Güngör Karagüzel

Severe ischemia of the glans penis following circumcision : A successful treatment via pentoxifylline

Abstract Severe ischemia or necrosis of glans penis is rare. We report the case of an 11‐year‐old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.

Midline Dorsal Plication to Repair Recurrent Chordee at Reoperation for Hypospadias Surgery Complication

PURPOSE Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We investigated the efficacy of midline dorsal plication for recurrent chordee in complicated hypospadias reoperations. MATERIALS AND METHODS We retrospectively evaluated the charts of 25 boys who underwent reoperation between 1999 and 2004 due to complications of primary hypospadias repair other than meatal stenosis. A total of 15 cases were initially managed elsewhere for primary repair or complications. The etiology of recurrent chordee was defined at surgical correction. When recurrent chordee was noted a midline dorsal plication was performed. RESULTS Of 25 patients 10 had previously undergone chordee repair. Nine of these patients were observed to have recurrent chordee and 1 had de novo chordee. A total of 10 patients had recurrent or delayed onset chordee. Mean patient age at primary repair was 6.28 years (range 1 to 33). Mean age at last operation for chordee was 15.9 years (range 4 to 66). Mean interval to recurrent chordee was 6 years (range 1 to 16), excluding a 66-year-old blind patient who did not know when recurrent chordee developed. Five patients had chordee recur before puberty at a mean interval of 2.6 years. Mean reoperation rate was 2.4 for recurrent chordee cases and 2.6 for chordee-free cases. Mean followup after midline dorsal plication for recurrent chordee repair was 22 months (range 8 to 56), while mean followup in pubertal and postpubertal cases was 20 months. No recurrence of chordee or surgery related morbidity was observed after recurrent chordee repair by midline dorsal plication. CONCLUSIONS Chordee may recur during puberty following successful chordee repair. The midline dorsal plication technique is simple, efficient and safe even in patients who have undergone multiple surgeries for hypospadias and chordee repair.

Intrathyroidal ectopic thymic tissue may mimic thyroid cancer: a case report

Abstract Ectopic intrathyroidal thymus tissue that may be present as a thyroid nodule is rarely reported. We present a case of a 4-year-old boy with a solitary thyroid nodule. Real-time thyroid ultrasound showed a calcified nodule in the right lobe. Complete blood count, serum calcitonin, and thyroglobulin concentration were normal and antithyroid antibodies were negative. Fine-needle aspiration (FNA) biopsy was revealed as inadequate for cytological examination. During his follow-up, nodular enlargement was found, and the patient was subjected to surgical total excision of the right lobe of the thyroid gland. Pathological examination showed an ectopic intrathyroidal thymus tissue. In childhood, ectopic intrathyroidal thymus tissue can present as an enlarging microcalcified thyroid nodule that may mimic thyroid cancer and may grow during follow-up.

Unilateral spermatic cord torsion without ipsilateral spermatogenetic material: effects on testicular blood flow and fertility potential

This experiment was planned to answer the question of how the elimination of ipsilateral spermatogenetic material, which is necessary for contralateral testicular damage caused by an autoimmune response, affects contralateral testicular blood flow and fertility potential in unilateral spermatic cord torsion (USCT). Thirty-four male and 68 female adult albino rats were divided into three groups. Group 1 rats underwent a control operation, group 2 rats underwent subepididymal orchiectomy to eliminate spermatogenetic material, and group 3 rats underwent USCT after subepididymal orchiectomy. Testicular blood flows of the rats were measured by 133Xe clearance technique. Additionally, to determine fertility potential, each male rat was housed with two female rats. Numbers of impregnated and delivered rats were recorded. Both mean testicular blood flow and fecundity of group 3 were significantly lower than those of groups 1 and 2. When compared with groups 1 and 2, fertility and mean number of the impregnated rats of group 3 were lower but the differences were not significant. These findings suggest that absence of spermatogenetic material in USCT reduces contralateral blood flow and fertility potential. Therefore, contralateral testicular damage originating from blood flow alterations rather than autoimmune mechanism should be considered to explain fertility problems encountered following USCT.

The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children.

Background:  We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg·kg−1) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery.

Cryptococcal mesenteric lymphadenitis: an unusual cause of acute abdomen.

Cryptococcal infection of intraabdominal organs or tissues is extremely rare. Herein we report a child with mesenteric cryptococcal lymphadenitis who presented with an acute abdomen misdiagnosed as acute appendicitis. Definitive diagnosis was established with 2nd look and lymph node biopsy. Clinicians should remember that cryptococcal infection of mesenteric lymph nodes may rarely mimic an acute abdomen and cause delay in diagnosis.

