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    A COMPARATIVE REVIEW OF PEDIATRIC AND ADULT PATIENTS WITH MILIARY TUBERCULOSIS
    (Modestum Ltd, 2007) Tanrikulu, Cetin; Gurkan, Fuat; Dagli, Canan Eren; Gozu, Ayfer; Suner, Ali
    Aim: Miliary tuberculosis (MTB) is a serious and rare form of tuberculosis. Studies comparatively reviewed children and adults with MTB are lacking. Methods: We retrospectively evaluated 56 pediatric and 26 adult MTB patients at a university hospital, between 1990 and 2003 Results: The median age at presentation was 3.5 years for children and 38 years for adults. Thirtyeight of all patients of whom 86.8% were children had family history of tuberculosis Presenting symptoms and signs of adult and pediatric patients were loss of weight (51.8% vs. 61.5%), anorexia (76.9% vs. 57.8%), dyspnea (12.5% vs. 57.8%), diarrhea/ vomiting (35.0% vs. 27.0%), fever (53.8% vs. 17.9%), hepatomegaly (30.8% vs. 51.8%), pulmonary crepitations (42.3% vs. 42.9) and cough (46.2% vs. 35.7%), respectively. The presenting symptoms/signs and laboratory abnormalities were generally more frequent in adults. Detected laboratory abnormalities were leukocytosis (73.2%), increased sedimentation rate ( 73.2%), anemia (52.4%), hypoalbuminemia (47.6%), elevated liver transaminases (36.6%), elevated lactate dehydrogenase (50.0%) and hyponatremia (25.6%) in whole study group. The diagnosis was proven microbiologically in 15 (18.3%) patients. Among 56 pediatric cases, there were 8 (14.3%) children with positive BCG scar and only 16 (28.6%) children with positive reaction to 5TU tuberculin test. Radiological findings of all patients, either on chest X-ray or high resolution computerized tomography, were characteristic for MTB. One fourth of patients had accompanying tuberculous meningitis. Predisposing factors for TB were found in 13 patients (15.9%). No patients had HIV infection. Overall 6 (7.3%) patients had died. Conclusion: High rate of history of family contact and low rate of BCG vaccination in our patients with MTB were significant public health problems. Identifying different features in children and adults may contribute to early diagnosis of MTB, which is highly relevant to its outcome.
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    Interstitial Lung Disease in Coppersmiths in High Serum Copper Levels
    (Humana Press Inc, 2010) Dagli, Canan Eren; Tanrikulu, Abdullah Cetin; Koksal, Nurhan; Abakay, Abdurrahman; Gelen, Mehmet Emin; Demirpolat, Gulen; Yuksel, Murvet
    Coppersmith is a worker who uses copper most commonly for the production of kitchen appliances in Turkey. This is an ancient occupation practiced for centuries in Turkey. Our objective was to investigate the prevalence of parenchymal lung diseases among coppersmiths in Kahramanmaras city in Turkey. Thirty coppersmiths were included to the study, and they all signed an informed consent. Demographics, spirometric test results and high-resolution computed tomography (HRCT) scans, and blood samples were obtained. Laboratory analysis of the serum samples showed that serum copper levels of the subjects were 0.93 +/- 0.14 mg/L. Serum copper level in control group was found as 0.70 +/- 0.14 mg/L, and it was significantly different between the two groups (p < 0.05). Of 30 coppersmiths, 17 HRCT findings are abnormal and seen with diffuse parenchymal interstitial lung disease pattern-ten (58.8%) respiratory bronchiolitis interstitial lung disease, five (29.4%) nonspecific interstitial pneumonia, and two (11.8%) usual interstitial pneumonia. The most prevalent HRCT pattern was micronodular pattern in workers. This is the first field study reporting the radiologic findings of coppersmiths and effect of the occupation on lung diseases.
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    Pulmonary Alveolar Microlithiasis: Radiologic Findings of Eight Cases in Turkey
    (Ortadogu Ad Pres & Publ Co, 2010) Tanrikulu, A. Cetin; Dagli, Canan Eren; Senyigit, Abdurrahman; Nazaroglu, Hasan; Babayigit, Cenk
    Objective: Pulmonary alveolar microlithiasis (PAM) is a rare idiopathic disease characterized by presence of diffuse innumerable minute calculi called microliths The aim of this report was to describe the radiographic findings of PAM with particular attention to features provided by chest X-ray and high resolution computerized tomography (HRCT). Material and Methods: We diagnosed three index cases of PAM who came from the same village in 1996. In 2005 we performed a study including 279 residents of that village by using microfilm screening to determine undiagnosed cases. Five additional cases of PAM were detected and underwent HRCT. HRCT and chest X-ray images of eight cases were assessed specifically for patterns, distribution, and profusion of pulmonary abnormalities. Results: Of eight cases, four were adults and four were children. Diffuse typical microcalcifications were detected in chest X-ray in three cases while reticulonodular pattern was seen in three cases and reticular pattern in two cases. Fine microcalcification, parenchymal band and fisssural prominence were the most common findings on HRCT. Small subpleural cysts were detected in five cases but only case 1 showed black pleural line in chest X-ray. One case had small subpleural bullae and bronchiectatic changes in both lower lobes predominantly in the left lung in HRCT. Conclusion: Relatives of a patient with PAM having reticular or reticulonodular pattern in chest X-ray must be investigated in detail for PAM because it can be the early stage of the disease. HRCT has a major importance for the detection of the rapid progression.
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    Unusual Combination of Tracheobronchopathia Osteochondroplastica and AA Amyloidosis
    (Yonsei Univ Coll Medicine, 2009) Kirbas, Goekhan; Dagli, Canan Eren; Tanrikulu, Abdullah Cetin; Yildiz, Fetin; Buekte, Yasar; Senyigit, Abdurrahman; Kiyan, Esen
    Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause characterized by the presence of multiple submucosal osseous and/or cartilaginous nodules that protrude into the lumen of the trachea and large bronchi. A simultaneous diagnosis of TO and amyloidosis is rarely reported. In this report, a case initially suspected to be asthma bronchiole that could not be treated, was radiologically diagnosed as TO, and also secondary amyloidosis is presented. A 53 years, man patient reported a 3 years history of dyspnea. Pulmonary function tests (PFTs) showed an obstructive pattern. Chest X-rays revealed right middle lobe atelectasis. FOB and CT detected nodular lesions in the trachea and in the anterior and lateral walls of the main bronchi. AA amyloidosis was confirmed by endobronchial biopsy. In the abdominal fat pad biopsy, amyloidosis was not detected. Asthma bronchiole was excluded by PFTs. This case illustrates that it is possible for TO and amyloidosis to masquerade as asthma. TO and amyloidosis should be suspected in patients of older ages with asthma and especially with poorly treated asthmatic patients. Although nodular lesions in the anterior and lateral tracheobronchial walls are typical for TO, a biopsy should be obtained to exclude amyloidosis.