Salim Bilici

Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study

Today, in spite of the developments in imaging methods and antibiotherapy, childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years, it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options. We excluded from the study cases with: i) thoracoscopic intervention and fibrinolytic agent were contraindicated; ii) immunosuppression or additional infection focus; iii) concomitant diseases, those with bronchopleural fistula diagnosed radiologically, and Stage I cases. This gave a total of 54 cases: 23 (42.6%) in stage II, and 31 (57.4%) cases in stage III. These patients were randomized into two groups of 27 cases each for debridement or fibrinolytic agent application by video-assisted thoracoscopic decortication (VATS). The continuity of symptoms after the operation, duration of thoracic tube in situ, and the length of hospital stay in the VATS group were of significantly shorter duration than in the streptokinase applications (P=0.0001). In 19 of 27 cases (70.37%) in which fibrinolytic treatment was applied and in 21 cases of 27 (77.77%) in which VATS was applied, the lung was fully expanded and the procedure was considered successful. There was no significant difference with respect to success rates between the two groups (P=0.533). The complication rate in our cases was 12.96% and no mortality was observed. Similar success rates in thoracoscopic drainage and enzymatic debridement, and the low cost of enzymatic drainage both served to highlight intrapleural streptokinase treatment as a reliable method in reducing the need for surgery in complicated empyema.

Conservative Surgical Treatment of Pulmonary Hydatid Disease in Children: An Analysis of 35 Cases

AbstractPurpose. Hydatid cyst disease is a major health problem for people who live in endemic countries such as Turkey. The definitive cure for pulmonary hydatidosis is still surgical. This study evaluates our experience of treating pulmonary hydatidosis, focusing on the conservative surgical management of children with this disease. Methods. We retrospectively analyzed 35 children ranging in age from 3 to 13 years old, treated for pulmonary hydatidosis during a recent 4-year period. Results. The 35 patients had a collective total of 48 cysts. Twenty-seven patients had a single cyst, 7 had unilateral multiple cysts, and 1 had bilateral multiple cysts. Six patients had multiple coexisting liver cysts. The 33 pulmonary cysts were intact and uncomplicated. Of the total 48 cysts, 34 were larger than 5 cm in diameter. Fever, cough, and dyspnea were the most common symptoms and chest radiography gave a correct diagnosis in 96.4% of the patients. Conservative surgical treatment was carried out in 33 of the 35 children (94%). There were few postoperative complications, and no mortality or recurrence in this series. Conclusions. Parenchyma-saving surgical procedures such as cystotomy and capitonnage are the preferred methods of treatment for pulmonary hydatid disease in childhood. These simple procedures are safe, reliable, and successful. Combined medical treatment can be given but not as an alternative to surgery. Simultaneous surgical procedures for coexisting liver cysts may be preferred because of the lower morbidity rates and hospitalization. Ultrasound or computed tomography scanning should be done to detect coexisting liver cysts in every patient with pulmonary hydatid disease.

Closure of large myelomeningocele defects using dorsal intercostal artery perforator flap.

Small meningomylocele defects can be closed primarily. Other repair techniques are required for closure of meningomyelocele defects of >5 cm. In this anomaly, in which random or musculocutaneous flaps are usually used, the technique for skin defect closure should have the following criteria: a safely harvested flap with good blood supply; minimal morbidity in the donor site; closure with adequate thickness to protect the underlying neural structure; and a repair to prevent leakage of cerebrospinal fluid. The dorsal intercostal artery perforator flap is a new perforator flap with a large skin island that can be used safely in the dorsal region. In this article, repair of large skin defects due to myelomeningocele has been attempted using a dorsal intercostal artery perforator flap, and the results are discussed.

