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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.

The Cases of the Thoracic Surgery in Our ClinicsA total of 1232 pediatric thoracic surgery patients were admited to the Department of Pediatric Surgery of Ondokuz Mayıs University Faculty of Medicine in tire period of January 1979 to June 1996. We performed surgical procedure to 1019 cases because of surgical thoracic pathology. The pathologies, treatment modalites and results were evaluated. The major patient groups consist of the group of Esophagus-Mediastinum (58.3%) and Lung-Pleura (32.5%). When cases are evaulated in terms of mortality following surgery, ratio of all pediatric thoracic surgery cases was found to be 4.1% .In accordance with the increasing number of patients and the developments in recent years, it was observed that the number and kind of surgery, and also the number of incoming patients and treated patients suffering thoracic pathologies were increasing over the years .As a conclusion, thoracic surgery was believed to be one of the most important area of pediatric surgery.Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalı'na Ocak 1979 ile Haziran 1996 tarihleri arasında toplam 1232 çocukluk çağı toraks cerrahisi olgusu kabul edilmiştir. Bu hastalardan, 1019 olguya cerrahi girişim uygulanmıştır. Bu hastaların pa-tolojileri, tedavi şekilleri t ve sonuçları değerlendirildi. Olgular incelendiğinde en büyük hasta gruplarının; özofagus-mediasten grubu (%58.3) ile akciğer-plevra grubu(%32.5) hastaların olduğu görüldü. Olgular cerrahi sonrası mortalite açısından değerlendirildiğinde tüm pediatrik torasik cerrahi olgulan için oranın %4.1 (42 olgu) olduğu bulundu.Son yıllardaki gelişmelere ve artan genel hasta sayısına parelel olarak kliniğe başvuran ve te-davi gören toraks patolojili hasta sayısıyla birlikte, uygulanan cerrahi girişim sayısının ve niteliğinin yıllar içinde giderek artığı görüldü. Sonuç olarak toraks cerrahisinin çocuk cer-rahisinin önemli bir uğraşım alanı olduğu kanısına varıldı.

Thirty newborn with gastrointestinal system perforations were managed at Pediatric Surgecy Department of Ondokuz Mayıs 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 pa¬tient died bbecause of his general deterioration before surgical intervention. We could not find the cause of perporation 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 occured 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 con¬genital aganglionic megacolons) 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 mor¬tality in stomach perforations was found to be less than ileal, cecal and colonic perfora¬tions. The cause of death was 60% sepsisTemmuz 1980-Aralık 1994 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalında 30 yenidoğan gastrointestinal perforasyon nedeniyle takip edildi. Bu olguların 19'u miadında, yedisi prematüre, dördü ise düşük doğum ağırlıklıydı. Hastaların 29'u acil olarak öpere edildi. Biri genel durumunun kötü olması nedeniyle öpere edilemeden kaybedildi. Öpere edilen hastaların 11'inde perforasyon nede¬ni birinde perforasyonun yeri saptanamadı. Olgularımızın yedisinde midede, yedisinde kolonda, sekizinde ileumda, dördünde çekumda, birinde duodenumda, biride de hem mi¬dede hem de ileumda perforasyon vardı. Bu perforasyonlar daha çok intestinal atrezi(4), anorektal malformasyon(3), nekrotizan enterokolit(3) mekonyum ileusu(3)kongenilal aganglionik megakolon(2) gibi barsak duvarı veya lümenindeki patolojilere daha az olarak Ladd bantlarım, omfalomezenterik bant(i), mezenter damar anomalisi(i) gibi barsak dışı patolojilerle ilgiliydi. Hastalara perforasyonlann yerine göre hızlı ve uygun cerrahi işlem uygulandı. Mortalite %48 idi. Mortalitenin, mide perforasyonlannda ileum., çekum ve kolon perforasyonlarından daha düşük olduğu bulundu. Ölüm nedeni %60 oranında sepsisti.

The diagnosis of traumatic diaphragmatic rupture is relatively easy on the left side, but is frequently difficult on the right, partly because the herniated organ is usually the liver. A right-sided diaphragmatic rupture due to gun shot injury in a 13 year-old boy, diagno¬sed by thoracoscopy, is reported.Torakoabdominal travmalı hastalarda diafragma rüptürü tanısı sol tarafta daha kolaydır. Sağ diafragmatik rüptür teşhisi, diafragma altındaki karaciğerin diğer organların toraks içine fıtıklaşmasını engellenmesi nedeniyle, zordur. Ateşli silah yaralanması ile gelen 13 yaşındaki bir erkek hastada sağ diafragma rüptürü, şüphe üzerine yapılan torakoskopi ile konulmuştur.

