Tamer Sekmenli

Isolated omental hydatid cyst: clinical, radiologic, and pathologic findings

Hydatid disease (HD) is a parasitic disease that is most commonly caused by the larval stage of Echinococcus granulosus. It is still a severe public health problem in the world and most commonly involves the liver and the lungs. However, HD can occur in almost any part of the body. Isolated omental hydatid cyst is one of the least common sites. Information about the appearance of cysts within the omentum is limited because of their extremely rare occurrence. In the evaluation of HD, clinical findings, serologic tests, and imaging methods such as plain radiography and ultrasonography are useful. This report describes the clinical, radiologic, and pathologic findings of omental hydatid cyst in addition to a literature review.

Epinephrine Injection Associated Scrotal Skin Necrosis

Male circumcision is among the most frequent surgical interventions throughout history. Although considered as a minor intervention, it may have complications ranging from insignificant to catastrophic. These complications can be attributed to the surgical procedure and anesthesia. In this report we present two cases of scrotal skin necrosis after lidocaine with epinephrine injection using subcutaneous ring block technique prior to circumcision.

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones

Purpose: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Methods: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. Results: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Conclusions: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.

Multiple Intestinal Perforation and Necrosis due to Magnet Ingestion

Among the few foreign bodies swallowed, multiple magnets are very rare. Ingestion of Multiple Magnets may lead to a number of dire complications. The present case report is about the ingestion of multiple singing magnets by 4-year-old child leading to intestinal segmental necrosis and perforations.

Unexpected Death Due to Acute Gastric Dilatation and Gastric Necrosis in an 11-Year-Old Boy.

AbstractThis report is related to the unusual case of an 11-year-old boy presenting with acute gastric dilatation after the intake of excessive food and carbonated beverages after a 12-hour fasting who died of complications of acute reperfusion syndrome after decompression of the stomach with gastrotomy. An enormously distended stomach was encountered without volvulus and obstruction in the operation. Autopsy and histological findings revealed a severely distended stomach, the walls of which were notably thin and displayed transmural necrosis. The reported case demonstrated that enormous food and beverage intake may cause acute gastric dilatation and gastric necrosis, and subsequently, sudden death may develop in children. The subject reported here is the youngest child in literature dying from acute gastric dilatation and necrosis without any underlying disorders and exposed to autopsy.

The effects of melatonin and colchicine on ischemia-reperfusion injury in experimental rat testicular torsion model.

PURPOSE The aim of the present study is to investigate the efficiency of colchicine and melatonın in an experimental rat testicular torsion model in the light of histological and biochemical data. METHODS A total of 34 Wistar albino male rats were randomly divided into 5 groups as: Group C (control, n=6), Group S (sham; underwent only left scrotal exploration, n=7), Group TD (torsion and detorsion; 6h of ischemia and 7days of reperfusion, n=7), Group TD/M (TD+Melatonin; 6h of ischemia and 7days of reperfusion and 7days of 17mg/kg intraperitoneal melatonin per day, n=7), group TD/Col (TD+Colchicine; 6h of ischemia and 7days of reperfusion and 7days of 1mg/kg oral colchicine per day, n=7). Histopathologic evaluation of seminiferous tubule deterioration was performed by Johnsens scoring system. Total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels were analyzed in each group. RESULTS The histopathologic scores, total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels in groups C and TD/Col were significantly lower than groups TD and TD/M (P<.001). CONCLUSION Our study results revealed that colchicine reduced testicular ischemia-reperfusion injury in experimental rat testis torsion model. Although detorsion of testis is crucial for the preserving the testicular viability, antioxidant and anti-inflammatory treatment modalities like colchicine might help to reduce ischemia-reperfusion injury in detorsed testis.

Response to the Letter: The Effects of JJ Stents for Extracorporeal Shock Wave Lithotripsy in Pediatric Urolithiasis (Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?)

