Successful Mesenchymal Stem Cell Application in Supraventricular Tachycardia-Related Necrotizing Enterocolitis: A Case Report.

BACKGROUND: Necrotizing enterocolitis (NEC) is one of the most important life- threatening diseases in neonates. Recurrent episodes of supraventricular tachycardia (SVT) can lead to gut ischemia, with subsequent reperfusion injury resulting in NEC. Mesenchymal stem cells (MSCs) are multi-potential cells which can differentiate into multiple cell types. Case report: A 22-day old male baby delivered to 34 yr old mother at 37-weeks' gestation via cesarean section, birth weight 3550 g, developed NEC 14 hours after being treated with cardioversion for SVT. At laparotomy, there was pan-NEC, and 60 cm of necrotic and perforated bowel was resected. 1 × 107 umbilical cord origin allogeneic MSCs were given intravenously, with subsequent improvement of the remaining bowel. Conclusion: MSC may be a promising treatment for adjacent ischemic bowel in NEC helping prevent short bowel syndrome.

Central Diabetes Insipidus in an Infant with Pneumococcal Meningitis.

BACKGROUND: Central diabetes is an infrequent complication reported in the neonatal period. CASE REPORT: CDI as a complication of Streptococcus pneumoniae (S. pneumoniae) sepsis and meningitis in a 9-day-old boy is presented. The CDI developed on day 3 after admission and was controlled with nasal vasopressin on the 20th day of admission. Despite antibiotic support, the child died from Acinetobacter sepsis at 4 months of age, but the CDI was well controlled. CONCLUSION: Newborns with bacterial meningitis can develop CDI as a sequalae. Treatment of the CDI with nasal vasopressin can be successful in this period. To our knowledge, this is the first newborn of CDI associated with S. pneumoniae meningitis.

Retrospective analysis of simple and stage II renal cysts: Pediatric nephrology point of view.

BACKGROUND: Increased ultrasonography (US) use has been correlated with an increased incidence of pediatric renal cysts. For simple and stage II cysts, the malignancy risk is low in adulthood, no follow up is recommended; but there is no consensus on childhood management. Given that pediatric renal cysts may be manifestations of hereditary cystic diseases, a different approach and follow up should be taken for these patients. Herein we present the clinical characteristics and follow-up data of pediatric patients with simple and stage II renal cysts. METHODS: This cross-sectional study involved 57 children (mean age, 12.44 ± 3.65 years) with simple (n = 35) and stage II cysts (n = 22) who were diagnosed and followed at the present institution for ≥2 years. RESULTS: The median follow-up period was 2.84 years for simple and 3.10 years for stage II cysts. None of the patients developed complications. No change in cyst diameter was detected in 65.7% of simple or in 45.5% of stage II cysts, whereas 13 simple cysts (37.1%) and eight stage II cysts (36.4%) increased in diameter. The diameter change per year was significantly higher in the stage II cysts than in the simple cysts (P = 0.017). Overall, 13 patients (22%) had an estimated glomerular filtration rate <90 mL/min/1.73 m2 , and two patients had hypertension. CONCLUSION: Although the malignancy risk of simple and stage II kidney cysts is low for this age group, potential complications such as renal dysfunction, hypertension and hereditary cystic disease should be closely monitored.

Can ultrasonography-guided aspiration and steroid injection treat reflux venous blood flow around symptomatic Baker's cysts? Our short-term experience.

OBJECTIVE: The aim of the current study was to investigate the efficacy of ultrasonography-guided aspiration treatment with concomitant steroid injection on relieving reflux blood flow in veins located next to symptomatic Baker's cyst. METHODS: All patients were examined by ultrasonography at administration and 1 month follow-up after intervention. Puncture and aspiration of the cyst, as well as injection of 1 ml dexamethasone were performed by the same radiologist. Compression on popliteal vein and vena saphena parva and the degrees of reflux before and after treatment were recorded. RESULTS: Twenty-six patients were included in the study. An overall reduction of the cyst's size was observed in all patients of the study group. Reduction of the cyst size is more evident during the 1st week, which was observed by a slight enlargement during the 1st and the 3rd months controls. CONCLUSION: Ultrasonography-guided puncture, aspiration and steroid injection seems to yield promising outcomes in terms of relieving venous reflux flow around simple Baker's cysts.

