[Pneumomediastinum and subcutaneous emphysema during asthmatic attacks in three patients]. / Uç olguda astim atagi sirasinda görülen subkütan amfizem ve pnömomediastinum.

Pneumomediastinum is defined as free air or other gases contained within the mediastinum. In children it is an uncommon clinical condition with good prognosis. It most frequently occurs with exacerbations of asthma but also may occur after cough, vomiting, excessive valsalva maneuver and after the first wheezing attack as well. The first-line treatment for pneumomediastinum is to relieve the inciting factor. Otherwise, no specific therapy is recommended for uncomplicated cases, three boys, with the ages of 4, 8 and 13, presented in the emergency department, each after a few days of shortness of breath and respiratory distress. Chest radiography revealed pneumomediastinum and subcutaneous emphysema which had occured after severe asthmatic attacks. All of these patients have improved spontaneously with conservative treatment.

A case of hypomagnesemia with secondary hypocalcemia caused by Trpm6 gene mutation.

An offspring of marriage between two first cousins presented with atonic seizures developed on the 20(th) day of life. The physical examination of the case was normal. In laboratory results, Ca(+2) level was 5.7 mg/dl, Mg(+2): 0.4 mg/dl (1,3-2,1), PTH: 28.4 pg/ml (12-92), and P-: 4.5 mg/dl. The case was diagnosed as hypomagnesemia with secondary hypocalcemia (HSH) and TRPM6 gene mutation analysis revealed a homozygote mutation of E157X.

[Co-existence of Kala-azar and salmonellosis in a 16 month-old baby? Or a false positive widal reaction in Kala-azar?]. / 16 aylik bir bebekte Kala-azar ve salmonellozis birlikteligi mi? Kala-azar'da yanlis pozitif Widal reaksiyonu mu?

A 16 month-old boy was referred to our hospital with a prolonged fever, hepatosplenomegaly, anemia and leucopenia. Visceral leishmaniasis was the first suspected diagnosis but the bone-marrow aspiration material revealed no Leishmania amastigotes. As the group agglutination test for Salmonella typhi-O was positive at 1/320 dilution, a diagnosis of salmonellosis was made and meropenem therapy was started. Although the fever decreased on the fourth day of therapy, the expected clinical improvement did not occur and there was a recurrence of the fever. At that point even though his parents were told about the seriousness of his condition, they had the patient charged from the hospital. About one week later, the patient was hospitalized again with the same complaints. His organomegaly had increased and his pancytopenia was more severe at this time. The re-assessment of the patient raised again the suspicion of kala azar. IFAT for Leishmania infection demonstrated a high level of positivity (1/1024) and a second bone-marrow aspiration material revealed Leishmania amastigotes. After the patient was started on meglumine antimonate therapy, his clinical and laboratory findings improved. The case has been evaluated according to two different points of view based on the co-existence of salmonellosis and kala azar or a possible false positive Widal reaction in kala-azar.

Complications of varicella in healthy children in Izmir, Turkey.

BACKGROUND: The purpose of the paper was to evaluate the indications of hospital admissions and complications of varicella infection in immunologically healthy children. METHODS: Between 1997 and 2001, patient records of children hospitalized due to varicella infection were reviewed. Incidence and clinical spectrum of complications and their distribution related to age and seasonal variations were analyzed. RESULTS: A total of 178 immunocompetent children were hospitalized for varicella complications during the study period. This resulted in a crude incidence of 6.3/100 000 population at risk. All hospital admissions were due to accompanying complications. The majority of complications occurred in preschool-age children with a median age of 3 years. No gender predominance was found. The most frequent complications were infectious complications, which were observed in 79 children (44%). Superinfections of the skin were present in 24 patients. Pneumonia was observed in 59 children: 49 had bacterial, 10 had viral pneumonia. Pyogenic arthritis was seen in two children and one had concomitant osteomyelitis. Group A beta-hemolytic streptococci were recovered from two patients with invasive bacterial infections. A total of 68 (38%) neurologic complications were observed. Cerebellar ataxia was present in 24, encephalitis was present in 17. Infectious complications occurred more frequently in younger children (median age: 2 years), whereas neurologic complications occurred at an older age (median age: 6 years). Hematologic complications were seen in nine children. There was a seasonal distribution of complications with a peak in January. CONCLUSION: Complications of varicella requiring hospitalization in immunocompetent children are more frequent than previously thought.