Regulation of matrix metalloproteinase-2 and -9 during healing of dermal wounds after incision using radiofrequency energy in neonatal and adult rats.

BACKGROUND: Radiofrequency energy (RFE) has many medical applications in the treatment of adults and children. The impact of RFE on healing-regulation systems in the developing tissues is not fully known. Matrix metalloproteinases (MMPs) are involved in the remodeling of the extracellular matrix and the inflammatory processes. MMPs are regulated differently among the different age groups. We evaluated possible changes in MMP activity after an incisional wound using a radiofrequency scalpel in neonatal and adult rats. METHODS: In 30 Wistar rats [15 4-day-old (neonates) and 15 4-month-old (adults) rats], a ventral wound was created using a radiofrequency scalpel. Wounded areas and non-wounded tissues were harvested one, three and seven days after the intervention. Enzymatic activities of MMP-2 and MMP-9 were evaluated using gelatin zymography. RESULTS: Adults expressed higher activity than neonates for MMP-2 on day 7 (Mann -Whitney U-test, p =0.009) and for MMP-9 on days one (p =0.005) and three (p =0.005). MMP-9 was expressed in higher amounts in the wounded tissue in comparison with non-wounded tissue during days one and three (Wilcoxon signed rank test, p =0.028 and p =0.043, respectively). MMP-2 was produced in equal amounts in the wounded and non-wounded tissue at all time-points. Only in the adult wounds at day seven, higher activity was noted compared with non-wounded skin (Wilcoxon signed rank test, p=0.043). CONCLUSIONS: RFE, despite its local burning effect, does not interfere with known patterns of MMP regulation. Neonates have lower activity of MMPs than adults. Energy conduction through adjacent non-wounded tissues does not have an impact upon MMP regulation. HIPPOKRATIA 2017, 21(1): 85-92.

Circumcision - A new approach for a different cosmetic result.

AIM: To assess the difference in aesthetic result after a non-religious circumcision with classic Johnston's technique and a new proposed technique. MATERIALS AND METHODS: A total of 76 children were circumcised (not for religious purposes) in a period of 6 years using the classic Johnston's technique (50 patients) and a new proposed technique (26 patients). Parents of circumcised children were interviewed three months after the operation. The aesthetic result was scored by both the parents and the patients as bad, acceptable, good or very good. Scores between the two groups were compared. RESULTS: No major complications were encountered. The aesthetic result score between the two groups had a statistically significant difference (Mann Whitney U Test, p<0.0005). Children being circumcised with the new technique and their parents were more satisfied with the aesthetic result three months after the operation. CONCLUSIONS: In communities in which religious circumcisions are being performed relatively rare, the aesthetic result of a classic method may seem awkward to the patient and his family. Therefore, circumcision being performed for non religious reasons necessitates an acceptable aesthetic result. Our technique fulfills this prerequisite. Hippokratia 2014; 18 (2):116-119.

Wireless Capsule Endoscopy Detects Meckel's Diverticulum in a Child with Unexplained Intestinal Blood Loss.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, affecting about 2% of the population. Most cases of Meckel's diverticula are asymptomatic. The diagnosis of symptomatic MD is often difficult to make. We report the case of an 8-year-old boy who presented with GI bleeding due to MD. The diagnostic difficulties after an initial negative endoscopic evaluation and the diagnostic value of the various endoscopic procedures are discussed. The patient had suffered from bright red stools for 20 h before hospital admission. GI scintigraphy with (99m)Tc-Na-pertechnetate was negative for heterotopic gastric tissue in the small bowel area. Colonoscopy performed in order to exclude Crohn's disease was also negative. He was placed on ranitidine at a dose of 6 mg/kg body weight twice daily. The patient remained asymptomatic over a period of 6 months before he was readmitted due to macroscopic rectal bleeding. Upper endoscopy and colonoscopy used to investigate the source of bleeding showed normal macroscopic findings. Radiolabeling of blood constituents with (99m)Tc on delayed imaging showed radionucleotide concentration in the ascending and transverse colon suggestive of a lesion in the ileocecal area. Further investigation with the use of wireless capsule endoscopy revealed a MD. Wireless capsule endoscopy may thus be indicated for patients with GI blood loss when other diagnostic methods, such as upper and lower endoscopy and colonoscopy, have failed to identify the source of bleeding.

