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Öğe Acrodermatitis enteropathica(2001) Şimşek, EnverAcrodermatitis enteropathica is well-known disease, especially in pediatric and dermatology clinics. This rare disease is caused by an inability to absorb sufficient zinc from the diet (1). Initial signs and symptoms begin in the early period of life. The cutaneous eruptions consist of vesiculobullous, eczematous, dry, scaly, or psoriasiform skin lesions symmetrically distributed in the perioral, acral, and perineal areas (2). Diagnosis is established through a constellation of clinical findings and via the detection of a low plasma zinc concentration levels.Öğe Assessment of magnesium status in newly diagnosed diabetic children: measurement of erythrocyte magnesium level and magnesium tolerance testing(Turkish J Pediatrics, 2005) Şimşek, Enver; Karabay, Meltem; Kocabay, KenanThe aim of this study was to investigate the relationship between serum, erythrocyte and urine magnesium levels and retained magnesium percentage in newly diagnosed diabetic children. In a cross-sectional study, 34 children with insulin dependent diabetes mellitus (IDDM) and 21 healthy age- and sex-matched control subjects were screened for their serum, erythrocyte, and urine magnesium levels. Magnesium tolerance test was performed on diabetic and control subjects: Serum and erythrocyte magnesium levels in diabetic children were significantly lower than in healthy controls (plasma magnesium, p < 0.05; erythrocyte magnesium, p < 0.001); however, serum magnesium level was in normal range in diabetics and controls. Erythrocyte magnesium levels in diabetic children showed an inverse correlation with percentage of retained magnesium load (r=-0.44, p < 0.01). Urine magnesium excretion in diabetic children (7.12 +/- 2.18 mmol/g creatinine/24-hr) was significantly higher than in healthy controls (4.0 +/- 1.35 mmol/g creatinine/24-hr) (p < 0.001). There was a negative correlation between erythrocyte magnesium (2.07 +/- 0.62 mmol/L) and urine magnesium (7.12 +/- 2.18 mmol/g creatinine/24-hr) (r=-0.68 p < 0.01) in diabetic children. Magnesium tolerance test showed that percentage of retained magnesium in diabetic children (66 +/- 26%) was significantly higher than in controls (16 +/- 7%) (p < 0.001). This study is the first study to simultaneously investigate serum, erythrocyte and urine magnesium levels and magnesium tolerance test in newly diagnosed diabetic children. In conclusion, erythrocyte magnesium levels decrease earlier than serum magnesium in diabetic children. The follow-up parameters in diabetics may include the policy of monitoring magnesium status. Erythrocyte magnesium measurement is preferred to serum magnesium. Magnesium tolerance test is a reliable and sensitive method, which may be used as an alternative to erythrocyte magnesium measurement or in combination with it in hospitalized diabetic children.Öğe Atypical meningioma and extensive calvarium defects in neurofibromatosis type 1(Springer-Verlag, 2003) Şimşek, Enver; Yavuz, Cevdet; Üstündağ, NilA 9-year-old girl with neurofibromatosis type 1 (NF1) presented with a massive atypical meningioma and calvarial defect. Skull radiographs and cranial CT showed an extensive lytic bone lesion at the vertex. MRI demonstrated a large mass invading the calvarium and sagittal sinus. The histopathological and immunohistochemical diagnosis of the resected mass was atypical meningioma. To our knowledge, this is the first case of NF1 associated with atypical meningioma and massive calvarial defect in a child.Öğe Biotinidase deficiency in a four-week-old infant with infantile spasms(2006) Şenses, Dursun Ali; Şimşek, Enver; Yar, Neşe Ersöz; Keskin, Mahmut; Kocabay, KenanProfound biotinidase deficiency was diagnosed in a 28-day old infant with seizures-like infantile spasms, alopecia and erythematous rash. Clinical signs improved dramatically with biotine treatment. Clinical features of biotinidase deficiency are discussed.