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Objective: In this study, we aimed to evaluate the role of pediatric surgery in the problem-based learning (PBL) system, which is included in the curriculum of our medical faculty. Material and Methods: In order to comparatively evaluate the contributions of teaching staff of Department of Pediatric Surgery”, contributions of lecturers serving in the blocks, curriculum commitees and clinical scenarios of PBL were reviewed The distribution of clinical scenarios which also included pediatric surgery among years and education terms were assessed. Results: Within the last 6 years, clinical scenarios related to pediatric surgery were elaborated in two blocks in the Years I and III of the medical faculty. DPS contributed to 8 (38 %) out of 21 blocks of the first three years (38 %). From the 68 clinical scenarios of the above mentioned blocks, DPS contributed directly to the writing process of 25 (36.8 %) scenarios. Among 40 departments of the medical faculty, our department was one of the departments which made the greatest contributions to the PBL system. Lecturers of DPS had assumed responsibilities in three blocks and curriculum,and student assessment commitees. Conclusion: Pediatric Surgery has a very large area of interest, which opens opportunities to contribute to the medical education both in the learning of clinical sciences and basic medical sciences. © Cocuk Cerrahisi Dergisi. All rights reserved.

Aim: In this comparative study, we retrospectively evaluated ovarian and paraovarian cysts. Patients and Methods: Thirty-four children with ovarian and paraovarian cysts were evaluated according to age, clinical and imaging findings, treatment modality, lenght of hospital stay (LOS) and complications. Cysts less than 5 cm were not operated. Patients diagnosed as intrauterine ovarian and paraovarian cysts were evaluated after birth. Detorsion was performed in patients with torsion. The gonads were preserved excepting cases with marked ovarian necrosis. Cysts were evacuated, and their epithelium was peeled off. Results: The median age of the patients was 13 years (3 days-17 years). Ultrasonography and abdominal CT revealed cysts more than 5 mm or torsioned cysts in all patients but two. Each patient with acute abdomen and abdominal mass underwent laparoscopy without any finding at imaging modality. Twenty-two patients were operated laparoscopically, and 12 with open surgery. We detected ovarian/tubal torsion in 17, ovarian cysts in 12, paraovarian cysts in 4, concomittant ovarian and retroperitoneal cysts in 1 patient, respectively. The largest diameters of the cysts were 6-30 cm. Oopherectomy was performed in 7 patients. Each one patient had prolonged ileus and intraoperative bleeding. No further complication was seen. One patient with open surgery had a mature cystic teratoma, whereas all other patients had simple cysts. The mean duration of lapa-roscopic surgery (TOS) was significantly decreased (Open surgery 88.1±13.3 min and laparoscopic surgery 72.8±13.5 min) (p

Aim: The aim of this study was to determine and compare functional outcomes of single stage transanal endorectal pull-through (TAP) and staged Soave procedure. Methods: Medical records of 41 patients (28 males, 13 females) who were operated on for Hirschsprung's disease between February 2004 and March 2007 were reviewed retrospectively. Three non-survived patients were excluded from study. No patient had total colonic aganglionosis. Demographic findings, type of surgery and length of hospital stay (LOS) were recorded for each patient. The parents were asked to fill a questionaire containing questions about quality of life, growth, nutrition, daily frequency of defecation, presence of enterocolitis, constipation and incontinance. Chi-square and Fisher 's exact tests were used to determine the difference between groups. Results: Single-stage TAP procedure was performed in 21, and, two- stage Soave procedure in 20 patients, respectively. Median LOS was shorter in TAP group (3 days) compared with staged Soave procedure group (7 days) (p

[No abstract available]

Aim: We evaluated the efficacy and the reliability of the flexible endoscopy in the diagnosis and treatment of benign esophageal strictures. Material and Method: Between February 2004 and April 2005, 23 patients with esophageal strictures and dilatation by flexible endoscopy were evaluated according to the age, sex, clinical and radiologic findings, surgical interventions and postoperative complications. During flexible esophagoscopy, a guidewire was advanced through the instrument channel of the esophagoscope, an anterior dilatator and/or a balloon catheter was advanced according to the Seldinger method to the distal esophagus. Under flouroscopic control, a dilatation was performed. Results: In 23 patients (mean age 1.5), we performed 66 esophageal dilatations. Fourteen patients had an esophageal atresia, 1 congenital esophageal stenosis, one achalasia, one GERD, three acid ingestion, 3 alkali ingestion. All of the patients experienced difficulties during feeding. The esophagographies of all patients showed strictures. In 19 cases, a balloon dilatation was performed and in 4 patients, both antegrade dilatator and balloon catheter dilatation were made. In one patient with a esophageal pseudodiverticulum, a self-limited perforation occured with spontaneous healing. No other complication was seen. In early postoperative follow up, the feeding was without any problem. Conclusion: The esophageal dilatation by means of flexible endoscopy is a safe and effective tool in children with benign esophagus strictures.

