Metin Gündüz

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones

Purpose: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Methods: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. Results: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Conclusions: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.

Unexpected Death Due to Acute Gastric Dilatation and Gastric Necrosis in an 11-Year-Old Boy.

AbstractThis report is related to the unusual case of an 11-year-old boy presenting with acute gastric dilatation after the intake of excessive food and carbonated beverages after a 12-hour fasting who died of complications of acute reperfusion syndrome after decompression of the stomach with gastrotomy. An enormously distended stomach was encountered without volvulus and obstruction in the operation. Autopsy and histological findings revealed a severely distended stomach, the walls of which were notably thin and displayed transmural necrosis. The reported case demonstrated that enormous food and beverage intake may cause acute gastric dilatation and gastric necrosis, and subsequently, sudden death may develop in children. The subject reported here is the youngest child in literature dying from acute gastric dilatation and necrosis without any underlying disorders and exposed to autopsy.

The effects of melatonin and colchicine on ischemia-reperfusion injury in experimental rat testicular torsion model.

PURPOSE The aim of the present study is to investigate the efficiency of colchicine and melatonın in an experimental rat testicular torsion model in the light of histological and biochemical data. METHODS A total of 34 Wistar albino male rats were randomly divided into 5 groups as: Group C (control, n=6), Group S (sham; underwent only left scrotal exploration, n=7), Group TD (torsion and detorsion; 6h of ischemia and 7days of reperfusion, n=7), Group TD/M (TD+Melatonin; 6h of ischemia and 7days of reperfusion and 7days of 17mg/kg intraperitoneal melatonin per day, n=7), group TD/Col (TD+Colchicine; 6h of ischemia and 7days of reperfusion and 7days of 1mg/kg oral colchicine per day, n=7). Histopathologic evaluation of seminiferous tubule deterioration was performed by Johnsens scoring system. Total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels were analyzed in each group. RESULTS The histopathologic scores, total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels in groups C and TD/Col were significantly lower than groups TD and TD/M (P<.001). CONCLUSION Our study results revealed that colchicine reduced testicular ischemia-reperfusion injury in experimental rat testis torsion model. Although detorsion of testis is crucial for the preserving the testicular viability, antioxidant and anti-inflammatory treatment modalities like colchicine might help to reduce ischemia-reperfusion injury in detorsed testis.

Immunohistochemical and morphometric evaluation of neuronal dysfunction in pelviureteral junction obstruction.

PURPOSE The pathophysiology of pelviureteral junction obstruction remains unclear. In this study, we attempted to evaluate the neuronal dysfunction using immunohistochemical and morphometric parameters. MATERIALS AND METHODS Using specific antibodies, we studied the neuronal markers and morphometry of specimens from 10 cases of pelviureteral junction obstruction and 10 normal pelviureteral junctions by immunohistochemistry using synaptophysin (synaptic vesicle membrane protein), S-100 (nerve cell fiber marker), protein gene product 9.5 (neuron specific protein) and CD-117 (transmembrane receptor with tyrosine kinase activity). RESULTS In pelviureteral junction obstruction, smooth muscle thickness was significantly higher than in normal specimens. Cytoplasmic cells stained by synaptophysin were found in the pelviureteral junction obstruction specimens but were absent in normal pelviureteral junction specimens. In addition, significantly more intense staining for S-100 was found in the pelviureteral junction obstruction specimens compared with the normal specimens. Immunohistochemical staining for protein gene product 9.5 showed no differences between the normal and pelviureteral junction obstruction specimens. Neither the normal specimens nor pelviureteral junction obstruction groups were stained by CD-117. CONCLUSION We propose that the cause of neuronal dysfunction in pelviureteral junction obstruction depends on the increase in number and structure of neuronal cells and smooth muscle thickness. These factors could play an important role in the pathophysiology of pelviureteral junction obstruction by affecting motility and peristalsis.

Response to the Letter: The Effects of JJ Stents for Extracorporeal Shock Wave Lithotripsy in Pediatric Urolithiasis (Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?)

