How the Aperture of Femoral Tunnel Affected in ACL Reconstruction Performed with AM Portal Technique?

PURPOSE OF THE STUDY The purpose of this study was to evaluate the position of tibial tunnel (TT) and femoral tunnels (FT) performed by using the anteromedial (AM) portal technique and its effect on the aperture of FT. MATERIAL AND METHODS A total 44 patients operated for anterior cruciate ligament (ACL) rupture by AM portal technique between January 2013 and July 2015, were included in this study. They were subjected to a magnetic resonance imaging of the knee to assess the FT, dimensions of the FT aperture and TT. The location of the ACL graft within the joint was compared with the intact ACL of healthy individuals. The patients were also evaluated using Lysholm and IKDC subjective scores for functional outcome. RESULTS The mean FT angle on both the coronal plane (42.88°±5.83°) and the sagittal plane (68.47°±9.57°) was significantly different from the intra-articular part of the hamstring autograft angles (74.93°±7.27° and 58.74°±4.88°, respectively) (p<0.0001). The mean distance of the FT aperture was 13.18 (±2.49) mm on vertical axis, 10.97 (±1.50) mm on the sagittal axis (p<0.0001). The difference between TT axis and the axis of the intra-articular part of autograft on both coronal (72.78°±4.67° and 74.93°±7.27°, respectively) and sagittal planes (60.12°±5.53° and 58.74°±4.88°, respectively) were not significant (p>0.05). DISCUSSION Ilingrowth et al. claimed that the FT were scattered in the very large distance and some of them were placed outside of anatomical range in the series included the cases performed with transtibial and transtibial independent techniques. In this series, in which we used a femoral guide to drill the FT at lateral femoral condyle at 2 or 10 o'clock position depended upon the site of operation, we obtained a consistent FT which is comparable with the intra-articular part of native ACL. Amano et al. found that the FT aperture enlargement was significant in the series when hamstring tendons were used as autograft, over a 6-month period. We also found a significant difference between the narrowest part of the FT (7.01 ± 1.05 mm) and its aperture (10.97 ± 1.50 mm in sagittal, 13.18 ± 2.49 mm in vertical direction). The enlargement was mainly in the vertical direction, due to the fact that the loads resulting from daily life are mostly on the horizontal plane. CONCLUSIONS The direction of intra-articular part of the ACL graft in the cases operated with the AM portal technique is significantly different from the FT direction in both the coronal and sagittal planes. The enlargement of the FT aperture is larger in the vertical axis compared to the sagittal axis. Although the long-term clinical consequences of asymmetrical enlargement of the FT aperture are not known yet, to avoid this potential risk, a technique to approximate the direction of FT to the intra-articular part of the ACL without changing the FT entry site, can be used. Key words: knee, anterior cruciate ligament reconstruction, femoral tunnel, tibial tunnel, anteromedial portal.

Knowledge levels and attitudes of adult individuals about cancer and its risk factors

Background

Cancer maintains its importance as a major public health issue in the world and developing countries such as Turkey. Determining individuals' knowledge and attitudes about cancer is very important for cancer prevention. Research on knowledge and attitudes plays an important role in the development of targeted policies in the fight against cancer.

Aims

The aim of this study was to determine the knowledge and attitudes of adult individuals about cancer and its risk factors.

Methods

The study was conducted descriptively in the city center of Trabzon. The study population and sample consisted of 105.071 and 1200 adults aged 40 and over living in the city center, respectively. For the sample selection, multistage randomized sampling method was used. The data were collected using a questionnaire, which was developed by the researchers after reviewing the literature and receiving expert opinions. The findings were presented as descriptive statistics with numbers, percentages, and averages.

Results

It was found that 45.7% of the participants smoked, 9.1% consumed alcohol, 40.8% consumed acidic foods, 33.0% had family history of cancer in first degree relatives, and 28.5% had cancer-related death in first degree relatives. The participants stated that cancer was the most fatal disease and listed the first three cancer-causing factors as cigarettes (95.7%), mobile phones (90.4%) and alcohol (90.2%). 62.4% of them did not know the symptoms of cancer, and 86.4% and 76.4% believed that 'sadness and stress cause cancer' and 'cancer is inherited', respectively.

Conclusion

The study revealed that adult individuals had a significant level of false and incomplete information about cancer, and their behaviors having risk factors for cancer could not be altered and transformed into appropriate ones. Therefore, it is thought that informative studies on cancer should be carried out continuously to carry out the fight against cancer successfully.

