Alphan Cura

Complications of central venous catheterization in critically ill children

Background: Placement of central venous catheter is essential in the management of critically ill children. The purpose of the present paper was to evaluate the success rate, mechanical and thrombotic complications and risk factors associated with these complications from different central venous access sites in critically ill children.

Alterations of blood pressure in type 1 diabetic children and adolescents

The aim of this study was to assess the association between metabolic control, microalbuminuria, and diabetic nephropathy with ambulatory blood pressure monitoring (ABPM) in normotensive individuals with type 1 diabetes mellitus (DM). ABPM was undertaken in 68 normotensive type 1 diabetic patients with a mean age of 14.4±4.2 years. Microalbuminuria was diagnosed on the basis of a urinary albumin excretion rate grater than 20 μg/min in two of the three 24-h urine collections. Hypertension (HT) frequency was greater in the microalbuminuric patients than normoalbuminuric patients (54 vs 17.54%, p=0.05) with ABPM. Microalbuminuric patients had a higher diastolic pressure burden than normoalbuminuric patients. There were no differences in systolic and diastolic dips between the two groups. Diastolic pressure loads in all periods showed a significant correlation with duration of diabetes, mean HbA1c from the onset of diabetes, and level of microalbuminuria. Nocturnal dipping was reduced in 41.2% of the patients. In the normoalbuminuric group 41.1% and in the microalbuminuric group 63.6% were nondippers. Our data demonstrate higher 24-h and daytime diastolic blood pressure load and loss of nocturnal dip in type 1 diabetic adolescents and children. High diastolic blood pressure burden in diabetic patients could represent a risk for nephropathy.

Effect of enalapril on proteinuria, phosphaturia, and calciuria in insulin-dependent diabetes.

Abstract. Elevated urinary calcium and phosphate excretion have been observed in children with insulin-dependent diabetes mellitus (IDDM). This may be related to a defect in tubular reabsorption. It is well known that converting enzyme inhibition decreases microalbuminuria and may prevent or retard diabetic nephropathy. We investigated whether enalapril also improves the defect in calcium and phosphate reabsorption. We studied 16 children and young adults (age 12–21 years) with IDDM and persistent microalbuminuria before and during 12 weeks of enalapril treatment. Before treatment microalbuminuria, urinary calcium excretion, and fractional tubular phosphorus reabsorption (TPR) were 153±53 μg/min, 5.5±0.9 mg/kg per day, and 71.4±3.6%, respectively. At the end of the 12th week, microalbuminuria had decreased to 20.3±7.9 μg/min and calcium excretion to 3.3±0.4 mg/kg per day (P<0.01), while the TPR increased to 80.1±3.8% (NS). The renal threshold phosphate concentration increased from 1.8±0.15 to 2.92±0.23 mg/dl (P<0.01). The fasting serum glucose and hemoglobin Alc levels did not change significantly during the study. Systolic and diastolic blood pressures were 120.4±2.2/79.3±1.4 mm Hg and 110.5±1.8/ 71.3±0.9 mm Hg before and after 12 weeks, respectively. We conclude that enalapril treatment improves not only microalbuminuria but also abnormal calcium and phosphate excretion in microalbuminuric children with IDDM.

Inferior vena cava indices determine volume load in minimal lesion nephrotic syndrome.

Abstract The pathogenesis of edema in nephrotic syndrome has not been entirely understood. We investigated the value of the echographic parameters [inferior vena cava index (IVCI), inferior vena cava collapsibility index (IVCCI), and left atrium diameter (LAD)] to determine the volume load in children with minimal lesion nephrotic syndrome (MLNS). Twelve children with MLNS (seven boys, five girls) were included in this study. The patients were classified into three different stages (stage A: edematous; stage B: 50% decrease in weight gain; stage C: edema free) following measurement of their ideal weights. The ideal weight of patients in stage A was increased 13±7%. Serum total protein, albumin and urine sodium levels were found to be low in these patients. Plasma renin activity (PRA) and serum aldosterone levels in stage A were significantly different from those of the control group (P<0.05). PRA and serum aldosterone levels were not different from those of the control group in stage B (P>0.05). However, the increase in PRA was significant in stage C. Although a significant weight decrease was found in stages B and C, it had no effect on IVCI, LAD, and cardiothoracic index. We consider IVCI, IVCCI, and LAD measurements by echocardiography (ECHO) to be easy and reliable clinical methods for assessing the intravascular volume load in patients with MLNS.

Lymphocyte subpopulations in children with vitamin D deficient rickets.

Recent studies have shown 1,25(OH)2D3‐mediated modulation of the immune system. We examined lymphocyte subpopulations of 16 children with nutritional rickets. Most of the patients suffered more frequent infection episodes than the control group of 15 healthy children and low serum levels of 25OHD and 1,25(OH)2D, such as 38.2 ± 8.6 ng/mL and 15.7 ± 2.6 pg/mL respectively. This decrease correlated with a significant decrease in total T lymphocytes and an increase in B lymphocytes expressing surface IgA, IgM, IgG molecules. These results suggest that vitamin D plays an important role in the impaired functions of T lymphocytes which may lead to frequent infection episodes in nutritional rickets.

