Ascending testis following inguinal hernia repair in children.

OBJECTIVE: Failure to replace the testes in the scrotum during hernia repair leads to iatrogenic undescended testes. At other times, the testes may spontaneously move back to the inguinal area after being placed in the scrotum, thus resulting in ascending testes. The cases in this study were assessed. PATIENTS AND METHODS: Records of 910 boys operated due to inguinal hernia were assessed retrospectively. Following hernia repair, the testes were placed in the scrotum. After the operation, all the testes were checked for being in the scrotum. They were called for follow-up after the operation. Their testes were checked for remaining in the scrotum. RESULTS: Ascending testes were detected in 4 (0.43%) of the patients. These patients had scrotal hypoplasia and/or retractile testes. Their age ranged between 1-3 years. Ascending testes were bilateral in 2 patients, and on the right side in 2. Human chorionic gonodotropin (hCG) was initiated in 3 patients. Two of them improved. Two underwent scrotal orchiopexy. CONCLUSIONS: These patients may benefit from hCG in the early postoperative period. Later, scrotal orchiopexy may be needed. Patients who have retractile testes or scrotal hypoplasia in addition to inguinal hernia need orchiopexy together with herniorrhaphy.

Immunologic features of HIV-1-infected women on HAART at delivery.

BACKGROUND: The conjoint effect of HIV infection and pregnancy on the immune system of women submitted to the prophylactic antiretroviral therapy presently recommended is still poorly understood. METHODS: We evaluated 44 HIV-infected women (HIV) and 45 HIV-negative women (CT) at parturition and we compared them to 20 healthy nonpregnant women (NP). Immunophenotyping of lymphocytes was done by four-color flow cytometry. RESULTS: All HIV-infected women received HAART during pregnancy and 56.8% had viral load <50 copies/mL at delivery. CD4+T cells/mm(3) were lower in HIV (447) than CT (593) and NP (738) (P < 0.05). CD8+T cells/mm(3) were higher in HIV (799) than CT (384) and NP (395) (P < 0.05). NK cells/mm(3) were lower in HIV (146) than in CT (253) and NP (198) (P < 0.05). CD38 expression on CD4+T and on CD8+T cells was higher in HIV (CD4:12.1; CD8:14.9) than in CT(CD4:9.2; CD8:10.2) and NP(CD4:8.6; CD8:6.0) (P < 0.05). However, CD56 expression on CD8+T cells (a marker of cytolytic effector function) was lower in HIV(7%) than in CT(12%) and NP(9%) (P < 0.05). CONCLUSIONS: Even with low levels of viremia, HIV-infected women at delivery showed a different immunologic profile from both healthy non-HIV-infected women in the puerperium and nonpregnant women, with lower CD4+T and higher CD8+T cells, high levels of CD38 expression, but low CD56 expression on CD8+T cells and low NK cell numbers.

Injection sclerotherapy of rectal prolapse in children with 15 percent saline solution.

PURPOSE: A wide variety of sclerosing agents have been used in the treatment of rectal prolapse (RP) in children. We have used 15 % saline solution for the first time in the treatment. The aim of this study is to review the results of a 15 % saline solution and other sclerosing agents. PATIENTS AND METHODS: A total of 16 children with RP were treated by injection of 15 % saline solution. Under general anesthesia, the patient was placed in the lithotomy position. The left index finger was inserted into the rectum to control the position of the needle, a 20-gauge spinal needle was introduced through the perianal skin and was advanced. The saline was slowly injected, the needle was then withdrawn slightly, and the injection was continued until 2 - 3 ml of 15 % saline were injected. The injection was made into the submucosal tissue, the right perirectal area, the left perirectal area, and posterior to the rectum at 5 points. RESULTS: Conservative treatment had previously failed in all patients. Prolapse ceased in 15 (93.7 %) of the 16 children after the first injection. Only one patient required a second injection. There were no complications. CONCLUSIONS: The success rates and complications of the treatment reported in the literature differ for each sclerosing agent. 15 % saline is preferable because of the high cure rate, the safety of the procedure, the easy injection, and the lack of complications.

Oophoropexy in children with ovarian torsion.

