Serum Basic Fibroblastic Growth Factor Levels in Children with Infantile Hemangioma.

OBJECTIVES: To determine serum levels of basic fibroblastic growth factor (b-FGF) in hemangioma patients under 2 y of age. METHODS: The study group consisted of 43 children with infantile hemangioma and b-FGF levels were analyzed using ELISA. RESULTS: The serum b-FGF levels were higher in hemangioma patients than in healthy control individuals (p 0.01). There were no differences between the lesion size, number of lesions, patient age and serum b-FGF levels. CONCLUSIONS: Thus, b-FGF is an important growth factor that plays a central role in hemangioma, but determining b-FGF serum levels was not helpful in distinguishing between patients who require treatment and those who do not.

Clinical and laboratory findings of pigmented purpuric dermatoses.

BACKGROUND: Pigmented purpuric dermatoses (PPD) are chronic, recurrent group of disorders characterized by petechial and pigmentary macules usually localized on the lower limbs. Its etiopathogenesis is unknown. There are very few clinical and etiological studies on PPD in the literature. OBJECTIVE: We aim to examine the etiopathogenetic factors of PPD retrospectively. METHODS: Demographic characteristics, history of co-morbid disorders and drug usage, hepatitis markers, levels of serum lipids, findings of Doppler ultrasonography in lower extremities, and patch test results of the 24 patients of PPD were examined retrospectively. The patch test results, history of drug use, and co-morbid disorders of the patients were compared with those of the control groups. RESULTS: The male-to-female ratio was 1 : 2, and 83.3% of the patients had Schamberg disease. Seventeen patients had co-morbid disorders and 16 used various drugs, but there was no statistically significant difference between the controls and patients. One patient was positive for hepatitis B surface antigen and 1, for anti-hepatitis C virus antibody. Nine had elevated total cholesterol levels, and 5 had elevated triglyceride levels. Further, 30% of them were positive for at least 1 allergen, while 16% of the control subjects were positive for at least 1 allergen, but statistically significant difference was not found between the 2 groups. Variable degrees of venous insufficiency were detected in 75% of the patients on Doppler ultrasonography of the lower extremities. CONCLUSION: Venous insufficiency and hypercholesterolemia might be the basic predisposing factors for PPD. Further studies are needed to show if diabetes mellitus and hypertension may cause perivascular inflammation in PPD.

Comparison of corneal curvature and anterior chamber depth measurements using the manual keratometer, Lenstar LS 900 and the Pentacam.

PURPOSE: The purpose of this study was to compare keratometry and anterior chamber depth (ACD) measurements from the Lenstar LS 900 (Haag-Streit AG, Switzerland) and the Pentacam (Oculus, Weltzar, Germany), and compare the keratometry readings of these two systems to a manual keratometer (MK), (Haag-Streit, Switzerland). MATERIALS AND METHODS: In this prospective study, keratometry and ACD measurements were obtained in 50 eyes of 50 normal subjects with the Lenstar and the Pentacam. Keratometry was also measured using a MK. Correlation, comparison, and interdevice agreement was evaluated using intraclass correlation analysis, Wilcoxon test, and Bland-Altman plots. RESULTS: The keratometry and ACD measurements obtained from the Lenstar and the Pentacam showed excellent correlation. The mean interdevice differences in mean keratometry (Km) for the Lenstar and the Pentacam, the Lenstar and the MK, and the Pentacam and the MK were 0.39 D, 0.10 D, and 0.30 D respectively; and the 95% limits of agreement (LoA) for Km were 0.04-0.82 D; -1.90-2.10 D; and -2.30-1.70 D, respectively. The mean interdevice difference in ACD for the Lenstar versus the Pentacam was 0.09 mm, with 95% LoA of 0.23-0.05 mm. CONCLUSIONS: The ACD measurements obtained using the Lenstar and the Pentacam seem to be interchangeable, whereas, the keratometry measurements obtained using the Lenstar, Pentacam, and MK differ considerably, and are not interchangeable.

Reference values of serum cystatin C in very low-birthweight premature infants.

