Filiz Ekici

Heparin Infusion to Prevent Umbilical Venous Catheter Related Thrombosis in Neonates

OBJECTIVEnTo investigate umbilical venous catheter (UVC) related thrombosis by Doppler echocardiographic evaluation of neonates infused with heparin or placebo.nnnMETHODSnWe conducted a prospective study to determine UVC-related thrombosis in term and nearterm neonates. Heparin or placebo (0.5 IU/mL) was infused at a rate of 1 mL/hr to the study and control group. Doppler echocardiography was performed at 1, 3, and 5 days after UVC insertion.nnnRESULTSnForty-six neonates (63% males) with a mean gestational age of 38.2 ± 1.8 weeks, and a mean birth-weight of 2993 ± 563 grams were included. No UVC-related thrombosis was observed in the study group, which included 19 neonates. Among the 27 neonates in the control group, one neonate developed UVC-related thrombosis. There were no statistical differences between the groups for gestational age, birth weight, postnatal age, UVC duration, mortality, mechanical ventilation, and inotrope requirement, and hemagram or coagulation profile. The complications were as follows, mild pulmonary hemorrhage, 6.5% (3); leak-out, 4.3% (2); peritoneal leakage, 2.2% (1); occlusion, 2.2% (1); gastrointestinal findings, 6.5% (3); sepsis, 10.9% (5); and catheter-related thrombosis, 2.2% (1).nnnCONCLUSIONnThis study demonstrated that heparin infusion of 0.5 IU/mL through the UVC had no effect on catheter-related thrombosis in term and near-term neonates. Randomized controlled trials are necessary to conclusively evaluate the effect of heparin on UVC-related thrombosis.

Effects of vagus nerve stimulation on heart rate variability in children with epilepsy

PURPOSEnThe aim of this study was to evaluate the effects of vagus nerve stimulation (VNS) on heart rate variability (HRV) in children with epilepsy.nnnMETHODSnThe subgroups of HRV, namely time domain (Standard deviation of NN interval (SDNN), SDNN index, Standard deviation of the averages of NN intervals (SDANN), Root mean square of successive differences (RMMSD), Adjacent NN intervals differing by more than 50 ms in the entire recording divided by the total number of all NN intervals (PNN50), triangular index) and frequency domain (Low-frequency (LF), High-frequency (HF), LF/HF), were investigated in 20 pediatric patients before and after 6 and 12months of VNS treatment during day and night by comparing their data with those of 20 control subjects. In addition, subgroups of age, epilepsy duration and localization, and antiepileptic drugs (AEDs) were also evaluated if they had further effects on basal HRV levels.nnnRESULTSnIncreased heart rates (HRs); decreased SDNN, SDANN, RMMSD, and PNN50; and increased LF/HF ratios were identified before VNS therapy (p<0.05). Even though remarkable improvement was seen after 6months of VNS treatment (p<0.05), no further changes were observed in 12-month compared with 6-month levels (p>0.05) in all parameters, still even significantly lower than those of controls (p<0.05). Longer duration of epilepsy and localization of epileptic focus, such as in the temporal lobe, were also found to further contribute to diminished basal HRV levels (p<0.05).nnnCONCLUSIONnThe cardiovascular system is under deep sympathetic influence in children with epilepsy. Although VNS seems to provide a substantial improvement by achieving increased parasympathetic effects in short-term therapy, the levels were still lower than those of healthy children after either short- or long-term therapy. Therefore, impaired cardiovascular autonomic regulation may be associated with the epileptic process itself as well as with the contribution of some additional factors. Overall, different aspects such as age, epilepsy duration, epileptic focus, seizure frequency, and AEDs should also be considered for their further possible effects on HRV during VNS therapy.

The Effect of Recombinant Human Growth Hormone Therapy on Left-Ventricular Chamber Size and Function in Children With Growth Hormone Deficiency

This study was designed to assess the effect of recombinant human growth hormone (rhGH) therapy on left-ventricular (LV) chamber size and function in children with idiopathic isolated growth hormone deficiency (GHD) using conventional echocardiography and tissue Doppler imaging (TDI). Thirty patients (19 boys and 11 girls) with idiopathic isolated GHD were followed-up for 12xa0months. Mean age of patients was 11.0xa0±xa02.6xa0years (range 6.3–15.5). At baseline and at 3, 6, and 12xa0months of treatment, the structure of the left ventricle was assessed by conventional echocardiography and myocardial rates and time intervals by TDI. There was a significant increase in LV mass (LVM) compared with pretreatment values. Like LVM, relative wall thickness (RWT) was also increased significantly. The significant increase in LVM indexed to body surface area and RWT became apparent at month 3 of treatment with a significant increase in LVM indexed to height2.7 at treatment month 6. Normalized LVM increased as early month 3 of treatment, and a steady increase was observed until month 12. However, no patient had LVM > +2 standard deviation scores at month 12 of treatment. No significant differences were observed in functional parameters of the left ventricle and the interventricular septum. The results of this study showed that rhGH therapy causes an increase in myocardial mass without changing the geometry or function of the myocardium. Therefore, the increase in myocardial mass appears to be concentric, thus causing remodeling instead of hypertrophy.

