Ibrahim Uygun

Fluoroscopic balloon dilatation for caustic esophageal stricture in children: an 8-year experience.

PURPOSE Esophageal balloon dilatation (EBD), when performed early and correctly, can efficiently treat caustic esophageal stricture (ES). Herein, we present 8 years of experience treating caustic ES, and discuss the technique as well as the complications. METHODS We retrospectively reviewed the medical records of 38 children in whom we performed fluoroscopic EBD under general anesthesia for caustic ES between November 2004 and November 2012 in our hospitals. The patients were grouped into the early dilatation group, who began EBD earlier (mean, 15 days) after caustic ingestion, and the late dilatation group who was referred later (mean, 34 days) for EBD by other centers. The ESs were classified into short and long strictures. Balloon size was increased gradually to a sufficient diameter over consecutive sessions. Characteristics of patients and ES, details of the EBD, and treatment results were analyzed. RESULTS A total of 369 EBD sessions were successfully performed in 38 children (aged 14 months to 14 years, median 3.5 years). In six patients, EBD treatments are continuing, one patient was lost to follow up, one patient who received a stent was excluded, and three returned to their previous centers. The remaining 27 patients were treated successfully by repeated EBD treatments. Nevertheless, in the early dilatation group (n=16), EBD treatment was significantly faster and shorter than that in the late dilatation group (n=11). In addition, the short stricture treatment was also of significantly shorter duration than the long stricture treatment. Six (1.6%) esophageal perforations occurred in five patients (13.2%); all were treated conservatively. There was no mortality. CONCLUSIONS For treatment of caustic ES, fluoroscopically guided EBD is safe and has a low rate of complications as well as a 100% success rate. However, it should be begun earlier, and in children, should be performed gently with balloons of gradually increasing appropriate diameters over consecutive sessions.

Peripherally inserted central catheters in the neonatal period

PURPOSE Peripherally inserted central catheters (PICC) have been extensively used in neonates. However, insertion of these thinnest catheters is a very delicate procedure associated with a high failure rate. In our Neonatal Surgical Intensive Care Unit, we developed a very easy new PICC insertion and evaluated the neonates treated with PICCs which were inserted by using our technique as well as catheter features such as success rate, number of insertion attempts, reason for removal and complications. METHODS Information was retrospectively collected on all 40 PICCs inserted at Kutahya Evliya Celebi Goverment Hospital and Dicle University Hospital during a 6-years period from September 2004 to September 2010. RESULTS A total of 40 PICCs were inserted in 37 patients (26, 70% males, 11, 30% females) by using new technique. The median age of patients was 8.3 days (range 1 to 66 days) and the median weight of patients was 2365 g (range 600 to 5000 g). The vein most commonly accessed was long saphenous vein (85%). The length of PICCs in the body was 19.6 cm (range 5 cm to 30 cm). The tip was located in a central vein in all patients. Surgical abdomen was the most common cause for PICC insertion (38%). Duration of catheterization was 7.7±5.6 days (1-F 5.5 days, 2-F 8.6 days). Almost all of the PICCs were inserted successfully (40/42, success rate 95%) and in the first venipucture (36/42, 86%). Completion of therapy and removed after death were achieved with 87% of PICCs. Three minor complications were noted. Minor bleeding in the insertion site which was stopped via compression occurred in two neonates. Major complication was not seen. No deaths were directly attributed to PICCs use. CONCLUSION The new insertion technique of the neonatal peripherally inserted central catheters may be one of the easiest and safest techniques, in comparison to previous techniques reported in the literature.

The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child

A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.

Traumatic diaphragmatic rupture in children

BACKGROUND The purpose of this study was to describe our experience with traumatic diaphragmatic rupture (TDR). Very little has been written about this condition in the pediatric age group. METHODS Between January 2000 and December 2011, data on twenty-two patients with TDR were analyzed, and clinical data were recorded. The patients were divided into subgroups based on injury type and ISS values. RESULTS Four patients were female, and eighteen were male. Mean age was 9.4 years (range 2-15 years). TDR was left-sided in twenty (91%) patients and right-sided in two (9%). The mean ISS (Injury Severity Score) was 19 (range 11-29). No significant difference in morbidity was noted between firearm and other injuries (p=0.565) or between ISS values below and above 16 (p=0.565). Seven patients (32%) had isolated diaphragmatic injury, while the other fifteen cases had additional associated injuries. Diagnoses were determined via a chest radiograph alone in the majority of cases, while suspected cases were confirmed by multidetector computed tomography if the patients were hemodynamically stable. Herniation was observed in twenty patients. Primary suture of the diaphragm and tube thoracostomy were performed in all patients. Postoperative complications included ileus (two cases), intussusception (one case), empyema (one case), and one patient succumbed during the operation. CONCLUSIONS TDR, while uncommon, should be considered in cases of thoracoabdominal injury. All patients should undergo meticulous examination preoperatively. When the chest radiograph does not provide a definitive diagnosis, multidetector computed tomography, including multiplanar reconstruction or volume rendering, may be beneficial for confirming suspicion of diaphragmatic rupture.

