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Öğe Blunt renal trauma in children with previously undiagnosed pre-existing renal lesions and guidelines for effective initial management of kidney injury(Wiley, 2002) Önen, A; Kaya, M; Cigdem, MK; Otçu, S; Öztürk, H; Dokucu, AIObjectives To record pre-existing renal lesions (PERL) found incidentally during evaluation for blunt renal trauma in children. determine their importance. suggest guidelines for the effective initial management of children with significant renal trauma and to evaluate the role of temporary percutaneous nephrostomy tube drainage (TPND) in these patients. Patients and methods We reviewed 338 children who were hospitalized with blunt abdominal trauma between 1992 and 2000. Thirty-one patients had significant renal injury, 17 before 1997 (reviewed retrospectively) and the others reviewed and followed prospectively. Results Eleven of the 31 children had a PERL. which had been undiagnosed before the injury. The mean (range) follow-up was 52 (15-104) months. There were 22 boys and nine girls (mean age 9.1 years, range 2-13). The mean age was lower in patients with a PERL than in children with isolated renal injury. The most common cause of blunt renal injuries was a fall (45%) followed by motor vehicle accidents. Renal stones were present in five children, pelvi-ureteric junction obstruction in four, megaureter in one and a renal cyst in one. The mean injury severity scores were 12 in the children with a PERL and 14 in patients without. TPND was used in seven (22%) children: four were associated with a PERL. The mean grade of injury score for the kidney was higher in patients with a PERL and in children who underwent TPND than in patients who previously had a normal kidney and in children who did not undergo TPND. Early surgical intervention was required in three children; all were associated with a PERL. Of the 13 children who underwent surgery 11 had previous disease. Conclusions The frequency of PERL is high (36%) in children with blunt renal trauma. PERL can predispose minor trauma to cause kidney injury even with no evidence of hydronephrosis. When a minor trauma results in renal injury, it is important to seek a PERL. In selected patients. TPND may decrease the length of hospital stay and improve the outcome of the injured kidney. thereby decreasing the need for further surgery in those with isolated renal injury: however, it appears not to decrease the need for later operations in children with a PERL.Öğe Characteristics of penetrating abdominal firearm injuries in children(Hippokrates Verlag Gmbh, 2000) Dokucu, AI; Otcu, S; Öztürk, H; Önen, A; Özer, M; Bükte, Y; Özates, MPenetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children less than or equal to 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8: 41 children had an ISS value of greater than or equal to 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value greater than or equal to 16 were hospitalized significantly longer than those with less than or equal to 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.Öğe Colon injuries in children(W B Saunders Co, 2000) Dokucu, AI; Öztürk, H; Yagmur, Y; Otçu, S; Önen, A; Azal, ÖF; Gürkan, FBackground/Purpose: Colonic injuries are rare in childhood, but when they do occur, they are mostly associated with penetrating abdominal injuries. The primary repair of colon injuries without stoma is still controversial within surgical experience, and the potential risk factors affecting morbidity and mortality is not sufficiently known. Methods: Between 1985 and 1997, 34 children presenting with traumatic colonic perforations were reevaluated by analyzing the relationship between the overall morbidity and mortality and the potential risk factors. Results: Of the 34 children in the case study, 27 boys and 7 girls, there were 7 (21%) isolated colonic injuries. The remaining 27 (79%) patients showed colonic injuries most frequently associated with the small bowel, the liver, and the bladder. Localization of injury was distributed thus: 21% in the right colon, 29% in the transverse colon, and 50% in the left colon, Primary repair, with or without intestinal resection, was performed in 27 (79%) of the patients. In total, postoperative complications occurred in 10 (29%) of the patients. Risk factors such as age, abdominal contamination, and associated abdominal organ injuries were found significant in these complications, however, the mechanism of injury, shock, blood transfusion, and localization of injury were not correlated significantly to postoperative complications. Flint's Colon Grading System was used to ascertain the sensitivity of trauma scoring systems for postoperative complications. Conclusion: Colonic wounds can be repaired primarily without the need of colostomy in the majority of cases in children when the required selections are established. J Pediatr Surg 35:1799-1804. Copyright (C) 2000 by W.B. Saunders Company.