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Öğe Anxiety disorder and eating habits in adolescents with gastroesophageal reflux disease(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2018) Ozbeyler, Omer; Eliacik, Kayi; Uzum, Ozlem; Kanik, Ali; Cagan Appak, Yeliz; Karakoyun, Miray; Orbatu, Dilek; Engin Ozyurt, Gonca; Bolat, Nurullah; Baran, MasallahObjective: It was aimed to evaluate the relationship between eating habits and reflux by investigating eating habits in adolescent patients with gastroesophageal reflux disease, and also to assess the interplay between gastroesophageal reflux disease and anxiety. Methods: We included patients between the ages of 12 and 18 diagnosed as gastroesophageal reflux disease in the pediatric gastroenterology outpatient clinic but who had not yet been treated. The control group consisted of age matched adolescents who applied for upper respiratory tract infection. The relationship between eating habits and reflux was assessed with Adolescent Nutrition Checklist, and relationship between gastroesophageal reflux disease and anxiety was assessed with Anxiety Disorder Screening Questionnaire. Results: Seventy adolescents with reflux disease and 67 adolescents as the control group were included in the study. There was no significant difference between the groups regarding the eating habits and anxiety scores. However, it was seen that most of the patients in both groups. had poor eating habits and higher general anxiety score. Conclusion: No relation was found between the gastroesophageal reflux disease, anxiety and eating habits in adolescents. These results suggested that reflux disease should be separated from other gastrointestinal complaints such as abdominal pain which may be psychosomatic. However, there was a quantitative increment in poor eating habits in those with gastroesophageal reflux disease. For this reason there is a need for further studies which investigate the eating habits with a larger sample size of this population.Öğe Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children(Aves, 2014) Unal, Fatih; Cakir, Murat; Baran, Masallah; Duygulu, Sengul; Aydogdu, SemaBackground/Aims: Data about the efficiency and outcome of therapeutic endoscopic techniques in children with nonvariceal upper gastrointestinal bleeding (UGB) are scarce. We aimed to analyze our experience with endoscopic hemoclip application in children with non-variceal UGB. Materials and Methods: During a 3-year period, a total of 1715 endoscopies were performed in our pediatric endoscopy unit; 182 (10.6%) of them were performed for UGB to 158 patients. Fifty-six of them had emergent endoscopy. Among them, 15 cases with nonvariceal UGB were only given endoscopic hemoclips. Demographic, clinical, and laboratory findings at initial admission; endoscopic appearance of bleeding lesions; and outcome of hemoclip application were recorded from the hospital files and endoscopy records. Results: Ten patients (66.6%) had gastric ulcer, 3 (20%) had duodenal ulcer, 1 (6.7%) had Dieulafoy lesion, and 1 (6.7%) had bleeding at the post-polypectomy site. Initial homeostasis after hemoclip application was achieved in all patients (100%). Rebleeding was seen in only one patient (6.5%) with a Dieulafoy lesion, who needed hemoclip application for a second time, and the bleeding was controlled successfully. Permanent hemostasis was 100%. The median number of hemoclips used per case and per application was 3.4 and 3.2, respectively. None of the patients experienced any complication related to hemoclip application. Median duration of hospitalization was 6 days. On follow-up, none of the patients received surgical therapy, and 30-d mortality related to bleeding was 0%. Conclusion: The use of hemoclips for nonvariceal UGB in children is an effective modality to control bleeding without any complications in children.