Surgical treatment of cervicofacial cystic hygromas in children

AIM

The aim of this study was to evaluate the results of surgical treatment of cervicofacial cystic hygromas in children.

PATIENTS AND METHODS

Medical records of 17 patients who were operated for cervicofacial cystic hygroma between 1985 and 2004 were evaluated in terms of age, gender, symptoms, diagnostic workups, outcomes and complications.

RESULTS

There was a slight male predominance -- 10 (59%) boys and 7 (41%) girls. Nine (53%) out of 17 lesions were located on the left side of the neck, 7 (41%) lesions were located on the right side of the neck and 1 lesion (6%) was located in the middle of the neck. Eleven (65%) lesions were located in the infrahyoid region, 6 (35%) lesions in the suprahyoid region. Following surgical excision of the lesion, we encountered 4 postoperative complications: 1 recurrence (6%), 2 facial paralyses (12%) and 1 collection of fluid (6%) at the resection site. The patient who had a recurring lesion needed to be reoperated, other complications were treated conservatively.

CONCLUSIONS

Cervicofacial cystic hygromas are easy to diagnose. There is no need for expensive and time-consuming imaging studies. Surgery seems the treatment of choice. However, nonsurgical treatment options may be considered for the lesions located over the parotid region in order to avoid complications of surgery.

Single center experience in patients with unilateral multicystic dysplastic kidney

OBJECTIVE

To determine the clinical features, long-term outcomes, and additional urological anomalies of patients treated for multicystic dysplastic kidney (MDK).

MATERIALS AND METHODS

Patients with MDK who were followed between January 2004 and October 2012 were reviewed retrospectively. Demographic, clinical, laboratory, and radiological data were evaluated.

RESULTS

A total of 68 patients with MDK were followed for a mean period of 46.8 ± 32.4 months. MDK was detected by antenatal ultrasound in 64 (94.1%) of the patients. Ten patients had (14.7%) additional urological anomalies in contralateral kidney. Vesicoureteral reflux was found in five patients (7.3%). Other urological anomalies were megaureter (two), cortical renal cyst (two), ureteropelvic junction obstruction (one), and renal ectopy (one). Urinary tract infection was detected in 14 (20.5%) patients. Four (5.9%) patients had hypertension. Compensatory hypertrophy was detected in 29 (42.6%) patients. Eight (11.8%) of these 29 patients had glomerular hyperfiltration and three (4.4%) of these eight patients also had proteinuria. Follow-up ultrasound revealed complete involution in 19 (35.8%) patients. Nephrectomy was performed in 15 (22.0%) patients. Indications of nephrectomy were, recurrent urinary infection (four), hypertension (three), ureterocele (two), renal calculi (one), flank pain (one), hematuria (one), persistent large cystic kidney (three), and atypical US findings (two).

CONCLUSION

In patients with MDK, depending on the clinical, laboratory, and radiological findings, appropriate timing of operation by multidisciplinary approach is important for early detection and treatment of any possible complications.

Paraurethral Skene's duct cyst in a newborn

Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene's duct cyst in a newborn which was treated by incision and drainage.

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.

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.

Does tourniquet application alter the nitrergic responses of rabbit corpus cavernosum penis? A functional study

OBJECTIVE

To investigate the effects of short and long periods of tourniquet application on corporal nerves, endothelium and smooth muscle responses.

METHODS

After the rabbits were anesthetized with xylazine (5 mg/kg) and ketamine hydrochloride (35 mg/kg), a standard rubber circular band was applied to the base of the penis. After waiting for 20, 40 and 60 min, the tourniquets were removed and the penil tissue was reperfused for 5 min. In all groups, relaxation [carbachol, sodium nitroprusside (SNP) and electrical field stimulation (EFS) and contraction (phenylephrine and EFS)] responses were examined. In another set of experiments, the rabbits were killed 24 h after the tourniquet period of 60 min and carbachol-induced relaxation responses were obtained.

RESULTS

SNP- and EFS-induced relaxation responses were similar in all groups. Carbachol-induced relaxation responses were not altered in tissues from 20 min tourniquet group, but they were significantly reduced in tissues from 40 and 60 min tourniquet group compared to that from control group. The impaired endothelium-mediated relaxation responses did not return to control levels after 24 h of reperfusion period. Neither phenylephrine nor EFS-mediated contraction responses were altered with tourniquet application.

CONCLUSIONS

The results suggest that long period of tourniquet application altered endothelium-dependent muscarinic receptor-mediated relaxation responses. This is the first functional study that examined the effects of tourniquet application on corpus cavernosum tissue. In conclusion, it can be suggested that if tourniquet is necessary in penile surgery the application time of up to 20 min is more appropriate instead of prolonged usage.

