MCBÜ Açıkerişim Sistemi :: Browsing by Author "Yuksel H."

Browsing by Author "Yuksel H."

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Chloralhydrate in children undergoing echocardiography
(The Indian Journal of Pediatrics, 2001) Coskun S.; Yuksel H.; Onag A.
Transthoracic echocardiography (TTE) is a painless, noninvasive and risk-free diagnostic method in children with known or suspected congenital heart disease. Sedation is frequently required for an optimal achievement of this procedure. The purpose of this study was to determine the safety and efficacy of chloral hydrate (CH) sedation in undergoing TTE. The study population included 360 patients with a median age of 19 months. (2 weeks to 8 years). The median dosage of CH given was 75 mg/kg (ranging 50 and 100 mg), with either oral or rectal administration. Oral administration could not be achieved successfully in 90 patients (20%) because of the bitter taste of the drug, in the other 108 patients (30%), vomiting occurred immediately after drug administration. Prior to CH administration and until discharge; respiratory rate; heart rate, blood pressure and oxygen saturation were recorded. Sedation was successfully achieved in 342 (95%) of the patients. No child had a clinically significant change in heart rate, blood pressure and respiratory rate during sedation. There were also no significant differences in heart rate, respiratory rate, blood pressure and oxygen saturation before and after sedation. Although CH has a bitter taste and is a gastric irritant for oral medication, because of the minimal side effects and efficacy for sedation, it remains as a safe and successful drug for use in children for TTE. [Indian J Pediatr 2001; 68 (4) : 319-322].
Lower arrythmogenic risk of low dose albuterol plus ipratropium
(The Indian Journal of Pediatrics, 2001) Yuksel H.; Coskun S.; Polat M.; Onag A.
Objective: Wheezy infants are in need of urgent bronchodilatation owing to their intermittent bronchoconstriction. β2 agonists are frequently used in emergencies and have previously shown to increase the QT dispersion (QTd), which may be associate with high risk of cardiac arrhythmia, in asthmatics. However, effect of low dose β2 agonist therapy in combination with the anticholinergic agents on QTd in wheezy infants is not known. This study aimed to assess the effect of standard dose of nebulized albuterol (NAB) and low doses of NAB combined with ipratropium-bromide (NIB) on QTd in wheezy infants. Methods: Twenty-nine children, under 2 years old, with the diagnosis of wheezy infant with acute exacerbation were enrolled in the study. Thirteen were treated by standard dose of NA therapy (0.15 mg/kg) and low doses of NAB (0.075 mg/kg) plus NIB (250 μg/dose) therapy was given to the remaining subjects. Respiratory distress score, 02 saturation and side effects were studied and QTd were measured from the standard electrocardiograms at baseline and after treatment. Significant improvement was achieved in clinical score and oxygenation of both groups. Result: The evaluation of the corrected QTd (QTcd) showed that there was no significant difference between pretreatment values of both groups (p>0.05). However, while there was no statistically significant difference in the pre and post-treatment values of QTcd of infants treated with combination therapy, QTcd was found to be significantly increased in NAB group after treatment (p<0.05). Conclusion: Our results suggest that, while clinical improvement is same, the increase of the QT dispersion is more prominent with the use of standard dose of NAB compared to low dose NAB plus NIB therapy. So, low dose of β2 agonist in combination with anticholinergic agents may much safer than the use of standard dose of β2 agonists alone in regard to preventing the possibility of arrythmogenic effects in wheezy infants with acute exacerbation.
Standard dose of inhaled albuterol significantly increases QT dispersion compared to low dose of albuterol plus ipratropium bromide therapy in moderate to severe acute asthma attacks in children
(2001) Coskun S.; Yuksel H.; Tikiz H.; Danahaliloglu S.
