Congenital hiatus hernia: A case series.

OBJECTIVE: Hiatus hernia is frequent in adults and rare in children; congenital hiatus hernia is even rarer. In this study, we describe a group of infants with congenital hiatus hernia and discuss its management. METHODS: Records of patients (male: 3, female: 4) who were diagnosed with congenital hiatus hernia between 2010 and 2016 were extracted. Demographic data, presenting symptoms, diagnostic investigations, operative details, postoperative follow-up, and early and late postoperative complications were evaluated retrospectively. RESULTS: Four patients were female and three were male. One patient was diagnosed prenatally while the mean age at diagnosis for others was 18.6 months. Four patients had type IV hernia, 2 had type III hernia, and one had type I hernia. The diagnosis was confirmed by chest X-ray, computerized tomography (CT) and/or upper gastrointestinal series. The hiatal repair was done in all patients either by laparotomy or laparoscopy. During the procedure, 2 patients had Nissen fundoplication and 3 patients had Thal fundoplication. Recurrence of hernia occurred in the 2 patients who had Thal fundoplication. CONCLUSION: Recurrence of sliding hernias with Thal fundoplication seem more frequent in the series. If the esophagogastric junction is present in the thorax, mediastinal dissection of the esophagus may be required to achieve a good abdominal esophagus structure, which will prevent a recurrence.

Can mean platelet volume, Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, Platelet-to-Lymphocyte ratios be favourable predictors for the differential diagnosis of appendicitis?

OBJECTIVE: To investigate whether some ratios obtained from complete blood count could be favourable predictors in differentiating appendicitis from mesenteric lymphadenitis, appendicitis and familial Mediterranean fever. METHODS: The retrospective cross-sectional study was conducted at AfyonKocatepe University Medical Faculty, Afyonkarahisar, Turkey, from January 1, 2014, to December 31, 2016, and comprised data of patients who presented to the department of paediatric surgery and paediatrics with symptoms of acute abdomen. Mean platelet volume, neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, and platelet/lymphocyte ratio of the patients calculated at the time of admission were analysed. SPSS 20 was used for data analysis. RESULTS: Of the 301 patients, there were 139(46.2%) males and 162(53.8%) were females. The overall mean age was 11.5 } 4.33 years. Of the total, 137(45%) had appendicitis, 65(22%) familial Mediterranean fever, and 99(33%) had mesenteric lymphadenitis. Mean platelet volume was significantly different among the study groups (p<0.05). Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were statistically significantly higher (p<0.05) while lymphocyte/monocyte ratio was significantly lower (p<0.05) in appendicitis cases compared to the others. CONCLUSIONS: Mean platelet volume, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were found to be the potent predictors for the differential diagnosis of familial Mediterranean fever and mesenteric lymphadenitis which are mostly confused with appendicitis.

Examination of histopathological changes of scalpel, monopolar, bipolar, and thermocautery applications in rat experimental circumcision model.

This study endeavors to analyze the effects of thermocautery, bipolar cautery, monopolar cautery, and the scalpel to show that the thermocautery is a safe device to be used in circumcision. Twenty-four rats were assigned to 4 different groups: the scalpel, thermocautery, bipolar cautery, and monopolar cautery groups. Circumcisions were performed using the scalpel, thermocautery, bipolar cautery, or monopolar cautery devices. The circumcised foreskin was removed for histopathological analysis. The circumcision techniques were compared in terms of the depth of injury on the prepuce. Wound healing on the 5th day on the circumcision plane was evaluated by using a grading scale from 0-4 and by comparing re-epithelization, granulation tissue, and collagen deposition. Blood samples were taken 1st hour after the operation and the 5th day, prior to the necropsy. The totals of the oxidant/anti-oxidant levels were determined. For statistical analyses, the SPSS packet program was used. Statistical significance was determined as a P value <0.05. The least trauma was with the scalpel which was comparable with the thermocautery in regard to depth of injury, epithelization, granulation tissue formation, and collagen buildup. Thermocautery group showed superior collagen proliferation compared with the monopolar cautery group, while being superior in epithelization and injury depth when compared with the bipolar cautery group. The use of thermocautery for circumcision has shown to be safe and resulted in better wound healing in rats with no apparent complications, and, if used in the human population, it may be a safe and effective technique.

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study.

OBJECTIVE: To evaluate the effect of inguinal operations performed with a modified Ferguson technique upon testicular volume and blood flow. METHODS: This study involved 23 children receiving surgery for inguinal hernia, hydrocele, and cord cyst. This was a prospective study performed between April 2016 and June 2016 in a medical faculty pediatric surgery unit. The color Doppler ultrasound (CDUS) was used to assess testicular volume and blood flow before and after a modified Ferguson technique surgery. The pre- and post operative testicular volume and blood flow were compared with the contralateral testes. SPSS software was used to statistically analyze the data arising; the Mann-Whitney U test and Friedman test were used to compare samples, and P<0.05 was accepted as statistically significant. RESULTS: Preoperative and postoperative testicular volumes were not statistically different when compared to contralateral testes. In patients with right sided inguinal pathology, testicular blood flow on the right side was significantly lower than that on the left side (P=0.023). The testicular blood flow was not statistically different compared with the contralateral testes during the first week evaluation and first month evaluation. The blood flow, probably reduced due to the pressure caused by inguinal pathology, was normalized through surgery. CONCLUSIONS: The modified Ferguson technique do not change the testes volume and blood flow.

