Şükrü Arslan

Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children.

Deadly nightshade (Atropa belladonna) intoxication has been infrequently reported in both children and adults in the literature. In this article, the clinical and laboratory findings of 49 children with acute deadly nightshade intoxication are reviewed. Our purpose was to enlighten the findings of deadly nightshade intoxication in childhood. The most common observed symptoms and signs were meaningless speech, tachycardia, mydriasis, and flushing. None of the children required mechanical ventilation or died in our series. The patients were categorized into two groups, mild/moderate and severe intoxication. Children with and without encephalopathy were accepted as severe and mild/moderate intoxication, respectively. While 43 children were placed in the group of mild/moderate intoxication, six were in severe intoxication group. We found that meaningless speech, lethargy, and coma were more common, but tachycardia was less common in the severe intoxication group (children with encephalopathy) (P B-0.05). In the treatment, neostigmine was used in all children because of no available physostigmine in our country. In conclusion, our findings showed that the initial signs and symptoms of acute deadly nightshade intoxication might be severe in some children, but no permanent sequel and death were seen in children. We also showed that meaningless speech, lethargy, coma, and absence of tachycardia were ominous signs in deadly nightshade intoxication in childhood. Lastly, we suggest that neostigmine may be used in cases of deadly nightshade intoxication if physostigmine cannot be available.

Report of Eight Infants with Acute Infantile Hemorrhagic Edema and Review of the Literature

Acute infantile hemorrhagic edema (AIHE) is a cutaneous leukocytoclastic vasculitis, clinically characterized by the symptom triad of fever, large purpuric skin lesions, and edema. The clinical picture has a violent onset, a short benign course, and spontaneous complete recovery. In this article, we present eight patients who were admitted with rashes on the skin and edema on the eyelids and extremities, and were diagnosed with AIHE according to their clinical and histopathological features (immunohistological study was also performed in three of them). Our purpose was to emphasize that, aside from Henoch‐Schönlein purpura, meningococcemia, septicemia, and purpura fulminans, AIHE benign disorder should also be considered in the differential diagnosis to determine the clinical course and treatment protocol in patients with purpuric rashes.

PFAPA syndrome mimicking familial Mediterranean fever: report of a Turkish child

The PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitidis) syndrome is characterized by periodic fever, adenitis, pharyngitis, and aphthous stomatitis. Herein, we present a Turkish child with PFAPA syndrome mimicking familial Mediterranean fever because of a rare presentation. A 9-year-old boy was admitted with recurrent fever, aphthous stomatitis, sore throat, headache, and general body pains, lasting 2 to 3 days since 3.5 years of age. He was completely symptom-free between the attacks. He was diagnosed as having familial Mediterranean fever according to the clinical findings when he was 6 years of age and Colchicum tablet was administrated. Despite colchicines therapy for 8 months, his attacks did not subside; therefore, the drug was discontinued. He had high fever, a painful cervical lymphadenopathy, aphthous stomatitis, and tonsillo-pharyngitis. The patient was then diagnosed as having PFAPA syndrome. He was given a single dose of prednisolone (0.35 mg/kg/dose). His complaints dramatically and completely disappeared 3 h after administration of the drug. During the 8th month of follow-up, a similar febrile attack lasting only 1 day was noted and it was controlled with a single dose of prednisolone (0.5 mg/kg/day). At this writing the patient is in the 12th month of follow-up, and there have been no symptoms after the second attack. In conclusion, our patient shows that PFAPA syndrome can be confused with familial Mediterranean fever. We also would like to emphasize that the typical PFAPA syndrome can be easily diagnosed by detailed history-taking and physical findings.

Hyponatremic dehydration: an analysis of 78 cases.

