Bullet trajectory detection in the lung: Multiplanar reformatted imaging of multidetector computed tomography in children.

BACKGROUND: Trauma is a leading cause of childhood injuries. Although blunt traumas in children are more common in penetrating traumas, children in civilian life and near conflict areas can often be affected by gunshot wounds. Among all gunshot wounds, thoracic injuries constitute a significant proportion. In our study, we detected bullet trajectory in children with gunshot wounds penetrating the thorax by analyzing reformatted images of multidetector computed tomography (CT). METHODS: Nineteen pediatric patients with thoracic gunshot wounds were evaluated retrospectively. After all patients admitted the emergency service, their hemodynamics were stabilized first. Then, PA-AC radiography and thorax CT were taken and necessary imaging studies of other body parts were performed. CT scans were performed with multi-detector CT. RESULTS: Using reformatted axial, sagittal, and coronal and oblique images of multidetector CT, we detected projectile trajectory in the lung parenchyma in 74% of patients. In 26% of the patients, the projectile trajectory could not be detected due to excessive parenchymal hemorrhage, hemothorax, and pneumothorax. CONCLUSION: In our study, a standard could not be made due to the fact that the types of weapons used could not be determined, the firing distances could not be known, different ages and different bullet entry and exit angles. However, detecting the trajectory of the bullet in the lungs will assist the physician in making the treatment plan and following up the patient. In addition, the evaluation of the data obtained will be beneficial to forensic medicine physicians and scientists interested in wound ballistics.

Xanthogranulomatous Salpingitis Presenting as Pyosalpinx in a Non-Sexually Active Adolescent Girl.

INTRODUCTION: Although pelvic inflammatory disease is seen in sexually active women, it can also be seen in virgin girls. One of the conditions that can develop if not treated appropriately is pyosalpinx. A case of pyosalpinx causing xanthogranulomatous inflammation, a rare type of inflammation, is presented. CASE: A 15-year-old virgin adolescent patient underwent salpingectomy for left pyosalpinx, and the pathology result revealed xanthogranulomatous salpingitis. CONCLUSION: Pelvic inflammatory disease is extremely rare in virgin adolescents and there is usually an underlying anatomic anomaly. No anatomical anomaly was detected in our case, but the detection of E.coli in the abscess fluid culture and the chronic constipation of our patient made us think that the cause of the disease was an ascending infection originating from the gastrointestinal tract.

Non-operative management of iatrogenic esophageal perforation in a 6-year-old child.

BACKGROUND: Esophageal perforations are rare, the most common encountered esophageal perforation is iatrogenic in origin. It can be life-threatening if not diagnosed and treated early. Medical treatment has been recommended primarily in hemodynamically stable children. Drainage of intrathoracic or periesophageal fluid formation should be reserved to patients with hemodynamic instability. Surgical intervention may seldomly be required, depending on the localization and size of the defect. CASE REPORT: A 6-year-old male patient was referred to our clinic due to an esophageal perforation whilst removing the foreign body from upper esophagus under direct vision of a rigid esophagoscope. A radiologic appearance similar to esophageal duplication was detected along the esophagus in the esophagogram. A secondary esophagoscopy was carried out by our clinic, laceration at the esophagopharyngeal junction and dissection along the esophagus were observed and the foreign body was propelled into the stomach. The patient, whose clinical condition was stable, was managed medically without the need for a surgical intervention. CONCLUSIONS: Esophageal perforation is rare, yet perilous if not handled properly. We do not encounter this clinical entity frequently. Despite its rarity it can arise either iatrogenically or while managing a previous complication such as a simple nasogastric tube insertion in an infant or during an endoscopy for an esophageal foreign body. Its management is challenging, and we believe that non-operative treatment is still an important option in childhood esophageal perforations.

Multiorgan Echinococcosis with Uterine Involvement Causing Bilateral Hydronephrosis in a Child: Case Report.

Hydatid cyst is a parasitic infection transmitted by oral ingestion of Echinococcus granulosus eggs. Hydatid cyst of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We present an 8-yr-old girl with complaints of swelling of lower abdomen, pollakiuria and bilateral flank pain was brought to Emergency Department of Harran University, Turkey, in Jun 2019. The patient had simultaneous hydatid cysts of the liver, mesentery and uterus. We performed abdominal exploration and completely removed the inner germinal layer of cyst through an incision made in the anterior of the uterine fundus. Then, we applied total excision to the two cysts in the right and left colon mesentery. Finally, we performed partial cystectomy to the cyst in the liver, and we removed the cyst membrane totally. In endemic regions, hydatid cysts should be considered for the diagnosis of children with cystic mass lesions. Uterine-sparing approach should be kept in mind as an option, especially in young women. Early surgical treatment of large pelvic cysts that cause obstructive uropathy may prevent the progression of renal damage.

