An unusual complication of appendicitis, perforation of pelvic appendicitis into the uterinal cavity in a 3-year-old girl, is presented in this report.

Appendicitis↗

PubMed2001

A recurrent aphthous stomatitis case due to paediatric Behçet's disease.

Behçet's disease is a rare condition in children and characterized by a triad of recurrent aphthous stomatitis, genital ulceration and uveitis. The aetiology is unknown, but systemic vasculitis is the main pathology. The oral lesions resemble Sutton disease, which is another form of recurrent aphthous stomatitis (RAS) that composes approximately 10 per cent of cases and is known as major aphthous stomatitis, can easily be overlooked if the other symptoms are not questioned. We presented a 12-year-old girl with the initial complaint of recurrent aphthous stomatitis. During the follow-up period, we observed the other cardinal signs of the Behçet's disease.

Behcet Syndrome↗

PubMed2001

Ringer-Lactate solution versus isotonic saline solution on mucociliary function after nasal septal surgery.

Irrigation with isotonic saline is one of the most frequently used solutions after nasal surgery. However, the effect of saline solutions on mucociliary clearance is not well known. In a previous study, it was found that isotonic saline solution had a negative effect on ciliary beat frequency but Ringer-Locke solution had no effect in vitro. In this study we compared the effects of Ringer-Lactate solution and isotonic saline solution on mucociliary transport time before, and after, nasal septal surgery in patients with nasal septal deviation. We found that patients who used Ringer-Lactate solution as irrigation after surgery had a significantly better mucociliary transport time than the patients using isotonic saline solution (p < 0.05). In conclusion, it is better to use Ringer-Lactate solution instead of 0.9 per cent saline solution for nasal irrigation.

Adolescent↗

PubMed2001

A left pulmonary artery aneurysm secondary to pulmonary hypertension.

We report a case of pulmonary trunk aneurysm extending into the left pulmonary artery, due to pulmonary hypertension secondary to mitral valve disease. The mitral valve was replaced with a bileaflet mechanical prosthesis. A Dacron graft interposed between main trunk and left pulmonary artery branch, and right pulmonary branch attached to the graft in an end-to-side fashion. Early postoperative angiogram revealed a very successful treatment.

Aged↗

PubMed2001

[Hip fracture-dislocation (Pipkin type IV) associated with an apparent traumatic aortic valve rupture. Case history].

Traumatic aortic valve rupture with resultant aortic insufficiency is a rare complication of blunt trauma. Here reported is a case with a posterior fracture-dislocation of the hip (Pipkin type-IV) and an undisplaced sternum fracture who developed hemodynamic instability in the clinical follow-up and was diagnosed having a traumatic aortic valve rupture using echocardiography. He first was treated with a biological valve replacement. Two weeks later a total hip arthroplasty combined with the osteosynthesis of the posterior wall of the acetabulum was performed. Sternum fracture healed conservatively. In multiply injured patients especially with a blunt thorax trauma hemodynamic instability despite appropriate fluid replacement should rise the suspicion of cardiac injuries, especially traumatic aortic valve rupture. Echocardiography is a simple but reliable method for the diagnosis.

Aged↗

PubMed2001

Acute aortic valve regurgitation secondary to blunt chest trauma.

Blunt injury to the cardiac valves leads to progressive acute ventricular failure, which often requires urgent surgical management. In this case report, we describe an acute aortic valve rupture caused by air-bag inflation during an automobile accident. Laceration of an aortic valve cusp was treated successfully with urgent aortic valve replacement. A concomitant orthopedic injury was treated electively 15 days after cardiac surgery Acute aortic valve rupture is a very rare complication of blunt chest trauma. We discuss how to diagnose and manage this potentially catastrophic event.

Accidents, Traffic↗

PubMed2001

[Coronary bypass surgery in octogenarians].

