Traumatic Rupture of Choledochal Cyst in Children: Use of Computed Tomography in the Emergency Department.

The case of an 11-year-old girl who developed acute abdomen after an accidental fall over an iron bar is reported to discuss the diagnostic features and treatment options for traumatic rupture of a choledochal cyst (CC) in children. The patient was admitted to the emergency department with complaints of vomiting and abdominal pain. Physical examination revealed tenderness at the right upper quadrant of the abdomen. Computed tomography findings revealed a rupture of a type IV CC and laceration of the liver. Cholecystectomy, total excision of the cyst, and hepaticojejunostomy were performed. Traumatic rupture of a CC is extremely rare in children, and only 2 cases have been reported. Because patients can be misdiagnosed as experiencing liver hematoma, computed tomography should be performed for all patients with free fluid in the abdomen and cystic mass on the initial evaluation.

Homozygosity for two missense mutations in the leptin receptor gene (P316:W646C) in a Turkmenian girl with severe early-onset obesity.

Leptin receptor gene mutations are a very rare cause of severe early-onset obesity. They are also associated with lack of pubertal development and intense hyperphagia. Presented here is a case of a 6-year-old Turkmenian girl with monogenic obesity due to a congenital deficiency of the leptin receptor. She was born from a consanguineous marriage of second cousins after 40 gestational weeks following an uncomplicated pregnancy. Her birth weight was 3500 g. However, rapid weight gain was observed after 6 months. On presentation she was 130 cm tall [> 97th percentile; standard deviation score (SDS): +2], with a weight of 90 kg (> 97th percentile; SDS: +5.3) and a body mass index (BMI) of 53.2 kg/m2 (SDS: +3.6). Results of genetic evaluation revealed the patient to be homozygous for two missense mutations in the leptin receptor gene (P316T;W646C) resulting in complete loss of leptin receptor function. Both parents were heterozygous for the same pair of missence mutations.

Protective effects of caffeic acid phenethyl ester (CAPE) on intestinal damage in necrotizing enterocolitis.

OBJECTIVE: To determine the preventative effect of caffeic acid phenethyl ester (CAPE) in necrotizing enterocolitis (NEC) in an experimental rat model of NEC. MATERIALS AND METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into three groups; as NEC, NEC + CAPE and control. NEC was induced by enteral formula feeding, subjected to hypoxia-hyperoxia and cold stress. Pups in the NEC + CAPE group were treated with CAPE at a dose of 30 mg/kg daily by intraperitoneal route from the first day to the end of the study. All pups were executed on the fourth day. Proximal colon and ileum were allocated for histopathologic and biochemical evaluation, including xanthine oxidase (XO), total antioxidant status (TAS), total oxidant status (TOS), malonaldehyde (MDA) and myeloperoxidase (MPO) activities. RESULTS: The pups in the NEC + CAPE group had better histopathologic and apoptosis evaluations (TUNEL and caspase-9) and the severity of bowel damage was significantly lower in the NEC + CAPE group compared to the NEC group (P < 0.01). The clinical sickness scores and body weight in the NEC + CAPE group was significantly better compared to the NEC group (P < 0.05). Tissue MDA, MPO, XO levels and TOS were remarkably reduced in the NEC + CAPE group, however, TAS was significantly increased in the NEC + CAPE group (P < 0.05). CONCLUSION: Treatment with CAPE reduces the intestinal damage in NEC.

Surgical Treatment of Childhood Inflammatory Myofibroblastic Tumors.

Aim A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives of childhood inflammatory myofibroblastic tumors (IMTs). Patients and Methods Patients who underwent surgical treatment for IMT between 2000 and 2015 were evaluated for age, sex, presenting symptoms, physical examination findings, diagnostic methods, treatment modalities, histopathologic findings, and results of surgical treatment during long-term follow-up. Results Eleven patients who underwent surgical treatment were included in the study. Male:female ratio was 7:4 and the mean age of the patients was 6.09 years (1-10 years). Presenting symptoms were respiratory difficulty, cough (n = 7, 63.3%), abdominal pain, vomiting (n = 2, 18.8%), loss of body weight (n = 1, 9.09%), palpable mass (n = 1, 9.09%), and rectal bleeding (n = 1, 9.09%). Ultrasonography (n = 4, 36.3%) and computed tomography (n = 9, 81.1%) were used for diagnosis. Localizations of tumors were lungs (n = 5, 45.4%), mediastinum (n = 2, 18.1%), spleen (n = 1, 9.09%), neck (n = 1, 9.09%), colon (n = 1, 9.09%), and rectum (n = 1, 9.09%). The mean size of mass was 6.6 cm (2-12 cm) and six patients were diagnosed with preoperative biopsy. Lung lobectomy (right lower lobe; n = 3, right middle and lower lobe; n = 2), total resection of mass with adjacent bowel (n = 2), partial splenectomy (n = 1), total resection of neck mass (n = 1), and incomplete resection (n = 2) were the choice of surgical treatment. Incomplete resection was performed in masses closely adjacent to atrium and mediastinal structures. In histopathologic evaluation, surgical margins were free of tumor in four cases, positive in six cases, and were not reported in one case. Anaplastic lymphoma kinase (ALK) positivity was detected in six cases, negative in two cases, and was not evaluated in three cases. Two cases who had residual mass with positive ALK received chemotherapy. Mean follow-up time was 68.2 months (5 months to 12 years). During follow-up, there was no recurrence or distant metastasis. Ten patients survived and one patient was lost to follow-up. Conclusion IMT is a rare tumor of childhood with a spectrum of clinical findings because of variable localization. Surgical treatment is the first choice of treatment. Patients with residual mass and ALK positivity may require medical treatment. In our series, long-term survival of patients was favorable in patients with total resection.

