood count recovery (CRi), PR, overall survival (OS) and event free survival (EFS) were assessed. A total of 30 patients with a median age of 67 (range= 33-84) from 5 differ- ent centers were included in the final analysis. Overall response rate (ORR) was 63.3% (n= 19); 15 (50%) patients achieved CR or CRi and 4 (13.3%) patients achieved PR while 11 patients (37.7%) did not respond to therapy. Median 8 months follow-up, 6 months OS rate 66.7%, 1-year OS rate was 19.8% with a median OS was 7 months (95% CI: 7.8 -10.1). The mortality risk of patients under 60 is statistically significantly lower than those over 60 (p= 0.007, HR: 0.109 (95% CI: 0.022 - 0.55). Combination of venetoclax + HMA in patients with relapse refractory AML with poor performance score, it provided somewhat higher response rates and additionally, the responding patients benefited surival advantage when compared to non-responding patients. Keywords: AML, Elderly, Venetoclax, Azacitidine, Survival

İntrakraniyal dermoid kistler, tipik radyolojik görüntüleme özelliklerine sahip nadir lezyonlardır.Genellikle asemptomatik ve tesadüfen ortaya çıkarlar

Conventional karyotyping in the patients with Multiple myeloma (MM) is very important. Because chromosomal abnormalities which detected in these patients have diagnostic and prognostic value. In this retrospective study we aim to evaluate cytogenetic abnormalities in 133 MM patients which diagnosed at the Hematology Department of Hacettepe University. Samples were treated with trypsin and stained with Giemsa (GTG banding). 20 metaphases of each patient were examined and karyotypes were formed. Cytogenetic results of the patient’s bone marrow samples were not obtained in 19 patients, while in 116 patients karyotyping was performed. Among of these 116 patients showed that 80 patients had normal karyotpe while 34 patients had abnormal karyotypes. Both numerical and structural chromosomal anomalies were detected in patients with abnormal karyotype. Numerical and structural anomalies of chromosomes 1, 9, 16 and 13 were detected most frequently among these complex karyotypes. The anomalies we found in our patient group were consistent with the literature.

Choroidal fissure cysts are often incidentally discovered. They are usually asymptomatic. The authors report a case of growing and hemorrhagic choroidal fissure cyst which was treated surgically. A 22-year-old female presented with headache. Cranial MRI showed a left-sided choroidal fissure cyst. Follow-up MRI showed that the size of the cyst had increased gradually. Twenty months later, the patient was admitted to our emergency department with severe headache. MRI and CT showed an intracystic hematoma. Although such cysts usually have a benign course without symptoms and progression, they may rarely present with intracystic hemorrhage, enlargement of the cyst and increasing symptomatology.

BACKGROUND/AIM Posterior cervical laminoforaminotomy is an effective surgical treatment in selected cases of cervical radiculopathy caused by posterolateral herniated discs or foraminal stenosis. The aim of the present study was to evaluate the surgical techniques, rates of complications, long-term outcomes, advantages, and disadvantages of keyhole foraminotomy retrospectively. MATERIALS AND METHODS Keyhole foraminotomy was performed in 83 patients. In 51 patients (61.5%) soft disc herniation was removed, and in 32 of them (38.5%) osteophytes were evident. The clinical data were evaluated according to Odom's criteria, and the mean follow-up time was 6 months. RESULTS Postoperative results were classed as excellent in 66 patients (79.5%), good in 13 patients (15.7%), fair in 3 patients (3.6%), and poor in only 1 patient (1.2%). Radiculopathy symptoms regressed in 79 patients (95%). Among the 83 patients, surgical complications (dural injury and level error) were noted in 2 patients (2.4%). CONCLUSION Posterior laminoforaminotomy is applied to selected patients with a low complication rate. The advantages of this surgery are suitable visualization of the nerve root, preserved motion of the operated segment, avoidance of cervical instability, and a decrease in the length of hospital stay.

AIMThe function of the circle of Willis, an arterial polygon, is to protect the brain from ischemia. The aim of this study is to define the structural characteristics of the circle of Willis within the Turkish adult population, along with variations and arteries involved in the measurement of diameters and lengths on cadavers.MATERIAL AND METHODSThe circle of Willis was evaluated in 100 fresh adult cadavers. Structures of the circle of Willis were evaluated as being typical or atypical images and according to the diameter of AComP. All arteries forming the circle's length and diameters were measured.RESULTSAll arteries forming the circle of Willis as 91% were anatomically observed. The typical structure in which hypoplasia arteries is not involved was obtained as 8%. The atypical circle of Willis with aplasia was seen as 9%. 87% of adult, 9% fetal, and 4% transitional configuration in the samples were detected. The variations of the circle of Willis were more common in the posterior portion. Hypoplasia was found to be the most common variation and noted as a maximum in AComP (85%). Aplasia was noted as the second most common variation after hypoplasia and again the most common in AComP (5%).CONCLUSIONAdvances in radiological methods which provide images of cerebral vessels and the development of cerebrovascular surgery have increased the importance of the circle of Willis in neurosurgery and neurology. The structure of the circle of Willis is of great importance in occlusive cerebrovascular diseases and cerebrovascular surgery.

