The effect of written document in perioperative information on the anxiety level and family-centered care of parents of children undergoing ambulatory surgery: A randomized controlled trial.

PURPOSE: To evaluate the effect of preoperative information based on written documents on anxiety levels and the family-centered care of parents of pediatric patients who had ambulatory surgery. DESIGN AND METHODS: It is a randomized controlled study. Parents were randomly divided into two groups as intervention (n = 30) and control (n = 30). Parents in the intervention group were given written document and verbal information the day before the surgery. A brochure was prepared in accordance with the verbal information describing the perioperative process as a written document. The control group was given only verbal information. Parental State Anxiety Inventory (SAI) and Family Centered Care Assessment Scale (FCCAS) were assessed before and within 1-2 h after surgery, with verbal information based on written documentation. Data were evaluated with Student's t-test for dependent and independent groups and mixed design ANOVA test for time×group interaction. Partial eta square (η2) was calculated for the effect size. RESULTS: There was a significant difference between the post-intervention pretest and posttest SAI and FCCAS scores of the parents in the intervention and control groups (p < 0.05). Time group interactions anxiety and family-centered care (p < 0.001) scores had a significant and large effect size. CONCLUSION: Verbal information supported by written documentation before pediatric ambulatory surgery can reduce parental SAI and increase parental FCCAS more than standard care. PRACTICE IMPLICATIONS: Providing written document-based information to parents before surgery may be beneficial in reducing SAI and increasing FCCAS. The trial was registered in ClinicalTrials.gov (identifier: NCT05668416).

A simple machine learning approach for preoperative diagnosis of esophageal burns after caustic substance ingestion in children.

PURPOSE: The unresolved debate about the management of corrosive ingestion is a major problem both for the patients and healthcare systems. This study aims to demonstrate the presence and the severity of the esophageal burn after caustic substance ingestion can be predicted with complete blood count parameters. METHODS: A multicenter, national, retrospective cohort study was performed on all caustic substance cases between 2000 and 2018. The classification learner toolbox of MATLAB version R2021a was used for the classification problem. Machine learning algorithms were used to forecast caustic burn. RESULTS: Among 1839 patients, 142 patients (7.7%) had burns. The type of the caustic and the PDW (platelet distribution width) values were the most important predictors. In the acid group, the AUC (area under curve) value was 84% while it was 70% in the alkaline group. The external validation had 85.17% accuracy in the acidic group and 91.66% in the alkaline group. CONCLUSIONS: Artificial intelligence systems have a high potential to be used in the prediction of caustic burns in pediatric age groups.

Determination of Melatonin Deprivation Impact on Sepsis With Acute Phase Reactants.

BACKGROUND: The aim of the present study is to determine the association of melatonin hormone level on CRP, Total Antioxidant Status, Leukocyte, Procalcitonin, and Malondialdehyde, all acute phase reactants in the dark and light cycle of rats with sepsis model. MATERIALS AND METHODS: In this study, 54 rats were divided into three groups. Whereas the first and third groups had a 12 h dark-light cycle, the second group was exposed to light for 24 h at 21°C-22°C for 10 d without any water and food restrictions. In the second and third groups, sepsis model was formed by cecal ligation and puncture (CLP) method at the end of 10th day, and blood samples were taken at the end of the 10th day. C-reactive protein, Malondialdehyde, Procalcitonin in the blood samples were analyzed by ELISA, and the levels of Total Antioxidant Status and leukocyte were determined by colorimetric method in the subsequent 12 and 24 h. RESULTS: CRP values increased in the second group rats, which were kept continuously under light and had undergone CLP, from 288.8 mg/L to 584.0 mg/L at the end of the 12 h and the end of the 24 h, approximately, two times. In rats, which were kept under 12 h of light, 12 h of darkness, and applied CLP (group 3), these values increased from 416.9 to 619.1; an increase of 1.5 times. When assessed for MDA, it was determined that the differences between Group 2 and Group 3 were more prominent between 0 h and 12 h. While the MDA values in group 2 increased from 16.53 nmol/mL at the 12 h to 17.66 nmol/mL at the 24 h. However, MDA values did not yield statistically significant changes in the third group. Changes in the in PCT values were similar to the MDA values obtained. Increase coefficient of the PCT values between 0 h and 12 h in the second group 2 was 1.26; however, in the third group, it was negligible. CONCLUSIONS: An increase in the oxidative stress was observed in the rats that underwent CLP and melatonin deprivation via continuous 24 h light exposure for 10 d. Accordingly, deprivation of light is considered to be effective in sepsis treatment due to the increase in melatonin levels in intensive care unit patients.

