Levent Duman

The efficacy of single-dose 5-fluorouracil therapy in experimental caustic esophageal burn

INTRODUCTION Accidental ingestion of caustic substances may cause serious problems in children. Approximately 20% of caustic ingestions result in esophageal stricture formation, resulting from excessive collagen synthesis to the extracellular matrix by fibroblasts. Recent studies showed that a single application of 5-fluorouracil (5-FU) is a very effective inhibitor of fibroblast proliferation and differentiation for prolonged periods. Using an experimental model, we investigated the efficacy of single-dose 5-FU on stricture formation after caustic esophageal burn. MATERIALS AND METHODS Forty Wistar-Albino rats were divided randomly into 4 equal groups: group 1 (sham-operated group), the esophagus was uninjured and untreated; group 2 (control group), the esophagus was injured and left untreated; group 3 (intraperitoneal treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraperitoneal dose (20 mg/kg) of 5-FU; group 4 (local treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraesophageal application of 5-FU at a concentration of 25 mg/mL. Caustic esophageal burn was produced by instilling 10% NaOH in the distal esophagus. The distal esophagi were harvested at 28 days postoperatively. Histologic sections were assessed by measuring the stenosis index (SI) and histopathologic damage score. Hydroxyproline (HP) levels in the tissues were determined biochemically. RESULTS There were significant reductions in the SI (P < .05), histopathologic damage score (P < .05), and HP level (P < .05) in the intraperitoneal treatment group when compared with the control group. No significant differences in the SI and histopathologic damage score were detected between the control and local treatment groups (P > .05), whereas significant reduction in the HP level was determined between these groups (P < .05). CONCLUSION A single intraperitoneal dose of 5-FU had a preventive effect on stricture formation after caustic esophageal burn. This observation suggests that 5-FU may prevent this undesirable complication in the clinical setting. Clinical studies are now required to verify this form of treatment. Local intraesophageal application of 5-FU immediately after the burn injury was not effective. Further investigations are required to determine the appropriate timing of application of 5-FU at the local site of injury.

Hyponatremic seizure due to huge abdominal cerebrospinal fluid pseudocsyt in a child with ventriculoperitoneal shunt: a case report.

Placement of ventriculoperitoneal(VP) shunt is a worldwide accepted procedure for treatment of hydrocephalus. This procedure have various intra-abdominal complications, of which pseudocyst formation is a rare one. Common presentations of this complication are abdominal mass, abdominal pain, intestinal obstruction, and shunt dysfunction. In this paper, we report a case of 3 year-old boy with cerebrospinal fluid (CSF) pseudocyst of the VP shunt presenting with hyponatremic seizure. To the best of our knowledge, hyponatremic seizure has not been previously reported as a presentation of abdominal CSF pseudocyst in the literature. Our case has also the largest CSF pseudocyst with respect to body surface area of the child in the literature.

Efficacy of lanolin and bovine type I collagen in the treatment of childhood anal fissures: A prospective, randomized, controlled clinical trial

PurposeWe designed an open-labeled, prospective, randomized, controlled clinical trial to test the efficacy of topical lanolin ointment (PureLan) and bovine type I collagen spray (Gelfix) in the treatment of childhood anal fissures.MethodsSeventy-one children with acute anal fissure were divided randomly into three groups: group I (control; n = 25), group II (PureLan; n = 28), and group III (Gelfix; n = 18). All children were assigned to have warm sitz baths, topical analgesic creams, and stool softeners. Patients in groups II and III were also treated with topical lanolin ointment and bovine type I collagen, respectively. All children were re-examined 4 weeks later.ResultsComplete healing of the anal fissure was observed in 68% of the group I patients, but in 92.9% and 100% of the group II and III patients, respectively. The difference among groups was significant in terms of complete fissure healing (P = 0.003), but the efficacy of topical lanolin ointment and bovine type I collagen spray did not differ significantly (P = 0.078).ConclusionOur data suggest that topical lanolin ointment and bovine type I collagen spray are effective in the treatment of acute anal fissure in children.

Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum

Foreign body (FB) ingestion is a common condition in childhood. Most ingested FBs pass through the GI tract without any complication. Nevertheless, penetration of the intestinal tract is possible by sharp or pointed objects. Perforation may occur if such objects become lodged in a narrow segment of the GI tract. The morbidity depends on the continued route of the penetrating object and whether septic sequela ensue. 1 Although FBs may migrate to any intra-abdominal organ, perforation of the duodenum and migration into the liver are extremely rare. Only one case has been reported in the literature, in an adult woman. The pin was described in the liver, with the head of the pin in the lumen of the duodenum. In that case, the pin was removed laparoscopically. 2 Tothebestofourknowledge,wereportherethefirstpediatric case of an ingested pin that migrated from the duodenum into the liver. The pin was removed by flexible EGD by using a polypectomy snare, with the patient under general anesthesia. The patient tolerated the procedure well, without untoward effects.

Percutaneous management of bile-plug syndrome: a case report

Bile-plug syndrome is defined as an obstruction of the common bile duct by bile sludge in full-term infants. It is a correctable cause of obstructive jaundice in infants and is generally treated surgically. Here, we present a case of a 5-month-old infant with bile-plug syndrome, which was treated by percutaneous biliary interventions. To the best of our knowledge, percutaneous treatment of bile-plug syndrome is reported for the first time in an infant. This minimal invasive treatment modality may be a useful alternative to surgery in infants with bile-plug syndrome.

Cystic Eechinococcosis in Childhood: Five-Years of Experience From a Single-Center.

OBJECTIVE To evaluate the clinical data and prognosis of cystic echinococcosis during a 5-year period who were followed by the pediatric clinics. METHODS Demographic, clinical, laboratory, and prognosis data of 34 patients with cystic echinococcosis obtained between 2009 to 2014 were retrospectively evaluated. Of these, 10 patients were excluded because of incomplete data or failure to follow up. RESULTS A total of 24 (12 males and 12 females) children were included the study. The mean ages of patients were 11.17 ± 3.71 (range, 5-17) years. The most common symptoms were abdominal pain (41.7%), cough (16.7%), and fatigue (12.5%). Localization of the parasite in the patients was determined to be as follows: liver (54.2%), lung (33.3%), and intraabdominal (4.2%). Multiorgan involvement was observed in 8.3% of the cases. Indirect hemagglutination test was positive in 13 (54.2%) patients at admission. All patients received treatment with albendazole. Seven patients were treated with puncture-aspiration-injection-re-aspiration (PAIR) (29.2%). Open surgery was performed in six patients (24.2%). One patient was treated with both PAIR and open surgery. CONCLUSIONS Cystic echinococcosis is a serious public health problem in developing countries. Hydatid cyst should be considered in the presence of suspicious radiological and clinical findings in endemic areas.

The correlation between preputial blood flow and microvessel density in distal hypospadias: A prospective clinical study

OBJECTIVE A prospective clinical study was designed to investigate the correlation between preputial blood flow (BF) and microvessel density (MVD). PATIENTS AND METHODS A total of 44 children were included in the study. The hypospadias group consisted of 16 children undergoing distal hypospadias repair, and the control group consisted of 28 age-matched healthy children undergoing circumcision. BFs were measured using a laser Doppler flowmeter on the most distal part of the dorsal prepuces, and then the tissue samples were harvested from the same location. They were immunostained with an antibody against CD31 in order to assay MVD. The statistical analyses were carried out using Students t test and Pearsons correlation analysis. RESULTS The preputial MVD was found to be significantly decreased in the patients with hypospadias compared with the healthy children (33.95 ± 9.79 vs. 48.25 ± 10.08; p < 0.05), whereas there was no difference in terms of the BF (40.58 ± 16.16 vs. 33.09 ± 19.65; p > 0.05). CONCLUSIONS We found no correlation between the preputial MVD and BF in the present study. This result suggests that reduced preputial MVD does not have any influence on BF in distal hypospadias.

Early diagnostic clues in neonatal chronic gastric volvulus.

