Severe abdominal trauma involving bicycle handlebars in children.

OBJECTIVES: To emphasize the severity of the underlying injury which may not be realized during the initial patient admission to the emergency department. METHODS: A retrospective case note review of children admitted to our institution with the severe abdominal injury. RESULTS: Eight children were identified with the severe abdominal injury secondary to the trauma from a bicycle handlebar that needed special care in the intensive care unit. All injuries were due to blunt trauma. The mean delay from the time of the accident to the time of presentation was 34.5 hours. All patients had an imprint of the handlebar edge on the hypochondrium. There were 3 pancreatic lacerations, 1 duodenal laceration, 1 jejunal laceration, 1 liver laceration, 1 abdominoinguinal laceration that all required open surgery, and 1 duodenal hematoma that resolved in 4 weeks follow-up period. The patients who required open surgery were evaluated with computed tomographic scans before surgery. CONCLUSIONS: Children with an imprint made by the handlebar edge on the abdominal wall or give a clear history of injuries by a bicycle handlebar should be treated with great care. Early computed tomography evaluation may help to reduce the morbidity resulting from the delay in diagnosis of injuries to the internal organs.

Corset Usage for Gastrointestinal and Respiratory Problems in a Newborn with Prune Belly Syndrome.

Prune Belly syndrome (PBS), comprises a triad of anomalies that include abdominal wall flaccidity, urologic anomalies and bilateral cryptorchidism in males. The abdominal musculature hypoplasia predisposes to respiratory problems, respiratory infections secondary to impaired cough mechanism, and cause chronic constipation secondary to ineffective valsalva ability. Here, the authors present a newborn baby with Prune Belly syndrome who had respiratory and gastrointestinal problems which resolved after corset use. To the authors knowledge, this is the first case of corset usage in the treatment of PBS in a newborn infant.

A rare cause of acute abdominal distention: opening of the pancreatic duct into hydatic cyst. / Causa rara de distensión abdominal aguda: apertura del conducto pancreático en un quiste hidatídico.

INTRODUCTION: Hydatid cyst, which is caused by Echinococcus granulosus, is mostly seen in the liver and lungs although it may also rarely be found in any organ or soft tissue. This study presents an interesting case of pancreatic hydatid cyst in which the pancreatic duct opened into this cyst. CASE REPORT: A 10-year-old boy presented to our clinic with significant abdominal distension and pain in the epigastric region which had started 10 days previously. Serum amylase level was 3709 U/L and hemagglutination inhibition for hydatid disease was 1/160. At abdominal computed tomography, two separate lesions and ascites were determined, a CE2 hydatid cyst in the region of the tail of the pancreas and a CE1 hydatid cyst in the left lobe of the liver. Percutaneous drainage was applied to the cyst in the pancreatic tail, and the patient was started on albendazole. The drainage catheter was removed, and the patient has since been followed-up on an outpatient basis with no complications.

Laparoscopy-Assisted Percutaneous Cholangiography in Biliary Atresia Diagnosis: Comparison with Open Technique.

Introduction. Biliary atresia is a surgical cause of prolonged jaundice, which needs to be diagnosed with cholangiography that has traditionally been performed via laparotomy. Laparoscopic assistance has lately been introduced to avoid unnecessary laparotomy. We aim to evaluate the benefits of the laparoscopy-assisted cholangiography and compare it to the traditional procedure via laparotomy. Patients and Method. The medical records of the cases who had undergone cholangiography for prolonged jaundice between 2007 and 2014 were analyzed. The patients were grouped according to cholangiography technique (laparotomy/laparoscopy). The laparoscopy and laparotomy groups with patent bile ducts were focused and compared in terms of operation duration, postoperative initiation time of enteral feeding, and full enteral feeding achievement time. Results. Sixty-one infants with prolonged jaundice were evaluated between 2007 and 2014. Among the patients with patent bile ducts, operation duration, postoperative enteral feeding initiation time, and the time to achieve full enteral feeding were shorter in laparoscopy group. Conclusion. Laparoscopic cholangiography is safe and less time-consuming compared to laparotomy, with less postoperative burden. As early age of operation is a very important prognostic factor, laparoscopic evaluation should be an early option in work-up of the infants with prolonged jaundice with direct hyperbilirubinemia, for diagnosis/exclusion of biliary atresia.

