Management and treatment of liver injury in children.

BACKGROUND: We aimed to assess the causes of trauma that result in liver injury and additional solid organ injuries, management types and results of management in children referred to our clinic for liver injuries. METHODS: The records of 52 patients who were managed for liver injuries due to blunt abdominal trauma between January 2005-2010 were reviewed retrospectively. RESULTS: The patients were 1-17 (8.3±5.4) years old; 32 (62%) were male and 20 (38%) were female. Causes of injuries included pedestrian traffic accidents (19, 37%), falls from height (15, 29%), passenger traffic accidents (8, 15%), bicycle accidents (8, 15%), and objects falling on the body (2, 4%). Isolated liver injury was present in 32 patients (62%), while 20 patients (38%) had other organ injuries. Liver injuries were grade I in 6 patients (12%), grade II in 14 (28%), grade III in 22 (43%), grade IV in 9 (17%), and grade V in 1 (2%). Forty-five patients (87%) were managed conservatively in this series of liver injury, whereas seven patients (13%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were significantly lower in surgically managed patients. CONCLUSION: As a result, conservative management should be preferred in patients with liver injuries who are hemodynamically stable. Conservative management has some advantages, including shorter duration of stay in hospital, less need for blood transfusion and lower morbidity and mortality rates.

Effectiveness of lycopene on experimental testicular torsion.

AIM: We aimed to demonstrate the long term effectiveness of lycopene, a precursor of vitamin A, on the testes for ischemia-reperfusion injury. MATERIALS AND METHODS: Seventy male Wistar albino rats were used for this experiment. The rats were divided into seven groups. Group 1 served as the control group; group 2 was sham-operated; group 3 received 20mg/kg/day lycopene (intraperitoneally); in group 4, the right testes of rats were kept torted for 2hours and then were detorted and the animals lived for three days; in group 5, the right testes of rats were kept torted for 2hours and then were detorted and the animals lived for ten days; in group 6, the right testes of the rats were kept torted for 2hours and then detorted and the animals received 20mg/kg/day lycopene (intraperitoneally) for three days; in group 7, the right testes of the rats were kept torted for 2hours and then were detorted and the animals received 20mg/kg/day lycopene (intraperitoneally) for ten days. Lycopene was used intraperitoneally. Some of the testes tissues were used for biochemical analyses and the other tissues were used for histological procedures. The Johnsen's score was used for seminiferous tubule deterioration. The TUNEL method was utilized to show apoptosis of testicular tissue. Testosterone levels were measured from blood samples and SOD, MDA, TNF-α, IL-1ß and IL-6 measurements were recorded from tissue samples. The results were analyzed statistically. RESULTS: In groups 1, 2 and 3 there was normal testicular structure. Rats in groups 4 and 5 had damaged testicular tissues. In groups 6 and 7, in which we used lycopene, the testes were not better than those in groups 4 and 5. The MSTD and JTBS values were better in group 6, but not in group 7 among the torsion groups. As a result, MDA, SOD, TNF-α and IL-1ß were increased and serum testosterone and IL-6 levels were decreased in groups 4 and 5 compared to group 1. There was no improvement in the groups treated with lycopene for therapeutic purposes. CONCLUSION: It was shown that lycopene, as an antioxidant agent, is not effective for testicular torsion in the long term. This study can be considered as a preliminary study showing the need for further researches using different antioxidant agents to determine their long term effects in ischemia-reperfusion injuries in an appropriate experimental design.

Diffusion weighted imaging in differentiating malignant and benign neuroblastic tumors.

PURPOSE: Our aim was to assess diffusion weighted imaging (DWI) of neuroblastic tumors and whether apparent diffusion coefficient (ADC) value may have a role in discrimination among neuroblastoma, ganglioneuroblastoma and ganglioneuroma. MATERIAL AND METHODS: The DWIs (b = 0-800 s/mm(2)) of 24 children (13 girls, 11 boys) who were diagnosed neuroblastic tumors on histopathological examination (neuroblastoma = 15, ganglioneuroblastoma = 5, ganglioneuroma = 4) were evaluated retrospectively. The ADC maps were performed by drawing freehand ROI on PACS (Sectra Workstation IDS7, Linköping, Sweden). RESULTS: We observed a significant decrease in ADC value of neuroblastomas 0.869 ± 0.179 × 10(-3) mm(2)/s compared to ganglioneuroblastomas 0.97 ± 0.203 × 10(-3) mm(2)/s and ganglioneuromas 1.147 ± 0.299 × 10(-3) mm(2)/s (p = 0.026). There was no significant difference in between ganglioneuroblastoma and ganglioneuroma (p = 0.16). In detecting neuroblastomas; the sensitivity, specificity, negative and positive predictive values of ADC were 74, 67, 78.6, 66 % respectively with a cut-off value of 0.93 × 10(-3) mm(2)/s. CONCLUSION: Our study stands out as the most comprehensive study with larger sample size on this topic. Moreover, we are able to suggest a cut-off value which can discriminate neuroblastoma from ganglioneuroblastoma and ganglioneuroma. We believe that ADC will evolve to an objective, quantitative measurement in discrimination among malignant and benign neuroblastic tumors.

