Incidence and Management of Appendiceal Neuroendocrine Tumors in Pediatric Population: A Bicentric Experience with 6285 Appendectomies

BACKGROUND

Neuroendocrine tumors (NETs) are rare tumors that arise from neuroendocrine cells and are the most common tumors of the appendix. NETs of the appendix usually cause no symptoms and often go unnoticed until they cause acute appendicitis or are discovered during an accidental appendectomy. As the trend towards the conservative treatment of acute appendicitis increases in the pediatric population, the question arises as to whether the majority of NETs go undetected and are only discovered at an advanced stage. The purpose of the proposed study is to review the incidence and outcomes of treatment for NETs of the appendix in children and include the data presented in the data pool for further review.

METHODS

From 1 January 2009 to 1 November 2023, a total of 6285 appendectomies were performed in two large pediatric centers in Croatia. After a retrospective review of the case records and histopathologic findings, a total of 31 children (0.49%) were diagnosed with NET of the appendix and included in the further analysis. The primary outcome of this study was the incidence and treatment outcome of pediatric patients diagnosed with NET of the appendix. Secondary outcomes included the patients' demographic, clinical, and laboratory data and the histopathologic characteristics of tumor species.

RESULTS

The overall incidence of NETs of the appendix was stable over the study years, with minor fluctuations. The median age of patients was 14 (interquartile range-IQR: 12, 16) years, with a female predominance (64.5%). The majority of patients (96.8%) presented with acute abdominal pain and underwent appendectomy because acute appendicitis was suspected. Acute appendicitis was confirmed by histopathology in 18 (58%) cases. NETs of the appendix were not detected preoperatively in any of the patients. Among patients with confirmed acute appendicitis, most (n = 14; 77.8%) were found to have non-perforated acute appendicitis. In most children, the tumor was located at the tip of the appendix (n = 18; 58.1%), and the majority of tumors had a diameter of less than 1 cm (n = 21, 67.7%). The mitotic count (n = 25, 80.6%) and Ki-67 proliferation index (n = 23, 74.2%) were low in most patients, so most tumors were classified as NET G1 (n = 25, 80.6%), while NET G2 and NET G3 were found in four (12.9%) and two (6.5%) patients, respectively. All children were treated with appendectomy only. The median follow-up time was 54 (IQR: 24, 95) months.

CONCLUSIONS

The incidence of appendiceal NET among pediatric patients is very low. NET occurs most frequently in adolescents, with a female predominance. Most tumors are less than 1 cm in diameter, located at the tip, and associated with non-perforated appendicitis. Appendectomy is the treatment of choice, and major surgery was not necessary in our cohort.

Martensitic Transformation in Fe_{x}Mn_{80-x}Co_{10}Cr_{10} High-Entropy Alloy

High-entropy alloys and even medium-entropy alloys are an intriguing class of materials in that structure and property relations can be controlled via alloying and chemical disorder over wide ranges in the composition space. Employing density-functional theory combined with the coherent-potential approximation to average over all chemical configurations, we tune free energies between face-centered-cubic and hexagonal-close-packed phases in Fe_{x}Mn_{80-x}Co_{10}Cr_{10} systems. Within Fe-Mn-based alloys, we show that the martensitic transformation and chemical short-range order directly correlate with the face-centered-cubic and hexagonal-close-packed energy difference and stacking-fault energies, which are in quantitative agreement with recent observation of two phase region (face-centered cubic and hexagonal closed pack) in a polycrystalline high-entropy alloy sample at x=40 at.%. Our predictions are further confirmed by single-crystal measurements on a x=40 at.% using transmission-electron microscopy, selective-area diffraction, and electron-backscattered-diffraction mapping. The results herein offer an understanding of transformation-induced or twinning-induced plasticity in this class of high-entropy alloys and a design guide for controlling the physics at the electronic level.

