Anxiety, depressive, and somatoform disorders in children and adolescents referred to paediatric cardiology with somatic symptoms.

INTRODUCTION: Chest pain, palpitations, and syncope are among the most common referrals to paediatric cardiology. These symptoms generally have a non-cardiac aetiology in children and adolescents. The aim of this study was to investigate the rate of common psychiatric disorders in children and adolescents referred to the paediatric cardiology clinic with chest pain, palpitations, and syncope and the relationship between cardiological symptoms and psychiatric disorders. METHODS: Children and adolescents aged 8-16 years who presented at the paediatric cardiology clinic with primary complaints of chest pain, palpitation, or syncope were included in the study. After a detailed cardiology examination, psychiatric disorders were assessed using the DSM IV-TR diagnostic criteria and a semi-structured interview scale (KSADS-PL). The Child Depression Inventory and Spielberger's State-Trait Anxiety Inventory for Children were also applied to assess the severity of anxiety and depression. RESULTS: The study participants comprised 73 (68.90%) girls and 33 (31.10%) boys with a mean age of 12.5 ± 2.4 years. Psychiatric disorders were determined in a total of 48 (45.3%) participants; 24 (38.7%) in the chest pain group, 12 (48.0%) in the palpitation group, and 12 (63.2%) in the syncope group. Cardiological disease was detected in 17% of the cases, and the total frequencies of psychiatric disorders (p = 0.045) were higher in patients with cardiological disease. CONCLUSION: It is clinically important to know that the frequency of psychiatric disorders is high in patients presenting at paediatric cardiology with chest pain, palpitations, and syncope. Physicians should be aware of patients' psychiatric problems and take a biopsychosocial approach in the evaluation of somatic symptoms.

Prolotherapy: An effective therapy for Tietze syndrome.

PURPOSE: To compare the short-term effect of prolotherapy and conservative terapy for the Tietze syndrome. PATIENTS AND METHODS: From 2013 to 2014, twenty-one patients underwent prolotherapy (group 1) and thirteen underwent conservative therapy with analgesics (group 2). A visual analogue score (VAS) was recorded for measurement of pain intensity in all patients before (Pre VAS) and after injection first day (VAS1), first week (VAS2) and fourth week (VAS3). Group 2 were received systemic nonsteroidal anti-inflammatory drug. VAS score was recorded similarly at the same times (Pre VAS, VAS1, VAS2, VAS3), and clinical affects were compared between the two groups. RESULTS: The mean VAS score (mm) before prolotherapy was 7.10 in patients who received prolotherapy, and 7.14 mm in patients who treated nonsteroidal anti-inflammatory drug. The mean VAS after the fist injection was 2.19 mm and dropped to 1.52 mm after the third injection. The mean VAS after the nonsteroidal anti-inflammatory drug treatment dropped 2.62 mm and during the same scores to 3 weeks later. There was no significant difference between the group 1 and group 2 in the age, sex and comorbidity. Also there was no significant difference between the group 1 and group 2 in clinical and radiological evidence. The prolotherapy group showed a faster recovery, including significantly reduced clinic findings (p: 0.001). Third VAS is significant finding for the prolotherapy group. CONCLUSION: Prolotherapy could be performed safely and is a method with a favorable long term treatments for Tietze Syndrome. It may be the ideal procedure for patients with drugs side effects and advers events especially for those with limited liver and kidney reserve or significant comorbidities.

Factors related with unintentional injuries in children with newly diagnosed attention-deficit/ hyperactivity disorder.

The aim of the present study was to investigate the factors associated with unintentional injury in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). One thousand four hundred and thirty children between the ages of 6 and 18 who were diagnosed with ADHD for the first time in child psychiatry outpatient clinics were included in the present study. The socio-demographic information of the children, their developmental histories, chronic physical health conditions, comorbid psychiatric disorders, and information obtained via the Turgay DSM-IV-based Child and Adolescent Disorders Screening and Rating Scale were examined retrospectively. It was determined that 12.8% of the children (n D 183) experienced unintentional injury. It was established that age, male gender, disruptive behavioural problems, and low education levels among mothers were predictive of unintentional injuries. The results of the present study suggest that behavioural problems accompanying ADHD and comorbid psychiatric disorders are important in terms of unintentional injuries.

Factors related with unintentional injuries in children with newly diagnosed attention-deficit/hyperactivity disorder.

