A prospective study for an alternative probe site for pulse oximetry measurement in male patients with severe burn trauma: penile shaf.

BACKGROUND: Authors widely use pulse oximetry in clinical monitoring of heart rate (HR) and peripheral oxygen saturation (SpO2) by attachment to the fingers; however, there can be a need for an alternative attachment site, especially for burned patients. We investigate the availability of a pulse oximeter probe attached to the penile shaft as an alternative site in pediatric male patients if all extremities became unavailable for pulse oximetry measurement due to severe burn and/or trauma. METHODS: We designed a prospective comparative study in a training and research hospital. After local ethical committee approval, pediatric male cases eligible for penile and extremity pulse measurements were evaluated during general anesthesia for medical dressing and/or grafting due to severe burns. One probe was attached to the fingers of the unburned extremity, and the other was to the penile shaft. Furthermore, we recorded SpO2and HR values at 5-min intervals; 0th (baseline), 5th, 10th and 15th minutes. We compared HR and SpO2values measured by the finger probe with those measured by the penile probe. RESULTS: Data of 51 patients (median age, 2.9 years (interquartile range, 2.0-5.0 years)) in whom the duration of dressing was at least 15min were analyzed. There was no significant difference either in comparisons of hemodynamic measurements (HR and SpO2 ) obtainedby finger probe and by a penile probe for each measurement time. The Bland-Altman plot analysis reveals agreement for penile and finger probes with a mean bias value between 0.20 and 0.37 on HR and between 0.43 and -0.20 on SpO2. DISCUSSION: This clinical trial demonstrated that pulse oximetry measurement under nonhypoxic conditions we could perform confidently using penile probes in pediatric male patients whose extremities are unavailable for measurement.

Clinical trials of 3D printing splints to avoid contracture development in burned children

Background/aim: We evaluated the feasibility of producing splints with 3D printer technology to prevent contractures in burned children in our clinical prospective study. Materials and methods: After approvals, children with burns greater than 2nd degree were included in the study. Age, sex, burn percentages, printing time, filament types, number of filament trials, splint suitability, patient and doctor comments, preclinical trials' significances and financial impact were evaluated statistically. Results: Seventy-six trials were conducted on 18 patients. Fourteen of the patients were male and 4 are female. Average ages of boys and girls were 5 and 3, respectively. Burn percentage was 36.9 ± 13. Polylactic acid (PLAFlex), polyurethane (PolyFlex), semiflexible copolyester (nGenFlex), and thermoplastic polyurethane (TPU) were the main filaments that were used in the study. Printing time differed from 4 to 29 h according to body regions. Splints were suitable for 81.25% in upper extremity, for 66.7% in lower extremity, and for 100% in mouth. Burn percentage was significantly correlated with total number of filament (p = 0.049). Other statistical evaluations were insignificant. Conclusion: The 3D printer seems to be useful in children with burns. However, difficulties caused by some reasons like production must be overcome. By increasing clinical experience, this emerging custom-made technology may become standard, and documented problems can be solved.

Expression of Epstein-Barr virus in children with sacrococcygeal pilonidal sinus determined by immunohistochemical methods.

In this study, we probed whether chronic infections of skin such as pilonidal sinus could be a potential site of Epstein-Barr virus (EBV) replication. Pilonidal sinus is associated with a high recurrence rate. Therefore, we decided to determine the role of EBV's presence to explain whether it is correlated with the recurrence of pilonidal sinuses. This study was conducted on 36 patient samples with sacrococcygeal pilonidal sinus. Samples were immunohistochemically stained for EBV, CD3 and CD20 expression. Thirty-six adolescents with pilonidal disease were evaluated. EBV-positive cells were located in dermis with high inflammatory activity. EBV-positive cells stained positive for the B-cell antigen CD20 and were detected in 10 of 36 (27%) pilonidal sinus specimens. Among those who had experienced a relapse, three were positive for EBV expression. In addition, EBV expression was detected in eight cases with severe inflammation, and in two with minimal or moderate inflammation. Our study advances the field by demonstrating that similar to gastrointestinal mucosa, skin could be a reservoir for EBV. EBV was found to be restricted to B cells in skin lesions, and it was found that skin lesions with severe inflammation showed higher frequency of EBV expression in comparison to minimal or moderately inflammed skin lesions. Additionally, recurrence was more frequently observed among EBV-positive cases. These findings point out for a role of EBV infection in the recurrence of pilonidal sinuses.

Association of anterior thoracic meningocele and azygos lobe of the lung.

Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

Teratoid Wilms' tumor exhibiting extensive squamous differentiation.

Teratoid Wilms' tumor is a rare renal tumor. Herein, we report an unusual variant of such tumor which simulated renal teratoma because of abundant keratinized squamous epithelium within the tumor.

Diagnosing granulomatous disease during appendectomy.

