Lower urinary tract effects of ureteral stent length and intravesical position.

PURPOSE: Ureteral stents can cause lower urinary tract problems such as stent-related irritative symptoms and urinary tract infections. This study aimed to determine the lower urinary tract effects of ureteral stent length and intravesical position in children. METHODS: Patients who underwent double-J stenting after urological procedures between January 2017 and January 2022 were included in the study. The patients were assessed in terms of age, irritative symptoms, urinary tract infections, and stent length. The intravesical position of the ureteral stents was grouped as cross-trigonal and ipsilateral. The distribution of irritative symptoms, frequency of urinary tract infections and stent length were analyzed according to intravesical location. RESULTS: A total of 47 patients were included in the study. The median age was 5 years (range: 1-16). Cross-trigonal stent position was significantly associated with symptoms of urgency (p = 0.046), suprapubic pain (p = 0.002), and lower mean age (p = 0.004). Urinary tract infections were more frequent in patients whose placed stents were longer than recommended (p < 0.001) or were in cross-trigonal position (p = 0.043). CONCLUSION: Our results suggest that stent-related irritative symptoms and urinary tract infections can be reduced in pediatric patients using a suitably sized ureteral stent and considering its intravesical position.

pH and specific gravity of corrosive agents as indicators in caustic injuries.

BACKGROUND: Video endoscopy, which remains the diagnostic gold standard after ingestion of a corrosive substance, is performed under general anesthesia in children, requires advanced technology, and is costly. Simple and accessible methods are therefore needed to determine the need for endoscopy. The aim of this study was to evaluate the role of the pH and specific gravity of ingested substance in determining endoscopy indications after corrosive ingestion. METHODS: This prospective study included pediatric patients who presented after ingesting a corrosive substance from June 2018 to June 2019. Relationships between the extent of damage detected by endoscopy and the patient's age, physical examination findings, and the pH and specific gravity of the causative substance were evaluated. RESULTS: The degree of damage detected on endoscopy was significantly milder for corrosive substances with a pH between 2 and 12 (P = 0.003). In addition, pH values between 2 and 12 were significantly more common among patients without physical examination findings (P = 0.029). Specific gravity less than 1,005 was associated with mild injury detected by video-endoscopy (P = 0.011). Patients in whom severe injury was detected by endoscopy had marked findings on physical examination (P < 0.001). There was no significant relationship between physical examination findings and the specific gravity of the substance involved (P = 0.087). CONCLUSIONS: The results of this study suggest that conservative treatment options can be used without performing endoscopy in patients who have no physical examination finding after corrosive ingestion and where the pH of the substances is between 2 and 12 and the specific gravity of the substances is less than 1,005.

Assessment of clitoral anatomy in human fetuses.

PURPOSE: To determine fetal clitoral dimensions in antenatal period and to provide a contribution to external genital morphology determination in premature infants. METHODS: Thirty-one formalin fixed female fetuses aged between 18 and 40 weeks (17 fetuses aged 21.53 ± 1.88 weeks in the second trimester and 14 fetuses aged 31.00 ± 4.90 weeks in the third trimester) were evaluated. 20 (64.5%) fetuses were between 3 and 97% percentile range and within normal limits. Clitoris appearance (completely covered by labium majus/partially showing/prominent), length and width of clitoris, labium minus length, length, and width of labium majus were assessed. RESULTS: Clitoris length during the second trimester was 4.84 ± 1.09 mm, whereas it was 5.43 ± 1.07 in the third trimester. Clitoris width was as 3.35 ± 0.88 mm in the second trimester and as 4.55 ± 0.96 mm in the third trimester. A statistically significant increase was seen in width of clitoris, length, and width of labium majus and length of labium minus with gestational age in the second and third trimesters (p < 0.05). No significant difference was found between the second and third trimesters in terms of clitoris length (p = 0.146). A homogenous spread in clitoris appearance was obtained between the second and third trimesters without any significant difference (p = 0.912). In addition, fetus percentiles showed a homogenous spread without any significant differences between completely covered, partially covered and prominent groups (p = 0.452). CONCLUSION: The anatomical data can be beneficial to the development of fetal radiological screening procedures in females and also in morphological assessment criteria in premature infants, effectively assisting in diagnosing anomalies during the early term.

