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Purpose: Undescended testis is one of the most common pathologies encountered by pediatric surgeons. In traditional orchidopexy operation, PPV is dissected from testicular vessels and spermatic cord. In this study, it was aimed to compare the results of undescended testis patients with and without PPV closure in terms of recurrence and atrophy Methods: After the approval of the local ethics committee, patients who were operated for undescended testis between January 2007 and December 2022 were evaluated. Patients were determined in two groups. first group was with PPV ligation (n=171), second group was without PPV ligation (n=1637). Results: Inguinal hernia was not observed after operation in 15 years of follow-up. There were 23 recurrences (%13,4) in group 1 and 48 recurrences (%2,9) in group 2. According to the preoperative evaluation; A decrease in testicular size was detected in 5 patients (2.9%) in Group 1 and 8 patients (0.4%) in Group 2 in the postoperative follow-up. Conclusion: There is no need to ligate the PPV with additional dissection and open the external oblique fascia if it is predicted that the spermatic cord and testicular vessels may come to scrotum without tension in patients who underwent orchiopexy surgery. Key Words: undescended testis, orchidopexy, processus vajinalis

Objective: Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods: Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results: This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p< 0.001), total hospitalization time (< 0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion: Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.

Gears have wide range application areas in various industries which no matter they are small-scaled or large-scaled. As a part of their design, gears inner bodies are full filled with their solid material and significantly increase the weight of systems which they used in. If the weight of gears’ body mass can be decrease during their design process, the mechanical properties that expected from the systems can be achieved with the minimum cost of material via additive manufacturing comparing to the traditional manufacturing processes. First ideas which comes to mind presents two choices for the way should follow. This study focused on design optimization of material layout rather than material selection. Generative design technic also known as topology optimization can create new designs via mathematical methods that optimize material layouts within a specific design space. Absolute geometry is depending on various parameters such as given set of loads, boundary conditions and constraints. Alternatively, lattice structures are designs which inspired from bio-entities based on repeating unit cells. As a result of static analysis of a helical gear’ s uniform lattice structure, output parameters have been used for varying unit cells’ beam thickness and optimize lattice design. End of this study which used nTopology as engineering software for whole implicit design and analysis process, the analysis of generative designed geometry and pattern of lattice structure gave different results. These outputs compared on point of weight savings.

Introduction Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention. Materials and Methods Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ–Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social–emotional problems, respectively. Results Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal–social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal–social skills. Conclusion Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

BACKGROUND The aim of this study is to determine whether pentraxin 3 (PTX3) levels can be used in the diagnosis of appendicitis in children. METHODS Fifteen children under 18 years old, who gave blood samples for reasons other than inflammatory conditions, and 40 children who were proved to have appendicitis (non-perforated or perforated) between August 2017 and January 2018, were enrolled in the study. Patients were classified into subgroups: group 1 (healthy children without any sign of inflammation, n = 15), group 2 (non-perforated appendicitis, n = 25), and group 3 (perforated appendicitis, n = 15). RESULTS The median PTX3 value was 1.01 ng/mL (minimum value: 0.82, maximum: 1.28) in the control group. The median PTX3 values prior to surgery were 20.68 ng/mL (minimum: 1.02, maximum: 28.471) and 1.46 (minimum: 1.05, maximum: 23.421) ng/mL for non-perforated appendicitis and perforated appendicitis respectively. The PTX3 levels were significantly higher in groups 2 and 3 than in group 1 (P

Medya, iletileri ve göstergeleri okur, izleyici ve dinleyicilere ileten bir ortam mekanizması olarak kamuoyuna enformasyon sağlayan bir kaynaktır. Kamuoyu eğlenmek, bilgilenmek, inanç ve değerleri öğrenmek için medyaya bağımlı durumdadır. Medyanın bu gücünün farkında olan büyük sermaye sahipleri çeşitli imtiyazlar elde edebilmek ve toplumda saygın bir pozisyona yükselebilmek için medya sektörüne yönelmektedir. Yaşanan bu yoğun güç gösterisine maruz kalan medya tekelleşen ve holdingleşen bir ortama dönüşmüştür. Herman ve Chomsky 1993 yılında yayımladıkları ‘Medya Gerçeği’ adlı eserde Propaganda Modeli isimli bir yapı ortaya koymuştur. Herman ve Chomsy’nin ortaya koyduğu bu teorinin temel bileşenleri haber süzgeçleridir. 5 süzgeçten oluşan bu sistemin ilki kitle medyasının büyüklüğü, mülkiyeti ve kar yönelimli olmasıdır. Çalışma bu süzgeç üzerinden tekelleşme ve Türk medyasındaki tekelleşme olgusunun değerlendirilmesi üzerine odaklanmıştır. Türkiye’de özellikle 1980’lerden itibaren temel ekonomik politika olarak benimsenen liberal görüş basın üzerinde de ciddi değişimleri beraberinde getirmiştir. Daha önceki süreçlerde gazeteci kişiler veya gazetecilik kökenli ailelerin yönettiği basın sektörü artık büyük sermaye sahiplerinin eline geçmiş ve bu mecra tekelleşme trendi içerisine girmiştir. Bu çalışmada öncelikle Herman ve Chomsky’nin Propaganda Modeli tanımlanacak ardından, tekelleşme kavramı ve Türk medyasının tekelleşme süreci anlatılıp, gelişmelerin sektör üzerindeki etkileri irdelenecektir.

Bullous lung diseases may cause primary spontaneous pneumothorax (PSP) in children. The microRNAs (miRNAs) are non-coding RNAs that participate in regulation of inflammation and cancer. We hypothesized that children with bullous lung disease and PSP may have altered miRNA expressions in their exhaled breath condensates (EBCs). Therefore, a prospective study was performed to evaluate the miRNA-24 and 21 expression, and the matrix metalloproteinase-7 (MMP-7) levels in EBC of children with PSP. Children with PSP were evaluated for age, gender, clinical features and results of surgical treatment. EBC samples (500–1000 ml) were collected to evaluate the miRNA-21, 24 expressions, and MMP-7, and tissue-inhibitor-MMP-1 (TIMP-1) levels. miRNA expressions and MMP levels of patients were compared with healthy controls (control group (CG), n = 12). Subjects (n = 16) with a mean age of 15 years (10–19 years), and a male-to-female ratio of 14:2 were enrolled in this study. The most common presenting symptom was sudden chest pain (n = 14). In 62.5% of the cases an underlying bullous lung disease were detected. During an average of 16.6 months (1–60 months) follow up period, four subjects relapsed. The mean MMP-7 (1.74–1.57 ng ml−1), and TIMP-1 (1.92–1.84 ng ml−1) levels were similar between both groups (p > 0.05). miRNA-24 expression was significantly decreased in the PSP group, when compared to the CG (0.16–1 2−ΔΔCT, p < 0.05). In addition, the miRNA-21 expression was not different between the two groups (p > 0.05). In conclusion, the miRNA-24 levels were significantly decreased in children with PSP. Taken together, children with PSP, especially those with bullous disease, should be closely monitored in the long-term period.

