Asymptomatic diaphragmatic rupture with retroperitoneal opening as a result of blunt trauma

Blunt traumas of the abdomen and thorax are important clinical problems in pediatric ages. Severity of trauma may not always be compatible with the patients′ clinical situation. A 2-year-old male child was admitted to our emergency clinic as a result of tractor crash accident. Physical examination of the child was normal. The abdominal and thoracic ultrasonography (USG) examination performed in the emergency clinic was normal. In thoracic computed tomography (CT) scan of the patient, there was irregularity of the right diaphragmatic contour that was described as micro perforation-rupture (the free air was just in the perihepatic and retroperitoneal area, which was not passing through the abdomen). The patient was followed-up for 1 week in the hospital with a diagnosis of retroperitoneal diaphragmatic rupture. It is not appropriate to decide the severity of trauma in childhood on the basis of clinical findings. Although severe trauma and sustaining radiological examinations, the patients′ clinical pictures may be surprisingly normal, as in our patient. In such cases, there may not be any clinical symptom. CT scan examination must be preferred to USG for both primary diagnosis and follow-up of these patients. According to the current literature, there is no reported case with retroperitoneal rupture of the diaphragm

A practical offer for hypospadias dressing: Allevyn®

Introduction: An ideal hypospadias dressing material must be cheap and non-allergenic. It also must be easily and quickly applied, non-adherent to the incision, effectively absorb the leakages of the wound, pressurise the flaps and grafts effectively, without damaging the blood circulation, protect against infections, and must be easily and painlessly removable. We use a product that is produced for healing chronic wounds and burns, Allevyn Adhesive® , as a wound dressing after hypospadias surgery and circumcision. Materials and Methods: We included 61 hypospadias and 85 circumcision cases operated in our clinic between November 2007 and August 2010, for the study. Allevyn Adhesive® dressing was used in all the cases. For approximately every 10 patients a sheet sized 22.5 x 22.5 cm was used. Results: We did not meet any difficulty in application and removal of the dressings and the dressing could be performed easily even by inexperienced health personnel. The cost of the application is about $5 for each case. We did not encounter any complications with regard to the dressing during the follow-up. Conclusion: 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

Smooth muscle cells are derived predominantly from tissue explant of inguinal hernia sac

GİRİŞ ve AMAÇ: Processus vaginalisin (PV) kapanmasının, testisin inişini sağlamak için geçici olarak bulunan düz kas hücrelerinin, devamlılığına bağlı olduğu ileri sürülmüştür. Bu amaçla, inguinal herni keseleri, PV kapanması ve düz kas hücre varlığı arasındaki ilişkinin değerlendirilmesi için kültüre edildi. Bu çalışma, sadece inguinal herni keselerinde düz kas hücresi varlığını gösteren ek bilgiler vermekle kalmayıp, aynı zamanda inguinal herninin cerrahi dışı tedavisi için yapılacak çalışmalar için yeni fikirler sunmaktadır. YÖNTEM ve GEREÇLER: Herni keseleri, yaşları 2 ay ile 5 yaş arasında değişen 11 çocuktan inguinal herni ameliyatı sırasında elde edildi. Örnekler uygun şekilde hazırlandı ve kültüre edildi. Hücrelerin morfolojik özellikleri ışık mikroskobu ile değerlendirildi. Hücrelerin hayatiyetleri, tripan blue exclusion metodu ile değerlendirildi. Gelişen hücreler, imminohistokimyasal olarak aktin ve miyozin ile boyandı. BULGULAR: Işık mikroskobu incelemesi ile bu hücrelerin iğ şekilli olduğu ve santral yerleşimli yuvarlak çekirdeklerinin bulunduğu görülmüştür. Tüm flask üreyen hücrelerle dolduğunda, kontakt inhibisyon olmadığından, üst üste çoğalan hücreler tipik tepe-vadi görünümü oluşturmuştur. Hücrelerin canlılığı %95’ in üzerinde bulunmuştur. Gelişen hücrelerin % 80 inin düz kas aktin ve düz kas myosin antikorları ile boyandığı saptanmıştır. TARTIŞMA ve SONUÇ: Herni kesesi dokulardan gelişen hücrelerin büyük çoğunluğunu, düz kas hücreleri oluşturmuştur. Bu bulgu, PV’in inhibisyonu ile düz kas hücresi varlığı arasındaki ilişkiyi desteklemektedir. Bu bilgi inguinal herninin cerrahi dışı tedavisi üzerinde yapılacak çalışmalar için kullanılabilecektir.INTRODUCTION: Obliteration of processus vaginalis (PV) has been proposed to result from persistence of smooth muscle which is presented transiently to propel the testis. Sacs associated with inguinal hernia were cultivated to define the cells that are going to proliferate for evaluating the association of inhibition of obliteration of PV and the presence of smooth muscle (SM). The present study does not only provide additional information about the presence of SM in sacs from boys with inguinal hernia, but also provides a new tool for researches directed to define the non- operative treatment of inguinal hernia. METHODS: Hernia sacs were obtained from eleven boys with the ages ranging from two months to five years during operations for inguinal hernia. Samples were prepared and cultivated. Morphologic characteristics of cell populations were examined by light microscopy. Viability was estimated by trypan blue exclusion method. Growing cells were identified via immunohistochemical staining for smooth muscle actin and myosin. RESULTS: Light microscopic images of growing cells displayed characteristic spindle shaped morphology with centrally located round nucleus. When the flasks reached confluence, a hill-valley appearance was observed because of absence of contact inhibition. Cell viability was found more than 95%. Approximately, 80% of growing cell populations was stained positive with actins and myosin antibodies. DISCUSSION and CONCLUSION: In tissue explants of hernia sac, most commonly proliferating cell type is smooth muscle cells. This evidence supports the association of inhibition of PV and the presence of SM. The SM obtained from sacs associated with inguinal hernia may be used for researches directed to establish the non-operative treatment of inguinal hernia

Smooth Muscle Cells are Derived Predominantly from Tissue Explant of Inguinal Hernia Sac

INTRODUCTION: Obliteration of processus vaginalis (PV) has been proposed to result from persistence of smooth muscle which is presented transiently to propel the testis. Sacs associated with inguinal hernia were cultivated to define the cells that are going to proliferate for evaluating the association of inhibition of obliteration of PV and the presence of smooth muscle (SM). The present study does not only provide additional information about the presence of SM in sacs from boys with inguinal hernia, but also provides a new tool for researches directed to define the non- operative treatment of inguinal hernia

Asymptomatic diaphragmatic rupture with retroperitoneal opening as a result of blunt trauma

Blunt traumas of the abdomen and thorax are important clinical problems in pediatric ages. Severity of trauma may not always be compatible with the patients’ clinical situation. A 2-year-old male child was admitted to our emergency clinic as a result of tractor crash accident. Physical examination of the child was normal. The abdominal and thoracic ultrasonography (USG) examination performed in the emergency clinic was normal. In thoracic computed tomography (CT) scan of the patient, there was irregularity of the right diaphragmatic contour that was described as micro perforation-rupture (the free air was just in the perihepatic and retroperitoneal area, which was not passing through the abdomen). The patient was followed-up for 1 week in the hospital with a diagnosis of retroperitoneal diaphragmatic rupture. It is not appropriate to decide the severity of trauma in childhood on the basis of clinical findings. Although severe trauma and sustaining radiological examinations, the patients’ clinical pictures may be surprisingly normal, as in our patient. In such cases, there may not be any clinical symptom. CT scan examination must be preferred to USG for both primary diagnosis and follow-up of these patients. According to the current literature, there is no reported case with retroperitoneal rupture of the diaphragm