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BACKGROUND: Gastrointestinal perforation (GIP) during the neonatal period is still a significant problem despite improved neonatal care. The study aimed to report on incidence, management, morbidity and mortality. MATERIAL AND METHODS: Records of neonates with GIPs between October 2018 and November 2022 were retrospectively analysed. RESULTS: There were 47 patients, 22 (46.8%) males and 25 (53.2%) females. The incidence of neonatal GIP was 0.39% amongst all newborns treated in the neonatal intensive care unit. The mean gestational age was 30.4 ± 4.5 (23-38) weeks, and the mean birth weight was 1493.08 ± 753 (580-2940) g. Of 47 neonates, 5 (10.6%) were full term and 42 (89.4%) were preterm. The mean age of surgery was 12.25 ± 9.89 (0-41) days. A laparotomy was performed in 43 (91.4%) of 47 neonates, while seven of the patients underwent surgical intervention after decompression by percutaneous drainage. Four patients were managed with peritoneal drainage alone due to poor general condition. The pathologies unrelated to necrotising enterocolitis (NEC) were the most common cause of GIPs (55.3%) and included spontaneous intestinal perforation (n = 18), stomach perforation (n = 4), segmental volvulus (n = 2), acute mesenteric ischaemia (n = 1) and meconium peritonitis (n = 1). Overall survival was 55.4%. CONCLUSION: GIPs are one of the most significant causes of mortality in newborns. The most common cause of perforations is non-NEC entities and can be seen in the entire intestinal system from the stomach to the colon. Surgical exploration is still the primary management model.

RESUMEN

BACKGROUND: This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline. METHODS: A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023. RESULTS: Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle. CONCLUSION: While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.

Asunto(s)

Torsión del Cordón Espermático , Torsión del Cordón Espermático/cirugía , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/terapia , Torsión del Cordón Espermático/diagnóstico por imagen , Humanos , Masculino , Turquía , Encuestas y Cuestionarios , Pautas de la Práctica en Medicina/estadística & datos numéricos , Niño , Urólogos/estadística & datos numéricos , Cirujanos , Pediatría , Adhesión a Directriz/estadística & datos numéricos

RESUMEN

BACKGROUND: Ureteroinguinal herniation is a rare occurrence that is typically diagnosed during the surgical repair of inguinal hernias. CASE PRESENTATION: We present the case of a 4-year-old male who underwent inguinal hernia repair, during which a megaureter was discovered within the hernia sac. The surgical intervention included high ligation of the hernial sac and repositioning of the ureter back into the retroperitoneum. Postoperative investigations confirmed a diagnosis of primary non-refluxing and nonobstructive megaureter. CONCLUSION: Although ureteral herniation is rare in infants, it is crucial to remain vigilant about the possibility of encountering the ureter during hernia repair to prevent potential ureteral injuries. Additionally, any associated urinary tract anomalies should be thoroughly investigated and ruled out.

Asunto(s)

Hernia Inguinal , Enfermedades Ureterales , Humanos , Masculino , Hernia Inguinal/cirugía , Preescolar , Enfermedades Ureterales/cirugía , Enfermedades Ureterales/diagnóstico , Herniorrafia/métodos , Uréter/anomalías , Uréter/cirugía

RESUMEN

Background and Objectives: In this study, we aimed to investigate the effects of bosentan, an endothelin receptor antagonist, on endothelin-1 (ET-1), hypoxia-inducible factor-1 (HIF-1), nuclear factor-kappa B (NF-κB), and tumor necrosis factor (TNF)-α as inflammation markers, pro-oxidant antioxidant balance (PAB), and total antioxidant capacity (TAC) levels as oxidative stress parameters in lung tissues of rats in an experimental model of pulmonary contusion (PC) induced by blunt thoracic trauma. Materials and Methods: Thirty-seven male Sprague-Dawley rats were divided into five groups. C: The control group (n = 6) consisted of unprocessed and untreated rats. PC3 (n = 8) underwent 3 days of PC. PC-B3 (n = 8) received 100 mg/kg bosentan and was given orally once a day for 3 days. The PC7 group (n = 7) underwent 7 days of PC, and PC-B7 (n = 8) received 100 mg/kg bosentan and was given orally once a day for 7 days. Results: ET-1, NF-κB, TNF-α, HIF-1α, and PAB levels were higher, while TAC activity was lower in all groups compared with the control (p < 0.05). There was no significant difference in ET-1 and TNF-α levels between the PC-B3 and PC-B7 groups and the control group (p < 0.05), while NF-κB, HIF-1α, and PAB levels were still higher in both the PC-B3 and PC-B7 groups than in the control group. Bosentan decreased ET-1, NF-κB, TNF-α, HIF-1α, and PAB and increased TAC levels in comparison to the nontreated groups (p < 0.05). Conclusions: Bosentan decreased the severity of oxidative stress in the lungs and reduced the inflammatory reaction in rats with PC induced by blunt thoracic trauma. This suggests that bosentan may have protective effects on lung injury mechanisms by reducing hypoxia, inflammation, and oxidative stress. If supported by similar studies, bosentan can be used in both pulmonary and emergency clinics to reduce ischemic complications, inflammation, and oxidative stress in some diseases that may be accompanied by ischemia.

