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Öğe Association of macrophage migration inhibitory factor gene-173 G/C polymorphism with prognosis in turkish children with juvenile rheumatoid arthritis(Springer Heidelberg, 2006) Berdeli, G.; Oezyuerek, Arif Ruhi; Uelger, Zuelal; Guerses, Dolunay; Levent, Ertuerk; Salar, Koray; Guerpinar, Ali RahmiThe objectives of this study were to determine genotypic and allelic frequencies of macrophage migration inhibitory factor (MIF) gene -173 G/C polymorphism in patients with juvenile rheumatoid arthritis (JRA) and to evaluate the association of the MIF -173 C allele with the outcome of JRA. Genomic DNA was collected from 67 JRA patients and 153 healthy individuals. To evaluate the association of the MIF -173 polymorphism with the outcome, we analyzed the data concerning the treatment regimen, duration of glucocorticoid treatment, score on the childhood health assessment questionnaire (C-HAQ) and the number of joints with active arthritis. Nonsignificant differences were observed between the study and control groups in the distribution of genotype and allele frequencies of the MIF gene -173 G/C polymorphism. In JRA patients, carrying a MIF -173 C allele, the number of disease modifying antirheumatic drugs required for the treatment was more, the duration of glucocorticoid treatment was significantly longer, and at the last visits the C-HAQ scores and the number of joints with active arthritis were significantly higher. MIF gene -173 C allele frequency did not differ between the controls and JRA patients. MIF -173 C allele did not confer increased susceptibility to JRA in our study group. Carriage of the MIF -173 C allele was found to be a strong predictor of poor outcome in all types of JRA.Öğe A case report of tuberous sclerosis with cardiac rhabdomyomas diagnosed antenatally by fetal echocardiography(Galenos Yayincilik, 2009) Gurses, Dolunay; Levent, Ertuerk; Ulger, Zulal; Ozyurek, A. RuhiTuberous sclerosis is a multisystem disease, involving primarily the skin, the brain, the kidneys, the heart and the eyes The most frequent cardiac tumor is rhabdomyoma In our patient who was referred to our hospital due to fetal arrhythmia, multiple intracardiac masses were detected by fetal echocardiography performed in the 36th week of pregnancy. Cardiac rhabdomyoma was considered and the baby was investigated for tuberous sclerosis. The diagnosis of tuberous sclerosis was established by the presence of multiple subependymal calcific nodules and periventricular and subcortical tubers in the postnatal magnetic resonance imaging. Since the rhabdomyomas had not caused hemodynamic impairment, surgical treatment was not considered The patient was followed up and we observed that rhabdomyomas regressed and arrhythmia decreased without any medical treatment. We wanted to point out that the diagnosis of tuberous sclerosis should be considered in cases presenting with intracardiac masses on fetal echocardiography. (Turk Arch Ped 2009; 44: 146-8)Öğe A case report of tuberous sclerosis with cardiac rhabdomyomas diagnosed antenatally by fetal echocardiography(Galenos Yayincilik, 2009) Gurses, Dolunay; Levent, Ertuerk; Ulger, Zulal; Ozyurek, A. RuhiTuberous sclerosis is a multisystem disease, involving primarily the skin, the brain, the kidneys, the heart and the eyes The most frequent cardiac tumor is rhabdomyoma In our patient who was referred to our hospital due to fetal arrhythmia, multiple intracardiac masses were detected by fetal echocardiography performed in the 36th week of pregnancy. Cardiac rhabdomyoma was considered and the baby was investigated for tuberous sclerosis. The diagnosis of tuberous sclerosis was established by the presence of multiple subependymal calcific nodules and periventricular and subcortical tubers in the postnatal magnetic resonance imaging. Since the rhabdomyomas had not caused hemodynamic impairment, surgical treatment was not considered The patient was followed up and we observed that rhabdomyomas regressed and arrhythmia decreased without any medical treatment. We wanted to point out that the diagnosis of tuberous sclerosis should be considered in cases presenting with intracardiac masses on fetal echocardiography. (Turk Arch Ped 2009; 44: 146-8)Öğe A case with Wolf-Parkinson-White syndrome first presented with a devastating event: aborted sudden cardiac death(Turkish Soc Cardiology, 2009) Uelger, Zuelal; Karapinar, Buelent; Akyol, Bedir; Arslan, Mehmet Tayyip; Levent, Ertuerk; Oezyuerek, Arif RuhiÖğe A case-control study of early-stage radiological markers of endothelial dysfunction and cardiovascular findings in patients with osteogenesis imperfecta: genotype-phenotype correlations(Walter De Gruyter Gmbh, 2023) Evin, Ferda; Aydin, Derya; Levent, Ertuerk; Oezen, Samim; Darcan, Suekran; Gökşen, DamlaObjectives: Osteogenesis imperfecta (OI) is a disease caused by defective collagen synthesis. Collagen type 1 is found in many structures in