Congenital pouch colon associated with anorectal malformation: report of 2 cases

Congenital pouch colon associated with anorectal malformation is an unusual anomaly reported most frequently in Asian countries. Pediatric surgeons must be familiar with this anomaly and the pre- and postoperative problems of these patients. The aim of this report is to bring attention to congenital pouch colon associated with anorectal malformation by discussing experiences with 2 patients.

Effects of varicocele on electrical field stimulation-induced biphasic twitch responses in the ipsilateral and contralateral rat vasa deferentia

AIM

Although little is known about the mechanisms, varicocele is considered as one of the factors leading to male infertility. Since reduced motility of the vas deferens was shown to contribute to male infertility, in this study we aimed to investigate the effect of varicocele on electrical field stimulation (EFS)-induced biphasic contractions of the vas deferens in order to evaluate the effect of varicocele on the motility of the vas deferens.

MATERIAL AND METHODS

A total of 26 Sprague-Dawley rats (200-250 g) were assigned randomly into two groups: sham (n = 10) and varicocele (n = 16). Varicocele was produced by partial obstruction of the left renal vein. Four weeks after the surgical procedure, vasa deferentia were harvested and EFS-induced responses were recorded from the strips prepared from ipsilateral and contralateral sides via Grass isometric force displacement transducers. Exogenous alpha-beta methyl ATP was applied at the concentration of 10(-5)M to the vasa deferentia strips, and exogenous noradrenalin was applied cumulatively at the concentrations between 10(-7) and 10(-4)M. At the end of each experiment, 80 mM KCl was applied to induce contractions. All contractions were expressed as the percentage of the 80 mM KCl-induced contractions.

RESULTS

Varicocele significantly inhibited both phases of EFS-induced biphasic contractions in the ipsilateral side, whereas in the contralateral site it did not produce any change. However, there was no change in exogenously applied alpha-beta methyl ATP, noradrenalin and KCl-evoked contractions of the vasa deferentia obtained from both sides.

CONCLUSIONS

These results suggest that varicocele affects the ipsilateral vas deferens motility by reducing neurotransmitter release.

Pure gonadal dysgenesis (Swyer syndrome) due to microdeletion in the SRY gene: a case report

46,XY complete gonadal dysgenesis (Swyer syndrome) is a rare cause of disorder of sexual development. This syndrome is caused by a defect in the determination of sex during embryogenesis and is characterised with female external genitalia, normal or rudimentary uterus, and streak gonads, despite the presence of the 46,XY karyotype. Most of the studied cases presented with leak of secondary sex characteristics and primary amenorrhea during adolescence. Laboratory findings reveal hypergonadotropic hypogonadism. Herein we present the case of a female with a 46,XY karyotype who was admitted with delayed puberty and detected to have a microdeletion in the SRY gene and diagnosed to have Swyer syndrome. We highlight the importance of karyotype analysis in patients with delayed puberty and primary amenorrhea. Once the diagnosis of 46,XY complete gonadal dysgenesis is established, early laparoscopic removal of the dysgenetic gonads is crucial to prevent the development of gonadal malignancy.

A child with a giant omental cyst

A case of giant omental cyst diagnosed preoperatively is described. A 4-year old girl presenting with abdominal distension and misdiagnosed as having ascites, was subsequently proved to have a giant omental cyst. This is a rather difficult diagnosis to reach and results in wrong treatment methods. A high index of suspicion is therefore required early in the course of the disorder to decrease the complication rate. This report describes the diagnostic modalities and our approach to the patient who was cured by total excision of the cyst and free of disease in the fourth year of follow-up.

An unusual case: a giant paraesophageal hiatal hernia with intrathoracic spleen, preduodenal portal vein, malrotation, and left inferior vena cava

A giant paraesophageal hiatal hernia with preduodenal portal vein, nonrotating gut, intrathoracic spleen, and left inferior vena cava has not been reported to date. This set of complex anomalies can have significant clinical implications. Awareness of these anomalies is essential to avoid further complications.

Safety and Efficiency of Pyeloplasty in The First Six Weeks of Infants' Life

PURPOSE

The aim of this study was to assess the safety and the efficiency of pyeloplasty in infants with ureteropelvic junction obstruction (UPJO) in the first six weeks of their life.

MATERIALS AND METHODS

Clinical records of the patients who had surgery during first six weeks of life for UPJO between June 2009 and June 2014 were analysed retrospectively.