Surgical treatment of right middle lobe syndrome in children

OBJECTIVE: Right middle lobe syndrome is a rare entity in children, causing high morbidity. Our experience of these patients including their clinical and laboratory characteristics, indications forsurgical management, postoperative courses, and follow-up results was evaluated. METHODS: A retrospective analysis was performed involving 20 children with right middle lobe syndrome who were hospitalized and treated with surgical resection of the right middle lobe in Van Training and Research Hospital and Yüzüncüyil university hospital, Turkey, between January 2002 and January 2011. RESULTS: The mean age of the patients was 10.5 years (range, 5 to 15 years). Twelve patients were boys and eight were girls. The most frequent symptom was chronic cough (75%). Hemoptysis was present in two (10%) patients. One patient was being treated for asthma. 25% positive cultures were identified among the patients. Streptococcus pneumoniae was the most frequently identified agent in sputum. All patients underwent chest computed tomography. There were bronchiectasis in 11 (55%) patients, atelectasis and bronchiectasis in five (25%) patients, and destroyed lung in four (20%) patients. A narrowed middle lobe bronchus was shown in 15 (75%) patients. Bronchoscopy was performed in 18 (90%) patients. Stenosis due to external compression was seen in 12 (60%) patients, hyperemia and bronchitis in two (10%) patients, granulation tissue in two (10%) patients, and dense secretions in two (10%) patients. A history of doctor-diagnosed tuberculosis was present in two (10%) patients. These patients had completed antituberculous treatment. The patients had been symptomatic for the last 1 to 10 years (mean, 4 years) and had received several medical treatments. All patients (totally 20 patients) underwent right middle lobe resection. In one patient, a bronchial abnormality was found intraoperatively. One patient died on postoperative day 10 due to a brain abscess. Three other patients had postoperative complications (15%). Mean duration of follow-up of the patients was 4.5 years (range, 2 months to 12 years). Seventeen patients were asymptomatic, and two patients had improved. CONCLUSIONS: Children with right middle lobe syndrome unresponsive to medical treatment should undergo early lobe resection to avoid serious complications and the progression of the disease to other segments or lobes.

The Clinical Outcome of 260 Pediatric ITP Patients in One Center

In the current study, clinical and laboratory findings and treatment modalities of children with acute and chronic immune thrombocytopenic purpura (ITP) were evaluated retrospectively. Our purpose was to determine clinical outcome of children with ITP and their responses to different treatment regimes. Total of 260 children with ITP were enrolled in the study. The mean age of patients was 76.8 ± 48.1 months. The therapy responses of high-dose methylprednisolone (HDMP; n = 134), standard dose methylprednisolone (n = 32), and intravenous immunoglobulin (IVIG; n = 15) treatments were similar. Two (0.8%) of the 260 ITP patients had intracranial bleeding. None of the patients died due to hemorrhage. Of all the patients with ITP, 191 (73.5%) completely resolved within 6 months after initiation of the disease and therefore they were diagnosed as acute ITP; 69 patients (26.5%) had progressed into chronic ITP. The therapy responses of HDMP, standard dose methylprednisolone, and IVIG treatments are similar.

Undescended testis accompanying congenital Spigelian hernia: is it a reason, a result, or a new syndrome?

INTRODUCTION Frequent reporting of cases of the coexistence of a Spigelian hernia (SH) with an undescended testis (UT) suggests that this phenomenon may be a syndrome. In this article, four pediatric cases in which an UT accompanies a congenital SH have been discussed in light of the literature. METHODS In this study, four cases aged between 6 months and 5 years who had a SH accompanied by an UT were evaluated and underwent surgery. RESULT The patients ages were 6 months, 1 year, 2 years, and 5 years old. The testis was observed in the opened hernia sac. The patients did not have a gubernaculum or an inguinal canal on the side of the hernia. CONCLUSIONS Neither the theories suggesting that SH leads to an UT nor those suggesting that an UT leads to a SH are satisfactory. We believe that this coexistence may be the congenital Spigelian-cryptorchidism syndrome seen in boys. As in the four cases presented here, elements of this syndrome are defects in the Spigelian fascia and the hernia sac enveloping the testis and an absence of the gubernaculum and the inguinal canal.

