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Öğe Cardiac troponin-1 as a marker of myocardial dysfunction in children with septic shock(E M H Swiss Medical Publishers Ltd, 2004) Gurkan, F; Alkaya, A; Ece, A; Haspolat, K; Boşnak, Mehmet; Bilici, M; Kervancioglu, MObjectives: Cardiac depression is well known in severe sepsis and septic shock. Our aim was to investigate the incidence of myocardial ischaemia as shown by cardiac troponin I (cTnI) levels in patients with septic shock and to evaluate the correlation with myocardial dysfunction measured by echocardiography. Methods: The study was performed in the paediatric intensive care unit in Dicle University Hospital, Turkey, between January 2001 and December 2002. Patients in septic shock, with a mean age of 6.4 +/- 2.8 months, were simultaneously submitted to a two-dimensional echocardiograin and biochemical investigation on admission. Results: The mean serum cTnI level of the patients was 3.1 +/- 2.6 ng/ml (0.01-9.80 ng/ml) and the mean LVEF value was calculated as 48% +/- 11%. 21 patients (75%) had a cTnI level greater than or equal to0.6 ng/ml, and 15 patients (54%) had a LVEF <0.5. For cTnI levels greater than or equal to0.6 ng/ml, sensitivity and specificity were 9 3.3% and 46.2%, and positive and negative predictive values were 66.7% and 85.7% respectively. For cTnI values greater than or equal to2.0 ng/ml, sensitivity and specificity were 86.7% and 76.9%, and positive and negative predictive values were 81.3% and 83.3%, respectively. There was a statistically significant relationship between LV dysfunction and cTnI positivity (r(2) = 0. 3 16, p = 0.002). No significant difference was found for the cTnI levels greater than or equal to0.6 ng/ml between non-survivors and survivors (p >0.05). Conclusion: Myocardial ischaemia and cell injury seem to be common in patients with septic shock and correlate with left ventricular dysfunction. Measurement of cTnI may be an easy and practical tool for monitoring cardiac damage in critically ill septic patients.Öğe Child pedestrian fatalities in Diyarbakir, Turkey(Saudi Med J, 2005) Goren, S; Subasi, M; Gurkan, F; Tirasci, Y; Acar, KObjective: As there is an increase in modernization, transportation, unskilled, and drunk drivers, injuries from traffic accidents have taken on an epidemic form all over the world. The present study aims to describe the demographic data of childhood pedestrian fatalities in a large urban area in Turkey. Methods: The demographic data of childhood pedestrian fatalities in a large urban area in Turkey was described retrospectively, with respect to age, gender, injury pattern and location. Cases less than 16 years of age were collected retrospectively from the files of the Branch of the Council of Forensic Medicine in Diyarbakir between 1998 and 2003. Results: There were 232 childhood pedestrian fatalities among a total of 267 children involved in lethal traffic accidents. The mean age of the victims was 7.2 years, most of them being in the 6-10 years of age group (49.1%). Male predominated among our victims (76.3%). With regard to injury location, the most common site was the head (73.7%). There was an increase in pedestrian fatalities in the summer season (33.6%). There was no difference in rates of pedestrian deaths between years. Conclusion: Child pedestrian deaths have constituted a significant percentage of all child fatalities due to traffic accidents in our region. There were 6.4 deaths per 100,000 populations, and this rate was also higher than in other populations.Öğe Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey(Wiley, 2005) Tanrikulu, AC; Aldemir, M; Gurkan, F; Suner, A; Dagli, CE; Ece, AAbdominal tuberculosis (TB) is a rare manifestation, which can be overlooked on long-lasting and non-specific findings unless a high index of suspicion is maintained. The purpose of the present study was to investigate the diagnostic features of 39 patients hospitalized with tuberculous peritonitis (TBP) in Dicle University Hospital, Turkey between January 1994 and August 2003. Twenty-two patients were male; patient age ranged between 1 and 59 years (mean: 16.2 +/- 14.4 years). There were 21 patients (54%) under 15 years of age. Thirteen children had a history of familial TB and seven adults had prior history of TB. Six (29%) of 21 pediatric cases had bacille Calmette-Guerin (BCG) scars and results of 5-tuberculin units (TU) tuberculin test were positive in seven children (18%). Of all cases, the most common presenting findings were abdominal pain (95%), ascites (92%) and abdominal distention (82%). Five of the patients