Günyüz Temir

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.

Paraesophageal hiatal hernias in children.

SUMMARY Hiatal hernia is a rare condition, which may be a cause of important clinical problems either as a mediastinal mass or as a cause of failure of the antireflux mechanism. Nineteen patients treated for paraesophageal hiatal hernias were included in the study. We investigated demographic data, diagnostic studies and symptoms of the patients together with the type of operation and outcome. Respiratory and gastrointestinal complaints were the prominent symptoms in most patients. Plain X-ray, contrast radiological study and esophagoscopy were used in the diagnostic workup. Surgical repair was performed via thoracic, abdominal or thoraco-abdominal approaches. Concomitant antireflux procedures were performed in 13 patients. Hiatal hernias in children may be asymptomatic or may present with a variety of symptoms or dramatic complications. Because of the risk of complications, surgical treatment is necessary shortly after diagnosis. Repair of the hiatus combined with antireflux surgery seems to yield satisfactory results.

Burn-associated bloodstream infections in pediatric burn patients: Time distribution of etiologic agents

BACKGROUND Infections are the leading cause of morbidity and mortality in patients with burns in burn units. Bloodstream infections (BSIs) in patients with burns may result from burn wound infection, use of invasive devices such as central venous catheters, and translocation of the gastrointestinal flora. OBJECTIVE In this study, we investigated the distribution and antimicrobial drug resistance of causative pathogens in children with burns and the durational changes of microorganisms in the distribution of BSIs in children. METHODS This study was conducted at the Pediatric Burn Unit (PBU) of Dr. Behçet Uz Children Research and Training Hospital during the period of November 2008-April 2015. The study subjects were all the patients admitted to the PBU, in whom microorganisms were isolated at least from one of the cultures, including blood and catheter cultures. RESULTS Gram-positive bacteria were the most common causative agents of BSI in patients with burns (66.4%), followed by gram-negative bacteria (22.1%) and fungi (11.5%). The median duration of development of BSIs caused by gram-positive bacteria from the time of burn was 5 days (ranging from 2 to 54 days of burn), which was significantly shorter than that of BSIs caused by gram-negative bacteria (12 days) and fungal pathogens (13 days). CONCLUSION The etiologic agents of BSIs in children may differ from those in adults. Gram-negative drug-resistant bacteria such as multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were important agents of BSI in patients with burns, especially in the long term; however, gram-positive bacteria should also be considered while deciding the antimicrobial therapy, especially in the early periods of burn.

[Angiomyxoma: always myxoid, sometimes aggressive].

Angiomyxoma is a distinct soft tissue tumor characterized by the presence of prominent myxoid matrix and numerous thin-walled blood vessels. This tumor has a predilection for the trunk, head and neck, extremities, and genitalia. It is a benign tumor and total excision is curative. Recurrence is rare except for aggressive angiomyxomas. A 12-year-old girl with a 10-year history of a subcutaneous mass on the left gluteus measuring 4.5x4x3 cm had been referred. The tumor was encapsulated and was located in the reticular dermis and subcutaneous tissue, composed of stellate cells with mucinous stroma. Thin-walled blood vessels were prominent. Immunohistochemically, tumor cells were immunoreactive for vimentin. No immunoreactivity was present for estrogen receptor, CD34, smooth muscle actin, S-100 protein and desmin. The purpose of this report is to present a classical example of an isolated superficial angiomyxoma and discuss the differential diagnosis, because of its relatively infrequent occurence.

GÖĞÜS DUVARI HAMARTOMU : Olgu Sunumu

Gogus duvari hamartomu saptanan 4 aylik kiz bebek sunulmustur. Yenidogan ve infantlarda oldukca nadir gorulen bu karakteristik lezyon ; salt kitle varligiyla taninabilecegi gibi basiya bagli respiratuvar semptomlara yol acabilir. Spontan regresyon bildirmistir. Gunumuzde asemptomatik olgularda konservatif yaklasim yeglenmektedir. Ender gorulmesine karsin klinik olarak malignite kuskusu dogurabilecegi icin ; cocukluk cagi toraks tumorlerinin ayirici tanisinda akilda tutulmalidir. Burada lezyonu diger malign ve benign neoplazmlardan ayiran histopatolojik ozellikler irdelenmistir.