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Öğe Aortic aneurysm a rare complication of ulcerative colitis(Anadolu Kardiyol Derg 2007; 7: 459-62., 2007) Karakurt, Cemşit; Selimoğlu, Ayşe; Özen, Metehan; Koçak, GülemdamA 48-year-old man who was admitted to hospital because of syncope, transient ischemic attack, palpitations and chest pain. On physical examination, he had sight deficiency on the right eye. Electrocardiography revealed T-wave inversion in leads V1 through V6. The cardiac enzymes (creatine phosphokinase-MB and Troponin-T) were normal. Laboratory analysis was normal. Echocardiogram showed an apical mass resembling thrombus in apical region of the left ventricle (Video 1, 2. See corresponding video/movie images at www.anakarder.com). The coronary angiography (CAG) of the patient showed that the patient’s left anterior descending (LAD) artery was irregular, dissected, and recanalized spontaneously following the dissection; it also revealed the presence of double lumen structure and no aneurysm any where on ventricle (Fig. 1). The other coronary arteries were normal. Brain computed tomography revealed infarction in the occipital region. It was judged by neurologists that this lesion would not hinder open heart surgery. Anticardiolipin antibodies were negative. There was no stigma of connective tissue disorder. Due to the prolonged existence of mass and continuance of the patient’s complaints despite the maximal anticoagulant treatment (keeping INR 2-3), we decided to operate the patient with the techniques of standard cardiopulmonary bypass using moderate hypothermia and cardioplegia arrest. In the operation, a mass including thrombus with diameters of 20x15 mm adjacent to the papillary muscles on the left ventricular apical region was resected. Apical region was closed with felt (Fig. 2). However, we did not perform coronary artery bypass grafting (CABG) because of the absence of significant stenosisÖğe Clinical and ımaging findings in childhood posterior reversible encephalopathy syndrome(Iranıan journal of chıld neurology, 2018) Güngör, Serdal; Kılıç, Betül; Tabel, Yılmaz; Selimoğlu, Ayşe; Özgen, Ünsal; Yılmaz, Sezai; Sigirci, AhmetObjective Posterior reversible encephalopathy syndrome (PRES) is characterized by typical radiologic findings in the posterior regions of the cerebral hemispheres and cerebellum. The symptoms include headache, nausea, vomiting, visual disturbances, focal neurologic deficits, and seizures. The aim of this study is to evaluate the clinical and radiological features of PRES in children and to emphasize the recognition of atypical features. Materials & Methods We retrospectively examined 23 children with PRES from Mar 2010-Apr 2015 in Inonu University Turgut Ozal Medical Center in Turkey. We compared the clinical features and cranial MRI findings between underlying diseases of PRES. Results The most common precipitating factors were hypertension (78.2%) and medications, namely immunosuppressive and antineoplastic agents (60.8%). Manifestations included mental changes (100%), seizures (95.6%), headache (60.8%), and visual disturbances (21.7%) of mean 3.6 (range 1-10) days' duration. Cranial magnetic resonance imaging (MRI) showed bilateral occipital lesions in all patients, associated in 82.6% with less typical distribution of lesions in frontal, temporal or parietal lobes, cerebellum, corpus callosum, basal ganglia, thalamus, and brain stem. Frontal involvement was predominant, observed in 56.5% of patients. Clinical recovery was followed by radiologic resolution in all patients. Conclusion PRES is often unsuspected by the clinician, thus radiologists may be the first to suggest this diagnosis on an MRI obtained for seizures or encephalopathy. Atypical MRI finding is seen quite often. Rapid diagnosis and treatment are required to avoid a devastating outcome.Öğe Is Gastroesophageal Reflux Disease a Common Complication in Infants with Congenital Heart Disease?