Browsing by Author "Coskun, S"

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    A province-based study using sampling method to investigate the prevalence of cystic echinococcosis among primary school children in Manisa, Turkey
    Ok, UZ; Özkol, M; Kilimcioglu, AA; Dinç, G; Bayindir, P; Östan, I; Pabusçu, Y; Özcan, C; Korkmaz, M; Coskun, S; Yüksel, H; Girginkardesler, N
    A province-based field study using a portable ultrasound scanner (US) was performed for the first time using sampling method to investigate the prevalence of cystic echinococcosis (CE) in primary school children in Manisa, Turkey. A total of 6093 children from 37 primary schools was selected as the representative sample of the total number of 166,766 primary school children, and examined by the US. Prevalence was found to be 0.15%, as nine children were diagnosed with CE, seven new and two previously operated. A questionnaire applied to the children revealed no significant relationship between the risk factors and the infection (P > 0.05). In conclusion, it would be advisable to repeat the study at the same schools in eight years' time, in order to evaluate the efficacy of the control programs, since nearly all students involved in this study will have graduated by then. Besides, it is recommended to choose a sampling group to find the prevalence of an infection in a defined region. (c) 2007 Elsevier B.V. All rights reserved.
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    Clarithromycin-Induced Long QT Syndrome: A Case Report
    Cetin, M; Yildirimer, M; Özen, S; Tanriverdi, S; Coskun, S
    Long QT syndrome develops for a number of reasons. The number of non-antiarrhythmic drugs reported to induce QT interval prolongation with or without torsade de pointes continues to increase. Clarithromycin is a macrolide antibiotic being increasingly used for the treatment of atypical pneumonia. In this paper, we describe a patient who developed long QT prolongation syndrome after receiving clarithromycin for the treatment of atypical pneumonia.
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    Omalizumab in patients with severe persistent asthma in real life setting in Manisa, Turkey
    Havlucu, Y; Yorgancioglu, A; Kurhan, F; Özdemir, L; Coskun, S; Goktalay, T; Yilmaz, O; Celik, P
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    Henoch-Schonlein purpura, post-streptococcal glomerulonephritis and acute rheumatic carditis after Group A β-haemolytic streptococcal infection
    Çamlar, SA; Soylu, A; Akil, I; Ünlü, M; Coskun, S; Ertan, P; Kavukçu, S
    Besides association with acute rheumatic fever (ARF) and acute glomerulonephritis (APSGN), in up to 40% of cases, Group A beta-haemolytic streptococcal (GABHS) infections are also implicated as a trigger for Henoch-Schonlein purpura (HSP). A 7-year-old girl with GABHS throat infection who developed HSP, APSGN and rheumatic carditis is reported. She presented with palpable purpura and arthritis in both ankles and later developed carditis characterised by mitral/aortic regurgitation and glomerulonephritis characterised by mixed nephritic/nephrotic syndrome. She had a raised anti-streptolysin titre (ASOT), blood urea nitrogen and creatinine and hypocomplementaemia (C-3), and renal biopsy demonstrated endocapillary and extracapillary proliferative glomerulonephritis with crescents. Immunofluorescence microscopy demonstrated a full house' of immunoglobulin and complement, viz. IgA+2, IgG+3, IgM+2, C(3)c+1, Clq+2 with predominantly IgG deposition. One week earlier, her 4-year-old sister had presented to another hospital with HSP complicated by microscopic haematuria, nephrotic-range proteinuria and gastro-intestinal involvement, and with raised ASOT and low C-3 levels. Although HSP has been associated with either ARF or APSGN, this is the first case of a child with HSP, ARF and APSGN in combination.
