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Abstract
Thyroid carcinoma is rare in children and differs from its adult counterpart in many aspects, including that childhood thyroid carcinomas are all well differentiated. Here we present a 14-year-old female from a goitrous area with follicular thyroid carcinoma with a predominant insular component. The child was well without recurrence or metastases after 5 years of follow-up.
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Affiliation(s)
- E Kotiloglu
- Hacettepe University Children's Hospital, Ankara, Turkey
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2
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Abstract
A unilateral teratoid Wilms’ tumor in a 3-year-old girl is presented. Histopathologic features of this rare variety, differential diagnosis and effects of chemotherapy are discussed in light of other reports in the literature.
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Affiliation(s)
- E Kotiloğlu
- Pediatric Pathology Unit, Hacettepe University Medical School, Ankara, Turkey
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3
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Abstract
Pleuropulmonary blastoma is an uncommon primary malignant tumor of the lung. Surgery is the most important part of the treatment. Despite the use of chemotherapy with or without radiotherapy, the prognosis is poor. Here we report on the case of a 2.5 year-old boy presenting with pneumothorax who turned out to have a right hemithoracic mass. The patient underwent surgical resection of the mass. Pathologic diagnosis was type II pleuropulmonary blastoma. Postoperative thoracic CT showed nodular residual densities so the patient was given adjuvant combination chemotherapy with cisplatin and etoposide. He has been disease free for 12 months.
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Affiliation(s)
- E Güler
- Department of Pediatric Oncology, Faculty of Medicine Hacettepe University, Ankara, Turkey
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4
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User IR, Ekinci S, Kale G, Akyüz C, Büyükpamukçu M, Karnak I, Çiftçi AÖ, Tanyel FC, Şenocak ME. Management of bilateral Wilms tumor over three decades: The perspective of a single center. J Pediatr Urol 2015; 11:118.e1-6. [PMID: 25842994 DOI: 10.1016/j.jpurol.2014.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 11/19/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Outcomes of Wilms tumor improved in last 50 years and excellent survival rates can be achieved especially in case of non-metastatic disease and favorable histology. Nevertheless, bilateral cases still stand as a therapeutic challenge. Prognosis of bilateral Wilms tumor (BWT) is not as good as the unilateral tumors of similar stage and histology in terms of survival and renal function. OBJECTIVE Management of BWT is constantly evolving and still stands as a therapeutic challenge. This study is designed to review and share our experiences on this topic from a surgical standpoint. STUDY DESIGN The records of patients treated in our clinic between 1980 and 2013 according to Turkish Pediatric Group of Oncology protocol were analyzed retrospectively and clinical data, surgical details, pathology results, long term outcomes were analyzed. RESULTS Thirteen girls and 7 boys with a mean age of 2,5 years were treated. There were 2 patients with Wilms tumor-Aniridia-Growth Retardation complex and one with isolated hemihypertrophy. Metastasis were detected in lungs of 4 patients; liver of 2 and in the cranium of one. All patients except one with the presumptive diagnosis of unilateral Wilms tumor were given preoperative chemotherapy. To sum up; 19 nephroureterectomies, 8 partial nephrectomies and 13 enucleations were performed to 36 kidneys without any major early or late postoperative complications. Pathologic results revealed positive surgical margins in 2 lesions with enucleation and in 2 with partial nephrectomies and anaplasia in 4 patients. Two patients were not operated due to parental disapproval. Two patients had the need of dialysis; one was anephric and the others' renal functions recovered over a year. Seven patients received radiotherapy for pulmonary metastasis, positive surgical margins or local recurrences. Overall, 13 patients survived and 7 died due to metastasis, recurrences, and complication of dialysis and refusal of surgical treatment. Survival among all patients was 65% and 72.2% among operated ones. Of the 7 patients with the partial nephrectomy, 2 died and 5 survived. Among enucleation group, 8 out of 10 survived and 2 died. Survival was slightly higher among enucleation group (80% vs 71.4%). Median time of follow-up for survivors of disease is 5.8 years (min: 6 months and max: 14 years). DISCUSSION Outcomes of BWT management have changed dramatically during the last few decades from only survival, to a long life expectancy without the need of renal replacement therapy owing to improvements in treatment options. We argue that positive surgical margins do not necessarily lead to local recurrence. For this reason it may be wiser to favor on more nephron sparing surgery than to achieve negative surgical margins. Adjuvant chemotherapy and radiotherapy may be adequate to prevent local recurrence. Also, survival did not differ significantly between different ways of nephron sparing surgeries, so it may be wiser to choose enucleation over partial nephrectomy which preserves more nephrons. Nephron-sparing surgery should have utmost importance despite the risk of positive margins. On the other hand, there is not enough data to interpret if positive surgical margins have role on distant metastases or not. Presence of metastasis and recurrence seems to be an important determinant of prognosis given the fact that none of the survivors had any metastasis or recurrence. CONCLUSION Nephron preservation should be the aim while taking positive surgical margin risk on nephron sparing surgery side relying on postoperative chemotherapy and carefully planned radiotherapy to avoid recurrence. However, there is significant diversity on the management BWT in different centers and a certain validated guideline or protocol to provide the optimal treatment is still lacking.
