Analysis of Complications of a Neglected Disease: 13 Years of Experience with Liver Hydatid Cysts in a High-Volume Hospital.

Background and Objectives: The aim of this study was to evaluate the clinical presentation, treatment outcomes, and complications associated with hepatic hydatid cysts in a pediatric population. Materials and Methods: This retrospective study analyzed 214 pediatric patients with liver hydatid cysts, focusing on clinical presentation, treatment outcomes, and associated complications. Patients were classified based on treatment modality, including non-operative management with albendazole, PAIR, and surgical intervention. This study compared cyst characteristics, recurrence rates, and complications such as cysto-biliary fistulas. Results: Among the patients, 68% (n = 145) had a single cyst and 86% (n = 184) were found to have isolated liver cysts. No significant statistical difference was observed between Group 1 and Group 2 in terms of age, gender, and basic laboratory values and general characteristics of the cysts, such as the lobe where the cyst was located, involvement of multiple organs, number of cysts, the state of cyst rupture, and recurrence; no statistically significant difference was found between the groups (p > 0.05 for each comparison). Cyst rupture incidence was 6%, and the average incidence of recurrence was 2%, with a surgical recurrence incidence of 3%. A total of 37 patients had a laparotomy, while 7 had laparoscopic surgery. In total, capitonnage was performed in 68 patients, omentopexy in 4, and cystostomy in 6. Consequently, among the treated patients (PAIR + surgery), the incidence of cysto-biliary fistula was 11%, anaphylaxis was 2%, surgical recurrence was 3%, and the incidence of reoperation (Clavien-Dindo ≥ 3) was 6%. The average follow-up period was 72 months, during which no mortality was observed. Conclusions: We identified key clinical outcomes related to both non-surgical treatments (cyst rupture and recurrence) and surgical groups (cysto-biliary fistulas, anaphylaxis, the need for reoperation, rupture, and recurrence).

Can direct bilirubin-to-lymphocyte ratio predict surgery for pediatric adhesive small bowel obstruction?

OBJECTIVE: Estimating which patients might require surgical intervention is crucial. Patients with complete bowel obstructions exhibit disrupted enterohepatic cycles of bile and bacteremia due to bacterial translocation. The goal of this study was to develop a prediction index using laboratory inflammatory data to identify patients who may need surgery. MATERIALS AND METHODS: The patients were divided into two groups based on their management strategy: Non-operative management (Group 1) and surgical management (Group 2). RESULTS: The indirect bilirubin, direct bilirubin, and total bilirubin were significantly higher in Group 2 than in Group 1 (p = 0.001, p < 0.001, and p < 0.001, respectively). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-NLR (PNLR), and direct bilirubin-to-lymphocyte ratio (DBR) were significantly higher in Group 2 compared to Group 1 (p = 0.041, p = 0.020, and p < 0.001, respectively). In group 2, 78% have viable bowels. Resection was performed in 40% of cases, with 12% mortality and a 10-day average hospital stay. DLR performs the best overall accuracy (72%), demonstrating a well-balanced sensitivity (62%) and specificity (81%). CONCLUSIONS: This study suggested that DBR is a more accurate predictive index for surgical intervention in pediatric adhesive small bowel obstruction patients compared to NLR and PNLR, providing valuable guidance for treatment strategies.

OBJETIVO: Desarrollar un índice de predicción utilizando datos inflamatorios de laboratorio para identificar qué pacientes podrían necesitar cirugía. MÉTODO: Los pacientes se dividieron en dos grupos según su estrategia de manejo: no quirúrgico (grupo 1) o quirúrgico (grupo 2). RESULTADOS: Las bilirrubinas indirecta, directa y total fueron significativamente más altas en el grupo 2 que en el grupo 1 (p = 0.001, p < 0.001 y p < 0.001, respectivamente). Las relaciones neutrófilos-linfocitos, plaquetas-neutrófilos-linfocitos y bilirrubina directa-linfocitos fueron significativamente más altas en el grupo 2 que en el grupo 1 (p = 0.041, p = 0.020 y p < 0.001, respectivamente). En el grupo 2, el 78% tenían intestino viable. Se realizó resección en el 40% de los casos, con un 12% de mortalidad y una estancia hospitalaria promedio de 10 días. La relación bilirrubina directa-linfocitos tuvo la mejor precisión general (72%), demostrando una sensibilidad bien equilibrada (62%) y una buena especificidad (81%). CONCLUSIONES: Este estudio sugiere que la relación bilirrubina directa-linfocitos es un índice predictivo más preciso para la intervención quirúrgica en pacientes pediátricos con obstrucción adhesiva de intestino delgado en comparación con la de neutrófilos-linfocitos y la de plaquetas-neutrófilos-linfocitos, proporcionando una valiosa orientación para las estrategias de tratamiento.

Protective effects of Passiflora Incarnata on ischemia-reperfusion injury in testicular torsion: an experimental study in a rat model.

