Comparison of ischemic preconditioning and BotulinumA Toxin injection for the prevention of ischemia-reperfusion injury in musculocutaneous flaps

Background/aim: The aim of the study was to evaluate the protective effect of Botulinum A toxin injection against ischemia-reperfusion injury. Materials and methods: Thirty-two Sprague-Dawley rats were divided into: control, ischemia-reperfusion, ischemic preconditioning, and botulinum groups. In all groups the musculocutaneous pedicle flap was occluded for 4 h, and then reperfused to induce ischemia-reperfusion injury. Serum and tissue myeloperoxidase (MPO) and nitric oxide (NO) levels were measured at 24 h and at 10 days. Results: Tissue MPO levels did not differ significantly between the ischemic preconditioning and botulinum groups at 24 h but was significantly lower in the botulinum group at 10 days. Tissue NO levels were significantly higher in the ischemic preconditioning group compared to the botulinum group at 24 h and at 10 days. Serum MPO showed no significant difference between these two groups at 24 h but was significantly lower in the ischemic preconditioning group compared to the botulinum group at 10 days. Serum NO levels were not significantly different at 24 h but significantly higher in the botulinum group at 10 days. Conclusion: Findings show that botulinum has a protective effect against the ischemia-reperfusion injury via increased NO and decreased MPO levels in tissue. Based on tissue NO levels, ischemic preconditioning was significantly higher than botulinum.

Case Report: Isolated Renal Hydatid Cyst in a Boy

Hydatic cyst is a crucial and prevalent parasitic disease in the developing countries in the Mediterranean region. Its diagnosis is sometimes problematic because of non-specific complaints and unavailability of any positive results in a routine laboratory analysis. Isolated renal hydatid cysts are very rare. In this study, a primary left renal hydatid cyst which was found in a 12-year-old boy was presented. He was referred by another hospital to our department with a flank pain and cystic mass in left kidney. Indirect haemagglutination test (IHA) for Echinococcus was negative. Nephrectomy was performed with the diagnosis of renal cyst hydatic. Renal cyst hydatid may present with various clinical findings ranging from asymptomatic clinical course to total loss in renal function. It will be beneficial to consider a renal hydatid cyst in patients with blurred flank pain, even if IHA is negative.

A huge duplication cyst of the ileum.

BACKGROUND: Massive unilocular intraabdominal cysts in children are rare. Alimentary tract duplications can present diagnostic and therapeutic difficulties. Although they can occur anywhere from the mouth to the anus, they are commonly seen in relation to the ileum. We herein present an unusual case of duplication cyst itself occupying virtually all of the available intraabdominal volume. It appeared to be an enteric duplication cyst of ileal origin. CASE REPORT: A 3-month-old girl was admitted to our hospital for investigation of progressive abdominal distension and biliary vomiting. Plain radiography of the abdomen showed normal air-fluid level in the stomach and paucity of gases in rest of the abdomen. Magnetic resonance imaging showed a huge, homogenous cyst extending from the xiphisternum down to the pelvis. The cyst was excised completely. Macroscopic examination and histologic findings confirmed the diagnosis of a huge enteric duplication cyst arising from the ileum. CONCLUSIONS: Enteric duplication cyst should be considered in a patient with an abdominal cystic mass. Radiologist must take into account patient age, clinical parameters, and imaging findings to identify the likely etiology of a cystic mass.

Primary hydatid disease of the pancreas mimicking pancreatic pseudo-cyst in a child: case report and review of the literature.

Primary hydatid disease of the pancreas is very rare. We report the case of a 7-year-old girl who presented with abdominal pain and an epigastric mass. The Casoni and indirect hemagglutination test for hydatid disease were negative. A diagnosis of a pancreatic pseudocyst was established by ultrasonography (US) and computed tomography scan before surgery. Ultrasound guided percutaneous drainage was planned as treatment. During the procedure, the cyst was perforated and as germinative membrane was seen by US, we arranged surgery. Hydatid disease should be considered in the differential diagnosis of all cystic masses in the pancreas, even if Casoni and indirect hemagglutination tests negative, especially in geographic regions like Turkey, where the disease is endemic.

[Our childhood cases with intussusception and pneumatic reduction]. / Cocukluk çagi invajinasyon olgularlmlz ve pnömatik redüksiyon.

