Surfactant replacement therapy in a pediatric near-drowning case in manure.

Drowning is defined as suffocation by submersion especially in water and is a leading cause of injury-related death in children. Age groups at greatest risk are toddlers and male adolescents. It is the second most common cause of accidental death in children after road accidents. Treatment consists of resuscitation and stabilization. The use of surfactant after near-drowning in water is reported in the literature in few case reports.We report here a boy whose condition did not get better with conventional treatment, but dramatically improved after surfactant treatment after near-drowning in a fluid with manure.

Homocysteine and ghrelin link with polcystic ovary syndrome in relation to obesity.

AIM: Elevated levels of plasma homocysteine and depressed ghrelin levels have been found to be associated with insulin resistance in a number of clinical situations, such as polycystic ovary syndrome. This study was designed to determine the relationship of plasma homocysteine and ghrelin levels with obesity in polycystic ovary syndrome. MATERIAL AND METHODS: Forty-four adolescents and young women (24 lean, 20 obese) 16-21 years old with polycystic ovary syndrome and age matched 20 healthy adolescents and young women were participated the study. Fasting samples were collected for serum vitamin B12, folate, plasma total homocysteine and ghrelin levels. Serum levels of follicle-stimulating hormone, luteinizing hormone, dehydroepiandrosterone sulfate, insulin, 17-hydroxyprogesterone, free testosterone, sex-hormone binding globulin were measured. Also, serum concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides were determined. Oral glucose tolerance test was done, and HOMA-IR index was used to define insulin resistance. RESULTS: Plasma total homocysteine levels were significantly higher in women with polycystic ovary syndrome and their plasma ghrelin levels were depressed compared to control group (P < 0.05). Obese adolescents with polycystic ovary syndrome had more depressed plasma ghrelin levels compared to lean ones (P < 0.05). Homocysteine levels didn't correlate with body mass index, but positively correlated with insulin resistance (P < 0.05). CONCLUSION: Elevated plasma homocysteine levels in polycystic ovary syndrome was independent from obesity. Adversely ghrelin levels were depressed with polycystic ovary syndrome in relation to obesity.

Asymptomatic diaphragmatic rupture with retroperitoneal opening as a result of blunt trauma.

Blunt traumas of the abdomen and thorax are important clinical problems in pediatric ages. Severity of trauma may not always be compatible with the patients' clinical situation. A 2-year-old male child was admitted to our emergency clinic as a result of tractor crash accident. Physical examination of the child was normal. The abdominal and thoracic ultrasonography (USG) examination performed in the emergency clinic was normal. In thoracic computed tomography (CT) scan of the patient, there was irregularity of the right diaphragmatic contour that was described as micro perforation-rupture (the free air was just in the perihepatic and retroperitoneal area, which was not passing through the abdomen). The patient was followed-up for 1 week in the hospital with a diagnosis of retroperitoneal diaphragmatic rupture. It is not appropriate to decide the severity of trauma in childhood on the basis of clinical findings. Although severe trauma and sustaining radiological examinations, the patients' clinical pictures may be surprisingly normal, as in our patient. In such cases, there may not be any clinical symptom. CT scan examination must be preferred to USG for both primary diagnosis and follow-up of these patients. According to the current literature, there is no reported case with retroperitoneal rupture of the diaphragm.

Do children with adenotonsillar hypertrophy have lower IGF-1 and ghrelin levels than the normal children?

OBJECTIVES: We aimed to determine serum IGF-1 levels and plasma ghrelin levels in male children with adenoid and tonsillar hypertrophy and compare with healthy controls. METHODS: Forty-four male children with obstructive adenotonsillar hypertrophy between the ages of 8 and 11.9 years (mean 9.98+/-0.98 years) and age matched 40 healthy male children (between 8 and 12 years old, mean 9.83+/-0.85 years) as control group were enrolled in this study. In both the groups plasma ghrelin and serum IGF-1 levels were measured at 08.30, in the morning. RESULTS: Male children with adenotonsillar hypertrophy had significantly depressed serum IGF-1 levels (227.29+/-83.11 ng/ml) and plasma ghrelin levels (389.67+/-170.94 pg/ml) compared to control group (389.67+/-170.94 ng/ml and 629.76+/-263.62 pg/ml respectively, p<0.05). Body mass indexes of children with adenotonsillar hypertrophy were significantly lower than those of their healthy peers (15.72+/-2.08 kg/m(2) and 19.12+/-2.79 kg/m(2) respectively, p<0.05). CONCLUSIONS: Delayed growth in male children with adenotonsillar hypertrophy may be related to the lower serum IGF-1 and plasma ghrelin levels compared to that of normal male controls. Since ghrelin increases hunger and food intake and its levels increase before the meals, lower levels lead to decreased appetite and also swallowing difficulties in children with adenotonsillar hypertrophy may lead to suboptimal nutrition. Lower serum levels of IGF-1 in children with adenoid and tonsillar hypertrophy may be secondary to deficient growth hormone stimulation by ghrelin.

