Tanyel Fc

Sclerotherapy for lymphangioma in children

Although surgical excision has been considered to be the treatment of choice by most of the surgeons, sclerotherapy of lymphangioma has gained popularity during recent years. A prospective clinical trial was conducted to evaluate the efficacy of bleomycin and OK-432 sclerotherapies for treating lymphangioma in children. Fifteen patients were enrolled in the study conducted between 1998 and 2002. All patients were hospitalized. Bleomycin or OK-432 was injected into the lesion. Patients were observed in the hospital for 1 day. The response was considered as excellent in cases with total disappearance of the lesion. If the lesion was regressed more than 50% of the original size, the response was considered as good. Little or no change in the size of lesion was considered to be a poor response. Ten girls and five boys with ages ranging from 4 days to 12 years were treated. Five patients had been operated previously for lymphangioma. Most of the lesions were located only in the cervical region (n=13). Other cases revealed extensions into the mediastinum (n=1) or axilla (n=1). Bleomycin (n=8, 2.87+/-2.03 inj.), OK-432 (n=5, 2+/-1 inj.) or both in order (n=2, 6 and 16 injs.) were injected. No allergic reaction, scar formation or pulmonary complication was encountered. Fever (11%), local reactions (4%) and vomiting (2%) were encountered following a total of 55 injections. After a follow-up period of 6-36 months, the responses were excellent in 53.4%, good in 26.7% and poor in 6.6%. Macrocysts disappeared in the remaining 13.3% of patients who had mixed cervicofascial lymphangioma. Lower success rates were encountered among patients who had undergone prior surgery. Sclerotherapy with bleomycin and OK-432 is effective in the treatment of lymphangioma in children. Adverse effects are minor and rarely encountered. However, the surgeon should be alert for the possible serious complications. Sclerotherapy can be also used as an adjunctive therapy in the treatment plan of widespread or mixed forms of lymphangiomas. In the light of our results, sclerotherapy should be preferred as the primary mode of treatment in childhood lymphangiomas.

Bilateral Poland anomaly

Bilateral absence of the pectoralis major muscle with accompanying abnormalities of shoulder muscles has been reported in patients without Poland anomaly (PA). However, symmetric absence of pectoralis major muscles, hypoplasia of breasts and nipples with symmetric chest wall deformity and bilateral hand anomaly has not previously been reported. A 6-year-old girl with bilateral absence of pectoralis major muscles and hand involvement and symmetric chest wall deformity is, to our knowledge, the first known case of bilateral Poland anomaly.

Myofibroblasts defined by electron microscopy suggest the dedifferentiation of smooth muscle within the sac walls associated with congenital inguinal hernia

Objective To ascertain the presence of myofibroblasts in sacs associated with inguinal hernia in children, through an ultrastructural evaluation using electron microscopy

Gastrointestinal tract perforation due to blunt abdominal trauma.

Abstract A retrospective clinical study was performed to evaluate the etiology, diagnosis, and management of gastrointestinal tract perforation (GITP) due to blunt abdominal trauma (BAT) in order to find a predictor to avoid delay in diagnosis. Thirty-five children with GITP out of 805 BAT victims (4.3%) over a 21-year period formed the study group. Different parameters including preoperative (mechanism of injury, abdominal and X- ray findings at presentation, diagnostic modalities), operative (type and site of GITP, intra-abdominal associated injuries, surgical method), and postoperative (complications, mortality) status were analyzed. The patients were subdivided according to their initial clinical presentation as group I: evidence of peritonitis (n = 19, 54%); group II: abdominal findings such as distension, minimal tenderness, and guarding (n = 10, 29%); and group III: normal abdominal findings (n = 6, 26%). These groups were also statistically compared to each other with regard to the parameters mentioned above. The Mann-Whitney U, Wilcoxon rank-sum, and Kruskal-Wallis tests were used for statistical analysis. P < 0.05 was considered to be statistically significant. There were 28 boys and 7 girls; the mean age was 8.2 ± 2.4 years. Mechanisms of injury were motor vehicle accidents (MVA) (60%), falls (26%), and bicycle accidents (BA) (14%). Group I patients presented with significantly higher transaminase levels and white blood cell counts than groups II and III. Group I patients and MVA victims were operated upon significantly earlier than group III patients and BA victims because of significantly earlier development of clinical signs of peritonitis. A significantly higher number of multiple perforations was encountered in Group I and MVA victims than in groups II and III and BA victims. The presence of multiple perforations correlated significantly with the earlier development of clinical signs of peritonitis. The analysis of site of perforation with regard to the other parameters did not differ significantly. Fifty-four percent (n = 19) of the patients presented with peritonitis; a pneumoperitoneum was detected in 46% (n = 16). Diagnosis was accomplished by plain radiographs, ultrasound, computed tomography, and, most importantly, frequent abdominal examination of the patient. The sites of perforation were the stomach (4), duodenum (2), jejunum (11), ileum (12), jejunum and ileum (3), colon (2), and ileum and colon (1). Simple closure was the most common surgical procedure (n = 21), followed by resection and anastomosis (n = 12) and simple closure plus creation of a proximal ostomy (n = 2). Two deaths (5.7%) were directly due to head injuries. Our experience revealed that in spite of advanced imaging and laboratory modalities, frequent evaluation of the patient by an experienced surgeon is still the most important tool for early diagnosis and appropriate treatment. A child with BAT should be an inpatient and a high index of suspicion is always required, even in the presence of normal abdominal findings.

