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End-stage renal disease (ESRD) is a devastating disease associated with cardiovascular morbidity. The prevalence of pericardial syndromes associated with ESRD is increasing because the survival of chronic renal failure (CRF) patients is prolonged. Pericardial involvement in ESRD is seen commonly as acute uremic or dialysis pericarditis and infrequently as chronic constrictive pericarditis (CCP). Here, we report on a 17-year-old male patient who started hemodialysis after kidney graft loss and did not comply with the treatment, and presented with recurrent chest pain, dyspnea, and hypotension. Sequential hemodialysis treatment was given to the patient, who had recurrent pericardial effusion. Despite frequent hemodialysis treatment, the patient’s response to treatment was not adequate. After diagnosis with CCP, total pericardiectomy was performed for definitive treatment. A literature review revealed end-stage kidney disease appears to be a relatively rare cause of CCP. Only a few other cases have been reported so far, mostly in adulthood. This case highlights that CRF patients presenting with symptoms of right heart failure should be investigated for constrictive pericarditis with clinical evaluations and examinations., Son dönem böbrek yetersizliği (SDBY), kardiyovasküler morbidite ile yakından ilişkili yıkıcı bir hastalıktır. Kronik böbrek yetersizliği (KBY) tanılı hastalarının sağ kalım süresi arttığından, KBY ilişkili perikardiyal sendromların prevalansı artmaktadır. SDBY hastalarının perikardiyal tutulumu, yaygın olarak akut üremik perikardit veya diyaliz ilişkili perikardit ve seyrek olarak kronik konstriktif perikardit (KKP) olarak görülür. Bu olguda, böbrek greft kaybı sonrası hemodiyaliz tedavisi başlanan ve tedaviye uyum sağlamayan 17 yaşında erkek hastanın, göğüs ağrısı, nefes darlığı ile tarafımıza tekrarlayan başvuruları olan ve KKP tanısı alan olgu sunuldu. Tekrarlayan perikardiyal efüzyonu olan hastaya, yoğunlaştırılmış hemodiyaliz tedavisi uygulandı. Yoğunlaştırılmış diyaliz tedavisine yanıtı yeterli olmayan hastaya, KKP tanısı konuldu, total perikardiyektomi yapıldı. SDBY, KKP’nin nadir bir nedenidir, literatürde bildirilen vakaların çoğu yetişkin hastalarda tanımlanmış olup, pediatrik yaş grubunda çok nadirdir. Bu olgu, sağ kalp yetersizliği semptomları ile başvuran KBY hastalarının klinik değerlendirmesinde konstriktif perikardit açısından araştırılması gerektiğini vurgulamaktadır.

Amaç: Tam düzeltme ameliyatı yapılmış Fallot tetralojili hastalarımızın klinik durumlarının değerlendirilmesi, ritim bozukluklarının araştırılması, ekokardiyografi ile ventrikül fonksiyonlarının ve aort kökü dilatasyonunun değerlendirilmesidir.Gereç ve Yöntemler: İstanbul Üniversitesi, İstanbul Tıp Fakültesi Çocuk Kardiyoloji bölümünde izlenen, düzeltme operasyonu uygulanmış Fallot tetralojili 50 çocuk çalışmaya dahil edildi. Düzeltilmiş Fallot tetralojili olgular aort kökü dilate olanlar ve dilate olmayanlar diye iki guruba ayrıldı. Her iki gurup arasında cinsiyet, tam düzeltme operasyonu yaşı, aort yetersizliği, triküspit yetersizliği, pulmoner yetersizlik, palyatif tedavi ve transanüler yama kullanımı açısından farklar değerlendirildi. Pulmoner kapak yetmezliği, tam düzeltme ameliyatı sırasında uygulanan transanüler yama yapılanlar ve yapılmayanlar olarak karşılaştırıldı.Düzeltilmiş Fallot tetralojili olguların ekokardiyografik olarak ölçülen aort kökü ve asendan aort çapları