Comparison of the Radiologic and Clinical Findings of Adolescents With Breast Complaints.

INTRODUCTION: The American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) was developed to guide imaging-based surgical treatment in patients with breast cancer. Studies confirming the BI-RADS did not include adolescents. To evaluate the validity of this classification system in adolescents, we aim to investigate the relationship between the BI-RADS and pathology findings in adolescents. METHODS: The medical data of 67 female adolescent patients, aged 12 to 18, referred to our clinic for breast-related complaints between 2013 and 2016 were reviewed retrospectively for demographic data and the results of radiologic and surgical pathologies. RESULTS: The main underlying reasons for the visit at the clinic were fullness, tenderness, pain, and palpable masses. Of the 67 patients, 46 were enrolled in the study. After breast ultrasonography, patients whose complaints had diminished were subtracted from the follow-up. The mean age of the patients was 16 years (12 to 18 y). The mean mass diameter size was 3.69 cm (0.9 to 15 cm), and the mean clinical follow-up was 65.3 days (11 to 1095 d). All the patients who were surgically intervened had benign pathology. Of the 21 surgically intervened patients with BI-RADS levels of ≥3, most had fibroadenomas. CONCLUSIONS: The BI-RADS classification-based treatment algorithm may not be valid in adolescents. In the present study, all patients with lesions with BI-RADS ≥3 levels had revealed benign pathologies. The BI-RADS classification may show an increased risk. However, to determine the need for a biopsy in adolescents, there is a need for larger-scale pediatric and adolescent studies using the BI-RADS classification.

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

PURPOSE: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). METHODS: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. RESULTS: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. CONCLUSIONS: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.

Esophageal Stricture in a Child With Habit of Acidic Drinks.

A 12-year-old boy with Down syndrome referred to the authors' department with dysphagia and growth retardation. Dysphagia was especially with solid foods and had a 12-month history. When he was 7, he had started to drink Coke and from that time he had a Coke drinking habit. Every day he was drinking more than 2 L Coke and was eating meals in small amounts. Investigations of the patient revealed esophageal stricture related to acidic drink habit and gastro-oesephageal reflux. The patient was treated with recurrent bouginage, antireflux medication, and nutrional support. The patient became symptom free from 13 months and gained weight. The clinicians should take the nutrition habits into consideration when evaluating the esophageal stricture patients.

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.

Ruptured Hemorrhagic Cyst of Undescended Ovary Mimicking Mucocele: A Rare Pediatric Case.

Undescended ovary is a rare entity and usually presentedas a case report. It is associated with urinary and uterine anomalies. Symptomatic patients are diagnosed during surgery. Most of the patients are asymptomatic and treatment is unnecessary. They are incidentally diagnosed during infertility evaluation and treatment such as ovarian hyperstimulation studies. A 15-year-old female patient presented with the diagnosis of renal cystic massas identifiedduring ultrasonography in another hospital. Abdominal computedtomography image was requested. A cystic lesion of about 48×34 mm with well-defined borders associated with the appendix and probably with mucocele of the appendix was reported in the lower right abdominal quadrant close to the cecum. During exploration, the right ovary was seen to be attached to the cecum and was higher in position as well as a right ovary originated cystic structure of 5×5 cm. Using needle aspiration, intraovarian hemorrhage was confirmed and partial cystectomy was performed. The present study reports on an undescended ovary that hadacute abdomen symptoms imitating mucocele. In girls referring to the hospital with abdominal pain, although quite rare, undescended ovaries are to be also considered. As the incidence of renal and uterine anomalies is higher in suchpatients, in symptomatic cases relevant organs are to be investigated carefully during surgical intervention.

