Purpose: Aim of the study was to evaluate the efficacy of the transscrotal approach in redo orchiopexy.Material and Methods: Redo orchiopexy using the transscrotal approach was used to treat 16 testes during a 4-year period from 2005 to 2009. Five of these cases occurred following inguinal hernia repair and 11 after previous orchiopexy. Only testes located distal to the external ring that could be moved to the upper part of the scrotum were included in the study. The vas deferens and testicular vessels were dissected free from the surrounding tissue using a scrotal approach and the testis placed into a dartos pouch.Results: All testes except one could be placed into the scrotum with the transscrotal approach. The mean duration of surgery was 33 +/- 13 min. No patient suffered from atrophy or reascending testes.Conclusion: The transscrotal approach is a fast, simple and reliable method for redo procedures for undescended testes.

Introduction: The aim of this study was to determine whether the addition of gum chewing to standardized postoperative care is associated with a significantly earlier return of bowel function compared to simple postoperative management in children with intestinal anastomosis.Materials and Methods: We performed a prospective, randomized, controlled trial. All patients who underwent laparotomy with either colon or small bowel resection between June 2006 and March 2008 were randomized to one of two groups. Group one consisted of patients receiving standardized postoperative care Plus gum chewing (gum-chewing group) (n = 15); Group two consisted of patients receiving only standardized postoperative care (control group) (n = 15). The patients in the gum-chewing group chewed one stick of sugarless gum three times per day, for an hour, each day.Results: The groups were statistically similar. The time to first flatus was 35.73 +/- 14.67h in the gum-chewing group and 42.00 +/- 20.77h in the control group (p = 0.347). The time to first bowel movement was 56.27 +/- 22.14h in the gum-chewing group and 63.00 +/- 26.34 in the control group (p=0.444). The length of hospital stay was 5.80 +/- 0.68 days for the gum-chewing group and 6.67 +/- 0.98 days for the control group (p = 0.005). The hospital charges were 2451 +/- 806 YTL for the gum-chewing group and 2102 +/- 678 YTL for the control group (p = 0.206).Conclusions: The addition of guru chewing to the standardized postoperative care of children with intestinal anastomosis was not associated with a significantly earlier return of bowel function compared to simple postoperative management, but it was associated with an earlier discharge from hospital, although this earlier discharge had only minor clinical significance and no difference was found in hospital charges.

Crimean-Congo Hemorrhagic fever (CCHF) is a potentially fatal viral infection with reported case fatality rates of 5-30%. Humans become infected through tick bites, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. In this first report in the literature, we present the characteristics of three pregnant women with CCHF infection and the outcome of their babies. Transmission of the CCHF infection could be either intrauterine or perinatal. In endemic regions, CCHF infection should be considered in the differential diagnosis of HELLP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count), and obstetricians should be familiar with the characteristics of CCHF infection. In the aetiology of necrotising enterocolitis, CCHF should be considered.

Aim: The aim of the study was to evaluate the functional results, complications, the problems caused, and the outcomes of the transanal endorectal pull-through (TEPT) operation in Hirschsprung's disease.Patients and Methods: The 22 patients who were operated for Hirschsprung's disease with TEPT between November 2003 and September 2006 were reviewed retrospectively. The patients were evaluated for age, gender, operational findings, duration of hospitalization and functional outcomes after the operation.Results: A total of 22 patients, sixteen males (72.7%) and 6 females (27.3%) aged 23 days to 11 years (mean 19.3 +/- 6.9 months), were operated using TEPT over a 34-month period. The mean length of the resected aganglionic segment was 23 +/- 2.4 cm; the shortest segment was 7 cm and the longest 40 cm. The postoperative hospital stay was 3 - 10 days, oral feeding was started at 1 - 4 days, the first bowel movement was at 1 - 7 days and the number of daily movements for patients in whom the colostomy was closed was 2 - 5. The mean postoperative follow-up period was 18 +/- 2.4 months (1 - 33 months). Two patients (9%) were hospitalized once for enterocolitis. One patient had a constipation problem that resolved with medical treatment. One patient needed colostomy for anastomosis leakage on the 5th postoperative day, followed by a redo pull-through using a posterior sagittal approach. None of the patients had a continence problem. No urethral damage was observed and there were no abscesses at the muscular cuff. We observed that mucosal dissection was more difficult in the rectal biopsy area.Conclusions: Although only recently accepted, TEPT has quickly found a place in clinical practice as it is based on an operational technique whose results are well identified and accepted and with which there is extensive experience. It seems that TEPT has the advantages of having no additional problems compared to the classical techniques with respect to complications and functional outcomes while providing better patient comfort and cosmetic outcomes. We conclude that TEPT may be preferred in appropriate cases and will evolve to become a more practical and effective technique.

