Is conservative treatment an effective option for pilonidal sinus disease in children?

Pilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial. There are a few published studies on PSD in the paediatric literature; therefore, we present our experience of conservatively treating PSD in children. This study involved a retrospective review with telephone follow up. All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery. All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess). Data collection included demographics, type of management, recurrence, presence of infection, and total healing time. In the study period, 29 children were identified. Their mean age was 14.94 ± 1.09 (range: 12-16) years, and 51.7% were girls. The mean length of follow up was 8.34 ± 6.36 (range: 1-25) months. Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery. PSD is being seen in children more frequently in recent years. Conservative treatment may be the recommended initial approach for PSD in children.

Is 1p36 deletion associated with anterior body wall defects?

Epispadias and exstrophy of the cloaca, also known as OEIS complex (omphalocele, exstrophy, imperforate anus, spinal defects), respectively constitute the most benign and severe ends of the bladder exstrophy-epispadias complex (BEEC) spectrum. In 2009, El-Hattab et al. reported the first patient with OEIS complex associated with a chromosome 1p36 deletion. Here we report a second patient with 1p36 deletion who also has classic bladder exstrophy, supporting the possible role of genes in this region in the development of BEEC. The absence of omphalocele and imperforate anus in our patient places him toward classic bladder exstrophy while presence of spina bifida and the absence of coccyx suggest an overlap with OEIS complex. An additional differential diagnosis is the pentalogy of Cantrell in our patient as he also has a diaphragmatic hernia and an incomplete sternum. This is the second observation of a ventral midline birth defect in association with 1p36 deletion syndrome, following El-Hattab et al.'s report [2009]. The three genes (NOCL2, DVL1, and MMP23B) discussed as possible candidates are also among the deleted ones in our patient, supporting the possible role of these genes in BEEC spectrum. © 2016 Wiley Periodicals, Inc.

Neonatal colonic perforation.

Neonatal colonic perforation is a rarely seen condition. Plain abdominal radiography of a 28-hour newborn consulted for vomiting and bloody stool revealed the presence of subdiaphragmatic free air, which necessitated surgical exploration. Transverse colonic perforation was detected during the exploration, and subsequently, a colostomy and appendectomy were performed. The postoperative follow-up period was uneventful. Necrotizing enterocolitis, Hirschsprung disease, and mechanical obstruction are some of the causes of colonic perforation during the neonatal period. Herein, we have shared a case of colonic perforation in an asphyctic newborn delivered after prolonged labor.

Ultrasound-guided hydrostatic reduction of intussusception with saline: Safe and effective.

PURPOSE: The study was undertaken to assess the efficacy of ultrasound-guided saline enema in reducing intussusception and to determine the role of age and duration of symptoms on this event. METHODS: The case records of patients who were treated for intussusception at our institutions over the past 10 years were retrospectively analyzed. A total of 419 patients were treated for intussusception and 375 of them were included into the study. Patients were excluded if they had symptoms and signs of acute abdominal disease and required surgery as an initial treatment. RESULTS: Hydrostatic reduction was successful in 313 of the 375 patients (83.46%). The procedure-related complication rate was nil. There were 29 episodes of recurrences in 23 patients, and recurrence rates did not differ between patients who responded to hydrostatic reduction and those who required surgery. Younger age [median (range); 11 months (3-108 months) vs. 20 months (1-180 months); p<0.05], rectal bleeding (p<0.01) and long duration of symptoms [mean (range); 1.95 days (1-7 days) vs. 1.44 days (1-10 days); p<0.01] were significantly associated with failed hydrostatic reduction. CONCLUSION: Ultrasound-guided hydrostatic reduction is an easy, safe and effective method for the treatment of intussusception in the absence of acute abdominal findings.

Beneficial effects of taurine and carnosine in experimental ischemia/reperfusion injury in testis.

PURPOSE: Testicular torsion can be thought of as an ischemia/reperfusion (I/R) injury to the testis. This study aimed to investigate the effects of taurine (TAU) and carnosine (CAR), which are strong antioxidants, on experimental testicular I/R injury model. METHODS: Male Wistar albino rats were divided into four groups with eight animals in each. A sham operation was performed in group 1. To create testicular I/R, the left testis was torsioned 720° for 2 h followed by 2 h of detorsion. Groups 2 (I/R), 3 (I/R + TAU) and 4 (I/R + CAR) received intraperitoneal saline, TAU (250 mg/kg) and CAR (250 mg/kg), respectively, 1 h before detorsion. Thiobarbituric acid reactive substances (TBARS), diene conjugate (DC), protein carbonyls (PC), nonprotein sulfhydryl (NPSH), and vitamin C levels were measured in testis tissues as well as superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities. Histopathological evaluation was also performed. RESULTS: TBARS, DC, and PC levels were significantly increased in I/R group. TAU and CAR did not alter TBARS levels, but decreased the elevated DC and PC levels. There were no changes in testicular NPSH levels, SOD, and GPx activities in all groups; however, vitamin C significantly decreased in I/R group. CAR treatment was found to increase vitamin C levels as compared to I/R group. Histopathologically, both I/R + TAU and I/R + CAR groups showed significant increase in testicular spermatogenesis in comparison to I/R group. CONCLUSION: Our results indicate that TAU and CAR reduces oxidative stress and may have a protective role in testicular I/R injury.

