Mehmet Serif Arslan

Fluoroscopic balloon dilatation for caustic esophageal stricture in children: an 8-year experience.

PURPOSE Esophageal balloon dilatation (EBD), when performed early and correctly, can efficiently treat caustic esophageal stricture (ES). Herein, we present 8 years of experience treating caustic ES, and discuss the technique as well as the complications. METHODS We retrospectively reviewed the medical records of 38 children in whom we performed fluoroscopic EBD under general anesthesia for caustic ES between November 2004 and November 2012 in our hospitals. The patients were grouped into the early dilatation group, who began EBD earlier (mean, 15 days) after caustic ingestion, and the late dilatation group who was referred later (mean, 34 days) for EBD by other centers. The ESs were classified into short and long strictures. Balloon size was increased gradually to a sufficient diameter over consecutive sessions. Characteristics of patients and ES, details of the EBD, and treatment results were analyzed. RESULTS A total of 369 EBD sessions were successfully performed in 38 children (aged 14 months to 14 years, median 3.5 years). In six patients, EBD treatments are continuing, one patient was lost to follow up, one patient who received a stent was excluded, and three returned to their previous centers. The remaining 27 patients were treated successfully by repeated EBD treatments. Nevertheless, in the early dilatation group (n=16), EBD treatment was significantly faster and shorter than that in the late dilatation group (n=11). In addition, the short stricture treatment was also of significantly shorter duration than the long stricture treatment. Six (1.6%) esophageal perforations occurred in five patients (13.2%); all were treated conservatively. There was no mortality. CONCLUSIONS For treatment of caustic ES, fluoroscopically guided EBD is safe and has a low rate of complications as well as a 100% success rate. However, it should be begun earlier, and in children, should be performed gently with balloons of gradually increasing appropriate diameters over consecutive sessions.

Traumatic diaphragmatic rupture in children

BACKGROUND The purpose of this study was to describe our experience with traumatic diaphragmatic rupture (TDR). Very little has been written about this condition in the pediatric age group. METHODS Between January 2000 and December 2011, data on twenty-two patients with TDR were analyzed, and clinical data were recorded. The patients were divided into subgroups based on injury type and ISS values. RESULTS Four patients were female, and eighteen were male. Mean age was 9.4 years (range 2-15 years). TDR was left-sided in twenty (91%) patients and right-sided in two (9%). The mean ISS (Injury Severity Score) was 19 (range 11-29). No significant difference in morbidity was noted between firearm and other injuries (p=0.565) or between ISS values below and above 16 (p=0.565). Seven patients (32%) had isolated diaphragmatic injury, while the other fifteen cases had additional associated injuries. Diagnoses were determined via a chest radiograph alone in the majority of cases, while suspected cases were confirmed by multidetector computed tomography if the patients were hemodynamically stable. Herniation was observed in twenty patients. Primary suture of the diaphragm and tube thoracostomy were performed in all patients. Postoperative complications included ileus (two cases), intussusception (one case), empyema (one case), and one patient succumbed during the operation. CONCLUSIONS TDR, while uncommon, should be considered in cases of thoracoabdominal injury. All patients should undergo meticulous examination preoperatively. When the chest radiograph does not provide a definitive diagnosis, multidetector computed tomography, including multiplanar reconstruction or volume rendering, may be beneficial for confirming suspicion of diaphragmatic rupture.

A Rare Anomaly of Biliary System: MRCP Evidence of a Cystic Duct Cyst.

Cystic duct cysts are a rare congenital anomaly. While the other bile duct cysts (choledochus and the intrahepatic bile ducts) are classified according to the classification described by Tadoni, there is no classification method described by the cystic duct cysts, although it is claimed that the cystic duct cysts may constitute a new “Type 6” category. Only a limited number of patients with cystic duct cysts have been reported in the literature. The diagnosis is usually made in the neonatal period or during childhood. The clinical symptoms are nonspecific and usually include pain in the right upper quadrant and jaundice. The condition may also present with biliary colic, cholangitis, cholelithiasis, or pancreatitis. In our case, the abdominal ultrasonography (US) performed on a 6-year-old female patient who presented with pain in the right upper quadrant pointed out an anechoic cyst at the neck of the gall bladder. Based on the magnetic resonance cholangiopancreatography (MRCP) results, a cystic dilatation was diagnosed in the cystic duct. The aim of this case-report presentation was to discuss the US and MRCP findings of the cystic dilatation of cystic duct, which is an extremely rare condition, in the light of the literature information.

Intra-peritoneal administration of Ecballium elaterium diminishes postoperative adhesions

PURPOSE To evaluate the effects of Ecballium elaterium (EE), Elaterium officinarum, in postoperative intraperitoneal adhesions in rats. METHODS Thirty rats were divided into three groups and underwent midline laparotomy under 35 mg/kg ketamine and 5 mg/kg xylazine anaesthesia. In group 1 (n=10), the sham operation group, the abdominal walls were closed without any process. In group 2 (n=10), the control group, the antimesenteric border of the ceacum and the corresponding parietal peritoneum were abraded with dry sterile gauze. In group 3 (n=10), the EE group, 2.5 mg/kg dose of EE was administered as intraperitoneally to the rats after abrasion. All rats were sacrificed on postoperative day 15. Samples were obtained RESULTS The adhesion score was significantly decreased in the EE group (p=0.001) in comparison with the control group. Microscopically, the EE and sham groups were significantly lower than that of the control group (p<0.001 and p=0.000, respectively). Furthermore, the measurement of tissue levels of hydroxyproline was significantly lower in the sham and EE groups compared to the control group (sham group: 47.6 ± 10.6, EE group: 62.9 ± 9.7, CONTROL GROUP: 84.2 ± 22.1 mg /L/g-tissue). CONCLUSION The grade and severity of abdominal adhesion could be significantly reduced through administered Ecballium elaterium and therefore be a suitable anti-inflammatory agent for the prevention of postoperative peritoneal adhesion in the future.