Öğe Assessment and outcome of pediatric intestinal pseudo-obstruction: A tertiary-care-center experience from Turkey(Aves, 2019) Appak, Yeliz Cagan; Baran, Masallah; Oztan, Mustafa Onur; Karakoyun, Miray; Turhan, Soysal; Tugmen, Cem; Aydogdu, Sema; Karaca, Cezmi; Koyluoglu, GokhanBackground/Alms: Pediatric intestinal pseudo-obstruction (PIPO) is a severe disorder of gut motility. In this rare and difficult-to-manage disease, complex treatment method, such as intestinal transplantation, is sometimes needed. This study evaluated the management and follow-up results of patients with PIPO who received treatment at our center. Materials and Methods: The cases of 13 patients with PIPO were reviewed retrospectively. Demographic data, clinical features, etiologies, pharmacological and surgical treatments, nutritional support, anthropometric findings, small bowel transplantation (SBT), and survival rates were assessed. Results: Two of the patients were diagnosed at 1 and 5 years of age, while other patients were diagnosed during neonatal period. The etiological cause could not be identified for 5 patients. Pharmacological treatment response was observed in 38.4% of patients. Post-pyloric feeding was applied in 4 patients, but no response was observed. Gastrostomy decreased the clinical symptoms in 3 patients during the abdominal distension period. Total oral nutrition was achieved in 38.4% of the total-parenteral-nutrition (TPN)-dependent patients. It was observed that anthropometric findings improved in patients with total oral nutrition. Liver cirrhosis developed in 1 patient. Venous thrombosis developed in 4 patients. The SBT was performed on 3 patients. One of these patients has been followed up for the last 4 years. Conclusion: Pediatric intestinal pseudo-obstruction is a rare disease that can present with a wide range of clinical symptoms. While some patients require intestinal transplantation, supportive care may be sufficient in others. For this reason, patients with PIPO should be managed individually.Öğe Chronic constipation in Turkish children: clinical findings and applicability of classification criteria(Turkish J Pediatrics, 2009) Aydogdu, Sema; Cakir, Murat; Yuksekkaya, Hasan Ali; Arikan, Cigdem; Tumgor, Gokhan; Baran, Masallah; Yagci, Rasit VuralWe aimed to evaluate general features of children with chronic constipation and classified them according to the Iowa criteria and Rome II criteria in order to analyze applicability of these criteria in our population. The medical records of 485 children who were referred for chronic constipation over a six- year period were evaluated retrospectively. We found that 7.7% of the cases had an organic pathology, and short segment Hirschsprung disease was the leading cause. Other children (92.3%) were classified as functional constipation, with a mean age of 6.4 +/- 4 years and with slight male dominance. Encopresis was found in 117 children (51.7%) aged over four years, and was associated with older age, male predominance and long duration of symptoms. Both of the classification systems showed a similar prevalence of constipation, but 9.9% of the children with pediatric constipation were not recognized by Rome II criteria. Additionally, 1.8% of the children were not recognized by either Iowa or Rome criteria. Functional constipation is common in primary care, and most of the children were school-aged. Constipation associated with encopresis and nutritional problems such as obesity is less common in developing countries. Rome II criteria are too restrictive and do not recognize approximately 12% of the children. A new classification system must be simple, easy to understand especially by the primary care physician, and must include the common features of constipation recognized by the parents.Öğe Comparison of standard and standard plus vitamin E therapy for Helicobacter pylori eradications in children(Aves, 2014) Tumgor, Gokhan; Baran, Masallah; Cakir, Murat; Yuksekkaya, Hasan Ali; Aydogdu, SemaBackground/Aims: Although various drugs can be used in adults for Helicobacter pylori eradication in adults, treatment options are limited in children. The aim of this study was to compare the effects of the standard lansoprazole, amoxicillin, and clarithromycin (LAC) protocol to those of LAC + vitamin E (LACE) combination for H. pylori eradication. Materials and Methods: The study included 90 children (age range: 10-17 years) who were admitted to four pediatric gastroenterology centers between March 2011 and November 2012 with dyspeptic symptoms and who had tested positive for H. pylori by 14C-urea breath tests. The patients were randomized into two groups. The LAC group [45 patients (pts)] was treated with a standard regimen consisting of lansoprazole (1 mg/kg/day), amoxicillin (50 mg/kg/day), and clarithromycin (14 mg/kg/day), each of which was given in two equally divided