Band ligation of the perforated gall bladder during laparoscopic cholecystectomy

Perforation of the gall bladder is a frequent complication during laparoscopic cholecystectomy. Grasping the perforated part of the gall bladder, clip application, or endoscopic loop application are possible solutions to prevent spillage. We propose laparoscopic rubber band application to close the perforated part of the gall bladder as an easy and safe method. We performed rubber band application after iatrogenic perforation of the gall bladder during laparoscopic cholecystectomy in 5 patients. Two-millimeter-wide multiple rubber rings, cut from a 14-Fr Foley catheter, are loaded on a grasper. When a perforation occurred during the dissection of the gall bladder, the hole is grasped with this instrument and 1 of the rings is placed on the gall bladder by the aid of a dissector. Thus, the grasper remained available for traction of the Hartmann's pouch during further dissection of the gall bladder. The rubber bands were placed successfully in all cases. Two perforations occurred in 1 case, and 2 bands were placed with ease. Bile leakage or gall stone spillage did not occur. Operation time was not prolonged. Rubber band ligation of perforation of the gall bladder is a simple, safe, inexpensive, and effective method to prevent spillage of the bile or gallstones in laparoscopic surgery.     

Transient hypogammaglobulinemia and unclassified hypogammaglobulinemia: ‘Similarities and differences’

Keles S, Artac H, Kara R, Gokturk B, Ozen A, Reisli I. Transient hypogammaglobulinemia and unclassified hypogammaglobulinemia: ‘Similarities and differences’.
Pediatr Allergy Immunol 2010: 21: 843–851.
© 2010 John Wiley & Sons A/S Transient hypogammaglobulinemia of infancy (THI) is characterized by recurrent infections and one or more reduced serum immunoglobulin (Ig) levels. Usually, this clinical picture resolves spontaneously by 3 yr of age. However, hypogammaglobulinemia persists until adolescence in some patients. In recent years, those patients have been classified as undefined/unclassified hypogammaglobulinemia (UCH). We aimed to evaluate the clinical and immunologic features of patients with THI and UCH considering age of recovery and to assess relationships between hypogammaglobulinemia, infections, and allergic manifestations. We reviewed the medical records of children followed with a diagnosis of hypogammaglobulinemia from 2001 to 2007. Patients with decreased levels (<2 s.d.) of one or more major Ig isotypes (IgG, IgA, IgM) with normal antibody responses and lymphocyte subpopulations were included (n = 374). Those patients whose Igs normalized during the follow‐up period were classified as THI and the others as UCH. The THI group consisted of 71 patients (27 females, 44 males) with a mean recovery age of 68.87 ± 36.5 months. About 95% of patients with THI recovered before 10 yr of age. The UCH group consisted of 303 patients (105 females, 198 males) with a mean age at diagnosis of 52 ± 42 months. The most common presenting manifestations in the THI and UCH groups were upper respiratory tract infections (URTIs), lower respiratory tract infections, and asthma (42%, 50%, and 52% in the THI group vs. 39%, 53%, and 55% in the UCH group, respectively). In the THI group, the prevalence of atopic disease was related to age and found to be increased markedly after 44 months. In all patients, the prevalence of asthma was independently and positively associated with family history of atopy and age, whereas it was negatively associated with recurrent URTIs. Patients with THI and UCH have similar clinical and immunologic features. The normalization of Igs may be delayed in a majority of the patients with hypogammaglobulinemia. This observation may be a contribution to the classical definition and diagnostic criteria for THI.     

Clinical features and outcomes of 76 patients with COVID-19-related multi-system inflammatory syndrome in children

Clinical Rheumatology - Multi-system inflammatory syndrome in children (MIS-C) is a less understood and a rare complication of coronavirus disease-2019 (COVID-19). Given the scarce data regarding...     

Congenital contracture of the quadriceps muscle: confirming the diagnosis with magnetic resonance imaging

Congenital contracture of the quadriceps muscle can be defined as progressive loss of knee flexion due to fibrosis within the muscle without a history of trauma or intramuscular injection into the thighs. In the course of time, secondary changes might develop and vitiate the end result so this rare childhood disease needs particular attention for early diagnosis and treatment. Herein, we report a 14-year-old girl presented with inability to bend her knees completely. The clinical and radiological assessment was detailed with magnetic resonance imaging findings.     

Breast tuberculosis

Tuberculosis is the most widespread and persistent human infection in the world. Tuberculosis of the breast is an uncommon disease with an incidence range between 0.1-3%, for all the breast diseases treated surgically. We present a case with primary breast tuberculosis. The diagnosis was made based on result of pathological examination of incision biopsy and cure had been obtained with anti-tuberculosis therapy with 4 drugs. Especially for patients from the areas where tuberculosis is endemic, tuberculosis must be considered in differential diagnosis of breast lesions.     

Effects of pars plana vitrectomy on retrobulbar haemodynamics in diabetic retinopathy

BACKGROUND: The purpose of the present study was to determine the effects of pars plana vitrectomy on retrobulbar haemodynamics in patients with proliferative diabetic retinopathy (PDR). METHODS: Colour Doppler imaging was used for measurement of blood flow velocities and resistive index of the ophthalmic artery (OA), posterior ciliary arteries (PCA) and central retinal artery (CRA) in 14 eyes of 14 patients with PDR before pars plana vitrectomy and at the 1 and 6 months after operation. The patients were also treated by laser photocoagulation before or during surgery. Twenty age- and sex-matched healthy subjects were used as control group. RESULTS: Mean peak systolic velocity and the end diastolic velocity of the CRA in the patients with PDR were lower and the mean resistive index was higher than in those of the control group (P < 0.05). The mean end diastolic velocity of OA in the patients was lower and the mean resistive index was higher than in the control group (P < 0.05). The peak systolic velocity of the OA and the end diastolic velocity of the CRA were significantly increased (P = 0.043 and P = 0.018, respectively) and the mean resistive index of the CRA was significantly decreased after pars plana vitrectomy (P = 0.043). No significant changes were detected among preoperative and postoperative values of peak systolic velocity, end diastolic velocity, and resistive index of the PCA and the mean velocity of the central retinal vein (P > 0.05). CONCLUSIONS: The blood flow velocities of OA and CRA are decreased but the resistive index is increased significantly in patients with PDR. Pars plana vitrectomy in patients with PDR may decrease resistive index and improve blood flow in the CRA.     

One-stage surgical management for lung and liver hydatid diseases

BACKGROUND: Hydatid disease remains a serious health problem in Mediterranean areas. We reviewed the efficacy of a single-stage operation in coexisting cysts of lung and liver in patients. METHODS: Forty-one patients operated for the cysts located on the dome of the liver and right lung with one-stage surgical approach on between 1990 and 2010. There were 19 males (46%) and 22 females (54%) patients. The age range was 10–82 years, with a median age of 34 years. RESULTS: All patients had simultaneous operations for both organs via right thoracotomy and phrenotomy except one patient. Surgical techniques used in the lung were cystotomy and capitonnage, with wedge resection of the destroyed lung parenchyma in three (7.3%) and additional decortication in three (7.3%). Cystotomy was applied with membrane removal in the liver cysts. Postoperative complications were prolonged biliary drainage, empyema, prolonged air leak, pleural effusion in one case (2.4%) each, respectively. All patients managed successfully and discharged. No hospital mortality occurred. CONCLUSIONS: We propose that concomitant right pulmonary and liver dome hydatid cysts can be treated effectively and safely in a one-stage operation through a right posterolateral thoracotomy and phrenotomy.