OBJECTIVE: The current study aimed to explore the potential protective effect of Passiflora Incarnata L., (PI) in treating IR injury after testicular torsion in rats. MATERIALS AND METHODS: This research investigated the impact of PI on IR damage in male Wistar albino rats. Animals were divided to three groups: group 1 (sham), group 2 (IR), and group 3 (IR+PI). RESULTS: The malondialdehyde (MDA), myeloperoxidase (MPO) and glutathione (GSH) levels did not significantly differ across the groups (p = 0.830, p = 0.153 and p=0.140, respectively). However, Group 3 demonstrated a superior total antioxidant status (TAS) value compared to Group 2 (p = 0.020). Concurrently, Group 3 presented a significantly diminished mean total oxidant status (TOS) relative to Group 2 (p = 0.009). Furthermore, Group 3 showed a markedly improved Johnsen score relative to Group 2 (p < 0.01). IR caused cell degeneration, apoptosis, and fibrosis in testicular tissues. PI treatment, however, mitigated these effects, preserved seminiferous tubule integrity and promoted regular spermatogenesis. Furthermore, it reduced expression of tumor necrosis factor-alpha (TNF-α), Bax, and Annexin V, signifying diminished inflammation and apoptosis, thereby supporting cell survival (p < 0.01, p < 0.01, p < 0.01, respectively). CONCLUSIONS: This study revealed that PI significantly reduces oxidative stress and testicular damage, potentially benefiting therapies for IR injuries.

OBJETIVO: Explorar el posible efecto protector de Passiflora incarnata L. (PI) en el tratamiento de la lesión por isquemia-reperfusión (IR) después de una torsión testicular en ratas. MÉTODO: Se estudió el impacto de Passiflora incarnata en el daño por IR en ratas Wistar albinas machos. Los animales se dividieron tres grupos: 1 (simulado), 2 (IR) y 3 (IR+PI). RESULTADOS: Los niveles de malondialdehyde (MDA), myeloperoxidase (MPO) y glutathione (GSH) no difirieron significativamente entre los grupos (p = 0.830, p = 0.153 y p = 0.140, respectivamente). Sin embargo, el grupo 3 tuvo un valor de estado antioxidante total (TAS) superior en comparación con el grupo 2 (p = 0.020). Al mismo tiempo, el grupo 3 presentó un estado oxidante total (TOS) medio significativamente disminuido en comparación con el grupo 2 (p = 0.009). El grupo 3 mostró una mejora notable en la puntuación de Johnsen en comparación con el grupo 2 (p < 0.01). La IR causó degeneración celular, apoptosis y fibrosis en los tejidos testiculares. El tratamiento con PI mitigó estos efectos, preservó la integridad de los túbulos seminíferos y promovió la espermatogénesis regular. Además, redujo la expresión de factor de necrosis tumoral alfa, Bax y anexina V, lo que significa una disminución de la inflamación y de la apoptosis, respaldando así la supervivencia celular (p < 0.01, p < 0.01 y p < 0.01, respectivamente). CONCLUSIONES: Este estudio reveló que PI reduce significativamente el estrés oxidativo y el daño testicular, beneficiando potencialmente las terapias para lesiones por IR.

Comparison of Single-incision Laparoscopic Percutaneous and Cystoscope Forceps Assisted Morgagni Hernia Repair Techniques.

OBJECTIVE: Our goal was to compare single-incision laparoscopic percutaneous and cystoscope forceps-assisted Morgagni hernia repair techniques. MATERIALS AND METHODS: A total of 40 patients were allocated to two groups, each with 20 patients. Group 1: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with a 5 mm Storz laparoscopic scope entered through the umbilicus). Group 2: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with an 11 Fr [3.6 mm] cystoscope entered through the umbilicus + using forceps + sac plication, and sac cauterization). In Group 1; the sac was not removed. In group 2; we advanced the forceps through the cystoscope, caught the sac, pushed the needle through the sac, plicated the sac, and then cauterized the sac with Bugbee electrode. RESULTS: Of the 40 patients, 70 % (n = 28) were male. The symptoms at admission included repeated chest infections (40 %), dyspnea (30 %), vomiting (22 %), and abdominal pain (22 %). No difference was found between groups in terms of age, gender symptomatology, or associated anomalies. The operation time was shorter in group 2 compared to group 1 (p < 0.05; 25 min vs 40 min). Although there was one recurrence in Group 1, no recurrence was reported in Group 2. The recurrence incidence did not differ between groups (p > 0.05). CONCLUSIONS: Cystoscope-assisted repair of Morgagni hernia was found to be superior in terms of safety and shorter operation time. LEVEL OF EVIDENCE: Type III. TYPE OF THE STUDY: Retrospective study.

Protective effects of passiflora incarnata on ovarian ischemia/reperfusion damage in rats with ovarian torsion.

