Aytekin Kaymakçi

Laparoscopic-assisted pneumatic reduction of intussusception

The nonoperative treatment of intussusception is done by fluoroscopy, however, false-positive and negative images may lead to unnecessary operations. The aim of this study was to evaluate the feasibility of laparoscopy in pneumatic reduction. Surgical ileoileocolic intussusception was performed in 27 dogs. Sixteen dogs were observed for 3 days (group A), and 11 were observed for 5 days (group B). Laparoscopy was performed in the intussuscepted dogs during pneumatic reduction. Under general anesthesia, a 10-mm trocar was inserted supraumblically in the midline, and the laparoscope was introduced. The intussuscepted bowel was observed on the video monitor. A 5-mm trocar was inserted in the right upper quadrant. The mesentery of the terminal ileum was manipulated using grasping forceps to assist reduction. CO2 was insufflated into the rectum using a Foley catheter, and the reduction was observed on the video monitor. The success rate was 94% (mean reduction time, 2.5 minutes +/- 1.0) for group A and 100% (mean reduction time, 3.7 minutes +/- 0.8) for group B. Bowel perforation was observed in one dog, and recurrence of intussusception in another. The authors claim that observing the bowel on the video monitor may help in the differential diagnosis and reduction of difficult cases such as ileoileocolic and delayed intussusceptions. Therefore, unnecessary open surgery may be prevented.

Conn syndrome in a child, caused by adrenal adenoma

Hyperaldosteronism owing to aldosterone-producing adenoma (Conn syndrome) is a rare but potentially curable form of pediatric hypertension. The authors report on a 5-year-old girl who had symptoms of polyuria, polydipsia, and fatigue, and for whom the diagnosis of hyperaldosteronemia was suggested by a low serum potassium level and persistent hypertension. The diagnosis was confirmed by increased levels of plasma aldosterone and decreased levels of plasma renin. The tumor was localized with ultrasonography and computed tomography, which showed a 2-cm mass in the left adrenal gland. The left adrenal gland was excised, and pathological assessment showed an adenoma. Only 14 other pediatric cases (< 16 years of age) have been reported in the English-language literature.

Inguinal hernias containing the uterus: a case series of 7 female children.

BACKGROUND Hernia uteri inguinale (HUI), or uterus-containing inguinal hernia, is an extremely rare condition in which the uterus and uterine adnexa are found in the inguinal hernial sac in female infants. The uterus may be free within the sac adherent to the wall by adhesions or a true sliding component. However, in true sliding-type HUI, one of the walls of the hernia sac is formed by the uterus itself. PATIENTS AND METHODS The medical records for all female children with inguinal hernia who were operated from 1999 through 2010 were reviewed retrospectively (n = 3100). RESULTS Among these patients, we identified seven cases of HUI in infants with a normal female karyotype. The incidence of HUI was 0.23%. Patients were discharged on the postoperative 1st day with no complications. CONCLUSIONS Surgeons should be aware of the possibility of presence of the uterus or another organ in the hernial sac in phenotypic female children, and sliding components should be replaced carefully into the abdomen to prevent any damage.

Evaluation of patients with acute abdominal pain admitted to the pediatric emergency department

Metabolic syndrome (MetS) increases the frequency of cardivovascular events by causing atherosclerosis and impairment at left ventricle structure and function. Diastolic dysfunction (DD) is an early finding of subclinical cardiac injury. Left atrial volume may be used as an indicator for demonstrating severity and duration of DD. With this study, we investigated the relationship between subclinical atherosclerosis ,evaluated by carotid intima-media thickness (CIMT) measurement and subclinical cardiac injury evaluated by diastolic functions and left atrial volume index (LAVI) in MetS patients. 82 patients with MetS were enrolled to the study. Patients were divided into 2 groups according to CIMT measurement: 35 patients with CIMT≥1.0 mm were at group 1 and 47 patients with CIMTBu calismada, karin agrisi sikâyeti ile hastaneye basvuran hastalarin karin agrisi nedenlerini, eslik eden semptomlari, etken patojenlerin belirlenmesi ve gerekli tedavi yaklasimlarinin tartisilmasi planlandi. Cocuk acil poliklinigine karin agrisi sikâyeti ile basvuran, yaslari 2 ile 16 yil arasinda olan 626 hasta retrospektif olarak incelendi. En sik karin agrisi nedeni olarak, %40,8 oraninda akut gastroenterit saptandi. Bunu, uriner sistem enfeksiyonu %15, kabizlik %9,3, ust solunum yolu enfeksiyonu % 3,6 ve parazitozlar %3,6 orani ile izledi. Acil cerrahi tedavi gerektiren akut karin agrisi nedenleri %6,2 oraninda bulundu. Karin agrisi yaninda 512 hastada (%81,8) ek semptom bulunmaktaydi. Karin agrisina en sik eslik eden semptomlar, ishal %38, istahsizlik %29, kusma % 24, bulanti %16, ates %16 olarak bulundu. Hastalarin, klinigimize basvuru sirasinda alinan anamnezlerinde, karin agrisinin %55 hastada 0-24 saat, %22 hastada 24-72 saat, %11 hastada 72 saat-1ay, %7 hastada 1-6 ay ve %5 hastada 6 aydan fazla surdugu saptandi. Karin agrisi sikâyeti, cok genis bir hastalik grubunun semptomu olarak ortaya cikabilir. Karin agrisi sikâyeti ile basvuran hastalarin ayrintili anamnezlerinin alinmasi ve dikkatli bir sekilde fizik muayenelerinin yapilmasi, hastalarin buyuk bir kisminda taniyi koymada ve tedaviyi belirlemede yeterli olmaktadir.