Mustafa Kosecik

Assessment of bone ages: Is the Greulich‐Pyle method sufficient for Turkish boys?

Abstract Background : The Greulich‐Pyle (GP) Atlas of skeletal maturation has been prepared in white children who born between 1917 and 1942 in the USA, and is frequently used for assessment of skeletal maturity. In this study, we investigated whether or not the GP method is sufficient for Turkish children for the determination of the skeletal age.

Altered anti-oxidant status and increased lipid peroxidation in marasmic children.

Abstract Background: Protein energy malnutrition (PEM) is a common pediatric health problem in developing countries. Although the clinical features of PEM are well known, its pathophysiology is still unclear. Free radicals have been implicated in pathogenesis of PEM. In the present study, oxidant/anti‐oxidant status in marasmus was investigated.

Dilated cardiomyopathy due to nutritional vitamin D deficiency rickets.

Rickets due to vitamin D defi ciency is still an important and common problem in developing countries. 1 In patients with vitamin D defi ciency rickets asymptomatic left ventricular dysfunction that improves with treatment may develop, but dilated cardiomyopathy causing congestive heart failure is extremely uncommon. 2 – 5 In this report we describe a case of dilated cardiomyopathy due to nutritional vitamin D defi ciency rickets that improved with subsequent vitamin D and calcium supplementation.

Pericardial hydatid cyst presenting with cardiac tamponade.

Cases of cardiac hydatid cyst disease are uncommon, occurring in approximately 0.5% to 2% of patients with hydatid disease. Most cardiac hydatid cysts are located in the left ventricle and interventricular septum. Cardiac involvement may have serious consequences. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 10-year-old girl with cardiac tamponade secondary to a pericardial hydatid cyst is described.

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.

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