Süleyman Cüneyt Karakuş1, Alev Süzen1, Çiğdem Yenisey2, Nazile Ertürk1, Tuğrul Epikmen3, Emrah İpek3, İdil Rana User4, Burçin İrem Abas2
1Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Pediatric Surgery, Muğla, Turkey
2Adnan Menderes University, Faculty of Medicine, Department of Medical Biochemistry, Aydın, Turkey
3Adnan Menderes University, Faculty of Veterinary Medicine, Department of Pathology, Aydın, Turkey
4Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
Objective: The protective effect of hypothermia on ischemia/reperfusion injury is a well-known. Hypothermia can be easily applied clinically via ice bags in peroperative and postoperative period. In this study, we aim to study this effect of hypot-hermia via creating a model of clinically applicable rat testicular torsion/detorsion model.
Method: rats were divided into 5 groups (n=7): (1) sham (s), (2) torsion/detorsion (t/d): right testis was torsed for 1 hour, (3) torsion/detorsion + hypothermia 1 (t/d+h1): right testis was torsed for 1 hour, then submerged into iced water at 4°c for 30 min, (4) torsion/detorsion +hypothermia 2 (t/d+h2): right testis was torsed for 1 hour, then submerged into iced water at 4°c for a total of 90 min (30 min before and 1 hour after detorsion), (5) hypothermia (h): right testis was kept in iced water at 4°c for 90 min. testicular diameters at preoperative period and 8th postoperative week were measured. Biochemically, MPO, NO, 3-NT and 4-HNE in testicular tissue and serum levels of NO, PgF 2alfa, 3-NT, 8-OHdg and 4-HNE were studied. Histopathologic examination was also performed.
Results: Parameters of both groups T/D+H1 and T/D+H2 were statistically different from group T/D with respect to protec-tive effects of hypothermia. johnsen score was not statistically different only in group T/D+H1. There were no difference in all measurements except tissue 3-NT level between T/D+H1 and T/D+H2 groups. Increased tissue NO level and lower johnsen score although statistically indifferent were detected in group H when compared to sham group.
Conclusion: Hypothermia applied before detorsion has been shown to be macroscopically, biochemically and histopatho-logically beneficial in the long term. We think that further studies about hypothermic applications in the preoperative period should be planned in vivo and can be used in the routine daily practice. Since hypothermia in the reperfusion period is not beneficial, the effect of mild hypothermia rather than iced water in this period should be studied.
this presentation has been granted by the muğla sıtkı koçman university research projects coordination office through project grant number: 17/285.
MEDICAL APPROACH TO uRETHEROLITHIASIS IN PEDIATRIC POPuLATION
Asya Eylem Boztaş, Kamer Polatdemir, Arzu Şencan, Özge Atacan, Aytaç Karkıner, Akgün Oral
SBÜ. Dr. Behçet Uz Children’s Diseases and Thoracic Surgery Training and Research Hospital, Pediatric Surgery, Izmir, Turkey
Introduction: Incidence of uretherolithiasis in pediatric population is increasing in recent yearsTreatment options are, uRS, open surgery and medical; doxazosin and tamsulosin are prominant drugs. Recent studies showed these agents are safe in pediatric patients.In this study outcomes of patients with isolated uretherolithiazis treated with doxazosin presented. Method: Between june 2016-April 2017 12 patients with urether stone was treated with doxazosin. All patients had iv hid ration,antibiotics,analgesics. Prior to medication all went in echocardiography for possible underlying cardiac issue. Age, gender, number of stones,size, location, ap diameter, presence of uTI, need for surgery, complication, underlying cardiac pathology, stone passing time, duration of hospitalization are the parameters that utilized.
Results: Total 12 patients with 11 distal 1 proximal ureteral stones included in study-5 of them boys and 7 girls. Mean age is 10.7 (4-17). The mean medication duration 4.3 days (6-1), hospitalization day 3.6 (8-1); the mean stone passing time 4.2 days (8-1).
2 patients had to be interned with; left ventricule hypertrophia and low blood potassium which explains long duration of hospitalization.Only 1 patient underwent uRS because of rising in AP diameter. No complication is observed.
