[Show abstract][Hide abstract] ABSTRACT: Clostridial collagenase A (CCA) has been shown effective in degrading collagen in eschar tissue and promoting healing in partial-thickness burns. As there are also reports of fever, leukocytosis, increased C-reactive protein (CRP) levels and septic complications during treatment with CCA, we aimed to determine in rats whether CCA aggravates the systemic inflammatory response.
Rats with partial-thickness burns were randomly divided into groups with either no dressing (ND), povidone-iodine dressing (PID) or CCA dressing (CCAD). Body weights and temperatures, blood leukocyte counts, and serum levels of CRP, interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha), were measured at 0, 3, and 24h and days 3 and 7 from burn. Wounds were cultured on days 1, 3 and 7 and burn depth was evaluated on day 1.
Body weights for all groups were significantly lower after burn, with highest loss (25.5%) in the CCAD group. At 3h a significant drop in rectal temperature was noted in all groups. The CCAD group had higher rectal temperature levels than the PID group on days 3 and 7 (p<0.05). Changes in serum levels of CRP, IL-1 beta, IL-6 and TNF-alpha were not significant in the ND and PID groups; the CCAD group showed a significant rise in serum levels of CRP on day 1, of IL-6 on day 3 and of TNF-alpha on day 7. Wound infection was more common in CCAD group and increased on days 3 and 7, but this was insignificant.
CCA aggravated the systemic inflammatory response in rats with partial-thickness burns, which is accompanied by a higher risk of infection.
Burns: journal of the International Society for Burn Injuries 05/2008; 34(7):935-41. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adnexal torsion is a condition that may result in serious morbidity including adnexal removal. However, conservative management with preserving the torsed adnexa is not justified, and long-term outcomes remain unclear.
The records of 14 girls with ovarian torsion whose adnexal structures were preserved after detorsion were reviewed to evaluate the long-term results of conservative management. Data including age, previous history, duration of complaints, surgical findings and type of intervention, color Doppler ultrasound findings performed in the early and late postoperative periods, and final outcomes were collected.
Mean age of patients was 11.5 +/- 2.8 (range 6 to 15) years. Time interval between the onset of pain to surgery was 46.78 +/- 35.5 (range 12 to 126) hours. Seven patients had a benign solitary cyst as an underlying cause for adnexal torsion. The intervention performed by open surgery in 9 and by laparoscopy in 5 patients included detorsion, simple cyst aspiration, unroofing and/or cystectomy in 7 patients with ovarian cysts, and oophoropexy in 9 of 14 patients. Follow-up ranged from 3 to 66 (mean 21.9 +/- 20.1) months. Thirteen patients resumed normal size and folliculogenesis, whereas in 1 patient, the involved ovary atrophied. No recurrence or contralateral adnexal torsion was observed on follow-up.
Conservative management with untwisting the ovary and pexing both retained detorsed and contralateral ovaries especially in idiopathic torsions should be considered in cases of ovarian torsion in children.
Journal of Pediatric Surgery 05/2005; 40(4):704-8. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prophylactic antibiotic use in childhood burns is controversial. The efficiency of antibiotic prophylaxis in 77 pediatric burn patients was evaluated. Forty-seven patients received prophylactic antibiotics (Group AP), while 30 patients received no prophylaxis (Group NP). Age, wound depth, day of admission, mechanism of burn injury, type of dressings were similar for both groups (p > 0.05). Wound infection rates were 21.3 % in Group AP and 16.7 % in Group NP (p > 0.05). S. aureus, Enterobacter spp., P. aeruginosa, and E. coli were the most common microorganisms. Patients with wound colonization and infection had a larger burned total body surface area (BTBSA) in both groups (p < 0.01). Eight patients had clinical sepsis. All but one of the septic patients were from Group AP. Associated infections of the upper and lower respiratory tract (16), urinary tract (7), and otitis media (2) were more common in Group AP. One patient died from sepsis in Group AP. Hospital stays were longer in Group AP (21.7 +/- 16.4 vs. 13.5 +/- 10 days; p < 0.05). Antibiotic prophylaxis in childhood burns does not reduce the rate of wound infection. Age, wound depth and BTBSA are not critical variables for prophylaxis. Reinforcing the use of culture-specific antibiotics for more beneficial and cost-effective results in the treatment of childhood burns is recommended.
European Journal of Pediatric Surgery 12/2004; 14(6):422-6. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to explore the mechanisms, complications, morbidity, and mortality associated with electrical injuries in children.
