Accidental ingestion of concentrated white vinegar in Hatay children in Turkey.

White vinegar which contains high concentrations (~85 %) of acetic acid is a staple ingredient used in food preparation in many Mediterranean cuisines but in small amounts. Being corrosive, it can cause ulcerative injury to the oropharynx and oesophagus and upset the stomach with resulting nausea and vomiting. This study presents 11 cases of paediatric patients (five boys and six girls, aged between 11 and 89 months) with oesophageal strictures who drank white vinegar by accident. They all received endoscopic oesophageal dilation (with a bougie) ranging from one to 28 per patient, depending on the severity of the injury. Follow-up showed uneventful healing in eight patients, who at the time of the telephone call were able to swallow solids and liquids normally. Two patients who could not be reached by telephone were found healthy by consulting the national database (e-Nabiz). Unfortunately, one patient, who was discharged without any symptoms after the first dilation, suffered massive gastrointestinal bleeding 24 hours after the dilation and died. The loss of this patient shows that ingesting white vinegar can be very dangerous in children, especially if parents delay seeking medical help. We believe that controlling the production and sales of highly concentrated white vinegar and selling it in child-proof containers can help to prevent accidental ingestions by children and tragic outcomes such as the one reported here.

Can olive oil prevent distal colon mucosal atrophy caused by disuse in rats with colostomy? An experimental animal study.

AIM: This study aims to investigate the effects of pure olive oil on mucosal atrophy of the distal colon in rats. <br/><br/>Material and methods: The study included 28 male albino Wistar rats weighing 300-350 g. A total of 28 animals were randomly allocated to four groups: group 1: control group (n = 6); group 2: ostomy group (n = 6); group 3: ostomy + saline group (n = 8); group 4: ostomy + olive oil group (n = 8). By definition, group 1 did not undergo any procedure. The same surgical procedure was performed for groups 2, 3, and 4 as described below. In all animals from these groups, a two-centimeter-long mid-line incision was made and the colon was divided into 5 cm sections, measured from the distal colon to the caecum. Proximal and distal stomas were created 2 cm apart in the midline with the use of single-layer interrupted sutures. All rats were kept under close daily observation until they were terminated postoperatively after the 1st month. Animals from group 2 did not undergo any additional procedures, while those fromgroups 3 and 4 were given 2 mL of saline and olive oil twice a day, respectively. At the end of the 1st month, the rats were re-operated through the same approach. Biopsies were taken from the proximal and distal stomas of all rats in the same manner for further histopathological analysis. <br/><br/>Results: Group 1 showed no significant differences in terms of mucosal thickness, muscular thickness, wall thickness or colonic lumen diameter between the proximal and distal segments of the colon. Although there were significant differences between the proximal and distal colostomies for each parameter in groups 2, 3, and 4, the mucosal thickness, muscular thickness, wall thickness, and colonic lumen diameter differences for proximal and distal ostomies were very small in group 4 when compared to groups 2 and 3. <br/><br/>Conclusion: The administration of pure olive oil through the distal colon before colostomy closure may reduce the difference in diameter between the proximal and distal intestinal segments. As a result, a more straightforward surgical procedure may be achieved.

Successful Treatment of Major Abdominal Trauma in a 9-year-old Male due to Bomb Explosion.

The present case report describes a pediatric patient that sustained and survived major abdominal trauma due to an open-air explosion during the Syrian civil war. A 9-year-old male patient was brought to our hospital's paediatric emergency department after a bomb explosion that occurred 8 hours prior to presentation. The patient had a severe flap-like skin defect that extended from the below the umbilicus to the right femur. The defect was embedded with multiple stones, plastic, and soil fragments of varying size. Debridement of the anterior abdominal wall was performed, followed by exploratory laparotomy. Multiple sites of perforation of the small bowel were resected, and anastomosis was performed. Vacuum-assisted closure (VAC) was applied to the large wound area. The VAC dressing was changed every 3 days. Granulation tissue developed post-operatively after 26 days and the defect was repaired using skin grafts harvested from the patient's left leg. The patient was considered fully recovered and was discharged 34 days post-surgery. The presented case shows that despite the severity of the patient's major abdominal injuries, rapid wound debridement, exploratory laparotomy, VAC therapy and a multidisciplinary approach are crucial in preventing death and achieving a full recovery.

