A CASE OF HENOCH-SCHOENLEIN PURPURA PRESENTING WITH SUBCUTANEOUS EDEMA

Henoch-Schonlein purpura çocukluk yaş grubunda en sık görülen sistemik vaskülit olup, klasik bulguları non-trombositopenik purpura, artrit, renal ve gastrointestinal sistem tutulumudur. Ancak, hastalar zaman zaman atipik klinik bulgular ile başvurabilirler. Bu makalede el ve ayak sırtında, alın bölgesinde ve bilateral göz kapaklarında ağrı ve şişlik yakınmaları ile başvuran bir Henoch-Schonlein purpura olgusu sunulmuştur. Henoch-Schoenlein purpura, the most common systemic vasculitis in the pediatric age group, is classically characterized by non-thrombocytopenic purpura, arthritis, and renal and gastrointestinal tract involvement. However, some atypical presentations are described. Here, we describe a patient with Henoch-Schoenlein purpura presenting with edema and pain on his hand, foot, forehead and eyelids

İntravenous immunglobulin therapy in a casewith chronic bullous disease of childhood

Çocukluk çağının kronik büllöz hastalığı nadir görülen, etiyolojisi tam olarak bilinmeyen subepidermal büllü hastalıklardandır. Bu hastalıkta direkt immunofloresan yöntemi ile epidermal bazal membranda IgA'nın lineer depolanması patognomoniktir. Tedavide sıkılıkla dapson kullanılır. Intravenöz immunglobulin tedavide yeni bir yaklaşımdır. Oniki aylık erkek hasta özellikle ağız çevresinde olmak üzere yüzünde, kalçasında, kol ve bacaklarında çok sayıda bül varlığı yakınması ile başvuru üzerine hastaneye yatırıldı. Cilt biyopsi örneğinin direkt immunofloresan yöntemiyle incelenmesinde dermoepidermal hat boyunca IgA depolandığı görüldü. Bu bulgularla olguya çocukluk çağı kronik büllöz hastalığı tanısı konuldu. Olguda tedavi amacıyla intravenöz immunglobulin kullanıldı ve üç gün içinde tüm lezyonların tamamen iyilestiği belirlendi. Hasta bir yıldır herhangi bir tekrarlama görülmeksizin takip edilmektedir.Chronic bullous disease of childhood, one of the subepidermal bullous diseases is uncommon, and its etiology has not fully understood. A linear deposition of IgA at the epidermal basement membrane on direct immunoflorescence is pathognomonic for the disease. Dapson is commonly used in the therapy. Intravenous immunglobulin is a recent choice in the treatment. A twelve-months old boy was admitted to the hospital with the complaints of mutipl blisters on his face, especially perioral region, buttocks and extremities. Examination of the skin biopsy specimen with direct immunoflorescence method showed linear deposits of IgA along the dermoepidermal junction. In the light of the findings, condition was diagnosed as chronic bullous disease of childhood. Following the intravenous immunglobulin use for treatment, the skin lesions revealed rapid healing within three days

Hinman syndrome: case report

Hinman sendromu yapısal ve nörolojik bir neden olmaksızın eksternal sfinkterin iseme sırasında gevseyememesi ile karakterize bir hastalıktır. Dört yasındaki kız olgu kesik kesik idrar yapma, gece, gündüz ıslak kalma ve tekrarlayan idrar yolu enfeksiyonu yakınmaları ile yatırıldı. Bu yakınmalarının 7 ay önce basladıgı ögrenildi. Fizik muayenesinde glob vezikal saptanan hastanın yapılan batın ultrasonografisinde her iki böbrek pelvisinde dilatasyon, voiding sistoüretrografide mesane kapasitesinde azalma, kontur düzensizligi saptandı, vezikoüreteral reflü gösterilemedi. Ürodinamik çalısmaile detrusor sfinkter dissinerjisi saptandı ve Hinman sendromu tanısı kondu. Olgu ilgi çekici olması nedeniyle literatür esliginde sunuldu.Hinman syndrome, also called detrusor-sphincter dyssynergia is characterized by failure of the external sphinchter to relax during voiding in the absence of a definable structural and neurological cause. A four year-old girl was admitted hospital with the complaints of intermittant stream, daytime wetting and recurrent urinary tract infections. It was learned that these complaints had begun seven months ago. Globe vesicale was found in the physical examination; and abdominal ultrasonography revealed bilateral renal pelvic dilatation and decreased capasity; and irregular contour of bladder were detected in the voiding cystourethrogram but vesicoureteral reflux was not found. Detrussor sphyncter dyssynergia was determined according to the results of urodynamic studies and she was diagnosed as Hinman syndrome. This case was presented with a reviev of the literature since it was interesting

