Acquired Tracheoesophageal Fistula After Esophageal Atresia Repair

Background: Recurrence of tracheoesophageal fistula is a frequent complication after esophageal atresia repair. Acquired tracheoesophageal fistulas are long new fistulas that are localized at sites that are not typical of the congenital tracheoesophageal fistula. We present four cases to discuss the diagnostic and management challenges concerning various acquired tracheoesophageal fistula localizations. Case Report: We retrospectively evaluated the medical records of patients admitted with acquired tracheoesophageal fistula in the last 5 years. Among the 16 postoperative tracheoesophageal fistulas, 4 were classified as acquired tracheoesophageal fistula. Patients’ admission age ranged from 1 to 8 years. The female to male ratio was 2:2. The presented cases were admitted with recurrent respiratory tract infections, choking, and coughing. The acquired tracheoesophageal fistulas were observed between the esophagus and cervical trachea, between the esophagus and the right bronchus passing through intrathoracic abscess cavity, in the right bronchus, and between the colon conduit and trachea. One of the acquired tracheoesophageal fistulas healed spontaneously, whereas others required surgical ligation. Conclusion: Acquired tracheoesophageal fistula most often occurs secondary to local or diffuse mediastinitis. Acquired tracheoesophageal fistula may appear at unusual sites not typical of congenital tracheoesophageal fistula, such as esophagus-to-right bronchus and conduit to trachea. Therefore, the unusual locations of acquired tracheoesophageal fistula should be borne in mind, and patients evaluated and managed more comprehensively.PubMe

Sıçanlarda ozonun bağırsak iskemi-reperfüzyon hasarının akut evresi üzerine etkisi

BACKGROUND: In this study, we aimed to examine the therapeutic effects of ozone on the acute phase of intestinal ischemia-reperfusion (I/R) injury in rats to resemble clinical practice. METHODS: Eighteen Wistar albino rats were assigned to control (CG, n=6), sham (SG, n=6) and ozone groups (OG, n=6). A midline laparotomy was performed and a superior mesenteric artery (SMA) in the SG and OG was occluded with a 0/0 catgut suture, but in the CG, the incision was closed without any intervention. Tissue oxygenation was monitored with a tissue oxygenation monitor to achieve the same grade during intestinal ischemia. The incision was closed and, in the OG, ozone/oxygen mixture (0.7 mg/kg) was injected intraperitoneally, 20 minutes before reperfusion. Surgical incision was reopened and reperfusion was achieved after 60 minutes of ischemia in the SG and OG. After 60 minutes of reperfusion, 2 cm small intestine segment was sampled for histopathological assessment of the intestinal mucosal damage (Chiu score) and biochemical assessment of oxidative stress markers (nitric oxide: NO, malondialdehyde: MDA, superoxide dismutase: SOD) in all groups. RESULTS: The Chiu scores of the SG and OG were statistically increased than that of the CG (p=0.002; and p=0.002, respectively). Chiu score in the OG was higher compared to that in the SG, but not statistically significant (p=0.175). MDA levels were statistically higher in the SG and OG than that of the CG (p=0.004; and p=0.010, respectively). However, the difference between the SG and OG was not statistically significant (p=0.522). SOD and NO levels were not significantly different between groups (p=0.451 and p=0.056, respectively). CONCLUSION: Contrary to the literature, single-dose ozone therapy did not reduce the oxidative stress or improve the ischemic damage in intestinal I/R injury in rats. Further evaluation with different doses in different time periods is needed for potential clinical use.AMAÇ: Klinik uygulamalara benzer şekilde sıçanlarda ozonun intestinal iskemi-reperfüzyon (I/R) hasarının akut fazı üzerindeki terapötik etkilerini incelemeyi amaçladık. GEREÇ VE YÖNTEM: On sekiz Wistar albino sıçanı kontrol (CG, n=6), sham (SG, n=6) ve ozon gruplarına (OG, n=6) ayrıldı. Laparatomiyi takiben SG ve OG’de süperiyor mezenterik arter (SMA) 0/0 katgut dikişle oklüde edildi, ancak CG’de herhangi bir girişim yapılmadan insizyon kapatıldı. Eşit derecede bağırsak iskemisi elde etmek için bir doku oksijenasyon monitörü kullanıldı. İnsizyon kapatıldı ve OG’de, reperfüzyondan 20 dakika önce ozon/oksijen karışımı (0.7 mg/kg) intraperitoneal olarak enjekte edildi. SG ve OG’de 60 dakikalık iskemi sonrası cerrahi insizyon tekrar açıldı ve reperfüzyon sağlandı. Atmış dakikalık reperfüzyondan sonra tüm gruplarda bağırsak mukozal hasarının (Chiu skoru) histopatolojik değerlendirmesi ve oksidatif stres belirteçlerinin (nitrik oksit: NO, malonildialdehit: MDA, süperoksit dismutaz: SOD) biyokimyasal değerlendirmesi için 2 cm’lik ince bağırsak segmenti örneklendi. BULGULAR: Chiu skorları SG ve OG’de CG’ye göre istatistiksel olarak yüksekti (sırasıyla, p=0.002 ve p=0.002). Chiu skoru OG’de SG’ye göre daha yüksekti, ancak istatistiksel olarak anlamlı değildi (p=0.175). MDA düzeyleri SG ve OG’de CG’ye göre istatistiksel olarak daha yüksekti (sırasıyla p=0.004 ve p=0.010). Ancak, SG ve OG arasındaki fark istatistiksel olarak anlamlı değildi (p=0.522). SOD ve NO düzeyleri açısından gruplar arasında anlamlı olarak fark yoktu (sırasıyla, p=0.451 ve p=0.056). TARTIŞMA: Literatürün aksine, tek doz ozon tedavisi, sıçanlarda bağırsak I/R hasarında oksidatif stresi azaltmadı ve iskemik hasarı iyileştirmedi. Potansiyel bir klinik kullanım için farklı zaman aralıklarında farklı dozları içeren daha ileri değerlendirmeler yapılması gerekmektedir

