Gungor Karaguzel - Academia.edu (original) (raw)

Papers by Gungor Karaguzel

Archives of disease in childhood - Education & practice edition, 2016

A 6-month-old boy was referred to our clinic with a 4-month history of progressive bilateral brea... more A 6-month-old boy was referred to our clinic with a 4-month history of progressive bilateral breast enlargement (figure 1). There was no history of maternal medication, infection, trauma, nipple discharge, contact with oestrogen products or familial breast disorder. He had bilateral painless breast enlargement without nipple discharge and signs of inflammation. His testes were both palpable in the scrotum, measuring 2 mL in volume. Figure 1 General appearance of the patient. There were no signs of other endocrine abnormalities. 1. From the patient's clinical presentation, what is the most likely diagnosis? 1. Prepubertal gynaecomastia 2. 46,XX disorder of sex development 3. 17α-hydroxylase deficiency 4. 46,XY disorder of sex development 5. Breast abscess 2. Other than breast ultrasound, which investigation(s) would you perform (multiple answers are possible)? 1. Whole blood count and erythrocyte sedimentation rate 2. Prolactin, total testosterone and oestradiol 3. Free thyroxine, thyroid stimulating hormone (TSH) and cortisol 4. Human chorionic gonadotropic hormone 5. Karyotype …

Turkiye Klinikleri Journal of Medical Sciences, 2002

Turkiye Klinikleri Journal of Pediatric Surgery Special Topics, 2008

Swiss Surgery, 2003

Total colonic aganglionosis (TCA) extended to the ileum is seen quite rare among infants with Hir... more Total colonic aganglionosis (TCA) extended to the ileum is seen quite rare among infants with Hirschsprung's disease. Type and timing of definitive surgery in these patients are controversial. This report was presented to discuss the management of two siblings with TCA. Case 1: A two-day-old girl was operated for partial intestinal obstruction. During laparotomy, serial frozen biopsies proved TCA extended to the terminal ileum and a loop ileostomy was performed. At five months of age, a modified Duhamel-Martin procedure without protective ileostomy was performed. An endo-GIA stapler was transanally used for colo-ileal anastomosis. She is doing well for the last five years. Case 2: A one-day-old boy admitted to the hospital with similar findings to his sister. Frozen biopsies during first laparotomy proved that majority of ileum and entire colon was aganglionic and a proximal ileostomy was performed. At 10 months of age, he underwent a similar Duhamel-Martin operation. He is in a good condition for the last four years. Conclusion: In infants, our modification on Duhamel-Martin procedure, which is based on the use of an endo-GIA stapler transanally for colo-ileal anastomosis without protective ileostomy, may be utilized as an alternative method in the definitive treatment of patients with TCA.

Swiss Surgery, 2003

We report a 5-year-old patient with phytobezoar mimicking acute appendicitis preoperatively. Duri... more We report a 5-year-old patient with phytobezoar mimicking acute appendicitis preoperatively. During laparotomy, it was detected that terminal ileum was obstructed by several fragments of rubbery material. Bezoar was milked into the large bowel, and phytobezoar including tangerine residues was evacuated via appendix stump because of severe distended cecum, and high risk of the anastomotic leakage and intraperitoneal contamination following enterotomy of the inflamated and ischemic ileum. Postoperative course was uneventful. To date, such a procedure has not been described. We suggest that milking of vegetable fibers into the cecum and then emptying via appendix stump may be an alternative treatment of phytobezoar localizing in terminal ileum.

Surgery Today, 2003

We present the case of a neonate with a sacrococcygeal teratoma showing organoid differentiation.... more We present the case of a neonate with a sacrococcygeal teratoma showing organoid differentiation. A 5-day-old baby girl was transferred to our hospital with a large sacrococcygeal mass. Ultrasonography revealed a few well-limited fluid-filled lesions, indicating that the teratoma had cystic components. During surgery, a sac containing 30 cm of small bowel loops was found in the tumor. The bowel segment

Pediatric Surgery International, 1993

A patient with isolated esophageal atresia and congenital esophageal stenosis resulting from intr... more A patient with isolated esophageal atresia and congenital esophageal stenosis resulting from intramural tracheobronchial remnants (TBR) in the distal esophagus is presented. The esophagographic appearance and operative findings suggesting the presence of TBR are discussed.

