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Infants and small children with asthma are not commonly skin tested, as allergy is not considered to be a major cause of infantile asthma. The aim of this study was to determine the frequency of skin test positivity to various allergens in wheezy children less than 3 years of age. We evaluated 161 patients with infantile asthma (median age 20 months) and 100 healthy controls (median age 18 months). Infantile asthma was defined as three or more episodes of wheezing in a child less than 3 years of age, whose symptoms improved on treatment with beta-agonist and anti-inflammatory agents. All children were skin tested to house dust mites (HDM), pollens, molds, and cow milk extracts using prick technique. One hundred and eighteen (73.3%) children In the patient group tested positive to HDM, 84 (52.1%) to pollens, 37 (22.9%) to molds, and 16 (10%) to cow milk. Sensitization rates to HDM were significantly higher in the patient group than In the healthy controls. Sensitization rates to pollens were not statistically different between the two groups. There was no association between family history of atopy and frequency of sensitization to allergens in the wheezy and control groups. We concluded that skin sensitization to allergens was common In wheezy infants. The prevalence of sensitization to indoor allergens was higher than to outdoor or food allergens.

Individual cases of so-called Weber-Christian disease with a bleeding diathesis have been reported for several years. These were originally diagnosed as Weber-Christian disease, but have been recategorized on review as a chronic, visceral, and cutaneous histiocytic (cytophagic) panniculitis, progressing to liver dysfunction and jaundice and a terminal hemorrhagic diathesis. We report here a rare catastrophic form of systemic panniculitis in an adolescent girl. Despite compelling clinical evidence, the diagnosis was made only on postmortem biopsies.

Although the interaction between Hcy, NO(2)(-) and vascular disease has been extensively studied, there are no data verifying their ratios to HDL-C in coronary artery disease (CAD). We examined whether Hcy/HDL-C and NO(2)(-)/HDL-C ratios correlated with the degree of stenosis in CAD. Also, TC/HDL-C and LDL-C/HDL-C ratios were evaluated in the same individuals. Seventy subjects were divided into three groups according to coronary angiography findings: >50% stenosis (n=35, years: 50.9+/-3.4; Group 1), 5-50% stenosis (n=20, years: 50.6+/-3.8; Group 2), <5% narrowing (n=15, years: 49.0+/-3.2; control group). Hcy/HDL-C, NO(2)(-)/HDL-C, TC/HDL-C and LDL-C/HDL-C were statistically higher in both Group 1 patients (p=0.001, for all ratios) and Group 2 patients (p=0.001, p=0.001, p=0.03, 0.041, respectively) with respect to controls. The values were correlated with the degree of stenosis in the different significance levels (r=0.496, p=0.001; r=0.384, p=0.004; r=0.334, p=0.012; r=0.321, p=0.016, respectively). In patients with >50% stenosis, NO(2)(-)/HDL-C was only shown to change significantly in relation to obstructive artery number (p=0.026) and also showed a positive correlation (r=0.379, p=0.032). In conclusion, Hcy/HDL-C and NO(2)(-)/HDL-C appear to be more indicative than TC/HDL-C and LDL-C/HDL-C in the evaluation of CAD patients regarding the degree of stenosis. However, only NO(2)(-)/HDL evaluation seems to be a reliable indicator in the patients with heavy stenosis of CAD. Further studies are needed to confirm the results of present study.

Fucosidosis is a rare, autosomal recessive lysosomal storage disorder caused by a severe deficiency of alpha-L-fucosidase. Here we present a 27-month-old male who was referred to us for evaluation of developmental delay, which was first detected at age six months. His past medical history was also remarkable for recurrent pulmonary infections and myoclonic seiures. His family history revealed that he was the first living child from a consanguineous marriage. He had a younger sister who died at five months of age from pneumonia who had facial resemblance to the proband, developmental delay and a congenital heart defect. Physical examination revealed length: 81 cm (25-50p), weight: 10.2 kg (25-50p), and head circumference: 49 cm (50-75p). He had a coarse face, hepatomegaly and generalized spasticity. His initial laboratory examination revealed negative urine screening column chromatography for mucopolysaccharidosis. His X-ray findings were consistent with mild form of dysostosis multiplex. Based on clinical and laboratory features, fucosidosis was suspected. Fucosidase enzyme activity was zero. In addition to fucosidosis, thyroid function tests indicated primary hypothyroidism. This is, to the best of our knowledge, the fourth case of fucosidosis diagnosed in Turkey.

Hyperprolinemia type II (HP II) is a rare inherited metabolic disease due to the deficiency of pyroline-5-carboxylate dehydrogenase. It is generally believed to be a benign condition although some patients have neurological problems such as refractory convulsions. Here we report a six-year-old girl with HP II who admitted to our hospital with recurrent seizure refractory to multiple antiepileptic drugs. She was the third child of healthy, consanguineous parents. The family history was negative for neurological and renal disorders. On physical examination, she had no facial dysmorphy; the anthropometric measurements, and systemic and neurological examinations were normal. Mental and motor development was appropriate for her age. Laboratory findings revealed elevated levels of proline, glycine, and ornithine in serum and pyrroline-5-carboxylate and hydroxyproline in urine. Cerebral computerized tomography and magnetic resonance imaging were both normal. Electroencephalogram showed a very active epileptic abnormality; partial control of seizures was achieved by two antiepileptics. Increased plasma glycine and ornithine levels are the unique features of our case when compared to the other HP II cases reported in the literature.

