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The generators of the quasi-regular representation of the group SO(3,2) are obtained for parabolic coordinates. By the generators, the expression of the quadratic Casimir operator is presented. From the relation between the Casimir operator and Hamiltonian, the corresponding physical system is expressed, and its exact solution is given.

Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. Central nervous system is the most frequent place of both at the onset and relapse of the disease, but orbital involvement is rarely seen. A seven-year-old girl diagnosed with high risk ALL and Turkish ALL-Berlin Frankfurt Munster (BFM)-2000 high risk group treatment was given. However, after induction and consolidation treatments, before the maintenance treatment she had blindness in her right eye. Ophthalmologic examination her visual acuity was fingers to count in two meters. In her right eye there was exudative retinal detachment and her orbital magnetic resonance imaging (MRI) showed that, there was a mass lesion in the posterior of right orbital globe, on the neighbourhood of optic disc, consistent with metastasis. After ALL-REZ-BFM-2002 relapse protocol treatments and radiotherapy her visual acuity was increased to 6/10. In control orbital MRI regression of mass lesion size was established. Bone marrow transplantation was planned. Orbital involvement is rarely seen in leukemia, but it is responsive to chemotherapy and radiotherapy combination.

PubMedID: 30300449 Objectives: To evaluate the long-term efficacy and safety of deferasirox therapy in a large observational cohort of children with transfusion-dependent thalassemia (TDT) and sickle cell anemia (SCA) in Turkey. Methods: This was a multicenter, prospective cohort study including TDT and SCA patients aged 2-18 years with iron overload (?100 mL/kg of pRBC or a serum ferritin [SF] level >1000 µg/L) receiving deferasirox. Patients were followed for up to 3 years according to standard practice. Results: A total of 439 patients were evaluated (415 [94.5%] TDT, 143 [32.6%] between 2 and 6 years). Serum ferritin levels consistently and significantly decreased across 3 years of deferasirox therapy from a median of 1775.5 to 1250.5 µg/L (P

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175GC; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immunocompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue.Hemofagositik lenfohistiositoz (HLH) uzamış ateş, sitopeni, hepatosplenomegali semptomları ile seyreden, active olmuş, morfolojik olarak benign makrofaj ve doğal öldürücü hücreler ile sitotosik T lenfosit fonksiyon bozukluğu sonucu gelişen hiperenflamatuvar bir durumdur. İki aylık düşmeyen ateş yakınması ile başvuran hasta HLH tanısı aldı ve hastanın genetik incelemesinde UNC13D (c.175GC; p.Ala59Pro) geninde yeni tanımlanan bir mutasyon saptandı. Hastaya deksamatazon, etopozit ve intratekal metotreksat tedavileri başlandı. Tedavinin 2. haftasında, üç doz etopozit aldıktan sonra, yumuşak damakta plak lezyonu fark edildi ve bu nekrotik lezyon debride edildi. Debridman materyalinin patolojik incelemesinin PAS, Grocott boyamasında aspergilloz enfeksiyonu ile uyumlu olarak çok sayıda septalı hif görüldü. Etopozid tedavisi sonlandırılarak altı hafta boyunca amphotericin B tedavisi verildi. HLH 2004 tedavi protokolü oral siklosporin ile sekiz haftaya tamamlandı. HLH tedavisi sırasında yumuşak damak perforasyonuna neden olacak kadar ağır aspergilloz enfeksiyonu geçiren bir olgu bildirilmemiştir. İmmünyetmezlikli hastada mantar enfeksiyonları nazal septum perforasyonuna neden olabilmektedir ve tedavi nekrotik dokunun debridmanı ve antifungal tedavi ile sağlanabilmektedir.

The purpose of this study was to investigate the effects of theophylline and methylprednisolone on the mechanical response and histopathology of hemidiaphragm muscle in rats. In the current study, we aimed to investigate the effects of theophylline and methylprednisolone, which are frequently used in clinics and which have different effects on the respiratory system and on the biomechanics and histopathology of the diaphragm muscle. The study included four groups of rats. Group T received 1 mg/kg of intraperitoneal theophylline, group M received 2 mg/kg of intraperitoneal methylprednisolone, group TM received 1 mg/kg of intraperitoneal theophylline plus 2 mg/kg of intraperitoneal methylprednisolone, and group K received of 1 mL intraperitoneal isotonic solution (of 0.9 % NaCl). The medications were continued for 7 days in each group. The rats underwent cervical dislocation under anesthesia on the eighth day, and their diaphragm samples were extracted. The left hemidiaphragm was used for the investigation of biomechanical parameters, and the right hemidiaphragm was used for the histopathological evaluation. It was observed that the medication administered in group T increased the contraction strength and duration compared with that in group M. Additionally, the duration of semi-relaxation was prolonged in group T compared with group M. The highest contraction strength and the longest contraction period among all of the groups were observed in group TM. It was concluded that the combined use of theophylline and methylprednisolone had positive effects on the contraction strength and the durations of contraction and semi-relaxation of the diaphragm muscle. In addition, both drugs had synergistic effects on each other.

