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Ulusoy O, Şencan M, Ateş O, Hakgüder G, Olguner M, Bilici G, Erbil G, Akgür FM. Addition of Transfixation Suture to Purse String Suture During Intraperitoneal Inguinal Hernia Repair Increases Peri-Hernia Sac Neck Collagen Formation. J Pediatr Surg 2023:S0022-3468(23)00575-4. [PMID: 37845125 DOI: 10.1016/j.jpedsurg.2023.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The worldwide accepted repair for indirect inguinal hernia in children is high ligation of the hernia sac with open herniotomy. However, laparoscopic pediatric inguinal hernia repair (IHR) has been gaining popularity in the last two decades. An experimental study was conducted to investigate the effects of different intraperitoneal IHR suture techniques on the collagen formation at the hernia sac neck. METHODS Present study was conducted on thirty-five male adult (3-6 months old) Wistar-Albino rats (260-300 g). Intraperitoneal IHR with different hernia sac neck suturing techniques (purse string suture only, transfixation suture only and purse string suture plus transfixation suture) were performed through median laparotomy using open operative techniques. Non-absorbable 2/0 braided polyester suture with 16 mm 1/2 curved round needle (Ti-cron, Covidien, MN) was used as suture material. RESULTS The highest collagen thickness around the suture was detected in intraperitoneal IHR with purse-string plus transfixation suture group. The collagen thickness of the intraperitoneal IHR with purse string suture only and IHR with tranfixation suture only groups were not statistically significantly different. The collagen thickness of the intraperitoneal IHR with purse string suture plus transfixation suture group was statistically significantly higher compared with the intraperitoneal IHR with purse string suture only and intraperitoneal IHR with transfixation suture only groups. CONCLUSIONS The combined usage of purse string suture and transfixation suture during laparoscopic intraperitoneal inguinal hernia repair further stimulates mesothelial fibrosis at the hernia sac neck compared with mesothelial fibrosis induced by purse string suture only or transfixation suture only.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
| | - Müge Şencan
- Department of Pediatric Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Gökçen Bilici
- Department of Histology and Embryology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - Güven Erbil
- Department of Histology and Embryology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey; Department of Histology and Embryology, University of Kyrenia, Faculty of Medicine, Kyrenia, Northern Cyprus
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
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Ulusoy O, Aydın E, Ateş O, Hakgüder G, Özer E, Olguner M, Miraç Akgür F. Clues for the early loss of renal function in congenital hydronephrosis: Analysis of renal pelvis collagen ratio, diuresis renography and upper urinary tract morphology. J Pediatr Urol 2022; 19:197.e1-197.e7. [PMID: 36464563 DOI: 10.1016/j.jpurol.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Diagnosing real urinary obstruction and surgical decision making for the operative correction of urinary obstruction, are still problematic in congenital hydronephrosis (CH). Compliance of the renal pelvis is one of the important defense mechanisms of renal parenchyma against urinary obstruction. We observed early loss of function in some cases of CH with low and moderate anteroposterior diameter of the renal pelvis (APDRP). OBJECTIVE To evaluate structural properties of the renal pelvic tissue of patients with CH and the relation of these structural properties with renal function and Anteroposterior diameter of the renal pelvis. STUDY DESIGN Ureteropelvic junction (UPJ) excised during UPJ obstruction operations from 2013 to 2019 were evaluated histopathologically. The patients were divided into the two groups according to initial renal function, i.e. group with initial preoperative differential renal function (DRF) less than 35% and group with initial DRF greater than 35%. The percentage of collagen to whole tissue area were analyzed using image processing program. The relationship between DRF and tissue collagen ratio, SFU and APDRP was evaluated. RESULTS There were 5 patients in the DRF <35% group and 16 patients in the DRF >35% group. However, APDRP's of the DRF <35% group were also significantly lower than the DRF >35% group. The collagen distribution in the muscle layer was more prominent in the DRF <35% group. Proportionally, percentage of collagen stained surface was significantly higher in DRF <35% group. DISCUSSION There are numerous histopathological studies evaluating the cause of UPJ obstruction. Besides these studies that are oriented to etiology, there are many studies comparing the histopathological changes at UPJ with surgical outcome and prognosis. In the present study, we found that renal pelvis collagen ratio was significantly increased in patients with lower APDRP and with severe renal function loss. This increase in the collagen content in the renal pelvis have been shown to affect the compliance negatively and decrease APDRP, which leads to a faster loss of renal function. Thus, pelvic structural changes accompanying UPJ obstruction may aggravate urinary obstructive process. CONCLUSION Increased renal pelvis collagen ratio negatively affects the expansion of the renal pelvis, which is one of the protective mechanisms of the renal parenchyma, and may be one of the triggering mechanisms of early loss of renal function.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
| | - Efil Aydın
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Erdener Özer
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Ulusoy O, Karakuş OZ, Ateş O, Hakgüder G, Olguner M, Akgür FM. Diagnostic failures in ovarian torsion during childhood: The effect of ovarian cyst size on the diagnostic accuracy of Doppler ultrasonography. J Clin Ultrasound 2022; 50:660-665. [PMID: 35235217 DOI: 10.1002/jcu.23167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
| | | | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
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Ulusoy O, Sabuncu S, Karakuş OZ, Ateş O, Hakgüder G, Olguner M, Akgür FM. Urinary continence after high urogenital sinus repair conducted with posterior prone approach: electromyography-uroflowmetric assessment. Int Urol Nephrol 2021; 53:1813-1818. [PMID: 34037908 DOI: 10.1007/s11255-021-02895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to present the results of urinary continence assessment objectively with electromyography (EMG)-uroflowmetry after high urogenital sinus (HUGS) repair with posterior prone approach without division of rectum. METHODS The records of patients who underwent HUGS repair via posterior prone approach between January 2005 and July 2018 were reviewed retrospectively. Incontinence, dysuria, hesitation, and straining during urination were evaluated during the clinical follow-up. Dysfunctional voiding scoring system was used as a questionnaire. Patients were re-evaluated with EMG-uroflowmetry in terms of voiding volume and pattern, voiding time, maximum flow rate, average flow rate, maximum flow time, and post-voiding residual volume. RESULTS Seven patients with HUGS were treated with a posterior prone approach. The median age of the patients was 18 months (8-21 months). The median UGS length was 4.4 cm (3.6-5.5 cm), urethral length was 1.1 cm (1.0-1.5 cm), and vaginal length was 4.9 cm (4.1-5.1 cm). No urination or defecation problems were described by the patients or their parents. When the results of the dysfunctional voiding scoring systems questionnaire were analyzed, results scored 7 (range 5-8). EMG-uroflowmetric test graphics of the patients showed normal flow curves without plateau, intermittency or irregularity. Pelvic EMG assessment was normal in all patients. CONCLUSION EMG-uroflowmetry has shown objectively that urinary continence and normal voiding pattern are preserved after HUGS repair with posterior prone approach without division of rectum.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey.
