Post-traumatic stress disorder in mothers of children who have undergone cancer surgery.

BACKGROUND: The aim of this study was to investigate the rate of post-traumatic stress disorder (PTSD) and associated risk factors among mothers of children who underwent cancer surgery. METHOD: This cross-sectional, multi-center study included a total of 60 mothers whose children underwent major thoraco-abdominal surgery and were under follow up in the outpatient setting between February 2016 and May 2016. Clinical Data Form, Hospital Anxiety and Depression Scale (HADS), and Clinician-Administered PTSD scale were used. RESULTS: Of all participants, 13 (21.7%) were diagnosed with PTSD. These mothers had shorter duration of marriage, longer duration of hospital stay after surgery, and higher HADS scores, compared with the others without PTSD. Thoughts of guilt such as "I am being punished or tested" were more frequent in mothers with PTSD. Insomnia, irritability, concentration problems, and psychological reactivity were the most common symptoms. CONCLUSION: Post-traumatic stress disorder is a severe disorder that may worsen the daily functioning of mothers and may also have an unfavorable effect on child. It is therefore of utmost importance for clinicians to recognize PTSD and the associated risk factors in order to guide these parents.

Ovotesticular disorder of sexual development and a rare 46,XX/47,XXY karyotype.

Ovotesticular disorder of sexual development (DSD) is characterized by the presence of both ovarian and testicular tissues in the same individual. The most common karyotype is 46,XX. Here, we report the case of a boy with a 46,XX/47,XXY karyotype diagnosed as ovotesticular DSD by gonadal biopsy. A 5-month-old boy presented with hypospadias, unilateral cryptorchidism, and a micropenis. Pelvic magnetic resonance imaging revealed a suspicious gonad tissue that is solid in structure in the right scrotum and a suspicious gonad that is cystic in structure in the left inguinal canal. He underwent a diagnostic laparoscopy. Cytogenetic analysis of peripheral blood revealed a 46,XX/47,XXY karyotype. Histopathologic examination of the left gonad showed ovarian tissue containing primordial follicles with ipsilateral undifferentiated tuba uterina. The right gonad showed immature testis tissue. He underwent left gonadectomy and hypospadias repair, and was raised as a male. Through this rare case, we highlight the importance of histological and cytogenetic investigation in DSD.

Subsequent alterations in the contractile property of the vas deferens according to duration of spermatic cord torsion.

OBJECTIVE: To determine whether twisting of the ipsilateral vas deferens results in alteration of its contractility. DESIGN: Experimental study. SETTING: University animal lab. ANIMAL(S): 24 male Wistar rats. INTERVENTION(S): All the rats in the experimental groups underwent spermatic cord torsion. Durations of torsion were 45 minutes, 3 hours, and 24 hours in groups 2, 3, and 4, respectively. In groups 2 and 3, subgroups b were created to evaluate late effects using in vitro pharmacological techniques. MAIN OUTCOME MEASURE(S): The contractility of the vas deferens was evaluated in groups 1, 2a, 3a, and 4 right after and in groups 2b and 3b 48 hours after the initial operation. RESULT(S): Group 4 and subgroups 2b and 3a had significantly diminished responses compared with the control group, whereas in subgroups 2a and 3b, the responses to noradrenaline and to single-pulse field stimulation were not significantly different. CONCLUSION(S): The impairment of contractility with the twisting of the vas deferens might be another factor responsible for subfertility, particularly that related to sperm transport. The unfavorable late change in short duration of torsion may be the result of either ischemia and reperfusion injury or sympathetic overactivation in the acute period of torsion.

Gorham-Stout syndrome with chylothorax in a six-year-old boy.

Gorham-Stout syndrome, also called "disappearing bone disease, diffuse cystic angiomatosis of bone, disseminated lymphangiomatosis, Gorham's vanishing bone disease, phantom bone disease or idiopathic massive osteolysis, is a rare disease of unknown etiology and pathogenesis. It is characterized by rapidly progressive localized massive osteolysis associated with proliferation of vascular structures of benign origin in which the absence of new bone formation is representative. When it is complicated by chylothorax, the prognosis is poor. The authors report a 6-year-old boy with Gorham-Stout syndrome who presented with pleural effusion showing features of chylothorax, who responsed poorly to currently available therapeutic modalities.

The morphological evaluation of ipsilateral and contralateral vasa deferentia in a rat model of unilateral spermatic cord torsion.

