Erol Mir

The Management of Appendiceal Mass in Children: Is Interval Appendectomy Necessary?

Abstract In this study we aimed to show that performing interval appendectomy is unnecessary in the management of appendiceal mass in children. Between 1990 and 1996, 866 patients were treated for appendicitis. Abdominal ultrasonography (USG) was performed in patients who were admitted with abdominal pain, vomiting, and fever accompanying a mass in the right lower quadrant. Seventeen patients (12 boys and 5 girls, with a mean age of 9.5 years) with a mass in the appendiceal lodge and no abscess formation were treated conservatively. Appendectomy was performed on any patients with perforated or unperforated appendicitis who had an appendiceal abscess with a mass in the right iliac fossa. Three-agent antibiotic therapy was administered for at least 1 week. These patients were discharged after a mean hospital time of 9.7 days if regression of the mass was seen ultrasonographically. They were followed up for 1–60 months by physical examination and USG, and 11 of the 17 also underwent barium enema. USG demonstrated disappearance of the mass and barium enema showed a normal appendix in 10 of the 11 patients. No recurrent appendicitis was detected during follow-up for 1–7 years. This study shows that appendiceal masses that are perforated, but localized with no fluid content revealed by USG, can be treated conservatively even if they are detected late.

The Effect of Circumcision Status on Periurethral and Glanular Bacterial Flora

Introduction: Circumcision is a historical operation which is still performed for different purposes. The aim of this study is to investigate the changes in periurethral and glanular sulcus flora due to circumcision to determine the role of circumcision on urinary tract infections (UTIs). Patients and Methods: Fifty patients who were circumcised for social-religious reasons between January 2000 and January 2001 were evaluated in this prospective study. Two swabs were taken from the periurethral and glanular sulcus regions both just before circumcision and 4 weeks after, and the bacteria cultured were recorded. Results: We isolated pathogenic bacteria in the periurethral region of 32 (64%) patients (enterococci in 14 cases; Escherichia coli in 12 cases) before circumcision, and this number decreased to 5 (10%) after circumcision. Similarly, pathogenic bacteria were cultured from the glanular sulcus swabs of 33 (68%) patients (enterococci in 14 cases; E. coli in 10 cases), as well as coagulase-negative staphylococci in another 15 patients before circumcision. Following circumcision, we detected pathogenic bacteria in the glanular cultures of only 4 cases, whereas 40 children had non-pathogenic skin flora. Only 1 of 5 children with history of UTIs (n = 1) and retractable phimosis (n = 4) had periurethral pathogenic bacteria (Proteus spp.) in the post-circumcision period. The differences between pre- and post-circumcision values of the pathogenic bacterial colonizations were statistically significant in both groups sampled (p < 0.05). Conclusion: Non-circumcised patients have similar pathogenic bacterial colonizations in the periurethral and the inner preputial regions, although they have no phimosis. The origin of periurethral flora should be the deeper preputial regions. The flora greatly changed with skin commensals after circumcision. Circumcision might be beneficial from this point of view.

Effect of alarm Treatment on bladder storage capacities in monosymptomatic nocturnal enuresis

Objective: Despite a great number of studies, very little is known about the mechanism of action of enuresis alarm systems. Nevertheless, as a result of this treatment many children are able firstly to wake up before urination occurs and then, in time, to sleep through the night without voiding. The aim of this study was to investigate the effect of enuresis alarms on bladder storage capacities. Material and Methods: A total of 28 children aged >7 years who were not polyuric but who voided once every night, slept alone in their own bedroom and who were willing, along with their family members, to cooperate were recruited. Patients were asked to record their urine output using a frequency/volume chart for two consecutive days. After these records and the results of physical and laboratory examinations were taken into consideration, treatment was instituted with the bell‐and‐pad (alarm) system for a period of 12 weeks. At the end of this period, patients were asked to complete another frequency/volume chart. Results: The pre‐ and post‐treatment maximum functional bladder capacity was 178.35 ± 87.86 ml and 243.03 ± 102.84 ml, respectively and the pre‐ and post‐treatment mean day‐time bladder capacity was 111.11 ± 45.87 and 148.445 ± 7.68 ml. Both of these differences were statistically significant (p < 0.0001 and <0.0001, respectively). The maximum nocturnal bladder capacity was found to be increased from 177.85 ± 84.95 to 255.25 ± 124.52 ml after treatment (p < 0.0001). Conclusion: Treatment with the alarm system for a period of 12 weeks was seen to be associated with a significant increase in bladder storage capacities (maximum nocturnal bladder capacity, maximum functional bladder capacity and mean day‐time bladder capacity).

