Prevalence of inguinoscrotal pathologies and risk factors in a cohort of 388 children with spina bifida.

BACKGROUND: There is limited information about the prevalence and risk factors of inguinal hernia and undescended testis in patients with spina bifida (SB). The aim of this study was to identify the properties and prevalence of inguinoscrotal diseases in these patients. METHODS: A questionnaire was completed by parents of patients with the diagnosis of SB in our center. Together with demographic data, presence an of inguinal hernia, side, operation history, presence of ventriculoperitoneal (VP) shunt, type of SB aperta or occulta, recurrence and presence of undescended testis were questioned. Patients were grouped into 2 as SB aperta and occulta. The prevalence of these pathologies and their clinical properties were evaluated. RESULTS: In this study, 388 patients were evaluated. Of these, 238 patients had SB aperta and 150, SB occulta. There was no significance in comparison of gender. The prevalence of inguinal hernia was 12.6% in general. A hernia was noted in 37 SB aperta patients (15.6%) whereas this was seen in 12 of the SB occulta patients (8%) (p=0.029). When there was a VP shunt, hernia prevalence was 21.5% and when there was no shunt, this ratio was 7.1% (p=0.0001). Prevalence of inguinal hernia was 21.8% in males and 3.2% in females (p=0.0001). When there was a VP shunt with SB aperta the prevalence was 21.9% and when a VP shunt was present with SB occulta, this number was found to be 13.3% (p=0.006). The prevalence of undescended testis was 17.7% and there was no difference between SB aperta and occulta patients. CONCLUSIONS: Inguinal hernia and undescended testis are more frequent in SB patients when compared to the normal population. VP shunts and male gender may be risk factors for inguinal hernia in these children. These findings may imply neurological factors in the etiology of inguinal hernia and undescended testis.

Protective effect of the thoracic cage on parenchyma in response to trauma direction in blunt thoracic trauma: an experimental study.

BACKGROUND: We aimed to investigate the protective potential of the thoracic cage on the parenchyma in response to blunt trauma from different directions in an animal model. METHODS: Female Wistar albino rats were divided into control, anterolateral, lateral and posterolateral trauma groups, with six rats in each group. A weight of 500 g was dropped from a height of 40 cm on the left hemithorax to produce an energy of 1.96 joules, using a specially designed platform. Respiratory rates and heart rates were noted before and at 0, 1, and 5 minutes after trauma. Twenty-four hours later, the left lungs were excised for wet lung weight measurement, histological examinations and tissue malondialdehyde determination. RESULTS: Severe pulmonary contusion was observed in all trauma groups according to histological parameters. Malondialdehyde was increased in both the lateral and posterolateral groups. Wet lung weight was increased only in the posterolateral trauma group when compared to controls. Histologically, macrophages were increased and mononuclear cell infiltration was significant in the posterolateral trauma group. There were no significant changes in physiological parameters in the groups. CONCLUSION: Lung parenchyma seems to be badly affected after trauma to the posterolateral thoracic wall. Different thoracic regions may respond differently to the same traumatic stress, and this may be related to the biomechanical properties of the thoracic cage.

Abdominotransanal approach to pouch colon associated with rectal atresia.

Pouch colon anomaly and high anorectal malformation are well-defined rare anomalies. The association of pouch colon anomaly with rectal atresia has previously been defined in only one case. In this study, a 2-day-old baby is presented with pouch colon anomaly without fistula and with rectal atresia. As a second case in the literature, this pathologic condition has been treated through the abdominotransanal route by using a single-stage endorectal coloanal pull-through. Being uncommon and having an important therapeutic approach, this case has been evaluated as worth presenting.

Hepatic pseudocyst as a result of ventriculoperitoneal shunts: case report and review of the literature.

Hepatic pseudocyst formation is a rare intra-abdominal complication of ventriculoperitoneal shunts. The presence of an intracranial tumor and a history of central nervous system infection are major risk factors for the development of this complication. Hepatic pseudocysts secondary to ventriculoperitoneal shunts can be classified as intra- and extra-axially growing cysts. On abdominal computed tomography images, extra-axially growing pseudocysts are typically surrounded by a fine annulus that shows continuity to hepatic parenchyma. For treatment of extra-axially growing hepatic pseudocysts, surgical unroofing of the cyst and repositioning of the catheter is an effective method if there is no shunt infection and/or dysfunction.