Pediatric Anesthesia, 2005

We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular ef... more We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg.kg(-1)) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery. All children were randomly allocated to receive 2 mg.kg(-1) propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Anaesthesia was maintained with 66% nitrous oxide in oxygen and 100-120 microg.kg(-1) propofol or sevoflurane approximately 2-3% inspired concentration with controlled ventilation. The ulnar nerve was stimulated at the wrist by a train-of four (TOF) stimulus every 20 s and neuromuscular function was measured at the adductor pollicis. When the response to TOF was stable, 0.2 mg.kg(-1) mivacurium was given. The trachea was intubated successfully at the first attempt in all patients. Onset time following a single dose of mivacurium was shorter in the sevoflurane group (2.99 min), than in the propofol group (4.42 min). The times to 25, 50, 75, and 90% recovery were significantly longer in the sevoflurane group (13.1, 15.7, 18.6, and 21.2 min, respectively) than in the propofol group (11.4, 13.2, 14.4, and 17.2 min respectively). TOF ratios of 50, 70, and 90% were significantly occurred later in sevoflurane group than propofol group. Our results indicate that when compared with propofol group, the sevoflurane group had an accelerated onset and a delayed recovery of neuromuscular block induced by mivacurium in children.

Journal of Pediatric Surgery, 1999

Journal of Pediatric Hematology/Oncology, 2012

Renal cell carcinoma is very rare in childhood. It is a different entity from its adult counterpa... more Renal cell carcinoma is very rare in childhood. It is a different entity from its adult counterpart. We report a case of renal cell carcinoma presented with hypocalcemia in a 16-year-old girl that is, to the best of our knowledge, the first such published incident. The patient was treated by radical nephrectomy with regional lymphadenectomy. Hypocalcemia amended after surgery. Neither chemotherapy nor radiotherapy was given. She has remained disease free for 34 months.

International Journal of Urology, 2005

Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with... more Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.

Pediatric Surgery International, 2005

We present an unusual case of Currarino syndrome with a mucosa-lined deep perineal fissure extend... more We present an unusual case of Currarino syndrome with a mucosa-lined deep perineal fissure extending to the sacrum, penoscrotal transposition, perineal hypospadias, and a penile ventral skin defect. The child had a sigmoid diverting colostomy because of high anal atresia. Magnetic resonance imaging illustrated absence of the levator ani and muscle complex in the pelvis. At 15 months, perianal examination pointed

Intensive Care Medicine, 2012

To evaluate the effects of three specific conditions related to critical care on adrenal function... more To evaluate the effects of three specific conditions related to critical care on adrenal function with special regard to the levels of serum cortisol, corticotropin (ACTH), dehydroepiandrosterone sulfate, and cytokines. The study enrolled a total of 74 children who were divided into three groups. Group 1 comprised 23 patients who had acute critical illness (ACI) associated with severe sepsis/septic shock. Group 2 comprised 27 patients who had ACI without sepsis. Group 3 comprised 24 patients who underwent major surgery. Blood samples were obtained for baseline measurements and a low-dose ACTH stimulation test (LD-ST) was performed. Serial ACTH and cortisol levels were measured with an interval of 3 days and LD-ST was repeated on day 14 for all groups. Baseline cortisol, ACTH, and dehydroepiandrosterone sulfate levels were significantly higher in patients with adrenal insufficiency (AI) than those of without AI. AI was detected in four patients in group 1, seven in group 2, and ten in group 3. Consecutive cortisol and ACTH levels did not differ significantly among the groups. On day 14, the recovery rate in patients with AI was 82 % in the whole group. Patient's age and interleukin-10 level were found to be independent predictors of AI. A considerable proportion of patients in these three groups had AI with a high spontaneous recovery rate in 2 weeks. The presence of sepsis was not associated with an increased risk of AI. Our serial cortisol and ACTH values in these different groups could be used as reference values for further studies.

