The clinical and laboratory characteristics of patients with periodic fever, apthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome

Objective: The aim of this study is to evaluate the clinical and laboratory findings and results of the treatment in patients with PFAPA

Foreign body aspiration mimicking croup syndrome: Case report

The term croup refer to a group of conditions involving inflammation of the upper airway that leads to a cough that sounds like a bark, difficulty breathing, and a grunting noise or inspiratory stridor during breathing. The most common characteristics of these ailments are upper airway obstruction. The obstruction level determines the degree of respiratory distress and rarely causes respiratory failure as well. Except for croup the other causes of acute upper airway obstruction in children are inhalated foreign bodies, retropharyngeal abscess, bacterial tracheitis and epiglottitis. Two cases presented to the emergency department with the diagnosis of croup syndrome. A 9 month old girl had an incremental stridor which was lasting for two months. She underwent rigid bronchoscopy with removal of an undefined foreign body organized at vocal cord level. The other case, a 19 month old boy, was admitted with cardiac arrest. On observation after a choking episode he ejected a piece of peanut spontaneously

Evaluation of Chronic Cough in Children

Chronic cough in children is among the problems that lead to frequent consultations with a doctor. in this study, we attempted to research the reasons for chronic cough by an evaluation method using the guidelines that were suggested for children by the American College of Chest Physicians (ACCP) in 2006. We studied 108 children between 6 and 14 years of age who had a cough that lasted for > 4 weeks. The patients were reevaluated during the second to fourth weeks, and until either the cough terminated or resolved. Twenty-five percent of the patients received diagnoses of asthma and asthma-like symptoms, 23.4% received diagnoses of protracted bronchitis, 20.3% received diagnoses of tipper airway cough syndrome (UACS), and 4.6% received diagnoses of gastroesophageal reflux disease. Asthma and asthma-like symptoms, protracted bronchitis, and UACS were detected in order of frequency as the reason for chronic cough in children. We concluded that the 2006 ACCP guidelines for the management of chronic cough in children are effective and can be successfully utilized in a nonaffluent study setting

Parental knowledge and practices regarding febrile convulsions in Turkish children

Aims: Families with children afflicted with febrile convulsions must be given adequate information regarding seizures and fever, and they need emotional support and first-aid demonstrations. In this study, we aimed to determine parental knowledge and practices regarding febrile convulsions in Turkish children. Materials and Methods: Questionnaires were given to 122 parents whose children were admitted to the emergency service of Behcet Uz Children's Hospital between July 2006 and April 2007 with febrile convulsion episodes. Sixty-three parents whose children had a febrile convulsion for the first time (Group 1) and 59 parents whose children had a recurrent febrile convulsion (Group 2) completed the survey. Differences in parental knowledge and practices regarding febrile convulsions in the two groups were tested by Student's test or chi-square (X(2)) test. Results: Parents in both groups generally believed that febrile convulsion is a life-threatening event (81.2% and 90%), and that EEG and CT were necessary (81% and 88.1%). Forty-seven parents (73.4%) in Group 1 and 52 (85.2%) in Group 2 had concerns about possible development of epilepsy in their children in the future. Approximately half of the parents did not know what to do during a febrile convulsion episode. Conclusions: We believe the questionnaire facilitates the quantitative measurement and systematic evaluation of the knowledge, attitude and concerns of families in the matter of febrile convulsions. Furthermore, the efficiency of parental first-aid practices can be evaluated and significant improvement can be achieved by giving adequate information to the parents

A Case of Acute Mediastinitis Presenting with Generalized Edema

Acute mediastinitis is a serious infection which occurs around the mediastinal tissues. It is a rare clinical condition. The most common causes are esophageal perforation and postoperative infection, particularly following median sternotomy. Early diagnosis is effective on mortality but because of atypical initial findings the diagnosis can be delayed. We report a 3-year-old boy admitted with generalized edema, fever and cough. His chest radiography revealed an acute mediastinal widening and computed tomographic scan showed a mediastinal abscess with pericardial and pleural effusion

Pneumomediastinum and subcutaneous emphysema during asthmatic attacks in three patients

