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Biomedical subjects

H Sarihan

Publications and source records attributed to H Sarihan.

At least 19 recordsLinked to original sources

The effect of ATP-MgCl(2) on prevention of reperfusion injury after unilateral testicular torsion.

This study was designed to investigate the effect of ATP-MgCl(2) administered before and after detorsion on the prevention of reperfusion injury after unilateral testicular torsion. The rats were divided into six groups, each containing six rats. Torsion was created by rotating the left testes 720 degrees in a clockwise direction. Group 1 functioned as a control group. Torsion only was carried out in Group 2. Detorsion was carried out in Group 3. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately before detorsion in Group 4. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately after detorsion in Group 5. Saline was injected intravenously immediately after detorsion in Group 6. The effect of ATP-MgCl(2) on reperfusion injury was investigated by determining the levels of thiobarbituric acid-reactive substances (TBAR) and resulting lipid peroxidation in the bilateral testicular tissue. Testicular torsion and detorsion caused a significant increase in the TBAR levels in the bilateral testicular tissue. TBAR levels decreased to approximately normal levels in Groups 4 and 5. It is concluded that if reperfusion injury has occurred in both testes after unilateral testicular torsion, ATP-MgCl(2) administered before or after detorsion may prevent reperfusion injury in testicular torsion.

Adenosine Triphosphate↗

Morgagni hernia: an unexpected cause of respiratory complaints and a chest mass.

Morgagni hernia (MH) is the least common type of congenital diaphragmatic hernias. Although its course is often asymptomatic, it may be associated with various respiratory and gastrointestinal symptoms. We describe 7 children with MH during a 5-year period in three pediatric centers in Turkey. All children had acute or chronic respiratory symptoms; cough was the most frequent. The diagnosis was made by posterior-anterior (PA) and lateral chest X-rays. The PA chest X-rays showed a homogenous mass in 2 and a gas-filled cystic image in 3 children in the right cardiophrenic angle. A retrocardiac homogeneous density in one child, and bilateral consolidation in lower lung areas in another child were also seen. All lateral chest X-rays showed gas-filled bowel loops above the diaphragm. The diagnosis was confirmed by barium-contrast radiograph. Four patients had five additional anomalies, i.e., ventricular septal defect, right inguinal hernia, congenital hip dislocation, pectus carinatum, and obstruction of the uretero-pelvic junction. All of the hernias were repaired by an abdominal approach. There were no complications or recurrences during follow-up. In conclusion, MH should be considered in the differential diagnosis of cases of long-standing respiratory symptoms and/or when an unexplained radiological image, especially on the right cardiophrenic area, is present.

Barium Compounds↗

Effects of caudal block on cortisol and prolactin responses to postoperative pain in children.

We have performed a randomized controlled study in 60 children (ASA 1.8 month to 10 yrs) undergoing lower abdominal and genitourinary surgery, to assess the effects of caudal anaesthesia on plasma cortisol and prolactin concentrations during early postoperative period. After induction of anaesthesia by inhalation or intravenously, thirty children received a standardized general anaesthetic (control group) while the remaining children received caudal anaesthetics with 0.25% bupivacaine in addition to a similar general anaesthetic (caudal group). Blood samples for cortisol and prolactin were taken after induction and 1 hour after surgery. Postoperative analgesia was assessed by modified pain objective scale and side effects were noted. Children in the caudal group had significantly smaller plasma cortisol and prolactin concentrations at 1 hr postoperatively, compared with those in the control group. Plasma cortisol concentration after induction was higher than after one hour of surgery in the caudal group. These results were correlated with pain scores. No serious side effects were recorded. In conclusion, caudal anaesthesia attenuated the postoperative cortisol and prolactin responses to surgery and pain in children.

Abdomen↗

Congenital malformation of the lung.

Congenital malformations of the lung are rare and vary widely in their presentation and severity. However, frequently they present with dramatic symptoms resulting in the need for prompt diagnosis and treatment. Five patients with congenital lung malformations were treated in Karadeniz Technical University Farabi Medical School Pediatric Surgery Department between June 1992 and January 1997. There were one girl and four boys. The mean age was 42 days (range 1 to 120 days) and the mean weight was 3.9 kg (range 2.4 to 5.4 kg). The following cases were included; one pulmonary agenesis, two congenital lobar emphysema, one pulmonary sequestration, and one cystic adenomatoid malformation. Respiratory distress was the most common presenting symptom. The diagnosis was performed by chest X-ray with postero-anterior and lateral view and thoracic computed tomography (CT). Associated congenital anomalies were detected in one patient and the following anomalies were found; esophageal atresia, tracheo-esophageal fistula, short distal esophagus, and small intrathoracic stomach Posterolateral thoracotomy was used for all patients and complete surgical resection was performed in four patients. Corrective surgery was delayed in one patient in whom extended respiratory support was required and he died on the ninth day due to respiratory failure. In four patients prognosis was excellent. In this article, diagnosis and treatment of congenital lung malformations are discussed.

Diagnosis, Differential↗

Selected abstracts

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Journal Article↗

Congenital splenic cyst--a report of two cases.

