Dystrophic calcification of fetal myocardium: a case report.

OBJECTIVE: A diagnosis of myocardial dystrophic calcification, a rare cause of fetal cardiac masses, is presented. METHODS: The fetal echocardiography of a 26-year-old pregnant woman who was referred to the Pediatric Cardiology Department at 20 weeks' gestation revealed an echogenic mass in the post wall of the left ventricle. RESULTS: The pregnancy was terminated. The histopathology of the necropsy material revealed dystrophic calcification. CONCLUSION: The dystrophic calcification of myocardium must be kept in mind in prenatal differential diagnosis of intracardiac masses for patient management and genetic counseling.

Anomalous systemic arterial supply to normal Basal segments of the left lower lobe of the lung: therapeutic implication.

We describe a 5-month old infant who presented with a continuous murmur and enlargement of the left heart. The patient's diagnosis was an anomalous systemic arterial supply to basal segments of the left lower lobe characterized by a lack of a pulmonary arterial supply. This condition was treated without lobectomy. To our knowledge, this report is the first to describe an anomalous systemic arterial supply to basal segments of the lower lobe of the left lung with a single arterial supply that was treated in childhood without lung resection. Our case offers an alternative treatment to surgical lobectomy for this abnormality.

An echocardiographic assessment of cardiac functions and structure in children on dialysis.

BACKGROUND: Cardiovascular complications are the most important cause of mortality in end stage renal disease. The aim of this study is to evaluate systolic and diastolic functions of children with chronic renal disease. METHODS: Twenty-five children on renal replacement therapy (16 on peritoneal dialysis, 9 on hemodialysis), 10 children in chronic renal insufficiency group, and 27 healthy subjects were examined by echocardiography. RESULTS: No significant difference was observed in systolic functions between patients and controls. Left ventricular mass index was significantly higher in hemodialysis and peritoneal dialysis patients when compared with controls, where no significant difference was determined between chronic renal insufficiency group and controls. Although left ventricular mass index was tended to be higher in hemodialysis than peritoneal dialysis group, this was not significant. Peak late diastolic flow velocity (A) was significantly higher in dialysis groups when compared to controls. E/A ratios were significantly lower in dialysis groups than controls. CONCLUSION: The finding that the diastolic functions were impaired in both children on peritoneal dialysis and hemodialysis suggests that peritoneal dialysis is not superior to hemodialysis for preserving diastolic cardiac functions. Further studies with larger patient groups are needed to show long-term effects of peritoneal dialysis and hemodialysis on cardiac functions.

Myocardial noncompaction: report of three cases.

Myocardial noncompaction is a rare type of cardiomyopathy which can be an isolated entity or in association with other congenital heart diseases. We present three children with myocardial noncompaction: one male with isolated left ventricular noncompaction, another with right ventricular noncompaction and dysplastic tricuspid valve, and the last with left ventricular noncompaction, ventricular septal defect and coarctation of aorta, to stress especially the different clinical forms of the disorder and the importance of early diagnosis, as it may result in a fatal outcome.

Venous collapsibility index changes in children on dialysis.

AIM: Hypervolemia is an important factor for the development of cardiac failure in end-stage renal disease. The aims of this study are to evaluate whether collapsibility index (CI) is a useful method to assess the volume status in children on haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and to test whether the small amounts of fluid removed after a single dialysis exchange will be reflected by a change in CI in peritoneal dialysis patients. METHODS: Sixteen CAPD, nine HD patients aged from 5 to 18 years and 27 age- and sex-matched healthy children were enrolled in the study. Inferior vena cava diameters were measured from subxiphoidal long axis position in 2 cm to its junction to right atrium and CI were calculated. RESULTS: The collapsibility index was significantly lower in HD patients before HD and in the CAPD group before dialysate exchange when compared with the controls. No significant difference was found between the CAPD and HD groups. We observed significant increase in CI after HD, CI values reached nearly to control levels after HD. Ultrafiltrate was 1.93 +/- 0.98 kg in HD, 0.23 +/- 0.09 kg in the CAPD group. Although the change in CI values before and after dialysate exchange was significant in the CAPD group, there was still a significant difference between the CI values of the control group and the CAPD patients after dialysate exchange. CONCLUSION: We suggest that serial measurements of CI in children will be a useful guide to assess the volume changes in an individual instead of a single measurement.

Rheumatic heart disease and coronary vasculitis in children.

UNLABELLED: Rheumatic fever is a systemic inflammatory disease which may also cause vasculitis in multiple organ systems. CONCLUSION: Two children with rheumatic mitral valve disease and mitral valve replacement developed myocardial ischaemia due to coronary vasculitis. One of them had neurological findings that may be attributed to cerebral vasculitis.

Pulmonary tuberculosis and cutaneous mycobacterial infection in a patient with incontinentia pigmenti.

Lupus vulgaris is reinfection tuberculosis of the skin and may result from direct extension, or hematogenous or lymphatic spread from a tuberculosis focus. Lupus vulgaris following bacille Calmette-Guerin (BCG) vaccination is a rare entity. Incontinentia pigmenti is an X-linked dominant genodermatosis in which vesicular, verrucous, and pigmented lesions are associated with various developmental defects. There is evidence of altered immunologic reactivity in some patients with incontinentia pigmenti. A 12-year-old girl hospitalized for pulmonary tuberculosis presented with bizarre-shaped brown macules following Blaschko lines on the left deltoid area, compatible with incontinentia pigmenti, which had appeared following BCG vaccination at the age of 7 years. Histopathologic examination found noncaseated granulomas in the dermis. Antituberculous treatment for pulmonary and cutaneous tuberculosis was initiated along with genetic counseling. Immunologic abnormalities have been reported in conjunction with incontinentia pigmenti. Simultaneous occurrence of pulmonary and cutaneous tuberculosis in our patient might be either coincidental or indicate derangements in the cellular immune system.

Ciprofloxacin treatment in newborns with multi-drug-resistant nosocomial Pseudomonas infections.

OBJECTIVES: To evaluate the efficacy and acute side effects of ciprofloxacin treatment in newborns who developed nosocomial Pseudomonas aeruginosa infection. METHODS: Intravenous ciprofloxacin treatment was given to 30 newborns who developed nosocomial P. aeruginosa infection as proven by culture antibiogram results. Initial doses of 10 mg/kg/day were given and increased up to 40 mg/kg/day according to clinical response, laboratory and culture results. During therapy, complete white blood cell counts, urinalysis, liver and renal function tests were performed weekly. All patients were examined daily during treatment for possible symptoms of joint toxicity such as erythema and swelling. The patients were evaluated by general physical examination, with special attention to joints, 1 week after discharge. RESULTS: Two of the patients (6.6%) died due to pseudomonas infection, but the bacteria were successfully eradicated in 28 patients (93.4%). Four patients died from other causes. No laboratory abnormality related to ciprofloxacin was observed during treatment. Swelling and hyperemia of the joints were not encountered during treatment and the 1-week period after discharge. Ciprofloxacin-resistant P. aeruginosa isolates were not grown during the study. CONCLUSION: Ciprofloxacin treatment is effective in life-threatening multi-drug-resistant P. aeruginosa infections.