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Drug-induced gingival enlargement is proportional to the inflammation caused by poor oral hygiene. In this case report, gingival enlargement due to the use of the antihypertensive drug amlodipine, which is a Ca channel blocker derivative, is presented. In the anamnesis taken from a 56-year-old female patient who applied to Ankara University Faculty of Dentistry Periodontology Department with complaints of swollen and bleeding gingival enlargements, pain and discomfort when chewing, it was learned that she had been using 10 mg amlodipine (Norvasc®, Pfizer, USA) daily for 6 years due to hypertension. During clinical examination, it was determined that the patient had poor oral hygiene and the presence of gingival growths. In the patient's treatment, the hypertension medication was first changed to an alternative with cardiology consultation. The patient underwent scaling, root planing and oral hygiene training. Growth regression was observed at the patient's 1st, 3rd and 6th month follow-up visits. Following medication change and non-surgical periodontal treatment, at the 1-year followup, the gingival growths had completely regressed, no bleeding was detected on probing, and plaque control was achieved. The patient gained oral hygiene habits and left satisfied. In cases of gingival enlargement due to amlodipine use, drug replacement, scaling, root planing, plaque control, oral hygiene motivation and regular patient follow-up play a key role in the treatment of these diseases. [ABSTRACT FROM AUTHOR]

Objective: Patients with benign prostatic hypertrophy (BPH) are treated with transurethral resection of the prostate (TURP). The passage of irrigation fluid into the systemic circulation can cause hypervolemia, hyponatremia and due to them TURP syndrome with restlessness, confusion, dyspnea, arrhythmia and seizures. The most important point is early diagnosis. Our aim was to reveal the statistical relationship between serum sodium (Na) values and the pleth variability index (PVI) in patients who underwent TURP. Methods: Thirty-three ASA I-III and 40-80 years old patients who underwent TURP under spinal anesthesia were included in the study. The patients were taken to the operating room and standard monitoring was applied. Venous blood samples were taken from the peripheral vascular access before and after the procedure, and Na values were determined; PVI values were recorded at 5-minute intervals from the preoperative period to the postoperative period by performing PVI monitoring. Results: The PVI data correlated with postoperative osmolarity, postoperative Na concentration, resection time and irrigation amount as an early predictor of hypervolemia and seconder hyponatremia. Conclusion: We think that more comprehensive case studies are needed in terms of the usability of PVI, which is a noninvasive method compared to blood gas sampling, an invasive method for the diagnosis of hypervolemia and hyponatremia, and that continuous monitoring and follow-up provide an advantage in early diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Breath-holding spells (BHS) are common paroxysmal events in earlychildhood with unknown pathophysiology. Hypoxia can be the cause or result of BHS and the damage caused by hypoxia is of paramount importance. Therefore, exposure to hypoxia should be minimized in children with BHS. The present study, for the first time in the literature, investigated the staging of palatinetonsil and soft palate hypertrophy in children with BHS and their relationship with BHS. Material and Methods: The retrospective study included 45 children with BHS with no iron deficiency and no complaints of frequent infections and had been followed up for a minimum of one year over between 2012 and 2016. A control group of 45 age-matched subjects. BHS was diagnosed based on patient history, clinical observations, and video records. Duration of spell, spell type, and the staging of palatinetonsil and soft palate hypertrophy were compared among the patients and with the control subjects in terms of age groups and genders. Results: Mean age was 28.9±12.9 (range, 8-56) months in the BHS group. In the same group, the patients had stage 1-2 palatinetonsil hypertrophy (total 81.8%) and stage 2-3 soft palate hypertrophy (78.9%) and a significant difference was found between the BHS and control groups (p=0.000). In patients with cyanotic BHS, tonsillar hypertrophy was grade 2-3 and a positive correlation was found between cyanotic BHS and tonsillar hypertrophy (r: 0.315, p=0.032). Mean duration of spell was 3.5±1.3 minand tonsillar hypertrophy established a stronger correlation with spell duration and soft palatinetonsil hypertrophy (r: 0.459, p=0.000;r: 0.734, p=0.000, respectively). Conclusion: The results indicated that the BHS patients with no iron deficiency and no complaints of frequent infections had greater palatinetonsil hypertrophy and a higher stage of soft palate hypertrophy compared to control subjects. We suggest that the presence of a high-stage soft palate hypertrophy increases the risk of developing BHS and the duration of spell by 1.5 times and thus requires early intervention and clinical follow-up. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the clinical, and laboratory factors that may effect the left ventricular mass index in children with stage predialysis chronic renal disease. Method: Children with predialysis chronic renal disease consisted the study group. The weight, height, renal diagnosis and follow-up duration were retrieved from medical records. Instantaneous and ambulatory blood pressure measurements were performed. Laboratory tests were performed. The left ventricular mass index was calculated based on the echocardiographic measurements. Frequency of hypertension was calculated, and the correlation between the clinical and laboratory parameters and the left ventricular mass index was investigated. Results: Mean left ventricular mass index was 48.8±12.74 g/m2.7, and left ventricular hypertrophy was detected in 16 (76.1%) patients. Hypertension was detected in 5 (23.8%) patients by instantaneous measurements. However, ambulatory measurements showed systolic and diastolic hypertension in 6 (28.6%) and only diastolic hypertension in 2 (9.5%) patients. A positive and significant correlation was detected between left ventricular mass index and relative body mass index, mean night diastolic blood pressure, night diastolic load and cholesterol level (p<0.05). Also a negative significant correlation between albumin and hemoglobin was detected (p<0.05). Conclusion: The results of our study indicate that in predialysis children; ambulatory blood pressure measurement is superior to instantaneous measurements in prediction of left ventricular hypertrophy, and the left ventricular mass index significantly correlates with hemoglobin, cholesterol and albumin levels in addition to blood pressure parameters. [ABSTRACT FROM AUTHOR]

