Portal Hypertension in Children: A Tertiary Center Experience in Turkey.

Purpose: Portal hypertension (PH) and its complications have a significant impact on morbidity and mortality. This study aimed to evaluate the etiology; clinical, laboratory, and endoscopic findings; treatment approaches; long-term outcomes; and prognosis of pediatric PH. Methods: This retrospective study included 222 pediatric patients diagnosed with PH between 1998 and 2016, and data encompassing clinical, laboratory, and radiological features; treatments; and complications were analyzed. Results: The most common causes of PH were portal vein thrombosis (20.3%), progressive familial intrahepatic cholestasis (18.9%), and biliary atresia (12.2%). Among the enrolled patients, 131 (59.0%) were included in the cirrhotic group and 91 (41.0%) in the non-cirrhotic group. Hepatomegaly and increased transaminase levels were more frequent in the cirrhotic group than in the non-cirrhotic group. Additionally, portal gastropathy, esophageal varices, and variceal bleeding were more frequent in the non-cirrhotic group, whereas ascites, hepatopulmonary syndrome and hepatic encephalopathy were more common in the cirrhotic group. The incidence of hepatomegaly was higher in the presinusoidal group than in the prehepatic group (p<0.001). Hyperbilirubinemia was more frequent in the prehepatic group (p=0.046). The frequency of esophageal varices was similar between the prehepatic and presinusoidal groups; however, variceal bleeding was more frequent in the prehepatic group (p=0.002). Conclusion: Extrahepatic portal vein obstruction, genetic-metabolic diseases, and biliary atresia were the most prevalent causes of PH in our country. In patients with PH, hepatomegaly, increased transaminase levels, and synthesis dysfunction were suggestive of cirrhotic PH. Notably, PH in patients without cirrhosis might be more severe than that in those with cirrhosis.

The effects of different vasovasostomy techniques on motility of vas deferens (vas motility following vasovasostomy).

PURPOSE: Vasovasostomy is used to correct vas deferens (VD) transections encountered during surgery or to reverse sterilization vasectomies. Achieving vasal patency is the primary goal and the success is assessed on various factors including VD patency, flow rates, and pregnancy rates. While preserving vas motility is not a major concern in surgical practice, it is worth noting that VD has peristaltic activity which plays crucial role during ejaculation. Any disruption in its motility could potentially lead to negative outcomes in the future. We conducted an experimental study to assess vas motility changes following vasovasostomy. METHODS: The study was approved by Gazi University, Animals Ethic Committee. Twenty-four rats were allocated to four groups. Left-sided VD was harvested in control group (Gr1). The rest of the animals were subjected to transection of VD. Gr2 and 3 underwent microscopic and macroscopic anastomosis, respectively, while Gr4 underwent vasal approximation. After 12 weeks, all left-sided VD were resected, electrical field stimulation (EFS) and exogenous drugs were applied to induce contractions. Statistical analyses were performed and p value < 0.05 was regarded as statistically significant. RESULTS: The first and second phases of EFS-induced contractile responses(CR) increased for Gr3 and decreased for Gr4 at submaximal and maximal frequencies. An increase only at maximal frequency for second phase EFS-induced CR was encountered for Gr2. α-ß-methylene-ATP-induced CR decreased for Gr3 and 4. Noradrenaline-induced CR increased for Gr2, and 3 and decreased for Gr4. CONCLUSION: The results suggest that vasovasostomy performed using a surgical technique that minimizes disruption or damage to VD may have a favorable impact on motility.

Obstructive jaundice and severe pancreatitis due to the foramen of Winslow hernia with multiple anomalies.

Internal hernia through the foramen of Winslow is a very rare condition, especially in children. Here we report a 16-month-old girl who presented with obstructive jaundice and elevation of pancreatic enzymes and was ultimately diagnosed with internal hernia and malrotation by radiologic investigation and open approach surgery. To the best of our knowledge, obstructive jaundice with pancreatitis and other congenital abnormalities in children with the foramen of Winslow hernia have not been reported previously in the literature.

Changes in cholinergic and nitrergic systems of defunctionalized colons after colostomy in rabbits.