doses every 12 h for 14 days; the LACE group (45 pts) was given the standard regimen and vitamin E at 200 IU/day for 14 days. H. pylori eradication was assessed using the 14C-UBT in the 6th week after the cessation of treatment. Results: H. pylori was eradicated in 21 (46.6%) pts in the LAC group, while it was eradicated in 29 (64.4%) pts in the LACE group. There was no statistical difference between the two groups (p=0.13). Conclusion: The eradication rate of H. pylori in children while using the LAC regimen has decreased in the last years. The LACE regimen has been associated with an increased eradication rate but can reach to statistically significance. Further studies with larger cohorts are needed to examine the success of the LACE regimen for H. pylori eradication.Öğe Evaluation of emotional, behavioral problems and family functioning in adolescents with chronic gastritis(Soc Argentina Pediatria, 2019) Ozyurt, Gonca; Cagan-Appak, Yeliz; Karakoyun, Miray; Baran, MasallahObjectives. The aim of the present study was to investigate psychiatric symptoms in adolescents diagnosed as having chronic gastritis, and to evaluate family functioning. Methods. The population consisted of adolescents who were diagnosed endoscopically and histopathologically as having chronic gastritis without additional chronic disease. The anxiety levels, depression levels, and emotional and behavioral symptoms of the adolescents were measured using the Screen for Child Anxiety Related Emotional Disorders (SCARED), Beck Depression Inventory (BDI), and Strengths and Difficulties Questionnaire (SDQ). Family functioning was evaluated using the Family Assessment Device (FAD). Results. Fifty eight adolescents were included to study. According to the SDQ subscale results, adolescents with gastritis had more problems in emotional, hyperactivity, and peer relations areas, but the results in conduct problems and prosocial behaviors were normal. Levels of all subscales of Family Assessment Device were higher than 2, showing problems in family functioning. Conclusions. This study suggests that adolescents with chronic gastritis experience more difficulties in peer relations and family functioning, and they express more emotional problems.Öğe Evaluation of Growth After Liver Transplantation in Turkish Children(Springer, 2011) Baran, Masallah; Cakir, Murat; Unal, Fatih; Tumgor, Gokhan; Yuksekkaya, Hasan Ali; Arikan, Cigdem; Kilic, Murat; Aydogdu, SemaAims Currently, the main interest in childhood liver transplantation (LT) is to prevent long-term complications and optimize growth. The aim of this study is to analyze (1) nutritional status in the pretransplantation period, and (2) posttransplantation growth and associated factors in children. Patients and Methods Eighty children were included in the study. Height (Z (H)) and weight (Z (W)) Z scores were calculated before transplantation and postoperatively at the 6th month and 1st, 2nd, 3rd, 4th, and 5th year. Results Patients' Z (H) and Z (W) scores at LT were -1.6 +/- A 1.3 and -1.5 +/- A 1.4, respectively. Both Z (H) and Z (W) scores increased after LT, especially in the first 6 months, and then continued to rise gradually. Both reached beyond -1 Z score at 2nd year and -0.5 at 4th year. Age, primary diagnosis, total steroid dose (< 1,000 mg), and absence of rejection episodes had positive impact on posttransplantation growth, whereas gender, immunosuppression type, surgical complications, and presence of tumor had no impact on posttransplantation growth. Age at time of LT was negatively correlated with Z (W) score at 5th year (P = 0.02, r = -0.43). Both Z (W) and Z (H) scores at time of LT were positively correlated with Z (W) and Z (H) scores and negatively correlated with a dagger Z (W) and a dagger Z (H) scores at 5th year. Conclusions LT is not only a modern, life-saving treatment technique but also an efficient method of facilitating growth, an indispensable component of childhood and the best indicator of health.