Peritoneal dialysis in children: Infectious and mechanical complications: Experience of a tertiary hospital in Elazig, Turkey.

Background: Peritoneal dialysis (PD) is frequently used in pediatric patients with renal failure. Aim: In the present study, we evaluated the indications and complications of PD and patients' outcomes in pediatric patients. Patients and Methods: Medical records of patients who underwent PD between 2012 and 2019 were analyzed retrospectively. The patients were divided into two groups as acute PD (APD) (Group 1) and chronic PD (CPD) (Group 2). If the patient was diagnosed with acute kidney injury (AKI), an APD catheter was inserted, while a CPD catheter was inserted for patients with stage 5 chronic renal failure or those in which AKI persisted for more than 6 weeks. Results: Group 1 and Group 2 consisted of 62 and 64 patients, respectively. The most common indications for PD were AKI (64.5%) in Group 1, and obstructive uropathy and reflux nephropathy (45.3%) in Group 2. The overall complication rate was 30%. These were leakage at the catheter insertion site (11.2%), catheter occlusion (4.8%), and peritonitis (4.8%) in Group 1; and peritonitis (14.1%), catheter occlusion (6.2%), and inguinal hernia (4.6%) in Group 2. The mortality rate was 72.5% and 23.4% in Group 1 and Group 2, respectively. The most common causes of mortality were multisystem organ failure (40%) and sepsis (33.5%) in both groups. A total of 83 patients (32 in Group 1 and 51 in Group 2) had omentectomy. Catheter revision and/or removal were performed in 11.9% of all patients. Omentectomy had no effect on the prevention of catheter occlusion (p > 0.05). Conclusion: The mortality rate is lower in CPD patients than in APD patients. Although PD in pediatric patients is associated with potential complications, its actual rate is relatively low. The primary catheter dysfunction rate is low, and omentectomy has no significant effect on preventing catheter occlusion.

Laboratory results and clinical findings of children with hydatid cyst disease.

OBJECTIVES: The relationship hydatid cyst (HC) is a parasitic disease that is endemic worldwide. AIMS: To study the clinical findings and laboratory results of patients with hydatid disease. MATERIALS AND METHODS: Total number of patients (n = 78) who underwent surgery for HC disease from 2000 to 2017 were retrospectively evaluated. The patients' demographic characteristics, reasons for admission into hospital, lesion location and size, laboratory results, and complications were recorded. RESULTS: Of the HCs, 59% and 26.9% were located in the liver and lungs, respectively. The rate of multiple organ involvement was 10.3%. A total of 16 (20.5%) cases had ruptured HCs (7 livers, 7 lungs, 1 spleen, and 1 omentum). There was no significant difference in the rate of eosinophilia between patients with and without cyst rupture (P = 0.9). Indirect hemagglutination (IHA) tests yielded negative results in 38.9% of the patients; among them, 32.1% had ruptured HCs. A negative IHA test result was significantly associated with rupture (P = 0.046). No significant difference between rupture and cyst size or location was found. CONCLUSIONS: HC rupture was not correlated with cyst size. The sensitivity of serological tests and the blood eosinophil count was low, even in cases of ruptured HCs. The recurrence rate can be reduced by open surgery and medical treatments.

Is stent type used in snodgrass method a factor in fistula formation?

CONTEXT: Snodgrass method (tubularized incised plate urethroplasty [TIPU]) is a widely used technique for hypospadias repair. AIM: It was aimed to compare the outcome of hypospadias repair with stenting using feeding tube compare with those with Foley catheter. SUBJECTS AND METHODS: The demographic characteristics of the 123 patients who underwent hypospadias repair with Snodgrass method, the success of the applied method, and the factors affecting fistula complication were evaluated retrospectively. Patients were divided into two groups: those operated before January 2010 (Group A) and those who were operated after (Group B). In Group A patients, urethroplasty was performed using silicone Foley catheters, in which balloon of these catheters was filled by saline at appropriate size. In Group B, urethroplasty was performed using feeding catheter. RESULTS: Group A and Group B consisted of 32 and 91 patients, respectively. Fistula developed in 10 (31.3%) and 4 (4.39%) patients in Group A and Group B, respectively. There was a statistically significant difference between the two groups in terms of the development of fistula complication (P = 0.0002). CONCLUSION: The use of a feeding catheter in TIPU could be a more advantageous than using a Foley catheter.

