Rare laryngotracheobronchial anomalies in children: a retrospective study of 249 bronchoscopic cases in a single center.

Background: Laryngotracheobronchial anomalies in children are rare, and their clinical manifestations are diverse. In this study, we report the clinical aspects and prevalence rates of tracheal bronchus (TB) and congenital subglottic stenosis (CSS) in a select group of patients at our institution and briefly review and discuss the literature to draw attention to these rare anomalies. Case series: We retrospectively reviewed the clinical records of 249 children for whom senior surgeons performed rigid bronchoscopy for suspected or confirmed food choking or foreign body aspiration in children between August 2013 and January 2020. Bronchoscopic findings and demographics of the patients with laryngotracheobronchial anomalies were documented. Four among the 249 patients (1.6 %) had right-sided TB (two males aged 24 and 42 months and two females aged 14 and 60 months), while three (1.2 %) had grade 1 CSS (one male aged eight months and two females aged 11 and 13 months). There was no previous history of endotracheal intubation for any subglottic stenosis (SS), though all three patients were admitted with sudden onset of respiratory difficulty. One of the TB cases had congenital cardiac anomalies, and two were symptomatic before their admission to the emergency department. Conclusions: The prevalence of CSS and TB in the healthy population is low. Physicians dealing with the pediatric airways should consider such anomalies for prompt diagnosis, proper instrumentation, management, and follow-up of these cases. Our data also correlate with previous data, indicating that these anomalies' prevalence rates have not increased during the last few decades. HIPPOKRATIA 2023, 27(2):59-63.

Is rigid endoscopy necessary with childhood corrosive ingestion? a retrospective comparative analysis of 458 cases.

The aim of this study was to determine the necessity of endoscopy in cases in which a corrosive substance was ingested and to find a practical way to avoid unnecessary endoscopies for similar cases in the future. The clinical records of 458 hospitalized cases with clinical histories of corrosive substance ingestion between January 2007 and December 2013 were retrospectively reviewed. The demographics of the cases, the ingested substances, and the rigid endoscopy findings were evaluated. The three most commonly ingested corrosive agents were household bleach (22.9%), household degreaser (15.9%), and drain cleaner (13.1%). Rigid esophagoscopy was performed in 367 of the 458 cases. Corrosive agents were grouped according to their purpose of household use; eight groups were created. The degree of corrosive injury observed in the different groups was compared with the degree of injury caused by household bleach. Among the corrosive agent groups, dishwashing machine products (Gr.1), laundry products (Gr.2), liquid cleaners (Gr.3), and household bleach (Gr.4) did not cause high-grade injuries. The resulting injuries and esophagoscopy results among the above groups, whether symptomatic or not, did not differ from one another. Corrosive agents such as drain cleaner (Gr.6), household degreaser (Gr.7), and several other acidic products (Gr.8) caused high-grade injuries in the esophagus; however, lime remover/HCl (Gr.5) did not. Thus, hospitalization and rigid endoscopy seem unnecessary to assess esophageal injury in most cases, if the ingested corrosive agent fits into group 1, 2, 3, or 4 and if the patient can be easily fed. Esophagoscopy is useful to shorten the hospitalization times in cases where strong corrosive agents were ingested, such as those in groups 5, 6, 7, and 8.

Diagnostic value of hydrodistention of the ureteral orifice.

INTRODUCTION/OBJECTIVE: The dynamic hydrodistention (HD) classification is a basic and objective way of rating the ureteral orifice opening. This study evaluated the value of hydrodistention of the ureteral orifice in the diagnosis of vesicoureteral reflux (VUR). MATERIAL AND METHODS: Between January 2012 and March 2013 the HD grade in 106 ureters was prospectively assigned. A 9.5-Fr rigid cystoscope with a 0-degree lens was used in all procedures. Warm saline was used and the irrigation bag was placed approximately 1 m above the bladder level on full flow. The grading is as follows: H0 denotes absence of ureteral dilation; H1 indicates dilation of the ureteral orifice only; H2 allows visualization of the intramural ureter; and H3 allows visualization of the extramural ureter. Indications for cystoscopy were endoscopic and open surgical treatment of VUR, stent removal, and any other diagnostic reasons. Exclusion criteria were patients with: infravesical obstruction, neuropathic bladder, severe detrusor over activity/dysfunctional voiding, duplex system, paraureteral diverticulum, bladder exstrophy and grade-1 VUR. The 51 refluxing ureters (RUs) were compared with 55 non-refluxing ureters (NRUs). Finally, sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD were evaluated. RESULTS: A total of 106 ureters in 61 patients with a mean age of 5.3 ± 3.9 years (range 2 months-15 years, median 5 years) were prospectively assigned. The mean HD grade in the RUs was 2.17 ± 0.55. The mean HD grades were 2.0 ± 0.63, 2.07 ± 0.53, 2.38 ± 0.5 and 2.5 ± 0.57 for VUR grades 2-5, respectively. The mean HD grade in the NRUs was 1.60 ± 0.70. The HD grades were H0 to H3 in 7.3%, 30.9%, 56.4% and 5.4% of the NRUs, respectively. The RUs group (2.17 ± 0.55) showed a statistically higher HD grade than the NRUs group (1.60 ± 0.70) (P < 0.005). Sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD grading in the diagnosis of VUR were 92%, 38%, 58%, 84%, and 64%, respectively. The mean HD grade in contralateral ureters of unilateral VUR was 1.55 ± 0.72 and HD grades were H0-H3 in 0%, 55.6%, 33.3% and 11.1% of these nine ureters, respectively. In these nine non-refluxing contralateral ureters, after endoscopic correction of ipsilateral VUR, new contralateral VUR did not occur. CONCLUSION: Even though HD grade was high in the VUR group and popularity of the HD grading is on the increase, HD grading by itself still has a low diagnostic value.

