ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 16 (3)
Volume: 16  Issue: 3 - 2011
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1.Improvement of the histopathology on a maintenance regimen in children with autoimmune hepatitis.
El-Sayed I. Salama, Nermine A. Ehsan, Behairy E. Behairy, Mohsen H. Hussein, Menan E. Salem
Pages 178 - 187
Autoimmune hepatitis (AIH) is a chronic liver disease characterized histologically by interface hepatitis and fibrosis. Recent studies have reported that hepatic fibrosis and cirrhosis may be reversible by treatment in some patients. Combined low dose prednisolone and azathioprine regimen was rarely studied in children with AIH. Twenty children with median age 8±3.5 yrs (9 girls, 11 boys), 18 AIH type I and two were AIH type II, who were in clinical and biochemical remission for at least 6 months, and who had a diagnostic and a follow-up liver biopsy, were included in this study. Different histological stains were used for assessing the grade of necroinflammatory activity (HAI) and for evaluating the stage of fibrosis according to Ishak scoring system. Morphometric analysis using LeicaQ500IS image analyzer was applied on Perl's stained liver sections to assess the percentage of liver fibrosis. Data revealed significant decrease in the median HAI from 8.85 to 3.6 (p=0.001). The median fibrosis score showed significant reduction from 3.9 to 2.4 (p=0.001) and the median fibrosis percentage decreased from 28.7 to 12.8 (p=0.001). These data provide evidence for regression of fibrosis in AIH in children who responded to the combined low dose immunosuppressive prednisolone and azothioprine regimen.

2.Comparison of ICU and non-ICU patients infected with the 2009 H1N1 influenza virus in a Florida Children’s Hospital between April and December 2009
Haidee T. Custodio, Michael O. Gayle, Christine S. Bailey, Peter S. Wludyka, Mobeen H. Rathore
Pages 188 - 193
We conducted a retrospective comparative review of children < 21 years of age infected with the 2009 H1N1 influenza virus hospitalized between April and December 2009 in northeast Florida, United States. Patients admitted to the Pediatric Intensive Care Unit (PICU) and general medical ward were compared based on patient demographics, chronic medical conditions, complications, co-infections, length of stay and outcome. Of the 119 hospitalized children, 25 (21%) were admitted to the PICU and 94 (79%) were admitted to the general medical ward. Overall, there were 63 (53%) male and 54 (45%) African-American. Mean age was 6.4 years with 52 (44%) patients < 5 years of age. Fever was seen in 114 (96%) patients and 60 (50%) patients had respiratory distress of varying severity. More than 70% of patients had at least one chronic medical condition, with the three most common being pulmonary, immunosuppression and neurodevelopmental conditions. The incidence of microbiologically-proven co-infections and mortality rate were 6.7% and 0.8%, respectively. Patients stayed at the hospital for an average of 4.3 days. Our analysis demonstrated that patients in the PICU had a statistically significant higher rate of chronic medical conditions, complications and longer lengths of stay compared to patients admitted to the general medical ward.

3.Management and treatment of foreign bodies ingestion in childhood
Mehmet Melek, Ufuk Cobanoglu, Salim Bilici, Burhan Beger, Baran Serdar Kizilyidiz, Yasin Melek
Pages 194 - 198
Ingestion of foreign bodies (FBs) is a significant problem that causes morbidity and mortality in childhood. The aim of this retrospective study was to report our experience of foreign body ingestion in pediatric patients. The medical records of 165 patients who were hospitalized for foreign body (FB) ingestion in pediatric and chest surgery departments between 2005 and January 2010 were evaluated retrospectively. X-ray films and abdominal ultrasound scan were used for the diagnostic approach of the patients. The common complaints were odynophagia-dysphagia (n=107), hypersalivation (n=81), cough (n=21), vomitting (n=20) and asymptomatic in 34 patients. Radiological examinations showed that FB was located in the esophagus in 81.2% (n=134) of the patients, in the stomach of 6.74% (n=11) patients, in the intestinal segments in 10.4% (n=17), in the rectum in 1.21% (n=2) and in the liver parenchyma 0.6% (n=1) patients. Endoscopic examination performed in 134 (81.2%), FB proceeded uneventfully in 23 (13.9%) in follow up period and 8 (4.8%) patients underwent surgery. The type of ingested FB varied widely. The coins (n=54, 32.7%) and pieces of plastic toys (n=29, 17.5%) were the most frequently ingested FBs. Foreign body ingestion is a major problem in childhood. Management depends on carefully and close follow up for complications and favorable treatment choice.