The aim of the present study was to investigate the factors associated with unintentional injury in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). One thousand four hundred and thirty children between the ages of 6 and 18 who were diagnosed with ADHD for the first time in child psychiatry outpatient clinics were included in the present study. The socio-demographic information of the children, their developmental histories, chronic physical health conditions, comorbid psychiatric disorders, and information obtained via the Turgay DSM-IV-based Child and Adolescent Disorders Screening and Rating Scale were examined retrospectively. It was determined that 12.8% of the children (n = 183) experienced unintentional injury. It was established that age, male gender, disruptive behavioural problems, and low education levels among mothers were predictive of unintentional injuries. The results of the present study suggest that behavioural problems accompanying ADHD and comorbid psychiatric disorders are important in terms of unintentional injuries.

Pleural multicystic mesothelial proliferation that presented with hemothorax.

Pleural multicystic mesothelial proliferation is a very rare serosal pathology. In this paper, we share a pleural multicystic mesothelial proliferation case arrives the emergency service with sudden chest pain and dyspnea complaint that presented with hemothorax complication. In the literature, there is only one pleural multicystic mesothelial proliferation issue that is determined by coincidence. Even though being a rare benign pathology; pleural multicystic mesothelial proliferation can cause some vital complications as a hemothorax.

Prevelance of mental disorders and associated factors in institutionalized 3-5 year old children.

OBJECTIVE: In this study, we aimed to determine the prevelance and severity of mental disorders in institutionalized children between the ages of 3-5 years, investigate the factors associated with the mental disorders and compare these findings with the data of a community sample composed of children who were raised by their own families. METHOD: Thirty-four children raised in three institutions in Kocaeli were compared with an age- and sex-matched community sample. Children were assessed according to DSM-IV diagnostic criteria. The Socio-demographic information form, and Early Childhood Inventory-4 (ECI-4) parent scale were used for data collection. RESULTS: Children that were reared in institutions had evidence of higher rates of mental disorders. In institution-reared children, symptom severity of attention deficit hyperactivity disorder, reactive attachment disorder, oppositional deficient disorder, and pervasive developmental disorder were higher than the community subjects. Age, time spent with father, duration of institutionalization, number of siblings, number of hospital admissions because of physical symptoms and presence of abuse before institutional care were determined to be predictive factors for psychiatric symptoms. CONCLUSION: These findings revealed that institutionalized children are at risk for mental disorders and protective measures are as important as instutional care for these children. Our results suggest that essential steps should be taken to protect the mental health of children in institutional care.

Pulmonary Sequestration with Renal Aplasia and Elevated SUV Level in PET/CT.

Extralobar sequestration with other bronchopulmonary malformations is commonly seen; however, the association of extralobar sequestration with renal aplasia is very rare. A 75-year-old female patient was admitted with back pain. Ultrasonography revealed aplasia of the left kidney and tomography showed 6 × 4.5 cm sized tumor in the left hemithorax at the posterobasal area. The lesion has focally increased glycolytic activity (SUVmax: 3.2) at the left upper pole on positron emission tomography scan (PET/CT). Sequestrectomy was performed after the confirmation by frozen section that the lesion was benign and of extrapulmonary sequestration. No complication occurred during postoperative and 50-month follow-up period.

An unusual case of foreign body aspiration and review of the literature.

Tracheobronchial foreign body aspiration is a health problem that can be seen in all age groups, and it requires urgent diagnosis and intervention. We report a case of an unusual foreign body aspiration in a laryngectomized patient and we aim to discuss this situation according to the literature. A 72-year-old man, who underwent total laryngectomy 7 years ago for a squamous cell carcinoma of the larynx, was reported with complaint of aspiration of a silicone tracheostomy canula. Foreign body aspiration can present with a wide variety of symptoms. Although it is sometimes asymptomatic, mostly there exists cough, dispnea, hemoptisis and even respiratory arrest. Clinical history and radiological examinations are enough for the diagnose but in some cases, it is difficult to diagnose even by bronchoscopy. In this report, ethiology, pathogenesis, clinical presentation, diagnose and treatment of foreign body aspirations are discussed under the light of the literature. Ethiology and pathogenesis are beneficial for the assessment of treatment time and method. Appropriate and ontime clinical intervention makes the diagnosis to be easier. Treatment timing and methods are important to prevent the complications. Flexible bronchoscopy can be used for the diagnose and is preferential to remove small and fit foreign bodies. For children, for complicated cases and in order to remove penetrating or amorph-shaped bodies rigit bronchoscopy should be preferred.

Mortality and associated factors in a thoracic surgery ICU.

OBJECTIVE: To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. METHODS: We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. RESULTS: Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). CONCLUSIONS: Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.

