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Objectives:We compared the results of patients who underwent transanal endorectal pull-through (TEPT) and Martin-modified Duhamel operations for Hirschsprung’s disease (HD).Materials and Methods:Between 2002 and 2007, we evaluated 53 patients with HD treated with TEPT (group 1, n=24), endorectal pull-through with a laparotomy requirement after an initiated transanal approach (group 2, n=12) and Martin-modified Duhamel (group 3, n=17). Age, gender, length of aganglionic segment, intraoperative details, postoperative early complications and long term functional outcomes are evaluated and compared among these patient groups.Results:In this study age at the time of the operation, duration of the operation, time to first oral feeding, time to first stool and hospital stay in the patients the group 1 were significantly less or shorter than those ones in group 2 and group 3 (p0.05). Postoperative enterocolitis had a higher incidence in group 3, but there was also no significant difference (p>0.05). There was no difference in the long-term functional results (continence, fecal soiling, constipation) of all three procedures (p>0.05).Conclusion:TEPT is both a feasible and safe technique. It may be the first choice particularly in patients with early diagnosed rectosigmoid HD patients without enterocolitis or bowel dilatation.

WOS:000545915900008 PubMed: 32073407 [Özet Yok]

BACKGROUND: In this study, we aimed to examine the therapeutic effects of ozone on the acute phase of intestinal ischemia-reperfusion (I/R) injury in rats to resemble clinical practice. METHODS: Eighteen Wistar albino rats were assigned to control (CG, n=6), sham (SG, n=6) and ozone groups (OG, n=6). A midline laparotomy was performed and a superior mesenteric artery (SMA) in the SG and OG was occluded with a 0/0 catgut suture, but in the CG, the incision was closed without any intervention. Tissue oxygenation was monitored with a tissue oxygenation monitor to achieve the same grade during intestinal ischemia. The incision was closed and, in the OG, ozone/oxygen mixture (0.7 mg/kg) was injected intraperitoneally, 20 minutes before reperfusion. Surgical incision was reopened and reperfusion was achieved after 60 minutes of ischemia in the SG and OG. After 60 minutes of reperfusion, 2 cm small intestine segment was sampled for histopathological assessment of the intestinal mucosal damage (Chiu score) and biochemical assessment of oxidative stress markers (nitric oxide: NO, malondialdehyde: MDA, superoxide dismutase: SOD) in all groups. RESULTS: The Chiu scores of the SG and OG were statistically increased than that of the CG (p=0.002; and p=0.002, respectively). Chiu score in the OG was higher compared to that in the SG, but not statistically significant (p=0.175). MDA levels were statistically higher in the SG and OG than that of the CG (p=0.004; and p=0.010, respectively). However, the difference between the SG and OG was not statistically significant (p=0.522). SOD and NO levels were not significantly different between groups (p=0.451 and p=0.056, respectively). CONCLUSION: Contrary to the literature, single-dose ozone therapy did not reduce the oxidative stress or improve the ischemic damage in intestinal I/R injury in rats. Further evaluation with different doses in different time periods is needed for potential clinical use. AMAÇ: Klinik uygulamalara benzer şekilde sıçanlarda ozonun intestinal iskemi-reperfüzyon (I/R) hasarının akut fazı üzerindeki terapötik etkilerini incelemeyi amaçladık. GEREÇ VE YÖNTEM: On sekiz Wistar albino sıçanı kontrol (CG, n=6), sham (SG, n=6) ve ozon gruplarına (OG, n=6) ayrıldı. Laparatomiyi takiben SG ve OG’de süperiyor mezenterik arter (SMA) 0/0 katgut dikişle oklüde edildi, ancak CG’de herhangi bir girişim yapılmadan insizyon kapatıldı. Eşit derecede bağırsak iskemisi elde etmek için bir doku oksijenasyon monitörü kullanıldı. İnsizyon kapatıldı ve OG’de, reperfüzyondan 20 dakika önce ozon/oksijen karışımı (0.7 mg/kg) intraperitoneal olarak enjekte edildi. SG ve OG’de 60 dakikalık iskemi sonrası cerrahi insizyon tekrar açıldı ve reperfüzyon sağlandı. Atmış dakikalık reperfüzyondan sonra tüm gruplarda bağırsak mukozal hasarının (Chiu skoru) histopatolojik değerlendirmesi ve oksidatif stres belirteçlerinin (nitrik oksit: NO, malonildialdehit: MDA, süperoksit dismutaz: SOD) biyokimyasal değerlendirmesi için 2 cm’lik ince bağırsak segmenti örneklendi. BULGULAR: Chiu skorları SG ve OG’de CG’ye göre istatistiksel olarak yüksekti (sırasıyla, p=0.002 ve p=0.002). Chiu skoru OG’de SG’ye göre daha yüksekti, ancak istatistiksel olarak anlamlı değildi (p=0.175). MDA düzeyleri SG ve OG’de CG’ye göre istatistiksel olarak daha yüksekti (sırasıyla p=0.004 ve p=0.010). Ancak, SG ve OG arasındaki fark istatistiksel olarak anlamlı değildi (p=0.522). SOD ve NO düzeyleri açısından gruplar arasında anlamlı olarak fark yoktu (sırasıyla, p=0.451 ve p=0.056). TARTIŞMA: Literatürün aksine, tek doz ozon tedavisi, sıçanlarda bağırsak I/R hasarında oksidatif stresi azaltmadı ve iskemik hasarı iyileştirmedi. Potansiyel bir klinik kullanım için farklı zaman aralıklarında farklı dozları içeren daha ileri değerlendirmeler yapılması gerekmektedir.

WOS: 000528311600001 The purpose of the study is to investigate the effects of extractum cepae (EC), heparin sodium (HS), and allantoin (AA) on postoperative peritoneal adhesion (PPA) prevention. Forty-eight rats were allocated into six groups (n = 8). PPA was performed by Harris method. In group 1, no additional procedure was done. Abdominal cavity was washed with normal saline in group 2, EC in group 3, HS in group 4, AA in group 5, and EC-HS-AA mixture (EHA-m) in group 6. On the 21st postoperative day, PPA was scored with Nair adhesion score and examined for fibrosis histopathologically and hydroxy-proline levels (OHP) biochemically. Macroscopically, PPA was decreased in groups 2, 4, and 6 compared to groups 1, 3, and 5 (p < 0.05) and decreased in group 2 compared to other groups (p < 0.05). Histopathologically, fibrosis was decreased in groups 2, 4, and 6 compared to other groups and decreased in group 2 compared to other groups (p < 0.05). Tissue OHP level was decreased in groups 2, 3, 4, and 5 compared to groups 1 and 6 (p < 0.05). Tissue OHP level was decreased in group 6 compared to group 1, but the difference was not statistically significant. PPA formation decreases with normal saline, HS and EHA-m, whereas increases with EC and AA both macroscopically and microscopically. Although HS and EHA-m seem to have adhesion prevention effect, washing the intestines with saline seems to be more effective. Kirikkale University Scientific Research CouncilKirikkale University [2014/81] This study was supported by Kirikkale University Scientific Research Council (2014/81) for only purchasing laboratory animal and other materials stated in the methods.

