Evaluation of the effectiveness of mother milk exosomes in the experimental corrosive esophagitis model.

PURPOSE: We aimed to examine the effectiveness of mother milk exosomes in treating corrosive esophageal burns. MATERIALS AND METHODS: 32 rats were separated into four equal groups and weighed individually before the procedure. A corrosive esophageal burn model was created with 12.5% sodium hydroxide by a 3F Fogarty catheter. Group 1 did not apply any process or treatment, Group 2 was burned, and no treatment was performed. Group 3 was burned, and then 0.5 cc/day of mother milk exosome extract was given. Group 4 was not applied any process, and 0.5 cc/day mother milk exosome extract was given. All rats were weighed again and sacrificed. Biopsy samples were sent to the pathology laboratory for histopathological examination (in terms of inflammation, fibrosis, and necrosis).Kindly check and confrm all email ids.The e-mail addresses and affiliation of all authors were checked. Affiliation departments are as stated on the title page. There is no change. RESULTS: A significant difference was found in the results of inflammation and fibrosis. There was a meaningful difference in fibrosis between the 2nd and 3rd groups. There was weight gain in groups 1, 3 and 4. Statistical evaluations for each group were significant. CONCLUSION: It was observed that breast milk exosomes may be effective in inflammation and fibrosis formation in treating corrosive esophageal burns. This suggested that breast milk exosomes reduce stricture formation due to esophageal corrosion.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [specify authors given name] Last name [specify authors last name]. Also, kindly confirm the details in the metadata are correct.The names and affiliation of all authors were checked. Affiliation departments are as stated on the title page. There is no change. Also we confirm the details in the metadata.

Prenatal and Postnatal Management of Intrauterine Pleural Effusions Associated with Nonimmune Hydrops Fetalis.

OBJECTIVE: Nonimmune hydrops fetalis (NIHF) is defined as the accumulation of excess fluid in two or more body cavities in the fetus without blood incompatibility between mother and baby. We aimed to present our prenatal and postnatal management of intrauterine pleural effusions associated with NIHF. STUDY DESIGN: A total of 60 patients diagnosed with NIHF with intrauterine pleural effusion were analyzed retrospectively. Gestational age of delivery or fetal demise, the intrauterine treatment procedure including extrauterine intrapartum treatment (EXIT), chest tube, and medical treatment methods in fetuses with chylothorax analyzed. RESULTS: Thirty-nine patients (65%) were born alive between 26 and 38 weeks. A thoracoamniotic shunt was placed in one patient during the intrauterine period. Seven patients were placed bilaterally during the postnatal period, all without the umbilical cord being clamped during delivery. But 25 patients died within the first few days following birth. A total of four patients had chylothorax. Two patients who did not respond to medical treatment (somatostatin) were injected with thoracic local batticon and cured. A total of 14 patients were discharged with healing. CONCLUSION: Cases of progressive prenatal pleural effusions associated with NIHF have a high risk for fetal and neonatal death. We think that extreme prematurity increases postnatal mortality because it negatively affects the development of the lung and heart. A close obstetric follow-up and a multidisciplinary approach are required for the management to be selected.

Effects of myricetin on testicular torsion-detorsion injury in rats.

Testicular torsion is an emergency, and unless there is an urgent intervention, irreversible ischaemic damage and gonad loss occur in the testicle. We aimed to investigate myricetin's antioxidant properties as well as its protective effect against ischaemia-reperfusion (I/R) damage in the testicular torsion model. A total of 18 rats were divided into three equal groups. Group 1 was the sham group. Group 2: testicular torsion was performed, and orchiectomy was done 2 hr after detorsion. Group 3: received torsion and 1 mg/kg intraperitoneal myricetin was given 30 min before detorsion, and orchiectomy was applied 2 hr after detorsion. We evaluated tissue malondialdehyde, superoxide dismutase, and catalase levels and Johnsen Testicular Biopsy Score to show its histopathological effect. There was a statistically significant decrease in MDA values in myricetin group compared to Group 2 (p < .017). There was no significant difference in the statistical analysis of SOD and CAT values (p = .337 and p = .025). There was a statistically significant difference in testicular I/R damage in the myricetin group compared to Group 1 and Group 2 (p < .017). Myricetin treatment significantly decreased testicular tissue damage compared to the torsion group but did not reach the values close to the control group.

