Management of Pediatric Appendicitis

Appendicitis is the most common surgical diagnosis for children who present with abdominal pain to the emergency department. However, there are nonspecific examination findings and variable historical features during its presentation. Diagnosis of appendicitis in the pediatric patient may be challenging for the clinician dealing with these children. It is important to have a high index of suspicion and taking a detailed history and physical examination. In diagnosis of appendicitis, adjunctive studies that may be useful are the white blood cell count, C-reactive protein, urinalysis, ultrasonography and computerized tomography when necessary. When appendicitis is suspected, patients should receive immediate surgical consultation, as well as volume replacement and antibiotics if indicated. The most accurate diagnostic tool is perhaps the serial examinations by the same examiner. With this timely approach, it will be possible to prevent the significant morbidity that is associated with delayed diagnoses in younger patients

Environementally Sensitive Hyaluronan Hydrogel Adjustable by Physical and Chemical Cross-links for Biomedical Applications

In recent years, hydrogels developed to promising tools for biomedical and industrial applications. For biomedical approaches hydrogels, possess the capacity to immobilize and release cells, they offer the desired 3D environment to induce cell specific behaviour or serves as a drug delivery system. Moreover, they can be used for tissue engineering approaches by mimicking the ECM. In this thesis, a novel hybrid double cross-linked hydrogel is presented and designed based on the bottom-up approach of synthetic biology. It consists of simultaneously formed chemical and physical cross-links and made out of two components: (1) thiol functionalized HA (74 kDa) (HA-DTPH) and (2) ionic crosslinker (Cl+). HA-DTPH provides the chemical cross-link by forming disulphide bonds and the ionic cross-linker forms physical cross-links, such as hydrogen bonds and salt bridges. Three different ionic cross-linker were used: (1) deacetylated disaccharide unit of HA (dHA+) (2) charged glucosamine (GluA+) and (3) ammonium chloride (NH4+). These ionic cross-linker were chosen due to their biocompatibility and ability to form physical cross-links, such as hydrogen bonds and salt bridges. The increasing capacity to form hydrogen bonds from NH4+ to dHA+ enabled us to study the influence of the physical cross-link on the hydrogel properties. I could show that the disulphide bond formation was enhanced, by adding an ionic cross-linker and led to the formation of stable hydrogels. Under the same reaction conditions, HA-DTPH without an ionic cross-linker, needed further oxidation with hydrogen peroxide to result in a stable hydrogel (HA-DTPH-Ox.). By varying the degree of thiolation on HA and additionally by varying the type and concentrations of the used ionic cross-linker, the mechanical stiffness, swelling properties and response to external stimuli were tuneable. Varying the degree of modification and used ionic cross-linker enables a specific adjustment of the hydrogels specifically the hydrogel suitable for cell studies with mechanical range of 0.1 Pa to 8 kPa. Furthermore, swelling ratios of HA-DTPH-Cl+ hydrogels are highly influenced by the ionic strength and pH. Remarkably HA- DTPH- dHA+ hydrogels upon incubation in a solution of pH 7 showed a feedback loop swelling behaviour. At the swollen state of the hydrogel, the ionic cross-linker dHA+, leaked out of the hydrogel network, acidified the solution, which resulted in shrinking of the hydrogel. Biological properties like enzymatic degradability showed that the half-live of HA-DTPH-Cl+ hydrogels are increasing with increasing capacity of the ionic cross-linker to form hydrogen bonds. Moreover, due to the absence of any toxic agent during the hydrogel formation the hydrogel system was used for live cell applications such as cell encapsulation or cell adhesion studies. To conclude, a hybrid double cross-linked hydrogel system could be presented, mimicking the ECM, in a minimal model and a critical influence of physical cross-links is observed from results obtained by characterizing the physical and biochemical properties by investigating the gels’ swelling capability, response to environmental changes and sensitivity to hyaluronidases. Depending on the desired biomedical application, these hydrogel systems can be tuned in regards to their stiffness, swelling behavior and degradability enabling applications in 3D tissue engineering, drug delivery and regenerative medicine

A rare complication of the Sistrunk’s procedure in thyroglossal duct remnant: tracheal injury

