Objective: Fetal echocardiography (FE) is considered for fetal, maternal or hereditary reasons in pregnants with suspect of intrauterine heart disease (IUHD). However, in few studies it was reported that most of the fetuses with IUHD are in the low-risk group (suspicion of IUHD during 2 nd trimester ultrasound, lack of good vision of the heart, self-referral). Our aim is to examine retrospectively the reasons for referral of pregnants, the results of FE, distribution of pregnants having fetuses with IUHD according to low-and high-risk factors and to evaluate reliability of FE. Methods: Our study group consisted of 1395 fetuses and 1370 pregnants underwent FE between 1999 and 2006. These cases included selfreferred women and the pregnants having previous child or family history of cardiac anomaly or referred by obstetricians. The prevalence of IUHDs in low-and high-risk pregnancies was compared by Chi-Square test. Results: The low risk group included 453 patients and the remaining 917 women were in the high-risk group. Intrauterine heart diseases were detected in 152 (10.9%) of 1395 fetuses. The prevalence of IUHDs was 19% in the low-risk group and 7% in the high-risk group. Of the152 fetuses 56.6% were in the low-risk group and 43.4% were in the high-risk group. The sensitivity of FE for diagnose of IUHDs was 97%, the specificity was 100%. Conclusion: Fetal echocardiography is highly reliable method for diagnosing of IUHDs. The most IUHDs occur in the low-risk group. (Anadolu Kardiyol Derg 2010; 10: 263-9) Key words: Fetal echocardiography, congenital heart disease, indication, low-risk and high-risk factors ÖZET Amaç: Fetal, maternal ve herediter nedenlerle FE yapılan gebeler, konjenital kalp hastalıklı (KKH) fetusa sahip olma olasılığı yüksek olan gebelerdir. Ancak yapılan çok az sayıdaki çalışmada KKH'lı fetusların çoğunun düşük riskli (ikinci trimester ultrasonunda KKH şüphesi, kalbin iyi görüntülene-memesi, gebelerin kendi istediğiyle başvurması) gebelik grubuna dahil olduğu bildirilmiştir. Bu çalışmada bölümümüzde son yıllarda FE'si yapılan gebelerin başvuru nedenlerini, ekokardiyografi sonuçlarını ve fetuslarında KKH'ı olan gebelerin düşük ve yüksek risk faktörlerine göre dağılımlarını ve FE sonuçlarımızın güvenilirliğini retrospektif olarak değerlendirdik. Yöntemler: Çalışmamızda Ekim 1999-Haziran 2006 tarihleri arasında Ünitemizde 1536 gebeye FE yapıldı. Postnatal ekokardiyografi sonucu bilinen 1243 normal kalp bulguları olan fetus ile postnatal ekokardiyografisi ve/veya otopsisi bilinen 152 intrauterin kalp hastalıklı (IUKH) fetus olmak üzere toplam 1395 fetus ve 1370 gebe çalışma grubumuzu oluşturdu. Bu olgular, kadın hastalıkları ve doğum uzmanları tarafından yönlendirilen, kendi isteğiyle başvuran ve ailesinde veya daha önceki gebeliklerinde KKH'ğı olan gebelerden oluşmaktadır. Düşük ve yüksek riskli gebelerdeki IUKH'ğı prevalansı Ki-Kare testiyle karşılaştırılmıştır. Bulgular: Düşük risk grubunda 453 (%33.1), yüksek risk grubunda 917 (%66.9) gebe yer almaktaydı. 1395 fetusun 152'sinde (%10.9) IUKH ...

Our objective was to determine the factors that affect (i) the rectal-axillary temperature measurement difference (RATD) for digital and mercury-in-glass thermometers and (ii) the difference between mercury-in-glass and digital thermometer readings taken by the rectal and axillary routes. Children (between the ages of 2 and 48 months) who were admitted to Hacettepe University Children Hospital and Corum Children's Hospital in 2 months period were included in this study. Two measurements were taken from each patient within 2 days at two different occasions including day/night and sleep/awake by the same physician. A total of 135 patients were enrolled. RATD was 0.61 + 0.54 degrees C in the mercury-in-glass thermometer, and 0.81 +/- 0.57 degrees C in the digital thermometer. The mean differences between digital and mercury-in-glass thermometers were 0.16 degrees C for rectal routes and -0.02 degrees C for axillary routes. Children at older age with hypoalbuminemia and children exposed to higher ambient temperatures had lower values of RATD than others. Temperature recordings from different sites might change with ambient temperature and individual characteristics of children.

Correspondence 301patients is unusual. We report a child with chronic urticaria to cockroach.A 12-year-old boy was referred to our hospital because of chronic urticaria that had begun when he was 7 years old. It had improved with the use of antihistamine therapy but he had stopped taking the antihistamines. He did not develop allergic rhinitis, asthma, or atopic dermatitis. His weight and height percentiles were 25%. He had urticarial plaques but his breathing sounds were clear, and his heartbeat was regular, without murmur. Abdominal examination was normal without any organ enlargement.The white blood cell count was 7440/mm 3 , eosinophil percent was 9%, eosinophil count was 670/mm 3 , total immunoglobulin E level was 2066, sedimentation rate was 19 mm/hour, urine examination was normal, parasite examination was negative. He underwent a complete allergy evaluation. Antihistamines were withheld for 10 days before the tests. Skin prick test was performed. Only cockroach hypersensitivity was found.Chronic urticaria is a very common skin disease with a considerable impact on quality of life. Whereas atopics are at increased risk for acute urticaria/angioedema as well as some forms of physical urticaria, most patients with chronic urticaria/angioedema are, surprisingly, not atopic. The underlying cause of mast cell degranulation in the majority of patients with chronic urticaria/angioedema cannot be determined. Although there is a widespread belief that cockroach allergy is a common problem in patients with respiratory allergies (4), little is known about its possible role in chronic urticaria.Our patient's chronic urticaria dramatically improved following the avoidance of cockroach. We have reported him because there are no data about chronic urticaria with isolated cockroach hypersensitivity. We propose that cockroach hypersensitivity be considered and investigated in chronic urticaria patients.

A 1-year-old boy with weight loss, decreased activity, and psychomotor regression is presented. He was subjected to an extremely detailed evaluation, including electroencephalography (EEG) and magnetic resonance imaging (MRI), until a simple hemogram in our center revealed that he had macrocytic anemia with megaloblastic changes in the bone marrow. His history revealed that he had been exclusively breast-fed by his vegetarian mother. Further investigations showed low serum vitamin B12 concentration, methylmalonic aciduria, and homocysteinemia, indicating that the macrocytic anemia was due to vitamin B12 deficiency. This boy represents a case of macrocytic anemia and hypotonia owing to vitamin B12 deficiency that developed because of exclusive breast-feeding by a vegetarian mother.

We present a case of venobiliary fistula due to umbilical venous catheter (UVC). UVC was inserted the day before surgery in a newborn who was scheduled for type IIIB jejunal atresia surgery. The UVC was superimposed on the liver. It was noted that the gastric drainage became chylous and increased to 790 and then 1977 mL daily. I.v. contrast tomography with 650 mL contrast showed that the opaque substance was dispersed around the catheter and a venobiliary fistula formed, with the administered fluid accumulating in the duodenum. Rapid improvement was seen in the clinical picture after the UVC was removed. Venobiliary fistula may develop in patients with UVC that is not placed appropriately, and can direct the fluid administered from the UVC to the gastrointestinal system through the choledochal duct. The importance of contrast computed tomography in the diagnosis of venobiliary fistula in the newborn is also emphasized.