AIM: Spermatic cord torsion is a surgical emergency that requires early intervention to protect the effected testicle. The literature review about this ischemic reperfusion (I/R) injury reveals not only ipsilateral, but also contralateral testicular and epididymal injuries in a broad fashion. However, there is no data about vas deferens injury related with this surgical emergency. The aim of the study is to evaluate the morphological changes of the vas deferens due to testicular I/R injury. MATERIALS AND METHODS: Eighteen Wistar-Albino rats were allocated to three groups. Bilateral vasa deferentia of control group (Gr C, n = 6) were harvested without any surgical intervention. The torsion group was subjected to 2 h torsion and 2 h detorsion of the left testicle (Gr T, n = 6) and the third group underwent sham operations (Gr S, n = 6). Bilateral vasa deferentia of Gr T and S were harvested after surgery. The either side of the vas deferens was divided into three equal segments and these regions (adjacent to urinary bladder, medial and adjacent to testicle) were evaluated histopathologically. RESULTS: The electron microscopic evaluation of bilateral vasa deferentia of Gr T revealed different degrees of degeneration on either side. The region adjacent to testicle of the contralateral vas deferens was the most effected segment when compared with the other segments. CONCLUSION: In the light of these findings, it can be said that testicular I/R injury effects not only testis and epididymis, but also the adjacent vas deferens. This effect seems to be bilateral, like the testis and epididymis injury. Moreover, it mostly seems to depend on the apoptotic processes.

Fournier's gangrene in childhood: a report of 3 infant patients.

Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy. Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively. Especially, prematurity and diaper rash are rare predisposing factors in the pediatric population; therefore, high index of suspicion, prompt diagnosis, conservative surgery, and multidisciplinary approach are the mainstays of management in children with Fournier's gangrene.

Thoracoscopic assessment of mediastinal tuberculous lymphadenitis in a 4-month-old child.

Isolated mediastinal tuberculous lymphadenitis is a relatively common entity in children, second in frequency after cervical localization. In the absence of an accompanying parenchymal lesion, mediastinal tuberculous lymphadenitis may pose a diagnostic dilemma on admission and must be distinguished from other causes of mediastinal masses. Bronchoscopy is suggested as a diagnostic tool where tuberculosis cannot be excluded by radiology or specific skin tests. Thoracotomy and excision is reported as necessary to treat the obstructive symptoms. In this report, the diagnostic and therapeutic feasibility of thoracoscopic mediastinal node biopsy in a 4-month-old presenting mediastinal tuberculous lymphadenitis is reported.

Incomplete duodenal obstruction in a newborn.

A case of newborn with incomplete duodenal obstruction caused by superior mesenteric artery syndrome has been presented with this report. A full term, 1-day-old baby girl was referred to our hospital because of recurrent bilious vomiting since birth and upper gastrointestinal barium study revealed the incomplete obstruction at the 3rd part of the duodenum with a vertical abrupt cutoff. The diagnosis of superior mesenteric artery syndrome was made with ultrasonography and duodenojejunostomy was carried out. Although it is extremely rare, superior mesenteric artery syndrome should also be considered as one of the rare cause of incomplete duodenal obstruction in newborn period.

A continuous debate on contralateral processus vaginalis: evaluation technique and approach to patency.

We present our experience with the transinguinal diagnostic laparoscopy and discuss its efficacy in evaluating the contralateral side in unilateral inguinal hernias. The possible influence of the initial side of hernia, age and gender on recognized bilateralism were also evaluated in two study groups (diagnostic laparoscopy vs clinical diagnosis). In this retrospective study, we evaluated 36 bilateral, 158 left-sided and 303 right-sided consecutive inguinal hernia cases. A total of 211 out of 461 unilateral cases underwent hernia repair and transinguinal laparoscopic evaluation of the contralateral side. Complications and difficulties of the technique, the mean duration of laparoscopy and operative times were additionally analyzed from operation charts. In this study, bilateralism was determined by transinguinal laparoscopy in Group 1 (children with a contralateral patent processus vaginalis) and clinically in Group 2 those who had a metachronous hernia. The patients were also analyzed according to the side of the inguinal hernia, age and gender in both groups. We found an overall positive contralateral patency in 41 cases (19.4%). We failed to perform a successful diagnostic laparoscopy in six cases (2.7%). No anesthetic or surgical complications were noted. Transinguinal laparoscopy did not add any considerable time to the mean operation time. The incidence of bilateralism in Group 1 was higher in girls than boys. Clinically detected bilateralism was significantly higher in 0-6 month age group and contralateral patency detected via laparoscopy was high in all other age groups. We may conclude that transinguinal diagnostic laparoscopy is a feasible technique in children. We advocate its use as a tool with minimal complication risk even in the hands of novice.

