Gokhan Koyluoglu

Amyand's hernia in the children: a single center experience.

BACKGROUND The presence of a vermiform appendix in an inguinal hernial sac is termed Amyands hernia. It may present as a tender inguinal or inguinoscrotal swelling, and it is often misdiagnosed as an incarcerated or strangulated hernia. METHODS Between 1998 and 2006, we have managed 564 patients with acute appendicitis, 1,090 patients with inguinal hernia, 33 patients with incarcerated inguinal hernia, and 12 patients with Amyands hernia on our pediatric surgery service. A retrospective analysis of clinical data of these patients with Amyands hernia was performed. RESULTS All patients with Amyands hernia were boys with a median age of 40 days (range, 15 days-14 months). One patients condition was diagnosed pre-operatively. All of them, therefore, underwent emergency operation with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 2 normal appendices, 6 inflamed appendices, and 4 appendices with external signs of serosal inflamation of uncertain significaince in the inguinal hernial sac. Two patients with a normal appendix had hernia repair without an appendectomy. The other 10 patients with an abnormal appendix underwent an emergency open appendectomy with repair of the inguinal hernia. None of the patients developed recurrent hernia. The median postoperative follow-up period was 2.5 years. CONCLUSION In pediatric patients with Amyands hernia, the inflammatory status of the appendix can be used to determine the type of hernia repair and the operative approach. Incidental appendectomy in the case of a normal appendix is not favored by us. Treatment includes appendectomy (via the hernia sac) and hernia repair in children with an inflamed appendix.

Effects of nimesulide and pentoxifylline on decreased contractile responses in rat ileum with peritonitis.

The aim of this study was to determine the effects of nimesulide and pentoxifylline on the contractile effects of KCl, carbachol and substance P in the longitudinal muscle of rat ileum during peritonitis. Peritonitis was induced in rat ileum by cecal ligation and puncture. Thirty rats were operated on to induce peritonitis, 10 of which received nimesulide (5 mg/kg, subcutaneously) and 10 of which received pentoxifylline (25 mg/kg, subcutaneously) before the operation; 10 other rats underwent a sham operation and acted as controls. Twenty-four hours after the operation, ileum segments were transferred to isolated organ baths and responses to KCl, carbachol and substance P were recorded. Emax values of KCl, carbachol and substance P were markedly lower (P<0.05), with no change in the pD2 values, in the peritonitis group than in the controls. Peritonitis-induced changes in the KCl, carbachol and substance P responses of ileum were significantly restored by nimesulide (P<0.05), but not by pentoxifylline. The improved contractile responses following nimesulide treatment indicate that products of cyclooxygenase-II may be, at least in part, responsible for the decreased contractile responses to KCl, carbachol and substance P in peritonitis.

Primary hydatid disease of the pancreas mimicking pancreatic pseudo-cyst in a child: case report and review of the literature.

Primary hydatid disease of the pancreas is very rare. We report the case of a 7-year-old girl who presented with abdominal pain and an epigastric mass. The Casoni and indirect hemagglutination test for hydatid disease were negative. A diagnosis of a pancreatic pseudocyst was established by ultrasonography (US) and computed tomography scan before surgery. Ultrasound guided percutaneous drainage was planned as treatment. During the procedure, the cyst was perforated and as germinative membrane was seen by US, we arranged surgery. Hydatid disease should be considered in the differential diagnosis of all cystic masses in the pancreas, even if Casoni and indirect hemagglutination tests negative, especially in geographic regions like Turkey, where the disease is endemic.

Unusual presentation of pancreatic hydatid cyst in a child.

