Comparison of Femoral and Internal Jugular Vein Catheterisation Trends in Sick Infants.

OBJECTIVE: To compare two different ways of central venous access in newborns regarding complications and success rates. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Third-level Newborn Intensive Care Units in Kahramanmaras Sutçu Imam University Health Practice and Research Hospital and Megapark Private Hospital, Turkey, between July 2017 and May 2019. METHODOLOGY: The data of 132 and 81 patients who underwent tunnelled femoral vein (FV) and percutaneous internal jugular vein (IJV) access procedures, respectively, for advanced medical management were reviewed. Planned procedures performed in an operating room under general anaesthesia were included in the study. Demographic data of infants, kind and the number of complications, and findings in clinical follow-up were recorded. RESULTS: There were similar success rates between techniques. No complication requiring intervention occurred during the placement of the FV catheters. Four procedures were interrupted due to periprocedural complications requiring intervention in the placement of IJV catheters. The median value of catheter duration was 25.5 (15-36.75) and 14 (9-20) days in FV and IJV group, respectively, and the difference is significant (p<0.001). Lower infectious complications (p=0.008) were detected in the use of FV catheters. CONCLUSIONS: Similar success rates were found for both ways of central venous access. IJV stent's intrathoracic complications can be too severe for sick infants to cope with. FV stents can also be used in infants with well-tolerated complications. Further studies should confirm the low infectious complication rate of this study in FV catheters. KEY WORDS: Femoral vein, Internal jugular vein, Central venous access, Catheter-related infection, Infants.

The Diagnostic Value of Presepsin in Acute Appendicitis and Reference Ranges for Healthy Children.

OBJECTIVE: This study aimed to investigate the diagnostic value of presepsin, a new inflammatory marker for paediatric appendicitis, and to determine a reference range of presepsin for children. METHODS: This single-center prospective study was conducted in our paediatric emergency department between 1 February 2021 and 1 July 2021. Patients aged 0-18 years diagnosed with acute appendicitis, which was pathologically confirmed, and healthy volunteers in the same age group were included in the study. Serum presepsin levels were analysed using an enzyme-linked immunosorbent assay reader. In addition to presepsin, other acute-phase reactants, paediatric appendicitis scores and imaging methods were evaluated. RESULTS: There were 94 patients in the acute appendicitis group and 102 healthy volunteers in the control group. Median values were compared between the two groups, and no statistically significant differences were found (p = 0.544). In addition, no statistically signivficant differences in presepsin levels were found between the acute and perforated appendicitis groups (p = 0.344). The median (IQ1-IQ3) reference range for presepsin in healthy children was 0.9950 (0.7575-1.610) ng/mL. CONCLUSION: Presepsin is not a suitable marker for the diagnosis of acute appendicitis. We observed that serum presepsin levels were not elevated in paediatric appendicitis, which is a local infection, in contrast to previous studies.

Dressing or Not after Tubularized Incised Plate Urethroplasty.

BACKGROUND: Many surgical techniques, as well as dressing models, were identified in the treatment of hypospadias. There are many publications in the literature that are the result of the effort to find the ideal dressing after hypospadias surgery. The dressing has some benefits; however, it has some adverse effects. The present study aimed to discuss outcomes of the patients who have been operated through the tubularized incised plate urethroplasty (TIPU) method and followed with and without dressing postoperatively. METHODS: Patients operated on through the TIPU method between March 2015 and August 2019 were reviewed retrospectively. The patients were divided into two groups, dressing and undressing. Preoperative hypospadias severity was evaluated according to the Glans-Urethral Meatus-Shaft (GMS) scoring method. The care results of the patients were recorded. Postoperative outcomes were compared according to the Hypospadias Objective Scoring Evaluation (HOSE) scale, and statistical analyses were conducted. The results of both groups were compared statistically. RESULTS: One hundred and nineteen patients were divided into two groups: dressing (n = 56) and nondressing (n = 63). The patients' average age was 3.54 ± 2.97 years in group 1 and 3.50 ± 3.01 years in group 2 (p = 0.940). There was not any statistically significant difference between the two groups for demographic data. Minimal bleeding had stopped in three patients in the nondressing group spontaneously before discharging. No severe edema or hematoma, which might have concerned the parents, appeared. Two (3.5%) and 3 (4.7%) patients underwent a maximum of three urethral dilation sessions in dressing and nondressing groups, respectively (p = 0.556). We found no significant difference between groups in the comparison of preoperative GMS and postoperative HOSE scoring. DISCUSSION: The most important limitation of the study is that it is retrospective. Pre- and postoperative scoring systems are objective. The data obtained in the literature show that surgeons prefer to apply dressings commonly after the TIPU technique. Advantages and disadvantages of dressing are mentioned in the literature. Even if the paradigm is dressing in hypospadias surgery, according to the results of our study, dressing may not affect the functional and cosmetic results of TIPU repair. CONCLUSION: Postoperative functional and cosmetic results of TIPU in hypospadias appear to be independent of dressing. However, the results must be supported by further research.

