Choledochoduodenal fistula: An unusual cause of recurrent cholangitis in children.

Choledochoduodenal fistula (CDF) is an unusual clinical entity and a diagnostic challenge in children. We herein present CDF as an unusual cause of recurrent cholangitis in a 6-year-old child. To the best of our knowledge, this is the youngest patient reported until date. In this paper, we also highlight possible etiologic factors, presenting symptoms, diagnostic methods, and treatment modalities of CDF.

Effects of apple cider vinegars produced with different techniques on blood lipids in high-cholesterol-fed rats.

Red delicious apples were used to produce natural apple cider with and without inclusion of maceration. Traditional surface and industrial submersion methods were then applied to make vinegar from apple ciders. Apple cider vinegar samples produced with inclusion of maceration in the surface method had the highest total phenolic content, chlorogenic acid, ORAC, and TEAC levels. Cholesterol and apple vinegar samples were administered using oral gavage to all groups of rats except the control group. Apple cider vinegars, regardless of the production method, decreased triglyceride and VLDL levels in all groups when compared to animals on high-cholesterol diets without vinegar supplementation. Apple cider vinegars increased total cholesterol and HDL and LDL cholesterol levels and decreased liver function tests when compared to animals on a high-cholesterol diet without vinegar supplementation. A high-cholesterol diet resulted in hepatic steatosis. VSBM and VSB groups significantly decreased steatosis.

Efficacy of lanolin and bovine type I collagen in the treatment of childhood anal fissures: a prospective, randomized, controlled clinical trial.

PURPOSE: We designed an open-labeled, prospective, randomized, controlled clinical trial to test the efficacy of topical lanolin ointment (PureLan) and bovine type I collagen spray (Gelfix) in the treatment of childhood anal fissures. METHODS: Seventy-one children with acute anal fissure were divided randomly into three groups: group I (control; n = 25), group II (PureLan; n = 28), and group III (Gelfix; n = 18). All children were assigned to have warm sitz baths, topical analgesic creams, and stool softeners. Patients in groups II and III were also treated with topical lanolin ointment and bovine type I collagen, respectively. All children were re-examined 4 weeks later. RESULTS: Complete healing of the anal fissure was observed in 68% of the group I patients, but in 92.9% and 100% of the group II and III patients, respectively. The difference among groups was significant in terms of complete fissure healing (P = 0.003), but the efficacy of topical lanolin ointment and bovine type I collagen spray did not differ significantly (P = 0.078). CONCLUSION: Our data suggest that topical lanolin ointment and bovine type I collagen spray are effective in the treatment of acute anal fissure in children.

A battered child case with duodenal perforation.

Battered child syndrome can refer to children exposed to harmful, non-accidental and preventable physical treatment by those are responsible for their care which prevents the child's physical, cognitive and spiritual development. A 28 months old boy was submitted to hospital due to abdominal blunt trauma. He had been firstly applied to Isparta Children Hospital by his parents with the complaint of fever. In the first examination, he was conscious, his general condition was poor there was respiratory acidosis, and neck stiffness was present. There were several fresh traumatic lesions on his face and left arm. His complaints were thought due to meningitis and antibiotics were started. He was transported to Suleyman Demirel University Hospital after a day because of vomiting, abdominal pain, tender, distended and silent abdomen, and air-fluid levels in direct abdominal X-rays. An old fracture of the right 9th rib was detected with chest X-ray in university hospital. Additionally, abdominal ultrasound scan showed distended bowel loops filled with fluid. Laparotomy revealed a complete rupture of the junction of the third and fourth parts of the duodenum and several hemorrhagic regions on bowel loops. The patient was discharged after 42 days. This case report described the case through both medical and legal processed in Turkey.

The effect of Nomega-nitro-L-arginine methyl ester and L-arginine on lung injury induced by abdominal aortic occlusion-reperfusion.

