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BACKGROUND: Priapism is a rare condition in children and the treatment algorithm is controversial in this age group. Herein, we report eight cases with low-flow priapism and our stepwise treatment approach in light of literature. METHODS: We present a simple stepwise treatment for low-flow priapism including five steps. Step 1: Cold compress and analgesia while evaluation the priapism and its etiology. Step 2: Corporal aspiration and adrenaline infusion in the ward. Step 3: Modified Winter shunt in the same place. Step 4: Ketamine application and caudal block in the operating room. Step 5: Sapheno-cavernous (Grayhack) shunt. Eight cases with low-flow priapism were reviewed retrospectively. Symptoms, duration of tumescence, the interventions, and step that provide detumescence were recorded. RESULTS: The mean age of patients was 8.5 years (1-17 y). The median time of the priapism before admission was 15 h (4-165 h). The etiological factors were sickle cell disease, hemodialysis due to chronic renal failure, and factor V Leiden mutation in three patients. Detumescence was achieved in one patient at Step 2, in two patients at Steps 3, 4, and 5, respectively. Rigidity of cavernous body was observed in one patient in long-term follow-up. CONCLUSION: Low-flow priapism is a urological emergency that may cause erectile dysfunction. Treatment options should be selected according to a protocol that prevents time loss and avoids more invasive treatment in unnecessary situations. Our algorithm with simple nature and its steps from less invasive to more invasive procedures may be an alternative for the treatment of low-flow priapism.

Patients with nutcracker syndrome (NCS) associated left varicocele are at high risk of varicocele recurrence when treated only with routine surgical approach for varicocele. An eleven year-old boy who had mild symptoms for NCS and left grade 3 varicocele referred to our clinic. To cure varicocele and to decrease left renal vein pressure, an end to end anastomosis was performed between left spermatic vein and inferior epigastric vein after inguinal microscopic varicocelectomy. His six months follow-up was uneventful. In this case report, we present that this method in children with NCS is a safe and effective method.

Aim: The most important stage of percutaneous nephrolithotomy (PNL), which is an effective and reliable method in the treatment of large and complex kidney stones, is to create a suitable and effective tract after the accessory is provided. For this purpose, different techniques such as Amplatz, baloon and Alken dilators have been described. We aimed to compare the efficacy and safety of single-step Amplatz dilatation technique with stepwise Amplatz dilatation technique in pediatric PNL patients. Methods: This is a retrospective cohort study. We evaluated the data from 75 PNL operations performed on 72 pediatric patients in our center within the last decade. The data from single-step dilation technique patient group (group 1, n: 41) and the stepwise dilatation technique patient group (group 2, n: 34) was compared in terms of durations of fluoroscopy and surgery, stone-free and complication rates, pre and postoperative hematocrit levels and blood transfusions rates. Results: There was no significant difference between the groups in terms of demographic data, mean stone burden, duration of surgery, decrease in hematocrit, blood transfusion rates, stone-free rate and complication rates. The median fluoroscopy durations of group 1 and group 2 were 120 and 220 seconds, respectively. Duration of surgery and fluoroscopy were significantly shorter in the single-step dilatation group Conclusion: PNL is a safe and effective procedure for pediatric stone diseases. Performing this procedure with a single-step dilatation technique ensures that children are less exposed to radiation.

Abscess, hemangiomas and soft tissue masses are present in the differential diagnosis of genital masses in children. We aimed to present an adolescent patient with labial angiomyxoma. Fourteen years-old girl had a hard, immobile, painless mass in her right labium which has been growing progressively for last 9 months. Magnetic resonance imaging revealed a 42x33x38 mm sized, multiloculated and lobulated contoured mass in right labium. The mass was excised and the pathological examination was compatible with angiomyxoma. There are no intraoperative or postoperative complications. She had no local recurrence in postoperative 1 year-follow-up. Genitourinary angiomyxomas are rarely seen in adolescent patients. Close follow-up after surgical excision for local recurrence is essential., Çocuklarda genital bölge kitlelerinin ayırıcı tanısında abseler, hemanjiomlar ve yumuşak doku kaynaklı kitleler yer alır. Labial anjiomiksomalı adolesan hastayı sunmayı amaçladık. On dört yaşında kız hasta 9 ay içinde progresif büyüyen sağ labiumda sert, immobil, ağrısız bir kitle ile başvurdu. Yapılan manyetik rezonans incelemede sağ labium majus düzeyinde 42x33x38 mm boyutlu, multilokule, lobule konturlu kitlesel lezyon saptandı. Eksize edildi ve patolojisi anjiyomiksoma ile uyumlu saptandı. Hastanın lokal nüks açısından takipleri devam etmekte olup ameliyat sırasında ve sonrasında herhangi bir sorun yaşanmadı. Genitoüriner anjiomiksomalar adolesanlarda nadiren görülür. Cerrahi eksizyonu ve lokal nüks açısından postoperatif yakın takibi önemlidir.