Background: Interstitial lung disease (ILD) represents a spectrum of lung diseases that may contain different levels of fibrosis and inflammation. Sometimes, the clinical picture and imaging studies are insufficient to determine the diagnosis and lung biopsy becomes crucial, which may be performed in a thoracoscopic or open manner. The aim of this study was to present a new minimally invasive biopsy method that seems to be technically easy, safe, and inexpensive. Herein, we present a minimally invasive method for thoracoscopic lung biopsy using a Vicryl loop. Methods: The charts of patients with suspected ILD who underwent thoracoscopic lung biopsy using a Vicryl loop between 2007 and 2017 were analyzed retrospectively. Results: Nine patients were identified, four were boys and five were girls. The median age was 76 months. The mean weight of the patients was 10.9 kg. The mean chest tube removal time was 3.8 days. The mean surgical time was 37 minutes. There was an air leakage for 13 days in one child postoperatively. Conclusions: Thoracoscopic lung biopsy with a knot and scissors is an easily applicable and minimally invasive method that may be performed in children with suspected ILD.

Objective Aim of the study is to determine the hemostatic techniques among pediatric urologists in Turkey. Material and methods Questionnaire forms were sent to 459 pediatric urologist by e-mail. Results Ninety eight of 459 participants answered the questionnaire forms. Eighty-one (84.4%) of the participants were using tourniquet. The participants who didn't use tourniquet stated their justifications as follows: lack of need (n=10: 66.7%), development of edema, ischemia, delay of wound-graft healing and fistula risk (n=5: 33.3%). The indications of tourniquet use were stated as follows: penile (91.4%: n=74), distal (72.8%: n=59), penoscrotal (55.6%: n=45) hypospadias; fistula repair (33.3%: n=27), cripple hypospadias (33.3%: n=27), repair with flaps (30.9%: n=25), repair with grafts (27.2%: n=22), and isolated penile curvature (21%: n=17). Most commonly used tourniquet material (49.9%) was latex glove. Erection test was applied by 43.8% of participants. Scalp vein set was the most commonly (54.8%) used injector during erection test. Only 9.4% of participants were using adrenaline. Adrenaline dosages used at 1/100.000 dilution by 55.6%, lidocaine with 1/100.000 adrenaline by 44.4% of participants. Conclusion Beside a few experimental ones there is a paucity of studies that can serve as a guideline for using these techniques in the literature. There is a necessity of realizing prospective, randomized studies with long-term follow up to evidence that postoperative complications could develop secondary to hemostatic techniques and also to facilitate safe use of these techniques.

The treatment of MH entails surgical repair either by open abdominal or thoracic approaches or by minimal invasive surgery. The aim of this study is to evaluate the surgical and clinical outcomes of children who underwent laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique. This retrospective study includes pediatric patients who underwent surgery for MH between January 2015 and February 2019. The patients’ demographic data, symptoms, operative findings and technique and postoperative outcomes were recorded. A total of 17 children with MH were treated. There were 13 boys (76.5%) and four (23.5%) girls. Six patients had trisomy 21 (37%). The mean operation time was 40 min (25–90 min). The hernia sac was removed in all patients and there was no need for prosthetic patch in any of the children. Mean time to start feeding was 10 h (6–24 h). The mean hospitalization time was 2 days (1–5 days). There were no complications intraoperatively or postoperatively. The mean follow-up time was 24 months (6–40). No recurrence occurred during the follow-up time. Laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique is a preferable method with excellent outcomes and short hospitalization and feeding time postoperatively. This technique may be performed easily and safely without requiring any additional experience other than basic laparoscopy skills.

Summary The aim of this study is to review the experience on managing foreign body ingestion in children with special emphasis on the endoscopic techniques and specific retrieval devices used for foreign body (FB) extraction. The charts of 341 children were reviewed retrospectively. Demographic data, ingested material, removal technique and tool, level of FB, complications, and outcomes were recorded. A total of 364 FBs were removed from 341 children. Among these, 56.5% (n: 206) were entrapped in esophagus, 39% (n: 142) were in stomach, and 4.5% (n: 16) in duodenum and intestine. The most frequently ingested items were coin (42.5%), button batteries (20.6%), and safety pins (12%). Optical forceps (37.9%) were the most commonly used tool and they were used during retrieval of esophageal FB by rigid endoscopy. Retrieval net (20.7%) was the second most common tool and the most common one during flexible endoscopy. Depending on our experience, we strongly advocate rigid endoscopy for esophageal FBs and food impaction in children because it allows both to use optical forceps with a strong grasping ability for blunt FBs and to position sharp and pointed objects inside the rigid endoscope. We recommend retrieval net as the first tool for the extraction of blunt objects and rat tooth retrieval forceps is the best tool for sharp and pointed FBs in stomach.

Introduction Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. Patients and methods This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. Results This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12–20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1–14) days. Mean follow up was 44.6 (8–82) months for primary excision and closure group and 8.1 (1–19) months for phenol group. Conclusion Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. Treatment study Level III

Aim: Echinococcosis is still an important health problem throughout the world, particularly in the Mediterranean area. In humans, the lungs are the second most commonly affected sites. The disease may affect children and its treatment may be challenging. In children, small hydatid cysts of the lungs respond favorably to the medical treatment. Surgery is the standard option for the treatment of large and complicated cysts. In current practice, thoracotomy and parenchyme-saving procedures such as cystostomy and capitonnage remain the standard surgical approach for pulmonary hydatid cysts in children. However, surgical experience with thoracoscopy is limited. The aim is to present the experience in thoracoscopic management of pulmonary hydatid cysts in children. Patients and Methods: Medical records of children who underwent thoracoscopic cystostomy of pulmonary hydatid cysts between 2008- 2016 were reviewed. Surgical treatment was recommended for patients who remained symptomatic on medical treatment and when the cyst size was larger than 6 cm in diameter. Parenchyme-saving surgery was preferred which included cystostomy, removal of germinative membrane and control of air leaks. Capitonnage was not preferred because of the risk of deterioration in lung capacity. Results: Fifteen patients underwent 16 thoracoscopy procedures for pulmonary hydatid cysts. One of the patients had bilateral complicated pulmonary hydatid cysts. There were conversions to mini-thoracotomy in 3 (20%) procedures because the air leaks could not be controlled safely. The procedure was completed thoracoscopically in 12 patients. In thoracoscopically completed cases, prolonged air leak (over a week) occurred in 3 (25%) patients and one of them underwent thoracotomy to control bronchopulmonary fistula. One of the patients underwent laparoscopic cystostomy and capitonnage for associated liver hydatid cyst. There were no recurrences during 60 months of mean follow-up time and no problem was observed during the follow-up period. Conclusion: Thoracoscopic management is recommended in children with uncomplicated hydatid cyst. In complicated hydatid cysts, however, thoracoscopic wedge resection is recommended. If there is difficulty in controlling bronchial openings, mini-thoracotomy could be considered.

