Peak expiratory flow in healthy Turkish children

This study was conducted on 1359 healthy, non-smoking Turkish children (727M, 632F) with a mean age of 11.7 ± 3.4 (6–17) years, in order to determine the normal values of peak expiratory flow (PEF) in Turkish children and to compare various peak-flow meters (PEFMs). PEF values increased with age and height in boys and girls. The relative increase in boys was significantly higher at puberty (p < 0.01). The values of Turkish children were found to be similar to those of Europeans. The results obtained from the three PEFMs were closely correlated.     

Effect of shunt surgery on spleen size, portal pressure and oesophageal varices in patients with non-cirrhotic portal hypertension

Shunt surgery is considered to be the treatment of choice in patients with non-cirrhotic portal hypertension. There is little data on the effect of side-to-side lieno-renal (SSLR) shunt on oesophageal variceal size, splenic size and splenic pulp pressure (SPP) in patients with non-cirrhotic portal hypertension. We evaluated pre- and postoperatively endoscopic grading of varices, splenic size and SPP for predicting shunt patency in 86 patients with non-cirrhotic portal hypertension: 56 with extrahepatic portal venous obstruction (EHPVO) and 30 with non-cirrhotic portal fibrosis (NCPF). The EHPVO patients with patent shunts (n= 47) showed significant reduction in SPP (pre-operative 43.56±7.9 vs postoperative 29.96±7.7 cm of saline), splenic size (6.5±2.8 vs 4.00±2.6 cm below costal margin) and varices grades (2.96±0.5 vs 0.92±0.8). Patients with blocked shunt (n= 9) did not show significant reduction in SPP and varices grades. However, there was reduction in spleen size (8.6±3.0 vs 6.3±4.3). In the NCPF group, 28 had patent shunts and showed significant reduction in SPP (46.3±13.5 vs 33.8±7.6 cm of saline), splenic size (9.1±3.3 vs 6.8±4.6 cm below costal margin) and varices grades (2.8±0.7 vs 1.05±0.96). As only two patients with NCPF had blocked shunts, no statistical comparison between patients with patent and patients with blocked shunts could be done. In conclusion, following SSLR, there is a significant reduction in SPP and varices grades in patients with patent shunts. Endoscopic grading of varices can be used to predict shunt patency. However, spleen size is not a good criteria for predicting shunt patency.     

Lupus erythematosus associated with erythema multiforme: report of two cases and review of the literature

Rowell's syndrome (RS) is a rare presentation of lupus erythematosus (LE) with erythema multiforme‐like lesions associated with antinuclear, anti‐La (SS‐B)/anti‐Ro (SS‐A) antibodies and rheumatoid factor (RF) positivity. This syndrome is suggested to be a different variant of cutaneous lupus erythematosus by some authors in literature. Here we present a 64‐year‐old woman with LE and a 51‐year‐old woman with LE and Sjögren syndrome (SS) who had erythema multiforme‐like eruptions and discuss the coexistence of lupus erythematosus and erythema multiforme.     

Controlled FiO2 Therapy to Neonates by Oxygenhood in the Absence of Oxygen Analyzer

Background

A study was conducted to evaluate a system of standardizing the oxygen concentration inside the oxygen hood and to develop guidelines for controlled FiO₂ administration by changing size of the hood, lid position on the hood and the oxygen flow rate, without an oxygen analyzer. The effect of low flow rates on carbon dioxide (CO₂) retention was also studied.

Method

A dummy patient and thirty neonates, requiring oxygen to be delivered through head box, constituted the material for the study group. Oxygen content in the head box was measured using a standard oxygen analyzer while the size of head box, flow rate and lid position were changed independently and in combination. The head boxes were tested on a dummy patient. These results were analyzed, and applied to thirty neonates requiring oxygen therapy using a head box.

Result

Volume of headbox had an inverse relation with the oxygen concentration inside the headbox and smaller sized headbox achieved more predictable oxygen concentration at all flow rates. Maximum difference in oxygen concentration by varying the lid position was seen in the large headbox. Keeping the variables constant, oxygen concentration was significantly lower in babies as compared to dummy. No significant CO₂ retention was found at a flow rate of four litres per minute (lpm) in small and three lpm in a medium and large head box respectively, while lower flow rates were associated with CO₂ retention.

Conclusion

It is possible to predict the oxygen concentration inside the head box without the use of oxygen analyzer. Larger head box and higher lid position, results in lower oxygen concentration, at a given oxygen flow rate. Oxygen concentration achieved in babies is lesser than the concentration achieved in a dummy. Flow rates of less than four lpm in small and three lpm in medium and large sized head boxes are associated with CO₂ retention. These results are not applicable to infants weighing less than 2 kg.Key Words: Neonates, Oxygen therapy, Oxygen hood, Oxygen concentration, Oxygen analyzer     

Management of Rh-isoimmunised Pregnancies : Our Experience

Background

The aim of this study was to assess the role of middle cerebral artery peak systolic velocity (MCA-PSV), as measured by doppler ultrasound, in detecting foetal anaemia in Rh- isoimmunised pregnancies. Intra-uterine foetal blood transfusion was performed in such anaemic foetuses to tide over the crisis of foetal immaturity till considered fit for extra-uterine survival.

Methods

Rh-isoimmunised pregnancies reporting to a tertiary institute from 2003 to 2005, were screened by doppler ultrasound to estimate MCA-PSV to detect foetal anaemia. If the foetus developed MCA-PSV of more than 1.5 multiple of median (MoM) for the gestational age, foetal blood sampling through cordocentesis was performed to confirm foetal anaemia, followed by intrauterine foetal blood transfusion to all anaemic foetuses at the same sitting. Neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained and need for blood transfusion in the neonatal period.

Results

A total of thirteen isoimmunised pregnancies were evaluated. Three pregnancies did not require in-utero foetal blood transfusion. Twenty-one intrauterine foetal blood transfusions were performed in the remaining ten patients. Five received blood transfusion in the neonatal period. Intra uterine foetal death occurred in one grossly hydropic foetus and favourable neonatal outcome was recorded in the rest.

Conclusion

The clinical outcome of these pregnancies justifies the use of doppler studies of MCA-PSV in detecting foetal anaemia and intra uterine foetal blood transfusion is the only hope of prolonging pregnancy and salvaging such foetuses.Key Words: Rh-isoimmunisation, Middle cerebral artery peak systolic velocity, Foetal anaemia, Foetal blood transfusion