BACKGROUND: This study aimed to investigate whether Passiflora Incarnata (PI) has a protective effect against ischemia-reperfu-sion (IR)-induced oxidative and inflammatory ovarian damage. METHODS: The effects of PI on ovarian ischemia-reperfusion injury were investigated in female Wistar albino rats. The animals were randomly divided into three groups: Group 1 (sham), Group 2 (IR), and Group 3 (IR+PI). RESULTS: The mean levels of Malondialdehyde (MDA), Myeloperoxidase (MPO), and Total Oxidant Status (TOS) were higher in the IR group (p=0.025, p<0.001, and p=0.016, respectively). The Total Antioxidant Status (TAS) levels were lower in the IR group (p=0.005). Immunostaining revealed significant differences across the groups for Tumor necrosis factor-alpha (TNF-α): 13.84%, 49.51%, and 22.51% for Groups 1, 2, and 3, respectively (p<0.01). Bax: 10.53%, 46.74%, and 26.46% for Groups 1, 2, and 3, respectively (p<0.01). Annexin V: 12.24%, 44.86%, and 23.28% for Groups 1, 2, and 3, respectively (p<0.01). The mean scores for hemorrhage, inflammation, follicular degeneration, and congestion showed significant variations among the groups, all registering p<0.001. CONCLUSION: Passiflora Incarnata exhibited antioxidant, anti-inflammatory, and anti-apoptotic properties, promoting cell survival, histologically protecting ovarian tissue, and ameliorating IR injury by reducing oxidative stress.

Effectiveness of extracorporeal shock wave lithotripsy in urolithiasis patients under 2 years of age.

OBJECTIVE: In this study, we present our extracorporeal shock wave lithotripsy (ESWL) outcomes in urolithiasis patients under the age of two. MATERIALS AND METHODS: The procedure was performed with patients < 2 years of age sedated, under anesthesia using ketamine and Dormicum (midazolam), in the supine position. Fragmentation was evaluated by fluoroscopy after the procedure. RESULTS: A total of 74 procedures were performed on 65 kidneys. One patient with bilateral stones had two sessions of ESWL on the right side; three sessions of ESWL were performed in one patient with a unilateral stone, and two sessions were performed in seven patients with unilateral stones. All other patients underwent one session of ESWL. As post-procedural complications, hematuria was observed in 14 patients (12 mild and 2 significant), and vomiting occurred in 1 patient. Ureterorenoscopy was performed in 5 patients, and percutaneous nephrolithotomy in 6 patients due to a failed procedure. CONCLUSION: As a result, ESWL treatment is effective and has advantages such as a short hospitalization time, good reproducibility, cost-effectiveness, and a low rate of complications. Therefore, we recommend ESWL as the first-line treatment for renal and proximal ureteral stones in infants < 2 years of age.

OBIETIVO: En este estudio, presentamos nuestros resultados de ESWL en pacientes con urolitiasis menores de dos años. MATERIALES Y MÉTODOS: El procedimiento se realizó con pacientes menores de dos años sedados, bajo anestesia con ketamina y Dormicum (midazolam), en posición supina. La fragmentación se evaluó mediante fluoroscopia después del procedimiento. RESULTADOS: Se realizaron total de 74 procedimientos en 65 riñones. Un paciente con cálculos bilaterales tuvo dos sesiones de ESWL en el lado derecho; se realizaron tres sesiones de LEOC en un paciente con litiasis unilateral y dos sesiones en siete pacientes con litiasis unilateral. Todos los demás pacientes se sometieron a una sesión de ESWL. Como complicaciones post-procedimiento se observó hematuria en 14 pacientes (12 leves y 2 significativas) y vómitos en 1 paciente. Se realizó URS en 5 pacientes y NLP en 6 pacientes debido a un procedimiento fallido. CONCLUSIONES: Como resultado, el tratamiento de la ESWL es efectivo y tiene ventajas como un tiempo de hospitalización corto, buena reproducibilidad, costo-efectividad y baja tasa de complicaciones. Por tanto, recomendamos la ESWL como tratamiento de primera línea para cálculos renales y ureterales proximales en bebés < 2 años de edad.

Analysis of mortality and long-term outcomes of pediatric patients with tracheoesophageal fistula/esophageal atresia.

BACKGROUND/PURPOSE: This study analyzed factors that affect mortality in patients surgically treated for EA, then explored the long-term problems encountered by these patients. MATERIALS AND METHODS: Among 252 patients with EA who were either diagnosed, treated, and subsequently followed at the Department of Pediatric Surgery, Dicle University Medical Faculty Hospital, or were treated surgically elsewhere but followed at our center, between January 2010 and January 2020,214 patients were included in the study. RESULTS: Early complications:One or more early complications were observed in 132(62.5%) of the 211 patients who underwent surgical EA repair. The most common early complication was AS, which developed in 106(50.2%) patients. Anastomosis leakage. Was detected in 48 (22.7%) patients. Late complications: The late findings of 161 patients who underwent definitive surgery and had a mean follow-up period of 68 months (range, 6-120 months) were evaluated. The most common late complication was GER. MORTALITY: Of the 214 patients in our study, 63(29.4%) died, including 48(76.2%) during the early period after the first surgery. Of the 10(15.9%) patients who died during the late period. CONCLUSION: In our study, the most common early complication was anastomotic stenosis in patients with esophageal atresia. We recommend balloon dilation in the treatment of anastomotic stenosis.Gastroesophageal reflux is the most common long-term complication. Most of these can be treated conservatively and medically. The association of low birth weight, cardiac anomalies, prematurity and VACTERL increased mortality in patients with esophageal atresia in our study. KEY WORDS: Esophageal Atresia, Morbidity, Late Period, Mortality, Tracheoesophageal Fistula.