the cardiovascular system. Endothelial dysfunction, which develops prior to the emergence of structural and clinical signs of atherosclerosis, is believed to play a key role in atherogenesis. Endothelial dysfunction may be detected presymptomatically by non-invasive radiologic methods, such as flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT). These modalities may provide early indicators of endothelial dysfunction. This cross-sectional comparative study aimed to investigate early-stage radiological markers of endothelial dysfunction and cardiovascular diseases in OI patients and healthy controls and to investigate the correlation of findings with OI genotype.Methods: Thirty patients diagnosed with OI were paired with thirty healthy age- and gender-matched controls and echocardiogram findings were compared.Results: None of the patients had known underlying cardiovascular disease. The mean age was 13.18 +/- 2.91 years. According to Sillence classification, 15 patients had Type 1 OI, 10 had Type III, and 5 had Type IV. Mean CIMT in the OI group was higher in the control group (OI group: 0.42 +/- 0.06 vs. healthy controls: 0.34 +/- 0.04 mm, p<0.01), and mean FMD percent was lower in the patient group (p<0.01). Left ventricular ejection fraction was 78.97 +/- 10.32 vs. 77.56 +/- 8.50 %, (OI group: 7.00 +/- 3.06 vs. healthy controls: 12.14 +/- 1.99, p=0.56), and fractional shortening was 42.68 +/- 11.94 vs. 40.23 +/- 7.99 %, (p=0.35), in OI patients and controls, respectively.Conclusions: Pediatric patients with OI without clinical signs of cardiovascular abnormality had significantly worse CIMT and FMD findings than healthy controls. However, no difference was determined when comparing left ventricular ejection fraction or fractional shortening. OI patients may need to be screened for cardiovascular system complications starting from an early age.Öğe Evaluation of Premature Ventricular Contractions in Children with Structurally Normal Hearts: A Single-Center Study(Galenos Publ House, 2024) Tosyali, Merve; Levent, ErtuerkAim: Premature ventricular contractions are a prevalent arrhythmia in children, with the majority of cases exhibiting normal cardiac function and no anatomical abnormalities. The objective of this study was to assess the clinical course of premature ventricular contractions in children who do not have any structural heart abnormalities. Materials and Methods: In this study, 60 patients younger than 18 years of age who were diagnosed with premature ventricular contractions in our clinic and who did not have any structural cardiac abnormalities on echocardiography were included. Demographic data, 12-channel standard resting electrocardiography, 24-hour Holter electrocardiography monitoring, and the exercise test records of the patients were retrospectively analyzed from their follow-up files. Results: This study assessed 60 patients diagnosed with premature ventricular contraction, of whom 55% were male. Out of the total number of patients, 28 (46.7%) were asymptomatic, while the most often reported symptom was palpitations. Additionally, it was stated that five children had syncope. Medical treatment was given to 40 patients (66.7%). Beta-blockers (52.2%) were the most commonly prescribed drugs. Malignant arrhythmia or sudden cardiac death did not occur in any of the patients throughout the follow-up period. According to all patients' follow-up Holter electrocardiography results, a 61.6% decrease in premature ventricular contraction rates was observed. Complete recovery was observed in 16.7% of the patients. Conclusion: Premature ventricular contractions in children generally have a good prognosis. Most cases are asymptomatic, and regardless of the origin, spontaneous regression rates over time are quite substantial. Determining the origin may help predict the prognosis.Öğe The relation of arterial stiffness with intrauterine growth retardation(Wiley-Blackwell Publishing, Inc, 2009) Levent, Ertuerk; Atik, Tahir; Darcan, Suekran; Ulger, Zulal; Goksen, Damla; Ozyurek, A. RuhiBackground: Much epidemiological evidence has linked low birthweight with late cardiovascular risk. Intrauterine growth retardation (IUGR) is associated with the increased risk of cardiovascular disease in adult life; it is unclear whether the relationship is present at younger ages. We evaluated whether abdominal aortic stiffness was altered in patients with IUGR (born at term with birthweight small for gestational age) in younger ages. Methods: Thirty-two (24 girls and eight boys) IUGR children aged 8.77 +/- 2.05 years were enrolled in the study. The birthweight was traced from the medical records. Their gestational ages were 38.9 +/- 0.85 weeks and birthweights 2130 +/- 198 g, respectively. Thirty-one healthy subjects who had normal gestational age and birthweight, matched for age and sex were recruited as a control group. Aortic strain, pressure strain elastic modulus (Ep), and normalized Ep and aortic