Analyzing the effect of laparoscopy duration time on peroperative gastroesophageal reflux

Background/aim: Intraabdominal pressure (IAP) is one of the main reasons for gastroesophageal reflux (GER). This study investigates whether IAP during laparoscopic surgery leads to GER in a time-dependent manner. Materials and methods: In a laparoscopy model, 15 mmHg IAP was created in 8 Wistar albino rats in the Trendelenburg position (TP). A 5 mm laparotomy was performed in the left lower abdominal region, and a 6 Fr catheter was placed intraabdominally. Air was insufflated into the abdominal cavity, and the pressure was kept constant at 15 mmHg. Esophageal pH alterations were measured by pH sticks for 4 h every 30 min. Results: The basal median esophageal pH value was 9 (8­10), the value after placing the catheter was 9 (7­10) (P = 0.47), and the median pH value after placing the subjects in TP was 9 (8­10) (P = 0.70). In our experimental model, esophageal pH values were found to decrease significantly at the 150th minute in TP and at 15 mmHg IAP (P < 0.05). Two rats died: one at the 120th minute and the other at the 240th minute (P > 0.05) Conclusion: Esophageal pH values decreased and continued to remain low following IAP increase and TP in this experimental rat model. Prolonged laparoscopic procedures can particularly lead to GER that requires instant recognition and rapid and appropriate intervention.

Effectiveness of endoscopic balloon dilatation in grade 2a and 2b esophageal burns in children.

PURPOSE: To evaluate the predictability of the initial endoscopic evaluation of the effectiveness of endoscopic balloon dilatation (EBD) in childhood esophageal strictures caused by corrosive ingestion. MATERIAL AND METHODS: Medical records of 635 endoscopies caused by corrosive ingestion between January 2000 and December 2015 in children between the ages of 0 and 18 years were retrospectively analyzed. Among them, five children with grade 2a and 15 with grade 2 b who developed esophageal strictures were evaluated for the effectiveness of endoscopic balloon dilatation. RESULTS: The stricture rate was 5/136 (3.6%) in grade 2a and 17/25 (68%) in grade 2 b esophageal burns. Strictures with grade 2a burn had seven (1-10) EBD sessions, and grade 2 b had 8.8 (1-30) EBD sessions. For grade 2a burns, the treatment period was 15 months and 18.8 months for grade 2 b burns. Three patients with grade 2 b and two patients with grade 2a are still on the EBD program. CONCLUSION: Initial endoscopy for caustic ingestion and esophageal injury grading may help to provide healthcare givers with information about future stricture formation and management.

Diagnostic value of red blood cell distribution width in pediatric acute appendicitis.

BACKGROUND: The aim of this study was to evaluate the diagnostic value of red blood cell distribution width (RDW) in children with acute appendicitis. METHODS: In this retrospective study, a total of 344 children aged ≤18 years with clinically suspected acute appendicitis who underwent appendectomy between January 2007 and January 2014 were reviewed, and 200 healthy controls of the same age group were included. Based on histopathology, the patients were classified as having normal appendix, simple or perforated appendicitis, and preoperative white blood cell count (WBC), C-reactive protein (CRP) and RDW were compared. RESULTS: Compared with the controls, mean WBC, CRP and RDW were significantly higher in the appendectomy group (P <0.001). The children with simple or perforated appendicitis had significantly higher WBC, CRP and RDW than did those with normal appendix (P <0.001). Mean WBC and CRP were significantly higher in the children with perforated appendicitis (P <0.001), but no statistically significant difference was found in RDW between the simple and perforated appendicitis groups (P = 0.081). CONCLUSIONS: Children with histologically proven acute appendicitis have higher RDW than children without appendicitis, but the diagnostic value of RDW was not superior to WBC or CRP in children with acute appendicitis. Although higher RDW may be valuable for aiding the diagnosis of acute appendicitis in children, it is not a useful marker for predicting perforated appendicitis.

The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer) in the treatment of primary vesico-ureteral reflux.

