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Nutcracker sendromu sol renal venin abdominal aorta ile süperior mezenterik arter arasında ya da abdominal aorta ile vertebral kolon arasında sıkışmasından kaynaklanmaktadır. Sol renal venden inferior vena kavaya olan kan akımının dıştan bası nedeniyle azalması; artmış venöz basınç, böbrek konjesyonu, hematüri ve proteinüriye sebep olur. Ortostatik hematüri ile başvuran hastalarda akılda tutulmalıdır. Hematüriyle başvuran hastalarda öyküde hematürinin ortostatik yani ayakta kalmakla artıp artmadığının ve mesleğin sorgulanması son derece önemlidir. Dikkatli anemnez alınmaması sonucunda böbrek biyopsisini de içeren birçok gereksiz tetkik yapılması ve sonucunda net tanı konulamaması durumu hastalarda endişeye neden olabilir. Tanısal yöntemler doppler ultrasonografi, bilgisayarlı tomografi, MR ve altın standart yöntem olarak sol renal ven ile inferior vena cava arasındaki basınç farkının venografi ile ölçülmesidir. Nutcracker sendromunun yönetimi ise tartışmalıdır ve spontan remisyon nedeniyle özellikle genç ve hafif hematürisi olan kişilerde izlem tercih edilir. Ortostatik hematüri ile başvuran ve Posterior Nutcracker Sendromu tanısı alan genç bir kadın hasta vaka sunumu olarak tartışılmıştır.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic that affects the world is a major public health problem that causes fatal consequences in many countries. The possibility of early detection of disease spreads that will lead to pandemic is an important component of disease control and eradication. The combination of disease data and spatial analysis methods offers a great opportunity to develop more effective disease control and solution strategies. In this collection, a literary-based study, specifically containing COVID-19, was conducted to evaluate the applications of geographical information systems (CBS) in epidemicology and the relationship between control and eradication of epidemic diseases. In research in the field of epidemiology, CBS-based analysis and models are becoming increasingly important in terms of how the researched disease data is distributed and accumulated, and in terms of the planning of the short, medium and long-term control and eradication interventions. When the difficulties in control and eradication of COVID-19 are combined with strong infectious characteristics, a long period of scratch, population flow and mobility and other factors, scientific and technological support is needed to control and prevent the spread of the disease. The purpose of this collection is to understand the development of CBS-based tools and to provide up-to-date information about the use of CBS in COVID-19 pandemic management.
Nutcracker sydrome is associated with extrinsic left renal vein compression between abdominal aorta and superior mesenteric vein or between abdominal aorta and vertebral column. Decreased blood flow from the left renal vein to the inferior vena cava due to external compression results in increased venous pressure, kidney congestion, hematuria and proteinuria. Patients with orthostatic hematuria should be screened for nutcracker syndrome. In patients presenting with hematuria, it is extremely important to question whether orthostatic hematuria increases with standing and the profession. As a result of not taking a careful anamnesis, many unnecessary tests, including kidney biopsy, and the inability to make a clear diagnosis as a result may cause anxiety in patients. Diagnostic methods are Doppler ultrasonography, computed tomography, MRI and, as the gold standard method, measuring the pressure difference between the left renal vein and the inferior vena cava by venography. The management of Nutcracker syndrome is controversial and because of spontaneous remission, follow-up is preferred especially in young people with mild hematuria. A young female patient who presented with ortostatic hematuria and diagnosed with posterior nutcracker syndrome is discussed hereby in the case report.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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