We do agree that the population size was small in our study as mentioned by Yanaral et al. It is only since 2012 that pediatric renal stones are being removed using shock wave lithotripsy in our department, so these results are the first of its kind and further studies with large populations can be performed. We did not need to use statistical analyses for assessing the stone free rate and complications. We still are of the opinion that the percentage of stone free rate and mentioned complications are clear and adequate. In our research, the stone size was under 20 mm (7–15 mm) and as known, it is one of the main factors effecting the success of shock wave lithotripsy. In conclusion, we have similar opinions about preoperative JJ stenting in children with renal stones. However, further studies evaluating larger stone sizes are needed. Disclosure Statement

Vesicovagynal reflux or not

We read the recently published study by Indiran with great interest [1]. The study was about collection of urine in the vagina (urocolpos) due to vesicovaginal reflux (VVR) or a fistula. We would like to comment about this article. VVR is known as the collection of urine in the vagina during enuresis. Such patients refer to health centers due with complaints such as frequent urinary tract infections, abdominal pain, and underwear wetting. During the diagnosis, other causes—such as voiding problems, conditions leading to urinary tract infections, and vesicovaginal or urethrovaginal fistula—should be excluded [2]. Additionally, imaging studies such as ultrasonography, voiding cystourethrography, and magnetic resonance imaging cystourethroscopy should also be planned for. Defining enuresis position and conducting interventions for total labium opening are the most important steps during treatment [3]. In the case presented by the authors, the presence of urocolpos and ureteropelvic stricture as well as VVR is quite interesting. However, we consider that VVR was not used appropriately in that case, as the reflux was not from the bladder but from the urethra. If it were from the bladder, there would be a separate path, and the condition would be labeled as vesicovaginal fistula. So, naming the condition as urethrovaginal reflux is more appropriate than VVR.

Little negligence leading to irreparable harm: thinner burns -

The aim of the present study is to evaluate the epidemiology and outcome of paint thinner induced burn injuries at a local burn center. A retrospective analysis of 55 patient paint thinner thermal burn cases was conducted. Relevant patientsÂ’ data such as age, sex, etiologic factors, burn extent and localization, employed methods of treatment, hospitalization period, and results were evaluated in retrospect from patientsÂ’ records. 50 male and five female patients with a mean age of 26,78 (14-47) years participated in the presented study. Kindling fire with paint thinner was the most frequent etiologic factor. Total body surface burn area was 22,5 % (5-90). The mean hospitalization period of the survivors was 24 (5-64) days. Early excision and split-thickness sking grafting was applied in 22 patients. The remaining 26 patients were treated with topical agents. Total mortality was only 7 (12.7%). These patients had paint thinner induced burned body surfaces of 60 % with accompanying inhalation injuries. Paint thinner may cause catastrophic thermal injuries even with terminal outcomes and should therefore never used to kindle a fire.

Süt Çocuğunda Aganglionik Kolon Ansı Yapan Teratom: Olgu Sunumu

Over ve sakrokoksigeal bolgede nadiren gorulen matur teratom literatur gozden gecirilerek sunuldu. Reteoperitoneal teratomlar cocuklarda ender olarak gorulur. Teratomlar, ortaya ciktiklari organa veya bolgeye yabanci bircok dokudan olusur. Barsaklarin organoid gelisimini gosteren teratomlar cok nadirdir. Retroperitoneal bolgede aganglionik kolonik loplara sahip teratomasi olan uc aylik hastanin makroskopik ve histopatolojik bulgularini tanimladik.

A new anastomosis technique for intestinal diseases with proximal dilated segments.

A number of techniques have been described for intestinal anastomosis. We describe a different, simple, and safe technique that can be used in patients with intestinal diseases, such as jejunoileal atresia and perforation that has proximal dilated segments. In this technique, an atraumatic bowel clamp was applied on the proximal dilated bowel at a 90° angle. In the narrow distal segment, we resected the bowel at a 0° angle and continued at a 30° angle from the antimesenteric side. Finally, a two-layer interrupted anastomosis was performed. We applied this technique to a 31-day-old patient who had a divided jejunostomy due to malrotation and perforation with a proximal dilated bowel. Neither anastomotic complications nor feeding and passage problems were seen postoperatively.

çocukta akut batın; wandering pelvik spleen torsiyonu

Wandering spleen is an uncommon clinical entity. Acute splenic torsion of wandering spleen is a potentially fatal surgical emergency case, and its correct and early identification continues to represent a challenge especially in children. A 11 years old girl was taken to the operative room for an explorative laparotomy due to abdominal pain, tenderness, and a midabdominal mass. Preoperative computerise tomography showed a torsion of an enlarged wandering pelvic spleen which was in a serious ischemic suffering due to a 720 degrees clock torsion around its exceptionally long pedicle. Splenectomy has been the treatment for symptomatic wandering spleen as in our case.