Can Ischemia-Modified Albumin Be a Helpful Marker in the Diagnosis and Follow-Up of Childhood Intussusception?

OBJECTIVES: Intussusception is the invagination of a proximal segment of the intestine into a more distal segment. The present study aimed to determine the sensitivity of the ischemia-modified albumin (IMA) and the correlation between IMA and the severity of intestinal ischemia in intussusception cases. METHODS: Thirty-six consecutive children aged between 0 and 16 years presenting with the clinical and radiological features of intestinal obstruction caused by intussusception were enrolled in the study. The age- and sex-matched control group was composed of patients undergoing outpatient surgery. The patients were categorized as cases of type I (ileoileal), type II (ileocecal), and type III (colocolic) based on the ultrasonography findings. RESULTS: The mean IMA level of the intussusception group was 179.13 ± 220.33 ng/mL, whereas the mean level was found as 89 ± 70.9 ng/mL in the control group. When the patients were categorized as ileoileal, ileocecal, and colocolic, the mean IMA levels were detected as 235.65 ± 268.14 ng/mL, 174.46 ± 212.8 ng/mL, and 46.95 ± 19.56 ng/mL, respectively. There was a moderate correlation between the invaginated segment lengths measured by the surgeon during the operation and IMA levels. CONCLUSIONS: Our study findings reveal that IMA can be used as an auxiliary diagnostic marker in patients presenting with symptoms and signs suggestive of intussusception. Thus, patients can be screened for mechanical bowel obstruction due to intussusception and may be referred to pediatric surgery centers earlier for further examination.

Unusual localization and coexistence of primary hydatid cyst: a case report.

Hydatid cysts are zoonotic parasitic infections caused by Echinococcus granulosus. Although witnessed in all body parts, the first and most important locations for this parasite are the liver and lungs. Unusually, hydatid cysts are rarely located in the pelvic region. The majority of such cysts generally develop secondary to spontaneous rupture of an hepatic hydatic cyst or due to surgical inoculation. Incidentally diagnosed in a patient admitted with the picture of acute abdomen, a case of primary hydatid cyst located in retrovesical region, an uncommon localization for hydatid cysts, is presented in this report. In patients admitted with symptoms of abdominal pain in endemic regions, and in those suspected of having unidentified cystic lesions, the unusual localization of a primary hydatid cyst should be considered.

The Collocation of Ischemia-Modified Albumin and Blood Gas Parameters in the PICU Setting.

Ischemia modified albumin (IMA) is a marker that has been determined to be elevated in hypoxic conditions. This study aimed to investigate the relationships between serum IMA and blood gas parameters (BGPs) and evaluate whether IMA can be used as a parameter clinically in terms of reflecting tissue hypoxia in ventilator management. BGPs and serum IMA level were measured in blood samples drawn simultaneously from patients. Mean serum IMA levels, mean pCO2, mean pO2, and lactate levels were 82.56 ± 25.47 ng/mL, 47.99 ± 22.81 mm Hg, 53.62 ± 30.43 mm Hg, and 2.13 ± 3.22 mmol/L, respectively. No correlation was found between serum IMA level and BGPs. Our findings showed that serum IMA level can be concluded not to be a suitable parameter in ventilator management. However, IMA can be a reliable guide if used together with venous BGPs in terms of the estimating of tissue oxygenation, especially within the last few hours.

Two Sisters with Angelman Syndrome: A Case Series Report.

Angelman syndrome (AS) is known as an intellectual disability related to speech impairment, ataxia and behavioral uniqueness, including a combination of frequent laughter and smiling, apparent happy demeanor, excitable personality and hypermotor behavior. In this report, we present a 5-year-old girl with AS associated with atypical clinical manifestations, including developmental dysplasia of the hip and simian line in the right hand, and her elder sister with AS. Even if any gene mutation cannot be demonstrated, it should be kept in mind that different mutations may exist in the cases that are the suggestive of clinical AS. Therefore, AS patients can be exposed to special education, and their quality of life can be elevated.

A case report with sacral appendage: Is it accessory penis or human tail?

Kocaoglu C, Kocaoglu Ç, Akkoyun I, Karanis IE. A case report with sacral appendage: Is it accessory penis or human tail? Turk J Pediatr 2017; 59: 335-337. Lumbo-sacro-coccygeal appendages are very rare congenital anomalies. It is difficult to say that they are a evolutionary inheritance (tail) from our ancestors or an anomaly (pseudotail) occuring during embrional development. If it is a true tail, this lesion contains adipose and connective tissue, striated muscle, blood vessel and nerves, and is covered by skin. However, if this lesion is a pseudotail, it may be an anomalous prolongation of the coccygeal vertebra, lipoma, teratoma, condrodystrophy or parasitic fetus. We present an infant with a sacral appendage resembling a penis, and its clinical and pathologic differential diagnosis and management are discussed based on literature. Sacral appendages, such as asaccessory penis or human tail, are treated through simple surgical excision. However, patients must be carefully evaluated regarding teratoma and spinal cord pathology.

Are obesity and metabolic syndrome associated with plasma adropin levels in children?

Studies performed on mice suggest that adropin is a peptide hormone playing a role in metabolic homeostasis and prevention of obesity-associated insulin resistance. Our study was conducted to investigate the role of adropin in children with obesity or metabolic syndrome. The study group consisted of 70 patients, including 42 obese and 28 with metabolic syndrome, and 26 healthy volunteers. After anthropometric variables and blood pressure of all participants were measured, serum lipids were analyzed, liver USG and oral glucose tolerance test were performed, and HOMA-IR values were calculated. Plasma adropin levels were collectively analyzed from collected plasma samples. In patient and control groups, no difference was observed in the levels of adropin (327.7±124.7 vs. 344.6±208.5 ng/L, respectively). The adropin levels of metabolic syndrome, obesity, and control groups also showed no difference (316±142.3, 335.8±112.5, and 344.6±208.5 ng/L, respectively). While the adropin levels of patients with and without hepatic steatosis were 319.6±123.7 and 347.8±128.7 ng/L, respectively, patients with HOMA-IR values of <3.16 and ≥3.16 had levels 342.3±124.8 and 296.5±136.7 ng/L, respectively. Although statistically insignificant, our findings are considered to support the hypothesis suggesting a nexus between adropin and obesity and metabolic syndrome. Small sample size in our study may have prevented our results to reach a more significant level. So, long-term follow-up studies with large population are needed to enlighten the role of adropin in metabolic homeostasis.

Cerebral atrophy in a vitamin B12-deficient infant of a vegetarian mother.

In developed countries, vitamin B12 (cobalamin) deficiency usually occurs in children, exclusively breastfed ones whose mothers are vegetarian, causing low body stores of vitamin B12. The haematologic manifestation of vitamin B12 deficiency is pernicious anaemia. It is a megaloblastic anaemia with high mean corpuscular volume and typical morphological features, such as hyperlobulation of the nuclei of the granulocytes. In advanced cases, neutropaenia and thrombocytopaenia can occur, simulating aplastic anaemia or leukaemia. In addition to haematological symptoms, infants may experience weakness, fatigue, failure to thrive, and irritability. Other common findings include pallor, glossitis, vomiting, diarrhoea, and icterus. Neurological symptoms may affect the central nervous system and, in severe cases, rarely cause brain atrophy. Here, we report an interesting case, a 12-month old infant, who was admitted with neurological symptoms and diagnosed with vitamin B12 deficiency.