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Öğe An alternative way to cover ventral penile skin defect in Mathieu technique(Hippokrates Verlag Gmbh, 2000) Koltuksuz, U; Gürsoy, MH; Aydinç, M; Mutus, M; Çetin, S; Karaman, AMathieu technique is used satisfactorily in distal penile hypospadias without chordee or with minimal chordee. After using this technique, a large defect may sometimes appear on the ventral surface of the penis. To cover the defect, a few techniques, including preputial island flap, Byar's flap and Ombredanne-Nesbit's flap, are used. We describe a new flap to cover the defect more cosmetically. Twenty-four patients ranging in age from one year to 14 years (median age 6.5 years) were operated on. In the patients for whom the defect could not be covered primarily, a longitudinal incision was made along the midline through the penile shaft skin from penile radix up to the border of preputial skin. The relaxed penile skin, which was incised on the dorsal surface, could be approached and sutured easily on the ventral surface without stretching. The new defect that developed on the dorsal surface was closed with the prepuce matching the defect. Nine patients, two with chordee and seven without chordee, underwent this technique. The cosmetic and functional results were excellent in all patients and none of the patient's parents complained about the cosmetic aspect. Only one fistula complication, which healed spontaneously, developed on the 20th postoperative day. Considering these results, we may conclude that excellent cosmetic results can be accomplished by the use of this flap technique.Öğe Caffeic acid phenethyl ester prevents intestinal reperfusion injury in rats(W B Saunders Co-Elsevier Inc, 1999) Koltuksuz, U; Özen, S; Uz, E; Aydinç, M; Karaman, A; Gültek, A; Akyol, ÖBackground/Purpose: Ischemia-reperfusion injury is encountered frequently in conditions that diminish intestinal blood flow. Caffeic acid phenethyl ester (CAPE), which is a specific component of the honeybee hive product propolis, exhibits potential antioxidant: properties. This experimental study was designed to determine the effect of CAFE on ischemia-reperfusion injury in rat intestine. Methods: Fifty rats were divided into 5 groups: sham (SH), saline ischemia (SI), saline reperfusion (SR), CARE ischemia (CI), and CARE reperfusion (CR). Either CAFE, 10 mu mol/kg, or saline was administered intraperitoneally 30 minutes before ischemia. Intestinal ischemia for 30 minutes and reperfusion for 60 minutes were applied. Ileum specimens were obtained to determine the tissue levels of malondialdehyde, superoxide dismutase, catalase, and histological changes. Results Malondialdehyde levels in the CR group did not increase after reperfusion when compared with the CI group. However, statistically significant differences were observed between the SR and SI groups. Additional mucosal injury in the CR group when compared with the CI group was not observed. Whereas, there was a statistically significant increase in mucosal injury in the SR group. Reperfusion did not cause further injuries through both biochemical and histological parameters in the CR group. Conclusions: Results of this study showed that prophylactic administration of CAFE in ischemic condition prevents reperfusion injuries by eliminating oxygen radicals and inhibiting polymorphonuclear leukocyte infiltration. CARE may be useful in combating the diseases of oxidative stress. J Pediatr Surg 34:1458-1462. Copyright (C) 1999 by W.B. Saunders Company.Öğe The effect of caffeic acid phenethyl ester on ischemia-reperfusion injury in comparison with ?-tocopherol in rat kidneys(Springer-Verlag, 2001) Irmak, MK; Koltuksuz, U; Kutlu, NO; Yagmurca, M; Özyurt, H; Karaman, A; Akyol, ÖOxygen-derived free radicals have been implicated in the pathogenesis of renal injury after ischemia-reperfusion. Caffeic acid phenethyl ester (CAPE), an active component of propolis extract, exhibits antioxidant and anti-inflammatory properties. To determine whether CAPE offers any advantage over alpha -tocopherol, we compared their effects on an in vivo model of renal ischemia-reperfusion injury in rats. CAFE at 10 mu mol/kg or alpha -tocopherol at 10 mg/kg was administered intraperitoneally before reperfusion. Acute administration of CAFE suppressed ischemia-reperfusion induced renal lipid peroxidation and tissue injury more than alpha -tocopherol. CAFE may therefore offer a therapeutic advantage in acute injury settings.