Associations between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and prognosis in patients with neuroblastoma

OBJECTIVES

Recent studies have shown that the neutrophil-to-lymphocyte ratio (NLR) is a new inflammatory marker that is effective in determining the prognosis of many solid tumors, chemotherapy responses, survival, and their recurrence rate. Therefore, we performed a retrospective study to investigate the effect of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio (PLR) on risk factors and prognosis in these patients.

MATERIALS AND METHODS

In this study, 246 pediatric patients with neuroblastoma who were diagnosed, treated, and followed up during 2000-2021 in Division of Pediatric Oncology, Çukurova University Faculty of Medicine, were included. Required information of patients was obtained from archive files, Mergentech hospital program, and E-pulse system.

RESULTS

Median value for NLR was found to be 1.06, for PLR it was found as 92. The relationship of NLR values with age, stage, risk group, and Shimada was found to be statistically signifıcant with p < .001, vanillylmandelic acid (VMA) (p = .006) also depicted the signifıcant value. Likewise, the relationship of PLR values with age (p < .001), stage (p = .022), Shimada (p = .004), and N-Myc amplification (p = .039) was found to be statistically significant as well. Survival analysis showed that no statistically significant difference was observed among the higher and lower values of NLR. Survival rates were noticed to be higher in the lower values of NLR (10-year overall survival [OS] 55% vs. 49%, 10-year event-free survival (EFS) 54% vs. 43%), albeit nonsignificant.

CONCLUSION

Pretreatment evaluation of NLR and PLR values in patients with neuroblastoma may be instructive in respect of prognosis and risk group.

Clinical Characteristics and Outcomes of Cancer Cases Among Syrian Refugees From Southern Turkey

Importance

Cancer was a common noncommunicable disease in Syria before the present conflict and is now a major disease burden among 3.6 million Syrian refugees in Turkey. Data to inform health care practice are needed.

Objective

To explore sociodemographic characteristics, clinical characteristics, and treatment outcomes of Syrian patients with cancer residing in the southern border provinces of Turkey hosting more than 50% of refugees.

Design, Setting, and Participants

This was a retrospective hospital-based cross-sectional study. The study sample consisted of all adult and children Syrian refugees diagnosed and/or treated for cancer between January 1, 2011, and December 31, 2020, in hematology-oncology departments of 8 university hospitals in the Southern province of Turkey. Data were analyzed from May 1, 2022, to September 30, 2022.

Main Outcomes and Measures

Demographic characteristics (date of birth, sex, and residence), date of first cancer-related symptom, date and place of diagnosis, disease status at first presentation, treatment modalities, date and status at last hospital visit, and date of death. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision and International Classification of Childhood Cancers, Third Edition, were used for the classification of cancer. The Surveillance, Epidemiology, and End Results system was applied for staging. The diagnostic interval was defined as the number of days from first symptoms until the diagnosis. Treatment abandonment was documented if the patient did not attend the clinic within 4 weeks of a prescribed appointment throughout the treatment.

Results

A total of 1114 Syrian adult and 421 Syrian children with cancer were included. The median age at diagnosis was 48.2 (IQR, 34.2-59.4) years for adults and 5.7 (IQR, 3.1-10.7) years for children. The median diagnostic interval was 66 (IQR, 26.5-114.3) days for adults and 28 (IQR, 14.0-69.0) days for children. Breast cancer (154 [13.8%]), leukemia and multiple myeloma (147 [13.2%]), and lymphoma (141 [12.7%]) were common among adults, and leukemias (180 [42.8%]), lymphomas (66 [15.7%]), and central nervous system neoplasms (40 [9.5%]) were common among children. The median follow-up time was 37.5 (IQR, 32.6-42.3) months for adults and 25.4 (IQR, 20.9-29.9) months for children. The 5-year survival rate was 17.5% in adults and 29.7% in children.

Conclusions and Relevance

Despite universal health coverage and investment in the health care system, low survival rates were reported in this study for both adults and children with cancer. These findings suggest that cancer care in refugees requires novel planning within national cancer control programs with global cooperation.

Pediatric posterior reversible encephalopathy syndrome: Age related clinico-radiological profile and neurologic outcomes

BACKGROUND

The aim of this study was to analyze the characteristics of pediatric posterior reversible encephalopathy syndrome (PRES) to determine clinical and radiologic differences between younger and older age groups, and to identify risk factors for development of any neurologic sequelae.

METHODS

The study cohort consisted of confirmed pediatric PRES patients in a tertiary care university hospital from January, 2015, to December, 2020. Demographic and clinical properties, radiological manifestations, and neurologic outcomes were noted. Children aged ≤6 years were compared with those older than 6 years and factors affecting neurologic outcomes were evaluated.

RESULTS

The most common underlying diseases were oncological (37%) and kidney diseases (29%). Epileptic seizures were the most frequent symptoms at initial clinical presentation. The regions in the brain that were most commonly involved were the occipital region (n = 65, 96%), the parietal region (n = 52, 77%), and the frontal lobe (n = 35, 54%). Magnetic resonance imaging (MRI) findings were consistent with atypical patterns in most of the study cohort (71%). Patients with unfavorable clinical outcomes (n = 13, 19.1%) had longer initial seizure times and longer encephalopathy times, lower leucocyte and absolute neutrophil counts, and lower neutrophil to lymphocyte ratios. No relationship was found between MRI findings, involvement patterns, and neurologic outcomes.

CONCLUSIONS

No clinically specific differences between two different age groups were found. Atypical imaging manifestations of pediatric PRES in our study had an incidence that was as high as those found in earlier adult studies. Multivariate logistic regression analysis showed that the initial neutrophil to lymphocyte ratio, absolute neutrophil counts, and white cell counts could not predict poor neurologic outcomes.

Total nucleated cell dose in graft is a better prognostic factor for survival in pediatric patients transplanted with bone marrow compared to CD34+, CD3+, or total mononuclear cell count

BACKGROUND

Most studies investigating the impact of graft composition on transplant-related outcomes have focused on the effect of CD34+ cell dose and reported equivocal results. The aim of this study is to investigate the impact of doses of total nucleated cells (TNCs), total mononuclear cells (TMCs), CD3+, and CD34+ cells on the outcome of children receiving allogeneic hematopoietic stem cell transplantation (HSCT).

