Asunto(s)
Enfermedades Autoinmunes del Sistema Nervioso , Leucoencefalopatías , Malformaciones del Sistema Nervioso , Enfermedades Autoinmunes del Sistema Nervioso/diagnóstico , Humanos , Leucoencefalopatías/diagnóstico por imagen , Leucoencefalopatías/genética , Malformaciones del Sistema Nervioso/diagnóstico por imagen , Malformaciones del Sistema Nervioso/genéticaRESUMEN
Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability.
Asunto(s)
Apnea/inducido químicamente , Apnea/tratamiento farmacológico , Imidazoles/envenenamiento , Naloxona/administración & dosificación , Medicamentos sin Prescripción/envenenamiento , Administración Oral , Relación Dosis-Respuesta a Droga , Estudios de Seguimiento , Humanos , Imidazoles/uso terapéutico , Recién Nacido , Infusiones Intravenosas , Masculino , Medicamentos sin Prescripción/administración & dosificación , Medición de Riesgo , Resultado del TratamientoRESUMEN
PURPOSE: To determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference. METHODS: Contrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated. RESULTS: There was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent. CONCLUSIONS: Diameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.
Asunto(s)
Aorta Torácica/anatomía & histología , Arteria Pulmonar/anatomía & histología , Radiografía Torácica , Tomografía Computarizada por Rayos X , Adolescente , Análisis de Varianza , Aorta Torácica/diagnóstico por imagen , Distribución de Chi-Cuadrado , Niño , Preescolar , Medios de Contraste , Femenino , Humanos , Lactante , Masculino , Arteria Pulmonar/diagnóstico por imagen , Valores de Referencia , Estudios Retrospectivos , Enfermedades Torácicas/diagnóstico por imagenRESUMEN
Acute poststreptococcal glomerulonephritis (APSGN) is the most common prototype of acute glomerulonephritis in children, and is characterized by the sudden onset of gross hematuria, edema, hypertension and volume overload. Brain natriuretic peptide (BNP) is produced in both the brain and the heart. Its prohormone, proBNP, is cleaved to biologically active BNP and an inactive N-terminal peptide of proBNP (NT-proBNP). NT-proBNP is released predominantly from the ventricles in response to hypervolemia and pressure overload. We therefore investigated the relationship between NT-proBNP levels and cardiac functions of patients with APSGN. NT-proBNP levels were measured in 28 patients with APSGN (17 boys and 11 girls of 8.2 +/- 2.9 years old) and in 26 healthy children (control group). Echocardiograms were performed in both patient and control groups on admission, and only in the patient group two weeks later. Upon admission, the plasma NT-proBNP levels were higher in the patients than in the control group (8876.2 +/- 9650.8 vs 69.5 +/- 22.2 pg/mL, p < 0.001), and left ventricular dysfunction was detected in six patients. Moreover, NT-proBNP levels were significantly higher in the patients with left ventricular dysfunction than other patients (n = 22). There was no significant difference in the levels of NT-proBNP between the patient and control groups, after diuretic treatment of the patients. Plasma NT-proBNP levels were positively correlated with the severity of APSGN. Thus, NT-proBNP level may be a useful marker to assess the volume overload and cardiac function in the follow up of selected APSGN patients.
Asunto(s)
Glomerulonefritis/sangre , Glomerulonefritis/etiología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Infecciones Estreptocócicas/complicaciones , Disfunción Ventricular Izquierda/patología , Niño , Ecocardiografía , Femenino , Humanos , Masculino , Disfunción Ventricular Izquierda/etiologíaRESUMEN
A 1-year-old boy with epistaxis, gastrointestinal bleeding and severe anemia that caused cardiorespiratory distress presented to our unit. The results of coagulation tests were normal. An erythrocyte suspension transfusion was given to the patient. On the second day of his hospitalization, a leech was removed from his nose. In developing countries, leech infestation should be considered in cases where epistaxis, hematemesis, gastrointestinal bleeding and severe anemia are of unknown origin.