Öğe The effects of caffeic acid phenethyl ester (CAPE) on spinal cord ischemia/reperfusion injury in rabbits(Oxford Univ Press Inc, 1999) Ilhan, A; Koltuksuz, U; Ozen, S; Uz, E; Ciralik, H; Akyol, OObjective: Oxygen-derived free radicals have been implicated in the pathogenesis of spinal cord neuronal injury after both trauma and ischemia-reperfusion. Caffeic acid phenethyl ester (CAPE), an active component of propolis extract, exhibits antioxidant properties. This experimental study was designed to determine the effect of CAFE on ischemia-reperfusion of spinal cord in rabbits. Methods: Forty-one New Zealand white rabbits were used in the study. The animals undergone aortic occlusion were divided into three groups each consisting of 11 rabbits: methylprednisolone (MP), CAFE, and control. CAFE 10 mu mol/kg, methyl prednisolone (MP) 30 mg/kg or similar dose saline were injected intraperitoneally before surgical intervention. Animals were subjected to 21 min of cross-clamp time. At the end of occlusion time, the clamps were removed and restoration of the blood flow was verified visually. Animals in sham group (n = 8) underwent a surgical procedure similar to the other groups but the aorta was not occluded. Neurological status was scored by assessment of hindlimb motor function deficit. Results: The scores in CAFE group was different from control groups at 48 h (3.91 +/- 0.5 vs. 2.91 +/- 0.7; P = 0.0013). Spinal cord specimens were obtained to determine the tissue levels of malondialdehyde, superoxide dismutase, catalase, and histological changes. Malondialdehyde levels in control group were increased significantly when compared to sham group (124.22 +/- 24.36 and 41.92 +/- 10.08 nmol/g wet tissue, P = 0.0003). MDA levels in the CAFE group were lower than MP group and differences between the two groups were statistically significant (56.77 +/- 15.265 and 107.74 +/- 19.31 nmol/g wet tissue, P = 0.0001), We did not observe additional tissue injury in CAFE group when compared to control group. SOD and CAT activities were not concordant in all the groups. Conclusions: These results suggest that CAFE may be an available agent to protect the spinal cord from ischemia-reperfusion injury. (C) 1999 Elsevier Science B.V, All rights reserved.Öğe Effects of caffeic acid phenethyl ester and epidermal growth factor on the development of caustic esophageal stricture in rats(W B Saunders Co, 2001) Koltuksuz, U; Mutus, HM; Kutlu, R; Özyurt, H; Çetin, S; Karaman, A; Gürbüz, NBackground/Purpose: An experimental study was performed to modify the healing response in caustic esophageal burns to prevent stricture development. Two different agents with different modes of actions, caffeic acid phenethyl ester (CAPE) and epidermal growth factor (EGF), were studied. CAPE has antiinflammatory, immunomodulatory, antioxidant, and antimitotic properties. EGF has known properties in supporting wound healing and in protecting esophagus from injuries. Methods: The model described by Gehanno and its modification by Liu was used to create standard esophageal burns with 50% NaOH. The study was performed with 76 rats in 4 main groups (sham, CAPE, EGF, and control) and 2 subgroups in each for 5 and 28 days of observation. Efficacy of treatment was assessed in 28-day subgroups by measuring weight gain, contrast esophagograms on day 27, histologic evaluation by measuring stenosis index (wall thickness/lumen diameter), and collagen deposition, and biochemically by determining tissue hydroxy proline (OHP) content. Results: In the end of the study, increase rates of mean body weights of the animals in the 28-day subgroups were as follows: sham, 30%; CAPE, 23%; EGF, 22%; and control, 14%. Although all the animals in subgroups significantly gained weight, the mean weight gain was significantly low in controls when compared with sham, CAPE, and EGF groups (P < .05). Contrast esophagograms on day 27 showed no stenosis in the sham, mild stenosis in CAPE and EGF, and severe stenosis with proximal dilatation in controls. Stenosis indices