Arif Nuri Gürpınar

Necrotizing pneumonia in children.

Aim: Clinical features and outcome of 36 patients with necrotizing pneumonia (NP) as well as 36 children with parapneumonic effusions (PPE) and 36 with severe control pneumonia (CP) were investigated. The mean age of the patients in the NP, PPE and CP groups were similar (3.8 ± 3.3 (mean ± SD), 4.2 ± 3.0 and 4.2 ± 3.0 y, respectively (p < 0.05)). The duration of symptoms at presentation were 11.9 ± 8.5, 9.2 ± 7.2 and 6 ± 3.6 d, respectively (p > 0.01). The diagnosis of NP was established by computerized tomography. The mean (mean ± SD) laboratory results in patients with NP revealed a white blood cell (WBC) count of 19 300 ± 8 700/mm3, erythrocyte sedimentation rate (ESR) of 71 ± 22mm/h, C‐reactive protein (CRP) of 13.6 ± 11.7 mg/dl and aspartate aminotransferase (AST) of 66 ± 132 U/L. The values of WBC, ESR, CRP and AST in the NP group were significantly higher than those of the other groups (p > 0.001). The duration of hospitalization in the NP, PPE and CP groups was 26 ± 9, 16 ± 6 and 10 ± 5d, respectively (p > 0.001). The number of febrile days was 8 ± 4, 4 ± 3 and 3 ± 3 (p > 0.001), and the duration of normalization of CRP was 14 ± 4, 11 ± 4 and 7 ± 3 d (p > 0.001), respectively. The average cost of treatment was US 3 476, 1 646 and 844, respectively (p > 0.001). Conclusion: All NP patients except two (94%) were complicated with PPE. The effusion in patients with NP and PPE was complicated with bronchopleural fistula (55% and 0%, respectively, p > 0.001). Surgical treatment was required in 66%, 8% and 0% in patients with NP, PPE and CP, respectively (p > 0.001). The mortality rate was 5.5%, 2.7% and 0% (p < 0.05).

Management of thoracic empyema in children

Abstract The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim of this study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. A series of 25 consecutive children who had loculated pleural empyemas that did not respond to tube thoracostomy and antibiotics is presented. Their ages ranged from 1 to 12 years (mean 4.2). There were 19 boys and 6 girls, and all epyemas were postpneumonic. The fibrinolytic agent used was urokinase in 17 and streptokinase in 8. The mean duration of fibrinolytic treatment was 4.3 days (range 2 to 8) and the mean duration of chest-tube drainage was 8.9 days (range 7 to 13). In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multiloculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases.

Esophageal atresia and tracheo-esophageal fistula in a patient with digeorge syndrome

DiGeorge Syndrome (DGS) is a congenital disorder that affects the thymus, parathyroid glands, and heart and brain. Thymus involvement in DGS may vary between absence/hypoplasia of thymus to various forms of reduced T cell function. TBX1 deficiency causes a number of distinct vascular and heart defects, suggesting multiple roles in cardiovascular development, specifically, formation and growth of the pharyngeal arch arteries, growth and septation of the outflow tract of the heart, interventricular septation, and conal alignment. Here the authors describe a case of DGS presenting with severe combined immunodeficiency, esophageal atresia, and tracheoesophageal fistula (TEF). DGS is an important differential diagnosis in TEF.

Surgical correction of muscular torticollis in older children with Peter G. Jones technique

In the Department of Pediatric Surgery, Uludağ University Medical Faculty in Bursa, during the last 11 years, the Peter G. Jones technique for the surgical correction of muscular torticollis in older children has been introduced. Twenty children between 4 and 13 years of age were treated for muscular torticollis. They were followed up from 3 months to 10 years after surgery. All patients had a middle-third open transection of the sternocleidomastoid muscle. Preoperative and postoperative assessment by a rigid scoring system showed that all patients improved in terms of function as well as cosmesis. Children younger than 10 years showed the most improvement, with 90% excellent and good results. Late middle-third open transection of the sternomastoid in muscular torticollis may give acceptable results.

Open surgical removal of tracheobronchial foreign bodies: A case report

Tracheobronchial foreign bodies can usually be extracted by skillful application of endoscopic techniques. The authors report on experience in the treatment of an infant in whom a plastic object was extracted by an open surgical approach. The authors discussed clinical presentation and treatment options in the treatment of this patient who had a plastic pencil top lodged in the lung. In highly selected cases, an open surgical procedure entails less risk than endoscopic extraction.