We report on two girls with large epidermoid splenic cysts. They presented with abdominal pain, fever, and non-bilious vomiting. In both cases the cyst was diagnosed by means of computer tomography and ultrasonography. One of the patients was successfully treated with partial splenectomy. In the other case percutaneous drainage was initially carried out, but this treatment was insufficient. Splenectomy was then performed.

Abdominal Pain↗

Nonoperative management of intra-abdominal bleeding due to blunt trauma in children: the risk of missed associated intestinal injuries.

Nonoperative management of intra-abdominal bleeding (IAB) from blunt injuries in children has been advocated for many years. Nonoperatively managed patients, however, are at risk for missed associated intestinal injuries. To evaluate this question, we reviewed the charts of 120 children who had traumatic IAB; 106 were initially managed nonoperatively and observation failed in 2. Fourteen underwent emergency operation. Forty patients had isolated liver and/or splenic injuries while the others had injuries associated with several organs. During observation peritonitis developed in 3 patients and further radiologic examinations failed to confirm an intestinal injury. Diagnostic peritoneal lavage demonstrated contaminated blood and fecal particles from injured intestines in 3 patients; they underwent emergency operation at 10, and 26 h after admission. There was no mortality or morbidity associated with delayed treatment. These data suggest that the majority of patients with IAB may be successfully treated nonoperatively, but associated intestinal injuries should be suspected in all cases.

Abdominal Injuries↗

Mesenteric fibromatosis.

Two rare cases of mesenteric fibromatosis are presented. The first patient had a right upper quadrant mass and colicky abdominal pain. The tumor originated from the mesentery of the colon and it infiltrated the gallbladder, cystic duct, and the liver. The second patient had severe hematemesis and melena. The origin of the tumor, which infiltrated 3/4 part of the stomach, the gastrohepatic ligament, the first part of the duodenum, and the liver could not be determined. In the first patient, partial colectomy and cholecystectomy were performed and the liver lesion was completely excised. The second patient underwent subtotal gastrectomy and left lobectomy of the liver. The first part of the duodenum was excised. Gastrojejunostomy was performed. No recurrence was recorded in either patients during 16 and 13 months follow-up, respectively. In this report, diagnostic aids, differential diagnosis and treatment of this rare disease are discussed.

Child↗

Congenital bladder diverticula in infants.

OBJECTIVE: Congenital bladder diverticula (CBD) usually occur in areas where the muscle is inadequately formed, typically at the ureterovesical junction, or between bundles of hypertrophied muscle. CBD are mostly asymptomatic and the cases are found incidentally. Occasionally, some cases of CBD may produce urinary obstruction as a result of compression of the urethra or urinary tract infection which result in retention of urine within the diverticulum. MATERIAL AND METHODS: We present 3 infants with CBD accompanied with urinary tract infection (2 cases) and outlet obstruction (1 case). RESULTS AND CONCLUSIONS: The means of surgical intervention included simple excision in 1 case intravesically and the other 2 cases extravesically. We also performed an antireflux procedure in the first case who had grade III reflux of the left ureter, and left nephrectomy in the third case who had multicystic dysplastic kidney. The postoperative follow-up in all cases was uneventful with normal voiding.

Diverticulitis↗

Empyema in children.

Empyemas develop following bacterial pneumonias, thoracic trauma and surgery which are still among the common diseases, causing illness and death throughout the developing world. With the advent of potent antibiotics the mortality of empyema has been drastically reduced. In this study 52 patients (29 boys and 23 girls) with thoracic empyema were evaluated retrospectively. In this series the causes of empyema were postpneumonic in 50 patients, esophageal anastomotic leak in one patient, and thoracic trauma in one patient. The diagnosis was suspected clinically and by the finding of a pleural effusion on chest roentgenogram. Definitive diagnosis was confirmed by pleural aspiration which pus was obtained. Responsible organisms included; Staphylococcus aureus, Streptococcus pneumonia, Haemophilus influenza, pseudomonas, and Klebsiella. The most common is Staphylococcus aureus. The patients were treated in various ways; 14 patients were treated with antibiotics and thoracentesis, 38 patients were treated with a closed tube thoracostomy. Eight of 38 patients had the chest tube converted to an open empyema tubes for long term management. Fourteen of 38 patients developed abcess formation. Nine of 14 patients were treated with computed tomography guided catheter placement, five patients encountered thoracotomy and decortication. In this article, appropriate treatment and result of long-term follow-up of empyema were evaluated.

Anti-Bacterial Agents↗

Kasabach-Merrit syndrome in infants.

METHODS: Four infants with Kasabach-Merrit syndrome syndrome have been treated at the University Hospital, Trabzon. They had large varied-site cutaneous hemangiomas. Diagnosis was performed with clinical and laboratory studies. All patients has severe thrombocytopenia and anemia. Fibrinogen and fibrin split products were examined in two patients and lower fibrinogen and over fibrin split products levels were detected in them. All patients were admitted to the intensive care unit and they were treated with antibiotics, fresh blood transfusion and thrombocyte suspension. Two out of four patients were previously treated with steroids unsuccessfully and one patient died due to disseminated intravascular coagulopathy. Three patients were treated with interferon alfa-2a and compression. RESULTS: In two patients the lesions regressed 60-80% following the five months therapy and in the other patient the lesion was completely excised after one month therapy. CONCLUSIONS: Interferon alfa-2a and compression were found to be remarkably effective in the treatment of Kasabach-Merrit syndrome.

