No effect of long-term valproate therapy on thyroid and parathyroid functions in children

In this study, we studied serum calcium, phosphorus, alkaline phosphatase, thyroid hormones (total thyroxine, free thyroxine, thyroid-stimulating hormone), parathyroid hormone, and osteocalcine levels in children with epilepsy who had been receiving long-term valproate (VPA) therapy in order to determine whether there was any effect of VPA therapy on these hormones. The study included 31 patients with epilepsy receiving VPA and 22 healthy age-matched controls. The age ranged from 15 months to 16 years and 18 months to 17 years in the study and control group, respectively. The duration of VPA use was between 12 months and 5 years (1.93 +/- 1.90 years). When comparing the results, we did not find any significant difference in any of the parameters, including serum calcium, phosphorus, alkaline phosphatase, osteocalcine, and thyroid and parathyroid hormone levels, between the study and control group. We suggest that VPA can safely be used with regard to thyroid and parathyroid dysfunction in childhood epilepsy.     

Short-wavelength automated perimetry in patients with migraine

Background The aim was to investigate short-wavelength sensitivity deficits in patients with migraine.Methods Fifteen migraine and 18 age-matched healthy volunteers with normal ophthalmologic examination participated in this study. Migraine characteristics were graded by the Migraine Disability Assessment Questionnaire (MIDAS). All participants underwent SWAP (short wavelength amplitude perimetry) testing using a Humphrey field analyzer; there was a 30-2 presentation pattern.Results Short wavelength amplitude perimetry parameters for mean deviation (MD; p<0.0001) and pattern standard deviation (PSD; p<0.0001) were significantly worse in the migraine group. In the migraine group 53.3%. of eyes had glaucoma hemi-field tests (GHT) outside normal limits and 10 of these had early glaucomatous visual field loss. Statistically significant correlations were found between frequency of migraine attacks and MD (p=0.02; r=0.56) and PSD (p=0.03; r=0.41) and also between the MIDAS score and MD (p=0.03; r=0.49) and PSD (p=0.04; r=0.51). In all migraine cases with early glaucomatous visual field defect a corresponding site of the head was predominantly involved in headache (p=0.03).Conclusion Some patients with severe migraine have earlier defects on SWAP suggesting a common vascular insult of glaucoma and migraine, and all migraine cases with high MIDAS scores should be further evaluated for early glaucomatous visual field defects using SWAP.     

Risk factors and infant outcomes associated with umbilical cord prolapse.

OBJECTIVES: Our goal was to identify risk factors associated with umbilical cord prolapse and to review the perinatal outcome of cases of cord prolapse. METHODS: During the study years 77 cases were identified retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. RESULTS: Of the 77 fetuses with umbilical cord prolapse 9.1% had a fetal weight of < 2500 gas compared with 9.4% for fetuses in control group (P > 0.05). The umbilical cord prolapse occurred in association with vertex presentation 66 times (85.7%), breech presentation nine times (11.7%) and transverse presentation two times (2.6%). The occurrence of breech presentation among the control cases was 2.6%, and that of transverse lie was 1.7% (P < 0.01). Case mothers were 1.6 times more likely to be multiparas compared with the control group (P < 0.01). The perinatal mortality rate was 39/1000. CONCLUSIONS: Our study showed that abnormal fetal presentation and multiparity are associated with an increased risk of umbilical cord prolapse. The association of risk of cord prolapse with low birth weight was statistically insignificant (P > 0.05). We suggest that the cesarean delivery decreased the risk of perinatal mortality among cases of cord prolapse.     

Transitional cell carcinoma of the ovary

Five patients with transitional cell carcinoma of the ovary constituted 1.0% of all patients with primary ovarian carcinoma (5/494) managed in the study period (1984–93). The average age at diagnosis was 59.2 years. All the patients presented with a pelvic mass. The average size of the primary tumoral mass at surgery was 5.2 cm. Only one patient had grossly bilateral involvement. All of the patients were subjected to a primary surgical staging procedure. One patient had stage IIA, two had stage IIB, one had stage IIIC and one had stage IVB disease. Four patients were treated with adjuvant multiagent chemotherapy consisting of cisplatinum and cyclophosphamide for 6 cycles. The other patient received monthly melphalan for 10 courses. Three of the patients were subjected to a second-look procedure. Of them, one with stage IIA disease was found to be negative for tumor after melphelan chemotherapy. This patient is still alive. While the patient with stage IIB disease was found to be tumor-free, the patient with stage IIIC disease had macroscopic tumor at second-look. The other patients with stage IIB and IVB disease were lost to follow-up after 6 months. Four of the patients had grade 3 disease. While epithelim membrane antigen was positive in tumors, intermediate filaments such as vimentin and desmin could not be demonstrated in any. Absence of stromal calcification and CEA immunohistochemical staining, which are common in Brenner tumors, as well as the presence in almost all cases of high grade disease in advanced stages appear to support the establishment of transitional cell carcinoma of the ovary as a separate entity.     

Autoimmune hemolytic anemia with warm antibodies in children: retrospective analysis of 51 cases

In this paper, research based on 51 children with a positive antiglobulin test is presented. Eighteen of the children had acute anemia and 33 had chronic anemia. Two clinical patterns were distinguished: an acute transient type and a prolonged chronic type. Corticosteroid therapy was effective in all acute cases but its results were variable in the chronic cases. The acute form was more frequent in young children, while chronic autoimmune hemolytic anemia (AIHA) occurred mainly among children at puberty. In the chronic form of the disease, it was sometimes necessary to add immunosuppressive drugs and in two cases to perform a splenectomy.     

Biphenotypic characteristics, cell size and prognosis in childhood acute myeloblastic leukemia

In order to determine the prognostic significance of cell size together with expression of biphenotypic markers in childhood acute myeloblastic leukemia (AML), we evaluated the cell size of children with AML, 12 with and 21 without biphenotypic markers. The patients were followed up for at least 12 months. The cells which were stained with FITC conjugated surface marker antibodies were divided into small, middle or large cell groups according to their mean channel number of forward scatter by flow cytometry. Nine of 12 biphenotypic and 15 of 21 non-biphenotypic children either died or relapsed within the first 12 months. The percentages of the small, middle and large cells were similar in children and in deceased patients, regardless of whether or not they expressed biphenotypic markers. We believe that biphenotypic marker expression is a poor prognostic factor regardless of cell size.