Ufuk Ates

Percutaneous tracheostomy by Griggs technique under rigid bronchoscopic guidance is safe and feasible in children

OBJECTIVE The aim of this study is to report prospective data of pediatric cases that underwent percutaneous tracheostomy (PT) to show that PT is a safe and feasible procedure in children even in small infants. PATIENTS AND METHODS PT was done in 51 consecutive patients. Demographic data, indications, complications and outcome were recorded prospectively. Initial 6 PT was done by Giaglia technique whereas the Griggs technique was used in the consecutive 45 patients. RESULTS Fifty-one patients with mean age of 38±54months (1month-17years) and, mean weight of 12.4±13kg underwent PT. The only major complication was perforation of esophagus (n=1, 2%) which was recognized early and immediately repaired by cervical approach. This complication occurred in the 6th case done with the Giaglia technique. After conversion to the Griggs technique no major complication was encountered in the consecutive 45 procedures. The mean period of follow up was 21±13.7months. Narrowing of the stoma site requiring simple dilation was developed in 3 (5.8%) patients. CONCLUSION PT is a safe and easy procedure and a less invasive alternative to surgical tracheostomy even in small infants. We strongly recommend PT done by Griggs technique in children. It is important that it should be done in an operating room setting and under rigid bronchoscopic guidance.

Balloon dilatation in esophageal strictures in epidermolysis bullosa and the role of anesthesia.

Esophageal involvement, which causes stricture, is a complication in epidermolysis bullosa. This causes dysphagia and malnutrition and leads to deterioration of skin lesions in these patients. The charts of 11 patients with epidermolysis bullosa and esophageal stricture who were included into dilatation program between 2003 and 2015 were retrospectively reviewed. Seven of the patients were female and four were male. The median age was 14 (2-32) years. The mean body weight of patients was 27.8 (9-51) kg. The location and number of strictured parts of the esophagus were previously evaluated with upper gastrointestinal contrast study and after that flexible endoscopy was used for dilatation. Eight patients had middle esophageal, three patients had proximal esophageal and one of them had both proximal and middle esophageal strictures. The strictures were dilated 56 times in total (mean 5 times). One patient underwent gastrostomy and was medically followed-up after a perforation occurrence during the dilatation procedure. In a 32-year-old female patient, colon interposition was performed after four dilatations since optimal nutritional and developmental status could not be achieved. The dilatation program of nine patients is still in progress. Seven of them can easily swallow solid food but two of them have some difficulties in swallowing between dilatations. One patient rejected the program and quitted, while one patient refused colon interposition and died because of complications related to amyloidosis during the dilatation program. After resolution of the swallowing problem, skin lesions were observed to heal quickly. Epidermolysis bullosa is a rare cause of dysphagia. Esophageal balloon dilatation with flexible endoscopy is a safe and efficient method in patients with this condition.

The Effects of Local and Systemic Growth Hormone Treatment on Germ Cell Population and Fertility in an Experimental Unilateral Testicular Torsion and Orchiectomy Model

PURPOSE We evaluated the effects of local and systemic growth hormone on the germ cell population of the contralateral testes of pubertal rats subjected to unilateral testicular torsion and orchiectomy 24 hours later. MATERIALS AND METHODS A total of 40 male Wistar-Albino rats at age 3 weeks were divided into 5 groups. In the sham operated group the right testis was sutured and orchiectomy was performed 24 hours later. In groups 2 to 5 orchiectomy was performed 24 hours later following testicular torsion. In groups 3 and 4 unloaded and growth hormone loaded gelatin films, respectively, were sutured on the contralateral testes. In group 5 systemic growth hormone was administered for 7 days. Five weeks later each rat was cohabited with 2 female rats and the left testes were removed for evaluation. Mean seminiferous tubular diameter, mean testicular biopsy score and the mean haploid cell percentage were calculated. Mating studies were performed and fertility parameters were assayed. RESULTS Mean seminiferous tubular diameter, mean testicular biopsy score and the mean haploid cell percentage of the contralateral testes were significantly decreased in the control and gelatin groups compared with the other groups. There was no difference between the local and systemic growth hormone groups regarding the haploid cell percentage. There were no differences between the groups in mean fetus numbers, mating or fertility and fecundity indexes except in the gelatin group, in which the mean fetus number was significantly lower. CONCLUSIONS Fertility is not affected in rats after 24 hours of testicular torsion and orchiectomy, although there is germ cell injury and a decrease in the percent of haploid cells. Growth hormone administration resulted in the restoration of germ cell histology and an increase in the haploid cell percentage of the contralateral testes. Growth hormone may improve fertility after unilateral testicular torsion and orchiectomy.

