Mehmet Karacı

Late Presenting Congenital Diaphragmatic Hernia as Tension Gastrothorax

To the Editor: Congenital diaphragmatic hernia (CDH) occurs in about 1 in 2500–3000 births. The most common defect is the posterolateral (Bochdalek) type [1]. Tension gastrothorax develops when the stomach, herniated through a congenital diaphragmatic defect into the thorax, is massively distended by trapped air [2]. A previously healthy 26-mo-old boy was admitted to a local hospital with dyspnea, stridor, nausea, and fatigue and treated with tube thoracostomy on account of pneumothorax of the left lung and pneumonic infiltrations on chest Xray the day before been admitted to authors’ hospital. On physical examination, his respiratory rate was 44/min and SPO2 94 % (room air). Left hemithorax was less ventilated and breath sounds were diminished on the left. On account of left pneumothorax and mediastinal shift to the right on chest radiograph, the patient was misdiagnosed as having tension pneumothorax (Fig. 1). Chest tube was placed but no clinical or radiological response was observed. Then a computed tomography of the chest was obtained and intra-operatively Bochdalek type hernia including the whole dilated stomach as well as a small segment of left colon through a defect of 7–8 cm on the postero-lateral side of the diaphragm was demonstrated (Fig. 2). The patient was discharged without any complication (Fig. 3). In cases of acute respiratory failure with radiological evidence of air filling one hemithorax, gastrothorax as well as tension pneumothorax should be investigated [3]. To distinguish a tension pneumothorax and a gastrothorax the most important method is insertion of a nasogastric tube before R

Compliance of the Physicians with the Guidelines for the Management of Community- Acquired Pneumonia in Childhood

Objective: This study was performed to evaluate the impact of adherence to national guidelines for management of community-acquired pneumonia (CAP) in different groups of doctors.Methods: In this study, a questionnaire was filled interview with a total of 322 with physicians working in hospitals, in different cities of Turkey. The recommendations of the national guideline were compared with the responses.Results: The physicians, only 11.8% made the diagnosis of pneumonia only with symptoms and physical examinations findings. Averagely, 60% used the investigations of chest x-ray, complete blood count and CRP together for diagnosis. 55% of the doctors preferred parenteral treatment with the first choice ampicillin/sulbactam in outpatient treatment.Conclusion: As a result of this study, it was observed that the physicians did not comply with the national guidelines in terms of diagnosis and treatment of CAP in childhood.

A Neonatal Pneumonia Presented with Spontaneous Pneumothorax Due to Listeria Monositogenes

Listeria Monositogenes is a facultative anaerob gram(+) agents that presents in soil, water, plants and in many mammals intestinal system. Listeria Monositogenes is one of the most common factors of early neonatal sepsis and neonatal pneumonia during the perinatal period. Maternal obstetric complications are frequently seen in patients. Patients are often premature and have low birth weight. Responsible microorganisms frequently originate from maternal. The disease involes multisystems and the prognosis is usually fulminant. In the congenital pneumonia, respiratory distress syndrome is prominent. Symptomatic spontaneous pneumothorax brings about serious morbidity and mortality in newborns. The cause and risk factors of symptomatic pneumothorax in term newborns are not completely understood. The risk factors were reported as prematurity, male sex, high birth weight and birth the use of vacuum. We aimed to present a case with neonatal pneumonia associated with symptomatic spontaneous pneumothorax due to Listeria Monositogenes.

Atelektaziyle Giden Aberan Sağ Subklavian Arter: Olgu Sunumu

Aberrant right subclavian artery (ARSA) is the most common embryological abnormalities of the aortic arch. It is seen 0,5-1,8 per hundreds overall the population. Aberrant right subclavian artery can be seen asymptomatic in infants; whereas it can also occur severe symptoms such as respiratory distress, stridor, wheezing, dyspnea, dysphagia, recurrent lung infections due to compression on trachea, main bronchi and esophagus. We report a three month- old girl who received a long-term treatment due to recurrent pneumonia with atelectasis. Without any etiological abnormalities about recurrent pneumonia, aberrant right subclavian artery that was compressing right main bronchia, right upper bronchi, and right pulmonary artery was detected via cardiac catheterization. We aimed to emphasize the possibility of aberrant right subclavian artery in who have recurrent or non-healing pneumonia without any etiology despite receiving long-term treatment.

The Protective Effect of the BCG Vaccine on the Development of Type 1 Diabetes in Humans

Type 1 diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia which is the result of irreversible destruction of insulin-secreting beta islet cells. Since 1921, there has been no new way to control blood glucose levels except through the use of insulin, diet, and exercise, which makes research into methods to prevent type 1 diabetes important. We conducted a case-control study to see if vaccination with bacillus Calmette-Guerin (BCG) has a protective effect on the development of type 1 diabetes. A total of 130 cases and 260 healthy controls (age 0–18 years) were included. The type 1 diabetes cases had fewer BCG scars compared to the control group (p=0.0001). Among those with type 1 diabetes, there was no significant relationship between the number of BCG scars and age of onset. We found that administration of BCG in the first month of life was more protective against the development of type 1 diabetes than later administration (p=0.0001). Among those with type 1 diabetes, there was no relationship between age at vaccination and age of onset. These findings suggest that if the BCG vaccine is administered at least twice, and if the first dose is given in the newborn period, the vaccine may protect against the development of type 1 diabetes in children.