Esat Yilgor

Additive effects of dexamethasone in nebulized salbutamol or L-epinephrine treated infants with acute bronchiolitis.

Abstract Background : Although it is the most common lower respiratory infection of infancy, the optimal treatment for acute bronchiolitis is still controversial. The aim of this study was to compare the early and late effects of nebulized l‐epinephrine (EPI) and intramuscular dexamethasone (DEX) combination therapy with nebulized salbutamol (SAL) and dexamethasone combination and bronchodilators alone in outpatients with acute bronchiolitis.

Denver developmental screening test II for early identification of the infants who will develop major neurological deficit as a sequalea of hypoxic-ischemic encephalopathy.

Abstract Background : The primary aim of this study was to find widely available, inexpensive, and non‐invasive parameters for early identification or prediction of the infants with hypoxic‐ischemic encephalopathy (HIE) who will have a severe adverse outcome (classified as death or a major neurological deficit).

Evaluation of Cerebral Maturation by Visual and Quantitative Analysis of Resting Electroencephalography in Children With Primary Nocturnal Enuresis

This study was undertaken to evaluate resting electroencephalographic (EEG) changes and their relations to cerebral maturation in children with primary nocturnal enuresis. Cerebral maturation is known to be important in the pathogenesis of this disorder. Twenty-five right-handed patients with primary nocturnal enuresis, aged 6 to 14 years, and 23 age- and sex-matched healthy children were included in this cross-sectional case-control study. The abnormalities detected using such techniques as hemispheral asymmetry, regional differences, and hyperventilation response in addition to visual and quantitative EEG analysis were examined statistically by multivariate analysis. A decrease in alpha activity in the left (dominant hemisphere) temporal lobe and in the frontal lobes bilaterally and an increase in delta activity in the right temporal region were observed. We concluded that insufficient cerebral maturation is an important factor in the pathogenesis of primary nocturnal enuresis, and EEG, as a noninvasive and inexpensive method, could be used in evaluating cerebral maturation. (J Child Neurol 2001;16:714-718).

Lack of association between plasma leptin levels and appetite in children with iron deficiency

A negative correlation between leptin and appetite or food intake has been shown in healthy individuals. However, the role of leptin in clinical conditions characterized by anorexia has not been established. One of the well-known clinical features of iron-deficiency anemia is poor appetite. We examined the changes in plasma leptin levels in relation to expected improvement in appetite with iron treatment in children with iron deficiency. In 24 infants and small children (mean age +/- standard deviation = 19.6 +/- 7.7 months) with iron deficiency, we studied plasma leptin levels before and after iron therapy. After 15.0 +/- 2.4 wk of iron treatment, serum ferritin levels improved significantly, with accompanying increases in their subjective appetite scores and food intakes. However, as their mean age and plasma leptin levels adjusted their body mass indexes were unchanged. Serum ferritin correlated significantly with appetite score (r = 0.680, P < 0.001) and food intake (r = 0.480, P < 0.01). Leptin correlated only with body mass index (r = 0.405, P < 0.01). Lack of association between plasma leptin levels and degree of appetite in iron-deficient children treated with iron suggests a leptin-independent mechanism for the observed increase in appetite.

Bilateral adrenal cystic neuroblastoma with massive hepatomegaly and intracystic hemorrhage