Congenital-infantile fibrosarcoma of the ileocecal region: the first case presentation.

Infantile fibrosarcoma is a very rare soft tissue tumor that originates most commonly in the body and extremities. We present a neonate with an infantile fibrosarcoma that originated in the ileocecal region and was detected incidentally without symptoms. This is the first case of fibrosarcoma reported in the ileocecal region.

Protective Effect of Cordycepin on Experimental Testicular Ischemia/Reperfusion Injury in Rats

ABSTRACT Objective: To investigate the role of cordycepin in testicular ischemia/reperfusion injury in rats. Materials and methods: Forty Wistar albino rats were randomly divided into four groups, as follows: group one, control (C); group two, torsion and ischemia (I); group three: detorsion with ischemia–reperfusion (IR); and group four, detorsion/cordycepin. The rats were then analyzed macromorphologically and histopathologically, and blood tests were performed. Specifically, the total oxidant status (TOS) and total antioxidant status (TAS) were determined, and malondialdehyde (MDA), tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β levels were analyzed. In addition, pyknotic nuclei, spermatozoa, edema, and hemorrhage were assessed. Results: When the IR and cordycepin groups were compared with the other groups, there was a statistically significant decrease in TNF-α and MDA levels (p < 0.05). Increased TAS levels were observed in the cordycepin group compared with the control group. TOS levels were significantly increased in the I and IR groups, but decreased in the cordycepin group (p < 0.05). Similar effects were observed in tissue biochemistry analysis. Histopathological evaluations revealed that the spermatozoa count was decreased in the I and IR groups. However, there was an increase in the cordycepin group, as well as a statistically significant difference between the IR and cordycepin groups (p < 0.01). Finally, edema and inflammation were increased in the I and IR groups, but decreased in the cordycepin group. Conclusions: Histological and biochemical findings revealed that cordycepin protected against IR-induced testicular injury.

Effects of Ecballium Elaterium on Proinflammatory Cytokines in a Rat Model of Sepsis.

ABSTRACT Objective: Ecballium elaterium (EE) is a plant from Cucurbitaceae family. Its anti-inflammatory role in sepsis is not well understood. We investigated the effects of EE on serum levels of proinflammatory cytokines and further explored the mechanisms underlying histological changes in liver and ileum following EE administration in a polymicrobial sepsis model. Methods: Thirty rats were divided into three groups of 10 rats each. Rats were subjected to sham laparotomy plus normal saline administration (control group, CG), laparotomy with cecal ligation and puncture (CLP) (sepsis group, SG), and laparotomy with CLP plus 2.5 mg/kg EE administration (experimental group, EG). Twenty-four hours after laparotomy, animals underwent cardiac puncture, and blood was collected for interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) assessment. Whole sections of liver and ileum tissues were collected for histologic examination. Results: The serum level of IL-6 was significantly lower in EG as compared to SG. Although IL-6 levels were shown a statistically significant (p < 0.0001) decline to near control values, no significant changes were observed in serum levels of IL-1 and TNF-α after EE treatment. Histologic examination revealed statistically significant reduction in collagen formation (p = 0.001) on serosal surface of ileum and hepatic venous congestion (p = 0.040) in EG as compared to SG. Conclusion: EE might play a protective role in sepsis prevention and treatment by decreasing IL-6 production and reducing liver damage and may influence bacterial translocation by reinforcing intestinal barrier function.

Type II A2 duplication of urethra in an 8-month-old male child: A case report

Urethral duplication is a rare congenital anomaly, usually found with multiple anatomical variants. In this article was presented a case of urethral duplication in an 8-month-old male child. The malformation was characterized by the presence of continent hypospadic and normal apical urethra. Retrograde urethrogram through both urethral tracts simultaneously revealed the malformation as Effmann Type II A-2. The accessory ventral urethra was excised without complication.

Amyand's hernia complicated with acute appendicitis: A case report and literature review

Amyands hernia is the presence of the appendix within an inguinal hernia sac. It is a rare condition, occurring in 1% of inguinal hernia patients. The clinical presentation varies depending on the extent of appendix inflammation. Amyands hernia is difficult to diagnose clinically. However, imaging studies are valuable for both its diagnosis and detection of the associated complications. Here, we report a case of Amyands hernia in a 3-year-old male child who presented with a history of right inguinal tenderness, pain, and swelling. An operation revealed a hernia sac containing the inflamed appendix; hence, an appendectomy was performed along with a right inguinal herniotomy.

Total Esophageal Avulsion at the Esophagogastric Junction after Blunt Trauma

Total avulsion and transection of the esophagus at the esophagogastric junction are very rare after blunt trauma, and their management is challenging. Here, we present the case of a boy with this injury. To date, only two cases have been reported in children. One was treated successfully and the other died. The initial emergency operation should aim to save the life and native esophagus. Therefore, a primary or early thoracal end esophagostomy with gastrostomy should be performed, while primary repair should not be.