Meltem Ceyhan

Cerebral vasculitis in a child with Henoch-Schönlein purpura and familial Mediterranean fever.

In this case report, a 10-year-old girl with Henoch–Schönlein purpura (HSP) with severe central nervous system involvement and also having familial Mediterranean fever (FMF) is presented.

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Mammary duct ectasia in infant breast with bloody nipple discharge: Sonographic findings

Bloody nipple discharge is very rare in childhood. We report the sonographic findings of mammary duct ectasia and cystic changes under the nipple with abnormal content involving a 3‐month‐old boy with bloody nipple discharge.

The role of ultrasonography in the diagnosis and management of non-traumatic acute abdominal pain

Our aim was to assess the effects of initial ultrasonography (US) evaluation on the diagnosis and management of non-traumatic acute abdominal pain in the emergency department. Three hundred patients with the complaint of non-traumatic acute abdominal pain who were sent for US examination with an initial clinical impression were included in the study. Pre-US and post-US surveys were designed for the clinicians who requested US. The percentage concordance of US findings with the discharge diagnosis made by clinical follow-up, imaging modalities and surgery was determined by calculating the confidence interval. The concordance of the initial clinical impression and the US diagnosis with the discharge diagnosis were compared using the McNemar test. US could not detect any pathology in 102 (34%; 95%CI, 28.6–39.3%) of the patients. The US revealed a different diagnosis than the clinical impression in 69 (23%; 95%CI, 18.2–27.7%), and confirmed the diagnosis in 121 (40%; 95%CI, 34.4–45.5%) patients. The US changed the treatment plans in 47% (95%CI, 41.3–52.6%) of the patients. The clinicians stated US helped them “very much” or “moderately” in making a diagnosis in 83% (95%CI, 78.7–87.2%). When US results were compared with the discharge diagnosis, there was concordance in 238 (79.3%; 95%CI, 74.3–83.6%) patients but not in 62 (20.6%; 95%CI, 16–25.1%). Among 121 patients the initial clinical impression agreed with the US diagnosis and there was concordance with the discharge diagnosis in 105 (86.7%; 95%CI, 80–92.7%). The concordance of US findings with the discharge diagnosis was significantly higher than that of the initial clinical impression statistically. In the initial evaluation of the patients with acute abdominal pain, US is considerably helpful in making the correct diagnosis, and that the concordance with the discharge diagnosis is high. When whole abdominal scanning is not performed, targeted US study according to the initial clinical impression decreases the clinical benefit of US.

Crimean Congo hemorrhagic fever and diffuse alveolar haemorrhage

Although the pathology of Crimean Congo haemorrhagic fever (CCHF) is mainly related to a haemorrhagic process with secondary cytokine storm, there have been no published reports of this fatal disease being a cause of diffuse alveolar haemorrhage (DAH). There are many aetiological factors emphasizing the direct role of endothelial injury on DAH. We present the case of a young adult Turkish man with diffuse bilateral alveolar haemorrhage without an episode of gross haemoptysis caused by the CCHF virus. Successful clinical results and a rapid clinical and radiological clearance were obtained within few days after starting daily oral ribavirin treatment. This fatal infection should be considered to exist in any patient presenting with DAH, and should rapidly be treated with ribavirin. Another very important factor which should always be borne in mind is the contagious character of the CCHF virus. It is one of the most dangerous microorganisms transmitted from person to person. Even the bronchoscopes contaminated with patient blood carry a high risk for nosocomial spread to medical staff and other patients.

Intrathoracic malignant peripheral nerve sheath tumor with angiosarcoma in a child with NF1.

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon in children and adolescents but occur more frequently in NF1 patients. Angiosarcomatous differentiation in MPNSTs is a rare entity with poor prognosis. We report on a 13-year-old boy with intrathoracic angiosarcoma arising in MPNST associated with NF1.

