Ebru Yesildag

Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty.

To decide whether antireflux surgery should be used in the presence of vesico‐ureteric reflux (VUR) in children, in whom an augmentation procedure is needed, because secondary VUR in children with a neurogenic bladder, infravesical obstruction and primary VUR in the exstrophy‐epispadias complex is expected to resolve after augmentation, which decreases the intravesical pressure and increases capacity.

Arterial carbon dioxide markedly increases during diagnostic laparoscopy in portal hypertensive children.

Several factors are responsible for hypercarbia during laparoscopic procedures. This study was undertaken because we observed a sudden increase in Paco2 in children with portal hypertension (PHT), which was unusual in healthy children undergoing laparoscopic procedures. Fifty-seven children underwent laparoscopic procedures under general anesthesia and were mechanically ventilated. Arterial blood samples were obtained 5 min after intubation (T0), 15 min and 30 min after CO2 pneumoperitoneum (T15 and T30), 5 min after desufflation (Tend), and 10 min after extubation (Text) for blood gas analysis. The changes in Paco2, pH, and ETco2 were statistically significant during the study periods in both groups (P < 0.05). The percentage of Paco2 increase between T0 and T15 was 11.5% and 20.1%, respectively, in the control group and the PHT group (P < 0.05). This increase reached 36.8% at T30 in the PHT group, whereas the control group had a 17.2% increase (P < 0.05). ETco2 presented similar changes. The variability in base excess, bicarbonate, Pao2, arterial oxygen saturation, and Spo2 was not significant in either group (P > 0.05). The Paco2 increased remarkably in children with PHT undergoing laparoscopy, with no difference in intrahepatic or extrahepatic origin. Limiting the duration of CO2 pneumoperitoneum and intraabdominal pressure and adjusting ventilatory variables to accommodate hypercarbia are of the utmost importance for such cases.

Esophageal Variceal Bleeding Secondary to Portal Hypertension: Endoscopic Sclerotherapy as the First-Step Treatment

BACKGROUND Variceal bleeding from the esophagus is an important cause of mortality and morbidity in children with portal hypertension (PHT). PATIENTS AND METHODS A series of 69 PHT cases (41 intrahepatic, 28 extrahepatic) have been evaluated in our department since 1990. According to the Child-Pugh classification, 49 cases were in class A, 16 cases were in class B, and 4 cases were in class C at admission. In our protocol, endoscopic sclerotherapy is performed in all patients, and the diagnosis is achieved directly by diagnostic laparoscopy and fine-needle liver biopsy. The procedure is applied under general anesthesia, and 1% aethoxysclerol (polidocanol) is injected paravariceally and intravariceally with the use of a flexible endoscope. RESULTS The Sugiura procedure was performed in nine patients who presented with recurrent bleeding episodes despite the strict sclerotherapy protocol. Liver transplantation was performed in two patients who were in Child class C. The total mortality rate in this series was 7% (5/69). CONCLUSION Endoscopic sclerotherapy, as presented herein, decreases the need for additional surgical interventions in children with PHT.

Extrathoracic Liver Hamartoma

Mesenchymal hamartoma is a benign tumor of the liver that often presents because of a palpable abdominal mass or respiratory distress. An unusual protrusion of this tumor through the chest wall of a neonate with Poland’s syndrome is reported.

A case of wandering spleen causing urinary symptoms after correction of a posterolateral diaphragmatic hernia.

Abstract A 12-year-old girl who had had an operation for a posterolateral diaphragmatic hernia was admitted to the hospital because of enuresis. Physical examination and radiologic studies revealed the spleen behind the urinary bladder, left-sided hydronephrosis, and a high volume of residual urine. The hydronephrosis and residual urine resolved immediately following splenectomy.

Doppler Ultrasonography in Searching the Collateral Network in Portal Hypertensive Children

A diffuse collateral network forms all around the body both in extrahepatic and intrahepatic portal hypertension and radiologic imaging of these collaterals is an important step in evaluation of a portal hypertensive patient. The intraabdominal collaterals and splanchnic hemodynamics of 17 portal hypertensive children in the endoscopic sclerotherapy program, were evaluated with Doppler ultrasonography. An increased blood flow of the hepatic artery was found in all cases independent from the underlying etiology. The decrease in the blood flow of the portal vein was more remarkable in the extrahepatic group. The diameter of the portal vein was not a determinant in the progression of the disease. More diffuse collaterals were found in the liver hilus and retroperitoneum in extrahepatic portal hypertension. On the other hand, the splenic hilus and splenorenal region were leading in intrahepatic cases. The blood flow of the left renal vein was evidently higher than that of the right in these cases. Demonstration of collateral anatomy is an important step in order to estimate the response, complications, treatment options and clinical outcome in patients with portal hypertension. Doppler ultrasonography is a non-invasive and easily applicable technique that provides valuable information about collateral pathways.

Caroli's disease in children: Is it commonly misdiagnosed?

Aim: Carolis disease is a simple form of intrahepatic bile duct ectasia. It can be complicated with the involvement of liver parenchyma and portal hypertension. Herein, the difficult management of delayed presentation of Carolis disease is reported. Methods and results: We report on four different forms of clinical presentation of Carolis disease: an infant with fulminant liver failure, a teenager with persistent biliary fistula, a boy with hypersplenism in the face of portal hypertension and a girl with variceal bleeding.

Equality of the left and right renal venous flow predicts the severity of variceal bleeding in portal hypertensive children

Portasystemic collaterals develop as a result of portal hypertension. The collaterals in the cardioesophageal region is the leading cause of bleeding from esophageal varices. Some of the portal hypertensive patients present with bleeding episodes but the others do not, and some of the bleeders do not respond to endoscopic sclerotherapy procedure, although the underlying pathology is the same. The capacity of the natural collateral vessels might be a determining factor about the hemorrhagic events. Since the first step of portasystemic collateralization takes place in the naturally existent vascular channels, the present study, with its anatomic and clinical parts, was focused on these venous structures.

Üç yaşında saptanmış bir laringosel olgusu Olgu Sunumu

Laryngocele is a rare cervical lesion of childhood that may present either with a mass or respiratory distress Therefore other causes such as thyroglossal cyst or dermoid cyst are primarily suspected in a case with a midline cervical mass and the diagnosis of laryngocele is usually made after surgical exploration and histopathologic analysis Herein a three year old boy in whom the diagnosis of an external laryngocele was achieved after surgical intervention and histopathological analysis is presented and the differential diagnosis is overviewed Key words: cervical mass children laryngocele

Non Paraziter Dalak Kistleri

In children besides hematologic diseases injury due to blunt abdominal trauma and congenital or acquired cysts are other surgical pathologies of the spleen Non parasitic cysts of the spleen are rare lesions Splenectomy was performed in all these cases previously but because of postsplenectomy sepsis risk spleen saving procedures are preferred in recent years Three cases of non parasitic spleen cyst and the clinical approach in these patients are presented Key words: Non parasitic spleen cyst postsplenectomy sepsis