Mehmet Emin Çelikkaya

Duodenal perforation: an unusual complication of sickle cell anemia

Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presented with abdominal and back pain. The patient was operated on for acute abdomen and diagnosed with duodenal perforation. Helicobacter pylorus was negative. There was no risk factor to account for duodenal perforation other than sickle cell anemia. Surgical intervention was successful and without significant sequelae. Duodenal perforation is a rare entity described in patients with sickle cell anemia. To our knowledge, this is the first report of duodenal perforation in a patient sickle cell anemia.

Bronchoscopy for foreign body aspiration and effects of nebulized albuterol and budesonide combination

Objective: A foreign body aspiration in the tracheobronchial tree is a dangerous medical condition in the childhood period. Although rigid bronchoscopy is a safe procedure, it may cause complications. The aim of this study was to present our bronchoscopy experience and to evaluate the efficacy of pre-operative administration of nebulized albuterol and budesonide combination for reducing intra-operative complications in foreign body aspirated cases. Methods: In this retrospective study our pediatric cases in which a foreign body was removed from tracheobronchial tree in last 8 years were analyzed. After excluding the patients who needed emergent and negative bronchoscopies, the remaining clinically stable 84 patients were compared for the effects of preoperative administration of nebulized albuterol and budesonide combination on bronchoscopy complications. Results: There were 51 boys (60.3%) and 33 girls (39.7%). There were 38 children in the non-nebulized group and 46 children in the nebulized group. We found that the combined albuterol and budesonide nebulization decrease complications such as arterial oxygen desaturation (p<0.05), and bronchospasm (p<0.05) during the bronchoscopic intervention. Conclusion: Preoperative nebulization of albuterol and budesonide combination may decrease perioperative complications of bronchoscopy.

Yenidoğan Döneminde Nadir bir İntra-abdominal Kistik Kitle: Over Otoampütasyonu

Bir adneksin torsiyone olmasi enfarktus, nekroz ve sonrasinda overin kopmasina neden olabilir. Ampute olan over kalsifikasyona ugrayarak karin boslugunda serbestce yuzen bir kitle haline domusebilir. Antenatal ultrasonografi ve postnatal bilgisayarli tomografi bulgulari ile 4 gunluk kiz bebekte saptanan over amputasyonu sunulmustur. Degisken lokalizasyonlari olan mobil intraabdominal kistik kitlelerin ayirici tanisinda mutlaka amputasyona ugramis over de akilda tutulmalidir.

Induction with Propofol Decreases Emergence Agitation in Pediatric Patients

Background and objectives: Emergence agitation (EA) is a common complication seen after inhalational anesthesia especially with sevoflurane, with an incidence of 20-80%. The hypothesis of the study was that induction with propofol reduces the incidence and severity of emergence agitation when compared with sevoflurane in children undergoing inguinal hernia surgery. Methods: 116 Children undergoing inguinal hernia were randomly assigned to two groups: Sevoflurane group received sevoflurane increasing concentrations up to 8% and propofol group received 3 mg kg propofol in induction. Postoperative agitation treatment and analgesia was standardized, and postoperative assessments included Cole Agitation Scale and narcotic consumption for agitation, Wong-Baker Faces Pain Rating Scale for pain, first spontaneous eye opening time, first verbal command follow time, post-anesthesia care unit (PACU) staying time, first analgesic requirement time and parents satisfaction. Results: The incidence of EA at arrival in PACU and the cumulative incidences at the end of the postoperative two hours were significantly lower in the propofol group. EA scores were lower in propofol group in all measurement times during postoperative 30 minutes. Fentanyl consumption at arrival in PACU and the sum of the two hours were significantly lower in propofol group. Pain scores were lower in propofol group in the postoperative 24 hours. First analgesic requirement time and parents satisfaction were higher in propofol group. Conclusion: Propofol in accurate dose is effective in reducing the incidence and intense of EA in children undergoing inguinal hernia and maybe preferred in children with high risk of EA.