4.High immunogenicity of measles AIK-C vaccine produced in Vietnam
Nguyen Dang Hien, Le Thi Luan, Nguyen Thuy Huong, Nguyen Nu Anh Thukral, Tran Hong Thuy, Nguyen Xuan Hoa, Le Quoc Hung, Duan Huy Hau, Dao Xuan Vin, Dinh Hong Duong, Shuzo Ishikawa, Tomio Lee, Tetsuo Nakayama
Pages 199 - 207
The goal of measles elimination has been set for 2012 in the WHO Western Pacific Region. To achieve this goal, an enhanced immunization strategy is required, and measles vaccines have been provided through the Expanded Programme on Immunization (EPI) in Vietnam. A large quantity of vaccines should be supplied for a two-dose immunization schedule with a supplementary catch-up campaign. The live measles vaccine AIK-C strain was produced in Vietnam through technical transfer from the Kitasato Institute, Japan. PolyVac I was produced from bulk materials imported from Japan and PolyVac II from the AIK-C seed. Two clinical trials were conducted using three vaccines: PolyVac I, and II, and the EPI vaccine (Rouvax) for the control. A total of 160 subjects were examined for the immunogenicity of PolyVac I and 57 for that of the EPI vaccine. All subjects became sero-converted in PolyVac I groups for three different Lots, but 54 (94.7%; 88.9-100%) of 57 recipients of the EPI vaccine became sero-positive. For PolyVac II, 118 initially sero-negatives became sero-converted. Whereas, 107 (95.5%; 91.7-99.3%) of 112 initially sero-negatives in the EPI group showed sero-conversion. The mean titers of post-immunization sera of sero-converted subjects receiving PolyVac I and II were lower than that for the EPI vaccine. No significant difference was observed in the incidence of adverse clinical events. Essentially the same results were obtained using PolyVac I and II, showing higher sero-conversion rates than the EPI vaccine, and PolyVac measles AIK-C will be favorable in Vietnam and Southeast Asian countries.

5.Hemoptysis in pulmonary tuberculosis - contrast tomography unmasking Rasmussen’s aneurysm
George Peter, Maroli Roshan
Pages 208 - 210
Hemoptysis is a common symptom in respiratory clinical practice, but very rarely the images of Rasmussen’s aneurysm are demonstrated in a case of hemoptysis. In this report of a 53 year old man with massive hemoptysis, we are able to demonstrate a Rasmussen’s aneurysm by contrast enhanced computer tomography (CECT) of the thorax along with features of pulmonary tuberculosis.

6.Interesting images of ingested long metallic needles lodged in the second part of duodenum
Rakesh Mittal, Baljeet K Basra, Nikhil Talwar, Anil K Sarda
Pages 211 - 214
Ingestion of foreign body is not uncommon. However, long metallic needles with sharp pointing ends in the second part of the duodenum are rare. Most ingested sharp metallic bodies pass through the digestive tract spontaneously and patients can be managed conservatively. Sometimes, however, complications like perforation occur and surgical treatment becomes necessary. We came across such an interesting case where a patient had ingested two sharp long metallic needles and was asymptomatic. There were no associated complications. The needles could not be retrieved by upper gastrointestinal endoscopy and had to be removed by laparotomy.

7.Kluver-Bucy syndrome developed after convulsion: A case report
Mesut Okur, Cahide Yılmaz, Serdar Epçaçan, Lokman Üstyol, Avni Kaya, Hüseyin Çaksen
Pages 215 - 217
Kluver-Bucy syndrome is characterized by increased appetite, hypersexuality, hypermetamorphosis, memory disorders, visual agnosia, stagnancy, aphasia, bulimia, polyuria, and polydipsia. A 14 year old girl had generalized tonic-clonic convulsions at admission, and an incomplete Kluver-Bucy syndrome with hypersexuality, recent memory disturbance, hypermetamorphosis, speech disturbance, hyperactivity, agitation, aggressiveness, and hallucinations, developed the following day. Here in, we report a case of KBS in a child with epilepsy.

8.Choledochus cyst: a case report
Avni Kaya, Fesih Aktar, Mehmet Açıkgöz, Lokman Üstyol, Murat Başaranoğlu, Şükrü Arslan
Pages 218 - 220
The etiologies of choledochus cysts are not exactly known. Its classic triads are abdominal pain, mass in abdominal area and icter. A 2-year-old girl was brought in with temperature, vomiting and abdominal pain complaints. In her physical examination, there was no sensitivity, defense and rebound in the abdomen. There was also no icter in her body. In the laboratory examination aspartate transaminase and alanine aminotransferase were slightly high, gama-glutamyl transferase and alkaline phosphatase also significantly high. Her abdomen ultrasonography showed a dimensionally cystic dilatation with dimensions of 2x1,5 cm and cholecytitis was seen in choledochus proximals. In abdomen computerized tomography a dimensionally 13 mm cystic structure was observed in choledochus distal terminus adjacency associated with choledochus. Our case was orientated to pediatric surgery in terms of follow-up and therapy.