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Affiliation(s)
- I R User
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Ekinci
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - G Kale
- Pediatric Pathology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - C Akyüz
- Pediatric Oncology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Büyükpamukçu
- Pediatric Oncology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - I Karnak
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Ö Çiftçi
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F C Tanyel
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M E Şenocak
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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5
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Cavkaytar O, Duzova A, Teksam O, Kale G, Ozen S. PReS-FINAL-2258: Final diagnoses of pediatric patients presenting with musculoskeletal symptoms in a center from the eastern Mediterranean. Pediatr Rheumatol Online J 2013. [PMCID: PMC4045402 DOI: 10.1186/1546-0096-11-s2-p248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- O Cavkaytar
- Department of Pediatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - A Duzova
- Department of Pediatric Nephrology and Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - O Teksam
- Department of Pediatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - G Kale
- Department of Pediatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - S Ozen
- Department of Pediatric Nephrology and Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey
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6
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Balci-Hayta B, Talim B, Topaloglu H, Kale G, Dincer P. P.8.2 Reduction of LARGE expression in different types of muscular dystrophies other than dystroglycanopathy. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Karakaya M, Talim B, Kale G, Topaloglu H. P.9.1 Clinical and histopathological features of nemaline myopathy. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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Karakaya M, Talim B, Kale G, Topaloglu H. P.9.13 Congenital myopathies in a pediatric referral center. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Uysal-Yazıcı M, Orhan D, Gülhan B, Beşbaş N, Kale G, Özen S. AB0040 Il17 and IFN gamma are important in the severity of kidney disease in SLE. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Mitsuhashi S, Ohkuma A, Talim B, Karahashi M, Koumura T, Aoyama C, Kurihara M, Mitsuhashi H, Goto K, Koksal B, Kale G, Noguchi S, Hayashi Y, Nonaka I, Sher R, Sugimoto H, Nakagawa Y, Cox G, Topaloglu H, Nishino I. O.11 A novel congenital muscular dystrophy with mitochondrial structural abnormalities caused by defective de novo phosphatidylcholine biosynthesis. Neuromuscul Disord 2010. [DOI: 10.1016/j.nmd.2010.07.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Talim B, Akcoren Z, Haliloglu G, Orhan D, Gucer S, Kale G, Topaloglu H. G.P.2.01 Frequency of different forms of congenital muscular dystrophies in a referral center. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Koksal B, Talim B, Akcoren Z, Orhan D, Gucer S, Kale G, Topalogˇlu H. G.P.3.01 Clinical and histopathological features in muscle biopsies of children with suspected mitochondrial disease. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Bircan Cavkaytar Ö, Düzova A, Teksam Ö, Ayaz NA, Derman O, Bakkaloglu A, Kale G, Özen S. Assessment of children presenting with rheumatic complaints to a tertiary center in Turkey: differences in an Eastern Mediterranean population. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333935 DOI: 10.1186/1546-0096-6-s1-p138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Teksam O, Gumus P, Bayrakci B, Erdogan I, Kale G. 103: Acute Cardiac Effects of Carbon Monoxide Poisoning in Children. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Topaloglu H, Gempel K, Talim B, Schneiderat P, Schoser B, Volkmar H, Kale G, Tokatli A, Quinzii C, Hirano M, Naini A, Di Mauro S, Prokisch H, Lochmüller H, Horvath R. M.O.2 Mutations in the electron-transferring-flavoprotein dehydrogenase (ETFDH) gene cause myopathic form of coenzyme Q10 deficiency. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Talim B, Haliloglu G, Orhan D, Gucer S, Akcoren Z, Kale G, Topaloglu H. C.P.3.07 Muscle pathology in alpha-dystroglycanopathies with central nervous system malformation. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Talim B, Koksal B, Akcoren Z, Topcu M, Alehan D, Kale G, Topaloglu H. C.P.2.12 Congenital muscular dystrophy with mental retardation, dilated cardiomyopathy and abnormally located mitochondria. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Topaloğlu H, Talim B, Orhan D, Haliloğlu G, Horwath R, Kale G. G.P.3 01 Isolated myopathy with muscle coenzyme Q10 deficiency. Neuromuscul Disord 2006. [DOI: 10.1016/j.nmd.2006.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Talim B, Fütterer N, Plecko B, Kale G, Topaloglu H, Horvath R. G.P.3 02 Six children with early-onset mitochondrial encephalomyopathy and one heterozygous pathogenic mutation in POLG1. Neuromuscul Disord 2006. [DOI: 10.1016/j.nmd.2006.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Abstract
BACKGROUND The presence of varying amounts of smooth muscle (SM) in the patent processus vaginalis suggests that SM plays a role in the descent of the testis. Myogenesis within the gubernaculum (representing primitive mesenchymal tissue) has been evaluated. MATERIALS AND METHODS Bilateral gubernacula of ten male and five female fetuses were obtained. Sections were stained with hematoxylin-eosin, van Gieson and Gomori trichrome. Expressions of human muscle actin, desmin, vimentin, alpha-smooth muscle actin, human myosin, fast myosin, slow myosin, and Myo-D were determined through immunohistochemistry. The structural alterations and expressions according to the fetal ages were determined within the gubernacula of both sexes. RESULTS Gubernacula revealed striated muscle at twelve weeks of age. Despite expression of actin and desmin, those muscles did not express Myo-D. Actin and desmin expressing striated muscles ceased to exist until 22 weeks of age. Both vascular SM and cremaster muscle (CM) expressed Myo-D during the 22nd and 23rd weeks. CM additionally expressed alpha-smooth muscle actin. Detection of myofibroblasts in the 22nd week was followed by appearance of the SM in the 27th week in the gubernacula of male fetuses. The same alterations were encountered among the female fetuses at later time points. CONCLUSION Both smooth muscle and CM develop within the gubernaculum. CM may have transdifferentiated from the vascular SM. If the gubernaculum represents primitive mesenchymal tissue, it ceases to exist after the development of muscles.