Which men have better attitudes and participation to family planning services? A study in primary care settings from Northern Turkey

Background

Turkey is the third most populous country of the European region located at the crossroads of Asia, Europe, and the Middle East. In Turkey, approximately 2 million pregnancies occur every year. Half of the pregnancies are involuntary, and five out of every 100 pregnancies end with wanted abortion. There are limitations in access to modern methods in the north of Turkey. This study was aimed to determine the factors associated with better attitudes and participation to family planning (FP) services in primary care settings from Northern Turkey.

Materials and Methods

This cross-sectional study, based on primary care settings, was conducted in the Middle Black Sea Region of Turkey with 400 married men. Male attitudes and participation were measured by a questionnaire form. Chi-square testing and logistic regression analyses were applied.

Results

We found that male participation was present in 302 participants (75.5%), and 363 participants (90.8%) approved the use of FP. Male participation was significantly different by age, occupation, education, marriage age, spouses' education and occupation, and attitudes towards FP. Based on multivariate analysis, male participation was significantly associated with spouses' level of education, employment status, currently using FP, and the perception of spousal communication.

Conclusion

Better participation existed among participants with higher educated spouses, employed spouses, current users of FP, and the better self-perception of communication.

Calculation of Intraocular Lens Power with the Srk Ii Formula for Axial High Myopia

AIM

The SRK II formula has been widely used for intraocular lens (IOL) power calculations. The predictability of this formula is evaluated in axial myopic patients.

METHODS

Planned extracapsular cataract extraction and posterior chamber IOL implantation (PECCE + IOL) were performed on 98 eyes of 98 patients with axial length > 24.5 mm. Cases had no preoperative complications and postoperative visual acuity was at least 0.5 (Snellen). Corneal refractive power and axial length were measured preoperatively and emmetropic IOL power calculations were made using the SRK II formula. Long-term (mean 4.7 months) visual acuities and refractions were noted postoperatively.

RESULTS

The absolute refractive error was < 1.00 Diopters (D) in 57 eyes (58.2%) and < 2.00 D in 83 eyes (84.7%). The mean absolute error of the SRK II formula in axial myopia was 1.16 D +/- 0.78 SD.

CONCLUSIONS

The SRK II formula is not very accurate in axial myopic patients.

Health literacy among schoolteachers in Çorum, Turkey

Teachers' health literacy is an important part of school health promotion programmes. This study in 2013 assessed health literacy and related factors in schoolteachers in Çorum, Turkey. In a cross-sectional study, 500 primary and secondary teachers answered a questionnaire about self-reported health behaviours and completed the 6-item Newest Vital Sign tool. The mean score on the health literacy scale was 2.12 (SD 1.82). Overall, 44.0% of the teachers had very limited, 29.8% limited and 26.2% adequate health literacy. Adequate health literacy levels were significantly higher among those without chronic disease, non-smokers, non-alcohol users and those interested in healthy lifestyle topics in the media. In binary logistic regression analysis, the risk of limited health literacy was significantly greater in the older age groups, in men and in those whose partner was an educator or a housewife. In view of the low health literacy levels, we suggest that teacher candidates could benefit from health education programmes after graduation.

Flow cytometric detection of anti-AB antibody titers in blood group O recipients of blood group A2 donor kidneys

AIM

ABO-incompatible kidney transplantation has been accepted for end-stage renal failure patients who have no ready opportunity for a deceased or living donor. Antibody titration for ABO-incompatible renal transplantation is not only difficult but also lacks conformity among laboratories. Herein we analyzed 20 living related renal transplant couples to detect recipient anti-A2 antibody using flow cytometric analysis.

MATERIALS AND METHODS

Patients were admitted to our center for renal transplantation between January 1999 and December 2010. All but four of them had undergone a previous renal transplantation from an ABO-compatible donor but experienced graft failure. All donor blood groups were subtyped by our blood bank using a lectin-based dilution assay. To detect recipient anti-A2 antibody titers we used a tube hemagglutination method. A/B antibody titer analysis by flow cytometry incubated serially diluted serum samples with donor erythrocytes. Each analysis was repeated three times over a 2-week period using an older and the last sera simultaneously.

RESULTS

The 13 male and 7 female patients showed our overall mean age of 32 ± 12 years. All patients had panel-reactive antibody levels below 15%. The level of flow cytometric antibody titers did not vary upon repeated analysis (P = .01). When compared with the tube method there was a discrepancy of the level at which the antibody titer became negative.

DISCUSSION

Flow cytometric antibody titration is a practical and rapid technique to determine the amount of anti-A2 antibody in renal recipients.

Hospital admissions for anaphylaxis in Istanbul, Turkey

BACKGROUND

There are very limited data characterizing the epidemiology of anaphylaxis from low- and middle-income country settings. We aimed to estimate the frequency of anaphylaxis admissions to hospitals in Istanbul.

