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Öğe Congenital eventration of the diaphragm in children: 25 years' experience in three pediatric surgery centers(Georg Thieme Verlag Kg, 2003) Yazici, M; Karaca, I; Arikan, A; Erikci, V; Etensel, B; Temir, G; Sencan, A; Ural, Z; Mutaf, OEventration of the diaphragm is generally defined as an abnormal elevation of all or a portion of an attenuated but otherwise intact diaphragmatic leaf Previous studies have indicated that eventration is a relatively rare condition, which can be symptomatic and requires surgery. We aimed to evaluate our patients with diaphragmatic eventration, and to discuss their characteristics in the light of the relevant literature. We retrospectively analyzed age, sex, incidence, location of the eventration, symptoms, associated anomalies, surgical technique, complications and survival in our patients. Between 1974 and 1999, 33 patients were treated in the Pediatric Surgery Departments of Ege University, SSK Children's Hospital and Behcet Uz Children's Hospital, 18 of them boys and 15 girls. The ages of our patients ranged from three days to 12 years. All of the patients had at least one of the respiratory symptoms such as cough, respiratory distress and fever; 3 newborns were admitted with severe respiratory distress while children belonging to higher age groups had symptoms of acute or recurrent pulmonary infections and failure to thrive. The eventration was right-sided in 22, 11 eventrations were left-sided. Diagnosis was performed with the help of a number of radiological studies such as fluoroscopic investigation, contrast study of the upper gastrointestinal system, direct X-ray graphies of the thorax, CT scan and ultrasonography, as necessary. Surgery was performed via thoracotomy in 20 patients and the 12 other patients underwent laparotomy for plication. One patient underwent thoracoabdominal plication. Two patients died because of cardio-respiratory complications in the early postoperative period and the rest of them survived to annual follow-ups. In conclusion, diaphragmatic eventration is an important condition which can eventually be mortal. Early diagnosis is necessary and plication is the treatment of choice.Öğe Congenital eventration of the diaphragm in children: 25 years' experience in three pediatric surgery centers(Georg Thieme Verlag Kg, 2003) Yazici, M; Karaca, I; Arikan, A; Erikci, V; Etensel, B; Temir, G; Sencan, A; Ural, Z; Mutaf, OEventration of the diaphragm is generally defined as an abnormal elevation of all or a portion of an attenuated but otherwise intact diaphragmatic leaf Previous studies have indicated that eventration is a relatively rare condition, which can be symptomatic and requires surgery. We aimed to evaluate our patients with diaphragmatic eventration, and to discuss their characteristics in the light of the relevant literature. We retrospectively analyzed age, sex, incidence, location of the eventration, symptoms, associated anomalies, surgical technique, complications and survival in our patients. Between 1974 and 1999, 33 patients were treated in the Pediatric Surgery Departments of Ege University, SSK Children's Hospital and Behcet Uz Children's Hospital, 18 of them boys and 15 girls. The ages of our patients ranged from three days to 12 years. All of the patients had at least one of the respiratory symptoms such as cough, respiratory distress and fever; 3 newborns were admitted with severe respiratory distress while children belonging to higher age groups had symptoms of acute or recurrent pulmonary infections and failure to thrive. The eventration was right-sided in 22, 11 eventrations were left-sided. Diagnosis was performed with the help of a number of radiological studies such as fluoroscopic investigation, contrast study of the upper gastrointestinal system, direct X-ray graphies of the thorax, CT scan and ultrasonography, as necessary. Surgery was performed via thoracotomy in 20 patients and the 12 other patients underwent laparotomy for plication. One patient underwent thoracoabdominal plication. Two patients died because of cardio-respiratory complications in the early postoperative period and the rest of them survived to annual follow-ups. In conclusion, diaphragmatic eventration is an important condition which can eventually be mortal. Early diagnosis is necessary and plication is the treatment of choice.