METHODS

Children and adolescents who underwent allogeneic HSCT for malignant hemato-oncological diseases or nonmalignant diseases in Cukurova University Faculty of Medicine, Pediatric Bone Marrow Transplantation Center between 2010 and 2020 were enrolled in the study.

RESULTS

A total of 212 patients receiving allogeneic HSCT (154 bone marrow transplantation; 58 peripheral blood stem cell transplantation) from matched related or unrelated donors were included in the study. Higher TNC doses associated with a superior 5-year event-free survival (EFS; 67.7% vs 44.7%) in the whole group (log-rank P = .027). Overall survival (OS) and EFS of bone marrow-transplanted patients differed significantly according to TNC doses (log-rank P = .041 and .027, respectively). Multivariant analysis for OS revealed a P value of .038 for TNC, Exp(B) = 1.939 (95% CI: [1.038, 3.621]). That for EFS revealed a P value of .025 for TNC, Exp(B) = 1.992 (95% CI: [1.088, 3.647]). There was no relationship between doses of CD34+ cells, CD3+ cells, TMC, TNC, and neutrophil or platelet engraftment.

CONCLUSION

Our data suggest that TNC dose is a better prognostic factor for pediatric allogeneic HSCT outcomes than doses of CD34+ cells, CD3+ cells, or TMC in patients transplanted with bone marrow. Future studies analyzing cell subsets and other components in TNC could elaborate the factor(s) accompanying this observed survival advantage.

Effect of mentha on performance, haematological and biochemical parameters in laying hens

Effects of Mentha piperita (peppermint) extract and juice on performance and immune parameters were evaluated in laying hens. A total of 252 Babcock laying hens were allocated to seven treatments with four replications of nine hens. The control hens were fed a basal diet without supplementation. Other hens were given diets supplemented with mentha extract (ME) at 50 (50ME), 100 (100ME), and 200 (200ME) mg/kg of feed or with 50 mentha juice (50MJ), 100 (100MJ) and 200 (200MJ) mg/L that was provided in the drinking water. No significant differences were detected among treatments in bodyweight, feed intake, egg mass, egg production, eggshell breaking strength, Haugh unit, and haematological and serological parameters. The ratio of gram feed to gram egg mass (feed conversion) was significantly better in the birds that received 100ME and 200ME compared with the control hens. The yolk colour index was higher in mid trial analysis (28th day). Thus, although the ME supplementation had a positive effect on feed conversion ratio and egg yolk colour at dosage rates up to 200 mg/kg, further research is needed to establish the efficacy of this herbal product and to determine the most appropriate amount to include in diets for laying hens.

Comparison of Different Doses of Granulocyte Colony-stimulating Factor in the Treatment of High-risk Febrile Neutropenia in Children With Cancer

Febrile neutropenia (FEN) is a significant side effect after chemotherapy, and it is known that using granulocyte colony-stimulating factor (G-CSF) has positive effects on treatment results. In this study, the effects of different G-CSF doses (5 to 10 mcg/kg/day) on treatment results in patients with high-risk FEN were evaluated. A total of 124 high-risk FEN episodes of 62 patients were enrolled in the study between June 2017 and October 2018. The episodes were divided into 2 groups according to G-CSF treatment doses, they received from 5 to 10 mcg/kg/day. The clinical characteristics of the patients, the treatments they received, laboratory findings, microbiologic results, and cost analysis were recorded. No statistically significant difference was found between 2 groups in terms of the mean duration of recovery from neutropenia, duration of fever, total length of hospital stay, duration of FEN episode, duration of G-CSF use, costs, bacteremia frequency, and other treatments. In patients with solid tumors, the cost of filgrastim was significantly higher in the high-dose G-CSF group. Using different doses of G-CSF in high-risk FEN episodes did not show any different effects on clinical and treatment results. The dose of 5 mcg/kg/day would be more appropriate in FEN treatment.

Pistacia terebinthus as a dietary supplement for laying hens

The aim of this study was to explore the potential of Pistacia terebinthus (terebinth) seed meal as a dietary supplement for laying hens. One hundred and ninety-two Babcock 30-week-old laying hens were assigned to one of six treatments (n = 32) with four replicates (n = 8). The hens were fed diets containing 0%, 1%, 2%, 3%, 4%, and 5% terebinth seed meal for eight weeks. Weekly egg production, feed consumption, egg weight, and egg mass were recorded. Egg quality was assessed at the beginning, middle and end of the study. Blood sampling was carried out on 12 birds from each treatment. Total antioxidant capacity, total oxidant status and oxidative stress index were determined. Egg production was greater from hens fed 3% and 4% terebinth than those in the other treatments. Egg weight was increased by supplementation with 2% or more terebinth. Feed consumption, feed conversion ratio, eggshell breaking strength, yolk colour, Haugh units, concentrations of glucose, total cholesterol, high density lipoprotein, low density lipoprotein, alanine aminotransferase, aspartate aminotransferase, total protein, phosphorus and calcium in serum, and total antioxidant capacity, total oxidant status, and the oxidative stress index did not differ across treatments. It is concluded that dietary terebinth seed supplementation generated positive effects on egg production and egg weight without adverse effects on egg quality or the metabolism of the hen.Keywords: antioxidant, egg production, egg quality, feed consumption, serum biochemistry

Unicentric Castleman Disease Mimicking an Autoinflammatory Disorder: A Diagnostic Challenge in a Pediatric Patient With Recurrent Fever

Unicentric Castleman disease (CD) is a rare lymphoproliferative disorder that is characterized by the enlargement of lymph nodes on the neck, mediastinum, and retroperitoneum. Herein, we present a 6-year-old female patient, referred to our medical center because of recurrent fever accompanied by cervical lymphadenopathy and elevated inflammatory markers since 3 years of age. Fever episodes lasting 1 day continued irregularly without any accompanying symptom. MEditerranean FeVer (MEFV) gene analysis showed no mutations; however, as inflammatory markers including serum amyloid A remained markedly high during attack-free periods, colchicines was initiated. The patient did not respond to maximally tolerated doses of colchicine; therefore, we added canakinumab and systemic methylprednisolone, subsequently. Unresponsiveness to 3 doses of bimonthly canakinumab and new-onset hepatosplenomegaly led us to investigate large-vessel vasculitis and malignancy; therefore, we performed Position emission tomography, which further revealed a hypermetabolic retroperitoneal solid mass. After performing the excisional biopsy, the patient has been diagnosed as suffering from hyaline vascular variant CD, confirmed by histopathology. In conclusion, we report a pediatric unicentric CD, which resembled autoinflammatory diseases and responded well to surgical resection, with the normalization of inflammatory markers 1 month after the procedure. CD, even the unicentric and hyaline vascular variant, should be considered in the differential diagnosis of the patients with an autoinflammatory phenotype.

