Solitary intestinal fibromatosis is a cause of bile vomiting in a neonate.
Explore the source record for details and available documents.
Fibroma↗
Biomedical subjects
A O Ciftci
Publications and source records attributed to A O Ciftci.
Gastric outlet obstruction due to corrosive ingestion: incidence and outcome.
A retrospective clinical study was performed to determine the incidence, management, and outcome of gastric outlet obstruction (GOO) caused by caustic ingestion in children. Of 220 patients who sustained caustic substance ingestion and were treated at our unit between 1976 and 1996, 168 ingested alkaline substances; of these, 9 children (5.3%) developed GOO in addition to esophageal strictures. The remaining 52 patients ingested acid agents, and 2 of them (3.8%) presented with GOO without esophageal strictures. The overall incidence of corrosive GOO was 5% (n = 11). The mean age of the patients with GOO was 5.7 +/- 2.8 years (range 2-14) with a female:male ratio of 6:5. Sodium hydroxide (n = 6), potassium hydroxide (n = 3), and hydrochloric acid (n = 2) were the ingested caustic agents. The patients were subdivided into two groups according to serial endoscopic and radiologic findings: group I: moderate (dense superficial and spotty ulcerations with intact mucosa) mucosal injury with partial pyloric obstruction; and group II: severe (deep ulcerations, extreme hemorrhagic erosions, eschar formation with white plaques) mucosal injury with complete pyloric obstruction. Group I consisted of 5 patients who ingested alkali agents while group II included 6 who presented with ingestion of alkaline (n = 4) and acid (n = 2) agents. Surgical treatment included Billroth I (n = 6) operations performed in group II and Finney (n = 3) and Heineke-Mikulicz (n = 2) pyloroplasty procedures done in group I. All patients are alive without any complaints. Fiberoptic endoscopy should be the preferred method of evaluating a patient with ingestion of a corrosive agent. It determines the presence of injury and assesses the extent of damage, establishing the diagnosis and allowing therapy to be instituted immediately. Our experience revealed that substantial damage has occurred early after ingestion, and early surgical intervention has decreased the morbidity and mortality. The extent of the mucosal injury and status of the pylorus and antrum determined the type of surgical treatment. A Billroth I procedure recommended for severely injured mucosa with complete pyloric obstruction, and pyloroplasty for moderate mucosal injury associated with partially obstructed but still viable pylorus. In contrast to the current belief, alkali ingestion also has a high risk of corrosive gastric injury causing GOO, which should be considered during assessment of the injury. We emphasize that a detailed evaluation of radiologic and especially endoscopic findings is very important for determining the timing, necessity, and type of appropriate surgical treatment.
Alkalies↗
Pulmonary blastoma: diagnostic and therapeutic aspects.
Pulmonary blastoma (PB) is an extremely uncommon intrathoracic neoplasm in children. It accounts for 0.5% of all primary malignant tumors of the lung, and 20%-25% of the cases present in childhood. A new case of PB in a 3-year-old girl is discussed with special emphasis on diagnosis and treatment. The authors point out that the possibility of a primary lung tumor should be considered for any childhood cases with intractable signs and symptoms of a space-occupying lesion. A primary lung malignancy should not be excluded only on the basis of the patient's age, and childhood lung disorders should receive the same detailed and vigorous diagnostic evaluation and appropriate treatment given to adults.
Abdominal Pain↗
Congenital lobar emphysema: diagnostic and therapeutic considerations.
