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Öğe A rare cardiac anomaly in Goldenhar's syndrome: Isolated partial anomalous pulmonary venous return(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2014) Balli, Sevket; Ece, Ibrahim; Kibar, Ayse Esin; Oflaz, Mehmet Burhan; Bulut, GoncaGoldenhar syndrome is a rare congenital abnormality characterized by incomplete development of the ear, nose, soft palate, lip, and mandible. It is associated with anomalous development of the first and second branchial arch. Common clinical manifestations include limbal dermoids, preauricular skin tags, and strabismus. Here we present a case of a four months old female with Goldenhar's syndrome and partial anomalous pulmonary venous return.Öğe Assessment of 17 Pediatric Cases With Colchicine Poisoning in a 2-Year Period(LIPPINCOTT WILLIAMS & WILKINS, 2016) Alaygut, Demet; Kilic, Suar Caki; Kaya, Ali; Oflaz, Mehmet Burhan; Bolat, Fatih; Cevit, Omer; Icagasioglu, Fusun DilaraAim The aim of the study is to discuss clinical effects, treatments, and outcomes of pediatric colchicine poisoning. Method This study was designed as an observational case series study. The medical records of children aged between 0 and 18 years, who were hospitalized for colchicine poisoning at the Department of Pediatric Intensive Care Unit, Cumhuriyet University Faculty of Medicine, between January 2010 and January 2012, were retrospectively evaluated. Results We presented 17 children with colchicine poisoning. The mean (SD, range) age of patients was 71.5 (69.19, 18-204) months. The period to apply to the hospital after taking the medications was 7.3 hours (7.97, 30 minutes-26 hours) on average. The use of colchicine was due to diagnosis of Familial Mediterranean fever (FMF) in the families of 8 patients, diagnosis of Behcet disease in 1 patient's father, diagnosis of Behcet disease in 1 patient herself, and diagnosis of FMF in 6 patients themselves. Thirteen patients had taken colchicine at the dose of less than 0.5 mg/kg known as subtoxic and 1 patient had taken colchicine at the dose of greater than 0.8 mg/kg, and doses taken by 3 patients were not known. Fourteen patients (82.4%) had involuntary drug intake. Fifty percent of them were symptomatic at the moment of application and all had gastrointestinal complaints. All patients were observed in intensive care unit upon first admission and received supportive care. One of patients showed total alopecia, one showed leucocytosis, and another one showed acute abdomen picture. None of the patients showed mortality. Conclusions Mortality of colchicine toxicity is high and quick assessment is absolutely required. In regions where FMF is common and the use of colchicine is high, clinicians should pay attention to symptoms and findings related to colchicine intoxication and keep them in mind in differential diagnosis.Öğe Assessment of Cardiac Functions in Fetuses of Gestational Diabetic Mothers(SPRINGER, 2014) Balli, Sevket; Pac, Feyza Aysenur; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Kandemir, OmerWe investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E (a)-wave (p = 0.02), A (a)-wave (p = 0.04), and S (a)-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E (a) (p = 0.02) and A (a) (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E (a)/A (a) ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E (a) ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.Öğe Assessment of Fetal Cardiac Function in Mild Preeclampsia(SPRINGER, 2013) Balli, Sevket; Kibar, Ayse Esin; Ece, Ibrahim; Oflaz, Mehmet Burhan; Yilmaz, OzcanThis study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26-40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.Öğe Bradycardia Seen In Children With Crimean-Congo Hemorrhagic Fever(MARY ANN LIEBERT, INC, 2013) Oflaz, Mehmet Burhan; Kucukdurmaz, Zekeriya; Guven, A. Sami; Karapinar, Hekim; Kaya, Ali; Sancakdar, Enver; Deveci, Koksal; Gul, Ibrahim; Erdem, Alim; Cevit, Omer; Icagasioglu, F. DilaraIntroduction: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. Methods: Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. Results: Fifty-two patients (mean age 11.24.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 +/- 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). Conclusion: Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.