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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 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 The nilpotence height of P-t(s) for odd primes(Amer Mathematical Soc, 1999) Karaca, IK. G. Monks has recently shown that the element Pb has nilpotence height 2[s/t] + 2 in the mod 2 Steenrod algebra. Here the method and result are generalized to show that for an odd prime p the element Pb has nilpotence height p[s/t] + p in the mod p Steenrod algebra.Öğe Nilpotence relations in the mod-p Steenrod algebra(Elsevier Science Bv, 2002) Karaca, IIn our paper we generalize some results proved by Monks (Bol. Mex. Mat. Soc. 37 (1992) 401-416) and find formulas for the nilpotence of P(n) for certain values of n. (C) 2001 Elsevier Science B.V. All rights reserved.Öğe Paraesophageal hiatal hernias in children(Blackwell Publishing Asia, 2003) Yazici, M; Karaca, I; Etensel, B; Temir, G; Gunsar, C; Guclu, C; Mutaf, OHiatal hernia is a rare condition, which may be a cause of important clinical problems either as a mediastinal mass or as a cause of failure of the antireflux mechanism. Nineteen patients treated for paraesophageal hiatal hernias were included in the study. We investigated demographic data, diagnostic studies and symptoms of the patients together with the type of operation and outcome. Respiratory and gastrointestinal complaints were the prominent symptoms in most patients. Plain X-ray, contrast radiological study and esophagoscopy were used in the diagnostic workup. Surgical repair was performed via thoracic, abdominal or thoraco-abdominal approaches. Concomitant antireflux procedures were performed in 13 patients. Hiatal hernias in children may be asymptomatic or may present with a variety of symptoms or dramatic complications. Because of the risk of complications, surgical treatment is necessary shortly after diagnosis. Repair of the hiatus combined with antireflux surgery seems to yield satisfactory results.Öğe Paraesophageal hiatal hernias in children(Blackwell Publishing Asia, 2003) Yazici, M; Karaca, I; Etensel, B; Temir, G; Gunsar, C; Guclu, C; Mutaf, OHiatal hernia is a rare condition, which may be a cause of important clinical problems either as a mediastinal mass or as a cause of failure of the antireflux mechanism. Nineteen patients treated for paraesophageal hiatal hernias were included in the study. We investigated demographic data, diagnostic studies and symptoms of the patients together with the type of operation and outcome. Respiratory and gastrointestinal complaints were the prominent symptoms in most patients. Plain X-ray, contrast radiological study and esophagoscopy were used in the diagnostic workup. Surgical repair was performed via thoracic, abdominal or thoraco-abdominal approaches. Concomitant antireflux procedures were performed in 13 patients. Hiatal hernias in children may be asymptomatic or may present with a variety of symptoms or dramatic complications. Because of the risk of complications, surgical treatment is necessary shortly after diagnosis. Repair of the hiatus combined with antireflux surgery seems to yield satisfactory results.Öğe Treatment and prophylaxis with sucralfate ameliorates hypoxia/reoxygenation-induced intestinal injury in pup rats(Int Scientific Information, Inc, 2005) Sencan, AB; Sencan, A; Aktas, S; Habif, S; Kabaroglu, C; Parildar, Z; Karaca, IÖğe 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 Unstable modules over the Steenrod algebra(Elsevier Science Bv, 2002) Karaca, IIn this paper we generalize some results of Jmoui and Peterson (J. Pure Appl. Algebra 97 (1994) 37-50) to an odd prime p. In particular, we give a characterization in terms of the action of the Steenrod algebra of those unstable modules which are concentrated in even degrees and admit an injective resolution of which at least the first three terms are reduced. (C) 2001 Elsevier Science B.V. All rights reserved.
