Dysfunctional voiding in children with asthma.

A prospective study was performed to evaluate the prevalence of suspected dysfunctional voiding (DV) and associated risk factors in children with asthma. The DV is defined as any voiding symptoms and/or urinary incontinence. Children (4-10-year-old) with asthma (n=178) and healthy subjects (n=197) were enrolled. DV and Incontinence Scoring System were administrated. Demographic features and asthma related characteristics were recorded. Suspected DV was noted in 19 (27.9%) of patients with asthma and 5 (6.6%) of healthy subjects in children younger than 6 years of age (p=0.001). In this patient group, asthma increased the risk of suspected DV (OR=5.7 (95% CI 1.988 to 16.344)). Children with asthma older than 6 years of age had similar prevalence of suspected DV but they had higher frequency of voiding and urgency. Asthma is associated with higher DV symptom scores in younger children who have already completed toilet training and with some of DV symptoms such as frequency and urgency in older children.

Evaluation of omental inflammatory response with P-/E-selectin levels and histopathologic findings in experimental model.

AIM: The omentum plays a crucial role in abdominal defense mechanism by adhering to sites of inflammation and absorbing bacteria and debris from the peritoneal cavity. An experimental study was conducted to evaluate the inflammatory response of omentum in different abdominal events with omental P-/E-selectin levels and histopathologic findings. MATERIALS AND METHODS: Thirty Wistar rats were placed into 5 groups (n = 6), including a control group (CG), sham group (SG), bladder perforation (BP) group, splenic laceration (SL) group, and cecal ligation and puncture (CLP) group. Omental samples were obtained in CG after median laparotomy. In accordance with described models, BP, SL, and CLP were performed in experimental groups. Twenty-four hours after the first laparotomy, localization of the omental pad was noted, and omental samples were obtained for biochemical analysis of levels and histopathologic findings (no. of vessels in sections, polymorphic nuclear leukocytes [PMLs], lymphocytes). The mean P-/E-selectin levels and histopathologic findings of inflammation were compared between groups. RESULTS: Although omentum was adhered to the cecum in all subjects after CLP, similar findings were not detected in other groups. P-selectin and E-selectin levels and number of PML were significantly increased in the CLP group when compared with other groups (P < .05). The number of vessels in sections was significantly increased in CLP group when compared with SG and BP groups (P < .05), and the BP group had a decreased number of vessels than CG (P < .05). The number of PML was significantly increased in SG and SL and BP groups with respect to CG (P < .05). CONCLUSION: Among different experimental intraabdominal catastrophes, only CLP caused an inflammatory response and increased levels of adhesion molecules in the omentum. These findings suggest that the nature of the inflammation is the main determining factor for the omental function in intraabdominal events.

Effect of phototherapy on growth factor levels in neonatal rat skin.

AIM: Neonates undergoing surgery may receive phototherapy (PT) for the treatment of hyperbilirubinemia. Although the effects of PT on neonatal structures are well documented, the effect of PT on wound healing has not been previously evaluated. An experimental study was performed to evaluate the effect of PT on growth factor levels responsible for wound healing in neonatal rat skin. MATERIALS AND METHODS: Eighteen Wistar newborn rats (7 ± 2 g) were included in the study. Rats were randomized into 3 groups: control (CG), PT, and sham (SG) (n = 6). Both groups had 1-cm median dorsal skin incision. In CG, 1 × 1 cm of dorsal skin was sampled including the incised skin. The PT group received 5 banks of blue light (wave density, 30-40 µw/cm(2) per nanometer; exposure distance, 45 cm). Phototherapy was started 24 hours after birth and exposed during light period (mean duration, 21 hours to 15 minutes ± 2 hour to 1.5 minutes). Sham group consisted of animals that received a bank of white light with same exposure distance and a total duration of 26 hours to 18 minutes ± 3 hours to 9.1 minutes. After exposure, 1 × 1 cm dorsal skin samples were obtained from both PT and SG groups, including the median incision. The effect of PT was evaluated with the expressions of vascular endothelial growth factor (VEGF), its receptor (VEGF receptor), and transforming growth factor ß (TGF-ß) in endothelial vessels and fibroblasts of neonatal skin samples. RESULTS: There was no significant difference between groups in VEGF receptor and transforming growth factor ß expressions. The VEGF levels in endothelial vessels were significantly decreased in PT and SG when compared with CG (P < .05). CONCLUSION: Vascular endothelial growth factor is a mediator of angiogenesis and may decrease in neonatal rat skin after light exposure. It can be suggested that decreased levels of VEGF after PT application may alter angiogenesis and also may adversely affect the healing features of neonatal skin.

Ambiguous genitalia: an overview of 17 years' experience.

AIM: The newborn with abnormal genital development presents a difficult diagnostic and treatment challenge for the pediatric surgeon providing care. The purpose of this study was to evaluate the results of surgical treatment for children with ambiguous genitalia. PATIENTS AND METHODS: The records of 85 children managed surgically for ambiguous genitalia in our unit from 1988 to 2005 were reviewed retrospectively. Age at surgery, operative procedures, sex of rearing, and outcome were recorded. RESULTS: The intersex committee's decision concerning sex assignment was female for 62 children (75%) and male for 23 children (25%). The etiologies of children reared as female were congenital adrenal hyperplasia (n = 37), male pseudohermaphroditism (n = 12), mixed gonadal dysgenesis (n = 6), true hermaphroditism (n = 4), and Mayer-Rokitansky syndrome (n = 3). Fifteen children with male pseudohermaphroditism, 5 children with congenital adrenal hyperplasia, and 3 children with true hermaphroditism were reared as male. The mean age at surgery was 4.4 years and follow-up period averaged 7 years. Eighteen (29%) patients with feminization procedures and 8 (34%) of 23 patients with masculinization procedures experienced complications and required redo operations. Vaginal stenosis was the most common complication. CONCLUSION: The surgical management of ambiguous genitalia has always been difficult, and it must be performed by skilled pediatric surgeon. Genital surgery in infancy needs to be reassessed in the light of literature findings revealing poor outcome. In patients who underwent feminizing genitoplasty, vaginal reconstruction should be delayed until adolescence to achieve better cosmetic and functional results.