| | - Serra Sabuncu
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Osman Zeki Karakuş
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
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Ulusoy O, Karakus OZ, Ateş O, Hakgüder FG, Olguner M, Akgür FM. Successful outcomes in adolescent varicocele treatment with high-level laparoscopic varicocelectomy. J Pediatr Surg 2020; 55:1610-1612. [PMID: 31378366 DOI: 10.1016/j.jpedsurg.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE In this study, we aimed to compare the effects of testicular vein ligation level on complications encountered; i.e. high-level ligation cranial to the linea terminalis vs ligation caudal to the linea terminalis. METHODS A total of 47 unilateral adolescent patients, treated with laparoscopic varicocelectomy between January 2004 and December 2017, were reviewed retrospectively. Patients were divided into two groups in terms of ligation level: caudal to the linea terminalis as group 1 and cranial to the linea terminalis as group 2. Symptoms, varicocele grades, preoperative testicular growth arrest, operative method, hydrocele formation, postoperative recurrence and testicular catch-up growth were recorded. RESULTS The mean operation time was 38.6 ± 10.2 min (34-53 min) in group 1 and was 33.6 ± 6.4 min (29-42 min) in group 2. Single hydrocele occurred in the laparoscopic nonselective varicocelectomy in group 1 (4.5%) and was successfully treated with open hydrocelectomy. Single varicocele recurrence was observed in the laparoscopic selective varicocelectomy in group 1 (4.5%) and treated with laparoscopic nonselective varicocelectomy cranial to the linea terminalis. CONCLUSIONS The high-level ligation of the spermatic veins cranial to the linea terminalis during laparoscopic varicocelectomy, independent of the technique applied, may contribute to reasonable low hydrocele and recurrence rates. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
| | - Osman Zeki Karakus
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Faika Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Ulusoy O, Özer E, Karakuş OZ, Ateş O, Hakgüder G, Olguner M, Akgür FM. Laparoscopic Excision of the Retroperitoneal Mullerian Cyst in a Different Location. J Pediatr Adolesc Gynecol 2020; 33:318-320. [PMID: 31874314 DOI: 10.1016/j.jpag.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Herein, we report laparoscopic excision of a retroperitoneal Mullerian cyst, which is uniquely located medial to the left adrenal gland, mimicking adrenal adenoma in an adolescent girl. CASE A healthy 13-year-old adolescent girl presented with secondary amenorrhea. Ultrasound and magnetic resonance imaging showed a solid-cystic mass medial to the left adrenal gland. Laparoscopic cyst excision was performed. The histopathological findings were consistent with a benign cyst of Mullerian origin. SUMMARY AND CONCLUSION To the best of our knowledge, this is the first case report of Mullerian cyst located medial to the adrenal gland in all age groups.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
| | - Erdener Özer
- Department of Pathology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Osman Zeki Karakuş
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Karakuş OZ, Ulusoy O, Ateş O, Hakgüder G, Olguner M, Akgür FM. Indirect inguinal hernia repair conducted with single conventional port intracorporeal conventional equipment-endoscopic surgery. Hernia 2020; 24:1063-1068. [PMID: 32152805 DOI: 10.1007/s10029-020-02165-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Laparoscopic or laparoscopy-assisted inguinal hernia repair (IHR) can be performed using one port plus two stab wounds. We herein present our experience with laparoscopic IHR conducted using a single conventional port and a single working instrument. METHODS The records patients who underwent single conventional port intracorporeal IHR during November 2013-December 2018 were evaluated. The main outcome measurements were patient's demographic characteristics, hernia side, presence of incarceration, operative time, and complications. RESULTS A total of 132 inguinal hernias (52 right, 40 left, and 20 bilateral) were repaired in 112 patients (76 boys, 36 girls). The mean ages of the patients were 69.8 ± 53.4 months (3 months to 17 years). In six patients, contralateral processus vaginalis was found to be patent during operation. Incarcerated inguinal hernia was present in two patients. Mean operative time was 17.9 ± 3.8 min (9-30 min) in unilateral hernias and 28.9 ± 6.5 min (24-45 min) in bilateral hernias. No intraoperative and postoperative complications were encountered. The mean hospital stay of the patients was 8.8 ± 5.0 h (4-36 h). Postoperative follow-up was 16.5 ± 5.1 months (6-24 months). No recurrent inguinal hernias were detected during follow-up. CONCLUSION Single conventional port intracorporeal IHR obviates additional stab wounds. Additionally, present technique eliminates the risk of skin puckering, subcutaneous granuloma, infection, nerve, and muscle damage development induced by the subcutaneously placed knot in laparoscopy-assisted IHR. Single conventional port intracorporeal IHR in children is a feasible and safe operative technique with low complication rates.
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Affiliation(s)
- O Z Karakuş
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey.
| | - O Ulusoy
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - O Ateş
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - G Hakgüder
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - M Olguner
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - F M Akgür
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
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Tekin A, Karakuş OZ, Hakgüder G, Ateş O, Özer E, Olguner M, Akgür FM. Distribution of interstitial cells of Cajal in the bladders of fetal rats with retinoic acid induced myelomeningocele. Turk J Urol 2016; 42:285-289. [PMID: 27909623 DOI: 10.5152/tud.2016.98474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Myelomeningocele (MMC) is one of the most common reason of neurogenic bladder dysfunction in children. Although neurogenic bladder dysfunction occurrence is related with bladder innervation, also there are some changes seen in the smooth muscle and neural cells of the bladder. Interstitial cells of Cajal (ICC) are the pacemaker cells found in organs with peristaltic activity. Although it has been shown that ICC are diminished in the rat urinary bladder with traumatic spinal cord injury, there is no data about ICC in fetal rat bladders with MMC. This study has been conducted to investigate the ICC in the bladders of fetal rats with retinoic acid induced MMC. MATERIALS AND METHODS Time dated pregnant Wistar albino rats were divided into 3 groups. In MMC group, dams were fed with gavage solution containing 60 mg/kg all-trans retinoic acid dissolved in olive oil on 10. embryologic day. Sham group animals were fed only olive oil. Control group dams were fed with standard rat chow. Fetuses were delivered by cesarean section and harvested on 22. embryologic day. MMC was identified by observing MMC sacs at the back of the fetuses. Distribution of ICCs were evaluated using immunohistochemical staining. RESULTS ICCs were found in all groups, which have the same morphological features that had been described earlier in the gastrointestinal tract and the bladder. The density of the ICC in the MMC group was found to be significantly decreased when compared with the control and the sham groups (p<0.05). CONCLUSION The density of the ICC in the urinary bladder decreased in the neurogenic bladder developed in MMC.