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Affiliation(s)
- F C Tanyel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey.
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21
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Balci B, Wilichowski E, Haliloğlu G, Talim B, Aurino S, Kremer E, Ebinger F, Senbil N, Anlar B, Kale G, Nigro V, Topaloğlu H, Bonnemann C, Dinçer P. Beta-sarcoglycan gene mutations in Turkey. Acta Myol 2004; 23:154-8. [PMID: 15938573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The term limb-girdle muscular dystrophy (LGMD) refers to a group of muscular dystrophies that, at the outset, affect primarily the muscles of the hip and shoulder girdle. Limb-girdle muscular dystrophy is genetically heterogeneous comprising autosomal dominant (types LGMD 1A-1E) as well as autosomal recessive forms (types LGMD 2A-2J known). A subgroup among the autosomal recessive forms comprises the sarcoglycanopathies (LGMD2C-2F), caused by mutations in the gamma (gamma-SG), alpha (alpha-SG), beta (beta-SG) and delta (delta-SG) sarcoglycan genes, respectively. The sarcoglycans form the sarcoglycan complex, part of the dystrophin-associated glycoproteins. Mutations in the beta-SG gene causes LGMD2E. Disease severity, in this form, varies from mild to severe phenotypes depending on the individual mutation. Homozygous missense mutations in critical locations may result in the total absence of alpha-, beta- and gamma-sarcoglycan from the muscle membrane and a phenotype as severe as null mutations. In the present study, through screening 80 unrelated LGMD2 families, we identified 13 families with LGMD2E. Mutations in the beta-SG gene were identified in 12 patients from nine families. One of these patients carried a previously reported truncating mutation (Q11X), while the other 11 carried novel missense/rameshift mutations (M1L, V89M, I92T, I92S, 739insA), some of which were seen in more than one patient and may, therefore, be more common in the Turkish population.
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Affiliation(s)
- B Balci
- Hacettepe University, Faculty of Medicine, Department of Medical Biology, Turkey
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22
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Büyükyavuz I, Talim B, Ciftci AO, Kale G, Senocak ME, Büyükpamukçu N. An experimental study of choleretic effect and histopathologic alterations in the gastrointestinal system after whole-bowel irrigation. J Pediatr Surg 2004; 39:582-6. [PMID: 15065032 DOI: 10.1016/j.jpedsurg.2003.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Whole-bowel irrigation (WBI) has been used for different purposes. It has been the preferred method of bowel cleansing before large bowel surgery and colonoscopy. There are some studies about histopathologic alterations in the gastrointestinal system caused by WBI. It was reported that large quantities of bile-stained intraluminal fluid were seen after WBI with lactated Ringer's solution. In light of all these studies, the authors have decided to inspect whether WBI is choleretic and whether the histopathologic findings in the gastrointestinal system are caused by this choleretic effect. METHODS During the experimental procedures, animals at first were divided into 2 major groups of A and B; A consisted of the animals whose bile was not collected, and B consisted of animals whose bile was collected. Later, these 2 groups were divided into 4 subgroups consisting of 6 animals each. Sham operations were performed on the animals in group SH-A and SH-B. The animals in group saline-A and saline-B were given 0.9% of sodium chloride (isotonic sodium chloride). The animals in group LR-A and LR-B received lactated Ringer's solution. The last group (PEG-A and PEG-B) underwent WBI by using polyethylene glycol solution (PEG). After completing WBI, animals were rested for 4 hours, and at the end of resting time, laparotomy was performed to take biopsy specimens from stomach, small bowel, and large bowel. All of the specimens were evaluated and graded for congestion, edema, and inflammation by the individual blinded pathologist. RESULTS According to the results, WBI has been shown to affect biliary secretion and to have a choleretic effect (P <.05, Tuckey-Kramer). The choleretic effect has also been shown to be responsible for histopathologic alterations in some groups (P <.05, Tuckey-Kramer). The most severe changes of congestion, edema, and inflammation have been detected in isotonic sodium chloride solutions in all groups. The least alterations have been seen in lactated Ringer's and PEG solutions. CONCLUSIONS In light of these findings, it might be concluded that the use of WBI can cause different degrees of histopathologic changes in gastrointestinal system depending on the type of solutions. WBI has been shown to have choleretic effect, and it was found that there is a connection between histopathologic changes in gastrointestinal system and choleretic effect of WBI.
