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Introduction: This study aimed to evaluate the changes made by the pandemic in pediatric appendicitis, the Alvarado score and the contribution of ultrasonography to the diagnosis. Methods: This study was conducted on patients who underwent surgery for appendicitis to compare the COVID-19 pandemic period versus the same period the year before. Data regarding demographics, age, the time between symptom onset and admission to hospital, laboratory, ultrasonography and pathology results and Alvarado score were considered. Results: A total of 211 patients were operated on for appendicitis, 132 patients in the control group and 79 patients in the COVID-19 group. No significant differences between the groups in terms of age, gender and the distribution of appendicitis severity were found. The median time between the onset of symptoms and admission to the hospital was 2.72 days during the COVID-19 pandemic period and there was a significant difference between the two groups(p=0.043). Alvarado score and ultrasonography were evaluated together, in the control group sensitivity 98.4%, specificity 87.5%, PPV 96.9% and NPV 93.3%; if in the COVID-19 group were 94.5%, 88.8%, 97.2% and 80%, respectively. Conclusions: This study has shown that the evaluation of the Alvarado score and ultrasonography together, increases both sensitivity and specificity for the diagnosis of childhood appendicitis. That's why the combination of these tests becomes more important in special situations such as the COVID-19 period.

Resumen Antecedentes La dehiscencia glandular (DG) es una de las principales complicaciones que se producen tras la cirugia de hipospadias. Existe un numero limitado de publicaciones sobre la DG en la literatura. Objetivo Esta revision tiene como objetivo revelar los factores que afectan la DG mediante una revision bibliografica. Adquisicion de la evidencia Se realizo una busqueda literaria de articulos relacionados en la base de datos utilizando el termino de busqueda dehiscencia del glande sin establecer limite temporal ni ningun otro limite. Se incluyeron en este estudio todos los articulos relacionados con la dehiscencia del glande tras la cirugia de hipospadias. Tras recopilar la informacion de los textos completos, se incluyeron 71 articulos en esta revision sistematica. Se obtuvieron los siguientes datos para la realizacion del estudio: la localizacion del meato hipospadico, el tipo de cirugia, y otros datos clinicos que se consideraron factores de riesgo de la DG. Se utilizo la prueba de X2 para comprobar las diferencias entre los distintos parametros, considerando un valor p Resultados Tras evaluar los 71 articulos que cumplian los criterios de inclusion, en esta revision se detectaron 309 casos (3,48%) de DG tras 8.858 reparaciones de hipospadias. Las tasas de DG fueron significativamente altas en el caso de las reparaciones de hipospadias proximales (5%), las reparaciones en dos tiempos quirurgicos (5%) y las reintervenciones (8,75%) (p = 0,002, 0,022 y 0,004, respectivamente). El ancho del glande de Conclusiones El aumento de la tasa de DG se asocia a cirugias de hipospadias proximales, cirugias previas fallidas (cripple) y reparacion por etapas, al ancho de glande

Tracheomalacia (TM) is a disease that causes the airway obstruction of the tracheal lumen as a result of the structural disorder of the tracheal cartilage. We present a 4-month-old patient who developed ventilator depended TM after repair of esophageal atresia with tracheoesophageal fistula. Aortopexy and intraoperative flexible bronchoscopy were first performed via partial sternotomy in Turkey for this patient. He was weaned from ventilatory support and extubated at the first and discharged at the 8th post-operative day. Partial sternotomy is performed in the supine position, thus it allows for intraoperative flexible bronchoscopy permitting to check for the adequacy of the aortopexy.

We describe in situ skin graft tubularisation over the urethral catheter. This tehnique allows preparation of a urethral tube on a fixed line and suture the wound sides comfortably while preventing the movement of the graft.

Accidental ingestion of foreign bodies is a common situation in infants and children. Although coins are frequently swallowed by children, the introduction of electronic devices into our lives as a result of technological advances and the increase in battery use in toys have led to an increase in battery swallowing cases. Ingestion of button batteries is a more urgent situation than other foreign body ingestion, as it may cause complications such as perforation, trachea-esophageal fistula, large vein fistulization, esophageal stricture, vocal cord paralysis or spondylodiscitis. With this case report, we wanted to present an interesting case in which a 10-month-old boy who swallowed a 15 mm diameter button battery and developed esophageal perforation at the tracheal carina level after being pushed into the stomach whose perforation healed spontaneously with a conservative approach with chest tube, total parenteral nutrition and gastrostomy., Bebek ve çocuklarda kaza sonucu yabancı cisim yutulması sık karşılaşılan bir durumdur. Çocuklarda sıklıkla madeni para yutulmakla birlikte günümüzde teknolojik ilerlemeler sonucu hayatımıza elektronik cihazların girmesi ve oyuncaklarda pil kullanımın artması pil yutma vakalarında artışa sebep olmuştur. Yassı pillerin yutulması diğer yabancı cisim yutulmalarına göre perforasyon, trakea-özofagus fistül, büyük damara fistülizasyon, özofagus darlığı, vokal kord felci veya spondilodiskit gibi komplikasyonlara neden olabileceğinden daha acil bir durumdur. Biz de bu vaka sunumuyla 15 mm çapında yassı pil yutan ve mideye itilme sonrası trakeal karina seviyesinde özofagus perforasyonu gelişen 10 aylık erkek çocukta göğüs tüpü, total parenteral nutrisyon ve gastrostomi tedavisinden oluşan konservatif yaklaşımla perforasyonun kendiliğinden iyileştiği ilginç vakayı sunmak istedik.