OBJECTIVE: The age of the patients referred for coronary bypass surgery is getting older progressively. Early and late postoperative outcome of octogenarians were evaluated and compared with younger age group in this study. METHODS: Records of 55 patients aged 80 years or older (mean age 82.7 +/- 2.8) among 3834 patients, who had coronary bypass graft procedure, operated between 1995 and 2001 were reviewed retrospectively. RESULTS: There were 39 men (70.9%) and 16 women (29.1%). Three patients had aortic valve replacement, 1 had left ventricular aneurysm repair, 1 had carotid endarterectomy additionally. Atrial fibrillation (21.8%), renal dysfunction (16.4%), and prolonged ventilation (10.9%) were the prominent complications. The hospital mortality rate was 7.27% (4 patients). Kaplan Meier Survival Analysis estimated that at the end of 5 years 83.1 + 5.2% of patients were still alive. CONCLUSION: Coronary bypass operations can be performed in octogenarians with slightly increased but acceptable hospital mortality and longer hospital stay. Early intervention and individual modifications in cardiopulmonary bypass techniques may improve the results in this patient population.

Adult↗

PubMed2000

Problems with and pitfalls of photodynamic therapy.

OBJECTIVE: To delineate the various factors that may influence the outcome of photodynamic therapy of the retina and choroid. DESIGN: Experimental animal study. ANIMALS: Pigmented and nonpigmented rabbits; rhesus monkeys. INTERVENTION: The hydrophilic photosensitizer, mono-L-aspartyl chlorin e6, which is maximally activated at 664 nm, was studied after intravenous injection into pigmented and nonpigmented rabbits and rhesus monkeys. Laser light was supplied by a red diode laser coupled to a modified slit-lamp biomicroscope and delivered to the ocular fundus after passing through a standard fundus contact lens. Standard photodynamic parameters were used. The effects of fundus pigmentation, intraocular pressure, spot focus and defocus, region of fundus treated, equivalent fluence, and retreatment were observed in the different animal species. MAIN OUTCOME MEASURES: Slit-lamp biomicroscopy, fluorescein angiography, light and transmission electron microscopy. RESULTS: Fundus pigmentation appeared to be a factor only at the lowest fluence level tested, where only 4 of 12 lesions attempted in pigmented fundi were noted on fluorescein angiography, compared with 12 of 12 lesions in albino rabbits. At normal intraocular pressures and a given fluence, 10 of 10 lesions were fully manifested on fluorescein angiography, compared with 4 of 10 at 30 mmHg and 0 of 10 at pressures sufficient to blanch the optic nerve (>60 mmHg). For laser spots either focused or defocused, there were 6 of 6 lesions that were fully manifested on fluorescein angiography for each of the parameters. Lesions treated in the fovea resulted in larger spots on fluorescein angiography. The fluence of 5 mW for 10 seconds resulted in a larger lesion on angiography than the equivalent fluence of 10 mW for 5 seconds. Areas of retreatment in rabbits demonstrated more thinning of the neurosensory retina and loss of photoreceptor outer segments and nuclei than corresponding areas receiving one treatment. CONCLUSIONS: Photodynamic therapy results varied, depending on intraocular pressure, region of fundus treated, ocular pigmentation, and the total time of exposure to the photosensitizer. Retreatment resulted in progressive thinning of the neurosensory retina with loss of photoreceptor outer segments and nuclei in the rabbit eye.

Animals↗

PubMed2000

The efficacy of plasminogen-urokinase combination in inducing posterior vitreous detachment.