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Affiliation(s)
- I Büyükyavuz
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey
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23
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Abstract
Prenatal diagnosis of congenital atresia of the larynx is difficult but is possible by the findings of increased lung echogenicity and size coexisting with fetal ascites in ultrasonography. Sonographic findings may not always be typical. We report on a case of congenital laryngeal atresia diagnosed prenatally by the findings of fetal hydrops and hyperechogenic lungs. Our case presented with oligohydramnios. We also review syndromes that demonstrate laryngeal anomalies.
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Affiliation(s)
- L Onderoglu
- Department of Obstetrics and Gynecology, Unit of Maternal Fetal Medicine, Hacettepe University Ankara, Turkey
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24
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Abstract
Occludin, the transmembrane integral protein of the tight junction, plays a crucial role in the molecular organization and function of tight junction. While the homotypic interaction of extracellular loops of occludin appears to determine the barrier function of tight junction, the intracellular C-terminal tail, C-occludin, interacts with other tight junction proteins such as ZO-1, ZO-2, and ZO-3 and with the actin filaments of cytoskeleton. In the present study we phosphorylated GST-fused C-occludin on tyrosine residues, in TKX1 Epicurian coli or by active c-Src in vitro. c-Src binds to occludin and phosphorylates it on tyrosine residues. The effect of tyrosine phosphorylation of C-occludin on its ability to bind ZO-1, ZO-2, ZO-3, and F-actin was evaluated. Results show that the amounts of ZO-1, ZO-2, and ZO-3 bound to tyrosine phosphorylated C-occludin were several fold less than the amounts bound to non-phosphorylated C-occludin. However, the amount of tyrosine phosphorylated C-occludin bound to F-actin was not significantly different from the amount of non-phosphorylated C-occludin bound to F-actin. These results demonstrate that tyrosine phosphorylation of occludin reduces its ability to bind ZO-1, ZO-2, and ZO-3, but not F-actin. Results also suggest that c-Src-mediated disruption of tight junction may involve tyrosine phosphorylation of occludin.
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Affiliation(s)
- G Kale
- Department of Physiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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25
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Akyüz C, Emir S, Büyükpamukçu M, Büyükpamukçu N, Cağlar M, Kale G, Calişkan U. Successful treatment with interferon alfa in infiltrating angiolipoma: a case presenting with Kasabach-Merritt syndrome. Arch Dis Child 2003; 88:67-8. [PMID: 12495967 PMCID: PMC1719259 DOI: 10.1136/adc.88.1.67] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report a case of infiltrating angiolipoma who presented with a large mass on the shoulder and the signs of Kasabach-Merritt syndrome. She improved dramatically within one month and the mass completely disappeared after six months of interferon treatment.
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Affiliation(s)
- C Akyüz
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
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26
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27
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Yurt B, Koçak N, Ozen H, Yüce A, Gürakan F, Kale G. Non-Wilsonian cirrhosis in Turkish children. Indian Pediatr 2001; 38:1035-8. [PMID: 11568381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- B Yurt
- Division of Gastroenterology and Pathology, Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkiye
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28
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Abstract
Skeletal metastases is relatively rare in hepatocellular carcinoma and accounts for 4-16% of extrahepatic metastases. The authors report a 13-year-old girl with fibrolamellar hepatocellular carcinoma, who rejected further systemic chemotherapy following hepatic lobectomy and experienced sternal and vertebral painful metastases nearly 5 years after the operation. The sternal metastatic lesion was removed surgically, whereas external irradiation was delivered to the lumbar vertebral lesion. The patient received no systemic treatment following metastases and died with widespread disease. Despite metastatic disease, the patient survived 6.5 years following the initial diagnosis.
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Affiliation(s)
- M T Kutluk
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey.
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29
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Abstract
The structures of sacs from boys and girls with inguinal hernia, and from boys with undescended testis or hydrocele were evaluated and compared. Particular attention was directed to determine if a clue helpful in describing the mechanism of obliteration of processus vaginalis (PV) exists. Sacs from boys (n: 8) and girls (n: 11) with inguinal hernia, and sacs from boys with undescended testis (n: 11) and hydrocele (n: 10) were obtained and stained with hematoxylin-eosin, trichrome and elastic van Gieson. The histologic structures of each group of samples were determined and compared. Smooth muscle was presented as a layer within the sacs of girls and boys with inguinal hernia. However, smooth muscle bundles were sparsely presented in sacs associated with undescended testis and hydrocele. Myofibroblasts were commonly encountered in sacs associated with inguinal hernia. The smooth muscle was invariably presented in sacs that contained myofibroblasts. While sacs from boys only had smooth muscle, sacs from girls also had striated muscle. Since the muscle components of sacs vary, PV is sexually dimorphic. Persistence of PV seems to be associated with the presence of smooth muscle and myofibroblasts within the sac wall. Myofibroblasts may have originated from the smooth muscle, and reflect the attempts at obliteration of PV.
