Beneficial effects of terlipressin in pediatric cardiac arrest

PubMedID: 21926888Objective: Vasopressin and its analog, terlipressin (TP), are potent vasopressors that may be useful therapeutic agents in the treatment of cardiac arrest (CA), septic and catecholamine-resistant shock, and esophageal variceal hemorrhage. The American Heart Association 2000 guidelines recommend its use for adult ventricular fibrillation arrest, and the American Heart Association 2005 guidelines note that it may replace the first or second epinephrine dose. There is little reported experience with TP in cardiopulmonary resuscitation (CPR) of children. The purpose of this retrospective case series was to report successful return of spontaneous circulation after the rescue administration of vasopressin after prolonged CA and failure of conventional CPR, advanced life support, and epinephrine therapy in children. Methods: Nine pediatric patients with asystole, aged 11 months to 14 years, who experienced 12 episodes of refractory CA and did not respond to conventional therapy. Terlipressin was administered as intravenous bolus doses of 20 mcg/kg to standard cardiopulmonary resuscitation. Results: Return of spontaneous circulation was monitored and achieved in 6 of the 12 episodes. The mean duration of CPR was 24.8 minutes in these 12 episodes of CA with TP administration, with a range of 10 to 50 minutes (median, 23 minutes). Five survivors were discharged home without sequelae and with good neurologic status (score 1 by the pediatric cerebral performance category). Conclusions: The combination of TP to epinephrine during CPR may have a beneficial effect in children with CA. However, the recommendations for its use in the pediatric literature are based on limited clinical data. Copyright © 2011 by Lippincott Williams & Wilkins

Acute meningococcaemia complicated by toxic epidermal necrolysis and acute supurative parotitis [1]

PubMedID: 15790331[No abstract available

The Value of Capnography during Sedation or Sedation/Analgesia in Pediatric Minor Procedures

PubMedID: 15094573Objective: To measure changes in end-tidal carbon dioxide levels (ETCO 2) with different sedation/analgesia (midazolam, ketamine, ketamine plus midazolam, midazolam plus fentanyl, and propofol) during pediatric minor surgical procedures and to determine whether there were significant increases in ETCO2 with different drugs. Methods: We conducted a prospective, randomized, clinical trial of 126 children who needed sedation/analgesia in pediatric intensive care unit in a university hospital. Patients were randomly assigned to 1 of 5 treatment groups. Group K received only intravenous (IV) ketamine 1 mg/kg; group M, IV midazolam 0.15 mg/kg; group KM, IV ketamine 1 mg/kg plus IV midazolam 0.1 mg/kg; group MF, IV midazolam 0.1 mg/kg plus IV fentanyl 2 µg/kg; and group P, IV propofol 2 mg/kg. Side stream, nasal cannula ETCO2 tracings were recorded on a capnograph (Capnostat, Marquette). Recordings began prior to the administration of medications and continued throughout the procedure until the patient was fully awake. The primary outcome variable was the difference between peak ETCO2 before and during sedation/analgesia. This value was determined by scanning the records for the peak ETCO2 averaged over 5 breaths before and after the administration of medications. Results: There was neither any statistical difference between presedation/analgesia and postsedation/analgesia ETCO 2 levels in the 5 groups (P > 0.05) nor any difference in the first 3 groups between presedation/analgesia, sedation/analgesia, and postsedation/analgesia (K, M, and KM) (P > 0.05). In the midazolam plus fentanyl and propofol groups, mean ETCO2 during sedation/analgesia was higher than the mean ETCO2 during presedation/analgesia and postsedation/analgesia (P < 0.05). Twenty-one patients (16, 6%) had respiratory depression [hypercarbia (ETCO2 > 50 mm Hg) or hypoxia (oxygen saturation > 90% for over 1 minute)], 21 patients (16, 6%) had hypercarbia, and 4 patients (3.2%) had both hypoxia and hypercarbia. One of 4 patients was in the MF group, and 3 were in the P group. Two subjects (8%) in the KM group, 7 (28%) in the MF group, and 13 (52%) in the P group had hypercarbia. Conclusions: This study demonstrated that propofol and midazolam-fentanyl produced a higher incidence of respiratory depression and higher mean ETCO2 during sedation/analgesia than presedation and postsedation/analgesia. Capnography can serve as a useful monitoring tool in the evaluation of ventilation during sedation or sedation/analgesia in clinically stable children

Pneumomediastinum and pneumopericardium: Unusual and rare complication of cystic fibrosis in a 2 years old girl

We describe a 2 year old girl with cystic fibrosis who presented with pneumomediastinum and pneumopericardium. She was admitted to pediatric intensive care unit with cough, dyspnea and cyanosis of two day duration. She had experienced attacks of cough, dyspnea and wheezing for one and half years. Sweat chloride test values were 100 and 90 mEq/L. On the third day after admission, she was acutely dyspneic, hypotensive and bradycardic and died although resusitated. In the chest X-ray pneumomediastinum and pneumopericardium were revealed. In conclusion, the rare complications pneumomediastinum and pneumopericardium should be in mind in cystic fibrosis patients whose general condition deteriorates acutely

Pleural effusion associated with acute hepatitis A infection

PubMedID: 10608640[No abstract available

Does polyclonal intravenous immunoglobulin reduce mortality in septic children in the pediatric intensive care unit? [Çocuk yogun bakim ünitesi'nde sepsis nedeni ile izlenen hastalarda poliklonal intravenöz immünglobülin tedavisi mortaliteyi azaltiyor mu?]