Asunto(s)
Anemia/etiología , Epistaxis/etiología , Hemorragia Gastrointestinal/etiología , Sanguijuelas/patogenicidad , Anemia/parasitología , Anemia/terapia , Animales , Preescolar , Epistaxis/fisiopatología , Enfermedades del Esófago/parasitología , Hemorragia Gastrointestinal/parasitología , Hemorragia Gastrointestinal/terapia , Humanos , Lactante , Masculino , Resultado del TratamientoRESUMEN
Hyperbilirubinemia is an important health problem in newborns. The most common causes are Rh and ABO incompatibility, hemolytic anemias, enzyme deficiencies, sepsis, hypothyroidism, pyloric stenosis and breast-milk jaundice. Adrenal hemorrhage is a rare cause of hyperbilirubinemia in the neonate. We present a six-day-old newborn with hyperbilirubinemia and suprarenal hematoma who was born at home without assistance of healthcare personnel. Adrenal hematoma should also be considered in the differential diagnosis of hyperbilirubinemia, particularly in newborns that experienced a difficult delivery.
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Enfermedades de las Glándulas Suprarrenales/complicaciones , Hematoma/complicaciones , Hiperbilirrubinemia Neonatal/etiología , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Glándulas Suprarrenales/diagnóstico por imagen , Diagnóstico Diferencial , Hematoma/diagnóstico , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Recién Nacido , Masculino , Enfermedades Raras , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
This study aims to compare neurological examination and cranial magnetic resonance imaging (MRI) findings in patients with serious hyperbilirubinemia. Twenty-one serious hyperbiluribinemic term neonates (6 girls, 15 boys) who underwent exchange transfusions were included in the study. Neurological examination findings, body weight, age at admission, blood culture, urine culture, urine analysis, C-reactive protein, thyroxine, thyroid-stimulating hormone, total and indirect bilirubin levels, causes of hyperbilirubinemia (blood group typing, glucose-6-phosphate dehydrogenase, blood smear, tandem mass), treatment and duration of follow-up, auditory test results, and cranial MRI findings were evaluated. All patients were term neonates with an average body weight of 2943 +/- 533 g. The mean age at admission was 4.47 +/- 2.22 days, and the mean bilirubin level was 35.0 +/- 10.8 mg/dL. Exchange transfusion was performed once in all, except 4 patients who needed 2 transfusions. Kernicterus findings were found in 76% of patients on neurological examination, and cranial MRI detected a pathological finding in 71% of patients. In 2 patients, cranial MRI showed kernicterus findings, despite normal neurological examination. In contrast, in 3 patients, despite kernicterus findings in neurological examination, cranial MRI was normal. Although cranial MRI has an important place in the diagnosis of kernicterus, it does not always correlate with clinical findings. We believe that studies with larger series are warranted.
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Encéfalo/patología , Hiperbilirrubinemia/diagnóstico , Imagen por Resonancia Magnética , Estimulación Acústica , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Femenino , Humanos , Hiperbilirrubinemia/fisiopatología , Recién Nacido , MasculinoRESUMEN
Scimitar syndrome with bilateral abnormal venous drainage and horseshoe lung is extremely rare. These rare complex anomalies were diagnosed in a 5-year-old boy by 64-slice multidetector CT (MDCT). This technique provides high-quality visualization of vascular, bronchial and parenchymal structures in a single session, such that no further invasive techniques are required. One obvious disadvantage of MDCT is the radiation exposure, especially in paediatric patients. The use of a single phase of contrast material administration reduces radiation exposure. The workstation platforms of MDCT systems allow multiplanar 2-D and 3-D postprocessing. As a result, various complex pathologies, such as that discussed here, can be diagnosed following a single imaging session with a certain precision.
Asunto(s)
Pulmón/anomalías , Venas Pulmonares/diagnóstico por imagen , Síndrome de Cimitarra/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Preescolar , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Pulmón/diagnóstico por imagen , Masculino , Enfermedades RarasRESUMEN
High potency or/and extended use of topical corticosteroids, particularly in children, may cause suppression of the hypothalamopituitary-adrenal axis. However, iatrogenic Cushing's syndrome in infantile age group is very rare and only a few patients have been reported to date in the literature. Here, we report a case of iatrogenic Cushing's syndrome in a 6-month-old male child whose parents have admitted to the hospital for overweight and skin fragility.