Bochdalek hernia and intrathoracic ectopic kidney: Presentation of two case reports and review of the literature.

Bochdalek hernia is a congenital abnormality with high morbidity and mortality characterized by passage of the abdominal organs into the thoracic cavity through a diaphragmatic defect. Intrathoracic location of abdominal organs such as kidneys is very rare, with a reported incidence of only 0.25% in the literature. Herein, we present two cases of Bochdalek hernia with a herniation of intra-abdominal organ such as kidney that was treated in our clinic and compare this rare case with those in the literature. In both cases, the functionally normal kidneys were left in situ during diaphragmatic repair. No complications were observed during the postoperative period, and 10- and 1-year follow-ups. In cases with Bochdalek hernia associated with an intrathoracic ectopic kidney, the functionally normal ectopic kidneys were left in situ during repair of the diaphragmatic defect without complications.

Ghrelin and NUCB2/Nesfatin-1 expression in unilateral testicular torsion-induced rats with and without N-acetylcysteine.

Testicular torsion (TT) is a common urological problem in the field of pediatric surgery. The degree and duration of torsion determines the degree of testicular damage; however, its effects on the expression of octanoylated ghrelin and nucleobindin 2 (NUCB2) /nesfatin-1 synthetized from testicular tissue remain unclear. We explored the effects of experimentally induced unilateral TT on serum and contralateral testicular tissue ghrelin and NUCB2/nesfatin-1 levels, and determined whether N-acetyl cysteine (NAS) treatment had any effects on their expression. A total of 42 Wistar Albino strain rats were divided into 7 groups: Group (G) I control, GII sham, GIII 12-hour torsion, GIV 12-hour torsion + detorsion + 100 mg/kg NAS, GV 24-hour torsion, GVI 24-hour torsion + detorsion + 100 mg/kg NAS, and GVII 100 mg/kg NAS. Octanoylated ghrelin and NUCB2/nesfatin-1 concentrations were evaluated in serum using the ELISA method and in testicular tissue with immunohistochemical methods. Immunoreactivity of octanoylated ghrelin significantly increased in GI compared to GIII, GV, and GVI (p<0.05). NUCB2/nesfatin-1 immunoreactivity increased in GV and GVIII relative to GI (p<0.05). In the 12-hour torsion group, a significant decrease in octanoylated ghrelin levels with NAS treatment was observed; however, in the 24-hour torsion group, a significant decrease was not observed. In the 12-hour torsion + NAS treatment group, a significant change was not observed in NUCB2/nesfatin-1 expression. Following 24-hour torsion, an increase in NUCB2/nesfatin-1 levels was observed, and NAS treatment did not reverse this increase. It was determined that increases in the expression of octanoylated ghrelin and NUCB2/nesfatin-1, the latter of which was a result of TT, reflect damage in this tissue. Importantly, NAS treatment could prevent this damage. Thus, there may be a clinical application for the combined use of NAS and octanoylated ghrelin in preventing TT-related infertility.

Irisin immunohistochemistry in gastrointestinal system cancers.

Cancer is the leading cause of morbidity and mortality worldwide. Some studies have shown that high heat kills cancer cells. Irisin is a protein involved in heat production by converting white into brown adipose tissue, but there is no information about how its expression changes in cancerous tissues. We used irisin antibody immunohistochemistry to investigate changes in irisin expression in gastrointestinal cancers compared to normal tissues. Irisin was found in human brain neuroglial cells, esophageal epithelial cells, esophageal epidermoid carcinoma, esophageal adenocarcinoma and neuroendocrine esophageal carcinoma, gastric glands, gastric adenosquamous carcinoma, gastric neuroendocrine carcinoma, gastric signet ring cell carcinoma, neutrophils in vascular tissues, intestinal glands of colon, colon adenocarcinoma, mucinous colon adenocarcinoma, hepatocytes, hepatocellular carcinoma, islets of Langerhans, exocrine pancreas, acinar cells and interlobular and interlobular ducts of normal pancreas, pancreatic ductal adenocarcinoma, and intra- and interlobular ducts of cancerous pancreatic tissue. Histoscores (area × intensity) indicated that irisin was increased significantly in gastrointestinal cancer tissues, except liver cancers. Our findings suggest that the relation of irisin to cancer warrants further investigation.

