Atalay Demirel

Epidemiological analysis of retinopathy of prematurity in a referral centre in Turkey

Purpose To collect data towards the establishment of a guideline to predict the population under risk for the development of retinopathy of prematurity (ROP) in Turkey. Methods Medical reports of 2950 preterm infants who underwent screening examinations for ROP between 1996 and 2010 at Istanbul Faculty of Medicine, Department of Ophthalmology were reviewed. The study population was classified as inpatient infants and referred infants. A risk factor analysis was performed limited to the 788 inpatient infants. The demographical variables regarding birth weight (BW), gestational age (GA) and postnatal age at the time of treatment were compared independently between 403 referred and 64 inpatient infants who were treated for severe ROP. Results The mean GA of the infants with severe ROP was 31.2±2.7 weeks, mean BW was 1543.4±508.3 g. The risk factor analysis of inpatient infants revealed BW<1500 g, GA<32 weeks; intraventricular haemorrhage, respiratory distress syndrome, sepsis, apnoea and phototherapy were associated with a higher incidence of ROP. In addition, sepsis, male gender, multiple gestations, BW<1500 g were associated with a higher incidence of progression to severe ROP, whereas maternal pre-eclampsia was associated with a lower incidence. On the other hand, comparison of demographic features revealed that the referred infants with ROP were born at a significantly higher BW and needed significantly earlier treatment than inpatient infants with ROP. Conclusions The high BW and GA of infants with severe ROP indicate wider screening criteria should be used in our country. BW might be a more important criterion than GA for ROP screening.

Preliminary Anatomical and Neurodevelopmental Outcomes of Intravitreal Bevacizumab As Adjunctive Treatment for Retinopathy of Prematurity

Abstract Purpose: To evaluate the two-year follow-up of patients with type 1 retinopathy of prematurity (ROP) who received intravitreal bevacizumab (IVB) as adjunctive treatment. Materials and methods: We conducted a longitudinal follow-up study of premature infants who received 0.625 mg IVB therapy in addition to standard laser photocoagulation therapy. For comparison of the ophthalmological and neurological assessment outcomes of these infants, a control group was formed with 13 birth weight- and gestational age-matched infants who were treated with laser therapy alone for type 1 ROP. The neurological status of the study group and the control group was examined systematically, and neurodevelopmental evaluation was assessed by the Bayley Scales of Infant Development (BSID-III). Results: A total of 18 eyes of 13 infants were included in the study. Anatomical success was obtained in 14 eyes (78%) and retinal detachment was observed in 4 eyes (22%). At two years of age, no significant difference was found in terms of spherical or cylindrical refractive errors compared to the control group. In control group, 2/13 patients’ and in study group, 3/13 patients’ neurological examinations were abnormal. No significant difference was found in the mean cognitive, language or motor BSID-III test scores of the groups. Conclusions: IVB appears to be useful for advanced ROP when laser treatment is precluded or not sufficient for preventing the progression of ROP. This pilot study indicates that IVB seems to contribute no further complications to the complications already present due to prematurity.

Reversible acute tetraventricular hydrocephalus complicating possible mumps meningoencephalitis

Hydrocephalus rarely develops as a complication of mumps meningoencephalitis. There were only 16 cases reported as mumps meningoencephalitis related with hydrocephalus. It is reported that hydrocephalus may develop during or several years after meningoencephalitis. 1,2 Many cases with triventricular hyrocephalus due to aqueductal stenosis are reported. 3,4 We presented here the case of a 9-year-old boy who had complications of tetraventricular hydrocephalus in the third day of mumps meningoencephalitis.

Çocuk acil servisinde kanama nedenleri Orijinal Araştırma

Amac: Damar duvarinda zedelenme sonucunda kan akiminin engellenemedigi, kanamanin durdurulamadigi ve damar butunlugunun saglanamadigidurumlarda kanama olusur. Anormal kanama edinsel ya da kalitsal olarak pihtilasma faktorleri, trombosit veya damar duvar hastaliklarisonucunda gelisebilir. Kanama genellikle aileleri korkutan bir acile basvuru nedenidir.Gerec-Yontem: Bu calismada Ocak 1998- Ocak 2003 tarihleri arasinda Cerrahpasa Tip Fakultesi Cocuk acil birimine kanama nedeni ilebasvuran 78 olgu etiolojik olarak degerlendirildi ve sunuldu.Bulgular: Kanama olarak en sik hematuri dikkat cekti (20/78 ; %26). Olgularin %30’unda etiolojik neden idrar yolu enfeksiyonu idi. Sindirim sistemi kaynaklikanama olarak melena, hematemez, hematosezi toplam 20 (%26) olguda saptandi. Akut gastroenterit ozellikle hematosezi nedeni olarak %33 oranindasaptanirken; melena ve hematemez etiolojisinde ise gastrit, ulser ve ust sindirim sistemi kanamalari onemli yer tutmakta idi. Epistaksis ucuncu sikliklarastlanilan bir bulgu idi (18/78; % 23). Ust solunum yolu enfeksiyonu en sik epistaksis nedeni olarak bulundu ( % 60). Cilt kanamalari (petesi 10/78; ekimoz4/78) %18 oraninda saptandi. Etiolojisinde % 80 idiyopatik trombositopenik purpura vardi. Ancak % 10 olguda malinite ve %50 olguda travma etioloji nedeniidi. Yumusak doku, hemartroz ve mukozal kanamalarin nedeni ise genellikle kanama diyatezi idi. Kanama nedeni ile hasta kaybedilmedi.Cikarimlar: Kanama acil tetkik ve tedavisi gereken bir durumdur. En sik saptanan nedenler goz onunde tutularak gereksiz pahali tetkik vegirisimlerden kacinarak iyi oyku ve klinik verilerle kisa surede sonuca ulasilabilir.Bu calismada Cocuk Acil birimine kanama nedeni ilebasvuran olgular etiolojik olarak degerlendirilmis vesunulmak istenmistir.Gerec ve YontemOcak 98- Ocak 2003 dort yillik donemde Cerrahpasa TipFakultesi Cocuk Acil poliklinigimize bas vuran 37 059cocuk geriye donuk olarak dosyalarindan degerlendirildi.Bunlardan 78 (% 0,2) olgunun acile basvuru nedeni sadecekanama idi. Olgularin 30’u kiz , 48’i erkekti. Olgular, yasve kanama bolgesine gore gruplandirilarak altta yatan neden

Enfeksiyon ve koagülasyon Derleme

Son zamanlarda hemostaz ve enfeksiyon arasindaki iliski giderek daha cok ilgi cekmektedir Bakteriyel ya da bakteriyel olmayan enfeksiyonlar yaygin damar ici pihtilasmasi ya da coklu organ yetersizligi ile sonuclanan pihtilasma mekanizmasi bozukluklarina neden olabilir Yakin donemde yapilan calismalarda sitokinlerin etkisi ile ortaya cikan doku faktorunun ekstrensek yol uzerinden pihtilasma mekanizmasini tetikledigi gosterilmistir Eskiden sadece destek tedavileri ile takip edilen enfeksiyonlarda dusuk bulunan pihtilasma ve fibrinolitik ajanlarin yerine koyma tedavilerinin gelecekte enfeksiyon hastaliklari tedavi protokollarina girmesi kacinilmaz olacaktir Anahtar Kelimeler: enfeksiyon koagulasyon sepsis yaygin damar ici pihtilasmasi