Foreign body aspiration in childhood

Amaç: Solunum sistemine aspire edilen yabancı cisimlerin belirlenip, çıkarılması komplikasyonların önlenmesi açısından önemlidir. Bu nedenle 10 aylık sürede yabancı cisim aspirasyonu süphesi ile klinigimize yatan 22 hasta retrospektif olarak degerlendirildi. Hastalar ve yöntem: Hastaların 16'sı erkek, 6'sı kız ve yasları 11 ay ile 57 ay arasında idi (ortalama 24 ay). En sık basvuru sikayeti; öksürük, hısıltılı solunum ve morarma olup, hastaların sadece 8'i solunum sıkıntısı ile basvurmustu. Olguların 15'inde fizik muayene bulguları, 14' ünde ise akciger grafisi bulguları tanıyı desteklemekteydi. Yabancı cisim öyküsü olan 19 olgunun 14'ünde akciger dinleme bulguları, 11'inde radyoloji pozitif saptandı. Öyküsü olmayan 3 olgunun 1'inde akciger dinleme bulguları varken, hepsinde radyoloji pozitif bulundu. Bulgular: Hastaların 21'inde (%95,5) bronkoskopide yabancı cisim çıkarıldı. Bir olguda yabancı cisim bulunamadı ve bol mukus aspire edildi. Yabancı cisim öyküsü oldugu halde fizik muayenede ve akciger grafisinde herhangi bir bulgusu olmayan 4 olgunun 3'ünde yabancı cisim çıkarılması öykünün öneminin vurgulanması açısından degerli bulundu. Çıkarılan yabancı cisimlerin 15'i organik, 2'si inorganik idi, 2'sinin orijini belirlenemedi. Iki hastada darlık yapan granülasyon dokusu tespit edildi ve bu granülasyon dokuları kürete edildiginde; 1'inde bitkiye benzer materyal saptanırken digerinde granülasyon dokusu içinde yabancı cisime rastlanmadı. Yabancı cisimlerin hastaların 10'unda (%47.6) sol ana bronstan çıkarılması ilginç bulundu. Hastaneye basvuru sürelerine göre olgular klinik, semptomatoloji ve radyolojik bulgulara göre karsılastırıldıgında iki grup arasında sadece radyolojik bulgular açısından anlamlı fark bulundu(p=0.0045). Sonuç: Bu çalısma 6 yas altı çocukluk döneminde yabancı cisim aspirasyonlarının sanılandan daha sık oldugu, yabancı cisimden süphelenmenin ve iyi bir öykünün en önemli tanı kriterleri oldugunun hatırlatılması amacıyla sunuldu.Aim: Determining and removing the aspirated foreign bodies from airways is important in preventing complications. Thus, 22 patients who had admitted to our clinic with the suspicion of airway foreign body within a period of 10 months were retrospectively evaluated. Material and methods: Sixteen patients were boys and six were girls, and their ages differed from 11 to 57 months (median 24 months). The common complaints were cough, wheezing and cyanosis. Only 8 patients were admitted to the hospital with respiratory distress. The physical examination revealed the diagnosis in fifteen of the patiens. On the other hand, the chest roentgenography revealed the diagnosis in thirteen. The foreign bodies were removed by bronchoscopy in 21 patients (95.5%). In spite of positive history, no signs and symptoms were determined by physical examination and chest roentgenography in 3 of 4 patients, the foreign body was removed from airway and it was accepted valuable to stress the importance of history. Results: Fifteen of the removed foreign bodies were organic, 2 were inorganic, and 2 could no be determined. In 2 patients the granulation tissue which had caused obstruction in the airway was curetted and in one patient a plant- like material was obtained. Only in one patient no foreign body was obtained. In 10 patients (47.6%) the foreign body was removed from left main bronchi, in 8 patients (38.1%) from right main bronchi, in 2 patients from trachea and in 1 patient from bilateral bronches. Conclusion: We presented this study to remind that in making the diagnosis of airway foreign body, which is more common in infancy than expected, suspicion and history are the most important diagnostic criteria

Pediatric Emergency Department Visits Related to Home Accident in the Era of COVID-19 Pandemic

Introduction:The Coronavirus disease-2019 pandemic has been caused several physical, mental and psychosocial problems alongside being a respiratory system infection. During pandemic, children were forced to stay at home as a preventative measure. Thus, we aimed to assess the number and characteristics of home accident-related visits in a pediatric emergency department during the pandemic.Methods:This cross-sectional study included all children aged under 18 years who admitted with home accident in two curfew periods and the corresponding periods of previous year. Demographic and clinical data was consisted of age, gender, admission time, time elapsed between accident and pediatric emergency department admission, type of home accident, medical and surgical interventions, length of stay in pediatric emergency department, hospitalization, or intensive care unit admission and mortality. The data of curfew periods was compared with its control periods by using Mann- Whitney U test, t-test or chi-square. The statistical significance was defined as p≤0.05.Results:We enrolled 744 patients. There was no significant difference in age, gender, time elapsed from the accident, ratio of hospitalization between curfew and control periods. The proportions of home accidents among all admissions were higher in two curfew periods (p=0.001 and p<0.001). The ratio of poisoning and foreign body ingestions was increased during both two curfew periods (0.7% vs. 0.3%, p=0.001 and 0.7% vs. 0.1%, p<0.001 for poisoning; 0.4% vs. 0.1%, p<0.001 and 0.8% vs. 0.1%, p<0.001 for foreign body ingestion) and the ratio of trauma was increased in the curfew-2 period (1.2% vs. 0.3%, p<0.001).Conclusion:We suggested a higher ratio of home accidents especially poisoning and foreign body ingestions in curfew period. Thus, in case of global disasters such as pandemic the authorities should improve preventative and healthcare strategies to establish a safe environment for children and adolescents