Proximal ureteral access for symptomatic stone removal using ultrathin semirigid ureterorenoscope in preschool-age children: Is it possible?

INTRODUCTION AND OBJECTIVES: We aimed to point out the ureteral access facility and obstruction removal efficiency of mini-URS in the use of proximal ureteral stone management in children under five-year-old. PATIENTS: We retrospectively reviewed the data of 26 children who underwent mini-URS-LL for obstructive stones in proximal ureter between January 2016 and August 2018. The effectiveness of the mini-URS-LL was assessed based on the feasibility, reliability, and success of the technique. RESULTS: Mean age was 3 ± 1.3 years, and 11 (42.3%) patients were ≤2 years old, remaining 15 (57.7%) were aged 3-5 years. Mean stone size was 9.11 ± 3.02 mm. A stone-free status was obtained at the end of 31 ureteroscopic procedure in 24 (92.3%) patients. The mean age was found significantly higher in patients who had the procedure without pre-stenting than the others who did (P = .027). No perioperative complication was experienced. CONCLUSION: In preschool-age children, laser lithotripsy with mini-URS may be a safe technique in the hands with advanced endo-urological skills but it has low efficacy with higher rates of prestenting causing additional anesthesia sessions.

Use of a Stent in Distal Hypospadias Repaired by Tubularized Incised Plate Urethroplasty: A Comparative Study.

PURPOSE: We present our experience of stented and unstented distal hypospadias repaired by tubularized incised plate urethroplasty (TIPU). PATIENTS AND METHODS: Data of 84 patients who were operated by TIPU method in 2 hospitals were retrospectively analyzed, and they were invited to be included in the study. Sixty-six patients agreed to participate in the study and were divided into 2 groups. Group 1 consisted of 38 boys operated in Sütçü Imam University Hospital on using a stent between 2015 and 2017. Group 2 consisted of 28 boys operated in Private Hospital of Megapark on without a stent between 2016 and 2017. The hypospadias objective scoring evaluation (HOSE) scale was used to compare the groups. RESULTS: The median age was 2.81 years in group 1 and 1.95 years in group 2 (p = 0.243). The mean follow-up duration was 25.74 ± 4.62 and 24.5 ± 4.19 months in groups 1 and 2 respectively (p = 0.268). The HOSE scores were similar in both groups with comparable results (p = 0.622). CONCLUSIONS: No difference was observed between the groups in this study, regarding functional and cosmetic outcomes according to the HOSE score. However, the results should be supported by prospective studies with a sufficient number of patients.

The effectiveness of pneumoreduction for intussusception.

INTRODUCTION: To detect the effectiveness of pneumoreduction (PR) in intussusception, which is one the most common reasons of abdominal pain in infancy and childhood. METHODS: The records of patients treated in our clinic for intussusception between January 2005 and June 2012 were reviewed retrospectively. There were 150 patients aged between 2 months - 12 years of age; 48% (72) were girls, 52% (78) were boys. RESULTS: The most common complaint and clinical findings were abdominal pain (94,6%), vomiting (82.6%), rectal bleeding (81.3%), and discomfort (70.9%). An abdominal mass was observed in 73.3% of patients. PR was successfully performed in 86% of patients. It was carried out once in 86% of these patients and twice in 8.1%. PR was unsuccessful in six patients and they underwent surgery. Manual reduction (31 or 67.4% of operated patients) and resection - anastomosis (15 or 32.6 % of patients) were performed by surgery. Perforation occured in two patients (1.3%) during manual reduction. CONCLUSION: PR is an effective method in the treatment of intussusception with a high success ratio and a low complication ratio. It was possible to perform the procedure especially in patients who came in the early stage of the condition.

Management and treatment of liver injury in children.

BACKGROUND: We aimed to assess the causes of trauma that result in liver injury and additional solid organ injuries, management types and results of management in children referred to our clinic for liver injuries. METHODS: The records of 52 patients who were managed for liver injuries due to blunt abdominal trauma between January 2005-2010 were reviewed retrospectively. RESULTS: The patients were 1-17 (8.3±5.4) years old; 32 (62%) were male and 20 (38%) were female. Causes of injuries included pedestrian traffic accidents (19, 37%), falls from height (15, 29%), passenger traffic accidents (8, 15%), bicycle accidents (8, 15%), and objects falling on the body (2, 4%). Isolated liver injury was present in 32 patients (62%), while 20 patients (38%) had other organ injuries. Liver injuries were grade I in 6 patients (12%), grade II in 14 (28%), grade III in 22 (43%), grade IV in 9 (17%), and grade V in 1 (2%). Forty-five patients (87%) were managed conservatively in this series of liver injury, whereas seven patients (13%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were significantly lower in surgically managed patients. CONCLUSION: As a result, conservative management should be preferred in patients with liver injuries who are hemodynamically stable. Conservative management has some advantages, including shorter duration of stay in hospital, less need for blood transfusion and lower morbidity and mortality rates.