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Re: Age of Patient is a Risk Factor for Urethrocutaneous Fistula in Hypospadias Surgery

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Antienflamatuar and antiadhesive effect of clioquinol

36 a 2012 Journal of Ped http://dx.doi.org/10.1016/j.jpurol.20 Abstract Objective: There is still much debate regarding the effect that age at hypospadias operation has on the rate of complications. The aim of this study was to evaluate whether patient age is a risk factor for surgical complications when using the tubularized incised plate (TIP) urethroplasty technique. Methods: Between 2005 and 2011, 307 pediatric patients with distal or mid-penile hypospadias underwent the TIP procedure. Demographic and surgical data were evaluated. Results: The complications recorded across all age groups were: fistula, meatal stenosis, glans dehiscence and urethral stenosis. Fistula was the most frequent complication in 10e14 year olds compared to the younger patient groups, and this difference was statistically significant. Conclusion: Age and surgical technique should be taken into consideration when planning hypospadias surgery, since the complication rate increases with patient age. The TIP technique is a safe procedure with a low rate of fistula formation in distal and mid-penile hypospadias repair for patients of any age during the prepubertal period. a 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Simple patch closure for perforated peptic ulcer in children followed by Helicobacter pylori eradication

BACKGROUNDS/AIMS The aim of this study is to investigate the expected adhesion-modifying effect of clinoquinol which has metal-chelating feature that limits the inflammation and fibroblastic activity. METHODS A total of 40 Wistar Albino rats were included, which were divided into 5 groups. Group-1 constituted the sham group. Other groups, adhesions were induced by performing cecal abrasion on the rats. For treatment, saline solution was added to Group-2, carboxymethylcellulose was added to Group-3, methylene blue was added to Group-4, and clioquinol was added to Group-5. Blood samples were obtained from the heart to measure IL-10 and TNF α-levels. Adhesions were evaluated both macroscopically and histopathologically. RESULTS Clioquinol reduced adhesions at significant level via decreasing the inflammation and fibroblastic activity in the adhesion-induced rats. At macroscopic level, carboxymethylcellulose and clioquinol were the most potent agents in reducing adhesions. Nonetheless, significant foreign body-reaction was observed in the carboxymethylcellulose-treated group. CONCLUSIONS Clioquinol could reduce the formation of intra-abdominal adhesions. It exerts this activity by limiting the inflammation and fibroblastic activity between the intestines and serous surfaces. Furthermore, it does not induce a foreign body reaction. Due to these properties, we conclude that clioquinol can be used as an alternative agent to prevent adhesions.

Analsis of the risk factors for child appendicitis

Objective: Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of children who have undergone operations for perforated duodenal ulcers. We report our experience with the modified Graham technique for perforated duodenal ulcers in nine children and review the literature. Methods : The records of patients operated on for a perforated duodenal ulcer in the last 8 years in two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to admission to hospital, operative findings, and postoperative clinical course were evaluated. Results : Nine children (mean age 13.2 years, range 6–170 years) were included. All patients were admitted in the first six hours after their abdominal pain started. In three patients, there was free air on plain x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for Helicobacter Pylori, and the results were positive. All patients underwent triple therapy with lansoprazole, amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3–94) months. Conclusions : Peptic ulcer perforation should be suspected in children who have acute abdominal pain and peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in children.

A Rare Cause of Chylothorax in Children: Gorham-Stout Syndrome

BACKGROUND Appendicitis is the most common form of abdominal pain requiring surgery among children. This study evaluates the association of age, sex, seasonal, and familial factors with the histopathology of appendectomies. METHODS 588 patients who underwent operations for acute appendicitis between 2009 and 2011 were included in this study. The patients were classified in one of three groups based on histopathological results: acute, perforated, and negative appendectomy. This study evaluates the association between age, sex, seasonal, and familial factors and the histopathological classification. RESULTS The mean age of the patients was 11.8±3.26 years (range 1 to 16 years). Among these patients, appendicitis was 2.41 times more common in children greater than 10 years old. Appendicitis occurred 4.63 times more often among males than in females. Negative appendectomy occurred more often in children greater than 10 years of age. Appendicitis was associated with both seasonal factors and family history; however this association did not meet the threshold for statistical significance (p>0.05). DISCUSSION The age and sex of the patient should be taken into account when considering appendicitis surgery to improve the accuracy of the diagnosis. In addition, the histopathology of appendicitis is influenced by familial and environmental factors.

Risk Factors of Pilonidal Sinüs in Teenagers

Gorham-Stout disease is a complex disease in which lytic lesions of bone tissue are accompanied by chylothorax and abdominal lymphangioma. The etiology is still unknown. The diagnosis is made by the patient’s clinical and laboratory findings and biopsy results. It may be fatal depending on the organs involved. Although many treatments have been described, successful results have been reported with interferon alpha 2b in recent years. We discuss the clinical diagnosis and treatment of a 5-year-old female patient with osteolytic lesions in the bones after she was referred with chylothorax.

Risk Factors for Pilonidal Sinus Disease in Teenagers

Pilonidal sinus disease (PSD) is a chronic disease in skin which is characterized by inflammatory sac and contains hair bundles. It usually occurs in sacrococcygeal region. Pilonidal sinus is a condition often encountered among young adults. Recently, the incidence of PSD has been reported to increase in teenagers. The etiology of PSD comprises both congenial and acquired theories. Etiology of the disease is exactly unknown. But there are a lot of risk factors. Age, gender, obesity, duration of daily sitting, genetic predisposition, bathing frequency, skin color and race, body hair, deeper natal cleft, and smoking are described as the risk factors for PSD. If risk factors can be controlled, PSD may be prevented.