Serdar Moralioglu

Surgical treatment of cervicofacial cystic hygromas in children.

Aim: The aim of this study was to evaluate the results of surgical treatment of cervicofacial cystic hygromas in children. Patients and Methods: Medical records of 17 patients who were operated for cervicofacial cystic hygroma between 1985 and 2004 were evaluated in terms of age, gender, symptoms, diagnostic workups, outcomes and complications. Results: There was a slight male predominance – 10 (59%) boys and 7 (41%) girls. Nine (53%) out of 17 lesions were located on the left side of the neck, 7 (41%) lesions were located on the right side of the neck and 1 lesion (6%) was located in the middle of the neck. Eleven (65%) lesions were located in the infrahyoid region, 6 (35%) lesions in the suprahyoid region. Following surgical excision of the lesion, we encountered 4 postoperative complications: 1 recurrence (6%), 2 facial paralyses (12%) and 1 collection of fluid (6%) at the resection site. The patient who had a recurring lesion needed to be reoperated, other complications were treated conservatively. Conclusions: Cervicofacial cystic hygromas are easy to diagnose. There is no need for expensive and time-consuming imaging studies. Surgery seems the treatment of choice. However, nonsurgical treatment options may be considered for the lesions located over the parotid region in order to avoid complications of surgery.

Sequential cytokine levels in the diagnosis of appendicitis

Objective. To determine the diagnostic value of sequential white blood cell count (WBC), tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) in patients with abdominal pain. Material and methods. Tests were determined at hospital admission and 6 h later in 105 children. Patients who were non‐operatively followed and had a normal histopathology were classified as the non‐appendicitis (NA) group. Patients with symptoms consistent with appendicitis were classified as the appendicitis group (A). Data were analyzed as positive/negative predictive value, sensitivity, specificity and accuracy rate (AR). The global power of the variables in discriminating the patients between the two groups and advanced/simple appendicitis was assessed from the area under the receiver operating characteristic (ROC). Results. Initial measurements showed WBC to be a valuable diagnostic tool in acute appendicitis (AR = 74 %), whereas IL‐6 and TNF‐α were found not to be valuable. The second measurements revealed higher values, and IL‐6 reached its highest AR (89 %). When initial values were evaluated in combination, the highest AR of 73 % was observed with TNF‐α + WBC. The highest AR (90 %) was seen with IL‐6 + TNF‐α in the second measurements. ROC analysis showed WBC to be the most valuable parameter of the three. The area under the curve (AUC) was 0.750 for the initial measurement and 0.779 for the repeat measurement of WBC (p = 0.001). The most useful diagnostic parameter in discriminating between the simple and the advanced cases was IL‐6 as assessed with the ROC curve (p<0.01). Conclusions. WBC elevation in patients with suspected acute appendicitis is an important parameter supporting the diagnosis at initial admission, whereas IL‐6 is a more valuable tool in diagnosing advanced appendicitis.

A child with a giant omental cyst.

Abstract A case of giant omental cyst diagnosed preoperatively is described. A 4-year old girl presenting with abdominal distension and misdiagnosed as having ascites, was subsequently proved to have a giant omental cyst. This is a rather difficult diagnosis to reach and results in wrong treatment methods. A high index of suspicion is therefore required early in the course of the disorder to decrease the complication rate. This report describes the diagnostic modalities and our approach to the patient who was cured by total excision of the cyst and free of disease in the fourth year of follow-up.

Surgical Breast Lesions in Adolescent Patients and a Review of the Literature

Abstract Background/purpose: Breast disease in adolescence is uncommon, with most presenting lesions being benign. Breast lesions in adolescent patients are discussed in this article with a review of world literature. Patients and methods: The clinical records of 30 patients operated upon for breast lesions in our hospital during 18 years were reviewed. Results: There were 25 female and five male patients, ranging in age from 16 years. Twenty-five female patients were operated on for breast mass and/or discharge, and five male adolescents were operated on for gynaecomastia. The most frequent (n = 27) complaint was palpation of mass in the breast. The most common histologies were fibro-adenoma (n = 14) and gynaecomastia (n = 5). The average duration of pre-operative symptoms was 2.9 months for fibro-adeno-ma, 1. 6 years for gynaecomastia (extremes 2 days to 1 year). Nipple discharge was observed in three patients. Average diameters of palpable masses were 2.9 cm for fibro-adenomas and 5 cm for gynaecomastia. Lesions were excised surgically in all patients. Masses diagnosed as fibro-adenomas in the pre-operative period were reported upon pathological examination to be precancerous lesions such as cystosarcoma phylloiedes, juvenile fibro-adenoma, solitary intra-ductal papilloma, tubular adenoma and juvenile papilloma. One postoperative wound infection and one recurrence of fibro-adenoma was seen. Conclusion: The most frequently encountered breast masses were fibro-adenomas. These lesions are mostly benign in nature and can be treated conservatively but the possibility of precancerous lesion should be considered during follow-up.

Postoperative intussusception in children.

Abstract Postoperative intussusception (POI) is an uncommon cause of postoperative mechanical bowel obstruction in children. Four cases of POI during a period of 15 years (1987-2001) were analysed retrospectively. Symptoms developed after a median period of 2.5 days following the operation. All cases were succesfully treated with operative manual reduction. POI occurs after a wide variety of surgical procedures and is often difficult to diagnose because the symptoms are often obscure. As a conclusion, we state that reaching a diagnose requires a high index of suspicion.