PubMed: 31787583 Introduction: This study was performed to evaluate the oxidative and histopathological changes that occur following the application of electrosurgical devices (monopolar or bipolar cautery) to penile tissue. Material and methods: Eighteen Wistar albino male rats were randomly distributed into three groups. In the control group (CG, n = 6), all penile tissues were sampled without any additional process following the administration of anesthesia. In the monopolar cautery group (MPG, n = 6), a 15-W cauterization process lasting 5 s was performed on an approximately 2 mm2 area of the ventral side of the penile shaft, 0.5 cm proximal to the edge of the glans in the midline. Bipolar cautery was practiced in the third group (BPG, n = 6) using the same techniques outlined in the previous statement. Penile tissues consisted of the cautery application area, the edge of the glans, and dorsal side of the penis and were sampled after 90 min; then, histopathological evaluation and biochemical examination involving malondialdehyde (MDA), nitric oxide (NO), and superoxide dismutase (SOD) measurements were performed. Results and discussion: Histopathologically, the MPG and BPG demonstrated increased inflammation, fibrosis, and epithelial loss in the urethra in the areas to which cautery was applied as compared to the CG (P < 0.05). The vascular structures of the corpus cavernosa were significantly decreased in the cautery application area of both the MPG and the BPG as compared to the CG (P < 0.05). In the Masson's trichrome stained samples, significant collagen deposition was observed in the cautery application area both in the MPG and the BPG as compared to the CG (P < 0.05). However, S-100 staining was decreased in these groups as compared to the CG (P < 0.05). S-100 staining was also decreased in the MPG as compared to the BPG on the edge of the glans (P < 0.05). Biochemically, MDA values were significantly increased in the MPG as compared to the CG and the BPG (P < 0.05). Conclusion: Monopolar and bipolar cautery both did cause oxidative changes and triggered inflammatory, vascular, and peripheral nerve alterations in the cautery application area while bipolar cautery did not cause any distant effects. © 2019 Journal of Pediatric Urology Company

WOS: 000377113400001 Background Surgical suture materials are accepted to be associated with a substantial proportion of surgical site infections. These infections are related with biofilm formation similar to that of other synthetic and implantable medical devices. Methods We conducted an in vitro study to investigate the bacterial adherence to different types of braided surgical sutures. The included sutures were polyglactin (Vicryl (R)) group (VG), rapidly absorbable polyglactin (Rapide-Vicryl (R)) group (RVG), nitrofurazone-coated polyglactin (Vicryl (R)) group (FVG), polyethylene terephthalate (Etibond (R)) group (EG), and natural silk (Silk (R)) group (SG). All sutures were cut in 1 cm length, embedded into tryptic soy broth, and then 10(6)-CFU/ml Escherichia coli and Staphylococcus aureus were added. After the 24th and 96th hour of incubation, bacterial colonies were counted, and results were expressed as CFU/cm. Results E. coli adhesion was significantly lower in VG and significantly higher in SG compared to FVG, RVG, and EG at the 24th and 96th hour of cultivation (p< 0.05). The S. aureus adhesion results at 24th hour showed that VG had the least bacterial adhesion, and FVG had the most bacterial adhesion compared to other sutures (p< 0.05). The S. aureus adhesion results at the 96th hour of cultivation showed that bacterial adhesion on sutures was not significantly different between groups (p> 0.05). Conclusion Of all braided surgical sutures, bacterial adhesion is significantly lower in polyglactin and significantly higher in silk sutures. Nitrofurazone coverage of suture worsens S. aureus contamination of the suture.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000350825200009 PubMed: 25746698 Purpose: To investigate the effects of enteral hormones on pyloric muscle in order to clarify the etiopathogenesis of hypertrophic pyloric stenosis (HPS). Methods: Forty-two newborn Wistar-Albino rats were included. No intervention was done in the control group (CG, n = 6). In the sham group (SG, n = 6) 1 ml saline (0.9% NaCl solution), in the Nw-nitro-L-arginine methyl ester hydrochloride (L-NAME) group (LNG, n = 6) 100 mg/kg/d L-NAME, in the somatostatin group (STG, n = 6) 7 mcg/kg/d ST, in the cholecystokinin group (CCKG, n = 6) 3 mcg/kg/d CCK, in the substance P group (SPG, n = 6) 5 ml/kg/d SP, and in the prostaglandin-E1 group (PGE1G, n = 6) a cumulative dose of 360 mcg/kg PGE1 was given intraperitoneally for 14 days. On the 21st day, histopathological examination and muscle thickness measurements were done. Results were evaluated statistically. Results: Total and circular pyloric muscle thicknesses were significantly increased in the LNG compared to the CG and SG (p < 0.05). Circular pyloric muscle thickness was not increased in the STG, CCKG and SPG compared to the CG and SG (p > 0.05). In the PGE1G, muscle thickness was significantly decreased in the pylorus and increased in the antrum compared to the CG and SG (p < 0.05). Conclusion: Nitric oxide synthase (NOS) inhibition with L-NAME seems to be a causative factor in HPS by increasing pyloric muscle thickness. PGE predominantly affects antral gastric muscle and has no profound effect on pyloric muscle. (C) 2015 Elsevier Inc. All rights reserved. Kirikkale University Scientific Research CouncilKirikkale University [2013/61] This study was supported by Kirikkale University Scientific Research Council (2013/61). Special thanks go to Mrs. Corrine Can for her kind contribution to the English revision of the manuscript.

Objective: Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, since no investigation can confidently exclude torsion of testis from the differential diagnosis.Methods: A review of all boys presenting with acute scrotal pain who underwent emergency scrotal exploration between January 1983 and March 2003 was performed.Results: 195 boys were included in this study. They were divided into 3 groups: group 1–73 with epididymo-orchitis, group 2–63 with torsion of testicular appendages and group 3–57 with spermatic cord torsion. The patients in group 2 were older than group 1, also patients in group 1 were older than group 3. During neonatal period the most common pathology was spermatic cord torsion, whereas in prepubertal period torsion of appendages was more common. In all boys, mean duration of pain at presentation was 2.11 days. Epididymo-orchitis was diagnosed in 37% of patients, with torsion of the appendages being the next most common entity. Testicular torsion was diagnosed in 29% of patients. In the group with testicular torsion salvage rate of testis was 37% because of late admission. The perioperative morbidity and mortality was not seen in any of the groups.Conclusion: We believe that any boy with acute scrotal pain and any suspicion of testicular torsion in physical examination must be applied routine surgical exploration.

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000429301400046 PubMed: 28693848 Purpose: To investigate the effects of penile tourniquet (PT) application on bacterial adhesion to urothelium. Methods: Fifty-six ratswere allocated into control group (CG), shamgroup (SG), PT group (PTG). No intervention was applied in CG. A 5mm-length urethral repair was performed in SG and PTG. In PTG, a 10-min duration of PT was applied during the procedure and the tissue oxygenation monitor was used to adjust the same degree of ischemia in all subjects. Sampleswere examined for wound healing parameters and tissue levels of inflammatory markers, eNOS, e-selectin, and ICAM-1antibodies. The adhesion of Escherichia coli to urotheliumwas investigated with in vitro adhesion assay. Results: Inflammation was higher and wound healing was worse in SG than CG and in PTG in comparison to CG and SG (p < 0.05). The endothelial damage, as shown by eNOS expression, was significantly higher in PTG compared to CG and SG (p < 0.05). The staining with ICAM-1 and e-selectin antibodies, showing increased inflammatory response to bacterial adhesion, was significantly higher in PTG compared to CG and SG (p < 0.05). In vitro urethral cell proliferation was achieved only in CG and SG revealing significantly increased adhesion in SG compared to CG (p < 0.05). The PT application caused endothelial corruption and prevented cell proliferation in cell culture. Conclusion: The PT application does not improve wound healing and increases bacterial adhesion molecules in penile tissue. The in vitro assays showed that PT causes severe endothelial damage and inhibits endothelial cell proliferation. (c) 2017 Elsevier Inc. All rights reserved. Kirikkale University Scientific Research CouncilKirikkale University [2014/82] This study was supported by Kirikkale University Scientific Research Council (2014/82).

