Case Report: Cola Can Stay-Tab Ingestion in an 8-Year-Old Boy

Foreign body ingestion is a common problem in children. The most commonly ingested objects are coins, toy parts, bones, pins, and disc batteries. The radiolucency of the pull-tabs or stay-tabs of Cola cans constitutes another difficulty. In cases with ingested Cola can stay-tabs, as was in our patient, diagnosis should be confirmed at least by oesophagogram to avoid potential complications.

Incarcerated Inguinal Hernia in Children

Introduction

The aim of this study was to document the data of incarceration in a group of children with inguinal hernia and to investigate whether incarceration could have been prevented.

Materials and methods

A retrospective study reviewed the records of 3100 children who underwent herniorrhaphy between 1989 and 2007 in one centre, with 113 patients having hernia incarceration. In 16 patients, manual reduction was not attempted because of signs of strangulation, and in the remaining ones, reduction following sedation was not successful. The patients were evaluated with respect to age, postoperative mortality, and morbidity and especially whether he or she had been scheduled for operation in a surgical department. The incidence of incarcerated inguinal hernia and risk factors were analysed.

Results

Of the 113 patients with incarcerated inguinal hernia, 105 were boys (92.9%), with a male to female ratio of 13:1. The majority of the patients were under one year of age (n=73); and 47 were 0-3 months old. Three laparotomies, 7 small intestinal resection and primary anastomoses, 2 oophorectomy, 7 partial omentectomy and 8 appendectomies were performed. During the 6 months to 18 years follow-up, testicular atrophy was seen in 4 boys. Two babies died. Scrotal oedema, testicular atrophy and mortality rate were significantly higher in incarcerated hernia patients compared with those without incarceration (all with p=0.001).

Conclusions

Apparently, incarceration may be a preventable problem. Priority should be given to the treatment of inguinal hernias in infants less than 1 year of age, especially those 1-3 months old, as their risk of incarceration is higher.

Effect of polaprezinc on experimental corrosive esophageal burns in rats

Unconsciously caustic ingestion is one of the most common causes of serious esophageal strictures in children. The aim of this study is to determine the efficiency of polaprezinc in preventing stricture formation after corrosive esophageal burns (CEB); this was the first time it has been used to treat experimental CEB in rats. Twenty-four rats were divided into four groups, three of which received CEB by the instillation of 1 mL of 10% NaOH solution into their isolated esophageal segments for three minutes. Group C (control) was uninjured and untreated. Group B (esophageal burn) received CEB but were left untreated. Groups PT1 and PT2 had CEB and received 100 mg/kg/day and 200 mg/kg/day, respectively, of intraperitoneal polaprezinc treatment (PT) for the first two weeks, then oral PT for another two weeks. We assessed the treatment's efficiency of the treatment after the fourth week by evaluating the stenosis index (SI) and the histopathological damage score, determining tissue hydroxyproline content (HP), and measuring the weight of the rats before and after the experiment. Mean SI was statistically lower in the groups PT1 and PT2 when compared with Group B (p = 0.006, 0.004, respectively). HP levels were highest in Group B, but it was insignificant (P> 0.05). In terms of histopathological damage score, treatment groups demonstrated less collagen deposition, mucosal, and submucosal damage than both Group B (p = 0.01) and Group C (p = 0.02). Group PT1 and Group PT2 (P> 0.05) showed similar results, indicating the treatment's effectiveness was independent of dosage. Outside of Group C, weight gain was detected only in Group PT2, though it was statistically insignificant. In Group PT1, weight loss was lower than in Group B. Polaprezinc, with its antifibrotic, antioxidant, anti-inflammatory, wound-healing and antiapoptotic effects, was efficient in reducing stricture formation by decreasing HP levels and histopathologic damage, preventing stenosis, and weight gain in higher dosages in the treatment group.

Obstructive jaundice resulted from hydatid cyst of pancreatic head

BACKGROUND/AIM

Compression of the common bile duct by a hydatid cyst located at the head of the pancreas is one of the quite rare causes of obstructive jaundice in childhood.

CASE REPORT

We report a 9-year-old child with obstructive jaundice caused by compression of the intrapancreatic portion of the bile duct by a hydatid cyst located at the pancreatic head. Furthermore, we considered that this is a reportable case in aspect of childhood development. The patient was treated successfully by surgical procedure and albendazole chemoprophylaxis. The postoperative course was uneventful.

CONCLUSION

In endemic areas, hydatid cysts should be considered among the differential diagnosis in cystic lesions of any organ including the pancreas.