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Affiliation(s)
- Ali Tekin
- Departments of Pediatric Surgery, Section of Pediatric Urology, Ege University School of Medicine, İzmir, Turkey
| | - Osman Zeki Karakuş
- Departments of Pediatric Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Gülce Hakgüder
- Departments of Pediatric Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Oğuz Ateş
- Departments of Pediatric Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Erdener Özer
- Departments of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mustafa Olguner
- Departments of Pediatric Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Feza Miraç Akgür
- Departments of Pediatric Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Karakuş OZ, Ulusoy O, Ateş O, Hakgüder G, Olguner M, Akgür FM. Conventional single-port laparoscopic appendectomy for complicated appendicitis in children: Efficient and cost-effective. J Minim Access Surg 2016; 12:16-21. [PMID: 26917914 PMCID: PMC4746969 DOI: 10.4103/0972-9941.171958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND: Laparoscopic appendectomy (LA) is gradually gaining popularity among paediatric surgeons for complicated appendicitis. A retrospective study was conducted to compare conventional single port LA, multiport LA and open appendectomy (OA) for complicated appendicitis in children. PATIENTS AND METHODS: From January 1995 from December 2014, 1,408 patients (604 girls, 804 boys) underwent surgery for uncomplicated and complicated appendicitis. The patient characteristics, operation times, duration of hospitalization, operative costs, and postoperative complications were recorded. A 10-mm 0° scope with a parallel eye piece and an integrated 6 mm working channel were inserted through an 11-mm “conventional umbilical port” for single port LA. RESULTS: A total of 314 patients with complicated appendicitis (128 girls, 186 boys) underwent appendectomy. Among these, 102 patients (32.4%) underwent single port LA, 17 patients (5.4%) underwent multiport LA and 195 patients (62.1%) underwent OA. The hospital stay of the single port LA group was significantly less (3.88 ± 1.1) compared with multiport LA (5.41 ± 1.2) and OA groups (6.14 ± 1.1) (P < 0.001). Drain usage, wound infection and adhesive intestinal obstruction rates were significantly high in the OA group. There was no significant difference between the groups in postoperative intraabdominal abscess formation. Single-port LA performed for complicated appendicitis was cheaper compared with the other groups. CONCLUSIONS: The present study has shown that single-port LA for complicated appendicitis can be conducted in a reasonable operative time; it shortens the hospitalization period, markedly reduces postoperative wound infection and adhesive intestinal obstruction rates and does not increase the operative cost.
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Affiliation(s)
- Osman Zeki Karakuş
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Izmir, Turkey
| | - Oktay Ulusoy
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Izmir, Turkey
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Karakuş OZ, Ateş O, Tekin A, Hakgüder G, Olguner M, Akgür FM. Tubularized incised plate urethroplasty for the treatment of penile fistulas after hypospadias repair. J Pediatr Urol 2014; 10:455-8. [PMID: 24309516 DOI: 10.1016/j.jpurol.2013.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Urethrocutaneous fistula is the most common complication of hypospadias repair. Tubularized incised plate urethroplasty (TIPU) has been used for the management of distal fistulas. This study reports the usage of TIPU in the treatment of large penile fistulas. MATERIALS AND METHODS Between April 2002 and September 2012, 15 patients with large penile fistulas who were managed with TIPU were included in the study. The fistulas were sited along the penile shaft from proximal to distal penile localization. Glanular and coronal fistulas were excluded. The surgical technique was completed according to the standard TIPU technique. The surrounding scar tissue of the fistula was circumferentially excised, and the urethral plate at the level of the fistula was incised to provide performance of loose urethral tubularization. A urethral stent was kept for 5-7 days. RESULTS The mean age of the patients was 7.3 ± 3.1 years. Primary operation of these patients was tubularized preputial island flap (n = 6), on-lay preputial island flap (n = 4), and TIPU (n = 5). The sites of the hypospadias fistulas were as follows; penoscrotal (three), mid-penile (eight) and subcoronal (four). Fistulas recurred in two patients after fistula repair. The postoperative follow up of the patients was 12.4 ± 7.7 months. CONCLUSION TIPU may be used safely for the treatment of fistulas after hypospadias repair.
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Affiliation(s)
- O Z Karakuş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey.
| | - O Ateş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - A Tekin
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - G Hakgüder
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - F M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
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Hakguder G, Olguner M, Gürel D, Akgür FM, Flake AW. Induction of fetal diuresis with intraamniotic furosemide injection reduces intestinal damage in a rat model of gastroschisis. Eur J Pediatr Surg 2011; 21:183-7. [PMID: 21341178 DOI: 10.1055/s-0031-1271708] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Contact with amniotic fluid causes intestinal damage (ID) in fetuses with gastroschisis. Intraamniotic meconium has been shown to be responsible for ID, and ID has been shown to correlate with intraamniotic meconium concentrations. ID can be prevented by lowering the intraamniotic meconium concentration. A new method to lower intraamniotic meconium concentration might consist in the induction of fetal diuresis with intraamniotic diuretic injection. This hypothesis was tested in a rat model. MATERIALS AND METHOD There were 4 experimental groups. CONTROL GROUP Rat fetuses without any manipulation. Fetuses were harvested by cesarean section for examination at E21.5 (Term). SHAM GROUP: On E18.5, the hind limb of the rat fetuses were exteriorized by hysterotomy and replaced in the uterus. GASTROSCHISIS GROUP: Gastroschisis was surgically created in rat fetuses on E18.5, under a dissection microscope (16×). GASTROSCHISIS+FUROSEMIDE GROUP: After surgical creation of gastroschisis on E18.5, intraamniotic furosemide (5 mg/kg) was administered to the fetuses on E20. All fetuses were harvested on E21.5. RESULTS There was no significant difference between intestinal serosal thicknesses of the control and sham groups. The serosal thickness was significantly higher in the gastroschisis group compared to the control group. In the gastroschisis+furosemide group, the intestinal serosal thickness was found significantly decreased compared with the gastroschisis group. CONCLUSION Intraamniotic furosemide injection caused a substantial decrease in ID encountered in gastroschisis. The induction of fetal diuresis with intraamniotic furosemide injection seems promising as a prenatal treatment modality.
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Affiliation(s)
- G Hakguder
- Department of Pediatric Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.
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12
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Ateş O, Ağartan CA, Hakgüder G, Olguner M, Yenici O, Akgür FM. Can pulse oxymetry be used for measuring intestinal blood flow? Eur J Pediatr Surg 2007; 17:199-202. [PMID: 17638160 DOI: 10.1055/s-2007-965143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM When studying intestinal blood flow (IBF) using radiolabeled erythrocytes in the rabbit intestinal volvulus model, we also evaluated whether a pulse oxymeter (POX) could be used for the measurement of intestinal blood flow. METHODS IBF was measured with radiolabeled erythrocytes and POX in the rabbit intestinal volvulus model. The study was performed on 3 groups: 1) baseline, 2) volvulus, 3) volvulus plus devolvulus. RESULTS The POX and scintigraphic measurements were in correlation and showed that IBF stopped for 6 hours following volvulus. IBF was significantly decreased in the volvulus plus devolvulus group compared to the baseline group (p < 0.01). IBF measured with POX correlated with scintigraphic measurements. CONCLUSION POX is useful for the measurement of IBF and thus may be a cheap and reliable alternative to other intestinal blood flow measurement methods.