Half metallicity in Cr substituted Fe2TiSn

Band structure tailoring has been a great avenue to achieve the half-metallic electronic ground state in materials. Applying this approach to the full Heusler alloy Fe₂TiSn, Cr is introduced systematically at Ti site that conforms to the chemical formula \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\text{Fe}}_{2} {\text{Ti}}_{{1 - x}} {\text{Cr}}_{x}$$\end{document}Fe2Ti1-xCrxSn. Compositions so obtained have been investigated for its electronic, magnetic, and electrical transport properties with an aim to observe the half-metallic ferromagnetic ground state, anticipated theoretically for Fe₂CrSn. Our experimental study using synchrotron X-ray diffraction reveals that only compositions with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$x \le$$\end{document}x≤ 0.25 yield phase pure L2\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_1$$\end{document}1 cubic structures. The non-magnetic ground state of Fe₂TiSn gets dramatically affected upon inclusion of Cr giving rise to a localized magnetic moment in the background of Ruderman–Kittel–Kasuya–Yosida (RKKY) correlations. The ferromagnetic interactions begin to dominate for x = 0.25 composition. Results of its resistivity and magnetoresistance (MR) measurement point towards a half-metallic ground state. The calculation of exchange coupling parameter, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hbox {J}_{{ij}}$$\end{document}Jij, and orbital projected density of states that indicate a change in hybridization between 3d and 5p orbital, support the observations made from the study of local crystal structure made using the extended X-ray absorption fine structure spectroscopy. Our findings here highlight an interesting prospect of finding half-metallicity via band structure tailoring for wide application in spintronics devices.

The effects of severe plastic deformation on the mechanical and corrosion characteristics of a bioresorbable Mg-ZKQX6000 alloy

In this work, a bioresorbable Mg-ZKQX6000 (Mg-6Zn-0.6Zr-0.4Ag-0.2Ca (wt%)) alloy was severely plastically deformed via equal channel angular pressing (ECAP) according to three unique hybrid routes at low temperatures (200 °C to 125 °C). The roles of ECAP processing on microstructure, and ensuing mechanical properties and corrosion rates, are assessed. Microstructurally, ECAP induces a complex plethora of features, especially variations in grain sizes and precipitates' sizes, distributions, and morphologies for individual cases. Mechanically, ECAP generally refined grain size, resulting in ultra-high strength levels of about 400 MPa in ultimate tensile strength for several cases; however, deformation via ECAP of precipitates induced embrittlement and low elongation to failure levels. Corrosion testing, conducted in simulated bodily fluid at bodily pH levels to mimic conditions in the human body, revealed consistent corrosion rates across several techniques (mass loss, hydrogen evolution, and electrochemical impedance spectroscopy (EIS)), showing that severe plastic deformation deteriorates corrosion resistance for this material. In-situ corrosion monitoring explained that corrosion accelerated after ECAP due to the creation of heterogeneous, anodic shear zones, which exhibited dense regions of refined grains and fine precipitates. Suggestions for future design and thermomechanical processing of Mg alloys for bioresorbable orthopedic implants are provided.

The dynamics of the inflammatory response during BBN-induced bladder carcinogenesis in mice

Background

Bladder cancer (BC) is the most common malignant disease of the urinary tract. Recurrent high grade non muscle invasive BC carries a serious risk for progression and subsequent metastases. The most common preclinical mouse model for bladder cancer relies on administration of N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) to mice. BBN-induced tumors in mice recapitulate the histology of human BC and were characterized with an overexpression of markers typical for basal-like cancer subtype in addition to a high mutational burden with frequent mutations in Trp53, similar to human muscle invasive BC.

Methods

Bladder cancer was induced in C57BL/6J male mice by administering the BBN in the drinking water. A thorough histopathological analysis of bladder specimen during and post BBN treatment was performed at 2, 4, 16, 20 and 25 weeks. RNA sequencing and qPCR was performed to assess the levels of expression of immunologically relevant genes at 2 weeks and 20 weeks during and post BBN treatment.

Results

We characterized the dynamics of the inflammatory response in the BBN-induced BC in mice. The treatment with BBN had gradually induced a robust inflammation in the first 2 weeks of administration, however, the inflammatory response was progressively silenced in the following weeks of the treatment, until the progression of the primary carcinoma. Tumors at 20 weeks were characterized with a marked upregulation of IL18 when compared to premalignant inflammatory response at 2 weeks. In accordance with this, we observed an increase in expression of IFNγ-responsive genes coupled to a pronounced lymphocytic infiltrate during the early stages of malignant transformation in bladder. Similar to human basal-like BC, BBN-induced murine tumors displayed an upregulated expression of immunoinhibitory molecules such as CTLA-4, PD-L1, and IDO1 which can lead to cytotoxic resistance and tumor escape.

Conclusions

Despite the recent advances in bladder cancer therapy which include the use of checkpoint inhibitors, the treatment options for patients with locally advanced and metastatic BC remain limited. BBN-induced BC in mice displays an immunological profile which shares similarities with human MIBC thus representing an optimal model for preclinical studies on immunomodulation in management of BC.