Background: In this study, it was aimed to evaluate the correlation of ultrasonography (USG) parameters (pyloric muscle sizes) with age in term infants diagnosed with infantile hypertrophic pyloric stenosis (IHPS). Materials and Methods: Data of 49 patients diagnosed with IHPS between November 2015 and December 2019 and underwent pyloromyotomy surgery were retrospectively analyzed for this study. The demographic and laboratory data were obtained from the electronic records of the patients. USG parameters such as pyloric muscle thickness (PMT), pyloric diameter (PD), and pyloric muscle length (PML) were measured separately. Term infants were divided into two groups as neonatal (0-28 days) and postneonatal (29-364 days) in order to compare the distribution of USG parameters by age. Infants whose clinical data and USG images were not available together with preterm infants (gestational age <37 weeks) were excluded from the study. Results: Of the 32 patients included in the study, 24 (75%) were male and 8 (25%) were female, and the mean age of the infants was 57.8 days and the median (minimum-maximum) value was 57.5 (9-180) days at the time of admission. In USG examinations, the hypertrophic pyloric muscle was detected in elongated and thick appearance, narrowing the lumen in all patients. There were 15 (46.9%) infants in the neonatal period and 17 (53.1%) in the postneonatal period. In the preoperative measurements, PMT, PD, and PML were high (median value; 4.8, 11.2 and 19.5 mm, respectively). The pyloric measurements of infants in the neonatal and postneonatal period were similar between the two groups, and there was no statistically significant difference (p> 0.05). The correlation between PMT and PML (r = 0.490, p = 0.033) and the correlation between PMT and PD (r = 0.741, p < 0.001) were significant. However, no significant correlation was found between age and pyloric measurements (p> 0.05). When comparing laboratory data, hemoglobin values were significantly lower in infants in the postneonatal period compared to the neonatal group (11±1.5 and 13.7±2.7 g/dL; p < 0.001, respectively). Conclusion: Due to the advantages of USG ionizing radiation used in the diagnosis of IHPS, high sensitivity, and dynamic examination, it is an effective and reliable imaging method that should be preferred first. Although pyloric measurements are valuable for diagnosis, it has been concluded that there is no significant correlation between age and pyloric sizes. [ABSTRACT FROM AUTHOR]

Aim: Upper respiratory tract obstruction can cause cardiac and pulmonary dysfunction in children, which are largely reversible. We assessed the impact of upper respiratory tract obstruction on cardiac function in children scheduled for surgery for adenoidal and/or tonsillar hypertrophy. Methods: In total, 30 patients who were admitted to the ear nose and throat outpatient clinic and were scheduled for surgery for adenoidal and/or tonsillar hypertrophy and 30 control subjects were included into study. Peak nasal inspiratory flow (PNIF) was measured in all subjects, and echocardiographic and electrocardiographic examinations were performed. Results: The mean age of the patients was 9.43±2.51 years. The mean PNIF was significantly lower in patients (110.0 ± 43.9 L/min) than in the control group (140.7±39.4 L/min; p=0.006), and the mean P wave amplitude was significantly higher in patients than in controls (p<0.001). The mean pulmonary ejection time (ET) was significantly shorter in patients than in controls. Conclusion: Lower mean PNIF values in the patient group indicated increased airway resistance, suggesting that PNIF values below 110 L/min may affect right heart function. PNIF can be used by the pediatrician for screening to guide surgeons in children with adenoidal and/or tonsillar hypertrophy. [ABSTRACT FROM AUTHOR]

Objective: The nasal cavity is anatomically and functionally communicates with eyes, paranasal sinuses, nasopharynx, middle ear and lower airways. Therefore, comorbid diseases such as asthma, chronic sinusitis, adenoid hypertrophy allergic conjunctivitis are common in patients with allergic rhinitis. In our study, we aimed to evaluate the frequency of comorbid diseases, clinical features of patients who referred to our outpatient clinic with allergic rhinitis. Method: The study included children aged between 3-17 years who were diagnosed with moderate to severe allergic rhinitis between September 2015 and March 2016 in our pediatric allergy outpatient clinic. Patient files were retrospectively reviewed; comorbid diseases, family history, eosinophil percentage, total IgE level and allergy test results and the number of drugs used were recorded. In the first month of the treatment, visual analog scale was used to score the symptoms. P<0.05 was considered significant in the statistical analysis. Results: A total of 106 patients (33 female, 73 male) with respective median ages of 7.25 and 5.13 years [range: 3.0-17.0, years] were included in the study. In 84.9% of our patients, skin test was positive, and in 69.8% of the patients the symptoms persisted for more than 2 years. The most common comorbid diseases were asthma (52.8%) and adenoid hypertrophy (30.2%). In our study, the incidence of adenoid hypertrophy was higher and total IgE levels were lower in the skin test-negative group (p=0.019, p=0.027). Conclusion: In our study, the most common comorbid diseases in patients with allergic rhinitis were asthma and adenoid hypertrophy, and in the skin test-negative group adenoid hypertrophy was more frequent. [ABSTRACT FROM AUTHOR]