AIM: To determine reference values for cystatin C (CysC) and its correlation with creatinine (Cr), gestational age, birthweight and maternal Cr status in very low-birthweight (VLBW) preterm infants. METHOD: The study included 113 VLBW premature infants (<1500 g) of ≤ 32 gestational week. Serum Cr and CysC of the infant and serum Cr of the mother were analysed. RESULTS: The mean level of CysC was 1.77 ± 0.38 mg/L on day 1 and 1.61 ± 0.37 mg/L on day 3, and the decrease was statistically significant. There was a significant correlation only between maternal Cr and first-day Cr values and negative correlations between Cr and gestational age and birthweight on third day. Creatinine was not correlated with CysC both on day 1 (r = -0.077, p = 0.417) and day 3 (r = 0.132, p = 0.164). CONCLUSION: Here, we report the reference ranges for CysC and Cr on first and third day in VLBW infants. CysC concentrations significantly decrease by day 3 compared with day 1 and are independent of gestational week, birthweight and maternal renal function status in VLBW preterm infants.

Fecal calprotectin levels are increased in infants with necrotizing enterocolitis.

OBJECTIVE: To investigate the value of fecal calprotectin in diagnosis and predicting severity of necrotizing enterocolitis (NEC) in preterm infants. METHODS: A prospective controlled study was conducted including preterm infants with stage 2 to 3 NEC, and birth weight and gestational age-matched controls. Fecal samples were obtained both at the time of NEC diagnosis and 3-5 days later from the patients, and at similar postnatal age from controls. RESULTS: Twenty-five infants with stage 2 to 3 NEC and 25 controls were enrolled. Median fecal calprotectin concentrations were 1,282 and 365 µg/g at diagnosis in infants with NEC and controls, respectively. Fecal calprotectin levels of infants with NEC were significantly higher than those of the control group both in the first and second samples. Although the fecal calprotectin levels gradually decreased from the time of diagnosis to the second sampling time in stage 2 NEC, in stage 3 NEC fecal calprotectin concentrations increased to a higher level. A fecal calprotectin value of 792 µg/g was found to be 76% sensitive and 92% specific for the diagnosis of definite NEC. CONCLUSION: Fecal calprotectin increases in infants with NEC and serial measurements may be useful as a noninvasive prognostic marker for progression of disease.

Automated determination of neutrophil VCS parameters in diagnosis and treatment efficacy of neonatal sepsis.

INTRODUCTION: The Coulter LH780 hematology analyzer can evaluate mean neutrophil volume (MNV), conductivity (MNC), scatter (MNS), and distribution width (DW). We sought to investigate the value of volume, conductivity, and scatter (VCS) parameters in diagnosis and treatment efficacy of neonatal sepsis. RESULTS: We observed significant increases in MNV, volume distribution width (VDW), conductivity distribution width (CDW), and significant decreases in MNC and MNS in septic newborns. There were significant decreases in MNV, VDW, and CDW, whereas MNC and MNS increased at the end of the treatment. Gram-negative sepsis caused higher MNV and VDW than Gram-positive sepsis. DISCUSSION: This is the largest reported study seeking to determine cutoff levels of neutrophil VCS parameters in diagnosis of sepsis, and the first study in the evaluation of treatment efficacy and the effects of sepsis onset time and birth weight. We suggest that neutrophil VCS parameters and their DWs are useful both for early diagnosis and evaluation of treatment efficacy in neonatal sepsis without requirement for any extra blood collection. METHODS: Peripheral blood samples from 304 newborns, 206 in group I (76 proven and 130 clinical sepsis) and 98 in group II (control group), were studied on diagnosis, 3rd day, and at the end of the treatment.

Comparison of stored umbilical cord blood and adult donor blood: transfusion feasibility.

OBJECTIVE: This study aimed to compare the storage properties of red blood cell (RBC) concentrates of umbilical cordblood (UCB) and adult donor blood (ADB), and to evaluate the feasibility of UCB-RBC concentrate as an autologoussource for blood transfusion in very low birth weight (VLBW) preterm neonates. MATERIAL AND METHODS: In all, 30 newborn (10 preterm, 20 full term) UCB and 31 ADB units were collected.RBC concentrates were stored and compared with regard to pH, potassium (K(+)), 2,3-biphosphoglycerate (2-3-BPG),adenosine tri-phosphate (ATP), plasma Hb, and bacterial contamination on d 1, 21, and 35 of storage. RESULTS: The K(+) level increased with time and differed significantly between storage d 1 and 21, and between storaged 1 and 35 in both the UCB and ADB units. Initial and d 21 K(+) levels were higher in the UCB units than in the ADBunits. The 2,3-BPG level did not differ significantly between the UCB-PRC and ADB-PRC samples. After 35 d of storageboth UCB-PRC and ADB-PRC samples exhibited significant differences from the initial free Hb, intracellular ATP, andpH values. Significant differences in intracellular ATP and pH were also observed between the UCB-PRC and ADB-PRCsamples. CONCLUSION: The volume of harvested and prepared UCB-PRC can be used for some of the blood transfusions requiredduring the neonatal period and thus may decrease the number of allogeneic transfusions, especially in preterm newborns.The hematological and biochemical changes that occurred in UCB during storage were comparable with those observedin ADB, and do not pose a risk to the immature metabolism of neonates. UCB-RPC prepared and stored under standardconditions can be a safe alternative RBC source for transfusions in VLBW newborns.

