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Öğe Complications of central venous catheterization in critically ill children(Wiley, 2007) Karapinar, Bulent; Cura, AlphanBackground: Placement of central venous catheter is essential in the management of critically ill children. The purpose of the present paper was to evaluate the success rate, mechanical and thrombotic complications and risk factors associated with these complications from different central venous access sites in critically ill children. Methods: A prospective study was undertaken from February 2000 to March 2005 of 369 central venous catheterizations in children in a pediatric intensive care unit. Results: The veins most frequently used were femoral vein (45%), subclavian vein (32.2%), and internal jugular vein (22.8%). Mean +/- SD duration of catheterization was 9.5 +/- 6.5 days. The procedure was performed under emergency conditions in 18% of patients with an overall success rate of 92.4%. The success rate was significantly lower in younger patients with subclavian catheterization. Insertion-related complications were noted, including 33 arterial punctures (8.9%), 27 cases of malposition (7.3%), 19 hematomas (5.2%), 12 cases of minor bleeding (3.3%), and three cases of pneumothorax (0.8%), and they were more common in the subclavian vein than in the internal jugular and femoral vein. Multiple attempts and failed attempts significantly correlated with higher incidence of complications. Maintenance-related complications included obstruction (n = 26; 7%), accidental removal (n = 14; 3.8%), central venous thrombosis (n = 8; 2.2%), subcutaneous extravasation (n = 14; 3.8%), dislodgment (n = 1; 0.25%), and extravascular infusion (n = 1; 0.25%). The frequency of catheter maintenance-related complications was significantly higher in femoral catheterizations and increased significantly with an increase in the duration of catheterization. A total of five serious complications were seen (pneumothorax in three, dislodgment in one and extravascular infusion in one) in the present series. Conclusions: Central venous catheterization in critically ill children is a relatively safe procedure, with a 1.3% rate of serious complications and no mortality. It seems safer to choose initially the femoral or internal jugular vein instead of the subclavian vein because of high success rate without serious insertion-related complications.Öğe Familial Mediterranean fever gene mutation frequencies and genotype-phenotype correlations in the Aegean region of Turkey(Springer Heidelberg, 2011) Ozalkaya, Elif; Mir, Sevgi; Sozeri, Betul; Berdeli, Awg; Mutlubas, Fatma; Cura, AlphanFamilial Mediterranean fever (FMF) is a disease characterized by recurrent, self-limiting fever and serositis and caused by altered pyrin due to mutated MEFV gene. The aim of this study was to investigate clinical manifestations and MEFV mutations among patients with FMF and healthy controls in the Aegean region of Turkey. This study included 308 patients and 164 healthy controls. Patients were divided into three groups according to Tel-Hashomer criteria; definitive, probable, and suspicious. Among the patients, 146 were women (47.4%) and 162 were men (52.6%). The mean age (+/- SD) of the patients at the diagnosis was 9.6 +/- A 3.95 (range 0.5-18). The mean age (+/- SD) at onset of the symptom was 6.2 +/- A 3.95 (range 1-18). Symptoms were seen earlier onset in definitive group than the suspicious group in our cohort (4.7 +/- A 3.9 years, 6.6 +/- A 3.9 years, respectively; P = 0.001). Clinical features were abdominal pain (83.1%), fever (55%), arthritis (17.1%), myalgia (4.5%), pleuritis (10%), and erysipelas-like erythema (7.7%). Fever, arthralgia, arthritis, chest pain, and amyloidosis were found statistically significant more in definitive group than suspicious group (P < 0.001, P < 0.001, P < 0.001, P < 0.05, and P < 0.001, respectively). MEFV gene mutations were identified in 199 patients (64.6%). The most commonly encountered MEFV mutation among the patients was M694V homozygote (25%). M694V homozygous mutation was found most frequently in definitive FMF group than other groups (49, 9, 8.9%, respectively). To our knowledge that FMF should be suspected in the case of non-specific but recurrent attacks of serositis and high fever, and molecular analysis should be performed in order to make diagnosis of FMF.