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Öğe Analysis of risk factors for appendicitis in children: A multicenter epidemiological study(Dicle Üniversitesi Tıp Fakültesi, 2016) Arslan, Serkan; Aydoğdu, Bahattin; Arslan, Mehmet Şerif; Zeytun, Hikmet; Okur, Mehmet Hanifi; Basuguy, Erol; Karakaya, Ali Erdal; Uygun, İbrahim; Otcu, SelcukObjectives: In our study, the assessment of age, gender, incidence and seasonal differences in the regions related to appendicitis were investigated. Methods: 676 patients that received an operation following a diagnosis of appendicitis in 3 hospitals from 3 different regions of Turkey occurring at different dates were examined retrospectively after being categorized by region. The differences among groups were compared to each. Results: The mean age of male (63%) (n = 426) and female (37%) (n = 250) patients (total = 676) was 10.8 years (range, 1–18 years). The percentage of female patients in the The Black Sea Region (BR) group was significantly higher (48%) than that in the other two groups (%33 for SR, 30% for MR) (P = 0.001). The frequency of appendicitis was higher (36%) in the spring and winter (25%) than that during summer or fall. The number of cases increased the most in the BR group in spring (47%) (P < 0.001). When the types of appendicitis in the different age groups were compared with season, acute appendicitis (P < 0.02) was more frequently (93%) seen in the child-adolesan (CA) group in the spring; however, perfore apandicitis (45%) was greater in the Infant-Preschool (IPS) group (P < 0.02). Acute appendicitis comprised 55% and perforated appendicitis comprised 45% of cases in the IPS group, whereas acute appendicitis comprised 78% and perforated appendicitis comprised 22% in the CA group. Conclusion: According to the results of our study, appendicitis was most frequently seen in the spring and winter seasons and more frequent in boys between the ages of 10-13 years. As age decreases, the frequency of perforated appendicitis increases. Appendicitis is affected by environmental factors. Reducing the incidence of appendicitis may be possible by establishing regional and specific studies related to this subject and the etiologies of the disease.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 Biliary ascaris-induced obstructive jaundice: a case of acute abdomen(Turkish Assoc Trauma Emergency Surgery, 2009) Oeztuerk, Hayrettin; Oeztuerk, Huelya; Duran, Hatun; Otcu, SelcukAscaris lumbricoides is one of the most common helminthic diseases worldwide and it can cause various complications. The presence of this worm in the biliary tree, however, is a rare condition, especially in children. We describe a child with biliary ascariasis who was presenting clinical symptoms mimicking surgical acute abdomen. The diagnosis was made by ultrasound. The child was successfully treated with mebendazole and anti-spasmolytic. Biliary ascariasis should be added to the differential diagnosis of acute abdominal pain in patients, even in children, from endemic areas.Öğe Congenital Pubic Sinus: Clarified Nomenclature(Coll Physicians & Surgeons Pakistan, 2013) Uygun, Ibrahim; Arslan, Mehmet Serif; Otcu, Selcuk[Abstract Not Available]Öğe Cytogenetic and clinical features of a 13 year old male with trisomy 8(Georg Thieme Verlag Kg, 2012) Balkan, Mahmut; Fidanboy, Mehmet; Ozmen, Cihan; Ozbek, M. Nuri; Otcu, Selcuk; Kapi, Emin; Budak, TurgayTrisomy 8 is a relatively rare chromosomal abnormality. The majority of cases present with the mosaic form. Regular trisomy 8 is usually lethal and frequently results in miscarriage, while those with trisomy 8 mosaicism are more likely to survive. We report clinical observations and cytogenetic studies of a 13-year-old male with regular trisomy 8 and compared with those of other known cases of trisomy 8. The most discriminating findings for this condition are skeletal anomalies, restricted articular function, and speech problems. Our results are in agreement with those of previous studies for trisomy 8.