Unusual complication of bladder catheterization in child: catheterization of ureter.

Bladder probing is an invasive procedure that is often used by paediatric and other surgeons. We present a case who was ureter catheterized accidentally while placing a probe into the right ureter in an 18 months old female. If different catheter localization is determined during the examination, the process must be terminated immediately and the relevant specialist should be informed right away.

Inframammarial Giant Fibroadenoma Removing and a Nipple-sparing Breast Reconstruction in an Adolescent: A Case Report.

Fibroadenomas are common, benign breast tumors that usually affect women in the second and third decade of life. Giant fibroadenomas often cause significant concern for the patient or family regarding malignant potential and altered breast development. Most fibroadenomas are benign. Local excision of small lesions through a circumareolar or inframammary incision rather than radical surgery is appropriate. Breast ultrasound represents the most commonly used imaging modality for the study of pediatric female breast masses and fibroadenomas. Detailed descriptions of the sonographic appearances of fibroadenomas in young girls are sparse. We believe that surgical treatment for the patient should include tumor extirpation and immediate restoration of breast appearance, minimizing visible scars, protection of the developing breast bud, nipple, and areola. This modality reduces psychosocial comorbidity.

Short-gap Isolated Esophageal Atresia Causing Stridor Due to Compression of the Trachea.

Isolated esophageal atresias are reported always to be associated with long gap in the literature. In this manuscript, we aimed to discuss the imaging and surgical treatment methods of an isolated esophageal atresia case with 'short gap' who had stridor due to compression of the trachea by dilated upper esophageal pouch and had not identified previously in the literature.

Evaluation of the systemic immune inflammation index and the systemic inflammatory response index as new markers for the diagnosis of acute appendicitis in children.

BACKGROUND: Abdominal pain is a common and non-specific symptom in children. It is important to be able to distinguish the source of abdominal pain before surgery. OBJECTIVES: Assess importance of the systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and other systemic inflammatory response blood cell indices in predicting the diagnosis and prognosis of acute appendicitis in children. DESIGN: Retrospective cohort SETTING: Single center in Turkey PATIENTS AND METHODS: The files of patients with abdominal pain aged 0-18 years who underwent surgery for appendicitis in our clinic between January 2011 and January 2022 were reviewed. According to the pathology results, patients were divided into two groups, those with pathologic findings of appendicitis (positive for appendicitis) and those without appendicitis. Systemic inflammation markers were statistically compared between the groups. MAIN OUTCOME MEASURES: Systemic inflammation markers. SAMPLE SIZE: 1265 patients RESULTS: Of the 1265 patients, 784 (62%) were male and 481 were female (38%). According to the pathologic examinations, 256 (20.2%) patients did not have appendicitis, and 1009 (79.8%) patients had acute appendicitis. The SIRI level was significantly higher in patients with acute appendicitis compared with patients without acute appendicitis (P<.001). Levels of SII were significantly higher in patients with acute appendicitis (P<.001). CONCLUSION: In children presenting with abdominal pain, high SIRI and SII values alone support the diagnosis of acute appendicitis at a rate of 95%. When physical examination findings, duration of pain, and imaging test results are added, the diagnosis becomes clear at a rate of 98%. LIMITATIONS: Single-center study and retrospective.

Comparison of conventional Doppler imaging techniques and superb microvascular imaging in determination of vascularization in undescended testes.

Aim: Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes. Material and methods: We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume. Results: Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging (p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes (p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes. Conclusions: The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes.