Purpose Myelomeningocele (MMC) is one of the commonest congenital malformations. Hydrocephalus develops in 65-85% of cases with MMC. Only 3-10% of MMC patients have normal urinary continence. We aim to investigate the effects of early and late operation in MMC patients in terms of development of hydrocephalus, motor deficits, and bladder functions. Methods Medical records of MMC patients operated between January 2008 and December 2014 were reviewed retrospectively. Results We retrospectively investigated patients' records of 43 patients. Twenty of the patients were operated within the first 48 h after the delivery (early repair group), while 23 of the patients were operated after 48 h of delivery (late repair group). In the early repair group, 15 patients were operated due to hydrocephalus. Urodynamic problems were detected in 17 (85%) patients. In the late repair group, shunts were placed in 14 (61%) patients during follow-up period and urodynamic problems were detected in 19 (82.6%) patients. Mean operation time for the late group was 4.6 months. There was no statistical difference between the early and late group in terms of neurological and urodynamic deficits. The mean follow-up period was 45.5 months. Conclusion In the literature, surgery in the first 48 h of life is recommended for MMC patients. There was no difference between the early- and late-operated groups by means of hydrocephalus, urodynamic functions, and motor deficits in our study. Late surgery of intact sacs may avoid complications related to surgery in the neonatal period.

© 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.The scar tissue occurring in operating area after the repair of hypospadias which is one of the common congenital anomalies of male children has part in formation of post-operative complications. Many surgical techniques and materials have been used to reduce complications. The purpose of this study is to research the effects of contractubex® (allantoin, heparin, extractum cepae [AHEC]) gel on development of scar in the area repaired after urethrotomy. In the study, 45 male White New Zealand rabbits were used. The rabbits were divided into three groups randomly. Group 1(K): The group to which urethrotomy and primary closure were applied Group 2(A): The group to which urethrotomy, primary closure + 15-day AHEC were applied Group 3(B): The group to which urethrotomy, primary closure + 30-day AHEC were applied Urethras of the rabbits in the groups were calibrated with angiocath (24 Fr) once a day for 30 days. Along with calibration, AHEC was applied to the urethras of the rabbits in 2nd group for 15 days and urethras of the rabbits in the 3rd group for 30 days. To evaluate scar tissue, macroscopic and histopathological evaluations were carried out. Although inflammation was much more in the groups to which AHEC was applied, fibrosis was determine d to be less. It is thought that the application of AHEC may be effective in reducing scar formation after operation.

We aimed to evaluate the efficacy and safety of intravesical onabotulinum toxin A (onaBoNTA) injections for the treatment of children diagnosed with refractory overactive bladder (OAB) by using non-invasive methods. A total of 31 pediatric patients with a mean age of 10.2 years received intravesical onaBoNTA injection at the dose of 10 U/kg (max: 200 U). Twenty-one patients who failed to respond to the first injection, received second injection 6 months after the first one. The patients were retrospectively evaluated after the 1st and the 2nd injections by means of standardized questionnaire forms and voiding diary records. In the 6-month follow-up, 10 patients (32.2%) were determined to have full response after the first injection. The number of patients with partial response and no response were found to be 15 (48.4%) and 6 (19.4%), respectively. The mean value of Dysfunctional Voiding and Incontinence Symptom Score (DVISS) of the patients with full response was 8.5 before the injection, which decreased to 1 at 6-month follow-up and to 0.5 at 12-month follow-up (p

Presence of multiple calculi in a single system ureterocele is a rare condition. A 3-year-old boy presented with recurrent urinary tract infections in whom multiple calculi were noted in the urinary bladder on x-ray and ultrasound scan. In addition, ultrasound showed the presence of ureterocele in the size of 18x15x12 mm. Open surgery revealed an ureterocele with multiple stones. Here, we present a boy with multiple stones in the left ureterocele diagnosed intra-operatively due to its rarity, etiology and treatment options.

