Evaluation of Cardiovascular Changes in Children with BAVs.

The objectives of this study were to investigate left ventricular (LV) function, aortic dilation, and atherosclerosis in children with mildly deteriorated isolated bicuspid aortic valve (BAV) function using echocardiographic studies and biochemical markers of atherosclerosis and to correlate results with normal children. Biochemical analyses indicating cardiovascular risk of atherosclerosis and vascular changes in the aorta in relation to BAV were performed in 41 children aged 5-15 years old with isolated BAV and in 25 children with tricuspid aortic valves. Evaluations of aortic valve structures and functions; examinations of the LV M-mode and ascending aorta Doppler; and measurements of the LV Tei index (MPI), propagation velocity, ascending aorta at four levels, and carotid intima-media thickness (CIMT) were performed. There were no statistically significant differences in CIMTs, plasma matrix metalloproteinase-9, tissue metalloproteinase inhibitor-1 levels, or other biochemical parameters indicating cardiovascular risk or atherosclerosis between study and control groups. Deterioration of LV function, which could not be seen with M-mode echocardiography, was evident by MPI. MPI values in the study versus control groups were 0.46 ± 0.080 versus 0.40 ± 0.086 (p < 0.05). Diameters of the aorta in the study and control groups were 19.7 ± 4.7 and 17.2 ± 2.8 mm (p < 0.05) at the sinotubular junction level and 20.6 (14.4-40.5) and 18.3 (12.4-24) mm at the ascending aorta level (p < 0.05). Increased aortic valve insufficiency was related to increased aortic diameter. No sign of atherosclerosis was detected in children with BAV. Deterioration of LV function was seen using MPI, and aortic dilation was related to the severity of aortic valve insufficiency.

Cardiovascular changes in children with coarctation of the aorta treated by endovascular stenting.

The aim of this study was to investigate the echocardiographic, biochemical short- and mid-term effects of the stenting procedure on left ventricular function, aortic stiffness, elasticity and systemic hypertension in children with coarctation of the aorta (CoA). Fifteen patients with native or recurrent CoA and 30 healthy controls who were sex and age matched were included in the study. The blood pressure values, echocardiographic measurements, elastic functions of ascending aorta and serum N-Terminal ProBNP (NT-ProBNP) levels were recorded prospectively before and at the first and sixth month after stenting. The mean arterial pressure recorded before stenting was 134.4±16.3 mm Hg; at the sixth month it was 115.5±9.5 mm Hg and in the control group it was 107.3±9.4 mm Hg. Although blood pressure levels were lower compared with the pre-stenting measurements (P<0.05), they were still significantly higher compared with the control group (P<0.05). Although a significant reduction was detected in the LVMIz at the end of the sixth month (50.4±14.3 g m(-2.7)) compared with the baseline (66.6±17.9 g m(-2.7); P<0.05), it was still higher compared with the control group (35.7±6.2 g m(-2.7); P<0.05). The baseline aortic elasticity (6.4±3.4 cm(2) dyn(-1) 10(-6)) was lower compared with the control group (10.0±1.7 cm(2) dyn(-1) 10(-6); P<0.05), and prestenting aortic stiffness was higher than that of the control group (5.6±1.6 dyn(-1) 10(-6); 2.5±0.45 dyn(-1) 10(-6); P<0.05). A statistically significant negative correlation was detected between the pressure gradient at the lesion site and aortic elasticity (r: -0.53, P: 0.04). Although resolution of the coarctation by endovascular stenting led to a reduction in the arteriopathy that had already begun before treatment, it was demonstrated that these children did not completely return to normal.

The relationship between scoring systems and cytokine levels in neonatal sepsis.

In this study, 20 newborn infants with sepsis were evaluated and scored according to the criteria of Töllner and Rodwell and associates. Leukocyte count, serum C-reactive protein (CRP), tumour necrosis factor (TNF)-alpha and interluekin (IL)-6 levels were also studied in all infants. The aim of this study was to determine if a relationship exists between the scoring systems and the cytokine levels in neonatal sepsis. The infants were divided into two groups as blood culture positive and negative. Blood culture was positive in 12 (60%) infants. We did not find a significant difference for leukocyte count, cytokine levels and scoring systems between the blood culture positive and negative groups. However, we found a positive correlation between the scoring systems and serum CRP and TNF-alpha levels (P < 0.05), but no correlation with IL-6. In conclusion, we suggest that only serum CRP level without performing scoring and studying serum TNF-alpha concentration may be used in early diagnosis of neonatal sepsis. However, further studies are necessary to define this because of the small sample size of our pilot study.