Thalassemia major (TM) results in hemolytic anemia, an increase in intestinal iron absorption, and occurrence of iron loading due to erythrocyte transfusion; the disease is characterized by oxidative damage in major organs. Oxidative stress leads to vascular endothelial damage and forms the basis for serious cardiovascular diseases. Pentraxin-3 (PTX-3) is one of the markers of vascular endothelial damage that increases in response to the oxidative stress, which can be used as an early diagnostic marker for inflammation. This study's purpose is to define the relation between PTX-3 and the vascular endothelial damage that increases with oxidative stress in thalassemia patients. Our study included 35 TM patients, 30 β-thalassemia minor patients, and 30 healthy children. As a result of our study, in TM patients, a positive relation was detected between the PTX-3 levels and the total oxidative stress, triglyceride, and very low-density lipoprotein values, whereas a negative relation was detected with the total antioxidant capacity and high-density lipoprotein values. This result shows that as oxidant stress increases, PTX-3 levels also increase; very low-density lipoprotein and triglyceride contribute to the endothelial damage occurring with oxidative stress. As a result, it was concluded that vascular endothelial damage in thalassemia patients can be evaluated through the serum PTX-3 level. © Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.

We considered the Gauss decomposition for the Lie group SL(2,ℝ). The Casimir operator of the group and continuous state solution of the system were obtained. The Laplace-Beltrami operator on the surface of the manifold was given and the relation between the Casimir operator and the Laplace-Beltrami operator was observed.

Cytosine arabinoside (ARA-C) is a pyrimidine analog that may cause keratoconjunctivitis when used in high doses. The underlying mechanism may be the increased amounts of reactive oxygen radicals that may damage the DNA synthesis of corneal and conjunctival epithelial cells. Topical corticosteroids are one of the prophylactic treatments for keratoconjunctivitis induced by ARA-C. Forty Wistar-type albino rats were included in this study the rats were divided into four groups. The first group (Group 1) received only ARA-C, the second group (Group 2) received ARA-C and N-acetylcysteine (NAC), the third group (Group 3) received only NAC and the fourth group (Group 4) was the control group. The total oxidant status (TOS), the total antioxidant capacity and the oxidative stress index (OSI) measurements of the cornea and the conjunctiva were evaluated in these four groups. The mean TOS and OSI value was the highest in Group 1 and the lowest in Group 3. The differences in TOS and OSI values were statistically significant between Group 1 and Group 2. There are decreases in TOS and OSI values in rats which received ARA-C with NAC administration. NAC may have a protective effect on ARA-C-induced keratoconjunctivitis. © 2016, Springer Science+Business Media Dordrecht.

AMAÇ: Lökopeni lökosit sayısının 4000/µL’ nin altında olmasıdır. Çocuklarda lökopeni çok çeşitli nedenlere bağlı gelişebilmektedir. Bu çalışmanın amacı çocuk hematoloji polikliniğine başvuran hastalarda bening lökopeni sıklığını ve nedenlerini belirlemektir.YÖNTEMLER: Haziran 2010-Şubat 2013 tarihleri arasında Pamukkale Üniversitesi Çocuk Hematoloji Polikliniğine başvuran lökosit sayısı 4000/µL’ nin altında olan hastalar retrospektif olarak incelendi. Takipte olan kanser hastaları, otoimmün hastalığı olanlar, aplastik anemi ve kronik nötropenili hastalar çalışma dışında tutuldu. Hastalar demografik özellikleri, lökopeni nedenleri ve komplikasyonlar açısından değerlendirildi. BULGULAR: Belirtilen sürede polikliniğimize ilk kez başvuran hasta sayısı 2.650 idi. Lökopeni tespit edilen 85 hasta [45 kız (%52.9), 40 erkek (%47.1), ortalama yaş 8.7±4.4 yıl] incelemeye alındı. Lökopeni insidansı % 3.2 bulundu. Ortalama lökosit sayısı 2.965±489/uL, ortalama lökopeni süresi 6.3±2.4 gün, ortalama takip süreleri 15±6 gün olup, tüm hastalarda lökopeninin düzeldiği görüldü. En sık lökopeni nedeni olarak enfeksiyonlar (%68.2) tespit edildi. Diğer lökopeni nedenleri %10.6 ilaç kullanımı, %9.4 demir eksikliği ile birlikte vitamin B12 eksikliği, %4.7 vitamin B12 eksikliği, %4.7 malnütrisyon, %2.4 prematürite olarak saptandı. Demir eksikliği ile birlikte vitamin B12 eksikliği olan hastalarda enfeksiyon olmaksızın lökopeni geliştiği görüldü. SONUÇ: Çalışmamızda çocukluk çağında akut geçici lökopeninin en sık nedeni literatürle uyumlu olarak enfeksiyon saptandı. Ayrıca miks tip anemisi olanlarda da enfeksiyon olmaksızın lökopeni gelişebildiği ve izole vitamin B12 eksikliğine göre lökosit sayılarının daha düşük olduğu ve düzelme süresinin daha uzun olduğu görüldü., OBJECTIVE: The condition that lekocyte count below 4000 known as leukopenia. Leukopenia may develop due to various causes. Our aim in this study is to determine the frequency and the causes of bening leukopenia which pediatric patients admitted to the hematology clinic.METHODS: The patients with total leukocyte count less than 4000/μL who were admitted to the hematology clinic between June 2010- February 2013 are analyzed retrospectively. The patients with cancer, autoimmune disease, aplastic anemia and chronic neutropenia are excluded. Patients are evaluated according to their demographic properties, leukopenia factors and complications.RESULTS: During the mentioned period, the total number of patients was 2650. Eighty-five cases with leukopenia [45 girls (52.9%), 40 boys (41.7%); mean age 8.7±4.4] are analyzed. Leukopenia incidence was 3.2 %. Median duration of leukopenia was 6.3±2.4 days, mean duration of follow up was 15±6 days, all patients were recovered. The most common reason of leukopenia was infections (68.2%). Other reasons were medications (10.6%), B12 deficiency in addition to iron defficiency anemia (9.4%) (mix anemia), vitamin B12 defficiency (4.7%), malnutrition (4.7%) and prematurity (2.4%) respectively. In patients with both iron defficiency and vitamin B12 defficiency anemia, without infection, leukopenia exists. CONCLUSION: In this study, consistent with literature, the most common causes of pediatric acute transient leukopenia were infections and drugs. Our study resulted as In mixed anemia without infection leukopenia could be seen and also white blood cell count was lower and recovery time was longer.

