The presence of clinical signs in malnourished infants with acute lower respiratory tract infections

OBJECTIVES:

To determine the reliability of respiratory rate and subcostal retractions in diagnosing acute lower respiratory tract infection in malnourished children.

METHODS:

One hundred forty-three children with acute lower respiratory tract infection were classified according to the Gomez classification as normal, mildly, moderately or severely malnourished. The presence of tachypnea, subcostal retractions and the sensitivity of either sign in identifying children with a clinical and radiological diagnosis of acute lower respiratory tract infection in each of the nutritional categories were evaluated and compared.

RESULTS:

According to the Gomez classification, 21 (15%) of 143 subjects were severely malnourished, 40 (28%) were moderately malnourished, 38 (26%) were mildly malnourished and 44 (31%) were well nourished. The mean respiratory rates in subjects with normal nutrition and in mildly, moderately and severely malnourished subjects were 62.6±9.38 breaths/min, 61.3±5.57 breaths/min, 57.6±11.65 breaths/min and 49.9±9.04 breaths/min, respectively. The mean respiratory rate of those with normal nutrition was not significantly different from that of those with mild malnutrition (P>0.05), but there was a statistically significant difference between the normal subjects and both the moderately malnourished (P=0.03) and severely malnourished (P<0.001) subjects. Subcostal retraction was observed in 78% of total children, which represents 41 (93%) subjects with normal nutrition, 34 (89%) mildly malnourished subjects, 30 (75%) moderately malnourished subjects and 10 (47%) severely malnourished subjects.There was no statistically significant difference between the frequencies of subcostal retractions observed in children with normal nutrition and mildly malnourished children (P>0.05), but subcostal retraction frequencies were significantly lower both in moderately (P=0.03) and severely (P<0.001) malnourished children. Tachypnea frequency was also found to be significantly lower in moderately (P=0.04) and severely (P=0.03) malnourished children compared with the normal group. As a consequence, the sensitivity of the presence of both of these signs was found to be lower in these two groups. The coexistence rates of both findings were 95% for the patients with normal nutrition and 47% for the severely malnourished patients.

CONCLUSIONS:

The current World Health Organization algorithm must be supported with other signs for the diagnosis of acute lower respiratory tract infection, especially in severely mal-nourished children.     

Urethral coitus and urinary incontinence in a case of Mayer-Rokitansky syndrome: an alternative surgical procedure

A patient with vaginal agenesis presented with complaints of urethral damage due to urethral coitus. We performed a urethrospincteric reconstruction and formation of a new vagina using the bladder flap and the urethra which was used for coitus, respectively. To the best of our knowledge, this is the first report of this procedure.     

Factor V 1691 G-A mutation in children with intracardiac thrombosis: a prospective study

The objective of this study was to determine the association between intracardiac thrombosis and hereditary causes of thrombophilia, including factor V 1691 G-A (factor V Leiden, FVL) and prothrombin 20210 G-A mutations. Over a period of 3 y, genetic risk factors were evaluated in 13 consecutive children (mean age 6.27 ±5.44 y) with intracardiac thrombosis, diagnosed by cross-sectional echocardiography. Thrombi were localized in the left heart in four patients and the right heart in nine patients. All children had predisposing factors for thrombus formation: ventriculoatrial shunt for hydrocephalus ( n = 3), indwelling catheter for chemotherapy ( n = 5), cardiomyopathy ( n = 2), sepsis ( n = 1), homocystinuria ( n = 1) and tetralogy of Fallot ( n = 1). Six of the 13 children with intracardiac thrombosis were heterozygotes for FVL mutation. Three of these six children with FVL mutation had ventriculoatrial shunt for hydrocephalus, two children had cardiomyopathy and one had sepsis. None of the patients carried the prothrombin 20210 G-A mutation.

Conclusion : It is recommended that FVL mutations should be investigated in all cases of intracardiac thrombosis irrespective of whether or not a predisposing factor is identified. When a predisposing factor is found antithrombotic prophylaxis may be considered in patients carrying the FVL mutation.     

Pantothenate kinase-associated neurodegeneration: MR imaging,proton MR spectroscopy,and diffusion MR imaging findings

We herein report the case of a 15-year-old male patient with pantothenate kinase-associated neurodegeneration. The classic "eye-of-the-tiger" appearance was initially present on the globus pallidi on T2-weighted MR images and had disappeared by the time of the 10-month follow-up examination. Fluid-attenuated inversion recovery images revealed marked hypointensity in the globus pallidi and dentate nuclei and high signal intensity changes in the deep cerebral white matter. Proton MR spectroscopy revealed markedly decreased N-acetylaspartate in the globus pallidi, associated with decreased N-acetylaspartate and increased myoinositol in the deep cerebral white matter. Diffusion MR images (b=1000 s/mm(2)) were negative (normal appearing) for deep cerebral white matter lesions, whereas apparent diffusion coefficient values were slightly increased (1.08-1.12 x 10(-3) mm(2)/s), compared with the apparent diffusion coefficient values from the normal white matter regions. Apparent diffusion coefficient values in the globus pallidi were lower than those in the unaffected thalamus.     