A novel diagnostic scoring system for pediatric appendicitis based on age and sex-adjusted hematological parameters.

BACKGROUND: Acute appendicitis diagnosis can sometimes be a real challenge in pediatric patients. OBJECTIVE: To establish the importance of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other hematological parameters adjusted for age and sex in the prediction of acute appendicitis, as well as to describe a new scoring system. MATERIAL AND METHODS: Medical records of 946 children hospitalized for acute appendicitis were retrospectively analyzed. A scoring system based on NLR, PLR, lymphocyte/monocyte ratio (LMR), and C-reactive protein (CRP) adjusted for age and sex was developed. RESULTS: Patients were divided into group I, with negative examination, and group II, with acute appendicitis; mean ages were 12.20 ± 2.31 and 11.56 ± 3.11, respectively. Leukocyte count, neutrophil percentage, NLR, PLR, LMR and PCR were higher in group II. The scores ranged from 0 to 8 points; 4.5 was determined to be the best cut-off point for acute appendicitis with the highest area under the curve (0.96), sensitivity (94%), specificity (86%), positive predictive value (97.5%), negative predictive value (65%), accuracy (92.6%) and misclassification rate (7.4%). CONCLUSION: The proposed scoring system, calculated based on patient age and gender, can be used for unnecessary surgeries to be avoided.

ANTECEDENTES: El diagnóstico de apendicitis aguda representa un reto en pacientes pediátricos. OBJETIVO: Establecer la importancia del índice neutrófilos-linfocitos (INL), índice plaquetas-linfocitos (IPL) y otros parámetros hematológicos ajustados por edad y sexo en la predicción de apendicitis aguda, así como describir un nuevo sistema de calificación. MATERIAL Y MÉTODOS: Se analizaron retrospectivamente expedientes clínicos de 946 niños hospitalizados por apendicitis aguda. Se desarrolló un sistema de calificación basado en INL, IPL, ILM y proteína C reactiva (PCR) ajustados por edad y sexo. RESULTADOS: Los pacientes se dividieron en grupo I de exploración negativa y grupo II de apendicitis aguda; las medias de edad correspondientes fueron 12.20 ± 2.31 y 11.56 ± 3.11. El recuento leucocitario, porcentaje de neutrófilos, INL, IPL, ILM y PCR fueron superiores en el grupo II. La calificación osciló entre 0 y 8 puntos; se determinó que 4.5 fue el mejor punto de corte para apendicitis aguda con mayor área bajo la curva (0.96), sensibilidad (94 %), especificidad (86 %), valor predictivo positivo (97.5 %), valor predictivo negativo (65 %), precisión (92.6 %) y tasa de clasificación errónea (7.4 %). CONCLUSIÓN: El sistema de calificación que se propone, calculado por edad y sexo de los pacientes, se puede utilizar para evitar cirugías innecesarias.

Nuevo sistema de calificación diagnóstica para apendicitis pediátrica basado en parámetros hematológicos ajustados por edad y sexo / A novel diagnostic scoring system for pediatric appendicitis based on age and sex-adjusted hematological parameters

Resumen Antecedentes: El diagnóstico de apendicitis aguda representa un reto en pacientes pediátricos. Objetivo: Establecer la importancia del índice neutrófilos-linfocitos (INL), índice plaquetas-linfocitos (IPL) y otros parámetros hematológicos ajustados por edad y sexo en la predicción de apendicitis aguda, así como describir un nuevo sistema de calificación. Material y métodos: Se analizaron retrospectivamente expedientes clínicos de 946 niños hospitalizados por apendicitis aguda. Se desarrolló un sistema de calificación basado en INL, IPL, ILM y proteína C reactiva (PCR) ajustados por edad y sexo. Resultados: Los pacientes se dividieron en grupo I de exploración negativa y grupo II de apendicitis aguda; las medias de edad correspondientes fueron 12.20 ± 2.31 y 11.56 ± 3.11. El recuento leucocitario, porcentaje de neutrófilos, INL, IPL, ILM y PCR fueron superiores en el grupo II. La calificación osciló entre 0 y 8 puntos; se determinó que 4.5 fue el mejor punto de corte para apendicitis aguda con mayor área bajo la curva (0.96), sensibilidad (94 %), especificidad (86 %), valor predictivo positivo (97.5 %), valor predictivo negativo (65 %), precisión (92.6 %) y tasa de clasificación errónea (7.4 %). Conclusión: El sistema de calificación que se propone, calculado por edad y sexo de los pacientes, se puede utilizar para evitar cirugías innecesarias.

