Effectiveness of erdosteine, a second generation mucolytic agent, in children with acute rhinosinusitis: a randomized, placebo controlled, double-blinded clinical study.

AIM: To evaluate whether mucolytic agents have an adjuvant role with antibiotics in the treatment of children with rhinosinusitis. METHODS: Ninety-two children with rhinosinusitis were recruited for this randomized, placebo controlled, double-blinded clinical trial. Mean age was 8.5 +/- 3.2 years. Erdosteine (5-8 mg/kg/day) was administered to 49 children, and 43 children received placebo. Changes in symptoms were recorded with the standard S5 scoring for 14 days. Complete resolution of symptoms on day 14 was considered to be clinical improvement. RESULTS: Eighty-one participants completed the study. Forty-one were in the treatment group and 40 in the placebo group. The average S5 scoring value at the onset of study was 11.0 in treatment group and 12.1 in placebo group. On day 14, mean scores were 3.1 in the treatment group and 2.8 in the placebo group. Complete improvement was 78% in the treatment group and 74.4% in the placebo group. There was no significant difference between the groups. There were no clinically detected serious side effects or complications in both groups. CONCLUSION: Use of erdosteine as a mucolytic agent in children with acute rhinosinusitis does not directly affect the success of treatment.

Corticosteroid treatment of childhood Bell's palsy.

The therapeutic effect of corticosteroids in acute idiopathic peripheral nerve paralysis (Bell's palsy) in children is controversial. The authors evaluated the effect of steroids on the early and late outcome of children with Bell's palsy in a prospective randomized controlled setting. Forty-two patients (21 females, 21 males) with complete paralysis were enrolled in the study. Group 1 (n = 21) received methylprednisolone (1 mg/kg daily for 10 days orally); Group 2 (n = 21) did not. All patients were observed in the first 3 days of the disease and at 4, 6, and 12 months of follow-up. The mean age of Group 1 was 52.4 +/- 4.3 months, not significantly different from that of Group 2. In Group 1, 86% and 100% exhibited normal nerve function at 4 and 6 months of follow-up, respectively; in Group 2, 72% and 86% demonstrated complete recovery at 4 and 6 months, respectively, with improvement in all patients by 12 months. The improvement rates between the treated and untreated groups did not differ significantly. No side effects necessitated steroid withdrawal. The results of this study indicate that steroid therapy initiated at an early stage of childhood Bell's palsy does not significantly improve the outcome.

Airway foreign bodies in childhood.

OBJECTIVE: To define clinical spectrum of airway foreign body aspiration in children and to evaluate the outcome and complications. METHODS: A total of 53 patients (27 girls, 26 boys) with a mean age of 30.0+/-32.7 months, who aspirated foreign bodies were treated with bronchoscopy were divided into two groups with respect to the time they were diagnosed as early (Group 1, n=22,

Hemobilia from a ruptured hepatic artery aneurysm in a 16-year-old girl.

A 16-year-old girl with hepatic artery aneurysm due to fibromuscular dysplasia which caused hemobilia is presented. This most unusual and life-threatening type of gastrointestinal bleeding was successfully treated by ligation of the common hepatic and gastroduodenal arteries. The clinical aspects and operative procedures of hepatic artery aneurysm are discussed.

Long-term prognosis of poststreptococcal acute glomerulonephritis.

Five hundred and eighty-eight patients diagnosed as having PSAGN were treated at our University Hospital and called in for a reevaluation study in 1988 to determine the long-term prognosis of the disease. Fifty-nine patients responded to the follow-up call, all of them being in good physical health. The blood pressure, urinalysis, serum creatinine, blood urea and beta 1C globulin levels were within normal limits. These results led us to the conclusion that the long-term prognosis was favorable in our PSAGN patients since chronic renal failure had not been encountered.

Age-specific seroepidemiology of hepatitis A, B, and E infections among children in Istanbul, Turkey.

