Biomedical subjects
Publications and source records attributed to M E Senocak.
Gastric teratoma is a very rare benign tumor. Fifty-three cases, only two of which were females, have previously been reported. This report concerns two cases of teratoma arising from stomach. One of them is the third female case described in the literature.
Achalasia is infrequently reported in infants and children. It occurs exceedingly rarely in siblings. Only 33 cases of familial childhood achalasia were collected in the literature till 1987. Three definite cases and one suspicious additional case are presented and the aetiology is discussed.
Gastric volvulus is a rare entity in children. During the last ten-year period of 1977 to 1987, 21 children were operated upon with the diagnosis of chronic gastric volvulus at The Department of Paediatric Surgery, Hacettepe University School of Medicine. This study includes retrospective analysis of these cases. The patients were investigated with respect to associated anomalies, radiological diagnosis, surgical treatment and prognosis. Results are presented and discussed.
Congenital "H type" urethroanal and urethroperineal fistulas are extremely rate anomalies. The treatment of these pathologies is very complex and there is no well established surgical approach. An urethroperineal fistula is presented and the treatment is discussed. Additionally the literature in English on the subject is reviewed.
Cystosarcoma phylloides is an exceedingly rare breast lesion in adolescent females. The tumour contains both stromal and epithelial elements. Benign, malignant and intermediate forms have been described. Complete simple excision is adequate for therapy in all variants. An additional case treated by wide local excision is presented and treatment is discussed.
Thyroid carcinoma is rare in children and differs from its adult counterpart in many aspects, including that childhood thyroid carcinomas are all well differentiated. Here we present a 14-year-old female from a goitrous area with follicular thyroid carcinoma with a predominant insular component. The child was well without recurrence or metastases after 5 years of follow-up.
In childhood, benign tumors of the cervix and corpus uteri are very rare. Clinical and pathological findings of a benign multilocular cystic polyp of the cervix uteri in a 5-year-old girl are presented and the origin of the polyp is discussed.
Infantile pyloric stenosis is one of the most common conditions requiring surgery during the first few weeks of life. The association of infantile pyloric stenosis with gastric volvulus in an extremely uncommon occurrence. A 10-month-old male infant operated for infantile pyloric stenosis at two months of age is presented. His current problem was recurrent pulmonary infections and he was diagnosed to have organoaxial gastric volvulus and gastroesophageal reflux. The common features of presentation, radiological findings, surgical procedures and possible mechanisms of gastric volvulus associated with infantile pyloric stenosis are discussed.
A retrospective clinical study was performed to evaluate the hernias encountered in the anterior part of the diaphragm. Twenty patients (14 males, 6 females; aged 7 days-7 years) with hernias located in the anterior part of the diaphragm who were treated surgically formed the study group. The exact locations, contents and additional malformations were evaluated. The locations were parasternal in 14 and retrosternal in six. Parasternal locations were the right side in 11, left side in two and bilateral in one patient. Three patients had trisomy 21 syndrome. A sac was presented in all cases and included the colon in 12 patients. A patient with retrosternal location also had trisomy 21 syndrome. The patients with retrosternal hernias also presented with sacs, and the colon was the most commonly included viscus. In the presented series, no intrapericardial herniations or anteromedial defects were encountered. Comparison of previously reported patients and the present series suggests that the anterior part of the diaphragm hosts various hernias of congenital origin in its different locations. According to the exact location and the presence or absence of sacs, four different types of hernias occur in this area: retrosternal hernias with a sac, intrapericardial herniation, and parasternal and anteromedial hernias with either unilateral or bilateral involvements. Since four different hernias were distinguished, the term Morgagni hernia does not include or define all the hernias of the anterior part of the diaphragm. We believe they should, therefore be designated according to the location and presence or absence of a sac.
Duplications of the alimentary tract are one of the rare anomalies of the gastrointestinal system. Because of the wide spectrum of the signs and symptoms, preoperative diagnosis frequently cannot be made. A close familiarity with clinical and surgical characteristics provides appropriate management and treatment of duplications. A retrospective clinical study was conducted to evaluate clinical and surgical characteristics and the treatment of duplications of the alimentary tract. During a 26-year period between 1971 and 1997, 38 patients with duplications of alimentary tract underwent operation at the Hacettepe University Department of Pediatric Surgery. Forty-two duplications in 38 patients (20 male, 53%; 18 female, 47%) were encountered. Sixty-nine percent of the patients were symptomatic under the age of one year, with 24 percent presenting with symptoms in the neonatal period. There were one sublingual, nine intrathoracic (including 2 thoracoabdominal) and 32 intraabdominal duplications. Abdominal mass, abdominal distention, constipation, vomiting and respiratory distress were the most frequently encountered signs and symptoms. Plain thoracic and abdominal X-rays, ultrasonography, and computed tomography of the chest and abdomen were the most commonly used diagnostic radiological methods. Thirty-three duplications (79%) were spherical and nine (21%) were tubular. Multiple duplications were encountered in two patients (5.3%). Fourteen duplications (33%) contained heterotopic mucosa, mostly gastric type. More than one type of heterotopic mucosa in the same duplication was encountered in four duplications (10%). Additional malformations were encountered in 26 percent of patients. Six patients (15.8%) died from unrelated causes. The signs and symptoms vary among duplications. Signs and symptoms leading to diagnosis and surgery varied according to the age of patient, location of the duplication, type of mucosal lining, duration of disease and presence of complication. The ideal surgical treatment of duplication is complete excision. However, the other treatment options should be well known.
