Dr Sami Ulus Childrens Hospital

Ankara, Turkey

Dr Sami Ulus Childrens Hospital

Ankara, Turkey

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Ceylan M.F.,Dr Sami Ulus Childrens Hospital | Sener S.,Gazi University | Bayraktar A.C.,Gazi University | Kavutcu M.,Gazi University
Psychiatry and Clinical Neurosciences | Year: 2012

Aims: Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder with an etiopathogeny not fully understood. According to the prevailing view, the main factors contributing to the disorder are prefrontal dopamine deficiency and central dopaminergic dysfunction, but the factors/mechanisms involved in the brain dysfunction and its consequences are not well known. We suggest that changes in oxidative metabolism and cellular immunity may be involved. In this study, we aimed to investigate whether there are associations between ADHD and changes in serum levels of nitric oxide synthase (NOS), xanthine oxidase (XO), glutathione S-transferase (GST) and paraoxonase-1 (PON-1) activities, which are important markers of oxidative stress, and adenosine deaminase (ADA) activity, marker of cellular immunity. Methods: The study sample consisted of 35 child or adolescent patients diagnosed with ADHD according to DSM-IV-TR criteria. Thirty-five healthy subjects were also included in the study as controls. Venous blood samples were collected, and NOS, XO, GST, PON-1 and ADA activities were measured. Results: NOS, XO and ADA activities of the patients were significantly higher than those of the controls. GST and PON-1 activities of the patients were significantly lower than those of the controls. Conclusions: Changes in oxidative metabolism and cellular immunity may have a role in the etiopathogenesis of ADHD. © 2012 Japanese Society of Psychiatry and Neurology.


Yuksel D.,Dr Sami Ulus Childrens Hospital | Diren B.,Ankara Medicana Hospital | Ulubay H.,Ankara Medicana Hospital | Altunbasak S.,Cukurova University | Anlar B.,Hacettepe University
Neurology | Year: 2014

Objective: We performed diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) studies in a group of patients with subacute sclerosing panencephalitis (SSPE) in order to estimate the pathologic process underlying the phenotypic variability. Methods: Patients with SSPE who had MRI including DTI and MRS examinations were evaluated according to their clinical status as determined by the SSPE Scoring System and their mental age as determined by tests appropriate for age and developmental level. Comparisons of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values and metabolite ratios of frontal periventricular white matter, parieto-occipital periventricular white matter, and globus pallidus in both hemispheres were made between control and SSPE groups, and between SSPE subgroups. Results: Control (n = 18) and SSPE (n = 39) groups differed in all DTI and MRS parameters except FA, choline (Cho), and Cho/creatine (Cr). SSPE cases had higher ADC and lower N-acetylaspartate (NAA), NAA/Cho, and NAA/Cr in all regions of interest, suggesting cell loss. Disease progression rate and neurologic deficit appeared to be associated with the degree of ADC elevation and NAA reduction: the group with severe global deterioration had the lowest NAA (230.75 ± 197.97 in forceps minor), and rapid progression was associated with acute reduction in NAA. Conclusions: The combination of MRS and diffusion MRI findings suggests neuronal loss can be a primary target in rapidly or subacutely progressing SSPE, and preservation or regeneration of axonal structure may be beneficial in chronic cases. © 2014 American Academy of Neurology.


Tumer T.B.,Middle East Technical University | Tumer T.B.,Canakkale Onsekiz Mart University | Sahin G.,Dr Sami Ulus Childrens Hospital | Arinc E.,Middle East Technical University
Archives of Toxicology | Year: 2012

Microsomal epoxide hydrolase, EPHX1, plays a central role in the detoxification of potentially genotoxic epoxide intermediates. In this study, we firstly aimed to investigate the relationship between EPHX1 Tyr113His and His139Arg variants, and the risk of incidence of childhood acute lymphoblastic leukemia (ALL) in Turkish population, comprised of 190 healthy controls and 167 ALL patients. In exon 3 Tyr113His polymorphism, 113His/His homozygous mutant genotype with slow activity was 18.6% in ALL patients and 9% in controls, indicating 113His/His slow activity genotype was significantly associated with an increased risk of childhood ALL (OR: 2.3, 95% CI, 1.2-4.4, P = 0.01). No significant association was found between exon 4 His139Arg variant and the risk of ALL. When both exon 3 Tyr113His and exon 4 His139Arg polymorphisms were considered together, only the exon 3 113His/His, homozygous mutant, slow activity genotype with exon 4 wild-type genotype 139His/His was significantly increased the risk of ALL 2.4-fold (OR: 2.4, P = 0.02). We also evaluated whether haplotype analysis for EPHX1 Tyr113His polymorphism together with DNA protein XRCC1 Arg399Gln variant known for its deficient DNA repair capacity would represent more prominent risk factors for the development of childhood ALL. Accordingly, the co-presence of Tyr113His variant of EPHX1 and Arg399Gln variant of XRCC1 in the same individuals significantly increased the risk of childhood ALL up to 2.1-fold (OR = 2.1, P = 0.03). Moreover, homozygous mutant genotype for both genes significantly and considerably increased the risk of childhood ALL 8.5-fold (OR: 8.5, P = 0.03). In conclusion, individuals with EPHX1 113His/His slow activity genotype may not detoxify reactive carcinogenic epoxides efficiently, binding of reactive epoxides to DNA cause DNA damage. With the inadequate polymorphic DNA repair protein, XRCC1, this situation ultimately leads to significantly increased susceptibility for childhood ALL. © 2011 Springer-Verlag.