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    Asymmetric dimethylarginine levels and diabetes duration: Relationship with measures of subclinical atherosclerosis and cardiac function in children and adolescents with Type 1 diabetes
    Ersoy, B; Eroglu, N; Çetin, M; Onur, E; Özkol, M; Coskun, S
    Aims: We aimed to evaluate asymmetric dimethylarginine levels in young patients with Type 1 diabetes mellitus according to diabetes duration and to examine the relationship between these levels and measures of atherosclerosis and myocardial function. Materials and methods: In total, 83 patients (8.5-22years) with Type 1 diabetes mellitus were stratified by diabetes duration: 12-60months (Group 1, n=27), >60-120months (Group 2, n=29) and >120months (Group 3, n=27). Asymmetric dimethylarginine levels were assessed. Carotid intima-media thickness was measured. Myocardial function was assessed by M-mode, conventional Doppler and tissue Doppler echocardiography. Results: Asymmetric dimethylarginine level was significantly higher in Group 1, while carotid intima-media thickness was significantly greater in Group 3 (p<0.05). Tissue Doppler echocardiography showed the ratio of peak early to peak late diastolic myocardial annular velocity decreased significantly in Groups 2 and 3 with a negative correlation with duration (r: -0.310, p=0.004) and HBA1c levels (r=-0.391, p<0.001). Myocardial performance index in all groups and isovolumic relaxation time in Group 3 increased significantly. Asymmetric dimethylarginine levels were negatively correlated with carotid intima-media thickness and isovolumic relaxation time (p<0.05). Conclusion: In contrast to adult diabetics, asymmetric dimethylarginine concentration decreases as diabetes duration increases in young Type 1 diabetic patients and is associated with worsening measures of cardiovascular risk and poorer diastolic function.
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    Evaluation of the Relationship Between Systemic Hypertension and Subfoveal Choroidal Thickness Using Optical Coherence Tomography in Pediatric Patients
    Alkan, F; Sen, S; Çavdar, E; Mayali, H; Coskun, S
    Objective: Hypertension (HT) can cause vascular and microvascular changes. There is no barrier between systemic blood and ocular region. Changes in choroidal perfusion pressure due to HT may impair retinal function and oxygenation, and subfoveal choroidal thickness (SCT) may be affected by these changes. The aim of this study was to evaluate the effect of arterial HT on SCT in children. Method: The study was performed on 102 cases (51 patients and 51 controls), prospectively. Optical coherence tomography was used for the measurement of SCT and mean values of 3 consecutive measurements were evaluated. All cases had blood pressure measurements during all day via ambulatory blood pressure monitoring. Also, both groups were evaluated for the target organ damage. Results: There were 51 cases in patient group with the average age of 14.4 +/- 2.8 years, and the rest of 51 control cases were meanly 14.5 +/- 2.8 years in age (p=0.980). SCT was measured thinner in patients with target organ damage than the cases without target organ damage (p=0.027). SCT measurements of patients and control cases were not statistically significant different (p=0.569). Especially SCT was statistically significantly thinner in cases with increased left ventricular mass, left ventricular mass index and hypertensive nephropathy (p=0.02, p=0.00, p=0.039, respectively). Conclusion: Choroidal thickness decreases in patients with HT who develop target organ damage. Therefore, close follow-up of hypertensive patients with appropriate life changes and medical treatments is important before target organ damage develops.
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    Evaluation of markers of inflammation, insulin resistance and endothelial dysfunction in children at risk for overweight
    Akinci, G; Akinci, B; Coskun, S; Bayindir, P; Hekimsoy, Z; Özmen, B
    OBJECTIVE: Childhood obesity is associated with impaired endothelial function, insulin resistance and inflammation. Being at risk for overweight has been defined as having a body mass index (BMI) between the 85(th) and 94(th) percentile for age and sex. In this study, we looked for features linked to cardiovascular, risk in children who are at risk for overweight. DESIGN: Twenty-one children who were at risk for overweight (study group) and 20 children with a BMI between the 25(th)-74(th) percentiles (controls) were studied. Fasting blood levels of glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, uric acid, fibrinogen and high sensitive C-reactive protein (CRP) were assessed in both groups. LDL-cholesterol, HOMA-IR and QUICKI indices were calculated. Flow-Mediated Vasodilatation (FMD) was determined for the evaluation of endothelial function. RESULTS: Increased HOMA-IR was observed in children who were at risk for overweight. Waist circumference was the main predictor of insulin resistance in these children. Higher levels of CRP were found in the study group compared to controls, while plasma fibrinogen died not differ in the two groups. The children who were at risk for overweight had lower FMD values and slightly elevated lipids compared to controls; however, these differences were not statistically significant. CONCLUSION: Insulin resistance and inflammation indices were higher in children who were at risk for overweight as has been shown for obese children. The data suggest that appropriate treatment strategies for weight control are essential not only for obese children but also for those at risk for overweight.