Öğe Closure of patent ductus arteriosus with oversized Amplatzer occluder in a patient with pulmonary hypertension(TERMEDIA PUBLISHING HOUSE LTD, 2013) Karapinar, Hekim; Kucukdurmaz, Zekeriya; Oflaz, Mehmet Burhan; Gul, Ibrahim; Yilmaz, AhmetDiagnosis of patent ductus arteriosus is rare in adulthood. Closure of ductus is difficult when diagnosed at an adult age due to the development of pulmonary hypertension and pulmonary arterial disease that generally occurs. Closure of the ductus might be contraindicated, as it may lead to deterioration of the pulmonary arterial perfusion or to a pulmonary hypertensive crisis. In addition, another risk associated with percutaneous closure for these patients is the risk of embolism of the asymmetrically shaped device to the systemic circulation. We present in this manuscript a case with patent ductus arteriosus diagnosed at an adult age that underwent successful closure by the percutaneous method. During closure, an oversized Amplatzer duct occluder device was used to reduce the risk of device embolism.Öğe Early Subclinical Left-Ventricular Dysfunction in Obese Nonhypertensive Children: A Tissue Doppler Imaging Study(SPRINGER, 2013) Kibar, Ayse Esin; Pac, Feyza Aysenur; Balli, Sevket; Oflaz, Mehmet Burhan; Ece, Ibrahim; Bas, Veysel Nejat; Aycan, ZehraA direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 +/- A 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI a parts per thousand yen 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 +/- A 2 cm/s), peak early myocardial velocity (Am = 8.7 +/- A 1.3 cm/s), Em/Am ratio (1.8 +/- A 0.3), isovolumetric relaxation time (IVRT = 59.2 +/- A 8.2 ms), MPI (0.39 +/- A 0.03), and DI (25.5 +/- A 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 +/- A 1.2 cm/sn, 6.9 +/- A 0.6 cm/sn, 2.6 +/- A 0.2, 51.2 +/- A 9.6 ms, 0.34 +/- A 0.03, and 33.13 +/- A 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.Öğe Effect of Antiepilepsy Drug Therapy on Ventricular Function in Children With Epilepsy: A Tissue Doppler Imaging Study(SPRINGER, 2014) Kibar, Ayse Esin; Unver, Olcay; Oflaz, Mehmet Burhan; Guven, Ahmet Sami; Balli, Sevket; Ece, Ibrahim; Erdem, Sevcan; Icagasioglu, Fusun DilaraImpaired cardiac myocardial function may contribute to the risk for sudden unexpected death of a patient with epilepsy. This study aimed to investigate the effect of antiepilepsy drugs (AEDs) on cardiac function in pediatric epileptic patients using standard and tissue Doppler imaging (TDI) echocardiography. This hospital-based, prospective cross-sectional study investigated 52 epileptic children (mean age 9.3 +/- A 3.1 years) treated with AEDs (duration 2.4-10.0 years) and 36 healthy children (mean age 9.5 +/- A 4.0 years). In the epilepsy group, standard echocardiography showed increased left ventricular (LV) end-diastolic and end-systolic diameters, an increased LV mass index, and preserved ejection fraction. The patients also exhibited increased mitral peak A-wave velocity and mitral E-wave deceleration time as well as a decreased mitral E/A ratio. The E/Em ratio was significantly higher in the epilepsy group (5.6 +/- A 1.2) than in the control group (5.2 +/- A 1.1) (p = 0.016). In the epilepsy group, TDI showed an increased isovolumetric relaxation time and myocardial performance index (MPI). It also exhibited decreased early diastolic velocity (Em) and a decreased mitral annular displacement index in these patients. There were positive correlations between the LV lateral wall MPI (r = 0.231), septal MPI (r = 0.223), and LV mass index (p < 0.05) but no correlation with the duration of AED treatment. The authors detected subclinical ventricular dysfunction associated with AEDs at a preclinical stage. They suggest that TDI can be useful for determining the short- and long-term cardiac effects of AEDs.