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Öğe Abdominoscrotal Hydrocele - Case-Report and Review of the Literature(Springer Verlag, 1992) Erdener, A; Mevsim, A; Herek, OAbdominoscrotal hydrocele is a collection of fluid in the tunica vaginalis extending through the inguinal canal into the abdominal cavity. Although this rare type of hydrocele was first described by Dupuytren in 1834, only 16 pediatric cases have been reported in the literature to date. On the basis of our own case and those described in the literature, the clinical features, diagnostic procedures, and operative therapy are summarized and discussed.Öğe Accessory perineal scrotum associated with anorectal malformation(Blackwell Science Ltd, 1999) Ozcan, C; Celik, A; Erdener, AÖğe Accumulation of Tc-99(m)-polyclonal immunoglobulin in different stages of infection: An experimental study(Chapman Hall Ltd, 1996) Burak, Z; Ozcan, ZB; Ozcan, C; Ozacar, T; Basdemir, G; Erdem, S; Argon, M; Erdener, A; Duman, YIn this experimental study, the utility of Tc-99(m)-polyclonal human immunoglobulin (Tc-99(m)-HIG) for localizing acute and chronic phases of inflammatory lesions was investigated. Three groups of rats were inoculated with Staphylococcus aureus in the right thigh. Then, 24 h (group I, n = 12), 48 h (group II, n = 12) and 72 h (group Ill, n = 12) post-inoculation, the rats received 40 MBq Tc-99(m)-HIG into the jugular vein. In addition, two control rats were studied at 24 h after inoculation of sterile saline. Both visual and quantitative evaluations were undertaken. The acute and chronic stages of inflammation were determined by pathological examination. The mean (+/- S.D.) lesion/contralateral uptake ratios at 4 and 24 h after Tc-99(m)-HIG injection were: group I, 1.22 +/- 0.1 and 2.12 +/- 0.16; group Il, 1.15 +/- 0.08 and 2.25 +/- 0.16; group III, 1.06 +/- 0.09 and 2.08 +/- 0.14. In conclusion, the acute and chronic phases of infection showed non-significant differences in Tc-99(m)-HIG uptake ratios.Öğe Adnexal torsion in children may have a catastrophic sequel: Asynchronous bilateral torsion(W B Saunders Co-Elsevier Inc, 2002) Ozcan, C; Celik, A; Ozok, G; Erdener, A; Balik, EBackground/Purpose: Adnexal torsion is a serious condition that frequently may result in ovarian removal, and there always is a risk of castration if the contralateral ovary undergo torsion as well. In this study, the authors present their experience with adnexal torsion in 15 children and describe a catastrophic event, asynchronous bilateral adnexal torsion, with review of the literature. Methods: Between November 1993 and November 2000, 15 children under 15 years of age who had undergone operation because of torsion of uterine adnexal structures were evaluated. Two illustrative cases with asynchronous bilateral adnexal torsion are presented. Results: Fourteen cases were associated with additional adnexal pathology, whereas in 1 case the torsion was of normal uterine adnexa. Sonographic studies improved the preoperative diagnosis. Hemorrhagic necrosis of the adnexa secondary to the torsion was found in all cases except 3 and necessitated adnexal resection. In only 3 cases preservation of the adnexa was possible. Asynchronous adnexal torsion occurred in 2 patients in the time course. Both were treated by laparotomy and adnexal untwisting and fixation by permanent multiple interrupted sutures. In their final evaluation at 40 and 8 months after the operation, they were found to have good ovarian function. Conclusion: Considering the risk of subsequent contralateral torsion and its impact on future fertility, the authors believe that conservative management (untwisting the ovary and pexing, both retained cletorsed and contralateral, ovaries) should be considered in cases of ovarian torsion in children. Copyright 2002 Elsevier Science (USA). All rights reserved.Öğe Amniotic Membrane Wrapping - An Alternative Method To the Splenorrhaphy In the Injured Spleen(Hippokrates Verlag Gmbh, 1992) Erdener, A; Ulman, I; Ilhan, H; Soydan, SHuman amnion, which has been used experimentally and clinically as an ideal bioprosthesis, was used in the present study to wrap the experimentally injured spleens and the technique was compared to splenorrhaphy. Standard splenic injuries were made on 30 male albino rats. 15 of the spleens were repaired by splenorrhaphy and the other 15 were wrapped with sterile human amniotic membrane. Isotope uptakes of the spleens calculated at the 30th postoperative day were similar in both groups (p < 0.05). But the histopathological examination revealed a better healing in the amnion group with better preservation of the splenic architecture. It was concluded that in heavily injured spleens, amnion wrapping may be an effective alternative to splenorrhaphy.