Öğe Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma(Springer-Verlag, 2003) Öztürk, H; Önen, A; Otçu, S; Dokucu, AI; Yagmur, Y; Kaya, M; Yücesan, SPurpose. Intestinal perforation due to blunt abdominal trauma is rarely seen in children and delayed diagnosis is a major concern. Because the potential risk factors affecting morbidity are not well known, we evaluated whether diagnostic delay increases morbidity in gastrointestinal perforation from blunt abdominal trauma in children. Methods. Twenty-nine children with gastrointestinal perforation caused by blunt abdominal trauma, admitted to our clinic between 1983 and 2001, were retrospectively evaluated by analyzing the relationship between overall morbidity and potential risk factors. Results. There were 23 boys and 6 girls. Most of the injuries were caused by falls and motor vehicle accidents. The jejunum was the most frequent site of perforation followed by the ileum. Simple closure was the most common surgical procedure. Postoperative complications developed in five patients (17%) and included wound infections in two, wound dehiscence in one, and adhesive small bowel obstruction in two. Potential risk factors such as trauma mechanism, the presence of shock on admission, and associated organ injury were not significantly correlated with postoperative complications, whereas a period of delay exceeding 8h and an Injury Severity Score (ISS) exceeding 15 were significantly related to septic complications (P < 0.05). The relative risk of a septic complication developing was higher than 2 for the following risk factors: a fall from a flat-roofed house and a time delay before operative intervention. There were three deaths (10%) in this series, caused by sepsis in two patients and head injury in one. Conclusion. These findings suggest that rapid diagnosis and treatment is important for preventing complications in patients with intestinal perforation caused by blunt abdominal trauma. A delay exceeding 8h and an ISS score exceeding 15 were related to significant septic complications, and falls from flat-roofed houses are an important public safety risk in Turkey.Öğe Does the analysis based on a histological and immunohistochemical grading system in the model of BDL kidney allow the quantification of the degree of injury?(Taylor & Francis Ltd, 2004) Büyükbayram, H; Öztürk, H; Kara, IJ; Arslan, AThe aim of this study is to evaluate histopathological findings induced by N-Omega-nitro-L-arginine methyl ester (L-NAME) and molsidomine (MOL) on the kidney of bile duct ligated rats. Forty Sprague-Dawley rats, each weighing 125 to 140 g, were included in the study. Extent of histological glomerular injury scores (GIS), arterial injury scores (AIS), and tubulointerstitial injury scores (TIS) in each animal were graded. Alpha-smooth muscle actin (alpha-SMA), tenascin, lectin (Ulex europaeus agglutinin-1), and vimentin were used to determine extent of the injury. The cholestasis was evidenced by a significant increase in the levels of serum total bilirubin in BDL rats (p<0.01). Malondialdeyde MDA levels increased by the bile duct ligation (BDL) to 12.10 +/- 0.45. This value was significantly higher than the other groups (p<0.01). Changes in the BDL kidney were marked at 7 days after surgery. GIS were observed to have the highest score, especially at juxtamedullary region in BDL/L-NAME rats, and AIS were also the highest score in this region. These observations were lower in BDL/MOL rats. There is a correlation between GIS and AIS scores (r=.2, p<.01). TIS revealed that BDL/L-NAME rats were significantly more damage than rats in the other groups (p<.001). MOL-treated rats showed considerably fewer lesions in the tubules and interstitium (p<.001). The tubular injuries observed in BDL and BDL/L-NAME rats were significantly attenuated by MOL treatment. Lectin was more and extensively stained in tubular epithelia of the BDL/L-NAME group than in the other (p<.05). Expression of tenascin in tubular epithelia was significantly higher in BDL and BDL/L-NAME as compared with controls (p<.01). Fibrous tissue was only observed in the BDL and BDL/L-NAME group. These areas were weakly stained with vimentin. alpha-SMA staining was more reduced in the L-NAME-treated arterioles than in BDL/MOL (p<.05). In conclusion, the analysis of cell injury based on a histological grading system in the model of BDL kidney allows the quantification of the degree of injury.