Laparoscopic versus open portoenterostomy for treatment of biliary atresia: a meta-analysis

OBJECTIVE

Our goal was to compare laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia.

MATERIALS AND METHODS

Using the databases EMBASE, PubMed, and Cochrane, we carried out a thorough literature search up to 2022. Studies comparing laparoscopic and open surgery for the treatment of biliary atresia were included.

RESULTS

Twenty-three studies comparing laparoscopic portoenterostomy (LPE) (n = 689) and open portoenterostomy (OPE) (n = 818) were considered appropriate for meta-analysis. Age at surgery time was lower in the LPE group than OPE group (I² = 84%), (WMD - 4.70, 95% CI - 9.14 to - 0.26; P = 0.04). Significantly decreased blood loss (I² = 94%), (WMD - 17.85, 95% CI - 23.67 to - 12.02; P < 0.00001) and time to feed were found in the laparoscopic group (I² = 97%), (WMD - 2.88, 95% CI - 4.71 to - 1.04; P = 0.002). Significantly decreased operative time was found in the open group (I² = 85%), (WMD 32.52, 95% CI 15.65-49.39; P = 0.0002). Weight, transfusion rate, overall complication rate, cholangitis, time to drain removal, length of stay, jaundice clearance, and two-year transplant-free survival were not significantly different across the groups.

CONCLUSIONS

Laparoscopic portoenterostomy provides advantages regarding operative bleeding and the time to begin feeding. No differences in remain characteristics. Based on the data presented to us by this meta-analysis, LPE is not superior to OPE in terms of overall results.

The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry

OBJECTIVES

Postoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome.

STUDY DESIGN

Among the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates.

RESULTS

Among 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups.

CONCLUSION

We demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.

Has the frequency of complicated appendicitis changed in children in the first year of the COVID-19 pandemic?

Background

The COVID-19 pandemic period suggests that the rate of complications may have increased in patients requiring surgical treatment due to the fact that they could not come to the hospital at the onset of the symptom. This study aims to evaluate the difference in the frequency of complicated appendicitis and postoperative complications in the COVID-19 pandemic.Patients included those who underwent appendectomy in 1 year before the COVID-19 pandemic and in the first year of the pandemic. The patients were categorized into two groups: pre-pandemic and pandemic periods. Clinical and histopathology results were compared between the pre-pandemic and pandemic periods.

Results

A total of 407 patients were included in the study, 207 of whom were included during the pre-pandemic and 200 of whom during the pandemic period. The mean time to hospital admission after the onset of symptoms was 1.3 ± 0.9 days, pre-pandemic, and 1.4 ± 0.8 days during the pandemic group. In the pre-pandemic group, 0.4% intrabdominal abscess developed and 37.5% complicated appendicitis was detected. In the pandemic group, it was found that there were 1% abscess, 0.5% wound infection, 0.5% brid ileus, and 31.9% complicated appendicitis. The pre-pandemic group length of hospitalization was 2.4 ± 0.8 days, and the pandemic was 2.1 ± 0.9 days There was no difference between pre-pandemic and pandemic groups in terms of age, gender, white blood cell count, duration of symptoms, postoperative complications and frequency of complicated appendicitis, and duration of hospitalization.

Conclusions

In the first year of the COVID-19 pandemic, we found that the rate of complicated appendicitis and postoperative complications were not different from pre-pandemic.

Is There a Supporting Value of Platelet Distribution Width and Plateletcrit in the Diagnosis of Acute Appendicitis in Children?

This study was designed to investigate the diagnostic value of platelet distribution width (PDW) and plateletcrit (PCT) for acute appendicitis in childhood. A retrospective review was conducted of the records of 373 patients younger than 18 years who underwent appendectomy. Demographic data, white blood cell count, neutrophil count, and PDW and PCT values were recorded for all patients. A control group was formed of age- and gender-matched healthy children. The study results showed that the PDW level is not valuable as a marker for the diagnosis of acute appendicitis in children. PCT levels were determined to be statistically significantly increased in pediatric acute appendicitis with low specificity.