Reverse Tubularized Pelvis Flap Method for the Treatment of Long Segment Ureteropelvic Junction Obstruction.

OBJECTIVE: The most common cause of urinary obstruction is ureteropelvic junction (UPJ) obstruction. In short stenosis, a dismembered pyeloplasty is performed, but for long segment stenosis, the procedure is not well defined. We present the reverse flap ureteroplasty method, which we prepared from the pelvis for use in long segment UPJ obstruction. METHODS: Between 2007 and 2016, we operated on 6 cases (4 males, 2 females) with an age range of 2-6 months. After reaching the UPJ region, depending on the length of the long segment obstruction, a flap measuring 25-35 mm in length was prepared from the pelvis so that its width would be 10-12 mm on the pelvis side and 10 mm in the distal portion. It was then reversed and tubularized with an absorbable suture over a 10-French nelaton catheter. The end of this ureter and the end of the distal ureter were spatulated and anastomosed. A double J and minivac drain were used in each case. RESULTS: There were no complications in the postoperative period of all our patients. They were all discharged with good health. Follow-up with renal ultrasonography showed that the anteroposterior diameters were decreased and that parenchymal thicknesses had returned to normal. Secondary stenosis, flap necrosis, and retraction did not develop. CONCLUSION: Because the blood supply of the pelvis is increased in patients with UPJ obstruction, a reverse flap of adequate length with preserved blood supply can be achieved and tubularized. We suggest that this method will be appropriate for the treatment of long segment UPJ obstruction.

Gastrointestinal stromal tumor in a newborn diagnosed in prenatal period: a case report and review of literature.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Only 1.5% to 2% of all GISTs are observed in children and adolescents. Most of the pediatric cases are between 10 and 18 years of age, with a median age of 13 years. GIST is extremely rare in the newborn period. We could find only 5 reports on the neonatal cases. Herein, we have reported a case with abdominal tumor that was identified by prenatal ultrasonography and magnetic resonance imaging, and diagnosed as GIST on the seventh day of life. We have also reviewed the neonatal GIST cases reported in the English literature.

Oxidative, inflammatory and immunologic status in children with undescended testes.

BACKGROUND: In order to better understand the pathogenesis of risk of future sub-/infertility in children with undescended testes (UDT), we designed this prospective study to examine the oxidative stress, inflammatory response and autoimmunity in children with UDT. We examined the concentrations of malondialdehyde (MDA), interleukin-6 (IL-6) and antisperm antibodies (ASA) in children with UDT and healthy controls. METHODS: The UDT group consisted of 88 boys (aged 1-14 years, unilateral in 67 and bilateral in 21 cases), and 44 boys with normal descended testes served as a control group. Clinical evaluation revealed no testicular or other system abnormalities. MDA was used as lipid peroxidation index. IL-6 levels were measured using a commercial enzyme-linked immunosorbent assay kit. ASA was determined with an anti-human spermatozoa immunoglobulin G test. RESULTS: Mean age values ± SD were 4.6 ± 3.2 in the UDT group and 4.7 ± 3.4 in the control group (P= 0.872). MDA and IL-6 results for the UDT and control groups were significantly different (P= 0.003 and P= 0.019, respectively), but those for ASA were not (P= 0.473). The mean MDA and IL-6 values were significantly higher in bilateral cases than the respective values in the unilateral cases (MDA: 4.03 ± 3.68 vs 3.49 ± 5.22, P= 0.015; IL-6: 7.70 ± 6.86 vs 3.48 ± 6.50, P= 0.001) (P= 0.015). CONCLUSION: The results indicate that children with UDT are exposed to high levels of oxidative stress and inflammatory reaction. This could negatively affect the future fertility in these children.

Effectiveness of Hypericum perforatum Extract in the Treatment of Corrosive Esophageal Burns.

