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Öğe Bilateral testicular teratorna in infancy: Report of a rare case treated by testis-sparing surgery(Georg Thieme Verlag Kg, 2004) Herek, O; Ulman, L; Ozcan, C; Avanoglu, ATesticular tumors are rarely seen in childhood, with germ-cell tumors as the most common type. Teratoma is second only to yolk sac tumor in frequency. Bilateral testicular teratoma is extremely rare. Orchiectomy has been the standard treatment for most tumors of the testes in the past. However, in children, testis-sparing surgery has become the treatment of choice for benign lesions including teratoma. A 10-month-old infant with synchronous bilateral testicular teratomas, one of which was disclosed by ultrasonography, is presented here. While the larger teratoma required unilateral orchiectomy, the smaller tumor in the contralateral testicle was enucleated by testis-sparing surgery. The follow-up at three years was uneventful with normal development of the testis and the boy. Testicular teratoma may reside in both testicles without clinical symptoms. Ultrasound of both testes provides coherent preoperative diagnosis, allowing the surgeon to consider testicular-sparing procedures, thus preventing anorchia in these rare occurrences.Öğe Bladder ultrasonography in the evaluation of the efficacy of dextranomer/hyaluronic acid injection for treating VUR(Blackwell Publishing Ltd, 2004) Ergun, R; Ozcan, C; Ozbek, S; Avanoglu, A; Ulman, IÖğe Blood transfusion requirements in children with blunt spleen and liver injuries(Hippokrates Verlag Gmbh, 1998) Avanoglu, A; Ulman, I; Ergun, O; Ozcan, C; Demircan, M; Ozok, G; Erdener, AThe records of 174 children sustaining blunt spleen and liver injuries in a 16-year period were analyzed retrospectively to determine blood transfusion requirements in surgically versus conservatively managed patients. The whole study group consisted of 97 spleen, 70 liver, and 7 combined spleen and liver injuries respectively. Seventy-eight patients were managed conservatively while 96 children had undergone various operative procedures. The hematocrit (Hct) values, transfused blood volumes (ml/kg), and length of hospital stay were compared between the non-operative and operative treatment groups. Although the initial Hct values were found to be similar in non-operative versus operative groups (26.7 % +/- 2.7 % vs. 24.8 % +/- 3.5 %), transfused blood volumes were significantly higher in the surgically treated group respectively (20.9 ml/kg vs. 39.5 ml/kg) (p < 0.05). Similarly, mean length of hospital stay was longer in the surgical groups. Associated injuries were seen in 105 (60.3%) patients distributed randomly among two study groups. Twelve patients in the series died of other system/organ involvement. There were no deaths in isolated spleen and/or liver injuries. Increased blood transfusion requirement in surgical groups may be due to excessive bleeding prior to the operation which virtually provides the indication for laparotomy. Manipulation and suturing enhances additional bleeding to elevate the total volume to be delivered. Operative choice should be spared for very selected cases, and conservative management is safe; procedures such as splenorrhaphy are not superior to observation therapy as a means of controlling intraabdominal bleeding.Öğe Characteristics of multisystem organ failure in neonates(Hippokrates Verlag Gmbh, 1997) Avanoglu, A; Ergun, O; Bakirtas, F; Erdener, AThe records of 45 neonatal deaths in a four year period were reviewed retrospectively. Sixteen patients (35.5%) developed multisystem organ failure (MSOF). The criteria for pulmonary, hepatic, renal, hematologic, cardiac and microvascular failures were established. The onset of the first organ involvement was calculated in days prior to death. The earliest organ involved was kidney (14.2 +/- 15.1) followed by microvascular (9.4 +/- 7.6), hematologic (8.4 +/- 10.1), liver (6.8 +/- 6.7), lung (6.3 +/- 6.6) and cardiac (6.0 +/- 8.7) failure. Blood culture analyses revealed 5 patients with culture-positive sepsis. Yeast was the leading septic agent (n = 3) followed by Klebsiella pneumoniae (n = 2), Pseudomonas sp. (n = 1) and E. coli (n = 1). The first organ involvement was noted at 17.6 +/- 23.2 days. We concluded that the sequence of neonatal MSOF is different from that of adults, yet the inciting events are not clear-cut. Lung, which is the first organ involved in adults, seems to be a lately involved organ in neonates.