distensibility were measured by a sphygmomanometer and transthoracic echocardiography in all subjects from the abdominal aorta. Results: There was no statistically significant difference between the study and the control groups in sex, mean age, body mass index, lipid profile, leptin, insulin-like growth factor-1 or insulin-like growth factor binding protein 3. In IUGR children, aortic strain (0.201 +/- 0.027 vs 0.254 +/- 0.031, P < 0.001) and aortic distensibility (1.08 +/- 0.19 vs 1.42 +/- 0.24, P < 0.001) were significantly lower compared with the control group. However Ep (188 +/- 36.2 vs 146 +/- 27.1, P < 0.001) and normalized Ep (2.97 +/- 0.40 vs 2.1 +/- 0.39, P < 0.001) were significantly higher in IUGR patients. Conclusions: This study demonstrates that abdominal aortic stiffness is increased in IUGR patients. These data suggest that prenatal events could be related to cardiovascular risk in later life.Öğe The relation of arterial stiffness with intrauterine growth retardation(Wiley-Blackwell Publishing, Inc, 2009) Levent, Ertuerk; Atik, Tahir; Darcan, Suekran; Ulger, Zulal; Goksen, Damla; Ozyurek, A. RuhiBackground: Much epidemiological evidence has linked low birthweight with late cardiovascular risk. Intrauterine growth retardation (IUGR) is associated with the increased risk of cardiovascular disease in adult life; it is unclear whether the relationship is present at younger ages. We evaluated whether abdominal aortic stiffness was altered in patients with IUGR (born at term with birthweight small for gestational age) in younger ages. Methods: Thirty-two (24 girls and eight boys) IUGR children aged 8.77 +/- 2.05 years were enrolled in the study. The birthweight was traced from the medical records. Their gestational ages were 38.9 +/- 0.85 weeks and birthweights 2130 +/- 198 g, respectively. Thirty-one healthy subjects who had normal gestational age and birthweight, matched for age and sex were recruited as a control group. Aortic strain, pressure strain elastic modulus (Ep), and normalized Ep and aortic distensibility were measured by a sphygmomanometer and transthoracic echocardiography in all subjects from the abdominal aorta. Results: There was no statistically significant difference between the study and the control groups in sex, mean age, body mass index, lipid profile, leptin, insulin-like growth factor-1 or insulin-like growth factor binding protein 3. In IUGR children, aortic strain (0.201 +/- 0.027 vs 0.254 +/- 0.031, P < 0.001) and aortic distensibility (1.08 +/- 0.19 vs 1.42 +/- 0.24, P < 0.001) were significantly lower compared with the control group. However Ep (188 +/- 36.2 vs 146 +/- 27.1, P < 0.001) and normalized Ep (2.97 +/- 0.40 vs 2.1 +/- 0.39, P < 0.001) were significantly higher in IUGR patients. Conclusions: This study demonstrates that abdominal aortic stiffness is increased in IUGR patients. These data suggest that prenatal events could be related to cardiovascular risk in later life.Öğe Transcatheter Closure of Secundum Atrial Septal Defects in Pediatric Patients: A 15-Year Single-Center Experience(Springernature, 2024) Dogan, Eser; Levent, ErtuerkPurpose: Transcatheter closure is the first -line treatment option for hemodynamically significant secundum atrial septal defects (ASDs). This study examines our center's experience with this procedure over the last 15 years. Materials and methods: Pediatric patients aged 0-18 years with secundum ASDs who were planned for transcatheter closure in our clinic between January 2007 and January 2023 were retrospectively evaluated. Results: Transcatheter secundum ASD closure was planned for a total of 334 patients during the study period: 191 girls (57.2%) and 143 boys (42.8%). Their mean age was 8.08 +/- 3.9 years, and their mean weight was 30 +/- 15.6 kg. Defect diameter measured transesophageally ranged from 5 to 35 mm, with a mean of 12.56 +/- 4.02 mm. Transesophageal echocardiographic examination revealed a single secundum ASD in 319 patients (95.5%) and multiple secundum ASDs in 15 patients (4.5%). In 11 patients (3.3%), the procedure was terminated before initiating transcatheter ASD closure because of insufficient vena cava rims or a very large or multi -fenestrated defect. The 323 patients (96.7%) who underwent transcatheter ASD closure had a mean pulmonary artery pressure of 15.1 +/- 4.0 mmHg and a mean Qp/Qs ratio of 1.97 +/- 0.56. The procedure failed in four patients (1.3%) because of device embolization (n=2) or the inability to properly position the device (n=2). Major complications other than device embolization observed during or after transcatheter closure included anesthetic -induced respiratory depression (n=1) and total atelectasis of the lung (n=1). No new major complications were detected during the patients' long-term follow-up. Conclusion: With appropriate patient and device selection, transcatheter closure is a safe and effective treatment for secundum ASD and should be the first treatment of choice.
