Biomedical subjects

M Yilmaz

Publications and source records attributed to M Yilmaz.

121 records · Page 7Linked to original sources

PubMedDate not supplied

Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 years old girl.

We describe a 4-year-old girl with asthma who presented with pneumomediastinum, pneumopericardium and subcutaneous emphysema. She was admitted to our hospital with dyspnea, chest pain, palpitation and cough of two days duration. She had attacks of cough, dyspnea and wheezing from two years of age, but she did not have a diagnosis of asthma previously. She was dyspneic and had subcutaneous emphysema in the neck, axilla and thorax. In the skin prick test (Center Lab. USA) she had positive reaction to Dermatophagoides pteronyssinus, Dermatophagoides farinae, mold mix, tree mix and grass mix. Pulmonary function tests could not be performed. In the chest X-ray air was seen in mediastinum and subcutaneous area and the epicardium was surrounded completely with air. She was treated successfully with inhaled salbutamol and budesonide. Radiological signs of pneumopericardium and pneumomediastinum disappeared completely in ten days period. In the light of this case we want to mention that early diagnosis and treatment of asthma should be done to prevent serious complication of asthma.

Albuterol↗

PubMedDate not supplied

The effects of long term use of inhaled corticosteroids on linear growth, adrenal function and bone mineral density in children.

In this study we aimed to investigate the long term effects of inhaled steroids on linear growth, adrenal function and bone mineral density. Thirty children with moderate asthma were randomly divided into two groups. Fifteen children (8 boys, 7 girls mean age; 10.6 +/- 2.1) were treated with budesonide (group 1), and 15 (9 boys, 6 girls, mean age; 9.6 +/- 2.4). with fluticasone propionate (group 2). Control group included 30 children. Anthropometric assessment, symptom and medication scores, pulmonary functions, bone mineral density, serum and urine cortisol levels and ACTH stimulation test were evaluated at the beginning of the study and after one year period. Symptom and medication scores, pulmonary functions improved significantly in both groups (p < 0.05). The mean annual growth was similar in group 1 and 2 and control group. Bone mineral density was comparable with control group at the beginning of the study and after one year. Mean serum cortisol level diminished at the end of the therapy but no significant differences were found between the initial and end values in respect to urine cortisol levels and cortisol/creatinine ratio. Of three groups ACTH stimulation test revealed that there were no significant difference between study and control groups. In conclusion, although we did not observed any side effects of inhaled corticosteroids we suggest that children treated with inhaled corticosteroids for a long time should be followed closely with respect to side effects.

Administration, Inhalation↗

PubMedDate not supplied

Life-threatening facial edema due to pine caterpillar mimicking an allergic event.

BACKGROUND: Approximately 150 species of Lepidoptera have been described as causing damage to human skin. One of these species is the pine processionary caterpillar, which is responsible for dermatitis, contact urticaria, ocular lesions and rarely respiratory signs and anaphylactic reactions through IgE-mediated or non-IgE-mediated mechanisms. We report a pediatric case of severe orofacial edema mimicking an allergic reaction after ingestion of a pine processionary caterpillar; urgent airway intubation was required. CASE REPORT: A 15-month-old boy was sleeping under a pine tree when his mother noted a pine caterpillar on his tongue. Because of rapidly developing facial swelling and respiratory distress, the infant was first taken to a local hospital where he received intravenous dexamethasone and pheniramine hydrogen maleate. On arrival at our emergency department, diffuse swelling and edema involving the tongue, perioral, nasal and perimandibular regions, and neck was noted, requiring urgent orotracheal intubation. There were no findings of anaphylaxis. The results of skin prick tests and specific IgE to common aero- and food allergens were negative. A skin prick test with extract of pine caterpillar was also negative. Prednisolone and pheniramine hydrogen maleate were administered for 7 days. The child gradually improved and was successfully extubated 4 days later. CONCLUSION: Although oral contact with a pine processionary caterpillar in the form of ingestion is rare, it may cause significant local reaction and airway compromise mimicking an allergic event. In this situation, early intubation to maintain airway patency is a life-saving measure.

Airway Obstruction↗

PubMedDate not supplied

Ruptured and non-ruptured sinus of Valsalva aneurysms: five case studies.

