Hacettepe Üniversitesi Açık Erişim Sistemi (HÜAES)
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PROSTAT KANSERİNDE SİSTEMİK TEDAVİ YANIT DEĞERLENDİRİLMESİNDE Ga-68 İŞARETLİ PSMA PET-BT İLE BİYOKİMYASAL BELİRTEÇLERİN ROLÜ VE PROGNOSTİK ÖNEMİ
(Tıp Fakültesi, 2026) Oğuz Kodaz; Nükleer Tıp
Kodaz O. The Role and Prognostic Significance of Ga-68 Labeled PSMA PET/CT and Biochemical Markers in the Assessment of Systemic Treatment Response in Prostate Cancer, Hacettepe University Faculty of Medicine, Department of Nuclear Medicine, Thesis of Residency, Ankara, 2026. Prostate cancer is the second most common cancer in men, and accurate assessment of treatment response in the metastatic stage is critically important for patient management. Although serum prostate-specific antigen (PSA) is the principal biomarker for monitoring treatment response, it may be limited in reflecting the true tumor burden, particularly in the castration-resistant stage. Ga-68 labeled PSMA PET/CT, on the other hand, is a powerful imaging modality capable of demonstrating tumor burden at the volumetric and molecular levels. The aim of this study is to determine the role of PSMA PET/CT and biochemical markers such as serum PSA in the assessment of response to chemotherapy and radionuclide therapy in metastatic prostate cancer, the relationship of these parameters with one another, and their prognostic significance. This retrospectively designed study included three patient groups: patients with de-novo metastatic hormone-sensitive prostate cancer (mHSPC) receiving androgen deprivation therapy and docetaxel (Group A, n=49); patients with metastatic castration-resistant prostate cancer (mCRPC) receiving docetaxel chemotherapy (Group B, n=26); and patients with mCRPC receiving 177Lu-PSMA radionuclide therapy (Group C, n=96). In all cases, semiquantitative parameters obtained from pre- and post-treatment PSMA PET/CT, primarily total tumor volume (TTV), and serum PSA levels were recorded; treatment response was evaluated using the RECIP 1.0, PSMA PET Progression (PPP), and PCWG3/PCWG4 criteria together with serum PSA response criteria. The agreement (concordance-discordance) between imaging response and PSA response and the relationship of these parameters with overall survival were investigated. Our findings demonstrated that in the hormone-sensitive stage, in which the disease is highly responsive to treatment, there was a high degree of concordance between serum PSA changes and PSMA PET parameters, with discordance remaining low. However, as the disease progressed to the castration-resistant stage, this agreement was markedly disrupted; this suggested that tumor biology changes in mCRPC cases and that PSA may be insufficient to reflect the true tumor burden. In patients with discordance, PSMA PET response was found to be determinant for survival. A positive correlation between PSA and TTV changes was observed in patients receiving systemic therapy, particularly in the group receiving radionuclide therapy. PSMA PET-based response criteria that jointly consider volumetric change or the development of new lesions were found to provide more comprehensive information compared with assessments based solely on clinical and PSA data. In conclusion, particularly in the mCRPC stage, routinely evaluating PSMA PET/CT before making PSA-based treatment-change decisions is important for excluding pseudoprogression and for detecting early relapse before PSA progression develops. These retrospective findings need to be supported by multicenter and prospective studies involving larger patient cohorts.
Primer Biliyer Kolanjit Hastalarında Miyopati Varlığının Değerlendirilmesi
(Tıp Fakültesi, 2026-10-15) Şahin, Yiğit Berk; Balaban, Hatice Yasemin; Apraş Bilgen, Şaziye Şule; Pınar, Aslı; Yıldız, Adalet Elçin; Dağ, Osman; Atay, Beyza; Kart Bayram, Gözde Sevgi; Üçdal, Mete Tuğcan; İç Hastalıkları
Şahin, YB., Evaluation of the Presence of Myopathy in Patients with Primary Biliary Cholangitis, Hacettepe University Faculty of Medicine, Internal Medicine Specialty Thesis. Ankara, 2026 Primary biliary cholangitis (PBC) is a cholestatic liver disease characterized by chronic autoimmune destruction of the intrahepatic bile ducts. The mechanisms underlying fatigue, a symptom that substantially impairs patients’ quality of life, have not yet been fully elucidated. Recent reports of myopathy associated with antimitochondrial antibodies have suggested that muscle involvement may occur in PBC. This study aimed to evaluate the presence of myopathy in patients with PBC, identify clinical features associated with muscle involvement, and investigate its potential relationship with carnitine metabolism.
