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    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, AI
    Objectives 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.
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    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, S
    Purpose. 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.
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    Esophageal, tracheal and pulmonary parenchymal alterations in experimental esophageal atresia and tracheoesophageal fistula - A histological and morphometric study
    (Karger, 2002) Otcu, S; Kaya, M; Ozturk, H; Buyukbayram, H; Dokucu, AI; Onen, A; Yucesan, S
    Pulmonary complications are among the most important causes of morbidity and mortality in neonates with esophageal atresia and tracheofistula. We aimed to investigate the possible causes of respiratory complications encountered in esophageal atresia (EA) and tracheoesophageal fistula (TEF) in an experimental model. Sprague-Dawley fetal rats treated with adriamycin were used for the experiment. Time mated pregnant rats were given 1.75 mg/kg of adriamicyn intraperitoneally on days 6-9 of gestation. The fetuses were sacrified on day 21, weighed, and dissected under the surgical microscope. The animals were divided into four groups: (1) control group; (2) saline-injected group; (3) adriamycin-induced EA group, and (4) adriamycin administered but without development of EA. The lungs, esophagus, and trachea were excised and underwent histological examination. The mucosa of distal esophagus was thickened (p < 0.05); the submucosa was thinner (p < 0.05); and the muscular layer was thickened (p < 0.05) in fetuses with EA and TEF. In adriamycin-treated rats, in which EA and TEF developed, tracheal cartilage was loosened and formed into a D or C shape. The cartilage was fragmented into several segments on transverse sections in most fetuses. Alveolar septa were thin in lungs of fetus with EA and TEF (p < 0.05), without any fibrosis or evidence of parenchymal abnormality microscopically. Our findings suggest that respiratory complications may contribute to structural lesions in the trachea and particularly in the distal esophagus but not in the pulmonary parenchyma itself. Copyright (C) 2002 S. Karger AG, Basel.
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    Long-term outcome of posterior urethral rupture in boys
    (Elsevier Science Inc, 2005) Onen, A; Öztürk, H; Kaya, M; Otcu, SU
    Objectives. 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.
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    Long-term outcomes of conservatively treated paediatric pelvic fractures
    (Elsevier Sci Ltd, 2004) Subasi, M; Arslan, H; Necmioglu, S; Onen, A; Özen, S; Kaya, M
    The long-term orthopaedic, urologic, and psychiatric outcomes of patients treated non-operativety for unstable pelvic fractures were assessed. There were 55 mates and 3 females with an average age of 7 (3-13). Eighty-one percent of the fractures were caused by motor vehicle accidents, and 68% by auto-pedestrian accidents. Thirty-four of the 58 fractures were type Tile type B and 24 were type C. Posterior urethral injury was determined in 41 patients, and head injury in 21. Three patients with type C injury died within the first 3 days. After an average follow-up period of 7.4 years of the patients with type B injuries, leg length discrepancy of 1 cm was determined in two, and limited motion associated with open-knee wound in one, and tow back pain in two. Of the patients with type C injuries, low back pain was found in four, gait abnormality in three, sacroiliac ankylosis in one, and symphyseal ossification in two. Urethral. stricture was determined in 11 patients, urinary incontinence in 6 and erectile dysfunction in 6. A total of 31 patients were diagnosed with 41 psychiatric illnesses, including dysthymic disorder, social phobia, post-traumatic stress disorder, and major depression. No difference was found in the treatment outcomes of the two groups. From a holistic standpoint, Long hospital stays and urologic complications are associated with serious psychological problems, and thus should be considered during selection of treatment modality. (C) 2004 Elsevier Ltd. All rights reserved.
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    Retroperitoneal lipoblastoma involving the right common iliac artery and vein
    (Georg Thieme Verlag Kg, 2003) Dokucu, AI; Öztürk, H; Yildiz, FR; Kaya, M; Aras, N; Bükte, Y; Özçetin, C
    A case of benign lipoblastoma of the retroperitoneum in a 12-month-old boy, presenting as a huge abdominal mass and right lower extremity swelling, was reported. Surgery revealed involvement of the right common iliac artery and vein by lipoblastoma, requiring the sacrifice of both vessels for complete removal of the tumour. Vascular continuity of both vessels was re-established by a saphenous vein graft interposition. Involvement of a great artery by benign lipoblastoma has not been reported before.