yaş, cinsiyet ve vücut yüzey alanlarına göre normal dağılımları ile değerlendirildi. Bulgular: Çalışmaya 24 Ocak-15 Mayıs 2014 tarihleri arasında 50 olgu alındı. Çalışmaya katılan olguların yaşları 2-21 yıl arasında değişmekte olup, ortalama 9.9 ±4.5 yıldır. Çalışmaya katılanların %52’si (n=26) erkek, %48’i (n=24) kızdır. Olguların total düzeltme yaşları 6 (0.5 yıl) ile 190 (15.8 yıl) ay arasında değişmekte olup, ortalama 28.3 ± 28.3 (2.3 ± 2.3 yıl) aydır. Postoperatif süreleri 1.3-17.8 yıl arasında değişmekte olup, ortalama 8.0 ± 4.1 yıldır. Olguların %28’ine (n=14) palyatif tedavi uygulanmıştır. Olguların aort kök ölçümleri 18.0 ile 42.5 mm arasında değişmekte olup, ortalama 27.9 ±5.3 mm’dir. Olguların %12’sinin (n=6) aort kökü dilatasyonu yok iken, %88’inin (n=44) aort kökü dilatasyonu vardır. Olguların tamamında (%100) sağ ventrikül dilatasyonu ve asendan aort dilatasyonu vardır. Transanüler yama uygulananlarda, orta ve ağır pulmoner yetmezlik daha az saptandı (p: 0.02). Sonuç: Olguların %88’inde (n: 44) aort kökü dilatasyonu saptandı. Yıllık aort kökü çapı ölçümlerinin verilmesi, Fallot tetralojili hastalarda ilerleyici aort kökü dilatasyonunun tedavisinde daha etkili bir stratejisinin planlanmasına yardımcı olacaktır., Objective: This study aims to evaluate clinic situations, investigate arrhythmias, and assess ventricle function by echocardiography and aortic root dilation of patients with Tetralogy of Fallot who had undergone total correction surgery. Material and Methods: 50 children with Tetralogy of Fallot and who had undergone a total correction operation in I.U. Faculty of Medicine Pediatric Cardiology Department were included to study. Corrected Tetralogy of Fallot cases were divided into two main groups as “aortic root dilated group” and “aortic root not-dilated group”. Groups were evaluated as to their gender, age of correction surgery, presence of aortic failure, tricuspid failure, pulmonary failure, aorta pulmonary shunt treatment and usage of transannular patch. Pulmonary valve failure was compared as those with and without transannular patches applied during the total correction surgery. Echocardiographically measured aortic root and ascending aorta diameters were assessed according to age, gender, and body surface area of the corrected Fallot Tetralogy cases.Results: 50 subjects were involved to study in date between 24th Jan. 2014 and 15th May 2014. Age of the cases in study varied between 2 and 21 years and average age was 9.9 ± 4.5 years. 52% (n=26) of them are male and 48% are female (n=24). Total correction age was varied between 6 months (0.5 years) and 190 months (15.8 years) and average age was 28.3±28.3 months (2.3 ±2.3 years). Their postoperative periods were varied between 1.3 and 17.8 years and average period was 8.0±4.1 years. 28% (n=14) of the cases were received palliative treatment. Aortic root size was varied between 18 and 42.5 and average size was measured as 27.9±5.3 mm. Aortic root dilation ratio of the cases was 88% (n=44) while 12% of cases (n=6) had no aort root dilatation. All patients had right ventricle and ascending aorta dilation. Moderate and severe pulmonary failure was found less in those who underwent transannular patch.Conclusion: Aortic root dilation was detected in 88% (n=44) of the cases. Providing annual aortic root diameter measurements will help to plan a more effective strategy for the treatment of progressive aortic root dilatation in patients with Fallot tetralogy.

