Objective: The aim of this study was to evaluate the detection of Legionella species from the respiratory tract samples by Polymerase Chain Reaction method.
Methods: The bronchoalveolar lavage fluid and transtracheal aspiration samples of patients with atypical pneumonia hospitalized in the Intensive Care Unit of Chest Diseases Department were examined to identify Legionella species by Polymerase Chain Reaction method. This method was performed to amplify a 386-bp product within the 16SrRNA gene of Legionella pneumophila in these samples sent to Bacteriology Laboratory of this department.
Results: The Polymerase Chain Reaction method was applied to 56 respiratory samples and only in one specimen Legionella species was identified.
Conclusion: It was concluded that for patients with atypical pneumonia Polymerase Chain Reaction method is fast and effective to isolate Legionella species from the respiratory samples.

Key words: Bronchoalveolar lavage fluids, transtracheal aspiration, Legionella spp, PCR

Objective: In this study, we have investigated the demographic and clinical characteristics  of pediatric cases with diabetic - ketoacidosis (DKA) followed-up in intensive care units.
Methods: This is a retrospective analysis of all patients’ files with respect to  their demographic factors as gender, complaints, age and clinical features. Mann Whitney U and chi-square statistical tests were performed.
Results: The study group consists 16 female and 9 male children with a mean age of  9.9±3.7 years. The most frequent complaints of the cases were dyspnea, polydipsia, weight loss and polyuria in decreasing order of frequency. They admitted to the hospital because of respiratory distress, tachypnea tachycardia and acidosis. They treated by DKA protocol in the intensive care unit. We normalized Glasgow Coma Scores (GKS) in 12±5, blood sugar levels in 14±7, and blood gas levels in 14±7 hours. Any complication had not developed and the patients under glycemic control were discharged from the hospital with recommendations for outpatient follow-up.
Conclusion: DKA cases could be treated rapidly and successfully thanks to  accurate and rapid diagnosis followed by strict monitorization protocol. In conclusion we wanted to emphasize that monitorization of patients with DKA should be performed in pediatric intensive care units.

Key words: child, diabetic ketoascidosis, pediatric intensive care

Gastrointestinal stromal tumours (GISTs) are uncommon primary mesenchymal tumors of the gastrointestinal tract mostly observed in the adults. Small intestinal GISTs are relatively rare even in adults and it can be regarded as exceptional in childhood. Most GISTs arise because of a mutation in a gene called c-kit. This gene encodes a transmembrane receptor for the growth factor termed stem cell factor.

An 11-month-old girl was referred to our hospital with vomiting. A small bowel mass was detected by radiological examination and the patient underwent surgery. During surgery, a 2 cm solid tumoral mass arising from the wall of the jejunum was identified. Immunohistochemical analysis of the specimen revealed to be positive for CD117 (c-KIT protein) consistent with a diagnosis of GIST. Forty two months later, a recurrent mass developed on the omentum. Specimen obtained during re-operation revealed similar features with the primary tumor. The treatment with imatinib was started following surgical resection of the recurrent tumor. After the second surgery, the patient had an uneventful course and remained disease-free during seven years of follow-up.

Key words: Childhood, small bowel, gastrointestinal stromal tumor

Two rare genetic diseases can cause rickets in children. Alpha 1 hydroxylase enzyme is defective, and calcitriol can not be synthesized in vitamin D dependent rickets type 1 or pseudovitamin D deficiency. Vitamin D receptors are defective the disease is known as hereditary vitamin D resistant- rickets or vitamin D dependent rickets type 2. Both diseases are rare autosomal recessive disorders, and characterized with hypocalcemia, elevated parathyroid hormone and alkaline phosphatase levels and similar clinical features as nutritional rickets. The differential diagnosis of these diseases can be made with determination of serum 1.25(OH)2D levels. Patients with type 1 have lower levels of 1.25(OH)2D, but patients with type 2 have increased levels of 1.25 (OH)2D. In this article, these rare genetic diseases are presented with two cases.

Key words: Vitamin D dependent rickets, vitamin D resistant rickets, hypocalcemia

Kawasaki disease is an acute systemic vasculitis with unknown etiology which effects small and moderate sized arteries. The early diagnosis and rapid treatment of the disease is essential to obtain favourable results in the management of coronary artery disease. There is no laboratory test specific to the disease, and diagnosis is made according to clinical signs. Because of insufficient criteria for clinical diagnosis in some patients, the diagnosis of the disease may be delayed in some patients who presented with atypical symptoms at the onset. Central nervous system involvement should be an atypical starting symptom of the disease. In this article, a 7-year-old boy diagnosed firstly as aseptic meningitis and then Kawasaki disease following fever, erythematous rash, vomiting, and abdominal pain is presented. Since with early diagnosis and treatment, the cardiovascular sequelae can be prevented, Kawasaki disease should be considered in the differential diagnosis especially in patients who are unresponsive to the treatment of meningitis.

Key words: Aseptic meningitis, Atypical case, Kawasaki disease

Tuberculosis is one of the most frequently encountered diseases in our country, and it should be taken into account in children presented with complaints of chronic respiratory airway diseases. We aimed to discuss the clinical, radiological, bronchoscopical and biopsy findings of primary progressive tuberculosis in a case presented with clubbing. A 15-year-old male adolescent admitted to our clinic with complaints of coughing, chest pain, weight loss, anorexia and weakness. When patients were physically examined, clubbing was seen on both hand fingers. On chest radiogram, densities compatible with lympadenopathy in paracardiac area and left lower lobe consolidation were seen. Acid-fast bacteria (AFB) were searched in the sputum. Bronchoscopical examination was done. In biopsy specimens and bronchoalveolar lavage fluid samples, growth of acid-fast bacteria were identified. Diagnosis was confirmed by bacterial culture. This case was presented to emphasize that the diagnosis of tuberculosis should be suggested as an etiologic factor for chronic lung disease when adolescents presented with weight loss, chronic coughing, night sweats, bloody sputum in addition to clubbing.

Key words: Adolescent, clubbing, primary tuberculosis