Bradicardia sinusal inducida por corticoesteroides en un niño con insuficiencia suprarrenal y septicemia / Corticosteroid-induced sinus bradycardia in a young boy with adrenal insufficiency and sepsis

La bibliografía no incluye frecuentemente alteraciones en el ritmo cardíaco de los pacientes que reciben corticoesteroides; se desconoce su mecanismo exacto. En este artículo, presentamos el caso de un paciente con bradicardia sinusal asociada con una dosis de estrés de corticoesteroides. Se ingresó a un niño de 9 años con antecedentes de panhipopituitarismo con gastroenteritis y neumonía y presentó choque septicémico el día de la hospitalización. El tratamiento con líquidos intravenosos, dosis de estrés de hidrocortisona y antibióticos permitió la recuperación. Sin embargo, luego se documentó bradicardia sinusal con una frecuencia cardíaca de 45 latidos por minuto. Esta se resolvió después de reducir gradualmente la hidrocortisona. La bradicardia sinusal inducida por corticoesteroides es un efecto adverso que suele resolverse tras interrumpir el tratamiento. Se debe considerar el monitoreo hemodinámico en estos casos. Este es el primer informe de bradicardia sinusal posterior al uso de hidrocortisona en niños con insuficiencia suprarrenal

The literature does not commonly describe cardiac rhythm disturbances, including bradycardia, in patients who are receiving corticosteroids, and the exact mechanism of such disturbances remains unknown. Herein, we present a case of sinus bradycardia associated with stress-dose corticosteroid therapy. A nine-year-old boy with a history of panhypopituitarism was admitted with gastroenteritis and pneumonia and developed septic shock on the day of admission. Management using intravenous fluids, stress doses of hydrocortisone, and antibiotics resulted in full recovery. However, within 24 hours following treatment, sinus bradycardia was documented, with a heart rate of 45 beats per minute (BPM). The bradycardia resolved after the dose of hydrocortisone was decreased gradually. Corticosteroidinduced sinus bradycardia is an adverse effect that usually resolves after corticosteroid treatment is discontinued. During stress-dose corticosteroid therapy, hemodynamic monitoring should be considered. To our knowledge, this is the first report of sinus bradycardia following the use of hydrocortisone in children who have adrenal insufficiency.

¿El licopeno puede eliminar los efectos perjudiciales de la hiperoxia en los cerebros inmaduros? / Can lycopene eliminate the harmful effects of hyperoxia in an immature brain?

Objetivos: Al ser un antioxidante, el licopeno protege a las células contra el daño causado por los radicales libres, fortalece los enlaces intercelulares y mejora el metabolismo celular. Este estudio analiza los efectos del licopeno sobre los trastornos neurodegenerativos por hiperoxia en ratas recién nacidas a término. Métodos: Estas ratas se dividieron en cuatro grupos: grupo 1 de referencia con normoxia, grupo 2 con normoxia + licopeno, grupo 3 de referencia con hiperoxia y grupo 4 con hiperoxia + licopeno. Los grupos 1 y 2 se supervisaron en condiciones de aire ambiental, y los grupos 3 y 4 se supervisaron con un nivel de oxígeno > 85 % O2. Los grupos 2 y 4 recibieron inyecciones intraperitoneales de licopeno de 50 mg/kg/día; los otros grupos recibieron inyecciones intraperitoneales de aceite de maíz con el mismo volumen. Las ratas se sacrificaron en el día 11, después de 10 días con hiperoxia. Se extrajeron los cerebros, y se evaluaron los parámetros del sistema oxidativo. Resultados: Se detectaron lesiones cerebrales por hiperoxia en sustancia blanca, regiones corticales y tálamo. Aumentó la cantidad de células apoptóticas y disminuyó la cantidad de células PCNA positivas en los grupos 3 y 4, comparados con el grupo 1. No se observó una mejora significativa en la cantidad de células apoptóticas y células PCNA positivas en los grupos 3 y 4; además, aumentó la apoptosis. Conclusión: Se halló que el licopeno no mostró efectos terapéuticos para el daño cerebral en ratas recién nacidas. Además, se demostró que el licopeno podría causar efectos tóxicos.