PURPOSE: The aim of this study was to examine the effects of Nomega-nitro-L-arginine methyl ester (L-NAME) and L-arginine on lung injury after aortic ischemia-reperfusion (IR). METHODS: Twenty-four Wistar-Albino rats were randomized into four groups (n = 6) as follows: Control (sham laparotomy), Aortic IR (30 min ischemia and 120 min reperfusion), L-Arginine (intraperitoneal 100 mg kg(-1) live weight)+aortic IR, and L: -NAME (intraperitoneal 10 mg kg(-1) live weight)+aortic IR. In the lung specimens, the tissue levels of malondialdehyde (MDA), vascular endothelial growth factor (VEGF), and nitric oxide (NO) were measured and a histological examination was done. RESULTS: Aortic IR increased MDA, VEGF, and NO. L-Arginine further significantly increased MDA and NO, and decreased VEGF (P < 0.05 vs aortic IR). L-NAME significantly decreased MDA and NO (P < 0.05 vs L-arginine+aortic IR) and increased VEGF (P < 0.05 vs other groups). A histological examination showed the aortic IR to significantly increase (P < 0.05 vs control) while L-arginine also further increased (P > 0.05 vs aortic IR), whereas L-NAME caused a significant decrease in pulmonary leukocyte infiltration (P < 0.05 vs aortic IR). CONCLUSIONS: Our results indicate that L-arginine aggravates the lung injury induced by aortic IR, while L-NAME attenuates it.

The use of recombinant activated factor VII in the circumcision operation in the case of a congenital factor VII deficiency.

Congenital factor VII deficiency is a rare autosomal recessive hemorrhagic disorder and surgery is normally the cause of excessive bleeding. In this report, we describe the first case with congenital factor VII deficiency admitted to our clinics for the sunnet operation (circumcision), in which recombinant activated factor VII (rFVIIa; NovoSeven) was used to manage the bleeding. The patient was an 8-year old boy with moderate factor VII deficiency (factor VII level, 4%), and rFVIIa was administered at a dose of 20 microg/kg per dose during the circumcision operation. The same dose was repeated at 2, 4, 6, 9, 12, 15, 18, 21 and 24 h post operation. The circumcision operation could therefore be safely performed in patients with congenital factor VII using rFVIIa.

Gadolinium chloride attenuates aortic occlusion-reperfusion-induced myocardial injury in rats.

OBJECTIVE: Aortic ischemia and reperfusion periods, which are often associated with infrarenal abdominal aortic cross-clamping and declamping, cause injury in distant organs including the heart. We recently reported that Kupffer cell blockage with gadolinium chloride (GdCl3) attenuates lung injury induced by aortic ischemia-reperfusion (IR). Therefore, we hypothesized that GdCl3 may attenuate myocardial injury induced by aortic IR. METHODS: The study was carried out in June 2005, in the Laboratory of Experimental Studies of Suleyman Demirel University Medical School, Isparta, Turkey. We studied the effect of GdCl3 on myocardial injury induced by abdominal aortic occlusion-reperfusion in rats by measuring the tissue levels of superoxide dismutase, catalase, malondialdehyde and activity of myeloperoxidase in rat heart specimens. Wistar-Albino rats (8 per group) were randomized into 3 groups. The control group underwent midline laparotomy and dissection of the infrarenal abdominal aorta without occlusion; the aortic IR group underwent laparotomy and clamping of the infrarenal abdominal aorta for 30 minutes followed by 60 minutes of reperfusion; and the GdCl3 + aortic IR group was pretreated with intravenous GdCl3 10 mg/kg 24 hours before the aortic IR. RESULTS: Aortic IR significantly increased whereas pretreatment with GdCl3 significantly decreased oxygen free radical production, lipid peroxidation and neutrophil activation in the heart tissues of the rats. CONCLUSION: Our results indicate that Kupffer cell blockage with GdCl3 attenuates the myocardial injury induced by aortic IR. We think that the novel findings of the present study may be a basis for further studies investigating the role of GdCl3 pretreatment in reducing myocardial morbidity and mortality caused by aortic IR during aortic surgery.

Intestinal atresia with segmental musculature and neural defect.