Background: Beta-2 agonist therapy has previously shown to increase the QT dispersion (QTd) in asthmatic patients and increased QTd has been well documented in association with cardiac arrhythmias and sudden death. However, the data concerning the effect of low doses of beta-2 agonist therapy in combination with the anticholinergic agents to potentiate bronchodilatation on QTd in asthmatic children are limited. The objectives of this study was to investigate the changes on QTd during both the standard dose of nebulized albuterol therapy and low dose nebulized albuterol plus inhaled ipratropium therapyn to assess the potential arrhytmogenic risk of these two treatment strategies in children with acute asthmatic attacks. Methods: Forty-three children with the diagnosis of moderate to severe acute asthma were enrolled in the study. Standard dose of nebulized albuterol therapy (0.15 mg/kg) were administered to 20 patients (group 1) and low dose of nebulized albuterol (0.075 mg/kg) plus nebulized ipratropium bromide therapy (250 μg/dose) were given to the remaining 23 patients (group 2). Respiratory distress score, peak expiratory flow rate, arterial blood pressure, O2 saturation, serum potassium and urea nitrogen levels were studied and QT interval parameters were measured from the standard 12-lead electrocardiograms at baseline and after treatment. Results: Significant improvement was achieved in respiratory distress score and peak expiratory flow rate after three dose inhalation. No significant difference was observed between the pre and post-treatment values of serum potassium, blood urea nitrogen, O2 saturation and arterial blood pressure values. The evaluation of the corrected QTd (QTcd) showed that while there was no statistical difference in the pre and post-treatment values in group 2 (30.4 ± 3.1 msn vs 32.1 ± 3.9 msn), QTcd was found to be significantly increased in group 1 after treatment (29.0 ± 3 msn vs 40.6 ± 5.1 msn, P < 0.0001). Conclusion: The data of the present study suggest that the increase of the QTd is more prominent with the use of a standard dose of albuterol compared to low dose albuterol plus ipratropium therapy. Therefore, it may be concluded that a low dose of albuterol plus ipratropium bromide therapy may be preferred to avoid rhythm disturbances in asthmatic children.
Repeated subcutaneous administration of dermatophagoides allergen does not cause immune or non-immune glomerular injury in wistar-albino rats
(2004) Akil I.; Yuksel H.; Ayhan S.; Nese N.; Giray G.
We aimed to investigate the risk of immune or non-immune mediated glomerular injury associated with immunotherapy with dermatophaogoides allergen. Three groups of 7 male rats aged 10 weeks were gathered. Group 1 received 1250 units of dermatophaogoides allergen injection 3 times with an interval of 2-weeks via subcutaneous route, group 2 received 2500 units of dermatophaogoides allergen injection, and the control group received isotonic saline solution equal in volume to the antigen. Kidneys were evaluated by both light and immunofluorescence microscopy. Urine was analyzed with urinalysis strips and light microscopy. Some cases demonstrated mesangial proliferation as well as an increase in mesangial matrix and tubulointerstitial inflammation. However, these changes did not differ statistically significantly between the groups (P>0.05 for mesangial proliferation, increase in mesangial matrix and tubulointerstitial inflammation). Neither hematuria nor proteinuria was detected in control or treatment groups at the beginning or at the end of the study. This study demonstrated that repeated inoculation of dermatophagoides allergen, as required for subcutaneous allergen specific immunotherapy, did not result in any non-immune or immune complex induced glomerular injury. Thus, despite the fact that dermatophagoides allergen are exogenous macromolecules, subcutaneous allergen specific immunotherapy using these purified allergens may not have any risk for glomerular injury.
Is the menstrual cycle affecting the skin prick test reactivity?
(2004) Kirmaz C.; Yuksel H.; Mete N.; Bayrak P.; Baytur Y.B.
Allergen skin prick tests (SPT) are very sensitive and specific tests to detect allergic sensitization in atopic patients. Certain factors like antihistamines, antidepressant therapies or circadian rhythms can alter the results of SPT. In women, the changes in endogenous hormone levels throughout the menstrual cycle may affect the allergic responses and natural course of allergic diseases. The aim of this study was to investigate the probable influence of the phases of the menstrual cycle on SPT reactivity to allergen extracts and histamine. Forty-two female patients with seasonal allergic rhinoconjunctivitis were enrolled in the study. Skin prick test reactivities to allergens and histamine were measured at the beginning of the menstrual cycle (3rd or 4th day), mid-cycle (14th or 15th day) and end-cycle (27th or 28th day) consecutively. Serum estradiol, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels were determined simultaneously. We observed the most significant reactions to allergens when SPT is performed at mid-cycle. However, SPT reactivity to histamine did not vary throughout the menstrual cycle. Serum estradiol and LH levels showed positive correlation with SPT reactivity to allergens at mid-cycle. Our results suggest that SPT give the best results when they are performed at mid-cycle. Additionally, allergens seem to cause mast cell degranulation to a greater extent in subjects in which endogenous hormones like estradiol and LH are elevated.