Öğe Differential Expression of CD34, S100, and c-Kit in Interstitial Cells of Cajal in Infantile Hypertrophic Pyloric Stenosis - Immunochemical Study(Wroclaw Medical Univ, 2009) Ozturk, Hulya; Ozturk, Hayrettin; Yilmaz, Fahri; Okur, Hanifi; Otcu, Selcuk; Dokucu, Ali IhsanBackground. The pathogenesis of infantile hypertrophic pyloric stenosis (IHPS) is poorly understood although many hypotheses have been proposed. Objectives. Assessment whether the differential expression of c-Kit, CD34, and S100 may be involved in the development of IHPS. Material and Methods. Specimens from 14 infants with IHPS and seven control subjects were immunohistochemically stained for c-Kit, CD34, and S100. The numbers of CD34(+), S100(+), and c-Kit(+) cells in five random fields per specimen were compared via light microscopy (x200). Results. In normal pyloric tissue, specific and intense c-Kit immunoreactivity was observed in the muscle layers and moderate staining was observed around the myenteric plexus. In IHPS patients, c-Kit+ cells were either absent or markedly reduced around the myenteric plexus. In control and IHPS patients, CD34(+) cells were not observed around the myenteric plexus. In the vascular endothelium, moderate CD34 staining was observed in specimens from control subjects, whereas intense staining was observed for IHPS patients. In normal pyloric tissue, moderate S100 immunoreactivity was observed in the muscle layers and intense staining was observed in the myenteric plexus. In IHPS patients, few S100(+) cells were observed in the pyloric muscle layers and S100 immunoreactivity decreased markedly around the myenteric plexus. Conclusions. These results suggest that the numbers of c-Kit(+) and S100(+) cells are markedly decreased in the pyloric muscle layers and around the myenteric plexus in IHPS patients. Thus a lack of c-Kit and S100, but not CD34, expression may be a critical factor in the pathogenesis of IHPS and may serve as a useful prognostic tool in the treatment of this disease (Adv Clin Exp Med 2009, 18, 1, 33-39).Öğe Dilated ureter for esophageal substitution: A preliminary experimental study in the rat(Elsevier Masson, 2014) Uygun, Ibrahim; Otcu, Selcuk; Ozekinci, Selver; Okur, Mehmet Hanifi; Arslan, Mehmet Serif; Aydogdu, BahattinBackground: Esophageal replacement using digestive organs such as the colon, stomach, or jejunum has been used to treat long-gap esophageal atresia and caustic esophageal strictures. Nevertheless, it presents a major challenge. Here, we report a preliminary experimental study that examined the use of a free dilated ureter as an option for esophageal substitution in a transplantation rat model. Methods: Ten 28-week-old male donor rats underwent distal ureteral ligation for 4 weeks, and the total dilated ureters were recovered. In each of the ten recipient 20-week-old male rats, a ureter was transplanted through the mediastinum into the esophageal bed, without vascular anastomosis. All rats received cyclosporine and cotrimoxazole for 10 days. On postoperative day 10, the rats were sacrificed, and the transplanted ureters were evaluated macroscopically and histopathologically. Results: All procedures were achieved. In the early postoperative period, three transplanted rats died. Upon macroscopic evaluation, no evidence of complications was observed, and all transplanted ureters exhibited apparently good firm tissue. Histopathological examination showed a viable ureteral structure with good vascularity, low inflammation, and regenerated epithelium in all rats. Conclusion: As an option for esophageal substitution, heterotopic ureteral transplantation can be performed directly into the mediastinal location of the esophagus, without vascular anastomosis in a rat model. In the future, free dilated ureters might be useful for esophageal grafting or patching in humans; however, this procedure must be validated in additional large animal models before being attempted in humans. (C) 2013 Elsevier Masson SAS. All rights reserved.Öğe Effects of lexipafant (BB-882), a platelet activating factor receptor antagonist, on liver damage due to bile duct ligation in rats(Univ Catholique Louvain-Ucl, 2006) Oeztuerk, Hulya; Oeztuerk, Hayrettin; Dokucu, Ali Ihsan; Otcu, SelcukBackground and study aims : Extrahepatic cholestasis is one of the main factors causing liver fibrosis. In this study, we aimed to evaluate the effects of lexipafant (BB-882), a platelet activating factor receptor antagonist, on liver damage in rats with bile duct ligation. Methods: A total of 30 male Sprague-Dawley rats weighing 160-190 g were used in this study. Group I (Sham-control, n = 10) rats were undergone laparotomy alone and bile duct was just dissected from the surrounding tissue. Group 2 rats (BDL/Untreated, n = 10) were subjected to