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Empyema is the presence of purulent material in the pleural cavity, and it is a well-known and frequent complication of pneumonia in children. Despite the new antimicrobial treatment options and the different drainage techniques, parapneumonic pleural empyema still represents a significant cause of morbidity and mortality. Streptococcus pyogenes is an infrequent cause of empyema. In this article, we will present a four-teen years old girl with empyema who presented with severe additional clinical symptoms including hypotension and hypoxia. Streptokinase is five times table fibrinolytic therapy improved after implementation of broad-spectrum antibiotics, has been used up to six weeks. We wanted to present this case because of the challenges that we faced in the management of the disease.

Objective Acute mesenteric ischaemia leads to intestinal damage. Restoration of blood flow results in further damage to tissue, which is called reperfusion injury. This study aimed to investigate the protective effects of short-interval postconditioning and to determine the optimal interval for reperfusion in an experimental rat model of intestinal ischaemia. Methods Forty adult male Wistar rats were grouped as follows: sham (Sh), ischaemia + reperfusion (IR), ischaemia + postconditioning for 5 seconds (PC5), ischaemia + postconditioning for 10 seconds (PC10), and ischaemia + postconditioning for 20 seconds (PC20). For postconditioning, 10 cycles of reperfusion (5, 10, or 20 seconds) interspersed by 10 cycles of 10 seconds of ischaemia were performed. Blood glutathione reductase (GR) and glutathione peroxidase (GPx) levels were measured. Intestinal tissue damage was assessed histopathologically. Results GR levels were significantly higher in the PC5 group than in the IR group (37.7 ± 9.0 vs. 18.5 ± 2.0 min/g Hb). GPx levels were significantly higher in the PC10 group than in the IR group (43.2 ± 9.2 vs. 15.9 ± 4.6 U/g Hb). The histopathological score was significantly lower in the PC5 group (1.1 ± 0.1) than in the IR group (2.1 ± 0.2). Conclusion Short-interval postconditioning reduces reperfusion injury in the ischaemic bowel and the optimal interval for reperfusion is 5 seconds. The long-term effects of short-interval postconditioning and the optimal reperfusion interval in intestinal ischaemia–reperfusion in rats need to be investigated.

Despite the prompt diagnosis and treatment of testicular torsion (TT), there are problems with fertility and atrophy after testicular salvage. Dexpanthenol (Dxp) is the biologically active alcohol of pantothenic acid (PA). Dxp is converted to PA in tissues. PA increases the content of reduced glutathione (GSH), Coenzyme A and ATP synthesis in cells. GSH and glutathione-dependent peroxidases (GPX) are the major defense systems against oxidative stress. GPX-4 is the major antioxidant in testicular tissue. However, the activity of GPX-4 appeared and increased only after puberty. We investigated the effect of Dxp on testicular atrophy after TT at the 60th day. Rats were separated randomly into four groups. Group C: control group, group Td: torsion + detorsion, group Sal: torsion + saline + detorsion, group Dxp: torsion + Dxp + detorsion. The left testis was rotated 720 degrees for 2 h. In group Sal, normal saline and in group Dxp, Dexpanthenol were injected intraperitonally, 30 min before detorsion. After 60 days, the testicular weights and volumes were measured. Histopathology of the left testis was evaluated with mean seminiferous tubular diameter (MSTD) and mean testicular biopsy score (MTBS). The left (torsed) testicular weight and volume of groups Td and Sal were significantly lower compared to group Dxp. The MSTD and MTBS of group Td and Sal were significantly lower than group Dxp. Contralateral testicular weight and volume of groups Td, Sal and Dxp had no significant difference compared to the control group. Dxp significantly prevented testicular atrophy after 60 days of TT. Dxp has FDA approval, is safe, cost effective and readily available. Its relevance for clinical trials may especially be for the problem of testicular atrophy catastrophe, seen very frequently following testicular salvage.