Öğe A case of primary Addison's disease with hyperemesis gravidarum and successful pregnancy(Elsevier Sci Ireland Ltd, 2004) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Şimşek, Enver; Yıldız, İdrisWe followed up a pregnant woman with Addison's disease diagnosed before conception. She presented with hyperemesis gravidarum. Throughout pregnancy, she received prednisone and the basic disease did not deteriorate during pregnancy. She was delivered by caesarean section due to breech presentation. The fetal prognosis was good.Öğe Comparison of imaging studies and diagnostic tests for the diagnosis and follow-up of recurrent urinary tract infection in children(2004) Şimşek, Enver; Koloğlu, Nuri; Yugunt, İbrahim; Kocabay, KenanObjective: To compare the imaging studies and diagnostic tests for the diagnosis and follow-up of urinary tract infection (UTI) in children. Methods: Ninety-two children with recurrent urinary tract infection were studied. Urinalysis, dipstick examination of urine for leukocyte-esterase (LE) and nitrite reaction, urine culture, sedimentation rate, C-reactive protein, renal ultrasonography, and voiding cystourethrography (VCUG) were performed. The renal cortical 99mTC dimercaptosuccinic acid (DMSA) scanning was performed during the acute phase of infection for the localization of UTI in some patients and after six months of the treatment in all patients. VCUG was performed six months later again in children who had vesicoureteral reflux (VUR). Intravenous pyelography (IVP) was used for selected cases to screen for urinary obstruction or malformations. Results: All children were followed-up until 39 months. Of the 92 patients, the prevalence of pyuria and bacteriuria were found in 74 (80.4%) and 78 (85%), respectively; hematuria in 62 (67%); and positive LE and nitrite on dipstick in 48 (52%) and 30 (33%) children, respectively. Sedimentation rate was higher than 20 mm/hour in 76 (83%) children. Positive C-reactive protein (CRP) level (> 10 mg/dl) was found in 68 (74%) children. Of the 92 children, 82 (89%) had positive culture result: 64 (78%) females and 18 (22%) males. Renal ultrasonography (US) was abnormal in 28 (30%) children. Renal scarring was revealed by DMSA scanning in 56 (61%) children. DMSA was abnormal in 34 (37%) children who had normal renal ultrasonography, and in 22 (24%) children who had normal VCUG. Ultrasound was abnormal in 2 (2%) children who had normal DMSA. VCUG showed grade I reflux in one (1%) patient who had normal DMSA. IVP revealed VUR in 4 (4%) children who had normal US. DMSA was abnormal in all patients who had abnormal IVP findings. Conclusion: Using the combination of urinalysis, dipstick examination for leukocyte esterase, sedimentation rate, and CRP as screening tests in symptomatic patients, prevents overdiagnosis of UTI and unnecessary treatment. Renal ultrasonography, VCUG, and renal cortical DMSA scanning should be the minimum imaging studies for the evaluation of recurrent UTI in children. IVP is recommended only for selected cases when anatomic detail is required.Öğe Congenital hypothyroidism and iodine status in Turkey: A comparison between the data obtained from an epidemiological study in school-aged children and neonatal screening for congenital hypothyroidism in Turkey(2003) Şimşek, Enver; Karabay, Meltem; Şafak, Alper; Kocabay, KenanBackground: Congenital hypothyroidism and endemic iodine deficiency are the most common cause of mental retardation. However in both cases retardation is of non-preventable nature. Objective: The aim of the study was to investigate whether epidemiological study in school-aged children or neonatal screening of congenital hypothyroidism (CH) was useful to assess iodine status and monitor the preventive measures of iodine deficiency disorders (IDD). Subjects: To study the epidemiology, 1046 school children, aged 8 to 12 years from 23 primary schools in rural and urban areas from three cities in Turkey were included. Neonatal screening for congenital hypothyroidism (CH) was carried in. Methods: Goiter and thyroid volume were assessed by palpation and ultrasound, respectively. Thyroid stimulating hormone (TSH), total thyroxine (T4), and urinary iodine excretion (UIE) were measured. Neonatal screening for CH was adjusted according to the guidelines of Pediatric Endocrinology of the European Society for Pediatric Endocrinology. Results: There was no significant difference between the median TSH in school-aged children and the cities of Bolu and Düzce (p>0.05). Median TSH of Zonguldak was significantly different from the median TSH of Bolu (p=0.046) and Düzce (p=0.028). There was no significant difference between the median T4 levels of Bolu and Düzce (p>0.05). The median T4 of Zonguldak showed a significant difference from the median T4 value of Bolu (p=0.018), but an insignificant difference from the median T4 of Düzce (p>0.05). The overall goiter prevalence in 1046 children was 52%. In two years, 18606 newborns were screened. With a cut-off point at TSH >20 ?U/ml, the recall rate was 1.6% and the incidence of CH 1/2326. There was 26.7% children with TSH >5 ?U/ml. Both data of the epidemiological study in school-aged children and neonatal screening for CH indicated that the West Black Sea Region is affected by mild to moderate iodine deficiency. Conclusion: the implementation of neonatal screening for congenital hypothyroidism using TSH measurement has many advantages. It can detect congenital hypothyroidism and transient primary hypothyroidism, and can also be used for monitoring tools of preventive measures of IDD. Countries, such as Turkey, which has not begun national screening for CH yet, should make implementation of neonatal screening for CH using primary TSH measurement a political priority.Öğe Congenital sialoblastoma (embryoma) associated with premature centromere division and high level of alpha-fetoprotein(John Wiley & Sons Ltd, 2005) Özdemir, İsmail; Şimşek, Enver; Sılan, Fatma; Demirci, FuatSialoblastoma is a rare, locally aggressive, and potentially malignant perinatal salivary tumor that predominantly affects the parotid glands. To date, 29 cases of sialoblastoma have been reported. We report a further case of sialoblastoma diagnosed at 37 weeks of gestation presenting with novel findings that are the premature centromere division and a high level of alpha-fetoprotein.Öğe Deprem bölgesindeki çocukluk çağı pnömonilerinin epidemiyolojik özellikleri(2004) Şimşek, Enver; Yılmaz, Ebru; Karabay, Meltem; Avşar, Yılmaz; Kocabay, KenanAmaç: İki büyük depreminin gerçekleştiği Düzce ve çevre illerde görülen çocukluk çağı pnömonileri üzerine etkili risk faktörlerinin irdelenmesi. Gereç ve Yöntem: Nisan 1998 ile Mart 2003 tarihleri arasında Düzce Tıp Fakültesi Çocuk Kliniği'nde alt solunum yolu infeksiyonu tanısı konulan 172 (98 [57%] erkek, 74 [43%] kız) çocuk hasta çalışmaya alındı. Alt solunum yolu infeksiyonu tanısı ve tedavisi Dünya Sağlık Örgütü kriterlerine göre yapıldı. Vakalar yaş, cinsiyet, getirildikleri bölge, yaşam koşulları, beslenme şekli, gelişim özelliklerine göre irdelendi. Bulgular: Yüz yetmiş iki hastanın 124'ü (%72) hastaneye yatırılarak, 48'i (%28) ayaktan tedavi edildi. Hastaneye yatırılan 124 hastanın 89'unu (%72) Bolu, Düzce, Adapazarı ve Zonguldak il merkezlerinden, 35'ini (%28) bu illerin kırsal kesimlerinden gelen hastalar oluşturuyordu. Ayaktan izlenen hastaların 32'sini (%66) kırsal kesimden gelen, 16'sını (%34) şehir merkezinden gelen hastalar oluşturuyordu. Hastaların tanı anındaki yaşları 2 hafta ile 17.4 yıl arasında olmak üzere, ortalama (± S.E.M) tanı yaşı 37 (± 7.4) hafta olarak bulundu. Yüz yetmiş iki çocuğun 54'ünde (%31) ağırlık yaşa göre ağırlığın %60 ile %75'i arasında, 26'sında (%15) ise yaşa göre ağırlığın %60'ın altında saptandı. Tanı konulan mevsimlere göre, 84 (%49) çocukta kış, 46 (%27) çocukta ilkbahar, 23 (%13) çocukta yaz ve 19 (%11) çocukta sonbahar mevsiminde tanı konuldu. Ortalama (± S.E.M) pnömoni tedavi süresi, plevral effüzyonu olmayan vakalarda 13 ± 5 gün, ampiyemi olan vakalarda ise 21 ± 8 gündü. Çalışmaya alınan hastalardan 19'u (%11) kaybedildi. Bu vakaların 17'sini (%89) 2 yaş altındaki çocuklar oluşturuyordu. Mortalite ile yaş arasında negatif korelasyon