Eosinophilic fasciitis--progression to linear scleroderma: a case report

Eosinophilic fasciitis is a rare disease in children. Although changes similar to linear scleroderma have been reported, the outcome is usually good. In this report, a 10-year-old boy who developed eosinophilic fasciitis without a good response to steroids is presented. He progressed to linear scleroderma within months. Our case reinforces the hypothesis that eosinophilic fasciitis may be an early manifestation or a variant of localized scleroderma similar to the other cases in the literature.     

Prevalence of otitis media with effusion in first and second grade primary school students and its correlation with BCG vaccination

OBJECTIVE: The object of this study was to determine the prevalence of otitis media with effusion (OME) in first and second grade primary school students, to analyze the causes of the difference in the prevalence, to define the effect of OME on the academic performance of the children and to investigate a correlation between the prevalence of OME and Bacillus Calmette-Guerin (BCG) vaccination. STUDY PLAN AND METHODS: The study was conducted during the September-November, 2002 period in Elazig. A total of 3675 clinically healthy primary school children attending primary schools in the central district of Elazig, living in the same region and of a similar socioeconomic status and age group were included in the study. Of the 3675 children, 2042 were in their first and 1633 in their second grade of primary school. The routine ear-nose and throat examinations of the children were carried out at their schools by the same medical team. The tympanometric test was performed in children diagnosed with OME following otoscopic examination. A scale measuring the academic performance of the children was developed. This scale was filled in by the student's teachers prior to physical examination. RESULTS: OME was diagnosed in 64 out of 2042 (3.1%) first grade and in 25 out of 1633 (1.5%) second grade students. The difference between the percentages of OME in first and second grade students was statistically significant (P < 0.05). The frequency of other ear-nose and throat pathologies accompanying OME was similar to those in children without OME. There was no statistically significant difference between the academic performances of children with and without OME (P > 0.05). CONCLUSION: The analysis of risk factors for OME revealed no difference between first and second grade students. The reason for the difference in the prevalence of OME between first and second grade students may be the positive effect on the immune system of the BCG vaccine which had been administered to the second grade students 4 months previously.     

The effect of swimming exercise on lipid peroxidation in the rat brain, liver and heart

We intended to study the effect of swimming exercise on the brain, liver and heart malondialdehyde (MDA) levels which are the last product of oxidation, and to compare them with the brain, liver and heart MDA levels of controls. The experiments were carried out on 20 Wistar rats which were fed with a standard laboratory chow diet ad libitum. Rats were distributed in two groups, control group (n = 10) and exercise group (n = 10). The exercise group rats were exposed to swimming exercise for 30 minutes. After this animals in each group were sacrificed by decapitation, their brain, liver and heart tissues were quickly removed. MDA levels of the brain, liver and heart were determined according to the method in which MDA reacts with thiobarbituric acid. Results were evaluated by the Mann-Whitney U test. The liver and heart MDA levels in the exercise group were (29.59+/-6.73 and 10.49+/-1.90 nmol/g tissue, respectively) significantly higher than in the control group (21.78+/-3.46 and 8.86+/-1.25 nmol/g tissue, p<0.01 and p<0.05, respectively). However, the brain MDA levels were similar in both groups (exercise group 19.37+/-5.50 nmol/g tissue and control group 16.58+/-2.44 nmol/g tissue; p=0.325). It is concluded that swimming exercise might cause oxidative stress.     

Persistent stapedial artery: MR angiographic and CT findings

A 2-year-old girl was found to have a pink pulsatile mass behind the right tympanic membrane on physical examination. We report the high-resolution CT and MR angiographic findings of persistent stapedial artery with hypoplasia of the A1 segment of the right anterior cerebral artery.     

