Fügen Çullu

Haemoperfusion in Amanita phalloides Poisoning

Amanita phalloides is responsible for about 90 per cent of all fatal cases of mushroom intoxication. The amatoxins, the main toxic component of these fungi, are responsible for gastro-intestinal symptoms as well as hepatic and renal failure. Three brothers with Amanita phalloides poisoning were admitted with gastro-intestinal symptoms beginning 12 h after ingestion. Jaundice, hepatomegaly and neurological symptoms were not present, but liver enzymes were moderately increased. Alfa-amanitin was detected in sera of all patients. All patients underwent charcoal hemoperfusion and two of them had additional hemodialysis along with conservative therapy. Liver enzymes that showed a marked increase on the second day of therapy decreased to normal levels on the 28th day. All of our patients survived. This life saving role of early haemoperfusion in Amanita phalloides poisoning is emphasized.

Helicobacter pylori stool antigen test

Objective :Helicobacter pylori (H.pylori) infection is usually acquired in early childhood. Invasive techniques used for diagnosis ofH.pylori infection require endoscopic examination which is expensive and inconvenient and may cause complications. the aim of this study was to evaluate the performance of a new noninvasive diagnostic method, stool antigen test forH.pylori in untreated children with recurrent abdominal pain.Methods: Eighty children (35 female, 45 male) who have undergone upper gastrointestinal endoscopy due to recurrent abdominal pain were included in the study. theH.pylori stool antigen test (HpSA) is based on a sandwich enzyme immunoassay with antigen detection. HpSA sensitivity, specificity, and positive and negative predictive values were determined with reference to the results of both histology and rapid urease test as a gold standard (H. pylori status).Results: While 49 of the 80 children (61%) tested were positive forH.pylori according to the results of both histology and rapid urease test, 28 children had negativeH.pylori status. Among those 49 children, 48 were found to be positive by HpSA. Of 28 patients with negativeH.pylori status, 28 were H.py/ori-negative also in the stool test. the sensitivity, specificity, and positive and negative predictive values of HpSA were found to be 98%, 100%, 100%, and 96.5%, respectively.Conclusion: these findings have demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection ofH.pylori infections in children.

A case of vertical transmission of hepatitis A virus infection

We present a case of hepatitis A infection in a 2.5‐month‐old male who became icteric after 18 d of birth. The diagnosis of hepatitis A was made by compatible clinical symptoms, laboratory results and liver biopsy showing evidence of hepatitis, and confirmed by detection of anti‐HAV IgM antibodies. Because the mother had an acute icteric hepatitis A 1 week before delivery, and the viraemic phase of hepatitis A infection is very short, approximately 7 d, we suggest that the infant was infected by his mother, before birth.

Clinical spectrum of acute abdominal pain in Turkish pediatric patients : A prospective study

Abstract Background : The aim of the present study was to determine the prevalence, associated symptoms, and clinical outcomes of children with acute abdominal pain who had been admitted to an emergency department.

Hepatitis B virus vaccination in children with steroid sensitive nephrotic syndrome: Immunogenicity and safety?

We investigated the efficacy and safety of Hepatitis B vaccine (HBVac) in steroid sensitive nephrotic syndrome (SSNS) children. 41 patients with SSNS and 30 controls were vaccinated with HBVac(Engerix B(®)). Patients were divided into 3 subgroups:full dose steroid users, alternate-day steroid users and steroid non-users. Seroconversion rate was lower in steroid users than non-users at the 6th(p=0.015) and 12th(p=0.036) months. Antibody to Hepatitis B surface antigen(HBsAb) titers were significantly different between subgroups and controls at the 15th month. However, HBsAb and response rates were not different between subgroups at the 12th and 15th months (p>0.05). Five patients were unresponsive to HBVac. Relapse rates after the vaccination were higher than those in the prevaccination period (p=0.002). HBVac is less effective in producing immune response in SSNS children with steroid therapy. HBVac may trigger relapse in some patients. We recommend HBVac to SSNS children with low dose steroid therapy or after steroids are discontinued.