Fetal Oropharyngeal and Neck Tumors: Determination of the Need for Ex-Utero Intrapartum Treatment Procedure.

BACKGROUND: The aim of this study was to assess the ex-utero intrapartum therapy (EXIT) applied to 3 of the 7 cases with oropharyngeal or neck masses and review the indicators of the need for an EXIT procedure. CASE REPORT: Prenatal presentation, size and localization of the masses, existence of fetal hydrops and associated findings such as polyhydramnios, intraoperative managements, complications, and maternal and neonatal outcomes were evaluated through a retrospective analysis. Four cases had neck masses and three cases had oropharyngeal masses. Prenatal sonography was used as the main diagnostic tool for all patients. The median gestational age was 34.5 weeks at the time of diagnosis and 36 weeks at delivery. Polyhydramnios was observed in three of the seven cases and they were delivered prematurely. Interventions such as endotracheal intubation or tracheostomy were performed to provide patency of the airway during delivery by the EXIT procedure in three cases. Hemangioma was found in two cases, teratoma in two cases, lymphangioma in two cases and hamartoma in one case following pathological examination of the masses. CONCLUSION: The localization of mass, its characteristics, invasion (if it exists), and relation to the airway are the main factors used to determine the need for EXIT. The presence of polyhydramnios may be an important indicator to predict both the need for EXIT and fetal outcomes.

[Foreign body aspiration in children]. / Cocuklarda yabanci cisim aspirasyonu.

OBJECTIVES: The aim of this study was to present the demographic data of our patients who underwent bronchoscopy for suspected aspiration of a foreign body. We also assessed the sensitivity and specificity of history, symptoms, physical examination, and radiological findings in these patients. PATIENTS AND METHODS: One-hundred and two patients underwent bronchoscopy for suspected foreign body aspiration during a 23-month period. Bronchoscopy was performed under general anesthesia with a rigid bronchoscope. RESULTS: A foreign body was detected in 78 patients. The male-to-female ratio was 1.7:1, the mean age was 30.4 months, and the median age was 18 months. Nut and sunflower seeds were the most common types of foreign bodies. There were three minor complications and no death in our series. No tracheotomy or thoracotomy were required. The sensitivity and specificity of history, symptoms, physical examination, and radiological findings for suspected foreign body aspiration were 100% and 4.2%, 97.4% and 8.4%, 89.7% and 37.5%, 76.8% and 50%, respectively. CONCLUSION: A chocking crisis is an absolute indication for bronchoscopy. Our low complication rate allowed us to perform bronchoscopy more liberally in patients with suspected foreign body aspiration. The sensitivity of history, symptoms, and physical findings were very high, whereas the specificity of history and symptoms were very low.

Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures.