BACKGROUND: The purpose of this study was to determine the epidemiological features of cases that were registered for burns and treated at a hospital after the Van earthquake to compare burn cases from the previous year and to determine the factors that influenced mortality. METHODS: Patients who were admitted to the Van Region Training and Research Hospital within the 3-month period after the earthquake were categorized as group 1; patients who were admitted within the same time interval in the previous year were categorized as group 2. RESULTS: There were 121 patients in Group 1 and 89 patients in Group 2. It was determined that there were 36% more burn cases in Group 1. Flame burns were observed 4.8 times more often in Group 1 compared to Group 1 (p=0.002). Exitus was observed in 25.4% of cases in Group 1 and in 7% of cases in Group 2 (p=0.0069). CONCLUSION: It was determined that the number of burn cases registered after the earthquake, the number of flame burns, the percentage of burns and the rate of mortality were higher than the data before the earthquake. Language: en

Leishmaniasis is a reticuloendothelial system disease that mostly observed before the age of 5. Visceral infection causes long-standing fever, weight loss, weakness, pancytopenia, and hepatosplenomegaly. Leishmania infantum is responsible for visceral leishmaniasis (VL) in Turkey. We present a case of hemophagocytic syndrome due to Leishmania infection diagnosed with an immunofluorescence antibody test (IFAT). Leishmania amastigotes were not observed on bone marrow aspiration. We consider that IFAT is very important for parasite detection in the diagnosis of VL in children, particularly when amastigotes are not obtained on bone marrow aspiration.

To investigate the effects of occupational exposure to anaesthetic gases on myeloperoxidase activity, oxidative and antioxidative parameters in operating room personnel.The cross-sectional study was conducted at Yuzuncu Yil University, Van, Turkey, in May 2011, and comprised equal number of operating room and non-operating room personnel. Serum myeloperoxidase activity, sulfhydryl group levels, lipid hydroperoxide levels and catalase activity were determined. SPSS 11 was used for data analysis.There were 64 subjects; 32(50%) each in the two groups. Myeloperoxidase activity and lipid hydroperoxide levels were significantly higher in operating room personnel than in the non-operating room personnel (p0.001; p0.001), while catalase activity and sulfhydryl group levels were significantly lower (p0.009; p0.003). Catalase activity negatively correlated with lipid hydroperoxide levels in operating room personnel (r=-0.293; p=0.018). Myeloperoxidase activity negatively correlated with sulfhydryl group levels in operating room personnel (r=-0.267; p=0.031).Operating room personnel exhibited higher oxidative stress, which may be due to the oxidative effect of anaesthetic gases.

Background: In this experimental study, we primarily aimed to show the hemodynamic effects and superiority of this newly designed cannula for perfusion compared to standard subclavian cannulation. The new cannula (Figure 1) allows bidirectional axial flow and it directly fits in the brachiocephalic trunk (innominate artery). Methods: We used a cardiopulmonary bypass roller pump, reservoir, 3/8- 1/2- 1/4-inch Y-connectors and tubing set. Lines were set as seen in Figures 2, 3, 4 and 5. The anatomy of the aorta (ascending, arch, branches, descending) was mimicked, using tubing sets with different sizes and the connectors yielding similar angles and configurations. In this experimental vascular system, systemic vascular resistance was created with partial clamping of the common tubing set. The cannulation sites were created in the subclavian artery and the innominate artery. Perfusion was established with the same pump rate and the same occlusion pressures (systemic vascular resistance). The pressure readings were obtained in the right carotid artery, the left carotid artery and the left subclavian artery. Results: These experimental models of vasculature allowed us to measure pressures in the carotid system for different cannulation set-ups, using both our newly designed double-outflow cannula, which was introduced via the innominate artery, and the standard arterial cannula, which was introduced via the subclavian artery. Higher pressure recordings were obtained in the carotid system with the new cannula introduced through innominate artery. Conclusion: Higher cerebral perfusion readings were obtained with our newly designed bidirectional cannula introduced via the innominate artery compared to standard cannulation through the right subclavian artery.