Management of renal injury in children.

PURPOSE: To evaluate types of trauma, other organ injuries and types and results of management in children who were admitted to our clinic because of renal trauma in the last 5 years. METHODS: Thirty one patients who were treated in our clinic for renal injury occurring after blunt abdominal trauma between January 2005-2010 were assessed retrospectively. RESULTS: The patients were aged between 1-16 (mean 8.2) years old. Twenty (64.5%) patients were boys and 11 (35.5%) were girls. The most common causes of injury were falls from height (13 patients, 41.9%). Sixteen patients (52%) had only renal injury and the others (48%) had other organ injuries. Two patients with grade III injury (20%), three patients with grade IV injury (27%) and one patient with grade V injury (100%) were operated on, although all of the patients with grade I and II injuries were managed conservatively. Twenty five patients (81%) were managed conservatively and six patients (19%) whose vital signs were not stable were operated on. CONCLUSION: Conservative management should be preferred in patients with renal injuries who are stable hemodynamically. Most renal traumas in children can be treated conservatively. Conservative management has some advantages like shorter hospitalization time, less need for blood transfusion and less morbidity and mortality than surgical management.

Management and treatment of splenic trauma in children.

AIM: To assess types of splenic traumas, accompanying injuries, their management and results. METHODS: We studied the reports of 90 patients (64 boys, 26 girls) who were treated for splenic injuries as a result of blunt abdominal trauma between 2005-2012. Age, sex, hospitalization time, mechanisms of traumas, accompanying injuries and management methods were recorded. RESULTS: Causes of trauma were falls from height (46 patients, 51%), pedestrian traffic accidents (17 patients, 19%), passenger traffic accidents (11 patients, 12%), bicycle accidents (10 patients, 11%) and falling objects from height (6 patients, 6.6%). Splenic injury alone was observed in 57 patients (63.3%) and other organ injuries together with splenic injury in 33 patients (36.7%). Splenectomy was performed in six patients (6.6%) due to hemodynamic instability and small intestine repair due to small intestine injury in one patient (1.1%). None of these patients died from their injuries. CONCLUSION: A large proportion of splenic injuries recover with conservative therapy. Some of the advantages of conservative therapy include short hospitalization time, less need for blood transfusion, and less morbidity and mortality. Falls from height and traffic accidents are important factors in etiology. The possibility of other organ injuries together with splenic injuries should be considered.

The effectiveness of pneumoreduction for intussusception.

INTRODUCTION: To detect the effectiveness of pneumoreduction (PR) in intussusception, which is one the most common reasons of abdominal pain in infancy and childhood. METHODS: The records of patients treated in our clinic for intussusception between January 2005 and June 2012 were reviewed retrospectively. There were 150 patients aged between 2 months - 12 years of age; 48% (72) were girls, 52% (78) were boys. RESULTS: The most common complaint and clinical findings were abdominal pain (94,6%), vomiting (82.6%), rectal bleeding (81.3%), and discomfort (70.9%). An abdominal mass was observed in 73.3% of patients. PR was successfully performed in 86% of patients. It was carried out once in 86% of these patients and twice in 8.1%. PR was unsuccessful in six patients and they underwent surgery. Manual reduction (31 or 67.4% of operated patients) and resection - anastomosis (15 or 32.6 % of patients) were performed by surgery. Perforation occured in two patients (1.3%) during manual reduction. CONCLUSION: PR is an effective method in the treatment of intussusception with a high success ratio and a low complication ratio. It was possible to perform the procedure especially in patients who came in the early stage of the condition.