The comparison of ultrasound-guided ilioinguinal/iliohypogastric nerve block and pre-incision wound infiltration for pediatric inguinal hernia repair: A prospective randomized clinical study.

OBJECTIVES: Inguinal hernia repair is one of the most common daily surgeries performed in pediatrics. This prospective randomized clinical trial aims to compare ultrasound (USG)-guided ilioinguinal/iliohypogastric (IL/IH) nerve block and pre-incisional wound infiltration (PWI) in terms of post-operative analgesia on pediatric unilateral inguinal hernia repair. METHODS: After receiving ethics committee approval, 65 children aged 1-6 years who had unilateral inguinal hernia repair were allocated to USG-guided IL/IH nerve block (group IL/IH, n=32) and (group PWI, n=33). In both groups, 0.5 mg/kg 0.25% bupivacaine+2% prilocaine mixture was used by calculating the volume as 0.5 mL/kg for the block and infiltration. The primary outcome was to compare both groups' post-operative Face, Legs, Activity, Cry and Consolability (FLACC) scores. The secondary outcomes included the time to first analgesic request and the total acetaminophen consumption. RESULTS: The FLACC pain scores at the 1st, 3rd, 6th, and 12th h were statistically significantly lower in group IL/IH than in group PWI (p=0.013, p<0.001, p<0.001, and p=0.037, respectively) (p<0.001). There was no difference between the groups at the 10th and 30th min and at 24 h (p=0.472, p=0.586, and p=0.419, respectively) (p>0.05). CONCLUSION: USG-guided IL/IH nerve block in pediatric patients with inguinal hernia repair was found to be superior to PWI in terms of lower pain scores, less additional analgesia requirement, and longer first analgesia requirement.

Anaesthesia-Related Pediatric Neurotoxicity: A Survey Study.

OBJECTIVE: Millions of children are exposed to anaesthetic drugs every day; however, the possible adverse effects of these agents on the central nervous system remain controversial. This study evaluated anaesthesiologists' and pediatric surgeons' knowledge and daily practices regarding anaesthesia-induced neurotoxicity. METHODS: A survey consisting of 12 questions was sent to members of the Turkish Anaesthesiology and Reanimation Association and the Turkish Pediatric Surgery Association via the Google forms program. RESULTS: A total of 202 anaesthesiologists and 51 pediatric surgeons participated in this survey. The results demonstrate that anaesthesiologists and surgeons are aware of the risk of anaesthesia-related neurotoxicity and are willing to take action. Approximately, half of the anaesthesiologists and pediatric surgeons expected to postpone operations lasting at least 3 hours for patients <3 years of age. Also, one-third of the anaesthesiologists would seek feasible and more reliable alternative anaesthetic strategies. CONCLUSIONS: More than two-thirds of the participants knew about the US Food and Drug Administration neurotoxicity warning; however, uncertainty about anaesthesia-related neurotoxicity is ongoing. Many questions remain unanswered. The results of large-scale prospective randomized studies to evaluate the effect of anaesthetics and surgery on the cognitive development of pediatric patients are needed.

The Effect of Botulinum Toxin in Experimental Hypertrophic Pyloric Stenosis.

