BACKGROUND:Inguinal hernia repair is a common procedure in daily pediatric surgical practice. OBJECTIVES:The present study was planned to find out whether transinguinal laparoscopic exploration (TILE) of the contralateral groin is effective in reducing the need of operation for contralateral metachronous inguinal hernia (CMIH) in children. STUDY DESIGN:Charts of 1103 children who underwent inguinal hernia repair between 2006 and 2016 were retrospectively analyzed. Eighty-eight children with bilateral hernia at the presentation were excluded, and 705 patients whose parents could be contacted by phone to get the latest information about children's condition were included in the study. RESULTS:Of the 705 children with unilateral inguinal hernia repair, 362 (51.4%) and 343 (48.6%) of them had right-sided and left-sided inguinal hernia, respectively. Transinguinal laparoscopic exploration was performed in 479 of the 705 children with unilateral hernia and a hernia or contralateral patent processus vaginalis (PPV) was found and ligated in %28.3 (n = 136) of them. Mean follow-up time was 60 ± 36 months. Fifteen (4.3%) of 479 patients who had TILE and 31 (13.6%) of 226 the patients who did not have TILE developed CMIH. When the videos of 15 patients who developed CMIH were reviewed, overlooked PPV was found in 10 (3.3%) patients who had TILE during early phases of institutional learning curve. DISCUSSION AND CONCLUSIONS:TILE of the contralateral side during pediatric inguinal hernia repair is a simple and effective method to evaluate contralateral PPV. This approach clearly and significantly reduces the need of operation for a metachronous hernia at a later date.

Introduction: The aim of this study is to evaluate and analyse the reasons for conversion to open surgery in laparoscopic cases in childhood, compared to the adult literature and differentiate the preventive measures for decreasing the rates for conversions. Patients and methods: The charts of 2068 patients who had appendectomy, Nissen fundoplication, cholecystectomy and splenectomy operations between 2003-2015 were reviewed retrospectively. Laparoscopic and open procedures and the cases that were converted from laparoscopy to open surgery and the reasons of conversions were analysed. Results: Between the years of 2003-2015, total of 2068 cases; appendectomy (1539), cholecystectomy (120), Nissen fundoplication (323) and splenectomy (86) operations were performed. Among these procedures, 181 (8.8%) of them were performed by laparotomy. 1887 (91.2%) of them were intended to be performed by laparoscopy. Among laparoscopically started cases, 1848 (97.9%) of them were completed laparoscopically and in 39 cases (2.1%) conversions were required. The conversion rates were 0.34%, 9.7%, 2.8% and 7.4% in appendectomy, Nissen fundoplication, cholecystectomy and splenectomy, respectively. Conclusion: Preoperative detailed and specific examinations before laparoscopic procedures can decrease the conversion rates in laparoscopic surgery. Complications do not have to be the only conversion indication and elective conversion must be performed without wasting time to avoid complications.

The study aims to evaluate the effectiveness and safety of endoscopic balloon dilatation (EBD) in childhood benign esophageal strictures. The medical records of 38 patients who underwent EBD from 1999 to 2013 were retrospectively reviewed. Demographic features, diagnoses, features of strictures, frequency and number of EBD, complications, outcome, and recurrence data were recorded. Median age was 1.5 years (0-14), and female/male ratio was 17/21 (n = 38). Primary diagnoses were corrosive esophageal stricture (n = 19) and esophageal atresia (n = 19). The length of strictures were less than 5cm in 78.9% (n = 30). No complication was seen in 86.8% (n = 33). Perforation was seen in 10.5% (n = 4), and recurrent fistula was seen in 2.7% (n = 1). Total treatment lasted for 1 year (1-11). Dysphagia was relieved in 60.5% (n = 23). Recurrence was seen in 31.6% (n = 12). Treatment effectiveness was higher, and complication rates were lower in strictures shorter than 5cm compared with longer ones (70% vs. 25%, P < 0.05, and 3.4% vs. 37.5%, P < 0.05). Although there was no statistical difference, treatment effectiveness rates were lower and complication and recurrence rates were higher in corrosive strictures compared with anastomotic ones (P > 0.05). EBD is a safe and efficient treatment choice in esophageal strictures, especially in strictures shorter than 5cm and anastomotic strictures.

