Comparison of shear wave elastography and dimercaptosuccinic acid renal cortical scintigraphy in pediatric patients.

BACKGROUND: Although it causes low-dose radiation exposure, dimercaptosuccinic acid (DMSA) renal cortical scintigraphy is the gold standard examination method in the noninvasive diagnosis of renal scar tissue (RST). Shear wave elastography (SWE) has recently come to the fore as a technique for measuring kidney stiffness in the examination of RST. The present study aims to compare DMSA and SWE tests to evaluate whether SWE can be used instead of DMSA as a test that does not cause radiation exposure in pediatric patients. METHODS: In this prospective study, sonographic elastography was performed on pediatric patients with DMSA images. In the SWE examination, measurements were made from each kidney's upper, middle and lower parts. DMSA and elastography data were compared for the diagnosis of RST. RESULTS: A total of 64 patients were included in the present study. There were 68.8% female ( n = 44) and 31.2% ( n = 20) male patients. There were 45 pediatric patients [Female 30 (66.7%), male 15 (33.3%)] in group 1 (pathological group) and 19 pediatric patients [Female 14 (73.7%), male 5 (26.3%)] in the control group. When DMSA data and SWE values were compared, it was found that elastography did not show a statistically significant performance in predicting renal scarring. CONCLUSION: In the existing literature, various studies reported different values for the diagnosis of renal stiffness using SWE. Similar to some previous studies, the present study observed no significant correlations between DMSA and SWE. Thus, DMSA preserves its major role and effectiveness as an important predictor of RST in pediatric patients.

Pseudo-Meigs syndrome secondary to endodermal sinus tumor.

Ovarian tumors are the most common gynecological tumors seen in girls. Approximately 60-70% of them are germ cell tumors. Pseudo-Meigs syndrome is characterized by the presence of pelvic tumoral mass (benign or malign), pleural effusion, and massive acid. If the tumor is removed, acid and hydrothorax disappear. Endodermal sinus (yolk sac) tumor is a very rare cause in the diagnosis of Pseudo-Meigs syndrome, and only a few cases have been reported. This case is one of the rare cases presenting with Pseudo-Meigs syndrome and pathologically diagnosed as yolk sac tumor.

The management of children aged 0-5 years with suspected foreign body aspiration: a prospective study.

INTRODUCTION: A simple algorithm for bronchoscopy was prepared in very young children. METHODS: The patients aged 0-5 years who were applied with bronchoscopy because of suspected foreign body aspiration (FBA) analysed. RESULTS: Evaluations were made of 89 patients, as 55 (61.7%) in the FBA (+) group and 34 (38.3%) in the FBA (-) group. FBA was determined most in the 1-2 years age group (28 patients, 50.9%, p = 0.04) due to organic hard foodstuffs (94.5%, p < 0.001). The parameters found to be significant were witnessing the event (OR 12.133, 95% CI 3.147-46.774, p < 0.001) and not obtaining unilateral respiratory sounds (OR 7.556, 95% CI 2.681-21.292, p < 0.001). The most significant diagnostic finding was the determination of unilateral hyperventilation on X-ray (OR 16.730, 95% CI 4.541-61.632, p < 0.001). The operating time and length of stay in hospital was significantly shorter in the FBA (-) patients (p < 0.001). CONCLUSION: The presence of a witness, not obtaining unilateral respiratory sounds, and unilateral hyperventilation seen on X-ray are indications for bronchoscopy. In FBA (-) patients applied with bronchoscopy, the complication rate associated with the procedure is low, and the operating time and length of stay in hospital are short.

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.

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.

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Caudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. In this double-blind prospective randomized trial, we aimed to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries under general anesthesia. MATERIALS AND METHODS: After approval was obtained from the ethics committee, in this prospective randomized double-blind trial, 53 patients under general anesthesia undergoing inguinal hernia repair and orchiopexy surgeries randomly received caudal block or QLB. Demographic data, postoperative analgesic requirement, Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 30 min, 1, 2, 4, 6, 12 and 24 hours, parent satisfaction scores and complications were recorded. RESULTS: The study included 52 patients, after excluding one patient because of a failed caudal block. There were no significant differences between the groups based on demographic data (p>0.05). The number of patients who required analgesics in the first 24 hours was significantly lower in QLB group (p=0.001). Postoperative 4, 6, 12 hours FLACC scores were significantly lower in the QLB group (p<0.001, p=0.001 and p<0.001, respectively). Parent satisfaction scores were higher in the QLB group (p=0.014). CONCLUSION: According to the results of this study, QLB can provide much more effective analgesia than caudal block without adjuvants in multimodal analgesia management of children undergoing inguinal hernia repair and orchiopexy surgeries. TRIAL REGISTRATION NUMBER: NCT03294291.

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.

Diuretic renography in hydronephrosis: a retrospective single-center study.

PURPOSE: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of hydronephrosis other than transient hydronephrosis. In children with unilateral hydronephrosis, mercaptoacetyltriglycine-3 diuretic renography (MAG3) is used to calculate differential renal function and to assess drainage. The aim of our study is to examine whether anteroposterior pelvic diameter on renal ultrasound (US) scan can predict both differential renal function (DFR) and obstruction in pediatric patients, and whether an US adequately identifies those patients who need further investigation. We also aimed to design a study with a larger sample size than previous studies investigating the relationship between MAG3 and US. METHODS: We retrospectively reviewed the MAG3, US, dimercaptosuccinic acid scan (DMSA) findings, and medical records of pediatric patients with hydronephrosis and/or atrophy who were at follow-up between January 2013 and December 2016 in our center which is located in the south-east region of Turkey. RESULTS: Two hundred and twenty-five pediatric patients (M/F = 156/69) with unilateral hydronephrosis but without VUR were enrolled in this study. The mean age of the children was 45.4 ± 48.3 months (range 2-173 months). Sixty-nine patients had obstructive pattern on 99mTc-MAG3. With respect to obstructive pattern, there was a significant difference between the hydronephrosis groups both with 15 and 20 mm border. An APD of greater than 20 mm had 15.8 times (95% CI 5.72-43.69) higher likelihood of having obstruction MAG3 findings. On the other hand, an APD of greater than 15 cm had 9.2 times (95% CI 3.01-28.57) higher likelihood of having obstruction MAG3 findings. The incidence of urinary tract infections was lower than in the obstructive group than the other groups. The regression analysis showed that an APD of greater than 20 mm was a risk factor for low DRF (OR = 5.208, 95% CI 1.529-17.743, p = 0.008). However, the regression analysis showed that an APD of greater than 15 mm was not a risk factor low DRF. CONCLUSIONS: The combination of ultrasound and MAG3 provides the necessary anatomical and functional information to follow the degree of obstruction and to decide between surgical intervention and conservative follow-up. Our study supports a threshold of 20 mm rather than 15 mm for severe obstruction and a low DRF. An APD threshold greater than 15 mm did not have a predictive value in DRF estimation.

Henoch-Schönlein purpura complicated by acalculous cholecystitis and intussusception, and following recurrence with appendicitis.

Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. Gastro-intestinal involvement occurs in two-thirds of patients. The characteristic skin lesions generally precede abdominal symptoms or present concurrently. A 7-year-old boy presented with intussusception and acalculous cholecystitis and had a cholecystectomy. Two weeks later he was re-admitted with features typical of HSP which responded to corticosteroids. Eleven months later he presented with abdominal pain and recurrence of HSP and, at laparotomy, there was acute appendicitis. This is the first case of a child presenting with HSP complicated by acalculous cholecystitis.