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Öğe Congenital lobar emphysema(Wiley-Blackwell, 2008) Ulku, Refik; Onat, Serdar; Ozcelik, CemalBackground: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that usually presents in the neonatal period with respirator distress and pulmonary lobar hyperinflation. It is commonly confused with pneumothorax. The aim of the present paper was to review the authors' experience in order to emphasize the importance of differential diagnosis with pneumothorax. Methods: Children with CLE treatment at Department of Thoracic Surgery, Dicle University School of Medicine, Turkey, between January 1993 and June 2004, were reviewed. Results: Ten children consisting of six boys and four girls (age range, 6 h-12 months) had CLE. Major presenting symptoms were tachypnea(n = 100%) and respiratory distress in (n = 80%). On chest radiograph, emphysema was seen in all patients, and shift-herniation to the opposite lung, atelectasis were observed. Computed tomography was performed in all patients, which indicated emphysema in the affected lobes in all cases. Pulmonary perfusion scan was performed in two patients, showing loss of perfusion in the affected lobe. The most common affected lobe was the left upper lobe (50%). In the present series, three patients were mistakenly diagnosed as pneumothorax and intercostal drains were inserted in the emergency department. Eight patients underwent lobectomy, and postoperative course was uneventful. Two patients were followed conservatively. Emphysema was detected in all pathological specimens. One patient was lost to follow up. Mean follow-up duration of all patients was 26.8 +/- 29.24 months (range, 1-89 months). Conclusions: CLE is established on combined clinical, radiological and scintigraphic imaging. Surgical excision of the affected lobe is the appropriate treatment. Particularly, differential diagnosis should be made between CLE and pneumothorax.Öğe The demonstration of the inferior sternal cleft using three-dimensional reconstruction: a case report(Editura Acad Romane, 2009) Tuncer, M. Cudi; Aluclu, M. Ufuk; Karabulut, Oezlen; Ulku, Refik; Hatipoglu, E. Savas; Nazaroglu, HasanCongenital sternal cleft is a rare disorder in which there is a gap in the midline of the anterior chest wall between the two halves of the sternum. Typically, the contour of the mediastinal structures can be seen beneath the skin. It is rare and the exact incidence is not known. It results from failure of fusion of the two lateral mesodermal sternal bars by 8 weeks of gestation. Most cases are diagnosed shortly after birth and are reported only rarely in adults. We report here one of the congenital major chest wall deformities; inferior sternal cleft is rarely seen, associated with sternal and costal variations in a 22-year young man.Öğe Esophageal Injury with Unusual Trauma(Springer Heidelberg, 2009) Ulku, Refik; Onat, Serdar; Yilmaz, Guelsen; Akay, HaticeEsophageal foreign bodies are frequently encountered in the pediatric population and specific high-risk groups of adults. Foreign bodies in the esophagus can result in serious complications, depending on the size and the shape of the ingested object. We report the case of a four-year-old boy with an esophageal injury after the accidental ingestion of an umbrella wire.Öğe Evaluation of factors affecting prognosis in penetrating thoracic injuries(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2018) Oruc, Menduh; Ulku, RefikBackground: This study aims to investigate the prognostic factors affecting survival and clinical outcomes in patients exposed to pediatric penetrating thoracic injury. Methods: A total of 267 pediatric penetrating thoracic injury patients (217 males, 50 females; mean age 10.8 years; range, 3 to 17 years) who were treated at our hospital during the recent 20 years were analyzed retrospectively. Penetrating thoracic injuries were divided into three groups: incisive/stabbing injuries, gunshot injuries, explosive injuries. Patients' age, gender, New Injury Severity Score, injury type, injuries accompanying thoracic trauma, types of treatment applied, length of hospital stay, and morbidity and mortality outcomes were examined. Their prognostic characteristics were compared to their injury types, New Injury Severity Scores, lengths of hospital stay and complications. Results: Of the patients, 103 were exposed to gunshot injuries, 128 to incisive/stabbing injuries, and 36 to explosive injuries. Of the penetrating thoracic injuries, while 211 (79%) were isolated injuries, 56 (21%) were accompanying non-thoracic injuries. Mean New Injury Severity Score was 13 +/- 10. Of the patients, 50 (18.6%) were treated with medical therapy alone, 199 (74.5%) with tube thoracostomy, and 18 (6.7%) with thoracotomy. Fifty-one patients (19%) developed complications. Length of hospital was 9 +/- 2.7 days. Twenty-one patients (7.9%) died. New Injury Severity Scores, rates of combined injuries, complications, length of hospital stay, and mortality were higher in explosive injuries (p<0.05). Conclusion: Pediatric penetrating thoracic injuries may be observed in all age groups in children, the most severe type being explosive injuries. Prognostic factors may vary according to injury type, complications, treatment approach, and presence of accompanying non-thoracic injuries.