BACKGROUND: Gastro-oesophageal reflux may accompany the corrosive oesophageal damage caused by the ingestion of corrosive substances and affect its treatment. The factors that affect the development of reflux in these cases and their effects on treatment still remain unclear. AIMS: Our aim is to investigate the prevalence of gastro-oesophageal reflux in children with corrosive oesophageal strictures, the risk factors affecting this prevalence and the effects of gastro-oesophageal reflux on treatment. STUDY DESIGN: Case-control study. METHODS: We enrolled 52 patients with oesophageal stricture due to corrosive substance ingestion who were referred to our clinic between 2003 and 2010. Groups, which were determined according to the presence of gastro-oesophageal reflux (GER), were compared with each other in terms of clinical findings, results of examination methods, characteristics of the stricture and success of the treatment. RESULTS: The total number of patients in our study was 52; 30 of them were male and 22 of them were female. The mean age of our study population was 4.2±2.88 years. Thirty-three patients had gastrooesophageal reflux (63.5%). Patients who had strictures caused by the ingestion of alkali substances were 1.6-times more likely to have reflux. There were no differences between patients with or without reflux in terms of number and localisation of strictures. Mean distance of stricture was longer in patients with reflux (3.7±1.8 cm) than in patients without (2.2±1.0 cm) (p<0.005). Only one patient among 17 who had a long stricture (≥4 cm) did not suffer from reflux. Patients with long stricture were 1.9-times more likely to have reflux. Dilatation treatment was successful in 69.6% of patients with reflux and in 78.9% of patients without. The mean treatment period was 8.41±6.1 months in patients with reflux and 8.21±8.4 months in the other group. There was no significant difference between groups in terms of frequency of dilatation and dilator diameters (p>0.05). CONCLUSION: Corrosive oesophageal stricture was usually accompanied by gastro-oesophageal reflux and the length of stricture is an important risk factor. Negative effects of reflux over dilatation treatment have not yet been demonstrated in the short-term. Nevertheless, this frequent rate of reflux may eventually increase the risk of oesophagitis and Barrett's oesophagus; therefore, we suggest that these effects should be prospectively evaluated in a large number of patients and these patients should be followed-up routinely in terms of the long-term effects of reflux.

Clinical characterization of unusual cystic echinococcosis in southern part of Turkey.

BACKGROUND AND OBJECTIVES: The incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients. DESIGN AND SETTINGS: A retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcal Hospital. PATIENTS AND METHODS: Among the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis. RESULTS: Of 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases. CONCLUSION: CE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.

Congenital peribronchial myofibroblastic tumor: a case report and review of the literature.

BACKGROUND: Congenital peribronchial myofibroblastic tumor is a rare, solid mesenchymal tumor of the neonate, usually associated with non-immune hydrops fetalis. CASE REPORT: We present a case of congenital peribronchial myofibroblastic tumor, in whom a right lung mass was detected in intrauterine life. 12 days after delivery by caesarean section, right lobectomy was performed. The tumor was limited to the lung, and was composed of spindle cells, proliferating around a bronchial unit. Central necrosis and 4-5 mitoses per 10 high power fields were present. The patient is well 26 months after surgery. CONCLUSION: We report this rare tumor with clinical, radiological and pathologic findings and a review of the literature.

Renal sparing surgery using focus ultracision harmonic scalpel in patients with bilateral wilms' tumor: case report.

BACKGROUND: Bilateral Wilms' tumor is rare and surgical treatment requires an individual approach. Surgical approach to the tumors located in the central part of the kidney represents a major challenge and nephrectomy is usually essential. Renal sparing surgery is difficult in such cases. CASE REPORT: We describe a 3 year-old female patient with bilateral Wilms' tumor arising in the central localisation of the right and foci in the left kidney enucleated successfully with a simple and comfortable renal preserving operative technique using Focus Ultracision Harmonic Scalpel. CONCLUSION: In cases when tumors are located in the central part of the kidney and partial nephrectomy is consequently very difficult, the use of a Focus Ultracision Harmonic Scalpel provides easy dissecting, enucleation, and excision of the tumor.

Causa rara de distensión abdominal aguda: apertura del conducto pancreático en un quiste hidatídico / A rare cause of acute abdominal distention: opening of the pancreatic duct into hydatic cyst

Introducción. El quiste hidatídico, causado por Echinococcus granulosus, se observa mayormente en el hígado y los pulmones, aunque raramente también puede localizarse en cualquier órgano o tejido blando. En este artículo se presenta el caso de un paciente con quiste hidatídico pancreático con apertura del conducto pancreático en el quiste. A propósito de un caso: Se atendió en nuestra clínica a un niño de 10 años de edad con distensión abdominal significativa y dolor en el epigastrio de 10 días de evolución. La concentración de amilasa sérica era de 3709 U/l y la inhibición de la hemaglutinación para hidatidosis era de 1/160. En la tomografía computarizada de abdomen se observaron dos lesiones separadas y ascitis, un quiste hidatídico de tipo CE2 en la región de la cola del páncreas y un quiste hidatídico de tipo CE1 en el lóbulo izquierdo del hígado. Se realizó el drenaje percutáneo del quiste ubicado en la cola del páncreas y se inició tratamiento con albendazol. Se retiró la sonda de drenaje, y desde ese momento se ha realizado el seguimiento del paciente sin que se observen complicaciones.

