Tuberculin skin test positivity without tuberculosis contact: A major challenge in childhood.

AIM: Worldwide, tuberculin skin tests (TSTs) commonly give false positive results for those who had been given the Bacillus-Calmette-Guerin vaccine such as is routinely administered in Turkey. This study aimed to evaluate the patients referred to us who had positive TSTs despite lack of tuberculosis (TB) disease contacts. METHODS: Between September 2011 and September 2012, 183 patients were prospectively evaluated for differential diagnosis of TST positivity despite lack of TB disease contact. They were then followed up by us to determine an accurate diagnosis. RESULTS: Among our patients' most common symptoms indicating a need for TST were chronic cough, productive cough or sputum expectoration, and recurrent or persistent wheezing. Chest x-rays were taken of all patients, and the findings were noted. Interferon gamma release assays were performed on 75% of the patients, of which 96% were negative for TB. The most common final diagnoses were asthma (44%), allergic rhinitis (13%), bronchopneumonia (11%) and reactive lymphadenitis (6.5%). Further evaluations for TB were required of 36 patients, and TB disease was established in 12 of them (6.5%). CONCLUSIONS: In patients who had had no known TB contact, the most common symptom indicating need for TST was chronic cough; the most common diagnoses were asthma and allergic rhinitis. Cavitary lesions, haemoptysis, persistent infiltration, pleural effusion and thoracic lymphadenopathy despite antibiotherapy should alert physicians to the possibility of TB.

Nontuberculous pulmonary cavitary diseases of childhood.

We describe the demographic, clinic and radiologic features of nontuberculous cavitary pulmonary diseases in 42 patients with a mean age of 91.1±6.8 months. Infectious etiology was the most common cause (64%), including necrotizing pneumonia (n=15), ruptured hydatid cyst (n=5), lung abscess (n=5) and fungal infection (n=2). Other causes were bronchiectasis, congenital anomalies, foreign body aspiration, sarcoidosis and tumor.

Can appropriate diagnosis and treatment of childhood asthma reduce excessive antibiotic usage?

INTRODUCTION: This study compared the frequency of antibiotic usage and the number of asthma episodes before and after the diagnosis and treatment of pediatric asthma patients who were followed up by specialists. SUBJECTS AND METHODS: Included in this study were 334 patients (211 males and 123 females) of 2-16 years of age who were diagnosed with asthma and followed up for at least 1 year in our clinic. The frequency of antibiotic usage and the number of asthma episodes in the year prior to diagnosis and treatment were compared to these same variables after 1 year of follow-up by specialists. RESULTS: The median age was 84 months (range: 24-192) and 212 (63%) children were at school or in day care centers. Atopy and a family history of asthma were present in 200 (60%) of the patients, and 137 (41%) reported that at least one member of their household smoked. Antibiotics were used a median number of 7 times [interquartile range (IQR) = 6] in the year before the asthma diagnosis, and 2 times (IQR = 3) during the year after treatment (p < 0.001). The mean number of asthma episodes before diagnosis, i.e. 4 (IQR = 8) was reduced to 0 (IQR = 2) in the year after treatment when the patients were followed up by specialists (p < 0.001). CONCLUSION: This study shows that appropriate diagnosis and treatment of childhood asthma significantly reduce the frequency of antibiotic usage and the number of asthmatic episodes.

Is oxidative stress related to childhood urolithiasis?

BACKGROUND: Urolithiasis is a common condition in pediatric populations in Turkey. The role of oxidative stress in renal stone formation in pediatric patients has not been reported to date. The aim of this study was to assess oxidative stress in childhood urolithiasis. METHODS: Seventy-four children diagnosed with urolithiasis and 72 healthy control subjects were enrolled in the study. Kidney stone formers were evaluated by analysis of metabolic conditions related to urolithiasis, such as hypercalciuria, hyperoxaluria, hypocitraturia and hyperuricosuria. Urine total antioxidant status (TAS), and total oxidant status (TOS) were measured, and oxidative stress index (OSI) was calculated as an indicator of the degree of oxidative stress. RESULTS: Among the stone formers, metabolic analyses revealed that 30 % had hypercalciuria, 45 % had hypocitraturia, 6 % had hyperoxaluria and 40 % had hyperuricosuria. Elevated levels of the renal tubular damage marker urinary N-acetyl- beta-D-glucosaminidase (NAG) was elevated in 25 % of the patient group, but microalbuminuria was not detected. Total oxidant status and total antioxidant status were significantly higher in stone formers than in the controls (p = 0.023 and 0.004, respectively). In addition, urinary NAG was significantly correlated with TOS (r = 0.427, p = 0.019). CONCLUSIONS: The results of this study show that oxidative stress may play an important role in the pathogenesis of pediatric stone formers.

Pure laparoscopic management of a giant ovarian cyst in an adolescent.

PATIENT: Female, 16 FINAL DIAGNOSIS: Ovarian cyst Symptoms: - MEDICATION: - Clinical Procedure: Laparoscopic surgery Specialty: Surgery. OBJECTIVE: Rare disease. BACKGROUND: The use of the laparoscopic approach versus open approach for the management of giant ovarian cysts is controversial. Exclusion of malignant conditions has critical importance in the laparoscopic management of these cases. However, in some cases, the possibility of malignancy and the ovarian origin of a cyst cannot be excluded during the preoperative period. CASE REPORT: Herein we present the case of a 16-year-old girl with a giant ovarian cyst. The abdominal cavity was laparoscopically explored, and no signs suggestive of malignancy were encountered; the ovarian origin of the cyst was confirmed. A Veress needle was inserted percutaneously, and the cyst was drained and laparoscopically excised. No complications were encountered at follow-up visits 3 and 6 months after surgery. CONCLUSIONS: In addition to the well-known advantages of laparoscopic surgery (e.g., decreased postoperative pain, length of hospital stay, and wound infection), perfect cosmetic results are particularly important for young women. The pure laparoscopic management of giant ovarian cysts is safe and feasible.