PURPOSE: To investigate the toxicity of intravitreal plasminogen, urokinase, and their combination, and to evaluate their efficacy in the production of posterior vitreous detachment (PVD) in the rabbit eye. METHODS: Fifty-six albino New Zealand rabbits were examined before and after injection using the indirect ophthalmoscope, slit-lamp biomicroscopy, and electroretinography. Various concentrations of urokinase or recombinant plasminogen or a combination were injected intravitreally into the right eyes of four rabbits for each concentration. The left eyes of the animals served as controls and received 0.1 mL balanced salt solution. Group 1 was injected with pure urokinase (1,000, 5,000, or 10,000 IU); Group 2 with recombinant plasminogen (0.1, 0.4, 1.0, 2.0, 4.0, 8.0, or 16.0 caseinolytic units [CU]); and Group 3 with a combination of 1,000 IU urokinase (highest nontoxic dose) and nontoxic concentrations of plasminogen (0.1, 0.4, 1.0, or 2.0 CU). The animals were killed and the eyes enucleated 15 days after injection. Electron and light microscopy were performed. RESULTS: A concentration of 1,000 IU of urokinase was found to be nontoxic to the retina. Plasminogen concentrations of 2.0 CU or less did not produce retinal toxicity, whereas 4.0, 8.0, and 16.0 CU of plasminogen caused minimal-to-severe inflammatory response in the vitreous without histologic or electroretinographic changes. Neither plasminogen nor urokinase alone was successful in producing PVD. The combination of 1,000 IU of urokinase and 1.0 to 2.0 CU of plasminogen was effective without causing retinal toxicity. CONCLUSION: Posterior vitreous detachment can be produced in the rabbit eye using a combination of plasminogen and urokinase.

Animals↗

PubMed2000

Echocardiographic findings in professional league soccer players. Effect of the position of the players on the echocardiographic parameters.

BACKGROUND: The purpose of the study was to compare the echocardiographic parameters of soccer players to healthy controls and to assess the effect of the position of the soccer players on the echocardiographic findings. METHODS: M Mode 2D and Doppler echocardiographic examination were carried out on 83 professional league soccer players and 52 healthy controls. RESULTS: Soccer players had increased interventricular septum (1.14+/-0.13 cm vs 0.99+/-0.17 cm, p<0.001) left ventricular posterior wall (1.08+/-0.16 cm vs 0.91+/-0.13 cm, p<0.001) thickness, increased left ventricular diastolic diameter (5.24+/-0.40 cm vs 4.88+/-0.43 cm, p<0.001), volume (133+/-23 ml vs 113+/-22 ml, p<0.001) and increased left ventricular mass index (142+/-28 g/m2 vs 103+/-23 g/m2, p<0.001) compared to controls. Soccer players had greater mitral E wave to A wave ratio (2.08+/-0.53 vs 1.65+/-0.43, p<0.001) compared to controls. Soccer players were subgrouped according to their position in the play as goal keepers, defensive, midfielder, and offensive players. Comparison among defensive, midfield and offensive players revealed subtle differences between defensive and midfield players. Right ventricular dimensions were higher in goal keepers compared to midfielders due to the greater body surface area of the goal keepers (2.8+/-0.4 cm vs 2.4+/-0.5 cm, p<0.05). Left ventricle end diastolic dimension were similar between groups but when these dimensions were corrected for the greater height of the defensive players the difference between midfields and defensive players became significant (3.05+/-0.18 vs 2.89+/-0.22, p=0.05). On Doppler flow parameters the ratio of peak E wave to A wave velocity (2.27+/-0.55 vs 1.84+/-0.36, p<0.05) was increased in midfield players compared to defensive players. CONCLUSIONS: It was concluded that soccer players had greater left ventricular wall thickness, volume and mass compared to controls. But the effect of the position of the players on the measured cardiac dimensions were minimal. These subtle findings were explained by the leveling effect of the playing system and training, and lack of physical training during the previous month.

Adult↗

PubMed1999

Management of rectal prolapse in children: Ekehorn's rectosacropexy.

Although surgical intervention is occasionally required for rectal prolapse (RP), there is both vagueness as to the indications for surgery and confusion as to the technique that should be used for children who need surgical treatment. Using Ekehorn's transanal suture rectosacropexy technique, 56 children with RP were treated surgically between 1987 and 1998 at our hospital. There were 36 boys and 20 girls, the average age was 4.5 years, and the duration of the recurrent prolapse prior to admission ranged from 3 to 8 months. The technique consists of simply inserting one "U"-shaped suture through the rectal ampulla and tying the strands of the suture outside at the level of the sacrococcygeal junction. In this series, follow-up periods ranged from 1 to 10 years and there were no recurrences. We believe that surgical indications for RP need to be defined more clearly and that Ekehorn's technique offers a simple and effective method for the surgical treatment of complete RP in children.