Objectives. In addition to protecting cells against free radical harm thanks to its anti-oxidant nature, lycopene strengthens the bonds among cells and improves cell metabolism. This study focuses on analyzing therapeutic effects of lycopene in hyperoxia-induced neurodegenerative disorders in newborn rats. Methods. Term newborn rats were divided into four groups as the normoxia control group (group-1), normoxia+lycopene group (group-2), hyperoxia control group (group-3) and hyperoxia+lycopene group (group-4). Group-1 and group-2 were monitored in room air while the group-3 and group-4 were monitored at > 85% O2. The group-2 and group-4 were injected with lycopene intrapertioneally (i.p. ) at 50mg/kg/day while the other groups were injected with corn oil i.p. at the same volume. The rats we sacrificed on the 11th day following the 10-day hyperoxia. The brains were removed and oxidant system parameters were assessed. Results. Injury resulting from hyperoxia was detected in the white matter, cortical regions, and thalamus of the brains. It was observed that the number of apoptotic cells increased and the number of proliferating cell nuclear antigen (PCNA) positive cells decreased in the groups-3 and 4 compared to the group-1. No significant improvement in the number of apoptotic cells and PCNA positive cells was observed in the groups-3 and 4, and apoptosis increased as well. Conclusion. This study found that lycopene, did not show any therapeutic effects for brain damage treatment in newborn rats. In addition, this study demonstrated that lycopene might lead to toxic effects.

Experiencia de las madres de niños con síndrome de Down al momento del diagnóstico / Experience of mothers with Down syndrome children at the time of diagnosis

Introducción. El síndrome de Down (SD) es un trastorno genético frecuente. Las familias de los niños con SD en general no reciben suficiente información al momento del diagnóstico. El objetivo de este estudio fue evaluar las experiencias de las madres de niños con SD al momento que le dieron el diagnóstico y la comunicación que brindaron los profesionales de la salud. Población y métodos. Se incluyeron madres de niños con síndrome de Down. Se evaluaron sus experiencias con la información del diagnóstico y las actitudes de los profesionales, mediante una entrevista semiestructurada. Resultados. La muestra fue 43 madres. Se diagnosticó SD durante el control prenatal en ocho niños y en 35 después del nacimiento. Dieciocho madres recibieron el diagnóstico en la clínica pediátrica, y a 16 les informaron en la maternidad. Más de la mitad de las madres recibieron la primera información sobre el diagnóstico de su hijo del pediatra. Solo cinco de las 43 madres habían recibido información detallada. De 32 madres, 23 dijeron que percibieron una actitud negativa. La mayoría de los informes del diagnóstico a las familias, duraron menos de cinco minutos. Conclusiones. Las madres de niños con SD desean recibir más información sobre el SD de parte de los profesionales de la salud. Además, desean que esta información se brinde de manera comprensiva y sensible. Los profesionales de la salud, en especial los pediatras, necesitan dedicar el tiempo suficiente para conversar con la familia sobre el SD y los desafíos que presenta.

Introduction. Down's syndrome (DS) is a common genetic disorder. The families of children with DS generally do not receive sufficient information at the time of the diagnosis. They are dissatisfied with the manner of healthcare professionals. The objective was to evaluate the experiences of mothers of children with DS at the time of the diagnosis and the communicative attitudes of healthcare professionals. Population and methods. Mothers who had children with Down syndrome were included. The experiences of the mothers at the time of diagnosis and the attitudes of the healthcare professionals were evaluated by a semistructured interview. Results. The study sample was 43 mothers. Eight children had been diagnosed with DS prenatally, and 35 had been diagnosed postnatally. Eighteen of the mothers had received the diagnosis in a pediatric clinic, and 16 had been told of the diagnosis in an obstetric clinic. More than half the mothers had received the first information about their child's diagnosis from a pediatrician. Only five of the 43 mothers had received detailed information. Twenty-three of 32 mothers said that they were met with a negative attitude. Generally, the time put aside to inform the families about the diagnosis was less than 5 min. Conclusions. Mothers of DS children want more information about DS from healthcare professionals. Furthermore, they want this information to be delivered in a supportive and sensitive manner. Healthcare professionals, especially pediatricians need to allocate sufficient time to discuss DS and its challenges with the family.

comparison of anterolateral and posterolateral approaches in primary total hip arthroplasty

The aim of this study was to compare the short-term clinical and radiological results of anterolateral and posterolateral approaches in total hip arthroplasty

The study included patients who were operated on for hip osteoarthritis. The patients were allocated to one of two groups for applying uncemented total hip prosthesis with the anterolateral or posterolateral approach. They were operated on by one surgical team composed of two senior surgeons. They were clinically evaluated using the Harris Hip Score and radiologically using direct radiographs. Various parameters were recorded in both the groups, including amount of blood loss, surgical time, and duration of hospitalization