Conclusion: Doxazosin is related with a greater incidence of expulsion of ureteral calculi in a short preiod of time - need less day of hospitalization. However need for analgesic agents isn’t reduced.
27 full thickness skIn graft use In cIrcumcIsIon complIcatIon
Ökkaş Aytaç Karkıner, Asya Eylem Boztaş, Özge Öztürk Akar, Özge Atacan, Kamer Polatdemir, Arzu Şencan, Akgün Oral
Health Sciences University Dr. Behçet Uz Children’s Hospital, Department of Pediatric Surgery, İzmir, Turkey
Introduction: Circumcision is excision of penil skin that covers glans penis in a certain dimension, for medical or religious moral reasons. When it is performed under unsuitable conditions by untrained person, risk of complicaiton increase dra-matically. Circumcision complications are penile adhesions, skin birdges, meatal stenosis, redundant foreskin, recurrent phimosis and the most serious dehiscence of circumcised penil skin. In this study; 3 patients with total excised penile skin after circumcision reconstructed with full thickness skin graft taken from the groin are presented.
Methods: 3 patients aged 8-11 years old presented to clinic with unhealed wounds after having circumcision by untrained and unauthorized person. In physical examination; excessively cut penile skin from coronal sulcus to root of the penis and granulation tissue was detected. urethra and urethral meatus was intact. After recieving wound site infection control, reconstruction with full thickness skin graft from upper left groin is performed. All patients were hospitalized with urinary catheter to keep the surgical wound clean and closed dressing for five days. urinary catheters are removed at postoperati-ve sepostoperati-venth day. Inguinal incisions were ephitelized and grafts were viable. Patients were followed up for at least 10 months. No graft rejection, urinary disfunction or erection problem were seen.
Conclusions: Circumcision made by untrained nonmedical persons under nonsuitable conditions has higher complication rates. A full thickness skin graft taken from groin without hair root is suitable for reconstruction in skin defects after circum-cision.
CAN DISTAL uRETERAL DIAMETER MEASuREMENT PREDICT PRIMARy vESICOuRETERAL reflux clInIcal outcome and success of endoscopIc InJectIon
Ayşe Demet Payza1, Erkin Serdaroğlu2, Münevver Hoşgör1, Arzu Şencan1
1Health Sciences University Dr. Behçet Uz Children’s Hospital, Department of Pediatric Surgery, Izmir, Turkey
2Health Sciences University Dr. Behçet Uz Children’s Hospital, Department of Pediatric Nephrology, Izmir, Turkey
Objective: To evaluate the predivtive value of distal ureteral diameter ratio (uDR) on outcome of primary vesicoureteral reflux (vuR) and reflux resolution after endsocopic injection.
Methods:383 voiding cystourethrograms (vCug) of patients with primary vuR between 2010-2015 were rewieved. The ureteral diameter ratio (uDR) was calculaterd as the largest ureteral diameter within the false pelvis divided by the distan-ce between L1-L3. Analyzed variables included age, gender, grade, laaterality, history of febril urinary tract infection, bladder-bowel dysfunction. Clinical outcome was defined as spontaneous resollution and surgical correction. Cox regressi-on analysis was utilized to calculate odds ratio, effective variables in the success of treatment was analyzed by chi-squared, t-test and logistic regression analysis.
Results: 383 patients were enrolled. Mean age was 5,07 years. 321 patients underwent operation, 62 had spontaneous resolved vur. there was a strong correlation between udr and grade of reflux (p>0.0001). mean distal ud was 4,36 mm. Mean uDR was 0.24. The avarage uDR and uD for each grade were demonstrated to be higher in the operative interventi-on group compared to the resolved cases. The test for linear trend was significant for the operative group (p<0.05). the predictive intervention group compared to the resolved cases. The predictive value of uDR for spontaneous resolution was more significant than grade (p<0.001). Maximum uD was 4.67±2.08 mm and maximum uDR was 0.31±0.13 in patients with spontaneous resolution. There was no spontaneous resolution over these ratio. uD and uDR were significant predictors of endoscopic injection success. Each 0.005 units increase in the uDR affected the success of endoscopic injection negatively (95% cI: 0.001-0.071).
Conclusion: uDR provides an objective measurement of vuR and appears to be a new predictive tool for clinical outcome and success after endoscopic injection.
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