OBJECTİVE: Classical transverse, verticalabdominal or thoracoabdominal incisions inpediatric patients are frequently used to removelarge abdominal tumors such as hepatoblastomaand neuroblastoma. We present our initial experienceson our patients who was operated by modifiedMakuuchi incision.MATERİALS AND METHODS: We used this incisionin 6 cases with large abdominal tumors (1 hepatoblastomaand 5 neuroblastoma and/or ganglioneuroma)between January 2019 and August 2020.RESULTS: These patients had previously receivedchemotherapy according to appropiate protocol. Theexposure of surgical field was perfect with this incisionand dissection of the tumors was easily performed.Complete removal of large abdominal tumors was successfullyachieved in the patients although the masseshave close proximity and adhesions with importantstructures and organs. There was serous collection in2 patients and it resolved spontaneously. No wound infection, hernia or wound dehiscence was observedduring a mean follow-up of 9.6 months (ranged from3 to18 months).CONCLUSİON: According to our preliminary experiences,the Modified Makuuchi incision provides a niceexposure for removal of large abdominal tumors to thesurgeons and is well tolerated by children.Las incisiones clásicastransversa, abdominal vertical o toracoabdominal enpacientes pediátricos son utilizadas frecuentementeen la escisión de tumores abdominales de gran tamañocomo el hepatoblastoma y el neuroblastoma.Presentamos nuestra experiencia inicial en pacientesoperados usando la incision de Makuuchi modificada.MATERIALES Y MÉTODOS: Usamos esta incision en6 casos con tumores abdominales de gran tamaño (1hepatoblastoma y 5 neuroblastomas y/o ganglioneuroma)entre Enero 2019 y Agosto 2020.Los pacientes recibieron quimioterapianeoadyuvante según protocolo. La exposicióndel campo quirúrgico, así como la disección del tumor,fue perfecta con esta incisión. Se logró remover la totalidadde los tumores con éxito a pesar de su proximidady adherencias a órganos vecinos. Dos pacientespresentaron colecciónes serosas que se resolvieronespontáneamente. No se observaron infecciones de herida, hernias o dehiscencia de heridas durante elperíodo de seguimiento con una media de 9.6 meses(rango de 3-18 meses).Según nuestra experiencia preliminar,la incisión de Makuuchi modificada ofrece alcirujano una buena exposición del campo quirúrgicopara la extirpación de tumores abdominales de grantamaño, además de ser bien tolerada por los niños.

Background: The rate of bladder injury during inguinal hernia repair in children is not well known. However, it is known that bladder injury during childhood inguinal hernia repair places a serious morbidity burden on children. We sought to determine an algorithm to avoid accidental bladder injuries. Methods: Reports that included pediatric patients with inguinal hernias containing the bladder were searched. Keywords and mesh term searches were conducted in the MEDLINE, Scopus, and Web of Science databases. We reviewed our clinical records and found that two patients had inguinal hernias containing the bladder. Results: Nineteen articles reporting on 26 patients diagnosed with the presence of the bladder within the inguinal canal from 1962 to 2021 were included in this article. Our two patients were added to this group. Diagnoses were made incidentally during genitourinary radiological examinations (n = 3), intraoperatively during hernia repair (n = 7), or due to clinical symptoms and findings (n = 18) after standard hernia repair. Bladder augmentation was required for three patients. Conclusions: During the operation, if there is any suspicion regarding the presence of the bladder in the inguinal region, we suggest performing a preoperative cystogram to confirm the position of the bladder and its injury. We recommend that the sac should be opened and the contents inspected before performing transfixion during high ligation of the hernia sac.

Surgicel is a hemostatic agent that consists of oxidized regenerated cellulose and used in surgical procedures as an aid to bleeding control. It is left in the operation site for hemostasis, could cause an operation by mimicking the recurrence of tumor, as in our patient.A 3-year-old boy was operated by us at the age of 40 days and 2.5 years, respectively, due to pelvic neuroblastoma. He was re-operated for mimicking recurrence or residue tumor secondary to the prior placement of Surgicel within the peritoneal cavity.Re-laparotomy was performed and the mass approximately 2.8 × 2×1 cm in size in front of the right ureter and iliac vessels and behind the bladder was removed by blunt and sharp dissection without damaging these organs. While gelatinous content was evacuated from this mass, there was no apparent tumor appearance. Pathology report was reported as fibrotic tissue characterized by foreign body and foreign body giant cells. The postoperative period was uneventful and he was discharged on the 2nd postoperative day.In the light of our case, the use of hemostatic agents should be kept to a minimum and should not be left in the body unless it is difficult. Thus, unnecessary examination or recurrent surgery can be avoided.

Surgery for pilonidal disease (PD) often is followed by an unpleasant postoperative course that restricts school and social activities. We performed a retrospective medical record review to evaluate the outcome of the Gips procedure on 19 adolescents with PD. We recorded each patient's age at surgery, surgical history, symptoms, duration of operation and hospital stay, time to return to activity, wound healing time, and recurrence. Our review demonstrated that the Gips procedure is an easy-to-use technique in adolescents with PD and had a high success rate. Furthermore, it is less restrictive on school and social activities than traditional surgical therapies.

Glanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature.The aim of this work is to reveal the factors that affect GD after a literature review.A literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p 0.05 was taken as statistically significant.After evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width14 mm, urethral plate (UP) width7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD.The rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width15 mm and UP width8 mm, postpubertal surgeries, and caudal anesthesia use during surgery.

