A rare cause of severe periorbital edema and dermonecrotic ulcer of the eyelid in a child: brown recluse spider bite.

Spider bites are a worldwide problem. Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal failure, and death. Eyelid bites from brown recluse spiders are rare. We report a child with severe facial edema and a dermonecrotic ulcer on the eyelid. Upon laboratory examination, leukocytosis with a significant left shift was detected. The patient was treated with antibiotics, systemic corticosteroid and conservative therapy that included saline compresses and ocular lubrication. No surgical excision was required. Vision was not impaired. A dermonecrotic ulcer is a severe complication of brown recluse spider bites. Since the diagnosis is difficult, clinical and epidemiological findings and a detailed history are important for an accurate diagnosis.

Neonatal tetanus in Turkey; what has changed in the last decade?

BACKGROUND: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. METHODS: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. RESULTS: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. CONCLUSION: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.

The contribution of nitric oxide on the relaxation effects of diethylstilbestrol.

OBJECTIVE: To evaluate the contribution of nitric oxide NO on the relaxation effects of diethylstilbestrol on rat uterus. METHODS: Uterine rings from 8 nonpregnant Wistar Albino rats 300-350 g in the pro-estrous phase were suspended in an organ bath and electrical field stimulation applied for recording isometric tension. The influence of NO on contractile responses of rat uterine rings was investigated. The effects of NO precursor L-arginine (10(-7) - 10(-4)M) concentration and NO synthase inhibitor L-nitro-arginine-methyl ester (10(-7) - 10(-4)M) concentration and a combination of them on contractile responses were studied in the presence and absence of diethylstilbestrol (2 x 10(-4)M) concentration. The study was carried out at the Department of Pharmacology Laboratory, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. RESULTS: Totally, 30 samples were investigated n=6 for each group, 5 groups. Diethylstilbestrol inhibited contractile responses 64.2+/- 4.5% n=6, p<0.05. Contractile responses decreased in the presence of L-arginine n=6, p<0.05 and this inhibition was abolished in the presence of L-nitro-arginine-methyl ester n=6, p<0.05. The inhibition on contractile responses to diethylstilbestrol was potentiated in the presence of L-arginine under similar conditions n=6, p<0.05. The contractile responses to electrical field stimulation in the presence of diethylstilbestrol were not affected by L-nitro-arginine-methyl ester n=6, p>0.05. CONCLUSION: These data provide evidence that NO may potentiate the inhibitory effects of diethylstilbestrol by different mechanisms on the electrically induced contractions of the non-pregnant rat uterus.

Ureterovesical junction obstruction causes increment in smooth muscle contractility, and cholinergic and adrenergic activity in distal ureter of rabbits.

BACKGROUND/PURPOSE: The controversy in management of primary obstructed megaureter necessitates further elucidation of the underlying pathophysiology. We evaluated smooth muscle contractility, and cholinergic, adrenergic and serotonergic activity of rabbit distal ureters after ureterovesical junction (UVJ) obstruction. METHODS: Sham (SH) operation, partial obstruction (PO) and complete obstruction (CO) of the right UVJ were performed in rabbits. Three weeks later, distal ureters were isolated; spontaneous contractions (SC), contractile responses to electrical field stimulation (EFS), high KCl, carbachol, phenylephrine and serotonin were recorded. RESULTS: SC amplitudes increased in CO compared to PO and SH (p<0.001). SC frequency was higher in CO (p<0.05). EFS-induced contraction amplitudes were greater in CO than other groups (p<0.05). High KCl-induced contractions were greater in CO (p<0.001) and PO (p<0.01). Carbachol-induced contractility was enhanced in CO and PO (p<0.05). Contractile response to phenylephrine was greater in CO than other groups (p<0.05). Serotonin induced contractile responses in CO and PO, greater in CO (p<0.05). UVJ obstruction also increased spontaneous contractility in contralateral PO and CO ureters. CONCLUSIONS: UVJ obstruction increased spontaneous and neurotransmitter-induced contractions in an obstruction grade-dependent manner. Obstruction also altered contractility of the contralateral ureters. Our findings may serve to provide further understanding of the pathophysiology of megaureter.