saptandı (r=-0.33, p<0.001). Yaşamın erken döneminde pnömoni olması yanında, annenin yaşlı olması, tanı anında lökosit sayısı ve sedimentasyon hızı yüksekliği ile birlikte akciğerlerde yaygın infiltrasyonun bulunması prognozun olumsuz olabileceğine işaret eden parametrelerdi. Sonuç: Sağlıksız yaşam koşulları, halen deprem bölgesinde çocukluk çağı pnömonileri için en önemli risk faktörü olma özelliğini korumaktadır. Deprem bölgesindeki çocukluk çağı pnömonilerinin prognozu üzerine olumsuz etkisi olan risk faktörlerinin çoğu önlenebilir özelliktedir. Sağlıksız ortamlardan kalıcı ve hijyenik ev koşullarına geçiş, bölgedeki çocukluk çağı pnömoni insidansının azalmasına etkili önemli faktörlerden birisidir. Aşılama programlarının düzenli yapılması, pnömoni gelişiminde önemli risk faktörü olan mikroorganizmalara karşı yeni jenerasyon aşıların da ülke rutin aşı programına alınması ve anne sütü kullanım oranının istenen seviyelere çıkarılması pnömoni sıklığını azaltabilecek diğer önemli faktörlerdir.Öğe Hipertiroidi, hiperkortizolizm ve püberte prekoks ile seyreden McCune-Albright sendromu: İki vaka sunumu(2003) Şimşek, Enver; Yavuz, Taner; Kocabay, KenanMcCune-Albright sendromu (MCAS) kemiğin fibrodisplas-tik lezyonu, düzensiz, sütlü kahve lekeleri şeklinde cilt lezyonları ( "cafe au lait"), hiperfonksiyon ile seyreden bir veya birden fazla endokrinopati ile karakterizedir. Sendrom Ga proteininde aktivasyon mutasyonu sonucu ortaya çık-maktadır. Erken puberte, hipertiroidi, Cushing sendromu, akromegali veya jigantizm sıklıkla eşlik eden endokrinopatilerdir. Endokrin hiperfonsiyonlar hipotalamohipofizer aksdan bağımsızdır. Kliniğimizde MCAS tanısı konulan iki vaka (14 aylık erkek sütçocuğu, 7 yaşında kız) sunuldu. Endokrinopati olarak 14 aylık vakada hipertiroidi ve hiperkortizolizm, 7 yaşındaki vakada periferik erken puberte bulguları saptandı. Çocukluk çağında birden fazla hiperfonksiyon ile seyreden endokrinopatinin eşlik ettiği olgularda ve periferik erken pubertesi olan vakalarda, sütlü kahve lekeleri şeklinde kenarları, düzensiz cilt lezyonları görülürse, ayırıcı tanıda MCAS'nün da dikkate alınması açısından iki vakanın sunumu yapıldı.Öğe Hypogonadotropic hypogonadism and growth hormone deficiency in a patient with primary hypothyroidism associated with pituitary hyperplasia mimicking pituitary macroadenoma(Karger, 2006) Şimşek, Enver; Şimşek, Tülay; Erdoğmuş, Beşir; Döşoğlu, Murat; Kocabay, KenanBackground: ATSH secreting pituitary macroadenoma is only 5% of all pituitary adenomas and it is extremely rare in children. Long standing untreated primary hypothyroidism may be cause pituitary hyperplasia which will be simulating macroadenoma.Öğe Insulin-like growth factor (IGF-I) in Mauriac syndrome or diabetic dwarfism(2002) Şimşek, Enver; Kocabay, KenanMauriac syndrome is characterized by the development of dwarfism, obesity and hepatomegaly in patients with insulin dependent diabetes mellitus (1). Growth retardation and hepatomegaly in diabetes mellitus should alert physicians over the insufficient management of diabetes mellitus and the related development of Mauriac syndrome. The cause of growth failure in Mauriac syndrome has remained obscure, although it is presumably related to the poor metabolic control of diabetes (2). Growth hormone deficiency has not been found in reported cases of Mauriac syndrome (3,4). The most important growth promoting effect of growth hormone is mediated by IGF-I (5). The determination of IGF-I and insulin-like growth factor binding protein 3 (IGF-3) had become a widely used tool in the diagnostic evaluation of growth disorders. Although IGF-I levels are commonly considered an indication of growth hormone (GH) secretion or action, its synthesis and secretion are regulated by a multifactorial and complex mechanism. Nutrition, insulin, sex steroids, cortisol, and thyroxin have positive stimulatory effects on the release of IGF-I (6). We report on two cases of diabetes mellitus associated with Mauriac syndrome and limited joint mobility.