Mustafa Kir

Evaluation of serum lipids and carotid artery intima media thickness in epileptic children treated with valproic acid

The aim of this study is to evaluate the carotid artery intima media thickness and serum lipids in pediatric patients with epilepsy treated with valproic acid. The study included 44 pediatric epileptic and 40 healthy children. Intima media thickness of left common carotid artery and fasting lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) were assessed. Although we did not observe any differences regarding serum lipid profiles, intima media thickness of common carotid artery was significantly higher in epileptic patients treated with valproic acid. We suggest that this increase in intima media thickness of common carotid artery may be due to epilepsy and/or valproic acid treatment.

Chorioangiomatosis Presenting with Severe Anemia and Heart Failure in a Newborn

Although chorioangiomas are the most common placental tumors, multiple chorioangiomas (or chorioangiomatosis) are extremely rare. We report a female newborn at 37 weeks of gestation presenting with severe anemia, thrombocytopenia, heart failure, and intrauterine growth retardation. The pathological examination of the placenta revealed chorioangiomatosis explaining the pathophysiology of the symptoms presented. The patient was treated successfully with erythrocyte and thrombocyte transfusions and was discharged after full recovery. We conclude that evaluating placental lesions may be of great value in explaining severe problems during the fetal and the neonatal period and thus prevents performing unnecessary clinical investigations.

The effect of L-thyroxine treatment on left ventricular functions in children with subclinical hypothyroidism

Objective The aim of this study was to search for evidence suggesting treatment for childhood subclinical hypothyroidism (SH) by evaluating left ventricular (LV) functions of children with SH by using M-mode and tissue Doppler echocardiography (TDE). Methods Children with SH and euthyroid healthy children (control group) were enrolled in the study. At baseline and 6 months after euthyroidism was achieved, M-mode and TDE were performed and LV functions were evaluated. Pretreatment parameters of the SH group were compared with those of controls and post-treatment parameters. Results 31 children with SH and 32 euthyroid healthy children were enrolled in the study. The groups had similar age, gender, puberty and body mass index. Interventricular septum thickness and LV mass index, which are the parameters for LV morphology, were slightly increased in the SH group than in the controls (p<0.05). In TDE, children with SH had significant changes in LV diastolic (lower E′m, higher E/E′m ratio and longer isovolumic relaxation time) and systolic functions (lower isovolumic contraction time) compared with controls (p<0.05). Six months after euthyroidism was achieved, TDE showed a significant improvement of some of the diastolic and systolic parameters (p<0.05). Conclusions The results of this study showed that SH is associated with subclinical alterations in LV function, and LT4 replacement may improve LV systolic and diastolic parameters. However, since SH is usually a self-limiting process, these improvements in LV functions may simply be associated with the natural course of the disease and/or physiological linear growth of the children.

Noninvasive assessment of left-to-right shunting in ventricular septal defects by the proximal isovelocity surface area method on Doppler colour flow mapping

BACKGROUND AND AIM The proximal isovelocity surface area (PISA), which is the zone of flow convergence appearing on the left ventricular septal surface where flow approaching the defect accelerates, allows quantitative estimation of ventricular septal defect (VSD) flow and defect area on colour Doppler imaging. In the present study, the clinical applicability and reliability of the PISA method in assessing the amount of left-to-right shunting in patients with VSDs were evaluated. PATIENTS AND METHODS Fifty-eight patients aged 0.25 to 15 years (mean age 4.3+/-4.4 years) with VSDs were prospectively studied. Maximum PISA radius in peak systole (r), peak velocity (V(max)) and velocity time integral (VTI(VSD)) of flow through the VSD were measured. In addition, peak VSD flow (2pir(2) Nyquist limit [NL]), amount of left-to-right shunting (Qp-Qs = heart rate x [2pir(2) x NL x VTI(VSD)]/V(max)) and defect area ([2pir(2) x NL]/V(max)) were calculated. RESULTS There were significant positive correlations between Qp-Qs values calculated by PISA and other spectral Doppler methods using the cross-sectional area, as well as the VTI of pulmonary-aortic (r=0.73, P<0.001) or mitral-tricuspid (r=0.58, P<0.001) flows and cardiac catheterization (20 patients, r=0.82, P<0.001). PISA-derived left-to-right-shunting discriminated moderate to large defects from small defects, which were classified according to the catheter-derived Qp/Qs ratio (2 or greater versus less than 2; P=0.001) or clinical evaluation (P<0.001). CONCLUSIONS The present study demonstrated that the PISA method is a reliable semiquantitative method to determine the amount of left-to-right shunting of VSDs and to discriminate moderate to large defects from small defects. Consequently, this method may serve as a simple and useful adjunct to conventional spectral Doppler methods in the noninvasive assessment of patients with VSDs.

Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B‐type natriuretic peptide and tissue Doppler findings

To evaluate the relationship between 24‐h blood pressure (BP) measurements and diastolic heart function evaluated by Doppler tissue imaging and B‐type natriuretic peptide (BNP) levels in children with type 1 diabetes mellitus (DM).

Endocrinological and cardiological late effects among survivors of childhood acute lymphoblastic leukemia.

Objective: Survival rates for childhood acute lymphoblastic leukemia (ALL) have significantly improved and late effects of therapy have been important in the follow-up of survivors. The objective of this study is to identify the endocrinological and cardiological late effects of ALL patients treated in our pediatric hematology unit. Materials and Methods: Patients treated for ALL with BFM protocols after at least 5 years of diagnosis and not relapsed were included in the study. Endocrinological late effects (growth failure, obesity, insulin resistance, dyslipidemia, thyroid gland disorders, osteopenia/osteoporosis, and pubertal disorders) and cardiological late effects were evaluated. The study group was evaluated with anthropometric measurements, body mass index, and laboratory testing of fasting glucose, insulin, serum lipids, thyroid functions, and bone mineral densities. Echocardiography and pulsed wave Doppler imaging were performed for analysis of cardiac functions. Results: Of the 38 ALL survivors, at least 1 adverse event occurred in 23 (60%), with 8 of them (21%) having multiple problems. Six (16%) of the survivors were obese and 8 (21%) of them were overweight. Subjects who were overweight or obese at the time of diagnosis were more likely to be overweight or obese at last follow-up. Obesity was more frequently determined in patients who were younger than 6 years of age at the time of diagnosis. Insulin resistance was observed in 8 (21%) subjects. Insulin resistance was more frequently seen in subjects who had family history of type 2 diabetes mellitus. Hyperlipidemia was detected in 8 (21%) patients. Hypothyroidism or premature thelarche were detected in 2 children. Two survivors had osteopenia. Cardiovascular abnormalities occurred in one of the subjects with hypertension and cardiac diastolic dysfunction. Conclusion: We point out the necessity of follow-up of these patients for endocrinological and cardiological late effects, since at least one adverse event occurred in most of our cases. Conflict of interest:None declared.

Takayasu’s arteritis with bilateral renal artery stenosis: Unilateral kissing balloon angioplasty

Takayasu’s arteritis is a systemic non-specific vasculitis artery and bilateral stenosis at main renal arteries (Fig. 1). In primarily affecting the walls of large vessels. Renal arterial stenosis may be bilateral and usually seen with coexisting aortic involvement [1]. Percutaneous transluminal renal balloon angioplasty (PTRBA) is successful in up to 90% of cases and blood pressure control is achieved in approximately 68%. PTRA alone or supported with stent implantation has also been helpful in patients with suboptimal results after PTRBA and for managing recurrent restenosis [2]. Renal arterial bifurcational stenosis can be dilated by the kissing balloons technique, thus rendering difficult vascular surgery unnecessary [3]. In this article, a case with Takayasu arteritis that received the kissing balloon technique for a bifurcational renal artery stenosis was reported. An eleven-year-old girl was admitted to our clinic with complaints of malaise, headache, and exercise intolerance and diminished weight gain since she was four. Her physical examination showed right arm blood pressure of 110/70 mmHg, right leg blood pressure of 230/110 mm Hg. Her left radial, brachial and carotid pulses were not palpable and the pulses that belong to the lower extremities were palpable bilaterally. All laboratory findings were normal. Angiographic examination revealed narrowing of the right subclavian artery, bilateral carotid arteries, total occlusion of the left subclavian artery, normal left and right coronary arteries and minimal aortic insufficiency (Fig. 1). There was no stenosis at the pulmonary arteries. Aortography showed a bifurcational stenosis at an upper segment of the right renal

