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Öğe A case report of spleen tuberculosis treated by splenectomy(2004) Önen A.; Yaramiş A.; Şenyi?it A.; Deveci E.A 4-years-old boy who had weakness, anorexia, coughing, fever, night sweats, and weight loss that had persisted for 20 months admitted to our institution. Although he had received three antituberculous agents due to pulmonary tuberculosis for almost a year, there has been no significant improvement in his overall condition. Micronodular infiltration in chest x-ray, multiple nodules and/or small abscesses in the spleen in abdominal ultrasound and computerized tomography were found. Because of the failure of antituberculous therapy, splenectomy has been performed. Intraoperatively, the spleen was completely calcified and covered with multiple nodules and micro abscesses. Following the splenectomy, the patient's symptoms resolved and he began to gain weight. He received antituberculous therapy for two years concomitant with surgery. After 4 year-follow up, he still had no symptom and continued to do well with normal growth. The incidence of spleen tuberculosis has increased recently. The suspicion of tuberculous spleen abscess especially in endemic area and early diagnosis with early nonoperative management is important. The cases associated with severe drug resistant multiple tuberculous spleen abscesses that delayed in tuberculous treatment may benefit from splenectomy.Öğe Cerebral vasculitis and obsessive-compulsive disorder following varicella infection in childhood(2009) Yaramiş A.; Hergüner S.; Kara B.; Tatli B.; Tüzün Ü.; Özmen M.Varicella is largely a childhood disease, with more than 90% of cases occurring in children younger than 10 years. The primary infection is characterized by generalized vesicular dermal exanthemas, which are extremely contagious. Secondary bacterial infection and varicella pneumonia, usually seen in the immunocompromised or adult populations, may have high morbidity and mortality. Varicella in childhood is a generally benign and self-limited disorder; however, severe, life-threatening neurological complications may occur. We report a previously healthy eight-year-old boy who presented with acute hemiplegia and obsessive-compulsive disorder secondary to a lesion in lentiform nuclei associated with a history of recent varicella infection. The child was treated with sertraline for obsessive-compulsive disorder symptoms and made a full recovery.Öğe Diphtheria in patient presenting multiple system damage(2006) Yaramiş A.; Katar S.A 10 year-old girl was admitted to our hospital with five-day history of fever, bilateral neck swelling, and dyspnea. The patients symptoms suggested nasopharyngeal diphtheria and she was administered penicilin and, antitoxin immediately. Nevertheless myocarditis, syncope, neuropathy and hepatitis developed after two-week hospitalization. The patient was therefore administered carnitine, dopamine, dobutamine and immunglobulin. After hospitalization for 52 days, the patient was discharged with minimal hemiparesis. The remaining of symptoms resolved on follow-up. In this article we report a patient with diphtheria and review the literature.Öğe Enteric fever in 19 children cases with positive hemocultures(2006) Katar S.; Onur H.; Yaramiş A.; Özbek M.N.; Ecer S.Clinical and laboratory findings of 19 children with enteric fever and positive hemocultures, hospitalized in the Infection Clinic of Diyarbakir Children's Hospital, were evaluated retrospectively. Ten patients were male and nine were female, and mean age was 9.3 years. The most common symptoms were fever, malaise and lack of appetite. On admission, clinical and laboratory findings were coated tongue in all cases, abdominal tenderness in four, hepatomegaly in three, nuchal rigidity in two, anemia in 12, leukopenia in four, thrombocytopenia in four, and high levels of transaminases in nine of the cases. Widal test titration was above 1/200 in 15 cases (79%). Antibiogram was applied to all patients; no resistance to antibiotics was determined. All cases were discharged with complete recovery. Given clinical and laboratory findings of enteric fever cases whose cultures were positive within this study, it is implied that multi-drug resistance against Salmonella typhi is an important health problem in Turkey, especially in the southeastern anatolia region.Öğe Hyperekplexia in cases and its differential diagnosis with convulsion: Report of two cases(2005) Yilmaz K.; Tatli B.; Buran Y.; Yaramiş A.; Aydinli N.; Çalişkan M.; Özmen M.Hyperekplexia (HE) is a benign disease characterized by increased startle response to auditory, tactile and visual stimuli. We report two girls with HE. The patients, at 52 and 21 days of age, were referred to our department with the complaint of seizure onset at the first day of life. For the second case, it was stated that seizure had been refractory to treatment and had no evident etiology. Their medical histories were unremarkable. Physical examination revealed that tactile stimuli yielded generalized myoclonus, which sometimes was persistent as tonic spasms. HE was entertained in the view of clinical and laboratory findings. The symptoms almost fully resolved after clonazepam, and the infants' development was normal in the follow-up. These cases emphasize that nonepileptic events should be considered in the differential diagnosis of convulsions. Performing tactile stimuli would be helpful to elucidate HE in patients with spasms that may be considered as convulsion at first sight.Öğe Neonatal tetanus in Southeast Turkey(2006) Yaramiş A.; Katar S.; Nuri Özbek M.; Ecer S.Neonatal tetanus is unfortunately still seen in southeast Turkey. Twenty-four patients with neonatal tetanus who were admitted to our clinic between January 1999 and December 2002 were reviewed retrospectively according to clinical features, prognostic aspects and risk factors. Sixteen of 24 cases were male and their ages were from 2 to 15 days. Fever and lack of sucking reflex were the main complaints the admission. Lack of sucking (100%), trismus (79%), fever (58%), risus sardonicus (29%), omphalitis (33%), and opisthotonus (17%) were the most common presenting signs. Untrained traditional birth attendants delivered all the patients at home, and umbilical cords were cut using non-hygienic instruments. Seventy-five percent of the patients who were admitted died. The most important risk factors were uneducated parents, birth at home, cutting of cords using non-hygienic instruments, failure to give mothers tetanus toxoid immunizations during pregnancy, and poor health and sanitary conditions of the mothers and their babies.Öğe Neonatal tetanus in the southeast of Turkey: Risk factors, and clinical and prognostic aspects: Review of 73 cases, 1990-1999(2000) Yaramiş A.; Taş M.A.Although neonatal tetanus (NT) can be prevented by immunization of expectant mothers and by good hygiene and asepsis during delivery, it is still a common cause of neonatal mortality in developing countries. The objective of this study was to determine indicators in NT. We reviewed the clinical records of 73 neonates admitted to the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, Turkey, with the diagnosis of NT. Delivery had occurred at home by untrained traditional birth attendants in all cases. None of the mothers had immunization with tetanus toxoid during pregnancy. The median age of infants at presentation was 7.3 days and the mean age at onset of symptoms was 5.6 ± 2.8 days. The overall mortality was found to be 52 percent. Mortality was significantly associated with an incubation period of 4.3 days or less and fever. The incidence of NT in Turkey is on the decline due to widespread tetanus toxoid use in pregnant women, but in some regions, especially in the so-called rural poor areas, there is still risk of preventable diseases. Hygienic deliveries and immunization of pregnant women are very important for the prevention of NT deaths, and universal prenatal care, including education programs on appropriate perinatal and cord care, can significantly reduce NT incidence and mortality in developing countries.