METHODS

We obtained data from all 45 hospitals in Istanbul over a 12-month period and used ICD-10 codes to extract data on those admitted with a recorded primary diagnosis of anaphylaxis. Because of concerns about possible under-coding, we undertook an additional analysis to identify patients admitted with two or more clinical codes for symptoms and/or signs suggestive of, but not coded as having, anaphylaxis.

RESULTS

A total of 114 cases (79 people with anaphylaxis codes and 35 with symptoms and signs suggestive of anaphylaxis) were identified, giving an overall estimate of 1.95 cases per 100 000 person-years.

CONCLUSION

The novel two-stage identification approach employed suggests significant under-recording of anaphylaxis in those admitted to hospitals in Istanbul.

Prevalence of asthma and other allergic diseases in children born after in vitro fertilisation

BACKGROUND

Children born after in vitro fertilisation (IVF) are under greater risk of development of some health problems than those children born after spontaneous conception. Yet it is not exactly known what the prevalence of asthma and other allergic diseases among these children is.

AIMS OF THE STUDY

To investigate the prevalence of asthma, allergic rhinitis and atopic dermatitis in children born after IVF, and controls born after spontaneous pregnancy using questionnaires of International Study of Asthma and Allergies in Children (ISAAC).

METHODS

We recruited 158 children (mean age: 4.60 +/- 2.14 years) born after IVF pregnancies and 102 children (mean age: 5.27 +/- 2.8 years) as control group to investigate the prevalences of asthma, atopic dermatitis and allergic rhinitis. The questions in the questionnaire were asked to the parents by telephone or face to face.

RESULTS

Wheezing ever has been reported in 19 % of the children born after IVF and in 17.6 % of the control group (p > 0.05). No significant differences were found between groups, in terms of use of any anti-asthma drugs, physician diagnosed asthma and admission to emergency room with wheezing (p > 0.05). In addition, prevalence of allergic rhinitis and atopic dermatitis were also comparable between two groups (p > 0.05).

CONCLUSIONS

Prevalences of asthma, allergic rhinitis and atopic dermatitis are similar in children born after IVF and children born after spontaneous conception.

Modern and traditional practices of Turkish infertile couples

OBJECTIVE

This investigation was carried out to determine modern and traditional practices of infertile couples in Kayseri, Turkey.

METHODS

Two hundred and fifty-two infertile couples were selected from the study area. Modern and traditional practices of the infertile women and their husbands were investigated through a questionnaire. The effects of some factors on the utilization of traditional methods were analysed through the logistic regression method.

RESULTS

It was found out that 92.5% of the infertile women and 71.8% of their husbands had consulted a physician for infertility and 92.1% of the women and 32.6% of their husbands had applied for medical or surgical intervention. However, only 11.1% of the couples had attempted in vitro fertilization. In contrast, 61.5% of the infertile couples admitted to carrying out traditional practices. All traditional practices were more prevalent among the women than the men.

CONCLUSION

It was concluded that traditional practices were more prevalent in the rural areas and among the older couples.

Frequency of allergic diseases following measles

OBJECTIVE

Viral and bacterial infections in childhood decrease the likelihood of allergic diseases in later life. The frequency of allergic diseases in patients with a history of measles has been reported to be low but some studies still suggest that measles can increase the frequency of allergic diseases. The aim of this study was to investigate the frequency of allergic diseases following measles in childhood.

METHODS

Fifty-two children hospitalized in our clinic with measles were compared with 51 children without measles. Allergic diseases were investigated in both groups by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. In all children, allergy skin tests were performed with the four most common allergens.

RESULTS

Sensitivity to Dermatophagoides pteronyssinus was less frequent in children with measles than in those without (p < 0.05). A history of nebulized salbutamol use in the emergency room in the previous 12 months was also less frequent in the measles group (p < 0.05). Inhaled corticosteroid use was more common in the group without measles (p < 0.05).

CONCLUSION

The results of this study indicate that findings of allergic disease are less frequent in children with a history of measles. These children were less sensitive to D. pteronyssinus.

Epidemiological and clinical characteristics of migraine and tension type headache in 1146 females in Kayseri, Turkey

In a female population of Turkey (1146 adult females), some epidemiological and clinical characteristics of migraine and tension type headache and their subtypes were investigated. The relation of the headache severity to clinical characteristics were inquired. Migraine prevalence was found to be statistically higher in the 35-44 years age group (P < 0.01) and those who were university graduates (P < 0.001), married (P < 0.01) and living in urban areas (P < 0.01). Tension type headache was found to be higher in the 45-64 years age group (P < 0.05). Chronic tension type headache patients were found to be older than episodic type (P < 0.01) and frequently were in the lowest education level (P < 0.05). Presence of impact on daily activities because of the severity of headache was found to be related to aggravation by physical activities (P = 0.001) in tension type headache, with no clinical characteristics in migraine headache and on consideration of all headache patients with throbbing nature (P < 0.05), aggravation on physical activities (P = 0.001), nausea (P < 0.01), vomiting (P < 0.05) and phonophobia (P < 0.05).