Öğe Extremely Low-Frequency Magnetic Field Decreased Calcium, Zinc and Magnesium Levels in Costa of Rat(Humana Press Inc, 2011) Ulku, Refik; Akdag, Mehmet Zulkuf; Erdogan, Sait; Akkus, Zeki; Dasdag, SuleymanElectromagnetic field (EMF) can affect cells due to biochemical change followed by a change in level of ions trafficking through membrane. We aimed to investigate possible changes in some elements in costa of rats exposed to long-term extremely low-frequency magnetic field (ELF-MF). Rats were exposed to 100 and 500 mu T ELF-MF, which are the safety standards of public and occupational exposure for 2 h/day during 10 months. At the end of the exposure period, the samples of costa were taken from the rats exposed to ELF-MF and sham. The levels of elements were measured by using atomic absorption spectrophotometry (AAS) and ultraviolet (UV) spectrophotometry. Ca levels decreased in the ELF-500 exposure group in comparison to sham group (p < 0.05). Statistically significant decrease was found in Mg levels in the ELF-500 exposure group in comparison to sham and ELF-100 exposure groups (p < 0.05). Zn levels were found to be lower in the ELF-500 exposure group than those in the sham and ELF-100 exposure groups (p < 0.05). No significant differences were determined between groups in terms of the levels of P, Cu and Fe. In conclusion, it can be maintained that long-term ELF-MF exposure can affect the chemical structure and metabolism of bone by changing the levels of some important elements such as Ca, Zn and Mg in rats.Öğe Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center(Biomed Central Ltd, 2010) Onat, Serdar; Ulku, Refik; Cigdem, Kemal M.; Avci, Alper; Ozcelik, CemalBackground: We reviewed our experience with non-iatrogenic traumatic cervical esophageal perforations, paying particular attention to factors affecting the outcome of such cases. Methods: In total, 30 patients treated surgically between 1980 and 2008 for non-iatrogenic traumatic cervical esophageal perforation in our clinic were reviewed. Results: There were 25 male and 5 female patients with a median age of 27.5 years. The type of injury was external trauma in 21 (70%) patients and endoluminal injury in the remaining 9 (30%) patients. The mechanism of injury was gunshot in 16 patients, stabbing in 4, falling in 1 (extraluminal injury), and foreign body in 9 (endoluminal injuries). The overall mortality rate was 16.6% (5/30). The mortality rate for extraluminal injuries was 19%, and for endoluminal injuries was 11.1%. Mortality in patients treated within 24 h of sustaining injury was substantially less than in those for whom diagnosis and treatment were delayed (12.5 and 21.4%, respectively). The mortality rate was 33.3% (3/9) for patients with tracheal injuries and 9.5% (2/21) for those without tracheal injuries. Conclusions: A treatment delay greater than 24 h, the presence of tracheal injury, or extraluminal perforation significantly affected the outcome of surgically treated non iatrogenic traumatic cervical esophageal perforation.Öğe Hemangioma of the Sternum(Elsevier Science Inc, 2008) Onat, Serdar; Ulku, Refik; Avci, Alper; Mizrak, Bulent; Ozcelik, CemalPrimary tumors of the sternum are rare and most of them are malignant. Benign lesions are typically chondromas, bone cysts, or hemangiomas. Among these tumors, hemangiomas are extremely rare. We report a rare case of hemangioma of the sternum. The patient was successfully treated with complete resection of the tumor and sternum stability was obtained by polypropylene mesh and methylmethacrylate.Öğe The importance of serum and fluid Vascular Endothelial Growth Factor (VEGF) level and fluid/serum VEGF ratio in the differential diagnosis of Malign Pleural Mesothelioma (MPM).