Glassy Phonon Heralds a Strain Glass State in a Shape Memory Alloy

Shape memory strain glasses are frustrated ferroelastic materials with glasslike slow relaxation and nanodomains. It is possible to change a NiCoMnIn Heusler alloy from a martensitically transforming alloy to a nontransforming strain glass by annealing, but minimal differences are evident in the short- or long-range order above the transition temperature-although there is a structural relaxation and a 0.18% lattice expansion in the annealed sample. Using neutron scattering we find glasslike phonon damping in the strain glass but not the transforming alloy at temperatures well above the transition. Damping occurs in the mode with displacements matching the martensitic transformation. With support from first-principles calculations, we argue that the strain glass originates not with transformation strain pinning but with a disruption of the underlying electronic instability when disorder resonance states cross the Fermi level.

A Sensory Material Approach for Reducing Variability in Additively Manufactured Metal Parts

Despite the recent growth in interest for metal additive manufacturing (AM) in the biomedical and aerospace industries, variability in the performance, composition, and microstructure of AM parts remains a major impediment to its widespread adoption. The underlying physical mechanisms, which cause variability, as well as the scale and nature of variability are not well understood, and current methods are ineffective at capturing these details. Here, a Nickel-Titanium alloy is used as a sensory material in order to quantitatively, and rather rapidly, observe compositional and/or microstructural variability in selective laser melting manufactured parts; thereby providing a means to evaluate the role of process parameters on the variability. We perform detailed microstructural investigations using transmission electron microscopy at various locations to reveal the origins of microstructural variability in this sensory material. This approach helped reveal how reducing the distance between adjacent laser scans below a critical value greatly reduces both the in-sample and sample-to-sample variability. Microstructural investigations revealed that when the laser scan distance is wide, there is an inhomogeneity in subgrain size, precipitate distribution, and dislocation density in the microstructure, responsible for the observed variability. These results provide an important first step towards understanding the nature of variability in additively manufactured parts.

Reversible Martensitic Transformation under Low Magnetic Fields in Magnetic Shape Memory Alloys

Magnetic field-induced, reversible martensitic transformations in NiCoMnIn meta-magnetic shape memory alloys were studied under constant and varying mechanical loads to understand the role of coupled magneto-mechanical loading on the transformation characteristics and the magnetic field levels required for reversible phase transformations. The samples with two distinct microstructures were tested along the [001] austenite crystallographic direction using a custom designed magneto-thermo-mechanical characterization device while carefully controlling their thermodynamic states through isothermal constant stress and stress-varying magnetic field ramping. Measurements revealed that these meta-magnetic shape memory alloys were capable of generating entropy changes of 14 J kg^-1 K^-1 or 22 J kg ^-1 K^-1, and corresponding magnetocaloric cooling with reversible shape changes as high as 5.6% under only 1.3 T, or 3 T applied magnetic fields, respectively. Thus, we demonstrate that this alloy is suitable as an active component in near room temperature devices, such as magnetocaloric regenerators, and that the field levels generated by permanent magnets can be sufficient to completely transform the alloy between its martensitic and austenitic states if the loading sequence developed, herein, is employed.

Fibroadenoma with "immature-like" type of usual ductal hyperplasia

We herein report a case of the breast fibroadenoma with foci of so-called immature variant of the conventional ductal hyperplasia. This type of usual ductal hyperplasia is histologically characterised by encircling intraductal proliferation of large cells with pale to amphophilic cytoplasm and large nuclei which vary in shape and in staining quality of the chromatin. We showed here, using the cytokeratin immunohistochemistry, that the proliferating cells were not of immature but rather mature immunohistochemical phenotype. Because of the presented discordance between immature histology and mature immunohistological profile we suggest that this rare type of usual ductal hyperplasia should be called "immature-like".

Effect of grain constraint on the field requirements for magnetocaloric effect in Ni45Co5Mn40Sn10 melt-spun ribbons

The influence of grain constraint on the magnetic field levels required to complete the isothermal martensitic transformation in magnetic shape memory alloys has been demonstrated for a NiCoMnSn alloy, and the magnetocaloric performance of an optimally heat treated alloy was quantified. Ni45CoxMn45-xSn10 melt spun ribbons with x = 2, 4, 5, and 6 were characterized. The x = 5 sample was determined to exhibit the lowest transformation thermal hysteresis (7 K) and transformation temperature range during transformation from paramagnetic austenite to nonmagnetic martensite, as well as a large latent heat of transformation (45 J kg-1 K-1). For this composition, it was found that increasing the grain size to thickness ratio of the ribbons from 0.2 to 1.2, through select heat treatments, resulted in a decrease in the magnetic field required to induce the martensitic transformation by about 3 T due to the corresponding reduction in the martensitic transformation temperature range. This decrease in the field requirement ultimately led to a larger magnetocaloric entropy change achieved under relatively smaller magnetic field levels. The giant inverse magnetocaloric effect of the optimized alloy was measured and showed that up to 25 J kg-1 K-1 was generated by driving the martensitic transition with magnetic fields up to 7 T.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginning of the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Biomechanical properties of Achilles tendon in diabetic vs. non-diabetic patients

BACKGROUND/OBJECTIVES

Structural and functional impairments of the Achilles tendon in diabetic patients has the potential to contribute to ulcer formation through altered foot mechanics. This study aimed to examine the biomechanical and histopathological alterations in Achilles tendon specimens from diabetic vs. non-diabetic individuals.

