Permanent resiprokan kavşak taşikardisine bağlı dilate kardiyomiyopati: Bir olgu sunumu

We present a four-year-old girl who was admitted to our hospital with the complaints of dyspnea, tachypnea, cough, excess sweating and fatigue. Electrocardiogram (ECG) in the tachycardic girl showed inverted P waves in leads 2, 3 and aVF along with a P-R interval of 0.16 sec and an R-P interval of 0.28 sec. Transthoracic echocardiography revealed an enlarged and spherical left ventricle with diminished systolic functions. Holter ECG confirmed long R-P tachycardia with a rate of 140-160 beats/minute. She was diagnosed as having permanent junctional reciprocating tachycardia-induced dilated cardiomyopathy and successfully treated with catheter ablation and flecainide.Bu olgu sunumunda hastanemize dispne, takipne, öksürük, aşırı terleme ve yorgunluk yakınması ile başvuran dört yaşında kız olgu sunduk. Taşikardik olan hastanın elektrokardiyografisinde (EKG) V2, V3 ve aVF derivasyonlarında ters P dalgaları ile birlikte 0,16 sn P-R aralığı ve 0,28 sn R-P aralığı mevcuttu. Transtorasik ekokardiyografide sistolik fonksiyonları azalmış, geniş ve sferik sol ventrikül saptandı. Holter EKG'de kalp hızı 140-160/dk olan uzun R-P intervalli taşikardi konfirme edildi. Hastaya permanent resiprokan kavşak taşikardisine bağlı dilate kardiyomiyopati tanısı kondu ve hasta kateter ablasyonu ve flekainamid tedavisi ile başarılı bir şekilde tedavi edildi

Residents and interns in the 3 university hospitals: their knowledge of and attitudes to drug allergy

Background: Previous studies revealed there are many gaps in the awareness and knowledge regarding the diagnosis and management of drug allergy (DA) among various health-care professionals. Objective: To assess the knowledge, attitudes, and practices towards DA among residents and interns of 3 university hospitals in the region of Trakya (Thrace), Turkey. Methods: A cross-sectional survey was conducted at university hospitals of 3 cities in the Trakya region: 1. Trakya University Medical Faculty, Edirne (n = 405), 2. Namik Kemal University Medical Faculty, Tekirdag (n = 114), and 3. Canakkale 18 Mart University Medical Faculty, Canakkale (n = 111). A Turkish questionnaire was developed based on previous published studies. Results: The majority of participants (67%) had not received education on DA as a separate subject during their medical education. Less than a third (28.3%) of all respondents were satisfied with their knowledge concerning patients with clinical signs of DA. Of the 6 knowledge questions on DA, the average score for the study was 3.51 out of 6 (58.5%). Residents had a higher knowledge score (3.93 +/- 1.1) compared with interns (3.05 +/- 1.2) (p < 0.001). The lowest percentage of correct answers were in response to questions on laboratory confirmation of drug-related anaphylaxis (14.5%) and the possibility of penicillin toleration in patients with a history of penicillin allergy (11.8%). The majority of participants (92%) believe that medical doctors should be educated in DA. There were no significant correlations between taking DA histories and the frequency during daily practice of encountering patients. Conclusion: Our study revealed that DA knowledge and attitudes are not at satisfactory level among respondents, and we concluded the importance and necessity of reinforcement of DA education in pre- and postgraduate education of medical doctors

Prospective evaluation of pituitary function in cases with the diagnosis of head trauma.

