Effects of local and sustained release of FGF, IGF, and GH on germ cells in unilateral undescended testis in rats.

OBJECTIVES: To evaluate the effects of the local release of fibroblast growth factor (FGF), insulin-like growth factor (IGF), and growth hormone (GH) on a germ cell population of ipsilateral undescended and contralateral descended testes of rats with a surgically created unilateral abdominal testis for 12 weeks and after the application of growth factors after orchidopexy. METHODS: Forty 4-week old male Wistar albino rats were divided into 5 groups as follows: group 1, sham; group 2, gelatin; group 3, FGF; group 4, IGF; and group 5, GH. In the sham group, the right testis was exposed and sutured with 5-0 silk sutures. In groups 2-5, a right intra-abdominal testis was surgically created. After 12 weeks, orchidopexy was performed, and 1 cm(2) gelatin films were sutured to the right testes, either unloaded (group 2), or containing 2.5 microg FGF (group 3), 5 microg IGF (group 4), or 5 microg GH (group 5). After 30 days, both testes were removed for histopathologic investigation and DNA flow cytometry. The mean seminiferous tubular diameters (MSTDs), mean testicular biopsy scores (MTBSs), and percentages of haploid (1n) cells were calculated. RESULTS: Ipsilateral MSTD and MTBS significantly decreased in the gelatin and FGF groups compared with the sham, IGF, and GH groups. Contralateral MSTDs and MTBSs did not differ among groups. The haploid cell percentage significantly decreased in the ipsilateral and contralateral testes of the gelatin group compared with the sham, FGF, IGF, and GH groups. CONCLUSIONS: Local release of IGF and GH resulted in the preservation of germ cell histology in the ipsilateral testes of rats with a surgically created unilateral undescended testis for 12 weeks and after orchidopexy. The administration of IGF, GH, and FGF increased the haploid germ cell population in both ipsilateral undescended and contralateral descended testes.

An unusual journey of a retained fecalith.

Retained fecalith after appendectomy is an uncommon complication and is mostly presented as an intra-abdominal abscess. Development of an extra-abdominal abscess due to retained fecalith is extremely rare. There are only a few cases reported in adults. In this paper, we present a case complicated by a gluteal abscess with intra-abdominal extension due to an unusual journey of a retained fecalith after an appendectomy. As far as we know, this is the first case of a gluteal abscess due to a retained fecalith in children.

Successful living-related liver transplantation in a child with familial yellow nail syndrome and fulminant hepatic failure: report of a case.

An 11-yr-old boy with familial YNS and FHF and who underwent LRLT is presented. LRLT was performed from his father with YNS. The findings of hepatic failure resolved immediately after LRLT, but severe respiratory complications and chylous ascites were observed during the follow-up. At 12 months after successful LT, the patient has good graft function, but findings of YNS including chronic cough, lymphedema and yellow nails are still present. To the best of our knowledge, this is the first case of YNS who underwent LRLT for FHF.

The effects of local and sustained release of fibroblast growth factor on wound healing in esophageal anastomoses.

BACKGROUND/PURPOSE: Postsurgical complications, such as anastomotic leaks in patients with esophageal atresia, have remained unchanged during the last 3 decades. Growth factors enhance healing in several wound-healing models. Therefore, an experimental study was used to evaluate the effects of local and sustained release of basic fibroblast growth factor (FGF) on wound healing in esophageal anastomoses. MATERIALS AND METHODS: Twenty-four male Wistar albino rats, which were subjected to a 1-cm segmental resection of the abdominal esophagus followed by end-to-end anastomosis, were allocated into 3 groups. Group I, the control group, had no gelatin film applied to the anastomosis. In group II (gelatin film without FGF) and group III (gelatin film with FGF), anastomoses were covered with unloaded and 2.55 mug FGF-loaded gelatin films, respectively. On postoperative day 7, bursting pressures, histopathologic collagen deposition, and tissue hydroxyproline concentrations of the anastomoses were then analyzed and compared. RESULTS: Mean bursting pressures, mean submucosal and muscular collagen deposition scores, and mean tissue hydroxyproline concentrations differed significantly between groups. Mean bursting pressures were 22.5 +/- 3.1 mm Hg in group I, 29 +/- 1.6 mm Hg in group II, and 63.2 +/- 6.8 mm Hg in group III (P < .001). Mean submucosal collagen deposition scores (group I: 0.7 +/- 0.2, group II: 0.7 +/- 0.1, group III: 1.5 +/- 0.2; P = .02) and mean muscular collagen deposition scores (group I: 0.8 +/- 0.2, group II: 0.8 +/- 0.1, group III: 1.8 +/- 0.1; P = .01) were significantly higher in FGF animals than the other in the other 2 groups. Mean tissue hydroxyproline concentrations were 2.4 +/- 0.5 microg/mg in group I, 3.9 +/- 0.4 microg/mg in group II, and 6.0 +/- 1.0 microg/mg in group III (P = .007). CONCLUSION: Local and sustained release of FGF enhanced wound healing in esophageal anastomoses in this animal model.