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    The role of brain natriuretic peptide in the prediction of cardiac performance in coronary artery bypass grafting
    Saribulbul, O; Alat, I; Coskun, S; Apaydin, AZ; Yagdi, T; Kiliccioglu, M; Alayunt, EA
    The relationship between brain natriuretic peptide and cardiopulmonary bypass has not been examined sufficiently In this study, we prospectively examined brain natriuretic peptide levels in the plasma of 26 patients undergoing coronary artery bypass grafting. Brain natriuretic peptide measurements were carried out at 4 times: preoperatively, 3 hours after institution of cross-clamping, 24 hours after institution of cross-clamping, and on the 5th postoperative day. In addition, we measured individual variables and compared them to brain natriuretic peptide levels. Mean preoperative brain natriuretic peptide levels were significantly higher in patients with histories of myocardial infarction (P = 0.0047) and heart failure (ejection fraction less than or equal to0.40) (P = 0.0001). There was a significant correlation between preoperative brain natriuretic peptide levels and cross-clamp times (P = 0.028), and an inverse correlation between those levels and preoperative cardiac indices (P = 0.001). The preoperative brain natriuretic peptide level also correlated inversely with left ventricular ejection fraction before (P = 0.001) and 5 days after (P = 0.01) operation. When the Clinical Severity Scoring System was applied, preoperative brain natriuretic peptide plasma concentrations in 19 patients with risk scores of 0-2 were significantly lower than in the 7 patients whose risk scores were 3-6 (P = 0.006). There was also a significant relationship between preoperative brain natriuretic peptide plasma concentrations and the postoperative requirement for inotropic agents (P = 0.027). This study suggests that plasma brain natriuretic peptide concentration could be one of the predictors of risk in patients undergoing coronary artery bypass grafting.
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    Cardiac functions in children with growth hormone deficiency: Effects of one year of GH replacement therapy
    Alkan, F; Ersoy, B; Kizilay, DO; Coskun, S
    Introduction: Children with Growth Hormone deficiency (GHD) are prone to heart dysfunction and, if left untreated, will result in marked cardiac dysfunction in adulthood. The aim was to evaluate the effect of GHD and growth hormone (GH) therapy on cardiac structure in children and adolescents, and to investigate the role of insulin like growth factor-1 (IGF-1) in this. Methods: M-mode, pulse-wave Doppler echocardiography and tissue Doppler imaging (TDI) were performed in 49 children with GHD who were divided into those with a peak GH response < 7 mu g/L and 7-10 mu g/L after two GH stimulation tests, aged 8-16 years at baseline and at six and 12 months after GH initiation, and 49 healthy peers. IGF-1 concentration was measured. Results: Although the left ventricular end diastolic and systolic diameters in both GH deficient groups were significantly lower than controls (p < 0.01), both diameters increased significantly with one year of treatment and achieved normal values (p > 0.05). Using TDI in both two patients group revealed increased E/A, prolonged isovolumic relaxation time, shortened ejection time, and a significant increase in myocardial performance index compared to controls (p < 0.001). Significant improvement was observed in these parameters from the sixth month of GH treatment (p < 0.001), this improvement does not match parameters measured in healthy peers, even after one year of treatment in both patients group. (p < 0.001). No correlation was found between IGF-1 concentration and any echocardiographic parameter. Conclusion: Echocardiographic parameters were similar in children with a GH peak < 7 mu g/L and 7-10 mu g/L. In TDI, both systolic and diastolic function was impaired in GHD children compared to controls. These parameters improved after one year of GH therapy but did not recover to healthy control levels.
