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

Introduction: Paraesophageal hernia (PEH) is a rare condition in children. The symptomatology of these patients is usually non-specific in the form of repeated attacks of respiratory infection and/or recurrent attacks of vomiting but can also lead to serious complications such as intrathoracic gastric strangulation and perforation. Case Report: A 6-year old girl was referred from a regional hospital for haematemesis and abdominal pain. She had fever and sepsis. Physical examination revealed abdominal tenderness, rebound and failure to thrive. Air-fluid level was seen in the posterior of left hemithorax at the AP and lateral chest radiographs. Thorax CT demonstrated pleural fluid, opacity, volume loss and left lung being pushed to the right of heart. Stomach and splenic flexura were moved to the left hemithorax. At laparatomy, stomach and splenic flexura had passed along the esophageal hiatus toward the chest and fundus of the stomach was perforated within the hernia sac. Greater curvature and fundus of the stomach were necrotic and hernia sac and intraabdominal space was filled with food. Stomach was pulled into the abdomen. Hernia sac was excised and defect was primarly repaired. Necrotic areas of the stomach were debrided. Then, perforation of stomach was repaired and gastrostomy was performed. Control esophagogastroduodenography revealed a 2 cm filling defect at the greater curvature and fundus of stomach due to previous gastric resection. Antireflux medical treatment was successful. Conclusion: PEH may be asymptomatic and encountered incidentally. It has the potential for serious complications such as strangulation and perforation which may present with unusual symptoms and physical findings reflecting the original pathology. Due to the risk of these serious complications, elective surgical repair is necessary after diagnosis. © The Journal of Current Pediatrics, published by Galenos Publishing.

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

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

Thirty newborn with gastrointestinal system perforations were managed at Pediatric Surgecy Department of Ondokuz Mayıs University, Faculty of Medicine from July 1980 to December 1994. Of these cases; 19 were mature, seven were premature and four were small for gestational age. Twenty-nine of them underwent emergent surgery, but one pa¬tient died bbecause of his general deterioration before surgical intervention. We could not find the cause of perporation in 11 cases and the place of perforation in one case. The perforation sites in our cases were stomach(7), colon(7) ileum(8), cecum(4) duodenum(1) and both the stomach and the ileum in one case. These perforations most commonly occured in association with the pathologies of the wall or the lumen of the gut such as intestinal atresia(1), anorectal malformation(3) necrotizing enterocolitis(3)meconium ileus(3), and con¬genital aganglionic megacolons) and less commonly result of compressing factors outside the bowel such as Ladd's bands(2), omphlomesenteric band(3)and vascular anomaly of the mesentery(1). A prompt and an appropriate surgical intervention was carried out for each patient according to the place of perforation. The overall mortality was 48% and the mor¬tality in stomach perforations was found to be less than ileal, cecal and colonic perfora¬tions. The cause of death was 60% sepsisTemmuz 1980-Aralık 1994 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalında 30 yenidoğan gastrointestinal perforasyon nedeniyle takip edildi. Bu olguların 19'u miadında, yedisi prematüre, dördü ise düşük doğum ağırlıklıydı. Hastaların 29'u acil olarak öpere edildi. Biri genel durumunun kötü olması nedeniyle öpere edilemeden kaybedildi. Öpere edilen hastaların 11'inde perforasyon nede¬ni birinde perforasyonun yeri saptanamadı. Olgularımızın yedisinde midede, yedisinde kolonda, sekizinde ileumda, dördünde çekumda, birinde duodenumda, biride de hem mi¬dede hem de ileumda perforasyon vardı. Bu perforasyonlar daha çok intestinal atrezi(4), anorektal malformasyon(3), nekrotizan enterokolit(3) mekonyum ileusu(3)kongenilal aganglionik megakolon(2) gibi barsak duvarı veya lümenindeki patolojilere daha az olarak Ladd bantlarım, omfalomezenterik bant(i), mezenter damar anomalisi(i) gibi barsak dışı patolojilerle ilgiliydi. Hastalara perforasyonlann yerine göre hızlı ve uygun cerrahi işlem uygulandı. Mortalite %48 idi. Mortalitenin, mide perforasyonlannda ileum., çekum ve kolon perforasyonlarından daha düşük olduğu bulundu. Ölüm nedeni %60 oranında sepsisti.

