Hickman catheter-induced cardiac tamponade-related cardiac perforation management by mediastinotomy in children and a review of the literature.

OBJECTIVE: Hickman catheter placement rarely causes cardiac tamponade due to cardiac perforation in children. Cardiac perforation can be managed with timely perceive and appropriate approach. We present a case of the cardiac perforation related to Hickman catheter insertion in a 7-year-old girl and a review of the supporting literature. CASE REPORT: The patient had previous history of Thalassemia and admitted to hospital for Hickman catheter placement for bone marrow transplantation. The catheter was placed in the right internal jugular vein by ultrasonography. During the postoperative period she had hypoxia, hypotension and tachycardia. The patient underwent an emergency surgery and there was a small perforation between vena cava superior and right atrium. That wound was managed by mediastinotomy. The patient was discharge on the 8th postoperative day. CONCLUSION: Cardiac perforation is one of the rare and unexpected complications of Hickman catheter placement. Unfortunately, the complication may cause significant mortality. The prompt diagnosis and early intervention provides satisfactory results.

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.

Association between plasma kisspeptin levels and adolescent gynecomastia.

BACKGROUND: Gynecomastia is defined as benign proliferation of male breast glandular tissue. To date, the pathophysiology of adolescent gynecomastia (AG) remains unclear. Kisspeptin is a polypeptide that plays an important role in the regulation of the hypothalamic-pituitary-gonadal hormonal axis. In this study, we investigated whether there is a relationship between kisspeptin and AG. MATERIALS AND METHODS: This study included 40 males between 9 and 18 years of age diagnosed with gynecomastia. The control group consisted of 30 young healthy males in the same age range. The participants were evaluated with respect to anthropometric measurements (age, height, body weight, body mass index, breast and pubic stages and testicular volume). The levels of kisspeptin, follicle-stimulating hormone, luteinizing hormone, estradiol (E2), testosterone (T), and ratio of E2 to T were measured in both groups. RESULTS: The mean age was 13.8 years. There were no differences between the groups in terms of anthropometric parameters, plasma gonadotropin levels, estrogen levels, and E2/T (P > 0.05). Plasma kisspeptin (0.77 and 0.54 ng/mL, P < 0.05) and T (253.9 ng/dL and 117.9 ng/dL) levels were significantly higher in the AG group than in the control group (P < 0.001). CONCLUSION: Kisspeptin levels are an important factor in AG.

A comparison of manual versus hydrostatic reduction in children with intussusception: single-center experience.

OBJECTIVE: In recent years several techniques have been recommended for intussusception treatment. In this study, an evaluation was made of intussusception cases that presented at our clinic and had reduction applied together with saline under ultrasonography (USG) and cases, which were surgically treated. PATIENTS AND METHODS: A retrospective evaluation was made of the records of 72 cases treated for a diagnosis of intussusception between January 2010 and July 2012. Patients were evaluated demographics, clinical presentation, management strategy, during the hospitalisation and outcome. RESULTS: A total of 72 cases which consists of 44 male and 28 female with age range between 5 and 132 months were treated with a diagnosis of intussusception. USG was applied to all cases on initial presentation. As treatment, hydrostatic reduction (HR) together with USG was applied to 47 cases. Of these, the HR was unsuccessful in 13 cases. Surgical treatment was applied to 38 cases. Of these cases, ileocolic intussusception was observed in 30 cases, ileoileal in seven cases and colocolic in one case. Meckel diverticulum was determined in five of these cases, polyps in two cases, lymphoma in two cases, lymph nodule in one case and 28 cases were observed to be idiopathic. There was no mortality in any case. CONCLUSION: HR together with USG is a safe technique in the treatment of intussusception, which also shortens the duration of hospitalisation and significantly reduces the treatment costs.

Pulmonary hydatid disease is difficult recognized in children.

PURPOSE: Pulmonary hydatid disease is a significant health problem for children in endemic areas. Pulmonary hydatid disease is more frequent than hepatic hydatid disease in children. The aim of this study was to evaluate the characteristics of pulmonary hydatid disease for children in our province which is endemic for echinococcosis. PATIENTS AND METHODS: This study was performed retrospectively between 2007 and 2012 by reviewing the medical records of patients (≤17 years) who were diagnosed with pulmonary hydatid disease. The medical records of these patients were evaluated with respect to the demographic characteristics of patients, management strategies, length of hospital stay, and outcomes. RESULTS: A total of 120 (52.9% boys and 46.3% girls) patients with the diagnosis of pulmonary hydatid disease were enrolled in this study. The mean age was 10.15 ± 3.93 years. The significant numbers of patients were admitted with a ruptured hydatid disease and managed with lung preservation. The mean follow-up was 11.3 ± 3.8 (3-24) months. Recurrence was detected in three patients during follow-up. CONCLUSION: Pulmonary hydatid disease is usually symptomatic. Hydatid disease must be considered in differential diagnosis while evaluating thoracic lesions in endemic areas.