Single-center experience with sirolimus therapy for vascular malformations.

Vascular malformations (VMs) are described as congenital malformations of the vasculature derived from capillaries, veins, lymphatic vessels, arteries, or a combination of these vessels. They can cause significant morbidity resulting from soft tissue hypertrophy-related disfiguration, bony abnormalities, and even organ compromise. They are usually treated with various interventional procedures to achieve local control; however, the chance of success decreases as the anatomical distribution of the malformation widens. Unfortunately, medical treatment options have been quite limited in these patients. Sirolimus is an antiangiogenetic and antiproliferative pharmacologic agent that has been used for the management of VM in the last decade. We report 6 pediatric patients (4 with capillary lymphaticovenous malformations, 1 with lymphaticovenous malformation, and 1 with venous malformation) seen at our clinic within the last 2 years with lesions covering wide anatomical areas. After the patients had unsuccessfully undergone various treatments at various centers, they were treated at our facility with peroral sirolimus. The mean duration of treatment was 13 months, but in 3 patients, tapered dosing continues. Five patients achieved partial responses. The response to sirolimus treatment increased as the lymphatic component of the VM increased. All patients tolerated sirolimus well; side effects were acceptable. Sirolimus is a safe and effective medical treatment for widely distributed VMs with significant lymphatic components and no further local treatment option.

Is there a relationship between talar osteochondral lesions and foot angles?

PURPOSE: We aimed to evaluate the relationship between talar osteochondral defects (OCDs) and foot angles in this study. MATERIALS AND METHODS: We performed a retrospective study that included 25 patients with talar OCD and 29 patients without OCD who underwent magnetic resonance imaging in our department between September 2013 and January 2015. We retrospectively measured the foot angles (Bohler's angle, lateral talocalcaneal angle and calcaneal inclination angle) on ankle radiographs in both groups. RESULTS: Bohler's angle showed no significant differences between the patients (range 20.50°-48.10°, mean 33.40° ± 6.09°) and the control group (range18.80°-42.40°, mean 31.95° ± 4.21°) (p = 0.397). Calcaneal inclination angle showed no significant differences between the patients (range 3°-29.2°, mean 20.55° ± 6.73°) and the control group (range 10.20°-29.80° mean 20.47° ± 4.21°) (p = 0.956). However, talocalcaneal angle was significantly higher in the patients (range 27.80°-44.80°, median 39.50° ± 6.18°) compared with the control group (range 22.60°-40.50°, median 34.10° ± 4.26°) (p = 0.032). CONCLUSION: There is an association between lateral talocalcaneal angle and non-traumatic talar OCD.

Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis.

OBJECTIVE: The objective of this study was to radiologically determine frontal sinus drainage pathway variations with respect to superior attachment of uncinate process (SAUP) and their effect on prevalence of frontal rhinosinusitis. DESIGN: This was a retrospective cohort study. METHODS: Computed tomography scans of the 919 frontal sinus sides of 460 patients (252 female, 208 male; mean age, 35.1 ± 10.5 years) who were candidates for endoscopic sinus surgery were evaluated retrospectively between August 2012 and January 2013 by 3 radiologists to determine the SAUP types and the presence of frontal rhinosinusitis. RESULTS: The frontal sinus outflow tract was localized medial to the SAUP in 651 frontal sinus sides and lateral to the SAUP in 268 sides. We determined 3 types (types 7, 8, and 9) of SAUP in addition to 6 types defined in literature. The most common type of SAUP was type 3 (n = 332, 36.1%) followed by type 2 (n = 256, 27.8%) and type 7 (n = 160, 17.4%). Of the evaluated sides, 316 (34.3%) had frontal rhinosinusitis. Frontal rhinosinusitis was more common in the sides where the frontal sinus outflow tract was localized medial to the SAUP than those localized lateral (37.2% vs 27.6%, P = 0.006). CONCLUSIONS: Endoscopic approach to frontal recess usually requires uncinectomy, and it is necessary to know SAUP to prevent postoperative retained superior portion of the uncinate process. The location of frontal sinus outflow tract on the SAUP affects the prevalence of frontal rhinosinusitis as well. Frontal rhinosinusitis is significantly more common when the frontal sinus outflow tract was localized medial rather than lateral to the SAUP. LEVEL OF EVIDENCE: 2b.