A retrospective review was conducted on 132 patients aged between two and 15 years with cervical lymphadenitis and/or with abscess formation to determine the epidemiologic and clinical presentation of these infections. The most common locations were the upper anterior cervical space (43.2%) and the submandibular space (27.3%). The duration of symptoms ranged from 12 hours to 20 days. Results of the pus cultures were available in 31 patients (23.5%). Of these, 16 cultures (51.6%) were positive. The isolated organisms were Staphylococcus aureus (50%), Staphylococcus epidermidis (31.3%), group A beta-hemolytic streptococcus (12.5%), Streptococcus pneumoniae (6.3%) and Escherichia coli (6.3%). One of the specimens yielded mixed organisms (Staphylococcus epidermidis and Streptococcus pneumoniae). Penicillin resistance was documented in six (37.5%) of the 16 gram-positive bacteria isolated from the pus culture. Both throat and blood cultures were available in all 132 patients. Seven throat cultures (5.3%) were positive for group A beta hemolytic streptococci, whereas five blood cultures (3.8%) were reported to have bacterial growth. Sixty-seven patients (50.8%) were treated with ampicillin-sulbactam, 53 patients (40.1%) with ampicillin-sulbactam and ornidazole and 12 patients (9.1%) with ceftriaxone parenterally. The mean duration of hospital stay related to the infection was 7.30 +/- 3.89 days (range, 2-28 days). The mean period for downsizing of the cervical mass by half was 4.05 +/- 2.05 days, and the recovery period (total antibiotic usage period) was 13.72 +/- 5.33 days. All of the patients had an uneventful recovery without complications. Results of both throat and blood cultures were not predictive for etiologic agents in our study group. Since ultrasonographic evaluation of each patient has limited additional benefits in clinical management, it must be reserved for selected cases to document abscess formation.

Objective: To compare the immunogenicity and safety of a virosome-adjuvanted influenza vaccine (Inflexal V; Berna Biotech, Berne, Switzerland) and a split influenza vaccine (Fluarix; GlaxoSmithKline Biologicals, Rixensart, Belgium) in children., Subjects and Methods: The subjects, 453 children ages 6 to 71 months, were stratified into primed and unprimed and age groups (6 to 35 and 36 to 71 months) and then randomized 1:1 to receive virosome-adjuvanted (n = 224) or split influenza vaccine (n = 229), a half or full dose was given intramuscularly according to age. Unprimed children received a second dose after 4 weeks. Blood samples (n = 326) collected pre-and 28 days postvaccination were analyzed by hemagglutination inhibition test. Safety assessments were made at baseline and follow-up visits by the investigators and by parents for the 4 days after vaccinations., Results: Both vaccines induced an effective immune response. Seroconversion rates (>4-fold titer rise) against the WHO recommended strains A/New Caledonia (H3N2), A/Moscow (H1N1) and B/Hongkong (B) were 80.1, 66.0 and 90.4% for the virosome-adjuvanted and 75.9, 62.9 and 89.4% for the split influenza vaccine, respectively. Unprimed children's seroconversion rates for H3N2 were significantly higher (P = 0.02) for the virosome-adjuvanted (88.8%) than for split influenza vaccine (77.5%). Seroprotection rates (titer of > 40) for H3N2, H1N1 and B, respectively, were 87.8, 80.1 and 90.4% after vaccination with the virosome-adjuvanted vaccine and 82.9, 78.2 and 89.4% after the split influenza vaccine. Unprimed children's seroprotection rate was significantly higher (P = 0.03) for H3N2 after the virosome-adjuvanted (88.8%) than those for the split influenza vaccine (78.3%). Equivalent geometric mean titer fold increases were evident for both vaccines. No serious adverse events were seen. Pain/ tenderness, redness and swelling/induration was found in 25.4, 11.2 and 8.9% for the virosome-adjuvanted vaccine and in 24.0, 9.2 and 6.1% for the split influenza vaccine, respectively. The rates of fever, malaise/irritability and shivering was 6.3, 11.6 and 2.7% for the virosome-adjuvanted vaccine and 8.3, 11.8 and 2.6% for the split influenza vaccine, respectively., Conclusions: The virosome-adjuvanted influenza vaccine showed greater immunogenicity over the split influenza vaccine in unprimed children and showed a trend toward better immunogenicity in the rest of the study population. Both vaccines were well-tolerated.

Thyroxin (T4) binding globulin (TBG) the major thyroid hormone transport protein in humans. Congenital or acquired problems lead to TBG excess. Inheritance of TBG excess follows an X-linked pattern. A 21-month-old boy with ichthyosis was referred to the Pediatric Endocrinology Clinic with high levels of thyroid hormones (TT3 = 325 ng/dl, TT4 23 microg/dl, FT3 = 3.49 pg/dl, FT4 = 1.44 ng/dl, TSH = 2.48 microIU/ml). He was clinically euthyroidic. Thyroid gland was normal in size and homogeneous. Thyroid autoantibodies were negative. TSH responded normally to thyroid releasing hormone (TRH) stimulus. TBG was elevated (56 microg/ml). Family investigation revealed high levels of TBG in mother grandfather, and an uncle. To our knowledge, no other TBG excess with ichthyosis has been reported in the literature.

Secondary brain injury is a complicated, multifactorial process that results from hypoxemia, hypercapnia or hypocapnia, and increased ICP. Implementation of a traumatic brain injury protocol for patients with head injury including hemodynamic management, pulmonary care, maintenance of body temperature, control of the environment, positioning of patients, and seizure prophylaxis provides critical care nurses a proactive means to prevent or minimize the development of secondary brain injury in the emergency department.

To reduce the number of injections needed to comply with paediatric vaccination requirements, a liquid, hexavalent vaccine (DTaP-IPV-PRP-T-HBs; Hexavac; Aventis Pasteur MSD) has been developed for primary and booster vaccination of infants and toddlers. In extensive clinical studies, Hexavac has been shown to be highly immunogenic. Seroconversion or seroprotective titres of antibodies against all antigens were achieved in the majority of infants following a primary series of three doses administered at 1-2-month intervals from 2 months of age. Hexavac also induced immunologic memory, as evidenced by the anamnestic response to booster vaccination at 12-18 months of age. These responses were comparable with those seen following concomitant administration of Pentavac (DTaP-IPV//PRP-T) and monovalent hepatitis B vaccine (H-B-Vax II), and were also within the ranges observed for other relevant licensed vaccines. Clinical studies comparing the immunogenicity of Hexavac administered at either 2, 3 and 4 months or 2, 4 and 6 months demonstrated that it can be used by either vaccination schedule. A further study also supported the use of primary doses of Hexavac at 3 and 5 months with a booster at 12 months of age. Hexavac demonstrated a good reactogenicity and tolerability profile. The most frequently reported adverse events after both primary and booster doses were local reactions of redness and swelling/induration and a systemic response of mild fever, irrespective of the vaccine used for priming. Hexavac provided immunity against six important childhood diseases with a single injection at each visit.

