Search

Aim:Micafungin is one of three currently available echinocandin for the treatment of candidiasis and candidemia. We aimed to discuss the effectiveness of micafungin and any possible side effects in the treatment of proven candidemia in children.Materials and Methods:In this study, children who were treated with micafungin for proven candidemia between May, 2017 and October, 2019 were included. The time to achieve negative culture, liver and renal functions as well as blood counts were recorded using the hospital data system.Results:Forty-five patients (52.3%) who received micafungin for proven candidemia were included in this study. The median age of the children who received micafungin due to invasive candidiasis (IC) was 4 months (range: 12 days to 216 months). Of these 45 IC patients, 10 (22.2%) were neonates, 19 (42.2%) were infants, 11 (24.4%) were between 1 and 5 years old, and 5 (11.1%) were between 10-18 years old. The median duration of micafungin treatment to culture negativity for C. albicans related candidemia episodes was shorter (6 days, 1-26 days) than non-albicans Candida spp. related candidemia episodes (7 days, 1-35 days) (p=0.10). Culture negativity could not be achieved at the end of the 14th day of micafungin treatment in 15 of the 45 (33.3%) candidemia episodes. The most commonly isolated Candida spp. in patients with treatment failure was C. parapsilosis (n=6), followed by C. albicans (n=5), C. guilliermondii (n=1), C. tropicalis (n=2) and C. tropicalis and C. guilliermondii co-infection (n=1) respectively. None of the patients developed side effects due to micafungin treatment.Conclusion:Micafungin was found to be safe and effective for the treatment of culture proven candidemia in pediatric patients, including neonates.

BACKGROUND: Acute appendicitis is one of the most common causes of emergency department (ED) admission among pediatric patients, and the most common cause of abdominal pain requiring surgical intervention. The present study aimed to measure the success of three different appendicitis scoring systems in patients who were operated due to acute appendicitis (AA) upon presenting at the pediatric ED with acute abdominal pain. METHODS: The study included a total of 226 patients who were admitted to Pediatric Emergency Department and who underwent an appendectomy between December 2018 and May 2019. Through a retrospective review of patient files; age, gender, clinical findings, laboratory results, Pediatric Appendicitis Score (PAS), Lintula score, Acute Inflammatory Response (AIR) score, ultrasonography (USG) findings and pathology results of the patients operated due to AA were recorded. RESULTS: A total of 226 patients were included in the study, with a mean age of 11.6±3.66 (1-17) years, and 57.1% (n=129) of the patients were female and 42.9% (n=97) were male. The pathology results were evaluated under three categories: suppurative (phlegmonous) appendicitis, 74.3%; perforated appendix, 9.7%; and reactive lymphoid hyperplasia, 15.9%. The cut-off values gt;3 for AIR, gt;7 for PAS and gt;15 for Lintula were found statistically significant. Among the three scoring systems, Lintula had the highest sensitivity (91.5%) and PAS had the highest specificity (69.4%). DISCUSSION:Although scoring systems are used to diagnose AA, the selected cut-off values for the scoring systems have an effect on the results.. Patients with a PAS score of ≥7 were found to have more significant AA results. We believe that PAS is likely to be a preferred scoring system in pediatric patients, especially under busy ED conditions; however, further studies with larger populations are needed to develop scoring systems that will guide physicians to establish a final diagnosis.

Background: Once it has been first described by Song et al., in 1984, anterolateral thigh (ALT) flap gains wide popularity as a free flap with only a few reports in the literature regarding its application as a pedicled flap in regional soft-tissue reconstruction in pediatric patients. Materials and Methods: The author describes his experience about the role of pedicled ALT flap in reconstruction of different local defects in pediatric patients. Representative cases are presented for illustration. Results: Nine patients with ischial, trochanteric, and groin defects have been reconstructed by pedicled ALT flap between January 2018 and January 2019. The patients were between 7- and 15-year-old. The size of the flaps measured from 4 cm × 6 cm to 19 cm × 17 cm. The type of the flap was myocutaneous flaps in six cases and as perforator flaps in three cases. Primary closure of the donor site has been done in seven cases while split-thickness skin grafts were done in two cases. Eight flaps have been totally survived while partial necrosis has been occurred in the distal end of one case. Conclusion: Pedicled ALT flap provide a reliable and versatile option for plastic surgeons in reconstruction of difficult regional soft-tissue defects in pediatric patients especially when bulkiness and resistance of infection is indicated, with accepted functional and cosmetic results.