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Affiliation(s)
- O Ateş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
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13
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Abstract
BACKGROUND/PURPOSE Georgeson et al. have reported a new operative technique for the treatment of high anorectal malformations (ARM) instead of posterior sagittal anorectoplasty (PSARP). With this new operative technique, anorectal pull-through is performed without a posterior sagittal incision with laparoscopic assistance. Herein we report our experience with laparoscopy-assisted anorectal pull-through (LAARP). METHODS The hospital and the digital video records of 4 high ARM male patients who underwent LAARP between January 2002 and June 2004 were evaluated retrospectively. The LAARP procedure was accomplished as described by Georgeson et al. Dilatation of the neoanus was started on the 15th postoperative day and was continued twice daily until the desired anal diameter had been reached. The colostomies were closed thereafter. RESULTS LAARP was performed in the presence of colostomy in four patients. The first two patients are passing stools two or three times a day. A bowel management program has been initiated for the third patient, who is 4 years old. The last patient still has a colostomy. CONCLUSIONS The laparoscopically excellent visualization of the pelvic musculature, especially of the pubococcygeal muscles, provides a great opportunity for accurate placement of the rectum in its anatomically precise place, without dividing the sphincteric muscle complex. Although there is not enough data regarding fecal continence after LAARP, we think that LAARP provides a unique opportunity for the operative treatment of high ARM and should be the first choice procedure for the operative treatment of high ARM.
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Affiliation(s)
- G Hakgüder
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
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Hakgüder G, Ateş O, Olguner M, Riza Sişman A, Akgür FM. Is induction of fetal diuresis with intraamniotic furosemide effective for the removal of intestinal waste products from amniotic fluid? Eur J Pediatr Surg 2002; 12:293-8. [PMID: 12469253 DOI: 10.1055/s-2002-35958] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM In gastroschisis, contact with amniotic fluid (AF) causes intestinal damage. Intraamniotic meconium has been shown to be responsible for the intestinal damage, and intestinal damage has been shown to correlate with intraamniotic meconium concentrations. Intraamniotic meconium below a threshold level does not cause intestinal damage. Intraamniotic meconium concentrations can be lowered by AF exchange. Can induction of foetal diuresis by an intraamniotic injection of furosemide be used as an alternative method for the same purpose? METHOD Pregnant rabbits on the 23rd - 25th gestational days (normal gestation time: 31 - 33 days) were divided into two groups, the control group and the furosemide group. Initial AF samples were taken, then either 5 mg/kg furosemide or a placebo was injected into the amniotic cavity. Final AF samples were obtained 6 hours later. AF urea nitrogen, creatinine, amylase, alkaline phosphatase and bilirubin levels were determined. RESULTS There was no significant difference between the initial and final levels of AF urea nitrogen, creatinine, bilirubin, amylase, and alkaline phosphatase in the control group, while the final AF urea nitrogen and creatinine levels of the furosemide group were not significantly different from the initial levels (p > 0.05). Final AF bilirubin, amylase and alkaline phosphatase levels of the furosemide group were significantly decreased compared with initial levels (p < 0.01). CONCLUSION Induction of foetal diuresis with intraamniotic furosemide is effective for the removal of intestinal waste products from amniotic fluid.
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Affiliation(s)
- G Hakgüder
- Department of Paediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
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16
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Abstract
BACKGROUND/PURPOSE Contact with amniotic fluid (AF) causes intestinal damage in gastroschisis, which has been shown to be caused by intraamniotic meconium. However, whether this intraamniotic meconium-induced intestinal damage is concentration dependent has not been investigated previously. The purpose of this study is to investigate the effects of intraamniotic human meconium at various concentrations on the intestines of chick embryo with gastroschisis. METHODS Five-day-old fertilized chick eggs were used. Gastroschisis was created through the amniotic cavity without opening the allantoic cavity. Sterile meconium was obtained from newborn humans. Meconium suspensions at various concentrations were prepared using saline and instilled into the amniotic cavity. RESULTS Intraamniotic 1:200 and 1:400 meconium was found to cause intestinal damage. Meconium concentrations lower than 1:400 did not cause intestinal damage. Histopathologic examination of the intestines of the 1:200 and 1:400 meconium groups showed serosal thickening, inflammation, focal fibrin, and collagen deposits. Histopathologic features of the intestines of the 1:600 and 1:800 meconium groups did not differ from the intestines of the control group. CONCLUSION Intraamniotic meconium, which is responsible for intestinal damage in gastroschisis, must reach a threshold level to induce intestinal damage. J Pediatr Surg 36:1811-1815.
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Affiliation(s)
- A Api
- Departments of Pediatric Surgery and Pathology, Dokuz Eylül University Medical School, Izmir, Turkey
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Aktuğ T, Ozdemir T, Ağartan C, Ozer E, Olguner M, Akgür FM. Experimentally prefabricated bladder. J Urol 2001; 165:2055-8. [PMID: 11371927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
PURPOSE Long life expectancy after augmentation cystoplasty increases the importance of late complications of augmentation cystoplasty. Many complications are related to the mucosa of the intestinal flap used for augmentation cystoplasty. We compared a new prefabricated enterocystoplasty flap with the classic techniques of enterocystoplasty using seromuscular flaps. For prefabrication the seromuscular flap was partially grafted with uro-epithelium before augmentation cystoplasty. MATERIALS AND METHODS The study consisted of 4 groups. In the first 2 groups seromuscular flaps were used for augmentation cystoplasty with different sides of the flap inside the bladder. The muscular and serosal surfaces were prefabricated in groups 3 and 4, respectively. Prefabricated seromuscular flaps were used for augmentation cystoplasty after remaining in situ for 2 weeks. RESULTS While mean augmented bladder capacity in groups 1, 2 and 4 was 18 to 20 ml. after 8 weeks, capacity in the prefabricated seromuscular enterocystoplasty group was 50 ml. Histopathological examination showed severe fibrosis in all except the prefabricated seromuscular enterocystoplasty group. CONCLUSIONS Prefabrication allows the avoidance of the complications caused by intestinal mucosa in the reservoir and results in good capacity when the raw surface of the seromuscular flap is partially grafted with uro-epithelium before use.
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Affiliation(s)
- T Aktuğ
- Department of Pediatric Surgery, Dokuz Eylül University, School of Medicine, Inciralti, Izmir, Turkey
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Olinde JG, Zibari GB, Brown MF, Howell JG, Akgür FM, Granger DN, McDonald JC. Persantine attenuates hemorrhagic shock-induced P-selectin expression. Am Surg 2000; 66:1093-7; discussion 1097-8. [PMID: 11149578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Ischemia/reperfusion (I/R), a phenomenon that is associated with conditions such as organ transplantation, trauma, vascular disease, and stroke, involves the recruitment of activated and adherent leukocytes that subsequently mediate tissue injury. Endothelial cell adhesion molecules such as P-selectin mediate I/R-induced leukocyte recruitment and allow the adherent leukocytes to damage the vascular wall and parenchymal cells. This study examines the influence of dypiridamole (persantine) on hemorrhagic shock (H/S)-induced P-selectin expression. H/S was induced in C57BL/6 mice by withdrawing blood to drop the mean arterial blood pressure to 30 to 35 mm Hg for 45 minutes. The mice were resuscitated by infusing the shed blood and Ringer's lactate (50% shed blood volume). In vivo P-selectin expression was determined using a dual monoclonal antibody technique in the heart, lung, liver, kidneys, stomach, small bowel, and colon of a control group, a hemorrhagic shock group, and a hemorrhagic shock group that was pretreated with Persantine (Boehringer, Ingelheim, Ingelheim, Germany). H/S significantly (P < 0.01) increased P-selectin expression in all regional vascular beds of untreated mice. Persantine treatment largely prevented the H/S-induced P-selectin expression in the same vascular beds. Persantine significantly attenuates the upregulation of P-selectin in the hemorrhagic shock model.
