Mustafa Buyukavci

The effects of ondansetron and granisetron on electrocardiography in children receiving chemotherapy for acute leukemia.

5-HT3 receptor antagonists, including granisetron and ondansetron, are widely used in the prophylactic treatment of chemotherapy-induced nausea and vomiting. Although the cardiac safety of granisetron and ondansetron has been investigated in several adult studies, there is no report investigating the effects of those agents on electrocardiography (ECG) in children. The effects of intravenously infused (over 30 seconds) 0.1 mg/kg ondansetron and 40 μg/kg granisetron on ECG were assessed in 22 children receiving high-dose methotrexate therapy for acute lymphoblastic leukemia. The ECG recording was obtained at before and just after the infusion, and repeated at 1, 3, 6, and 24 hours of treatment. Granisetron administration resulted in a statistically significant decrease of mean heart rate at 1 and 3 hours, and significant prolongation of mean QT and QTc dispersions at 1 hour of infusion. In patients treated with ondansetron, no meaningful change was observed. In conclusion, intravenous granisetron but not ondansetron causes clinically asymptomatic and transient changes on ECG measurements in children receiving high-dose methotrexate therapy.

Bone mineral density in children with cerebral palsy.

Abstract Background : The purpose of the present study was to evaluate the severity of and factors related to osteopenia in children with cerebral palsy (CP).

Prevention of acute adriamycin cardiotoxicity by dantrolene in rats

Possible preventive effect of dantrolene against the peroxidative damage in rat heart which was induced by the administration of an acute dose of adriamycin (ADR, 20 mg/kg, i.p.) has been examined. Forty-eight hours after ADR administration, biochemical changes including the activities of serum creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) and the levels of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in heart tissue were measured. Pretreatment of rats with dantrolene, given i.p. 30 min prior to ADR injection, substantially reduced the peroxidative damage in the myocardium, and markedly lowered the serum CKMB, LDH and AST. The protective effects obtained by dantrolene administration, however, were not complete and did not reach those of the control group. Dantrolene, at 5 mg/kg, was useful to obtain significant protective effects, while the protector effect of higher dantrolene dosing level (10 mg/kg) was weak or absent. These results suggest that, at least in part, due to antioxidative properties, dantrolene may provide a significant protective effect against acute ADR-induced cardiotoxicity.

A childhood case of primary hepatic actinomycosis presenting with cutaneous fistula

Primary hepatic actinomycosis is extremely rare in children. Although the infection has the capability of extension to surrounding tissues or organs, involvement of the abdominal wall is infrequently reported even in adults. We present a childhood case of primary hepatic actinomycosis infiltrating the anterior abdominal wall and spontaneously draining through the skin.

Significance of bone marrow examination in the diagnostic process of paraspinal mass in children: a case report.

Spinal cord compression is a rare but serious complication of non-Hodgkin lymphoma or leukemia. Biopsy of the mass with or without laminectomy would be necessary for diagnosis in patients presenting with isolated paraspinal mass in the absence of other overt clinical symptoms or findings or laboratory abnormalities that would specifically suggest leukemia or lymphoma. The authors describe a 6-year-old girl with symptoms of spinal cord compression due to a paraspinal mass who had undergone surgical intervention; she was later shown to have acute B-cell lymphoblastic leukemia. A bone marrow aspiration should be considered in such patients to avoid unnecessary surgical intervention.

Leukaemia/lymphoma cell microparticles in childhood mature B cell neoplasms

Aims: Because of the observation of an abundance of leukaemia/lymphoma cell microparticles in the bone marrow aspiration sample of a patient with Burkitt’s leukaemia at diagnosis, the occurrence of this phenomenon in leukaemia/lymphoma samples with available immune phenotyping data was investigated retrospectively. Methods: Flow cytometric immune phenotyping and spontaneous apoptosis analysis of the bone marrow mononuclear cell preparation of the index case were performed. Microparticles isolated form the bone marrow sample were also studied for the presence of leukaemia/lymphoma cell microparticles. List mode analysis of 225 cases of acute leukaemia or lymphoma with previously performed immune phenotyping was also carried out. Results: The presence of leukaemia/lymphoma cell microparticles could be detected by flow cytometry and they were found to be different from apoptotic bodies. Leukaemia/lymphoma cell microparticles were released in all cases of mature B cell neoplasms studied, although this phenomenon was rare in precursor B cell disorders and acute myeloid leukaemia. Conclusions: The generation of leukaemia/lymphoma cell microparticles in mature B cell neoplasms appears to be a common phenomenon. The pathogenesis and clinical implications must be investigated.

Miller fisher syndrome with negative Anti-GQ1b immunoglobulin G antibodies

Miller Fisher syndrome is characterized by a triad of ataxia, ophthalmoplegia, and reduced or absent tendon reflexes, with minimal if any limb weakness. Anti-GQ1b immunoglobulin G antibodies are present in high titers in most patients. Presented is a two-year-old female with Miller Fisher syndrome whose blood serum was negative for anti-GQ1b immunoglobulin G antibodies.

Comparison of safety and effectiveness of two different transfusion rates in children with severe anemia.

We compared the safety and efficacy of 2 transfusion regimens in children with severe anemia (hemoglobin <5 g/dL) and without overt signs of congestive heart failure requiring transfusion of packed red blood cells (PRBCs). Forty-three patients were randomly divided into 2 groups: group A and group B. The transfusion regimens consisted of continuous infusion of PRBC at a rate of 1 mL/kg/h for group A and 3 mL/kg/h for group B. The patients were closely monitored for any clinical signs of heart failure throughout transfusion. Heart and respiratory rate, and arterial blood pressure were measured hourly for 6 hours during transfusion. None of the patients developed any signs of cardiac failure during or after the transfusion. The mean heart rate, respiratory rate, diastolic and systolic blood pressure were similar in both groups throughout transfusion. Group A needed significantly more PRBC units than group B to attain the same hemoglobin increase. Transfusion of PRBC at a rate of 3 mL/kg/h, and at a rate of 1 mL/kg/h, is a safe regimen for children with severe anemia of gradual onset requiring transfusion therapy.

Late vitamin K deficiency bleeding: 16 cases reviewed.

In this study, clinical and demographic features of 16 cases with late vitamin K deficiency bleeding are presented. Ages of infants were between 30 and 130 days. Their delivery histories were uneventful, and family histories for bleeding disorders were negative. All parents except one were unaware of whether their children received vitamin K at birth or not. All cases did not have any underlying illness to explain the abnormal coagulation profile. The common presenting finding was pallor (62.5%). Intracranial haemorrhage was the most common bleeding site (37.5%), and two patients (12.5%) died because of it. Late vitamin K deficiency bleeding is still an important handicap in infants. Parents and healthcare providers should be informed about the importance of vitamin K prophylaxis to prevent vitamin K deficiency in infants.

An alarming sign for serious diseases in children: bilateral facial paralysis

Facial paralysis in children is most often idiopathic, and isolated facial nerve palsy resulting from leukemic infiltration is a rare occurrence. We report a 13-year-old male with acute lymphoblastic leukemia presenting with bilateral facial palsy, who was previously diagnosed with idiopathic facial palsy and treated with steroids. This rare presentation of acute lymphoblastic leukemia should be kept in mind as a diagnostic possibility in a patient with bilateral facial nerve paralysis.