PURPOSE: Subureteral injection of bulking agents in the endoscopic treatment of vesicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this success, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR) with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA) and Polyacrylate polyalcohol copolymer (PPC). MATERIALS AND METHODS: A total 80 patients (49 girls and 31 boys) aged 1-12 years (mean age 5.3 years) underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/HA (45 patients and 57 ureters) and PPC (35 patients and 45 ureters). VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters. RESULTS: VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters). Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients. CONCLUSIONS: Our short term data show that two different bulking agent injections provide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material.

Congenital laryngomucocele: a rare cause of airway obstruction in a newborn.

Congenital laryngoceles are defined as cystic dilatation of laryngeal saccules and are an extremely rare cause of newborn respiratory distress. A laryngomucocele occurs when the neck of the laryngocele gets obstructed and fills with the mucoid secretions of the saccule. It may cause stridor, respiratory distress, and severe airway obstruction in the narrow airway of a newborn and necessitates urgent surgical intervention. There is only 1 case of congenital laryngomucocele reported in an autopsy examination in the English literature, and here we report the first living congenital laryngomucocele case and discuss the clinical approach.

Pyocalycosis: a report of two cases of complicated hydrocalycosis.

Hydrocalycosis is defined as cystic dilatation of a major calyx with a demonstrable connection to the renal pelvis and an epithelial lining of the cyst wall. Although this condition has long been known, there are no sufficient data concerning this pathology in the literature. In this study, we present two complicated hydrocalycosis--'pyocalycosis'--and discussed the therapeutic approaches.

Challenging diagnosis between intussusception and necrotizing enterocolitis in premature infants.

Although necrotizing enterocolitis (NEC) is a frequently encountered entity in premature infants in the neonatal intensive care unit, intussusception is extremely rare. Abdominal distension, bilious/non-bilious gastric residuals and bloody stool are the common clinical findings of both entities. Here we present three cases of intussusception misdiagnosed as NEC, two of which were complicated with intestinal perforation. Similar clinical findings of NEC and intussusception leads to misdiagnosis and delay in treatment, particularly in premature infants with intussusception.

Primary lymph node gastrinoma: a rare cause of abdominal pain in childhood.

Gastrinoma is a hormone-secreting tumor associated with the Zollinger-Ellison syndrome. It is quite rare among children. The discovery of gastrinomas in unusual locations such as lymph nodes, bones, ovaries, and the liver poses a diagnostic dilemma as to whether the tumor is primary or metastatic. Here, we present a case of a primary gastrinoma within a lymph node.

Anogenital distance and anal position index in cadaveric human fetuses.

The aim of this study is to contribute to the determination of the normal values of human anogenital distance (AGD) and anal position index (API) in the antenatal period. 59 formalin-fixed human fetuses were examined. AGD was measured by the distance between the center of the anus and the posterior fourchette in females, and the distance between the center of the anus and the posterior scrotal raphe in males. API in female fetuses was determined with the formula API = fourchette-center of anus/fourchette-coccyx formula, and API = posterior scrotal raphe-center of anus/posterior scrotal raphe-coccyx in males. The mean AGDs of the female and male fetuses in the second trimester were 5.60 ± 1.60 mm and 9.64 ± 2.75 mm and 12.88 ± 4.14 mm and 17.26 ± 5.55 mm in the third trimester, respectively. The AGD values were found to be significantly higher in the males (p = 0.002). While the API values detected in the female and male fetuses were 0.43 ± 0.085 and 0.55 ± 0.072 in the second trimester, they were 0.46 ± 0.079 and 0.55 ± 0.058 in the third trimester. The API values were found to be significantly higher in the male fetuses (p < 0.001). When the distribution of API values of the fetuses in the second and third trimesters was examined, no significant difference was found (p = 0.499). In addition, no significant correlation was found between API and AGD values and percentile groups of fetuses (p Ëƒ 0.05). The AGD and API differed significantly between female and male fetuses starting from the antenatal second trimester, and the difference was preserved independently of the fetal percentile in the later stages of pregnancy.

Evaluation of gastroesophageal reflux in pediatric laparoscopic appendectomy procedures.

