Transinguinal laparoscopic evaluation of contralateral side during unilateral inguinal hernia repair for children.

BACKGROUND: Inguinal hernia repair is a common procedure in daily pediatric surgical practice. OBJECTIVES: The present study was planned to find out whether transinguinal laparoscopic exploration (TILE) of the contralateral groin is effective in reducing the need of operation for contralateral metachronous inguinal hernia (CMIH) in children. STUDY DESIGN: Charts of 1103 children who underwent inguinal hernia repair between 2006 and 2016 were retrospectively analyzed. Eighty-eight children with bilateral hernia at the presentation were excluded, and 705 patients whose parents could be contacted by phone to get the latest information about children's condition were included in the study. RESULTS: Of the 705 children with unilateral inguinal hernia repair, 362 (51.4%) and 343 (48.6%) of them had right-sided and left-sided inguinal hernia, respectively. Transinguinal laparoscopic exploration was performed in 479 of the 705 children with unilateral hernia and a hernia or contralateral patent processus vaginalis (PPV) was found and ligated in %28.3 (n = 136) of them. Mean follow-up time was 60 ± 36 months. Fifteen (4.3%) of 479 patients who had TILE and 31 (13.6%) of 226 the patients who did not have TILE developed CMIH. When the videos of 15 patients who developed CMIH were reviewed, overlooked PPV was found in 10 (3.3%) patients who had TILE during early phases of institutional learning curve. DISCUSSION AND CONCLUSIONS: TILE of the contralateral side during pediatric inguinal hernia repair is a simple and effective method to evaluate contralateral PPV. This approach clearly and significantly reduces the need of operation for a metachronous hernia at a later date.

Endoscopic balloon dilatation of benign esophageal strictures in childhood: a 15-year experience.

The study aims to evaluate the effectiveness and safety of endoscopic balloon dilatation (EBD) in childhood benign esophageal strictures. The medical records of 38 patients who underwent EBD from 1999 to 2013 were retrospectively reviewed. Demographic features, diagnoses, features of strictures, frequency and number of EBD, complications, outcome, and recurrence data were recorded. Median age was 1.5 years (0-14), and female/male ratio was 17/21 (n = 38). Primary diagnoses were corrosive esophageal stricture (n = 19) and esophageal atresia (n = 19). The length of strictures were less than 5 cm in 78.9% (n = 30). No complication was seen in 86.8% (n = 33). Perforation was seen in 10.5% (n = 4), and recurrent fistula was seen in 2.7% (n = 1). Total treatment lasted for 1 year (1-11). Dysphagia was relieved in 60.5% (n = 23). Recurrence was seen in 31.6% (n = 12). Treatment effectiveness was higher, and complication rates were lower in strictures shorter than 5 cm compared with longer ones (70% vs. 25%, P < 0.05, and 3.4% vs. 37.5%, P < 0.05). Although there was no statistical difference, treatment effectiveness rates were lower and complication and recurrence rates were higher in corrosive strictures compared with anastomotic ones (P > 0.05). EBD is a safe and efficient treatment choice in esophageal strictures, especially in strictures shorter than 5 cm and anastomotic strictures.

Pentoxifylline attenuates reperfusion injury in testicular torsion.

OBJECTIVES: An experimental study was designed to evaluate the effects of pentoxifylline (Ptx) on lipid peroxidation, and histopathology in both testes after unilateral testicular torsion and detorsion. MATERIALS AND METHODS: Forty adult male albino Wistar rats were randomly divided into 4 groups of sham operation, sham operation with Ptx, torsion and detorsion, torsion and detorsion with Ptx. After intraperitoneal administration of Ptx at a dose of 50 mg/kg 15 min before torsion; right testes of the rats underwent 30 min of torsion and 30 min of detorsion. Malondialdehyde (MDA) levels were assayed and histopathological changes were evaluated in both testes of all groups. RESULTS: Unilateral testicular torsion and detorsion caused an increase in the MDA levels of both testes. Histopathological evaluation showed interstitial hemorrhage on the ipsilateral side. Pentoxifylline decreased MDA levels on both side, and attenuated interstitial injury on the ipsilateral side. CONCLUSIONS: The results of this study suggest that pentoxifylline treatment attenuates reperfusion damage on both side, possibly with its effects on blood flow and neutrophils. However, further studies are necessary to evaluate the effects of pentoxifylline on testicular torsion.