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    Atherosclerosis risk factors in children of parents with the metabolic syndrome
    Akinci, G; Coskun, S; Akinci, B; Hekimsoy, Z; Bayindir, P; Onur, E; Ozmen, B
    Background: Metabolic syndrome is a constellation of disorders that produces a high risk of atherosclerosis. Endothelial dysfunction is the key event in atherosclerosis and already present even in the childhood. The aim of the present study is to investigate inflammatory and radiological signs of atherosclerosis in children who have parents with the metabolic syndrome. Design and methods: Fifty children of parents with the metabolic syndrome and 38 age- and sex-matched controls were studied. Anthropometric measurements, blood pressure assessment, echocardiography, flow-mediated vasodilatation (FMD) which is a non-invasive test for the evaluation of endothelial function and fasting blood measurements including blood glucose, insulin, total cholesterol, HDL cholesterol, triglyceride, hsCRP and soluble CD40 ligand were performed. Results: Serum sCD40L and hsCRP levels were significantly higher in the study group compared to the controls. FMD values did not differ between the study and control groups. Increased serum sCD40L levels were positively correlated with body mass index, waist hip ratio, LDL/HDL cholesterol ratio, and the number of metabolic syndrome components in parents, whereas showed negative correlation with the serum HDL cholesterol levels. High hsCRP levels were positively correlated with body mass index and the number of metabolic syndrome components. Multiple regression analysis demonstrated that the number of metabolic syndrome components in parents presented as being a significant predictor of the serum sCD40L and hsCRP levels of their children. Conclusion: Our results suggest that children of patients with metabolic syndrome have higher values of the serum markers of inflammation, which may be associated with increased risk for development of cardiovascular disease. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
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    Vein of Galen aneurysm that was diagnosed prenatally and supracardiac obstructed total anomalous pulmonary venous return with pulmonary hypertension: case report
    Tanriverdi, S; Baytur, Y; Tansug, N; Çetin, M; Coskun, S
    The vein of Galen aneurysm is the most common form of symptomatic cerebrovascular malformation in neonates and infants. This anomaly may be diagnosed prenatally by several imaging modalities and causes high cardiac output, which may lead to cardiac failure, in newborns. Total anomalous pulmonary venous return is a rare entity that makes up approximately 0.4%-2% of all congenital heart diseases. The most common type of total anomalous pulmonary venous return is the supracardiac type. The pulmonary veins drain to a confluence posterior to the heart and then to a vertical vein, most commonly on the left, which enters the innominate vein and the drains to the right atrium. Obstructed pulmonary veins with supracardiac- type total anomalous pulmonary venous return can cause severe cardiac and respiratory failure. In this article, a case of a neonate with a vein of Galen aneurysm diagnosed prenatally by magnetic resonance imaging, and a supracardiac obstructed type of total anomalous pulmonary venous return with pulmonary hypertension is presented.
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    Relation between Vascular Endothelial Markers and Right Ventricular Function in the Children with Asthma
    Cetin, M; Karaboga, B; Yilmaz, O; Yilmaz, M; Yuksel, H; Coskun, S
    Objectives: The aim of the study was to evaluate the possible relationship of clinical severity during asthmatic exacerbation with the ventricular functions and the levels of vascular endothelial-related biomarkers endothelin-1 (ET-1) and platelet-derived growth factor-BB (PDGF-BB) in the condensed breathing air in the children with asthma. Methods: The study included a total of 80 children with acute asthmatic episode; of these, 28 had a mild, 26 had a moderate, and 26 had a severe attack. Samples of condensed breathing air were obtained for being analyzed for ET-1 and PDGF-BB levels during the study. All patients were evaluated by echocardiography at the beginning of the study and two weeks after the treatment of asthmatic episode. Results: Before treatment, mPAP in moderate and severe asthma groups was significantly higher than in mild asthma group (21.6 +/- 7.3, 30.1 +/- 9.8 and 32.7 +/- 7.8; P < 0.01, P < 0.001, respectively). After treatment, no significant difference was detected between the asthma groups (P > 0.05). Am and Em waves, and IVRT, IVCT, ET and RV MPI during the asthmatic attack and after treatment did not change significantly between the groups; pre-and post-treatment values of these parameters also did not show significant differences. In exhaled air samples of the group with severe asthma exacerbation ET-1 and PDGF-BB were higher than those in the moderate and mild group (0.80 +/- 0.42, 0.58 +/- 0.30, 0.50 +/- 0.15; P = 0.002 and 281.7 +/- 253.2, 167.3 +/- 148.1, 135.9 +/- 74.9; P = 0.008 respectively). Conclusions: Ourstudy resultsshowedthatmPAPin direct proportion with the increasedinflammatory cytokineswassignificantly higher in asthma attacks and levels of ET-1 and PDGF-BB were significantly increased with severity of asthma, indicating a vascular response.
