Can Ischemia-Modified Albumin Be a Helpful Marker in the Diagnosis and Follow-Up of Childhood Intussusception?

OBJECTIVES: Intussusception is the invagination of a proximal segment of the intestine into a more distal segment. The present study aimed to determine the sensitivity of the ischemia-modified albumin (IMA) and the correlation between IMA and the severity of intestinal ischemia in intussusception cases. METHODS: Thirty-six consecutive children aged between 0 and 16 years presenting with the clinical and radiological features of intestinal obstruction caused by intussusception were enrolled in the study. The age- and sex-matched control group was composed of patients undergoing outpatient surgery. The patients were categorized as cases of type I (ileoileal), type II (ileocecal), and type III (colocolic) based on the ultrasonography findings. RESULTS: The mean IMA level of the intussusception group was 179.13 ± 220.33 ng/mL, whereas the mean level was found as 89 ± 70.9 ng/mL in the control group. When the patients were categorized as ileoileal, ileocecal, and colocolic, the mean IMA levels were detected as 235.65 ± 268.14 ng/mL, 174.46 ± 212.8 ng/mL, and 46.95 ± 19.56 ng/mL, respectively. There was a moderate correlation between the invaginated segment lengths measured by the surgeon during the operation and IMA levels. CONCLUSIONS: Our study findings reveal that IMA can be used as an auxiliary diagnostic marker in patients presenting with symptoms and signs suggestive of intussusception. Thus, patients can be screened for mechanical bowel obstruction due to intussusception and may be referred to pediatric surgery centers earlier for further examination.

Testicular volume loss in the long-term follow-up after surgical detorsion of the testis.

AIM: The aim of this study is to evaluate sonographic testicular volume of patients who underwent surgical detorsion due to testicular torsion and to reveal the frequency of long-term testicular volume loss and the factors affecting it. METHOD: The files of patients who underwent surgical detorsion due to unilateral testicular torsion in our hospital between 2011 and 2019 were reviewed retrospectively. Age at the time of detorsion surgery, time from the onset of pain to surgery, degree of torsion, and ultrasonographic testicular volumes before detorsion were noted. Afterward, patients with at least 6 months of follow-up were contacted by phone and testicular volumes were measured by scrotal ultrasonography (US). The sonographic formula Length × Width × Height × 0.72 was used to determine testicular volumes. RESULTS: There were 97 patients who underwent surgical detorsion within the given time frame. However, 43 of these patients accepted to be involved in the study and a follow-up scrotal US was performed. The mean age at the time of detorsion was 13.6 ± 5.6 years, whereas it was 16.7 ± 6.2 years at the time of the follow-up visit. The median time from the onset of pain to surgery was 4 h (range 1-36 h). In the preoperative US, the mean volume of the affected testis was 10.8 ± 5.6 mm3, while the mean contralateral testis volume was 10.2 ± 5.4 mm3 (p = 0.134). The median follow-up time in our study was 24 months (range 6-96 months). In the control US, the mean volume of the affected testis was 9.5 ± 7.1 mm3, while the mean volume of the contralateral testis was 14.4 ± 9 mm3 (p = 0.001). The affected testicular volumes decreased in 23 patients (range 1.1-100%), there was no change in testicular volumes in two patients, and there was an increase in testicular volumes in 18 patients (range 3.8-100%). In the ROC analysis, risk of testicular volume loss can be predicted with 87.5% sensitivity and 83.9% specificity when the time from the onset of pain to surgery exceeds 5.5 h (AUC = 0.904). CONCLUSION: Our results indicated that if the time from the onset of pain to surgery exceeds 5.5 h, the testicular volume loss may be expected in the long term. Thus, patients and parents should be informed accordingly.

Evaluation of parental sociocultural background and education level in response to pediatric testis torsion.

INTRODUCTION: Acute scrotal pain (ASP) remains one of the most common male urologic emergencies in the pediatric age group. The most concerning outcome of testicular torsion (TT) is the need for orchiectomy, which has a negative impact on the child's development in general and on sexual development and psychology in particular. Time is the most important factor in the treatment of TT. Parental awareness of ASP indicating the possibility of TT is a significant factor in children's hospital admission time. Sociocultural background may be an indicator in parental awareness. OBJECTIVE: This study sought to determine if parental sociocultural and education level is associated with delayed treatment for TT. STUDY DESIGN: This retrospective study evaluated data for patients with scrotal or abdominal pain and TT at two hospitals in Konya, Turkey from 2012 to 2020. Study participants were the parents of the patients treated for TT. Participants were contacted by telephone and asked about their educational background. The study population was divided into 2 groups based on parent characteristics. Group 1 parents had an education level less than high school, had no health insurance, were in need of state aid, and had a low sociocultural background. Group 2 parents had an education level of at least high school or higher and had health insurance. Symptom duration (time between symptom onset and hospital admission) and surgical procedures for the patients were compared between the 2 parent groups. RESULTS: Of the 140 patients who received a diagnosis of TT, 77 were in Group 1 and 63 in Group 2. Mean patient age was 12.7 ± 2.7 (5-16) years Median symptom duration was 7 (1-120) hours. Symptom duration was higher in Group 1, but no statistically significant differences were noted between groups (Group 1 duration was 8h vs. Group 2 duration of 6h; p = 0.331). Orchiectomy was performed for 62 (44.3%) patients and testicular-sparing surgery for 78 (55.7%). Orchiectomy rates between groups were statistically significant and higher in Group 1 with 41 (53.2%) versus 21 (33.3%) in Group 2. CONCLUSION: Factors such as low sociocultural family background and low parental education level increase the risk of orchiectomy for their children. Awareness of the symptoms of TT may minimize the possibility of testicular loss.