Temporary stretch of the testicular pedicle may damage the vas deferens and the testis

BACKGROUND/PURPOSE The authors aimed to investigate the effects of temporary stretching of the spermatic cord, a commonly performed manipulation during inguinal surgery, on the vas deferens and the testis. METHODS Forty adult male Wistar-Albino rats were divided equally into 4 groups. The right spermatic cord and testis were exposed via a transverse suprascrotal incision. In the study groups, a continuous horizontal stretch force was applied to the vas deferens and vessels in a distal direction for 60 seconds. In group 1 (G1) a 1.25-Newton (N), and in group 2 (G2) a 0.75-N stretch force was applied. Group 3 (G3) and group 4 (G4) served as sham and control groups, respectively. The animals were killed 28 days later. Sections of the vas deferens were examined histologically and their dimensions measured. Both testes were excised, weighed, and examined microscopically. Kruskal-Wallis test and Mann-Whitney U test were used to compare means in the different groups. RESULTS The mean wall thickness of the vas deferens was 378 +/- 133 mum in G1 and was significantly diminished compared to G2, G3, and G4, in which the mean wall thickness was 497 +/- 142 mum, 500 +/- 10 mum and 521 +/- 95 mum, respectively (P <.05). The mean right testicular weights were 1.18 +/- 0.10 g and 1.23 +/- 0.17 g in G1 and G2, respectively, and each was significantly lower than in G3 (1.23 +/- 0.09 g) and G4 (1.25 +/- 0.08 g; P <.05). The mean right testicular weights showed no difference between G1 and G2 (P >.05). Necrosis was seen in the right testes in 50.0% and 42.9% of the animals in G1 and G2, respectively. No histopathologic alterations were observed in the vas deferens in all groups. Microscopic examination of the left testes was normal. CONCLUSIONS In an experimental animal model, temporary stretching of the spermatic cord resulted in significant thinning of the smooth muscle layer of the vas deferens and testicular atrophy.

Effects of intrinsic denervation on intestinal morphology in rats with short-bowel syndrome.

Abstract When benzalkonium chloride solution (BACs) is locally applied, to the serosal surface of the intestine, it causes intrinsic denervation (ID) of the myenteric plexus (MP), changes intestinal morphology, and slows intestinal passage by prolonging small-bowel transit time. These effects of ID suggest that chemically-induced bowel denervation may be useful in the treatment of short-bowel syndrome (SBS). How ID affects intestinal morphology in rats with SBS has not previously been investigated. A 75%–80% mid-small-bowel resection was performed in 20 rats with mean body weight 247 ± 30 g. The proximal and distal 2 cm of the resected bowel were examined histologically. After intestinal continuity was maintained by end-to-end anastomosis, a 2-cm jejunal segment was marked with silk sutures to form the test segment. BACs 0.1% was applied to 10 of the 20 test segments according to the modified Fox method, resulting in MP destruction (G1). Saline solution was applied to the other 10 test segments to form the control group (G2). Three months later, the rats were killed and the jejunal, ileal, and test segments were evaluated morphologically. Results were expressed as mean ± standard deviation. The Wilcoxon parametric test was performed to compare the groups during the operation and after death, while the Mann–Whitney U-test was used to compare the data in G1 and G2. No intestinal obstruction was observed in either group. In G1, the body weight increased by 19.1% and the total small-intestinal lengthening was 62.2% (P < 0.05). In the test segment of G1, 75% of the ganglia in the MP were destroyed and villus height, crypt depth, intestinal muscle thickness, number of enterocytes, and villus density increased compared to G2. In the ileal segments of G1, there was an increase of 28.8% in intestinal diameter, 14% in muscle thickness, and 15% in villus density (P < 0.05). No change was observed in the untreated jejunal segments of G1 and G2. Thus, ID of the MP after segmental BACs application of the jejunal level: (1) does not cause intestinal obstruction after 3 months; (2) the increase in bowel diameter in the test and ileal segments increases the absorptive surface of the mucosa; (3) the morphologic changes in the test and ileal segments verify an increase in intestinal adaptation; and (4) BACs application in rats with SBS is an easy procedure with no morbidity or mortality, and can be used to increase intestinal adaptation in rats with SBS.