Abstract Background: Acute appendicitis diagnosis can sometimes be a real challenge in pediatric patients. Objective: To establish the importance of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other hematological parameters adjusted for age and sex in the prediction of acute appendicitis, as well as to describe a new scoring system. Material and methods: Medical records of 946 children hospitalized for acute appendicitis were retrospectively analyzed. A scoring system based on NLR, PLR, lymphocyte/monocyte ratio (LMR), and C-reactive protein (CRP) adjusted for age and sex was developed. Results: Patients were divided into group I, with negative examination, and group II, with acute appendicitis; mean ages were 12.20 ± 2.31 and 11.56 ± 3.11, respectively. Leukocyte count, neutrophil percentage, NLR, PLR, LMR and PCR were higher in group II. The scores ranged from 0 to 8 points; 4.5 was determined to be the best cut-off point for acute appendicitis with the highest area under the curve (0.96), sensitivity (94%), specificity (86%), positive predictive value (97.5%), negative predictive value (65%), accuracy (92.6%) and misclassification rate (7.4%). Conclusion: The proposed scoring system, calculated based on patient age and gender, can be used for unnecessary surgeries to be avoided.

DOES GALLIC ACID HAVE A POTENTIAL REMEDIAL EFFECT IN EXPERIMENTAL CORROSIVE BURN INJURY TO THE ESOPHAGUS?

Gallic acid, acting as an antioxidant, anti-precipitant and cytoprotective agent, was used as a possible remedial natural component for treating experimentally induced esophageal burn. Wistar rats (n=24) were divided into three groups. Control group was given 1 mL 0.9% NaCl. Experimental esophageal burn was induced with 1 mL 40% NaOH application to the esophagus in groups 2 and 3. Gallic acid® (20 mg/kg) was administered to the treated group via oral gavage for 10 days. Removed tissues were fixed and paraffin blocks were prepared. Histopathological examination was performed after the sections had been stained with hematoxylin-eosin. Tumor necrosis factor alpha and caspase-3 antibodies were used on immunohistochemical analysis. In the esophageal burn group, necrosis, degeneration and numerous apoptotic cells, as well as intense inflammatory cell infiltration and fibrosis in the muscle layer were observed under light microscope. In the treated group, remodeling of epithelial cells with marked reduction in the connective tissue collagen content was observed, as well as marked reduction in the volume of collagen and abundance of inflammatory cells in blood vessels. Gallic acid treatment may help heal esophageal burns and prevent complications.

The effect of low-dose Cordyceps on ischemia-reperfusion injury of the kidney in rats.

OBJECTIVE: None of studies have been conducted in terms of demonstrating the same effect with the low dose in cordycepin. In our study, we analyzed the histopathological and biochemical changes of low-dose Cordycepin(c) on a rat model in the kidney. MATERIALS AND METHODS: Twenty-four male Wistar Albino rats were randomly allocated to three groups (n = 8): the sham-control group (Group 1), the renal I/R-untreated (Group 2) group, and the I/R-C-treated (Group 3) group. Cordyceps was administered intraperitoneally at 5 mg/kg twice. Renal histological changes were compared and the relevant parameters of oxidative stress and inflammation were detected. RESULTS: In blood and tissue biochemistry, it was observed that IL-1 Beta, IL 6, TNF alpha, MDA, TOS, and OSI increased in Group 2 and decreased in Group 3. It was determined that TAS values were increased in Group 3, and decreased in Group 2. In the histopathological evaluation, while Group 1 was evaluated as normal, significant kidney damage was detected in Group 2. It was determined that there was a significant decrease in kidney damage in Group 3. CONCLUSION: These results suggest that low dose Cordycepin was as effective as normal dose on renal ischemic reperfusion and reduction of damage.

OBJETIVO: Ninguno de los estudios se ha realizado en términos de demostrar el mismo efecto con la dosis baja de cordicepina. En nuestro estudio, analizamos los cambios histopatológicos y bioquímicos de Cordycepin(c) en dosis bajas en un modelo de rata con isquemia-reperfusión (I/R) inducida en el riñón. MATERIALES Y MÉTODOS: Veinticuatro ratas macho Wistar Albino se asignaron al azar a tres grupos (n = 8): el grupo de control simulado (Grupo 1), el grupo sin tratamiento I/R renal (Grupo 2) y el grupo tratado con I/R-C (Grupo 3). Cordyceps se administró por vía intraperitoneal a 5 mg/kg dos veces. Se compararon los cambios histológicos renales y se detectaron los parámetros relevantes de estrés oxidativo e inflamación. RESULTADOS: En bioquímica sanguínea y tisular se observó que IL-1 Beta, IL 6, TNF alfa, MDA, TOS y OSI aumentaron en el Grupo 2 y disminuyeron en el Grupo 3. Se determinó que los valores de TAS aumentaron en el Grupo 3, y disminuyó en el Grupo 2. En la evaluación histopatológica, mientras que el Grupo 1 fue evaluado como normal, se detectó daño renal significativo en el Grupo 2. Se determinó que hubo una disminución significativa del daño renal en el grupo 3. CONCLUSIÓN: Estos resultados sugieren que la cordicepina en dosis bajas fue tan efectiva como la dosis normal en la reperfusión isquémica renal y la reducción del daño.

