Erdal Gökçay

Evaluation of bone mineral density in children receiving antiepileptic drugs

The effects of the valproic acid and carbamazepine monotherapies on bone mineral density were evaluated. Bone mineral density was measured in 53 children with primary epilepsy taking either valproic acid (n = 25) or carbamazepine (n = 28) for longer than 1 year and in a healthy control group (n = 26) by the dual-energy x-ray absorptiometry method at L2-L4 levels of lumbar vertebrae. The mean serum levels of valproic acid and carbamazepine were 66 +/- 2.2 microg/mL and 7.0 +/- 9.3 microg/mL, respectively, and the mean duration of treatment for each drug was 2.4 +/- 0.2 years and 2.6 +/- 0.5 years, respectively. Calcium intakes in diet were similar in both the control and study groups. The serum levels of calcium and phosphorus in all groups were normal. Bone mineral density values of both valproic acid and carbamazepine groups were not statistically different from that of the control group (P > 0.05).

Plasma Trace Element, Plasma Glutathione Peroxidase, and Superoxide Dismutase Levels in Epileptic Children Receiving Antiepileptic Drug Therapy

Summary: Some antiepileptic drugs (AEDs) may altertrace element metabolism and free radical scavenging enzyme activities in humans and experimental animals. We investigated the effect of longterm AED therapy on copper (Cu), zinc (Zn), manganese (Mn), selenium (Se), magnesium (Mg), glutathione peroxidase (GSH‐PX), and superoxide dismutase (SOD) in the plasma in children with epilepsy. During treatment with valproate (VPA) or carbamazepine (CBZ) monotherapy plasma Cu, Zn, Mn, Se, and Mg concentrations of patients were not statistically different from those of control subjects. The level of seoxidation may be causally involved in some forms of epilepsies, and the decreased free radical scavenging enzyme activity is believed to cause the increased risk of anidiosyncratic drug reaction encountered in the manage‐ment of epilepsy. Because GSH‐PX and SOD are themost important members of antioxidant defense mechanisms, we quantitated the activities of these enzymes inplasma of children with epilepsy receiving VPA or CBZ. Only plasma GSH‐PX activities in VPA group werehigher than those of the control group, and the differencewas statistically significant.

High‐dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice

A controlled study was conducted to assess the role of high‐dose i.v. immunoglobulin (HDIVIG) therapy in neonatal immune haemolytic jaundice. Patients with ABO and/or Rh incompatibilities proved by significant hyperbilirubinaemia (<204mmol 1−1), positive direct antiglobulin test and high reticulocyte count (>10%) were randomly assigned to receive either conventional phototherapy alone or phototherapy with high‐dose i.v. immunoglobulin (1 g kg−1, over 4h) as soon as the diagnosis was established. Exchange transfusions were performed if serum bilirubin concentrations exceeded 290 mmol 1−1 and increased by more than 17 mmol 1−1 per h despite both treatment manoeuvres. Eight of 58 patients in the HDIVIG group required exchange transfusions, whereas it became necessary in 22 of 58 patients in the control group (p < 0.001). The durations of phototherapy and hospitalization in terms of hours were significantly shorter in the HDIVIG group (p < 0.05). No side effects of HDIVIG therapy were observed. In conclusion, HDIVIG therapy in newborns with ABO or Rh haemolytic diseases reduces haemolysis, serum bilirubin levels and the need for blood exchange transfusion, a procedure which has potential complications and carries a risk of mortality.

Brainstem auditory-evoked potentials in iron-deficiency anemia

Slight-to-moderate impairments may be observed in mental and motor developments of infants with iron- deficiency anemia. Brainstem auditory-evoked potentials provide a noninvasive means of examining the auditory aspect of the central nervous system functions. In this study the effect of iron-deficiency anemia on auditory functions was investigated by using brainstem auditory-evoked potentials. Brainstem auditory-evoked potentials of the 20 iron-deficient infants were not significantly different from those of the control group that included 20 healthy age-matched infants. Furthermore, there was not a statistically significant difference between the brainstem auditory-evoked potentials of the study group performed before and 3 months after oral iron therapy. Although we could not demonstrate a hearing loss in infants with moderate iron-deficiency anemia in this study, the relationship between severe iron-deficiency anemia and hearing loss or auditory dysfunction remains to be determined.Slight-to-moderate impairments may be observed in mental and motor developments of infants with iron- deficiency anemia. Brainstem auditory-evoked potentials provide a noninvasive means of examining the auditory aspect of the central nervous system functions. In this study the effect of iron-deficiency anemia on auditory functions was investigated by using brainstem auditory-evoked potentials. Brainstem auditory-evoked potentials of the 20 iron-deficient infants were not significantly different from those of the control group that included 20 healthy age-matched infants. Furthermore, there was not a statistically significant difference between the brainstem auditory-evoked potentials of the study group performed before and 3 months after oral iron therapy. Although we could not demonstrate a hearing loss in infants with moderate iron-deficiency anemia in this study, the relationship between severe iron-deficiency anemia and hearing loss or auditory dysfunction remains to be determined.