Married men's opinions and involvement regarding family planning in rural areas

As men play a prominent role in reproduction, it is therefore extremely useful to assess and encourage them to be involved in contraception, particularly in developing countries, where contraceptive goals have not been reached. This study was carried out in Kayseri, Turkey, in order to determine the attitudes and behavior of married men concerning family planning. A questionnaire was presented to 123 married men. In our study, 91.9% of men approved of family planning, but only 54.4% actually used any contraceptive methods; 66.7% of the men said that the decision should be a joint one, 66.4% wanted to limit their family size. Approximately one fourth of the men had never heard of voluntary sterilization. No one in the study group was aware of the mini-pill, diaphragm or Norplant. In the study group, 26.8% of the men did not want their wives to use intrauterine devices and 31.7% of them did not agree with women using the contraceptive pills. Among those unwilling to use a condom (46.3%), 70.1% stated that it might interrupt intercourse. If a contraceptive pill for males could be used, 25.2% of members of the group would be prepared to use it. Only 17.5% men in the study group had contacted a doctor or a health foundation to obtain information. The main sources of family planning information were TV/radio, followed by friends and newspapers/magazines. In order to encourage men's involvement in family planning, the use of mass media and continual training programs, to try to reach both men and women, could be very useful.

Sensitivity to local anaesthetics among asthmatic children

OBJECTIVES

Although true allergic reactions to local anaesthetics are rare in the general population, the importance of the problem among asthmatic children has yet to be documented.

SAMPLE AND METHODS

Skin prick, intradermal and incremental challenge tests with lidocain were performed in 157 asthmatic children aged 8-15 years and compared with 72 nonasthmatic children of a similar age. All of the asthmatic subjects were allergic to at least one allergen, most frequently pollens and house dust mites. Prick testing began with an undiluted solution in patients without a history of allergy and with 1:100 dilution in those with a reaction history. Following negative prick testing, intradermal or incremental challenge tests were performed.

RESULTS

A total of 125 patients (80%) had been given local anaesthetics in the past, only three children gave history of an adverse local reaction. At the end of the tests, none of the subjects including controls, were found to have immediate or delayed-type allergy to lidocain.

CONCLUSIONS

Local anaesthetic allergy does not seem to be a serious problem among asthmatic children and testing in all asthmatic children is not warranted. Those with an adverse reaction history to local anaesthetics should be tested with these drugs.

The relation between recurrent acute subglottic laryngitis and asthma in children

OBJECTIVE

Acute subglottic laryngitis is caused by some viruses and may recur several times in children. Risk factors underlying the recurrences of this disease are obscure. The present study was undertaken to investigate the relation between acute subglottic laryngitis, asthma and allergy.

METHODS

Twenty five children with recurrent acute subglottic laryngitis were evaluated for risk factors for recurrent respiratory tract infections and allergy. Eight of the children had high IgE levels and six of them were found to be allergic by skin prick tests.

RESULTS

During a 1 year follow-up period four children showed asthma symptoms and in three of these patients recurrences of croup attacks disappeared after asthma treatment with nebulized budesonide.

CONCLUSION

We concluded that recurrent acute subglottic laryngitis may be an early sign of subsequent asthma development.

Prevalence of chronic bronchitis and associated risk factors in a rural area of Kayseri, Central Anatolia, Turkey

This population-based cross-sectional survey was carried out to determine the prevalence of chronic bronchitis and associated risk factors in a rural area of Kayseri, Central Anatolia, Turkey. Subjects (1,023) aged 20-83 yrs (81.8% of eligible subjects) were interviewed using a modified version of the adult questionnaire compiled by the European Community Respiratory Health Survey. Subjects with "presence of cough and phlegm on most days during at least three months per year for at least the two previous years" were classified as having chronic bronchitis. According to the criteria used, 138 (13.5%) were classified as having chronic bronchitis. The prevalence was higher in males (17.8%) than females (10.0%). There was no overall significant association between chronic bronchitis and age in males, but, in females, the difference between age groups was important. There was no association between chronic bronchitis and family income, although the prevalence was highest in the low-income group. Subjects who reported childhood respiratory illnesses had a 1.7-fold increased risk of chronic bronchitis compared to those without such a history. The prevalence was much higher among people exposed to biomass fuel combustion and among smokers and exsmokers than among nonsmokers. In multivariate analyses, a significant increase in the prevalence of chronic bronchitis was seen in males, those who had received poor schooling, those reporting childhood respiratory illnesses, and those exposed to biomass fuel combustion and according to smoking habit.

