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Öğe Associated malformations in Morgagni hernia(Springer, 2007) Cigdem, Murat Kemal; Onen, Abdurrahman; Okur, Hanifi; Otcu, SelcukMorgagni hernia (MH) is a congenital herniation of the abdominal organs through the subcostosternal portion of the diaphragm. It is a rare type of diaphragmatic hernia that has been associated with other congenital anomalies. The purpose of this clinical review was to determine the incidence of associated anomalies in patients with MH at a major pediatric referral center. The medical records of all patients with the diagnosis of MH were reviewed retrospectively between 1983 and 2006. The age, sex, side of herniation, presenting symptoms and signs, associated anomalies, radiologic features, intraoperative findings, postoperative course, complications, and mortality were recorded. There were 11 males and 5 females. The average age of the patients was 34.5 months (range 2 months-14 years). Twelve patients (75%) had at least one associated congenital malformation and eight (66.6%) of them had multiple anomalies. Six (37.5%) patients had a chromosomal anomaly, Down's syndrome in five and Turner syndrome in one. MH has a high incidence of associated congenital malformations.Öğe A comprehensive analysis of 51 neonates with congenital intestinal atresia(Saudi Med J, 2007) Ozturk, Hayrettin; Ozturk, Hulya; Gedik, Senol; Duran, Hatun; Onen, AbdurrahmanObjective: To determine contemporary patterns of presentation and trends in the management and outcome of 51 newborn infants with intestinal atresia. Methods: We retrospectively reviewed 51 cases of intestinal atresia between January 1983 and February 2003. Clinical data included antenatal history, age, gender, weight, presenting symptoms and signs, diagnostic procedures, location and type of atresia, associated abnormalities, surgical treatment, associated problems, morbidity, mortality and plans of treatment. Results: Twenty children had duodenal obstruction, 24 had jejunoileal atresia, and 7 had colonic atresia. Approximately one-fourth of patients associated with duodenal atresia. had preterm delivery and all patients with jejunoileal and colonic atresia were full term. Clinical features such as vomiting, abdominal distention, delayed meconium passage and jaundice were more frequent in jejunoileal atresia patients. Other associated organ anomalies particularly Down's syndrome were more frequent in duodenal atresia patients. A duodeno-duodenostomy was preferred in most of the patients with duodenal atresia and annular pancreas; duodenotomy and web excision for those with duodenal webs; and resection with end-to-end anastomosis for those with jejunoileal atresia. In all patients with colonic atresia, colostomy procedure was performed as the first step of surgery. Conclusion: Experienced neonatal care and prompt total parenteral. nutrition by placing central line during surgery may improve the outcome of such patients.Öğe Cytogenetic and clinical studies of a male infant with disorder of sexual development: case report(Elsevier Science Inc, 2008) Balkan, Mahmut; Duran, Hatun; Onen, Abdurrahman; Oral, Diclehan; Isi, Hilmi; FIdanboy, Mehmet; Alp, M. NailObjective: To report a translocation between chromosomes 3 and 4: 46, XY, t(3; 4)(p25; q31.3) in a male infant with a disorder of sexual development. Design: Case report. Setting: University hospital. Patient(s): A 1-year-old infant who presented with abnormal location of the urethral meatus. Intervention(s): Cytogenetic analysis, fluorescence in situ hybridization (FISH), and serum concentrations measurement (using peripheral blood), and clinical examination. Main Outcome Measure(s): Karyotype and clinical findings. Result(s): On clinical examination, bilateral testicular volume and phallus were determined to be undersized. Serum concentrations of T and DHEAS were low. G-banding of his chromosomes showed that the patient had a balanced translocation involving chromosomes 3 and 4: 46, XY, t(3; 4)(p25; q31.3). This karyotype finding was confirmed by FISH. The FISH analysis revealed the presence of sex-determining region (SRY). The proband inherited this translocation from his father. His sister had the same translocation. However, the father and sister of the proband were clinically normal. Conclusion(s): The presence of this chromosomal anomaly and hypospadias was unique to our patient compared with others with the 46, XY, t(3; 4) translocation. Although no such association has been reported to date, we think that the severe hypospadias in our case might be associated with this translocation. (Fertil Steril (R) 2008; 90: 2003. e13-e16. (C)2008 by American Society for Reproductive Medicine.)