Sacrococcygeal Teratoma Showing Organoid Differentiation: Report of a Case

We present the case of a neonate with a sacrococcygeal teratoma showing organoid differentiation. A 5-day-old baby girl was transferred to our hospital with a large sacrococcygeal mass. Ultrasonography revealed a few well-limited fluid-filled lesions, indicating that the teratoma had cystic components. During surgery, a sac containing 30 cm of small bowel loops was found in the tumor. The bowel segment was supplied by a mesentery-like structure originating from teratoid tissue. Histopathological examination verified a benign mature teratoma with fully developed small bowel loops. The tumor was defined as a sacrococcygeal fetiform teratoma. The terminological, structural, and clinical aspects of this unusual tumor are discussed, with a review of the English literature.

An uncommon association relating to cloacal maldevelopment: Bladder agenesis, anorectal atresia, and absence of vulva, vagina, and uterus

The authors report on a newborn girl with complex urogenital and hindgut abnormalities. Urogenital anomalies consisted of absence of vulva and vagina, uterine and urethral atresias, bladder agenesis with ectopic ureteric opening, and bilateral pelvic ectopic kidneys. In addition, the baby had anorectal atresia without fistula as a hindgut anomaly. Herein, clinical evaluation and embryological review are made to explain the concomitant occurrence of these rare malformations.

An unusual method for immediate airway management in a tracheostomized patient with tracheal obstruction due to granulomas.

SIR—Tracheal obstruction caused by tracheal stenosis after tracheostomy is a well-known complication of intubation or tracheostomy and standard care measures may not prevent its occurrence, especially in children (1). Despite adequate tracheostomy tubes, careful handling for maintenance and removal of the tube, the incidence of the complications related to tracheostomy seems to be higher in a pediatric population (2). The main reason for high risk of tracheal stenosis in children is prolonged intratracheal cannulation (3). Unfortunately, tracheal stenosis may lead to an acute, progressive and life-threatening airway obstruction. Airway patency should be restored immediately by inserting an intubation tube, which would pass below the obstructed segment of the trachea. A 10-year-old boy was admitted to our intensive care unit with a diagnosis of subarachnoid and intraparenchymal hemorrhage, cerebral edema, and cervical vertebral dislocation at the level of C3. He was unconscious and tetraplegic with no spontaneous respiratory effort, so surgical tracheostomy was performed. After 7 months, tracheal stenosis at 2.5 cm below the inferior rim of the stoma and granulation tissue around the stenosis were observed when flexible bronchoscopy was performed to investigate the reason for high airway pressures exceeding 45 cmH2O. An incision including the second, third, and fourth tracheal cartilages was made. The airway pressures decreased to normal after the operation and the patient was discharged home on the ventilator. Unfortunately, after 200 days, he was admitted via the emergency room with progressive desaturation and increase in peak airway pressure. Urgent bronchoscopy showed the trachea filled with granulomas and it was impossible to pass through the stenosis even with the pediatric flexible bronchoscope (4.8 mm). There was only a narrow space between the granulomas allowing airflow during inspiration but not in the expiratory phase as the trachea collapsed. Blood gases with FIO2 1.0, 30 brÆmin )1

Multidirectional and simultaneous evaluation of gastroschisis-related intestinal damage in chick embryos.

PURPOSE In a chick model of gastroschisis, we aimed to investigate the morphological/cellular, molecular, and ultrastructural changes taking place in gastroschisis-related intestinal damage (GRID). METHODS 13-Day fertilized eggs were divided into two groups. CONTROL GROUP chorio-amnio-allontoic membranes opened and abdominal wall exposed. Gastroschisis group: an anterior abdominal wall defect created after opening membranes. Embryos from both groups were surgically removed on post-fertilization day 19. Intestinal samples were obtained for histopathology, immunohistochemistry, molecular biology, and electron microscopy. RESULTS The histopathological grade of intestinal damage which primarily involved mucosal structures was significantly higher in the gastroschisis group when compared to the control group (p<0.001). Immunohistochemically, E-cadherin and synaptophysin immunoreactivity in the gastroschisis group was significantly lower than control group (p<0.05 and p<0.01, respectively), whereas there was no significant difference in laminin and type-4 collagen immunoreactivity between the groups (p>0.05). Molecular analyses indicated a significant decrease in NFκB and IκB expression in the gastroschisis group (p<0.05 and p=0.001, respectively). Electron microscopy showed that the gastroschisis group had considerable ultrastructural damage, manifested by apoptosis in all layers. CONCLUSIONS GRID affected all layers but was more prominent in mucosa. The damage may depend on E-cadherin and synaptophysin downregulation. Increased apoptotic activity, associated with decreased NFκB and IκB expression, may be an important component of this multifactorial damaging process.