The charts of pediatric patients who had been admitted to the authors' center with electrical burn injuries (EBI) between January 1993 and October 2002 were reviewed retrospectively.
Of the 764 acute burn admissions over a 9-year period, 5% (38 patients) had EBI. Mean age was 9.6 +/- 4.4 years (range, 1 to 16 years). Seventy-six percent of the EBI patients were boys (M to F, 29:9), and the extent of the burn wounds ranged from 1% to 50% of total body surface area (TBSA; mean, 18.6% +/- 14.7%). High-voltage (HV) electricity accounted for 63% of the EBI (1 lightning), and 37% were caused by low-voltage (LV) current. In 19 children, serious high-voltage injuries occurred by direct contact with outlet electrical transfer wires with a metal from a balcony or with manual contact while climbing to the pole. A total of 153 surgical procedures were performed on the EBI patients, and 26% of the cases (10 of 38) required amputations. Patients who sustained HV electrical injuries had associated major complications. All of the patients underwent close cardiac monitoring, and none had cardiac complications. The average hospital stay was 23.8 +/- 14.2 (range, 2 to 48) days. One patient died of wound sepsis.
Although not frequent, EBI remain a serious problem, particularly in adolescent boys, and short- and long-term morbidity are significant. HV injuries occur mainly in the adolescent population and require more aggressive care. Balcony injury is a specific etiology for EBI, and special consideration is required to prevent this type of injury in our country.
Journal of Pediatric Surgery 09/2004; 39(8):1233-7. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Haematocele is an unusual scrotal disorder in children, and is generally associated with direct trauma to the inguinoscrotal region. A 6-year-old boy with acute communicating haematocele who had a history of blunt abdominal trauma one week earlier is presented. Interestingly, no solid organ injury was detected on his previous admission for abdominal trauma, nor there was a history of hydrocele.
European Journal of Emergency Medicine 01/2004; 10(4):342-3. · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Seventy-eight pediatric burn patients treated by enzymatic debridement with collagenase clostridiopeptidase A (CCA), were compared to 41 patients those burn wounds were excised surgically. Patients whose burn wounds were initially assessed as partial-thickness at admission were enrolled in the study. Total removal of eschar was achieved in 49 of 78 (62.8%) patients by CCA only (group D). In 29 patients (37.2%), therapy with CCA was ceased because of the development of burn wound infection or a manifest need for grafting of the wound, therefore, these patients underwent tangential wound excision (group DS). The records of 41 patients, treated by early tangential excision, having similar burn wounds by extent and depth with groups D and DS were used as controls (group S). There was no significant difference between the time to achieve a clean wound bed in groups D, DS and S (mean 7.8, 8, and 7 days, respectively, P>0.05). In group D, none of the patients required blood transfusion, except one. Patients in group DS were found to have fewer excisions (mean 1.1) when compared to those in group S (mean 1.5, P<0.05). The shortest hospital stay was found in group D (12.5 days, P<0.01). In conclusion, the use of CCA, provided a short hospital stay, reduced the overall need for surgery and blood transfusions in patients with partial-thickness burns. Thus, CCA should be considered as an initial treatment of choice for removal of eschar in children, having a partial-thickness burn wound without infection.
[Show abstract][Hide abstract] ABSTRACT: Adnexal torsion is a serious condition that frequently may result in ovarian removal, and there always is a risk of castration if the contralateral ovary undergo torsion as well. In this study, the authors present their experience with adnexal torsion in 15 children and describe a catastrophic event, asynchronous bilateral adnexal torsion, with review of the literature.
Between November 1993 and November 2000, 15 children under 15 years of age who had undergone operation because of torsion of uterine adnexal structures were evaluated. Two illustrative cases with asynchronous bilateral adnexal torsion are presented.
Fourteen cases were associated with additional adnexal pathology, whereas in 1 case the torsion was of normal uterine adnexa. Sonographic studies improved the preoperative diagnosis. Hemorrhagic necrosis of the adnexa secondary to the torsion was found in all cases except 3 and necessitated adnexal resection. In only 3 cases preservation of the adnexa was possible. Asynchronous adnexal torsion occurred in 2 patients in the time course. Both were treated by laparotomy and adnexal untwisting and fixation by permanent multiple interrupted sutures. In their final evaluation at 40 and 8 months after the operation, they were found to have good ovarian function.
Considering the risk of subsequent contralateral torsion and its impact on future fertility, the authors believe that conservative management (untwisting the ovary and pexing, both retained detorsed and contralateral, ovaries) should be considered in cases of ovarian torsion in children.
