The effect of ribavirin on bone density in patients with chronic hepatitis C treated with interferon-ribavirin therapy

OBJECTIVE: The objective of this study was to investigate the effects of ribavirin on bone mineral metabolism in patients with chronic hepatitis C who had been treated with interferon and ribavirin. METHODS: Twenty patients (3 female, 17 male) with chronic hepatitis C were enrolled. Age range was 6 to 15 years (mean+/-SD, 11.15+/- 2.3 years). Thirteen patients received combined interferon alpha-2b and ribavirin therapy (Group 1), and 7 patients received only interferon alpha-2b (Group 2). Both groups were treated for 12 months. Bone mineral density, z-scores and biochemical bone markers were evaluated in both groups before and after treatment. RESULTS: There were no significant differences between the groups in age or gender. Mean lumbar vertebral bone mineral density and mean z-scores in groups 1 and 2 before and after treatment were not significantly different. In both groups, serum and urinary biochemical values and bone markers were all normal and there were no differences between the pretreatment and post-treatment values. CONCLUSION: Contrary to studies in adults, we did not find any ribavirin-dependent changes related to bone mineral metabolism in our pediatric study groups. Further studies are needed to obtain more detailed information about the effects of ribavirin on bone mineral density.     

Pediatric electrical injuries: a review of 38 consecutive patients

Background/purpose

The aim of this study was to explore the mechanisms, complications, morbidity, and mortality associated with electrical injuries in children.

Methods

The charts of pediatric patients who had been admitted to the authors’ center with electrical burn injuries (EBI) between January 1993 and October 2002 were reviewed retrospectively.

Results

Of the 764 acute burn admissions over a 9-year period, 5% (38 patients) had EBI. Mean age was 9.6 ± 4.4 years (range, 1 to 16 years). Seventy-six percent of the EBI patients were boys (M to F, 29:9), and the extent of the burn wounds ranged from 1% to 50% of total body surface area (TBSA; mean, 18.6% ± 14.7%). High-voltage (HV) electricity accounted for 63% of the EBI (1 lightning), and 37% were caused by low-voltage (LV) current. In 19 children, serious high-voltage injuries occurred by direct contact with outlet electrical transfer wires with a metal from a balcony or with manual contact while climbing to the pole. A total of 153 surgical procedures were performed on the EBI patients, and 26% of the cases (10 of 38) required amputations. Patients who sustained HV electrical injuries had associated major complications. All of the patients underwent close cardiac monitoring, and none had cardiac complications. The average hospital stay was 23.8 ± 14.2 (range, 2 to 48) days. One patient died of wound sepsis.

Conclusions

Although not frequent, EBI remain a serious problem, particularly in adolescent boys, and short- and long-term morbidity are significant. HV injuries occur mainly in the adolescent population and require more aggressive care. Balcony injury is a specific etiology for EBI, and special consideration is required to prevent this type of injury in our country.     

Enzymatic debridement of burn wound with collagenase in children with partial-thickness burns

Seventy-eight pediatric burn patients treated by enzymatic debridement with collagenase clostridiopeptidase A (CCA), were compared to 41 patients those burn wounds were excised surgically. Patients whose burn wounds were initially assessed as partial-thickness at admission were enrolled in the study. Total removal of eschar was achieved in 49 of 78 (62.8%) patients by CCA only (group D). In 29 patients (37.2%), therapy with CCA was ceased because of the development of burn wound infection or a manifest need for grafting of the wound, therefore, these patients underwent tangential wound excision (group DS). The records of 41 patients, treated by early tangential excision, having similar burn wounds by extent and depth with groups D and DS were used as controls (group S).

There was no significant difference between the time to achieve a clean wound bed in groups D, DS and S (mean 7.8, 8, and 7 days, respectively, P>0.05). In group D, none of the patients required blood transfusion, except one. Patients in group DS were found to have fewer excisions (mean 1.1) when compared to those in group S (mean 1.5, P<0.05). The shortest hospital stay was found in group D (12.5 days, P<0.01). In conclusion, the use of CCA, provided a short hospital stay, reduced the overall need for surgery and blood transfusions in patients with partial-thickness burns. Thus, CCA should be considered as an initial treatment of choice for removal of eschar in children, having a partial-thickness burn wound without infection.     