AIM: Children who have suffered from ovarian torsion may be at increased risk for a repeat event, and after unilateral ovarian loss, the contralateral ovary is at risk for future torsion. Oophoropexy has not been emphasized enough in the literature. We present our experiences with oophoropexy in children. METHODS: The medical records of 10 patients with ovarian torsion, who underwent oophorectomy and contralateral oophoropexy between April 1992 and April 2003, were reviewed retrospectively. The ovary was connected to the peritoneum of the posterior abdominal wall avoiding a disturbance of the tubo-ovarian anatomic relationship. RESULTS: The ages of patients ranged from 5 days to 14 years, with a mean age of 7.7 years. The period from onset of symptoms to hospital admission was ranged from 2 hours to 11 months. Only 1 ovary was salvaged after detorsion and bilateral oophoropexy was performed. In the other patients, the torsion caused necrosis, and oophorectomy or salpingo-oophorectomy and contralateral oophoropexy were carried out. Ovarian torsion occurred in 4 previously normal ovaries, in 5 cystic ovaries, and in 1 ovary containing a mature cystic teratoma. Two out of 10 patients had thrombus formation within the vessels of the twisted ovaries. An embolic phenomenon did not develop in any of the cases. At follow-up, all pubertal girls had normal menstrual periods. CONCLUSIONS: Failure to protect ovaries from subsequent torsions can result in castration, and we performed oophoropexy in both retained detorsed and contralateral ovaries without any postoperative complication. We performed medial oophoropexy to avoid tubo-ovarian disturbance. Oophoropexy is an easy and reversible procedure, and should be done in all cases of ovarian torsion.

A treatment for biliary hypoplasia: tube cholecystostomy and irrigation.

PURPOSE: Biliary Hypoplasia (BH), characterised by a small ductal system and reduction in the number of interlobular bile ducts, has a bad prognosis. It has been claimed that other treatment methods apart from liver transplantation are not effective. Seven patients with BH underwent tube cholecystostomy, decompression and saline irrigation of the biliary tree via tube cholecystostomy. We present our treatment method, together with the early and late biochemical and histopathological results of these patients. PATIENTS AND METHODS: The records of seven patients with BH were reviewed retrospectively. BH was proved by operative cholangiography. Irrigation was performed intermittently with warm saline to the biliary tract via tube cholecystostomy over two to three months. SGOT, SGPT, alkaline phosphatase (AP) and bilirubin levels were evaluated preoperatively and postoperatively. Histopathological findings were also evaluated. RESULTS: Median age at operation was 46 days (range 20 - 90 days). There were six males and one female. Five patients recovered completely. There was a statistical difference between preoperative and postoperative SGOT, SGPT, AP, and bilirubin levels of patients who recovered (p < 0.05). CONCLUSION: Similar to biliary atresia, many factors such as the patient's age, postoperative bilirubin level, histopathology of liver, treatment method, and cholangitis as a complication of the surgical procedure affect the prognosis of BH. Operation before the age of 70 days, normal bilirubin levels after operation, no cholangitis attack, intracellular and intracanalicular cholestasis, and mild mixed cellular infiltration are favourable factors. We believe that decompression and irrigation of the biliary tract is an effective treatment method for suitable cases of BH.

Traumatic subarachnoid-pleural fistula in children. Report of 2 cases and review of the literature.

Traumatic subarachnoid-pleural fistula (TSAPF) is a rare complication of thoracic trauma. Late diagnosis is a problematic dilemma in these cases. Patients with thoracic injury have persistent pleural leakage, thoracic vertebral injury, pneumocephalus, urinary retention and paraplegia should alert the surgeon for TSAPF. Two cases of TSAPF due to gunshot injury are reported.

The effect of ATP-MgCl(2) on prevention of reperfusion injury after unilateral testicular torsion.