bile duct ligation and no drug was applied. Group 3 rats (BDUBB-882, n = 10) received a daily dose of BB-882 intraperitoneally for 14 days after BDL. At the end of the two-week period, biochemical and histological evaluation was processed. Results : The mean serum bilirubin and liver enzymes level significantly decreased, and Superoxide dismutase, catalase and glutathione peroxidase values were significantly increased in BDL/BB-882 group when compared to BDUUntreated group. The histopathological score was significantly less in the BDUBB-882 group compared to the BDL/Untreated rats. In the BDL/BB-882 group was observed less fibrosis and neutrophil infiltration. Conclusions : These results suggest that BB-882 (lexipafant) may reduce the severity of the inflammatory response to liver injury produced by bile duct ligation in rats.Öğe Efficacy and safety of endoscopic laser lithotripsy for urinary stone treatment in children(Springer, 2012) Uygun, Ibrahim; Okur, Mehmet Hanifi; Aydogdu, Bahattin; Arayici, Yilmaz; Isler, Burak; Otcu, SelcukWe reviewed our 6 years of experience with endoscopic holmium: yttrium aluminum garnet (YAG) laser lithotripsy for treatment of urinary stones in different locations in 111 children. A retrospective review was performed on endoscopic holmium: YAG laser lithotripsy procedures performed to treat stones in children between March 2006 and March 2012. In total, 120 laser lithotripsy procedures were performed to treat 131 stones in 111 children (80 males and 31 females; age range, 11 months to 16 years; median age, 6 years). Stones were located in the kidney in 48 cases (36.7 %), ureter in 52 (39.7 %), bladder in 21 (16.0 %), and urethra in 10 (7.6 %). Stone size ranged from 4 to 30 mm (mean, 12.8 mm), and anesthesia duration was 10-170 min (mean, 56 min). Forty-four ureters required balloon dilation, and 61 double J stents were inserted. Follow-up ranged from 3 to 75 months (mean, 35 months). Complete stone clearance was achieved at the end of the procedure in 102 (91.9 %) patients (age < 7 years, 93.3 % vs. age a parts per thousand yen 7 years, 90.2 %; p > 0.05). The success rate was 81.3 % for kidney stones (< 10 mm, 90.9 % vs. a parts per thousand yen 10 mm, 78.4 %; p > 0.05) and 100 % for the ureter, bladder, and urethral stones. Overall success rate with extracorporeal shockwave lithotripsy was 100 %. No major complications were encountered during or after the procedures. These results confirm the effectiveness and safety of holmium laser lithotripsy for treating all urinary stone locations in children of all ages.Öğe Esophageal transplantation in the rat(W B Saunders Co-Elsevier Inc, 2013) Uygun, Ibrahim; Okur, Mehmet Hanifi; Aydogdu, Bahattin; Ozekinci, Selver; Otcu, SelcukPurpose: Esophageal replacement surgery has been used to treat long-gap esophageal atresia, caustic esophageal stricture, and esophageal avulsion. Here, we report total esophageal transplantation in rats without vascular anastomosis as an option for esophageal replacement surgery. Methods: Fourteen total segments of esophageal transplants were harvested from 24-week-old male Sprague-Dawley rats using a harvesting procedure. The segments were transplanted through the mediastinum in the esophageal bed of 15-week-old male Sprague-Dawley rats without adjacent vascular anastomosis using the transhiatal pull-up technique. The ends of the transplanted esophagus were ostomized using cervical and abdominal esophagostomies. An immunosuppressive-treated (IT) group (n = 7) received cyclosporine and cotrimoxazole for 10 days, while an untreated (UT) group (n = 7) received only cotrimoxazole for 10 days. On post-operative day 10, the rats were sacrificed, and the transplant and recipient esophagi were evaluated macroscopically and histopathologically. Results: All transplantations were successful and all transplanted rats survived. Upon macroscopic evaluation, no evidence of complications was observed and all transplanted esophagi in the two groups appeared to exhibit excellent firm tissue; however, mild necrosis was observed in the cervical end of the transplant in one rat in the IT group. Histopathologic examination showed a viable esophageal structure in all rats. Inflammation and muscular atrophy were lower in the IT group than in the UT group, whereas vascularity was higher in the IT group than in the UT group. Conclusion: Total esophageal transplantation was performed directly without vascular anastomosis into recipients in a rat model. This procedure should be done in larger animal models before being attempted in humans. (C) 2013 Elsevier Inc. All rights reserved.