Determination of Risk Factors for Nausea and Vomiting in Children After Appendectomy.

PURPOSE: This study aimed at investigating the risk factors for postoperative nausea and vomiting (PONV) in pediatric patients undergoing appendectomy. DESIGN: This is a prospective, descriptive, cross-sectional study. METHODS: The study involved 163 children aged 5 to 18 years who underwent appendectomy in the pediatric surgery clinic of a tertiary hospital between December 2022 and June 2023. The study data were collected through the patient information form, Baxter Retching Faces scale, and Wong-Baker Faces Pain Rating Scale, which included questions about the descriptive and clinical characteristics of the participants and was prepared by the researcher consistent with the literature. FINDINGS: A significant relationship was observed between the severity of postoperative pain and the occurrence of PONV in patients with both nonperforated and perforated appendicitis (P < .001). In addition, operative time and the time to the first oral feeding were shorter in patients with nonperforated appendicitis in the non-PONV group (P = .005 and P = .042, respectively) Logistic regression analysis revealed that postoperative pain, family history of PONV and appendix perforation were risk factors for PONV in children with both nonperforated and perforated appendicitis (P < .001, P = .040, and P < .001, respectively). CONCLUSIONS: In children undergoing appendectomy, family history of PONV, severity of postoperative pain, increased operative time, and increased transition time to oral feeding are risk factors for PONV. Pediatric nurses, who have an important role in the management of PONV, should evaluate patients in terms of PONV risk in the preoperative period within the scope of evidence-based practices and perform pharmacological or nonpharmacological interventions according to the degree of risk.

Effects of menthol gum chewing on postoperative nausea, vomiting, and length of hospital stay in children undergoing appendectomy: A randomized controlled trial.

PURPOSE: This study aimed to determine the effects of menthol gum chewing on nausea, vomiting, and length of hospital stay after appendectomy in children. BACKGROUND: Postoperative nausea and vomiting (PONV) can be induced by general anesthesia. Several drugs are available to reduce the risk of PONV; however, their cost and side effects limit their clinical use. METHOD: This was a randomized controlled clinical trial that included 60 children aged 7-18 years who underwent an appendectomy at the Pediatric Surgery Clinic of a tertiary hospital between April and June 2022. Data for this study were collected via the developed information form, which included participants' descriptive characteristics and bowel function parameters, and the Baxter Retching Faces (BARF) nausea scale. Children in the study group who underwent an appendectomy were given chewing gum and asked to chew it for an average of 15 min, whereas those in the control group received no intervention. RESULTS: The BARF nausea score measured during the menthol gum chewing period was lower in the study group, and the difference score value calculated after pretest time was higher in the study group, as expected (p < 0.001). Moreover, menthol gum chewing was found to shorten hospital stay by 1 day (p < 0.05). CONCLUSION: Menthol gum chewing reduced the severity of postoperative nausea and length of hospital stay. PRACTICE IMPLICATION: Chewing gum can be used as a nonpharmacological method by pediatric nurses in clinical practice to reduce the severity of postoperative nausea and length of hospital stay.

Laparoscopic Excision of a Pyloric Duplication Cyst in a Child.

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Suprapubic Percutaneous Assisted Cystoscopic Excision of Posterior Urethral Fibroepithelial Polyps in Pediatric Patients.

PURPOSE: The aim of this study was to evaluate pediatric posterior urethral fibroepithelial polyps, their diagnosis and endoscopic treatments with suprapubic assisted transurethral polyp excision which is described by us. MATERIALS AND METHODS: We reviewed the charts of patients (n=6) who underwent suprapubic percutaneous assisted cystoscopic excision for posterior urethral fibroepithelial polyp from 2014 to 2019. Their data were retrospectively reviewed in terms of clinical features, diagnostic methods, endoscopic approaches, and postoperative results. RESULTS: The 6 patients, the mean age of 3 years (4 months-6 years), with a solitary polyp of posterior urethra diagnosed and removed by suprapubic percutaneous assisted cystoscopic excision in five years. The most common complaint was urinary tract infection (n:3). The urethral polyps were diagnosed by ultrasound and cystoscopy. There was no intraoperative or postoperative complication except for one patient with bleeding from the trocar site. All of the specimens after histopathology examinations showed fibroepithelial polyps and no recurrence was seen. CONCLUSION: Posterior urethral polyps may cause obstructive effect in the urinary tract. The treatment should be performed with the least possible invasive method without injuring urethral wall.  We believe that suprapubic percutaneous assisted cystoscopic resection, described by us is an easy, reliable and effective method for treatment procedure of posterior fibroepithelial urethral polyps.