European Journal of Pediatric Surgery, 2006

Experiential studies suggest that re-expansion of a collapsed lung may result in pulmonary ischae... more Experiential studies suggest that re-expansion of a collapsed lung may result in pulmonary ischaemia-reperfusion injury. We aimed to evaluate the effect of lung re-expansion on urinary lipid peroxidation products in neonates with pneumothorax. This study included 20 mechanically ventilated neonates with pneumothorax, and 18 healthy neonates (controls). A chest tube was inserted immediately following the diagnosis of pneumothorax. Urine samples were obtained just before tube thoracostomy (first period), after one hour (second period), every 12 hours by complete reexpansion (third period). Vital signs and ventilatory parameters were recorded. Urinary lipid peroxidation was evaluated by measurement of thiobarbituric acid-reacting substances (TBARS). No significant difference was found between urinary TBARS concentrations in the first, second and third periods (4.08 +/- 2.4 nmol/L, 2.8 +/- 2.3 nmol/L and 3.3 +/- 2.1 nmol/L, respectively). Control TBARS levels (4.1 +/- 2.1 nmol/L) did not significantly differ from those of the neonates with pneumothorax (p > 0.05). The neonates with pneumothorax had higher heart rates compared to the controls (p < 0.01). When compared with controls, the systolic pressure was lower in all periods (p < 0.01), and diastolic blood pressure was lower only in the first and second period (p < 0.05). Oxygen saturation significantly decreased in the first period compared to saturation of the second period and of controls (p < 0.01). Ventilatory parameters did not show any significant difference between the periods. This prospective study showed that re-expansion of the lung did not significantly affect urinary TBARS concentration in neonatal pneumothorax. Indirectly, short-term lung collapse followed by re-expansion might not cause a clinically significant reperfusion injury in newborns.

European Journal of Pediatric Surgery, 1994

Duodenal varices complicating extrahepatic portal hypertension in a 12-year-old girl resulted in ... more Duodenal varices complicating extrahepatic portal hypertension in a 12-year-old girl resulted in her presentation with massive upper gastrointestinal bleeding. This unusual occurrence resulted in delay in correctly localizing the bleeding varices.

European Journal of Pediatric Surgery, 1996

Although thyroid surgery is mainly based on the malignancy risk, determination of cases with thyr... more Although thyroid surgery is mainly based on the malignancy risk, determination of cases with thyroid malignancy among the patients with enlarged thyroid is a controversial issue in children. To find out whether thyroid enlargements have any predictive clinical or laboratory characteristic for thyroid malignancy, a retrospective clinical study was scheduled. A total of 137 patients who had undergone surgery for thyroid enlargement in a 15-year period were evaluated. The series was composed of 90 (65.7%) cases with uninodular goiter, 40 (29.2%) cases with multinodular goiter and seven (5.1%) cases with diffuse goiter. Histopathologic examination showed nine (6.6%) patients with differentiated thyroid carcinoma. All the remaining patients had benign thyroid enlargements. Analysis of results showed no ideal or near-ideal predictive one for thyroid malignancies among clinical or laboratory characteristics consisting of age, sex, presumptive symptoms, previous irradiation, type of nodularity, nodule localization and size, lymphadenopathy, thyroid function tests, ultrasonography and thyroid scan. No characteristic studied had a simultaneous high level of positive and negative predictive value. Only two physical characteristics including nodule size less than 2.5 cm in diameter and lymphadenopathy had simultaneous high levels of sensitivity and specificity above 50%. Therefore new guidelines with higher predictivity should be sought for surgical evaluation of the childhood thyroid enlargements. Fine-needle aspiration biopsy that is extensively used in adults may also be an alternative approach despite some restrictive aspects in children.

The Journal of …, 2006

Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We inves... more Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We investigated the efficacy of midline dorsal plication for recurrent chordee in complicated hypospadias reoperations. We retrospectively evaluated the charts of 25 boys who underwent reoperation between 1999 and 2004 due to complications of primary hypospadias repair other than meatal stenosis. A total of 15 cases were initially managed elsewhere for primary repair or complications. The etiology of recurrent chordee was defined at surgical correction. When recurrent chordee was noted a midline dorsal plication was performed. Of 25 patients 10 had previously undergone chordee repair. Nine of these patients were observed to have recurrent chordee and 1 had de novo chordee. A total of 10 patients had recurrent or delayed onset chordee. Mean patient age at primary repair was 6.28 years (range 1 to 33). Mean age at last operation for chordee was 15.9 years (range 4 to 66). Mean interval to recurrent chordee was 6 years (range 1 to 16), excluding a 66-year-old blind patient who did not know when recurrent chordee developed. Five patients had chordee recur before puberty at a mean interval of 2.6 years. Mean reoperation rate was 2.4 for recurrent chordee cases and 2.6 for chordee-free cases. Mean followup after midline dorsal plication for recurrent chordee repair was 22 months (range 8 to 56), while mean followup in pubertal and postpubertal cases was 20 months. No recurrence of chordee or surgery related morbidity was observed after recurrent chordee repair by midline dorsal plication. Chordee may recur during puberty following successful chordee repair. The midline dorsal plication technique is simple, efficient and safe even in patients who have undergone multiple surgeries for hypospadias and chordee repair.

