Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures.

BACKGROUND: Gastro-oesophageal reflux may accompany the corrosive oesophageal damage caused by the ingestion of corrosive substances and affect its treatment. The factors that affect the development of reflux in these cases and their effects on treatment still remain unclear. AIMS: Our aim is to investigate the prevalence of gastro-oesophageal reflux in children with corrosive oesophageal strictures, the risk factors affecting this prevalence and the effects of gastro-oesophageal reflux on treatment. STUDY DESIGN: Case-control study. METHODS: We enrolled 52 patients with oesophageal stricture due to corrosive substance ingestion who were referred to our clinic between 2003 and 2010. Groups, which were determined according to the presence of gastro-oesophageal reflux (GER), were compared with each other in terms of clinical findings, results of examination methods, characteristics of the stricture and success of the treatment. RESULTS: The total number of patients in our study was 52; 30 of them were male and 22 of them were female. The mean age of our study population was 4.2±2.88 years. Thirty-three patients had gastrooesophageal reflux (63.5%). Patients who had strictures caused by the ingestion of alkali substances were 1.6-times more likely to have reflux. There were no differences between patients with or without reflux in terms of number and localisation of strictures. Mean distance of stricture was longer in patients with reflux (3.7±1.8 cm) than in patients without (2.2±1.0 cm) (p<0.005). Only one patient among 17 who had a long stricture (≥4 cm) did not suffer from reflux. Patients with long stricture were 1.9-times more likely to have reflux. Dilatation treatment was successful in 69.6% of patients with reflux and in 78.9% of patients without. The mean treatment period was 8.41±6.1 months in patients with reflux and 8.21±8.4 months in the other group. There was no significant difference between groups in terms of frequency of dilatation and dilator diameters (p>0.05). CONCLUSION: Corrosive oesophageal stricture was usually accompanied by gastro-oesophageal reflux and the length of stricture is an important risk factor. Negative effects of reflux over dilatation treatment have not yet been demonstrated in the short-term. Nevertheless, this frequent rate of reflux may eventually increase the risk of oesophagitis and Barrett's oesophagus; therefore, we suggest that these effects should be prospectively evaluated in a large number of patients and these patients should be followed-up routinely in terms of the long-term effects of reflux.

Severe abdominal trauma involving bicycle handlebars in children.

OBJECTIVES: To emphasize the severity of the underlying injury which may not be realized during the initial patient admission to the emergency department. METHODS: A retrospective case note review of children admitted to our institution with the severe abdominal injury. RESULTS: Eight children were identified with the severe abdominal injury secondary to the trauma from a bicycle handlebar that needed special care in the intensive care unit. All injuries were due to blunt trauma. The mean delay from the time of the accident to the time of presentation was 34.5 hours. All patients had an imprint of the handlebar edge on the hypochondrium. There were 3 pancreatic lacerations, 1 duodenal laceration, 1 jejunal laceration, 1 liver laceration, 1 abdominoinguinal laceration that all required open surgery, and 1 duodenal hematoma that resolved in 4 weeks follow-up period. The patients who required open surgery were evaluated with computed tomographic scans before surgery. CONCLUSIONS: Children with an imprint made by the handlebar edge on the abdominal wall or give a clear history of injuries by a bicycle handlebar should be treated with great care. Early computed tomography evaluation may help to reduce the morbidity resulting from the delay in diagnosis of injuries to the internal organs.

Testicular biopsy during orchidopexy procedure: does it have an adverse effect on fertility?

INTRODUCTION: The aim of this study is to evaluate the effect of the gonadal biopsy procedure on fertility and histology of the experimentally created undescended testis. MATERIALS AND METHODS: Thirty Wistar-Albino rat litters were divided into three groups. In the first two groups, undescended testes were obtained by dividing the right gubernaculum in the first 48 h and the third group constituted the sham group. When the rats were 30 days old, orchidopexy was performed in the first group (O), whereas orchidopexy and testicular biopsy were performed in the second group (OB). After the fertility study all rats were sacrificed at week 11 and testicular weights, mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were measured. RESULTS: One testis in the O group and three testes in the OB group were atrophied and these rats were excluded from the study. Testicular weights, MSTD and MTBS values of the operated side in the O and OB groups were lower than those in the sham group. There was a statistically significant difference between the MSTD values of the ipsilateral testes in the OB group and sham group (p<0.05). MTBS values of the ipsilateral testes in the O and OB groups were <8. There was no difference in all parameters in the contralateral testes between all groups (p>0.05). All the evaluated rats were fertile. While there was no difference in number of fetuses and fertility scores between the O and OB group, however, the differences were significant between each of these groups and the sham group (p<0.05). CONCLUSION: Testicular biopsy in the unilateral undescended testis model results in limited histological changes without affecting the fertility.