Pediatrik tromboz epidemiyolojisi, patofizyolojisi ve tedavi öncelikleri nedeniyle erişkin tromboz yönetiminden çok farklı özelliklere sahiptir. Tromboz teşhisi konan çocuklar, multidisipliner bir ekip tarafından tanı, tedavi ve takip süresince değerlendirilmelidir. Burada pediatrik tromboz hastalarımızın yönetildiği 2 yıllık multidisipliner tromboz konseyi deneyimimizi sunuyoruz. Kasım 2017-Ağustos 2019 tarihleri arasında 61 çocuk (95 başvuru) için tromboz konseyi olgu sunumlarını ve konsey sonuçlarını geriye dönük olarak inceledik. Değerlendirilen hastalarda erkek/kadın oranı 1,54 saptandı, çocuklar ve adolesanlar çoğunluktaydı. Hastaların klinik ve radyolojik durumlarına göre tedavi ve profilaksi süreleri belirlendi. Olgularımız içinde serebral arteriyel ve sinovenöz tromboz olguları daha fazla idi. Kazanılmış risk faktörleri, kalıtsal olanlardan daha fazla olup, infeksiyon ve Faktör VIII yüksekliği sık idi. Otuz dokuz hastaya (%64) farklı süreler boyunca K vitamini antagonistleri, aspirin veya LMVH ile primer veya sekonder profilaksi uygulandı. Pediatrik trombozda kanıta dayalı kılavuzların iyileştirilmesi için tedavi ve profilaksi yönetimi üzerine daha fazla çalışmaya ihtiyaç vardır. Multidisipliner tromboz konseyi komplike pediatrik trombozlu çocuk hastalarda hasta bakımını iyileştirebilir., Pediatric thrombosis has unique characteristics due to its epidemiology, pathophysiology and treatment considerations. Children diagnosed with thrombosis should be evaluated by a multidisciplinary team at the level of diagnosis, treatment, and follow-up. Here we present our 2 years experience of pediatric thrombosis patients with a multidisciplinary thrombosis council management. We retrospectively reviewed case presentations and recommendations of monthly thrombosis council for 61 children (95 admissions) between November 2017 and August 2019. The male/female ratio was 1.54 and children and adolescents were the majority of evaluated 61 patients. Based on patients' clinical and radiological status, treatment and prophylaxis periods were determined. Cerebral arterial and sinovenous thrombosis were more common in our pediatric thrombosis council cases. Acquired risk factors for thrombosis were more common than congenital thrombophilia. Infection and elevated Factor VIII were commonest, respectively. Thirty-nine patients (64%) received primary or secondary prophylaxis with vitamin K antagonists, aspirin or LMVH for different periods. Further studies on treatment and prophylaxis management are needed for the improvement of evidence-based guidelines in pediatric thrombosis. Multidisciplinary councils may improve patient care for pediatric patients with complicated thrombosis.

Pallister-Killian syndrome is a rare genetic disorder characterized by craniofacial dysmorphism, growth retardation, mental retardation, hypotonia, seizures, vision and hearing disorders, congenital malformations and congenital heart disease. Ventricular septal defect and atrial septal defect are the most common cardiac malformations. Arrhythmias have been reported rarely in these patients. In this case report, recurrent ventricular tachycardia episodes were reported an eleven years old patient with Pallister-Killian syndrome and wanted to emphasize that patients with Pallister Killian syndrome should be screened for the arrhythmia., Pallister-Killian sendromu, kraniyofasiyal dismorfizim, gelişme geriliği, zeka geriliği, hipotoni, nöbetler, görme ve işitme bozuklukları, doğumsal malformasyonlar ve doğumsal kalp hastalıkları ile birliktelik gösteren nadir bir genetik hastalıktır. Ventriküler septal defekt ve atriyal septal defekt en sık görülen kardiyak malformasyonlardır. Aritmiler, bu hastalarda nadiren bildirilmiştir. Bu olgu sunumunda tekrarlayan ventriküler taşikardi ataklarının eşlik ettiği onbir yaşında Pallister-Killian sendromlu bir hasta sunuldu ve Pallister-Killian sendromlu hastaların aritmi açısından da taranması gerektiği vurgulanmak istendi.