Crystallized phenol for treatment of pilonidal sinus disease in children: a comparative clinical study.

BACKGROUND: The aim of this study was to present our experience in the use of crystallized phenol (CP) to treat pediatric patients with 'simple' and complex' Pilonidal sinus disease (PSD). MATERIALS AND METHODS: Patients who underwent CP treatment in between January 2015 and January 2020 were evaluated retrospectively, using prospectively collected data. The patients were divided into simple and complicated groups. The groups were assigned depending on the number of sinuses and clinical presentation. The groups were compared in terms of age, sex, number of sessions, cost analysis, body mass index (BMI), recurrence, time resolution, cosmetic results, results /improvement, and complications. RESULTS: This study included 54 patients: 28 (52%) girls and 26 (48%) boys. The mean number of sinuses was 2.4. Symptoms included discharge in 50 (92%) patients, and pain in 42 (78%) patients. Fifty (93%) patients experienced mild pain during the procedure, whereas four (7%) patients had moderate pain. The mean number of CP sessions was 2.9; mean numbers of CP sessions were 2.2 and 4.2 in the Simple and Complicated groups. In total, 5 of 54 patients (9%) had recurrence.At the end of treatment, therapeutic success was achieved in 49 of 54 (91%) patients: 31 of 33 (94%) patients in the Simple group and 18 of 21 patients (86%) in the complicated group. The mean treatment cost for the whole cohort was $17.40. One patient (2%) presented with moderate skin burns. Cosmesis was deemed acceptable by patients, although there was evidence of minor skin burns following the procedure. CONCLUSIONS: The findings showed that the CP procedure was advantageous for treatment of PSD, because it was minimally invasive, cost-effective, provided good cosmesis, and had a high success rate and low complication rate. Furthermore, it did not require prior examination, and could be performed under local anesthesia. Therefore, the CP procedure may be useful as a first-line treatment option in children with PSD.

A different approach to leakage of esophageal atresia in children.

BACKGROUND: In this study, we aimed to present the results of patients treated for esophageal leakage with a different conservative approach. METHODS: Ninety-eight patients with esophageal atresia and tracheoesophageal fistula (EA) who underwent surgery in our clinic between February 2013 and January 2018 were retrospectively reviewed in this study. Patients' anastomosis leakage, gestational week, gender, body weight, referral date, recovery time and stenosis were recorded. After leakage detection, the nasogastric catheter was fluoroscopically converted into a nasojejunal catheter using a guidewire and feeding continued. RESULTS: Anastomotic leakage developed in 18 (18.3%) patients. The average gestational age at birth was 35.4 weeks; the patients included ten girls and eight boys of average weight 2.41 kg; the average referral period was 2.1 days after birth and the average time of surgery was 2.4 days after birth. The average recovery time was 21.1 days (range: 8-60 days). Eight patients developed stenosis that recovered with dilatation. CONCLUSION: Our findings suggest that our conservative treatment approach, which uses a nasojejunal catheter, is an effective method that would reduce complications, enable earlier feeding, and reduce the cost compared to other treatment approaches.

Operative and non-operative management of children with abdominal gunshot injuries.

BACKGROUND: Non-operative management (NOM) is a standard treatment method for solid organ injuries worldwide. There is no consensus on the management of gunshot wounds (GSW) because of the higher frequency of hollow viscus injuries (HVI) and the unpredictable depth of tissue damage produced by kinetic energy transfer during retardation of the bullet. Here we aimed to reevaluate indications for surgery and NOM based on our pediatric patients with abdominal GSW. METHODS: We performed a retrospective analysis of patients evaluated and treated for abdominal GSW at University of Dicle between January 2010 and October 2016. Patients with hemodynamic instability, signs of peritonitis on serial abdominal examination, and free air in the abdomen underwent laparotomy; these were included in group I (n=17). Patients managed non-operatively were included in group II (n=13). RESULTS: Our statistical analysis showed significantly lower Hb levels and systolic blood pressure levels (p<0.001) and higher pulse rate, higher mean injury severity score, and longer length of stay at intensive care unit in patients in group I than in those in group II (p<0.001). We further detected colon perforation (n=10) and small bowel perforation (n=7) in patients in group I; liver laceration (n=4), splenic injury (n=1), and renal injury (n=3) but no solid organ injury or HVI (n=5) were detected in patients in group II. CONCLUSION: The major drawback of NOM is the difficulty in diagnosing HVI in abdominal GSW, which may delay treatment. We suggest that patients with solid organ damage who are hemodynamically stable and exhibit no signs of peritonitis upon serial abdominal exam may be treated with NOM.

Protective Effect of Cordycepin on Experimental Testicular Ischemia/Reperfusion Injury in Rats.