(2019) Demirtas, Mehmet Semih; Karakurt, Cemşit; Selimoğlu, Ayşe; Gözükara Bağ, HarikaAbstract: Objective: Gastroesophageal reflux disease (GERD) is believed to be one of the most common complications of congenital heart disease (CHD) in infants though the exact prevalence is not known. In this study, we aimed to investigate GERD symptoms in infants with CHD. Material and Methods: Infant Gastroesophageal Reflux Questionnaire Revised was applied twice for 109 infants with CHD and 81 healthy infants, both with a median age of 5 months, two months apart and data were analyzed. Results: Mean reflux score was 4.81±0.56 (0-23) and 5.1±5.71 (0-24) in the CHD and control groups, respectively (p=0.62). According to ROC curve analysis, we considered a score of 7 (95% CI=53%-76.6%) as being a cut-off value for GERD. Thirteen infants, 7 with CHD (6.42%) and 6 healthy infants (7.40%) had reflux score?16 (p==0.79). Conclusion: GERD is not more common in CHD than in healthy babies. As the only difference in terms of individual symptom prevalence is in apnea and cyanosis, symptoms of CHD as well, it was concluded that there is a need for more objective methods and new questionnaires to be used for infants with CHD.Öğe Report of seven children with hepatopulmonary syndrome(Turk J Gastroenterol 2014; 25: 724-9, 2014) Erge, Duygu; Selimoğlu, Ayşe; Karakurt, Cemşit; Karabiber, Hamza; Elkıran, Özlem; Çatal, FeratHepatopulmonary syndrome is an important pulmonary vascular complication of liver disease. Its diagnosis is based on the presence of hypoxaemia and the demonstration of intrapulmonary shunting by contrast-enhanced echocardiography or perfusion lung scanning. Awareness of this condition is critical to improve the outcomes of patients with chronic liver disease and/or portal hypertension because hepatopulmonary syndrome receives additional priority on the waiting list for transplantation. A non-invasive measurement of the blood oxygen saturation with pulse oximetry is recommended as a screening tool for this syndrome. The aim of this report was to present clinical and laboratory findings and follow-up of seven paediatric patients who were diagnosed with HPS at our centre.Öğe Sirozlu çocuklarda kalp fonksiyonlarının doku Doppler görüntüleme ile değerlendirilmesi(2017) Çelik, Elif; Karakurt, Cemşit; Çelik, Serkan Fazlı; Selimoğlu, Ayşe; Varol, Fatma İlknurGiriş ve Amaç: Sirotik kardiyomiyopati siroz varlığında oluşan kardiyak disfonksiyon olarak tanımlanmaktadır. Pediatrik yaş grubunda sirotik kardiyomiyopati ile ilgili yapılmış çok az sayıda çalışma vardır. Bu çalış- mada sirozlu çocuklarda kardiyak fonksiyonlar ile pulmoner komplikas- yonları tespit etmek amaçlandı. Gereç ve Yöntem: Bu çalışmada İnö- nü Üniversitesi Tıp Fakültesi Çocuk Gastroenteroloji Bölümü'nde, Ekim 2011-Aralık 2013 tarihleri arasında retrospektif olarak iki yıllık süreçte izlenen 52 sirozlu çocuk hasta ile yaş ve cinsiyetleri benzer 30 sağlıklı çocuk konvansiyonel, renkli Doppler ve doku Doppler ekokardiyorafik görüntüleme yöntemleriyle değerlendirildi. Bulgular: Çalışmaya alınan 52 olgunun yaş ortalaması 6.5±4.6 yıl, 28'i erkek (%53,3), 24'ü kız (%47,7) idi. Kontrol grubunun yaşlarının ortalaması 6.88±3.04 yıl, 16'sı erkek (%53,3), 14'ü kız (%46,6) olmak üzere toplam 30 idi. Hastaların M-mod değerlendirmelerinde sol ventrikül arka duvarı kontrol grubun- dan daha kalındı (5.9±1.7 mm ve 5.1±1.8 mm, p:0.03). Renkli Doppler- le mitral kapaktan ölçülen E/A oranı hasta grubunda anlamlı derecede düşüktü (1.46±0.43 ve 1.61±0.46, p: 0.01). Hasta grubu daha uzun izovolümik relaksasyon süresine (48.5±12.5 ms ve 42.6±11.64 ms, p: 0.001) ve daha kısa izovolümetrik kontraksiyon süresine (43.6±9.5 ms ve 48.6±11.6 ms, p: 0.001) sahipti. Hasta grubunda sol ventrikü- lün miyokard performans indeksi anlamlı olarak yüksekti (0.57±0.13 ve 0.50±0.67, p: 0.02). Hastaların 8 tanesine (%15) hepatopulmoner sendrom tanısı kondu. Hepatopulmoner sendromlu hastaların ekokar- diyografik değerlendirilmelerinde, hepatopulmoner sendromu olmayan hasta grubuna göre interventriküler septum diastolik kalınlığı (6,9±1.2 mm ve 6.4±1.8 mm, p: 0.04) ve yavaşlama süresi (154.1± 35.6 ms ve 140.4±39.8 ms, p: 0.03) daha fazla idi. Sonuç: Sirotik çocuklarda başta diyastolik disfonksiyon olmak üzere kardiyak disfonksiyon vardır. hepa- topulmoner sendromlu grupta bu etkilenme daha fazladır. Çalışmamız doku Doppler ekokardiyografinin, hastalık progresyonunun saptanması