Tutku Soyer

Use of autologous platelet rich fibrin in urethracutaneous fistula repair: preliminary report.

Urethrocutaneous fistula (UCF) is one of the most common complications occurring after hypospadias repair. Despite the surgical advancement in hypospadias, multiple failed fistula closures are commonly referred to paediatric urologists. Although several techniques have been described to interpose a waterproof layer between urethral and skin closures, occurrence of urethrocutaneous fistula cannot be eliminated completely. In addition to several local tissue grafts, autologous and homologous fibrin sealants are used to prevent UCF. Platelet rich fibrin (PRF) is known as an autologous source of growth factors obtained from the sera of the patient. PRF supports collagen synthesis and tissue repair and accelerates wound healing. We aimed to present our initial experience about the use of autologous PRF in a 3‐year‐old boy with a UCF after hypospadias repair.

Electrophysiologic evaluation of genitofemoral nerve in children with inguinal hernia repair

AIMnGenitofemoral nerve (GFN) injury may occur because of chronic pressure of hernia sac or surgical intervention. A prospective study was performed to evaluate GFN electrophysiologically in children with inguinal hernia repair.nnnMETHODSnChildren with inguinal hernia were evaluated for GFN electrophysiologically before and after (3-6 months postoperatively) inguinal hernia repair. Bilateral GFN motor response latencies and durations were investigated electrophysiologically by surface electrodes. Wilcoxon signed ranked test was used for statistical analysis, and P values lower than .05 was considered to be significant.nnnRESULTSnEleven patients with a mean age of 4.45 +/- 2.16 were enrolled in the study. Mean latency of patients was 2.37 +/- 0.89 milliseconds preoperatively and 3.14 +/- 1.02 milliseconds postoperatively. Latency of GFN was found prolonged after hernia repair (P = .008). Duration of GFN motor response was 9.94 +/- 1.49 milliseconds and 11.18 +/- 2.44 milliseconds, respectively, in preoperative and postoperative recordings. There was no significant difference detected in mean durations (P > .05).nnnCONCLUSIONnLatency of GFN may prolong after inguinal hernia repair. Prolongation of GFN latency may be the result of surgical injury during hernia repair and consequently also related with chronic groin pain.

Effect of phototherapy on growth factor levels in neonatal rat skin

AIMnNeonates undergoing surgery may receive phototherapy (PT) for the treatment of hyperbilirubinemia. Although the effects of PT on neonatal structures are well documented, the effect of PT on wound healing has not been previously evaluated. An experimental study was performed to evaluate the effect of PT on growth factor levels responsible for wound healing in neonatal rat skin.nnnMATERIALS AND METHODSnEighteen Wistar newborn rats (7 ± 2 g) were included in the study. Rats were randomized into 3 groups: control (CG), PT, and sham (SG) (n = 6). Both groups had 1-cm median dorsal skin incision. In CG, 1 × 1 cm of dorsal skin was sampled including the incised skin. The PT group received 5 banks of blue light (wave density, 30-40 μw/cm(2) per nanometer; exposure distance, 45 cm). Phototherapy was started 24 hours after birth and exposed during light period (mean duration, 21 hours to 15 minutes ± 2 hour to 1.5 minutes). Sham group consisted of animals that received a bank of white light with same exposure distance and a total duration of 26 hours to 18 minutes ± 3 hours to 9.1 minutes. After exposure, 1 × 1 cm dorsal skin samples were obtained from both PT and SG groups, including the median incision. The effect of PT was evaluated with the expressions of vascular endothelial growth factor (VEGF), its receptor (VEGF receptor), and transforming growth factor β (TGF-β) in endothelial vessels and fibroblasts of neonatal skin samples.nnnRESULTSnThere was no significant difference between groups in VEGF receptor and transforming growth factor β expressions. The VEGF levels in endothelial vessels were significantly decreased in PT and SG when compared with CG (P < .05).nnnCONCLUSIONnVascular endothelial growth factor is a mediator of angiogenesis and may decrease in neonatal rat skin after light exposure. It can be suggested that decreased levels of VEGF after PT application may alter angiogenesis and also may adversely affect the healing features of neonatal skin.

Childhood asymmetric labium majus enlargement: is a conservative approach available?

Unilateral vulva swelling during prepubertal period consists of a wide variety of inflammatory and neoplastic lesions. A group of labial lesions that showed normal radiologic, histopathologic and surgical findings are reported as childhood asymmetric labium majus enlargement. An 11-year-old girl with childhood asymmetric labium majus enlargement is presented to discuss the clinicopathologic features, differential diagnosis, and indications of conservative approach in the treatment of this rare entity.

