Cahit Karakelleoglu

Bone mineral density in children with cerebral palsy.

Abstract Background : The purpose of the present study was to evaluate the severity of and factors related to osteopenia in children with cerebral palsy (CP).

Vitamin D intoxication and therapy with alendronate (case report and review of literature)

Dear editor, We read the article of Bereket and Ertogan [1], reporting a 3-month-old boy with vitamin D intoxication, who was treated with alendronate, with great interest. Here we present a 7-year-old male with acute vitamin D intoxication, who was treated with oral alendronate. A 7-year old male child was admitted to our Pediatric Emergency Unit with symptoms of anorexia, nausea, vomiting, polydipsia, polyuria and constipation. In history, he was administered 300,000 units of oral vitamin D (cholecalciferol) daily for 15 days by an internist, who suspected vitamin D deficiency. Above mentioned symptoms had occurred at the end of 15 days. The physical examination on admission revealed impaired turgor of the skin and dryness of the oral mucosa consistent with moderate dehydration. The rest of the examination was unremarkable. On admission, laboratory findings are shown in Table 1. The patient was admitted to the ward and emergency treatment was initiated with IV hydration (2,500 mL/m/d, additional 20 mEq/l potassium chloride), furosemide (1 mg/kg/dose, every 6 h). Dietary calcium and vitamin D intake were restricted. A repeat serum calcium level was 14.8 mg/dL on the following day. Urinary calcium/creatinine ratio was initially high. Renal ultrasonography was reported as normal. Alendronate sodium 5 mg/d given by mouth was added to treatment after obtaining informed consent from the father. Serum calcium was still 14.3 mg/dL on the 3rd day of admission, the dose of alendronate was increased to 10 mg/d. Calcium levels decreased gradually in the following days. Then serum calcium dropped to 10.3 mg/dL on the 16th day and treatment was discontinued without any relapse. No side effects were noted with this treatment. Serum calcium levels remained normal thereafter. Urinary calcium/creatinine ratio decreased gradually to normal levels on 2nd month. Renal ultrasound examination at 2nd month after the admission did not show any evidence of nephrocalcinosis or other abnormalities. A radiographs of the hand taken on the admission, at 1 and 2 months after the admission did not show metaphyseal sclerosis. Laboratory values and treatment during follow-up are shown in Table 1. It is known that rapid normalization of serum calcium level and maintaining of normocalcemia are necessary to prevent acute complications and prolonged hypercalciuria and nephrocalcinosis [6]. Relative potency of alendronate to inhibit bone resorption is 10–20 times higher than that of pamidronate [7]. Although pamidronate has been used in children with vitamin D intoxication [2, 4], studies examining the efficacy of oral alendronate in children are limited. In literature, we found one case report which represented efficacy of alendronate in hypervitaminosis D [1]. There is currently little information to guide clinicians as to duration of treatment and what criteria should be used to indicate termination of the treatment. In our study normalization of serum calcium level also took almost two weeks and hypercalcemia did not recur. Another condition is duration of treatment effect. It is currently unclear how long the effect of bisphosphonate treatment will last once discontinued. When administered, bisphosphonates are cleared rapidly from the circulation. Its half-life in serum is short, a few hours or less, whereas the half-life in the bone Z. Orbak . H. Doneray . F. Keskin . A. Turgut . H. Alp . C. Karakelleoglu Department of Pediatric Endocrinology, Ataturk University Faculty of Medicine, Erzurum, Turkey

Efficacy and safety of rectal thiopental: Sedation for children undergoing computed tomography and magnetic resonance imaging

Abstract Purpose: We evaluated the clinical safety, effectiveness, efficiency and potential side effects of rectally administered thiopental in 30 children undergoing computed tomography (CT) and magnetic resonance imaging (MRI).

Intragastric alendronate therapy in two infants with vitamin D intoxication: A new method

In recent years, alendronate, an oral biphosphonate, has been added to therapy of hypercalcemia secondary to vitamin D intoxication in children. Alendronate may cause mucosal ulcerations in the mouth and esophagus. We report our experience in two infants with vitamin D intoxication to whom alendronate therapy was administered through nasogastric tube, an alternate route for alendronate administration.

Clinical outcomes in children with hyoscyamus niger intoxication not receiving physostigmine therapy.

Objective Diagnosis of hyoscyamus niger intoxication is based on clinical symptomatology and history. Therapy includes stomach lavage, supportive therapy, and physostigmine as a specific antidote. Physostigmine is not available in Turkey. This retrospective study investigated the clinical outcomes in children with hyoscyamus niger intoxication who did not receive physostigmine therapy. Methods Twenty-three children whose history and medical records indicated hyoscyamus niger intoxication were included the study. Results None of the cases had any abnormal laboratory findings. All the patients were performed gastric lavage and provided with supportive therapy. None of the children had any complications, and none required mechanical ventilation or died. All the patients were discharged in good health within 48 h. Conclusion Our findings suggest that hyoscyamus niger intoxication in children is self-terminating and responds to supportive therapy and that routine use of physostigmine is unnecessary in every case with hyoscyamus niger intoxication.

Late vitamin K deficiency bleeding: 16 cases reviewed.