The histopathological effect of tissue adhesive on urethra wound healing process: An experimental animal study.

INTRODUCTION AND OBJECTIVE: The present study aimed to determine the histopathological effect of Tisseel tissue adhesive on the urethral wound healing process after urethroplasty in a rat model. STUDY DESIGN: A total of 24 animals were randomly allocated into three groups: Group 1; control group (n = 6); Group 2; suture-closure group (n = 9); and Group 3; suture + adhesive group (n = 9). In group 2, an incision 4 mm long was made on the ventral skin of the penis along the midline from the glans penis, to open the dartos muscle, corpus spongiosum, and urethra. Next, initially, the urethra alone, and then the layers up to the skin were covered in layers with 8/0 vicryl interrupted sutures. Group 3 underwent the same procedures as group 2, but after the urethra was repaired 0.1 cc of Tisseel tissue adhesive was applied over the urethra. Penile tissue samples were obtained 21 days later, and tissue samples were sent for histopathological analysis. RESULTS: Urethral epithelial thickness and connective tissue thickness in group 3 were higher than in group 1 and group 2. Fibrosis in group 3 was higher than in group 2. The difference in inflammation between group 3 and group 2 was not significant. There was no significant difference in microvessel density between group 2 and group 3. DISCUSSION: Both increased fibrosis and connective tissue thickness were noted in group 3 compared to group 2 and group 1. These increases may have been caused by the hemostatic effect of the Tisseel adhesive and its triggering of fibroblast growth factors. The epithelial thickness increased significantly in group 3 and group 2 compared to group 1. This increase in tissue thickness without an increased number of epithelial cells can be explained by the development of oedema. CONCLUSION: The present study suggests that while Tisseel tissue adhesive increases connective tissue thickness and fibrosis, it does not demonstrate a prolonged inflammation or increased neovascularization in the urethral wound at 3 weeks after surgery. The data obtained in our study does not support the use of Tisseel in urethroplasty surgery. The results obtained in this study demonstrate a significantly higher formation of fibrosis (scar tissue), which underlines the importance of new studies to identify new treatments for urethral wound healing after urethra trauma or surgery.

Innocent Children in the Syrian Civil War.

INTRODUCTION: Our aim is to present the clinical and surgical characteristics of the children affected by the Syrian civil war. MATERIALS AND METHODS: Medical records were reviewed retrospectively for Syrian war victims between the ages of 0 and 18 who were brought to the emergency department of the Education and Research Hospital between March 2011 and March 2019. Each patient was evaluated with respect to demographic data (gender, age), type of injury, history of operations in Syria, injured organ(s), accompanying traumas and the mortality and trauma score. RESULTS: The majority of our study population of 147 patients were male (108/147, 73.46%), and 39 of the total were girls (26.53%). The mean age of the patients was 9 (7.5 ± 4). The mean age of the girls was 8.5 (range: 7 months to 16 years), and the mean age of the boys was 9.2 (4 months to 17 years). Seventeen patients who had abdominal surgery in Syria were operated on again after clinical and radiological observations. A total of 83 patients were operated on in Turkey. For 66 of those patients, the operation in Turkey was their first surgery on their war injuries. Seventeen patients were operated on in Syria but needed surgery again in Turkey. CONCLUSION: War affects not only the battlefield, but also the neighboring countries in many aspects such as medical, social, and economic. Hollow organ injuries are the most common intraabdominal pathologies. Delayed intervention is associated with increase mortality and morbidity.

Effects of Probiotic Use on Bacterial Translocation in Created Rat Models with Biliary Obstructions.

