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Öğe A comparison of early primary realignment and delayed urethroplasty in the management of posterior urethral injuries in children(2000) Otçu S.; Kaya M.; Dokucu A.I.; Önen A.; Öztürk H.; Azal Ö.F.; Aydin G.Early or late treatment modialities may be instituted in urethral injuries related to trauma. Forty-six boys with urethral injuries that were treated were retrospectively analysed to review our results with early primary realignment and delayed urethroplasty. Thirty-six children were treated with early primary realignment while 10 had a delayed urethroplasty. Urethral strictures developed in 14 cases (39 %) of the realignment group and in 2 cases (12 %) of the urethroplasty patients. The primary realignment patients had a more unfavorable outcome when compared to the delayed repair group. We believe that delayed urethroplasty should be favored to early primary alignment in childhood posterior urethral injuries.Öğe Comparison of the therapeutic efficiency of verapamil, captopril and GBE, in prevention of the warm ischemia-reperfusion injury of kidneys(2000) Otçu S.; Özer M.; Öztürk H.; Dokucu A.I.; Gezici A.; Yücesan S.Injury related to warm ischemia is a problem in renal transplantation. In this study the therapeutic efficiency of verapamil, captopril and Ginkgo-Biloba-Extract (GBE) in prevention of the warm ischemia reperfusion injury is investigated. Fifty Sprague-Dawley rats were divided in 5 groups. Right nephrectomy was performed in the sham group while a right nephrectomy and a 30 minute ischemia and 60 minute reperfusion was applied to the left kidney in the remaining groups. Among the remaining 4 groups verapamil, captopril and GBE were administered before the ischemia while the fourth group formed the control group. All rats had a left nephrectomy on the 8th postoperative day after having a Tc 99m DMSA scintigraphy and blood urea, creatinine sampling. Kidneys were histopathologically investigated. In the three treatment groups, blood urea and creatinine levels were significantly lower than the control group and radioisotope uptake was significantly higher. When treatment groups are compared among each other, although there is no significant change in the blood urea and creatinine levels (p>O.05), radioisotope uptake is significantly higher in the GBE group and the results are statistically significant (p<0.05). Histopathologically the control group revealed gross necrosis while the captopril and verapamil group had less necrosis and glomeruli and distal tubules were preserved in the GBE group. As a conclusion, all three agents are effective in preventing warm ischemia of the kidney. GBE has a more potent effect in the prevention mechanism.Öğe Effect of admission time on morbidity and mortality in children with intussusception: Analysis of 123 cases(2001) Öztürk H.; Ihsan Dokucu A.; Otçu S.; Önen A.; Gedik Ş.Background/Aim: Intussusception is one of the most frequent reasons of intestinal obstruction in newborn and infants. Delay in diagnosis results in severe morbidity and mortality. We aimed to investigate the effects of admission time on morbidity and mortality in children with intussusception. Methods: A total of 123 intussusception cases were diagnosed and treated at our department between June 1983 and March 2000. We reviewed the charts of these cases retrospectively and evaluated the age, sex, the time of hospitalization, symptoms and signs, the type of intussusception, leading point, recurrence, the mode of treatment, postoperative complications, and mortality. According to time of the admission, we grouped the patients into three; G1: admitted before 12 hours after the first sign, G2: admitted between 12 to 24 hours, G3: admitted after 24 hours. The differences between the groups were investigated for postoperative complications and mortality. Results: Seventy six percent of the cases were under the age of 12 months: The most frequent symptom of the cases in admission were vomiting. Eighty per cent of the cases occurred between the months of April and September when epidemic gastroenteritis is very frequent. The most frequently encountered type of intussusception was ileocaeco-colic (77 %). The leading point of the disease were seen only in 7 % of the cases in. Colon enema with barium for hydrostatic reduction was performed in 25 patients and reduction could be successful in 5 (20 %) of them. Sixty-three percent of cases was treated by manual reduction, 30 % by resection and anastomosis, 3 % resection and ostomy. Postoperative complications were observed in 27 % of the patients. The mortality rate of our patients was 6.5 %. The postoperative complication and mortality rate in the group 3 (>24h) was found significantly different in comparison with G1 and G2 (p<0.0001, p<0.0001). Conclusion: The method of non-invasive treatments may be more frequently used in children diagnosed in early period of disease, while the delay in diagnose determine the mode of the treatment as surgery which cause high morbidity and mortality.