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Öğe Estrogen Treatment in Children(Nova Science Publishers, Inc, 2009) Soyer, Tutku; Evliyaoğlu, OlcayEstrogen treatment is rarely indicated during childhood. A limited number of patients requires either topical or systemic estrogens in selected cases. Labial adhesions in which the labia minora fused over the vestibule is the most common indication for topical estrogen treatment in children. Although the most accepted theory of labial adhesions is low estrogen levels, the use of topical estrogen treatment is still controversial. The systemic application of estrogen is used in girls with hypogonadism. Either in hypo or hypergonadotropic hypogonadism, low doses of estrogen treatment is initiated at pubertal age as a replacement treatment, to mimic normal puberty. In Turner syndrome, which is an example of hypergonadotropic hypogonadism, estrogen treatment should be also initiated at pubertal age in addition to growth hormone replacement. Although in girls, 'constitutional growth and pubertal delay' is not observed as frequently as in boys, very low doses of estrogen therapy for a short duration can be considered to induce normal puberty. Another indication of systemic estrogen treatment is for tall stature in carefully selected cases to fuse epiphysis. Though topical estrogen treatment in labial adhesions is preferred and used by many practitioners, systemic use of this hormonal therapy is only constituted by pediatric endocrinologists. In this chapter, our aim is to discuss the estrogen treatment in children with special emphasis on indications, treatment doses and results.Öğe Experience with long-term glucocorticoid treatment in congenital adrenal hyperplasia: Growth pattern compared with genetic height potential(Walter De Gruyter Gmbh, 2006) Aycan, Zehra; Öcal, Gönül; Berberoğlu, Merih; Çetinkaya, Ergun; Adıyaman, Pelin; Evliyaoğlu, OlcayObjective: Long-term replacement treatment with high doses of steroids in congenital adrenal hyperplasia (CAH) is known to have a negative influence on growth. We evaluated the effects of long-term steroid treatment in patients with classical CAH on height development in relation to genetic height potential. Patients and Methods: Twenty-three patients with CAH (16 females, 7 males, mean age: 9.8 +/- 3.5 years) were included in this longitudinal study. The effect of steroid treatment on growth was determined by monitoring patients for 8.61 +/- 3.46 years (2-17 years) while they were treated with hydrocortisone at a mean dosage of 17.64 +/- 3.60 mg/m(2)/day. The height standard deviation scores (Ht-SDS), target Ht-SDS, and corrected Ht-SDS for target height was calculated for all patients. Predicted adult height according to bone age was calculated and it was determined whether height was developing according to the genetic height potential. In addition, patients were grouped as 'tight control' or 'poor control' according to their mean serum 17OH-progesterone or ACTH levels while on treatment. We evaluated whether height development was different for the tight and poor control groups. Results: The mean chronological age of our patients at the time of the study was 9.89 +/- 3.53 years, Ht-SDS -0.77 +/- 1.57, target height (TH) 161.03 +/- 6.54 cm, TH-SDS -0.60 +/- 0.90, predicted height (PH) 157.2 +/- 11.16 cm, PH-SDS -1.1 +/- 1.69, and corrected Ht-SDS -0.75 +/- 1.14. There was no significant difference between the actual Ht-SDS and TH-SDS of our patients (p > 0.05) but the corrected Ht-SDS was less than zero. Only 28.5% of our patients had normal height according to their genetic potential while 71.5% were shorter than their genetic height potential. While the Ht-SDS and corrected Ht-SDS were similar in the tight and poor metabolic control groups, the predicted height was significantly greater in the tight control group. Conclusion: We demonstrated that a hydrocortisone dose of 17.64 +/- 3.60 mg/m(2)/day in classical CAH had a negative influence on height development for genetic height potential in 8.5 years of follow-up and that it is necessary to use the lowest possible steroid dosage by individualizing the dose.