A 13-year-old boy was transferred to our department from a provincial hospital. The patient had been admitted to the other hospital for loss of weight and lack of appetite. He had no history of abdominal pain, jaundice, or trauma. He had no epigastric tenderness on physical examination. Liver function parameters and serum amylase levels were within normal ranges. Serologic test results for hydatid disease were positive. Abdominal ultrasonography and computerized tomography (CT) demonstrated an oval solitary cyst measuring 12 × 10 cm in the body and tail of the pancreas (Fig. 1). The cyst was homogenous and sharply delineated, and it had no internal structure. There were no cysts in other abdominal viscera. While the patient waited for the surgery on the pancreatic cyst, he was admitted because of acute abdominal pain, nausea, and vomiting. On physical examination, there was tenderness in the epigastric abdomen. All laboratory test results, including serum amylase level, were normal except for mild leukocytosis. CT showed that the germinal and laminated membranes of the hydatid cyst, known as the “endocyst,” were separated completely from the ectocyst and floated freely in the cyst cavity (Fig. 2). The patient was taken to the surgery department because peritoneal rupture was suspected, but no perforation of the pancreatic cyst was observed. The cyst was opened, and the endocyst was removed. No communication with the pancreatic duct was noted during surgery. Part of the remaining adventitial ectocyst was excised, and the edge was oversewn with continuous absorbable suture. The cystic cavity was drained into the closed system. On the third postoperative day, pancreatic juice began to pass through the drain, in amounts ranging from 125 to 250 mL per day. On the fifth postoperative day, subcutaneous administration of octreotide acetate, a somatostatin analogue, was initiated at a dosage of 2.5 g/kg/d. A progressive decrease in the fluid output was achieved, and the fistula ceased draining by postoperative day 15. The patient was discharged in good condition on postoperative day 18. Two years’ clinical and ultrasonographic follow-up has shown no recurrence.

A huge duplication cyst of the ileum

Summary Background: Massive unilocular intraabdominal cysts in children are rare. Alimentary tract duplications can present diagnostic and therapeutic difficulties. Although they can occur anywhere from the mouth to the anus, they are commonly seen in relation to the ileum. We herein present an unusual case of duplication cyst itself occupying virtually all of the available intraabdominal volume. It appeared to be an enteric duplication cyst of ileal origin. Case Report: A 3-month-old girl was admitted to our hospital for investigation of progressive abdominal distension and biliary vomiting. Plain radiography of the abdomen showed normal air-fluid level in the stomach and paucity of gases in rest of the abdomen. Magnetic resonance imaging showed a huge, homogenous cyst extending from the xiphisternum down to the pelvis. The cyst was excised completely. Macroscopic examination and histologic findings confirmed the diagnosis of a huge enteric duplication cyst arising from the ileum. Conclusions: Enteric duplication cyst should be considered in a patient with an abdominal cystic mass. Radiologist must take into account patient age, clinical parameters, and imaging findings to identify the likely etiology of a cystic mass.

General Practitioners' Knowledge Levels About Circumcision

Objective: This study was carried out to investigate knowledge levels of general practitioners and their thoughts about circumcision in Middle Anatolia. Materials and Methods: This descriptive and cross-sectional study was carried out with 247 general practitioners working in Sivas. A questionnaire was prepared by the authors using previous reports. Questionnaires were sent to subjects by post. One hundred and seventy eight general practitioners (57 women, 121 men) responded and were included in the study. For statistical analysis, Chi-square test was used and palt;0.05 value was accepted as significant. Results: 42.1% of subjects believed that circumcision should be performed between 2 and 6 years of age. 2.2% of subjects declared that circumcision could be done at home and 7.3% believed that the location of the operation is not important. 9.6% of subjects believed that the person who performs the circumcision does not have to be a doctor. 21.3% of subjects believed that circumcision could be performed without anesthesia during the newborn period because of undeveloped pain sensation. Conclusion: This study demonstrated that general practitioners, who are the most easily accessible health staff for information about health, do not have updated information about the way to perform circumcision and its necessity. Therefore, it is concluded that education programs about circumcision for general practitioners must be continued and updated. Turkish Baslik: Pratisyen Hekimlerin Sunnetle Ilgili Bilgi Duzeyleri Anahtar Kelimeler: Sunnet, pratisyen hekim, tip egitimi Amac: Bu calisma Orta Anadolua#39;daki pratisyen hekimlerin sunnetle ilgili dusunce ve bilgi duzeylerinin saptanmasi amaciyla gerceklestirildi. Gerec ve Yontemler: Kesitsel ve tanimlayici bir arastirma olarak planlanan calisma, Sivas il sinirlari icinde calismakta olan pratisyen hekimler arasinda yapildi (n=247). Anket formu, arastirmacilar tarafindan literatur isiginda hazirlandi. Anketler posta yoluyla gonderildi. Toplam 178 hekim (erkek=121, kadin=57) anket formunu uygun olarak yanitladi. Karsilastirmalarda achi;2 testi kullanildi; anlamlilik duzeyi olarak palt;0.05 kabul edildi. Bulgular: Hekimlerin %42.1a#39;i 2-6 yas arasinda sunnet yapilmasini onerirken, %2.2a#39;si sunnetin evde yapilmasi gerektigini, %7.3a#39;u de yapilan yerin bir onemi olmadigini belirtmistir. Sunnetin kim tarafindan yapilmasinin uygun oldugu sorusuna ise %9.6a#39;si yapan kisinin onemi olmadigini soylemistir. Sunnetin yapilma sekliyle ilgili olarak da %21.3a#39;u yenidogan doneminde agri duyusu gelismedigi icin anestezi uygulanmadan sunnet yapilabilecegini belirtmistir. Sonuc: En kolay ulasilabilen, saglikli bilgi alinabilecek hekim grubu olan pratisyen hekimlerin sunnetin gerekliligi ve yapilma sekliyle ilgili guncel bilgi eksiklikleri mevcuttur. Pratisyen hekimlerin sunnet konusunda bilgilerinin guncellenmesi ve egitimlerinin surdurulmesi gereklidir.