The aim of this study is to evaluate late side effects that affect quality of life in children with sacrococcygeal teratoma (SCT).The patients with SCT were evaluated retrospectively. The data were expressed by percentage and the subgroups were compared statistically.A total of 40 children with SCT were identified with median age 12 days (range: 1 day-14.6 years), 27 of whom were analyzed in this study with urodynamic data available for 24 and anal manometric evaluations for 20. Chronic constipation with need for laxative was reported in (7/27) 25.9%, fecal incontinence was present in (1/27) 3.7%, and urodynamic abnormalities were reported in (16/24) 66%. Among those with urodynamic abnormalities, low bladder capacity, dyssyergia and neurogenic bladder were observed in (21/24) 87.5% and anticholinergic treatment was applied. Urinary incontinence was present in (2/27) 7%, with clean intermittent catheterization utilized in (7/27) 25.9%. While defecation was observed more in the patients with Altman types II, III, and IV, micturation problems were observed more in the patients with Altman types II and IV. It was found that urodynamic dysfunctions were more frequent in the patients with increased number of operations.Although the rate of symptomatic patients was low, abnormalities determined by radiological and urodynamic evaluations were high.

Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.

It is well established that testicular differentiation of the human embryonic gonad depends on the action of the Y-chromosomal gene SRY. However, exceptional cases such as SRY-negative cases of 46,XX testicular disorder of sexual development (DSD), and of 46,XX ovotesticular DSD document that testicular tissue can develop in the absence of the SRY gene. These SRY-negative XX sex reversal cases are very rare and usually sporadic, but a few familial cases have been reported. We present a large, consanguineous family with nine affected individuals with phenotypes ranging from 46,XX testicular DSD to 46,XX ovotesticular DSD, with predominance of male characteristics. Absence of SRY in peripheral blood was documented by fluorescence in situ hybridization (FISH) and PCR analysis in all nine affected individuals, and by FISH analysis on gonadal sections with testicular tissue in four affected individuals. By quantitative PCR, a duplication of the SOX9 gene was excluded. In addition, as linkage analysis showed that the nine affected members of the family do not share a common SOX9 haplotype, any mutation at the SOX9 locus could be ruled out. Together, these findings implicate a mutation at a sex-determining locus other than SRY and SOX9 as the cause for the XX sex reversal trait in this family.

Background: Treatment with anticholinergic agents is the mainstay of therapy for detrusor instability (DI), a chronic and morbid condition characterized by urge urinary incontinence. The aim of this study is to assess the effectiveness and tolerability of tolterodine and oxybutynin in children with DI. Methods: A total of 60 children with DI were enrolled, 30 (14 male, 16 female, mean age 7.97 ± 2.71 years) in the tolterodine group and 30 (12 male, 18 female, mean age 7.33 ± 2.23 years) in the oxybutynin group. In this prospective study we reviewed data from 60 children followed for at least 6 months. All of the patients in the study population had a history of dysfunctional voiding. Urodynamic investigations were conducted in all of the patients before and after anticholinergic treatment. Episodes of urge urinary incontinence and adverse events were also evaluated. Results: Improvements in urge incontinence episodes were similar for the children who received tolterodine or oxybutynin. Improvements in the urodynamic parameters were also the same in the two groups. Adverse events were significantly lower in the tolterodine group (13 events in 13 patients) compared to the oxybutynin group (27 events in 20 patients; P = 0.027). Conclusion: Reductions in urge urinary incontinence episodes were similar with tolterodine and oxybutynin in children with DI. Side-effects were more common with oxybutynin. Treatment of children with DI with tolterodine shows significantly better tolerability and this may enhance children's compliance during long-term treatment.