Twenty years of experience with perineal injury in children.

PURPOSE: The aim of this study was to review our 20 years of experience determining the common mechanisms of perineal trauma and initial management to evaluate the effects of classification for treatment. METHODS: A total of 75 children with perineal injuries were reviewed retrospectively, including patient demographics, mechanism of injury, associated injuries, injury severity score, presenting symptoms and methods of diagnosis and treatment. RESULTS: Amongst the 75 children (55 females and 20 males; mean age, 8 years), fall from height, followed by motor vehicle crash and sexual abuse were the most common reasons for injury. The most common symptom on presentation was bleeding, followed by abdominopelvic pain and tenderness. Eleven patients were allowed to heal secondarily, and 64 were examined under general anaesthesia. The affected area was repaired in 48, further diagnostic tools were needed in 20 and 11 cystoscopic, 10 rectoscopic, and 5 vaginoscopic evaluations were performed. Six patients with full-thickness injuries that extended to the peritoneum were treated with colostomy, and all were victims of motor vehicle crashes. CONCLUSION: The genital injury score is a useful genital trauma scale for predicting anogenital injury severity. Identifying the mechanism and severity of perineal and associated injuries under general anaesthesia may facilitate appropriate classification and management.

Bladder perforations in children.

CONTEXT: Bladder perforations in children occur due to several different reasons. AIM: In this clinical series study, we focused on bladder perforations due to the pelvic injury, and our aim also was to create awareness for a rare type of bladder injuries. SETTING AND DESIGN: This was a retrospective study of the patients who were treated in our clinic for bladder perforation between 2006 and 2011. SUBJECTS AND METHODS: We reviewed the documents of childhood bladder perforations, and demographic and clinical characteristics of the patients were obtained. No statistical analyses were used because of the limited number of cases. RESULTS: There were ten patients who suffered from bladder perforation in 5-year period; 5 were male, and 5 were female. The mean age of the patients was 4.35 years. Four patients (40%) experienced iatrogenic perforation and six patients (60%) experienced perforation due to the accident. Common symptoms were hematuria, abdominal tenderness, and inability to urinate. Three patients were diagnosed via emergency laparotomy, without any radiological examinations performed before surgery. Four patients suffered from the intraperitoneal perforation, three patients suffered from extraperitoneal injury and three of them both of intraperitoneal and extraperitoneal injuries. Mean recovery time for patients was 15 days. One patient developed a urinary tract infection and one newborn died due to accompanying morbidities. Nine patients were discharged from the hospital. CONCLUSION: If the patients had a pelvic injury, surgeons must pay attention for the bladder perforation. Isolated bladder perforations are rare, and they are generally associated with iatrogenic injuries. Clinicians should pay attention to findings such as anuria, inability to insert a urinary catheter, and free fluid in the abdomen in order to diagnose the bladder perforation in newborns. Novice surgeons should pay more attention to avoid causing iatrogenic bladder perforation during inguinal hernia repair.

The roles of extracellular matrix proteins, apoptosis and c-kit positive cells in the pathogenesis of ureteropelvic junction obstruction.