Prevention of tissue damage after testicular torsion caused by I/R injury is still a clinical and experimental problem. There are many experimental studies made with several chemicals in the literature for decreasing the effect of reactive oxygen species after ischemia and reperfusion. Dexpanthenol (Dxp) is the biologically active alcohol of pantothenic acid. Pantothenic acid increases the content of reduced glutathione, Coenzyme A and ATP in cell. We studied the effect of Dxp on lipid peroxidation and testicular damage. Forty adult rats were separated randomly into five groups: group Sh, Sham-operation; group TD, torsion-detorsion; group NS, torsion-normal saline-detorsion; group D, torsion-Dxp 250 mg/kg detorsion; group D2, torsion-Dxp 500 mg/kg detorsion group. Serum MDA levels were taken before detorsion, after torsion at the first and fifth minute and at the first hour. Tissue sample was taken at the first hour. The alterations of I/R injury on testis were histological graded. Serum MDA levels were significantly lower in group D2 compared to all groups. The histopathology score of group D2 was significantly lower than groups TD, NS and D. Histopathological score and serum MDA levels are strikingly compatible. Dxp attenuated lipid peroxidation and tissue damage at I/R injury. This effect depends on its antioxidant effect with increasingly reduced glutathione, Coenzyme A and ATP. The effect of Dxp on I/R injury has been shown for the first time in the experimental testicular torsion.

Omphalocele is often associated with the presence of other congenital anomalies. Isolated minor omphaloceles are known to have a favorable prognosis. Case reports have demonstrated nonclassical associations occurring in minor omphaloceles. Intestinal atresia is seldom described as being associated with minor omphaloceles. Special attention should be paid to intestinal exploration in small omphaloceles to avoid complications. Here we report a new association of a minor omphalocele, type IV ileal atresia and congenital ostomy.

A retrospective analysis of the medical records of 205 children with renal injuries secondary to blunt abdominal trauma is used to make recommendations regarding the initial diagnostic and therapeutic approaches in this type of patient. It was found that the absence of hematuria on initial urinalysis does not exclude a serious renal injury. Thus, following blunt abdominal trauma, all children should undergo imaging procedures to exclude renal injury, whether they have hematuria or not. Ultrasound is a good initial screening procedure in all patients. Computed tomography is recommended for the definitive evaluation of suspected major renal injuries. Since even major renal injuries may heal without surgical intervention, conservative management is the recommended initial treatment of choice. Surgery is reserved for those children who are hemodynamically unstable and those that develop complications.

SUMMARY Hiatal hernia is a rare condition, which may be a cause of important clinical problems either as a mediastinal mass or as a cause of failure of the antireflux mechanism. Nineteen patients treated for paraesophageal hiatal hernias were included in the study. We investigated demographic data, diagnostic studies and symptoms of the patients together with the type of operation and outcome. Respiratory and gastrointestinal complaints were the prominent symptoms in most patients. Plain X-ray, contrast radiological study and esophagoscopy were used in the diagnostic workup. Surgical repair was performed via thoracic, abdominal or thoraco-abdominal approaches. Concomitant antireflux procedures were performed in 13 patients. Hiatal hernias in children may be asymptomatic or may present with a variety of symptoms or dramatic complications. Because of the risk of complications, surgical treatment is necessary shortly after diagnosis. Repair of the hiatus combined with antireflux surgery seems to yield satisfactory results.

Anonychia (absence of nails) is a very rare congenital or acquired anomaly. Congenital anonychia has been described in association with a wide variety of other congenital anomalies. Of these abnormalities, the most frequent are some hypoplastic nails, this is incomplete anonychia. Simple anonychia, meaning congenital absence of the nails without any other coexisting major congenital anomaly, is an extremely rare variety of this condition. This is mostly due to autosomal recessive inheritance. A newborn case with congenital but non-inherited absence of all fingernails and toenails together with the absence of both fifth distal phalanges without any other major structural anomaly is reported.