Cebocephaly is a very rare congenital anomaly combining a severe midline facial malformation and holoprosencephaly. Here we report on first case of cebocephaly with semilobar holoprosencephaly, hypotelorism, and a single nostril due to intrauterine TORCH infection (Toxoplasmosis, other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus [CMV], and Herpes infections) in the English language literature. Chromosomal analysis showed normal karyotyping.

We aimed to investigate the value of scintigraphically determined evacuation fraction (EVF) as an objective follow-up criterion in medically treated children with chronic constipation, and to evaluate the relation between patients' symptoms and rectal emptying rate. Thirty children (m: 22, f: 8, mean age: 8.9 +/- 0.9 year) suffering from chronic constipation were assessed by scintigraphic evacuation study. All patients underwent anal manometric and scintigraphic examinations before their therapy was started. During 3 months, they received conventional laxative treatment for constipation, and scintigraphic studies were repeated in 20 of 30 patients. Scintigraphic examinations consisted of instillation of artificial stool into the rectum up to the volume impending rectal evacuation, and acquisition of pre- and post-evacuation images. EVF values were then calculated from the images using a fixed region of interest. All of the patients had high resting anal canal pressure (75 +/- 12 mmHg) and had positive rectoanal inhibitory reflex. In 14/20 patients (70%) who benefited from therapy, mean EVF changed from 43.6% to 62.2% (p < 0.001), while decreasing in 6120 who did not benefit. The volume arousing rectal evacuation was significantly lower at the second scintigraphic study (261 +/- 98 ml) than the first study (354 +/- 138 ml) (p < 0.05). As a conclusion: 1) EVF was low in chronically constipated children, 2) it was improved after conventional laxative treatment and, 3) radionuclide EVF determination may be a useful method for follow-up.

Methods: The authors evaluated 21 patients (10 boys, 11 girls) who had anorectal malformations (ARM). Ten of them had infralevator (low-group I) and 11 of them had supralevator (high-group II) type ARM. All of the patients underwent urodynamic investigation before and after posterior sagittal anorectoplasty (PSARP) operation. Results: Sacral and spinal anomalies were found in 54% (6 of 11) patients who had supralevator type ARM. None of the patients with infralevator type ARM had additional sacral or spinal anomalies. Before PSARP operation urodynamic investigations of all infralevator type ARM patients were within normal limits, whereas 82% (9 of 11) of patients with supralevator type ARM showed neurovesical dysfunction (NVD). There was no significant difference between the preoperative and postoperative urodynamic findings. The possibility of additional sacral or spinal anomalies and NVD in supralevator type ARM was high. After PSARP operation no additional lower urinary tract dysfunction was detected in the urodynamic evaluation of ARM patients.

Tumors of the urinary bladder are rare in children and nearly all of them are of mesodermal in origin. Herein we report a case of transitional cell carcinoma of the urinary bladder in a 13-year-old boy who presented after blunt abdominal trauma. It should be remembered that hematuria could develop after blunt abdominal trauma in children, for reasons other than the trauma itself (e.g. tumors of the urinary tract).

Objective To investigate the efficacy of the rectus abdominis muscle flap (RAMF) technique for the closure and augmentation of small, inelastic bladder extrophies using a rabbit model with a large bladder defect. Materials and methods Fifteen New Zealand White rabbits were studied in two groups; nine rabbits in group 1 underwent resection of 65% of the bladder and then bladder augmentation using a full-thickness RAMF, including peritoneum, and six rabbits in group 2 (control) underwent a similar bladder resection but the bladder remnant was closed primarily. Urodynamic investigations were carried out in both groups pre-operatively and 4 weeks after surgery. Intravenous pyelography (IVP), voiding cystourethrography (VCUG), urodynamic and histopathological investigations were also carried out for up to 4 months after surgery. Results As assessed by IVP, the urinary system appeared normal, with no signs of upper urinary tract dilatation and VCUG showed a normal voiding pattern. After surgery, the bladder capacity and compliance decreased in both groups, but both variables partially recovered in group 1, although not significantly. Conclusions This animal model indicates that the RAMF technique is a suitable alternative for the management of large bladder defects and bladder exstrophies with small, inelastic, non-compliant bladders.

