Search

The 16th Annual Scientific Meeting of the Society for Neuro-Oncology in Conjunction with the AANS/CNS Section on Tumors, Orange County, California, USA, 17-20 November 2011. In Neuro-Oncology, 2011, v. 13 n. Suppl. 3, p. iii111, abstract no. ET-18

Department of Pediatrics, Afyon Kocatepe University, Afyon 03200, TurkeyReceived 11 January 2007; accepted 13 August 2007ABSTRACT: Purpose. Inguinal hernia is one of themost common surgical pathologies in childhood. Anyof the abdominal organs can slide into the hernial sacand become incarcerated there. In girls, the fallopiantubes, ovaries, uterus, and—rarely—ovarian cysts canform the sliding component of an inguinal hernia.The aim of this study was to investigate the diagnos-tic value of preoperative sonographic examination ingirls with nonreducible inguinal masses.Methods. Nine girls ranging in age from 2 monthsto 8 years who were admitted to our clinic with nonre-ducible inguinal masses were included in the study.All patients underwent sonographic examination fol-lowed by surgery on the day of admission.Results. A definitive diagnosis was obtained in 6patients on preoperative sonographic evaluation,whereas 3 patients were misdiagnosed. One patientwas diagnosed sonographically as having lymphade-nopathy, but surgery revealed an ovarian cyst slidingintothehernialsac.Asecondpatientwasfoundtohaveaninfectedlymphnodeatsurgeryinsteadofastrangu-lated bowel loop as diagnosed on sonographic exami-nation. In the third patient, the preoperative sono-graphicdiagnosiswasanovariancystintheherniasac,butsurgeryrevealedacystofthecanalofNuck.Conclusion. Inguinal masses in young girls must becarefully evaluated, because the sonographic preop-erative diagnosis may be misleading.

L'ectopie renale intra thoracique partielle ou complete avec ascension du rein au-dessus du niveau du diaphragme dans le mediastin posterieur est la plus rare de toutes les ectopies renales, avec une incidence de moins de 1 sur 10000 cas. Nous presentons le cas d'un nouveau-ne avec une hernie diaphragmatique droite associee a une ectopie renale. Le diagnostic de l'ectopie a ete realise avant la chirurgie. Le fascia de Gerota est utilise pour fermer le defect diaphragmatique. Bien que cette anomalie renale soit habituellement asymptomatique, elle ne necessite aucun traitement specifique. Neanmoins, apprecier la fonction et l'anatomie du rein avant la chirurgie est important et benefique. Nous discutons l'aspect embryologique de cette association et l'importance de la scintigraphie renale chez les patients avec une ectopie renale.

Ekingen, gulsen/0000-0002-3331-8395; Karacay, Safak/0000-0001-8615-7727; Bilge, S.Sirri/0000-0003-2878-6968 WOS: 000296572000039 PubMed: 21890132 Objective: To determine whether twisting of the ipsilateral vas deferens results in alteration of its contractility. Design: Experimental study. Setting: University animal lab. Animal(s): 24 male Wistar rats. Intervention(s): All the rats in the experimental groups underwent spermatic cord torsion. Durations of torsion were 45 minutes, 3 hours, and 24 hours in groups 2, 3, and 4, respectively. In groups 2 and 3, subgroups b were created to evaluate late effects using in vitro pharmacological techniques. Main Outcome Measure(s): The contractility of the vas deferens was evaluated in groups 1, 2a, 3a, and 4 right after and in groups 2b and 3b 48 hours after the initial operation. Result(s): Group 4 and subgroups 2b and 3a had significantly diminished responses compared with the control group, whereas in subgroups 2a and 3b, the responses to noradrenaline and to single-pulse field stimulation were not significantly different. Conclusion(s): The impairment of contractility with the twisting of the vas deferens might be another factor responsible for subfertility, particularly that related to sperm transport. The unfavorable late change in short duration of torsion may be the result of either ischemia and reperfusion injury or sympathetic overactivation in the acute period of torsion. (Fertil Steril (R) 2011; 96: 1234-8. (C) 2011 by American Society for Reproductive Medicine.)

Primary intestinal lymphangiectasia is an uncom- mon congenital anomaly. It is an intrinsic abnor- mality of the intestinal lymphatics system. Over the years, various treatment options such as diuretics, albumin transfusions and a medium chain triglycerides (MCT) diet as well as surgical options such as resection of isolated segments and peritoneal-venous shunts have been used. An MCT diet, which is a low fat, high protein diet, is increasingly used in the management of this anomaly. Aim: The aim was to review the evidence for medium chain triglycerides as a therapeutic option in patients with primary intestinal lymph- angiectasia. Material and Methods: A literature search was performed and individual case details were extracted. We found 55 cases, of which 3 were from our own institute. The cases were divided in 2 groups: Group A (n = 27) consisted of patients treated with MCT, and Group B (n = 28) consisted patients not treated with MCT. Cases were ana- lysed for symptomatic response to MCT as well as mortality. Results: 17 of 27 cases (63 % ) treated with MCT had complete resolution of symptoms while only 10 of 28 (35.7 % ) patients in group B showed complete resolution. Mortality for Group A was 1 out of 27 (3.7 % ), while mortality in group B was 5 of 28 (17.85 % ) patients. Conclusion: We conclude that, although an MCT diet is not completely curative in all cases, it does improve the symptoms of primary intes- tinal lymphangiectasia and reduces mortality. Hence it is a valid option in the paediatric age group.