An Infantile Splenic Hemangiopericytoma Case Treated with Partial Splenectomy

Splenic hemangiopericytoma is a very rare tumor. So far only 10 patients (9 adults, 1 child) have been reported in the literature and all of them were treated with total splenectomy. Herein, we report the first infant case of the splenic hemangiopericytoma in a 10-month-old girl and the first case that was treated with partial splenectomy for splenic hemangiopericytoma.

Immediate primary anastomosis for isolated oesophageal atresia: A single-centre experience

Background: Isolated oesophageal atresia without tracheo-oesophageal fistula represents a major challenge for most paediatric surgeons. Here, we present our experience with six neonates with isolated oesophageal atresia who successfully underwent immediate primary anastomosis using multiple Livaditis circular myotomy. Materials and Methods: All six neonates were gross type A isolated oesophageal atresia (6%), from among 102 neonates with oesophageal atresia, treated between January 2009 and December 2013. Five neonates were female; one was male. The mean birth weight was 2300 (range 1700-3100) g. Results: All six neonates successfully underwent immediate primary anastomosis using multiple myotomies (mean 3; range 2-4) within 10 (median 3) days after birth. The gap under traction ranged from 6 to 7 cm. One neonate died of a major cardiac anomaly. Another neonate was lost to follow-up after being well for 3 months. Three anastomotic strictures were treated with balloon dilatation, and four anastomotic leaks were treated conservatively. The mean duration of follow-up was 33 months. Conclusions: To treat isolated oesophageal atresia, an immediate primary anastomosis can be achieved using multiple myotomies. Although, this approach is associated with high complication rates, as are other similar approaches, these complications can be overcome.

Total Esophageal Avulsion at the Esophagogastric Junction after Blunt Trauma

Total avulsion and transection of the esophagus at the esophagogastric junction are very rare after blunt trauma, and their management is challenging. Here, we present the case of a boy with this injury. To date, only two cases have been reported in children. One was treated successfully and the other died. The initial emergency operation should aim to save the life and native esophagus. Therefore, a primary or early thoracal end esophagostomy with gastrostomy should be performed, while primary repair should not be.

Cordycepin prevents postoperative formation of intra-abdominal adhesion in a rat model: An experimental study

BACKGROUND The aim of the present study was to investigate whether cordycepin prevented adhesion formation in a rat model. METHODS Rats were randomly assigned to 3 groups of 10 rats. CONTROL GROUP The absence of adhesion was confirmed via laparotomy. Adhesion group: The cecum was removed from the abdomen and scraped with a dry gauze bandage until petechial hemorrhagic foci developed. Cordycepin group: The same surgical procedure was performed as in the adhesion group, and 10 mg/kg cordycepin was administered intraperitoneally. After 15 days, the rats were sacrificed humanely via cardiac blood withdrawal under anesthesia. The rats were then analyzed morphologically and histopathologically, and hydroxyproline (OH-p) and malondialdehyde (MDA) levels were measured. RESULTS Macroscopic analysis revealed significantly less adhesion in the cordycepin group than in the adhesion group (p<0.01). Furthermore, significant histopathological improvement was also evident in the cordycepin group compared to the adhesion group (p<0.05). The levels of OH-p and MDA in blood and tissue were higher in the adhesion group than in the control group, and lower in the cordycepin group than the adhesion group. Interestingly, MDA level was significantly lower (blood: p<0.05; tissue: p<0.01) in the cordycepin group than in the adhesion group, whereas only tissue OH-p was significantly lower in the cordycepin group compared with the adhesion group (p<0.05). One rat in both adhesion group and cordycepin group died postoperatively. CONCLUSION Results indicated that cordycepin effectively reduced adhesion in a rat abrasion model. Thus, this agent may be valuable to prevent postoperative adhesion.