Evaluation of the antioxidant effects of melatonin on the larynx mucosa of rats exposed to environmental tobacco smoke

OBJECTIVES

This study's aim was to investigate the effect of melatonin in terms of mitigating the effects of smoking on the laryngeal mucosa of rats exposed to environmental tobacco smoke.

DESIGN

Rats were divided into four groups: Melatonin + Smoking group exposed to smoke with melatonin; Smoking group exposed to smoke without melatonin; Saline group not exposed to smoke without melatonin; Melatonin group not exposed to smoke with melatonin. CuZn-superoxide dismutase (CuZn-SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) activities were evaluated in plasma and tissues. Tissues were also examined the changes of squamous hyperplasia, keratosis, parakeratosis and epithelial hyperplasia by light microscope and the ultrastructural changes by electron microscope.

RESULTS

Tissue SOD, CAT and GSH-Px activities were significantly higher in Saline and Melatonin groups than Melatonin + Smoking and Smoking groups. Plasma CuZn-SOD and CAT activities were significantly higher in Saline and Melatonin groups than Smoking group. Plasma GSH-Px showed no significant difference. The rate of epithelial hyperplasia was significantly higher in Smoking group than the other groups. The rate of parakeratosis was significantly higher in Smoking group than the other groups. The epithelial cells in Melatonin + Smoking group displayed, normal cell structure similar to those in Saline group under electron microscope.

CONCLUSIONS

The study shows that smoking induces substantial pathological changes in the laryngeal mucosa and melatonin may have some beneficial effects in partially reversing smoking-induced laryngeal injury by inducing the expression of antioxidants; biochemical and histological outcomes also support these findings due to preventing tissue damage in laryngeal mucosa exposed to smoke.

Diagnostic Dilemma in Hydatid Cysts: Tumor-Mimicking Hydatid Cysts

OBJECTIVES

Hydatid cysts are sometimes confused with different pathologies, and problems arise in their diagnosis and treatment. In this study, cases that are followed up with a diagnosis of lung malignancy and that are detected to have hydatid cysts were retrospectively examined.

MATERIAL AND METHODS

Seven patients with hydatid cysts whose clinical and radiological features were consistent with lung malignancy were retrospectively examined between 2010 and 2014 regarding sex, age, symptoms, diagnostic methods, surgical procedures performed, and postoperative complications. In the diagnosis of the patients, radiological diagnostic methods such as chest radiography, thoracic computed tomography (TCT), and positron emission tomography+computed tomography (PET-CT) as well as invasive diagnostic methods such as bronchoscopy, fine-needle aspiration biopsy, thoracentesis, and video-assisted thoracoscopic surgery were used.

RESULTS

The average diameter of the lesions was determined as 4.14±1.57 cm in TCT. Maximum standardized uptake value (SUV max) was measured as 8.77±3.41 (5.4-15.1) in the PET-CT analysis. Bronchoscopy, fine-needle aspiration biopsy, and thoracentesis yielded no results. Definitive diagnosis was established by performing thoracotomy and video-assisted thoracoscopic surgery.

CONCLUSION

Pulmonary hydatid cysts can appear as malignant diseases such as lung cancer as well as infectious pathologies such as tuberculosis or benign pathologies. Radiologically, it should be kept in mind that pulmonary hydatid cysts can mimic many pulmonary pathologies, particularly malignancies. Necessary examinations towards its differential diagnosis must be performed in the preoperative period.

Crossed testicular ectopia: Report of six cases

Crossed testicular ectopia or transverse testicular ectopia is an extremely rare anomaly characterised by migration of one testis towards the opposite inguinal canal, usually associated with unilateral inguinal hernia. This report describes six cases of crossed ectopic testes, one of the largest series, and with unusual clinical histories.

Should ureteroscopy be considered as the first choice for proximal ureter stones of children?

OBJECTIVES

In this study, we aimed to analyze the ureter stones that had been treated using rigid ureteroscopy and pneumatic lithotripsy without mechanically dilating the ureteral orifice.

PATIENTS AND METHODS

Records of 110 patients who had undergone rigid ureteroscopy and pneumatic lithotripsy due to ureteral stone between February 2005 and May 2011 were retrospectively analyzed. The location and size of the stone and additional anomalies in the urinary tract on the preoperative direct urinary system (DUS) X-Ray, urinary system ultrasonography (USG), intravenous pyelography (IVP) if performed, and computed tomography (CT), were found from the records of the patients.