RESUMEN
OBJECTIVE: We aimed to investigate the rate of kernicterus, and physical and laboratory examination findings in hyperbilirubinemic infants with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. MATERIALS AND METHODS: This study was carried out in the Dicle University Hospital Neonatal Intensive Care Unit between June 2005 and June 2006. Out of 56 male neonates who needed an exchange transfusion due to hyperbilirubinemia, 10 with G-6-PD deficiency were included in the study. Maternal age, gestational age, route of delivery, birth weight, age at the time of admission, and treatment and outcome were recorded. Laboratory investigations included determination of direct and indirect serum bilirubin concentrations, blood group typing, direct Coomb test, complete blood count, blood smear, thyroid-stimulating hormone, T4, C-reactive protein, urine analysis, and G-6-PD level. RESULTS: Out of 56 male neonates requiring exchange transfusion, 10 had G-6-PD deficiency (18%). In G-6-PD deficient neonates, other factors known to cause hyperbilirubinemia were excluded. The mean gestational age and the mean maternal age was 38.2+/-1.0 weeks and 31.3+/-5.9 years, respectively. The mean bilirubin level was 42.1+/-13.7 mg/dL. Four patients required a second exchange transfusions, and only 1 transfusion was sufficient for the remaining patients. Five patients (55%) developed kernicterus. CONCLUSIONS: Early detection of G-6-PD deficiency in the affected newborns may be important for reducing the risk of severe hyperbilirubinemia, kernicterus, and the need for exchange transfusion.
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Recambio Total de Sangre , Deficiencia de Glucosafosfato Deshidrogenasa/epidemiología , Hiperbilirrubinemia Neonatal/epidemiología , Kernicterus/epidemiología , Adulto , Peso Corporal , Comorbilidad , Femenino , Estudios de Seguimiento , Deficiencia de Glucosafosfato Deshidrogenasa/diagnóstico , Deficiencia de Glucosafosfato Deshidrogenasa/terapia , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/terapia , Recién Nacido , Kernicterus/diagnóstico , Kernicterus/terapia , Imagen por Resonancia Magnética/métodos , Masculino , Sensibilidad y Especificidad , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
This prospective study was done over seven years from 1996 to 2003 to investigate the chest computed tomography scan findings along with other radiologic examinations that included chest roentgenography and cranial computed tomography in children with tuberculous meningitis (TBM). Chest roentgenography demonstrated abnormal findings in 32 cases (43%) (hilar adenopathy, 32%; miliary pattern, 18%; bronchopneumonic infiltrate, 24%), while chest computerized tomography was abnormal in 65 cases (88%; p<0.005): mediastinal and hilar lymphadenopathy were present in 46% (p<0.005); miliary pattern, in 23% (p<0.05); and bronchopneumonic infiltrate, in 23% (p<0.05). Cranial computerized tomography was abnormal in 68 cases (92%). Chest computerized tomography scan helps establish the diagnosis of TBM when chest radiography is normal or inconclusive, and it is useful in assessing children with suspected TBM.
Asunto(s)
Tomografía Computarizada por Rayos X , Tuberculosis Meníngea/diagnóstico por imagen , Adolescente , Antituberculosos/uso terapéutico , Niño , Preescolar , Diagnóstico Precoz , Femenino , Humanos , Lactante , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Estudios Prospectivos , Radiografía Torácica , Cráneo/diagnóstico por imagen , Tuberculosis Ganglionar/diagnóstico por imagen , Tuberculosis Meníngea/complicaciones , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagen , TurquíaAsunto(s)
Colchicina/envenenamiento , Alopecia/inducido químicamente , Preescolar , Femenino , Lavado Gástrico , HumanosRESUMEN
We aimed to investigate the presence of psychomotor retardation, physical and laboratory examination in infants with megaloblastic anemia. Inclusion criteria for the study were; age 9 to 36 months, refusal of food except for breast and cow milk, loss of appetite, developmental delay, significant pallor, and hypersegmentation neutrophils in the peripheral blood smear. A total of 33 children fulfilling the inclusion criteria were enrolled among 3368 patients attending Pediatric Outpatient Clinics of sirnak-Cizre State Hospital between January 25, 2004 and May 5, 2004. Mean age was 16.4 months. Thirty-two patients had Vitamin B12 deficiency, 1 patient had folate deficiency, and 10 patients had combined vitamin B12 and folate deficiency. Statistically, a positive significant relationship was detected between serum vitamin B12 levels and mean corpuscular volume (P = 0.001, r = 0.56), and between vitamin B12 levels and hemoglobin (P = 0.004, r = 0.49). We believe that preventative measures such as fortification of flour with vitamin B12, nutritional support with vitamin B12 for the mother during pregnancy and nursing, provision of adequate primary preventive health services, and starting complementary food after 6 months of age are important determinants for preventing megaloblastic anemia.