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    Evaluation of cardiac structure, exercise capacity and electrocardiography parameters in children with partial and complete growth hormone deficiency and their changes with short term growth hormone replacement therapy
    Alkan, F; Ersoy, B; Kizilay, DO; Ozyurt, BC; Coskun, S
    Purpose To evaluate cardiac structure, exercise capacity and electrocardiography (ECG) parameters of children with complete and partial growth hormone (GH) deficiency (GHD) and the effect of 12 months GH treatment on these. Methods M-mode echocardiography, ECG and exercise test expressed as metabolic equivalent (MET) were performed in children with GHD, aged 9-14 years, divided into those with a peak GH response < 7 mu g/L (complete GHD; n = 30) and 7-10 mu g/L (partial GHD; n = 17) after two GH stimulation tests, at baseline and 12 months after GH initiation. Forty-eight healthy peers underwent the same tests once. Results Left ventricular mass (LVM) was significantly lower before treatment in both groups with GHD compared to healthy peers (p = 0.015 and p = 0.032) but LVM in the GHD groups was similar to controls after 12 months of treatment. The increase in LVM in the complete GHD group was significant (p = 0.044). LVM index was significantly reduced with treatment in children with partial GHD (p = 0.035). Max METs, VO2max and exercise duration were significantly increased in children with complete GHD after treatment (p = 0.022, p = 0.015 and p = 0.002, respectively). Significant changes in P wave and QTc dispersion on ECG between groups were within physiological limits. Conclusion This study showed that children with both partial and complete GHD had smaller cardiac structures and less exercise capacity compared to their healthy peers prior to GH treatment but this improved with 12 months of treatment. The cardiac trophic effect of GH, as well as the effect of increasing exercise capacity, is greater in those with complete GHD than in those with partial GHD.
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    Evaluation of the effect of gestational diabetes mellitus on fetal cardiac functions with Myocardial Performance Index
    Alkan, F; Oncel Alanyali, M; Artunc Ulkumen, B; Coskun, S
    BACKGROUND: We aimed to evaluate the fetal cardiac functions with Myocardial Performance Index (MPI) in gesta-tional diabetes mellitus (GDM). METHODS: In this study, 35 patients who were diagnosed with GDM, and 35 pregnant without glucose intolerance and their babies were evaluated. Fetal echocardiographic, biometric measurements, umbilical artery pulsatility indices (UAPI) and ductus venosus pulsatility indices (DVPI) measurements were performed to evaluate fetal well-being be-tween the groups. RESULTS: There was no statistically significant difference between the groups in terms of UAPI, DVPI, systolic func-tions, the mode of delivery and 5-minute APGAR scores (P=0.849, P=0.485, P=0.770, P=0.060, P=0.587). There was statistically significant difference between the isovolumetric relaxation time and isovolumetric contraction time of groups (P=0.006, P=0.03). The MPI results were statistically different between the groups (P=0.000). Postpartum need for hos-pitalization was more frequently observed in GDM than the control group (P=0.014). CONCLUSIONS: MPI, which is independent of the ventricular anatomy and fetal heart rate, showing both diastolic and systolic functions, was found significantly higher in GDM. We recommend performing MPI measurement routinely to fetal cardiac functions in GDM.
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    Should pediatric cardiologists refer all patients with unexplained chest pain to a psychiatrist?