Increased expression of angiogenic markers in patients with seasonal allergic rhinitis
(2004) Kirmaz C.; Ozbilgin K.; Yuksel H.; Bayrak P.; Unlu H.; Giray G.; Kiliccioglu B.
Background. Increased vascularity due to neo-angiogenesis is an essential part of airway remodelling. Vascular endothelial growth factor (VEGF), CD34 and von Willebrand's factor (FvW) are known angiogenic markers. Angiogenesis and airway remodelling has been documented in asthma but not in allergic rhinitis.Objective: We aimed to investigate the presence of increased angiogenesis and its relation to angiogenic molecules, namely VEGF, CD34 and FvW, in endothelial cells of nasal mucosa in patients with seasonal allergic rhinitis (SAR), using three different immunohistochemical analysis methods, namely HSCORE, microvessel density (MVD) and vascular surface density (VSD). The findings in allergic rhinitis were compared with the findings in nasal septal deviation (NSD), which is not associated with increased angiogenesis. Methods. Twenty patients with symptomatic SAR, who were not under treatment, were enrolled in the study. Ten patients with NSD, who needed surgical therapy, served as the control group. Demographic characteristics did not differ between the two groups. Inferior turbinate biopsy was obtained from SAR patients and control patients, under local anaesthesia and during surgery respectively. All biopsies were evaluated for angiogenesis on the basis of VEGF, CD34 and FvW by two blinded histologists using three immunohistochemical analysis methods (HSCORE, MVD and VSD). Results. HSCORE, estimated on the basis of each staining technique, showed statistically significant differences among the two groups (p=0.002; p=0.045; p=0.016, respectively). Anti-CD34 and anti-VEGF showed higher MVD values in SAR when compared to the controls (p=0.038; p=0,009, respectively). No statistically significant difference was found in Anti-FvW-based MVD between SAR patients and controls (p=0.071). The measurements of VSD for FvW and VEGF from nasal biopsy specimens displayed a statistically significant difference between the two groups (p=0.004; p=0.0001, respectively). However, measurement of VSD for CD-34 was not significantly different between the groups (p=0.086). On the other hand, morphometric data obtained by all three methods did not correlated. Conclusion. There are a few studies that have investigated the essential role of angiogenesis in the pathogenesis of allergic rhinitis. We conclude that, increased angiogenesis may be as prominent in patients with allergic rhinitis as in patients with non-allergic nasal pathologies and may play an important role in the remodelling of nasal mucosa of subjects with SAR.
Sexual dysfunction in patients with allergic rhinoconjunctivitis
(American College of Allergy, Asthma and Immunology, 2005) Kirmaz C.; Aydemir O.; Bayrak P.; Yuksel H.; Ozenturk O.; Degirmenci S.
Background: Sexual dysfunction in chronic diseases has recently attracted attention owing to its impact on quality of life (QoL). Allergic rhinoconjunctivitis (ARC) affects QoL, causing limitations in many areas. However, there has not been research on changes in sexual function in patients with ARC. Objective: To report the effect of ARC and its treatment on sexual function in men and women. Methods: Forty-three sexually active patients with seasonal ARC aged 22 to 49 years were included in the study. The control group was composed of 40 healthy individuals aged 22 to 46 years. Conjunctival symptom scores (CSSs) and nasal symptom scores (NSSs) of patients with symptomatic ARC were determined, as were sexual function scores (SFSs) using the Female Sexual Function Index and the International Index of Erectile Function during allergen exposure in the pollination period and after treatment with oral desloratadine, 5 mg/d, for 30 days. The SFSs were evaluated in the control group. Results: The CSSs and NSSs significantly improved in treated ARC (P < .001). In women, Female Sexual Function Index results in symptomatic ARC were significantly lower than in treated ARC and controls (P = .003). In men, International Index of Erectile Function results in treated ARC (P = .001) and controls (P < .001) were significantly higher than in symptomatic ARC. Furthermore, correlation between improvement in CSSs and NSSs and that of SFSs was determined (P = .007 for women; P = .001 for men). Conclusion: Improvement in sexual function as a variable of QoL may accompany the treatment of symptoms in patients with ARC.