RESULTS

The mean age of the patients was 5.2 (range 1-17 years). 74 (67.2%) of the patients were males and 36 (32.8%) were females. A total of 115 rigid ureteroscopies were performed on 110 patients. 72 (65%) of the stones were located in the lower ureter, 21 (19%) were located in the middle part of the ureter, and 17 (15.4%) were located in the upper ureter. The mean stone size was determined as 7.5 mm (range 5-15). The mean stone size was determined as 7.4 mm in the lower ureter, as 8.3 mm in the middle ureter, and 8.4 mm in the upper ureter. No difference was found between the sizes of the stones in different locations (p = 0.121). The stone free rate was found as 92.2% for all ureteral stones. The total stone free rate according to the location of the stones was determined as 79.2% in the upper ureter, as 94.4% in the middle ureter and 93,8% in the lower ureter (p = 0.022). The total complication rate was 7.6%. Complication rates were 7.2%, 4.1% and 10.7% for the lower, middle and upper ureter, respectively (p = 0.411) (Table I). No difference was found in terms of complication rates according to location of the stone in the ureter. No major perioperative or postoperative complications developed. A double J stent was inserted in 36 (32%) patients for 2-3 weeks.

CONCLUSIONS

We suggest that rigid ureteroscopy may be considered as the first choice for treatment of not only distal-middle ureter stones, but also for proximal ureter stones.

Acute appendicitis in two children with Henoch-Schönlein purpura

In Henoch-Schönlein purpura (HSP), involvement of the ileum and ascending colon with vasculitis can mimic appendicitis and cause unnecessary appendicectomy. A 13-year-old boy presented with signs of HSP and abdominal pain. He was treated with prednisolone (2 mg/kg/day) for 10 days, but there was no improvement. At laparotomy he had acute suppurative appendicitis. A 12-year-old girl presented with HSP associated with abdominal pain and bloody diarrhoea and at laparotomy was also found to have suppurative appendicitis. Both patients had vasculitic areas in the ileum. In HSP, although suppurative appendicitis is rare, it should always be considered and appropriate investigations, including ultrasonography, undertaken.

Beneficial influence of topical extra virgin olive oil application on an experimental model of penile fracture in rats

Penile fracture (PF) is known as a traumatic rupture of the tunica albuginea of corpus cavernosum. In this study, we aimed to investigate the healing influence of topical extra virgin olive oil (EVOO) on PF through evaluating levels of some oxidative stress biomarkers for the first time. Histopathological evaluation was also realized. A total of 18 male Sprague-Dawley albino rats were divided into three groups of six rats each as control group, in PF (alone) group, and PF + EVOO group. Experimental PF was formed via incising from the proximal dorsal side of the penis in the rats of all groups except control. While in PF (alone) group, fracture was formed and the incision was primarily closed, in PF + EVOO group in addition to foregoing processes, EVOO was also administrated topically twice a day for 3 weeks. At the end of the experiment, all rats were killed and penectomy was carried out. While malondialdehyde, myeloperoxidase, lipid hyroperoxide, and total oxidant status significantly (p < 0.05) increased, reduced glutathione and total free sulfhydryl groups markedly (p < 0.05) decreased in PF (alone) group when compared with PF + EVOO group. Levels of these parameters were reversed to nearly normal values by topical EVOO application. Protection by EVOO is further substantiated via the improved histological findings in PF + EVOO group as against degenerative changes in the rats of PF (alone) group. Our data revealed that EVOO has protective effect in penile cavernosal tissue through probably its antioxidant, free radical defusing, anti-inflammatory, and antimicrobial effects.

The effectiveness of extracorporeal shock wave lithotripsy in the treatment of ureteral stones in children

PURPOSE

In our study, we evaluated retrospectively the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral stones in children.

MATERIALS AND METHODS

Between the dates of 2005-2010, 62 children who were applied ESWL due to the ureteral stone in our Clinic and consisted of 42 males and 20 girls whose mean age was 6.6+/=3.1 were evaluated. 31 (50%) of the patients were upper ureteral stone, 10 (16.1%) of them were middle ureteral stone and 21 (33.9%) of them were lower ureteral stone. The sizes of the stones were 4 to 17 mm, the average was 7.1 mm. ESWL was performed in the supine position for upper ureteral stones, in the supine/prone position for middle and lower ureteral stones.

