Aybars Özkan

Do gastrointestinal and respiratory signs and symptoms correlate with the severity of gastroesophageal reflux

BackgroundGastroesophageal reflux (GER) is a disorder that is common by seen in childhood and may lead to severe complications. In this study, we ascertained the incidence of GER among the children who had typical and atypical complaints of GER and whether there was a difference between two groups comparing the findings of 24-hour pH-meter.Methods39 out of 70 patients with typical and atypical GER symptoms were diagnosed as GER by 24-hour pH-meter monitoring. The patients were divided into three groups, those having gastrointestinal complaints, those having respiratory complaints and those having both gastrointestinal and respiratory symptoms.ResultsEvaluated the GER prevalence in these groups, it was found to be 60% in the gastrointestinal group, 48.6% in the respiratory group and 75% in the mixed group. When pH-meter measurements of GER positive patients were compared within the clinical groups, the fraction of time that pH was lower than 4 was found to be significantly higher in the mixed group (p = 0.004).ConclusionsThe coexistence of gastrointestinal and respiratory symptoms in the patients with GER may be related to the severe reflux.

A case of bronchogenic cyst mimicking foreign body aspiration.

Bronchogenic cysts (BCs) can be life threatening if they compress vital structures in infants and small children. In particular, subcarinal cysts can be life-threatening and compromise the airways. In infants, the initial presentation may be respiratory distress. We report a case of mediastinal cystic mass compressing the main left bronchus. The case was an 18-month-old boy who had been admitted with acute respiratory distress. Chest x-ray showed overdistension of the left lung and a mediastinal shift. Foreign body aspiration was diagnosed. Magnetic resonance imaging was performed, which has shown a mediastinal cystic mass; therefore, the patient underwent thoracotomy. Surgical intervention revealed a subcarinal extrapulmonary BC that compresses the left main bronchus. The diagnosis of BC was confirmed with pathological investigation. In this report, we present a case of BC with the emphasis on the differential diagnosis with foreign body aspiration.

The Scintigraphic Findings of Gastroesophageal Reflux in Children is Related to Body Weight

Background Gastroesophageal reflux disease (GERD) is the most common cause of children admissions to pediatric gastroenterology unit and affects about 30% of pediatric population. Body weight and height percentiles of children with GERD and their relationship between presence and the severity of reflux on scintigraphic images were studied. Methods Patients who underwent reflux scintigraphy between 2005 - 2012 were retrospectively reviewed. Among 200 patients, 49 patients were involved that their ages were ranging from 0 to 18 years old and body weight and height percentiles were recorded. Accurately 37 MBq (1 mCi) 99mTc-MAA in 100 - 150 mL of milk was ingested by the patient. Presence, number, duration and level of reflux were evaluated on the dynamic images. Presences of reflux within last ten minute were also recorded. Region-of-interests were drawn on esophagus and stomach and reflux ratio (RR) was calculated. Results The ratio of the presence of reflux which occurred within the last ten minutes was significantly higher in children with low body weight percentile. High-level reflux frequency was higher in these children than in normal’s. Presence of reflux which occurred within the last ten minutes was related with low body weight percentile. Conclusions If reflux is shown within the last ten minutes and there is high level of reflux, the clinician should be warned about possible low body weight percentile in the future and scintigraphic study should be a guide or a reference for the assessment of more effective treatment methods.

An extremely rare cause of bruising in children: autoerythrocyte sensitization syndrome.

Autoerythrocyte sensitization syndrome (ASS)—also known as Gardner-Diamond syndrome—is an autoimmune vasculopathy associated with sensitization to phosphatidylserine, a phosphoglyceride of red blood cell membranes [1]. The syndrome was first described in 1955 by Gardner and Diamond in 4 female patients [2]. ASS is typically seen in adult females; however, pediatric and male patients have also been described [2-4]. The disease usually develops after psychic stress. It is characterized by development of painful edematous skin lesions that progress to ecchymoses during the following 24 h [5]. The diagnosis of ASS is confirmed via an autoerythrocyte sensitization test [2]. Herein we report ASS in a previously healthy 7-year-old boy.

Malrotation-associated cholecystoduodenal fistula

Patient: Female, 16 Final Diagnosis: Malrotation and cholecystoduodenal fistula Symptoms: Abdominal pain • anorexia • fever • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Anatomical anomaly/variation Background: Cholecystoduodenal fistula (CDF) is the most common cholecystenteric fistula. It is a late complication of gallbladder disease with calculus and is mainly encountered in the elderly and females. Case Report: We report the case of a teenage patient with cholecystoduodenal fistula and malrotation. Direct plain abdominal x-ray demonstrated air in the biliary system. Computed tomography revealed CDF-associated with an anomaly of intestinal malrotation. She had gallstones (with a few stones in the gallbladder) and cholecystitis. CDF is caused by malrotation, and cholecystitis has not been reported before. In this regard our patient is the first and youngest reported case. Conclusions: We suggest that CDF is probably a consequence of malrotation. The patient’s clinical features and operative management are presented and discussed with current literature.

A case of isolated thrombocytopenia due to cobalamin deficiency

The most common form of isolated thrombocytopenia is idiopathic thrombocytopenic purpura (ITP) in childhood. Hence, pediatricians consider a possible diagnosis of ITP in patients with isolated thrombocytopenia who are admitted to hospital with complaints of skin findings such as petechiae, purpura, and ecchymosis. It is well known that cobalamin deficiency may also cause thrombocytopenia together with anemia and leukopenia in children. However, isolated thrombocytopenia due to cobalamin deficiency has rarely been reported in literature. In this case report, we present a 7-year-old female patient with isolated thrombocytopenia that was improved by cyanocobalamin therapy.

A case of bronchogenic cyst admitted by recurrent pulmonary infection

Bronkojenik kist embriyonik foregutun anormal tomurcuk- lanmasi sonucu gelisen ender rastlanan bir bozukluktur. Bazen dogumda solunum sikintisina neden olurken bazen de eriskin doneme kadar asemptomatik kalabilir. Basiya bagli klinik bulgular yenidogan ve sut cocuklugu donemindeki en onemli yakinmalardir. Burada tekrarlayan akciger enfeksiyo- nu nedeniyle izlenen 9 aylik bronkojenik kist olgusu sunul- mustur. Tekrarlayan akciger enfeksiyonu etiyolojisinde bron- kojenik kistin de goz onunde bulundurulmasi gerektigini vurgulamak istedik. Bronchogenic cyst is a rare disorder that result from abnor- mal budding of embrionic foregut. While it sometimes cau- ses to respiratory distress at birth, it may also remain asymptomatic until adulthood. Clinical symptoms due to compression are most frequent complaints in neonatal and infancy period. Herein, a nine month old case of bronchoge- nic cyst followed for recurrent pulmonary infections was presented. We would like to emphasize that the bronchoge- nic cyst should be considered on etiology of recurrent pul- monary infections.