BACKGROUND/PURPOSE: Congenital lobar emphysema (CLE) is characterized by overinflation of a pulmonary lobe and may present as a diagnostic and therapeutic dilemma. The authors have reviewed their experience to clarify the controversies about the diagnosis and management of CLE in children. METHODS: Children who had CLE and were treated at our department between 1991 and 1998, inclusive, were reviewed. RESULTS: Fourteen children consisting of 8 boys and 6 girls (age range, 25 days to 2.5 years) had CLE. Eight children (57%) were symptomatic at birth. Major presenting symptoms were dyspnea (n = 8, 57%), cyanosis (n = 6, 43%) and recurrent respiratory tract infection (n = 4, 28.5%). Chest x-rays and computerized tomography scans showed hyperaeration of the affected lobes in 14 and 12 patients, respectively. Pulmonary perfusion scan was performed in 8 patients and showed loss of perfusion in the affected lobe in 7 cases. The affected sites were left upper lobe (n = 8, 57%), right middle lobe (n = 4, 28.5%) and right upper lobe (n = 2, 14.5%). Congenital cardiac anomalies were encountered in 2 patients (14.5%). Ten children underwent lobectomy, and postoperative course was uneventful. Nonoperative management was performed in 4 cases (28.5%) presenting at older age with milder symptoms. In the latter, although symptoms subsided, radiological abnormalities persisted during the follow-up period of 3 months to 4 years. No mortality was encountered in the series. CONCLUSIONS: The diagnosis of CLE is established by combined radiological and scintigraphic imaging methods. Surgical excision of the affected lobe is the appropriate treatment in all infants under 2 months of age and in infants older than 2 months presenting with severe respiratory symptoms. Infants older than 2 months presenting with mild to moderate respiratory symptoms associated with normal bronchoscopic findings can be treated conservatively. In conservative management, the children should be under close follow-up, and the family should be alarmed about the disease. Further studies are required to determine the long-term outcome of conservative management.
Algorithms↗
Spectrum of complicated intestinal amebiasis through resected specimens: incidence and outcome.
BACKGROUND/PURPOSE: Entamoeba hystolytica (EH) is an enteric protozoan that may cause serious complications that require operative management in children. A retrospective clinical trial was performed to find out the incidence and outcome of complicated intestinal amebiasis (IA) by means of surgically resected specimens in children. METHODS: The histopathologic evaluation of 554 intestinal specimens (including appendix and polyp) of 482 patients between 1980 and 1997, inclusive, were reviewed. Intestinal biopsy specimens taken from successfully medically treated patients with uncomplicated IA were excluded. RESULTS: Complicated IA was noted in 18 children (3.7%) consisting of 7 girls and 11 boys with a mean age of 9.2+/-2.3 years. EH was present in the (1) appendices of 4 patients with perforated appendicitis and 3 patients with normal appendix who underwent negative exploration; (2) juvenile polyps of 4 patients presenting with hematochesia; (3) colonic wall of 1 patient presenting with intussusception and treated by resection and anastomosis; (4) cecum of 1 patient presenting with right lower quadrant mass and underwent exploration with the presumptive diagnosis of lymphoma; (5) colonic wall of 5 patients who underwent ileostomy followed by subtotal colectomy and endorectal pull-through with the presumptive diagnosis of chronic inflammatory bowel disease (n = 3), toxic megacolon + peritonitis (n = 1), and total colonic polyposis (n = 1). All above-mentioned patients are alive and free of symptoms. CONCLUSIONS: The diagnosis of IA should be considered in a very wide spectrum of clinical appearances. IA may be associated with colonic polyps and perforated appendicitis, may act as a leading point for intussusception, and may mimic the clinical picture of appendicitis and lymphoma resulting in negative explorations. The diagnosis and treatment of complicated IA in patients who received a misdiagnosis of inflammatory bowel disease is a great challenge and requires major and emergency surgery.
Appendicitis↗
The role of nitrergic system on the contractility of colonic circular smooth muscle in Hirschsprung's disease.
