Use of autologous platelet rich fibrin in urethracutaneous fistula repair: preliminary report.

Urethrocutaneous fistula (UCF) is one of the most common complications occurring after hypospadias repair. Despite the surgical advancement in hypospadias, multiple failed fistula closures are commonly referred to paediatric urologists. Although several techniques have been described to interpose a waterproof layer between urethral and skin closures, occurrence of urethrocutaneous fistula cannot be eliminated completely. In addition to several local tissue grafts, autologous and homologous fibrin sealants are used to prevent UCF. Platelet rich fibrin (PRF) is known as an autologous source of growth factors obtained from the sera of the patient. PRF supports collagen synthesis and tissue repair and accelerates wound healing. We aimed to present our initial experience about the use of autologous PRF in a 3-year-old boy with a UCF after hypospadias repair.

Plastic bronchitis during childhood: Diversity of presentation, etiology, treatment, and outcomes.

OBJECTIVE: Plastic bronchitis (PB) is a rare disease in children, and reliable data are scarce. Here, we aimed to analyze the clinical features, management, and outcomes in children with PB. METHODS: The medical data of patients who were followed up with a diagnosis of PB between January 2010 and March 2022 were retrospectively analyzed. RESULTS: The median age of 15 patients was 9 (interquartile range: 4-10) years with a male/female ratio of 12/3. Initial symptoms included recurrent pneumonia (33.3%), persistent atelectasis (33.3%), cast expectoration (26.6%), and intense, persistent cough (6.6%). The most common underlying diagnosis was asthma (n = 12, 80%), and six of the patients were newly diagnosed. The most common radiological findings were atelectasis as a consequence of major airway obstruction on chest X-ray or computed tomography. Five patients, all diagnosed as having asthma, had recurrent PB and required multiple airway procedures for treatment and diagnosis. During a median 7-year follow-up of five patients, occasionally cast expectoration was observed in one patient with asthma who had poor compliance with inhaled corticosteroids. CONCLUSION: PB is a common reflection of the different underlying etiologies in the pediatric age group, and treatment and outcomes are closely related to these. It should be kept in mind that asthma can be a predisposing factor for the development of PB.

Oral Health Status among Children with Repaired Esophageal Atresia.

INTRODUCTION: Esophageal atresia (EA) is a congenital anomaly, presenting multifactorial etiology. Swallowing problems and gastroesophageal reflux disease may accompany EA, which have adverse effects on oral health. MATERIALS AND METHODS: In this descriptive study, intraoral examination of the children with repaired EA and of the dental patients without systemic/chronic disease was performed. Dental caries, dental erosion, and halitosis status were evaluated using the International Caries Detection and Evaluation System II, and the Basic Erosive Wear Examination indices as well as the Halimeter, respectively. RESULTS: There were 19 (n = 12 male; n = 7 female) case subjects and 16 (n = 10 male; n = 6 female) control subjects whose age ranged between 14 and 72 months. Among cases, 15 children had dental caries (78.9%; initial caries n = 4, moderate caries n = 4, and extensive caries n = 7). Of the controls, 13 had dental caries (81.2%; initial caries n = 5, moderate caries n = 5, and extensive caries n = 3). Although the median scores of decayed, missing, filled teeth (dmft) and decayed, missing, filled surfaces (dmfs)-for primary dentition-were not statistically significantly different between two groups, both dmft and dmfs were found to be higher among the case subjects (p = 0.172 for dmft; p = 0.230 for dmfs). Furthermore, six children with repaired EA had dental abnormalities (in shape, number, or calcification) and six children with repaired EA had dental erosion. The Halimeter measurement was performed for five case children of whom three had oral malodor, and for seven control children of whom two had oral malodor. CONCLUSION: Regular dental counseling adopting the multidisciplinary team approach for patients with EA is necessary to ensure better general and oral health.

The effect of whole gut irrigation on contractile responses of guinea pig gallbladder, ileum, and tissue cholecystokinin levels.