BACKGROUND: Intussusception is defined as telescopic insertion of the terminal ileum in to the colon after the cecum and colon. The aim of this study was to present our experience in pneumatic reduction of intussusception. METHODS: In our study, 118 intussusception cases treated between 1996 and 2008 were analyzed. Age, gender, admission time, diagnostic/treatment methods, types of intussusception including leading point, and postoperative complications were evaluated. RESULTS: Of these patients, 76 (64%) were male and 42 (36%) were female. Mean age was 25 +/- 34 months (3-180 months). The most common clinical presentations were vomiting, abdominal pain/irritable crying and bloody stools. Intussusceptions were ileocolic in 109 (92.3%) patients, ileoileal in 7 (6%) patients, and colocolic in 2 (1.7%) patients. No mortality was noted. Fifty-three patients (45%) were treated by nonoperative reduction whereas the remainder were treated surgically. Among 65 patients operated, 13 leading points were detected. Pneumatic reduction success rate was 86%. Age significantly reduced the pneumatic reduction success rate; however, the duration between the beginning of symptoms and hospital admission and bloody stool were not effective. CONCLUSION: Intussusception can be treated by non-operative methods when diagnosed early. Our results suggest that pneumatic reduction of intussusception in the pediatric population should be considered as a first choice.

[An interesting journey of a grass inflorescence from broncho to dorsum: case report]. / Bir pisipisi otunun bronslardan sirta ilginç yolculugu: olgu sunumu.

A 15-years-old male was presented with hyperemic and painful right flank mass. His medical history was consisted of a treatment for pneumonia and hemoptysis in the other hospital five months ago. Diagnostic X-rays was showed consolidation in the posterobasal segment of right pulmonary lobe and abscess in the paravertebral muscle extending from L4-5 level. The patient was discharged after antibiotic treatment. At the second hospitalization, a grass inflorescence was discharged from the fistula. When the patient was reevaluated his history was consisted of the aspiration of a grass inflorescence eight months ago. To our knowledge, this patient represents the first case of penetration by a grass inflorescence migrated out of the lumbar region.

Amyand's hernia in the children: a single center experience.

BACKGROUND: The presence of a vermiform appendix in an inguinal hernial sac is termed Amyand's hernia. It may present as a tender inguinal or inguinoscrotal swelling, and it is often misdiagnosed as an incarcerated or strangulated hernia. METHODS: Between 1998 and 2006, we have managed 564 patients with acute appendicitis, 1,090 patients with inguinal hernia, 33 patients with incarcerated inguinal hernia, and 12 patients with Amyand's hernia on our pediatric surgery service. A retrospective analysis of clinical data of these patients with Amyand's hernia was performed. RESULTS: All patients with Amyand's hernia were boys with a median age of 40 days (range, 15 days-14 months). One patient's condition was diagnosed pre-operatively. All of them, therefore, underwent emergency operation with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 2 normal appendices, 6 inflamed appendices, and 4 appendices with external signs of serosal inflamation of uncertain significaince in the inguinal hernial sac. Two patients with a normal appendix had hernia repair without an appendectomy. The other 10 patients with an abnormal appendix underwent an emergency open appendectomy with repair of the inguinal hernia. None of the patients developed recurrent hernia. The median postoperative follow-up period was 2.5 years. CONCLUSION: In pediatric patients with Amyand's hernia, the inflammatory status of the appendix can be used to determine the type of hernia repair and the operative approach. Incidental appendectomy in the case of a normal appendix is not favored by us. Treatment includes appendectomy (via the hernia sac) and hernia repair in children with an inflamed appendix.

[The role of apoptosis and protective effect of carnitine in contralateral testicular injury in experimental unilateral testicular torsion]. / Deneysel tek tarafli testis torsiyonundaki karsi testis hasarinda apoptozisin rolü ve karnitinin koruyucu etkisi.