Previous studies have reported the possible contribution of a primitive variant of the basal vein of Rosenthal (BVR) in the cause of idiopathic subarachnoid hemorrhage (ISAH). The purpose of this study was to assess the drainage patterns of the BVR among ISAH patients. The venous phase at cerebral angiography was retrospectively analyzed in 19 patients with ISAH and then compared with patients with unruptured aneurysms as controls. A relationship was found between ISAH and the presence of a primitive variant. However, the venous configuration effect on bleeding is still unknown.

BACKGROUND: Cerebral ischemia is a cause of serious morbidity and mortality. Strategies that would protect cerebral tissue against ischemic injury are important. The present study aimed to evaluate effects of surgical and medical treatments, either alone or in combination, on infarction area in an experimental rat model of cerebral ischemia.METHODS: Adult male Sprague-Dawley rats (n=30) were divided into 6 groups, each including 5 experimental animals. Cerebral ischemia was created by right common carotid artery occlusion (CCAO) under anesthesia. Decompressive craniectomy (DC) was performed in the relevant groups at the 12th hour following CCAO, whereas medical treatments were performed in the relevant groups at the 1st, 12th, and 24th hours following CCAO. After CCAO, the control group received 1 mL/kg physiological saline, hypertonic saline (HS) group received 3% hypertonic saline (1 mL/kg), and mannitol (MAN) group received 20% mannitol (1 g/kg). While only DC was performed following CCAO in the DC group, DC+HS group underwent DC together with hypertonic saline treatment and DC+MAN group underwent DC together with mannitol treatment. The rats were decapitated at the end of the 24th hour following ischemia. Cerebral sections were stained with 2% 2,3,5-triphenyltetrazolium chloride (TTC). The ratio of infarction area to the total area of section was calculated as percentage.RESULTS: Mean infarction areas were 27.9% in the control group, 13.7% in the HS group, 15.1% in the MAN group, 10.6% in the DC group, 8.1% in the DC+HS group, and 9.7% in the DC+MAN group. Mean infarction areas were significantly lower in all groups than in the control group. While the mean infarction area did not differ between the HS and MAN groups, it was lower in the groups undergoing DC as compared to these two groups. The best outcome was observed in the DC+HS group.CONCLUSION: Both medical and surgical treatments were effective in decreasing cerebral ischemic infarction. There was no difference between medical treatments groups in terms of efficacy, whereas DC led to a substantial decrease in ischemic infarction volume as compared with the medical treatment groups. Combined treatment approaches performed to decrease infarction volume also resulted in favorable outcomes.

Background: The circle of Willis is a major collateral pathway important in ischemic conditions. The aim of our study was to assess the structural characteristics of the circle of Willis within the Turkish adult population, along with variations and arteries involved in the measurement of diameters and lengths on cranial computed tomography angiography (CTA).Material/Methods: One hundred adult patients who underwent CTA images were evaluated retrospectively.Results: Results of the study revealed 82% adult, 17% fetal, and 1% transitional configurations. A complete polygonal structure was observed in 28% of cases. Variations of the circle of Willis were more common in the posterior portion. Hypoplasia was found to be the most common variation and was observed as a maximum in the posterior communicating artery (AComP).Conclusions: The patency and size of arteries in the circle of Willis are important in occlusive cerebrovascular diseases and cerebrovascular surgery. Although CTA is an easily accessible non-invasive clinical method for demonstrating the vascular structure, CTA should be evaluated taking into account image resolution quality and difficulties in the identification of small vessels.

Herniated lumbar discs presenting with cauda equina syndrome are rare. This is a case report of a patient with lumbar herniated disc presenting with partial cauda equina syndrome. The patient applied to our department with perianal hypoesthesia and sphincter disfunction without motor deficit and sciatica. Santral disc herniation was determined on level of L5-S1 and patient was operated. Cauda equina syndrome needs urgent diagnosis and surgical treatment. The patients may apply with just some of the symptoms of the cauda equina syndrome as our patient.

ÖZETSpinal metastaz malignitelerde sık görülen bir bulgu olmasına rağmen intradural ekstrameduller