OBJECTIVE: The aim of this study was to investigate the protective effects of the combined use of probiotic strains on the development of bacterial translocation in addition to liver and intestinal tissue damage due to biliary obstruction in rats. MATERIALS AND METHODS: Here, 3 groups each consisting of 10 rats were created:group 1 (sham group), group 2 (obstructive jaundice), and group 3 (obstructive jaundice+probiotic). Groups 1 and 2 were given 1 cc physiological saline solution by oral gavage twice a day; group 3 was given a probiotic solution that included Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, Enterococcus faecium, and Bifidobacterium longum microorganisms by oral gavage twice a day. RESULTS: Markers for liver damage were also found to be significantly improved (p<0.05) in the treatment group (group 3). When compared with groups 2 and 3 in terms of liver histology, damage was found to be significantly more severe in group 2 (p<0.01). With regard to ileal villous depth and ileal inflammation, the pathology was found to be significantly more severe in group 2 than that in group 3 (p<0.05). In blood, spleen, and mesenteric lymph node cultures, group 2 showed a microbiological growth rate of 33.8-58.8%, whereas group 3 showed a microbiological growth rate of 14.3-28.6%. This reduction was evaluated to be statistically significant (p<0.05). CONCLUSION: Our study showed that the combined use of a probiotic in bile duct obstructions reduced bacterial translocation and alleviated pathological changes arising in the liver and terminal ileum histology.

Bronchoscopy for foreign body aspiration and effects of nebulized albuterol and budesonide combination.

OBJECTIVE: A foreign body aspiration in the tracheobronchial tree is a dangerous medical condition in the childhood period. Although rigid bronchoscopy is a safe procedure, it may cause complications. The aim of this study was to present our bronchoscopy experience and to evaluate the efficacy of pre-operative administration of nebulized albuterol and budesonide combination for reducing intra-operative complications in foreign body aspirated cases. METHODS: In this retrospective study our pediatric cases in which a foreign body was removed from tracheobronchial tree in last 8 years were analyzed. After excluding the patients who needed emergent and negative bronchoscopies, the remaining clinically stable 84 patients were compared for the effects of preoperative administration of nebulized albuterol and budesonide combination on bronchoscopy complications. RESULTS: There were 51 boys (60.3%) and 33 girls (39.7%). There were 38 children in the non-nebulized group and 46 children in the nebulized group. We found that the combined albuterol and budesonide nebulization decrease complications such as arterial oxygen desaturation (p<0.05), and bronchospasm (p<0.05) during the bronchoscopic intervention. CONCLUSION: Preoperative nebulization of albuterol and budesonide combination may decrease perioperative complications of bronchoscopy.

Duodenal perforation: an unusual complication of sickle cell anemia.

Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presented with abdominal and back pain. The patient was operated on for acute abdomen and diagnosed with duodenal perforation. Helicobacter pylorus was negative. There was no risk factor to account for duodenal perforation other than sickle cell anemia. Surgical intervention was successful and without significant sequelae. Duodenal perforation is a rare entity described in patients with sickle cell anemia. To our knowledge, this is the first report of duodenal perforation in a patient sickle cell anemia.

Protrusion of a peritoneal catheter via abdominal wall and operated myelomeningocele area: a rare complication of ventriculoperitoneal shunt.

BACKGROUND: Ventriculoperitoneal shunting is mostly used in the treatment of hydrocephalus, and many complications have been reported with this method. These complications include obstruction, mechanical shunt failure, infection, and abdominal complications. Abdominal complications include intestinal obstruction, volvulus, peritonitis, peritoneal cyst, cerebrospinal fluid ascites, as well as migration of the distal catheter via the intestinal tract, umbilicus, scrotum, and vagina. Various mechanisms have been suggested with regards to the catheter migration. CASE REPORT: We present a case of a 21-month-old female patient who had myelomeningocele at birth. She underwent repair of the myelomeningocele at the age of 10 days. After 4 months, cranial computed tomography revealed hydrocephalus, and ventriculoperitoneal shunt was placed. Because of shunt dysfunction, a new ventriculoperitoneal shunt system was installed at the age of 12 months. Eight months later, her mother noticed the protrusion of peritoneal catheter via abdominal wall and repaired myelomeningocele area. Revision of the lower end of the shunt was done, and myelomeningocele area was repaired again. CONCLUSION: We report a unique patient with the protrusion of the distal catheter through repaired myelomeningocele area and abdominal wall in the lumbar region.