The prevalence and identification of risk factors for type 2 diabetes mellitus and impaired glucose tolerance in Kayseri, central Anatolia, Turkey

Type 2 diabetes mellitus is a chronic disease which causes neurologic, cardiac, vascular, ocular and renal complications. The present study documented the prevalence of diabetes and associated risk factors in 1774 adults who were older than 30 years. An oral glucose tolerance test (OGTT) was conducted according to the World Health Organization (WHO) criteria. Of the 1452 subjects, 58 (4%) had diagnosed diabetes, 41 (2.9%) undiagnosed diabetes and 130 (9%) had impaired glucose tolerance. The total glucose intolerance was 15. 9%. The prevalences of type 2 diabetes mellitus (9.7%-4.1%) were significantly different in low occupational and high occupational activity groups, respectively (P<0.0001). The prevalence of type 2 diabetes mellitus was 17.9% among the hypertensive group (P<0.0001). The prevalence of type 2 diabetes mellitus was higher in smokers (P<0.05). Patients with diagnosed diabetes, undiagnosed diabetes and IGT were older, more obese and have higher blood glucose values, triglyceride values, systolic and diastolic blood pressures than healthy subjects (P<0.001). We conclude that type 2 diabetes mellitus and IGT prevalences are quite high in the urban area of Kayseri, central Anatolia and multivariate analysis indicated that low occupational activity, low leisure activity, family history for diabetes, hypertension and obesity were significant independent risk factors for diabetes mellitus.

The inflammatory response to open tension-free inguinal hernioplasty versus conventional repairs

BACKGROUND

The tension-free inguinal hernioplasty is now a popular method because of less postoperative disability and low recurrence rate. The laboratory evaluation of the inflammatory response to the injury is an objective approach to determine the stress status of a surgical procedure. The aim of this study is to evaluate and to compare inflammatory responses to open tension-free and conventional repairs of inguinal hernias.

METHODS

Forty-eight male patients with primary indirect inguinal hernias were treated with elective operations, and separated into three groups according to surgical procedure: 12 pediatric patients treated with dissection of hernia sac in group 1, 16 adult patients with open tension-free hernioplasty in group 2, and 20 adult patients with conventional repairs in group 3. Ten healthy adult volunteers formed group 4 as control. The repair was performed with polypropylene mesh and suture as the Lichtenstein technique in group 2, and with polypropylene suture as one of Bassini, McVay, or Shouldice techniques in group 3. The inflammatory response was evaluated with serum interleukin-6 (IL-6) levels at 12 hours and serum C-reactive protein (CRP) levels at 48 hours postoperatively. Serum levels of IL-6 and CRP were measured in group 4 as control. Patient characteristics, operating time, and IL-6 and CRP levels were compared among the four groups.

RESULTS

There were no significant differences in mean age and operating time between the two groups of adult patients with hernia repair. Mean serum IL-6 levels of 12.1 +/- 5.2 and 8.2 +/- 2.7 pg/mL, and CRP levels of 34.3 +/- 13.8 and 7.5 +/- 4 mg/L in pediatric and control groups, respectively, were significantly lower than in the other two hernia groups. Mean serum IL-6 levels were 58.9 +/- 25.4 pg/mL in group 2 (tension-free repair) and 44.3 +/- 18.1 pg/mL in group 3 (conventional repair) (P > 0.05). Mean serum CRP levels were 111.3 +/- 41.3 and 83 +/- 43.2 mg/L in groups 2 and 3, respectively (P > 0.05). The differences not being statistically significant, a similar and considerable inflammatory response was noted in patients with either prosthetic mesh repair or with conventional repairs of indirect inguinal hernias.

CONCLUSIONS

The reinforcement of the posterior wall of the inguinal canal induces significant cytokine response regardless of tension-free or conventional repair. Open tension-free hernioplasty offered no advantages over conventional repairs from the standpoint of the inflammatory and acute phase response.