A comparative study of the effects of hemin and bilirubin on bilateral renal ischemia reperfusion injury.

BACKGROUND/AIMS: The aim of this study was to determine the effects of hemin, a heme oxygenase-1 inducer, and bilirubin on renal ischemia-reperfusion (I-R) injury. METHODS: 40 Wistar-Albino rats were allocated into six groups as follows: sham (S), bilirubin (B), hemin (H), ischemia/reperfusion (IR), IR + bilirubin (IRB) and IR + hemin (IRH). Conjugated bilirubin (20 mg.kg(-1) i.v.) was given to rats in groups B and IRB, and hemin (50 mg.kg(-1) i.p.) was given to rats in groups H and IRH just prior to reperfusion. Renal I-R was achieved by occluding the renal arteries bilaterally for 50 min. Following 6 h of reperfusion, blood was drawn to study BUN, creatinine and bilirubin, and tissue samples were harvested to determine the renal malonyldialdehyde and heme oxygenase-1 levels, and for histopathologic grading. RESULTS: BUN, creatinine and malonyldialdehyde levels in group IRH were similar to controls whereas the results of groups IR and IRB were significantly higher (p < 0.01). There was a grade 2 damage in all I-R groups. CONCLUSION: This study showed the preventive effect of hemin on renal ischemia reperfusion injury. Administration of exogenous bilirubin did not prevent the I-R injury.

The effects of melatonin on electrical field stimulation-evoked biphasic twitch responses in the ipsilateral and contralateral rat vasa deferentia after unilateral testicular torsion/detorsion.

It is not known whether there is an impairment in vas deferens motility after unilateral testicular torsion/detorsion. Therefore, we aimed to determine whether the electrical field stimulation (EFS)-evoked biphasic contractions are altered in ipsilateral and contralateral rat vasa deferentia obtained from animals exposed to the unilateral testicular torsion/detorsion procedure. We also evaluated the effects of melatonin (MLT), which is a strong antioxidant, on these contractile responses. Rats were subjected to torsion of the left testis for 2 h and then detorsion was performed. Contractility studies were carried out 2 h or 24 h after detorsion. Vas deferens strips were prepared from both the ipsilateral and the contralateral site 2 h or 24 h after the detorsion procedure to record EFS-evoked biphasic twitch responses. The same experimental protocol was repeated for the MLT-treated rats. Both phases of EFS-evoked contractions were decreased after torsion/detorsion in the ipsilateral vas deferens. MLT treatment increased torsion/detorsion-induced reduction of both phases of contractions after 2 h and 24 h. In the contralateral vas deferens, the first phase of EFS-evoked contractions was not changed, while the second phase of contractions was diminished 2 h and 24 h after detorsion. Although MLT decreased the second phase of contractions 2 h and 24 h after detorsion, it reduced the first phase of contractions only 2 h after detorsion. These results suggest that MLT produces an inhibition on EFS-evoked biphasic twitch responses in the ipsilateral and contralateral rat vasa deferentia following unilateral testicular torsion/detorsion in the rat.

Diffuse neonatal abdominal lymphangiomatosis: management by limited surgical excision and sclerotherapy.

Complete excision of diffuse abdominal lymphangiomatosis in the newborn is next to impossible. A 3-day-old female infant was found to have diffuse abdominal lymphangiomatosis predominantly in the left mesocolon and retroperitoneum. Initial management was by marsupialization, which was complicated by chylous ascites requiring periodic paracentesis and nutritional support. At the age of 45 days, left hemicolectomy and partial excision of the retroperitoneal cysts were performed together with intracystic injection of OK-432 into the residual cysts. The patient's progress after the second operation was satisfactory. Initial marsupialization followed by delayed partial resection together with injection of OK-432 into the residual cysts is an effective method of managing diffuse abdominal lymphangiomatosis in the newborn.

Effect of amrinone on mucosal permeability in experimental intestinal ischaemia/reperfusion injury.