Background: The aim of the study is to analyze the clinical symptoms and histopathologic diagnoses of patients with unilateral sinonasal symptoms who have been operated on in our clinic. Methods: We performed a retrospective review of the medical records of 54 patients with unilateral sinus disease who underwent surgical intervention and had pathological specimens between June 2013 and May 2017. Presenting symptoms, medical histories, and previous treatments were analyzed. Results: Fifty-four patients were diagnosed pathologically by endoscopic sinonasal surgery. In 40 of the patients non-tumoral pathologies were stabbed and in 14 patients tumoral pathology was detected. Of the nontumoral lesions, 29 patients had chronic sinusitis-nasal polyps, 5 patients had isolated inferior turbinate mulberry hypertrophy, 3 patients had rhinolitis, 2 patients had mucocele, and 1 patient had accessory middle turbinate. In tumoral pathologies, 6 patients had hemangiomas, 5 patients had inverted papillomas, 2 patients had osteomas and 1 patient had malignant melanomas. Epistaxis was more frequently detected in tumoral pathologies, while the most frequent cause was nasal obstruction. Conclusion: Although the majority of unilateral sinonasal pathologies are benign lesions, tumoral pathologies are more common than bilateral diseases. An important finding in our study is that inferior turbinate mulberry hypertrophy and nasal hemangiomas are not uncommon and constitute a significant part of unilateral nasal lesions. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this was to compare direct radiography and magnetic resonance imaging in analysis of hemophilic arthropathy. Materials and Methods: The direct radiography and magnetic resonance imaging findings of hemophilic arthropathy were compared in 109 joints of 23 male hemophilia patients. Kappa statistic was used to analyze the agreement between the methods. Results: Magnetic resonance imaging revealed effusion in 17 joints, hemosiderin-hemarthrosis in 48, cartilage loss in 29, osteonecrosis in 30, and detached fragment in 3, while direct radiography was negative. Direct radiography revealed osteoporosis in 16 joints, epiphysial growth in 16, subchondral surface irregularity in 30, narrowing in joint spaces in 28, joint related failure in 2, and joint deformity in 7, while magnetic resonance imaging was negative. Magnetic resonance imaging was negative in 3 joints where direct radiography found erosion. Between direct radiography and magnetic resonance imaging, there was aweak agreement in analysis of erosion, moderate agreement in subchondral cyst analysis, and weak agreement in synovial hypertrophy analysis. Conclusion: Magnetic resonance imaging is obviously superior than direct radiography in evaluating in-joint effusion, hemosiderin-hemarthrosis, synovial hypertrophy, erosion, subchondral cysts, cartilage loss, osteonecrosis and detached fragment of hemophilia patients. The sensitivity of MRI in evaluating synovial hyperthrophy and hemarthrosis makes it preffered imaging modality for the selection of patients who are candidate for prophylactic theraphy and for the decision of synoviectomy. [ABSTRACT FROM AUTHOR]

Objective: Drug therapy recommended for people with Type 1 diabetes is insulin. One of the complications of insulins medication is lipohypertrophy. The aim of this study was to analyze the frequency and risk factors of lipohypertrophy in the children with Type 1 diabetes. Material and Methods: A descriptive cross sectional study design was used. The study was conducted between June-October 2017 in a Diabetes Education and Monitoring Center in a Children's Hospital in Turkey. A descriptive information form was used to collect the data. Ethical approval and permission were obtained from the ethics committee and the institution, respectively. As a result of the study, number, percentage and chi-square analysis were used to evaluate the data. Results: In this study, 61.1% of the patients were found to have lipohipthrophy, and it was determined that lipohipertrophy was mostly found in arms (73.61%), arms were followed by abdominal region, its incidence was 18.5% in the abdominal region. However, it was determined that the duration of diabetes diagnosis, duration of diabetes treatment and field rotation were significant factors which affect the development of lipohipertrophy. Conclusion: In this study, it was determined that the incidence of lipohypertrophy in the children with Type 1 diabetes is substantial, lipohipertrophy was mostly observed in eyes. In addition, in children with Type 1 diabetes, diabet nurses should be careful about the duration of diabetes diagnosis, duration of insulin treatment and field rotation. It is recommended to perform randomized controlled interventional studies on how to prevent the development of lipohypertrophy. [ABSTRACT FROM AUTHOR]

Donohue syndrome (Leprechaunism) is characterized by severe insulin resistance, hyperinsulinemia, postprandial hyperglycemia, preprandial hypoglycemia, intrauterine and postnatal growth retardation, dysmorphic findings, and clinical and laboratory findings of hyperandrogenemia due to homozygous or compound heterozygous inactivating mutations in the insulin receptor gene. A female newborn presented with lack of subcutaneous fat tissue, bilateral simian creases, hypertrichosis, especially on her face, gingival hypertrophy, cliteromegaly, and prominent nipples. Her laboratory tests revealed hyperandrogenism, postprandial hyperglycemia and preprandial hypoglycemia, and very high concurrent insulin levels. She was diagnosed as having Donohue syndrome. Metformin and continuous nasogastric feeding were administrated. During follow-up, relatively good glycemic control was obtained. However, severe hypertrophic obstructive cardiomyopathy and severe malnutrition developed. She died aged 75 days of severe heart failure and pneumonia. Her INSR gene analysis revealed a compound heterozygous mutation. One of these mutations was a p.R813 (c.2437C>T) mutation, which was defined previously and shown also in her father, the other mutation was a novel p.777-790delVAAFPN^SSTSVPT mutation, also shown in her mother. The parents were heterozygous for these mutations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to present cross- sectional cranial imaging findings of cases with Dyke-Davidoff-Masson syndrome (DDMS). Methods: The findings of 16 cases in whom unilateral cerebral hemispheric atrophy was detected at computed tomography and/or magnetic resonance imaging were retrospectively evaluated. The cases consisted of 8 females and 8 males, the ages ranged between 5 and 53 (mean:24). Six of the cases were children and 10 were males. Five of the patients had CT and 13 had MRI scan. The images were retrospectively evaluated and cerebral parenchymal findings and compensatory cranial findings were noted. Results: All cases had unilateral cerebral hemispheric atrophy, ipsilateral cortical sulcal and lateral ventricular dilatation. Together with hemispheric atrophy ipsilateral atrophy of corpus callosum in 6 cases (37.5%), ipsilateral thalamic atrophy in 13 cases (81%), ipsilateral parahippocampal atrophy in 8 cases (50%), ipsilateral cerebral pedincular atrophy in 7 cases (44%) and ipsilateral pontine atrophy in 3 cases (19%) were detected. Gliotic signal changes were observed in 13 cases (81%). Of compensatory findings, unilateral calvarial thickening was focal in 4 cases (25%), and diffuse in 12 cases (75%). There was expansion in ipsilateral half of frontal sinus in 15 cases (94%) and expansion in temporal bone aeration in 5 cases (31%). Conclusion: DDMS is a syndrome presenting with findings of cerebral hemiatrophy and calvarial hypertrophy. Cross-sectional radiological imaging findings may be variable among cases. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine whether each of mitral annular calcification (MAC), left ventricular hypertrophy (LVH) and aortic calcification (AC) contribute to the increased risk of acute ischemic stroke in patients with cryptogenic stroke. Material and Methods: Three hundred and thirty patients with acute ischemic stroke were evaluated with transthoracic echocardiography for MAC, LVH and AC. and these echocardiography findings were analyzed for any correlation with stroke etiology. Results: Three hundred and thirty patients with acute ischemic stroke were classified according to the etiology as cardioembolic (n=83), atherothrombotic (n=48), lacunar (n=49), cryptogenic (n=125), multiple etiological groups (n=25). Twenty (24.1%) patients with cardioembolic, 7 (14.6%) patients with atherotrombotic, 8 (16.3%) patients with lacunar, 20 (16%) patients with cryptogenic, 5 (8.3%) patients with multiple etiological factor had MAC (p>0.05). Sixty-four (77.1%) patients with cardioembolic, 41 (85.4%) patients with atherotrombotic, 41 (83.7%) patients with lacunar, 95 (76%) of patients with cryptogenic, 2 (8%) patients with multiple etiological factors had LVH (p>0.05). Forty-two (50.6%) patients with cardioembolic, 29 (60.4%) of patients with atherothrombotic, 31 (63.3%) of patients with lacunar, 76 (60.8%) patients with cryptogenic, 15 (10.6%) patients with multiple etiological factor had AC (p>0.05). Conclusion: This study shows that there is no association between the presence of mitral annular calcification, left ventricular hypertrophy and aortic calcification with cryptogenic stroke. [ABSTRACT FROM AUTHOR]