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To demonstrate the feasibility of retrograde intrarenal surgery (RIRS) in pediatric age group. Methods: Data of patients who underwent RIRS for the treatment of kidney stones were retrospectively analyzed. The procedure was performed using 7.5 Fr FlexX™ 2 flexible ureterorenoscope in all patients. Ureteral access sheath was not used in any patients. A double-j stent was inserted and the procedure was delayed for 2 weeks whenever access to the ureter was not possible. The stones were fragmented using laser and fragments smaller than 2 mm were left for spontaneous passage. Postoperative success was evaluated using ultrasonography and kidney, ureter and bladder (KUB) x-ray. Results: 14 patients with a mean age of 7.5±2.47 (range: 3-12) years were included. Male to female ratio was 8/6 and six patients had a stone on the right side. The mean stone size was 12.3±3.49 (range: 8-20) mm. Of the patients, 10 had a history of unsuccessful shock wave lithotripsy (SWL) treatment. Mean operation and fluoroscopy screening times were 33.5±6.9 (range: 25-45) and 45.3±15.4 (range: 30-75) minutes, respectively. The median hospital stay was 1.07±0.2 (range: 1-2) days. No major complications were noticed during the operation. Double-J stents were removed on the 2nd postoperative week and all patients were stone-free during the follow-up. Conclusion: RIRS can be performed safely and efficaciously in pediatric patients. (The Medical Bulletin of Haseki 2015; 53:52-6)

F-18 fluorodeoxyglucose positron emission tomography (PET) and hybrid PET/computerized tomography (CT) are important imaging modalities that are commonly used in pediatric malignancies. Hybrid PET/magnetic resonance imaging (MRI) has recently been introduced into the clinical practice and pediatric patients are its most important indication due to the advantage of reduced radiation dose. The radiation dose that pediatric patients are exposed to due to PET/CT imaging could be significantly reduced if PET/MRI is used instead. However, there are only limited number of studies published about the usage of PET/MRI in pediatric patients. The aim of our article was to review and summarize the published manuscripts about pediatric PET/MRI and to share the available data in order to be used in further clinical studies. [ABSTRACT FROM AUTHOR]

Aim: To demonstrate the feasibility of retrograde intrarenal surgery (RIRS) in pediatric age group. Methods: Data of patients who underwent RIRS for the treatment of kidney stones were retrospectively analyzed. The procedure was performed using 7.5 Fr FlexX™ 2 flexible ureterorenoscope in all patients. Ureteral access sheath was not used in any patients. A double-j stent was inserted and the procedure was delayed for 2 weeks whenever access to the ureter was not possible. The stones were fragmented using laser and fragments smaller than 2 mm were left for spontaneous passage. Postoperative success was evaluated using ultrasonography and kidney, ureter and bladder (KUB) x-ray. Results: 14 patients with a mean age of 7.5±2.47 (range: 3-12) years were included. Male to female ratio was 8/6 and six patients had a stone on the right side. The mean stone size was 12.3±3.49 (range: 8-20) mm. Of the patients, 10 had a history of unsuccessful shock wave lithotripsy (SWL) treatment. Mean operation and fluoroscopy screening times were 33.5±6.9 (range: 25-45) and 45.3±15.4 (range: 30-75) minutes, respectively. The median hospital stay was 1.07±0.2 (range: 1-2) days. No major complications were noticed during the operation. Double-J stents were removed on the 2nd postoperative week and all patients were stone-free during the follow-up. Conclusion: RIRS can be performed safely and efficaciously in pediatric patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is assessment of eight children who were operated on our clinic between 2010 and 2012 for replantation or revascularization of amputation at the level of zone 2. Materials and methods: From June 2010 to February 2012 eight children, aged between 3 and 15, were operated in our department with zone 2 amputations. Types of amputations were crash injury in 4 children and gyotin type regular amputation in 4 children. Mean ischemia time of the amputates was 3,5 hours (range 1,5-8 hours). In 5 children successful replantation were achieved but in 3 children the replantation was failed because of insufficient circulation despite recurrent anastomosis. Papaverin was used preoperatively in all cases. Mean follow-up period was 9 months (range 2-16 months). Results: Local administration of papaverin facilitates the replantation with promoting vasodilatation meaningfully. In addition, solutions used preoperatively such as lidocain, heparin, warm irrigation solutions (mean 28°C 0,9% NaCl) and also postoperatively administration of low molecular weight dextran and heparin, acetyl salicylic acid, pentoxyphyllin increase the success rate of replantation. Another important factor is also short of mean ischemia time. Conclusion: Some tools and methods are essential for management of the replantation at zone 2 in pediatrics such as, a good magnification, sensitive microsurgery equipment, 10/0-11/0 micro-sutures, effective vasodilatation per-operatively, adequate bone shortening and surgical exploration and close follow-up postoperatively. Postoperative rehabilitation is also an obligation to increase the success of the replantation. [ABSTRACT FROM AUTHOR]