BACKGROUND: The preventive effect of amrinone on ischaemia/reperfusion (I/R) injury has been shown in the medical literature. The purpose of the present study was to investigate the preventive effect of amrinone on I/R injury of the small bowel of the rat. METHODS: Thirty-two Wistar albino rats (140-180 g) were divided into four groups (n = 8). In all groups except the sham group the superior mesenteric artery was clamped for 30 min. At the beginning of reperfusion, 1 mL of 2405 Bq/mL 51Cr-ethylenediamine tetra-acetic acid (EDTA) was administered into the prepared ileal segment. Following 30 min of reperfusion, 1 mL of blood was obtained from the portal vein. After the rats were killed, the small intestine was removed for histopathological studies. A total of 5 mg/kg amrinone was administered to the rats in group 1 before ischaemia and in group 2 before reperfusion, whereas only saline was administered to the rats in the control group. Statistical analysis was carried out with Kruskal-Wallis and chi2 test, P < 0.01 was considered significant. RESULTS: Both the blood 51Cr-EDTA measurements (mean +/- SD) and mucosal injury grades (MIG) were highest in the control group (3.95 +/- 0.71 c.p.m.; MIG, 3-5) followed by group 2 (0.50 +/- 0.35 c.p.m.; MIG, 1-3), group 1 (0.47 +/- 0.34 c.p.m. MIG, 0-3), and sham group (0.12 +/- 0.05 c.p.m.; MIG, 0). The difference between groups 1 and 2 and the control group were statistically significant (P < 0.01 for each comparison). The results of group 1 and 2 were similar statistically (P > 0.05). CONCLUSIONS: Amrinone was found to be effective in preventing intestinal I/R injury.

Advantages of video-assisted approach in detecting epididymal anomalies and treatment of nonpalpable testis.

In children with a nonpalpable abdominal testis, preoperative localization is very helpful prior to surgical investigation both to reduce the time required and to plan the correct surgical procedure. It is no doubt that laparoscopy is useful in both diagnosis and management of nonpalpable testis. In this study, 15 patients with 17 nonpalpable testes admitted to our clinic in 2 years period were evaluated retrospectively. Ultrasound study was performed in all patients after detailed physical examination. Testicular location, size, and configuration of epididymis were determined by laparoscopy and compared with ultrasound findings. Laparoscopy, in conjunction with ultrasound, permits not only a better localization and anatomy of the testis but is also superior in planning the best choice of management. We believe that the video-assisted inguinal approach is a feasible method in the treatment of nonpalpable testis when compared to pure open surgery.

Early enteral feeding in newborn surgical patients.

OBJECTIVE: We report the results of a multicenter prospective trial of early enteral trophic feeding in a group of 56 neonates who required abdominal surgery for a variety of congenital anomalies. METHODS: In this clinical study, 33 neonates were fed in the early postoperative period (early enteral nutrition [EEN] group), and the remaining 23 (control [C] group) were fasted until resolution of postoperative ileus. Patients in the EEN group (Kocaeli feeding protocol) received 3 to 5 mL of breast milk every hour through a nasogastric feeding tube, starting a mean of 12 h (8 to 20 h) after surgery. The nasogastric tube was clamped for 40 min after each infusion and then opened for drainage. Groups were further divided into two subgroups according to whether an intestinal anastomosis or laparotomy was performed. The change in daily gastric drainage, time to first stool, day of toleration to full oral feeding, and length of hospital stay were compared. Blood bilirubin levels, white blood cell count, and C-reactive protein levels were monitored. RESULTS: The time to first stool and day of toleration to full oral feeding occurred significantly sooner, whereas nasogastric tube drainage duration and hospital stay were significantly shorter in the EEN-anastomosis group than in the C-anastomosis group. Time to first stool occurred significantly sooner in the EEN-laparotomy group than in the C-laparotomy group, although other parameters did not differ. Neither anastomotic leakage nor dehiscence was observed in any group. There were two cases of wound infection and two of exitus among patients in the C group. CONCLUSION: Postoperative, early intragastric, small-volume breast milk feeding is well tolerated by newborns. It is a reliable and feasible approach in neonates even in the presence of an intestinal anastomosis after abdominal surgery.

Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase.

