Publications by authors named "Yalım Dikmen"

21 Publications

  • Page 1 of 1

Tocilizumab in COVID-19: The Cerrahpaşa-PREDICT score.

J Infect Chemother 2021 May 12. Epub 2021 May 12.

Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.

Background: Cytokine release syndrome (CRS), characterized by overproduction of proinflammatory cytokines in the course of severe coronavirus disease 2019 (COVID-19), has been suggested as the major cause of mortality. Tocilizumab, a recombinant humanized monoclonal antibody against human IL-6 receptor, poses a therapeutic option for the treatment of CRS leading to severe acute respiratory syndrome in coronavirus-2 (SARS-CoV-2) infection.

Methods: We performed a single-center retrospective study to reveal the outcome of COVID-19 patients on tocilizumab and proposed "the Cerrahpaşa-PREDICT score", a new clinical scoring system using clinical and laboratory parameters that would help predicting the 28-day mortality of COVID-19 patients receiving tocilizumab.

Results: Eighty-seven patients (median age: 59 years) were included of whom 75.8% were male. Tocilizumab use significantly improved clinical and laboratory parameters. The 28-day mortality rate on tocilizumab was 16.1%. The Cerrahpaşa-PREDICT score, consisting of platelet counts, procalcitonin, D-dimer levels, SOR and the time from symptom onset to tocilizumab administration had a positive predictive value of 94.5% and negative predictive value of 92.9% for anticipating 28-day mortality.

Conclusions: Severe COVID-19 should closely be monitored for the signs of hyperinflammation. We showed that administration of tocilizumab early in the course of the disease (prior to ICU admission) resulted in a favorable outcome. Close monitoring usually aids identifying patients who would benefit from tocilizumab. In this regard, the Cerrahpaşa-PREDICT score might serve as a practical tool for estimating the 28-day mortality in COVID-19 patients who received tocilizumab and would facilitate timely recognition of fatal cases to be evaluated for other therapeutic options.
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http://dx.doi.org/10.1016/j.jiac.2021.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114762PMC
May 2021

Co-existence of multiple sclerosis and anti-NMDA receptor encephalitis: A case report and review of literature.

Mult Scler Relat Disord 2020 Jul 30;42:102075. Epub 2020 Apr 30.

Neurology, Istanbul University Cerrahpasa-Cerrahpasa School of Medicine, Istanbul.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a serious autoimmune disorder characterized by psychiatric symptoms, seizures and movement disorder. Predisposing factors have been reported since the time it was described, and its pathophysiology has been tried to be clarified over the years. Although overlap with other demyelinating diseases had been reported, such an association between Multiple Sclerosis (MS) anti ANTİ-NMDAR encephalitis is limited to only a few case reports. In this article, a patient diagnosed with relapsing remitting multiple sclerosis (RRMS) for ten years who then developed NMDA-R encephalitis while on disease modifying treatment will be presented and possible common pathophysiology with previously reported literature will be discussed.
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http://dx.doi.org/10.1016/j.msard.2020.102075DOI Listing
July 2020

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project.

Intensive Care Med 2019 12 29;45(12):1703-1717. Epub 2019 Oct 29.

General Internal Medicine, Infectious Diseases, and Psychometric Medicine, Ghent University Hospital, Ghent, Belgium.

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock).

Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis.

Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation.

Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.
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http://dx.doi.org/10.1007/s00134-019-05819-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6863788PMC
December 2019

Non-invasive ventilation during surgery under neuraxial anaesthesia: a pathophysiological perspective on application and benefits and a systematic literature review.

Anaesthesiol Intensive Ther 2019 ;51(4):289-298

Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.

Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden and risk of respiratory adverse events in the post-operative period. However, both patients affected by chronic obstructive pulmonary disease (COPD) and chest wall disorders and/or neuromuscular diseases may experience the development or the worsening of respiratory failure, even during surgery performed under NA; this latter negatively affects the function of accessory respiratory muscles, resulting in a blunted central response to hypercapnia and possibly in an exacerbation of cardiac dysfunction (NA-induced relative hypovolemia). According to European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines, non-invasive ventilation (NIV) is effective in the post-operative period for the treatment of both impaired pulmonary gas exchange and ventilation, while the intra-operative use of NIV in association with NA is just anecdotally reported in the literature. Whilst NIV does not assure a protected patent airway and requires the patient's cooperation, it is a handy tool during surgery under NA: NIV is reported to be successful for treatment of acute respiratory failure; it may be delivered through the patient's home ventilator, may reverse hypoventilation induced by sedatives or inadvertent spread of anaesthetic up to cervical dermatomes, and allow the avoidance of intubation in patients affected by chronic respiratory failure, prolonging the time of non-invasiveness of respiratory support (i.e., neuromuscular patients needing surgery). All these advantages could make NIV preferable to oxygen in carefully selected patients.
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http://dx.doi.org/10.5114/ait.2019.88572DOI Listing
August 2020

Sedation Practices and Preferences of Turkish Intensive Care Physicians: A National Survey.