Short-term effects of montelukast in stable patients with moderate to severe COPD
(2005) Celik P.; Sakar A.; Havlucu Y.; Yuksel H.; Turkdogan P.; Yorgancioglu A.
This study aims to investigate the possibility of additional value of leukotriene receptor antagonist (LTA) on dyspnea score, arterial blood gases (ABG), pulmonary function tests (PFTs), and quality of life (St. George QoL) in chronic obstructive pulmonary disease (COPD) patients. In this randomized, prospective, single-blind, and controlled study, 117 non-reversible COPD patients defined by global initiative for chronic obstructive lung disease (GOLD) criteria were randomized to receive ipratropium bromide, formoterol and montelukast (n:58, montelukast group) or ipratropium bromide and formoterol (n:59, control group) after a 2-week run-in period. There was no significant demographic difference between the two groups (P > 0.05). Baseline ABG, PFT, visual analoque scores (VAS), and QoL scores were obtained and at first month and second month, PFT, VAS, and QoL scores were repeated and ABG was obtained at second month and the values were compared with baseline values. As the result of the comparision, there was significant increase in vital capacity, FVC, FEV1, VAS, and PaO2 parameters (P < 0.05), and a significant decrease in the QoL scores (P < 0.05) in the montelukast group. These parameters did not show any difference in the control group (P > 0.05). Sputum samples that could be obtained in 24 of the COPD patients were evaluated and in the montelukast group, there was a decrease in neutrophilic activity after treatment (n:13) (P : 0.059). These results suggest that LTA that is used additionally in routine treatment protocol can produce additive improvement on PFT, dyspnea score and especially QoL in patients with stable COPD and for these reasons, LTA may be taken into account when there is need for an additional anti-inflammatory treatment in COPD patients. © 2004 Elsevier Ltd. All rights reserved.
Symptoms of the olive pollen allergy: Do they really occur only in the pollination season?
(2005) Kirmaz C.; Yuksel H.; Bayrak P.; Yilmaz Ö.
Background: Olive (Olea europaea; O.e.) pollen is a major cause of seasonal respiratory allergy. The O.e. pollination season lasts two months from the beginning of May till the end of June. It was expected that patients with allergic disease from O.e. sensitization were symptomatic only during this period. However, during the last few years, we have observed that the clinical symptoms appear not only during the O.e. pollination season but also during the rest of the year. Objective: The aim of this study was to observe and document symptoms of respiratory allergic diseases in the O.e. sensitized patients during the O.e. pollination season and after it. Methods: One hundred and twenty-seven patients with respiratory allergic disease were enrolled in the study. Allergenic sensitizations were shown by SPT. Finally, patients were split into two groups as monosensitized with O.e. (n=19) and polysensitized (n=108). Patients were assessed by using scores of respiratory allergic disease symptoms and percentage of peak expiratory flow rate values (PEFR %) (only for asthmatic patients) during the O.e. pollination season and after it. Results: Of the patients with O.e. monosensitization, 13 had allergic rhinitis (AR) only while six had allergic asthma (AA) additionally. AR alone and accompanied by AA was present in 84 and 24 polysensitized patients respectively. Eleven patients with O.e. sensitization (57.9 %) and 86 patients with polysensitization (79.6 %) had AR symptoms throughout the year irrespective of the O.e. pollination season. Similarly, three of the O.e. monosensitized and ten of the polysensitized patients with AA had asthmatic symptoms during the O.e. pollination season and also after it. Conclusions: In the patient group sensitive to O.e. along with other pollen extracts, it was possible to observe symptoms outside the pollination season. However, patients with O.e. monosensitization also had symptoms to a great extent outside the season. © 2005 Esmon Publicidad.
Premedication during micturating cystourethrogram to achieve sedation and anxiolysis
(2005) Akil I.; Ozkol M.; Ikizoglu O.Y.; Polat M.; Tuncyurek O.Y.; Taskin O.; Yuksel H.