Öğe The effect of lidocain infiltration applied pre or postoperatively on postoperative pain after inguinal hernia repair(2003) Önen A.; Kararmaz A.; Tosyali A.N.; Otiçu S.; Öztürk H.; Dokucu A.I.; Kaya M.Aim: To compare the effect of lidocain infiltration applied pre or postoperatively on postoperative pain after inguinal hernia repair. Method: Eighty-one children between 2 to 9 years of age who underwent inguinal hernia repair were reviewed prospectively. The patients were divided into three groups. Control group patients (n=20) underwent herniectomy alone. Five mg/kg lidocain 1% was infiltrated into the incision area 5 minutes before incision in preincisional group (n=35) and at the end of operation in postincisional (n=26) group. The severity of postoperative pain was evaluated by 4 staged pain scale. Results: Sixty-nine were boys and 12 were girls. Thirty-six had right-sided, 31 had left-sided, and 14 had bilateral inguinal hernia. The mean age was 3.6±1.9 years in control, 4.3±2.01 years in preincisional, and 3.3±1.6 years in postincisional group. The mean postoperative pain score was 0.65±0.75 in pre-incisional group, 0.80±0.87 in post-incisional group, and 1.7±0.78 in control group. While there was no significant difference between study groups, the postoperative pain score was significantly higher in control group compared to lidocain groups (p<0.001). The first analgesic demand time was 128.4±46.08 minutes in pre-incisional, 83.6±29.88 in post-incisional, and 27.2±14.9 in control group. The first analgesic demand time was significantly higher in pre-incisional group compared to others (p<0.001). Conclusion: Perioperative local infiltration of lidocain, which does not need additional equipment and experience, seems to be easy to perform, safe, and effective in decreasing postoperative pain after hernioplosty. In addition, the pre-incisional infiltration of lidocain allows more long postoperative painless period.Öğe The epidemiology and control of nosocomial infections in pediatric surgery(2002) Önen A.; Çi?dem M.K.; Geyik M.F.; Otçu S.; Öztürk H.; Dokucu A.I.Purpose: To investigale the epidemiology and control methods of nosocomial infection (NCI) in pediatric surgery. Method: We retrospectively reviewed 2844 hospitalized children in the pediatric surgical clinic between January 1997 and December 2000. The diagnosis of NCI was made based on criteria proposed by "Centers for Disease Control and Prevention (CDC)". The incidence of NCIs, type of microorganisms and infections, age, sex and risk factors were determined. The mortality rate and hospitalization period of patients with NCI were compared with 78 control patients whose age, sex and primary disease were identical and free of NCI. Results: There were 78 children with NCI; the overall incidence was 2.74% (4.99% in 1997, 3.89% in 1998, 1.33% in 1999, 1.44% in 2000). The meanage was 28 months the most frequent infections were surgical wound and urinary tract infection, in the NCI and 26 months in the control group. The most frequent risk factors were urethral catheter (10.26%), trauma (9.25%), and parenteral nutrition (8.70%). The mean hospitalization period was 16 days (range 4-28 days) in patients with NCI, while it was 9 days (range 2-22 days) in control group. There was a significant difference in mortality rate and hospitalization period (p<0.05, p<0.001, respectively) between the patients with NCI and those of controls. Conclusion: Surgical wound infection was the most common NCI in Pediatric Surgery. Urethral catheterization, trauma and parenteral nutrition were the most frequent risk factors. NCIs caused high mortality, prolonged hospitalization period and increased cost. Close relationship between the pediatric surgical team and the infection disease team; the education of medical staff; handwashing and disinfetion; limited antibiotics; close follow-up for risk factors; minimized invasive interventions and catheterizations; isolation; and early enteral nutrition resulted in significant decrease in the incidence of NCIs in our clinic in the last two years.Öğe Gastric perforation in neonates: Analysis of five cases(2003) Öztürk H.; Önen A.; Otçu S.; Dokucu A.I.; Gedik Ş.The 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 Gastric volvulus secondary to paraesophageal hiatal hernia in a child: A case report(2001) Öztürk H.; Kaya M.; Otçu S.; Dokucu A.I.Gastric volvidus within a paraesophageal hiatal hernia is rarely seen in childhood. We report a twenty month old boy with gastric volvulus secondary to paraesophageal hernia. The gastric fundus bulged into the right hemithorax through esophageal hiatus. The hernia was reduced by laparatomy and a Boix-Ochoa antireflux procedure was performed. Postoperative upper GI contrast study demonstrated resolution of GER and a normal positioned stomach. The patient is symptom free at 8 months follow-up.