High ligation to treat pain in varicocele

Purpose: There are limited data about the effectiveness of surgery in patients withpainful varicocele. We report a retrospectivestudy done for the follow up on all varicocelehigh ligations performed for pain to evaluatethe effectiveness of the operations.Materials and methods: The patients who were all physically active workers and who underwent high inguinal ligation of varicocelefor pain from January 1995 to January 2000,were invited for interviews. Their charts werereviewed to document patient age, grade andlocation of varicocele, duration and quality ofpain, response to conservative treatment. Allpatients who could be contacted were interviewed for resolution of pain and complications, their physical examinations were made.Results: 87 of 140 (62.1%) patients wereavailable for the follow up. Median patient agewas 26 (15 to 34) years old. The varicocele wason the left side in 82 patients and bilateralin 5. The pain was dull in 42, throbbing in 25,sharp in 6 and as a pulling sensation in 14.The longest conservative therapy given in theliterature failed in all patients. Varicocelegrades were as follows: Grade I in 17, Grade IIin 34 and Grade III in 36 patients. Highinguinal ligation was used in all patients. 72(82.8%) patients reported complete resolution, 8 (9.2%) patients reported partial response, 7(8%) patients had persistant pain.Conclusions: High inguinal ligation iseffective in the treatment of painfulvaricocele in highly selected patients.Prospective randomized studies are neededcomparing surgical and conservativetreatments.     

Diffusion magnetic resonance imaging of solid vestibular schwannomas

Six patients with solid vestibular schwannomas were studied by diffusion magnetic resonance imaging to assess if this modality adds new information for these tumors, because there is no previous report in the relevant literature. The sizes of the tumors ranged from 2.2 to 4.7 cm with respect to their largest diameters. They were isointense to the normal brain parenchyma on b = 1,000 s/mm2 images. The apparent diffusion coefficient (ADC) values in the tumors were high (range: 1.14-1.72 x 10(-3) mm2/s, mean = 1.42 +/- 0.17 x 10(-3) mm2/s) compared with normal brain parenchyma ADC values (mean = 0.80 +/- 0.11 x 10(-3) mm2/s). High ADC values of solid vestibular schwannomas were in conformity with increased diffusion rates, indicating the presence of increased amounts of extracellular water (a relatively loose tissue) in the tumor matrix.     

Congenital cleft in the pontomedullary junction

A 4-month-old boy is reported with complete absence of horizontal gaze. Magnetic resonance imaging revealed a congenital cleft at the pontomedullary junction directed from the right anterior paramedian region toward the posterior midline, sparing the posterior region of the pontine tegmentum and the medulla oblongata. Such clefts are extremely rare, and there is only 1 previous report in the literature.     

Can laparoscopic hernia repair alter function and volume of testis? Randomized clinical trial

Testicular atrophy is a sequela of inguinal hernioplasty. The purpose of this study was to evaluate the effects of Lichtenstein (LHR) and laparoscopic totally extraperitoneal (TEP) hernia repair techniques on testicular function and volume. This study is a randomized prospective clinical trial with the blind assessment of outcome. A total of 26 patients who underwent elective herniorrhaphy for groin hernia were included in the study. Each patient was randomly assigned into one of two groups: either TEP or LHR (n = 13 for each). Six of the patients had bilateral hernia (n = 3 for each group). Luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone levels, and testicular volume by Doppler ultrasonography were detected just before and 3 months after the operation. LH, FSH levels did not change, when compared preoperative and postoperatively in both groups. Testicular volume and testosterone levels were observed to be significantly decreased after TEP when compared with LHR while no significant preoperative changes were observed between those groups. This affected the testicular volume in normal limits. TEP or LHR could not affect LH, FSH, testosterone values, but TEP could lead a decreasing effect on volume of testis in normal limits.     

Glutathione peroxidase, glutathione reductase, Cu-Zn superoxide dismutase activities, glutathione, nitric oxide, and malondialdehyde concentrations in serum of patients with chronic lymphocytic leukemia

BACKGROUND: Chronic lymphocytic leukemia (CLL) is a rare neoplasm that comprises a substantial proportion of all leukemias in middle-aged persons and is the most common type among elderly persons. The major causes are not known nor is there a detailed understanding about how the elusive origin(s) may relate to clinical expression, basic biological mechanisms, or pathogenesis. METHODS: Glutathione peroxidase (GSH-Px), glutathione reductase (GRD), Cu-Zn superoxide dismutase (Cu-Zn SOD) activities, glutathione (GSH), nitric oxide (NO(*), and malondialdehyde (MDA) concentrations were measured in serum of patients with CLL and a healthy control group. RESULTS: Serum GSH-Px, Cu-Zn SOD activities, GSH concentration were lower in patients with CLL while serum NO(*) and MDA concentrations were higher in these patients compared with the control group. Serum GRD activity was not statistically significant in patients with CLL compared with the control. However, there was no statistically significant difference in the parameters on the basis of stages in these patients. Serum GSH concentration negatively correlated with serum MDA (r=30.63, p<0.05) and NO(*) concentrations (r=0.72, p<0.05) in patients with advanced stage (III+IV). However, no other correlation could be found among the parameters in healthy controls and patients with CLL CONCLUSIONS: There is significant changes in antioxidant defense system in CLL cases, which may lead to enhanced action of oxygen radical, resulting in lipid peroxidation.