Coronary artery fistula: Review of 54 cases from single center experience

Background: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. Methods: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study. Results: A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients’ complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%. Conclusions: Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed

Pandemic Influenza A (H1N1) virus-associated acute myopericarditis

Although pandemic influenza A (H1N1) virus may cause an upper respiratory tract infection similar to that caused by seasonal influenza, it can lead to serious complications such as pneumonia, encephalitis, and myocarditis. We describe a 2-year-old girl admitted with fever, cough, and vomiting followed by acute respiratory distress and diagnosed as H1N1-related myopericarditis. (Turk Arch Ped 2011; 46: 337-9

Leukoderma and chronic inflammatory demyelinating polyradiculoneuropathy in an adolescent with graft-versus-host disease

A 15-year-old Iraqi male patient with acute lymphoblastic leukemia received an allogeneic bone marrow transplant from his brother. On the 18th day after the transplant, the patient developed grade II acute graft-versus-host disease, and treatment included methylprednisolone. On day 140, the patient was diagnosed with leukoderma. On day 150, the patient was admitted to hospital because of numbness and muscle weakness in the extremities and a disturbance of the gait. Neurologic examination showed muscle weakness in the upper and lower extremities and there were no deep tendon reflexes. Nerve conduction studies showed reduced conduction speeds of the motor nerves with demyelinating features. The patient was diagnosed as having a chronic inflammatory demyelinating polyradiculoneuropathy (CIDB) based on clinical and electrophysiological findings. Treatment included methylprednisolone and intravenous immunoglobulin. The neurologic function improved but the skin lesions persisted. This case shows that graft-versus-host disease can act as a triggering factor for the appearance of autoimmune diseases

Pandemik İnfluenza A (H1N1) virüsü ile ilişkili akut miyoperikardit

Although pandemic influenza A (H1N1) virus may cause an upper respiratory tract infection similar to that caused by seasonal influenza, it can lead to serious complications such as pneumonia, encephalitis, and myocarditis. We describe a 2-year-old girl admitted with fever, cough, and vomiting followed by acute respiratory distress and diagnosed as H1N1-related myopericarditis. (Turk Arch Ped 2011; 46: 337-9

CARBAPENEM RESISTANCE DUE TO BLA(OXA-48) AMONG ESBL-PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE ISOLATES IN A UNIVESITY HOSPITAL, TURKEY

Bacterial isolates producing Class D OXA-48 carbapenemase may be missed in routine laboratory testing, allowing them to spread undetected. The purpose of the present study was to detect bla(OXA-48) among ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates collected from a university hospital, Turkey. Ninety-two ESBL-producing isolates (66 E. coli, 26 K. pneumoniae) were obtained in 2010. Antibiotic susceptibility tests were performed using the disc diffusion method and VITEK 2 system. Carbapenemase activity was screened using modified Hodge test. Beta-lactamase genes were detected by PCR and bla(OXA-48)-positive amplicons were sequenced. Genetic relatedness among K. pneumoniae isolates was investigated by pulsed-field gel-electrophoresis (PFGE). Carbapenemase activity was detected in 1 E. coli and 9 K. pneumoniae isolates and 8 of the K. pneumoniae plus the E. coli isolates were resistant to ertapenem. Three K. pneumoniae and 1 E. coli isolates were resistant to imipenem. All 10 isolates were susceptible to meropenem. bla(OXA-48) was present in all 10 isolates. Additionally, 9 isolates contained at least one beta-lactamase gene, including bla(SHV), bla(CTX-M) and bla(VEB) type. PFGE revealed different karyotypes among 9 K. pneumoniae isolates suggesting that the dissemination of bla(OXA-48) gene was not spread by a single K. pneumoniae clone. Thus OXA-48-producing isolates found in carbapenem-susceptible strains according to CLSI guidelines

Evaluation of Chest X-ray and Thoracic Computed Tomography in Patients with Suspected Tuberculosis

Objective To investigate if there is any correlation between positive findings detected by posterior-anterior (PA) chest radiograph and thoracic computerized tomography (CT) in cases with suspected lung tuberculosis (TB) due to positive tuberculin skin test (TST) results

Clinical and Laboratory Characteristics of Children Referred for Early Puberty: Preponderance in 7-8 Years of Age

Objective: The aim of this study was to evaluate the girls referred to the pediatric outpatient clinic with a presumptive diagnosis of early puberty due to early onset of breast development or pubarche

Relationship between clinical findings and genetic mutations in patients with familial Mediterranean fever.