Evaluation of late cerebral vascular complications in cranially irradiated pediatric cancer patients with magnetic resonance angiography

BACKGROUND:

We aimed to establish the early diagnosis of cerebral vascular complications by using cerebral magnetic resonance angiography (MRA) in patients who were treated with cranial RT in childhood as part of their cancer treatment.

PROCEDURE:

Patients who had received cranial RT before the age of 18 and had been in remission for at least 1 year were enrolled in the study. A data form including demographic and clinical characteristics and findings of cerebral MRA was filled in for each patient.

RESULTS:

Cerebral MRA examination was performed between November 2013 and October 2015 in 53 patients who met the inclusion criteria. Abnormalities were found in 7 patients (13.2%). All patients were asymptomatic at the time of examination. There was a significant difference between patients in the abnormality-positive and abnormality-negative groups related to cranial radiation dose (p = 0.013) and age at the time of examination (p = 0.015) in univariate analysis. In multivariate analysis, cranial radiation dose was found to have an impact on developing cerebral vascular abnormalities (p = 0.045).

CONCLUSIONS:

Cerebral MRA is a noninvasive method of follow-up for late cerebral vascular complications in surviving pediatric oncology patients who were treated with cranial RT as part of their cancer treatment.

ICHTHYOSIS LINEARIS CIRCUMFLEXA: NOT ALWAYS A PART OF NETHERTON SYNDROME

Ichthyosis Linearis Circumfiexa (ILC) is a rarely seen autosomal recessive keratinization disorder and is characterized by erythematous, polycystic, plaques with 'double-edged' scales. Its histological features resemble psoriasis. A triad of ichthyosis (usually Ichthyosis Linearis Circumfiexa), trichorrhexis invaginata (a distinctive hair shaft disorder) and atopy is named as Netherton syndrome. Herein, we report a 12 year-old girl presenting with ILC not accompanied with typical atopy findings and hair shaft disorder.

Meropenem versus piperacillin-tazobactam as empiric therapy for febrile neutropenia in pediatric oncology patients

BACKGROUND

Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/ TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer.

MATERIALS AND METHODS

Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patients received PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode.

RESULTS

Two hundred eighty four febrile neutropenic episodes were documented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/ TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not different between two groups. Success rates and modification rate between two groups showed no significant differences (p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. No serious adverse effects occurred in either of the groups.

CONCLUSIONS

Meropenem and PIP/TAZ monotherapy are equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.

Replacing actinomycin-D with Carboplatin for newly diagnosed rhabdomyosarcoma

BACKGROUND

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the pediatric age group. All patients with RMS regardless of their initial stage or group receive combination chemotherapy as 'standard therapy' consisting of vincristine, actinomycin-D and cyclophosphamide. Actinomycin-D was not readily available in Turkey at one time. Carboplatin was used instead in order to prevent delays in treatment. The aim of this report is to present the results of patients with rhabdomyosarcoma receiving carboplatin or actinomycin-D therapy.

MATERIALS AND METHODS

Twenty four patients with rhabdomyosarcoma treated between December 2000 and June 2011 were included in this retrospective study. The patients were treated according to International Rhabdomyosarcoma Study Group guidelines. Eleven patients were treated with actinomycin-D and 13 with carboplatin (250 mg/m2/dose for 2 days). The two groups were then compared in terms of 2- and 5-year overall survival (OS) and hematological and non-hematological toxicities.

RESULTS

Age, sex, stage and the mean duration of follow-up were similar in both groups (p>0.05 ). Two- and five-year OS levels were 68.2% in the carboplatin group and 78.0% and 40.0%, respectively, in the actinomycin-D group. There was no statistical difference in the number of febrile episodes (p=0.86 ) and no other hematological and non-hematological adverse effects were recorded in both groups.

CONCLUSIONS

The findings show that carboplatin can be used as an alternative drug in the primary treatment of rhabdomyosarcoma in the event that actinomycin-D is unavailable or not tolerated.

Dermatopathic lymphadenitis associated with human papilloma virus infection and verruca vulgaris

Here we present a pediatric case of human papilloma virus associated with dermatopathic lymphadenitis (DL). A 5-year-old boy presented to the pediatric oncology clinic with swelling of the neck and warts on his lower jaw. His blood chemistry and complete blood count were normal, as was chest x-ray. HIV, EBV, CMV, and parvovirus serologies were negative. The patient was investigated for malignancy and lymphoma but no association was found. Histopathologic examination of the lymph node and the lesion revealed DL and verruca vulgaris, respectively. DL represents a benign form of reactive lymph node hyperplasia and described in patients with HIV and EBV infections. It is a rare entity described in patients with human papilloma virus infection. To our knowledge, this is the first report of DL in a patient with human papilloma virus infection.

The protective effect of hesperidin on methotrexate-induced intestinal epithelial damage in rats: an experimental study

OBJECTIVE

The purpose of this experimental study was to evaluate the efficacy of hesperidin (HES) in protecting against methotrexate (MTX)-induced intestinal damage using histopathological and immunohistochemical techniques.

MATERIALS AND METHODS

Seventy-eight male Wistar albino rats were divided into 4 groups that received (a) saline only (control group), n = 19; (b) HES only, n = 19; (c) MTX only, n = 19, and (d) MTX plus HES, n = 21. On the first day of the study, a single dose of MTX (20 mg/kg) was administered intraperitoneally to group 3 and 4 rats. The HES (200 mg/kg) was administered by gavage for 5 days. For the MTX plus HES group, HES (200 mg/kg) was administered by gavage for 5 days after MTX treatment. Rats were sacrificed on the 2nd, 4th and 6th day of the study. Tissue samples from the jejunum were taken for histopathological and immunohistochemical analysis.

