Evaluation of the systemic immune inflammation index and the systemic inflammatory response index as new markers for the diagnosis of acute appendicitis in children.

BACKGROUND: Abdominal pain is a common and non-specific symptom in children. It is important to be able to distinguish the source of abdominal pain before surgery. OBJECTIVES: Assess importance of the systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and other systemic inflammatory response blood cell indices in predicting the diagnosis and prognosis of acute appendicitis in children. DESIGN: Retrospective cohort SETTING: Single center in Turkey PATIENTS AND METHODS: The files of patients with abdominal pain aged 0-18 years who underwent surgery for appendicitis in our clinic between January 2011 and January 2022 were reviewed. According to the pathology results, patients were divided into two groups, those with pathologic findings of appendicitis (positive for appendicitis) and those without appendicitis. Systemic inflammation markers were statistically compared between the groups. MAIN OUTCOME MEASURES: Systemic inflammation markers. SAMPLE SIZE: 1265 patients RESULTS: Of the 1265 patients, 784 (62%) were male and 481 were female (38%). According to the pathologic examinations, 256 (20.2%) patients did not have appendicitis, and 1009 (79.8%) patients had acute appendicitis. The SIRI level was significantly higher in patients with acute appendicitis compared with patients without acute appendicitis (P<.001). Levels of SII were significantly higher in patients with acute appendicitis (P<.001). CONCLUSION: In children presenting with abdominal pain, high SIRI and SII values alone support the diagnosis of acute appendicitis at a rate of 95%. When physical examination findings, duration of pain, and imaging test results are added, the diagnosis becomes clear at a rate of 98%. LIMITATIONS: Single-center study and retrospective.

Comparison of conventional Doppler imaging techniques and superb microvascular imaging in determination of vascularization in undescended testes.

Aim: Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes. Material and methods: We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume. Results: Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging (p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes (p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes. Conclusions: The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes.

The Effect of Botulinum Toxin in Experimental Hypertrophic Pyloric Stenosis.

Purpose: Infantile hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in the first month of life. Botulinum toxin (BT) is a neurotoxin produced by clostridium botulinum, which causes paralysis in skeletal muscles. We aimed to evaluate the effectiveness of BT in the experimental pyloric stenosis model. Methods: The study protocol was approved by the Selcuk University Medical Faculty Ethics Committee (2017/20). We performed an experimental study using 32 Wistar-Albino newborn rats. Rats were divided randomly into four groups with six rats in both control (C), and L-nitro-arginine methyl ester hydrochloride group, and 10 rats in each sham (S), and BT group. 100 mg/kg per day L-NAME was applied to all groups intraperitoneally for 14 days from birth except control group. 0.2 mL saline and 20 U/kg BT was injected by surgery to S and BT groups, respectively, at 21 days from birth. After 35 days all rats were sacrificed and biopsies were performed from pyloric muscle for histopathological examination. The results were evaluated with the "one-way ANOVA" test. Results: Total and circular muscle thickness of the groups were compared. The total muscle thickness of the L-NAME group was significantly higher than the control group (P = .031). Comparing the circular muscle thickness of botox group (BTG) with control group (CG) and L-NAME GROUP (LNG), muscle thickness was significantly smaller (P < .001, P < .001). The total muscle thickness of BTG was significantly different between LNG (P < .001). Conclusions: Hypertrophy of pylor in an experimental model was reduced by BT injection in this study. We think that Botox injection through endoscopic or interventional radiological methods may be an alternative method for surgery.

Red cell distribution width and neutrophil-to-lymphocyte ratio as a predictive factor in treatment of pediatric patients with burns.

BACKGROUND: Red cell distribution width (RDW) is associated with mortality in certain diseases. Neutrophil-to-lymphocyte ratio [NLR] is being used as a decisive parameter in inflammatory diseases. The association between morbidity and RDW-NLR in children with burns is unclear. We aimed to evaluate effectivity of these markers in children with burn. METHODS: Retrospectively the treatment records of 39 children with second-degree superfisial, second-degree deep, and third-degree burns were evaluated. First group included patients those treated with grafts and second group included those treated with topical agents. Total body surface area [TBSA], age, RDW, NLR, sex, and albumin values were evaluated. The association of RDW and NLR with both groups were analysed. RESULTS: Patients in group 2 had mild increase in RDW and NLR values but it was not more statistically significant than in group 1. A positive relationship between NLR and length of hospital stay, TBSA and length of hospital stay, and RDW and lymphocyte values was found. A negative correlation between albumin values and length of hospital stay was found. CONCLUSION: NLR is associated with morbidity in patients with burns; although RDW has not any relationship with morbidity in pediatric scald burns.