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Affiliation(s)
- J G Olinde
- Department of Surgery, Louisiana State University Medical Center-Shreveport, 71130-3932, USA
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19
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Akgür FM, Aktuğ T, Hakgüder G, Olguner M. Differences between amnioinfusion and amniotic fluid exchange. J Pediatr Surg 2000; 35:1846-7. [PMID: 11101754 DOI: 10.1053/jpsu.2000.19295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Olguner M, Akgür FM, Ozdemir T, Aktuğ T, Ozer E. Amniotic fluid exchange for the prevention of neural tissue damage in myelomeningocele: an alternative minimally invasive method to open in utero surgery. Pediatr Neurosurg 2000; 33:252-256. [PMID: 11155062 DOI: 10.1159/000055964] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Experimental studies have shown that neural tissue damage in myelomeningocele (MMC) is acquired, resulting from exposure of neural tissue to amniotic fluid (AF). Similar to neural tissue damage in MMC, in gastroschisis, intestines exposed to AF are damaged. In gastroschisis, intestinal damage can be prevented by changing the composition of the AF with partial AF exchanges. An experimental study was performed to investigate whether the neural tissue damage in MMC can be prevented by AF exchange. METHODS Thirteen-day-old fertilized chick eggs were used. In group 1, the amnio-allantoic membrane was opened to create a common cavity, and MMC was created (MMC-only group). In group 2, after creation of MMC, amnio-allantoic fluid exchange was performed (MMC-plus-exchange group). Chicks were extirpated for histopathologic examination 5 days later. RESULTS While edema, focal calcification, fibrosis, capillary cell proliferation and scattered mononuclear cells were observed in the MMC-only group, histopathologic changes were mild in the exchange group. The number of neuron-specific enolase stainings (+) neural cell count was significantly higher in the exchange group compared to the MMC-only group (p < 0.01). CONCLUSION Exposure of MMC to AF causes structural neural tissue damage that can be prevented by AF exchange. AF exchange is minimally invasive compared to open in utero surgery for the closure of MMC. By AF exchange, neural tissue damage that occurs during the gestational period may be prevented.
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, School of Medicine, Izmir, Turkey.
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Affiliation(s)
- G Hakgüder
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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22
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Abstract
Bilateral perinatal testicular torsion (PTT) is an extremely rare condition. A baby boy at the postnatal 28th hour presented with right scrotal erythema and swelling, and left hydrocele were detected. There were no systemic symptoms. Right hydrocele had been detected during prenatal ultrasonography at the 34th week of gestation. Emergency technetium Tc 99m pertechnetate scintigraphy showed hypoperfusion in both sides suggesting testicular torsion. The patient underwent surgery immediately. Right necrotic testis was removed, left testis was judged as viable, and thus was treated with detorsion. Bilateral PTT in the neonate is a true emergency because of the risk of anorchia. Controversy still exists regarding the treatment of unilateral PTT. Some investigators suggest delayed operation regarding the anesthetic risk imposed on the neonate and the reality that operative salvage of the prenatally torsed testicle is a remote possibility. However, although asynchronous bilateral PTT is rare, the patient with unilateral PTT is at risk of contralateral testicular torsion in the waiting period of delayed operation. Therefore, the authors recommend early surgical intervention.
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University Medical School, Izmir, Turkey
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Abstract
Superoxide has been implicated in the regulation of endothelial cell adhesion molecule expression and the subsequent initiation of leukocyte-endothelial cell adhesion in different experimental models of inflammation. The objective of this study was to assess the contribution of oxygen radicals to P-selectin expression in a murine model of whole body ischemia-reperfusion, i.e., hemorrhage-resuscitation (H/R), with the use of different strategies that interfere with either the production (allopurinol, CD11/CD18-deficient or p47(phox)-/- mice) or accumulation [intravenous superoxide dismutase (SOD), mutant mice that overexpress SOD] of oxygen radicals. P-selectin expression was quantified in different regional vascular beds by use of the dual-radiolabeled monoclonal antibody technique. H/R elicited a significant increase in P-selectin expression in all vascular beds. This response was blunted in SOD transgenic mice and in wild-type mice receiving either intravenous SOD or the xanthine oxidase inhibitor allopurinol. Mice genetically deficient in either a subunit of NADPH oxidase or the leukocyte adhesion molecule CD11/CD18 also exhibited a reduced P-selectin expression. These results implicate superoxide, derived from both xanthine oxidase and NADPH oxidase, as mediators of the increased P-selectin expression observed in different regional vascular beds exposed to hemorrhage and retransfusion.
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Affiliation(s)
- F M Akgür
- Department of Pediatric Surgery, School of Medicine, Dokuz Eylül University, Izmir, Turkey 35340, USA
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey.
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Abstract
BACKGROUND Ependymomas, the common glial tumors of the spinal cord, occur occasionally outside the central nervous system and are called exstraspinal ependymomas (EEP). EEPs are found primarily in sacrococcygeal region during childhood. The pathogenesis and the treatment of the sacrococcygeal (SC) ependymomas are still controversial. Therefore, we present our case with metaanalysis of other case reports to determine the optimal treatment modality for SC EEPs. METHODS A metaanalysis of case reports of SC EEPs, including the current case, was conducted. Also all available case reports of EEPs, without age limit, were analyzed to determine the distribution of EEPs localization. RESULTS EEPs usually are found in teratoma localizations such as the SC area, ovary, paraovarian structures, and medastinum. The distribution of EEPs localization differs with age. Local recurrence rate of EEPs after coccyx excision is zero, however, it increases to 71% when the coccyx was left behind. CONCLUSION The identical clinical characteristics of the SC teratomas and EEPs imply that the SC EEPs may be monophasic teratomas as their ovarian counterparts are named. Coccyx excision is an important part of the surgical treatment of these tumors, with an apparent decrease in the recurrence rate.
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Affiliation(s)
- T Aktuğ
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Abstract
BACKGROUND/PURPOSE Urinary waste products in the amniotic fluid has been implicated as a cause of intestinal damage (ID) in gastroschisis based on the fact that fetus urinates physiologically into the amniotic cavity. However, experimental and clinical data suggest that intrauterine defecation is a physiological event, thus gastrointestinal waste products also may be responsible for ID in gastroschisis. An experimental study was performed to investigate the effects of intraamniotic human neonatal urine and diluted meconium on the intestines of chick embryo with gastroschisis. METHODS Five-day-old fertilized chick eggs (Gallus domesticus) were used. Gastroschisis was created through amniotic cavity without opening the allantoic cavity. Sterile urine and meconium were obtained from newborn humans, and 1% meconium suspension was prepared. The eggs were divided in to 3 groups. In the first group, gastroschisis was created, and amniotic fluid was reinstilled without changing its composition (control group). Equal amounts of amniotic fluid and urine mixture was instilled into the amniotic cavity in second group (urine group) and 1% meconium suspension was instilled in similar fashion in the third group after creation of gastroschisis (meconium group). RESULTS Histopathologic features of the intestines of the urine group did not differ from the intestines of the control group. The meconium group's bowel showed serosal thickening, inflammation, focal fibrin, and collagen deposits. Histopathologic changes of intestines induced by intraamniotic diluted meconium are consistent with the ones described for human gastroschisis specimens. CONCLUSION Gastrointestinal waste products seem responsible for the ID in gastroschisis rather than urinary waste products.