Cognitive and behavioral characteristics of children with caustic ingestion

BACKGROUND/AIMnChildren with attention-deficit/hyperactivity disorder (AD/HD) have risk taking behavior and are more prone to sustaining injury. It is aimed to evaluate the cognitive and behavioral characteristics of children with caustic ingestion.nnnPATIENTS AND METHODSnNinety two children with a history of nonsuicidal caustic ingestion (CI, n=46) and healthy subjects (HS, n=46) admitted to pediatric surgery department were enrolled into the study. Patients in groups were evaluated for age, sex, number of siblings and educational status of the parents. Before filling the questionnaires, the children were undergone flexible endoscopy and treated accordingly. Conners Parents Rating Scale-revised long form (CPRS-R:L), validated for Turkish Children, was used to evaluate the cognitive and behavioral characteristics of children. Parents rate their childs behavior with a four-point Likert scale. Subscales of CPRS-R:L including cognitive problems/inattention (CG/I), hyperactivity (H), attention deficit hyperactivity disorder index (AD/HD-I), Conners Global Index-discomfort-impulsivity (CGI-DI), DSM-IV-symptom subscale-inattention (DSMIV, SS-I), DSM-IV-symptom subscale-hyperactivity-impulsivity (DSM-IV, SS-HI), DSMIV-symptom subscale-total score (DSM-IV SS-T) were used to determine the severity of the AD/HD symptom. Demographic features and cognitive/behavioral characteristics of children with caustic ingestion were compared with healthy subjects.nnnRESULTSnThe median age of the patients was 4 (2-14 years) in both CI and HS groups. Female male ratio was 13:33 in CI and 12:34 in HS. Sixty seven percent of patients were preschool children (younger than 5 years of age) in both CI and HS groups. There was no difference between groups for number of siblings (p>0.05). Parents of HS group had higher educational status than parents in CI (p<0.05). When subscale scores of CPRS-R:L compared between CI and HS groups, CI group had higher CGI-DI scores than HS (p<0.05). Children younger than five years of age had higher scores of H, emotional instability and total CG/I in CI than HS group (p<0.05).nnnCONCLUSIONnChildren with caustic ingestion had impulsiveness behavior when compared to healthy children. In addition to impulsivity, hyperactivity can be also assessed as a risk factor for caustic ingestion in children younger than 5years of age. We suggest that association between AD/HD behavior and risk of sustaining injuries was also confirmed for caustic ingestion in children.

Protective effect of intraperitoneal ozone application in experimental ovarian ischemia/reperfusion injury

AIMnThe current accepted management of ovarian torsion is ovary-sparing surgery. Ozone therapy is used to reduce ischemia/reperfusion (I/R) injury in several situations. An experimental study was designed to evaluate effect of ozone application in ovarian I/R injury.nnnMATERIALS AND METHODSnThree groups (n = 6) and 18 rats were included in the study. After anesthesia, right ovaries were fixed and removed at the end of 2 hours in sham group (SG). In torsion group (TG), right ovaries underwent 720° torsion in a counterclockwise direction. Ovaries were removed after 2 hours torsion and 2 hours reperfusion. In ozone group (OG), torsion was created by the same technique, and 95% oxygen plus 5% ozone gas mixture was given intraperitoneally (25 μg/mL, 0.5 mg/kg) 10 minutes before reperfusion. After 2 hours reperfusion, ovaries were removed. Histopathologic examination of ovarian and periovarian sections was performed for the presence of congestion (C), hemorrhage, interstitial edema (IE), and polymorphonuclear neutrophilic infiltrations. Tissue samples were analyzed for malondialdehyde, nitric oxide (NO), and total sulphidryl (t-SH) values. Results were compared between 3 groups.nnnRESULTSnAt histopathologic examination, the TG have elevation in terms of ovarian C, polymorphonuclear neutrophilic infiltration, and periovarian IE when compared with SG (P < ,05). In OG, ovarian C and periovarian IE were reduced according to TG, whereas the increase was observed only in ovarian C compared with SG (P < .05). At biochemical evaluation of oxidative stress markers in SG and TG, there was no difference between them (P < .05). Malondialdehyde levels were significantly lower in OG than TG, whereas NO and t-SH values were higher (P < .05). Malondialdehyde levels were decreased in OG compared with SG (P < .05). However, no difference was observed in NO and t-SH levels (P > .05).nnnCONCLUSIONnIntraperitoneal application of ozone creates a positive impact on histologic and biochemical markers on I/R injury owing to ovarian torsion. The ozone application can be developed to support efforts to protect ovary in ovarian torsion.

Pepsin levels and oxidative stress markers in exhaled breath condensate of patients with gastroesophageal reflux disease

AIMnTo evaluate the pepsin and oxidative stress markers in exhaled breath condensate (EBC) in patients with gastroesophageal reflux disease (GERD).nnnPATIENTS AND METHODnPatients with a presumptive diagnosis of GERD with recurrent respiratory and gastrointestinal problems aged between 2 and 14 years were included in the study. All patients underwent pH monitoring. Patients with a reflux index (RI) ≥4 were assessed as the reflux group, and those with an RO <4 were assessed as the non-reflux group. Pepsin levels and oxidative stress markers [NO metabolites (NOX) and total sulphydrile (TSH) levels] were measured in the EBC.nnnRESULTSnThere were 24 patients in the reflux group [RI 17.6 (6.6-46.4)] [median, interquartile range] and 23 in the non-reflux group [RI 0.8 (0.5-1.9) (p<0.001). Pepsin levels in the EBC were below the level of detection. The median levels of NOx in the EBC of children with reflux [13.7 μmol/L (7.3-24.5)] were lower in than non-reflux group [21.0 μmol/L (14.0-25.2)] (p=0.034). There was a negative correlation between reflux index and NOX levels in EBC (rs: -0.331, p=0.023). In contrast, there was no difference in TSH levels between the reflux and non-reflux groups [37.4 μmol/L (30.2-44.6) vs 40.1 μmol/L (37.4-44.9), respectively, (p>0.05)].nnnCONCLUSIONnDecreased levels of NOX in patients with GER disease suggest increased oxidative stress in airways of these patients.

