Hypoglycemia after albuterol overdose in a pediatric patient

Albuterol overdose can lead to tachycardia, hypotension, tremor, hypokalemia, and hyperglycemia in children. Hypoglycemia had been previously reported in only one child. We describe a 3-year-old boy who ingested high-dose albuterol in this report. On arrival to the emergency department, the child was agitated and had noticeable restlessness, sinus tachycardia, mild hypokalemia (3.2 mEq/L), and hyperglycemia (187 mg/dL). Activated charcoal and intravenous hydration were given, and electrocardiogram monitoring was performed. Sinus tachycardia resolved within 4 to 6 hours. Hypoglycemia (45 mg/dL) was identified 4 hours after admission. The child recovered uneventfully within 24 hours with glucose replacement. This case suggests that hypoglycemia could be a late complication of acute albuterol overdose; thus, the period of observation should be extended in these cases.     

Solitary eosinophilic granuloma of sternum

Primary bone tumors of the chest wall are uncommon, although a wide variety of both benign and malignant tumors arise within the chest wall. Among those tumors, sternal tumors are rare and usually malignant. We report an extremely rare case of eosinophilic granuloma developed in the sternum in a 30-year-old woman. She presented anterior chest pain and somewhat tender mass over the sternum. Chest roentgenogram, computed tomography scanning of the thorax, and total body bone scintigraphy revealed an isolated lytic lesion in the corpus sterni. A tru-cut biopsy of the mass exhibited the typical histologic appearance of eosinophilic granuloma. The solitary lesion was removed completely surgically. This rare condition should be kept in mind in differential diagnosis of sternal lesions.     

The importance of genomic copy number changes in the prognosis of glioblastoma multiforme

Glial tumors are the most common tumors of the nervous system, affecting individuals at any age. Since understanding of the molecular pathologies underlying human gliomas is still very poor, the treatment and therefore prognosis of this malignancy could not yet be improved. In order to determine whether different glioblastoma-associated genomic aberrations may serve as prognostic markers in combination with histopathological findings, 20 primary glioblastoma multiforme tumors were screened by comparative genomic hybridization, and the results were compared with histopathological and clinical features. All tumors showed genomic copy aberrations detected by comparative genomic hybridization. Regional and numerical increases in chromosome 7 copy number were the most frequently seen abnormality (10/20 tumors), followed by loss of chromosome 10 (8/20). Both of these aberrations were associated with shorter surveillance time. Chromosome 12q amplification was detected in seven tumors. Loss of 17p, 1p, and 19q in combination was seen in three cases. One of them was a giant cell GBM, whereas the remaining two cases were still alive. Combination of chromosome 1p and 19q deletions was also seen in a case with long surveillance. According to the preliminary findings of this study, in addition to the EGFR gene, amplification of other genes on chromosome 7 and the deletion of PTEN gene and other cancer-related genes on chromosome 10 appeared important to the development of glioblastoma multiforme and were associated with poor prognosis, whereas the combination of chromosome 1p and 19q deletions seems to be an informative molecular marker for better prognosis. The clinical features and genetic alterations of primary and secondary glioblastoma multiforme should be compared in large series to clarify the effective prognostic markers; and further molecular analyses focused on chromosomes 7 and 10 will be very helpful for understanding the molecular mechanisms underlying the progression of glioblastoma.     

Letrozole-induced polycystic ovaries in the rat: a new model for cystic ovarian disease

BACKGROUND: Our objective was to develop a new animal model for the study of polycystic ovaries by using the non-steroidal aromatase inhibitor, letrozole. METHODS: Thirty four rats were divided into four groups, including a control group of 10 rats that received vehicle only (1% aqueous solution of carboxmethlycellulose [CMC]) once daily orally (p.o.) and three treatment groups of eight rats each that were administered letrozole at concentrations of 0.1 or 0.5 or 1 mg/kg p.o. dissolved in 1% CMC (2 mL/kg) once daily. The treatment period was 21 days. During this period, vaginal smears were collected daily for estrus cycle determination. On the day subsequent to last letrozole dose administration, rats were killed; uteri and ovaries were then excised and weighed. Serum hormone levels and histologic changes in ovaries were examined. RESULTS: When compared to control group, ovaries from study groups showed high incidence of subcapsular ovarian cyst and capsular thickening together with incomplete luteinization and decreased number of corpora lutea. Letrozole treatment brought about dose-dependent suppression of uterine weight despite having no significant effect on ovarian weight. Although serum estradiol and progesterone levels were reduced in a dose-dependent manner, testosterone levels were elevated as were levels of luteinizing hormone (LH). Serum follicle-stimulating hormone (FSH) levels were markedly increased at higher doses of letrozole (0.5 and 1.0 mg/kg), contrary to low dose of letrozole (0.1 mg/kg) at which slight decrease was observed. CONCLUSIONS: Despite the fact that this is not a fully convincing model for the study of polycystic ovaries or of polycystic ovary syndrome (PCOS) as a whole, this animal model in several ways is similar to the human polycystic ovary syndrome.     