Objective: The aim of this study was to evaluate ventricular performance before and after exercise in children who had surgically repaired coarctation of aorta (CoA) by using two dimensional, M- mode and Doppler echocardiography and to determine whether this method can be used for identifying recoarctation in comparison to Magnetic Resonance Imaging (MRI). Design: We studied on 24 patients who were operated for CoA previously and compared with 24 healthy controls. Blood pressure monitoring, echocardiographies at rest and after exercise and MRI of aortic arc were performed. Patients having had ? 30 % of isthmic stenosis on MRI was diagnosed as recoarctation. The patient group were divided as Group A (patient without recoarctation) and Group B (patients with recoarctation) and were compared. Results: We found that 8 of 24 patients had recoarctation on MRI. Physical examination and echocardiographic evaluation revealed that hypertension on the right arm at rest, systolic and diastolic hypotension on the left leg after exercise, increased values of ejection fraction, fractioned shortening and aortic gradient on exercise may predict more than 30 % narrowing of the aortic isthmus. Conclusion: These findings can be useful as predictors for recoarctation., Amaç: Bu çalışmanın amacı cerrahi olarak düzeltilmiş aort koarktasyonlu çocuklarda egzersiz öncesi ve sonrası yapılan 2 boyutlu, M-mod ve Doppler ekokardiyografiyle değerlendirilen sol ventrikül fonksiyonlarının, rekoarktasyonu gösterip göstermediğinin Magnetik Rezonans Görüntüleme ile kıyaslanarak belirlenmesidir. Gereç ve Yöntemler: Aort koarktasyonu operasyonu geçiren 24 çocuk, 24 sağlıklı kontrolle karşılaştırıldı. Kan basıncı monitorizasyonu, istirahat ve egzersizde ekokardiyografik değerlendirme ve MRG yapıldı. MRG'de %30 ve daha çok isthmus daralması görülen çocuklar rekoarktasyon olarak değerlendirildi. Rekoarktasyon grubu Grup A, kontrol grubu Grup B olarak belirlendi. Bulgular: MRG'de 24 hasta çocuktan 8'inde rekoarktasyon saptandı. Fizik muayene ve ekokardiyografiye göre istirahatte sağ kolda hipertansiyonu olma, egzersizle bacakta sistoNaci lik ve diyastolik hipotansiyon olma, ekokardiyografide yüksek ejeksiyon fraksiyonu, fraksiyone kısalma ve aortik gradyent olması rekoarktasyon göstergesi olarak kabul edildi. Sonuçlar: Bu bulgular rekoarktasyonu göstermesi açısından önemlidir

Amaç: Bu araştırmanın amacı tıp fakültesi dekanlarının Türk Tabipleri Birliği Mezuniyet Öncesi Tıp Eğitimi Araştırması Anket Formu rsquo;na verdikleri yanıtlarla Türkiye 39;deki mezuniyet öncesi tıp eğitimi ile ilgili bir durum saptaması yapmaktır.Gereç ve Yöntem: Bu araştırma tanımlayıcı tipte bir çalışmadır Veri toplama formu öğrenci aldığı belirlenen 65 tıp fakültesine gönderilmiştir.Bulgular: Türkiye rsquo;de yeni açılacak dokuz tıp fakültesi ile birlikte tıp fakültesi sayısı 2010 yılında 74 rsquo;e yükselmektedir Tıp fakültelerinin 58 rsquo;i devlet 16 rsquo;sı vakıf üniversitesi tıp fakültesidir Türkiye 39;de 2009 2010 ders yılında tıp fakültelerinde toplam öğrenci sayısı 38 536 rsquo;dır Temel bilimler öğretim üyeleri için bir öğretim üyesine ortalama 22 6 öğrenci klinik bilimler öğretim üyeleri için ortalama 4 5 öğrenci toplamda ise bir öğretim üyesine 3 5 öğrenci düştüğü görülmektedir Fakültelerde profesörlerin ve beş yılık doçentlerin tam zamanlı çalışma oranı 2010 yılı için 78 3 rsquo;dür Elli altı tıp fakültesinden 34 rsquo;ünde 60 7 karma 18 rsquo;inde 32 1 eğitici merkezli ve dördünde 7 1 öğrenci merkezli eğitim modeli kullanılmaktadır Müfredat incelendiğinde 47 rsquo;sinde 83 9 sistem temelli entegre beşinde 8 9 disiplin temelli klasik ve üçünde 5 3 probleme dayalı müfredat birinde 1 7 ise entegre ve klasik müfredat uygulandığı bildirilmektedir Çıkarımlar: Son iki yılda tıp fakültesi sayısındaki artış çarpıcıdır., Although pandemic influenza A H1N1 virus may cause an upper respiratory tract infection similar to that caused by seasonal influenza it can lead to serious complications such as pneumonia encephalitis and myocarditis We describe a 2 year old girl admitted with fever cough and vomiting followed by acute respiratory distress and diagnosed as H1N1 related myopericarditis Turk Arch Ped 2011; 46: 337 9