Mortalidade e fatores associados em uma UTI de cirurgia torácica / Mortality and associated factors in a thoracic surgery ICU

OBJETIVO: Determinar a mortalidade e identificar fatores de riscos associados em pacientes em uma UTI de cirurgia torácica. MÉTODOS: Foram avaliados retrospectivamente 141 pacientes admitidos na UTI de cirurgia torácica do Hospital Estadual de Denizli, localizado na cidade de Denizli, Turquia, entre janeiro de 2006 e agosto de 2008. Foram coletados dados sobre gênero, idade, causa de admissão, intervenções invasivas e operações, status de ventilação mecânica invasiva, infecções e tempo de permanência na UTI. RESULTADOS: Dos 141 pacientes, 103 (73,0 por cento) eram do sexo masculino e 38 (23,0 por cento) do sexo feminino. A média de idade foi de 52,1 anos (variação: 12-92 anos), e a taxa de mortalidade foi de 16,3 por cento. A causa de admissão mais frequente foi trauma. A mortalidade correlacionou-se com idade avançada (p < 0,05), uso de ventilação mecânica invasiva (OR = 42,375; p < 0,05), longa permanência na UTI (p < 0,05) e causas de admissão específicas - trauma, injúria por arma de fogo, injúria por arma branca e malignidade (p < 0,05 para todos). CONCLUSÕES: Os pacientes em uma UTI de cirurgia torácica têm alta morbidade e mortalidade. Um conhecimento maior dos fatores de risco de mortalidade pode melhorar a eficiência do tratamento, resultando em diminuição da morbidade e mortalidade, o que gerará economia de tempo e reduzirá os custos financeiros.

OBJECTIVE: To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. METHODS: We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. RESULTS: Of the 141 patients, 103 (73.0 percent) were male, and 38 (23.0 percent) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3 percent. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). CONCLUSIONS: Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.

Comparison of mitomycin-c and heparin affects in experimental corrosive esophagitis on rats.

OBJECTIVE: We comparative effects of mitomycin-c and heparin which have different mechanism of action in a minimal invasive corrosive esophagitis model which was formed by NaOH 40%. METHOD: The study was performed on forty female Wistar albino rats; were divided into four equal groups each including ten animals. Group C (n=10); control, the group that esophagus was washed with normal saline, group I (n=10); injury group; alkali esophagus burn, not treated, group M (n=10); alkali esophagus burn, mitomycin-c treatment group, group H (n=10); alkali esophagus burn, heparin treatment group. The study was performed on a minimal invasive model which did not require general anesthesia and abdominal operation. In 28 day, all subjects were killed and their esophagus's were removed by thoraco-abdominal cut. Total esophagi from oropharynx to stomach were removed and they were examined macroscopically and microscopically and evaluated for esophageal tissue collagen deposition and histopathologic damage score. RESULTS: When group C is compared with each of the other groups, statistically significant weight losses were detected; [(p<0.005, p<0.05, p<0.005), respectively]. Significant inflammation increase was detected in groups I, M and H in comparison to group C [(p<0.001, p<0, 0001, p<0.005)]. When granulation scores of groups were compared; statistically significant granulation increases were detected in groups I, M, and H [(p<0.05, p<0.05, p<0.05) compared to group C]. Significant collagen increase was detected in all 3 layers in groups; I, M and H according to group C [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers in groups M and H were significantly less according to group I [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers was less in group M than group H (p<0.05). CONCLUSION: In corrosive esophagitis due to NaOH, heparin treatment is more effective in inflammation and granulation formation, mitomycin-c treatment is more effective in preventing the collagen accumulation step. Heparin decreases the tissue damage by preventing the inflammation and granulation formation; and prevents collagen accumulation and stricture development. As completing the effect of heparin; mitomycin prevents fibroblastic activity inhibition with direct collagen accumulation and stricture development strongly.

Infecções relacionadas a cateteres torácicos / Thoracic catheter-related infections

