Olgu Sunumu Medial Calcific Sclerosis (Mönckeberg) Case Report

Karaaslan ve Arkadaşları
8
Maltepe Tıp Dergisi/ Maltepe Medical Journal
some characteristics of infections of deep neck spaces
in young children.
MAtERIALS AND MEtHODS
From January 2000 through June 2007 a total
of 39 children younger than 24 months of age with
the diagnosis of IDNS at the Sisli Etfal Education and
Research Hospital, Istanbul were enrolled into the study.
History of the illness, clinical presentation, physical
examination, radiological findings, laboratory evaluation
(such as complete blood counts, C-reactive protein,
sedimentation rate, routine biochemical tests, culture
results and PPD results), surgical drainage, antibiotic
regimen, hospitalization period and complications
were taken into the consideration in the study.
The following findings were accepted in the favour
of deep neck infections: Fever, restlessness, a mass or
fluctiation on the neck, hepatomegaly, splenomegaly
and lymphadenopathy. In all of the patients neck was
investigated with ultrasonography for the localization,
presence of abscess formation and number and size of
lymph nodes. Blood and pus cultures were taken from
all and surgically drained patients.
All of the patients had also been seen by an
otorhinolaryngolog after hospitalization and began
to take either of the following antibiotic regimens
intravenously before learning the culture results:
ampicillin+sulbactam (100-150 mg/kg/day IV) or
cephazoline (150mg/kg/day) + clindamycin (30mg/kg/
day)(4). The patients were followed-up both clinically
and radiologically with regular intervals. In addition,
complete blood counting, erytrocyte sedimentation
rate, CRP and blood cultures were repeated on the
third day and USG on the fifth day.
StAtIStICAL ANALYSIS
The study data were analyzed with NCSS 2007
software program. Descriptive statistics were provided
for the numeric and categorical variables using means,
Standard deviations and percent distributions where
necessary. Student t-test was used for comparison of
groups consisted of independent and Chi-square test to
compare percent distributions across levels of nominal
variables. A p value less than 0.05 was accepted as
statistically significant.
RESULtS
During the last seven years 39 patients were
hospitalized in our hospital with the diagnosis of IDNS.
The mean age was 11.4±6.2 months and 23 (59%) of
these children were male. The mean period between
the occurrence of the first symptoms and admission to
the hospital was 4 days. The most common symptoms
were restlessness (100%) and fever (97.5%). The
swelling was on the right side of the neck in 15 patients
(38.5%), on the left side in 19 patients (48.7%) and
bilateral in 5 patients (12.8%). Ultrasonography
revealed multiple lymphadenopathies in 26 patients
(66.7%) and 1-3 lymphadenopathies in 13 patients
(33.3%). Fluctuation was found in 8 of patients (20.8%)
on the infected neck regions. Laboratory investigation
revealed a mean 21788±7756/mm white blood cells
with a mean neutrophil count of 13879±6840/mm.
Mean erythrocyte sedimentation rate was 61.7±21
mm/h and qualitative CRP measurement was high
in all patients. Blood culture results were positive
in 5 patients (12.8%) (Gram positive cocci in three
patients, meticilline-sensitive Staphylococcus aerius in
one patient and non-hemolytic streptococcus in one
patient).
Abscess was drained in 9 patients (23%) and in five
of these patients (55.5%) culture results were positive
(Streptococci in three patients and Staphylococci in two).
One of the patients developed deep vein thrombosis,
and she was referred to cardiothoracic surgery. The
mean hospitalization period of the patients was 9.4±3
(5-14) days and there was no significant differences
between two group (p