Management of thyroglossal duct remnants (TGDRs) is a common clinical concern in childhood. A girl with an unusual complication of tracheal injury secondary to the Sistrunk’s procedure is presented and discussed with regard to the relevant literature on airway injuries during the procedure. Surgical resection is an optimal choice of therapy in TGDRs and may be associated with high morbidity, especially recurrence. Although the Sistrunk’s procedure is a safe and successful technique, lifethreatening complications should be kept in mind during the management of TGDRs

Complications of ventriculoperitoneal shunt in hydrocephalic children: a case report and a review of the literature

This case study was carried out to focus on three unusual cases of complications in hydrocephalic children with ventriculoperitoneal shunts (VPSs) – namely, intestinal obstruction and protrusions of the shunt catheters into the right hemiscrotum. These children were treated at the Department of Pediatric Surgery, Dr. Behc¸et Uz Children’s Hospital, and at the Department of Neurosurgery, Tepecik Training Hospital. Management of these patients with special emphasis on the literature pertaining to the migration of shunt catheters into the scrotum is reviewed and discussed. Complications of intestinal obstruction and protrusion of the VPS catheters into the scrotum are rarely seen in hydrocephalic children with VPSs. Early identification of these complications is recommended as they may cause life-threatening acute abdominoscrotal conditions, and prompt surgical intervention is necessary not only for immediate treatment of the child but also to ensure good quality of the patient’s life in the long term.Keywords: complication, hydrocephalic children, ventriculoperitoneal shun

Bağlanma stillerine göre varoluşçu temaların keşfi: Genç yetişkinlerin ilişkisel dünyasının fenomenolojik olarak incelenmesi

İnsanın diğerleriyle ilişkiler kurması yadsınamaz bir gerçektir. İnsan ilişkilerinde bireyin diğerleriyle kurmuş olduğu güçlü bağların nedenlerini açıklamaya çalışan bağlanma kuramı son yıllarda birçok araştırmaya konu olmuştur. İlişkisel bir varlık olarak dünyada yaşamını sürdüren insan, insanın dünyada olma halleri, insanın dünyaya ve ilişkilerine dair anlam arayışı, varoluşçu yaklaşımın anlamaya çalıştığı konulardır. Literatüre bakıldığında, insan ilişkilerini anlamaya yönelik olarak, bağlanma stilleri ve varoluşçu yaklaşımın bir arada incelendiği çalışmaya rastlanmamıştır. Çalışmanın amacı, bireylerin bağlanma stillerine göre ilişkisel dünya deneyimlerini anlamaya çalışmak, bu deneyimlerde açığa çıkan varoluşçu temaları keşfetmektir. Örneklem, Kayseri ilinde ikamet eden 4 kadın ve 4 erkek olmak üzere 8 katılımcı şeklinde belirlenmiştir. Her katılımcı kendisine verilen ilgili ölçeği değerlendirmiş, sonrasında her katılımcı ile birebir ve yüz yüze olan görüşmeler gerçekleştirilmiştir. Bu görüşmelerde katılımcıların onayı ile ses kaydı alınmıştır. Katılımcılarla gerçekleştirilen görüşmeler, nitel araştırma yöntemi olan yorumlayıcı fenomenolojik analiz tekniği ile incelenmiştir. Analiz sonuçlarına göre “ilişkilerin fiziksel boyutu, ilişkilerin sosyal boyutu, ilişkilerin kişisel boyutu ve ilişkilerin tinsel boyutu” olmak üzere 4 üst tema belirlenmiştir. Her üst tema, aynı zamanda farklı sayılarda alt temaya ayrılmıştır. Tüm temalar, ilgili literatürde yer alan araştırmalar aracılığıyla tartışılmıştır

A paratubal cyst associated with flegmonous appendicitis: A case report and review of literature

Paratubal cysts (PTCs) are rare clinical entities and are believed to originate from the mesothelium or to be a remnant of Mullerian duct and Wolffian duct. These masses have been reported in all age groups,  beginning from the premenarchial period up to menopause, and are mostly benign. A 14-year-old girl with flegmonous appendicitis diagnosed and treated during the management of PTC is presented. This report shows that PTC and flegmonous appendicitis can be seen together as distinct entities in children.Keywords: children, flegmonous appendicitis, paratubal cys