[Blunt renal trauma in children: a retrospective analysis of 41 cases]. / Çocuklarda künt böbrek travmalari: Kirk bir olgunun geriye dönük olarak degerlendirilmesi.

BACKGROUND: The majority of renal injury secondary to blunt abdominal trauma can be successfully treated conservatively. In the present study, the clinical features and outcomes of children who presented with renal injury secondary to blunt abdominal trauma were evaluated. METHODS: This study was carried out retrospectively using data from children at the Department of Pediatric Surgery who were hospitalized for renal injury due to blunt abdominal trauma between 2000 and 2012. Patient characteristics, clinical presentation, management strategy, and outcome were evaluated. RESULTS: Forty-one patients were hospitalized. The mean age of the patients was 10±4.85 years. The majority of renal injuries were grade 1 and 2. Falling was the cause of most renal injuries. All patients were initially treated conservatively. Three patients underwent acute surgical exploration for life-threatening renal bleeding (grade 4-5 injury). Nephrectomy was performed in 3 patients due to injury to the pedicle. CONCLUSION: The conservative treatment of pediatric renal parenchymal injuries is safe and effective in children. Although the vast majority of renal injuries do not require surgical intervention, life-threatening renal bleeding, regardless of the grade of injury, should be treated surgically.

The characteristics and outcomes of penetrating thoracic and abdominal trauma among children.

PURPOSE: Trauma is the most important etiology of morbidity and mortality among children. Penetrating injuries to the thorax and abdomen are extremely rare in children. In the present study, we compared the characteristics of patients, management, and outcomes of penetrating thoracic and abdominal trauma in children. MATERIALS AND METHODS: Data from children who were hospitalized for penetrating injuries of the thorax and abdomen from 2006 to 2012 were evaluated retrospectively. These injuries were evaluated with respect to patient details, clinical presentation, circumstances of trauma, management, and outcomes. RESULTS: Eighty-four patients were hospitalized for penetrating injuries to the thorax and abdomen. The mean age was 10.3 ± 3.79 years. Patient injuries comprised 26 gunshots injuries and 58 stabbing injuries. Thirty-one patients were wounded in the thorax, 43 were wounded in the abdomen, and 10 were wounded in both the thorax and abdomen. Thirty-one patients had undergone surgical interventions, while the other 53 were managed conservatively. The mean hospital stay was 4.41 ± 6.84 days. CONCLUSIONS: The incidences of penetrating abdominal and thoracic trauma did not differ significantly. Penetrating injuries may be successfully managed by conservative therapy.

Characteristics and outcomes of liver and lung hydatid disease in children.

Our study retrospectively evaluates and compares the characteristics of lung and liver hydatid disease (HD) in children. This retrospective study was performed between 2007 and 2012 using the medical records of patients aged ≤17 years of age who had liver and/or lung HD. They were evaluated using the demographic characteristics of the patients, clinical presentation, hospital stay and outcome. A total of 252 cysts were identified in 152 of the patients. The incidence of HD increased with age and the majority of patients were older than 9 years. Overall, lung HD was more complicated and symptomatic than liver HD on initial admission.

Preliminary study of efficacy of hyaluronic acid on caustic esophageal burns in an experimental rat model.

BACKGROUND: The aim of this study was to investigate the effectiveness of hyaluronic acid on the prevention of esophageal damage and stricture formation after experimental caustic (alkaline) esophageal injury in rats. MATERIALS AND METHODS: Twenty-one Wistar albino rats were randomly divided into three groups. A caustic esophageal burn was created following the Gehanno model: Group l (n=7) underwent operation, but no injury; Group 2 (n=7) was injured and left untreated; and Group 3 (n=7) was injured and treated with hyaluronic acid, first topically and then orally by gavage (2×0.3mL; 12.5mg/mL for 7days). The caustic esophageal burn was created by instilling 25% NaOH into the distal esophagus. All rats were euthanized on day 22 for evaluation. The efficacy of hyaluronic acid treatment was assessed histopathologically and biochemically via blood determination of the total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and sulfhydryl group (SH) and lipid hydroperoxidase (LOOH) levels. Statistical analyses were performed. RESULTS: Weight gain was significantly lower in Group 2 than in the other two groups (P<0.05). The mean stenosis index, histopathologic damage score, TAS, TOS, OSI, and SH and LOOH levels were higher in Group 2 than in the other two groups. The mean stenosis index, inflammation, TAS, SH and OSI in Group 2 were significantly different than those in the other two groups (P<0.05). CONCLUSION: Hyaluronic acid treatment is effective in treating damage and preventing strictures after caustic esophageal burn in rats.

