İrfan Karaca

The Effectiveness of Sucralfate Against Stricture Formation in Experimental Corrosive Esophageal Burns

PurposeIn this study, the effectiveness of sucralfate against stricture formation in experimental corrosive esophageal burn is reported.MethodsSixty-four Swiss albino adult male rats were divided into three groups, group A (control; n, 7), group B (esophageal burn induced but not treated; n, 25), and group C (esophageal burn induced and treated with sucralfate, n, 32). Groups B and C were further subdivided into subgroups for evaluation on days 2, 7, and 28. A standard esophageal burn was performed by the method of Gehanno, using 50% NaOH. Oral sucralfate treatment was given to group C at a dosage of 50 mg/100 g twice daily. The rats were then killed after 2, 7, or 28 days. Levels of tissue hydroxyproline were measured in excised abdominal esophageal segments, and a histopathological evaluation was performed with hematoxylin–eosin and Masson’s trichrome staining.ResultsThe tissue hydroxyproline levels were significantly lower in group C than in group B (P = 0.017). There was a significant difference in the stenosis index between groups B and C (P = 0.016). When compared with group B, the collagen deposition in the submucosa and tunica muscularis was significantly lower in group C (P = 0.02).ConclusionSucralfate has an inhibitory effect on stricture formation in experimental corrosive burns and can be used in the treatment of corrosive esophageal burns to enhance mucosal healing and suppress stricture formation.

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.

Percutaneous Treatment of Hydatid Liver Cysts in Children as a Primary Treatment: Long-term Results

PURPOSE To evaluate the effectiveness and long-term results of percutaneous treatment for hydatid liver cysts in pediatric patients. MATERIALS AND METHODS Thirty-four pediatric patients (15 male, 19 female; ages 4-17 years; mean age, 9.4 years) with 51 hydatid liver cysts underwent ultrasound (US)-guided percutaneous treatment with albendazole prophylaxis. There were 15 type II lesions with membrane detachment and 36 type I lesions resembling simple hepatic cysts with pure anechogenic content or small echogenic reflections and a regular well-delineated wall. The method of US-guided puncture, aspiration, injection of hypertonic saline solution, and reaspiration was preferred for 21 lesions. For the remaining 30 larger cysts, the intervention was performed with the same percutaneous technique but followed by catheterization, drainage, control cystography, and sclerotherapy with ethanol. During follow-up, US examinations were performed at 1, 3, 6, and 12 months for the first year and yearly thereafter. RESULTS Percutaneous treatment of hepatic hydatid disease was successful in 33 patients (97.1%). During follow-up, US findings in the lesions changed significantly; at year 1, the inner content of the lesions became heterogeneous with a semisolid appearance, and the mean reduction in volume was 81.4%. At 2-year follow-up, most hydatid cysts had become solid in nature and the reduction in volume reached 65%-99% (mean, 85.1%). There were no recurrences or additional lesions after the follow-up of 1-6 years (mean, 3.1 years). Average hospital stay for the whole group in this study was 3.5 days. CONCLUSIONS The long-term results of percutaneous liver hydatid cyst treatment in children are in accordance with the results in adults. Percutaneous treatment of uncomplicated type I and type II liver hydatid cysts in pediatric patients is an efficient and safe treatment with short hospitalization.

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.

Effects of intrinsic denervation on intestinal morphology in rats with short-bowel syndrome.

Abstract When benzalkonium chloride solution (BACs) is locally applied, to the serosal surface of the intestine, it causes intrinsic denervation (ID) of the myenteric plexus (MP), changes intestinal morphology, and slows intestinal passage by prolonging small-bowel transit time. These effects of ID suggest that chemically-induced bowel denervation may be useful in the treatment of short-bowel syndrome (SBS). How ID affects intestinal morphology in rats with SBS has not previously been investigated. A 75%–80% mid-small-bowel resection was performed in 20 rats with mean body weight 247 ± 30 g. The proximal and distal 2 cm of the resected bowel were examined histologically. After intestinal continuity was maintained by end-to-end anastomosis, a 2-cm jejunal segment was marked with silk sutures to form the test segment. BACs 0.1% was applied to 10 of the 20 test segments according to the modified Fox method, resulting in MP destruction (G1). Saline solution was applied to the other 10 test segments to form the control group (G2). Three months later, the rats were killed and the jejunal, ileal, and test segments were evaluated morphologically. Results were expressed as mean ± standard deviation. The Wilcoxon parametric test was performed to compare the groups during the operation and after death, while the Mann–Whitney U-test was used to compare the data in G1 and G2. No intestinal obstruction was observed in either group. In G1, the body weight increased by 19.1% and the total small-intestinal lengthening was 62.2% (P < 0.05). In the test segment of G1, 75% of the ganglia in the MP were destroyed and villus height, crypt depth, intestinal muscle thickness, number of enterocytes, and villus density increased compared to G2. In the ileal segments of G1, there was an increase of 28.8% in intestinal diameter, 14% in muscle thickness, and 15% in villus density (P < 0.05). No change was observed in the untreated jejunal segments of G1 and G2. Thus, ID of the MP after segmental BACs application of the jejunal level: (1) does not cause intestinal obstruction after 3 months; (2) the increase in bowel diameter in the test and ileal segments increases the absorptive surface of the mucosa; (3) the morphologic changes in the test and ileal segments verify an increase in intestinal adaptation; and (4) BACs application in rats with SBS is an easy procedure with no morbidity or mortality, and can be used to increase intestinal adaptation in rats with SBS.