Introduction: Costello syndrome is probably an autosomal dominant inherited disorder that is characterized by postnatal growth retardation, developmental delay, coarse facies, loose skin, nonprogressive cardiomyopathy and friendly behavior. The aim of this study was to evaluate a variety of clinical findings and cardiac involvement of six patients diagnosed as Costello syndrome. Materials and Methods: Six cases that had a typical features of Costello syndrome admitted to pediatric cardiology department due to cardiac murmur between 2002-2013 years were evaluated. Their complaints, clinical findings, treatments and clinical courses were examined. Results: Three of the patients were male and the mean age of patients was 34±12 months (7 months to 11 years). All of the cases had coarse faces, deep palmar and plantar creases, hypertelorism, epicanthal folds, depressed nasal bridges and cardiac murmur at auscultation. Congenital heart disease was found in all patients. Five patients had pulmonary stenosis and balloon pulmonary valvuloplasty was performed in 3 of these patients. Atrial septal defect was detected in 3 patients and 1 of the patient had hypertrophic cardiomyopathy. Mental retardation was found in 2 patients. Conclusions: Costello syndrome must be keep in mind in all patients with psychomotor retardation, coarse faces, sparse hairs, deep palmar and plantar creases, phenotypical features resembling a storage disease especially in association with pulmonary stenosis and hypertrophic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Obstructive hypertrophy with adenoid and/or tonsil inflammation is one of the most common problems in pediatric group patients. Especially adenoid tissue, which is a component of Waldeyer's ring, may play an important role in the pathogenesis of otitis media, according to its anatomic position, when inflamed and/or enlarged. Therefore, adenoid surgery is thought to have a role in the management of odds media with effusion. According to the relationship between the adenoid tissue and eustachian tube, it has been accepted that an inflammation that occurs in adenoid tissue can lead to transmission of infection to the middle ear and eventually can cause acute infections in the middle ear .Also hypertrophy of the adenoid tissue can lead to obstruction or dysfunction of eustachian tube, and effusion in the middle ear as a result. If the consisting effusion is not treated, it might cause adhesive otitis media or the other middle ear pathologies, which results with irreversible conductive heating loss. Therefore, the early diagnosis and treatment is important in these patients. The aim of the adenoidectomy in these patients is to remove both chronically infected and the tissue causing the obstruction. Adenoid surgery is inevitable when adenoid tissue leads to complaints of snoring or nasal congestion because of hypertrophy. But, treatment modality in patients who have not shown obstructive symptoms or adenoid hypertropy findings, are still controversial. Also, the additon of adenoideetomy or adenotonsillectomy in the treatment of otitis media with effusion is still debatable. In this respect, different results were reported in the literature. [ABSTRACT FROM AUTHOR]

Aim: To compare the symptomatic and urodynamic aspects of mono-therapies and combination therapies of tolterodine and tamsulosin. Meterial and Methods: Sixty-six patients with lower urina tract symptoms due to benign prostatic hyperplasia were separated into three treatment groups as tolterodine only group, tamsulosin mono-therapy group, and tolterodine+tamsulosin combination therapy group. Demographics of the patients were noted and prostate specific antigen, prostate volumes, and international prostate symptom scores were determined before and-after the.-treatment. Qmax, PdetQmax, cystometric bladder capacities and detrusor hyperactivities, residual urine portions, Abramas-Griffith obstruction scores (Obstlnd) were established. Patients took 2 mg of tolterodine twice a day in first group, 0:4mg of tamsulosine once a day in second group, and equal doses of these medicines were given as combination in third group. All three groups took the medications for six months. International prostate symptom score and pressure-flow studies were repeated after the treatment; and the differences were analyzed both in, and between the groups. Results: There was no statistically significant difference in tolterodine group for residual urine portions, but these values were significantly lowered in tamsulosin group and combination-therapy groups. Qmax, PdetQmax, cystometric capacity, and Abrams-Griffith obstruction scores were similar in tolterodine and tamsulosin monotherapy groups, whereas significant improvements were achieved in combination therapy group. Tamsulosin group had similar international prostate symptom score -total, international prostate symptom score-obstructive, Vr, PdetQmax and Obstlnd values with combination therapy group. Moreover, combination therapy group was significantly more efficient in international prostate symptom score irritative sub-score and nocturia frequency. Conclusions: We concleded that patients who have overactive bladder symptoms and lower urinary, tract symptoms due to benign prostatic hyperplasia, and who do not benefit from alpha-blockers will benefit from combined treatment. [ABSTRACT FROM AUTHOR]