BACKGROUND: The increased intra-abdominal pressure during laparoscopic surgical procedures was reported to be a factor in the development of gastroesophageal reflux. This study evaluated the presence of gastroesophageal reflux and associated factors using 24-h pH monitoring in children undergoing laparoscopic appendectomy. METHODS: Children who underwent laparoscopic surgery for presumed acute appendicitis between June 2017 and June 2018 were included in the study. After pre-operative endotracheal intubation, pH catheters were placed for 24-h esophageal pH monitoring. Relationships between gastroesophageal reflux and procedure time, pre-operative fasting time, age, weight, and body mass index (BMI) were evaluated. RESULTS: A total of 60 pediatric patients were included in the study. Their mean (SD) age was 11.82 (3.71) years (range, 4-17 years). The mean (SD) body weight was 41.27 (16.72) kg (range, 15-90 kg) and the mean (SD) BMI were 17.96 (4.37). The mean pre-operative fasting time was 15.52 (12.1) h, while the mean operative time was 38.42 (17.96) min. Lower age and weight were significantly associated with the presence of post-operative gastroesophageal reflux (p<0.05). Mean procedure time, mean pre-operative fasting time, and BMI were not significantly associated with intra- or post-operative gastroesophageal reflux (p>0.05). CONCLUSION: The lack of a significant relationship between mean procedure time and gastroesophageal reflux suggests that the mean duration of the laparoscopic procedures performed in this study is safe in terms of gastroesophageal reflux. The results also indicate that young age and low weight should be considered risk factors for gastroesophageal reflux in pediatric patients undergoing laparoscopic appendectomy.

Can serum Neutrophil Gelatinase Associated Lipocalin and Kidney Injury Molecule-1 help in decision making for surgery in antenatally dedected hydronephrosis.

INTRODUCTION: Congenital obstructive uropathies are among leading reasons for renal failure in children. Answers to questions such as what the critical threshold of obstruction is or which degree of obstruction disrupts the development of the kidney still remain unclear. Several biomarkers such as Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Associated Lipocalin (NGAL) may help clinicians in the clinical evaluation and appropriate planning of the disease. OBJECTIVE: This study aimed to investigate whether serum and urinary KIM-1 and NGAL levels contribute to conventional methods in decision-making for surgery in the postnatal period of infants with antenatal hydronephrosis. STUDY DESIGN: 34 patients with the diagnosis of antenatal hydronephrosis were evaluated prospectively. Renal pelvis diameters of all patients were above 10 mm in the ultrasonography (USG). Patients underwent diuretic renal scintigraphy after neonatal period. Patients were divided into two groups as surgery or follow-up based on USG and scintigraphy findings. Blood and urine samples were collected at first visits in both groups and again at the 3. Postoperative month in the surgery group. Serum and urinary NGAL and KIM-1 levels were measured by ELISA method. Study data were compared through the Mann-Whitney U and Wilcoxon Signed-Ranks test. RESULTS: There were 10 patients in the surgery group and 24 patients in the follow-up group. The age and gender did not differ between the groups. The surgery group had significantly higher median serum NGAL values (259.2 ng/mL) than that in the follow-up group (46.8 ng/mL, p = 0.028). The postoperative reduction of the median serum NGAL to 68.1 ng/mL compared to preoperative level was also found to be significant (p = 0.037) in the surgery group. Between the groups and within the surgery group no statistically significant difference was detected in terms of median urinary NGAL, and serum and urine KIM-1 levels. DISCUSSION: USG and renal scintigraphy are frequently used in determining whether patients with antenatal hydronephrosis need surgical intervention in the postnatal period. Several new biomarkers might help clinicians in decision making for surgery. KIM-1 and NGAL levels can be measured both in urine and serum. To our knowledge, this is the only study where serum NGAL and KIM-1 levels were measured in patients with antenatal diagnosis. Small sample size, lack of long term findings and control group are limitations of our study. CONCLUSION: Serum NGAL levels of patients with antenatal hydronephrosis may help in decision making on the surgical intervention.

The role of trapidil on neuronal apoptosis in neonatal rat model of hypoxic ischemic brain injury.