A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis

BackgroundAlthough the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis.MethodsWe reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively.ResultsMean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old). Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%), hemoptysis (35%), empyema (6%), and lung abscess (5%). There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2%) patients. Follow-up data were obtained for 123 (95%) of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection.ConclusionsSurgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

Acute appendicitis in two children with Henoch-Schönlein purpura.

Abstract In Henoch–Schönlein purpura (HSP), involvement of the ileum and ascending colon with vasculitis can mimic appendicitis and cause unnecessary appendicectomy. A 13-year-old boy presented with signs of HSP and abdominal pain. He was treated with prednisolone (2 mg/kg/day) for 10 days, but there was no improvement. At laparotomy he had acute suppurative appendicitis. A 12-year-old girl presented with HSP associated with abdominal pain and bloody diarrhoea and at laparotomy was also found to have suppurative appendicitis. Both patients had vasculitic areas in the ileum. In HSP, although suppurative appendicitis is rare, it should always be considered and appropriate investigations, including ultrasonography, undertaken.

Beneficial influence of topical extra virgin olive oil application on an experimental model of penile fracture in rats

Penile fracture (PF) is known as a traumatic rupture of the tunica albuginea of corpus cavernosum. In this study, we aimed to investigate the healing influence of topical extra virgin olive oil (EVOO) on PF through evaluating levels of some oxidative stress biomarkers for the first time. Histopathological evaluation was also realized. A total of 18 male Sprague-Dawley albino rats were divided into three groups of six rats each as control group, in PF (alone) group, and PF + EVOO group. Experimental PF was formed via incising from the proximal dorsal side of the penis in the rats of all groups except control. While in PF (alone) group, fracture was formed and the incision was primarily closed, in PF + EVOO group in addition to foregoing processes, EVOO was also administrated topically twice a day for 3 weeks. At the end of the experiment, all rats were killed and penectomy was carried out. While malondialdehyde, myeloperoxidase, lipid hyroperoxide, and total oxidant status significantly (p < 0.05) increased, reduced glutathione and total free sulfhydryl groups markedly (p < 0.05) decreased in PF (alone) group when compared with PF + EVOO group. Levels of these parameters were reversed to nearly normal values by topical EVOO application. Protection by EVOO is further substantiated via the improved histological findings in PF + EVOO group as against degenerative changes in the rats of PF (alone) group. Our data revealed that EVOO has protective effect in penile cavernosal tissue through probably its antioxidant, free radical defusing, anti-inflammatory, and antimicrobial effects.

Borchardt Triade: A Symptom of Acute Gastric Volvulus

DOI: 10.4328/JCAM.821 Received: 02.10.2011 Accepted: 18.10.2011 Printed: 01.07.2014 J Clin Anal Med 2014;5(4): 328-30 Corresponding Author: Salim Bilici, Department of Pediatric Surgery, Faculty of Medicine, Yuzuncu Yil University, 65200 Van, Turkey. T.: +905053509630 F.: +90 4322167519 E-Mail: salbilici@yahoo.com Özet Gastrik volvulus özellikle akut olgularda strangulasyon, perforasyon, peritonit, şok ve ölümle sonuçlanabilir. Çocuklarda nadirdir, fakat yaşamı tehdit ettiği için erken tanı ve tedavisi önemlidir. Akut gastrik volvuluslu hastalarda, klinik olarak üst abdomende veya alt toraksta ani başlayan şiddetli ağrı ve distansiyon, öğürmeye rağmen kusamama ve nazogastrik kataterin ilerletilememesi bulgularıyla karakterize Borchardt triadı gözlenebilir. Bu yazıda, Borchardt triadı ile tanı konan, diyafragma hernisi ve gezici (wandering) dalağın eşlik ettiği akut mezenteroaksiyal gastrik volvuluslu bir çocuk olgu sunularak Borchardt triadının vurgulanması amaçlandı.