UNLABELLED: The contribution of nitrergic tone on the contractility of colonic smooth muscle in Hirschsprung's disease (HD) was investigated. METHODS: Ganglionic and aganglionic bowel specimens were taken from 8 patients with HD during pull-through operations and electrical field stimulation (EFS)-induced isometric contractions of the circular smooth muscle were recorded in vitro. Isolated circular muscle strips prepared from colonic segments of sex- and age-matched patients (n = 3) who underwent surgery for nonmotility-related colonic diseases formed the control group. Statistical analysis was performed by two way analysis of variance and unpaired Student's ttest. RESULTS: The amplitude of spontaneous rhythmic activity was lower in aganglionic segments than in ganglionic ones. The amplitudes of contractile responses were significantly greater in aganglionic segments. In ganglionic preparations, N(omega)-nitro-L-arginine (L-NNA) addition into the medium increased the contractile responses to the level of aganglionic preparations. This increase was completely blocked by L-arginine application. Neither L-NNA nor L-arginine produced any change in aganglionic segments. A relaxation phase was detected in both ganglionic and aganglionic segments. In ganglionic preparations, this relaxation phase was completely inhibited by L-NNA and restored by L-arginine, whereas no effect was detected in aganglionic ones. Responses obtained from the control group were similar to the ganglionic segments of HD patients. CONCLUSIONS: In normal colon and as well as in ganglionic segments of HD, the evoked contractile activity and relaxations are under the tonic influence of the nitrergic system. Aganglionic segments totally lack the nitrergic activity in both evoked contraction and relaxation responses, while still maintaining an inefficient relaxation capacity under unknown mechanisms.
Child↗
Colorectal carcinoma in children.
BACKGROUND/PURPOSE: Colorecta I carcinoma is extremely rare in children and presents with a poor prognosis. Surgical management and long-term follow-up of this entity are still obscure because of lack of data. Therefore, a retrospective clinical trial was performed to evaluate the clinical characteristics of childhood colorectal carcinoma and to determine the predictors of poor outcome. METHODS: Records of children who had colorectal carcinoma and were treated at our unit between 1972 and 1997, inclusive, were reviewed retrospectively. Information recorded for each patient included age, sex, clinical characteristics, diagnostic procedures, extent of disease, treatment methods, histological types, and outcome. A modified Dukes staging scheme was used. RESULTS: There were 12 boys and 8 girls who were treated for colorectal carcinoma (range, 7 to 16 years). Predisposing conditions were encountered in 2 patients (10%), one with Bloom's syndrome and another with familial occurrence of colonic carcinomas. Predominant symptoms were abdominal pain, vomiting, and rectal bleeding. Barium enema, ultrasonography, computerized tomography, and endoscopic procedures were used for the diagnosis. Rectosigmoid region was the most common site for the primary tumor (65%). All patients presented with advanced stages of disease (stage C, 7; stage D, 13). Surgical procedures were incisional biopsy (n = 4), palliative permanent colostomy (n = 4), segmental resection (n = 5), complete resection (n = 6), and rectal biopsy (n = 1). Peritoneum was the most common site of extensive intraabdominal disease followed by omentum majus and liver. The lung also was involved in 2 patients. Predominant histological type was mucinous adenocarcinoma (80%). All patients but one received adjuvant chemotherapy, and 2 received palliative radiotherapy. Thirteen patients died of disease in a period ranging from 1 day to 1 year after initial surgery. The fate of 4 patients who were discharged in a very ill status was unknown. Three patients were alive for 2 years to 4 years postoperatively, and one of them presented with end stage disease. CONCLUSIONS: Delayed diagnosis, advanced stages of disease at presentation, and, most importantly, mucinous type of histology are the major determinants of poor outcome in childhood colorectal carcinoma. We emphasize that possibility of a malignant colorectal tumor should be considered for any childhood case with signs and symptoms of intestinal obstruction, intractable abdominal pain, alteration in bowel habits and gastrointestinal bleeding. Colorectal malignancy should not be excluded only on the basis of the patient's age. Because of the steadily increasing incidence of precancerous bowel diseases and poor prognosis of colorectal carcinoma, childhood cases of bowel disorders should receive the same detailed and vigorous diagnostic evaluation and appropriate treatment as given to adult cases. Contrast studies, ultrasonography, computed tomography, and endoscopy are essential procedures for both confirming the diagnosis and detecting the extent of the disease.