BACKGROUND: Hypoxic ischemic brain injury (HIBI) is a common cause of neonatal mortality and morbidity. Trapidil is an antiplatelet agent and several studies demonstrate the beneficial effect of trapidil in various forms of tissue injury. The effects of trapidil on neuronal apoptosis in HIBI have not been reported previously. AIMS: The aim of this study is to evaluate the effect of trapidil on neuronal apoptosis in neonatal rat model of HIBI. STUDY DESIGN: Seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia (92% nitrogen and 8% oxygen) for 2h. They were treated with trapidil or saline either immediately before or after hypoxia. In sham group animals, neither ligation, nor hypoxia were performed. Neuronal apoptosis was evaluated by the terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL) and caspase-3 staining methods. RESULTS: Trapidil treatment either before or after hypoxia results in significant reduction of the numbers of apoptotic cells in both hemispheres, when it is compared with saline treatment group. The numbers of apoptotic cells in right hemispheres in all groups are significantly higher than that in the left hemispheres. CONCLUSIONS: These results show that trapidil administration either before or after hypoxia reduces neuronal apoptosis and we propose that trapidil may be a novel approach for the therapy of HIBI.

The impact of surgical intervention on renal function in cystinuria.

INTRODUCTION: Cystinuria is an autosomal recessive disorder due to intestinal and renal transport defects in cystine and dibasic amino acids, which result in recurrent urolithiasis and surgical interventions. This study aimed to assess the impact of surgical interventions on renal function by analyzing estimated glomerular filtration rates. METHODS: Thirteen pediatric patients with cystinuria, who were followed-up in a single tertiary institution between 2004 and 2016, were included in the study. Medical records were reviewed to collect data on clinical presentation of patients, urine parameters, stone formation, medical treatment, surgical intervention, stone recurrence after surgical procedure, stone analysis, ultrasonography, 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) radionuclide imaging results, and follow-up time. Creatinine clearances estimated by modified Schwartz (eGFR) formula before and after surgery were used to assess renal function and compared statistically. RESULTS: Nine patients (69.2%) had renal scarring which were detected with 99mTc-DMSA radionuclide imaging. In ten patients (76.9%), open surgical intervention for stones were needed during follow-up. Significant difference was not detected between eGFR before and after surgical intervention (mean 92 versus 106, p = 0.36). Nine of the patients (69.2%) were stone free in the last ultrasonographic examination. Relapses of stone after surgery were seen in 66.6% of patients who underwent surgical intervention. CONCLUSIONS: Surgical interventions for urinary stones are commonly required in patients with cystinuria. Renal scarring is a prevalent finding in cystinuric patients. Surgical interventions have no negative impact on eGFR in patients with cystinuria according to the present study.

Platelet-activating factor antagonist (ABT-491) decreases neuronal apoptosis in neonatal rat model of hypoxic ischemic brain injury.

Hypoxic ischemic brain injury (HIBI) is a common cause of neonatal mortality and morbidity. To date, no study has investigated the role of platelet-activating factor (PAF) antagonists on neuronal apoptosis in neonatal rat model of HIBI. In the present study, we evaluated the effect of a highly potent and selective PAF antagonist (ABT-491) on neuronal apoptosis in neonatal rat model of HIBI. Seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia (92% nitrogen and 8% oxygen) for 2 h. They were treated with ABT-491 or saline either immediately before or after hypoxia. In sham group animals, neither ligation, nor hypoxia was performed. Neuronal apoptosis was evaluated by the terminal-transferase mediated dUTP biotin nick-end-labeling (TUNEL) and caspase-3 staining methods. Administration of ABT-491 either before or after hypoxia resulted in significant reduction of the numbers of apoptotic cells in both hemispheres, when compared to saline treatment group. The numbers of apoptotic cells in right hemispheres in all groups were significantly higher than that in the left hemispheres. These results suggested that ABT-491, a highly potent and selective PAF antagonist, administration either before or after hypoxia reduces apoptosis and we propose that ABT-491 may be a novel approach in the treatment of HIBI.

Laparoscopic one-stage Fowler-Stephens orchiopexy preserving gubernaculum.

