Mustafa Melikoglu

Differentiated thyroid carcinoma in children and adolescents. Clinical characteristics, treatment and outcome of 15 patients.

Background: Thyroid carcinoma in childhood and adolescence is uncommon and because of the slow progression of disease the standard treatment is controversial. The aim of this study was to perform a retrospective analysis of treatment results for differentiated thyroid carcinoma in this age group treated in our clinic. Material and Methods: From August 1988 to February 2001, 15 patients between the ages of 8 and 21 years (average 16.8) were treated for differentiated thyroid carcinoma at Akdeniz University Medical School Departments of General and Pediatric Surgery. The patients included 10 (67%) females and 5 (33%) males. None of the patients had a previous positive history of head and neck irradiation. All patients, except 2, were euthyroid at the time of diagnosis. Results: Nine of the patients underwent total thyroidectomy and in 6 cases subtotal thyroidectomy was performed. There were multiple lymph node metastases in 4 (27%) patients and (various forms of) cervical lymph node dissections were performed in these patients. In addition, 2 children (13%) showed pulmonary metastasis. The incidence of surgical complications was 20% (1 permanent, 1 transient hypoparathyroidism and 1 permanent laryngeal nerve injury). Histological examinations revealed the following: papillary carcinoma in 9 (60%), follicular carcinoma in 5 (33%) patients, and Hurthle cell carcinoma in 1 (7%) patient. Postoperative radioiodine ablation was also added to treatment in 10 (67%) of the patients and all patients received L-thyroxine in suppressive doses. After a median follow-up period of 57 months (range 5–149), all patients are alive and disease-free. Conclusion: Our observations suggest that although most children and adolescents with differentiated thyroid carcinoma are seen with more extensive disease than adults, a total or subtotal thyroidectomy with an appropriate lymph node dissection followed by ablative radioiodine treatment carries a more favorable prognosis.

Deformability and oxidant stress in red blood cells under the influence of halothane and isoflurane anesthesia

1. The effects of halothane and isoflurane anesthesia on red blood cell (RBC) deformability, lipid peroxidation and antioxidant enzymes were tested in rabbits. 2. RBC transit time was significantly increased to 2.12 +/- 0.07 msec after 1-hr halothane anesthesia preceded by 6 mg/kg pentobarbital injections from 1.98 +/- 0.07 msec preanesthesia value (p < 0.05). Thiobarbituric acid-reactive substances also were increased significantly, being 23.35 +/- 2.75 nmol/gHb and 33.11 +/- 5.34 nmol/gHb before and after anesthesia, respectively (p < 0.05). 3. Under halothane anesthesia without prior pentobarbital injection or under isoflurane anesthesia with or without pentobarbital injection, no significant alterations were observed in these parameters. 4. RBC superoxide dismutase activity was decreased in the group anesthetized with the pentobarbital-halothane combination. The impaired RBC deformability and increased oxidant damage might be related to the free radical formation during the metabolism of halothane. Pentobarbital can potentiate this effect either by inducing cytochrome P-450 or by altering antioxidant defense. 5. Alterations in RBC mechanical properties may contribute to the tissue perfusion problems that develop after surgery under general anesthesia.

Ultrasound-guided percutaneous sclerotherapy of hydatid liver cysts in children

Abstract To evaluate the efficacy of ultrasound (US) guided percutaneous sclerotherapy in the pediatric population, 14 hydatid liver cysts (HLC) in eight male patients whose ages ranged between 6 and 16 years (mean 9.9 years) were treated. The maximum diameter was 110 mm. Albendazole was administered orally to all patients for 1 week before percutaneous treatment and for 3–6 months after the procedure to prevent dissemination of the disease. Cyst puncture was performed with 20 G Chiba needles using US guidance. More than one-half of the estimated cyst volume was aspirated, then 20% hypertonic saline (7 cysts) or sterile 96% alcohol (7 cysts) equivalent to one-third of the estimated cyst volume was injected into the cavity and left for 5–15 min. Finally, all the fluid in the cavity was reaspirated. Catheterization was not performed. Follow-up US examinations were performed every month during the first 6 months and every 3 months thereafter. The follow-up period ranged between 6 and 51 months (mean 15 months). No major complications were seen during or after the procedures. Two cysts in two patients completely disappeared. Volumes of the 11 cysts in five patients who were followed for 6–21 months were markedly reduced (22%–64% of the initial volume) and thick septations and solid debris-like structures were seen within the cyst cavities. There was no significant change in 1 cyst. US-guided percutaneous sclerotherapy is thus a safe and effective treatment of HLC in children.

Severe ischemia of the glans penis following circumcision : A successful treatment via pentoxifylline

Abstract Severe ischemia or necrosis of glans penis is rare. We report the case of an 11‐year‐old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.

The effect of location of the ureteric orifice on the efficacy of endoscopic injection to correct vesico-ureteric reflux.

To review our 11‐year experience and identify the mechanisms responsible for the failure of endoscopic injection for vesico‐ureteric reflux (VUR) with three different injectable agents, based on the location of the ureteric orifice on endoscopy.