In this study, clinical and demographic features of 16 cases with late vitamin K deficiency bleeding are presented. Ages of infants were between 30 and 130 days. Their delivery histories were uneventful, and family histories for bleeding disorders were negative. All parents except one were unaware of whether their children received vitamin K at birth or not. All cases did not have any underlying illness to explain the abnormal coagulation profile. The common presenting finding was pallor (62.5%). Intracranial haemorrhage was the most common bleeding site (37.5%), and two patients (12.5%) died because of it. Late vitamin K deficiency bleeding is still an important handicap in infants. Parents and healthcare providers should be informed about the importance of vitamin K prophylaxis to prevent vitamin K deficiency in infants.

Late side effects of high-dose steroid therapy on skeletal system in children with idiopathic thrombocytopenic purpura.

Corticosteroids have been widely used in the treatment of idiopathic thrombocytopenic purpura (ITP). We evaluated the late side effects of high-dose methylprednisolone (HDMP) therapy on bone metabolism in children with ITP. Twenty-eight children with acute ITP treated with HDMP (30 mg/kg/d for 3 d then 20 mg/kg/d for 4 d) and 28 controls were enrolled in the study. Bone mineral density (BMD), urinary calcium creatinine ratio, urinary levels of deoxypyridinoline, serum levels of calcium, phosphate, parathyroid hormone, total alkaline phosphatase, and bone-specific alkaline phosphatase were measured in both groups. Magnetic resonance imaging of the femoral head was performed only in study group. The mean levels of serum phosphate, parathyroid hormone, urinary deoxypyridinoline, and calcium creatinine ratio were significantly increased in the study group. There was no significant difference between the 2 groups in terms of serum calcium, total alkaline phosphatase, bone-specific alkaline phosphatase, and BMD values. There was a statistically significant negative correlation between cumulative steroid dose and BMD values in study group (r=−0.379). Osteonecrosis was observed in 3 of 25 patients by magnetic resonance imaging. In conclusion, HDMP therapy, especially in high cumulative doses, increases the bone resorption and may cause osteonecrosis in children with ITP.

Diagnosis of Group A β-Hemolytic Streptococcus Using the Breese Clinical Scoring System

This study was planned to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis and to evaluate its significance in different age groups. The research population was divided into two age groups. Group 1 consisted of children aged three and below and group 2 comprised children over three years of age. All of them were then evaluated using both the Breese scoring system and throat swab cultures. In group 1, there was no difference between the mean Breese scores of group A &bgr;-hemolytic Streptococcus (GABHS)-positive and negative patients. However, in group 2, the mean Breese scores were higher in GABHS-positive patients than in GABHS-negative patients (P < 0.001). The diagnostic value of the Breese scoring system in group 1 was sensitivity, 3.4%; specificity, 93.6%; positive predictive value, 18.2%; and negative predictive value, 70.1%. In group 2, sensitivity was 68.8%; specificity, 82.5%; positive predictive value, 78.8%; and negative predictive value, 73.7%. The results indicate that the Breese scoring system is still a useful scoring system for streptococcal pharyngitis in children over three years of age, and may help in deciding whether or not to take a throat-swab culture. A score >29 can be used as an indication for antibiotherapy. So it seems to be a useful marker for decision-making regarding antibiotherapy in emergency departments.

Febril Konvülsiyonlarda Klinik Özellikler ve Rekürrens Risk Faktörlerinin Prevalansı

Uc yillik bir sure icinde febril konvulsiyon nedeni ile takip ve tedavi edilen 85 febril konvulsiyonlu cocuk calisma kapsamina alindi ve bu hastalara ait klinik ozellikler retrospektif olarak incelendi Tum olgularin 46 si 54 11 ilk 18 i 21 17 ikinci konvulsiyonla basvurdu Rekurrensli toplam olgu sayisi 39 45 88 idi Uc veya daha fazla rekurrens gosterenler 21 olgu 24 70 ve kompleks ozellikli rekurrens gosterenler 10 olgu 11 76 idi Birinci konvulsiyonla getirilen cocuklarin ortalama yaslari 30 32±20 34 ay idi median: 24 nbsp; Ilk konvulsiyonla basvuranlar arasinda rekurrens icin risk faktorleri sayilan ilk konvulsiyon gecirme yasinin 1 yasin altinda olmasi 10 86 ailede epilepsi veya febril konvulsiyon hikayesinin bulunmasi 6 52 konvulsiyon suresinin gt;15 dk olmasi 17 39 bir hastalik esnasinda birden fazla konvulsiyon gecirme 2 17 ve rektal isinin lt;40°C olmasi 82 60 oraninda saptanmistir Tum olgularin basvurularinda saptanan rektal isi dereceleri arasinda ve ates sureleri arasinda konvulsiyonun sayisi ve sekline gore fark bulunmadi p gt;0 05 Olgularin yas ortalamalari incelendiginde basit ve kompleks nobet gecirenler arasinda istatistiksel fark saptandi p lt;0 05 Olgularin 14 11 inde enfeksiyon kaynagi saptanamazken 12 94 unde bronkopnomoni 4 7 inde gastroenterit 61 17 sinde ust solunum yolu enfeksiyonu 12 94 unde otitis media 2 35 inde shigellozis 1 17 sinde sellulit 1 17 sinde uriner enfeksiyon saptandi Olgularin yalnizca birinde 1 17 ailede epilepsi oykusu alindi Ailede febril konvulsiyon hikayesi ise 10 olguda 11 76 saptandi Basit konvulsiyon geciren olgularin dokuz 13 23 ve kompleks nobet geciren olgularin birinde 5 88 oyku pozitif idi p gt;0 05 Anahtar kelimeler: Febril Konvulsiyon Rekurrens Icin Risk Faktorleri