Protocol: A systematic review and meta-analysis of the role of fetal and infantile environmental exposure in etiopathogenesis of infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is one of the hallmark pediatric surgical diseases. However, its etiology remains incompletely understood. By systematically reviewing the literature, we aim to clarify the effect of the effect of occupational and environmental factors and role of nitric oxide (NO) metabolism in the etiopathogenesis of IHPS. The systematic review is drafted with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). Systematic literature search will be performed for the period 2000 (Jan) to 2020 (Dec) in the databases: MEDLINE, EMBASE, PubMed. The systematic search will cover the literature in English and Turkish language and will be limited to studies on human subjects. Four investigators will independently search the databases (MEDLINE, EMBASE, PubMed) according to the defined search strategy. The full-text of the selected articles will be screened independently by four reviewers, against the inclusion criteria. Descriptive data will be extracted from each study regarding: study details, methods, participants, outcomes and calculations of association for potential further statistical analysis. If meta-analysis could not be undertaken, systematic approach to analyzing the findings of included multiple studies will be described. Heterogeneity will be assessed by quantifying the inconsistency across studies using I2 statistic. Statistical analysis will be performed using Comprehensive Meta-Analysis Version 3.0 software. The p values lower than 0.05 will be considered statistically significant for all analyses

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

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

Smooth Muscle Cells are Derived Predominantly from Tissue Explant of Inguinal Hernia Sac

INTRODUCTION: Obliteration of processus vaginalis (PV) has been proposed to result from persistence of smooth muscle which is presented transiently to propel the testis. Sacs associated with inguinal hernia were cultivated to define the cells that are going to proliferate for evaluating the association of inhibition of obliteration of PV and the presence of smooth muscle (SM). The present study does not only provide additional information about the presence of SM in sacs from boys with inguinal hernia, but also provides a new tool for researches directed to define the non- operative treatment of inguinal hernia

Smooth muscle cells are derived predominantly from tissue explant of inguinal hernia sac

GİRİŞ ve AMAÇ: Processus vaginalisin (PV) kapanmasının, testisin inişini sağlamak için geçici olarak bulunan düz kas hücrelerinin, devamlılığına bağlı olduğu ileri sürülmüştür. Bu amaçla, inguinal herni keseleri, PV kapanması ve düz kas hücre varlığı arasındaki ilişkinin değerlendirilmesi için kültüre edildi. Bu çalışma, sadece inguinal herni keselerinde düz kas hücresi varlığını gösteren ek bilgiler vermekle kalmayıp, aynı zamanda inguinal herninin cerrahi dışı tedavisi için yapılacak çalışmalar için yeni fikirler sunmaktadır. YÖNTEM ve GEREÇLER: Herni keseleri, yaşları 2 ay ile 5 yaş arasında değişen 11 çocuktan inguinal herni ameliyatı sırasında elde edildi. Örnekler uygun şekilde hazırlandı ve kültüre edildi. Hücrelerin morfolojik özellikleri ışık mikroskobu ile değerlendirildi. Hücrelerin hayatiyetleri, tripan blue exclusion metodu ile değerlendirildi. Gelişen hücreler, imminohistokimyasal olarak aktin ve miyozin ile boyandı. BULGULAR: Işık mikroskobu incelemesi ile bu hücrelerin iğ şekilli olduğu ve santral yerleşimli yuvarlak çekirdeklerinin bulunduğu görülmüştür. Tüm flask üreyen hücrelerle dolduğunda, kontakt inhibisyon olmadığından, üst üste çoğalan hücreler tipik tepe-vadi görünümü oluşturmuştur. Hücrelerin canlılığı %95’ in üzerinde bulunmuştur. Gelişen hücrelerin % 80 inin düz kas aktin ve düz kas myosin antikorları ile boyandığı saptanmıştır. TARTIŞMA ve SONUÇ: Herni kesesi dokulardan gelişen hücrelerin büyük çoğunluğunu, düz kas hücreleri oluşturmuştur. Bu bulgu, PV’in inhibisyonu ile düz kas hücresi varlığı arasındaki ilişkiyi desteklemektedir. Bu bilgi inguinal herninin cerrahi dışı tedavisi üzerinde yapılacak çalışmalar için kullanılabilecektir.INTRODUCTION: Obliteration of processus vaginalis (PV) has been proposed to result from persistence of smooth muscle which is presented transiently to propel the testis. Sacs associated with inguinal hernia were cultivated to define the cells that are going to proliferate for evaluating the association of inhibition of obliteration of PV and the presence of smooth muscle (SM). The present study does not only provide additional information about the presence of SM in sacs from boys with inguinal hernia, but also provides a new tool for researches directed to define the non- operative treatment of inguinal hernia. METHODS: Hernia sacs were obtained from eleven boys with the ages ranging from two months to five years during operations for inguinal hernia. Samples were prepared and cultivated. Morphologic characteristics of cell populations were examined by light microscopy. Viability was estimated by trypan blue exclusion method. Growing cells were identified via immunohistochemical staining for smooth muscle actin and myosin. RESULTS: Light microscopic images of growing cells displayed characteristic spindle shaped morphology with centrally located round nucleus. When the flasks reached confluence, a hill-valley appearance was observed because of absence of contact inhibition. Cell viability was found more than 95%. Approximately, 80% of growing cell populations was stained positive with actins and myosin antibodies. DISCUSSION and CONCLUSION: In tissue explants of hernia sac, most commonly proliferating cell type is smooth muscle cells. This evidence supports the association of inhibition of PV and the presence of SM. The SM obtained from sacs associated with inguinal hernia may be used for researches directed to establish the non-operative treatment of inguinal hernia

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