Myopathy and pseudohypertrophy of muscles accompanied by acquired or congenital hypothyroidism is called Kocher-Debre-Semelaigne syndrome. Kocher-Debre-Seimelaigne syndrome is a rare disorder which is often presented by symmetrical proximal muscle weakness, accompanied by polymyositis, pseudohypertrophy in muscles, muscle rigidity, involuntary muscle contractions, exercise intolerance, myxedema, failure to thrive and neuromuscular findings like cretinism. In thus case report, we present a 5-year-old girl with delayed diagnosis of hypothyroidism and poor compliance to treatment. We suspected Kocher-Debre-Semelaigne syndrome when she developed difficulty in climbing stairs and walking. She had bilateral pseudohypertrophy of gastrocnemius and quadriceps muscles of the lower extremities, elevation in serum creating kinase levels and physical examination findings relevant with myopathy as hypoactive deep tendon reflexes. It was emphasized that this syndrome should not to be overlooked in cases with pseudohypertrophy due to hypothyroidism. [ABSTRACT FROM AUTHOR]

Objective: Respiratory disorders related to sleeping problems are examined in a wide spectrum ranging from simple snoring to obstructive sleep apnea syndrome. Hypertension and the risk for cardiovascular morbidity because of obstructive sleep apnea syndrome have been demonstrated in many previous studies. But, there are limited number of studies demonstrating the influential blood pressure changes during the rime interval from primary snoring to obstructive sleep apnea syndrome. Methods: Twenty children who had no obstructive sleep apnea symptoms with tonsillar hypert- rophy (grade 3-4) and twenty children as control subjects (range: 6-13 years) were included in this study. Healthy children consisting of equal number of boys and girls who were in the same age group with the patient group with no complaints were chosen as a control group. All partici- pants were evaluated by twenty 24-ambulatory blood pressure monitorization, and the data obtained were compared. Results: There was no significant difference between the groups as for average blood pressure measurements obtained during the whole day, daytime and at night Still blood pressure load, blood pressure index and blood pressure variability of both groups did not differ statistically significantly. The number of non-dippers in the patient group was greater than the those in the control group. Although intergroup difference did not reach a statistical significance. Conclusion: This study showed that cardiovascular complications like systemic hypertension did not become manifest in children with tonsillar hypertrophy but without any sign of clinical obs- tructive sleep apnea. Higher number of non-dippers in the patient group, reveal the requirement for larger population-based studies. [ABSTRACT FROM AUTHOR]

Asthma is a chronic lung disorder marked by recurring episodes of airway obstruction accompanied especially by wheezing and coughing and by a sense of constriction in the chest, and triggered by hyperreactivity to various stimuli. Its pathophysiology involves mucus hypersecretion, bronchial hyperresponsiveness, smooth muscle hypertrophy and airway obstruction. Current therapeutic modalities of asthma have not been proved to be successful in reversing the already established chronic changes in airways. Ultimately, an important part of the treatment will aim at immunomodulation and preventing the chronic irreversible changes in asthma. For this reason interventions including dietary changes before the sensitization and remodelling period would be beneficial in terms of preventing those changes. Very long chain fatty acids are the substrates for cyclooxygenase and lipoxygenase and give rise to mediators that often have different biological actions or potencies than those formed from arachidonic acid. This paper provides a short synopsis of the immunological pathology of asthma and discusses potential targets for omega-3 fatty acids. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is a complex and relatively common genetic cardiac disorder with heterogeneous clinical course and expression. We reported a case with implantable cardioverter defibrillator implantation in a patient with nonobstructive hypertrophic cardiomyopathy associated A-V complete block presenting with syncope after football hit to the chest. [ABSTRACT FROM AUTHOR]