Öğe Effects of in vivo freezing and mannitol in intestinal ischaemia-reperfusion injury(Elsevier Sci Ltd, 2003) Aldemir, M; Öztürk, H; Güloglu, C; Büyükbayram, HPurpose: The main purpose of this study was to investigate whether in vivo freezing and mannitol administration can protect the small intestine against ischaemia-reperfusion (I-R) injury. Methods: Fifty male Sprague-Dawley rats (200-225 g) were divided into 5 groups each containing 10 rats; group SO, sham operation group; group 1, mesenteric ischaemia group; group R, ischaemia-reperfusion (I-R); group FR, I-R plus in vivo freezing; group MR, I-R plus mannitol treatment. Intestinal ischaemia for 30 min and reperfusion for 60 min were applied. Ileum specimens were obtained to determine the tissue levels of malondialdehyde (MDA) and histological changes. Results: The mucosal injury scores of group R were significantly higher than those of the group I (P < 0.0001). The mucosal injury scores in the groups FR and MR were significantly lower than the group R (P < 0.0001 and P < 0.0001, respectively). In the group FR, mucosal injury scores were not significantly different from those of group I (P = 0.123). However, mucosal injury scores of group MR were significantly less when compared to those of group I (P = 0.01). Mean MDA levels of group R were significantly higher than those of the group I (P < 0.0001). Mean MDA levels of groups FR and MR were significantly lower than those of group R (P < 0.0001 and P < 0.0001, respectively.). In addition, MDA levels of group FR were significantly higher than those of group MR (P < 0.0001). Conclusion: In conclusion, these observations suggest that the in vivo freezing of SMA and the pre-treatment with mannitol before reperfusion period may be useful in preventing intestinal reperfusion injury. (C) 2003 Elsevier Science Ltd. All rights reserved.Öğe Effects of melatonin administration on intestinal adaptive response after massive bowel resection in rats(Springer, 2006) Ozturk, H; Öztürk, H; Yagmur, Y; Uzunlar, AKThis study evaluates whether melatonin can improve the structure of the small intestine and enhance adaptation in an experimental model of short bowel syndrome. Thirty Sprague-Dawley rats were divided randomly into three experimental groups of 10 animals each. In one group, only laparotomy was performed and these rats served as the sham-control group (G 1). The remaining 20 rats under-went 90% small bowel resection (SBR) and formed the two experimental groups: the SBR/untreated group (G2), and the SBR/melatonin-treated group (G3). Rats in the SBR/untreated group received no therapeutic treatment. Rats in the SBR/melatonin-treated group received melatonin intraperitoneally for 3 weeks. The animals were weighed daily. All rats underwent relaparotomy on day 21 of the experiment. Remnant small bowel was excised and evaluated for villus height. total mucosal thickness, and crypt cell mitosis. After the 90% SBR, all animals suffered from diarrhea and weight loss between the first and the sixth postoperative days. The body weight of the SBR/melatonin group showed significant increases at the beginning of postoperative day 10 and day 21 in comparison to that of the SBR/untreated group. The rats treated with melatonin had significantly greater villus height and crypt cell mitosis compared to the sham-control group and the SBR/untreated group. In addition, the mucosal thickness was significantly increased in the SBR/melatonin-treated group compared to the SBR/untreated rats. These observations suggest that melatonin treatment increases villus height, total mucosal thickness, and crypt cell mitosis after massive SBR and it may exert a considerable effect oil the mucosal adaptive response in short bowel syndrome in rats.