Small bowel obstruction caused by massive ascariasis: two case reports.

Ascaris lumbricoides is an infestation that affects approximately one-seventh of the world's population. Ascaris lumbricoides is a common inhabitant of the intestines of people with low-socioeconomic incomes, especially in underdeveloped countries of the world. Ascaris lumbricoides infestation is more prone to infestation with serious complications such as intestinal obstruction, volvulus, intussusception, and intestinal necrosis at higher rates in children than in adults. Case presentation: The authors present here two cases of small bowel obstruction caused by massive Ascaris lumbricoides that were admitted to the pediatric surgery service after completing a clinical and physical examination, and we operated after rehydration. Both underwent surgical resection with an end-to-end anastomosis. The patient was discharged uneventfully with a plan for de-worming treatment in 6 weeks. Clinical discussion: Ascariasis is a round intestinal worm infestation transmitted by fecal or oral contamination. Eating and excreting ascaris eggs lead to ascariasis and excrete human feces, which contaminate foods, soil, and/or water in unsanitary environments. In contrast, in the first case of this study, the diagnosis was made by ultrasound and erect abdominal radiography, and, in the second case, an abdominal ultrasound result was equivocal and required an abdominal computed tomography scan for confirmation. Treatment of small bowel obstruction by roundworms is usually surgical, but in the absence of signs of peritonitis, medical management can give effective results, even in the case of total obstruction. Conclusion: The type of surgery undertaken is determined by the results of the laparotomy. If the bowel was found to be intact and the obstruction was at the ileum level, milking worms to the cecum can be done with caution to avoid trauma to the bowel wall. Primary anastomosis after resection of a necrotic bowel segment and removal of the worm bolus is a suitable method for treatment of the ascariasis obstruction.

A case of empyema necessitans in an adolescent with mycobacterium tuberculosis.

Introduction and importance: An empyema is a buildup of pus in the pleural space and is most commonly associated with pneumonia. Streptococcus pneumonia is the most common cause of pneumonia, although staphylococcus aureus is common in developing countries. empyema necsitans is An extravasation of purulent material outside the pleural space involving the chest wall. Case presentation: Here we present a 15-year-old girl presented with swelling on the right thorax wall. I was told that the swelling had been there for 1 year with moderate discomfort upon lifting objects, with no other complaints. Her medical history was unremarkable until the mass appeared. There was no history of fever, cough, or weight loss, and there was no family history of tuberculosis. Clinical discussion: Empyema necessitatis can be quite harmful. It has the potential to cause bone and soft tissue erosion. This may be asymptomatic at first and proceed at a slow and steady pace. Tuberculous EN can be treated with both surgical and medical treatments. This case applies to both surgical intervention and medical treatment with antituberculosis. Conclusion: Empyema necessitans is uncommon consequence of pleural space infection. pulmonary mycobacterium tuberculosis, Actinomyces, and nontuberculous organisms such Staphylococcus aureus are the most prevalent causes.

Expression of Epstein-Barr virus in children with sacrococcygeal pilonidal sinus determined by immunohistochemical methods.

In this study, we probed whether chronic infections of skin such as pilonidal sinus could be a potential site of Epstein-Barr virus (EBV) replication. Pilonidal sinus is associated with a high recurrence rate. Therefore, we decided to determine the role of EBV's presence to explain whether it is correlated with the recurrence of pilonidal sinuses. This study was conducted on 36 patient samples with sacrococcygeal pilonidal sinus. Samples were immunohistochemically stained for EBV, CD3 and CD20 expression. Thirty-six adolescents with pilonidal disease were evaluated. EBV-positive cells were located in dermis with high inflammatory activity. EBV-positive cells stained positive for the B-cell antigen CD20 and were detected in 10 of 36 (27%) pilonidal sinus specimens. Among those who had experienced a relapse, three were positive for EBV expression. In addition, EBV expression was detected in eight cases with severe inflammation, and in two with minimal or moderate inflammation. Our study advances the field by demonstrating that similar to gastrointestinal mucosa, skin could be a reservoir for EBV. EBV was found to be restricted to B cells in skin lesions, and it was found that skin lesions with severe inflammation showed higher frequency of EBV expression in comparison to minimal or moderately inflammed skin lesions. Additionally, recurrence was more frequently observed among EBV-positive cases. These findings point out for a role of EBV infection in the recurrence of pilonidal sinuses.