RESULTS

On the 4th day, crypt injury in the MTX plus HES group (1.00 ± 0.00) was less than that in the MTX group (2.00 ± 0.89; p < 0.05). The small intestinal damage score was lower in the MTX plus HES group (6.33 ± 0.82) as compared to the MTX group (8.00 ± 2.37). Inducible nitric oxide synthase and interleukin-8 levels were lower in the MTX plus HES group (65 and 25%, respectively) as compared to the corresponding values of the MTX group (80 and 52.5%, respectively). On the 6th day, the Ki-67 proliferation index in the MTX group (45%) was lower than that in the MTX plus HES group (76.67%) and the control group (p < 0.05). The small intestinal damage score was high in the HES group on the 4th day due to increased cellular infiltration. On the 6th day, the Ki-67 proliferation index rose in parallel with the decrease in cellular infiltration and therefore histopathological scoring. The proliferation-enhancing effect of HES also appeared in healthy rats.

CONCLUSION

HES seemed to have a protective effect against MTX-induced intestinal injury.

The effectiveness of heliox in acute respiratory distress syndrome

INTRODUCTION:

The management of acute respiratory distress syndrome (ARDS) was investigated with the use of heliox in an experimental model.

OBJECTIVES:

To investigate whether heliox can be considered a new therapeutic approach in ARDS.

METHODS:

ARDS was designed in Wistar albino male rats, 250-300 g in weight, by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats with ARDS were pressure-controlled ventilated. At the end of 210 min, helium gas was tried. All rats were assigned to two groups: Group 1 (n = 10) was the control group, and was given no treatment; group 2 (n = 7) was given heliox (He: O₂ = 50:50). The heliox group received heliox for 1 h continously. Rats were continued to be kept on a ventilator through the experiment. Two hours after the last inhalation, both lungs of the rats were excised for both histopathological examination and immunohistochemical evaluation.

STATISTICAL ANALYSIS USED:

Histopathological grading were expressed as median interquartile range. Mann–Whitney U-test was used to assess the relationships between the variables.

RESULTS:

The infiltation of neutrophils were decreased in rats treated with heliox. Edema in the interstitial and intraalveolar areas was less than that of the control rats. Also, the diminishing of perivascular and/or intraalveolar hemorrhage was apperant. Hyaline membrane (HM) formation decreased in the heliox group compared with the control group. Decreased inducible nitric oxide synthase expression was shown via immunohistochemical examination in the heliox group.

CONCLUSION:

The present study histopathologically indicated the effectiveness of heliox in the decreasing of neutrophil infiltation, interstitial/intraalveolar edema, perivascular and/or intraalveolar hemorrhage and HM formation in ARDS. Besides the known effect of heliox in obstructive lung disease, inhaled heliox therapy could be associated with the improvement of inflamation in ARDS.

Brain natriuretic peptide levels in pediatric cancer patients with febrile neutropenia

Brain natriuretic peptide (BNP) is considered as a prognostic marker in patients with sepsis, but no data are available on BNP in pediatric cancer patients with febrile neutropenia (FN). Twenty-five pediatric cancer patients with FN were included in this study. Serum BNP level was measured. The mean BNP level was 330.8 ± 765.3 pg/mL (5.9-3806 pg/mL). BNP levels of 12 patients were found over the normal level. High BNP levels were related to some conditions of the patients, and these were statistically significant (P < .05). These conditions were required erythrocyte suspension, had pneumonia, time stayed in hospital, and neutropenia time. When regression test was done, required erythrocyte suspension for anemia and had pneumonia were found to be statistically significant. In conclusion, this is one of the first studies on BNP levels in pediatric cancer patients with FN. However, further studies with large sample sizes are needed to confirm the results and provide new data about this issue.

Thrombotic microangiopathy in allogeneic stem cell transplantation in childhood

OBJECTIVES

We define the incidence, risk factors, and mortality rates for the occurrence of thrombotic microangiopathy in 50 children who underwent transplants between January 2006 and June 2008 at 2 Turkish pediatric centers.

MATERIALS AND METHODS

The diagnosis of thrombotic microangiopathy was done according to the reports of International Working Group in 2007.

RESULTS

Fifty patients (27 male and 23 female; age range, 3 months to 18 years) were included. Patients with malignant and nonmalignant diseases were 13 (26%) and 37 (74%). Myeloablative and nonmyeloablative conditioning regimens were used in 29 (58%) and 21 patients (42%). Bone marrow was used as the source of stem cells in 32 patients (62%) and peripheral blood was used in 18 patients (36%). Thrombotic microangiopathy was seen in 3 of 50 cases (6%). Thrombotic microangiopathy developed in 3 of 18 patients in whom peripheral blood was used as the source of stem cells while none of 32 patients who had bone marrow as the source developed thrombotic microangiopathy (P < .05).

CONCLUSIONS

Using peripheral blood as a source of stem cells is a risk factor for development of thrombotic microangiopathy.

Myeloid antigen positivity in Turkish children with acute lymphoblastic leukemia lacks influence on prognosis

INTRODUCTION

Several studies have suggested that the presence of myeloid antigens is a poor prognostic factor in patients with acute lymphoid leukemia (ALL).

OBJECTIVE

We aimed to assess this possibility in Turkish patients.

MATERIALS AND METHODS

Seventy-three children with a diagnosis of ALL-L1 and 38 with ALL-L2 were included. Flow cytometry and fluorescein-isothiocynate conjugated antibodies were used to determined surface antigens on blasts.

RESULTS

Myeloid antigens were positive in 48.4% with ALL-L1 and 60.5% with ALL-L2, the difference not being significant. Overall survival rates of myeloid antigen positive patients at 36, 60, and 72 months were 76%, 58%, and 48%, respectively, comparable to the corresponding 70%, 56%, and 46% in myeloid antigen negative patients (p >0.05).

CONCLUSION

We did not find any association between myeloid antigen positivity and clinical and laboratory features of ALL.

Fms-like tyrosine kinase 3 mutations in childhood acute leukemias and their association with prognosis

INTRODUCTION

In recent years, Fms-like tyrosine kinase (FLT) 3 has been the subject of several studies as a prognostic marker.

OBJECTIVE

In this study, the presence of FLT3 mutations in childhood acute leukemias patients and their association with prognosis were investigated.