MATERIALS AND METHODS

42 Achilles tendon samples obtained from patients treated with below-knee or above-knee amputation for chronic diabetic foot ulcers (n=21) or for non-diabetic conditions (n=21) were included. A tensile test was performed for each tendon and a stress vs. strain graft was obtained to calculate following biomechanical parameters: elasticity (Young modulus), load, stiffness, toughness, energy, strain, elongation and tenacity. Groups were also compared with regard to histopathological findings (inflammatory cell infiltration, collagen organization, and degeneration).

RESULTS

Non-diabetic tendons exhibited a superior biomechanical profile over diabetic tendons with regard to the following biochemical parameters: elasticity, maximum load, stiffness, toughness, load, energy, strain and elongation at break point, tenacity, and strain at automatic load drop (p<0.05 for all comparisons). Diabetic tendons had mild impairment of collagen organization and focal collagen degeneration, whereas neither diabetic nor non-diabetic tendons had inflammatory cell infiltration.

CONCLUSION

The structural and functional alterations associated with diabetes adversely affect the biomechanical properties of the Achilles tendon, potentially acting together with neuropathy and ischemia in the development of diabetic foot ulcers.

Melanoma in the ampulla of Vater

BACKGROUND

The most common tumors in the ampulla of Vater are adenocarcinomas. Although malignant melanoma usually occurs on the skin, it can also arise in the gastrointestinal and biliary tract.

METHOD

We present a case of a 52-year-old, previously healthy man who presented with painless jaundice.

RESULTS

Clinical examination revealed dilated intrahepatic and extrahepatic bile ducts and pancreatic duct due to the obstructive mass in the ampulla of Vater. The patient underwent pancreaticoduodenectomy and histopathological diagnosis of the resected tumor mass was malignant melanoma. Thorough clinical examination was preformed, but no other primary or metastatic site of melanoma could be found. In the next few months, the patient developed multiple liver metastases and died.

CONCLUSION

An isolated amelanotic lesion in the ampulla of Vater can be a potential diagnostic pitfall, especially in patients who have had melanoma.

Squamous metaplasia of the peritoneum: report of a case

The ability of the peritoneum to undergo metaplasia, especially to Müllerian-type epithelium has been recognized for a long time. The ability of mesothelial cells to modulate cytoskeletal filaments and shape is provided through the distinct form of subserosal cells, called multipotential subserosal cells, that have the function of replicative cells that differentiate into surface epithelium when affected by various stimuli. Rare forms of peritoneal metaplasia include squamous and cartilaginous metaplasia. This report presents a case of fully developed, mature peritoneal squamous metaplasia in an 85-year-old woman who underwent surgery because of small bowel perforation leading to diffuse peritonitis. This rare incidental finding almost always occurs in the background of chronic peritoneal irritation as a response to mesothelial injury. Squamos peritoneal metaplasia should not be interpreted as metastatic squamous cell carcinoma. The most important distinguishing criteria are the lack of nuclear atypia, mitoses, necrosis, and desmoplastic stromal response.

Her-2/neu assessment for gastric carcinoma: validation of scoring system

BACKGROUND/AIMS

Gastric cancer is the second leading cause of cancer mortality in the world. Amplification of HER-2/neu oncogene has become an important biomarker for identifying patients who respond to HER-2 targeting therapy. A number of studies have analyzed HER-2/neu overexpression in gastric carcinoma, and the rate of HER2 positivity is variable, ranging from 6% to 35%.

METHODOLOGY

In our study HER-2/neu expression was assessed on 73 samples of primary gastric cancer, using immunohistochemistry. For 19 patients preoperative biopsy samples and resected specimens were available. Additionally, internal ring study was performed to estimate intraobserver variability of IHC scoring among pathologists at our department.

RESULTS

HER-2/neu overexpression was found in 10 (13.6%) of the tested samples, and it was more common in intestinal (22.5%) than the diffuse type (3.7%). Not one of the 6 analyzed mixed type tumors showed HER-2/neu expression. For the paired samples (preoperative biopsy samples and resected specimens) the concordance rate for HER-2/neu expression was 94.7%.