The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures. The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gag reflex, nausea, vomiting, cough, number of desaturation episodes (SpO2

Background Neostigmine, the currently commonly used agent for reversal of neuromuscular blockade. Sugammadex is a novel and unique compound designed as an antagonist of steroidal neuromuscular blockers. In this study, we evaluated the effects of sugammadex or neostigmine on kidney functions in patients scheduled for elective surgery. Material/methods Patients scheduled for a surgical procedure under desflurane/opioid anesthesia received an intubating dose rocuronium. Patients were divided into 2 groups receiving either sugammadex or neostigmine atropine to reverse neuromuscular blockade. Cystatin C, creatinine, urea, blood urea nitrogen, sodium, potassium, and calcium levels in the blood and α1microglobulin, β2microglobulin, and microalbumin levels in the urine were measured. Results There was no significant difference between the groups with regard to the demographic data. In the Neostigmine Group, although β2microglobulin and microalbumin were similar, a significant increase was found in the postoperative α1microglobulin and cystatin C values. In the Sugammadex Group, although β2-microglobulin and cystatin C were similar, a significant increase was found in the postoperative α1-microglobulin and microalbumin values. The only significant difference was cystatin C value variation in the Neostigmine Group compared to the Sugammadex Group. Conclusions We believe that the use of more specific and sensitive new-generation markers like cystatin C to evaluate kidney function will provide a better understanding and interpretation of our results. Sugammadex has more tolerable effects on kidney function in patients than does neostigmine. However, when compared to preoperative values, there is a negative alteration of postoperative values. Neostigmine and sugammadex do not cause renal failure but they may affect kidney function.

Objectives: Evaluation of the peripapillary retinal nerve fiber layer thickness, subfoveal choroidal thickness, and retinal vessel caliber measurements in children with thalassemia minor., Methods: In this cross-sectional and comparative study, 30 thalassemia minor patients and 36 controls were included. Heidelberg spectral domain optical coherence tomography was used for peripapillary retinal nerve fiber layer thickness, subfoveal choroidal thickness, and retinal vessel caliber measurements., Results: There was no statistically significant difference in retinal nerve fiber layer thickness and subfoveal choroidal thickness between the two groups (p > 0.05). There was no correlation between retinal nerve fiber layer thickness and hemoglobin values. Both the arterioral and venular calibers were higher in thalassemia minor group (p < 0.05)., Conclusion: There is increased retinal arterioral and venular calibers in children with thalassemia minor compared with controls.

Wolfram syndrome-1 is a rare and severe autosomal recessive neurodegenerative disease characterized by diabetes mellitus (DM), optic atrophy, diabetes insipidus, and deafness. Poorly controlled type 1 DM increases the risk for thrombosis. However, coexistence of DM and hereditary thrombosis factors is rarely observed. Here we present the case of a 13.5-year-old, nonfollowed girl newly diagnosed with poorly controlled Wolfram syndrome on the basis of the results of clinical and laboratory examinations. On the eighth day after diabetic ketoacidosis treatment, pulmonary embolism developed in the subject. Thrombus identified in the right atrium using echocardiography was treated by emergency thrombectomy. Homozygous mutation in the methylenetetrahydrofolate reductase gene C677T, heterozygous factor-V Leiden mutation, and active protein C resistance were identified in the patient. The patient was lost because of a recurring episode of pulmonary embolism on the 86th day of hospitalization. We present this case to highlight the need for investigating hereditary thrombosis risk factors in diabetic patients in whom thromboembolism develops. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Introduction: We evaluated that response to parenteral iron therapy could be helpful in distinguishing the types of iron deficiency anemia. Patients and Methods: This study analyzed responses to IV iron sucrose therapy of 15 children with unexplained refractory iron deficiency anemia (URIDA). We compared the results at diagnosis, 6 weeks and 6 months after the therapy. Results were compared with responses of 11 patients' results with iron-refractory iron deficiency anemia (IRIDA) from our previous study. Result: Six weeks after the start of treatment, ferritin, MCV, MCH and Hb values were in normal range in 10 patients. The increase in Hb, MCH, MCV, and ferritin values ranged 2.6-3.5 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. In five patients, Hb, MCH, and MCV mean (range) values [11.2 g/dL (11-12.2), 24.5 pg (24-25.6), and 67 fL (65-70)] were nearly normal but ferritin mean (range) values [9.8 ng/mL (8-11)] were below normal. Six weeks after the start of treatment, Hb, MCH, MCV and ferritin values of patients with IRIDA were increased. The increase in Hb, MCH, MCV, and ferritin values ranged 0.8-2.7 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. IRIDA is only partially responsive to parenteral iron supplementation. In conclusion, this study demonstrated that the response to intravenous iron therapy for the URIDA cases improved blood parameters more effectively than hereditary IRIDA. Response to parenteral iron therapy would be helpful to distinguish unexplained refractory IDA from hereditary IRIDA for clinicians who do not have access to hepcidin or TMPRS6 mutation analysis. © 2016 John Wiley & Sons Ltd.