PURPOSE: The purpose of our study is to determine the effectiveness of "Hypericum perforatum" extract in corrosive esophageal burns and to shed light on the search for new treatments. MATERIALS AND METHODS: A total of 32 Sprague Dawley rats were separated into 4 groups. A standard esophageal burn model was created. Group 1 was identified as the sham group. Group 2 was burned and no treatment was performed afterward. Group 3 was burned and then 2 cc/day H. perforatum extract was given for 21 days. Group 4 was not applied any process and 2 cc/day H. perforatum extract was given for 21 days. The rats were sacrificed and biopsy specimens were taken for histopathological examination for the presence of inflammation, fibrosis, and necrosis. RESULTS: There was a significant difference between groups in terms of inflammation, fibrosis, and necrosis. Furthermore, in the bilateral comparisons between the groups, there was a meaningful difference in terms of inflammation and fibrosis between Group 2 and Group 3. However, there was no meaningful difference between the same groups in terms of necrosis. CONCLUSION: H. perforatum extract may be effective on inflammation, fibrosis, and necrosis in corrosive esophageal burns.

Primary posterior mediastinal Burkitt lymphoma.

A 14-year-old boy admitted to our clinic with a 20-day history of fever, cough and respiratory distress. Mediastinal enlargement was observed on chest radiograph. Computed tomography of the chest demonstrated a large posterior mediastinal mass. The histopathological examination of the mass revealed Burkitt's lymphoma. We report this case because primary posterior mediastinal involvement in Burkitt lymphoma is extremely rare in childhood.

Effects of carbon dioxide pneumoperitoneum on exocrine and endocrine functions, and oxidative state of rat pancreas.

We investigated the effects of increased intra-abdominal pressure during laparoscopy on the endocrine and exocrine functions, oxidative stress and histopathology of the pancreas in rats. We established three experimental groups of eight animals. Group 1 was the untreated control. Forth other two groups, pneumoperitoneum with CO2 was established for 60 min at 6 mm Hg for group 2 and 12 mm Hg for group 3; groups 2 and 3 animals were allowed to re-perfuse for 30 min. Amylase, glucagon and insulin levels were analyzed in blood samples and insulin:glucagon ratio was calculated. Histopathology and malondialdehyde assay were performed on pancreatic tissue samples. Histological damage scores for vasocongestion were increased significantly in groups 2 and 3 compared to group 1. Histological damage scores for inflammatory cell infiltration were increased significantly in group 3 compared to group 1. Malondialdehyde levels were increased significantly in group 3 compared to group 1. We found no significant differences among groups for serum amylase levels or histological damage scores for hemorrhage. Insulin and glucagon levels, and the insulin:glucagon ratio was increased significantly in group 3 compared to groups 1 and 2. We found that in rats routine laparoscopy caused increased serum insulin and glucagon levels, and histopathological changes that indicated ischemia-reperfusion injury to the pancreas.

Acute pancreatitis in children: A single center experience over ten years.

Sag E, Kaya G, Bahat-Özdogan E, Karahan SC, Imamoglu M, Sarihan H, Çakir M. Acute pancreatitis in children: A single center experience over ten years. Turk J Pediatr 2018; 60: 153-158. Acute pancreatitis (AP) is an inflammatory disease characterized by sudden onset abdominal pain together with elevation of pancreatic enzymes and radiographic changes. Increased incidence of AP in children have been reported in recent reports. In this study; we aimed to analyze the demographic characteristics, etiology, outcome and incidence of AP among hospitalized children in our center. Medical records of the children with AP since January 2005 were analyzed from hospital files (N=63). Major etiologies were systemic diseases (14.3%), trauma (11.1%), cholelithiasis (9.5%); 54% (N=34) of the patients had mild AP, while 28.6% (N=18) had moderately severe AP and 17.4% (N=11) had severe AP. Organ dysfunction was found in 11 patients (17.4%) at initial examination. During the follow-up period (68.1±24.3 months), 10 patients (15.9%) experienced 24 recurring AP (RAP) attacks. Male gender, presence of local pancreatic or systemic complications at initial attack, metabolic and hereditary diseases were associated with the increased risk of RAP (p < 0.05 for all). The mortality rate associated with AP was 4.84%. There was an increase in the incidence of AP since 2010 (9.57 in 2009-2010 vs. 39.17/10,000 patients in 2015-2016 years; p=0.0002; OR: 4.1) among the hospitalized patients. Our results indicate that AP is a mild disease in children and the incidence is increasing among hospitalized children. Male gender, presence of local pancreatic or systemic complications at initial attack, metabolic diseases and hereditary diseases were associated with the increased risk of RAP.

A case of ureteral triplication associated with ureteropelvic junction obstruction.