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Affiliation(s)
- F C Tanyel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
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30
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Affiliation(s)
- C Akyüz
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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31
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Dinçer P, Akçören Z, Demir E, Richard I, Sancak O, Kale G, Ozme S, Karaduman A, Tan E, Urtizberea JA, Beckmann JS, Topaloğlu H. A cross section of autosomal recessive limb-girdle muscular dystrophies in 38 families. J Med Genet 2000; 37:361-7. [PMID: 10807695 PMCID: PMC1734591 DOI: 10.1136/jmg.37.5.361] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Limb-girdle muscular dystrophies constitute a broad range of clinical and genetic entities. We have evaluated 38 autosomal recessive limb-girdle muscular dystrophy (LGMD2) families by linkage analysis for the known loci of LGMD2A-F and protein studies using immunofluorescence and western blotting of the sarcoglycan complex. One index case in each family was investigated thoroughly. The age of onset and the current ages were between 11/2 and 15 years and 6 and 36 years, respectively. The classification of families was as follows: calpainopathy 7, dysferlinopathy 3, alpha sarcoglycan deficiency 2, beta sarcoglycan deficiency 7, gamma sarcoglycan deficiency 5, delta sarcoglycan deficiency 1, and merosinopathy 2. There were two families showing an Emery-Dreifuss phenotype and nine showing no linkage to the LGMD2A-F loci, and they had preserved sarcoglycans. gamma sarcoglycan deficiency seems to be the most severe group as a whole, whereas dysferlinopathy is the mildest. Interfamilial variation was not uncommon. Cardiomyopathy was not present in any of the families. In sarcoglycan deficiencies, sarcoglycans other than the primary ones may also be considerably reduced; however, this may not be reflected in the phenotype. Many cases of primary gamma sarcoglycan deficiency showed normal or only mildly abnormal delta sarcoglycan staining.
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Affiliation(s)
- P Dinçer
- Department of Medical Biology, Hacettepe University Medical School, 06100 Ankara, Turkey
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32
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Bingöl-Koloğlu M, Senocak ME, Talim B, Kale G, Ocal T, Büyükpamukçu N. A comparative histopathologic evaluation of the effects of three different solutions used for whole bowel irrigation: an experimental study. J Pediatr Surg 2000; 35:564-8. [PMID: 10770382 DOI: 10.1053/jpsu.2000.0350564] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Although whole bowel irrigation (WBI) is a widely used method of bowel preparation in daily surgical practice, almost nothing is known about the histopathologic alterations caused by WBI and whether these differences have any detrimental effect on the outcome of gastrointestinal surgical procedures. Therefore, an experimental study has been conducted to evaluate and compare the effects of WBI with various solutions on the histology of gastrointestinal tract. METHODS During the experimental procedures animals were divided into 4 groups consisting of 8 animals each as follows: group A, WBI performed by using isotonic saline solution; group B, WBI performed by using an isoosmolar solution containing polyethylene glycol (PEG); group C, WBI performed by using Lactated Ringer's solution; group D, Animals that were not irrigated but sham operations that were performed served as controls. Four hours after WBI the animals underwent laparotomy and a segment of transverse colon with intact vascular peduncle was prepared. After waiting for 30 minutes, specimens from duodenum, small intestine, large bowel, colonic segment, and liver were obtained from each animal. Histopathologically, all of the specimens were evaluated and graded by 3 parameters including congestion, edema, and inflammation. RESULTS Although varying degrees of congestion, edema, and inflammation were encountered from all of the specimens of group A, B, and C, only slight congestion was noted in all specimens of group D. The difference between group D and other groups was statistically very significant (P < .001). When the sections from duodenums of groups were evaluated, the degree of congestion, edema, and inflammation were found to be moderate in group B, mild-moderate in group A, and mild in group C. Histopathologic examinations of specimens of the small, large bowel, and isolated colonic segment showed severe congestion, edema, and inflammation in group A, moderate-mild in group B, and mild in group C. The difference between A and B, A and C, and A and D was statistically significant (P < .01). Although severe congestion was encountered in liver specimens of group A, only mild congestion was encountered in groups B and C (P= .0001). The matched durations of irrigations and total volume of irrigation solutions were found to be not related with the difference in histopathologic findings. CONCLUSIONS WBI has induced varying degrees of histopathologic alterations from mild to severe in the rat gastrointestinal tract. Lactated Ringer's solution and PEG solution have induced the least alterations. Therefore, WBI with Lactated Ringer's solution and PEG solution seem to be safe alternatives of mechanical bowel preparation before elective large bowel surgery. Because saline solution has caused detrimental alterations in distal gastrointestinal tract histology, WBI with saline solution seems to be unadvisable.