Pneumomediastinum is defined as free air or other gases contained within the mediastinum. In children it is an uncommon clinical condition with good prognosis. It most frequently occurs with exacerbations of asthma but also may occur after cough, vomiting, excessive valsalva maneuver and after the first wheezing attack as well. The first-line treatment for pneumomediastinum is to relieve the inciting factor. Otherwise, no specific therapy is recommended for uncomplicated cases, three boys, with the ages of 4, 8 and 13, presented in the emergency department, each after a few days of shortness of breath and respiratory distress. Chest radiography revealed pneumomediastinum and subcutaneous emphysema which had occured after severe asthmatic attacks. All of these patients have improved spontaneously with conservative treatment

Clinical and laboratory evaluation of cases with Periodic Fever Aphtous Stomatitis, Pharyngitis and Adenopathy syndrome

Objective: Periodic Fever Aphatous Stomatitis, Pharyngitis and Adenopathy (PEAPA) syndrome is characterized by fever, aphthous stomatitis, tonsillitis, pharyngitis and cervical adenopathy. This syndrome is sporadic and has no specific laboratory findings. The aim of this study was to evaluate the clinical and laboratory findings of the patients with PFAPA syndrome and to determine the response to administered therapies. Material and Methods: Patients who presented with periodic fever and were diagnosed with the PFAPA syndrome between January 2005 and January 2008 were evaluated retrospectively. Results: In this study, we evaluated 12 children (9 males) with PFAPA syndrome, between the ages of 2 to 5 years. Clinical findings started at a mean age of 19.83 +/- 11.51 months. Febrile attacks lasted for 3-6 days and they recurred every 4.16 +/- 1.11 weeks. Other symptoms associated with high fever were pharyngitis (100%), cervical adenopathy (91%), aphtous stomatitis (66%) and exudative tonsillitis (58%). All patients were given oral prednisolone (1-2 mgr/kg/day) and their body temperature temporarily decreased within 2 to 8 hours and did not increase up to the next cycle. The period between febrile episodes seemed to lengthen following steroid therapy; however the symptoms recurred. Three patients were given cimetidine. One of them had a longer period between febrile episodes, however the other two were not affected. Two patients who had undergone adenotonsillectomy did not have any Febrile episodes. Conclusion: PFAPA syndrome can be easily diagnosed by detailed history, physical findings and observation of the patients who have periodic febrile episodes with tonsillopharyngitis. Early diagnosis will also prevent unnecessary antibiotic therapy in such patients

Clinical Accuracy of Tympanic Thermometer and Noncontact Infrared Skin Thermometer in Pediatric Practice An Alternative for Axillary Digital Thermometer

Introduction: The aim of this study was to compare the body temperature measurements of infrared tympanic and forehead noncontact thermometers with the axillary digital thermometer

Pediatric emergency department visit characteristics of the patients on the ketogenic diet

Background: The ketogenic diet (KD) has been frequently used for the patientswith drug-resistant epilepsy in recent years. The management of these patients in emergency departments (EDs) has some difficulties due to the special needs of KD.We aimed to determine the characteristics and themanagement of the patients on the KD in the pediatric ED setting.Methods: Patientswhowere on the KD and admitted to the ED were included in the study. Demographic, clinical, and laboratory data of all patients were retrospectively reviewed and recorded.Results: Therewere 105 emergency admissions of 27 patients. Themedian age of all patientswas 55.0 (IQR: 29.0– 91.0) months. The most common symptom was vomiting (43.8%). Four patients had upper gastrointestinal bleeding, and one patient had hyperammonemic acute hepatic failure while receiving KD. Of the patients, 41.9% had seizure-related ED admission. Infectionswere present in 41.9% of the ED visits. The frequency of status epilepticus was significantly lower in the patients who were on the KD for more than 6 months (p b 0.01). In 42.9% of all ED admissions, dextrose containing maintenance fluids was administered mistakenly; although ketosis rate was lower, no seizure was observed in this group.Conclusion: The patients on the KD can be admitted to EDswith intercurrent illnesses or adverse effects of the KD. For accurate management, emergency physicians must be aware of the common reasons for ED admission ofthese patients and the effects of the KD.</div