TURKISH …, 2007

Rhabdomyosarcoma (RMS) is a common, highly malignant, uniformly fatal childhood malignancy, which... more Rhabdomyosarcoma (RMS) is a common, highly malignant, uniformly fatal childhood malignancy, which presents extremely rarely in the neonatal period; there are only a few reports about this tumor in this age group. While the primary tumor may arise virtually anywhere in the body, the extremity, orbit and genitourinary region are the most frequent sites; the retromammary region is extremely rare. Herein, we report a neonate with embryonal RMS arising from the anterior chest wall musculature at birth.

British Journal of Urology, 1994

To evaluate the effect of chemical sympathectomy on lactic acid and hypoxanthine concentrations i... more To evaluate the effect of chemical sympathectomy on lactic acid and hypoxanthine concentrations in both testes during unilateral testicular torsion in a rat experimental model. Four groups, comprising 10 rats each, were studied. Group I was the control group, Group II rats received a placebo and underwent unilateral testicular torsion, Groups III and IV received guanethidine monosulphate and 6-OH-dopamine hydrobromide respectively, and underwent unilateral testicular torsion. The levels of lactic acid and hypoxanthine in both testes were measured. In rats in Group II the levels of lactic acid and hypoxanthine in both testes were significantly elevated when compared to the control group. In the groups of rats that had undergone chemical sympathectomy, the levels of lactic acid and hypoxanthine were significantly decreased in the contralateral testes compared to rats in Groups I and II. Chemical sympathectomy prevents the elevation of lactic acid and hypoxanthine levels in the contralateral testis of rats with unilateral testicular torsion. Therefore, we conclude that contralateral testicular damage during unilateral testicular torsion may result through a reflex activating sympathetic system.

Archives of disease in childhood - Education & practice edition, 2016

A 6-month-old boy was referred to our clinic with a 4-month history of progressive bilateral brea... more A 6-month-old boy was referred to our clinic with a 4-month history of progressive bilateral breast enlargement (figure 1). There was no history of maternal medication, infection, trauma, nipple discharge, contact with oestrogen products or familial breast disorder. He had bilateral painless breast enlargement without nipple discharge and signs of inflammation. His testes were both palpable in the scrotum, measuring 2 mL in volume. Figure 1 General appearance of the patient. There were no signs of other endocrine abnormalities. 1. From the patient's clinical presentation, what is the most likely diagnosis? 1. Prepubertal gynaecomastia 2. 46,XX disorder of sex development 3. 17α-hydroxylase deficiency 4. 46,XY disorder of sex development 5. Breast abscess 2. Other than breast ultrasound, which investigation(s) would you perform (multiple answers are possible)? 1. Whole blood count and erythrocyte sedimentation rate 2. Prolactin, total testosterone and oestradiol 3. Free thyroxine, thyroid stimulating hormone (TSH) and cortisol 4. Human chorionic gonadotropic hormone 5. Karyotype …

Turkiye Klinikleri Journal of Medical Sciences, 2002

Turkiye Klinikleri Journal of Pediatric Surgery Special Topics, 2008

Swiss Surgery, 2003

Total colonic aganglionosis (TCA) extended to the ileum is seen quite rare among infants with Hir... more Total colonic aganglionosis (TCA) extended to the ileum is seen quite rare among infants with Hirschsprung's disease. Type and timing of definitive surgery in these patients are controversial. This report was presented to discuss the management of two siblings with TCA. Case 1: A two-day-old girl was operated for partial intestinal obstruction. During laparotomy, serial frozen biopsies proved TCA extended to the terminal ileum and a loop ileostomy was performed. At five months of age, a modified Duhamel-Martin procedure without protective ileostomy was performed. An endo-GIA stapler was transanally used for colo-ileal anastomosis. She is doing well for the last five years. Case 2: A one-day-old boy admitted to the hospital with similar findings to his sister. Frozen biopsies during first laparotomy proved that majority of ileum and entire colon was aganglionic and a proximal ileostomy was performed. At 10 months of age, he underwent a similar Duhamel-Martin operation. He is in a good condition for the last four years. Conclusion: In infants, our modification on Duhamel-Martin procedure, which is based on the use of an endo-GIA stapler transanally for colo-ileal anastomosis without protective ileostomy, may be utilized as an alternative method in the definitive treatment of patients with TCA.