AIM: To investigate histopathological changes in ureteropelvic junction obstruction (UPJO) from an etiological perspective. PATIENTS AND METHODS: Medical records of patients with UPJO were reviewed and pathological specimens collected. Nephrectomy materials from forensic autopsies were taken as controls. Specimens were assessed with light microscopy. Fibronectin, type 4 collagen, laminin, Bax and Bcl-2 expression for apoptosis, together with interstitial cells of Cajal determination with c-kit were determined immunohistochemically. Staining scores were evaluated semiquantitatively. Results were evaluated using Mann-Whitney U-test. RESULTS: Control group comprised 14 children (median age, 3.5 years; 6 months-17 years). Study group comprised 22 children with UPJO (median age, 9 months; 1 month-10 years). Light microscopy revealed non-specific inflammation, epithelial proliferation and atrophy with fibrosis in the smooth muscle of the UPJ in all patients. Fibronectin, type 4 collagen and laminin were found to be significantly increased in UPJO at the intrafascicular space of smooth muscle and the matrix of stroma. Bcl-2 expression was increased in UPJO. c-Kit was unable to stain interstitial cells of Cajal, but staining for mast cells was significant. CONCLUSIONS: High expression of fibronectin, laminin and type 4 collagen may indicate a relation to the pathogenesis of UPJO. Defective kidney morphogenesis, during branching and tubulogenesis of ureteric bud, may be responsible for this congenital pathology.

The efficacy of conservative treatment for late term ovarian torsion.

BACKGROUND/PURPOSE: Recent reports have focused on detorsion after ovarian torsion in the literature. The aim of the study was to investigate late term changes in both ovaries after delayed detorsion following ovarian torsion in rats. MATERIALS: Female, prepubertal, Wistar albino rats were divided into four groups (n = 6/group). The left ovaries were used for the study and the right ovaries were kept as the control. The groups were constituted as follows: Group 1: left ovarian fixation, bilateral oophorectomy 48 hours later; Group 2: left ovarian torsion and fixation, bilateral oophorectomy 48 hours later; Group 3: detorsion 48 hours after torsion and bilateral oophorectomy after another 48 hours; Group 4: detorsion 48 hours after torsion and bilateral oophorectomy after 21 days. The total injury score (TIS) was compiled histologically in a double-blind fashion. Congestion, edema, bleeding and polymorphonuclear lymphocyte infiltration were assessed for TIS. RESULTS: The TIS was found to be 8 points in Group 1; 38 in Group 2; 28 in Group 3 and 12 in Group 4, respectively. The TIS was based on results from the left ovaries in Group 1, whereas 31 points were attributable to the left ovaries and 7 to the right ovaries in Group 2. In Groups 3 and 4, TIS points were the same in both study and control ovaries. The difference between the left ovaries of Groups 1 and 2 and the left ovaries of Groups 2 and 4 was statistically significant (p < 0.05). CONCLUSION: Viable ovarian tissue can be detected even after 48 hours of torsion, which is a relatively long period of ischemia. Tissue injury decreases significantly after detorsion during late recovery. In view of previous case reports in the literature and the present findings, detorsion is recommended in children with ovarian torsion regardless of the ischemic period and/or macroscopic appearance.

Does a fibrin-collagen patch support early anastomotic healing in the colon? An experimental study.

BACKGROUND: The aim of this study was to evaluate the effect of absorbable fibrin-collagen patch (FCP) during early colonic anastomotic healing in rats. METHODS: Prepubertal Wistar albino rats were randomly divided into 6 groups of 6 rats each. Colon was transected and then anastomosed with sutures (Group A), sutures+FCP (TachoComb; Nycomed, Austria) (Group AT) or only FCP (Group T). Rats were sacrificed either 3 or 7 days after the anastomosis. Anastomoses were evaluated for perianastomotic adhesion formation, bursting pressures and histological features. RESULTS: Perianastomotic adhesion formation was significant in Groups AT and T. Bursting pressures were in higher group AT than in Group A on postoperative day 3 and lower on day 7 (p < 0.05). Histological examinations revealed an increase in inflammatory cells in Group T on day 3 and decreased wound healing in Group AT when compared to Group A on day 7 (p < 0.05). CONCLUSIONS: In the early period of anastomotic healing, FCP supports anastomotic integrity. However, it also causes an inflammatory reaction which may increase the time necessary for healing process. Thus, the use of this biomaterial should be preferred in only selective clinical cases with a careful follow-up.