Adenocarcinoma, Mucinous↗
Fetal distress does not affect in utero defecation but does impair the clearance of amniotic fluid.
PURPOSE: An experimental study was performed to evaluate the effect of fetal distress on in utero defecation and clearance of amniotic fluid (AF). METHODS: Sixteen pregnant New Zealand white rabbits underwent laparotomy at 25 days' gestation (full term, 31 to 32 days) as group A (n = 8) and B (n = 8). Uteroplacental ischemia was achieved by constriction of the aorta below the renal arteries to cause fetal distress in group B, whereas sham operation was done in group A. In both groups, 0.1 mL of technetium-99m (99mTc)-HIDA containing 1 mCi of radioactivity was injected into the gluteus muscle of each fetus, which had been exposed through the uterus. Beginning 2 hours after injection, a live fetus was killed every 2 hours for 48 hours in both groups. Tissue samples from the reference organs (lung, heart, stomach, kidney, bladder) and liver, meconium in proximal, mid and distal bowels, AF, and maternal blood were taken. The radioactivity of each sample was determined by a gamma counter and the percentage injected dose (uptake) per gram of tissue (%ID/g) was calculated. The total uptake and mean transit time (MTT) showing intestinal transport were calculated using the linear trapezoidal approximation and extrapolation. The peak concentration (Cmax, %ID/g) and time corresponding to the peak (tmax, h) were obtained. RESULTS: (1) Significant difference was noted between the groups with regard to uteroplacental perfusion pressure and blood pH (51.0+/-2.6 mm Hg; pH, 6.9+/-0.1 in group B; 80.1+/-2.7 mm Hg, pH, 7.3+/-0.1 in group A; P < .05). (2) 99mTc-HIDA was predominantly trapped by the liver and excreted into the gastrointestinal tract and AF in both groups. (3) In liver and bowel, shape of the profile was bimodal because of fetal swallowing and similar in both groups, tmax was the same in both groups, Cmax was lower in group B than in group A, the total uptake was smaller in group B than in group A, and intestinal transport time was similar (44.2 hours in group A and 43.0 hours in group B). In amniotic fluid, shape of the profile was sigmoidal in group B and reached a Cmax value of 11.6% ID/g, whereas unimodal profiles were observed in group A with a Cmax value of 12.6% ID/g; radioactivity was eliminated from the AF with a rate constant of 0.48% ID/g h in group A (AUC, 273% ID/g h); whereas accumulation of radioactivity was noted in group B (AUC, 308% ID/g h). (5) In maternal blood, shape of the profile was sigmoidal in group A with a Cmax value of 2.9% ID/g and unimodal in group B (Cmax, 1.6% ID/g), accumulation of radioactivity was noted in group A (AUC, 93% ID/g h), whereas a rapid decline of radioactivity (k, 0.06% ID/g h) was noted in group B (AUC, 47% ID/g h). CONCLUSIONS: Fetal distress did not affect the intestinal transport dynamics and in utero defecation but impaired the clearance of AF and the passage into the maternal circulation, which was shown by the accumulation of radioactivity in AF only in group B and in maternal blood only in group A without any elimination rate. This finding suggests that meconium-stained AF is not related to meconium passage after fetal distress; rather, it reflects impaired clearance of AF, which already has containing meconium caused by physiological in utero defecation.
Amniotic Fluid↗
Biochemical predictors for differentiating intraperitoneal and extraperitoneal bladder perforation.