Öğe Effects of methoctramine on bladder overactivity in a rat model(Elsevier Science Inc, 2003) Öztürk, H; Onen, A; Guneli, E; Cicek, R; Hekimoglu, ATObjectives. To determine the functional effects of methoctramine as an M-2 muscarinic receptor antagonist on isolated detrusor strips in vitro and bladder overactivity in vivo in rats. Methods. A total of 114 Sprague-Dawley rats were used in the present study. Isolated rat detrusor strips were contracted by depolarizing the preparations with carbachol. Methoctramine was added to the tissue bath in increasing concentrations, and contraction inhibition was assessed. Isovolumetric contractions were evoked by electrical stimulation using a bipolar electrode. Efficacy against bladder instability was evaluated using the obstructed hypertrophied bladder model in the rat. The acetic acid bladder cystometry model was used to assess the efficacy of methoctramine in neurogenic detrusor overactivity. Results. Methoctramine inhibited carbachol-induced bladder contractions significantly in isolated rat detrusor strips in a concentration-dependent manner. The amplitude of electrically evoked isovolumetric contractions was decreased significantly after methoctramine exposure. In vivo methoctramine administered intravenously significantly increased the voiding interval and bladder compliance. In addition, a decrease occurred in the number of spontaneous contractions during the filling phase in a model of neurogenic and obstruction-induced detrusor overactivity. Conclusions. M-2 antagonists in general may represent a new useful class of drug worth considering in the treatment of bladder overactivity. (C) 2003, Elsevier Science Inc.Öğe Epidemiology and control of nosocomial infections in paediatric surgery(W B Saunders Co Ltd, 2002) Önen, A; Cigdem, MK; Geyik, MF; Kökoglu, ÖF; Otçu, S; Öztürk, H; Dokucu, AIThe purpose of this study was to determine the epidemiology and control of hospital-acquired infections (HAI) in paediatric surgery. We reviewed 2844 hospitalized children in a paediatric surgical clinic between January 1997 and December 2000. The diagnosis of HAI was made based on criteria proposed by Centers for Disease Control and Prevention (CDC). The incidence, type of micro-organisms and infections, age, sex, risk factors, and the economic aspects were recorded. The mortality, duration of hospitalization and economic aspects of patients were compared with 78 control patients matured for age, sex and primary illness and free of HAI. There were 78 children with HAI, the overall incidence was 2.74% (4.99% in 1997, 3.89% in 1998, 1.33% in 1999, 1.44% in 2000). The most frequent infections were surgical wound (28 patients) and urinary tract (25 patients). The most frequent risk factors were urethral catheterization (10.26%), trauma (9.25%), and parenteral nutrition (8.70%). Mean hospitalization was 16 days (range 4-28 days) in patients with infection compared with nine days (range 2-22 days) in control group. Eight patients died in the infection group, while two died in the control group. HAI caused a significant increase in mortality, prolonged hospitalization and increased costs (P < 0.05, P < 0.001, P < 0.001, respectively).Öğe Gastric perforation in neonates(Acta Medical Belgica, 2003) Öztürk, H; Önen, A; Otçu, S; Dokucu, AI; Gedik, SThe aetiology of neonatal gastric perforation (NGP) remains unknown and the mortality rate is still very high. We have treated five cases of gastric perforation over the past 17 years, and analysed them retrospectively to present our experience. Clinical data included age, sex, weight, maternal complication, fetal complication, gestational age, type of delivery, admission time, associated pathologies, localization of perforation, perforation age, operative procedures and outcome. There were four boys and one girl. Three of the infants were full-term, while two were premature. All of the infants were septic prior to rupture. Two infants had acute respiratory distress syndrome (ARDS); one due to prematurity and low gestational weight, and one due to meconium aspiration. Perforation was located at major curvature and anterior wall of the stomach in four patients, while it was located in minor curvature and anterior wall in one. The rupture was closed in two layers. Histopathology revealed local chronic inflammation and ischemia. Mortality rate was 60%. In conclusions, gastric perforation is a life-threatening complication in neonates. In our limited series, sepsis, prematurity and corticosteroid treatment were likely to be predictive for development of NGP. Early diagnosis and prompt management before clinical deterioration of the metabolic status may improve the outcome of such infants with NGP.