Öğe Foreign body ingestion in Turkish children(Turkish J Pediatrics, 2009) Aydogdu, Sema; Arikan, Cigdem; Cakir, Murat; Baran, Masallah; Yuksekkaya, Hasan Ali; Saz, Ulas Eylem; Arslan, Mehmet TayyipForeign body ingestion (FBI) is a common problem in the pediatric population. Even though morbidity and mortality due to foreign body ingestion are rare in childhood, they may cause serious anxiety in parents. We aimed to analyze the clinical presentation, etiology and management strategy of FBI in children in our country. Records of children admitting with a history of FBI over a three-year period were reviewed retrospectively. Data regarding gender, age, type of the ingested body, management strategy and outcome of the patients were recorded. Of 176 children, 98 (55.6%) were male. Mean age +/- SD of the patients was 3.75 +/- 4.25 years, and most of the patients were below four years of age (71.5%). Most of the children (64.7%) were seen within 48 hours, and most were asymptomatic. Blue beads attached to a safety pin (a cultural good luck charm) (38.6%), coins (27.8%) and turban pins (18.1%) were the most commonly observed foreign bodies. The blue beads/safety pin were found to be ingested primarily by infants, while ingestion of turban pins was mostly seen in adolescent girls who covered their heads. Localization of the foreign bodies was in the distal small intestine, stomach and esophagus in 61.4%, 23.8% and 14.7% of the cases, respectively. Sixty-nine endoscopic interventions were performed in 61 patients (34.6%), and these accounted for 7.3% of all endoscopic interventions during the three-year period. No major complication was observed during the procedure, and none of the patients underwent surgery. The frequently used accessory devices were retrieval net basket (57.9%), snare for pins (17.3%), tripod forceps and rat-tooth forceps. The blue beads/safety pin and turban pin were the commonly ingested foreign bodies in our center due to cultural factors. Education of the parents and of adolescent girls should greatly reduce the incidence of FBI. Endoscopic removal is safe without any major complications.Öğe Gastroesophageal reflux in children with functional constipation(Turkish Soc Gastroenterology, 2012) Baran, Masallah; Ozgenc, Funda; Arikan, Cigdem; Cakir, Murat; Ecevit, Cigdem Omur; Aydogdu, Sema; Yagci, Rasit VuralBackground/aims: Functional constipation and gastroesophageal reflux disease are two major and commonly encountered components of childhood functional gastrointestinal disorders. Epidemiological studies in, the adult population support that there is a significant overlap between the different functional disorders of the digestive tract. Therefore, we aimed to investigate the frequency of gastroesophageal reflux disease in children with functional constipation and to compare clinical findings and 24-h esophageal pH monitoring with a group of patients with suspected gastroesophageal reflux disease. Materials and Methods: Children between 4 and 16 years old with functional constipation (based on Rome III criteria, Group 1; n=38) were prospectively evaluated. A control group was composed of patients with symptoms suggesting gastroesophageal reflux disease (Group 2; n= 40). All patients included in the study were asked about reflux-related symptoms, and then all cases underwent 24-h esophageal pH monitoring analysis. Results: Delayed gastric emptying symptoms such as belching and hiccups were more common in patients in. Group 1 (p=0.002, p=0.021, respectively), whereas chronic cough was more common in patients in Group 2 (p=0.012). According to the 24-h esophageal pH monitoring, pathologic acid reflux in the lower and/or laryngopharyngeal portion of the esophagus was determined in 39.5% of the patients in Group 1 and in 42.5% of the patients in Group 2 (p=0.96). No significant difference was found in terms of age, gender and duration of constipation in patients with and without acid reflux in Group 1 patients. Pyrosis (66.6 vs. 0%, p=0.00001) was more common in Group 1 patients with acid reflux, but hiccups (20 vs. 69.5%, p=0.007) and belching (33.3 vs. 60.8%, p=0.184) were more common in patients in Group 1 without acid reflux. Conclusions: Gastroesophageal reflux disease should be considered in the treatment and monitoring of patients with functional constipation. Further studies are needed using 24-h pH multi-channel impedance.