of the subgroups were as follows: sham, 0.29; CAPE, 0.41; EGF, 0.41; control, 0.84. Index was significantly higher in controls (P < .05). Collagen accumulation scores in the esophageal wall were as follows: Sham, 0.0; CAPE, 0.87; EGF, 0.30; control, 2.70. Scores also were significantly higher in controls (P < .05). Tissue (OHP) levels were as follows (mg/g dry tissue): Sham, 1.48; CAPE, 1.53; EGF, 1.90; control, 4.01. Production of OHP was significantly higher in controls. Conclusions: The results of the parameters in the study indicate that administration of CAPE and EGF has beneficial effects in the prevention of caustic esophageal strictures. Those effects of CAPE may occur through its antiinflammatory, immunomodulatory, and antioxidant properties, and EGF may occur through its induced proliferative properties on the esophagus. Copyright (C) 2001 by WB. Saunders Company.Öğe Hypochlorous acid for accidental vincristine overdose: A preliminary experimental study(Inst Exp Pathol Oncol Radiobiol, 2003) Ozgen, U; Stout, M; Turkoz, Y; Ozugurlu, F; Kutlu, NO; Soylu, H; Koltuksuz, UAim: to investigate the potential efficacy of in vivo treatment of accidental vincristine (VCR) overdose using hypochlorous acid (HOCl). Methods: 24 New Zealand rabbits were divided into 4 groups as control, HOCl-treated, VCR + treated and HOCl + VCR-treated, and their clinical and laboratory indexes were examined. Results: there were no clinical and laboratory abnormalities observed in control and HOCl group subjects. All rabbits died after quadriplegia and respiratory insufficiency in VCR and HOCl + VCR groups. Bone marrow suppression was more pronounced and onset of the neurotoxicity was early in VCR group compared to HOCl + VCR group subjects. Serum half-life of VCR was lower in HOCl + VCR group animals suggesting a contribution of HOCl in eliminating VCR resulting in the observed clinical and laboratory differences in these two groups. Conclusion: although further research is necessary, our results indicate a potential role for HOCl in the treatment of accidental VCR overdose.Öğe Injuries of large vessels in high stage neuroblastoma surgery -: A case report(Edizioni Minerva Medica, 1999) Koltuksuz, U; Gürsoy, MH; Aydinç, M; Özgen, Ü; Ege, E; Mutus, MComplete resection of the primary lesion in stage III neuroblastoma improves survival. Neuroblastoma has a tendency towards surrounding and infiltrating the large vessels, leading to injuries during tumor resection. We operated on a stage III neuroblastoma, which resulted in the right and left common iliac artery and vein damage, The right common iliac artery and, veins were repaired by end to end anastomosis, There was a long gap between the two ends of the left common iliac artery and it was repaired using a mesenteric vein (marginal vein of the colon) graft. Digital subtraction angiography performed 6 months after the operation did not reveal any stenosis or aneurysmatic changes in the anastomoses. We conclude that short segments of large vessels may be sacrificed during the resection of neuroblastomas invading the vessel wall, and the resulting defects may be repaired by end to end anastomosis, or even by substituting mesenteric vein grafts, for the pur pose of total or near total removal.Öğe Intraabdominal lymphangiomyoma in an infant with protein-losing enteropathy and hemihypertrophy(Turkish J Pediatrics, 2000) Koltuksuz, U; Özgen, Ü; Özen, S; Saraç, K; Gürsoy, MHLymphangiomyoma is an extremely rare tumor occurring exclusively in women of reproductive age. The tumor is characterized by proliferation of immature smooth muscle along the lymphatic vessels of the abdomen, thorax and lung. Although lymphangiomyoma has been reported in a young girl and a girl infant, none has been reported in boys. We report herein a case of lympangiomyoma in a two-year-old boy. The unusual presentation in this patient was that the tumor arose from the small bowel mesentery without any evidence of lung involvement. The tumor was extirpated and lymphangiomyomatosis was confirmed pathologically.Öğe Intraoperative laparoscopy by a flexible scope: Is a a good alternative to routine bilateral exploration in childhood hernias?