Mustafa Erman Dorterler

Airway management in newborn with Klippel-Feil syndrome

Klippel-Feil syndrome (KFS) has a classical triad that includes short neck, low hair line and restriction in neck motion and is among one of the congenital causes of difficult airway. Herein, we present a 26-day, 3300g newborn with KFS who was planned to be operated for correction of an intestinal obstruction. She had features of severe KFS. Anesthesia was induced by inhalation of sevoflurane 2-3% in percentage 100 oxygen. Sevoflurane inhalation was stopped after 2min. Her Cornmack Lehane score was 2 and oral intubation was performed with 3.5mm ID non-cuffed endotracheal tube in first attempt. Operation lasted for 45min. Following uneventful surgery, she was not extubated and was transferred to the newborn reanimation unit. On the postoperative third day, the patient died due to hyperdynamic heart failure. This case is the youngest child with Klippel-Feil syndrome in literature and on whom oral intubation was performed. We also think that positioning of this younger age group might be easier than older age groups due to incomplete ossification process.

A Giant Mature Cystic Teratoma Mimicking a Pleural Effusion

The vast majority of teratomas originating from more than a single germ layer are benign. Often, such teratomas are initially asymptomatic. Later symptoms are caused by the weight per se of the teratoma and include chest pain, cough, dyspnea, and/or recurrent attacks of pneumonia. A mediastinal teratoma is treated by total surgical resection of the mass. Here, we report a case of giant mature cystic teratoma mimicking a pleural effusion in the thorax at the 7-month-old female patient with a symptom of persistent pulmonary infection and tachypnea.

Is conservative treatment an effective option for pilonidal sinus disease in children

Pilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial. There are a few published studies on PSD in the paediatric literature; therefore, we present our experience of conservatively treating PSD in children. This study involved a retrospective review with telephone follow up. All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery. All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess). Data collection included demographics, type of management, recurrence, presence of infection, and total healing time. In the study period, 29 children were identified. Their mean age was 14.94 ± 1.09 (range: 12‐16) years, and 51.7% were girls. The mean length of follow up was 8.34 ± 6.36 (range: 1‐25) months. Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery. PSD is being seen in children more frequently in recent years. Conservative treatment may be the recommended initial approach for PSD in children.

Hypertrophic pyloric stenosis following repair of oesophageal atresia and tracheo-oesophageal fistula in a neonate

Development of hypertrophic pyloric stenosis (HPS) after a few weeks of repair of an oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) is a rare condition in early infancy. Although vomiting or feeding intolerance in operated cases of OA+TOF are attributed to oesophageal stricture, gastro-oesophageal reflux and oesophageal dysmotility, it may also be caused by HPS. Herein, we report a newborn infant who had OA and TOF operation on day 2 of life and diagnosed to have HPS at 15th day of age. Even though it is a rare anomaly, HPS should be kept on mind in the presence of persistent vomiting following repair of OA.

What is the Diagnostic Value of Plasma Antioxidative/Oxidative Status in Parapneumonic Effusions in Children?

Objecive: Pleural effusions are associated with high morbidity in children. Oxidative stress, which refers to an imbalance between oxidants and antioxidants, is associated with various diseases including lung diseases. The aim of this study was to investigate to the total oxidative status (TOS) and total antioxidative status (TAS) in differentiating exudates from transudates in children. Material and Methods: In this cross-sectional study, data from patients who were hospitalized for parapneumonic effusions and underwent thoracentesis from October 2012 to December 2013 in the pediatric surgery department. The patiens were divided into two groups (the exuda and transude groups) according to Light’s criteria. Blood plasma and parapneumonic effusions were analyzed and compared with respect to the total antioxidative and oxidative status. Results: The study consisted of blood plasma and pleural effusion from 40 children with parapneumonic effusions (PPEs) (transude group [n=20]; exuda group [n=20]) and just blood plasma from 30 healthy children (control group). There were no significant difference between the groups in terms of gender and age. The blood plasma TAS level of the control group was significantly higher than the level of blood plasma TAS level of the exuda and transude groups with statistically significant (p<0.001). The value of plasma oxidative stress index (OSI) and TOS of exuda group were significantly higher than those of the control and transude groups with statistically significant (p<0.05). Conclusion: This study suggests that inflammation is associated with PPE in children that increased OSI in blood plasma from PPE patients is related to tissue damage and turnover.

