Bülent Oran

Sydenham's chorea: a clinical follow-up of 65 patients.

Sydenhams chorea, the neurological manifestation of rheumatic fever, is the most common acquired chorea of childhood. In this retrospective study, the authors aim to present the clinical and laboratory findings of 65 Sydenhams chorea patients, followed up in a clinic over less than 7 years. The mean age at the onset of the symptoms was 11.7 ± 2.6 years (range, 6-17 years). Of the patients, 63% were female and 37% were male (male/female: 1.7/1). Chorea was generalized in 78.5% of the patients, right hemichorea in 12.3%, and left hemichorea 9.2%. There was a history of rheumatic fever in 30.8% of the patients. Echocardiographic study showed cardiac valve involvement in 70.5% of 61 patients. Brain magnetic resonance imaging, which was performed on only 18 patients, was evaluated as normal in all. Electroencephalography was also performed on only 18 patients and showed abnormal waves in 50% of them. Pimozide was mostly the first choice of drug therapy. Nevertheless, drug therapy was not needed in 18.5% of the patients. The recovery period of the first attack of the chorea was 1 to 6 months in 51.7% of the patients. The recurrence rate was 37.9%. In conclusion, Sydenhams chorea is still an important health problem in Turkey with respect to its morbidity.

Acute rheumatic fever in Konya, Turkey.

Abstract Background: Patients with acute rheumatic fever (ARF), who were admitted to Pediatric Cardiology Unit of Selçuk University Faculty of Medicine from July 1993 to 1998, were studied retrospectively to verify the clinical profile of the disease and to compare the results with those from other countries.

Serum cardiac troponin-I in active rheumatic carditis.

Objective :The study was performed to investigate the level of serum cardiac troponin I (cTnl), a specific marker for myocardial cell damage, in the acute rheumatic carditis (RC).Methods : Twenty seven consecutive patients with acute RC and 23 healthy children were enrolled.Result: cTnl level in both groups showed no statistical difference (p > 0.05).Conclusion: Serum cTnl level did not gain clinical use.

Normal values of left and right ventricular function measured by M‐mode, pulsed doppler and Doppler tissue imaging in healthy term neonates during a 1‐year period

BACKGROUND The measurements of left and right ventricular functions change after birth due to the influence of several hemodynamic changes upon the immature myocardium. AIM The aim of this study was to investigate the changes in left (LV) and right ventricular (RV) functions of healthy term newborns using conventional and Doppler echocardiography during a 1-year period. SUBJECTS AND METHODS Fifty healthy term newborns were examined prospectively on the first day, 3-4, 6-7, 9-10 and 11-12 months of their lives by M-mode, pulsed Doppler (PD) and Doppler tissue imaging techniques (DTI). PD velocities were obtained from mitral and tricuspid valves while DTI velocities were obtained from the lateral annuluses of atrioventricular valves. RESULTS EF and FS did not change significantly by time. Early (E) flow velocity and early myocardial (Em) velocity were higher than late (A) flow velocity and atrial systolic (Am) velocity for LV, while A and Am velocities were higher than E and Em velocities for RV, respectively during the study period. E, A, Em, Am, Sm velocities and Em/Am ratios increased while E/Em ratios decreased significantly by time (P<0.05) for both ventricle. However, E/A ratios of LV and RV did not change significantly by time. Myocardial performance index (MPI), obtained by PD for RV and by DTI for LV, decreased significantly by time (P<0.05) and these DTI values were higher than PD values during the study period. CONCLUSIONS Due to hemodynamic and maturation change of myocardium PD and DTI velocity changes took place during the first year of life which reflects differences in ventricular adaptation.

Atherogenic lipid profile and systolic blood pressure are associated with carotid artery intima-media thickness in children with Turner syndrome.

