Embiya Dilber

Amitraz intoxication in children in the rural Black Sea region: analysis of forty-three patients

Amitraz is used topically in the treatment of demodicosis and other ectoparasitic infestations. Amitraz poisoning in children has been reported in a few cases. We presented 43 cases with amitraz intoxication. Of the patients, 14 had skin exposure. We compared the skin to peroral exposure group considering intoxication findings and outcome. In the peroral exposure group symptoms and recovery were more severe than in the skin exposure group, but mortality was not seen in two groups.

Crimean-Congo haemorrhagic fever among children in north-eastern Turkey.

Abstract Aim: To analyse the epidemiological and clinical features of children with Crimean–Congo haemorrhagic fever (CCHF) in north-eastern Turkey. Methods: A retrospective study of demographic features and physical and laboratory findings in 21 children with CCHF is described. Clinical course, treatment modalities and outcome were analysed. Results: Most patients were admitted in June and July 2008; most were from the Gumushane and Kelkit valleys and half of them lived in rural areas. Mean (SD) age was 10.3 (3.9) years and the disease was more common in males (71.4%). Approximately 70% had a history of tick bite. The main symptoms were fever (17, 80.9%), nausea (11, 52.3%), malaise (10, 47.6%) and headache (7, 33.3%). At initial examination, approximately 70% of patients had leukopenia and 65% had thrombocytopenia. Anaemia developed during follow-up in six patients. Liver involvement was seen in 12 patients and one patient had acute tubular necrosis. Six patients had haemophagocytosis. Patients were hospitalised for a median 8 days (range 3–22) and nine patients had bleeding from various sites approximately 3–5 days after hospitalisation. Subcutaneous haematoma (6), especially epistaxis and at venepuncture sites (6) were the most common sites of bleeding. Pulmonary haemorrhage developed in two patients and they required ventilatory support. Overall mortality related to CCHF was 4.7% (one patient). Conclusion: Early diagnosis of CCHF and early referral to specialised centres are important for outcome. Exceptional epidemics may be seen in future owing to ecological and environmental changes.

High-dose methylprednisolone in children with Crimean-Congo haemorrhagic fever

Treatment options for Crimean-Congo haemorrhagic fever (CCHF) are limited and based on general supportive managements. Thrombocytopenia is the major risk factor of CCHF. We report our experience with high-dose methylprednisolone (HDMP). This study included five patients with CCHF. Patients were given HDMP if there were findings compatible with virus-associated haemophagocytic syndrome and the effects of HDMP were evaluated. Following this, HDMP fever subsided and platelet counts increased within 24 hours. Leukocyte counts began to increase and visceral bleedings were improved. HDMP treatment was discontinued within approximately five days. After HDMP, only one patient required blood products. HDMP is effective in CCHF, especially on fever and platelet counts. Dependency on blood products was decreased. Further controlled randomized studies with large series are needed in order to analyse the timing and duration of HDMP treatment and its effect on outcome.

Hemophagocytic syndrome as an initial presentation of miliary tuberculosis without pulmonary findings.

A 9-y-old girl was admitted with fever, weakness and weight loss. She had pancytopenia in peripheral blood, hypocellularity and hemophagocytosis in bone marrow. Disseminated tuberculosis was diagnosed after a long delay, with involvement of the lungs, bone marrow, liver, spleen and central nervous system. Tuberculosis can be a cause of hemophagocytosis and should be taken into account in the differential diagnosis of fever of unknown origin associated with pancytopenia and hemophagocytosis.

Lead Extraction in Children and Young Adults Using Different Techniques

Objective: To describe our experience with removal of pacing lead in children using different techniques. Patients and Methods: Between 1999 and 2006, removal of 39 leads was attempted in 30 patients: 21 males and 9 females aged 4–21 years (mean 12 ± 5 years). Sixteen patients had previous corrective cardiac surgery. The leads had been implanted for 46 ± 31 months (range 1–120 months). The reasons for removal included lead fracture in 14, upgrading in 8, infection in 7, dislodgment in 5, pacing system not needed in 2, and other reasons in 3. Results: Of the 39 leads, 29 (74.3%) were completely removed. Twelve leads were removed with simple traction and rotation and 9 were removed using a locking stylet combined with simple traction and rotation; a laser extraction system was used in 10 cases in which 8 leads were successfully removed. Duration of implantation was the only important predictor for successful removal. Three patients necessitated surgical lead removal and had epicardial pacemaker implantation. Conclusion: Using currently available techniques, percutaneous pacemaker lead removal was possible in the majority of cases, although a significant number of cases were not successful. Attempted lead removal with simple traction and rotation resulted in the need for surgical removal in a significant number of patients. Newer techniques should be developed to increase the success rate.

Listeria monocytogenes meningitis in two immunocompetent children.

Abstract Listeria monocytogenes is an uncommon cause of bacterial meningitis beyond the neonatal period. Patients with immunosuppression or neoplastic disease are at increased risk of developing serious invasive disease, particularly meningitis. L. monocytogenes meningitis in two previously healthy, immunocompetent children aged 7 years and 18 months is described. One of them was successfully treated with ampicillin and amikacin. In the other there was resistance to ampicillin, and meropenem, vancomycin and amikacin were given. One patient developed unilateral abducens paralysis and inappropriate antidiuretic hormone secretion. L. monocytogenes should be suspected in children with bacterial meningitis who fail to respond to empirical antibiotic therapy.

Pontocerebellar hypoplasia in two siblings with dysmorphic features.