CONCLUSIONS

According to high concordance rate in paired samples we consider it appropriate to evaluate HER2 expression on biopsy specimens, especially in unresectable cases, and to re-evaluate it on resected specimens if available, due to high heterogeneity of a gastric cancer.

Corrosion fatigue behavior of a biocompatible ultrafine-grained niobium alloy in simulated body fluid

The present study reports on the corrosion fatigue behavior of ultrafine-grained (UFG) Niobium 2 wt-% Zirconium (NbZr) alloy in simulated body fluid (SBF). The alloy was processed using multipass equal channel angular processing at room temperature, resulting in a favorable combination of high strength and ductility along with superior biocompatibility and excellent corrosion resistance. Electrochemical measurements revealed stable passive behavior in SBF saline solutions, similar to conventional Ti-6Al-4V alloy. High-cycle fatigue tests showed no alteration in the crack initiation behavior due to the SBF environment, and an absence of pitting and corrosion products. More severe test conditions were obtained in the fatigue crack growth experiments in saline environments. Crack growth rates in UFG NbZr were marginally increased in SBF as compared to laboratory air at a constant test frequency of 20 Hz. Upon a 100 fold decrease in the test frequency, slightly higher crack growth rates were observed only in the near-threshold region. Such excellent corrosion and corrosion fatigue properties of UFG NbZr recommend it as an attractive new material for biomedical implants.

Does gum chewing reduce postoperative ileus after intestinal resection in children? A prospective randomized controlled trial

INTRODUCTION

The aim of this study was to determine whether the addition of gum chewing to standardized postoperative care is associated with a significantly earlier return of bowel function compared to simple postoperative management in children with intestinal anastomosis.

MATERIALS AND METHODS

We performed a prospective, randomized, controlled trial. All patients who underwent laparotomy with either colon or small bowel resection between June 2006 and March 2008 were randomized to one of two groups. Group one consisted of patients receiving standardized postoperative care plus gum chewing (gum-chewing group) (n=15); Group two consisted of patients receiving only standardized postoperative care (control group) (n=15). The patients in the gum-chewing group chewed one stick of sugarless gum three times per day, for an hour, each day.

RESULTS

The groups were statistically similar. The time to first flatus was 35.73+/-14.67 h in the gum-chewing group and 42.00+/-20.77 h in the control group (p=0.347). The time to first bowel movement was 56.27+/-22.14 h in the gum-chewing group and 63.00+/-26.34 in the control group (p=0.444). The length of hospital stay was 5.80+/-0.68 days for the gum-chewing group and 6.67+/-0.98 days for the control group (p=0.005). The hospital charges were 2451+/-806 YTL for the gum-chewing group and 2102+/-678 YTL for the control group (p=0.206).

CONCLUSIONS

The addition of gum chewing to the standardized postoperative care of children with intestinal anastomosis was not associated with a significantly earlier return of bowel function compared to simple postoperative management, but it was associated with an earlier discharge from hospital, although this earlier discharge had only minor clinical significance and no difference was found in hospital charges.

Design and application of a mechanical load frame for in situ investigation of ferromagnetic shape memory alloys by magnetic force microscopy

An in situ mechanical load frame has been developed for a commercially available atomic force microscope. This frame allows examining changes in topography and magnetic domain configuration under a given constant load or strain. First results obtained on Ni-Mn-Ga ferromagnetic shape memory alloy single crystals are presented. The magnetic force microscopy (MFM) measurements under different strain levels confirm the one-to-one correspondence, i.e., the magnetomicrostructural coupling between the martensite twins and the magnetic domains. Additionally, the growth of the twin variant with favorable orientation to the compression axis during martensite detwinning was observed. It will be shown that this load frame can be used for the investigation of the relationship between the microstructure and the magnetic domain structure in ferromagnetic shape memory alloys by MFM.

External cystic rectal duplication: an unusual presentation of rectal duplication cyst

Duplications of gastrointestinal tract are rare anomalies, and rectal duplications account for five percent of the alimentary tract duplications. We present an unusual case of rectal duplication, which was located externally in a newborn female, and discuss the types of distal hindgut duplications.

Our experience with transanal endorectal pull-through in Hirschsprung's disease

AIM

The aim of the study was to evaluate the functional results, complications, the problems caused, and the outcomes of the transanal endorectal pull-through (TEPT) operation in Hirschsprung's disease.