Öğe 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 A Case of Sigmoid Volvulus Secondary To Hirschsprungs-Disease(Springer Verlag, 1995) Erdener, A; Ulman, I; Ozcan, C; Genc, KWe report a case of sigmoid volvulus accompanied by undiagnosed Hirschsprung's disease (HD). A 3-year-old boy who had had chronic constipation since birth was admitted because of progressive abdominal distention and obstipation. A plain abdominal film was compatible with megacolon and distal obstruction. Sigmoid volvulus secondary to HD was found at emergency laparotomy, and a colostomy was performed after detorsion. A Soave procedure performed 3 months later yielded complete loss of symptoms. Whenever an operation for sigmoid volvulus is performed in children, a frozen biopsy section of distal colon to exclude HD is recommended.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 Does colonization of Helicobacter pylori in the heterotopic gastric mucosa play a role in bleeding of Meckel's diverticulum?(W B Saunders Co, 2002) Ergun, O; Celik, A; Akarca, US; Sen, T; Alkanat, M; Erdener, ABackground/Purpose: Helicobacter pylori is a microorganism known to colonize in gastric type of mucosa and is associated with gastritis and peptic ulceration. The aim of the study was to determine whether colonization of H pylori in heterotopic gastric mucosa plays a role in bleeding of Meckel's diverticulum. Methods: Histopathologic slides of patients who had undergone resection of Meckel's diverticulum in recent 5 years were reexamined for the presence of H pylori in heterotopic gastric mucosa. Polimerase chain reaction (PCR) test was used to trace the genetic material of urease gene and 16s rDNA amplifications for H pylori. Results: Thirteen of the 30 histopathologic slides of Meckel's patients presented with acute bleeding of the diverticula, whereas 3 of them were asymptomatic. None of the 13 gastric mucosa bearing diverticula were colonized with H pylori. PCR was unable to show any trace of genetic material for H pylori. Conclusion: Although the role of H pylori is well established in the gastric mucosal ulceration, its presence is not essentially required to induce "heterotopic gastritis" that may result in bleeding of the Meckel's diverticulum. Copyright 2002, Elsevier Science (USA). All rights reserved.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 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 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 Jugular Phlebectasia In Children(Hippokrates Verlag Gmbh, 1993) Balik, E; Erdener, A; Taneli, C; Mevsim, A; Sayan, A; Yuce, GJugular phlebectasia is a congenital dilatation of jugular vein which appears as a soft, compressible mass in the neck only during straining or crying. It should be differentiated from laryngocele, cysts and tumors of neck which may also appear during straining. Comparable ultrasonography (US) and computerized tomography (CT) are diagnostic methods to distinguish the pathology. Four children with jugular phlebectasia diagnosed by venography, US and CT are reported. Surgical excision of the dilated segment was performed in each case. The inevitability of surgical intervention is discussed.Öğe Long-term results of conservative management of adnexal torsion in children(W B Saunders Co, 2005) Celik, A; Ergun, O; Aldemir, H; Ozcan, C; Ozok, G; Erdener, A; Balyk, KBackground/Purpose: Adnexal torsion is a condition that may result in serious morbidity including adnexal removal. However, conservative management with preserving the torsed adnexa is not justified, and long-term outcomes remain unclear. Methods: The records of 14 girls with ovarian torsion whose adnexal structures were preserved after detorsion were reviewed to evaluate the long-term results of conservative management. Data including age, previous history, duration of complaints, surgical findings and type of intervention, color Doppler ultrasound findings performed in the early and late postoperative periods, and final outcomes were collected. Results: Mean age of patients was 11.5 +/- 2.8 (range 6 to 15) years. Time interval between the onset of pain to surgery was 46.78 +/- 35.5 (range 12 to 126) hours. Seven patients had a benign solitary cyst as an underlying cause for adnexal torsion. The intervention performed by open surgery in 9 and by laparoscopy in 5 patients included detorsion, simple cyst aspiration, unroofing and/or cystectomy in 7 patients with ovarian cysts, and oophoropexy in 9 of 14 patients. Follow-up ranged from 3 to 66 (mean 21.9 +/- 20.1) months. Thirteen patients resumed normal size and folliculogenesis, whereas in 1 patient, the involved ovary atrophied. No recurrence or contralateral adnexal torsion was observed on follow-up. Conclusions: Conservative management with untwisting the ovary and pexing both retained detorsed and contralateral ovaries especially in idiopathic torsions should be considered in cases of ovarian torsion in children. (c) 2005 Elsevier Inc. All rights reserved.