Comparison of the Electrothermal Bipolar Sealing System (LigaSure) Versus Endoloop in Pediatric Laparoscopic Appendectomy.

Background: Laparoscopic appendectomy has long been in the process of replacing open appendectomy owing to a better wound healing, better cosmetic appearance, less pain, and less postoperative adhesion. Although there are many methods for ligating the appendix stump, studies on energy-based coagulation methods have attracted great interest in recent years. In our study, we aimed to compare the use of LigaSure™ appendiceal sealing and ligation of appendiceal stump by endoloop with regard to duration of surgery, length of hospital stay, and complications in laparoscopic appendectomies. Materials and Methods: A total of 174 consecutive patients under the age of 18 who underwent laparoscopic appendectomy in our clinic between September 2016 and February 2021 were retrospectively analyzed. Patients with perforated appendicitis were excluded from the study. The patients were divided into two groups as the appendix stump was ligated with endoloop (Group 1) and sealed with LigaSure (Group 2). Demographic characteristics of the patients, duration of surgery, length of hospital stay, and complications were recorded. Results: Of the 132 patients who were included in the study, Group 1 consisted of patients using endoloop (n = 39) and Group 2 comprised patients that LigaSure was employed (n = 93). There was no significant difference between Groups 1 and 2 in terms of age and length of hospital stay (P = .126 and P = .784, respectively); however, the operation time was found to be significantly shorter in Group 2 (P < .001). Conclusion: The use of LigaSure is a safe and fast method to seal the mesoappendix and appendix stump in pediatric laparoscopic appendectomy. We think that infection complications due to stump leakage and intra-abdominal spillage will less be encountered.

Protective effect of osthole on testicular ischemia/reperfusion injury in rats.

BACKGROUND: Testicular torsion is a urological emergency that requires urgent surgical intervention which results in testicular loss if not diagnosed and treated in a timely fashion. Ischemic tissue damage with oxygen deficiency, which starts with the decrease in blood flow to the tissue, continues to increase with the reoxygenation of the damaged tissues as soon as reperfusion is achieved. In various studies, osthole has also been shown to reduce cerebral, spinal cord, intestinal, renal, and myocardial ischemia/perfusion (I/R) damage. The aim of this study is to examine the effects of osthole on testicular I/R injury. METHODS: 28 Wistar-albino rats were randomly divided into four experimental groups (n=7). Group 1 was the sham operation group. In Group 2 (I/R), 3-h ischemia was created by rotating the testis 720° clockwise, followed by 3 h of reperfusion. In Group 3 (I/R + single dose of Osthole), 20 mg/kg ostol was administered intraperitoneally half an hour before detorsion after 3 h of torsion. The testis was detorsioned. Three h of detorsion was applied. In Group 4 (I/R + twice doses of Osthole), 20 mg/kg ostol was administered intraperitoneally half an hour before detorsion, followed by 3-h torsion. The testis was released and detorsioned. Half an hour after the detorsion, an intraperitoneal dose of 20 mg/kg osthole was administered again. Detorsion was done for 3 h. All rats were sacrificed after 6 h and right orchiectomy was performed for blood for biochemical analysis and histopathological sample. RESULTS: Glutathion, nuclear respiratory factor 2, Superoxide dismutase, and 8-hydroxydeoxyguanosine levels were decreased in I/R rats, while interleukin-6, malondialdehyde, and myeloperoxidase levels were increased. While caspase 3, caspase 8, caspase 9, and TUNEL showed moderate immunopositive tissues immunohistochemically in rats with I/R damage, mild immunopositive tissues were detected in Group 3 and Group 4. In the histochemical examination, degenerative tubule structure and separation of epithelial cells were observed in I/R rats, while partially healed testicular tissue was detected in Group 3 and Group 4. CONCLUSION: In our study, we observed that osthole reduced oxidative damage, suppressed the inflammatory process, prevented apoptosis, and reduced cell damage. We think that with repeated doses, cellular damage would gradually decline.

Use of video-assisted thoracoscopy surgery in the removal of an intrathoracic bullet: A case report.

The use of video-assisted thoracoscopy surgery (VATS) as a minimally invasive surgical technique in many lung and pleural diseases is well-established. However, the efficacy of VATS in the removal of retained intrathoracic foreign bodies is unclear. Here, we report the use of VATS in the successful removal of an intrathoracic bullet from a 7-year-old patient.

