Bülent Akçora

A different type of congenital lumbar hernia associated with the lumbocostovertebral syndrome.

Congenital lumbar hernia is rare in infancy and childhood, and its association with the lumbocostovertebral syndrome is even more unusual. Only 20 cases have been reported in the English literature. We present the case of a child with multiple costovertebral anomalies, undescended testis, and lateral abdominal wall hernia that is not within the anatomical boundaries of traditional lumbar hernias.

Gradual detorsion of torsioned rat testis attenuates ischemia reperfusion injury

AIM This study was designed to investigate effect of gradual detorsion on testicular ischemia reperfusion injury. MATERIALS AND METHODS A total of 21 male rats were divided into 3 groups, each containing 7 rats. Torsion was created by rotating the left testis 720 degrees in a clockwise direction. Group 1 underwent sham operation. Group 2 (sudden detorsion) served as a torsion/detorsion group, receiving 2 hours torsion and 2 hours detorsion. In group 3, 360 degrees detorsion was done for 20 minutes after 720 degrees torsion for 2 hours. Then, testis was done full detorsion for 100 minutes. At the end of the experiments (fourth hour), left orchiectomy was performed to measure the tissue levels of malondialdehyde (MDA), superoxide dismutase, and glutathione peroxidase and to perform histologic examination in testes. RESULTS The MDA levels of testis tissues were significantly increased in the sudden detorsion group as compared with the sham group. We found decrease of the MDA level in gradual detorsion group, but it was not a statistically significant amount. Significant decrease was found in the superoxide dismutase and glutathione peroxidase activities in the sudden detorsion group as compared with the sham and gradual detorsion groups. Histologic examinations were in accordance with the testicular tissue MDA levels. CONCLUSION In the light of our biochemical and histopathologic findings, we can say that gradual detorsion has a trend to decrease the degree of testicular reperfusion injury in the rat torsion/detorsion model.

The protective effect of darbepoetin alfa on experimental testicular torsion and detorsion injury

Aim:  Testicular torsion is a serious urological emergency, usually involving newborns, children, and adolescents which can lead to subfertility and infertility. Prevention of testicular damage caused by torsion is still a clinical and experimental problem. So far many chemicals and drugs have been investigated for decreasing ischemia/reperfusion (I/R) injury in experimental animals. The possible protective effect of darbepoetin alfa, a novel erythropoietic protein, on testicular tissue after I/R injury was examined in this study.

The Neuroprotective and Anti-inflammatory Effects of Diltiazem in Spinal Cord Ischaemia–Reperfusion Injury

The protective effects of diltiazem were examined in a rabbit model of spinal cord ischaemia–reperfusion induced by infrarenal aortic occlusion for 30 min. In the diltiazem group (n = 6), an intravenous infusion (2 μg/kg per min) was started 10 min before ischaemia induction; normal saline solution was infused in the control group (n = 6). Neurological function was assessed using modified Tarlov criteria 24 h after surgery. Plasma samples were analysed for interleukin (IL)-6 and IL-10. Spinal tissue was analysed for malondialdehyde, nitric oxide and reduced glutathione activities. Tarlov scores of the diltiazem-treated rabbits indicated significantly improved hind-limb motor function compared with the control group. The diltiazem group also had better quantitative and qualitative histopathological findings. Diltiazem infusion significantly reduced IL-6 levels 3 and 24 h after reperfusion compared with the control group. The mean IL-10 level in the diltiazem group was significantly higher than in the control group 24 h after reperfusion. It is concluded that diltiazem has cytoprotective and anti-inflammatory properties, leading to reduced spinal cord injury.

A rare and frequently unrecognised pathology in children: femoral hernia

A femoral hernia is the protrusion of the abdominal contents through the femoral canal. It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%. We believe that misdiagnosis and mistreatment usually occur due to insufficient physical examination, knowledge and experience about childhood femoral hernias. Here, we report and discuss the clinical appearance and treatment approach of three patients operated with the diagnosis of femoral hernias.

Duodenal perforation: an unusual complication of sickle cell anemia

Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presented with abdominal and back pain. The patient was operated on for acute abdomen and diagnosed with duodenal perforation. Helicobacter pylorus was negative. There was no risk factor to account for duodenal perforation other than sickle cell anemia. Surgical intervention was successful and without significant sequelae. Duodenal perforation is a rare entity described in patients with sickle cell anemia. To our knowledge, this is the first report of duodenal perforation in a patient sickle cell anemia.

A newborn with duodenal atresia and a gastric perforation

Congenital duodenal atresia complicated by gastric perforation (GP) is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

Life‐threatening retroperitoneal hemorrhage due to late vitamin K deficiency

The incidence of retroperitoneal and intraperitoneal hemorrhage is increased in preterm infants and in prolonged or complicated deliveries, especially with associated perinatal asphyxia or stress. The spectrum of presentation is considerable, ranging from asymptomatic to severe life-threatening intra-abdominal hemorrhage. Similarly, clinical examination may vary considerably and may be normal or demonstrate an abdominal mass with a significant hemorrhage. However, retroperitoneal hemorrhage associated with vitamin K deficiency is extremely rare and we have not come across such a case in our search of the medical literature. We report the first case of an infant diagnosed as having gross retroperitoneal and minimal intraperitoneal hemorrhage due to late vitamin K deficiency.

Bronchoscopy for foreign body aspiration and effects of nebulized albuterol and budesonide combination

Objective: A foreign body aspiration in the tracheobronchial tree is a dangerous medical condition in the childhood period. Although rigid bronchoscopy is a safe procedure, it may cause complications. The aim of this study was to present our bronchoscopy experience and to evaluate the efficacy of pre-operative administration of nebulized albuterol and budesonide combination for reducing intra-operative complications in foreign body aspirated cases. Methods: In this retrospective study our pediatric cases in which a foreign body was removed from tracheobronchial tree in last 8 years were analyzed. After excluding the patients who needed emergent and negative bronchoscopies, the remaining clinically stable 84 patients were compared for the effects of preoperative administration of nebulized albuterol and budesonide combination on bronchoscopy complications. Results: There were 51 boys (60.3%) and 33 girls (39.7%). There were 38 children in the non-nebulized group and 46 children in the nebulized group. We found that the combined albuterol and budesonide nebulization decrease complications such as arterial oxygen desaturation (p<0.05), and bronchospasm (p<0.05) during the bronchoscopic intervention. Conclusion: Preoperative nebulization of albuterol and budesonide combination may decrease perioperative complications of bronchoscopy.

Yenidoğan Döneminde Nadir bir İntra-abdominal Kistik Kitle: Over Otoampütasyonu

Bir adneksin torsiyone olmasi enfarktus, nekroz ve sonrasinda overin kopmasina neden olabilir. Ampute olan over kalsifikasyona ugrayarak karin boslugunda serbestce yuzen bir kitle haline domusebilir. Antenatal ultrasonografi ve postnatal bilgisayarli tomografi bulgulari ile 4 gunluk kiz bebekte saptanan over amputasyonu sunulmustur. Degisken lokalizasyonlari olan mobil intraabdominal kistik kitlelerin ayirici tanisinda mutlaka amputasyona ugramis over de akilda tutulmalidir.