Effective management of cricopharyngeal achalasia in infants and children with dilatation alone

AIM Cricopharyngeal achalasia (CPA) is a rare clinical condition that is characterized by aspiration, choking, and nasopharyngeal regurgitation. The aim of this study is to introduce the outcomes of dilatation alone in children with CPA. PATIENTS AND METHOD After the evaluation of upper esophageal sphincter with endoscopy, dilatation was performed. All patients underwent videofluoroscopic evaluation and swallowing therapy after the surgical procedure. A retrospective chart review was performed in children with CPA. RESULTS Thirty children who were videofluoroscopically proven to have CPA were included in the study. Their age range was 15days-7years (median 11months). Twenty-one of them were neurologically impaired. Two children were lost to follow-up. Nineteen patients (68%) had a total resolution of CPA and were symptom-free with 1-6 dilatations (median 2). Three of the children (11%) who were severely neurologically impaired had resistant CPA. Three children (11%) treated recently with short follow-up were added to the group. Their VFS evaluations demonstrated improvement, thus we accepted their result as successful. There were two perforations in the series. Three patients died; one 2-month-old (2500g) baby who was accepted from the intensive care unit passed away on postoperative on the 7th day. Two other babies who were unresponsive to dilatation therapy died on follow-up. CONCLUSION Dilatation can be a safe and effective method on children who are correctly diagnosed to have CPA.

Increase in pro-apoptotic Bax expression and decrease in anti-apoptotic Bcl-2 expression in newborns with necrotizing enterocolitis

BACKGROUND/AIM The aim of the present study was to find out if there is an increase in the expression of pro-apoptotic Bax and reduction in expression of anti-apoptotic Blc-2A1 in newborn intestines with necrotizing enterocolitis (NEC). MATERIALS AND METHODS We compared 8 consecutive newborn patients undergoing bowel resection for NEC with 8 neonates undergoing intestinal resection for ileal atresia. Histopathological evaluation of tissue injury and apoptosis was performed by using light microscopic examination and TUNEL method. The mRNA level of apoptotic (CASP3, CASP6, CASP7, Bax, BIRC2) and anti-apoptotic genes were evaluated by PCR array method. Protein expression was assessed by immunohistochemistry. RESULTS We compared 8 consecutive newborn patients undergoing bowel resection for NEC with 8 neonates undergoing intestinal resection for ileal atresia. Histopathological evaluation of tissue injury and apoptosis was performed by using light microscopic examination and TUNEL method. The mRNA level of apoptotic (CASP3, CASP6, CASP7, Bax, BIRC2) and anti-apoptotic genes were evaluated by PCR array method. Protein expression was assessed by immunohistochemistry. CONCLUSIONS Our data in humannewborns suggest that alteration of the balance between pro-apoptotic Bax expression and anti-apoptotic Bcl-2A1 expression in the site of injury is a possible mechanism in the pathogenesis of NEC.

Evaluation of Additional Anomalies in Concomitance of Hypospadias and Undescended Testes

Amac: Hipospadias erkek cocuklarda 200-300 canli dogumda bir gorulen genitouriner sistem (GUS) anomalisidir. Hipospadias olgularina eslik eden anomaliler arasinda inmemis testis saptanmasi siktir. Ozellikle proksimal hipospadias ve bilateral inmemis testis birlikteligi cinsel farklilasma bozukluklarina isaret edebilir. Bu calismada inmemis testisin eslik ettigi hipospadiasli cocuklarda ek anomalilerin degerlendirilmesi amaclandi. Gerec ve Yontemler: 2007-2016 yillari arasinda hipospadias nedeniyle ameliyat olan 392 cocugun verileri geriye donuk olarak tarandi. Bunlardan 65 (%16.6) olguda meatus skrotal ve penoskrotal, 327’sinde (%83.4) glanuler, koronal, subkoronal ve midpenil yerlesimliydi. Olgular her iki testisi yerinde olan ve olmayanlar olarak ayrildi ve ek anomaliler kaydedildi. Bulgular: Proksimal hipospadiasli cocuklarin ortanca yasi 21 ay (6-240 ay)’di. Proksimal hipospadiasli cocuklardan 26’sinin (%40) inmemis testisi mevcutken, 39 (%60) olguda testisler skrotumda ele geldi. Inmemis testisi olan gruptaki hastalarin 17’sinde bilateral (%65.4), dokuzunda tek tarafli (%34.6) inmemis testis saptandi. Inmemis testisi olan grupta 24 hastada (%92.3) fizik muayenede kuskulu dis genitalya (bifid skrotum, penoskrotal transpoziyon, mikropenis ve penoskrotal hipospadias beraberligi, skrotalize labium majus) mevcuttu. Inmemis testisi olan grupta uc hastada (%11.5) ek uriner anomali, on hastada (%38.5) ise diger sistem anomalilerinin eslik ettigi saptandi. Her iki testisin ele geldigi proksimal hipospadias hasta grubunda 10 hastada ( %25.5) kuskulu dis genitalya mevcuttu. Her iki testisi skrotumda ele gelen 39 hastanin birinde (%2.5) ek uriner patoloji, besinde (%12.8) ise diger sistem anomalilerine rastlandi. Distal hipospadiasli cocuklarin ortanca yasi 33 ay (6-156 ay)’di. Distal hipospadiasli 327 cocugun 9’unda (%2.8) inmemis testis mevcuttu. Bunlardan besinde bilateral (%55.6), 4’unde tek tarafli (%44.4) inmemis testis izlendi. Distal hipospadiasi olan hastalarin hic birinde (%0) fizik muayenede kuskulu genitalya saptanmadi. Inmemis testisi olan grupta bir hastada (%11.1) ek uriner patoloji, bir hastada (%11.1) ise diger sistem anomalilerinin eslik ettigi saptandi. Her iki testisi skrotumda ele gelen yedi hastada (%2.2) ek uriner patoloji, 32 hastada (%9.8) ise diger sistem anomalilerine rastlandi. Sonuc: Sonuclarimiza dayanarak inmemis testisin eslik ettigi proksimal hipospadiasli olgularda urogenital sisteme yonelik ultrasonografi, gerektiginde pelvik MRG, endokrinolojik analiz, genetik inceleme gibi ileri tetkik gerekliliginin akilda tutulmasi gerektigi, tum hipospadiasli cocuklarda ek anomaliler acisindan tum sistemleri iceren ayrintili anamnez ve fizik muayene ile tetkik edilmesi gerektigi kanisindayiz