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Affiliation(s)
- M Bingöl-Koloğlu
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Oğuzkurt P, Akçören Z, Kale G, Tanyel FC. Polyarteritis nodosa involving the hepatobiliary system in an eight-year-old girl with a previous diagnosis of familial Mediterranean fever. Eur J Pediatr Surg 2000; 10:145-7. [PMID: 10877088 DOI: 10.1055/s-2008-1072346] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Polyarteritis nodosa (PAN) is a vasculitis of small- and medium-sized muscular arteries with deposition of immune complex in the vessel wall. Although gastrointestinal involvement is common, the symptomatic involvement of the hepatobiliary system is rare. An eight-year old female patient with a previous diagnosis of familial Mediterranean fever (FMF) was hospitalized for right upper quadrant pain and fever. The thickened gall bladder wall by ultrasonography, called for exploration. Histopathological evaluations of the liver biopsy and gall bladder revealed PAN. Corticosteroid therapy was initiated and the patient recovered fully. This case represents one of the rarest forms of PAN in childhood.
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Affiliation(s)
- P Oğuzkurt
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Talim B, Kale G, Topaloglu H, Akçören Z, Caglar M, Gögüş S, Elkay M. Clinical and histopathological study of merosin-deficient and merosin-positive congenital muscular dystrophy. Pediatr Dev Pathol 2000; 3:168-76. [PMID: 10679036 DOI: 10.1007/s100240050021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The clinical features of merosin-positive congenital muscular dystrophy (CMD) and merosin-deficient CMD are well known, with those of merosin-deficient CMD being more severe. Whether the severity of histopathological findings correlates with these clinical features remains unanswered. In this study, the clinical and histopathological findings of 39 merosin-deficient and 37 merosin-positive CMD patients were compared. Merosin-deficient CMD patients were found to be younger, with earlier onset of symptoms, age of diagnosis, and a more severe clinical state (reflecting maximum motor capacity and contractures). On histopathological evaluation, endomysial fibrosis, perimysial fibrosis, and histopathological state (reflecting fibrosis, adiposis, necrosis, and variation in fiber size) were more severe in merosin-deficient CMD. There was a correlation between clinical and histopathological states only in merosin-deficient CMD.
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Affiliation(s)
- B Talim
- Department of Pediatric Pathology, Hacettepe Children's Hospital, 06100 Ankara, Turkey
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35
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Karnak I, Senocak ME, Kale G, Akçören Z, Büyükpamukçu N, Hiçsönmez A. A previously unmentioned surgical observation in the treatment of intussusception. Surg Today 1999; 29:979-82. [PMID: 10554318 DOI: 10.1007/s005950050632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Intussusception is one of the most common causes of bowel obstruction in infancy which may require surgical treatment. We have recently recognized a pathologically weakened linear area located on the wall of the reduced colon at operation. Thus, a retrospective study was conducted to evaluate the operative and pathological findings of the resected bowel segments for the treatment of intussusception. A pathologically weakened longitudinal linear area was encountered in five patients. This line was strikingly antimesenteric and under the taenia libera. The bowel wall was very thin and effaced on palpation along this whitish line and showed mucosal necrosis, disruption of the muscularis mucosa, and loss of some of the muscular tissue on microscopic examination. The line may result from compression of the inner layers of the bowel wall between the intussusceptum and the noncompliant taenia. Location on the antimesenteric border and under the taenia libera can be explained by local vascular compromise due to the distribution of the terminal arteries of the colon. Thus, the antimesenteric border as well as the mesenteric side should be checked carefully for a longitudinal weakened pressure line. The recognition of such a potentially dangerous weak line on the bowel wall indicates resection.
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Affiliation(s)
- I Karnak
- Departments of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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36
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Balci S, Güler G, Kale G, Söylemezoğlu F, Besim A. Mohr syndrome in two sisters: prenatal diagnosis in a 22-week-old fetus with post-mortem findings in both. Prenat Diagn 1999; 19:827-31. [PMID: 10521839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Oral-facial digital syndrome type II (OFP syndrome II; orofaciodigital syndrome II) is a rare autosomal recessive syndrome, first described by Mohr (1941). We present two sisters with Mohr syndrome from a consanguineous family. One is a three-day-old female patient, the other is 22-week-old fetus. Polydactyly with bifid thumbs in both hands, bilateral polysyndactyly of halluces, lateral polysyndactyly and bilateral pes equinovarus were demonstrated in the fetus sonographically. Corpus callosum agenesis, congenital heart disease, bilateral bifid thumbs and halluces and polydactyly were seen in both patients. In addition, post-mortem findings showed absence of olfactory nerve, single atrium. VSD, abnormal lung lobulation and natal teeth in the fetus. Absence of olfactory nerve and natal teeth have not been reported previously in Mohr syndrome.