Öğe Isolated 17,20-lyase (desmolase) deficiency in a 46,XX female presenting with delayed puberty(Elsevier Science Inc, 2005) Şimşek, Enver; Özdemir, İsmail; Lin, Lin; Achermann, John C.Main Outcome Measure(s): Detailed biochemical, radiological, and molecular analysis, including pelvic ultrasound, basal steroid hormone analysis in serum and aspirated follicle fluid, serum steroid measurement after ACTH (Synachten) and human chorionic gonadotropin (hCG) stimulation, and molecular analysis of CYP17. Result(s): This girl with hypergonadotropic hypogonadism (LH 65 U/L, FSH 50 U/L) had a 46,XX karyotype, small uterus and enlarged cystic ovaries, and markedly delayed bone age (9 years). Basal (serum, follicular) and stimulated (serum) steroid hormone levels were consistent with isolated 17,20-lyase deficiency whereas relatively normal P and 17-hydroxyprogesterone concentrations were detected together with very low androstenedione, T, and E2 levels. Conclusion(s): Isolated 17,20-lyase deficiency should be considered in the differential diagnosis of hypergonadotropic hypogonadism in 46,XX females, and follicular fluid steroid analysis is a useful adjuvant test. Failure to detect mutations in CYP17 raises the possibility of a novel association of these phenotypes.Öğe Kistik tiroid teratomu(2000) Şimşek, Enver; Alper, Murat; Özyürek, Hamit; Berk, Derya; Gözükara, Aynur; Kocabay, KenanTeratomlar konjenital tümörlerdir ve en sık sakrokoksigeal bölge olmak üzere birçok yerleşimde ortaya çıkabilirler. Tiroid yerleşimli teratomlar çok nadir ölüp, çocukluk çağında sık görülüp, çoğu kistik ve benign karakterlidir. Burada liistopatpjojik olarak tanısı konulan tiroid yerleşimli bir kistik teratom olgusu sunuldu.Öğe Neonatal screening for congenital hypothyroidism in West Black Sea area, Turkey(Blackwell Publishing Ltd, 2005) Şimşek, Enver; Karabay, Meltem; Kocabay, KenanThe aim of this study was to investigate the incidence of congenital hypothyroidism (CH) in the West Black Sea Area, a mild-to-moderate iodine deficient area in Turkey. Neonatal screening for CH was performed using blood specimens collected onto filter paper. Thyrotropin [thyroid-stimulating hormone (TSH)] was measured by radioimmunoassay, and a value >20 mu U/ml was considered as cut-off point for re-examining. Venous serum was obtained to measure TSH, thyroxin (T4), free T4 (FT4) and thyroglobulin (TG). To determine the iodine status of the study area, median urinary iodine was measured in 212 randomly selected neonates and their mothers. A total of 18606 neonates were screened from three cities (Bolu, Duzce, and Zonguldak) between 2000 and 2002. With a cut-off point of TSH value >20 mu U/ml, the recall rate was found 1.6%. Eight cases of CH were diagnosed (incidence 1/2,326).There were three cases of transient hypothyroldism, with an incidence of 1/6202. Twenty-six percent of the TSH values was greater than 5 mu U/ml. Median urinary iodine concentrations in neonates and their mothers were 85 mu g/l and 40 mu g/l, respectively. The incidences of CH, transient hypochyroidism and the recall rate were higher in our study area than many countries in Europe. The study area has been affected by mild-to-moderate iodine deficiency. Neonatal screening for CH should be introduced in Turkey without delay. A national comprehensive infantile hypothyroidism and iodine prophylaxis policies should be developed.Öğe A new mutation of the fukutin gene in a non-Japanese patient(Wiley-Liss, 2003) Sılan, Fatma; Yoshioka, Mieko; Kobayashi, Kazuhiro; Şimşek, Enver; Tunç, Murat; Alper, Murat; Cam, Meryem; Güven, AyselFukuyama-type congenital muscular dystrophy (FCMD) , Walker-Warburg syndrome, and muscle-eye-brain disease are clinically similar autosomal recessive disorders characterized by congenital muscular dystrophy, cobblestone lissencephaly, and eye anomalies. FCMD is frequent in Japan, but no FCMD patient with confirmed fukutin gene mutations has been identified in a non-Japanese population. Here, we describe a Turkish CMD patient with severe brain and eye anomalies. Sequence analysis of the patient's DNA identified a homozygous 1bp insertion mutation in exon 5 of the fukutin gene. To our knowledge, this is the first case worldwide in which a fukutin mutation has been found outside the Japanese population. This report emphasizes the importance of considering fukutin mutations for diagnostic purposes outside of Japan.