Öğe The First Report of an Intraperitoneal Free-FloatingMass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child(Hindawi Ltd, 2012) Uygun, Ibrahim; Aydogdu, Bahattin; Okur, Mehmet Hanifi; Otcu, SelcukA free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.Öğe Fluoroscopic balloon dilatation for caustic esophageal stricture in children: An 8-year experience(W B Saunders Co-Elsevier Inc, 2013) Uygun, Ibrahim; Arslan, Mehmet Serif; Aydogdu, Bahattin; Okur, Mehmet Hanifi; Otcu, SelcukPurpose: Esophageal balloon dilatation (EBD), when performed early and correctly, can efficiently treat caustic esophageal stricture (ES). Herein, we present 8 years of experience treating caustic ES, and discuss the technique as well as the complications. Methods: We retrospectively reviewed the medical records of 38 children in whom we performed fluoroscopic EBD under general anesthesia for caustic ES between November 2004 and November 2012 in our hospitals. The patients were grouped into the early dilatation group, who began EBD earlier (mean, 15 days) after caustic ingestion, and the late dilatation group who was referred later (mean, 34 days) for EBD by other centers. The ESs were classified into short and long strictures. Balloon size was increased gradually to a sufficient diameter over consecutive sessions. Characteristics of patients and ES, details of the EBD, and treatment results were analyzed. Results: A total of 369 EBD sessions were successfully performed in 38 children (aged 14 months to 14 years, median 3.5 years). In six patients, EBD treatments are continuing, one patient was lost to follow up, one patient who received a stent was excluded, and three returned to their previous centers. The remaining 27 patients were treated successfully by repeated EBD treatments. Nevertheless, in the early dilatation group (n = 16), EBD treatment was significantly faster and shorter than that in the late dilatation group (n = 11). In addition, the short stricture treatment was also of significantly shorter duration than the long stricture treatment. Six (1.6%) esophageal perforations occurred in five patients (13.2%); all were treated conservatively. There was no mortality. Conclusions: For treatment of caustic ES, fluoroscopically guided EBD is safe and has a low rate of complications as well as a 100% success rate. However, it should be begun earlier, and in children, should be performed gently with balloons of gradually increasing appropriate diameters over consecutive sessions. (C) 2013 Elsevier Inc. All rights reserved.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 An Infantile Splenic Hemangiopericytoma Case Treated with Partial Splenectomy(Taylor & Francis Inc, 2012) Uygun, Ibrahim; Okur, Hanifi; Firat, Ugur; Otcu, Selcuk; Ozturk, HayrettinSplenic hemangiopericytoma is a very rare tumor. So far only 10 patients (9 adults, 1 child) have been reported in the literature and all of them were treated with total splenectomy. Herein, we report the first infant case of the splenic hemangiopericytoma in a 10-month-old girl and the first case that was treated with partial splenectomy for splenic hemangiopericytoma.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 Magnetic compression gastrostomy in the rat(Springer, 2012) Uygun, Ibrahim; Okur, Mehmet Hanifi; Cimen, Hasan; Keles, Aysenur; Yalcin, Ozben; Ozturk, Hayrettin; Otcu, SelcukMagnetic compression anastomosis is used for gastrointestinal, biliary, and urinary anastomoses. We have developed a simple magnetic compression gastrostomy technique in rats. Animals were randomized into two groups (n = 12 each): magnetic gastrostomy (MG) and surgical gastrostomy (SG) (control). In the MG group, a magnetic insertion catheter was coupled with the first magnetic ball and introduced transorally into the stomach. A second magnetic ball was placed subcutaneously into the left upper quadrant. The two magnetic balls (4 mm) were strongly coupled together. On postoperative day (PD) 20 (MG group) and PD10 (SG group), rats were killed, gastrostomies were evaluated macroscopically and histopathologically, and mechanical burst testing was performed. Two animals died due to suspected leaks. Macroscopic evaluation indicated no gastrostomy canal in one rat in each group. Mild adhesion was observed in two rats in the MG group. Moderate adhesion was observed in all rats in the SG group. No significant differences were observed in burst pressure between the two groups (means: MG group, 143 mmHg, n = 9; SG group, 159 mmHg, n = 8). Magnetic compression gastrostomy can be performed easily in rats, and may be developed in future as a simple alternative to some gastrostomy procedures in humans.