WOS: 000406457100009 PubMed: 28616621 Isolated tubal torsion -a rare cause of acute abdomen in children-is usually difficult to diagnose because of non-specific findings. Surgical salphingectomy is required in delayed diagnosis in most cases. Three sexual inactive adolescents diagnosed in isolated tubal torsion (ITT) were discussed for its diagnostic features and surgical management. Laboratory tests and radiological studies including ultrasonography (US), color doppler ultrasound were performed in all patients after evaluation for acute lower abdominal pain in emergency department and they underwent surgical intervention with laparotomy (n:2) and laparoscopy (n:1). One of the patients in this study had salpingectomy. Detorsion of the fallopian tube and cyst excision were performed in the remaining two patients who also had paratubal cysts. There was no recurrence in these patients during the follow-up for 3 and 2 years. The isolated tubal torsion should be kept in mind and early surgical management is essential in order to preserve fallopian tube because of its importance in fertility. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Soyer, Tutku/0000-0003-1505-6042 WOS: 000327254400051 PubMed: 23375616 Aim: Although absent cremasteric reflex is a significant clinical finding for testicular torsion (TT), there is limited information about microcirculation of the cremasteric muscle (CM) after TT. This experimental study was performed to evaluate CM microcirculation by intravital microscopy after TT. Materials and methods: Twelve Wistar rats were allocated into two equal groups: control (CG) and torsion (TG). After anesthetization of the CG rats, the CM flap was dissected through a left ventral inguinal incision with its vascular pedicle. In TG rats, TT was performed by rotating left testicles 720 degrees in clockwise direction for 1 h. Then, the CM flap was dissected as in CG, and was placed under an intravital microscope. Vessel diameters, functional capillary perfusion and leukocyte activation in post-capillary venules were measured and evaluated statistically. Results: There was a significant decrease in vessel diameter in TG compared to CG (p < 0.05). The median of perfused capillaries in CG and TG was 13 (11.75-14.30) and 5.5 (4.75-7.25), respectively (p < 0.05). Number of granulocytes (rolling, sticking, transmigrated) was greater in TG than CG (p < 0.05). Conclusion: Intravital microscopic evaluation of CM after TT showed decrease in vessel diameter and number of perfused capillaries, and increase in granulocyte activation. Clinical, electrophysiological alterations in CM after TT can be explained by deterioration of microcirculation of CM. (C) 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

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.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000346905500013 PubMed: 24000129 AimA retrospective study was performed to evaluate the results of multichannel intraluminal impedance (MII) pH metry in symptomatic children with normal pH monitoring (PM) findings. Patients and MethodsChildren who have reflux index (RI) less than 4% in PM and recurrent symptoms were included. All children underwent MII. Children who received antireflux treatment with normal PM findings were excluded from the study. MII results were evaluated for RI, content of reflux (acid, weak acid, and alkaline) number and type of impedance events, esophageal bolus clearance time and proximal extent of reflux (PER). ResultsEight patients (age range: 5-13 years) were included to the study. The male female ratio was 5:3. The recurrent symptoms were related with gastrointestinal (n=5) and upper respiratory system (n=3). One of the patients was operated for esophageal atresia and one was followed for corrosive esophageal disease. Four of the patients had RI higher than 4% in MII. Patients with normal RI in MII, had weak acid reflux (n: 1), alkaline reflux (n=1) and no reflux (n=2). When number of impedance events evaluated, four patients had abnormal reflux episodes (70 or more reflux episodes). Impedance event recordings were correlated in 75% of PM findings. The content of impedance events were mixed and gas in nature. Prolonged esophageal clearance time and PER were detected in patients with chest pain and operated esophageal atresia. ConclusionMII can be considered as a superior diagnostic tool to detect weak acid and alkaline reflux in patients who had recurrent symptoms with normal PM studies. MII also provides information about bolus clearance time and extent of reflux.

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000346338600013 PubMed: 23939657 Background A thoracic traumamodel was designed to evaluate the effect of dimethyl sulfoxide (DMSO) and dexamethasone (DX) on histopathologic and oxidative changes in lung parenchyma seen after pulmonary contusion. Methods Twenty-four Wistar albino rats were included in the study. They were allocated into control (CG, n = 6), sham (SG, n = 6), DX (DXG, n = 6), and DMSO (DMG, n = 6) groups. Only a lung biopsy was performed in CG. In the experimental groups, blunt thoracic trauma was induced by dropping a cylindrical metal weight (0.5 kg) through a stainless steel tube onto the right hemithorax from a height of 0.4 m (E = 1.96 J). In the SG, 1 mL of physiologic saline was injected intraperitoneally, in the DXG 10 mg/kg of DX was injected intraperitoneally, and in the DMG 1.2 g/mL of DMSO was injected intraperitoneally 15 minutes after trauma. After 6 hours, lung biopsy was performed for histopathologic and oxidative injury markers. Results Histopathologically, congestion, hemorrhage, neutrophil infiltration, endothelial-nitric oxide synthase (E-NoS), and total pathologic score were significantly higher in SG, DXG, and DMG when compared with CG (p < 0.05). Neutrophil infiltration, total pathologic score, and E-NoS were significantly decreased in DMG when compared with SG and DXG (p < 0.05). Biochemically, superoxide dismutase (SOD) level was significantly higher in SG, DXG, and DMG than in CG. SOD level was significantly lower in DXG and DMG than in SG (p < 0.05). Conclusion DMSO prevents further injury by decreasing neutrophil infiltration and endothelial injury in lung contusions. DX may have a role in the progression of inflammation but not in preventing the pathologic disruption of pulmonary parenchyma. Kirikkale University Scientific Research CouncilKirikkale University [2012/87] The study was supported by Kirikkale University Scientific Research Council (2012/87). There is no financial or personal relationship with other people or organizations that could inappropriately influence (bias) the work. There is no conflict of interest.

This study describes the pediatric inguinal hernia and hydrocele experience of a tertiary care training hospital.A total of 3776 patients who had been operated between January 2005 and June 2009 for inguinal hernia, cord hydrocele, and hydrocele were included. The surgeries and patient follow-up were performed by 6 pediatric surgery specialists and 8 pediatric surgery residents.The patient age varied from 6 days to 17 years. There were 2959 (78.4%) males and 817 (21.6%) females (ratio: 3.6:1). The hernia was on the right in 2306 (61.1%) patients, on the left in 1111 (29.4%) patients, and bilateral in 359 (9.5%) patients. Age at presentation was younger in males (p.001). Contralateral hernia repair was required later on during follow-up in 2% of the patients. Postoperative complications developed in 1.2% of the patients. Reoperation was needed because of wound infection in 0.6%, recurrence in 0.4%, hematoma in 0.1%, testicular atrophy in 1 patient, and acquired undescended testis in 1 patient.The age of first hernia symptoms was younger in males compared to females and in premature babies compared to term babies (p.05). The recurrent hernia rate was higher in infancy. The complication rate was higher in hernia surgery in the newborn period and in cases of incarcerated hernia compared to the overall rate (p.05). There was no indication for contralateral routine exploration.

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.

