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    Management of postpneumonic empyemas in children
    (Oxford Univ Press Inc, 2004) Ozcelik, C; Ülkü, R; Onat, S; Ozcelik, Z; Inci, I; Satici, O
    Objectives: Despite continued improvement in medical therapy, pediatric empyema remains a challenging problem for the surgeon. Multiple treatment options are available; however, the optimal therapeutic management has not been elucidated. The aim of this study is to assess different treatment options in the management of postpneumonic pediatric empyemas. Methods: A retrospective review was performed of pediatric patients admitted to Dicle University School of Medicine Thoracic and Cardiovascular Surgery Department between 1990 and 2002, with the diagnosis of empyema. Data tabulated included patient demographics, presentation, treatment and outcome. Results: There were 515 children (289 boys and 226 girls) with a mean age of 4.7 ranging from 18 days to 15 years. Empyema was secondary to pneumonia in all children. The most common radiologic finding was pleural effusion in 285 patients (55.32%). Staphylococcus aureus was the most frequently encountered organism and found in 105 patients (20.38%). Pleural fluid cultures were negative in 195 patients (37.86%). In addition to antibiotic therapy, initial treatment included serial thoracenthesis (n = 29), chest tube drainage alone (n = 214), chest tube drainage with intrapleural fibrinolytic therapy (n = 72), chest tube drainage with primary operation (n = 191), and primary operation without chest tube drainage (n = 9). Overall response rate with fibrinolytic treatment (complete and partial response) was obtained in 58 patients. In addition to decortication pulmonary resections were performed in 12 patients. Overall mortality rate was 1.55%. There was no operative mortality. Postoperative morbidity included wound infection in 21, delayed expansion in 8, and atelectasis in 35 patients. Conclusions: Multiple therapeutic options are available for the management of pediatric empyema. Depending on stages, every option has a role in the treatment of postpneumonic pediatric empyema. In the absence of bronchopleural fistula, intrapleural fibrinolytic treatment should be tried in all patients with multiloculations in stage II empyema. In the absence of pneumonia, decortication for empyema is a safe approach with low mortality and morbidity rates. (C) 2003 Elsevier B.V. All rights reserved.
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    Öğe
    Menstrual disorders and pelvic pain after sterilization
    (Kluwer Academic Publ, 1995) Taner, CE; Hakverdi, AU; Erden, AC; Satici, O
    Changes in menstrual cycle length, menstrual duration, number of pads, dysmenorrhea and non-cyclic pelvic pain were studied in 43 women following tubal sterilization with three different techniques. One group consisted of 17 women undergoing laparotomy by Pomeroy technique; the second group consisted of 11 women undergoing laparoscopy by Fallope rings; and the third group consisted of 15 women undergoing colpotomy by fimbriectomy. The differences before and after sterilization in cycle length were non-significant in all groups (p>0.05). After sterilization, menstrual duration and number of pads were significantly increased in the laparotomy (p<0.001) and laparoscopy (p<0.01) groups but non-significantly in the colpotomy group (p>0.05). Comparison of these parameters between the groups did not show any significant differences (p>0.05). After sterilization, increases in the severity of dysmenorrhea and non-cyclic pelvic pain were non-significant in all groups (p>0.05). We concluded that there were no significant differences in menstrual disorders after sterilization among these three different techniques.