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Öğe Acute Rheumatic Fever in Konya, Turkey(Blackwell Science Asia, 2000) Karaaslan, Sevim; Oran, Bülent; Reisli, İsmail; Erkul, İbrahimBackground: Patients with acute rheumatic fever (ARF), who were admitted to Pediatric Cardiology Unit of Selcuk University Faculty of Medicine from July 1993 to 1998, were studied retrospectively to verify the clinical profile of the disease and to compare the results with those from other countries. Methods: All patients were examined by one: of the two pediatric cardiologists in our study group. Every patient had a chest X-ray, electrocardiogram and an echocardiographic investigation. Throat culture, antistreptolysin O test, C-reactive protein and sedimentation rates were investigated for each patient. Results: During the study period, 274 cases with ARF were identified among patients admitted to the present institution. There were 8032 visits during the study period, giving an occurrence rate of 3.4%. Arthritis was the most common major manifestation (81.4%). It was followed by carditis (60.9%) and chorea (17.9%). Subcutaneous nodules (0.7%) and erythema marginatum (0.4%) were both seen in patients with carditis, The mitral valve was the most commonly affected valve (95.8%), followed by the aortic valve (40.1%). Two patients died and regurgitation disappeared in 21% of patients with mitral regurgitation. Fifteen patients (14%) with isolated arthritis and pure chorea had mitral regurgitation demonstrated by echocardiographic investigation but without any significant murmur. Conclusion: The present study indicates that ARF is still a significant problem in Konya and that recurrences can be prevented by administering a 3-week benzathine penicillin G regimen.Öğe Benign Rheumatoid Nodules – Reply(AMER MEDICAL ASSOC, 1994) Yavuz, Haluk; Özel, Ahmet; Erkul, İbrahimWe think that our article1 has been misunderstood. The word "swelling" was used to describe the nodule by parents. The patient had only nodules and limited motion of the arms in the morning. Pain orjoint swelling were not present either in the history or on physical examination. Morning stiffness alone cannot be regarded as a criterion of objective arthritis in the diagnosis of JRA.2 The negative test resultfor rheumatoidfactor does not exclude the diagnosis of benign rheumatoid nodules as well as JRA.3 We think that the criteriafulfilling the diagnosis of JRA have not developed in our patient.Öğe Conn Syndrome in a Child, Caused by Adrenal Adenoma(W B SAUNDERS CO, 1996) Abasıyanık, Adnan; Oran, Bülent; Kaymakçı, Aytekin; Yaşar, Cengiz; Çalışkan, Ümran; Erkul, İbrahimHyperaldosteronism owing to aldosterone producing adenoma (Conn syndrome) is a rare but potentially curable form of pediatric hypertension. The authors report on a 5-year-old girl who had symptoms of polyuria, polydipsia, and fatigue, and for whom the diagnosis of hyperaldosteronemia was suggested by a low serum potassium level and persistent hypertension. The diagnosis was confirmed by increased levels of plasma aldosterone and decreased levels of plasma renin. The tumor was localized with ultrasonography and computed tomography, which showed a 2-cm mass in the left adrenal gland. The left adrenal gland was excised, and pathological assessment showed an adenoma. Only 14 other pediatric cases (<16 years of age) have been reported in the English-language literature. Copyright (C) 1996 by W.B. Saunders CompanyÖğe Corticosteroid-Therapy and Severe Chickenpox(MOSBY-ELSEVIER, 1994) Yavuz, Haluk; Özel, Ahmet; Erkul, İbrahimTo the Editor." We read with interest the article by Abzug and Cotton. 1 Although some reports indicate that varicella infections may have a more severe clinical course in patients receiving corticosteroids, there are studies suggesting the opposite. 