Imaging of an atypical case of congenital toxoplasmosis.

In this article we describe the cranial computerized tomography findings of an infant with congenital toxoplasmosis, which was performed because she showed an atypical clinical course consisting of meningitis and multiple cerebral abscesses. In this case the cranial computerized tomography allowed the diagnosis of hydrocephalus and multiple cerebral abscesses, and guided the therapeutic approach.

Gliclazide-induced hepatitis, hemiplegia and dysphasia in a suicide attempt.

The drugs used to treat diabetes mellitus are diverse and include several classes. One class is sulfonylureas which primarily cause serum glucose reduction by stimulating the release of preformed insulin from the pancreatic islets. Gliclazide, a second generation sulfonylurea, is used to control glycemic levels in non-insulin-dependent diabetes mellitus. We report a 14 year-old non-diabetic girl who developed hepatitis, hemiplegia and dysphasia after ingestion of an overdose of gliclazide (20 mg/kg/day) in a suicide attempt. Our purpose is to draw attention to the severity of gliclazide-induced neurological signs. To the best of our knowledge, gliclazide-induced hemiplegia and dysphasia have not been previously reported in the literature.

Asymmetric crying facies and congenital hypothyroidism: report of two patients.

A congenital asymmetric crying facies (ACT) is caused by congenital hypoplasia or agenesis of the depressor anguli oris muscle. Associations of this facial defect with major congenital anomalies have been reported, most commonly in the cardiovascular system and less frequently involving the genitourinary, musculoskeletal, cervicofacial, respiratory, and rarely, the endocrine system. It is also well known that congenital hypothyroidism may be associated with other congenital malformations, especially with cardiac defects. Two newborn infants who had ACF associated with congenital heart defect and congenital hypothyroidism are described. To the best of our knowledge the association of ACF and congenital hypothyroidism has not previously been published.

Pott's disease.

A 15-year-old boy was hospitalized with a 1-month history lumbago and fever. His family history was noncontributory for tuberculosis, and the findings of the physical examination were normal. The sedimentation rate and C-reactive protein level were 55 mm/hour and 48 mg/l, respectively. The result of a purified protein derivative test was 11 x 10 mm. Results of other tests, including rheumatologic studies, serum agglutination for brucellosis, chest radiography, abdominal ultrasonography, and myelography, were normal. The bone biopsy revealed chronic active inflammation. Mycobacterium tuberculosis was not cultured from clinical specimens. However, the patient's symptoms improved after antituberculosis drugs were begun.

Septic arthritis in childhood.