Novel sonographic clues for diagnosis of antral gastritis and Helicobacter pylori infection: a clinical study.

OBJECTIVES: The purpose of this study was to find out whether transabdominal sonography may have a predictive role for detection of antral gastritis and Helicobacter pylori infection in the antrum. METHODS: A total of 108 patients and 54 control participants were allocated into 3 groups: group 1, controls without any symptoms or findings of antral gastritis and H pylori infection; group 2, patients with symptoms and endoscopic findings consistent with gastritis in the absence of documented H pylori infection; and group 3, patients with symptoms and endoscopic findings consistent with gastritis and documented H pylori infection. These groups were compared in terms of demographics, antral wall thickness, mucosal layer (together with muscularis mucosa) thickness, and mucosal layer-to-antral wall thickness ratio. RESULTS: The groups had no statistically significant differences with respect to age, sex, body mass index, and smoking habits. However, it turned out that both antral walls and muscularis mucosa layers were thicker and the mucosal layer-to-antral wall thickness ratio was higher in groups 2 and 3 compared to group 1 (P > .001). In addition, group 3 had statistically significantly thicker antral walls and muscularis mucosa layers and a significantly increased mucosal layer-to-antral wall thickness ratio than group 2 (P < .001). CONCLUSIONS: Our results suggest that antral gastritis caused by H pylori infection is associated with characteristic features such as thickening of antral walls and mucosal layers on sonography. These novel clues may be useful in the diagnosis of gastritis, and unnecessary interventions and measures can be avoided in some cases.

Reliability of preoperative multidetector computed tomography scan in patients with chronic otitis media.

OBJECTIVE: The objectives of this study were to specify the objective criteria of existence of cholesteatoma in chronic otitis media on the preoperative multidetector computed tomography (MDCT) and to evaluate the complications of disease. METHODS: We compared the results of preoperative MDCT scan with intraoperative findings in 71 patients (22 women, 49 men; mean age, 16-73 years) who had mastoidectomy operation between January 2008 and May 2012. Multidetector computed tomography evaluations of temporal bone were performed on a workstation using high-spatial-resolution magnified images with intended angle and plane. RESULTS: We observed cholesteatoma formation in all patients with scutum erosion (n = 11), dural exposure (n = 6), and lateral semicircular canal fistula (n = 5). Computed tomography revealed these findings with 100% sensitivity. Distortion of ossicular integrity (n = 11) and facial canal dehiscence (n = 5) was significantly higher in cholesteatoma patients. Using the criteria of osteolysis, the sensitivity, specificity, and the accuracy rates of MDCT in detecting cholesteatoma were 71%, 93%, and 88%, respectively. The best diagnostic clue of a cholesteatoma was a mass-like soft tissue located in a retraction pocket in the posterosuperior quadrant of the Shrapnell membrane, causing widening of Prussak space and scutum erosion. Evaluation of computed tomography scan showed nearly 100% sensitivity in detecting tympanic opacification, dural height, dehiscence of lateral semicircular canal, tegmen tympani erosion, and deformation of malleoincudal articulation. However, its contribution to detecting minor ossicular erosion, facial canal dehiscence, and incudostapedial joint evaluation was limited. CONCLUSIONS: Preoperative assessment of chronic otitis media via MDCT with intended angle and plane produces important guidance to understand the extent of disease and to prevent possible intraoperative complications.

Can Ultrasonographic Measurement of Bone Cortical Thickness Predict Osteoporosis?

RATIONALE AND OBJECTIVES: In this study, we aimed to describe a more accessible and safe diagnostic tool for osteoporosis or osteopenia diagnosis. We utilized cortical thickness (CoT) measurement of various bones via ultrasonography and evaluated the method's accuracy relative to bone mineral density (BMD) results determined by dual-energy X-ray absorptiometry (DXA). MATERIALS AND METHODS: A total of 200 volunteers (all female) who agreed to participate in the study and had undergone BMD measurement (femoral or vertebral) were included in the study. Patients with normal BMD result (≥-1.0 T-score) were defined as controls. CoT measurements were made from three bones (radius, tibia, and second metatarsal) for each patient via ultrasonography. RESULTS: Radius CoT and tibial CoT measurements of both femoral and vertebral osteoporotic or osteopenic patients were significantly higher compared to controls. Second metatarsal CoT of femoral osteoporotic and osteopenic patients was also found to be significantly higher than the control group. We found tibia CoT and radius CoT to have high sensitivity and positive predictive value in identifying patients with abnormal femoral T-scores (<-1). In multivariable analyzes, radius CoT was found to be independently predictive in distinguishing patients with abnormal T-score (<-1) from controls in both the femur and vertebral BMD groups. CONCLUSION: Radius CoT and tibia CoT values appear to have value in predicting patients with abnormal T-scores measured via DXA. This method may be a very simple technique that can be used for early detection of osteoporosis and osteopenia, but its results need to be supported by more comprehensive studies.