2 A metaanalysis on the corticosteroid-infection association revealed that use of prednisone may increase the risk of infectious complications when the dose exceeds 10 mg daily or 700 mg cumulatively)Öğe Effects of Phototherapy on the Growth Plate in Newborn Rats(Lippincott Williams & Wilkins, 2006) Atabek, Mehmet Emre; Pirgon, Özgür; Kurtoğlu, Selim; Tavlı, Lema; Esen, H. Hasan; Köylü, Öznur; Erkul, İbrahimThe aim of the present study was to evaluate the effect of phototherapy and oxidative stress on the growth plate of newborn rats. Forty newborn Sprague-Dawley rats were randomized into a phototherapy group and a control group. Twenty of the rats received phototherapy for 7 days. All zones of the growth plate were assessed with quantitative histomorphometric analysis. Individual zonal lengths were measured for the reserve zone (RZ), the proliferative zone (PZ), the hypertropbic zone (HZ), ossifying cartilage (OC), and total zone (TZ) of the growth plate. Levels of plasma malondialdehyde (MDA), an index of oxidative stress, were also evaluated. Compared with zonal lengths on day 7 after phototherapy between the two groups, the phototherapy group had significantly lower values than those of controls for RZ (5.13 +/- 0.36 vs. 6.4 +/- 0.85 mm X 10(-2); P < 0.001), PZ (20.6 +/- 3.0 vs. 29.25 +/- 1.68 mm X 10(-2); p < 0.001), HZ (15.4 +/- 1.44 vs. 20.87 +/- 1.12 mm X 10(-1); P < 0.001), OC (47.08 +/- 4.25 vs. 62.06 +/- 3.7 mm X 10(-2); p < 0.001), and TZ (88.15 +/- 6.56 vs. 118.48 +/- 4.50 mm X 10(-2); p < 0.001). Plasma MDA levels were correlated with the size of the PZ in the phototherapy group (r = -0.53, P = 0.01). In a multivariate regression model for all rats, being in the phototherapy group was the best predictor of the size of the TZ (beta = -0.94, P < 0.001), with the total variance explained being 88%. These results suggest that in newborn rats, receiving phototherapy is associated with early impairment of growth plate structure, and oxidative stress may be the main risk factor for growth plate injury.Öğe Honey Poisoning in Turkey(LANCET LTD, 1991) Yavuz, Haluk; Özel, Ahmet; Akkuş, İdris; Erkul, İbrahimSIR,- Food poisoning associated with honey is not uncommon in the Black Sea region of Turkey. Nectar from some plants in the area is toxic. This form of poisoning is mentioned in Xenophon's Anabasis but published reports are very rare. We describe here a large series.Öğe The Importance of Karyotyping in Girls With Inguinal Hernia (Case Report)(2002) Atabek, Emre; Pirgon, Özgür; Erkul, İbrahimKomplet androgen insensitivite sendromu, tek gen bozukluğuyla X'e bağlı geçiş gösteren nadir bir hastalıktır. Fenotipik olarak normal kız görünümüyle birlikte erken yetişkin çağda primer amenore ile farkedilmektedir fakat süt çocukluğu döneminde anlamlı olarak inguinal herni bulunmakadır. Bu çalışmada, tanı konulmadan önce inguinal herni nedeniyle öpere edilen 2.5 yaşında komplet androgen insensitivite sendromu olan bir kız hasta sunulmaktadır. Cerrahi sırasında fıtık kesesi içinde bulunan gonadlar över sanılarak abdomen içine yerleştirilmişti. Hastanemize geldiğinde komplet androgen insensitivite sendromu tanısı konuldu. Bu vaka; inguinal herni ile gelen kız hastaların dikkatli değerlendirilmesi sonucunda .komplet androjen insensitivite sendromu tanısının erken konulabileceğini vurgulamak amacıyla sunulmuştur.Öğe Konya'da 1-15 Yaş Grubu Çocuklarda Kabakulak Seroprevalansı(1999) Koç, Hasan; Ataş, Erkan; Baykan, Mahmut; Reisli, İsmail; Altındiş, Mustafa; Taştekin, Ayhan; Erkul, İbrahimKabakulak hastalığının görülme sıklığını ve duyarlı kesimi belirlemek amacıyla Konya II merkezi ve çevre köylerinden 1-15 yaş grubu 896 çocuk çalışmaya alındı. Seropozitiflik oranı açısından kız ve erkekler arasında anlamlı farklılık yoktu. 1-2 yaş grubunda Seropozitiflik oranı %25 iken, 13-15 yaş grubunda %89.3 bulundu. 