Öğe Magnetic Compression Ostomy as New Cystostomy Technique in the Rat: Magnacystostomy(Elsevier Science Inc, 2012) Uygun, Ibrahim; Okur, Mehmet Hanifi; Cimen, Hasan; Keles, Aysenur; Yalcin, Ozben; Ozturk, Hayrettin; Otcu, SelcukOBJECTIVE To report the first creation of magnetic compression cystostomy (magnacystostomy) using an easy and simple new technique in rats. Magnetic compression anastomoses (magnamosis) have been previously described for gastrointestinal, biliary, urinary, and vascular anastomoses. METHODS Female rats were randomized into 2 groups (n = 10 each): a magnetic cystostomy group and a formal surgical cystostomy group as the control group. In the magnetic cystostomy group, a very small cylindrical magnet was inserted into the bladder. The external magnetic ball was placed subcutaneously into the suprapubic region, and the 2 magnets were coupled together strongly. On postoperative day 20 in the magnetic cystostomy group and day 10 in the surgical cystostomy group, the rats were killed, and the cystostomies were evaluated macroscopically, histopathologically, and by mechanical burst testing. RESULTS In the surgical cystostomy group, 3 rats died. In the remaining rats, no evidence of complications was observed. However, mild adhesion in 1 rat in the magnetic cystostomy group and moderate adhesions in all the rats in the surgical cystostomy group were observed. No significant difference was found in burst pressure between the 2 groups (mean 162 mm Hg in the magnetic cystostomy group [n = 6] and 185 mm Hg in the surgical cystostomy [n = 5] group). However, the procedure time between the magnetic cystostomy group (7.70 +/- 1.64 minutes) and surgical cystostomy group (18.50 +/- 2.01 minutes) was significantly different (P < .001). CONCLUSION Magnacystostomy is easy and safe in the rat model and could be useful for some suprapubic cystostomy procedures in humans. UROLOGY 79: 738-742, 2012. (C) 2012 Elsevier Inc.Öğe Magnetic Compression Ostomy for Simple Tube Colostomy in Rats - Magnacolostomy(Wroclaw Medical Univ, 2012) Uygun, Ibrahim; Okur, Mehmet H.; Arayici, Yilmaz; Keles, Aysenur; Ozturk, Hayrettin; Otcu, SelcukBackground. Magnetic compression anastomoses (magnamosis) have been previously described for gastrointestinal, biliary, urinary, and vascular anastomoses. Objectives. Herein, the authors report the creation of a magnetic compression colostomy (magnacolostomy) using a simple technique in rats. Material and Methods Animals were randomized into two groups (n = 8, each): a magnetic colostomy (MC) group and a control surgical tube colostomy (SC) group. In the MC group, the first magnetic ball (3 mm) was rectally introduced into the rat colon. The second magnetic ball (4 mm) was placed subcutaneously into the left quadrant, and the two magnetic balls strongly coupled. On postoperative day 20 for the MC group and postoperative day 10 in the SC group, the rats were sacrificed and the colostomies evaluated macroscopically, histopathologically, and for mechanical burst testing. Results. From the macroscopic evaluation, two rats failed to form the colostomy canal due to colostomy catheter and magnetic ball removal. In the remaining rats, evidence of complications were not observed. Two rats in the MC group displayed mild adhesion and all rats in the SC group displayed moderate adhesion. No significant differences between the burst pressures were observed. However, a significant difference (p < 0.001) between the procedure times of the MC (4.13 +/- 1.00 minutes) and SC groups (14.25 +/- 2.05 minutes) was evident. Conclusions: Magnacolostomy is an easy and effective procedure in the rat model and presents a safe, minimally invasive alternative to current tube colostomy procedures such as antegrade continence enemas, percutaneous endoscopic, and colostomy/cecostomy in humans (Adv Clin Exp Med 2012, 21, 3, 301-305).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.