Effect of ginger extract on liver damage in experimental obstructive jaundice produced by main bile duct ligation

BACKGROUND

Obstructive jaundice is one of the most important surgical causes of childhood jaundices. The aim of this study is to investigate effects of ginger (Gingiber officinalis) extracts on liver damage in experimental obstructive jaundice produced by main bile duct ligation.

MATERIALS AND METHODS

Forty two Wistar-albino rats were randomly allocated into 7 groups (n = 6). Nothing was performed in the control (C) group. Only laparatomy was performed in the sham (Sh) group. The ginger 1 and 2 (G1 and G2) groups received only 100 and 200 mg/kg/day doses of ginger extract for 1 week orally. In study group, common bile duct ligation was done. In treatment 1 and 2 (T1 and T2) groups common bile duct ligation was followed by administration of 100 and 200 mg/kg/day doses of ginger extract for 1 week orally from the third post operative day, respectively. Blood samples and liver were harvested in order to evaluate the serum aspartate aminotransferase (AST), alanine amino transferase (ALT), gama glutamyltransferase (GGT), total bilirubin (bil), superoxide dismutase (SOD), glutathione (GSH), malondialdehyde (MDA) and liver tissue SOD, GSH, MDA levels and liver apoptosis. Results were analyzed by Mann-Whitney U test statistically.

RESULTS

Ginger administration did not result in any differences of serum or tissue levels of the studied parameters and liver apoptosis between the groups statistically (except AST levels in group T2). Tissue GSH and serum SOD levels were only mildly increased in groups receiving ginger alone.

CONCLUSIONS

There is no evidence for protective, inhibitive and decreasing effects of ginger extract on liver injury in experimental obstructive jaundice with these findings.

The effect of enalapril on renal resistive index, urine electrolyte levels and TGF-β1 levels of kidney tissues in rats with unilateral partial ureteropelvic junction obstruction

BACKGROUND

This study aimed to investigate renal arterial resistive index measurements and urine electrolytes before and after enalapril therapy in a rat model of unilateral ureteropelvic obstruction. The transforming growth factor (TGF)-β1 response of the renal tissue was also investigated.

MATERIALS AND METHODS

30 Wistar albino rats were randomly allocated into 5 groups (n=6). Group C rats served as controls. Group S rats had only laparotomy. Group E rats were only treated with enalapril. Rats in group UP and group UPE underwent laparotomy to create a left unilateral moderate partial obstruction. 2 weeks after establishing partial ureteropelvic junction obstruction, group UPE rats were treated with enalapril. Urine was collected over 24 h in all groups. Intrarenal arterial resistive index measurements were performed before and 2 weeks after surgery and after enalapril treatment in group UPE, and before and after enalapril treatment in group E. Rats were sacrificed by intracardiac puncture and left kidneys were harvested to evaluate levels of mRNA TGF-β1.

RESULTS

There was no significant difference in ARI values in group E. In group UPE, the difference between ARI values before and after surgery was statistically significant; the difference between ARI values after surgery and after enalapril treatment was also statistically significant. There was no statistically significant intra-group difference in urine electrolyte levels for UP group or UPE group. There was no difference in renal mRNA TGF-β1 levels.

CONCLUSION

Enalapril maintained renal blood flow by decreasing the arterial resistive index and maintained renal tubular function by protecting urine concentration and dilution ability in a rat model with unilateral ureteropelvic junction obstruction.

Effect of stent placement, balloon or cutting balloon dilatation on stricture formation after caustic esophageal burn in rats

INTRODUCTION

This study aimed to evaluate the effects of stent placement prior to stricture development following caustic esophageal burn (CEB) in an animal model. The outcomes after stent placement were also compared with those after balloon dilatation and cutting balloon dilatation performed after stricture development. Groups were compared with regard to stricture development and weight loss.

MATERIALS AND METHODS

40 rats were divided into 5 groups. CEB was created as described by Gehanno et al. In Group A (control) no CEB was performed and the esophagus was only rinsed with saline. Group B rats underwent CEB with no subsequent treatment. Group C rats underwent CEB followed by balloon dilatation in the 3 (rd) and 4 (th) week. Group D rats underwent CEB followed by cutting balloon dilatation in the 3 (rd) week. Group E rats underwent CEB with subsequent placement of a silicon stent in the same session. The animals were sacrificed in the 6 (th) week, and the stenosis index (SI), collagen deposition, and hydroxyproline (HP) levels were determined in the esophageal segments and statistically compared.