Background: Subclinical hypothyroidism (SH) is defined as elevated serum thyroid-stimulating hormone (TSH) concentration associated with normal serum-free thyroxine levels. Effects of hypothyroidism on hemorheology had widely attracted the attention of researchers during the last decade. Objective: The purpose of this study is to determine alterations in hemorheological parameters and carotid intima-media thickness (CIMT) in children with SH. Methods: Fifty-three SH children and 31 healthy controls were enrolled. Erythrocyte deformability and aggregation were determined by an ektacytometer and plasma viscosity (PV) by a cone-plate rotational viscometer. CIMT was evaluated sonographically. Results: Erythrocyte deformability of the SH group measured at 0.53 and 1.69-30 Pa was lower than that of the control group. The erythrocyte aggregation index, aggregation half time and PV were not different between the groups. However, the aggregation amplitude and mean corpuscular hemoglobin concentration were significantly higher in SH compared to the control group. There was a negative correlation between TSH and deformability values measured at 5.33-30.0 Pa. CIMT in patients with SH was significantly higher than in the control group (p = 0.001; SH = 0.48 ± 0.04 mm, control group = 0.43 ± 0.03 mm). Conclusion: Impaired hemorheology and increased CIMT are well-known risk factors for developing cardiovascular pathologies. The results of the current study suggest the treatment of children with SH in order to avoid early circulatory problems.

Background Reticulocytes are the youngest erythrocytes released from the bone marrow into the blood and they circulate for 1-2 days before becoming mature erythrocytes. In literature, there were studies about reticulocyte parameters that could help in differentiation of iron deficiency anemia (IDA) from vitamin B12 deficiency anemia. However, in those studies there were no data about differentiation of mixed anemia (vitamin B12 deficiency and IDA). The purpose of this study is to explore a response to 'could reticulocyte parameters help in differential diagnosis of mixed anemia?' in 6-12 years old children. Methods The study enrolled 26 patients with IDA, 22 patients with mixed anemia, 32 patients with vitamin B12 deficiency, and 32 age and gender matched healthy controls. Blood for hematological parameters such as complete blood count, reticulocyte count, CHr, MCVr, CHCMr were collected into standard tubes containing EDTA. Results There is a statistically significant difference of both MCV (mean corpuscular volume)/MCVr (Reticulocyte mean corpuscular volume) ratio and MCVr between IDA and controls; in controls and vitamin B12 deficiency anemia; in controls and mixed anemia; in IDA and vitamin B12 deficiency anemia; in IDA and mixed anemia. Also in terms of both CHr and CHCMr (Corpuscular mean hemoglobin concentration of reticulocyte), there is a statistically significant difference between controls and IDA; controls and mixed anemia; IDA and mixed anemia; IDA and vitamin B12 deficiency anemia. Conclusions In mixed anemia, MCV could be normal or decreased, and in peripheral blood smear erythrocytes cells could be morphologically normal. For this reason diagnosis of mixed anemia is not easy and needs additional laboratory investigations. Our results suggest that in a differential diagnosis of mixed anemia from vitamin B12 deficiency, IDA, and healthy controls, CHr, CHCMr, and MCVr (together with MCV and individually) could be useful. So, with a simple and cheap laboratory parameter, differentiation of mixed anemia could be done.

It is well-known that β-thalassemia is associated with changes in plasma lipids and lipoproteins [1,2,3]. To our knowledge, no data are available on lipid profiles in Turkish β-thalassemia major (TM) and β-thalassemia trait (TT) patients together. The aim of this study was to evaluate lipid profiles in two groups of patients with β-TM and β-TT and to compare them with healthy controls. The study included a total of 311 subjects. Group 1 included 131 β-TM patients (mean age: 16.3±7.58 years). Group 2 included 68 β-TT patients (mean age: 7.25±4.43 years). Group 3 consisted of 112 age- and sex-matched healthy controls (mean age: 9±4.7 years). Serum ferritin level was 2487±1103 (range: 661-5745) ng/mL in Group 1. In comparing the correlation between ferritin and lipid parameters, while a significantly negative relationship was detected between ferritin and highdensity lipoprotein cholesterol (HDL-C) (p=0.000, r=-0.602), a significantly positive relationship was detected between ferritin and triglyceride (TG) levels (p=0.02) in TM patients. Serum lipid profiles of the 3 groups are shown in Table 1.

Adenovirus is an infectious viral agent that causes variety of clinical presentations such as respiratory disease, conjunctivitis, and gastroenteritis. Hepatitis, pancreatitis, myocarditis, encephalitis, and disseminated infection are primarily seen in immunocompromised patients. Rarely, adenovirus infection can present with pertussis-like syndrome. Described here is case of pertussis-like syndrome associated with adenovirus presenting with hyperleukocytosis.