(Amer Soc Clinical Oncology, 2016) Kaplan, Muhammet Ali; Duzkopru, Yakup; Ulku, Refik; Tanrikulu, Cetin; Kucukoner, Mehmet; Onat, Serdar; Abakay, Abdurrahman[Abstract Not Available]Öğe Insidious Threat of Children: Esophageal Foreign Body Ingestion(Aves, 2014) Sahin, Atalay; Meteroglu, Fatih; Erbey, Ahmet; Sizlanan, Ahmet; Ulku, RefikObjective: Foreign body ingestion commonly occurs in children. Objects that may not easily pass the esophagus cause severe complications, such as impaction, perforation, and obstruction. Different methods are used for their removal. We aimed retrospectively to analyze the cases in which we performed emergent esophagoscopy. Material and Methods: Between 2002 and 2013, 732 children with suspicion of foreign body ingestion were studied. Of them, 720 underwent emergency intervention. Objects located at the first narrowing of the esophagus were removed under sedation, and the remaining objects were taken out under general anesthesia with the aid of rigid esophagoscopy. Results: The mean age of the children was 3.9 years (range 1 month and 16 years). Coins in 648 cases and a variety of objects, opaque and non-opaque, were removed under direct vision. Urgent intervention was carried out in 6 cases with dyspnea, in 2 delayed cases, and in 3 patients with esophageal perforation. Successful removal was performed in 69 patients (95.8%). Perforation occurred in 3 cases. Removal was succeeded within surgery in 2 cases (2.7%). One patient died. Conclusion: A delay in esophageal body ingestion increases the complication rate. Round batteries and objects that are non-oval, long, large, and spiky should be dealt with great attention.Öğe Mediastinal Gastroenteric Cyst in a Neonate(Galenos Yayincilik, 2016) Ipek, Mehmet Sah; Ertugrul, Sabahattin; Ulku, RefikMediastinal cysts in neonates are infrequently reported. Enteric cysts in the posterior mediastinum are mostly asymptomatic. Vertebral malformations may contribute. Clinical presentation may include respiratory distress. Herein, we report a case of mediastinal gastroenteric cyst and meningomyelocele in a neonate presented respiratory distress signs after delivery. The patient was well managed by excision of mediastinal cyst and closure of dura mater of meningomyelocele. A detailed antenatal scan may help in early diagnosis and better outcome. Moreover, vertebral anomaly in chest radiograph of infants with respiratory distress should suggest the possible presence of a mediastinal enteric cyst.Öğe A new method: measurement of microleakage volume using human, dog and bovine permanent teeth(Univ Catolica De Valparaiso, 2006) Yavuz, Izzet; Aydin, Haluk; Ulku, Refik; Kaya, Sadullah; Tumen, CanerThis study investigates the feasibility of a different new approach to determining the microleakage volume associated with dental restorations (Class V cavity restorated with glass ionomer cement + high copper amalgam) and the relative marginal adaptation deficiency of dog, bovine and human permanent teeth in in vitro conditions. Also researched is the appropriateness of using dog and bovine teeth in in vitro studies rather than human teeth. Our method utilizes the molecular adsorption characteristics of methylene blue. Within the framework of this study, 60 permanent teeth (20 human, 20 dogs and 20 bovine) were used. These groups were evaluated statistically, of which indicated no statistically significant differences (p > 0.05). It was also concluded that this preliminary investigation showed that the new microleakage volume measurement method may be a valuable new technique for the in vitro study of microleakage dynamics around dental restorations.Öğe Resection of Intercostal Hemangioma with Involved Chest Wall and Ribs in an 11-Year-Old Girl(Texas Heart Inst, 2010) Ulku, Refik; Onat, Serdar; Avci, Alper; Ozmen, Cihan AkgulWe report a case of an 11-year-old girl who presented with a slowly enlarging mass in the right posterolateral chest wall. Computed tomography showed a soft-tissue mass 8.5 x 7.5 x 5.5 cm in size, arising from the right posterolateral 9th, 10th, and 11th intercostal spaces. Magnetic resonance imaging confirmed a vascular mass. The patient underwent complete resection of the tumor, together with the right 8th, 9th, 10th, 11th, and 12th ribs and their intercostal muscles. Reconstruction of the chest wall was performed with methyl methacrylate and Mar lex mesh. Histopathologic examination of the tumor confirmed an intercostal cavernous hemangioma. At last examination, 6 months after the operation, the child was doing well, with no evidence of recurrence. (Tex Heart Inst J 2010;37(4):486-9)Öğe Right-sided Bochdalek hernia in an adult: a case report(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2011) Ulku, Refik; Avci, Alper; Onat, Serdar; Ozcelik, CemalCongenital right diaphragmatic hernia of Bochdalek rarely occurs in adults. Most of them are asymptomatic. In this article, we report a case of a 21-year-old male with right-sided Bochdalek diaphragmatic hernia who presented with abdominal pain and dyspnea. The chest radiography showed features suggestive of right-sided diaphragmatic hernia. This was confirmed on a computed tomography. The patient underwent right posterolateral thoracotomy whereby a 10 cm posterolateral diaphragmatic defect with herniation of the colon and kidney through the opening was found. During surgery the colon and right kidney were reduced into peritoneal cavity, and the diaphragmatic defect was repaired with non-absorbable sutures. The patient's recovery was uneventful. He remained well at six-month follow-up.