Transcranial Doppler in Sickle Cell Anemia

TEZ9759Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2012.Kaynakça (s. 46-54) var.x, 55 s. : res. (bzs. rnk.), tablo ; 29 cm.Amaç: Bu çalışmada orak hücre anemili çocuklar ile sağlıklı çocukların beyin kan akım hızlarını ölçerek farklılıklarını ortaya koymayı ve inme riskini belirlemeyi amaçladık. Gereç ve Yöntem: Çalışmaya Şubat 2010 – Mayıs 2011 tarihleri arasında, yaşları 3 ile 20 arasında değişen, 38’i erkek, 42’si kadın olmak üzere orak hücre anemili 40 hasta ve kontrol grubu olarak 40 sağlıklı çocuk alındı. Hasta ve kontrol grubunda Transkraniyal Doppler cihazı ile transtemporal ve oksipital penceredenbeynin ana damarları değerlendirildi. Hasta ve kontrol grubunun verileri karşılaştırılıp, orak hücre anemili çocukların sonuçları STOP kriterlerine göre sınıflandırıldı. Bulgular: Orak hücre anemili çocuklarda sağlıklı bireylere göre gerek vertebrobaziler sistemde gerekse karotid sistemde anlamlı derecede hız artışı mevcuttur.(p>0,05) Serebral arterlerin ortalama kan akım hızları ile yaş arasında negatif korelasyon saptanmıştır.(p<0,01) Orak hücre anemili grupta beynin iki taraflı alınan ölçümlerinde orta serebral arter ortalama kan akım hızı farklılık gösterirken, kontrol grubunda farklılık izlenmemiştir. Ayrıca orak hücre anemili 3 (% 7,5) çocukta orta serebral arter ortalama kan akım hızı 170 cm/sn’den yüksek bulundu. Bu çocuklar STOP kriterlerine göre borderline kabul edilerek üç aylık peryodlarla takip edildi. Takip sonucunda transfüzyon ihtiyacı izlenmedi. Sonuç: Orak hücre anemili çocuklarda inme riskini belirlemede ve bu çocukların takiplerinde Transkraniyal doppler etkin,ucuz ve non invaziv bir yöntemdir.Purpose: In this study we compared the brain blood flow velocity of healty children and children with sickle cell anemia. By this, we have to foresee aimed the risk of stroke in children with sickle cell anemia Materials and methods: Between February 2010- May 2011, forty patients with sickle cell anemia and forty healthy children as the control group were included in this study. There were 38 male, 42 female children aged from 3 to 20 years. Transtemporal and occipital windows were used as access points for Transcranial Doppler examination middle, anterior, posterior cerebral arteria and vertebral, basillar arteria were sampled. Findings of two groups were compared and the results of the children with sickle cell anemia was classified according to STOP criteria. Results: Sickle cell anemia group had increased blood flow velocity in carotid and vertebrobasillar circulation compared to the healty children. Negative correlation was detected between age and blood flow of serebral arteries. (p<0.01) The mean blood flow velocity of middle cerebral arteria was detected to be higher than 170 cm/sn in three children (7,5 %) with sickle cell anemia and these children were considered borderline according to STOP criteria and were followed for three-monthly periods. At the end of the follow-up no transfusion therapy was needed. Conclusion: Transcranial doppler is a non invasive, effective, inexpensive method for clinical follow-up and identification of risk of cerebralinfarction in the children with sickle cell anemia

Evaluation of cases with infantile hemangioma requiring treatment

Aim: Infantile hemangiomas are the most common benign vascular tumours in infants. In this study, we aimed to evaluate the effectiveness of propranolol therapy in patients with infantile hemangioma. Materials and methods: This study included patients with infantile hemangiomas in the age range of 0 to 24 months who received propranolol therapy between September 2015 and 2019. Hemangioma activity score, ultrasonography imaging and photographic evaluations were performed before and at 6 months of treatment. Parental satisfaction with the results of treatment was recorded. Results: Our study included 85 patients with infantile hemangioma requiring treatment. Twenty patients were boys and 65 were girls. The mean age at starting treatment was 7.2±5.9 months (median: 5.0). While the average lesion area measured by ultrasonography before treatment was 209.7±207.5 mm2, it reduced to 105.1±145.7 mm2 (p<0.001) after treatment. Similarly, while the mean hemangioma activity score was 3.8±0.9 before treatment, it decreased significantly to 1.3±0.8 after the treatment (p<0.001). A noticeable improvement in photographic evaluation with the treatment was observed in infantile hemangiomas of the patients and 82% of the families were satisfied with the results of the treatment. Conclusions: The results of the study suggested that propranolol therapy used in the treatment of infantile hemangioma is an effective treatment option according to the photographic comparison, ultrasonography data, and hemangioma activity score evaluations

