Rectal duplications accompanying rectovestibular fistula: report of two cases.

Rectal duplication (RD) cysts are rare congenital anomalies that can be diagnosed with the presence of another opening in the perineum. They seldom accompany anorectal malformations (ARM). Two cases of RD accompanying ARM at opposite ends of the phenotypic spectrum, are described. A 3-month-old baby and a 2-year-old girl with ARM were scheduled for posterior sagittal anorectoplasty. The infant had an orifice at the anal dimple and the other had an orifice at the vestibulum posterior to the rectovestibular fistula. The infant presented with no other anomalies whereas the older one presented with an unusual coexistence of caudal duplication and caudal regression syndromes. Perioperatively both orifices were found to be related to retrorectal cysts, and were excised. Clinicians should always be alert when dealing with complex malformations. Because these malformations have variable anatomical and clinical presentations, they can represent a diagnostic and therapeutic challenge.

Pyosalpinx and hydrosalpinx in virginal adolescents: report of two cases.

Pyosalpinx and hydrosalpinx are conditions mainly seen in adult women, but also among sexually active adolescents and can bring added hazard to fertility. However these conditions are very rare in childhood, as well as in adolescent girls who are not sexually active. We are presenting two rare cases of young girls in early puberty with hydrosalpinx and pyosalpinx. Both girls had a history of abdomino-pelvic surgery in childhood for congenital bowel anomalies and fecal incontinence. Such cases are good reminders that girls with known abdomino-pelvic anomalies and surgical procedures in childhood need long term follow-up, in particular when entering puberty and maturation. The two cases show how fallopian tubes can be indirectly affected and present in adolescence with serious problems needing surgical procedures and potentially threatening future reproductive system performances.

A rare cause of acute abdominal pain in adolescence: hydrosalpinx leading to isolated torsion of fallopian tube.

Torsion of the fallopian tube accompanying hydrosalpinx is a rare occurrence in the pediatric population. This report describes a 13 year old sexually inactive girl with isolated tubal torsion due to hydrosalpinx. The girl had lower left abdominal pain for two days. The physical examination revealed left lower quadrant tenderness with a firm round anterior mass on rectal examination. Abdominal ultrasound showed left tubal enlargement with free pelvic peritoneal fluid. Magnetic Resonance Imaging (MRI) showed engorgement and dilatation of the left fallopian tube without contrast enhancement suspicious of tubal torsion. At operation, torsion of the left tube on its longitudinal axis was observed, and a salpingectomy was performed. Although rare, the diagnosis of torsion of the fallopian tube should be considered when evaluating acute abdominal pain. The earlier tubal torsion is diagnosed, the greater the likelihood of salvaging the fallopian tube.

Ostomy complications in patients with anorectal malformations.

PURPOSE: Ostomy is an important step in the treatment of patients with anorectal malformation (ARM). Sometimes this basic surgical procedure may cause a devastating complication. METHODS: The medical reports of the patients with ARM who had ostomy in the past were inspected. How many of them were operated in this center or sent from others, the type of ARM, what type of ostomy performed and which place of the bowel used and the complication type and rate related to ostomy and ostomy closure were evaluated. RESULTS: Nearly, 157 of 230 patients with ARM had ostomy during twenty-two years were evaluated. The prevelent type of ostomy was loop (50.3%) and then separated (36.9%), end (7%), double barrel (4.4%) and window (1.2%). The ostomies were located in the tranverse colon (53.5%), descending colon (24.2%), sigmoid colon (17.8), pouch colon (2.5%) and ileum (1.9). Total complication rate was found to be 15.2% (24/157) (window 100%, double barrel 42.8%, separated 15.5%, loop 11.3%, end 9%). The main complication of loop ostomies was prolapse whereas wound problems, stenosis, intestinal obstruction or perforation were serious problems of separated ostomies. Complication rate in the descending colon and tranverse colon was found to be 7.1 and 28%, respectively (p = 0.001). Any difference for complication rate between loop and separated ostomies was not found. Eighteen of separated ostomies had mucous fistula and six of them (33%) were complicated, this rate was higher than those without mucous fistula (p = 0.012). Two babies with separated ostomy were lost due to surgical complications (1.2%). Complication rate after ostomy closure was 10.7% [wound infection (4.4%), intestinal obstruction (1.7%)]. CONCLUSION: According to this study, ostomy performed in the descending colon carries greater risks for complication regardless of its type. Nevertheless, separated ostomy with mucous fistula should be performed by experienced hands.

Negative appendectomy experience in children.