Effect of Penile Tourniquet on Growth Factors in Rat Penile Tissue

AIMnThis study aimed to evaluate the effect of penile tourniquet application on growth factors in rat penile tissues.nnnMATERIALS AND METHODSnForty Wistar male rats were included in the study. Rats were divided into 4 groups. After anesthetization, perimeatal penile skin and the corpus cavernosum were sampled in the control group (CG). A Mathieu-like flap was designed without a penile tourniquet (PT) to serve as a sham group (SG). In the PT groups, a Mathieu-like flap was created and a 5 mm diameter rubber circular band was applied at the base of the penis. The PT was applied for 10 min in the PT-10 group and for 30 min in the PT-30 group. Penile tissue was sampled 24 h after PT application in the SG and PT groups. Tissues obtained were examined in three sections: the subepithelial vascular plexus (SVP), the corpus cavernosum (CC) and the smooth muscle-like mesenchymal cells in the corpus cavernosum (MC). Acute inflammation was evaluated with hematoxylin-eosin staining. The effect of PT on vascular endothelial growth factor (VEGF), VEGF receptor (VEGFR) and transforming growth factor beta receptor (TGF beta-R) levels was evaluated.nnnRESULTSnHigher grades of acute inflammation were encountered in the PT-10 and PT-30 groups compared to the CG and SG (p<0.005). However, mean grades of acute inflammation did not show a statistical difference between the PT-10 and PT-30 groups (p>0.05). When the levels of growth factors were compared between the CG and PT-10 group, the PT-10 group showed increased levels of VEGF and TGF beta-R. In the PT-30 group, both VEGF and VEGFR levels were found to be decreased. When acute inflammation grades of tissues were correlated with VEGF and TGF beta-R, higher acute inflammation grades correlated with decreased VEGF and increased TGF beta-R levels (Spearmans correlation, p<0.005). Although alterations in VEGF and TGF beta-R levels were detected in the SVP and CC of penile tissues, altered VEGFR levels were only detected in the MC sections.nnnCONCLUSIONnPT caused higher grades of acute inflammation which correlated with decreased VEGF levels and increased TGF beta-R levels. Decreased VEGF levels after PT may alter the angiogenesis phase of wound healing and cause poor angiogenesis in penile skin flaps. Increased levels of TGF beta-R can be considered as an acute inflammatory response to PT. These results confirmed that prolonged PT application may result in altered growth factors in penile tissue and may reduce the success rate of repair.

Myofibroblastoma of breast in a male infant.

Breast masses are very rare in infants and premature telarche due to excessive endogen or exogenous estrogens is the most common presentation during infancy. Myofibroblastoma is a stromal tumor of the breast, occurring especially in elder males. This breast mass has a close relationship between androgen receptors and has not been reported in infants previously. A 10-month old male baby with a left breast mass, which is diagnosed as myofibroblastoma, is discussed to evaluate the clinical features and treatment modalities of breast myofibroblastomas in children.

Evaluation of genitofemoral nerve motor conduction in inguinoscrotal pathologies

AIMnInguinoscrotal pathologies are commonly seen in childhood. The genitofemoral nerve (GFN) is responsible for sensitive innervations of scrotal region and the motor innervations of cremasteric muscle. GFN also innervates the afferent and efferent pathways of cremasteric reflex. A prospective study was performed to evaluate the possible relation between inguinoscrotal pathologies and GFN motor functions.nnnMETHODSnPatients with inguinal hernia, hydrocele, undescended or retractile testicles, aged between 2-12 years were enrolled in the study. Bilateral latency and duration of GFN motor conductions (GFNMC) were obtained electrophysiologically by surface electrodes. GFNMC recordings of non-pathological sides were assessed as control group. Latency and duration of each group were compared with control group (Mann-Whitney U test). P values lower than .05 were considered significant.nnnRESULTSnSeventy-three electrophysiologic evaluations were investigated in inguinal hernia (n:18), hydrocele (n:9), undescended testicle (n:14), retractile testicle (n:12) and control (n:20) groups. There was no age difference between groups and controls. Latency was significantly prolonged in inguinal hernia group when compared with control group (P = .028). Although the latencies were shortened in undescended testicle group, no significant difference detected (P > .05).nnnCONCLUSIONnProlonged latencies in inguinal hernia may be a result of nerve trap caused by hernia sac. GFN motor functions showed no causative role in other inguinoscrotal pathologies. It can be also suggested that clinical features of other inguinoscrotal pathologies were not affected by GFN motor functions. Electrophysiological studies in younger age groups with large number of patients are needed to support our suggestions.