OBJETIVO: Determinar o status de colonização de uma amostra de pacientes que recebeu cateteres torácicos (CTs) e correlacionar esse status a possíveis fatores prognósticos. MÉTODOS: Estudo retrospectivo com 48 pacientes (17 mulheres e 31 homens) que receberam CTs no Departamento de Cirurgia Torácica do Hospital Universitário Adnan Menderes, localizado na cidade de Aydin, Turquia, entre dezembro de 2008 e março de 2009. Amostras de sangue para cultura foram coletadas da porção distal dos CTs e de cada um dos 48 pacientes. Procuramos por correlações entre culturas positivas e possíveis fatores prognósticos de infecção. RESULTADOS: Resultados positivos de cultura em amostras de CT ocorreram somente 3 pacientes, em sangue em 2, e nas duas amostras em outros 2. A idade avançada correlacionou-se com culturas positivas das amostras de CT e sangue (r = 0,512 e r = 0,312, respectivamente; p < 0,05), assim como o uso prolongado do CT e com culturas positivas das mesmas amostras (r = 0,347 e r = 0,372, respectivamente; p < 0,05). Houve uma correlação significativa entre o status cirúrgico dos pacientes (aqueles submetidos a cirurgias) e culturas positivas somente das amostras de CT (p < 0,05), mas a presença de malignidade inoperável correlacionou-se com o crescimento bacteriano em ambos os tipos de amostras (p < 0,05 para ambos). CONCLUSÕES: Os fatores de risco acima citados aumentam o risco de infecções. No caso de pacientes com CTs e que apresentam tais fatores de risco, é imperativo que se utilize uma profilaxia com antibióticos de amplo espectro.

OBJECTIVE: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.

Postresectional lung injury in thoracic surgery pre and intraoperative risk factors: a retrospective clinical study of a hundred forty-three cases.

INTRODUCTION: Acute respiratory dysfunction syndrome (ARDS), defined as acute hypoxemia accompanied by radiographic pulmonary infiltrates without a clearly identifiable cause, is a major cause of morbidity and mortality after pulmonary resection. The aim of the study was to determine the pre and intraoperative factors associated with ARDS after pulmonary resection retrospectively. METHODS: Patients undergoing elective pulmonary resection at Adnan Menderes University Medical Faculty Thoracic Surgery Department from January 2005 to February 2010 were included in this retrospective study. The authors collected data on demographics, relevant co-morbidities, the American Society of Anesthesiologists (ASA) Physical Status classification score, pulmonary function tests, type of operation, duration of surgery and intraoperative fluid administration (fluid therapy and blood products). The primary outcome measure was postoperative ARDS, defined as the need for continuation of mechanical ventilation for greater than 48-hours postoperatively or the need for reinstitution of mechanical ventilation after extubation. Statistical analysis was performed with Fisher exact test for categorical variables and logistic regression analysis for continuous variables. RESULTS: Of one hundred forty-three pulmonary resection patients, 11 (7.5%) developed postoperative ARDS. Alcohol abuse (p = 0.01, OR = 39.6), ASA score (p = 0.001, OR: 1257.3), resection type (p = 0.032, OR = 28.6) and fresh frozen plasma (FFP)(p = 0.027, OR = 1.4) were the factors found to be statistically significant. CONCLUSION: In the light of the current study, lung injury after lung resection has a high mortality. Preoperative and postoperative risk factor were significant predictors of postoperative lung injury.

[Minimally invasive approach in the pleural fluids]. / Plevral efüzyonlarda minimal invaziv yaklasim.

The excess production or depleted absorbtion of pleural fluid is the major mechanism of pleural effusion formation. Primary lung pathologies or pathologies that originated from the other organs can be cause of pleural effusion. The search for suitable, practical and ideal treatment is continued at the present day. We have reviewed 94 patients with pleural effusion that have been treated by 10F catheter with local anesthesia in 2007-2008. The patient with dispenea, massive effusion or reoccurrent pleural effusion have been administrated pleural catheter through 7th or 8th intercostal interspace with local anesthesia. The mean age of patients (58 male, 36 female) was 57.2 (26-94). The most common etiologic causes were primary broncho carcinoma (34 cases 36.1%), cardiac failure (11 cases 11.1%) and empyema (eight cases 9.5%). Fifty three (56.3%) have been administrated pleurodesis because of treatment failure or reoccurrence. In 19 of these cases (20.2%), pleurodesis was successful. Pleurodesis agent was talc or tetracycline according to patients pain threshold. The treatment methods of pleural effusion include thoracentesis, thoracoscopy, tube thoracostomy and catheters with permanent tunnel. The simple and small-diameter catheters are administrated easily with minimal morbidity and no mortality. It's not only used in malign effusion but also used in benign effusion. Finally, simple catheter can be first treatment choice in short-term therapy and alternative choice in long-term therapy because of it's administrating facility, effectiveness in pleurodesis and cost-effectiveness.

A rare association; pulmonary blastoma developing on extrapulmonary sequestration basis.

Pulmonary blastoma (PB) is a thoracopulmonary mesenchymal disembryogenic neoplasm which is rarely seen and generally in childhood. Pulmonary sequestration is one of the less observed congenital malformations. A 45-year-old female patient who was diagnosed with PB, histopathologically developed on atypically placed extrapulmonary sequestration in the left upper zone is presented in this study.