Three-dimensional CT of congenital esophageal atresia and distal tracheoesophageal fistula in neonates: preliminary results.

OBJECTIVE: Radiography was traditionally used in the preoperative treatment of neonates with tracheoesophageal atresia and tracheoesophageal fistula. The aim of this study was to assess the potential use of three-dimensional CT in the evaluation of this complex congenital malformation. CONCLUSION: Three-dimensional CT coupled with reformations in the three orthogonal planes may have a complementary diagnostic role in congenital esophageal atresia.

The split notochord syndrome with dorsal enteric fistula, meningomyelocele and imperforate anus.

A male infant was referred to our department because of lumbosacral meningomyelocele, dorsal enteric fistula and imperforate anus. The mother had received a parenteral drug containing estradiol benzoate and progesterone for inducing abortion in the first trimester. She also used an anal pomade containing triamcinolone and lidocaine-HCl during the pregnancy for hemorrhoids. Sigmoid end colostomy was performed after meningomyelocele repair. On abdominal exploration a wandering spleen was detected but no other anomalies. Two months later, an abdominoperineal pullthrough was performed, and the patient was discharged well after three weeks. Our case is the sixth that had split notochord syndrome associated with dorsal enteric fistula and imperforate anus. Additionally, penoscrotal transposition and wandering spleen were present in this case. To our knowledge, these associated anomalies have been extremely rare.

Ultrastructural and hormonal changes in the contralateral adrenal gland in unilateral adrenal gland ischemia: an experimental study in rats.

While it is well known that unilateral tissue ischemia may result in contralateral damage in some paired organs, there is no universally accepted mechanism to explain why these contralateral changes occur. The aim of the present study was to investigate the ultrastructural and hormonal changes that occur in the contralateral nonischemic adrenal gland after unilateral ischemia of an adrenal gland in a rat model. The animals were divided into four groups of four rats each; namely, a control group which received a sham operation without any ischemic insult, a 2-h ischemic group, a 4-h ischemic group, and an 8-h ischemic group. The left adrenal blood vessels were ligated in all ischemia groups and blood samples were taken for hormonal study 2, 4, and 8 h later, after which bilateral adrenalectomy was performed to determine the ultrastructural changes. The plasma concentrations of aldosterone and cortisol were determined by radioimmunoassays. There was an increase in both aldosterone and cortisol levels related to the duration of the ischemia, but the differences among the groups were not statistically significant. Contralateral ultrastructural damage such as heterochromatin in nuclei, mitochondrial degeneration, endoplasmic reticulum cisternal widening, increased lipid droplets, and lysosomes, were demonstrated electron-microscopically after unilateral adrenal ischemia.

Pentoxifylline inhibits overflow and reduces intestinal reperfusion injury.

The aim of this study was to determine the effects of pentoxifylline (Ptx) in reperfusion injury of the small bowel as a leukocyte stabilizer, free radical scavenger, and microcirculatory regulator. Ninety-six male Sprague-Dawley rats were used to determine the biochemical, histopathologic and blood flow changes of the reperfused small intestines after 30 minutes of a warm ischemic insult. Animals were divided into six groups: Sham (S), sham plus Ptx (SP), ischemia (I), ischemia plus Ptx (IP), reperfusion (R), and reperfusion plus Ptx (RP). Pentoxifylline was administered intraperitoneally at a dose of 50 mg/kg 15 minutes before ischemia. The superior mesenteric artery (SMA) was occluded distal to the right colic artery and collateral arcades were ligated as described by Megison. Sixty of the 96 rats (n = 10) were used to determine histopathologic changes, malondialdehyde (MDA), and myeloperoxidase (MPO) levels in tissue. Mucosal lesions were graded on a scale from 0 to 5 as described by Chiu. MDA and MPO levels of the intestinal mucosa were assayed to reflect the free radical formation and neutrophil sequestration, respectively. Thirty-six rats (n = 6) were used to measure blood flow changes of the intestine using 133Xe clearance technique. All data were presented as the mean values plus or minus the standard error of the means (means +/- sem). Although in the R group, mucosal injury score, blood flow, MPO, and MDA levels were higher significantly from the other groups (P < .05), in the RP group blood flow, MPO, and MDA levels were significantly decreased to the basal values (P < .05). Mucosal injury score of the RP group were lower than the reperfusion group but higher than the normal (P < .05). The authors conclude that pentoxifylline pretreatment before reperfusion stabilizes blood flow, decreases MPO and MDA levels to the normal, and attenuates but not completely prevents mucosal damage.

