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INTRODUCTION: With this study, it was aimed to reveal the frequency of monosymptomatic enuresis (MSE) and factors affecting MSE in school children aged 7-12 years in Elazığ city. METHODS: In our study, a total of 1888 students, including 945 boys and 943 girls aged between 7-12, were included with the simple random sampling method. In our study, a questionnaire containing factors that might affect enuresis was used. Detailed histories of all cases were taken, physical examinations and laboratory examinations were performed. The findings were evaluated by the chi-square test. RESULTS: MSE was detected in 352 (18.6%) of 1888 students. The frequency of MSE in boys was 20.8% (n=197) and 16.4% (n=155) in girls (P=0.044). The rate of MSE was higher in children with a family history of epilepsy (6.8%) compared to those without (3.4%) (P=0.013). The monthly income level of families of enuretic children is below the minimum wage in 53.1% (n=186), between the minimum wage and twice its amount in 34.9% (n=122), and more than twice the minimum wage in 12.0% (n=42) of the families. (P=0.027). MSE was present in 18.8% of circumcised and 27.2% of non-circumcised children. Cardiac murmur was found in 4.3% of enuretic and 0.3% of nonenuretic patients (P=0.001). Inguinal hernia enuresis was detected in 0.6%, of enuretic, and in 0.2% (P=0.001) of nonenuretic, patients. While undescended testicular was found in 1.7% of enuretic, and in 0.1% of nonenuretic patients (P=0.001). Sacral hair growth, dermal sinus, and hyperpigmentation was encountered in 11.7% of enuretic children (P=0.001). DISCUSSION AND CONCLUSION: It has been understood that the incidence of MSE is higher in Elazig Province, according to the literature. While the frequency of enuresis decreased in circumcised patients, an inverse relationship was detected between income level and enuresis. It was determined that enuresis decreased school success. In addition, enuresis is more common with pathologies such as family history of epilepsy, cardiac murmur, inguinal hernia, undescended testicle, sacral hair growth, dermal sinus and hyperpigmentation.

Ectopic adrenocortical tissues (EAT) are rare pathologies in children. They are frequently encountered in the inguinal region incidentally during surgical procedures but they are also classically known to be located from diaphragm to pelvis. EAT were investigated during inguinal procedures including inguinal hernia, hydrocele, hydrocele of cord and undescended testis (UDT) in 1,069 patients, 159 girls, 910 boys, from April 1997 until April 2006. All these nodules were confirmed to be adrenocortical tissues after histopathological examinations. Statistical analysis was done with Fisher's exact test. EAT were noted on the plexus pampiniformis external to processus vaginalis of 22 male patients (1.73%) during inguinal explorations. This figure was 1.63% for inguinal explorations of inguinal hernia, hydrocele and hydrocele of cord and 5.1% for UDT. This difference was statistically significant (P < 0.0001). There were no EAT detected during inguinal exploration of female patients. EAT are uncommon pathologies seen during inguinoscrotal explorations. Incidence of EAT is significantly increased with UDT. This increase may be explained with the embryological events that take place during adrenal and gonadal development. The relatively low observation of EAT in girls may be due to the localization of gonads and association of EAT with gonadal position. Adrenal rests in inguinal region may suggest an association with descent of gonads.

