Successful outcomes in laparoscopic pyeloplasty using knotless self-anchoring barbed suture in children

INTRODUCTION

Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures.

MATERIAL AND METHOD

We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (V-Loc^TM, Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion.

RESULTS

The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110 min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p = 0.001 and p = 0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p = 0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months.

CONCLUSION

In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.

Relationship of sleep quality and quality of life in children with monosymptomatic enuresis

BACKGROUND

Health-related quality of life (QoL) in children with monosymptomatic nocturnal enuresis might be influenced by impaired quality of sleep. The aim of this study was to evaluate possible deteriorations in QoL and sleep quality and the association between these parameters in children with monosymptomatic nocturnal enuresis.

METHODS

The study consisted of 44 children with monosymptomatic nocturnal enuresis and 27 healthy controls aged 6-15 years. KINDL QoL and Pittsburgh Sleep Quality Index (PSQI) were applied to all children.

RESULTS

Mean total KINDL scores in enuresis and control groups were 65.1 +/- 11.0 vs. 67.4 +/- 13.7, respectively (P = 0.44). PSQI scores were not significantly different between the groups (P > 0.05l). In the enuresis group, age showed significant negative correlation with self-esteem domain of KINDL (r = -0.39, P = 0.01) and positive correlation with sleep duration sub-score of the PSQI (r = 0.37, P = 0.03). Duration of enuresis showed significantly negative correlation with total KINDL score and self-esteem domain (r = -0.32 and r = -0.39, P = 0.04 and P = 0.01, respectively). There was significant correlation between physical well-being sub-score of KINDL with daytime dysfunction and total scores of PSQI (r = -0.53, P = 0.001 and r = -0.41, P = 0.02, respectively). Daytime dysfunction sub-score of PSQI was significantly correlated with friends sub-score of KINDL (r = -0.33, P = 0.04).

CONCLUSIONS

As age of the child and duration of enuresis increase, self-esteem domain of QoL worsens. Moreover, there is a significant correlation of physical well-being and friends domains of QoL score and total and daytime dysfunction scores of PSQI. These findings necessitate global evaluation of QoL and sleep quality in children with monosymptomatic nocturnal enuresis to increase efficacy of health care.

Albendazole as an alternative therapeutic agent for childhood giardiasis in Turkey

The efficacy of albendazole for the treatment of giardiasis has been indicated by previous in-vitro and in-vivo studies. In order to compare the therapeutic efficacy of albendazole and metronidazole, 107 Giardia-positive children (aged 3-15 years), diagnosed by three consecutive positive stool examinations, were enrolled in the study. Of these children, 52 were given a single daily dose of albendazole 10 mg/kg for 5 days, and 55 were given metronidazole 20 mg/kg daily in three doses for 7 days. Parasite eradication was achieved in 47 (90.4%) of 52 children treated with albendazole and 49 (89.1%) of 55 children treated with metronidazole (p > 0.05). These results suggest that albendazole is an effective treatment option for childhood giardiasis.

Dientamoeba fragilis, a neglected cause of diarrhea, successfully treated with secnidazole

OBJECTIVE

To evaluate the pathogenicity of Dientamoeba fragilis by comparing it with Giardia lamblia and to investigate the effect of a single dose of secnidazole in dientamoebiasis.

METHODS

Stool samples of 400 patients, admitted to the Department of Parasitology, Celal Bayar University, were examined by direct wet mount, formalin-ethyl acetate concentration and trichrome staining methods on three consecutive days. All cases positive for D. fragilis were treated with a single dose of secnidazole, 30 mg/kg for children, and 2 g for adults. On the seventh and fourteenth days, at the end of the treatment, stool samples were examined by the same methods, and clinical symptoms were again evaluated.

RESULTS

D. fragilis and G. lamblia were detected in 35 (8.8%) and 34 (8.5%) cases, respectively. The most frequent symptoms were found to be abdominal pain and diarrhea in both infections. D. fragilis was eradicated in 34 (97.1%) patients with a single dose of secnidazole, but a second dose was necessary in one patient. Clinical symptoms disappeared in 27 (77.1%) and decreased in eight (22.9%) cases, after eradication.

CONCLUSIONS

These data suggested that D. fragilis is as prevalent and pathogenic as G. lamblia, and secnidazole seems to be highly effective in achieving parasitologic and clinical cure. To our knowledge, this is the first report of secnidazole being used in the treatment of dientamoebiasis.

