Handan Alp

Pelvic ultrasound measurements in normal girls: relation to puberty and sex hormone concentration.

Pelvic ultrasonography was performed on 75 normal girls. Values were obtained for uterine length, fundal/cervical ratio (FCR), ovarian volume and sex hormones. The resultant data were grouped according to age and pubertal stage (Tanner). For uterine length, FCR and ovarian volume, the data were positively skewed, and the variance increased with age and pubertal stage (p < 0.001). The uterus underwent a regular increase in size and the corpus gradually became larger than the cervix. Uterine length, right ovary volume, FCR and hormones (serum estradiol, follicle-stimulating hormone and luteinizing hormone) showed a correlation with the Tanner score (p < 0.001). Although the correlations were significant, the best correlation was between pubertal stage and serum estradiol level.

Amitraz poisoning in children: Retrospective analysis of 21 cases

The clinical and laboratory findings of 21 children with amitraz poisoning were evaluated retrospectively. Poisoning route, signs and symptoms of poisoning, duration of hospitalization and outcome were recorded. The mean age was 3.5 ± 1.9 years and the ratio of males to females was 1.63. In all cases poisoning was via the oral route. The time from ingestion to onset of symptoms was 30–180 min. Drowsiness (100%) and loss of consciousness (100%) were the most common clinical findings, followed by vomiting (61.9%). Hypotension was observed in 66.7% of cases, bradycardia in 61.9%, respiratory depression in 42.9%, hypothermia in 9.3%, and 14.3% had generalized seizures responsive to diazepam. Hyperglycaemia and glycosuria were detected in 47.6% and 38.1% of cases, respectively. Minimally elevated transaminases and alkaline phosphatase levels were detected in 23.8% of cases. All patients recovered completely and were discharged within 1.0–5.2 days (mean, 2.1 ± 1.1).

Vitamin D intoxication and therapy with alendronate (case report and review of literature)

Dear editor, We read the article of Bereket and Ertogan [1], reporting a 3-month-old boy with vitamin D intoxication, who was treated with alendronate, with great interest. Here we present a 7-year-old male with acute vitamin D intoxication, who was treated with oral alendronate. A 7-year old male child was admitted to our Pediatric Emergency Unit with symptoms of anorexia, nausea, vomiting, polydipsia, polyuria and constipation. In history, he was administered 300,000 units of oral vitamin D (cholecalciferol) daily for 15 days by an internist, who suspected vitamin D deficiency. Above mentioned symptoms had occurred at the end of 15 days. The physical examination on admission revealed impaired turgor of the skin and dryness of the oral mucosa consistent with moderate dehydration. The rest of the examination was unremarkable. On admission, laboratory findings are shown in Table 1. The patient was admitted to the ward and emergency treatment was initiated with IV hydration (2,500 mL/m/d, additional 20 mEq/l potassium chloride), furosemide (1 mg/kg/dose, every 6 h). Dietary calcium and vitamin D intake were restricted. A repeat serum calcium level was 14.8 mg/dL on the following day. Urinary calcium/creatinine ratio was initially high. Renal ultrasonography was reported as normal. Alendronate sodium 5 mg/d given by mouth was added to treatment after obtaining informed consent from the father. Serum calcium was still 14.3 mg/dL on the 3rd day of admission, the dose of alendronate was increased to 10 mg/d. Calcium levels decreased gradually in the following days. Then serum calcium dropped to 10.3 mg/dL on the 16th day and treatment was discontinued without any relapse. No side effects were noted with this treatment. Serum calcium levels remained normal thereafter. Urinary calcium/creatinine ratio decreased gradually to normal levels on 2nd month. Renal ultrasound examination at 2nd month after the admission did not show any evidence of nephrocalcinosis or other abnormalities. A radiographs of the hand taken on the admission, at 1 and 2 months after the admission did not show metaphyseal sclerosis. Laboratory values and treatment during follow-up are shown in Table 1. It is known that rapid normalization of serum calcium level and maintaining of normocalcemia are necessary to prevent acute complications and prolonged hypercalciuria and nephrocalcinosis [6]. Relative potency of alendronate to inhibit bone resorption is 10–20 times higher than that of pamidronate [7]. Although pamidronate has been used in children with vitamin D intoxication [2, 4], studies examining the efficacy of oral alendronate in children are limited. In literature, we found one case report which represented efficacy of alendronate in hypervitaminosis D [1]. There is currently little information to guide clinicians as to duration of treatment and what criteria should be used to indicate termination of the treatment. In our study normalization of serum calcium level also took almost two weeks and hypercalcemia did not recur. Another condition is duration of treatment effect. It is currently unclear how long the effect of bisphosphonate treatment will last once discontinued. When administered, bisphosphonates are cleared rapidly from the circulation. Its half-life in serum is short, a few hours or less, whereas the half-life in the bone Z. Orbak . H. Doneray . F. Keskin . A. Turgut . H. Alp . C. Karakelleoglu Department of Pediatric Endocrinology, Ataturk University Faculty of Medicine, Erzurum, Turkey