Mesenchymal stem cell application in a newborn with severe intraventricular hemorrhage and respiratory distress.

In this case, we present a patient with respiratory distress syndrome, pulmonary interstitial lung disease, and grade 4 intraventricular hemorrhage, in which we applied mesenchymal stem cells simultaneously by intraventricular, intravenous, and intratracheal routes.

Sonographic cortical bone thickness measurement: can it predict bone mineral density in the pediatric population?

PURPOSE: To explore sonographic cortical bone thickness (CoT) as a potential indicator of bone mineral density (BMD) measured by dual-energy X-ray absorptiometry for screening and diagnosing pediatric osteoporosis. METHODS: A prospective study included 41 osteopenic or osteoporotic patients and 52 healthy children. Radius cortical thickness (R-CoT), tibial cortical thickness (T-CoT), and second metatarsal cortical thickness (M-CoT) were measured by B-mode ultrasound; CoT values were compared between groups and the correlation between BMD and CoT was examined. RESULTS: There were no significant differences in R-CoT (P = 0.433), T-CoT (P = 0.057), and M-CoT (P = 0.978) values between the patient and control groups. No significant correlations were found between BMD T-scores and R-CoT (r = -0.073, P = 0.490), T-CoT (r = -0.154, P = 0.141), and M-CoT (r = 0.047, P = 0.657) values. CONCLUSION: Sonographic CoT values in children do not correlate with BMD values. Unlike in adults, sonographic CoT measurements do not appear to have a role in assessing BMD in the pediatric population.

Sonographic diagnosis of choledochocele.

We present a case of a 48-year-old female with a history of cholecystectomy and recurrent attacks of pancreatitis whose initial abdominal sonography (US) revealed multiple conglomerated stones in the descending part of the duodenum. Abdominal CT, MRI, and magnetic resonance cholangiopancreatography showed the same findings. The distended sacciform distal intramural segment of the common bile duct was protruding into the duodenum. The imaging findings explained the etiology of the patient's recurrent attacks of pancreatitis and led to surgical excision of the choledococele.

Comparison of three natural surfactants according to lung ultrasonography scores in newborns with respiratory distress syndrome.

INTRODUCTION: Lung ultrasonography (LUS) is a noninvasive bed-side test and increasingly used by clinicians in the management and follow-up of respiratory distress syndrome (RDS) in premature infants. OBJECTIVE: To compare the results of three natural surfactants according to LUS scores in premature infants with RDS. METHODS: This was a prospective study on 62 preterm infants (25-34 weeks) with RDS and receiving surfactant according to 2016 European guidelines. All patients underwent a clinical evaluation and chest X-ray at three study points; at the first hours of life (presurfactant), and at 6-12th hour (early postsurfactant) and 24th hour (late postsurfactant) of surfactant. Simultaneously fractional inspired oxygen (FiO2) need, arterial PaO2 values, Downes and LUS scores were noted. The patients were randomized into three groups; Group 1 (n = 23), poractant alpha; Group 2 (n = 20), beractant; and Group 3 (n = 19), calfactant. The groups were compared according to clinical, laboratory and radiological variables as well as LUS scores. RESULTS: Gestational age (p = .05), birthweight (p = .07), and SNAPPE-II scores (p = .57) were similar in three groups. Repeated dose need was the highest in Group 3 (p = .04). FiO2 need (p = .04) was the highest and PaO2 values (p = .03) were the lowest at late postsurfactant point in the same group. LUS scores were also the highest in Group 3 at this period (p = .02). Downes scores were similar in groups at all points (p > .05). NICU stay were similar in groups (p = .53). The durations of total oxygen supplementation, mechanical ventilation, and hospital stay were the same in groups (p > .05). CONCLUSIONS: In newborns with RDS, poractant alpha and beractant have similarly reduced oxygen need in accordance to the LUS findings. However, they seem to be superior compared to calfactant.