Thoracoabdominal duplication symptomatic on both sides: a case report.

Thoracoabdominal foregut duplications account for less than 2% of all gastrointestinal duplications. Here, we report a case of thoracoabdominal duplication cyst in an eight-month old boy who presented with both respiratory and abdominal complaints. Excision of both thoracic and abdominal extensions of the thoracoabdominal duplications in the same session is an appropriate and safe option to prevent possible complications.

Extravesical approach in paraureteral bladder diverticulum: a case report.

Bladder diverticulaeare herniations of bladder mucosa through fibers of the detrusor muscle. We present the extravesical approach to a case of paraureteral bladder diverticulum in a six-year-old boy who had a history of recurrent urinary infection. In case of recurrent urinary complaints, the possibility of presence of a bladder diverticulum should be kept in mind. Voiding cystourethrogram is helpful for the differential diagnosis of the bladder diverticulum. Excision by extravesical approach of the paraureteral bladder diverticulum is a good choice.

Primary Burkitt lymphoma presenting as a solitary rectal polyp in a child.

Non-Hodgkin lymphoma (NHL) accounts for approximately 60% of all lymphomas in children and adolescents. It represents 8-10% of all malignancies in children aged between 5 and 19 years. Primary rectal lymphoma in childhood is extremely rare. This report focuses on the importance of considering the possibility of malignancy in rectal polyps. We report a 5-year-old girl with fresh rectal bleeding who was admitted in our clinic. In physical exam, we found a single pedicled polyp on the posterior wall of the rectum. Surgical removal under general anesthesia involved polyp and its pedicle. Dimensions of the extirpation material were 1.5 x 1.0 x 0.8 cm. Histopathological examination and immunohistochemistry study of the polyp revealed a high-grade B-cell lymphoma (Burkitt lymphoma). These studies also showed lymphoma cells on the surgical border. The patient was referred to pediatric oncology center for chemotherapy. Primary rectal lymphoma in childhood is extremely rare; therefore, the possibility of malignancy in rectal polyps should be considered in the pediatric patients.

The most commonly cited articles in pediatric surgical journals.

AIM: This study aimed to investigate the characteristics of the most frequently cited articles published in 3 main journals dedicated to the field of pediatric surgery (Journal of Pediatric Surgery, Pediatric Surgery International and European Journal of Pediatric Surgery). MATERIAL AND METHODS: A search was initiated using the database (1985 - 2006) of the Science Citation Index of the Institute for Scientific Information. The total number of publications and their citation numbers were found and the most cited articles were investigated in detail. A total of 600 (200 from each journal) most cited articles were identified and chosen for further analysis. RESULTS: The total number of citations in these 3 journals was 20 271. The citations of the most cited articles ranged from 10 to 224. The articles were published between 1985 and 2003 and the mean number of citations/article was 33.78. Articles originated from 39 counties and 256 institutions. The leading countries were the United States (203 articles from 75 institutions), Germany (50 articles from 21 institutions), Japan (34 articles from 17 institutions), Switzerland (34 articles from 8 institutions), United Kingdom (32 articles from 19 institutions), and Canada (28 articles from 7 institutions). Of the institutions with the highest number of cited articles, four institutions were from the USA followed by Switzerland with two institutions. The leading topics were the gastrointestinal system (n = 239), respiratory system (n = 94), urology (n = 61) and oncology (n = 56), and diaphragmatic hernia (n = 41) was the most common special topic. There were 42 case reports (7 %) and 75 experimental research articles (12.5 %). Thirty-four authors from 14 countries and 30 institutions had articles in more than one journal. The most cited author was N. S. Adzick from the USA with 224 citations. CONCLUSION: In this study, we found that the Journal of Pediatric Surgery predominated with the greatest number of cited articles. The most cited articles, authors and institutions originated from the USA and English-speaking countries. The gastrointestinal system, respiratory system, urology and oncology were the leading topics and diaphragmatic hernia was the most common special topic.