Asunto(s)

Bosentán , Modelos Animales de Enfermedad , Inflamación , Estrés Oxidativo , Ratas Sprague-Dawley , Sulfonamidas , Traumatismos Torácicos , Heridas no Penetrantes , Animales , Bosentán/uso terapéutico , Bosentán/farmacología , Estrés Oxidativo/efectos de los fármacos , Masculino , Ratas , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/tratamiento farmacológico , Sulfonamidas/farmacología , Sulfonamidas/uso terapéutico , Inflamación/tratamiento farmacológico , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/análisis , Hipoxia/complicaciones , Hipoxia/tratamiento farmacológico , Hipoxia/metabolismo , FN-kappa B/metabolismo , Endotelina-1/análisis , Antagonistas de los Receptores de Endotelina/uso terapéutico , Antagonistas de los Receptores de Endotelina/farmacología

RESUMEN

PURPOSE: This study aims to evaluate the quality and reliability of YouTube videos about bowel management in children. METHODS: On April 6th, 2023, the search results for "bowel management in children" on YouTube were rated independently by two authors. JAMA Benchmark Criteria (score 0-4) and a modified DISCERN tool (score 16-80) used for quality and reliability assessment. Data was analyzed by Chi-square test and one-way analysis of variance (ANOVA). RESULTS: Out of 48 videos included, 15 (31.2%) videos were intended for professionals and 33 (68.8%) for the public. The mean number of views was 144.806 and duration was 22 ± 28.4 min. The respective mean duration of videos for professionals 57.7 ± 21.4 min and median number of views was 404.5 (17-8.840) and those for public was 5.7 ± 10.7 min and 8400 (8-5.175.975) (both, p < 0.005). The respective mean DISCERN and JAMA scores of the videos for the public was 45.30 ± 13.18 and 2.93 ± 1.07, and for professionals 75.73 ± 6.52 and 3.8 ± 1.06 (both, p < 0.05). CONCLUSION: Although the reliability of the videos uploaded for the professionals about pediatric bowel management was higher than for public, duration of the videos was longer and the viewing rates were lower. Shorter but comprehensive and easy-to-understand guidance videos for the public may be of help. TYPE OF STUDY: Descriptive study. LEVEL OF EVIDENCE: IV.

Asunto(s)

Fuentes de Información , Medios de Comunicación Sociales , Humanos , Niño , Reproducibilidad de los Resultados , Análisis de Varianza , Benchmarking , Difusión de la Información , Grabación en Video

