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    Is paracetamol responsible for fatal acute liver failure in pediatric patients after hip dysplasia surgery?
    (Verduci Publisher, 2020) Ceylan, M. F.; Baskiran, A.; Varol, F., I; Samdanci, E. T.; Karakaplan, M.; Ozkan, A. S.
    OBJECTIVE: It is well known that local complications, such as avascular necrosis and arthrosis can develop after surgery for developmental dysplasia of the hip (DDH). Thus far, systemic complications that may develop in such cases have not been identified in the literature. This study is the first case series to evaluate acute liver failure (ALF) development after DDH surgery in pediatric patients. PATIENTS AND METHODS: Six patients, five female and one male. who underwent DDH surgery were selected for this study. Perioperative fasting time. laboratory values, treatments. histopathological evaluations, and prognoses after ALF in these patients were evaluated retrospectively. RESULTS: All the patients were administered paracetamol and sevoflurane in therapeutic doses. The patients were referred postoperatively to our pediatric emergency department after 5 +/- 1.67 days (range = 3-7 days) on average. The average perioperative fasting time was 9.3 +/- 0.82 hours (range = 8-10 hours). Due to the very high aminotransferases and use of paracetamol, intravenous N-acetylcysteine was administered alongside supportive treatments to all the patients. After liver transplantation, two of three patients with grade 3 encephalopathy, died in the early postoperative period. Histopathological evaluations of the three patients' explants were compatible with toxic hepatitis due to paracetamol. CONCLUSIONS: Paracetamol is a commonly used analgesic after pediatric surgery. The therapeutic dose of paracetamol remains uncertain in children who have been fasting for a long time and have been exposed to hepatotoxic drugs due to previous surgery. In conclusion, caution should be exercised in the use of paracetamol in children with DDH who will undergo surgery, and careful perioperative clinical and laboratory monitoring for ALF is essential.
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    Mid-term Results of Two-Stage Tendon Reconstruction of Zone II Flexor Tendon Injuries
    (Wolters Kluwer Medknow Publications, 2021) Karakaplan, M.; Kilinc, O.; Ceylan, M. F.; Ertem, K.; Aslanturk, O.
    Background: Secondary repair of flexor tendon injuries remains a challenging procedure for hand surgeons. Usually, secondary reconstruction should be performed by a staged approach. Two-stage surgical reconstruction of the flexor tendons by the Hunter technique is the salvage option in case of a severely damaged fibro-osseous canal or neglected flexor tendon injury. Aims: We report the results of staged flexor tendon reconstruction in 10 patients (10 fingers) with neglected or failed primary repair of flexor tendon injuries in zone II. Materials and Methods: Between 2012-2016, patients who underwent two-stage tendon reconstruction due to flexor digitorum profundus (FDP) sectioning or tearing in zone II with destruction of flexor pulleys and extensive scarring in the flexor tendon bed were included in the study. Results: Ten patients included to study with a mean follow-up of 34 months (range 12-70 months) and the results were assessed by clinical examination and questionnaire. According to the Strickland score, one (20%) of the results were excellent, five (50%) were good, two (20%) were fair and two (20%) were poor. After the second stage, good to excellent results were achieved in 60% of patients, one patient needed graft tenolysis. These results were similar to the subjective scores given by the patients, four of whom complained of functional problems in daily life at follow-up. There was no complication after the first stage. But after the second stage, there was one bowstringing and one adhesion that require tenolysis. Conclusions: Hunter technique is still the reference procedure for the reconstruction of flexor tendons. The results of our study showed that two-stage tendon reconstruction which is applied in patients with tendon sheath disruption as a result of acute or delayed tendon injuries which are not possible for primary repair is reliable and satisfactory.