Purpose: Infantile hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in the first month of life. Botulinum toxin (BT) is a neurotoxin produced by clostridium botulinum, which causes paralysis in skeletal muscles. We aimed to evaluate the effectiveness of BT in the experimental pyloric stenosis model. Methods: The study protocol was approved by the Selcuk University Medical Faculty Ethics Committee (2017/20). We performed an experimental study using 32 Wistar-Albino newborn rats. Rats were divided randomly into four groups with six rats in both control (C), and L-nitro-arginine methyl ester hydrochloride group, and 10 rats in each sham (S), and BT group. 100 mg/kg per day L-NAME was applied to all groups intraperitoneally for 14 days from birth except control group. 0.2 mL saline and 20 U/kg BT was injected by surgery to S and BT groups, respectively, at 21 days from birth. After 35 days all rats were sacrificed and biopsies were performed from pyloric muscle for histopathological examination. The results were evaluated with the "one-way ANOVA" test. Results: Total and circular muscle thickness of the groups were compared. The total muscle thickness of the L-NAME group was significantly higher than the control group (P = .031). Comparing the circular muscle thickness of botox group (BTG) with control group (CG) and L-NAME GROUP (LNG), muscle thickness was significantly smaller (P < .001, P < .001). The total muscle thickness of BTG was significantly different between LNG (P < .001). Conclusions: Hypertrophy of pylor in an experimental model was reduced by BT injection in this study. We think that Botox injection through endoscopic or interventional radiological methods may be an alternative method for surgery.

The effects of nitroglycerin in the zone of stasis in a rat burn model.

BACKGROUND: Studies evaluating the recovery of the zone of stasis is an important issue in burn research. In this study, we aimed to evaluate and compare the efficiency of an anti-ischemic and vasodilatory agent, a topical agent containing 2% nitroglycerin with 1% silver sulfadiazine, and bacitracin-neomycin sulfate in the zone of stasis histomorphologically and immunohistochemically. METHODS: We conducted an experimental study using 30 Wistar-Albino rats, each weighing 250-300 grams. The rats were divided randomly into five groups (six rats in each group). In this study, the "comb model," which was deemed to be the most appropriate experimental model to produce an injury with predictable zones and was first described by Regas and Erhlich, was used. The following were applied to the zone of stasis after creating a burn model in 0, 24, and 48 hours: topical 2% nitroglycerin, 1% silver sulfadiazine, bacitracin-neomycin sulfate, and Vaseline-lanolin (sham). After 72 hours, biopsies were performed from the zone of stasis and evaluated by histomorphological and immunohistochemical CD 34 (expressed in human endothelial and hematopoietic cells) and D 2-40 (expressed in the endothelium of lymphatic capillaries) methods. The results were evaluated using the chi-square test. RESULTS: Compared with the other groups, a statistically significant difference was found in edema, inflammation, and vascular proliferation in the nitroglycerin group. Significantly more intense staining for CD 34 was found in the nitroglycerin group compared with the other groups. Immunohistochemical staining for D 2-40 was also found statistically significant in the nitroglycerin group (p<0.05). CONCLUSION: A topical containing 2% nitroglycerin increases vascular proliferation in the zone of stasis affects the recovery and may be used as a new agent in burn injury treatment.

Modified Hinderer's Technique for Serious Proximal Hypospadias with Ventral Curvature: Outcomes and Our Experience.

PURPOSE: Hypospadias is a congenital anomaly that includes defi¬cient ventral structure of the penis. Proximal hypospadias cases make up 20% of all hypospadias cases. The choice of operative technique for hypospadias repair depends on the severity, and it is influenced by the surgeon's experience and perception of where priorities should lie. Several other factors interact to determine the type of repair, such as meatal site, presence of chordee, availabil-ity of the prepuce, and quality of the urethral plate and in addition surgeon's experience affects the type of repair. MATERIALS AND METHODS: The treatment records of 42 penoscrotal and perineal hypospadias cases that were treated in our clinic from 1998 to 2017 were reviewed retrospectively. Cases with penoscrotal and perineal meatus were included in the study at the beginning of the urethroplasty. All cases had surgical intervention via Hinderer's tech-nique. RESULTS: Acceptable cosmetic results were obtained in 37 (85%) patients with an objective scoring system (HOSE) for evaluating the results of hypospadias surgery score. The mean score after surgery was 14.8. Fistula and wound breakdown occurred in 7 out of the 42 cases. CONCLUSION: In conclusion, the modified Hinderer's technique is a safe and reliable technique for both proximal and perineal hypospadias. Low complication rates and application in a single surgical session increase the comfort of both the patient and the surgeon.