Case records of 32 patients (22 female and 10 male) with sacrococygeal teratoma who were treated in our department between 1984 and 1994 were reviewed. 27 patients had benign sacrococcygeal teratoma and the majority of the benign sacrococygeal teratomas were newborns. Total excision with coccygectomy was performed in this group. In cont¬rast, only one of the patients with malignant tumor was a newborn. In malignant group excision and multiagent chemotherapy were used for the treatment and two recurrences were noted. The average survival was increased and early mortality was decreased for all patients in comparison with past decades.1984 ile 1994 yıllan arasında servisimizde takip edilen 32 Sakrokoksigeal teratomlu hasta (22 kız ve 10 erkek) yeniden gözden geçirildi. Hastaların 27 tanesi benign teratomdu ve bunlann çoğu yenidoğan döneminde başvurmuştu. Bu gruptaki hastalara total ekslzyonla beraber koksigektomi uygulandı. Tersine, malign tümör grubunda yalnız bir hasta yeni¬doğan döneminde başvurmuştu. Bu grupta ise tedavi amacıyla ekzisyon ve multiajan kemoterapi uygulandı ve iki rekürens gözlendi. Geçen dekadlarla karşılaştınldığında, son dekadda hastaların yaşam sürelerinin uzadığı ve erken mortalitenin düştüğü saptandı.

2-day-old newborn, weighing 1450 g diagnosed as having isolated esophageal atresia (EA) without fistula has been found to have a bronchogenic cyst in the mediastinum. We discuss the possibility of Interruption of the esophageal development by mechanical way because of the cyst.Fistülsüz tipte izole özefagus atrezisi tanısı alan 1450 g ağırlığındaki 2 günlük yeni-doğanda mediastinal bronkojenik kist saptandı. Bu olgu sunuda kist nedeniyle özefagus gelişiminin mekanik olarak engellenme olasılığı tartışılmıştır.

İt is essentially important to perform the ventilatory management to hospitalized or opera¬ted newborns. However, the cold steam inhalation is acceptable in some of the newborn units and not acceptable in some others. In our study, we designed two groups included the newborns without steam therapy in the first group (n: 12) and the second group with steam therapy (n: 40) in order to evaluate the effects of cold steam inhalation on throat flora of the newborns. The pathological microorganisms were identified 40% in the first group and 38.5% in the second. Here, in this study, we did not determinate any signifi¬cant difference between two groupsYenidoğan döneminde hospitalize edilen ya da operasyon uygulanan hastalara verilecek solunum desteği son derece önemlidir. Ancak yenidoğan döneminde soğuk buhar uygula¬ması bazı merkezlerde kullanılırken bazı merkezlerde ise bu uygulamadan kaçınılmaktadır. Bu nedenle çalışmamızda, buhar tatbik edilen ve edilmeyen olarak iki grup oluşturuldu ve 52 yenidoğanda soğuk buharın boğaz florası üzerine etkileri incelen¬di. Yenidoğanlardan soğuk buhar uygulamasının öncesinde ve sonrasında boğaz kültürleri alınarak floradaki değişiklikler saptandı. Birinci grupta patolojik üreme %40 iken, ikinci grupta bu oran %38.5 olmuştur. Her iki grup arasında üreyen mikroorganiz¬maların türü açısından da belirgin fark gözlenmemiştir. Çalışmamızda, yenidoğan döneminde soğuk buhar uygulamasının boğaz florası üzerine belirgin etkisinin olmadığı sonucu ortaya çıkmıştır

Neuroblastoma usually presents as an upper abdominal mass arising from the adrenal gland. Recent experience with neuroblastoma of the spermatic cord, bladder and pelvis demonstrates the propensity of this tumour to arise in unusual areas. The total surgical excision of neuroblastoma cases are great important for prognosis. We report a case of pelvic ganglioneuroblastoma totally excised with posterior-sagittal and abdominal app¬roach.

Comparative Evaluation Of Synthetic Materials Used For Experimental Abdominal Wall Closure✓ Three prosthetic materials Mersilen (Dacron), Polyropylen (Marlex) and P.T.F.E. (Goretex) have been popularly used for the closure of abdominal wall defects resulting from various reasons. In this study, different prosthetic materials were used to close the 2x2 cm. full-thickness experimental abdominal wall defects, in each of the three experimental groups consisting of ten rats. After a three weeks period of recovery, three major groups of para-meters were evaluated: abdominal bursting pressures, adhesions and wound healing (macroscopic evaluation), and, nature of the tissue filling te defect, the amount and the thickness of the defect, the amount and the thickness of the fibrous tissue and foreign body reactions (microscopic evaluation). Macroscopic and microscopic results were enu¬merated in a scoring system and were used separately and in combination to make a comparison between experimental groups. Bursting pressure was lowest in Mersilen and highest in P.T.F.E. (193.+22 mmHg and 365.0±8.6 mmHg respectively), and the difference was statistically significant (p