Öğe Genital trauma in children(Elsevier Science Inc, 2005) Onen, A; Öztürk, H; Yayla, M; Basuguy, E; Gedik, SObjectives. To determine the severity and, accordingly, the treatment of genital trauma in a pediatric population. Methods. A total of 116 children with genital trauma and anorectal injury were retrospectively reviewed. The severity of trauma was graded according to the genital injury score (GIS), which we developed as a genital trauma scoring system. Results. The median age was 8 years. Of the 116 children, 80 were girls and 36 were boys. The etiology of the trauma was traffic road accident (53 patients), fall, sexual abuse, and gunshot wound. Sixty-one patients had additional organ injuries. The GIS was I for 25 children, 11 for 19, 111 for 32, IV for 23, and V for 17. In addition to the primary repair, colostomy was performed in 22 patients. The most frequent postoperative complication was wound infection. The postoperative complication rate was significantly greater in patients with an injury severity score greater than 15, severe contamination, prolonged delay (longer than 8 hours), and a GIS of IV or V. Conclusions. The clarification of the mechanism and severity of the genital injury and associated organ injuries under general anesthesia may help in the appropriate classification. Primary repair should be the standard approach in genital trauma patients with a GIS of IV or less. Those with a GIS of V associated with severe contamination and prolonged delay require colostomy for improved outcome. (c) 2005 Elsevier Inc.Öğe Influence of L-NAME and L-Arg on ischaemia-reperfusion induced gastric mucosa damage(Acta Medical Belgica, 2002) Öztürk, H; Kara, IH; Otçu, S; Kilinc, N; Yagmur, YObjective : The aim of this study was to investigate effects of L-NAME and L-Arginine on gastric mucosal injury induced by ischaemia-reperfusion. Methods : In the experiment, 20 New Zealand rabbits were used (2700-3000 g). Celiac artery was clamped for 30 min for ischaemia and then 60 min of reperfusion followed this after all rabbits were anaesthetized. In the Sham-control group (G 1, n = 5), laparotomy was performed, and the celiac artery was prepared without clipping. Group 2 (Untreated, n = 5) rabbits were only subjected to ischaemia-reperfusion. Group 3 (n = 5) rabbits had L-Arginine Methyl Ester (L-Arg) 3 mg/kg/min as IV infusion during the first 15 min of the reperfusion. Group 4 (n = 5) rabbits had a nitric oxide inhibitor NG-nitro-L-arginine methyl ester (L-NAME) 100 mug/kg/min IV during the first 15 min of the reperfusion. After 60 min of reperfusion, the rabbits were killed, and their stomachs were removed for histopathologic evaluation and determination of malondialdehyde (MDA) level. Results : After ischaemia-reperfusion, Untreated group had macroscopic necrosis involving 50 +/- 6% of total gastric mucosa area and deep mucosal necrosis involving 10 +/- 5% of mucosal strips. In the group treated with L-NAME, macroscopic mucosal necrosis involved 52 +/- 6% of total gastric mucosa area and deep mucosal necrosis involved 11 +/- 3 % of mucosal strips (both p > 0.05 versus Untreated group). L-Arg treatment significantly reduced macroscopic mucosal necrosis area to 20 +/- 6% and deep mucosal necrosis to 3 +/- 1% (both p < 0.05 versus Untreated group and L-NAME group). MDA level in the L-Arg group was significantly lower when compared to control and L-NAME group MDA level (p < 0.05). Conclusion : These results suggest that NO increase induced by L-Arginine injection is involved in the protection of gastric mucosa after isehaemia-reperfusion.Öğe Long-term outcome of posterior urethral rupture in boys(Elsevier Science Inc, 2005) Onen, A; Öztürk, H; Kaya, M; Otcu, SUObjectives. To evaluate the long-term outcome of posterior urethral rupture due to pelvic trauma. Methods. We retrospectively reviewed the records of 49 children with posterior urethral rupture from 1986 to 2000. The urologic evaluation at the last follow-up visit was made by the same surgeon and included physical examination, ultrasonography, simultaneous retrograde urethrography, and voiding cystourethrography, as well as cystourethroscopy in some cases. The long-term urologic results were determined by voiding function, continence and erectile function, and semen analysis. Results. The mean follow-up was 12 years (range 4 to 17). The average age was 8 years at the time of trauma and 20 years at the last follow-up visit. Primary realignment (22 patients), immediate repair (8), and delayed repair (16) were performed for posterior urethral rupture. Urethral continuity was achieved in 97.9% of patients, and 30 (61.2%) were free of symptoms. The overall rate of long-term complications was significantly greater in patients with a prostatic urethra location injury, and it was similar for the three surgical procedures. Conclusions. The results of our study have shown that, apart from partial injury, all types of surgical treatment are equally problematic, with similar complication rates and long-term morbidity. The procedure of choice should be individualized, depending on the anatomy and the extent of the urethral injury, stability of the patient, and presence of additional injuries.