RESULTS

Although weight loss occurred in Group C and Group B rats (238.87±15.95 g vs. 233.83±19.01 g), weight loss in Group C rats was less marked compared to Group B. Similarly, the SI in Group C was lower compared to that of Group B and the difference was statistically significant. Although there was no difference in weight between the rats in Group C and Group B before the procedure (p=0.318), there was statistically significant difference thereafter (p=0.002). The SI of Group D was also lower compared with that of Group B, and the difference was statistically significant. Weight gain in Group E rats was similar to that noted in Group A rats and was higher compared to Group B; this difference was statistically significant. The SI for Group E was lower compared to that of Group B.

CONCLUSION

Stenting performed at the time of corrosive injury and cutting balloon dilatation performed after stricture formation had a positive effect with regard to SI and weight gain in an animal model.

Our experience with McKusick-Kaufman syndrome patients

AIM

McKusick-Kaufman syndrome (MKKS) is a rare autosomal recessive disorder. Less than one hundred cases have been reported in the English literature to date. We report three different aged children with a large hydrometrocolpos and postaxial polydactyl.

PATIENTS AND RESULTS

These children had various degrees of associated renal disorders. Bardet Biedl syndrome (BBS) is characterized by retinal dystrophy or retinitis pigmentosa, postaxial polydactyl, obesity, nephropathy, mental disturbances or mental retardation. Typically MKKS is diagnosed in young children especially in neonates whereas the diagnosis of BBS is delayed until the teenage years.

CONCLUSION

All MKKS cases should be re-evaluated for Retinitis pigmentosa, other signs of BBS and for disorders that may worsen with time (Ref. 12).

Omental incarceration may cause hydrocele and this hydrocele confused simple or scrotal hydrocele

BACKGROUND

The recommended approach to hydrocele repair in children is inguinal. Recently, a transscrotal approach has been recommended for hydroceles in children. This report describes our experience with hydrocele with omentum incarceration.

METHODS

This retrospective study reviewed the records of ten children who underwent inguinal hydrocele repair with omentum incarceration in our clinic.

RESULTS

The mean age of the patients was 4.5 years (range 1.5-16). Hydroceles were located on the right side in all patients. Scrotal erythema, inguinal pain, signs of intestinal obstruction and hernia sac were not determined. Hydrocele repairs were made by inguinal approach in all patients. The procesus vaginalis was rougher than normal and noted as the hernia sac. Thus, the hernia sacs were opened and omental incarceration was defined in all cases. Omentum protruded into the abdomen in all cases. A high ligation was performed and the distal parts of the sacs were fenestrated.

CONCLUSIONS

In the light of our experience, a scrotal approach to hydrocele repair in children would be difficult in cases of incarceration with hernia. Omental incarceration may cause hydrocele, and this hydrocele can be confused with normal hydrocele. Therefore, we would continue to recommend an inguinal approach for childhood hydroceles.

Where should the normal position of the umbilicus be in the neonate?

INTRODUCTION

The aim of this study was to determine the normal position of the umbilicus so as to offer a guide to improve cosmetic results after the repair of congenital abdominal wall defects.

MATERIALS AND METHODS

The position of the umbilical center was determined in 187 neonates with respect to the xiphoid process, the center of the umbilicus and the pubis. The distance between the xiphoid process and the center of the umbilicus (XU), between the pubis and the center of the umbilicus (PU) and from the xiphoid process to the pubis (XP) were measured while the babies lay in a supine position. The PU:XU ratio was calculated based on these measurements.

RESULTS

Mean XP was 11.93±1.40 cm, mean XU was 7.41±1.08 cm and mean PU was 4.52±0.70 (mean±SD). The PU:XU ratio was calculated as 0.61±0.12 (ratio±SD).

CONCLUSION

We suggest that the PU:XU ratio should be 0.61 offering an ideal localization in umbilical reconstruction.

Resection of blind ending bifid ureter in a patient with grade V vesicoureteric reflux

Blind-ending bifid ureter is an extremely rare congenital anomaly. The authors report on a 13-year-old boy who presented with a previous diagnosis of right duplicated ureter and who had undergone a bilateral ureteroneocystostomy for vesicoureteral reflux in another clinic. The revision showed right blind-ending bifid ureter. The embryology, clinic and treatment of this anomaly is discussed.

