Psoriasis in childhood and adolescence: evaluation of demographic and clinical features

BACKGROUND: The present study was aimed to define the gender ratio, familial occurrence, age of onset, precipitating factors, clinical types, nail and joint involvement of psoriasis in childhood and adolescence in Turkey. METHODS: A total of 61 children with psoriasis under 18 years old were evaluated retrospectively, for age, gender, age of disease onset, family history, concomitant disease, the clinical type of psoriasis, clinical localization, nail and joint involvement and treatment modalities. RESULTS: Of the patients, 23 (37.70%) were boys and 38 (62.30%) were girls. Mean age was 9.28 +/- 4.02 years in girls and 11.18 +/- 3.85 years in boys (9.96 +/- 4.03 years in all children). Mean age at the onset of the disease was 6.81 +/- 4.11 years in girls and 7.03 +/- 4.28 years in boys (6.89 +/- 4.14 years in all patients). In 14 (23%) cases, a positive family history was detected. The most frequent probable triggering factors were upper respiratory tract infections (14.8%) and positive throat culture for A group ss-hemolytic streptococcus (21.3%). Frequency of emotional stress and psychiatric morbidity were 54% and 9.8%, respectively. The most frequent localizations at onset were trunk (44.3%), extremities (54.0%), and scalp (36.0%). Three children (4.9%) had a history of dissemination from psoriatic diaper rash. In total, 51 (83.6%) patients presented with psoriasis vulgaris, eight (13.1%) with generalized pustular psoriasis, and the remaining two (3.3%) with erythrodermic psoriasis. CONCLUSION: The incidence of psoriasis among dermatological patients in childhood and adolescence was 3.8%. The disease tends to appear earlier in girls than boys. The authors suggested that stress and upper respiratory infections are the most important triggering factors in childhood and adolescence psoriasis.     

PLASMA CONCENTRATIONS OF BUPIVACAINE AND ITS ENANTIOMERS DURING CONTINUOUS EXTRAPLEURAL INTERCOSTAL NERVE BLOCK

Plasma concentrations of bupivacaine have been measured in 12patients given bupivacaine through a paravertebral catheterplaced under direct vision at thoracotomy. After an initialbolus of 0.5% bupivacaine 20 ml, mean (SEM) CPmax was 1.45 (0.32)fig mt1 and median (range) tCPmax was 25 (10-60) min. A concentrationof 4.43 ug mt' measured in one patient was not associated withtoxic signs. During continuous infusion of bupivacaine for 120h, CPmax was 4.9 (0.7) fig mt' and tCPmax 48 (5–96) h.No symptoms or signs of toxicity occurred. Separate measurementof R- and S-bupivacaine concentrations demonstrated significantlydifferent concentration-time profiles. (Br. J. Anaesth. 1993;70: 201–204)     

Prevalence of hypertension among schoolchildren aged 13-18 years in Gemlik, Turkey

Arterial hypertension is the permanent elevation of blood pressure(BP). Previous studies have documented that hypertension maybegin in adolescence, perhaps even in childhood. The purposeof this study was to determine the prevalence of hypertensionamong adolescents in the Gemlik Research and Training Area,Turkey. Between January and March 1994, all secondary and highschool students aged 13–18 years were included in thisstudy. An elevated BP was defined according to the Report ofthe Second Task Force on Blood Pressure Control in Children.Of the 3,641 students screened, 262 (7.2%) had elevated systolicand/or diastolic BP, 161 (4.4%) students had significant hypertensionand 101 (2.8%) students had severe hypertension. We found thatsystolic and diastolic BP increased with age, height and weight.BP measurements should be included in physical examinationsas part of the continuing care of the child.     

When is open ureterolithotomy indicated for the treatment of ureteral stones?

AIM: Improvements in extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy have almost eradicated the need for open surgery in ureteral stones. The aim of this study was to assess characteristics of patients who underwent open ureterolithotomy. METHODS: During a 5-year period, a total of 654 patients with ureteral stones were treated. Initial management consisted of ureteroscopy in 524 patients, ESWL in 62 patients and percutaneous nephrolithotomy (PCNL) in 12 patients. Open surgery was performed in 56 patients. Stone location, size and success rates were retrospectively analyzed. RESULTS: Ureteroscopy resulted in successful stone removal in 94%, 98% and 98.5% of proximal, mid and distal ureteral stones, respectively. A total of 14 patients with ureteroscopy failure were referred for open surgery. ESWL treatment resulted in success in 55 patients (88%), and those with ESWL failure were referred for either ureteroscopy (n = 3) or open surgery (n = 4). Open surgery was performed in a total of 56 patients, 38 of whom had been referred from other centers. Stone location was proximal ureter in 25 (44.6%) patients (stone size: 2-12 cm(2)), mid ureter in five (8.9%) patients (stone size: 2-6 cm(2)) and distal ureter in 26 (46.4%) patients (stone size: 4-9 cm(2)). A history of previous unsuccessful endourological procedure was observed in 33 (58%) of 56 patients. Children under age 16 (range 1-15 years) comprised 17.8% of patients undergoing open surgery. CONCLUSION: Open surgery, which is nowadays being replaced with laparoscopic techniques, is generally indicated for failed endourological procedures (58%), particularly in centers that do not have flexible ureteroscopy or laser lithotriptor, and in patients with larger stones (>3 cm). Children (17.8%) are also candidates for open surgery, if specifically designed endourological equipment is not available.