[Ruptured pulmonary hydatid cyst: a case report]. / Çocukta Rüptüre Akciger Kist Hidatigi Olgusu.

Hydatid cyst (HD), a very common disease in the world, is often transmitted to humans through dog feces. HD is especially common in countries where agriculture and animal husbandry is prevalent. HD is caused by Echinococcus granulosus. The clinic course of HD usually features settling in the liver and lungs. Lung involvement with chest pain, cough, shortness of breath can cause non specific symptoms such as fever and hemoptysis. Diagnostic interventions for HD include chest X-ray tomography, and physical examination. Although the treatment options of HD vary according to the clinical findings of the patients, the primary treatment may be considered as surgery. The most frequently applied methods of surgical treatment are cystectomy and capitonnage. Medical treatment is usually warranted for complicated cases, including the patients with multiple and unresectable lesions, patients who refuse surgery and the patients who cannot tolerate surgery. Treatment with albendazole and its derivatives are used. In this case report, we present a child with primary complaints of cough, chest pain, dyspnea, fatigue and fever who was latterly diagnosed with lung HD.

An atypical bladder diverticulum presented with recurrent peritonitis: case report.

Bladder diverticula develop from congenital detrusor muscle defect and frequently present with urinary tract infection, which occurs as a result of urinary stasis in the diverticula. Different clinical presentations, such as bladder outlet obstruction, cyanosis of the lower extremities, intestinal obstruction, ureteral obstruction (which may occur due to direct diverticular compression), and peritonitis due to spontaneous rupture of the diverticula, were reported previously. Here, we report a case with the diagnosis of bladder diverticulum that caused recurrent generalized peritonitis without perforation and mimicked perforated appendicitis.

Graves disease with exophtalmia in a two-year old child.

UNLABELLED: Thyrotoxicosis is one of the rare disorders diagnosed in childhood and adolescence. The most frequent cause is Graves disease. One of the Graves' disease complications is thyroid-associated orbitopathy. A 2-year-old girl was referred to our hospital for decreased weight gain. Her physical examination was normal except for a palpable thyroid tissue and exophtalmia. After laboratory examination, she was referred to the departments of nuclear medicine and radiology for the diagnosis of hyperthyroidism and Graves ophthalmia. When evaluated with the physical examination, laboratory and imaging results the patient was diagnosed as Graves' disease with orbital involvement. So the patient was taken on methimazole treatment. CONFLICT OF INTEREST: None declared.

A newborn with duodenal atresia and a gastric perforation.

Congenital duodenal atresia complicated by gastric perforation (GP) is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

Gradual detorsion of torsioned rat testis attenuates ischemia reperfusion injury.

AIM: This study was designed to investigate effect of gradual detorsion on testicular ischemia reperfusion injury. MATERIALS AND METHODS: A total of 21 male rats were divided into 3 groups, each containing 7 rats. Torsion was created by rotating the left testis 720 degrees in a clockwise direction. Group 1 underwent sham operation. Group 2 (sudden detorsion) served as a torsion/detorsion group, receiving 2 hours torsion and 2 hours detorsion. In group 3, 360 degrees detorsion was done for 20 minutes after 720 degrees torsion for 2 hours. Then, testis was done full detorsion for 100 minutes. At the end of the experiments (fourth hour), left orchiectomy was performed to measure the tissue levels of malondialdehyde (MDA), superoxide dismutase, and glutathione peroxidase and to perform histologic examination in testes. RESULTS: The MDA levels of testis tissues were significantly increased in the sudden detorsion group as compared with the sham group. We found decrease of the MDA level in gradual detorsion group, but it was not a statistically significant amount. Significant decrease was found in the superoxide dismutase and glutathione peroxidase activities in the sudden detorsion group as compared with the sham and gradual detorsion groups. Histologic examinations were in accordance with the testicular tissue MDA levels. CONCLUSION: In the light of our biochemical and histopathologic findings, we can say that gradual detorsion has a trend to decrease the degree of testicular reperfusion injury in the rat torsion/detorsion model.

Macrocephaly and bitemporal arachnoid cysts not associated with glutaric aciduria type I in a child.