MATERIALS AND METHODS

A total of 120 patients, 80 with acute lymphoblastic leukemia (ALL) and 40 with acute myeloblastic leukemia (AML), were included. Real time polymerase chain reaction methods on a high resolution melting analysis device were used to determine FLT3 mutations.

RESULTS

FLT3/ITD (internal tandem duplication) mutations were found in 6 (7.5%) of the patients with ALL and in 9 (22.5%) of those with AML, whereas no FLT3/TKD (trans kinase domain) mutation was evident in any case. There was no difference between the ALL patients positive and negative for FLT3/ITD with regard to overall survival (OS), event free survival (EFS) and disease free survival (DFS) (p=0.37, p=0.23, p=0.023, respectively). However, in FLT3/ITD positive and negative AML patients, there was a statistically significant difference in OS (p=0.0041), but not EFS and DFS (p=0.09, p=0.095, respectively). A significant difference was found between age and FLT3/ITD positivity (p=0.036).

CONCLUSION

We found that FLT3/ITD positivity increased with age and that it was associated with decrease in OS in AML patients, providing further evidence that it is an independent factor negatively influencing prognosis.

Meropenem monotherapy as an empirical treatment of febrile neutropenia in childhood cancer patients

INTRODUCTION

Chemotherapy related neutropenia developing in oncologic patients is a significant condition and major cause of morbidity and mortality. Febrile neutropenic attacks without complications can be successfully treated with wide-spectrum anti-pseudomonal cephalosporins or carbapenems.

OBJECTIVE

We investigated the efficacy and safety of meropenem in the treatment of febrile neutropenia (FN) in children with cancer.

MATERIALS AND METHODS

Twenty four patients who had a febrile neutropenic episodes followed by initiation of empirical meropenem therapy were included in the study.

RESULTS

Of all the patients, 13 (54.2%) had solid tumors, while 11 (45.8%) were diagnosed to have acute leukemia. Among all, 7 (29.2%) and 15 (62.5%) infections were identified microbiologically and clinically, respectively. Fever of unknown origin was observed in 2 (8.3%) patients. The mean duration of neutropenia was 7.2 +/- 3.1 (4-14) days in patients with solid tumors, and 9.3 +/- 4.7 (2-17) days in the group with leukemia. This difference was not statistically significant (log rank, p=0.063). Average time of stay in hospital was 10.1 +/- 6.4 (4-21) days for patients with solid tumors, and 15.9 +/- 11.7 (5-37) days for patients with leukemia (log rank, p=0.041). FN duration was observed to be significantly longer in patients with an absolute neutrophil count (ANC) of less than 100/mm3 and even those with an ANC of less than 200/mm3, and in children who were not in remission for the underlying malign disease (p<0.05). While 22 (91.7%) of the patients were discharged from the hospital, 2 (8.3%) died. The success rate of empirical therapy started with meropenem was 87.5%.

CONCLUSION

Meropenem is effective and safe for treatment of FN in pediatric cancer patients.

Flow cytometry results at diagnosis and relapse in childhood acute lymphoblastic leukemia

INTRODUCTION

Several studies have focused on the immunophenotype of the leukemic population at the time of relapse compared to that observed at diagnosis.

OBJECTIVE

The question of whether differences exist between surface antigens levels on blasts at the time of diagnosis and at relapse in cases of acute lymphoblastic leukemia (ALL) was addressed.

MATERIALS AND METHODS

A total of 25 All patients were included. Flow cytometry and fluorescein-isothiocynate conjugated antibodies were used to determined surface antigens levels.

RESULTS

The most frequently detected five antigens were I2 (n=21), CD10 (n=17), CD41 (n=16), CD2 (n=14) and CD7/CD19 (n=13/n=13) at the time of diagnosis and CD41 (n=21), I2 (n=20), CD10 (n=14), CD19 (n=16) and CD2 (n=12) at the time of relapse. There was a significant difference only between CD41 levels at the time of diagnosis and at the time of relapse (p=0.041).

CONCLUSION

We found changes in antigen expressions at the time of relapse in ALL patients. This condition ought to be evaluated with reference to prognosis of leukemia.

Incidence and prognostic importance of molecular genetic defects in children with acute myeloblastic leukemia

INTRODUCTION

Acute myeloblastic leukemia (AML) accounts for 15 to 25 percent of childhood acute leukemias. The most common genetic abnormalities seen in pediatric AML patients are AML1-ETO, PML-RARα and CBFB-MYH11 genes resulting in t(8;21), t(15;17) and inv(16). These genetic defects are seen in approximately 20-25% of AML patients.

OBJECTIVE

We investigated in this study, incidence and prognostic significance of the AML1-ETO, PML-RARα and CBFB-MYH11 genes in children with AML.

MATERIALS AND METHODS

The authors analyzed 34 children with AML using the real time-polymerase chain reaction for AML1-ETO, PML-RARα and CBFB-MYH11 genes.

RESULTS

Of the patients, 8.8% were positive for t(8;21), 8.8% for t(15;17) and 3% for inv(16). There were a statistically significant differences between 48 month overall survival rates of the patients positive and negative for t(8;21), t(15;17) and inv(16).

CONCLUSION

It was concluded that t(15;17), t(8;21) and inv(16) impact on disease prognosis positively, but comprehensive studies with larger patient series are now needed for confirmation.

Potential association between allergic diseases and pertussis infection in schoolchildren: results of two cross-sectional studies seven years apart

BACKGROUND

In this study, we aimed to investigate the relationship between pertussis infections and allergic diseases in two cross-sectional questionnaire-based surveys carried out in 1997 and 2004. We also measured serum level of antibody to B. pertussis.

MATERIAL AND METHODS

Two cross-sectional, questionnaire-based surveys were carried out in 1997 (n = 3164) and 2004 (n = 3728). 361 cases and 465 controls were recruited from both surveys. The skin tests were performed using standardised extracts. The level of pertussis specific IgG was measured in 136 allergic and 168 non-allergic children.

RESULTS

We found that allergic diseases prevalence was significantly higher in the children suffering from pertussis infections (22.3 % fi rst and 8.8 % second survey) compared to children who did not suffer from pertussis infections (6.6 % fi rst and 4.5 % second survey) (p = 0.001 and p = 0.035, respectively). Asthma prevalence was also significantly higher in children suffering from pertussis infection (37.6 % fi rst and 26.2 % second survey) compared to children who did not suffer from pertussis (7.4 % fi rst and 5.0 % second survey) (p = 0.001 and p = 0.001, respectively). However, the mean serum levels of anti-pertussis IgG were similar in allergic and non-allergic groups (p > 0.05).