Öğe Giant cell hepatitis and autoimmune hemolytic anemia after chickenpox(Aves, 2010) Baran, Masallah; Ozgenc, Funda; Berk, Omer; Gokce, Demir; Kavakli, Kaan; Yilmaz, Funda; Sen, Sait; Yagci, Rasit VuralAutoimmune hemolytic anemia with giant cell hepatitis is a distinct entity in children. It is usually fatal with progressive liver disease. Immunosuppressive treatment with conventional drugs offers some response; however, it is usually only temporary. Alternative therapeutic options with monoclonals have been reported with promising remission of the disease. We report a case with autoimmune hemolytic anemia+giant cell hepatitis after varicella infection. She was resistant to standard immunosuppressive combinations, and rescue therapy with rituximab was used. Remission was not achieved with the drug and the child died with septic complication.Öğe Helicobacter pylori infection in children with celiac disease(Taylor & Francis Ltd, 2008) Aydogdu, Sema; Cakir, Murat; Yuksekkaya, Hasan Ali; Tumgor, Gokhan; Baran, Masallah; Arikan, Cigdem; Yagci, Rasit V.Objective. To analyze the prevalence of Helicobacter pylori (H. pylori) infection in children with celiac disease (CD) and to examine the role of H. pylori infection in clinical, laboratory and histopathological presentations of CD. Material and methods. Data on 96 children with CD and 235 children who underwent endoscopy were compared for the prevalence and gastric histology pattern of H. pylori. Clinical presentation, laboratory and histological findings of CD children with and without H. pylori infection were compared. Results. Twenty-one subjects (21.8%) in the CD group and 56 subjects (23.8%) in the control group had H. pylori gastritis. Gastric metaplasia is higher in CD patients with H. pylori gastritis (19%) than in patients without H. pylori gastritis (1.3%) and in the control group (3.5%) (p0.05 for all groups). Abdominal distension is more common at initial admission in CD patients with H. pylori gastritis (57.1% versus 14.6%, p0.05). No significant difference was found between H. pylori (+) and (-) CD patients in terms of prevalence of anemia, iron deficiency and iron-deficiency anemia. Only mild duodenal histological findings were more common in H. pylori patients (57.1% versus 26.7%, p < 0.05). Conclusions. CD may be associated with H. pylori gastritis, but it does not affect the clinical presentation of the disease, except for abdominal distension; CD is associated with mild duodenal lesions. A gluten-free diet improves the symptoms in all patients independently of the presence of H. pylori gastritis. Gastric metaplasia increases in the presence of H. pylori gastritis. Further prospective studies are needed to examine the clinical and histopathological outcomes of gastric metaplasia associated with H. pylori gastritis in CD patients.Öğe Infants with extrahepatic biliary atresia: Effect of follow-up on the survival rate at Ege University Medical School transplantation center(Aves, 2017) Karakoyun, Miray; Baran, Masallah; Turan, Caner; Kilic, Murat; Ergun, Orkan; Aydogdu, SemaBackground/Aims: Biliary atresia (BA) is the main cause of neonatal cholestasis and the primary reason for infant liver transplants worldwide. It is an obliterative cholangiopathy observed only in children and caused by progressive inflammation and fibrosis of the bile duct. We collaborated with a liver transplantation center to investigate the effects of follow-up in patients with BA. Materials and Methods: Medical records of 99 patients who were diagnosed with BA and monitored at our center from 1990 to 2002 (27 patients) and from 2003 to 2015 (72 patients) were analyzed retrospectively. Patients were evaluated for birth weight; age at jaundice onset; age at alcoholic stool detection; age at the time of Kasai portoenterostomy (KPE), if performed; age at admission to our center; age at liver transplantation; duration between KPE and transplantation; pediatric end-stage liver disease (PELD) scores during transplantation; and growth and developmental status. The periods 1990-2002 and 2003-2015 were defined as phases I and II, respectively. Results: The median age of the patients at presentation to our hospital was 149 (range: 20-730) days during phase I and 61 (range: 28-720) days during phase II. The median age at jaundice onset was 7 days, and the median age at alcoholic stool detection was 15 days. There was no significant difference between phases I and II in terms of age at jaundice onset, age at alcoholic stool detection, or birth weight. Twenty-five (92.5%) of the 27 patients in the phase I group were admitted to our center after undergoing KPE. Forty-four (61.1%) of the 72 patients in the phase II group (median age at the time of