PURPOSE: A retrospective clinical study was performed to find out whether serum biochemistry alterations may serve to differentiate the traumatic bladder perforation to be either intraperitoneal or extraperitoneal. METHODS: Thirty-two children treated for traumatic bladder perforation between 1970 and 1997, inclusive, formed the study group. Patients were divided into two groups: intraperitoneal bladder perforation (IBP) and extraperitoneal bladder perforation (EBP) groups. The groups were compared with regard to age, sex, mechanism of injury, and hemodynamic parameters (blood pressure, hematocrit) at presentation (each group was further subdivided into two subgroups according to the duration between trauma and presentation as early (duration <24 hours) and late (duration >24 hours) presentation groups). The subgroups were compared with each other with respect to serum concentrations of urea, creatinine, sodium, potassium, and chloride. RESULTS: There were 21 boys and 11 girls with a mean age of 8.7+/-4.9 years. Mechanisms of injury were motor vehicle accidents (75%), falls (19%), and gunshot wounds (6%). There was no significant difference between the IBP and EBP groups with regard to age, sex, mechanism of injury and hemodynamic parameters at presentation. The biochemical parameters were found to be within normal range in the EBP group, whereas significantly higher levels of creatinine, potassium, and lower level of sodium were noted in IBP group regardless of presentation time. Significantly higher level of serum urea was recorded in a late presentation group of IBP patients. CONCLUSIONS: The authors emphasize that patients presenting with IBP are more likely to present with significantly higher levels of creatinine, potassium, and lower level of sodium compared with the patients with EBP regardless of presentation time. Increased level of serum urea concentration is a characteristic of IBP patients with late presentation. Biochemical alterations can be used to differentiate traumatic IBP and EBP in children with subtle physical examination and radiological findings.
Adolescent↗
Childhood splenic hemangiopericytoma: a previously unreported entity.
The first childhood case of splenic hemangiopericytoma in a 10-year-old boy is presented. The clinicopathologic features of this unique entity are discussed with special emphasis on differential diagnosis and treatment by comparing with the previously reported adult cases. There are no specific presumptive clinical and laboratory findings, including tumor markers and imaging techniques that distinguish hemangiopericytoma from other splenic masses. The most important diagnostic aid is to bear this entity in mind when a child presents with an unexplained splenic mass. Splenectomy associated with chemotherapy or radiotherapy in the presence of systemic or local recurrences is mandatory for the appropriate treatment.
Child↗
Pulmonary lymphomatoid granulomatosis in a 4 year old.
The authors report a pulmonary lymphomatoid granulomatosis (LG) in a 4-year-old girl. The clinicopathologic and radiological features of this rare entity are discussed with special emphasis on differential diagnosis, including a brief literature review. LG is an aggressive multiorgan disease that primarily affects the adult lung. There are no specific presumptive clinical and laboratory findings, including tumor markers and imaging techniques, that distinguish LG from other pulmonary nodular lesions. The most important diagnostic aid is to bear this entity in mind when a child presents with pulmonary nodule associated with intractable long-lasting symptoms. Open lung biopsy and total excision is mandatory for the appropriate diagnosis and treatment.
Child, Preschool↗
Liver transplantation indications in children.
Explore the source record for details and available documents.
Child↗
Epigastric heteropagus: a case report with review of the literature.
Incomplete conjoined twinning or heteropagus attached at the autosite's epigastrium is an extremely rare form of conjoined twinnings. We report a case of epigastric parasitic twinning in which the parasite has a well developed lower trunk and pelvis with rudimentary lower limbs, and well developed upper extremities without shoulder girdles and thoracic cage. The clinical features of this rare entity are discussed with a literature review. We emphasize that in spite of monstrous appearance, autosite component of epigastric heteropagus can be treated successfully with minor surgery. This fact should be kept in mind during the intrauterine evaluation of these type of anomalies in order to avoid needless terminations.
Abnormalities, Multiple↗
Gastrointestinal tract perforation due to blunt abdominal trauma.