Objective The aim of this study is to report prospective data of pediatric cases that underwent percutaneous tracheostomy (PT) to show that PT is a safe and feasible procedure in children even in small infants. Patients and methods PT was done in 51 consecutive patients. Demographic data, indications, complications and outcome were recorded prospectively. Initial 6 PT was done by Giaglia technique whereas the Griggs technique was used in the consecutive 45 patients. Results Fifty-one patients with mean age of 38±54months (1month–17years) and, mean weight of 12.4±13kg underwent PT. The only major complication was perforation of esophagus ( n =1, 2%) which was recognized early and immediately repaired by cervical approach. This complication occurred in the 6th case done with the Giaglia technique. After conversion to the Griggs technique no major complication was encountered in the consecutive 45 procedures. The mean period of follow up was 21±13.7months. Narrowing of the stoma site requiring simple dilation was developed in 3 (5.8%) patients. Conclusion PT is a safe and easy procedure and a less invasive alternative to surgical tracheostomy even in small infants. We strongly recommend PT done by Griggs technique in children. It is important that it should be done in an operating room setting and under rigid bronchoscopic guidance.

Bahadir, Gulnur Gollu/0000-0001-8163-2226; Aktug, Tanju/0000-0003-0078-7838 WOS: 000371535800010 PubMed: 25515612 The study aims to evaluate the effectiveness and safety of endoscopic balloon dilatation (EBD) in childhood benign esophageal strictures. The medical records of 38 patients who underwent EBD from 1999 to 2013 were retrospectively reviewed. Demographic features, diagnoses, features of strictures, frequency and number of EBD, complications, outcome, and recurrence data were recorded. Median age was 1.5 years (0-14), and female/male ratio was 17/21 (n = 38). Primary diagnoses were corrosive esophageal stricture (n = 19) and esophageal atresia (n = 19). The length of strictures were less than 5cm in 78.9% (n = 30). No complication was seen in 86.8% (n = 33). Perforation was seen in 10.5% (n = 4), and recurrent fistula was seen in 2.7% (n = 1). Total treatment lasted for 1 year (1-11). Dysphagia was relieved in 60.5% (n = 23). Recurrence was seen in 31.6% (n = 12). Treatment effectiveness was higher, and complication rates were lower in strictures shorter than 5cm compared with longer ones (70% vs. 25%, P < 0.05, and 3.4% vs. 37.5%, P < 0.05). Although there was no statistical difference, treatment effectiveness rates were lower and complication and recurrence rates were higher in corrosive strictures compared with anastomotic ones (P > 0.05). EBD is a safe and efficient treatment choice in esophageal strictures, especially in strictures shorter than 5cm and anastomotic strictures.

Objective: Hypospadias is a common genitourinary system (GUS) anomaly in boys occurring in 1 of 200 to 300live births. Undescended testes is frequently detected among accompanying anomalies in cases with hypospadias.Especially in proximal hypospadias and bilateral cases, this association may indicate sexual differentiation disorders. Theaim of the study was to evaluate the togetherness of additional anomalies in hypospadiac children with undescendedtestes.Material and Methods: Between 2007 and 2016, data of 392 children who underwent surgery for hypospadias wereevaluated retrospectively. Urethral meatus was present at scrotal and penoscrotal in 65 cases (16.6%) and glanular,coronal, subcoronal and midpenile in 327 cases (83.4%). The cases were divided into two groups as those with bothtestes in the scrotum and those with undescended testes, and the anomalies were recorded.Results: The mean age of the children with proximal hypospadias was 21 months (6-240 months). Of the childrenwith proximal hypospadias, 26 (40%) had undescended testes and 39 (60%) had testes in the scrotum. Undescendedtestes were detected bilaterally in 17 patients (65.4%) and unilaterally in nine patients (34.6%) in the undescendedtestes group. In the undescended testes group, 24 patients (92.3%) had suspected external genitalia (bifid scrotum,penoscrotal transposition, togetherness of micropenis and penoscrotal hypospadias, scrotalized labium majus) onphysical examination. In the undescended testes group, three patients (11.5%) had additional urinary pathology andten patients (38.5%) had other system anomalies. Ten patients (25.5%) had suspicious external genitalia on physicalexamination in the proximal hypospadias group who had both testes in scrotum. Additional urinary pathology wasdetected in one patient (2.5%) while other system anomalies were detected in five (12.8%) patients.The mean age of children with distal hypospadias was 33 months (6-156 months). Nine of 327 children with distalhypospadias (2.8%) had undescended testes. Of these, five were bilateral (55.6%) and 4 had unilateral undescendedtestes (44.4%). None of the patients with distal hypospadias had any suspicious genitalia on physical examination. Inthe undescended testes group, one patient (11.1%) had additional urinary pathology and one patient had other systemanomaly. Seven patients (2.2%) who had both testes in scrotum had additional urinary pathology and 32 patients (9.8%)had other system anomalies.Conclusion: According to our results, further tests such as genitourinary ultrasonography, pelvic MRI if necessary,endocrine and genetic evaluation should be considered in cases where the proximal hypospadias is accompanied byan undescended testicle, and detailed anamnesis and physical examination covering all systems is necessary in allhypospadiac children in terms of additional anomalies., Amaç: Hipospadias erkek çocuklarda 200-300 canlı doğumda bir görülen genitoüriner sistem (GÜS) anomalisidir.Hipospadias olgularına eşlik eden anomaliler arasında inmemiş testis saptanması sıktır. Özellikle proksimal hipospadiasve bilateral inmemiş testis birlikteliği cinsel farklılaşma bozukluklarına işaret edebilir. Bu çalışmada inmemiş testisin eşlikettiği hipospadiaslı çocuklarda ek anomalilerin değerlendirilmesi amaçlandı.Gereç ve Yöntemler: 2007-2016 yılları arasında hipospadias nedeniyle ameliyat olan 392 çocuğun verileri geriye dönük olarak tarandı.Bunlardan 65 (%16.6) olguda meatus skrotal ve penoskrotal, 327’sinde (%83.4) glanüler, koronal, subkoronal ve midpenil yerleşimliydi.Olgular her iki testisi yerinde olan ve olmayanlar olarak ayrıldı ve ek anomaliler kaydedildi.Bulgular: Proksimal hipospadiaslı çocukların ortanca yaşı 21 ay (6-240 ay)’dı. Proksimal hipospadiaslı çocuklardan 26’sının (%40) inmemiştestisi mevcutken, 39 (%60) olguda testisler skrotumda ele geldi. İnmemiş testisi olan gruptaki hastaların 17’sinde bilateral (%65.4),dokuzunda tek taraflı (%34.6) inmemiş testis saptandı. İnmemiş testisi olan grupta 24 hastada (%92.3) fizik muayenede kuşkulu dışgenitalya (bifid skrotum, penoskrotal transpoziyon, mikropenis ve penoskrotal hipospadias beraberliği, skrotalize labium majus) mevcuttu.İnmemiş testisi olan grupta üç hastada (%11.5) ek üriner anomali, on hastada (%38.5) ise diğer sistem anomalilerinin eşlik ettiği saptandı.Her iki testisin ele geldiği proksimal hipospadias hasta grubunda 10 hastada ( %25.5) kuşkulu dış genitalya mevcuttu. Her iki testisiskrotumda ele gelen 39 hastanın birinde (%2.5) ek üriner patoloji, beşinde (%12.8) ise diğer sistem anomalilerine rastlandı.Distal hipospadiaslı çocukların ortanca yaşı 33 ay (6-156 ay)’dı. Distal hipospadiaslı 327 çocuğun 9’unda (%2.8) inmemiş testis mevcuttu.Bunlardan beşinde bilateral (%55.6), 4’ünde tek taraflı (%44.4) inmemiş testis izlendi. Distal hipospadiası olan hastaların hiç birinde (%0)fizik muayenede kuşkulu genitalya saptanmadı. İnmemiş testisi olan grupta bir hastada (%11.1) ek üriner patoloji, bir hastada (%11.1) isediğer sistem anomalilerinin eşlik ettiği saptandı. Her iki testisi skrotumda ele gelen yedi hastada (%2.2) ek üriner patoloji, 32 hastada (%9.8)ise diğer sistem anomalilerine rastlandı.Sonuç: Sonuçlarımıza dayanarak inmemiş testisin eşlik ettiği proksimal hipospadiaslı olgularda ürogenital sisteme yönelik ultrasonografi,gerektiğinde pelvik MRG, endokrinolojik analiz, genetik inceleme gibi ileri tetkik gerekliliğinin akılda tutulması gerektiği, tüm hipospadiaslıçocuklarda ek anomaliler açısından tüm sistemleri içeren ayrıntılı anamnez ve fizik muayene ile tetkik edilmesi gerektiği kanısındayız