KPE: 47 days) were operated at our center. Median ages of the patients at the time of KPE at our center were 67.5 (range: 25-220) and 47 (range: 28-139) days during phases I and II, respectively. The median age of the 28 patients who were transferred from another center was 70 (range: 45-105) days during phase II. Liver transplantation was performed in 55 of 99 patients (55.5%). Significant differences were observed in the age at transplantation, duration between KPE and transplantation, and PELD scores between patients with BA who underwent KPE at our center and who underwent KPE at other institutes from other institutes. Conclusion: These findings demonstrate the importance of a timely diagnosis of BA and undergoing KPE before malnutrition and/or cirrhosis deteriorate the patient's health. Furthermore, follow-up of patients with BA at a liver transplantation center increased the success of KPE and improved survival rates.Öğe Liver Involvement in Children with Alpha-1 Antitrypsin Deficiency: A Multicenter Study(Korean Soc Pediatric Gastroenterology & Nutrition, 2020) Cakir, Murat; Sag, Elif; Islek, Ali; Baran, Masallah; Tumgor, Gokhan; Aydogdu, SemaPurpose: Alpha-1 antitrypsin deficiency (A1ATD) in one of the most common genetic causes of liver disease in children. We aimed to analyze the clinical characteristics and outcomes of patients with A1ATD. Methods: This study included patients with A1ATD from five pediatric hepatology units. Demographics, clinical findings, genetics, and outcome of the patients were recorded (n=25). Results: Eight patients (32.0%) had homozygous PiZZ genotype while 17 (68.0%) had heterozygous genotype. Patients with PiZZ genotype had lower alpha-1 antitrypsin levels than patients with PiMZ genotype (37.6 +/- 7.7 mg/dL vs. 66.5 +/- 22.7 mg/dL, p=0.0001). Patients with PiZZ genotype were diagnosed earlier than patients with PiMZ genotype, but this was not significant (13 +/- 6.8 months vs. 23.7 +/- 30.1 months, p=0.192). Follow-up revealed the death of one patient (12.5%) with a homozygous mutation, and revealed that one patient had child A cirrhosis, five patients (62.5%) had chronic hepatitis, and one patient (12.5%) was asymptomatic. Nine of the 17 patients with a heterozygous mutation had chronic hepatitis (52.9%), two (11.7%) had child A cirrhosis, and six (35.2%) were asymptomatic. Overall, 18 (72%) of the 25 children had liver pathology in the long-term. Conclusion: Although prevalence is rare, patients with liver disorders should be checked for alpha-1 antitrypsin levels. Moreover, long-term follow-up is essential because most patients have a liver pathology.Öğe Liver transplantation for acute liver failure due to toxic agent ingestion in children(Wiley, 2009) Akman, Sezin Asik; Cakir, Murat; Baran, Masallah; Arikan, Cigdem; Yuksekkaya, Hasan Ali; Tumgor, Gokhan; Saz, Ulas Eylem; Zeytunlu, Murat; Kilic, Murat; Aydogdu, SemaALF is characterized by sudden onset, impaired liver function, jaundice and encephalopathy, without previous liver disease. We analyzed the patients who underwent LT due to toxic agent induced ALF to raise community awareness about preventing the toxic agent induced ALF. Five children (three boys, two girls) underwent LT due to toxic agent ingestion. Toxic agents were mushroom poisoning (n = 2), Datura stramonium (n = 1), yellow phosphorous (n = 1) and INH (n = 1). On admission, one patient had stage IV, two had stage III and two had stage II hepatic encephalopathy but worsened during the follow-up. One patient had renal failure, and three patients required mechanical ventilation. Three patients underwent LRLT and others from a DD. Post-operative complications were managed by supportive managements successfully, and overall all the patients are alive (100% survival) without any organ sequelae. Although outcome of these patients are excellent, ALF may be prevented in these cases by educating the public about consuming mushrooms and toxic effects of wild plants, prohibiting fireworks and serial liver enzyme measurements after initiating INH.