Evaluation of cases with infantile hemangioma requiring treatment

Aim: Infantile hemangiomas are the most common benign vascular tumours in infants. In this study, we aimed to evaluate the effectiveness of propranolol therapy in patients with infantile hemangioma. Materials and methods: This study included patients with infantile hemangiomas in the age range of 0 to 24 months who received propranolol therapy between September 2015 and 2019. Hemangioma activity score, ultrasonography imaging and photographic evaluations were performed before and at 6 months of treatment. Parental satisfaction with the results of treatment was recorded. Results: Our study included 85 patients with infantile hemangioma requiring treatment. Twenty patients were boys and 65 were girls. The mean age at starting treatment was 7.2±5.9 months (median: 5.0). While the average lesion area measured by ultrasonography before treatment was 209.7±207.5 mm2, it reduced to 105.1±145.7 mm2 (p<0.001) after treatment. Similarly, while the mean hemangioma activity score was 3.8±0.9 before treatment, it decreased significantly to 1.3±0.8 after the treatment (p<0.001). A noticeable improvement in photographic evaluation with the treatment was observed in infantile hemangiomas of the patients and 82% of the families were satisfied with the results of the treatment. Conclusions: The results of the study suggested that propranolol therapy used in the treatment of infantile hemangioma is an effective treatment option according to the photographic comparison, ultrasonography data, and hemangioma activity score evaluations

Intrapleural and Intraperitoneal Free Fluid in Calcium Channel Blocker Overdose

Aim: Toxicity findings affecting many systems, particularly the cardiovascular system, are observed in calcium channel blocker (CCB) overdose. Here, we aimed to present the incidence of CCB overdose patients with intraperitoneal and intrapleural free fluids detected by abdominal ultrasonography (USG). Materials and Methods: CCB overdose patients admitted to the emergency room in a 2-year period were prospectively included. All patients with CCB overdose were evaluated by bedside abdominal USG in terms of the presence of pleural and peritoneal fluid. Results: A total of 14 patients with CCB poisoning were included in our study. Six (42.8%) patients had taken verapamil, 7 (50%) patients amlodipine, and 1 (7.2%) patient nifedipine. The mean age of the patients was 27.2±15.9 years (range: 18–65 years). The median time from drug intake to arrival at the hospital was 3.0 h (IQR: 1.75–5). Nine (64.28%) of these patients were detected to have intraperitoneal and intrapleural free fluid by bedside USG. The mean arterial pressure of patients with intraabdominal and intrapleural fluid was lower than that of patients without the detected fluid, i.e., 56.8 (IQR: 54.8–61.8) vs. 65.6 (IQR: 64.2–66.8), respectively (p<0.001). Conclusion: Besides the cardiovascular findings, intraperitoneal and intrapleural free fluid is also a common feature in CCB overdose. Bedside USG may help to identify these patients. (Eurasian J Emerg Med 2016; 15: 82-5)Aim: Toxicity findings affecting many systems, particularly the cardiovascular system, are observed in calcium channel blocker (CCB) overdose. Here, we aimed to present the incidence of CCB overdose patients with intraperitoneal and intrapleural free fluids detected by abdominal ultrasonography (USG). Materials and Methods: CCB overdose patients admitted to the emergency room in a 2-year period were prospectively included. All patients with CCB overdose were evaluated by bedside abdominal USG in terms of the presence of pleural and peritoneal fluid. Results: A total of 14 patients with CCB poisoning were included in our study. Six (42.8%) patients had taken verapamil, 7 (50%) patients amlodipine, and 1 (7.2%) patient nifedipine. The mean age of the patients was 27.2±15.9 years (range: 18–65 years). The median time from drug intake to arrival at the hospital was 3.0 h (IQR: 1.75–5). Nine (64.28%) of these patients were detected to have intraperitoneal and intrapleural free fluid by bedside USG. The mean arterial pressure of patients with intraabdominal and intrapleural fluid was lower than that of patients without the detected fluid, i.e., 56.8 (IQR: 54.8–61.8) vs. 65.6 (IQR: 64.2–66.8), respectively (p<0.001). Conclusion: Besides the cardiovascular findings, intraperitoneal and intrapleural free fluid is also a common feature in CCB overdose. Bedside USG may help to identify these patients. (Eurasian J Emerg Med 2016; 15: 82-5