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Delay in diagnosis and treatment of esophageal foreign bodies (FBs) increases morbidity and mortality. Anamnesis, radiological imaging and endoscopy are important in this diagnosis. A nine-month-old male patient was admitted to the hospital an hour after swallowing a coin. Pulmonary radiographic images detected the FB in the 2nd narrowing of the oesophagus and the FB was removed using a foley catheter. Six hours after removal of the FB, the patient was re-admitted by the emergency service upon development of puffiness in the neck and chest area. Physical examination revealed subcutaneous crepitation on the anterior wall of the thorax. Esophagography revealed that the contrast agent leaked from the right lateral of the oesophagus into the chest cavity. The nasogastric tube was inserted, the oral nutrition was stopped and antibiotherapy was started. Primary oesophagus repair was performed via thoracotomy on the 7th day of conservative follow-up upon the deterioration of the general condition and continuing leakage of contrast agent as observed in the fluoroscopy. In conclusion, The use of foley catheter in the removal of esophageal FBs can lead to serious complications.

Introduction:The aim of this study was to reveal the factors that affect the clinical outcomes of patients undergoing surgery in our university hospital for intestinal atresia (IA) and to share our experience.Methods:We analyzed data from 74 newborns with IA who underwent surgical treatment between January 1997 and December 2016.Results:The study population consisted of 40 female and 34 male newborns with a mean age at diagnosis of 6.4±8.3 days. The mean birth weight was 2.3±0.6 kg, the mean gestational age was 35.6±2.8 weeks, the mean maternal age was 28.9±6.1 years, and the mean hospitalization time was 24.5±25.3 days. Duodenal atresia was the most common diagnosis (n=31, 42%) and colonic atresia the least common (n=2, 3%). The longest and shortest mean hospital stays occurred in patients with jejunal (32.8±41.6 days) and those with colonic (8±0 days) atresia, respectively. Although the survival rates were low in newborns with either intestinal or duodenal atresia (80% or 81%, respectively), all patients with pyloric or colonic atresia survived. Of the patients who died, 82% (9/11) had additional congenital abnormalities (X2=8.461, p=0.004), which included major cardiac defects (n=3), Down syndrome (n=2), biliary atresia (n=1), esophageal atresia + tracheoesophageal fistula + anal atresia + tracheal atresia (n=1), esophageal atresia + tracheoesophageal fistula (n=1), and microcephaly (n=1). The mean hospital stay of patients with or without additional abnormalities was 26.4±21.4 or 23.04±28.04 days, respectively (p=0.207).Conclusion:Among newborns with IA, duodenal atresia was the most common diagnosis and colonic atresia the least common. Additional congenital abnormalities negatively affect the hospital stay and mortality rate of newborns with IA.

Background The correct diagnosis rate in acute appendicitis (AA) is between 72 and 94% despite advanced laboratory and radiologic examinations. This study was conducted to determine the effectiveness of laboratory parameters in the diagnosis of children with appendicitis. Materials and methods Patients who underwent appendectomy were divided as AA (subdivided into two groups as perforated and non-perforated) and without appendicitis. White blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), red cell distribution (RDW), mean platelet volume (MPV), C-reactive protein (CRP), procalcitonin levels and Alvarado score were recorded. Results WBC, NLR and CRP levels were higher in patients with AA (p Conclusions CRP is the most effective bioindicator in the diagnosis of AA, the detection of perforated cases. It was revealed that NLR is effective in the diagnosis of AA, procalcitonin and RDW values are effective in the separation of perforated cases.

Introduction:The purpose of this study is to investigate the effects of tetracycline (TC), clarithromycin (CM) and bleomycin (BLM) on the cyst diameter and ovarian tissues in the treatment of simple ovarian cysts.Methods:We employed Wistar albino female rats (n=38) to create ovarian cysts, and did not intervene in any form in the control group (GC) (n=6). In total, 32 female rats underwent unilateral salpingectomy for the creation of cysts. Macroscopic cysts were manifested in 25 (78%) rats who underwent salpingectomy. We divided the rats (n=25) with cysts into four groups. Salpingectomy with saline was performed in G1, salpingectomy with tetracycline (TC) was performed in G2, and salpingectomy with Clarithromycin (CM) was performed in G3. Additionally, salpingectomy with BLM was exploited in G4.Results:There was a significant decrease in the diameter of the cyst in G2 as compared to G1, but there was no significant difference among the other groups. There was no significant change in total ovarian reserve in the groups (p=0.066). There was a statistically significant increase in fibrosis in G1 and G3 groups as compared to GC (p