Adolescent↗

PubMed1999

Jugular phlebectasia in children: is it rare or ignored?

BACKGROUND/PURPOSE: Phlebectasia of the jugular veins is a venous anomaly that usually presents in children as a soft cystic swelling in the neck during straining. The purpose of this report is to discuss the differential diagnosis, the methods of imaging, the mode of treatment, and to demonstrate some factors that have made us believe that the condition may not be an actual rarity but rather has been ignored. METHODS: Eight cases of unilateral internal jugular phlebectasia were treated surgically (ie, excision of the dilated portion of the vein) from 1987 to 1998. The age of the patients ranged from 3 to 14 years. There were 3 girls and 5 boys. The lesions were right sided in 6, and left sided in 2 children. The patients underwent surgery after comparative ultrasonographic confirmation of the diagnosis. Furthermore, the authors prepared a simple questionnaire for evaluating the level of knowledge about this lesion among the related specialists. One hundred ten physicians were asked to describe the jugular phlebectasia and its ideal treatment. RESULTS: All of the patients were discharged from the hospital 24 hours after surgery. Follow-up periods ranged from 6 months to 6 years and no complaints were noted at the time of most recent visits. Our questionnaire results showed that 96% of 73 pediatricians, 37% of 22 otorhinolaryngologists, and 40% of 15 pediatric surgeons did not know what the jugular phlebectasia was. CONCLUSIONS: Color Doppler sonography alone is sufficient for the diagnosis of jugular phlebectasia. The authors recommend surgical excision in asymptomatic cases for cosmetic and psychological purposes. The rarity of the lesion may be caused by a lack of knowledge among the related physicians and the tendency of reporting only surgical results.

Adolescent↗

PubMed1999

Ocular toxicity of intravitreal clarithromycin.

OBJECTIVE: To investigate the ocular toxicity and clearance of intravitreal clarithromycin lactobionate (Klaricid) and to determine the highest nontoxic dose. MATERIALS AND METHODS: To evaluate toxicity, 24 New Zealand white rabbits were divided into six groups (four rabbits each). Rabbits were examined preoperatively and electroretinography (ERG) was performed. The left eyes of the animals served as controls and received intravitreal injection of 0.1 mL sterile water. Klaricid (0.1 mL) was injected into the midvitreous cavity of the right eyes at concentrations of 25 microg, 250 microg, 500 microg, 1.0 mg, 2.0 mg, and 4.0 mg/0.1 mL. The animals were followed up to 15 days postinjection by clinical examination and ERG. The animals were killed and the eyes were enucleated and processed for light microscopy. Ten New Zealand rabbits were used for the vitreous clearance study as drug test rabbits and two additional rabbits were used to generate control retina and vitreous. The highest nontoxic dose (1 mg) was injected into the vitreous and the concentration of clarithromycin in the vitreous was determined using high-performance liquid chromatography at various time intervals after injection. RESULTS: Cataract occurred after intravitreal doses of 2.0 and 4.0 mg. Electroretinography showed decreasing b-wave amplitude with both dark- and light-adapted stimulus in the 4.0-mg group; it was normal in other groups. Histopathologic sections showed localized retinal necrosis and disorganization with the 2.0 and 4.0 mg dosage. No histologic changes were found in the other groups. The half-life of intravitreal clarithromycin was found to be 2 hours. No metabolites of clarithromycin were observed in the vitreous samples. CONCLUSION: Intravitreal clarithromycin lactobionate is nontoxic to rabbit eyes up to a dose of 1.0 mg. Because of its broad-spectrum antibiotic effect and appropriate half-life in the vitreous, it may be a good choice for intravitreal treatment of susceptible organisms.

Animals↗

PubMed1998

Sudden total bilateral deafness due to asymptomatic mumps infection.

Mumps is the most common cause of unilateral acquired sensorineural hearing loss in children. Although it usually affects the salivary glands. the inner ear may be involved. Deafness is usually unilateral, sudden in onset, profound and permanent. Bilateral total sensorineural hearing loss had been rarely reported in English literature. We present a case of total deafness due to asymptomatic mumps infection.

Child, Preschool↗