Introduction. Hydatid cyst, which is caused by Echinococcus granulosus, is mostly seen in the liver and lungs although it may also rarely be found in any organ or soft tissue. This study presents an interesting case of pancreatic hydatid cyst in which the pancreatic duct opened into this cyst. Case report. A 10-year-old boy presented to our clinic with significant abdominal distension and pain in the epigastric region which had started 10 days previously. Serum amylase level was 3709 U/L and hemagglutination inhibition for hydatid disease was 1/160. At abdominal computed tomography, two separate lesions and ascites were determined, a CE2 hydatid cyst in the region of the tail of the pancreas and a CE1 hydatid cyst in the left lobe of the liver. Percutaneous drainage was applied to the cyst in the pancreatic tail, and the patient was started on albendazole. The drainage catheter was removed, and the patient has since been followed-up on an outpatient basis with no complications.

Effect of circumcision on genital colonization of Malassezia spp. in a pediatric population.

This study aimed to determine the prevalence of yeast fungi in samples from the glans penis and prepuce of circumcised and uncircumcised children. Impression preparations were made on modified Dixon and Leeming-Notman agar without cycloheximide. The isolates were identified by morphological and physiological characteristics. The yeasts were detected in 32 (28.6%) of 112 children, 12 (18.2%) being among 66 circumcised and 20 (43.5%) among 46 uncircumcised children. The most common species was Malassezia globosa (40.6%) followed by, Malassezia furfur (31.3%), Malassezia slooffiae (15.6%), Candida albicans (6.3%), Candida tropicalis (3.1%) and Candida parapsilosis (3.1%). The colonization with yeasts, and especially lipophilic species was more frequently observed among uncircumcised versus circumcised children. While age was not found to be a factor (P > 0.05), circumcision was responsible for increasing the colonization rate by 4.8 times (95% CI: 1.6-14.5) (P < 0.01). The circumcision status was not found to effect the distribution of Malassezia spp.

Testicular biopsy during orchidopexy procedure: does it have an adverse effect on fertility?

INTRODUCTION: The aim of this study is to evaluate the effect of the gonadal biopsy procedure on fertility and histology of the experimentally created undescended testis. MATERIALS AND METHODS: Thirty Wistar-Albino rat litters were divided into three groups. In the first two groups, undescended testes were obtained by dividing the right gubernaculum in the first 48 h and the third group constituted the sham group. When the rats were 30 days old, orchidopexy was performed in the first group (O), whereas orchidopexy and testicular biopsy were performed in the second group (OB). After the fertility study all rats were sacrificed at week 11 and testicular weights, mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were measured. RESULTS: One testis in the O group and three testes in the OB group were atrophied and these rats were excluded from the study. Testicular weights, MSTD and MTBS values of the operated side in the O and OB groups were lower than those in the sham group. There was a statistically significant difference between the MSTD values of the ipsilateral testes in the OB group and sham group (p<0.05). MTBS values of the ipsilateral testes in the O and OB groups were <8. There was no difference in all parameters in the contralateral testes between all groups (p>0.05). All the evaluated rats were fertile. While there was no difference in number of fetuses and fertility scores between the O and OB group, however, the differences were significant between each of these groups and the sham group (p<0.05). CONCLUSION: Testicular biopsy in the unilateral undescended testis model results in limited histological changes without affecting the fertility.

Epidermal growth factor and bombesin act synergistically to support intestinal adaptation in rats with massive small bowel resection.