Dysplastic kidney cysts are developmental cysts of the kidney. They are mostly multi-cystic, and usually involve the whole kidney. In addition, the segmental and solitary form is rare. A one-year-old boy with an antenatal ultrasound diagnosis of a left kidney cyst was followed-up. Postnatal ultrasound examination revealed a duplex left kidney with a cystic dilatation in the upper pole and a normal appearing parenchyma in the lower pole. The cystic lesion (10×10 cm) with an upper polar location that did not show any regression was excised laparoscopically. The ureter communicating with the cystic component of the kidney was not seen on the left side during laparoscopy. Histopathologic diagnosis was a cystic renal dysplasia. We present a very rare case of a duplex kidney with a solitary dysplastic cyst and ureteric atresia and discuss the diagnostic and therapeutic process.

This study investigated changes in the concentrations of serum and urine neutrophil gelatinase lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (IL-18), and cystatin-C (Cys-C) induced by parenchymal and tubular damage following blunt kidney trauma, as well as their potential utility as biomarkers in the detection and follow-up of patients with suspected blunt renal trauma. Three-month-old male Sprague-Dawley rats (n = 18) were divided into three groups (n = 6 in each): group 1: control group (no intervention); group 2: sham group (explorative surgery and exposure of the left kidneys); and group 3: trauma group (explorative surgery and induction of blunt renal trauma of the left kidneys). Serum and urine samples were collected before and 12-24, 36-48, and 60-72 hours later for NGAL, KIM-1, IL-18, and Cys-C measurements. In the trauma group, there was a statistically significant increase in post-operative NGAL, KIM-1, and IL-18 values after 12-24 h and 36-48 h, as compared with pre-operative values. There was also a statistically significant increase in post-operative serum and urine Cys-C values after 60-72 h, as compared with pre-operative values. NGAL, KIM-1, and IL-18 may represent novel non-invasive descriptive candidate biomarkers of early-stage tubular damage in children with renal trauma.

Summary Introduction Hypospadias is one of the most common congenital anomalies of the male genitalia. Sonic hedgehog homologue (SHH) signalling pathway is believed to be involved in the development of the male genital system. Objective In this clinical prospective study, the role of the SHH pathway in hypospadias aetiology was investigated. Study design In this study, 200 healthy children (boys without hypospadias, control group), 118 patients (boys with distal hypospadias) and 82 patients (boys with proximal hypospadias) of age 0–16 years were included. The expression of the genes suppressor of fused protein (SUFU), SHH, protein patched homologue (PTCH; PTCH1 and PTCH2), glioma-associated oncogene homologue (GLI; GLI1, GLI2, GLI3 and GLI4), smoothened, frizzled-class receptor (SMO) and serine/threonine-protein kinase 36 (STK36) that are involved in SHH pathway were investigated. Furthermore, polymorphism analyses of GLI2, SHH and PTCH1 genes were performed. The history of hypospadias in the first and second-degree relatives of the patients in boys with distal hypospadias and boys with proximal hypospadias was inquired. Results Ten patients in the boys with distal hypospadias and twenty patients in the boys with proximal hypospadias had a history of hypospadias in first or second-degree relatives (p 0.05). Discussion SHH expression is required for the growth and differentiation of the genital bulge. Developmental defects in the external genital organs were demonstrated in mice with SHH deletion. It has been demonstrated that SHH mainly plays a role in the formation of sinusoid morphology of the penis. In the present study, although SHH and PTCH gene expressions were found to be decreased only in the penile tissues of proximal hypospadias, GLI2 gene expression was decreased in penile tissues of boys with both distal hypospadias and boys with proximal hypospadias. Conclusion Genes involved in the SHH pathway might play a role in the aetiology of hypospadias. Furthermore, there is a correlation between molecular defects in this pathway and severity of hypospadias. Summary Table . Fold-changes in mRNA expression in genes examined in penile tissue among cases with distal hypospadias and with proximal hypospadias. No Cases with distal hypospadias Cases with proximal hypospadias Gene name mRNA fold-change p-value∗∗∗ mRNA fold-change p-value 1 SUFU 1035 0.898 1028 0.922 2 SHH 1087 0.753 0451 0.044∗ 3 PTCH1 1087 0.754 0441 0.041∗ 4 PTCH2 1035 0.899 1035 0.901 5 GLI1 1157 0.586 1133 0.639 6 GLI2 0,330 0021∗ 0,302 0018∗ 7 GLI3 1181 0.537 1117 0.676 8 GLI4 0.818 0457 0.877 0609 9 SMO 0.920 0746 0.986 0948 10 STK36 1214 0.475 1275 0.378 p calculated as One way anowa test. ∗p

