When dealing with giant lipomas, liposarcomas should always be included in the differential diagnosis.

Background: Brain natriuretic peptide (BNP) is a cardiac hormone secreted from the ventricular myocardium as a response to ventricular volume expansion and pressure overload. Rheumatic heart disease (RHD) is still an important cause of heart failure in developing countries. Aims: To measure BNP levels in patients with RHD and to determine whether BNP concentrations correlate with clinical and echocardiographic findings. Methods: Eighty-eight patients with rheumatic valve disease and 24 age-and sex-matched healthy subjects were entered in the study. BNP was measured using the Triage B-Type Natriuretic Peptide test (Biosite Diagnostics, San Diego, CA). Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure. Results: The plasma concentrations of BNP were significantly higher in patients with rheumatic heart disease than in control subjects (232 F 294 vs. 14 F 12 pg/ml, p < 0.0001). The plasma BNP level was significantly higher in NYHA class III + IV than in class II (463 F 399 vs. 192 F 243 pg/ml, p < 0.0001) and in NYHA class II than in class I (192 F 243 vs. 112 F 135 pg/ml, p < 0.001). The independent determinants of higher BNP levels were NYHA functional class and systolic pulmonary artery pressure in multivariate analysis. Conclusion: We found increased plasma BNP levels in patients with rheumatic heart disease compared with healthy subjects.

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Aim. Dihydropyridine calcium channel blockers (CCB) are widely preferred for the treatment of hypertension for their efficacy, metabolic neutrality and low side effect profile. However pedal edema formation limits their usage. The aim of the present study is to evaluate the incidence of pedal edema formation with a different dihydropyridine CCB in hypertensive patients who developed pedal edema during a dihydropyridine CCB therapy. Method. Fifty-eight hypertensive patients (34 female, 24 male, mean age: 65.3±10.5) in whom pedal edema developed during treatment with a dihydropyridine CCB (amlodipine 10mg/day in 40 patients, amlodipine 5mg/day in 14 patients, nifedipine GITS 30mg/day in 4 patients) were enrolled. CCB which caused pedal edema was withdrawn and a different CCB (felodipine or lacidipine) were initiated after the resolution of the pedal edema. CCB therapy was continued as long as the patient tolerated pedal edema. Results. At the end of one year, 44 out of 58 patients (36 [81.8%] free of pedal edema, 8 [19.2%] with pedal edema) continued CCB therapy. Eleven (37.9%) patients in the felodipine group and 9 (31.0%) patients in the lacidipine group developed pedal edema. In 7 patients in felodipine group and in 5 patients in the lacidipine group the study drug was withdrawn due to pedal edema. In two patients, study drug was withdrawn due to intractable headache (felodipine group) or due to flushing (lacidipine group). Conclusion. A different group of dihydropyridine CCB be used as an alternative therapy for hypertension whenever pedal edema develops during treatment with a dihydropyridine CCB.Keywords: Hypertension, dihydropyridine calcium channel blockers, edema Özet Amaç. Dihidropiridin kalsiyum kanal blokerleri (KKB) etkinlikleri, metabolik nötraliteleri ve düşük yan etki profilleri nedeniyle hipertansiyon tedavisinde yaygın olarak tercih edilirler. Ancak tedavi sırasında ayak bileği ödemi gelişimi kullanımlarını kısıtlar. Bu çalışmanın amacı dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen hipertansif hastalarda farklı bir dihidropiridin KKB' ne geçilmesiyle ayak bileği ödemi gelişim oranının araştırılmasıdır. Yöntem. Dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen 58 hipertansif hasta (34 kadın, 24 erkek, ortalama yaş 65,3±10,5) çalışmaya alındı. Bunlardan 40'ında ayak bileği ödemine yol açan KKB amlodipin 10mg/gün, 14'ünde amlodipin 5mg/gün ve 4'ünde nifedipine GITS 30mg/gün idi. Ayak bileği ödemi yapan KKB kesilerek ödem kaybolduktan sonra farklı bir dihidropiridin KKB (felodipin ya da lasidipin) başlandı. Yeni başlanan KKB tedavisine hasta ayak bileği ödemini tolere ettikçe devam edildi. Bulgular. grubunda 11 (%37,9) ve lasidipin grubunda 9 (%31,0) hastada ayak bileği ödemi gelişti. Felodipin grubunda 7, lasidipin grubunda 5 hastada ayak bileği ödemi geliştiği için tedavi kesildi. Felodipin grubunda bir hastada şiddetli başağrısı, lasidipin grubunda bir hastada ise flushing nedeniyle tedavi sonlandırıldı. Sonuç. Dihidropiridin KKB tedavisi sırasında ayak bile...

Serum sickness and serum sickness-like reactions are the type III hypersensitivity reactions that occur in the presence of culprit agents which can be an exogenous protein, drug, bacteria, virus. Clinical symptoms usually begin in 6-21 days after exposure to antigenic stimulation. Typical clinical findings are characterised as fever (10-20%), erythematous rash (95%), polyarthritis and / or polyarthralgia (10-50%), and lymphadenopathy (10-20%). There are no specific laboratory findings and diagnostic criteria for serum sickness-like reaction. Laboratory findings usually include leukocytosis, mildly increased erythrocyte sedimentation rate, and rarely proteinuria and hematuria. Even though there are no diagnostic criteria for serum sicknesslike reaction, it can be diagnosed with the presence of fever, rash, arthritis-arthralgia, lymphadenopathy, myalgia which occurs in 1-2 weeks after exposure to an agent that can trigger the disease. Recommended or achieved a consensus for the treatment of the serum sickness-like reaction doesn't occur and the information about this subject in the literature is limited by the authors' case reports who share their experiences.

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Objective: This research was planned to evaluate how mothers with 0-12-month-old infants who had been admitted to health centers in the city center of Van. Methods: The data of this descriptive research were collected by face-to-face interviews with 635 mothers. The data were evaluated by chi-square and logistic regression analysis. Results: The mean duration of exclusive breastfeeding of infants was 4 months. While 47.9% of 1-6-month-old infants were still being breastfed, 53.5% of 7-12-month-old infants were being fed with proper nutrition in addition to breast milk. It was confirmed that infants of 6 months or younger are four times better fed than babies of 7 months and older, infants breastfed in the first postnatal hour are fed 1.6 times better than those breastfed after the first hour, and that infants not given pacifiers are two times better fed compared to those that are not given these aids. Conclusion: In the present study, the frequency of exclusive breastfeeding was higher than that indicated average of Turkey. Additionally, a negative relationship was found between using pacifiers and proper nutrition. Our study showed that the aims that WHO and of the United Nations Children's Fund (UNICEF) suggest could not be reached but results were still found to be better compared to those of TNSA-2008 and TNSA-2013.