Many treatment modalities have been described for thoracic empyema in children but the optimal timing of appropriate treatment remains controversial. The aim of this study is to find out the outcome of postpneumonic empyema in children after a conservative approach.The reports of patients who were admitted to our hospital from January 1990 to October 2002 with a diagnosis of postpneumonic thoracic empyema were reviewed retrospectively. The comparative data were age, duration of prehospital illness, complaints, blood and pleural fluid analyses, radiological evaluations, microbiological studies, modes of treatment, duration of chest tube drainage, and length of hospital stay.A total of 115 patients (65 males and 50 females), aged from 3 months to 13 years, were evaluated. The most common symptoms were fever (96.5%), cough (85.2%), and dyspnea (50.4%). Chest X-rays revealed a minimal collection in 22 (19.2%), a moderate collection in 40 (34.8%), and a massive collection in 53 patients (46%). Staphylococcus aureus was the most common microorganism isolated from the bacterial cultures and Mycobacterium tuberculosis was the next most common. Twelve patients (10.4%) underwent surgical decortication. The mean duration of chest drainage was 10.1 +/- 1.39 days. The mean hospitalization period was 24.2 +/- 6.15 days and it was significantly shorter in patients with a minimal collection than in those with a massive collection (13.9 +/- 2.21 vs 28.47 +/- 6.38 days, P0.01).The majority of postpneumonic thoracic empyema cases in children can be successfully treated with a conservative approach. Detailed investigations should also be done to rule out tuberculosis in these patients.

Hepatic pseudocyst formation is a rare intra-abdominal complication of ventriculoperitoneal shunts. The presence of an intracranial tumor and a history of central nervous system infection are major risk factors for the development of this complication. Hepatic pseudocysts secondary to ventriculoperitoneal shunts can be classified as intra- and extra-axially growing cysts. On abdominal computed tomography images, extra-axially growing pseudocysts are typically surrounded by a fine annulus that shows continuity to hepatic parenchyma. For treatment of extra-axially growing hepatic pseudocysts, surgical unroofing of the cyst and repositioning of the catheter is an effective method if there is no shunt infection and/or dysfunction.

A case of Horner syndrome diagnosed during the follow-up after major thoracic trauma is presented in this report. A 10-year-old boy was admitted to the emergency service with severe thoracic trauma with left clavicular and first rib fracture after a traffic accident. During the follow-up, myosis and ptosis were recognized in his left eye. Cranial tomography and neurological examination were all normal. The symptoms were thought to be caused by compression of the local hematoma to the cervical ganglia. After 30 days of conservative treatment with tube thoracostomies, he was discharged with his Horner syndrome. After 6 months of follow-up, the findings of Horner syndrome were found to be partially resolved. First rib fracture associated with Horner syndrome is very rarely seen in children, and only 2 cases were found in English-language literature. Our case seems to be the third reported case. Horner syndrome should be kept in mind in cases of first rib fractures. When head trauma is considered, as it can be mistaken with anisocoria, this knowledge may help the surgeon in differential diagnosis.

Cutaneous bronchogenic cysts (CBC) are rare solitary lesions which originate from primitive tracheobronchial tree. The periscapular location of these lesions is even a rare condition. The aim of this study is to evaluate this pathology after our case with literature review. An one-year-old girl was brought to our clinics with the complaint of a drainage at the back of her shoulder. In her physical examination, a hyperemic enduration with a sinus and purulent drainage was noted at the left scapular region. Ultrasonography revealed a lesion of 15x11 mm2 in size with a thick wall and a hypoechoic center. The lumen of the cyst was demonstrated with fistulography. Surgical excision of the lesion was performed and pathological examination revealed a cutaneous bronchogenic cyst. CBC have been reported in 64 cases in the literature. They are often found in the lower neck, sternum and shoulders. They arise due to abnormal bronchial budding during the embryological period. Only in 12 of these patients, including our case, the lesion was located in the periscapular area. Its treatment is surgical because of malignant transformation and infection. The recognition of this entity may help the surgeon for early diagnosis.

Intussusception is a common surgical problem in childhood and is defined as a prolapse of a part of the intestine into the lumen of an immediately adjoining part. 1 - 3 Double intussusception (DI) in children is a very rare entity, and its diagnosis is made during surgical interventions. In classic cases, the displacement of 1 segment of bowel is defined, whereas, very rarely, 2 separate segments can prolapse into the same distal segment, giving rise to DI. 4 , 5 To our knowledge, 3 DI cases in the pediatric age group have been reported in the English literature to date. 4 , 5 A target sign is a typical finding of classic intussusception on sonography and computed tomography (CT). 6 , 7 The sonographic and tomographic findings in an 8-year-old patient with DI were evaluated retrospectively, and the "triple-circle" sign was noticed, which was different from the classic target sign and which, to our knowledge, has not been defined previously.

