Hypothyroidism Due to Hepatic Hemangioendothelioma: A Case Report

Although hemangioendothelioma (HHE) is a commonly encountered hepatic tumor during infancy, HHE−related hypothyroidism is rare. We present a patient who developed HHE−related hypothyroidism during the neonatal period and showed marked improvement in hypothyroidism by regression of HHE. A 28−day−old boy with TSH level of 77 mIU/mL on neonatal screening and diagnosed as congenital hypothyroidism was started on L−thyroxine (L−T4) (11 μg/kg/day) therapy on the 21th day of life. On physical examination, the liver was palpable 5 cm below the right costal margin, and the thyroid gland was nonpalpable. Thyroid ultrasonography was normal. Although L−T4 dose was increased to 15 μg/kg/day, TSH was not suppressed and free T3 level remained low. HHE in both lobes of the liver was detected by abdominal ultrasonography and magnetic resonance imaging. Treatment was started with prednisolone 2 mg/kg/day and alpha−interferon 3 million U/m2/3 times per week. Thyroid dysfunction was thought to be due to type 3 iodothyronine deiodinase activity expressed by HHE. L−T4 therapy was changed to Bitiron® tablet, which includes both T4 and T3, and euthyroidism was attained within 1 month. Thyroid hormone requirement was reduced and treatment was discontinued after regression of the HHE. At the most recent visit, the patient was 21 months old and off treatment. His growth and neurological development were normal for age and he was euthyroid. HHE should be considered in cases with severe hypothyroidism resistant to high−dose thyroid hormone replacement. The treatment of HHE in combination with T4 and T3 therapy results in euthyroidism

Evaluation of cardiac functions by tissue Doppler echocardiography in the long term follow-up of patients with childhood Hodgkin Lymphoma

Amaç: Hodgkin lenfoma hastalarında tedavi ile ilişkili kardiyomiyopati yakınmasız da olabilen bir sorundur. Bu çalışmanın amacı Hodgkin lenfoma hastalarında potansiyel olarak var olan tedavi ile ilişkili kardiyomiyopatiye tanı konmada doku Doppler ekokardiyografi tekniğinin geleneksel ekokardiyografi tekniğine oranla bir üstünlüğünün olup olmadığının araştırılmasıdır. Gereç ve Yöntem: En az dört yıl süreyle hastalıksız izlenen ve kalp yakınması olmayan 17 Hodgkin lenfoma hastası (12 erkek, 5 kız) ve kontrol grubu olarak 14 sağlıklı kişi (8 kız, 6 erkek) çalışmaya alındı. Hastaların kalp işlevleri M-mod, 2 boyutlu, renkli Doppler, CW Doppler ve pulse Doppler teknikleri ile değerlendirildi. Veri analizleri Statistical Package for Social Science for Windows 11,5 paket programı ve sırasıyla Shapiro Wilk, Student’s t testi, Mann Whitney U, Fisher’in kesin sonuçlu ki-kare testleriyle yapıldı. Çalışma için hastane yerel etik kurul onayı alındı (07.05.2007/no:5639). Bulgular: Her iki grup geleneksel ekokardiyografi yöntemleri ile ejeksiyon fraksiyonu ve kısalma fraksiyonu açısından değerlendirildiğinde gruplar arasında fark gözlenmedi (sırasıyla p=0,302 ve p=0,860). Her iki grup sol ventrikül izovolemik ivmelenme zamanı açısından değerlendirildiğinde ölçümler hasta grubunda kontrol grubuna oranla istatiksel olarak anlamlı biçimde kısa bulundu (p:0,038). Miyokardiyal performans indeksi ölçümleri ve sol ventrikül izovolemik kasılma zamanı ölçümleri açısından değerlendirildiklerinde ise yapılan ölçümler hasta grubunda kontrol grubuna oranla istatistiksel olarak anlamlı biçimde uzamış olarak bulundu (sırasıyla p=0,029 ve p=0,049). Çıkarımlar: Sol ventrikül izovolemik ivmelenme zamanı, miyokardiyal performans indeksi ve sol ventrikül izovolemik kasılma zamanlarının tedavi ile ilişkili kardiyomiyopatiyi erken belirlemede önemli ölçümler olduğu sonucuna varılmıştır. (Türk Ped Arfl 2011; 46: 228-33)Aim: Treatment-associated cardiomyopathy which is one of the side effects of treatment, can be asymptomatic in Hodgkin lymphoma patients. The aim of this study was to find out whether tissue Doppler echocardiography was superior to conventional echocardiography in determining potential cardiac problems in the patients diagnosed with Hodgkin lymphoma. Material and Method: A total of 17 Hodgkin lymphoma patients (12 males, 5 females), and whose treatment had been stopped for at least 4 years were being followed-up with disease-free status and without cardiac symptoms and a control group of 14 healthy persons (8 males, 6 females) were included in the study. The cardiac functions of the patients were evaluated by M-mode, 2 dimentional, colour Doppler, CW Doppler and pulse Doppler techniques. Data analyzes were evaluated by program of Statistical Package for Social Science for Windows 11.5, and Shapiro Wilk, Student’s t testi, Mann Whitney U, Fisher’s exact chi square tests, respectively. Hospital ethic committee consent was received for the study (07.05.2007/no:5639). Results: There were no statistical differences between the two groups (p=0.302 and p=0.860 respectively) when both groups were evaluated in terms of ejection fraction and fraction shortening by conventional echocardiography technique. Evaluation of both groups for the left ventricle isovolumic contraction time revealed a statistically significant longer time in the patient group compared with the control group (p: 0.038). The results were found longer in the patient group compared with the control group when both groups were evaluated in terms of myocardial performance index parameters and the left ventricle isovolumic contraction time parameters (p=0.029 and p=0.049, respectively). Conclusions: We concluded that the left ventricle isovolumic contraction time, the left ventricle isovolumic acceleration time and myocardial performance index tests are important parameters for the early detection of cardiac pathologies that may develop in relation to chemotherapy. (Turk Arch Ped 2011; 46: 228-33

Cross-sectional study: long term follow-up care for pediatric cancer survivors in a developing country, Turkey: current status, challenges, and future perspectives

Aim: The main purpose of this study is to determine the current status of long-term follow-up (LTFU) for childhood cancer survivors and the challenges of LTFU for pediatric cancer survivors at pediatric oncology institutions in Turkey

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19