Background: Familial Mediterranean fever (FMF) is one of the most frequent genetic diseases encountered inthe Mediterranean region. We aimed to investigate the correlation between genetic mutations and theclinical findings in 562 patients with FMF.Methods: In this retrospective cross-sectional study conducted with patients’ files between 2006, and 2013, reversehybridization assay for MEFV gene mutations was used and the 12 most frequent mutations were screened. Mutationtypes and clinical findings were compared with variance analysis.Results: The mean age was 6.9 ± 3.4 years (range, 1.8-11.6 years). The most common symptom was fever (97.3 %).Thirty-four of the patients (6.04 %) were admitted with periodic fever only. Of these patients, M694V was the mostcommon mutation type (73.5 %). The percentage of the patients predominantly presenting with recurrent abdominalpain was 77.78 % and the most frequent mutations were M694V and E148Q. The rate of arthritis and arthralgia wassignificantly higher in patients with M694V and E148Q mutations. Chest pain was reported more often in patientshomozygous for M694V (61.4 %). Pericardial effusion was documented in the echocardiography of 10.9 % of the 229children with chest pain. Some patients had both FMF and Henoch Schönlein purpura (HSP), and were more likelyto harbor either homozygote M694V or E148Q mutations. The frequency of episodes was higher in patients withhomozygous M694V mutations (number of attacks = 4.4 ± 1.6/month). Proteinuria was detected in 106 patients ofcases (29.2 %), at an average of 854 ± 145 mg/L. Most of the patients with proteinuria and elevated serum amyloid-Ahad homozygous M694V mutation.Conclusion: The most common mutation in children in Turkey with FMF is the M694V mutation. Recurrentabdominal pain, arthritis or arthralgia, chest pain, and pericarditis were commonly seen in patients withM694V and E148Q mutations

Relationship between clinical findings and genetic mutations in patients with familial Mediterranean fever

BACKGROUND: Familial Mediterranean fever (FMF) is one of the most frequent genetic diseases encountered in the Mediterranean region. We aimed to investigate the correlation between genetic mutations and the clinical findings in 562 patients with FMF. METHODS: In this retrospective cross-sectional study conducted with patients’ files between 2006, and 2013, reverse hybridization assay for MEFV gene mutations was used and the 12 most frequent mutations were screened. Mutation types and clinical findings were compared with variance analysis. RESULTS: The mean age was 6.9 ± 3.4 years (range, 1.8-11.6 years). The most common symptom was fever (97.3 %). Thirty-four of the patients (6.04 %) were admitted with periodic fever only. Of these patients, M694V was the most common mutation type (73.5 %). The percentage of the patients predominantly presenting with recurrent abdominal pain was 77.78 % and the most frequent mutations were M694V and E148Q. The rate of arthritis and arthralgia was significantly higher in patients with M694V and E148Q mutations. Chest pain was reported more often in patients homozygous for M694V (61.4 %). Pericardial effusion was documented in the echocardiography of 10.9 % of the 229 children with chest pain. Some patients had both FMF and Henoch Schönlein purpura (HSP), and were more likely to harbor either homozygote M694V or E148Q mutations. The frequency of episodes was higher in patients with homozygous M694V mutations (number of attacks = 4.4 ± 1.6/month). Proteinuria was detected in 106 patients of cases (29.2 %), at an average of 854 ± 145 mg/L. Most of the patients with proteinuria and elevated serum amyloid-A had homozygous M694V mutation. CONCLUSION: The most common mutation in children in Turkey with FMF is the M694V mutation. Recurrent abdominal pain, arthritis or arthralgia, chest pain, and pericarditis were commonly seen in patients with M694V and E148Q mutations