RESUMEN

INTRODUCTION: We aimed to evaluate the patient characteristics of neonates treated with peritoneal dialysis (PD) and review our experience with placement of PD catheters. METHODS: Records of neonates treated with PD between January 2019 and January 2022 were retrospectively analyzed. RESULTS: Swan neck curl PD catheters with double cuffs were used in 85 neonates as a bedside procedure with one cuff remaining within the abdomen. There were 44 (51.7%) males and 41 (48.3%) females. Their mean gestational age was 33.6 ± 4.9 (22-40) weeks and the mean birth weight was 2315,5 ± 1039 (500-4700) g. The primary diagnoses were asphyxia (n = 22, 25.9%), prematurity (n = 21, 24.7%), inborn errors of metabolism (n = 11, 12.9%), sepsis (n = 7, 8.2%), necrotizing enterocolitis (n = 5, 5.9%), dehydration (n = 5, 5.9%), hydrops fetalis (n = 5, 5.9%), congenital heart diseases (n = 5, 5.9%) and renal anomalies (n = 4, 4.7%). The mean duration of PD was 11.6 ± 13.7 days (range 1 to 75 days). Catheter-related complications occurred in 7 (8.2%) patients. These were drainage problems (n = 4), leakage (n = 1), incisional hernia (n = 1) and wound dehiscence (n = 1). Mortality because of underlying condition occurred in 57 (67.1%) patients. Mean pre-dialysis pH and sodium levels were statistically higher in surviving newborns than in those with a fatal outcome (7.19 vs 7.09 and 144.4 mmol/L vs 134.6 mmol/L, respectively) (p<0.05). CONCLUSIONS: PD is a safe, simple and effective therapy in neonates. The mortality rate in those treated with PD is high, especially due to serious underlying diseases. Lack of appropriate devices necessitates revisions in the catheters and techniques used for PD treatment. TYPE OF STUDY: Case series LEVEL OF EVIDENCE: IV.

Asunto(s)

Diálisis Peritoneal , Masculino , Femenino , Recién Nacido , Humanos , Lactante , Estudios Retrospectivos , Diálisis Peritoneal/efectos adversos , Recien Nacido Prematuro , Cateterismo/métodos , Catéteres de Permanencia/efectos adversos , Complicaciones Posoperatorias/etiología

RESUMEN

Introduction and importance: We aimed to report a case of acute mesenteric ischemia in a newborn with COVID-19. Case presentation: A 1-day-old male baby, with a birth weight of 2050 g, delivered by spontaneous vaginal delivery at 34 weeks of gestation from a 32-year-old COVID-19 infected mother in her third pregnancy, was taken to the newborn intensive care unit. On physical examination, the patient was alive and active. The abdomen was soft. Laboratory values of the patient were within the normal range. Echocardiography and abdominal ultrasonography were normal. COVID-19 PCR test drawn at 48 h of age was positive. On the postnatal 4th day, the patient suddenly had tachycardia and abdominal tension. Free air in the abdomen was detected on direct abdominal X-ray. The patient was taken to surgery urgently. On laparotomy, brownish ascites and necrotic small bowel and colon starting from 20 cm of ligamentum of Treitz to the middle part of the transverse colon were seen. Jejunostomy was constructed at area that 50 cm distal to Treitz with a relatively better appearance (with circulatory disorder but not full-thickness necrosis) and transverse colon mucous fistula without primary anastomosis. The patient died one day after surgery due to cardiorespiratory arrest and multiorgan failure. Conclusions: Although most of the reported symptoms of the COVID-19 are related to the respiratory system, there is concern that the occurrence of serious and life-threatening manifestations such as mesenteric ischemia in the gastrointestinal tract may be overlooked in also neonatal period.

RESUMEN

BACKGROUND: We aimed to present cecum pathologies which are the cause of acute abdomen. METHODS: Between January 2015 and June 2019, patients that were operated with the diagnosis of acute abdomen and patients with the primary cecum pathologies were evaluated retrospectively. RESULTS: There were eight patients, five males and three females. The mean age was 7.2±2.9 years. Complaints were abdominal pain and vomiting in all patients. Physical examination was consistent with acute abdomen. In the imaging studies, the preliminary diagnosis was considered as two patients had acute appendicitis, two had invagination (one due to Meckel diverticulum and one with mesenteric cyst), two had ileus, one had perforated appendicitis, and one had cecum diverticulum. In surgery, five patients had cecum mass, one had cecum diverticulitis, one had cecum volvulus, and one had inflamed necrotic cecum. All patients underwent cecum resection and ileocolonic anastomosis. Histopathologic examination was resulted as Burkitt's lymphoma in three patients, cecum diverticulum in two, duplication of cecum in one, tuberculosis of cecum in one, and gangrenous necrosis due to volvulus in one patient. The mean follow-up period was 25 months (2 months-4 years). Follow-up was uneventful. CONCLUSION: Primary cecum pathologies are very rare. This leads to lack of standardization in treatment planning. Considering the patients with malignancy in the series, ileocolonic anastomosis with cecum resection is an adequate and appropriate treatment option in children with primary cecum pathology.