This study was designed to investigate the effect of ATP-MgCl(2) administered before and after detorsion on the prevention of reperfusion injury after unilateral testicular torsion. The rats were divided into six groups, each containing six rats. Torsion was created by rotating the left testes 720 degrees in a clockwise direction. Group 1 functioned as a control group. Torsion only was carried out in Group 2. Detorsion was carried out in Group 3. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately before detorsion in Group 4. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately after detorsion in Group 5. Saline was injected intravenously immediately after detorsion in Group 6. The effect of ATP-MgCl(2) on reperfusion injury was investigated by determining the levels of thiobarbituric acid-reactive substances (TBAR) and resulting lipid peroxidation in the bilateral testicular tissue. Testicular torsion and detorsion caused a significant increase in the TBAR levels in the bilateral testicular tissue. TBAR levels decreased to approximately normal levels in Groups 4 and 5. It is concluded that if reperfusion injury has occurred in both testes after unilateral testicular torsion, ATP-MgCl(2) administered before or after detorsion may prevent reperfusion injury in testicular torsion.

Congenital splenic cyst--a report of two cases.

We report on two girls with large epidermoid splenic cysts. They presented with abdominal pain, fever, and non-bilious vomiting. In both cases the cyst was diagnosed by means of computer tomography and ultrasonography. One of the patients was successfully treated with partial splenectomy. In the other case percutaneous drainage was initially carried out, but this treatment was insufficient. Splenectomy was then performed.

Mesenteric fibromatosis.

Two rare cases of mesenteric fibromatosis are presented. The first patient had a right upper quadrant mass and colicky abdominal pain. The tumor originated from the mesentery of the colon and it infiltrated the gallbladder, cystic duct, and the liver. The second patient had severe hematemesis and melena. The origin of the tumor, which infiltrated 3/4 part of the stomach, the gastrohepatic ligament, the first part of the duodenum, and the liver could not be determined. In the first patient, partial colectomy and cholecystectomy were performed and the liver lesion was completely excised. The second patient underwent subtotal gastrectomy and left lobectomy of the liver. The first part of the duodenum was excised. Gastrojejunostomy was performed. No recurrence was recorded in either patients during 16 and 13 months follow-up, respectively. In this report, diagnostic aids, differential diagnosis and treatment of this rare disease are discussed.

Nonoperative management of intra-abdominal bleeding due to blunt trauma in children: the risk of missed associated intestinal injuries.

Nonoperative management of intra-abdominal bleeding (IAB) from blunt injuries in children has been advocated for many years. Nonoperatively managed patients, however, are at risk for missed associated intestinal injuries. To evaluate this question, we reviewed the charts of 120 children who had traumatic IAB; 106 were initially managed nonoperatively and observation failed in 2. Fourteen underwent emergency operation. Forty patients had isolated liver and/or splenic injuries while the others had injuries associated with several organs. During observation peritonitis developed in 3 patients and further radiologic examinations failed to confirm an intestinal injury. Diagnostic peritoneal lavage demonstrated contaminated blood and fecal particles from injured intestines in 3 patients; they underwent emergency operation at 10, and 26 h after admission. There was no mortality or morbidity associated with delayed treatment. These data suggest that the majority of patients with IAB may be successfully treated nonoperatively, but associated intestinal injuries should be suspected in all cases.

Congenital bladder diverticula in infants.

OBJECTIVE: Congenital bladder diverticula (CBD) usually occur in areas where the muscle is inadequately formed, typically at the ureterovesical junction, or between bundles of hypertrophied muscle. CBD are mostly asymptomatic and the cases are found incidentally. Occasionally, some cases of CBD may produce urinary obstruction as a result of compression of the urethra or urinary tract infection which result in retention of urine within the diverticulum. MATERIAL AND METHODS: We present 3 infants with CBD accompanied with urinary tract infection (2 cases) and outlet obstruction (1 case). RESULTS AND CONCLUSIONS: The means of surgical intervention included simple excision in 1 case intravesically and the other 2 cases extravesically. We also performed an antireflux procedure in the first case who had grade III reflux of the left ureter, and left nephrectomy in the third case who had multicystic dysplastic kidney. The postoperative follow-up in all cases was uneventful with normal voiding.

Nonpalpable undescending testis. Value of magnetic resonance imaging.