RESULTS

Stone-free rate was determined as 93.5% in three-month follow-up of the patients. Re-treatment was done at 14.5% of the patients. The implementation of ESWL was ended unsuccessfully at 4 children (6.5%). A significant difference was not detected between three-month stone-free rates in terms of the size of the stones and location. There was not any serious complication at any of the patients.

CONCLUSIONS

According to these findings ESWL with its high stone-free rates and negligible complications is the first method to be refered in the treatment of ureteral stones in children.

Surgical treatment of right middle lobe syndrome in children

OBJECTIVE:

Right middle lobe syndrome is a rare entity in children, causing high morbidity. Our experience of these patients including their clinical and laboratory characteristics, indications forsurgical management, postoperative courses, and follow-up results was evaluated.

METHODS:

A retrospective analysis was performed involving 20 children with right middle lobe syndrome who were hospitalized and treated with surgical resection of the right middle lobe in Van Training and Research Hospital and Yüzüncüyil university hospital, Turkey, between January 2002 and January 2011.

RESULTS:

The mean age of the patients was 10.5 years (range, 5 to 15 years). Twelve patients were boys and eight were girls. The most frequent symptom was chronic cough (75%). Hemoptysis was present in two (10%) patients. One patient was being treated for asthma. 25% positive cultures were identified among the patients. Streptococcus pneumoniae was the most frequently identified agent in sputum. All patients underwent chest computed tomography. There were bronchiectasis in 11 (55%) patients, atelectasis and bronchiectasis in five (25%) patients, and destroyed lung in four (20%) patients. A narrowed middle lobe bronchus was shown in 15 (75%) patients. Bronchoscopy was performed in 18 (90%) patients. Stenosis due to external compression was seen in 12 (60%) patients, hyperemia and bronchitis in two (10%) patients, granulation tissue in two (10%) patients, and dense secretions in two (10%) patients. A history of doctor-diagnosed tuberculosis was present in two (10%) patients. These patients had completed antituberculous treatment. The patients had been symptomatic for the last 1 to 10 years (mean, 4 years) and had received several medical treatments. All patients (totally 20 patients) underwent right middle lobe resection. In one patient, a bronchial abnormality was found intraoperatively. One patient died on postoperative day 10 due to a brain abscess. Three other patients had postoperative complications (15%). Mean duration of follow-up of the patients was 4.5 years (range, 2 months to 12 years). Seventeen patients were asymptomatic, and two patients had improved.

CONCLUSIONS:

Children with right middle lobe syndrome unresponsive to medical treatment should undergo early lobe resection to avoid serious complications and the progression of the disease to other segments or lobes.

Undescended testis accompanying congenital Spigelian hernia: is it a reason, a result, or a new syndrome?

INTRODUCTION

Frequent reporting of cases of the coexistence of a Spigelian hernia (SH) with an undescended testis (UT) suggests that this phenomenon may be a syndrome. In this article, four pediatric cases in which an UT accompanies a congenital SH have been discussed in light of the literature.

METHODS

In this study, four cases aged between 6 months and 5 years who had a SH accompanied by an UT were evaluated and underwent surgery.

RESULT

The patient's ages were 6 months, 1 year, 2 years, and 5 years old. The testis was observed in the opened hernia sac. The patients did not have a gubernaculum or an inguinal canal on the side of the hernia.

CONCLUSIONS

Neither the theories suggesting that SH leads to an UT nor those suggesting that an UT leads to a SH are satisfactory. We believe that this coexistence may be the congenital Spigelian-cryptorchidism syndrome seen in boys. As in the four cases presented here, elements of this syndrome are defects in the Spigelian fascia and the hernia sac enveloping the testis and an absence of the gubernaculum and the inguinal canal.