    Alkan, F; Sapmaz, SY; Kardelen, C; Bircan, O; Bilac, O; Kandemir, H; Coskun, S
    Objective:The present study aimed to investigate the relationship between unexplained chest pain in children with parents' mental problems, parental attitudes, family functionality, and the child's mental problems.Material and Method:A total of 433 children (between 11 and 18 years of age) applied to the Pediatric Cardiology Outpatient Clinic due to chest pain in the last year. A clinical interview was conducted by a child psychiatrist with 43 patients and 33 controls included in the study due to unexplained chest pain.Results:Family history of physical illness was significantly higher in the chest pain group. When evaluated in terms of psychosocial risk factors, life events causing difficulties, derangement in the family, loss of a close person, and exposure to violence were statistically significantly higher in the group with chest pain. Mental disorders were observed in 67.4% of the children in the chest pain group as a result of the clinical interview. The total score of the DSM-5 somatic symptoms scale, which evaluates other somatic complaints in the chest pain group, was also significantly higher. When the family functions of both groups were evaluated, communication, emotional response, behaviour control, and general functions sub-dimensions were statistically significantly higher in families in the chest pain group.Conclusion:We recommend that psychiatric evaluation be included in diagnostic research to prevent unnecessary medical diagnostic procedures in children describing unexplained chest pain, as well as to prevent the potential for diagnosing mental disorders in both children and adults.
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    Diagnosis of asymptomatic atrial septal aneurysms using two-dimensional color Doppler and contrast transthoracic echocardiography
    Coskun, S; Sekuri, C; Bayturan, Ö; Yüksel, H; Saribülbül, O; Bilge, A
    Objective To evaluate the dimensions of atrial septal aneurysm (ASA), the presence and characteristics of interatrial shunt, the movement of the wall of the aneurysm, and correlation between these findings and sign and/or symptoms suggesting embolism in Manisa, a district of a western Anatolian city of Turkey. Methods Two thousand five hundred cases were examined by routine transthoracic echocardiography (TTE) in both pediatric and adult cardiology outpatient clinics. ASA was detected in 20 cases and evaluated by two-dimensional color Doppler echocardiography (CDE). The length of the base, the maximum radius and the maximum displacement of ASA were measured. The shunt between the atria was examined by CDE. In cases where a shunt could not be found, galactose and palmitic acid was injected. Standard 12-lead electrocardiogram ( ECG) and exercise stress test were also performed. Results No clinical signs or symptoms were found, suggesting a systemic or cerebral embolism. The maximum displacement of ASA was between 2 and 5 mm. All of the aneurysms were localized in the right atrium, and the walls of the aneurysm did not move beyond the base of the left atrium during the maximum displacement. Interatrial shunt was detected in 14 of 20 patients (70%) by CDE and in the remaining six cases by contrast TTE. Frequent ventricular ectopic beats were observed in one patient. Conclusions During routine TTE we observed 0.8% asymptomatic ASA in our population. The use of a contrast agent was found to be a valuable additional method in patients with ASA when the shunt could not be detected by CDE. The risk for embolism is not high when the maximum displacement of the wall of ASA was 5 mm or less and no bulge into the left atrium was observed. Based on our experience with this method, TTE is easy to perform, well-tolerated and acceptable.
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    Protective effect of leukotriene receptor antagonist montelukast on smoking-induced lung injury in Wistar rats
    Yüksel, H; Ozbilgin, K; Coskun, S; Tuglu, I
    Increased activation of alveolar macrophage, neutrophil and mast cell has been proven in cigarette smoking (CS)-related lung disorders (CSLD). An increased production of cysteinyl-leukotrienes (LTs), which are mediators secreted from the mentioned cells, in response to CS has been shown in humans. The protective effect of LT1 receptor-1 antagonist (LTR-1AT) on CSLD is, however, not known. In this study we aimed to determine whether there is any protective effect of a LTR-1AT, montelukast (MK), on CSLD in Wistar rats. Nine controls and twenty-three smoke-exposed rats were enrolled into this study. Controls were exposed to non-filtered air, and the smoke-exposed rats were exposed to CS for 6 h/day, 6 days/week for three weeks. The CS-exposed rats were also treated with 0.1 mg/kg/day of MK or saline. Morphometric criteria for lung injury were determined as the mean linear intercept of alveolar septa (L-m), the volume density of alveolar septa (V-vspt) and the density of the alveolar surface area per unit volume of lung parenchyma (S-va.pa). Lung mast cells (LMC), which are a major source of Us, were also counted. Results showed that I'm of the control group was significantly lower and V-vspt, S-va.pa of the controls were significantly higher compared to those of the CS-exposed groups. Animals treated with MK had significant protection against CSLD. L-m was significantly higher and V-vspt, S-va.pa were lower in the saline group than in the MK-treated group. The number of LMC in the CS-exposed groups was also significantly higher than that in the control group. Based on these results, one can suggest that some part of the pathogenesis of CSLD may be related to an enhanced Us synthesis and LTR-1AT. Therefore, montelukast may protect against active or passive smoking-induced lung injury and related disorders.