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University Medical School, Izmir, Turkey
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Akgür FM, Zibari GB, McDonald JC, Granger DN, Brown MF. Kinetics of P-selectin expression in regional vascular beds after resuscitation of hemorrhagic shock: a clue to the mechanism of multiple system organ failure. Shock 2000; 13:140-4. [PMID: 10670844 DOI: 10.1097/00024382-200013020-00008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leukocyte-endothelial cell interactions play an important role in mediating organ dysfunctions observed after hemorrhagic shock. P-selectin is the first endothelial cell adhesion molecule to be upregulated after an ischemic insult. The objective of this study was to define kinetics of P-selectin expression in different regional vascular beds of mice exposed to hemorrhagic shock. In-vivo P-selectin expressions were determined using dual radiolabeled monoclonal antibody technique in lungs, heart, liver, kidneys, intestinal mesentery, stomach, small bowel, and colon 0.5, 1, 2, 5, 10, and 24 h after resuscitation of 40 mmHg hemorrhagic shock. In another group, P-selectin expression was determined in same organs 5 h after resuscitation of 30 mmHg hemorrhagic shock. Hemorrhagic shock of 40 mmHg caused significant upregulation of P-selectin in lungs and liver at 30 min after resuscitation (P < 0.001). There was a second and more pronounced upregulation of P-selectin in lungs and liver at 5 h after resuscitation (P < 0.001). In heart, intestinal mesentery, stomach, small bowel, and colon, P-selectin was not upregulated until 5 h after resuscitation from 40 mmHg hemorrhagic shock (P < 0.001). While hemorrhagic shock of 40 mmHg did not cause P-selectin upregulation in kidneys, hemorrhage to 30 mmHg did elicit a significant increase at 5 h after resuscitation (P < 0.001). We conclude that P-selectin is upregulated after resuscitation of hemorrhagic shock in lungs, liver, heart, stomach, and intestines. P-selectin upregulation in kidneys only takes place after more severe hemorrhagic shock.
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Affiliation(s)
- F M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, School of Medicine, Izmir, Turkey
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Akgür FM, Olguner M, Aktug T. Investigating the effectiveness of ultrasound as a triage tool to evaluate blunt abdominal trauma in children. J Trauma 1999; 47:1162-3. [PMID: 10608557 DOI: 10.1097/00005373-199912000-00039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Dextran and pentoxifylline have been shown to prevent leukocyte-endothelium adherence encountered after hemorrhagic shock. P-Selectin is the first endothelial cell adhesion molecule to be upregulated after an ischemic insult. We investigated the effects of resuscitation with dextran 70 and administration of pentoxifylline during resuscitation on hemorrhagic shock-induced P-selectin expression. MATERIAL AND METHODS Hemorrhagic shock was induced in C57BL/6 mice by withdrawing blood to reduce mean arterial blood pressure to 30 mm Hg for 45 min. Animals were resuscitated by infusing one of the following solutions (each n:5): (1) Ringer's lactate, (2) 6% dextran 70, (3) Ringer's lactate plus 50 mg/kg pentoxifylline, (4) 5% human albumin. Afterward shed blood was infused. In vivo P-selectin expression was determined using dual-radiolabeled monoclonal antibody technique in lung, heart, liver, kidney, mesentery, stomach, small bowel, and colon 5 h after resuscitation. RESULTS P-Selectin was significantly upregulated in all of the organs studied in the Ringer's lactate resuscitation group (P < 0.001). Resuscitation with dextran 70 and administration of pentoxifylline during resuscitation prevented P-selectin upregulation. Resuscitation with human albumin caused significant attenuation but could not prevent P-selectin upregulation (p < 0.01). CONCLUSION Our study implies that the prevention of hemorrhagic shock-induced leukocyte-endothelium adherence by dextran 70 and pentoxifylline observed in other studies may be mediated by prevention of P-selectin expression by these agents.
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Affiliation(s)
- F M Akgür
- School of Medicine, Dokuz Eylül University, Izmir, Turkey.
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey.
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Akgür FM, Ozdemir T, Olguner M, Aktuğ T, Ozer E. An experimental study investigating the effects of intraperitoneal human neonatal urine and meconium on rat intestines. Res Exp Med (Berl) 1998; 198:207-13. [PMID: 9879599 DOI: 10.1007/s004330050104] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Urinary waste products (UWP) in the amniotic fluid have been held responsible for the intestinal damage (ID) in gastroschisis, based on the fact that the fetus urinates physiologically into the amniotic cavity. However, experimental and clinical evidence suggests that intrauterine defecation is a physiological event; thus gastrointestinal waste products (GWP) may also be responsible for ID in gastroschisis. An experimental study was performed to investigate the effects of intraperitoneal human neonatal urine and diluted meconium on rat intestines. Adult Wistar albino rats were used. Sterile urine and meconium were obtained from newborn humans and 5% meconium suspension was prepared. Histopathological features of the intestines of the rats injected with urine did not differ from the intestines of the untreated rats. The bowel in rats injected with a meconium suspension showed serosal thickening, inflammation, focal fibrin and collagen deposits. Histopathological changes in intestines induced by intraperitoneal diluted meconium were consistent with those described for human gastroschisis specimens. We conclude that GWP, rather than UWP, seems to be responsible for the ID in gastroschisis.
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Affiliation(s)
- F M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey.
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Abstract
Colonic atresia Hirschsprung's disease association (CAHDA) is usually diagnosed after several failures of intestinal anastomoses. Having previously reported one of the cases of CAHDA, we established the diagnosis in a patient before attempting intestinal anastomosis for stoma closure. We herein report the first patient with CAHDA in the literature diagnosed before a therapeutic challenge. We recommend a biopsy of the distal colonic segment either during initial laparotomy or before attempting intestinal anastomosis for closure of colostomy to prevent therapeutic challenge in the patients with colonic atresia.