Novel prognostic grayscale ultrasonographic findings in the testis from a comprehensive analysis of pediatric patients with testicular torsion.

INTRODUCTION: Although grayscale and Doppler ultrasound (US) findings of testicular torsion (TT) have previously been described in the literature, other US findings may provide more prognostic information to families. OBJECTIVE: The authors hypothesized that a comprehensive analysis of US findings of TT that focused on time-dependent changes would lead to additional ultrasonographic morphologic findings and clinically relevant prognostic information. STUDY DESIGN: The authors reviewed the records of pediatric patients with acute TT from 2010 to 2017. The sizes and parenchymal characteristics of the torsed and contralateral testes on US were analyzed in relation to the time duration from the onset of scrotal pain to the time of surgery (0-6 h, 6-12 h, 12-24 h, 24-48 h, and >48 h), torsion degree, and clinical outcomes of the testes. RESULTS: Patient demographics, time intervals, and US measurements of the torsed and contralateral testes showed significant differences with respect to testicular viability (Summary Table). The mean volume ratios of torsed to contralateral testis showed significant differences between the 0-6 h and the 12-24 h time groups as well as the 6-12 h and the 12-24 h time groups (P = 0.003 and P = 0.035, respectively), as well as significant differences between the viable and non-viable testes (P = 0.005). Regarding testicular heterogeneity, two novel grayscale sonographic findings were noted: (1) multiple hypoechoic lines that were termed 'testicular fragmentation' and (2) hyperechoic patches that were termed 'testicular patching'. The presence of these two findings were significantly increased as TT time duration increased (P < 0.001), and these findings were significantly associated with testicular non-viability (P < 0.001). Torsion degree was also noted to be significantly higher in the non-viable testes (P < 0.001). Presence of hydrocele or scrotal edema also showed significant differences between the TT time groups (P < 0.001). DISCUSSION: The results of this study demonstrated ultrasonographic findings related to time dependent changes in TT and provided prognostic information regarding testicular viability. CONCLUSIONS: Specific US grayscale findings in torsed testes (testicular fragmentation and testicular patching) were identified that provide prognostic information regarding time duration of testicular torsion and testicular viability. Testicular fragmentation and testicular patching significantly increased as TT time increased, with increasing risk for testicular non-viability.

Characteristics, diagnosis, and treatment modality of pediatric patients with cystic echinococcosis: a single centre experience.

Kaman A, Tanir G, Çakmakçi E, Demir P, Öz FN, Aydin Teke T, Metin Ö, Gayretli Aydin ZG, Karaman A. Characteristics, diagnosis, and treatment modality of pediatric patients with cystic echinococcosis: a single centre experience. Turk J Pediatr 2019; 61: 704-713. Cystic echinococcosis (CE) is among the most common zoonotic infections worldwide. Studies about CE are limited in childhood. The aim of this study was to evaluate clinical, radiological and laboratory characteristics of childhood CE at a tertiary care pediatric hospital. Medical records of children with CE were analyzed between January 2005 and January 2015. A total of 130 patients with a median age of 10.4 years (IQR= 7.2-years-13.2 years) were evaluated. The anatomic locations of cysts were as follows; liver (76.9%), lung (36.9%), spleen (6.2%), pelvic region (3.8%) and kidney (2.3%). The most common symptoms were abdominal pain and cough in the patients with liver cysts and lung cysts, respectively. The indirect hemagglutination (IHA) test positivity was 58%. Elevated serum total immunoglobulin E levels were detected in 59% of the patients. Fourty-four patients with liver CE, 33 patients with lung CE were treated surgically and 23 patients with liver CE were treated with percutaneous aspiration, injection and re-aspiration (PAIR) along with medical treatment. The recurrence was observed in five patients with liver CE. It was demonstrated that CE mainly involves liver but lung cysts are more frequently symptomatic and prone to be complicated than liver cysts in children. IHA test positivity together with abdominal ultrasonography are useful to diagnose liver CE but thorax CT is usually needed to diagnose lung CE. Liver cysts that are sized greater than 5 cm are more frequently treated with PAIR or surgery but smaller liver cysts can be treated medically.