We aimed to investigate the protective potential of the thoracic cage on the parenchyma in response to blunt trauma from different directions in an animal model.Female Wistar albino rats were divided into control, anterolateral, lateral and posterolateral trauma groups, with six rats in each group. A weight of 500 g was dropped from a height of 40 cm on the left hemithorax to produce an energy of 1.96 joules, using a specially designed platform. Respiratory rates and heart rates were noted before and at 0, 1, and 5 minutes after trauma. Twenty-four hours later, the left lungs were excised for wet lung weight measurement, histological examinations and tissue malondialdehyde determination.Severe pulmonary contusion was observed in all trauma groups according to histological parameters. Malondialdehyde was increased in both the lateral and posterolateral groups. Wet lung weight was increased only in the posterolateral trauma group when compared to controls. Histologically, macrophages were increased and mononuclear cell infiltration was significant in the posterolateral trauma group. There were no significant changes in physiological parameters in the groups.Lung parenchyma seems to be badly affected after trauma to the posterolateral thoracic wall. Different thoracic regions may respond differently to the same traumatic stress, and this may be related to the biomechanical properties of the thoracic cage.

Pouch colon anomaly and high anorectal malformation are well-defined rare anomalies. The association of pouch colon anomaly with rectal atresia has previously been defined in only one case. In this study, a 2-day-old baby is presented with pouch colon anomaly without fistula and with rectal atresia. As a second case in the literature, this pathologic condition has been treated through the abdominotransanal route by using a single-stage endorectal coloanal pull-through. Being uncommon and having an important therapeutic approach, this case has been evaluated as worth presenting.

Background/Purpose The significance of spot urine 5–hydroxyindoleacetic acid (5-HIAA) levels in the early diagnosis of acute appendicitis (AA) is questioned. Methods Forty young, pigmented, male rabbits were divided into 4 groups. Groups are summarized as follows: group 1, control (n = 10); group 2, laparotomy, sham (n = 10); group 3, peritonitis with cecal ligation and puncture (n = 10); and group 4, experimental appendicitis (n = 10). Spot urine samples were obtained for 5-HIAA determination, and appendectomy materials were examined histopathologically and peritoneal fluid cultures were obtained after 12 hours in the study groups. The results were analyzed statistically with 1-way analysis of variance and Scheffe and Tukey's HSD tests. Results The mean 5-HIAA levels in the control group was 5.7 ± 0.6 mg/L, whereas it is 5.9 ± 0.9 mg/L, 6.6 ± 0.6 mg/L, 9.4 ± 0.9 mg/L in the sham, peritonitis, and appendicitis groups, respectively. The levels of 5-HIAA in the appendicitis group were higher than those in the other groups, which was statistically significant ( P Conclusions Spot urine 5-HIAA determination may be a practical, objective, and noninvasive method in the early diagnosis of AA. Because other radiological and laboratory tests can be insufficient, especially in the early period of AA, this test may be used effectively instead. Clinical studies are necessary for further conclusions.

Tube thoracostomy is a common therapeutic approach applied in medical practice. Certain complications of this procedure have been described in the literature. Oculosympathetic paresis, or Horner's syndrome, occurs from the interruption of second order preganglionic neurons and manifests as miosis, ptosis, hemifacial anhidrosis and enophthalmos. Iatrogenic Horner's syndrome, on the other hand, very rarely couples with tube thoracostomy. Only seven cases have been described in the literature, two of whom were in the pediatric age group. Herein we present a three-year-old girl operated for diaphragmatic hernia who later developed Horner's syndrome at the same side of the thorax tube. Upon the development of the pathology, the tube was repositioned and after one month only a slight ptosis persisted. Our patient seems to be the third case described in the literature. The clinical significance of this pathology is assessed in this report.