Crush syndrome was more severe in children with multiple extremity injuries and acute renal failure frequently developed in these children. Peak serum creatine kinase level as well as potassium, urea, uric acid, creatinine, lactic dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and calcium levels were the helpful biochemical parameters in estimating the severity of crush syndrome.

Anemia, which is a common problem in cancer patients, has a negative effect on survival by decreasing the efficacy of chemotherapy and particularly of radiotherapy, as well as impairing the quality of life (QoL) of patients. Recombinant human erythropoietin (rHuEPO) decreases a patient's need for transfusions and increases their QoL. The aim of this study was to evaluate the effect of weekly single-dose EPO treatment on transfusion rates, QoL, and hemoglobin (Hb) levels. In addition, patients were followed up for a long period to assess the impact of EPO treatment on survival. The study was conducted from December 2001 to December 2002 in patients with newly diagnosed lymphoma or solid tumors using a prospective and controlled design. EPO-β was given as a single dose of 450 U/kg once a week for 12 weeks. The study and control groups included 16 patients each. Hb levels measured in the study group at the 4th, 8th, and 12th weeks were significantly higher than the values recorded before the start of chemotherapy. In the control group, Hb levels post chemotherapy were significantly lower than values recorded prior to treatment. The increased Hb levels in the study group were significant at the 8th and 12th weeks of treatment compared to levels measured prior to treatment. In the control group, Hb levels at the 4th and 8th weeks were significantly lower than pretreatment levels. When the percent increase of Hb levels of the study and control groups with respect to treatment week was compared, the difference was statistically significant at the 4th, 8th, and 12th weeks. Although the increase on the performance scale within each group during treatment was significant in both the study and control groups, the increase was more marked in the study group. The percent increase on the performance scale with respect to week of treatment was higher in the study group than in the control group. In EPO treatment group, side effects were seen in 38% of patients, with 19% being local pain in the injection area, 13% local hyperemia, and 6% headache. The mean follow-up period of the study and control group was 7.03 ± 0.41 (6.0-7.41) and 7.46 ± 0.45 (6.58-7.83) years, respectively; no statistically significant difference existed between these figures. Overall survival at the end of 7 years of follow-up was 68.8% and 81.3% for the study and control groups, respectively. The use of EPO-β in lymphoma and solid tumor patients on a once-weekly regimen (450 U/kg) was determined to be effective in increasing Hb levels, decreasing transfusion rates, and improving QoL. This regimen was safe, did not cause serious side effects, and can be recommended because of its high patient compliance and tolerability. An effect of EPO on prognosis was not evident. We could not have an explanation on the effect of EPO treatment on prognosis, as there were low number of patients and advanced-staged patients died earlier. Therefore, a larger number of patients are needed to clarify the effect of EPO treatment on prognosis.

Non-immune hydrops fetalis (NIHF) is a challenging entity as it represents the end stage of several different disorders. Renal and genitourinary causes of NIHF are rare and include congenital renal malformations, tumors and ureter-urethra disorders. Herein, two NIHF cases with different renal causes were presented. The first case that had antenatal NIHF was diagnosed neonatal Bartter syndrome. The second case of NIHF with antenatal large cyst in the surrenal gland area required surgery and ectopic renal cyst was diagnosed. To our best of knowledge, these are the first reports of NIHF associated with neonatal Bartter syndrome and ectopic renal cyst in neonates. Although it may be coincidental, these cases suggest that both neonatal Bartter syndrome and unilateral ectopic renal cyst may cause NIHF development in neonates by several different mechanisms. Therefore, these two rare entities should be suspected in cases of NIHF with similar findings.

Sirs, Calcinosis cutis (CC) is characterized by the deposition of hydroxyapatite crystals of calcium phosphate in the skin. CC is a common feature of scleroderma (SD), CREST syndrome (calcinosis, Raynoud's phenomenon, esophageal dysfunction, sclerodactyly and telangiectasia), dermatomyositis (DM), systemic lupus erythematosus (SLE), overlap syndromes and malignancies [1,2]. In SLE, mainly the dystrophic form, CC has been described, but it has been rarely reported in children with SLE. Here, we report on a patient who was diagnosed SLE and antiphospholipid syndrome at 3 years of age, and his renal biopsy showed diffuse proliferative glomerulonephritis. He developed extensive areas of skin ulcers and calcifications at 5 years of age, and the lesions resolved with diltiazem and acetylsalicylic acid treatment.A 9-year-old boy presented with symptoms of weakness, abnormal gait, pitting edema, generalized arthralgia, malar rash and dark urine in November 2003. Laboratory investigation revealed antinuclear antibody (ANA) 1/100 (+), anti-nuclear (n)DNA antibody 2 +, anti-doublestranded (ds)DNA antibodies 2 +, anti-Ro and anti-La antibodies, positive, complement C3 101 mg/dl (normal 90-140 mg/dl), complement C4 5.7 mg/dl (normal 10-40 mg/dl), anti-cardiolipin antibody immunoglobulin (Ig)M (+), IgG (−), hematuria (++) and a 24-h protein concentration of 2 g/l. The patient had SLE and antiphospholipid syndrome together, and his renal biopsy showed class IV lupus nephritis. He was treated with five doses of pulse methylprednisone and follow-up oral prednisolone at a dose of 2 mg/kg per day. At the follow-up examination, 1 year after the diagnosis, the patient was readmitted with a malar rash and proteinuria. Azathiopurine (2 mg/kg per day) was added to his steroid treatment. However, during follow-up, the patient did not respond to this therapy and extensive leg ulcers developed. He underwent seven treatments of plasmapheresis and received eight doses of pulse cyclophosphamide in 2004. Five months later, he presented with ulcers on the face and extensor side of his extremities and was hospitalized. His test results for anti-cardiolipin antibody IgM were positive. His therapy was changed to enoxaparin sodium (2 mg/kg per dose) and oral steroids (60 mg/day), and cyclosporine was started at a dose of 5 mg/kg per day. As his lesions resolved, the steroid dose was decreased at the follow-up examination. One year later, the patient presented with a limited range of motion and subcutaneous nodules with a maximum diameter of 1 cm× 0.5 cm in the back and extensor part of the extremities. His plain radiographs revealed multiple calcifications in soft tissues ( Fig. 1) and multiple calcifications with acoustic shadows that were found superficially by ultrasonography. No other calcinosis was determined in his abdominal ultrasonography and computed tomography images. His laboratory studies showed blood urea 20 mg/dl, creatinine 0.7 mg/dl, sodium 132 mEq/l, potassium 3.8 mEq/l, calcium 9.2 mg/dl, phosphorus 4.8 mg/dl, parathormone 42 pg/m...

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