The effects of nitroglycerin in the zone of stasis in a rat burn model.

BACKGROUND: Studies evaluating the recovery of the zone of stasis is an important issue in burn research. In this study, we aimed to evaluate and compare the efficiency of an anti-ischemic and vasodilatory agent, a topical agent containing 2% nitroglycerin with 1% silver sulfadiazine, and bacitracin-neomycin sulfate in the zone of stasis histomorphologically and immunohistochemically. METHODS: We conducted an experimental study using 30 Wistar-Albino rats, each weighing 250-300 grams. The rats were divided randomly into five groups (six rats in each group). In this study, the "comb model," which was deemed to be the most appropriate experimental model to produce an injury with predictable zones and was first described by Regas and Erhlich, was used. The following were applied to the zone of stasis after creating a burn model in 0, 24, and 48 hours: topical 2% nitroglycerin, 1% silver sulfadiazine, bacitracin-neomycin sulfate, and Vaseline-lanolin (sham). After 72 hours, biopsies were performed from the zone of stasis and evaluated by histomorphological and immunohistochemical CD 34 (expressed in human endothelial and hematopoietic cells) and D 2-40 (expressed in the endothelium of lymphatic capillaries) methods. The results were evaluated using the chi-square test. RESULTS: Compared with the other groups, a statistically significant difference was found in edema, inflammation, and vascular proliferation in the nitroglycerin group. Significantly more intense staining for CD 34 was found in the nitroglycerin group compared with the other groups. Immunohistochemical staining for D 2-40 was also found statistically significant in the nitroglycerin group (p<0.05). CONCLUSION: A topical containing 2% nitroglycerin increases vascular proliferation in the zone of stasis affects the recovery and may be used as a new agent in burn injury treatment.

What predicts spontaneous passage of ≤1 cm ureteral stones in children?

PURPOSE: The aim of this study is to determine what factors predict spontaneous passage of ≤1 cm ureteral stones in children. METHODS: Files of the patients diagnosed with a single ureteral stone on a given side between 2008 and 2017 were retrospectively reviewed. Patients with congenital obstructive uropathy, neurogenic bladder, vesicoureteral reflux and those with a stone diameter of >1 cm were excluded. Detection of ureteral stones was done using ultrasonography (US) primarily, and computed tomography when US findings were inconclusive. Patients were treated either conservatively or surgically. Conservative treatment included adequate hydration and pain management whereas surgical treatment included ureteroscopic intervention. Apart from those who required urgent intervention, patients were referred for surgical treatment after 2-4 weeks of follow-up with no spontaneous passage. Factors analyzed for association of spontaneous passage included age, gender, type of hematuria, stone localization, laterality, presence of concomitant kidney stone, degree of hydronephrosis, stone size and stone composition. RESULTS: A total of 70 patients (38 males, 32 females); median age 4.7 years had a ≤ 1 cm ureteral stone (median diameter 7 mm). US was able to diagnose the ureteric stone in 47 patients while computed tomography was required in 23 patients. Spontaneous passage was observed in 40 patients (57.1%). Median time for stone passage was 8 days (3-34 days). Stone size and presence of hematuria (macroscopic and microscopic combined) were factors associated with spontaneous passage and 6.7 mm was found to be the cut-off (AUC = 0.953; 95% CI 0.905-1.000; sensitivity 96.7%, specificity 82.5%, p < 0.001). Moreover, age, degree of hydronephrosis or stone location were not associated with spontaneous passage. CONCLUSION: Patients with a ureteric stone size <6.7 mm can safely be followed conservatively, with a spontaneous passage rate of 82.5%. Type of Study Case series with no comparison group. Level of Evidence IV.