Lipid peroxidation and extracellular matrix in normal and cirrhotic rat livers following 70% hepatectomy.

BACKGROUND/AIMS: The aim was to measure the deposition of collagens and proteoglycans and the underlying mechanism leading to lipid peroxidation due to oxidative stress in partially hepatectomized normal and cirrhotic rats. METHODOLOGY: Four groups of adult Wistar rats were used comprising normal livers, regenerated normal livers, cirrhotic livers, and regenerated cirrhotic livers. Cirrhosis was induced by intragastric administration of carbon tetrachloride and phenobarbital in the drinking water of the rats. Hydroxyproline, as a constituent of collagens, uronic acid, as a constituent of proteoglycans, and malondealdehyde, an end-product of lipid peroxides, were measured in normal and cirrhotic rats, and following partial hepatectomy. RESULTS: Hydroxyproline, uronic acid and malondealdehyde levels were 234.2 +/- 41.2, 11.82 +/- 1.92, 46.3 +/- 5.8 and 211.8 +/- 43.6, 9.16 +/- 1.41, 48.5 +/- 7.5 for normal and regenerated normal livers respectively. The values after partial hepatectomy in cirrhotic and regenerated cirrhotic livers were 396.9 +/- 48.5, 17.96 +/- 1.62, 144.5 +/- 25.1 and 309.6 +/- 43.2, 13.35 +/- 1.72, 229.9 +/- 24.4, respectively. When the cirrhotic liver group was compared with the normal liver group, the levels of hydroxyproline, uronic acid and malondealdehyde were significantly higher (p < 0.001). Uronic acid levels of regenerated normal and regenerated cirrhotic livers and hydroxyproline level of regenerated cirrhotic liver were significantly less than those of their non-regenerated states (p < 0.01). Although the malondealdehyde levels of normal and regenerated normal livers did not differ significantly (p > 0.05), the malondealdehyde levels of regenerated cirrhotic liver was significantly higher than cirrhotic liver (p < 0.01). The histopathological examination with light microscopy did not reveal any obvious difference between the groups other than between normal and cirrhotic. CONCLUSIONS: Cirrhotic livers revealed a significantly higher amount of extracellular matrix constituents and lipid peroxidation than normal livers. Although partial hepatectomy in cirrhotic livers caused decreases in the tissue levels of collagens and proteoglycans, it did not actually lower the ongoing oxidative stress, known as physiological lipid peroxidation, in normal and cirrhotic livers following partial hepatectomy.

[Newborn with genital interlabial mass with spontaneous resolution: case report]. / Recién nacida con tumoración genital interlabial de resolución espontánea. Caso clínico.

Interlabial masses of newborns are rare issues that fall into the interest of pediatricians, pediatric surgeons, urologists, dermatologists and gynecologists. The most common are the hymenal cysts and paraurethral gland cysts. Several interlabial masses, including those of embryological origin, ectopic tissue, prolapse, urological anomaly, or neoplasia, can superficially resemble simple cysts. These include prolapsed urethra, prolapsed ectopic ureterocele, prolapsed vagina or uterus, Gartner's duct cyst, hydrometrocolpos associated with an imperforate hymen and botryoid rhabomyosarcoma. The differential diagnosis is important both for treatment approach and for follow up. We present a 3- day- old baby girl patient diagnosed with hymenal cyst.

N-acetylcysteine may prevent severe intestinal damage in necrotizing enterocolitis.