Presence of ectopic adrenocortical tissues in inguinoscrotal region suggests an association with undescended testis.

Ectopic adrenocortical tissues (EAT) are rare pathologies in children. They are frequently encountered in the inguinal region incidentally during surgical procedures but they are also classically known to be located from diaphragm to pelvis. EAT were investigated during inguinal procedures including inguinal hernia, hydrocele, hydrocele of cord and undescended testis (UDT) in 1,069 patients, 159 girls, 910 boys, from April 1997 until April 2006. All these nodules were confirmed to be adrenocortical tissues after histopathological examinations. Statistical analysis was done with Fisher's exact test. EAT were noted on the plexus pampiniformis external to processus vaginalis of 22 male patients (1.73%) during inguinal explorations. This figure was 1.63% for inguinal explorations of inguinal hernia, hydrocele and hydrocele of cord and 5.1% for UDT. This difference was statistically significant (P<0.0001). There were no EAT detected during inguinal exploration of female patients. EAT are uncommon pathologies seen during inguinoscrotal explorations. Incidence of EAT is significantly increased with UDT. This increase may be explained with the embryological events that take place during adrenal and gonadal development. The relatively low observation of EAT in girls may be due to the localization of gonads and association of EAT with gonadal position. Adrenal rests in inguinal region may suggest an association with descent of gonads.

Horner syndrome due to first rib fracture after major thoracic trauma.

A case of Horner syndrome diagnosed during the follow-up after major thoracic trauma is presented in this report. A 10-year-old boy was admitted to the emergency service with severe thoracic trauma with left clavicular and first rib fracture after a traffic accident. During the follow-up, myosis and ptosis were recognized in his left eye. Cranial tomography and neurological examination were all normal. The symptoms were thought to be caused by compression of the local hematoma to the cervical ganglia. After 30 days of conservative treatment with tube thoracostomies, he was discharged with his Horner syndrome. After 6 months of follow-up, the findings of Horner syndrome were found to be partially resolved. First rib fracture associated with Horner syndrome is very rarely seen in children, and only 2 cases were found in English-language literature. Our case seems to be the third reported case. Horner syndrome should be kept in mind in cases of first rib fractures. When head trauma is considered, as it can be mistaken with anisocoria, this knowledge may help the surgeon in differential diagnosis.

Spot urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis.

BACKGROUND/PURPOSE: The significance of spot urine 5-hydroxyindoleacetic acid (5-HIAA) levels in the early diagnosis of acute appendicitis (AA) is questioned. METHODS: Forty young, pigmented, male rabbits were divided into 4 groups. Groups are summarized as follows: group 1, control (n = 10); group 2, laparotomy, sham (n = 10); group 3, peritonitis with cecal ligation and puncture (n = 10); and group 4, experimental appendicitis (n = 10). Spot urine samples were obtained for 5-HIAA determination, and appendectomy materials were examined histopathologically and peritoneal fluid cultures were obtained after 12 hours in the study groups. The results were analyzed statistically with 1-way analysis of variance and Scheffé and Tukey's HSD tests. RESULTS: The mean 5-HIAA levels in the control group was 5.7 +/- 0.6 mg/L, whereas it is 5.9 +/- 0.9 mg/L, 6.6 +/- 0.6 mg/L, 9.4 +/- 0.9 mg/L in the sham, peritonitis, and appendicitis groups, respectively. The levels of 5-HIAA in the appendicitis group were higher than those in the other groups, which was statistically significant (P < .001). CONCLUSIONS: Spot urine 5-HIAA determination may be a practical, objective, and noninvasive method in the early diagnosis of AA. Because other radiological and laboratory tests can be insufficient, especially in the early period of AA, this test may be used effectively instead. Clinical studies are necessary for further conclusions.

Scapular bronchogenic cysts in children: case report and review of the literature.

