Ayhan Söğüt

Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

BackgroundCephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS).ObjectiveTo evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity.Materials and methodsThe study population consisted of 39 children, aged 4–12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded.ResultsCranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=−0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH (P<0.001).ConclusionsThere is significant correlation between cephalometric data and AHI score severity in children with OSAS. Adenotonsillar hypertrophy affects the cephalometric measurements adversely. The study clearly mandates the institution of early and effective therapy of adenotonsillar hypertrophy in children with OSAS.

Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea.

Background/Aims: We aimed to determine the effects of adenoidectomy and/or tonsillectomy (AT) on cardiac functions in children with adenoid and/or tonsillary hypertrophy and obstructive sleep apnea syndrome (OSAS) by using echocardiography with tissue Doppler imaging facility (TDI). Methods: Twenty-nine children with adenoid and/or tonsillary hypertrophy and OSAS and 26 children with primary snoring entered the study. Cardiac functions were assessed by echocardiography with TDI in both groups. Tests were repeated in the OSAS group 6 months after treatment with AT. Results: Echocardiography showed a decrease in estimated pulmonary artery systolic pressure from 31 ± 4.2 to 13.1 ± 2.3 (p < 0.001). In TDI, tricuspid Em and Em/Am increased from 11.0 ± 2.7 to 13.5 ± 2.7 cm/s (p < 0.001), and 1.46 ± 0.52 to 1.82 ± 0.53 (p = 0.004), respectively, following AT, indicating improvement in right ventricular diastolic dysfunction. Similarly, mitral Em and Em /Am increased from 12.3 ± 2.1 to 16.3 ± 2.7 cm/s, and from 1.65 ± 0.51 to 2.30 ± 0.54, respectively (p < 0.001). There was no significant difference between postoperative values and control group values. Conclusion: TDI is a technique able to detect diastolic dysfunction unnoticeable by conventional echocardiography. Following AT, we observed improvement in both left and right ventricular diastolic functions using TDI.

Ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge

Ceftriaxone is known to induce precipitates that mimic a gallstone on sonograms in the gallbladder of children and adults. Terms such as ‘biliary pseudolithiasis’ are now used to denote the reversible, benign character of this complication upon discontinuation of ceftriaxone therapy. 1–3 The first sonographic demonstration of precipitates forming in the gallbladder during ceftriaxone therapy was reported by Schaad et al . in 1986. 3 In subsequent reports, biliary sludge or biliary pseudolithiasis, has frequently been reported with this antibiotic. 1,2,4 Ceftriaxone-induced urinary calculi are rarely observed. Six cases of ceftriaxone urinary calculi have been published. 1,4–7 In this study, we report a case who developed ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge, which were completely resolved after the ceftriaxone treatment ceased. To our knowledge ceftriaxone-induced urinary bladder sludge has not been reported previously. In this case, we report the first documented case of ceftriaxone-induced urinary bladder sludge.

Gallbladder and urinary tract precipitations associated with ceftriaxone therapy in children: a prospective study

Abstract The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20–30-minute periods, for 5–14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4–9 days of ceftriaxone therapy, and resolved completely 7–19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.

Effects of allergen-specific immunotherapy on functions of helper and regulatory T cells in patients with seasonal allergic rhinitis.

BACKGROUND Seasonal allergic rhinitis (SAR) is characterized by a helper T (Th)2 cell-mediated immune response at the target site. There is a relative Th1 and/or regulatory T (Treg) cell insufficiency in patients with SAR. It has been demonstrated that there is a change in the balance between these cells after allergen-specific immunotherapy (SIT), which is a curative treatment modality for this disease. However, there are few studies that evaluate the number and function of these cells in the inflammatory area after SIT treatment. OBJECTIVE We aimed to investigate the distribution of Th1, Th2 and Treg cells in nasal biopsies and lavage fluid (NLF) specimens from patients with SAR, before and after SIT. METHODS Twenty-four, symptomatic SAR patients sensitized to Olea europeae, were enrolled in the study prior to treatment. Fifteen, non-allergic subjects with nasal septum deviation, who needed surgical treatment, served as the control group. NLF and inferior turbinate biopsies were obtained from both groups during the pollen season. Conventional, subcutaneous SIT with Olea europeae extract was initiated in patients with SAR. One year after the first biopsy, biopsies and NLF specimens were again obtained for reevaluation. All biopsies were evaluated for Th1, Th2 and Treg cell counts by means of their transcription factors (T-bet, GATA-3 and FoxP3) using an immunohistochemical analysis method. Additionally, all NLF specimens were evaluated for the functions of these cells, by means of their specific cytokines, using an ELISA method. RESULTS When the basal status of those patients with SAR was evaluated based on transcription factors, prior to treatment, Th1 and Treg cells were found to be fewer than in non-allergic controls (p=0.001 for both T-bet and FoxP3). It was demonstrated that numbers of GATA-3-carrying cells, which are a marker for Th2, were not significantly different between the groups (p=0.276), but evaluation of the Th1/Th2 ratio revealed a relative Th2 dominance in patients with SAR prior to treatment. When evaluated on the basis of cytokine levels, it was observed that Th1-originated IFN-γ was lower in patients with SAR compared to the control group, both before and after treatment (p=0.012 for both comparisons), Th2-originated IL-4 levels were not significantly different between the groups either before or after treatment (p=0.649, p=0.855; respectively). Th2- and Treg cell-originated IL-10 levels were higher in patients with SAR before treatment (p=0.033), but this difference was not statistically signifant following treatment compared with controls (p=0.174). Treg cell-originated TGF-β levels were slightly lower in patients with SAR compared to the controls, although the difference was not statistically significant (p=0.178, p=0.296; respectively). None of the above mentioned cytokine levels changed significantly as a result of SIT. CONCLUSION The results of our study indicate that although clinical findings improve after one year of SIT, this duration may not be sufficient to detect changes in cytokine patterns and transcription factors. Further studies that evaluate outcome over a longer duration of treatment would provide valuable information.

