Huseyin Ilhan

Giant mesenteric lipoma.

Mesenteric lipoma is a rare benign tumor of mature fat cells. Asymptomatic abdominal mass, progressive abdominal distension, and intraperitoneal radiolucent fat density mass on computed tomography are the main diagnostic criteria. Main differential diagnosis is lipoblastoma or lipoblastomosis. Treatment is surgical excision. As an unusual case, a 3-year-old boy with a giant mesenteric lipoma is presented in this report.

Diagnostic steps and staged operative approach in Currarino's triad: a case report and review of the literature

Abstract The Currarino triad is a combination of a presacral mass, a congenital sacral bony abnormality and an anorectal malformation. It mostly presents with constipation. Rectal examination, plain radiographs and magnetic resonance imaging are the main tools for the diagnosis. If the mass is a meningocele, colostomy and neurosurgical exploration should precede ano- plasty due to the risk of meningitis. A 14-month-old female patient with anal stenosis, a sacral scimitar defect and an anterior meningocele is presented in this report.

Effects of the anti-ICAM-1 monoclonal antibody, allopurinol, and methylene blue on intestinal reperfusion injury

PURPOSE The aim of this study was to evaluate the effect of allopurinol, methylene blue, and a monoclonal antibody to the adhesion molecule ICAM-1 in intestinal ischemia and reperfusion injury. METHODS The rats were divided into 5 groups. CG (n = 8) was untreated controls, SISG (n = 11) received sterile isotonic saline solution, ICAMG (n = 12) received a monoclonal antibody to rat ICAM-1, ALLOG (n = 12) received allopurinol, and MBG (n = 14) received methylene blue. Intestinal ischemia was performed for 60 minutes followed by 60 minutes of reperfusion. The agents were injected 10 minutes before the reperfusion to animals. After 60 minutes of reperfusion, the plasma samples for myeloperoxidase (MPO) activity, tumor necrosis factor alpha (TNF-alpha) and uric acid levels, and the intestinal biopsies of ileum and jejunum for histopathologic examination were taken. RESULTS The mucosal damage was attenuated, and TNF-alpha level significantly decreased in ALLOG and ICAMG compared with SISG. The MPO activity was the lowest in ICAMG, and uric acid level was significantly decreased in ALLOG compared with the other groups. Methylene blue decreased TNF-alpha response to reperfusion injury but significantly increased the grade of the mucosal damage and the MPO activity. CONCLUSIONS This study shows that prereperfusion application of allopurinol and monoclonal antibody to the adhesion molecule ICAM-1 may attenuate the damage caused by intestinal ischemia and reperfusion, but the different time-points for application, the effects observed in the different ischemia and reperfusion durations, and the long-term results also should be investigated in the same experimental model before the final conclusion. Methylene blue was not effective to prevent or attenuate the intestinal tissue injury, but because this was the first study examining the effect of methylene blue on intestinal reperfusion injury, further studies with the different doses, ischemic duration, and application times will be needed.

An additional child case of an aldosterone-producing adenoma with an atypical presentation of peripheral paralysis due to hypokalemia.

Aldosterone-producing adenoma, which is characterized by hypertension, hypokalemia, and elevated aldosterone levels with suppressed plasma renin activity, is a rare condition during childhood and is also potentially curable. To the best of our knowledge, nearly 25 cases of childhood aldosterone-secreting adenoma have been reported in the literature to date. Here we describe a 13-yr-old girl with primary hyperaldosteronism secondary to aldosterone-secreting adenoma. The patient was admitted to our hospital with the neuromuscular complaints of muscle weakness and inability to walk due to hypokalemia. She had been misdiagnosed as having hypokalemic periodic paralysis 2 months before admission and her symptoms had radically improved with potassium supplementation. However, her blood pressure levels had increased and her symptoms reappeared 2 days priorto being observed during hospitalization in our institution. Laboratory examinations revealed hypokalemia (2.1 mEq/l), and increased serum aldosterone levels with suppressed plasma renin activity. Abdominal ultrasonography and abdominal magnetic resonance imaging revealed left adrenal mass. Laparoscopic adrenalectomy was performed and histopathological examinations showed benign adrenal adenoma. Serum aldosterone levels and blood pressure levels returned to normal after surgical intervention. This case demonstrates the importance of a systemic evaluation including blood pressure monitorization of children with hypokalemia as intermittent hypertension episodes may be seen; cases without hypertension may be misdiagnosed as rheumotalogical or neurological disorders such as hypokalemic periodic paralysis, as in our case.

Neutropenic enterocolitis: is it possible to break vicious circle between neutropenia and the bowel wall inflammation by surgery?