Prevalence of asthma symptoms in school children in Ankara, Turkey

The aim of this study was to determine the prevalence of symptoms suggestive of asthma in children aged 7-14 years in Ankara, Turkey. For this purpose, the recently developed ISAAC (International Study for Asthma and Allergies in Childhood) questionnaire supplemented with six additional questions was issued to parents of 3154 primary school children from 12 schools. A separate page with questions regarding risk factors was also added to the questionnaire. The response rate was 88.3%. The cumulative and 12-month prevalence of wheezing were 14.4 and 4.7% respectively. The prevalence of physician-diagnosed asthma was 8.1%. A family history of atopy was found to be the strongest risk factor for having ever had wheezing (odds ratio (OR) = 2.89, 95% confidence interval (CI) = 2.32-3.60), wheezing in the past 12 months (OR = 3.21, CI = 2.21-4.67), and severe attack (OR = 2.41, CI = 1.36-4.25). Passive smoking was a risk only for having ever had wheezing (OR = 1.33, CI = 1.03-1.76). Increasing age was associated with a lower risk of current wheezing (OR = 0.85, CI = 0.81-0.90) and severe attack (OR = 0.77, CI = 0.67-0.88). Gender, socio-economic level and pet ownership did not appear to be risk factors for asthma-related symptoms. This study, the first epidemiological survey in Ankara, Turkey, using the ISAAC protocol, clearly shows that symptoms suggestive of asthma, albeit lower than in most European countries, are quite common and constitute a major health problem in Turkey.

Latex sensitivity among hospital employees and atopic children

Allergic reactions to latex products are an important health problem for health care workers and children. To investigate the prevalence of latex and latex-associated food sensitivities among hospital employees and atopic children, 61 hospital employees (44 nurses, 13 cleaning staff, 4 technicians) and 40 atopic children were evaluated by in vivo and in vitro testing methods. All subjects were also skin prick tested with common inhalant allergens and some cross-reactive food allergens to latex. In addition, all subjects were evaluated using an enzyme-linked immunometric assay for detection of specific IgE to inhalant allergens and to the known food latex cross-reactant food allergens (banana, chestnut, peanut and kiwi fruit). Latex challenges were performed in 12 history-negative and anti-latex IgE positive atopic children. Seven of the 61 hospital staff (11.4%) and four of the 40 atopic children (10%) showed skin reactivity to latex. By serologic testing, hypersensitivity to latex was found in 30 subjects, to banana in 23, to chestnut in 37, to peanut in 32 and to kiwi fruit in 22 subjects. Latex challenges were negative in all of the children who were tested. Total IgE was higher than expected in 32 subjects and 50 individuals tested positive for specific IgE to common inhalant allergens (AlaTOP). These results indicate that latex allergy may be a health problem for our hospital staff and atopic children. In vitro testing may detect latex-specific IgE in atopic children even when no history of an adverse reaction to latex is present.

Comparison of four different measures of bronchial responsiveness in asthmatic children

Although several tests are available to assess the presence and severity of bronchial hyperresponsiveness (BHR), there is no agreement on the most appropriate stimulus. The most commonly used stimuli are methacholine, histamine, and exercise. Daily peak expiratory flow (PEF) variation has been reported to correlate with the severity of BHR, and in recent years this has been widely used because of its noninvasiveness and ease of performance. This study was carried out to determine the relationship among these four commonly used measures of bronchial responsiveness in asthmatic children. For this purpose, 12 asthmatic children of varying disease severity were recruited. Subjects underwent three challenges on 3 separate days in 1 week. During the week preceding the challenges (methacholine, histamine, and exercise), patients recorded PEF three times a day. All patients had PC20 less than 8 mg/ml with methacholine and histamine. Patients with PC20 greater than 3.5 mg/ml for both methacholine or histamine had negative exercise challenges. The strongest correlation was between histamine and methacholine (r = 0.95). Exercise-induced bronchospasm had substantial and significant correlation with the other three measures. No significant correlation was observed between PEF variability and histamine or methacholine. The varying degrees of relationships among the four commonly used measures suggests that each method yields information on different but related phenomena. More than one measure may be required to detect the different aspects of asthmatic bronchial responsiveness.

Two-dimensional ultrasonographic findings of atelectatic lung segments

Thirteen cases with pulmonary atelectasis were examined by two-dimensional sonography in our clinics between October 1990 and April 1993. Patients' ages ranged from 2 to 16 years. Five patients revealed atelectasis with pleural effusion and eight patients had only atelectasis. Two-dimensional sonography showed a solid mass indistinguishable from lung parenchyma in patients with atelectatic lung segment without pleural effusion while atelectatic segment was readily identified in those with pleural effusion. We conclude that sonography is a useful and non-invasive technique in differentiating cardiac from extracardiac masses, because atelectatic lung segment with moderate to large pleural effusion may mimic intrapericardial masses.

The prevalence of self-reported asthma and respiratory symptoms in Ankara, Turkey

The prevalence of self-reported asthma was studied in a group of Turkish adults using the European Community Respiratory Health Survey (ECRHS) questionnaire distributed during 1994 local elections in Ankara, Turkey. A total of 2020 questionnaires were issued and 1820(90%) were returned. The mean age of the subjects was 34.5 +/- 10.2 years. The prevalence of wheezing at any time in the past was 39.1% which is much higher than has been reported in the literature. However, only 21.7% of the study population had wheezing in the year preceding the survey and 2.9% of them had severe asthma attacks. The prevlaences of nocturnal wheeze, nocturnal cough and morning tightness were higher in females (P = 0.05 for each). The results of this study showed a high rate of reported symptoms but a low rate of diagnosis and treatment of asthma among the adult population in Ankara.