Case A five year and four month old female patient was referred to an external hospital with a complaint of thickening and cyanosis in the tips of the fingers and toes which was noted for the last two months She was referred to our clinic for further investigation and treatment with a prediagnosis of malignancy because of multiple nodular lesions found on chest x ray and thoracic tomography Her personal history revelaed no pathology except for occasional epistaxis At presentation her physical examination revealed the following: her general status was well her consciousness was open she was cooperated her weight and height were between the 5 25 50th percentile cyanosis was observed in her tounge lips oral mucosa and finger tips In addition clubbing was present in her finger tips Telengiectasies were found on her face Examination of the respiratory system was normal Her apical heart beat was found to be 130 min and her blood pressure was found to be 90 70 mmHg Cardiac sounds were found to be normal Examination of the gastrointestinal and nervous systems was normal However she had an articulation disorder for a few words White blood cells: 11900 mm3 hemoglobin: 15 1 g dL hematocrite 45 7 platelet count: 405000 mm3 LDH: 263 U L Other laboratory findings were found to be normal Echocardiography was found to be normal The patient was referred to our clinic with a prediagnosis of malignancy metastasis when bilateral diffuse nodular lesions were found on chest x ray Picture 1 and multiple nodular lesions with various localizations and sizes were found diffusely in both lungs on high resolution lung tomography with the largest one in the superior segment of the lower lobe in the right lung with a size of 14x11 mm and additionally consolidation areas including air bronchograms were found in the anterobasal segments of the lower lobe in the right lung and posterobasal segments of the lower lobe in the left lung The laboratory findings in our hospital were as follows: hemoglobin: 13 7 g dL hematocrite: 41 3 erythrocyte count: 5 44 mm3 white blood cells: 14500 mm3 Acute phase response PT aPT INR creatinine ALT AST fasting blood glucose electrolytes and methemoglobin levels were found to be normal LDH was found to be 506 U L Capillary oxygen saturation was found to be 69 in room air and no increase in capillary oxygen saturation was observed when 100 oxygen was inhaled beginning: 69 final: 72 The patient who had normal echocardiography findings had a normal caridothoracic index on telegraphy Further investigations were decided to be performed Diagnosis: Osler Weber Rendu syndrome It was thought that the patient might have pulmonary arteriovenous malformation or fistula because of presence of central cyanosis recurrent epistaxis and telengiectasies on the face absence of pathology in the heart and exclusion of methemoglobinemia Echocardiography performed using contrast material revelaed the right atrium and right ventricle were filled with bubbles initially and the left atrium was filled with bubbles in the second cycle Contrast enhanced lung tomography was ordered Nodular lesions showing multiple dense contrast uptake in bilateral lung paranchymes with the larger one with a size of 6x25 mm in the basal segment of the lower lobe of the right lung were observed on contrast enhanced lung tomography and arteriovenous malformation was considered when the supplying artery and draining vein were noted clearly in the lesion which was especially large in the right lung Highly diffuse arteriovenous malformations especially prominent in the lower lobes were observed with selective pulmonary artery injections performed seperately in both pulmonary arteries during cardiac catheterization Figure 2A 2B Especially two arteriovenous malformations were observed to have multiple supplying arteries and direct filling into the pulmonary vein from these arteries was observed Hyperechoic nodular lesions containing internal vascularization surrounded by a hypoechoic moon were found in the center of the liver with dimensions of 18x15x12 mm adjacent anteriorly