This study was performed for evaluation of seroprevalence of hepatitis A, B, and E among children in Istanbul, Turkey. The study group included 909 children who were 6 months-15 years of age. The children were separated to three age groups: Group 1 (6 months-4.9 years; n = 321), Group 2 (5.0-9.9 years; n = 318), and Group 3 (10.0-15.0 years; n = 270). Group I was divided to two subgroups for evaluation of the maternal antibody sera (6 months-2 years and over 2 years). Serum IgG anti-HAV, anti-HBc, and anti-HEV were tested by commercial ELISA kits. The data were studied by multivariant analysis. In all subjects, seroprevalence of hepatitis A, B, and E were determined as 29, 15.9, and 2.1% respectively. The prevalence of hepatitis A increased with age (p < 0.05; Group 1 15.1% and Group 3 49.6%). Anti-HBc IgG level did not significantly change with age (Group 1 18.6% and Group 3 15.4%; p > 0.05). The seroprevalence of hepatitis E virus infection was higher in Group 1 (3.7%) than Group 3 (0.3%; p < 0.05). In Group 1 first subgroup, between 6 month and 2 year, antibody levels were 12.2, 17.3, and 4.8% respectively, for anti-HAV IgG, anti-HBc IgG and anti-HEV IgG. Hepatitis A and B infection is a community health problem, but hepatitis E infection is low in children in Istanbul, Turkey. The high positive rate in Group I for IgG anti-HEV may be due to maternal antibodies.

Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis.

OBJECTIVE: To evaluate the prevalence of recent parvovirus B19 infection in a cohort of children presenting with acute arthropathy and to determine the prevalence of a subsequent diagnosis of juvenile rheumatoid arthritis in this cohort. METHOD: In this prospective study, parvovirus B19 IgM antibody was investigated in 75 patients who were referred to our clinic with acute joint complaints and also in 75 healthy controls. One patient in each group was excluded due to neuroblastoma and acute lymphoblastic leukaemia. The characteristics of parvovirus B19 IgM positive patients who were accepted as parvovirus B19 arthropathy were further evaluated. All the patients were followed up for at least 6 weeks and the patients with chronic progression of joint complaints were followed for at least 6 months to determine their progress. The cases of juvenile rheumatoid arthritis in this chronic group were identified. RESULTS: Parvovirus B19 IgM was detected in 16 of 74 patients (21.6%) with acute arthropathy compared with 3 of 74 (4.1%) in the healthy control group (chi(2) = 8.67; P = 0.003). The parvovirus B19 positive patients with arthropathy were more likely to become chronic (P = 3.7 x 10(-7)) and to be diagnosed as juvenile rheumatoid arthritis (P = 0.03) than the parvovirus B19 IgM negative group with arthropathy. Additional joint destruction developed in one case who was parvovirus B19 IgM positive in whom juvenile rheumatoid arthritis was diagnosed during follow up. CONCLUSION: These data support the hypothesis that parvovirus B19 infection may be associated with the onset of juvenile rheumatoid arthritis in a proportion of patients.

Coexistence of VATER association and recurrent urolithiasis: a case report.

VATER association is diagnosed by the combined presence of at least three of the following features: vertebral anomalies, anal atresia, tracheo-esophageal fistula and/or esophageal atresia, radial ray anomalies, and renal anomalies (53%). Urolithiasis has not been reported in this syndrome. A 4-month old girl presented because of irritability, and the presence of stones in the diapers. Physical examination revealed anal atresia for which colostomy was performed in the newborn period. The diagnosis of VATER association was established by the additional findings of hemivertebrae, sacral dysgenesis, and horseshoe kidney which was partly non-functional. Urinary pH was repeatedly below 6. An excreted stone consisted of pure uric acid. Metabolic investigations detected no specific pathology in purine metabolism. Urolithiasis did not recur after reconstructive anal and anorecto-vaginoplasty, implying that it was a consequence of colostomy and/or of the underlying renal anomaly. We suggest that after colostomy patients with VATER association should be followed for possible urate stones, e.g. by regular screening of urinary pH.

Calvarial tuberculosis.

We report a six-year-old boy who presented with swelling of the forehead, and had calvarial tuberculosis, a rare form of tuberculous osteitis.