Kasabach-Merrit syndrome in infants.

METHODS: Four infants with Kasabach-Merrit syndrome syndrome have been treated at the University Hospital, Trabzon. They had large varied-site cutaneous hemangiomas. Diagnosis was performed with clinical and laboratory studies. All patients has severe thrombocytopenia and anemia. Fibrinogen and fibrin split products were examined in two patients and lower fibrinogen and over fibrin split products levels were detected in them. All patients were admitted to the intensive care unit and they were treated with antibiotics, fresh blood transfusion and thrombocyte suspension. Two out of four patients were previously treated with steroids unsuccessfully and one patient died due to disseminated intravascular coagulopathy. Three patients were treated with interferon alfa-2a and compression. RESULTS: In two patients the lesions regressed 60-80% following the five months therapy and in the other patient the lesion was completely excised after one month therapy. CONCLUSIONS: Interferon alfa-2a and compression were found to be remarkably effective in the treatment of Kasabach-Merrit syndrome.

Empyema in children.

Empyemas develop following bacterial pneumonias, thoracic trauma and surgery which are still among the common diseases, causing illness and death throughout the developing world. With the advent of potent antibiotics the mortality of empyema has been drastically reduced. In this study 52 patients (29 boys and 23 girls) with thoracic empyema were evaluated retrospectively. In this series the causes of empyema were postpneumonic in 50 patients, esophageal anastomotic leak in one patient, and thoracic trauma in one patient. The diagnosis was suspected clinically and by the finding of a pleural effusion on chest roentgenogram. Definitive diagnosis was confirmed by pleural aspiration which pus was obtained. Responsible organisms included; Staphylococcus aureus, Streptococcus pneumonia, Haemophilus influenza, pseudomonas, and Klebsiella. The most common is Staphylococcus aureus. The patients were treated in various ways; 14 patients were treated with antibiotics and thoracentesis, 38 patients were treated with a closed tube thoracostomy. Eight of 38 patients had the chest tube converted to an open empyema tubes for long term management. Fourteen of 38 patients developed abcess formation. Nine of 14 patients were treated with computed tomography guided catheter placement, five patients encountered thoracotomy and decortication. In this article, appropriate treatment and result of long-term follow-up of empyema were evaluated.

A new treatment with bleomycin for complicated cutaneous hemangioma in children.

Cutaneous hemangiomas are the most common tumors of infants and children. Although they frequently resolve spontaneously, approximately 5% produce complications such as bleeding, infection, consumption coagulopathy and unesthetic appearance. Various methods of treatment are described for these complicated hemangiomas. We used a new type of treatment for complicated cutaneous hemangiomas as intralesional bleomycin (BLM) injection, for the first time in the literature. This agent produced extensive fibrosis and spontaneous resolution of hemangiomas. Fourteen patients with complicated hemangiomas (twelve capillary and two cavernous) have been treated with this method during a three-years period. Of these fourteen patients, five had bleeding, three had infection, one had ulceration, and five had unesthetic appearance and continued rapid growth. Lesions of three patients were completely excised after only one BLM injection. In the other eleven patients lesions regressed 60-100% during 6-14 months with two to three BLM injections. We believe that intralesional BLM injection is simple, and very useful for treatment of complicated cutaneous hemangiomas.

Traumatic asphyxia in children.

Eight children with traumatic asphyxia were evaluated retrospectively. There were five boys and three girls. The mechanism of injuries was motor vehicle accidents in six children. A fall in one patient and compression by lift in one patient. Clinical features of traumatic asphyxia developed in all patients. Five patients were disoriented and consciousness. Associated injuries were noted in all patients often involving thorax and head. Cerebral seizures complicated head injury in one patient. No mortality was recorded.

Blunt thoracic trauma in children.

Thirty four children with blunt thoracic trauma were treated at the university hospital, Trabzon. Eighteen of them were sustained in motor vehicle accidents, 14 were falls and two were a result of miscellaneous causes. Rib fracture developed in 16 patients and pulmonary contusion occurred in 18 patients. Pneumothorax existed in 19 patients, and hemothorax was noted in ten patients. Traumatic asphyxia occurred in seven patients. Associated head, abdominal, and orthopedic injuries were present in 21 patients. Chest drainage was performed in nineteen patients, while 15 patients received conservative treatment. Five patients required an emergency operation. Complications developed in five patients. Four patients were lost due to multiple system injuries. In this study, the injury patterns, complications and mortality of blunt thoracic injuries were discussed.

Congenital diaphragmatic eventration: treatment and postoperative evaluation.

Three patients with congenital diaphragmatic eventration have been reported. The diagnosis was established by chest radiography which showed an abnormally elevated diaphragm. Additionally fluoroscopy, ultrasonography and pulmonary function tests were used. Diaphragmatic plication was performed in order to restore normal pulmonary parenchymal volume and the diaphragm was replaced in its normal localization. All the patients had been discharged in good condition following uneventful postoperative courses. In this study we discussed the etiology, diagnosis, treatment and postoperative courses of diaphragmatic eventration.

A rare case of truncal duplication.

A rare case of truncal duplication is presented in which the infant had an extra truncus with well-formed extremities, a hypoplastic thorax, and a small abdomen. The truncus was attached to the infant from the thorax to the umbilicus. Successful separation of the truncus and reconstruction of the thoracoabdominal wall defect were performed in the neonatal period.