The Role of Nitric Oxide in Pediatric Patients with Portal Hypertension

The hyperdynamic circulation of cirrhosis and portal hypertension has been postulated to be due to the vasodilatory effects of nitric oxide. However, there have been conflicting results in adults and no studies in children. We aimed to measure the nitric oxide level in serum of pediatric patients with portal hypertension with and without cirrhosis, in order to assess its role in the development of hemodynamic changes. We measured nitric oxide levels in 41 pediatric patients (21 patients with intrahepatic portal hypertension and 20 with extrahepatic portal hypertension). The mean age of the study population was 11.2 +/- 4.6 years; 53 per cent were female. Twenty healthy children were included as a control group. Nitric oxide levels were measured by Boehringer-Mannheim colorimetric assay and the statistical significance was calculated by Kruskal-Wallis one-way ANOVA. Significantly higher nitric oxide levels were found in patients independent of the type of portal hypertension compared with the control group (29.4 +/- 6 in patients with intrahepatic portal hypertension, 29.5 +/- 5.8 in patients with extrahepatic portal hypertension, and 23.6 +/- 6.5 in the control group; p < 0.007). These data showed a difference between the groups and suggest that nitric oxide, predominantly independent of cirrhosis, plays a primary role in the pathogenesis of portal hypertension.

Olanzapine-induced atypical neuroleptic malignant syndrome in an adolescent man with anorexia nervosa

Anorexia nervosa (AN) is a serious mental illness that causes significant physical, emotional, cognitive, and social impairments. AN most often develops during adolescence or young adulthood and has high mortality and morbidity rates, in addition to cost burden. Current treatment of AN is multidisciplinary and is typically with a combination of medical, nutritional, and psychological interventions [1] . Antipsychotic medications have been especially used for weight gain and to treat body focused delusional thoughts in adolescent patients with AN [2]. Olanzapine is the most prominent second-generation antipsychotics (SGA) used for the treatment of this condition. However, although it is reported that these drugs are safe to use in adolescents with AN, side effects such as neuroleptic malignant syndrome (NMS) may vary in both the presenting and progressing features in patients with AN. NMS is a rare, idiosyncratic, and potentially fatal complication of antipsychotic medication. Cardinal features of NMS are muscle rigidity, hyperthermia, autonomic instability, and altered mental state. Laboratory findings are non-specific, but leukocytosis is common, and the levels of creatine kinase (CK) are often elevated. Approximately 66 % of NMS cases develop within the first week of initiating of antipsychotic treatment or a change of dose, and almost all cases develop within 30 days [1]. We report a case of an adolescent man with AN, who developed symptoms consistent with NMS after 2 days of treatment with a low dose of olanzapine, and although the symptoms of NMS had been resolved, these symptoms recurred after a month.

As Few Pediatricians as Possible and as Many Pediatricians as Necessary

Jochen Ehrich, MD, DCMT, Laila Burla, MD, Angel Carrasco Sanz, MD, Ellen Crushell, MD, FRCPI, FRCPCH, Fügen Cullu, MD, Jana Fruth, PhD, Andreas Gerber-Grote, MD, Hilary Hoey, MD, FRCPI, FRCPCH, Karoly Illy, MD, Jan Janda, MD, Danielle Jansen, PhD, Reinhold Kerbl, MD, Julije Mestrovic, MD, Aida Mujkic, MD, Leyla Namazova-Baranova, MD, Alf Nicholson, MD, FRCPI, FRCPCH, Massimo Pettoello-Mantovani, MD, PhD, Vladimir Pilossoff, MD, Sergey Sargsyans, MD, Eli Somekh, MD, Mario Trošelj, MD, Mehmet Vural, MD, and Andreas Werner, MD

Persistent vacuoles in leukocytes: Familial Jordans anomaly

Multiple persistent vacuoles were seen in the neutrophils, monocytes and eosinophils of a 9 year old boy and his 10 year old sister. The siblings were both asymptomatic. In the bone marrow, the cytoplasmic vacuoles were also present in the promyelocytes, myelocytes and metamyelocytes, but not in the myeloblasts and they tended to be single and large in immature cells. The cytoplasmic vacuoles did not stain with PAS, Sudan Black or Oil Red O; Sudan III positivity of the vacuoles was found only in a very small number of granulocytes. The vacuoles appeared as round and bright bodies with phase contrast microscopy. By electron microscopy, the vacuoles contained material of low electron density and had no surrounding membrane. Granulocyte functions were unimpaired. Muscle biopsy showed normal morphology. This anomalous vacuolization of the leukocytes is consistent with familial Jordans anomaly.