Tıpta Uzmanlık TeziBu çalışmada, kafa travması tanısı almış çocuklarda hipofiz işlev bozukluğunun gelişip gelişmediği, en fazla hangi eksenlerin etkilendiği, kafa travmasının şiddeti ve tanıdan sonra geçen süre ile hipofiz işlev bozuklukları arasında bir bağlantı olup olmadığının araştırılması amaçlanmıştır. Nisan 2006-Aralık 2008 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Çocuk Acil servisinde kafa travması tanısı alıp, en az 24 saat süresince hastanede tedavi altında kalan, Glaskow koma ölçeği 13 ve altında ya da bilgisayarlı beyin tomografisinde patolojisi olan 24 olgu hipofiz hormon eksikliği açısından değerlendirildi. Tüm olgulardan 12 saatlik açlık sonrasında serum kortizol, serbest tiroksin, serbest triiyodotronin, tiroid stimulan hormon, prolaktin, insulin benzeri büyüme faktörü-1, serum sodyum, idrar dansitesi, folikül stimulan hormon, lüteinizan hormon, kız olgularda östradiol, erkek olgularda total testosteron çalışıldı. Çalışmaya alınan 24 (16 erkek, 8 kız) olgunun yaş ortalaması 9,5±3,1 desimal yıl idi. Olguların 14'ü (%58,3) prepubertal, 10'nu (%41,7) pubertaldi. Glaskow koma ölçeğine göre 14 (%58,3) olgu hafif, 9 (%37,5) olgu orta ve 1 olgu (%4,2) ağır kafa travmasıydı. Olguların travma sonrası geçen süreleri 29,4±9,8 (12-44) aydı. Tüm olguların çalışma anında boy standart deviasyon skoru (-0,059±1,1) ve tartı standart deviasyon skoru (-0,016±0,85) idi. Olguların büyüme hormonu ve adrenokortikotropik hormon ekseni dışında diğer eksenlere yönelik hormonal değerlendirmelerinde patoloji saptanmadı. Tüm olguların İnsülin like growth factor-1 değerleri normal olmasına karşın İnsülin like growth factor-1 z-skoru < -2 standart deviasyon olan 9 (%37,5) olgu saptandı. Ancak bu olguların boyları normal sınırlar içindeydi ve hiçbirinde boy uzamasında duraklama öyküsü yoktu. Bir (%4,2) olgunun bazal kortizol değeri düşük bulundu. Bu olguya yapılan düşük doz adrenokortikotropik hormon uyarı testine kortizol yanıtı normaldi. Çalışmaya alınan hastalarda hipofiz hormon eksikliği olan olgu saptanmadı. Tüm hastalar ileri dönemde ortaya çıkabilecek hormonal eksiklikler açısından poliklinik izlemine alındı. Travma sonrası gelişen hipofiz işlev bozukluğu erken dönemde gözlenebilmekle birlikte, bazı olgularda geç dönemde de ortaya çıkabileceği için tüm olguların uzun dönem klinik izleme alınmaları gerektiği sonucuna varılmıştır. Anahtar kelimeler: Kafa travması, hipofiz işlev bozukluğu, travmatik beyin hasarı, çocuk.AbstractAim of this study was to determine whether pituitary dysfunction occur after head trauma in children or not and which axis is affected more; to define the association of pituitary dysfunction with the severity of head trauma and duration time after the diagnosis of head trauma. In this study, 24 children who were diagnosed with head trauma in Trakya University, Faculty of Medicine, Pediatric Emergency Service between April 2006 and December 2008, treated at least for 24 hours, took less than or equal to 13 points in Glasgow Coma Scale or abnormality noted in computer tomography, were evaluated for pituitary hormone deficiency. In all cases, after 12 hour fasting, serum cortisol, free thyroxine, free triiodothyronine, thyroid stimulation hormone, prolactin, insulin like growth factor-1, serum sodium, urine density, follicle stimulating hormone, luteinizing hormone, in female cases estradiol, in male cases total testosterone levels were determined. Mean age of children was 9.5+/-3,1 years, 14 children were prepubertal and 10 (41,7%), were pubertal. 14 children (58,3%) had mild, 9 children (37,5%) had moderate and 1 children (4,2%) had severe head trauma according to Glasgow Coma Scale. Mean duration time after head trauma was 29.4+/-9.8 months. Height standart deviation score was (-0,059±1,1) and weight standart deviation score was (-0,016±0,85). In all cases, no pathologic condition was determined in pituitary hormonal axis except for growth hormone axis and adrenocorticotropic hormone. Although insülin like growth factor-1 levels were normal in all cases, there were 9 cases (37,5%) with a z-score < -2 standart deviation score. However height of these cases were normal and there was no pausing history for growth in length. In one children (4,2%), low basal cortisol level was found. After low dose adrenocorticotropic hormone stimulation test, cortisol response was found to be normal in this child. There were no children with hormonal deficiency in this study. All cases will be followed in outpatient clinic with respect to hormonal deficiency developing in future. In conclusion, although pituitary dysfunction after head trauma may develop in early period, some may present in the late period, therefore all cases should be followed up at outpatient clinics for longer period of time. Key words: Head trauma, pituitary dysfunction, traumatic brain injury, child

