Publications by authors named "Senol Emre"

27 Publications

  • Page 1 of 1

Transient minimal hydronephrosis on contralateral kidney in infants with unilateral hydronephrosis: Is it an early sign of worsening of the affected kidney?

Turk J Med Sci 2021 Apr 26. Epub 2021 Apr 26.

Background And Aim: The criteria for surgical management of ureteropelvic junction obstruction are not well-defined, and there is a risk for loss of renal function before the operation. In this context, certain changes in contralateral kidney had been investigated in order to increase the sensitivity of diagnosis. In this study we aimed to investigate whether contralateral transient minimal hydronephrosis (CTMH) can be considered as an ?early alarm? sign for worsening of the affected kidney in infants with hydronephrosis.

Material And Method: A total of 182 infants (92 surgically treated and 90 conservatively followed-up) with unilateral hydronephrosis were retrospectively analyzed. Ultrasonography and renal scan findings were evaluated. Correlation between the appearance of CTMH, contralateral compensatory hypertrophy (CCH) on ultrasonography, and prognosis of the affected kidney were evaluated.

Results: Among the surgically treated patients; 18 (19.6%) patients developed CTMH on average 7 months (0-13 months) before surgery. Among these 18 patients with CTMH; 12 patients (66.6%) had loss of renal function preoperatively, while this ratio was 29.7% on their counterparts (p=0049). CCH was observed in 31 (33.7%) individuals in surgically treated patient group including all 18 patients with CTMH, while none of the conservatively followed-up patients developed CCH and/or CTMH. In the multiple logistic regression analysis, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and of the poor prognosis (p = 0.011 and p = 0.0004 respectively).

Conclusion: In our study, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and poor prognosis in infants followed-up with isolated unilateral hydronephrosis. Additionally, CTMH can be considered as an ?early alarm? sign for worsening of the affected kidney and the need for surgical intervention.
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http://dx.doi.org/10.3906/sag-2012-99DOI Listing
April 2021

Using Immersive Technologies to Develop Medical Education Materials.

Cureus 2021 Jan 12;13(1):e12647. Epub 2021 Jan 12.

Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR.

Principles of modern surgical education for clerkship and residency were established by the novel approaches of Sir William Osler, MD, Flexner report, and Halsted's principles. The evaluation of surgical education has continued to benefit from the wisdom of the past by harnessing technologies. Rapidly changing and improving the nature of the surgery fostered that evaluation and enforced the institutions to find new solutions for surgical education. In the present descriptive technical report, our aim was threefold: (1) to share acquired educational materials based on immersive technologies involving 3D-printing, Augmented Reality (AR), and 360-degree video recording to improve ongoing pediatric surgery student training at our faculty, (2) to describe workflow underlying the construction of the materials, and (3) to provide approaches that may help other students and lecturers to develop their educational materials. The educational materials, including 3D-printed models, AR hybrid student book, a hydrogel-based simulation model of the kidney, and Mirror World Simulation, were constructed. The authors, who are medical students, led the construction of the educational materials, so the educational materials were shaped by a collaboration between students and pediatric surgeons. The materials constructed enabled the students to practice surgical procedures and experience different surgical environments. We believe these educational materials can serve as a valuable resource for training in many medical specialties in the future. This work was presented at the American College of Surgeons (ACS) Quality and Safety Conference Virtual, August 21-24, 2020.
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http://dx.doi.org/10.7759/cureus.12647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872886PMC
January 2021

The history of surgery in disorders of sexual development.

J Pediatr Surg 2021 Feb 15;56(2):429-433. Epub 2020 Dec 15.

University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.

Disorders of sexual development (DSD) have been documented throughout human history with fascination. Healers of all cultures have struggled to explain, and later correct with surgery, the physical manifestations of DSD. DSD was portrayed in the mythology, legends, and art of the ancient Greeks, Romans, Sumerians, Babylonians, and Egyptians. Techniques of feminizing genitoplasties date to the time of Celsus in the time of Christ. Acceptable operative therapy for feminine phenotypes of DSD came in the 19th and 20th centuries. Masculinizing procedures, inherently more complex than feminizing genitoplasties, initially were variations of procedures for severe forms of hypospadias. Today most total penile reconstruction procedures use reconstructive and microvascular techniques invented in 20th century.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.09.056DOI Listing
February 2021

Resection of Inferior Vena Cava Without Reconstruction for Intravascular Intrusion of Wilms Tumor.

Urology 2021 Mar 13;149:e29-e33. Epub 2020 Nov 13.

Pediatric Surgery Unit, Sapienza University of Rome, Rome, Italy. Electronic address:

Persistent inferior vena cava (IVC) tumor thrombus in Wilms tumor patients represents a management challenge. We describe three pediatric cases with preoperative evaluation documenting complete IVC occlusion and well-developed collaterals. They underwent nephrectomy and tumor thrombus removal accomplished with circumferential resection of the retrohepatic IVC without vascular reconstruction. All patients are asymptomatic and disease-free at 9, 2.5, and 2 years after stopping therapy. Cavectomy without reconstruction is safe and well tolerated in Wilms tumor patients with completely occlusive IVC tumor thrombus. Additionally, when performed en bloc with nephrectomy and with clear margins, cavectomy obviates the need for radiotherapy per protocol.
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http://dx.doi.org/10.1016/j.urology.2020.11.004DOI Listing
March 2021

Adrenal masses in children: Imaging, surgical treatment and outcome.