Aim/Background Although many agents have been tested as treatment options for caustic esophageal burn (CEB), none have successfully suppressed the formation of strictures. Thus,the purpose of this study was to determine the efficacy of Contractubex® gel (10% onion extract, 50 U/gr heparin, and 1% allantoin) in stricture preventing after CEB. Methods In this study, 24 Wistar-albino rats were divided into 4 groups. CEB was initiated with an instillation of 1 mL of 10% NaOH solution into the an isolated esophageal segment for 3 min. Group C (control) was uninjured and untreated. In Group CEB, was initiated but no treatment was given. In Groups CTX1 and CTX2, the animals received 100 and 200 mg/kg/d, respectively, of Contractubex® for 4 weeks via gavage after CEB was initiated. The stenosis indices (SI), histopathologic damage scores, tissue hydroxyproline (HP) levels, and weights of the rats were taken before the experiment and 4 weeks after the experiment. Results The Mean SI levels, HP levels, and histopathologic damage scores were statistically lower in Groups CTX1 and CTX2 when compared with Group CEB (p 0,05); the efficacy of the treatment was not dose-dependent. Conclusion For the first time, Contractubex® was used for its antifibrotic, antioxidant, anti-inflammatory, and wound healing effects to treat caustic esophageal burn in rats. It was effective in reducing stricture formation by decreasing the HP levels and histopathologic damage as well as preventing stenosis and weight gain in the treatment groups.

Aim: The aim of the present study is to investigate the neuroprotective effects of l-Arginine (l-arg) in the seven-day-old rat hypoxia-ischemia model. Materials and methods: L-Arginine (n = 10) or saline (n = 8) was administered intraperitoneally to seven-day-old rats before hypoxia-ischemia. In addition, 18 seven-day-old rats were given l-Arginine (n = 10) or saline (n = 8) after hypoxic-ischemic insult. Neuronal apoptosis was investigated by terminal dUDP-biotin nick end-labeling (TUNEL) following three days of recovery. The ratios of right side numerical density to the sum of right and left sides' numerical densities (right apoptosis index) were calculated for every brain region in rats receiving l-arginine and they were compared with the vehicle groups. Results: Right side apoptosis indexes of the hippocampus (mean +/- SD; 35.0 +/- 16.1) and striatum (41.9 +/- 16.0) were significantly decreased in the l-Arginine post-treatment groups when compared to vehicles (61.0 +/- 17.0 and 62.4 +/- 27.0 respectively) (p < 0.05). There was no significant difference in the right apoptosis indexes of the cortex between l-Arginine post-treated group and the vehicle group. There were also no significant differences between the right side apoptosis indexes of the l-Arginine pretreatment groups and those of the vehicle group in any of the three regions (p > 0.05). Conclusions: It is concluded that neuronal apoptosis due to hypoxic-ischemic injury may likely to be reduced by post-treatment of l-Arginine in the neonatal rat model and l-Arginine provides a new possibility for neuroprotective strategies based on NO production.

Aims: Ureteropelvic junction obstruction (UPJO) may originate from extrinsic or intrinsic causes in children. The aim of this study is to present preoperative and postoperative data of our patients operated for UPJO. Methods: A total of 64 patients who underwent open pyeloplasty were investigated retrospectively. They were evaluated in terms of demographically, clinics, hydronephrosis, differential renal functions (DRFs), half-time tracer clearance (½TC), and histopathologic results. Patients’ numerical results were stated as mean ± standard deviation (SD). Results: Male gender was more prevalent ( n = 47, 73.4%) and mean age at surgery was 46.87 months. UPJO was located at the left side in 56.3% ( n = 36), and at the right side in 39.1% ( n = 25) of patients. It was bilateral in 4.7% ( n = 3). Hydronephrosis was found antenatally in 68.8% ( n = 44) of patients. The mean preoperative DRF was 49.7% (21–78%) and mean postoperative DRF was 49.2% (20–56%). Mean renal scintigraphic t1/2 was >20 min for all patients. The mean AP diameter was 21.58 mm (10–62 mm). Muscular hypertrophy was the most common pathological finding, mean length of excised segment was 10.26 mm (3–40 mm). Crossing vessel (CV) was detected in 17.18% ( n = 11). The CV was statistically associated with increased age of operation, left side, and female gender. Statistically significant hydronephrosis was found in non-CV patients. Re-operation was required in seven patients (7.8%). Conclusions: Intrinsic pathologies are more seen in the etiology of UPJO patients with antenatal diagnosis and this group needs operation at an earlier age. However, CV is found more commonly in patients who are diagnosed and operated at older ages.

This study aimed to investigate renal arterial resistive index measurements and urine electrolytes before and after enalapril therapy in a rat model of unilateral ureteropelvic obstruction. The transforming growth factor (TGF)-β1 response of the renal tissue was also investigated. 30 Wistar albino rats were randomly allocated into 5 groups (n=6). Group C rats served as controls. Group S rats had only laparotomy. Group E rats were only treated with enalapril. Rats in group UP and group UPE underwent laparotomy to create a left unilateral moderate partial obstruction. 2 weeks after establishing partial ureteropelvic junction obstruction, group UPE rats were treated with enalapril. Urine was collected over 24 h in all groups. Intrarenal arterial resistive index measurements were performed before and 2 weeks after surgery and after enalapril treatment in group UPE, and before and after enalapril treatment in group E. Rats were sacrificed by intracardiac puncture and left kidneys were harvested to evaluate levels of mRNA TGF-β1. There was no significant difference in ARI values in group E. In group UPE, the difference between ARI values before and after surgery was statistically significant; the difference between ARI values after surgery and after enalapril treatment was also statistically significant. There was no statistically significant intra-group difference in urine electrolyte levels for UP group or UPE group. There was no difference in renal mRNA TGF-β1 levels. Enalapril maintained renal blood flow by decreasing the arterial resistive index and maintained renal tubular function by protecting urine concentration and dilution ability in a rat model with unilateral ureteropelvic junction obstruction.