OBJECTIVE: The aim of this study was to evaluate the preventive effect of N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in an experimental rat model. MATERIAL AND METHODS: Thirty newborn Sprague-Dawley rats were randomly divided into 3 groups: NEC, NEC + NAC, and control. Necrotizing enterocolitis was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. Pups in the NEC + NAC group were administered NAC at a dose of 150 mg/kg daily by intraperitoneal route from the first day until the last day of the study. All pups were killed on the fifth day. Proximal colon and ileum were excised for histopathologic, immunohistochemical (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and caspase-3, caspase-8, caspase-9), and biochemical evaluation, including xanthine oxidase, total antioxidant status, total oxidant status, malondialdehyde, and myeloperoxidase activities. RESULTS: The pups in the NEC + NAC group had better clinical sickness scores compared with those in the NEC group (P < .05). In histopathologic and apoptosis evaluations (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling and immunohistochemical evaluation for caspase-3 and caspase-9), the severity of bowel damage was significantly less in the NEC + NAC group compared with the NEC group (P < .01). Tissue malondialdehyde, myeloperoxidase, xanthine oxidase levels, and total oxidant status were significantly decreased in the NEC + NAC group, whereas total antioxidant status (TAS) was significantly increased in the NEC + NAC group (P < .01). CONCLUSION: N-acetylcysteine therapy significantly reduced the severity of intestinal damage in NEC.

Recién nacida con tumoración genital interlabial de resolución espontánea: Caso clínico / Newborn with genital interlabial mass with spontaneous resolution: Case report

Las tumoraciones interlabiales en las recién nacidas son temas infrecuentes, de interés para pediatras, cirujanos, urólogos, dermatólogos y ginecólogos infantiles. Los quistes interlabiales neonatales más frecuentes son los quistes himeneales y los quistes glandulares parauretrales. Varias tumoraciones interlabiales, incluyendo las de origen embrionario, tejido ectópico, prolapso, anomalías urinarias o neoplasias, pueden aparentar ser simples quistes. Entre estos están el prolapso de uretra, vagina o útero, el ureterocele ectópico, el quiste del conducto de Gartner, el hidrometrocolpos asociado a himen imperforado y el rabdomiosarcoma botroide. El diagnóstico diferencial es importante tanto para el enfoque terapéutico como por el seguimiento. Se presenta el caso de una niña de 3 días de edad con diagnóstico de quiste himeneal y sus posibles diagnósticos diferenciales.

Interlabial masses of newborns are rare issues that fall into the interest of pediatricians, pediatric surgeons, urologists, dermatologists and gynecologists. The most common are the hymenal cysts and paraurethral gland cysts. Several interlabial masses, including those of embryological origin, ectopic tissue, prolapse, urological anomaly, or neoplasia, can superficially resemble simple cysts. These include prolapsed urethra, prolapsed ectopic ureterocele, prolapsed vagina or uterus, Gartner's duct cyst, hydrometrocolpos associated with an imperforate hymen and botryoid rhabomyosarcoma. The differential diagnosis is important both for treatment approach and for follow up. We present a 3- day- old baby girl patient diagnosed with hymenal cyst.

In vitro antifungal effect of human milk.

A lower incidence of infection occurs among breast-fed babies because of the presence of antibacterial, antiviral, and antiparasitic effects, but little is known about the antifungal effects to fungi other than Candida albicans. This study was undertaken to assess the antifungal effect of human milk to the fungi in the environmental air, which also may be allergenic. Milk samples were obtained from lactating mothers of healthy term infants between the 3rd and 8th days of lactation. Ninety-six Sabouraud agar petri dishes were separated into three groups, closed, and incubated in the same location after 15 minutes uncovered. The first group (group 1, n=48 dishes) was used to detect the fungal flora of the environmental air. The second group (group 2, n=24 dishes) was rubbed with a thin layer of human milk by a sterile pipette. The last group (group 3, n=24 dishes) was rubbed with 0.9% NaCIlsolution. After 7 days of incubation, the colony-forming fungal growths of all dishes were evaluated by a microbiologist who did not know the groups of the dishes. The number offungal colonies grown in human milk-rubbed dishes in group 2 was less than both of the other groups (group 1 and 3; p < 0.001 and p < 0.001, respectively). These results indicated that human milk may have antifungal effects to fungi present in the environmental air as tested by Sabouraud agar petri dishes. To prevent infections and allergic diseases, human milk must be considered the ideal food for newborns.

Blastocystis hominis--an emerging and imitating cause of acute abdomen in children.

Two children aged 12 and 11 years with a similar history of abdominal pain, nausea, vomiting and fever with abdominal tenderness, and muscle guarding at the right lower quadrant for few days were admitted to our hospital. They subsequently developed diarrhea but without clinical relief. Just before the decision of laparotomy, both patients were diagnosed as having Blastocystis hominis infection with light microscopic examination of the stools and were treated uneventfully with the appropriate antibiotics.