Space occupying lesions in the fetal chest evaluated by MRI.

BACKGROUND: The most common space occupying lesions of the fetal thorax are congenital diaphragmatic hernia (CDH), congenital cystic adenomatoid malformation (CCAM), and bronchopulmonary sequestration (BPS). Although applications of prenatal MRI have been vastly improved in the recent years, its use in the assessment of space occupying lesions of the fetal chest differs among centers. OBJECTIVES: To evaluate MRI findings in the diagnosis and follow-up of space-occupying lesions in the fetal chest with the review of relevant literature. PATIENTS AND METHODS: The fetuses with space-occupying lesions of the chest were retrieved from our 1.5T fetal MRI database of 347 patients. MRI features including the shape, signal characteristics, feeding artery, margin, mass effect, affected organ parts and anatomic location were reviewed. The results were correlated with the pathology results, follow-up and surgical findings. RESULTS: Nineteen MR images of 17 fetuses (mean gestational age, 23.8 weeks) with spaceoccupying lesions (5 CCAMs including one involuted case), 2 BPSs, 2 hybrid lesions, 8 CDH) were evaluated. One case of CCAM completely involuted in utero, four newborns were operated, and the resulting 12 fetuses were terminated. The surgical and pathological findings were in accordance with MRI findings. CONCLUSION: MRI can reliably differentiate CDH from CCAM and BPS in utero. Follow-up is of utmost importance as lesions may involute or progress in utero. Prenatal MRI findings help postnatal decision-making, surgical planning and parental counseling.

Histoacryl blue versus sutured left colonic anastomosis: experimental study.

BACKGROUND: Cyanoacrylates have been advocated as a protective seal in colonic anastomosis to prevent leakage. In order to assess the effects of n-butyl-2-cyanoacrylate on left colonic anastomosis it was compared to the sutured anastomosis in the rat. METHODS: Forty male Wistar albino rats were divided into two groups of 20 each. On days 3 and 7, 10 animals in each group were killed. The comparisons between n-butyl-2-cyanoacrylate and sutured groups were made with respect to outcome measures including anastomotic leakage, anastomotic stricture, peritonitis and wound infections, and adhesion formation, anastomotic bursting pressure, histological appearance of the anastomotic area. RESULTS: Although the adhesion formation was significantly more extensive in the n-butyl-2-cyanoacrylate group on day 3 (P < 0.001), there was no significant difference between the groups on day 7. The more inflammatory reaction also occurred in the n-butyl-2-cyanoacrylate group. The mean +/- SD anastomotic bursting pressure was significantly higher in the suture group than in the n-butyl-2-cyanoacrylate group (63 +/- 14 mmHg vs 43 +/- 8 mmHg) on day 3. The bursting pressure was also found to be higher on day 7 in the suture group (187 +/- 26 mmHg vs 49 +/- 12 mmHg, P < 0.0001). The suture group had a significantly higher bursting pressure on day 7 compared to day 3 (P < 0.05). CONCLUSIONS: Left colonic anastomosis with n-butyl-2-cyanoacrylate in rats does not improve the healing process; on the contrary, it has a negative influence during the first week. As a consequence, the routine use of n-butyl-2-cyanoacrylate in colonic anastomosis in the clinical situation does not appear to be justifiable.

A standardised protocol for the acute management of corrosive ingestion in children.