Objective To determine the influence of midazolam on the function of the lower urinary tract when used to sedate the patient. Patients and methods Urodynamic studies were performed on 20 patients (seven boys and 13 girls, mean age 4.04 years, range 1 day to 10 years) before and after the intranasal administration of 0.5 mg/kg of midazolam. The patients' heart rate, respiratory rate and oxygen saturation were monitored and the level of sedation recorded by an anaesthesiologist and a surgeon during the study. Results Heart rate and respiratory rate did not change and the percentage oxygen saturation remained stable throughout the study period. The childrens' behaviour began to change 3-5 min after the intranasal administration of midazolam. The sedation lasted 2 h and the full co-operation of the patient was assured. The difference between the initial and post-midazolam evaluation of maximal cystometric capacity, contractility, compliance, intravesical pressure, maximum flow rate, intravesical pressure at maximum flow and the amount of residual urine were statistically insignificant (P > 0.05). Electromyographic characteristics showed no significant change with the use of midazolam (P > 0.05). Conclusion Despite the suggestion that benzodiazepines, especially diazepam, are useful for the relaxation of pelvic floor striated musculature in voiding dysfunctions, there was no effect on urodynamic variables when midazolam was used in a single dose intranasally. The anxiolytic and sedative effects allowed children to undergo urodynamic studies in comfort.

Summary Purpose Cystic echinococcosis, which is one of the most important helminthic infestations, is a serious life-threatening health problem in developing countries. Hydatid cyst of the kidney is a rare condition in children that can be treated with medical therapy or surgical treatment in some resistant cases. Here, we present a case of renal hydatid cyst that was treated with laparoscopic excision with diode laser. Patients and methods A 15-year-old female patient was admitted with abdominal pain. Abdominal ultrasonography revealed a 32 × 23 × 19-mm solid mass with cystic component at lower pole of right kidney. An indirect hemagglutination (IHA) test for echinococcosis granulosus was positive at a 1:320 titer. Other laboratory tests were within normal limits. The patient received albendazole therapy for 3 months. The follow-up magnetic resonance imaging showed a solitary lesion with exophytic extensions that contained large separations. No contrast enhancement could be detected after gadolinium injection. As no regression could be detected radiologically, surgical treatment was planned. Laparoscopic renal lower pole mass cyst excision with diode laser was performed (Figure). The patient was hospitalized for 1 day without any blood transfusion. Histopathological examination was consistent with hydatid cyst of the kidney. Conclusion Diagnosis of hydatid cyst of the kidney is generally made incidentally and can be misdiagnosed as a primary kidney tumor. Radiological studies may be insufficient for accurate diagnosis. In our case, laparoscopic excision of cyst and histopathological examination confirmed the diagnosis of cyst hydatid. At the postoperative second month the ultrasonography of kidneys were normal. For patients from endemic areas, hydatid cyst should always be included in the differential diagnosis. Laparoscopic excision of renal hydatid cysts with diode laser is a feasible and safe technique for resistant cases. Download : Download high-res image (336KB) Download : Download full-size image Figure . Dissection of cyst from renal tissue using diode laser.

Computed tomography is a very useful diagnostic tool in children's trauma. In the present case report, retrograde filling of the renal vein during computerized tomographic examination of a patient with renal trauma is presented. This is an indirect sign of traumatic renal artery injury. This finding might assist in the early diagnosis of severe renovascular trauma.