Peripherally inserted central catheter in neonates: A safe and easy insertion technique

PURPOSE Peripherally inserted central catheters (PICC) are used extensively in neonates. However, insertion of these thinnest catheters is a very delicate procedure. We developed an easy and safe insertion technique for 2-French (F) PICCs with a new fine-tipped introducer cannula created without modifying commercial products by advancing a 24-gauge peripheral venous cannula through a half-peeled (20-gauge) introducer cannula. We evaluated neonates treated with our new PICC insertion technique. METHODS Information was collected retrospectively on all 32 2-F PICCs inserted during the 4-year period from November 2010 to November 2014. We monitored neonates, recording the success rate of placement, number of insertion attempts, reasons for removal, and complications. RESULTS In total, 32 2-F PICCs were placed in 31 patients (19 (61%) males and 12 (39%) females; median age 7 (range: 1-36) days, median weight 2200 (range: 800-4100) g) using the new technique. The vein accessed most commonly was the long saphenous vein (87%). The duration of catheterization was 10.3 ± 4.2 days. Almost all PICCs were inserted successfully (32/33, success rate 97%) and in the first venipuncture (28/32, 88%). Of the PICCs, 81% were removed after completion of therapy or upon death. Two minor bleeding complications were noted at the insertion site. CONCLUSIONS This novel technique is an easy and safe way of inserting a 2-F PICC in neonates. It can be used by anyone in a neonatal unit who can insert a 24-gauge peripheral venous access.

Analysis of Risk Factors for Appendicitis in Children: A Multicenter Epidemiological Study