Öğe Effects of carvedilol therapy on cardiac autonomic control, QT dispersion, and ventricular arrhythmias in children with dilated cardiomyopathy(INT SCIENTIFIC LITERATURE, INC, 2013) Oflaz, Mehmet Burhan; Balli, Sevket; Kibar, Ayse Esin; Ece, Ibrahim; Akdeniz, Celal; Tuzcu, VolkanBackground: The purpose of this study was to examine the effects of carvedilol therapy on autonomic control of the heart and QT-interval dispersion (QTd) among children with idiopathic dilated cardiomyopathy (DCM) whose symptoms were not adequately controlled with standard congestive heart failure therapy. Material/Methods: Patients with DCM who were treated with carvedilol were enrolled in the study. All patients had undergone carvedilol therapy in addition to standard therapy for at least 6 months. Clinical, echocardiographic, and electrocardiographic parameters, and 24-h Holter records of patients were retrospectively evaluated before and after carvedilol treatment. Results: A total 34 patients (mean age: 7.4 +/- 4.3 years) with DCM were analyzed in the study. The median follow-up period was 9.5 months. After the 6 months of carvedilol therapy the clinical score significantly improved, left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) significantly increased, and left ventricle end-diastolic dimensions and end-systolic dimensions significantly decreased. There were statistically significant increases in mean SDNN, SDANN, rMSSD, and pNN50 (p=0.002, p=0.001, p=0.008, and p=0.026, respectively). After the carvedilol therapy, SDNN was correlated with the clinical score, heart rate, LVEF, LVFS, and total premature ventricular contractions (PVCs). In addition, rMSSD and pNN50 were correlated with heart rate, LVEF and LVFS. A significant reduction was observed in QTc-minimum, QTc-maximum, and QTd values (434.9 +/- 40.7 vs. 416.1 +/- 36.5, 497.8 +/- 43.6 vs. 456.3 +/- 41.7, 58.6 +/- 17.1 vs. 49.3 +/- 15.6; p<0.001, p=0.001, and p=0.008, respectively). QTd was significantly related to PVCs (r=0.62, p=0.02). Conclusions: We conclude that the addition of carvedilol to standard therapy can improve clinical symptoms and heart rate variability, and reduce in arrhythmia markers in children with DCM.Öğe Evaluation of Cardiac Functions of Patients with Benign Joint Hypermobility Syndrome(SPRINGER, 2014) Balli, Sevket; Aydin, Mehmet Zafer; Gerdan, Vedat; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Sen Dalkiran, EylemWe sought to investigate whether echocardiography with tissue Doppler imaging identifies myocardial dysfunction in children with benign joint hypermobility syndrome (BJHS). This cross-sectional study enrolled 75 children with BJHS and 70 healthy children. We performed detailed echocardiography in individuals with BJHS without inherited connective tissue disorders. Any congenital or acquired cardiac disease was excluded by clinical and echocardiographic examination. Both groups were similar in terms of age, sex, and body mass index. The diameter of the aortic annulus and sinus valsalva were wider in patients with BJHS. There was no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the two groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Deceleration time of early mitral inflow was prolonged in patients with BJHS. Mitral and tricuspid annulus Ea velocity were significantly lower in children with BJHS. Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in patients with BJHS than in the control group. The E/Ea ratio was greater in patients with BJHS than in the control group. Isovolumic relaxation time and right-ventricular (RV) and left-ventricular (LV) myocardial performance indices (MPIs) were greater in patients with BJHS. This study showed the diastolic dysfunction in patients with BJHS. In addition, we detected increased LV and RV MPI. We believe that BJHS may affect proteins of the myocardial cytoskeleton and extracellular matrix.Öğe Evaluation of morphological characteristics of septal rims affecting successful transcatheter atrial septal defect closure in children and adults(TERMEDIA PUBLISHING HOUSE LTD, 2013) Oflaz, Mehmet Burhan; Pac, Feyza Aysenur; Kibar, Ayse Esin; Balli, Sevket; Ece, IbrahimIntroduction: Determining other echocardiographic predictors along with the measured atrial septal defect (ASD) size and evaluating the closure together with these predictors would increase the chance of success for transcatheter closure of ASD. Aim: To evaluate echocardiographic parameters affecting defect closure in children and adult patients with secundum ASD. Material and methods: In all patients, size of ASD, total length of atrial septum (TS), superior-posterior, inferior-posterior, superior-anterior and inferior-anterior rims surrounding the defect were measured by transesophageal echocardiography (TEE), and several measurement ratios were derived on the basis of TEE parameters. Results: A total 216 patients with secundum ASD were included in this study. The device was successfully implanted in 65 children and 65 adults. Both in pediatric and adult cases, the