Asunto(s)

Abdomen Agudo , Apendicitis , Vólvulo Intestinal , Divertículo Ileal , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Apendicitis/diagnóstico , Ciego/cirugía , Niño , Preescolar , Femenino , Humanos , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/diagnóstico por imagen , Masculino , Divertículo Ileal/diagnóstico , Divertículo Ileal/diagnóstico por imagen , Estudios Retrospectivos

RESUMEN

BACKGROUND: Intrauterine midgut volvulus is a very rare, life-threatening condition, and prenatal diagnosis is difficult. In this article, we present a case of midgut volvulus followed by a pre-diagnosis of antenatal jejunal atresia. CASE PRESENTATION: A 1-day-old Turkish male baby, who was followed with a diagnosis of antenatal jejunal atresia, with a birth weight of 3600 g, delivered by cesarean section at 38 weeks of gestation from a 19-year-old mother in her fourth pregnancy, was taken to the newborn intensive care unit. The patient underwent surgery on the postnatal first day with a preliminary diagnosis of jejunal atresia. It was observed that the small intestine was rotated two full cycles from the mesenteric root. Bowel blood circulation was good. Volvulus was untwisted. There was malrotation. Ladd's procedure was performed. The baby was discharged on the seventh postoperative day with full oral feeding. The patient is still in the first postoperative year and follow-up has been uneventful. CONCLUSION: Intrauterine midgut volvulus has been associated with high mortality in the literature. Differential diagnosis of midgut volvulus in patients with antenatal intestinal obstruction, close prenatal follow-up, appropriate delivery and timing of surgical intervention may significantly reduce morbidity and mortality.

Asunto(s)

Atresia Intestinal , Obstrucción Intestinal , Vólvulo Intestinal , Adulto , Cesárea , Femenino , Humanos , Recién Nacido , Atresia Intestinal/diagnóstico por imagen , Atresia Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/cirugía , Intestinos , Masculino , Embarazo , Adulto Joven

RESUMEN

BACKGROUND: Oesophageal colonic interposition in oesophageal atresia (OA) patients is almost exclusively done as a staged operation with an initial oesophagostomy and gastrostomy followed by the definitive surgery months later. This study presents a series of patients in whom a cervical oesophagostomy was not performed before the substitution surgery. PATIENTS AND METHODS: Records of EA patients were evaluated for those who underwent colon interposition without cervical oesophagostomy. RESULTS: There were five patients: three with pure EA and two with proximal tracheo-oesophageal fistula. A delayed primary repair could not be performed because of intra-abdominally located distal pouch. The mean age at the time of definitive operation was 5.54 (±2.7) months and the mean weight was 6.24 (±1.3) kg. A right or a left colonic segment was used for interposition keeping the proximal anastomosis within the thorax. The post-operative results were quite satisfactory within a median follow-up period of 33.2 months. CONCLUSION: Avoiding cervical oesophagostomy and its inherent complications and drawbacks is possible in a subset of patients with long-gap EA who underwent colonic substitution surgery. This approach may be seen as an extension of the consensus that the native oesophagus should be preserved whenever possible, because it uses the native oesophagus in its entirety.

Asunto(s)

Colon/cirugía , Atresia Esofágica/cirugía , Gastrostomía/métodos , Adulto , Anastomosis Quirúrgica/métodos , Endoscopía Gastrointestinal , Esofagostomía , Femenino , Humanos , Masculino , Resultado del Tratamiento

RESUMEN

AIM: We aimed to present our laparoscopic treatment experience in Morgagni hernia repair. METHODS: The patients who underwent laparoscopic surgery with diagnosis of Morgagni hernia between 2016 and 2019 were evaluated retrospectively. RESULTS: Their mean age at diagnosis was 4,1 ± 2,6 years (1 year-13 years). All patients were male. The presenting complaints were respiratory tract infection in 3 patients and vomiting in 3. Two patients were diagnosed incidentally. Associated Down's Syndrome was detected in 3 (38%) cases. The defect was left-sided in 7 (87.5%) patients and bilateral in 1 (12,5%). Omentum was herniated in 2 patients, colon and omentum were in 6 and colon, omentum and stomach were in one. All patients underwent primary repair extracorporeally by removing sutures from single incision, without removal of the hernia sac. There were no complications or recurrence in the mean 19,2 ± 15,8 months (6-42 months) follow-up period. CONCLUSIONS: Minimal invasive repair of Morgagni hernia is efficient and safe. It should be the first choice because of fast recovery and better cosmetic results. In this series, it was seen that leaving the hernia sac had no effect on early and late complications. Leaving the hernia sac may prevent potential complications due to unnecessary dissection.