A 45-month-old child who had bitemporal arachnoid cysts and macrocephaly unrelated to glutaric aciduria type 1 (GA 1) was reported. The patient was admitted to the emergency unit after head trauma at 11 months of age. CT and MRI showed bitemporal arachnoid cysts (BACs). Acylcarnitine profile was normal in serum using tandem mass spectrometry. Urine and blood screening tests were within normal range for metabolic disorders. There were no unusual organic acids in urine and blood samples. No additional clinical findings of metabolic disorders such as GA 1 developed during follow-up. The majority of children affected with GA 1 have macrocephaly and BACs on CT or MRI. These signs should alert neurosurgeons to the possibility of GA 1. Neurosurgeons evaluating patients with head trauma or suspected non-accidental head injury should include GA 1 in the differential diagnosis of BACs associated with macrocephaly, and an evaluation should be performed.

A different type of congenital lumbar hernia associated with the lumbocostovertebral syndrome.

Congenital lumbar hernia is rare in infancy and childhood, and its association with the lumbocostovertebral syndrome is even more unusual. Only 20 cases have been reported in the English literature. We present the case of a child with multiple costovertebral anomalies, undescended testis, and lateral abdominal wall hernia that is not within the anatomical boundaries of traditional lumbar hernias.

Orchiectomy or testosterone receptor blockade reduces intestinal mucosal damage caused by ischemia-reperfusion insult.

The aim of the present study was to investigate whether orchiectomy or administration of flutamide an antagonist of the testosterone receptor can reduce oxidative stress and histologic damage in the rat small bowel subjected to mesenteric ischemia/reperfusion (I/R) injury. A total of 32 Sprague-Dawley rats were divided into four groups. Group 1 was control (sham), group 2 was I/R, group 3 was I/R plus orchiectomy (orchiectomy was performed 14 days before I/R), group 4 was I/R plus flutamide (flutamide was given throughout 14 days before mesenteric IR). Rats were subjected to 45 min of mesenteric ischemia followed by 3 h of reperfusion. The levels of ileal malondialdehyde (MDA) and nitric oxide (NO) were found to be significantly lower in orchiectomy and flutamide treatment groups compared with I/R group (P < 0.05). The histopathological injury scores were consistent with the MDA and NO levels. These results suggest that castration or testosterone receptor blockade decreases the level of intestinal I/R injury in male rats and it is an another example for disease variations based on gender differences.

A new term: complete preputial agenesis.

Preputium is the extended part of the foreskin of the penis and covers the glans penis. Several congenital anomalies of the preputium such as disproportionate preputial growth, epidermoid cyst, and phimosis have been reported previously. Although lack of the ventral part of preputium is associated with hypospadias, there are no articles about complete agenesis of the preputium. Here, we report a case with the diagnosis of "complete preputial agenesis." This case is the first in our knowledge.

The protective effect of darbepoetin alfa on experimental testicular torsion and detorsion injury.

AIM: Testicular torsion is a serious urological emergency, usually involving newborns, children, and adolescents which can lead to subfertility and infertility. Prevention of testicular damage caused by torsion is still a clinical and experimental problem. So far many chemicals and drugs have been investigated for decreasing ischemia/reperfusion (I/R) injury in experimental animals. The possible protective effect of darbepoetin alfa, a novel erythropoietic protein, on testicular tissue after I/R injury was examined in this study. METHODS: Thirty rats were divided into three groups: sham operation, torsion/detorsion, and torsion/detorsion plus darbepoetin alfa groups. After torsion (2 hours) and detorsion (4 hours), bilateral orchiectomy was performed. Malondialdehyde, nitric oxide and glutathione levels were determined in testicular tissue. RESULTS: Administration of darbepoetin alfa caused a decrease of malondialdehyde and nitric oxide levels and an increase in glutathione levels compared with the torsion/detorsion group. In addition, histological injury scores were significantly decreased in the treatment group more than the torsion/detorsion group. CONCLUSION: The results suggest that darbepoetin alfa may be a potential protective agent for preventing testicular injury caused by testis torsion.