ve izlenmesi için yararlı bir yöntem olduğunu göstermektedirÖğe Sirozlu çocuklarda kalp fonksiyonlarının doku Doppler görüntüleme ile değerlendirilmesi(Akademik Gastroenteroloji Dergisi, 2017) Çelik, Elif; Karakurt, Cemşit; Selimoğlu, Ayşe; Varol, Fatma İlknurSirotik kardiyomiyopati siroz varlığında oluşan kardiyak disfonksiyon olarak tanımlanmaktadır. Pediatrik yaş grubunda sirotik kardiyomiyopati ile ilgili yapılmış çok az sayıda çalışma vardır. Bu çalış- mada sirozlu çocuklarda kardiyak fonksiyonlar ile pulmoner komplikasyonları tespit etmek amaçlandı. Gereç ve Yöntem: Bu çalışmada İnö- nü Üniversitesi Tıp Fakültesi Çocuk Gastroenteroloji Bölümü’nde, Ekim 2011-Aralık 2013 tarihleri arasında retrospektif olarak iki yıllık süreçte izlenen 52 sirozlu çocuk hasta ile yaş ve cinsiyetleri benzer 30 sağlıklı çocuk konvansiyonel, renkli Doppler ve doku Doppler ekokardiyorafik görüntüleme yöntemleriyle değerlendirildi. Bulgular: Çalışmaya alınan 52 olgunun yaş ortalaması 6.5±4.6 yıl, 28’i erkek (%53,3), 24’ü kız (%47,7) idi. Kontrol grubunun yaşlarının ortalaması 6.88±3.04 yıl, 16’sı erkek (%53,3), 14’ü kız (%46,6) olmak üzere toplam 30 idi. Hastaların M-mod değerlendirmelerinde sol ventrikül arka duvarı kontrol grubundan daha kalındı (5.9±1.7 mm ve 5.1±1.8 mm, p:0.03). Renkli Dopplerle mitral kapaktan ölçülen E/A oranı hasta grubunda anlamlı derecede düşüktü (1.46±0.43 ve 1.61±0.46, p: 0.01). Hasta grubu daha uzun izovolümik relaksasyon süresine (48.5±12.5 ms ve 42.6±11.64 ms, p: 0.001) ve daha kısa izovolümetrik kontraksiyon süresine (43.6±9.5 ms ve 48.6±11.6 ms, p: 0.001) sahipti. Hasta grubunda sol ventrikü- lün miyokard performans indeksi anlamlı olarak yüksekti (0.57±0.13 ve 0.50±0.67, p: 0.02). Hastaların 8 tanesine (%15) hepatopulmoner sendrom tanısı kondu. Hepatopulmoner sendromlu hastaların ekokardiyografik değerlendirilmelerinde, hepatopulmoner sendromu olmayan hasta grubuna göre interventriküler septum diastolik kalınlığı (6,9±1.2 mm ve 6.4±1.8 mm, p: 0.04) ve yavaşlama süresi (154.1± 35.6 ms ve 140.4±39.8 ms, p: 0.03) daha fazla idi. Sonuç: Sirotik çocuklarda başta diyastolik disfonksiyon olmak üzere kardiyak disfonksiyon vardır. hepatopulmoner sendromlu grupta bu etkilenme daha fazladır. Çalışmamız doku Doppler ekokardiyografinin, hastalık progresyonunun saptanması ve izlenmesi için yararlı bir yöntem olduğunu göstermektedirÖğe Subclinical diastolic dysfunction in children with Wilson s disease assessed by tissue Doppler echocardiography a possible early predictor of cardiac involvement(Acta cardiologica, 2013) Elkıran, Özlem; Karakurt, Cemşit; Selimoğlu, Ayşe; Karabiber, Hamza; Koçak, Gülemdar; Çelik, Faruk Serkan; Çolak, CemilBackground The aim of this study was to evaluate the left ventricular systolic and diastolic functions and cardiac rhythm problems for the early detection of myocardial dysfunction in children with Wilson’s disease. Methods We compared patients who had Wilson’s disease (n = 22) with age- and sex-matched healthy control subjects (n = 21). The diagnosis of Wilson’s disease was based on clinical symptoms and laboratory tests (serum ceruloplasmin, urinary and hepatic copper concentrations). Standard echocardiographic examination, as well as pulsed-wave Doppler, tissue Doppler echocardiography examinations of all patients were performed. 24-hour ECG Holter monitoring was also performed in all subjects. Results All patients were asymptomatic on cardiological examination and had sinus rhythm on electrocardiography. Left ventricular ejection fraction, fractional shortening, wall thickness and left ventricular mass were similar in both groups. In comparison to healthy subjects, children with Wilson’s disease had signifi cantly lower mitral E velocity, mitral E/A ratio (P = 0.046, P= 0.021, respectively) and longer isovolumetric relaxation time values (P = 0.015) as estimated by pulsed wave Doppler echocardiography. Wilson patients had longer isovolumetric relaxation time (IVRT) values estimated by tissue Doppler echocardiography (P = 0.006) compared to the controls. On 24-hour ECG Holter monitoring, none of the Wilson patients showed life-threatening cardiac arrhythmia. Conclusion Our study showed results that might be consistent with subclinical diastolic dysfunction in cardiologically asymptomatic Wilson’s disease children which probably represents an early stage of cardiac involvement. Therefore it may be useful to monitor these signs in the follow-up of the patients.