Using the DPP polarograms of wet digested cauliflower sample in acetate buffer at pH values of 2, 4 and 6, Fe, Zn, Mo, Se, Cr, Cd, Pb, Ti and Cu quantities were determined. The best separation and determination conditions for Zn, Se and Mo was pH 2; for Cr, Zn, Mo and As was pH 4; for Pb pH 6, for Ti, Cu and Fe was pH 6-7 EDTA, for Cd pH 2 EDTA and for lead pH 6, all in acetate buffer. The trace element ranges for cauliflowers from two different seasons were (first figure for winter, the second for summer) for Se 120-250mugg(-1), Fe 70-85mugg(-1), Cu 320-150mugg(-1), Ti 90-120mugg(-1), Cr 130-630mugg(-1), Zn 90-550mugg(-1), Mo 170-230mugg(-1), Cd 20mugg(-1) (in winter) and Pb 130-300mugg(-1) in dry sample. Cd was under the detection limit in summer. The length of digestion time had no effect on the recovery of copper, iron, molybdenum and zinc between 15 and 3h of digestion.

Background and Objective: To evaluate lacrimal drainage in patients who have undergone successful dacryocystorhinostomy using quantitative dacryoscintigraphy., Patients and Methods: This study included 72 eyes of 72 patients. There were 26 males and 46 females, with a mean age of 39.6 years (range, 8 to 67 years). The patients were subdivided into three groups. Group 1 consisted of 35 eyes with external dacryocystorhinostomy, group 2 consisted of 15 eyes with endoscopic dacryocystorhinostomy, and group 3 consisted of 22 eyes with conjunctival dacryocystorhinostomy with a Jones tube. There was no epiphora in patients and the lacrimal drainage systems were patent by irrigation. The other normal eyes of the patients were evaluated as controls., Results: In groups 1 and 2, the mean T(1/2) values for the palpebral aperture were lower than those for normal eyes, and this difference was statistically significant (P < .01). In group 3, no significant difference was detected in the mean T(1/2) values for the palpebral aperture., Conclusions: Tear flow was slower in patients who had had external and endoscopic dacryocystorhinostomy, but conjunctival dacryocystorhinostomy did not affect T(1/2) values for the palpebral aperture.

Benign airway obstruction is known as curable by therapeutic bronchoscopic methods. Compared by surgical therapies it is comfortable and has no risks for the patients. For five patients who applied our clinic after tracheostomy and endotracheal intubation stenosis we used therapeutic bronchoscopic methods; "laser-stenotic silicon stent". In two patients after vaporization of membranous stricture by Neodimum Yttrium Aliminum Pevroskite Laser (Nd-YAP laser) who were seen posttracheostomy and postentubation; stenotic stent was implanted mechanically and/or by means of baloon dilatation. Membranous stricture area was coagulated by Nd-YAP-laser in other three cases and anatomic airway diameter was achieved mechanically and by baloon dilatation. In the follow up period we applied stenotic silicon stent implantation after second laser resection in whom restenosis observed. In conclusion; patients who had stenotic silicon stent implantation and having no problems in the follow up this therapeutic method is found to be curative.

Literature indicating clinical growth hormone deficiency due to depression is extremely limited, despite a well-known impaired basal and/or stimulated growth hormone secretion in depressive disorders. In this communication, we present a case of short stature due to growth hormone neurosecretory dysfunction in a nine year old girl with major depressive disorder.

The purpose of this study was to examine whether the serum levels of nitric oxide end products and the ratio of nitrite to lipoproteins are valid instruments in the clinical follow-up of patients with coronary artery disease. 65 subjects were divided into three groups, including patients with coronary artery disease, silent coronary artery disease and controls. The serum nitrite level and also the ratio of nitrite to high-density lipoprotein were significantly different between the groups. According to the number of obstructed arteries, the serum nitrite level and the ratio of nitrite to high-density lipoprotein were found statistically different between the groups. There was a positive correlation between the serum nitrite level and the ratio of nitrite to high-density lipoprotein and the number of obstructed arteries. In conclusion, the serum nitrite level and ratio of nitrite to high-density lipoprotein may provide a beneficial guide to follow-up the status of patients with coronary artery disease.

We study distributions of eigenvalue curvatures for a block-diagonal random matrix perturbed by a full random matrix. The most natural physical realization of this model is a quantum chaotic system with some inherent symmetry, such that its energy levels form two independent subsequences, subject to a generic perturbation which does not respect the symmetry. We describe analytically a crossover in the form of a curvature distribution with a tunable parameter, namely, the ratio of intersubsystem/intrasubsystem coupling strengths. We find that the peak value of the curvature distribution is much more sensitive to the changes in this parameter than the power-law tail behavior. This observation may help to clarify some qualitative features of the curvature distributions observed experimentally in acoustic resonances of quartz blocks.

Background: Most countries practice some form of infection control (IC) to minimize hospital-acquired infections. There is still considerable diversity in IC activities in Turkey. Little is known about practical issues and perceptions of physicians regarding IC in Turkey., Methods: The authors developed an 11-item questionnaire addressing questions on IC activities. Physicians attending a national infection control meeting (n = 285) were asked to participate., Results: The response rate was 86%. Respondents from nonuniversity teaching hospitals stated a higher involvement in IC. Physicians from university hospitals were in greater need of IC training., Conclusions: Academic hospitals are particularly concerned with IC. Domains such as surveillance of endemic hospital infections, specific preventive protocols, antibiotics policy, and staff education should be addressed by IC committees. IC is well established in Turkey, but there is still a long way to go to reach the standards found in developed countries.