10-12 yaş grubuna kadar yaş ile birlikte Seropozitiflik oranının artışı istatistiksel olarak anlamlıydı (p0.001). Çalışmada 7-9 yaş ve 10-12 yaş gruplarında, il merkezi ve kenar mahallelerde yaşayan çocukların köylerde oturanlara göre hastalığa daha fazla yakalandığı belirlendi. Anaokulu veya kreşe gitmek kabakulak ile enfekte olma için ilave bir risk oluşturmuyordu. Bununla beraber, kabakulak hastalığını geçirme durumu kardeş sayısının artışı ile doğru orantılı bulundu. Çalışmamızda elde edilen sonuçlara göre yan etkisi az ve koruyucu değeri yüksek olan kabakulak aşısının ülkemizde de rutin aşı takvimi içinde yer alması ve MMR aşısının 12-15 aylık bebeklere uygulanması önerildi.Öğe Plasma Homocysteine Concentrations in Adolescents With Subclinical Hypothyroidism(Freund Publishing House Ltd, 2003) Atabek, Mehmet Emre; Pirgon, Özgür; Erkul, İbrahimObjective: Hyperhomocysteinemia is a risk factor for premature atherosclerotic vascular disease and venous thrombosis. The aim of the present study was to assess plasma total homocysteine (tHCys) concentrations in adolescent patients with subclinical hypothyroidism. Patients and Methods: Nineteen patients with subclinical hypothyroidism and 19 healthy children were studied. Fasting plasma concentrations of tHCys and its putative determinants (plasma concentrations of free thyroxine [FT4], folate, vitamin B-12 and renal function) were measured. Results: tHCys concentrations showed no statistical difference between patients and controls (p >0.05). Moreover, the difference in tHCys and total cholesterol concentrations was not significant between patients with mild TSH elevations (less than or equal to10 mIU/l) and patients with prominent TSH elevations (>10 mIU/l). No correlation was found between tHCys concentrations and its putative determinants. Conclusions: We concluded that plasma tHCys concentrations were not increased in adolescent patients with subclinical hypothyroidism.Öğe Plasmapheresis as an Adjunct Treatment in Severe Botulism(SPRINGER-VERLAG, 2002) Atabek, M. Emre; Yavuz, Haluk; Oran, Bülent; Karaaslan, Sevim; Erkul, İbrahimAn 11-year-old boy, previously healthy, had consumed a packet of commercially canned food, and lassitude or fatigue and headache had developed. The next day he was transferred to our unit. He was unable to talk and had developed ptosis, impairment of ocular movements and mild symmetrical limb weakness. He was afebrile and orientated. His pupils were fixed and dilated bilaterally.Öğe Prophylactic Efficiency of 3-Weekly Benzathine Penicillin G in Rheumatic Fever(The Indian Journal of Pediatrics, 2000) Oran, Bülent; Taştekin, Ayhan; Karaaslan, Sevim; Baş, Levent; Ayçiçek, Ali; Çeri, Ayhan; Sütçü, Ali; Erkul, İbrahimBenzathine penicillin G (BPG) is effective for secondary prophylaxis of rheumatic fever (RF). However, interval between injections a remains a controversial matter. In a study population of 74 patients, following the initial diagnosis of RF, 3-weekly BPG (1.2 million units) regimen was started. During the first three-week period, serum penicillin concentrations were examined on the 7th, 14th and 21st days and throat done for group-A b hemolytic streptococcal (GABHS) infection. Ten patients (13.5%) at 21st day of injection had low serum penicillin concentration after the first BPG. GABHS was isolated in 5 patients during this period. Although two of these 5 patients had symptoms of respiratory tract infection, according to laboratory data, the other three were accepted as carriers. There was no PR among regular (missing no more than one injection a year) group. We concluded that 3-weekly BPG regimen was satisfactory for secondary prophylaxis in RF, even though serum penicillin level was inadequate during the third week in some of the patients.