Aim Meconium obstruction(MO) is a clinical entity primarily affecting very-low-birth-weight(VLBW) premature infants. Intestinal obstruction symptoms in a VLBW infant who did not have evidence of necrotizing enterocolitis, did not have another mechanical or functional cause of obstruction defined as MO. Method We report a series of 14 infants, whose clinical course is indicative of MO of prematurity. Results One-hundred-thirty VLBW infants born between January 1, 2010 and December 31, 2011. Fourteen(11%) patients were diagnosed as MO. Mean gestational age and birth weight were 28.8±2.6 weeks and 943.7±238.3 g, respectively. Ninety-three percent of infants were delivered by C/S. Eight (57%) of infants had afermentioned prenatal risk factors for MO. The time of the passage of the first meconium was between 10-to-72 hours. All patients presented with distended abdomen and feeding intolerance. Abdominal plain x-rays showed multiple distended intestinal loops without air-fluid levels in all cases. Medical therapy, consisting of rectal enema with saline, if failed, enema with N-acetylcysteine was performed. Eleven of the patients underwent ileostomy surgery between posnatal age of 2-to-43 days. Nine patients (64%) survived, and the times to full enteral feeding was between day of life 13-to-81 days, the median length of hospital stay was 50 days (range 15–92 days) in these patients. One of the patients was diagnosed as Hirschsprung’s disease in the follow-up period. Conclusion VLBW infants with MO can be diagnosed based on their typical clinical and plain radiographic characteristics. Medical management is effective, whereas some cases may need surgically management as ours.

Candida lipolytica has infrequently been identified as a cause of infection and is associated mostly with vascular catheter-related fungaemia. Patients reported in the literature have been successfully treated with catheter removal or amphotericin B treatment. We report 2 infants with C. lipolytica fungaemia unresponsive to catheter removal and amphotericin B therapy and treated successfully with the addition of caspofungin to amphotericin B.

BACKGROUND/PURPOSE:This study was carried out to evaluate the effects of local and sustained release of fibroblast growth factor (FGF) on testicular blood flow and morphology in spermatic artery--and vein-ligated rats. METHODS:Forty male Wistar albino rats weighting 300 +/- 20 g were allocated randomly into 5 groups consisting of 8 in each as follows: G-S (sham); G-C (control); and G-T0.85, G-T1.70, G-T2.55. After the ligation of the left spermatic artery and vein, 1 cm2 of unloaded and 0.85 microg, 1.70 microg, and 2.55 microg of FGF-loaded gelatin films were sutured on the left epididymis in G-C, G-T0.85, G-T1.70, and G-T2.55, respectively. After 30 days, bilateral capsular (CBF) and intratesticular (IBF) blood flows were evaluated by colored Doppler ultrasonography (CDUS) and testicular blood flow (TBF) by 133Xe clearance technique. Tunica albuginea and intertubular tissues were studied for the increase of peritesticular and intratesticular vessels. Mean intertubular vascular structure counts, seminiferous tubular diameters, testicular biopsy scores, and Leyding cell scores of each group were recorded and compared. RESULTS:CBF was present in all animals of G-S, G-T0.85, G-T1.70, and G-T2.55 groups in CDUS, and it was detected in 62% of the G-C rats (P < .05). However, IBF was present in only 25% of the G-C rats, and this percentage was increased from 50% up to 87.5% for treatment groups, and 100% for G-S rats, respectively. 133Xe clearance showed that TBF was significantly decreased in G-C compared with G-S (P < .05). In G-T2.55, TBF was significantly increased, but still could not reach the level of G-S. Although mean testicular weights were significantly decreased for controls (G-C), G-T0.85, and G-T1.70, almost no difference was observed between G-T2.55 and G-S. Although a slight increase in the vascular structures of tunica albuginea was present in G-C rats, a significant increase was observed in treatment groups. The mean number of intertubular vascular structures was significantly increased in treatment groups when compared with G-S and G-C (P < .05). Mean seminiferous tubular diameters and Leydig cell scores were decreased in G-C but significantly increased in treatment groups (P < .05). Mean testicular biopsy scores were increased in treatment groups compared with G-C but could not reach to sham levels. CONCLUSIONS:Ligation of the spermatic artery and vein has detrimental effects on the ipsilateral testicular blood flow and morphology. These effects may be reversed by local application of FGF.