Yucwe M.,Ondokuz Mayis University | Zoroglu S.S.,Istanbul University | Ceylan M.F.,Dr sami Ulus Childrens Hospital | Kandemir H.,Harran University | Karabekiroglu K.,Ondokuz Mayis University
Neuropsychiatric Disease and Treatment | Year: 2013

Objective: We aimed to determine distribution and diversities of psychiatric comorbidities in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in terms of age groups, sex, and ADHD subtype. Materials and methods: The sample included 6-18 year old children and adolescents from Turkey (N=108; 83 boys, 25 girls) diagnosed with ADHD. All comorbid diagnoses were determined based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version assessment. Results: 96.3% of the cases were found to have at least one psychiatric comorbid diagnosis. The most frequent psychiatric comorbid disorder was oppositional defiant disorder (69.4%) followed by anxiety disorders (49%) and elimination disorders (27.8%). Disruptive behavior disorders were more common in ADHD-combined type. Depression and anxiety disorders were more common in girls. Separation anxiety disorder and elimination disorder were more common in children, whereas depression, bipolar disorder, obsessive-compulsive disorder, and social phobia were more common in the adolescents. Conclusion: According to our results, when a diagnostic tool was used to assess the presence of comorbid psychiatric disorders in children and adolescents diagnosed with ADHD, almost all cases had at least one comorbid diagnosis. Therefore, especially in the clinical sample, ADHD cases should not be solely interpreted with ADHD symptom domains, instead they should be investigated properly in terms of accompanying psychiatric disorders. © 2013 Yüce et al.


Karatayli-Ozgursoy S.,Dr Sami Ulus Childrens Hospital | Demireller A.,Kent Hospital
Ear, Nose and Throat Journal | Year: 2012

We report our experience with hyoid suspension surgery in patients with obstructive sleep apnea (OSA) diagnosed on the basis of polysomnographic criteria. We conducted a prospective, observational study of 20 patients-18 males and 2 females, aged 15 to 52 years (mean: 42.1)-who were treated at our tertiary care center. All patients underwent hyoid suspension surgery and uvulopalatopharyngoplasty (UPPP) in a single session. Postoperative success was defined as either (1) a reduction in the apnea-hypopnea index (AHI) from 20 or higher to less than 20 or (2) a reduction in AHI of at least 50%. Postoperative follow-up polysomnography indicated that surgery was successful in 18 of 20 patients (90%). No important complications were observed. We conclude that hyoid suspension surgery is an effective procedure with low morbidity for the treatment of OSA in selected patients with hypopharyngeal obstruction. We believe it is a good option for those patients who will not or cannot tolerate therapy with continuous positive airway pressure. © 2012 Vendome Group, LLC.


Demirkiran H.G.,Hacettepe University | Bekmez S.,Dr Sami Ulus Childrens Hospital | Celilov R.,Hacettepe University | Ayvaz M.,Hacettepe University | And 2 more authors.
Journal of Pediatric Orthopaedics | Year: 2015

Background: Serial casting is an effective treatment modality in early-onset idiopathic scoliosis; however, the role of this method in congenital scoliosis is not well studied.Methods: A total of 11 patients with progressive congenital scoliosis were treated with serial cast application. Age at initial cast application, magnitudes of the congenital, compensatory and sagittal deformities, coronal balance, T1 to T12 height, number of casts and time-in cast per patient, subsequent surgical interventions, and complications were evaluated.Results: Mean age at the first cast application was 40 months, and the average number of cast changes was 6.2 per patient. There were no major complications. The average precasting curve magnitude was 70.7 degrees (range, 44 to 88 degrees) and was significantly reduced to 55.1 degrees (range, 16 to 78 degrees) at the latest follow-up (P=0.005). The average precasting compensatory curve was 55.8 degrees (range, 38 to 72 degrees) and was significantly reduced to 39.8 degrees (range, 23 to 62 degrees) at the latest follow-up (P=0.017). Average T1 to 12 height increased from 12.8 cm at post-first cast to a 14.6 cm at the latest follow-up (P=0.04). Average time in cast was 26.3 months (range, 13 to 49 mo). During the treatment period, none of the patients required surgery for curve progression.Conclusions: Serial derotational casting is a safe and effective time-buying strategy to delay the surgical interventions in congenital deformities in the short-term follow-up.Level of Evidence: Level IV, case series. © 2014 by Lippincott Williams and Wilkins.