Journal of Pediatric Surgery 12/2002; 37(11):1617-20. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early diagnosis of development of cholestasis is a current major problem for patients receiving total parenteral nutrition (TPN). Conventional tests for hepatic function such as serum transaminases and alkaline phosphatase do not often reflect simultaneously histopathologic changes of the liver. The aim of this study is to find out the relationships between conventional hepatic function tests, total serum bile acid concentrations (TSBA), and the histopathologic changes in the liver during TPN administration in rats.
Forty Albino rats were divided into four experimental groups, each consisting of 10 rats, as follows: control group (C), 0.9% saline for 14 days; T7 group, TPN for 7 days; T14 group, TPN for 14 days; T7O7 group, TPN for 7 days and then 0.9% saline for the next 7 days. All solutions were administered by infusion through intraperitoneal catheter in two equal doses. During the experiment, rats also maintained on rat chow and water ad libitum. Levels of serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, and TSBA were measured. Liver was evaluated histopathologically by light microscope and then Morphological Cholestasis Index (MCI) was calculated.
Cholestasis was present in all experimental groups except control. Levels of transaminases and alkaline phosphatase were not correlated with the histopathologic changes (P > .05), but TSBA concentrations were correlated with MCI in all groups (P< .01). TSBA concentrations and MCI in all groups also were correlated with the duration of exposure with TPN (P< .01).
Measurement of TSBA seems to be more sensitive in early diagnosis of TPN-induced cholestasis. Therefore, periodical determination of TSBA during TPN administration can be done routinely.
Journal of Pediatric Surgery 04/1999; 34(4):565-7. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The records of 174 children sustaining blunt spleen and liver injuries in a 16-year period were analyzed retrospectively to determine blood transfusion requirements in surgically versus conservatively managed patients. The whole study group consisted of 97 spleen, 70 liver, and 7 combined spleen and liver injuries respectively. Seventy-eight patients were managed conservatively while 96 children had undergone various operative procedures. The hematocrit (Hct) values, transfused blood volumes (ml/kg), and length of hospital stay were compared between the non-operative and operative treatment groups. Although the initial Hct values were found to be similar in non-operative versus operative groups (26.7% +/- 2.7% vs. 24.8% +/- 3.5%), transfused blood volumes were significantly higher in the surgically treated group respectively (20.9 ml/kg vs. 39.5 ml/kg) (p < 0.05). Similarly, mean length of hospital stay was longer in the surgical groups. Associated injuries were seen in 105 (60.3%) patients distributed randomly among two study groups. Twelve patients in the series died of other system/organ involvement. There were no deaths in isolated spleen and/or liver injuries. Increased blood transfusion requirement in surgical groups may be due to excessive bleeding prior to the operation which virtually provides the indication for laparotomy. Manipulation and suturing enhances additional bleeding to elevate the total volume to be delivered. Operative choice should be spared for very selected cases, and conservative management is safe; procedures such as splenorrhaphy are not superior to observation therapy as a means of controlling intraabdominal bleeding.
European Journal of Pediatric Surgery 01/1999; 8(6):322-5. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aluminum contaminates parenteral nutrition solutions and accumulates in bone and liver of patients receiving total parenteral nutrition therapy. Although previous reports have shown that parenteral administration of aluminum in pharmacologic doses to rats results in the production of elevated total serum bile acid concentrations alone or in combination with decreased bile flow, they have failed to demonstrate any abnormalities in the histologic appearance of liver tissue. The effects of aluminum in total parenteral nutrition and of aluminum chloride on total serum bile acid concentrations, aluminum contents of the liver, and histopathologic changes in the liver were studied in rats.
The aluminum concentrations in the aluminum chloride solution and total parenteral nutrition formula were equal (300 microg/l). They were given intraperitoneally as follows: control group, 0.9% saline for 14 days; T7 group, total parenteral nutrition for 7 days; A7 group, aluminum chloride for 7 days; A14 group, aluminum chloride for 14 days; T7A7 group, total parenteral nutrition for 7 days and aluminum chloride for the next 7 days; and T7O7 group, total parenteral nutrition for 7 days and 0.9% saline for the next 7 days. Volumes of 0.9% saline, aluminum chloride, and total parenteral nutrition given to rats were equal. During the experiment, rats were maintained on rat chow and water ad libitum. Serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, alkaline phosphatase, and bile acid concentrations and aluminum content of the liver were measured. The liver was evaluated histopathologically by light microscope, and a morphologic portal inflammation index was calculated.