Effects of Varicocele on Electrical Field Stimulation-Induced Biphasic Twitch Responses in the Ipsilateral and Contralateral Rat Vasa Deferentia

Aim: Although little is known about the mechanisms, varicocele is considered as one of the factors leading to male infertility. Since reduced motility of the vas deferens was shown to contribute to male infertility, in this study we aimed to investigate the effect of varicocele on electrical field stimulation (EFS)-induced biphasic contractions of the vas deferens in order to evaluate the effect of varicocele on the motility of the vas deferens. Material and Methods: A total of 26 Sprague-Dawley rats (200–250 g) were assigned randomly into two groups: sham (n = 10) and varicocele (n = 16). Varicocele was produced by partial obstruction of the left renal vein. Four weeks after the surgical procedure, vasa deferentia were harvested and EFS-induced responses were recorded from the strips prepared from ipsilateral and contralateral sides via Grass isometric force displacement transducers. Exogenous α-β methyl ATP was applied at the concentration of 10–5M to the vasa deferentia strips, and exogenous noradrenalin was applied cumulatively at the concentrations between 10–7 and 10–4M. At the end of each experiment, 80 mM KCl was applied to induce contractions. All contractions were expressed as the percentage of the 80 mM KCl-induced contractions. Results: Varicocele significantly inhibited both phases of EFS-induced biphasic contractions in the ipsilateral side, whereas in the contralateral site it did not produce any change. However, there was no change in exogenously applied α-β methyl ATP, noradrenalin and KCl-evoked contractions of the vasa deferentia obtained from both sides. Conclusions: These results suggest that varicocele affects the ipsilateral vas deferens motility by reducing neurotransmitter release.

Cefoperazone Induced Gastro-intestinal Haemorrhage. A Case Report

Abstract Cefoperazone is a parenteral third generation cephalosporin which is active against many Gram positive and Gram negative organisms. Cefaperazone, like other cephalosporins which contain methyltiotetrazole side chain, can cause hypoprotrombinaemia and bleeding problems. Here we report a nine-year old child with Meckel’s diverticulum who had cefoperazone induced massive gastrointestinal bleeding on the fifth day following the operation.

INHIBIN B LEVELS IN PERIPHERAL VEIN DO NOT CORRELATE WITH INHIBIN B LEVELS IN THE SPERMATIC VEIN IN ADOLESCENTS WITH VARICOCELE

This study was conducted to evaluate the inhibin B with FSH and LH levels on spermatogenesis in varicocele patients. The study group consisted of 10 adolescent with left idiopathic varicocele of grade II and III. Blood specimens were obtained from dilated spermatic vein and peripheral vein simultaneously. Peripheral samples were also collected from 7 healthy children as controls. Inhibin B was measured with ELISA inhibin B kits. FSH and LH were analyzed by radioimmunoassay techniques. The results were analyzed using Mann-Whitney U and Spearmans rank tests. A value of p < 0.05 was considered significant. Peripheral FSH, LH and inhibin B levels were the same in the study and control group (p > 0.05). Mean inbibin B levels of spermatic vein were significantly higher than the control and peripheral blood of the study groups (p < 0.05). FSH, LH, and inhibin B levels correlated poorly each other (p > 0.05). Preoperative serum inhibin B concentration could not reliably predict a response to varicocelectomy, but the increase in inhibin B levels after treatment might suggest an improvement in testicular function.

Effects of Mexiletine on Electrical Field Stimulation-Induced Contractile Responses in the Ipsilateral and Contralateral Vasa Deferentia after Unilateral Testicular Torsion/Detorsion

Aim: To investigate testicular torsion-induced changes on the electrical field stimulation (EFS)-induced contractions in rabbit vasa deferentia and to evaluate the effect of mexiletine. Methods: 18 male New Zealand albino rabbits were used in this experiment. Rabbits were divided into three groups: (1) control group (n = 6); (2) torsion group (n = 6), and (3) mexiletine group (n = 6). In the control group, vasa deferentia on both sides were harvested. In the torsion and mexiletine groups, the left testes of the rabbits were subjected to 720° of clockwise torsion for 2 h and then detorsion was performed. In the mexiletine group, 50 mg/kg i.p. mexiletine was administered 1 h before detorsion. Following 24 h of the torsion, vasa deferentia on both sides were harvested and 2-cm strips including both the prostatic and epididymal portions were prepared to record EFS-induced contractions. Results: Testicular torsion caused a significant inhibition in both phases of EFS-induced biphasic contractions of the ipsi- and contralateral vasa deferentia. Mexiletine treatment did not affect these inhibitory responses. Torsion/detorsion of the spermatic cord did not alter exogenously applied noradrenaline-induced contractions in both vasa deferentia. However, KCl-induced contractions diminished significantly in ipsilateral vas deferens of the torsion group and mexiletine restored this inhibition. Conclusions: Unilateral testicular torsion/detorsion leads to inhibition in both phases of EFS-induced biphasic contractions of the ipsi- and contralateral vasa deferentia by causing a defect in presynaptic nerve transmission. However, mexiletine has no effect on this inhibition. Inhibition of the KCl-induced contractions in the ipsilateral vas deferens, which indicates postsynaptic tissue damage, is restored by administering mexiletine 1 h prior to detorsion.

Intestinal Perforation Due to Phytobezoar Obstruction: a Case Report

Abstract Phytobezoars are uncommon causes of acute abdomen. We report a patient who presented with acute abdomen and who was intra-operatively diagnosed as having a small intestinal perforation due to an intestinal phyto-bezoar.