Objective: The present study was carried out to evaluate the safety and immunogenicity of the Haemophilus influenzae type b-CRM197 (Hib-CRM197) conjugate vaccine in relation to the change of adjuvant from aluminum hydroxide to aluminum phosphate (AlPO4)., Methods: The present study was a clinical phase II, observer-blind, randomized, multicenter, controlled study. Subjects were healthy infants aged 6-12 weeks, eligible for expanded program of immunization (EPI) routine vaccination and admitted to Hacettepe University Department of Social Pediatrics and Gülveren Health Center, Ankara. A total of 520 healthy infants were randomized in a 2:2:1 ratio to receive at either Chiron Hib/AlPO4 vaccine or VaxemHib (aluminum hydroxide adjuvant) vaccine or HibTiter (no adjuvant). Vaccines were administered simultaneously with routine diphtheria, tetanus and pertussis (DTaP) and oral polio vaccine (OPV) vaccines at 2, 4 and 6 months of age. Blood samples for anti-plain polysaccharide (PRP) antibody measurement were collected before the first vaccination and 1 month after the last vaccination. After each vaccination parents filled out a diary for 7 days., Results: Out of 520 subjects enrolled, 514 received three doses and were included for safety analysis. Local and systemic reactions occurred with low and similar frequencies in all groups. Only erythema was more common in Chiron Hib/AlPO4 vaccine (19, 10, 11% in Chiron Hib/AlPO4, VaxemHib and HibTiter, respectively, P < 0.05). Nine serious adverse events were reported in seven cases of which none were related to vaccines. A total of 504 subjects were included in the immunogenicity analysis. The three vaccines were highly immunogenic and equivalent in terms of percentage of acquisition of long-term protective levels. The anti-PRP geometric mean titers were 9.9, 8.3 and 5.14 micro g/mL, respectively (P < 0.05)., Conclusions: The use of aluminum compounds adjuvants in Hib-CRM197 conjugate vaccines does not impact the safety profile, while it does increase the magnitude of anti-PRP antibody titers.

PCR assay has been shown to be a promising option for the diagnosis of brucellosis. However, few studies have been performed with field samples in order to evaluate the assay as a diagnostic tool. In this study, routine use of a species-specific PCR assay previously developed for the identification of Brucella cultures was assessed for the detection of Brucella DNA directly from the stomach contents of aborted sheep fetuses. The assay is based on the insertion sequence IS711 in the Brucella chromosome. In the study, during 3 successive lambing seasons (1998-1999, 1999-2000 and 2000-2001) 126 aborted fetus samples each from different flocks and locations were examined. Brucella strains were isolated from 39 (31%) of the samples and all of the strains were identified as Brucella melitensis by biochemical characteristics, agglutination with monospecific A and M sera and PCR. Thirty-seven of 39 B. melitensis isolates were biotyped as biotype 3, and 2 isolates as biotype 1. From 38 of 39 culture positive fetal stomach contents B. melitensis-specific DNA was detected by PCR. PCR was found negative in all of the culture negative samples. Compared with culture, sensitivity and specificity of PCR were determined as 97.4 and 100%, respectively. The results indicate that this PCR procedure has a potential for use in routine diagnosis of sheep brucellosis., (Copyright 2003 Elsevier Science B.V.)

Promyositis is a term used to denote primary pyogenic infection of the skeletal muscle. Because striped muscle tissue is normally resistant to bacterial infection, pyomyositis is very rare. In tropical countries, pyomyositis accounts for about 4% of hospital surgical admission, but it is far less common in temperate climates. It is more common in adults and especially in men, but it can occur at any age. We would like to present an 8-month-old infant to make pediatricians aware of the possibility of pyomyositis in cases of a mass over muscle, or of children complaining of joint pain or muscle aches even in the infancy period.

This prospective, randomized, placebo-controlled, double-blinded study was designed to evaluate the efficacy of tropisetron in preventing postoperative nausea and vomiting after elective supratentorial craniotomy in adult patients. We studied 65 ASA physical status I-III patients aged 18 to 76 years who were undergoing elective craniotomy for resection of various supratentorial tumors. Patients were divided into two groups and received either 2 mg of tropisetron (group T) or saline placebo (group P) intravenously at the time of dural closure. A standard general anesthetic technique was used. Episodes of nausea and vomiting and the need for rescue antiemetic medication were recorded during 24 hours postoperatively. Demographic data, duration of surgery and anesthesia, and sedation scores were comparable in both groups. Nausea occurred in 30% of group T patients and in 46.7% of group P patients (P >.05). The incidence of emetic episodes was 26.7% and 56.7% in the two groups (P <.05). Rescue antiemetic medication was needed in 26.7% and 60% of the patients (P <.05). Administration of a single dose of tropisetron (2 mg intravenously) given at the time of dural closure was effective in reducing postoperative nausea and vomiting after elective craniotomy for supratentorial tumor resection in adult patients.

The purpose of this study was to determine whether there is a relation between job satisfactionand quality of life (QOL) of nurses. The study was based on a sample of 501 nurses. Job satisfaction was measured by means of the Short Form Minnesota Questionnaire and QOL by means of WHOQOL-BRIEE The results demostrated a positive correlation between job satisfaction and QOL. It was also found that job satisfaction and QOL scores of nurses showed a significant difference according to their age, economic level, marital status, duration of working life, and position at work.

Type 1 diabetes mellitus (DM) develops as a result of autoimmune destruction of the pancreatic beta-cells. The aim of this study was to explore possible associations between serum levels of cytokines, IL-1, IL-2, TNFalpha and INFgamma and metabolic parameters in children with type 1 DM and their non-diabetic siblings to determine whether these cytokines could be indicators of disordered immune regulation. The study population consisted of 41 children with type 1 DM, 32 non-diabetic siblings, and 28 healthy controls. Children with DM were divided into three subgroups: 1) newly diagnosed patients with diabetic ketoacidosis (ND + DKA), 2) newly diagnosed patients without DKA (ND - DKA), and 3) previously diagnosed patients (PD). The highest serum IL-1alpha level was found in the ND - DKA group, which was significant compared to both the ND + DKA (p < 0.05) and the siblings (S) (p < 0.005). IL-2 levels were similar among all groups. The highest TNFalpha level was observed in the ND + DKA group, which was significant against the ND - DKA (p < 0.05), PD (p < 0.001), S (p < 0.05), and control (C) (p < 0.005) groups. TNFalpha concentration in the PD group was significantly lower than those of S (p< 0.005) and C (p < 0.001) groups. The ND - DKA group had the highest INFgamma and this was statistically significant when compared with the S (p < 0.005) and C (p < 0.05) groups. Both the newly diabetics and all diabetics as a group had statistically significantly higher INFgamma levels than both the S (p < 0.01 for both) and C (p < 0.05 for both) groups. In the diabetics as a whole group, TNFalpha showed correlations with INFgamma (r = 0.370, p < 0.05). IL-1 showed correlation with TNFalpha (r = 0.368, p < 0.05) INFgamma (r = 0.796, p < 0.001) and IL-2 (r = 0.862, p < 0.001) in the all diabetics group. IL-2 was correlated with TNFalpha (r = 0.320, p < 0.05) and INFgamma (r = 0.754, p < 0.01) in the all diabetics group. In conclusion, our results suggest that proinflammatory cytokines TNFalpha, INFgamma, IL-1alpha and IL-2 may play important roles alone or in combination in the pathogenesis of type 1 diabetes mellitus.