Öğe Management of anorectal injuries in children(Georg Thieme Verlag Kg, 2003) Öztürk, H; Onen, A; Dokucu, AI; Otçu, S; Yagmur, Y; Yucesan, SAnorectal injuries (ARI) are rare in childhood and yet occur due to sexual abuse and firearm injuries in developed countries. The labeling of ARI remains controversial in spite of a number of divergent reports over the past decade. We evaluated the surgical indications for primary repair of ARI without stoma, and also the potential risk factors affecting morbidity and mortality in children with ARI. Between 1983 and 2001, 41 children were diagnosed as ARI in our institution due to blunt or penetrating trauma. There were 17 male and 24 female patients. Causes of anorectal injury were blunt injuries in the majority of cases (56%). Vagina and extremity fractures were the organs most frequently associated with ARI. There was isolated ARI in 49% of cases. Intraperitoneal organ injury was found in 3 patients (7%). The distribution of injury location according to the classification of ARI in our children was as follows: 10% in G I, 32% in G II, 51% in G III, and 10% in G V. Primary repair without colostomy was performed in 51% of cases. Primary repair and diversion of faecal stream by loop colostomy was required in 20 (49%) patients. Postoperative septic complications occurred in 29% of cases. Some potential risk factors such as trauma mechanism and associated organ injury were not significantly correlated to postoperative septic complications, while other risk factors such as mode of treatment, time of operative intervention and contamination were significantly related to postoperative septic complications (p < 0.05). The sensitivity of trauma scoring systems for the estimation of postoperative complication occurrence was significant for ISS (p < 0.05) and ARI score (p < 0.05). The relative risk of developing a postoperative septic complication was higher than 2 for patients with ARI grade III, ISS > 15, primary repair + colostomy group, and time of operative intervention > 8 hours. A child in the colostomy + primary repair group died on the first postoperative day from rapidly progressing septicaemia and multiple organ failure (2.4%). The management of ARI can be carried out by primary repair procedure without colostomy in the majority of cases if the needed selectivity is established.Öğe The nitric oxide donor molsidomine prevents ischemia/reperfusion injury of the adult rat small intestine(Springer, 2003) Öztürk, H; Aldemir, M; Dokucu, AI; Yagmur, Y; Kilinç, N; Sahin, AHIt is suggested that gastrointestinal mucosal blood flow depends on a balanced release of vasoactive substances from the endothelium. The present study investigated the effects of molsidomine on the small intestine after ischemia-reperfusion (I/R) injury in four groups of 10 rats each composed: (1) SO, sham operation; (2) untreated I/R; (3) ML, I/R plus molsidomine pretreatment; (4) L-NAME, I/R plus N-omega-nitro-L-arginine methyl ester pretreatment. Intestinal ischemia for 45 min and reperfusion for 60 min were applied. Ileum specimens were obtained to determine the tissue level of malondialdehyde (MDA) and histologic changes. Mean MDA levels in the SO, untreated I/R, ML, and L-NAME groups were 95.60 +/- 2.59, 136.90 +/- 4.35, 121.10 +/- 3.38, and 137.40 +/- 4.42 nmol/g wet tissue, respectively. Although the MDA level in the ML group was higher than in the SO group (P < 0.0001), it was significantly lower compared to the untreated I/R and L-NAME groups (P < 0.0001, P < 0.0001). Mucosal injury scores (MIS) in groups 1-4 were 0.2 +/- 0.42, 3.9 +/- 0.73, 1.5 +/- 0.70, and 4.1 +/- 0.56, respectively. In group 3 the MIS was significantly lower than in groups 2 and 4 (P < 0.0001, P < 0.0001). Molsidomine plays a role in attenuating reperfusion injury of the small intestine by depression of tissue MDA levels and MIS and regulates post-ischemic intestinal perfusion while restoring the intestinal microcirculatory blood flow and histologic injury.