Our purpose was to determine thefrequency of convulsion in children withhyponatremic dehydration (HD). We alsoinvestigated whether or not there was arelationship between the severity ofhyponatremia and the degrees of malnutrition inour region (Eastern Anatolia of Turkey) inwhere malnutrition is frequently observed.In this study, the clinical and laboratoryfindings of 78 patients with diarrhoea (acute,persistent or chronic diarrhoea) and HD werestudied. When diarrhoea lasts longer than 2 and4 weeks they were accepted as persistent andchronic diarrhoea, respectively. Patients weresaid to have HD if they had the clinicalfindings of dehydration associated withhyponatremia [Serum sodium (SNa)<130 mmol/L)]. Nutritional status of thechildren was assessed by the Gomezclassification using weight for age; it wasaccepted as normal those were between90%–110%, mild malnutrition 75%–89%,moderate malnutrition 60%–74% and severemalnutrition <60%. Of 78 patients, 40 wereboys, 38 were girls. The age and weight of thepatients ranged from 40 days to 36 months(8.94 ± 5.49 months) and from 2000 to 10300 g(5535.25 ± 1702.10 g) respectively. Allpatients except four had malnutrition; 15(20.3%) had mild malnutrition, 30 (40.5%) hadmoderate malnutrition and 29 (39.2%) hadsevere malnutrition. Forty-seven patients hadacute, 16 patients had persistent, and 15patients had chronic diarrhoea. SNa levels werebetween 104 and 129 mmol/L(121.21 ± 6.12 mmol/L). There was notstatistically a significant difference betweenSNa level and the degree of malnutrition, andSNa level and the types (acute, persistent orchronic) of diarrhoea (p > 0.05). Of 78patients, 12 (15.3%) patients had convulsion,of whom eight had convulsion associated withfever. Convulsion was noted in nine (19.1%)and three (18.7%) patients with acute andpersistent diarrhoea, respectively (p > 0.05).Also, we observed that when hyponatremia wasseverer, convulsions tended to be more occuring(p < 0.05). Five (6.4%) children died and allof them had severe malnutrition and septicemia.We determined that the frequency of convulsionin HD was 15.3% (12/78), and there was not adifference between the cases of acute,persistent and chronic diarrhoea for thefrequency of convulsion. We also found asignificant difference was not present betweenSNa level and the degree of malnutrition, andbetween SNa level and the types (acute,persistent or chronic) diarrhoea. However, weobserved that when hyponatremia was severer,convulsions tended to be more occuring.

Silent Stroke in a Case of β-Thalassemia Major Associated With Chronic Renal Failure and Diabetes Mellitus:

Severe anemia, growth retardation, diabetes mellitus, cardiac disorders, and, infrequently, stroke are well-known complications of thalassemia major. We report a girl, age 7 years, 2 months, with βthalassemia major associated with chronic renal failure, diabetes mellitus, and cardiomyopathy in whom a silent stroke was noted during follow-up. She was diagnosed with thalassemia major at age 6 months, chronic renal failure at age 3 years, 3 months, and diabetes mellitus and cardiomyopathy at age 7 years. Although cranial computed tomography was found to be normal at the age of 3 years, 3 months, magnetic resonance imaging showed cerebral infarct in the right frontal region at 7 years, 2 months. A thrombophilic panel revealed increased factor VIII and decreased protein C concentrations. She died from disseminated intravascular coagulation at age 7 years, 9 months. We did not record any clinical findings of stroke during her follow-up. We think that diabetes mellitus, dilated cardiomyopathy, and increased factor VIII and decreased protein C concentrations led to the occurrence of cerebral infarct. In conclusion, we emphasize that children with thalassemia major should be monitored closely for stroke. We also suggest that stroke can show a silent progression in severely affected children, as in our case. (J Child Neurol 2003;18:798—800).

Use of interferon alpha-2b and prednisolone in the treatment of severe intractable diarrhea in a child with systemic mastocytosis

Systemic mastocytosis (SM) is a rare disorder characterized by abnormal growth and accumulation of mast cells in skin, bone marrow, bone, gastrointestinal tract, liver, spleen and lymph nodes. Although no effective therapy for patients with SM is known, some patients might benefit from corticosteroid and interferon α -2b (INFα ) treatment. 1,2 We report a case of SM associated with intractable diarrhea, in whom INFα and prednisolone were successfully used to control intractable diarrhea. To our knowledge there are no reports regarding the use of this drug combination in the treatment of intractable diarrhea in SM in the published literature.

Hyperkalemia most likely associated with massive cephalhematoma in a newborn infant who was treated with urgent peritoneal dialysis: case report.

Cephalhematomas rarely lead to serious complications such as infection, osteomyelitis and skull fractures. However, we present a newborn infant with hyperkalemia in the context of a serious complication believed to be caused by hemolysis of a large cephalhematoma. The patient was treated with urgent peritoneal dialysis and discharged with a successful outcome. In conclusion, neonates with massive cephalhematoma should be closely examined in terms of bilirubin counts as well as electrolyte counts.