Enürezis nokturnası (EN) olan çocuklarda aile öyküsüne çok sık rastlanmakta ama bu olguların klinik özellikleri, aile öyküsünün tedavi etkinliğine etkisi bilinmemektedir. Ailesel EN olgularının demografik, klinik özelliklerini incelemek ve aile hikâyesinin tedavi etkinliğine olan etkisini değerlendirmek için prospektif bir çalışma planlanmıştır.Bu çalışma prospektif, tanımlayıcı ve anket bazlı bir çalışmadır. Çalışmaya EN nedeniyle kliniğimizde takip edilen 117 olgu ve EN şikâyeti olmayan 150 sağlıklı çocuk dâhil edilmiştir. Çalışmaya alınan tüm olguların demografik özellikleri, aile eğitim düzeyleri, tuvalet eğitimi zamanı, idrar yolu enfeksiyonu öyküsü, ailede EN öyküsünü ölçmeyi amaçlayan anket yapılmıştır. EN’li olgular içinde aile hikâyesi olan ve olmayan hastalar tedavi açısından karşılaştırılmıştır. Olguların yaş ortancası EN’li (n:117) ve sağlıklı çocuklarda (n:150) 8 yaştır (7-9 yaş) (p>0.05). Kız/erkek oranı EN grubunda 52/65, sağlıklı çocuklarda 63/87’dir. Aile eğitim düzeyleri karşılaştırıldığında, yüksek eğitim gören anne, baba oranlarının sağlıklı çocuklarda EN’si olan olgulara oranla daha fazla olduğu izlenmiştir (p0.05). EN’li olgularda aile öyküsü sağlıklı çocuklara oranla daha sık gözlenmektedir. EN öyküsü olan çocukların aile eğitim düzeyi sağlıklı çocukların ailelerine göre daha düşük, tuvalet eğitim zamanları ise daha geçtir. Aile öyküsü olan ve olmayan çocuklar arasında fark bulunmamaktadır. Aileler tarafından değerlendirilen tedavi etkinliği aile öyküsü olan ve olmayan hastalar arasında fark göstermemektedir.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000368558600028 PubMed: 27511333 Background/aim: The aim of this study was to electrophysiologically evaluate the effect of increased intraabdominal pressure (IAP) on genitofemoral nerve (GFN) motor conduction. Materials and methods: Seven Wistar albino rats were included. After anesthetization, latency and duration of GFN conduction was recorded with a needle-probe at rest. IAP was increased to 15 mmHg by insufflating atmospheric air with a percutaneous intraperitoneal needle. At 30 min of IAP, GFN motor conduction was recorded. Abdominal pressure was then increased to 20 mmHg. At 60 min, GFN motor conduction was recorded again. The consecutive recordings of latency and duration of GFN conduction (rest, 30 min, 60 min) were evaluated statistically. Results: There was a significant difference between latencies at rest (1.90 +/- 0.22 ms), at 30 min (2.3 +/- 0.36 ms), and at 60 min (2.74 +/- 0.57 ms) (Friedman test, P = 0.001). The latency was significantly increased at 60 min compared to rest (post hoc Tukey test, P = 0.003). No similar difference was detected between the recordings at 30 and 60 min. The duration of GFN motor conduction showed no difference between consecutive recordings (P = 0.067). Conclusion: Both increased and prolonged IAP causes prolonged latency of GFN conduction, probably due to a compression effect on GFN. Neuropraxial consequences of increased IAP are thought to be related to the compression effect of peripheral nerves. Kirikkale University Scientific Research CouncilKirikkale University [2013/01] This study was presented at the 14th European Congress of Pediatric Surgery in 2013, Leipzig, Germany, and was supported by the Kirikkale University Scientific Research Council (2013/01).

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.

BACKGROUND/AIM The aim is to evaluate the long-term outcome of asymptomatic patients who underwent surgical correction for midgut volvulus. MATERIALS AND METHODS Seven patients managed surgically for midgut volvulus in the last 3 years were included. Demographic features, symptoms at presentation, diagnoses, surgical procedures, and complications were recorded. Patients were then contacted for follow-up and evaluation of long-term outcomes. General physical conditions, anthropometric parameters, feeding habits, and defecation histories were evaluated. Laboratory examinations were performed. Color Doppler ultrasonography (CDUS) was performed to evaluate blood flow in the superior mesenteric artery (SMA). RESULTS In total, seven patients were identified. The median age at admission was 3 days (0-90 days). Mean age at follow-up was 17 ± 2 months. Growth parameters were normal in all cases. Four patients had low levels of ferritin and transferrin saturation. One patient had microcytic anemia. Another patient had low serum zinc level. One patient who had ileal resection had a high level of steatorrhea in stool examination. In CDUS, SMA blood flow volume was low in all cases. Peak-systolic velocity and resistance index were low in all but one case. CONCLUSION Despite uneventful postoperative courses, all patients operated on for midgut volvulus showed mild laboratory changes and decreased blood flow in the SMA in long-term follow-up.

The aim of this study was to determine whether the admission and active observation of children where the diagnosis of acute appendicitis is uncertain is a safe and effective way to improve the diagnostic accuracy of appendicitis and safely reduce the incidence of negative laparotomies without increasing complications.We performed a retrospective cohort study of children who presented with a complaint of right lower quadrant pain and were hospitalized with a diagnosis of appendicitis or suspected appendicitis from 1 January to 31 December 2007.A total of 569 patients were included in the study. The mean age was 9.5 +/- 3.2 (range 1.1-17) years. The number of patients directly operated on with a diagnosis of appendicitis was 186 (32%) from the total of 575 while 389 patients (68%) were observed in the surgical ward as the examination and/or investigation findings were equivocal. Of the 383 patients admitted for observation, 173 (45%) were operated on with a suspicion of appendicitis after 14.4 +/- 6.7 h while 210 (55%) were discharged after 1.1 +/- 1.2 days as there seemed to have no surgical problem. Our total negative appendectomy rate was 4% (14/350) and total perforation rate was 37.4% (131/350). The patients operated on directly and those operated on after observation were similar, and there was no difference for the preoperative duration of symptom, histopathological diagnosis, postoperative complication rate, postoperative inpatient days and hospital charges. Total hospitalization duration was significantly longer and the hospital charges significantly higher in the negative appendectomy group.Both the features and results and the complication rates and costs of the group operated on after observation were the same as the directly operated on group. However, patients undergoing a negative appendectomy stayed as inpatients longer than only observation patients with higher treatment charges. We could therefore decrease the negative appendectomy rate, the associated cost and duration of hospitalization without causing extra complications if we observe and investigate patients with right lower quadrant pain with a doubtful diagnosis and did not operate on them directly.

Superficial epithelial ovarian tumors are unusual in adolescent girls (when compared with adult women) and extremely rare before menarche. Mucinous cystadenoma (MCA) in children that is a rare form of epithelial tumor is a benign cystic ovarian neoplasm. To our knowledge, there are only eight cases of mucinous cystadenoma, three of borderline mucinous cystadenoma, and three of mucinous cystadenocarcinoma reported in the English-language literature. We present a 14-year-old premenarchal girl with a giant ovarian mucinous cystadenoma. This review is supported by the finding that epithelial ovarian neoplasms are extremely rare prior to puberty and that only 14 mucinous tumors have been reported prior to menarche.