A single-center experience of pediatric foreign-body aspiration: A retrospective 4-year case series.

INTRODUCTION: Foreign body aspirations (FBA) in children are serious life-threatening clinical conditions that require immediate intervention. In this study, it was aimed to retrospectively investigate the demographic features, clinical diagnosis and treatment methods of children admitted to our clinic due to FBA. MATERIALS AND METHODS: The study included 86 children aged <16 years, diagnosed with tracheobronchial foreign body aspiration (FBA) between January 2013 and December 2017. All patients with two-way chest radiography were examined for foreign body aspiration diagnosis. In case of suspicion of diagnosis, low-dose multi-slice chest CT was taken. In cases of FBA diagnosis, rigid bronchoscopy was performed under sevoflurane and propofol anaesthesia supported by controlled ventilation. Evaluation was made of the patient demographic characteristics, type and localization of the foreign body removed with bronchoscopy and operation-related complications. RESULTS: The mean age of the patients with FBA diagnosis was 3.17 years and 55.8% (n = 48) of the patients were male. The most commonly aspirated foreign body was nuts (peanut and hazelnut) (70%) and the most common finding on the chest radiographs was obstructive emphysema, determined on 51% of the patients. Bronchoscopy revealed that the foreign body was in the right main bronchus and left main bronchus in 41%. CONCLUSION: The main treatment for FBA is prevention. However, in patients applied with bronchoscopy for FBA, controlled ventilation and appropriate general anesthesia should be generally used. Early bronchoscopic intervention with safe anesthesia and controlled ventilation support will improve the success rates in FBA cases.

A Giant Mature Cystic Teratoma Mimicking a Pleural Effusion.

The vast majority of teratomas originating from more than a single germ layer are benign. Often, such teratomas are initially asymptomatic. Later symptoms are caused by the weight per se of the teratoma and include chest pain, cough, dyspnea, and/or recurrent attacks of pneumonia. A mediastinal teratoma is treated by total surgical resection of the mass. Here, we report a case of giant mature cystic teratoma mimicking a pleural effusion in the thorax at the 7-month-old female patient with a symptom of persistent pulmonary infection and tachypnea.

Firearm injury in a child: An uncommon case of penile trauma.

Genitourinary system injuries generally occur due to blunt and penetrating trauma. Approximately 10% of all injuries encountered in the emergency department are related to the genitourinary system. Male genital trauma is a urological emergency because of the high risk of infection and the priority of protecting the sexual, endocrine, and reproductive functions. Blunt injuries to the penis are more often seen due to the mobility and localization of the penis than due to penetrating injuries caused by firearms or cutting instruments. We aimed to present and discuss a case involving shrapnel that became lodged in the penis of a child in a war zone. After 2 weeks of medical treatment, the patient underwent surgery. Surgery includes primary repair to the penis and urethra.

Hemostatic efficacy of a traditional medicinal plant extract (Ankaferd Blood Stopper) in bleeding control.

The aim of this study is to assess the in vivo hemostatic effect of Ankaferd Blood Stopper (ABS) on rats using a tail bleeding model. Wistar rats were randomized into 4 groups of 9 each: group 1, control, no pretreatment, irrigated with saline; group 2, no pretreatment, irrigated with ABS; group 3, control, heparin pretreatment, irrigated with saline; and group 4, heparin pretreatment, irrigated with ABS. To control bleeding, compressive dressings were placed after instilling 1 mL of either ABS or saline to the bleeding area. Without heparin pretreatment, ABS shortened hemostasis time by 1.57 minutes and reduced the amount of bleeding by 0.85 g. With heparin pretreatment, ABS shortened hemostasis time by 3.29 minutes and reduced the amount of bleeding by 1.32 g. The ABS was more effective than saline irrigation for treating tail tip bleeding in rats, with or without heparin pretreatment, while also using a compressive dressing.

A comparison of manual versus hydrostatic reduction in children with intussusception: single-center experience.

OBJECTIVE: In recent years several techniques have been recommended for intussusception treatment. In this study, an evaluation was made of intussusception cases that presented at our clinic and had reduction applied together with saline under ultrasonography (USG) and cases, which were surgically treated. PATIENTS AND METHODS: A retrospective evaluation was made of the records of 72 cases treated for a diagnosis of intussusception between January 2010 and July 2012. Patients were evaluated demographics, clinical presentation, management strategy, during the hospitalisation and outcome. RESULTS: A total of 72 cases which consists of 44 male and 28 female with age range between 5 and 132 months were treated with a diagnosis of intussusception. USG was applied to all cases on initial presentation. As treatment, hydrostatic reduction (HR) together with USG was applied to 47 cases. Of these, the HR was unsuccessful in 13 cases. Surgical treatment was applied to 38 cases. Of these cases, ileocolic intussusception was observed in 30 cases, ileoileal in seven cases and colocolic in one case. Meckel diverticulum was determined in five of these cases, polyps in two cases, lymphoma in two cases, lymph nodule in one case and 28 cases were observed to be idiopathic. There was no mortality in any case. CONCLUSION: HR together with USG is a safe technique in the treatment of intussusception, which also shortens the duration of hospitalisation and significantly reduces the treatment costs.

