Splenic rupture presenting with marked scrotal ecchymosis in a 2-day-old newborn

Splenic rupture is a rare and severe condition in neonates. The signs and symptoms are vague and non-specific and are often not recognised before the onset of hypovolaemic shock or death. A 2-day-old infant presented with scrotal ecchymosis, and ultrasonography detected haemorrhage in the scrotal, right inguinal and adrenal regions. Computed tomography demonstrated a peri-splenic haematoma. Haemoglobin (Hb) was 2.79 g/dL and, despite repeated transfusions, the Hb level could not be sustained. Exploratory laparotomy detected a large haematoma in the splenic region, and, because of the uncontrolled haemorrhage, splenectomy was required.

ATPase inhibition by omeprazole reveals role of heat shock proteins on testicular torsion

Testicular torsion leads ischaemic injury and generates reactive oxygen species. Reactive oxygen species triggers lipid peroxidation, protein degradation and DNA damage. These biochemical processes trigger tissue damage. Heat shock proteins (HSPs) are important in spermatogenesis, and this work elucidates role of HSPs at the testicular torsion-detorsion process. A proton-pump inhibitor, omeprazole, tested to reveal the drug's curative effect since HSP functions through ATP hydrolysis. Thirty-two male Wistar Albino rats were divided into four groups: sham, control, omeprazole and serum physiologic groups. Right testis was torsed, while left ones remained untorsed. Protein peroxidation, DNA damage and lipid hydroperoxide levels as well as HSP expression were measured. Further, the effects were visualised with histopathologic imaging. HSP expression increases at the torsed right testis compared to the contralateral testis. Although HSP70 and HSP90 help antioxidant enzymes to keep their native structure, their anti-apoptotic properties accelerate the tissue damage. Omeprazole a proton-pump inhibitor employed to impair electron transfer chain and to inhibit HSP ATPase function. Omeprazole effectively inhibits HSPs and alleviates lipid peroxidation and DNA damage levels both at molecular and at tissue level, and the drug has profound curative effect on testicular torsion recovery.

Can Fetuin-A, CRP, and WBC Levels Be Predictive Values in the Diagnosis of Acute Appendicitis in Children with Abdominal Pain?

Background: Acute appendicitis (AA) is the most common cause of emergency surgery. Therefore, perforation is common. Early diagnosis and new markers are needed. The aim of this study was to investigate the effects of plasma Fetuin-A (FA) levels in patients with an acute abdomen (AB). Material and Method: This prospective study included 107 patients younger than 16 years of age who were admitted to the emergency department for abdominal pain between January and December 2018. The patients who presented abdominal pain were divided into two groups as AA and other causes (OC) of AB. Patients with acute appendicitis; intraperitoneal, retrocolic/retrocecal, and appendicitis were divided into three groups. Additionally, the AA group was divided into two groups as perforated appendicitis and non-perforated appendicitis. Serum FA levels of the patients were evaluated in the emergency department. Results: In the AA group, C-reactive protein (CRP) and white blood cell (WBC) levels were higher, and FA levels were significantly lower than in the AB group. Intraperitoneal localization was 95.2% and perforation was frequent. When significant values in the univariate regression analysis for acute abdomen and perforation were compared in the multivariate regression analysis, CRP, WBC, and FA levels were found to be prognostic. Furthermore, decreased FA levels were associated with AA, while too greatly decreased FA levels were associated with the risk of perforation. Conclusion: Current diagnosis can be made by history, physical examination, laboratory, and imaging methods in appendicitis cases. While trying to diagnose AA in children, the FA, CRP, and WBC levels may be predictive values to identify risk factors.

A Fifteen-Year Analysis of Rare Isolated Fallopian Tube Torsions in Adolescent Children: A Case Series

Isolated tubal torsions presenting to the emergency department are a very rare cause of pediatric acute abdominal pain. Since making the diagnosis early is of importance in terms of affecting tubal damage and fertility, we aimed to evaluate cases of isolated tubal torsions in light of the literature. This study included 10 patients under 18 years of age who presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5 ± 1.43 years (range: 12-17 years). The demographic characteristics, surgical findings and techniques, and concomitant pathology results of these patients were retrospectively evaluated. The reason for presenting to the emergency department for the 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 h in seven patients (70%) and more than 24 h in three patients (30%). Of the patients, nine (90%) had tenderness in the lower abdominal quadrant, five (5%) had defense, and three (30%) had rebound. Nausea, vomiting and leukocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Eight patients (80%) underwent open surgery and two (20%) underwent laparoscopic intervention. Detorsion was performed on five (50%) patients and salpingectomy was performed on five (50%) patients. Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the preservation of fertility.

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome in Which a Different De Novo Actg2 Gene Mutation was Detected: A Case Report

INTRODUCTION

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is characterized by bladder distension without urinary tract obstruction, decreased or absent intestinal peristalsis and microcolon. Although the definitive cause remains unknown, changes in the ACTG2 gene are thought to be responsible for the intestinal and bladder hypoperistalsis.

CASE REPORT

This female newborn with MMIHS had a c.532C>A /p.Arg178Ser heterozygous de novo mutation detected in the ACTG2 gene. Normal immature ganglion cells, normal calretinin punctate positivity, maintence of smooth muscle actin immunoreactivity, and decreased numbers of interstitial cells of Cajal(ICCs) were detected.

CONCLUSION

This previously unreported c.532C>A /p.Arg178Ser heterozygous de novo mutation in the ACTG2 gene may lead to a severe form of MMIHS.