Stuck tunneled central venous catheters in children: four cases removed by angiography assistance

Ateş U, Taştekin NY, Mammadov F, Ergün E, Göllü G, Can ÖS, Uçar T, Bingöl-Koloğlu M, Yağmurlu A, Aktuğ T. Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance. Turk J Pediatr 2018; 60: 221-224. Adherent tunneled catheters can usually be removed by a surgical cut down, but in some cases the line can become stuck to the wall of the central veins. In such cases, forceful traction can cause vascular injury, or fracture of the catheter. We present four cases of fixated cuffed tunneled catheters. Three children had acute lymphoblastic leukemia and one had an immunodeficiency syndrome. All catheters were made from polyurethane. Indwelling times were 12-24 months. All patients` catheters were removed with great difficulty by trans-femoral access. The angiography-assisted technique is safe and easily-applied for the removal of stuck catheters in pediatric patients. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous catheters (CVCs) in children.

Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results

Obesity is one of the most rapidly increasing health problems in children. Laparoscopic sleeve gastrectomy (LSG) is one of the best treatment options and is feasible and safe in children. The aim of this study was to present the short‐term results of a laparoscopic sleeve gastrectomy series in children.

Ginger (Zingiber officinale Roscoe) for the treatment and prevention of necrotizing enterocolitis

ETHNOPHARMACOLOGICAL RELEVANCE Necrotizing enterocolitis (NEC) is the most important gastrointestinal emergency affecting especially preterm infants and causes severe morbidities and mortality. However, there is no cure. Oxidant stress, inflammation, apoptosis, as well as prematurity are believed to responsible in the pathogenesis of the disease. Ginger and its compounds have anti-inflammatory, antimicrobial, anti-oxidant properties and immunomodulatory, cytoprotective/regenerative actions. AIM OF THE STUDY This study aimed to evaluate the beneficial effects of ginger on the intestinal damage in an experimental rat model of NEC. MATERIALS AND METHODS Thirty newborn Wistar rats were divided into three groups: NEC, NEC + ginger and control in this experimental study. NEC was induced by injection of intraperitoneal lipopolysaccharide, feeding with enteral formula, hypoxia-hyperoxia and cold stress exposure. The pups in the NEC + ginger group were orally administered ginger at a dose of 1000 mg/kg/day. Proximal colon and ileum were excised. Histopathological, immunohistochemical (TUNEL for apoptosis, caspase 3 and 8) and biochemical assays including xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malonaldehyde (MDA) and myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin1β (IL-1β), and interleukin 6 (IL-6) activity were evaluated. RESULTS Compared with the NEC group, the rat pups in the NEC + ginger group had better clinical disease scores and weight gain (p < 0.05). Macroscopic evaluation, Histopathologic and apoptosis assessment (TUNEL, caspase 3 and 8) releaved that severity of intestinal damage were significantly lower in the NEC + ginger group (p < 0.05). The levels of TNF-α, IL-1β and IL-6 in the ginger treated group were significantly decreased (P < 0.05). The GSH-Px and SOD levels of the ginger treated group were significantly preserved in the NEC + ginger group (p < 0.05). The tissue XO, MDA and MPO levels of the NEC + ginger group were significantly lower than those in the NEC group (P < 0.05). CONCLUSION Ginger therapy efficiently ameliorated the severity of intestinal damage in NEC and may be a promising treatment option.

Endoscopic Drainage And Cystoduodenostomy In A Child Presented With Pancreatic Pseudocyst

An 11-year-old morbidly obese boy was diagnosed with pancreatic pseudocyst. Following fine needle aspiration, the cyst recurred in 1-month follow-up. Therefore, endoscopic drainage and cystoduodenostomy was performed following endosonography. Control ultrasonography (USG) revealed a completely shrunken cyst. During the 3 years of follow-up, the patient was asymptomatic with no evidence of cyst on computerized tomography scans. Endoscopic drainage and cystoduodenostomy is a minimally invasive, effective, and safe approach in the management of pancreatic pseudocysts in children.