Effectiveness of magnetic resonance angiography in the evaluation of lung perfusion in constrictive bronchiolitis obliterans

Childhood constrictive bronchiolitis obliterans (CBO) is characterized clinically by the persistence of obstructive respiratory symptoms following a prolonged episode of lower respiratory viral infection. The diagnosis depends on the clinical, radiological and laboratory findings. Perfusion defects on scintigraphy may predict the severity. This report describes a 2‐year‐old girl who presented with a 15‐day history of respiratory distress despite treatment. Auscultation of the lungs revealed prolonged expiration and bilateral crepitant rales. CXR revealed bilateral paracardiac infiltration. She improved with a treatment regimen of bronchodilators, systemic steroids and antibiotherapy; however, rales were detected again 10 days after discharge. HRCT of the lung revealed an oligaemic‐mosaic pattern, more prominent in the left lung. The diagnosis of CBO was made on the basis of these clinical and radiological findings. Perfusion was normal in the right lung but diffusely decreased in the left lung on perfusion scintigraphy by Tc99m‐MAA. Magnetic resonance (MR) angiography source images of the lungs revealed significant but not diffuse perfusion defects in the left lung, in contrast to radionuclide scintigraphy. There were areas of low perfusion in the right lung, which were not evident in radionuclide scintigraphy. The use of source images of MRI angiography of the lungs may be more sensitive and specific for the detection of perfusion defects in patients with CBO and may assist in determining the prognosis.

Isovaleric acidaemia: cranial CT and MRI findings

Isovaleric acidaemia is an inborn error of leucine metabolism due to deficiency of isovaleryl-CoA dehydrogenase, which results in accumulation of isovaleric acid in body fluids. There are acute and chronic-intermittent forms of the disease. We present the cranial CT and MRI findings of a 19-month-old girl with the chronic-intermittent form of isovaleric acidaemia. She presented with severe metabolic acidosis, hyperglycaemia, glycosuria, ketonuria and acute encephalopathy. Cranial CT revealed bilateral hypodensity of the globi pallidi. MRI showed signal changes in the globi pallidi and corticospinal tracts of the mesencephalon, which were hypointense on T1-weighted and hyperintense on T2-weighted images.

Ailevi Akdeniz Ateşi ile birliktelik gösteren Juvenil Ankilozan Spondilitli bir olgu

Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery.Iki tarafli ses teli felci (ISTF) siklikla tiroid ve paratiroid cerrahisi gibi iyatrojenik bir hasar sonucu olusur. Fakat serebral infarkt sonrasi hava yolu tikanikligina neden olan BVKP nadir olarak bildirilmistir. Bu yazida tekrarlayan serebral infarktin, gec ortaya cikan ve hayati tehdit eden bir komplikasyonu olarak solunum durmasi ile sonuclanan bir ISTF olgusu sunduk. Atmis yedi yasinda erkek hasta, son 3-4 aydir giderek artan solunum yetmezligi sikayetiyle acil servisimize basvurdu. Ozgecmisinde kalp yetmezligi ve kronik obstruktif akciger hastaligi oykusu olmayan hasta, yaklasik bir yil once bir ayda iki kez serebral infarkt gecirmisti. Yapilan solunum sistemi muayenesinde bilateral wheezing ve stridor; norolojik muayenesinde ise sag tarafta kuvvet kaybi mevcuttu. Ust solunum yolu obstruksiyonunu degerlendirilmek uzere endoskopik laringoskopi yapildi. Laringoskopide iki tarafli ses tellerinin orta hatta sabit ve hareketsiz oldugu goruldu. Solunum yetmezliginde artma ve tekrarlayan solunum durmasi nedeniyle hastaya trakeostomi acildi. Operasyon sonrasi hastanin solunum yetmezligi geriledi. Solunum fonksiyonlari normale donen hasta taburcu edildi.Dysphagia aortica is a rare etiological factor of dysphagia resulting from extrinsic compression of the esophagus by thoracic aorta. There is no gold standard diagnostic proscedure for dysphagia aortica. Dysphagia aortica is usually escaped to attention in the differential diagnosis of dyssphagia. Here, we reported compression of the esophagus by thoracic aorta in a 54 years-old male patient who comsplained from dysphagia.

Summary of Consensus Report on Preoperative Evaluation

INTRODUCTION The clinician has three aims in the preoperative evaluation: to determine the risk of preoperative complications, to decrease the risk of perioperative complications, and to eliminate the risk factors in patients who have a risk of complications in the postoperative period. For this purpose, an accurate preoperative evaluation would allow the patient to be operated on with minimum risk.

Samsun ili kreş ve anaokulu çocuklarında besin alerjisi yaygınlığı

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Şükrü Nail Güner MD, Ondokuz Mayıs University, Medical Faculty, Pediatric Allergy and Immunology Clinic, Samsun, Turkey E-mail: gunersukru@hotmail.com Re cei ved/Ge lifl Ta ri hi: 08.09.2012 Ac cep ted/Ka bul Ta ri hi: 16.04.2013 Turkish Archives of Pediatrics, published by Galenos Publishing / Türk Pediatri Arşivi Dergisi, Galenos Yayınevi tarafından basılmıştır. Prevalence of food allergy in nursery and kindergarten children in Samsun Original Article