INHIBIN B LEVELS IN PERIPHERAL VEIN DO NOT CORRELATE WITH INHIBIN B LEVELS IN THE SPERMATIC VEIN IN ADOLESCENTS WITH VARICOCELE

This study was conducted to evaluate the inhibin B with FSH and LH levels on spermatogenesis in varicocele patients. The study group consisted of 10 adolescent with left idiopathic varicocele of grade II and III. Blood specimens were obtained from dilated spermatic vein and peripheral vein simultaneously. Peripheral samples were also collected from 7 healthy children as controls. Inhibin B was measured with ELISA inhibin B kits. FSH and LH were analyzed by radioimmunoassay techniques. The results were analyzed using Mann-Whitney U and Spearman's rank tests. A value of p < 0.05 was considered significant. Peripheral FSH, LH and inhibin B levels were the same in the study and control group (p > 0.05). Mean inbibin B levels of spermatic vein were significantly higher than the control and peripheral blood of the study groups (p < 0.05). FSH, LH, and inhibin B levels correlated poorly each other (p > 0.05). Preoperative serum inhibin B concentration could not reliably predict a response to varicocelectomy, but the increase in inhibin B levels after treatment might suggest an improvement in testicular function.

Sequential cytokine levels in the diagnosis of appendicitis

OBJECTIVE

To determine the diagnostic value of sequential white blood cell count (WBC), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in patients with abdominal pain.

MATERIAL AND METHODS

Tests were determined at hospital admission and 6 h later in 105 children. Patients who were non-operatively followed and had a normal histopathology were classified as the non-appendicitis (NA) group. Patients with symptoms consistent with appendicitis were classified as the appendicitis group (A). Data were analyzed as positive/negative predictive value, sensitivity, specificity and accuracy rate (AR). The global power of the variables in discriminating the patients between the two groups and advanced/simple appendicitis was assessed from the area under the receiver operating characteristic (ROC).

RESULTS

Initial measurements showed WBC to be a valuable diagnostic tool in acute appendicitis (AR = 74 %), whereas IL-6 and TNF-alpha were found not to be valuable. The second measurements revealed higher values, and IL-6 reached its highest AR (89 %). When initial values were evaluated in combination, the highest AR of 73 % was observed with TNF-alpha + WBC. The highest AR (90 %) was seen with IL-6 + TNF-alpha in the second measurements. ROC analysis showed WBC to be the most valuable parameter of the three. The area under the curve (AUC) was 0.750 for the initial measurement and 0.779 for the repeat measurement of WBC (p = 0.001). The most useful diagnostic parameter in discriminating between the simple and the advanced cases was IL-6 as assessed with the ROC curve (p<0.01).

CONCLUSIONS

WBC elevation in patients with suspected acute appendicitis is an important parameter supporting the diagnosis at initial admission, whereas IL-6 is a more valuable tool in diagnosing advanced appendicitis.

Effects of different suture materials on wound healing and infection in subcutaneous closure techniques

BACKGROUND

In this study we aimed to investigate the effects of different suture materials on wound healing and infection in subcutaneous closure techniques.

MATERIALS AND METHODS

Twenty-nine rats were randomly allocated to 5 groups. All subjects received 2-cm vertical dermal and subdermal incisions on their backs under sterile and proper surgical conditions. The subdermal cuts were then closed with vicryl (polyglycolic acid), biosyn (monofilament glycomer), prolene (polypropylene) and tissue adhesive (2-octylcyanoacrylate). After 10 days, all sutured areas were examined for seroma, haematoma formation and cosmetic outcome. The incisional lines were excised with 1-cm-wide skin strips and tissue hydroxyproline levels were determined. The specimens obtained were evaluated for the presence of giant cells, mononuclear cells, fibrosis and neutrophils.

RESULTS

No differences in tissue hydroxyproline levels were found between any of the suture materials used. Fibrotic process and inflammatory cell infiltration were more prominent in the biosyn and prolene groups than in other groups. Foreign body giant cells were observed in the biosyn group.

CONCLUSION

Vicryl and tissue adhesive should be preferred in subcutaneous closure techniques.

Cefoperazone induced gastro-intestinal haemorrhage. A case report

Cefoperazone is a parenteral third generation cephalosporin which is active against many Gram positive and Gram negative organisms. Cefaperazone, like other cephalosporins which contain methyltiotetrazole side chain, can cause hypoprotrombinaemia and bleeding problems. Here we report a nine-year old child with Meckel's diverticulum who had cefoperazone induced massive gastrointestinal bleeding on the fifth day following the operation.

Association of tumor necrosis factor, interleukin-6 and cyclooxygenase pathway with lipopolysaccharide-induced intussusception

INTRODUCTION

Many factors and mechanisms have been proposed as causes for intussusception (IN); however, the etiology remains unclear. Inflammatory mediators such as tumor necrosis factor (TNF) and interleukin-6 (IL-6), which are elevated during infectious diseases, can significantly affect gastrointestinal motility. Motility changes caused by these agents might contribute to the development of IN. The aim of this experimental study was to determine the preventive effects of indomethacin on lipopolysaccharide (LPS)-induced IN in mice and to investigate the role of TNF and IL-6 on intussusception.