CONCLUSION

Although pertussis antibody levels in atopic and non-atopic children were similar to each other, pertussis infection still seemed to have a significant effect on the development of atopic diseases.

The use of a protein and energy dense eicosapentaenoic acid containing supplement for malignancy-related weight loss in children

BACKGROUND

The aim of nutritional therapy in cancer patients is to prevent weight loss and to improve functional capacity and quality of life. Clinical studies however, have continued to demonstrate that a reduction in body weight loss is difficult to achieve in cancer cachexia. Several studies have shown that supplementation with eicosapentaenoic acid (EPA), an omega-3 fatty acid, has anti-cachectic effects in adult cancer patients. This study evaluated the clinical effects of a protein and energy dense EPA containing nutritional supplement in a group of pediatric cancer patients receiving active chemotherapy treatment.

METHODS

The study was a prospective, randomized, single center, open-label design. Fifty-two patients diagnosed with pediatric malignant disease and receiving intensive chemotherapy were included. Thirty-three patients received a nutritional supplement containing EPA in addition to their regular food intake. Nineteen control patients did not receive supplementation. Patients were examined and their data (body weight, body mass index, and weight percentile) were recorded regularly once a month for 3 months. A subgroup of patients was evaluated for 6 months.

RESULTS

At 3 months, there were significantly fewer patients in the treatment group as compared to controls that showed losses in body weight (P = 0.001), BMI (P = 0.002), and a negative deviation in weight percentile (P = 0.021). In addition, remission rate was significantly (P = 0.036) higher in the treatment group as compared to controls.

CONCLUSIONS

This study demonstrates a decrease in cancer-induced weight loss in pediatric patients fed a protein and energy dense nutrition supplement containing EPA.

Imipenem in the treatment of febrile neutropenic children

INTRODUCTION

Infection of neutropenic children treated with malignancies is even now the major cause of early morbidity and mortality. Febrile neutropenic attacks without complications are successfully treated with wide-spectrum anti-pseudomonal cephalosporins or carbapenems.

OBJECTIVE

To determine the efficacy and safety of imipenem in the treatment of febrile neutropenia in children with cancer.

MATERIALS AND METHODS

Twenty-four patients who had a febrile neutropenic (FN) episodes followed by initiation of empirical imipenem therapy were included in the study.

RESULTS

Of the patients, 10 (41.7%) had solid tumors, while 14 (58.3%) were diagnosed to have acute leukemia. Among all, 5 (20.8 %) and 15 (62.5 %) of the infections were identified microbiologically and clinically, respectively. Fever of unknown origin was observed in 4 (16.7 %) patients. The mean duration of neutropenia was 6.3 -/+ 1.4 (4-8) days in patients with solid tumors, and 9.3 -/+ 7.4 (3-25) days in the group with leukemia. Average time of stay in hospital was 9.0 -/+ 4.1 (4-20) days for patients with solid tumors, and 14.4 -/+ 10.6 (4-33) days for patients with leukemia. FN duration was observed to be significantly longer in patients with an ANC of less than 200/mm3, and in children who were not in remission for the underlying malignant disease. In addition, average time of stay in hospital was observed to be significantly longer in patients who were not in remission for the underlying malign disease. All of the patients were discharged. The success rate of empirical therapy started with imipenem was found be 95.8 %.

CONCLUSION

Imipenem is effective and safe in the treatment of FN in pediatric cancer patients.

A giant paediatric mandibular aneurysmal bone cyst and reconstruction with bilateral iliac bone graft

A giant paediatric mandibular aneurysmal bone cyst and reconstruction with bilateral iliac bone graft. Aneurysmal bone cyst (ABC) is an unusual, non-neoplastic, expansile lesion of the bone. ABC is not a true cyst and it is characterised by the replacement of bone by fibro-osseous tissue containing blood-filled sinusoidal or cavernous spaces. The expanding mass often disrupts the normal bony architecture, with erosion of the cortex. Surgical treatment consists of complete excision or curettage. In this report, we present a 5-year-old girl with a huge aneurysmal bone cyst in the corpus of the mandible, which was reconstructed with bone graft taken from bilateral anterior iliac crests.

A newborn infant with intrapericardial rhabdomyosarcoma: a case report

Cardiac tumors are uncommon in neonates and most of them are histologically benign. The most common cardiac tumor in neonates and infants is rhabdomyoma. Malignant cardiac tumors are considerably rarer, and rhabdomyosarcoma (RMS) is the leading malignancy. To our knowledge, only one case of intrapericardial RMS was reported in the literature, in a seven-month-old baby. Here we present another newborn baby with intrapericardial RMS.

A case of concha pyocele (concha bullosa mucocele) mimicking intranasal mass

Concha bullosa is the most common anatomic variant of the middle turbinate that usually remains asymptomatic. If the mucosal lining of pneumatized middle turbinate becomes inflamed, symptoms such as nasal obstruction, post-nasal discharge, snoring, headache, and fever occur. We report a case of concha pyocele (concha bullosa mucocele) in a 19-year-old girl. Computed tomography identified a right intranasal mass expanding towards the medial wall of the right maxillary sinus, nasal septum and right ethmoidal cells. The concha pyocele caused obstruction of the ostiomeatal complex, leading to right maxillary, ethmoid and sfenoid sinusitis. The patient was endoscopically treated under local anaesthesia. Histological examination of the mass revealed an active chronic inflammation caused by a foreign body.

Diagnostic Dilemma in an Adolescent Boy: Hemophagocytic Syndrome in Association with Kala Azar

Leishmaniasis is caused by infection with the hemoparasite Leishmania. The disease is a major public health problem in at least 88 countries, including Turkey. Prolonged fever with anorexia and loss of appetite are the major presenting features of visceral leishmaniasis. It is rarely defined as an etiological cause of hemophagocytic syndrome. The clinical course triggered by leishmania infection and hemophagocytosis may coincide, and this may lead to considerable diagnostic difficulty, especially in young children. In this report, we describe an adolescent boy with visceral leishmaniasis as a rare cause of the hemophagocytic syndrome. This is the first reported association between hemophagocytosis and visceral leishmaniasis in an adolescent.

