Sefa Tigrak

Background. Actinomycotic osteomyelitis is a rare, chronic infection caused by Actinomyces species, anaerobic bacteria normally found in the oral flora. Mandibular involvement is uncommon and may mimic malignancies, complicating diagnosis. Case Presentation. A 15-year-old previously healthy male presented with painful neck swelling and trismus. Examination revealed a firm mass at the angle of the mandible. Imaging suggested osteomyelitis but raised concern for malignancy. Surgical drainage was performed, and histopathology confirmed actinomycotic infection. The patient initially received empirical intravenous vancomycin, cefotaxime, and metronidazole. Due to persistent fever and elevated inflammatory markers, the regimen was switched to teicoplanin plus piperacillin/tazobactam. Therapy was subsequently escalated to meropenem due to recurrent fever and based on magnetic resonance imaging findings suggestive of osteomyelitis, then vancomycin was replaced with teicoplanin because of vancomycin-associated nephrotoxicity. Following clinical improvement, the patient was discharged on oral amoxicillin/clavulanate to complete a total of six weeks of therapy. Discussion. Pediatric mandibular actinomycotic osteomyelitis is extremely rare. Its indolent course often mimics tumors or granulomatous disease. In this case, delayed diagnosis and nonspecific imaging findings led to initial misinterpretation. Surgical intervention played a key role in diagnosis and treatment. Early recognition and combined medical-surgical management are crucial to avoid complications. This case highlights the importance of considering infectious causes in mandibular masses and underscores the diagnostic challenges associated with them.

Background/Objectives: To evaluate pancreatic size and echogenicity using ultrasonography in newly diagnosed pediatric Type 1 Diabetes Mellitus patients within five days of diagnosis, and compare early childhood (p < 0.001), with greater reductions in adolescents (head: 21%, body: 26.7%) vs. young children (head: 14.4%, body: 15.5%). Isoechoic pancreases were more common in young patients (80% vs. 40.9%; p = 0.033). C-peptide and HgbA1c were higher in adolescents (p < 0.05), with no echogenicity–autoantibody association. Conclusions: This first early-post-diagnosis ultrasonography study reveals age-specific pancreatic atrophy and echogenicity changes in children, more severe in adolescents, reflecting type 1 diabetes mellitus endotypes. Ultrasonography offers a practical noninvasive tool for early detection and endotype stratification, informing personalized diabetes care.

To estimate the exact incidence of trocar site hernia (TSH) through sonographic examination and to evaluate the predisposing risk factors of TSH. Three hundred patients who underwent laparoscopic surgery for benign gynecologic indications were included in this study and called back for a follow-up visit. All patients underwent an ultrasound evaluation for the detection of TSH. Risk factors for TSH formation were investigated. Twenty-five (8.3%) TSHs were diagnosed among 300 postoperative laparoscopies. The highest rate of TSH development among the surgeries was found in tubal ligation cases with 19%. Parity ≥3 [odds ratio (OR), 3.13; 95% confidence interval (CI): 1.21-8.09; p=0.018], and not closing fascia (OR: 6.74; 95% CI: 2.72-16.70; p<0.001) were statistically significant risk factors for the development of TSH in multivariate analysis. The prevalence of TSH is higher than previously reported, and ultrasonographic examination is adequate for detecting subclinical types of this complication.