Buts: Le but de cette etude etait d'evaluer les resultats fonctionnels, les complications, les problemes causes et le devenir de l'abaissement transanal (TEPT) dans la maladie de Hirschsprung. Patients et Methodes: Les 22 patients qui ont ete operes pour une maladie de Hirschsprung avec DEPT entre novembre 2003 et septembre 2006 ont ete revus retrospectivement. Pour ces patients, etaient etudies l'âge, le sexe, les decouvertes operatoires, la duree de l'hospitalisation et le devenir fonctionnel apres l'operation. Resultats: Un total de 22 patients, 16 garcons (72,7%) et 6 filles (27,3%) âges de 23 jours a 11 ans (moyenne de 19,3 ±6,9 mois) ont ete operes par le TEPT sur une periode 34 mois. La longueur moyenne du segment aganglionnaire reseque etait de 23 ± 2,4cm; le segment le plus court etait de 7 cm et le plus long de 40cm. Le sejour a l'Hopital etait de 3 a 10 jours, l'alimentation orale etait commencee entre le premier et le quatrieme jour post-operatoire, la reprise du transit etait notee du premier au septieme jour et le nombre des patients pour lesquels la colostomie etait fermee etait de 2 a 5 jours. Le suivi post-operatoire moyen etait de 18±2,4 mois (1 a 33 mois). Deux patients (9%) etaient hospitalises une fois pour enterocolite. Un patient avait un probleme de constipation qui a ete resolu par un traitement medical. Un patient necessitait une colostomie pour fistule anastomotique au Seme jour post-operatoire suivi d'un nouvel abaissement utilisant une approche sagittale posterieure. Aucun patient n'avait de probleme de continence, aucun probleme ureteral n'etait observe et il n'y avait aucun abces dans la couche musculaire. Nous observons que la dissection muqueuse etait plus difficile dans la zone de la biopsie rectale. Conclusion: Quoique recemment accepte, TEPT a rapidement trouve sa place en pratique clinique et base sur une technique operatoire dont les resultats sont bien identifies et acceptes et avec lesquels il y a une experience importante. Il semble que TEPT a les avantages de n'avoir aucun probleme complementaire compare aux techniques classiques en ce qui concerne les complications et le devenir fonctionnel permettant un meilleur confort au patient et un meilleur aspect. Nous concluons que TEPT peut etre prefere dans les cas appropries et deviendra la technique la plus utilisee et la plus efficace.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000344155900027 PubMed: 25552166 Background/aim: To compare dysfunctional voiding symptom scores (DVSSs) between enuretic children and nonenuretic controls and to investigate associated factors that may affect DVSS. Materials and methods: A questionnaire including demographic features, educational status of parents, DVSS questions, and urinary tract infection (UTI) history was designed. A total of 269 patients were included; Group 1 comprised 161 patients with no voiding symptoms and Group 2 comprised 108 patients with nocturnal enuresis (NE). Children with DVSS of greater than 8.5 were suspected to have dysfunctional voiding. The results were evaluated using SPSS 15.0 with Kruskal-Wallis and multivariate logistic regression tests. Results: The median DVSS was 2 (interquartile range [IQR]: 1-3) in Group 1 and 8 (IQR: 5-12) in Group 2. The percentage of children with DVSS greater than 8.5 was 0.6% in Group 1 and 53.1% in Group 2 (P = 0.01). The percentage of children with UTI history was significantly higher in Group 2 (34.3%) than Group 1 (15.9%) (P = 0.03). An increase in the educational level of the father decreased DVSS by 0.5-fold. Presence of UTI history increased DVSS 2.5-fold. Conclusion: The DVSS is a rapid, easy tool for determining abnormal voiding parameters in children. Children with NE had higher DVSSs, which was significantly affected by the father's educational status and the child's UTI history.

Summary Background Dorsal penile block (DPB) is a frequently used technique for regional anesthesia, but the effect of DPB on penile tissue has not been reported so far. Objective An experimental study was conducted to evaluate the acute effects of DPB on penile tissue. Methods Eighteen male rats were included and randomly assigned to three groups. No intervention was made in the control group (CG, n = 6). In the sham group (SG, n = 6) 1 ml normal saline, and in DPB group (PBG, n = 6) 1 ml of 0.25% bupivacaine without adrenaline (0.5 mg/kg), was infused with a 30 mm, 23 gauge needle. DPB was performed by inserting the needle in the midline when pulling down the penis and directing the needle to the 11 and 1 o'clock positions. Another puncture was done at the midline on the ventral side and the remaining drug was infused slowly. The penile tissues were harvested for biochemical (malonyldialdehyde: MDA; nitric oxide: NO; superoxide dismutase: SOD) and histopathological examination. Histopathological assessments were made of inflammation, edema and fibrosis; epithelial degradation in the urethra; vascular obliteration in periurethral tissue; and the peripheral nerve cells. Results Concentrations of NO and SOD were significantly decreased in the PBG compared with the CG and SG (p 0.05). In hematoxylin and eosin stain samples, vascular structures of the corpus cavernosa were slightly decreased in number in the SG and PBG compared with the CG, but that difference was not statistically significant (p > 0.05). The S-100 staining was significantly higher in the PBG and SG compared with the CG (p Discussion DPB causes alteration in oxidative stress markers because of an unknown effect. Although the results revealed increased inflammatory reaction in penile tissue after DPB, they are not enough to suggest not using bupivacaine for DPB in clinical practice. Conclusion Although DPB does not cause any major histopathological alteration, it results in an increase in inflammatory response in the penile tissue in the short term. Table . The median values of biochemical analysis results with inter-quartile ranges in brackets. NO umol/g protein MDA nmol/mg protein SOD U/mg protein CG 3.40 (2.80–7.58) 2.55 (2.28–3.24) 4.40 (3.89–4.64) SG 3.87 (2.42–7.84) 3.06 (2.41–3.68) 4.41 (3.75–5.07) PBG 1.8 (0–2.33) α 5.88 (4.09–10.42) β 3.72 (3.06–4.20) μ CG: control group; NO: total nitrite/nitrate; MDA: malonyldialdehyde; PBG: penile block group; SG: sham group; SOD: superoxide dismutase. α, β, μ: significantly different compared to CG and SG, p

Soyer, Tutku/0000-0003-1505-6042 WOS: 000347840000035 PubMed: 25790556 Background/aim: An experimental study was performed to evaluate the effect of extracorporeal shock wave lithotripsy (ESWL) on the distribution of interstitial cells of Cajal (ICC) in rabbit renal pelvis and proximal ureter. Materials and methods: Six New Zealand rabbits were included. Right kidneys were exposed to a total of 3000 shock waves (14 kV) by using an electrohydraulic-type ESWL device. Right sides were allocated as the ESWL group (EG, n = 6) and left sides as the control group (CG, n = 6). Tissues were harvested on day 7. Tissues were examined histopathologically for the presence of edema, inflammation, congestion, hemorrhage, fibrosis, and vascularization. Mast cell tryptase and CD117 (c-kit) staining was performed for ICC distribution. Results: Although increased tissue edema in renal pelvises and increased inflammation in ureters were observed in EG, no statistical difference was detected between groups (P > 0.05). In CG, positive CD117 staining was detected in 2 renal pelvises and ureters. None of the EG samples showed CD117 staining and no statistical difference was detected between groups (P > 0.05). Conclusion: Rabbit does not appear to be a good model for investigating ICCs. ESWL may cause histopathological alterations in the renal pelvis and ureter. Since it has not been statistically proven, reduced contractility of the ureter after ESWL may not be attributed to altered distribution of ICCs in the renal pelvis and ureter. Kirikkale University Scientific Research CouncilKirikkale University [2011/59] This study was supported by the Kirikkale University Scientific Research Council (2011/59). It was presented at the 24th Congress of the European Society of Pediatric Urology, Genoa, Italy, in 2013.

