Discussion of Follow-Up and Treatment Results of Children With High-Grade Renal Trauma.

PURPOSE: The aim of the study is to examine the follow-up and treatment results of late renal functions in children with high-grade (Grades 4, 5) renal trauma resulting from blunt abdominal injury. METHODS: The follow-up and treatment reports of 41 patients with renal trauma admitted to our clinic between the years 2005 and 2015 were reviewed retrospectively. RESULTS: Eight of the 41 cases had Grade 1, five had Grade 2, and 12 had Grade 3 renal trauma. The remaining 16 cases (12 of which were Grade 4, four were Grade 5) had high grade renal trauma. Four (25%) patients with high-grade renal trauma were operated (JJ stent placement was performed on one, renorraphy was performed on two, pyeloplasty and urinoma drainage were performed on one), and 12 patients were followed conservatively. In the long-term follow-up (>1 year), Tc-99m mercaptoacetyltriglycine (MAG3) kidney scintigraphy examination of three (30%) patients out of the 10 patients who were followed up conservatively, the affected kidneys were found to be nonfunctional (renal differential function 0%). The mean differential renal function in four patients who underwent surgery was 31% (between 25% and 40%). CONCLUSION: It should be kept in mind that kidneys may become atrophic or non-functional in the late period of follow-up in cases that are followed conservatively due to high-grade renal trauma. There is no standard algorithm or treatment method in the management of high-grade renal trauma. In order to achieve a good outcome, the treatment should be individualized as much as possible.

Immunohistochemical and morphometric evaluation of neuronal dysfunction in pelviureteral junction obstruction.

PURPOSE: The pathophysiology of pelviureteral junction obstruction remains unclear. In this study, we attempted to evaluate the neuronal dysfunction using immunohistochemical and morphometric parameters. MATERIALS AND METHODS: Using specific antibodies, we studied the neuronal markers and morphometry of specimens from 10 cases of pelviureteral junction obstruction and 10 normal pelviureteral junctions by immunohistochemistry using synaptophysin (synaptic vesicle membrane protein), S-100 (nerve cell fiber marker), protein gene product 9.5 (neuron specific protein) and CD-117 (transmembrane receptor with tyrosine kinase activity). RESULTS: In pelviureteral junction obstruction, smooth muscle thickness was significantly higher than in normal specimens. Cytoplasmic cells stained by synaptophysin were found in the pelviureteral junction obstruction specimens but were absent in normal pelviureteral junction specimens. In addition, significantly more intense staining for S-100 was found in the pelviureteral junction obstruction specimens compared with the normal specimens. Immunohistochemical staining for protein gene product 9.5 showed no differences between the normal and pelviureteral junction obstruction specimens. Neither the normal specimens nor pelviureteral junction obstruction groups were stained by CD-117. CONCLUSION: We propose that the cause of neuronal dysfunction in pelviureteral junction obstruction depends on the increase in number and structure of neuronal cells and smooth muscle thickness. These factors could play an important role in the pathophysiology of pelviureteral junction obstruction by affecting motility and peristalsis.

Migration of intra-articular K-wire into the contralateral pelvis after surgery for developmental dysplasia of the hip: a case report.

Transarticular fixation of femoral head into acetabulum with K-wire is a seldomly used surgical method in difficult cases of developmental dysplasia of the hip (DDH). This paper presents a child with intrapelvic transvesicular migration of a K-wire without any symptoms after treatment of DDH. Eight years old girl who had multiple surgeries 4 years ago due to bilateral DDH applied to the orthopedics clinic with limping. She had good range of motion of both hips. At the pelvis radiograph, there was an intrapelvic K-wire standing between two hemipelvises like a bridge. She did not have any enteral and urological symptoms after the previous operations. We planned to remove the K-wire in cooperation with the pediatric surgery department. On the cystoscopy, K-wire was seen passing through the urinary bladder. Wire was cut at the middle point and taken out of the body by laparotomy. The patient was discharged without any postoperative complications. K-wire retention in the body has high chance of migration. Early postoperative removal of the K-wire is necessary to prevent possible complications.

The healing effects of tissue glues and healing agent locally applied on esophageal anastomoses.