Coexisting urogenital anomaly and duodenal atresia in two atypical Holt-Oram syndrome.

Holt-Oram syndrome (HOS) is a rare autosomal dominant disorder, characterized by upper limb dysplasia and congenital cardiac defect. We report two cases with HOS, first associated with renal agenesis, coronal hypospadias, urethral duplication and second associated with duodenal atresia and horseshoe kidney that have not been reported in English literature.

Benign Cystic Mesothelioma in a Child: Case Report and Review of the Literature.

BACKGROUND: Benign cystic mesothelioma (BCM) is a rare tumor with benign characteristic. There are only 8 child cases reported in the English literature. In this report, we present this rare entity a brief review of the literature. CASE REPORT: A two year-old boy presenting with abdominal swelling was hospitalized. Physical examination revealed a mass filling the abdomen. Laboratory findings were not specific. Abdominal computerized tomography showed a 15×13×11 cm cystic mass extending from the bladder to the liver with no solid components and no infiltration to adjacent organs. Operation revealed a cystic mass filled with yellow-green serous fluid which was attached to the right lobe of the liver with a 1 cm thick peduncle. Total excision of the mass was performed by clamping and cutting the narrow attachment. Recovery was uneventful. Pathology revealed multiple cysts lined with mesothelial cells. No recurrence was seen after 5 years of follow-up. CONCLUSION: BCM should be kept in mind as a rare cause of the abdominal mass in children, as it may lead to confusion in preoperative diagnosis. Although rare, patients should be followed throughout life because of the risk of recurrence and malignant degeneration.

Laryngeal fracture due to blunt trauma presenting with pneumothorax and pneumomediastinum.

AIM: Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. CASE: A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. CONCLUSION: Pneumomediastinum is a rare result of a laryngeal fracture and if not suspected, the fracture can easily be missed. It should be kept in mind after blunt cervical trauma with pneumomediastinum and/or pneumothorax. Direct endoscopy and cervical tomography may be necessary for the differential diagnosis.

A practical offer for hypospadias dressing: Allevyn®.

INTRODUCTION: An ideal hypospadias dressing material must be cheap and non-allergenic. It also must be easily and quickly applied, non-adherent to the incision, effectively absorb the leakages of the wound, pressurise the flaps and grafts effectively, without damaging the blood circulation, protect against infections, and must be easily and painlessly removable. We use a product that is produced for healing chronic wounds and burns, Allevyn Adhesive® , as a wound dressing after hypospadias surgery and circumcision. MATERIALS AND METHODS: We included 61 hypospadias and 85 circumcision cases operated in our clinic between November 2007 and August 2010, for the study. Allevyn Adhesive® dressing was used in all the cases. For approximately every 10 patients a sheet sized 22.5 x 22.5 cm was used. RESULTS: We did not meet any difficulty in application and removal of the dressings and the dressing could be performed easily even by inexperienced health personnel. The cost of the application is about $5 for each case. We did not encounter any complications with regard to the dressing during the follow-up. CONCLUSION: We did not encounter any of the complications with Allevyn Adhesive® that were seen with the use of traditional dressing products, such as, problems with removal of the dressing, development of maceration secondary to inadequate absorption of leakages from the wound, cohesions of the wound lips, and infections and necrosis of the flaps and grafts, secondary to erroneous locations of the dressings. There was no additional therapeutical cost due to the use of this product. For these reasons we thought that Allevyn Adhesive® is a good alternative for the dressing of hypospadias and circumcision.

Early effects of laparotomy and laparoscopy on bacterial behavior and proinflammatory cytokines on bacterial peritonitis in rats I: Escherichia coli.

PURPOSE: The aim of this study was to investigate in rats with peritonitis the effect of CO2 insufflation on behavior of bacteria, including antibiotic resistance, and the systemic and regional host response. METHODS: Inbred weaned Wistar albino rats were used. Escherichia coli ATCC 25922 was used to induce peritonitis. Rats with peritonitis were allocated to 4 groups: group 1, control; group 2, laparotomy; group 3, laparoscopy; group 4, laparoscopy + laparotomy and were killed at the end of the second hour of peritonitis. Serum, peritoneal fluid, and intraabdominal organs were taken for microbiological (biochemical markers-urease, citrate, indole; virulence factors-biofilm, protease, gelatinase, adherence), systemic immunologic (interleukin 1 [IL-1]alpha, IL-1beta, tumor necrosis factor alpha, IL-6), and regional histopathologic evaluations. Isolated strains were tested against minimum inhibitory concentrations (MICs) and sub-MICs of amikacin and amoxicillin. RESULTS: Regional inflammatory response was the highest in group 2 but the lowest in group 4. Systemic IL-1alpha level was significantly higher in group 2, and TNF-alpha level was higher in group 3. After the peritonitis process, Escherichia coli began to use citrate and urea in control groups (without antibiotic treatment). In groups 2 and 4, amoxicillin resistance developed. CONCLUSIONS: In peritonitis, in all experimental groups, Escherichia coli used different metabolic pathways other than in normal atmospheric conditions. Amoxicillin resistance developed in open surgery groups. Further kinetic microbiological and immune response studies are needed concerning the early and late effects of CO2 insufflation on various strains of bacteria and mixed infections.