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Affiliation(s)
- S Balci
- Department of Clinical Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Seyrantepe V, Kale G, Topaloglu H, Alikasifoglu A, Ozgüc M. Common deletion of mitochondrial DNA in a 5-year-old girl with failure to thrive, ptosis, ophthalmoplegia and ragged-red fibers. Brain Dev 1999; 21:413-5. [PMID: 10487476 DOI: 10.1016/s0387-7604(99)00035-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A girl aged 4 years and 10 months presented with failure to thrive, ptosis, ragged-red fibers and the common 4.9 kb mitochondrial DNA deletion. She had elevated serum lactic and pyruvic acids. The onset was at around 18 months. There were no signs of retinitis, and abnormal renal, liver or pancreatic functions. She later developed mild ophthalmoplegia at 6 years of age. Additional features of chronic progressive external ophthalmoplegia (CPEO) or Kearns-Sayre syndrome (KSS) are the conditions that should be watched and investigated in the long-term follow-up of this girl.
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Affiliation(s)
- V Seyrantepe
- Department of Medical Biology, Hacettepe University, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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Abstract
BACKGROUND/PURPOSE Entamoeba hystolytica (EH) is an enteric protozoan that may cause serious complications that require operative management in children. A retrospective clinical trial was performed to find out the incidence and outcome of complicated intestinal amebiasis (IA) by means of surgically resected specimens in children. METHODS The histopathologic evaluation of 554 intestinal specimens (including appendix and polyp) of 482 patients between 1980 and 1997, inclusive, were reviewed. Intestinal biopsy specimens taken from successfully medically treated patients with uncomplicated IA were excluded. RESULTS Complicated IA was noted in 18 children (3.7%) consisting of 7 girls and 11 boys with a mean age of 9.2+/-2.3 years. EH was present in the (1) appendices of 4 patients with perforated appendicitis and 3 patients with normal appendix who underwent negative exploration; (2) juvenile polyps of 4 patients presenting with hematochesia; (3) colonic wall of 1 patient presenting with intussusception and treated by resection and anastomosis; (4) cecum of 1 patient presenting with right lower quadrant mass and underwent exploration with the presumptive diagnosis of lymphoma; (5) colonic wall of 5 patients who underwent ileostomy followed by subtotal colectomy and endorectal pull-through with the presumptive diagnosis of chronic inflammatory bowel disease (n = 3), toxic megacolon + peritonitis (n = 1), and total colonic polyposis (n = 1). All above-mentioned patients are alive and free of symptoms. CONCLUSIONS The diagnosis of IA should be considered in a very wide spectrum of clinical appearances. IA may be associated with colonic polyps and perforated appendicitis, may act as a leading point for intussusception, and may mimic the clinical picture of appendicitis and lymphoma resulting in negative explorations. The diagnosis and treatment of complicated IA in patients who received a misdiagnosis of inflammatory bowel disease is a great challenge and requires major and emergency surgery.
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Affiliation(s)
- A O Ciftci
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey
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39
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Abstract
Pulmonary blastoma (PB) is an extremely uncommon intrathoracic neoplasm in children. It accounts for 0.5% of all primary malignant tumors of the lung, and 20%-25% of the cases present in childhood. A new case of PB in a 3-year-old girl is discussed with special emphasis on diagnosis and treatment. The authors point out that the possibility of a primary lung tumor should be considered for any childhood cases with intractable signs and symptoms of a space-occupying lesion. A primary lung malignancy should not be excluded only on the basis of the patient's age, and childhood lung disorders should receive the same detailed and vigorous diagnostic evaluation and appropriate treatment given to adults.
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Affiliation(s)
- I Karnak
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, 06100 Ankara, Turkey
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40
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Abstract
The authors report a pulmonary lymphomatoid granulomatosis (LG) in a 4-year-old girl. The clinicopathologic and radiological features of this rare entity are discussed with special emphasis on differential diagnosis, including a brief literature review. LG is an aggressive multiorgan disease that primarily affects the adult lung. There are no specific presumptive clinical and laboratory findings, including tumor markers and imaging techniques, that distinguish LG from other pulmonary nodular lesions. The most important diagnostic aid is to bear this entity in mind when a child presents with pulmonary nodule associated with intractable long-lasting symptoms. Open lung biopsy and total excision is mandatory for the appropriate diagnosis and treatment.
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Affiliation(s)
- I Karnak
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey
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41
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Topaloglu R, Denamur E, Akyüz C, Kale G, Bakkaloglu A. Wilms' tumour-associated late nephrotic syndrome responsive to treatment. Nephrol Dial Transplant 1999; 14:954-6. [PMID: 10328478 DOI: 10.1093/ndt/14.4.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Topaloglu
- Department of Pediatric Nephrology and Rheumatology, Hacettepe University Children's Hospital, Ankara, Turkey
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42
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Olcay L, Besim A, Senocak ME, Göçmen A, Büyükpamukçu M, Kale G, Cetin M, Gürgey A. Hydatid cyst mimicking pulmonary hematoma in a patient with hemophilia A. Turk J Pediatr 1998; 40:425-9. [PMID: 9763908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We present a patient of 2.5 years of age with hemophilia A and a pulmonary hydatid cyst. A chest x-ray taken by chance showed a paracardiac opacity resembling an intrapulmonary hematoma which did not reduce in size after infusions of fresh frozen plasma and factor VIII but rather enlarged. Transabdominal ultrasound, colored echocardiography, thoracic computed tomography and magnetic resonance imaging findings were consistent with a cyst that was firmly attached on the border of the right atrium and also indented it; the wall was remarkably thick with no internal echoes. Hydatid cyst was diagnosed after thoracotomy.