Aim: The aim of this retrospective study was to compare the results of delayed repair and early primary realignments in patients with posterior urethral injury. Methods: From 1990 to 2003, 20 children were admitted to the Medical Faculty of Uluday University, Bursa, Turkey, for posterior urethral injuries. Traffic accidents were the most common cause of injury (n = 17). Twelve patients (60%) who were referred early (1–10 days) underwent early realignment over a urethral tube. A total of eight patients (40%) underwent delayed repair using transpubic route. In these patients, surgical repair of the urethra was performed 5–6 months later. Results: Of the 12 patients who underwent early urethral realignment, six required at least one visual internal urethrotomy following the removal of the urethral catheter. Urethral stricture developed in two of 12 patients (16.6%) who underwent early urethral realignment. Of the eight patients who underwent delayed repair, six required at least one visual internal urethrotomy following removal of the urethral catheter. Urethral stricture developed in three of eight patients (37.5%) who underwent delayed repair. This difference was statistically significant (P

The aim of this study was to assess the relation between the use of cocaine during pregnancy and development of necrotizing enterocolitis in a rat model. Different doses of cocaine HCl were given to pregnant Wistar Albino rats during gestation. Total number of live births, mean birth weight, mean placental weight and histopathological examination of the maternal uterus, placenta, embryonal G-I tract and liver were investigated. These results were compared with a control group and showed that the number of live births, mean birth weight and mean placental weight were lower than in non-cocaine controls. Histopathologic examinations revealed severe inflammation and vascular changes in the uterus and placenta. We also observed focal necrosis, necrobiosis, cellular debris, haemorrhage, inflammatory reactions in the G-I tract of embryos. These findings indicate that maternal cocaine abuse should probably be considered a major risk factor for development of NEC in baby rats and embryos.

The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim Of this Study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. A series of 25 consecutive children who had loculated pleural empyemas that did not respond to tube thoracostomy and antibiotics is presented. Their ages ranged from I to 12 years (mean 4.22). There were 19 boys and 6 girls, and all epyemas were postpneumonic. The fibrinolytic agent used was urokinase in 17 and streptokinase in 8. The mean duration of fibrinolytic treatment was 4.3 days (range 2 to 8) and the mean duration of chest-tube drainage was 8.9 days (range 7 to 13). In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multi-loculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases.

PURPOSE: The aim of this study is to evaluate the effect of division of the tethered spinal cord urodynamically in spinal dysraphic cases. METHODS: Between 1995-1997, 20 cases (11 males, 9 females) aged from 5 months to 13 years with TSC were investigated. 13 cases (65%) were classed as belonging to the myelomeningocele group and 5 cases (35%) to the spina bifida occulta group. We used a computerized urodynamic system to evaluate the functions of the lower urinary tracts pre- and postoperatively. The definitive diagnosis of cord tethering was made using magnetic resonance imaging (MRI) in 19 cases (95%) and spinal ultrasound in 1 case (5%). Division of filum terminale and laminectomy were carried out in all cases by the Neurosurgery Department, and 2 cases with retethering were operated on twice. RESULTS: All of these cases were assessed urodynamically in the preoperative and postoperative period. Significant improvements were noted in detrusor functions (35%); electromyography recordings (45%); high leak point pressures (55%) and anal and urinary continence (70%). CONCLUSION: Lower urinary tract dysfunctions secondary to tethered cord syndrome are very common in spinal dysraphic cases and significant improvements can be achieved with a judiciously timed division of the spinal tethered cord.

Selective non-operative management of splenic injury in children is generally considered to be safe, and the majority of those with isolated injuries do not require blood transfusion. Eighty-four children were treated for blunt splenic trauma from 1988 to 1997 in the Department of Paediatric Surgery, The Medical Faculty of Uludag University, Bursa, Turkey. Management involved non-operative care in 56 cases (66.7%), splenectomy in 20 (23.8%) and splenorraphy in eight (9.5%) cases. There were no later complications related to splenic injury. The overall mortality was 9.5% (8/84) and the factors effecting mortality were additional intra-abdominal and/or other system injuries. Twenty-two children were not transfused during non-operative treatment. In our study, only 57.1% of the children in the non-operative group received blood transfusions. Some of the patients in this group received only small amounts of blood and probably would have recovered without it. It is concluded that, based on a very strict protocol in conservative management, the total amount of transfused blood could be reduced in children with splenic injuries due to blunt abdominal trauma.

