Determining The Risk Factors For Anastomotic Stricture Development After Esophageal Atresia Repair: Results From The Turkish Esophageal Atresia Registry.

INTRODUCTION: Anastomotic stricture (AS) is the second most common complication after esophageal atresia (EA) repair. We aimed to evaluate the data in the Turkish Esophageal Atresia Registry to determine the risk factors for AS development after EA repair in a large national cohort of patients. METHODS: The data between 2015 and 2021 were evaluated. Patients were enrolled into two groups according to the occurrence of AS. Patients with AS (AS group) and without AS (No-AS group) were compared according to demographic and operative features, postoperative intubation status, and postoperative complications, such as anastomotic leaks, fistula recanalization, and the presence of gastroesophageal reflux (GER). A multivariable logistic regression analysis was performed to define the risk factors for the development of AS after EA repair. RESULTS: Among the 713 cases, 144 patients (20.19%) were enrolled into the AS group, and 569 (79.81%) in the non-AS group. The multivariable logistic regression showed that ,being a term baby (OR 1.706; p = 0.006), having a birth weight over 2500 g (OR 1.72; p = 0.006), presence of GER (OR 5.267; p<0.001), or having a recurrent tracheoesophageal fistula (TEF, OR 4.363; p = 0.006) were the risk factors for the development of AS. CONCLUSIONS: The results of our national registry demonstrate that 20% of EA patients developed AS within their first year of life. In patients with early primary anastomosis, birth weight greater than 2500 g, and presence of GER were risk factors for developing AS. When patients with delayed anastomosis were included, in addition to the previous risk factors, being a term baby, and having recurrent TEF also became risk factors.

Oxidative stress responses of virtual reality use in refugee children undergoing elective surgery: A randomized controlled trial.

BACKGROUND: With the Virtual Reality (VR) technique, 3D movies can be made for refugee children for pre-operative stress. The study aims to reveal the oxidative responses of the VR technique in pre-operative anxiety in elective surgery in children aged 5-12 years. METHODS: The Study was designed according to the CONSORT checklist with a randomized controlled parallel design. The whole sample (n = 23), VR experimental group (n = 12), and control group (n = 11) were determined according to the total count method prospectively in 6 months. Oxidative stress parameters (Cortisol, Malondialdehyde, Nitric oxide, Glutathione) were measured in blood samples from the first hospitalization (beginning) and before the intervention (pre-operative) in the experimental and control groups. FINDINGS: MDA, NO, and cortisol levels (p < 0.05), which indicate the stress level, are high in all groups. In pre-operative measurements, oxidative parameters were lower in the VR experimental group than in the control group. At the same time, the anti-stress antioxidant factor Glutathione was higher in the VR experimental group in pre-operative measurements. DISCUSSION: The application of 3D film as a VR technique reduces stress parameters in pre-operative stress, and its antioxidant system activating effect has been determined. APPLICATION TO PRACTICE: It can be applied to refugee child groups for pre-operative stress by shooting 3D movies in different languages.

Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility.

INTRODUCTION: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. METHODS: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. RESULTS: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). CONCLUSION: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.

Secondary blast injury: radiological characteristics of shrapnel injuries in children.

PURPOSE: The aim of this study is to examine the radiological images of child victims suffering from secondary blast injuries, to reveal organ-based injury patterns and their interrelationships, and to record mortality rates that may develop due to injured systems. METHODS: A total of 65 patients with secondary blast injury due to bomb explosion were included in the study. Injury findings due to shrapnel in radiologic images of the patients were examined. Injured systems and types of injuries were recorded. RESULTS: The most common injuries were intra-abdominal injuries (63%) and fractures (58.5%). Lung injury was observed in 4 (9.8%) of 41 patients with intra-abdominal injury, while 37 (90.2%) did not, and this was statistically significant (p = 0.003). The most common intra-abdominal organ injury was a small bowel injury in 23 (35.4%) patients. The coexistence of small bowel injury and large bowel injury was present in 8 patients (34.8%), and it was statistically significant (p = 0.019). A total of 14 (21.5%) of the patients died. There was no significant relationship between mortality and gender (p = 319). Brain damage was present in 10 (71.4%) of the 14 (21.5%) patients who died, which was statistically significant (p < 0.001). CONCLUSION: Our results showed that the most common injuries were intra-abdominal injuries, damage to different organs could occur at the same time, and deaths were especially associated with brain injuries. For this reason, it should not be forgotten that CT scans will have an important place in the triage of the patient, especially in victims with shrapnel at the abdominal and cranial levels in radiography examinations.