The role of nitric oxide in an experimental necrotising enterocolitis model.

BACKGROUND: Necrotising enterocolitis (NEC) causes a significant life-threatening gastrointestinal system (GIS) disease with severe mortality and morbidity, particularly in premature infants. Nitric oxide (NO) has many functions in the GIS. Therefore, in the present study, we evaluated the effects of NO in experimentally induced NEC of newborn 1-day-old rats following hypoxia/reoxygenation (HR). MATERIALS AND METHODS: Thirty Wistar albino rats (weight, 5-8 g) were randomly divided into three groups: group 1 (HR), group 2 (HR + nitroglycerine), and group 3 (control). HR was achieved by placing the rat in carbon dioxide (CO2) for five minutes at 22°C, which was followed by five minutes of 100% oxygen. After HR, nitroglycerine was administered for three days at 50 µg/Kg/day. On day 4, the rats were decapitated and the intestines between the duodenum and sigmoid colon were resected and histopathologically examined. RESULTS: The histopathological findings of groups 1 and 2 were characteristic of NEC. Intestinal injury in group 1 was significantly more prevalent than that in group 2 (χ2 = 21.55, P = 0.000). The intestinal injury score in group 3 was significantly lower than that in the other groups (P < 0.05). CONCLUSIONS: NO treatment was effective for treating experimentally induced NEC.

Abdominal injuries related to bicycle accidents in children.

PURPOSE: Bicycling is a well-liked sporting activity in which many children participate, and bicycle accidents are one of the most common causes of abdominal injuries in children. We evaluated the characteristics and outcomes of abdominal injuries due to bicycle accidents in children. PATIENTS AND METHODS: This study was carried out retrospectively on children at the Department of Pediatric Surgery who were hospitalized for abdominal injury due to a bicycle accident, from 2008 to 2012. Abdominal injury-related bicycle accidents were evaluated with respect to patient characteristics, clinical presentation, management strategy, and outcome. RESULTS: Fifty-nine patients were hospitalized for abdominal injuries related to a bicycle accident. The mean age of the patients was 11.48 ± 3.6 years. Most patients had an imprint of the handlebar edge on their abdomen. The most common abdominal organ injury due to a bicycle accident was laceration of the liver. Most patients were treated conservatively. Surgery was performed in 14 (24.1 %) patients. Hospital stay was 1-68 (mean 4.34 ± 11.6) days. CONCLUSIONS: Abdominal injuries following a bicycle accident are frequent, serious, and preventable. Most patients were treated conservatively. Bicycle injuries can be prevented.

Factors affecting the clinical outcome of low-voltage electrical injuries in children.

PURPOSE: This study evaluated the clinical features of low-voltage (220-240 V) electrical injuries and their mortality in children. METHODS: This cross-sectional study evaluated 36 patients younger than 18 years who suffered a low-voltage electrical shock and presented to the emergency department between January 2009 and October 2011. For statistical analysis, Fisher exact test was used for categorical variables, and the Mann-Whitney U test for continuous variables. RESULTS: In the 34-month period, 36 patients (27 boys [75%] and 9 girls [25%]) were injured. The mean patient age was 9.19 ± 4.10 years (range, 2-17 years). Of the 36 patients, 5 (13.9%) died. Significant relationships were found between mortality and age (P =0.004), unconscious at the time of admission to the emergency department (P =0.013), the presence of clinical shock (P = 0.005), sinus tachycardia (P = 0.003), and high lactate dehydrogenase levels (P = 0.001). There were also significant relationships between mortality and hospital stay (P = 0.005), intensive care unit stay (P = 0.002), and detection of bacterial growth in blood culture (P = 0.024). By contrast, sex, the presence of an electrical exit wound, degree of the burn, surface area of the burn (%), accompanying flash burn, time elapsed transferring the patient from the accident scene to hospital, incomplete bundle-branch block or ST-wave changes on the electrocardiogram, increased troponin T, and creatine phosphokinase myocardial bundle did not affect mortality. CONCLUSIONS: Complications such as sepsis and electrolyte imbalance lead to mortality rather than low-voltage electrical injury itself.

The characteristics and outcomes of foreign body ingestion and aspiration in children due to lodged foreign body in the aerodigestive tract.