Objectives Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy. Methods The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse-string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally. Results There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day-18 years), and the average body weight was 13 kg (2300 gr-65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate. Conclusion The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.

Amaç: Robotik cerrahi, minimal invaziv cerrahi konusundaki gelişmelerin en yenisidir. Cerrahların bu konudaki görüşleri farklılık göstermekle beraber robotik cerrahi genel olarak alışma ve yaygınlaşma sürecine girmiştir. Bu yaygınlaşma ve alışma periyodunun belli bir süreçte gerçekleşeceği bildirilmiştir. Bu zaman içerisinde robotik cerrahinin avantajları ve dezavantajlarının gelişim sürecine etki edeceği açıktır. Çalışmanın amacı, robotik cerrahinin Türkiye’deki yaygınlığı ve bunu etkileyen faktörleri ortaya koymaktır.Gereç ve Yöntemler: Robotik cerrahinin üstünlükleri ve kısıtlılıklarını içeren anket hazırlandı. Hazırlanmış olan anket internet üzerinden Survey Monkey Anket Sistemi aracılığıyla aktif olarak robotik cerrahi ile uğraşan 104 cerraha gönderildi. Ankete yanıt veren 41 (%39.4) cerrahın yanıtları incelendi.Bulgular: Kırk bir katılımcının 32’si 10 yıldan fazla süredir uzman doktor olarak çalışmaktaydı. Robotik cerrahi ile uğraşan cerrahların %80’i (n=32) ileri endoskopik cerrahi deneyimine sahip olduğunu belirtti. Otuz bir cerrah endoskopik deneyimin robotik cerrahi uygulamasına geçişte bir üstünlük sağladığını düşünmekteydi. Ankete katılan cerrahların %40’ı (n=15) yurtdışında, %60’ı (n=25) ise yurtiçinde robotik cerrahi eğitimi aldığını belirtti. Yurtdışında eğitim alma gerekliliğini savunan cerrahlar olsa da katılımcıların %80’i yurtiçinde eğitim almanın gerekliliğini savunuyordu. Ankete yanıt verenlerin %22’si (n=9) robotik cerrahi ile toplamda 100 olgunun üzerinde ameliyat gerçekleştirmiş, %60’ı (n=25) ise 25 olgudan daha az ameliyat yapmışlardı. Bu ameliyat sayıları, robotik cerrahinin; cerrahların %73’ünün (n=30) rutin pratiklerinin %10’undan daha azını kapsadığını yansıtıyordu. Cerrahların %90’ı (n=37) hastaya dokunmamayı kısıtlılık olarak görmediğini ifade ediyordu. Katılımcıların %76’sı robotik cerrahi eğitiminin uzmanlık eğitimi tamamlandıktan sonra alınması gerektiğini düşünüyordu. Robotik cerrahinin endoskopik cerrahiye göre üstünlükleri sorgulandığında katılımcıların %83’ü (n=34) üstün olduğunu düşünüyordu. Bu üstünlükler ise şöyle sıralandı: Katılımcıların %98’i (n=40) üç boyutlu ve büyütülmüş görüntü olanağını, %88’i (n=36) kameranın cerrah tarafından kontrol edilmesini, %85’i (n=35) el bileği hareketli enstrümanları en önemli üstünlükler olarak belirledi. Dikiş atmada kolaylık (%75), kamerada ve aletlerde titremenin olmaması (%73), gelişmiş görüntüleme teknikleri (%68) ve ergonomi (%68) ise sırasıyla diğer önemli üstünlükler olarak belirtildi. Robotik cerrahinin kısıtlamaları sorgulandığında ise katılımcıların %63’ü (n=25) endoskopik cerrahiye göre kısıtlamaların olduğunu, %65’i (n=26) açığa dönüşte robotik cerrahinin endoskopik cerrahiye göre daha dezavantajlı olduğunu belirtmiştir. Cerrahların %90’ı (n=37) robotik cerrahinin Türkiye’de yaygınlaşma alanı bulacağını düşünmekteydi. Robotik cerrahinin yaygınlaşmasının önündeki engeller sorgulandığında ise katılımcıların %100’ü (n=41) maliyetin, %66’sı (n=27) sağlık güvencesi geri ödemelerindeki yetersizliklerin yaygınlaşmanın önünde engel olabileceğini savunurken, ön hazırlık zamanının uzun olması (%20), ekip ve ekipman teminindeki zorluklar (%24) da robotik cerrahinin yaygınlaşmasının önünde yer alabilecek engeller olarak belirtildi.Sonuç: Robotik cerrahinin Türkiye’de yaygınlaşma alanı bulacağı düşünülmektedir. Maliyet düzenlemeleri ve yurtiçi eğitim olanaklarının artırılması ile bu sürecin hızlanacağı görülmektedir., Objective: Robotic surgery is the newest of minimal invasive surgery developments. The opinions of surgeons are different about this topic, though robotic surgery is in a widespread period. This period is going to take some time. The advantages and disadvantages of robotic surgery is going to play a role in this period. The aim of this study to reveal the generality of robotic surgery in Turkey and the factors effect that.Material and Methods: A questionnaire on the advantages and disadvantages of robotic surgery was prepared. It was sent to 104 actively working robotic surgeons via the SurveyMonkey System. The answers of the 41 responders (39.4%) were evaluated. Results: Of the 41 responders, 32 had been working as a specialist for more than 10 years. Eighty percent of them (n=32) stated that they had advanced endoscopic surgery experience. Thirty-one stated that endoscopic experience was an advantage for performing robotic surgery. Forty percent of responders (n=15) had received robotic surgery training abroad and sixty percent (n=25) in Turkey. Even though there were some attendees who thought training abroad was important, 80% of the responders believed that training in Turkey was necessary. We found that 22% (n=9) of the responders had performed more than 100 robotic procedures while 60% (n=25) had performed less than 25. These numbers were less than 10% of the routine operations for 73% (n=30) of the participants. Ninety percent (n=37) of the surgeons stated that not touching the patient was not a limitation. Seventy-six percent reported that robotic surgery training should take place after the residency period. When the superiority of robotic to endoscopic surgery was queried, 83% (n=34) stated that robotic surgery was superior. The advantages of robotic surgery were listed as follows; 98% (n=40) three dimensional – magnified imaging, 88% (n=36) surgeon–controlled camera, 85% (n=35) wrist motion instruments, 75% easier suturing, 73% no camera and instrument tremor, 68% advanced imaging techniques and ergonomy. When the limitations of robotic surgery were queried, 63% (n=25) of the participants reported that robotic surgery had some limitations when compared to endoscopic surgery, and 65% stated that robotic surgery was more disadvantageous when it comes to conversion to open surgery. Ninety percent (n=37) of the surgeons thought that robotic surgery would become widespread in Turkey. The obstacles in front of robotic surgery were determined as cost (100%), insufficiency of health insurance paybacks (66%), long preparation time (20%), and the difficulty of assuring the equipment and a team.conclusion: Robotic surgery is considered to have a wide range of usage in Turkey. Arrangements regarding the cost should be done and national training facilities should be increased to accelerate this process