Modified Hinderer's Technique for Serious Proximal Hypospadias with Ventral Curvature: Outcomes and Our Experience.

PURPOSE: Hypospadias is a congenital anomaly that includes defi¬cient ventral structure of the penis. Proximal hypospadias cases make up 20% of all hypospadias cases. The choice of operative technique for hypospadias repair depends on the severity, and it is influenced by the surgeon's experience and perception of where priorities should lie. Several other factors interact to determine the type of repair, such as meatal site, presence of chordee, availabil-ity of the prepuce, and quality of the urethral plate and in addition surgeon's experience affects the type of repair. MATERIALS AND METHODS: The treatment records of 42 penoscrotal and perineal hypospadias cases that were treated in our clinic from 1998 to 2017 were reviewed retrospectively. Cases with penoscrotal and perineal meatus were included in the study at the beginning of the urethroplasty. All cases had surgical intervention via Hinderer's tech-nique. RESULTS: Acceptable cosmetic results were obtained in 37 (85%) patients with an objective scoring system (HOSE) for evaluating the results of hypospadias surgery score. The mean score after surgery was 14.8. Fistula and wound breakdown occurred in 7 out of the 42 cases. CONCLUSION: In conclusion, the modified Hinderer's technique is a safe and reliable technique for both proximal and perineal hypospadias. Low complication rates and application in a single surgical session increase the comfort of both the patient and the surgeon.

Hemorragia masiva: una complicación tardía del reemplazo de la gastrostomía endoscópica percutánea. A propósito de un caso / Massive hemorrhage: a late complication of replacement percutaneous endoscopic gastrostomy: case report

La gastrostomía endoscópica percutánea (GEP) se utiliza como alternativa de la alimentación enteral/nasoenteral en situaciones en las que la alimentación por vía oral a largo plazo no es eficaz o no se tolera. Se prefiere principalmente en pacientes con afecciones neurológicas y, además, como apoyo de la nutrición en pacientes con enfermedades cardíacas congénitas, fibrosis quística, enfermedad intestinal inflamatoria y diversas enfermedades orofaríngeas. Si bien la colocación es sencilla en comparación con muchos procedimientos invasivos, presenta complicaciones, que incluyen desde la infección de la herida hasta la muerte. La GEP exige personal médico experimentado, antibióticos profilácticos adecuados e información exhaustiva para los pacientes o sus familias sobre el procedimiento y los cuidados posteriores. Presentamos una complicación rara, aunque importante, que surgió durante el reemplazo de la sonda de gastrostomía después del método de "corte y empuje". El tope, que debe llegar hasta el extremo distal del estómago, se desplazó hacia arriba, hasta el esófago proximal, y causó una úlcera profunda en la mucosa esofágica y una hemorragia masiva.

Percutaneous endoscopic gastrostomy (PEG) is used as an alternative to enteral/nasoenteral feeding in situations where long-term oral feeding is ineffective or not tolerated. It is mostly preferred in patients with neurological conditions and also to support nutrition in patients with congenital heart diseases, cystic fibrosis, inflammatory bowel disease, and various oropharyngeal diseases. Although it is easily applicable compared to many invasive procedures, it has complications ranging from wound infection to death. PEG requires experienced medical personnel, appropriate prophylactic antibiotics and exhaustive information to the patients or their families about the procedure and subsequent care. We present a rare but important complication during the replacement of the gastrostomy tube subsequent to the "cut and push" method. The bumper portions, which should move to the distal end of the stomach, moved upwards to the proximal esophagus, caused a deep ulcer in the esophageal mucosa and a massive hemorrhage.

Massive hemorrhage: a late complication of replacement percutaneous endoscopic gastrostomy: case report. / Hemorragia masiva: una complicación tardía del reemplazo de la gastrostomía endoscópica percutánea. A propósito de un caso.