had accompanying pulmonary TB, and six patients (15%) had intestinal TB who were admitted to emergency service with acute abdomen, of whom three (8%) had perforation and three (8%) had ileus. Histopathologically 20 cases (51%) were proven on abdominal ultrasonography, and computed tomography revealed most commonly ascites and thickening of peritoneum. No microbiologic evidence was obtained except three positive culture results for Mycobacterium tuberculosis. As a result, TBP should be considered for diagnosis, in patients with non-specific symptoms of abdominal pain, wasting, fever, loss of appetite, abdominal distension and even symptoms of acute abdomen, because early diagnosis and effective treatment will decrease morbidity and mortality. (C) 2005 Blackwell Publishing Asia Pty Ltd.Öğe Electrocution-related mortality: A review of 123 deaths in Diyarbakir, Turkey between 1996 and 2002(Tohoku Univ Medical Press, 2006) Tirasci, Y; Goren, S; Subasi, M; Gurkan, FElectrical burns are responsible for considerable morbidity and mortality, and are usually preventable with simple safety measures. We conducted a retrospective Study of non-lightening electrocution deaths in Diyarbakir, Turkey between 1996 and 2002. All 123 deaths investigated were accidental. The age range was 2 to 63 years with a mean age of 20.7 +/- 15.3 years. Eighty-six victims (69.9%) were male. The Upper extremity was the most frequently involved contact site in 96 deaths (48%). No electrical burn mark was present in 14 (11.4%) cases. Home accidents were responsible for 56 cases deaths (45.5%). Deaths were caused most frequently by touching an electrical wire (52 cases, 42.3%). There was an increase in electrocution deaths in the summer (47 cases, 38.2%). One hundred one cases (82.1%) were dead oil arrival at hospital. The unique findings of our Study include younger age (0-10 years) of victims (39 cases, 31.7%) and a means of electrocution (electrical water heaters in bathroom) in 23 cases (18.7%). Rate of deaths due to electrocution among all medicolegal deaths was found higher in Out,Study than in previous Studies. The public Should be educated to prevent children to play near electrical appliances and to avoid electrical heaters in the bathroom.Öğe Fatal falls from heights in and around Diyarbakir, Turkey(Elsevier Ireland Ltd, 2003) Goren, S; Subasi, M; Tyrasci, Y; Gurkan, FFalls from high places, such as from a building, are frequently encountered in suicides, in some accidents, and sometimes in homicides. In this study, we evaluated the demographic data, mortality rates, fall causes, and post-mortem findings of individuals who fell from heights. Our cases were collected retrospectively from the files of the Branch of the Council of Forensic Medicine in Diyarbakir between 1996 and 2001. There were 431 accidental and 53 suicidal deaths due to blunt injury resulting from falls. Of the victims, 188 were female and 296 were male. The average age of the 484 victims was 27.05 years (range: 4 months-100 years). For buildings, the height ranged from 3 to 8 storeys for suicides and from 1 to 8 storeys for accidents. We proceeded to analyse the characteristics of accidental falls as follows. The majority of falls were from balconies or rooftops due to the tendency of people to sit and sleep on these places during the hotter months of the year. Some 54.5% of all falls occurred in May-August. The 53 suicidal jumps all occurred off buildings. The victims ranged in age from 15 to 70 years, and comprised 29 women and 24 men. One of the deceased jumped from the roof of a school in which he was boarding, and another from the seventh storey of a hospital in which he was receiving treatment. The remaining 51 jumped from heights ranging from 3 to 8 storeys. Psychiatric illness was reported in 18 (33.9%) of the suicide deaths, while 10 (18.8%) of the 53 suicides were single women. The results of this study were at variance with literature data with respect to the following: falls from heights were most common in the 0-5 year age group, females had a higher suicide rate than males, and the majority of accidental falls occurred at home rather than in the workplace. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Foreign body asphyxiation in children(Indian Academy Pediatrics, 2005) Goren, S; Gurkan, F; Tirasci, Y; Kaya, Z; Acar, KWe aimed to investigate the frequency and epidemiological features of deaths due to foreign body asphyxiation (FBA) in childhood, over 1990-2003. Of the victims, 14 (63.6%) were male and 8 (36.4%)females. The mean age of the victims was 2.2 +/- 0.6 years. There were 20 (90.9%) children between 1 and 3 years, and two other cases at 2112 and 5 years of ages. All aspirations had occurred at home. Eight (36.4%) of the victims were dead on arrival, 11 (50%) on intervention, and 3 (13.6%) after complications. Food material was the most commonly aspirated foreign body in 81.8% of the cases, nuts being the most common (50%). Food asphyxiation remains a common problem particularly in children between I and 3 years of age in our region. These fatal accidents can be prevented by parental education and early recognition and management of the situation.Öğe Medicolegal deaths in children and adolescents(Saudi Med J, 2005) Tirasci, Y; Goren, S; Gurkan, F; Uzun, I[Abstract Not Available]Öğe Purulent pericarditis in childhood(W B Saunders Co, 2002) Cakir, Ö; Gurkan, F; Balci, AE; Eren, N; Dikici, BünyaminBackground/Purpose: Purulent pericarditis is a rapidly fatal disease if left untreated. This article describes our experience with diagnosis and management of 18 patients seen over a 10-year period. Methods: Eighteen children with purulent pericarditis were treated in our clinics between 1990 and 2000. Ten patients were boys and 8 were girls, and the mean age of all patients was 4 years (range, 8 months to 12 years). Results: Most common findings were fever and cardiac tamponade. Staphylococcus aureus was the most common causative agent, and the most common predisposing factor was respiratory tract infection. Chest radiography and echocardiography were the most important methods for diagnosis, and pericardiosynthesis was diagnostic in purulent pericarditis. The treatment methods performed in our patients were subxiphoidal pericardial tube (10 patients), pericardiectomy after subxiphoidal pericardial tube (2 patients), pericardiectomy (3 patients), and pericardiocentesis-intrapericardial thrombolytic treatment (3 patients). Only one patient (5.5%) died who was critically ill at the time of admission. Conclusions: Subxiphoidal tube drainage and pericardiectomy were performed with good results in these cases. Intrapericardial streptokinase and pericardial aspiration method also was thought to be beneficial. Copyright 2002, Elsevier Science (USA). All rights reserved.Öğe Relationship among serum selenium levels, lipid peroxidation, and acute bronchiolitis in infancy(Humana Press Inc, 2004) Gurkan, F; Atamer, Y; Ece, A; Kocyigit, Y; Tuzun, H; Mete, MThirty-four infants with acute bronchiolitis and 25 age-matched healthy controls were enrolled to investigate the possible relationship between serum malondialdehyde (MDA) and selenium (Se) levels and the occurrence and severity of acute bronchiolitis in children. Serum samples were taken for serum Se and MDA measurements, and the clinical score was assessed at admission. Blood was taken again from the children with bronchiolitis at 2 mo after discharge from the hospital. Mean serum MDA levels were significantly higher in patients with acute bronchiolitis than at the postbronchiolitis stage and the controls (4.2+/-2.5 nmol/L, 1.4+/-0.8 nmol/L, and 0.7+/-0.2 nmol/L, respectively [p<0.001]). Infants with bronchiolitis had lower mean serum Se levels at the acute stage than after 2 mo (31.7+/-28.9 mug/L versus 68.4+/-26.4 mug/L, p<0.05, respectively); both of which were significantly lower than the control group measurements (145.0+/-21.9 mug/L) (p<0.001). There was a negative correlation between serum MDA and Se levels in the patient group (r=-0.85, p<0.001). The age of the patient, child's immunization status, parental smoking habit, and family crowding index were not correlated with serum Se, MDA levels, or clinical score at admission. In conclusion, increased MDA levels and impaired Se status demonstrate the presence of possible relationship of these parameters with pathogenesis of acute bronchiolitis, and antioxidant supplementation with Se might be thought to supply a beneficial effect against bronchiolitis.Öğe Serum leptin levels in asthmatic children treated with an inhaled corticosteroid(Amer Coll Allergy Asthma Immunology, 2004) Gurkan, F; Atamer, Y; Ece, A; Kocyigit, Y; Tuzun, H; Mete, NBackground: Recent observations suggest the presence of an interaction between leptin and the inflammatory system; however, there is no adequate knowledge about the role of leptin in atopic states such as asthma. Objectives: To evaluate the potential role of leptin in relation to bronchial asthma and inhaled corticosteroid therapy. Methods: Twenty-three children with mild-to-moderate, newly diagnosed asthma enrolled in this 2-period trial. The control group consisted of 20 age- and sex-matched children. Serum