(Monduzzi Editore, 1997) Gursoy, MH; Gurel, M; Koltuksuz, U; Uguralp, S; Aydinc, MNegative contralateral explorations go on raising the question on whether the contralateral exploration is still necessary or not. To iind out whether the contralateral processus vaginalis was patent or not, we performed intraoperative non-puncture laparoscopy by a flexible scope. We inserted the flexible scope through the open hernia sac and tried to see the opening of the contralateral processus vaginalis. The study involved a total of 20 children, 16 boys and 4 girls. The symptomatic side was explored and laparoscopy was performed through the opened hernial sac. We found a contralateral processus vaginalis in 6 children, 4 boys and 2 girls, by flexible scopy. We confirmed the results by exploring the opposite groin. There was 1 false-positive result in a girl. Intraoperative non-puncture laparoscopy by a flexible scope through the hernial opening is an uncomplicated, reliable and precise method. it may represent a very satisfactory alternative to routine bilateral inguinal exploration and also by its enhanced mobility, it may be much more beneficial than the recently developed technique of scoping children with a rigid laparoscope.Öğe Minimally conjoined omphalopagus twinning: A case report(Hippokrates Verlag Gmbh, 1998) Koltuksuz, U; Eskicioglu, S; Mehmetoglu, FIn most omphalopagus twinnings, joined structures include the gastrointestinal tract, liver, biliary tree and bladder. In some instances of omphalopagus, joined attachments are limited to the intestine and bladder. Eight cases like these, that are also called minimally conjoined twinning, have been reported before. This article describes a set of twins who were joined by an omphalocele sac and small bowel, There were several loops of bower in the conjoined omphalocele sac without any evidence of liver. One of the twins had atresia of the colon, rectum and anus and the other had a cloacal anomaly. The twins were separated at the 18th hour after birth due to intestinal obstruction. One of the twins survived, but the other died on the second day postoperatively.Öğe Morgagni hernia(Wiley-Liss, 2000) Soylu, H; Koltuksuz, U; Kutlu, NO; Sarihan, H; Sen, Y; Üstün, N; Baki, AMorgagni 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 bower 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. (C) 2000 Wiley-Liss, Inc.Öğe Multifocal omental mesenteric inflammatory pseudotumor (plasma cell granuloma)(Hippokrates Verlag Gmbh, 1999) Koltuksuz, U; Gürsoy, MH; Mutus, M; Aydin, A; Aydinc, M; Çetin, S; Çiralik, HInflammatory pseudotumor (IP) is an uncommon benign tumor during childhood. The most common location is lung, and sporadic cases of IP with extrapulmonary involvement such as liver and abdomen are reported. However, the IP among the reported cases have appeared as solitary masses. A multifocal IP in a 14-year-old girl presumed to result following an Entamoeba histolytica infestation is reported.Öğe Plasma superoxide dismutase activity and malondialdehyde level correlate with the extent of acute appendicitis(Springer-Verlag, 2000) Koltuksuz, U; Uz, E; Özen, S; Aydinc, M; Karaman, A; Akyol, ÖAlthough the mechanism of acute appendicitis (AA) is partly understood, the progression following the onset of inflammation has not yet been clarified. To determine oxidative activities in the plasma of patients with AA, superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured in samples from 31 patients diagnosed as having AA and 10 otherwise healthy children with inguinal pathologies. The patients with AA were divided into three subgroups: acute focal (AFA) (n = 8), acute suppurative (ASA) (n = 9), and acute perforated appendicitis (APA) (n = 14), according to the intraoperative findings and histopathologic examination.. SOD and MDA were compared statistically between these subgroups and between them and the control group. Additionally, mean leukocyte counts of each group were determined and the differences between the groups were evaluated. Both SOD and MDA were significantly higher in the ASA and APA groups compared to controls and AFA group. The mean leukocyte numbers of the ASA and APA groups were significantly higher compared to the AFA group. Based to these results, it may be speculated that oxygen free radicals (OFR) may play an important role in the extent of AA. To prevent the hazardous effects of OFR, the organism may increase SOD and other antioxidant enzyme levels and/or activities.