Objective: At the present times uterus transplantation is an alternative therapy for women with untreatable uterine-based infertility factors. Before transplantation, the donor organ must stored in some solutions, but they may not adequate for protection. In this study, we investigated the potential protective effects of acetyl L-carnitine, added into histidine-tryptophanketoglutarate (HTK) solution, on rat uterus. Methods: We divided 24 female Wistar Albino rats into four groups (n=6). Their uterine tissues were stored into four different solutions at different periods at 4oC ; Group 1 HTK, 4 hours; Group 2. HTK + acetyl L- carnitine, 4 hours, Group 3. HTK, 24 hours; Group 4. HTK + acetyl L- carnitine, 24 hours. Then tissues from uterus were used for histological and biochemical examination. Results: In the study the number of TUNEL positive cells in group 4 was lower than group 3. Biochemically evaluated TBARS and NOS levels were highest in group 3 however CAT level was highest in group 2. Conclusion: In conclusion, addition of acetyl L-carnitine to HTK solution reversed the histological alterations after 24 hours cold storage on rat uterus.Amac: Uriner sistem tas hastaliginin endourolojik tedavisinde ki gelismeler birincil secenek tedavi yontemleriyle ilgili tartismalara yol acmistir. Bu calismamizda, bobrek alt pol tasi olan hastalara klinigimizde uygulanan Ekstrakorporeal Şok dalga litotripsi (ESWL) tedavisinin sonuclari incelenmistir.Yontemler: Ocak- Temmuz 2013 tarihleri arasinda kontrastsiz bilgisayarli tomografi (BT) sonucuyla teshis edilip klinigimizde ESWL uygulanan 271 bobrek tasi hastasinin kayitlari retrospektif olarak incelendi. Tedavi oncesi ya da sonrasi izlemlerde kontrastsiz BT filmleri olmayan ve ESWL tedavisi tamamlanmayan hastalar calisma disi birakilmistir. 52 hasta, ESWL basarisina gore iki gruba ayrilmistir. ESWL basarisi, tasin buyuklugu, tasin yogunlugu ve tasin cilde olan uzakligi; kontrastsiz BT kayitlarinin incelenmesi ile saglanmistir.Bulgular: Calismamiz, 28 (%54) erkek ve 24 (%46) bayan hastadan olusmaktadir. Ortalama yas 46±12,3 (2173) idi. ESWL tedavisi alan ve calismaya dahil edilen 52 hastanin 24’u (%46,2) tedaviden fayda gormustur, 28’i (%53,8) tedaviden fayda gormemistir. Ortalama tas boyutu 9.8 mm (6-17 mm), ortalama tas-cilt mesafesi 93 mm idi, ortalama tas yogunlugu 845 HU idi. Tartisma: ESWL tedavisi bobrek alt pol taslarinda hala non-invaziv ve basarili bir yontemdir. ESWL basarisi degerlendirilirken secilen goruntuleme yontemi onemlidir ve abdominal BT’nin kullanimi dogru degerlendirme saglar. Minimal invaziv tedavi yontemlerinin yuksek basari oranlari umut vericidir ve gelecekteki tedavi yontemlerinin degisimine neden olabilirObjective: The aim of this study was to provide information on utilization of home health care services provided by government and determine health status of children and young people who received this medical care. Methods: Data for 576 patients who were followed and recorded by the health staff of the Ministry of Health between 2010 and 2015 were used in this study. Of these patients 234 (40.63 %) were female and 342 (59.37%) were male. The patients were divided into three age groups: 0-6 years of age: 93(16.15%), 7–14 years of age:219 (38.02%), and 15–22 years of age: 264 (45.83%). Results: There was no significant difference in gender between the age groups (χ2=1.077, p>0.05). In 2015, there was an increase in the prevalence of home care services across all age groups (χ2=38.734, p<0.01). Diyarbakir Children Hospital was more efficient than other hospitals (χ2=42.230, p<0.01) in providing this medical care. The most common diseases seen among these young patients were central nervous system diseases, neurodevelopmental diseases, and acquired brain injuries. In addition, epilepsy, SSPE, and cerebral palsy were also widely prevalent among this group of children and youth. The prevalence of cerebral palsy was larger in the 0–6 and 15–22 age groups (χ2=6.491, p<0.05). A prevalence of central nervous system diseases was seen most in the 0–6 age group (χ2=11.937, p<0.01). Apart from these, there were no other significance diseases observed by gender or age groups. Conclusion: After favorable adjustments to public home care services, an increase was seen in the utilization of services in recent years. As disabled patients need health care in their homes, this service has to be a primary goal for governments in order to provide them with a higher quality of life.Objectives: Papillary thyroid cancer (PTC) is the most common endocrine malignancy and the most common genetic anomaly with PTC is the BRAF V600E mutation. This mutation is linked to many clinical and pathological features and may have a diagnostic and therapeutic role especially in the era of targeted therapy. The aim of this study is to review the prevalence of BRAF V600E mutation in PTC, its distribution according to the histological subtype and geographic area and its association with the age of patients, gender, subtype and recurrence of tumors. Methods: The Pubmed database was searched to look for articles about BRAF mutation in PTC. Outcomes of interest included prevalence, age, gender, country, subtype and recurrence. Results: The prevalence of BRAF V600E mutation in PTC was 47%, with noticeably higher prevalence in the eastern countries. The prevalence of BRAF V600E was also higher in the tall and classic subtypes and could be associated with worse prognosis and higher risk of recurrence. Conclusions: The BRAF mutation, which is more prevalent in the eastern countries, is determined to be an important molecular marker for PTC.Objectives: In our study, the assessment of age, gender, incidence and seasonal differences in the regions related to appendicitis were investigated. Methods: 676 patients that received an operation following a diagnosis of appendicitis in 3 hospitals from 3 different regions of Turkey occurring at different dates were examined retrospectively after being categorized by region. The differences among groups were compared to each. Results: The mean age of male (63%) (n = 426) and female (37%) (n = 250) patients (total = 676) was 10.8 years (range, 1–18 years). The percentage of female patients in the The Black Sea Region (BR) group was significantly higher (48%) than that in the other two groups (%33 for SR, 30% for MR) (P = 0.001). The frequency of appendicitis was higher (36%) in the spring and winter (25%) than that during summer or fall. The number of cases increased the most in the BR group in spring (47%) (P < 0.001). When the types of appendicitis in the different age groups were compared with season, acute appendicitis (P < 0.02) was more frequently (93%) seen in the child-adolesan (CA) group in the spring; however, perfore apandicitis (45%) was greater in the Infant-Preschool (IPS) group (P < 0.02). Acute appendicitis comprised 55% and perforated appendicitis comprised 45% of cases in the IPS group, whereas acute appendicitis comprised 78% and perforated appendicitis comprised 22% in the CA group. Conclusion: According to the results of our study, appendicitis was most frequently seen in the spring and winter seasons and more frequent in boys between the ages of 10-13 years. As age decreases, the frequency of perforated appendicitis increases. Appendicitis is affected by environmental factors. Reducing the incidence of appendicitis may be possible by establishing regional and specific studies related to this subject and the etiologies of the disease.