Feyzullah Çetinkaya

Conservative Treatment of Empyema in Children

Seventy-two children with no underlying diseases were treated for empyema. Radical surgical approaches like decortication were necessary for only 3 children. In 66 children tube drainage was applied. Staphylococcus aureus was cultured or was shown in Grams stain in 32 (44%) and children with this microorganism had longer duration of tube drainage (p < 0.05). The period for normalization of chest X-ray was positively related with the age of the patient (p < 0.05). In 60 of 72 children, chest X-ray was normal after 3 months. Follow-up of the patients 18 months after the infection revealed that pulmonary radiograms were normal in all cases and pulmonary function tests were within normal limits in all of the tested children (n = 25). It is emphasized that avoiding major surgical approaches must be encouraged in childhood empyema.

Etiology of Upper Gastrointestinal Bleeding in Young Children

ObjectiveEvaluation of children younger than two years old admitted to a pediatric emergency department with upper gastrointestinal bleeding.MethodsThirty four (34) children aged < 2 years with upper gastrointestinal bleeding were studied. The demographic features, etiologies, laboratory and endoscopic findings and treatment procedures were evaluated retrospectively.ResultsThe study consisted of 34 patients (73.5 % male, 26.5 % female) with a median age 12.3 months (1.5–24 months). 30 patients (88 %) had an underlying disease. 21 patients (56 %) had a history of aspirin or nonsteroidal anti-inflammatory drugs intake. Endoscopic findings were pathological in 85% of patients.ConclusionThe incidence of upper gastrointestinal bleeding in children aged < 2 years due to antipyretics must be taken into consideration although most of them may also have an underlying disease.