The prevalence of thyroid nodules in children with family history for nodular goiter

Introduction: There is insufficient study on the genetic clustering of nodular goiter. Although twin studies have proved genetic clustering, there is no prospective study on this topic. The aim of this study is to investigate the existence of familial clustering by evaluating the prevalence of thyroid nodules in the children of families with nodular goiter.Methods: The prevalence of thyroid nodules was calculated by evaluating the thyroid ultrasound results of children from families with and without nodular goiter.Results: Nodular goiter was detected in 5 children (3.4%), 2 (2.5%) from families with nodular goiter history and 3 (4.7%) from the control group. There was no statistically significant difference between these two groups.Conclusions: This is the first prospective study to investigate the familial aspect of nodular goiter disease. In our study, children with nodular goiter were the target group. Following statistical analysis, clustering of nodular goiter was observed in the children of patients with multinodular goiter

The prevalence of thyroid nodules in children with family history for nodular goiter

Introduction: There is insufficient study on the genetic clustering of nodular goiter. Although twin studies have proved genetic clustering, there is no prospective study on this topic. The aim of this study is to investigate the existence of familial clustering by evaluating the prevalence of thyroid nodules in the children of families with nodular goiter.Methods: The prevalence of thyroid nodules was calculated by evaluating the thyroid ultrasound results of children from families with and without nodular goiter.Results: Nodular goiter was detected in 5 children (3.4%), 2 (2.5%) from families with nodular goiter history and 3 (4.7%) from the control group. There was no statistically significant difference between these two groups.Conclusions: This is the first prospective study to investigate the familial aspect of nodular goiter disease. In our study, children with nodular goiter were the target group. Following statistical analysis, clustering of nodular goiter was observed in the children of patients with multinodular goiter

Evaluation of pituitary function in cases with the diagnosis of pediatric mild traumatic brain injury: Cross-sectional study

Background: This study was to determine whether pituitary dysfunction occurs after head trauma in children or not and which axis is affected more; to define the association of pituitary dysfunction with the severity of head trauma and duration time after the diagnosis of head trauma. Materials and Methods: In this study, 24 children who were diagnosed with head trauma were evaluated regarding pituitary dysfunction. In all cases, after 12 h fasting, serum cortisol, fT3, fT4, thyroid-stimulating hormone, prolactin, insulin-like growth factor-1, serum sodium, urine density, follicle-stimulating hormone, luteinizing hormone, in female cases E2, in male cases, TT levels were determined. Results: Mean age of children was 9.5 ± 3.1 years, 14 children (58.3%) had mild, 9 children (37.5%) had moderate, and 1 children (4.2%) had severe head trauma according to the Glasgow coma scale. Mean duration time after head trauma was 29.4 ± 9.8 months. In all cases, no pathologic condition was determined in the pituitary hormonal axis. In one children (4.2%), low basal cortisol level was found. There were no children with hormonal deficiency in this study. Conclusion: Although pituitary dysfunction after head trauma may develop in the early period, some may present in the late period; therefore, all cases should be followed up at outpatient clinics for a longer period