A randomized controlled trial of early oral feeding in laryngectomized patients

OBJECTIVE: To evaluate the safety and efficacy of early oral feeding by comparing it with feeding through primary tracheoesophageal puncture after total laryngectomy with primary pharyngeal closure. STUDY DESIGN: A prospective, randomized, controlled study. METHODS: Patients who underwent total laryngectomy with primary pharyngeal closure and who were candidates for primary voice restoration (an in whose cases primary tracheoesophageal puncture [TEP] was created) were included. After total laryngectomy, patients were randomly assigned to either the oral group (study group) or the TEP group (control group). Patients in the oral group were fed orally with a clear liquid diet on the first postoperative day, then advanced to a regular diet, whereas patients in the TEP group were fed through tracheoesophageal puncture and received nothing orally until the seventh postoperative day; then they were fed orally if fistula had not occurred. Standard criteria for discharge were used for all the patients. RESULTS: During a 3-year period, 67 patients were enrolled in the trial, and complete data were available for 65 patients (32 patients in the oral group, 33 patients in the TEP group). The two groups were similar for factors reported to influence the rate of pharyngocutaneous fistula. In three (9%) patients in the TEP group, fistula occurred on the 5th, 7th, and 14th postoperative days, respectively. Two (6.2%) fistulas occurred in the oral group on the sixth and eighth postoperative days, respectively. In patients without fistula, the mean length of hospital stay was 7.6 days (range, 4-19 d [SD = 3.1 d]) for the oral group and 8.2 days (range, 7-18 d [SD = 2.6 d) for the TEP group. There was no significant difference between two groups for either the incidence of fistula or the length of hospital stay. CONCLUSIONS: Initiation of oral feeding on the first postoperative day in patients undergoing total laryngectomy with primary pharyngeal closure is a safe clinical practice. However, it does not shorten the length of hospital stay for these patients.     

First branchial cleft sinus presenting with cholesteatoma and external auditory canal atresia

First branchial cleft abnormalities are rare. They may involve the external auditory canal and middle ear. We describe a 6-year-old girl with congenital external auditory canal atresia, microtia, and cholesteatoma of mastoid and middle ear in addition to the first branchial cleft abnormalities. Clinical features of the patient are briefly described and the embryological relationship between first branchial cleft anomaly and external auditory canal atresia is discussed. The surgical management of these lesions may be performed, both the complete excision of the sinus and reconstructive otologic surgery.     

Bacteriemia in septoplasty and septorhinoplasty surgery

This study was conducted in an attempt to investigate whether bacteriemia developed in patients with septoplasty and septorhinoplasty in the postoperative period during which an anterior nasal pack was in their nose. Fifty-three patients who went through septoplasty or septorhinoplasty operations were followed in this study. Nasal smear cultures were obtained from all the subjects before the operation. After the packs were retrieved, smears were also obtained from the pack material. Venous blood samples were obtained from the patients immediately before the operation, after the operation and immediately following the retrieval of the pack. When preoperative nasal smear cultures and postoperative pack material cultures of the patients that were obtained at 48 hours were compared, it was seen that different microorganisms were present in 66% of the patients. Bacterial growth was not observed in any of the preoperative blood cultures; whereas 8 patients (15.0%) had bacteriemia in the blood samples obtained immediately after the operation and 9 (16.9%) had growth in the blood samples obtained following the retrieval of the pack. With these results we have seen that bacteriemia can develop in patients with septoplasty and septorhinoplasty. It did not cause serious clinical problems. However, in patients with cardiovascular problems, this possibility should be taken into consideration and relevant preoperative precautions should be implemented.     

Reversible postictal MRI change mimicking structural lesion

A reversible change on magnetic resonance imaging (MRI) following generalised seizure mimicking a tumour-like structural lesion is reported in a 15-year-old patient. MRI revealed a left fronto-parietal cortico-subcortical lesion on T2 weighted images. The control MRI after 5 weeks from the onset revealed no pathological finding. The reversible MRI changes may be the result of a local brain swelling, and a defect of cerebral autoregulation during seizure at the site of activity. The transient nature of such neuroradiological findings have to be taken into consideration in the differential diagnosis because of their similar appearance on imaging to intrinsic brain tumours.     

Pulmonary alveolar proteinosis in a patient with acute lymphoid leukemia regression after G-CSF therapy

Pulmonary alveolar proteinosis (PAP) is the intra-alveolar accumulation of periodic-acid schiff (PAS) positive material. PAP is one of the underrecognized causes of pulmonary infiltrates in patients with hematologic malignancies. Here, we present a patient with acute lymphoid leukemia (ALL) in first remission that developed fever and diffuse pulmonary infiltrates during the neutropenic stage of consolidation chemotherapy. The histopathologic examination of bronchoalveolar lavage (BAL) fluid and transbronchial biopsy specimen demonstrated the presence of PAS-positive eosinophilic material. Empirical antibiotherapy and granulocyte-colony stimulating factor (G-CSF) were given. After the correction of neutropenia with G-CSF, the patient's fever disappeared, acute phase reactants decreased, pulmonary infiltrates resolved. We present this case because it was the first patient in whom the correction of neutropenia with G-CSF was followed by resolution of PAP.