Treatment of severe amitriptyline intoxication with plasmapheresis.

Tricyclic antidepressant poisoning is one of the most common causes of serious intoxication. Here, we report a 2-year-old girl with severe amitriptyline (70 mg/kg) intoxication. She was in comatose, had generalized tonic clonic seizure, ventricular tachycardia, and wide QRS complexes. Although she did not respond to classical therapies, very good clinical response to plasmapheresis was obtained and she developed no complications. Thus, plasmapheresis may be an effective treatment modality in poisoning with drugs, which bind to plasma proteins with high affinity.

[Massive parapneumonic effusion caused by Mycoplasma pneumoniae in a child: a case report]. / Mycoplasma pneumoniae'ya bagli yogun parapnömonik efüzyonlu bir olgu sunumu.

Mycoplasma pneumoniae infection is usually mild course and self-limited. Parapneumonic effusion is not a common feature of M. pneumoniae. The treatment of parapneumonic effusion is macrolides and chest tube with adequate pleural drainage. We report here on a child with M. pneumoniae infection complicated by massive parapneumonic effusion. Protracted course of fever and respiratory distress was noted in patient. Pneumothorax was occurred subsequent to chest tube drainage.

Supernumerary nostrils together with oesophageal atresia and patent ductus arteriosus.

Supernumerary nostril is an extremely rare congenital anomaly. It can be unilateral or bilateral and it sometimes occurs in association with other congenital abnormalities. We describe a newborn infant with bilateral supernumerary nostrils together with oesophageal atresia and patent ductus arteriosus, an association that has not been reported previously in the literature.

Comparison between powdered gloves, powder-free gloves and hyaluronate/carboxymethylcellulose membrane on adhesion formation in a rat caecal serosal abrasion model.

OBJECTIVE: Intraabdominal adhesion formation and prevention is one of the major conflicts of modern surgery. We aimed to determine the effects of powdered gloves versus powder-free gloves and hyaluronate/carboxymethylcellulose membrane (H/CMCm) in a rat caecal serosal abrasion model. METHODS: Sixty wistar albino rats were subjected to a standardized lesion by caecal abrasion model. In group 1, the procedure was performed with sterile powdered gloves. In group 2, the procedure was performed with powder-free sterile gloves. The H/CMCm was applied directly to the abraded caecum in group 3. Formation of adhesions were determined on one half of the animals from each group on the 7th postoperative day, and on the other half on the 15th postoperative day. RESULTS: There was a statistically significant difference between the adhesion scores on day 7 and 15 in groups 1 and 2 (p = 0.005, p = 0.007). There was no significant difference in adhesion scores on day 7 and 15 in group 3 (p = 0.145). The mean adhesion score was significantly higher in group 1 (powdered glove group) than group 2 (powder-free glove group) and group 3 (powder-free glove plus H/CMCm) on postoperative day 7 (p = 0.001). However, no significant difference was found between groups regarding adhesion scores on postoperative day 15 (p = 0.607). The comparisons of group 2 versus group 3, both on postoperative day 7 (p = 0.051) was not statistically significant, whereas a significant difference was detected between group 1 versus group 2 and group 3 on postoperative day 7 (p = 0.013, p = 0.001). CONCLUSION: Our experiment shows that the use of powder-free gloves may be as beneficial as Seprafilm in preventing postoperative adhesion formation.

Bilateral multicystic renal dysplasia with potter sequence. A case with penile agenesis.

Hereditary renal adysplasia (HRA) is a rare autosomal dominant condition. Patients have several other anomalies including Potter facies, thoracic, cardiac, and extremity deformities. The case present dysmorphic facial features such as hypertelorism, prominent epicanthic folds, a flat and broad nose, choanal stenosis, low-set ears, and a receding chin. He had femoral bowing, hypoplastic right tibia and agenesis of the right foot. He had rich and thick skin. He had also a dysplastic empty scrotum, penile agenesis, and anal atresia. The autopsy revealed pulmonary hypoplasia, ventricular septal defect, bilateral multicystic renal dysplasia, agenesis of both ureter and bladder, intraabdominal testicles, and a single umbilical artery. The penile agenesis was first reported, and including the consanguinity in the parents might further delineate the bilateral multicystic HRA. Vater/caudal regression anomalies, Mullerian duct/aplasia, unilateral renal agenesis, and cervicothoracic somite anomalies association, and Coloboma, heart anomaly, choanal atresia, retardation, genital and ear anomalies syndrome has been considered in differential diagnosis.

Radiologic findings of a congenital suprasternal dermoid cyst.

A congenital cystic mass was detected at the suprasternal notch of a seven-month-old male infant. After radiologic examinations including ultrasonography, computed tomography, and magnetic resonance imaging, the cyst was excised and diagnosed as a dermoid cyst. Dermoid cysts of the head and neck are rare lesions, but a midline location is characteristic for these congenital masses. To our knowledge, only two reports have been published, which were similar to our case in localization. Dermoid cysts should be included in the differential diagnosis of midline cysts.

