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Öğe The accumulation and histological effects of organometallic fungicides Propineb and Maneb in the kidneys of fetus and female rats during pregnancy(Elsevier Ireland Ltd, 1998) Guven, K; Deveci, E; Akba, O; Onen, A; de Pomerai, DDithiocarbamate propineb and maneb are organometal fungicides, which are widely used for the control of diseases in plants. Female Wistar rats were exposed orally to 200 and 400 ppm propineb and 250 ppm maneb, from the sixth day of gestation up to birth. We found that the body weights of both one-day old litters and their fungicide-treated mothers were lower than those of controls. Histological examination of the kidneys of fetus and fungicide-treated pregnant females showed a variety of histopathological effects. Moreover, the analysis of zinc (Zn) and manganese (Mn) concentrations (using inductively coupled plasma-atomic emission spectrometry) in the kidneys of pregnant females exposed to organometallic fungicides during pregnancy demonstrated that the metal concentrations in the kidney were higher than those of controls. However, the renal metal concentrations were significantly increased in the litters subjected to the fungicides during gestation, indicating that high levels of the trace metals in the organ of fetus may well be due to the fungicides easily passing the placental barrier. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.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 The effects of nitric oxide on the expression of cell adhesion molecules (ICAM-1, UEA-1, and tenascin) in rats with unilateral testicular torsion(W B Saunders Co, 2003) Ozturk, H; Buyukbayram, H; Ozdemir, E; Ketani, A; Gurel, A; Onen, A; Otçu, SBackground/Purpose: The aim of this study was to determine the effects of nitric oxide (NO) on the expression of adhesion molecules in the early course of testicular I-R injury in rats. Methods: Forty male Sprague-Dawley rats were separated into 4 groups, each containing 10 rats. A sham operation was performed in group 1 (control). In group 2 (I-R), after 6 hours of unilateral testicular torsion, 1 -hour detorsion of the testis was performed. In group 3 (I-R/L-NAME), after performing the same surgical procedures as in group 11, L-NAME was given for 30 minutes. In group 4 (I-R/Mol), after performing the same surgical procedure (torsion and detorsion) as in group 11, molsidomine, an NO donor, was infused for 30 minutes. Then, ipsilateral orchiectomies were performed to measure the tissue levels of malondialdehyde (MDA) and NO and to make histologic examination. Results: MDA values and the testicular injury score decreased and NO values increased in the I-R/Mol-treated group compared with other experimental groups. The tenascin expression in the interstitial space and basement membrane of the tubuli seminiferi were milder in the I-R/Mol group compared with that of the I-R and the I-R/L-NAME. The acrosomes of the spermatids in I-R and I-R/L-NAME groups were stained mildly by lectin. In the I-R and I-R/L-NAME groups, the interstitial spaces, basement membrane of the tubuli seminiferi, and sertoli and germinal cells in testicular tissue were stained intensely by ICAM-1. Conclusions: The expression of adhesion molecules such as tenascin, lectin, and ICAM-1 in the totted testicular tissue may be a pathophysiologic sign of inflammation. NO regulates adhesion molecules expression.Öğe 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, SPulmonary 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.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 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 Long-term outcomes of conservatively treated paediatric pelvic fractures(Elsevier Sci Ltd, 2004) Subasi, M; Arslan, H; Necmioglu, S; Onen, A; Özen, S; Kaya, MThe 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.Öğe Long-term urologic, orthopedic, and psychological outcome of posterior urethral rupture in children(Elsevier Science Inc, 2005) Onen, A; Subasi, M; Arslan, H; Ozen, S; Basuguy, EObjectives. To evaluate the long-term urologic, orthopedic, and psychological outcome of children after posterior urethral rupture (PUR) due to pelvic trauma. Methods. We retrospectively reviewed the records of 49 children with PUR from 1986 to 2000. The long-term urologic results were determined by voiding function, continence, and erectile function. The orthopedic results were determined by pelvic radiography and a questionnaire. Psychiatric diagnoses were made using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria and the Structured Clinical Interview for DSM-IV Axis I Disorders. Results. The mean follow-up was 12 years (range 4 to 17). The average age was 8 years at the time of the trauma and 20 years at the last follow-up. Urethral continuity was achieved in 97.9% of the children. Of the 49 patients, 19 had at least one urologic complication, 18 had orthopedic pathologic findings, and 21 had psychiatric diagnoses. The number of urologic procedures required (more than three), presence of long-term complications, and total number of hospitalizations (more than three) secondary to the injury significantly affected the development of a psychological disorder. Conclusions. The results of our study have shown that posttraumatic PUR in children is associated with a significant rate of long-term complications. Nonoperative treatment of pediatric pelvic fractures associated with PUR has been quite successful. Repeated operations, the presence of long-term urologic complications, and frequent and long hospital stays result in serious attendant psychological problems. Therefore, careful and prolonged follow-up of posttraumatic urethral injury with a multidisciplinary approach is necessary to provide better outcomes and a better quality of physical and social life for these children.