Ligation of patent ductus arteriosus in low birth weight premature infants: timing for intervention and effectiveness of bed-side surgery

BackgroundPatent ductus arteriosus is a common congenital cardiac condition. Its importance is mostly underestimated and accepted as an “easy” heart disease. Physiological consequences of pulmonary overflow may cause severe mortality in premature neonates. Accurate timing of surgical intervention is essential to decrease the mortality in very low birth weight premature infants. On-site surgery in the intensive care units (ICUs) results excellent surgical quality without jeopardizing the safety of the patients.MethodsWe have summarized the clinical and operative data of 26 premature neonates (<37 weeks of gestational age), which were operated for the diagnosis of PDA in the ICUs of Dokuz Eylül University. Thirteen low birth weight infants (<1000 gr) have been compared with remaining 13 neonates (>1000 gr).ResultsThere was no surgical mortality in both groups. Co-existing problems were observed in both groups, which did not affect surgical mortality and morbidity.ConclusionsSurgery in the ICU is a safe method for premature neonates with physiologically significant PDA. This technique should be the method of choice in experienced centers.

Anemia and Its Effect on Cardiovascular Findings in Obese Adolescents

Objective: We assessed the effect of anemia on cardiovascular findings in obese adolescents. Materials and Methods: We studied 29 anemic and 33 nonanemic obese adolescents, and 33 nonobese healthy adolescents. These three groups were investigated for clinical and laboratory features of anemia and obesity. Echocardiography was used to examine cardiac functions. Results: The anemia was mild (mean hemoglobin: 11.67±0.79 g/dL), ferritin level was significantly low, and C-reactive protein and fibrinogen levels were significantly high in anemic obese patients. Increased cardiac pulse and echocardiographic findings, which may be indicative of early left ventricular diastolic dysfunction, were present in these patients. Conclusion: Anemia may develop due to iron deficiency and chronic inflammation in obese adolescents. Even mild anemia may cause increased heart rate and affect left ventricular diastolic functions. Diet programs for obese children should be carefully planned to avoid iron deficiency anemia, which may worsen the cardiac events in long-term follow-up.

The relationship between left to right shunting congenital heart disease and cardiotrophin-1 in children

Amac: Calismamizda cocuklarda soldan saga santli dogumsal kalp hastaliklarinda serum kardiyotrofin-1 (CT-1) duzeyleri ile sant miktarinin karsilikli etkilesimlerini arastirmak, bu belirtecin intrakardiyak defekt tipine gore degisimlerini incelemek amaclanmistir. Gerec ve Yontem: Calismamizda, 1 ay–13 yaslari arasinda, 45 hasta ve 23 saglikli cocuk incelendi. Hasta grubu icinde 19 olguda atriyal septal defekt (ASD), 17 olguda ventrikuler septal defekt (VSD), 6 olguda ASD ve VSD (ASD+VSD) ve 3 olguda patent duktus arteriyozus (PDA) mevcuttu. Tum cocuklara konvansiyonel ekokardiyografi incelemesi (iki boyutlu, M-Mode, iki boyutlu Doppler ve renkli Doppler ekokardiyografileri) yapildi. Tum olgulardan ekokardiyografi calismalari ile es zamanli olarak plazma BNP duzeyleri kemiluminisans ve CT-1 duzeyleri de “enzyme-linked immunosorbent assay” (ELISA) yontemleriyle olculdu. Bulgular: Hasta grubunda CT-1 ile sant miktari arasinda (p 2) CT-1 ile EF ve FS arasinda negatif korelasyon bulundu (p<0,001, r=0,71). Sonuc: CT-1’in soldan saga santli kalp hastaliklari grubunda yukselmis oldugu bulundu. Bunun yani sira intrakardiyak santi fazla, kalp yetersizligi riski yuksek olan grupta da CT-1’in sant miktariyla korele olarak arttigi saptandi. Sonuc olarak CT-1, eriskinlerde oldugu gibi cocuklardaki kalp yetmezliginin degerlendirilmesinde de kullanilmaya aday bir belirtectir. Ancak, cocukluk caginda CT-1 ile kalp fonksiyonlari arasindaki iliskiyi ortaya koymak icin daha fazla sayida hastanin incelendigi prospektif calismalara ihtiyac vardir.