Protective effects of montelukast on ischemia-reperfusion injury in rat ovaries subjected to torsion and detorsion: biochemical and histopathologic evaluation.

OBJECTIVE: To reveal the effects of montelukast as an antioxidant and tissue protective agent and study the biochemical and histopathologic changes in experimental ischemia and ischemia-reperfusion (I/R) injury in rat ovaries. DESIGN: Experimental study. SETTING: Experimental surgery laboratory in a university department. ANIMAL(S): Forty-eight rats with experimentally induced ovarian torsion. INTERVENTION(S): Group 1: sham; Group 2: ovarian ischemia; Group 3: a 30-hour period of ischemia followed by a 3-hour reperfusion. Groups 4 and 5: rats administered 10 and 20 mg/kg doses of montelukast before a half-hour of ischemia, then ovarian ischemia applied; after a 3-hour period of ischemia, the bilateral ovaries removed. Groups 6 and 7: 3-hour period of ovarian ischemia applied, then 2.5 hours after the ischemia induction, rats given montelukast. Group 8: sham operation and 20 mg/kg of montelukast; at the end of a 3-hour period of ischemia, 3-hours of reperfusion continued. MAIN OUTCOME MEASURE(S): Measurement of ovarian tissue concentrations of superoxide dismutase (SOD), glutathione (GSH), lipid peroxidation (LPO) and myeloperoxidase (MPO) activity; and histopathologic examination of all ovarian rat tissue. RESULT(S): Montelukast treatment normalized changes of LPO and MPO and stimulated an overproduction of endogenous SOD and GSH. The results of the histologic parameters showed that treatment with montelukast in the I/R group of rats ameliorated the development of ischemia and reperfusion tissue injury. CONCLUSION(S): Montelukast at different doses attenuates ovarian I/R-induced ovary tissue injury in rats.

Multiple and recurrent intestinal perforations: an unusual complication of Henoch-Schonlein purpura.

Intestinal perforation, intussusception, and infarction constitute the major surgical complications in Henoch-Schonlein purpura. Early corticosteroid treatment for intestinal complications is recommended. Here the authors describe the case of a 13-year-old boy with Henoch-Schonlein purpura who had multiple and recurrent perforations that occurred under corticosteroid treatment.

Environmental pollutant isotope measurements and natural radioactivity assessment for north Tushki area, south western desert, Egypt.

Natural radioactive materials under certain conditions can reach hazardous radiological levels. The natural radionuclide (238U, 232Th, 40K) contents of rock samples at various locations in the North Tushki area were investigated using gamma-spectrometric analysis. Estimates of the measured radionuclide content have been made for the absorbed dose rate of gamma radiation. The equivalent radium (Req) and the external hazard index (Hex) which resulted from the natural radionuclides in soil are also calculated and tabulated. The studied samples have been collected from various rock exposures in the North Tushki area. The distribution of major oxides, U and Th were studied. It is found that the enrichment and depletion of the major oxides are mainly due to the effect of hydrothermal alteration, which caused mobility of some major oxides, which increases some elements and decreases others. It is important to mention that the study area is far from the development region of the Tushki project and is only a local hazard. Therefore, additional regional studies of the Tushki Project area should be under taken to explore any unexpected environmental hazard due to the high concentration of the radioactive elements, which have been observed at its north boundary.

Hydatid disease of the liver in children: evaluation of surgical treatment.

The medical records of 55 paediatric patients with hepatic hydatidosis, who were treated between 1990 and 2001 at Atatürk University, Turkey, were reviewed retrospectively. The most common symptoms at presentation were abdominal mass (32.7% of cases) and pain (81.8% of cases) in the right upper quadrant of the abdomen. Cysts were found in the right lobe in 41 patients, in the left lobe in four patients and in both lobes in 10 patients. Multiple hepatic cysts were present in 12 cases and eight patients also had cysts in other organs. Surgical procedures were evacuation of the cyst and management of the cavity with tube drainage, capitonnage, omentoplasty, cystectomy or segmentectomy. Long-lasting biliary fistula (two patients) and cholangitis (two patients) developed following evacuation and tube drainage, and one patient developed cholangitis after capitonnage. This review suggests that omentoplasty and capitonnage are more effective than tube drainage in the management of the cyst cavity.

Perineo-pelvic diaphragmatic split: anorectal exstrophy.

Anorectal malformations are among the most common congenital anomalies that require neonatal surgery. Although the headlines of anorectal malformations present with a spectrum of defects of this region, generally, imperforate anus and its fistulous or nonfistulous connections are examined. Here the authors present a boy with anorectal malformation, with sacrococcygeal teratoma and meningocele. Interestingly, the patient had neither imperforate anus nor anorectal stenosis, but had widely open anorectum. This kind of anorectal malformation has never been described previously in the English-language literature.

Abdominal, scrotal, and thoracic calcifications owing to healed meconium peritonitis.

Meconium peritonitis is a form of chemical peritonitis resulting from in utero perforation of the gastrointestinal tract, with subsequent leakage of sterile meconium into the peritoneal cavity and the potential spaces connected with it. Involvement of the tunica vaginalis may be the sole presenting clinical manifestation of the gut perforation resolving spontaneously. In such instances, radiologically detectable calcifications in the abdomen, scrotum, and thorax are essential diagnostic points. In this study, a 4-month-old baby with abdominal, scrotal, and thoracic calcifications owing to healed meconium peritonitis is presented.

Four different hernias are encountered in the anterior part of the diaphragm.