Isolated double gastric rupture caused by blunt abdominal trauma in an eighteen months old child: a case report.

We report a case of an isolated double gastric rupture, resulted from blunt abdominal trauma, that we successfully repaired by primary closure. A 18-month-old girl injured in a motor vehicle accident was admitted to our hospital where the plain X-ray and the CT findings revealed the presence of free abdominal air. An immediate performed exploratory laparotomy disclosed two full-thickness ruptures of the stomach (on the greater curvature and the posterior wall). The ruptures were closed primarily by a two-layer closure. Twenty-four hours post-operatively the patient developed delayed shock as a result of chemical peritonitis. On the 8th postoperative day the girl developed septic shock and gastrorrhagia. She underwent a gastroscopy which revealed stress-ulcer, and was treated conservatively in the children intensive care unit of our hospital. She was discharged home on 20th postoperative day. At 3-month follow up, she was doing well with normal growth and eating a regular regimen about her age. Gastric rupture following blunt abdominal trauma is rare, with a reported incidence of 0.02-1.7%. The morbidity and mortality are directly related to the number of associated injuries, the delay in diagnosis and the development of intraabdominal sepsis. In this paper we emphasise the need for early diagnosis and the aggressive surgical treatment as a key to decreasing the mortality and morbidity from this relatively rare injury, especially in this age group of children.

Intralesional administration of interferon A for the management of severe haemangiomas.

Intralesional administration of interferon alpha (INF-A) is a new approach in haemangiomas treatment that we electively apply to our patients. The aim of this study is to report the beneficial results of this new kind of therapy. Thirty-two patients with severe haemangiomas, 19 females and 13 males, were treated at our department from January 2000 to December 2004. All patients received INF-A intralesionally at a dose of 1-3 MIU/m(2) of body surface once a day for the first week, and then once a week until completion of therapy. Reduction was evaluated after clinical and radiological measurement before, during and after completion of therapy and was graded as complete (>80%), significant (50-80%), medial (20-50%) and no response (<19%). Mean duration of therapy was 8 weeks (2 months). Most patients had not received prior therapy. Complete regression was noticed in 18 patients, satisfactory in 8 patients, minimal in 4 and no response in 2 patients. Minimal complications such as flu-like malaise with fever were reported by 23 patients at the beginning of therapy, but it was resolved easily by paracetamol administration. Complications such as haemorrhage or allergic reaction during administration or neurological symptoms were not reported or noticed. Intralesional administration of interferon A can be considered as a safe option for the management of massive or life-threatening haemangiomas as it requires reduced duration of treatment; hence this option results in reduced financial cost, is well tolerated by patients and is free of major complications.

Thyroglossal duct cyst's inflammation. When do we operate?

Thyroglossal duct cyst (TGDC) disease, one of the most common developmental neck lesion in the pediatric population, often presents as infected neck mass. The authors reviewed their experience in the management of inflamed TGDC cases, in order to suggest the most efficient approach of these patients regarding the ideal type and time of surgical intervention. The medical records of all the patients with the diagnosis of TGDC treated at our department from 1988 to 2003 were reviewed. Data collected included age, gender, preoperative inflammation, treatment and time of definitive surgery. The outcome of the operation was graded as successful, recurrence, or postoperative infection. Eighty-nine (89) patients with histologically confirmed TGDC were treated at our department. Mean age at operation was 6.0 years (range, 9 months-14 years). Male to female ratio was 1.2:1. All patients underwent Sistrunk operation and the mean follow-up was 3 years. Fifty-four (54) patients (60.6%) presented with an inflamed TGDC. Among them, 24 patients were operated immediately after diagnosis at the phase of acute inflammation, and 30 patients after antibiotic administration and resolution of inflammation. The overall recurrence incidence was 6.7%. Recurrence was noted in 6 of 24 (25%) patients operated during the acute phase of inflammation and none in patients operated after resolution of inflammation (P = 0.0052) or with no preoperative inflammation (P = 0.0002). Postoperative wound infection was noted in seven cases but none of them developed recurrence of the disease. The presence of inflammation at the time of surgery is an important risk factor for relapse. We suggest that in the inflamed cases of TGDC disease, the initial treatment should be antibiotic administration and after resolution of the inflammation, surgical management should follow.

