Sebuh Kuruoğlu

Doppler Ultrasonography in Searching the Collateral Network in Portal Hypertensive Children

A diffuse collateral network forms all around the body both in extrahepatic and intrahepatic portal hypertension and radiologic imaging of these collaterals is an important step in evaluation of a portal hypertensive patient. The intraabdominal collaterals and splanchnic hemodynamics of 17 portal hypertensive children in the endoscopic sclerotherapy program, were evaluated with Doppler ultrasonography. An increased blood flow of the hepatic artery was found in all cases independent from the underlying etiology. The decrease in the blood flow of the portal vein was more remarkable in the extrahepatic group. The diameter of the portal vein was not a determinant in the progression of the disease. More diffuse collaterals were found in the liver hilus and retroperitoneum in extrahepatic portal hypertension. On the other hand, the splenic hilus and splenorenal region were leading in intrahepatic cases. The blood flow of the left renal vein was evidently higher than that of the right in these cases. Demonstration of collateral anatomy is an important step in order to estimate the response, complications, treatment options and clinical outcome in patients with portal hypertension. Doppler ultrasonography is a non-invasive and easily applicable technique that provides valuable information about collateral pathways.

The prevalence of pineal cyst in patients with cerebral palsy

PURPOSE Pineal cysts are common incidental findings during magnetic resonance imaging (MRI) examinations. The etiology of pineal cyst development is still unclear. We aimed to determine whether there is an association between periventricular leukomalacia and pineal cyst prevalence. METHODS Clinical and MRI data of 201 patients with periventricular leukomalacia (110 female, 91 male; mean age, 6 years; range, 2-18 years) and 687 control patients (355 female, 332 male; mean age, 6 years¸ range, 2-18 years) who did not have any evidence of periventricular leukomalacia were independently evaluated by two radiologists for presence or absence of pineal cyst. RESULTS Pineal cysts were detected in 32.3% of the study group (65/201) and 8.4% of the control group (58/687) (P < 0.001). Patients with periventricular leukomalacia were more likely to have a pineal cyst. In terms of pineal cyst detection on MRI, interobserver reliability was high between the two radiologists. CONCLUSION The prevalence of pineal cysts is higher in patients with periventricular leukomalacia. We suggest that an ischemic process may have a role in the etiopathogenesis of pineal cyst development.

Caroli's disease in children: Is it commonly misdiagnosed?

Aim: Carolis disease is a simple form of intrahepatic bile duct ectasia. It can be complicated with the involvement of liver parenchyma and portal hypertension. Herein, the difficult management of delayed presentation of Carolis disease is reported. Methods and results: We report on four different forms of clinical presentation of Carolis disease: an infant with fulminant liver failure, a teenager with persistent biliary fistula, a boy with hypersplenism in the face of portal hypertension and a girl with variceal bleeding.

Equality of the left and right renal venous flow predicts the severity of variceal bleeding in portal hypertensive children

Portasystemic collaterals develop as a result of portal hypertension. The collaterals in the cardioesophageal region is the leading cause of bleeding from esophageal varices. Some of the portal hypertensive patients present with bleeding episodes but the others do not, and some of the bleeders do not respond to endoscopic sclerotherapy procedure, although the underlying pathology is the same. The capacity of the natural collateral vessels might be a determining factor about the hemorrhagic events. Since the first step of portasystemic collateralization takes place in the naturally existent vascular channels, the present study, with its anatomic and clinical parts, was focused on these venous structures.

