Aim: Until now, the association between subepicardial adipose tissue (SAT), insulin resistance and intima-media thickness (IMT) has not been evaluated in obese children. In this study, we evaluated whether echocardiographic SAT is related to insulin resistance and IMT in obese children. Subjects and Methods: A total of 46 obese subjects (10.2 ± 2.5 years of age, 25 male patients) and 30 age-and gendermatched lean subjects (10.8±3.1 years of age, 13 male patients) were included in this study. The criterion for diagnosing obesity was defined as the body mass index (BMI) being over 97% percentile of the same gender and age. Serum triglyceride (TG), low-and high-density lipoprotein, cholesterol, glucose and insulin levels were measured during the fasting state. Each subject underwent a transthoracic echocardiogram and the SAT thickness was measured during end-diastole from the parasternal long-axis views. Results: The obese subjects had significantly higher SAT thickness and IMT values compared with the subjects in the control group (5.7±1.4 vs 3.0±0.7 mm, 0.78±0.15 vs 0.51±0.11 mm, P ¼ 0.001, respectively). Simple linear regression analysis showed no significant correlation between SAT and insulin resistance (r ¼ 0.170, P ¼ 0.253), whereas there was significant correlation between SAT and BMI, age and IMT (r ¼ 0.625, P ¼ 0.02, r ¼ 0.589, P ¼ 0.001, r ¼ 0.343, P ¼ 0.02, respectively). As an optimal cutoff point, a SAT thickness of 4.1 mm determined insulin resistance with 90% sensitivity and 61% specificity. Conclusions: Our study showed that SAT was significantly correlated with age, BMI and IMT, but not insulin resistance. However, our findings suggest that a 4.1 mm cutoff of SAT thickness might be used as a simple, inexpensive and non-invasive screening method because of its ability to predict insulin resistance with high sensitivity in obese children.

Head-up tilt testing with or without isoproterenol is extensively used in the evaluation of patients with unexplained syncope. However, sensitivity and specificity of tilt protocols with and without isoproterenol have not been clarified in children, due to lack of age matched control subjects. This study was designed to assess and to compare the sensitivity and specificity of tilting alone and tilting in conjunction with isoproterenol. Thirty children with unexplained syncope (group I) and 15 age-matched control subjects (control group I) underwent successive 60 degrees head-up tilts for 10 minutes during infusions of 0.02, 0.04, and 0.06 microgram/kg/min of isoproterenol, after a baseline tilt to 60 degrees for 25 minutes. Also, 35 children (group II) with unexplained syncope and 15 healthy control subjects (control group II) were evaluated by head-up tilt to 60 degrees for 45 minutes without an infusion of isoproterenol. In response to tilt protocol with graded isoproterenol, 23 (76.6%) of the patients in group I and 2 of the 15 (13.3%) control subjects developed syncope. Accordingly, the sensitivity of tilt testing with isoproterenol was 76.6%, and its specificity was 86.7%. Tilt testing without isoproterenol was positive in 17 (48.5%) of the patients in group II but in only 1 of the 15 (6.6%) control subjects. Thus, sensitivity and specificity of tilt testing without isoproterenol were 48.5% and 93.4%, respectively. The mean heart rate and systolic blood pressure decreased significantly (P < 0.001) in all tilt positive patients during syncope. In conclusion, the head-up tilt test is a valuable diagnostic test in the evaluation of children with unexplained syncope, and isoproterenol is likely to increase the sensitivity of the test without decreasing its specificity.

MLAEP latencies increase at the influence of sevoflurane in a dose-dependent manner and in relation to age. These results imply that MLAEP detection is a reasonable tool for monitoring hypnotic effects at all ages. Further studies are required to standardize MLAEP alterations related to effects of medication used for general anaesthesia at all different ages.

Aspirin is widely used as an antiinflammatory drug especially in children with rheumatic fever arthritis. The diminishing effects of aspirin on antioxidant enzymes and hepato-renal systems at high doses are well-known. It is now evident that the damage at antioxidant system worsens the clinical picture of the disease and prolongs the treatment time. Thus, we investigated the effect of antioxidant enzyme cofactors-zinc and selenium-supplementation on superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) levels (erythrocyte and liver) and hepato-renal toxicity during aspirin treatment at therapeutic doses. The rats were divided into five groups. The first and second groups were given aspirin 75 mg/kg/day and aspirin plus selenium (Selenium 200, selenium 200 mg tablet as selenium yeast, GNC) and zinc (Zinc 100, zinc 100 mg tablet as zinc gluconate, GNC), respectively, the third and fourth take 50 mg/kg/day aspirin and aspirin plus selenium and zinc twice a day, respectively. The fifth group was control. The rats were treated with aspirin for 5 weeks as in the treatment of rheumatic fever arthritis in children. Erythrocyte SOD and MDA levels were preserved with supplementation, whereas there was no change for GSH-Px levels. Liver SOD, GSH-Px, and MDA levels were not changed. In zinc- and selenium-supplemented groups, the levels of serum alanine aminotransferase, uric acid, and direct bilirubin levels were found statistically decreased compared with nonsupplemented groups. There was no significant histopathologic change in specimens of hepatic and renal tissues. Trace element supplementation may prevent free radical damage and shorten treatment time in children using long-term aspirin treatment.

SUMMARYAzygos continuation is seen in 0.6% of patients with congenital heart disease. The major significance of this anomaly lies in its association with complex cardiac defects and the technical difficulty that can accompany cardiac catheterization. We report our experience with successful catheter ablation of a right posteroseptal concealed accessory pathway in a 6-year-old boy with infrahepatic interruption of the inferior vena cava and azygos continuation. (Int Heart J 2005; 46: 537-541) Key words: Azygos continuation, Accessory pathway, Ablation USE of radiofrequency catheter ablation (RFCA) in the treatment of supraventricular tachycardias (SVT), as well as its success and complication rates, is influenced by the presence of congenital anomalies. We wish to share our experience with successful catheter ablation of a right posteroseptal concealed accessory pathway (AP) in a 6-year-old boy with infrahepatic interruption of the inferior vena cava (IVC) and azygos continuation. To the best of our knowledge, catheter ablation has not yet been reported in this anomaly. CASE REPORTA 6-year-old boy was admitted because of palpitations and dizziness. His history revealed that the palpitations had started two years earlier, recurred 2-3 times a year, lasted 1-3 hours, and started and ended abruptly.His body weight and height were 21 kg and 115 cm (50 th centile for both), respectively. A physical examination was normal. A 12-lead surface ECG showed sinus rhythm, with no signs of abnormal conduction or impulse generaFrom the