Giant cell arteritis (GCA) is a common systemic vasculitis with an unknown etiology. It mainly affects people older than 50 years of age and often presents with symptoms such as headache, jaw claudication, visual loss, polymyalgia rheumatica and increased erythrocyte sedimentation rate (ESR). Established blindness is irreversible if the steroid treatment is not administered within a few days. Here, we report a case of GCA in a patient with a normal ESR whose left eye perceived just light at the initiation of treatment. Immediately prior to the combined treatment with high dose oral steroids and cyclophosphamide, the ESR level had increased to 80 mm/h and the vision improved after the combined treatment four months later.

An 11-year-old prepubertal girl with a history of metabolically poorly controlled type 1 diabetes for six years was diagnosed with diabetic nephropathy based on persistent overt proteinuria, hypertension, and renal biopsy findings typical of diabetic nephropathy. This case illustrates that diabetic nephropathy can develop even before puberty when metabolic control of the disease is not sufficient.

Aims: To determine whether digital rectal examination (DRE) would affect uroflowmetry parameters and whether these findings were not due to the circaidan changes., Methods: A total of 79 male patients (59 in study and 20 in control group) were included in this study. First uroflowmetry was done at 10:00 am just before the genitourinary physical examination in the study group. Second and third uroflowmetry was performed at the 6th and 24th hour after the first uroflowmetry. The same uroflowmetry tests were done in a control group without DRE. Voided volume and maximum and average flow rate parameters of uroflowmetry were interpreted in our study. The relationship among first, second, and third uroflowmetry parameters were determined in the study and control groups., Results: There were statistically no difference between the mean first, or 6th- or 24th-hour uroflowmetry parameters of the study and control groups (P > 0.05)., Conclusions: We could not find any effect of DRE on uroflowmetry parameters. Studies in a larger patient series would be appropriate for recommending DRE before or after uroflowmetry test., (Copyright 2003 Wiley-Liss, Inc.)

Nitric oxide (NO) is a free radical that is produced by a number of mammalian cell types from L-arginine and a critical mediator that acts in many tissues to regulate a diverse range of physiological processes. The major metabolic end product for NO is nitrate (NO(3)) and nitrite (NO(2)), which are stable metabolites within tissue, plasma, and urine. Measurements of nitrate and nitrite values reveal alterations in NO production. Endogenously generated or exogenously applied NO causes DNA cleavage by endonuclease activation. We investigated the effect of L-arginine and mitomycin C (MMC) on cultured lymphocytes of healthy individuals. We observed chromosome breaks, apoptotic cells and increased NO levels after L-arginine and MMC addition. In conclusion, our results confirmed that NO may be the cause of apoptotic cell death in L-arginine added lymphocyte culture.

Fractures are not rare in male osteoporosis and bone mineral density (BMD) measurement is used in the diagnosis and monitoring, preventing and/or treating the disease. Muscle strength and BMD are highly related to each other. The distal radius is one of the most common sites of osteoporotic fractures. The relationship of quantitative muscle strength and BMD of the forearm has not yet been established. The objective of this study was to assess forearm muscle strength and grip strength in relation to BMD in 46 osteoporotic and randomly selected 45 healthy male participants. Forearm muscle strength and BMD were quantitatively measured using an isokinetic dynamometer and dual-energy-X-ray-absorptiometry (DEXA), respectively. Significant correlation was found among the muscle strength and dominant forearm BMD in 60 and 120 deg/s velocities. In the non-dominant arm, the 120 deg/s velocity was only significantly positively correlated to forearm BMD. Pearson's Product coefficient presented a moderate correlation between muscle strength and BMD at the dominant arms of both groups, whereas, the difference in the non-dominant forearm came from the difference of usage frequency. In conclusion, quantitative forearm muscle strength and BMD is moderately correlated and exercise can be advised to prevent distal radius fractures in male osteoporosis.

Sensorineural hearing loss is an important complication of mumps. Audiologic tests of 26 children with mumps meningoencephalitis, 25 uncomplicated mumps cases and 20 control cases were performed, and hearing level thresholds at speech and high frequencies were determined. The mean hearing level thresholds in the mumps meningoencephalitis group were higher than those of mumps cases at frequencies from 6,000 to 18,000 Hz in the right ear and at 250 and from 4,000 to 18,000 Hz in the left ear (P < 0.05). Mumps meningoencephalitis cases had higher mean hearing thresholds than did control groups at all frequencies other than 125 and 250 Hz in the right ear and 10,000 Hz in the left ear. The mean hearing thresholds of mumps cases were higher than those of control group at frequencies of 1,000 and 4,000 Hz in the right ear and 1,000 and 10,000 Hz in the left ear (P < 0.05). These results show that mumps meningoencephalitis causes a higher risk of hearing loss than does mumps.