RESULTS

In this period, twenty-six dismembered pyeloplasties were performed in twenty-four patients on mean operation age of 27.3 ± 10.2 days (range 8-42 days). On the first postnatal ultrasound all twenty-six renal units had SFU-4 hydronephrosis. Mean preoperative and postoperative anterior-posterior pelvic diameter and parenchymal thickness were 33.1 ± 8.9mm (range 14-49mm), 3.2 ± 1mm (range 1-4,6mm) and 14.7 ± 6.6mm (range 6-27mm) and 7.8 ± 1.9mm (range 3.0-10.4mm), respectively. The differences between preoperative and postoperative parenchymal thickness and anterior-posterior pelvic diameter were statistically significant (P ˂ 0.0001). Preoperative MAG3 dynamic renal scintigraphy showed obstructive pattern on the diuretic renogram in 26 units. Mean preoperative and postoperative differential renal function on dynamic renal scintigraphy of the affected renal units were 46 ± 15 and 44 ± 15, respectively. Postoperative drainage was normal on dynamic renal scintigraphy in 25 (96.2%) of the 26 units, redo-pyeloplasty was needed in only one unit (3.8%).

CONCLUSION

In conclusion, patient selection and timing of surgery are very important in the protection of renal function in newborn with UPJO. In our opinion, if there is indication for surgery, early surgical intervention should not postpone in this period. Surgical treatment of UPJO during first six weeks of life is safe and effective.

Effects of Mexiletine on Electrical Field Stimulation-Induced Contractile Responses in the Ipsilateral and Contralateral Vasa Deferentia after Unilateral Testicular Torsion/Detorsion

AIM

To investigate testicular torsion-induced changes on the electrical field stimulation (EFS)-induced contractions in rabbit vasa deferentia and to evaluate the effect of mexiletine.

METHODS

18 male New Zealand albino rabbits were used in this experiment. Rabbits were divided into three groups: (1) control group (n = 6); (2) torsion group (n = 6), and (3) mexiletine group (n = 6). In the control group, vasa deferentia on both sides were harvested. In the torsion and mexiletine groups, the left testes of the rabbits were subjected to 720 degrees of clockwise torsion for 2 h and then detorsion was performed. In the mexiletine group, 50 mg/kg i.p. mexiletine was administered 1 h before detorsion. Following 24 h of the torsion, vasa deferentia on both sides were harvested and 2-cm strips including both the prostatic and epididymal portions were prepared to record EFS-induced contractions.

RESULTS

Testicular torsion caused a significant inhibition in both phases of EFS-induced biphasic contractions of the ipsi- and contralateral vasa deferentia. Mexiletine treatment did not affect these inhibitory responses. Torsion/detorsion of the spermatic cord did not alter exogenously applied noradrenaline-induced contractions in both vasa deferentia. However, KCl-induced contractions diminished significantly in ipsilateral vas deferens of the torsion group and mexiletine restored this inhibition.

CONCLUSIONS

Unilateral testicular torsion/detorsion leads to inhibition in both phases of EFS-induced biphasic contractions of the ipsi- and contralateral vasa deferentia by causing a defect in presynaptic nerve transmission. However, mexiletine has no effect on this inhibition. Inhibition of the KCl-induced contractions in the ipsilateral vas deferens, which indicates postsynaptic tissue damage, is restored by administering mexiletine 1 h prior to detorsion.

Thoracoabdominal duplication symptomatic on both sides: a case report

Thoracoabdominal foregut duplications account for less than 2% of all gastrointestinal duplications. Here, we report a case of thoracoabdominal duplication cyst in an eight-month old boy who presented with both respiratory and abdominal complaints. Excision of both thoracic and abdominal extensions of the thoracoabdominal duplications in the same session is an appropriate and safe option to prevent possible complications.

Extravesical approach in paraureteral bladder diverticulum: a case report

Bladder diverticulaeare herniations of bladder mucosa through fibers of the detrusor muscle. We present the extravesical approach to a case of paraureteral bladder diverticulum in a six-year-old boy who had a history of recurrent urinary infection. In case of recurrent urinary complaints, the possibility of presence of a bladder diverticulum should be kept in mind. Voiding cystourethrogram is helpful for the differential diagnosis of the bladder diverticulum. Excision by extravesical approach of the paraureteral bladder diverticulum is a good choice.

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

BACKGROUND

This study was designed to assess smooth muscle function and motility in defunctionalized colonic segments and subsequent changes in pathways responsible for gastrointestinal motility.

METHODS

Two-month-old New Zealand rabbits were randomly allocated into control and study groups. Sigmoid colostomies were performed in the study group. After a 2-month waiting period, colonic segments were harvested in both groups. For the in vitro experiment, the isolated circular muscle strips which were prepared from the harvested distal colon were used. First, contraction responses were detected using KCl and carbachol; relaxation responses were detected using papaverine, sodium nitroprusside, sildenafil, and l-arginine. The neurologic responses of muscle strips to electrical field stimulation (EFS) were evaluated in an environment with guanethidine and indomethacin. EFS studies were then repeated with atropine, Nω-nitro-l-arginine methyl ester, atropine, and Nω-nitro-l-arginine methyl ester-added environments.