Relationship between levels of serum creatinine and perirenal hyperintensity on heavily T2-weighted MR images.

OBJECTIVE: To determine the frequency of perirenal hyperintensity on heavily T2-weighted images and to evaluate its relationship with serum creatinine levels. SUBJECTS AND METHODS: Axial and coronal single-shot fast spin-echo images which have been originally obtained for MR cholangiopancreatography in 150 subjects were examined by two observers individually for the presence of perirenal hyperintensity. The morphologic properties of perirenal hyperintensity (peripheral rim-like, discontinuous, polar) were recorded. Chi square test was used to test whether the frequencies of bilateral perirenal hyperintensity differ significantly in subjects with high serum creatinine levels and those with normal creatinine levels. This test was also used to compare the frequencies of perirenal hyperintensity in patients with and without renal cysts and in patients with and without corticomedullary differentiation. A p value of less than 0.05 was considered to be statistically significant. RESULTS: The perirenal hyperintensity was identified in 40 of 150 cases (26.6%) on heavily T2-weighted image. Serum creatinine levels were high in 18 of 150 cases (12%). The perirenal hyperintensity was present in 11 of 18 subjects (61%) with high serum creatinine levels and 26 of 132 subjects (19.7%) with normal creatinine levels. The difference of rates in two groups was statistically significant. Odds ratio was 6407 (95% confidence interval 2264 -18,129) . The frequency of perirenal hyperintensity was also significantly higher in subjects with renal cyst or cysts in whom serum creatinine levels were normal (p<0.05) (37.5% vs. 11.8%). CONCLUSION: Perirenal hyperintensities are more frequent in patients with high serum creatinine levels. They are also more common in patients with simple renal cysts.

What are the cut-off levels for IL-6 and CRP in neonatal sepsis?

Neonatal sepsis, characterized by systemic signs of infection in the first month of life, remains an important clinical syndrome. Despite advances in neonatology, it has high rates of mortality and morbidity. The combine or alone usage of interleukin-6 (IL-6) and C-reactive protein (CRP) has recently been proven to be useful in the early diagnosis of sepsis in newborns. The study included 282 patients; there were 232 in Group I (170 proven and 62 clinical sepsis) and 50 in Group II (control group). The optimum cut-off value in the diagnosis of neonatal sepsis was found to be 24.65 pg/ml for IL-6 and 4.82 mg/l for CRP. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this IL-6 cut-off for neonatal sepsis were 72, 84, 95, and 42%, respectively. Sensitivity, specificity, PPV, and NPV of the CRP cut-off for neonatal sepsis were 67, 97, 99, and 39%, respectively. The combination of IL-6 (>24.65 pg/ml) and CRP (>4.82 mg/l) in the diagnosis of neonatal sepsis gave sensitivity, specificity, PPV, and NPV of 53, 100, 100, and 33%, respectively. To our knowledge, this is the largest reported study seeking to determine cut-off levels for IL-6 and CRP in the diagnosis of neonatal sepsis. In conclusion, we think that it is useful to evaluate IL-6 and CRP, in combination, for the early diagnosis of neonatal sepsis.

Utility of ApoB/ApoA1 ratio for the prediction of cardiovascular risk in children with metabolic syndrome.

OBJECTIVE: To assess whether apoB/apoA1 ratio is associated or not with metabolic syndrome in obese children. METHODS: A 198 obese children and 41 healthy control subjects were enrolled in a cross-sectional study. The apoB/apoA1 ratio and other metabolic syndrome components in obese children with/without metabolic syndrome were compared to healthy controls. RESULTS: The apoA1 level did not show significant difference (p = 0.664) but apoB level (p = 0.000) and apoB/apoA1 ratio (p = 0.001) were significantly higher in obese group than in control group. Also, the apoB/apoA1 ratio was significantly higher in obese children with metabolic syndrome when compared to obese children without metabolic syndrome (p = 0.007) and showed positive correlation with triglyceride (r = 0.404, p = 0.000) and negative correlation with high-density lipoprotein cholesterol (r = -0.593, p = 0.000). CONCLUSIONS: The apoB/apoA1 ratio is associated with metabolic syndrome in obese children. An elevated apoB/apoA1 ratio may constitute an important feature of the metabolic syndrome. There is a need for long term follow-up studies concerning cardiovascular risk in obese children with metabolic syndrome and high apoB/apoA1 ratio.