An unusual presentation of patent urachus: report of a case.

Congenital umbilical disorders are frequently seen in the pediatric population and are mostly classified as retained umbilical cord structures or failure of umbilical ring closure. Vitelline duct anomalies, urachal anomalies and umbilical herniations comprise the main group of these congenital problems. Here we report a new presentation of vesicoumbilical patency in a 20-day-old male baby. A brief review of the literature concerning the classification of patent urachus to explain the possible mechanism of the anomaly is given.

Sacrococcygeal heart: a very rare differentiation in teratoma.

A mature teratoma was identified in a two-month-old girl who was operated for a sacrococcygeal mass. The cystic components of the mass were accidentally opened during surgery, and a solid, rudimentary organ resembling a heart emerged. It had a vascular pedicle and a pulsation like cardiac activity different from the infant's heart rate. The mass was totally excised together with the coccyx, and in histological examinations, it was diagnosed as a mature teratoma and a rudimentary heart. To the best of our knowledge, the case presented in this report is only the second case of a cardiac development in a teratoma in the literature. In the light of data obtained about this case and related literature, we consider that fetus-in-fetu and teratoma may not be irrelevant entities, and that they possibly have the same developmental malformation. We also suggest that such an intermediate case is a combination of fetus-in-fetu and teratoma.

Detection of bacterial translocation during intestinal distension in rats using the polymerase chain reaction.

To investigate whether distension causes bacterial translocation (BT), a rat model reported earlier by us was used and to detect the presence of bacterial DNA in blood by polymerase chain reaction (PCR) assay, the most sensitive detection method to date. In 4 groups of 4-week-old Wistar-albino rats a total of 15 animals each were included. In the 1st group (distension+gavage), 1010 Escherichia coli colonies were given via gavage and distension was carried out by rectal air inoculation. In the 2nd group (gavage), animals were inoculated with E. coli and no distension was induced. The 3rd group (distension) were only distended and no bacteria were inoculated. The control group were neither distended nor inoculated with E. coli. Blood samples were collected 3 h after manipulations and both blood cultures and PCR assays were performed. According to the PCR results BT was evident in 80% of group 1, 20% of group 2, and 33% of group 3 animals. BT was not determined in the control group. Significantly low percentages of positivity were observed in blood cultures in all groups (P < 0.05). These results confirm reports that BT occurs in the presence of distension and that PCR is a superior way of determining BT. Thus, it would be advisable to utilize PCR technology in cases where the possibility of distension exists, as early intervention might be useful before any severe clinical pathology (sepsis, multiple-organ-system failure) becomes evident.

Protective effect of melatonin on antioxidative system in experimental ischemia-reperfusion of rat small intestine.

AIMS: Effect of exogenously administered melatonin (N-acetyl 5-methoxytryptamine) on antioxidant systems in experimental Ischemia-Reperfusion (I-R) of rat gastrointestinal system (GIS) was examined. METHODS: A total of 40 rats were divided into 4 groups: Group 1 (Sham), Group 2 (I-R), Group 3 (I-R + 10 mg/kg melatonin) and Group 4 (I-R + 20 mg/kg melatonin). Activity levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined in small intestines. RESULTS: There was a significant (p<0.05) reduction in GSH-Px levels in Group 2 (64.16+/-7.02 U/mg protein) compared to Group 1 (80.15+/-9.32 U/mg protein). We observed a meaningful increase in GSH-Px levels in melatonin applied groups (Group 3: 75.94+/-9.83 U/mg protein, Group 4: 78.55+/-9.11 U/mg protein) compared to Group 2. Correspondingly, SOD activity levels were significantly reduced (p<0.001) in Group 2 (24.14+/-4.35 U/mg protein) compared to controls (52.91+/-6.13 U/mg protein). A stronger effect (p<0.001) of melatonin was observed on SOD levels compared to GSH-Px levels in both doses (Group 3: 38.96+/-6.39 U/mg protein, Group 4: 43.07+/-7.76 U/mg protein). Levels of selenium were reduced significantly in Group 2 (1.11+/-0.31 microg/g tissue) compared to Group 1 (2.01+/-0.19 microg/g tissue). Melatonin application in Group 3 (1.13+/-0.28 microg/g tissue) and Group 4 (1.89+/-0.48 microg/g tissue) caused an increase in selenium levels. There was a strong correlation between increases in selenium and GSH-Px levels in Group 4 (r:0.651 p<0.01). CONCLUSIONS: Melatonin seems to exert its antioxidant effect in GIS tract by stimulating SOD and GSH-Px. Selenium also seems to have an antioxidant contribution on protecting rat gastrointestinal tract I-R injury.