En-bloc stapling of the splenic hilum in laparoscopic splenectomy.

Vascular staplers or clips for sectioning of the splenic artery and vein are the procedure of choice in laparoscopic surgery. There are some concerns about the possible complications such as pancreatic injury, arteriovenous fistula (AVF) formation and portal or splenic vein thrombosis related to stapler usage. Hence this study was aimed to evaluate the safety and advisability of en-bloc mass stapling of the splenic hilum. A retrospective chart review was performed of 17 consecutive children undergoing laparoscopic splenectomy between June 2003 and June 2005 by a single surgeon. A routine four-trocar technique was used in all patients. Vascular isolation was achieved with an Endo-GIA (powered vascular linear stapler) without individual dissection of the splenic artery and vein. Doppler ultrasonographic evaluation was performed in order to search for a possible portal or splenic vein thrombosis and arteriovenous fistula formation in all patients one year after the operation. En-bloc stapling of the hilum was successfully performed in all children. No immediate or short-term complications related to en bloc stapling were observed. There were no arteriovenous fistula formations and splenic or portal vein thrombosis related to the previous operation with a mean follow-up of 21 months (12-36 months). En-bloc stapling can thus be safely performed in pediatric laparoscopic splenectomy with no related short-term vascular complications.

Late presentation of a traumatic rupture of the diaphragm with gastric volvulus in a child: report of a case.

Rupture of the diaphragm following blunt trauma is rare in children. A late presentation of a left diaphragmatic rupture with gastric volvulus is also highly exceptional. The authors report the case of a 5-year-old boy with a left diaphragmatic rupture, who presented with acute respiratory distress and volvulus of the herniated stomach 6 months after injury. The features of this uncommon entity are discussed with special emphasis on early diagnosis. It is concluded that repeated chest radiographs during hospitalization, as well as some days after discharge, should be obtained in trauma patients to detect a slowly increasing herniation.

Effects of intrauterine treatment on interstitial cells of Cajal in gastroschisis.

AIM: An experimental study was performed to investigate the effects of amnio-allantoic fluid exchange and intrauterine bicarbonate treatment on intestinal damage and interstitial cells of Cajal (ICC) in gastroschisis. MATERIALS AND METHODS: Thirteen-day-old fertilized chick eggs were randomly allocated into 4 groups as control, gastroschisis, gastroschisis + amnio-allantoic fluid exchange, and gastroschisis + bicarbonate treatment groups. In the treatment groups, amnio-allantoic exchange and bicarbonate treatments were performed for 3 days, after creating gastroschisis. Specimens were processed for hematoxylin-eosin and c-kit immunohistochemistry on the 18th day of incubation, after macroscopic examination. The intestines were evaluated with light microscopy for the presence of mucosal congestion and muscular and serosal edema. Mean muscular thickness and density of ICC were measured. RESULTS: Mean muscular thickness significantly increased in the gastroschisis group when compared with control and treatment groups. Labeling intensity, morphology, and localization of the ICC were similar in all groups. Mean ICC density significantly decreased in the gastroschisis group when compared with the control group (P < .01), and it significantly increased after amnio-allantoic fluid exchange treatment (P < .01). CONCLUSIONS: The decrease in ICC density encountered in damaged intestinal loops in gastroschisis was prevented with intrauterine treatment. The beneficial effects of amniotic exchange on intestinal motility may depend on both prevention of intestinal damage and preservation of ICC density and function. The density of ICC might be a reliable numeric parameter both to predict intestinal motility disorders in gastroschisis and to compare the effectiveness of intrauterine treatment methods.

Penile agenesis and congenital hypertrophic pyloric stenosis: an association or a random coexistence?

A neonate with penile agenesis and congenital hypertrophic pyloric stenosis is presented. The patterns of associated anomalies with penile agenesis, and those of congenital hypertrophic pyloric stenosis are discussed.