Raif Üçsel

Central venous catheters in pediatric patients – subclavian venous approach as the first choice

Background : It is critical to establish a safe and functional i.v. access in severely sick patients. We evaluated the frequency of application and complications of central venous catheters in a pediatric intensive care unit.

Efficacy of long duration resuscitation and magnesium sulphate treatment in amitriptyline poisoning.

A single dose of cyclic antidepressants leads to death in childhood. Myocardial depression and ventricular arrhythmia are the severe side effects in cyclic antidepressant overdose. A 23-month-old boy was brought to hospital because 36 mg/kg of amitriptyline had been taken. Cardiopulmonary resuscitation was applied for 70 minutes due to cardiac and respiratory arrest. Circulation was restored after resuscitative efforts. However, ventricular tachycardia was detected which did not respond to lidocaine, bicarbonate and cardioversion treatment. Magnesium sulphate treatment was started and cardiac rhythm normalized. No side effects were observed. The duration of resuscitation should be extended in cases of cardiopulmonary arrest secondary to tricyclic antidepressants intoxication. It should be continued at least for 1 hour. Magnesium sulphate was found to be extremely effective in a case of amitriptyline intoxication refractory to treatment.

Ceftriaxone-induced haemolytic anaemia in a child with no immune deficiency or haematological disease

Abstract: A 5‐year‐old girl, with no underlying immune deficiency or haematologic disease, was treated with ceftriaxone for a urinary tract infection. After receiving ceftriaxone intramuscularly, massive haemolytic anaemia developed. Laboratory studies showed the presence of an antibody against ceftriaxone, and the findings reflected immune complex type haemolysis. High‐dose corticosteroids appeared to be effective therapeutically.

Hypophosphatemia and its clinical implications in critically ill children: A retrospective study

PURPOSE The aims of this study were to determine the prevalence of hypophosphatemia and to discuss the clinical implications of hypophosphatemia in critically ill children. MATERIALS AND METHODS A retrospective review of the medical records of children admitted to the pediatric intensive care unit from December 2006 to December 2007 was conducted. RESULTS In 60.2% (n = 71) of the patients, any serum phosphorous level at admission and at the third day or seventh day after admission to pediatric intensive care unit was in hypophosphatemic range. Sepsis was present in 22.9% (n = 27) of the children studied and was associated with hypophosphatemia (P = .02). Hypophosphatemia was also associated with use of furosemide (P = .04), use of steroid (P = .04), use of β(2) agonist (P = .026), and use of an H(2) blocker (P = .004). There was a significant association between hypophosphatemia and the rate to attain target caloric requirements by enteral route (P = .007). The median time to attain target caloric requirements by enteral route was 2.9 ± 1.9 (0.2-10) days in the normophosphatemic group and 4.4 ± 2.8 (0.3-12) days in the hypophosphatemic group. In the multiple regression model, solely the rate to attain the target caloric requirements by enteral route demonstrated independent association with hypophosphatemia (P = .006; β = .27; 95% confidence interval, 0.02-0.09). Significant association was found between hypophosphatemia and the duration of mechanical ventilation and between hypophosphatemia and pediatric intensive care unit length of stay (P = .02 and P = .001, respectively). CONCLUSIONS Critically ill pediatric patients are prone to hypophosphatemia, especially if they cannot be fed early by enteral route. Hypophosphatemia is associated with an increased duration of mechanical ventilation and increased length of stay in the pediatric intensive care unit, suggesting that active repletion might improve these parameters.

Seizures associated with poisoning in children: tricyclic antidepressant intoxication

Background: The aim of this study was to examine the characteristics of seizure due to poisoning.

A rare cause of intracranial hemorrhage: Factor X deficiency

Congenital factor X deficiency is a rare inherited coagulation disorder, characterized by prolonged prothrombin time and partial thromboplastin time. For the definite diagnosis, specific factor X level should be investigated. We describe a patient with factor X deficiency who had intracranial hemorrhage. Hematologic tests showed prolonged prothrombin time, partial thromboplastin time, and a factor X level of 5%. The patient’s hemorrhage resolved with fresh frozen plasma replacement. In this article, we discuss the clinical features and management of factor X deficiency.

Neonatal suppurative parotitis: a vanishing disease?

A case of neonatal suppurative parotitis due toKlebsiella pneumoniae is described. This is the first case reported in the last 20 years. Infection with unusual microorganisms should be taken into account when planning antibiotic treatment, especially in hospital acquired infections of the salivary glands in the newborn.

Cerebral venous thrombosis in childhood.

[1] that high blood pressure is the cause of bleeding, a spinal epidural arterial structure should be the source of SSEH. The distribution of the arterial structures within the spinal epidural space, however, does not correlate with the typical distribution of the SSEH. The majority of these epidural hematomas are situated posterior or posterolaterally in the spinal canal, and are predominantly situated at the cervicothoracic and the thoraco-lumbar changeover. Moreover, a striking correlation between the level distribution and age has also been noticed, as thoraco-lumbar SSEHs mainly occur after the fourth decade. Before that age, the majority of SSEHs are situated in the C5–Th2 area. These phenomena are illustrated in Fig. 1.

Unusual Cause Of Pulmonary Mass In Childhood: Pleuropulmonary Blastoma

Pleuropulmonary blastoma is a malignant lung tumor affecting children. Pleuropulmonary blas- toma is a rare entity having an incidence between 0.25-0.5% of all primary lung malignancies that occurs exclusively in children younger than 6 years. The tumor usually originates from pul- monary parenchyma, mediastin and pleura and especially presents as a solitary pulmonary mass in unilateral lung. In this case report, we present a 3.5-year-old boy who was admitted with fever, dyspnea, wheezing, abdominal pain, weight loss and was diagnosed as pleuropulmonary blastoma. As pleuropulmonary blastoma is rarely seen in childhood, relevant literature on pleuropulmonary blastoma is reviewed.

Rubella Ensefaliti Olgusu

Rubella virusu nadiren postinfeksiyoz ensefalite yol acar ve bu hastalarin da buyuk bir kismi sekelsiz iyile- sir. Bu yazida, 14 yasinda, rubella postinfeksiyoz ensefaliti tanisi konulan bir cocuk sunulmaktadir. Hasta, akut bilinc kaybi ve konvulziyonlarla basvurdu. Beyin MRI incelemesi normal bulundu. Beyin omurilik sivisi ve serumda rubella spesifik IgM pozitif bulundu. Bilinc degi- siklikleri ile gelen her hastada viral ensefalit goz onune alinmali ve muhtemel etkenler arasinda rubella da dusu- nulmelidir.