to the main portal vein and 33x6x24 mm in the 6th segment on abdominal ultrasonography performed in terms of possible involvement in other internal organs Abdominal magnetic resonance imaging revealed a vascular lesion was observed with dimensions of 17x16 mm in the center of the 4 8th segment of the liver and 31x30 mm in the 6th segment of the liver showing mild hyperintense appearance on T2a examination and mild hypointense appearance on T1a examination and intense contrast uptake on post contrast examination This was considered as an arteriovenous malformation Cranial magnetic resonance imaging was found to be normal According to Curacao criteria 1 a diagnosis of Osler Weber rendu syndrome was made with spontaneous recurrent epistaxis mucocuteneous telengiectasia and arteriovenous malformations in the organs lung and liver Discussion Osler Weber rendu syndrome is a familial autosomal dominant vascular dysplasia characterized by telengiectasies and mucosal bleedings The incidence of the disease ranges between 1 5000 and 1 8000 The most common pathologic finding is telengiectasies which lead to mucocutaneous bleedings and epistaxis is frequently the first finding in the childhood The second most common finding is arteriovenous malformations AVM in the internal organs The most common localizations include lung brain and hepatic circulation 1 2 3 The diagnostis criteria in Osler Weber Rendu syndrome include spontaneous recurring epistaxis mucocutaneous telengiectasies AVM rsquo;s in the internal organs and presence of Osler Weber Rendu syndrome in the first degree relatives The diagnosis is made with presence of at least three criteria 1 The diagnosis of arteriovenous malformations is possible with contrast enhanced echocardiography contrast enhanced CT and angiography 4 The fact that mucocutaneous findings are not prominent especially in the first ten years and recurrent epistaxis which is the most common finding is associated with trauma upper respiratory infection and allergic diseases in children makes the diagnosis difficult 5 Considering all age groups recurrent epistaxis is observed in 90 95 of the patients 6 7 and gastrointestinal bleedings are observed in 10 33 of the patients 8 9 due to mucosal involvement Considering internal organ involvement AVM rsquo;s are observed in the lung in 30 40 of the patients and in the brain 15 20 of the patients while the frequency in the liver is not exactly known Rarely AVM rsquo;s may also be observed in the spleen coronary arteries eye and genitourinary tract 3 10 11 12 AVM in the lung may be observed in a single lung or as a single lesion in both lungs or may be diffuse 13 14 15 Diffuse AVMs in both lungs and two AVMs in the liver were found in our patient and there was no AVM in the brain Patients who have AVM in the lungs may stay asymptomatic for a long time In symptomatic patients respiratory complaints exercise intolerance and cyanosis are obsevred commonly 3 Our patient had clubbing in the fingers ans cyanosis Cyanosis was related to lung involvement Since the first finding in undiagnosed patients may sometimes be life threatening lung bleeding stroke due to righ to left shunt or brain bascess early diagnosis and treatment is important 3 13 To diagnose arteriovenous malformations contrast enhanced studies should be performed 4 13 14 15 If nodular lesions are observed on chest x ray amd thoracic CT in patients with cyanosis contrast enhanced studies should be performed for internal organs 4 13 14 15 Our patient is a good example for this Otherwise malignancy metastasis may be considered incorrectly in presence of nodular lesions as in this patient This may lead to loss of the patient before the diagnosis is made as a result of diagnostic biopsy of the nodular lesion or as a result of spontaneous acute hemorrhage In treatment manuel transcatheter embolization aimed at local AVMs or surgery is performed In patients with highly diffuse AVMs lung transplantation is recommended 3 4 15 Embolization and surgical intervention were not performed in our patient since the AVMs in the lungs were bilateral and diffuse However the patient and parents