ratio of successful closure was found to be significantly higher when the ratio of defect size to TS was <= 0.35, the ratio of superior-anterior (SA) rim to the defect size was > 0.75 and the ratio of inferior-posterior (IP) rim to the defect size was > 1.0. It was found that having more than one of these predictors in a single case increased the chance of closure success significantly (p < 0.001). Conclusions: We concluded that a ratio of the defect size to TS <= 0.35, a ratio of SA rim to defect size > 0.75 and a ratio of IP rim to defect size > 1.0 were found to be echocardiographic predictors that could be used in successful transcatheter ASD closure both in children and adults.Öğe Evaluation of Platelet Activity Markers in Prognostic Value of Children with Crimean-Congo Hemorrhagic Fever(Georg Thieme Verlag Kg, 2020) Guven, Ahmet Sami; Duksal, Fatma; Akcan, Ozge Metin; Aygunes, Utku; Oflaz, Mehmet BurhanObjective The aim of this study is to investigate the prognostic value of platelet (PLT) activity markers in children with Crimean-Congo hemorrhagic fever (CCHF) and compare results with healthy controls. Materials and Methods A total of 135 patients with CCHF and 100 healthy children were included in this retrospective study. Mean age was 12.4 +/- 3.3 years in CCHF group, and 92 patients were male. We measured PLT count, mean platelet volume (MPV), platelet distribution width (PDW), and mean platelet mass (MPM) as PLT activity markers. Results A statistically significant decrease in MPM and PLT, and significantly higher levels of PDW and activated partial thromboplastin time (aPTT) and no significant difference in MPV were observed in patients with CCHF compared with controls. Although there were no significant differences between the severe and nonsevere CCHF groups in term of MPV and PDW, the MPM value was significantly decreased in severe patients ( p < 0.001). Furthermore, MPM values were inversely correlated with aPTT ( r = -0.617, p = 0.015), and positively correlated with PLT ( r = 0.703, p < 0.001) which are considered likely to be indicators of disease severity. Multivariate logistic regression analysis revealed MPM as an independent risk factor for severe disease. Conclusion Our study demonstrated that MPM values were decreased in severe cases compared with nonsevere in children with CCHF. The MPM as an indicator of PLT activation at the time of diagnosis in children with CCHF can be used as a prognostic index for disease severity.Öğe Evaluation of the Doppler flow patterns of patent ductus arteriosus in preterm infants(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2013) Balli, Sevket; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Bulut, GoncaObjective: Aim of study was to evaluate both ductal diameter (Dd) and pulsed wave Doppler (PWD) patterns of patent ductus arteriosus (PDA), the treatment requirement of different patterns. Methods: In this retropective study evaluation and classification of PDA of 139 preterms born before 34 weeks gestation was performed by color Doppler and PWD. Ratio of left atrium/aortic root were evaluated in parasternal long axis. Ductal patterns were compared with both Dd and left atrium/aortic root ratio. PDA was treated by ibuprofen. The treatment requirement and thrombocyte count of patterns was evaluated. Results: 85,5% of preterms were very low birth weight (< 1500 g). Median gestational age was 28,5 (23-34) weeks. Median birth weight was 1050 (750-1850) g. 39 (17,3%) pulmonary hypertension (PH), 43 (19,1%) growing, 68 (30,3%) pulsatile, 75 (33,3%) closing pattern were observed. PH pattern was more often in first three days (p< 0,001). There was significantly difference among patterns in term of Dd (p< 0,001). The largest Dd was observed in PH pattern the smallest Dd was observed in closing pattern. The need for treatment was higher in pulsatile pattern (52,4% of patients). There was a positive corelation between left atrium/aortic root and ductal diameter in pulsatil, growing and closing pattern except PH pattern. There was no relation between platelet count and flow paterns (p> 0,05). Conclusion: We determined significant relationship between Dd and flow pattern. There was no relationship between ductal pattern and thrombocyte count. Pulsatile pattern were hemodynamically significant. Despite greater Dd, treatment requirement in PH pattern was less due to low left-right shunt. Both ductal diameter and pattern together is important to identify hemodynamically of hemodynamically significant PDA.