Effect of trimethoprim-sulfamethaxazole in Blastocystis hominis infection

OBJECTIVE

Blastocystis hominis (B. hominis) is a common intestinal parasite that has long been considered nonpathogenic. Recently there have been many reports supporting a role for the organism as a potential pathogen. We performed a study to examine the pathogenicity of B. hominis and the effect of trimethoprim-sulfamethaxazole (TMP-SMX) on this organism.

METHODS

Stool samples of patients, who came to the Department of Parasitology, Faculty of Medicine, Celal Bayar University, were examined by direct wet-mount, trichrome staining, formalin-ethyl acetate concentration, and Kinyoun acid fast techniques for intestinal parasites, and bacteriological stool cultures were performed. Fifty-three symptomatic patients (38 children and 15 adults) with two consequent stool samples positive for abundant B. hominis (five or more organisms per x400 field) and negative for other parasitic and bacterial pathogens were treated with TMP-SMX for 7 days, children 6 mg/kg TMP, 30 mg/kg SMX, and adults 320 mg TMP, 1600 mg SMX, daily. On the seventh day, at the end of treatment, stool samples of all patients were examined by same methods, and clinical symptoms were again evaluated.

RESULTS

B. hominis was eradicated in 36 of 38 (94.7%) children, and 14 of 15 (93.3%) adults. Clinical symptoms disappeared in 39 (73.6%), decreased in 10 (18.9%), and no change was observed in one (1.9%) patient, whereas symptoms persisted in all three (5.7%) patients in whom B. hominis could not be eradicated. Mean number of stools per day was significantly decreased from 4.3 to 1.2 in the 33 children (p < 0.001), and decreased from 3.5 to 1.0 in the four adults (p = 0.06) with diarrhea.

CONCLUSIONS

These results suggested that B. hominis may be pathogenic, especially when it is present in large numbers, and TMP-SMX is highly effective against this organism. Although there are some anecdotal reports, to our knowledge this is the first study examining the effect of TMP-SMX on B. hominis in humans.

Relationship between pinworm and urinary tract infections in young girls

Urinary tract infection is particularly common in young girls and Enterobius vermicularis (pinworm) is one of the most prevalent worms found in children worldwide. Young girls, with or without urinary tract infection, were examined for pinworms in order to explore a possible relationship between these two problems. Of the 55 young girls with urinary tract infection, 20 (36.4%) had pinworm eggs in the perianal and/or perineal region monitored using the cellophane tape method, while 9 (16.4%) of 55 young girls who had never previously had a urinary tract infection were found to have Enterobius eggs in at least one of the cellophane tape tests, and the difference was found to be significant (p<0.05). These results suggested that urinary tract infections may be related to pinworms. When a urinary tract infection is diagnosed in young girls, cellulose tape should be applied to both the perianal and the perineal regions on at least three consecutive occasions.

Should children with infection be tested for lipid, lipoprotein and apolipoprotein?

The lipid profile is known to alter in patients with infection, but there has not been a study of the apolipoprotein levels in serum of otherwise healthy children during infection. Lipids, lipoproteins, apolipoproteins A-1 and B and lipoprotein (a) were evaluated prospectively in 31 consecutive children, aged 4-15 years, who were admitted to the hospital with bacterial pharyngitis. The degree of dyslipidemia associated with bacterial pharyngitis was assessed using each child as his/her own control and by comparison with 79 healthy children who had not had an infection during the past 3 months. Serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A-1 and apolipoprotein B levels were significantly decreased during the symptomatic phase of the disease, whereas the serum triglyceride level was slightly elevated. Serum lipoprotein (a) concentration did not change significantly. In conclusion, it is suggested that serum lipids, lipoproteins and apolipoproteins should not be assessed during infection because of the possible transient changes of these parameters during infection or inflammation.

Increased serum copper and decreased serum zinc levels in children with iron deficiency anemia

In order to evaluate serum copper and zinc status in children with iron deficiency anemia (IDA), 60 children with IDA aged 1-14 yr and 64 healthy children as controls aged 1-14 yr were included the study. Serum copper levels were higher in children with IDA (189 +/- 49 micrograms/dL) than those of controls (163 +/- 37 micrograms/dL) (p = 0.001). Serum zinc levels were lower in the patient group (109 +/- 59 micrograms/dL) than those of control subjects (135 +/- 56 micrograms/dL) (p = 0.017). In addition, there were statistically significant negative correlations between hematological parameters and serum copper levels in the patient group, but not in controls. No correlation between hematological parameters and serum zinc levels were found in both patient and control groups, except positive correlation between mean corpuscular volume (MCV) and serum zinc level in patients. It was concluded that at the time of managing children with IDA, zinc deficiency must be borne in mind and if necessary treatment should be initiated with zinc.