Volkan Sarper Erikci

Isolated salpingeal torsion in children: a case series and review of the literature.

This study was carried out to evaluate and determine the history, clinical presentation, and physical examination and laboratory findings in a pediatric (n=1) and adolescent (n=2) population with isolated tubal torsion (ITT) and to examine its surgical management. A retrospective review of all the cases of ITT treated in our hospital between January 2000 and December 2012 was performed. The diagnosis of ITT was performed by physical examination and radiological studies including ultrasonography (US), color Doppler US, and computed tomography (CT) and confirmed by surgical intervention. There were 3 children with ITT in the study period. Two of the patients were adolescents and one was diagnosed in the neonatal period. Two patients had left-sided ITT. The neonatal patient was diagnosed with abdominopelvic mass antenatally. ITT in the other two children occurred three days after the onset of symptoms. All the patients in this study were treated with salpingectomy. ITT is rarely diagnosed preoperatively, and is treated mostly by salpingectomy. A better recognition of this entity may help to improve the treatment of this rare condition. As advocated for ovarian salvage in adnexal torsions, earlier diagnosis and preservation of the tube, if possible, with prompt surgical intervention may increase the future reproductive potential of these patients.

Management of epididymal cysts in childhood

BACKGROUND A retrospective review was carried out to evaluate the clinical presentation of children with epididymal cysts (EC) and outcome of management at our institution. METHODS There were 49 patients with EC in this series. The diagnosis of EC was made by physical examination and confirmed by ultrasound (US). RESULTS The average age at presentation was 10.7 years (2 months-16 years). Scrotal mass (n: 22) and pain (n: 21) were the most frequent symptoms. Seven patients were lost to follow-up. The cysts were solitary in 32 patients and multiple in 10 patients. The mean value of cysts was 6.7 mm (2-20 mm). The cyst localisations were 22 in left, 16 in right, and bilateral in 4 patients. Complete involution of cysts was detected in 14 children. The average involution time was 11.2 months (1-37 months). In 20 cases, a decrease in cyst size was found. Cyst excision was performed in 8 patients with persistent scrotal pain or no cyst involution observed during follow-up. CONCLUSION Conservative management of epididymal cysts is practical. However, surgical excision is recommended in patients with intractable scrotal pain or if the cyst size does not seem to involute.

Demographic characteristics in patients with short-gap and long-gap esophageal atresia: a comparative study

BackgroundThe knowledge of the size of the gap between esophageal ends in esophageal atresia (EA) before surgery is of clinical importance. The aim of this study was to compare the demographic characteristics between patients with short-gap esophageal atresia (SGEA) and long-gap esophageal atresia (LGEA). Patients and methodsMedical records of all patients managed for EA spectrum in our department between 2003 and 2012 were evaluated, retrospectively. Demographic data included the maternal age, the number of parities and deliveries, the presence of polyhydramnios and the prenatal diagnosis, sex, the gestational age and prematurity, the type of delivery and the birth weight, age at the time of diagnosis and treatment, the presence of associated anomalies including VACTERL-type and non-VACTERL-type anomalies, the type of EA according to Gross classification, and discrepancies between the diameters of atretic esophageal ends. SGEA and LGEA were defined as a gap of less than three vertebral bodies or three or more vertebral bodies in length between the atretic esophageal ends, respectively. ResultsThere were 99 patients treated for the diagnosis of EA spectrum during the study period: 81 in the SGEA group and 18 in the LGEA group. Most of the parameters studied did not differ between the two groups. Type-C EA was more prevalent in patients with SGEA (n=77/81) and type-A was more frequent in children with LGEA (n=8/18) (P<0.05). The frequency of prenatal diagnosis (2.5% for SGEA vs. 22.2% for LGEA) was more common in the LGEA group (P<0.05). Cesarean section compared with normal vaginal delivery was more commonly seen in both groups (56.8% for SGEA vs. 66.7% for LGEA). ConclusionMost of the demographic parameters were similar between the two groups of patients. However, the frequency of prenatal diagnosis was more common in patients with LGEA. Most of the patients in both groups were delivered by a cesarean section. Type-C EA was more prevalent in patients with SGEA and type-A was more frequent in children with LGEA. Further analysis of this topic is warranted and may be beneficial in revealing the true demographic differences between patients with SGEA and LGEA.

Treatment of acute scrotum in children: 5 years’ experience

BACKGROUND A retrospective review was carried out to determine the incidence of various causes and outcome of management in patients with acute scrotum. METHODS Fifty children had a diagnosis of acute scrotum between 1st January 2007 and 15th May 2012. Age, mode of presentation, associated anomalies, and results of treatment were studied. Diagnosis of acute scrotum was confirmed by physical examination, Doppler ultrasound and biochemical investigations. RESULTS Clinical presentation consisted of sudden swelling and pain in the inguinoscrotal region. The average age was 7.5 years (2 months-14 years). Causes of acute scrotum were orchitis/epididymo-orchitis (O /EO) in 22, strangulated inguinal hernia (SIH) in 16, testicular torsion (TT) in 11, and torsion of testicular appendage (TTA) in 1. Associated urological anomalies were found in 5 patients with O /EO. Medical treatment was applied to patients with O /EO, and surgical treatment was performed in patients with SIH, TT and TTA. CONCLUSION In this series, O /EO was found to rank first as the cause of acute scrotum. Immediate surgical treatment in acute scrotum patients, except those with O /EO, is necessary. Associated urological anomalies should be investigated in patients with O /EO.

Repair of Pulmonary Air Leakage with Polyglicolic Acid Sheet in Children with Pulmonary Hydatid Cyst

Immune thrombocytopenic purpura (ITP) is a common pediatric disease characterized by a low circulating platelet count. A 12-year-old female presented to the Emergency Department with menorrhagia of 10 days. Her physical exam was remarkable for ecchymosis in the lower extremities with petechia in the ankles. Hemoglobin and Hematocrit were 7.7 g/dl and 23.4% with platelets of 10/mm³ and giant platelets seen on the smear. She was admitted in the inpatient unit and successfully treated. ITP is a diagnosis of exclusion and a complete workup should be performed to rule out other etiologies. The risk of serious bleeding remains small.

A Paratubal Cyst Associated with Flegmonous Appendicitis: A Case Report and Review of Literature

Paratubal cysts (PTCs) are remnants of paramesonephric or mesonephric ducts and mostly benign. Paraovarian and paratubal cysts are used synonymously. These masses have been reported in all age groups, beginning from premenarchial period up to menopause, but most commonly are seen in the third and fourth decades of life. A 14- year-old girl wih flegmonous appendicitis diagnosed and treated during the management of PTC is presented and discussed.

A rare complication of the Sistrunk's procedure in thyroglossal duct remnant: tracheal injury

Management of thyroglossal duct remnants (TGDRs) is a common clinical concern in childhood. A girl with an unusual complication of tracheal injury secondary to the Sistrunk’s procedure is presented and discussed with regard to the relevant literature on airway injuries during the procedure. Surgical resection is an optimal choice of therapy in TGDRs and may be associated with high morbidity, especially recurrence. Although the Sistrunk’s procedure is a safe and successful technique, life-threatening complications should be kept in mind during the management of TGDRs.