Prospective evaluation of acute and chronic renal function in children following matched related donor hematopoietic stem cell transplantation.

Acute and chronic renal impairment are important complications after HSCT. A prospective study was conducted to investigate the glomerular renal function in children who received allogeneic HSCT from matched related donors. Non-radiation conditioning regimens were used in all but one patient. CrCl and serial measurements of serum creatinine were evaluated prior to HSCT, within the first 100 days and one yr after. AKI was defined as at least a 1.5-fold rise in pre-HSCT serum creatinine within the first 100 days and classified as grade 1 to 3 according to the new definition criteria proposed by "AKI Network." Fifty-seven patients were enrolled in the study and 24 patients (42%) had AKI. CsA, amphotericin B, and SOS were found as risk factors for AKI. One yr after HSCT five patients (10%) had CKD and none of them required dialysis. None of the parameters were found as a predictor for CKD. We conclude that AKI is an important complication of HSCT. Careful monitoring of renal function, minimizing the use of nephrotoxic medication, prophylaxis, and effective treatment of SOS might be effective preventive measures to decrease the incidence of AKI.

Aflatoxin exposure in viral hepatitis patients in Turkey.

BACKGROUND/AIMS: Hepatocellular carcinoma is the fifth most common cancer and a major public health problem worldwide. Differences in distribution of hepatocellular carcinoma incidence are probably due to different levels of exposure to hepatocellular carcinoma risk factors: chronic infections with hepatitis B virus (HBV) and aflatoxin exposure in developing countries, and smoking and alcohol abuse in developed countries. Aflatoxin is one of the most important of the environmental toxins that contribute to the pathogenesis of hepatocellular carcinoma, especially in the regions where dietary foodstuffs (peanuts, corn, Brazil nuts, pistachios, spices and figs) are highly contaminated. High aflatoxin levels have been shown in the foodstuffs that are produced in our country. The specific aim of this study was to assess the rate of aflatoxin exposure and to determine some clues about aflatoxin metabolism by measuring and comparing the levels of carcinogenic forms in healthy subjects, in different stages of viral disease, and in different viral hepatitis types. METHODS: This was a cross-sectional observational, single-center study. A total of 203 (male/female: 119/84) viral hepatitis patients who were consecutively admitted to Ankara University, School of Medicine, Gastroenterology Clinic, between January 2006 and June 2007 were enrolled into the study. Sixty-two healthy subjects (male/female: 33/29) with normal blood chemistry and negative viral serology served as controls. Chemical forms AFB1, AFB2, AFG1, and AFG2 were assessed in plasma of study participants by high-performance liquid chromatography. RESULTS: AFB1, AFB2, AFG1, and AFG2 were detected in 24.6%, 17.2%, 22.7%, 18.2% of the 203 patients, respectively, and were significantly higher than in the control group for all chemical forms. Percentage of AFB1-positive patients was significantly higher than in the control group irrespective of disease stage. There was no significant difference between chronic infected patients, cirrhotic patients and patients with Hepatocellular carcinoma with respect to percentage of aflatoxin-positive individuals. CONCLUSIONS: With this study, we have documented that in viral hepatitis patients, aflatoxin exposure is significantly higher than in healthy subjects in Turkey and it may play an important role in the development of hepatocellular carcinoma. Thus, large studies exploring the relation between aflatoxin exposure, viral hepatitis status, and risk of hepatocellular carcinoma development are needed.

Non-alcoholic steatohepatitis with normal aminotransferase values.

AIM: To investigate the aspects of liver histology in patients with non-alcoholic steatohepatitis (NASH) who had normal aminotransferase levels. METHODS: Thirty-four patients diagnosed with liver steatosis by ultrasonographic examination participated in the study. We compared all non-alcoholic fatty liver disease and NASH cases, according to aminotransferase level, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio and presence of metabolic syndrome. RESULTS: Sixteen of 25 patients with high aminotransferase levels were diagnosed with NASH and nine with simple fatty liver according to liver histology. Among the nine patients with normal aminotransferase levels, seven had NASH and two had simple fatty liver. The patients with normal and high liver enzyme levels had almost the same prevalence of NASH and metabolic syndrome. Liver histology did not reveal any difference according to aminotransferase levels and AST/ALT ratio. CONCLUSION: Aminotransferase levels and AST/ALT ratio do not seem to be reliable predictors for NASH. Despite numerous non-invasive biomarkers, all patients with fatty liver should undergo liver biopsy.