Blunt renal injuries in Turkish children: a review of 205 cases

A retrospective analysis of the medical records of 205 children with renal injuries secondary to blunt abdominal trauma is used to make recommendations regarding the initial diagnostic and therapeutic approaches in this type of patient. It was found that the absence of hematuria on initial urinalysis does not exclude a serious renal injury. Thus, following blunt abdominal trauma, all children should undergo imaging procedures to exclude renal injury, whether they have hematuria or not. Ultrasound is a good initial screening procedure in all patients. Computed tomography is recommended for the definitive evaluation of suspected major renal injuries. Since even major renal injuries may heal without surgical intervention, conservative management is the recommended initial treatment of choice. Surgery is reserved for those children who are hemodynamically unstable and those that develop complications.

Primary Duhamel-Martin operations in neonates and infants.

Abstract Background : With advances in neonatal anesthetic and surgical care, a safe, one stage, definitive procedure has been possible in Hirschsprung’s disease. Since 1996, we have performed this type of operation in the neonatal and early infancy period. We aimed to review our data to state the feasibility of this operation in these age groups.

Congenital midline cervical cleft: a rare embryopathogenic disorder

Abstract. Congenital midline cervical cleft (CMCC) is a rare disorder of the ventral neck. The cleft consists of an epithelium-covered, longitudinal central depression with a protuberance at the cervical end. The adjacent skin is tethered by scar tissue forming a depression, which ends in a blind sinus at the caudal end. Although a variety of embryological mechanisms are proposed, its etiology is obscure. Up to the present time, fewer than 50 cases have been reported in the English literature. CMCC can be seen in association with several midline anomalies related to the branchial arches, including median cleft of the lower lip and mandible, and hypoplasia or absence of other midline neck structures. We present a 36-day-old boy with CMCC to illustrate its clinical presentation and the result at 24 months postoperatively.

Long-term effect of pentoxifylline and NG-nitro-L-arginine methyl ester on testicular function in spermatic artery ligation

Objective. To investigate long-term testicular function in pentoxifylline- and NG-nitro-L-arginine methyl ester (L-NAME)-treated rats prior to spermatic artery ligation by assessing serum inhibin B concentration, a reliable endocrine marker of spermatogenesis. Material and methods. Forty prepubertal rats were randomly divided into four equal groups. Right orchiectomy was performed in all rats. Intraperitoneal pentoxifylline and L-NAME were administered to Groups 1 and 2, respectively. Rats in Group 3 did not receive any medication. The spermatic arteries of the left testes were ligated in all groups with the exception of the sham controls (Group 4). One month postoperatively, a histopathologic evaluation was performed and serum inhibin B concentrations were assessed in all groups. Results. There were no statistically significant differences in testis size or serum inhibin B concentration between Groups 1, 2 and 3. However, the testes were significantly smaller (p1=0.01, p2=0.01, p3=0.01) and serum inhibin B levels were significantly decreased (p1=0.01, p2=0.01, p3=0.01) when Groups 1–3 were compared with Group 4. Histopathological evaluations revealed necrosis and calcification in all specimens with the exception of the sham-operated group. Conclusions. The long-term outcomes of spermatic artery ligation were poor and testicular atrophy developed in rat testes in all study groups. Testicular atrophy could not be reversed by preoperative administration of pentoxifylline and L-NAME.

Ureteral fibroepithelial polyps in children

Fibroepithelial polyps of the ureter presenting as pelviureteric junction (PUJ) obstruction in two boys are reported. These neoplasms are uncommon, especially in children. Surgical excision of the PUJ with the polyp and dismembered pyeloplasty was performed in each case. Postoperative recoveries were uneventful.