Micturating cystourethrogram (MCUG) is an imaging technique indicated in the diagnosis and follow-up of many diseases. We investigated the reliability and the efficacy of midazolam and chloral hydrate in sedation and anxiolysis during micturating cystourethrogram. Fifty-three children of similar ages (39 girls, 14 boys, mean age of 5.8±3.5 years) were randomized to midazolam (n=17), chloral hydrate (n=18) and control groups (n=18). Oral midazolam 0.6 mg/kg or chloral hydrate 25 mg/kg or saline were administered to the study groups 15-30 min prior to the urinary catheterization. Brietkopf and Buttner, Frankl and Houpt scales and Spielberger's State Anxiety Inventory and parent's impressions were used to assess the level of sedation and anxiety. The Brietkopf and Buttner classification of emotional status and Houpt behavior rating scale demonstrated a significantly better emotional status and sedation in the midazolam group when compared to controls (P=0.01 and P=0.018, respectively). The catheterization was described as a more unpleasant and distressing event by the parents of the control and the chloral hydrate groups when compared to the parents of the midazolam group (P<0.05). Bladder capacity and frequency of detection of residual urine were not statistically different between the three study groups (P>0.05). Vital signs did not change significantly in any child. Sedation with midazolam does not have adverse effects on the results of micturating cystourethrogram, while it reduces the discomfort in children undergoing this radiological technique. © IPNA 2005.
Effects of glucan treatment on the Th1/Th2 balance in patients with allergic rhinitis: A double-blind placebo-controlled study
(2005) Kirmaz C.; Bayrak P.; Yilmaz O.; Yuksel H.
Background. Allergic rhinitis (AR) is a disease characterized by IgE-mediated, allergic inflammation of the nasal mucosa. T helper (Th) 2 cells play an important role in the development of IgE-mediated diseases such as AR, with local overproduction of Th2 cytokines (IL-4, IL-5 and IL-13) at the site of allergic inflammation. Th1 cytokines (IL-12 and IFN-γ) are known to suppress this Th2 immune response, aiding the treatment of these diseases. β-1,3-1,6-glucan (Glucan) is an immunomodulator stimulating particularly the antitumor response. An efficient antitumor stimulation can be achieved through a Th1-mediated immune response. Objective. The aim of this study was to investigate the effects of Glucan on the immunopathogenic processes in the microenvironment to determine if it reverses the Th2-mediated immune response in AR to Th1-mediated response. Methods. 24 Olea europea mono-sensitized patients with AR were randomized into Glucan and placebo groups. The Glucan group consisted of 12 patients who received Glucan treatment for 12 weeks, while the placebo group of 12 patients received placebo during the same period. A nasal provocation test (NPT) with Olea europea was performed at the beginning and end of treatment, and nasal lavage followed the positive NPT. IL-4, IL-5, IFN-γ and IL-12 levels and the eosinophil count (%) were measured in nasal lavage fluid (NLF) samples. Simultaneously, peripheral blood eosinophil % values were measured. Results. After treatment, IL-4 and IL-5 levels in NLF from the Glucan group were found to have decreased significantly (p = 0.027, p = 0.04; respectively), while IL-12 levels were found to have significantly increased (p = 0.008). However, IFN-γ levels had not changed. On the other hand, none of the cytokine levels had changed significantly in the placebo group following treatment. Moreover, the percentage of eosinophils in the NLF was found to have decreased significantly after treatment in the Glucan group (p = 0.01), while that of the placebo group did not change. Peripheral blood percentage eosinophil levels had not changed significantly in any group. Conclusion. Th2-originated IL-4 and IL-5 levels responsible for the allergic inflammatory response in the microenvironment of patients with AR, are decreased with Glucan while levels of Th1-originated IL-12 are increased. Moreover, eosinophils, which are important effector cells of the inflammatory response, are decreased in the microenvironment. As a result, Glucan may have a role as an adjunct to standard treatment in patients with AR.
The effect of seasonal changes on blood pressure and urine specific gravity in children living in Mediterranean climate.
(2006) Polat M.; Akil I.; Yuksel H.; Coskun S.; Yilmaz D.; Erguder I.; Onag A.