Swiss Surgery, 2003

We report a 5-year-old patient with phytobezoar mimicking acute appendicitis preoperatively. Duri... more We report a 5-year-old patient with phytobezoar mimicking acute appendicitis preoperatively. During laparotomy, it was detected that terminal ileum was obstructed by several fragments of rubbery material. Bezoar was milked into the large bowel, and phytobezoar including tangerine residues was evacuated via appendix stump because of severe distended cecum, and high risk of the anastomotic leakage and intraperitoneal contamination following enterotomy of the inflamated and ischemic ileum. Postoperative course was uneventful. To date, such a procedure has not been described. We suggest that milking of vegetable fibers into the cecum and then emptying via appendix stump may be an alternative treatment of phytobezoar localizing in terminal ileum.

Surgery Today, 2003

We present the case of a neonate with a sacrococcygeal teratoma showing organoid differentiation.... more We present the case of a neonate with a sacrococcygeal teratoma showing organoid differentiation. A 5-day-old baby girl was transferred to our hospital with a large sacrococcygeal mass. Ultrasonography revealed a few well-limited fluid-filled lesions, indicating that the teratoma had cystic components. During surgery, a sac containing 30 cm of small bowel loops was found in the tumor. The bowel segment

Pediatric Surgery International, 1993

A patient with isolated esophageal atresia and congenital esophageal stenosis resulting from intr... more A patient with isolated esophageal atresia and congenital esophageal stenosis resulting from intramural tracheobronchial remnants (TBR) in the distal esophagus is presented. The esophagographic appearance and operative findings suggesting the presence of TBR are discussed.

Pediatric Anesthesia, 2005

We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular ef... more We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg.kg(-1)) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery. All children were randomly allocated to receive 2 mg.kg(-1) propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Anaesthesia was maintained with 66% nitrous oxide in oxygen and 100-120 microg.kg(-1) propofol or sevoflurane approximately 2-3% inspired concentration with controlled ventilation. The ulnar nerve was stimulated at the wrist by a train-of four (TOF) stimulus every 20 s and neuromuscular function was measured at the adductor pollicis. When the response to TOF was stable, 0.2 mg.kg(-1) mivacurium was given. The trachea was intubated successfully at the first attempt in all patients. Onset time following a single dose of mivacurium was shorter in the sevoflurane group (2.99 min), than in the propofol group (4.42 min). The times to 25, 50, 75, and 90% recovery were significantly longer in the sevoflurane group (13.1, 15.7, 18.6, and 21.2 min, respectively) than in the propofol group (11.4, 13.2, 14.4, and 17.2 min respectively). TOF ratios of 50, 70, and 90% were significantly occurred later in sevoflurane group than propofol group. Our results indicate that when compared with propofol group, the sevoflurane group had an accelerated onset and a delayed recovery of neuromuscular block induced by mivacurium in children.

Journal of Pediatric Surgery, 1999

Journal of Pediatric Hematology/Oncology, 2012

Renal cell carcinoma is very rare in childhood. It is a different entity from its adult counterpa... more Renal cell carcinoma is very rare in childhood. It is a different entity from its adult counterpart. We report a case of renal cell carcinoma presented with hypocalcemia in a 16-year-old girl that is, to the best of our knowledge, the first such published incident. The patient was treated by radical nephrectomy with regional lymphadenectomy. Hypocalcemia amended after surgery. Neither chemotherapy nor radiotherapy was given. She has remained disease free for 34 months.

International Journal of Urology, 2005

Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with... more Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.