Demographic characteristics in patients with short-gap and long-gap esophageal atresia: a comparative study

Background The knowledge of the size of the gap between esophageal ends in esophageal atresia (EA) before surgery is of clinical importance. The aim of this study was to compare the demographic characteristics between patients with short-gap esophageal atresia (SGEA) and long-gap esophageal atresia (LGEA).Patients and methods Medical records of all patients managed for EA spectrum in our department between 2003 and 2012 were evaluated, retrospectively. Demographic data included the maternal age, the number of parities and deliveries, the presence of polyhydramnios and the prenatal diagnosis, sex, the gestational age and prematurity, the type of delivery and the birth weight, age at the time of diagnosis and treatment, the presence of associated anomalies including VACTERL-type and non- VACTERL-type anomalies, the type of EA according to Gross classification, and discrepancies between the diameters of atretic esophageal ends. SGEA and LGEA were defined as a gap of less than three vertebral bodies or three or more vertebral bodies in length between the atretic esophageal ends, respectively.Results There were 99 patients treated for the diagnosis of EA spectrum during the study period: 81 in the SGEA group and 18 in the LGEA group. Most of the parameters studied did not differ between the two groups. Type-C EA was more prevalent in patients with SGEA (n= 77/81) and type-A was more frequent in children with LGEA (n= 8/18) (P < 0.05). The frequency of prenatal diagnosis (2.5% for SGEA vs. 22.2% for LGEA) was more common in the LGEA group (P < 0.05). Cesarean section compared with normal vaginal delivery was more commonly seen in both groups (56.8% for SGEA vs. 66.7% for LGEA).Conclusion Most of the demographic parameters were similar between the two groups of patients. However, the frequency of prenatal diagnosis was more common in patients with LGEA. Most of the patients in both groups were delivered by a cesarean section. Type-C EA was more prevalent in patients with SGEA and type-A was more frequent in children with LGEA. Further analysis of this topic is warranted and may be beneficial in revealing the true demographic differences between patients with SGEA and LGEA

Chitosan coating on microcapsule treated fabric and its effect on laundering durability