MATERIALS AND METHODS

Seventy-eight mice were divided into five groups. In the Control group (n=6), no procedure was done. In the Sham group (n=6), 1 ml saline, in the Indomethacin group (n=6), 10 mg/kg of indomethacin, in the LPS group (n=30), 12 mg/kg of LPS was administered intraperitoneally (IP). In the Treatment group (n=30), 10 mg/kg of indomethacin was administered IP following 12 mg/kg of LPS. All animals were laparotomized 6 hours following IP injections. The existence of IN was noted and blood specimens were obtained. TNFalpha and IL-6 plasma level measurements were performed by standard ELISA for mice. The results were compared using the Mann-Whitney U test and one-way ANOVA test. A value of p<0.05 was considered significant.

RESULTS

Five mice (1 in the control, 2 in the LPS, 2 in the Treatment group) were excluded from the study. IN was observed in 6 (20%) mice in the LPS group, whereas it was not found in any mice in the Treatment group. Mean TNFalpha and IL-6 levels were statistically higher in the LPS group (394.72+/-403.79; 195.18+/-218.37 pg/ml, respectively) compared to all other groups, including the Treatment group (p<0.05 for each comparison). Within the LPS group of mice, the levels were higher in animals with IN compared to the mice without IN.

CONCLUSION

Increased TNFalpha and IL-6 levels induced by LPS correlated well with the occurrence of IN, and a decrease in these levels via cyclooxygenase (COX) inhibition by indomethacin prevented IN from forming in this experimental model.

Treatment of postoperative enterocutaneous fistulas with octreotide in two neonates

Enterocutaneous fistula (EF) in newborns and prematures is a well-recognized complication after necrotizing enterocolitis and other abdominal surgical procedures. Conservative management consists of bowel rest, antibiotics, wound care, and the administration of drugs that either reduce gastrointestinal motility or secretions. Octreotide decreases gastrointestinal secretions, inhibits or blocks the effects of gastrointestinal hormones, diminishes gut motility and thus reduces the flow through the fistula. We used octreotide and were able to report successful spontaneous closure of a fistula in our 2 neonatal patients, one a premature neonate with necrotizing enterocolitis (NEC) and the other with meconium peritonitis.

Congenital neck masses in children and their embryologic and clinical features

Congenital neck masses in children and their embryologic and clinical features. Neck masses of congenital origin can be diagnostic and therapeutic challenges for internists, paediatricians and surgeons. Treatment modalities of congenital neck masses are different depending on their nature, symptoms and location. Differential diagnosis includes a variety of diseases that can cause cervical masses such as infectious and neoplastic neck tumours. Our objective is to review the embryologic and clinical features of some of the most common congenital neck masses such as the haemangioma, branchial cleft anomalies, thyroglossal duct cyst, ectopic thyroid, congenital midline cervical cleft, congenital cervical teratoma, lymphangioma, cervical thymic cyst, dermoid cyst and congenital muscular torticollis.

Ankyloglossia and effects on breast-feeding, speech problems and mechanical/social issues in children

BACKGROUND

This aim of this study was to define the characteristics of the patients who underwent surgery for ankyloglossia.

PATIENTS AND METHODS

The patients (n = 127) with ankyloglossia underwent surgery between 1987 and 2005. The patients were evaluated for age, gender, complaints, grade, and operative procedures. This study did not cover postoperative evaluation of the procedure.

RESULTS

The ages of the children ranged from 20 days to 7 years, and 84% of them were under 1 year of age. Seventy-two percent were boys; 28% were girls. The most common complaint of the parents of infants under one year of age was breast-feeding (35/84). When the tongue movements of the patients were examined, 57 patients (of whom 18 were over one year of age) had limited tongue mobility. The mean frenulum length of the patients was grade 1 in 72 patients and grade 2 in 55 patients. Ankyloglossia was corrected by frenotomy. Three patients had bleeding from their frenotomy site which resolved with local pressure. General anaesthesia was preferred for 77 patients, and there was a need for suturing in 20 patients.

CONCLUSION

The correction of ankyloglossia at an early age reduces the risk of latent complications. In addition, the early correction will mitigate the feeding- and speech-related concerns of parents and doctors alike.

Treatment of Morgagni hernias by transabdominal approach

BACKGROUND

Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy.

SUBJECTS AND METHODS

Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome.

RESULTS

The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up.

