Relationship Between Acute Appendicitis and Platelet Indices in Childhood

Introduction: Appendicitis is the inflammation of the appendix vermiformis. Clinical diagnosis of acute appendicitis in children is still a problem. Platelet indices, platelet distribution width and mean platelet volume have been evaluated for some infectious and inflammatory diseases. In this study, we aimed to investigate whether platelet distribution width values and mean platelet volume were decisive for the diagnosis of appendicitis in children. Methods: In our hospital, 504 pediatric patients who presented with acute abdomen and received the diagnosis of acute appendicitis between 2011 and 2016, and 106 children living in the same region, who attended the pediatric outpatient clinics for general follow-up, were included in the study. The patient and control groups were analyzed for gender, age, platelet count, platelet distribution width and mean platelet volume. A receiver operating characteristic (ROC) curve was drawn to describe the parameters that may be statistically significant. Results: There was a significant difference in platelet distribution width and mean platelet volume values between the two groups (p14.3 fL for platelet distribution width for the diagnosis of appendicitis with a sensitivity, specificity, positive predictive value, and negative predictive value of 77.6%, 85.8%, 96.3%, and 44.6%, respectively. A cut-off value of <9.35 fL for mean platelet volume was used for the diagnosis of appendicitis with a sensitivity, specificity, positive predictive value, and negative predictive value of 78.1%, 81.1%, 95.2%, and 43.9%, respectively. Conclusion: Our results suggest that platelet distribution width and mean platelet volume may be used for the diagnosis of appendicitis in children with the sensitivity of at least 77.6% and 78.1%, respectively. Mean platelet volume and platelet distribution width, which can easily be investigated in complete blood count, may serve as markers for the diagnosis of appendicitis in children, however, further large-scale studies are needed

Treatment Management of Childrens With Sexual Development Disorders.

TEZ9491Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2011.Kaynakça (s. 40-46) var.vii, 47 s. : res. (bzs. rnk.), tablo ; 29 cm.Amaç: Bu çalışmanın amacı, Çukurova Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalı?nda 2002-2009 yıllarında cinsel gelişim bozukluğu tanısı konan hastaların tanı ve tedavi uygulamalarını değerlendirmektir. Hastalar ve yöntem: Dosya bilgileri geriye doğru incelenerek, hastaların başvuru yaşı, başvuru nedeni, fizik muayene bulguları, tanısı, laboratuvar değerleri, kromozom analizi sonuçları, ultrasonografi, manyetik rezonans görüntüleme, genitogram, endoskopi bulguları, gonad biyopsileri, „Cinsiyet Araştırma Konseyi? kararları ve cerrahi tedavileri değerlendirmeye alındı. Bulgular: Toplam 36 hastanın yaş ortalaması 39 aydı. Hastaların % 66,6?sı iki yaşından küçüktü, en sık başvuru nedeni cinsiyet belirsizliği idi, yarıdan fazlası dişi psödohermafrodit (% 61,1), diğerleri erkek psödohermafrodit (% 33,33) ve mikst gonadal disgenezi (% 5,55) idi. Etiyolojik neden dişi psödohermafroditlerin % 95,4?ünde 21-hidroksilaz enzim eksikliğiydi. Erkek psödohermafroditlerin % 58,3?ünde etiyolojik neden belirlenemedi. Genitogram ve endoskopik inceleme çok yararlı görüntü yöntemleriydi. Hastaların % 22,2?sinde ailenin verdiğinden farklı bir isim değişikliğine geçildi. Kız yönünde düzeltici ameliyat yaşı ortalama 44,7 aydı; bu hastaların % 47?si iki yaş öncesinde ameliyat edildi, 12?sine (% 33,3) tek aşamalı kliterovajinoplasti yapıldı. Kız cinsiyet kararı verilen 27 hastanın beşinde yüksek tip vajinal açılım nedeni ile safhalı ameliyat gerçekleştirilerek önce kliteroplasti yapıldı, vajinoplastileri ergenlik dönemine bırakıldı. Sonuç: Cinsel gelişim bozukluklarında cinsiyet kararı, bir dizi laboratuvar ve görüntü incelemesinin multidisipliner bir çalışma ile gerçekleGtirilmesi sonucunda, anne ve baba ile işbirliği içinde verilir. Cerrahinin zamanlaması konusunda klinik tartışmalar sürmekle birlikte, kısa ürogenital sinüse ve alçak konumlanmış vajina açılımına sahip hastalarda erken cerrahinin sonuçları olumludur.Aim: The aim of this study is to evaluate the diagnostic and therapeutic applications of the patients with sexual development disorders, who were followed at Çukurova University Faculty of Medicine, Department of Pediatric Surgery, between 2002 and 2009. Patients and Methods: We analyzed the files of patients retrospectively by taking into account their age of admission, reason of application, findings of physical examination, diagnosis, laboratory results, chromosome analysis, ultrasonography, magnetic resonance imaging, genitogram, endoscopic findings, gonad biopsies, decisions of „gender research council? and surgical treatments. Results: The average age of 36 patients was 39 months. Of the patients 66.6% was younger than the age of two. The most frequent reason of applications was gender ambiguity and more than half of the patients were female pseudo hermaphrodite (61.1%) and others were male pseudo hermaphrodite (33,33%) and mixed gonadal dysgenesis (5.55%). Etiological cause was 21-OH deficiency at the 95.4% of female pseudo hermaphrodite patients. Etiology was unknown at the 58.3% of male pseudo hermaphrodite patients. Genitogram and endoscopical examinations were useful diagnostic methods. First name of the 22.2% of patients was changed. Average age of the female corrective surgery was 44.7 months. Of these patients 47% was operated before two-year-age and 12 of them (33.3%) were operated as single stage clitero-vaginoplasty. Due to high type of vaginal opening, among 27 patients whom their gender was decided as girl, five of them had two-stage procedure: Cliteroplasty was performed and vaginoplasty was left to adolescence. Conclusion: Gender of the patients with sexual development disorders is decided with a multidisciplinary series of laboratory and imaging study, in cooperation with the parents. Timing of surgery debatable but results of early surgery for short urogenital sinus and low vaginal opening is favorable

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030