BACKGROUND: We aimed to evaluate the effects of seasonal changes on urinary specific gravity, blood pressure and urinary erythrocyte number in children living in Mediterranean climate. MATERIAL/METHODS: The study was conducted on 547 children who presented for routine follow up to healthy-child care department between January 1997 and December 2002. Age, sex, weight, height, blood pressure, urinary specific gravity and urinary erythrocyte number were recorded by retrospective evaluation of files. Then, the parameters during summer were compared with those during winter. Additionally, correlation between the blood pressure, urinary specific gravity and urinary erythrocyte number was assessed separately during summer and winter. RESULTS: Anthropometrical measurements and mean age of the patients in summer and winter groups were similar. There was no significant change in urinary specific gravity (p > 0,05), while systolic and diastolic blood pressures were significantly higher in winter (p = 0.031 and p = 0.028 respectively). Temperature and humidity levels did not change significantly among different years but mean air temperatures during summer positively correlated with time from 1997 till 2002 (r = 0.965, p = 0.002). Blood pressure and urinary specific gravity were not correlated to each other at any time. Contrarily, there was a positive correlation between urinary specific gravity and erythrocyte number in summer (p = 0.01). The number of children with hematuria and degree of hematuria did not differ significantly between summer and winter. CONCLUSIONS: Seasonal changes in Mediterranean climate do not lead to changes in hydration status or in urinary erythrocyte number in children. Therefore, the decrease in blood pressure during summer can not be attributed to the hydration status.
The prevalence of asthma and allergic symptoms in Manisa, Turkey (a western city from a country bridging Asia and Europe)
(2006) Sakar A.; Yorgancioglu A.; Dinc G.; Yuksel H.; Celik P.; Dagyildizi L.; Coskun E.; Kaya E.; Ozyurt B.; Ozcan C.
The aim of this study was to determine the prevalence of asthma and allergic symptoms in Manisa city center, Turkey, to evaluate the determinants effective on those values, and to review the prevalence rates reported from different parts of the country. Data were collected from 610 households and complete interviews were conducted with 1,336 adults over 18 years of age by using European Community Respiratory Health Survey-ECRHS questionnaire. The prevalences of current asthma, cumulative asthma and asthma-like symptoms were found in 1.2, 1.0 and 25.0%, respectively, of the 20-44 years age group and the prevalences of allergic rhinitis, allergic dermatitis and family atopy were found in 14.5, 10.9, and 15.2%, respectively, in all age group. Wheezing with breathlessness, wheezing without cold, woken up with shortness of breath and woken up with cold were reported by 9.1%, 6.9%, 6% and 16.1% of the study population, respectively. Gender, age, active or passive smoking, family atopy and home condition effect on prevalence of asthma and allergic symptoms. In this study prevalence of asthma correlated with the studies reporting low prevalence rates of Turkey.
Evaluation of sleep quality and anxiety-depression parameters in asthmatic children and their mothers
(2007) Yuksel H.; Sogut A.; Yilmaz O.; Demet M.; Ergin D.; Kirmaz C.
Background: Having a child with a chronic disease may cause anxiety and depression and impair the sleep quality in the mothers. The aim of this study was to evaluate sleep quality in asthmatic children and their mothers as well as the status of anxiety-depression in the mothers. Methods: Study group consisted of 75 asthmatic children aged between 7 and 16 years (mean±SD 8.4±2.9) and the control group consisted of 46 healthy children aged between 7 and 15 years (mean±SD 9.1±3.6). Pittsburgh Sleep Quality Index (PSQI) was administered to both the children and their mothers while Hospital Anxiety and Depression Scale (HADS) was administered only to the mothers. Results: Total PSQI score of the mothers in the asthmatic group was significantly correlated with asthma severity of the children (r=0.49, p=0.00). There was a significant correlation between asthma symptom score and sleep disturbing factors subscore in children with asthma (r=0.34, p=0.01). Moreover, anxiety and depression subscores of the mothers in the asthma group were significantly higher (p=0.02). Conclusion: Asthma may be associated with altered sleep quality in children and their mothers. Similarly, mothers of children with asthma may have disorder of anxiety and depression. Therefore, children with and their mothers need to be assessed for the requirement of support regarding sleep quality and anxiety-depression status. © 2007 Elsevier Ltd. All rights reserved.