Öğe Subclinical diastolic dysfunction in children with Wilson s disease assessed by tissue Doppler echocardiograpy a possible early predictor of cardiac involvement(Acta Cardiol, 2013) Elkıran, Özlem; Karakurt, Cemşit; Selimoğlu, Ayşe; Karabiber, Hamza; Koçak, Gülemdar; Çolak, CemilBackground: The aim of this study was to evaluate the left ventricular systolic and diastolic functions and cardiac rhythm problems for the early detection of myocardial dysfunction in children with Wilson’s disease. Methods: We compared patients who had Wilson’s disease (n = 22) with age- and sex-matched healthy control subjects (n = 21). The diagnosis of Wilson’s disease was based on clinical symptoms and laboratory tests (serum ceruloplasmin, urinary and hepatic copper concentrations). Standard echocardiographic examination, as well as pulsed-wave Doppler, tissue Doppler echocardiography examinations of all patients were performed. 24-hour ECG Holter monitoring was also performed in all subjects. Results: All patients were asymptomatic on cardiological examination and had sinus rhythm on electrocardiography. Left ventricular ejection fraction, fractional shortening, wall thickness and left ventricular mass were similar in both groups. In comparison to healthy subjects, children with Wilson’s disease had significantly lower mitral E velocity, mitral E/A ratio (P = 0.046, P = 0.021, respectively) and longer isovolumetric relaxation time values (P = 0.015) as estimated by pulsed wave Doppler echocardiography. Wilson patients had longer isovolumetric relaxation time (IVRT) values estimated by tissue Doppler echocardiography (P = 0.006) compared to the controls. On 24-hour ECG Holter monitoring, none of the Wilson patients showed life-threatening cardiac arrhythmia. Conclusion: Our study showed results that might be consistent with subclinical diastolic dysfunction in cardiologically asymptomatic Wilson’s disease children which probably represents an early stage of cardiac involvement. Therefore it may be useful to monitor these signs in the follow-up of the patients.Öğe Virulence factors and antibiotic resistance in children with helicobacter pylori gastritis(Journal of Pediatric Gastroenterology and Nutrition, 2014) Karabiber, Hamza; Selimoğlu, Ayşe; Otlu, Barış; Yıldırım, Özge; Özer, AliObjectives: There are limited data regarding the pattern of Helicobacter pylori (Hp) antibiotic resistance and virulence factors in children. Evaluation of prevalence of drug resistance and virulence-factor genotype in children with Hp gastritis and to investigate whether there is any relation between drug resistance and genotype were our aims in this study. Methods: Ninety-eight children with polymerase chain reaction–positive Hp gastritis were included. Antimicrobial susceptibility was tested by disc diffusion method and polymerase chain reaction assays were used for the determination of virulence factors. Results: The resistance rates to clarithromycin, metronidazole, and amoxicillin were 23.5%, 11.7%, and 3.9%, respectively. All strains carried vacA genotype, and 51%, 70.4%, 49%, 34.7%, and 25.5% were cagA-, cagE-, babA2-, iceA1-, and iceA2-positive, respectively. Of those 98 specimens, 81.6%, 19.4%, 38.8%, and 63.3% carried vacAs1, vacAs2, vacAm1, and vacAm2, respectively. Dominant vacA type was s1am2 (32.7%), followed by s1am1 (14.3%) and s2m2 (12.2%). Significant rates of clarithromycin resistance were observed in cagE-, iceA1-, babA2-, and vacAs1c-positive groups. In those with metronidazole resistance, vacAs1 and vacAs1c were more common (P < 0.05). Conclusions: The cagE-positive and vacA s1a/m2 genotypes, which are correlated with increased antibiotic resistance, were predominant in our population. In countries where Hp infection is prevalent, studies focusing on virulence factors and antibiotic susceptibility may provide anticipation of the prognosis and may be helpful to reduce morbidity and mortality.