Neonatal hypertrophic pyloric stenosis: congenital or infantile?

Hypertrophic pyloric stenosis (HPS) is very rare during the newborn period. Here we present a fullterm male neonate with abundant hematemesis 12 hours after birth which interrupted oral feeding. Bleeding subsided within three days after conservative measures, and oral feeding was restarted but not tolerated. The vomiting was effortless and nonbilious. An upper gastrointestinal series revealed gastric dilatation and partial obstruction of the gastric outlet. HPS was found by laparotomy on the fourth day and Fredet-Ramstedt pyloromyotomy relieved the gastric emptying. This is one of the few cases of HPS present at birth, which was diagnosed and surgically treated early, and we suggest a congenital etiology in previously reported cases of HPS. Hypertrophic pyloric stenosis (HPS) is a common cause of pediatric surgery. Usually young infants are involved; HPS is extremely rare in neonates and infants older than 6 months. Vomiting typically begins between the 3rd and 6th week of life, although some infants may have mild symptoms like regurgitation from birth.

Distal penile hypospadias repair in children, with complete mobilization of pendulous urethra and triangular glandular flap.

OBJECTIVE: To present a technique for repair of distal hypospadias. PATIENTS AND METHODS: Sixteen children (average age 6.6 years) were treated between January 1985 and January 1991. The procedure is described. RESULTS: One child developed a mild meatal stenosis and another had a small urethral fistula; both responded to treatment. Results were excellent in the remaining 14 patients. CONCLUSION: This simple operative procedure was successful in the majority of patients and there were only two minor complications.

Blood flow determination in contralateral ovary with 133 Xe in unilateral ovarian torsion (experimental study in rabbits).

Clinical and experimental studies have shown that, in unilateral testicular torsion, some structural and hormonal changes may occur in the contralateral testis. The present study was designed to determine the effect of unilateral ovarian torsion on the blood flow in the contralateral ovary using #133Xe. Basal blood flow of the bilateral ovaries was determined in 40 prepubertal, female New Zealand rabbits. Right ovaries were then torsioned 720 degrees in all groups with the exception of the control group, where only laparotomy was performed. Bilateral ovarian blood flows were measured in the first group one hour after torsion, in the second group 8 hours after torsion, in the third group 24 hours after torsion and at the same times after laparotomy in the control group. Basal and post torsional blood flow measurements were analyzed. Contralateral ovarian blood flow was reduced after unilateral torsion in all of the groups. In the control group, there were no changes in these criteria.

A bronchopleurocutaneous fistula caused by an unusual foreign body aspiration simulating acute abdomen.

A 12-year-old boy was admitted to hospital for abdominal pain, vomiting and fever. On physical examination he had râles on the lower right hemithorax without any respiratory complaints. Chest X-ray revealed a condensation in the right lower chest. Abdominal findings were secondary to lobar pneumonia. Treatment of pneumonia with antibiotics showed no improvement over 2 days. On bronchoscopy no foreign body was seen, but pus was aspirated. Two days later a mass appeared on the right hemithorax and fistulized. An organic foreign body, Hordeum murinum, with 3-5 ml of pus was observed. Chest X-ray taken at the day of fistulization showed no pneumothorax or subcutaneous emphysema. Less than 11 cases of pneumocutaneous fistulas secondary to aspiration of grasses have been reported in literature. Why an ear of Hordeum murinum can migrate only in a forward direction and why a pneumothorax had not developed is discussed.