Kimura's disease, characterized by a triad of painless subcutaneous masses in the head and neck, prominent eosinophilia and markedly elevated immunoglobulin E levels, is an uncommon idiopathic, chronic inflammatory disease that usually affects young and middle-aged Asian males. Kimura's disease is known usually as a localized process and is an extremely rare cause of generalized lymphadenopathy in children. We report an eight-year-old Turkish boy with Kimura's disease who presented with generalized lymphadenopathy masquerading as malignant lymphoma.

Objectives: Trauma and appendicitis are the most common conditions of childhood for which surgical consultation is sought in emergency departments. Occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. We aimed to evaluate our patients with traumatic appendicitis and to discuss their properties in the light of the literature. Methods: We retrospectively reviewed the charts of children of blunt abdominal trauma accompanied by appendicitis. Results: Of 29 cases of blunt abdominal trauma that had required surgical exploration, five were found to have gross findings of acute appendicitis and underwent appendicectomy. Appendicitis was confirmed histopathologically. Conclusion: It should be kept in mind that children managed for severe blunt abdominal trauma may develop appendicitis. If clinical outlook suggests appendicitis in cases conservatively managed for blunt abdominal trauma, physical examinations, abdominal ultrasonography and/or abdominal computed tomography should be repeated for diagnosis of traumatic appendicitis. This approach will help to protect the patients against the complications of appendicitis that are likely to develop.

Intestinal obstruction caused by an anomalous congenital band is very rare in adults and children. A 7-year-old boy was admitted with acute intestinal obstruction. His parents mentioned that the child always had mild abdominal distention and failure to thrive from his infancy. On his medical history, there were not any attacks of abdominal pain, fever and hospitalization. Laparotomy showed an ileal loop compressed by an anomalous band, which extended from the ileum to the sigmoid mesentery resembling a mesenteric remnant. The band was resected. Histologically, it was composed of loose connective tissue containing mature vessels.

Background/Purpose Colonic atresia (CA) is one of the rarest causes of neonatal intestinal obstructions, and no large series can be reported. Therefore, we did perform a retrospective clinical trial to delineate our CA cases and carry out a literature survey. Methods We reviewed the charts of CA cases treated in our center between 1992 and 2002. We aimed to collect all reported cases in Medline, and personal communications with the authors of published series were used to reach the missing data. Results The chart review revealed 9 newborns with CA treated in our center (6 cases of type III, 2 cases of type II, and 1 case of type IV). These accounted for 3.7% of all gastrointestinal atresias managed in our center. Of the CA cases, 3 were isolated and 6 had at least one or more associated congenital anomalies. The preferred surgical technique at the initial treatment of CA was performing a proximal stoma and distal mucous fistula in an average of postnatal 59.4 hours. The literature survey enabled us to reach 224 cases of CA, including our cases. Conclusions Because of the low incidence of CA, delay in diagnosis and treatment may occur. The mortality is statistically higher when the surgical management is performed after 72 hours of age. However, the prognosis of CA is satisfactory if diagnosis and surgical management could be made promptly and properly.

Urethral duplication is among the rarest congenital anomalies and is characterized by two urethral canals. The urethral canals are most commonly located in the sagittal plane. We present a case of abortive hypospadiac urethral duplication and its surgical management with tubularized incised plate urethroplasty.