[Our childhood cases with intussusception and pneumatic reduction]

BACKGROUND

Intussusception is defined as telescopic insertion of the terminal ileum in to the colon after the cecum and colon. The aim of this study was to present our experience in pneumatic reduction of intussusception.

METHODS

In our study, 118 intussusception cases treated between 1996 and 2008 were analyzed. Age, gender, admission time, diagnostic/treatment methods, types of intussusception including leading point, and postoperative complications were evaluated.

RESULTS

Of these patients, 76 (64%) were male and 42 (36%) were female. Mean age was 25 +/- 34 months (3-180 months). The most common clinical presentations were vomiting, abdominal pain/irritable crying and bloody stools. Intussusceptions were ileocolic in 109 (92.3%) patients, ileoileal in 7 (6%) patients, and colocolic in 2 (1.7%) patients. No mortality was noted. Fifty-three patients (45%) were treated by nonoperative reduction whereas the remainder were treated surgically. Among 65 patients operated, 13 leading points were detected. Pneumatic reduction success rate was 86%. Age significantly reduced the pneumatic reduction success rate; however, the duration between the beginning of symptoms and hospital admission and bloody stool were not effective.

CONCLUSION

Intussusception can be treated by non-operative methods when diagnosed early. Our results suggest that pneumatic reduction of intussusception in the pediatric population should be considered as a first choice.

[An interesting journey of a grass inflorescence from broncho to dorsum: case report]

A 15-years-old male was presented with hyperemic and painful right flank mass. His medical history was consisted of a treatment for pneumonia and hemoptysis in the other hospital five months ago. Diagnostic X-rays was showed consolidation in the posterobasal segment of right pulmonary lobe and abscess in the paravertebral muscle extending from L4-5 level. The patient was discharged after antibiotic treatment. At the second hospitalization, a grass inflorescence was discharged from the fistula. When the patient was reevaluated his history was consisted of the aspiration of a grass inflorescence eight months ago. To our knowledge, this patient represents the first case of penetration by a grass inflorescence migrated out of the lumbar region.

[A case of endobronchial aspergilloma]

Infections caused by Aspergillus spp. in immunocompromised or atopic patients may present as invasive aspergillosis, allergic bronchopulmonary aspergillosis and aspergilloma. In this report a 69 years old female patient admitted to the hospital with the complaints of intermittent cough and sputum and diagnosed as endonbronchial aspergilloma, has been presented. The patient was not immunocompromised, however she has bronchial asthma for 10 years and the disease is now under control. The chest radiography and computed tomography revealed lung infiltration with undefined borders, and bronchoscopy demonstrated the presence of a mass at left lower lobe. In the pathologic examination of biopsy specimen with the use of methenamine silver and PAS methods, hyphae formations concordant with Aspergillus were detected. The direct microscopic examinations of biopsy material and sputum obtained after bronchoscopy, have also revealed the presence of hyphae. A. fumigatus was isolated from the cultures of biopsy material and sputum specimen. The patient was diagnosed as endonbronchial aspergilloma, however the follow-up was failed since she has not accepted medical or surgical treatment. In conclusion, aspergilloma should be considered in the differential diagnosis of mass lesions in the endobronchial area.

[Antibacterial and cytotoxic effects of N-butyl-2-cyanoacrylate used as a tissue adhesive]

In this study, the antibacterial and cytotoxic effects of a synthetic tissue adhesive called n-butyl-2-cyanoacrylate (Histoacryl) which provide rapid healing in incision in oral surgical procedures were investigated. The antibacterial effects of Histoacryl were tested by using standard reference strains of Streptococcus pyogenes, Streptococcus mitis, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus grown in Mueller-Hinton media (sheep blood supplemented Mueller-Hinton for streptococcus strains) by diffusion technique. The cytotoxic effects were also researched on continuous Vero and primary gingival fibroblast cell cultures by using agar overlay method. In these methods, the inhibition zones produced by Histoacryl were evaluated. As a result, Histoacryl was found to have antibacterial effect on the tested bacteria and produce cytotoxic and cytopathic effects on the tested cell cultures.

[Diagnostic value of ELISA for determining the occurrence of antibodies to antigen A60 in active pulmonary tuberculosis]

IgG antibodies against the purified antigen 60 have been detected in the sera of 48 active, 12 inactive pulmonary tuberculosis patients and 46 tuberculosis free controls with ELISA. Diagnostic value of this test has been evaluated in the conditions of our country. The detection of IgG antibodies against antigen 60 has 67% sensitivity, 90% specificity and 81% positive predictive values. It has been decided that these values have no superiority compared to the sputum examination. It was also found out that sensitivity of antigen 60 ELISA IgG test is very low (22%) in the condition of primary pulmonary tuberculosis cases where direct sputum microscopy sensitivity is also very low.

[The cytotoxic effects of composite resin adhesive agents on gingival cell culture using the agar coating method]

Because the luting agent interfaces of restorations can approximate the periodontium, it is critical to determine the biocompatibility of luting agents. In this study, the cytotoxic potential of resin luting agents on cultures of gingival fibroblasts was evaluated for direct microscopic cytotoxicity. For light cured composite resin luting agents, the exposure time was found to be significant. To compare the chemically and light cured resins, fully cured microfill resin's cytotoxicity was equal to the chemically cured resin's cytotoxicity. The least cytotoxic effect was occurred with hybrid type composite resin while the profound effect with unpolymerized microfill resin.