Ureteral triplication is one of the rarest malformations of the upper urinary tract. The association of ureteral triplication and obstruction is even rarer. We report a case of ureteral triplication associated with hydronephrosis due to ureteropelvic junction (UPJ) obstruction at the middle pole ureter. To our knowledge, such a malformation has not been described previously.

Duodenocolic fistula due to safety pin ingestion.

The authors describe the case of a 16-month-old boy with benign duodenocolic fistula due to safety pin ingestion who presented with abdominal pain, diarrhea and weight loss. Etiology, symptomatology, diagnosis and management are discussed and the literature is reviewed. Early diagnosis and surgical management are necessary to avoid serious morbidity.

Intestinal stenosis from mesenteric injury after blunt abdominal trauma in children: case reports.

The incidence of mesenteric injury after blunt abdominal trauma (BAT) has increased in recent years; however, relatively little attention has been paid to instances of its sequelae, especially in childhood. We present three children who had post-traumatic intestinal stenosis (PIS). A history of BAT was obtained in all. They had abdominal pain, bilious vomiting and peritoneal signs. The time intervals, the duration from the initial trauma to the onset of symptoms, ranged from 23 to 62 days. Stenotic segments were parallel to the location of the previously recognized mesenteric hematoma (MH), and resection with primary anastomosis was performed. Pathological examinations of specimens confirmed mucosal and mural ischemia and full-thickness fibrosis of the intestinal wall. In our opinion, large MH may pose an increasing risk of narrowing in the adjacent intestine at different time points. Therefore, if there is a large MH at laparotomy after BAT, it should be evacuated and the bleeding halted. For the differential diagnosis, typical BAT should be investigated carefully in cases presenting with intermittent colic abdominal pain and/or partial intestinal obstruction findings.

Long-term effects of elevated intra-abdominal pressure on testes an experimental model of laparoscopy.

PURPOSE: To determine the long-term outcomes of pneumoperitoneum on the testes in an experimental laparoscopy model. MATERIALS AND METHODS: Twenty-four rats were divided into three groups: Group A, the control group; Group B, exposed to a 10 mmHg intra-abdominal pressure (IAP); and Group C, exposed to a 20 mmHg IAP with CO2 pneumoperitoneum for 60 minutes. After 6 weeks, the testes were removed, and testicular injury score and Johnson score were examined histologically. Germ cell apoptosis was also detected using flow cytometry. RESULTS: A significant difference was determined between all groups in terms of testicular injury scores, Johnson scores, and germ cell apoptosis percentages. For the testicular injury score, there were significant differences between the groups for the right testis (group A versus B, P = .009; group A versus C, P < .0001; and group B versus C, P = .001) and for the left testis (group A versus B, P = .001; group A versus C, P < .0001; and group B versus C, P = .002). Significant differences were determined in the Johnson scores for the right testis between all groups (group A versus B, P= .001; group A versus C, P < .0001; and group B versus C, P = .008, respectively). Percentage of apoptotic testis cells were significantly differed between all groups (P = .001 for each). CONCLUSION: This study shows that increased IAP during pneumoperitoneum causes histopathology and apoptotically-evident damage to the testes in the long-term, depending on the magnitude of IAP increase, which may cause sub/infertility. Considering the experimental nature of this study,further clinical studies are needed for a more decisive conclusion.

Ultrasonographic evaluation of fatty meal stimulated gallbladder contraction in the diagnosis of biliary dyskinesia in children.