The records of 100 children with hydatid disease were reviewed retrospectively from 1978 to 1997; 43 were girls and 57 were boys. The mean age was 9.14 years; 61 patients had 124 hepatic cysts. Presenting symptoms were asymptomatic abdominal masses, found masses incidentally during ultrasonography (US), or acute abdomen. Plain X-ray films, US, or computerized tomography (CT) are sufficient for diagnostic evaluation in endemic areas. In the differential diagnosis, laboratory investigations such as the Casoni and Weinberg tests, indirect hemagglutination, eosinophilia, and ELISA were also used. These tests may give negative results, however, in some patients with hydatid disease. The mean follow-up time was 10.5 years (range 1–18 years), the mean duration of hospitalization 7 days. The complication rate was 3.6%. Mortality was 3.27% and occurred after the administration of formaldehyde and hypertonic scolicidal agents. Hydatid disease of the liver can be treated medically in selected patients; conservative surgical approaches that save as much parenchyma as possible, such as partial cystectomy and capitonnage, are indicated in the other cases.

Dans cette etude, la fiabilite de la manometrie anorectale (ARMM) est evaluee dans la maladie de Hirschprung (HD) pendant la periode neonatale. ARMM a ete realisee chez 59 patients (d'âge intermediaire entre 2 et 90 jours) chez lesquels une HD etait suspectee. Une biopsie rectale a ete realisee chez 23 nouveau-nes chez qui le reflexe recto-anal inhibiteur (RAIR) n'a pas ete retrouve et chez 13 nouveau-nes avec RAIR positif presentant une symptomatologie clinique severe permettant de supposer HD. Les autres RAIR positifs ont ete suivis de 1 mois a 3 ans et demi sans aucune manifestation pathologique. La comparaison des etudes ARMM avec les biopsies rectales chez 36 nouveau-nes a montre qu'il y avait seulement 1 resultat faux positif et 2 faux negatifs. La sensibilite, la specificite et la valeur predictive de l'ARMM dans le diagnostic de HD a ete de 91,6%, 95,6%, 84,6% et 91,6% respectivement. Les auteurs concluent que ARMM peut etre utilisee comme un test tres bon lorsque HD est suspectee pendant la periode neonatale. II doit etre combine avec d'autres tests sur le plan diagnostic definitif.

OBJECTIVE To compare the urodynamic findings and clinical outcome in different bladder augmentation techniques. PATIENTS AND METHODS From 1987 to 1996, 32 bladder augmentations were performed in 30 (M:F/18:12) patients. Mean age was 8.1 years (range: 1-15 years) and the mean follow-up period was 3.2 years (range: 6 months to 8 years). The following techniques were used for bladder augmentation: sigmoid colon in eleven cases, stomach in nine cases, ileum in six cases, ileocaecum in two cases and rectus abdominis muscle flap (RAMF) in four cases. Seven patients also underwent Mitrofanoff procedure to create a continent stoma. RESULTS According to the urodynamic evaluation the mean capacity was 237 +/- 120 ml in the colonic group, 115 +/- 86 ml in the gastric group, 240 +/- 45 ml in the ileal group, 250 +/- 0 ml in the ileocaecal group and 30 +/- 10 ml in the RAMF group. The mean compliance was 20.6 +/- 14 ml/cm H2O in the colonic group, 10.7 +/- 10.4 ml/cm H2O in the gastric group, 21.6 +/- 9 ml/cm H2O in the ileal group, 25.5 +/- 5.5 ml/cm H2O in the ileocaecal group, 5.8 +/- 1.5 ml/cm H2O in the RAMF group. The upper urinary tract was normal without hydronephrosis in all but except two patients. These two patients are still treated medically for chronic renal failure by the pediatric nephrology team. The patients are using their Mitrofanoff or native urethra with clean intermittent catheterization (CIC) or self-CIC technique for continence. CONCLUSION Comparing these five different techniques, ileal, ileocaecal and colonic groups were in advantage to achieve high volume reservoirs, followed by the gastric group. Regarding complications; in colonic cases, mucus problems, stone formation and surgical complications related to gastrointestinal tract (intestinal obstruction, perforation) were the most common ones. Perineal dermatitis was the main complication in gastric cases. In the ileal group, complication rate was low. Absence of mucus production and the low postoperative complication rates were the two major advantages of RAMF technique. However this technique is not recommended as an augmentation procedure due to its low capacity and compliance rates. Recently, ileal augmentation has became the most popular method in our institution.