Epidermal growth factor and bombesin act synergistically to support intestinal adaptation in rats with massive small bowel resection.

Intestinal adaptation is the most important event in short bowel syndrome following a massive small bowel resection. Effects of various growth factors and their synergism have been well documented in intestinal adaptation. This study aimed to compare the effect of two different trophic agents, epidermal growth factor (EGF) and bombesin (BBS), on intestinal adaptation following massive intestinal resection. Sprague-Dawley male rats were assigned to one of four groups after a 75% small bowel resection. Either EGF (90 microg/kg), BBS (10 microg/kg), EGF+BBS, or bovine serum albumin (BSA) were injected subcutaneously three times a day. The animals were killed 10 days after the operation. Weight loss and morphologic parameters such as mucosal thickness, villus height, crypt depth, villus-to-crypt ratio, and muscularis propria height were measured. In the EGF+BBS group, mucosal thickness was found to be significantly increased compared with the other study groups (p<0.05). Similarly, villus height was significantly increased only in the EGF+BBS group (p<0.05). In the BBS group, both villus height and mucosal thickness showed a slight increase, but the values were not statistically significant compared with the vehicle-treated group. There were no significant differences in any of the remaining parameters between the groups. The results of this study indicate that the gut hormones EGF and BBS act synergistically in facilitating the adaptive response of the remnant ileum to massive intestinal resection.

[Foreign body aspiration in children]. / Cocuklarda yabanci cisim aspirasyonu.

OBJECTIVES: The aim of this study was to present the demographic data of our patients who underwent bronchoscopy for suspected aspiration of a foreign body. We also assessed the sensitivity and specificity of history, symptoms, physical examination, and radiological findings in these patients. PATIENTS AND METHODS: One-hundred and two patients underwent bronchoscopy for suspected foreign body aspiration during a 23-month period. Bronchoscopy was performed under general anesthesia with a rigid bronchoscope. RESULTS: A foreign body was detected in 78 patients. The male-to-female ratio was 1.7:1, the mean age was 30.4 months, and the median age was 18 months. Nut and sunflower seeds were the most common types of foreign bodies. There were three minor complications and no death in our series. No tracheotomy or thoracotomy were required. The sensitivity and specificity of history, symptoms, physical examination, and radiological findings for suspected foreign body aspiration were 100% and 4.2%, 97.4% and 8.4%, 89.7% and 37.5%, 76.8% and 50%, respectively. CONCLUSION: A chocking crisis is an absolute indication for bronchoscopy. Our low complication rate allowed us to perform bronchoscopy more liberally in patients with suspected foreign body aspiration. The sensitivity of history, symptoms, and physical findings were very high, whereas the specificity of history and symptoms were very low.

Epididymitis in infants with anorectal malformation.

OBJECTIVE: To document the characteristics of epididymitis in boys with anorectal malformations. METHODS: Sixty-six boys with anorectal malformation were treated between January 1990 and January 2000, in our center. Four of these boys experienced epididymitis attacks. The first three patients had rectourinary fistula and the fourth had a low type anorectal malforation without a rectourinary fistula. RESULTS: Patients were followed up for seven to nine years and epididymitis did not recur after the definitive operation in the first three patients. The fourth patient had four other episodes of epididymitis postoperatively and no reason for these episodes could be found during the further urological evaluation. Two patients had urinary tract infection and one patient had urinary tract contamination during their episodes of epididymitis. CONCLUSION: The cause of the epididymitis can be anorectal malformation with rectourethral fistula itself or another urogenital anomaly that is associated with anorectal malformation. There is a relationship between urinary tract infection and epididymitis in these patients.

Double intussusception in an infant.

Intussusception is a common surgical disorder in infancy. Double intussusception (DI), however, is an extremely rare form of this pathology. The authors report a case of idiopathic DI in an 8-month-old girl, which is the third case of idiopathic DI in childhood in the English-language literature.