Failed hypospadiass cases may result in hypovascular, scarred penis with residual penile chordee and leave the patient with minimal residual skin for penile resurfacing and urethroplasty. Local tissue expansion has become a good alternative to provide skin for penis by using expanders however they require long periods of time for expansion. Besides, rapid tissue expansion was also described in different tissues. We used rapid intraoperative expansion technique by using a Foley catheter in a failed hypospadias case who had minimal residual skin secondary to infection and we concluded that rapid intraoperative tissue expansion with Foley catheter is an effective, feasible reconstructive method for easy dissection and penile resurfacing in failed hypospadiass cases.

Summary Background Inguinal hernia repair is a common procedure in daily pediatric surgical practice. Objectives The present study was planned to find out whether transinguinal laparoscopic exploration (TILE) of the contralateral groin is effective in reducing the need of operation for contralateral metachronous inguinal hernia (CMIH) in children. Study design Charts of 1103 children who underwent inguinal hernia repair between 2006 and 2016 were retrospectively analyzed. Eighty-eight children with bilateral hernia at the presentation were excluded, and 705 patients whose parents could be contacted by phone to get the latest information about children's condition were included in the study. Results Of the 705 children with unilateral inguinal hernia repair, 362 (51.4%) and 343 (48.6%) of them had right-sided and left-sided inguinal hernia, respectively. Transinguinal laparoscopic exploration was performed in 479 of the 705 children with unilateral hernia and a hernia or contralateral patent processus vaginalis (PPV) was found and ligated in %28.3 (n = 136) of them. Mean follow-up time was 60 ± 36 months. Fifteen (4.3%) of 479 patients who had TILE and 31 (13.6%) of 226 the patients who did not have TILE developed CMIH. When the videos of 15 patients who developed CMIH were reviewed, overlooked PPV was found in 10 (3.3%) patients who had TILE during early phases of institutional learning curve. Discussion and conclusions TILE of the contralateral side during pediatric inguinal hernia repair is a simple and effective method to evaluate contralateral PPV. This approach clearly and significantly reduces the need of operation for a metachronous hernia at a later date.

Kilic, Birim Gunay/0000-0002-4566-2564; Bahadir, Gulnur Gollu/0000-0001-8163-2226; Sertcelik, Mehmet/0000-0001-7031-3318; Soyer, Tutku/0000-0003-1505-6042 WOS: 000352140500009 PubMed: 25840059 Background/aim: Children with attention-deficit/hyperactivity disorder (AD/HD) have risk taking behavior and are more prone to sustaining injury. It is aimed to evaluate the cognitive and behavioral characteristics of children with caustic ingestion. Patients and methods: Ninety two children with a history of nonsuicidal caustic ingestion (CI, n = 46) and healthy subjects (HS, n = 46) admitted to pediatric surgery department were enrolled into the study. Patients in groups were evaluated for age, sex, number of siblings and educational status of the parents. Before filling the questionnaires, the children were undergone flexible endoscopy and treated accordingly. Conners Parents Rating Scale-revised long form (CPRS-R:L), validated for Turkish Children, was used to evaluate the cognitive and behavioral characteristics of children. Parents rate their child's behavior with a four-point Likert scale. Subscales of CPRS-R: L including cognitive problems/inattention (CG/I), hyperactivity (H), attention deficit hyperactivity disorder index (AD/HD-I), Conners' Global Index-discomfort-impulsivity (CGI-DI), DSM-IV-symptom subscale-inattention (DSMIV, SS-I), DSM-IV-symptom subscale-hyperactivity-impulsivity (DSM-IV, SS-HI), DSMIV-symptom subscale-total score (DSM-IV SS-T) were used to determine the severity of the AD/HD symptom. Demographic features and cognitive/behavioral characteristics of children with caustic ingestion were compared with healthy subjects. Results: The median age of the patients was 4 (2-14 years) in both CI and HS groups. Female male ratio was 13:33 in CI and 12:34 in HS. Sixty seven percent of patients were preschool children (younger than 5 years of age) in both CI and HS groups. There was no difference between groups for number of siblings (p > 0.05). Parents of HS group had higher educational status than parents in CI (p < 0.05). When subscale scores of CPRS-R: L compared between CI and HS groups, CI group had higher CGI-DI scores than HS (p < 0.05). Children younger than five years of age had higher scores of H, emotional instability and total CG/I in CI than HS group (p < 0.05). Conclusion: Children with caustic ingestion had impulsiveness behavior when compared to healthy children. In addition to impulsivity, hyperactivity can be also assessed as a risk factor for caustic ingestion in children younger than 5 years of age. We suggest that association between AD/HD behavior and risk of sustaining injuries was also confirmed for caustic ingestion in children. (C) 2015 Elsevier Inc. All rights reserved.

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000337346800008 PubMed: 23460465 Aim An experimental study was performed to evaluate the effect of whole gut irrigation (WGI) solutions on contractile responses of the gallbladder and ileum and also on tissue cholecystokinin (CCK) levels. Materials and Methods Thirty guinea pigs were enrolled into five groups including control group (CG) and WGI group (saline physiologic [SP], Ringer lactated [RL], polyethylene glycol [PEG], and dibasic sodium phosphate [DNP]). After median laparotomy, the distal esophagus was ligated and SP, PEG, RL, and DNP infusions (2 mL/kg/min) were performed via gastric catheter until rectal discharge became clear in WGI groups. Ileum and gallbladder samples were obtained for in vitro and biochemical studies without irrigation in CG and after irrigation with different WGI solutions. Isolated ileum and gallbladder preparations were suspended in organ baths for contractile responses of carbachol and CCK. Also, biochemical analysis of tissue CCK levels was performed in ileum and gallbladder samples. Results In PEG group, gallbladder and ileum CCK levels were significantly higher than CG (p < 0.05). Also, DNP irrigation caused increased CCK levels in gallbladder samples (p < 0.05). In lower carbachol concentrations, PEG group showed increased contraction responses in gallbladder samples when compared with controls (p < 0.05). However, ileal responses to carbachol did not show any significant difference between groups, contraction responses to CCK was decreased in PEG group when compared with CG (p < 0.05). Conclusion Among WGI solutions, PEG caused the highest CCK levels in gallbladder and ileum samples. Different WGI solutions affected the contractile responses of gallbladder and ileum smooth muscles divergently. Increased levels of CCK in PEG group support the decreased contractile responses in ileum. Therefore, our results confirm that the effect of WGI on gallbladder and ileum contractility may be CCK related. Kirikkale University Scientific Research CouncilKirikkale University This study is supported by Kirikkale University Scientific Research Council and presented at the 28th National Congress of Turkish Association of Pediatric Surgeons, September 22-25, 2010, Antalya, Turkey. Special thanks to Serkan Sahinoglu, MS4 for his kind contribution to review the English of the manuscript.