A total of 70 patients were followed up for a mean duration of 18 months [range 6-36 months], 34 in the anterolateral group and 36 in the posterolateral group. No statistically significant differences were observed between the anterolateral and posterolateral approaches for a total hip prosthesis in terms of the clinical and radiological results. The most successful results can be obtained using the technique that the surgeon performs better according to his experience of total hip arthroplasty

effect of partial cross clamping administration on postoperative healing of pulmonary functions for coronary artery bypass graft operations

To compare partial cross clamping and mechanic pulmonary ventilation technique with total cross clamping utilization during cardiopulmonary bypass in coronary artery bypass graft operations in terms of pulmonary healing. Between February and April 2007, isolated coronary artery bypass graft operation was performed for 30 patients in the Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, and the Cardiovascular Surgery Department, Medical Faculty, Akdeniz University, Antalya, Turkey. The patients were divided into 2 groups; Group A [n=15] with total cross clamping, and Group B [n= 15] partial cross clamping and mechanic pulmonary ventilation in cardiopulmonary bypass. Postoperative pulmonary functions were studied in 2 main data; 1] the oxygenization rate of artery blood gas, and 2] spirometer results. Additionally, total cardiopulmonary bypass and total cross-clamping times, extubation times, numbers and types of grafts, days of intensive care unit treatment, and hospitalizations were recorded. There was no statistically significant difference between the 2 groups for oxygenization rate, and surgery hospitalization details. We observed a statistically significant difference with advantage in Group B in spirometric results in terms of healing of pulmonary functions. Total cross clamping and circulatory arrest of the lungs are the main sources of postoperative pulmonary complications based on the pulmonary inflammatory response in coronary artery bypass surgery

Medial open reduction of developmental dysplasia of the hip using the Weinstein-Ponseti approach

To evaluate the efficacy and safety of medical open reduction using the Weinstein - Ponseti approach to treat developmental dysplasia of the hip [DDH]. In this retrospective study 35 hips were treated in 24 children [one boy and 23 girls, mean age 10.8 +/- 2.82 months, range 6-16 months] in the Department of Orthopedic Surgery Medical Faculty, Harran University, Sanliurfa, Turkey, between April 1997 and February 2009. We evaluated radiologically the patients hip pre-operatively using the Tonnis grading system and acetabular index. Group 1 included 13 patients aged younger than 12 months [19 hips] and Group 2 included 11 patients aged 12 months or older [16 hips]. Clinical and radiographic evaluations were made according to the McKay and Severins criteria, respectively. Avascular necrosis [AVN] was evaluated according to the Kalamchi and Mac Ewens classification. The average follow-up period was 5.6 +/- 3.1 years [range, 2-12 years]. Five hips [14.2%] required a second procedure. Avascular necrosis was observed in 6 hips [17.1%]. Clinical and radiological assessments showed that the outcome was not significantly different between the 2 groups. Furthermore, after this follow up period, the rates of AVN were similar. Analyzing retrospectively after comparison of this method before and after the age of 12 months, we found no difference between the 2 groups. Children with DDH can be successfully treated by this method up to 16 months

Comparison of traditional and Dorgan's lateral cross-wiring of supracondylar humerus fractures in children

To evaluate the outcomes of traditional mediAl lateral and Dorgan's lateral cross-wiring of supracondylar humerus fractures in children. In our retrospective study, we evaluated 51 children in the Department of Orthopedic Surgery, Harran University Medical Faculty, Sanliurfa, Turkey between February 2005 and January 2009. Group 1 [traditional] included 25 [16 male and 9 female, mean age 6.5 +/- 3.3 years] and group 2 [Dorgan's lateral] included 26 [19 male and 7 female, mean age 7.1 +/- 2.8 years] patients. Functional and cosmetic results were evaluated according to Flynn et al's criteria. Preoperative and postoperative neurologic examination was performed. The mean follow-up periods were 18.4 +/- 1.7 months in group 1 and 16.3 +/- 1.7 months in group 2. The neurologic, functional, and cosmetic results of 51 patients were reviewed. There were no statistically significant differences found between the groups for gender, age, follow-up periods, fracture types, neurological or function, and cosmetic results. Although postoperative iatrogenic ulnar nerve injuries occurred in 2 [8%] patients treated with the traditional medial lateral [group 1] cross-wiring technique, no nerve injury occurred in the Dorgan's lateral group [group 2]. We recommend Dorgan's lateral cross-wiring technique as it is as effective as the traditional mediAl lateral cross-wiring technique, and prevents iatrogenic ulnar nerve injuries

Mutation and association analysis of the PVR and PVRL2 genes in patients with non-syndromic cleft lip and palate

Orofacial clefts (OFC; MIM 119530) are among the most common major birth defects. Here, we carried out mutation screening of the PVR and PVRL2 genes, which are both located at an OFC linkage region at 19q13 (OFC3) and are closely related to PVRL1, which has been associated with both syndromic and non-syndromic cleft lip and palate (nsCLP). We screened a total of 73 nsCLP patients and 105 non-cleft controls from the USA for variants in PVR and PVRL2, including all exons and encompassing all isoforms. We identified four variants in PVR and five in PVRL2. One non-synonymous PVR variant, A67T, was more frequent among nsCLP patients than among normal controls, but this difference did not achieve statistical significance.