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Affiliation(s)
- L Olcay
- Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara
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Topaloğlu H, Talim B, Vignier N, Helbling-Leclerc AH, Yetük M, Afşin IE, Cağlar M, Kale G, Guicheney P. Merosin-deficient congenital muscular dystrophy with severe mental retardation and normal cranial MRI: a report of two siblings. Neuromuscul Disord 1998; 8:169-74. [PMID: 9631397 DOI: 10.1016/s0960-8966(98)00013-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The evidence of severe structural brain abnormalities in association with severe mental retardation is characteristic in congenital muscular dystrophy (CMD) forms other than the 'classical' form. However, it seems that the nosology of CMD is not complete yet, as we have clinical, immunohistochemical and genetic data suggesting that there are other unclassified forms. Here we report two CMD siblings from a consanguineous family with partial merosin-deficiency in muscle biopsies, severe mental retardation and normal MRI of the brain. The disease was not linked to the LAMA2 gene (6q22-23) or to Fukuyama congenital muscular dystrophy (FCMD) (9q31-33). To our knowledge, such an association may constitute a new entity within the broad clinical spectrum of CMD.
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Affiliation(s)
- H Topaloğlu
- Department of Child Neurology Hacettepe University Children's Hosptial, Ankara, Turkey. htopalogggenetic.gen.hun.edu.tr
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Affiliation(s)
- I Peksoy
- Department of Nuclear Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
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Topaloglu H, Talim B, Vignier N, Helbling-Leclerc A, Yetuk M, Akçören M, Çaglar M, Kale G, Guicheney P. Merosin-deficient congenital muscular dystrophy with severe mental retardation and normal cranial MRI. Neuromuscul Disord 1997. [DOI: 10.1016/s0960-8966(97)87171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Ozçelik U, Ozkara HA, Göçmen A, Akçören Z, Kocagöz T, Kiper N, Göğüs S, Cağlar M, Kale G, Kotiloğlu E. Detection of Mycobacterium tuberculosis DNA in tissue samples of children with sarcoidosis. Pediatr Pulmonol 1997; 24:122-4. [PMID: 9292905 DOI: 10.1002/(sici)1099-0496(199708)24:2<122::aid-ppul9>3.0.co;2-q] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
Pyogenic granuloma is a common vascular lesion in childhood. The occurrence of pyogenic granulomas after various kinds of trauma to the skin is quite common; however, multiple lesions secondary to a burn are very rare. For this reason, an 18-month-old girl with multiple pyogenic granulomas following a second-degree burn is reported.
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Affiliation(s)
- M Ceyhan
- Pediatric Infectious Diseases Section, Hacettepe University School of Medicine, Ankara, Turkey
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48
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Abstract
Adenocarcinoma of ampulla of Vater causing obstructive jaundice in an 11-year-old boy is reported. He first underwent pylorus-preserving duodenectomy, which later necessitated classical Whipple operation because of the microscopical evidence of the disease beyond surgical margins. This child is the youngest case of adenocarcinoma of ampulla of Vater in the English-language literature.
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Affiliation(s)
- F Andiran
- Department of Pediatric Surgery, Hacettepe University, Children's Hospital, Ankara, Turkey
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49
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Abstract
Cross syndrome is a rare syndrome characterized by ocular and cutaneous hypopigmentation and neurological manifestations. A few reports have been published since 1967. In this report, we present a new case of Cross syndrome with additional findings such as urinary tract abnormality, bilateral inguinal hernia, focal interventricular septal hypertrophy of the heart and vacuolization of myeloid series cells and distinct ultrastructural features of the skin.
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Affiliation(s)
- I Tezcan
- Hacettepe University, Department of Pediatrics, Ankara, Turkey
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Abstract
BACKGROUND Reports concerning nonsyndromic paucity of the interlobular bile ducts are not common. METHODS The clinical, biochemical, and histological features of ten such children were described. RESULTS All presented with jaundice, starting in the first month in seven and in the fourth, seventeenth, and thirtieth month in the others. Alcoholic stools were present intermittently in seven and persistently in three patients. Pruritus was a prominent symptom in five. Liver function tests were abnormal in all but one. Liver biopsies were performed at ages of 20 days to 3 years (median 5 months). In addition to a paucity of interlobular bile ducts, histology revealed intracellular cholestasis in all, portal fibrosis in four, and regenerative nodules in two patients. Complications of fat-soluble vitamin deficiency occurred in seven. Therapy consisted of supplementation of those vitamins and administration of cholestyramine, phenobarbital, prednisolone, or ursodeoxycholic acid. While one child had a successful orthotopic liver transplantation, three died. Consanguinity rate was 80% among the parents, and five of the patients had siblings with similar symptoms. CONCLUSIONS Prognosis of these patients is variable. Differentiation from other forms of cholestasis is important especially to avoid surgery.
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Affiliation(s)
- N Koçak
- Pediatric Gastroenterology Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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