Omer Dogru

Preoperative sonography of nonreducible inguinal masses in girls.

Inguinal hernia is one of the most common surgical pathologies in childhood. Any of the abdominal organs can slide into the hernial sac and become incarcerated there. In girls, the fallopian tubes, ovaries, uterus, and—rarely—ovarian cysts can form the sliding component of an inguinal hernia. The aim of this study was to investigate the diagnostic value of preoperative sonographic examination in girls with nonreducible inguinal masses.

Umbilical perforation: an unusual complication of a ventriculoperitoneal shunt

IntroductionVentriculoperitoneal shunt operations are the most common pediatric neurosurgical procedures in the treatment of hydrocephalus. However, ventricular shunting is frequently associated with a wide variety of complications. Umbilical perforation is an extremely rare complication of ventriculoperitoneal shunts.Case reportWe present an infant with umbilical abscess, meningitis, and umbilical perforation of the distal end of the ventriculoperitoneal shunt, which was placed for congenital hydrocephalus.

Pleural effusion: a rare complication of hepatitis A.

Hepatitis A (HAV) infection, which is the most common form of hepatitis in the paediatric age group and which sometimes has a fulminant course, is endemic in Turkey, constituting one of the countrys important health problems. Pleural effusion also represents a rare benign complication of acute HAV infections. We describe here a case of Hepatitis A who developed pleural effusion.

Lacrimo-auriculo-dento-digital syndrome with QT proglongation

We have read the article by E. Onrat et al. entitled “Lacrimo-auriculo-dento-digital syndrome with QT prolongation1. It was amazing to realize that the same boy presented to the paediatric emergency department with seizures 4∞∞months earlier. The patient had been diagnosed with epilepsy before and had been treated with phenobarbital, without any benefit. Thereafter during a screening programme he was diagnosed as having long QT syndrome, in addition to the LevyHollister syndrome, upon which beta-blockers were started. During follow-up, the prolongation of QT did not change and the dose of the beta-blockers was doubled again without any improvement. On admission to the emergency department, the boy was found to be severely hypocalcaemic (serum calcium level 4.3∞∞mg/dl). It is stated in the above article that his serum levels of sodium potassium and calcium were normal, but no quantitative values were given. The QTc on admission was 500∞∞∞msec. Emergency treatment of hypocalcaemia was achieved by bolus administration of i.v. calcium gluconate, followed by continuous infusion. Serum phosphorus was 11.66∞∞mg/dl during the hypocalcaemic period. The serum magnesium level was 1.40∞∞mg/dl, within the normal range. The serum parathormone level was 3.00∞∞pg/ml, far below the normal range of 10-65∞∞mg/ml. Computed tomography of the skull yielded calcifications of the basal ganglia. This work-up for hypocalcaemia revealed that the patient had had hypoparathyroidism which was the main cause of the hypocalcaemia and the resultant QT prolongation. Upon the diagnosis of hypoparathyroidism the patient was given i.v. calcium first, followed by oral calcium after determining that serum calcium levels reached normal levels. After correction of hypocalcaemia QTc was found to be 340∞∞msec. The patient was also given calcitriol, first at 0.25∞∞mcg/24h followed by 0.75∞∞mcg/24h when it was impossible to maintain normal serum calcium only with calcium administration. The beta-blocker therapy used for the last 2∞∞years was stopped. The patient is still receiving treatment with oral calcium and alcitriol and is without symptoms. His QTc is 320∞∞msec. We have to emphasize that what is new in this particular patient is not the QT prolongation but rather the hypoparathyroidism. This may be part of the LADD syndrome or a coincidence which will become clearer after further research and case reports. Hypoparathyroidism has not been reported before in the LADD syndrome but it is well known that it can occur in several dysmorphic syndromes and even a specific syndrome has been reported in Middle Eastern children2. In hypoparathyroidism, enamel hypoplasia may occur, with dry and scaly skin and horizontal lining of the nails, and keratoconjunctivitis, which were prominent features in our patient also. These overlaps strongly suggest that LADD syndrome and hypoparathyroidism may have a common aetiology, or both may be a part of a sequence. Therefore, we believe that what is new in this specific patient with LADD syndrome is not the QT prolongation but rather the hypoparathyroidism and for the time being, hypoparathyroidism should be kept in mind when evaluating LADD patients.

Ayın olgusu Olgu Sunumu

Multipl sclerosis is a chronic disease of the central nervous system characterized by discrete areas of demyelination and axon injury The occurrence of multipl sclerosis in children younger than 16 years has been found to between 2 5 The incidence of posterior fossa plaques and tumefactive lesions were higher in children A fourteen year old boy who had a history of acute disseminhated encsephalomyelitis one year before and demosttrated tumefactive plaques confused with tumor or abscess in the second attack was diagnosed as multipl sclerosis Current knowledge of nbsp; the diagnosis differential diagnosis and therapy of nbsp; multipl sclerosis are discussed Key words: child interferon beta nbsp; multipl sclerosis tumefactive plaque