Intestinal web is a thin membrane structure with central localization; including mucosa, submucosa and muscularis externa, but not serosa. It is give permission to partial passing. Vomiting after birth is diagnostic. Intestinal web can occur with bilios or nonbilios vomiting and generally radiologic examination is enough for diagnosis. We presented three cases mis diagnosed with clinical and radiological examination, the correct diagnosis was made by endoscopy. For this reason between 2000-2004 we examined the seven intestinal web cases which are operated in our hospital. We saw that two of them were antral webs and the other five were duodenal webs. In all cases repeating vomiting was the common symptom. The patient with antral web and the other two patients with duodenal webs were diagnosed at endoscopy. Clinical and radiologic examinations were not enough for diagnosis. The patients diagnosed at endoscopy were 4-month, 14-month old and 2.5 years old. The four patients diagnosed with clinical and/or radiological examination were between 4-days and 2.5 month old. Finally, clinic and radiologic examination can not be enough if the intestinal passage is not completely obstructed and the web is not so thick andalso diagnosis can be late. For this reason, cases with repeating vomiting with normal radiologic examination must be examined with endoscopy, because it is reliable and it does not need anesthesia.

Aim: Fetal wound healing differs dramatically from adult tissue repair, especially with the characteristic of minimal inflammation response and scarless healing. However in recent studies, it has also been shown that fetal wound healing can change to adult type in some conditions. In this study, the effects of different prosthetic materials on fetal wound healing and proliferation of fetal fibroblasts were evaluated. Method: In this experimental study, the skin of the fetal rabbit was excised 0.5×0.5 cm in size on the 23±1 day of gestation. In group 1 (control group), the excised skin was sutured in the same place. In group 2, an inorganic material (goretex patch) was sutured inplace of the excised skin. In group 3, an organic material (skin patch excised from another sibling fetus) was sutured inplace of the excised skin. All groups (n:16) were divided into two subgroups depending on the time of evaluation (24th and 72nd hours, subgroups a and b) The macroscopic scale, microscopic scale and PCNA (Proliferating Cell Nuclear Antigen) index of the fibroblasts were evaluated. Results: Evaluation of macroscopic scales revealed that the scores were higher in group 2 in subgroups a and b. The differences were significant between the groups 1a and 1b and 1b and 2b and 2b and 3b. Microscopically the scores were also higher in group 2 and the differences were significant between the groups 1b and 2b and 2b and 3b. The highest PCNA scores were also found in group2. Conclusion: In this study, the presence of prosthetic material in fetal wound increases fetal inflammatory response resembling adult type healing depending on the duration and type of material used. Goretex resulted in the highest response between these groups. The increase of fetal fibroblastic PCNA was in accordance with the degree of adult type inflammatory response.

The effects of intralesional long-acting corticosteroid injection were investigated in rats with alkali-induced corrosive esophageal burns. In 30 rats, a standard esophageal burn was produced as described by Gehanno. The rats were then divided into three groups as follows: group I, rats with esophageal burns and parenteral antibiotic, group II, rats with esophageal burns and systemic corticosteroid and parenteral antibiotic, group III, rats with esophageal burns treated with antibiotic and intralesional long-acting corticosteroid. All animals were sacrified on the 21th day of experiment. Histopathologic evaluation was performed and collagen deposition in the submucosa, damage to the muscularis mucosa, damage and collagen deposition in the tunica muscularis were investigated for each group. Overall criteria for histopathologic evaluation in the group II were better than group I (p

Thirty newborn with gastrointestinal system perforations were managed at Pediatric Surgery Department of Ondokuz Mayis University, Faculty of Medicine from July 1980 to December 1994. Of these cases; 19 were mature, seven were premature and four were small for gestational age. Twenty-nine of them underwent emergent surgery, but one patient died because of his general deterioration before surgical intervention. We could not find the cause of perforation in 11 cases and the place of perforation in one case. The perforation sites in our cases were stomach (7), colon (7) ileum (8), cecum (4), duodenum (1) and both the stomach and the ileum in one case. These perforations most commonly occurred in association with the pathologies of the wall or the lumen of the gut such as intestinal atresia (1), anorectal malformation (3), necrotizing enterocolitis (3), meconium ileus (3), and congenital aganglionic megacolon (2) and less commonly result of compressing factors outside the bowel such as Ladd's bands (2), omphlomesenteric band (3) and vascular anomaly of the mesentery (1). A prompt and an appropriate surgical intervention was carried out for each patient according to the place of perforation. The overall mortality was 48% and the mortality in stomach perforations was found to be less than ileal, cecal and colonic perforations. The cause of death was 60% sepsis.