Increased Laterality of the Thalamus in Children and Adolescents with Asperger's Disorder: An MRI and Proton Spectroscopy Study

Objective Thalamic abnormalities have been reported in people with pervasive developmental disorders (PDD) including Aspergers Disorder (ASP). The aim of the present study was to compare the volume and volume fraction of the thalamus and the metabolite concentrations in children and adolescents with ASP using the magnetic resonance imaging and proton magnetic resonance spectroscopy. Additionally, the relationships between thalamic abnormalities and clinical features were examined. Methods Volume and volume fractional and metabolic measurements of bilateral thalamus were collected from 15 boys with ASP with a total IQ over 70 (age range 7-18 years, mean age 11.6±3.79 years), and 15 healthy controls matching age, sex and IQ. The thalamic volumes, hemisphere volumes and total brain volumes (TBV) were estimated using the stereological methods on magnetic resonance images. Chemical metabolites of thalamus were evaluated by 1H spectroscopy. Results No differences in thalamic volumes, volume fractions and metabolites were observed between the groups. There were significant correlation between thalamic volume and total brain volume in both groups. The ASP group showed a significant left-minus-right thalamus difference as well as a significantly greater laterality index. In addition, a significant correlation between the laterality index and Autism Behavior Checklist language scores was observed. Conclusion Findings from this investigation point to a significant increase in laterality of the thalamus and a relationship with language problems in individuals with ASP. Our findings suggest that thalamic abnormalities may be related to mild language problems observed in ASP.

Hepatic hydatid cyst rupture and anaphylaxis after a fall

A 15-year-old boy presented to the emergency unit complaining of dyspnea, urticaria and vomiting developed after he fell down when he was playing football. Abdominal ultrasound showed a ruptured hydatid cyst in the right lobe of the liver which was of communicating type. Echinococcus granulosus serologic tests were positive. Medical treatment was started immediately. One week later, follow up US showed no changes in the findings. Intrabdominal fluid leakage was not detected. Patient’s general condition showed improvement and he was discharged 12 days later.

Diffuse multicystic encephalomalacia in a preterm baby due to homozygous methylenetetrahydrofolate reductase 677 C-->T mutation.

Methylenetetrahydrofolate reductase catalyzes the formation of 5-methyltetrahydrofolate from 5,10-methylentetrahydrofolate and produces folate for the methylation of homocysteine to methionine. Due to insufficient conversion of homocysteine to methionine, plasma homocysteine levels increase in methylenetetrahydrofolate reductase deficiency. Homocysteine is an amino acid that contains a neurotoxic sulfur molecule and can induce neuronal apoptosis. Methylenetetrahydrofolate reductase deficiency is 1 of the etiological factors that causes neurological symptoms and signs in the newborn and childhood period. Here, we report a premature baby with prenatal onset diffuse multicystic encephalomalacia and cerebellar atrophy due to homozygous methylenetetrahydrofolate reductase mutation.

Absence and size of massa intermedia in patients with schizophrenia and bipolar disorder

Objective: To evaluate the absence and size of massa intermedia (MI), a midline thalamic structure, and its gender-specific alteration in patients with schizophrenia and bipolar disorder. Methods: Thirty-five patients with schizophrenia (17 females and 18 males), 21 patients with bipolar disorder (15 females and 6 males) and 89 healthy controls (50 females and 39 males) were evaluated by magnetic resonance imaging. Thin-slice magnetic resonance images of the brain were evaluated. MI was determined in coronal and sagittal images, and area of the MI was measured on the sagittal plane. Results: Females had a significantly lower incidence of absent MI compared with males in the healthy control group. The absence of MI in schizophrenia and bipolar patients was not higher than the incidence in healthy controls. The size of MI showed a gender difference. The mean MI area size was smaller in female schizophrenia patients than in female controls, while no significant difference was observed between male schizophrenia patients and their controls. Conclusions: The size of MI, a gender difference midline structure, is smaller in females with schizophrenia, and the results of this study support other studies of structural aberration of the thalamus and other midline structures in the brains of patients with schizophrenia.