CONCLUSION

The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

Surgical breast lesions in adolescent patients and a review of the literature

BACKGROUND/PURPOSE

Breast disease in adolescence is uncommon, with most presenting lesions being benign. Breast lesions in adolescent patients are discussed in this article with a review of world literature.

PATIENTS AND METHODS

The clinical records of 30 patients operated upon for breast lesions in our hospital during 18 years were reviewed.

RESULTS

There were 25 female and five male patients, ranging in age from 16 years. Twenty-five female patients were operated on for breast mass and/or discharge, and five male adolescents were operated on for gynaecomastia. The most frequent (n = 27) complaint was palpation of mass in the breast. The most common histologies were fibro-adenoma (n = 14) and gynaecomastia (n = 5). The average duration of pre-operative symptoms was 2.9 months for fibro-adenoma, 1.6 years for gynaecomastia (extremes 2 days to 1 year). Nipple discharge was observed in three patients. Average diameters of palpable masses were 2.9 cm for fibro-adenomas and 5 cm for gynaecomastia. Lesions were excised surgically in all patients. Masses diagnosed as fibro-adenomas in the pre-operative period were reported upon pathological examination to be precancerous lesions such as cystosarcoma phylloiedes, juvenile fibro-adenoma, solitary intraductal papilloma, tubular adenoma and juvenile papilloma. One postoperative wound infection and one recurrence of fibro-adenoma was seen.

CONCLUSION

The most frequently encountered breast masses were fibro-adenomas. These lesions are mostly benign in nature and can be treated conservatively but the possibility of precancerous lesion should be considered during follow-up.

Unusual localization of hydatid cyst

We report a case of a single large echinococcal cyst that originated from the retroperitoneal space. Diagnosis was confirmed with serologic test and radiological examinations. Especially in the endemic areas hydatid cyst should be considered when evaluating cystic masses and it can be treated by extraperitoneal operation.

Omentum prevents intestinal adhesions to mesh graft in abdominal infections and serosal defects

BACKGROUND

Many studies have evaluated the use of grafts in the reconstruction of abdominal wall defects. In this study, the effects resulting from the presence or absence of the omentum were evaluated in the setting of infection or serosal defects in the formation of adhesions in abdominal closures using mesh grafts.

METHODS

For this study, 60 Wistar albino rats were divided into six groups. A circular 3.79-cm(2) fascioperitoneal defect was created. After group-specific procedures, defects were reconstructed using polypropylene mesh grafts. In group C (control group), only a mesh graft recontruction was performed, whereas group O (O for omentectomy) underwent an omentectomy plus mesh closure. In group SD (serosal defect group), the cecum was abrased with a brush before mesh closure. Group SDO underwent cecal abrasion plus an omentectomy. In group I (infection group), the intraabdominal space was filled with 1 ml of solution containing 100,000 colony-forming units (CFUs) of Escherichia coli per milliliter. Group IO received the same same amount of E. coli solution plus an omentectomy before mesh closure. After 28 days, the groups were evaluated by intraabdominal and blood cultures, grading of intraabdominal adhesions, graft-organ adhesions, proportion of adhesions to graft size, and histopathologic studies. The results were statistically evaluated using one-way variant analysis and Scheffe's and Fisher's definite chi-square tests.

RESULTS

For the groups in which the greater omentum was preserved, intestinal adhesions to the graft surface were less frequently observed, especially in cases with intraabdominal infections and serosal defects (p < 0.05).

CONCLUSIONS

Preservation of the greater omentum reduces the formation of intestinal adhesions, especially in cases with underlying infections and serosal defects in abdominal closures using mesh grafts. This could be beneficial in related clinical situations in lowering the rate of intestinal fistulas, erosions, and obstructions that can be attributed to the formation of adhesions.

Effect of melatonin on healing of colonic anastomosis in a rat model of peritonitis

BACKGROUND

The aim of this study is to determine the effect of melatonin on intestinal anastomosis in the presence of peritonitis.

MATERIAL AND METHODS

32 Wistar albino rats were randomized into four groups (n = 8): A (sham), B (control), C (melatonin 5 mg/kg), and D (melatonin 10 mg/kg). In group A, only cecal dissection was carried out. In the other groups, cecal ligation and puncture (CLP) followed cecal dissection in order to induce bacterial peritonitis. 24 h after the previous operation, cecal resection and ileocolic anastomosis were performed in the rats of all groups. In group C (5 mg/kg) and group D (10 mg/kg), melatonin was injected for 5 consecutive days starting after CLP. At the 48th hour of the CLP procedure, blood was drawn via the tail vein for tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) analysis, and on the 4th day of the experiment relaparotomy was carried out for bursting pressure (BP) measurements. The intestinal tissue containing the anastomotic line was then snap-frozen in liquid nitrogen and stored at -80 degrees C for determination of tissue levels of malondialdehyde (MDA) and glutathione (GSH).