Serpentine-like syndrome associated with encephalocele.

Introduction Congenital short oesophagus and with intrathoracic development of the stomach is a rare developmental anomaly of the gastrointestinal system. Knowledge regarding its aetiology and management is limited. We report a case in which, in addition to short oesophagus and intrathoracic stomach, an encephalocele was identified during the antenatal period. After the postpartum examination, encephalocele, split notochord malformation, midline localized liver and congenital short oesophagus were confirmed. The report of this case adds to the body of knowledge on this rare condition.

Endoscopy-guided balloon dilatation of oesophageal strictures in children

The aim of the study is to evaluate the indications, safety, and efficacy of endoscopy guided balloon dilatation (EGBD) in the treatment of strictures of the oesophagus in children. Between 1998 and 2002, 12 infants and children with oesophageal strictures were treated with EGBD in our institute. Median age was 4.1 years (range, 2 months-11 years). Of 12 patients, four had oesophageal strictures, following repair of oesophageal atresia; six had short-segment caustic strictures; and two had anastomotic strictures after oesophageal replacement (colon, 1; stomach, 1). All patients had previously failed to respond to conventional bouginage (mean, 6 sessions; range 2-14). All patients underwent contrast studies before EGBD. EGBD was performed using flexible endoscopy and fluoroscopic screening under general anaesthesia. The mean number of EGBD procedures per patient was six (range 4-10). The functional results were complete in ten and temporary in two patients. There has been no morbidity or mortality. EGBD is safe and effective for treating oesophageal anastomotic and short-segment caustic strictures.

Treatment of recurrent tracheo-oesophageal fistula in an infant using bronchoscopic I application of fibrin glue

SummaryRecurrent tracheo-oesophageal fistula (TEF) is the most common and serious complication of the treatment of oesophageal atresia with TEF. Following this complication, the patient might need several operations. In this study, the authors report on the treatment of recurrent TEF using bronchoscopic application of fibrin glue (FG) to the fistula tract.

Swallowed open safety pin and amulet in infants: Consequences of a tradition in Turkey

SummaryIngestion of safety pins (SP) is relatively uncommon in infants. To attach an amulet with SP on the clothes of a baby is widely-accepted as a tradition in Turkey with the result that ingestion of open SP is more common here. 15 patients were admitted during a 3 year period after having swallowed an open safety pin; eight were males in the age range 7–12 months. All of the patients were asymptomatic. The sites of the foreign bodies were; the oesophagus (four), stomach (four), duodenum (three), small bowel (three), and rectum (one). Extraction by means of flexible gastroscopy was successful in 10 patients (90.6 %) while one (9.4 %) required a laparotomy. The remaining four patients discharged the foreign body via the rectum without any complication. Endoscopic extraction of open safety pins with the flexible endoscope is usually successful in infants.

Çocuklarda Özofagus Yabancı Cisimleri

Foreign bodies of the esophagus are common problems in children and there are various methods to manage esophageal foreign bodies We retrospectively reviewed our cases in respect to the time of admittance after ingestion the presenting symptoms the site and type of the foreign body and the management undertaken From 1991 to 1998 134 esophageal foreign bodies were managed in our institution There were 77 boys and 57 girls 56 7 n:76 of the children were less than 3 years old 91 8 n:123 of foreign bodies were opaque and 8 2 n:1 1 were nonopaque 98 of opaque foreign bodies were coins 106 of foreign bodies were located at the proximal third 14 at the middle third and 14 at the distal third of the esophagus Duration of ingestion was less than 12 hours in 64 9 n: 87 of the patients and the longest duration was three months Complications were observed in two patients 84 8 n:127 of foreign bodies were managed with McGill pliers extraction n: 85 with foley balloon extraction n: 16 with endoscopic extraction n:25 with fogarty cathater extraction n:1 under general anesteshesia and with magnetic exraction n:3 Four of the foreign bodies were pushed into the stomach We believe that removal of the esophageal foreign bodies in children must be performed in the operation theatre McGill pliers and foley balloon catheter are suitable for removal of proximal third esophageal foreign bodies and endoscopy for removal of middle or distal third esophageai foreign bodies If the removal of the foreign bodies is impossible advancement into the stomach is suitable Key words: Esophagus Foreign Bodies Children