INTRODUCTION This study aimed to evaluate the effects of stent placement prior to stricture development following caustic esophageal burn (CEB) in an animal model. The outcomes after stent placement were also compared with those after balloon dilatation and cutting balloon dilatation performed after stricture development. Groups were compared with regard to stricture development and weight loss. MATERIALS AND METHODS 40 rats were divided into 5 groups. CEB was created as described by Gehanno et al. In Group A (control) no CEB was performed and the esophagus was only rinsed with saline. Group B rats underwent CEB with no subsequent treatment. Group C rats underwent CEB followed by balloon dilatation in the 3 (rd) and 4 (th) week. Group D rats underwent CEB followed by cutting balloon dilatation in the 3 (rd) week. Group E rats underwent CEB with subsequent placement of a silicon stent in the same session. The animals were sacrificed in the 6 (th) week, and the stenosis index (SI), collagen deposition, and hydroxyproline (HP) levels were determined in the esophageal segments and statistically compared. RESULTS Although weight loss occurred in Group C and Group B rats (238.87±15.95 g vs. 233.83±19.01 g), weight loss in Group C rats was less marked compared to Group B. Similarly, the SI in Group C was lower compared to that of Group B and the difference was statistically significant. Although there was no difference in weight between the rats in Group C and Group B before the procedure (p=0.318), there was statistically significant difference thereafter (p=0.002). The SI of Group D was also lower compared with that of Group B, and the difference was statistically significant. Weight gain in Group E rats was similar to that noted in Group A rats and was higher compared to Group B; this difference was statistically significant. The SI for Group E was lower compared to that of Group B. CONCLUSION Stenting performed at the time of corrosive injury and cutting balloon dilatation performed after stricture formation had a positive effect with regard to SI and weight gain in an animal model.

Background: The present study aimed to investigate whether the inflammatory and antioxidant lycopene has a therapeutic effect against renal ischemia/reperfusion (I/R) injury. Materials and methods: In this study, 24 Wistar-Albino rats, weighing from 200 to 250g, were divided into four groups. All rats underwent median laparotomy under anesthesia. No procedures were performed in the control group (Group C), whereas 100 mg/kg lycopene was administered by gavage in the lycopene group (Group L). The arteries of both kidneys were clamped for 45 min in the ischemia group (Group I), whereas 100 mg/kg lycopene was administered by gavage 30 min before clamping renal arteries, and ischemia was performed in the treatment group (Group T) rats. For all rats, blood samples and renal tissues were collected at 6 h of reperfusion. Samples were used to examine serum BUN, creatinine, MDA and GSH levels, and the renal tissues were used to examine MDA and GSH levels, and renal histopathologies. Results: The treatment group had statistically significant lower serum MDA levels, histopathological tubular vacuolization, loss of brush border and tubular dilatation (p0.05). Conclusion: The present study demonstrated that lycopene, which was administered prior to renal I/R injury, prevented renal damage through biochemical and histopathological parameters.

The purpose of this study is to describe a technique, that is as successful as microsurgery in terms of patency rates and histopathologic assessments, and can be performed even by untrained hands in microsurgery, for repairing vas deferens injuries that can be percieved during inguinal herniorrhaphy. Thirty male Wistar-Albino rats were randomly allocated to five groups. In control group, the vas deferens was harvested without any surgical intervention (Group 1) and in sham group the vas was harvested after a limited dissection (Group 2). Three suture approximation technique was carried out in Group 3, and a novel vasovasostomy technique was carried out by using a hypodermal needle in Groups 4 and 5, with polypropylene and polyglactin 910 (rapid vicryl(R)), respectively. Results were evaluated in terms of operative time, patency and flow rates, inflammation and sperm granuloma. The mean operative times for hypodermal needle assisted approximation of Groups 4 and 5 were found significantly less than Group 3. The compared results of the groups in terms of patency, flow rate, inflammation and spermatic granuloma indicated Group 4 to be superior to the other groups. We have found the hypodermal needle assisted approximation technique to be easier, less time consuming and cost effective. With these promising results, this modus operandi can be described as an appropriate technique for vas deferens transection repairs.

Many studies have evaluated the use of grafts in the reconstruction of abdominal wall defects. In this study, the effects resulting from the presence or absence of the omentum were evaluated in the setting of infection or serosal defects in the formation of adhesions in abdominal closures using mesh grafts.For this study, 60 Wistar albino rats were divided into six groups. A circular 3.79-cm(2) fascioperitoneal defect was created. After group-specific procedures, defects were reconstructed using polypropylene mesh grafts. In group C (control group), only a mesh graft recontruction was performed, whereas group O (O for omentectomy) underwent an omentectomy plus mesh closure. In group SD (serosal defect group), the cecum was abrased with a brush before mesh closure. Group SDO underwent cecal abrasion plus an omentectomy. In group I (infection group), the intraabdominal space was filled with 1 ml of solution containing 100,000 colony-forming units (CFUs) of Escherichia coli per milliliter. Group IO received the same same amount of E. coli solution plus an omentectomy before mesh closure. After 28 days, the groups were evaluated by intraabdominal and blood cultures, grading of intraabdominal adhesions, graft-organ adhesions, proportion of adhesions to graft size, and histopathologic studies. The results were statistically evaluated using one-way variant analysis and Scheffe's and Fisher's definite chi-square tests.For the groups in which the greater omentum was preserved, intestinal adhesions to the graft surface were less frequently observed, especially in cases with intraabdominal infections and serosal defects (p0.05).Preservation of the greater omentum reduces the formation of intestinal adhesions, especially in cases with underlying infections and serosal defects in abdominal closures using mesh grafts. This could be beneficial in related clinical situations in lowering the rate of intestinal fistulas, erosions, and obstructions that can be attributed to the formation of adhesions.