Preoperative chemotherapy with doxorubicin in Wilms tumor

BACKGROUND

Vincristine and actinomycin-D have long been used as the preoperative chemotherapy before nephrectomy in patients with Wilms tumor (WT). Actinomycin-D is not readily found in Turkey, and delay in treatment, occurring basically from commercial and marketing problems, prompted us to administer alternatives such as doxorubicin, another antitumor antibiotic available in Turkey, to our newly diagnosed patients with WT.

PROCEDURE

Between November 2009 and January 2011, 12 consecutive patients with WT were included in the study. Preoperative chemotherapy consisted of vincristine (1.4 mg/m, days 1, 8, 15, and 22) and doxorubicin (20 mg/m, 1 to 3 d).

RESULTS

All renal tumors showed shrinkage drastically after 4 weeks of preoperative chemotherapy. Surgery of all the patients was uneventful and without any complications. At the end of the median follow-up time of 8 months (range, 6 to 17 mo), all patients are in remission without a sign of the disease.

CONCLUSIONS

Preoperative chemotherapy consisting of vincristine and doxorubicin seems to be successful as a preoperative treatment in achieving shrinkage and reducing the risk of surgical complications. On the basis of the promising results in our study, it is worth administering a similar regimen with further follow-up in larger populations.

Oxidative Stress and Antioxidant Enzyme Activities in Newborns with Oesophageal Atresia and Their Mothers

OBJECTIVE: To measure the oxidant/antioxidant status of newborn babies with oesophageal atresia and their mothers, compared with healthy control subjects. METHODS: This case—control study included 40 participants: 10 newborns with oesophageal atresia and their mothers, and 10 healthy newborns and their mothers. Whole blood malondialdehyde (MDA) levels and the activities of antioxidant enzymes (catalase, carbonic anhydrase [CA], glucose-6-phosphate dehydrogenase [G-6-PD], and superoxide dismutase [SOD]) were measured. RESULTS: MDA levels and CA activity were significantly higher, and catalase, SOD and G-6-PD activities were significantly lower, in newborns with oesophageal atresia and their mothers than in healthy newborns and their mothers. Although CA activity was similar between the newborns and mothers in the patient group, it was significantly lower in newborns than in mothers in the healthy group. CONCLUSIONS: Increased lipid peroxidation might play an important role in the pathogenesis of oesophageal atresia. Impairment of the free radical/antioxidant balance may lead to increased free radical and decreased antioxidant levels in oesophageal atresia.

Our eight-year surgical experience in patients with pulmonary cyst hydatid

BACKGROUND

In this clinical retrospective study, we aimed to investigate our experinces and whether capitonnage is an effective therapy method for a pulmonary hydatid cyst or not.

MATERIAL AND METHODS

A total of 412 patients with hydatid cyst operated in our hospitals were evaluated retrospectively between January 2003 and January 2011. In order to create a study group to compare the hydatid cyst operations with and without capitonnage in our department, 60 uncomplicated patients with the diagnosis of hydatid cyst who had undergone operations in the previous two years, were divided into two groups; while no capitonnage was performed and bronchial leaks were closed in one group, standard cystotomy plus the capitonnage operation was performed in the second group. All patients underwent surgery.

RESULTS

In many patients, one or more symptoms were present on admission (339 cases, 82%). Perforated cysts/ nonperfore cysts rate was statistically significant (p = 0.001). There was no statistical difference between patients with or without capitonnage in terms of morbidity rates between patients with or without capitonnage (p = 0.041). However, morbidity rates were higher in the group without capitonnage. There were found statistically significant between capitonnage and non capitonnage groups in terms of length of hospital stay (p=0.001).

CONCLUSIONS

In the surgical treatment, resection should be avoided as much as possible. An average time of 3-5 minutes should be allocated and capitonnage should be performed. Capitonnage should always be performed in the surgical treatment of hydatid cyst. We believe that povidone iodine per se provides sufficient disinfection.

A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis

Background

Although the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis.

Methods

We reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively.

Results

Mean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old). Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%), hemoptysis (35%), empyema (6%), and lung abscess (5%). There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2%) patients. Follow-up data were obtained for 123 (95%) of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection.