BACKGROUND/PURPOSE: The aim of this study was to investigate the possible etiologic factors of small bowel atresia and to detect the prognostic role of adequate resection and tapering in postoperative morbidity and mortality. METHODS: Intestinal resection specimens were obtained from 10 patients with jejunoileal atresia and 3 control subjects without any gastrointestinal disease. Intestinal specimens taken from 2-cm and 4-cm proximal sides of atresia, atretic segment, and 1-cm and 2-cm distal sides of atresia were stained with Masson trichrome and H&E. Immunohistochemical staining of the biopsy specimens with synaptophysin was also performed to ascertain the number, the intensity, and the morphology of ganglia. RESULTS: At the blind proximal end, there was segmental absence of muscular layers, presence of neural defects, and replacement of the muscular layers with fibrous tissue beside the relatively intact mucosa. CONCLUSIONS: Segmental defects in muscular and neural structures of the intestinal wall observed in both the antimesenteric and mesenteric sides of the atretic small bowel were considered to support the vascular insult theory as an etiologic factor. Adequate resection rather than tapering the dilated proximal atretic intestinal segment should be included in the surgical treatment of this pathology to avoid the intestinal dysmotility, which may result in gut-related sepsis and death in the postoperative period.

Diameter of the infrarenal abdominal aorta in children with cerebral palsy.

The diameters of the infrarenal abdominal aorta by ultrasonography have not yet been reported in children with cerebral palsy (CP). Because the demand for the surgical applications of the abdominal aorta probably increases in the CP population owing to their prolonged life-span, we planned a study to assess the diameter of the infrarenal abdominal aorta by ultrasonography in children with CP and to compare them with those of healthy subjects. The study comprised 60 children with CP and 95 age- and sex-matched healthy children. The diameter of the infrarenal abdominal aorta was measured by B-mode ultrasonography. The correlation between the aortic diameter, weight, height, body surface area (BSA), and body mass index was studied. The diameter of the infrarenal abdominal aorta was found to be smaller in children with CP than in healthy children (p < 0.05). There was a significant correlation between the aortic diameter, weight, height, and BSA in both groups (p < 0.05). When a vascular surgical treatment is needed in children with CP, the probability of a small-diameter infrarenal abdominal aorta should be considered.

An unusual type of severe barotrauma owing to automobile tire biting in a child.

The authors report a rare case of a barotraumatic pneumothorax and pneumomediastinum associated with esophageal perforation and orbital emphysema. A 4-year-old boy presented with sudden respiratory distress after blowout of a defective tire that he bit. Computed tomography scan showed right pneumothorax and bilateral orbital emphysema. A linear rupture has been detected in the cervical esophagus in esophagoscopy. Stamm gastrostomy and tube thoracostomy were performed, and broad-spectrum antibiotics have been introduced. Oral feeding started 23 days after blowout of tire, and the patient was discharged 50 days after injury.

Clinical experience of removing aerodigestive tract foreign bodies with rigid endoscopy in children.

OBJECTIVES: This study was undertaken to document the aerodigestive tract foreign body accidents among children, and to investigate the circumstances surrounding these events. METHODS: A review of the charts of pediatric patients admitted with the definitive or suspicious diagnosis of aerodigestive tract foreign bodies was carried out in the period between January 1, 1998 to December 31, 2002. RESULTS: There were 53 eligible children; 39 boys and 14 girls, with an age range of 7 months to 14 years. Food items were the most common airway foreign bodies and coins were the most common esophageal foreign bodies. Among the 32 patients who underwent bronchoscopy, no foreign body was identified in 9 patients. Among the 21 patients who underwent esophagoscopy, foreign body was removed in 19 patients. In 2 cases, large foreign bodies which we could not extract with forceps were pushed into the stomach. CONCLUSIONS: Foreign bodies in the airway and esophagus constitute a constant hazard in all age groups, which demands immediate approach and management. Although the rigid endoscopic removal of aerodigestive foreign bodies was successful in this series, the most effective treatment of foreign body accidents is their prevention.

Acute respiratory distress due to fibrosarcoma of the carina in a child.

We report a 12-year-old boy with primary bronchopulmonary fibrosarcoma (PBPF). He was misdiagnosed a having asthma until he presented with acute respiratory distress syndrome. Chest x-ray showed atelectasis of the right lung. Bronchoscopy performed to rule out foreign body inhalation revealed a friable mass obstructing the right main bronchus. Successful treatment was achieved with surgical resection of the lesion followed by radiotherapy and chemotherapy.

Lung injury after aortic occlusion-reperfusion in rats: the role of gadolinium chloride.