BACKGROUND: The aim of this study was to discuss the findings of our patients who had negative appendectomy. PATIENTS AND METHODS: Hospital records of negative appendectomy for abdominal pain patients were evaluated retrospectively. RESULTS: Negative exploration for acute appendicitis (AP) was done in 149 patients. The most frequent complaints were abdominal pain, vomiting and fever. The commonly established diagnoses after negative exploration were gastroenteritis and urinary infections. However, the frequent pathologies observed during the operation were mesenteric lymphadenitis and Meckel's diverticulum. All patients with systemic disease such as Henoch-Schonlein's purpura operated for AP had it diagnosed during the postoperative course. Interestingly, two different types of worms were found in the lumen of the appendices. CONCLUSION: Despite new techniques, 100% correct diagnosis of AP is still a challenging problem. Furthermore, appendicitis is a deadly disease if not treated properly. Therefore, it is best to perform exploration without undue delay in cases with suspicious AP.

Apart from the other members of PDE inhibitors' family, enoximone does not enhance renal ischemic reperfusion injury: the effects of enoximone on renal ischemia reperfusion.

Many pharmacological agents were investigated for the prevention of renal ischemic reperfusion (IR) injury as well as the phosphodiesterase (PDE) inhibitors. The aim of the study was to examine the possible renoprotective effect of enoximone as a member of this family on IR injury. Thirty-six Wistar-Albino rats were allocated to six groups. Sham (S) and control groups (E1, E2) only received 0.09% NaCl, 5 mg/kg and 10 mg/kg enoximone via caudal caval vein, respectively. In ischemia (I) and treatment groups (IE1, IE2), the rats were subjected to bilateral renal artery occlusion and were given 0.09% NaCl, 5 mg/kg and 10 mg/kg enoximone in the same route, respectively. Bilateral kidneys were removed at the sixth hour of laparotomy for histopathological and biochemical analysis, such as superoxide dismutase, myeloperoxidase, malonyldialdehyde, and nitric oxide end products. Blood samples were taken in order to evaluate renal function tests. The data were analyzed by using one-way analysis of variance, and p < .05 was considered to be statistically significant. The worst results were achieved in ischemia group (p < .05). Treatments groups showed nearly similar findings with this group (p < .05). There was no significant difference between control and sham groups. In this study, we found that apart from the other members of the PDE inhibitors' family, enoximone did not contribute to the attenuation of IR injury of kidney.

Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus.

BACKGROUND/PURPOSE: In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. METHODS: Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature. RESULTS: Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF). CONCLUSIONS: In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.

Ankyloglossia and effects on breast-feeding, speech problems and mechanical/social issues in children.

BACKGROUND: This aim of this study was to define the characteristics of the patients who underwent surgery for ankyloglossia. PATIENTS AND METHODS: The patients (n = 127) with ankyloglossia underwent surgery between 1987 and 2005. The patients were evaluated for age, gender, complaints, grade, and operative procedures. This study did not cover postoperative evaluation of the procedure. RESULTS: The ages of the children ranged from 20 days to 7 years, and 84% of them were under 1 year of age. Seventy-two percent were boys; 28% were girls. The most common complaint of the parents of infants under one year of age was breast-feeding (35/84). When the tongue movements of the patients were examined, 57 patients (of whom 18 were over one year of age) had limited tongue mobility. The mean frenulum length of the patients was grade 1 in 72 patients and grade 2 in 55 patients. Ankyloglossia was corrected by frenotomy. Three patients had bleeding from their frenotomy site which resolved with local pressure. General anaesthesia was preferred for 77 patients, and there was a need for suturing in 20 patients. CONCLUSION: The correction of ankyloglossia at an early age reduces the risk of latent complications. In addition, the early correction will mitigate the feeding- and speech-related concerns of parents and doctors alike.

Association of tumor necrosis factor, interleukin-6 and cyclooxygenase pathway with lipopolysaccharide-induced intussusception.

INTRODUCTION: Many factors and mechanisms have been proposed as causes for intussusception (IN); however, the etiology remains unclear. Inflammatory mediators such as tumor necrosis factor (TNF) and interleukin-6 (IL-6), which are elevated during infectious diseases, can significantly affect gastrointestinal motility. Motility changes caused by these agents might contribute to the development of IN. The aim of this experimental study was to determine the preventive effects of indomethacin on lipopolysaccharide (LPS)-induced IN in mice and to investigate the role of TNF and IL-6 on intussusception. MATERIALS AND METHODS: Seventy-eight mice were divided into five groups. In the Control group (n=6), no procedure was done. In the Sham group (n=6), 1 ml saline, in the Indomethacin group (n=6), 10 mg/kg of indomethacin, in the LPS group (n=30), 12 mg/kg of LPS was administered intraperitoneally (IP). In the Treatment group (n=30), 10 mg/kg of indomethacin was administered IP following 12 mg/kg of LPS. All animals were laparotomized 6 hours following IP injections. The existence of IN was noted and blood specimens were obtained. TNFalpha and IL-6 plasma level measurements were performed by standard ELISA for mice. The results were compared using the Mann-Whitney U test and one-way ANOVA test. A value of p<0.05 was considered significant. RESULTS: Five mice (1 in the control, 2 in the LPS, 2 in the Treatment group) were excluded from the study. IN was observed in 6 (20%) mice in the LPS group, whereas it was not found in any mice in the Treatment group. Mean TNFalpha and IL-6 levels were statistically higher in the LPS group (394.72+/-403.79; 195.18+/-218.37 pg/ml, respectively) compared to all other groups, including the Treatment group (p<0.05 for each comparison). Within the LPS group of mice, the levels were higher in animals with IN compared to the mice without IN. CONCLUSION: Increased TNFalpha and IL-6 levels induced by LPS correlated well with the occurrence of IN, and a decrease in these levels via cyclooxygenase (COX) inhibition by indomethacin prevented IN from forming in this experimental model.