OBJECTIVE: To investigate the role of cordycepin in testicular ischemia/reperfusion injury in rats. MATERIALS AND METHODS: Forty Wistar albino rats were randomly divided into four groups, as follows: group one, control (C); group two, torsion and ischemia (I); group three: detorsion with ischemia-reperfusion (IR); and group four, detorsion/cordycepin. The rats were then analyzed macromorphologically and histopathologically, and blood tests were performed. Specifically, the total oxidant status (TOS) and total antioxidant status (TAS) were determined, and malondialdehyde (MDA), tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1ß levels were analyzed. In addition, pyknotic nuclei, spermatozoa, edema, and hemorrhage were assessed. RESULTS: When the IR and cordycepin groups were compared with the other groups, there was a statistically significant decrease in TNF-α and MDA levels (p < 0.05). Increased TAS levels were observed in the cordycepin group compared with the control group. TOS levels were significantly increased in the I and IR groups, but decreased in the cordycepin group (p < 0.05). Similar effects were observed in tissue biochemistry analysis. Histopathological evaluations revealed that the spermatozoa count was decreased in the I and IR groups. However, there was an increase in the cordycepin group, as well as a statistically significant difference between the IR and cordycepin groups (p < 0.01). Finally, edema and inflammation were increased in the I and IR groups, but decreased in the cordycepin group. CONCLUSIONS: Histological and biochemical findings revealed that cordycepin protected against IR-induced testicular injury.

Cordycepin prevents postoperative formation of intra-abdominal adhesion in a rat model: An experimental study.

BACKGROUND: The aim of the present study was to investigate whether cordycepin prevented adhesion formation in a rat model. METHODS: Rats were randomly assigned to 3 groups of 10 rats. CONTROL GROUP: The absence of adhesion was confirmed via laparotomy. Adhesion group: The cecum was removed from the abdomen and scraped with a dry gauze bandage until petechial hemorrhagic foci developed. Cordycepin group: The same surgical procedure was performed as in the adhesion group, and 10 mg/kg cordycepin was administered intraperitoneally. After 15 days, the rats were sacrificed humanely via cardiac blood withdrawal under anesthesia. The rats were then analyzed morphologically and histopathologically, and hydroxyproline (OH-p) and malondialdehyde (MDA) levels were measured. RESULTS: Macroscopic analysis revealed significantly less adhesion in the cordycepin group than in the adhesion group (p<0.01). Furthermore, significant histopathological improvement was also evident in the cordycepin group compared to the adhesion group (p<0.05). The levels of OH-p and MDA in blood and tissue were higher in the adhesion group than in the control group, and lower in the cordycepin group than the adhesion group. Interestingly, MDA level was significantly lower (blood: p<0.05; tissue: p<0.01) in the cordycepin group than in the adhesion group, whereas only tissue OH-p was significantly lower in the cordycepin group compared with the adhesion group (p<0.05). One rat in both adhesion group and cordycepin group died postoperatively. CONCLUSION: Results indicated that cordycepin effectively reduced adhesion in a rat abrasion model. Thus, this agent may be valuable to prevent postoperative adhesion.

The Adrenal Gland: An Organ Neglected in Pediatric Trauma Cases.

PURPOSE: Adrenal gland injury (AGI) caused by trauma may cause bleeding and life-threatening problems in children.The objective of this study was to analyze the prevalence of AGI in final diagnoses of trauma. MATERIALS AND METHODS: The records of 458 patients with abdominal trauma (out of a total 8,200 pediatric patientswith trauma of any sort), who were referred to our clinic between January 2009 and July 2014, were reviewed retrospectively.The numbers of patients with AGI and their ages, gender, trauma patterns, affected organs, pediatrictrauma scores (PTSs), and injury severity scores (ISSs) were recorded, as well as the associated ultrasound (US)and tomographic scan data, treatments, and complications. Computed tomography (CT) scans obtained after traumawere subjected to both primary and secondary evaluation. RESULTS: In total, 28 patients with AGI were detected; their average age was 8.54 ± 4.09 (3-17) years. Twenty(71%) patients were male and 8 (29%) were female. Nineteen (68%) patients had fallen from heights; the mostcommonly injured organs were the kidneys, spleen, and lungs. Injuries were right-sided in 26 (92.9%) patients.The mean ISS was 13.2 (range 5-50) and the mean PTS 8.6 (range 0-11). Seven patients had ISS > 16 and ninehad PTS < 8. AGI was diagnosed by CT in 14 (50%) patients and in 3 (9%) by US at primary evaluation. Uponsecondary scan inspection focusing on the possibility of adrenal gland injury, such injury was ultimately detectedin 28 patients. All patients underwent conservative follow-up, and one died. CONCLUSION: We recommend calculation of the PTS, as well as other trauma scores, when pediatric patients sufferingmultiple or blunt abdominal trauma(s) present to the emergency . In addition, we believe that in children withtrauma involving the liver, spleen or kidneys, careful evaluation using a CT scan would increase the diagnosis ofAGI and reveal a realistic rate of AGI in trauma cases.

Management of gastrointestinal perforation from blunt and penetrating abdominal trauma in children: analysis of 96 patients.

