Cushing's syndrome caused by use of synthetic ocular steroid.

WHAT IS KNOWN AND OBJECTIVE: Cases of Cushing's syndrome (CS) following ocular steroid use have been reported in recent years, albeit rarely. CASE DESCRIPTION: We report a case of iatrogenic CS in a child induced by fluorometholone-containing eyedrops. Our patient was referred to our endocrinology clinic due to rapid weight gain. His history revealed that 1.5 months previously he had been started on fluorometholone eyedrops. WHAT IS NEW AND CONCLUSION: To the best of our knowledge, no cases of CS have been reported following ocular fluorometholone use. Although eyedrops containing potent glucocorticoids may lead to CS, fluorometholone, a relatively less potent steroid, may also cause the syndrome, as in our case.

Quality of Life and Psychological Screening in Children with Type 1 Diabetes and their Mothers.

This study aimed to assess the levels of depression in children with type 1 diabetes mellitus (T1DM) and evaluate the quality of life as well as levels of depression and anxiety of their mothers.30 children with T1DM (mean age: 12.9±2.9 years) and their mothers (mean age: 40.0±7.5 years) were included in the study. Control group consisted of 30 healthy children (mean age: 12.7±2.7 years) and their mothers (mean age: 39.8±7.2 years). The presence and severity of depressive symptoms in the children were evaluated using the Children's Depression Inventory (CDI). The short form 36-health survey (SF-36), the Beck Depression Inventory (BDI), and Spielberg's State-Trait Anxiety Inventory (STAI) were administered to all mothers.The children with T1DM had higher scores of depression compared to healthy children in the control group. The mothers of children with T1DM had significantly lower scores on all subscales of SF-36 except the bodily pain subscale. We observed a significant difference between groups in their BDI scores; the mean BDI score was higher in mothers of children with T1DM (p=0.004). There was a significant difference in STAI scores between groups. CDI scores positively correlated with the ages of and HgA1C levels in the children with T1DM. There was a positive correlation between CDI scores of children with T1DM and BDI scores of their mothers. In addition, CDI sores negatively correlated with the scores of vitality and social functioning subscales of SF-36.Our findings suggest screening for mental health issues and quality of life in diabetic children and their mothers.

Cardiac involvement in Sydenham's chorea: clinical and Doppler echocardiographic findings.

Sydenham's chorea is often encountered in pure form, but it may also occur in association with carditis. Recently, it has been reported that silent, mild valvular regurgitation has been encountered in patients with rheumatic fever manifested by isolated polyarthritis and pure chorea. We studied 22 children with Sydenham's chorea to determine clinical and subclinical heart involvement at the time of the initial diagnosis. Ages of the patients ranged from 6-19 y (mean 13.14+/-3.0), and the female/male ratio was 3.4:1. All patients were evaluated by clinical and echocardiographic examination with respect to heart involvement. Carditis was detected in only 5 of 22 patients (23%) by auscultation. Clinical valvular involvement was determined: mitral regurgitation in three and combined mitral and aortic regurgitation in two. The frequency of valvular involvement increased significantly to 63% 2(14/22) after adding silent mitral regurgitation detected by colour Doppler echocardiography (chi2=7.50, p=0.0062). We found that clinically inaudible, but echocardiographically significant, mild valvular regurgitation was frequent in patients with pure chorea. It is concluded that colour Doppler echocardiography may be useful in detecting silent valvular regurgitation and in deciding the duration of prophylaxis.

Central nervous system tuberculosis in children: a review of 214 cases.

OBJECTIVE: To study the clinical, laboratory, and treatment features observed in pediatric patients with tuberculous meningitis in Turkey. Study Design. Retrospective case review study. METHODS: Review of medical records for demographic data, medical history, clinical manifestations, auxiliary test results, complications, and treatment of 214 children with central nervous system tuberculosis (TB) admitted to Dicle University's hospital between August 1988 and February 1996. RESULTS: Of the 214 patients with tuberculous meningitis, 112 (52%) were male. The mean age at presentation was 4. 1 years, with 165 patients (77%) younger than 5 years. Twenty-two patients (10%) were in the first stage of the disease, 120 (56%) in the second, and 72 (34%) in the third. Our epidemiologic data showed that 141 (66%) of the patients had a family history of TB, and 64 (30%) had a Mantoux skin test result of >10 mm of induration. Radiographic studies demonstrated abnormal chest findings in 187 patients (87%) (hilar adenopathy, 33%; infiltrates, 33%; miliary pattern, 20%; and pleural effusions, 1%, and 172 (80%) cases with hydrocephalus, 26% with parenchymal disease, 15% with basilar meningitis, and 2% with tuberculomas. Only 22 (13%) of 164 children had a positive acid-fast bacilli smear in cerebrospinal fluid, and Mycobacterium tuberculosis was isolated in 49 patients (30%). All the patients were treated with Isoniazid, rifampin, and streptomycin or pyrazinamide for 2 months, followed by 10 months of Isoniazid and rifampin alone. Also, all the patients received adjuvant treatment with steroids early in the course of treatment, and 140 of 172 cases with hydrocephalus had surgical intervention. The overall mortality rate was 23%. CONCLUSION: One or more of these findings: a family history of TB, positive tuberculin skin test results, abnormal cranial computed tomography, and/or cerebrospinal fluid analysis compatible with TBM were found in all but 3 children in our study. central nervous system, tuberculous meningitis, diagnosis, hydrocephalus, children.

Aminophylline reversal of flunitrazepam sedation.

Seventeen otherwise healthy patients were given either intravenous physiologic saline, 5 ml, or aminophylline, 2 mg/kg, randomly 30 min after they were given intravenous flunitrazepam in doses adequate to produce sleep and sedation during spinal anesthesia for anorectal surgery. In the control group, mean sedation scores were 1.8 +/- 0.3 and 1.0 +/- 0.4 15 and 45 min after injection of placebo. Fifteen and 45 min after the injection of aminophylline the mean scores of sedation were 0.4 +/- 0.2 and 0.2 +/- 0.2, respectively. Even though the patients in both groups appeared to be equally alert and responsive after 75 min, Trieger tests revealed that psychomotor function was still significantly impaired in the control group 90 min after the injection of placebo. The amnesic effects of flunitrazepam were not affected by aminophylline. Aminophylline may be used to reverse the sedative and psychomotor effects of flunitrazepam.

Epidural morphine for postoperative pain relief in anorectal surgery.

Postoperative analgesia and side effects of a single dose of 20 ml of 2% epidural prilocaine followed immediately by either morphine (3 mg in 3 ml saline) or saline (3 ml) were studied in 79 patients scheduled for anorectal surgery. Pain relief was evaluated by a linear scale for 24 hr and by an assessment of the requirement for parenteral analgesics. Of the patients given epidural morphine, 25% did not require analgesics, whereas all patients given prilocaine alone asked for additional analgesia. Remaining patients given morphine were pain-free for a mean duration of 7.6 +/- 5.1 hr (SD). Only 9% of patients given morphine required a maximum of three analgesic parenteral injections in 24 hr. Urinary retention was the most prominent side effect observed in patients given epidural morphine. No early or delayed respiratory depression was noted in our patients.