Elasticity of ascending aorta and left ventricular myocardial functions in children with bicuspid aortic valve

The aim of the study was to determine the aortic elasticity parameters (EPs) and myocardial function in children with bicuspid aortic valve (BAV). Additionally, we evaluated the effect of aortic leaflet phenotype (ALP) and aortic dilatation on elasticity parameters.

The association of consumptive hypothyroidism secondary to hepatic hemangioma and severe heart failure in infancy.

Although hemangiomas are the most common vascular tumors of the liver in infancy, data regarding hypothyroidism and heart failure related to hepatic hemangiomas are limited. Here, we present a 15- day -old girl who presented with prolonged jaundice at the age of 15 days. Because her TSH level was found to be 74 μIU/mL, she was initially diagnosed with congenital hypothyroidism and L-Thyroxine replacement therapy was initiated. On follow-up examination performed two months later, it was observed that her TSH level was not suppressed and a mass was noticed in the right upper abdomen on physical examination. Abdominal ultrasonography revealed multiple masses with sizes of about 3-3,5 cm covering the whole liver. When evaluated with clinical and radiological appearance, oral methylprednisolone at a dose of 5 mg/kg/day and propranolol at a dose of 2 mg/kg were initiated with a diagnosis of hepatic hemagioma/hemangioendothelioma. Consumptive hypothyroidism due to hepatic hemangioma and congestive heart failure were considered in the patient who had findings of heart failure. The dose of L-Thyroxine was increased 2-fold. The patient received intensive care treatment for severe heart failure. Because his findings resolved, he was started to be followed up with propranolol, steroid and L-Thyroxine treatment.

Mid-Aortic Syndrome Demonstrated by Three-Dimensional Computed Tomography: Case Report

A 14-year-old male patient was admitted to our clinic for evaluation of systemic arterial hypertension. His right and left arm arterial blood pressures were extremely high and measured 200/120 and 180/120 mmHg, respectively. His bilateral femoral pulses were weak, and lower limb blood pressures could not be measured. By conventional echocardiography, increased left ventricular wall thickness, narrowed lumen size, and disturbed antegrade flow at the lower thoracic part of aorta were shown (Fig. 1, Movie clip 1). Three-dimensional computed tomography (CT) clearly demonstrated a long-segment severe coarctation involving the distal half of thoracic aorta (Fig. 2). The affected segment was 3 cm in length, and the intra-aortic lumen size decreased gradually to 95 % of the expected lumen size. Intrarenal part of the abdominal aorta was also narrowed, and there were no stenosis in the other branches of the aorta. Multiple aortico-aortic collaterals were also detected by CT evaluation. Cranial magnetic resonance imaging and ophthalmologic examinations were normal, and serum inflammatory markers were within the normal ranges. Thus, the patient was diagnosed with an idiopathic form of mid-aortic syndrome (MAS). Due to long-segment involvement of aorta, percutaneous transluminal angioplasty of the aorta could not be performed. We therefore planned aorta‐aortic bypass graft surgery for this patient. MAS is a rare congenital abnormality characterized by segmental narrowing of the abdominal or distal descending thoracic aorta [2‐5]. It is frequently seen with stenosis of the renal and mesenteric arteries. It can be acquired or congenital. Acquired forms are usually associated with neurofibromatosis, fibromuscular dysplasia, retroperitoneal fibrosis, Williams syndrome, mucopolysaccharidosis, and giant-cell arteritis [2, 4]. Three-dimensional CT can provide more detailed information regarding cardiovascular structures than conventional echocardiographic techniques. MAS can cause severe renovascular hypertension in children and adolescents. It is generally difficult to manage the hypertension which requires treatment with several

A Rare Cause of Chest Pain in Children: Spontaneous Pneumomediastinum

Pneumomediastinum is the presence of free air in the mediastinum. It is rarely seen in children. The causative reason cannot be found in most cases. Here, we present two cases with pneumomediastinum who presented with the complaint of chest pain. Pneumomediastinum was suspected because of the insufficient imaging of mediastinal structures at the suprasternal window during echocardiography in both of these patients. The free air image can sometimes not be detected sometimes at direct graphy as in our first case. Patients suspected of having pneumomediastinum must therefore always be reevaluated by computed tomography if the direct films are normal.