AIM: The objective of the present study was to evaluate the diagnostic methods, concomitant organ injuries, factors affecting mortality and morbidity, treatment methods, and outcomes of patients treated for traumatic gastrointestinal (GI) perforation. MATERIALS AND METHODS: We conducted a retrospective review of the medical records of 96 patients who had been treated for GI perforation between January 2000 and October 2015. Data were collected and organised according to the following categories: general patient information, age, gender, hospitalisation period, trauma mechanisms, concomitant injuries, radiological assessment, diagnosis and treatment methods, treatment forms, and complications. The cases were divided into two groups, blunt and penetrating traumas, and the patients within each group were compared. Colorectal trauma cases were not included in this study. Patients suspected of a GI perforation were assessed by standing plain abdominal radiograph (SPAR) and ultrasound scan (US). Patients who had a normal SPAR, and showed free or viscous fluid in the abdomen on US underwent computed tomography (CT) scanning. Surgery was performed if patients displayed free air in the abdomen on a SPAR or CT scan, showed viscous fluid without any additional injury, provided normal radiological images but displayed signs of peritonitis, or were clinically unstable. The patients were scored according to the Injury Severity Score (ISS) system. RESULTS: In total, 96 patients, with an average age of 10.3 ± 4 years (1-17 years) and diagnosed with a GI perforation, were reviewed retrospectively. The patients included 88 (91 %) males and 8 (9 %) females. The presence of free air on SPAR was detected in 42 (52 %) patients, whereas no free air was detected in 39 (48 %) patients. Non-specific significant findings were detected in 45 (76 %) out of 59 patients by USS, and in 78 % of patients by CT (viscous fluid, fluid, free air). The most affected organ was the ileum, which was detected in 37 (39 %) patients. Primary repair was performed on 71 (74 %) patients, while resection was performed on 22 (23 %); 3 (3 %) patients underwent an ostomy. Ten (10 %) patients experienced complications and five (5 %) patients died. The ISS scores for blunt and penetrating traumas were 14, 15 and no significant difference was detected between the scores (p > 0.05). CONCLUSIONS: Although the complication rate for patients with penetrating trauma was higher than for those with blunt trauma, the rate of mortality increased in patients with blunt trauma. Free air may not be detected by SPAR even if a GI perforation exists. Since diagnostic challenges may increase the rate of mortality and morbidity in GI perforations, we believe that a combination of radiological imaging and rapid abdominal examination is important in cases where SPAR cannot detect free air.

Effects of Ecballium Elaterium on Proinflammatory Cytokines in a Rat Model of Sepsis.

OBJECTIVE: Ecballium elaterium (EE) is a plant from Cucurbitaceae family. Its anti-inflammatory role in sepsis is not well understood. We investigated the effects of EE on serum levels of proinflammatory cytokines and further explored the mechanisms underlying histological changes in liver and ileum following EE administration in a polymicrobial sepsis model. METHODS: Thirty rats were divided into three groups of 10 rats each. Rats were subjected to sham laparotomy plus normal saline administration (control group, CG), laparotomy with cecal ligation and puncture (CLP) (sepsis group, SG), and laparotomy with CLP plus 2.5 mg/kg EE administration (experimental group, EG). Twenty-four hours after laparotomy, animals underwent cardiac puncture, and blood was collected for interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) assessment. Whole sections of liver and ileum tissues were collected for histologic examination. RESULTS: The serum level of IL-6 was significantly lower in EG as compared to SG. Although IL-6 levels were shown a statistically significant (p < 0.0001) decline to near control values, no significant changes were observed in serum levels of IL-1 and TNF-α after EE treatment. Histologic examination revealed statistically significant reduction in collagen formation (p = 0.001) on serosal surface of ileum and hepatic venous congestion (p = 0.040) in EG as compared to SG. CONCLUSION: EE might play a protective role in sepsis prevention and treatment by decreasing IL-6 production and reducing liver damage and may influence bacterial translocation by reinforcing intestinal barrier function.

The Outcome of Percutaneous Nephrolithotomy Using Intravenous Catheter for Obtaining Percutaneous Access as a Treatment for Renal Stone Disease in Children: A Pilot Study.

PURPOSE: Using percutaneous nephrolithotomy (PNL), it is easy to reach stones in various parts of the kidney via a single access tract. In the current study, we set out to demonstrate that the intravenous catheter is a safe way to gain renal access, and that PNL is safe in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who underwent PNL as a treatment for renal stone disease at our center between September 2013 and December 2014. There were no specific exclusion criteria. We used 14 gauge intravenous catheter for renal access in all cases. RESULTS: Eleven of the 32 patients (34.4%) were female and 21 (65.6%) were male. The mean ± SD patient age was 4.7 ± 3.71 years (9 months-16 years). Six patients (18.7%) were infants less than 1 year of age. Fifteen of the stones (46.8%) were located in the right kidney, and 17 of the stones (53.1%) were located in the left kidney. The average stone size was 13.9 ± 4.8 mm (range, 12-28). The average duration of operation was 69.7 ± 10.4 minutes (range, 50-110), and the average duration of fluoroscopy was 2.21 ± 1.06 minutes (range, 1-6). There were complications in 5 of the cases (15.6%). CONCLUSION: The access and dilatation stages are quite important. We propose that the intravenous catheter is a safe and inexpensive tool for renal access in PNL in pediatric age group patients.