We do agree that the population size was small in our study as mentioned by Yanaral et al. It is only since 2012 that pediatric renal stones are being removed using shock wave lithotripsy in our department, so these results are the first of its kind and further studies with large populations can be performed. We did not need to use statistical analyses for assessing the stone free rate and complications. We still are of the opinion that the percentage of stone free rate and mentioned complications are clear and adequate. In our research, the stone size was under 20 mm (7–15 mm) and as known, it is one of the main factors effecting the success of shock wave lithotripsy. In conclusion, we have similar opinions about preoperative JJ stenting in children with renal stones. However, further studies evaluating larger stone sizes are needed. Disclosure Statement

Vesicovagynal reflux or not

We read the recently published study by Indiran with great interest [1]. The study was about collection of urine in the vagina (urocolpos) due to vesicovaginal reflux (VVR) or a fistula. We would like to comment about this article. VVR is known as the collection of urine in the vagina during enuresis. Such patients refer to health centers due with complaints such as frequent urinary tract infections, abdominal pain, and underwear wetting. During the diagnosis, other causes—such as voiding problems, conditions leading to urinary tract infections, and vesicovaginal or urethrovaginal fistula—should be excluded [2]. Additionally, imaging studies such as ultrasonography, voiding cystourethrography, and magnetic resonance imaging cystourethroscopy should also be planned for. Defining enuresis position and conducting interventions for total labium opening are the most important steps during treatment [3]. In the case presented by the authors, the presence of urocolpos and ureteropelvic stricture as well as VVR is quite interesting. However, we consider that VVR was not used appropriately in that case, as the reflux was not from the bladder but from the urethra. If it were from the bladder, there would be a separate path, and the condition would be labeled as vesicovaginal fistula. So, naming the condition as urethrovaginal reflux is more appropriate than VVR.

Calcified fibrous pseudotumor with Castleman disease

Simultaneous calcified fibrous pseudotumor (CFT) and Castleman disease (CD) is an extremely rare association. CD is an uncommon lymphoproliferative disease that can arise in various sites of the body, while CFT is a rare type of benign fibrous lesion that frequently affects children and young adults, occurring as solitary or multiple lesions throughout the human body. Both entities are rare and exhibit typical and diverse histomorphological features. We report the case of a 15-year-old female patient, who, at the age of 13 had a biopsy performed at an external medical center; however, after 4 months the lesion had regrown. This lesion was removed with a surgical operation; however, it regrew 2 years later and was removed a third time. The results of the latter two biopsies were the same: CFT accompanying CD. The histologic examination of the excised lymph node and the surrounding tissue showed hyalinized fibrous tissue containing dystrophic and psammomatous calcification. In this case, the hyaline vascular type of CD was found to be intertwined with a CFT, which hampered the differentiation of whether both entities emerged within the lymph node or if the CFT developed from the soft tissue and then involved the lymph node. Future studies involving larger case series will provide a more precise insight, which should serve to resolve the current uncertainty.

Little negligence leading to irreparable harm: thinner burns -

The aim of the present study is to evaluate the epidemiology and outcome of paint thinner induced burn injuries at a local burn center. A retrospective analysis of 55 patient paint thinner thermal burn cases was conducted. Relevant patientsÂ’ data such as age, sex, etiologic factors, burn extent and localization, employed methods of treatment, hospitalization period, and results were evaluated in retrospect from patientsÂ’ records. 50 male and five female patients with a mean age of 26,78 (14-47) years participated in the presented study. Kindling fire with paint thinner was the most frequent etiologic factor. Total body surface burn area was 22,5 % (5-90). The mean hospitalization period of the survivors was 24 (5-64) days. Early excision and split-thickness sking grafting was applied in 22 patients. The remaining 26 patients were treated with topical agents. Total mortality was only 7 (12.7%). These patients had paint thinner induced burned body surfaces of 60 % with accompanying inhalation injuries. Paint thinner may cause catastrophic thermal injuries even with terminal outcomes and should therefore never used to kindle a fire.