Pulmonary hydatid disease is difficult recognized in children.

PURPOSE: Pulmonary hydatid disease is a significant health problem for children in endemic areas. Pulmonary hydatid disease is more frequent than hepatic hydatid disease in children. The aim of this study was to evaluate the characteristics of pulmonary hydatid disease for children in our province which is endemic for echinococcosis. PATIENTS AND METHODS: This study was performed retrospectively between 2007 and 2012 by reviewing the medical records of patients (≤17 years) who were diagnosed with pulmonary hydatid disease. The medical records of these patients were evaluated with respect to the demographic characteristics of patients, management strategies, length of hospital stay, and outcomes. RESULTS: A total of 120 (52.9% boys and 46.3% girls) patients with the diagnosis of pulmonary hydatid disease were enrolled in this study. The mean age was 10.15 ± 3.93 years. The significant numbers of patients were admitted with a ruptured hydatid disease and managed with lung preservation. The mean follow-up was 11.3 ± 3.8 (3-24) months. Recurrence was detected in three patients during follow-up. CONCLUSION: Pulmonary hydatid disease is usually symptomatic. Hydatid disease must be considered in differential diagnosis while evaluating thoracic lesions in endemic areas.

[Blunt renal trauma in children: a retrospective analysis of 41 cases]. / Çocuklarda künt böbrek travmalari: Kirk bir olgunun geriye dönük olarak degerlendirilmesi.

BACKGROUND: The majority of renal injury secondary to blunt abdominal trauma can be successfully treated conservatively. In the present study, the clinical features and outcomes of children who presented with renal injury secondary to blunt abdominal trauma were evaluated. METHODS: This study was carried out retrospectively using data from children at the Department of Pediatric Surgery who were hospitalized for renal injury due to blunt abdominal trauma between 2000 and 2012. Patient characteristics, clinical presentation, management strategy, and outcome were evaluated. RESULTS: Forty-one patients were hospitalized. The mean age of the patients was 10±4.85 years. The majority of renal injuries were grade 1 and 2. Falling was the cause of most renal injuries. All patients were initially treated conservatively. Three patients underwent acute surgical exploration for life-threatening renal bleeding (grade 4-5 injury). Nephrectomy was performed in 3 patients due to injury to the pedicle. CONCLUSION: The conservative treatment of pediatric renal parenchymal injuries is safe and effective in children. Although the vast majority of renal injuries do not require surgical intervention, life-threatening renal bleeding, regardless of the grade of injury, should be treated surgically.

The characteristics and outcomes of penetrating thoracic and abdominal trauma among children.

PURPOSE: Trauma is the most important etiology of morbidity and mortality among children. Penetrating injuries to the thorax and abdomen are extremely rare in children. In the present study, we compared the characteristics of patients, management, and outcomes of penetrating thoracic and abdominal trauma in children. MATERIALS AND METHODS: Data from children who were hospitalized for penetrating injuries of the thorax and abdomen from 2006 to 2012 were evaluated retrospectively. These injuries were evaluated with respect to patient details, clinical presentation, circumstances of trauma, management, and outcomes. RESULTS: Eighty-four patients were hospitalized for penetrating injuries to the thorax and abdomen. The mean age was 10.3 ± 3.79 years. Patient injuries comprised 26 gunshots injuries and 58 stabbing injuries. Thirty-one patients were wounded in the thorax, 43 were wounded in the abdomen, and 10 were wounded in both the thorax and abdomen. Thirty-one patients had undergone surgical interventions, while the other 53 were managed conservatively. The mean hospital stay was 4.41 ± 6.84 days. CONCLUSIONS: The incidences of penetrating abdominal and thoracic trauma did not differ significantly. Penetrating injuries may be successfully managed by conservative therapy.

Characteristics and outcomes of liver and lung hydatid disease in children.