Intramuscular Dipyrone versus Oral Ibuprofen or Nimesulide for Reduction of Fever in the Outpatient Setting

OBJECTIVE

To compare the effectiveness and rate of temperature reduction of three antipyretic medications in febrile children.

DESIGN

A single-dose, randomised, prospective, modified double-blind, parallel clinical trial.

SETTING

The paediatric emergency department of a university hospital that has 13 000 annual visits.

STUDY PARTICIPANTS

252 otherwise healthy children aged 6 months to 14 years with acute, intercurrent, febrile illness.

INTERVENTIONS

Enrolled children were assigned to receive a single dose of oral ibuprofen 10 mg/kg, oral nimesulide 2.5 mg/kg, or parenteral dipyrone 10 mg/kg.

MAIN OUTCOME MEASURES AND RESULTS

Axillary temperature was measured at the time of antipyretic administration and at 30, 45, 60 and 120 minutes thereafter. All three medications were effective in reducing the axillary temperature during the 2-hour testing period. The rates of axillary temperature change between the three medications were significantly different for the ibuprofen and dipyrone groups (p = 0.023). In addition, the axillary temperature in the dipyrone group was significantly lower than that in the ibuprofen group (p = 0.036) at 120 minutes. There was no significant difference in antipyretic effect between the nimesulide group and the other two groups during the testing period. Within each group the difference between initial temperature and the temperature at the end of the testing period was statistically significant (p = 0.036) for the dipyrone group only.

CONCLUSIONS

All three antipyretic medications were effective in reducing the axillary temperature in febrile children. Although administration of intramuscular dipyrone seemed to be more effective than ibuprofen, this relationship was not significant when nimesulide was considered. In addition, in view of its known side effects and the problems associated with intramuscular administration in children, the preference for orally administered nimesulide or ibuprofen over dipyrone in the setting of the emergency department seems more logical provided that the child accepts oral therapy.

Comparison of the effects of melatonin and pentoxifylline on carbon tetrachloride-induced liver toxicity in mice

The purpose of the study was to determine whether along and in combination melatonin (MLT) and pentoxifylline (PTX) exerted beneficial effects on histopathological changes and changes in oxidant and antioxidant systems in liver caused by CCl4-induced liver toxicity in mice. Mice were randomly divided into six groups: control, olive oil, toxicity, MLT, PTX, PTX+MLT. MLT 10 mg/kg/day, PTX 50 mg/kg/day, and the same individual doses in MLT+PTX combination were given intraperitoneally to mice for 7 day. CCl4 0.8 mg/kg/day was administered on the 4th, 5th, and 6th days of therapy in all groups except the control and olive oil groups. In the toxicity group, increased concentrations of malondialdehyde (MDA) and lipid hydroperoxides (LOOH) and decreased glutathione peroxidase (GSH-Px) and catalase (CAT) activities were found compared to the control and olive oil groups (p < 0.05). Compared to the toxicity group, both the PTX group and the PTX+MLT group had decreased MDA and LOOH levels, whereas MLT reduced only LOOH levels (p < 0.01). MLT, PTX and MLT+PTX increased the GSH-Px and CAT activities compared to the toxicity group (p < 0.05). MLT increased CAT activity compared to PTX and MLT+PTX (p < 0.05). Superoxide dismutase enzyme activity did not change in any group (p < 0.05). Histopathologically, ballooning, degeneration, apoptosis, and bridging necrosis were seen in the toxicity group. MLT, PTX and MLT+PTX decreased the apoptosis and bridging necrosis (p < 0.01), and PTX and MLT+PTX decreased balloon degeneration compared to the toxicity group (p < 0.01). These results indicate that administration of PTX and MLT alone and in combination before onset of liver toxicity might prevent the oxidative damage by reducing oxidative stress and increasing antioxidant enzyme levels.

Primary giant leiomyoma of the ovary--case report

Primary leiomyoma of the ovary, which is of unknown origin, is an extremely rare tumor of ovary. We report a rare case of giant primary ovarian leiomyoma with an unusual presentation, ascites, elevated CA125 and discuss the preoperative imaging findings. A 45-year-old woman was referred for evaluation of an adnexal mass of 8 x 9 cm with ascites and elevated CA125 levels. Preoperative imaging studies were in accordance with fibroma/thecoma. At laparotomy total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological and immunhistochemical examination revealed primary ovarian leiomyoma.

A neonate with malignant ectomesenchymoma

Malignant ectomesenchymoma is a rare tumor reported in head-neck, abdomen and perineal regions. It consists of mesenchymal and neuroectodermal elements. In this tumor group, neoplastic cells are differentiated into neuronal cells. It also has at least one malignant mesenchymal element, generally rhabdomyosarcoma. In this report we present a neonate with ectomesenchymoma.

Papillary thyroid carcinoma presenting as a giant cervical mass: a case report

Papillary thyroid carcinoma (PTC) is a relatively uncommon malignancy. The prognosis is generally good and the mortality rate is low. PTC is more common in younger patients; incidence is two to three times higher in women and in individuals with radiation exposure to the neck. We report on a 75-year-old woman with PTC admitted to our clinic for a giant mass in the neck dating back ten years. A hyperintense huge cystic lesion and hypo-intense central solid component were seen on T1- and T2-weighted magnetic resonance imaging. No distant metastasis was present. The PTC was treated surgically and radioiodine (131I) treatment was applied postoperatively. No recurrence was observed one year later.

The prevalence of asthma and allergic diseases in children of school age in Adana in southern Turkey

The aim of this study was to determine the prevalence of asthma and other allergic disorders as well as the factors affecting these disorders in school-children in Adana. This cross-sectional population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was carried out on 3164 school-children aged between 6-18 years during March to June 1997. There were 1521 (48.1%) boys and 1643 (51.9%) girls. The prevalence of asthma, allergic rhinitis and eczema in the 6-18 year-old children was found to be 12.6%, 13.6% and 8.3%, respectively. The prevalence of asthma was highest in 6-10 year-old school-children (14.7%), and lowest (6.0%) in 15-18 year-old children. The prevalence of asthma diagnosed by a doctor was 5.0%. The cumulative and current prevalences of wheezing were found to be 19.0% and 13.5%, respectively. The cumulative prevalence of allergic disorders was found to be 23.4%. The presence of domestic animals at home and dampness of the home were found to be important risk factors for asthma. Family histories of asthma, eczema, and diagnosis made by a doctor, and history of frequent sinusitis were found to be significantly higher in asthmatics. In conclusion, asthma is an important chronic disease of childhood in Adana in southern Turkey.