Priliminary Report from a Newly Opened Enuresis Outpatient Clinic

Amaç: Enürezis (EN) polikliniğinde son bir yılda izleme alınan ve Türkiye Enürezis Kılavuzu (TEK) rehberliğinde tedavisi yapılan hastaların sonuçlarını değerlendirmek amacıyla ileriye dönük bir çalışma planlanmıştır. Gereç ve Yöntemler: EN polikliniğimize başvuran hastaların demogra? k özellikleri, şikayetleri, ? zik inceleme-laboratu- var tetkik sonuçları, uygulanan tedaviler ve takip sonuçları ileri dönük olarak kaydedilmiştir. Bulgular: Olguların yaş ortalaması 8.592.53dır (N59). Erkek/kız oranı 2,9/1dir. Tüm olgular primer ENdir. 38 olguda yalnız gece altını ıslatma şikayeti varken, 21 olguda (%35.6) gündüz semptomu da vardır. Haftada ortalama altını ıslatma sıklığı 5.541.7 gündür. Olguların 21i (%35.6) günde 8den fazla, 7si (%11.9) 3den az idrar yapıyorlardı. Olguların %57.6sında (n34) yetişememe, %49.2sinde (n29) idrar tutma manevrası, %6.8sinde (n4) zorlanma, %18.6sında (n11) idrar yolu enfeksiyonu (İYE) öyküsü, %32.2inde (n19) kabızlık vardı. Fizik inceleme bir olgu dışında normaldi. Tümünde idrar tetkiki normaldi. USG istenen 20 olgunun hiçbirinde patolojik bulgu saptanmadı. Ürodinami yapılan 9 olgunun 4inde aşırı aktif detrusör, 5inde düşük kapasite, 2inde artmış kapasite, 4ünde artmış detrüsör aktivitesi vardı. Üro? ovmetre yapılan 12 olgunun birinde kesintili işeme, birinde Crede manevrası ile işeyebilme vardı. Tüm olgularda davranış düzenlenmesi yapılmış; olguların 20ine desmopressin, 4üne oksibutinin, 1ine alarm, 1ine temiz aralıklı kate- terizasyon, 14üne kombine tedavi başlanmıştır. Tedavinin 15. gününde yapılan ilk kontrolde 18 olgu görülmüş, tedavi cevabı %6625.3 bulunmuştur. Bunların yarısında tedaviye devam edilirken, yarısında desmopressin dozu arttırılmıştır. Birinci ayda kontrolüne gelen 16 olgunun 12sinde tedaviye devam edilmiş, 2inde desmopressin dozu arttırılmış, 2inde tedaviye oksibutinin eklenmiştir. Üç ay tedavisi tamamlanan 7 olgunun 1inde nüks nedeniyle kombine tedaviye yeniden başlanmıştır. Sonuç: Enürezis tedavisi, aile uyumunun önemli rol oynadığı zahmetli bir süreç gerektirmektedir. Çalışmamızdaki olgu- ların yalnız %30.5i takiplere gelebilmiştir. Tedavi etkinliğini değerlendirmek için randomize-kontrollü çalışmalar gerek- mektedir.Objective: The aim of the study is to evaluate the results and prognosis of the patients admitted to our new enuresis clinic in the last year and managed according to the Turkish Enuresis Guide. Material and Methods: The demographic features, symptoms, physical examination and laboratory fi ndings, treatment modalities, and treatment results of the patients were recorded prospectively. Results: The mean age (N59) of the patients was 8.59±2.53 years. The male/female ratio was 2,9/1. Twenty-one cases (35.6%) had daytime symptoms. Enuresis frequency per week was 5.54±1.7 days. Voiding frequency per day was more than 8 times in 21 cases (35.6%), and less than 3 times in 7 cases (11.9%). There was urgency in 34 (57.6%) patients, holding maneuvers were used in 29 (49.2%), straining was observed in 4 (6.8%) cases, urinary tract infection (UTI) was present in 11 (18.6%) cases, and there was constipation in 19 (32.2%) cases. Physical examination fi ndings were normal in all except one patient. Urinalysis and ultrasonography was normal in all patients. Urodynamic study was performed in 9 cases, revealing over-active detrusor in 4 cases, low capacity in 5 patients, increased capacity in 2 cases and hyperactive detrusor in 4 patients. Urofl owmeter measurements were performed in 12 cases showing 1 staccato voiding, and 1 voiding with Crede maneuver case. Behavioral modifi cations were used in all cases, and desmopressin therapy was initiated in 20 cases, oxybutynin therapy in 4 patients, alarm therapy in one case, clean intermittent catheterization in 1 patient, and combined therapy in 14 patients. Treatment effectiveness was 66±25.3% in 18 cases on the 15th day and desmopressin dosage was increased in half of this group. Treatment was continued in 12 cases, the desmopressin dosage was increased in 2 patients, and oxybutynin was added in 2 of 16 cases at the 1st month. Only 1 of 7 cases at the 3rd month had recurrence and was prescribed combined therapy. Conclusion: The management of enuresis is a diffi cult process in which compliance of the families plays a major role. Only 30.5% of cases came for follow-up in the present study. Randomized controlled studies are needed to evaluate the effectiveness of enuresis treatment