Perforation of the gastrointestinal tract in neonates is still associated with high mortality rates. Laparotomy is usually required to treat gastrointestinal perforation, however peritoneal drainage under local anesthesia has been also described as an alternative mode of treatment. In our institute, laparotomy was the first choice for the management of gastrointestinal perforation in neonates until 1999. Because of the high mortality rates in this group of patients, our policy has since changed to the use of primary peritoneal drainage instead. The aim of this study is to compare the effectiveness of primary peritoneal drainage (PPD) and primary laparotomy (PL) procedures in the management of gastrointestinal perforation due to necrotizing enterocolitis in neonates. Between 1994-1998, ten babies with intestinal perforation underwent PL, whereas fifteen newborns with similar findings were treated with PPD between 1999 and 2003. Eight (80%) of the patients died in the PL group prior to 1999. In the PPD group 8 (53.3%) of babies required no further treatment and were discharged without any complications. Four (26.7%) patients in this group needed laparotomy later, and three (75%) of them survived. in conclusion, we believe that PPD is more effective than PL for the management of perforated necrotizing enterocolitis in neonates. Laparotomy can be used in particularly unresponsive cases after primary peritoneal drainage.

Objective: Foreign body ingestion is not an uncommon problem in children. Children can ingest various foreign objects. One of such objects is safety pin, which is not widely reported in the literature. The purpose of this study is to consider the efficacy of Magill forceps for removal of safety pins from upper esophagus. Methods: A retrospective chart review was conducted for all children admitted to our hospital with safety pin ingestion from 1995 to 2003. In 58 children who had been found to ingest safety pin, the attachment site was gastrointestinal tract. In 12 of the cases, safety pins were located in the upper end of the esophagus. In seven of the children safety pin extraction was achieved by using a Magill forceps with the assistance of a laryngoscope maintaining general anesthesia with mask inhalation. Results: Safety pins were successfully removed with Magill forceps without any complications in seven patients whom they were located in the upper esophagus. Upper esophageal safety pins in the other five patients were extracted with rigid esophagoscopy for they were not seen under direct laryngoscopy. There were no complications. Conclusions: This is a preliminary report, but we believe that the Magill forceps technique for the removal of safety pin in the upper end of the esophagus is safe and minimally invasive method compared to rigid esophagoscopy.

TAR syndrome is manifested by the presence of hypomegakaryocytic thrombocytopenia and the bilateral absence of radii. An 8-day-old female newborn was referred to our clinic with diagnosis of TAR syndrome and symptoms of intestinal obstruction. On perineal examination she also had anal atresia with rectovestibular fistula. Because of persistent bile-stained drainage from the nasogastric tube, an upper gastrointestinal contrast study was performed and partial duodenal obstruction was detected. At operation, an annular pancreas was encountered and side-to-side duodenoduodenostomy was performed. A small number of gastrointestinal system malformations associated with TAR syndrome has been reported. Our case is unique; the association with annular pancreas and anal atresia with rectovestibular fistula has never been previously reported.

PURPOSEThere is still an argument concerning the correct management of pleural empyema. The aim of this study is to compare the effectiveness of closed-tube thoracostomy and open thoracotomy procedures in the management of empyema in children.METHODSThis is a prospective study of 30 patients with parapneumonic empyema who were managed randomly either by closed-tube thoracostomy or open thoracotomy procedures. The two procedures were compared based on the respective times to achieving normal body temperature and breath rates, duration of tube drainage, length of hospitalization, and complication rates. Both groups were also assessed by comparing tube drainage duration, pleural fluid pH, agent pathogen and glucose level.RESULTSAverage tube duration was 7.5 +/- 1.1 days and average hospital stay was 9.5 +/- 1.5 days in the open thoracotomy group. In the closed tube thoracostomy group tube, duration was 13.8 +/- 2.3 days and average hospital stay 15.4 +/- 2.3 days. In the open thoracotomy group 73.3% of the patients had achieved normal body temperature and 66.7 % had a normal breath rate within the first 48 hours. In the closed tube thoracostomy group these rates were 40% and 20%, respectively. In both groups, tube drainage duration was found to be longer in patients whose pleural fluid pH was < 7.2.CONCLUSIONThe authors conclude that open thoracotomy is a safe, efficient, and easy method of treatment for pleural empyema in children. It was also observed that pleural fluid pH level is the most important prognostic criteria in pleural empyema.

Gastrointestinal teratoma is a rare neoplasm seen most often as gastric teratoma in children. This is a report of a neonate who had a ruptured omphalocele, ileal teratoma, and multiple associated anomalies. According to an English-language literature review this is the first case report of an ileal teratoma. J Pediatr Surg 35:1370-1371. Copyright © 2000 by W.B. Saunders Company.