Difficulties during surgery are uncommon situations in appendectomy. For granulomatous appendicitis, literature is insufficient about surgical findings. The procedure of a 17-year-old male patient was a struggle due to adhesions. I thought a surgeon could expect granulomatous diseases by evaluating the macroscopic appearance of the appendix during surgical procedure.

Bilateral spontaneous pneumothorax in a newborn with N1303K mutation of cystic fibrosis (CFTR) gene.

Cystic fibrosis is the most frequent and lethal inherited disease, affecting populations of European and Caucasian origin. Pneumothorax is life threatening pulmonary complication of cystic fibrosis. Bilateral pneumothorax is rarely seen and is a predictor of poor prognosis. We report a newborn presenting with bilateral pneumothorax whose diagnosis was cystic fibrosis with N1303K mutation on CFTR gene.

Torsion of an encysted fluid collection.

Torsion of a cyst within the tunica vaginalis is a rare entity and clinical course can easily be confused with other diseases that cause acute scrotum. We report a 6-year-old child with 3 days of acute scrotum findings. Patient had surgery with the suspicion of testis torsion. Torsion of a cyst within the tunica vaginalis was found intraoperatively. In pathologic evaluation, a necrotic funicular cyst was diagnosed. Two different mechanisms were reported for the reason of this disease: hernia sac protrusion in the hydrocele sac and bell-clapper deformity. Our observations were on the side of bell-clapper deformity. We aimed to share our findings with this report.

Can spinal bupivacaine analgesia treatment make a difference on urinary bladder healing according to the intramuscular pethidine analgesia treatment in rats?

We designed a study to compare the healing levels found with intramuscular pethidine with those found with intrathecal local anesthetic treatments. The urinary bladder is suggested to be the most useful tissue in the evaluation of the effects of the drugs. Nineteen male, Sprague-Dawley rats weighing 200 C300 g were used in this study. A sagittal section was made in the urinary bladder after suitable anesthesia and laparotomy. Bladders were closed with 5-0 plain catguts 5 min later. There were nine rats in the control group and pethidine (0.5 g/kg) was administered intramuscularly in the gluteal muscle region to treat pain after the operations. There were 11 rats in the study group and each received a spinal injection of 0.25% bupivacaine after the operation. Rats were followed for 7 days to define pain. Specimens, particularly the incised region of the bladder, were evaluated for inflammation and fibrosis. Grading scales were used for this purpose. Statistical analyses of the data were performed using the Chi-square test. Statistical analyses were nonsignificant for inflammation (p

Osseous presentation of Hodgkin's disease: a case report and review of the literature.

The bone involvement in the later stages of Hodgkin's disease is an expected phenomenon, but it is very rare in early stages of the disease. About 49 cases of Hodgkin's disease presenting with bone involvement have been reported in the literature. We reported a 14-year-old boy initially evaluated with pain localized at the left ilium. Although all the radiological examinations suggested an osseous anomaly, histopathologic evaluation of the pelvic lymphadenopathies provided definite diagnosis of the disease. We discuss the possible differential diseases and review the literature regarding the osseous presentation of Hodgkin's disease.

Segmental neurofibromatosis: report of two cases.

Neurofibromatosis (NF), or von Recklinghausen's disease is comprised of a heterogeneous group of disorders, primarily affecting the skin, soft tissue, bone and central nervous system. Segmental neurofibromatosis (SN) is a rare form of NF, characterized by "café-au-lait" macules, freckles, and/or neurofibromas limited to a body segment. There are approximately 150 cases reported in the English published work. Bilateral segmental neurofibromatosis is a rare subtype of SN, manifesting with bilateral involvement of the body segments. Herein, we report two patients with SN; one associated with pectus excavatum, and the other case diagnosed as bilateral segmental neurofibromatosis. Asymmetry of the skull and thorax, kyphoscoliosis and segmental bone hypertrophy of the leg are skeletal abnormalities previously reported with SN. To the best of our knowledge, this is the first case of SN in association with pectus excavatum.

Evaluating incorrect management of transferred pediatric burn patients.

BACKGROUND: Burns constitute one of the most important, potentially fatal types of trauma. Appropriate emergency management is essential in the avoidance of complication and the success of treatment. Emergency management and indications of transfer throughout the country were reviewed in the present study. METHODS: Charts of 187 patients transferred to the present hospital from other cities between January 2009 and December 2013 were evaluated. Factors included demographics, referral vehicles, intravenous fluid therapy, respiratory conditions, urine drainage, and surgical complications. RESULTS: According to transfer criteria, only 15 patients (8%) were transferred under appropriate conditions. In the transfer of 172 (92%) patients, at least 1 error was found. CONCLUSION: Transport failure, and incorrect management and treatment causing complications such as the development of respiratory problems after unnecessary sedation, occur in developing countries such as Turkey. Referral protocols for burn patients have already been defined in the country, though training and feedback regarding effective treatment is still lacking.

The outcomes of becoming a pediatric burn center in Turkey.