Objective: Women with Turner syndrome (TS) have greater carotid artery intima-media thickness (cIMT) known to be a risk factor for atherosclerosis in adults. To determine whether there are risk factors for atherosclerosis in children with TS, we compared cIMT, anthropometric and metabolic parameters between children with TS and healthy controls. Methods: Data of children with TS with XO karyotype (n=24, mean age: 11.6±3.6) were compared with those of healthy children (n=24, mean age: 10.5±3.6) with respect to anthropometric parameters, lipid levels, insulin resistance and cIMT which was measured by high resolution B-mode ultrasonography. Results: Mean age and cIMT values were similar in the two groups of children. However in children with TS, fasting glucose (p=0.01), total cholesterol (p=0.006), triglyceride (p=0.04) levels and HDL-cholesterol (p=0.002) levels were higher than those of controls. In the TS group, cIMT correlated positively with LDL-cholesterol (r=0.435, p=0.034) and with systolic blood pressure (r=0.430, p=0.036) and negatively with HDL-cholesterol (r=-0.518, p=0.01). In stepwise regression analysis, HDL-cholesterol emerged as a significant predictor of cIMT (b= -0.518, p=0.01) contributing to 26.8 % of its variability. Conclusion: The systolic blood pressure and dyslipidaemia were shown to be risk factors for atherosclerosis in children with TS. Conflict of interest:None declared.

Increased Cardiac Troponin I Concentration in Diabetic Ketoacidosis

OBJECTIVE To examine the hypothesis that diabetic ketoacidosis may be associated with some degree of induced injury to heart muscle, related either to acidosis or hyperglycemia. METHODS Nineteen diabetic patients with acute ketoacidosis and 19 healthy children were enrolled in this study. Cardiac troponin I (cTnI), creatine kinase (CK)-MB and myoglobin levels were analyzed soon after admission and after 24 h. Patients were subdivided into two groups according to blood pH. RESULTS At the time of admission, the diabetic patients had significantly higher values than the controls for cTnI (0.193+/-0.008 vs 0.176+/-0.006 ng/dl; p <0.001), CK-MB (24.1+/-2.1 vs 22.7+/-1.2 U/l; p = 0.02), and myoglobin (85.5+/-7.4 vs 52.5 +/-8.3 microg/dl; p <0.001). The diabetic patients also had significantly higher values than the controls for CK-MB (24+/-2.1 vs 22.7+/-1.2 U/l; p = 0.02) and for myoglobin (78.5+/-2.5 vs 52.5+/-8.3 microg/dl; p <0.001) at 24 h. cTnI had normalized in patients at 24 h. All parameters were significantly different between patients with pH > or =7.0 and patients with pH <7.0. In addition, serum cTnI levels correlated negatively with blood pH (r = -0.57, p = 0.026) and HCO3- (r = -0.65, p = 0.008) in the patients with diabetic ketoacidosis on admission. CONCLUSION Our findings suggest that diabetic ketoacidosis, particularly when severe, has a detrimental effect on the myocardium.

Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers

Abstract Aim: To compare echocardiographic findings of infants of diabetic mothers (IDMs), macrosomic infants of nondiabetic mothers and healthy full term appropriate-for-gestational-age (AGA) infants. Methods: Included in this study were 83 infants, admitted to our Neonatology Unit. Thirty-three IDMs, including both macrosomic and nonmacrosomic, comprised Group A, 25 macrosomic infants of nondiabetic mothers comprised group B, and 25 healthy full term AGA infants comprised group C. Echocardiographic measurements were performed in the first three days after birth and compared by using one-way ANOVA, Post Hoc Tukey HSD and Students t tests. Results: The left ventricular end-systolic/left ventricular end-diastolic diameter ratio of group A was significantly smaller than that of group C (P<0.05). The interventricular septum/posterior wall thickness ratios of groups A and B were greater than those of group C (P<0.05). The left ventricular mass index of group A was greater than those of groups B and C (P<0.05). The shortening fraction and ejection fraction of group A were increased in comparison to group C (P<0.05). When comparing the values of echocardiographic measurements of macrosomic IDMs (n=9) with nonmacrosomic ones (n=24), and infants of pregestational diabetic mothers (n=11) with those of gestational diabetes mothers (n=22), no statistical difference was found. Conclusion: The present study suggests that underlying mechanisms common to both macrosomic infants of nondiabetic mothers and IDMs lead to less cardiac alterations in the macrosomic infants of nondiabetic mothers than in IDMs.