RESUMEN

INTRODUCTION: Bosentan is an endothelin-1 receptor antagonist with anti-inflammatory, antioxidant, and antiproliferative effects. We aimed to evaluate its effects on lung tissue in a pulmonary contusion (PC) model. MATERIALS AND METHODS: The rats were randomly divided into five groups: PC3: PC evaluated on the 3rd day (n = 8), PC-B3: PC enteral bosentan 100 mg/kg/day, for 3 days (n = 8), PC7: PC evaluated on the 7th day (n = 7), PC-B7: PC 7 days bosentan 100 mg/kg/day, for 7 days (n = 8), C: control (n = 6). Unilateral lung contusion was created by dropping a metal weight onto the chest. The rats were sacrificed on the 3rd or the 7th days. The lung tissue was evaluated histopathologically for alveolar edema, congestion, and leukocyte infiltration, biochemically for malondialdehyde (MDA), superoxide dismutase (SOD), and nitric oxide (NO) levels, and immunohistochemically for inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), and apoptosis scores. RESULTS: Alveolar edema, congestion, and leukocyte infiltration scores were increased in all groups compared with the control group (p < 0.05) and decreased in bosentan-treated groups compared with the relevant nontreated groups (p < 0.05). Fibrosis was observed only in PC7 and PC-B7 groups. Bosentan did not have any effect on fibrosis development. iNOS and eNOS levels were higher in all groups compared with the control (p < 0.05) without a difference in the nontreated versus treated groups (p > 0.05). Bosentan treatment caused decreased MDA and increased SOD levels in comparison to the nontreated groups (p < 0.05). Tissue NO levels did not show any significant difference among groups. PC groups had higher levels of apoptosis compared with the control group (p < 0.05). The degree of apoptosis decreased in bosentan-treated groups compared with the nontreated groups (p < 0.05). CONCLUSION: PC causes progressive lung tissue damage. Bosentan reduced leukocyte infiltration and alveolar edema and congestion caused by PC. It also decreased MDA levels and increased SOD levels. Bosentan prevents tissue damage by inhibiting acute inflammatory response and reduces oxidative stress secondary to inflammation. It has therapeutic effects on apoptosis.

Asunto(s)

Bosentán/uso terapéutico , Contusiones/tratamiento farmacológico , Antagonistas de los Receptores de Endotelina/uso terapéutico , Lesión Pulmonar/tratamiento farmacológico , Heridas no Penetrantes/tratamiento farmacológico , Animales , Antiinflamatorios/uso terapéutico , Antioxidantes/uso terapéutico , Apoptosis/efectos de los fármacos , Contusiones/metabolismo , Contusiones/patología , Endotelina-1/antagonistas & inhibidores , Etiquetado Corte-Fin in Situ , Lesión Pulmonar/metabolismo , Lesión Pulmonar/patología , Malondialdehído/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico Sintasa de Tipo II/metabolismo , Óxido Nítrico Sintasa de Tipo III/metabolismo , Distribución Aleatoria , Ratas Sprague-Dawley , Superóxido Dismutasa/metabolismo , Heridas no Penetrantes/metabolismo , Heridas no Penetrantes/patología

RESUMEN

OBJECTIVE: Inguinal hernia surgery is the most common surgery performed by pediatric surgeons. Giant inguinoscrotal hernia has not been clearly defined yet. The definition of giant inguinoscrotal hernia and the reliability of the surgical procedure were investigated in this study. MATERIALS AND METHODS: Sixtyfour of totally 1548 male patients who have been operated with inguinal hernia from May 2015 to January 2018 were included in the study considering the diagnosis of giant inguinoscrotal hernia. The criteria for the diagnosis of giant inguinoscrotal hernia were determined as, observing that the hernia sac was filled with intestinal loops from the inguinal region to the scrotum during the physical examination, herniation of the intestines to the scrotum again as soon as the hernia was reduced and 2 cm and above inner ring diameter. High ligation and hernioplasty to 29 (45.3%) patients and hernioplasty using Zig maneuver to 35 (54.6%) patients were performed during the study. RESULTS: Postoperative wound infection was observed in 2 patients (6.8%) with high ligation and 1 (2.8%) patient with hernioplasty with Zig maneuver. Scrotal edema was detected in all the patients, which persisted until postoperative month 1. Recurrence was seen in 6 (20.6%) of 29 patients who operated using the high ligation method while it was seen in 2 (5.7%) of other 35 patients. None of the patients had testicular atrophy and/or iatrogenic undescended testis. CONCLUSION: Giant inguinoscrotal hernias should be defined and evaluated as a group apart from classical inguinoscrotal hernias. Recurrence and morbidity rates were lower in patients who underwent hernioplasty using Zig maneuver.