Öğe Clinical results with anterior diagonal iliac osteotomy in bladder exstrophy(Lippincott Williams & Wilkins, 2000) Ozcan, C; Ulman, I; Kara, S; Avanoglu, A; Kapubagli, A; Gokdemir, APurpose: We report our clinical experience with anterior diagonal iliac osteotomy in 10 patients who underwent surgery for bladder exstrophy. Technique and long-term results are discussed. Materials and Methods: A total of 10 boys 1 month to 9 years old with bladder exstrophy underwent this procedure during a 2-year period. Results: None of the patients had bladder closure dehiscence or prolapse after the operation. There were neither infectious complications nor injury to the vessels or nerves in any case. Blood loss was minimal for anterior diagonal iliac osteotomy. The only significant complication in our series was the polypropylene erosion of the urethra, necessitating endoscopic removal in 1 patient 1 month postoperatively. All patients had wide diastasis of the pubis preoperatively (average pubic distance 53.3 cm., average pubic ratio 0.9). At surgery suturing the sym physis after bilateral osteotomy resulted in a satisfactory symphyseal approximation and tension-free closure of the abdominal wall was easily achieved in all cases. Radiological studies at a mean followup of 34.6 months (range 14.8 to 49.5) revealed significant recurrent diastasis of the pubic bones in all but 1 patient in whom bone grafts were applied between the iliac fragments. Mean interpubic distance was 42 cm. and mean pubic ratio was 0.6 at long-term followup. Conclusions: Diagonal osteotomy may correct the principal bony deformity in exstrophy and enables initial symphyseal approximation. Pubic diastasis may recur, probably due to opening forces generated by soft, tissue elements of the pelvis.Öğe Cost-effectivity of circumcision in hemophilia(W B Saunders Co-Elsevier Inc, 2005) Kavakli, K; Avanoglu, A; Celik, AÖğe The effect of suturing technique and material on complication rate following hypospadias repair(Hippokrates Verlag Gmbh, 1997) Ulman, I; Erikci, V; Avanoglu, A; Gokdemir, ANinety-seven children with distal hypospadias were treated surgically using perimeatal-based flap urethroplasty (Mathieu procedure) in a two and a half years period. A review of the medical records revealed two distinct groups of patients according to the suturing type and suture material. In the first group of 36 patients (group I), neourethra was constructed using 6/0 polyglactine (Vicryl(R)) in a single layer, full-thickness, uninterrupted fashion. Skin flaps were approximated using interrupted simple 5/0 polyglactine (Vicryl(R)) sutures. In the second group of 61 patients (group II), 7/0 polydioxanone (PDS(R)) was used in the urethral anastomosis performed in a subcuticular, uninterrupted fashion. The skin flaps were closed using interrupted simple 5/0 rapidly absorbable polyglactine (Rapid Vicryl(R)) sutures. Patients were followed-up from 6 to 12 months. Urethral or meatal stenosis was not observed in any patient. There was no infectious complication. Urethrocutaneous fistula rate was significantly higher in group I (16.6%) compared to group II (4.9%) (p < 0.01). Complication rate following hypospadias repair can be reduced by the use of a subcutaneous suture technique utilizing polydioxanone suture material in urethroplasties.