OBJECTIVE: Injury due to foreign body (FB) aspiration and/or ingestion is a common and serious pediatric emergency. Foreign body injury (FBI) most commonly occurs in children younger than 6 years, and the incidence of FBI has increased in recent years. The aim of the present study was to evaluate and compare the characteristics of FBI due to ingestion and aspiration. METHODS: Data from patients who were hospitalized for FB ingestion and/or aspiration and underwent rigid bronchoscopy and esophagoscopy from 2008 to 2011 were retrospectively evaluated. Foreign body in the upper aerodigestive tract was evaluated with respect to the characteristics of patients, clinical presentation, management strategy, the outcome, and features of FB. RESULTS: A total of 192 patients admitted for FB ingestion or aspiration in the pediatric surgery department were evaluated. The mean age was 40.97 (SD, 35.73) months. The majority of patients were younger than 4 years. Foreign bodies were mainly located in the upper esophagus for ingested FBs (60.8%), whereas for aspiration 43% of FBs were in the main right bronchus. A total of 4 patients died. The hospitalization period of patients admitted for FB aspiration was longer than that of patients with FB ingestion. Surgery was performed in 4 patients. The most commonly ingested FBs were coins, whereas seeds were the most commonly aspirated. CONCLUSION: Prevention is the key to dealing with FBIs. Because the frequency of foreign bodies is higher in underdeveloped countries, education of parents regarding the dangers and prevention of aspiration and ingestion is important.

An extra-large ovarian mucinous cystadenoma in a premenarchal girl and a review of the literature.

OBJECTIVE: Epithelial ovarian neoplasms are extremely uncommon in children. Ovarian mucinous cystadenoma is benign and an extremely rare presentation in the premenarchal period. We present a case of giant mucinous cystadenoma of the left ovary in a 13-year-old and a review of the supporting literature. CASE REPORT: The patient was admitted with a history of increasing abdominal distension and pain for approximately 3 months and a history of an ovarian mass for 3 years. An adnexal mass measuring 40 × 30 × 20 cm was detected by abdominal ultrasonography and computed tomography. The tumor markers CEA, CA 19-9, and CA-125 were elevated, although α-fetoprotein and human chorionic antigen levels were within the normal range. The patient underwent surgery. The smooth-surfaced mass filled the abdomen. A frozen section biopsy was performed, and the results indicated a benign mucinous cystadenoma. A unilateral oophorectomy with tumor removal was performed. CONCLUSION: The ovarian mass was revealed by abdominal distension, and a diagnosis was established by frozen biopsy. Complete and careful surgical resection provides satisfactory results; however, careful follow-up is required.

Acquired Umbilico-Inguinal Fistula with Persistent Discharge due to Suture Reaction: A Case Report and Review of the Literature.

The aim of this paper is to stay a very rare umbilico-inguinal fistula (UIF) resulting from a delayed suture reaction after the use of silk suture to repair an inguinal hernia. A 3-year-old boy presented with persistent umbilical discharge. The initial diagnosis was omphalitis and he was treated with broad-spectrum antibiotics but a UIF was subsequently diagnosed. Surgery was performed to ascertain the cause of the UIF. This case demonstrates that silk suture used in inguinal hernia repair can lead to a UIF, which should be considered in the differential diagnosis of a patient presenting with persistent umbilical discharge.

Urinary retention as the presentation of Bartholin's duct cyst in a neonate.

Patients with a vaginal mass (large Bartholin's duct cyst) associated with a contralateral renal cyst and hydroureteronephrosis are unable to urinate. While occasionally seen in adults, Bartholin's duct cyst is rare in neonates. The origins of Bartholin's and Gartner's cysts can be traced to the mesonephric duct. Given the rarity of these cysts, there is significant confusion regarding their diagnosis, management, and prognosis. Here, we present the first report of an interlabial mass as a Bartholin's duct cyst in a neonate. The treatment of vaginal cysts is also discussed.

A prospective, randomized, double-blind study comparing the efficacy of diltiazem, glyceryl trinitrate, and lidocaine for the treatment of anal fissure in children.

PURPOSE: Anal fissure (AF) is a common perianal condition in children. Although adult patients with AF have been treated successfully using diltiazem, it has not been studied in children. The present randomized, prospective, double-blind study assessed the response, side effects, and recurrence of diltiazem. METHODS: Ninety-three children with AF were randomly divided into three groups. Each group received topical ointment. Group GTN received 0.2% glyceryl trinitrate, group L received 10% lidocaine, and group D received 2% diltiazem ointment. RESULTS: Eighty-two patients completed the 12-month study. At the end of the first 8-week course, the healing rate in group D was significantly higher than that of the other groups (p < 0.0001, χ (2) = 19.82). Nonresponders received a second course of the same treatment. Group D showed significantly higher healing rates than the other groups (p < 0.05, χ (2) = 7.227) at the end of the second 8-week course. The group D recurrence rate was significantly different than that of the other groups (p < 0. 002, χ (2) = 12.79). CONCLUSION: Diltiazem application is effective and safe for the treatment of AF in children, and has a low recurrence rate. The smooth dose-concentration curve causes minimal side effects.