Turk J Anaesthesiol Reanim 2019 Jun 24;47(3):220-227. Epub 2019 Feb 24.

Department of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey.

Objective: Sedation is one of the most common practices applied in the intensive care units (ICUs), and the management of sedation, analgesia and delirium is a quality measure in the ICUs. Several guidelines on sedation had been published, and many surveys investigated the practices of sedation in the ICUs, but knowledge on the sedation practices in Turkey is lacking. The aim of the present study was to provide baseline knowledge on the sedation practices and preferences of Turkish intensive care physicians and to establish some points to be improved.

Methods: An electronic survey form consisting of 34 questions was generated and posted to email addresses. The survey included questions about demographics and practices on sedation, analgesia, neuromuscular blockage and delirium.

Results: Of 1700 email addresses, 429 (25.0%) were returned. Sedation was practised by 98.0% of the respondents, and mechanical ventilation was indicated as the primary indication (94.0%) for sedation. The presence of a written sedation protocol was 37.0%. For drug choices for sedation, midazolam was the most preferred agent (90.0%). With regard to pain questions, the most commonly used evaluation tool was Visual Analogue Scale (69.0%), and the most preferred drug was tramadol. Nearly half of the participants routinely evaluated delirium and used the confusion assessment method in the ICU.

Conclusion: The results of this survey have indicated some areas to be improved, and a national guideline should be prepared taking pain, agitation and delirium in focus. ClinicalTrials.gov ID: NCT03488069.
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http://dx.doi.org/10.5152/TJAR.2019.49799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537960PMC
June 2019

Noninvasive ventilation: education and training. A narrative analysis and an international consensus document.

Adv Respir Med 2019 4;87(1):36-45. Epub 2019 Mar 4.

Respiratory Unit, AO Ospedali dei Colli Naples PO, Monaldi, Italy.

Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.
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http://dx.doi.org/10.5603/ARM.a2019.0006DOI Listing
February 2020

Non-Invasive Mechanical Ventilation in Critically Ill Trauma Patients: A Systematic Review.

Turk J Anaesthesiol Reanim 2018 Apr 1;46(2):88-95. Epub 2018 Apr 1.

Hospital Morales Meseguer, Intensive Care Unit, Murcia, Spain.

There is limited literature on non-invasive mechanical ventilation (NIMV) in patients with polytrauma-related acute respiratory failure (ARF). Despite an increasing worldwide application, there is still scarce evidence of significant NIMV benefits in this specific setting, and no clear recommendations are provided. We performed a systematic review, and a search of clinical databases including MEDLINE and EMBASE was conducted from the beginning of 1990 until today. Although the benefits in reducing the intubation rate, morbidity and mortality are unclear, NIMV may be useful and does not appear to be associated with harm when applied in properly selected patients with moderate ARF at an earlier stage of injury by experienced teams and in appropriate settings under strict monitoring. In the presence of these criteria, NIMV is worth attempting, but only if endotracheal intubation is promptly available because non-responders to NIMV are burdened by an increased mortality when intubation is delayed.
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http://dx.doi.org/10.5152/TJAR.2018.46762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937470PMC
April 2018

Perioperative hyperoxia: perhaps a malady in disguise.

Rom J Anaesth Intensive Care 2017 Apr;24(1):53-56

Istanbul University, Cerrahpasa Medical School, Department of Anesthesiology and Reanimation, Turkey.