A retrospective clinical study was performed to evaluate the etiology, diagnosis, and management of gastrointestinal tract perforation (GITP) due to blunt abdominal trauma (BAT) in order to find a predictor to avoid delay in diagnosis. Thirty-five children with GITP out of 805 BAT victims (4.3%) over a 21-year period formed the study group. Different parameters including preoperative (mechanism of injury, abdominal and X- ray findings at presentation, diagnostic modalities), operative (type and site of GITP, intra-abdominal associated injuries, surgical method), and postoperative (complications, mortality) status were analyzed. The patients were subdivided according to their initial clinical presentation as group I: evidence of peritonitis (n = 19, 54%); group II: abdominal findings such as distension, minimal tenderness, and guarding (n = 10, 29%); and group III: normal abdominal findings (n = 6, 26%). These groups were also statistically compared to each other with regard to the parameters mentioned above. The Mann-Whitney U, Wilcoxon rank-sum, and Kruskal-Wallis tests were used for statistical analysis. P < 0.05 was considered to be statistically significant. There were 28 boys and 7 girls; the mean age was 8.2 +/- 2.4 years. Mechanisms of injury were motor vehicle accidents (MVA) (60%), falls (26%), and bicycle accidents (BA) (14%). Group I patients presented with significantly higher transaminase levels and white blood cell counts than groups II and III. Group I patients and MVA victims were operated upon significantly earlier than group III patients and BA victims because of significantly earlier development of clinical signs of peritonitis. A significantly higher number of multiple perforations was encountered in Group I and MVA victims than in groups II and III and BA victims. The presence of multiple perforations correlated significantly with the earlier development of clinical signs of peritonitis. The analysis of site of perforation with regard to the other parameters did not differ significantly. Fifty-four percent (n = 19) of the patients presented with peritonitis; a pneumoperitoneum was detected in 46% (n = 16). Diagnosis was accomplished by plain radiographs, ultrasound, computed tomography, and, most importantly, frequent abdominal examination of the patient. The sites of perforation were the stomach (4), duodenum (2), jejunum (11), ileum (12), jejunum and ileum (3), colon (2), and ileum and colon (1). Simple closure was the most common surgical procedure (n = 21), followed by resection and anastomosis (n = 12) and simple closure plus creation of a proximal ostomy (n = 2). Two deaths (5.7%) were directly due to head injuries. Our experience revealed that in spite of advanced imaging and laboratory modalities, frequent evaluation of the patient by an experienced surgeon is still the most important tool for early diagnosis and appropriate treatment. A child with BAT should be an inpatient and a high index of suspicion is always required, even in the presence of normal abdominal findings.
Abdominal Injuries↗
Gastric diverticulum: an uncommon cause of abdominal pain in a 12 year old.
A 12-year-old girl presented with long-lasting intractable abdominal pain associated with a gastric diverticulum. The clinicopathologic features of this rare entity are discussed with emphasis on pathogenesis, diagnosis, and treatment. The authors emphasize that congenital diverticulum of the stomach should be considered in the differential diagnosis of abdominal pain in childhood. Surgical treatment consisting of simple excision of the diverticulum is warranted in cases presenting with long-lasting symptoms after failure of medical treatment.
Abdominal Pain↗
Chest wall hamartoma: an alarming chest lesion with a benign course.
Chest wall hamartoma is a very rare mass lesion of the chest wall that is manifest at birth or in early infancy with deformity of the thoracic wall and/or varying grades of respiratory distress. The authors report on an 11-month-old infant presenting with chest wall hamartoma who was treated by en bloc excision of the lesion including the involved ribs. They emphasize the importance of early and complete excision of the lesion even in minimally symptomatic patients to avoid lethal respiratory complications, more severe postoperative orthopedic problems, and malignant transformation.
Disease-Free Survival↗
Hydatid cyst: an unusual etiology for a cystic lesion of the posterior mediastinum.
The cystic lesions of the posterior mediastinum include bronchogenic, enteric and intramural esophageal cysts, lymphangioma, and anterior meningocele. Hydatid cysts are usually located in the liver, lung, and brain. Although many uncommon locations have been reported, hydatid cyst has not previously been encountered as an isolated posterior mediastinal lesion. A 4-year-old boy with a posterior mediastinal cystic lesion, which has been proven to be a hydatid cyst, is reported.
Child, Preschool↗
Serial transabdominal amnioinfusion in the management of gastrochisis with severe oligohydramnios.
Explore the source record for details and available documents.
Abdominal Muscles↗