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000323609800025 Aim: To compare effects of contrast medium, air, and ozone on ischemia/reperfusion injury due to intussusception. Materials and methods: Thirty Wistar rats were allocated into five groups (n = 6). In the control group (CG), 2 cm of colonic segment, 5 cm distal to ileocecal valve, was removed. Intussusception was performed at 5 cm distal to the ileocecal valve by pushing a proximal intestinal segment distally by stile in experimental groups. One hour later, in the sham-operated group (SG), manual reduction was performed. In the reduction groups, reduction of intussusception was performed by contrast medium (CMG, 1/1 diluted omnipaqueR, infusion rate 2 mL/min), by air (AG, Pmax = 60 mmHg), or by ozone (OG, 10 mu g/mL, 0.5 mg/kg, Pmax = 60 mmHg). One hour after reduction, 2 cm of colonic segment was removed. Colonic tissues were evaluated for histopathological grades and oxidative injury markers (malondialdehyde [MDA], nitric oxide [NO], and total sulfhydryl [T-SH] values). Results: Mucosal injury score was significantly higher in AG then in CG or SG (P < 0.05). There was no difference regarding mucosal injury between the other groups (P > 0.05). MDA levels were significantly higher and NO levels were significantly lower in CMG, OG, and AG than in CG (P < 0.05). There was no difference between OG and the other experimental groups in both MDA and NO levels (P > 0.05). Conclusion: None of the reduction methods in intussusception have superiority over others in preventing ischemia/reperfusion injury. Kirikkale University Scientific Research CouncilKirikkale University This study was presented at the 29th National Congress of Turkish Pediatric Surgeons, in 2011 in Istanbul, Turkey, and was supported by the Kirikkale University Scientific Research Council.

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

Background: An in vitro study was performed to evaluate the adherence of Escherichia coli and Staphylococcus epidermidis to different dressing materials. Methods: Hydrophyl gauze swab (GS), sterile flax swab (FS), and their nitrofurazone (Furacin®) absorbed forms (GSF and FSF), sterile paraffin-covered gauze with chlorhexidine acetate (0.5 %) (Bactigrass®, BG), and semipermeable transparent film gauze (Tegaderm®, TG) were used in the study. A 1 cm 2 of each material was placed in culture plates, and E. coli ATCC 25922 and S. epidermidis ATCC 12228 were suspended in each plate. After 24, 48 h, and 1 week of incubation period, colony counts were calculated in colony-forming units (CFU) per square centimeter unit. Bacterial adhesion was compared between groups, and each dressing material was also compared for different incubation periods (24, 48 h, and 1 week). Results: The colony counts were significantly decreased in GSF and FSF groups (Kruskal-Wallis test, p < 0.05). There was no difference for E. coli adhesion in GS, FS, BG, and TG groups (p > 0.05). The significant difference detected for S. epidermidis adhesion in the first 24 to 48 h could not be detected at the end of a 1-week period. There was no statistical difference in groups when compared for 24-, 48-h, and 1-week periods of incubations (Wilcoxon signed-rank test, p > 0.05). In BG group, E. coli adhesion was increased, and S. epidermidis adhesion was decreased without a significant difference at the end of a 1-week period (p > 0.05). Conclusions: Nitrofurazone absorbed sterile gauze materials have less bacterial adhesion. In vitro adhesion of E. coli and S. epidermidis did not differ between the 24-h and 1-week period. E. coli adhesion to BG can be increased if the duration of dressing prolonged up to a 1-week period.Level of Evidence: Not ratable. © 2013 Springer-Verlag Berlin Heidelberg. DA12/06 The study was supported by the Baskent University Scientific Research Fund (DA12/06). Acknowledgments The study is supported by Başkent University Research Fund.

Swallowing foreign bodies is a common problem in children. Although most objects pass through the gastrointestinal tract with no untoward effect; long, sharp-pointed, or slender objects can perforate the gut. Migration of an object to the liver is extremely rare and very few cases have been reported in the literature. The aim of this study is to draw attention to this subject once again by contributing a case report of a child with a hepatic sewing needle. A survey of the literature over the period from 1971 to 2006 revealed a total of five cases of childhood hepatic sewing needle together with our case. The practical lesson illustrated by this report is that the surgeon must carefully evaluate the liver when foreign body was not found in gastrointestinal system and also perforation site was found anywhere.

PubMed ID: 25698279, [No abstract available]

KISA, Ucler/0000-0002-8131-6810 WOS: 000343140200006 PubMed: 25280648 Aim: Intestinal ischemia/reperfusion (I/R) injury is a serious clinical condition. Colchicine and low-dose methotrexate have anti-inflammatory features. An experimental model was conducted to investigate the effect of colchicine and methotrexate on intestinal I/R injury. Methods: Twenty-four rats were included. Only laparotomy was done in control group (CG, n = 6). In experimental groups, superior mesenteric artery was occluded. After 1 h ischemia, reperfusion (1 h) was started by de-occlusion. 30 min before reperfusion, saline in sham group (SG,n: 6), colchicine (1 mg/kg) in colchicine group (CNG, n: 6), andmethotrexate (0.1 mg/kg) in methotrexate group (MTXG, n: 6) were infused intraperitoneally. Small intestines were harvested for evaluation of intestinal mucosal injury (Chiu score) and oxidative stress markers (nitric oxide: NO, malondialdehyde: MDA, superoxide dismutase: SOD). Results: Biochemically, MDA levels were significantly low in CG compared to SG, CNG, and MTXG (p < 0.05). NO levels were significantly low and SOD levels were significantly high in CG compared to MTXG (p < 0.05). Histopathologically, Chiu score was significantly low in CG compared to SG, CNG, and MTXG (p < 0.05), and significantly high in MTXG compared to SG and CNG (p b 0.05). Conclusion: The present experimental model caused I/R injury in rat intestines. Contrary to literature, it was found that methotrexate worsens and colchicine does not attenuate intestinal I/R injury. (C) 2014 Elsevier Inc. All rights reserved.