Aortic ischemia-reperfusion (AIR) induced lung injury has already been documented. Kupffer cell blockage (KCB) with gadolinium chloride (GdCl3) has also been shown to attenuate remote organ damage caused by ischemia reperfusion. The present study was designed to examine the effect of GdCl3 in lung ischemia-reperfusion injury induced by aortic occlusion. Thirty-two rats were randomly allocated to four groups as follows: SHAM (Sham Laparotomy), SHAM+KCB, AIR, and AIR+KCB. An atraumatic microvascular clamp was placed across the infrarenal abdominal aorta just after its origin from the aorta for 30 minutes. The microvascular clamp on the infrarenal abdominal aorta was removed and reperfused for 60 minutes. GdCl3 was given 24 hours prior to the experiment. Malondialdehyde (MDA) level and myeloperoxidase (MPO) activity were assayed in lung tissues. MDA level and MPO activity in the AIR group were significantly higher than those in the other groups. When compared to AIR group, KCB with GdCl3 significantly decreased MDA level and MPO activity in the AIR+KCB group. These results suggest that GdCl3 attenuates the lung injury caused by AIR. The effects of GdCl3 on reduced lung damage may be mediated through significant decreases in both MDA level and MPO activity.

The antioxidant effect of melatonin in lung injury after aortic occlusion-reperfusion.

Acute aortic occlusion with subsequent ischemia-reperfusion of the lower extremities is well known to predispose to lung injury. Melatonin (MEL), a pineal hormone, is a free radical scavenger and an antioxidant. The purpose of this study was to assess the putative protective role of MEL in lung ischemia-reperfusion injury induced by aortic occlusion-reperfusion. Thirty-two rats were randomly allocated to four groups as follows: SHAM (Sham Laparotomy), SHAM+MEL, Aortic Ischemia Reperfusion (AIR) and AIR+MEL. Twenty mg/kg live weight MEL was given intraperitoneally 1 h prior to the experiment. An atraumatic microvascular clamp was placed across the infrarenal abdominal aorta (IAA) just after its origin from the aorta for 30 min. The microvascular clamp on IAA was removed and reperfused for 12 h. Lung tissues were assessed for malondialdehyde (MDA) level and myeloperoxidase (MPO) activity. MDA level and MPO activity, indicating the extent of lipid peroxidation and neutrophil infiltration of lung, respectively, significantly increased in AIR group when compared to SHAM and SHAM+MEL groups (P<0.05). Treating rat with MEL significantly decreased MDA levels as well as MPO activity in AIR+MEL group when compared to AIR group (P<0.05). In this study, exogenously administered MEL reduced lung injury after aortic occlusion reperfusion.

The effects of unilateral testicular ischemia and hemicastration on contralateral testicular IGF-1 level, histology and lipid peroxidation.

Hemicastration is followed by compansatory hypertrophy whereas unilateral testicular torsion is followed by atrophy in contralateral testicle in rats. Insulin-like growth factor (IGF-1) has important roles in testicular paracrine and autocrine functions. In this study it was aimed to compare ischemic parameters and IGF-1 levels in the contralateral testicle in unilateral spermatic cord ligation, testicular torsion, and hemicastratron. 32 wistar rats were equally altocated into sham, ligation, torsion, and hemicastration groups. In ligation group, right spermatic cord was ligated with 3/0 silk suture. In the torsion group, right testis was tcrsed for 720 degrees. In hemicastration group, right orchiectomy was done. 48 hours later left orchiectomy was done in all groups. Malondialdehyde (MDA) and IGF-1 levels were determined in the testicle. Average values of the groups were compared with Anova followed by Dunnett T3 multiple comparison tests. MDA levels were significantly reduced in ligation and torsion groups (p < 0.05). This reduction was more prominent in hemicastration group (p < 0.05). Contralateral testicular IGF-1 levels in ligation and torsion groups were not different compared with the sham group. Left testicular IGF-1 level in the hemicastration group was decreased significantly compared with other groups (p < 0.05). Histological. changes evaluated. Contralateral Johnsen's testicular biopsy scores were significantly decreased in all experimental groups but mean tubular diameter was not changed in all groups.