An increasing incidence of invasive infections caused by group A streptococci (GAS) has been reported from various parts of the world. Recently we have noted a similar increase in our hospital and communication with colleagues in various other parts of Turkey has revealed that they too are noting an increase (unpublished data). We therefore report the recent increase in invasive GAS infections in children admitted to the paediatric infectious diseases and paediatric surgical units of Ankara University Medical School. Thirteen children with invasive GAS infection were treated between 2000 and 2002 and some of their clinical features are outlined in Table 1. All were treated successfully with antibiotics with or without surgical intervention. The most commonly used antibiotic regimen was ceftriaxone plus clindamycin. (excerpt)

Objectives. To evaluate the efficiency of pentoxifylline (PTX), a methyl xanthine derivative, in preventing renal scar formation after the induction of pyelonephritis in an experimental rat model with delayed antimicrobial therapy.Methods. An inoculum of 1 x 10(9) colony-forming units/0.1 mL of the K-12 strain of Escherichia coli, which has both type 1 and P pili, was injected directly into both renal parenchyma of Wistar rats (n = 40). Group 1 (control) received isotonic saline instead of bacterial solution (n = 10). Four equal groups were then formed: group 2 was not treated and group 3 was treated only with ciprofloxacin for 5 days, starting 3 days after bacterial inoculation; in group 4, 50 mg/kg of PTX, and in group 5, PTX (50 mg/kg) and ciprofloxacin (15 mg/kg) together were administered intraperitoneally for 5 days, starting 3 days after bacterial inoculation. Six weeks after bacterial inoculation, all the rats were killed, and both kidneys were examined histopathologically for renal scarring.Results. Delayed treatment with antibiotics had no effect on scarring compared with the untreated controls. However, the addition of PTX to the delayed antibiotic therapy significantly inhibited renal scarring compared with the untreated or antibiotic-only groups (P < 0.05).Conclusions. These results suggest that PTX is effective in preventing renal scar formation in pyelonephritis when the initiation of antimicrobial treatment is delayed in this rat model of pyelonephritis. (C) 2003, Elsevier Inc.

Objectives : An experimental study was designed to evaluate the effects of pentoxifylline (Ptx) on lipid peroxidation, and histopathology in both testes after unilateral testicular torsion and detorsion. Materials and Methods : Forty adult male albino Wistar rats were randomly divided into 4 groups of sham operation, sham operation with Ptx, torsion and detorsion, torsion and detorsion with Ptx. After intraperitoneal administration of Ptx at a dose of 50 mg/kg 15 min before torsion; right testes of the rats underwent 30 min of torsion and 30 min of detorsion. Malondialdehyde (MDA) levels were assayed and histopathological changes were evaluated in both testes of all groups. Results : Unilateral testicular torsion and detorsion caused an increase in the MDA levels of both testes. Histopathological evaluation showed interstitial hemorrhage on the ipsilateral side. Pentoxifylline decreased MDA levels on both side, and attenuated interstitial injury on the ipsilateral side. Conclusions : The results of this study suggest that pentoxifylline treatment attenuates reperfusion damage on both side, possibly with its effects on blood flow and neutrophils. However, further studies are necessary to evaluate the effects of pentoxifylline on testicular torsion.

OBJECTIVE:Radiography was traditionally used in the preoperative treatment of neonates with tracheoesophageal atresia and tracheoesophageal fistula. The aim of this study was to assess the potential use of three-dimensional CT in the evaluation of this complex congenital malformation.CONCLUSION:Three-dimensional CT coupled with reformations in the three orthogonal planes may have a complementary diagnostic role in congenital esophageal atresia.

A male infant was referred to our department because of lumbosacral meningomyelocele, dorsal enteric fistula and imperforate anus. The mother had received a parenteral drug containing estradiol benzoate and progesterone for inducing abortion in the first trimester. She also used an anal pomade containing triamcinolone and lidocaine-HCl during the pregnancy for hemorrhoids. Sigmoid end colostomy was performed after meningomyelocele repair. On abdominal exploration a wandering spleen was detected but no other anomalies. Two months later, an abdominoperineal pullthrough was performed, and the patient was discharged well after three weeks. Our case is the sixth that had split notochord syndrome associated with dorsal enteric fistula and imperforate anus. Additionally, penoscrotal transposition and wandering spleen were present in this case. To our knowledge, these associated anomalies have been extremely rare.