Öğe Liver transplantation for acute liver failure due to toxic agent ingestion in children(Wiley, 2009) Akman, Sezin Asik; Cakir, Murat; Baran, Masallah; Arikan, Cigdem; Yuksekkaya, Hasan Ali; Tumgor, Gokhan; Saz, Ulas Eylem; Zeytunlu, Murat; Kilic, Murat; Aydogdu, SemaALF is characterized by sudden onset, impaired liver function, jaundice and encephalopathy, without previous liver disease. We analyzed the patients who underwent LT due to toxic agent induced ALF to raise community awareness about preventing the toxic agent induced ALF. Five children (three boys, two girls) underwent LT due to toxic agent ingestion. Toxic agents were mushroom poisoning (n = 2), Datura stramonium (n = 1), yellow phosphorous (n = 1) and INH (n = 1). On admission, one patient had stage IV, two had stage III and two had stage II hepatic encephalopathy but worsened during the follow-up. One patient had renal failure, and three patients required mechanical ventilation. Three patients underwent LRLT and others from a DD. Post-operative complications were managed by supportive managements successfully, and overall all the patients are alive (100% survival) without any organ sequelae. Although outcome of these patients are excellent, ALF may be prevented in these cases by educating the public about consuming mushrooms and toxic effects of wild plants, prohibiting fireworks and serial liver enzyme measurements after initiating INH.Öğe Long-Term Effect of Gluten-Free Diet on Growth Velocity in Turkish Children with Celiac Disease(Springer, 2009) Aydogdu, Sema; Midyat, Levent; Cakir, Murat; Tumgor, Gokhan; Yuksekkaya, Hasan Ali; Baran, Masallah; Arikan, Cigdem; Ozgenc, Funda; Yagci, Rasit VuralWe sought to analyze the long-term growth in children with celiac disease (CD) as well as the association of height and weight SD score at the end of 4 years with the demographic and clinical presentation at initial admission. Thirty-four children with CD were enrolled in the study and followed for at least 4 years. Patients were divided into three groups (Group 1: patients a parts per thousand currency sign5 years old, Group 2: patients 5-10 years old, and Group 3: patients > 10 years, at the time of diagnosis). Patients' charts were reviewed for demographic and clinical features at initial admission. Anthropometric measurements at initial admission, at 6th months, and 1st, 2nd, 3rd, and 4th years were recorded. Gluten-free diet led to rapid increase in weight SD and height SD score in patients a parts per thousand currency sign5 years old at the time of diagnosis (Group 1). Increment in height SD score was the highest in patients 5-10 years old (Group 2) at the end of 4 years. A negative correlation was found between age at the time of diagnosis and weight and height SD score at the end of 4 years (r = -0.503, P = 0.03 and r = -0.554, P = 0.01). Multiple regression analysis revealed that height SD score at the end of the 4 years was associated with age at the time of diagnosis. The other factors had no effect on the weight and height SD score at the end of 4 years. Early diagnosis and good adhesion to a gluten-free diet are essential for long-term growth in CD. Celiac societies and the mass media must expand an effort to educate the community regarding the symptoms of the disease.Öğe Long-Term Effect of Gluten-Free Diet on Growth Velocity in Turkish Children with Celiac Disease(Springer, 2009) Aydogdu, Sema; Midyat, Levent; Cakir, Murat; Tumgor, Gokhan; Yuksekkaya, Hasan Ali; Baran, Masallah; Arikan, Cigdem; Ozgenc, Funda; Yagci, Rasit VuralWe sought to analyze the long-term growth in children with celiac disease (CD) as well as the association of height and weight SD score at the end of 4 years with the demographic and clinical presentation at initial admission. Thirty-four children with CD were enrolled in the study and followed for at least 4 years. Patients were divided into three groups (Group 1: patients a parts per thousand currency sign5 years old, Group 2: patients 5-10 years old, and Group 3: patients > 10 years, at the time of diagnosis). Patients' charts were reviewed for demographic and clinical features at initial admission. Anthropometric measurements at initial admission, at 6th months, and 1st, 2nd, 3rd, and 4th years were recorded. Gluten-free diet led to rapid increase in weight SD and height SD score in patients a parts per thousand currency sign5 years old at the time of diagnosis (Group 1). Increment in height SD score was the highest in patients 5-10 years old (Group 2) at the end of 4 years. A negative correlation was found between age at the time of diagnosis and weight and height SD score at the end of 4 years (r = -0.503, P = 0.03 and r = -0.554, P = 0.01). Multiple regression analysis revealed that height SD score at the end of the 4 years was associated with age at the time of diagnosis. The other factors had no effect on the weight and height SD score at the end of 4 years. Early diagnosis and good adhesion to a gluten-free diet are essential for long-term growth in CD. Celiac societies and the mass media must expand an effort to educate the community regarding the symptoms of the disease.