Standardization of methacholine inhalation challenge

Methacholine inhalation challenge has been shown to be an extremely useful diagnostic test. The purpose of this study was to document the reproducibility of methacholine inhalation challenge used in our clinic. In addition, we also examined the output of the delivery system, the stability of four-month-old methacholine solution, and the cumulative effect of methacholine. To document reproducibility, two identical challenges were performed in each of 19 asthmatic children. The influence of the previous doses of methacholine on bronchial response was examined by performing a third challenge with a single dose of methacholine in ten of these children. The remaining nine children were also tested for the third time with four-month-old methacholine solution to examine the stability of that solution. The output of the delivery system was assessed by measuring the change in weight of the nebulizer. Responses to methacholine were highly reproducible within one doubling dose interval. There was a small but significant cumulative effect of methacholine. Comparable results were obtained with newly prepared methacholine solution and four-month-old solution. The variability of the output of the same nebuliser was less than that of different nebulisers of the same model. The major clinical implication of our results is that our methacholine inhalation challenge procedure is standardized. This encourages more widespread use of this important diagnostic test for demonstration of airway hyper-responsiveness.

The prevalence of asthma and other allergic diseases in a province of Turkey

To document the prevalence of asthma and other allergic disorders among children, a questionnaire study involving 3,118 children aged six to 14 years was done. The overall prevalence of allergic diseases was 27.4 percent and the prevalence of each disorder was as follows: rhinitis 11 percent, asthma 10.2 percent, conjunctivitis 7.1 percent, and skin diseases 6.3 percent. Atopic diseases were reported most commonly among the families of children with allergic rhinitis. When compared with internal regions of Turkey, the prevalence of allergic diseases was found to be very high. It was concluded that allergic diseases are an important health problem among children in our region.

The incidence and significance of increased backscatter in myocardial ultrasonography of patients on hemodialysis

Ultrasonic backscatter is substantially modified by pathologic changes in myocardium. To define the incidence and significance of increased backscatter in myocardial ultrasonography of patients on chronic hemodialysis, 41 patients (aged 9-63 years) and 20 healthy controls were studied with conventional two-dimensional and M-mode echocardiography and with analysis of integrated backscatter. Increased histogram values were found in all patients especially in those whose two-dimensional echocardiographic examinations revealed mitral annular calcification (n = 3), aortic valve calcification (n = 2) and aortic plus mitral annular calcification (n = 1). It was concluded that ultrasonographic-integrated backscatter may be a useful method for early identification of cardiac calcification in uremic patients.

Endophthalmitis in a young child with meningococcal meningitis

Meningococcic meningitis is still a serious infection with high rates of morbidity and mortality. It is associated with severe complications. In recent years ocular complications have occurred less frequently, and endophthalmitis has been recognized as a rare complication. We present a case of meningococcic meningitis complicated by endophthalmitis.

Amphotericin B in the treatment of candida meningitis in three neonates

Candidiasis is an opportunistic infection and may result in significant morbidity and mortality in neonates. Cerebral candidiasis is rare and usually associated with systemic candidiasis. Information concerning the toxicity and efficacy of antifungal therapy for neonates is limited. In this report, we present three neonates with candidiasis. All of the patients were premature with low birth weights, and received antibiotic therapy for one to four weeks before the onset of candidiasis. Candida albicans was isolated from cerebrospinal fluid cultures. Amphotericin B was given administered at an initial dose of 0.25 mg/kg/day intravenously (IV) and increased to a dosage of 2 mg/kg/day, and therapy was continued for three to four weeks. A transient and mild elevation in hepatic enzyme concentration was observed in two patients, and transient thrombocytopenia occurred in all of them.

Hepatitis B seroprevalence among children in a Turkish hospital

Hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) were examined using enzyme-linked immunosorbent assay methods in 1316 patients from Onkoduz Mayis University Children's Hospital to investigate the epidemiology of hepatitis B in children from our region. The age range was from one month to 16 years. Seroprevalence of HBsAg and anti-HBs was 3.2 and 13.3%, and increased with age. None of the children had received hepatitis B vaccine. Hepatitis B is an important health problem in our region, and all children should be vaccinated.