Cutaneous bronchogenic cysts (CBC) are rare solitary lesions which originate from primitive tracheobronchial tree. The periscapular location of these lesions is even a rare condition. The aim of this study is to evaluate this pathology after our case with literature review. An one-year-old girl was brought to our clinics with the complaint of a drainage at the back of her shoulder. In her physical examination, a hyperemic enduration with a sinus and purulent drainage was noted at the left scapular region. Ultrasonography revealed a lesion of 15x11 mm2 in size with a thick wall and a hypoechoic center. The lumen of the cyst was demonstrated with fistulography. Surgical excision of the lesion was performed and pathological examination revealed a cutaneous bronchogenic cyst. CBC have been reported in 64 cases in the literature. They are often found in the lower neck, sternum and shoulders. They arise due to abnormal bronchial budding during the embryological period. Only in 12 of these patients, including our case, the lesion was located in the periscapular area. Its treatment is surgical because of malignant transformation and infection. The recognition of this entity may help the surgeon for early diagnosis.

Conservative treatment of postpneumonic thoracic empyema in children.

PURPOSE: Many treatment modalities have been described for thoracic empyema in children but the optimal timing of appropriate treatment remains controversial. The aim of this study is to find out the outcome of postpneumonic empyema in children after a conservative approach. METHODS: The reports of patients who were admitted to our hospital from January 1990 to October 2002 with a diagnosis of postpneumonic thoracic empyema were reviewed retrospectively. The comparative data were age, duration of prehospital illness, complaints, blood and pleural fluid analyses, radiological evaluations, microbiological studies, modes of treatment, duration of chest tube drainage, and length of hospital stay. RESULTS: A total of 115 patients (65 males and 50 females), aged from 3 months to 13 years, were evaluated. The most common symptoms were fever (96.5%), cough (85.2%), and dyspnea (50.4%). Chest X-rays revealed a minimal collection in 22 (19.2%), a moderate collection in 40 (34.8%), and a massive collection in 53 patients (46%). Staphylococcus aureus was the most common microorganism isolated from the bacterial cultures and Mycobacterium tuberculosis was the next most common. Twelve patients (10.4%) underwent surgical decortication. The mean duration of chest drainage was 10.1 +/- 1.39 days. The mean hospitalization period was 24.2 +/- 6.15 days and it was significantly shorter in patients with a minimal collection than in those with a massive collection (13.9 +/- 2.21 vs 28.47 +/- 6.38 days, P < 0.01). CONCLUSIONS: The majority of postpneumonic thoracic empyema cases in children can be successfully treated with a conservative approach. Detailed investigations should also be done to rule out tuberculosis in these patients.

The roles of free oxygen radicals, nitric oxide, and endothelin in caustic injury of rat esophagus.

PURPOSE: The authors aimed to find out the roles of free oxygen radicals, nitric oxide (NO), and endothelin (ET) in caustic injury of rat esophagus. METHODS: Forty-five Wistar albino rats were used to form 6 groups. The study groups are summarized as 1, sham (S; n = 7); 2, sham + L-arginine (SA; n = 7); 3, sham + L-NAME (SN; n = 7); 4, injury (I; n = 8); 5, injury + L-arginine (IA; n = 8); 6, injury + L-NAME (IN; n = 8). Normal saline in the sham groups and 50% NaOH in the caustic injury groups were administered to the distal esophagus. Free oxygen radicals and NO were detected by chemiluminescence from tissue samples, and they were correlated with histologic examinations. Tissue ET was measured also with immunohistochemistry. RESULTS: The injury was verified histologically. Free oxygen radical levels were found to be increased as well as NO and ET with the caustic injury (P <.05). L-arginine caused a histologic increase in the injury that was close to statistical significance (P =.08). L-NAME showed no significant effect. CONCLUSIONS: Free radicals, NO, and ET increase in the early phase of caustic esophageal injury. Understanding their early interactions during the caustic injury may help in future therapeutic strategies.

Horner's syndrome secondary to tube thoracostomy.

Tube thoracostomy is a common therapeutic approach applied in medical practice. Certain complications of this procedure have been described in the literature. Oculosympathetic paresis, or Horner's syndrome, occurs from the interruption of second order preganglionic neurons and manifests as miosis, ptosis, hemifacial anhidrosis and enophthalmos. Iatrogenic Horner's syndrome, on the other hand, very rarely couples with tube thoracostomy. Only seven cases have been described in the literature, two of whom were in the pediatric age group. Herein we present a three-year-old girl operated for diaphragmatic hernia who later developed Horner's syndrome at the same side of the thorax tube. Upon the development of the pathology, the tube was repositioned and after one month only a slight ptosis persisted. Our patient seems to be the third case described in the literature. The clinical significance of this pathology is assessed in this report.