Comparison of the measurement methods of bursting pressure of intestinal anastomoses.

BACKGROUND/AIMS: This study was designed to determine whether there exists a difference between in vivo and in vitro measurements of bursting pressure (BP) of experimental intestinal anastomosis studied in Wistar-albino rats. METHODOLOGY: In the first group (n=8), the BP was measured using in vivo method without detaching the adhesions around the anastomosis. BP was determined with digital manometer, and then anastomotic region was removed to measure tissue hydroxyproline (HP) levels. In the second group (n=8), the BP was measured with in vitro method after the segment of intestine including the anastomosis was dissected and isolated. The isolated specimen was then submerged in a normal saline bath. BP was determined with a digital manometer and anastomotic region was removed to measure tissue HP levels. RESULTS: While HP value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 121.11 +/- 16.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.195). The BP was determined as 240.71 +/- 11.65 mmHg in the first group, 144.71 +/- 16.41 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found to be statistically different whereas tissue HP levels were normal between the groups. CONCLUSIONS: These results make us consider that mechanical changes occur about the isolated anastomotic line and dissection of adhesions weakens the anastomosis.

Comparison of the experimental intestinal anastomoses performed by different surgeons.

BACKGROUND/AIMS: This study was designed to determine the effects of different surgeons on the experimental anastomosis studied in rats. METHODOLOGY: Sixteen Wistar-albino rats were equally separated into two groups. The rats operated on by the first surgeon were coded Group 1 and operated on by the other surgeon were coded Group 2. Both surgeons were trained on the gastrointestinal surgery. The procedure of the study were standardized and dictated to the surgeons. Bursting pressure and tissue hydroxyproline content were determined as parameters of the anastomotic strength and healing on the seventh day postoperatively. RESULTS: The bursting pressures were measured with a digital manometer and anastomotic lines were removed to measure tissue hydroxyproline level. While hydroxyproline value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 104.02 +/- 17.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.521). The bursting pressure was determined as 240.71 +/- 11.65 mmHg in the first group, 190.75 +/- 14.09 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found statistically different whereas tissue hydroxyproline levels were normal between the groups. CONCLUSIONS: These results make us to consider mechanical differences occur related to the surgeons in the studies performed with the same technical detail.

Management of fetal bronchogenic lung cysts: a case report and short review of literature.

Congenital malformations of the lung (CML) are rare with similar embryological and clinical spectra and could result in mortality if left untreated. Bronchogenic cysts are formed during the budding of the tracheal diverticula and ventral foregut in the embryological period. In this paper we want to present a case of bronchogenic cyst with continuous intrauterine cyst aspiration follow-up. After the baby birth was operated and the postoperative period was uneventful. The pathological examination revealed a bronchogenic cyst.

[3D-CT investigation of craniofacial and cervical spine anomalies in congenital muscular torticollis]. / Konjenital müsküler tortikolliste kranyofasiyal ve servikal vertebra anomalilerinin 3B-BT ile incelenmesi.

PURPOSE: To investigate the accompanied craniofacial and cervical spine anomalies in congenital muscular torticollis (CMT) with three-dimensional computerized tomography (3D-CT). MATERIALS AND METHODS: We examined six cases of CMT. Cranial and cervical 3D CT was performed in all cases. Facial midline deviation angle (FDA), upper hemifacial width, lower hemifacial width (LHFW), length of hemimandible and zygomatic arcus, posterior hemicranial width (PHCW), anterior hemicranial width and cranial base midline deviation angle (CBDA) were measured on cranial 3D-CT images. Value of orbital index was calculated. Data achieved both ipsilaterally and contralaterally were compared with paired t-test. Atlanto-axial rotation angle (AARA) and atlantodental interval (ADI) values were measured on cervical 3D-CT images. RESULTS: Ages ranged between 2-26 years with a M/F ratio of 1/5. Facial asymmetry was diagnosed in all cases and LHFW was significantly undersized when compared to contralateral side (p < 0.05). FDA was measured 5.4+/-2.0 degrees on the average. Zygomatic arcus and hemimandible were significantly undersized on the side of torticollis (p < 0.05). Occipital plagiocephaly existed in all cases and PHCW was significantly extensive on torticollis side (p < 0.05). CBDA was measured 4.5+/-1.7 degrees on the average. Rotational movement of atlas over axis was observed in all cases where the AARA was 15.0+/-7.4 degrees. ADI was lesser than 3 mm in all cases. CONCLUSION: Even occipital plagiocephaly, maxillary and orbital deformity were commonly found in cases of CMT, most dominant asymmetry was observed in lower hemifacial region, zygomatic arcus and mandible by 3D-CT imaging. Rotational movement of first cervical vertebra over the second one was determined in all cases.