Öğe Evaluation of the serum levels of soluble IL-2 receptor and endothelin-1 in children with Crimean-Congo hemorrhagic fever(WILEY, 2014) Deveci, Koksal; Oflaz, Mehmet Burhan; Sancakdar, Enver; Uysal, Elif Bilge; Guven, Ahmet Sami; Kaya, Ali; Alkan, Filiz; Cevit, OmerWe aimed to assess the association between serum levels of soluble IL-2 receptor (sIL-2r) and endothelin-1 and severe infection in children with Crimean-Congo hemorrhagic fever (CCHF). Fifty-two patients under 18 years of age with a laboratory-confirmed diagnosis of CCHF and 38 healthy controls were enrolled in the study. Patients were classified into two groups based on disease severity (severe group and non-severe group). The sIL-2r and endothelin-1 levels were observed to be significantly higher in patients with severe CCHF compared with those with non-severe CCHF and the control group (p < 0.05). In addition, those with non-severe CCHF were also found to have a significantly higher sIL-2r level relative to the control group (p < 0.001). Although there was a positive correlation between sIL-2r and endothelin-1 levels, serum levels of both sIL-2r and endothelin-1 were negatively correlated with the platelets count. In children with CCHF, serum levels of sIL-2r and endothelin-1 were increased, and this increase is related to the severity of the disease. In this study, we concluded through prognosis that serum levels of sIL-2r and endothelin-1 might be related, and that hemophagocytic lymphohistiocytosis and endothelial injury might contribute to a pathogenesis of the disease.Öğe Fallot Pentalojisi'nin eşlik ettiği Dandy-Walker varyasyonu: Olgu sunumu(2014) Güven, Ahmet Sami; Oflaz, Mehmet Burhan; Kaya, Ali; Bolat, Fatih; Gülsever, Osman; Salk, İsmail; Bozoklu, Özlem AkkarDandy-Walker varyasyonu, 4. ventrikül ve sisterna magna arasındaki devamlılıkla sonuçlananvermisin parsiyel agenezisi ile karakterize santral sinir sisteminin nadir bir anomalisidir.Literatürde ilk kez 1988de Kohyama ve ark. [10] tarafından bildirilen Dandy-Walker varyasyonuve Fallot Tetralojisi birlikteliği daha sonraki yıllarda birkaç vaka sunumu şeklinde bildirilmiştir.Biz bu yazıda, Dandy-Walker varyasyonu ve Fallot Pentalojisi olan 2 günlük bir erkek hastayıbildiriyoruz.Öğe Is Atrial Electromechanical Coupling Delayed in Patients with Secundum Atrial Septal Defect?(WILEY-BLACKWELL, 2013) Oflaz, Mehmet Burhan; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Guven, Ahmet Sami; Gumrukcuoglu, Hasan Ali; Sarikaya, Savas; Yilmaz, AhmetBackground: There is no available published information about the atrial electromechanical coupling time (AEMCT) in patients with atrial septal defect (ASD). The aim of this study was to investigate the relationship between ASD and AEMCT obtained by tissue Doppler imaging (TDI). Methods: A total of 35 patients with ASD and 22 healthy controls were included in the study. The time intervals from the onset of the P-wave on the surface electrocardiogram to the beginning of the late diastolic A-wave (PA) representing AEMCT were obtained from the lateral mitral annulus, septal mitral annulus, and right ventricular (RV) tricuspid annulus, and named PA-lateral, PA-septal, and PA-tricuspid, respectively. The difference between PA-septal and PA-tricuspid, PA-lateral and PA-septal, and PA-lateral and PA-tricuspid were defined as intra-right AEMCT, intra-left AEMCT, and inter-AEMCT, respectively. Results: PA-tricuspid, PA-septal, and PA-lateral values were longer in patients with ASD when compared with the controls, but did not reach statistical significance (39.9 +/- 19.1 vs. 37.2 +/- 15.5, P = 0.952; 49.6 +/- 14.0 vs. 45.4 +/- 11.1, P = 0.826 and 60.3 +/- 16.3 vs. 59.7 +/- 12.5, P = 0.437, respectively). There were no significant differences between the ASD and control groups in terms of inter-atrial, intra-right atrial, and intra-left AEMCT (21.3 +/- 2.3 vs. 20.8 +/- 4.6, P = 0.957; 9.7 +/- 3.3 vs. 6.9 +/- 1.3, P = 0.723 and 13.6 +/- 4.7 vs. 10.9 +/- 4.5, P = 0.518, respectively). Furthermore, ASD diameter and total septum length did not correlate with AEMCT. Conclusion: Both intra-and inter-AEMCT were not increased in patients with ASD than control subjects. In addition, we found no association between the ASD diameter and indices of AEMCT in patients with ASD.