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.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000316110800020 PubMed: 23378565 A prospective study was performed to evaluate the prevalence of suspected dysfunctional voiding (DV) and associated risk factors in children with asthma. The DV is defined as any voiding symptoms and/or urinary incontinence. Children (4-10-year-old) with asthma (n=178) and healthy subjects (n=197) were enrolled. DV and Incontinence Scoring System were administrated. Demographic features and asthma related characteristics were recorded. Suspected DV was noted in 19 (27.9%) of patients with asthma and 5 (6.6%) of healthy subjects in children younger than 6 years of age (p=0.001). In this patient group, asthma increased the risk of suspected DV (OR=5.7 (95% CI 1.988 to 16.344)). Children with asthma older than 6 years of age had similar prevalence of suspected DV but they had higher frequency of voiding and urgency. Asthma is associated with higher DV symptom scores in younger children who have already completed toilet training and with some of DV symptoms such as frequency and urgency in older children. European Academy of Allergy and Clinical Immunology Congress in Istanbul, Turkey This study was presented at the European Academy of Allergy and Clinical Immunology Congress in 2011 in Istanbul, Turkey, and was awarded the best poster presentation.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000327254600027 PubMed: 23660491 Aim: Absent cremasteric reflex (CR) is a well known but not reliable sign of testicular torsion. We hypothesized that CR can also be altered in other causes of acute scrotum in children. An experimental study was performed to evaluate the clinical and electrophysiological features of CR in orchitis. Method: Eighteen Wistar albino rats were allocated into three groups: control (CG), sham (SG) and orchitis (OG). In CG, after anesthetization with ketamine hydrochloride, the medial site of the anterior superior iliac spine was stimulated to obtain CR electrophysiologically, and latency and duration were recorded with a needle electrode placed in the cremasteric muscle. Electrophysiologic evaluations were performed 24 h after injection of 0.1 ml of 10(6) cfu/ml Escherichia coli (0: 6 strain) in 1 ml of physiologic saline into the right testicle in OG, and 1 ml of saline only in SG. All testicles were sampled to check for orchitis after the electrophysiologic evaluations. Results: CR was obtained in all rats in CG and in 83.3% and 66.6% in SG and OG respectively (p < 0.05). The latency of CR was significantly higher in OG (15.1 +/- 0.9 ms) and SG (15.5 +/- 1.2 ms) than CG (10.5 +/- 0.7 ms) (p < 0.017). The duration of CR was 15.1 +/- 3.2 ms in CG, 16.2 +/- 4.9 ms in SG and 18.5 +/- 3 ms in OG (p > 0.05). Histopathologic confirmation of orchitis was obtained in all testicle samples in OG, and number of neutrophils and total orchitis score was significantly higher in OG than the other groups (p < 0.05). Conclusion: Electrophysiologic parameters of CR may be altered in orchitis. Prolonged latency of CR in orchitis may be due to inflammation of the genitofemoral nerve or cremasteric muscle. (C) 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000325332200029 PubMed: 24094975 Aim: This study aimed to evaluate the effect of P/E-selectin blockage on antisperm antibody (ASA) development and histopathological alterations in experimental orchitis. Materials and Methods: Thirty-six Wistar albino-type male rats weighing 100-150 g were included in the study. Rats were allocated into six groups (n = 6) including control (CG), sham (SG), orchitis (OG), antimicrobial treatment (AG), P/E-selectin blockage (PESG), and both antimicrobial and P/E-selectin treatment (TG) groups. In CG, serum samples were taken from the tail vein prior to the procedure and followed by extraction of both testes. In SG, 1 ml of saline solution was injected in testicular parenchyma. OG was obtained by injecting 0.1 ml 106 cfu/ml Escherichia coli (0: 6 strain) and 1 ml saline solution into the right testes. AG received ciprofloxacin (50 mg/kg/day) twice a day through gastrogavage 24 hours after generating orchitis. In PESG, P/E-selectin antibody (100 mu g) was administered intravenously via the tail vein 24 hours after the induction of orchitis. Finally, both ciprofloxacin and P/E-selectin antibody were administered in TG 24 hours after the induction of orchitis for 14 days. At the end of treatment, 1 ml of serum sample was obtained to evaluate the ASA, P-selectin and E-selectin levels. In order to evaluate spermatogenesis (Johnsen score) and testicular injury (Cosentino score), both testes were extracted at the end of the 14th day. Results: In orchitis-induced groups (OG, ATG, PSEG, TG), ASA levels were significantly increased at the 14th day when compared to SG (p < 0.05). In TG, ASA levels were decreased when compared to AG. However, similar alteration in ASA levels was not detected in PSEG (p > 0.05). In OG and AG, P-selectin levels were decreased at the 14th day when compared to levels observed on 0 day (p < 0.05). E-selectin levels on 0 day showed that each group had higher levels of E-selectin when compared to CG (p > 0.05). There was no significant difference regarding E-selectin when compared to CG (p > 0.05). No significant differences regarding E-selectin levels were detected on the 0th and 14th days between AG and CG (p > 0.05). When the Cosentino and Johnsen scores were compared among groups, TG and PSEG has decreased scores of Cosentino than OG on the right testicle (p < 0.05). In contrast, an increased Johnsen score was detected in TG and PSEG when compared to OG (p < 0/05). No significant difference was detected for both Cosentino and Johnsen scores on the left testicle (p > 0.05). There was no difference with regard to the right and left testicular injury in TG. In P/E-blocked groups, decreased histopathological alterations were observed in the contralateral testis. Conclusion: P/E-selectin blockage may reduce ASA production after orchitis when combined with antimicrobial treatment. P/E-selectin blockage not only has a protective effect on blood-testis barrier but also decreases the histopathological alterations in both the affected and contralateral testis. Histopathological parameters of spermatogenesis may also be prevented by P/E-selectin blockage in experimental orchitis. (C) 2013 Elsevier Inc. All rights reserved. Kirikkale University Scientific Research CouncilKirikkale University This study was supported by Kirikkale University Scientific Research Council and presented at the National Congress of Turkish Pediatric Surgeons, Istanbul, Turkey, 2011.

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000319065700019 PubMed: 22568526 Urethrocutaneous fistula (UCF) is one of the most common complications occurring after hypospadias repair. Despite the surgical advancement in hypospadias, multiple failed fistula closures are commonly referred to paediatric urologists. Although several techniques have been described to interpose a waterproof layer between urethral and skin closures, occurrence of urethrocutaneous fistula cannot be eliminated completely. In addition to several local tissue grafts, autologous and homologous fibrin sealants are used to prevent UCF. Platelet rich fibrin (PRF) is known as an autologous source of growth factors obtained from the sera of the patient. PRF supports collagen synthesis and tissue repair and accelerates wound healing. We aimed to present our initial experience about the use of autologous PRF in a 3-year-old boy with a UCF after hypospadias repair.

Kucukaslan, Ibrahim/0000-0002-3458-4409; Scholbach, Jakob/0000-0001-6324-6268; Soyer, Tutku/0000-0003-1505-6042 WOS: 000317719000008 PubMed: 23093435 Aim Ultrasonography (US) has high diagnostic value in testicular torsion but is vulnerable to several potential errors, especially in the early period. Echotexture (ETX) analysis software provides a numerical expression of B-mode images and allows quantitative evaluation of blood flow due to ischemic damage using power Doppler US (PDUS) analysis. Our aim in this study was to determine the diagnostic value and effective parameters of EXT analysis software in the early period of torsion using B-mode and PDUS images. Materials and Methods In this study, eight rats were used. Following anesthesia, the right testis was rotated to a 1080-degree counterclockwise position whereas the left testis was left in place to have a control group. B-mode and PDUS images of both sides were recorded with a portable US device immediately (0 hour) and 1 and 2 hours after torsion. The B-mode images were analyzed in terms of gradient, homogeneity, and contrast using the BS200pro software (BAB Digital Imaging System 2007, Ankara, Turkey). Intensity (I)-red and area (A)-red values were measured on PDUS images with the Pixelflux (Version 1.0, Chameleon-Software, Leipzig, Germany). The data were evaluated by the Mann-Whitney U and Wilcoxon tests. Results Data from B-mode US image EXT analysis showed no significant difference between the right and left testicles in 0 to 2 hours (p > 0.05). The values obtained from PDUS analysis (I-red and A-red) significantly decreased at the testicular torsion side at the end of the second hour (p < 0.05). I-red and A-red values at 0 to 1 hour of torsion indicated similar blood flow alterations (p > 0.05) whereas the flow was significantly lower at 2 hours (p < 0.05). Conclusion In experimental testicular torsion, ischemic changes can be detected by PDUS power/angiomode using blood flow alterations as early as the second hour. Tissue damage cannot be evaluated within the first 2 hours of torsion with B-mode ETX analysis.