TREATMENT OF WILMS TUMOR: A Report from the Turkish Pediatric Oncology Group (TPOG)

Aim: To standardize diagnosis and treatment of childhood Wilms tumor (WT) in Turkey. Methods and patients: Between 1998 and 2006, WT patients were registered from 19 centers. Patients <16 years with unilateral WT whose treatment started in first postoperative 3 weeks were included. Treatments were stage I favorable (FH) and unfavorable histology (UH) patients, VCR + Act-D; stage IIA FH, VCR + Act-D; stage IIB FH, VCR + Act-D + radiotherapy (RT); stage III–IV FH, VCR + Act-D + adriamycin (ADR) + RT; stages II–IV UH tumors, VCR + Act-D + ADR + etoposide + RT. Results: 165/254 registered cases were eligible (bilateral, 5.9%) [median age 3.0 years; M/F: 0.99; 50/165 cases ≤2 years]. 9.7% cases had UH tumors. Disease stages were stage I 23.6%; IIA 36.4%; IIB 5.5%; III 22.4%; IV 12.1%. Cases >2 years had significantly more advanced disease. 1/11 cases with recurrent disease died; 2/165 had progressive disease, 2/165 had secondary cancers, and all 4 died. In all cases 4-year OS and EFS were 92.8 and 86.5%, respectively. Both OS and EFS were significantly worse in stage IV. Conclusions: Despite problems in patient management and follow-up, treatment results were encouraging in this first national experience with a multicentric study in pediatric oncology. Revisions and modifications are planned to further improve results and minimize short- and long-term side effects.

Midline Dorsal Plication to Repair Recurrent Chordee at Reoperation for Hypospadias Surgery Complication

PURPOSE Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We investigated the efficacy of midline dorsal plication for recurrent chordee in complicated hypospadias reoperations. MATERIALS AND METHODS We retrospectively evaluated the charts of 25 boys who underwent reoperation between 1999 and 2004 due to complications of primary hypospadias repair other than meatal stenosis. A total of 15 cases were initially managed elsewhere for primary repair or complications. The etiology of recurrent chordee was defined at surgical correction. When recurrent chordee was noted a midline dorsal plication was performed. RESULTS Of 25 patients 10 had previously undergone chordee repair. Nine of these patients were observed to have recurrent chordee and 1 had de novo chordee. A total of 10 patients had recurrent or delayed onset chordee. Mean patient age at primary repair was 6.28 years (range 1 to 33). Mean age at last operation for chordee was 15.9 years (range 4 to 66). Mean interval to recurrent chordee was 6 years (range 1 to 16), excluding a 66-year-old blind patient who did not know when recurrent chordee developed. Five patients had chordee recur before puberty at a mean interval of 2.6 years. Mean reoperation rate was 2.4 for recurrent chordee cases and 2.6 for chordee-free cases. Mean followup after midline dorsal plication for recurrent chordee repair was 22 months (range 8 to 56), while mean followup in pubertal and postpubertal cases was 20 months. No recurrence of chordee or surgery related morbidity was observed after recurrent chordee repair by midline dorsal plication. CONCLUSIONS Chordee may recur during puberty following successful chordee repair. The midline dorsal plication technique is simple, efficient and safe even in patients who have undergone multiple surgeries for hypospadias and chordee repair.

Unilateral spermatic cord torsion without ipsilateral spermatogenetic material: effects on testicular blood flow and fertility potential

This experiment was planned to answer the question of how the elimination of ipsilateral spermatogenetic material, which is necessary for contralateral testicular damage caused by an autoimmune response, affects contralateral testicular blood flow and fertility potential in unilateral spermatic cord torsion (USCT). Thirty-four male and 68 female adult albino rats were divided into three groups. Group 1 rats underwent a control operation, group 2 rats underwent subepididymal orchiectomy to eliminate spermatogenetic material, and group 3 rats underwent USCT after subepididymal orchiectomy. Testicular blood flows of the rats were measured by 133Xe clearance technique. Additionally, to determine fertility potential, each male rat was housed with two female rats. Numbers of impregnated and delivered rats were recorded. Both mean testicular blood flow and fecundity of group 3 were significantly lower than those of groups 1 and 2. When compared with groups 1 and 2, fertility and mean number of the impregnated rats of group 3 were lower but the differences were not significant. These findings suggest that absence of spermatogenetic material in USCT reduces contralateral blood flow and fertility potential. Therefore, contralateral testicular damage originating from blood flow alterations rather than autoimmune mechanism should be considered to explain fertility problems encountered following USCT.

Percutaneous sclerotherapy of a symptomatic simple renal cyst in a child: observation of membrane detachment sign

A 6-year-old girl with 21 sy mptomatic renal cyst underwent successful percutaneous aspiration and sclerotherapy with hypertnic saline under US guidance. Although membrane detachment sign was seen clearly during aspira tion, it was confirmed to he a simple cyst. In contrast to prey ious reports, membrane detachment sign is not pathognomonic for hydatid and may be seen after simple cyst aspiraion. Therefore differntiation of a symptomatic renal cyst from a hydatid cyst should not depend solely on membrane detachmentIn either case US- or CT-guided percutatneous sclerotherapy should always be considered before surgery.

Cryptococcal mesenteric lymphadenitis: an unusual cause of acute abdomen.

Cryptococcal infection of intraabdominal organs or tissues is extremely rare. Herein we report a child with mesenteric cryptococcal lymphadenitis who presented with an acute abdomen misdiagnosed as acute appendicitis. Definitive diagnosis was established with 2nd look and lymph node biopsy. Clinicians should remember that cryptococcal infection of mesenteric lymph nodes may rarely mimic an acute abdomen and cause delay in diagnosis.