Percutaneous endoscopic gastrostomy (PEG) is used as an alternative to enteral/nasoenteral feeding in situations where long-term oral feeding is ineffective or not tolerated. It is mostly preferred in patients with neurological conditions and also to support nutrition in patients with congenital heart diseases, cystic fibrosis, inflammatory bowel disease, and various oropharyngeal diseases. Although it is easily applicable compared to many invasive procedures, it has complications ranging from wound infection to death. PEG requires experienced medical personnel, appropriate prophylactic antibiotics and exhaustive information to the patients or their families about the procedure and subsequent care. We present a rare but important complication during the replacement of the gastrostomy tube subsequent to the "cut and push" method. The bumper portions, which should move to the distal end of the stomach, moved upwards to the proximal esophagus, caused a deep ulcer in the esophageal mucosa and a massive hemorrhage.

La gastrostomía endoscópica percutánea (GEP) se utiliza como alternativa de la alimentación enteral/nasoenteral en situaciones en las que la alimentación por vía oral a largo plazo no es eficaz o no se tolera. Se prefiere principalmente en pacientes con afecciones neurológicas y, además, como apoyo de la nutrición en pacientes con enfermedades cardíacas congénitas, fibrosis quística, enfermedad intestinal inflamatoria y diversas enfermedades orofaríngeas. Si bien la colocación es sencilla en comparación con muchos procedimientos invasivos, presenta complicaciones, que incluyen desde la infección de la herida hasta la muerte. La GEP exige personal médico experimentado, antibióticos profilácticos adecuados e información exhaustiva para los pacientes o sus familias sobre el procedimiento y los cuidados posteriores. Presentamos una complicación rara, aunque importante, que surgió durante el reemplazo de la sonda de gastrostomía después del método de "corte y empuje". El tope, que debe llegar hasta el extremo distal del estómago, se desplazó hacia arriba, hasta el esófago proximal, y causó una úlcera profunda en la mucosa esofágica y una hemorragia masiva.

Comparison of the Radiologic and Clinical Findings of Adolescents With Breast Complaints.

INTRODUCTION: The American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) was developed to guide imaging-based surgical treatment in patients with breast cancer. Studies confirming the BI-RADS did not include adolescents. To evaluate the validity of this classification system in adolescents, we aim to investigate the relationship between the BI-RADS and pathology findings in adolescents. METHODS: The medical data of 67 female adolescent patients, aged 12 to 18, referred to our clinic for breast-related complaints between 2013 and 2016 were reviewed retrospectively for demographic data and the results of radiologic and surgical pathologies. RESULTS: The main underlying reasons for the visit at the clinic were fullness, tenderness, pain, and palpable masses. Of the 67 patients, 46 were enrolled in the study. After breast ultrasonography, patients whose complaints had diminished were subtracted from the follow-up. The mean age of the patients was 16 years (12 to 18 y). The mean mass diameter size was 3.69 cm (0.9 to 15 cm), and the mean clinical follow-up was 65.3 days (11 to 1095 d). All the patients who were surgically intervened had benign pathology. Of the 21 surgically intervened patients with BI-RADS levels of ≥3, most had fibroadenomas. CONCLUSIONS: The BI-RADS classification-based treatment algorithm may not be valid in adolescents. In the present study, all patients with lesions with BI-RADS ≥3 levels had revealed benign pathologies. The BI-RADS classification may show an increased risk. However, to determine the need for a biopsy in adolescents, there is a need for larger-scale pediatric and adolescent studies using the BI-RADS classification.

Posttraumatic stress disorder symptoms in children exposed to circumcision under general or local anesthesia.

Kozanhan B, Kocaoglu C, Gündüz M, Akça ÖF. Posttraumatic stress disorder symptoms in children exposed to circumcision under general or local anesthesia. Turk J Pediatr 2018; 60: 718-725. The aim of this study was to investigate the impact of general versus local anesthesia on the Posttraumatic Stress Disorder (PTSD) symptoms after circumcision. Of the 134 consecutive children (7-12 years of age) who underwent circumcision, 71 had general anesthesia (GA) and 63 had local anesthesia (LA). All participants completed the child depression inventory (CDI), State Anxiety (SA) and Trait Anxiety (TA) inventories, and Childhood Anxiety Sensitivity Index (CASI) before the operation as well as the Child Posttraumatic Stress Reaction Index (CPSRI) one month after the operation. The CDI, CASI and TA scores of the children were similar in both groups, while the SA scores of the LA group were higher than those in GA group (p < 0.001). The CPSRI scores of the GA group were higher than those of the LA group (p=0.04). When the other parameters were controlled via regression analysis, only the CDI scores and being in the GA group predicted the CPSRI scores. This study suggests that children witnessing the surgical procedure of the circumcision developed no serious symptoms of PTSD. In contrast, children exposed to GA during circumcision developed more serious PTSD symptoms than children who had LA. The severity of depressive symptoms may be important in the development of PTSD symptoms after circumcision.