Thymic masses constitute one of the least common mediastinal masses in childhood. While producing symptoms of airway compromise, they also raise the suspicion of malignancy when detected. Radiological, operative and pathological findings of patients that have been operated for thymic masses in our institution is presented in this paper. Nine patients were operated in our institution during a 12-year-period between 1985-1997 for thymic masses. Ages of the patients ranged from four months to 13 years. With the exception of one, who was diagnosed with a routine chest x-ray, all the patients had respiratory complaints. All the patients had been evaluated with computed tomography preoperatively. In total, seven sternotomies and four thoracotomies were performed to reach the anterior mediastinum. The distribution of masses was as follows two malignant thymomas, three thymic hyperplasia, one lymphocyte-rich thymoma, one epithelial thymoma, one cystic thymoma and one lymphoblastic lymphoma. Although rare, thymic enlargement may be a cause of intractable respiratory complaints in childhood. Because of the high incidence of primary malignancy of the mediastinal neoplasms in childhood, thymic enlargement requires accurate pathological diagnosis and treatment. Median sternotomy with intensive anesthetical care allows proper tumoral exposure.
This study was designed to determine and compare the results of the Duhamel and Swenson procedures. The hospital records of patients who had undergone the Swenson or Duhamel operation over a 17-year period were reviewed and the patients were contacted for a final evaluation. The early and late complications of these operations were defined and compared. It was determined that the Swenson operation had been performed in 138 patients and the Duhamel in 59. Among the various complications, such as wound infection, dehiscence, anastomotic leak, adhesive intestinal obstruction, pelvic abscess, intraabdominal abscess, mucosal prolapsus, anastomotic stricture and fistulas, only the anastomotic stricture showed significantly higher percentages in patients who had undergone the Swenson procedure. When urinary incontinence, enterocolitis, soiling and constipation were considered, there was no significant difference between these two groups. There was one death in the Swenson group and none in the Duhamel group. The authors suggest the Duhamel operation as a simpler and safer method for the treatment of Hirschsprung's disease.
The roles of heterotopic gastric mucosa either with or without colonization of Helicobacter pylori (HP) upon the diverse symptomatology of Meckel's diverticulum (MD) in children have been evaluated retrospectively. The medical records of 92 patients who underwent MD excision either incidentally or symptomatically between 1976 and 1997 were reviewed retrospectively. Age at admission and symptoms were recorded. The slides were stained with hematoxylin eosin and Giemsa to identify the presence of heterotopic tissue, ulceration, hemorrhage, inflammation and HP. Bleeding, obstruction and inflammatory groups were statistically compared with chi-square test. The age of the patients ranged between 1 day and 14 years with a mean of 3.5+/-3.8 years. The male: female ratio was 3.6:1. Among 92 MD, 18 (19.5%) were remove incidentally, one of which had heterotopic gastric mucosa. The indications fo surgical removal of MD were intestinal obstruction, diverticulitis and bleeding in 45 (48.9%), 11 (11.9%) and 18 (19.5%) patients, respectively. Heterotopic gastric mucosa was detected in 28 (30.4%) patients, of whom 8, 3, and 16 presented with intestinal obstruction, diverticulitis and bleeding, respectively. Helicobacter pylori was not detected in one patient with incidental removal of MD; with heterotopic gastric mucosa however, three patients with obstruction, one patient with diverticulitis and one patient with bleeding had HP in the heterotopic gastric mucosa located in MD. MD may become symptomatic due to a complicated course such as rectal bleeding, intestinal obstruction or diverticulitis. The presence of heterotopic gastric mucosa in MD seems to mainly associate with rectal bleeding. The presence of HP colonization in heterotopic gastric mucosa does not increase the incidence of rectal bleeding. The other complications of MD, including intestinal obstruction and diverticulitis, are not directly related to the presence of heterotopic gastric mucosa in the MD. However, colonization of heterotopic gastric mucosa by HP seems to increase the incidence of these complications.
Whole bowel irrigation (WBI) was performed in 60 children aged two to 16 yrs (mean 5.1 +/- 0.5 yrs) in preparation for surgery (n: 59) and rectoscopy (n: 1). Isotonic saline (n: 43) and lactated Ringer's solutions (n: 17) were infused for irrigation. Vital signs remained stable during the procedure. Negligible electrolytic alterations were encountered. In general, WBI was well tolerated by all the patients. Two (3.3%) patients had abdominal cramps, vomiting was observed in nine (15%) and edema developed in one (16%). The results of the preparation were assessed as satisfactory in 45 cases (75%), adequate in 10 cases (16.6%) and poor in 5 cases (8.3%). Diarrhea, as a complication of saline, has not been reported previously in the literature, but was observed in 32 of our cases (74.4%), and lasted 2-5 days (mean 3.38 +/- 0.7 days) after irrigation. In addition, it is noteworthy that bile-stained intraluminal clear fluid was seen only in the patients who had been irrigated with lactated Ringer's solution. Our research related to this observation is continuing.
Paraesophageal hiatus hernia is a very rare entity in children. The majority of cases remain asymptomatic and some are diagnosed incidentally. The clinical course of a massive paraesophageal hiatus hernia containing colon and stomach in a five-year-old boy is presented.
A sixteen-year-old girl treated by total splenectomy for epidermoid cyst of the spleen is presented: Epidermoid cysts of the spleen account for ten percent of non-parasitic cysts. Abdominal ultrasonography and computed tomography are the most reliable studies available in the diagnosis of these cysts. Partial splenectomy is the best mode of treatment for this disease, if feasible.
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