Öğe Risk factors affecting post-traumatic acute respiratory distress syndrome development in thoracic trauma patients(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Avci, Alper; Sarac, Ezgi Ozyilmaz; Eren, Tahir Sevval; Onat, Serdar; Ulku, Refik; Ozcelik, CemalBackground: This study aims to investigate the risk factors affecting post-traumatic acute respiratory distress syndrome development in thoracic trauma patients. Methods: This two-centered, retrospective study included 3,080 thoracic trauma patients (2,562 males, 518 females; mean age 33.9 +/- 19.4 years; range, 2 months to 91 years) treated between January 2005 and January 2019. Demographic characteristics, mechanisms of injury, traumatic injuries, injury severity score and new injury severity score results, treatments, comorbidities, complications, morbidity and mortality rates, and durations of hospital stay were collected. Data were used to predict the risk factors for development of post-traumatic acute respiratory distress syndrome by univariate and multivariate statistical analysis. Results: Acute respiratory distress syndrome was detected in 81 patients. In multivariate logistic regression analysis; age, pulmonary contusion, intracranial hemorrhage, rib fracture (unilateral and four-five pieces), femur and tibia fracture, diabetes mellitus, chronic obstructive pulmonary disease, blood transfusion (>= 3 units), high white blood cell count at admission, sepsis, and hepatic injury were detected as independent risk factors (p<0.05). Optimal cutoff points (sensitivity/specificity ratios) for acute respiratory distress syndrome development risk were >= 16 (79%/68%) for injury severity score, >= 27 (90%/68.7%) for new injury severity score, and >= 16,000 (75.3%/71.6%) for admission white blood cell count. New injury severity score was superior than injury severity score to predict the development of acute respiratory distress syndrome. Conclusion: Acute respiratory distress syndrome causes significant mortality and morbidity in trauma patients. In addition to the well-known risk factors, diabetes mellitus and chronic obstructive pulmonary disease were independent risk factors. We defined a cutoff value for new injury severity score to predict post-traumatic acute respiratory distress syndrome.Öğe The role of mediastinoscopy in the diagnosis of non-lung cancer diseases(Dove Medical Press Ltd, 2017) Onat, Serdar; Ates, Gungor; Avci, Alper; Yildiz, Tekin; Birak, Ali; Ozmen, Cihan Akgul; Ulku, RefikBackground: Mediastinoscopy is a good method to evaluate mediastinal lesions. We sought to determine the current role of mediastinoscopy in the investigation of non-lung cancer patients with mediastinal lymphadenopathy. Materials and methods: We retrospectively reviewed clinical parameters (age, gender, histological diagnosis, morbidity, mortality) of all patients without lung cancer who consecutively underwent mediastinoscopy in Hospital of Faculty of Medicine of Dicle University between June 2003 and December 2016. Results: Two-hundred twenty nine patients without lung cancer who underwent mediastinoscopy for the pathological evaluation of mediastinum during the study period were included. There were 156 female (68%) and 73 male (32%) patients. Mean age was 52.6 years (range, 16 to 85 years). Mean operative time was 41 minutes (range, 25 to 90 minutes). Mean number of biopsies was 9.3 (range, 5 to 24). Totally, 45 patients (19.6%) had previously undergone a nondiagnostic bronchoscopic biopsy such as transbronchial needle aspiration or endobronchial ultrasound-guided transbronchial needle aspiration. Mediastinoscopy was diagnostic for all patients. Diagnosis included sarcoidosis (n=100), tuberculous lymphadenitis (n=66), anthracosis lymphadenitis (n=44), lymphoma (n=11) metastatic carcinoma (n=5), and Castleman's disease (n=1); there was a diagnosis of silicosis in one patient and tymoma in one patient. Neither operative mortality nor major complication developed. The only minor complication was wound infection which was detected in three patients. Conclusion: Although newer diagnostic modalities are being increasingly used to diagnose mediastinal diseases, mediastinoscopy continues to be a reliable method for the investigation of mediastinal lesions.