The aim of this study was to determine the effects of pentoxifylline (Ptx) in reperfusion injury of the small bowel as a leukocyte stabilizer, free radical scavenger, and microcirculatory regulator. Ninety-six male Sprague-Dawley rats were used to determine the biochemical, histopathologic and blood flow changes of the reperfused small intestines after 30 minutes of a warm ischemic insult. Animals were divided into six groups: Sham (S), sham plus Ptx (SP), ischemia (I), ischemia plus Ptx (IP), reperfusion (R), and reperfusion plus Ptx (RP). Pentoxifylline was administered intraperitoneally at a dose of 50 mg/kg 15 minutes before ischemia. The superior mesenteric artery (SMA) was occluded distal to the right colic artery and collateral arcades were ligated as described by Megison. Sixty of the 96 rats (n = 10) were used to determine histopathologic changes, malondialdehyde (MDA), and myeloperoxidase (MPO) levels in tissue. Mucosal lesions were graded on a scale from 0 to 5 as described by Chiu. MDA and MPO levels of the intestinal mucosa were assayed to reflect the free radical formation and neutrophil sequestration, respectively. Thirty-six rats (n = 6) were used to measure blood flow changes of the intestine using 133Xe clearance technique. All data were presented as the mean values plus or minus the standard error of the means (means +/- sem). Although in the R group, mucosal injury score, blood flow, MPO, and MDA levels were higher significantly from the other groups (P < .05), in the RP group blood flow, MPO, and MDA levels were significantly decreased to the basal values (P < .05). Mucosal injury score of the RP group were lower than the reperfusion group but higher than the normal (P < .05). The authors conclude that pentoxifylline pretreatment before reperfusion stabilizes blood flow, decreases MPO and MDA levels to the normal, and attenuates but not completely prevents mucosal damage.

Hypertrophic pyloric stenosis (HPS) is very rare during the newborn period. Here we present a fullterm male neonate with abundant hematemesis 12 hours after birth which interrupted oral feeding. Bleeding subsided within three days after conservative measures, and oral feeding was restarted but not tolerated. The vomiting was effortless and nonbilious. An upper gastrointestinal series revealed gastric dilatation and partial obstruction of the gastric outlet. HPS was found by laparotomy on the fourth day and Fredet-Ramstedt pyloromyotomy relieved the gastric emptying. This is one of the few cases of HPS present at birth, which was diagnosed and surgically treated early, and we suggest a congenital etiology in previously reported cases of HPS. Hypertrophic pyloric stenosis (HPS) is a common cause of pediatric surgery. Usually young infants are involved; HPS is extremely rare in neonates and infants older than 6 months. Vomiting typically begins between the 3rd and 6th week of life, although some infants may have mild symptoms like regurgitation from birth.

Objective To present a technique for repair of distal hypospadias. Patients and methods Sixteen children (average age 6.6 years) were treated between January 1985 and January 1991. The procedure is described. Results One child developed a mild meatal stenosis and another had a small urethral fistula; both responded to treatment. Results were excellent in the remaining 14 patients. Conclusion This simple operative procedure was successful in the majority of patients and there were only two minor complications.

Clinical and experimental studies have shown that, in unilateral testicular torsion, some structural and hormonal changes may occur in the contralateral testis. The present study was designed to determine the effect of unilateral ovarian torsion on the blood flow in the contralateral ovary using #133Xe. Basal blood flow of the bilateral ovaries was determined in 40 prepubertal, female New Zealand rabbits. Right ovaries were then torsioned 720 degrees in all groups with the exception of the control group, where only laparotomy was performed. Bilateral ovarian blood flows were measured in the first group one hour after torsion, in the second group 8 hours after torsion, in the third group 24 hours after torsion and at the same times after laparotomy in the control group. Basal and post torsional blood flow measurements were analyzed. Contralateral ovarian blood flow was reduced after unilateral torsion in all of the groups. In the control group, there were no changes in these criteria.

This study was planned to investigate the extent of cellular damage of the contralateral ovary in unilateral ovarian torsion and to determine possible changes histopathologically by light and ultrastructurally by electron microscopy. Unilateral ovarian torsion was performed in 21 prepubertal, female New Zealand rabbits. One, 8 and 24 hours after the torsion, contralateral ovaries were biopsied. The control group consisted of rabbits without any torsion. Contralateral cellular damage was demonstrated after unilateral torsion. Oocytic nuclei, mitochondria, lysosomes and ovarian stromal cells were also affected when evaluated ultrastructurally.

19750 school children, ages 6 to 15 years, were examined by the authors of this study, 1,220 (6.18%) had congenital abnormalities. In this group, 4.23% were boys and 1.88% were girls. Case histories revealed inbreeding amongst the parents (families) of children with congenital malformation to be 8.9% and 8.2% for the rest of the families in this study. There were 27 different congenital abnormalities identified, with prevalence rates of 0.05/1,000 to 15.85/1,000. The most prevalent abnormalities were umbilical hernia (15.85/1000), inguinal hernia (14.50/1,000), pectus carinatum and excavatum (7.68/1,000), undescended testes (9.00/1,000 boys), congenital nevus (3.54/1,000), retractile testis (4.45/1,000 boys), pilonidal sinus (2.63/1,000), pes planus (2.28/1,000), and hemangioma (1.16/1,000). Of the 19,750 children, 70 had multiple anomalies (3.75/1,000).