Summary Introduction Kidneys are the most frequently injured organ in the genitourinary system, but there is no specific biological marker for this trauma. Renalase may be a descriptive biomarker of the pathology that causes renal ischemia, nephrotoxicity, and acute renal failure. Objective This study investigated the role of serum and urine levels of renalase for the diagnosis of renal injury in rats with experimentally induced blunt renal trauma. Study design Thirty 3-month-old Sprague–Dawley adult male rats were divided into five groups (n = 6) as follows: control (Group 1), sham (Group 2), right nephrectomy (Group 3), left renal trauma (Group 4), and right nephrectomy plus left renal trauma (Group 5). Serum samples were acquired 3, 24 and 48 h post-trauma, and urine samples were acquired between 0–24 and 24–48 h post-trauma. Changes in serum and urine levels of renalase, dopamine, epinephrine, metanephrine, normetanephrine, urea, and creatinine were assessed after blunt renal trauma. Results No significant changes in serum levels of these compounds were observed at 3 h post-trauma in Groups 1 and 2 or in urine collected sequentially at 0–24 and 24–48 h. By contrast, levels of renalase, dopamine, metanephrine, and normetanephrine in serum increased during hour 3 in Groups 4 and 5. Moreover, increases in urine levels of renalase, dopamine, epinephrine, metanephrine, and normetanephrine were observed at hours 0–24 in Groups 4 and 5. Discussion A definitive diagnosis of traumatic renal injury in children is made with contrast-enhanced computed tomography. However, the scan results in high doses of radiation exposure to children. Here, we report for the first time that renalase levels may be useful as a biomarker for the diagnosis of renal injury due to blunt renal trauma. Conclusion Renalase may be a simple, effective, and noninvasive biomarker that indicates traumatic renal injury. It could be used as an adjunct for evaluation, particularly for isolated traumatic renal injury in cases where access to computed tomography is not straightforward. Download : Download high-res image (507KB) Download : Download full-size image Summary Figure . Renalase levels in a) serum (3, 24, and 48 h) and b) urine (0–24 and 24–48 h).

Germ cell tumors may manifest as a burned-out testis tumor in the abdomen that is characterized by lymph node metastasis or another manifestation of a metastatic neoplasm with a partially or totally histologically regressed, occult primary tumor in the testis.An 8-month-old boy presented with abdominal mass and hypospadias. On physical examination, a palpable abdominal mass in the left abdomen, the absence of the left testis in the scrotum, and hypospadias were found. Color flow Doppler ultrasonography revealed a well-defined, hypoechoic mass with no vascular flow. A laparoscopy was performed. No testis was found in the inguinal region and the abdomen. An amputated, smooth surface with brown color mass was found in the retrovesical area of the peritoneum. The mass was removed, and macroscopic examination of the lesion yielded a well-defined, stone hard mass. No live tissue was found histopathologically. Immunohistochemical studies revealed relatively positive findings for germ cell tumor.To our knowledge, this case report is the first burned-out germ cell tumor that developed in the undescended testis in children. Here, we present the clinical and imaging findings of a burned-out germ cell tumor of the undescended testis.

A ventriculoperitoneal (VP) shunt is a standard treatment option for the treatment of hydrocephalus. Small bowel perforation is a rare complication of VP shunt placement. We describe a case and image findings of a 15-year-old male with VP shunt who had an asymptomatic small bowel perforation. He had a history of constipation and occasional abdominal pain. The imaging findings were confirmed surgically. The results of abdominal complications of VP shunts are excellent when diagnosed and treated early. Mortality and morbidity decrease significantly with early diagnosis and treatment, especially in asymptomatic bowel perforations. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

Comamonas testosteroni (formerly Pseudomonas testosteroni) is a common environmental bacterium, which is not a part of the human microbiome. It is rarely found as an infectious agent in clinical practice. The bacterium has low virulence potency and rarely causes human disease. Although this agent is generally considered to be of low virulence, reports of infections with C. testosteroni are increasing. With the exception of intra-abdominal infections, C. testosteroni is mainly reported as an opportunistic pathogen in immunocompromised patients. However, C. testosteroni has also been reported as a pathogen in patients with appendicitis (especially when perforated), suggesting that this bacterium may belong to the normal intestinal microbiota of some individuals. In this article, we present two children with appendicitis in whom C. testosteroni was isolated from appendix tissue samples.