were informed that treatment consisted of lung transplantation The patient is stil being followed up in the outpatient clinic of pediatric cardiology and lung diseases Conclusively history and physical examination findings should be evaluated carefully in patients with central cyanosis and nodular lesions in the lung AVM should be investigated using contrast enhanced radiologic studies in internal organs if necessary and the diagnosis of Osler Weber Rendu syndrome should be excluded References 1 Shovlin CL Guttmacher AE Buscarini E Faughnan ME Hyland RH Westermann CJ Kjeldsen AD Plauchu H Diagnostic criteria for hereditary hemorrhagic telangiectasia Rendu Osler Weber syndrome Am J Med Genet 2000; 91: 66 67 2 Begbie ME Wallace GM Sholvin CL Hereditary hemorrhagic telangiectasia Osler Weber Rendu syndrome : a view from the 21st century Postgrad Med J 2003; 79: 18 24 3 Sharathkumar AA Shapiro A Hereditary haemorrhagic telangiectasia Haemophilia 2008; 14: 1269 1280 4 Faughnan ME Palda VA Garcia Tsao G Geisthoff UW McDonald J Proctor DD Spears J Brown DH Buscarini E Chesnutt MS Cottin V Ganguly A Gossage JR Guttmacher AE Hyland RH Kennedy SJ Korzenik J Mager JJ Ozanne AP Piccirillo JF Picus D Plauchu H Porteous ME Pyeritz RE Ross DA Sabba C Swanson K Terry P Wallace MC Westermann CJ White RI Young LH Zarrabeitia R HHT Foundation International Guidelines Working Group International guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia J Med Genet 2011; 48: 73 87 5 Guttmacher AE Marchuk DA White RI Jr Hereditary hemorrhagic telangiectasia N Engl J Med 1995; 333: 918 924 6 Assar Os Friedman CM White RI Jr The natural history of epistaxis in hereditary hemorrhagic telangiectasia Laryngoscope 1991; 101: 977 980 7 Pau H Carney AS Murty GE Hereditary haemorrhagic telangiectasia Osler Weber Rendu syndrome : otorhinolaryngological manifestations Clin Otolaryngol Allied Sci 2001; 26: 93 98 8 Plauchu H de Chadar eacute;vian JP Bideau A Robert JM Age related clinical profile of hereditary hemorrhagic telangiectasia in an epidemiologically recruited population Am J Med Genet 1989; 32: 291 297 9 Ingrosso M Sabb agrave; C Pisani A Principi M Gallitelli M Cirulli A Francavilla A Evidence of small bowel involvement in hereditary hemorrhagic telangiectasia: a capsule endoscopic study Endoscopy 2004; 36: 1074 1079 10 Vase P Holm M Arendrup H Pulmonary arteriovenous fistulas in hereditary hemorrhagic telangiectasia Acta Med Scand 1985; 218 1 : 105 109 11 Fulbright RK Chaloupka JC Putman CM Sze GK Merriam MM Lee GK Fayad PB Awad IA White RI Jr MR of hereditary hemorrhagic telangiectasia: prevalence and spectrum of cerebrovascular malformations AJNR Am J Neuroradiol 1998; 19: 477 484 12 Garcia Tsao G Liver involvement in hereditary hemorrhagic telangiectasia HHT J Hepatol 2007; 46: 499 507 13 Cottin V Plauchu H Bayle JY Barthelet M Revel D Cordier JF Pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia Am J Respir Crit Care Med 2004; 169: 994 1000 14 Cottin V Dupuis Girod S Lesca G Cordier JF Pulmonary vascular manifestations of hereditary hemorrhagic telangiectasia Rendu Osler disease Respiration 2007; 74 4 : 361 378 15 Jaskolka J Wu L Chan RP Faughnan ME Imaging of hereditary hemorrhagic telangiectasia AJR Am Roentgenol 2004;183: 307 314, Beş yaş dört aylık kız hasta başka bir hastaneye yaklaşık iki aydan bu yana fark edilen el ve ayak parmak uçlarında kalınlaşma ve morarma yakınmasıyla başvurmuş. Akciğer grafisinde ve toraks tomografisinde akciğerde değişik boyutta ve yerleşimde çok sayıda nodüler lezyon saptanması nedeniyle malinite ön tanısıyla ileri tetkik ve tedavi amaçlı kliniğimize yönlendirilmiş. Öz geçmişinde seyrek burun kanamasından başka özellik yokmuş. Başvurusundaki fizik muayenesinde; genel durumu iyi, şuur açık, koopere, ağırlık ve boy 25-50 persantil arasında, dil, dudaklar ve ağız mukozası ve parmak uçları siyanoze imiş. İlaveten parmak uçlarında çomaklaşma varmış. Yüzde telanjiektaziler saptanmış. Solunum sistemi muayenesinde özellik yokmuş. Kalp tepe atımı 130/dak ve TA 90/70 mm/Hg olarak saptanmış. Dinlemekle kalple ilgili patoloji saptanmamış. Sindirim ve nörolojik sistemler normalmiş.