Öğe Review of Turkish Patients with Growth-Hormone Insensitivity (Laron Type)(Scandinavian University Press, 1995) Yordam, Nurşen; Kandemir, Nurgün; Erkul, İbrahim; Kurdoğlu, Selim; Hatun, ŞükrüClinical spectrum and endocrine details of thirteen Turkish children (age 0.3-14.2 years; eight females and five males; ten prepubertal, three pubertal) with growth hormone insensitivity are presented. All patients display phenotypical features of severe growth hormone deficiency. The diagnosis based on height standard deviation score (SDS), basal growth hormone (GK), basal insulin-like growth factor I (IGF-I, IGF-I response in an IGF generation test and growth hormone binding protein (GHBP) measurements. The median height SDS was -7.4 (range -3.2 to -10), weight for height index was 100 (range 81-152) and bone age/height age ratio was 2 (range 1.6-3.3). Endocrine investigations showed a median basal GH concentration of 61.4 mU/1 (range 23.5-120mU/l). Basal IGF-I level was below 10 ng/ml in all patients except one. None of the patients showed a significant IGF-I response to injections of GH (0.1 U/kg body weight for 4 days). The median IGFBP-3 level was 0.23 mg/l (range 0.1-0.56 mg/l). The GHBP level was undetectable in all of 10 patients. The high number of patients in our center may be due to the high rate of consanguinity among the Turkish population and the referral facility of our center in the area. These patients may benefit from the new therapy with recombinant human IGF-I.Öğe Selçuk Üniversitesi 2000 Yılı Perinatal Mortalitesi(2001) Atabek, M. Emre; Koç, Hasan; Pirgon, Özgür; Erkul, İbrahimAMAÇ: Selçuk Üniversitesi 2000 yılı perinatal mortalite hızını araştırmak. GEREÇ VE YÖNTEM : Bu çalışmada, 1 Ocak 2000 ile 31 Aralık 2000 tarihleri arasında hastanemizdeki Perinatal mortalite hızı (PNMH), ölü doğum hızı ve erken neonatal mortalite hızı prospektif olarak araştırıldı. En sık gözlenen ölüm nedenleri saptandı ve sonuçlarımız daha önceki çalışmaların sonuçları ile karşılaştırıldı. BULGULAR: Çalışmamızda toplam doğum sayısı 2406 olarak belirlendi. PNMH %0 52.7, ölü doğum hızı %0 31.58, erken neonatal mortalite hızı %0 21.19 olarak hesaplandı. Genişletilmiş Wigglesworth Sınıflamasına göre ölüm nedenlerinden ilk üç sırayı % 41.5, % 23.3 ve % 13.3 gibi değerlerle sırasıyla ölü doğumlar, prematürelik ve sorunları ve letal konjenital malformasyonlara bağlı ölümler aldı. Perinatal mortalite hızı 1997 ve 1999 'da yapılan çalışmalardan daha düşük bulundu. SONUÇ: Bu bulgularla yüksek riskli gebelerin büyük oranda kabul edildiği Selçuk Üniversitesi Tıp Fakültesi hastanesinde; perinatal bakımın iyileştirilmesi, prematüreliğin önlenmesi, doğumların uygun şekilde yapılması, optimal solunum desteği sağlanması, enfeksiyonlardan koruma, ölümlerin otopsi ile değerlendirilmesi, prenatal genetik çalışmaların artırılması, yenidoğan servisinin teknik donanım ve personel yönünden iyileştirilmesi, prenatal ve neonatal mortalite hızının düşürülmesi hedefler olarak görülmektedir.Öğe Selçuk Üniversitesi Tıp Fakültesi Hastanesi Yenidoğan Servisi Prematüre Mortalite Istatistikleri (1992-1998)(2000) Koç, Hasan; Reisli, İsmail; Yılmaz, Hızır; Taştekin, Ayhan; Çakır, Münire; Çalışkan, Ümran; Erkul, İbrahimAMAÇ: Hastanemiz yenidoğan yoğun bakım ünitesine kabul edilen prematüre bebek mortalitesini belirlemek YÖNTEM: Retrospektif olarak kayıtların incelenmesi ile Ocak 1992-Aralık 1998 tarihleri arasında 2218 prematüre bebek kabul edildiği belirlendi. Bebekler doğum ağırlığı, gebelik haftaları, ölüm zamanları ve ölüm nedenleri yönünden değerlendirildi. Mortalite oranları her yıl için ayrı ayrı çıkarıldı. BULGULAR: Yedi yılın ortalama yüzde mortalite oranı 26,784,85 olarak bulundu. Hastanemiz Kadın Hastalıkları ve Doğum Kliniğinde doğan prematüre Serdeki mortalite oranı, evden gelen veya Konya içi yada dışı başka bir hastaneden sevk edilen prematürelere göre daha düşüktü (p0,01). Mortalite yüzdelerinin gebelik süreleri ve bebeklerin doğum ağırlıkları arttıkça azaldığı saptandı. Bin g ve altında doğanlarda yıllık ortalama yüzde mortalite oranı 88,459,42 idi. En yüksek ölüm yüzdesinin hayatın ilk 24 saati içinde olduğu görüldü. Klinik tanılarına göre en önemli ölüm nedenlerinin solunum güçlüğü sendromu ve sepsis olduğu saptandı. SONUÇ: Prematüre mortalite oranlarını azaltabilmek için prematüre doğumların önlenmesine ilaveten prematüre doğumların uygun merkezlerde yapılmasının sağlanması optimal solunum desteği ve sepsisten korumanın gerekli olduğu sonucuna varıldı.