A critical observation about the pathogenesis of abdominoscrotal hydrocele.

Abdominoscrotal hydrocele is a very rare anomaly. Although various theories about this condition have been proposed, controversy still continues on the etiology of this lesion. The authors present two consecutive cases of abdominoscrotal hydrocele in infancy. On their first examination, these patients only had inguinoscrotal hydroceles. After a 2-month period of observation, these inguinoscrotal hydroceles developed into abdominoscrotal hydroceles. These findings also were confirmed by ultrasonography. The authors question the currently proposed theories of abdominoscrotal hydrocele development.

Timing of surgery in perineal ectopic testes: analysis of 16 cases.

Between 1993 and 1998, 16 patients with perineal ectopic testes (PET) (1%) were diagnosed among the 1,576 patients operated upon for undescended testes (UDT) in two pediatric surgical centers. The mean age was 23 +/- 22.5 months. The clinical presentation was an empty scrotum with an ipsilateral palpable perineal mass in 16 patients and an inguinal hernia in 5. In all except 1 patient whose atrophic testis was removed, orchiopexy into the dartos pouch was easily performed through a standard inguinal skin-crease incision. The length of the testicular vessels and vas deferens was adequate and retroperitoneal dissection was not required. Although the complications of UDT are the same as for PET, the timing of surgery should be different. It is generally accepted that children must not be below 6 months of age for surgical correction of UDT, but there is no need to delay surgery in PET, which can easily be diagnosed by physical examination in the neonatal period. Surgery is indicated even if there is no hernia present.

Congenital muscular torticollis: early and intensive treatment is critical. A prospective study.

BACKGROUND: Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of this outcome, such as treatment duration and exercise frequency. The aim of the present study was to define factors related to treatment duration, to compare different frequencies and intensities of home treatment programs and their effect on the speed of recovery. METHODS: The present study was a prospective study of 45 infants (26 male, 19 female) with congenital muscular torticollis referred to the pediatric surgical outpatient during a I year period. Following a standardized initial assessment, parents were taught our intensive home treatment protocol, consisting of passive stretching exercises repeated every 3 h. RESULTS: The mean age at initial assessment was 38.6 days (range 15-120 days). Mean treatment duration was found to be 3.2 +/- 1.3 months. All patients were treated by use of our intensive protocol of passive stretching exercises (100% success). No surgery was necessary. CONCLUSIONS: In patients with early treated congenital muscular torticollis, there is no place for surgical treatment. This group of patients can be successfully treated using an intensive protocol of passive stretching exercises. In addition, this treatment protocol has a very short treatment duration compared with other standardized protocols. A successful outcome depends primarily on good cooperation with the parents, especially in developing countries.

Duplicated exstrophy in one of identical twins.

The characteristic of duplicated exstrophy is the presence of a patch of exstrophic bladder mucosa in the infraumbilical region with a low-set umbilicus, in addition to the normal bladder. Musculoskeletal defects, diastasis pubis, and rectus abdominis can also be found in these patients. We report the first case of a female twin baby with appearance of a low-set umbilicus and diastasis pubis associated with a pubic sinus. The external genitalia and urinary continence were normal. Duplicated exstrophic mucosal remnant was excised, and the histopathologic study of the specimen confirmed urothelium.

Hydatid disease of the liver in childhood.

The records of 100 children with hydatid disease were reviewed retrospectively from 1978 to 1997; 43 were girls and 57 were boys. The mean age was 9.14 years; 61 patients had 124 hepatic cysts. Presenting symptoms were asymptomatic abdominal masses, found masses incidentally during ultrasonography (US), or acute abdomen. Plain X-ray films, US, or computerized tomography (CT) are sufficient for diagnostic evaluation in endemic areas. In the differential diagnosis, laboratory investigations such as the Casoni and Weinberg tests, indirect hemagglutination, eosinophilia, and ELISA were also used. These tests may give negative results, however, in some patients with hydatid disease. The mean follow-up time was 10.5 years (range 1-18 years), the mean duration of hospitalization 7 days. The complication rate was 3.6%. Mortality was 3.27% and occurred after the administration of formaldehyde and hypertonic scolicidal agents. Hydatid disease of the liver can be treated medically in selected patients; conservative surgical approaches that save as much parenchyma as possible, such as partial cystectomy and capitonnage, are indicated in the other cases.