Background/purpose : Breast disease in adolescence is uncommon, with most presenting lesions being benign. Breast lesions in adolescent patients are discussed in this article with a review of world literature. Patients and methods : The clinical records of 30 patients operated upon for breast lesions in our hospital during 18 years were reviewed. Results : There were 25 female and five male patients, ranging in age from 16 years. Twenty-five female patients were operated on for breast mass and/or discharge, and five male adolescents were operated on for gynaecomastia. The most frequent (n = 27) complaint was palpation of mass in the breast. The most common histologies were fibro-adenoma (n = 14) and gynaecomastia (n = 5). The average duration of pre-operative symptoms was 2.9 months for fibro-adeno- ma, 1. 6 years for gynaecomastia (extremes 2 days to 1 year). Nipple discharge was observed in three patients. Average diameters of palpable masses were 2.9 cm for fibro-adenomas and 5 cm for gynaecomastia. Lesions were excised sur- gically in all patients. Masses diagnosed as fibro-adenomas in the pre-operative period were reported upon pathologi- cal examination to be precancerous lesions such as cystosarcoma phylloiedes, juvenile fibro-adenoma, solitary intra- ductal papilloma, tubular adenoma and juvenile papilloma. One postoperative wound infection and one recurrence of fibro-adenoma was seen. Conclusion : The most frequently encountered breast masses were fibro-adenomas. These lesions are mostly benign in nature and can be treated conservatively but the possibility of precancerous lesion should be considered during follow-up.

The preventive effect of amrinone on ischaemia/reperfusion (I/R) injury has been shown in the medical literature. The purpose of the present study was to investigate the preventive effect of amrinone on I/R injury of the small bowel of the rat.Thirty-two Wistar albino rats (140-180 g) were divided into four groups (n = 8). In all groups except the sham group the superior mesenteric artery was clamped for 30 min. At the beginning of reperfusion, 1 mL of 2405 Bq/mL 51Cr-ethylenediamine tetra-acetic acid (EDTA) was administered into the prepared ileal segment. Following 30 min of reperfusion, 1 mL of blood was obtained from the portal vein. After the rats were killed, the small intestine was removed for histopathological studies. A total of 5 mg/kg amrinone was administered to the rats in group 1 before ischaemia and in group 2 before reperfusion, whereas only saline was administered to the rats in the control group. Statistical analysis was carried out with Kruskal-Wallis and chi2 test, P0.01 was considered significant.Both the blood 51Cr-EDTA measurements (mean +/- SD) and mucosal injury grades (MIG) were highest in the control group (3.95 +/- 0.71 c.p.m.; MIG, 3-5) followed by group 2 (0.50 +/- 0.35 c.p.m.; MIG, 1-3), group 1 (0.47 +/- 0.34 c.p.m. MIG, 0-3), and sham group (0.12 +/- 0.05 c.p.m.; MIG, 0). The difference between groups 1 and 2 and the control group were statistically significant (P0.01 for each comparison). The results of group 1 and 2 were similar statistically (P0.05).Amrinone was found to be effective in preventing intestinal I/R injury.

Massive ovarian oedema is an unusual clinical entity occurring in teenage girls. It is a rare tumour-like condition of the ovary characterized by marked enlargement of one or both ovaries due to marked accumulation of oedema fluid in the ovarian stroma. Massive ovarian oedema may result from partial or intermittent torsion of the mesovary, interfering with venous and lymphatic drainage, but not with arterial blood flow. The patients most commonly present with lower abdominal pain and enlargement. This entity can clinically mimic a neoplasia. We report three cases with massive ovarian oedema.

Human echinococcosis is endemic in Turkey and many other areas of the world. Fifteen years of surgical assessment related to involved structures, operative procedures, complications, and the recurrence rate is analyzed in pediatric patients with pulmonary and abdominal hydatid cysts. Between 1986 and 2001, the records of 42 pediatric patients (15 girls, 27 boys; ages 2-15 years) with pulmonary and abdominal hydatid cysts operated on in our clinic were analyzed retrospectively. The features of the disease, involved structures, operative procedures, complications, and recurrences were noted. A total of 26 patients presented with solitary cysts in the lung (9) and liver (17). Another 11 had multiple cysts in both lung and liver, and 5 had disseminated abdominal disease. Conservative surgical procedures were used for all lung and liver cysts: cystotomy (7) or cystotomy plus capitonnage (13) for lung cysts; partial pericystectomy with capitonnage (25), omentoplasty (28), tube drainage in the presence of bile leakage (5), or a combination of these procedures for liver cysts. Cyst excision was used for omental and peritoneal localizations when feasible. Radical procedures were never used (wedge or major liver and lung resections). Operative mortality was zero, and the morbidity rate was 14%. Three patients with disseminated disease (7%) showed recurrence. We suggest that no partial organ resections are necessary for hydatid disease, and highly successful results can be achieved using conservative surgical approaches, such as cystotomy plus capitonnage for lung cysts and partial pericystectomy with capitonnage, omentoplasty, or both for liver cysts.

A 15-years-old girl was admitted to our Paediatric Surgery Department with a history of rapidly increasing enlargement of the right breast over the previous five months. Sonography revealed a non-infiltrative large tumour located in the right breast. The mass was excised and the histopathological examination established a diagnosis of giant fibroadenoma of the breast. The postoperative period was uneventful, and cosmetic intervention was accepted by the patient. Giant fibroadenoma is a rare pathology, usually presenting in adolescence, characterised by massive and rapid enlargement of an encapsulated mass. Currently, there are some preoperative difficulties in distinguishing it from cystosarcoma phyllodes, which has benign and malignant forms. It is important to differentiate the two pathologies before surgery as they have a different therapeutic approach and different follow-up. In cases of fibroadenoma, breast tumours over 5 cm in diameter and showing rapid enlargement should be excised and a histopathological diagnosis must be made. (Gazi Med J 2012; 23: 94-6)

Ewing sarcoma (ES) is a malignant neoplasm usually affecting the skeletal system. Extraskeletal ES is a rare tumor. To date, only 1 case of primary mesocolon ES has been previously reported in an adult. Herein, we present the first case of ES in the mesocolon in a child. (C) 2012 Elsevier Inc. All rights reserved.