Although cleft palate anomaly is frequent, the criterion standards in surgical treatment have not been determined yet. There are a few techniques described for cleft palate repair owing to the limited tissue in the palatal mucosa, the rigid structure of the palatal mucosa, and the limited vascularity of the hard palate. In this study, a novel cleft palate repair technique based on separating the soft palate from the hard palate as a musculomucosal flap and using it as a rotation flap has been described. The operation is evaluated individually for each anomaly because variations occur in the surgical technique according to the extension of the cleft toward the teeth in the palate. This operation was performed on a total of 28 patients (17 girls and 11 boys) aged between 1.5 and 16 years and presented to our clinic. Patients were assessed for speech analysis outcomes, tympanogram values, hearing functions, magnitude of palatal lengthening during the operation, and rate of fistulae. Statistically significant differences in values of the speech analysis and the audiometric assessment were determined between before and 6 months after surgery. Complete recovery of otitis was observed 1 month after surgery without another treatment in 9 (42.8%) of 21 patients who were detected to have serous otitis media preoperatively. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all types of cleft palate, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this technique.

The study was planned to determine the frequency of parental and non-sibling family donor transplants in our center and to investigate the rate of familial donor availability at two HLA-typing laboratories in Turkey. Among 203 patients who underwent hematopoietic stem cell transplantation (HSCT), 151 (74.4%) received stem cells from siblings, 48 (23.6%) from non-sibling family donors, two (1.0%) from unrelated cord blood, and two (1.0%) autologous transplantation. Of these 48 patients received stem cells from non-sibling family donors; donors were mothers for 26 (12.8%), fathers for 20 (9.9%), and aunts for two (1.0%). The rate of transplants from parental donors was 22.6% in this patient population with increased frequency of inherited diseases (58.1%). Among these 203 patients, there was consanguinity between parents in 60.6% of the patients. Of 833 subjects applying as donor candidates to HLA-typing laboratories, 527 (63.3%) had HLA 6/6 identical family donors. Among 527 full-matched donors, 479 (90.9%) were sibling, 21 (4.0%) were fathers, and 17 (3.2%) were mothers. The remaining 10 (1.9%) were other relatives. The results have shown that the unfavorable factor of consanguinity marriage may increase the availability of family donors for HSCT in particularly developing countries where large donor registries are lacking.

The major aims of correction of hypospadias include construction of a neourethra, removal of the chordee, and reduction of the probability of postoperative fistulization. Here, we describe a new technique that can be easily used in cases with subcoronal distal penile hypospadias (even those with chordee) for the construction of the urethra using meatus-based transverse flaps. This new technique was used in 10 patients (mean age, 4.6 years). There were no complications such as fistula formation, chordee recurrence, hematoma formation, or flap necrosis during the follow-up period (mean follow-up period, 13.4 months). We believe that this surgical technique can be used in cases with chordee, carries a low risk of fistula formation, has the advantage of the use of richly vascular flaps for construction of the urethra, and yields a better cosmetic result. Hence, it can safely be used for surgical correction of distal hypospadias.

Of the 488 pediatric patients with thrombosis in a single center, 50 (10.2%) had nonstroke arterial thrombosis. Half of the nonstroke arterial thrombosis patients had a preceding arterial catheterization history. Infection was a common contributing underlying disorder among both catheterized and overall groups (28 and 42%, respectively). The third most common underlying risk factor for development of arterial thrombosis was associated cardiac disease, and 70% of these patients had congenital heart disease and 30% had dilated cardiomyopathy. The most common site of arterial thrombosis was the heart, and 22% of the patients developed arterial thrombosis following cardiac surgery for congenital heart diseases. The prothrombotic risk factors were also analyzed in the study group and factor V G1691A and PT G20210A heterozygous mutations were detected to be higher (16 and 4%, respectively) than those in healthy controls (7.4 and 2.3%, respectively). In addition to factor V G1691A and PT G20210A mutations, other prothrombotic risk factors including protein C and protein S deficiencies and elevated factor VIII levels were commonly associated with pediatric nonstroke arterial thrombosis cases in the present study. This finding indicates the importance of these factors in arterial thrombosis development, similar to venous thrombosis. Another striking factor of the study is the higher number of prothrombotic risk factors (more than three) in patients who had persistent thrombosis, indicating the need for more intensive treatment in these patients. Blood Coagul Fibrinolysis 19:519-524 © 2008 Wolters Kluwer Health Lippincott Williams & Wilkins.