Öğe Effects of H-2 receptor blocking agents on bacterial translocation in burn injury(Hippokrates Verlag Gmbh, 1997) Avanoglu, A; Herek, O; Ulman, I; Ergun, O; Tunger, A; Alkanat, M; Erdener, AWe experimentally studied the effects of Hz receptor blockers (ranitidine) on bacterial translocation (BT) in 42 male albino rats. Sham group (Group I, n = 12 rats) were exposed to 21 degrees C water while Burn group (Group II, n = 15 rats) and Ranitidine group (Group III, n = 15 rats) were exposed to 95 degrees C hot water for 10 seconds to produce a full thickness burn in 30% of total body surface area. 300 mg/kg ranitidine was administered to Group III starting immediately after the burn injury. Rats were sacrificed on the fifth postburn day. Sham group gained weight while groups II and III had significant weight loss. Gastric pH increased with the administration of ranitidine. Both gram negative and total number of bacteria were found to be reduced in cecal stool cultures in ranitidine group. Significant increase in BT was observed in Group III, and translocating bacteria were found to be different in burn and ranitidine groups with a final conclusion that administration of ranitidine changes intestinal ecological equilibrium and promotes BT.Öğe Esophagoplasty In the Treatment of Caustic Esophageal Strictures In Children(Blackwell Science Ltd, 1995) Mutaf, O; Ozok, G; Avanoglu, AA total of 111 children with caustic oesophageal strictures who have subsequently undergone oesophagoplasty were reviewed. Overall 80 patients had a retrosternal colon transplant; a two-stage operation with delayed cervical oesophagocolostomy was the preferred method in 68 of them. Of those having retrosternal surgery two had total necrosis and three had necrosis at the distal end of the transplant. The incidence of cervical anastomotic stenosis was six of 12 in the group undergoing single-stage surgery, compared with seven of 68 in those having the two-stage operation. Ten patients underwent a right thoracic retrohilar colon transplant, seven of whom developed redundancy of the graft. Redundancy was a lesser problem in the retrosternal placement of the transplant. Three patients underwent jejuno-oesophagoplasty which resulted in terminal necrosis in one patient and total necrosis in two. The remaining 18 patients had segmental resection of the intrathoracic oesophageal stenosis followed by end-to-end anastomosis. The overall mortality rate in the series was 3.6 per cent (four of 111).Öğe Evaluation of the lower urinary tract function in caudal duplication (dipygus) anomaly(W B Saunders Co, 1996) Ulman, I; Avanoglu, A; Erdener, A; Sahin, AH; Gokdemir, ACaudal duplication is a rare anomaly with less than 30 reported cases, For those patients who also have double bladders, there are nor enough data regarding the function of the lower urinary tract, A bay with caudal duplication anomaly was evaluated fluoroscopically and urodynamically. The results of the evaluation showed that the bladders were filling and emptying synchronously with normal and almost identical detrusor pressures, The child did not require either or both bladders to be resected. Because the level of the duplication in dipygus cases varies, thorough evaluation of the lower urinary tract, including urodynamics, should be considered for every case. Copyright (C) 1996 by W.B. Saunders CompanyÖğe 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 Fibrin glue for circumcision in severe hemophilia(F K Schattauer Verlag Gmbh, 1997) Kavakli, K; Nisli, G; Polat, A; Aydinok, Y; Oztop, S; Cetingul, N; Ozcan, C; Avanoglu, A; Ulman, I; Gokdemir, AÖğe Gastrointestinal perforations in children: A continuing challenge to nonoperative treatment of blunt abdominal trauma(Williams & Wilkins, 1996) Ulman, I; Avanoglu, A; Ozcan, C; Demircan, M; Ozok, G; Erdener, AThe present trend towards conservative management of hemodynamically stable pediatric trauma patients may be increasing the risk of delay in the diagnosis of traumatic hollow viscus perforations (HVP). The purpose of this study is to determine whether there is a delay in the diagnosis of HVP because of expectant management, A survey of factors leading to diagnostic delay was also made and the value of current diagnostic tools were reevaluated. In 1,283 trauma admissions between 1980-1994, 34 patients were operated for HVP caused by blunt abdominal trauma, Sites of perforation were; stomach (four), duodenum (five), jejunum (12), ileum (nine), and jejunum/ileum (four). Signs of