Öğe Management of pneumothorax in children(Edizioni Minerva Medica, 1998) Genc, A; Ozcan, C; Erdener, A; Mutaf, OBackground. The efficacy of tube thoracostomies inserted at the sixth intercostal space at midaxillary line was evaluated retrospectively in children. Methods. Ninety-seven children with pneumothorax, treated by tube thoracostomy were taken into the study. There were 67 male and 30 female patients with a mean age of 6.5 years (range 1 days to 15 years) Results. Pneumothorax was located at the right side in 50 (51.5%), and at the left in 38 (39.1%) of the cases. Bilateral pneumothorax was found in 9 additional patients (9.2%). All patients were treated with tube thoracostomy placed in the pleural cavity at the sixth intercostal space at the mid-axillary line. Postoperative course was uneventful and no complication was encountered at any of the patients. Conclusions. On the basis of these data we suggest that all thoracostomy tubes should be inserted on the sixth intercostal space where both air and the accumulating fluid can be reached. The insertion of the thoracostomy tube at the second intercostal space must be avoided since it carries a high risk of subclavian vein injury in small children, and also a secondary tube is frequently required to drain the accompanying intrapleural fluid.Öğe Microcolon-Intestinal Hypoperistalsis Without Megacystis - Uncommon Form of Neonatal Intestinal Pseudoobstruction(Georg Thieme Verlag Kg, 1995) Ozok, G; Erdener, A; Herek, O; Tuncyurek, M; Alkanat, M; Gokdemir, ATwo cases of microcolon-intestinal hypoperistalsis without megacystis are reported. They had dilated proximal small bowel and narrowed distal small bowel and malrotated microcolon. No organic obstructive intestinal lesion was found and double-barrel ileostomy was performed. The biopsy specimens showed ganglion cells to be normal in number and appearance in the entire intestinal wall. The ileostomy did not function postoperatively and drugs stimulating bowel movement failed to induce peristalsis. We have suggested that microcolon-intestinal hypoperistalsis without megacystis may be the cause of functional intestinal obstruction in neonates and it is a variant of megacystis-microcolon-hypoperistalsis syndrome.Öğe Microphthalmos associated with esophageal atresia(W B Saunders Co, 1996) Ulman, I; Herek, O; Genc, AK; Erdener, AThe authors report on a neonate who had esophageal atresia and tracheoesophageal fistula associated with unilateral microphthalmos and glandular hypospadias. Primary repair of the esophageal defect was accomplished in the first week of life. This is the first report of such a combination of congenital anomalies. Copyright (C) 1996 by W.B. Saunders CompanyÖğe A New Suture Material For Repair of the Injured Spleen(Springer Verlag, 1994) Erdener, A; Taneli, C; Ozcan, C; Duman, Y; Ozdemir, NParenchyma-Set, a new absorbable collagen-tape suture material, was used in the present study for the repair of experimentally injured spleens and the results compared with polyglactin. Standard splenic injuries were produced in ten mongrel dogs. The spleens of five (group I) were repaired with Parenchyma-Set and those of the other five (group II) with polyglactin. Isotope uptakes of the spleens performed on the 30th postoperative day showed varying degrees of scintigraphic defects in group II in comparison with group I. The histopathologic examinations revealed better healing in group I with better preservation of the splenic architecture. We conclude that Parenchyma-Set appears to be the suture material of choice for repair of the injured spleen.Öğe A new variant of esophageal atresia associated with esophageal heterotopic pancreas(W B Saunders Co, 2002) Ozcan, C; Celik, A; Erdener, AAn infant with esophageal atresia (EA) and absence of gas on abdominal radiographs was found to have an obliterated distal tracheoesophageal fistula (TEF). Preoperative bronchoscopy and surgical exploration found that the reason for gasless abdomen was the atresia of the distal portion of lower esophagus, which also contained heterotopic pancreatic tissue. The type of trachea/esophageal anomaly found in this patient, with the association of esophageal heterotopic pancreas (EHP), has not yet been reported in the literature, J Pediatr Surg 37:116-118, Copyright (C) 2002 by W.B. Saunders Company.Öğe Non-operative management of isolated solid organ injuries due to blunt abdominal trauma in children(Georg Thieme Verlag Kg, 2004) Ergun, O; Erdener, A