The role of melatonin in prevention of intestinal ischemia-reperfusion injury in rats.

BACKGROUND/PURPOSE: The aim of this study was to determine the effect of melatonin, a hormone that is known as an antioxidant, on the prevention of tissue damage during mesenteric ischemia/reperfusion (I/R). METHODS: A total of 40 young Wistar-albino rats were divided equally into 4 groups with varied treatment. Group 1 was control (sham), group 2 was I/R, group 3 was I/R plus melatonin (10 mg/kg) and group 4 was I/R plus melatonin (20 mg/kg). I/R was realized as follows: after laparatomy, a microvascular atraumatic clip was placed across the superior mesenteric artery (SMA) under general anaesthesia, and it was removed after ischemia for 30 minutes. The first dose of melatonin was applied intraperitoneally at the start of reperfusion. The second and third doses were applied intramuscularly on the first and second day. Only SMA dissection under general anaesthesia was carried out in the control group rats. On the third day of the study all the rats were killed, and their bowels were removed. Malondialdehyde (MDA) levels were assayed as an index of lipid peroxidation reflecting free radical reaction in the intestine. Histopathologic analysis was made using light microscopy in a blind fashion. RESULTS: The levels of tissue MDA were found to be significantly lower in groups 3 and 4 compared with group 2 (P < .05). The MDA levels of group 4 did not differ significantly from that of the control group (P > .05). The histopathologic results were consistent with the MDA levels. CONCLUSION: These results suggest that melatonin has a strong antioxidant effect in preventing intestinal I/R damage, and that this effect is exerted in a dose-dependent manner.

Prune-belly syndrome associated with extra-abdominal abnormalities in a 7-year-old boy.

Prune-belly syndrome (PBS) is an association of abdominal wall deficiency, genitourinary anomalies, and in males, cryptorchidism. Other congenital anomalies are associated with PBS, particularly musculoskeletal deformities and gastrointestinal tract anomalies. In this report, a seven-year-old boy with PBS had mega cisterna magna variant, microcornea, aortic stenosis with bicuspid aortic valves, cholelithiasis, and Hirschsprung's disease. Coexistence of these abnormalities with PBS supports the concept of PBS being caused by an early disturbance of not only mesodermal development but also of the other germ layers. There was maternal ingestion of drugs in the 1st month of gestation. All cases with PBS should be evaluated thoroughly for extra-abdominal abnormalities resulting from disturbances of ectodermal and endodermal development. Even though disturbances related to ectodermal and endodermal development may be asymptomatic, early diagnosis of the disturbances may help in preventing possible future problems.

Migration of the abdominal catheter of a ventriculoperitoneal shunt into the scrotum--case report.

A 3-day-old male neonate presented with migration of the ventriculoperitoneal (VP) shunt tip through the patent processus vaginalis resulting in scrotal hydrocele. The association of myelomeningocele with hydrocephalus may have been a predisposing factor in this rare complication. Development of scrotal swelling or hydrocele in a child with VP shunt should be recognized as a possible shunt complication.

Preoperative sonographic diagnosis of sliding appendiceal inguinal hernia.

Rarely, the appendix forms the sliding component of an inguinal hernia. We report the case of a 2-month-old boy who was preoperatively diagnosed with sliding appendiceal inguinal hernia by sonographic examination. To our knowledge, this is the first report in the literature of the preoperative sonographic diagnosis of a sliding appendiceal inguinal hernia.