Osteonecrosis is a rare and serious complication that can be developed during or after treatment for acute lymphoblastic leukemia (ALL). The incidence of symptomatic osteonecrosis related to ALL treatment is 1.6-9.3%. High-dose steroid therapy is the major risk factor for osteonecrosis. The pathophysiology is unclear. It is thought that osteonecrosis occurs due to steroid use causing thromboembolism in sinusoidal veins leading to hypoxia resulting in decreased osteoblast activity and increased osteoclast activity. Magnetic resonance imaging is the most sensitive diagnostic method in early period. We present two girls, 15 and 14-year-old, in whom osteonecrosis developed during ALL maintenance therapy., Osteonekroz; çocuklarda akut lenfoblastik lösemi tedavisi sırasında veya sonrasında nadir görülen fakat ciddi sorunlara yol açabilen bir komplikasyondur. Yapılan çalışmalarda ALL tedavisi alan çocuklarda semptomatik osteonekroz insidansı %1,6-9,3 olarak bulunmuştur. Yüksek doz steroid tedavisi en önemli risk faktörüdür. Osteonekrozis fizyopatolojisi tam olarak açıklanamamıştır. Kortikosteroidlerin, sinüzoidal venlerdeki tromboembolilere bağlı mekanik tıkanmaya neden oldukları bunun sonucunda kan akımının azalmasıyla birlikte hipoksiye bağlı olarak osteoblast aktivitesinin azalıp, osteoklast aktivitesinin artmasıyla oluştuğu düşünülmektedir. Osteonekroz tanısında manyetik rezonans görüntüleme erken dönemde en duyarlı tanı yöntemidir. Burada ALL tanısıyla takip edilirken idame tedavisi sırasında osteonekroz gelişen 15 ve 14 yaşlarında 2 kız hasta sunulmuştur

Objective: Outpatient anesthesia requires a safe anesthetic method and an anesthetic agent that provides a rapid anesthesia depth and hemodynamic stability. To provide an uneventfully recovery, the anesthetic must also be rapidly metabolized, and its metabolites should not accumulate in the body. This study compared sedo-analgesia effects, recovery times, postoperative complications, Modified Aldrete Scale, Visual Analog Scores, and patient and surgeon satisfaction between propofol and ketofol, administered as anesthetics during the probe curettage procedure.Methods: A total of 60 female patients included in the study. Group P was administered 2 mg/kg of propofol and a 1 μg/kg intravenous bolus of fentanyl for induction and 100 μg/kg/min of propofol for maintenance. Group K was administered a 600 µg/kg IV bolus of ketofol for induction and 100 µg/kg/min of ketofol for maintenance. Additional fentanyl (50 µg) was administered to Group P, and 25 µg/kg/min of ketofol was administered to Group K according to autonomic and hemodynamic responses.Results: Demographic data of the 2 groups were similar. A significant decrease in hemodynamic values was detected in patients in Group P after induction. No change in these values was detected during or after induction in Group K. The additional analgesia requirement was 66.6% in Group P. Nausea was detected in 2 patients in Group K. Additionally, hallucination was detected in 2 patients in Group K. Patient and surgeon satisfaction were complete in both groups.Conclusion: According to our findings, ketofol anesthesia may be a good option in uterine curettage, patients recover quickly and comfortably, and ketofol both provides sufficient analgesia for the minor surgical intervention and reduces complications. J Clin Exp Invest 2015; 6 (3): 244-250Key words: Ketofol, propofol, sedo-analgesia, uterine curettage, Amaç: Günübirlik anestezi, hemodinamik stabiliteyi koruyacak ve anestezi derinliğini hızla sağlayacak bir anestezik ajan ile güvenli bir anestezi metodu gerektirir. Sorunsuz bir uyanma sağlamak için anestezik ilaçlar hızla metabolize olmalıdır ve metabolitleri vücutta birikmemelidir. Bu çalışma da; probe küretaj işlemi uygulanacak hastalarda, propofol ve ketofol anestezisinin sedoanaljezik etkisine, uyanma zamanına, postoperatif komplikasyonlara, Modifiye Aldrete Skalasına, Visüel Analog Skoruna, hasta ve cerrah memnuniyetine bakmayı amaçladık.Yöntemler: Çalışmaya 60 kadın hasta alındı. Grup p’ye indüksiyonda intravenöz 2 mg/kg propofol ve 1μg/kg fentanyl uygulandı. İdamede propofol 100 μg/kg/dk ile devam edildi. Grup K’ya ise indüksiyonda intravenöz 600 µg/kg ketofol ve idamede 100µg/kg/dk ketofol verildi. Otonomik ve hemodinamik cevaplara göre Grup P’ye 50 µg fentanyl, Grup K’ya ise 25µg/kg/dk ketofol ek doz yapıldı. Bulgular: Her iki grupta demografik veriler benzerdi. Grup P’de indüksiyondan sonra hemodinamik parametrelerde belirgin bir düşme görüldü. Grup K’da indüksiyondan sonra hemodinamik parametrelerde herhangi bir değişiklik gözlemlenmedi. Grup P’de ek analjezik gereksinimi %66,6 idi. Grup K’da 2 hastada bulantı ve 2 hastada halüsinasyonlar görüldü. Hasta ve cerrah memnuniyeti her iki grupta tamdı. Sonuç: Bizim bulgularımıza göre küçük cerrahi girişim olan uterin küretaj da Ketofol anestezisi iyi bir seçenektir. Hasta da rahat ve hızlı bir uyanma sağlar, ayrıca minör cerrahi girişimlerde analjezi gereksinimini azaltarak postoperatif komplikasyonları da azaltır