Cefoperazone induced gastro-intestinal haemorrhage. A case report.

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.

The effects of varicocele and its surgical correction on vas deferens motility.

Varicocele is the abnormal dilation of venous pampiniform plexus and internal spermatic vein. Its prevalence in the adolescent period is almost equal to the prevalence of adult age. That is why the disease is accepted to appear in early adolescence and does not disappear spontaneously. Varicocele is established to be the most common cause of infertility in the adulthood period in terms of the testicular and/or epididymal damages it causes. Besides, malfunctioning of testis and/or epididymis cannot be blamed as the one and only reason of infertility. One major reason of the male infertility is vas deferens motility disorders. There is limited data in the literature investigating the effects of varicocele on the vas deferens motility. The aim of the study is to evaluate not only the motility defects of vas deferens for the period of varicocele, but also the effects of surgical varicocele correction on vas deferens motility. Thirty male Wistar-Albino rats were allocated to five groups. In the control group (Gr C, n = 6) bilateral vas deferens strips were harvested without any surgical intervention. Using the partial left renal vein obstruction technique, the experimental varicocele model was performed for the other four groups. Varicocele was apparent for these animals after the fourth week of the venous ligation. Bilateral vas deferens strips of varicocele group (Gr V, n = 6) were harvested. The rest of the animals having varicocele underwent relaparotomies. Three different surgical procedures were performed to these animals. The animals of group P (Gr P, n = 6) and group I (Gr I, n = 6) underwent Palomo and Ivanissevich procedures, respectively, for varicocele correction. And the animals of group S (Gr S, n = 6) underwent sham operation. After 4 weeks of relaparotomies, bilateral vas deferens strips of all three groups harvested. The electrical field stimulation (EFS) induced responses of all vas deferens strips as well as exogenous drug induced responses were recorded and analysed. The results of the study showed that the varicocele significantly inhibited the first phase of biphasic response of vas deferens in the ipsilateral side. However the correction of varicocele, free from surgical technique, ameliorated the affected first phase of EFS induced biphasic response in the ipsilateral side. The results of this study suggest that varicocele can be the reason of male infertility by not only causing testicular and/or epididymal damages but also triggering vas deferens motility defects. The correction of varicocele free from surgical technique may reverse the damaging of the vas deferens. Therefore when indicated surgical correction of varicocele is essential. It seems that varicocele surgery does not only prevent late term testicular and/or epididymal damages but also avoids vas deferens motility defects.

Congenital pouch colon associated with anorectal malformation: report of 2 cases.

Congenital pouch colon associated with anorectal malformation is an unusual anomaly reported most frequently in Asian countries. Pediatric surgeons must be familiar with this anomaly and the pre- and postoperative problems of these patients. The aim of this report is to bring attention to congenital pouch colon associated with anorectal malformation by discussing experiences with 2 patients.

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 alpha-beta methyl ATP was applied at the concentration of 10(-5)M to the vasa deferentia strips, and exogenous noradrenalin was applied cumulatively at the concentrations between 10(-7) and 10(-4)M. 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 alpha-beta 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.

Effect of melatonin on healing of colonic anastomosis in a rat model of peritonitis.