Actinomycosis of the appendix in childhood- an unusual cause of appendicitis.

Actinomycosis is a rare chronic bacterial infectious disease in childhood. A 14-year-old boy admitted with cramping abdominal pain and vomiting. Physical examination revealed right lower quadrant tenderness. Appendectomy was performed. On the histological section, typical actinomycotic (sulfur) granules in the appendiceal lumen were observed.

CD117 and CD34 staining patterns in childhood benign mammary lesions.

OBJECTIVE: CD117 and CD34 are markers that have both been implied in cancer progression in adult breast lesions. This study was conducted in order to create a retrospective documentation and to analyze the expression patterns of these markers on childhood benign lesions along with a comparison with adult breast lesions' staining patterns. MATERIAL AND METHOD: Nine fibroadenomas, 2 tubular adenomas, 1 mammary hamartoma, 2 gynecomastias, 1 benign phyllodes tumor were retrieved from pathology archives of two reference centers between 2005-2010. RESULTS: CD117 staining was identified in the epithelium of all cases in fibroadenoma/tubular adenoma group and focally positive in 1 mammary hamartoma, 2 gynecomastias, and 1 benign phyllodes tumor. CD117 staining was detected in the stroma of 8 cases. Three fibroadenomas, 1 mammary hamartoma, 2 gynecomastias and 1 benign phyllodes tumor lacked stromal labelling for this marker. All cases were strongly and diffusely positive for CD34 except the benign phyllodes tumor case. This case presented marked loss of stromal CD34 staining when compared to the surrounding stroma. Additionally, pseudoangiomatous stromal hyperplasia was noted in 2 gynecomastias and in the peritumoral stroma of benign phyllodes tumor case. CONCLUSION: Our study demonstrated that fibroadenoma was the most commonly encountered breast lesion in childhood and that adolescent fibroadenomas showed similar staining patterns for CD117 and CD34 as for adult counterparts. On the other hand, different expression patterns of CD117 and CD34 between adenoma group and the gynecomastias and benign phyllodes tumor group may implicate different mechanisms of development and tumorigenesis among these groups.

Clinical experience in hypospadias: results of tubularized incised plate in 496 patients.

OBJECTIVES: To review the tubularized incised plate, a recently popularized technique, and provide outcomes. METHODS: From January 2000 to December 2006, 496 patients underwent the tubularized incised plate technique for hypospadias at our clinic. The patient age range was 6 months to 14 years. The postoperative follow-up time was 2 years (range 6 months to 3 years). The patients underwent the technique as described by Snodgrass, with some small technical modifications. The patients were hospitalized for 10 days postoperatively, with a urethral stent in place. RESULTS: Of the 496 patients, 48 experienced 53 complications. The most frequent complication was meatal stenosis (n = 27, 5%), followed by urethrocutaneous fistula (n = 25, 5%). Dehiscence was noted in 1 patient (0% of 496 patients and 2% of the 48 patients with complications). Initially, the fistula occurrence rate was 11% and 4% for all 496 and the 48 patients with complications, respectively, which had decreased to 3% and 8% in the most recent 3 years. During the study period, some technical modifications have applied, with a resulting decrease in the complication rates. Complications occurred in 48 patients (9%), of whom 25 required surgical repair (5% of 496 patients). CONCLUSIONS: The tubularized incised plate technique is a surgical method that can be applied to most hypospadias anomalies. Increasing clinical experience and minor additions to the technique have enhanced our success with this method.

Is hernial sac removal necessary? Retrospective evaluation of eight patients with Morgagni hernia in 5 years.

Eight children with Morgagni hernia were operated between January 2000 and May 2005. Medical records of the patients were evaluated retrospectively. Ages of the patients were between 3.5 months and 9 years. The diaphragmatic defect was on the right in all patients except one. One patient had bilateral diapragmatic hernia. All of the patients were operated by abdominal approach. All patients had hernial sacs. During operation sac of hernia was everted to peritoneal space without removal and the defect was closed by using nonabsorbable material. There was no intraoperative complication. The patients were discharged on the sixth day in uneventful condition. There was no complication or recurrence during follow up. Excision of sac of hernia is recommended in majority. Most of the published studies favour the removal of hernial sac. In our practise, in the treatment of Morgagni hernia we did not remove the hernia sac during the last 5 years.