Background/Purpose: Anal fissures would result in constipation in children, worsening the clinical picture, thus, justifying a fast response therapy. In this randomized, prospective, placebo-controlled study, it was aimed to determine the response rates to fissure treatment by lidocaine, EMLA and GTN on the 10th day and after 8 weeks of therapy. Related childhood literature is scarce, and EMLA is tried for the first time in fissure treatment. Methods: One hundred two children with anal fissures were allocated randomly into 4 groups. Placebo group (P; n=20) received vaseline; group L (n = 24), 10% lidocaine; group EMLA (n = 25), eutectic mixture of 5% prilocaine-5% lidocaine; and group GTN (n = 22), 0.2% glyceryl trinitrate ointment twice daily to the distal anal canal. Symptoms and physical findings were separately scored as 0, 1, and 2. On the 10th day, the number of patients with scores of 0 (unresponsive) and in the 8th week with scores of 2 (healed and symptom free) were analyzed statistically. Results: Ninety-one patients completed the study. On the 10th day children with 0 symptomatic and fissure healing scores were, respectively, 90% to 95% in group P, 75% to 80% in group L, 20% to 40% in group EMLA, and 5% to 10% in group GTN. These results were statistically significant. In the eighth week, children with symptomatic and healing scores of 2 were, respectively, 10% to 5% in group P, 42% to 29% in group L, 76% to 64% in group EMLA, and 91% to 82% in group GTN. Results in groups GTN and EMLA were statistically similar ( P >.05) and better than the other 2 groups ( P Conclusion: Faster response rates could be achieved by GTN application, and similar and high success rates could be gained by GTN or EMLA by 8 weeks of treatment. J Pediatr Surg 37:1313-1316. Copyright 2002, Elsevier Science (USA). All rights reserved.

Ureteral injuries represent less than 1% of all traumatic genitourinary injuries. The rarity of traumatic ureteral injury is at least in part because the ureters are relatively well protected in the retroperitoneum. Ureteral injuries after blunt trauma are not common, and bilateral disruption of the ureteropelvic junction (UPJ) has only been previously reported in just one child. This is the first documented case of operative ureteral repair of bilateral complete UPJ disruption with double J ureteral stents in a child. (c) 2008 Elsevier Inc. All rights reserved.

Pulse oximetry has been proposed as an appropriate and feasible technique in the assessment of intestinal ischemia in recent years. In this study the authors aimed to assess the reliability of anastomoses in the dog small intestine in which there is graded irreversible ischemia as measured by pulse oxymeter.In a control group of four dogs, without any devascularization, three small bowel anastomoses were formed in each dog. The study group consisted of 12 dogs. In each animal three intestinal segments with different levels of ischemia were created by ligating the marginal vessels proximally and distally in sequence beginning from the midpoint of the segmental vascular arcade. Preanastomotic pulse oximeter readings between 80% and 90% were assigned to mild ischemia, 70% and 80% to moderate, and 60% and 70% to severe ischemia group. Pulse oximetry measurements were obtained from probes applied to the antimesenteric serosal surfaces at the midpoint of small intestinal segments. A total of 48 intestinal segments (12 nonischemic in the control group and 36 with three different levels of ischemia in the study group) were transected in the midpoint and anastomosed in double layers. Postanastomotic SaO2 values were also noted. The anastomoses were evaluated 48 hours later macroscopically if there was any leakage, and biopsy specimens were obtained for histopathologic ischemic gradings. All results were studied statistically.Histopathologic grades between each group were statistically different (P.01 for each comparison) except for control and mild ischemia groups (P.05), worsening as the level of ischemia increased. Pre- and postanastomotic pulse oximetry measurements correlated very well with the histological gradings (r = -0.90, P.001 and r = -0.93, P0.001 respectively). Number of anastomotic leakages were none in control, one in mild, nine in moderate, and 12 (all of the anastomoses) in severe ischemia groups. In the moderate ischemia group with an average preanastomotic pulse reading of 76.75%, each of the leaking anastomoses had a postanastomotic pulse measurement of lower than 70%. The finding that the difference between histopathologic grades of control and mild ischemia groups with average preanastomotic pulse measurements of 96% and 85%, respectively is not statistically significant enables us to suggest that a saturation of at least 85% is necessary for a reliable anastomosis.These results suggest clearly that anastomotic reliability can be predicted objectively with pulse oximetry.

Appendiceal intussusception and mucosa-associated lymphoid tissue lymphoma are both uncommon entities, and this is the first report or the two occurring concomitantly in an 8-year-old boy. This report of a mucosa-associated lymphoid tissue lymphoma localised in the appendix has not been reported previously. (c) 2005 Elsevier Inc. All rights reserved.

Introduction Short bowel syndrome (SBS) is a clinical condition resulting from the loss of absorptive surface area following resection of 50% or more small bowel. Morphological and functional changes called “intestinal adaptation” occur in the residual intestine. Melatonin exists in the gastrointestinal tract and has effect on mitotic activity. Therefore, we hypothesized that melatonin may have beneficial effects on intestinal adaptation. Materials and Methods A total of 32 male Wistar albino male rats were divided into four groups. In group I (sham-S), small bowel was transected and reanastomosed. In group II (SBS-control), 75% small bowel resection and anastomosis were performed. In group III (SBS-vehicle), after 75% small bowel resection and anastomosis, 2 mL of 5% ethanol in saline was given intraperitoneally once a day. In group IV (SBS-melatonin), after 75% small bowel resection and anastomosis, 300 µg/kg melatonin was given intraperitoneally once a day. After 15 days, small bowels were removed and divided into two segments as jejunum and ileum. Each segment was weight and measured. Histological examination was performed in all samples. Bowel and mucosal weights and DNA/protein ratio were calculated. Apoptotic cells were also identified. Results The bowel length measurements were statistically longer in group IV. Mucosal and bowel weights were the highest in group IV. The villus height, crypt depth, and the number of mitotic figures were the highest in the jejunum of group IV. Melatonin also gave rise to a significant increase in DNA/protein ratios in group IV. Conclusion According to this study, melatonin significantly enhanced intestinal adaptation.