KOROZİV MADDE İÇİMİNE BAĞLI ÖZOFAGUS DARLIĞI GELİŞİMİ VE HLA İLİŞKİSİNİN İNCELENMESİ

Amac: Koroziv maddeye bagli ozofagus yanigi olusan olgularda ozofagus darligi gelisimi acisindan fark olabilmektedir. Bu calismada, o zofagus darl igi olusumunda Human Lokosit Antijen (HLA) tipine gore bir farklilik olup olmadiginin arastirilmasi amaclandi. Gerec ve Yontem: Koroziv madde alimi sonrasi yapilan ilk endoskopide grade 1 ve uzeri ozofagus yanigi saptanan olgular geriye donuk olarak degerlendirildi. Grup 1 ozofagus darligi gelisen 10, Grup 2 ise o zofagus darl igi gelismeyen 10 olgudan olusturuldu. Tum olgulardan kan ornegi alinarak HLA antijen tiplendirmesi ve istatistiksel analiz yapildi. Bulgular: Yas ortalamasi 4,75 yil (2-10 yil) idi. HLA antijenlerine gore; grup 1’de HLA-DRB1 ’ 11 antijeni, grup 2’de ise HLA-A3 antijeni sayisal olarak daha yuksek bulundu. Ancak istatistiksel olarak anlamli degildi. S onuc: Calismada iki grup arasinda HLA antijenleri acisindan anlamli fark bulunamamistir. On rapor niteligindeki bu calisma, HLA ozofagus darligi arasindaki ileri calismalara yol gosterici olabilir. Olgu sayisinin artirilmasi ile koroziv o zofagus darl iklarini n erken tan i ve tedavisinde HLA antijenlerinin rolu hakkinda daha kesin bilgiler edinilebilecegini dusunmekteyiz.

Traumatic neuroma after torticollis surgery: a rare occurrence

We report a 15 years old girl who admitted to our hospital with signs of recurrent torticollis after two failed operations and consistent pain at the side of surgery. The past operations were performed at 1 and 6 years of age and she has been suffering pain from previous incisions with neck movements. At physical examination, the sternocleidomastoid (SCM) muscle behaved like a fibrous band, restricting the neck movements and resulting in pain. The operation was indicated for the fibrotic SCM. At operation two separate incisions were performed on each end of the SCM to remove all of the fibrotic muscle. The histopathological examination demonstrated a traumatic neuroma which respectively correlates with the pain symptoms. The patient discharged on the second postoperative day and physiotherapy was started. The patient is symptom free one year after the surgery. This case demonstrates a rare occurrence of traumatic neuroma after torticollis surgery, which can manifest with pain.

Çocukluk çağı Hodgkin hastalığının seyri ile hematolojik ve diğer değişkenlerin ilişkisi Orijinal Araştırma

Aim: Hodgkin’s disease HD is a common malignancy in children and is curable in over 90 of cases At diagnosis prediction of the outcome is important to avoid overtreating some patients and identifying others who need more intensified chemotherapy In this study our aim is to determine the prognosis among relapsed deceased and patients who are in remission according to erythrocyte sedimentation rate ESR hemoglobin leukocyte and lymphocyte levels that were taken at the time of diagnosis Material and Method: There were 170 patients diagnosed as HD admitted to Cerrahpasa Faculty of Medicine Pediatric Hematology and Oncology Department during 1975 2006 The records were reviewed retrospectively Clinical evaluation and staging was performed in all patients Disease staging was done according to Ann Arbor classification system and histopathological subtypes were defined using Rye criteria One hundred twenty six patients were eligible out of 170 Results: The mean age was 8 6 2 3 years and male female ratio was 2 2 87 males 70 and 39 females 30 Staging was as follows: stage I; 3 2 ; stage II 83 66 ; stage III 24 19 ; stage IV 16 13 The most common histological subtype was mixed cellular MC: 69 55 followed by nodular sclerosis NS:35 28 lymphocyte predominance LP: 7 5 and lymphocyte depletion LD: 3 2 with 12 unkown histology 9 The mean hemoglobin Hb levels were 10 7±2 17 gr dl 4 5 13 5 Hb levels less than 10 5 gr dl were found in 29 23 Mean leukocyte count were 7550±2170 mm3 2100 21600 mm3 while leukocytosis gt; 15 000 mm3 and lymphoctopenia a lymphocyte count of less than 600 mm3 were rare respectively; 7 5 1 0 7 Mean ESR of the group was found 55 53±38 6 mm hour median: 47 range:1 160 The ESR values of relapsed expired or patients in remission were 52 4±31mm h 54 5±2mm h and 53 8±3mm h respectively Relapse occurred in 12 9 5 ; 11 died 8 7 ; and 103 patients 81 7 were in remission There was no difference between relapsed dead or remission patients for any hematological parameters Conclusion: It is found that hematological parameters in HD which were investigated to predict prognosis were not worthy in pediatric patients unlike adult patients B sympotms and histological subtypes had no impaction prognosis while treatment regiment were associated with overal survi Turk Arch Ped 2008; 43: 46 9 Key words: Childhood hematological parameters Hodgkin disease prognostic values