The use of surfactant in children with acute respiratory distress syndrome: efficacy in terms of oxygenation, ventilation and mortality

PURPOSE

The aim of this prospectively designed study was to investigate the efficacy of surfactant (S) for acute respiratory distress syndrome (ARDS) in children.

MATERIALS AND METHODS

Children with ARDS were included in this study. Surfactant (Survanta, Abbott, USA) was given intratracheally at a dose of 150 mg/kg every 12 h for a total of two doses. During the study period none of the patients received permissive hypercapnia, high frequency ventilation, nitric oxide or ECMO. Peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), ventilation rate, mean airway pressure, tidal volume (TV), Murray index, PaO2/FiO2, ventilation index (VI), oxygen index (OI) and arterial oxygen tension difference (A-aDO2) were measured before and 48 h after surfactant treatment. Duration of mechanical ventilation therapy, duration in paediatric intensive care unit (PICU) and mortality rate were recorded.

RESULTS

Among the 36 children who met the inclusion criteria, 12 were treated with surfactant. The mean age was 72.5+/-56.2 months; 47% of children were male. Infants were ventilated by pressure-controlled ventilators whereas for older children volume-controlled ventilators were used. Sepsis (42%) was the main predisposing factor followed by pneumonia (25%) and malignancy (17%). The baseline characteristics including age, predisposing factors, gender, PIP, PEEP, A-aDO2, PaO2/FiO2, OI, TV, VI and Murray index were similar in the surfactant and non-surfactant (NS) group (p>0.05). There were significant improvements in PIP, PEEP, A-aDO2, PaO2/FiO2, OI, TV, VI and Murray index in the surfactant group after surfactant treatment compared with NS group (p<0.05). Duration of PICU stay and ventilator treatment was longer in NS group (14+/-3.7, 1.8+/-3.2 days vs. 9.2+/-3.1, 8.6+/-1.9 days), (p<0.05). Mortality rate was 42% in surfactant compared with 63% in the NS group, (p>0.05). Children in the surfactant group lived significantly longer (p<0.05).

CONCLUSIONS

Modified natural surfactant is an effective treatment option in children with ARDS for improving gas exchange, decreasing the use of ventilatory support and increasing survival time.

The results of treatment with idarubicin in childhood acute nonlymphoblastic leukemia

Anthracycline and cytosine arabinoside are used in combination as the standard therapy for remission induction of acute nonlymphoblastic leukemia. Idarubicin, a synthetic daunorubicin analogue, shows an improved spectrum activity and diminishes acute or chronic toxicity when compared with the other anthracyclines. This study has been carried out in our clinic in order to evaluate the efficiency of the acute nonlymphoblastic leukemia protocol which includes idarubicin. Thirty-eight patients admitted to our Department between 1992-1999 and diagnosed as acute nonlymphoblastic leukemia (ANLL) were included in the study. Their median age was 7 years 6 months (range, 8 months to 14 years). Induction therapy consisted of idarubicin plus cytosine arabinoside and etoposide. Consolidation therapy consisted of two courses, followed by maintenance therapy with thioguanine, cytosine arabinoside, vincristine and cyclophoshamide. The complete remission rate was found to be 71%. The overall survival estimate was found to be 40% for one year and 23% for three years. We established that the protocol with idarubicin reached a higher remission ratio when compared with the other protocols with anthracycline. However, the degree of the hematologic toxicity ratios related to the therapy increased the complication ratios, which affected the long-term life analyses directly. Therefore this protocol may be revised according to socioeconomical conditions, especially in the developing countries.

Effects of poppy seed meal on egg production and hatching results in quail (Coturnix coturnix japonica)

This study was carried out to determine the effects of poppy seed meal (PSM) on the egg production and hatching of quail. Two experiments were undertaken. In the first experiment, 240 quail, reared under the same conditions, were divided into four groups of 60 birds each (which were, in turn, subdivided into four subgroups of 15 each for experimental replicates). The first, second, and third experimental groups were fed ratios containing 5%, 15%, and 25% PSM, respectively, over 12 weeks. The control group received no PSM. Feed and water were supplied ad libitum and artificial light was provided for 16 h a day. During the first experiment, egg production, egg weight, and feed conversion ratio (FCR) were measured. In the second experiment, 240 female and 48 male quail were divided into four groups, as in the preceding experiment, and the birds were housed in cages at a ratio of one male to five females. The diets and their presentation to the quails were the same as in the preceding experiment. The results of the two experiments showed that the addition of PSM to the feed ratios increased egg production, feed consumption, and feed conversion per kg of eggs and per dozen eggs. However, PSM addition at all percentages significantly reduced (P<0.001) hatchability, mainly because of increased infertility and embryonic deaths.

Hepatoprotective effect of Foeniculum vulgare essential oil

Hepatoprotective activity of Foeniculum vulgare (fennel) essential oil (FEO) was studied using carbon tetrachloride (CCl(4)) induced liver injury model in rats. The hepatotoxicity produced by acute CCl(4) administration was found to be inhibited by FEO with evidence of decreased levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and bilirubin. The results of this study indicate that FEO has a potent hepatoprotective action against CCl(4)-induced hepatic damage in rats.

Klippel-trenaunay-Weber syndrome with hydronephrosis and vesicoureteral reflux: an unusual association

The Klippel-Trenaunay-Weber syndrome is a rare disorder characterized by congenital vascular hamartomas, limb hypertrophy, cutaneous manifestations, lymphangiomas and atresia of lymph vessels with non-pitting edema. A three-year-old boy was referred to our clinic for progressive hypertrophy of leg and feet with 32-month history. We diagnosed Klippel-Trenaunay-Weber syndrome, and determined vesicoureteral reflux in our patient. To our knowledge, hydronephrosis and vesicoureteral reflux have not been described previously in the KTWS.