PurposeNeonatal gastric volvulus (GV) is a rare clinical entity with a challenging diagnosis. In this study, we aimed to identify clinical and radiological findings to aid in early diagnosis in neonatal GV.Materials and methodsThe medical records of all neonates with GV were retrospectively reviewed. Diagnosis was made based on clinical findings and radiological images, and was documented by an upper gastrointestinal (UGI) contrast study.ResultsA total of eight neonates were included in the study. The most common clinical presentations were non-bilious vomiting and epigastric distention. The findings highly suggestive for GV in plain radiographs include gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium.ConclusionGV should be suspected in any newborn with non-bilious vomiting and epigastric distention. It is also important to focus on the clues in the plain radiographs. Gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium must alert the physicians to the possibility of GV.

Successful Surgical Management of Congenital Prepubic Sinus

Address for Correspondence: Dr. Levent Duman, Department of Pediatric Surgery, Süleyman Demirel University Medical School, Isparta, Turkey Phone: +90 246 211 92 49 e-mail: leduman@gmail.com Received: 01 April 2016 Accepted: 02 August 2016 • DOI: 10.4274/balkanmedj.2016.0538 Available at www.balkanmedicaljournal.org Cite this article as: Duman L, Savaş Ç, Özbiçer C, Bircan S. Successful Surgical Management of Congenital Prepubic Sinus. Balkan Med J 2017;34:88-9 ©Copyright 2017 by Trakya University Faculty of Medicine / The Balkan Medical Journal published by Galenos Publishing House. Congenital prepubic sinus (CPS) is a rare anomaly characterized by a sinus tract extending from the prepubic area to the anterior bladder wall. Herein, we present a further case of CPS. A 20-month-old boy was admitted to our hospital with a 3-month history of recurrent mucopurulent discharge from a pinpoint opening located over the prepubic area (Figure 1a). He had no voiding problems. Physical and laboratory findings were normal. Soft-tissue ultrasound (USG) revealed a 26x9 mm cystic lesion containing loculated fluid collection in the prepubic soft tissue. Magnetic resonance imaging (MRI) (Magnetom Avanto 1.5T; Siemens, Erlangen, Germany) showed a sinus tract with no communication with the urinary system (Figure 1b). A retrograde urethrogram also showed no communication between the fistula and the urinary tract (Figure 1c). During the operation that ensued, a 3 cm-long tract running closely to the pubic symphysis and extending toward the bladder was totally resected (Figure 1d). Histopathologic examination showed that the sinus was lined by only a stratified squamous epithelium and surrounded by bundles of smooth muscles (Figure 1e). As the number of reported cases of CPS has steadily increased, its embryology is still unclear. The condition was first described as a variant of dorsal duplication of the urethra (1). The presence of a squamous epithelium in or near the skin and a transitional epithelium in the blind deeper part of the sinus with surrounding smooth muscle reinforces this theory (2). But the presence of only a squamous epithelium in our case does not support this theory. The other two theories are that it is a mild anomaly of a midline abdominal wall closure defect, or that it is a congenital fistula of the primitive urogenital sinus (3,4). A recent popular theory states that CPS may be caused by a residual cloacal membrane and umbilicophallic groove (5). CPS is usually asymptomatic in neonates, and a diagnosis is often made late after extrusion of pus from the sinus as in our patient. The 1Department of Pediatric Surgery, Süleyman Demirel University Medical School, Isparta, Turkey 2Department of Pathology, Süleyman Demirel University Medical School, Isparta, Turkey Levent Duman1, Çağrı Savaş1, Coşkun Özbiçer1, Sema Bircan2

Hypertrophic epicardial adipose tissue mimicking a thoracic mass.

A 25-year-old man presented with a complaint of left chest pain. Radiological images of the thorax showed a mass located in the left lower hemithorax (Figure 1a, 1b, 1c). A left thoracotomy revealed hypertrophic epicardial adipose tissue concomitant with a 2 3-cm brown mass suggesting hibernoma, which is an uncommon benign soft tissue tumor derived from remnants of fetal brown adipose tissue (Figure 1d). However, histopathologic examination showed only white adipose tissue (Figure 1e).