AIM: An experimental study was performed to evaluate the effect of whole gut irrigation (WGI) solutions on contractile responses of the gallbladder and ileum and also on tissue cholecystokinin (CCK) levels. MATERIALS AND METHODS: Thirty guinea pigs were enrolled into five groups including control group (CG) and WGI group (saline physiologic [SP], Ringer lactated [RL], polyethylene glycol [PEG], and dibasic sodium phosphate [DNP]). After median laparotomy, the distal esophagus was ligated and SP, PEG, RL, and DNP infusions (2 mL/kg/min) were performed via gastric catheter until rectal discharge became clear in WGI groups. Ileum and gallbladder samples were obtained for in vitro and biochemical studies without irrigation in CG and after irrigation with different WGI solutions. Isolated ileum and gallbladder preparations were suspended in organ baths for contractile responses of carbachol and CCK. Also, biochemical analysis of tissue CCK levels was performed in ileum and gallbladder samples. RESULTS: In PEG group, gallbladder and ileum CCK levels were significantly higher than CG (p < 0.05). Also, DNP irrigation caused increased CCK levels in gallbladder samples (p < 0.05). In lower carbachol concentrations, PEG group showed increased contraction responses in gallbladder samples when compared with controls (p < 0.05). However, ileal responses to carbachol did not show any significant difference between groups, contraction responses to CCK was decreased in PEG group when compared with CG (p < 0.05). CONCLUSION: Among WGI solutions, PEG caused the highest CCK levels in gallbladder and ileum samples. Different WGI solutions affected the contractile responses of gallbladder and ileum smooth muscles divergently. Increased levels of CCK in PEG group support the decreased contractile responses in ileum. Therefore, our results confirm that the effect of WGI on gallbladder and ileum contractility may be CCK related.

Effect of whole gut irrigation solutions on gastrointestinal smooth muscle activity.

BACKGROUND/PURPOSE: It has been suggested that whole gut irrigation (WGI), which is a preparation method for large bowel surgery or colonoscopy, increases gastrointestinal motility by creating a gastrocolic reflex. An experimental study was performed to evaluate the effect of different WGI solutions on gastrointestinal smooth muscle activity. MATERIALS AND METHODS: Thirty Wistar albino rats weighing 200 to 250 g were enrolled in the study. After anesthetization with thiopental sodium (50 mg/kg), proximal ileum, terminal ileum, and colon segments were removed via median laparotomy to obtain a control group. Four different groups (n = 6) were designated as having WGI with saline solution (SS), lactated Ringer's solution (RL), polyethylene glycol (PEG), and dibasic sodium phosphate (DNP). Bowel cleaning was performed by infusing solutions at a rate of 2 mL/min via gastric tube, until the stool was cleared. After completing the bowel cleaning, 2 cm of tissues were removed and suspended in Tyrode solution in an isolated organ bath with a resting tension of 1 g, to obtain carbachol and potassium chloride (KCl) responses. RESULTS: The mean bowel cleaning times were 87.5 +/- 9.35, 81.6 +/- 9.83, 86.6 +/- 11.6, and 85.0 +/- 0.0 minutes in SS, RL, PEG, and DNP groups, respectively. The total amounts of solutions needed for cleaning were 156.67 +/- 21.6, 195.0 +/- 20.0, 197.5 +/- 32.8, and 70.0 +/- 0.0 mL, respectively. Although there was no difference in cleaning time between the groups, the amount of solution required was significantly less in the DNP group (P = .02). In the proximal ileum segments, though there was no difference in carbachol responses between groups, KCl responses were significantly increased in the RL group (P < .05). When we evaluated the terminal ileum responses, carbachol responses were significantly increased in RL and PEG groups (P = .011) and decreased in the DNP group (P = .049). The KCl responses were also significantly increased in the RL group with respect to the other groups (P < .05). Colon segments showed no difference in contractile responses with respect to different WGI solutions (P > .05, analysis of variance, post hoc Dunn's test). CONCLUSION: The different WGI solutions demonstrated no significant differences in colon contractions. The increased contractile responses in the proximal and terminal ileum segments after WGI with RL may be related to the electrolyte composition of RL. Although the lower amount of DNP solution required to achieve bowel cleaning seems to be an advantage, the decreased ileal contractions can be assessed as a disadvantage of DNP irrigations.