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

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

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

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

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

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

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

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

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

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

[No abstract available]

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

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

PubMed: 15688271 BACKGROUND: We aimed to emphasize the importance of early diagnosis and treatment of traumatic diaphragmatic (TDR) rupture which is an uncommon but potentially life-threatening problem with a high incidence of associated injuries. METHODS: We presented 8 children with traumatic diaphragmatic ruptures who were admitted to our department within a 13 year period after the incident. Relevant information about clinical and radiological findings herniated organs into the thorax, type of injury and applied surgical intervention and outcome of patients were evaluated so as to draw important clues leading to early diagnosis and treatment of this potentially life threatening condition with associated morbidities. RESULTS: In five patients, TDR occurred after a blunt trauma. Five patients underwent laparotomy while 3 of them were managed with thoracotomy. The surgical interventions were performed successfully and only one patient failed to survive. One patient died of associated severe head injury. CONCLUSIONS: The TDR in children could be promptly identified and easily diagnosed, only if this pathology is highly suspected. Since, TDR must be ruled out in all severe cases of trauma, information related to the experiences of various centers must be considered as important clues which might lead to earlier diagnosis and prompt treatment.

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

A case of lobar agenesis of the left upper lobe of the lung in a 3 year- old girl is presented. Althought this anomaly is usually associated with other congenital anomalies, our patient had no associated anomaly. Pulmonary perfusion scintiscan and chest computed tomography examinations were found to be useful diagnostic modalities in our case.

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

We compared the effects of somatostation and ranitidine on treatment of stress ulcer on rats in an experimental study. Three groups were created; sham group, ranitidine group and somatostation group. Gastric mucosal damage index was measured in each group and Mann-Whitney U test was used for statistical analysis. Statistically, the mucosal damage index was significantly higher in thesomatostatin group comparing the control group (p>0.001) and also in the control group comparing the ranitidine group (p

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

Case records of 32 patients (22 female and 10 male) with sacrococygeal teratoma who were treated in our department between 1984 and 1994 were reviewed. 27 patients had benign sacrococygeal teratoma and the majority of the benign sacrococygeal teratomas were newborns. Total excision with coccygectomy was performed in this group. In contrast, only one of the patients with malignant tumor was a newborn. In malignant group excision and multiagent chemotherapy were used for the treatment and two recurrences were noted. The average survival was increased and early mortality was decreased for all patients in comparison with past decades.

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

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

Abdominoscrotal hydrocele (ASH) is a rarity among surgical pathologies. We herein report a bilateral case of ASH. We also point out that ASH should be considered in the differential diagnosis of lower abdominal masses.

Stress ulcers are acute gastric mucosal lesions developing as a result of the mucosal ischemia due to several initiating factors. It has been shown that the majority of tissue injury occurs during the reperfusion period when the oxygen derived free radicals, form and meet tissue. We have used an animal model to investigate the intensity and mechanism of tissue injury in stress ulceration with or without reperfusion. The role of oxygen radicals were also investigated. We have shown that the intensity of tissue injury is greatest in the reperfused group and that further injury can be prevented by deferoxamine which inhibits the formation of hydroxyl radicals.

An unusual case of heterotrophic brain tissue was confused with a malignant tumor of the face in a child. Such lesions are rare, but the diagnosis can be confirmed through frozen section examination. This has made the total excision of the mass possible in our case.

The effects of somatostatin and ranitidine on prophylaxis of stress ulcer are compared using three experimental groups of rats: Sham group, ranitidine group, and somatostatin group. Gastric mucosal damage index was measured in each group and Mann-Whitney U test was used for statistical analysis. Statistically, there was not any difference between the sham and the ranitidine groups (p > 0.05), but the mucosal damage index in the somatostatin group was significantly lower then in the sham and the ranitidine groups (p < 0.01). Somatostatin seems to be a more effective drug than ranitidine for the prophylaxis of stress ulcers.

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

[No abstract available]

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

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

[No abstract available]

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

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