A rare central nervous system tumor of childhood with spongiform appearance on brain magnetic resonance imaging; primary diffuse leptomeningeal oligodendrogliomatosis / Un raro tumor del sistema nervioso central de la infancia con apariencia espongiforme en la resonancia magnética cerebral; oligodendrogliomatosis leptomeníngea difusa primaria

Primary diffuse leptomeningeal oligodendrogliomatosis is a rare fatal tumor of childhood. Symptoms usually occur when the tumor causes hydrocephalus. Brain magnetic resonance imaging (MRI) may be nearly normal in the early stages of the disease, while hydrocephalus and multiple leptomeningeal cysts with spongiform appearance may appear later on. One may consider the diagnosis when radiologic findings become apparent with multiple leptomeningeal cysts. However, failure to recognize the imaging findings due to the rarity of the disease may delay the diagnosis. Here, we report a 3.5-year-old girl who presented with ataxia and vomiting and had a diagnosis of primary diffuse leptomeningeal glioneuronal tumor with remarkable brain MRI findings as diffuse multiple tiny cystic lesions on the brain and spinal cord. She benefited from radiotherapy and temozolomide treatment with remission of brain MRI findings. Increasing the number of reported cases will enable the elucidation of the disease's pathogenesis and the development of treatment protocol (AU)

La oligodendrogliomatosis leptomeníngea difusa primaria es un tumor fatal infrecuente de la infancia. Los síntomas generalmente ocurren cuando este causa hidrocefalia. La resonancia magnética (RM) cerebral puede ser casi normal en las primeras etapas de la enfermedad, mientras que la hidrocefalia y múltiples quistes leptomeníngeos con apariencia espongiforme pueden aparecer más adelante. Se puede considerar el diagnóstico cuando los hallazgos radiológicos se hacen visibles con la aparición de varios quistes leptomeníngeos. Sin embargo, el hecho de no reconocer estas evidencias en las imágenes debido a la rareza de la enfermedad puede retrasar el diagnóstico. Aquí, presentamos el caso de una niña de 3,5 años con ataxia y vómitos que tenía un diagnóstico de tumor glioneuronal leptomeníngeo difuso primario con muchas lesiones quísticas diminutas difusas en el cerebro y en la médula espinal observadas en la RM cerebral. La paciente se benefició del tratamiento con radioterapia y temozolomida con remisión de los hallazgos de la RM cerebral. El aumento del número de casos notificados permitirá dilucidar la patogénesis de la enfermedad y desarrollar protocolos de tratamiento (AU)

Sugammadex Improves Neuromuscular Function in Patients Receiving Perioperative Steroids.

CONTEXT: Sugammadex has steroid-encapsulating effect. AIM: This study was undertaken to assess whether the clinical efficacy of sugammadex was altered by the administration of steroids. SETTING AND DESIGN: Sixty patients between 18 and 60 years of age with the American Society of Anesthesiologists I-IV and undergoing elective direct laryngoscopy/biopsy were included in this study. MATERIALS AND METHODS: Patients were assigned to two groups based on the intraoperative steroid use: those who received steroid (Group S) and who did not (Group C). After standard general anesthesia, patients were monitored with the train of four (TOF) monitoring. The preferred steroid and its dose, timing of steroid administration, and TOF value before and after sugammadex as well as the time to recovery (TOF of 0.9) were recorded. STATISTICAL ANALYSIS USED: SPSS software version 17.0 was used for statistical analysis. RESULTS: There is no statistically significant difference between groups in terms of age, gender, preoperative medication use, and TOF ratio just before administering sugammadex. The reached time to TOF 0.9 after sugammadex administration was significantly shorter in Group S than Group C (P < 0.05). A within-group comparison in Group S showed no difference in TOF ratio immediately before sugammadex as well as the dose of sugammadex in those who received prednisolone; time to TOF 0.9 was higher in prednisolone receivers as compared to dexamethasone receivers (P < 0.05). CONCLUSION: In patients receiving steroids, and particularly dexamethasone, an earlier reversal of neuromuscular block by sugammadex was found, in contrast with what one expect. Further studies are required to determine the cause of this effect which is probably due to a potential interaction between sugammadex and steroids.

Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey

Objectives: The aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey. Methods: The study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing. Results: The prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR = 2.5, 95% CI: 1.3-4.7, p = 0.004), dampness at home (OR = 2.4, 95% CI: 1.2-4.8, p = 0.008), a history of intestinal parasites (OR = 4.3, 95% CI: 1.7-10.9, p = 0.002), previous history of pneumonia (OR = 6.9, 95% CI: 1.9-25.9, p = 0.004), initiation of complementary foods before the age of three months (OR = 6.1, 95%CI: 1.4-26.9, p = 0.02) and presence of food allergy (OR = 3.1, 95% CI: 1.1-9.2, p = 0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR=5.2, 95% CI: 0.9-28.7, p = 0.05) and high serum IgE levels (OR = 2.9, 95% CI: 0.9-9.0, p = 0.05) at borderline significance. Conclusion: Our study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors (AU)

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Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey.

OBJECTIVES: The aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey. METHODS: The study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing. RESULTS: The prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR=2.5, 95% CI: 1.3-4.7, p=0.004), dampness at home (OR=2.4, 95% CI: 1.2-4.8, p=0.008), a history of intestinal parasites (OR=4.3, 95% CI: 1.7-10.9, p=0.002), previous history of pneumonia (OR=6.9, 95% CI: 1.9-25.9, p=0.004), initiation of complementary foods before the age of three months (OR=6.1, 95%CI: 1.4-26.9, p=0.02) and presence of food allergy (OR=3.1, 95% CI: 1.1-9.2, p=0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR=5.2, 95% CI: 0.9-28.7, p=0.05) and high serum IgE levels (OR=2.9, 95% CI: 0.9-9.0, p=0.05) at borderline significance. CONCLUSION: Our study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.

Efficacy of a casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste in preventing white spot lesions in patients with fixed orthodontic appliances: A prospective clinical trial.

AIM: The aim of this prospective study was to test the efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste applied in-office to prevent white spot lesions (WSL) in patients undergoing fixed orthodontic treatment. MATERIALS AND METHODS: Study design: this study was designed as a randomised controlled clinical trial. Fifty-seven patients undergoing nonextraction fixed orthodontic treatment were enrolled and divided randomly into two groups (control n = 28, experimental n = 29). The pretreatment plaque, gingival and bleeding indices, and oral hygiene habits were recorded. One group received CPP-ACP paste (GC Tooth Mousse) at each monthly orthodontic follow-up examination; the control group received routine orthodontic treatment. The mean patient age was 16.9 years in the experimental group and 17.1 years in the control group. The periodontal indices, decayed, missing, and filled teeth (DMFT), decayed, missing, and filled surfaces (DMFS), and the WSL prevalence pre- and post-treatment were measured and compared between the groups. STATISTICS: differences between groups in normally distributed data between groups were assessed by the paired-t test, and the Wilcoxon Signed Rank test was used to compare variables that were not normally distributed. RESULTS: There was a lower incidence of WSL in the experimental group compared to the control group. Most of the WSL occurred at the maxillary incisors, mandibular canines and premolars. CONCLUSION: The in-office application of CPP-ACP paste did not prevent WSL development completely; however, it did significantly decrease the number of WSL compared to the control patients.

Evaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery.

BACKGROUND: Following maternal administration, local anesthetics pass into breast milk. In the present study, we aimed to compare the passage of levobupivacaine and bupivacaine into breast milk following epidural anesthesia for cesarean delivery. METHODS: A total of 20 women undergoing elective cesarean delivery under epidural anesthesia were randomized to receive either 0.5% levobupivacaine or 0.5% racemic bupivacaine via an epidural catheter. Immediately before and 30min, 1h, 2h, 6h, 12h and 24h after administration of epidural local anesthetic, maternal blood and breast milk samples were taken simultaneously. Drug concentrations in plasma and milk were determined via high-performance liquid chromatography. The infant's drug exposure was determined by calculating milk/plasma ratios of levobupivacaine and bupivacaine. RESULTS: Both levobupivacaine and bupivacaine were detected in breast milk 30min after epidural administration. Concentrations of both agents showed constant and similar decreases in milk and plasma and were nearly undetectable at 24h. The milk/plasma ratios were 0.34±0.13 for levobupivacaine and 0.37±0.14 for bupivacaine. CONCLUSIONS: Both levobupivacaine and bupivacaine pass into breast milk following epidural administration. The concentration of both drugs was approximately three times lower in breast milk than in maternal plasma.