Dexmedetomidine as a substitute for remifentanil in ambulatory gynecologic laparoscopic surgery

To compare dexmedetomidine with remifentanil in desflurane based ambulatory gynecologic laparoscopic surgery, in respect to its effects on orientation, discharge time, nausea-vomiting, and postoperative analgesic need. Sixty 20-40 year old ASA I-II patients undergoing gynecologic laparoscopic surgery were randomized into 2 groups. This study was performed in the operating theaters of the Hacettepe University Faculty of Medicine, Hacettepe, Turkey in 2004 as a prospective, randomized, and double blinded study. The remifentanil group group R, and dexmedetomidine group group D received a bolus of 1 ug/kg over 10 minutes, followed by 0.2 ug/kg/minute peroperative infusion of remifentanil, and 0.4 ug/kg/hour of dexmedetomidine. Hemodynamic parameters, time to extubation, and to orientation to person, place, and date, postoperative nausea, vomiting, pain, analgesic requirement at home, and satisfaction with anesthesia were recorded. Demographic, hemodynamic data, postoperative pain scores, and discharge time were similar in both groups. Time to extubation, to orientation to person, to place and date were shorter in group R. Postoperative nausea, vomiting, and analgesic requirements at home were less in group D. This study demonstrated that dexmedetomidine infusion causes a relatively slow recovery with reduced postoperative nausea, vomiting, and analgesic requirements, and similar hemodynamics compared to remifentanil in ambulatory laparoscopic surgeries. It may be an alternative to remifentanil in ambulatory anesthesia

Lack of mutations in the PVRL3 gene in North American caucasians with non-syndromic cleft lip/palate

Cleft lip with or without cleft palate (CLP) is one of the most common birth defects. In about 70 percent of cases, CLP occurs as an isolated anomaly, denoted non-syndromic CLP (nsCLP). Genetic linkage and association studies have implicated many loci in susceptibility to nsCLP, including some members of the nectin gene family. We performed mutation screening of the PVRL3 gene that encodes nectin-3 in 73 unrelated Caucasian nsCLP patients and 105 unrelated controls from North America. We detected no sequence variants in the PVRL3 gene in either the nsCLP patients or the controls. These data suggest that PVRL3 is not an important susceptibility gene for nsCLP in the North American Caucasian population.

Osteomalacic myopathy associated with coexisting celiac disease and primary biliary cirrhosis

To report a patient with coeliac disease [CD] associated with primary biliary cirrhosis [PBC] who presented with myopathy without classical symptoms of CD. Clinical A 42-year-old woman presented with inability to walk and marked loss of motor function. She had elevated liver enzymes with a cholestatic pattern. Antimitochondrial antibody M2 band, anti-endomysial antibody, antigliadin IgA and IgM were positive. Histopathologic findings of the liver revealed PBC and duodenal biopsy was consistent with CD. She was also found to have osteomalacia. She showed slow response to gluten-free diet, but accelerated full recovery with vitamin D replacement. In PBC patients with subclinical CD and myopathy, vitamin D status can provide a basis for treatment

Anatomical development of the normal urachus during the fetal period

To evaluate the development of the normal urachus during the fetal period. The study was carried out on 149 human fetuses [male 87, female 62] aged between 9-40 weeks, obtained with families' consent from Isparta Maternity and Children's Hospital, Isparta, Turkey, between 1997 and 2002. The study was carried out in the Department of Anatomy, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey during 2004. The type of the urachus was assessed and was classified. The length, antero-posterior depth, and the transverse width of the urachus were measured. Finally, the relationship between the urachus and umbilical arteries was evaluated during the fetal period, whether they ran parallel to each other. Two types of urachus were observed: the inverted funnel [84%] and tubular [16%]. The length, depth, and width of the urachus increased with gestational ages in all cases. A 2% variation was observed in the neighborhood between urachus and umbilical artery. Comparing our results with previous studies, the development of the urachus can be different in neonates and children. The mean urachus length was 14.8 -/+ 7.7mm during this period. The inverted funnel type is the most common type in our study. Hence, there can be some differences in the relationship between the urachus and umbilical arteries. The data obtained in the present study can be used as base knowledge related to the development of the urachus, and for evaluating the urachus in utero pediatric urology, radiology, pediatric surgery, and fetopathology