The objective of this study was to determine the role of cerebral nitric oxide and its powerful oxidant peroxynitrite following mild birth asphyxia. The cerebrospinal fluid levels of nitric oxide and 3-nitrotyrosine as a marker for peroxynitrite are measured in neonates with mild hypoxic-ischemic encephalopathy. Based on the classification of Sarnat and Sarnat, term neonates with mild hypoxic-ischemic encephalopathy and neurologically normal neonates suspected of sepsis were taken as the control group. Nitric oxide measurements were done by chemiluminescence, and nitrotyrosine measurements were made by high-performance liquid chromatography. The Mann Whitney U-test was used, and a Pvalue < .05 was considered significant. Eleven patients with grade 1 hypoxic-ischemic encephalopathy and nine controls were included. The gestational age and birthweights were similar in both groups. Neither of the cerebrospinal fluid levels of nitric oxide (8.60 +/- 0.49 micromol/L) and nitrotyrosine (0.45 +/- 0.33 micromol/L) of the neonates with hypoxic-ischemic encephalopathy showed significant differences from that of the means of nitric oxide (8.66 +/- 1.07 micromol/L) and nitrotyrosine levels (0.25 +/- 0.13 micromol/L) of the controls. These data suggest that the oxidative stress is not overexpressed to lead nitric oxide and peroxynitrite to play a pathologic role in the early phase of mild hypoxic-ischemic encephalopathy of the newborn.

Nasal natural killer T-cell lymphoma is a very aggressive and destructive disease with a poor prognosis. We hereby present two male patients in whom diagnostic problems and a mortal course were encountered. One patient (age 31 years) had progressive ulceration in the nasal area. Two biopsies that had been taken elsewhere were inconclusive. The other patient (age 40 years) was referred with a previous histopathologic diagnosis of squamous cell carcinoma. He complained of an unhealing wound in the hard palate. Biopsies were repeated in each case. Diagnosis was made by immunohistochemical examination. Both patients died shortly after the diagnosis. The importance of obtaining an adequate and deep biopsy sample and employing sophisticated immunohistochemical examination is emphasized for an accurate diagnosis.

The aim of this study was to determine the diagnostic accuracy of gadolinium-enhanced three-dimensional (3D) fast spoiled gradient-recalled (FSPGR) MR dacryocystography in patients with epiphora. Bilateral nasolacrimal systems of 19 patients suspected of having nasolacrimal canal obstruction were evaluated with MR dacryocystography. A sterile 0.9% NaCl solution containing 1:100 diluted gadolinium chelate was instilled into the bilateral conjunctival sacs of the patients. The 3D FSPGR sequence was used with 1.0-T scanner with the following parameters: TR 9.3 ms; TE 2 ms; flip angle 20; 256x224 matrix; 13- or 26-cm field of view; and 1-mm slice thickness. Seventeen patients had digital dacryocystography for comparison which we considered standard of reference. Thirty-four nasolacrimal systems were evaluated with MR and digital dacryocystography. Discrepancies between the findings of both methods were detected in 2 patients. The overall sensitivity of MR in detecting the obstruction was 100%. Magnetic resonance helped to determine the canalicular and ductal obstruction in 100% of the patients and the saccular obstruction in 80% of the patients. We conclude that 3D FSGR technique for MR dacryocystography is a reliable and noninvasive method in the evaluation of the obstruction level in the lacrimal system in patients with epiphora.

Many aspects of the biology and effective therapy of proliferative scars remain undefined, in part due to a lack of an accurate, practical, reproducible, and economical animal model for systematically studying hypertrophic scars. This study was designed to investigate whether hypertrophic scar formation could be induced in guinea pigs by removal of the panniculus carnosus alone, and by a combination of the removal of the panniculus carnosus with application of coal tar afterwards. Whole thickness skin excision or deep partial thickness injury was used to create the lesions on intact skin. Different anatomic locations were tested in different groups. Scars thus developed were examined morphologically by light microscopy and electron microscopy (TEM and SEM) and biochemically by measuring the activity of glucose-6-phosphate dehydrogenase (G6PD) to check whether these scars had morphological and biochemical properties specific to hypertrophic scars. The albino guinea pigs used in this study were divided into three groups. Removal of the panniculus carnosus was performed from the ventral aspect of the torso in animals in groups I and II. On the skin overlying the area of panniculectomy, circular skin excision was performed in group I, and deep partial thickness burn injury was inflicted in group II, to see whether wounds would heal with hypertrophic scars. In group III, dorsal aspect of the torso were used and wounds were produced by circular skin excisions followed by panniculectomy on both sides but coal tar was applied to only one side. Tissue samples were taken from the scars that were hypertrophic in appearance, and from normal scars and normal skin for comparison. Light and electron microscopic examinations and G6PD activity measurements were performed on these samples. While hypertrophic scar development was not seen in group I and group II, scars with morphological and biochemical properties specific to hypertrophic scars developed in one third of animals in group III after healing of the wounds treated with coal tar. In conclusion, it is shown that it is possible to develop experimental hypertrophic scars in guinea pigs with morphological and biochemical properties similar to those of human proliferative scars. Therefore this model is a new, practical, and economical experimental animal model to study proliferative scars, although improvements are needed to increase yield.

Absence or deficiency of tear volume (alacrima) is rarely seen in pediatric ophthalmology. It is often a part of the multiple systemic anomalies like Riley-Day syndrome and anhidrotic ectodermal dysplasia, or it may be associated with adrenal gland insufficiency, achalasia, and neurologic disorders like Allgrove's syndrome. We report on a 7-year-old girl presenting alacrima, achalasia, and mental retardation with normal adrenocortical function.

Background: Hepatitis A vaccine provides long term protection against hepatitis A infection in adults and children older than 2 years of age. Few data are available regarding children younger than 2 years of age., Methods: Children who were vaccinated in infancy with hepatitis A vaccine were revaccinated at 4 years of age, and antibody titers were followed. Forty-four subjects who had been vaccinated with hepatitis A vaccine [Havrix, 360 enzyme-linked immunosorbent assay units (EU)] at the age of 2, 4 and 6 months were revaccinated with 720 EU of inactivated hepatitis A vaccine (Havrix) at 4 years of age., Results: Geometric mean titer (GMT) of 44 evaluable cases was 41 mIU/ml and 34 children (77.3%) were seropositive before the booster dose. Postvaccination blood samples were obtained from 37 cases. One month after booster dose GMT increased to 2884 mIU/ml, and all subjects were seropositive. Ten seronegative cases also seroconverted. The GMT of the seropositive cases showed anamnestic response after the booster dose (57 mIU/ml before booster dose, 5623 mIU/ml after the booster). No serious adverse event was seen after the booster dose., Conclusion: We conclude that childhood hepatitis A virus revaccination after infant immunization is highly immunogenic and safe.