PATIENTS AND METHODS

The 22 patients who were operated for Hirschsprung's disease with TEPT between November 2003 and September 2006 were reviewed retrospectively. The patients were evaluated for age, gender, operational findings, duration of hospitalization and functional outcomes after the operation.

RESULTS

A total of 22 patients, sixteen males (72.7 %) and 6 females (27.3 %) aged 23 days to 11 years (mean 19.3 +/- 6.9 months), were operated using TEPT over a 34-month period. The mean length of the resected aganglionic segment was 23 +/- 2.4 cm; the shortest segment was 7 cm and the longest 40 cm. The postoperative hospital stay was 3 - 10 days, oral feeding was started at 1 - 4 days, the first bowel movement was at 1 - 7 days and the number of daily movements for patients in whom the colostomy was closed was 2 - 5. The mean postoperative follow-up period was 18 +/- 2.4 months (1 - 33 months). Two patients (9 %) were hospitalized once for enterocolitis. One patient had a constipation problem that resolved with medical treatment. One patient needed colostomy for anastomosis leakage on the 5th postoperative day, followed by a redo pull-through using a posterior sagittal approach. None of the patients had a continence problem. No urethral damage was observed and there were no abscesses at the muscular cuff. We observed that mucosal dissection was more difficult in the rectal biopsy area.

CONCLUSIONS

Although only recently accepted, TEPT has quickly found a place in clinical practice as it is based on an operational technique whose results are well identified and accepted and with which there is extensive experience. It seems that TEPT has the advantages of having no additional problems compared to the classical techniques with respect to complications and functional outcomes while providing better patient comfort and cosmetic outcomes. We conclude that TEPT may be preferred in appropriate cases and will evolve to become a more practical and effective technique.

Outcome of primary peritoneal drainage for perforated necrotizing enterocolitis: comparison between laparotomy and drainage

Perforation of the gastrointestinal tract in neonates is still associated with high mortality rates. Laparotomy is usually required to treat gastrointestinal perforation, however peritoneal drainage under local anesthesia has been also described as an alternative mode of treatment. In our institute, laparotomy was the first choice for the management of gastrointestinal perforation in neonates until 1999. Because of the high mortality rates in this group of patients, our policy has since changed to the use of primary peritoneal drainage instead. The aim of this study is to compare the effectiveness of primary peritoneal drainage (PPD) and primary laparotomy (PL) procedures in the management of gastrointestinal perforation due to necrotizing enterocolitis in neonates. Between 1994 - 1998, ten babies with intestinal perforation underwent PL, whereas fifteen newborns with similar findings were treated with PPD between 1999 and 2003. Eight (80 %) of the patients died in the PL group prior to 1999. In the PPD group 8 (53.3 %) of babies required no further treatment and were discharged without any complications. Four (26.7 %) patients in this group needed laparotomy later, and three (75 %) of them survived. In conclusion, we believe that PPD is more effective than PL for the management of perforated necrotizing enterocolitis in neonates. Laparotomy can be used in particularly unresponsive cases after primary peritoneal drainage.

Is endothelial function impaired in erectile dysfunction patients?

Erectile dysfunction (ED) and vascular disease are thought to be linked at the level of the endothelium. Endothelial dysfunction, resulting in the inability of the smooth muscle cells lining the arterioles to relax, prevents vasodilatation. Likewise, penile erection depends on the relaxation of smooth muscle in the corpus cavernosum and the wall of small arteries. The aim was to assess the systemic vascular function in patients with ED. In all, 32 ED patients diagnosed with Doppler Ultrasound and the International Index of Erectile Function-5-item questionnaire and 25 healthy men as a control group enrolled to the study. They all underwent the tests including serum glucose and lipid levels. Echocardiography and exercise stress test was performed routinely. Baseline demographics (body mass index, heart rate and blood pressures), fasting glucose and lipid levels were not significantly different between ED and control groups. Endothelial-dependent brachial artery flow-mediated vasodilatation and brachial artery response to 0.4 mg nitroglycerine (NTG) were measured. Participants were negative on exercise stress test, and echocardiographic parameters including ejection fraction were similar. Endothelial-dependent brachial artery percent diameter change with flow-mediated dilatation (6.01+/-2.9 vs 12.3+/-3.5) and brachial artery response to NTG (12.8+/-4.2 vs 17.8+/-5.2) were significantly different between groups (P<0.001). We found that endothelial function was impaired in ED patients with no apparent cardiovascular disease and diabetes mellitus. This impaired function might be explained by the abnormality in systemic nitric oxide-cyclic guanosine monophosphate vasodilator system and suggest that ED and vascular disease may be linked at the level of the endothelium.