Öğe The preventive effect of rofecoxib in postoperative intraperitoneal adhesions(Acta Medical Belgica, 2004) Aldemir, M; Öztürk, H; Erten, G; Büyükbayram, HBackground : Previous studies showed that nonsteroidal anti-inflammatory (NSAI) drugs suppressed prostaglandin synthesis and were able to prevent adhesion formation following surgical trauma to the peritoneum. The selective suppression inflammatory cascade may prevent adhesion formation. Therefore, we planned this study to experimentally evaluate the effects of Rofecoxib, the selective cyclo-oxygenase-2 inhibitor, in postoperative intraperitoneal adhesions in an animal model. Methods : Male Sprague-Dawley rats were divided into three groups of 10. All rats underwent midline laparotomy under ketamine anaesthesia (25 mg/kg im). In group I (n = 10), the sham operation group (SG); abdominal walls were closed without any process after 2 minutes. In Group 2 (n = 10), the control group (CG); standard serosal damage was constituted and the abdominal wall was closed. In group 3 (n = 10), the COX-2 group (COXG), after serosal damage, the abdominal wall was closed. A 12 mg/kg/day dose of was given orally to the rats during one week. On the 711, postoperative day, all rats were sacrificed and intra-abdominal adhesions were evaluated both macroscopically and microscopically. Results : Macroscopically, no serious adhesion formations were seen in the SG. Multiple adhesion formations of the CG were significantly more than those of the SG (p < 0.0001). It was determined that adhesions of the COXG diminished (p < 0.0001) when macromorphological adhesion scale results of the COXG were compared with those of the CG. The adhesion scores of the CG were compared microscopically with those of the COXG and granulation tissue formation and fibrosis in the COXG were found to be significantly less than those of the CG (respectively p = 0.002, p < 0.0001). Conclusions: We were of the opinion that Rofecoxib, the selective cyclo-oxygenase inhibitor, was effective in the prevention of postoperative peritoneal adhesions.Öğe The prognostic importance of trauma scoring systems for morbidity in children with penetrating abdominal wounds(W B Saunders Co, 2002) Öztürk, H; Dokucu, AI; Otcu, S; Onen, ABackground/Purpose: Risk factors that may independently predict morbidity in children with penetrating abdominal wounds (PAW) have not been elucidated fully. The aim of this study was to identify not only correlated risk factors for morbidity in children with PAW, but also to evaluate the independent predictive value of 3 different trauma scoring systems: the Injury Severity Score (ISS), the Penetrating Abdominal Trauma Index (PATI), and the Pediatric Trauma Score (PTS). Methods: Between January 1983 and November 2000, 119 children (99 boys, 20 girls) presenting with PAW were reevaluated by an analysis of the relationship between overall morbidity and potential risk factors. Results: Wounds were caused by firearm trauma in 85 children and stabbing in 34. Univariate analysis found that age greater than 10 years, trauma mechanism, number of intraabdominal organs injured (NOI) greater than 2, presence of penetrating injury, and ISS and PATI score were associated with greater than 3-fold increased incidence of morbidity (P<.05). The relative risk of a postoperative septic complication was higher than 2 for the following risk factors: age greater than 10 years, shotgun injury, number of organs injured greater than 2, presence of colon injury, ISS greater than 15, and PATI score greater than 15. Multivariate analysis showed that only ISS (P=.02), and PATI score (P=.03) were independently significant in predicting morbidity. Conclusion: ISS and PATI score were the most important indicators found to be independently associated with morbidity. J Pediatr Surg 37.93-98. Copyright (C) 2002 by WB. Saunders Company.Öğe The protective effects of captopril and nitric oxide on solitary kidney after chronic partial ureteric obstruction(Blackwell Science Ltd, 2001) Öztürk, H; Dokucu, AI; Otçu, S; Gezici, A; Ketani, A; Yildiz, FR; Özdemir, EObjective To determine whether vasodilator agents (captopril and nitric oxide) change the morphological and functional effects of chronic partial ureteric obstruction in solitary kidney tissue in unilaterally nephrectomized rats, Materials and methods Each of 50 prepubertal Wistar albino rats underwent right nephrectomy and were then assigned to one of five groups. Rats in group 1 underwent a sham operation (control) and in the other groups the ureter of the remaining kidney was partially obstructed by surgery. In group 2, no drug treatments were given; in groups 3, 4 and 5 captopril, L-arginine methyl ester (L-Arg) or NG-nitro-L-arginine-methyl ester, respectively, were given for 3 weeks, In all rats, diuretic scintigraphy was used to measure kidney perfusion, glomerular filtration rate (GFR) and concentration. Blood urea nitrogen (BUN), serum creatinine levels, kidney parenchymal weight and pelvic volume were measured and the kidneys evaluated histopathologically. Results Renal perfusion was significantly greater in both group 3 and 4 than in group 2, The GFR was 18% greater in group 3 