Pulmonary hemosiderosis with normocomplementemic urticarial vasculitis in a child
(PI-ME Tipografia Editrice S.r.l., 2007) Yuksel H.; Yilmaz O.; Savas R.; Kirmaz C.; Sogut A.; Özalp S.
Pulmonary hemosiderosis is rarely associated with urticarial vaculitis especially if normocomplementemic. An eigth year old girl presented with relapsing and remitting chronic and persistent urticarial lesions, conjunctival injection, recurrent cough and hemoptysis. Respiratory findings started at seven years of age. Physical examination revealed diffuse skin lesions mainly settled on the extremites, nonpurulent conjunctival injection, rare ronchi and fine crackles in bilateral lower zones of the lungs. Biopsy of the urticaria like skin lesions demonstrated leukocytoclastic vasculitis. Rheumatological markers were negative. Levels of complement fractions 3 and 4 were normal. Chest x-ray demonstrated diffuse alveolar infiltrative images. High Resolution Computed Tomography of the chest revealed diffuse ground-glass appearance, increased interstitial density. Diagnostic flexible fiberoptic bronchoscopy was performed and bronchoalveolar lavage fluid revealed hemosiderin laden alveolar macrophages. She was started on systemic corticosteroid treatment. During follow up, pulmonary symptoms disappeared, however skin lesions and conjunctival symptoms persisted and exacerbated four times in two years. CT of lungs after two years of treatment revealed rare patchy areas of ground glass appearance in bilateral lower lobes and right upper lobe as well as a few of milimetric pleural nodules. This patient is still followed up under low dose steroids and pulmonary findings regressed but low grade inflammation due to vasculitis is thought to continue as supported by the persistence of tomographic findings in the lungs despite the absence of any symptoms. This case demonstrates association of urticarial vasculitis and pulmonary hemosiderosis in the setting of normocomplementemia.
Improvement in symptoms of psoriasis in a child after treatment with grass pollen specific allergen immunotherapy
(Dermatologia Pediatrica, 2007) Sogut A.; Yilmaz O.; Yuksel H.
Psoriasis is a chronic inflammatory disease of skin in which Th1 lymphocytes have a central role. Similar to all inflammatory diseases, additional inflammation may lead to the exacerbation of manifestations. Allergic asthma is the chronic eosinophilic inflammatory disease of the bronchial mucosa in which Th2 lymphocyte activity predominates. A nine year old boy who had been under conventional topical treatment for psoriasis without improvement for three months, presented to the outpatient department with recurrent cough, dyspnea and wheezing of one year duration. The physical examination revealed white plaques on extensor surfaces of elbows and knees as well as prolonged expirium and wheezing. Positive allergen skin prick test against "olea europea" and "fraxinus excelsior" pollens were observed. Inhaled steroids and allergen specific immunotherapy were initiated with the diagnosis of allergic asthma. Psoriatic findings regressed without requirement for an additional topical treatment during follow up along with asthma findings. As a conclusion, inflammatory stress of allergic asthma may aggravate psoriasis and treatment with allergen specific immunotherapy may help decrease findings of psoriasis.
Increased expression of tissue vascular endothelial growth factor and foetal liver kinase-1 receptor in seasonal allergic rhinitis and relevance to asthma component
(2007) Yuksel H.; Kose C.; Yilmaz O.; Ozbilgin K.; Degirmenci P.B.; Pinar E.; Kirmaz C.
