Blastocystis hominis--an emerging and imitating cause of acute abdomen in children

Two children aged 12 and 11 years with a similar history of abdominal pain, nausea, vomiting and fever with abdominal tenderness, and muscle guarding at the right lower quadrant for few days were admitted to our hospital. They subsequently developed diarrhea but without clinical relief. Just before the decision of laparotomy, both patients were diagnosed as having Blastocystis hominis infection with light microscopic examination of the stools and were treated uneventfully with the appropriate antibiotics.     

Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial

Preoperative single, high-dose methylprednisolone administration improves postoperative outcomes after colonic surgery. Several randomized studies, including major surgeries, assessed various high-dose steroid regimens; however, evidence about the effect of administration of lower doses on postoperative outcomes in colorectal surgery is not available. The aim of the present study is to determine whether the administration of a single, low dose of dexamethasone before surgery would confer an outcome advantage after colorectal surgery. Thirty patients undergoing colorectal surgery were included in this randomized, double-blind study. Patients received 8 mg dexamethasone or serum physiologic preoperatively. Levels of Interleukin-6 and C-reactive protein, pain scores, postoperative nausea and vomiting, mobilization, complications, hospital stay, and readmissions were compared. Age, sex, indications, and operations were similar in both groups (P > 0.05). C-reactive protein and Interleukin-6 levels increased significantly postoperatively in each group (P < 0.05), but there were no differences between groups when compared (P > 0.05). There were also no significant differences between pain scores, bowel functions, mobilization, hospital stay, complication rates, and readmission rates between the two groups (P > 0.05). Preoperative 8 mg dexamethasone administration has no significant effect on reducing postoperative inflammatory response and also does not improve outcomes of colorectal surgery.     

Mammary duct ectasia in infant breast with bloody nipple discharge: sonographic findings

Bloody nipple discharge is very rare in childhood. We report the sonographic findings of mammary duct ectasia and cystic changes under the nipple with abnormal content involving a 3-month-old boy with bloody nipple discharge.     

Surgical treatment in postinfarction left ventricular pseudoaneurysm

AIM: We evauated the outcome of patients with left ventricular pseudoaneurysms, focusing on those treated surgically. METHODS: Between June 1990 and March 2007, 7 patients underwent surgery because of left ventricular pseudoaneursym following myocardial infarction, at our institution. The median time interval between myocardial infarction and the diagnosis of left ventricular psedoaneursym was 2.6 months (range: 15 days to 8 months). The aneursym was resected and the defect was closed with a Teflon patch or direct sutures. RESULTS: The location of the pseudoaneursym was posterior in 3 patients, inferolateral in 3 patients and anterolateral in 1 patient. The aneursym was resected and the defect was closed with a Teflon patch in 6 patients. In 1 patient with chronic pseudoaneurysm, the defect was closed with direct sutures reinforced with Teflon felt. In addition, 5 patients underwent coronary artery bypass grafting. The patients have been followed-up for a mean period of 45 months (range: 24 to 109 months). CONCLUSION: There was no intraoperative death. However, 2 patients died due to multiple organ failure, one 17 days and the other 1 month after the surgical operation. There was 1 late death due to the cancer. Currently, 1 patient is free of any cardiac symptoms, 2 patients have New York Heart Association (NYHA) Class II heart failure, and 1 patient with moderate mitral regurgitation is in class III.     

Immunolocalization of PCNA, Ki67, p27 and p57 in normal and dexamethasone-induced intrauterine growth restriction placental development in rat

Intrauterine growth restriction (IUGR) is a major clinical problem which causes perinatal morbidity and mortality. Although fetuses with IUGR form a heterogeneous group, a major etiological factor is abnormal placentation. Despite the fact that placental development requires the coordinated action of trophoblast proliferation and differentiation, there are few studies on cell cycle regulators, which play the main roles in the coordination of these events. Moreover it is still not determined how mechanisms of coordination of proliferation and differentiation are influenced by dexamethasone-induced IUGR in the placenta. The aim of the study was to investigate the spatial and temporal immunolocalization of proliferating cell nuclear antigen (PCNA), Ki67, p27 and p57 in normal and IUGR placental development in pregnant Wistar rats. The study demonstrated altered expressions of distinct cell cycle proteins and cyclin dependent kinase inhibitors (CKIs) in IUGR placental development compared to control placental development. We found reduced immunostaining of PCNA and Ki67 and increased immunostaining of p27 and p57 in the dexamethasone-induced IUGR placental development compared to control placental development. In conclusion, our data show that the cell populations in the placenta stain for a number of cell cycle related proteins and that these staining patterns change as a function of both gestational age and abnormal placentation.     

Results for Surgical Correction of Complete Atrioventricular Septal Defect: Associations with Age,Surgical Era,and Technique

Abstract Background: This study was conducted to evaluate the outcomes of patients undergoing complete atrioventricular septal defect (CAVSD) repair with particular attention to age at surgery, surgical era, and technique. Methods: One hundred and forty‐seven patients undergoing CAVSD repair between November 2002 and February 2012 were grouped according to surgical era and technique. Group I (age: 9.4 ± 5.0 months; weight: 6.8 ± 1.7 kg) consisted of 45 patients, operated before August 2006, and was divided into subgroup Ia (31 patients; two‐patch repair) and subgroup Ib (14 patients; modified single‐patch repair). One hundred and two patients operated after August 2006 were included in Group II (age: 5.2 ± 3.1 months; weight: 4.9 ± 2.6 kg), and was divided into subgroup IIa (59 patients; two‐patch repair) and subgroup IIb (43 patients; modified single‐patch repair). Groups were compared with regard to perioperative variables and postoperative data. Results: There were 19 early and five late deaths. Overall mortality was significantly higher in Group I, compared to Group II (p < 0.01). Comparison of Groups Ia to Ib and IIa to IIb revealed no statistically significant difference in mortality or morbidity. Age >8 months and preoperative common atrioventricular valve (CAVV) regurgitation ≥ moderate were significant risk factors for mortality and morbidity. After 40.8 ± 24.4 months, 99 (80.4%) of 123 (83.7%) survivors were asymptomatic without any medication, and 24 (19.5%) have mild symptoms. Conclusion: Our current results indicate that younger patient age and better preoperative CAVV functions were the main factors for a favorable outcome after surgical correction of CAVSD; and outcomes did not differ by the surgical technique. (J Card Surg 2012;27:745‐753)