An Analysis of a New Diagnostic Test for Children with Acute Appendicitis: Plasma Leptin Level

Aim: In the diagnosis of acute appendicitis, the most frequently-applied laboratory tests are blood leukocyte level (WBC) and serum C-reactive protein (CRP). In recent years, it has been thought that the leptin hormone level, which has been proven to be raised in acute inflammation, could be used diagnostically in patients with acute appendicitis. In this study, we aimed to determine the relationship between WBC, CRP, and leptin levels with inflammation in acute appendicitis and to define the role of leptin in the mechanism underlying loss of appetite, which is the most frequently observed symptom. Materials and method: The study comprised 40 patients diagnosed with acute appendicitis (AA) in the Pediatric Surgery Department and a control group of 20 age-matched patients. Blood samples were taken from all subjects in both groups and the levels of WBC, CRP and leptin were measured. Body mass index was calculated and all findings were compared. Results: In the AA group, the median leptin value was measured as 1.24 ng/ml preoperatively, 1.37 ng/ml perioperatively, and 0.81 ng/ml 2 days postoperatively. The leptin value in the control group was 1.90 ng/ml. No statistically significant difference was found between the two groups with respect to the preoperative and perioperative leptin values (p>0.05). The postoperative 2nd day leptin values of the AA group were statistically significantly lower than those of the control group (p<0.05). Conclusions: In cases of suspected acute appendicitis, leptin can be a useful diagnostic parameter since its levels increase during the early stages of inflammation.

Firearm injury in a child: an uncommon case of penile trauma

Genitourinary system injuries generally occur due to blunt and penetrating trauma. Approximately 10% of all injuries encountered in the emergency department are related to the genitourinary system. Male genital trauma is a urological emergency because of the high risk of infection and the priority of protecting the sexual, endocrine, and reproductive functions. Blunt injuries to the penis are more often seen due to the mobility and localization of the penis than due to penetrating injuries caused by firearms or cutting instruments. We aimed to present and discuss a case involving shrapnel that became lodged in the penis of a child in a war zone. After 2 weeks of medical treatment, the patient underwent surgery. Surgery includes primary repair to the penis and urethra.

Comparison of the hemostatic effects of oxidized cellulose and calcium alginate in an experimental animal model of hepatic parenchymal bleeding

Background: Despite all recent developments, bleeding is still one of the main causes of increasing morbidity and mortality following both trauma and elective hepatic surgery. The main goal of treatment is stop the bleeding immediately. In this study, the hemostatic and histopathological effects of Ankaferd blood stopper (ABS), oxidized cellulose (OC), and calcium alginate (CA) were compared in an experimental liver injury. Materials and Methods: Forty Wistar albino rats were randomly divided into four groups of ten animals each, receiving 0.9% NaCl, CA, OC, or ABS following liver resection. After 5 days, the samples from the resection site were acquired for histopathological evaluation. The efficacy of the agents was assessed using the hematocrit level and histopathological examination. Statistical analyses were applied. Results: The amount of bleeding was lowest in ABS-treated rats, followed by those treated with OC, CA, and NaCl, respectively. The difference among the groups was statistically significant (P < 0.001). ABS-treated rats also had significantly less necrosis than those receiving OC; other differences in this regard were not significant. Inflammatory status was significantly different between OC- and CA-treated rats (P < 0.05) but not among the other groups (P > 0.05). No significant difference was determined between the groups regarding granulation (P > 0.05). Conclusion : ABS reduced the volume of bleeding in liver surgery and partial liver resection. The hemostatic effect of CA was limited.