Comparison of closed-tube thoracostomy and open thoracotomy procedures in the management of thoracic empyema in childhood

PURPOSE

There is still an argument concerning the correct management of pleural empyema. The aim of this study is to compare the effectiveness of closed-tube thoracostomy and open thoracotomy procedures in the management of empyema in children.

METHODS

This is a prospective study of 30 patients with parapneumonic empyema who were managed randomly either by closed-tube thoracostomy or open thoracotomy procedures. The two procedures were compared based on the respective times to achieving normal body temperature and breath rates, duration of tube drainage, length of hospitalization, and complication rates. Both groups were also assessed by comparing tube drainage duration, pleural fluid pH, agent pathogen and glucose level.

RESULTS

Average tube duration was 7.5 +/- 1.1 days and average hospital stay was 9.5 +/- 1.5 days in the open thoracotomy group. In the closed tube thoracostomy group tube, duration was 13.8 +/- 2.3 days and average hospital stay 15.4 +/- 2.3 days. In the open thoracotomy group 73.3% of the patients had achieved normal body temperature and 66.7 % had a normal breath rate within the first 48 hours. In the closed tube thoracostomy group these rates were 40% and 20%, respectively. In both groups, tube drainage duration was found to be longer in patients whose pleural fluid pH was < 7.2.

CONCLUSION

The authors conclude that open thoracotomy is a safe, efficient, and easy method of treatment for pleural empyema in children. It was also observed that pleural fluid pH level is the most important prognostic criteria in pleural empyema.

Antimicrobial effects of Quercus ilex L. extract

The antimicrobial activities of the methanol extract of Quercus ilex L. (Pirnal oak) leaves were tested in vitro against a wide range of human and plant-associated microorganisms. A total of 132 microbial organisms belonging to 55 bacteria and five fungi and yeast species were studied using a disc-diffusion method and microdilution assays. The results were evaluated as inhibition zones around the disc impregnated with Q. ilex extract at a concentration of 300 micro L/mL. The results showed that Q. ilex did not have any antifungal activities against Alterneria alternata, Aspergillus flavus, Fusarium oxysporum, Penicillum spp., whereas there were inhibition effects on the growth of all Candida albicans isolates. In total 97 bacterial strains (74%) were found to be resistant to Q. ilex extract. The remaining 35 (27%) strains of seven different bacteria genera including Brucella, Bacillus, Enterobacter, Neisseria, Pseudomonas and Escherichia were susceptible to the extract tested. The minimum inhibitory concentrations (MIC) of the extract ranged from 125 to 500 micro L/mL. These results suggest that Q. ilex possesses compounds with antibacterial and anticandidal properties.

TAR syndrome with annular pancreas and anal atresia - a case report

TAR syndrome is manifested by the presence of hypomegakaryocytic thrombocytopenia and the bilateral absence of radii. An 8-day-old female newborn was referred to our clinic with diagnosis of TAR syndrome and symptoms of intestinal obstruction. On perineal examination she also had anal atresia with rectovestibular fistula. Because of persistent bile-stained drainage from the nasogastric tube, an upper gastrointestinal contrast study was performed and partial duodenal obstruction was detected. At operation, an annular pancreas was encountered and side-to-side duodenoduodenostomy was performed. A small number of gastrointestinal system malformations associated with TAR syndrome has been reported. Our case is unique; the association with annular pancreas and anal atresia with rectovestibular fistula has never been previously reported.

Evaluation of antimicrobial activities of Satureja hortensis L

The present study was designated to evaluate the antimicrobial activities of methonol and hexane extracts of Satureja hortensis L. which is an annual herb used as traditional folk medicine in Eastern Anatolia region of Turkey for the treatment of different infectious diseases and disorders. The antimicrobial activities of the extracts against 147 laboratory strains belong to 55 bacterial species, and 31 isolates of 1 yeast and 4 fungi species were tested by using disc diffusion assay. The results showed that hexane extract of Satureja hortensis had no antifungal, but antibacterial activity against four strains of three Bacillus species whereas methanol extract of Satureja hortensis had both anticandidal and antibacterial effects. It inhibited the growth of 23 strains of 11 bacterial species and 6 isolates of Candida albicans, at the concentration of 300microg/ml. Satureja hortensis did not show antimicrobial activity against the remaining microorganisms (83%) tested including most and all of the clinic and plant pathogenic microorganisms, respectively. Methanol extract showed stronger and broader spectrum of antimicrobial activity as compared to hexane extract.