Imipenem–cilastatin versus piperacillin–tazobactam as monotherapy in febrile neutropenia

Background: In view of the recent trend toward monotherapy in the treatment of febrile neutropenia, we evaluated the clinical efficacy and safety of imipenem–cilastatin versus piperacillin–tazobactam as an empiric therapy for febrile neutropenia in children with malignant diseases. Methods: Febrile neutropenic patients received either imipenem–cilastatin or piperacillin–tazobactam randomly. Improvement without any changes in the initial antibiotic treatment was defined as “success” and improvement with modification of the initial treatment and death was defined as “failure”. Results: Over 12 months, 99 febrile neutropenic episodes were treated with monotherapy in 63 patients with a median age of 5 years. At admission, median absolute neutrophil count was 50/mm³ and in 67% of episodes, neutrophil count was under 100/mm³. Median duration of neutropenia was 5 days. In 22% of episodes, neutropenia persisted for more than 10 days. Piperacillin–tazobactam was used in 52 episodes and imipenem–cilastatin was used in 47 episodes. There was no difference between groups in terms of age, sex, primary diseases, neutrophil count or duration of neutropenia. In the whole group, the success rate was 67% and the failure rate was 33%, whereas in the piperacillin–tazobactam group, the rates were 71% and 29%; and in the imipenem–cilastatin group they were 62% and 38%, respectively (P > 0.05). There were no deaths. No major adverse effects were seen in either group. Conclusions: Although failure was slightly higher in the imipenem–cilastatin group, this was statistically insignificant. Both of these antibiotics can be used safely for initial empirical monotherapy of febrile neutropenia.     

Long-term results of conservative management of adnexal torsion in children

Background/purpose

Adnexal torsion is a condition that may result in serious morbidity including adnexal removal. However, conservative management with preserving the torsed adnexa is not justified, and long-term outcomes remain unclear.

Methods

The records of 14 girls with ovarian torsion whose adnexal structures were preserved after detorsion were reviewed to evaluate the long-term results of conservative management. Data including age, previous history, duration of complaints, surgical findings and type of intervention, color Doppler ultrasound findings performed in the early and late postoperative periods, and final outcomes were collected.

Results

Mean age of patients was 11.5 ± 2.8 (range 6 to 15) years. Time interval between the onset of pain to surgery was 46.78 ± 35.5 (range 12 to 126) hours. Seven patients had a benign solitary cyst as an underlying cause for adnexal torsion. The intervention performed by open surgery in 9 and by laparoscopy in 5 patients included detorsion, simple cyst aspiration, unroofing and/or cystectomy in 7 patients with ovarian cysts, and oophoropexy in 9 of 14 patients. Follow-up ranged from 3 to 66 (mean 21.9 ± 20.1) months. Thirteen patients resumed normal size and folliculogenesis, whereas in 1 patient, the involved ovary atrophied. No recurrence or contralateral adnexal torsion was observed on follow-up.

Conclusions

Conservative management with untwisting the ovary and pexing both retained detorsed and contralateral ovaries especially in idiopathic torsions should be considered in cases of ovarian torsion in children.     

Role of autophagy in the progression and suppression of leukemias

Autophagy is a physiological process in which cellular components are degraded by the lysosomal machinery. Thereby, organelles are recycled and monomers are produced in order to maintain energy production. Current studies indicate autophagy might suppress or augment survival of cancer cells. Therefore, by elucidating the role of autophagy in cancer pathogenesis, novel therapeutic intervention points may be revealed. Leukemia therapy has advanced in recent years; but a definitive cure is still lacking. Since autophagy often is deregulated in this particular type of cancer, it is clear that future findings will have clinical implications. This review will discuss the current knowledge of autophagy in blood cancers.