Giriş ve amaç: Akut apandisitli (AA) çocuklarda apandiks ve periapandiküler bölgenin ultrasonografik görünümü, enflamasyonun derecesine ve perforasyon varlığına bağlı olarak değişkenlik göstermektedir. Bu çalı şmanın amacı preoperatif ultrasonografik (USG) incelemesi yapılmış olan akut (AA) ve perfore (PA) apandisitli olgularımıza ait ultrasonografik bulguların tanı değerlerini her iki grup için ayrı ayrı incelemek ve yayı nlanmış veriler ile karşılaştırmaktır. Gereç ve yöntem: Çalışmanın materyalini Ocak 1997- Mart 2000 yılları arasında apandisit nedeni ile opere edilen 188 olguya ait preoperatif USG bulguları oluşturmaktadır. Olguların USG incelemesinde kullanılan parametreler sırasıyla apandikse ait patolojik kitle görünümü (A), apandikolit (B), apandiks duvar kalı nlığı (tüm apandiks çapı)’nın mm cinsinden ölçümü (C), periapandiküler bölgede, pelvis veya Douglasda lokalize sıvı (D), yaygın periton içi sıvı (E), ileus bulguları (aperistaltik dilate barsak ansları) (F) ve normal ultrasonografik bulgular (G)’dır. Her iki gruptaki apandiks duvar kalınlı kları arasındaki farklılık istatistiksel olarak incelenmiştir. Bulgular: Ultrasonografik ölçüm parametrelerinin her iki gruptaki toplam 188 olgudaki dağılımı (olgu sayısı) Akut apandisitli olgular için: (A)61, (B)6, (C)51, (D)16, (E)8, (F)25, (G)20 ve Perfore apandisitli olgularda: (A)42, (B)9,(C)31, (D)29, (E)14, (F)24, (G)10 şeklindedir. Her iki grubun apandiks duvar kalınlıkları (C) AA için ort. 19,37 (±12,55) mm; PA için ise ort. 23,80 (±15,10) mm olarak hesaplandı. AA ve PA için USG ile ölçülen apandiks duvar kalınlıkları arasında istatistiksel olarak anlamlı bir fark saptanmadı (p>0,05). Apandiks duvar kalınlığı bir olgu hariç tüm olgularda (81 olgu) 6mm ve üzerinde bulundu. PA grubunda %34,9 oranı nda intraperitoneal sıvı birikimi gözlendi. Sonuç: USG apandisit tanısında güvenilir ve noninvaziv bir yöntem olup 6 mm’den büyük kitle görüntüsü tanıda önemlidir. Apandisit perforasyonu ile birlikte sonografik bulguların görülme sıklığı artmakta, apandiks çapı artmaktadır. Her iki grup arasında ileus bulguları yönünden önemli bir fark olmaması, bu kriterin akut apandisitin ultrasonografik tanısında yararlı olacağını düşündürmektedir. Background and aims: The ultrasonographic (USG) appearances of the appendix and periappendicular regions differ according to the degree of inflammation as well as the presence of perforation in children with acute appendicitis. The aim of this study was to evaluate the diagnostic value of ultrasonographical findings in patients with acute (AA) and perforated appendicitis (PA) with preoperative ultrasonographic investigations and to compare the results with the previously published data. Materials and methods: The material of this study included data regarding the ultrasonographical evaluation of 188 patients treated with the diagnosis of appendicitis in the period January 1997- March 2000. The parameters of USG evaluation were: the appearance of pathological appendiceal mass (A), appendicolith (B), diameter of the appendiceal wall (entire appendix) in mm (C), localized fluid in periappendicular region, pelvis, or Douglas (D), diffuse intraperitoneal fluid (E), findings of ileus (aperistaltic, dilated bowel loops) (F), and normal ultrasonographic findings (G). Appendiceal wall mass was calculated in both groups, and the difference was compared statistically. Results: The distribution of ultrasonographic parameters in each group for a total 188 patients were as follows: (A)61, (B)6, (C)51, (D)16, (E)8, (F)25, (G)20 for acute appendicitis; and (A)42, (B)9, (C)31, (D)29, (E)14, (F)24, (G)10 for perforated appendicitis. The average value for appendiceal wall thicknesses was calculated as 19.37 (±12.55) mm for AA, and 23.80 (±15.10) mm for PA. The difference between the two groups was not statistically significant. Appendiceal wall thicknesses were greater than 6 mm in all patients (81) except one. Intraperitoneal fluid collection was detected in 34.9% of the patients for the PA group. Conclusion: USG is a reliable and non-invasive method in the diagnosis of acute appendicitis; the appearance of 'mass' bigger than 6 mm in diameter is valuable in diagnosis. The incidence of sonographic findings and the measurement of the appendiceal wall increase in case of perforation. Because there was no important difference between the ileus findings of the two groups, we think it can serve as a useful criterion in the ultrasonographic diagnosis of acute appendicitis.