Öğe THE EFFECTIVENES AND ADVANTAGES OF MINI-URETERORENOSCOPY IN CHILDREN WITH UPPER URINARY TRACT STONE(Mary Ann Liebert, Inc, 2012) Onen, Abdurrahman[Abstract Not Available]Öğe THE EFFECTIVENESS OF SWL IN CHILDREN WITH URINARY STONE(Mary Ann Liebert, Inc, 2012) Onen, Abdurrahman[Abstract Not Available]Öğe ENDOUROLOGICAL RESULTS OF CHILDREN WITH VESICOURETERAL REFLUX(Mary Ann Liebert, Inc, 2012) Onen, Abdurrahman[Abstract Not Available]Öğe Exogenous human recombinant interleukin-10 protects the kidney against hypoxia-induced renal injury in immature rats(Wiley-Blackwell, 2006) Ozturk, Hayrettin; Onen, Abdurrahman; Ozturk, Hulya; Buyukbayram, HuseyinAim: The purpose of this study was to determine the effects of exogenous human recombinant interleukin-10 (rhIL-10) on hypoxia-induced renal injury in immature rats. Method: The study was performed on 1-day-old Sprague-Dawley rat pups. Group 1 (n = 8) served as non-hypoxic controls. Group 2 (untreated, n = 8) rats were subjected to hypoxia-reoxygenation (H/O) and were then returned to their mothers. Group 3 (rhIL-10 treated, n = 8) rats were subjected to H/O, were returned to their mothers, and were treated with rhIL-10 (75 mu g/kg subcutaneously) for the next 3 days. All animals were killed on day 4 and renal specimens were obtained to determine the tissue level of malondialdehyde (MDA) and histological changes. Results: In the untreated group, moderate or severe renal tubular necrosis was observed However, the tubular necrosis score was significantly less in the rhIL-10 treated rats than in the untreated rats (P < 0.05). In the untreated group, MDA levels were significantly increased compared with the control and rhIL-10 groups (P < 0.001 and P < 0.05, respectively). In the rhIL-10 treated group, MDA levels were not significantly different compared with the control group. Conclusion: RhIL-10 has a protective effect against hypoxia-induced renal injury in immature rats by depression of tissue MDA level and renal tubular necrosis score.Öğe Factors Affecting the Number of Shock Wave Lithotripsy Session in Children with Renal Stones: Are age and Radiolucency the Predictors of Success?(Aves, 2017) Kocaoglu, Canan; Soran, Mustafa; Kocaoglu, Celebi; Onen, AbdurrahmanObjective: We aimed to investigate the effectiveness of shock wave Lithotripsy (SWL) and factors affecting seance number while treating children with renal stones. Materials and Methods: A total of 50 children (53 renal units) who underwent SWL for renal stones between 2012 and 2014 were investigated retrospectively. The demographics of patients, the number, size, side, location, and radiolucency of stones in kidneys, placement of JJ stents, shock number, energy, seance number, stone- free rate, and complications were noted. Results: Patients involved 25 girls and 25 boys with a median age of 4.0 years ranging from eight months to 16 years (21 <= 3y). Stones were located in the renal pelvis and calyxes in 20 and 33 patients, respectively. Of the renal stones, 33 were single and 20 were multiple. The mean stone size was 11.02 +/- 5.4 mm. Success rates were 45.3, 75.5, and 92.5% after seances 1, 2, and 3, respectively. Per seance, the mean SWL shock waves and energy were 1219 +/- 262 and 12.6 +/- 0.9 kV. A significant relationship was found between the need for a third seance and patient age (<= 3 years and > 3), radiolucent and radiopague, <= 10 mm and > 10 mm or single and multiple stone (p< 0.05). However, no significant relationship was found between success rate and age; sex; number, size, location, and side of stones; and radiolucent stones. Conclusions: Age, radiolucency, stone size, and number of stones were significant predictors of SWL success in children. We observed that stone- free status is achieved more quickly, even within the first or second SWL seances by significantly decreasing the need for the third seance in group age <= 3 years, radiolucent, <= 10 mm or single renal stones.