OBJECTIVE: This study aimed to investigate the effects of cyanoacrylate (C), fibrin glue (FG), and natrium hyaluronate (NH) on the healing of esophageal anastomosis (EA). METHODS: Twenty-four rabbits were divided equally into 4 groups: primary anastomosis (PA), C, FG, and NH. A 1-cm-length of the cervical esophagus was resected through a cervical incision and then anastomosis was performed. C, FG, and NH were instilled into anastomosis lines in the respective groups. The animals were fed orally on postoperative day 7 on the condition that there was no esophageal leakage. The rabbits were sacrificed 8 weeks later to evaluate bursting pressure (BP), tissue hydroxyproline (HP) levels and wound healing scores (WHSs) in the anastomosis lines. RESULTS: BP was significantly higher in the C group than in the PA, FG, and NH groups, and HP was significantly lower than in the other groups. WHSs in the PA and NH groups were lower than in the C and FG groups. CONCLUSIONS: C and NH appear to be beneficial in EA healing with respect to increased BP and decreased HP when they are used simultaneously with PA prophylactically to prevent esophageal leakages and stricture.

Efficacy of antioxidant treatment in the prevention of testicular atrophy in experimental testicular torsion.

BACKGROUND/PURPOSE: This study aimed to compare dose schedules of the antioxidant treatment (melatonin and steroid) used as 1 dose and as once a day for 7 days in terms of salvage of the testes in the late period. METHODS: Sixty prepubertal rats were divided into 6 groups each containing 10 rats: sham (S), torsion-detorsion (TD), 1-dose melatonin (M(1)), 1-dose steroid (ST(1)), 7-dose melatonin (M(7)), and 7-dose steroid (ST(7)) groups. The left testes were rotated 720 degrees for 6 hours and detorsed for 6 hours thereafter. In the treatment groups, 17 mg/kg melatonin and 1 mg/kg steroid were injected 15 minutes before detorsion. Left orchiectomies were performed to determine testicular weights and Johnsen scores 3 months later. RESULTS: Testicular weights and Johnsen scores in the M(1), ST(1), and TD groups were significantly lower compared with those in the S group, and atrophy developed in these groups, whereas they were higher in the M(7) and ST(7) groups compared with the TD group. Testicular atrophy did not develop in the M(7) or ST(7) groups. CONCLUSIONS: Our results suggested that antioxidant agents used once a day for 7 days prevent testicular atrophy and are effective in terms of salvage of the testes.

The effect of cyanoacrylate in esophagocutaneous leakages occurring after esophageal anastomosis.

OBJECTIVE: Esophageal leakage (EL) continues to be a challenging pediatric surgical problem. The aim of this study was to investigate the effect of cyanoacrylate (Cy) in EL followed esophageal repair (ER). METHODS: Twelve rabbits were divided into control (C) and leakage (L) groups. A 1cm-length transverse esophageal incision at the level of the cervical region was made. In both groups, feeding was started orally 24h after the surgery for leakage creation. On postoperative day 7, primary repair was carried out in the C group and Cy instillation was performed in the L group. Esophagographic analysis was carried out on postoperative day 9 and the animals were fed orally on the same day on the condition that there was no esophageal leakage. The rabbits were sacrificed to measure diameters of the OR line, bursting pressure (BP), and hydroxyproline (HP) levels in the repaired cervical esophageal segment (RCES) 2 months later. RESULTS: The values of BP and HP in the C group were significantly higher than those in the L group. The diameters of the OR line in the L group were significantly greater compared to those in the C group. CONCLUSIONS: Cy glue instillation seems to be the ideal treatment for esophageal anastomosis leakages as shown by increased diameters of the OR line and decreased HP levels.

An oblique anastomosis has more linear length than a transverse anastomosis of a tubular structure in oesophageal anastomosis.

INTRODUCTION: Oesophageal stricture continues to be a challenging paediatric surgical problem. This study aimed to compare the results of oblique and transverse anastomosis to prevent anastomotic stricture that occurred following oesophageal repairs. MATERIALS AND METHODS: Twelve New Zealand rabbits were divided equally into two groups: oblique (O) and transverse (T). A 1-cm-long tract of the cervical oesophagus was resected through a cervical incision in both groups. Anastomosis was performed in both groups. Oesophagographic analysis was carried out on postoperative day 7 and the animals were fed orally on the same day on the condition that there was no oesophageal leakage. The rabbits were killed to measure diameters of the oesophageal lumen and bursting pressure (BP) in the anastomosis region 8 weeks later. RESULTS: The diameters of the oesophageal anastomosis lines (3.9 +/- 0.10 mm) in the O group were significantly greater than those (1.9 +/- 0.09 mm) in the T group (P < 0.05). The values of BP (189 +/- 10 mmHg) in the O group were also significantly higher than those (116 +/- 4 mmHg) in the T group (P < 0.05). CONCLUSIONS: Our results suggested that oblique anastomosis is a better surgical procedure for preventing oesophageal stricture, as shown by the increased diameters of oesophageal anastomosis lines and BP.