Intestinal adaptation is the most important event in short bowel syndrome following a massive small bowel resection. Effects of various growth factors and their synergism have been well documented in intestinal adaptation. This study aimed to compare the effect of two different trophic agents, epidermal growth factor (EGF) and bombesin (BBS), on intestinal adaptation following massive intestinal resection. Sprague-Dawley male rats were assigned to one of four groups after a 75% small bowel resection. Either EGF (90 microg/kg), BBS (10 microg/kg), EGF+BBS, or bovine serum albumin (BSA) were injected subcutaneously three times a day. The animals were killed 10 days after the operation. Weight loss and morphologic parameters such as mucosal thickness, villus height, crypt depth, villus-to-crypt ratio, and muscularis propria height were measured. In the EGF+BBS group, mucosal thickness was found to be significantly increased compared with the other study groups (p<0.05). Similarly, villus height was significantly increased only in the EGF+BBS group (p<0.05). In the BBS group, both villus height and mucosal thickness showed a slight increase, but the values were not statistically significant compared with the vehicle-treated group. There were no significant differences in any of the remaining parameters between the groups. The results of this study indicate that the gut hormones EGF and BBS act synergistically in facilitating the adaptive response of the remnant ileum to massive intestinal resection.

Aggressive angiomyxoma in a child with chronic renal failure.

Aggressive angiomyxoma (AAM) is a rare and nonmetastasizing soft-tissue tumor predominantly found in the female pelvis and perineum. It has a high risk of local recurrence. We report the unusual case of a 15-year-old boy with an AAM presenting as a slowly enlarging scrotal mass. The patient had had chronic renal failure since 1997 and had needed hemodialysis for the previous 11 months. He presented with a 12-month history of a nontender soft mass in the right scrotum. Ultrasound examination revealed a solid mass in the scrotum. After surgical resection, pathological analysis disclosed spindle-shaped neoplastic cells widely separated by a myxoid stroma rich in collagen fibers and prominent irregularly shaped blood vessels; the histological examination confirmed an AAM.

Integration of a problem-based multidisciplinary clinical cancer management course into undergraduate education.

BACKGROUND: Undergraduate cancer education programs usually involve diagnosis and treatment of various organs and tissues of the body that are invaded by this disease. Teaching organ system-based oncology by different disciplines causes a fragmented structure of knowledge with difficulty on reuniting the knowledge for the real patient. METHODS: Along with the reorganization process of the curriculum, an integrated, problem-based multidisciplinary clinical cancer management course has been introduced to fifth-year students. The course has consisted of group studies, panel discussions, site visits to departments involved in diagnosis and treatment of cancer, and lecture tutorials enriched with interactive learning methods. RESULTS AND CONCLUSION: Overall assessment of the course has been encouraging in terms of a clinical approach for students to the cancer patient, and innovations for better learning have been implemented for the following year.

Double intussusception in an infant.

Intussusception is a common surgical disorder in infancy. Double intussusception (DI), however, is an extremely rare form of this pathology. The authors report a case of idiopathic DI in an 8-month-old girl, which is the third case of idiopathic DI in childhood in the English-language literature.

Epididymitis in infants with anorectal malformation.

OBJECTIVE: To document the characteristics of epididymitis in boys with anorectal malformations. METHODS: Sixty-six boys with anorectal malformation were treated between January 1990 and January 2000, in our center. Four of these boys experienced epididymitis attacks. The first three patients had rectourinary fistula and the fourth had a low type anorectal malforation without a rectourinary fistula. RESULTS: Patients were followed up for seven to nine years and epididymitis did not recur after the definitive operation in the first three patients. The fourth patient had four other episodes of epididymitis postoperatively and no reason for these episodes could be found during the further urological evaluation. Two patients had urinary tract infection and one patient had urinary tract contamination during their episodes of epididymitis. CONCLUSION: The cause of the epididymitis can be anorectal malformation with rectourethral fistula itself or another urogenital anomaly that is associated with anorectal malformation. There is a relationship between urinary tract infection and epididymitis in these patients.