Diagnostic role of 99mTc hexamethyl-propyleneamine oxime brain single photon emission computed tomography in Sydenham's chorea

Abstract Background : The objective of this study was to determine whether technetium‐99m hexamethyl‐propyleneamine oxime (HMPAO) brain single photon emission computed tomography (SPECT) imaging is capable of detecting perfusional abnormalities in Sydenhams chorea (SC) patients and contributing to diagnosis of SC.

CARDIAC FUNCTIONS EVALUATED WITH TISSUE DOPPLER IMAGING IN CHILDHOOD CANCERS TREATED WITH ANTHRACYCLINES

Aim: The aim of this study was to assess the cardiac functions using conventional echocardiography and tissue Doppler imaging in childhood cancers treated with anthracyclines. Methods: The study group was selected from the patients admitted to the pediatric oncology department for a treatment protocol that included doxorubicin. Body surface area was calculated and complete 2-dimensional, M-mode, pulse wave Doppler and pulse wave tissue Doppler echocardiographic examinations were performed just before the first treatment and at least 6 months after the last treatment. Results: This study included 20 patients (12 males and 8 females). Mean cumulative antracycline dose was 189 ± 102.90 mg/m2. There were no significant differences between the pre- and post-treatment groups regarding systolic and diastolic blood pressures, heart rates, left ventricular ejection fraction and fractional shortening, right and left ventricular conventional and tissue Doppler diastolic parameters (E and A waves, E/A ratio, E′ and A′ waves, E′/A′ ratio), but there were significant differences between the pre- and post-treatment groups regarding body surface area, right and left ventricular myocardial performance index observed by conventional pulse wave and pulse wave tissue Doppler methods. Conclusion: Tissue Doppler imaging provided additional information on cardiac functions. While systolic and diastolic functions were in normal range, myocardial performance index observed by tissue Doopler method was impaired in children who were treated with anthracyclines.

Criteria for judging the improvement in subclinical rheumatic valvitis.

Recent technical improvements in cross-sectional echocardiography have made it possible to detect even mild organic regurgitation of the mitral and aortic valves in patients with acute rheumatic fever. To determine the prevalence and prognosis of subclinical valvitis, we have analyzed 104 patients with acute rheumatic fever referred to our institution. Of 53 patients who had no murmur, 22 of them with polyarthritis, 29 with chorea, and 2 with polyarthritis and chorea, 23 (43.4%) had subclinical valvitis. Isolated mitral regurgitation was the most common valvar lesion, seen in 82.6% of the patients. Isolated aortic regurgitation was detected in 4.4% of the cases, and combined mitral and aortic regurgitation in the remaining 13%. During follow-up, the degree of mitral regurgitation improved in 59.1%, decreased in 18.2%, and increased or remained unchanged in 22.7% according to the length of colour jet. According to criterions of velocity, mitral regurgitation improved in 86.4% of the patients, and increased or unchanged in the remaining 13.6%. Mitral regurgitation disappeared completely in 6 of the patients (27.3%) as judged according to both the length of colour jet and the velocity of regurgitation. Aortic regurgitation improved in all the patients with this problem, disappearing completely in two of the four. Based on this experience, we suggest that not only the disappearance of regurgitation, but also improvements in the echocardiographic diagnostic criterions of regurgitation, such as the length of the colour jet less than 1 cm, or velocity less than 2.5 m/s, or indicative of regurgitation that is either intermittent or of short duration, should also be considered as criterions indicating improvement in valvar regurgitation in patients with subclinical rheumatic valvitis.