The purpose of this study was to describe the common stress factors and coping strategies of parents whose children had been treated by hemodialysis. This study was conducted by using focus group interviews. The sample was composed of 31 parents. Five focus groups were made up from these parents. Data were analyzed by using the manifest content analysis method. According to the results, common stress factors of parents included financial and bureaucratic problems, growth and development of ill children, fluid-diet restriction and educational problems of children, lack of social support, and anxiety about losing their children at any moment. Coping strategies of parents were to give their attention to the positive side of matters, to share their feelings with their spouse or other parents, to cry, or pray., (Copyright 2002, Elsevier Science (USA). All rights reserved.)

This study was conducted to determine the hepatitis A virus (HAV) seroprevalence in nine provinces representative of Turkey as a whole. These provinces are representative of the country's geographical location, and demographic, economic and social characteristics. In each province, sample sizes were determined using published data on HAV seroprevalence, and sample sizes for each province and for the cluster were calculated for each group of subjects under the age of 30 for seroprevalence estimates within a 95% confidence interval. The samples were selected by a cluster method, and the planned recruitment was a total of 4,800 subjects, including 600 subjects each from five large provinces (Istanbul, Ankara, Izmir, Adana, Diyarbakir) and 450 subjects from each of the remaining four provinces (Samsun, Erzurum, Trabzon, Edirne). These numbers were distributed in accordance with the percentages for age groups in five-year increments starting from age five for the population under the age of 30 living in the rural and urban areas in each province. This study of 4,462 subjects under the age of 30 in nine provinces of Turkey identified an overall HAV seroprevalence rate of 71.3%. The distribution of HAV seroprevalences by age showed a steady increase from one year of age from 42.7% to 91.1% at 25-29 years of age. HAV seroprevalence was slightly higher in female subjects (73%) than in male subjects (69.3%). By educational status, seroprevalences were comparable except in young children under age six. Seroprevalence was notably higher in large families with six and more members (80.1%) than in small families with five or fewer members (66.7%). According to our study results, 50% of Turkish children are seropositive for HAV by the age of 10 years. We believe the date support the need for a routine primary immunization policy in Turkey and the development of effective prophylactic programs after possible exposure. Consequently, an immunization policy can be developed for each region according to its epidemiological conditions.

Twenty-nail dystrophy (TND) is an autosomal dominantly inherited idiopathic nail dystrophy characterized by excessive longitudinal striations and numerous superficial pits on nails with a typical 'sand papered' rough appearance. It is evident at birth and progresses slowly. It can also be associated with various diseases including lichen planus, alopecia areata, eczema, vitiligo and psoriasis. Peripheral blood chromosome analysis has not been performed in previously reported cases of TND. We report a mother and her 7-year-old daughter with TND. Both of them had a balanced translocation 46, XX, t(6q13;10p13). This may be a coincidental finding or may be related to the gene locus of TND.

Endoscopic dacryocystorhinostomy (EN-DCR) is a procedure that presents itself as an alternative choice to the conventional external approach. This study describes the results of endoscopic endonasal non-laser lacrimal surgery. We reported the data of 64 procedures of 63 patients with epiphora or chronic dacryocystitis who underwent primary EN-DCR by means of a microdrill or revision EN-DCR. One of these cases had bilateral surgery. There were 42 women and 21 men. Thirty-four cases had primary EN-DCR and 30 cases had revision EN-DCR secondary to previously failed external DCR. Mean follow up time was 11.34 months. The procedure was successful in 79.4% of primary EN-DCR cases and in 80% of revision EN-DCR cases. The overall success rate was 79.6%. Postoperative complications included periorbital edema, eyelid ecchymosis, punctal granuloma, cyst of the punctum, adhesion between the superior and inferior punctum. Tube dislocation occurred in 3 patients. Premature loss of silicone tube was determined in 5 patients and granulation tissue occurred at the internal osteum in 11 cases. EN-DCR, when compared with external dacryocystorhinostomy (EX-DCR), has lower success rate, but provides the potential advantages of better intraoperative hemostasis, and lack of cutaneous scar.

Objectives: We compared the findings of magnetic resonance imaging (MRI) with histopathologic results in laryngeal cancer., Patients and Methods: Twenty-five patients (24 males, 1 female; mean age 58 years; range 24 to 80 years) were evaluated preoperatively by MRI with regard to involvement of the thyroid cartilage, anterior commissure, vocal cords, sinus pyriformis, subglottic region, and prelaryngeal soft tissues. The findings were compared with those of histopathologic examination., Results: The highest accuracy was found in the detection of invasion to the prelaryngeal soft tissue (92%). The accuracy of MRI was 84% for the anterior commissure, 80% for vocal cords, 76% for the thyroid cartilage, and 72% for sinus pyriformis and the subglottic region., Conclusion: Magnetic resonance imaging proved to be useful in the preoperative evaluation of laryngeal cancers.

Background: CD44 variant exon 6 (v6) belongs to a family of transmembrane glycoproteins involved in cell adhesion., Objectives: To determine the prognostic role of CD44v6 in laryngeal cancer and to examine its relation with other clinicopathologic prognostic factors., Design: A retrospective cohort study was designed with 93 laryngeal cancer cases. They were selected randomly from patients treated with laryngectomy between January 1, 1983, and December 31, 1993., Setting: Faculty of Medicine, Hacettepe University, Ankara, Turkey., Patients: The ages of the patients ranged from 31 to 73 years. Eighty-eight patients were men and 5 were women. Three had stage I, 33 had stage II, 27 had stage III, and 30 had stage IV disease at the time of surgery., Intervention: Histological sections of tumors and metastatic lymph nodes were reevaluated for several histopathological factors. Sections were stained using anti-CD44v6 monoclonal antibody by immunohistochemical methods., Results: CD44v6 expression was seen only in the lower one third of the normal squamous epithelium but in all layers of dysplasia and in situ carcinoma. Besides a general evaluation of tumor staining, immunostaining was evaluated separately for cell groups located in the center of neoplastic islands (nonbasal cells), at the periphery of the neoplastic islands (basal cells), and at the infiltration zones (marginal cells). Decreased disease-free survival was noted when there was extensive staining in the general evaluation and in cases with extensive staining in marginal and nonbasal cells (P =.03). Using Cox regression analysis, the greatest dimension of the largest metastatic lymph node and extensive expression of CD44v6 in nonbasal tumor cells were independent prognostic factors., Conclusion: Our results suggest that CD44v6 expression is an important prognostic factor in laryngeal cancer.