A total of 61 patients who were followed at Hacettepe University, the Department of Gastroenterology and diagnosed with PBC according to the European Association for the Study of the Liver (EASL) criteria were prospectively enrolled. The patients’ demographic characteristics, fatigue symptoms, neurological examination findings, laboratory results, and biomarkers of myopathy were evaluated. Further investigations, including serum carnitine profile analysis, were conducted both to investigate the potential etiology of muscle involvement and to identify possible therapeutic targets.
Biochemical and serological findings potentially consistent with myopathy were detected in two patients. Magnetic resonance imaging findings consistent with myopathy were detected in these patients suspected of having muscle involvement. Furthermore, there were differences in carnitine metabolism both between the healthy population and patients with PBC, and between PBC patients with and without muscle involvement. Our findings suggest that myopathy is a rare extrahepatic manifestation of PBC, that is overlooked in patients with fatique. Further studies investigating the mitochondrial and metabolic functions in larger PBC cohorts are needed to elucidate the mechanisms of PBC-related myopathy.
ASTIM TANILI ERGENLERDE MENSTRUASYONUN ASTIM KONTROLÜ ÜZERİNE ETKİSİ
(Tıp Fakültesi, 2026) Arslan Ece; Çocuk Sağlığı ve Hastalıkları
Perimenstrual asthma (PMA) is a clinical condition characterized by an increase in asthma symptoms toward the end of the luteal phase and at the beginning of the menstrual phase of the menstrual cycle. The aim of this study was to investigate the presence of PMA in adolescent girls with asthma and to evaluate asthma symptoms, morning-evening peak expiratory flow (PEF) values, and PEF variability according to menstrual cycle phases. The study included 54 adolescent girls diagnosed with asthma who had been postmenarcheal for at least two years. Participants recorded their daily symptoms and morning-evening PEF measurements throughout one menstrual cycle. Thirty-eight participants completed their follow-up over at least one menstrual cycle. The relationships between participants’ asthma control levels, spirometric parameters, inflammatory markers, and the presence of premenstrual syndrome (PMS) and their PEF values and symptom scores were evaluated. In comparisons across phases, morning PEF, evening PEF, and PEF variability did not show statistically significant differences between menstrual phases. A difference approaching statistical significance was observed in PEF variability between the perimenstrual and luteal phases (p=0.056). Asthma symptoms were numerically higher during the perimenstrual phase; however, this difference did not reach statistical significance. No significant association was found between PEF values and asthma symptoms, asthma control, spirometric findings, inflammatory markers, or PMS. The fact that PMA was not detected in adolescents in our study may be related to the possibility that this phenotype could become more pronounced with advancing age as hormonal cycles mature and may be more frequently identified in the adult age group. In contrast, the tendency for symptoms to increase during the perimenstrual period suggests that PMA in this age group may be shaped more by symptom perception and mood changes than by objective airway obstruction. The findings support the need to clarify the adolescent PMA phenotype through prospective studies with larger sample sizes that simultaneously track symptoms and PEF measurements.