peritoneal irritation were positive in 32 of 34 patients, There was free air in only six of: 24 abdominal roentgenograms. Free peritoneal fluid without solid organ injury was detected in only four out of 13 patients with ultrasound, Peritoneal lavage was diagnostic in eight of nine patients. Time from admission to operating room averaged 24 +/- 4.1 (mean +/- standard deviation) hours, Eleven patients died after the operation mostly because of accompanying head injury, Only two of the deaths were the result of sepsis originating from the perforated bowel. There is an apparent delay in the diagnosis of traumatic HVP in this series, Signs of peritoneal irritation are the most consistent findings of HVP after blunt abdominal trauma in children, Persistence of abdominal signs indicates peritoneal lavage, which has a high diagnostic sensitivity for HVP compared to other diagnostic modalities.Öğe High-Pressure Oxygen Insufflation To Facilitate Submucosal Dissection In Soaves Operation(Springer Verlag, 1994) Balik, E; Ozok, G; Avanoglu, A; Ulman, I; Taneli, C; Herek, OThe aim of the present study is to demonstrate a new, simple method of facilitating the submucosal dissetion that is the most difficult and time-consuming part of Soave's operation. For rectal submucosal dissection, oxygen under high pressure is insufflated via a needle inserted into the submucosal space at a level just above the peritoneal reflection of the rectum down to the anal canal. The technique has been successfully used in 35 cases of Hirschsprung's disease. A considerable reduction in the operating time and the incidence of iatrogenic mucosal perforations could be achieved. We conclude that the method is time-saving and provides safety during a period of the operation where scrupulous care is needed.Öğe Malignant Gastric Teratoma In An Infant(Hippokrates Verlag Gmbh, 1990) Balik, E; Tuncyurek, M; Sayan, A; Avanoglu, A; Ulman, I; Cetinkursun, SMalignancy in gastric teratomas is extremely rare. Such teratomas are widely accepted and treated as benign lesions. A malignant gastric teratoma treated by total excision is presented. According to our knowledge, this is the second case of gastric teratoma having a malignant histology.Öğe Management of instrumental perforations of the esophagus occurring during treatment of corrosive strictures(W B Saunders Co, 1998) Avanoglu, A; Ergun, O; Mutaf, OBackground: The initial symptoms of esophageal perforations (EP) may be subtle, but the progression is very rapid, and the outcome may be disastrous unless the diagnosis is made early and proper treatment is started immediately. Methods: Between 1976 and 1996, 1,249 patients with caustic esophageal burns were treated at Ege University. The study group is composed of 52 patients with instrumental EP. Perforations occured during dilatation attempts of esophageal strictures, Twelve patients were referred from other institutions after the occurrence of EP. Results: In two patients, emergency surgical repair of the perforation was possible. Seventeen patients with unilateral and two patients with bilateral empyema were treated by pleural drainages. Anterior retrosternal mediastinal drainage was needed in one patient, and 11 patients required posterior mediastinal drainages. Three patients were treated by both anterior and posterior mediastinal drainage. Tracheoesophageal fistulas (TEF) developed in eight patients immediately after a dilatation attempt. Seven of these patients required esophageal replacement with colon to bypass the fistulas, and one patient in this group healed spontaneously. EP healed in 42.5 +/- 49.4 days. Twelve (23%) patients died of mediastinitis and sepsis. Conclusion: When EP is diagnosed and treated with these methods, the mortality rate should approach zero. Copyright (C) 1998 by W.B. Saunders Company.