9.Single coronary artery: a case report
Berkay Ekici, Aycan Fahri Erkan, Ebru Akgül Ercan, Gültekin Günhan Demir, Musa Şahin, Hasan Fehmi Töre, Emel Öztürk, Enver Ekici
Pages 221 - 224
In single coronary artery anomaly, there is single coronary artery ostium from which both coronary arteries arise with essentially normal peripheral distribution. In this case, we presented a 50-year-old male patient with single coronary artery who underwent coronary angiography. A 50 year-old caucasian male patient referred to the hospital for evaluation of palpitation and atypical chest pain. Myocardial perfusion scintigraphy (MPS) imaging revealed a mild ischemia at the midanteroseptum. We performed a cardiac catheterization and coronary angiography demonstrated a single coronary artery originating from the right sinus of Valsalva. Isolated single coronary arteries are relatively rare anomaly with a variable clinical presentation. This anomaly occasionally has been associated with sudden death. The case is interesting because of MPS demonstrated mild mid-anterior septum ischemia but coronary angiography images revealed no stenotic lesions and the single coronary artery did not travel in between the aorta and pulmonary artery.

10.Conservative surgery and fertility outcomes of borderline ovarian tumours: Case series and review of literature
Cihangir Mutlu Ercan, Kazim Emre Karasahin, Ibrahim Alanbay, Ali Kolusari, Hakan Çoksuer, Mufit Cemal Yenen
Pages 225 - 227
Borderline ovarian tumours are usually seen in younger aged women and the issue of conservative surgery is increasingly important in today’s fertility-preserving concept. We present three borderline ovarian tumour cases who underwent conservative surgery in our instutition between 2006-2008 and their long-term follow-ups for their reproductive capacity after treatment. No recurrence after conservative treatment in our cases had been noted. Fertility-preserving surgery may be the treatment of choice with careful follow-up in women with Stage I borderline ovarian tumours, who desire further childbearing. Assisted Reproductive Techniques should be taken into consideration after the initial treatment and second-look surgery may be performed in the course of a caesarean section.

11.Clustering seizures associated with rotavirus gastroenteritis in a two-month-old infant
Gema Iglesias, Cristina Calvo, Isabel Wilhelmi, Vanesa Montero, Alicia Sanchez-Fauquier
Pages 228 - 230
We present a case of 2-month-old infant with clustered convulsions and transient lactic acidosis associated with mild gastroenteritis caused by rotavirus. This is an unusual age for infection-related seizures. Rotavirus RNA was detected by RT-PCR in both fecal and cerebrospinal fluid (CSF) samples and were genotyped as G1 and G1(P8), respectively.

12.Asymptomatic female patient with ruptured sinus valsalva aneurysm: a case report
Berkay Ekici, Gültekin Günhan Demir, Aycan Fahri Erkan, Fatih Atik, Musa Sahin, Haldun Karagoz, Sengül Çehreli, Enver Ekici
Pages 231 - 234
Sinus of Valsalva aneurysms (SVA) are relatively rare lesions with a variable clinical presentation. Rupture of a SVA (RSVA) often causes hemodynamic instability due to intracardiac shunting or cardiac tamponade, therefore immediate diagnosis and urgent treatment are required. In this case, we presented a 53-year-old asymptomatic female patient, who had a ruptured right SVA with a fistula from the right sinus of Valsalva to the right ventricle (RV) of unknown etiology. A 53-year-old female patient with a history of erythema nodosum (EN) and hypertension (HT) for ten years was referred to our clinic, from department of dermatology for detailed evaluation of HT and target tissue damage. She was asymptomatic and incidentally diagnosed with a ruptured right sinus of Valsalva aneurysm during the transthoracic echocardiography (TTE). SVA are relatively rare anomalies. SVA may be either congenital or secondary to such underlying diseases as syphilis, bacterial endocarditis, atherosclerosis, and aortic dissection. In case of rupture, biventricular failure may occur as a result of systemic-pulmonary shunting. Surgical repair has been the traditional treatment choice of these aneurysms. Our case is interesting because the diagnosis was a coincidental finding in an asymptomatic patient.

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