Histologic and ultrastructural changes in the contralateral ovary in unilateral ovarian torsion: an experimental study in rabbits.

This study was planned to investigate the extent of cellular damage of the contralateral ovary in unilateral ovarian torsion and to determine possible changes histopathologically by light and ultrastructurally by electron microscopy. Unilateral ovarian torsion was performed in 21 prepubertal, female New Zealand rabbits. One, 8 and 24 hours after the torsion, contralateral ovaries were biopsied. The control group consisted of rabbits without any torsion. Contralateral cellular damage was demonstrated after unilateral torsion. Oocytic nuclei, mitochondria, lysosomes and ovarian stromal cells were also affected when evaluated ultrastructurally.

Prevalence of congenital abnormalities in Turkish school children.

19750 school children, ages 6 to 15 years, were examined by the authors of this study, 1,220 (6.18%) had congenital abnormalities. In this group, 4.23% were boys and 1.88% were girls. Case histories revealed inbreeding amongst the parents (families) of children with congenital malformation to be 8.9% and 8.2% for the rest of the families in this study. There were 27 different congenital abnormalities identified, with prevalence rates of 0.05/1,000 to 15.85/1,000. The most prevalent abnormalities were umbilical hernia (15.85/1000), inguinal hernia (14.50/1,000), pectus carinatum and excavatum (7.68/1,000), undescended testes (9.00/1,000 boys), congenital nevus (3.54/1,000), retractile testis (4.45/1,000 boys), pilonidal sinus (2.63/1,000), pes planus (2.28/1,000), and hemangioma (1.16/1,000). Of the 19,750 children, 70 had multiple anomalies (3.75/1,000).

Augmentation of mucosal adaptation following small-bowel resection by electromagnetic field stimulation in rats.

Survival following massive resection of the small intestine is often possible due to substantial hyperplasia of the mucosal surface in the remaining small intestine. While nutrients provide the major stimulus for hyperplasia in the clinical setting, the availability of drugs to augment this process would have obvious therapeutic implications. Electromagnetic field stimulation (EMF) of connective tissue and skin increased the DNA and messenger RNA and protein synthesis in experimental studies. We evaluated the ability of electromagnetic field stimulation to augment mucosal hyperplasia following massive small bowel resection in the rat. Two groups of 10 Wistar rats, 250 gr body weight, were subjected to 70% jejunoileal resection. The first group received EMF stimulation for ten days at a dosage of 43.20 gauss, the second group did not receive any stimulation. After fourteen days, segmental evaluation of mucosal mass in the remaining small intestine was determined by measuring mucosal protein, and disaccharidase levels, as well as intestinal length and circumference. EMF stimulation appears to augment mucosal adaptation following massive small bowel resection in rat, in the proximal and distal small intestine.

The effect of electromagnetic field stimulation on corticosteroids-inhibited intestinal wound healing.

Electromagnetic field (EMF) stimulation has been used successfully in the clinical setting to promote healing of ununited fractures. In a few studies, EMF stimulation enhanced soft tissue healing. To investigate the effect of EMF stimulation on intestinal wound healing in normal rats and in those treated with corticosteroids, 80 Wistar rats received twice-daily injections of either saline dexamethasone (0.1 mg/kg/day for 2 weeks. Animals then underwent creation of single-layer, inverting small intestine anastomoses. All injections were continued postoperatively. Animals were grouped as intestinal anastomoses; intestinal anastomoses plus EMF stimulation; intestinal anastomoses plus dexamethasone; and intestinal anastomoses plus dexamethasone plus EMF. On postoperative days 7 and 14, the anastomosed intestines were removed and the tensile strength (TS) and hydroxyproline (OH-P) contents measured. EMF stimulation significantly increased intestinal wound healing in normal animals by the 7th and 14th day. Corticosteroids significantly impaired the healing of the small intestine anastomoses, with decreased TS and OH-P contents after the first and second weeks. However, EMF stimulation significantly reversed this inhibitory effect.

