Anastomotic leaks and the relationship with anastomotic strictures after esophageal atresia surgery; effects of patient characteristics.

BACKGROUND: This study aimed to evaluate the link between anastomotic leaks (AL) and anastomotic strictures (AS) after esophageal atresia surgery and the influence of patient demographics. MATERIALS AND METHODS: The clinical data of neonates who underwent surgical repair for esophageal atresia were retrospectively reviewed. The results of AL treatment and the relationship with AS, also the effects of patient characteristics were examined with logistic regression analysis. RESULTS: Primary repair was performed on 122 of 125 patients who underwent surgery for esophageal atresia. AL occurred in 25 patients and 21 were treated non-operatively. While 4 patients were re-operated, AL recurred in 3 and led to the death of one. There was no correlation between the development of AL and sex or the presence of additional anomalies. The gestational age and birth weight of patients with AL were significantly higher than those of patients without. AS developed in 45 patients. The mean gestational age was significantly higher in patients who developed AS (p < .001). While the development of AS was significantly higher in patients with AL (p = .001), the number of dilatation sessions needed was also significantly higher in these patients (p = .026). Complications related to anastomosis were less common in patients whose gestational age was ≤33 weeks. CONCLUSION: Non-operative treatment remains effective for AL after esophageal atresia surgery. AL increases the risk of developing AS and significantly increases the number of dilatation sessions needed. Anastomotic complications are less common in patients with lower gestational age.NOVEL ASPECTSGestational age and birth weight were found to be significantly higher in patients with anastomotic leaks than in those without and fewer anastomotic complications were encountered in patients whose gestational age was ≤ 33 weeks.Anastomotic stricture development was significantly higher in patients with anastomotic leaks and the number of dilatation sessions needed for treatment was also significantly higher in these patients.

Effect of oral tamoxifen on the healing of corrosive oesophageal burns in an experimental rat model.

OBJECTIVES: Corrosive oesophagitis is a common health problem in children. Scar tissue can develop during the recovery period, and as a result, serious narrowing of the oesophagus can develop, in turn causing morbidity and mortality. In previous studies, it was argued that tamoxifen (TAM) may have antifibrotic effects beyond its oestrogen antagonist or agonist properties. We aimed to examine the possible effects of TAM on fibrosis and stricture formation, which are complications of corrosive oesophagitis. METHODS: Three study groups were formed as follows: a non-oesophageal burn group (NON-EB, n = 6), an oesophageal burn group (EB, n = 6) and an oesophageal burn + tamoxifen group (EB-TAM, n = 6). In the NON-EB rats, the oesophageal lumen was washed with 0.9% NaCl while, in the EB and EB-TAM rats, the distal oesophagus was burned with a 50% NaOH solution. After application of this solution to the EB-TAM group rats, 0.4 mg/kg/day of TAM was administered via gavage for 7 days. Twenty-two days later, the rat oesophagi were examined histopathologically for inflammation, granulation, collagen deposition and stenosis. RESULTS: In the EB group rats, the inflammation, collagen deposition and stenosis scores increased compared with those of the other groups. In the EB-TAM group, these three scores were lower compared with those of the EB group rats, but higher compared with those of the NON-EB group rats. No significant difference was observed in the granulation scores between the EB and EB-TAM groups. It was also observed that the EB-TAM group rats gained more weight than those in the EB group. CONCLUSIONS: According to the data obtained, TAM use prevents inflammation, collagenization and stricture development. TAM may be a useful medicine in the treatment of corrosive oesophagitis.