Objective: An experimental study was performed to evaluate the effect of dexmedetomidine on lung injury secondary to experimental intra-abdominal hypertension (IAH). Methods: Eighteen Wistar-albino rats were included and allocated into 3 groups - the control group (CG, n=6), the sham group (SG, n=6) and the dexmedetomidine group (DG, n=6). No intervention was made in CG. IAH was achieved by insufflating atmospheric air with a percutaneous intraperitoneal needle up to 15 mmHg pressures in SG and DG. At the 60th min of IAH, physiological serum (1.5 ml/100 grams/hr) in SG and dexmedetomidine (1 mcg/kg/hr) in DG were infused for 30 min through the tail vein. At the 90th min, the left inferior lobes of the lung were harvested for biochemical (nitric oxide-NO, malondialdehyde-MDA) and histopathological (alveolar hemorrhage, edema, congestion, leukocyte infiltration) examination. Results: There was no significant difference between any of the groups with regards to NO and MDA levels (p>0.05). His- topathologically, although alveolar hemorrhage, edema, congestion, leukocyte infiltration were increased in SG compared to CG and DG, the difference was not statistically significant (p>0.05). There was no significant difference between CG and DG with respect to histopathological grading (p>0.05). Conclusion: IAP of 15 mmHg in rats causes mild injury in lung parenchyma. The administration of DEX in clinical doses does not seem to significantly affect the lungs of rats. [Arch Clin Exp Surg 2016; 5(2.000): 100-104]

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042 WOS: 000311222500027 PubMed: 23163997 Aim: The omentum plays a crucial role in abdominal defense mechanism by adhering to sites of inflammation and absorbing bacteria and debris from the peritoneal cavity. An experimental study was conducted to evaluate the inflammatory response of omentum in different abdominal events with omental P-/E-selectin levels and histopathologic findings. Materials and methods: Thirty Wistar rats were placed into 5 groups (n = 6), including a control group (CG), sham group (SG), bladder perforation (BP) group, splenic laceration (SL) group, and cecal ligation and puncture (CLP) group. Omental samples were obtained in CG after median laparotomy. In accordance with described models, BP, SL, and CLP were performed in experimental groups. Twenty-four hours after the first laparotomy, localization of the omental pad was noted, and omental samples were obtained for biochemical analysis of levels and histopathologic findings (no. of vessels in sections, polymorphic nuclear leukocytes [PMLs], lymphocytes). The mean P-/E-selectin levels and histopathologic findings of inflammation were compared between groups. Results: Although omentum was adhered to the cecum in all subjects after CLP, similar findings were not detected in other groups. P-selectin and E-selectin levels and number of PML were significantly increased in the CLP group when compared with other groups (P < .05). The number of vessels in sections was significantly increased in CLP group when compared with SG and BP groups (P < .05), and the BP group had a decreased number of vessels than CG (P < .05). The number of PML was significantly increased in SG and SL and BP groups with respect to CG (P < .05). Conclusion: Among different experimental intraabdominal catastrophes, only CLP caused an inflammatory response and increased levels of adhesion molecules in the omentum. These findings suggest that the nature of the inflammation is the main determining factor for the omental function in intraabdominal events. (c) 2012 Elsevier Inc. All rights reserved.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000302322800009 PubMed: 22414006 Breast masses are very rare in infants and premature telarche due to excessive endogen or exogenous estrogens is the most common presentation during infancy. Myofibroblastoma is a stromal tumor of the breast, occurring especially in elder males. This breast mass has a close relationship between androgen receptors and has not been reported in infants previously. A 10-month old male baby with a left breast mass, which is diagnosed as myofibroblastoma, is discussed to evaluate the clinical features and treatment modalities of breast myofibroblastomas in children.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000314145000004 Objective: A retrospective study was performed to evaluate the effect of body mass index (BMI) on the clinical course of appendicitis in children. Material and Methods: Patients between 6 and 18 years of age, who had undergone appendectomy in the last 2 years, were evaluated for age, sex, BMI, time from the beginning of complaints to diagnosis, acute Or perforated appendicitis, duration of hospitalization and complications retrospectively. BMI was evaluated according to percentiles developed for Turkish children between 6 and 18 years of age. Patients with percentiles between 10 to 75 were accepted as the normal BMI group, lower than 10 was the low BMI group and more than 75 was assessed as the high BMI group. Results: Ninety-six patients were included in the study. The median age was 13 (min: 6, max:16) in the normal BMI group [n=37, male/female (M/F)=1.84], 12(6-16) in the low BMI group (n=38, M/F=1.53) and 9(6-15) in the high BMI group (n=21, M/F=3.2). The acute/perforated appendicitis ratios were 3.1, 2.8 and 1.3, respectively in the normal, low and high BMI groups. There was no significant difference between the groups regarding the time from the beginning of complaints to diagnosis and duration of hospitalization (p>0.05). Although complication rates showed no difference between the normal and low BMI groups, the high BMI group had a higher incidence of complications compared to the normal and low BMI groups (p=0.04 and p=0.018,respectively). The follow-up period of the patients were 2 months to 2 years and the most common complication was wound infection. Conclusion: Children with high BMI have higher complication rates during the clinical course of appendicitis compared to children with low and normal BMI.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000296869100020 PubMed: 22075343 Aim: Neonates undergoing surgery may receive phototherapy (PT) for the treatment of hyperbilirubinemia. Although the effects of PT on neonatal structures are well documented, the effect of PT on wound healing has not been previously evaluated. An experimental study was performed to evaluate the effect of PT on growth factor levels responsible for wound healing in neonatal rat skin. Materials and Methods: Eighteen Wistar newborn rats (7 +/- 2 g) were included in the study. Rats were randomized into 3 groups: control (CG), PT, and sham (SG) (n = 6). Both groups had 1-cm median dorsal skin incision. In CG, 1 x 1 cm of dorsal skin was sampled including the incised skin. The PT group received 5 banks of blue light (wave density, 30-40 mu w/cm(2) per nanometer; exposure distance, 45 cm). Phototherapy was started 24 hours after birth and exposed during light period (mean duration, 21 hours to 15 minutes perpendicular to 2 hour to 1.5 minutes). Sham group consisted of animals that received a bank of white light with same exposure distance and a total duration of 26 hours to 18 minutes +/- 3 hours to 9.1 minutes. After exposure, 1 x 1 cm dorsal skin samples were obtained from both PT and SG groups, including the median incision. The effect of PT was evaluated with the expressions of vascular endothelial growth factor (VEGF), its receptor (VEGF receptor), and transforming growth factor beta (TGF-beta) in endothelial vessels and fibroblasts of neonatal skin samples. Results: There was no significant difference between groups in VEGF receptor and transforming growth factor beta expressions. The VEGF levels in endothelial vessels were significantly decreased in PT and SG when compared with CG (P < .05). Conclusion: Vascular endothelial growth factor is a mediator of angiogenesis and may decrease in neonatal rat skin after light exposure. It can be suggested that decreased levels of VEGF after PT application may alter angiogenesis and also may adversely affect the healing features of neonatal skin. (C) 2011 Elsevier Inc. All rights reserved.

Objective: A cross-sectional study was performed to evaluate the prevalence of enuresis nocturna (EN) among 6-10 year-old primary school children in Kırıkkale. Material and Method: Children (n:1500) aged between 6-10 years were included in the study. Questionnaires were answered by the parents to evaluate the demographic and voiding characteristics, time of toilet training, dysfunctional voiding (DV) symptoms, prevalence of EN, methods and results of EN treatment. DV score (DVS) validated for Turkish children were surveyed and scores greater than 8.5 were considered significant. Results: Children (n:1372) who completed the questionnaire were included in the study. The mean age of students was 8.27 years (M: F: 707:659). EN was noted in 11.4 % (n:157, group 1) of children. EN history was noted in 37.5 % (n:515, group 2) of children, and 51.1 % (n:700, group 3) of them had never EN. Toilet training was completed after 5 years of age in 5.2 % of the students with EN and 1.3 % of the children without EN (p

Soyer, Tutku/0000-0003-1505-6042 WOS: 000296186200014 PubMed: 21544783 …