The Effect of Different Intraabdominal Pressures on Thiol/Disulfide Homeostasis in Children Who Underwent Ambulatory Laparoscopic Surgery: A Prospective Randomized Study.

BACKGROUND: Thiol/disulfide homeostasis is a significant parameter in determining the oxidative stress response after ischemia and reperfusion. We aimed to investigate the effects of applying different intraabdominal pressure (IAP) on thiol/disulfide homeostasis, ischemia-modified albumin (IMA) levels, and hemodynamics in pediatric laparoscopic surgery. MATERIALS AND METHODS: Blood samples were collected from 36 pediatric patients who were planned to undergo laparoscopic surgery for nonpalpable testis or varicocele under general anesthesia, immediately after intubation as the baseline and 5 minutes after abdominal desufflation for determining the thiol/disulfide, and IMA levels. The patients were divided into two groups; group 1 received a pneumoperitoneum pressure of 8 mm Hg (n = 18), and group 2 received 12 mm Hg (n = 18). The clinical characteristics and thiol/disulfide homeostasis and IMA levels of the patients were compared. RESULTS: No difference was detected regarding the clinical features between the groups. The comparison after intubation and after desufflation in group 1 demonstrated lower native thiol (453 ± 67 versus 422 ± 57 µmol/L, P = .059) and total thiol (497 ± 73 versus 466 ± 62 µmol/L, P = .061) levels, which was statistically insignificant. The serum native thiol level was found lower than baseline in group 2 where a 12 mm Hg IAP was applied, this difference was not statistically significant (429 ± 47 versus 412 ± 53 µmol/L, P = .078). The comparison of serum IMA levels after desufflation with the baseline (0.505 ± 0.018 versus 0.632 ± 0.022) in group 2 was found statistically significantly high (P = .031). The comparison of the perioperative heart rate and SpO2 levels with before induction was found statistically insignificant. CONCLUSIONS: Neither of 8 nor 12 mm Hg IAPs in pediatric laparoscopic surgery caused any changes in novel indicators of thiol/disulfide homeostasis parameters; however, 12 mm Hg IAP increased the levels of IMA.

Management of the patients with persistent Müllerian duct syndrome: Is the ultimate goal testicular descent?

OBJECTIVE: Persistent Müllerian duct syndrome (PMDS) is a rare congenital disease characterized by the presence of rudimentary Müllerian structures within an intra-abdominal or hernial sac in a virilized male, often presenting as undescended testes. In this study, we aim to present a series of the PMDS patients who were managed by orchiopexy without removal of Müllerian remnants (MR). MATERIAL AND METHODS: Between May 2010 and June 2017, we treated six cases diagnosed as PMDS in our department. Laparoscopy and gonadal biopsy were performed in all patients, and vessel ligation was done in four patients for the first session of Stephen-Fowler orchiopexy. After initial diagnosis, genetic analyses and endocrine investigations were performed. Demographic and clinical features of the patients, operative methods and follow-up data were analyzed retrospectively. RESULTS: Mean age of the patients was 5.5 years. Three boys had undergone inguinal surgery due to hernia or undescended testis, while others were diagnosed during laparoscopic investigation of nonpalpable testis. As a definitive operation, testes and MR were completely removed in an adult patient, and the remaining patients were treated with laparoscopic or open orchiopexy with or without utero-cervical splitting and the MRs were left in situ. Two testes atrophied during follow-up period. CONCLUSION: The goal of the approach in PMDS patients is to preserve testes, as well as carry them to their natural location. Leaving the MR in place is a suitable option for blood circulation of the testes but the long-term results are still unknown.

Effects of Different Anesthetic Agents on Surgical Site Hemorrhage During Circumcision.