BACKGROUND: The aim of this study is to determine the effect of melatonin on intestinal anastomosis in the presence of peritonitis. MATERIAL AND METHODS: 32 Wistar albino rats were randomized into four groups (n = 8): A (sham), B (control), C (melatonin 5 mg/kg), and D (melatonin 10 mg/kg). In group A, only cecal dissection was carried out. In the other groups, cecal ligation and puncture (CLP) followed cecal dissection in order to induce bacterial peritonitis. 24 h after the previous operation, cecal resection and ileocolic anastomosis were performed in the rats of all groups. In group C (5 mg/kg) and group D (10 mg/kg), melatonin was injected for 5 consecutive days starting after CLP. At the 48th hour of the CLP procedure, blood was drawn via the tail vein for tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) analysis, and on the 4th day of the experiment relaparotomy was carried out for bursting pressure (BP) measurements. The intestinal tissue containing the anastomotic line was then snap-frozen in liquid nitrogen and stored at -80 degrees C for determination of tissue levels of malondialdehyde (MDA) and glutathione (GSH). RESULTS: The tissue MDA level, blood TNF-alpha and IL-6 levels of group B were significantly higher than in the other groups, whereas the BP results and GSH levels of group B were found to be significantly lower than in the other groups. The results of groups C and D are statistically different from those of group B. When we compared the results of groups C and D, we found significantly higher results in terms of BP and GSH levels in group D and also significantly lower results in terms of MDA, blood TNF-alpha and IL-6 levels in group D. CONCLUSION: The findings of this experiment suggest that melatonin has a dose-independent positive effect on wound healing of colonic anastomosis.

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-alpha) 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-alpha 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-alpha + WBC. The highest AR (90 %) was seen with IL-6 + TNF-alpha 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.

Pharmacokinetics of orally administered tetrahydrobiopterin in patients with phenylalanine hydroxylase deficiency.

The oral loading test with tetrahydrobiopterin (BH(4)) is used to discriminate between variants of hyperphenylalaninaemia and to detect BH(4)-responsive patients. The outcome of the loading test depends on the genotype, dosage of BH(4), and BH(4) pharmacokinetics. A total of 71 patients with hyperphenylalaninaemia (mild to classic) were challenged with BH(4) (20 mg/kg) according to different protocols (1 x 20 mg or 2 x 20 mg) and blood BH(4) concentrations were measured in dried blood spots at different time points (T(0), T(2), T(4), T(8), T(12), T(24), T(32) and T(48 h)). Maximal BH(4) concentrations (median 22.69 nmol/g Hb) were measured 4 h after BH(4) administration in 63 out of 71 patients. Eight patients presented with maximal BH(4) concentrations approximately 44% higher at 8 h than at 4 h. After 24 h, BH(4) blood concentrations dropped to 11% of maximal values. This profile was similar using different protocols. The following pharmacokinetic parameters were calculated for BH(4) in blood: t (max) = 4 h, AUC (T(0-32)) = 370 nmol x h/g Hb, and t (1/2) for absorption (1.1 h), distribution (2.5 h), and elimination (46.0 h) phases. Maximal BH(4) blood concentrations were not significantly lower in non-responders and there was no correlation between blood concentrations and responsiveness. Of mild PKU patients, 97% responded to BH(4) administration, while one was found to be a non-responder. Only 10/19 patients (53%) with Phe concentrations of 600-1200 mumol/L responded to BH(4) administration, and of the patients with the severe classical phenotype (blood Phe > 1200 mumol/L) only 4 out of 17 patient responded. An additional 36 patients with mild hyperphenylalaninaemia (HPA) who underwent the combined loading test with Phe+BH(4) were all responders. Slow responders and non-responders were found in all groups of HPA.

Effects of propylthiouracil on testicular tissue in undescended testes of newborn rats.

AIM: The most important goal in the treatment of cryptorchidism is to preserve the potential for fertility. This experimental study was performed to investigate the effect of propylthiouracil (PTU) on the undescended testes (UTs) of newborn rats. MATERIALS AND METHODS: The experimental cryptorchidism model in newborn male rats consisted of 4 groups. The groups A (control) and B (PTU) underwent no surgical intervention, whereas in groups C (UT only) and D (treatment) UTs were produced by dissecting and suturing the future right scrotal area. In groups D and B, 0.1% (w/v) PTU was added to the drinking water of mother rats between 2 and 24 days. At the end of the 90th day rat body weights, testicular weights, Johnsen tubular biopsy scores (JTBSs), seminiferous tubule diameters (STDs), testosterone, and thyroid hormone levels were measured. Mann-Whitney U test was used for statistical analysis. RESULTS: Mean testicular weight was similar between groups A, B and D, and statistically lowest in group C. Mean body weight was statistically higher in groups A and C compared with groups B and D. Mean testosterone levels showed no statistical difference between the groups. Mean JTBSs were statistically higher in groups A and B compared with groups C and D. The value in treatment group D was statistically higher compared to group C (p<0.05). Mean STDs were statistically lowest in group C compared to other groups (p<0.05). No difference was found between groups A, B, and D (p>0.05). Both the mean free triiodothyronine and free thyroxine values between groups A and C and between groups B and D were similar. The values in groups A and C were statistically higher than those of groups B and D (p<0.05). CONCLUSION: PTU-induced transient hypothyroidism in the newborn rat UT model shows protective effects on testicular growth parameters.

Surgical breast lesions in adolescent patients and a review of the literature.

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-adenoma, 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 intraductal 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.