BackgroundNeutropenic enterocolitis is a devastating bowel wall inflammation in patients with protracted neutropenia. The approach for diagnosis and treatment is still controversial, and it is difficult and challenging to decide on what should be the next step in the management.Case presentationWe report a 10-year-old boy who developed neutropenic enterocolitis in the course of the conservative treatment for aplastic anemia. Oral mucositis and the perianal fissure with an ulcer were important indicators for what was happening on the colonic mucosa. Colonoscopy and biopsy confirmed the diagnosis. A fast recovery was achieved with a right hemicolectomy and ileostomy.ConclusionRetrospective analysis of the long-term follow-up of our patient suggests that defunctioning the colon by ileostomy breaks the vicious circle between neutropenia and bowel wall inflammation, and an early surgical intervention could be considered as an adjunctive approach to the conservative management of persistent cases.

Ventriculoperitoneal shunt catheter spontaneously protruding through the skin at the sacrococcygeal region.

from the tip of the catheter was positive for coagulasenegative staphylococcus, but she had no clinical signs or symptoms of meningitis. Lateral and anteroposterior projection of conventional radiographies depicted the peritoneal catheter placed intraperitoneally and the tip extruding through the skin at the sacrococcygeal space, 1 cm laterally to midline ( fig. 2 ). We disconnected the proximal end of the peritoneal catheter from the reservoir, pulled out the catheter through the distal end, and We present an extremely rare ventriculoperitoneal (V/P) shunt complication in a 7-month-old girl. Hydrocephalus and myelomeningocele had been diagnosed antenatally. On the second day of birth, she had undergone surgery for excision of the myelomeningocele sac and V/P shunt placement. Seven months after V/P shunt application, the distal tip of the slit-end-type catheter of a draining shunt protruded through the skin at the sacrococcygeal region ( fig. 1 ). Cerebrospinal fluid culture taken Received: May 31, 2007 Accepted after revision: September 18, 2007 Published online: March 27, 2008

Laparoscopic Approach to a Rare Cause of Ureteropelvic Junction Obstruction in a Child: Ureteral Polyp

Fibroepithelial polyps are a rare underlying reason of ureteropelvic junction obstruction. In the past, open surgery was the only option. However, due to development of minimal invasive technics, treatment alternatives have been changed. Resection by laparoscopy or endoscopy, laser fulguration and/or percutaneous resection are recommended in children and adults. Here, we present a 10-year-old boy with severe left hydronephrosis due to fibroepithelial polyp close to the ureteropelvic junction and our laparoscopic approach.

Çocuk Cerrahisi Ameliyatlarında Ameliyat Sürelerinin Belirlenmesi

Amac: Hastane verimliliginin artirilmasi ve basarili bir ameliyathane organizasyonu icin ameliyat surelerinin bilinmesi onemlidir. Bu calisma ile Cocuk Cerrahisinde en sik yapilan 3 cerrahi girisim icin ameliyathane surelerinin saptanmasi amaclanmistir. Gerec ve Yontem: Eskisehir Osmangazi Universitesi Tip Fakultesi Cocuk Cerrahisi Anabilim Dali’nda 02.01.2007–03.08.2009 yillari arasinda 3 ana grupta ameliyati gerceklestirilen toplam 860 olguda ameliyethanede gecen ortalama ameliyat oncesi, ameliyat ve ameliyat sonrasi sureleri belirlendi. Sunnet, kasik fitigi, inmemis testis nedeni ile opere olan olgular calismaya dahil edildi. Bu ana gruplar kasik fitigi ve inmemis testiste tek ve cift tarafli ve sunnetle beraber olmasina gore alt gruplara ayrildi. Bulgular: Hastalik gruplarina gore ortalama yas 1,6 yas ile 5,7 yas arasinda degismekteydi. Preoperatif ve postop bekleme sureleri degerlendirildiginde sadece sunnetin diger ameliyat alt gruplari ile karsilastirildiginda anlamli farklilik gosterecek duzeyde kisa oldugu gozlemlendi. Diger alt gruplar arasinda anlamli farklilik saptanmadi. Ortalama ameliyat sureleri tum alt gruplar icin 16,9 dakika ile 88,7 dakika arasinda degismekteydi. Ameliyat sureleri degerlendirildiginde sunnet ve tek tarafli kasik fitigi ortalama ameliyat surelerinin diger tum altgruplar ile karsilastirildiginda anlamli olarak kisa oldugu saptandi. Sonuc: Bu calisma, cocuk cerrahisinde en sik yapilan 3 ameliyat icin ameliyathane giris, ameliyat ve cikis surelerini tespit ederken, bu surelere etki eden muhtemel insan ve ameliyathane ortami ve hasta faktorlerini de tartismistir. Cerrahi girisimin surelerinin bilinmesi ameliyathanede basarili bir is akisini sagladigi gibi yasanabilecek olumsuzluklari da ortadan kaldirmaya yadimci olur