Complete androgen insensitivity syndrome associated with bilateral sertoli cell adenomas and unilateral paratesticular leiomyoma: A case report.

Complete androgen insensitivity syndrome (CAIS) disorder of sex development due to mutations that cause function loss in androgen receptors in 46, XY individuals. The risk of malignancy in CAIS is 5-10% until the age of 25 years. A 17-year-old patient raised as a female presented to our clinic complaining of amenorrhea. She had a history of surgery for inguinal hernia at the age of 2 years. The patient's niece of the same age had been diagnosed with CAIS at our department and gonadectomy had been performed six months ago. She had four other nieces with the same diagnosis. Her external genital appeared phenotypically female. On physical examination, breast development was Tanner stage 5 and pubic hair Tanner stage 2 with scarce axillary hair. The gonad was palpated in the left inguinal region. Chromosome analysis revealed 46, XY and sex determining region Y (SRY) was positive. The patient was diagnosed as CAIS with laboratory and radiology results. The Sexual Orientation and Gender Identity Committee decided on gonadectomy. Histopathological evaluation of the gonad revealed bilateral Sertoli cell tumor and right paratesticular leiomyoma.

Ultrasonographic clues for diagnosis of spina bifida occulta in children.

BACKGROUND: The aim of the current study was to find out if spinal ultrasonography might have a predictive potential for detection of spina bifida occulta (SBO) in pediatric nocturnal enuresis patients. METHODS: A total of 108 children (58 females, 50 males) with a mean age of 8 (range, 6-15) years diagnosed for nocturnal enuresis in our tertiary care center were included in this cross-sectional analysis. Half of the cases (n=54, 50%) were found to have SBO, while the other half did not have SBO. After obtaining radiographs and computed tomography examinations of L5-S1 vertebra, patients were examined by spinal ultrasound regarding radiologic clues which may aid in the detection of SBO. RESULTS: The clues of "single and double echogeneous cap signs and the V-shaped tip of spine" were found useful for diagnosing SBO at levels of L5 and S1 in pediatric patients suspected for SBO. Receiver operating curve (ROC) curve analysis of CT and ultrasonographic clues for diagnosis of SBO on S1 level revealed that these clues yielded a comparable diagnostic accuracy to CT. Areas under curve for CT and studied ultrasonographic clues were are 0.667±0.053 and 0.907±0.032 (P<0.001) respectively. CONCLUSIONS: Ultrasonography seems to be a useful and practical diagnostic tool for diagnosing spina bifida. However, to implement our ultrasonographic criteria in routine radiological practice, further studies in larger series are warranted.

Antral gastritis caused by Helicobacter pylori infection in the pediatric age group is associated with increased mesenteric lymph node dimension observed by ultrasonography.

BACKGROUND: To find out if transabdominal ultrasonography (US) may have a predictive role for detection of antral gastritis and Helicobacter pylori (HP) infection in the antrum of pediatric age group. METHODS: A total of 91 (63.6%) patients and 52 (36.4%) controls were allocated into two groups as follows: Group 1 (n=91): patients with complaints and endoscopic findings consistent with gastritis and documented HP infection; Group 2 (n=52): patients with complaints and endoscopic findings consistent with gastritis in the absence of documented HP infection. These two groups were compared in terms of demographics and biggest mesenteric lymph node detected, muscularis mucosa thickness, submucosal thickness, muscularis propria thickness, and total gastric wall thickness. RESULTS: The two groups exhibited no statistically significant difference with respect to age (P=0.747), and presenting symptoms (P=0.982). However, the mesenteric lymph node dimension was significantly increased in Group 1 (P=0.039). Median mesenteric lymph node dimension was 12.9 (±15.4) mm in Group 1, while 11.0 (±12.8) mm in Group 2. No significant difference was observed between groups in terms of muscularis mucosa thickness (P=0.243), submucosal thickness (P=0.174), muscularis propria thickness (P=0.356), and total gastric wall thickness (P=0.223). CONCLUSIONS: Antral gastritis caused by HP infection in the pediatric age group is associated with increased mesenteric lymph node dimension observed by US.