Öğe Hemolitik üremik sendromlu çocuklarda atipik başlangıç ve yineleme oranı(1997) Mir, Sevgi; Sönmez, Ferah; Cura, Alphan; Kabasakal, Caner; Başdemir, GülçinHemolitik üremik sendrom (HÜS) tipik ve başlangıçlı olabilmekte ve yineleme seyrek olarak bildirilmefttedir. Prognoza çeşitli faktörlerin etki edebileceği ileri sürülen HÜS'de yapılan böbrek biyopsisi oranı oldukça sınırlıdır. Bu çalışmada Ege Üniversitesi Tıp Fakültesi Pediatrik Nefroloji bilim dalında 1981-1994 yılları arasında izlenmiş 14 HÜS vakası değerlendirilmiş, klinik ve. patolojik bulguların prognoza etkisi araştırılmıştır. Vakaların % 50'si erkek ve yaş ortalamaları 9.7±1.2 yıldır. Bir vaka tipik, diğerleri atipik HÜS olarak değerlendirilmişlerdir.'Serimizde % 42 gibi yüksek oranda yineleme görülmesi ise yaş ortalamalarının yüksek olmasına atipik HÜS görülme sıklığına bağlanmıştır. Vakaların % 28'inde kronik böbrek yetmezliği, % 42'sinde santral sinir sistemi komplikasyonu, % 28'inde kardiyovasküler komplikasyon saptanmıştır. Serimizde % 42 gibi yüksek oranda yinelenme görülmesi ise yaş ortalamalarının yüksek olmasına ve atipik HÜS görülme sıklığına bağlanmıştır. Biyopsi yapılan vakalarımızda akut dönemde glomerüler ve arteriyel bulguların daha yoğun olduğu, bunlara da daha hafif düzeyde intersitisiyel bulguların eşlik ettiği görülmüştür.' Sonuç olarak vakalarımızda yüksek oranda atipik HÜS ve yineleyen HÜS gözlenmiştir. Santral sinir sistemi komplikasyonları ise mortalite oranımızı yükseltmiştir. Böbrek biyopsisinin atipik HÜS'da tanı ve prognozu belirlemede yol gösterici bir inceleme olduğu düşünülmüştür.Öğe Henoch-Schönlein purpura and IgA nephropathy occuring in one patient: Case report(1998) Keskinoğlu, Ahmet; Mir, Sevgi; Kabasakal, Caner; Cura, Alphan; Başdemir, GülçinHenoch-Schönlein Purpura is characterized by the involvement of skin, gut, joints and kidneys. IgA nephropathy is a renal disorder characterized by hematuria. A 6-year-old-male was referred with gross hematuria, abdominal pain, and joint pain following a sore throat. He had purpuric skin lessions with normal renal function. Investigation revealed macroscopic hematuria, mild proteinuria, elevated IgA level, normal C3 level and negative CRP. Renal biopsy revealed a mesangiocap-illary glomerulonephritis with IgA and C3 granular deposits in the mesangial area. It was grade II HSP according to WHO'S classification. During the follow up he remained well for 2 years with microscopic hematuria. During the next 2 years he had no proteinuria or hematuria. At the age of 10 years he developed painless gross hematuria without the involvement of the other systems. Laboratory findings showed normal renal function, macroscopic hematuria and slight proteinuria. IgA levels were elevated. Skin biopsy has no deposits. in the renal biopsy by light microscopy glomeruli have slight mesangial hyper-cellularity and on immunofluorescent granular, predominantly IgA and C3 deposits. It was grade II IgA nephropathy. Our case, who initially developed Henoch-Schönlein purpura and 4 years later developed biopsy proven-lgA nephropathy, sug-gested the hypotesis of common pathogenesis for these conditions.Öğe Inflammatory lipid mediators and immunologic recognition in allogeneic renaltransplantation.(1997) Keskinoğlu, Ahmet; Mir, Sevgi; Huseyinov, Afig; Cura, Alphan; Çoker, Işıl…Öğe Öğe Yoğun bakım gereksinimi gösteren ağır üst havayolu obstrüksiyonu tanılı hastalarda deneyimimiz(2004) Karapınar, Bülent; Midyat, Levent; Cura, AlphanBu çalışmada Şubat 2001- Eylül 2003 tarihleri arasında üst havayolu obstruksiyonu (ÜHYO) tanısıyla yoğun bakım gereksinimi gösteren hastalar dosyalarından geriye dönük olarak değerlendirildi. Çalışmaya ÜHYO tanısı alan, yaşları 35 gün- 15 yıl arasında değişen (ortanca: 13.2 ay), 7 erkek ve 5 kız hasta alındı. Enfeksiyöz nedenler ÜHYO nedenleri arasında ilk sırayı almaktaydı, bunu iyatrojenik ve tümoral etkenler izlemekteydi. Hastalardan 10'unda başvuru anında solunum sıkıntısı bulguları vardı. Bu hastaların 9' unda endotrakeal entübasyon uygulanırken, 1 hastaya acil trakeotomi açıldı. Entübasyon uygulanan hastalardan 3' üne izlemlerinde elektif trakeostomi uygulandı. Hastaların yapay havayolu gereksinimi gösterdikleri süre ortanca değeri 2 (1-18) gün, yoğun bakımda kalış süreleri ise 17.1 (3-90) gündü. Tam havayolu obstruksiyonu olan criptosporidyum larenjitli bir olgu yoğun bakım ünitesi sonrasındaki servis izlemi esnasında trakeostomi kanülünün tıkanma komplikasyonu sonucunda kaybedildi. Diğer hastalarda ÜHYO şifa ile sonlandı.
