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WOS:000708153500019 The duodenum is the most frequently obstructed region of the gastrointestinal tract, an important cause of mortality and morbidity in neonatal period. The objective of the present study was to summarize the causes of early mortality and morbidity in infants with congenital duodenal obstruction (CDO). Data on a total of 94 patients with CDO diagnosed in our clinic, and treated surgically between January 1993 and December 2012, were studied retrospectively. Patients were divided into 3 groups in terms of diagnosis: annular pancreas (n = 45), duodenal atresia (n = 31), and duodenal web (n = 18). The groups were compared in terms of sex, birth weight, age at the time of operation, and morbidity and mortality rates. Of the patients, 54 were male and 40 female, and the mean birth weight was 2278 g (range, 1180-3400 g). The average age at the time of the operation was 6.96 days (range, 1-38 days). The time to full oral intake postoperatively was 10.32 days (range, 4-38 days). Additional anomalies were found in 61 cases (64.8%). Early morbidity was most commonly associated with an anastomosis problem. Early mortality occurred in 6 cases (6.4%), and the most common causes were sepsis and cardiac anomalies. Elimination of sepsis, cardiac anomalies, and anastomosis problems is critical to ensure continued reductions in infant mortality and morbidity caused by CDO.

Objective This study summarises the outcomes of 149 patients who underwent surgery for antenatally diagnosed unilateral hydronephrosis. Methods The medical records of such patients over a 23-year period were reviewed retrospectively. Age at the time of operation, preoperative and postoperative mean pelvic diameter on ultrasound, split renal function, washout patterns on scintigraphy, and early and late complications were recorded. Results The mean preoperative follow-up period was five months (range: 1-66 months). One patient was operated on after 12 months and two patients after five years of follow-up. Mean preoperative pelvic diameter and renal function were 30.8 mm and 38.6%, respectively; all patients had an obstructive wash-out pattern. In the postoperative period, the corresponding measurements were 11.7 mm and 39.2%, with 111 non-obstructive, 24 partially obstructive, and 14 obstructive wash-out patterns. Three patients with severe caliectasis and low renal function underwent surgery despite mild hydronephrosis. The mean postoperative follow-up period was six (range 4-11) years. Complications developed in 14 (9.3%) patients. Conclusion Patients with antenatal hydronephrosis may need surgery even after a follow-up period of six years. Because of the potential late development of complications, postoperative follow-up should be continued for 10 years.

Background: To assess the effectiveness of the current vesicoureteral reflux (VUR) grading system according to the international classification of VUR (ICVUR) and to evaluate whether VUR grading accuracy could be improved by renal ultrasonography (RU) according to the Society for Fetal Urology (SFU) grading system. Objectives: Therefore, this study assessed the accuracy of the current VCUG staging system by assessing inter-rater reliability among pediatric radiologists and urologists; it also evaluated whether accuracy is increased by RU without consensus (with respect to VCUG grading). Methods: Four pediatric urologists and four pediatric radiologists independently graded 120 voiding cystourethrograms (VCUGs). Middle VUR grades were divided into the following three groups: VUR consensus grade III (group 1), VUR consensus grade IV (group 3), and VUR non-consensus grades III and IV (group 2). All groups were compared with respect to hydronephrosis grade using RU. Results: The intraclass correlation coefficient (ICC) values ranging from 0.86 to 0.89 reflected good reliability. The lowest agreement was associated with middle grades (III and IV). A marked difference in sensitivity was observed between groups 1 and 3 (35% and 95%, respectively, P < 0.05), indexed by SFU hydronephrosis grade, suggesting that VCUG cases in group 2 (n = 16 at SFU 0 or 1) could be accepted as grade III, and SFU scores of 2, 3, or 4 could be considered grade IV. Conclusions: Inter-rater accuracy could be improved at middle grades using renal ultrasonography (USG), which could promote communication between different specialists.

Purpose While several publications have reported the treatment of ruptured lung hydatid cysts (HC) in adults, there is limited information on the treatment of children. This study summarizes the treatment approach and outcomes of 11 children with spontaneous rupture of lung HCs into a bronchus. Methods The complete medical records of 11 patients with spontaneous lung HC bronchus rupture between March 1993 and April 2012 were examined retrospectively. Gender, age at the time of diagnosis, patient symptoms, lung localization, dimensions of the cyst, medical treatment duration, and associated morbidities were evaluated. Routine chest x-rays, ultrasonography, computed tomography and serological tests were used. Result The study included 11 patients [4 males, 7 females; average age 7.45 (range 5–11) years] presenting to the Emergency Department. The symptoms at the time of presentation were coughing in 81.8% ( n =9), hemoptysis in 54.5% ( n =6), and chest pain in 54.5% (n=6). The average cyst diameter was 8.71(35–15) cm. The rupture involved the left lung in 7 (63.6%) patients and the right in 4 (36.4%). Serological tests were positive in seven patients and all patients had eosinophilia. The treatment of one patient was discontinued, while all of the other patients were treated medically. Pneumonia developed in four patients and lung abscesses in two. Both patients who developed lung abscesses had cysts with diameters greater than 10cm. The average follow-up period was 48.4 (range 15–85) months; no mortality occurred. Conclusion In our experience, medical treatment is adequate for patients with lung HCs progressing to spontaneous bronchus rupture. There was a high rate of abscess development within the thoracic cavity in patients with cysts over 10cm in diameter; these patients can be treated effectively with a medical approach.