Öğe Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: Experience in 1,554 children(W B Saunders Co, 2002) Uguralp, S; Mutus, M; Koroglu, A; Gurbuz, N; Koltuksuz, U; Demircan, MBackground/Purpose: Although caudal and spinal blocks are modern and safe techniques, in many centers children still are operated on under general anesthesia (GA), or the blocks are used for postoperative analgesia after GA in infraumbilical operations. The authors aimed to document the results and the complications of 1,554 regional anesthesia cases, thereby assessing their validity. Methods: The analysis of 1,459 caudal and 95 spinal blocks cases collected until January 2001 in children from newborn to 12 years of age are documented retrospectively. The types of anesthesia analyzed in the study were caudal block (CB) only, CB plus GA, GA plus CB, GA plus spinal block, and spinal block only. Results: There were 1,338 caudal and 95 spinal block cases that clinically were satisfactory. Because the duration of CB produce a CB occurred in 82 cases (5.57%). There were 257 of 1,338 patients operated on under GA and supported by caudal block for postoperative analgesia. Conclusions: Caudal anesthesia seems to be an inexpensive, simple, and effective technique not only as a supplement for postoperative analgesia, but also as a single method of anesthesia. and the authors recommend its use in a wider setting of clinical entities in infraumbilical surgical procedures of children. Copyright 2002 Elsevier Science (USA). All rights reserved.Öğe Supernumerary breast tissue: A case of pseudomamma on the face(W B Saunders Co-Elsevier Inc, 1997) Koltuksuz, U; Aydin, ESupernumerary breast tissue usually develops along the milk line. But occasionally, it may be seen outside the milk line. In this article, the authors describe a case of pseudomamma on the face, one of the rarest locations for supernumerary breast tissue, The lesion was removed for cosmetic reasons, There was no associated anomaly. Copyright (C) 1997 by W.B. Saunders Company.Öğe Testicular nitric oxide levels after unilateral testicular torsion/detorsion in rats pretreated with caffeic acid phenethyl ester(Springer-Verlag, 2000) Koltuksuz, U; Irmak, MK; Karaman, A; Uz, E; Var, A; Özyurt, H; Akyol, ÖNitric oxide (NO) plays an important role in modulating blood flow in normal and in several pathological conditions, and its levels seem to change with ischemia-reperfusion injuries. Caffeic acid phenethyl ester (CAPE), an active component of propolis, exhibits antioxidant properties. This experimental study was designed to determine the changes in NO levels and the effect of CAPE on NO levels after testicular torsion/ detorsion in rats. Thirty-five adult male albino rats were divided into four groups: sham operation (n = 8), torsion (n = 9), saline/detorsion (n = 9), and CAPE/detorsion (n = 9). Rats in the sham operation group were killed after the testes were handled without torsion. Rats in the torsion group were killed after 720 degrees clockwise testicular torsion for 2 h. CAPE was administered 30 min before detorsion in the CAPE/detorsion group and saline was administered in the saline/detorsion group. After 4 h of testicular detorsion in both of these groups, the rats were killed and bilateral orchiectomy was performed to determine the tissue levels of NO. The level of NO in the torsion group (113.77 +/- 33.18 nmol/g protein) was significantly higher than that of the sham operation group (64.53 +/- 29.64 nmol/g protein). In the saline/detorsion group, the NO level (31.26 +/- 12.58 nmol/g protein) was significantly lower than in the torsion and sham operation groups. CAPE administration in the CAPE/detorsion group seemed to raise the NO level (72.63 +/- 23.87 nmol/g protein) above the level of the sham operation group. Contralateral testes were not affected by the torsion/detorsion processes performed on the ipsilateral testes. These results show that NO levels increase with torsion and decrease with detorsion. CAPE administration seems to increase tissue NO levels and this may be important for protecting the testes from torsion/detorsion injuries.