Pediatric Surgery International, 2005

We present an unusual case of Currarino syndrome with a mucosa-lined deep perineal fissure extend... more We present an unusual case of Currarino syndrome with a mucosa-lined deep perineal fissure extending to the sacrum, penoscrotal transposition, perineal hypospadias, and a penile ventral skin defect. The child had a sigmoid diverting colostomy because of high anal atresia. Magnetic resonance imaging illustrated absence of the levator ani and muscle complex in the pelvis. At 15 months, perianal examination pointed

Intensive Care Medicine, 2012

To evaluate the effects of three specific conditions related to critical care on adrenal function... more To evaluate the effects of three specific conditions related to critical care on adrenal function with special regard to the levels of serum cortisol, corticotropin (ACTH), dehydroepiandrosterone sulfate, and cytokines. The study enrolled a total of 74 children who were divided into three groups. Group 1 comprised 23 patients who had acute critical illness (ACI) associated with severe sepsis/septic shock. Group 2 comprised 27 patients who had ACI without sepsis. Group 3 comprised 24 patients who underwent major surgery. Blood samples were obtained for baseline measurements and a low-dose ACTH stimulation test (LD-ST) was performed. Serial ACTH and cortisol levels were measured with an interval of 3 days and LD-ST was repeated on day 14 for all groups. Baseline cortisol, ACTH, and dehydroepiandrosterone sulfate levels were significantly higher in patients with adrenal insufficiency (AI) than those of without AI. AI was detected in four patients in group 1, seven in group 2, and ten in group 3. Consecutive cortisol and ACTH levels did not differ significantly among the groups. On day 14, the recovery rate in patients with AI was 82 % in the whole group. Patient's age and interleukin-10 level were found to be independent predictors of AI. A considerable proportion of patients in these three groups had AI with a high spontaneous recovery rate in 2 weeks. The presence of sepsis was not associated with an increased risk of AI. Our serial cortisol and ACTH values in these different groups could be used as reference values for further studies.

European Journal of Pediatric Surgery, 2006

Experiential studies suggest that re-expansion of a collapsed lung may result in pulmonary ischae... more Experiential studies suggest that re-expansion of a collapsed lung may result in pulmonary ischaemia-reperfusion injury. We aimed to evaluate the effect of lung re-expansion on urinary lipid peroxidation products in neonates with pneumothorax. This study included 20 mechanically ventilated neonates with pneumothorax, and 18 healthy neonates (controls). A chest tube was inserted immediately following the diagnosis of pneumothorax. Urine samples were obtained just before tube thoracostomy (first period), after one hour (second period), every 12 hours by complete reexpansion (third period). Vital signs and ventilatory parameters were recorded. Urinary lipid peroxidation was evaluated by measurement of thiobarbituric acid-reacting substances (TBARS). No significant difference was found between urinary TBARS concentrations in the first, second and third periods (4.08 +/- 2.4 nmol/L, 2.8 +/- 2.3 nmol/L and 3.3 +/- 2.1 nmol/L, respectively). Control TBARS levels (4.1 +/- 2.1 nmol/L) did not significantly differ from those of the neonates with pneumothorax (p > 0.05). The neonates with pneumothorax had higher heart rates compared to the controls (p < 0.01). When compared with controls, the systolic pressure was lower in all periods (p < 0.01), and diastolic blood pressure was lower only in the first and second period (p < 0.05). Oxygen saturation significantly decreased in the first period compared to saturation of the second period and of controls (p < 0.01). Ventilatory parameters did not show any significant difference between the periods. This prospective study showed that re-expansion of the lung did not significantly affect urinary TBARS concentration in neonatal pneumothorax. Indirectly, short-term lung collapse followed by re-expansion might not cause a clinically significant reperfusion injury in newborns.

European Journal of Pediatric Surgery, 1994

Duodenal varices complicating extrahepatic portal hypertension in a 12-year-old girl resulted in ... more Duodenal varices complicating extrahepatic portal hypertension in a 12-year-old girl resulted in her presentation with massive upper gastrointestinal bleeding. This unusual occurrence resulted in delay in correctly localizing the bleeding varices.