RESUMEN

BACKGROUND: The aim of this study was to determine ovarian reserve using serum anti-Müllerian hormone (AMH) level in children who had undergone either ovarian-preserving surgery or oophorectomy because of ovarian torsion. METHODS: Patients aged > 10 years who had undergone surgery for unilateral ovarian torsion were contacted for the study with ethics committee approval. Seventeen patients agreed to be included. RESULTS: A total of 10 patients had undergone ovarian detorsion and seven had undergone oophorectomy. Mean age at operation was 11.6 ± 2.23 years (range, 8-15 years) and 13.2 ± 2.17 years (range, 10-16 years), respectively (P = 0.46). Ovarian torsion was isolated in four patients in the first group, and in three in the second. The remainder had associated benign masses. At the time of this study, mean patient age was 18 ± 2.11 years (range, 14-21 years) with a mean postoperative follow up of 5.9 ± 2.8 years (range, 2-10.5 years). Echogenicity of all preserved ovaries was normal on pelvic Doppler ultrasonography, with presence of antral follicles in six. Three ovaries were smaller than expected for age, although two of these had antral follicles. Mean AMH was 5.54 ± 2.25 ng/mL in the detorsion group and 2.70 ± 2.11 ng/mL in the oophorectomy group (P = 0.04). CONCLUSIONS: The presence of follicles in preserved ovaries after detorsion has been reported previously. AMH is expressed in granulosa cells of growing follicles and its serum level is valuable in assessing the quantitative aspects of ovarian reserve. Preservation of the ovary in children with torsion is justified in terms of future ovarian reserve.

Asunto(s)

Hormona Antimülleriana/sangre , Enfermedades del Ovario/sangre , Enfermedades del Ovario/cirugía , Reserva Ovárica , Anomalía Torsional/sangre , Anomalía Torsional/cirugía , Adolescente , Factores de Edad , Niño , Femenino , Estudios de Seguimiento , Humanos , Tratamientos Conservadores del Órgano , Enfermedades del Ovario/diagnóstico por imagen , Ovariectomía , Factores de Tiempo , Anomalía Torsional/diagnóstico por imagen , Ultrasonografía Doppler , Adulto Joven

RESUMEN

BACKGROUND/PURPOSE: Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic. METHODS: PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6months ago were done for the long-term results, including coherence to regional hair care. RESULTS: There were 268 patients with a median age of 16years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3months (7days-49months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6-63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences. CONCLUSIONS: Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level IV (Retrospective case series with no comparison group).

Asunto(s)

Seno Pilonidal/cirugía , Adolescente , Niño , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Cicatrización de Heridas

RESUMEN

Urethral prolapse is a disease of prepubertal black girls and postmenopausal women with an unknown cause. It may be congenital in origin or an acquired condition. It has never been reported in males. We report a 10-year-old Caucasian boy who presented because of recurrent right undescended testis. He had been operated on for bilateral undescended testes 7 years ago in another hospital, and circumcision was done during the same operation. The boy complained of a weak urinary stream during voiding. The physical examination was consistent with recurrent right undescended testis. Penile examination showed a circumferential urethral prolapse around the meatus. The urethral meatal appearance was apparent right after the circumcision. An orchiopexy operation as well as circumferential excision of the perimeatal urethral tissue with primary repair was done. The pathological examination of the specimen revealed keratinized stratified squamous epithelium consistent with urethral mucosa. The postoperative course was uneventful, and the patient urinates normally at the 8 postoperative month with a normal uroflowmetry study. This is the first report of urethral prolapse in a male. Because circumcision is a widely employed practice in many cultures, it is unlikely to be a predisposing factor. It is a benign condition that can be cured with simple resection and anastomosis.