Unlabelled: Inflammatory bowel disease is becoming increasingly frequent in children of all ages. In addition to the usual gastrointestinal stigmata of weight loss, anaemia, and rectal bleeding, children may exhibit prominent extra-intestinal manifestations such as joint symptoms, skin signs and some other auto-immune manifestations. Here we present a 15-year-old girl with ulcerative colitis in whom pyoderma gangrenosum and acute sensorineural hearing loss developed., Conclusion: Although pyoderma gangrenosum is well described with inflammatory bowel disease, sensorineural hearing loss a is very unusual finding, possibly of auto-immune aetiology. We recommend steroid or immunosuppressive therapy in such a patient.

Nitrogen monoxide (NO) is a potent endogenous vasodilator and is involved in cytotoxicity, neurotransmission, and immunological defense mechanisms. Phototherapy has long been known to change the distribution of blood flow throughout the body in newborn infants. The objective of this study was to investigate the effect of phototherapy on NO production in otherwise healthy newborns. Urinary NO levels were measured before and 6 h after phototherapy by a chemiluminescence method using Sievers NOA. Ten newborns (gestational age, 36.4 +/- 3.9 weeks; birth weight, 2863 +/- 677.44 g; postnatal age, 5.1 +/- 2.72 days) were started on phototherapy according to AAP guidelines and urine for NO measurement was collected prior to therapy and 6 h after the commencement of treatment. Urinary NO levels measured during phototherapy were significantly higher (108.8+/-50.69 micromol/mmol creatinine) than the levels measured before phototherapy (73.13+/-34.15 micromol/mmol creatinine; P < 0.05). These results suggest that newborns receiving phototherapy might have increased NO production, which might result in hemodynamic changes. However, further studies on the effects of phototherapy on NO and photorelaxation are needed before reaching firm conclusions.

Brucellosis may lead to complications that affect different organ systems, including the liver and spleen. In acute disease, hepatosplenic abscess is a rare complication. We report herein a woman with splenic abscess due to acute Brucella melitensis infection who was successfully treated with antibiotics alone.

Background: Permethrin 5% cream used against human ectoparasites suggests that it may be effective in papulopustular rosacea., Methods: This study included 63 patients diagnosed as having papulopustular rosacea based on the clinical and histological findings. Patients were randomly assigned into permethrin (n = 23), metronidazole (n = 20) and placebo (n = 20) groups. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and Demodex folliculorum were determined. Twenty-three patients were given permethrin 5% cream (Zalvor 5% skin cream, 20 patients metronidazole 0.75% gel (Roza gel and 20 patients placebo cream (Basis cream, in packages looking identical to those of metronidazole and permethrin creams, and were recommended to apply them to their faces twice a day. All patients were also given SPF 20 cream for protection against sunlight. Two months of treatment were planned, and the patients were invited to the clinic for fortnightly controls. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and D. folliculorum were recorded at each visit. The mean scores of erythema and the mean numbers of papules, pustules and D. folliculorum were determined at baseline and on days 15, 30, 45 and 60. Side effects were also detected., Results: The effect of permethrin 5% cream on D. folliculorum was superior to that of metronidazole 0.75% gel. The effect of permethrin 5% cream on erythema and papules was found to be more effective than placebo and as effective as metronidazole 0.75% gel. However, it had no effect on telangiectasia, rhinophyma and pustules., Conclusion: It can be concluded that the application of permethrin 5% cream twice daily for 2 months can be as effective and reliable as metronidazole in the treatment of rosacea and a greater benefit can be gained when it is combined with other systemic and/or topical treatments., (Copyright 2002 S. Karger AG, Basel)

Although osteomusculocutaneous flaps are used frequently in clinical practice to repair defects involving soft tissue and bone, there are still many questions that remain to be answered regarding their basic physiology. To accomplish such basic science studies, simple and reliable animal osteomusculocutaneous flap models are needed. The purpose of this study was to describe a new flap model in rats--namely, the iliac osteomusculocutaneous flap. Thirty adult Wistar rats weighing 200 to 250 g were used in this experiment. In 15 rats, the vascular anatomy of the iliolumbar vessels and their relation with adjacent soft tissues and the iliac bone was determined by anatomic dissection. Based on this anatomic study, the iliac osteomusculocutaneous flap model was created in rats. The flap is comprised of a skin island (3 x 3 cm) in the flank region, a 1 x 1-cm segment of iliac bone, and an abdominal wall muscle cuff. In 10 rats, the flap was raised as an island flap based on its vascular pedicle of iliolumbar vessels, and was replaced in situ. In the remaining 5 rats, the flap was transferred to the groin region as a free flap. Direct observation on postoperative day 7 revealed that the skin island of all the flaps was completely viable. Bone scintigraphy performed on postoperative day 3 in free flaps demonstrated radionuclide uptake, indicating viability of the bony segment. The dye injection study revealed ink staining within blood vessels of the bone, confirming its viability. Microangiography of the flap demonstrated vascularity of each component of the flap by the iliolumbar vessels, including a distinct branch to the iliac bone. The authors conclude that the iliac osteomusculocutaneous flap of the rat is a simple and reliable flap model that offers the following advantages: (1) It is a true osteomusculocutaneous flap, (2) it can be used as a free flap without the need for an isogeneic rat, (3) the vascular pedicle is consistent, and (4) it is harvested from a small-animal species.