and 22.3% greater in group 4 than in group 2. The GFR was decreased by 67% in group 5 compared with the control group, The mean parenchymal weight, mean pelvic volume, BUN and serum creatinine in the four groups with a partially obstructed ureter were significantly different from the control group. There also were significant differences between group 2 and groups 3-5, and between group 2 and group 3. Histological damage was severe in all four groups with partial ureteric obstruction, but in the drug-treated groups, medullary fibrosis was less frequent. Conclusion After 3 weeks of treatment, captopril and L-Arg both improved kidney perfusion, GFR, BUN and serum creatinine levels, but were less effective in preventing parenchymal atrophy and changes in pelvic volume.Öğe The protective effects of nitric oxide on the contralateral testis in prepubertal rats with unilateral testicular torsion(Blackwell Science Ltd, 2000) Dokucu, AI; Öztürk, H; Özdemir, E; Ketani, A; Büyükbayram, H; Yücesan, SObjective To investigate histological changes in the contralateral testis of rats with unilateral testicular torsion and the protective effects of nitric oxide (NO) on possible damage. Material and methods Twenty-eight prepubertal male Sprague-Dawley rats were divided into four equal groups. Group 1 underwent a sham operation of the right testis under general anaesthesia. Group 2 underwent a similar operation but the right testis was rotated 720 degrees clockwise for 6 h, maintained by fixing the testis to the scrotum, and saline infused during the procedure. Group 3 underwent similar torsion but L-arginine methyl ester (a precursor of NO) was infused during the procedure. In Group 4, N-G-nitro-L-arginine-methyl ester, a NO synthase inhibitor, was infused separately during the administration of L-arginine methylester and torsion. All the left (untwisted) testes were removed from rats 21 days after surgery and evaluated histologically, assessing seminiferous tubule diameter, loss of sperm and spermatids, loss of germ cell layers, disarray of germ cell layers, rupture of tubules, Leydig cell proliferation and reaction in the ruptured tubules, and oedema. Results There was a significant difference in the indicators of histological damage between groups 2 and 4 and groups 1 and 3, except for the Leydig cell reaction in the ruptured tubules and oedema. The damage was significantly less in group 3 than in groups 2 and 4. Conclusion These results suggest that long-term histopathological changes in the contralateral testes are important after unilateral testicular torsion and that NO has a protective effect on the contralateral testis.Öğe Protective effects of recombinant human interleukin-10 on intestines of hypoxia-induced necrotizing enterocolitis in immature rats(W B Saunders Co, 2002) Öztürk, H; Dokucu, AI; Ögun, C; Büyükbayram, HBackground/Purpose: The role of cytokines in the pathogenesis of hemodynamic instability or tissue destruction in patients with necrotizing enterocolitis (NEC) remains undefined. The aim of this study was to determine the effects of recombinant human interleukin-102 (rhIL-10) on intestines of hypoxia-induced necrotizing enterocolitis in immature rats. Methods: The study was performed on 1-day-old Sprague Dawley rat pups. Group 1 (n = 8) served as nonhypoxic controls. Group 2 (untreated, n 11) rats were subjected to hypoxia-reoxygenation (H/O) and then were returned to their mothers. Group 3 (rhIL-10 treated, n = 10) rats were subjected to H/O, were returned to their mothers, and were treated with rhIL-10 (75 mug/kg subcutaneously) for the next 3 days. All animals were killed on day 4, and intestine specimens were obtained to determine the tissue level of malon-dialdehyde (MDA) and histologic changes. Results: The microscopic lesions in the untreated rats were virtually the same as those seen in neonatal NEC, with destruction of villi and crypts, and in some cases extension to the muscularis. In contrast, in the rats treated with rhIL-10, lesions were limited essentially to the very tips of the villi. Intestinal injury score was significantly less in the rhIL-10-treated rats than in the untreated rats (P < .05). In the rhIL-10-treated group, Malondialdehyde (MDA) levels were not significant in comparison to the control group. In the untreated group, MDA levels were significantly increased when compared with the control and the rhIL-10-treated groups (P < .001 and P < .05, respectively). Conclusion: RhIL-10 has a protective effect on intestinal injury in NEC in an experimental model. Copyright 2002, Elsevier Science (USA). All rights reserved.