RESULTS

The tissue MDA level, blood TNF-alpha and IL-6 levels of group B were significantly higher than in the other groups, whereas the BP results and GSH levels of group B were found to be significantly lower than in the other groups. The results of groups C and D are statistically different from those of group B. When we compared the results of groups C and D, we found significantly higher results in terms of BP and GSH levels in group D and also significantly lower results in terms of MDA, blood TNF-alpha and IL-6 levels in group D.

CONCLUSION

The findings of this experiment suggest that melatonin has a dose-independent positive effect on wound healing of colonic anastomosis.

Pancreas pseudocyst associated with L-asparaginase treatment: a case report

A major complication of L-asparaginase used in the treatment of paediatric malignancies in children is pancreatitis (2%-16%). However, only seven paediatric cases of pancreatic pseudocyst caused by the utilization of the agent have been reported in literature. We present the case of a 5-year old girl who had abdominal pain and epigastric dullness after the third course of BMF-95 protocol with a diagnosis of ALL. A pancreatic pseudocyst of 10 x 10 cm size was found by abdominal tomography. The cyst was treated by percutaneous external drainage, total parenteral nutrition (TPN), administration of octreotide and antibiotherapy for one month. Percutaneous external drainage has proven to be an effective, noninvasive method in this special case with a systemic disorder and the high risk of mortality should a surgical intervention have been performed.

Postoperative intussusception in children

Postoperative intussusception (POI) is an uncommon cause of postoperative mechanical bowel obstruction in children. Four cases of POI during a period of 15 years (1987-2001) were analysed retrospectively. Symptoms developed after a median period of 2.5 days following the operation. All cases were succesfully treated with operative manual reduction. POI occurs after a wide variety of surgical procedures and is often difficult to diagnose because the symptoms are often obscure. As a conclusion, we state that reaching a diagnose requires a high index of suspicion.

Diagnostic value of plain abdominal radiographs in acute appendicitis in children

OBJECTIVE

The plain film of the abdomen (PAX) is still utilised in the diagnosis of acute appendicitis (Aap). Aim of this study was to evaluate the value of PAX in the diagnosis of Aap in children, since it continues to be a controversial subject.

DESIGN

A retrospective study.

SETTING

Department of Paediatric Surgery, Gazi University Medical School.

PATIENTS

The histopathological diagnoses and PAX of 213 children (mean age 9-6 years) operated for acute right-lower quadrant pain were evaluated retrospectively. There were 181 patients with Aap and 32 with normal appendix.

METHODS

The rate of detection of overall thirteen roentgenographic criteria defined in various reports in medical literature as indicating appendicitis were noted and compared with histopathological diagnoses. The PAX which revealed one or more of these signs in combination was considered to be positive for Aap. Data was analysed statistically and sensitivity, specificity and positive and negative predictive values of PAX in the diagnosis of Aap were determined.

RESULTS

Roentgenographic sign(s) were detected in 170 (79%) cases, 18 without Aap. The most frequent were lumbar scoliosis with left-sided convexity (50%) and small intestinal air-fluid levels (32%). In 39 cases, 25 with Aap, no sign(s) was detected. In all of the perforated cases, at least one of the determined criteria was seen. The percentage of roentgenographic signs found in cases with and without appendicitis was different significantly (p<0.01). The negative predictive value of PAX in the diagnosis of acute appendicitis was 32.5% and positive predictive value was 89%.

CONCLUSION

PAX could he helpful in diagnosis in children with suspected acute appendicitis.