Anemia↗

Pediatric safety pin ingestion.

Fifteen consecutive children with ingested safety pins were evaluated retrospectively. Eight patients were males and seven were girls. The mean age of the patients was 5.4 years ranging from 7 months to 16 years. Two of 15 patients were mentally retarded Seven safety pins ingestion were noted by parents, three older children applied with safety pin swallowing. Three infants referred with hypersalivation and swallowing difficulty. One of two mentally retarded patients had recurrent aspiration pneumonia, the other had neck abscess. These patients' lesions were detected incidentally by thoracic X-ray. Nine safety pins were at the level of the cricopharyngeus, one at the level of the aortic arch and five at the esophagogastric junction. A right esophagoscopy was used for extraction of safety pins under general anesthesia and endotracheal intubation were used. Before esophagoscopy control plain X-ray was obtained for location of safety pin. Nine safety pins were extracted by esophagoscopy. Three safety pins spontaneously and three during anesthesia induction passed through the esophagus falling down the stomach. Five of these six safety pins were spontaneously extracted without complication. However one open safety pin lodged at the duodenum and laparotomy was required. In this article, etiology and management of safety pin ingestion in children are discussed.

Adolescent↗

Nonpalpable undescending testis. Value of magnetic resonance imaging.

BACKGROUND: Magnetic resonance imaging (MRI) was performed in 18 male patients with 20 nonpalpable undescended testes and the results were compared with surgical findings. METHODS: The MRI examination located 13 (65%) of 20 gonads, all found at surgery. Eleven testes were found in the inguinal canal or just proximal to the internal inguinal ring, and two testes were demonstrated above the internal inguinal ring. RESULTS: Of the seven (35%) negative results, three were false negative and four agenetic testes were not found surgically. There was no false positive result. Thus, MRI had a sensitivity of 78.6% and specificity of 100% in the demonstration of nonpalpable undescended testes. CONCLUSIONS: MRI appears to be a more reliable and noninvasive method for the localization of nonpalpable undescended testes.

Child, Preschool↗

A new treatment with bleomycin for complicated cutaneous hemangioma in children.

Cutaneous hemangiomas are the most common tumors of infants and children. Although they frequently resolve spontaneously, approximately 5% produce complications such as bleeding, infection, consumption coagulopathy and unesthetic appearance. Various methods of treatment are described for these complicated hemangiomas. We used a new type of treatment for complicated cutaneous hemangiomas as intralesional bleomycin (BLM) injection, for the first time in the literature. This agent produced extensive fibrosis and spontaneous resolution of hemangiomas. Fourteen patients with complicated hemangiomas (twelve capillary and two cavernous) have been treated with this method during a three-years period. Of these fourteen patients, five had bleeding, three had infection, one had ulceration, and five had unesthetic appearance and continued rapid growth. Lesions of three patients were completely excised after only one BLM injection. In the other eleven patients lesions regressed 60-100% during 6-14 months with two to three BLM injections. We believe that intralesional BLM injection is simple, and very useful for treatment of complicated cutaneous hemangiomas.

Antibiotics, Antineoplastic↗

Traumatic asphyxia in children.

Eight children with traumatic asphyxia were evaluated retrospectively. There were five boys and three girls. The mechanism of injuries was motor vehicle accidents in six children. A fall in one patient and compression by lift in one patient. Clinical features of traumatic asphyxia developed in all patients. Five patients were disoriented and consciousness. Associated injuries were noted in all patients often involving thorax and head. Cerebral seizures complicated head injury in one patient. No mortality was recorded.

Abdominal Injuries↗

Congenital esophageal stenosis.

Congenital esophageal stenosis caused by membranous webs occurred in three infants. There were no associated anomalies. First patient applied with respiratory symptoms while the second and third patients reported food impactions. Correct diagnosis was performed during intraoperative (first patient) and esophagoscopic examination (second and third patients). Resection and anastomosis were performed in the first patient and hydrostatic dilatations in the second and third patients. In three patients, symptoms were relieved following treatment. In this report, etiology, diagnostic aids and management of this rare pathology are discussed.

Esophageal Stenosis↗

Congenital diaphragmatic eventration: treatment and postoperative evaluation.

Three patients with congenital diaphragmatic eventration have been reported. The diagnosis was established by chest radiography which showed an abnormally elevated diaphragm. Additionally fluoroscopy, ultrasonography and pulmonary function tests were used. Diaphragmatic plication was performed in order to restore normal pulmonary parenchymal volume and the diaphragm was replaced in its normal localization. All the patients had been discharged in good condition following uneventful postoperative courses. In this study we discussed the etiology, diagnosis, treatment and postoperative courses of diaphragmatic eventration.

Child↗