Efficacy of diffusion-weighted magnetic resonance imaging in follow-up patients treated with open partial cystectomy of liver hydatid cysts.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy of DWI in differentiation of patients with residual cavity and type 1 hydatid cyst (HC) in the liver. METHODS: 32 patients were included. 12 of these patients had type 1 HC and the remainders (n = 20) had postoperative residual cavities. In all patients, axial T2-weighted and DWI images were obtained. An apparent diffusion coefficient (ADC) map of the images was automatically generated and the ADC values were measured on this map for all patients. Mann-Whitney U test was used for comparison of continuous variables between two groups. RESULTS: The mean diameters of type 1 hydatid cyst and residual cavity groups were 83.42 mm, 49.30 mm, respectively (P = 0.001). There were no significant differences in gender and age between the groups (both P > 0.05). The mean ADC values of type 1 hydatid cyst and residual cavity groups were 2.58 ± 0.13 × 10(-3) s/mm(2), 2.58 ± 0.16 × 10(-3) s/mm(2), respectively (P = 0.953). CONCLUSION: DWI might not be suitable to differentiate the postoperative residual cavity from the type 1 hydatid cyst in the liver due to similarity of ADC values between postoperative residual cavity and type 1 hydatid cyst.

Surgical approach for patients with unusually located hydatid cyst.

INTRODUCTION: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus whose people is the intermediate host. Although this parasite can settle in any part of the human body, it is frequently seen in liver and lungs. The rate of unusual located hydatid cyst outside of liver and lungs is 13,9%. In this study, we aimed presenting unusual located hydatic cysts regarding 51 patients. MATERIAL AND METHOD: In this retrospective study, the files of the patients operated in our department between 2005 and 2012 with the diagnosis of hydatid cyst, characterized be an additional location besides liver and lung involvement and located outside of liver and lung were controlled. FINDINGS: We had a total of 51 patients between the ages of 6-79 (average age 35,34), 20 of them were men (39%) and the others were women (61%) (men/women = 1.56). The cysts outside of liver and lung were frequently seen in spleen (24/51), ovarium (9/51), intraabdominal (8/51), brain (8/51), kidney (6/51), psoas muscle (1/51), bladder (1/51), cervical lymph node (1/51), the heart(1/51) respectively. The most frequent symptom in our patients was stomachache. Besides, symptoms of cough, fever, respiratory disorder were present; only one patient suffered from hemophtysis. While 32 patient out of 51 were treated by laparotomy, 8 patients were operated with laparotomy and thoracotomy in the same session; the patient with 2 ovarian cysts was submitted to cystectomy through laparoscopic surgery. As a patient had a cyst both in brain and liver, he was submutted to laparotomy and craniotomy. 46 cysts in 9 patients with lung involvement were treated with lung resections: 7 wedges resection and 2 segmentectomies. The other lung cysts of the analysed patients were treated by cystectomy and capitonnage. Bile leakage was detected in a total of 7 patients: 3 of them were treated with T tube drainage and the others were endoscopically healed by means of ERCP. CONCLUSION: The incidence of hydatid cyst, which is an important health problem in endemic areas, can be reduced by means of simple preventive measures. Its basic treatment is surgery. Main objective of the surgery should be parenchyma sparing while taking off completely the cysts. Although the disease is frequently seen in liver and lung, other organ involvements should be considered. Thus, it does not matter where hydatid cyst is seen, abdomen and thorax should be attentively controlled by the simplest imaging method also outside of clinical symptoms. Abdomen and thorax imaging should be carried out at least once in the two following years to have an early detection of an eventual recurrence.

Pneumomediastinum and subcutaneous emphysema due to blunt neck injury: a case report and review of the literature.

Minor blunt neck injury from childhood trauma is a relatively common condition which can be potentially life-threatening in only rare circumstances. Pneumomediastinum may develop in up to 10% patients who have sustained blunt cervical or thoracic trauma and may be a significant cause of morbidity and mortality in affected individuals because of the associated damage to the oesophagus, larynx or trachea. Management of this condition varies from conservative approach with close observation and antibiotherapy to surgical interventions, depending on the extent and severity of aerodigestive injuries. We present a paediatric blunt neck trauma accompanied by subcutaneous emphysema and pneumomediastinum secondary to a bicycle accident (neck striking the handlebar). Its radiologic appearance, clinical presentation, and the options for initial management in the emergency department (ED) are reviewed.