Tracheal injury is an uncommon especially in neonates, and urgent recognition and management are needed because of its life-threatening complications. Here we present a- 2160 g-female newborn with 342/7 weeks gestation who sustained tracheal rupture following intubation for surfactant administration and treated with conservative management. Successful conservative management of tracheal perforation in infants involves the placement of uncuffed tubes distal to injury, holding of oral feeds and broad-spectrum antibiotics prophylaxis. Conservative management should be considered, especially in patient who has stable vital signs, Newborn, tracheal injury, pneumomediastinum, subcutaneous emphysemia. Trakeal hasarlanma özellikle yenidoğanlarda nadir görülür ve hayatı tehdit eden komplikasyonları nedeniyle acil tanı ve tedavi gerektirir. Biz de bu makalede 342/7 haftada, 2160 gr doğan, surfaktan tedavisi verilmesi sırasında trakeal rüptür gelișen ve konservatif tedaviyle iyileșen bir kız yenidoğan olgusunu sunmayı amaçladık. Trakeal perforasyon gelișen yenidoğanlarda konservatif tedavide hasarlı bölgenin ilerisine endotrakeal tüp yerleștirilmesi, oral beslenmenin kesilmesi ve antibiyotik profilaksisi yer alır. Stabil vital bulguları olan hastalarda konservatif tedavi göz önünde bulundurulmalıdır.

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000308810400027 PubMed: 22974614 Aim: The current accepted management of ovarian torsion is ovary-sparing surgery. Ozone therapy is used to reduce ischemia/reperfusion (I/R) injury in several situations. An experimental study was designed to evaluate effect of ozone application in ovarian I/R injury. Materials and methods: Three groups (n = 6) and 18 rats were included in the study. After anesthesia, right ovaries were fixed and removed at the end of 2 hours in sham group (SG). In torsion group (TG), right ovaries underwent 720 torsion in a counterclockwise direction. Ovaries were removed after 2 hours torsion and 2 hours reperfusion. In ozone group (OG), torsion was created by the same technique, and 95% oxygen plus 5% ozone gas mixture was given intraperitoneally (25 mu g/mL, 0.5 mg/kg) 10 minutes before reperfusion. After 2 hours reperfusion, ovaries were removed. Histopathologic examination of ovarian and periovarian sections was performed for the presence of congestion (C), hemorrhage, interstitial edema (IE), and polymorphonuclear neutrophilic infiltrations. Tissue samples were analyzed for malondialdehyde, nitric oxide (NO), and total sulphidryl (t-SH) values. Results were compared between 3 groups. Results: At histopathologic examination, the TG have elevation in terms of ovarian C, polymorphonuclear neutrophilic infiltration, and periovarian IE when compared with SG (P < ,05). In OG, ovarian C and periovarian IE were reduced according to TG, whereas the increase was observed only in ovarian C compared with SG (P < .05). At biochemical evaluation of oxidative stress markers in SG and TG, there was no difference between them (P < .05). Malondialdehyde levels were significantly lower in OG than TG, whereas NO and t-SH values were higher (P < .05). Malondialdehyde levels were decreased in OG compared with SG (P < .05). However, no difference was observed in NO and t-SH levels (P > .05). Conclusion: Intraperitoneal application of ozone creates a positive impact on histologic and biochemical markers on I/R injury owing to ovarian torsion. The ozone application can be developed to support efforts to protect ovary in ovarian torsion. (C) 2012 Elsevier Inc. All rights reserved. Kirikkale University Scientific Research CouncilKirikkale University This study was presented in the 29th National Congress of Turkish Pediatric Surgeons, in 2011, Istanbul, Turkey, and supported by Kirikkale University Scientific Research Council.

9th Annual Meeting of the British-Association-of-Paediatric-Endoscopic-Surgeons -- OCT 08-10, 2007 -- Istanbul, TURKEY Aydos, Tolga Resat/0000-0002-1832-9336; Soyer, Tutku/0000-0003-1505-6042 WOS: 000277885300019 PubMed: 19524263 Background. The metabolic changes associated with carbon dioxide (CO(2)) pneumoperitoneum include metabolic acidosis and lowered intra-abdominal pH values. An experimental study was performed to evaluate the effect of CO(2) pneumoperitoneum on esophageal and gastric smooth muscle sensitivity in response to several agonists. Methods. Wistar albino rats, weighing 200-250 g, were allocated into three groups. After anesthetization with ketamine hydrochloride and xylazine, abdominal esophagus, gastroesophageal junction, and gastric fundus were removed via median laparotomy in the control group. In the oxygen (O(2)) group, a 16G catheter was inserted into the abdomen above the umbilicus and insufflated with 95% O(2) and 5% CO(2) with a pressure of 10 mm Hg. In the CO(2) group, CO(2) was insufflated at the same pressure within the same time and the tissues were removed at the end of a 60 min period of pneumoperitoneum. Abdominal esophageal segment (n:6), gastroesophageal junction (n:6) and gastric fundus (n:12) were suspended under 0.5 to 2 g resting tension in Tyrode solution in organ baths. Contraction responses were obtained by carbachol and serotonin and relaxation responses were evaluated by isoproterenol in each group. All the responses were compared by nonparametric Kruskal Wallis test. Results. Carbachol and serotonin induced contractile responses of abdominal segments, gastroesophageal junction, and gastric fundus showed no difference between the control, O(2), and CO(2) groups (P > 0.05). Isoproterenol relaxation responses of the three groups were also not statistically different from each other (P > 0.05). Conclusion. CO(2) pneumoperitoneum of 60 min has no influence on esophageal and gastric smooth muscle responses to different agonists in rats. (C) 2010 Elsevier Inc. All rights reserved. British Assoc Paediat Endoscop Surg