The Role of Acidic Urine on Detrusor Pressure in Patients with Overactive Bladder: A Urodynamic Evaluation.

OBJECTIVES: To evaluate the relationship between urine pH value and urodynamic parameters in patients with overactive bladder. METHODS: The patients' data whose underwent standard urodynamic study at two tertiary centers in our city. The period between January 2015-January 2021 was reviewed retrospectively. The inclusion criteria were the patients with overactive bladder, over 18 years of age, and with urine analysis before urodynamic study. Patients were divided into two groups as those with acidic urine pH (Group 1) and without (Group 2). The detrusor pressures obtained from filling cystometry were compared between the groups. In addition, the correlation between detrusor pressure and urine pH was examined. RESULTS: The data from 211 patients (109 females, 102 males) were analyzed during the screening period. Eighty-two patients were in Group 1 and 129 patients in Group 2. The mean age was similar between the groups (p = 0.244). The bladder volume at first sensation of filling and urodynamic maximal bladder capacity was lower in Group 1 than Group 2 (p = 0.004; p < 0.001, respectively). The maximum detrusor pressure was higher in the acidic urine pH group (Group 1, 55.8 ± 20.6) than non-acidic urine pH group (Group 2, 14.5 ± 10.2), and it was statistically significant (p < 0.001). In addition, a significant negative correlation was observed between urine pH level and detrusor pressure (p < 0.001). CONCLUSIONS: The presence of acidic urinalysis is associated with many urodynamic findings. Significantly, the patients with detrusor overactivity had more acidic urine than without detrusor overactivity. Therefore, for patients with high detrusor pressure, urinalysis should be evaluated carefully.

The Role of Acidic Urine on Detrusor Pressure in Patients with Overactive Bladder: A Urodynamic Evaluation

Objectives: To evaluate the relationship between urine pH value and urodynamic parameters in patients with overactive bladder. Methods: The patients’ data whose underwent standard urodynamic study at two tertiary centers in our city. The period between January 2015–January 2021 was reviewed retrospectively. The inclusion criteria were the patients with overactive bladder, over 18 years of age, and with urine analysis before urodynamic study. Patients were divided into two groups as those with acidic urine pH (Group 1) and without (Group 2). The detrusor pressures obtained from filling cystometry were compared between the groups. In addition, the correlation between detrusor pressure and urine pH was examined. Results: The data from 211 patients (109 females, 102 males) were analyzed during the screening period. Eighty-two patients were in Group 1 and 129 patients in Group 2. The mean age was similar between the groups (p = 0.244). The bladder volume at first sensation of filling and urodynamic maximal bladder capacity was lower in Group 1 than Group 2 (p = 0.004; p < 0.001, respectively). The maximum detrusor pressure was higher in the acidic urine pH group (Group 1, 55.8 ± 20.6) than non-acidic urine pH group (Group 2, 14.5 ± 10.2), and it was statistically significant (p < 0.001). In addition, a significant negative correlation was observed between urine pH level and detrusor pressure (p < 0.001). Conclusions: The presence of acidic urinalysis is associated with many urodynamic findings. Significantly, the patients with detrusor overactivity had more acidic urine than without detrusor overactivity. Therefore, for patients with high detrusor pressure, urinalysis should be evaluated carefully (AU)

Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study.