Short course intermittent chemotherapy in childhood tuberculosis

SummaryA total of 130 children diagnosed as having pulmonary and extrapulmonary tuberculosis who received short course intermittent chemotherapy between 1978–1992 were evaluated retrospectively. One hundred and ten children with tuberculosis were treated with isoniazid (10–15 mg/kg, maximum 400 mg), rifampin (10–15 mg/kg, maximum 600 mg), and streptomycin (30 mg/kg, maximum 1 g) daily, for 15 days. Treatment was completed with similar doses of isoniazid and rifampin twice a week for a period of 9 months. Since 1986, 20 children with tuberculosis were being treated with the same regimen but without streptomycin. The majority of patients in these cases had pulmonary tuberculosis (75%), followed by lymph nodes (9%), pleural (7%), bone and joint (5%), miliary (3%), and abdominal tuberculosis (1%). The clinicoradiologic response to treatment was observed to be excellent. Only one case of relapse was detected, which was the case of a patient with lymph node tuberculosis that occurred 18 months after the completion of treatment. No serious adverse drug reaction was observed in any of the cases mentioned. In conclusion, short-course low-dose intermittent chemotherapy is an effective and economical treatment with minimal side effects for pulmonary and extrapulmonary tuberculosis in childhood.ZusammenfassungZwischen 1978 und 1986 wurden in der Abteilung für Pneumologie im Kinderkrankenhaus Hacettepe 110 Patienten mit Tuberkulose 2 Wochen lang täglich mit Isoniazid (10–15 mg/kg, Maximum 400 mg/d), Rifampicin (10–15 mg/kg, Maximum 600 mg/d) und Streptomycin (30 mg/kg, Maximum 1 g/d) behandelt. Danach wurde die Therapie mit Isoniazid und Rifampicin zweimal wöchentlich in der gleichen Dosierung für insgesamt 9 Monate weitergeführt. Ab 1986 wurden 20 Patienten diesmal ohne Streptomycin also nur mit Isoniazid und Rifampicin in der gleichen Weise behandelt. Die Mehrzahl der Patienten hatte Lungentuberkulose (75%), außerdem lagen in 9% der Fälle Lymphknoten-, 7% Pleura-, 5% Gelenk- und Knochentuberkulosen, 3% miliäre und 1% abdominale Tuberkulosen vor. Bei allen Patienten war die Behandlung erfolgreich. Bei der Langzeit-Beobachtung wurde bei einem Patienten mit Lymphknotentuberkulose ein Rückfall festgestellt. Außer einem vorübergehenden Transaminasenanstieg bei einem Patienten wurden keine Nebenwirkungen beobachtet. Die kurzfristige, niedrig dosierte Intermittierende Therapie wird als eine ökonomische Therapie, mit geringen Nebenwirkungen für verschiedene Formen pulmonaler und extrapulmonaler Tuberkulose im Kindesalter vorgeschlagen.A total of 130 children diagnosed as having pulmonary and extrapulmonary tuberculosis who received short course intermittent chemotherapy between 1978–1992 were evaluated retrospectively. One hundred and ten children with tuberculosis were treated with isoniazid (10–15 mg/kg, maximum 400 mg), rifampin (10–15 mg/kg, maximum 600 mg), and streptomycin (30 mg/kg, maximum 1 g) daily, for 15 days. Treatment was completed with similar doses of isoniazid and rifampin twice a week for a period of 9 months. Since 1986, 20 children with tuberculosis were being treated with the same regimen but without streptomycin. The majority of patients in these cases had pulmonary tuberculosis (75%), followed by lymph nodes (9%), pleural (7%), bone and joint (5%), miliary (3%), and abdominal tuberculosis (1%). The clinicoradiologic response to treatment was observed to be excellent. Only one case of relapse was detected, which was the case of a patient with lymph node tuberculosis that occurred 18 months after the completion of treatment. No serious adverse drug reaction was observed in any of the cases mentioned. In conclusion, short-course low-dose intermittent chemotherapy is an effective and economical treatment with minimal side effects for pulmonary and extrapulmonary tuberculosis in childhood. Zwischen 1978 und 1986 wurden in der Abteilung für Pneumologie im Kinderkrankenhaus Hacettepe 110 Patienten mit Tuberkulose 2 Wochen lang täglich mit Isoniazid (10–15 mg/kg, Maximum 400 mg/d), Rifampicin (10–15 mg/kg, Maximum 600 mg/d) und Streptomycin (30 mg/kg, Maximum 1 g/d) behandelt. Danach wurde die Therapie mit Isoniazid und Rifampicin zweimal wöchentlich in der gleichen Dosierung für insgesamt 9 Monate weitergeführt. Ab 1986 wurden 20 Patienten diesmal ohne Streptomycin also nur mit Isoniazid und Rifampicin in der gleichen Weise behandelt. Die Mehrzahl der Patienten hatte Lungentuberkulose (75%), außerdem lagen in 9% der Fälle Lymphknoten-, 7% Pleura-, 5% Gelenk- und Knochentuberkulosen, 3% miliäre und 1% abdominale Tuberkulosen vor. Bei allen Patienten war die Behandlung erfolgreich. Bei der Langzeit-Beobachtung wurde bei einem Patienten mit Lymphknotentuberkulose ein Rückfall festgestellt. Außer einem vorübergehenden Transaminasenanstieg bei einem Patienten wurden keine Nebenwirkungen beobachtet. Die kurzfristige, niedrig dosierte Intermittierende Therapie wird als eine ökonomische Therapie, mit geringen Nebenwirkungen für verschiedene Formen pulmonaler und extrapulmonaler Tuberkulose im Kindesalter vorgeschlagen.

Comparison of idiopathic thrombocytopenic purpura in children between 3 months and 2 years versus 2–5 years

It has been reported that infantile idiopathic thrombocytopenic purpura (ITP) has different clinical features than ITP seen in older ages and classification of bleeding sites and grading of bleeding severity can be used in determining the risk of bleeding. In this study, patients with ITP were divided into two groups according to age (<2 years and 2–5 years). The clinical features, laboratory findings, treatment modalities, rate of response and chronicity, bleeding sites, grades of bleeding were compared between each group. No significant differences were established. Pediatr Blood Cancer 2009;52:656–658.

