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Epispadias and exstrophy of the cloaca, also known as OEIS complex (omphalocele, exstrophy, imperforate anus, spinal defects), respectively constitute the most benign and severe ends of the bladder exstrophy-epispadias complex (BEEC) spectrum. In 2009, El-Hattab et al. reported the first patient with OEIS complex associated with a chromosome 1p36 deletion. Here we report a second patient with 1p36 deletion who also has classic bladder exstrophy, supporting the possible role of genes in this region in the development of BEEC. The absence of omphalocele and imperforate anus in our patient places him toward classic bladder exstrophy while presence of spina bifida and the absence of coccyx suggest an overlap with OEIS complex. An additional differential diagnosis is the pentalogy of Cantrell in our patient as he also has a diaphragmatic hernia and an incomplete sternum. This is the second observation of a ventral midline birth defect in association with 1p36 deletion syndrome, following El-Hattab et al.'s report [2009]. The three genes (NOCL2, DVL1, and MMP23B) discussed as possible candidates are also among the deleted ones in our patient, supporting the possible role of these genes in BEEC spectrum. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Purpose: The study was undertaken to assess the efficacy of ultrasound-guided saline enema in reducing intussusception and to determine the role of age and duration of symptoms on this event., Methods: The case records of patients who were treated for intussusception at our institutions over the past 10 years were retrospectively analyzed. A total of 419 patients were treated for intussusception and 375 of them were included into the study. Patients were excluded if they had symptoms and signs of acute abdominal disease and required surgery as an initial treatment., Results: Hydrostatic reduction was successful in 313 of the 375 patients (83.46%). The procedure-related complication rate was nil. There were 29 episodes of recurrences in 23 patients, and recurrence rates did not differ between patients who responded to hydrostatic reduction and those who required surgery. Younger age [median (range); 11 months (3-108 months) vs. 20 months (1-180 months); p<0.05], rectal bleeding (p<0.01) and long duration of symptoms [mean (range); 1.95 days (1-7 days) vs. 1.44 days (1-10 days); p<0.01] were significantly associated with failed hydrostatic reduction., Conclusion: Ultrasound-guided hydrostatic reduction is an easy, safe and effective method for the treatment of intussusception in the absence of acute abdominal findings., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Neonatal colonic perforation is a rarely seen condition. Plain abdominal radiography of a 28-hour newborn consulted for vomiting and bloody stool revealed the presence of subdiaphragmatic free air, which necessitated surgical exploration. Transverse colonic perforation was detected during the exploration, and subsequently, a colostomy and appendectomy were performed. The postoperative follow-up period was uneventful. Necrotizing enterocolitis, Hirschsprung disease, and mechanical obstruction are some of the causes of colonic perforation during the neonatal period. Herein, we have shared a case of colonic perforation in an asphyctic newborn delivered after prolonged labor.

Purpose: Testicular torsion can be thought of as an ischemia/reperfusion (I/R) injury to the testis. This study aimed to investigate the effects of taurine (TAU) and carnosine (CAR), which are strong antioxidants, on experimental testicular I/R injury model., Methods: Male Wistar albino rats were divided into four groups with eight animals in each. A sham operation was performed in group 1. To create testicular I/R, the left testis was torsioned 720° for 2 h followed by 2 h of detorsion. Groups 2 (I/R), 3 (I/R + TAU) and 4 (I/R + CAR) received intraperitoneal saline, TAU (250 mg/kg) and CAR (250 mg/kg), respectively, 1 h before detorsion. Thiobarbituric acid reactive substances (TBARS), diene conjugate (DC), protein carbonyls (PC), nonprotein sulfhydryl (NPSH), and vitamin C levels were measured in testis tissues as well as superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities. Histopathological evaluation was also performed., Results: TBARS, DC, and PC levels were significantly increased in I/R group. TAU and CAR did not alter TBARS levels, but decreased the elevated DC and PC levels. There were no changes in testicular NPSH levels, SOD, and GPx activities in all groups; however, vitamin C significantly decreased in I/R group. CAR treatment was found to increase vitamin C levels as compared to I/R group. Histopathologically, both I/R + TAU and I/R + CAR groups showed significant increase in testicular spermatogenesis in comparison to I/R group., Conclusion: Our results indicate that TAU and CAR reduces oxidative stress and may have a protective role in testicular I/R injury.

Thoracic empyema is a life-threatening condition in paediatric surgical practice and the appropriate management still remains controversial. The authors reviewed 79 (37 boys, 42 girls) cases of empyema thoracis who underwent thoracotomy and decortication between 1990 and 2005. The initial diagnosis based on history, physical examination and radiology was confirmed by thoracentesis. Fever, cough and dyspnoea were the most common presenting symptoms. In all cases aerobic cultures were performed and Staphylococcus aureus was the most common microorganism isolated. All patients except three received antibiotics and tube drainage as an initial treatment. The decision for early decortication was based on persistence of fever, dyspnoea, air leakage and lack of resolution on CT scan, in spite of medical therapy and tube drainage, at the end of 10 days. All but one with wound dehiscence showed rapid recovery and they were discharged on the fifth to eighth postoperative days. In conclusion, early decortication is a safe and curative treatment in childhood empyema thoracis with low morbidity.