Öğe Single Center Experience of Mesothelioma Patients in Southeast Region of Turkey(Akad Doktorlar Yayinevi, 2009) Cil, Timucin; Isikdogan, Abdurrahman; Onat, Serdar; Zincircioglu, Burhanettin; Ulku, Refik; Ozekinci, Selver; Ates, GungorMalignant mesothelioma (MM) is an aggressive tumor, which was originated from serous membranes. The most frequent malignant mesothelioma types are originated from pleura, peritoneum, tunica vaginalis of testis and pericardium respectively. The most frequent etiologic factor is asbestosis but rarely radiation or fibrous zeolit have been etiologic factors. MM is endemically present in some regions of Turkey including several provinces in the southeast region of the country, as a result of exposure to environmental fibrous minerals. We were analysed demographic principals, treatment options, chemotherapy protocols and treatment responses of 45 MM patients retrospectively who presented at the medical oncology division of the Dicle University Hospital in Turkey between 2004 and 2007. When we were retrospectively analysed our patients; 13 (28%) of them have been living in city center and 32 (72%) have been living in rural area. We saw any treatment responses; 6 (26%) in platin-gemcitabine and 5 (31.25%) in platin-pemetrexed were detected. In southeast region of Turkey, prevalence of MM is more than other regions of Turkey and also it is an important disease for southeast region of Turkey. Chemotherapy have been used for paliative treatment in MM. Treatment responses are very low with new agents in the literature. However, treatment responses in our patients are worse than literature.Öğe Spontaneous cyst-cutaneous fistula caused by pulmonary hydatid cyst: An extremely rare case(Dicle Üniversitesi Tıp Fakültesi, 2008) Onat, Serdar; Avcı, Alper; Ulku, Refik; Ozcelik, Cemal[Özet Yok]Öğe Thoracic Wall Necrotizing Fascitis in a Neonate: a Case Report(Derman Medical Publ, 2010) Onat, Serdar; Avci, Alper; Ulku, Refik; Oruc, Menduh; Ozcelik, CemalNecrotizing fasciitis (NF) is a rapidly progressive and potentially life-threatening infection of superficial fascia and subcutaneous tissue. Thoracic wall is one of the rarest locations for NF. Broad-spectrum antibiotics receiving, early surgical debridement, and skin grafting are life saving in NF. We report a 7-day-old female neonate who had left sided thoracic wall NF. She had undergone extensive surgical debridement within 4 hours of hospital admission, and reconstruction of skin defect by split-thickness skin grafting later. Early diagnosis is important, as prompt surgical debridement offers the best chance for survival. Early and extensive surgical debridement is a widely accepted clinical approach and the mainstay of effective treatment. The goals of surgical intervention are to remove all necrotic tissues, and to help control the progression of NF. Reconstruction of skin defects should be performed by early split-thickness skin grafting like our patient or primary closure. Because early wound resurfacing prevents fluid, electrolyte, and protein loss from the wound site, and decreases secondary infection. Although chest wall NF is rare in neonates, it is a rapidly spreading, highly lethal infection. A high index of suspicion, early diagnosis, and aggressive approach are essential to its successful treatment.Öğe Tracheobronchial Pebble Aspiration(Lippincott Williams & Wilkins, 2008) Ulku, Refik; Onat, Serdar; Oruc, Memduh[Abstract Not Available]Öğe Urgent thoracotomy for penetrating chest trauma: Analysis of 158 patients of a single center(Elsevier Sci Ltd, 2011) Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, CemalBackground: Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. Methods: A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. Results: A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 +/- 9.33 (range, 15-54) years. The mean LOS was 10.65 +/- 8.30 (range, 5-65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 +/- 9.92 days; stab wound, 8.76 +/- 6.42 days, p < 0.001). Patients who died had a significantly lower systolic blood pressure (SBP) on presentation in the emergency room (42.94 +/- 36.702 mm Hg) compared with those who survived (83.96 +/- 27.842 mm Hg, p = 0.001). The overall mortality rate was 10.8% (n = 17). Mortality for patients with stab wounds was 8/93 (8.6%) compared with 9/65 (13.8%) for patients with gunshot wounds (p = 0.29). Concomitant abdominal injuries (p = 0.01), diaphragmatic injury (p = 0.01), ISS (p = 0.001), chest AIS score (p < 0.05), ongoing output (p = 0.001), blood transfusion volume (p < 0.01) and SBP (p = 0.001) were associated with mortality. Conclusion: Penetrating injuries to the chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury. (C) 2010 Elsevier Ltd. All rights reserved.
