Prevalence and treatment of Pediculus humanus capitis with 1% permethrin and 0.4% d-phenothrin in Turkey

Pediculosis humanus capitis (head lice) is an important public health problem among school children. In our study, 20,612 schoolchildren (10,367 boys, 10,245 girls) were examined for Pediculus humanus capitis in 36 elementary schools between December 1996 and February 1998 in Ankara, Turkey. The prevalence of pediculosis capitis infestation was found to be 3.4% (701/20,612). Of these, 382 students were treated with application of 1% permethrin cream rinse, and 184 students with 0.4% d-phenothrin shampoo. On day 14 of the controlled trial, the success rates were 93.7% in the 1% permethrin cream rinse group and 75.5% in the 0.4% d-phenothrin shampoo group. The 1% permethrin cream rinse was also significantly more active in pediculicidal efficacy when compared to the 0.4% d-phenothrin shampoo (p<0.001). As a result, these findings demonstrate that pediculosis capitis still remains a widespread health problem.     

DCE‐MRI findings of invasive aspergillosis in patient with acute myeloid leukemia

Thoracic radiography and high resolution computerized tomography is used to diagnose pulmonary infections in immunosuppressed patients, although in some cases these do not provide enough information about the lesion. Dynamic contrast‐enhanced magnetic resonance imaging may be useful in these cases, especially for the characterization of cavitary lesions and assessment of their contrast diffusion.     

Classification of Giardia duodenalis parasites in Turkey into groups A and B using restriction fragment length polymorphism

PCR-RFLP (restriction fragment length polymorphism) analysis was used to determine the relation of Giardia duodenalis Groups A and B. Of these, 17 (85%) were found as Group A in symptomatic cases; 22 (92%) were Group B in asymptomatic cases by using PCR-RFLP (p < 0.001). Interestingly, 5 (83%) were Group A in examination of endoscopy aspirates of symptomatic cases, as 5 (83%) were Group B in asymptomatic cases.     

Emergency thyroidectomy: Due to acute respiratory failure

INTRODUCTION

Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention.

PRESENTATION OF CASE

A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cervical swelling progressively increased during the last 7 years and constituted severe respiratory failure which has become severe in the last one month. A giant nodular goiter of the left thyroid lobe extending retrosternally, causing tracheal compression, limiting the neck movements was detected with clinical examination and bedside ultrasound. Emergency thyroidectomy was planned. Fiberoptic-assisted awake nasal intubation was performed in the operating room. Emergency total thyroidectomy was performed for the life-threatening respiratory failure. Postoperative period was uneventful. She was transferred from intensive care unit to the ward on postoperative day 3 and was discharged from the hospital on the postoperative 7th day. Benign multinodular hyperplasia was reported on the histopathological report. Patient was included in routine follow-up.

DISCUSSION

In the present case tracheal destruction due to compression of the giant goiter was found in agreement with previous reports. Emergency thyroidectomy was performed after awake intubation since it is a common surgical option for the treatment of giant goiter causing severe airway obstruction.

CONCLUSION

Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.     

In vivo and in vitro effects of stellate ganglion blockade on radial and internal mammary arteries

OBJECTIVE: To investigate the effects of stellate ganglion blockade (SGB) on the internal mammary (IMA) and radial arteries (RA) in patients undergoing coronary artery bypass graft (CABG) surgery with in vivo and in vitro studies. DESIGN: Prospective, randomized trial. SETTING: University hospital. PARTICIPANTS: Thirty-seven patients undergoing CABG surgery. INTERVENTIONS: SGB was performed on 19 patients before anesthesia induction. Another group of 18 patients underwent surgery without SGB. Diameters of proximal RA, distal RA, and IMA were determined by Doppler ultrasonography before (T1) and after (T2) anesthesia induction. Control or blocked IMA and RA segments were obtained. Norepinephrine (NE) was applied to determine the contractile force of IMA and RA rings in a concentration-dependent manner. The maximal contractile response and the sensitivity of the vessels were compared. MEASUREMENTS AND MAIN RESULTS: The diameters of IMA and distal RA were statistically larger in the SGB group than those in the control group at T2. NE-induced maximum contraction was higher in the blocked RA rings than those in the control RA and blocked IMA rings. The sensitivity of IMA segments to NE was higher than that of RA segments in the SGB group. The control and blocked IMA segments showed similar sensitivity to NE. CONCLUSION: The present results show that SGB not only increases distal RA and IMA diameters but is also associated with in vitro differences, the mechanism of which remains to be elucidated. Therefore, SGB might be considered as an alternative to topical and systemic vasodilators for reducing vasospasm in patients undergoing CABG.     

Predictors of outcome in children with Langerhans cell histiocytosis

BACKGROUND: Our goal was to examine the clinical course of patients with Langerhans cell histiocytosis (LCH), with a special emphasis on bone disease and to attempt to identify and examine the factors that may predict reactivation and overall prognosis. PROCEDURE: We conducted a retrospective chart review of 132 consecutive pediatric patients treated at Children's Hospital Los Angeles for LCH from 1984 to 2001. RESULTS: The risk for reactivation after initial management is significantly higher for patients with multiple bone and those with multiple organ involvement as compared with patients who had a single bone lesion (hazard ratios are 7.1 and 11.6). Patients younger than 1 year in the multiple organ group have an increased risk of death at 2 years when compared with the older patients in that group (hazard ration = 6.2, P = 0.022). Endocrine abnormalities were seen in 20% and 7.5% of patients with or without skull lesions respectively. CONCLUSIONS: Patients with LCH involving only the bones have a significantly better outcome than those with other organ involvement. Patients with multiple organ involvement who are less than 1 year of age are at high risk of death and should be approached more aggressively upfront.