Portal inflammation was present in all groups except the control group. The morphologic portal inflammation correlated with hepatic aluminum accumulation in all groups and was the highest in the T7A7 group. Levels of serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, and alkaline phosphatase did not correlate with the histopathologic findings, but serum bile acid concentrations correlated with morphologic portal inflammation and hepatic aluminum accumulation in all groups. Hepatic aluminum accumulation also correlated with the duration of exposure to total parenteral nutrition and aluminum chloride concentration.
Aluminum in contaminating doses, not in pharmacologic doses, accumulates in the liver and can produce hepatobiliary dysfunction characterized by portal inflammation detectable in histologic examination of liver tissue.
Journal of Pediatric Gastroenterology and Nutrition 04/1998; 26(3):274-8. · 2.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present trend towards conservative management of hemodynamically stable pediatric trauma patients may be increasing the risk of delay in the diagnosis of traumatic hollow viscus perforations (HVP). The purpose of this study is to determine whether there is a delay in the diagnosis of HVP because of expectant management. A survey of factors leading to diagnostic delay was also made and the value of current diagnostic tools were reevaluated. In 1,283 trauma admissions between 1980-1994, 34 patients were operated for HVP caused by blunt abdominal trauma. Sites of perforation were; stomach (four), duodenum (five), jejunum (12), ileum (nine), and jejunum/ileum (four). Signs of peritoneal irritation were positive in 32 of 34 patients. There was free air in only six of 24 abdominal roentgenograms. Free peritoneal fluid without solid organ injury was detected in only four out of 13 patients with ultrasound. Peritoneal lavage was diagnostic in eight of nine patients. Time from admission to operating room averaged 24 +/- 4.1 (mean +/- standard deviation) hours. Eleven patients died after the operation mostly because of accompanying head injury. Only two of the deaths were the result of sepsis originating from the perforated bowel. There is an apparent delay in the diagnosis of traumatic HVP in this series. Signs of peritoneal irritation are the most consistent findings of HVP after blunt abdominal trauma in children. Persistence of abdominal signs indicates peritoneal lavage, which has a high diagnostic sensitivity for HVP compared to other diagnostic modalities.
The Journal of trauma 08/1996; 41(1):110-3. · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To review the results of the operative treatment of posterior urethral injuries in children.
A total of 29 children (25 boys and two girls, age range 3-14 years) with injuries to the posterior urethra were admitted to this department over 14 years. Twenty-three patients presented immediately after trauma and six were referred after unsuccessful attempt(s) at surgical repair.
Fourteen patients underwent suprapubic diversion and primary realignment over a catheter. Urethral continuity with normal urinary continence was achieved in seven of these patients. Four patients underwent a re-operation; urethral reconstruction was successful in these patients, but one patient remained incontinent. Primary realignment with anastomosis was performed in nine patients; the results were satisfactory in six. Urethral stricture developed in all of four patients who were managed with a suprapubic cystostomy alone; a staged repair using the transpubic approach was carried out in two of them and one improved. Partial urethral tears in two patients healed with urethral catheterization alone.
Primary realignment of the urethra with anastomosis and suprapubic diversion resulted in the highest rate of success for normal urethral continuity. Urethral strictures or urinary incontinence were not major problems in this group. Therefore, we recommend this approach for the initial management of urethral injuries in childhood. Transpubic urethroplasties may be reserved for secondary repair.
British Journal of Urology 05/1996; 77(4):597-600.
[Show abstract][Hide abstract] ABSTRACT: To determine the incidence of contralateral hernia development after unilateral inguinal hernia repair in girls, collected case series from two large hospitals were analyzed retrospectively. Among the 294 girls who had analyzed repair of a unilateral inguinal hernia (during a 15-year period), 245 could be traced; the mean follow-up period was 8.4 years. In 25 (10.2%) of the patients, contralateral hernia developed, mostly within one year (4 months to 6.5 years). The incidence of contralateral hernia development with respect to the original side of the inguinal hernia was significantly higher (19%) for the originally left-sided hernias than for the right-sided ones (6%) (P < .01). Although the incidence of contralateral hernia development for girls with a left inguinal hernia decreased as age increased, it was still 14.9% for the girls age 3 and up. Contralateral exploration should not be routine for girls who have a right-sided hernia, at any age. For left-sided hernias, it may be performed routinely for girls up to 2 years of age, and selectively for older patients.
Journal of Pediatric Surgery 01/1996; 30(12):1684-6. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mesenteric cysts are very rare. Most of the cases are asymptomatic except when complicated. A mesenteric cyst ruptured due to trauma in a 3-year-old boy is described. It was diagnosed intraoperatively and treated surgically.