INTRODUCTION: Kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are the leading novel biomarkers used efficiently in acute kidney injury (AKI). The levels of these biomarkers increase especially in the early period of nephrotoxic and ischemic renal damage. In this study, we aimed to investigate the clinical importance of NGAL and KIM-1 biomarkers used in the effective evaluation of kidney functions in patients with acute unilateral obstructive stone disease (AUOSD) in the management of endoscopic surgery. MATERIALS AND METHODS: We prospectively included patients who underwent endoscopic surgery due to AUOSD between January 2018 and December 2019. Urine KIM-1 and NGAL values of the patients were measured preoperative period, postoperative 4th h, and postoperative 7th day. The patients were evaluated according to the location and size of the stone, the degree of renal hydronephrosis, the duration of the operation, complications, and JJ stent placement. RESULTS: The study enrolled 50 patients. Urinary KIM-1/Cr and urinary NGAL/Cr ratios were higher in postoperative 4th h than in others (p < 0.001). Also, we found that urinary KIM-1/Cr and urinary NGAL/Cr ratios with Grade 2 and higher hydronephrosis were statistically higher than Grade 0-1 hydronephrosis (p < 0.001 and p: 0.042, respectively). Additionally, a preoperative urinary KIM-1 value of 1.24 ng/mL had a sensitivity of 78% and a specificity of 63% to predict the presence of hydronephrosis. When urine KIM-1 and NGAL results were compared with surgery time, stone size and location, serum creatinine (sCr) value, and Post-Ureteroscopic Lesion Scale grade, the difference was not statistically significant. Postoperative 7th day NGAL/Cr and KIM-1/Cr ratios were statistically higher in those with JJ stents placed (p: 0.03 and p: 0.004, respectively). CONCLUSION: KIM-1 and NGAL can be used in our assessment of renal function in patients with AUOSD, even if sCr is normal. Also, these biomarkers can predict the presence of hydronephrosis. It can be helpful in determining the time of surgical treatment, as well as providing information in the follow-up of patients with JJ stents after treatment.

The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: "Postsurgical Fatty Tumor." Is It Related to the Surgical Technique?

After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as "postsurgical fatty tumor." This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.

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.

Comparison of Oral Sodium Bicarbonate and Solifenacin Treatment in Female Overactive Bladder Patients With Acidic Urine pH.

OBJECTIVE: In this study, we planned to compare the effects of oral sodium bicarbonate (NaHCO3) and anticholinergic (solifenacin) treatments in women with overactive bladder (OAB) and acidic urine pH values (<6). METHODS: According to the referral order of OAB patients, 8 g/d oral NaHCO3 (group 1) or 5 mg/d solifenacin succinate (group 2) was given to the patients. Both treatment regimens were applied one at a time for 12 weeks in total. Laboratory values, bladder diary, Patient Perception of Bladder Condition score, Patient Perception of Intensity of Urgency Scale, Overactive Bladder-Validated 8-Question Awareness Tool, and the King's Health Questionnaire (KHQ) scores before and after treatment were compared. RESULTS: A total of 59 patients were evaluated. Thirty-one patients were included in group 1, and 28 patients were included in group 2. No difference was detected in pretreatment and posttreatment laboratory values other than urine pH values in both groups. Whereas there was no difference in pretreatment urine pH values among the 2 groups, posttreatment urine pH values were significantly higher in group 1 compared with group 2 (P = 0.08, P < 0.001, respectively). There was a significant amelioration in the bladder diary parameters, symptom scores, and KHQ values measured after treatment in both groups. However, degree of amelioration in posttreatment outcomes was similar among the groups. CONCLUSIONS: It was demonstrated that urinary alkalization made with oral NaHCO3 in female OAB patients with acidic urine pH had a significantly positive effect on symptoms and symptom scores, and these results are similar to the results of solifenacin treatment.

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 urine alkalinization with sodium bicarbonate orally on lower urinary tract symptoms in female patients: a pilot study.

INTRODUCTION AND HYPOTHESIS: In this study, we planned to explore the effects of sodium bicarbonate orally (NaHCO3) treatment on female patients with lower urinary tract symptoms (LUTS) who have acidic urine pH values (<6). METHODS: NaHCO3 was given orally to 33 female patients for 4 weeks at a dose of 2 × 4 g/day. Laboratory values, bladder diary, the Patient Perception of Bladder Condition Score (PPBC), Patient Perception of Intensity of Urgency Scale (PPIUS), Overactive Bladder-Validated 8-question Awareness tool (OAB-V8), Pelvic Pain and Urgency & Frequency Patient Symptom Scale tests (PUFSS), and the King's Health Questionnaire (KHQ) scores before and after treatment were compared. RESULTS: A significant increase was detected in urine pH values measured after treatment (5.31 ± 0.52 to 7.2 ± 0.66, p < 0.001), but not in blood pH values (7.369 ± 0.33 to 7.384 ± 0.28, p = 0.14). After treatment, a significant decrease was detected in daily frequency, nocturia, urgency, and urge incontinence prevalence (p < 0.001,p = 0.003, p < 0.001, p = 0.002, respectively) and PPBC, PPIUS, PUFSS, and OAB-V8 symptom scores (p = 0.004, p = 0.002, p < 0.001, p < 0.001, respectively). A significant decrease was detected in all KHQ subunit scores. CONCLUSION: Urine alkalinization with NaHCO3 orally in female patients with LUTS and acidic urine pH has a significant level of positive effects on symptoms and symptom scores. Our results show that this new treatment modality-which is inexpensive, easy to use, and has a low side-effect profile is effective in this chronic patient group.

Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl.

Atici A, Yilmaz E, Karaman A, Apaydin S, Afsarlar ÇE. Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl. Turk J Pediatr 2017; 59: 90-92. Ovarian auto-amputation is an extremely rare condition commonly encountered in the perinatal period. Spontaneous or secondary torsion of the ovary caused by an ovarian lesion may result in infarction and subsequent auto-amputation of the ovary. This paper demonstrates a case that underwent laparoscopic appendectomy with an incidental calcified auto-amputated right ovary. A 16-year-old adolescent girl was admitted to our department with a history of one-day abdominal pain. Physical examination of the patient revealed abdominal tenderness and rigidity on right lower quadrant. Her white blood cell count was 11x103/mL, and C-reactive protein was 69 mg/L. The patient underwent a laparoscopic appendectomy with a provisional diagnosis of acute appendicitis, and further exploration revealed a 2x2 cm white ovoid mass floating freely in the pelvis. The left ovary was clearly identified in its usual localization, but the right tuba was blindly ending without any fimbria or ovary. Postoperative course of the patient was uneventful, and she was discharged on postoperative day 2. The histopathological examination revealed a necrotic calcified ovarian teratoma. Auto-amputated ovary is a rare occasion mostly encountered during perinatal period, and it may be unilateral or bilateral. An auto-amputated ovarian mass may rarely be a teratoma although the most common cause of auto-amputation during perinatal and adolescent period is ovarian torsion due to an ovarian cyst.

Peutz-Jeghers syndrome: an unusual cause of recurrent intussusception in a 7-year-old boy.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by intestinal hamartomatous polyps in association with mucocutaneous pigmentations. Main symptoms of PJS in childhood are abdominal pain, obstruction, intussusception, and bleeding from hamartomatous polyps. PJS carries a high risk of gastrointestinal cancer with advancing years. Although, intussusception has been reported as a well-known complication of PJS, recurrent intussusception as an alarming finding in a patient with normal gastrointestinal endoscopy is uncommon. A 7-year-old boy who had recurrent intussusception episodes and diagnosed with PJS histopathological confirmation after surgical excision of involved bowel segments is presented to discuss the clinical features and treatment options of recurrent intussusception as a presenting finding of PJS.

Factors affecting mortality in stage 3b necrotizing enterocolitis.

This study aimed to determine the factors that may affect the development of mortality in patients with stage 3b necrotizing enterocolitis (NEC). Between January 2005 and December 2012, patients with the diagnosis of stage 3b NEC who were surgically treated were enrolled in the study. Gestational age, birth weight, presence of hypoxemia history, major congenital heart diseases, enteral feeding, age at perforation, drainage type, operation, and laboratory findings were considered regarding their possible relationship with mortality. Thirty-one patients were enrolled in this study. Following treatment, 15 patients died, while 16 patients recovered and were discharged. Feeding type, high levels of prothrombin time (PT), activated partial thromboplastin time (aPTT), creatinine, and low platelet count, as well as need of inotropic support were associated with mortality. When the cut-off point of platelet level for mortality development in stage 3b NEC was calculated by receiver operating characteristic (ROC) curve, the cut-off point for thrombocyte level was found to be 110,000/µL, with 93.3% sensitivity and 87.5% specificity. Despite the innovations in newborn intensive care, the mortality rate of stage 3b NEC remains very high. Breastfeeding has a significantly positive impact on the survival of patients with NEC. Thrombocytopenia is the most important risk factor of mortality in stage 3b NEC.