Öğe Hirschsprung's disease: An 18-years experience(2002) Öztürk H.; Otçu S.; Önen A.; Dokucu A.I.; Gedik Ş.; Yücesan S.Aim: In this study, we aimed to analyse the diagnostic and therapeutic features, morbidity, mortality and long-term functional results of patients with Hirschsprung's disease, whom the majority were treated hy Duhamel-Martin procedure. Method: A total of 64 Hirschsprung's disease cases were diagnosed and treated in the department between June 1983 and February 2001. We reviewed the charts of these retrospectively and evaluated the age, sex, symptoms and signs, associated anomalies, the length of bowel involved, type of pull-through performed, functional results of treatment, morbidity and mortality of these patients. Results: There were 52 boys and 12 girls. Thirty seven percent of the cases were diagnosed below the age of one month. The most frequent presenting symptom was abdominal distention (34%). Thirteen of the cases had associated anomalies (20%). The most frequent site of aganglionosis was at the rectosigmoid (82%). A decompressing enterestomy was performed in 56 patients. Soave-Boley's and Duhamel-Martin's technique with protective colostomy were performed in 7 and 41 patients respectively. Postoperative complications were seen in 25 % of the patients. In 4 cases a Duhamed-Martin's procedure was performed without a colostomy. In the postoperative period 16 cases (25%) developed a complication. The most frequent complication was intestinal obstruction due to adhesions (33%). Preoperative and postoperative enterocolotis was found in three (2%) and 5 (9%) patients respectively. Eight children (12%) died, one related to associated anomalies and six due to sepsis one patient died from enterocolitis after the definitive procedure. In the 10 to 15 year age and the greater than 15 year age groups, functional scores were significantly increased when compared to the 5 to 10 year age group (p<0.05). A significant correlation was not found between the functional score and age of the patients. Conclusion. As a conclusion, we have used Duhamel-Martin procedure in majority of patients with Hirschsprung's disease. Long-term fonctional evaluations have shown an improvement in functional score in children older than 10 year in comparison with younger ones.Öğe Idiopathic perforation of the colon in the newborn and infant(2004) Öztürk H.; Dokucu A.I.; Otçu S.; Önen A.; Gedik S.; Öztürk H.Aim: The aetiology of idiopathic colon perforation in neonates remains unclear. We present, 8 cases with idiopathic colon perforation occurring in the neonatal period and infancy. The aim of presenting these cases is the rarity of disease without definitive etiology and the features of diagnosis and therapy. Method: We reviewed eight patients with idiopathic colon. perforation from January 1996 to October 2002. Clinical data included age, sex, weight, associated problems, day of perforation, location of colon perforation, repair of perforation, fetal complication, morbidity, mortality and survival. Results: All patients were boys. The median age was 39.2 days. Seven of the newborn infants were full-term, while one was premature. The aetiology was established in none of the patients. The site of the perforation was transverse colon in three patients, left colonic flexure in two, and sigmoid colon in three patients. After resection of the perforation area, proximal colostomy was performed in four patients and sigmoid colostomy in four. Two patients died. Postoperative wound infection developed in five patients who survived. Ganglion cells were present in all colonic specimens. Conclucion: The main reason of colonic perforations in newborn is Hirschsprung disease while there is no etiologic reason found in some cases. We found no ganglionic abnormality in any of eight presenting cases. We think the prematurely and sepsis are the important risk factors leading to mortality for this disease.