The hydatid cyst (HC) is an endemic parasitic disease worldwide. Although the HC can locate in every part of a body, it rarely occurs over the abdominal wall. A 12-year-old female patient was brought to Department of Pediatric Surgery, Firat University School of Medicine, Elazig, Turkey in 2017. She had been suffering from abdominal pain for one week. A lump was determined underneath her skin in the suprapubic region. It was swollen, tense and movable. A cystic mass filling the midline was found in the radiological bladder superior. It was an anechoic cyst causing ondulation on the muscles of the anterior abdominal wall. The sizes of the mass were measured approximately as 9x7 cm (mesentery cyst?). The cystic mass was occurred in the urachal area of the anterior abdominal wall, not in the abdomen. After the cyst was emptied with applying mini median incision below the umbilicus, we saw the germinative membrane inside the cyst. Diagnosis of the HC was confirmed with the pathologic evaluation. For the differential diagnosis of a pure cystic mass, which can locate in every part of a body, diagnosis of the HC should be considered.

Tartar T, Sagmak-Tartar A, Sarac M, Bakal U, Akbulut A, Kazez A. Does microbial resistance profile change in community-based intra-abdominal infections? Evaluation of the culture results of patients with appendicitis. Turk J Pediatr 2018; 60: 520-526. Most common origin of intra-abdominal infections in children is appendicitis. Microorganisms responsible for community-based and hospital-acquired intra-abdominal infections vary. The aim of this study was to evaluate microbial culture outcomes and antibiotic susceptibilities of these microorganisms in samples obtained intraoperatively from pediatric patients with appendicitis, and to define the infectious microorganisms responsible for the community-based intra-abdominal infections in our region, and their antibiotic susceptibilities. This study included 231 patients between 0 and 16 years of age, operated on due to appendicitis between 2014 and 2017. Appendicular tissues were sampled intraoperatively. Antibiogram was studied in case of reproduction in tissue culture. Forms included information on the age and gender of the patients, intra-abdominal event, bacterial growth in microbial culture and antibiogram, antibiotic switch during follow-up, duration of the treatment, complications and outcomes were recorded. No microbial growth was observed following inoculation of the samples obtained from appendiceal tissue of 24.7% patients, whereas growth was positive in 75.3%. Gram negative bacteria were isolated in 94.3% of the patients, whereas gram positive bacteria was isolated in 5.7%. Polymicrobial growth was observed in 2.2% of the patients. E. coli in 79.9%, P. aeruginosa in 5.2%, Enterobacter cloacae in 3.4%, Coagulase-negative staphylococci in 3.4%, Klebsiella spp. in 1.7%, Citrobacter spp. in 1.7%, Enterococcus spp. in 1.7%, Comamonas testosteroni in 1.2% of patients produced. ESBL positivity is present in 51 (36.7%) of 139 E. coli strains reproducing in appendiceal tissue culture. ESBL was positivity detected in one of the reproduced 3 Klebsiella spp. strains. In E. coli, ciprofloxacin resistance as 20.86%, ampicillin-sulbactam resistance as 83.45%, and co-trimoxazole resistance as 41% were found. Our study clearly demonstrates that the resistance profile varies in community-based intra-abdominal infections. Empirical treatment protocols should be revised in especially the patients admitted with septic presentation and where the source control is not possible.

The aim of this study was to present our experiences with, as well as the factors that affect, the treatment and outcome of patients with neonatal gastrointestinal perforations (GIPs). Thirty-eight newborn cases that were operated on for GIP in our hospital’s tertiary newborn intensive care unit between January 2005 and December 2015 were retrospectively evaluated. The patients were divided into the two following groups: group 1, perforations related to necrotizing enterocolitis (NEC), and group 2, non-NEC perforations. In total, 38 patients (16 males, 22 females) participated in this study. The perforations were related to NEC in 12 patients (group 1; 31.6 %), and the other 26 patients (group 2; 68.4 %) were classified as non-NEC perforation cases. The incidence of neonatal GIP was 0.53 % in all newborn patients, while the incidence of perforation in NEC cases was 20 %. Of all patients, 25 (65.7 %) were premature. Non-NEC pathologies were the most common cause of GIP (68.4 %) and included stomach perforation related to a nasogastric catheter (n = 5), volvulus (n = 4), intestinal atresia (n = 3), esophageal atresia and tracheoesophageal fistula (n = 2), cystic fibrosis (n = 2), Hirschprung’s disease (n = 2), appendicitis (n = 2), congenital stomach anterior wall weakness (n = 1), duplication cyst (n = 1), invagination (n = 1), incarcerated inguinal hernia (n = 1), and idiopathic causes (n = 2). Primary surgical repair was performed in all cases without a conservative approach. The mortality rate related to GIP in newborn cases was 47.3 %. While the mortality rate in group 1 was 66.6 %, it was statistically insignificantly lower in group 2 (38.4 %) (p > 0.05). In group 1, the mortality rate of those with intestinal and colorectal perforations was 45.6 and 20 %, respectively (p > 0.05). Non-NEC pathologies are the most frequent causes of GIP in newborns, and primary surgical repair is the primary treatment choice for neonatal GIP. However, GIP remains one of the most significant causes of mortality in newborns. While the prognosis for neonatal colon perforation is good, that for stomach and jejunoileal perforations is worse.