Skeletal tuberculosis (TB) is usually seen in association with a primary pulmonary focus. However, it is being increasingly recognized that the former may be encountered without the latter, particularly in children. Sternal lesions have been frequently reported in infants, presumably secondary to Bacillus Calmette-Guerin (BCG) vaccination. Herein we report a case of rib TB and a cold abscess in a child who had previously had sternal TB ; that diagnosis had been missed at the time. Timely treatment of apparently solitary skeletal lesions may reduce the number of multifocal cases of skeletal TB in children.

Previous experimental studies have suggested that administration of antithrombotic, antioxidant, and cytoprotective agents have protective effects in caustic injury of the esophagus. Therefore, an experimental study was carried out to investigate the effects of iloprost, a stable analogue of prostacyclin, on the esophagus after caustic burns. Sixty Wistar albino rats were divided into three groups of 20 animals each. In group A, animals were uninjured and untreated. In group B, animals were injured but untreated. In group C, rats were injured and administered intravenous iloprost for 3 days. Caustic esophageal burn was produced by 1 ml of 15% NaOH. Efficacy of the treatment was assessed by measuring the tissue malondialdehyde (MDA), superoxide dismutase, and glutathione levels with biochemical methods on the 3rd postoperative day. Histopathological evaluation was done on the 28th postoperative day. The level of MDA was significantly increased in group B compared with the other groups. In group B, the histopathological damage score was significantly higher than in groups A and C. There was also a significant difference between groups A and C regarding the histopathologic damage. These results indicate that iloprost has a preventive effect in experimental caustic esophageal burn in rats.

Laparoscopy is the access of choice for functional surgery of the gastroesophageal junction, and oesophagocardiomyotomy, as the conventional surgical treatment of achalasia, is one of the favourable indications for laparoscopic surgery. Laparoscopic anterior myotomy technique is highly effective and secure for relieving dysphagia with minimal risk of gastroesophageal reflux. Fifteen patients with the diagnosis of achalasia were treated with laparoscopic anterior face oesophagocardiomyotomy without a concomitant antireflux procedure. There was not any perioperative complication and no procedure was converted to open operation. Oesophageal cineradiography, manometry and 24-h pH monitoring were repeated postoperatively. Manometry showed a significant reduction of the resting tone (48-34.4 to 18-3.2 mmHg), and patients were free of symptoms for reflux and dysphagia at the follow-up between 8 and 96 (median 42) months. Only one patient needed pneumatic dilation, 1 year after the operation for mild dysphagia, and one patient had moderate reflux, which was managed by medication. Thanks to minimal invasive technique of laparoscopic surgery and intraoperative endoscopy, oesophagocardiomyotomy can safely be performed in a length needed without dividing lateral and posterior phrenoesophageal ligamentous attachments. Consequently, adding an antireflux procedure routinely is not necessary. We advocate laparoscopic anterior oesophagocardiomyotomy alone as the first-line treatment for achalasia.

Objective: Proper antibiotic treatment and adequate pleural drainage is essential in successful management of pleural effusions. In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading ineffective chest tube drainage. Intrapleural fibrinolytic agents are employed to avoid thoracotomy in such complicated pleural effusions. Our study reviews the results of streptokinase treatment in children with pleural effusion. Methods: Thirty-two patients with parapneumonic pleural effusions were admitted to our hospital. The patients beyond the exudative stage were divided into two groups according to the initial radiological findings and biochemical parameters of pleural fluid. Intrapleural streptokinase treatment was started in an average of 2 days following initial chest tube placement in both Group I (14 patients) in fibrino-purulent phase with pleural effusion and fluid volume estimated to be larger than one-third of the involved lung and Group II (18 patients) with additional findings in radiological examination regarding the presence of air-fluid levels, multiple loculations, necrotic debris and pleural thickening. The effectiveness of therapy was assessed by monitoring the volume of the fluid, the level of LDH, glucose, pH and by radiological imaging, pre- and post-instillation. Results: There was statistically significant difference between two groups according to date of admission (6.8 vs 10.4 days), mean of total pleural fluid drainage before (106.9 vs 309.7 ml) and after (258.9 vs 511.2 ml) SK treatment, mean of total number of instillations (2.1 vs 3.6) required and total length of hospital stay (16.6 vs 22.4 days). There was a significant difference regarding pleural chemical analysis. Finally, surgical intervention was necessary in six intractable cases, all of which initially presented a significant small amount of pleural drainage in volume when compared to rest of the patients. The overall success rate of our treatment was calculated as 96% for G-I and 72.2% for G-II cases. Conclusions: Intrapleural streptokinase is an effective and safe adjunct in facilitating drainage in early and late stage II empyemas. A tendency of decreased rate of drainage besides persisting fever and respiratory symptoms, despite fibrinolytic treatment may be a clue for early surgical intervention. q 2004 Elsevier B.V. All rights reserved.

The effect of pentoxifylline as a hemorrheologic agent on skin flap survival has been observed. A caudally pedicled dorsal flap with an ischemic component in rats was used as the model. The flap survival was calculated to be 0.807±0.049 in the control group (n = 15), where flap survival was found to be 0.9713±0.018 in the pentoxifylline treated group (n = 15) (t = 12.19, p < 0.005). In the meantime, living flap length was measured as 9.96±0.72 in the control group, and 11.84±0.18 in the pentoxifylline treated group. With these results, we have come to the conclusion that parenteral pentoxifylline therapy is effective on ischemic skin flap survival in the rat model.