Öğe Congenital prepubic sinus: Possible variant of dorsal urethral duplication(Hippokrates Verlag Gmbh, 1998) Ergun, O; Sayan, A; Arikan, ACongenital prepubic sinus is a rare anomaly of the urinary tract. There have been few cases in the literature since the first report by Campbell et al in 1987. We present three male cases with this anomaly.Öğe Experience of the Izmir pediatric oncology group on neuroblastoma: IPOG-NBL-92 protocol(Taylor & Francis Inc, 2003) Olgun, N; Kansoy, SS; Aksoylar, S; Cetingul, N; Vergin, C; Oniz, H; Sarialioglu, F; Kantar, M; Uysal, K; Tuncyurek, M; Kargi, A; Aktas, S; Bayol, U; Karaca, I; Arikan, A; Balik, E; Aktug, TJ; Elmas, N; Kovanlikaya, A; Kinay, M; Anacak, Y; Degirmenci, B; Burak, ZThis multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.Öğe Experience of the Izmir pediatric oncology group on neuroblastoma: IPOG-NBL-92 protocol(Taylor & Francis Inc, 2003) Olgun, N; Kansoy, SS; Aksoylar, S; Cetingul, N; Vergin, C; Oniz, H; Sarialioglu, F; Kantar, M; Uysal, K; Tuncyurek, M; Kargi, A; Aktas, S; Bayol, U; Karaca, I; Arikan, A; Balik, E; Aktug, TJ; Elmas, N; Kovanlikaya, A; Kinay, M; Anacak, Y; Degirmenci, B; Burak, ZThis multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.Öğe Familial vesicoureteral reflux in asymptomatic siblings(Turkish J Pediatrics, 2002) Celik, A; Ulman, I; Aydin, M; Arikan, A; Avanoglu, A; Gokdemir, AA prospective study was established to identify the incidence of vesicoureteral reflux in the asymptomatic siblings of patients with reflux in our region. Of 32 patients with reflux, 37 siblings were screened with urine analysis, urine culture and contrast voiding cystourethrograms, and six (16.2%) were found to have reflux. Renal scan revealed scarring in five. We concluded that siblings of children with vesicoureteral reflux are at high risk, and must be screened so that renal damage and associated morbidity secondary to reflux might be minimized.Öğe Gastroesophageal reflux: A determinant in the outcome of caustic esophageal burns(W B Saunders Co, 1996) Mutaf, O; Genc, A; Herek, O; Demircan, M; Ozcan, C; Arikan, ADeep circumferencial burns of the esophagus always result in stricture formation and obstruction of the lumen. The usual treatment of caustic esophageal strictures is long-term esophageal dilatations. A new method of treatment, long-term stenting of the strictured esophagus gave superior results when compared with the classic dilatation therapy (heating rates, 68% v 33%; P < .01). Although success in the stent group was very satisfactory, the 32% failure rate requires explanation. In the years between 1991 and 1993, 53 stent-treated patients were screened for gastroesophageal reflux (GER). All patients were investigated with 24-hour ambulatory distal esophageal pHmetry. In 18 patients reflux index (RI) was found to be below 4. In 14 patients RI was between 4.1 and 19. In the final group of 21 patients RI was over 20 (minimum, 21.8; maximum, 72.8). When these data were compared with the healing rates of the patients, it was found that none of the 21 patients with RI over 20 responded to the described therapy. We conclude that the esophagus, after a serious caustic insult, not only narrows but also shortens thus altering the lower esophageal sphincter function leading to serious GER. Therefore all caustic esophageal burn patients should be screened for GER periodically during the dilatation or stent therapy programs, and GER should be controlled before RI approaches 20. Copyright (C) 1996 by W.B. Saunders Company.Öğe Neonatal bladder rupture: An unusual complication of umbilical catheterization(Hippokrates Verlag Gmbh, 1996) Sayan, A; Demircan, M; Erikci, VS; Celik, A; Arikan, ABladder injury in the neonatal period is an exceedingly rare phenomenon that is usually iatrogenic. Bladder rupture as a complication of umbilical catheterization in a newborn with urinary ascites, respiratory distress and hematuria is presented and discussed.