Effects of amrinone on bilateral renal ischemia/reperfusion injury

Renal ischemia/reperfusion injury could arise as a consequence of clinical conditions such as renal transplantation, shock, cardiac arrest, hemorrhage and renal artery surgery. In this experimental study, we aimed to determine the preventive effects of amrinone on bilateral renal ischemia/reperfusion injury in rats. A total of 60 Wistar-albino rats were divided into six groups ( n=10). Midline laparotomies were made under ketamine anesthesia. In the sham, amrinone1 and amrinone2 without ischemia (AWI1 and AWI2) groups saline, 5 and 10 mg/kg of amrinone was infused, respectively. In the ischemia, ischemia plus amrinone1 (IPA1) and ischemia plus amrinone2 (IPA2) groups, saline and 5 and 10 mg/kg of amrinone was infused, respectively, at the beginning of reperfusion, subsequent to 45 min of bilateral renal artery occlusion. Following 6 h of reperfusion, blood was drawn to study serum BUN and creatinine and a bilateral nephrectomy was done to determine tissue malonyldialdehyde ( MDA) and myeloperoxidase (MPO) levels. The results were analysed by Mann-Whitney U-test. The parameters studied were statistically higher in the ischemia group compared with the other groups ( P<0.05 for each comparison), indicating renal I/R injury. These parameters were lower in the amrinone without ischemia groups (AWI1 and AWI2) than in the sham group, however there were no significant differences between the groups ( P>0.05, for each comparison). The treatment groups IPA1 and IPA2 had statistically similar results compared with the sham group, showing the preventive effect of amrinone on renal I/R injury at the given doses. We conclude that amrinone prevented experimental renal ischemia/reperfusion injury in rats, independently of the administered doses. This preventive effect of the agent could depend on its effect of regulating the microcirculation, in decreasing intracellular calcium and in preventing neutrophil activation. We propose that this preventive effect of amrinone - which has gained clinical application especially in cases of cardiac insufficiency - could also be exploited in clinical conditions related with renal ischemia/reperfusion.

Colon interposition for esophageal stenosis in a patient with epidermolysis bullosa

Epidermolysis bullosa (EB) is a disease with 3 forms, most hereditary, characterized by spontaneous blistering lesions. The autosomally inherited form, epidermolysis bullosa dystrophica recessive (EBDR), is responsible for esophageal lesions consisting of web or stenosis. The authors could find only 9 cases treated by various esophageal replacement procedures in the literature, and the experience with 1 case treated by colon interposition is presented. J Pediatr Surg 36:1861-1863.

Effects of polyethyleneglycol-superoxide dismutase (PEG-SOD) and pentoxifylline on small intestinal anastomoses established in the 24th hour of reperfusion: an experimental study in rats

In a previous study, we had shown that anastomoses established in the 24th hour of reperfusion healed less than the ones established in earlier periods. In this study, we aimed to assess the impacts of polyethyleneglycol-superoxide dismutase (PEG-SOD), a free oxygen radical scavenger and of pentoxyfilline, a methyl-xanthine derivative on anastomotic healing at 24th hour of reperfusion. 18 Wistar-albino rats were divided into 3 groups (n = 6). In all groups superior mesenteric artery was occluded for 40 minutes and the intestine was reperfused for 24 hours. Rats were relaparotomized in the 24th hour and small intestinal anastomoses were established. In Sham group, saline (0.5ml); in Group PTX, pentoxyfilline (25mg/kg); and in Group PGS, PEG-SOD (1,500U/kg) was administered intravenously 20 minutes before anastomoses. In the 5th day, anastomotic healing was evaluated by bursting pressures and hydroxyproline contents. Results were analized by Mann-Whitney U test, p < 0.05 was considered significant. Both of average bursting pressures and average hydroxyproline contents were highest in Group PGS (240 mmHg +/- 23.9; 7.71 +/- 0.68 micromol/g-tissue), followed by sham group (168.3 +/- 18.3 mmHg; 5.94 +/- 0.62 micromol/g-tissue) and Group PTX (83.8 +/- 9.2 mmHg, 5.94 +/- 0.62 micromol/g-tissue). Differences of these two parameters between all groups were statistically significant (p < 0.05). Best anastomotic healing in the 24th hour of reperfusion was achieved by PEG-SOD administration, whereas pentoxyfilline did not favor the healing.

Hydatid cysts of the lung in childhood: is capitonnage advantageous?

In the treatment of thoracal hydatid cysts, there is not an agreement whether the cyst cavity to be capitonnaged or not. In this retrospective study, it was aimed to compare the cases of capitonnaged and not capitonnaged thoracal hydatid cysts with regard to hospital stay and post-operative chest tube removal day. Documents of 15 patients operated for pulmonary hydatid cysts in our clinic were reviewed. In 7 cases pericystectomy and removal of germinative membrane was performed whereas in 8 patients capitonnage was added to the procedure. In all cases open airways were suture controlled and pleural cavity was drained with chest tube connected to waterseal system. Average hospital stay of capitonnaged cases was 8 days and of uncapitonnaged ones was 12 days. Thoracal drainage tubes were removed in an average of 4 post-operative days in capitonnaged cases and of 7 days in the others. Statistical analysis were made by Mann-Whitney U test. Difference between the hospital stays of the 2 groups were not significant, whereas it was significant statistically between chest tube removal days (p<0.05). Capitonnage shortens postoperative chest tube drainage period in pulmonary hydatid cysts, resulting in lower morbidity compared with the uncapitonnaged cases.