BACKGROUND: The purpose of the present study was to determine whether there was a difference between septic arthritis (SA) combined with osteomyelitis and SA alone with regard to clinical and laboratory findings, such as symptoms on admission, age, sex, joint involvement and isolated micro-organisms, and a relationship between age and joint involvement in SA. In addition, we also aimed to determine the prognostic factors in SA. METHODS: The clinical and laboratory findings of 40 patients who were diagnosed with SA in our hospital were reviewed retrospectively. The diagnosis of SA was made according to the following criteria: immediate joint fluid aspiration (culture and Gram's stain positive, leukocyte count markedly elevated and glucose level low), blood culture positive and positive cultures from other possible sites of infection. RESULTS: Of the 40 patients, 22 were boys, 18 were girls and the male to female ratio was 1.2/1. Patient ages ranged from 6 months to 14 years (mean (+/- SD) 8.44 +/- 4.18 years). The most observed symptoms were fever (52.5%), arthralgia (50%) and joint swelling (45%). Thirty-four (85%) patients had only one joint and six patients (15%) had more than one joint involved. In total, arthritis was diagnosed in 49 joints. The joints diagnosed as having arthritis were the following: knee (n = 18), hip (n = 12), ankle (n = 12), elbow (n = 3), shoulder (n = 2), wrist (n = 1) and interphalangeal joint (n = 1). Of the 40 patients, 21 (52.5%) had SA alone and 19 (47.5%) had arthritis together with osteomyelitis. While arthritis was diagnosed in 27 joints in the group of patients with SA, it was diagnosed in 22 joints in the group of patients with SA combined with osteomyelitis; in the latter, an increase was not observed in the number of joints involved. Joint fluid culture was positive in 22 (55%) patients; the growth of Staphylococcus aureus was observed in 20 cases and Pseudomonas aeruginosa and Staphylococcus epidermidis were isolated in each patient. In contrast, in one patient, arthritis occured during meningococcal meningitis (in this patient, Gram-negative diplococci was isolated from a cerebrospinal fluid culture). Patients with SA combined with osteomyelitis and those with SA alone were compared for symptoms on admission, the history of trauma and antibiotic use, sex, age, fever, joint involvement, anemia, leukocytosis and micro-organisms isolated from joint fluid and blood; there were no significant differences for these parameters between the two groups (P > 0.05). In addition, we found that there was no relationship between age and joint involvement in SA and there was no effect of micro-organisms on mortality. Three of 40 patients died; the mortality rate was 7.3%. Of the three patients who died, two had SA alone and one had SA combined with osteomyelitis. The primary disease was sepsis in these three patients; S. aureus was cultured from blood in two patients and Gram-positive cocci was observed following examination of the joint fluid in the other patient. CONCLUSIONS: We would like to emphasize that SA is mono-articular, frequently localized in the knee, hip and ankle in 85% of patients, joint fluid culture was positive in 55% of patients, bacteria was isolated from one or more cultures of blood, joint fluid, pus or bone in 70% of patients and the most common isolated micro-organism was S. aureus. In addition, it must be pointed out that children younger than 2 years of age with fever, a positive trauma history and/or abnormal joint findings should be carefully examined for SA because the rate of SA was lower (7.5%) than expected in this age group. We also found that the mortality of SA was not influenced by age, joint involvement and bacterial agents, and there was no significant difference in symptoms on admission, the history of trauma and antibiotic use, sex, age, fever, joint involvement,anemia, leukocytosis and micro-organisms isolated from joint fluid and blood between patients with SA

Nitric oxide level in children with pulmonary hypertension.

Nitric oxide is a gas and free radical, which modulates pulmonary and vascular tone. Pulmonary vascular endothelial cell produce the nitric oxide. To define the relation between nitric oxide and hemodynamic parameters in children with pulmonary hypertension, we measured the nitric oxide concentrations of the right atrium, right ventricle, pulmonary artery, left ventricle and aorta in 40 patients during cardiac catheterizations. Patients were divided into two groups according to their pulmonary arterial pressure. In group I, the mean pulmonary arterial pressure was higher than 25 mmHg and in group II, lower than 25 mmHg. Pulmonary nitric oxide level in group I was significantly lower than group II (P < 0.05). The right ventricle and mean pulmonary arterial pressures, pulmonary vascular resistance and pulmonary flow/systemic flow of the patients in group I were significantly higher than those of group II (P < 0.05). In conclusion, we found low nitric oxide levels in patients with pulmonary hypertension and congenital heart defects.

Pulmonary complications in patients with staphylococcal sepsis.

BACKGROUND: The aim of the present study was to determine the pulmonary findings in patients with sepsis caused by Staphylococcus aureus. METHODS: The clinical and laboratory findings of 32 cases (82%) of pulmonary involvement (secondary pneumonia) of 39 patients with sepsis caused by S. aureus were studied retrospectively. The criteria for the diagnosis of sepsis were clinical evidence of infection plus hyperthermia/hypothermia, tachycardia, tachypnea and white blood cell abnormalities. Secondary pneumonia was diagnosed in patients who presented with staphylococcal disease at one or more non-pulmonary sites and who developed radiologic evidence of pulmonary involvement during the course of illness. RESULTS: Of the 32 patients, 23 were male and nine were female; the male to female ratio was 2.5/1. The ages of the patients ranged from 2 months to 14 years (7.87 +/- 4.71 years). Bronchopneumonic infiltration was bilateral in 18 patients and unilateral in 14 patients (20 patients (62.5%) had lobar consolidation). Pleurisy was noted in 12 (37.5%) patients; it was on the right side in five patients, on the left in five patients and bilateral in two patients. In contrast, pneumatocele and pneumothorax were observed in seven (21.9%) and four (12.5%) patients, respectively. Closed chest tubes were placed through a closed thoracotomy in five children who developed dyspnea, orthopnea with imminent respiratory failure and mediastinal shift. As well as the pulmonary involvement, arthritis was noted in 13 patients, osteomyelitis in 11 patients, rash in six patients, pericarditis in five patients and renal failure in one patient. Staphylococcus aureus was isolated from blood culture in all except for seven cases. While S. aureus was isolated from blood culture in all of the 12 patients with pleurisy, it was isolated from pleural fluid in only two (16.6%) patients. Six of 32 patients died; the mortality rate was 18.75%. CONCLUSIONS: It was found that the rate of pulmonary involvement was as high as 82% in sepsis caused by S. aureus, and the pulmonary findings, including bronchopneumonic infiltration and lobar consolidation, were frequently seen in S. aureus pneumonia, causing a mortality rate of 18.75%.