To The Editor: Cystic neuroblastoma (CNB) is a rare form of this tumor which is characterized by a large cystic lesion and microscopic cysts, and is frequently located in the adrenal gland. It has a little tendency to metastasis and it has an excellent prognosis if early diagnosis can be made [1–10]. Furthermore, bilateral adrenal CNB is an extremely unusual presentation of NB which may represent a second primary tumor or a contralateral metastasis [4]. Most of the patients with CNB are under 1 year of age. Moreover, massive intratumoral hemorrhage, hepatic metastases, and advanced clinical stage are also rare clinical findings. The differential diagnosis of a cystic suprarenal mass is difficult since it occurs not only in CNB, but also in adrenal hemorrhage, enteric cyst, extralobar sequestration, dilatation of upper-pole renal calyces, congenital adrenal cyst, cystic Wilms tumor, and adrenal abscess [2–4]. A 19-day-old girl, being born in another hospital, was admitted to our hospital with the symptoms of paleness, respiratory distress, and abdominal distention. Physical examination revealed tachycardia, tachypnea, hepatomegaly, and a large left-sided abdominal mass. Laboratory findings were as follows: hemoglobin 5.6 g/dl, serum lactate dehydrogenase 1,367 U/L, neuron specific enolase 56 ng/ml, ferritin 220 ng/ml, and urine vanillylmandelic acid 29.5 mg/day. Bone marrow infiltration with tumor cells (8%) was also found. Thorax CT revealed geometric shaped subpleural densities in the lungs consistent with atelectasis. Furthermore, CT scan of the abdomen showed bilateral adrenal cystic mass lesions with intracystic echogenities and fluid levels, suggesting intracystic hemorrhage. Besides hepatosplenomegaly, multiple hypodense lesions conforming to metastases in the liver were also observed (Fig. 1). Radionuclide bone scan was negative. Clinical diagnosis was congenital bilateral CNBwith liver metastases. However, lung metastases were also suspected. Since primary surgery could not be performed, chemotherapy was initiated. On the 8th day of chemotherapy, the patient died of extensive hepatic involvement, which caused respiratory and inferior vena cava compromise. Histopathologic examination revealed neuroblastoma cells at the wall of the almost entirely hemorrhagic cystic masses with favorable histology according to the Shimada classification, and lung, liver, and spleen involvement (Fig. 2). DNAcontent, N-myc expression, and allelic loss of chromosome 1p could not be obtained. Differentiation between adrenal hemorrhage and adrenal CNB is especially important because the treatment of hemorrhage is generally conservative. Although intratumoral hemorrhage is common in CNB, massive symptomatic hemorrhage is a rare finding [1,4,6]. To our knowledge, there have been only three reported cases with bilateral adrenalCNBwith intracystic hemorrhage [4,6,8]. In the newborn, reported by Lee et al. [4] the presence of the liver metastases made differential diagnosis easier as in our case. Since the other two reported cases with bilateral CNB which were diagnosed after the first month of life did not have liver involvement, the differential diagnosis of adrenal hemorrhagewas difficult [6,8]. MR imaging seems to be a good alternative radiological method in this differential diagnosis [6,9]. Most patientswithCNBare diagnosed in the early stage of disease with an excellent long-term prognosis, except patients with stage IV disease, hydrops, or massive hepatomegaly [2,3,10]. Only 9.7% of cases with CNB have metastatic disease at diagnosis [7]. When present, as in our case, the fetal liver is themost common site [5]. Two of three reported children with bilateral CNB had stage IVS, but one patient had stage IV disease. In children with CNB, less aggressive management may be warranted in the absence of stage IV disease. Some authors recommend that prenatally suspected non-metastatic CNB should undergo surgical intervention, unless tumor size decreases within about 1 month after birth [2,9]. While chemotherapy is necessary for advanced disease, as in our case, radiotherapy may be used in patients with unresectable or incompletely resected tumors [4]. One of two reported cases with bilateral CNB of stage IVS, to whom only surgical resection was performed, was lost to follow up,

Assessment of Cardiac Functions in Sickle Cell Anemia with Doppler Myocardial Performance Index

BACKGROUND The purpose of this study was to evaluate left and right ventricular functions by using the Doppler myocardial performance index (MPI), in children with sickle cell anemia (SCA). METHODS We examined 32 patients with SCA and 30 age-matched healthy children. Echocardiography and Doppler examinations were completed for each of the subjects. MPI was calculated from the Doppler tracings. RESULTS Compared with controls, left ventricle (LV) end-diastolic diameter, end-systolic diameter, early-diastolic mitral flow velocity and late-diastolic mitral flow velocity were significantly higher in the patients with SCA. Although, the LV ejection fractions were in the normal ranges in patients and controls, both LV and right ventricle (RV) MPI were significantly higher in patients than those in normal children. CONCLUSION MPI may be a useful noninvasive and sensitive tool for assessing the sub-clinical cardiac LV and RV dysfunctions in patients with SCA.

Effect of gestational age on plasma fibronectin concentrations in the neonate

Background : Fibronectin (FN) is known to have important roles in host defense against infection. The risk for neonatal sepsis increases with the degree of immaturity of the host. Conflicting results have been reported on the relationship between plasma FN levels and gestational age (GA) in the preterm neonate.