Posterior reversible encephalopathy syndrome in children: report of three cases

PurposePosterior reversible encephalopathy syndrome (PRES) is a condition characterized by varying degrees of headache, nausea, vomiting, visual disturbances, focal neurologic deficit, and seizures due to severe systemic hypertension. The knowledge of secondary hypertension in children is most commonly due to renal abnormalities, suggesting that the leading cause of PRES in childhood is renal diseases.MethodsThree pediatric patients who developed PRES due to various underlying renal diseases were reviewed.ResultsThe etiology of hypertension of our patients was all renal problems including atrophic kidney, hydronephrosis secondary to reflux nephropathia, nephrotic syndrome, and acute poststreptococcal glomerulonephritis. While two of them had typical of the parieto-occipital and frontoparietal involvement, the other had brain stem involvement. All of the patients were recovered by the control of high blood pressure.ConclusionPrimary involvement of the brain stem is rare in children. PRES should be taken into account, especially in children with renal disease in the appropriate clinical settings.

Septicaemia And Meningitis In An Infant

We read with interest the review article on necrotizing enterocolitis (NEC) in full-term neonates.1 Although the author mentioned various risk factors that are associated with NEC in term neonates, we call your attention to some of the more recent data we have published on this topic. First of all, NEC in term infants is a rare event, at least in this part of the world. The incidence quoted as 5–25% of NEC infants came from the studies published in the 1970s and 1980s. We published more recent figures derived from a detailed population-based study on the incidence and aetiology of NEC in full-term neonates born in New South Wales and Australian Capital Territory in Australia.2 The incidence in our region was 0.05 per 1000 live births which was similar to the crude estimation (0.06 per 1000) in > 2500 g infants based on the CDC hospital diagnosis information in the United States. With regards to risk factors, one important message is missing in this article. There is a great difference in aetiological factors between full-term and premature infants. Earlier institutional studies suggested the association of congenital diseases in term infants.3 The major finding in our recent regional study was that about two-thirds of the 29 NEC neonates had an underlying congenital disease, which included congenital heart lesions in 35% and endocrine lesions in 17%. This contrasts with prematurity being the major underlying risk factor in premature infants, who have an inherent gastrointestinal immaturity and other illnesses associated with prematurity. The role of T-cryptantigen screening in the management of NEC was discussed in this review. We would like to caution that the literature on antigen screen was derived primarily from the preterm population. NEC aetiological factors appear very different between the preterm and term infants. The mortality of our series is low and both deaths were not associated with haemolysis (circulatory collapse with panhypopituitarism and the other due to congenital anomaly). Furthermore, in the largest series of T-cryptantigen reported in preterm infants (27 antigen positive cases in 200 NEC infants) we have not been able to demonstrate reduced mortality since the introduction of routine screening,4 so the benefit of screening is yet to be proven in preterm infants, let alone in term infants. The author’s suggestion of exploring cytokine modulation therapy in the prevention of NEC in term infants is unlikely to be effective given the different aetiological factors, in particular the high incidence of associated congenital diseases in term infants. Furthermore, with the rarity of disease and low mortality in term neonates, even if we restrict the preventive therapy to high-risk term neonates such as infants with congenital heart disease it is extremely difficult to justify the expenditure involved. For example, during our study period of 6.5 years with over 539 000 live births, we would expect about 1300 cases born with major heart defects based on National Perinatal Statistics Unit data.5 Only 10 of these developed NEC! In short, NEC in term and preterm infants are very different in many aspects and the knowledge derived from preterm infants may not be applicable in term infants.

How to close open choledochotomy: primary closure, primary closurewith T-tube drainage, or choledochoduodenostomy?

BACKGROUND/AIM Although common bile duct stones are generally treated endoscopically, surgery is required if endoscopic removal is impossible. The aim of this study was to compare the surgical options in such patients. MATERIALS AND METHODS A total of 282 patients with common bile duct stones underwent open choledochotomy; primary closure was applied in 48 (17.0%), primary closure with T-tube drainage in 81 (28.7%), and choledochoduodenostomy in 153 (54.3%) patients. RESULTS Postoperative complications were seen in 8 (16.7%) patients in the primary closure, 33 (40.7%) patients in the primary closure with T-drainage, and 37 (24.2%) patients in the choledochoduodenostomy group. No significant differences were observed among the groups (P > 0.05). The mean postoperative hospital stays in the primary closure, primary closure with T-tube drainage, and choledochoduodenostomy groups were 5.5, 13.5, and 8.9 days, respectively. The mean postoperative hospitalization was significantly shorter in the primary closure group than in the other groups (P < 0.05). CONCLUSION Primary closure is a safe and feasible method in selected patients.