OBJECTIVE: Proper antibiotic treatment and adequate pleural drainage is essential in successful management of pleural effusions. In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading ineffective chest tube drainage. Intrapleural fibrinolytic agents are employed to avoid thoracotomy in such complicated pleural effusions. Our study reviews the results of streptokinase treatment in children with pleural effusion. METHODS: Thirty-two patients with parapneumonic pleural effusions were admitted to our hospital. The patients beyond the exudative stage were divided into two groups according to the initial radiological findings and biochemical parameters of pleural fluid. Intrapleural streptokinase treatment was started in an average of 2 days following initial chest tube placement in both Group I (14 patients) in fibrino-purulent phase with pleural effusion and fluid volume estimated to be larger than one-third of the involved lung and Group II (18 patients) with additional findings in radiological examination regarding the presence of air-fluid levels, multiple loculations, necrotic debris and pleural thickening. The effectiveness of therapy was assessed by monitoring the volume of the fluid, the level of LDH, glucose, pH and by radiological imaging, pre- and post-instillation. RESULTS: There was statistically significant difference between two groups according to date of admission (6.8 vs 10.4 days), mean of total pleural fluid drainage before (106.9 vs 309.7 ml) and after (258.9 vs 511.2 ml) SK treatment, mean of total number of instillations (2.1 vs 3.6) required and total length of hospital stay (16.6 vs 22.4 days). There was a significant difference regarding pleural chemical analysis. Finally, surgical intervention was necessary in six intractable cases, all of which initially presented a significant small amount of pleural drainage in volume when compared to rest of the patients. The overall success rate of our treatment was calculated as 96% for G-I and 72.2% for G-II cases. CONCLUSIONS: Intrapleural streptokinase is an effective and safe adjunct in facilitating drainage in early and late stage II empyemas. A tendency of decreased rate of drainage besides persisting fever and respiratory symptoms, despite fibrinolytic treatment may be a clue for early surgical intervention.

Thoracoscopic diaphragm plication in children and indications for conversion to open thoracotomy.

Thoracoscopic plication of the diaphragm has been recently described as an alternative treatment for eventration. It is considered to be much less traumatic than the conventional method. We attempted thoracoscopic diaphragm plication on three patients. Two patients were treated successfully by the minimally invasive technique and were discharged from hospital on the second postoperative day. In the third case, the presence of a mobile intrathoracic kidney due to previous diaphragmatic hernia repair necessitated conversion to open thoracotomy. This patient was discharged on postoperative day six following an uneventful recovery. All patients are well and asymptomatic on followup. We advocate thoracoscopic diaphragm plication in children as a safe procedure with less morbidity and excellent cosmetic results.

Fluoroscopy-guided laparoscopy in the management of intraabdominal foreign body.

Appendicitis or perforation as a result of intraluminal foreign body is uncommon. The method of diagnosis and proper approach for an elective appendectomy in an otherwise silent intraluminal foreign body is under dispute. A laparoscopic exploration under intraoperative fluoroscopy guidance was performed in a mentally retarded 9-year-old boy with asymptomatic foreign bodies in the right lower abdominal quadrant. The authors recommend laparoscopic appendectomy, assisted by intraoperative fluoroscopy for patients with pointed foreign bodies in the appendix.

Ultrasonographic findings after laparoscopic repair of paediatric female inguinal hernias: the 'vanishing rosebud'.

BACKGROUND: Laparoscopic surgery is a good alternative to the open technique for treating hernias in female paediatric patients. The laparoscopically inverted and sutured hernia sac forms a nodule, the long-term fate of which has not been previously studied radiologically. OBJECTIVE: To describe the early and delayed US changes after laparoscopic inversion and suturing of paediatric female inguinal hernias. MATERIALS AND METHODS: Twenty girls (age 1.5 months to 12 years; median 4.6 years) who underwent laparoscopic inguinal hernia repair were prospectively evaluated with US the day before and the day after the procedure. Delayed scans were obtained at 1, 6 and 12 months. RESULTS: The laparoscopic procedure involved inversion and suturing of the hernia sac, which resulted in a nodule that plugged the internal inguinal ring and resembled a rosebud laparoscopically. US detected the 'rosebud' in all cases on the first postoperative day. Initially appearing as a rounded or ovoid mass with a slightly hypoechoic texture, the 'rosebud' became progressively smaller, more hypoechoic and more lobulated on follow-up. It disappeared in all but two cases at 6 months and in all cases at 1 year. There was no US evidence of recurrence. CONCLUSIONS: The 'rosebud' formed by this laparoscopic procedure displays typical US features and temporal changes.