Is there a role of interstitial cells of Cajal and mast cells and eosinophils in appendicitis in children?

BACKGROUND/AIM: The aim of this study was to compare the distribution of interstitial Cajal cells, eosinophils, and mast cells in normal and inflamed appendices, and to evaluate the correlation of presence of these cells with severity of inflammation in appendicitis. MATERIALS AND METHODS: The appendicitis group (n = 30) was divided further into three groups according to the macroscopic description and the histological findings. Ten normal appendices served as controls. Tissue samples were processed for routine histological examination. Additionally, all sections were immunohistochemically stained with CD117 and mast cell tryptase antibodies. RESULTS: When specimens were compared in terms of Cajal cells, the observed mean number for the appendicitis group was 4.9 and for the control group it was 8.3. In contrast, eosinophils and mast cells were significantly increased in the appendicitis group when compared with the control group. CONCLUSION: We detected that eosinophils and mast cells are increased in appendicitis, and correlate with the degree of inflammation of the appendix. The density of interstitial Cajal cells was significantly lower in patients with severe appendix inflammation compared to controls. The histopathological differences observed in this study may help elucidate the pathophysiology of appendicitis.

Decision for surgery in the management of a rare condition, childhood gallbladder polyps, and the role of ultrasonography.

Gallbladder polyps are tumors or tumor-like protrusions of the gallbladder. They are rarely seen in the pediatric age. Most important issue about these mostly incidental lesions is the risk of malignant transformation. Size more than 10 mm is the classicalcutoff for determining this risk, but it is rarely valid in children. Ultrasonography is the method of choice for follow-up, but it rarely demonstrates change of size or malignant transformation. Hereby, we report 6 cases of childhood gallbladder polyps, none of which had a genetic risk factor. Follow-up was uneventful in 4 of them. Two patients had undergone surgery, but none of the lesions were neoplastic. In the follow-up, a single experienced radiologist should handle the patient, in order to prevent inter-observer variation. The cut-off size for deciding surgery should be 10 mm for those cases with genetic background creating malignancy risk (metachromatic leukodystrophy, pancreaticobiliary duct abnormalities, achondroplasia, Peutz-Jeghers syndrome) or with accompanying cholelithiasis, and 15 mm for those without any risk factors to prevent any unnecessary operations.

A comparison of polymer clips and endoloop applications for securing the appendiceal stump during laparoscopic surgery in children.

INTRODUCTION: In this study, for the first time in children a polymer clip and endoloop (EL) for securing an appendiceal stump have been prospectively correlated and evaluated radiologically. METHODS: Forty-nine patients aged 1 to 15 years were operated upon by the same surgeon for acute or perforated appendicitis between May 2008 and May 2009. The appendiceal stump was ligated by an EL or polymer clip. Patients were radiologically evaluated during the postoperative period. RESULTS: In the EL group, the mean operating time for perforated appendicitis was recorded as 57.40 minutes and in nonperforated appendicitis as 39.37 minutes, respectively. In the clips-applied group, these periods were 48.23 and 34.72 minutes, respectively. Clip application is 3 times cheaper than EL. CONCLUSIONS: Polymer clip is an instrument that is cheaper, safe, easily applicable, and takes less time for securing appendiceal stumps compared with EL.