Appendicitis is the most common surgical emergency in pediatric surgery. In the presence of an appendicular mass, surgical management can be difficult. We evaluate the results of appendix mass management both with immediate operation and conservative treatment over a period of 5 years. Forty children who presented with appendicular mass over a period of 5 years were reviewed. Their mean age was 7.6+/-2.7 years, and the mean duration of symptoms was 7.8+/-2.7 days. We evaluated the children in two groups: The first group included 19 children who were operated on immediately, and the second group included 21 children who were managed conservatively, followed by elective appendectomy. In the first group, mean hospitalization time was 8.7+/-3.2 days. The complication rate was found to be high (26.3%). Ileal injury occurred in two patients, intraabdominal abscess developed in one patient, and wound infection developed in another. Appendectomy could not be done in one patient who required another laparotomy 8 weeks later. In the second group, mean hospitalization time was 8.9+/-2.6 days. Two patients (8.6%) failed to respond to conservative management. Elective appendectomy was performed after 2-3 months. Two patients returned with perforated appendicitis 5 months and 12 months later, respectively, because they were not brought back for subsequent appendectomy. It can be concluded that conservative treatment of appendicular mass is safe; we also advocate elective appendectomy because of the probable risk of recurrence.

No abstract

Testicular torsion and detorsion are important clinical problems for infertile man and oxidative stress may have a role in this clinical situation. The aim of this study was to investigate the protective role of erdosteine, an antioxidant, on unilateral testicular reperfusion injury in rats. The rats were divided into four groups including seven rats in each group: control, torsion, torsion/detorsion and torsion/detorsion+erdosteine. Rats, except the sham operation group, were subjected to left unilateral torsion (720( composite function) rotation in the clockwise direction) without including the epididymis. The experiments were finished after sham operation time for control, 120 min torsion for torsion group and 120 min torsion and 240 min detorsion for torsion/detorsion groups. Bilateral orchiectomy was performed for all groups of rats. The ipsilateral and controlateral testis were divided into two pieces to analyse biochemical parameters and to investigate the light microscopic view. Malondialdehyde level of ipsilateral testis was increased in torsion and torsion/detorsion groups in comparison with the other groups (p < 0.05). Erdosteine treatment ameliorated lipid peroxidation after torsion/detorsion in ipsilateral testis (p < 0.05). Also, xanthine oxidase activity of ipsilateral testis was increased in torsion/detorsion group in comparison with the others (p < 0.05). Nitric oxide (NO) level of ipsilateral testis was higher in all experimental groups than sham operated control group (p < 0.05). Also, NO level of torsion group was increased in comparison with detorsion groups (p < 0.05). Erdosteine treatment caused increased glutathione peroxidase activity in comparison with torsion and torsion/detorsion groups and catalase activity in comparison with the other groups in ipsilateral testis (p < 0.05). Superoxide dismutase activity of ipsilateral testis was higher in torsion/detorsion and torsion/detorsion+erdosteine groups than control and torsion groups (p < 0.05). The biochemical parameters were not affected in controlateral testis in all groups. Torsion, torsion/detorsion and torsion/detorsion+erdosteine groups showed ipsilateral testicular damage in the histological examination, but the specimens from torsion/detorsion had a significantly greater histological injury than those from the other groups (p < 0.05). Control rats showed normal seminiferous tubule morphology. Rats in torsion group had slight-to-moderate disruption of the seminiferous epithelium. Rats in torsion/detorsion group displayed moderate-to-severe disruption of the seminiferous epithelium. In all animals from torsion/detorsion+erdosteine group, the testicular tissues were affected with slight-to-moderate degenerative changes of the seminiferous epithelium. Administration of erdosteine resulted in a significantly reduced histological damage associated with torsion of the spermatic cord compared with torsion/detorsion. In all groups, the contralateral testes were histologically normal. In conclusion, the results clearly displayed that erdost...

We did not encounter any of the complications with Allevyn Adhesive® that were seen with the use of traditional dressing products, such as, problems with removal of the dressing, development of maceration secondary to inadequate absorption of leakages from the wound, cohesions of the wound lips, and infections and necrosis of the flaps and grafts, secondary to erroneous locations of the dressings. There was no additional therapeutical cost due to the use of this product. For these reasons we thought that Allevyn Adhesive® is a good alternative for the dressing of hypospadias and circumcision.

ISS was found to be more valuable than other trauma scoring systems for prognostic evaluation of pediatric trauma patients. On the other hand, blood glucose, AST, and ALT are easily available, cheap, and valuable alternative laboratory findings in prognostic evaluation.

ACD is a rare congenital intestinal anomaly located posterior to the anus. It can be confused with other types of anorectal pathologies, such as hemorrhoids, fistula-in-ano, and perianal abscess at the time of diagnosis. Although ACD is often asymptomatic, it should be removed surgically because of the risk of inflammatory complications and colloidal cancer.

Trichobezoars are hair balls found in the stomach and formed following trichitillomania and trichopaghia. Rapunzel syndrome is a rare condition in which the presence of giant trichobezoars causes mechanical obstruction. To date, only two cases of stomach perforation caused by trichobezoars have been reported among pediatric patients. We report a 14-year-old female patient who experienced nausea, vomiting and severe abdominal pain for 1 month. Physical examination revealed diffuse abdominal distension. Palpation detected a mobile and sensitive mass, 15 x 15 cm , which filled the upper quadrant. Urgent surgery revealed that the stomach was perforated by the trichobezoar ball. This trichobezoar mass was totally excised by expanding the perforation area. Conclusion This is the reported third case of gastric perforation caused by trichobezoar in a pediatric patient. Among acute abdominal cases, gastric perforation should remain a possibility in differential diagnosis.

Inguinal masses in young girls must be carefully evaluated, because the sonographic preoperative diagnosis may be misleading.