Blunt renal injuries in Turkish children: a review of 205 cases

A retrospective analysis of the medical records of 205 children with renal injuries secondary to blunt abdominal trauma is used to make recommendations regarding the initial diagnostic and therapeutic approaches in this type of patient. It was found that the absence of hematuria on initial urinalysis does not exclude a serious renal injury. Thus, following blunt abdominal trauma, all children should undergo imaging procedures to exclude renal injury, whether they have hematuria or not. Ultrasound is a good initial screening procedure in all patients. Computed tomography is recommended for the definitive evaluation of suspected major renal injuries. Since even major renal injuries may heal without surgical intervention, conservative management is the recommended initial treatment of choice. Surgery is reserved for those children who are hemodynamically unstable and those that develop complications.

Simple testicular cyst: A rare cause of scrotal swelling in infancy

A simple testicular cyst is a rare cause of scrotal swelling in infancy. Only 10 cases have been reported in children less than two years of age in the English literature. Pathogenesis of the lesion is unclear. Preoperative diagnosis is possible using ultrasonography (US). Testis‐sparing surgery with simple enucleation of the cyst has a favorable outcome. We report two patients with a simple testicular cyst, who were 9 and 8 months of age. The first case was referred with a presumptive diagnosis of hydrocele, and the second infant was admitted with a history of testicular swelling. Ultrasonography provided accurate preoperative diagnosis in both of the cases. The patients were successfully treated with testis‐sparing surgery with outstanding long‐term results. This unusual lesion of infancy should be considered in the differential diagnosis of a scrotal mass.

Primary Duhamel-Martin operations in neonates and infants.

Abstract Background : With advances in neonatal anesthetic and surgical care, a safe, one stage, definitive procedure has been possible in Hirschsprung’s disease. Since 1996, we have performed this type of operation in the neonatal and early infancy period. We aimed to review our data to state the feasibility of this operation in these age groups.

Ureteral fibroepithelial polyps in children

Fibroepithelial polyps of the ureter presenting as pelviureteric junction (PUJ) obstruction in two boys are reported. These neoplasms are uncommon, especially in children. Surgical excision of the PUJ with the polyp and dismembered pyeloplasty was performed in each case. Postoperative recoveries were uneventful.

Waardenburg syndrome with extended aganglionosis: report of 3 new cases

PURPOSE The Waardenburg-Shah syndrome is an autosomal recessive disease with varied penetration where Hirschsprungs disease and the Waardenburg syndrome are seen together. Although the length of the involved intestinal segment varies in this syndrome, most patients had total colonic aganglionosis with or without small bowel involvement. We present in this study 2 siblings and one first-degree relative for a total of 3 male patients with Waardenburg syndrome and total colonic aganglionosis with or without small bowel involvement, together with their clinical characteristics and treatment methods. PATIENTS The patients who presented with intestinal obstruction findings within the first 48 hours after birth were operated on with 2 patients under elective conditions and 1 as an emergency. The ganglionic segment lengths were 6, 8, and 20 cm, respectively. Aganglionic enterostomy was performed, and the Ziegler operation was used for these patients. The enterostomies started to function on the third postoperative week, and they started to gain weight. However, all died because of sepsis on the 5th to 12th month. CONCLUSION Waardenburg-Shah syndrome patients have a higher incidence of total colonic aganglionosis with or without small bowel involvement. The Ziegler operation may be used in patients with inadequate ganglionic bowel length to gain some time for the child to grow and to decrease total parenteral nutrition complications.