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Anemia Megaloblástica/diagnóstico , Anemia Megaloblástica/etiología , Discapacidad Intelectual/etiología , Trastornos de la Destreza Motora/etiología , Deficiencia de Vitamina B 12/complicaciones , Preescolar , Femenino , Ácido Fólico/sangre , Deficiencia de Ácido Fólico/complicaciones , Deficiencia de Ácido Fólico/diagnóstico , Humanos , Lactante , Masculino , Neutrófilos/patología , Turquía , Vitamina B 12/sangreRESUMEN
The causes and risk factors of symptomatic spontaneous pneumothorax in term newborns are not completely understood. In the present study, our aim was to investigate the risk factors for and clinical and laboratory characteristics of term newborns with spontaneous symptomatic pneumothorax and to evaluate the outcome of management in this condition. A total of 11 term newborns admitted to the newborn intensive care unit with a diagnosis of symptomatic spontaneous pneumothorax were included during a 22-month period. Female to male ratio was 4:7, mean gestational age was 39.5 weeks, and 63% were delivered with a cesarean section, 18% of patients had renal and 55% had congenital cardiac anomalies. Rate of cardiac anomalies was more frequent in the study group compared to control group. Echocardiography in addition to renal ultrasonography may also be needed in term newborns with spontaneous symptomatic pneumothorax and further studies may be warranted to evaluate this association.
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Neumotórax/prevención & control , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Masculino , Neumotórax/diagnóstico , Neumotórax/epidemiología , Neumotórax/terapia , Estudios Prospectivos , Factores de Riesgo , Turquía/epidemiologíaRESUMEN
BACKGROUND: It has been reported that there are racial and regional differences in peak incidence age, histopathological features and response to steroid therapy in childhood idiopathic nephrotic syndrome. METHODS: One hundred and thirty-eight patients with a diagnosis of idiopathic nephrotic syndrome, followed up in 1994-2000, were assessed retrospectively. The aim of this study was to assess the patients' response pattern to steroid therapy, to determine whether the duration of the initial steroid therapy alters the steroid response pattern of the disease and to assess renal biopsy results. RESULTS: One hundred and fourteen patients who initially received only steroid therapy and were followed up regularly were classified according to response pattern. Of the 114 patients, 30 children had an initial response, 25 children had infrequent relapse, 19 had frequent relapse, 25 had steroid dependence and 15 children had steroid resistance. The 99 patients with steroid responsive nephrotic syndrome were divided into two groups with respect to duration of the initial steroid therapy. There was no statistically significant difference between standard and short therapy groups with respect to the steroid response patterns. Percutaneous renal biopsy was performed in 43 of the 138 patients. Mesengioproliferative glomerulonephritis was the most common histopathological lesion, followed by membranoproliferative glomerulonephritis. The proportions of membranous glomerulonephritis, focal segmental glomerulosclerosis and minimal change nephrotic syndrome were low in our group. CONCLUSIONS: Our study group is similar to one reported from Saudi Arabia with respect to the steroid response pattern and to Saudi Arabian and Nigerian reports with respect to the histopathology. Although it has been reported that short initial steroid therapy was followed by a higher rate of relapses, there was no statistically significant difference between standard and short therapy groups with respect to the relapse rate in our study group.
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Antiinflamatorios/uso terapéutico , Síndrome Nefrótico/tratamiento farmacológico , Prednisolona/uso terapéutico , Adolescente , Biopsia , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Síndrome Nefrótico/patología , Estudios Retrospectivos , Resultado del Tratamiento , TurquíaRESUMEN
OBJECTIVE: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. METHODS: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V, I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). RESULTS: The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. CONCLUSION: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.