Aim: In our study we compared the structure and functions of the heart between predialysis and hemodialysis patients and investigated the related factors. Methods: This study included a total of 105 patients (mean age: 18-75 years): 51 on continuous hemodialysis and 54 predialysis subjects followed by the Nephrology Clinic and not yet involved in dialysis program. Laboratory data showing calcium-phosphorus metabolism disorders and transthoracic echocardiography results were evaluated. Results: Serum parathormone, phosphorus, calcium x phosphorus, alkaline phosphatase levels were significantly higher in the dialysis group compared to the predialysis group (p<0.001). No statistical difference was found between the groups with regard to median values of ejection fraction, mean values of left ventricular hypertrophy index and frequencies of diastolic dysfunction, and valve calcifications. Conclusion: Since predialysis group had higher smoking rate (29.6%), low-density lipoprotein cholesterol levels [122 (100-148) mg/dL] and body mass index (27.6±3.8 kg/m2) and had been receiving systemic drugs in different ratios, the two groups were not similar regarding the traditional risk factors; thus, this may be the explanation for finding no statistical difference in echocardiographic parameters. Besides investigating all the factors involved in the pathogenesis of disease, echocardiographic evaluation should be done periodically in both predialysis and dialysis patients. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the degree of change in left ventricular mass index (LVMI) regression after aortic valve replacement (AVR) using three different valves. Methods: Group 1 (n=17) included patients with bioprosthesis (Medtronic Hancock 2), Group 2 (n=21) included patients with mono-leaflet mechanical valve (Medtronic Hall), and Group 3 (n=17) included patients with bi-leaflet mechanical valve (St Jude). The mean ages of Group 1, 2 and 3 patients were 70.8±9.1, 61.6±13.7 and 56.2±18.3 years, respectively. In this observational study, patients were followed-up after surgery and left ventricular wall thickness and valvular functions were evaluated with echocardiography. The findings were compared with preoperative values. Statistical analyses were performed using one-way variance analysis (ANOVA), Kruskal Wallis, and Chi-square tests. Results: Statistically significant difference was observed among the three groups with respect to age (p=0.015). LVMI regressed in all groups; Group 1 from 232.74±53.36 g/m2 (preoperative) to 174.64±46.33 g/m2 (postoperative) (p=0.0001), Group 2-from 198.49±40.53 g/m2 to 167.04±33.9 g/m2 (p=0.0001), and Group 3-228.77±47.87 g/m2 to 185.44±37.76 g/m2 (p=0.0001). No statistically significant difference was observed among the groups with respect to LVMI regression (p=0.054, p=0.363). Conclusion: Mid-term results of AVR with three different aortic valve prosthesis revealed that all groups showed a similar regression of left ventricular mass. However, we advocate that long-term results of an increased number of patients should be evaluated for assessment in depth. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine prevalence of snoring in children younger than 18 years of age and to identify associated risk factors and complications in a population based study. Material and Method: This cross sectional study was conducted in Manisa, Turkey. Questionnaires about snoring and associated risk factors were applied to 650 children who were determined using cluster sampling method (339 females, 311 males). Results: Prevalence of habitual snoring was 4.9%. Current history of wheezing or allergic rhinitis increased the odds of habitual snoring 3.1 times when compared to children without current wheezing (p=0.006; OR: 3.11, 95%CI: 1.3-7.3 and p=0.002; OR: 3.11, 95%CI: 1.5-6.6 respectively). Grade 3 tonsil hypertrophy increased odds of habitual snoring 22.5 times compared to no tonsil hypertrophy (p<0.001; OR: 22.4, 95%CI: 6.0-83.9). Nighttime symptoms like apnea were more frequent in habitual snorers when compared to non-snorers (28.1% vs 3.6%; p<0.001; OR: 10.5, 95%CI: 4.3-25.6). Conclusions: Current wheezing, allergic rhinitis and tonsil hypertrophy are significant risk factors for habitual snoring. Therefore, children with these disorders need to be assessed for snoring that may influence their development. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is a progressive disease marked by increased pulmonary artery resistance leading to right heart failure with a high mortality. PAH is histologically characterized by endothelial and smooth muscle cell proliferation, medial hypertrophy, inflammation, and thrombosis in situ. Elevated pulmonary vascular resistance is the result of an imbalance between locally produced vasodilators and vasoconstrictors, in addition to vascular wall remodeling. Recent evidence demonstrates that inflammatory processes are involved in the generation of pulmonary vascular remodeling leading to PAH. Viral infections or similar immune-modulators trigger auto-antibody generation by endothelial injury and indirectly lead to PAH. All these immune-modulators associated with PAH, are also known to decrease the regulatory subgroups (CD4) of T cells. With a recognition of important role of inflammation in the development of PAH, anti-inflammatory agents and anti-cancer drugs are accepted as potential specific targets for PAH treatment. Though clinical studies are not enough, anti-inflammatory agents seem to be promising in the treatment of this devastating disease. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of Intraoperative floppy iris syndrome (IFIS) in phacoemulsification surgery in our department, to evaluate the clinical properties and the surgical interventions in these cases. Materials and Methods: In this prospective study, 1567 eyes of 1530 patients who underwent phacoemulsification surgery and intraocular lens implantation between March 2006-November 2007 were evaluated. Patients were grouped as recent tamsulosin users (Group 1), previous tamsulosin users (Group 2), users of other a1-antagonists (Group 3), patients never used any kind of a1-antagonists (Group 4). Results: IFIS was examined in 25 eyes of 25 patients. Incidence of IFIS was found as 1.6% (25/1530) . IFIS was seen in 80% of patients in Group 1, 60% of Group 2, 1.18% of Group 4. All 6 patients in Group 3 had uneventful cataract surgery and IFIS was not seen in any. Incidence of IFIS in both recent and previous tamsulosin users were significantly higher compared to non tamsulosin users (p<0.001). There was no significant difference in IFIS incidence when tamsulosin was recently or previously used (p=1.000). Surgery was completed without any complications in 72% of eyes with IFIS. Discussion: Every patient undergoing cataract extraction should be questioned about benign prostate hypertrophy medications- especially tamsulosin, and IFIS propability should be considered in cases with poor preoperative mydriasis. Necessary preventions should be taken before the surgery in these cases and more experienced surgeons should complete the surgery when necessary. [ABSTRACT FROM AUTHOR]

The renin-angiotensin system (RAS) can play an important role as the underlying mechanism for the development and recurrence of atrial fibrillation (AF). In addition, AF itself can lead to atrial structural and/or electrophysiologic remodeling by activating the RAS. This remodeling serves as an arrhythmogenic substrate for AF. Thus, the inhibition of RAS with angiotensin converting-enzyme inhibitor or angiotensin receptor blockers may be a strategy to prevent occurrence and recurrence of AF in certain patients such as those with heart failure and hypertension in associated with left ventricular hypertrophy. In addition, it may facilitate the cardioversion of AF. In this review, we overview the effect of RAS blockers on cardioversion success and recurrence of AF. [ABSTRACT FROM AUTHOR]

A 23 year old woman was admitted to Dr. Lutfi Kirdar Kartal Training and Research Hospital 1.st Eye Clinic at April 2007 because of decreasing in visual acuity in her both eyes. The uncorrected visual acuity was 0.7 and corrected visual acuity was 1.0 in both eyes. During the patient's visual consultation, it was realized that theuncorrected visual acuity was 0.7 and corrected visual acuity was 1.0 in both eyes. The routine biomicroscopic evaluation revealed that anterior segment was normal but fundus examination pounted out that pigmented, well demarcated, oval lesions like pigment epithelium hypertrophy in both periphery of the retina. As it was tought that this lesions may associate with sistemic disorders, the patient was interrogated. It was learned that she had diarrhea and stomach ache for 6 months but it was unidentified. Owing to this reason the patient was consultated with internal medicine. When colonoscopy was performed, multipl polyps in the colon were demonstrated. The biopsy was taken and adenocarsinoma developed from the basement of polyposis coli was documented. Liver metastasis was identified with computarized tomography. The patients was thought to be familial adenomatous polyposis and family cross-hatching was made. Both of two brothers were diagnosed with polyposis coli and fundus examination showed the same pigmented oval lesions. The total colectomy was performed to all of the tree patients who were followed by general surgery. During the routine ophthalmologic examination, even if the visual acuity of the patient is good, the ophthalmologic examination is being made carefully, in fact the findings seeming to be not important may be helpful for early identification of serious ophthalmologic or systemic diseases. [ABSTRACT FROM AUTHOR]