Choledochocele (type 3 choleduct cyst) is rarely seen in children. Here we report the case of a 5-year-old female who complained of abdominal pain for 2 years. A choledochocele with a diameter of 31 mm localized on the second part of the duodenum, in the periampullary region, was detected. Upper gastrointestinal endoscopy revealed a mass starting from the second part of the duodenum and constricting the duodenal lumen. A 2-cm-long incision was made at the apex of the cyst using a needle tip sphincterectome and three 5- to 6-mm stones were extracted. There were no postoperative complications.

Aim Bochdalek hernias, which brought after the neonatal period, are also late-defined cases. In this study, we aimed to present the clinical characteristics of patients with late-presentation Bochdalek hernias who underwent surgery in a reference hospital and our experience regarding their diagnosis. Material and methods Patients with late-presentation Bochdalek hernia who underwent surgery in our clinic between 2001 and 2016 were analyzed retrospectively in terms of the causes of the delay in diagnosis, symptoms, and radiologic and surgical results. Results A total of seven patients with late-presentation Bochdalek hernia underwent surgery, four males and three females. The median age was 48 months. Of the 43 patients who underwent surgery for Bochdalek hernia during the same period, 7 (16.27%) presented to hospital late. In all late-presentation Bochdalek hernia cases, the defect was on the left side. Two patients had hernia sacs, and two patients had ectopic intrathoracic left kidneys. Six of the patients presented with gastrointestinal system symptoms, and one with respiratory system symptoms. The median time between the onset of symptoms and diagnosis was 60 days. The maternal age of four patients was ≥30 years. The gestational age and birth weights of the patients were normal. In physical examination, there was a scaphoid abdomen and an increased chest anterior-posterior diameter. In chest radiographs of all patients, the appearance was consistent with intestinal gas in the left hemithorax. The transverse length of the defect in the diaphragm (median value: 5 cm) in the patients with late-presentation Bochdalek hernia was longer than that (median value: 3 cm) of patients who were diagnosed early (p=0.02). The difference was statistically significant. All patients survived, were followed up for an average of 3 years, and no relapse was observed during the follow-up period. Conclusion Bochdalek hernia can be diagnosed after the neonatal period. Contrary to cases diagnosed in the neonatal period, gastrointestinal system symptoms are at the forefront in these cases, and these patients have good prognosis. Congenital diaphragmatic hernia should be considered in the differential diagnosis in patients with gastrointestinal system symptoms such as recurrent nausea and vomiting.

Background/aims Littre hernia (LH) is difficult to distinguish from other hernias until complications arise. In this research, we present the details of diagnosis, treatment, and frequency of LH cases with differentiated clinical properties. Materials and methods Littre hernia prevalence, clinical properties, and treatment details of cases diagnosed as incarceration/strangulation (I/S) of hernias between December 1996 and December 2017 were retrospectively investigated. Results Incarceration/strangulation was detected in 403 out of 3758 hernias within 21 years. Four cases were detected as LH (0.09%) in 403 I/S patients. Partly reduced 2 cases were treated by resection/anastomosis with the abdominal approach. Conclusion The possibility of LH in strangulated or partly reduced hernias should be considered. The abdominal approach may be necessary in nonreducible hernia with possible LH patients.

