Hüseyin Özbey

Bronchogenic cysts: A rare congenital cystic malformation of the lung

PurposeBronchogenic cysts are rare congenital cystic malformations of the lung. We retrospectively analyzed ten cases of bronchogenic cyst (BC) to reinforce the importance of recognizing this malformation.MethodsBetween 1985 and 2000, ten pediatric patients with BC were treated surgically in our department. Their clinical presentation, radiological, operative, and pathological findings were analyzed retrospectively.ResultsThere were five boys and five girls, ranging in age from 16 days to 6 years (mean 6.5 months). The clinical signs and symptoms included respiratory distress in seven patients (70%), cyanosis in four (40%), chronic cough and fever in five (50%), and dysphasia in two (20%). Routine chest X-ray revealed a pulmonary air-filled cyst in six patients (60%) and a pulmonary nodular opacity in four (40%). The diagnosis was supported by computed tomography in four patients and by ultrasonography in two. Eight of the patients were treated by cyst excision and two by lobectomy. The pathological diagnosis made from all specimens was bronchogenic cyst, with squamous metaplasia in two.ConclusionIn newborns, infants, and even children, the development of dyspnea, cyanosis, chronic cough, and fever should alert us to the suspicion of a cystic malformation in the lung, such as a bronchogenic cyst, especially if an air-filled cyst is seen on a plain chest X-ray.

Primary torsion of the omentum in a 6-year-old boy: report of a case.

In the absence of any pathological condition in the pelvis of children who present with acute abdomen, the observation of serosanguineous intraabdominal fluid should prompt the surgeon to investigate the omentum. A 6-year-old boy who was admitted with a clinical picture of acute appendicitis, and was later diagnosed during a laparotomy to have primary torsion of the omentum, is reported. Obesity, exercise, and the presence of a bifid omentum were confirmed to be the predisposing factors.

Disorders of sexual development in a cultural context.

Abstract Background: Disorders of sexual development (DSD) are congenital conditions in which the development of the chromosomal, gonadal or anatomical sex can be deemed atypical. The external genitalia should appear ‘normal’ in size and shape from birth, with no question of abnormality, and the individual must receive appropriate social-environmental feedback in the course of the sexual maturation process. Methods: We review regional differences in the variables considered important for gender assignment in individuals with DSD. Various approaches to certain forms of DSD are analysed within their cultural context. Results: The decision to leave the sex of rearing undisturbed or to change it is difficult. It depends on the patient’s age and the extent to which the gender identity has been established with parental gender preference, social, cultural and religious factors. Severe forms of genetically female congenital adrenal hyperplasia, androgen insensitivity syndrome, 17β-hydroxysteroid dehydrogenase-3, 5α-reductase and cytochrome P450 oxidoreductase deficiencies are found to be the most difficult cases to diagnose and/or manage. Conclusion: Gender assignment in children with DSD is a subject of intense debate. Each case of DSD must be evaluated individually and on its merits and potentials. Although early admission and appropriate diagnostic facilities could provide the correct diagnosis, this is not the case in some cultures. It is seen that ‘gender panic’, social and religious concepts affect the decision-making process in gender assignment, especially in delayed cases.

Use of Sterile Adhesive Film and Polypropylene Mesh in the Construction of a Temporary Silo in the Treatment of Omphalocele

When a primary closure is not feasible, a synthetic material must be used in patients with congenital abdominal wall defects. Sterile adhesive film (drape) is reinforced with polypropylene mesh, and then it is used as a prosthesis for constructing a temporary silo. The drape surface is applied to the herniated viscera, which provides a smooth surface that does not adhere to the bowel loops. The adhesive film (drape) is a sterile, impermeable, transparent, and flexible material, which is readily available in all operating rooms. When combined with polypropylene mesh, an effective prosthesis can be created for the staged surgical treatment of congenital abdominal defects such as omphalocele and gastroschisis.

Cervicomediastinal Thymic Cyst: Report of a Case

Congenital thymic cysts are rare. Consequently, they are often misdiagnosed and not included in the preoperative differential diagnosis of neck masses. We report the case of a 7-year-old boy with a large cervicomediastinal thymic cyst to increase the awareness of this unusual entity. We discuss the clinical features, presentation, and pathogenesis of thymic cysts.