We present two siblings with pontocerebellar hypoplasia who have progressive microcephaly, mental and motor retardation, truncal ataxia, strabismus, and progressive spasticity and hyperreflexia of the lower limbs. Extrapyramidal dyskinesia and epilepsy, other main clinical features of pontocerebellar hypoplasia, are absent. The older sibling also has a high arched palate, triangular-shaped face, thoracolumbar scoliosis, pectus carinatum, kyphosis, cubitus valgus, arachnodactyly, long extremities, and a tall stature, which were not previously reported in association with pontocerebellar hypoplasia. The clinical phenotype should be expanded, especially within type II, with the reports of additional cases. (J Child Neurol 2002;17:64-66).

Sturge-Weber syndrome in a 14-year-old girl without facial naevus

Sturge-Weber syndrome (SWS) is a neuroectodermal disease characterised by facial port-wine naevus, unilateral seizures (usually controlateral to the side of the facial naevus), and mental retardation with accompanying ocular, skeletal or cutaneous abnormalities [6]. A 14-year-old girl was admitted to hospital with partial seizure, secondarily generalised. Her first generalised tonic-clonic seizure had apparently occurred at the age of 1 year. Soon thereafter, she had suffered a febrile, secondary generalised tonic-clonic seizure several times and subsequently, a right hemiparesis had developed. She had been treated with several anti-epileptic drugs. On neurological examination, a right-sided central facial paralysis and right hemiparesis grade 4/5 were noted. No facial naevus was seen. Her ocular examination was normal. Intellectual impairment was apparent (IQ score was 69 according to Stanford Binet). An X-ray film of the skull showed ‘‘railroad calcification in the parieto-occipital region’’. An EEG revealed spike-wave activities over the left parieto-occipital area. A cranial CT scan showed cortical atrophy and gyriform calcification in the left parieto-occipital region (Fig. 1). A T2-weighted axial MRI scan demonstrated left parietooccipital atrophy and a contrast-enhanced scan revealed gyral contrast accumulation in the left parieto-occipital region. She still receives valproate (20 mg/kg per day) and phenytoin (7 mg/kg per day) orally and has been free of seizures for 2 months. SWS is the fourth most frequent neuroectodermal disorder [4]. It is characterised by a facial port-wine naevus and ipsilateral leptomeningeal haemangiomatosis. Encephalofacial angiomatosis has been sub classified into three groups: type I (both facial and leptomeningeal angiomas, glaucoma possible), type II (facial angioma without evidence of intracranial disease) and type III (isolated leptomeningeal angioma) [6]. In our case, facial angioma and glaucoma were not present and, according to this classification, she was considered as having type III. Epileptic seizures and intellectual impairment and glaucoma are common, whereas hemiparesis, hemiatrophy and visual field defects occur less often [4]. Most patients with SWS have normal neurological function for several months or even years after birth. Epileptic seizures and hemiparesis are often noted in conjunction with a febrile illness during the first 2 to 3 years, as in this case. Focal motor seizures or generalised tonicclonic seizures predominate initially; older children develop complex partial seizures [4,6]. In this case, initially generalised tonic-clonic seizures began at 1 year of age with febrile illness and thereafter, febrile seizures and hemiparesis developed. The presence of facial angioma in an epileptic patient usually gives a diagnostic clue to SWS. Only about 10% of patients with facial angioma have an intracranial lesion and the diagnosis of SWS should be reserved for these children [3,6]. Patients who have typical clinical and radiological findings of SWS but no facial angioma have previously been reported [1, 2, 3,5]. In the absence of facial angioma, diagnosis is based on the radiological confirmation of the leptomeningeal angiomatosis and demonstration of the intracranial calcification on the CT scan [3]. Enlargement and/or calcification of the choroid plexus, thickening of the calvarium, and focal brain atrophy can also be observed [3]. Gyriform calcification Eur J Pediatr (2002) 161: 505–506 DOI 10.1007/s00431-002-1033-6

Charcoal hemoperfusion in an infant with supraventricular tachycardia and seizures secondary to amitriptyline intoxication

Tricyclic antidepressant (TCA) overdose is one of the common causes of drug poisoning and it has cardiovascular, respiratory and neurological side effects. An 18-month male infant was admitted to our pediatric emergency service due to poisoning with amitriptyline. The infant was unconscious. Tachycardia, irregular and shallow breathing, and tonic-clonic seizures were observed on physical examination. An electrocardiogram displayed a narrow complex tachycardia that was consistent with re-entrant supraventricular tachycardia (SVT). Although antiarrhythmic and anticonvulsive agents were administrated, SVT and seizures persisted. Charcoal hemoperfusion (HP) was performed for 4 hours. The infant’s clinical condition has improved after the charcoal HP, seizures and SVT were not observed. It is concluded that charcoal HP can be used efficiently in patients with severe amitriptyline intoxication.

Effects of chronic amiodarone treatment on rat testis.

Amiodarone is a potent agent used to treat tachyarrhythmias, which are especially refractory to other medications, in both adults and children. Although widely used as an antiarrhythmic drug, amiodarone causes many serious adverse effects that limit its use. This study investigated the possible morphological and apoptotic effects of amiodarone on rat testes. Amiodarone was administered to male Sprague-Dawley rats at doses of 20 or 200mg/kg/day for 14 days. A histopathological examination of testicular tissue revealed the presence of inflammatory cells in the seminiferous tubule lumen together with swelling and vacuolization in the cytoplasm of some spermatogonia; these effects occured in a dose-dependent manner. Immunohistochemical staining showed evidence of apoptosis, including caspase-3, caspase-9, Bax and increased DNA fragmentation was detected via a terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. In conclusion, the results show that chronic amiodarone treatment causes dose-dependent degenerative and apoptotic effects on rat testes.