Accumulation of a potent gammadelta T-cell stimulator after deletion of the lytB gene in Escherichia coli

Activation of human Vgamma9/Vdelta2 T cells by many pathogens depends on the presence of small phosphorylated non-peptide compounds derived from the 2-C-methyl-d-erythritol 4-phosphate (MEP) pathway of isoprenoid biosynthesis. We here demonstrate that in Escherichia coli mutants deficient in lytB, an essential gene of the MEP pathway, a potent Vgamma9/Vdelta2 T-cell activator accumulates by a factor of approximately 150 compared to wild-type E. coli. The compound responsible for the strong immunogenicity of this E. coli mutant was subsequently characterized and identified as a small pyrophosphorylated metabolite, with a molecular mass of 262 Da, derived from the MEP pathway. Stimulation of human peripheral blood mononuclear cells (PBMC) with extracts prepared from the lytB-deficient E. coli mutant led to upregulation of T-cell activation markers on the surface of Vgamma9/Vdelta2 T cells as well as proliferation and expansion of Vgamma9/Vdelta2 T cells. This response was dependent on costimulatory growth factors, such as interleukin (IL)-2, IL-15 and IL-21. Significant levels of interferon-gamma (IFN-gamma) and tumour necrosis factor-alpha (TNF-alpha) were secreted in the presence of IL-2 and IL-15, but not in the presence of IL-21, demonstrating that proliferating phosphoantigen-reactive Vgamma9/Vdelta2 T cells do not necessarily produce proinflammatory cytokines.     

Diagnosis and Surgical Treatment of Morgagni Hernia: Report of Three Cases

Morgagni hernia is a rare congenital disorder, which is usually asymptomatic, but may cause respiratory or gastrointestinal symptoms. We reviewed the clinical findings of three patients with a Morgagni hernia, diagnosed and treated in our department between 1997 and 2000. The Morgagni hernia caused various symptoms in all three patients and surgery was performed via posterolateral thoracotomy in two, and via laparatomy in one. The hernial defect was closed by primary suturing in two patients and by synthetic mesh in one. All three patients had an uneventful postoperative recovery. We believe that the transthoracic approach is an effective way of repairing Morgagni hernia. Received: October 19, 2001 / Accepted: July 2, 2002 RID="*" ID="*" Reprint requests to: I.C. Kurkcuoglu, Ataturk Universitesi Tip Fakultesi, Gogus Cerrahisi ABD, 25240 Erzurum, Turkey     

Buccal midazolam for treatment of prolonged seizures in children

Midazolam is a relatively new anticonvulsive agent in the benzodiazepine group. It has a short onset of duration and is practical for use, providing several alternatives such as intravenous, intramuscular, and intranasal routes. The buccal route could be an alternative choice for seizure control in an emergency setting. However, no sufficient reports are available on buccal midazolam administration. The present study was designated to examine the efficacy of buccal midazolam in children at different ages with seizures of more than 5 min duration. Nineteen previously unreported children, aged from 1 month to 15 years, were treated with a 0.3 mg/kg dose of buccal midazolam; 13 had prolonged seizures, and six had status epilepticus, with a duration of 5-45 min (mean 22 min). Sixteen of 19 seizures (84.2%) stopped within 10 min of buccal midazolam being given. The drug efficacy in patients with status epilepticus was 50%. However, all patients with convulsions shorter than 30 min showed a perfect response (100%). Convulsion episodes stopped within 3.89+/-2.22 min (median time 3 min). Seizure duration was correlated with cessation of seizure (r=0.76, P<0.001). No clinically important side effects were seen in any patient. On the basis of this experience, we concluded that a 0.3 mg/kg dose of buccal administration of midazolam might offer an effective treatment in all ages of children.     

A case of pneumonia following human infection with avian influenza a (H5N1)

The H5N1 infection was diagnosed in 12 patients in Turkey and confirmed by the WHO. Of these 12 patients so far, 8 have been published. In this case, we are presenting a case of pneumonia that developed following avian influenza infection in Eskisehir. Our case is one of the 4 patients who were not reported previously.