Small Bowel Obstruction due to Anomalous Congenital Bands in Children

Introduction. The aim of the study was to evaluate our children who are operated on for anomalous congenital band while increasing the awareness of this rare reason of intestinal obstruction in children which causes a diagnostic challenge. Patients and Methods. We retrospectively reviewed the records of fourteen children treated surgically for intestinal obstructions caused by anomalous congenital bands. Results. The bands were located between the following regions: the ascending colon and the mesentery of the terminal ileum in 4 patients, the jejunum and mesentery of the terminal ileum in 3 patients, the ileum and mesentery of the terminal ileum in 2 patients, the ligament of Treitz and mesentery of the jejunum in one patient, the ligament of Treitz and mesentery of the terminal ileum in one patient, duodenum and duodenum in one patient, the ileum and mesentery of the ileum in one patient, the jejunum and mesentery of the jejunum in one patient, and Meckels diverticulum and its ileal mesentery in one patient. Band excision was adequate in all of the patients except the two who received resection anastomosis for intestinal necrosis. Conclusion. Although congenital anomalous bands are rare, they should be considered in the differential diagnosis of patients with an intestinal obstruction.

Consequences of extensive glanular dissection

I read with interest the article entitled “TIP hypospadias repair: A pediatric urology indicator operation” by Snodgrass and Bush [1]. The authors state that the increase in glans size does not reduce the likelihood for glans dehiscence, and it is the extent of dissection into the glans wings that effectively reduces dehiscence. A logical extension of this statement is that glans dehiscence is avoided at the expense of a reduced diameter of the glanular urethra, inevitably leading to stenosis. In their unpublished data, the authors do not specifically give the results for urethral stenosis in patients with “extensive” dissection to avoid glans dehiscence. Moreover, the authors’ most recent publication about extensive glans dissection includes a large series of patients, where they prefer to use the indistinct heading “urethroplasty complications,” instead of listing specific complications (stenosis, dehiscence, fistula, etc.) of glans and urethroplasties [2]. In the normal human penis, glans wings merge in the midline ventrally, but are separated by the so-called “septum glandis,” in conjunction with the frenulum [3]. This septum of the glans penis is a median partition within the ventral glans, which extends to the tunica albuginea and is attached to the frenulum and the urethra, and is more prominent after adolescence. The frenulum is also included in the formation of the distal (glanular and subcoronal) urethra [4]. Hence, the approximated glans wings should allow for ventral support of the glanular and subcoronal urethra by a reconstructed neofrenulum. Neither glanular surface enhancement nor extensive dissection of the glans wings and their full-length approximation are anatomically compulsory, and may in fact be counterproductive. According to our experience, the split glans wings should be

The effect of polycythemic hyperviscosity on ischemic bowel necrosis

It is known that polycythemia decreases the fluidity of the blood and impairs tissue perfusion due to red-cell sludging in the microcirculation. In this study, the effect of polycythemic hyperviscosity (PH) on bowel necrosis was evaluated in an experimental model of intestinal ischemia. Twenty-eight Wistar albino rats (90–170 g) were divided into two groups: group 1 was transfused to create hyperviscosity and then intestinal ischemia was produced (n = 16); in group 2 ischemia was produced without transfusion (n = 12). Intestinal ischemia was produced by clamping the superior mesenteric artery and the collateral arcades of the right colic artery for 30 min. Gross and histopathologic evaluations were performed by either immediate necropsy or relaparotomy 24 h later. Microscopic findings were graded from 0 to 3 according to the degree of ischemic changes. In group 1, 2 animals (12.5%) died before 24 h postoperatively; coagulation necrosis with grade 2 or 3 ischemic changes was observed in 10 animals (62.5%). In group 2 only a few hypertrophied Peyers patches and capillary dilation were found, and all histopathologic changes were between grades 0 and 1. The difference between the histopathologic gradings of the two groups was significant (P < 0.001). It appears that in addition to reduced splanchnic blood flow, a secondary effect of PH is needed to induce ischemic coagulation necrosis. PH of the newborn must be considered a risk factor for necrotizing enterocolitis, so-called spontaneous intestinal perforations, and even intestinal atresia.

Response to the comment on "Hypospadias repair with the glanular-frenular collar (GFC) technique"

We thank the correspondents for the opportunity to underline the basics of the human penis anatomy. It is on this premise that the GlanularFrenular Collar (GFC) technique has prompted a revision of current urethroplasties. In normal human penis anatomy, the corpus spongiosum covers the urethra up to the midglanular level. After that level, a fibrous tissue (septum glandis) surrounds the glanular urethra (fossa navicularis), connects the upper and lower median septum and holds the glanular urethra in the midline as a suspensory ligament (Fig. 1) [1]. Traversing the wings of the glans penis, the septum glandis is connected to the frenulum, which is an epidermally lined fibrous tissue included in the formation of the ventral aspect of the distal (glanular and subcoronal) urethra, as proposed