Altered contractile responsiveness in ileal longitudinal muscle after total gastrectomy in a rat model.

PurposeTo test the hypothesis that the changes in ileal smooth muscle contractility accompanying postgastrectomy syndromes are agonist-specific, we investigated the effects of potassium chloride (KCl), carbachol, substance P (SP), and serotonin on ileal smooth muscle contractility after total gastrectomy in rats.MethodsWe performed total gastrectomy in ten rats and a sham operation in another ten rats as a control. All of the rats were killed and their ileums excised 4 weeks postoperatively. The concentration–response relationships for KCl, SP, and serotonin were obtained by adding each agent cumulatively to the organ bath. Morphological changes in the ileum were also examined by light microscopy.ResultsThere was no significant difference between the responsiveness of gastrectomized and control tissues to KCl. Maximum responses (Emax) to carbachol and SP were less in the gastrectomized ileal segments than in the control ileal segments. Emax to serotonin was higher in the gastrectomized ileal segments than in the control ileal segments. The pD2value, i.e., the negative logarithm of the concentration for the half-maximal response, EC50, for carbachol, SP, and serotonin was unchanged in the gastroctomized ileal segments and the control segments. Total gastrectomy also caused morphological changes in the ileum.ConclusionsThese data indicate that the contractile response to various agents is altered after total gastrectomy and that receptor-mediated mechanisms may cause these changes.

Üç aylık erkek bebekte persistent müllerian kanal sendromu ve transvers testiküler ektopi: olgu sunumu

Ozet Persistent mullerian kanal sendromu (PMKS), erkek fenotipinde mullerian artiklarin (tuba uterina, uterus ve vajenin 1/3 ust kismi) bulunmasiyla karakterize bir tablodur. Fetal sertoli hucrelerinden mullerian inhibitor faktor (MIF) salinim eksikligi sonucu olusan eder bir erkek psodohermafroditizmidir. Bu sendrom nadiren transvers testikuler ektopi (iki testisin ayni skrotal kompartimanda saptanmasi; TTE) ile birlikte de olabilir. TTE nadir bir patolojidir ve rapor edilmis olgu sayisi 120 civarindadir. Hastalar genellikle normal erkek gorunumunde, tek ya da iki tarafli inmemis testisle birliktedir. Bu yazida uc aylik bir erkek hastada gorulen PMKS ve TTE birlikteligi sunulmaktadir. Uc aylik erkek bebek, sag kasik sisligi yakinmasiyla poliklinigimize getirildi. Fizik muayenede; haricen erkek, penis ve skrotum iyi gelismis, sag testis normal lokalizasyonda, sag inguinal kanalda kitle saptandi, sol testis ise nonpalpabl idi. Eksplorasyonda sag fitik kesesi icinde her iki gonad ve mullerian kanal artiklari saptandi. Sag kordon yapilari mullerian yapilardan ayrilarak sol testis skrotuma yerlestirildi. Yapilan kromozom analizinde 46, XY karyotip raporlandi. PMKS zemininde ender de olsa gelisebilecek tumor riski nedeniyle mullerian artiklarin testis ve vas deferensin zarar gormeyecegi sekilde cikartilmasi gerektigini dusunuyoruz. Rezidu mullerian dokunun birakildigi olgularin uzun donem izlemlerinin malign donusumu erken tanimak acisindan onemli oldugunu dusunuyoruz. Anahtar sozcukler: Transvers testikuler ektopi, mullerian kanal sendromu, inguinal herni. Abstract Persistent Mullerian duct syndrome (PMDS) is characterized by the presence of mullerian duct structures such as fallopian tubes, uterus and 1/3 upper part of vagina in the phenotypic male and is considered to be caused by the failure of synthesis or action of mullerian inhibitor substance. It is a rare form of male pseudohermaphroditism. This syndrome is rarely associated with transverse testicular ectopia (both testes migrate toward the same hemiscrotum). PMDS and transvers testicular ectopi is extremely rare; there are about 120 cases in the literature. Patients are normally virilised, although uni- or bilateral cryptorchidism may be present. In this paper we report a PMDS associated with transverse testicular ectopia in a boy. A 3-month-old-boy was admitted with right inguinal swelling. In this paper we report a PMDS associated with transverse testicular ectopia in a 3-mounth-old-boy. Physical examination demonstrated a normal phallus and scrotum but left testis was not palpable. At operation, both gonads and mullerian remnants with structures that appeared to be a well-developed uterus and fallopian tubes were found in right hernia sac. The Mullerian remnants was excised, bilateral orchidopexy was performed. Chromosomal analysis revealed a 46, XY, karyotype. Bilateral orchidopexy and resection of the remnant tissue is of utmost is the operative procedure of choice. These mullerian remnants are at an increased risk of malignant transformation, so remnants should be monitored for tumor formation in such cases. Keywords: Transverse testicular ectopia, mullerian duct syndrome, inguinal hernia.