Between 1987 and 2000, we observed retrospectively a series of five cases of surgically treated sinus of Valsalva aneurysms (SVAs) at the Department of Cardiovascular Surgery, Atatürk University, Erzurum, Turkey. The mean age of the five patients was 32.6 years (range, 18-48 years). Three were male and two were female. Aneurysms originated from the right coronary sinus in four patients, and from the non-coronary sinus in one. Three aneurysms fistulized to the right ventricle, one to the right atrium and the last, originating from the right coronary sinus, was non-ruptured. Two aortic insufficiencies, two ventricular septal defects, one patent ductus arteriosus and one left ventricular outlet obstruction were found as concomitant lesions. All cases were symptomatic. Ruptured SVAs were repaired by double approach involving both the chamber and aortic root. There was no late mortality either in the hospital or during the follow-up period (mean 40.4 months, range 13-66 months). No patient required re-operation.

Adolescent↗

PubMedDate not supplied

Multicentric cardiac myxoma treated with extended surgery.

We present the case of a 37-year-old male patient with a multicentric myxoma admitted to hospital with dyspnoea, syncope and chest pain. Physical examination revealed a grade 3/6 systolic murmur at the left lower sternal border and diffuse bilateral lung rales. Transthoracic echocardiography and thoraco-abdominal computed tomography revealed a right atrial mass and a right ventricular mass obstructing the outflow tract. The patient underwent urgent surgical treatment. At operation, a solitary right atrial myxoma and a right ventricular myxoma originating from the tricuspid valve and attached to the free wall of the right ventricle were seen. The tumours were successfully excised and the tricuspid valve was replaced with a No. 33 Omnicarbon metallic valve. The right ventricular free wall was repaired with a glutaraldehyde-treated pericardial patch. Histopathological examination of the tumours confirmed the diagnosis of myxoma. Post-operative recovery was uneventful and there was no recurrence after 1 year's follow-up.

Adult↗

PubMedDate not supplied

A case of truncus arteriosus type II.

A case of truncus arteriosus type II is reported. Truncus arterious is an uncommon congenital cardiac defect where a single great vessel exits the heart. Truncus arteriosus is usually fatal, if untreated. This defect occurs when the conus arteriosus and the truncus divide erroneously in the embryo. Palliative surgery in truncus arteriosus has been unsuccessful. Pulmonary banding has been tried and was ineffective and usually fatal. We operated on a nine-month-old (6200 g) male infant with a type II (Edwards-Collett) defect and a large ventricular septal defect. The pulmonary artery average pressure was 51 mmHg. We performed a cardiopulmonary bypass in the usual manner. Pulmonary arteries were resected from the truncal root, and primary end-to-end anastomosis of the truncal root to the ascending aorta was performed. Right ventricle to pulmonary artery continuity was provided using a valveless Gore-Tex graft. We lost our patient due to intractable pulmonary hypertension on the first postoperative day.

Anastomosis, Surgical↗

PubMedDate not supplied

Comparison between the use of adsorbed and aqueous immunotherapy material in Dermatophagoides pteronyssinus sensitive asthmatic children.