Unusual localization and coexistence of primary hydatid cyst: a case report.

Hydatid cysts are zoonotic parasitic infections caused by Echinococcus granulosus. Although witnessed in all body parts, the first and most important locations for this parasite are the liver and lungs. Unusually, hydatid cysts are rarely located in the pelvic region. The majority of such cysts generally develop secondary to spontaneous rupture of an hepatic hydatic cyst or due to surgical inoculation. Incidentally diagnosed in a patient admitted with the picture of acute abdomen, a case of primary hydatid cyst located in retrovesical region, an uncommon localization for hydatid cysts, is presented in this report. In patients admitted with symptoms of abdominal pain in endemic regions, and in those suspected of having unidentified cystic lesions, the unusual localization of a primary hydatid cyst should be considered.

Experience of Using Shear Wave Elastography Imaging in Evaluation of Undescended Testes in Children: Feasibility, Reproducibility, and Clinical Potential.

We aimed to determine the difference in tissue stiffness, which might reflect histologic damage, by comparing the potential of the shear wave elastography (SWE) values of operated undescended testes (OUT) with those of undescended testes (UT) and normal testes. A total of 120 patients (235 testes) were enrolled in the current study. Quantitative SWE values were measured by manually drawing contours of the entire testis structure with a free region of interest. A group of 66 OUT were classified as group A. Operation age and the period passed over the operation time and SWE values were compared among the testes assigned to group A. The 50 testes having inguinal canal placement were classified as group B, and the 119 testes whose sonography findings were normal were classified as group C. These 3 groups were compared in terms of the SWE values and volume. The SWE values of group A were significantly higher than those of groups B and C (P < 0.001). The SWE values of group B were significantly higher than those of group C (P < 0.001). The SWE values of OUT were significantly higher than those of the contralateral normal testes and UT (P < 0.001). There were no significant differences among operation age and period passed over the operation time and SWE values in the OUT (P > 0.05). There was no significant correlation between SWE values and testes' volume (P > 0.05). The SWE technique can be used effectively as a new parameter to assess stiffness of the OUT and UT to predict interstitial fibrosis and the severity of histologic damage.

Posttraumatic stress disorder symptoms in children exposed to circumcision under general or local anesthesia.

Kozanhan B, Kocaoglu C, Gündüz M, Akça ÖF. Posttraumatic stress disorder symptoms in children exposed to circumcision under general or local anesthesia. Turk J Pediatr 2018; 60: 718-725. The aim of this study was to investigate the impact of general versus local anesthesia on the Posttraumatic Stress Disorder (PTSD) symptoms after circumcision. Of the 134 consecutive children (7-12 years of age) who underwent circumcision, 71 had general anesthesia (GA) and 63 had local anesthesia (LA). All participants completed the child depression inventory (CDI), State Anxiety (SA) and Trait Anxiety (TA) inventories, and Childhood Anxiety Sensitivity Index (CASI) before the operation as well as the Child Posttraumatic Stress Reaction Index (CPSRI) one month after the operation. The CDI, CASI and TA scores of the children were similar in both groups, while the SA scores of the LA group were higher than those in GA group (p < 0.001). The CPSRI scores of the GA group were higher than those of the LA group (p=0.04). When the other parameters were controlled via regression analysis, only the CDI scores and being in the GA group predicted the CPSRI scores. This study suggests that children witnessing the surgical procedure of the circumcision developed no serious symptoms of PTSD. In contrast, children exposed to GA during circumcision developed more serious PTSD symptoms than children who had LA. The severity of depressive symptoms may be important in the development of PTSD symptoms after circumcision.

Unexpected Death Due to Acute Gastric Dilatation and Gastric Necrosis in an 11-Year-Old Boy.

This report is related to the unusual case of an 11-year-old boy presenting with acute gastric dilatation after the intake of excessive food and carbonated beverages after a 12-hour fasting who died of complications of acute reperfusion syndrome after decompression of the stomach with gastrotomy. An enormously distended stomach was encountered without volvulus and obstruction in the operation. Autopsy and histological findings revealed a severely distended stomach, the walls of which were notably thin and displayed transmural necrosis. The reported case demonstrated that enormous food and beverage intake may cause acute gastric dilatation and gastric necrosis, and subsequently, sudden death may develop in children. The subject reported here is the youngest child in literature dying from acute gastric dilatation and necrosis without any underlying disorders and exposed to autopsy.