Efficacy and safety of rectal thiopental, intramuscular cocktail and rectal midazolam for sedation in children undergoing neuroimaging

Background : This study was designed to investigate the overall usefulness of rectal thiopental, rectal midazolam and i.m. modified cocktail (meperidine‐chlorpromazine hydrochloride‐feniramin maleat) in 70 children undergoing computed tomography (CT) and magnetic resonance imaging (MRI).

Pott's puffy tumor: multidetector computed tomography findings.

A subperiostal abscess of the frontal bone as a complication of osteomyelitis, appearing as a puffy, indolent tumor of the forehead, was first described by Pott. This less-common complication of is known as Potts Puffy tumor. The complications of Potts Puffy tumor are preseptal and orbital cellulites by downward spread to the orbit and intracranial infection by posterior extension. We present a case of Potts Puffy tumor complicated by intracranial infection imaged by means of multidetector computed tomography.

Efficacy and safety of rectal thiopental: Sedation for children undergoing computed tomography and magnetic resonance imaging

Abstract Purpose: We evaluated the clinical safety, effectiveness, efficiency and potential side effects of rectally administered thiopental in 30 children undergoing computed tomography (CT) and magnetic resonance imaging (MRI).

Plasma and urine carnitine levels and carnitine supplementation in children with malnutrition.

The purpose of the present investigation was to determine serum and urinary carnitine levels in children suffering from protein-energy malnutrition (PEM) before and after dietary treatment and carnitine supplementation, and to compare them with those in healthy children. Plasma and urine carnitine levels were lower in patients with marasmus and kwashiorkor than in controls. There was no statistical difference between groups with and without carnitine supplementation on the first day. On the fifth day, in groups receiving carnitine supplementation, plasma and urine carnitine levels were significantly higher than in groups without supplementation (p < 0.01). On the 15th day there was no statistical significance between groups with PEM and controls.

Familial Mediterranean fever protracted febrile myalgia in children: report of two cases

Familial Mediterranean fever (FMF) is characterised by recurring, acute, self-limiting episodes of fever accompanied by serosal, synovial or cutaneous inflammation [1, 2]. One of the most common complications of FMF results from the deposition of amyloid A [3]. The clinical picture of FMF has been expanded appreciably in the last 10 years when additional features have been described, including severe myalgia [4], the protracted febrile myalgia syndrome [5], scrotal swelling [6] and cardiac involvement [7]. In this letter, we described protracted febrile myalgia with FMF in two children and draw attention to the protracted febrile myalgia as an entity that requires corticosteroid treatment.

Cystinosis presenting with findings of Bartter syndrome.

A five-year-old boy was referred to our pediatric clinic for evaluation of failure to thrive, headache, intermittent high fever, restlessness, polyuria, and polydipsia. His weight and height measurements were under the 3rd percentile. Clinical findings consisted of frontal bossing, carious teeth, O-bain deformity of the lower extremities, and moderate dehydration. The presence of metabolic alkalosis, hypokalemia, hypochloremia, and high renin and aldosterone levels were suggestive of Bartter syndrome and a treatment regimen for Bartter syndrome was started. At follow-up, the polyuria and hyponatremia were found to persist. A reassessment of the patient revealed findings consistent with proximal renal tubular acidosis such as metabolic acidosis with a high urinary pH, proteinuria, aminoaciduria with phosphaturia and hypercalciuria. Based on the presence of parental consanguinity as well as polyuria, proteinuria, low tubular reabsorption of phosphorus, generalized aminoaciduria, light yellow skin and hair color, the probable diagnosis of cystinosis was established and was confirmed by slit-lamp examination of the cornea showing cystine crystal deposition. Our case is a good example demonstrating that development of metabolic alkalosis does not exclude cystinosis and that all findings of the patient should be thoroughly evaluated. Conflict of interest:None declared.

Bone mineral density in malnourished children without rachitic manifestations

Background: The purpose of this study was to determine bone mineral density (BMD) of lumbar spine in malnourished children without rachitic manifestations, before and after dietary treatment and vitamin D supplementation, and to compare with healthy children of the same community.