Soyer, Tutku/0000-0003-1505-6042 WOS: 000269761700007 PubMed: 19387925 Aim: This study aimed to evaluate the effect of penile tourniquet application on growth factors in rat penile tissues. Materials and Methods: Forty Wistar male rats were included in the study. Rats were divided into 4 groups. After anesthetization, perimeatal penile skin and the corpus cavernosum were sampled in the control group (CG). A Mathieu-like flap was designed without a penile tourniquet (PT) to serve as a sham group (SG). In the PT groups, a Mathieu-like flap was created and a 5 mm diameter rubber circular band was applied at the base of the penis. The PT was applied for 10 min in the PT-10 group and for 30 min in the PT-30 group. Penile tissue was sampled 24 h after PT application in the SG and PT groups. Tissues obtained were examined in three sections: the subepithelial vascular plexus (SVP), the corpus cavernosum (CC) and the smooth muscle-like mesenchymal cells in the corpus cavernosum (MC). Acute inflammation was evaluated with hematoxylin-eosin staining. The effect of PT on vascular endothelial growth factor (VEGF), VEGF receptor (VEGFR) and transforming growth factor 0 receptor (TGF beta-R) levels was evaluated. Results: Higher grades of acute inflammation were encountered in the PT-10 and PT-30 groups compared to the CG and SG (p0.05). When the levels of growth factors were compared between the CG and PT-10 group, the PT-10 group showed increased levels of VEGF and TGF beta-R. In the PT-30 group, both VEGF and VEGFR levels were found to be decreased. When acute inflammation grades of tissues were correlated with VEGF and TGF beta-R, higher acute inflammation grades correlated with decreased VEGF and increased TGF beta-R levels (Spearman's correlation, p

WOS: 000253483600013 PubMed: 18060415 We aimed to detect the protective effect of trapidil in ischemia-reperfusion (IR) injury due to ovarian torsion and detorsion. Thirty-two pubertal New Zealand albino rabbits were used. Adnexal torsion was created by rotating the left adnexa including the tubal and ovarian vessels in a 360 clockwise direction. Adnexal detorsion was done by untwisting the adnexa. In the IR group, left oopherectomy was performed after 3 h of adnexal torsion and 3 h of adnexal detorsion. In the study group, a 3-h adnexal torsion was performed and trapidil was administered intraperitoneally as a single dose of 40 mg/kg, 1 h before detorsion. The left oopherectomy was performed after a 3-h adnexal detorsion. In the sham group, sham operation was performed followed by left oopherectomy. In the control group, normal ovarian tissue was evaluated. Catalase, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) levels of ovarian tissue were determined for each group. The values of SOD and GSH-Px activities in the IR group were significantly decreased (P < 0.05). In addition, the MDA level was significantly higher in the IR group (P < 0.01). The trapidil-administered group showed significant increase in the levels of GSH-Px (P < 0.05), catalase (P < 0.05), SOD (P < 0.05), and decreased MDA levels (P < 0.05) compared to those in the IR group. The study has shown that trapidil treatment prevents ischemia induced oxidative damage in the ovarian tissues of rabbits.

Proksimal ve distal hipospadiyas onarımlarında cerrahın deneyimi ve kullanılan tekniklerdeki gelişmeye karşın komplikasyon oranı hala %1-90 arasında değişmektedir. Literatüre bakıldığında; glans penis ile ilgili meatal darlık, prolapsus ve retraksiyonu içeren az sayıda komplikasyondan söz edilmiştir. Yapılan taramada; hipospadiyas cerrahisi sonrasında tanımlanmış glansın dorsal kısmı ile ilgili herhangi bir yayına rastlanmadı. Glansda askı, stentin tesbitlenmesi ya da her ikisinin kullanımı nedeni ile glansdan geçilen rekraksiyon dikişine bağlı gelişen ameliyat sonrası skar bu komplikasyonlara eklebilir. Bu çalışmanın amacı; hipospadiyas cerrahisi sırasında kullanılan askı dikişine bağlı glansda skar gelişen dört hastanın sunulmasıdır. The complication rates are still 1-90% both in proximal and distal hypospadias regardless of the surgeon’s experience and the usage of most developed techniques. The literature survey revealed few complications of glans penis including meatal stenosis, prolapsus and retraction. Despite our literature survey, we could not find any article concerning the permanent scar tissue at the dorsal part of glans following hypospadias surgeries. A new complication can be added to these, concerning glans which is the formation of postoperative scar tissue as a reaction to suture material used in traction, stent anchoring or both. The aim of this paper is to demonstrate four cases which had glanular scar due to traction suture following the surgical proce- dures for hypospadias repair.

Concentrations of acute phase proteins (CRP: C-reactive protein, albumin) change during surgery. We investigated the acute phase response to circumcision and the effects of anaesthesia on this response. The children were divided into four groups; group 1 (intratracheal general anaesthesia,n=40), group 2 (general anaesthesia with mask,n=20), group 3 (ketamine,n=20), group 4 (local anaesthesia,n=35). Blood samples were obtained, 24 hours before circumcision, after premedication, and 24 hours after circumcision. CRP and albumin before circumcision were comparable for all groups. There was no increase in CRP, and albumin remained steady throughout the study. No difference was observed among the groups, and related to anaesthesia. No responsiveness may be explained with the size of injured tissue or anatomical and histological type of preputium.

Introduction: Hematoma is a common complication of inguinoscrotal surgery in childhood. We aimed to identify the possible effects of extratesticular hematoma on blood flow and the histology of testes in the early period.Also, the dartos tissue was evaluated histologically. Materials and Methods: Unilateral extratesticular hematoma was created in 12 New Zealand rabbits. Parenchyma of the testes and scrotum walls was evaluated by B-mode ultrasound and the spectrum from the intratesticular vessels was obtained by color Doppler ultrasound on days 1, 7 and 15 of the procedure. Testes and scrotal walls were removed at the end of the study for histologic evaluation. Results: There were no significant pathologic findings in the evaluation of the parenchyma and hemodynamia of the testes on days 1, 7 and 15. A well-organized but continuing hematoma was observed on day 15. Increased fibroblastic activity, dense inflammatory cells, necrotic areas and destruction of the muscular layer were observed at pathologic evaluation of the scrotum. Conclusions: Extratesticular hematoma has no effect on testicular histology and hemodynamia in the early period. Pathologic evaluation revealed fibrosis of the dartos fascia at the end of the second week. Destruction and fibrosis of this tissue may have an adverse effect on spermatogenesis by altering thermoregulation.

Multiple failed hypospadias reconstructions may cause minimal residual skin, as a result of extensive scarring. However, extragenital full thickness skin grafts or mucosal grafts are often used for urethral substitutions; local tissue expansion can provide additional matched skin, which can be easily harvested and used for penile constructions. Though tissue expanders were used as the choice of treatment in children with multiple failed hypospadias repairs, the use of tissue expander in the management of staged proximal hypospadais repair has not been reported previously. A 3-year-old boy with proximal hypospadias is presented to discuss the use of tissue expansion in the management of staged proximal hypospadias repair. © 2010 Springer-Verlag.