Öğe A novel thyroid hormone receptor-beta mutation that fails to bind nuclear receptor corepressor in a patient as an apparent cause of severe, predominantly pituitary resistance to thyroid hormone(Endocrine Soc, 2006) Wu, Sharon Y.; Cohen, Ronald N.; Şimşek, Enver; Şenses, Dursun A.; Yar, Neşe E.; Grasberger, Helmut; Noel, JanetContext: Resistance to thyroid hormone ( RTH) is a dominantly inherited syndrome of variable tissue hyporesponsiveness to thyroid hormone ( TH). Objective: We report a newborn who presented with severe RTH ( Mkar) with serum TSH 1500 mU/ liter and free T-3 greater than 50 p(M) ( normal 3.1 - 9.4) and free T-4 25.3 pM ( normal 12 - 22). We hypothesized that the RTH was due to reduced ligand binding and/ or abnormal interaction with nuclear cofactors. Design: These were prospective in vivo and in vitro studies. Setting: The study was conducted at a tertiary care university hospital. Patients: Patients included a newborn child and two other subjects with RTH. Intervention: The effect of various TH- lowering agents in the subject with RTH was studied. In vitro studies including EMSA and mammalian two- hybrid assay as well as in vitro transfection studies were conducted. Main Outcome Measures: Sequencing of the TH receptor ( TR)beta and in vitro measurements of receptor- cofactor interaction were measured. Results: Sequencing of the TR beta demonstrated a de novo heterozygous mutation, 1590_ 1591insT, resulting in a frameshift producing a mutant TR beta( mutTR)-beta with a 28- amino acid ( aa) nonsense sequence and 2- amino acid carboxyl- terminal extension. The Mkar mutation was evaluated in comparison to three other TR beta frameshift mutations in the carboxyl terminus. EMSA demonstrated that the Mkar mutTR beta 1 had impaired ability to recruit nuclear receptor corepressor but intact association with silencing mediator of retinoid and thyroid receptor ( SMRT). Conclusion: Our data suggest that alterations in codons 436 - 453 in helix 11 result in significantly diminished association with nuclear eceptor corepressor but not SMRT. This novel mutTR beta demonstrates nuclear corepressor specificity that results in severe predominantly pituitary RTH due to impaired release of SMRT.Öğe Sensitivity of iodine deficiency indicators and iodine status in Turkey(Freund Publishing House Ltd, 2003) Şimşek, Enver; Şafak, Alper; Yavuz, Özlem; Aras, Şükrü; Doğan, Semih; Kocabay, KenanBackground. Iodine deficiency is a major health problem worldwide. Goiter prevalence and the median urinary iodine concentration in a population usually define endemic iodine deficiency. In addition to goiter prevalence and median urinary concentration, thyroid stimulating hormone (TSH) and thyroxine have been used as iodine deficiency indicators. Objective: To evaluate endemic goiter prevalence in Western Anatolia, Turkey, and to evaluate the sensitivity of thyroglobulin and height percentile as iodine deficiency indicators. Subjects: We examined 727 school-children (378 girls, 349 boys) in two cities (Bolu and Duzce) and six mountainous rural areas, in West Anatolia. Of the 727 children, 234 were from four urban schools, and 493 were from eight rural schools. Methods: Clinical examination and ultrasonography were used to evaluate goiter prevalence. Iodine in spot urine, serum total thyroxine (T-4), serum free thyroxine (FT4), thyroid stimulating hormone (TSH), and thyroglobulin (Tg) were measured. Iodine deficiency severity was classified based on thyroid volume measurements by ultrasonography and urinary iodine excretion. Results: The degree of iodine deficiency according to concentration of urinary iodine was severe in 2 76 children (38%), moderate in 151 (20.8%), mild in 114 (15.7%), and within normal levels in 186 (25.4%). Although urban areas showed