Mikrokapsüller, küçük katı partiküllerinin, sıvı damlacıklarının veya sıvı içinde disperge haldeki katıların üzerine mikron mertebesinde ince bir polimer tabakasının kaplanması vasıtasıyla gerçekleştirilen, mikron düzeyindeki bir paketleme tekniği ile üretilirler. Mikrokapsül ihtiva eden kumaşlar, akıllı kumaşlar olarak adlandırılırlar ve kozmetik, terapi, enerji verici, stres azaltıcı, nemlendirici ve konfor özelliği ayrı ayrı veya bazılarını aynı anda beraberce içerebilmektedirler. Mikrokapsüllerin içindeki aktif maddelerin kullanım sırasında çeşitli şekillerde ve zaman içinde yavaş yavaş salınması ile mikrokapsül uygulanmış kumaşlarda amaçlanan aktif maddelerden uzun süre faydalanabilmek mümkün olmaktadır. Mikrokapsüller kumaştaki liflere kullanılan çok özel binderler vasıtasıyla mükemmel bir şekilde bağlanabilmektedir. Bu çalışmada, içinde Myritol 318 (kokonat yağı) ve vitamin E ihtiva eden mikrokapsüller hazırlanmıştır. Fularda emdirme yoluyla, kokonat yağı ve vitamin E içerikli mikrokapsüller %90 poliamid, %10 elastan içeren örme kumaşa tatbik edilmiştir. Üç farklı çapta elde edilen mikrokapsüller, üç farklı reçete ile kumaşa uygulanmıştır. Daha sonra, mikrokapsül tatbik edilmiş kumaş, içerisinde Chitosan laktik asit çözeltisi bulunan fular banyosundan geçirilmiştir. Chitosan çözeltisinden geçirilmiş ve geçirilmemiş mikrokapsül içerikli kumaşlar, elektron mikroskobunda (SEM) ve gazkromotografi altında incelenerek; mikrokapsüllerin yıkama dayanım performansları ve chitosan ile kaplama yapılmış kumaş üzerinde chitosanın yıkama dayanımına olan pozitif etkisi yapılan analizlerin sonuçlarında kendisini göstermiştir. Anahtar Kelimeler: Mikrokapsül, mikrokapsül büyüklüğü, chitosan kaplama, yıkama dayanımı, elektron mikroskobu,  gazkromatografik analiz.Micro-encapsulation is a micro-packaging technique which traditionally involved the deposition of thin polymer coatings on small particles of solids, droplets of liquids or dispersions of solids in liquids. Microencapsulated fabrics are among the latest generation of fabrics known as intelligent fabrics, taking into account the functions they perform i.e. cosmetic, with a gradual release of active or volatile micro-capsules for cosmetic, therapeutic, energy-boosting, stress-busting, moisturizing or deodorizing, and, climatic fabrics with phase change microcapsules which are heat-regulating. A direct fragrance application on garment may not show durability to repeated laundering. But one can think of encapsulating those fragrance inside a capsule, which, when touched breaks and releases the active material inside. These microcapsules can be bonded very well with fibers via using some special type of binders. The total process of microencapsulation actually covers three separate processes on a time scale. The first process consists of forming a wall around the core material. The second process involves keeping the core inside the wall material so that it does not release. Also, the wall material must prevent the entrance of undesirable materials that may harm the core. And finally, it is necessary to get the core material out beginning at the right time and at the right rate. Since the beginning of the 90's, trade applications of micro-encapsulation in the textile field have appeared. Textile manufacturers show more and more interest in the textile with durable odour or a cosmetic product which is released by the contact with the skin. Therefore, the numbers of the researches in cosmetic effects of clothing textiles have started to get increased. The main reasons why clothing textiles need cosmetic effects are: Body care (not only face and hand care) is one of the major trends in cosmetics. Textiles cover a large part of the body for most of the day, which means a unique opportunity for the convenient transfer of cosmetics to large parts of the body. Continuous release of small doses of cosmetics may be more effective than single applications of large amounts of well-known drugs. Consumers are increasingly interested in and open to textiles with added effects: functional garments are massive trend in textile. On the other side, cosmetic effects of the clothing textile have been facing with some technical challenges in recent years. The main challenges to attach cosmetic ingredients onto textiles are in such a way that They are not destroyed in the finishing process. They remain stable during storage. They are not washed out during further launderings. They are transferred to the skin while the textiles are being worn and can therefore produce real controllable effects. The main technical challenges are the washing permanency and the controlled release properties. In this study, Myritol 318 (coconut oil) and vitamin E mixtured microcapsules were prepared. By using foulard process, coconut oil/ Vitamin E mixtured microcapsules were applied on 30/1 single jersey fabric (90% Polyamide, 10% Lycra), which is 240 g/sqm. Three different recipes were prepared by using three different microcapsule sizes. Furthermore, microcapsule treated fabric passed through the foulard, which had Chitosan lactic acid solution inside. After that, both Chitosan coated and no Chitosan coated fabric were analyzed under SEM (scanning electron microscopy) and under gas-chromatogram to see its laundering durability performance and the positive effect of Chitosan coating on laundering durability were proved after all these analyses. In this study, it was found out that, as studied with many researchers before, Chitosan played an active role to improve laundering durability by creating a kind of second membrane around microcapsules that are located inside of the fabric. By this way, the membrane shell of the capsules were strengthen with this second layer and the release of the myritol 318 coconut oil were slowed down. Therefore, the microcapsule life could have been extended within the fabric during further home laundering cycles. Creating a kind of second layer around the microcapsule wall decreased the risk of the capsule breakage. Capsules which have thinner membrane are normally much more brittle. Keywords: Microcapsule, microcapsule size, Chitosan coating, laundering durability, scanning electron microscopy and gas-chromatographic analysis

A pancreatic neuroendocrine tumor diagnosed during the management of acute appendicitis

Pancreatic neuroendocrine tumors (PNET) are increasingly being discovered. A case of PNET diagnosed and treated during the management of acute appendicitis is presented and discussed. The importance of imaging modalities in patients with acute abdominal pain is emphasized. To the best our knowledge, this is the first pediatric report of PNET and acute appendicitis combination.Keywords: acute appendicitis, children, pancreatic neuroendocrine tumo