The relationship between P-wave dispersion and diastolic functions in diabetic children.

OBJECTIVE: The aim of this study was to investigate the relations between the P-wave dispersion and diastolic functions in type 1 diabetic children. PATIENTS: A total of 33 diabetic patients without any cardiovascular disease, with a mean age of 12.3 plus or minus 4.2 years, and 29 healthy controls, with a mean age of 10.4 plus or minus 3.9 years were enrolled for this study. Left and right ventricular functions were assessed by using standard pulsed-wave Doppler echocardiography. P-wave dispersion was calculated by measuring minimum and maximum P-wave duration values on the surface electrocardiogram. RESULTS: For the diabetic patients, P-wave maximum duration and dispersion was found to be significantly increased compared with healthy controls. Likewise, mitral A velocity and A velocity time integral was significantly increased while the isovolumic contraction time was significantly higher in the diabetics. In tricuspid valve measurements, however, A velocity time integral was found to be significantly higher, whereas the deceleration time was significantly lower in the diabetics. No relation was found between the left ventricle diastolic functions and duration of diabetes, HbA1c levels and P-wave dispersion in the diabetic children. No correlation was found between the diastolic functions and P-wave minimum, maximum duration, and dispersion for all the participants. CONCLUSION: In type-1 diabetic children, the diastolic functions of both the ventricles were observed to be affected negatively together. Diabetes might be causing the prolongation of P-wave dispersion, but there was no relationship between the diastolic functions and P-wave dispersion in the diabetic children.

Do children with adenotonsillar hypertrophy have lower IGF-1 and ghrelin levels than the normal children?

OBJECTIVE: This study was designed to determine serum insulin-like growth factor-1 (IGF-1) and plasma ghrelin levels in male children with adenoid and tonsillar hypertrophy and compare them with healthy controls. METHODS: This study included 29 male prepubertal children between the ages of 6.5 and 10 years (mean age 8.8 +/- 2.5 years) with obstructive adenoid and tonsillar hypertrophy and 20 normal male controls between the ages of 5.7 and 10.8 years (mean age 8.2 +/- 2.9 years). Plasma ghrelin and serum IGF-1 levels were measured at 8.30, in the morning. RESULTS: Children with adenoid and tonsillar hypertrophy had significantly depressed serum IGF-1 levels (203 +/- 150 ng ml(-1)) and plasma ghrelin levels (175 +/- 66 pg ml(-1)) compared with healthy controls (354 +/- 242 ng ml(-1) and 243 +/- 93 pg ml(-1), respectively, P < 0.05). CONCLUSION: Depressed levels of ghrelin in children with adenoid and tonsillar hypertrophy lead to decreased appetite and insufficient energy intake. Lower serum levels of IGF-1 in children with adenoid and tonsillar hypertrophy may be secondary to deficient growth hormone stimulation by ghrelin.

Cross ectopic multicystic dysplastic kidney with ureterocele in nonectopic site.

Crossed renal ectopy (CRE) is the second most common fusion anomaly of the kidney, with an incidence of 1 in 7000 autopsies; it comes in second after horseshoe kidney. Crossed renal ectopy is associated with an ectopic ureter and generally an ectopic kidney fused with a normal kidney. A 7-month-old boy who had left-to-right crossed non-fused renal ectopy and multicystic renal dysplasia with ureterocele in nonectopic kidney was reported in English language literature. In this article, we present the first case of CRE where surgical intervention has been performed.

An unusual cause of gastric perforation in childhood: trichobezoar (Rapunzel syndrome). A case report.

Trichobezoars are hair balls found in the stomach and formed following trichitillomania and trichopaghia. Rapunzel syndrome is a rare condition in which the presence of giant trichobezoars causes mechanical obstruction. To date, only two cases of stomach perforation caused by trichobezoars have been reported among pediatric patients. We report a 14-year-old female patient who experienced nausea, vomiting and severe abdominal pain for 1 month. Physical examination revealed diffuse abdominal distension. Palpation detected a mobile and sensitive mass, 15 x 15 cm , which filled the upper quadrant. Urgent surgery revealed that the stomach was perforated by the trichobezoar ball. This trichobezoar mass was totally excised by expanding the perforation area. Conclusion This is the reported third case of gastric perforation caused by trichobezoar in a pediatric patient. Among acute abdominal cases, gastric perforation should remain a possibility in differential diagnosis.