Öğe Lymphedema Treatment in a Patient with a History of Intestinal Transplantation and Mesenchymal Stem Cell Transplantation(Aves, 2015) Eyigor, Sibel; Donmez, Ulku; Kilinc, Selcuk; Dogan, Murat; Tugmen, Cem; Baran, Masallah; Kebapci, Eyup; Karaca, CezmiLymphedema is a rare complication of sirolimus treatment in transplantation patients. We present a case of a 14-year-old female patient who developed lymphedema in three extremities. The patient had undergone ileal and colon resections after sustaining a gunshot to her abdomen. Four months after the injury, she had developed a short bowel syndrome and underwent small intestine transplantation from a cadaver and mesenchymal stem cell transplantation to prevent rejection. Because kidney failure developed at postoperative month 3, mycophenolate mofetil therapy was discontinued and sirolimus therapy was initiated. The patient was monitored under this therapy until postoperative month 11 when she had swelling in both the legs and left arm. Her condition significantly improved with complex decongestive therapy. This is the first case in the literature involving mesenchymal stem cell transplantation together with ileum transplantation. This case is also noteworthy in terms of lymphedema treatment administered and the involvement of three extremities.Öğe Lymphedema Treatment in a Patient with a History of Intestinal Transplantation and Mesenchymal Stem Cell Transplantation(Aves, 2015) Eyigor, Sibel; Donmez, Ulku; Kilinc, Selcuk; Dogan, Murat; Tugmen, Cem; Baran, Masallah; Kebapci, Eyup; Karaca, CezmiLymphedema is a rare complication of sirolimus treatment in transplantation patients. We present a case of a 14-year-old female patient who developed lymphedema in three extremities. The patient had undergone ileal and colon resections after sustaining a gunshot to her abdomen. Four months after the injury, she had developed a short bowel syndrome and underwent small intestine transplantation from a cadaver and mesenchymal stem cell transplantation to prevent rejection. Because kidney failure developed at postoperative month 3, mycophenolate mofetil therapy was discontinued and sirolimus therapy was initiated. The patient was monitored under this therapy until postoperative month 11 when she had swelling in both the legs and left arm. Her condition significantly improved with complex decongestive therapy. This is the first case in the literature involving mesenchymal stem cell transplantation together with ileum transplantation. This case is also noteworthy in terms of lymphedema treatment administered and the involvement of three extremities.Öğe Lymphedema Treatment in a Patient with a History of Intestinal Transplantation and Mesenchymal Stem Cell Transplantation(Aves, 2015) Eyigor, Sibel; Donmez, Ulku; Kilinc, Selcuk; Dogan, Murat; Tugmen, Cem; Baran, Masallah; Kebapci, Eyup; Karaca, CezmiLymphedema is a rare complication of sirolimus treatment in transplantation patients. We present a case of a 14-year-old female patient who developed lymphedema in three extremities. The patient had undergone ileal and colon resections after sustaining a gunshot to her abdomen. Four months after the injury, she had developed a short bowel syndrome and underwent small intestine transplantation from a cadaver and mesenchymal stem cell transplantation to prevent rejection. Because kidney failure developed at postoperative month 3, mycophenolate mofetil therapy was discontinued and sirolimus therapy was initiated. The patient was monitored under this therapy until postoperative month 11 when she had swelling in both the legs and left arm. Her condition significantly improved with complex decongestive therapy. This is the first case in the literature involving mesenchymal stem cell transplantation together with ileum transplantation. This case is also noteworthy in terms of lymphedema treatment administered and the involvement of three extremities.