Oesophageal strictures developing after caustic ingestion in children are a serious problem, and several protocols to prevent stricture formation have been proposed. A prospective clinical trial was conducted for preventing strictures in caustic oesophageal burns in a single clinic, and the results are presented. All children with caustic ingestion who had oesophagoscopy for diagnosing the severity of the burn were included in the study. Eighty-one children were included in the series, with ages ranging between 3 months and 12 years. The patients were given nothing by mouth until oesophagoscopy. IV fluids, broad-spectrum antibiotics, ranitidine, and a single-dose steroid were given. Oral burns were positive in 66 patients. Oesophagoscopy revealed a normal oesophagus in nine patients, grade 1 burn in 24, grade 2a in 21, grade 2b in 23, grade 3a in two, and grade 3b in one. Patients with grade 1 and 2a burns were discharged after oesophagoscopy. Patients with grade 2b and all grade 3 burns were given nothing by mouth for a week except water when swallowing their saliva, and were fed via total parenteral nutrition. After the 1st week, if there was no problem with swallowing, liquid foods were introduced. No intraluminal tubes were used. At the end of the 3rd week, a barium meal was administered and an upper gastrointestinal series taken. Dilatation was performed at 2-week intervals for strictures, which developed in one grade 2a patient, six grade 2b patients, and the grade 3b patient. Only one of these patients is currently on an oesophageal dilatation program. Limiting oral intake and avoiding foreign bodies in the oesophagus seem to provide a good success rate; however, further prospective studies are needed to decrease the incidence of corrosive oesophageal strictures.

Mesenteric cyst infected with non-typhoidal salmonella infection.

Although extra-intestinal non-typhoidal Salmonella infections are common in developing countries, infection of the mesenteric cyst with Salmonella enteritidis is an extremely rare occurrence. Review of the English literature has revealed one report up to this date. The case of a 4-year-old boy with a mesenteric cyst infected with Salmonella enteritidis is presented.

The effect of pentoxifylline on intestinal anastomotic healing after ischemia.

The negative effects of ischemia-reperfusion injury (IRI) on intestinal anastomotic healing have been described in previous studies. To determine the effect of pentoxifylline (PTF) on small-bowel anastomoses performed after IRI, 20 male Wistar albino rats were studied. Under ketamine anesthesia, the superior mesenteric artery was occluded for 30 min and ileal resection-anastomosis was performed after 10 min of reperfusion. In group I, no medication was given. In group II, PTF 50 mg/kg was administered intraperitoneally before reperfusion and i.m. on the 1st, 2nd, 3rd and 4th postoperative days (POD). All rats were killed and anastomotic segments were removed on the 7th POD. Anastomotic bursting pressure (ABP) and hydroxyproline (HP) content were measured in the anastomotic segments; parameters were compared statistically with Student's t-test. In group I, the mean ABP was 225.5 +/- 38.18 mmHg the and mean HP level was 16.03 +/- 1.91 micro mol/g tissue. In group II, these levels were 277 +/- 41.1 mmHg and 19.85 +/- 1.81 micro mol/g tissue, respectively. The differences between the groups were significant (P < 0.005). Thus, PTF can improve anastomotic healing in an experimental model after IRI by promotion of collagen synthesis.

Safety-pin ingestion in children: a cultural fact.

Pediatric foreign-body (FB) ingestion is a common problem. Many of these FBs are sharp objects such as needles, toothpicks and safety pins (SP). This report reviews the management of SP ingestion in children. During a 16-year period, we recorded 49 pediatric cases of witnessed SP ingestion. In all children, SPs were used to attach the blue beads to the child's suits with the belief of averting the evil eye. The mean age was 8 months ranging from 4 months to 2 years, and 30 patients were males and 19 were females. SPs were most commonly sited in esophagus (37%) and stomach (37%). In the remainder, the SPs have already reached the duodenum and intestine. In this series, 20 (41%) children passed SPs spontaneously, 14 (28.5%) required endoscopic removal and 15 (30.5%) underwent surgery. The outcome of all patients was uneventful. All of the esophageal SPs require endoscopic intervention, however, after passing into stomach the patients can be observed with keeping the surgical intervention in mind if the SP displays a fixed position for more than three days.

Morphologic changes and lipid peroxidation in renal tissues of young rats following intestinal ischemia-reperfusion.

Intestinal ischemia-reperfusion (IIR) is a complex phenomenon causing local and remote tissue destruction, and even multiple-organ failure. To examine the hypothesis that IIR affects renal function, 21-day-old male Sprague-Dawley rats underwent 45 min superior mesenteric artery occlusion and control rats were subjected to a sham laparotomy. After 2 and 24 h and 1 week of reperfusion, blood was sampled for urea and the kidneys were harvested for lipid peroxidation and histologic examination. Malondialdehyde (MDA) levels as an indicator of lipid peroxidation were significantly increased in renal tissue after 2 h of reperfusion, and this finding was in accordance with serum urea levels (SU) and endothelial injury. However, at 24 h of reperfusion MDA and SU had returned to normal. These data were supported by electron-microscopic studies suggesting reversibility of the changes. It is concluded that IIR leads to renal injury and that free radicals may be responsible for this injury.

Acute gastric perforation after acid ingestion.

Gastric outlet obstruction is a common late result after acid ingestion; early complications, such as gastric necrosis or perforations are unusual. This is a report of a patient with the history of strong acid ingestion who underwent total gastrectomy due to perforation and extensive necrosis of the stomach.