European Journal of Pediatric Surgery 09/1995; 5(4):238-9. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors report on eight patients with caustic esophageal burns in whom tracheoesophageal fistula (TEF) developed during dilatation programs. This study covered a period of 17 years between 1975 and 1992. The age of the patients ranged from 1.5 to 8 years (mean age, 3.4 years). TEF developed after 5 to 43 months after injury (mean, 20.05 months). In each case, after documentation of the fistula by esophagography, esophagoscopy, and/or bronchoscopy, the fistula was blocked by an intraluminal esophageal stent, a polytetrafluoroethylene (PTFE) tube with a large lumen (10-mm diameter maximum). In this period, patients were fed via a jejunostomy tube and by total parenteral nutrition (TPN) if indicated, while the existing pneumonia was being treated. In one patient, fistula closed spontaneously during the stent application program, which ended with a patent esophagus. In two patients primary closure of TEF was attempted. In one of them fistula recurred and in the other it was technically impossible to separate the esophagus from trachea safely because of the very tight adhesions. In five patients a two-stage coloesophagoplasty was performed to bypass the fistulated esophagus. In the first stage, retrosternal pull-through of the colon and coloesophagogastric anastomosis was performed. In the second stage, closure of the distal esophagus and cervical coloesophagostomy was carried out. The patient with the primary closure attempt and one patient with stage 1 coloesophagoplasty died 3 and 4 months, respectively, after the operations. The cause of death was uncontrollable pneumonia in both cases. Follow-up of the four patients showed no complications. Another fistula patient is currently on stent treatment program with pneumonia under control.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Pediatric Surgery 07/1995; 30(6):823-6. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A total of 111 children with caustic oesophageal strictures who have subsequently undergone oesophagoplasty were reviewed. Overall 80 patients had a retrosternal colon transplant; a two-stage operation with delayed cervical oesophagocolostomy was the preferred method in 68 of them. Of those having retrosternal surgery two had total necrosis and three had necrosis at the distal end of the transplant. The incidence of cervical anastomotic stenosis was six of 12 in the group undergoing single-stage surgery, compared with seven of 68 in those having the two-stage operation. Ten patients underwent a right thoracic retrohilar colon transplant, seven of whom developed redundancy of the graft. Redundancy was a lesser problem in the retrosternal placement of the transplant. Three patients underwent jejuno-oesophagoplasty which resulted in terminal necrosis in one patient and total necrosis in two. The remaining 18 patients had segmental resection of the intrathoracic oesophageal stenosis followed by end-to-end anastomosis. The overall mortality rate in the series was 3.6 per cent (four of 111).
British Journal of Surgery 06/1995; 82(5):644-6. · 4.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Two cases of microcolon-intestinal hypoperistalsis without megacystis are reported. They had dilated proximal small bowel and narrowed distal small bowel and malrotated microcolon. No organic obstructive intestinal lesion was found and double-barrel ileostomy was performed. The biopsy specimens showed ganglion cells to be normal in number and appearance in the entire intestinal wall. The ileostomy did not function postoperatively and drugs stimulating bowel movement failed to induce peristalsis. We have suggested that microcolon-intestinal hypoperistalsis without megacystis may be the cause of functional intestinal obstruction in neonates and it is a variant of megacystis-microcolon-hypoperistalsis syndrome.
European Journal of Pediatric Surgery 05/1995; 5(2):124-7. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the years 1963-1991 inclusive, 88 patients were operated on with a diagnosis of pulmonary hydatid disease. The cysts were intact in 69 and infected in 19 cases. It was possible to use a surgical technique that preserved the pulmonary parenchyma in 67 patients. In this technique, the cavity after removal of the mother membrane is left open and only the air leaks are sutured. Continuous postoperative drainage of the residual cavity and the ipsilateral hemithorax always resulted in complete inflation of the affected lung. Enucleation of the endocyst and extended resection of the sclerotic pulmonary parenchyma were performed in 15, enucleation and obliteration in three, lobectomy in two and Barrett's method was applicable in one patient. A bronchopleural fistula developed in 11 patients postoperatively and in four of these cases a second thoracotomy was necessary. Postoperative empyema developed in four cases. There were two postoperative deaths in the series. Eighty-six patients were symptom-free in the long-term postoperative follow-up. We conclude that in the surgical management of the disease it should not be necessary to obliterate the residual cavity with extensive suturing which always leads to extra fibrosis with loss of viable pulmonary parenchyma.
European Journal of Pediatric Surgery 05/1994; 4(2):70-3. · 0.84 Impact Factor