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Affiliation(s)
- F M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Aktuğ T, Uçan B, Olguner M, Akgür FM, Ozer E, Calişkan S, Onvural B. Amnio-allantoic fluid exchange for the prevention of intestinal damage in gastroschisis. III: Determination of the waste products removed by exchange. Eur J Pediatr Surg 1998; 8:326-8. [PMID: 9926298 DOI: 10.1055/s-2008-1071225] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Experimental amnio-allantoic fluid (AAF) exchange has been shown to prevent intestinal damage in the chicken embryo gastroschisis model. AAF contains both urinary and gastrointestinal waste products (UWP and GIWP). An experimental study was performed to find the waste products responsible for this intestinal damage. Gastroschisis was created in 20 chick embryos. Half were treated with AAF exchange, the other half were not treated. AAF samples were obtained for biochemical determination of urea nitrogen and creatinine as UWP, bile acids and bilirubin as GIWP at the end of the incubation. Intestines were evaluated by light microscopy. While GIWP (Bile salts and bilirubin) were significantly removed from AAF by exchange, the levels of UWP (urea nitrogen and creatinine) were unaffected. Intestinal wall thickness was less in the exchange group compared to the untreated group. The unchanged levels of UWP after AAF exchange may be attributed to their relatively rapid production compared to GIWP. Dilution of GIWPs by AAF exchange results in prevention of the intestinal damage in gastroschisis.
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Affiliation(s)
- T Aktuğ
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Aktuğ T, Uçan B, Olguner M, Akgür FM, Ozer E. Amnio-allantoic fluid exchange for prevention of intestinal damage in gastroschisis II: Effects of exchange performed by using two different solutions. Eur J Pediatr Surg 1998; 8:308-11. [PMID: 9825243 DOI: 10.1055/s-2008-1071220] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevention of intestinal damage in gastroschisis was reported after amnio-allantoic fluid (AAF) exchange using serum saline. However it is not clear why AAF exchange prevents intestinal damage. Are some harmful chemicals withdrawn from AAF by exchange or sodium content of AAF is merely increased? A study was planned to find the end results of AAF exchange performed by using two different solutions in the chicken embryo gastroschisis model. After creation of gastroschisis, three groups were studied. In the first group AAF exchange was not performed. In the second group AAF exchange was performed using 0.075% NaCl solution (physiologic saline for chicken). In the third group AAF exchange was performed using 0.054% NaCl plus 1% dextrose solution. Exchange with two different solutions prevented cellular infiltration and fibrous peel formation in intestines which are observed in the non-treatment group. In the third group, intestinal edema was an additional pathologic finding. This study shows that in gastroschisis, the intestines outside the abdominal cavity are very sensitive to the quality of the fluid in which they are bathed. The intestinal damage resembling that encountered in human gastroschisis can be prevented by removing the harmful chemicals from AAF by exchange.
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Affiliation(s)
- T Aktuğ
- Department of Pediatric Surgery and Pathology, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Abstract
BACKGROUND/PURPOSE Similar to open appendectomy (OA), most of the methods described for laparoscopic appendectomy (LA) require two steps: (1) dissection and division of mesoappendix and (2) excision of appendix. Dissection of mesoappendix requires more skill and experience during LA. In single endoscopic GIA stapler laparoscopic appendectomy technique (SESLAT), both mesoappendix and base of appendix may be divided in one step with the application of a single endoscopic GIA stapler. METHODS LA was attempted in 18 patients who had acute appendicitis and was successfully performed in 16 patients. RESULTS In two patients, the operation was converted to OA. The authors did not need conversion to OA because of complication resulting from the use of the stapler. CONCLUSIONS SESLAT is a quick, easy, and versatile method for LA in children that obviates dissection of mesoappendix and related complications. Thus, it enables LA to be performed by inexperienced beginners.
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Akgür FM, Ozdemir T, Olguner M, Erbayraktar S, Ozer E, Aktuğ T. A case of split notochord syndrome: presence of dorsal enteric diverticulum adjacent to the dorsal enteric fistula. J Pediatr Surg 1998; 33:1317-9. [PMID: 9722015 DOI: 10.1016/s0022-3468(98)90179-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Like umblical enteric remnants (eg, umblical sinus and omphalomesenteric fistula), enteric remnants can be seen on the dorsal aspect of the body (dorsal enteric sinus, dorsal enteric fistula IDEF], dorsal enteric diverticulum) in conjunction with complete cleft of the vertebral column. Complete cleft of the vertebral column associated with gastrointestinal tract and central nervous system anomalies is known as "split notochord syndrome" (SNS). The authors present an unreported variant of SNS having dorsal enteric diverticulum adjacent to the DEF. The patient died 17 days after surgical repair.
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Affiliation(s)
- F M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Abstract
Methylene blue (MB) alone, MB metabolites in the urine and the effect of MB plus alkalization on Candida species were determined. MB was used for the treatment of childhood renal candidiasis (CRC) in 3 patients as an irrigating solution. Besides irrigation, fluconazole 3 mg/kg/day intravenously and MB 0.2 mg/kg/day were administered perorally. Urine cultures were cleared of Candida. DMSA scans obtained after 6 months showed no evidence of scarring. MB can be used for irrigation of the urinary tract, with fewer side effects than amphotericin B (AB). Additionally we advocate the use of ureteral catheters instead of nephrostomy in the treatment of CRC.
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Affiliation(s)
- T Aktug
- Department of Paediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Aktuğ T, Demir N, Akgür FM, Olguner M. Pretreatment of gastroschisis with transabdominal amniotic fluid exchange. Obstet Gynecol 1998; 91:821-3. [PMID: 9572175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intestinal thickening in gastroschisis results from prolonged exposure to amniotic fluid (AF). Experimental AF exchange has been shown to prevent intestinal thickening in gastroschisis. CASE A 25-year-old primigravida was referred at 24 weeks' gestation with a prenatal diagnosis of gastroschisis. Transabdominal AF exchange was performed at 29 weeks. This pretreatment did not cause any complications and prevented intestinal thickening in our patient. Thus, we were able to perform primary fascial closure with an intra-abdominal pressure less than 5 mmHg. We began feeding the infant on the 5th day and discharged her on the 8th day. CONCLUSION Evidence obtained from this initial case seems promising for the further application of the AF exchange for prevention of intestinal thickening in gastroschisis.
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Affiliation(s)
- T Aktuğ
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey.
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Abstract
Hoarseness caused by mediastinal cystic hygroma has not been reported before. The authors report a case of mediastinal cystic hygroma in which the patient's only symptom was hoarseness. A 6-year-old girl had hoarseness. Physical examination findings were normal except for indirect laryngoscopy, which showed unilateral vocal cord paralysis. The chest radiograph showed an opacification 3 cm wide in the left side of the superior mediastinum. Through a median sternotomy, a large multicystic mass was resected. During resection, left laryngeal recurrent nerve was seen to be intact, and its integrity was preserved. Six months later the left vocal cord was moving to a limited extent. A chest radiograph should be considered in a case of hoarseness caused by a peripheral nerve lesion to detect a mediastinal mass without any cervical component.
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Affiliation(s)
- C Ağartan
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Abstract
A rare tumour of a prepubertal child, an epidermoid cyst, was excised with testicular preservation. Childhood testicular tumours are usually benign. Although epidermoid cysts of the testis may have teratomatous component, testicular teratomas are generally benign in the prepubertal child. For these reasons testis sparing surgery seems applicable in childhood epidermoid cysts.
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Affiliation(s)
- M Olguner
- Department of Paediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Abstract
A 3.5-year-old girl who had congenital esophageal stenosis caused by tracheobronchial remnants without esophageal atresia or tracheoesophageal fistula is presented. The diagnostic difficulties are discussed.