Öğe Mantar zehirlenmesi olan çocuk olguların değerlendirilmesi(2007) Hızel, Selda; Mısırlıoğlu, Emine Dibek; Özdoğan, Selver; Kırlı, Erkan; Evliyaoğlu, Olcay; Aliefendioğlu, DidemÖzet: Mantar zehirlenmesi mortalitesi yüksek zehirlenmelerdendir. Zehirli mantarlar özellikle ilkbahar ve sonbahar mevsimlerinde ortaya çıkarlar ve zehirlenmeleri bu dönemde daha fazla görülür. 2006 yılı 1 Ekim 31 Kasım tarihleri arasında Çocuk Sağlığı ve Hastalıkları bölümünde mantar zehirlenmesi tanısıyla izlenen olguların; semptomları, semptomların başlama zamanı, hastaneye getirilme zamanları, fizik inceleme bulguları, laboratuvar bulguları, uygulanan tedaviler, hastanede kalış süreleri ve prognozları kaydedildi. Tanımlanan süre içerisinde toplam 24 olgu görüldü. Bu olguların 8 (%33.3)’i sevk edilirken, 16 (%66.7)’sı yatırılarak izlendi. Bütün olguların başvuru anında bulantı-kusma yakınması varken, sadece 3 olguda (%12.5) nörolojik bulgular saptandı. Yedi olguda (%29.2) semptomlar mantar alımını takiben ilk 6 saatte ortaya çıkmıştı. Karaciğer fonksiyon testleri 4 olguda (%16.6) yükselmiş iken, böbrek fonksiyon testleri tüm olgularda normaldi. Sevk edilen olgulardan 2’si (%8.3) kaybedilirken yatırılarak izlenen 16 olgunun hepsi şifa ile taburcu edildi. Mantar zehirlenmesi mortalitesinin yüksekliği nedeniyle, önemli bir sağlık sorunudur ve en iyi tedavi halkın bilinçlendirilmesidir. Bu nedenle eğitim konusunda yürütülecek çalışmalarla halkın uyarılması, bulgular konusunda bilgilendirilmesi ve bulguların ortaya çıkması ile erken hastaneye başvurularının sağlanması mortaliteyi azaltacaktır.Öğe Side effects of metoclopramide: Does it deserve to prescribe for nausea, vomiting?(2010) Bülbül, Hızel Selda; Mısırlıoğlu, Dibek Emine; Tufan, Erennur; Evliyaoğlu, OlcayMetoklopramid antiemetik olarak kullanılan dopamin reseptör antagonistidir. Önerilen tedavi dozlarında da görülebilen ekstrapiramidal etkiler çocuklarda sık görülen akut yan etkilerdendir. Kırıkkale Üniversitesi Tıp Fakültesi ve Sağlık Bakanlığı Kırıkkale Çocuk Sağlığı ve Hastalıkları Hastanesi acil polikliniklerine Mart 2006-Mart 2007 tarihleri arasında metoklopramid kullanımı sonrası ortaya çıkan yan etkileri ile başvuran 19 olgu retrospektif olarak değerlendirildi. Çalışmadaki hastaların yaşları 4 ila 174 ay arasında değişmekte olup 10 (%52,7)’u kızdı. Görülen yan etkiler; distonik reaksiyon, okulogirik kriz ve konvülsiyon idi. Tüm hastalarda semptomlar metoklopramid kullanımını takip eden ilk üç günde ortaya çıkmıştı. 17 hasta tek doz biperidene yanıt verirken bir hastaya ikinci doz uygulanması gerekmişti. Bir hastada konvülsiyon nedeniyle tedaviye midazolom eklenmişti. Klinisyenler metoklopramide kullanımı sonrası yan etkiler açısından dikkatli olmalıdır.Öğe Wolff-Chaikoff effect in a newborn: is it an overlooked problem?(2006) Aliefendioğlu, Didem; Şanlı, Cihat; Çakmak, Murat; Ağar, Ayça; Albayrak, Meryem; Evliyaoğlu, OlcayHypothyroidism is a serious endocrine disorder emerging from deficient production of thyroid hormone (thyroid gland agenesis or dysgenesis, or inborn metabolic defects of thyroid hormone production) or a defect in thyroid hormonal receptor activity. Prevention of iodine organification by means of using iodine-containing drugs or solutions is a protective mechanism for the body and is known as the Wolff-Chaikoff effect. This effect blocks thyroid hormone generation and is often transient, with thyroid hormone synthesis recovering in a few days or weeks. We present a neonate with transient thyroid dysfunction resulting from topical exposure to iodine-containing antiseptic solution. Our aim was to increase awareness that the use of antiseptic iodine solutions in neonates may result in transient hypothyroidism through the Wolff-Chaikoff effect and should be considered after the use of iodine-containing solutions or drugs. © 2006 Elsevier Inc. All rights reserved.