Bilateral adrenal abscesses as a complication of neonatal suprarenal hemorrhage

A full-term male neonate was born in our hospital with a birthweight 3920 g. It was the first pregnancy and the first delivery of the mother. No problem was noted during the pregnancy, but during the perinatal period fetal distress occurred and the infant was delivered by cesarean section. He underwent resuscitation in the delivery room because of depressed respiration. The laboratory findings on the first day of life were as follows: hemoglobin 16.5 g/dL, hematocrit 49.3%, lactate dehydrogenase 1992 U/L and creatine kinase 1816 U/L. He suffered from perinatal asphyxia and was treated with oxygen in the neonatal intensive care unit for 3 days. He had hyperbilirubinemia and received phototherapy for a short period and then he was discharged on the 7th day in good condition. However, 3 days later, when he was 10 days old, he came back with profound jaundice. The unconjugated bilirubin level was 26.9 mg/dL and his hemoglobin level was 11.4 g/dL. He was treated with phototherapy again. White blood cells, platelet count, clotting tests, renal and hepatic functions, blood glucose and electrolytes were in the normal range but his C-reactive protein level was elevated (129 mg/dL) and there was no evidence of hemolysis. Because of severe hyperbilirubinemia and anemia, an internal hemorrhage was suspected and ultrasonographic examination was performed. Abdominal ultrasonography revealed bilateral adrenal cystic masses measuring 55 ¥ 41 ¥ 54 mm at the left and 61 ¥ 45 ¥ 58 mm in the right suprarenal fossa. The masses were well-circumscribed, roundshaped cystic lesions that contained internal mobile echoes and caused distal acoustic enhancement in the suprarenal space bilaterally. Adrenal hemorrhage was considered as the cause of the masses. Doppler ultrasonography (Fig. 1) and abdominal computed tomography (Fig. 2) confirmed the adrenal hematoma. To exclude a hemorrhagic neoplastic process such as neuroblastoma, neuron-specific enolase and 24-h urinary excretion of vanillylmandelic acid were measured and ultrasound-guided needle aspiration was performed. Neuron-specific enolase and vanillylmandelic acid levels were within the normal ranges, hemorrhagic and purulent material was aspirated from both sides and no neoplastic cells were found on microscopic examination. Pus was drained with percutaneous catheterization of the abscess and cultures were positive for Proteus mirabilis. Percutaneous drainage was continued for 10 days and, according to the antibiogram, the infant was treated with ceftriaxon plus netilmicin for 15 days. The second culture following antibiotic treatment was negative. During his stay in the hospital our patient did not suffer from fever, septic findings or feeding difficulties and he was discharged in good condition when he was 36 days old. His weight was 5600 g at the time of the discharge. His parents were informed about the clinical signs of adrenal insufficiency such as fever, vomiting, dehydration and altered mental status. At the control examination after 3 months, neuromotor and physical development of the child was appropriate to his age standards and sonographic findings revealed marked reduction in the size of the adrenal abscesses. The abscess on the right side was measured as 25 ¥ 21 ¥ 12 mm on the 15th day of treatment and 9.6 ¥ 8 ¥ 8.5 mm after 3 months. The abscess on the left side was 25 ¥ 17 ¥ 20 mm on the 15th day but had disappeared completely after 3 months.