AIM: Biliary dyskinesia (BD) is characterized by symptoms of biliary disease, no evidence of gallstones on ultrasonography (USG), and diminished gallbladder ejection fraction. The diagnosis is based on findings of abnormal gallbladder ejection fraction diagnosed by hepatobiliary scintigraphy before and after stimulation of gallbladder contraction with cholecystokinin (CCK). We used an easier diagnostic technique defined as ultrasonographic evaluation of fatty meal stimulated gallbladder contraction, employing USG with the diagnosis of biliary dyskinesia in children. The study was conducted by USG to investigate the volume and contractility of the gallbladder (GB) in fasting conditions and 45 min after a standardized fatty meal (SFM) in normal children and in a group of BD patients, and to compare the diagnostic value of this test with scintigraphy and to evaluate its use as a new method in the diagnostic algorithm of BD. METHODS: We assessed the volume changes and contractility of the GB in response to SFM by USG in 14 patients with BD diagnosed by cholecystokinin stimulated hepatobiliary scintigraphy (CCKs-HBS); and compared them with 14 control patients matched for age and gender before cholecystectomy. After an overnight fasting, GB volume was measured by USG then the GB volume was again measured after the SFM ingestion. Using USG, length, width and height of GB were measured, and volume of the GB was calculated using the 'Dodds' formula. These volume measurements were used to calculate the percentage of gallbladder emptying (ejection fraction). Fasting, after SFM and EF values comparisons between groups were done with student's t-test. RESULTS: No statistically significant difference of fasting GB volumes were demonstrated between BD and control groups (14.1+/-6.7 cm3 and 13.4+/-4.0 cm3 respectively). GB volumes of the BD group after SFM were significantly greater than in healthy controls (13.1+/-1.8 cm3 and 3.4+/-0.9 cm3 respectively, P<0.0005). The calculated percentage of gallbladder contraction (ejection fraction) was found to be lower in BD patients than in healthy controls (7.1%+/-1.8% and 73.8%+/-6.4%, respectively, P<0.0005). CONCLUSION: Ultrasonographic evaluation of fatty meal stimulated gallbladder contraction provides relatively reliable and reproducible results. Thus it can be used for scanning in patients with biliary symptoms as a prior modality to CCK-HBS since it is a relatively easier, safer and available method with which to make a definitive diagnosis of BD. The patients with symptoms of biliary disease and no evidence of gallstones on USG should be evaluated by the method proposed in this study before the routine laboratory and radiologic tests.

Diagnostic difficulties in children with coexisting pelvi-ureteric and vesico-ureteric junction obstruction.

OBJECTIVE: To assess the diagnosis of children with coexisting pelvi-ureteric junction (PUJ) and vesico-ureteric junction (VUJ) obstruction, and the management of such patients, as having these two anomalies in the same ureter creates serious diagnostic difficulties, but any delay in diagnosis might cause a deterioration of renal function and affect the success of surgery to correct either anomaly. PATIENTS AND METHODS: We assessed the diagnostic difficulties and approach to 14 patients with coexistent PUJ and VUJ obstruction, who were treated surgically in our clinic between 1994 and 2005; we also review related published reports in English. RESULTS: Surgery was used in all 14 patients over the 11-year period; only five patients had an accurate diagnosis before surgery. Six patients were diagnosed with uroradiological techniques immediately after pyeloplasty; three were diagnosed on investigating an associated anomaly later. CONCLUSION: In children with coexisting PUJ and VUJ obstruction there are serious diagnostic problems; to prevent any deterioration in renal function due to obstruction, these anomalies require early diagnosis and treatment. For an early and accurate diagnosis, the coexistence of these two anomalies in the same ureter should be considered.

Bloody nipple discharge in children: possible etiologies and selection of appropriate therapy.

An understanding of underlying causes of bloody nipple discharge (BND) is necessary to be able to advise treatment guidelines of this rare symptom in the pediatric age group. Of 11 patients with 14 breasts that had BND, data regarding age, sex, side and duration of BND, physical examination findings, laboratory values, culture reports, ultrasonography (US) findings, treatment approach, histopathologic details, and outcomes were obtained, and also, literature was reviewed. The patients were between 3 months and 12 years of age. There were six males and five females. The BND was located in the right breast in six patients, in the left in two, and it was bilateral in three. On physical examinations, seven patients had palpable cystic nodules located at the areolar area and three had a diffuse breast enlargement without skin findings. Laboratory investigations showed normal hormone levels in all patients. At US examinations, seven breasts had cystic lesions, three had hypoechoic tissue in the subareolar region, and others had normal US findings. In a girl with positive culture for Staphylococcus aureus, BND resolved after oral antibiotics. Two cases resolved spontaneously, with 6 months and 4 months follow-up periods, respectively. Surgical intervention was performed for the remaining eight patients, and mean time to operation after onset of symptoms was 10 months (range = 1-34 months). Histopathologic findings showed that the underlying cause of BND was duct ectasia in five breasts, gynecomastia in three, and fibrocystic change in two. Their follow-up periods ranged between 3 months and 6 years, and no recurrences were observed. Classification of breasts with BND for selecting appropriate therapy on the basis of results of careful physical examination, with an US evaluation in selected cases, is effective, and prevents unnecessary investigations.