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 Non-operative management of isolated solid organ injuries due to blunt abdominal trauma in children(Georg Thieme Verlag Kg, 2004) Ozturk, H; Dokucu, AI; Onen, A; Otçu, S; Gedik, S; Azal, OFThe purpose of this study was to evaluate essential prerequisites for a selective non-operative approach in children with solid organ injuries due to blunt abdominal trauma, and to determine the predictive value of two different trauma scoring systems: the Injury Severity Score (ISS) and the Paediatric Trauma Score (PTS). A retrospective review of children who were admitted with blunt abdominal solid organ injuries to a paediatric trauma Centre between January 1986 and September 2001 was performed. Hepatic, splenic, and renal injuries were graded, based on the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (ranged from grade I to IV). The patients were treated non-operatively or operatively and the two groups were compared for variables such as age, blood transfusion, ISS, PTS, length of hospitalisation, morbidity and mortality rate. Two hundred and five patients (147 boys and 58 girls) entered in this study. Median age was 7 years (1 - 15 yrs). The most common cause of trauma was falls (50%). Abdominal organ injuries were present in all patients with the spleen as the most commonly injured organ (111 patients). Fifty-one patients (32%) had additional extra-abdominal organ injuries. Thirty-five (17%) patients were treated operatively, while 170 (83%) were treated non-operatively. Post-traumatic complications developed in 10 patients treated operatively versus 4 patients treated non-operatively. Four patients died due to multiple organ failure (2 non-operative, 2 operative). When compared to the non-operative group, higher transfusion requirements (p < 0.05), a higher ISS (p < 0.01), lower PTS values (p = 0.0001), a longer hospitalisation period (p = 0.0001), and a higher complication rate (p < 0.05) were observed in the operative group. in addition, the non-operative treatment approach was more common in the last five years compared to the previous ten years (p = 0.002). In conclusion, the appropriate non-operative management of injured children reduces the risks of blood transfusion and decreases the length of hospital stay compared with a surgical approach. The use of physiological parameters and radiological findings may be sufficient criteria for observing haemodynamically stable patients with isolated abdominal organ injuries, and thus intensive care unit costs may be avoided. In addition, a careful and close follow-up is essential in injured patients with a low PTS or high ISS.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 Surgical treatment of pulmonary hydatid cysts in children(Georg Thieme Verlag Kg, 2004) Ülkü, R; Onen, A; Onat, SAim of the Study: Hydatid disease is a parasitic infestation which is endemic in many sheep and cattle raising areas and is still an important health problem in the world. The aim of our study was to present our surgical experience and strategy in the management of pulmonary hydatid disease. Methods: Sixty-six patients with 83 pulmonary hydatid cysts underwent surgical treatment in our institution between January 1990 and March 2003. We used double-lumen endotracheal tubes in children older than 12 years who were operated on for hydatic cyst in the last 8 years. Results: There were 38 boys and 28 girls with a mean age of 9.6 +/- 7 years (range 5-15 years). Of the 83 cysts, 61 were intact and 22 were ruptured cysts. Isolated pulmonary hydatid cyst was seen in 61 patients (92.4%), while 5 patients (7.6%) had combined pulmonary and hepatic cysts. Lateral thoracotomy was performed in 54 patients (82%), thoracophrenotomy in 5, bilateral thoracotomy in 4, and median sternotomy in 3 patients. Cystotomy and capitonnage was performed in 58 cysts, cystotomy alone in 21, and resection techniques were used in 4. There were 8 postoperative complications in 7 patients. The most common complication was atelectasis. Conclusions: Surgery is the treatment of choice for most patients with pulmonary hydatid cysts. The usage of double-lumen tubes may decrease intra- and postoperative complications. Thoracophrenotomy can be chosen as the surgical procedure in the management of hepatic and pulmonary hydatid cysts.Öğe The value of open surgical approaches for aspirated pen caps(W B Saunders Co-Elsevier Inc, 2005) Ülkü, R; Onen, A; Onat, S; Özçelik, CPurpose: The aim of this study was to present the therapeutic approach of aspirated pen cap foreign bodies, with emphasis on the importance of open surgical intervention. Methods: The records of patients who underwent bronchoscopy and bronchoscopy and surgical therapy for pen cap foreign bodies between January 1997 and June 2003 were reviewed retrospectively. Diagnosis was made based on history, physical examination, radiological methods, and bronchoscopy. Age, sex, symptoms, radiological methods, surgical procedure, complications, and outcomes were recorded. Results: A total of 24 bronchoscopies were performed on 19 patients (10 boys, 9 girls) with a median age of 11 years (range, 8 - 15 years). Pen caps were localized in the right bronchial tree in 14 cases (74%). Pen caps were extracted successfully by forceps during bronchoscopy in 9 patients. Of the remaining 10 patients, 5 underwent bronchoscopy and tracheostomy and 5 patients underwent thoracotomy and bronchotomy. Significant complications were observed in 2 patients (10.53%) (severe bronchospasm in one and pneumothorax and subglottic edema in another). Conclusions: Pen caps aspiration is a challenging problem because of the difficulties during extraction and higher morbidity compared with other foreign body aspirations. In such cases in which classic bronchoscopy failed and/or pen caps could not be removed via vocal cords, open surgical approaches, either bronchoscopy and tracheostomy or thoracotomy and bronchotomy, may be an alternative procedure of choice. (c) 2005 Elsevier Inc. All rights reserved.