BACKGROUND: We examined the role of programmed cell death (PCD) in the etiology of contralateral testis injury as well as the protective effect of carnitine. METHODS: Thirty-six Wistar Albino rats were used in the study. Rats were divided into six groups as control, sham, torsion-detorsion with 6- and 24-hour intervals, and torsion-detorsion-carnitine administration with 6- and 24-hour intervals. The left testes of all rats were torsioned 720 degrees. Intraperitoneal carnitine was administered to groups as 100 mg/kg one hour before detorsion. Orchiectomy was applied to the contralateral testis a week after detorsion. Testes were examined with respect to diameters of seminiferous tubules (DST), ratios of malonyl dialdehyde and Johnsen biopsy scores (JBS), and PCD ratios. Results were evaluated by ANOVA test. RESULTS: Programmed cell death ratios were significantly higher in the torsion-detorsion with 6- and 24-hour intervals groups compared to the sham group. Those increases were more prominent in the torsion-detorsion with 24-hour interval group. DST and JBS of the control group were significantly higher than in the experimental groups (p < 0.05). The protective effect of carnitine was significant in the 24-hour torsion group, while no significant difference were detected in the 6-hour torsion-detorsion-carnitine group. CONCLUSION: Increased injury and PCD in the contralateral testis was observed with prolonged exposure time in this model. It was possible to decrease the injury with carnitine.

Intermuscular hydatid cyst in a 4-year-old child: a case report.

Human Echinococcus infection still remains an important health problem in endemic regions. Primary musculoskeletal Echinococcus infection is very rare without involving the thoracic and abdominal organs. There has been no reported case of intermuscular hydatid cyst in the very early ages of childhood. Here we report a case of a 4-year-old girl with a primary intermuscular hydatid cyst in the left thigh. It was localized between the adductor muscles and iliopsoas muscle. It was removed without destroying the cyst wall and there were no complications. Hydatid cyst should be considered especially in the endemic areas when evaluating cystic masses. Hydatid cyst can be treated by operation.

Alterations in spontaneous contractions of rat proximal and distal colon after peritonitis.

BACKGROUND/PURPOSE: The aim of this study was to investigate the effect of peritonitis on spontaneous contractions of distal and proximal colon smooth muscle isolated from rats. METHODS: Peritonitis was induced by cecal ligation and puncture in 8 rats. Another group of 8 rats underwent a sham operation and acted as controls. Twenty-four hours after the operation, the rats were killed; and their distal and proximal colon smooth muscle was excised and placed in circular muscle direction in a 10-mL organ bath. Changes in the amplitude and frequency of contractions were analyzed before and after the addition of antagonists. RESULTS: Peritonitis induced the increase in the amplitude and frequency of spontaneous contractions. In both distal and proximal colon of the control group, the amplitude of spontaneous contractions was elevated by N(G)-nitro-L-arginine and tetrodotoxin; but the frequency of spontaneous contractions was significantly elevated only in the presence of N(G)-nitro-L-arginine. In both distal and proximal colon of the peritonitis group, the enhanced amplitude and frequency were significantly decreased and returned to control values in the presence of celecoxib. CONCLUSIONS: Peritonitis induces the increase in the amplitude and frequency of spontaneous contractions of distal and proximal colon, which can be attributed to a loss of inhibitor nitrergic and other neural control or rise of cyclooxygenase-2 levels.

Analysis of a 1-year-old cystinuric patient with recurrent renal stones.

Cystinuria is a hereditary disorder of cystine and dibasic amino acids (lysine, arginine, ornithine) transport across the luminal membrane of renal tubules and intestine, resulting in recurrent nephrolithiasis. Cystine stones frequently occur in the second or third decade of life with an occasional occurrence in infancy and in old age. Herein is presented the case of a 1-year-old girl with cystinuria and recurrent urolithiasis; the genetic basis of the disease was investigated by mutational analysis of the SLC3A1 gene. The data show that the present patient has an increased cystine (923.08 microg/mL) level and was heterozygote for M467T mutation.

Ceftriaxone-associated biliary pseudolithiasis in paediatric surgical patients.

It is well known that ceftriaxone leads to pseudolithiasis in some patients. Clinical and experimental studies also suggest that situations causing gallbladder dysfunction, such as fasting, may have a role for the development of pseudolithiasis. In this study, we prospectively evaluated the incidence and clinical importance of pseudolithiasis in paediatric surgical patients receiving ceftriaxone treatment, who often had to fast in the post-operative period. Fifty children who were given ceftriaxone were evaluated by serial abdominal sonograms. Of those, 13 (26%) developed biliary pathology. Comparison of the patients with or without pseudolithiasis revealed no significant difference with respect to age, sex, duration of the treatment and starvation variables. After cessation of the treatment, pseudolithiasis resolved spontaneously within a short period. The incidence of pseudolithiasis is not affected by fasting.