Vitamin B12’s main function is to support DNA synthesis required for cell division or proliferation in combination with folic acid. Pancytopenia can be seen in vitamin B12 deficiency. Often preferred parenteral treatment to oral treatment in vitamin B12 deficiency, especially of condition associated with thrombocytopenia oral alternatives are considered. Oral therapy is known fascilitating the adherence treatment in pediatric patients. In this article, 16-year-old girl is presented, followed by our clinic wih the diagnose of vitamin B12 and folic acid deficiency and then followed pansitopenic, treated by oral administration of intramuscular cobalamin preperates and oral folic acid. However, studies are needed with larger sample, to show the effectiveness of each treatment compared to each other., Vitamin B12’nin temel fonksiyonu, folik asit ile birlikte hücre bölünmesi veya çoğalması için gerekli olan DNA sentezini desteklemesidir. Eksikliğinde pansitopeni görülebilmektedir. Vitamin B12 eksikliğinde çoğunlukla parenteral yol tercih edilmekte beraber, trombositopeninin eşlik ettiği durumlarda oral tedavi alternatifleri düşünülmektedir. Oral tedavinin pediatrik hasta grubunda tedaviye uyumu da kolaylaştırdığı bilinmektedir. Bu yazıda, kliniğimizde vitamin B12 ve folik asit eksikliği tanısı ile takip edilen ve pansitopenik olması nedeniyle oral folik asite ek olarak intramuskuler kobalamin preperatının oral yoldan verilmesiyle tedavi edilen 16 yaşında kız olgu sunulmuştur. Ancak tedavilerinin birbirine olan üstünlüklerini göstermek için geniş örneklemle çalışmalar gerekmektedir.

Not Available

Hypercalcemia is rarely observed in acute lymphoblastic leukemia. So far, all cases presenting with hypercalcemia are pre-B cell ALL. In this case, a mature B-cell ALL patient presenting with hypercalcemia is discussed. A threeyear-old boy had a history of fever, weakness, swelling and pain in both kness. In the patient’s blood smear, 93% L3 type blasts were seen and 90% L3 type large blasts with vacuoles were seen in the bone marrow aspiration smear. The flow cytometry results were as follows: CD10: 87%; CD19: 85%; KAPPA: 66%; and Lambda: 35% was compliant with mature B cell ALL. His calcium level: 15 mg/dl. Although previous cases imply that hypercalcemia is usually treated with pamidronate, calcium levels gradually decreased to normal levels within five days with intravenous fluid therapy, furosemide, and steroids in our case. Conclusion: Hypercalcemia is rare in leukemia. So far, all cases presenting with hypercalcemia are pre-B cell ALL. It is important to know that hypercalcemia could be seen in the mature B-cell ALL.

Journal of Neuroradiology - In Press.Proof corrected by the author Available online since samedi 8 novembre 2014

Dört yaşında erkek hasta, sağ göz etrafında şişlik ve göz kapağında düşüklük şikayeti ile başvurdu. Hastanın bilgisayarlı tomografi görüntülemesinde sağ orbital lateral duvarda kemik yıkımı olduğu görüldü. Histopatolojik incelemesinde kronik inflamasyon ile uyumlu eosinofilden yoğun infilamasyon saptandı. Oral prednizolon tedavisi verilen hastanın klinik bulgularının ve kontrol tomografisinde kemik yıkımının düzeldiği gözlendi. Hastamız araştırmalarımıza göre kemik yıkımına neden olan ilk pediatrik orbital psödotümör vakası olmasıdır., A four-year-old boy was administered with periorbital swelling and ptosis of his right eye. His computerized tomography scans showed bone destruction of right orbital lateral wall. In his histopathological examination there was eosinophil dominant cell infiltration, which was compatible with chronic inflammation. He was treated with oral prednisolone. After treatment complete resolution of bone destruction and clinical improvement were observed. To the best of our knowledge this was the first pediatric case with orbital pseudotumor causing bone destruction.

We aimed to investigate the effects of vitamin B12 deficiency on hemorheological parameters, and the changes in these parameters following vitamin B12 treatment. 33 patients (mean-age:7±5.7 years) diagnosed as nutritional vitamin B12 deficiency, and 31 age and sex matched controls (mean-age:7.1±5.2 years) were enrolled. Erythrocyte deformability and aggregation were determined by an ectacytometer, plasma and whole blood viscosities by a cone-plate rotational viscometer. The differences between patients and controls were compared. Hemorheological parameters were repeated in the patient group following vitamin B12 treatment, and the results were compared with the initial results. In vitamin B12 deficiency, erythrocyte deformability and whole blood viscosity were found to be significantly decreased, eythrocyte aggregation was found to be significantly increased compared with the controls. Plasma viscosity was found to be decreased in deficiency but this decrease was not statistically significant. In patient group, erythrocyte deformability, whole blood and plasma viscosities were found to be significantly increased and erythrocyte aggregation was significantly decreased, after treatment. This study indicates that vitamin B12 deficiency has important effects on hemorheological parameters and adequate treatment of deficiency not only corrects the hematological parameters, but also by helping to normalize the hemorheological parameters, may contribute to the regulation of microvascular perfusion. © 2015 - IOS Press and the authors. All rights reserved.