Intravenous immunoglobulin treatment in children with Guillain-Barre syndrome

Guillain-Barre syndrome is an acquired demyelinating polyneuropathy that is presumed to be immune-mediated. On the basis of this assumption, intravenous immunoglobulin (IVIG) has been used in the treatment of Guillain-Barre syndrome in recent years and found to be effective. To test this we performed a randomized study in patients with Guillain-Barre syndrome by giving IVIG (1 g/kg body weight per day over 2 consecutive days) in 9 children who were compared with 9 patients who were observed but not given specific therapy. We concluded that intravenous immunoglobulin is a safe and effective treatment for childhood Guillain-Barre syndrome which shortens the time to recovery.

Application of ice water to the face in initial treatment of supraventricular tachycardia

Supraventricular tachycardia (SVT) is a life-threatening dysrhythmia in childhood. Initial treatment includes classic vagal maneuvers, some pharmacological agents, cardioversion and application of ice water to the face. In this paper we report our results of ice water application to the face in SVT. The study included ten patients between the ages of seven days and 15 years who were admitted to our hospital with supraventricular tachycardia in the previous year. Ice water was applied to their faces for five seconds immediately and all of them were digitalized. This procedure was utilized in 28 out of 36 SVT attacks, and was found to be effective in restoring sinus rhythm on 27 of 28 occasions (96%). Tachycardia recurred a total of 18 times in three of the ten patients. There was no recurrence in six patients. No response was noted in only one patient. Application of ice water to the face is an easy, safe, effective and repeatable procedure in the initial treatment of supraventricular tachycardia.

Cigarette smoking and lipids and lipoproteins in cord plasma

The effects of smoking on maternal and cord plasma lipid and lipoprotein levels were measured in 40 smoker mothers and their newborns and compared to nonsmokers. Significantly higher levels of total cholesterol, low density lipoprotein cholesterol and very low density lipoprotein cholesterol and lower levels of high density lipoprotein cholesterol were found in smoker mothers and their newborns in comparison to nonsmokers. These results suggest that smoking does not affect only the lipids and lipoproteins of pregnant women but also those of their fetuses.

Short course intermittent chemotherapy in childhood tuberculosis

A total of 130 children diagnosed as having pulmonary and extrapulmonary tuberculosis who received short course intermittent chemotherapy between 1978-1992 were evaluated retrospectively. One hundred and ten children with tuberculosis were treated with isoniazid (10-15 mg/kg, maximum 400 mg), rifampin (10-15 mg/kg, maximum 600 mg), and streptomycin (30 mg/kg, maximum 1 g) daily, for 15 days. Treatment was completed with similar doses of isoniazid and rifampin twice a week for a period of 9 months. Since 1986, 20 children with tuberculosis were being treated with the same regimen but without streptomycin. The majority of patients in these cases had pulmonary tuberculosis (75%), followed by lymph nodes (9%), pleural (7%), bone and joint (5%), miliary (3%), and abdominal tuberculosis (1%). The clinicoradiologic response to treatment was observed to be excellent. Only one case of relapse was detected, which was the case of a patient with lymph node tuberculosis that occurred 18 months after the completion of treatment. No serious adverse drug reaction was observed in any of the cases mentioned. In conclusion, short-course low-dose intermittent chemotherapy is an effective and economical treatment with minimal side effects for pulmonary and extrapulmonary tuberculosis in childhood.

Conservative treatment of empyema in children

Seventy-two children with no underlying diseases were treated for empyema. Radical surgical approaches like decortication were necessary for only 3 children. In 66 children tube drainage was applied. Staphylococcus aureus was cultured or was shown in Gram's stain in 32 (44%) and children with this microorganism had longer duration of tube drainage (p < 0.05). The period for normalization of chest X-ray was positively related with the age of the patient (p < 0.05). In 60 of 72 children, chest X-ray was normal after 3 months. Follow-up of the patients 18 months after the infection revealed that pulmonary radiograms were normal in all cases and pulmonary function tests were within normal limits in all of the tested children (n = 25). It is emphasized that avoiding major surgical approaches must be encouraged in childhood empyema.

The role of viruses and Mycoplasma pneumoniae in lower respiratory tract infections in childhood

Acute lower respiratory tract infections are one of the major causes of childhood morbidity and mortality in developing countries. This study was undertaken at Hacettepe University Children's Hospital to determine the role of viruses and Mycoplasma pneumoniae in respiratory tract infections in children. Eighty-three patients with lower respiratory tract infections were selected at random from among the children admitted to the hospital for evaluation of respiratory symptoms. Acute and convalescent serum samples were collected from all patients for the complement-fixation test and the following antigens were used: respiratory syncytial virus (RSV), adenovirus, parainfluenza virus Type 1, influenza viruses A and B, and Mycoplasma pneumoniae. The test was positive in 39 of 83 patients (47%), and RSV was the most frequent agent detected serologically (15.7%).