PURPOSE: To investigate the effects of ketamine+midazolam and propofol+sevoflurane anesthesia on surgical site hemorrhage during circumcision procedures. MATERIALS AND METHODS: The boys undergoing circumcision surgery were included in the study. The patients were divided into two groups. In Group 1 (n = 50), 0.01 mg/kg midazolam and 2 mg/kg IV ketamine were administered. In Group 2 (n = 50), 1 ?g/kg fentanyl, 1 mg/kg lidocaine 2%, and 2-3 mg/kg IV propofol were administered, and patency of airway was ensured with a laryngeal mask airway. The intraoperative bleeding scale was recorded during the procedure to evaluate surgical site bleeding. Hemorrhage was checked for the first three hours using the postoperative bleeding scale to follow the amount of hemorrhage. RESULTS: Intraoperative bleeding scores were significantly higher in Group 1 as compared to Group 2. However, there was no significant difference between the groups regarding frequency of postoperative hemorrhage. Themean blood pressure values measured at 5th, 10th, 15th minutes and recovery room were significantly higher in Group 1. CONCLUSION: The intraoperative bleeding scores were significantly higher with ketamine+midazolam compared to propofol+sevoflurane. On the other hand this hemorrhage can be controlled easily with appropriate hemostasis, and the amount of blood loss was not clinically significant. We think that our study makes a positive contribution to the literature about the effects of anesthetics on the surgical site bleeding during circumcision. CLINICAL TRIALS REGISTRATION: ACTRN12616000189426.

A New Method for Laparoscopic Stamm Gastrostomy.

BACKGROUND/OBJECTIVE: Many methods of laparoscopic gastrostomy have been described, but in the majority of these, purse-string sutures and fixation of the stomach to the abdominal wall are not performed simultaneously. In this study, we aim to present a new laparoscopic gastrostomy tube (GT) placement method developed in accordance with the classical Stamm method. MATERIALS AND METHODS: Intracorporeal purse-string suture is placed at the anterior wall of the stomach where the GT is intended to be placed. While purse-string sutures are being placed, in each bite, the needle is passed through from a loop thread prepared by extracorporeal and the two threads are suspended outside. The stomach is punctured with the hook cautery, the GT is inserted, and both threads are knotted outside the abdomen. RESULTS: We prospectively placed GT by using our method in 16 patients with an average age of 5 years and most of them with neurological developmental delay. Fundoplication was performed in most of the cases in the same session. No complications were encountered. CONCLUSIONS: Our method is a feasible approach for GT placement by the purse-string suturing and the fixation of the stomach to the abdominal wall without extending the port incision.

Surgical Treatment of Childhood Pulmonary Hydatidosis: An Analysis of 25 Cases.

BACKGROUND: Hydatid cyst disease is caused by the parasite Echinococcus granulosus and it is an important health problem in the childhood period. In the present study, we aimed to report our experience in 25 surgically managed pediatric hydatid cyst cases under the light of the relevant literature. MATERIALS AND METHODS: We retrospectively analyzed 25 patients below 15 years of age who were treated for pulmonary hydatid cyst at our clinic between 2005 and 2016. The patients were analyzed for age, sex, signs and symptoms, diagnostic methods, cyst localization, diameter, number, treatment modalities, mortality, morbidity, and recurrences. RESULTS: Of the 25 patients included in this clinical study, 16 were male and their mean age was 10.5 (range 5-15) years. The most common presenting symptom was paroxysmal cough which affected 18 patients. The cysts were located in lungs in 23 patients and lungs and liver in 2 patients. Nineteen pulmonary cysts were solitary, and 21 (66%) were in the lower lobe. Thirteen (52%) patients had perforated cysts. Fourteen (56%) patients were operated with cystotomy and capitonnage, 9 (36%) with cystotomy, and 2 (8%) with enucleation. No case of recurrence was observed during an average 12 (range 8-18) months of follow-up. CONCLUSION: Surgery is the primary treatment of pediatric pulmonary hydatid cyst disease. Cystotomy and capitonnage is the most commonly used parenchyma sparing technique.

Fetal Bowel Dilatation due to Intestinal Neuronal Dysplasia: A Rarity.

Intestinal neuronal dysplasia (IND) type B is characterized by malformation of parasympathetic plexus and manifests at more than 6 month of age with progressive severe constipation. We report a case of IND type B presented with bowel dilatation on antenatal scan and neonatal intestinal obstruction which is unusual with this type of IND.

Extralobar pulmonary sequestration as a cause of recurrent pulmonary hemorrhage in a neonate.

Pulmonary sequestration is acystic or solid congenital lung malformation comprised of non functional lung tissue that does not communicate with the normal tracheobronchial tree and has a systemic arterial blood supply. There are two forms of sequestration: intralobar and extralobar. Its treatment is surgical resection. Here we presented a case of premature neonate with extralobar pulmonary sequestration who had respiratory failure and recurrent pulmonary hemorrhage. Following surgery, the patient showed significant clinical improvement.