Objective: Appetite loss is seen in 90% to 95% of patients with acute appendicitis; however, the cause of this symptom remains unknown. This study is performed to determine whether changes in the blood levels of two anorexigenic hormones, leptin and NUCB2/nesfatin-1, can help to diagnose acute appendicitis in children and whether these two parameters can distinguish acute appendicitis from abdominal pain. Methods: Sixty children with comparable ages and body mass indices are divided into three groups of 20 children each: those with acute appendicitis, those with abdominal pain, and controls. The blood sample with acute appendicitis is taken preoperatively (T1), and subsequent samples are taken 24 hrs postoperatively (T2) and 3 days postoperatively (T3). The blood sample with abdominal pain subjects is also taken in the corresponding times with those with acute appendicitis while blood sample from controls is only taken in the T1 corresponding time. Leptin and NUCB2/nesfatin-1 levels are measured by enzyme-linked immunosorbent assay. Results: The serum leptin levels are significantly higher preoperatively than postoperatively in all three groups. The NUCB2/nesfatin-1 levels at T1 in acute appendicitis are significantly higher than those at T2 in all three groups, but are restored at T3 to levels similar to those of controls. Neutrophil percentage has a sensitivity of 100%, and specificity of 76.32%, NUCB2/nesfatin-1 level has a sensitivity of 47% and specificity of 95%, and the leptin level has a sensitivity of 64% and specificity of 51% in the diagnosis of acute appendicitis. Conclusions: High preoperative leptin and NUCB2/nesfatin-1 levels may be a causative factor for appetite suppression observed in patients with acute appendicitis. High preoperative and low postoperative serum leptin and NUCB2/nesfatin-1 concentrations may serve as new candidate biomarkers that help to distinguish acute appendicitis from abdominal pain in children in addition to high CRP concentration, high WBC count, and neutrophilia.

Background Amyand`s hernia is rarely noted in children, and appendicitis caused by a foreign body in Amyand`s hernia is even rarer. Case A 2-year-old girl presented with recurrent conglomerate lymph node enlargements and an abscess in the right groin existing for one year despite medical treatment. Direct radiography revealed a foreign body in the right inguinal region. Computed tomography showed a foreign body and soft tissue inflammation in the inguinal canal. Laparotomy was performed, and Amyand`s hernia was diagnosed. A foreign body was found in the lumen of the appendix vermiformis causing perforated appendicitis. This case is presented because of its rarity and unusual clinical presentation. Conclusion Amyand`s hernia should be considered in paediatric cases with the history of recurrent inguinal abscesses.

Objectives: The relationship hydatid cyst (HC) is a parasitic disease that is endemic worldwide. Aims: To study the clinical findings and laboratory results of patients with hydatid disease. Materials and Methods: Total number of patients (n = 78) who underwent surgery for HC disease from 2000 to 2017 were retrospectively evaluated. The patients’ demographic characteristics, reasons for admission into hospital, lesion location and size, laboratory results, andcomplications were recorded. Results: Of the HCs, 59% and 26.9% were located in the liver and lungs, respectively. The rate of multiple organ involvement was 10.3%. A total of 16 (20.5%) cases had ruptured HCs (7 livers, 7 lungs, 1 spleen, and 1 omentum). There was no significant difference in the rate of eosinophilia between patients with and without cyst rupture (P = 0.9). Indirect hemagglutination (IHA) tests yielded negative results in 38.9% of the patients; among them, 32.1% had ruptured HCs. A negative IHA test result was significantly associated with rupture (P = 0.046). No significant difference between ruptureand cyst size or location was found. Conclusions: HC rupture was not correlated with cyst size. The sensitivity of serological tests and the blood eosinophil count was low, even in cases of ruptured HCs. The recurrence rate can be reduced by open surgery and medical treatments. Keywords: Child, echinococcosis, hemagglutination test, recurrence, rupture

Background Hypertrophic pyloric stenosis (HPS) is a rare cause of non-bilious vomiting in young infants; the condition requires surgical management. Diagnosis is based on clinical, laboratory, and radiological findings. In the present study, we evaluate recent changes in the features of HPS. Method We retrospectively reviewed the demographic, clinical, and laboratory data on 56 HPS patients who underwent pyloromyotomy between 1996 and 2015. Patients were divided into two groups according to date of operation (group 1, 1996–2006; group 2, 2007–2015). Results Group 1 consisted of 30 patients and group 2, 26. The age at diagnosis was longer in group 2 (43.3 ± 13.1 days) than group 1 (37.4 ± 17.7 days). All diagnoses were confirmed on ultrasonography. Pyloromyotomy was performed on all 56 patients (48 boys, 8 girls). Significant between-group differences were evident in terms of age at onset of vomiting; rate of dehydration; development of palpable olive-shaped abdominal mass; serum urea and creatinine; acid–base status; and air distribution pattern on abdominal radiography (all P