Ostomy is an important step in the treatment of patients with anorectal malformation (ARM). Sometimes this basic surgical procedure may cause a devastating complication. The medical reports of the patients with ARM who had ostomy in the past were inspected. How many of them were operated in this center or sent from others, the type of ARM, what type of ostomy performed and which place of the bowel used and the complication type and rate related to ostomy and ostomy closure were evaluated. Nearly, 157 of 230 patients with ARM had ostomy during twenty-two years were evaluated. The prevelent type of ostomy was loop (50.3%) and then separated (36.9%), end (7%), double barrel (4.4%) and window (1.2%). The ostomies were located in the tranverse colon (53.5%), descending colon (24.2%), sigmoid colon (17.8), pouch colon (2.5%) and ileum (1.9). Total complication rate was found to be 15.2% (24/157) (window 100%, double barrel 42.8%, separated 15.5%, loop 11.3%, end 9%). The main complication of loop ostomies was prolapse whereas wound problems, stenosis, intestinal obstruction or perforation were serious problems of separated ostomies. Complication rate in the descending colon and tranverse colon was found to be 7.1 and 28%, respectively (p = 0.001). Any difference for complication rate between loop and separated ostomies was not found. Eighteen of separated ostomies had mucous fistula and six of them (33%) were complicated, this rate was higher than those without mucous fistula (p = 0.012). Two babies with separated ostomy were lost due to surgical complications (1.2%). Complication rate after ostomy closure was 10.7% [wound infection (4.4%), intestinal obstruction (1.7%)]. According to this study, ostomy performed in the descending colon carries greater risks for complication regardless of its type. Nevertheless, separated ostomy with mucous fistula should be performed by experienced hands.

The aim of this study was to present our experience in patients with intussusception (IN).One hundred and five cases of IN treated between 1991 and 2007 were analysed. Age, gender, symptoms, signs, diagnostic and treatment methods, types of IN including leading point, and postoperative complications were evaluated.The mean age of the patients was 2.5 years (range 1 month - 15 years). Fifty-nine per cent (62/105) were under 1 year of age, and of these 28% were receiving therapy for upper respiratory tract infection. The most common symptom was colicky abdominal pain. Rectal bleeding was present in all patients under 2 years of age. In 23 children (21.9%) leading points were detected. Thirty per cent of the patients were older than 4 years, and 76.6% of these had leading points. Ultrasonography demonstrated the invaginated segment in 93 patients. Hydrostatic reduction was attempted in 71.4% (75) of the patients and was successful in 48% (36), 70% of whom were under 1 year of age. Of the patients with unsuccessful hydrostatic reduction, 11 required intestinal resection and primary anastomosis and 35 manual reduction. Twenty-four patients were diagnosed by means of ultrasonography and were operated on immediately. Ten of these patients had signs of peritonitis on admission and were treated by resection-primary anastomosis.In patients with IN under 2 years of age, hydrostatic or pneumatic reduction may be successful. Considering the high incidence of leading points in older children, one should not persist with reduction but should rather design a treatment plan accordingly, i.e. laparotomy with manual reduction or resection.

Purpose: The pre and post-treatment effects of L-carnitine on apoptotic cell death due to hypoxia-ischemia in various regions of the brains of seven-day-old rats were investigat ed. Methods: L-carnitine (group 1; n = 8) or saline (group 2; n = 8) was administered intraperitoneally to seven-day-old rats before hypoxia-ischemia. In addition, 16 seven-day-old rats were given L-carnitine (group 3; n = 8) or saline (group 4; n = 8) after hypoxic ischemic insult. Apoptotic cell death was investigated by terminal dUDP-biotin nick end-labeling (TUNEL) in all subjects following three days of recovery. In the evaluation of TUNEL- positive cells, firstly the areas (in square milli meters) of the hippocampus, striatum and cortex in the right and left hemispheres were measured by IMAGE analysis. Then the numerical density was calculated as the number of cells per square millimeter by counting all TUNEL- positive cells. Afterwards, the ratios of right side numerical density to the sum of right and left si des' numerical densities (right apoptosis index) were calc ulated for every brain region in rats receiving L-carnitine and they were compared with the vehicle groups. Results: The right apoptosis indexes of the hippocampus (37.4 ± 18.8; mean ± SD) and striatum (39.2 ± 15.2) in rat pups pre-treated with L-carnitine were significantly lower than those in the vehicles (59.8 ± 17.9 vs. 60.4 ± 19.6 respectively) (p < 0.05), whereas they were not changed by L-carnitine pre-treatment in the cortex. Additionally, L-carnitine post-trea tment had no effect on right apoptosis indexes in any of the three brain regions. Conclusions: It is concluded that pre-treatment with L-carnitine might play a role in reducing apoptotic cell death due to neonatal hypoxic ischemic brain injury. Our results suggested that L-carnitine was useful in perinatal asphyxia for preventing hypoxic ischemic brain injury.