Infants With Cholestasis: Diagnosis, Management And Outcome

Objective: Infants with cholestatic jaundice were evaluated retrospectively in terms of etiologies, diagnostic methods, laboratory findings, treatment procedures and longterm prognosis. Patients and Methods: The study consisted of 70 children (52.8% male, 47.1% female) with cholestasis ranging in age from 15 days to 8 months (mean age, 60±26 days). Patients were divided into three groups according to the diagnosis: (i) patients with extrahepatic biliary atresia, (ii) patients with intrahepatic biliary hypoplasia, and (iii) patients with hepatocellular disease. Their clinical parameters were evaluated. Results: In the group with extrahepatic biliary atresia the onset of jaundice was significantly earlier and the presence of acholic stool and total bilirubin levels were remarkably higher than in the groups with intrahepatic biliary hypoplasia or hepatocellular disease. Serum gamma-glutamyl transpeptidase (GGT) and alkaline phosphotase (ALP) levels were found to be significantly higher in the groups with extrahepatic biliary atresia and intrahepatic biliary hypoplasia than the group with hepatocellular disease (p<0.001 and p<0.01, respectively). The contribution of technetium-99m (99mTc) scintigraphy to the diagnosis was significantly higher in the group with extrahepatic biliary atresia than the groups with intrahepatic biliary hypoplasia and hepatocellular disease (p<0.002). Conclusion: It was found that cholestasis, acholic stool and elevated GGT are better markers for extrahepatic biliary atresia than for intrahepatic biliary hypoplasia or hepatocellular disease in infants. The contribution of scintigraphy to the diagnosis was found to be higher in the group with extrahepatic biliary atresia than in the other groups. (Marmara Medical Journal 2012;25:83-6)

Penisilin ve diğer beta laktam antibiyotik alerjilerinde son görüşler Çağrılı Editör

Beta lactam antibiotics have been commonly used in general pediatrics practice since their inventions But allergic reactions to beta lactams represent the most frequent cause of immunological drug reactions and lead to concerns both in doctors and parents when they are used Unfortunately these reactions may be induced by all beta lactams available including penicillins cephalosporins aztreonam and carbapenems Parents’ and clinicians’ concerns about penicillin allergy constrains beta lactam antibiotic usage in daily practice and therefore increase undesirable and more expensive antibiotic use such as vancomycin Because of these reasons all physicians especially pediatricians should know all aspects of beta lactam allergies Turk Arch Ped 2008; 43: 36 9 Key words: Anaphilaxy beta lactam antibiotic penicillin

Mycoplasma Pneumomae nin Neden Olduğu Alt Solunum Yolları İnfeksiyonları: Dört Vakanın Takdimi

Mycoplasma pneumoniae cocukluk caginda alt solunum yollari infeksiyonlannin en onemli etkenlerinden biridir Bu yazida kompleman fiksasyon yontemi ile tanisi konulmus dort vaka takdim edilmis ve literatur bilgileri gozden gecirilmistir Anahtar kelimeler: Mycoplasma Pneumoniae Alt Solunum Yollari

Antiepileptik Kullanan Çocuklarda Tiroid Hormon Düzeyleri

Antiepileptik ilaclarin uzun sure kullandiklarinda organizmadaki cesitli hormonlarin metabolizma ve fonksiyonlari uzerine etkili olduklari bilinmektedir Bu calismada antiepileptik ilac kullanan 40 epileptik cocukta 20 fenobarbital 10 fenitoin ve 10 sodyum valproat tiroid fonksiyonlari calisilmis ve sonuclar 20 saglikli cocuktan olusan kontrol grubu ile karsilastirilmistir Fenobarbital kullanan cocuklarda serbest triiyodotironin duzeylerinin arttigi fenitoin kullanan cocuklarda ise total tiroksin ve serbest tiroksin duzeylerinin azaldigi gorulmustur Sodyum Valproat kullanan cocuklarda tiroksin ve triiyodotironin degerlerinde onemli degisiklik olmamistir Sonuc olarak uzun sureli antiepileptik kullanan cocuklarin kontrollerde tiroid fonksiyonlari yonunden de degerlendirilmesinin ve gerektiginde tiroid hormon duzeylerine bakilmasinin uygun olacagini dusunmekteyiz Anahtar kelimeler: Tiroid Hormonlari Antikonvulsan Ilaclar Epilepsi