Effects of topical application of platelet-rich plasma on esophageal stricture and oxidative stress after caustic burn in rats: Is autologous treatment possible?

BACKGROUND Caustic esophageal burn is still an important health problem in pediatric surgery. Although there are a number of experimental and clinical studies to increase the recovery of the esophagus and reduce the stenosis rate, there is no consensus on the treatment protocol. Platelet-rich plasma (PRP) is an autologous blood product, which has positive effects on wound healing, reepithelization and scar prevention. The aim of our study was to investigate the effects of PRP on stricture formation and oxidative status after caustic esophageal injury in rats. METHODS Twenty-one rats were divided into three groups [Sham operation (n = 8), corrosive esophageal burn with 30% NaOH (n = 6), topical PRP application after corrosive burn (n = 7)]. On the postoperative 21st day, oxidative markers were measured in the serum, and collagen accumulation and stenosis index were measured histopathologically to assess the efficacy of PRP treatment. RESULTS Postoperative weight was higher than preoperative weight in Sham and PRP groups, but lower in the Burn group (p < 0.05). No difference was observed between Sham and PRP groups at total antioxidant status and paraoxonase values, but a significant decrease was found in the Burn group. Group PRP had higher total oxidant status and arylesterase levels than Group Burn (p < 0.05). There was no difference in total thiol values between PRP and Sham group. Histopathological scoring for muscularis mucosa damage revealed a significant reduction in Group PRP, compared to Group Burn (p < 0.05). Esophageal wall thickness and SI were reduced, and luminal diameter was increased in Group PRP compared to Group Burn (p < 0.05). CONCLUSION For the first time in the literature, these results indicate that topical PRP treatment after the experimental corrosive burn has a positive effect on oxidative stress, mucosal healing and decreased stricture development. PRP may be an alternative at the clinical treatment because it can be used during diagnostic esophagoscopy. TYPE OF STUDY Treatment study Level I (randomized controlled trial).

Effects of a Multikinase Inhibitor Motesanib (AMG 706) Alone and Combined with the Selective DuP-697 COX-2 Inhibitor on Colorectal Cancer Cells

In the present study, we investigated the effects of motesanib (AMG 706), a multikinase inhibitor alone and in combination with DuP-697, an irreversible selective inhibitor of COX-2, on cell proliferation, angiogenesis, and apoptosis induction in a human colorectal cancer cell line (HT29). Real time cell analysis (RTCA, Xcelligence system) was used to determine the effects on colorectal cancer cell proliferation. Apoptosis was assessed with annexin V staining and angiogenesis was determined with chorioallantoic membrane model. We found that motesanib alone exerted antiproliferative, antiangiogenic and apoptotic effects on HT29 colorectal cancer cells. Combination with DUP-697 increased the antiproliferative, antiangiogenic and apoptotic effects. Results of this study indicate that motesanib may be a good choice in treatment of colorectal tumors. In addition, the increased effects of combination of motesanib with DuP-697 raise the possibility of using lower doses of these drugs and therefore avoid/minimize the dose-dependent side effects generally observed.