Conservative treatment of hemangiomas in infancy and childhood with interferon-alpha 2a.

Hemangioma is the most common tumor of infancy. Most hemangiomas proliferate for 8 to 18 months and then slowly regress over the next 5 to 8 years. So far, steroids have been the established means of treatment, but there have been some reports of the use of interferon-alpha 2a (IFN-A2a) in such tumors. To evaluate the efficacy of IFN-A2a in treating giant hemangiomas in infancy and childhood, we administered it to ten patients aged 4 h to 6.5 years with life-threatening hemangiomas in various parts of the body. The dose used was 3 MU/m2 body surface area subcutaneously every second day. All children had previously received corticosteroids for 2 to 5 weeks without obvious success. The results were satisfactory: five patients had total or almost total regression; the rest have had partial regression while treatment is still in progress. A flu-like syndrome with fever, rhinitis, etc. accompanied the injections in some patients. The symptoms were controlled with paracetamol as necessary. Mild, transient leukopenia occurred in some children as well, but subsided after cessation of therapy for 1 week. IFN-A2a appears to be a promising and well-tolerated element in the treatment of life-threatening hemangiomas in infancy and childhood.

Does incision of the tunica vaginalis during the Palomo procedure prevent post-operative hydrocele?

OBJECTIVE: To assess whether incision of the tunica vaginalis of the ipsilateral testis during the Palomo procedure affects the incidence of post-operative hydrocele. PATIENTS AND METHODS: Forty-two patients with varicocele were treated between 1992 and 1996, all undergoing the Palomo procedure. In 15 patients, incision of the tunica vaginalis of the ipsilateral testis was performed with the Palomo procedure, to prevent the formation of hydrocele. All patients were followed at regular intervals, for 3 months to 4 years. RESULTS: Of 27 patients who underwent the Palomo procedure alone, four developed post-operative hydrocele requiring operation. None of those who underwent incision of the tunica vaginalis with the Palomo procedure developed a hydrocele. The duration of hospital stay was the same in both groups (mean 2.5 days). During the follow-up, there was no difference in the size of the testes, as assessed with the Prader orchidometer, between the two groups. CONCLUSION: Incision of the tunica vaginalis of the ipsilateral testis in addition to the Palomo procedure prevents the development of post-operative hydrocele and causes no adverse sequelae.

Distal ileocolic intussusception: another cause of inversion of superior mesenteric vessels in infants.

OBJECTIVE: Inversion of the superior mesenteric vessels is associated with various conditions. The purpose of this study was to prospectively evaluate the position of these vessels in infants with idiopathic ileocolic intussusception. SUBJECTS AND METHODS: Abdominal sonography was performed before and after reduction of ileocolic intussusception in 16 infants. RESULTS: In 14 infants with ileocolic intussusception proximal to the splenic flexure, the relationship of the superior mesenteric vessels was normal (superior mesenteric vein to the right ventral side of superior mesenteric artery). Inversion of the superior mesenteric vessels (superior mesenteric vein to the left of the superior mesenteric artery) was found in two patients with distal ileocolic intussusception (head of the intussusceptum at the sigmoid colon or rectum). After reduction, the relationship of these vessels was normal in all 16 infants. CONCLUSION: Inversion of the superior mesenteric vessels is sometimes caused by distal ileocolic intussusception in infants.

Late postoperative results in males treated for testicular torsion during childhood.

Successful preservation of a testis that has undergone torsion is directly related to the duration and degree of torsion. From 1979 to 1991, 75 cases of testicular torsion were treated. Eleven orchiectomies were performed; operative detorsion was done in the other 64 cases, with concurrent orchiopexy of both testicles. Twenty-five patients were reexamined 1 to 12 years after the surgery. Age of torsion, duration of symptoms, and operative findings were reevaluated. Testicular volume was determined using Prader's orchidometer, a pachymeter, and ultrasonography. In four postpubertal patients, semen analysis was performed. According to clinical data, results of testicular atrophy correlated with duration of symptoms and operative findings. In all cases of surgical detorsion in which torsion lasted more than 24 hours and viability of the testis was questionable, subsequent atrophy was the rule.