Patient with Weismann-Netter and Stuhl (toxopachyosteosis) syndrome with communicant hydrocephalus and arachnoid cyst.

Weismann-Netter and Stuhl (toxopachyosteosis) syndrome is a rare bone disease, manifesting with anterior bowing of the tibiae, short stature and mild mental retardation. We report a patient with Weismann-Netter and Stuhl syndrome with an unusual manifestation communicant hydrocephalus and arachnoid cyst.

Diagnostic value of troponin T in neonates of mild pre-eclamptic mothers.

The measurement of myocardial damage by newer, highly specific markers of myocardial damage is now possible, including cardiac structural proteins such as troponin T (TnT). In neonates of pre-eclamptic mothers, it identifies minor myocardial damage missed by other biochemical markers. The present study was designed to determine the diagnostic value of TnT concentrations in neonates of pre-eclamptic mothers. Fifteen neonates of pre-eclamptic mothers were studied (9 boys and 6 girls), and 17 healthy full-term neonates (9 boys and 8 girls) were selected as a control group. The serum TnT concentration in neonates of pre-eclamptic mothers (0.70 ng/ml) was significantly higher than that in the control group (0.10 ng/ml). In an echocardiographic study, the mean mitral peak velocity at an atrial contraction (A) value of 39 cm/s in neonates of pre-eclamptic mothers was significantly lower than that in the control group (53 cm/s), and the mean mitral peak velocity of early diastole to peak velocity of the atrial contraction (E/A) value (1.75) in neonates of pre-eclamptic mothers was significantly higher than that in the control subjects (1.23). In conclusion, our study demonstrated high levels of cardiac TnT, lower mitral A values and high mitral E/A values in neonates of pre-eclamptic mothers, presumably associated with mild myocardial damage in the neonates of pre-eclamptic mothers.

5-Hydroxy-3-indole acetic acid levels in infantile colic: is serotoninergic tonus responsible for this problem?

Levels of 5-hydroxy-3-indole acetic acid (5-OH IAA), a metabolite of serotonin, were studied in infants with infantile colic in order to investigate the aetiology of infantile colic pathogenesis. The study included 16 patients with infantile colic and 10 control subjects. Random urinary 5-OH IAA levels of colicky infants were found to be higher than those in the control group. This finding suggested that high serotonin levels may be responsible for infantile colic.

Polycystic kidney disease, biliary dysgenesis in a patient with Larsen's syndrome.

Larsen's syndrome is characterised by multiple joint dislocations, flat face and talipes equinovarus. There is an autosomal dominant form and also a more severe autosomal recessive form. Several types of polycystic kidney disease have been reported in children. In this report we present an infant with a severe form of Larsen's syndrome (thought to be lethal Larsen-like), infantile-type polycystic kidney disease, biliary dysgenesis and osteosclerosis.

Protective effect of magnesium supplementation on experimental 3-methyl cholanthrene-induced fibrosarcoma and changes in tissue magnesium distribution during carcinogenesis in rats.

In this study, we wanted to examine the effect of magnesium (Mg2+) supplementation on the experimental 3-methyl cholanthrene (3-MC)-induced fibrosarcoma and alterations in (Mg2+) distribution in several tissues of the rats, during carcinogenesis. It was determined that serum and tissue (Mg2+) levels of the rats in (Mg2+)-supplemented diet group were higher than those of the rats in the (Mg2+)-nonsupplemented and control groups. The mean time of fibrosarcoma development for (Mg2+)-supplemented group was longer than (Mg2+)-nonsupplemented group (p < 0.05). Symptoms of hypermagnesemia were not observed in any of the rats. These results suggests that dietary (Mg2+) supplementation may have a partial anti-carcinogenic effect on experimental 3-MC-induced fibrosarcoma by prolongation of the latent period of carcinogenesis.