A Nonsurgical Approach to the Treatment of Phimosis: Local Nonsteroidal Anti-Inflammatory Ointment Application

PURPOSE We evaluated the effectiveness of topical application of nonsteroidal anti-inflammatory ointment for phimosis. MATERIALS AND METHODS A total of 52 children with phimosis was included in this study. Phimosis was graded according to severity. Of the patients 32 were given locally a nonsteroidal anti-inflammatory ointment prepared in ophthalmic usage form from sterile diclofenac sodium ampules (not commercially available). The control group comprised 20 patients given sterile petrolatum ointment. Patients were seen before and after treatment, and graded according to retractibility and appearance of the foreskin. Treatment continued for 4 weeks with 3 applications daily. RESULTS Of the 32 patients 24 responded to therapy and 8 remained unchanged or had insufficient improvement. Three controls responded to therapy and 17 did not. There were no side effects. CONCLUSIONS Nonsteroidal anti-inflammatory ointment application for phimosis may be an alternative to surgery and steroid application.

Double versus single phototherapy in term newborns with significant hyperbilirubinemia

The efficacy of double phototherapy, in the form of conventional phototherapy with special blue light plus fiberoptic phototherapy, was compared with conventional phototherapy consisting of special blue lamps alone in a relatively larger series of term newborns with significant hyperbilirubinemia. During the study period the sum of the average spectral irradiances in the double phototherapy group was significantly higher than that of the single phototherapy group (p < 0.05). Phototherapy was effective in decreasing bilirubin levels in both groups, but the response was greater in the double phototherapy group; the duration of exposure to phototherapy was significantly shorter (31.2 +/- 8.5 vs. 38.98 +/- 14.7 h, p < 0.05), and the overall bilirubin decline rate as mumol/l/h and per cent/h was significantly greater in the double phototherapy group (4.1 +/- 1.37 vs. 3.3 +/- 0.86 mumol/l/h, and 1.29 +/- 0.38 vs. 1.02 +/- 0.44 per cent/h, p < 0.05). In phototherapy treatment of term newborns with significant hyperbilirubinemia, double phototherapy provided more rapid and effective bilirubin reduction than conventional phototherapy alone due to higher spectral irradiance and larger body surface area exposed to phototherapy. The value of double phototherapy in the treatment of newborns with hemolytic hyperbilirubinemia remains to be determined.

Intravenous immunoglobulin therapy in acute disseminated encephalomyelitis associated with hepatitis A infection

A 12-year-old girl was admitted to Gülhane Military Medical Academy because of fever, headache, ataxia, and drowsiness which had been present for 3 days. She had been diagnosed with HAV infection 2 weeks before admission. Vital signs were normal on examination, except for a temperature of 38.7 ° C. She was awake, but easily distractible and extremely confused with expressive dysphasia. She had bilaterally increased deep tendon reflexes, and Babinski’s sign was positive. Cranial nerves were intact and cerebellar signs were not observed. There were no signs of meningeal irritation. No motor, sensory or sphincter disturbances were observed. Blood chemistry showed elevated aspartate aminotransferase (AST) (240 U/L) and alanine aminotransferase (ALT) (285 U/L) concentrations. Serum anti-HAV IgM and IgG antibodies were positive, and markers of hepatitis B and C were negative. There was no family history for hepatitis infection and markers of hepatitis A, B and C were negative in all family members. The cerebrospinal fluid (CSF) analysis revealed a protein concentration of 75 mg/dL, with pleocytosis of 70 cells/mm 3 (30% polymorphonuclear cells, 70% lymphocytes) and glucose of 44 mg/dL. There were no oligoclonal bands and the IgG index was normal. Magnetic resonance imaging (MRI) of the brain showed bilateral frontal and insular cortical enlargement with high signal intensity in the cortical and subcortical white matter on T2 weighted images. An additional hyperintense lesion was also noted in the right thalamus (Fig. 1). These lesions were not enhanced after intravenous administration of paramagnetic contrast material. Previous lesions completely resolved on images obtained 15 days after treatment (Fig. 2). There was no serological evidence for any acute or recent infection by measles, rubella, herpes simplex, toxoplasma, cytomegalovirus or mycoplasma. She was treated with a 5-day course of IVIG (400 mg/kg/day), and her signs significantly improved by the third day of therapy. A second lumbar puncture after completion of the treatment revealed normal CSF findings. Neurological examination was normal and MRI scan findings improved 3 weeks later.

The effect of iron supplementation on visual-evoked potentials in infants with iron-deficiency anemia.

Flash visual-evoked potentials were studied in 20 infants with iron-deficiency anemia to determine the effect of iron deficiency on visual function by using visual-evoked potentials in this type of anemia. After iron therapy for 12 weeks, visual-evoked potentials were retested in these otherwise healthy infants. All infants showed an excellent hematological response to iron therapy. Post-treatment visual-evoked potential N2 latencies (negative deflections) decreased significantly compared to the pre-treatment values (p < 0.05). These results suggest that iron-deficiency anemia causes subclinical visual impairment, and visual-evoked potentials may be a useful non-invasive means of detecting subtle effects of nutritional deficiencies and monitoring the nutritional status of infants.

Recurrent Streptococcus pneumoniae meningitis in a child with traumatic anterior cranial base defect.

Acute bacterial meningitis is a potentially life‐threatening infection of the cranial and spinal leptomeninges. Recurrent episodes of meningitis are rarely seen, but when they occur, an extensive investigation has to be made to find out responsible factors. 1–3 A single episode of acute meningitis may result from bacteriemia, but when followed by recurrent meningitis in pediatric patients, other possible routes of the bacteria invasion to the cerebrospinal fluid (CSF) should be considered. 1

Evaluation of renal tubular function in children taking anti-epileptic treatment.

Aim:  To assess the effects of anti‐epileptic drugs on renal tubular function.