Öğe The role of L-Arginine, a nitric oxide precursor, on deteriorating cardio-respiratory effects in experimentally produced traumatic diaphragmatic injury(2002) Öztürk H.; Gezici A.; Otçu S.; Dokucu A.I.; Kaya S.; Kirbaş G.; Yücesan S.Aim: In this study we aimed to in vestigate the protective effects of L-Arginine on cardio-respiratory complications in a diaphragmatig rupture model. Method: 40 Sprague-Dawley rats were used in this study. In Group I, only thoracotomy was performed. In Group II, III and IV, following left thoracotomy, the stomach was pulled into thorax and the intraabdominal pressure was increased by an insufflator. L-Arginine (L-Arg) was given in GIII and L-NAME was given in GIV at the 45th minute of the study, The parameters such as arterial blood pressure (BP), heart rate (HR), arterial blood gases analysis (pO2, pCO2, pH) and pulmonary scintigraphy were measured at the baseline, 30th, 45th and 60th minutes of the study. The left lungs were extracted for histopathological examination. Results: In the values of blood gases analysis following the performing herniation model the pO2 and pH values decreased and pCO2 values increased in GII in comparison with GI. The mean values of blood gases analysis in GIII following L-Arg infusion at the 60th minute of the study were found to be increased for pO2 and pH values and to be decreased for pCO2 values in comparison with the values of GII. Following L-NAME administration to the GIV, there was no difference found between GII and GIV. Pulmonary uptake decreased in GII, GIII and GIV when compared with GI, whereas pulmonary uptake in GIII was significantly increased in comparison with GII and GIV. Conclusion: The use of the precursor of nitric oxide, L-Arginine, may provide protective effects on cardio-respiratory complications related to organ herniation in the acute period of traumatic diaphragmatic rupture.Öğe The role of prenatal steroid and TRH treatment in rats with nitrofen induced diaphragmatic hernia(2000) Çi?dem M.K.; Dokucu A.I.; Önen A.; Otçu S.; Öztürk H.; Deveci E.; Yücesan S.The mortality of congenital diaphragmatic hernia (CDH) is high due to associated pulmonary hypoplasia and pulmonary hypertension. Thus studies aiming to prevent pulmonary hypoplasia in the prenatal period are gaining importance. In this study the role of glucocorticoids and "Thyroid releasing hormone" (TRH) on lung maturation in rats with nitrofen induced CDH is investigated. Ten pregnant Wistar-Albino female rats received nitrofen (100 mg) in two groups on their 9.5 day of pregnancy, while the control group had olive oil administered. In one nitrofen group additionally starting on day 16, glucocorticoids (0, 25 mg/kg betametazon) and TRH (25 ?g/kg) was administered for 5 days. Fetuses were delivered by ceaserean section on the 21st day of gestation and the fetal lungs were histopathologically investigated and DNA analysis and maturation were obtained. Nine fetuses in the control, 14 in the nitrofen and 7 in the treatment group could be investigated. No significant difference was identified in the morphologic evaluation and DNA analysis of the nitrofen and treatment groups. Histopathology revealed hypoplasia that was more prominent in the left lung in both groups. In conclusion the prenatal administration of TRH and glucocorticoids in prevention of nitrofen induced CDH has not been found effective. We believe this may be related to the initiation of treatment on day 16 of gestation.Öğe Successful treatment of Wilms' tumor with intracaval extension by preoperative chemotherapy: Report of two cases(2000) Dokucu A.I.; Öztürk H.; Söker M.; Alan S.; Bükte Y.; Özçelik C.; Zincircio?lu B.Two patients presenting with advanced Wilms' tumor extending to inferior vena cava anal right atrium, were successfully treated with chemotherapy and surgery. The first case presented with a right renal mass and intraatrial tumor extension. The original mass regressed 28 % in volume while the thrombus remained at the vena cava as it was before chemotherapy. Surgery was performed via laparotomy and sternotomy. The second case presented with bilateral Wilms' tumor and intracaval extension up to the right atrium. In this case, both renal masses and intracaval thrombus well regressed (up to 80 %) with chemotherapy. Surgical excision of the both masses and removal of intracaval thrombus were performed via laparotomy. The results obtained with preoperative chemotherapy as in these two patients mediates strongly against difficult surgery being undertaken as primary treatment for such patients.Öğe An uncommon association of cloacal malformation with Hirschsprung's Disease, congenital pouch colon and vaginal duplication(2001) Dokucu A.I.; Öztürk H.; Bükte Y.; Azal Ö.F.Cloacal malformations are characterized by a single opening that connects the urinary tract, the internal genitalia and the intestinal tract via a urogenital sinus. We describe the first reported case of a cloacal malformation consisting of congenital pouch colon associated with Hirschsprung's Disease and vaginal duplication in a 13 year-old girl. We also discussed the method of surgical treatment performed in this girl. To plan reconstruction for an individual case with cloaca, the surgeon should be acquainted with associated anomalies and a wide range of anatomy that may be present.