Conclusions

Surgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study

Today, in spite of the developments in imaging methods and antibiotherapy, childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years, it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options.WE EXCLUDED FROM THE STUDY CASES WITH: i) thoracoscopic intervention and fibrinolytic agent were contraindicated; ii) immunosuppression or additional infection focus; iii) concomitant diseases, those with bronchopleural fistula diagnosed radiologically, and Stage I cases. This gave a total of 54 cases: 23 (42.6%) in stage II, and 31 (57.4%) cases in stage III. These patients were randomized into two groups of 27 cases each for debridement or fibrinolytic agent application by video-assisted thoracoscopic decortication (VATS). The continuity of symptoms after the operation, duration of thoracic tube in situ, and the length of hospital stay in the VATS group were of significantly shorter duration than in the streptokinase applications (P=0.0001). In 19 of 27 cases (70.37%) in which fibrinolytic treatment was applied and in 21 cases of 27 (77.77%) in which VATS was applied, the lung was fully expanded and the procedure was considered successful. There was no significant difference with respect to success rates between the two groups (P=0.533). The complication rate in our cases was 12.96% and no mortality was observed. Similar success rates in thoracoscopic drainage and enzymatic debridement, and the low cost of enzymatic drainage both served to highlight intrapleural streptokinase treatment as a reliable method in reducing the need for surgery in complicated empyema.

Therapeutic strategies for complications secondary to hydatid cyst rupture

OBJECTIVE

Clinical approach and therapeutic methods are important in cases with complicated hydatid cysts of the lung. This study was designed to retrospectively investigate cases with hydatid cysts, thereby discussing diagnostic methods, treatment modalities, and rates of morbidity and mortality in line with the literature.

METHODS

176 cases with perforated hydatid cysts, who presented to our clinic and underwent surgery between 2003 and 2011, were included in the study. There were 71 (40.34%) females and 105 males (59.66%) with a mean age of 27.80±14.07. The most common symptom was dyspnea (44.31%) and the most common radiological finding was the water lily sign (21.02%). 88.06% of the cases were surgically treated by Cystotomy+closure of bronchial opening+ capitonnage, 3.97% by wedge resection, 4.54% by segmentectomy and 3.40% by lobectomy.

RESULTS

The cysts exhibited multiple localization in 24 cases (13.63%), bilateral localization in 14 cases (7.95%), with the most common localization (43.75%) being the right lower lobe. While the hydatid cyst rupture occurred due to delivery in three (1.70%), trauma in 11 (6.25%), and iatrogenic causes in seven (3.97%) cases, it occurred spontaneously in the rest of the cases (88.08%). Fourteen of the cases with spontaneously occurring rupture (7.95%) were detected to have received anthelmintic treatment for hydatid cyst during the preoperative period (albendazole). The rate of morbidity was 27.27% and the rate of mortality was 1.13% in our study. Two cases recurred during a one-year follow-up (1.13%).

CONCLUSION

Hydatid cyst rupture should be considered in the differential diagnosis of cases with pleural effusion, empyema, pneumothorax and pneumonia occurring in endemic regions. Symptoms occurring during and after perforation lead to errors in differential diagnosis. Performing the surgery without delay favorably affects postoperative morbidity and mortality. While parenchyma-preserving surgery is preferential, there is a need for resection in perforated hydatid cysts.

The association of anthropometric measurements and lipid profiles in Turkish hypertensive adults

BACKGROUND

Few studies have associated anthropometric measurements and lipid profile with hypertension in adult populations and to the best of our knowledge none has been done in Turkey

OBJECTIVES

To relate anthropometric derivatives of overweight/obesity with hyperlipidemia status in a group of Turkish hypertensive adults.

METHODS

Six hundred forty nine (307 male, 342 female) hypertensive adults aged between 20 and 64 years were included in the study.

RESULTS

The mean systolic and diastolic blood pressure (BP) of participants were measured as 147.6 ± 17.2 and 91.4 ± 10.4 mmHg for males and 149.9 ± 16.3 and 91.1 ± 9.4 mmHg for females, respectively. With respect to BMI classification systolic BP was significantly higher in obese males and females, and diastolic BP was only higher in obese females (p<0.05). According to BMIs for lipid profile, high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC) levels were found to be lower in normal females than other BMI groups. Age and waist circumference (WC) in particular was the most related factor for systolic and diastolic BP in both genders (p<0.05).