Eventration of the diaphragm is generally defined as an abnormal elevation of all or a portion of an attenuated but otherwise intact diaphragmatic leaf. Previous studies have indicated that eventration is a relatively rare condition, which can be symptomatic and requires surgery. We aimed to evaluate our patients with diaphragmatic eventration, and to discuss their characteristics in the light of the relevant literature. We retrospectively analyzed age, sex, incidence, location of the eventration, symptoms, associated anomalies, surgical technique, complications and survival in our patients. Between 1974 and 1999, 33 patients were treated in the Pediatric Surgery Departments of Ege University, SSK Children's Hospital and Behçet Uz Children's Hospital, 18 of them boys and 15 girls. The ages of our patients ranged from three days to 12 years. All of the patients had at least one of the respiratory symptoms such as cough, respiratory distress and fever; 3 newborns were admitted with severe respiratory distress while children belonging to higher age groups had symptoms of acute or recurrent pulmonary infections and failure to thrive. The eventration was right-sided in 22, 11 eventrations were left-sided. Diagnosis was performed with the help of a number of radiological studies such as fluoroscopic investigation, contrast study of the upper gastrointestinal system, direct X-ray graphies of the thorax, CT scan and ultrasonography, as necessary. Surgery was performed via thoracotomy in 20 patients and the 12 other patients underwent laparotomy for plication. One patient underwent thoracoabdominal plication. Two patients died because of cardio-respiratory complications in the early postoperative period and the rest of them survived to annual follow-ups.In conclusion, diaphragmatic eventration is an important condition which can eventually be mortal. Early diagnosis is necessary and plication is the treatment of choice.

Background Local flaps are widely used in reconstructive surgery. Tri-lobed skin flap is a relatively new flap and there has been no experimental model of this flap. This flap can be used for repair of full thickness defects in the face, ears and alar region. Based on the size of ears in a rabbit, we designed a model of ear reconstruction using expanded tri-lobed flap. Local flaps are more advantageous in that they provide excellent color and texture matching up with those of the face, adequately restore ear contour, place scars in a favorable location and ideally accomplish these goals in a single stage with minimal donor site morbidity. Methods Eight adult New Zealand rabbits were divided into two groups. 50 ml round tissue expander were implanted to four rabbits. After completion of the expansion, a superiorly based tri-lobed flap was elevated and a new ear was created from the superior dorsal skin of each rabbit. Scintigraphy with Technetium-99m pertecnetate was performed to evaluate flap viability. Results Subtotal flap necrosis was seen in all animals in non-expanded group. New ear in dimensions of the original ear was created in expanded group without complication. Perfusion and viability of the flaps were proved by Technetium-99m pertecnetate scintigraphy. Conclusion According to our knowledge this study is the first to demonstrate animal model in tri-lobed flap. Also, our technique is the first application of the trilobed flap to the possible ear reconstruction. We speculated that this flap may be used mastoid based without hair, in human. Also, tri-lobed flap may be an alternative in reconstruction of cylindrical organs such as penis or finger.

The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn’t performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.

