Nazan Tomac

Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

BackgroundCephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS).ObjectiveTo evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity.Materials and methodsThe study population consisted of 39 children, aged 4–12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded.ResultsCranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=−0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH (P<0.001).ConclusionsThere is significant correlation between cephalometric data and AHI score severity in children with OSAS. Adenotonsillar hypertrophy affects the cephalometric measurements adversely. The study clearly mandates the institution of early and effective therapy of adenotonsillar hypertrophy in children with OSAS.

Ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge

Ceftriaxone is known to induce precipitates that mimic a gallstone on sonograms in the gallbladder of children and adults. Terms such as ‘biliary pseudolithiasis’ are now used to denote the reversible, benign character of this complication upon discontinuation of ceftriaxone therapy. 1–3 The first sonographic demonstration of precipitates forming in the gallbladder during ceftriaxone therapy was reported by Schaad et al . in 1986. 3 In subsequent reports, biliary sludge or biliary pseudolithiasis, has frequently been reported with this antibiotic. 1,2,4 Ceftriaxone-induced urinary calculi are rarely observed. Six cases of ceftriaxone urinary calculi have been published. 1,4–7 In this study, we report a case who developed ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge, which were completely resolved after the ceftriaxone treatment ceased. To our knowledge ceftriaxone-induced urinary bladder sludge has not been reported previously. In this case, we report the first documented case of ceftriaxone-induced urinary bladder sludge.

Gallbladder and urinary tract precipitations associated with ceftriaxone therapy in children: a prospective study

Abstract The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20–30-minute periods, for 5–14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4–9 days of ceftriaxone therapy, and resolved completely 7–19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.

Effect of iodine supplementation on goiter prevalence among the pediatric population in a severely iodine deficient area

We evaluated goiter status and urinary iodine excretion (UIC) of 304 school-children (7-12 years old) 3 years after a law was passed for mandatory production of iodinated salt in an area previously characterized by severe iodine deficiency in Zonguldak, a mountainous city in the West Black Sea region in Turkey. We examined all the children for goiter by palpation, measured sonographic thyroid volumes (STV) and UIC. Eighty-two percent of families had been using iodinated salt. UIC was above 100 microg/l in 71.2% of the children and median UIC was sufficient (143.5 microg/l). The prevalence of goiter was lower at ultrasound (14.6%) than by palpation (19.4%). Median STV values were within recommended normal limits at all ages. Although Zonguldak had been a highly endemic region, it became mildly endemic 3 years after mandatory iodination of salt, with decrease of goiter prevalence.

Churg-Strauss Syndrome: A Patient Report in Infancy

C ghurg-Strauss syndrome (CSS) is a disorder characterized by pulmonary and systemic small-vessel vasculitis, extravascular granulomas, and hypereosinophilia. The clinical syndrome is characterized by the presence of asthma, fever, and variable manifestations of vasculitis. Pulmonary disease is almost always present, often with a history of long-standing asthma and the presence of infiltrates on chest radiograph. Mononeuritis multiplex, hypertension, and renal involve-

Midline cleft of the lower lip associated with Robinow syndrome.

Robinow syndrome (also named “fetal face syndrome”) includes a series of anomalies including mesomelic brachymelia, bifid terminal phalanges of the hands and feet, abnormalities of vertebrae and ribs, and hypoplastic external genitalia. A midline cleft of the lower lip and mandible is an extremely rare maxillofacial deformity. Seventy cases have so far been described to our knowledge. We report a patient with Robinow syndrome and midline cleft of the lower lip and mandible and describe the reconstruction of these anomalies. We propose that this anomaly should be added to the range of malformations associated with the syndrome.