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Umbilical discharge in neonates: A case-based management protocol performed from a different perspective

Aim: This study aimed to retrospectively investigate causes of umbilical discharge (UD), its clinical course, treatment modalities and follow-up in infants with UD complaints in a major teaching hospital in Turkey. Material and Method: Infants with an UD complaint who were referred to our clinic by a pediatrician or a family physician from January 2013 to June 2014 were investigated. Results: The study included 291 infants between the ages of 3 and 114 days. Of these infants, 194 (67%) had an umbilical granuloma, 83 (28.3%) had an umbilical polyp, and 14 (4.8%) had omphalitis. Among 14 infants with omphalitis who were treated with topical antibiotics, six infants had refractory or recurrent discharge and ultrasonography (US) was performed which revealed a 1-3 mm sized cystic appearance with no connection to the peritoneum or other tissues. These infants received systemic antibiotics in addition to topical antibiotics. During the follow-up period, cystic appearance was not present in US in three of these six patients and in the remaining three patients who did not present for follow-up we learned via phone calls that their complaints had not recurred. Discussion: Cauterization using a silver nitrate pencil was sufficient in the umbilical granuloma. Ligating, excising and cauterizing the base of the lesions was sufficient in an umbilical polyp. In cases with persistent or recurrent UD, high-resolution US should be primarily performed, which may direct the subsequent management.

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Metastatic lung carcinoma with unknown primary site

Carcinoma of unknown primary origin is defined as metastatic disease in which the primary tumor site is not detected despite all detailed examinations performed. CUP accounts for 3-5% of all cancer cases. The annual incidence is 7-12 in 100,000. It is the 7-8th most prevalent cancer and has the 4th highest mortality. The average age of diagnosis is 60-65 years. In children, it accounts for less than 1% of all cancers. A 71-year-old male applied to our clinic with the complaint of cough and shortness of breath during exercise for the last 4 months. In thoracic CT, an irregularly margined, 17x27 mm diameter, mass lesion was seen in the superior part of the left lower lobe of the lung, adjacent to a fissure. Transthoracic fine needle aspiration biopsy performed on the lesion showed an adenocarcinoma. PET-CT showed no metastatic lesion and the patient was operated on. The pathology report showed a metastatic character of the tumor, yet the primary origin could not be detected.

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Leg gangrene in a newborn

A full-term, vaginally delivered, 7-day-old boy presented with poor feeding, tachypnea, and color change on his leg. His prenatal and family histories were unremarkable. Lethargy, decreased neonatal reflexes, respiratory distress, and a necrotic appearance on the distal left foot were observed. Left femoral pulse was absent. Laboratory examination revealed metabolic acidosis, hypernatremia, increased serum creatinine and acute phase reactants, and prolonged coagulation parameters. Doppler ultrasound and computerized tomographic angiography revealed decreased calibration in the left external iliac artery, monophasic weak blood flow in the superficial femoral and popliteal arteries, and absence of blood flow in the dorsalis pedis artery. Thrombophilia and congenital metabolic disorders were excluded. Low molecular weight heparin and antibiotic therapy led to resolution of the clinical picture except for his leg. Amputation below the knee was performed after demarcation of the gangrene became clear . He was discharged after an uneventful postoperative period.

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