Öğe Hydatid cysts in children: analysis of 49 cases(Aves, 2006) Ozturk, Hlya; Ozturk, Hayrettin; Otcu, Selcuk; Onen, Abdurrahman; Duran, HatunPurpose: In this study, we aimed to analyze the diagnostic and therapeutic features, morbidity and mortality of patients with hydatid disease. Material and methods: 49 children (24 boys and 25 girls) infected by Echinococcus granulosus had surgery for hydatid disease. All patients were evaluated for age, sex, admission time, symptoms at admission, diagnostic techniques, locations of cysts, treatment modalities, morbidity and mortality rate. Ultrasonography, computed tomography, Casoni and Weinberg tests proved the diagnosis. Albendazole treatment was given to 27 of the patients in postoperative period. Results: Mean ages of the patients were 10.5 years. The most common symptom on admission was abdominal pain. The most common localization of the cyst was liver in 33 patients (% 67). Hydatid cysts were treated by conventional open surgery or percutaneous drainage. The form of surgical treatment was capitonnage and total excision of the cyst; and drainage of the cyst cavity in 47 patients (96%). Percutaneous treatment was performed in 2 patients (4%). There were no deaths. Recurrence rate was 4% during the follow-up period of 24 months (range, 8-60 months). Conclusion: Surgical treatment is successful in the hydatic cysts. Additionally, the study confirms the endemic state of the hydatic disease in our region.Öğe Is there a role for antioxidants in prevention of pulmonary hypoplasia in nitrofen-induced rat model of congenital diaphragmatic hernia?(Springer, 2010) Cigdem, Murat Kemal; Kizil, Goksel; Onen, Abdurrahman; Kizil, Murat; Nergiz, Yusuf; Celik, YusufMany studies suggest a role for antioxidants in the prevention of lung hypoplasia in nitrofen-induced rat models with congenital diaphragmatic hernia (CDH). This study investigates the oxidative status and the histological outcome of prenatal administration of vitamins E and C with synergistic effect, and effect of N-acetylcysteine (NAC) to improve lung maturation of nitrofen-induced rats. CDH was induced by maternal administration of a single oral dose of nitrofen on day 9.5 of gestation, and the Sprague-Dawley rats were randomly divided into five groups: nitrofen (N), nitrofen + vitamin C (NC), nitrofen + vitamin E (NE), nitrofen + vitamin C + vitamin E (NCE) and nitrofen + NAC (NNAC). A control group in which only vehicle was administered was included. Cesarean section was performed on day 21. Body weight (BW) and total lung weight (LW) of all fetuses with CDH were recorded; lung histological evaluation was performed, and protein content of lungs, determination of thiobarbituric acid reactive substances, and the protein carbonyls in tissue samples were determined. A total of 133 rat fetuses with CDH were investigated. The body weight and the lung weight of fetuses of all groups that were exposed to nitrofen were significantly decreased than of the control group (P < 0.05). The animals exposed to nitrofen with different antioxidants showed increased protein levels in lung tissue. However, in the NCE and the NNAC groups, protein levels were significantly increased than in the others. Malondialdehyde levels significantly decreased in the NCE and the NNAC groups when compared with the NC and the NE groups. In addition, the NCE and NNAC groups decreased protein oxidation to control levels, and no significant difference was observed between control and these two antioxidants groups. The N, NC, NE and NNAC groups showed minimal improvement in lung histology; the NCE groups showed the most improvement in lung histology when compared with the other nitrofen plus antioxidant groups. Prenatal administration of NAC and vitamin E in combination with vitamin C represented the best effects to avoid oxidative damage and protein content of the lungs in rat pups with CDH at birth.Öğe Late presentation of Bochdalek-type congenital diaphragmatic hernia in children: A 23-year experience at a single center(Springer, 2007) Cigdem, Murat Kemal; Onen, Abdurrahman; Otcu, Selcuk; Okur, HanifiPurpose. The purpose of this article is to report on our 23-year experience of treating children with late-presenting congenital diaphragmatic hernia (CDH), focusing on diagnostic difficulties, associated anomalies, and morbidity. Method. We reviewed 19 children in whom Bochdalek-type CDH was diagnosed after the neonatal period, between 1983 and 2005. Results. There were 14 boys and 5 girls, with a mean age of 18.3 months (range, 5 weeks-14 years). Ten (52.6%) of the patients presented with respiratory symptoms and five (26.3%) with gastrointestinal symptoms. The diagnosis of CDH was based on the findings of chest X-rays, gastrointestinal tract contrast radiographs, and computerized tomography findings. The CDH was on the left side in 16 patients