CONCLUSIONS

This study indicates most hypertensive adults surveyed were overweight and obese. Furthermore, age and WC were the important factors that affects the systolic and diastolic BP in both genders.

The clinical outcome of 260 pediatric ITP patients in one center

In the current study, clinical and laboratory findings and treatment modalities of children with acute and chronic immune thrombocytopenic purpura (ITP) were evaluated retrospectively. Our purpose was to determine clinical outcome of children with ITP and their responses to different treatment regimes. Total of 260 children with ITP were enrolled in the study. The mean age of patients was 76.8 ± 48.1 months. The therapy responses of high-dose methylprednisolone (HDMP; n = 134), standard dose methylprednisolone (n = 32), and intravenous immunoglobulin (IVIG; n = 15) treatments were similar. Two (0.8%) of the 260 ITP patients had intracranial bleeding. None of the patients died due to hemorrhage. Of all the patients with ITP, 191 (73.5%) completely resolved within 6 months after initiation of the disease and therefore they were diagnosed as acute ITP; 69 patients (26.5%) had progressed into chronic ITP. The therapy responses of HDMP, standard dose methylprednisolone, and IVIG treatments are similar.

Conservative surgical treatment of pulmonary hydatid disease in children: an analysis of 35 cases

PURPOSE

Hydatid cyst disease is a major health problem for people who live in endemic countries such as Turkey. The definitive cure for pulmonary hydatidosis is still surgical. This study evaluates our experience of treating pulmonary hydatidosis, focusing on the conservative surgical management of children with this disease.

METHODS

We retrospectively analyzed 35 children ranging in age from 3 to 13 years old, treated for pulmonary hydatidosis during a recent 4-year period.

RESULTS

The 35 patients had a collective total of 48 cysts. Twenty-seven patients had a single cyst, 7 had unilateral multiple cysts, and 1 had bilateral multiple cysts. Six patients had multiple coexisting liver cysts. The 33 pulmonary cysts were intact and uncomplicated. Of the total 48 cysts, 34 were larger than 5 cm in diameter. Fever, cough, and dyspnea were the most common symptoms and chest radiography gave a correct diagnosis in 96.4% of the patients. Conservative surgical treatment was carried out in 33 of the 35 children (94%). There were few postoperative complications, and no mortality or recurrence in this series.

CONCLUSIONS

Parenchyma-saving surgical procedures such as cystotomy and capitonnage are the preferred methods of treatment for pulmonary hydatid disease in childhood. These simple procedures are safe, reliable, and successful. Combined medical treatment can be given but not as an alternative to surgery. Simultaneous surgical procedures for coexisting liver cysts may be preferred because of the lower morbidity rates and hospitalization. Ultrasound or computed tomography scanning should be done to detect coexisting liver cysts in every patient with pulmonary hydatid disease.

A patient with an unusual complication of sliding inguinal hernia: Stercoral appendiceal fistula

An unusual case of sliding inguinal hernia complicated by stercoral appendicular fistula as a result of acute appendicitis was reported in a 3-month-old boy. A diagnosis was made using barium enema. Elective appendectomy and narrowing of the internal ring using a purse-string suture were carried out safely via a right transverse infraumblical incision. Postoperative follow-up was uneventful.

Protective effect of T-type calcium channel blocker in histamine-induced paw inflammation in rat

The aim of this paper was to investigate the protective effect of the T-type calcium channel blocker in a model of acute local inflammation (histamine-induced). The intraplantar injection of histamine elicited an inflammatory response that was characterized by a time-dependent increase in paw oedema and neutrophil infiltration in paw tissue. The maximal increase in paw volume was observed at 90 min after histamine administration (maximal paw volume: 0.97 +/- 0.07). In addition, polymorphonuclear leucocyte (PNL) number was markedly increased in the histamine-treated paw tissue (144 +/- 25.56). However, histamine-induced paw oedema was significantly reduced in a dose-dependent manner by treatment with mibefradil (given at 10, 25, 50, and 100 mg x kg(-1)) at 30, 60, 90, 120, 150, 180 min after injection of histamine. Mibefradil treatment also caused a significant reduction of the polymorphonuclear leucocyte number in the paw tissue. Our findings support the view that mibefradil exerts antiinflammatory effects.