Influence of unilateral ovarian torsion to the contralateral ovary.

An experimental study was planned to show the suppression of contralateral ovary in unilateral ovarian torsions. In the study, 55 New Zealand female rabbits were used. Basal and stimulation 17 beta estradiol values were measured and unilateral torsion in 20 rabbits, bilateral torsion in ten rabbits and bilateral oophorectomy in five rabbits were performed. Eight, 16, 24 hours after the procedure, 17 beta estradiol levels were measured again and the second stimulation values maintained. The control group consisted of 20 rabbits. Values were analyzed statistically and the results were significant.

Human amniotic membrane as an intestinal patch for neomucosal growth in the rabbit model.

This experiment was carried out as a preliminary study, an attempt to grow new intestinal mucosa on human amniotic membrane in the terminal ileum in 37 rabbits. After ketamin sulfate anesthesia at laparatomy, 5-cm ileal defects were patched with human amniotic membrane (5 x 2 cm). These patched intestines were investigated on the first postoperative day and the 2nd, 5th, 10th, and 20th weeks corresponding to 4, 5, 5, 10, and 10 rabbits, respectively. Only three rabbits died in the early postoperative period. There was no evidence of intestinal obstruction or dilatation with barium meal. Microscopically, the neomucosa consisted of a thin layer of columnar epithelial cells at 2 weeks with more maturity of the villi and less irregularity and branching by 20 weeks. All patches were covered with neomucosa commencing at 2 weeks and covering the whole patch area by 20 weeks. This technique's advantages are the large size and the ease of the availability of the human amniotic membrane for neonates at risk without jeopardizing the neonates tissues. It is hoped that this method might be considered when neonatal material is scarce.

Fertility after simulated Fowler-Stephens orchiopexy in rats.

In order to determine the effects of the Fowler-Stephens orchiopexy (FSO) on fertility, young rats underwent simulated FSO, FSO and concurrent contralateral orchiectomy (FSO/OR), unilateral orchiectomy (OR), or sham operation (controls). Twelve weeks after the operation, each male rat was mated to two proven-fertile female rats for 17 days (three ovulatory cycles). Two weeks later, both male and female rats were killed. No pregnancy resulted from the matings of the FSO/OR males. In contrast, pregnancy ensued in 13 of 16 (81%) females in the FSO group, 9 of 14 (64%) in the OR group, and 11 of 12 (92%) in the control group. There were no fertile males in the FSO/OR group. In the FSO group, eight of eight males induced pregnancy in at least one female; in the OR group, six of seven (86%) males were fertile as were all six males in the control group. No differences in litter size or fetal weight were observed between fertile females in various groups.

Effects of chronic corticosteroids and vitamin A on the healing of intestinal anastomoses.

The ability of vitamin A to reverse the inhibitory effects of chronic corticosteroids on cutaneous and fascial wound healing is well established. To investigate this in the unique low-collagen environment of the intestinal anastomosis, 35 rabbits received twice-daily injections of either saline (control), dexamethasone (0.1 mg/kg/day), dexamethasone plus low-dose vitamin A (1,000 IU/kg/day), or dexamethasone plus high-dose vitamin A (10,000 IU/kg/day) for a 2-week period. Animals then underwent creation of single-layer, inverting small and large intestine anastomoses. All injections were continued postoperatively. A fifth group received only dexamethasone preoperatively and dexamethasone plus high-dose vitamin A postoperatively. On postoperative day 7, animals underwent in situ assessment of anastomotic bursting pressure and subsequent histologic examination using a modified Ehrlich/Hunt scale. Corticosteroids significantly impaired the healing of small and large intestine anastomoses, with decreased bursting pressures and histologic parameters at 1 week. Only high-dose vitamin A significantly reversed this inhibitory effect, whether given preoperatively or only postoperatively.

Physical growth measurements of 18,719 primary school children living in Adana, Turkey.

Height and weight measurements of 18,719 healthy children were obtained and the results were compared with those obtained from children living in several regions of Turkey and the USA. The results of these measurements differed significantly. This study demonstrates that local growth standards should be established and used in the evaluation of children.