leptin levels were measured in patients at initiation and after 4 weeks of budesonide treatment and were compared with control group measurements. Results: Asthmatic children had higher mean +/- SD serum leptin levels at admission (19.3 +/- 5.1 ng/mL) than after budesonide treatment (10.6 +/- 1.6 ng/mL) and vs control group measurements (9.8 +/- 1.6 ng/mL) (P < .001). There was a significant correlation between serum leptin levels before and after budesonide treatment (r = 0.68; P = .007). Mean +/- SD body mass indices in patients and controls were 16.7 +/- 2.1 and 16.9 +/- 2.6 kg/m(2), respectively. Serum leptin levels did not correlate with body mass indices before budesonide treatment in the study group (r = -0.13; P = .65) but correlated well after budesonide treatment (r = 0.58; P = .009) and in the control group (r = 0.65; P = .008). Conclusions: The role of leptin elevation in children with asthma might be a regulatory mechanism rather than being etiologic, but a question may be raised whether it is possible that leptin may contribute to poor patient outcomes. Further research, both basic and clinical, is essential to explain the exact mechanism.Öğe Spontaneous pneumothorax in children in the South-east of Turkey(Wiley, 2004) Eren, S; Gurkan, F; Balci, AE; Ulku, R; Onat, S; Eren, MNBackground: The purpose of the present study was to investigate the etiological factors, symptomatology, management and outcome of spontaneous pneumothorax in children aged <15 years. Methods: The authors' reviewed the records of 44 children with spontaneous pneumothorax between January 1990 and February 2002. Results: The median age was 4.6 years (range 2 months-14 years), and 51% were male. Breathlessness and coughing were the most common symptoms. All pneumothoraces were initially managed by closed tube drainage. Thirty-seven (84%) of the children responded well and were cured of pneumothorax with closed tube thoracostomy alone. Seven children (16%) underwent thoracotomy. The median hospital stay was 12.9 days. There were two deaths from respiratory failure. Six- to 96-month follow-up information was available for 32 patients, and only one recurrence was found. Conclusions: Lung infections were the most frequently observed underlying pathology in the patients studied. Closed tube thoracostomy alone was sufficient for the majority of patients.Öğe Suicide in children and adolescents at a province in Turkey(Lippincott Williams & Wilkins, 2003) Goren, S; Gurkan, F; Tirasci, Y; Ozen, SDespite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides. is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged I I through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.Öğe Tuberculosis of the metacarpals and phalanges of the hand(Lippincott Williams & Wilkins, 2004) Subasi, M; Bukte, Y; Kapukaya, A; Gurkan, FSkeletal tuberculosis (TB) is less common than the pulmonary form. Involvements of the metacarpals and phalanges of the hand are infrequent. The authors report their experience with treatment and outcome of TB of the metacarpals and phalanges of the hand in 7 patients. There were 4 women and 3 men in the study who ranged in age from 3 to 60 years (average age, 22.7 years). The duration of complaints at presentation ranged from 4 to 17 months (average, 9 months). The most common presentation was pain and swelling. The presumptive preoperative diagnoses were bone tumor in 4 patients, spina ventosa in 2, and chronic pyogenic osteomyelitis in 1 patients. The results of the laboratory examination showed a mild increase in the erythrocyte sedimentation rate. No patient had an active tubercular lesion or history of pulmonary disease. The diagnosis was based on the clinical picture and radiographic features, and was confirmed by open biopsy. No patient had bony debridement or arthrodesis to control the infection. The treatment of all patients began with a 4-drug regimen for 2 months, followed by a 2-drug regimen for 10 months. The mean follow-up was 30.28 months (range, 16-52 months). At the time of the last follow-up, all lesions had heated with no recurrence. The functional results were satisfactory in all patients. One patient with thumb metacarpophalangeal TB had joint irregularity and thumb metacarpal shortening. Arthrodesis was not needed in any patient. TB of the metacarpals and phalanges of the hand can be difficult to diagnose during the early stages. TB should be suspected in cases of long-standing pain and swelling in the metacarpals and phalanges. It is necessary to keep TB in mind when making the differential diagnosis of several osseous pathologies.