RESULTS

Although macroscopic atrophy had developed in the distal colonic segment of the colostomy, the contraction and relaxation capacity of the smooth muscle did not change. EFS-induced nitrergic-peptidergic, cholinergic-peptidergic, and noncholinergic nonnitrergic responses significantly decreased at all frequencies (0.5-32 Hz) in the study group compared with those in the control group (P < 0.05).

CONCLUSIONS

Although the contraction capacity of the smooth muscle was not affected, the motility of the distal colon deteriorated owing to the defective secretion of presynaptic neurotransmitters such as acetylcholine, nitric oxide, and neuropeptides.

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.

Occurrence of paratubal cysts in childhood: An analysis of 26 cases

A retrospective analysis was conducted on the case files of patients operated on for adnexal pathology between January 2004 and December 2015 at our institution. The data of the patients with a diagnosis of paratubal cysts (PTCs) was extracted. A total of eighty-seven children were operated on for adnexal pathology. Twenty-six (29.9%) patients had PTCs. The patients were predominantly grouped as adolescents (n=22) and newborns (n=3). One of the patients was a pre-pubertal girl. Of the 26 PTC cases, 18 of them occurred on the contralateral side to ovarian pathology (OP) or physiologic ovarian changes (POC) such as corpus luteum cyst or follicular cyst which their final diagnosis confirmed by histopathology examination; in one case, the PTCs were bilateral; and in three cases, PTCs were ipsilateral with OP or POC. There were only 4 solitary PTC cases identified among the 26 cases. Paratubal cysts can be observed at every age, even in newborns. Their association with OP or POC in childhood cases needs to be clarified to further understand the hormonal mechanisms that are influencing the occurrence of these cysts.

Torsion/detorsion of the testis does not modify responses to nitric oxide in rat isolated penile bulb

Ischaemia-reperfusion damage induced by torsion/detorsion of the testicles may be a causative factor leading to erectile dysfunction through oxidative stress-dependent changes in the responses of the penile bulb, an erectile tissue of the penis. We aimed at investigating the effects of unilateral testicular torsion/detorsion (2 or 24 hr) treatment on relaxations induced by electrical field stimulation and sodium nitroprusside in rat isolated penile bulb. Male Sprague-Dawley rats used in the study were divided into two groups. The treatment group was subjected to unilateral torsion followed by detorsion for 2 or 24 hr, while the control group underwent only sham operation. For in vitro organ bath experiments, penile bulbs were isolated and responses to relaxant agents and electrical field stimulation (70 V, 1 msec., 0.5-8 Hz, 5 sec.) were recorded on a computer-based data acquisition system via a force displacement transducer. In tissues precontracted with phenylephrine (3 x 10(-6 )M), relaxations induced by electrical field stimulation were not significantly different before and after 2 or 24 hr of detorsion. Similarly sodium nitroprusside- (10(-8)-3 x 10(-6 )M) and papaverine-induced (10(-7)-10(-4 )M) relaxations were also found unchanged in the detorsion group compared to control. In conclusion, spermatic cord torsion did not lead to impairment in nitric oxide-mediated relaxant responses of the rat isolated penile bulb.

Is rigid endoscopy necessary with childhood corrosive ingestion? a retrospective comparative analysis of 458 cases

The aim of this study was to determine the necessity of endoscopy in cases in which a corrosive substance was ingested and to find a practical way to avoid unnecessary endoscopies for similar cases in the future. The clinical records of 458 hospitalized cases with clinical histories of corrosive substance ingestion between January 2007 and December 2013 were retrospectively reviewed. The demographics of the cases, the ingested substances, and the rigid endoscopy findings were evaluated. The three most commonly ingested corrosive agents were household bleach (22.9%), household degreaser (15.9%), and drain cleaner (13.1%). Rigid esophagoscopy was performed in 367 of the 458 cases. Corrosive agents were grouped according to their purpose of household use; eight groups were created. The degree of corrosive injury observed in the different groups was compared with the degree of injury caused by household bleach. Among the corrosive agent groups, dishwashing machine products (Gr.1), laundry products (Gr.2), liquid cleaners (Gr.3), and household bleach (Gr.4) did not cause high-grade injuries. The resulting injuries and esophagoscopy results among the above groups, whether symptomatic or not, did not differ from one another. Corrosive agents such as drain cleaner (Gr.6), household degreaser (Gr.7), and several other acidic products (Gr.8) caused high-grade injuries in the esophagus; however, lime remover/HCl (Gr.5) did not. Thus, hospitalization and rigid endoscopy seem unnecessary to assess esophageal injury in most cases, if the ingested corrosive agent fits into group 1, 2, 3, or 4 and if the patient can be easily fed. Esophagoscopy is useful to shorten the hospitalization times in cases where strong corrosive agents were ingested, such as those in groups 5, 6, 7, and 8.