and on the right side in three patients. A hernia sac was present in seven (36.8%) patients. The only postoperative complications were intestinal obstruction caused by adhesions, incisional hernia, and eventration of the diaphragm in one patient each. None of the patients died within this study period. Conclusion. The possibility of a delayed presentation of CDH should be considered in the differential diagnosis of recurrent non-specific respiratory or gastrointestinal tract symptoms in a child. A plain roentgenogram with a swallowed nasogastric tube might assist in the diagnosis. Early surgical correction of the diaphragmatic defect is crucial for preventing life-threatening complications.Öğe The mechanical complications of colostomy in infants and children(Springer, 2006) Cigdem, Murat Kemal; Onen, Abdurrahman; Duran, Hatun; Oeztuerk, Hayrettin; Otcu, SelcukThe purpose of this study was to determine the morbidity, mortality and possible risk factors in children who underwent colostomy. A total of 473 children who underwent colostomy in our clinic between 1983 and 2005 were retrospectively reviewed. Of these patients, 278 were boys and 195 were girls. The major indications for colostomy were anorectal malformation (252 patients), Hirschsprung's disease (117), and trauma (66). The patients' age ranged from 1 day to 15 years. Of the 473 patients, 254 (53.6%) were < 1 month of age, 97 (20.5%) were 1-12 months of age, and 122 (25.7%) were > 12 months of age. The side of colostomy was transverse in 341 (72%) patients and sigmoid in 132 (28%). The type of colostomy was loop in 364 (77%) patients and diverting in 109 (23%). Postoperative complication was observed in 80.5% of patients; excoriation (46.5%), prolapse (20.5%), stomal obstruction/stenosis (6.1%), and stomal bleeding (2.1%). A stomal revision was required for 26 (5.5%) patients. Overall, 50 (10.5%) patients died; 37 were related directly to major congenital anomalies, while 13 (2.7%) patients had a colostomy complication. The age of patients who died was < 1 month in 46 (92%) patients. The incidence of morbidity and mortality in children with colostomy is significantly high, particularly in neonates. Prompt colostomy procedure by an experienced hand, prompt stomal care under the supervision of a trained and experienced stomal care giver and early closure of the colostomy may increase the survival of these patients.Öğe Nonoperative management of pancreatic injuries in pediatric patients(Springer, 2011) Cigdem, Murat Kemal; Senturk, Senem; Onen, Abdurrahman; Siga, Mesut; Akay, Hatice; Otcu, SelcukNonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients. Between 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination. The most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extraabdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury. The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst.Öğe PERCUTANEOUS NEPHROLITHOTOMY IN CHILDREN WITH RENAL STONE(Mary Ann Liebert, Inc, 2012) Onen, Abdurrahman[Abstract Not Available]Öğe Postoperative abdominal evisceration in children(Springer, 2006) Cigdem, Murat Kemal; Onen, Abdurrahman; Otcu, Selcuk; Duran, HatunPostoperative abdominal evisceration may lead to high morbidity and mortality. The purpose of the present study was to determine possible risk factors, morbidity and mortality associated with abdominal evisceration in children. A total of 3,591 children underwent abdominal exploration in our clinic between 1983 and 2005. In this study, we retrospectively reviewed 29 patients who developed abdominal evisceration after abdominal exploration. The incidence for abdominal evisceration was found to be 0.8%. The mean age was 16 months (range 1 day-13 years), while 48.2% of the patients were younger than 1 month. The incidence of abdominal evisceration was significantly higher in patients younger than 1 month (2.5%) compared to older ones (0.4%) (P < 0.0001). The mean time interval between primary abdominal exploration and development of abdominal evisceration was 7 days (2-21 days). The risk for development of evisceration was significantly higher in patients who underwent colonic or small bowel surgery compared to those underwent laparotomy alone (P < 0.0001, P < 0.01, respectively). Absorbable suture was used in 15 patients for closure of abdominal fascia, while a silk suture material was used in 14 patients (P > 0.05). The age-weight percentile was lower than 3% in 41.3% of patients. At the follow-up period, 19 patients recovered completely whereas 10 (34.5%) died. As a result, the age (neonates), primary surgery (colo-rectal), type of incision (median), and emergency surgery were significant risk factors for development of abdominal evisceration in children.