Three rare anorectal malformation are presented: A two-month-old girl with a H-type congenital anovestibular fistula and normal anus. A case of a one-year-old boy with translevator type anal atresia and perineal fistula and bifid scrotum and a third case of five-month-old boy with an ectopic anus on the right gluteus. Anatomy, embryology and treatment of these rare anorectal malformation types are reviewed.

This experimental study aims to evaluate the relative effectiveness of splenic artery ligation and splenic autotransplantation as spleen-saving surgical procedures. Forty female Sprague-Dawley rats, weighing 162-270 g were divided into four groups: group I control, group II for splenectomy, group III for splenic artery ligation and group IV for splenic autotransplantation. Serum levels of complement 3 and 4 (C3, C4), immunoglobulin M, G, A (IgM, IgG, IgA) and fibronectin were measured, and control blood samples were cultured in all animals on the 30th postoperative day. On the 45th postoperative day Streptococcus pneumoniae type 25 was injected intraperitoneally, the same parameters tested 48th later. The animals were sacrificed after blood sampling to obtain lung tissue cultures. Penumococcal injections resulted in statistically significant differences in C3, IgM, fibronectin levels between the splenic artery ligation group (III) and the splenic autotransplantation group (IV). The sepsis induced by intraperitoneal Pneumococcus injection, colonization was detected in lung in group III and tissue cultures in 2 (20%) rats in group III and 4 (40%) rats in group IV. The elevated levels of C3, IgM and fibronectin in groups III and IV compared to group II were considered to be statistically significant (p < 0.01). These results indicated a statistically significant (p < 0.01) advantage of splenic artery ligation over autotransplantation.

Twenty eight cases with the diagnosis of goiter (one newborn (7/365 day) and the others aged between 9-16 years) were managed and treated at Ondokuz Mayis University, Faculty of Medicine, Pediatric Surgery Department, during June 1983 and April 1994. Of these cases 19 were female (67.8 %) and nine were male (32.2 %). We detected diffuse hyperplasia in eight patients, multinodular goiter in other eight patients and solitary nodular goiter in 12 patients. All cases were treated surgically. There were temporary postoperative complications in ten cases and the newborn patient died on the first postoperative day. Although in the literature it is strongly emphasized that there is an increased malignancy incidence in solitary thyroid nodule during childhood, we have not detected any histological malignancy in our series.

Usually it is possible to repair abdominal wall defects primarily. If the fascia defect is too large and not possible to repair it primarily synthetic materials can be used. In this study the results of our two cases (superior lumbar hernia and ventral hernia) which were repaired by using polytetrafluoroethylene synthetic materials were presented.

The effects of intraluminal short chain fatty acids (SCFAs) irrigation on colonic anastomosis, distal to the colostomy were investigated on 60 Swiss Albino male rats. Four groups each consists of randomly 15 rats were assigned. Out of group I (Sham group), loop colostomy 2.5 cm distal to the caecum were performed to all of the rats. While no additional procedures performed in group II, normal saline irrigation in group III and SCFAs irrigation in group IV, distal to the colostomy were performed. After 3 weeks, all the rats were reoperated, resection and anastomosis 5 cm distal to the caecum was performed. Irrigations were continued for one week and then the rats killed in order to investigate the anastomosis perforation pressure. In conclusion we demonstrated that irrigation with SCFAs increased the strength of colonic anastomosis.

A case of ileocolic intussusception due to cystic duplication of the caecum in a 8 months old girl is presented. A review of the literature reveals the extreme rarity of this entity.

We performed early decortication procedure to 22 cases during the period of February 1991 to December 1993 because of postpneumonic empyema. Fourteen of them were male and 8 of them were female. We evaluated these cases retrospectively. Decortication was saved for the patients that antimicrobial therapy and closed-tube drainage failed in treatment and performed on the 10-15th day after the diagnosis was established. Indications for the decortication were persistent fever (7), pulmonary air leakage (4), localised effusion (4), persistent respiratory distress (3) and pleural thickening without resolution (18). Decortication was performed through the standard posterolateral thoracotomy. Patients were discharged on the 6-9th postoperative day with minimal morbidity and none mortality. Because of the simplicity of the procedure; short hospitalisation period, low mortality and morbidity rates and good results were achieved with early decortication.