Clinicopathologic correlations of Henoch–Schönlein nephritis in Turkish children

Abstract Background: In this study, 66 patients with Henoch–Schönlein nephritis (HSN) were investigated clinicopathologically.

Plasma and urinary platelet activating factor concentrations and leukotriene releasing activity of leukocytes in steroid sensitive nephrotic syndrome of childhood

Platelet activating factor (PAF) is synthesized and secreted by glomerular mesangial and endothelial cells. It increases glomerular basement membrane permeability and induces proteinuria. Leukotrienes (LT) are mediators released by either leukocytes or glomerular cells under the PAF effect. The possible role of PAF in steroid sensitive nephrotic syndrome (SSNS) of childhood was studied in 8 children with SSNS in the acute stage, 5 children in remission and 8 healthy controls. The PAF concentrations in urine and plasma were determined. Leukocytes were stimulated in vitro and the LT release in response to stimulation was determined. The urinary and plasma concentrations of PAF were significantly higher in the acute phase than in remission and in control patients. Children with SSNS were found to have peripheral leukocytes with increased LT releasing activity in vitro. These results are in accordance with clinical and experimental observations indicating that PAF originates in the kidney and plays a role in normal kidney physiology. Urinary PAF concentrations may be related to proteinuria because they were strongly correlated in the present study. Elevated plasma PAF concentrations in the acute stage of SSNS could result from either its secretion from the circulating leukocytes or decreased acetyl hidrolase activity needed for its hydrolysis in plasma. The increased LT release in vitro suggests that these cells might have been activated by PAF secreted from glomeruli. It is proposed that PAF and different LT in systemic and glomerular circulation are important mediators in childhood SSNS.

Tc-99m DMSA localization in infantile hemangioma.

The authors describe a neonate with bilateral dysplastic kidneys who underwent Tc-99m DMSA scintigraphy for the assessment of renal cortical functions. Although poor renal uptake was noted on the Tc-99m DMSA scan, an unusual area of soft tissue accumulation was detected in the right hypochondrium. A color Doppler study confirmed the diagnosis of soft tissue hemangioma as the cause of extrarenal Tc-99m DMSA accumulation, which has not been reported before. Poor renal function resulting in high blood-pool activity of Tc-99m DMSA may lead to extrarenal localization of the tracer in infantile hemangioma.

Ayın Olgusu Olgu Sunumu

Olgu: Yedi yasinda erkek hasta goz kapaginda yuzde boyunda ve goguste sislik nedeniyle Acil servisimize basvurdu Hikayesinden iki gun once sag yanakta sislik daha sonra her Iki goz kapaginda yuzunde ve gogus on yuzunde belirgin sisme gelistigi ogrenildi Fizik muayenede genel durum iyi parotis bezinde sislik ve duyarliligin yani sira her iki goz kapaginda yuzde boyunda ve gogus on duvarinda belirgin odem saptandi Resim1 Iki tarafli stenon kanalinin acildigi bolgede hiperemi saptandi Diger sistem muayeneleri normal idi Laboratuvar bulgularinda lokosit:10 300 mm3 Hemoglobin:12 7gr dl trombosit: 283 000 mm3 amilaz: 646 IU L 25 125 ELISA enzyme linked immunosorbant assay yontemi ile kabakulak IgM pozitif saptandi Boyun ultrasonografide USG parotis ve submandibular bezlerde odem siyaloadenit ayrica yuz boyun ve gogus on duvar cilt ve cilt alti yagli alanlarda odem bulundu Hastaya klinik ve laboratuvar bulgular ile kabakulak tanisi konuldu Vena kava superior ayrici tanisi acisindan dopler USG de venoz sistemin acik oldugu goruldu Deri uzerinde kizariklik isi artisi olmadigi icin selulit olarak dusunulmedi Odem goruntusu hastaligin seyri sirasinda gorulen nadir komplikasyon olarak degerlendirildi Tedavi verilmeden izlenen hastanin odeminin iki gun icinde belirgin azaldigi ve ucuncu gunde ise tamamen geriledigi goruldu Resim 2

Nadir Bir Sistemik Hipertansiyon Nedeni: Portal Hipertansiyon

Systemic hypertension of childhood displays important differences from hypertension in adulthood It usually has renal origin Our case is presented with bilateral visual loss Hypertension probably developed as a consequence of a spontaneous splenorenal shunt due to hypertension dating back to 3 months of age The shunt caused an increase in venous pressure before the left kidney which reflected back to the left kidney leading to edema and arteriolar tension Finally activation of the renin angiotensin system resulted in the occurance of systemic hypertension The case is presented because of this rare mechanism Key words: Systemic Hypertension Portal Hypertension