BACKGROUND: dermatophagoides pteronyssinus (Der PI) is the major allergen which causes allergic asthma and perennial rhinitis. The extracts of Der PI may be used in treatment of patients who are unresponsive to pharmacological treatment and avoidance of allergens. The success of immunotherapy (IT) depends on the selection of appropriate patients and allergens as well as a regular follow up. OBJECTIVE: three different groups of IT materials and a placebo were tested on 34 patients with Der PI sensitive asthma. Clinical evaluations of allergen challenge and in vitro immunologic tests were made on the patients before, on the 6th month and at the end of the second year of IT. The results were compared to the placebo treated group. RESULTS: there were no significant differences among the groups in regard to age, sex and duration of illness. The time required for reaching the maintenance dose for group I (Alutard), II (APSI retard Ca) and III (Greer ) was 15.40 +/- 0.69, 18.2 +/- 4.0 and 108 +/- 33 weeks, respectively. Even though there was some significant difference between those receiving aqueous IT and the placebo (p < 0.05), there was a greater significant difference between those receiving adsorbed IT and placebo (p < 0.00001). Also there was a significant difference between the I and II groups receiving adsorbed IT. There was no significant difference in the maximum tolerated doses between group I and II (p > 0.05), but significant differences was found between group III and the other two groups (p < 0.05). Specific IgE levels were not changed by IT. There were no differences in the side effects scores among the groups (p < 0.05). The maximum tolerated dose of the diluted skin prick test (DSPT) solution increased significantly after 6 months and two years treatment as compared to the dose before specific immunotheraphy (SIT). Significant differences were found between group III and group I or group II as well as between the groups under treatment and that group given a placebo (p < 0.05). The maximum tolerated dose with the bronchial provocation test (BPT) increased significantly after IT (p < 0.05). The differences between the groups under treatment and that given a placebo were significant (p < 0.05). A significant increase was detected in the levels of the Der PI specific IgG4 after IT (p < 0.01). The difference between the treatment groups and the placebo group was significant. There was a significant difference between group I and the other groups (p < 0. 05) but differences between group II and III was not significant (p > 0.05). No significant correlation was found between (1) spIgE and the symptom medication score (SMS) (2) sp IgE and spIgG4 (3), DSPT and BPT. A significant positive correlation was found between the maximum tolerated dose with DSPT and increase in spIgG4 (r = 0.33, p = 0.046). A negative correlation was found between SMS and spIgG4 (p = 0.012, r = -0.42) after IT. CONCLUSION: SIT with Der PI is an effective and reliable treatment in allergic asthmatic children. Adsorbed extracts may be preferable to in childhood because of effectively, safety, tolerability and, fewer numbers of injection. The best IgG4 response and velocity of maintenance doses achieved was found in group I. Easy, cheap and safe parameters such a SMS and DSPT can be useful for a follow-up of SIT. Further investigation is required to determine which one of the products is the best.

Adolescent↗

PubMedDate not supplied

The effects of daily pulmonary rehabilitation program at home on childhood asthma.

OBJECTIVE: the aim of this study is to investigate the efficacy of pulmonary rehabilitation program in children with asthma. PATIENTS AND METHOD: twenty eight children with mild persistent or moderate asthma were included into a double blind, randomised study. Sixteen children (9 girls, 7 boys) with the mean age of 10.8 +/- 2.3 were assigned to receive pulmonary rehabilitation program with their parents for 30 days (group I). Control group included 12 children (6 girls, 6 boys ) with the mean age of 10.2 +/- 2.4 (group II). Symptom and medication scores quality of life index and pulmonary function tests were evaluated in rehabilitation and control group in the beginning of the study and after the one month period. RESULTS: the groups did not differ on all parameters before the study (p > 0. 05). Statistically significant decrease were found in symptom and medication scores in rehabilitation group (p < 0.05) and quality of life index was increased significantly in the same group (p < 0.05). Pulmonary function measures also significantly improved including vital capacity, forced vital capacity, FEV1, PEF and FEF25-75 in the rehabilitation group (p < 0.05). The best improvement were seen in FEF25-75 (10.09% increase) and PEF (7.81% increase) values. In control group no statistically significant differences were found in all parameters. CONCLUSION: in this study it was shown that daily pulmonary rehabilitation at home could improve quality of life and pulmonary functions. So pulmonary rehabilitation should be placed as a component of management in childhood asthma.

Anti-Asthmatic Agents↗

PubMedDate not supplied

Comparison of conventional and rush immunotherapy with der PI in childhood respiratory allergy.

BACKGROUND: Rush immunotherapy results obtained in Der PI-sensitive children with asthma and the changes in clinical and immunological parameters were investigated. METHODS: We studied 18 patients with Der PI sensitivity. Two groups were randomized: nine patients received RIT and nine patients received conventional immunotherapy (CIT) for three years. The RIT group reached the optimal maintenance dose at the end of one week. The CIT group reached the optimal maintenance dose in approximately three months. Symptom medication scores, lung function, side effects scores, skin-prick test, diluted skin-prick test with Der PI, bronchial provocation tests with Der PI, and Der PI-specific IgE and IgG4 were investigated in baseline conditions, at six months and at the end of the third year. RESULTS: There were no significant differences between groups in age, sex, and duration of illness. Treatment was tolerated very well. However, mean side-effect scores were higher in the RIT group than in the CIT group (p < 0.005). There were no significant differences between groups in the other parameters. CONCLUSION: CIT is more advantageous than RIT in Der PI-sensitive children, although the maintenance dose was achieved more rapidly with RIT.

Allergens↗

PubMedDate not supplied

Hereditary angioedema: case report of a family.