Background: During foreign body aspiration (FBA), identifying the type of object is frequently problematic. Objectives: This study assessed density changes over time in the most common organic, FBA materials using virtual bronchoscopy. We also examined volumetric changes in materials to determine the optimal removal time for each type of foreign body. Materials and Methods: Size-appropriate slots for each type of foreign body were created on a 2 × 30 × 30 cm sponge plate. Objects (shelled and blanched peanuts, roasted chickpeas, hazelnuts, walnuts, almonds, pistachios, watermelon seeds, shelled and unshelled sunflower seeds, shelled and unshelled pumpkin seeds, chickpeas, beans, lemon seeds, and apple seeds) were placed into the slots, after which a second sponge, with identical dimensions, was placed over the top of the first sponge to achieve closure. A moist environment was maintained for 7 days at body temperature (37°C). Multidetector computed tomography (MDCT) images of the sponges, volume and density measurements of objects performed each day were recorded. Intra-object differences in density and volume over time on MDCT were evaluated using time-density and time-volume curves, respectively. The SPSS for Windows software package (ver. 21.0; SPSS Inc., Chicago, IL, USA) was used to perform analyses. Pearson correlation analyses were used to determine differences in the volume and density of FBA materials across days. A time volumetric graph was also obtained. P < 0.05 was considered as significant. Results: Following aspiration, organic material volumes on day 7 were below baseline values, although objects exhibited a 30% average increase in volume during the first 4 days. The density values of objects increased between days 2 and 5, and decreased thereafter. Conclusions: Measuring daily changes in density allows for the identification of FBA materials. Our data indicate that object removal during days 1 - 3, and on day 7 should be easier compared to days 4 - 6.

Cystic abdominal masses in children are not an infrequently encountered condition of childhood. These lesions usually present with large size and mimick each other with similar presenting symptoms. Imaging examinations have an important role to determine the type of the cystic abdominal masses, which is crucial for management of patients and presurgical planning. In this pictorial essay, we summarized the imaging features of common cystic abdominal masses of children, including cystic lesions arising from liver, biliary ducts, kidney, pancreas, bowel, ovary, mesentery, and miscellaneous tissues. (C) 2013 Elsevier Inc. All rights reserved.

Background To evaluate whether there is an association between single nucleotide polymorphisms in magnesium-permeable TRPM6 ion channel and development of meningomyelocele (MMC). Therefore, we examined a total of 150 children with MMC, along with age- and gender-matched controls. DNA collected from whole blood was analyzed for the presence of two polymorphisms, rs2274924 (A > G; K1579E; Leu1579Glu) and rs3750425 (G > A; Val1393Ile), in TRPM6. Serum Mg2+ and calcium levels were also examined. Results A statistically significant difference in the distribution of rs2274924 genotypes (p = 0.049) was observed between the groups. Decreases in the AA genotype, and increases in the AG heterozygous genotype were also detected in the study group. The distribution of polymorphisms in the rs3750425 genotype and alleles was not statistically different between groups. Serum Mg2+ levels were lower in the GG genotype of rs3750425 compared with the GA and AA genotypes (p = 0.003). Conclusions A statistically significant difference in rs3750425 genotypes was observed between the patients with MMC and the controls, which corresponded to lower serum Mg2+ concentrations in these patients. Taken together, these results suggest that genetic variations in the Mg2+-permeable TRPM6 ion channel may play a role in the etiopathogenesis of MMC during embryonic development.

The aim of this study was to review our 20 years of experience determining the common mechanisms of perineal trauma and initial management to evaluate the effects of classification for treatment. A total of 75 children with perineal injuries were reviewed retrospectively, including patient demographics, mechanism of injury, associated injuries, injury severity score, presenting symptoms and methods of diagnosis and treatment. Amongst the 75 children (55 females and 20 males; mean age, 8 years), fall from height, followed by motor vehicle crash and sexual abuse were the most common reasons for injury. The most common symptom on presentation was bleeding, followed by abdominopelvic pain and tenderness. Eleven patients were allowed to heal secondarily, and 64 were examined under general anaesthesia. The affected area was repaired in 48, further diagnostic tools were needed in 20 and 11 cystoscopic, 10 rectoscopic, and 5 vaginoscopic evaluations were performed. Six patients with full-thickness injuries that extended to the peritoneum were treated with colostomy, and all were victims of motor vehicle crashes. The genital injury score is a useful genital trauma scale for predicting anogenital injury severity. Identifying the mechanism and severity of perineal and associated injuries under general anaesthesia may facilitate appropriate classification and management.