Sağlıklı bir beslenme alışkanlığının kazanılmasında çocukluk ve gençlik dönemi özel bir öneme sahip olup, diyabet, hipertansiyon ve şişmanlık gibi sağlık sorunlarının bu dönemlerde ki yanlış beslenme alışkanlıklarından kaynaklandığı ileri sürülmektedir. Çalışma; üniversite eğitimi gören kız öğrencilerin vücut ağırlığı ve beslenme durumunu değerlendirmek amacıyla yapılmıştır. Çalışmaya, İstanbul, Marmara ve Koç Üniversitelerinden basit rast gele örnekleme yöntemiyle seçilen toplam 368 öğrenci alınmıştır. Öğrencilerin beslenme durumu “besin tüketim formu” ile belirlenmiş ve Amerika Besin Öneri Komitesi’nin önerilerine göre değerlendirilmiştir. Öğrencilerin vücut ağırlığı ve boyu ölçülerek Beden Kitle İndeksi değerlendirilmiştir. Öğrencilerin; yaş ortalaması 19.9±0.9 yıl olup, vücut ağırlığı değerlendirmesinde %79.0’u normal, %15.7’si zayıf ve %5.3’ü hafif şişman ve şişman bulunmuştur. Öğrencilerin günlük enerji alımları ve enerjinin karbonhidrattan gelen oranı önerilenin altında, protein ve yağdan gelen oranları ise önerilenin üstündedir. Yine tiamin, folik asit, kalsiyum ve demir alımları düşük, posa ve E vitamini alımları sınırda, riboflavin, B6 vitamini, sodyum, potasyum ve çinko alımları önerilen düzeylerde, protein, A ve C vitaminleri alımları ise yüksek olarak saptanmıştır. Sonuç olarak, üniversiteli kız öğrenciler yetersiz ve dengesiz beslenmekte, besin alımları enerji ve bir çok önemli mikro besin ögeleri gereksinmelerini karşılamamakta ve öğrenciler arasında zayıflık, şişmanlıktan daha yüksek oranda görülmektedir. Bu nedenle, kız öğrencilere üniversite eğitimleri sırasında yeterli ve dengeli beslenme konusunda eğitim verilmesi, sağlık açısından olumlu beslenme alışkanlıkları edinmelerine önemli katkı sağlayacaktır, Childhood and adolescence have a special importance to gain and improve a healthy lifestyle and nutritional habits, and it is proposed as the basis of health problems like diabetes, hypertension and obesity at these stages of life. The study was performed to evaluate the body weights and nutritional status of female university students. A total 368 students from İstanbul, Marmara and Koç Universities selected by simple randomised sampling method. The nutritional status of the students were determined through a “food consumption form” and evaluated according to American Food Recommendation Committee. Body weights and heights were measured and evaluated by Body Mass Index. Students’ mean ages were 19.9±0.9 years, 79.0% of their weights were evaluated as normal, 15.7% were thin and 5.3% were overweight and obese, respectively. Students’ daily energy intakes and percent of energy from carbohydrates were below the recommendations; percent of energy from proteins and lipids were above the recommendations. Thiamin, folic acid, calcium and iron intakes were low, dietary fiber and vitamin E intakes were at borderline, riboflavin, vitamin B6, sodium, potassium and zinc intakes were at recommended levels, protein, vitamin A and C intakes were high. In conclusion, the female university students have an unhealthy nutritional pattern, their food intakes did not meet their energy and some important micronutrient requirements and being underweight was more prevalent than being overweight. The education of female students at their universities on healthy nutrition will contribute to their acquisition of positive nutritional habits and improvement of their health