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University Medical Faculty, Izmir, Turkey
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Olguner M, Aktug T, Akgür FM, Pabuçcuoglu U. Experimental study investigating the feasibility of a new method for laparoscopic indirect inguinal hernia repair. J INVEST SURG 1997; 10:189-92; discussion 192-3. [PMID: 9284003 DOI: 10.3109/08941939709032156] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
With the progress in laparoscopic techniques in recent years, there is an increased interest in laparoscopic hernia repair. The laparoscopic indirect inguinal hernia repair with simple closure of the internal ring seems feasible in childhood inguinal hernia repair; however, this technique carries the risk of postoperative patent processus vaginalis. In this-study we investigated the possibility of avoidance of this complication by chemical obliteration of processus vaginalis with 6% iodine solution in rats. The study population was comprised of three groups: simple suture of the internal ring, iodine application plus simple suture of the internal ring, and iodine application alone. While processus vaginalis was anatomically closed in 75% of the rats in the iodine plus simple suture of the internal ring group, it was closed in 10% of the iodine application alone group and was not closed in the simple suture of the internal ring alone group. No histopathologic injuries to the testis or cord were detected attributable to iodine. Our study showed that simple suture of the internal ring is not sufficient for hernia repair. Laparoscopic chemical agent application in addition to simple suture of the internal ring may be beneficial for successful laparoscopic indirect inguinal hernia repair in children.
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Affiliation(s)
- M Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Akgür FM, Aktuğ T, Olguner M, Kovanlikaya A, Hakgüder G. Prospective study investigating routine usage of ultrasonography as the initial diagnostic modality for the evaluation of children sustaining blunt abdominal trauma. J Trauma 1997; 42:626-8. [PMID: 9137248 DOI: 10.1097/00005373-199704000-00007] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this prospective study, 217 children sustaining blunt abdominal trauma were initially evaluated with ultrasonography (US) and those with any abnormal ultrasonographic findings were further evaluated with computed tomography. Results of ultrasonographic examination were normal in 157 children and showed abnormalities such as free intraperitoneal fluid (FIF), intra-abdominal organ injury, and intrapleural fluid in 60 children. Computed tomographic examination of the 42 children with organ injury, the seven children with minimal FIF of no definite source, and the three children with intrapleural fluid revealed findings consistent with ultrasonographic findings. Computed tomographic examination of the eight children with more than minimal FIF of no definite source detected by US showed the source as liver injury in one and spleen injuries in two patients. The source of FIF could not be identified with computed tomography in five patients. After clinic follow-up examination, one of these five patients was operated on for abdominal tenderness, fever, and air-fluid levels detected on plain abdominal radiographs, and duodenal perforation was encountered. Clinical courses of the patients with normal ultrasonographic findings were uneventful. We conclude that US, aside from being a screening tool, is alone sufficient in the evaluation of the majority of the children sustaining blunt abdominal trauma. Although this is a preliminary study with further work needed to be done, we propose that further evaluation with computed tomography should be performed on those children in whom more than minimal FIF of no definite source is detected with US.
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Affiliation(s)
- F M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey.
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Aktuğ T, Hoşgör M, Akgür FM, Olguner M, Kargi A, Tibboel D. End-results of experimental gastroschisis created by abdominal wall versus umbilical cord defect. Pediatr Surg Int 1997; 12:583-6. [PMID: 9354730 DOI: 10.1007/bf01371904] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An experimental study was conducted to determine the end-results of two different defects on the anterior abdominal wall: an abdominal wall defect (AWD) versus an umbilical cord defect (UCD) using chick embryos. The AWD was created by leaving an intact skin bridge between the defect and the umbilical cord in group 1; the UCD was created on the umbilical cord near the junction of the skin in group 2. At the end of incubation, the intestines appeared hemorrhagic in the AWD group, but not in the UCD group. During microscopic examination, hemorrhagic areas were observed in the bowel wall and mucosal villi in the AWD group but not in the UCD group. The end-result of the defect causing the physiological umbilical hernia resulted in bowel damage resembling the classic picture of gastroschisis (GS). We conclude that the site of the defect in GS is not the abdominal wall itself, but the physiological umbilical hernia.
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Affiliation(s)
- T Aktuğ
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Aktuğ T, Akgür FM. Diagnostic pneumoperitoneum accurately predicts the presence of patent processus vaginalis. J Pediatr Surg 1996; 31:1463. [PMID: 8906691 DOI: 10.1016/s0022-3468(96)90859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Akgür FM, Olguner M, Yenici O, Gökden M, Aktuğ T, Yilmaz M, Ataç G. The effect of allopurinol pretreatment on intestinal hypoperfusion encountered after correction of intestinal volvulus. J Pediatr Surg 1996; 31:1205-7. [PMID: 8887084 DOI: 10.1016/s0022-3468(96)90232-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
After reversal of blood flow following a prolonged period of ischemia, blood flow returns for a few seconds and is reduced afterward. This is called "no-reflow phenomenon." Antioxidants such as allopurinol have been shown to prevent the occurrence of this phenomenon in organs other than the intestine. An experimental study was conducted to investigate the effect of allopurinol pretreatment on intestinal blood flow after correction of intestinal volvulus in rabbits. In group 1, baseline intestinal blood flow (IBF) was evaluated using radiolabeled red blood cells. In group 2, 720 degrees intestinal volvulus was created and IBF was evaluated 6 hours later. In group 3, intestinal volvulus was created and devolvulus was performed 6 hours later. Intraperitoneal isotonic saline was injected 60 minutes before correction of the volvulus. IBF was evaluated after correction of the volvulus. Group 4 had the same procedures as group 3, but allopurinol (200 mg/kg) was injected in place of the isotonic saline. IBF stopped 6 hours after volvulus. Compared with the baseline group, IBF was significantly lower in the group with volvulus + devolvulus (P < .01). The IBF of the allopurinol-treated group was significantly higher than that of the isotonic saline group (P < .01) and it did not differ significantly from that of the baseline group. Histopathological examination showed that intestinal volvulus leads to histological injury. The histological injury was more pronounced in the devolvulus group and was less severe in the allopurinol group in comparison to the isotonic saline pretreatment group (P < .01). It is concluded that allopurinol pretreatment prevents the intestinal hypoperfusion (no-reflow phenomenon) and histological injury encountered after correction of intestinal volvulus of 6 hours' duration.
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Affiliation(s)
- F M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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Olguner M, Akgür FM, Aktuğ T, Canda T. Testis sparing surgery for epidermoid cyst of the testis: a case report. Int Urol Nephrol 1996; 28:215-7. [PMID: 8836792 DOI: 10.1007/bf02550864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A rare tumour of the prepubertal child, an epidermoid cyst was excised with testicular preservation. Childhood testis tumours are usually benign. Although epidermoid cysts of the testis may have teratomatous component, testicular teratomas are generally benign in the prepubertal child. For these reasons testis sparing surgery seems applicable in childhood epidermoid cysts.
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Affiliation(s)
- M Olguner
- Department of Paediatric Surgery, Dokuz Eylül University, Medical Faculty, Izmir, Turkey
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