Aim: We aim to study the quality of sedation and complications ratios during anesthesia applied with sodium thiopental and propofol and the reason of the magnetic imaging requests on pediatric patients retrospectively according to the hospital data. Material and Method: In this study, 109 patients, aged from 3 months to 5 years, that have been applied magnetic imaging process under anesthesia, have been examined retrospectively. Results: Pentotal sodium has been applied to 53 patients and propofol has been applied to 56 patients. Anesthesia processes were successfully performed on both groups. Conclusion: We recommend that pentothal sodium and propofol anesthesia can be used safely for outpatient anesthesia during magnetic imaging studies under appropriate physical and technical circumstances. [ABSTRACT FROM AUTHOR]

Delirium in children can be due to various etiologies and its clinical signs can differ from those of adults. Because of the increased prevalence of missed cases of delirium in children and adolescents and the limitation of literature from our country, this case presentation may be deemed important. A male patient of 11 years was found to have reduced sleep, irritability, visual hallucinations, and inability to focus and maintain attention after his operation. The complaints had an abrupt onset. He was using amoxicilline trihidrate 1000 mg/day, potassium clavulonate 250 mg/day, indomethacine50 mg/day and valproate 400 mg/day, at the time of presentation. It was learned that he was diagnosed with and received treatment for medulloblastoma, encephalitis and heterotopic ossification in the past. Laboratory investigations demonstrated reduced erythrocytes, hemoglobin, hematocrite and thrombocytes, elevated lactate dehydrogenase, generalized slowing in the baseline rythm, and changes secondary to the operation in the left cerebellar and occipital areas in the magnetic resonance imaging. The patient was thought to have Hypoactive-Mixed Delirium due to multiple etiologies and rispe ridone was started at 0.25 mg/day and titrated to 0.50 mg/day. Treatment directed at the underlying etiologies was initiated. It can be said that clinicians should pay attention to acute mental status changes in children and adults and that risperidone may be a viable treatment alternative for patients with hypoactive and mixed delirium. [ABSTRACT FROM AUTHOR]

Objectives: Double-J ureteral stent placement is a common procedure in urologic practice. The standard method for retrieval of ureteral stents is the cystoscopic technique. In this study, we evaluated the feasibility and efficacy of ureteroscopic removal of double-j stents in children. Materials and methods: All double-j stents were removed with semi-rigid ureterorenoscopy under general anesthesia in 27 patients. Patients were assessed in terms of age, sex and complications. Results: The mean patient age was 8.7 years (range 3-14 years). There were 17 boys and 10 girls (M/F: 1.7). The mean stent removal time was 3.3 weeks (range 2-8 weeks). All stents were successfully retrieved without complication and all children were discharged on the same day after the procedure. Conclusion: Ureterorenoscopic removal of double-j stent is effective, safe and tolerable in pediatric patients. Despite progress in the endourology, removal of the double-j stent using ureterorenoscopy should be considered as an option, especially, in the clinics which have inadequate instruments for children. [ABSTRACT FROM AUTHOR]