Çocuklarda akut skrotum birçok neden ile ortaya çıkabilir. Bu nedenlerden birisi de akut epididimit'dir. Çocuklarda akut epididimit altta yatan üriner sisteme ait bir patoloji veya anomalinin ilk bulgusu olabilir. Bakteriyel epididimit geçiren prepubertal çocuklarda idrar yolu enfeksiyonuna neden olan artmış bir üriner sistem anomalisi insidansı olduğu bilinmektedir. Kliniğimize, akut skrotum ön tanısıyla yatan ve daha sonra akut epididimit tanısı alan 60 olgu retrospektif olarak incelendi. Hastalarımızın ürolojik değerlendirmesinin yapılabilmesi amacıyla araştırma programında ultrasonografi, intravenöz pyelografi ve miksiyon sistoüretragrafi incelemesi yapılmıştır. Epididimit geçiren olguların 12 tanesi tıbbi tedavi sonrası istenen ürolojik incelemelerini tamamlayarak kliniğimize başvurduğu saptandı. Bu dosyaları tam olan 12 çocuğun ürolojik incelemeleri sonucunda 10 çocukta üriner sisteme ait anomali veya patoloji saptandı. Patoloji saptanan hastalarımızın 8'i prepubertal, 2'si postpubertal çocuktu. Epididimit geçiren prepubertal erkek çocuklarda altta yatan ürolojik anomalilerin saptanması amacıyla ürolojik değerlendirme yapılması gereklidir. There may be many reasons of acute scrotum in children. One of them is acute epididymitis. Epididymitis may be the first sign of underlying urinary tract pathology or anomaly. Boys with bacterial epididymitis have been reported to have an increased incidence of urinary tract anomalies, predisposing to urinary tract infection. The charts of 60 cases were reviewed retrospectively who were admitted with the diagnosis of acute scrotum and then the diagnosis of acute epididymitis was confirmed. For the urological evaluation of the patients, ultrasound, voiding cystouretrography and excretory urography was planned. Only 12 patients completed their investigations and they admitted to our clinic. In 10 of these 12 patients an urinary pathology or anomaly were diagnosed. Eight boys were prepubertal and 2 boys were post-pubertal. As a conclusion, prepubertal boys with epididymitis merits a urological evaluation to rule out an underlying urological anomaly.