Oxygen is an element, which is used liberally during several medical procedures. The use of oxygen during perioperative care is a controversial issue. Anesthesiologists use oxygen to prevent hypoxemia during surgical procedures, but the effects of its liberal use can be harmful. Another argument for using high oxygen concentrations is to prevent surgical site infections by increasing oxygen levels at the incision site. Although inconclusive, literature concerning the use of high oxygen concentrations during anesthesia show that this approach may cause hemodynamic changes, altered microcirculation and increased oxidative stress. In intensive care it has been shown that high oxygen concentrations may be associated with increased mortality in certain patient populations such as post cardiac arrest patients. In this paper, a review of literature had been undertaken to warn anesthesiologists about the potential harmful effects of high oxygen concentrations.
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http://dx.doi.org/10.21454/rjaic.7518.241.yalDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555429PMC
April 2017

Threshold of number of rib fractures in elderly blunt trauma: A simple or complex matter of numbers?

Surgery 2017 12 18;162(6):1343. Epub 2017 Apr 18.

Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Electronic address:

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http://dx.doi.org/10.1016/j.surg.2017.03.007DOI Listing
December 2017

Hyperoxic oxidative stress during abdominal surgery: a randomized trial.

J Anesth 2016 08 21;30(4):610-9. Epub 2016 Mar 21.

Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34040, Istanbul, Turkey.

Purpose: The hypothesis of our study is that during anesthesia, administration of 80 % oxygen concentration increases oxidative stress more than 40 % oxygen.

Methods: Forty ASA I-II patients were included in a randomized, single-blind study. Expiratory tidal volumes (ETV) were measured before induction and after extubation. After ventilation with 0.8 FiO2 and intubation, mini-bronchoalveolar lavage (mini-BAL), arterial blood gas (ABG), and blood samples were taken. Patients were randomly assigned to receive 0.8 (group I) or 0.4 (group II) FiO2 during management. Before extubation, mini-BAL, ABG, blood samples were taken. PaO2/FiO2, lactate, malondialdehyde (MDA), protein carbonyl (PCO), superoxide dismutase (SOD), total sulfhydryl (T-SH), non-protein sulfhydryl (NPSH), and protein sulfhydryl (PSH) were measured. In both groups, mean arterial pressure and heart rate values were recorded with 30-min intervals.

Results: ETV values were higher in group II after extubation. PaO2/FiO2 values were higher in group II after extubation compared to group I. In both groups, plasma PCO, SOD, and T-SH levels increased significantly before extubation, whereas the increase in MDA was not significant between groups. Plasma PCO, T-SH, and lactate levels were higher in group I, and plasma SOD, and PSH were higher in group I before extubation. In both groups, MDA, SOD, T-SH, and NPSH levels in mini-BAL increased significantly before extubation. Between-group comparisons, PCO, T-SH, PSH, and NPSH were significantly higher in the BAL samples of group II, and MDA levels were higher in group I.

Conclusions: We found that 80 % FiO2 decreased ETV and PaO2/FiO2 and increased lactate levels and oxidative stress more, inhibiting antioxidant response compared to 40 % FiO2.
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http://dx.doi.org/10.1007/s00540-016-2164-7DOI Listing
August 2016

Prone position in nonintubated hypoxemic respiratory failure. New tool to avoid endotracheal intubation?

J Crit Care 2015 Dec 4;30(6):1415. Epub 2015 Sep 4.

Intensive Care and Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain.

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http://dx.doi.org/10.1016/j.jcrc.2015.09.003DOI Listing
December 2015

Unplanned extubation and mortality in surgical critically patients: an accidental association or cause?

World J Surg 2014 Sep;38(9):2477-8

Intensive Care Unit and Noninvasive Ventilation Unit, Hospital Morales Meseguer, Avenida Marques de Los Velez, s/n, 3088, Murcia, Spain,

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http://dx.doi.org/10.1007/s00268-014-2525-zDOI Listing
September 2014

Hyperoxemia in critically mechanical ventilation patients: a factor yet to be fit for intensivists.

J Crit Care 2014 Feb 22;29(1):172. Epub 2013 Oct 22.

Department of Anesthesiology and Reanimation, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.jcrc.2013.09.028DOI Listing
February 2014

Perioperative Temperature Monitoring and Patient Warming: A Survey Study.

Turk J Anaesthesiol Reanim 2013 Oct 1;41(5):149-55. Epub 2013 Oct 1.

Department of Anaesthesiology and Reanimation, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey.

Objective: Hypothermia is defined as the decrease of core body temperature under 36°C. Hypothermia is observed at a rate of 50-90% in the perioperative period. In our study, we aimed to measure the perception of hypothermia in our country, to evaluate the measures taken by physicians to intercept hypothermia, to determine the frequency and the methods used to monitor body temperature and the techniques used in warming the patients. Another aim was to develop a guideline for preventing perioperative hypothermia.