Analysis of familial Mediterranean fever gene mutations in 202 patients with familial Mediterranean fever.

BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal recessive disorder, caused by mutations in MEFV gene that encodes pyrin protein. In this study, we analyzed the most common five mutations in MEFV gene of 202 patients who were diagnosed formerly as FMF according to Tel-Hashomer criteria. The results of genetical analysis, clinical symptoms, and demographical aspects of those patients were evaluated retrospectively. METHODS AND RESULTS: Between the dates of February 2005 and March 2007, we analyzed five common MEFV gene mutations, which were M680I, M694V, M694I, V726A, and E148Q, in 202 patients by the PCR-ELISA method in our medical genetics laboratory. The most frequent mutation detected in our patients was M694V, and other mutations according to frequency were E148Q, M680I, V726A, and M694I. The detected mutations were homozygous in 45 of the patients (22.2%), heterozygous in 103 (51%), compound heterozygous in 52 (25.8%), and in 2 patients (1%) complex alleles were defined. The most common symptom was abdominal pain (80.4%) and other symptoms, respectively, were fever (57.8%), arthralgia (36.7%), chest pain (4.5%), and skin rash (2%). Amyloidosis was present in seven patients, and five of them had M694V mutation (homozygous), one of them had E148Q (heterozygous) mutation, and the other one had M694V/M694I mutation. CONCLUSION: In our patients, we defined 21 different genotypes of MEFV gene and the most common mutation was M694V. The most common symptoms were abdominal pain and fever. We detected significant correlation between the M694V, E148Q, and V726A mutations and clinical findings.

Fascia, muscle and peritoneal rupture without any skin lesion as a result of blunt abdominal trauma--a case report.

BACKGROUND: Blunt abdominal trauma is one of the important causes of morbidity and mortality in childhood. Rapid and correct diagnosis is critical for blunt abdominal trauma cases. METHODS: A twelve-year-old male was admitted to our emergency service following a bicycle accident. He had mild abdominal discomfort by palpation located at the lower right abdominal quadrant. A hyperaemic area of 1 x 4 cm, was present on the skin surface. During the CT scan examination, a 1 x 1.8 cm rupture of the right rectus abmominis muscle at the pelvic inlet level was detected. Intra-operatively, we detected an approximately 10 cm irregular fascial rupture, an 8-10 cm muscular rupture of the rectus abdominis muscle and also a 10 cm peritoneal rupture. CONCLUSION: Blunt abdominal trauma may cause severe intra-abdominal tissue and visceral injuries, even if no important clinical findings are present. So, all standard diagnostic procedures must be called into mind in order not to overlook severe intra-abdominal injuries.

Osteocalcin. A biochemical marker of bone turnover during puberty.

During bone remodelling, osteocalcin is produced by osteoblasts and its level increases during the events characterized by rapid bone turnover. Osteocalcin is a bone matrix protein, which is specific for bone metabolism and it is not influenced by metabolic bone disorders. Osteocalcin is an important marker of bone turnover in physiological and pathological conditions. Physiologically, serum osteocalcin was increased in children, particularly during the first year of life and during puberty, when evolution of the concentration was related to rapidity of physical growth. Evidence of a correlation with growth rates comes from the observation that serum osteocalcin levels parallel the height velocity curve, with higher values in childhood and during adolescence, that later fall to adult values. There are previous studies reporting that there is age- and sex-dependent change in serum osteocalcin levels in children and adolescents with a pattern resembling height velocity curves for children and serum osteocalcin elevation coincides with the pubertal growth spurt. These findings demonstrate that pubertal development and sex should be taken into account rather than chronological age when serum levels of osteocalcin are evaluated. In most of the studies relationships among osteocalcin and chronological age and bone age, but not pubertal developmental stage (sexual maturation stage) were investigated. The aim of our study was to determine whether osteocalcin is a useful marker for the pubertal growth spurt period. In this study, osteocalcin levels in male adolescents were examined in relation to their sexual maturation stage and age. According to our findings, the follow up of osteocalcin levels in relation to sexual maturation stages could be a new method to determine the phase of the pubertal growth spurt. An increase or decrease in osteocalcin levels on consecutive measurements may indicate the child's entering accelerated or decelerated stages of the growth spurt, respectively. We emphasize that the follow up of adolescent growth is made by determination of the sexual maturation stage, and not by age. Osteocalcin is a highly specific, reliable and useful marker for evaluation of the growth spurt and is not influenced by nonosseous disorders.