Short-term effects of irbesartan treatment on microalbuminuria in patients with normotensive type 2 diabetes

A total of 40 normotensive type 2 diabetes patients [mean age 55.1 +/- 11.4 years] who had microalbuminuria were included in this non-comparative and prospective research study. The study took place in Ege University Hospital, Bornova-Izmir, Turkey, between January 2005 and April 2005. Patients were treated with irbesartan 300mg/day for 3 months. Physical examination, medical history, systolic and diastolic blood pressure levels, microalbuminuria, diabetes markers fasting and non-fasting blood glucose, glycosylated hemoglobin [HbA1c], lipid profile, creatinine and urea were obtained at baseline and after 3 months of irbesartan treatment. The primary assessment criterion was the change in microalbuminuria. The mean microalbuminuria level at baseline was 110.8 +/- 93.1mg/24 hours. It significantly decreased to 45.6 +/- 62.5mg/24 hours at the end of 3 months of irbesartan treatment [p < 0.001]. When patients were stratified according to the change in the microalbuminuria status after treatment, 90% of them either returned to normo albuminuria or their microalbuminuria decreased. Both diastolic and systolic blood pressures, fasting and non-fasting blood glucose, and HbA1c were found to be significantly decreased after 3 months of irbesartan treatment compared to pre-treatment values. The positive effect of irbesartan on microalbuminuria occurs independently from HbA1c, fasting blood glucose, and blood pressures. The short-term treatment of irbesartan is effective to decrease microalbuminuria in normotensive type 2 diabetes patients, independent of its antihypertensive effect. There is a need for multicenter prospective studies to investigate this further

proportions of the white and red pulps of the human fetal spleen

To compare the proportions of white and red pulps of the human spleen during the fetal period. We performed this study in the Department of Anatomy and Pathology of Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey, from the period between 2002-2003. Spleens from 137 dead fetuses aged between 9 and 40 weeks were embedded into paraffin blocks following classical histological steps and stained with hematoxylin and eosin. White and red pulps could be differentiated only in 25 cases [13 males, 12 females]. The proportions of the areas of white and red pulps [the trabeculae were included into the red pulp and the groups of lymphocytes were included into the white pulp] were estimated by point counting method on the sections taken from different parts of the spleens by systematic randomized sampling technique. It has been ascertained that the white pulp has been distinguished from 20th week onwards during the fetal period. The proportion of the white pulp area has been found to be 22.3% [of total white and red pulp areas] at the 20th week and has come to 37.6% at the 40th week. Concerning the trimesters, the proportion of the white pulp area has been found to be 30% [of total white and red pulp areas] at the 2nd trimester and has come to 36% at full term. While the white pulp area had a positive correlation with the gestational age [r: 0.34], the red pulp area had a negative one [r: -0.34]. No difference has been found among gender. Reference values have been obtained about the proportions of white and red pulp areas of human fetal spleen

Development of the liver during the fetal period

To investigate the development of the liver in human fetuses aged between 9-40 weeks. We studied 121 human fetuses [62 males, 59 females] with no external anomalies aged between 9-40 postmenstrual weeks during 2003-2004 in Suleyman Demirel University, Isparta, Turkey. The fetuses were divided into four groups as 1st, 2nd and 3rd trimesters and full term fetuses. We measured fetal weight, length, width, thickness, and volume of the liver. We established localization of the liver and its relation with the neighboring structures, its ligaments, and size of itself and its lobes, shapes of the liver and the localization of the porta hepatis on the visceral surface of the liver. We found significant correlations between the size, weight, volume of the liver, sizes of its lobe and gestational age [p<0.001]. Group comparisons disclosed significant differences between groups in all parameters except between 3rd and 4th groups with respect to the heights of the liver and the caudate lobe [p<0.05]. During the fetal period, the proportion of the distance between the porta hepatis and the right margin of the liver to the distance between the porta hepatis and the left margin of the liver did not change significantly [p>0.05]. However, the proportion of the distance between the porta hepatis and the upper margin to the distance between the porta hepatis and the lower margin decreased significantly with gestational age [p<0.05]. Type 3 liver [square] was the most commonly observed type of fetal liver [53%]. Our opinion is that the parameters obtained can be useful to diagnose pathologies of liver development and anomalies concerning several branches of medicine such as anatomy, pathologic anatomy [fetopathology], forensic medicine, medical imaging, obstetrics and pediatrics