El secuestro pulmonar es una malformación pulmonar congenita, quística o sólida, compuesta de tejido pulmonar no funcional sin conexión con el árbol traqueobronquial y que recibe sangre arterial de la circulación sistemica. Existen dos formas de secuestro: intralobular y extralobular. El tratamiento se realiza mediante resección quirúrgica. Se describe el caso de un recién nacido prematuro con secuestro pulmonar extralobular que presentó insuficiencia respiratoria y hemorragia pulmonar recurrente. Luego de la cirugía, el paciente mejoró en forma clínicamente significativa.

Secuestro pulmonar extralobular como causa de hemorragia pulmonar recurrente en un recién nacido / Extralobar pulmonary sequestration as a cause of recurrent pulmonary hemorrhage in a neonate

El secuestro pulmonar es una malformación pulmonar congenita, quística o sólida, compuesta de tejido pulmonar no funcional sin conexión con el árbol traqueobronquial y que recibe sangre arterial de la circulación sistemica. Existen dos formas de secuestro: intralobular y extralobular. El tratamiento se realiza mediante resección quirúrgica. Se describe el caso de un recién nacido prematuro con secuestro pulmonar extralobular que presentó insuficiencia respiratoria y hemorragia pulmonar recurrente. Luego de la cirugía, el paciente mejoró en forma clínicamente significativa.

Pulmonary sequestration is acystic or solid congenital lung malformation comprised of non functional lung tissue that does not communicate with the normal tracheobronchial tree and has a systemic arterial blood supply. There aretwo forms of sequestration: intralobar and extralobar. Its treatment is surgical resection. Here we presented a case of premature neonate with extralobar pulmonary sequestration who had respiratory failure and recurrent pulmonary hemorrhage. Following surgery, the patient showed significant clinical improvement.

The relationship between clinical findings and esophageal injury severity in children with corrosive agent ingestion.

BACKGROUND: The aim of the study was to investigate the indicators of corrosive esophageal injury (EI) severity in children. METHODS: We retrospectively reviewed data from children who accidentally ingested corrosive substance and underwent endoscopic evaluation over a one-year period. A total of 134 consecutive children with corrosive agent ingestion who underwent diagnostic endoscopy (74 boys, 60 girls) were included in this study. Patients were divided into two groups as low-grade and high-grade EI. Statistical differences and predictive values of common signs and symptoms and white blood cell (WBC) count of patients with low- and high-grade EI were analyzed. RESULTS: The majority of patients (70%) were asymptomatic at the initial examination. We found that drooling saliva and oral lesions were significantly more frequent in high-grade injury (p<0.05). Mean WBC count in the high-grade EI group was significantly higher than in the low-grade EI group (p=0.000). Sensitivity, specificity and predictive values of clinical findings in children were analyzed; none of them was shown to be valuable for estimating EI severity. WBC count was sensitive, but it is not a good predictor. CONCLUSION: Our study demonstrated the relationship between clinical findings and corrosive EI severity in children with accidental corrosive ingestion, but direct visualization of the esophagus is required for definitive diagnosis.

Evaluation of total oxidative and antioxidative status in pediatric patients undergoing laparoscopic surgery.

OBJECTIVE: Reactive oxygen species (ROS) induced by several diseases can trigger oxidative stress. During laparoscopy, increased intraabdominal pressure caused by pneumoperitoneum may lead to splanchnic ischemia followed by reperfusion because of deflation. Because ischemia reperfusion creates oxidative stress, in this study, we aimed to investigate the oxidative-antioxidative status of the pediatric patients with laparoscopic surgery. METHODS: The children underwent laparoscopic procedures under general anesthesia, and they were mechanically ventilated. Blood samples were obtained after induction of anesthesia, at the end of the surgery, and were centrifuged at 3000 revolutions per minute for 10 minutes to separate plasma. The plasma total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were determined. RESULTS: Plasma TOS and OSI levels were significantly higher at the end of the surgery than after induction of anesthesia (P < .05 and P < .01, respectively). On the other hand, plasma TAS levels were lower in the end of the surgery than after induction of anesthesia (P < .05). CONCLUSIONS: These results suggest that ROS are generated during the laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum, which causes oxidative stress and consume plasma antioxidants.

Effects of acute epididymitis on blood plasma oxidative and antioxidative status in an experimental rat model.