Neonatolojideki ve yoğun bakım olanaklarındaki gelişmelere bağlı olarak prematüre yaşam oranları artmış ve son 30 yılda nekrotizan enterokolitli olgu sayısı artarak bu hastalık özellikle prematüriteli olgular için önemli bir morbidite ve mortalite nedeni haline gelmiştir. Çalışmamızda Dr. Behçet Uz Çocuk Hastanesinde 1 yıllık süre içerisinde izlenen yenidoğan ve prematüre nekrotizan enterokolitli olgular incelenerek olguların demografik özellikleri, insidans, klinik ve radyolojik bulguları ve tedavi özellikleri değerlendirilmiştir. Haziran 1995 - Temmuz 1996 tarihleri arasında 414 prematüre bebekden 30'u nekrotizan enterokolit tanısı almıştır (insidans %7.24). Diğer yandan, aynı dönemde izlenen 2523 terminde yenidoğan bebek arasından ise 5 olgu (insidans %0.19) aynı tanıyı almıştır. Olguların çoğunluğunu (%57.14) erkek ve gestasyonel yaşı $leq$32 hafta (%42.85) olan bebekler oluşturmaktaydı. Ortalama doğum ağırlığı 1778 (±626) gramdı. Semptomların başlama günü ortalama 10.4 (±9.8) gündü. 1500 gramın altında doğum ağırlığı olanlarda ise semptomlar 13,4 gün ile en geç olarak görülmüştü. En sık rastlanan semptomlar gastrik rezidü, abdominal distansiyon, ve kusma olarak saptandı. Olguların 21'inde nekrotizan enterokolit sepsis ile birlikte bulunmaktaydı. Laboratuvar değerlerinde trombositopeni en sık rastlanan (%68.57) bulgu idi. En sık saptanan radyolojik bulgular dilate barsak ansları ve ileus bulguları olmuştur. Olguların %54.28'i Evre 1 nekrotizan enterokolit grubunda değerlendirildi. Prematürite en sık rastlanan risk faktörü olurken, 5 olguda cerrahi girişim uygulandı. Genel mortalite %48.57 olarak bulunmuş ve bu çalışma döneminde prematüriteye bağlı ölümlerin %7.07'sinden nekrotizan enterokolit sorumlu tutulmuştur. Sonuç olarak NEK sıklıkla prematürite ve düşük doğum ağırlıklı bebeklerde görülen ve formula ile beslenenlerde daha fazla karşılaştığımız bir hastalıktır. With advances in Neonatology and neonatal intensive care medicine the rate of premature survival has improved and for that reason incidence of patients with necrotizing enterocolitis has increased in the last 30 years and it has been an important cause of morbidity and mortality particularly in premature newborns. In this study, we evaluated the demographical data, incidence, clinical presentation, radiological findings and treatment characteristics of our patients with necrotizing enterocolitis in our hospital in one year period. Thirty premature patients out of 414 were diagnosed as necrotizing enterocolitis in the years between June 1995 - July 1996. Therefore incidence for prematurity was calculated as 7.4%. On the other hand, 5 patients out of 2523 (incidence 0.19%) term newborn baby was diagnosed as having the same disease in this time period. The majority of the patients were males (57.14%) and most of them had gestational age of $leq$32 weeks (42.85%). Average birth weight was 1778 (± 626) grams. The average beginning day of the symptoms was 10.4 (±9.8) days. The symptoms appeared latest, with an average of 13,4 days, in the patient group with birthweights$leq$1500 grams. The most frequently seen clinical symptoms were gastric residuals, abdominal distention and vomiting. Sepsis was found in 21 patients in association with necrotizing enterocolitis. Trombocytopenia was the most frequent finding (68.57%) among the laboratory tests. Dilated bowel loops and ileus patterns were the most frequent radiological findings. 54.28% of the patients were Grade 1 necrotizing enterocolitis: Prematurity was themost frequently encountered risk factor and surgery was indicated in 5 patients. The overall mortality was found as 48.57% and necrotizing enterocolitis was responsible from 7.07% of mortality between premature patients. In conclusion, NEC is frequently encountered in premature and very low birthweight infants and particularly in formula fed babies.

Ovarian masses are uncommon in children. Only 10 - 17 % of them are epithelial tumours. Mucinous cystadenoma in children is a benign cystic ovarian neoplasm, and it is met very rarely in the medical literature. We present a 13-year-old girl with a giant ovarian mucinous cystadenoma.

Myositis ossificans is a pathologic entity rarely met, but still it must be kept in mind in differential diagnosis of a tender soft tissue swelling. The authors present an 8-year old boy with nontraumatic myositis ossificans circumscripta in the left paravertebral muscle. In diagnostic workup, ultrasonography and computed tomography (CT)-scan showed a well marginated, regular, ossified mass in the paravertebral muscle, but we were not able to exclude malignancy on the clinical grounds. The mass was excised totally, and the histopathologic examination found myositis ossificans. The authors suggest that surgical intervention may be an option for diagnosis and treatment in unusual cases when diagnosis is not certain.

Truncal duplication represents one of the rare forms of conjoined twins. We observed a male infant with a truncal duplication; in the host twin no pathology was found except an atrial septal defect and a large omphalocele. The parasitic twin was attached to the xiphoid region (xiphopagus) in an opposite and "horseriding" manner, was acephalic, and had multiple gastrointestinal, genitourinary, and skeletal anomalies. The junction site consisted of lipoid and muscular structures. Surgical separation was done without any difficulty. The abdominal defect was repaired primarily. The host twin is doing well.

Complications of neonatal circumcision are generally minor and occur early; a few reports exist on the late or serious kind. The authors describe a case of urethrocutaneous fistula occurring 13 years postcircumcision. The patient also had a skin bridge, another late complication of circumcision. The authors suggest erections in puberty as the triggering factor for onset of fistula. To our knowledge, neither such a late occurrence of fistula nor coexistence of these complications have been reported.