Antimicrobial activity of aqueous and methanol extracts of Juniperus oxycedrus L

Aqueous and methanol extracts of the leaves of Juniperus oxycedrus were investigated for their in vitro antimicrobial properties. The plant was collected from Pelitli Village of Gebze, Kocaeli, in the Marmara region of Turkey. Juniperus oxycedrus is widely used as traditional folk medicine in Turkey for treatment of different infectious diseases. The antimicrobial activity of the extracts against 143 laboratory strains belonging to 56 bacterial species, and 31 isolates of 5 fungi species were evaluated based on the inhibition zone using the disc-diffusion assay, minimal inhibition concentration (MIC) and minimal bactericidal concentration (MBC) values. The aqueous extract of J. oxycedrus had no antimicrobial effect against the test microorganisms whereas the methanol extract had inhibitory effects on the growth of 57 strains of 24 bacterial species in the genera of Acinetobacter, Bacillus, Brevundimonas, Brucella, Enterobacter, Escherichia, Micrococcus, Pseudomonas, Staphylococcus, and Xanthomonas. In addition 11 Candida albicans isolates at a concentration of 31.25-250 micro g/ml were also inhibited.

Multicentral clinical evaluation of the aetiology of erectile dysfunction: a survey report

Patients with erectile dysfunction, who admitted to 4 different urological centres in Turkey were evaluated in terms of aetiological factors to establish the aetiology of erectile dysfunction in our population and compare it with the data derived from Western communities. After the history, physical examination, psychological evaluation and laboratory testing, a clinical diagnosis was established as primarily psychogenic, organic, or mixed aetiology. Mean patient age was 43.5 years (range 17 to 69), and 9 of the patients were unmarried. Of the patients 53 had vascular risk factors, and 10 reported a history of alcohol abuse. Eleven patients were using drugs that might interfere with the disorder. In this multicentral study of 115 impotent men, an organic cause was found in 43%, psychogenic in 47%, and mixed in 19%. Mean age of the overall patients was 43.48. When the ages of the patients with organic erectile dysfunction and those with psychogenic erectile dysfunction were compared, it was clearly seen that those with organic erectile dysfunction were much older (52.73 versus 33.02).

Comparison of histopathologists' workloads in two pathology departments in Croatia

AIM

To calculate workloads of Departments of Pathology and staff histopathologists at two Croatian University Hospitals by means of the Suvarna and Kay's Kim Unit (KU) activity index.

METHOD

The total number of specimens and KU activity/year were calculated to compare staff pathologists' workload in two Pathology Departments, one at Split and the other at Zagreb University Hospital. The individual specimen types were assigned a difficulty score on a scale of 1-5 units (KUs), depending on the time needed for specimen dissection and macroscopic description, number of sections and stains required, and time spent on microscopy of an "average case". KU activity was calculated for all pathologists individually in terms of histology (1-5 KUs), autopsy (10 KUs), supervision of residents, and outside consultations (2 KUs).

RESULTS

According to calculated Kim Unit activity index, pathologists' workload in two investigated pathology departments was not equally spread. In the Split Department of Pathology the distribution of workload was more uniform than in the Zagreb Department of Pathology. The average workload of both institutions was 4,562 KUs.

CONCLUSION

KU activity index is a very useful method for assessing average pathologists' workload. It may be also used in hospital administration for predicting changes in service and number of working pathologists.

Ruptured intracranial aneurysm associated with isolated aortic arch interruption

Interruption of the aortic arch is a very rare congenital defect consisting of discontinuity between the ascending and descending aorta. Few patients survive to adulthood, due to effective collateral arterial flow to the descending aorta. An intracranial aneurysm is reported in only one patient with aortic arch interruption. We report a 16-year-old boy with an isolated aortic arch interruption and a ruptured anterior communicating artery aneurysm.

The crowned dens syndrome: a rare form of calcium pyrophosphate deposition disease

The crowned dens syndrome has been termed as acute neck pain ascribed to CPPD deposits associated with a tomographic appearance of calcification surrounding the odontoid process. This rare entity resulting in cervical cord compression is generally seen in older female patients. We present a 26-year-old woman with cervical cord compression due to massive calcification in the periodontoid area and discuss the X-ray and CT findings of the disease.

Ectopic thymic tissue: a cause of emphysema in infants

Ectopic thymic tissue can present a diagnostic dilemma when it is located in the posterior mediastinum. The diagnosis can be made by awareness of it and by use of computed tomography (CT) and magnetic resonance imaging (MRI). Rarely, ectopic thymus are reported to cause airway obstruction. In infants ectopic thymic tissue should also be considered in the differential diagnosis of secondary pneumonias and emphysema especially located in the upper lung zones.

Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction

We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.