Long standing hypothyroidism without therapy leads to myopathy which is associated with proximal muscle weakness, fatigue, exertional pain, pseudohypertrophy due to myoedema, diminished deep tendon reflexes, and stiffness in muscles. Kocher-Debre-Semelaigne syndrome is a specific, rare form of hypothyroid myopathy, which causes hypertrophy of muscles. In this article, we emphasized hypothyroid myopathy by reporting a-13 4/12-year old girl with short stature who was diagnosed with hypothyroidism due to thyroid aplasia that caused pseudohypertrophy of muscles. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy, is unexplained reasons and characterized with left ventricular hypertrophy, is an inherited chronic disease of the heart muscle. Hypertrophic cardiomyopathy is seen rarely but it is very important because of genetic transmission and high risk of sudden cardiac death. Echocardiography is basic application for diagnosis left ventricular hypertrophy. We defined a rare case in literature which has massive left ventricular hypertrophy. [ABSTRACT FROM AUTHOR]

Objective: The development and growing up of organism was regulated by hormones and factors effective in growth along axis of hypothalamus- hypophysis. In this study, effects of IGFs were aimed to investigate on bone and muscle metabolism and its regulation and response to exercise. Main Findings: Insulin-like growth factors (IGFs) is synthesized by liver and many of tissue are effective in somatic growth. IGFs have two important forms as IGF-I and IGF-II. IGF-II is effective on intrauterine growth, whereas IGF-I is more effective on postnatal growth. IGFs binding proteins were transported to target organs. Six binding proteins have been defined (IGF 1-6). The binding proteins have three different receptor in cell membrane, insulin receptor; Type-I receptor and Type-II receptor. IGFs affected via autocrine and paracrine mechanisms on bone and muscle. Conclusion: The effect of IGF on muscle tissue increase with mechanic stress (resistance exercise). Owing to this condition, exercise plays an effective role on preventing muscle atrophy. [ABSTRACT FROM AUTHOR]

Objective: Previous studies showed relation between elevated serum leptin levels (SLL) and hypertension. The aim of this study was to evaluate relationship between SLL and left ventricular hypertrophy (LVH) and body mass index (BMI) in obese hypertensive patients. Methods: Eighty patients with newly diagnosed essential hypertension were included in this cross-sectional, case-controlled study. Hypertensive patients were classified as; level-I or level-II according to JNC-VII classification and as normal weighted (18-24.99 kg/m²), over weighted (25-26.99 kg/m²) and obese (27 kg/m² and above) according to BMI's. All the patients were evaluated by echocardiography and blood samples were withdrawn for determination SLL. Statistical analysis was performed using Wilcoxon sign rank, Mann Whitney U and Kruskal Wallis tests. Logistic regression analysis was applied for the evaluation of relationship between SLL and clinical variables. Results: Mean levels of arterial blood pressure (ABP) of total 80 patients (36 males and 44 females) was 155±1.1/95.1±0.7 mmHg and the mean age was 48.9±1.3 years. Patients with level I hypertension (n=32) had mean ABP of 149.7±0.5/90.9±0.6 mmHg and with level-II hypertension (n=48) - mean ABP 168.5±1.6/102.9±0.9 mmHg. The mean BMI in normal weighted group (n=26) was 22.7±0.3 kg/m², over weighted group (n=19)-26.1±0.2 kg/m² and obese group (n=35)-30.9±0.5 kg/m². There were no differences in LVH incidence between hypertension level groups and BMI groups (p>0.05). Serum leptin levels were similar in patients with level I and level II hypertension (33.5±2.9 ng/ml and 37.3±3.6ng/ml, respectively, p>0.05). However, leptin levels were higher in obese patients as compared with normal and over weighted patients (40.9±3.2 ng/ml versus 28.5±3.6 ng/ml and 32.8 ± 4.9 ng/ml, p<0.01). Patients with LVH had significantly higher levels of leptin as compared with patients without LVH (51.40±5.1 ng/ml versus 28.30±4.20 ng/ml, p<0.05). Logistic regression analysis demonstrated that SLL independently of blood pressure and BMI is related with LVH (OR - 1.7, %95 CI - 1.2-1.9, p<0.05). Conclusion: Our study showed that elevated serum leptin levels are significantly related with LVH independently of body mass index and level of blood pressure. Thus, elevated SLLs, independently of hypertension level and BMI classification, coexist with LVH. Sympathetic activation or direct cardiac receptor activation or proliferative effects of leptin may be responsible for this coexistence. [ABSTRACT FROM AUTHOR]

Objective: Characteristics of legal autopsy cases with cardiac rupture following myocardial infarction are investigated in this retrospective observational study and the results are compared with a control group consisting of acute myocardial infarction cases without rupture. Methods: Legal autopsy reports of 50 cases with heart tamponade resulting from heart muscle rupture following myocardial infarction, autopsied at the Morgue Department of the Council of Forensic Medicine between the years 1998-2005 were retrospectively reviewed. Findings were compared to control group consisting of 30 myocardial infarction cases without rupture. Results: The rupture was located in the left ventricle in 48 of 50 cases. At microscopic examination, infarction date was consistent with first three days, 4-7 days and 1-2 weeks for 30, 12 and 8 cases, respectively. The average volume of fluid leading to tamponade was 467 ml in males and 352.3 ml in females. There were no statistical differences between rupture and control groups for existence of hypertrophy and scar tissue in myocardium and advanced atheromatous lesions in coronaries (p>0.05). Considering the manner of death of the cases died due to heart wall rupture and tamponade formation, 28 of the cases were found dead at home, 6 died suddenly by falling to the ground at home or on the street, and 5 were delivered dead to the hospital. Conclusion: The rupture was located in the left ventricle in almost all cases. Ruptures in the left ventricle were found most frequently in the anterior wall. There was no relationship between development of rupture and existence of hypertrophy and scar tissue in myocardium, and advanced atheromatous lesions in coronaries. [ABSTRACT FROM AUTHOR]