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    Doppler echocardiographic evaluation of pulmonary arterial pressure in children with allergic rhinitis
    Yüksel, H; Coskun, S; Onag, A
    In children, persistent upper airway obstruction may lead to increased pulmonary arterial pressure (PAP). Allergic rhinitis (AR) is one of the frequent cause of persisting upper airway obstruction by nasal blockage in childhood. Regular use of nasal topical corticosteroids are effective in reducing nasal blockage and obstruction. However, whether symptomatic children with AR have increased PAP and curative effect of topical steroids are not known. The aims of this study were to clarify whether children having active symptoms of AR have increased PAP and to investigate the curative effect of reducing nasal obstruction by topical corticosteroids. Twenty-three children, aged between 5 and 16, diagnosed as AR, consisted of 17 seasonal AR (SAR) and seven perennial AR (PAR), were included in the study. Nineteen age and sex matched healthy children were received as controls. PAP was measured by using Doppler echocardiography in all subjects and symptom scores of AR were recorded in rhinitis group. After first evaluation, nasal steroid, budesonid, was given to rhinitis group for three months. Mean systolic PAP was 33.4 +/- 3.1 for children with AR mmHg and 23.6 +/- 4.3 mmHg for the control group. The difference was statistically significant (P < 0.05). Mean systolic PAP of children with PAR was significantly higher than children with SAR (P < 0.05). In rhinitis group, mean PAP decreased significantly after relief of upper airway obstruction by nasal corticosteroid therapy to normal level of 24.9 +/- 3.6 mmHg (P < 0.05). Our results showed that children with AR may have significantly higher PAP than healthy subjects and decreased to normal levels after relieving nasal blockage by nasal corticosteroids. Nevertheless, Doppler echocardiography is a safe, non-invasive and practical tool for cardiac investigation of children with AR. Therefore, in symptomatic period, evaluation of PAP of children with AR by using Doppler echocardiography may be useful in the planning and following of their therapy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
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    Effect of growth hormone on small intestinal homeostasis relation to cellular mediators IGF-I and IGFBP-3
    Ersoy, B; Ozbilgin, K; Kasirga, E; Inan, S; Coskun, S; Tuglu, I
    AIM: To evaluate the effects of growth hormone (GH) on the histology of small intestines which might be related to the role of insulin like growth factor (IGF)-I, IGF-binding protein 3 (IGFBP-3) and its receptors. METHODS: Twelve week-old adult male Wistar albino rats were divided into two groups. The study group (n = 10), received recombinant human growth hormone (rGH) at a dose of 2 mg/kg per day subcutaneously for 14 d and the control group (n = 10) received physiologic serum. Paraffin sections of jejunum were stained with periodic acid shift (PAS) and hematoxylin and eosin (HE) for light microscopy. They were also examined for IGF-I, IGFBP-3 and IGF-receptor immunoreactivities. Staining intensity was graded semi-quantitatively using the HS-CORE. RESULTS: Goblet cells and the cells in crypt epithelia were significantly increased in the study group compared to that of the control group. We have demonstrated an increase of IGF-I and IGFBP-3 immunoreactivities in surface epithelium of the small intestine by GH application. IGF-I receptor immunoreactivities of crypt, villous columnar cells, enteroendocrine cells and muscularis mucosae were also more strongly positive in the study group compared to those of in the control group. CONCLUSION: These findings confirm the important trophic and protective role of GH in the homeostasis of the small intestine. The trophic effect is mediated by an increase in IGF-I synthesis in the small intestine, but the protective effect is not related to IGF-I. (C) 2009 The WIG Press and Baishideng. All rights reserved.