Joint Congress of British-Association-of-Pediatric-Surgeons/European-Pediatric-Surgery-Association -- JUN 17-20, 2009 -- Graz, AUSTRIA Soyer, Tutku/0000-0003-1505-6042 WOS: 000288413100011 Aim: To compare the growth factor levels in patients with normal and hypospadiac prepuce. Materials and methods: Patients who underwent hypospadias repair were included in the study. The prepuce was excised after achieving successful hypospadias repair with satisfactory functional and cosmetic appearance. The patients who underwent preputial reconstructions and complicated repairs were excluded. The control group consists of boys without hypospadias. Elective circumcision was performed to have normal preputial samples. The VEGF levels, VEGF receptor (VEGFR) and TGF-beta receptor (TGF-beta-R) expressions were evaluated in preputial tissues by immunohistochemical analysis. Results: Fifteen patients were included in each group. The mean age of patients with normal and hypospadiac prepuce was 4.33 +/- 1.39 and 4.07 +/- 1.58, respectively (P>0.05). Although VEGF, VEGFR, and TGF-beta-R levels were decreased in hypospadiac prepuce, statistical significance was detected only in VEGF levels (P

Soyer, Tutku/0000-0003-1505-6042 WOS: 000281832100013 Aim: To evaluate the effect of caustic esophageal injury (CEI) on the number of interstitial cells of Cajal (ICC) Materials and methods: Wistar rats were divided into 3 groups. control, acid, and alkali induced CEI CEI was performed by the injection of 1 mL of 10% hypochloric acid in the acid group, and 1 mL of 10% sodium hydroxide was injected into the alkali group. Distal esophageal segments were removed 24 h after injection CEI was graded and the number of ICC were investigated (CD-117 staining) The number of ICC was compared in groups and correlated with CEI grades Results: Typical histopathologic features of CEI were encountered in acid (mean grade 0 25 +/- 0.15), and in alkali (median 2, range. 1 25-3) groups The number of ICC was decreased in both the acid (mean 12 8 +/- 9.2) and alkali (median 2, range 0.0-4 0) groups with respect to the control group (mean 30 5 +/- 6 5) (P < 0 05) In addition, alkali group had a decreased number of ICC, when compared to the acid group (P < 0 05) Histopathologic grading showed an inverse correlation with number of ICC in both the acid (rs: 0 678) and alkali (rs 0.759) groups Conclusion: CEI decreases the number of ICC in the rat esophagus. Alkali caustics cause a higher grade of esophageal injury and a greater decrease in the number of ICC Motility disorders after caustic ingestion may be related to the decreased number of ICC

Objective: Nodules of ectopic adrenal cortex are found incidentally during inguinal operations. These rests have some clinical significance as they may undergo marked hyperplasia in conditions associated with excessive ACTH production, and occasionally may give rise to neoplasms. In the present study, it is aimed to evaluate the ectopic remnants of adrenal tissue encountered during the inguinal operations in children. Patients and Methods: Four hundred and fifty-two inguinal operations were performed on 397 children (325 male/ 72 female; mean age 2.7 years), during a period of 36 months. Nodules resembling ectopic adrenal tissue from eleven patients (2.7%) were removed and the histopathological examination was performed using hematoxylin-eosin staining. Results: Ectopic adrenal cortical tissues were found in eight male patients (2%), located within the distal end of the spermatic cord. Macroscopically, the nodules were round to oval in shape, 1 to 5 mm in diameter, and bright yellow to orange in colour. Microscopically, they had three layers of adrenal cortex surrounded by a fibrous capsule and none contained any medulla. Hyperplasia or neoplastic changes were not detected, and no fetal cortex was identified. Conclusions: It is important for surgeons to be conscious of the possibility that a nodule along the spermatic cord may be the ectopic adrenal cortical tissue. As they are associated with hyperplasia and neoplastic change, removal of ectopic adrenal cortical tissue is warranted whenever it is encountered, but a routine search for them is not mandatory.

PubMed ID: 25698279, [No abstract available]

PubMed: 17161170 Hypothyroidism is a serious endocrine disorder emerging from deficient production of thyroid hormone (thyroid gland agenesis or dysgenesis, or inborn metabolic defects of thyroid hormone production) or a defect in thyroid hormonal receptor activity. Prevention of iodine organification by means of using iodine-containing drugs or solutions is a protective mechanism for the body and is known as the Wolff-Chaikoff effect. This effect blocks thyroid hormone generation and is often transient, with thyroid hormone synthesis recovering in a few days or weeks. We present a neonate with transient thyroid dysfunction resulting from topical exposure to iodine-containing antiseptic solution. Our aim was to increase awareness that the use of antiseptic iodine solutions in neonates may result in transient hypothyroidism through the Wolff-Chaikoff effect and should be considered after the use of iodine-containing solutions or drugs. © 2006 Elsevier Inc. All rights reserved.

Purpose: We determined the incidence of defects in 3 enzymes, namely 3 beta-hydroxysteroid dehydrogenase, 17 alpha-hydroxylase and 17,20-lyase, on the testosterone biosynthetic pathway in boys with hypospadias.Materials and Methods: We evaluated 30 boys with a 46,XY karyotype, fully descended testes and penoscrotal or proximal shaft hypospadias. Serum concentrations of the metabolites mediated by these enzymes were measured, from which the precursor-to-product ratios were calculated. Seven patients underwent adrenocorticotropic hormone stimulation. Findings were compared to previously published data on age matched normal boys.Results: A total of 11 boys had evidence of impaired function of 3 beta-hydroxysteroid dehydrogenase alone or in combination with impaired 17,20-lyase or 17 alpha-hydroxylase activity. An additional 4 boys had evidence of isolated 17,20-lyase deficiency. Thus, of the 30 boys studied 15 (50%) had evidence of a testosterone biosynthetic defect. The effect of adrenocorticotropic...

Bayram, Cem/0000-0001-8717-4668; Soyer, Tutku/0000-0003-1505-6042 WOS: 000327938200031 PubMed: 24314201 Aim: Platelet rich fibrin (PRF) is an autologous source of growth factors and promotes wound healing. An experimental study was performed to evaluate the effect of PRF on growth factor levels in urethral repair. Materials and Methods: Eighteen Wistar albino rats were included in the study. Rats were allocated in three groups (n:6): control (CG), sham (SG), and PRF (PRFG). In SG, a 5 mm vertical incision was performed in the penile urethra and repaired with 10/0 Vicryl (R) under a microscope. In PRFG, during the urethral repair as described in SG, 1 cc of blood was sampled from each rat and centrifuged for 10 minutes at 2400 rpm. PRF obtained from the centrifugation was placed on the repair site during closure. Penile urethras were sampled 24 hours after PRF application in PRFG and after urethral repair in SG. Transforming growth factor beta receptor (TGF-beta-R-CD105), vascular endothelial growth factor (VEGF) and its receptor (VEGF-R), as well as endothelial growth factor receptor (EGFR), were evaluated in subepithelia of the penile skin and urethra. Groups were compared for growth factor levels and growth factor receptor expression with the Kruskal Wallis test. Results: TGF-beta-R levels were significantly decreased in SG when compared to CG (p < 0.05). In PRFG, TGF-beta-R was increased in both subepithelia of penile skin and urethra with respect to SG (p < 0.05). When VEGF levels and its receptor expression were compared between SG and PRFG, VEGF levels were found to be increased in penile skin subepithelium, whereas VEGF-R expressions were decreased in urethral subepithelia in PRFG (p < 0.05). There was no difference between groups for EGFR levels (p > 0.05). Conclusion: Use of PRF after urethral repair increases TGF-beta-R and VEGF expressions in urethral tissue. PRF can be considered as an alternative measure to improve the success of urethral repair. (C) 2013 Elsevier Inc. All rights reserved. Kirikkale University Scientific CouncilKirikkale University This study is presented in 30th Congress of Turkish Pediatric Surgeons, in 2012, Ankara, Turkey and supported by Kirikkale University Scientific Council. Special thanks to Serkan Sahinoglu, MD for his kind contribution to review the English of the manuscript.