Evaluation of musroom intoxications presenting at the emercency department of dr. behçet uz children's hospital

Mantar zehirlenmeleri tüm dünyada sıkça görülen önemli bir sorundur. Eriskinlerde mantar zehirlenmeleri tüm akut zehirlenme vakalarının yaklasık %7'sini olusturmaktadır. Klinik, mantarın cinsine göre hafif bir bulantı kusmadan, karaciger yetmezligine kadar degismektedir. Bu çalısmada, Ocak-Aralık 2002 tarihleri arasında Dr. Behçet Uz Çocuk Hastanesi Acil Servisi'ne mantar zehirlenmesi nedeni ile basvuran 21 olgu retrospektif olarak degerlendirildi. Olguların 11'i (%52) kız, 10'u (%48) erkekti. 21 olgunun 9'unun (%43) 10 yas ve üzerinde oldugu ve 17'sinin (%81) sonbahar aylarında basvurdugu belirlendi. En sık gelis sikayeti; 17 olguda (%81) bulantı ve kusma, 5 olguda (%24) buna ek olarak ishal idi. 7 olguda (%33) kolinerjik semptomlar, 3 olguda karaciger yetmezlik bulguları ve 6 olguda (%28) nörolojik bulgular vardı. Ölüm 3 olguda (%14) karaciger yetmezligi nedeni ile olurken 18 olgu (%85) sekelsiz iyilesti. Sonuç olarak, Izmir ili ve çevresindeki mantar zehirlenmelerinin genellikle 10 yasın üzerinde ve sonbahar aylarında gerçeklestigi ve karaciger yetmezligi gelisenlerin dısında çogunlukla sekelsiz iyilestigi saptanmıstır.Mushroom toxicity is a worldwide concern. In the adult population, mushroom toxicity constitutes seven percent of all acute intoxications. The clinical feature may vary from mild nausea and vomiting to hepatic insufficiency according to the type of mushroom. In this study, we analyzed 21 patients who were seen at the Emercency Department of Dr. Behçet Uz Chıldren's Hospıtal from January 2002 to December 2002. 11 of the 21 patients (52%) were female and 10 of them (48%) were male. 9 of the 21 patients (43%) were older than 10 years and 17 of the 21 patients (81%) were hospitalized in spring. The most common symptoms were vomiting in 17 patients (81%) and diarrhea in 5 patients (24%).We observed cholinergic symptoms in 7 patients (33%), hepatic insufficiency in 3 patients (14%) and neurologic symptoms in 6 patients (28%). Death occured in 3 patients as a result of hepatic insufficiency and the rest of the patients recovered without any sequelae. Mushroom intoxications in Izmir and envira were mostly diagnosed in children older than 10 years and in spring. Most of the patients recovered without any problems, except patients who developed hepatic insufficiency

A Child with Acute Appendicitis Secondary to Blunt Abdominal Trauma: A Case Report and Review of the Literature

We present a child with abdominal pain and vomiting after blunt abdominal trauma (BAT). He had tenderness, guarding and rebound on the bilateral lower quadrant of the abdomen. He had no abrasion on the abdominal skin surface. He had marked leukocytosis and increased C-reactive protein level. Contrast-enhanced abdominal computed tomography revealed inflamed appendicitis. He was operated by pediatric surgeons and, an perforated appendix was illustrated on pathological examination. BAT and acute appendicitis (AA) are independently very frequent issues. In pediatric emergency departments, BAT and AA are very frequent issues, however, coexistence of these two condition in the same patient is rare. This case report and review of the literature showed that occurrence of AA after BAT should be considered by emergency physicians

Point-of-Care Ultrasound as a Diagnostic Tool for Nutcracker Syndrome in Pediatric Emergency Department

Abdominal pain is one of the most common causes of admission to pediatric emergency department. Point-of care ultrasonography combined with appropriate history and physical examination provides rapid and accurate management of abdominal pain in emergency setting. Here, we report a 15-year-old girl with abdominal pain who was diagnosed with Nutcracker syndrome by the guidance of point-of-care ultrasound findings