Determining the most suitable anesthesia method for circumcision surgery plays a fundamental role in pediatric surgery. This study is aimed to present pediatric surgeons’ perspective on the relative importance of the criteria for selecting anesthesia method for circumcision surgery by utilizing the multi-criteria decision making methods. Fuzzy set theory offers a useful tool for transforming linguistic terms into numerical assessments. Since the evaluation of anesthesia methods requires linguistic terms, we utilize the fuzzy Analytic Hierarchy Process (AHP) and fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). Both mathematical decision-making methods are originated from individual judgements for qualitative factors utilizing the pair-wise comparison matrix. Our model uses four main criteria, eight sub-criteria as well as three alternatives. To assess the relative priorities, an online questionnaire was completed by three experts, pediatric surgeons, who had experience with circumcision surgery. Discussion of the results with the experts indicates that time-related factors are the most important criteria, followed by psychology, convenience and duration. Moreover, general anesthesia with penile block for circumcision surgery is the preferred choice of anesthesia compared to general anesthesia without penile block, which has a greater priority compared to local anesthesia under the discussed main-criteria and sub-criteria. The results presented in this study highlight the need to integrate surgeons’ criteria into the decision making process for selecting anesthesia methods. This is the first study in which multi-criteria decision making tools, specifically fuzzy AHP and fuzzy TOPSIS, are used to evaluate anesthesia methods for a pediatric surgical procedure.

Background: Necrotizing enterocolitis (NEC) is among the most common and destructive diseases in the neonatal period. Imaging methods are important in the early diagnosis and treatment of such diseases. Ultrasound elastography (USE) is a fast and non-invasive imaging technique that deals with the viscoelastic properties of tissues. Objectives: The purpose of this study is to assess the effectiveness of USE, which determines tissue stiffness with grayscale and colored images, as an imaging tool in the diagnosis and treatment of NEC. Materials and Methods: Sixteen newborn Wistar albino gender rats were separated into two groups including eight rats each. The first group (G-I) was taken as a control group and was not exposed to any intervention. The second group (G-II) was exposed to 100% CO2 for 5 minutes and 4°C for 10 minutes. All these interventions were applied twice per day for 4 days. We observed elastographic data at 24, 48, and 96 hours. All rats were sacrificed on the fourth day. The combination of gray-scale US and elastography was performed by a 4-13 MHz with an average of 12 MHz bandwidth linear probe in Esaote Ultrasonography Systems, MyLab60 model, produced in Geneva, Italy; with ElaXto imaging application. Results: Statistically significant differences were detected in elastosonography ratios of terminal ileum at 24, 48, and 96 hours (P < 0.05). As ischemia period in NEC was prolonged, elastosonographic ratios of intestinum increased significantly. Conclusion: It was found that USE is a reliable technique with superior features in the assessment of the terminal ileum in the neonatal age group. It is due to its wide image window and better assessment of tissue stiffness with gray scale and color image. It has been observed that the USE technique is helpful in the diagnosis.

Background: One of the most important urologic emergencies is testicular torsion in children. Elastography is as an objective method in diagnosis and treatment of testicular torsion, with grayscale and colored images. Our study presents an original framework, which may guide certain research and practices in this field. Objectives: The aim of this study was to evaluate the effectiveness of ultrasound (US)-elastography for the diagnostic performance of testicular torsion. Materials and Methods: In this experimental study, 16 male white New Zealand rabbits of the same weight and age were selected and divided into two groups. In group I, the right testicle was fixed, and in group II, the right testicle underwent 720° torsion in a counterclockwise direction and fixed. Following 1 and 2 hours of ischemia, measurements of the right and left testicles were performed simultaneously. The left testicle was measured again after 24 hours in order to better observe the changes that right testicular ischemia might have had on the left testicle. Results: A statistically significant increase was detected in the elastography values of the right testicle at 1, 2, and 24 hours (P < 0.05). Elastography values were significantly increased in the left testicle after 24 hours (P < 0.05). The elastographic measurement values of the testicular tissue increased significantly with the increase in the duration of ischemia. Conclusion: With the width of its imaging window and healthy evaluation opportunity, elastography is a method in determining tissue stiffness of unilateral and contralateral testicular structures. In this study, the efficacy of elastography was evaluated. As a future research, further studies are needed to evaluate the elastography values in epididmo-orchitis and other causes of acute scrotum.