ÇOCUKLUK ÇAĞI HODGKİN LENFOMALI HASTALARDA TEDAVİNİN UZUN DÖNEMDE TİROİD ÜZERİNE ETKİLERİ
(Çocuk Sağlığı Enstitüsü, 2026) Ece İrem Deveci; Çocuk Sağlığı ve Hastalıkları
Deveci, E.I. Long-Term Effects of Treatment on the Thyroid in Patients with Childhood Hodgkin Lymphoma. Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics, Ankara, 2026. High survival rates in childhood Hodgkin lymphoma (HL) have increased the importance of treatment-related late effects. This study aimed to evaluate the frequency and timing of long-term thyroid function and structural abnormalities after childhood HL treatment and their associated factors. In this single-center retrospective study, records of 370 patients diagnosed with HL before age 18 between February 1, 1999, and February 1, 2024, were reviewed; 175 patients with post-treatment thyroid function test (TFT) abnormalities and/or pathological thyroid ultrasonography (US) findings who met the study criteria were evaluated. The most common first thyroid laboratory abnormality was subclinical hypothyroidism (61.1%); primary hypothyroidism was detected in 46.9% during follow-up. Median times to the first thyroid laboratory and US abnormalities were 2.22 and 5.40 years after treatment, respectively. Among patients who underwent US, thyroid parenchymal heterogeneity, decreased thyroid volume, and thyroid nodules were detected in 18.3%, 40.5%, and 42.5%, respectively. Secondary thyroid malignancy developed in 10 patients (5.7%), all of whom had the neck included in the radiotherapy (RT) field. In multivariable analysis, higher neck–supraclavicular fossa (SCF) RT dose was associated with higher odds of primary hypothyroidism (aOR per 1 Gy, 1.084; 95% CI 1.015–1.159; p=0.017), while longer total follow-up was associated with higher odds of thyroid nodules (aOR per year, 1.159; 95% CI 1.085–1.238; p<0.001). Inclusion of the neck in the RT field increased the hazard of thyroid disorders (aHR 1.886; 95% CI 1.118–3.182; p=0.017). Thyroid disorders were found to occur from the early post-treatment period and continue to emerge over many years, with thyroid function abnormalities detected earlier than structural abnormalities. The findings indicate that direct thyroid irradiation and increasing RT dose are associated with hypothyroidism, while the timing of thyroid late effects is associated with treatment and follow-up characteristics. Long-term monitoring of thyroid function and structural findings in childhood HL survivors is important, considering treatment exposures.
Keywords: Hodgkin disease; long term adverse effects; radiotherapy; survivors of childhood cancer; thyroid diseases.
Periferik Arter Hastalarında Femoropopliteal Endovasküler Girişim Başarısını Belirleyen Faktörlerin Değerlendirilmesi
(Tıp Fakültesi, 2026) Tunç Ateşsaçan, Begüm; Kardiyoloji
Technical success in femoropopliteal endovascular interventions may be associated with preprocedurally assessable factors, including lesion length, calcification severity, anatomical extent and the distal vascular flow. This study aimed to evaluate clinical, laboratory, and anatomical variables associated with technical success in patients undergoing femoropopliteal endovascular interventions for peripheral artery disease and develop a preprocedural scoring system predicting technical failure risk. This single-center retrospective study included 146 patients. Technical success was achieved in 90 patients (61.6%), while technical failure occurred in 56 (38.4%). Components of technical failure included guidewire crossing failure, residual stenosis greater than 30%, dissection, thrombosis, perforation and poor distal flow. Multivariable analysis identified stenosis length, high mPACSS scores and combined popliteal and trifurcation involvement as independently associated with technical failure. Accordingly, a femoropopliteal intervention risk evaluation score ranging from 0 to 6 points and incorporating stenosis length, mPACSS, anatomical extent and distal extension was developed. The optimal cutoff value for this score was determined to be 3 points or higher, yielding a sensitivity of 66.1%, specificity of 86.7%, positive predictive value of 75.5%, negative predictive value of 80.4% and overall classification accuracy of 78.8%. AUC was 0.814 (95% CI: 0.739–0.890). Technical failure rates were 18.1%, 34.9% and 90.3% in low-risk (0–1 points), intermediate-risk (2–3 points) and high-risk (4–6 points) groups, respectively. These findings suggest that the pilot scoring system based on anatomical assessment may contribute to preprocedural prediction and stratification of technical failure risk.