Öğe Pulmonary Hydatidosis In Children(Hippokrates Verlag Gmbh, 1994) Mutaf, O; Arikan, A; Yazici, M; Erdener, A; Ozok, GIn the years 1963-1991 inclusive, 88 patients were operated on with a diagnosis of pulmonary hydatid disease. The cysts were intact in 69 and infected in 19 cases. It was possible to use a surgical technique that preserved the pulmonary parenchyma in 67 patients. In this technique, the cavity after removal of the mother membrane is left open and only the air leaks are sutured. Continuous postoperative drainage of the residual cavity and the ipsilateral hemithorax always resulted in complete inflation of the affected lung. Enucleation of the endocyst and extended resection of the sclerotic pulmonary parenchyma were performed in 15, enucleation and obliteration in three, lobectomy in two and Barrett's method was applicable in one patient. A bronchopleural fistula developed in 11 patients postoperatively and in four of these cases a second thoracotomy was necessary. Postoperative empyema developed in four cases. There were two postoperative deaths in the series. Eighty-six patients were symptom-free in the long-term postoperative follow-up. We conclude that in the surgical management of the disease it should not be necessary to obliterate the residual cavity with extensive suturing which always leads to extra fibrosis with loss of viable pulmonary parenchyma.Öğe Treatment of gastroesophageal reflux with a gastric tube cardioplasty(W B Saunders Co-Elsevier Inc, 2003) Mutaf, O; Abasiyanik, A; Karaca, I; Arikan, A; Mir, EPurpose: Surgical control of gastroesophageal reflux (GER) is a challenging problem especially in neurologically impaired children and in acquired GER patients after caustic insult to the esophagus because of high failure rates of the classical antireflux procedures. A surgical technique has been designed to overcome this high relapse incidence. Methods: During the past 75 months, 39 children between 4 months and 14 years of age underwent a gastric tube cardioplasty fashioned from the lesser curvature as the antireflux barrier. Results: In all patients, the preoperative RI values of 72 to 10 (average, 32) fell to 0 to 5 (average, 2) after the described procedure, and, in the follow-up period of 2 to 75 months, the RI values did not deteriorate in any one of the cases. Conclusions: It is possible that a 6-cm antireflux barrier (HPZ) created from the lesser curvature of the stomach is enough to control GER at any age. Copyright 2003, Elsevier Science (USA). All rights reserved.Öğe Treatment of gastroesophageal reflux with a gastric tube cardioplasty(W B Saunders Co-Elsevier Inc, 2003) Mutaf, O; Abasiyanik, A; Karaca, I; Arikan, A; Mir, EPurpose: Surgical control of gastroesophageal reflux (GER) is a challenging problem especially in neurologically impaired children and in acquired GER patients after caustic insult to the esophagus because of high failure rates of the classical antireflux procedures. A surgical technique has been designed to overcome this high relapse incidence. Methods: During the past 75 months, 39 children between 4 months and 14 years of age underwent a gastric tube cardioplasty fashioned from the lesser curvature as the antireflux barrier. Results: In all patients, the preoperative RI values of 72 to 10 (average, 32) fell to 0 to 5 (average, 2) after the described procedure, and, in the follow-up period of 2 to 75 months, the RI values did not deteriorate in any one of the cases. Conclusions: It is possible that a 6-cm antireflux barrier (HPZ) created from the lesser curvature of the stomach is enough to control GER at any age. Copyright 2003, Elsevier Science (USA). All rights reserved.Öğe Unilateral inguinal hernia in girls: Is routine contralateral exploration justified?(W B Saunders Co, 1995) Ulman, I; Demircan, M; Arikan, A; Avanoglu, A; Ergun, O; Ozok, G; Erdener, ATo determine the incidence of contralateral hernia development after unilateral inguinal hernia repair in girls, collected case series from two large hospitals were analyzed retrospectively. Among the 294 girls who had undergone repair of a unilateral inguinal hernia (during a 15-year period), 245 could be traced; the mean follow-up period was 8.4 years. In 25 (10.2%) of the patients, contralateral hernia developed, mostly within one year (4 months to 6.5 years). The incidence of contralateral hernia development with respect to the original side of the inguinal hernia was significantly higher (19%) for the originally left-sided hernias than for the right-sided ones (6%) (P < .01). Although the incidence of contralateral hernia development for girls with a left inguinal hernia decreased as age increased, it was still 14.9% for the girls age 3 and up. Contralateral exploration should not be routine for girls who have a right-sided hernia, at any age. For left-sided hernias, it may be performed routinely for girls up to 2 years of age, and selectively for older patients. (C) 1995 by W.B. Saunders Company