Effects of melatonin on spermatogenesis and testicular ischemia-reperfusion injury after unilateral testicular torsion-detorsion.

PURPOSE: This study aimed to determine the effect of melatonin in preventing ischemia-reperfusion (I-R) injury-induced tissue damage and on spermatogenesis after experimental testicular torsion (TT). METHODS: Forty peripubertal rats were divided into 4 groups each containing 10 rats: control (C), sham (S), torsion plus detorsion (TD), and torsion plus melatonin (M). The left testes were rotated 720 degrees for 6 hours and detorsed for 6 hours thereafter. Serum inhibin B (IB) levels were measured in blood samples taken from all groups. Left orchiectomies were performed to determine the tissue levels of Johnsen's scores (JS) and malondialdehyde (MDA). RESULTS: Serum IB levels in the S and TD groups were significantly lower compared with that in the C group, whereas they were higher in the M group compared with the TD group. The MDA levels were significantly lower in the C, S, and, M groups compared with the TD group. Johnsen's scores were significantly higher in the C, S, and M groups compared with the TD group. CONCLUSIONS: Our results suggested that melatonin is a potent antioxidant agent in preventing testicular I-R injury, as shown by increased IB levels and JS.

Beneficial effects of melatonin compared with allopurinol in experimental testicular torsion.

BACKGROUND/PURPOSE: Several antioxidant agents such as allopurinol have been used to prevent ischemia-reperfusion (I/R) injury-induced tissue damage after experimental testicular torsion so far. The current study was designed to determine the effect of melatonin, which is a potent antioxidant agent, in preventing testicular damage following torsion. METHODS: Sixty prepubertal male Wistar-Albino rats were divided into 5 groups: control (C), torsion (T), torsion plus detorsion (TD), torsion plus allopurinol (200 mg/kg) plus detorsion (A), and torsion plus melatonin (50 mg/kg) plus detorsion (M). Left testes were rotated 720 degrees for 6 hours. The torsed testes were detorsed. Detorsion time was 6 hours. In all groups, left orchiectomies were performed to determine the tissue levels of malondialdehyde (MDA) and histopathologic changes. Blood samples were taken to measure serum creatine phosphokinase (CPK) levels. The results were analyzed statistically. RESULTS: Serum CPK levels of groups A and M were found to be significantly lower than groups T and TD (P <.05). Tissue MDA levels in group M were statistically different from groups T and TD (P <.05). However, in groups A and T, MDA levels were similar (P >.05). The highest histologic grade was determined in group TD (3.8 +/- 0.5). Histologic grade of group M was significantly lower than group TD (P <.001), but there was no histologic difference between testes of groups A and TD (P >.05). CONCLUSIONS: These results have shown that melatonin treatment prevents I/R injury both biochemically and histopathologically, whereas allopurinol treatment prevents it only biochemically in experimental testicular torsion. Melatonin is a potent antioxidant agent more effective than allopurinol in preventing testicular I/R injury.

Treatment of gastroesophageal reflux with a gastric tube cardioplasty.

PURPOSE: Surgical control of gastroesophageal reflux (GER) is a challenging problem especially in neurologically impaired children and in acquired GER patients after caustic insult to the esophagus because of high failure rates of the classical antireflux procedures. A surgical technique has been designed to overcome this high relapse incidence. METHODS: During the past 75 months, 39 children between 4 months and 14 years of age underwent a gastric tube cardioplasty fashioned from the lesser curvature as the antireflux barrier. RESULTS: In all patients, the preoperative RI values of 72 to 10 (average, 32) fell to 0 to 5 (average, 2) after the described procedure, and, in the follow-up period of 2 to 75 months, the RI values did not deteriorate in any one of the cases. CONCLUSIONS: It is possible that a 6-cm antireflux barrier (HPZ) created from the lesser curvature of the stomach is enough to control GER at any age.