UNLABELLED Intrauterine intussusception is one of the rare causes of intestinal atresia. CONCLUSION A case of ileal atresia due to intrauterine intussusception caused by Meckel's diverticulum is reported.

Growth and development were monitored for up to 42 months in nine neonates to whom ciprofloxacin, a fluoroquinolone, was given in the neonatal period at a dosage of 20 mg/kg/day. Ciprofloxacin was used only as a ‘life-saving’ therapy in cases of sepsis produced by bacterial agents resistant to other antibiotics. Two other groups of nine neonates, matched by birth weight and gestational age, were studied as controls: one group with sepsis, which was effectively treated with cefotaxime and a group of healthy neonates. No statistically significant differences in growth and development between the groups were found during follow-up for 42 months. No osteoarticular problems or joint deformities were observed in the ciprofloxacin group. Ciprofloxacin appears to provide a therapeutic option as a ‘life-saving’ therapy for newborns with sepsis produced by multiply resistant organisms.

A total of 24 neonates and infants, aged from 2 days to 10 months, received treatment with intravenous fluconazole for microbiologically documented or presumed fungal infection. The mean fluconazole dosage was 6 mg/kg/day (range 2 –16 mg/kg/day) and the mean duration of therapy was 25 days (range 5–72 days). Efficacy was evaluated in neonates with proven fungal infections, as documented by the presence of pathogen at baseline. A positive clinical response was achieved in 23 of the 24 clinically evaluable patients (96%); eradication of the fungal organism was also achieved in 23 of the 24 evaluable patients (96%). Adverse events occurred in two patients (8%) but therapy was not discontinued in either patient. The present results confirm the efficacy and safety of fluconazole in the treatment of neonates and infants with severe fungal infections.

Objective To investigate the efficacy of the reversed ileal seromuscular enterocystoplasty (RISMEC) technique and assess the urodynamic findings. Materials and method A large bladder defect was created in 12 New Zealand White rabbits; in six the bladder was closed primarily (control group) and in the remaining six the bladder was augmented using the RISMEC technique combined with omentoplasty. The results were assessed using intravenous pyelography (IVP), voiding cysto-urethrography (VCUG), histopathological investigations and urodynamic studies after 4 and 12 weeks. Results The IVP and VCUG revealed an apparently normal urinary system and voiding pattern in both groups. Histopathologically, in all rabbits undergoing RISMEC, the serosal surface of the reversed ileum was lined with transitional urinary epithelium; there was no evidence of severe fibrosis, inflammation, stone or mucus production. Urodynamic studies showed a significant decrease in the mean bladder capacity in the controls, but no significant change in the RISMEC group. The mean bladder compliance decreased from 5.85 to 1.36 mL/cmH2O in the controls (P

Objective To investigate the efficacy of the rectus abdominis muscle flap (RAMF) technique for the closure and augmentation of small, non-compliant bladder extrophies. Patients and methods The RAMF technique was used in two girls and two boys (mean age at operation, 31.7 months, range 3–72) with bladder exstrophy. The clinical outcome and urodynamics were assessed during a follow-up of 29 months to 6 years (mean 49.2 months) and included imaging, cystoscopy, biochemical and microbiological studies. Results There were no urinary tract infections, metabolic problems or electrolyte disturbances and kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMF with uroepithelium. No stone formation or mucus production were detected. Currently, three patients void using clean intermittent catheterization through the native urethra and the fourth through an appendiceal Mitrofanoff valve. However, the bladder volume was insufficient at the late follow-up and three patients required bladder augmentation. Conclusions The RAMF technique is a good alternative for closing bladder extrophies and achieves an increase in bladder capacity; however, although there is a mild improvement in bladder capacity and compliance, RAMF should not be used as a bladder augmentation procedure. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compliant bladder remnants and failed primary closures.

The oromandibular limb hypogenesis syndromes (OLHS), which are congenital malformations involving the tongue, mandible, and the limbs are extremely rare with a few sporadic cases reported in the literature. In this report, the authors report a case of OLHS with gastroschisis, that has not been described previously according to the medline search.