Our study retrospectively evaluates and compares the characteristics of lung and liver hydatid disease (HD) in children. This retrospective study was performed between 2007 and 2012 using the medical records of patients aged ≤17 years of age who had liver and/or lung HD. They were evaluated using the demographic characteristics of the patients, clinical presentation, hospital stay and outcome. A total of 252 cysts were identified in 152 of the patients. The incidence of HD increased with age and the majority of patients were older than 9 years. Overall, lung HD was more complicated and symptomatic than liver HD on initial admission.

Preliminary study of efficacy of hyaluronic acid on caustic esophageal burns in an experimental rat model.

BACKGROUND: The aim of this study was to investigate the effectiveness of hyaluronic acid on the prevention of esophageal damage and stricture formation after experimental caustic (alkaline) esophageal injury in rats. MATERIALS AND METHODS: Twenty-one Wistar albino rats were randomly divided into three groups. A caustic esophageal burn was created following the Gehanno model: Group l (n=7) underwent operation, but no injury; Group 2 (n=7) was injured and left untreated; and Group 3 (n=7) was injured and treated with hyaluronic acid, first topically and then orally by gavage (2×0.3mL; 12.5mg/mL for 7days). The caustic esophageal burn was created by instilling 25% NaOH into the distal esophagus. All rats were euthanized on day 22 for evaluation. The efficacy of hyaluronic acid treatment was assessed histopathologically and biochemically via blood determination of the total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and sulfhydryl group (SH) and lipid hydroperoxidase (LOOH) levels. Statistical analyses were performed. RESULTS: Weight gain was significantly lower in Group 2 than in the other two groups (P<0.05). The mean stenosis index, histopathologic damage score, TAS, TOS, OSI, and SH and LOOH levels were higher in Group 2 than in the other two groups. The mean stenosis index, inflammation, TAS, SH and OSI in Group 2 were significantly different than those in the other two groups (P<0.05). CONCLUSION: Hyaluronic acid treatment is effective in treating damage and preventing strictures after caustic esophageal burn in rats.

Abdominal injuries related to bicycle accidents in children.

PURPOSE: Bicycling is a well-liked sporting activity in which many children participate, and bicycle accidents are one of the most common causes of abdominal injuries in children. We evaluated the characteristics and outcomes of abdominal injuries due to bicycle accidents in children. PATIENTS AND METHODS: This study was carried out retrospectively on children at the Department of Pediatric Surgery who were hospitalized for abdominal injury due to a bicycle accident, from 2008 to 2012. Abdominal injury-related bicycle accidents were evaluated with respect to patient characteristics, clinical presentation, management strategy, and outcome. RESULTS: Fifty-nine patients were hospitalized for abdominal injuries related to a bicycle accident. The mean age of the patients was 11.48 ± 3.6 years. Most patients had an imprint of the handlebar edge on their abdomen. The most common abdominal organ injury due to a bicycle accident was laceration of the liver. Most patients were treated conservatively. Surgery was performed in 14 (24.1 %) patients. Hospital stay was 1-68 (mean 4.34 ± 11.6) days. CONCLUSIONS: Abdominal injuries following a bicycle accident are frequent, serious, and preventable. Most patients were treated conservatively. Bicycle injuries can be prevented.

The characteristics and outcomes of foreign body ingestion and aspiration in children due to lodged foreign body in the aerodigestive tract.

OBJECTIVE: Injury due to foreign body (FB) aspiration and/or ingestion is a common and serious pediatric emergency. Foreign body injury (FBI) most commonly occurs in children younger than 6 years, and the incidence of FBI has increased in recent years. The aim of the present study was to evaluate and compare the characteristics of FBI due to ingestion and aspiration. METHODS: Data from patients who were hospitalized for FB ingestion and/or aspiration and underwent rigid bronchoscopy and esophagoscopy from 2008 to 2011 were retrospectively evaluated. Foreign body in the upper aerodigestive tract was evaluated with respect to the characteristics of patients, clinical presentation, management strategy, the outcome, and features of FB. RESULTS: A total of 192 patients admitted for FB ingestion or aspiration in the pediatric surgery department were evaluated. The mean age was 40.97 (SD, 35.73) months. The majority of patients were younger than 4 years. Foreign bodies were mainly located in the upper esophagus for ingested FBs (60.8%), whereas for aspiration 43% of FBs were in the main right bronchus. A total of 4 patients died. The hospitalization period of patients admitted for FB aspiration was longer than that of patients with FB ingestion. Surgery was performed in 4 patients. The most commonly ingested FBs were coins, whereas seeds were the most commonly aspirated. CONCLUSION: Prevention is the key to dealing with FBIs. Because the frequency of foreign bodies is higher in underdeveloped countries, education of parents regarding the dangers and prevention of aspiration and ingestion is important.