OBJECTIVE: To assess gubernaculum-sparing laparoscopic one-stage Fowler-Stephens orchiopexy (FSO), in the management of high intrapelvic testis. MATERIAL AND METHODS: Medical reports of boys who underwent laparoscopic one-stage FSO were retrospectively reviewed. High intrapelvic testis was defined as testis ≥3 cm away from ipsilateral internal ring. Testes were evaluated on physical examination at 3rd, 6th and 18th months after surgery. Children were evaluated as for their demographic data, operative findings, interventional details and outcomes. RESULTS: Seven patients met inclusion criteria of the study. Six of 7 testis were small and had abnormal appearance, compared with the contralateral testis. Average distance of the testes from the internal ring was 4.2±1.1 cm (3 to 6). Average age at surgery was 6.1±4.2 years (2 to 12). Average follow-up period was 14±5.8 months (8 to 20), and 5 testis (71.4%) were considered to be normal in volume and scrotal location. Two testes were relatively atrophic and underwent orchiectomy. CONCLUSION: Our preliminary results shows a good testicular survival rate for one-stage laparoscopic FSO. Sparing collateral vasculature of the gubernaculum is important.

Laparoscopic management and its outcomes in cases with nonpalpable testis.

OBJECTIVE: Diagnostic laparoscopy is the gold standard in the algorithm of nonpalpable testis. Testicular tissue is examined and treatment is planned accordingly. In this study we reviewed the place of diagnostic laparoscopy, and evaluated the results and effectiveness of laparoscopy in the diagnosis and management of nonpalpable testis. MATERIAL AND METHODS: Children who had diagnostic laparoscopy for nonpalpable testes were included in the study. Physical examination results, ultrasonography (USG) reports, age at surgery, laparoscopic and inguinal exploration findings, surgical procedures, orchiopexy results, early and late-term complications were evaluated. Follow-up visits were performed at 3-month intervals for the first, at 6-month intervals for the 2. year, then at yearly intervals. Testicular size and location was evaluated by during control examination. RESULTS: Overall 58 boys, and 68 testes (26 left: 44.8%; 22 right: 37.9%, and 10 bilateral: 17.2%) were included in the study. Mean age at surgery was 5.5 years (10 months-17 years). Diagnostic value of USG was 15.7%. Diagnostic laparoscopy findings were as follows: Group 1: blind-ended vessels, n=7 (10.2%); Group 2: intraabdominal testes, n=8 (11.7%); Group 3: vas and vessels entering internal ring, n=53 (77.9%). Overall 43 testes underwent orchiopexy, which were normal (n=8) or hypoplastic (n=35). Mean follow-up period was 19 months (1-12 years), and on an average 7 visits were performed (5-14). On follow-up, 5 testes were normal-sized and located in the scrotum, while 4 testes were atrophic and underwent orchiectomy. Two testes were found in the inguinal canal and redo orchiopexy was performed. Control USG revealed reduced testicular blood supply and volume. CONCLUSION: Laparoscopic surgery is safe and effective in the management of nonpalpable testes. In the majority, routine use of diagnostic laparoscopy in the algorithma does not confer any additional contributions in many patients.

A Diagnostic Dilemma for the Pediatrician: Radiolucent Tracheobronchial Foreign Body.

BACKGROUND: The purpose of this study is to determine the role of clinical history, physical examinations, and radiological findings in the evaluation of patients with suspected radiolucent foreign body aspiration. METHODS: The medical records of 236 children (under the age of 18 years), on whom a rigid bronchoscopy was performed between 1999 and 2015 because of suspected radiolucent foreign body aspiration, were analyzed retrospectively. Sensitivity, specificity, positive and negative predictive values of clinical history, physical examinations, and radiological findings were evaluated. RESULTS: In 71.1% of all cases, the children were under the age of 3 years. The bronchoscopy showed the presence of a foreign body in 52.9% of cases, with the locations of the foreign bodies being as follows: (1) right main bronchus, 47.2%; (2) left main bronchus, 36.0%; (3) trachea, 11.2%; (4) both bronchi, 5.6%. Organic foreign bodies were found in 78% of the patients, whereas inorganic foreign bodies were detected in 22% of the patients. The sensitivity and specificity of clinical history, physical examinations, and radiological findings were 98.4% and 54.9%, 47.2% and 74.7%, and 35.2% and 92.7%, respectively. CONCLUSION: Tracheobronchial foreign body aspirations usually occur prior to the age of 3 years, with the most frequently aspirated foreign bodies being food or items of a radiolucent nature. Clinical history, physical examinations, and radiological findings are not able to detect the presence of a radiolucent foreign body aspiration in children. Therefore, a bronchoscopy should be performed on children in whom a choking event has been witnessed, even in cases of normal radiological and clinical findings.