Evaluation of intraabdominal hypertension and genitofemoral nerve motor conduction

Background/aim: The aim of this study was to electrophysiologically evaluate the effect of increased intraabdominal pressure (IAP) on genitofemoral nerve (GFN) motor conduction. Materials and methods: Seven Wistar albino rats were included. After anesthetization, latency and duration of GFN conduction was recorded with a needle-probe at rest. IAP was increased to 15 mmHg by insufflating atmospheric air with a percutaneous intraperitoneal needle. At 30 min of IAP, GFN motor conduction was recorded. Abdominal pressure was then increased to 20 mmHg. At 60 min, GFN motor conduction was recorded again. The consecutive recordings of latency and duration of GFN conduction (rest, 30 min, 60 min) were evaluated statistically. Results: There was a significant difference between latencies at rest (1.90 ± 0.22 ms), at 30 min (2.3 ± 0.36 ms), and at 60 min (2.74 ± 0.57 ms) (Friedman test, P = 0.001). The latency was significantly increased at 60 min compared to rest (post hoc Tukey test, P = 0.003). No similar difference was detected between the recordings at 30 and 60 min. The duration of GFN motor conduction showed no difference between consecutive recordings (P = 0.067). Conclusion: Both increased and prolonged IAP causes prolonged latency of GFN conduction, probably due to a compression effect on GFN. Neuropraxial consequences of increased IAP are thought to be related to the compression effect of peripheral nerves

Bilateral Pulmonary Langerhans's Cell Histiocytosis is Surgical Challenge in Children

Background  Pulmonary Langerhans's cell histiocytosis (PLCH) is a rare cause of interstitial lung disease in children and more than half of the cases are bilateral. Persistent respiratory distress due to spontaneous pneumothorax (SP) in bilateral PLCH may refractory to conservative treatment and posed a great challenge to surgical modalities. A 3-year-old boy with SP due to bilateral PLCH is presented to discuss the surgical options of recurrent and refractory PLCH cases in children. , Case Report  The patient was admitted to the emergency department with severe respiratory distress and SP. After chest tube insertion, biopsy from neck mass revealed Langerhans's cell histiocytosis. Chemotherapy including vinblastine and prednisone was initiated. Due to persistent respiratory difficulty and air leaks, talc pleurodesis and thoracoscopic bullae excision with pleural decortication were performed. Two months after the admission, due to nosocomial infection and severe respiratory distress, extracorporeal membranous oxygenation (ECMO) support was initiated. The patient was died of ECMO complications on 24th day of ECMO. , Conclusion  Despite the use of chemotherapy and surgical excision of cystic lesions, bilateral PLCH in children may have lethal outcome. Other treatment options including respiratory support with ECMO and lung transplantation should be considered as last resort of treatment alternative in persistent cases.PubMedWo