BACKGROUND: Magnetic resonance imaging (MRI) was performed in 18 male patients with 20 nonpalpable undescended testes and the results were compared with surgical findings. METHODS: The MRI examination located 13 (65%) of 20 gonads, all found at surgery. Eleven testes were found in the inguinal canal or just proximal to the internal inguinal ring, and two testes were demonstrated above the internal inguinal ring. RESULTS: Of the seven (35%) negative results, three were false negative and four agenetic testes were not found surgically. There was no false positive result. Thus, MRI had a sensitivity of 78.6% and specificity of 100% in the demonstration of nonpalpable undescended testes. CONCLUSIONS: MRI appears to be a more reliable and noninvasive method for the localization of nonpalpable undescended testes.

Congenital esophageal stenosis.

Congenital esophageal stenosis caused by membranous webs occurred in three infants. There were no associated anomalies. First patient applied with respiratory symptoms while the second and third patients reported food impactions. Correct diagnosis was performed during intraoperative (first patient) and esophagoscopic examination (second and third patients). Resection and anastomosis were performed in the first patient and hydrostatic dilatations in the second and third patients. In three patients, symptoms were relieved following treatment. In this report, etiology, diagnostic aids and management of this rare pathology are discussed.

A new treatment with bleomycin for complicated cutaneous hemangioma in children.

Cutaneous hemangiomas are the most common tumors of infants and children. Although they frequently resolve spontaneously, approximately 5% produce complications such as bleeding, infection, consumption coagulopathy and unesthetic appearance. Various methods of treatment are described for these complicated hemangiomas. We used a new type of treatment for complicated cutaneous hemangiomas as intralesional bleomycin (BLM) injection, for the first time in the literature. This agent produced extensive fibrosis and spontaneous resolution of hemangiomas. Fourteen patients with complicated hemangiomas (twelve capillary and two cavernous) have been treated with this method during a three-years period. Of these fourteen patients, five had bleeding, three had infection, one had ulceration, and five had unesthetic appearance and continued rapid growth. Lesions of three patients were completely excised after only one BLM injection. In the other eleven patients lesions regressed 60-100% during 6-14 months with two to three BLM injections. We believe that intralesional BLM injection is simple, and very useful for treatment of complicated cutaneous hemangiomas.

Traumatic asphyxia in children.

Eight children with traumatic asphyxia were evaluated retrospectively. There were five boys and three girls. The mechanism of injuries was motor vehicle accidents in six children. A fall in one patient and compression by lift in one patient. Clinical features of traumatic asphyxia developed in all patients. Five patients were disoriented and consciousness. Associated injuries were noted in all patients often involving thorax and head. Cerebral seizures complicated head injury in one patient. No mortality was recorded.

Blunt thoracic trauma in children.

Thirty four children with blunt thoracic trauma were treated at the university hospital, Trabzon. Eighteen of them were sustained in motor vehicle accidents, 14 were falls and two were a result of miscellaneous causes. Rib fracture developed in 16 patients and pulmonary contusion occurred in 18 patients. Pneumothorax existed in 19 patients, and hemothorax was noted in ten patients. Traumatic asphyxia occurred in seven patients. Associated head, abdominal, and orthopedic injuries were present in 21 patients. Chest drainage was performed in nineteen patients, while 15 patients received conservative treatment. Five patients required an emergency operation. Complications developed in five patients. Four patients were lost due to multiple system injuries. In this study, the injury patterns, complications and mortality of blunt thoracic injuries were discussed.

Congenital diaphragmatic eventration: treatment and postoperative evaluation.

Three patients with congenital diaphragmatic eventration have been reported. The diagnosis was established by chest radiography which showed an abnormally elevated diaphragm. Additionally fluoroscopy, ultrasonography and pulmonary function tests were used. Diaphragmatic plication was performed in order to restore normal pulmonary parenchymal volume and the diaphragm was replaced in its normal localization. All the patients had been discharged in good condition following uneventful postoperative courses. In this study we discussed the etiology, diagnosis, treatment and postoperative courses of diaphragmatic eventration.

Pediatric Morgagni hernia. Report of two cases.

Morgagni hernia is a rare condition in childhood, and it may be asymptomatic or produce respiratory symptoms. Two cases with Morgagni hernias are presented. Both patients had occasionally respiratory infection, coughing and fever. The diagnosis was made with a chest radiograph taken for respiratory infection. They were treated surgically and they were discharged in uneventful condition.