Öğe THE RESULTS OF URETERORENOSCOPY AND HOLMIUM:YAG LASER LITHOTRIPSY IN CHILDREN WITH UPPER URINARY TRACT STONE(Mary Ann Liebert, Inc, 2012) Onen, Abdurrahman[Abstract Not Available]Öğe RETROGRADE INTRARENAL SURGERY IN CHILDREN WITH UPPER URINARY TRACT PATHOLOGY(Mary Ann Liebert, Inc, 2012) Onen, Abdurrahman[Abstract Not Available]Öğe Retroperitoneal organ injury caused by anterior penetrating abdominal injury in children(Lippincott Williams & Wilkins, 2003) Ozturk, Hayrettin; Otcu, Selcuk; Onen, Abdurrahman; Dokucu, Ali IhsanObjective: To describe the retroperitoneal organ injury pattern after anterior penetrating abdominal injury in children. Setting: The paediatric surgical department of a university teaching hospital. Patients and methods: All children presenting with firearm and stab wounds to the anterior abdomen between January 1983 and April 2001. Results: Forty-nine children (34%) with penetrating anterior abdominal wounds had retroperitoneal organ injury. The most injured organs were the descending colon in 17 patients (35%), ascending colon in eight patients (16%), and kidney in seven (14%). The most commonly associated injured organ was the small bowel. Postoperative septic complications were seen in 10 patients (20%). The most common postoperative complication was wound infection. When we compared patients with intraperitoneal organ injury with patients with retroperitoneal injury, there was no difference in parameters such as age, associated organ injury, morbidity and mortality between both groups. The main causative factor of retroperitoneal injuries was shotgun wounds, whereas it was stabbing in intra-abdominal injuries (P < 0.05). The number of injured organs and the hospital stay is significantly greater in retroperitoneal organ injuries, and the trauma scores such as the Injury Severity Score (P < 0.001) and the Penetrating Abdominal Trauma Index (P < 0.001) were found to be significantly higher. Conclusion: Retroperitoneal organ injury is commonly associated with anterior penetrating abdominal trauma. Even if there is no preoperative sign of retroperitoneal organ injury, an exploratory laparotomy and a meticulous retroperitoneal exploration should also be performed for associated retroperitoneal organ injury. (C) 2003 Lippincott Williams & Wilkins.Öğe THE ROLE OF EARLY ENDOUROLOGICAL APPROACH IN CHILDREN WITH POSTERIOR URETHRAL RUPTURE(Mary Ann Liebert, Inc, 2012) Onen, Abdurrahman[Abstract Not Available]Öğe Selective Nonoperative Management of Penetrating Abdominal Injuries in Children(Lippincott Williams & Wilkins, 2009) Cigdem, Murat Kemal; Onen, Abdurrahman; Siga, Mesut; Otcu, SelcukBackground: Nonoperative management of solid organ injuries caused by blunt abdominal trauma has been the standard care for many years. However, operative management is considered the standard care for penetrating abdominal trauma by most surgeons. The aim of this study was to assess the feasibility of selective nonoperative management of penetrating abdominal trauma in children. Methods: A total of 90 children suffering from penetrating abdominal trauma between 2003 and 2008 were evaluated. Patients who had hemodynamic instability or signs of bowel perforation underwent an immediate laparotomy. The remaining patients were observed with serial clinical examinations, radiologic evaluation, and hemoglobin level. Results: There were 76 boys and 14 girls. The mean age was 9.9 years (range, 1-16 years). The mechanism of injury was stab Wound in 60 patients (67%) and gunshot in 30 (33%). The most commonly injured organ was bowel (51.7%). Omentum or bowel was eviscerated through wound in seven patients; none of these patients had organ injury. Although 5 1 (56.6%) were treated nonoperatively, 39 patients (43.4%) required Surgical treatment (19 of 60 stab wound, 20 of 30 gunshot). Of the 39 patients who underwent surgery, 6 (15.3%) were found to have no significant organ injury during surgery. Of the all, 51 patients who were initially followed nonoperatively, two patients required surgery. There were two complications. Conclusion: The majority of abdominal stab wound and many gunshot wounds can initially be managed nonoperatively in children, when there is no hemodynamic instability or signs of hollow viscus perforation.