INTRODUCTION: To evaluate the oxidative and antioxidative status in blood plasma after the induction of acute epididymitis in an experimental rat model. MATERIALS AND METHODS: Escherichia coli was inoculated into the ductus deferens of rats in the epididymitis group (n = 10), and saline, instead of bacteria, was injected into the saline group (n = 10). No inoculums were performed in control group (n = 10). The infection was confirmed by microbiological tests. As antioxidative parameters, the total peroxide (TP), indicative marker of lipoperoxidation and protein oxidation, and the total antioxidant response (TAR) were measured in blood samples. RESULTS: Acute epididymitis was demonstrated in all rats of the epididymitis group. The TP level increased significantly in the epididymitis group compared to the other two groups. The TAR level also increased significantly in the infected group (p < 0.05). CONCLUSIONS: Our results are concordant with the fact that the increased oxidative status caused by epididymitis was tolerated by the endogenous antioxidant defense system. Moreover, we suggest that the measurement of oxidative and antioxidative level may be useful in clinical practice to detect defective defense system and prevent possible complications.

Abdominal wall mucocele: a late complication of colostomy closure.

We present a case of incisional enteric mucocele formation 10 years following colostomy closure. The patient was admitted to the hospital with the symptoms of an abdominal wall mass lying on previously closed colostomy incision. Clinical presentation, diagnostic work up and pathology of the case were discussed. To our knowledge, this is the first abdominal wall mucocele after colostomy closure reported in the literature.

Initial temporary misdiagnosis of bronchiectasis following pumpkin seed aspiration.

Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. In this report, the authors present a rare case of temporary bronchiectasis of the left lung due to a long-standing retained foreign body in a child. Interestingly, the whole left lung was affected due to the check valve type of obstruction of the main bronchus. Unexpected, unilateral findings on a chest x-ray or a CT scan could be related to an inhaled foreign body, and any delay in making the diagnosis may result in serious complications.

Persistent mullerian duct syndrome with transverse testicular ectopia.

A 15-month-old boy was discovered to have internal female genitalia during an operation for bilateral inguinal hernia. The biopsies showed normal testicular tissue and the karyotyping result was 46XY, so the diagnosis of persistent mullerian duct syndrome (PMDS) was made. At the second operation, the uterine fundus and fallopian tubes were excised. Then, he underwent bilateral orchiopexy. We discuss a rare presentation of this disorder, its management, and genetic implications together with a review of the literature.

Acute renal failure due to bilateral uric acid lithiasis in infants.

Acute renal failure (ARF) is one of the complications of urolithiasis, but the role of medical treatment to relieve urinary obstruction in children with ARF is uncertain. We report on infants with acute obstructive uric acid lithiasis. We describe presentation features as well as diagnosis methods and medical treatment in five infants who were admitted to our institution with ARF due to uric acid lithiasis. The medical treatments for all patients were fluid liberalization, urine alkalinization, and oral allopurinol. Two children underwent urinary diversion. Within 8 h, urine output improved in all patients, and the stones passed spontaneously. All obstructed kidneys were relieved with medical treatment, and no renal sequel remained. So this series has showed a role of medical therapy in acute obstructive uric acid lithiasis.

Oxidative and antioxidative status in the testes of rats with acute epididymitis.

INTRODUCTION: Epididymitis is an inflammation or infection of the epididymis, a convoluted duct that lies on the posterior surface of the testicle. Oxidative stress due to excessive production of reactive oxygen species in epididymitis, impaired antioxidant defense mechanisms, or both, precipitates a range of pathologies that are currently believed to negatively affect the male reproductive function. How oxidative stress affects the testes is still unknown. We aimed to investigate the oxidative and antioxidative status of testes of rats with unilateral acute Escherichia coli epididymitis. METHODS: The study included 36 male Wistar albino rats which were divided into three groups. In the epididymitis group (n = 12), an E. coli suspension was injected into the right ductus deferens of rats, and the same amount of saline was injected in the saline groups (n = 12). No surgery was performed in the control group (n = 12) for baseline values. Rats were sacrificed after 24 h and the epididymis and testes removed. The infection was confirmed by histopathologic evaluation and microbiological tests. The oxidative status of testes was evaluated by measuring myeloperoxidase (MPO) activity, and antioxidative status was evaluated by measuring total antioxidant response (TAR) and total antioxidant capacity levels (TAC). RESULTS: MPO activity in both the ipsilateral and contralateral testes of the epididymitis group was significantly higher than those of the saline and control groups (p < 0.05). The TAR and TAC levels in both testes were also significantly elevated in the epididymitis group versus the two other groups (p < 0.05). CONCLUSIONS: Acute epididymitis causes an increase of oxidative stress in the ipsilateral and contralateral testes, but this condition is strived for to tolerate the increase of endogenous antioxidants.