European Journal of Pediatric Surgery, 1996

Although thyroid surgery is mainly based on the malignancy risk, determination of cases with thyr... more Although thyroid surgery is mainly based on the malignancy risk, determination of cases with thyroid malignancy among the patients with enlarged thyroid is a controversial issue in children. To find out whether thyroid enlargements have any predictive clinical or laboratory characteristic for thyroid malignancy, a retrospective clinical study was scheduled. A total of 137 patients who had undergone surgery for thyroid enlargement in a 15-year period were evaluated. The series was composed of 90 (65.7%) cases with uninodular goiter, 40 (29.2%) cases with multinodular goiter and seven (5.1%) cases with diffuse goiter. Histopathologic examination showed nine (6.6%) patients with differentiated thyroid carcinoma. All the remaining patients had benign thyroid enlargements. Analysis of results showed no ideal or near-ideal predictive one for thyroid malignancies among clinical or laboratory characteristics consisting of age, sex, presumptive symptoms, previous irradiation, type of nodularity, nodule localization and size, lymphadenopathy, thyroid function tests, ultrasonography and thyroid scan. No characteristic studied had a simultaneous high level of positive and negative predictive value. Only two physical characteristics including nodule size less than 2.5 cm in diameter and lymphadenopathy had simultaneous high levels of sensitivity and specificity above 50%. Therefore new guidelines with higher predictivity should be sought for surgical evaluation of the childhood thyroid enlargements. Fine-needle aspiration biopsy that is extensively used in adults may also be an alternative approach despite some restrictive aspects in children.

The Journal of …, 2006

Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We inves... more Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We investigated the efficacy of midline dorsal plication for recurrent chordee in complicated hypospadias reoperations. We retrospectively evaluated the charts of 25 boys who underwent reoperation between 1999 and 2004 due to complications of primary hypospadias repair other than meatal stenosis. A total of 15 cases were initially managed elsewhere for primary repair or complications. The etiology of recurrent chordee was defined at surgical correction. When recurrent chordee was noted a midline dorsal plication was performed. Of 25 patients 10 had previously undergone chordee repair. Nine of these patients were observed to have recurrent chordee and 1 had de novo chordee. A total of 10 patients had recurrent or delayed onset chordee. Mean patient age at primary repair was 6.28 years (range 1 to 33). Mean age at last operation for chordee was 15.9 years (range 4 to 66). Mean interval to recurrent chordee was 6 years (range 1 to 16), excluding a 66-year-old blind patient who did not know when recurrent chordee developed. Five patients had chordee recur before puberty at a mean interval of 2.6 years. Mean reoperation rate was 2.4 for recurrent chordee cases and 2.6 for chordee-free cases. Mean followup after midline dorsal plication for recurrent chordee repair was 22 months (range 8 to 56), while mean followup in pubertal and postpubertal cases was 20 months. No recurrence of chordee or surgery related morbidity was observed after recurrent chordee repair by midline dorsal plication. Chordee may recur during puberty following successful chordee repair. The midline dorsal plication technique is simple, efficient and safe even in patients who have undergone multiple surgeries for hypospadias and chordee repair.

TURKISH …, 2007

Rhabdomyosarcoma (RMS) is a common, highly malignant, uniformly fatal childhood malignancy, which... more Rhabdomyosarcoma (RMS) is a common, highly malignant, uniformly fatal childhood malignancy, which presents extremely rarely in the neonatal period; there are only a few reports about this tumor in this age group. While the primary tumor may arise virtually anywhere in the body, the extremity, orbit and genitourinary region are the most frequent sites; the retromammary region is extremely rare. Herein, we report a neonate with embryonal RMS arising from the anterior chest wall musculature at birth.

British Journal of Urology, 1994

To evaluate the effect of chemical sympathectomy on lactic acid and hypoxanthine concentrations i... more To evaluate the effect of chemical sympathectomy on lactic acid and hypoxanthine concentrations in both testes during unilateral testicular torsion in a rat experimental model. Four groups, comprising 10 rats each, were studied. Group I was the control group, Group II rats received a placebo and underwent unilateral testicular torsion, Groups III and IV received guanethidine monosulphate and 6-OH-dopamine hydrobromide respectively, and underwent unilateral testicular torsion. The levels of lactic acid and hypoxanthine in both testes were measured. In rats in Group II the levels of lactic acid and hypoxanthine in both testes were significantly elevated when compared to the control group. In the groups of rats that had undergone chemical sympathectomy, the levels of lactic acid and hypoxanthine were significantly decreased in the contralateral testes compared to rats in Groups I and II. Chemical sympathectomy prevents the elevation of lactic acid and hypoxanthine levels in the contralateral testis of rats with unilateral testicular torsion. Therefore, we conclude that contralateral testicular damage during unilateral testicular torsion may result through a reflex activating sympathetic system.