Öğe Kissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices(TERMEDIA PUBLISHING HOUSE LTD, 2012) Kucukdurmaz, Zekeriya; Karapinar, Hekim; Oflaz, Mehmet Burhan; Gul, Ibrahim; Yilmaz, AhmetEndovascular treatment has become an accepted treatment modality for atrial septal defects (ASD) in adults. In multiple defects on a hypermobile atrial septum with atrial septal aneurysm (ASA), surgery used to be the treatment of choice, but transcatheter occlusion has emerged as a successful alternative in appropriate cases. We present a case with multiple ASDs treated with two ASD occluder devices.Öğe Letter to Editor: Takotsubo cardiomyopathy(Kare Publ, 2013) Kucukdurmaz, Zekeriya; Karapinar, Hekim; Oflaz, Mehmet Burhan; Gul, Ibrahim; Aydin, Gulay; Gunes, Hakan; Yilmaz, Ahmet[Abstract Not Available]Öğe Noninvasive evaluation of cardiac autonomic modulation in children with primary Raynaud's phenomenon: a controlled study(SPRINGER LONDON LTD, 2014) Oflaz, Mehmet Burhan; Ece, Ibrahim; Kibar, Ayse Esin; Balli, Sevket; Alaygut, Demet; Guven, Ahmet Sami; Bolat, Fatih; Duksal, Fatma; Cevit, OmerThis study aimed to objectively evaluate autonomic nervous function in children with primary Raynaud's phenomenon (PRP). Thirty-two children with PRP and 30 healthy subjects were included in the study. We analyzed heart rate variability (HRV) in the time domain by the following six standard time-domain measures: standard deviation of all normal R-R intervals during 24 h (SDNN), standard deviation of all normal R-R intervals for all 5-min segments (SDNNi), standard deviation of the average normal R-R intervals for all 5-min segments (SDANN), root mean square of the successive normal R-R interval difference, percentage of successive normal R-R intervals longer than 50 ms, and triangular index (integral of the density distribution of NN intervals divided by the maximum of the density distribution). The mean heart rate throughout 24 h was significantly higher in the PRP group than in the control group (p = 0.001). Although heart rate during the activity period was not significantly different from that during the night period, it was higher in the PRP group than in the control group (p = 0.002). In children with PRP, HRV analysis showed significantly lower values of SDNN (p = 0.01), SDNNi (p = 0.005), SDANN (p = 0.02), and HRV triangular index (p = 0.02) compared with the control group. HRV analysis for sympathovagal balance demonstrated a preponderance for the sympathetic component in patients with PRP. We conclude that all time-domain parameters evaluated in HRV analysis are significantly lower in children with PRP than in healthy subjects.Öğe The Prevalence and Outcomes of Thrombocytopenia in a Neonatal Intensive Care Unit: A Three-Year Report(TAYLOR & FRANCIS INC, 2012) Bolat, Fatih; Kilic, Suar Caki; Oflaz, Mehmet Burhan; Gulhan, Elif; Kaya, Ali; Guven, Ahmet Sami; Aygunes, Utku; Icagasioglu, Dilara; Gultekin, AsimNeonatal thrombocytopenia is one of the most common hematologic disorders in neonatal intensive care units (NICUs). The purpose of this study was to determine the prevalence of thrombocytopenia and whether thrombocytopenia has an effect on the occurrence of intraventricular hemorrhage (IVH) >= grade 2 and on mortality rate. This study was carried out retrospectively in neonates admitted to NICU of Cumhuriyet University in Sivas, Turkey, between 2009 and 2012. Among 2218 neonates evaluated, 208 (9.4%) developed thrombocytopenia. The prevalence of IVH >= grade 2 was more in infants with thrombocytopenia (7.2%) than in those without thrombocytopenia (4.4%), although this was not statistically significant (P=.08). In univariate analysis, IVH >= grade 2 was higher in cases with very severe thrombocytopenia (35.7%, n = 5) than in those with mild (2.1%, n = 2), moderate (4.7%, n = 3), and severe thrombocytopenia (15.2%, n = 5) (P=.04). Multivariate logistic regression analysis showed that birth weight <1500 g (OR 6.2, 95% CI 3.4-9.8; P=.0001), gram-negative sepsis (OR 2.5, 95% CI 1.8-4.2; P=.01), very severe thrombocytopenia (OR 1.3, 95% CI 1.1-2.1; P=.03), and platelet transfusion >= 2 (OR 7.3, 95% CI 4.1-12.1; P=.001) were significant risk factors for mortality. The results of our study suggest that outcomes of neonates with thrombocytopenia depend not only on platelet count but also on decreased gestational age or birth weight, prenatal factors, and sepsis.