Effects of diphenhydramine HCl and methylprednisolone in the prevention of abdominal adhesions

OBJECTIVE

The purpose of this study was to determine the effects of diphenhydramine hydrochloride and methylprednisolone in peritoneal adhesions.

MATERIALS AND METHODS

Forty-eight male rats were used in the study. The rats were anesthetized by 5 mg/kg ketamine hydrochloride. After opening the abdomen, 10 longitudinal incisions of 2 to 3 cm in length were made on the right parietal peritoneum, and a 2 cm(2) peritoneal layer was excised from the left abdominal wall. The abdomen was closed with 3/0 silk suture. Group I was the control group, group II was given 10 mg/kg diphenhydramine intravenously, group III was given 20 mg/kg methylprednisolone intravenously, and group IV was administered both of the drugs in the above doses. A blood sample of 2 mL was taken from the rats on the 14th day after the operation. The animals were then sacrificed. The abdomen was opened and abdominal adhesions were examined. A tissue sample of 1 g was taken from the abdominal incision line. Albumin, zinc, and hemoglobin levels and leucocyte counts in the blood were determined as well as hydroxyproline levels in the tissue.

RESULTS

Numbers of adhesions were as follows: 9 in group I, 3 in group II, and 2 in group III. No adhesion was observed in group IV. Albumin, zinc, and hemoglobin levels and leucocyte counts were found to be similar in all groups. Hydroxyproline levels in the tissue were significantly lower in groups III and IV than in groups I and II (P <0.05).

CONCLUSIONS

Diphenhydramine and methylprednisolone reduced postoperative adhesions significantly in rats. Further investigations are needed in order to use these drugs as antiadhesive agents in humans.

Effects of topical Catalase application on dental pulp tissue: a histopathological evaluation

OBJECTIVES

recently, the role of antioxidant enzymes in wound healing and their therapeutic potential has been a subject of interest in medical sciences. However there is restricted knowledge on the results of topical application, optimal therapeutic dosage and carrier types. The purpose of this study was to investigate the wound healing response of dental pulp after direct pulp capping with an antioxidant enzyme; Catalase (C-40).

METHODS

three mongrel dogs were used in this study. A total of 32 perforated Cl V preparations were treated with either 0.8mg (n=16) or 1.6mg (n=16) Catalase (C-40) which was incorporated in gelatin carriers whereas 16 control teeth had carriers without Catalase. One millimeter thick Teflon disks were placed over the gelatin pellets and the cavities restored with silver amalgam. Short term and long term histopathologic reactions were evaluated after 7 and 90 days.

RESULTS

there were no statistically significant differences between the inflammatory cell responses of control and either dosage groups of Catalase at the 7-day evaluation period. However, after 90 days, better tissue healing was observed in the teeth treated with Catalase, resulting in significant differences with the control group.

CONCLUSIONS

it can be concluded that the results of this study encourage the topical use of antioxidant Catalase as a pulp-capping agent. However, further studies are required to determine optimal antioxidant dosages.

Microleakage of resin composite restorations with glass-ceramic inserts

OBJECTIVE

The purpose of this study was to evaluate the effects of glass-ceramic inserts and different application techniques of resin composites on marginal leakage.

METHOD AND MATERIALS

Three groups of 10 standardized, round, Class V cavities were prepared on the buccal surface of 30 extracted human molar teeth. Group 1 received resin composite restorations, placed in one increment (bulk). Group 2 received resin composite restorations that were placed in two increments, and group 3 received resin composite restorations with beta-quartz ceramic inserts. After the teeth were thermocycled and placed in 0.5% basic fuchsin for 24 hours, they were sectioned and examined for microleakage.

RESULTS

On the occlusal margins, there was no statistically significant difference between the restorations placed with the incremental technique and the restorations with beta-quartz inserts. The restorations placed with the bulk technique had significantly more microleakage than did the others. On the gingival margins, the restorations with beta-quartz inserts exhibited significantly less microleakage than did the other groups. The restorations placed with the bulk technique showed significantly more dye penetration than did the others.

CONCLUSION

The use of a glass-ceramic insert reduced the marginal leakage of Class V resin composite restorations.