A case report with sacral appendage: Is it accessory penis or human tail?

Kocaoglu C, Kocaoglu Ç, Akkoyun I, Karanis IE. A case report with sacral appendage: Is it accessory penis or human tail? Turk J Pediatr 2017; 59: 335-337. Lumbo-sacro-coccygeal appendages are very rare congenital anomalies. It is difficult to say that they are a evolutionary inheritance (tail) from our ancestors or an anomaly (pseudotail) occuring during embrional development. If it is a true tail, this lesion contains adipose and connective tissue, striated muscle, blood vessel and nerves, and is covered by skin. However, if this lesion is a pseudotail, it may be an anomalous prolongation of the coccygeal vertebra, lipoma, teratoma, condrodystrophy or parasitic fetus. We present an infant with a sacral appendage resembling a penis, and its clinical and pathologic differential diagnosis and management are discussed based on literature. Sacral appendages, such as asaccessory penis or human tail, are treated through simple surgical excision. However, patients must be carefully evaluated regarding teratoma and spinal cord pathology.

Endoscopic treatment of grades IV and V vesicoureteral reflux with two bulking substances: Dextranomer hyaluronic acid copolymer versus polyacrylate polyalcohol copolymer in children.

PURPOSE: We aimed at evaluating the efficacy and complications of two bulking substances: dextranomer/hyaluronic acid copolymer(Dx/Ha;Dexell®) versus polyacrylate polyalcohol copolymer(PPC;Vantris®) in subureteric injection treatment of children with high grades (grades IV-V) vesicoureteral reflux(VUR). METHODS: Data of patients undergoing endoscopic treatment of high grade VUR (January 2009-August 2015) were retrospectively investigated. Patients with high grade VUR caused by posterior urethral valve, duplex system, paraureteral diverticula and neurogenic bladder were excluded. Classical subureteric injection method (STING) was used. Seventy-three children (45 girls and 28 boys) who had 88 refluxing renal units (RRUs) with grades IV-V VUR (n=64/n=24) underwent endoscopic treatment using Dx/Ha (n=63 RRUs) and PPC (n=25 RRUs). RESULTS: Mean age of patients in Dx/Ha and PPC groups were 6 (3) and 6 (3.75) year (p=0.81), and volumes of these substances given were 1.3 (1) and 1 (0.5) mL (p=0.003), respectively. Overall, for the first endoscopic injection, success rate of grades IV-V VUR per RRU was 53.9% with Dx/Ha, compared to 80% in PPC-injected group, (p=0.024). Late ureterovesical junction obstruction developed only in one patient in PPC-injected group. No ureteral obstruction was observed in Dx/Ha-injected group. CONCLUSIONS: Endoscopic injection of PPC resulted in significantly higher success rate, compared to Dx/Ha in subureteric injection treatment of children with high grade VUR. However, the development of late ureterovesical junction obstruction should also be taken into account in PPC injection.

The effectiveness of 4.5F ultrathin semirigid ureteroscope in the management of ureteral stones in prepubertal children: is there a need for any ureteral dilatation?

OBJECTIVE: To evaluate the effectiveness of 4.5F ultrathin semirigid ureteroscope (ultrathin-URS) in the management of ureteral stones in prepubertal children without active or passive ureteral dilatation. MATERIALS AND METHODS: Records of 36 children undergoing ureteroscopy with ultrathin-URS were retrospectively reviewed in 2 different centers for ureteral calculi between November 2011 and December 2013. Stones were fragmented with holmium:yttrium-aluminum-garnet laser and pneumatic lithotripter. Patients' demographics, stone location and size, active dilatation, passive dilatation, postoperative stenting, stone-free rates, and complications were noted. RESULTS: Patients consisted of 21 girls and 15 boys with a mean age of 5.33±3 years. Stones were located in the distal, mid, and proximal ureter in 26, 5, and 5 patients, respectively. All ureteroscopies were performed with no active or passive dilatation. Ultrathin-URS was able to provide a stone-free status in the first procedure except 1 patient whose stone was too proximal. Postoperative ureteral stents (post-stenting) had initially been placed in 16 procedures at the end of the procedure to maintain the ureteral passage. However, after increasing occupational experience and learning that ureteral traumas were minimal with ultrathin-URS, no postoperative stent was used in the following procedures. As to complications, only 3 patients had mild hematuria, and 1 patient had febrile urinary tract infection, and 1 stone migration. No ureteral perforation, obstruction and avulsion were encountered. CONCLUSION: In ureteral stone management, ultrathin-URS along with either holmium:yttrium-aluminum-garnet laser or pneumatic lithotripter can be safely and effectively used with a minimal morbidity as a first-line treatment in prepubertal children without active or passive ureteral dilatation and postoperative stenting.