TRACHEOBRONCHIAL FOREIGN BODIES ASPIRATION IN CHILDREN%/ From January 1992 to March 1994, 58 cases were observed and treated because of trac-heobronchial foreign bodies aspiration. These cases were evaluated retrospectively with the review of the literature. The yougest one was at 7 months old ant the oldest one was at 16 years old. All of the foreign bodies were removed with rigit bronchoscope except two which removed by open thoracotomy. In our cases the most of the foreign bodies were the needles which use to close the head wraps by the muslim women (38%). These findings were found very interesting and not correlated with the literature.Kliniğimizde Ocak 1992-Mart 1994 tarihleri arasında trakeobronşial yabancı cisim aspirasyonu nedeniyle takip ve tedavi edilen 58 olgu literatür eşliğinde retrospektif olarak değerlendirildi. En küçüğü 7 aylık ve en büyüğü 16 yaşında olan olgularımızdan ikisinde yabancı cisim torakotomi ile çıkartılırken, diğerlerinin tümü rijit bronkoskop ile çıkartıldı. Olgularımızda yabancı cisim aspirasyonunun en sık 12-16 yaş grubunda olması (%34.5) ve en sık aspire edilen yabancı cismin teseddür iğnesi oluşu (%38) dikkat çekicidir ve bu özellikleri ile literatürle uyum göstermemektedir.

METASTATIC CARSINOID TUMOR IN CHILDHOOD*/ Metastasis of carcinoid tumors in childhood are very rare. A boy 11 years old operated with preoperative diagnosis of acute appendicitis. At the operation carcinoid tumor arising from the appendix and widespread metastases to the regional lymph nodes and liver were found. On the postoperative period, chemoterapy was started and after 6 mounts of follow up the patient was clinically well. This case is discussed in the light of the literature re¬view.Çocukluk çağı karsinoid tümör metastazları oldukça nadirdir. Akut apandisit ön tanısı ile öpere edilen 11 yaşındaki bir olgumuzda rejional lenf nodlarına ve karaciğere yaygın me-tastazlar yapmış apendiksten menşei alan karsinoid tümör olgusu saptadık. Postoperatif dönemde kemoterapi başlanan ve allı aylık dönemde klinik olarak belirgin iyileşme gözlediğimiz olgu literatür eşliğinde irdelendi.

From 1978 to 1993 28 cases of Hydatid cyst were treated at Pediatrics and Pediatric Sur¬gery departments of Ondokuz Mayıs University, Faculty of Medicine. We evaluate these cases retrospectively whom 17 of them were male (%60.7) and 11 were female (%39.3). The youngest case was at six and the oldest one was at 16 years old age. The cysts were located mostly in the liver and the second most frequency site for the cysts was the lung. CT scan (%100) and ultrasonography (%94.7) were the most sensitive methods among la-boratory and radiological diagnostic methods. The sensitivities of the Casoni and indirect hemagglutination tests were found to be 71% and 83.3%, respectively. All cases were trea-ted surgically but mebendazol treatment was admitted to 12 cases on the preoperative pe-riod and continued on the postoperative period. Inspite of mebendazol treatment two cysts relapsed in this group. The morbidity rate was found to be higher for the surgical procedure of marsupialization, which was used during the first seven years of the study. At the last eight years usually partial cystectomy+capitonage and/or omentoplasty proce¬dure was used and the morbidity rate was decreased. There is no mortality.1978-1993 yıllan arasında fakültemiz Çocuk Hastalıkları ve Çocuk Cerrahisi Anabilim Dalları'nda takip ve tedavi edilen 28 kist hidatik olgusu retrospektlf olarak değerlendirildi. 17'si (%60.7) erkek, 11'i (%39.3) kız olan olguların en küçüğü altı, en büyüğü 16 yaşındaydı. Kistler en sık karaciğer, ikinci sıklıkta akciğerlerde lokalizeydi. Laboratuvar ve radyolojik tanı metodlan arasında bilgisayarlı tomografi (%100) ve ultrasonografi (%94.7) en sensitif melodlar olarak bulundu. Serolojik testlerden Casoni deri testi %71, indirekt hemagglütinasyon testi %83.3 pozitif sonuç verdi. Vakaların tümü cerrahi olarak tedavi edildi. Vakalardan 12'sine preoperatif mebendazol tedavisi uygulandı ve bu vakalardan iki tanesinde postoperatuar nüks saptandı. Çalışmanın ilk yansında kullanılan marsupializa-syon yönteminde morbidité yüksek bulunurken ikinci yanda uygulamaya başlanılan parsiyel kistektomi+kapitonaj ve/veya omentoplasti yönteminde morbiditenin çok azaldığı görüldü. Tüm vakalarda mortalité sıfır olarak bulundu.

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.