Background: There is a difference in the extent of remodelling in allergic rhinitis (AR) and asthma. This may be attributed to the difference in local tissue response to these mediators. Objectives: The aim of this study was to compare vascular endothelial growth factor (VEGF) and its receptor foetal liver kinase (Flk)-1 expression between seasonal AR patients with or without asthma and non-allergic controls as well as that between AR patients with and without asthma. Methods: Thirteen subjects with seasonal AR and six non-allergic controls were included in the study. Allergic sensitization was demonstrated by a skin prick test. Inferior turbinate thiny biopsies were obtained from both groups. Monoclonal mouse antibodies were used to demonstrate VEGF and Flk-1. Nasal mucosal endothelial cells' staining intensity was graded semi-quantitatively and the histochemical score (HSCORE) was calculated. In all samples, VEGF- and Flk-1-labelled vessels were counted for the assessment of vascular surface density (VSD). Results: The mean HSCORE for VEGF and anti-VEGF-based VSD were significantly higher in the patient group (P=0.001 and 0.002, respectively). The mean HSCORE for Flk-1 and anti-Flk-1-based VSD in the patient group were significantly higher than those in the control group (P=0.016 and 0.028, respectively). Differences between the mean HSCORE for VEGF and anti-VEGF-based VSD in patients with pure AR and AR and asthma were insignificant (P=0.16 and 0.39, respectively). The mean HSCORE for Flk-1 and anti-Flk-1-based VSD in patients with pure AR were significantly lower than those in patients with AR and asthma (P=0.004 and 0.018, respectively). Conclusion: Angiogenic factor VEGF and its receptor Flk-1 is increased in AR. A similar increase in VEGF in AR with and without asthma despite a higher Flk-1 in AR patients with asthma may be a possible explanation for the presence of angiogenesis in the airway wall in patients with asthma but not in those with pure AR. © 2007 Blackwell Publishing Ltd.
A pediatric case of pyomyositis presenting with septic pulmonary emboli
(2007) Yuksel H.; Yilmaz O.; Orguc S.; Yercan H.S.; Aydogan D.
Pyomyositis is a suppurative infection of skeletal muscle most commonly caused by Staphylococcus aureus. It is mainly encountered in children and immunocompromised. Eight year old previously healthy girl presented with confusion, fever and swelling of the right knee two days after a trauma. Abdominal ultrasonography and computerized tomography taken upon development of hematemesis revealed no pathology in the abdomen, but potential bleeding sites in lung sections. Thorax CT images were interpreted in favor of septic pulmonary emboli due to the presence of peripheral nodular consolidation areas with central cavitation, mostly pathchy in medial areas. S. aureus was isolated in the blood culture. At the end of third week of hospitalization, gadolinium enhanced contrast MRI of right extremity was taken to evaluate right extremity swelling and revealed abcess formation as expected in the clinical progress of pyomyositis. Pyomyositis and septic pulmonary emboli are a rare association. This case demonstrates that the high index of suspicion in pediatric cases with muscle findings and septic pulmonary findings and early institution of therapy may improve the prognosis. © 2007 Elsevier Masson SAS. All rights reserved.
Is pulmonary arterial pressure affected by allergic rhinitis with nasal obstruction?
(2007) Bayrak P.; Kirmaz C.; Sekuri C.; Yuksel H.
Obstructive pathologies of the pulmonary tract may cause various levels of hypoxia. To compensate for the hypoxia, pulmonary arterial pressure and pulmonary arterial flow may increase. We investigated 35 patients with seasonal allergic rhinitis (AR) whether hypoxia caused by AR with a high level of obstruction in the airways may lead to an increased pulmonary arterial pressure. An echocardiographical evaluation was made following the determination of the symptomatic and non-symptomatic symptom scores. We found a positive correlation between the symptom scores both in the symptomatic and non-symptomatic periods, nasal obstruction scores and the mean pulmonary arterial pressures during these periods. Further studies with more cases are needed in order to determine the cardiac effects of hypoxia in AR, mainly pulmonary arterial hypertension.
The frequency of wheezing phenotypes and risk factors for persistence in aegean region of Turkey
(2007) Yuksel H.; Sakar A.; Dinç G.; Yilmaz O.; Gozmen S.; Yorgancioglu A.; Ozcan C.
The aim of the study was to determine the prevalence of wheezing and evaluate the risk factors for its persistence in children. Survey data was collected on 725 children aged 17 years or below. The mean age was 8.94 ± 5.16 years; 22.1% of them were reported to have had a wheezing episode at any point in their lives. A wheezing episode was reported in 18.1% of children 3 years of age or younger and persisted in 51% of these subjects; 69.6% of ever wheezers had late onset wheezing. Persistence was significantly common in males. Perinatal disease, lack of breast feeding, and low income were significant risk factors for persistence. In summary, breast feeding, perinatal disease, and income status may be significant risk factors influencing wheezing peristence and consequent asthma. Copyright © 2007 Informa Healthcare.

Browsing by Author "Yuksel H."

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