Liver histology according to the presence of metabolic syndrome in nonalcoholic fatty liver disease cases.

AIM: To investigate the histologic features of the liver in nonalcoholic fatty liver disease (NAFLD) cases according to the presence of metabolic syndrome or its individual components. METHODS: We enrolled 81 patients (40 male, 41 female) who were diagnosed with fatty liver by ultrasonographic scan and fulfilled the inclusion criteria. First anamnesis, anthropometric, clinical, laboratory and imaging features of all participants were recorded and then liver biopsy was performed after gaining consent from patients. Diagnosis of metabolic syndrome was dependent on patients having 3 or more out of 5 risk criteria defined by the WHO. Biopsy specimens were assessed according to Brunt et al's classification. RESULTS: Sixty-nine of the 81 patients had nonalcoholic steatohepatitis (NASH), 11 had simple fatty liver and 1 had cirrhosis according to histologic evaluation. Comparisons were made between two groups of NASH patients, those with and without metabolic syndrome. We did not detect statistically significant differences in liver histology between NASH patients with and without metabolic syndrome. CONCLUSION: NASH can progress without metabolic risk factors or the presence of metabolic syndrome.

[Prognostic value of serum TNF-alpha, IL-10, leptin and CRP levels in newborns with septicemia]. / Sepsisli yenidoganlarda serum TNF-alpha, IL-10, leptin ve CRP düzeylerinin prognostik degeri.

This study was aimed to investigate the prognostic value of tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), leptin and C-reactive protein (CRP) levels in newborn sepsis. A total of 57 newborns with nosocomial sepsis and 30 healthy newborns were included to the study. Serum TNF-alpha, IL-10, leptin (Biosource, Belgium) and CRP (Dade Behring, Germany) levels were investigated by ELISA methodology before the initiation of the therapy (day 0) and on the third and fifth days of therapy. Initial leptin levels were found to be high in the control group (p = 0.00) and CRP levels were found to be high in the patient group (p = 0.00). No significant difference was detected for IL-10 and TNF-alpha levels (p > 0.05). CRP levels were significantly higher in the patient group than the controls on the third day of the therapy (p = 0.001), however, no significant difference was detected for the other parameters (p > 0.05). On the fifth day of the therapy CRP (p = 0.023) and leptin (p = 0.00) levels were significantly high in the patient group and TNF-alpha in the control group (p = 0.00) while no significant difference was observed for IL-10 levels (p > 0.05). Mortality rate was 24.5%. When the mean TNF-alpha, IL-10, leptin and CRP levels on the 0th, 3rd and 5th days were analysed for alive (n = 43) and dead (n = 14) newborns with sepsis, it was observed that TNF-alpha, IL-10 and CRP levels were related with poor prognosis (p < 0.05). The ROC analysis performed for the determination of the prognostic performance of TNF-alpha and IL-10 revealed that these parameters had predictive value about mortality when their levels were above certain cut-off values (on the 5th day of therapy for IL-10 > 1.8 ng/ml and for TNF-alpha > 21.1 ng/ml). It can be concluded that besides routine laboratory parameters, serum TNF-alpha and IL-10 levels at the initiation of therapy and afterwards may help to predict prognosis and guide treatment in newborns with sepsis.

Evaluating sub-clinical cognitive dysfunction and event-related potentials (P300) in clinically isolated syndrome.

OBJECTIVE: This study investigated the presence of sub-clinical cognitive dysfunction in patients with clinically isolated syndrome (CIS) and the abnormalities of cognitive event-related potentials (ERPs). METHODS: Subclinical cognitive dysfunction was assessed in 20 patients with CIS and in 20 healthy controls. RESULTS: Patients had impairments in verbal learning and long-term memory, evaluating attention, executive function and visuospatial skills, in decreasing order of frequency. SDLT and SIT were the most, and COWAT and BNT were the least affected tests. The N200 and P200 latencies were prolonged, and N100, N200 and P200 amplitudes were reduced in the patients relative to the controls, from the Fz, Cz and Pz electrode positions (p<0.05). CONCLUSION: Detailed cognitive testing is valuable in determining subclinical cognitive dysfunction in CIS patients. ERP abnormalities as well as abnormalities in detailed cognitivetesting in patients with CIS are helpful in the diagnosis of sub-clinical cognitive dysfunction.