A retrospective clinical study was performed to evaluate the hernias encountered in the anterior part of the diaphragm. Twenty patients (14 males, 6 females; aged 7 days-7 years) with hernias located in the anterior part of the diaphragm who were treated surgically formed the study group. The exact locations, contents and additional malformations were evaluated. The locations were parasternal in 14 and retrosternal in six. Parasternal locations were the right side in 11, left side in two and bilateral in one patient. Three patients had trisomy 21 syndrome. A sac was presented in all cases and included the colon in 12 patients. A patient with retrosternal location also had trisomy 21 syndrome. The patients with retrosternal hernias also presented with sacs, and the colon was the most commonly included viscus. In the presented series, no intrapericardial herniations or anteromedial defects were encountered. Comparison of previously reported patients and the present series suggests that the anterior part of the diaphragm hosts various hernias of congenital origin in its different locations. According to the exact location and the presence or absence of sacs, four different types of hernias occur in this area: retrosternal hernias with a sac, intrapericardial herniation, and parasternal and anteromedial hernias with either unilateral or bilateral involvements. Since four different hernias were distinguished, the term Morgagni hernia does not include or define all the hernias of the anterior part of the diaphragm. We believe they should, therefore be designated according to the location and presence or absence of a sac.

Hemodynamic monitoring of the contralateral testis during unilateral testicular torsion describes the mechanism of damage.

Contralateral testicular perfusion during unilateral testicular torsion was evaluated using simultaneous blood flow and O2 content determinations. Two groups, each consisting of 7 rats, were studied. Sham operation or 720 degrees clockwise twisting was performed on the left testes, and blood flow, O2 content and temperatures were monitored in the right testes for 180 min. An ultrasonic perivascular Doppler flowmeter system, an electronic thermometer and an O2 electrode were used for the monitoring. The contralateral testicular blood flow and relative O2 contents were stable in the control group. However, the initial and 180 min blood flow values decreased from 0.21 +/- 0.04 to 0.11 +/- 0.02 ml/min (p < 0.001), and the O2 contents from 0.857 +/- 0.123 to 0.319 +/- 0.037 (1.0 corresponds to 19.6 mm Hg pO2, p < 0.05) in the experimental group. Unilateral testicular torsion decreases the blood flow and O2 content of the contralateral testis. The contralateral testicular injury encountered following unilateral testicular torsion might result from hypoxia following the decrease in blood flow.

DNA flow cytometry reveals depressed spermatogenetic activity in the contralateral testis within 24 h of ipsilateral spermatic cord torsion independently of the presence of the testis and epididymis.

An experimental study was planned to evaluate if contralateral testicular deterioration following ipsilateral torsion requires the presence of a twisted ipsilateral testis and/or epididymis. Five groups, each containing 6 rats, were established. The groups underwent sham operation, epididymo-orchiectomy, testicular torsion, torsion following subepididymal orchiectomy and torsion following epididymo-orchiectomy. After 24 h, the contralateral testes were harvested and the percentage of haploid cells was determined by DNA flow cytometry. Ipsilateral torsion, in the presence and absence of testis and epididymis, significantly decreased the number of haploid cells compared to sham and epididymo-orchiectomy procedures. Torsion of only the ipsilateral spermatic cord and adjacent vasculature seemed to suffice to damage the contralateral testis. Since the presence of the ipsilateral testis and epididymis is not mandatory for this acquired damage, which occurs within 24 h, a role for a preexisting congenital defect and autoimmunity seems unlikely.

Enteritis cystica profunda mimicking acute abdominal picture in a twelve-year-old boy.

Enteritis cystica profunda, an uncommon condition, is characterized by nonneoplastic cystic spaces within the wall of the small bowel. The third case of enteritis cystica profunda in children is presented with special emphasis on diagnosis and treatment. This rare entity may mimic acute abdomen and should be kept in mind in the differential diagnosis. Surgical excision of the involved segment is the appropriate treatment.

Gastrointestinal tract perforation due to blunt abdominal trauma.

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.

Bilateral multiple adrenal pseudocysts associated with incomplete Beckwith-Wiedemann Syndrome.

A newborn with an incomplete form of Beckwith-Wiedemann Syndrome associated with bilateral multiple adrenal pseudocysts is presented for the first time. A high index of suspicion and detailed diagnostic studies are required in the differential diagnosis of benign and malignant cystic lesions of the adrenal gland in the newborn. Exploratory laparotomy is warranted in selected cases.

Management of intestinal obstruction caused by ascariasis.

A retrospective clinical study to evaluate the effects of paralyzing vermifuges on the course of intestinal obstructions complicating ascariasis was performed. Forty-two patients, 26 patients with partial and 16 patients with complete intestinal obstructions, were treated over 7 years. Although 24 patients have not received any medications two patients with partial obstructions received flaccid paralyzing agent before referral. However, 12 of 16 patients with complete obstruction received spastic paralyzing agent, and the remaining patients received flaccid paralyzing agent before referral. Paralyzing agents, especially those causing spastic paralysis, should be avoided in patients with abdominal symptoms presumed to be related to ascariasis because of the risk of causing complete obstruction and making surgery more complex.

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.

Posttraumatic gallbladder torsion in a child.

Torsion of the gallbladder in an 8-year-old boy, which was precipitated by blunt abdominal trauma from a ball-strike during a soccer game, is reported. Of the 13 reported childhood cases of gallbladder torsion, this is the first to be precipitated by blunt abdominal trauma in the presence of congenital anatomic predilection.

Cloacal duplication.

Cloacal duplication including the rectum, anus, and genitourinary organs is one of supernumerary development. Only two cases have been reported in the literature. A case with cloacal duplication is presented. The patient was an 8-year-old girl who has had fecal incontinence since birth. Successful surgical treatment was achieved by removing one rectum and exteriorizing the other through perineal raphe.