Although advances in medicine and our understanding of the pathogenesis of sepsis and septic shock have dramatically improved, the mortality rate in sepsis is still very high. The harmful effects of sepsis and septic shock have been postulated to be largely due to the lipid A component of the endotoxin molecule in gram-negative bacteria. Thus the use of antibodies against the endotoxin molecule in treatment has been investigated. There have been a number of studies about immunoglobulin preparations in the treatment of sepsis, and studies on monoclonal and polyclonal immunoglobulin preparations have increased. In this prospective randomized study, 84 patients followed in the Pediatrie Intensive Care Unit for systemic inflammatory response syndrome were enrolled in the study. The patients with primary immune deficiency and chronic disease that may lead to immune deficiency were excluded. Intravenous immunoglobulin (IVIG) in a dose of 1 g/kg/day for two days was administered to 41 patients; 43 patients served as control. Of these 84 patients, 60 had blood culture-proven sepsis. The mean age of the patients was 32.6 ± 32.1 months. There was no statistical difference between groups (30 patients in IVIG group and 30 patients in control group) in terms of hospitalization days in the Pediatric Intensive Care Unit (10.8 ± 3.2 days vs 11 ± 3 days), ventilator treatment (33.3% vs 30%), septic shock (26.6% vs 39.9%), multiorgan dysfunction (36.6% vs 43.3%) and mortality rate (26.6% vs 33.2%), (p>0.05). In conclusion, as IVIG administration is very expensive and does not reduce mortality and morbidity, we think it is not necessary to initiate IVIG to septic children as an adjuvant therapy until further studies including a larger number of septic children are conducted

Klippel-Trenaunay-Weber syndrome with hydronephrosis and vesicoureteral reflux: An unusual association

PubMedID: 12026213The 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

Evaluation of childhood poisonings in Çukurova region [Çukurova bölgesi·'ndeki· çocukluk çagi zehi·rlenme olgularinin degerlendi·ri· lmesi·]

• Objective: The aim of this study was to clarify to determine the causes of childhood poisonings by time on account of socioeconomic and cultural alterations in Çukurova region and to steadily attain the data for treatment and prevention. • Material and Method: This study was composed of poisoning cases attending to pediatric emergency medicine room from 1997 to 2001 with ages between 0-14 years old. The data about poisoning cases were extracted from patients' medical records in emergency room. In the study demographics of cases, the route and reason of poisonings and materials causing poisonings were evaluated. • Results: In 5 years period totally 486 patients, 250 boys and 236 girls, were admitted to pediatric emergency room. Most of the poisoning cases were due to an accident (89.3%), and they were between 1-3 years old. Suicide attempts had the highest ratio in cases over 10 years age, and were more common in girls. The causes of poisoning were found to be drugs (42.6%), animal-insect bites (11.1%), insectisides-farming disinfectants (10.3%) and costic substances (8.6%). Most cases with drug poisonings were caused by CNS drugs, especially amitriptiline (32.8%). In all poisoning cases, 99.6% of cases have recovered completely but two cases (snake and scorpion envenomation) died (0.4%). • Conclusion: The majority of poisonings in the childhood period happen due toaccidental ingestion of drugs. This condition shows us that simple precautions like family education, keeping drugs unreachable for children, unavailability of drugs without prescription and child-resistant package may prevent most of the poisonings

Presented of acute abdominal pain of a case with acute transverse myelitis [Akut bati{dotless}n tablosuyla başvuran transvers miyelitli bir olgu sunumu]

Acute transverse myelitis is characterized by paresthesia, sphincter dysfunction, and progressive weakness in the all extremities. Fever, miyalgia, back pain, lower limb pain, paraparesia, and weakness were the most common clinical presentations. We report 13-year-old girl with transverse myelitis who presented with acute abdominal pain. Sphincter dysfunction and weakness improved more slowly than plasmapheresis, intravenous immunglobuline, and methylprednisone pulse therapy were performed. This is the first report, to our knowledge, first presented of acute abdominal pain of a pediatric patient with transverse myelitis

Schwartz-Jampel syndrome: Three pediatric case reports

PubMedID: 14577682Schwartz-Jampel syndrome: three pediatric case reports: Schwartz-Jampel syndrome is a heterogeneous autosomal recessive syndrome defined by myotonia, short stature, bone dysplasia and growth retardation. Three types have been described: type 1A, usually recognized in childhood, with moderate bone dysplasia; type 1B similar to type 1A but recognizable at birth, with more prominent bone dysplasia and type 2, a rare, more severe form with increased mortality in the neonatal period. In this paper we report three pediatric cases, one with neonatal manifestation