The main reasons for traditional right ventricle apical pacing were first, the ease of implantation and second, the stability of passive-fixation leads in the apical trabeculae. However, apart from some specific diseases like hypertrophic cardiomyopathy, apical pacing often results in substantial functional, hemodynamic, electrical, and structural changes as previously demonstrated in many studies. Only in recent years, interest in the use of alternate pacing sites has developed. Right ventricular outflow tract is the preferred site of pacing because of its potential advantages such as ease of application, better hemodynamics, synchronous activation, less myocardial perfusion defects than apical pacing. The present review article comprehensively discusses this novel technique in terms of its beneficial effects compared to apical pacing and as an alternative method for biventricular pacing. [ABSTRACT FROM AUTHOR]

• Aims: Leptin, which is a hormone secreted by adipose tissue, has many effects on the sympathetic nervous system and other systems. It is well-known that hypertension is associated with high leptin levels. The aim of this study was to determine whether there is any effect of leptin on the development of left ventricular hypertrophy(LVH) in hypertensive patients. • Material and methods: Forty hypertensive patients were enrolled to the study. The study population was divided into two groups according to LVH determined by echocardiography. Group 1 was consisted of 27 hypertensive patients with LVH(m/f: 9/18, the mean age:59.1±7.2yrs) while group 2 was composed of 13 hypertensive patients without LVH (m/f: 5/8,the mean age:62.4±4.9yrs). The blood samples was taken at fasting state and serums were kept at -80°C until examined. Plasma leptin levels were determined by ELISA. The clinical and echocardiographic parameters and the mean plasma leptin levels were compared to each other. • Results: We did not find any statistical significance between groups in terms of the treatment, the duration of hypertension and body mass index. The mean plasma leptin levels was 33.3±15.3 ng/ml in the group 1 whereas this was 28.3±17.6 ngr/ml in the group 2. There was not any statistical difference between them (p>0.05). • Conclusion: The plasma leptin levels in hypertensive patients with LVH was not different from that in hypertensive patients without LVH. It may be concluded that there is not any effect of leptin on the development of LVH in hypertension. [ABSTRACT FROM AUTHOR]

Virginal breast hypertrophy is a rare benign disease. It is characterized by rapid and excessive growth of one or two breasts during peripubertal period. There is no specific treatment algorithm, subcutaneous mastectomy and prosthesis replacement, reduction mammoplasty, medical treatment with particularly tamoxifen are all recommended in the literature. Unfortunately, all treatment methods have some disadvantages in this patient group who have not completed their sexual and physical maturation. Although these treatments are usually required, it should be noted that spontaneous remission could rarely be seen in virginal hypertrophy. We aimed to present a case of virginal hypertrophy, in whom symptomatic treatment has been used and breast growth regressed spontaneously. [ABSTRACT FROM AUTHOR]

Tetralogy of Fallot (FT) is the most common cyanotic congenital heart disease. FT is mainly composed of ventricular septal defect, right ventricular outflow tract obstruction, pulmonary stenosis and right ventricular hypertrophy, but also can include dextrapositioned aorta (overriding aorta), additional malformations such as atrial septal defect, and coronary artery anomalies. In the first week of life patients undergo palliative anastamosis between a pulmonary artery and subclavian artery and after they become eligible for major surgery total correction isperformed. With neurological involvement ischemic or venous stroke, syncope and seizures can occur. Generally, clinical presentation is cerebral venous thrombosis. IÝschemic stroke in children is associated with hyperviscosity and microstasis, and in adults with phlebotomy, microcytosis and traditional stroke risc factors such as hypertension, diabetes mellitus and cardiac rhythm disorders. Patients with uncorrected FT rarely survive adulthood. In this study, we present a case without total correction, who lived up to the age of 39 years and presented with arterial stroke instead of expected venous thrombosis, along with stroke mechanisms in the literature. [ABSTRACT FROM AUTHOR]

Breast massages applied to the newborns who have physiologic breast hypertrophy disrupt dermal integrity, facilitate dissemination of microorganisms and lead to manifestations of neonatal mastitis. Herein, a newborn case with the diagnosis of neonatal mastitis was presented to attract attention to the development of neonatal mastitis by bacteremia with serious complications and mortality risk which can also lead to breast tissue atrophy and cosmetic problems in advanced ages, if early diagnosis and therapy can not be accomplished. [ABSTRACT FROM AUTHOR]

B-cell prolymphocytic leukemia (B-PLL) comprises 1% of chronic lymphocytic leukemias. CD5 positivity is seen in 1/3rd of cases which generally arise from pre existing CLL. They have longer median survival compared with de novo B-PLL which are commonly CD5 negative and are more aggressive with an older age of presentation. Herewith, we describe a 48-year-old male of de-novo CD5+ B-PLL presenting with minimal lymphadenopathy and massive splenomegaly with 90% atypical lymphoid cells in the peripheral smear and bone marrow. Immunophenotyping was strongly positive for CD5, CD45, CD19, CD22, FMC-7, S-Ig and CD38, moderately positive for CD 11c, weakly positive for CD23 and negative for CD-103 and ZAP 70. The patient responded well to fludarabine and cyclophosphamide and had an uneventful hospital course. Our case illustrates a de-novo B-PLL with aberrant CD5 positivity who had a short duration of illness, younger age at presentation and favourable treatment outcome. [ABSTRACT FROM AUTHOR]