Aydin T.F.,Ondokuz Mayis University | Aydin T.F.,Dr Sami Ulus Childrens Hospital | Ichiyama T.,Yamaguchi University | Anlar B.,Hacettepe University
Brain and Development | Year: 2010

Subacute sclerosing panencephalitis (SSPE) is a neurodegenerative disease due to persistent measles virus infection. Its immunopathogenesis is unknown. Tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-6, IL-10 and IL-4 concentrations were measured in cerebrospinal fluid (CSF) and serum samples from 30 SSPE patients and 19 control subjects by cytometric bead array. CSF and serum IFN-γ, IL-12 and IL-18 levels were measured in 18 SSPE patients by ELISA. Serum IL-4 and IL-10 (p<0.001), CSF IL-4 (p<0.001) and IL-6 (p=0.049) concentrations were lower, and serum IL-2 concentrations, higher (p=0.001) in SSPE patients. Serum TNF-α and IL-6, CSF TNF-α, IL-10, and IL-2 concentrations were not different between SSPE and control groups. Serum IFN-γ levels were higher in stage I and II than stage III patients (p<0.05), whereas there was no difference between stages in terms of other cytokines. The levels of Th2-type cytokines: IL-4, IL-6 and IL-10 were suppressed in our SSPE cases. This finding, along with relatively elevated IFN-γ and IL-2 levels, may suggest more active effector T cells compared to regulatory T cells (Treg), especially induced Treg, in early disease. High serum IL-2 concentrations might indicate peripheral Th1 activation. Discrepancies between various reports in the literature should be examined in view of the ages, stage and treatments of the patients studied. The interplay of various cytokines or cellular systems which may vary over time and between patients. Studies of treatment measures favoring the preservation of the early inflammatory response may be of interest in SSPE. © 2009 Elsevier B.V.


Senel F.M.,Dr Sami Ulus Childrens Hospital | Demirelli M.,Elif Medical Center | Oztek S.,GAP Circumcision Clinic
Pediatric Surgery International | Year: 2010

Purpose: We aimed to analyze the outcome of circumcisions performed with a new minimally invasive circumcision device. Methods: This is the first study, which reports the results of 7,500 children circumcised with minimally invasive technique utilizing a plastic clamp device (Ali's clamp®) in our country. The results of this technique are compared to those of 5,700 children who underwent conventional circumcision. Results: The most common complication encountered after minimally invasive circumcision technique was found to be buried penis (1.04%). The second complication observed was infection (0.6%), which was significantly lower than the conventional group (p < 0.001). The third complication in plastic clamp group was bleeding with a rate of 0.4%. Bleeding was found to be the most common complication seen after conventional circumcision (5%) and was significantly higher than that of the plastic clamp group (p < 0.001). Total number of complications seen after plastic clamp technique was 2% when compared with 10.4% complication rate occurred after conventional circumcision (p < 0.001). The mean duration of circumcision time with plastic clamp technique was 4.5 ± 1.5 min whereas with conventional circumcision it was 23 ± 4 min (p < 0.0001). Conclusion: Minimally invasive circumcision technique utilizing plastic clamp significantly reduced the complication rates. The cosmetic appearance after circumcisions performed with this technique was observed to be better than the conventional circumcisions. Due to reduced complications, as well as short duration and ease of application, the minimally invasive technique is suggested as the circumcision procedure of choice. © 2010 Springer-Verlag.


Aim: The normative data for the newborn clitoral length will enable physicians to avoid overdiagnosing or underdiagnosing disorders related to the condition. The is study is the first to investigate clitoris length in newborn females in Turkey. Materials and methods: A total of 325 newborns with normal gestational age born by uncomplicated spontaneous vaginal delivery were included in the study. The body weight, body length, head circumference, and clitoral size were measured. Results: A special equation was generated to estimate clitoris length, and clitoral length percentiles were prepared. The 3rd (2.00 mm) and 97th percentile (8.04 mm) values for clitoris length were determined. The best cut-off point for cases where the labia majora covered the clitoris was determined. Conclusion: The equations and the percentile curves presented herein could be used as guides for expected clitoris length. Further studies, including larger measurement numbers, would enable the development of more sensitive equations and percentiles. © Tübitak.


Karaman I.,Dr Sami Ulus Childrens Hospital | Karaman A.,Dr Sami Ulus Childrens Hospital | Boduroglu E.C.,Dr Sami Ulus Childrens Hospital | Erdogan D.,Dr Sami Ulus Childrens Hospital | TanIr G.,Dr Sami Ulus Childrens Hospital
Surgery Today | Year: 2013

Invasive aspergillosis is most commonly seen in patients with immune disorders and usually in the lung. Local invasive aspergillosis of the gastrointestinal system is quite rare. A 13-year-old female without immune deficiency presented with acute abdomen due to full-thickness necrosis of the gastric fundus. The necrotic gastric wall was excised and the stomach repaired. The pathology revealed a gastric ulcer with invading Aspergillus hyphae and spores. Aspergillosis is an opportunistic infection and its spores cannot survive in the normal gastric mucosa. The Aspergillus spores in this case probably grew on a background of gastric ulcer and caused wall necrosis and that the surgical treatment possibly provided a cure because it remained localized to the gastric wall. © 2012 Springer.

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