Öğe Serum Cardiac Troponin-I in Active Rheumatic Carditis(The Indian Journal of Pediatrics, 2001) Oran, Bülent; Çoban, Hakan; Karaaslan, Sevin; Atabek, Emre; Gürbilek, Mehmet; Erkul, İbrahimObjective: The study was performed to investigate the level of serum cardiac troponin I (cTnl), a specific marker for myocardial cell damage, in the acute rheumatic carditis (RC). Methods : Twenty seven consecutive patients with acute RC and 23 healthy children were enrolled. Result : cTnl level in both groups showed no statistical difference (p>0.05). Conclusion : Serum cTnl level did not gain clinical use.Öğe Short-Term, High-Dose Corticosteroid-Therapy in Childhood Acute Immune Thrombocytopenic Purpura(Mosby-Elsevier, 1995) Yavuz, Haluk; Özel, Ahmet; Erkul, İbrahimWe read with interest the article by Blanchette et al. 1 A therapeutic regimen that increases the platelet count above a safe level for preventing intracranial hemorrhage by use of orally administered corticosteroids in relatively low doses would be the preferred form of therapy, but we think that the continuation of this therapy for 3 weeks is disadvantageous because of the development of untoward effects and the prolongation of therapy. Side effects may occur with the continued daily use of corticosteroids, and the hy pothalamus-pituitary-adrenal system would be suppressed if steroids were administered for periods longer than 15 days. 2 Moreover, effective treatment without any side effects have been reported in studies in which methylprednisolone was used in very high doses orally for 1 week. 3 We are still investigating'the effect of orally administered methylprednisolone, 10 mg/kg per day, for 5 days in the treatment of acute immune thrombocytopenic purpura in children. The preliminary data for 10 patients revealed mild elevation of the blood glucose concentration in two patients on day 3 and in the occult blood in the stool in one patient on day 7, which were transient. The mean platelet count increased from 21 X 109/L, to 47 × 109/L on the third day of therapy. The platelet count decreased below 20 x 109/L in only one patient during follow-up.Öğe Stevens-Johnson Syndrome-Like Exanthema Secondary to Methotrexate(2002) Atabek, Mehmet Emre; Çalışkan, Ümran; Pirgon, Özgür; Tol, Hüseyin; Erkul, İbrahimMethotrexate is an antineoplastic drug used commonly in leukemia treatment. Because of becoming resistant to standard doses after 1970s, it is used intermediate or high doses. The complications of high doses are mucositis, vomiting, dermatitis exfoliativa, B-cell dysfunction, hepatotoxicity, nephrotoxicity and bone marrow depression. There were only two studies in literature about Stevens-Johnson syndrome occuring in two patients with acute lymphocytic leukemia and non-Hodgkin lymphoma after receiving high doses methotrexate and leukoverin. We have reported a two-year-old boy patient suffering from acute lymphocytic leukemia (ALL) developed a severe skin reaction two days after administration of high dose methotrexate. The skin lesions simulated Stevens-Johnson syndrome with ulceration of the oral mucosa and erythema multiforme-like target lesions.Öğe Tüberküloz Tedavisinde Gelişen Fulminan Hepatit ( Olgu Sunumu )(1999) Atabek, M. Emre; Oran, Bülent; Demirezici, Pakize; Çalışkan, Ümran; Erkul, İbrahimAmaç: (INH) majör hepatotoksik bir ilaçtır ve rifampisinle (RIF) birlikte kullanıldığı zaman RIF'in güçlü enzim indükleyici özelliği nedeniyle INH'ın hepatotoksisitesi artabilir. Birçok olguda prognoz iyidir. Olgu sunumu: RIF ve imipenem-cilastinle birlikte, sadece 8 günlük INH tedavisi sonrası ağır fulminant hepatit gelişen bir olgu sunuyoruz. Sonuç: Karaciğer hasarı yapan ilaçlar antitüberküloz ilaçlarla birlikte kullanılmamalıdır.