Hereditary angioedema (HAE) is a rare disease resulting from deficiency of complement 1 esterase inhibitor (C1-INH). The clinical manifestations of this disease include recurrent attacks of self-limiting edema affecting face, extremities, gastrointestinal system and upper airways. In this report, we present eleven members of a family with HAE. Edema of the extremities was the most common symptom, occurring in ten patients. Three patients experienced severe laryngeal edema that required tracheotomy. Three patients developed facial and scrotal edema. Three patients experienced severe abdominal pain. The mean age at onset of symptoms was 11 years. C1-INH levels were undetectable in two patients and low in nine patients. CH50 was undetectable in all of the patients. C4 level for all patients was low. HAE in our first case, a 10-year-old boy, was diagnosed on the basis of low C1-INH, CH50 and C4, in addition to his familial history. Eleven members of this family, for whom laboratory studies could not be done, had similar symptoms and course. Two patients died as a result of laryngeal edema before establishment of diagnosis. This case report indicates the importance of recognition and early treatment of HAE to prevent a potentially fatal outcome.

Adult↗

PubMedDate not supplied

Assessment of the ear and otoacoustic emission findings in fibromyalgia syndrome.

OBJECTIVE: We aimed to assess otoacoustic emission (OAE) findings in fibromyalgia (FM) syndrome. METHODS: Thirty-two ears of 16 female patients with FM syndrome and 30 ears of 15 healthy female controls were also included in the study. Pure tone audiometry, speech discrimination testing, tympanometry and otoacoustic emission testing (both transiently evoked and distortion product) were performed. RESULTS: There was no significant difference between the pure tone hearing results of the patients and controls (p > 0.05). There was no significant difference between the distortion-product-otoacoustic emission results of the patients and controls. Audiologic findings of the patients with and without otologic symptoms were not significantly different than controls (p > 0.05). CONCLUSION: Although FM patients generally have subjective symptoms related to ear, clinical or laboratory assessments usually fail to find out any objective finding related to these subjective symptoms. The otologic functions seem spared in FM syndrome.

Adult↗

PubMedDate not supplied

The frequency of IgG subclass deficiency in children with recurrent respiratory infections.

We studied the frequency of IgG subclass deficiency in 61 children (ages 1-7 years, mean 3.8 years) with recurrent respiratory tract infections by using the radial immunodiffusion method. The overall frequency of IgG subclass deficiency was found to be 39.3 percent (24 patients). Among 26 children who had major immunoglobulin abnormalities, we found IgG subclass deficiency in 11 patients (42.3%). In children with normal immunoglobulin levels, the frequency of IgG subclass deficiency was 37.1 percent (13 patients).

Child↗

PubMedDate not supplied

Management of foreign body aspiration in infancy and childhood. A life-threatening problem.

It is well known that young children have tendency to place objects in their mouths, frequently leading to aspiration of foreign bodies (FBs) into the tracheobronchial tree (TBT). The patient group comprised 596 patients with a history of suspected aspiration of FBs into the TBT who were bronchoscoped for diagnosis and treatment. There were 306 male (51.3%) and 290 female (48.7%) patients, with a mean age of 2.4 years (range 3 months-13 years). Sunflower seeds and hazelnuts were the most common FBs that were extracted using an open-tube rigid bronchoscope (Storz, Germany) and suitable coaxial forceps (Storz, Germany). Patients admitted within 48 hours following the aspiration numbered 341 (57.2%). The distribution of FBs between the right and left lung and trachea was 53, 37 and five percent, respectively. The aspirated material was visible on the chest x-ray in only 10 percent cases, which facilitated in making the diagnosis. Despite a history of aspiration, bronchoscopy was negative in 21 (3.4%) of the cases. Thoracotomy and subsequent bronchotomy was the treatment of choice in seven (1.5%) and lobectomy in two (0.3%) cases. Cardiorespiratory arrest was observed in five (0.8%) cases, three of whom (0.5%) died during bronchoscopy (2 cases) or thoracotomy (1 case). In conclusion, patients with FB aspiration are rapidly recognized from their histories and easily treated by bronchoscopy and extraction of the aspirated foreign body. A high index of suspicion is crucial for early diagnosis. However, education is the best preventive measure for decreasing the incidence of this problem.

Airway Obstruction↗