BACKGROUND: This study was designed to assess smooth muscle function and motility in defunctionalized colonic segments and subsequent changes in pathways responsible for gastrointestinal motility. METHODS: Two-month-old New Zealand rabbits were randomly allocated into control and study groups. Sigmoid colostomies were performed in the study group. After a 2-month waiting period, colonic segments were harvested in both groups. For the in vitro experiment, the isolated circular muscle strips which were prepared from the harvested distal colon were used. First, contraction responses were detected using KCl and carbachol; relaxation responses were detected using papaverine, sodium nitroprusside, sildenafil, and l-arginine. The neurologic responses of muscle strips to electrical field stimulation (EFS) were evaluated in an environment with guanethidine and indomethacin. EFS studies were then repeated with atropine, Nω-nitro-l-arginine methyl ester, atropine, and Nω-nitro-l-arginine methyl ester-added environments. RESULTS: Although macroscopic atrophy had developed in the distal colonic segment of the colostomy, the contraction and relaxation capacity of the smooth muscle did not change. EFS-induced nitrergic-peptidergic, cholinergic-peptidergic, and noncholinergic nonnitrergic responses significantly decreased at all frequencies (0.5-32 Hz) in the study group compared with those in the control group (P < 0.05). CONCLUSIONS: Although the contraction capacity of the smooth muscle was not affected, the motility of the distal colon deteriorated owing to the defective secretion of presynaptic neurotransmitters such as acetylcholine, nitric oxide, and neuropeptides.

The effects of melatonin on intestinal adaptation in a rat model of short bowel syndrome.

INTRODUCTION: Short bowel syndrome (SBS) is a clinical condition resulting from the loss of absorptive surface area following resection of 50% or more small bowel. Morphological and functional changes called "intestinal adaptation" occur in the residual intestine. Melatonin exists in the gastrointestinal tract and has effect on mitotic activity. Therefore, we hypothesized that melatonin may have beneficial effects on intestinal adaptation. MATERIALS AND METHODS: A total of 32 male Wistar albino male rats were divided into four groups. In group I (sham-S), small bowel was transected and reanastomosed. In group II (SBS-control), 75% small bowel resection and anastomosis were performed. In group III (SBS-vehicle), after 75% small bowel resection and anastomosis, 2 mL of 5% ethanol in saline was given intraperitoneally once a day. In group IV (SBS-melatonin), after 75% small bowel resection and anastomosis, 300 µg/kg melatonin was given intraperitoneally once a day. After 15 days, small bowels were removed and divided into two segments as jejunum and ileum. Each segment was weight and measured. Histological examination was performed in all samples. Bowel and mucosal weights and DNA/protein ratio were calculated. Apoptotic cells were also identified. RESULTS: The bowel length measurements were statistically longer in group IV. Mucosal and bowel weights were the highest in group IV. The villus height, crypt depth, and the number of mitotic figures were the highest in the jejunum of group IV. Melatonin also gave rise to a significant increase in DNA/protein ratios in group IV. CONCLUSION: According to this study, melatonin significantly enhanced intestinal adaptation.

Paraovarian cyst torsion in children: report of two cases.

Paraovarian cysts are assumed to be rare in childhood. This assumption is due to the fact that most patients with paraovarian cyst are asymptomatic unless complicated. Owing to the wide range of pathologies in differential diagnosis, preoperative diagnosis of paraovarian cyst presents a challenge. Herein is reported two cases of complicated paraovarian cyst in children.

The morphological evaluation of ipsilateral and contralateral vasa deferentia in a rat model of unilateral spermatic cord torsion.