Context: Bladder perforations in children occur due to several different reasons.Aim: In this clinical series study, we focused on bladder perforations due to the pelvic injury, and our aim also was to create awareness for a rare type of bladder injuries.Setting and Design: This was a retrospective study of the patients who were treated in our clinic for bladder perforation between 2006 and 2011.Subjects and Methods: We reviewed the documents of childhood bladder perforations, and demographic and clinical characteristics of the patients were obtained. No statistical analyses were used because of the limited number of cases.Results: There were ten patients who suffered from bladder perforation in 5‑year period; 5 were male, and 5 were female. The mean age of the patients was 4.35 years. Four patients (40%) experienced iatrogenic perforation and six patients (60%) experienced perforation due to the accident. Common symptoms were hematuria, abdominal tenderness, and inability to urinate. Three patients were diagnosed via emergency laparotomy, without any radiological examinations performed before surgery. Four patients suffered from the intraperitoneal perforation, three patients suffered from extraperitoneal injury and three of them both of intraperitoneal and extraperitoneal injuries. Mean recovery time for patients was 15 days. One patient developed a urinary tract infection and one newborn died due to accompanying morbidities. Nine patients were discharged from the hospital.Conclusion: If the patients had a pelvic injury, surgeons must pay attention for the bladder perforation. Isolated bladder perforations are rare, and they are generally associated with iatrogenic injuries. Clinicians should pay attention to findings such as anuria, inability to insert a urinary catheter, and free fluid in the abdomen in order to diagnose the bladder perforation in newborns. Novice surgeons should pay more attention to avoid causing iatrogenic bladder perforation during inguinal hernia repair.Keywords: Bladder, child, iatrogenic, perforation, trauma

Bochdalek hernia is a congenital abnormality with high morbidity and mortality characterized by passage of the abdominal organs into the thoracic cavity through a diaphragmatic defect. Intrathoracic location of abdominal organs such as kidneys is very rare, with a reported incidence of only 0.25% in the literature. Herein, we present two cases of Bochdalek hernia with a herniation of intra‑abdominal organ such as kidney that was treated in our clinic and compare this rare case with those in the literature. In both cases, the functionally normal kidneys were left in situ during diaphragmatic repair. No complications were observed during the postoperative period, and 10‑ and 1‑year follow‑ups. In cases with Bochdalek hernia associated with an intrathoracic ectopic kidney, the functionally normal ectopic kidneys were left in situ during repair of the diaphragmatic defect without complications.Keywords: Bochdalek hernia, intrathoracic ectopic kidney, review of literature, two case reports

Congenital diaphragmatic hernia (CDH, Bochdalek type) is rarely seen in both members of identical twins. Herein, we report a 37 weeks′ twins with CDH along with a brief review of the literature. Both the neonates survived.

Report of incidentally detected sewing needles on plain abdominal radiographs in two patients without any prior history of ingestion or of being pierced: one in the liver and the other in the peritoneum encased by omentum. These case reports point out a rare mode of entry of needles into the abdominal cavity by penetration from outside.

WOS: 000371416800009 PubMed ID: 27026889 Objective: Appendicitis is very commonly encountered in emergency clinics. There is an urgent need for early and accurate predictive biomarkers of appendicitis in order to save lives, because currently-available biomarkers are imprecise and their delayed response impairs the ability of emergency doctors and pediatric surgeons to provide timely and potentially effective therapies. This study was performed to determine whether changes in the blood levels of neutrophil gelatinase-associated lipocalin (NGAL) can help to diagnose acute appendicitis in children and distinguish acute appendicitis from abdominal pain. Methods: Sixty children were enrolled and divided into three groups, with 20 patients per group: Group 1 (patients with appendicitis), Group 2 (patients with abdominal pain) and Group 3 (control). Blood NGAL levels were determined by ELISA. Results: The basal average serum NGAL levels were 8.2 ng/ml for Group 1, 3.9 ng/ml for Group 2, and 3.3 ng/ml for Group 3. Twenty-four and 72 h after surgery the levels were 5.1 and 2.8 ng/ml, respectively, in Group 1, 2.9 and 2.8 ng/ml in Group 2, and 2.6, 2.7 ng/ml in Group 3. Setting the cut-off point to 7 generated an area under the receiving operating curve (ROC) curve at 95 % confidence interval with 77.3 % sensitivity and 97.4 % specificity. Conclusion: These data indicate a significant difference in NGAL values between basal and postoperative measurements in appendicitis patients (p < 0.05). The ROC curve results showed that NGAL is a promising novel biomarker for the differential diagnosis of acute appendicitis from abdominal pain. FUBAP (Firat University Research Fund)Firat University [TF.12.35-2012] We would like to thank the FUBAP (Firat University Research Fund) coordinator ship (Project No: TF.12.35-2012) for financial support. We also thank Dr. Nurhan Halisdemir and Dr. Emrah Firat for statistical analysis.