Accidental corrosive ingestion is one of the common problems causing serious esophageal strictures in children. The acute phase treatment has a great effect on stricture development. In this study we aim to present our experience in the management of caustic ingestion, particularly during the acute phase. From January 1990 to January 2005, 296 children were admitted to our clinic with caustic ingestion. Ninety-one patients who received dilatation treatment due to esophageal strictures constituted the present study group. Forty-three of them were admitted to our centre immediately after caustic ingestion (Group A) whereas 48 of them received some kind of treatment in other hospitals and were referred us with the diagnosis of stricture 6 to 12 weeks after ingestion (Group B). In the acute phase, the patients were given nothing orally until esophagoscopy was performed in the first 24-48 hours. The patients with grades 2b and 3 lesions underwent a week of esophageal rest by using a nasogastric tube. IV fluids and broad-spectrum antibiotics with a single-dose steroid were given. IV ranitidine was also added to the medical treatment. If there were stricture formations on barium meal after 3 weeks, these patients underwent esophageal dilatation programmes. The response rates to dilatation treatment were higher in group A. In addition, increased perforation rates were observed in group B. Sixty per cent of patients in group A but none of the patients in group B have recovered in the first year. In conclusion, after caustic ingestion, esophageal rest combined with supporting treatment seems to provide a good success rate with respect to prevention of stricture development and other troublesome complications.

Oesophageal strictures developing after caustic ingestion in children are a serious problem, and several protocols to prevent stricture formation have been proposed. A prospective clinical trial was conducted for preventing strictures in caustic oesophageal burns in a single clinic, and the results are presented. All children with caustic ingestion who had oesophagoscopy for diagnosing the severity of the burn were included in the study. Eighty-one children were included in the series, with ages ranging between 3 months and 12 years. The patients were given nothing by mouth until oesophagoscopy. IV fluids, broad-spectrum antibiotics, ranitidine, and a single-dose steroid were given. Oral burns were positive in 66 patients. Oesophagoscopy revealed a normal oesophagus in nine patients, grade 1 burn in 24, grade 2a in 21, grade 2b in 23, grade 3a in two, and grade 3b in one. Patients with grade 1 and 2a burns were discharged after oesophagoscopy. Patients with grade 2b and all grade 3 burns were given nothing by mouth for a week except water when swallowing their saliva, and were fed via total parenteral nutrition. After the 1st week, if there was no problem with swallowing, liquid foods were introduced. No intraluminal tubes were used. At the end of the 3rd week, a barium meal was administered and an upper gastrointestinal series taken. Dilatation was performed at 2-week intervals for strictures, which developed in one grade 2a patient, six grade 2b patients, and the grade 3b patient. Only one of these patients is currently on an oesophageal dilatation program. Limiting oral intake and avoiding foreign bodies in the oesophagus seem to provide a good success rate; however, further prospective studies are needed to decrease the incidence of corrosive oesophageal strictures.

Although extra-intestinal non-typhoidal Salmonella infections are common in developing countries, infection of the mesenteric cyst with Salmonella enteritidis is an extremely rare occurrence. Review of the English literature has revealed one report up to this date. The case of a 4-year-old boy with a mesenteric cyst infected with Salmonella enteritidis is presented.

Hepatoblastoma is the most common primary liver tumour in children. Complete surgical removal is the treatment of choice for cure; however, in most cases the tumour is unresectable because of its extensive hepatic involvement. Nineteen pediatric cases (11 boys, 8 girls) with ages ranging from three months to 17 years were referred for management to our clinic from 1982 until 2000. All but three suffered from abdominal distention. The other frequent complaints were abdominal mass, anorexia, fatigue, abdominal pain and fever. Physical examination revealed enlarged liver in all patients. In addition to laboratory studies, they were pre-operatively examined by ultrasonography and, in recent cases, computed tomography was also used. Serum alpha-fetoprotein levels were found to be elevated in all patients. In thirteen cases, hepatic resections (10 lobectomies, 2 trisegmentectomies, 1 segmentectomy) were performed. In six children only liver biopsies could be done because of the huge tumour size. However, in three of them the tumours were excised at the second laparotomy, but only one patient survived. All of the patients - except two who were lost in the early postoperative period - received chemotherapy whether the tumour was excised or biopsied. In this series the mortality rate was found to be very high (91%) in the 1980s, and more reasonable (50%) in the 1990s, with an overall mortality rate of 73 per cent. This result might be explained with late referral and advanced stage at diagnosis. In addition, we speculate that a combination of improved chemotherapy and technical advances in anesthesia and hepatic resection caused the obvious differences in the survival rates between the two periods.

Gastric outlet obstruction is a common late result after acid ingestion; early complications, such as gastric necrosis or perforations are unusual. This is a report of a patient with the history of strong acid ingestion who underwent total gastrectomy due to perforation and extensive necrosis of the stomach.

Intestinal ischemia-reperfusion (IIR) is a complex phenomenon causing local and remote tissue destruction, and even multiple-organ failure. To examine the hypothesis that IIR affects renal function, 21-day-old male Sprague-Dawley rats underwent 45 min superior mesenteric artery occlusion and control rats were subjected to a sham laparotomy. After 2 and 24 h and 1 week of reperfusion, blood was sampled for urea and the kidneys were harvested for lipid peroxidation and histologic examination. Malondialdehyde (MDA) levels as an indicator of lipid peroxidation were significantly increased in renal tissue after 2 h of reperfusion, and this finding was in accordance with serum urea levels (SU) and endothelial injury. However, at 24 h of reperfusion MDA and SU had returned to normal. These data were supported by electron-microscopic studies suggesting reversibility of the changes. It is concluded that IIR leads to renal injury and that free radicals may be responsible for this injury.

We presented a case of neonatal hypopharyngeal perforation resulting from extraction of a breech presentation, with symptoms of regurgitation at all feedings and excessive salivation. Inability to pass a nasogastric tube suggested the diagnosis of esophageal atresia. The diagnosis and treatment of this condition is discussed, and the literature is reviewed.