normal or mild urinary iodine excretion, four rural areas showed from mild to severe iodine deficiency (p <0.001). Thyroid volumes of the severe iodine deficiency group were significantly higher than those of moderate and mild iodine deficiency groups (p <0.001). There was no significant difference between thyroid volumes in moderate and mild iodine deficiency groups. FT4 levels of the severe iodine deficiency group were significantly lower than in moderate and mild iodine deficiency groups (p <0.001). There was no significant correlation between TSH and iodine excretion (r = 0.01, p >0.05). Thyroglobulin (Tg) levels were significantly different between all groups (p <0.001). There was a significant negative correlation between Tg and urinary iodine excretion (r -0.27, p <0.001). Conclusions: Severe and moderate iodine deficiency areas are more prevalent in Turkey than mild and normal iodine concentration areas. In addition to urinary iodine concentration and thyroid volume, height percentile and Tg are also sensitive markers for endemic iodine deficiency. TSH screening should be performed nationwide in Turkey. We recommend compulsory iodination of table and industrial salt.Öğe Sonographic assessment of the normal limits and percentile curves of liver, spleen, and kidney dimensions in healthy school-aged children(Amer Inst Ultrasound Medicine, 2005) Şafak, Alp Alper; Şimşek, Enver; Bahçebaşı, TalatObjective. The purpose of this study was to determine the normal standards of liver, spleen, and kidney dimensions and the relationship of each with sex, age, body weight, height, body mass index, and body surface area in. healthy school-aged children. Methods. Seven hundred twelve healthy school-aged children (7-15 years) in 2 neighboring cities, including rural areas and, city centers, were evaluated prospectively. Sex, age, weight, height, body mass index, and body surface area were determined for each case. Organ dimensions were measured 3 times, and the mean values were recorded. All Measured organs had a normal position, shape, and echo texture. The children were separated into 5 groups according to body weight. Results. There were no significant differences in organ dimensions with respect to sex (P >.05). The mean right kidney length was shorter than the left kidney length, and the difference was significant (P =.009). Body weight showed the best correlation with liver, spleen, and kidney dimensions. The results were also supported by the variance and covariance of the correlation coefficients. Conclusions. The normal limits of the liver, spleen, and kidneys are important parameters during a sonographic examination. This study revealed that organ dimensions showed the best correlation with body weight. To our knowledge, in clinical practice there are no pediatric organ dimension percentile graphs for interpretation of sonographic examinations. We hope this study contributes to daily practice in radiology clinics.Öğe Subacute sclerosing panencephalitis (SSPE) associated with congenital measles infection(Turkish J Pediatrics, 2005) Şimşek, Enver; Öztürk, Ayhan; Yavuz, Cevdet; Kocabay, KenanA 13-month-old male presented with repetitive episodes of myoclonic jerks of the head and extremities for two months. His past medical history revealed that his non-immunized mother had measles at the time of delivery. Measles antibody titers in serum and cerebrospinal fluid (CSF) were 1/512 (hemagglutinin inhibition [HI]) and 1/128 HI, respectively. Immunofixation electrophoresis of CSF revealed an oligoclonal IgG band. The magnetic resonance imaging (MRI) of the brain on T2-weighted images showed lesions of high signal intensity in the subcortical white matter. Electroencephalography (EEG) revealed periodic high-amplitude slow waves. Diagnosis of subacute sclerosing panencephalitis (SSPE) was based upon clinical presentation, a characteristic EEG, and abnormal CSF studies. MRI findings supported the diagnosis. To the best of our knowledge, this is only the 3(rd) case to date, of SSPE-associated congenital measles in the literature.