BACKGROUND: Burns are one of the most important causes of traumatic death in children worldwide. A pediatric burn center was established in our hospital in August 2009. The aim of this study was to compare patient profiles and data before and after the burn treatment center was established. METHODS: Burn patients were admitted to the pediatric surgery department between January 2005 and August 2009, and there was no intensive care service in this department. Intensive care service has been provided since August 2009 with the burn center established at our hospital. The 316 cases that were followed-up at the pediatric surgery department in the first period were identified as Group I and the 442 cases that were admitted to the burn center in the second period were identified as Group II. The data of the groups were then compared. RESULTS: Mean age of the cases was 5.1 years in Group I and 7.7 years in Group II. The total mean body burn percentage was 16.12% in Group I and 17.54% in Group II. Although scalding burns were the most subtype in both groups, flame burns were 2.13 times, electrical burns 3.44 times, flame+inhalation burns 8.33 times, and burns with an over 40% total burn surface area were 2.41 times more common in Group II than in Group I. The mortality rates were 0% in Group I and 2.26% in Group II. CONCLUSION: Converting to a normal department admitting burn patients in a burn unit format to an actual burn center means more severe cases will be admitted. This requires a patient and attentive process while the burn team struggles with the new patient profile on one hand and has to learn how to overcome with less personal trauma the loss of patients, a feeling it is unfamiliar with, on the other, which is also an actual training process for the entire burn team.

Coexistence of Anal Atresia, Anophthalmia and Intestinal Neuronal Dysplasia Type-A in a Newborn.

We report a patient with anal atresia, anophthalmia and intestinal neuronal dysplasia type A.

An unusual case of esophageal and laryngotracheal atresia.

Esophageal atresia with or without tracheoesophageal fistula is a relatively common congenital anomaly. However, esophageal atresia with associated laryngotracheal atresia, double tracheoesophageal fistula and cardiac malformations is an extremely rare condition. In this article we report a newborn infant with severe respiratory distress at birth who had both esophageal and laryngotracheal atresia with congenital cardiac malformations, in an attempt to bring attention to the clinical presentation, and emergent diagnostic and therapeutic approaches.

A circumcision method in an old surgical textbook (Cerrahiyyetul Haniyye): reminding of a forgotten procedure.

PURPOSE: Circumcision is one of the historical surgical procedures. Some sources throughout the history contain various definitions about different circumcision methods. we described the details of the method, and aimed to remind the possibility of contemporary usage. MATERIALS AND METHODS: We compared circumcision chapters of Sabuncuoglu and Zahrawi to explain the historical origin of Sabuncuoglu's favorite circumcision method. RESULTS: We found a method which might be summarized as "knotting with rope technique" in one of historical textbooks named as Cerrahiyyetul Haniyye (Imperial Surgery) written by Serefeddin Sabuncuoglu (1385-1468?) in 1465. CONCLUSION: This circumcision method is not used currently. In addition this method has not been defined in the history of medical literature yet.

Measurement of hydroxyproline and nitric oxide, and comparison of sac fluid acidity in different inguinal pathologies.

PURPOSE: To compare hydroxyproline and nitric oxide levels, and fluid acidity between sac tissues from inguinal hernia, hydrocele and undescended testis patients. MATERIAL AND METHOD: Thirty patients were in the inguinal hernia group, 11 patients in the hydrocele group and 5 patients in the undescended testis with inguinal hernia group. Intrasaccular fluid acidity, and nitric oxide and hydroxyproline levels in sac tissues were measured and analyzed statistically between groups. RESULTS: Intrasaccular fluid could be obtained from 24 inguinal hernia and 6 hydrocele patients. Acidity level (pH) was 7.5 ± 0.74 in the hernia group and 7.86 ± 0.63 in the hydrocele group (p < 0.05). All patients in the three groups were evaluated for nitric oxide and hydroxyproline. Results for hydroxyproline (mg/g dry tissue)/nitric oxide (nmol/g wet tissue) were 3.53 ± 0.54/2.02 ± 0.39 for inguinal hernia, 2.89 ± 0.9/1.92 ± 1.05 for hydrocele and 3.02 ± 1.23/2.86 ± 1.09 for undescended testis group (p > 0.05). CONCLUSION: Hydroxyproline and nitric oxide pathways do not seem to be responsible for the different characteristics of inguinal diseases. However, differences in the acidity of sac fluid may be evidence of the different mechanisms of hernia and hydrocele formation.

Controversies on clitoroplasty.

A review of the literature regarding the current state of knowledge of the anatomic and physiologic features of the female clitoris was conducted. Based on this evaluation, operations on the clitoris were reviewed. The anatomic and physiologic reconstruction problems of surgical techniques for female pseudohermaphroditism that have previously been reported were reviewed. The author suggests that clitoroplasty is essential for patients with ambiguous genitalia, but the decision regarding the correct procedure, taking into account anatomic and physiologic success, can be controversial. This may be because of unclear anatomic and physiologic definitions, even for healthy people. As a temporary solution, more conservative procedures for maximally effective treatment are suggested.