Epidermolysis bullosa (EB) is a disease with 3 forms, most hereditary, characterized by spontaneous blistering lesions. The autosomally inherited form, epidermolysis bullosa dystrophica recessive (EBDR), is responsible for esophageal lesions consisting of web or stenosis. The authors could find only 9 cases treated by various esophageal replacement procedures in the literature, and the experience with 1 case treated by colon interposition is presented. Copyright (C) 2001 by W.B. Saunders Company.

The postoperative development of necrotizing enterocolitis (NEC) following major surgery in neonates has often been described. We report herein the case of an older infant in whom postoperative NEC developed following emergency repair of an incarcerated inguinal hernia.

Introduction: The aim of this study was to determine the normal position of the umbilicus so as to offer a guide to improve cosmetic results after the repair of congenital abdominal wall defects. Materials and Methods: The position of the umbilical center was determined in 187 neonates with respect to the xiphoid process, the center of the umbilicus and the pubis. The distance between the xiphoid process and the center of the umbilicus (XU), between the pubis and the center of the umbilicus (PU) and from the xiphoid process to the pubis (XP) were measured while the babies lay in a supine position. The PU: XU ratio was calculated based on these measurements. Results: Mean XP was 11.93 ± 1.40 cm, mean XU was 7.41 ± 1.08 cm and mean PU was 4.52 ± 0.70 (mean±SD). The PU:XU ratio was calculated as 0.61 ±0.12 (ratio±SD). Conclusion: We suggest that the PU:XU ratio should be 0.61 offering an ideal localization in umbilical reconstruction.

Blind-ending bifid ureter is an extremely rare congenital anomaly. The authors report on a 13-year-old boy who presented with a previous diagnosis of right duplicated ureter and who had Undergone a bilateral ureteroneocystostomy for vesicoureteral reflux in another clinic. The revision showed right blind-ending bifid ureter. The embryology, clinic and treatment of this anomaly is discussed.

Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Although many agents have been tried experimentally to treat strictures, few have gained clinical application. The aim of this study was to investigate the influence of mitomycin C (MMC), which inhibits fibroblastic proliferation in treating delayed caustic esophageal strictures.Forty-two rats were allocated into 3 groups. Caustic esophageal burns were created as described by Gehanno. Group A was instilled only with saline. Group B was injured with 10% NaOH and left untreated. Group C was injured and received topical MMC at 0.04% concentration in the fourth week. At 56 days, stenosis index (SI), collagen deposition, and hydroxyproline content (HP) were determined in distal esophageal segments. Statistical analyses were performed.The mean SI in group B was significantly higher than others (SI: 1.15 +/- 0.37 d/lum, P.05). Collagen accumulation was highest in group B, followed by groups C and A, respectively. Collagen deposition in group C was statistically lower than group B (P.018). The mean HP in group B was statistically higher than others (5.07 +/- 1.30 microg/mg tissue, P.05), and similar between groups A and C (1.20 +/- 0.20, 1.91+/- 0.79, respectively, P = .73).In the current study, MMC treatment ameliorated caustic esophageal stricture as reflected in the significantly lower SI. We conclude that MMC application is effective in the treatment of caustic esophageal strictures.

Enterocutaneous fistula (EF) in newborns and prematures is a well-recognized complication after necrotizing enterocolitis and other abdominal surgical procedures. Conservative management consists of bowel rest, antibiotics, wound care, and the administration of drugs that either reduce gastrointestinal motility or secretions. Octreotide decreases gastrointestinal secretions, inhibits or blocks the effects of gastrointestinal hormones, diminishes gut motility and thus reduces the flow through the fistula. We used octreotide and were able to report successful spontaneous closure of a fistula in our 2 neonatal patients, one a premature neonate with necrotizing enterocolitis (NEC) and the other with meconium peritonitis.

A case of giant omental cyst diagnosed preoperatively is described. A 4-year old girl presenting with abdominal distension and misdiagnosed as having ascites, was subsequently proved to have a giant omental cyst. This is a rather difficult diagnosis to reach and results in wrong treatment methods. A high index of suspicion is therefore required early in the course of the disorder to decrease the complication rate. This report describes the diagnostic modalities and our approach to the patient who was cured by total excision of the cyst and free of disease in the fourth year of follow-up.

Hydatid cysts (HCs) of the liver are a major problem in the areas to which they are endemic. Approximately 15% of hepatic cysts have been shown to communicate with the biliary system. In 2 cases in which patients were undergoing HC surgery, the cystic fluid appeared to be clear, but after the germinative membranes were removed, a connection with the biliary system could be seen. This observation suggests that the decision to inject a scolicidal or sclerosing agent during surgery should be evaluated carefully, as should the use of percutaneous HC treatment. Otherwise, conditions associated with serious morbidity, such as sclerosing cholangitis, may occur.

The aim of this study was to discuss the findings of our patients who had negative appendectomy. Hospital records of negative appendectomy for abdominal pain patients were evaluated retrospectively. Negative exploration for acute appendicitis (AP) was done in 149 patients. The most frequent complaints were abdominal pain, vomiting and fever. The commonly established diagnoses after negative exploration were gastroenteritis and urinary infections. However, the frequent pathologies observed during the operation were mesenteric lymphadenitis and Meckel’s diverticulum. All patients with systemic disease such as Henoch-Schonlein’s purpura operated for AP had it diagnosed during the postoperative course. Interestingly, two different types of worms were found in the lumen of the appendices. Despite new techniques, 100% correct diagnosis of AP is still a challenging problem. Furthermore, appendicitis is a deadly disease if not treated properly. Therefore, it is best to perform exploration without undue delay in cases with suspicious AP.

We report a case of a single large echinococcal cyst that originated from the retroperitoneal space. Diagnosis was confirmed with serologic test and radiological examinations. Especially in the endemic areas hydatid cyst should be considered when evaluating cystic masses and it can be treated by extraperitoneal operation.