Prepubertal Vaginal Discharge: Vaginoscopy To Rule Out Foreign Body

This clinical study is designed to evaluate the results of vaginoscopies performed to rule out vaginal foreign body in prepubertal girls with vaginal discharge. Medical records of all prepubertal patients who underwent vaginoscopy to rule out vaginal foreign body between 2004 and 2013 were reviewed retrospectively. All patients were evaluated by pediatricians prior to surgical consultation. Vaginoscopy is performed in the operating room under general anesthesia. During the study period, 20 girls with persistent vaginal discharge with a mean age of 6.8 years (1-13 years) underwent vaginoscopy to rule out vaginal foreign body. Six patients had bloody vaginal discharge and 4 had recurrent vaginal bleeding lasting for more than one month. Ten patients had purulent vaginal discharge lasting for 1-7 months. None of vaginal cultures revealed pathological bacteria or candida species. Preoperative imaging techniques revealed vaginal foreign body in one patient only. Vaginoscopy demonstrated vaginal foreign bodies in four patients. Foreign bodies were grass inflorescence, safety pin and undefined brownish particles (n= 2), which may be pieces of toilet paper or feces. There was no complication related to vaginoscopy and removal of foreign body. Hymen integrity was preserved in all patients. Persistent or recurrent vaginal discharge in prepubertal girls should raise the suspect of vaginal foreign body. Continuous flow vaginoscopy is mandatory to detect and remove any vaginal foreign body. Early diagnosis would prevent complications secondary to long-standing foreign bodies.WoSScopu

Factors Affecting Survival In Neonatal Surgery Unit In A Tertiary Care University Hospital During 26 Years

This clinical study was designed to evaluate mortality rate and the factors that may affect survival in neonatal surgery unit. Randomly chosen 300 (beta: 0.20) patients among 1,439 patients treated in neonatal surgery unit during years 1983 to 2009, were evaluated retrospectively. The patients were separated into three groups according to date of treatment; Group A: 1983 - 1995, Group B: 1996 - 2005 and Group C: 2005 - 2009. M/F ratios did not differ between non-survived and survived patient populations. Mortality rates were 37%, 22% and 13% in Group A, B, and C respectively (p < 0.001). Parenteral nutrition, maternal age, time until admission and gestational age did not affect mortality rate, however median age of newborn was lower in non-survived cases (1 day vs. 3 days, p < 0.001). Associating abnormality, low birth weight (< 1,500 g), associating sepsis, need of globulin and requirement of respiratory support were determinants of lower survival (p < 0.001). The mortality rate for patients that underwent thoracotomy (42%) and laparotomy (41%) were higher than patients that underwent other operations (8%) and observation (10%) (p < 0.001). Diaphragmatic hernia had higher mortality rates than the other pathologies (p < 0.001). Survival rate is increasing to date in newborn pediatric surgery unit; it is independent from parenteral nutrition, maternal age, time to admission and gestational age however it is affected adversely by the age of patient, associating abnormality, low birth weight, presence of sepsis and requirement of respiratory support. Increase in survival could be related to various additional factors such as development of delicate respiratory support machines, broad spectrum antibiotics, hospital infection control teams, central venous catheters, use of TPN by central route, volume adjustable infusion pumps, monitoring devices, neonatal surgical techniques, prenatal diagnosis of pediatric surgical conditions and developments of environmental control methods in neonatal surgical units.WoSScopu

Gluteal Congenital Fibrous Hamartoma of Infancy: A Case Report

Fibrous hamartoma of infancy (FHI) is a rare benign subcutaneous tumor which is commonly seen in the first year of life. Patients usually present with a single, painless, rapidly growing mass located mostly on the upper extremities. It can be difficult to distinguish this lesion from the malignant soft tissue sarcomas because of the rapid growth and radiological characteristics. Here we report a 5-month-old boy with a large gluteal mass and cutaneous findings which was initially thought to be an infiltrative malignant tumor and finally diagnosed as FHI. [Cukurova Med J 2013; 38(2.000): 333-337

Drainage Systems' Effect on Surgical Site Infection in Children with Perforated Appendicitis

WOS: 000410618200003Aim: Effect of replacing open drainage system to closed drainage system on surgical site infection (551) in children operated for perforated appendicitis was evaluated. Material and Method: Hospital files and computer records of perforated appendicitis cases operated in 2004-2010 were evaluated retrospectively. Open drainage systems were used for 70 in cases (group I) and closed systems were used in the others (group II). Results: Eleven of 551 cases had superficial infection and 3 had the organ/space infection. 551 rate was 15.795 for group I and 7.59'n for the group II. The antibiotic treatment length was 7.5 t 3.4 days for group I and 6.4 2.2 days for group II and the difference between groups was not statistically significant. Hospitalization length for group I was 8.2 3.1 days and 6.8 1.9 days for group II and the difference was statistically significant. Discussion: 551 is an important problem increasing morbidity and treatment costs through increasing hospitalization and antibiotic treatment length. Open drainage system used in operation in patients with perforated appendicitis leads an increased frequency of SSI when compared to the closed drainage system. Thus, closed drainage systems should be preferred in when drainage is necessary in operations for perforated appendicitis in children

Surgical Treatment Results In Unilateral Wilms Tumor: Experience From A High-Volume Pediatric Oncology Center In Turkey

Objective: The aim of the present study was to evaluate the clinical characteristics, factors affecting treatment approach, and long-term outcome of patients with Wilms tumor. Methods: We identified the demographic features, mode of presentation, applied treatments, and long-term outcomes of 88 patients treated between 1990 and 2011 at Hacettepe University Ihsan Dogramaci Children's Hospital according to the Turkish Pediatric Oncology Group protocol. Data were analyzed using SPSS program, and chi-square test was used for statistical analysis. Results: The study included 88 patients (50 females and 38 males) with a mean age at presentation of 3 +/- 2.48 years. Patients were classified as stage 1 (n=35, 39.8%), stage 2 (n=16, 18.2%), stage 3 (n=17, 19.3%), and stage 4 (n=20, 22.7%). Pathological examination of tumors revealed favorable histology in 76 (86.4%) patients and unfavorable histology in 10 (11.4%) patients. Forty-nine (55.6%) patients received preoperative chemotherapy, and patient's age at diagnosis and physical examination findings influenced the decision of the administration of preoperative chemotherapy (p<0.05). Of the 88 patients, 25% aged <1 year and 75% aged between 3 and 5 years received preoperative chemotherapy. The palpated mass was crossing the midline in 20.5% of patients who were subjected to primary surgery. Tumor ruptured in 5.6% of patients intraoperatively. Long-term prognosis of patients was as follows: 68 (83.9%) children were cured and 13 (16%) children died due to recurrences and metastases. Survival rates reached 100% in stage 1 and 2 patients but decreased to 75% and 50% in stage 3 and 4 patients, respectively. Conclusion: Age at presentation and physical examination findings are significant in surgical planning. Stage is the most important prognostic factor. Patients with Wilms tumor are treated with low complication and high survival rates due to multidisciplinary treatment approach at our institution.Wo