The hormonal and radiological evaluation of adrenal glands, and the determination of the usefulness of low dose ACTH test in patients with renal amyloidosis.

Amyloidosis is a multisystem disease which may cause organ loss. Renal involvement is the most common clinical problem in amyloidosis, however involvement of endocrin organs is possible. In this study to assess adrenocortical function and to evaluate the usefulness of low dose ACTH test in patients with renal amyloidosis, we determined cortisol, 17-hydroxyprogesteron (17-OHP) and 11-deoxycortisol (11-DOC) responses to both 1 microg and 250 microg Synacthen. We also determined the size of adrenal glands radiologically by using computerized tomography. Twenty one patients with renal amyloidosis and 16 healthy subjects for hormonal evaluation, and 20 patients with renal amyloidosis and 22 healthy subjects for radiologic evaluation were included in the study. In four patients (19%) peak serum cortisol levels following stimulation with the low dose of Synacthen were less than 20 microg/dL (550 nmol/L). Two of them had also subnormal cortisol response to the 250 microg Synacthen stimulation test. Basal and stimulated levels of 11-DOC were lower than those of control values (p=0.000 and p<0.01 respectively). The mean 11-DOC responses to stimulation with 1 microg Synacthen were also significantly lower than the values obtained after the simulation with 250 microg Synacthen (p<0.01 and p=0.000). Cortisol responses to the stimulation with 250 microg Synacthen were also lower than the control responses (p<0.05). 17-OHP responses were similar to the control values in both tests. In the radiological evaluation the mean maximum width of right adrenal glands and the mean anterior and maximum width of left adrenal glands were significantly greater in the patient group (p<0.01). In conclusion, adrenal involvement and adrenal insufficiency is common in amyloidosis. Low 11-DOC levels in amyloidosis is a new finding and further detailed studies is required to explain its cause.

Neonatal poisonings in middle Anatolia of Turkey: an analysis of 72 cases.

In this study, 72 newborn infants who were followed with the diagnosis of poisoning in Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, between 1975 and 1997 were evaluated retrospectively. Our purpose was to emphasize the importance of newborn poisoning among general poisoning in childhood. The age of infants ranged from 10 min to 25 days (0.82 +/- 2.81 days). Forty-seven (65.2%) infants were poisoned before or during delivery. Of the 47 infants' mothers, 46 had preeclampsia or eclampsia, and 27 received only magnesium sulfate; nine magnesium sulfate + diazepam; four magnesium sulfate + nifedipine; and the others received various drug combinations. Aside from these, one mother had Addison's disease and she used long-term dexamethasone during her pregnancy. In the newborn period, five (6.9%) infants inhaled organophosphate insecticides; eight (11.1%) ingested corrosive agents (four benzalkonium chloride; three chlorhexidine gluconate + cetrimide and an infant ammonium); four (5.5%) were poisoned by overdose of digoxin; three (4.1%) ingested overdose of phenobarbital; and two (2.7%) received acepromazine maleate. In addition, each infant ingested diphenoxilate HCL + atropine sulfate, pipenzolate bromid and tizanidine HCL. Follow-up period of the infants ranged from 24 hr to 26 days (0.82 +/- 2.81 days). The mortality rate was 17% (12/72). Death was not noted in the infants who were followed with poisoning after delivery. The causes of death were as follows: sepsis in four infants, meningitis, respiratory distress syndrome and necrotizing enterocolitis in two infants each, and the effects of overdose of magnesium sulfate and diazepam in two infants, respectively. In conclusion, we would like to stress that newborn infants whose mothers received magnesium sulfate or another drug during pregnancy or delivery should be closely monitored, and calculation of drug doses should be carefully taught to hospital nurses. When baby-rooms are disinfected with organophosphate insecticides in a hospital or house, infants should be removed from the room for at least 24 hr, and use of drugs should be explained in detail to the mothers.

Bilateral proptosis caused by orbital myositis. A case report.

Proptosis, unilateral or bilateral, is a frequent indication for medical evaluation and orbital computed tomography. The most common cause of proptosis in adults and children is inflammatory disorders. Orbital myositis is a subgroup of the orbital pseudotumor syndrome in which one or more of the extraocular muscles are primarily infiltrated by an inflammatory process. Computed tomography and ultrasonography showed enlargement of one or more extraocular muscles in orbital myositis. In our case, we observed clinically and by orbital computed tomography, evidence of isolated bilateral extraocular muscle swelling after upper respiratory tract infection. Proptosis and other findings were spontaneously and completely resolved after twenty days. Because proptosis caused by orbital myositis is extremely rate in children and there is limited information in the literature, this case was reported.

Amitraz poisoning in children: clinical and laboratory findings of eight cases.

Amitraz poisoning is a rare disorder characterised by central nervous system and respiratory depression, bradycardia, hypotension, hypothermia, hyperglycemia, vomiting, convulsion and glycosuria. In this study, eight pediatric patients with amitraz poisoning were presented. This study revealed that clinical manifestations of poisoning by oral and dermal route emerged within 30-120 min and that central nervous system depression which is the most important sign resolved with 8-18 h and others 36-48 h. All cases were discharged as recovered after 48 h. To our knowledge only six cases have been reported in the literature. Because of the limited information in the literature, the cases were reported.

Neuroblastoma and Poland syndrome in a 15-year-old boy.

A 15-year-old boy with neuroblastoma associated with Poland syndrome is presented. He was admitted with a 2-month history of progressive back pain and a 3-day history of weakness of the lower extremities, encopresis and enuresis. On physical examination, in addition to paraplegia, absence of the pectoralis major muscle was diagnosed on the right side of his chest. A large heterogeneous mass in the right side of the thorax was revealed on computerized tomography. Neuroblastoma was diagnosed on histopathological analysis of the mass. To the authors' knowledge this is the first case of neuroblastoma associated with Poland syndrome in the literature.