Ruptured Hemorrhagic Cyst of Undescended Ovary Mimicking Mucocele: A Rare Pediatric Case.

Undescended ovary is a rare entity and usually presentedas a case report. It is associated with urinary and uterine anomalies. Symptomatic patients are diagnosed during surgery. Most of the patients are asymptomatic and treatment is unnecessary. They are incidentally diagnosed during infertility evaluation and treatment such as ovarian hyperstimulation studies. A 15-year-old female patient presented with the diagnosis of renal cystic massas identifiedduring ultrasonography in another hospital. Abdominal computedtomography image was requested. A cystic lesion of about 48×34 mm with well-defined borders associated with the appendix and probably with mucocele of the appendix was reported in the lower right abdominal quadrant close to the cecum. During exploration, the right ovary was seen to be attached to the cecum and was higher in position as well as a right ovary originated cystic structure of 5×5 cm. Using needle aspiration, intraovarian hemorrhage was confirmed and partial cystectomy was performed. The present study reports on an undescended ovary that hadacute abdomen symptoms imitating mucocele. In girls referring to the hospital with abdominal pain, although quite rare, undescended ovaries are to be also considered. As the incidence of renal and uterine anomalies is higher in suchpatients, in symptomatic cases relevant organs are to be investigated carefully during surgical intervention.

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

PURPOSE: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). METHODS: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. RESULTS: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. CONCLUSIONS: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.

The effects of melatonin and colchicine on ischemia-reperfusion injury in experimental rat testicular torsion model.

PURPOSE: The aim of the present study is to investigate the efficiency of colchicine and melatonin in an experimental rat testicular torsion model in the light of histological and biochemical data. METHODS: A total of 34 Wistar albino male rats were randomly divided into 5 groups as: Group C (control, n=6), Group S (sham; underwent only left scrotal exploration, n=7), Group TD (torsion and detorsion; 6h of ischemia and 7days of reperfusion, n=7), Group TD/M (TD+Melatonin; 6h of ischemia and 7days of reperfusion and 7days of 17mg/kg intraperitoneal melatonin per day, n=7), group TD/Col (TD+Colchicine; 6h of ischemia and 7days of reperfusion and 7days of 1mg/kg oral colchicine per day, n=7). Histopathologic evaluation of seminiferous tubule deterioration was performed by Johnsen's scoring system. Total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels were analyzed in each group. RESULTS: The histopathologic scores, total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels in groups C and TD/Col were significantly lower than groups TD and TD/M (P<.001). CONCLUSION: Our study results revealed that colchicine reduced testicular ischemia-reperfusion injury in experimental rat testis torsion model. Although detorsion of testis is crucial for the preserving the testicular viability, antioxidant and anti-inflammatory treatment modalities like colchicine might help to reduce ischemia-reperfusion injury in detorsed testis.

Unexpected Death Due to Acute Gastric Dilatation and Gastric Necrosis in an 11-Year-Old Boy.

This report is related to the unusual case of an 11-year-old boy presenting with acute gastric dilatation after the intake of excessive food and carbonated beverages after a 12-hour fasting who died of complications of acute reperfusion syndrome after decompression of the stomach with gastrotomy. An enormously distended stomach was encountered without volvulus and obstruction in the operation. Autopsy and histological findings revealed a severely distended stomach, the walls of which were notably thin and displayed transmural necrosis. The reported case demonstrated that enormous food and beverage intake may cause acute gastric dilatation and gastric necrosis, and subsequently, sudden death may develop in children. The subject reported here is the youngest child in literature dying from acute gastric dilatation and necrosis without any underlying disorders and exposed to autopsy.