Öğe Management of Tracheoesophageal Fistula As a Complication of Esophageal Dilatations In Caustic Esophageal Burns(W B Saunders Co, 1995) Mutaf, O; Avanoglu, A; Mevsim, A; Ozok, GThe authors report on eight patients with caustic esophageal burns in whom tracheoesophageal fistula (TEF) developed during dilatation programs. This study covered a period of 17 years between 1975 and 1992. The age of the patients ranged from 1.5 to 8 years (mean age, 3.4 years). TEF developed after 5 to 43 months after injury (mean, 20.05 months). In each case, after documentation of the fistula by esophagography, esophagoscopy, and/or bronchoscopy, the fistula was blocked by an intraluminal esophageal stent, a polytetrafluoroethylene (PTFE) tube with a large lumen (10-mm diameter maximum). In this period, patients were fed via a jejunostomy tube and by total parenteral nutrition (TPN) if indicated, while the existing pneumonia was being treated. In one patient, fistula closed spontaneously during the stent application program, which ended with a patent esophagus. In two patients primary closure of TEF was attempted. In one of them fistula recurred and in the other it was technically impossible to separate the esophagus from trachea safely because of the very tight adhesions. In five patients a two-stage co(oesophagoplasty was performed to bypass the fistulated esophagus. In the first stage, retrosternal pull-through of the colon and coloesophagogastric anastomosis was performed. In the second stage, closure of the distal esophagus and cervical coloesophagostomy was carried out. The patient with the primary closure attempt and one patient with stage 1 coloesophagoplasty died 3 and 4 months, respectively, after the operations. The cause of death was uncontrollable pneumonia in both cases. Follow-up of the four patients showed no complications. Another fistula patient is currently on stent treatment program with pneumonia under control. The most important factor that influences survival in these patients is the degree of pneumonia caused by esophagotracheal leak. Primary repair of the fistula is technically difficult and dangerous in caustic esophageal burns because of extensive and tight adhesions between trachea and esophagus. On the other hand, an intraesophageal stent blocks the fistula, thus rendering the pneumonia curable, and also there is a good chance that the fistula will close spontaneously while the esophagus is being stented. Therefore, a stent trial is essential before a surgical attempt is made to obliterate the proximal esophagus with an esophageal bypass procedure. Copyright (C) 1995 by W.B. Saunders CompanyÖğe Neuroanatomy of the Human Striated Urethral Sphincter(Blackwell Science Ltd, 1995) Ulman, I; Avanoglu, A; Gokdemir, AÖğe Pelvic floor stimulation in the treatment of detrusor instability in children(Blackwell Publishing Ltd, 2004) Altug, N; Avanoglu, A; Bolisik, B; Emir, N; Ulman, IÖğe The place of Mitrofanoff neourethra in the repair of exstrophy-epispadias complex(Hippokrates Verlag Gmbh, 1998) Ulman, I; Ergun, O; Avanoglu, A; Gokdemir, AThe authors present their experience with seven patients having an exstrophy-epispadias complex who had undergone Young-Dees-Leadbetter bladder neck reconstruction with an adjuvant Mitrofanoff neourethra. All the patients, but one, were male with a mean age of 7.4 +/- 3.9 years. Six of them had had previous primary closure of their exstrophied bladders accompanied by anterior diagonal iliac osteostomies, and one having pure epispadias had an incompetent bladder neck and a very low bladder capacity. Four of these patients had breakdown of their reconstructed bladder necks due to clean intermittent catheterization (CIC) via urethra. Ileocystoplasties were performed in all of the patients for their unacceptably low bladder capacities (mean 20.9 +/- 12.9 mi) with an adjuvant Mitrofanoff neourethra, The patients were put on CIC every 3-4 hours via Mitrofanoff channel. Six were totally continent, and one had to use a pad during daytime, There were no complications related to the Mitrofanoff stoma except two patients complained about temporary difficulty on catheterization. The authors conclude that incorporating a Mitrofanoff stoma to bladder neck reconstruction procedures in exstrophy-epispadias complex, prevents injury to the bladder neck during CIC, and thus lowers the risk and incidence of failure.
