The values of WBC, neutrophil count, and N/L ratio differ significantly from those of the control group. The WBC and N/L ratio may help for an earlier diagnosis in children with acute ischemic stroke. WBC, thrombocyte count, MPV, PDW, and N/L ratio do not constitute a risk in overall survival, disease-free survival, and sequelae development.
ÖZAmaç: Kardiyak kateterizasyon için femoral girişim uyguladığımız hastalarda vasküler komplikasyon sıklığını ölçmeyi, olası risk faktörlerini belirlemeyi ve gelecekte bunlara karşı önlemler alarak komplikasyon sıklığını azaltmayı amaçladık. Yöntem: Bölümümüzde 2011-2015 yılları arasında anjiyografi yapılan 106 hasta çalışmaya alın-mıştır. Hastaların yaşı, kilosu, prosedür tipi, süresi, kullanılan kılıf boyutu, işlemden sonra geçen süre, kateterizasyon sayısı, işlem sırasında karşılaşılan komplikasyon, hastanın ek sağlık sorunları hasta dosyalarından kaydedildi. Her hastanın bilateral eksternal iliak, yüzeyel femoral arter ve venleri ultrasonografi ile görüntülendi. Bulgular: Çalışmaya alınan 45 erkeğin ortalama yaşı 21, 61 kızın ortalama yaşı 42 aydı. Anjiyografi sırasında hastaların vücut ağırlığı, erkeklerde 10, kızlarda 13,5 kg'dı. Son anjiyografiden sonra geçen ortalama süre 28,5 (7,75-60,25) aydı. Anjiyografide kılıfın en sık ve en az yerleştirilen damar sırasıyla sağ femoral ven iken, sol femoral arterdi. En sık kullanılan kılıf 5 French çapında, kullanılan en büyük kılıf 10Fr (3 kez sağ femoral vene, 1 kez sol femoral vene), en küçük kılıf ise 4 Fr'di (sağ femoral artere 4, sağ femoral vene 2, sol femoral artere 2 kez). Ortalama işlem süresi 44 (30-50) dakikaydı. Toplam 106 femoral ven ve arter Doppler ultrasonografi incelemesi yapıldı. VSD tanısıyla takip edilen ve basınç ve saturasyon ölçümü için anjiyografi yapılan yapılan 18 aylık erkek hastada sağ inguinalde hematom belirlendi. Anjiyografiden sonra geçen süre 3 aydı, izleminde kendiliğin-den düzeldi. Sonuç: Gelişen teknoloji ile daha küçük çaplı kılıf ve taşıyıcı sistem geliştirilmesi, işlem sırasında ve sonrasında iyi anti-koagülasyon sağlanması, işlem süresinin kısa tutulması ile eskiye oranla komplikasyon riski azalmıştır.Anahtar kelimeler: femoral, çocuk, komplikasyon, kateter ABSTRACT Objective: We aimed to find out the incidence of vascular complications, possible risk factors of having complication in the patients who had femoral access for cardiac catheterization. We planned to take precautions and decrease complication incidence. Methods: One hundred and six patients who had catheterization in our center between 2011, and 2015 were included in the study. Age, weight, type of procedure, sheath size, duration after last angiography, complications, additional health problems of patients were recorded. Bilateral external iliac, femoral artery and veins were visualized with Doppler ultrasonography. Results: Median ages of 45 boys, and 42 girsl included in the study were 21, and 42 months, respectively. Median bodyweights of boys and girls during angiography was 10 kg and 13.5 kg. Median time period after the last angiography was 28.5 months. Most commonly vessel that femoral sheath was inserted into right femoral vein, while femoral artery the least used vessel. Most commonly 5 French (Fr) sheath was used. Smallest sheath was 4 Fr, and the largest one was 10 Fr. Median duration of procedures was 44 minutes. Doppler ultrasonography of total of 10...
Background: Paroxysmal nocturnal hemoglobinuria (PNH) is an ultrarare bone marrow insufficiency of childhood consisted of the triad of diagnostic symptoms: hemolytic anemia, thrombosis, and peripheral blood cytopenias. Acute abdominal pain is one of the most important prodrome of PNH mostly due to venous thrombosis of intra-abdominal veins, including hepatic, portal, mesenteric, and splenic blood vessels. Aims: To show how a complicated course of diseases due to "abdominal mask'' resulted in more than 2 years delay in diagnosis might be fatal to a PNH patients. Methods: We report a boy of 15th, suffered from PNH, who presented long before the diagnosis with seasonal (spring and autumn only) paroxysmal acute and severe (8-9 VAS score) abdominal pain with cramps and tenderness and no other hematological presentation of disease. There were a couple attacks observed during the season with complete resolution of abdominal symptoms in between. He had been diagnosed as acute appendicitis, peptic ulcer disease, pancreatitis or cholecystitis especially when hyperbilirubinemia emerge, Crohn and atypical celiac disease for more than 2 years. Since a peripheral pancytopenia followed by severe anemia required erythrocyte transfusions during the last 2 attacks occurred, hematologist had been asked for consultation. Due to severe anemia with reticulocytosis, hyperbilirubinemia, highly elevated LDH, meaningful splenomegaly and almost nondetectable concentration of serum haptoglobin and a dark urine with confirmed hemoglobinuria, with a weak bone marrow aplasia, the diagnosis of PNH was feasible. The cytometric results, which revealed no expression of GPI proteins in 93.8% of type III PMNs, confirmed the diagnosis (percentage of RBC lacking GPI was not persuasive, as he has been previously transfused). Up to this point of his disease, except of transient, he had no fixed postembolic lessons in liver and kidney, and a negligible bowel signs revealed for the several time in CT/MR-angiography. He had no other embolic events in other organs as well. Results: As the results of HSCT are questionable in PNH, especially in children, we decided to start eculizumab. The complete clinical remission assessed as complete symptoms resolution had been achieved with the 2nd dose, and complete biochemical remission, based on LDH normalization, was confirmed with the 3rd dose of a MoAb therapy. The presence and percentage of PNH clones tested twice since diagnosis in both PNMs and RBCs did not change till now. We have not observed any complications during a year and half of treatment up to date of publication. Summary/Conclusion:The insidious and hidden course of thrombosis of intra-abdominal veins even accompanied by hemolysis may mask the real reason and significantly prolong the diagnosis of ultrarare disease such as a PNH, especially in children. Eculizumab is a treatment of choice of childhood PNH.
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