Methods: The questionnaire consisted of 26 multiple-choice questions. The time needed to answer the questions was 8-10 minutes.

Results: Of the 1380 individuals, 312 (22.6%) answered the questions in the questionnaire. Of these, 148 (47.4%) declared they were working in university hospitals, 80 (25.6%) in training and research hospitals, 51 (16.4%) in government hospitals and 33 (10.6%) in various private hospitals. Of the 312 individuals, 134 (42.9%) were specialists, 107 (34.3%) were resident physicians, 71 (22.8%) were academics. In addition, 212 (67.9%) reported working in operating rooms, 49 (15.7%) in intensive care units and 42 (13.5%) both in operating rooms and intensive care units. In the answers, there was variation among the hospital types in applications of body temperature monitoring and warming the patient. Another finding was that the individuals had different approaches to the concepts on perioperative hypothermia and its consequences.

Conclusion: The perceptions of physicians and the allied health personnel in government and private hospitals should be enhanced by informing them about the passive and active heating systems to prevent hypothermia. Although the situation in university and training and research hospitals seems to be better, defects are still observed in practice. Preparation of a national guideline for prevention of perioperative hypothermia is needed.
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http://dx.doi.org/10.5152/TJAR.2013.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894089PMC
October 2013

Mechanical ventilation outside intensive care unit. A growing demand in a vulnerable population. Are there possible solutions?

J Crit Care 2013 Oct;28(5):876-7

Intensive Care Unit, Hospital Morales Meseguer, Murcia 30500, Spain. Electronic address:

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http://dx.doi.org/10.1016/j.jcrc.2013.03.008DOI Listing
October 2013

Nasal high flow and respiratory patterns: determinants of underlying lung functions--are complex interactions easily controlled?

Respiration 2013 28;86(4):352. Epub 2013 Aug 28.

Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.

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http://dx.doi.org/10.1159/000353428DOI Listing
August 2014

Patients with obstructive sleep apnea after laparoscopic bariatric surgery: oxygen and continuous positive pressure could always be enough?

Surg Obes Relat Dis 2013 Jul-Aug;9(4):588-9. Epub 2013 Apr 20.

Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.

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http://dx.doi.org/10.1016/j.soard.2013.03.012DOI Listing
October 2014

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).

Ann Clin Microbiol Antimicrob 2013 May 4;12:10. Epub 2013 May 4.

Ondokuz Mayis University Medical School, Samsun, Turkey.

Background: Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey.

Methods: We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention.

Results: During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 - 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.

Conclusions: The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.
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http://dx.doi.org/10.1186/1476-0711-12-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674978PMC
May 2013

The value of Gram staining of catheter segments for rapid detection of peripheral venous catheter infections.

Diagn Microbiol Infect Dis 2006 Mar 19;54(3):165-7. Epub 2006 Jan 19.

Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, 34303 Aksaray/Istanbul, Turkey.

Catheter-related bloodstream infections are common in hospitalized patients. Peripheral venous catheters (PVCs) are the most frequently used vascular access devices with usually low reported infection rates. We conducted a study to find the rate of PVC-related infections using semiquantitative (roll plate) and quantitative catheter culture techniques. We found significant growth in 9.5% of the PVCs by quantitative culture, which was predictive of a BSI in 43% of cases, which seems to be the major limitation of the method. We conclude that Gram stain is a fast and reliable diagnostic tool for rapid detection of PVC infection.
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http://dx.doi.org/10.1016/j.diagmicrobio.2005.09.006DOI Listing
March 2006

Chediak-Higashi syndrome in the intensive care unit.

Paediatr Anaesth 2004 Aug;14(8):685-8

Department of Anaesthesiology, Cerrahpasa Medical School, Istanbul University, Sadi Sun ICU, Istanbul, Turkey.

Chediak-Higashi Syndrome is a rare autosomal recessive disease characterized by recurrent infections, giant cytoplasmic granules and oculocutaneous albinism. We describe the clinical and laboratory findings of a patient with Chediak-Higashi syndrome who was diagnosed and treated in the intensive care unit because of bleeding tendency after surgery.
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http://dx.doi.org/10.1111/j.1460-9592.2004.01257.xDOI Listing
August 2004