Ipsilateral and contralateral testicular blood flows during unilateral testicular torsion by133Xe clearance technique

Testicular blood flows during unilateral testicular torsion were measured by Xenon-133 clearance technique. Xenon-133 was injected via the left carotid artery into the heart. Measurements were performed in control and left-sided testicular torsion groups, each consisting of ten rats. Left and right testicular blood flows, which were 29.157±2.272 ml/100 g/min and 29.773±2.934 ml/100 g/min in the controls, were 11.983±3.655 ml/100 g/min and 16.098±3.757 ml/100 g/min in the experimental group and differed significantly. The decrease in contralateral testicular blood flow may play an important role in the contralateral testicular damage encountered following unilateral testicular torsion.

Subsequent biological effects of chemical sympathectomy in rats undergoing unilateral testicular torsion.

The effects of chemical sympathectomy on contralateral testicular histology, fertility and fecundity following unilateral testicular torsion were evaluated in rats. Four groups, placebo plus sham operation, 6-OH-dopamine plus sham operation, placebo plus torsion, and 6-OH-dopamine plus torsion, were established. When the placebo plus sham operation and placebo plus torsion groups were compared, it was found that contralateral testicular damage following unilateral testicular torsion occurred with significantly decreased values for mean seminiferous tubular diameter (MSTD), mean testicular biopsy score (MTBS) and fertility. The relatively normal values for MSTD, MTBS and fertility in the 6-OH-dopamine plus sham operation and 6-OH-dopamine plus torsion groups indicate the preventive role of chemical sympathectomy on contralateral testicular damage. Since chemical sympathectomy prevents contralateral histologic deterioration and preserves fertility in unilateral testicular torsion, the decreased blood flow in the reflex-activating sympathetic system may play a role in contralateral testicular damage.

Torsion of only spermatic cord in the absence of testis and/or epididymis results in contralateral testicular hypoxia

Unilateral spermatic cord torsion in the presence or absence of ipsilateral testis causes hypoxia in the contralateral testis. An experimental study was conducted to find the most important structure that causes contralateral testicular hypoxia following ipsilateral twisting. In five groups each consisting of 10 rats sham operations, epididymoorchiectomy, spermatic cord torsion, spermatic cord torsion following subepididymal orchiectomy or spermatic cord torsion following epididymoorchiectomy were performed. Lactic acid, hypoxanthine and thiobarbituric acid reactive products of lipid peroxidation (TBAR) were determined in the contralateral testis. While lactic acid, hypoxanthine and TBAR values did not differ significantly following sham and epididymoorchiectomy procedures, evaluation of other groups revealed significantly increased values compared with sham and epididymoorchiectomy groups. Since torsion of only spermatic cord and testicular vasculature causes contralateral testicular hypoxia, testis and epididymis do not seem to be mandatory for occurrence of contralateral testicular hypoxia. Testicular artery under distress seems to be the most important structure that results in contralateral testicular hypoxia following torsion.

Cremaster muscles obtained from boys with an undescended testis show significant neurological changes

Objective To compare cremaster muscles (CMs) obtained from boys with inguinal hernia, hydrocele or an undescended testis and those obtained from girls with inguinal hernia, thus defining the changes associated with each clinical condition.

Acute scrotum due to edidymo-orchitis associated with vasal anomalies in children with anorectal malformations

Epididymo-orchitis, an uncommon cause of acute scrotum in prepubertal boys, is infection or inflammation of epididymis and testis. Epididymo-orchitis may be associated with urinary tract infections or reflux of urine predisposed by an underlying vasal anomaly. Two infants with anorectal malformations who presented with acute scrotum are reported. The surgical exploration of the testes showed findings consistent with epididymo-orchitis. Further radiological investigations of urinary tract showed vasal anomalies in both patients. If a patient with anorectal malformation presents with acute scrotum, epididymo-orchitis should be suspected initially. Evaluations should be directed toward defining predisposing vasal anomaly, and appropriate therapeutic measures should be undertaken to prevent recurrences.

Excessive sac pressures: the pathogenesis and innocence of hydroceles in children

Objective To determine whether paediatric hydroceles result entirely from a small‐calibre patent processus vaginalis, allowing free communication between the abdominal cavity and hydrocele sac, or whether there are other mechanisms.