AIM: Spermatic cord torsion is a surgical emergency that requires early intervention to protect the effected testicle. The literature review about this ischemic reperfusion (I/R) injury reveals not only ipsilateral, but also contralateral testicular and epididymal injuries in a broad fashion. However, there is no data about vas deferens injury related with this surgical emergency. The aim of the study is to evaluate the morphological changes of the vas deferens due to testicular I/R injury. MATERIALS AND METHODS: Eighteen Wistar-Albino rats were allocated to three groups. Bilateral vasa deferentia of control group (Gr C, n = 6) were harvested without any surgical intervention. The torsion group was subjected to 2 h torsion and 2 h detorsion of the left testicle (Gr T, n = 6) and the third group underwent sham operations (Gr S, n = 6). Bilateral vasa deferentia of Gr T and S were harvested after surgery. The either side of the vas deferens was divided into three equal segments and these regions (adjacent to urinary bladder, medial and adjacent to testicle) were evaluated histopathologically. RESULTS: The electron microscopic evaluation of bilateral vasa deferentia of Gr T revealed different degrees of degeneration on either side. The region adjacent to testicle of the contralateral vas deferens was the most effected segment when compared with the other segments. CONCLUSION: In the light of these findings, it can be said that testicular I/R injury effects not only testis and epididymis, but also the adjacent vas deferens. This effect seems to be bilateral, like the testis and epididymis injury. Moreover, it mostly seems to depend on the apoptotic processes.

Effects of mexiletine on electrical field stimulation-induced contractile responses in the ipsilateral and contralateral vasa deferentia after unilateral testicular torsion/detorsion.

AIM: To investigate testicular torsion-induced changes on the electrical field stimulation (EFS)-induced contractions in rabbit vasa deferentia and to evaluate the effect of mexiletine. METHODS: 18 male New Zealand albino rabbits were used in this experiment. Rabbits were divided into three groups: (1) control group (n = 6); (2) torsion group (n = 6), and (3) mexiletine group (n = 6). In the control group, vasa deferentia on both sides were harvested. In the torsion and mexiletine groups, the left testes of the rabbits were subjected to 720 degrees of clockwise torsion for 2 h and then detorsion was performed. In the mexiletine group, 50 mg/kg i.p. mexiletine was administered 1 h before detorsion. Following 24 h of the torsion, vasa deferentia on both sides were harvested and 2-cm strips including both the prostatic and epididymal portions were prepared to record EFS-induced contractions. RESULTS: Testicular torsion caused a significant inhibition in both phases of EFS-induced biphasic contractions of the ipsi- and contralateral vasa deferentia. Mexiletine treatment did not affect these inhibitory responses. Torsion/detorsion of the spermatic cord did not alter exogenously applied noradrenaline-induced contractions in both vasa deferentia. However, KCl-induced contractions diminished significantly in ipsilateral vas deferens of the torsion group and mexiletine restored this inhibition. CONCLUSIONS: Unilateral testicular torsion/detorsion leads to inhibition in both phases of EFS-induced biphasic contractions of the ipsi- and contralateral vasa deferentia by causing a defect in presynaptic nerve transmission. However, mexiletine has no effect on this inhibition. Inhibition of the KCl-induced contractions in the ipsilateral vas deferens, which indicates postsynaptic tissue damage, is restored by administering mexiletine 1 h prior to detorsion.

A novel technique for vas deferens transection repairs.

The purpose of this study is to describe a technique, that is as successful as microsurgery in terms of patency rates and histopathologic assessments, and can be performed even by untrained hands in microsurgery, for repairing vas deferens injuries that can be perceived during inguinal herniorrhaphy. Thirty male Wistar-Albino rats were randomly allocated to five groups. In control group, the vas deferens was harvested without any surgical intervention (Group 1) and in sham group the vas was harvested after a limited dissection (Group 2). Three suture approximation technique was carried out in Group 3, and a novel vasovasostomy technique was carried out by using a hypodermal needle in Groups 4 and 5, with polypropylene and polyglactin 910 (rapid vicryl), respectively. Results were evaluated in terms of operative time, patency and flow rates, inflammation and sperm granuloma. The mean operative times for hypodermal needle assisted approximation of Groups 4 and 5 were found significantly less than Group 3. The compared results of the groups in terms of patency, flow rate, inflammation and spermatic granuloma indicated Group 4 to be superior to the other groups. We have found the hypodermal needle assisted approximation technique to be easier, less time consuming and cost effective. With these promising results, this modus operandi can be described as an appropriate technique for vas deferens transection repairs.