Asian J Surg 2020 Jan 6;43(1):207-212. Epub 2019 Apr 6.

Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Turkey.

Background/objective: This study aims to evaluate the current surgical approach to adrenal masses in the pediatric age group.

Methods: We retrospectively analyzed cases that underwent surgery for adrenal masses between 2007 and 2017. Patients were assessed regarding age, sex, primary diagnosis, image defined risk factors (IDRF), surgical treatment method, complications, duration of hospital stay, and follow-up.

Results: We examined 50 patients who underwent surgery for adrenal mass (mean age: 4.8 years; range: 5 days-14 years). For IDRF assessment, Ultrasonography was used in 42, Computed Tomography in 36, and Magnetic Resonance Imaging in 36 patients. Lesions were present on the right in 25, left in 21, and bilateral in 4 patients. Histopathological findings were neuroblastoma (n = 29), ganglioneuroma (n = 6), adrenal cortex tumor (n = 5), ganglioneuroblastoma (n = 4), pheochromocytoma (n = 3), cyst (n = 1), and adrenal hematoma (n = 2). Laparotomy was performed on 37 patients, and laparoscopy on 13 patients. None of the cases had any operative complications.

Conclusion: The crucial factors determining the surgical approach to adrenal masses in pediatric cases are the histopathology of the mass, volume, and IDRF. Minimally invasive procedures could be reliably performed in appropriate cases.
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http://dx.doi.org/10.1016/j.asjsur.2019.03.012DOI Listing
January 2020

Frequency of ALK and GD2 Expression in Neuroblastoma.

Fetal Pediatr Pathol 2019 Aug 7;38(4):326-334. Epub 2019 Apr 7.

f Istanbul University Cerrahpa ş a-Cerrahpa ş a Faculty of Medicine, Pathology , Istanbul , Turkey.

The aim of this study was to elucidate the significance of immunohistochemical staining patterns of ALK and GD2 in peripheral neuroblastic tumors with different stages and favorable/unfavorable features. 32 neuroblastomas, 7 ganglioneuroblastomas, and 1 ganglioneuroma cases were immunohistochemically stained with ALK and GD2, and the expressions were graded and correlated with differentiation, size, and favorable/unfavorable histology. There was no statistically significant correlation between ALK immunopositivity and tumor differentiation or stage. Although there was no statistically significant correlation between GD2 immunopositivity and stage, the intensity and prevalence of GD2 immunostaining were statistically significantly higher in the well differentiated group and in tumors which were smaller than 10 cm. GD2 immunostaining levels correlated with tumor differentiation and size. ALK immunostaining was not related to tumor differentiation or stage.
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http://dx.doi.org/10.1080/15513815.2019.1588439DOI Listing
August 2019

Complications during esophageal endoscopy with or without baloon dilation under general anesthesia in pediatric patients: a prospective and observational study.

Arch Argent Pediatr 2018 Apr;116(2):98-104

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Background: Complications can occur during esophagoscopy as a result of applied procedure in children, especially during dilation techic. Our aim was to identify cardio-respiratory alterations during esophagoscopy with or without baloon dilation under anesthesia in children, and to investigate the postoperative complications.

Methods: Prospective, observational study of endoscopic procedures in patients 0-16 years. The patients were divided into two groups: the endoscopy-dilation group (Group ED: endoscopy and balloon dilation due to esophageal stricture) and endoscopy without dilation (Group E: endoscopy for diagnostic reasons, control esophagoscopy or sclerotherapy). Hemodynamic and ventilatory parameters alterations and complications during endoscopy, dilation and two-hours follow-up time in the postoperative recovery room were recorded.

Results: 102 procedures in 60 patients were included. Peak inspiratory pressure (PIP) values significantly increased after endoscopy in both groups (p<0.001). There was a significant increase in mean PIP values in the dilation group during the procedure (p<0,001). The difference in PIP values before and after the endoscopy was negatively correlated with age in both groups. When the groups were subdivided taking two years of age as a cut-off point in comparing PIP difference before-after endoscopy, PIP increase was statistically significant in both groups under two-years old. In the dilation group, statistically significant increase of HR was detected during the procedure (p<0,001).

Conclusion: During endoscopy PIP increased in patients with or without baloon dilation especially in the dilation group. PIP increase was higher in younger children. Severe respiratory and cardiovascular complications during balloon dilation under general anesthesia should be carefully observed and managed.
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http://dx.doi.org/10.5546/aap.2018.eng.98DOI Listing
April 2018

A rare cause of vomiting: annular pancreas.

Turk Pediatri Ars 2017 Dec 1;52(4):236-239. Epub 2017 Dec 1.

Istanbul University, Cerrahpaşa Medical Faculty, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul, Turkey.

Annular pancreas is a rare congenital anomaly that consists of a ring of pancreatic tissue partially or completely encircling the second part of the duodenum. It can affect anyone from neonates to adults, and is difficult to diagnose because it can present in a wide range of clinical conditions. Although cases have also been reported in adults, symptomatic cases are often referred in infancy or early childhood. A 17-year-old female patient who was diagnosed as having annular pancreas is reported. The patient had had non-bilious vomiting accompanied by abdominal pain, especially 5-10 minutes after meals, for seven years. Annular pancreas, which may be seen at any age, should be considered in the differential diagnosis of patients with non-bilious vomiting, particularly after meals, over a long period.
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http://dx.doi.org/10.5152/TurkPediatriArs.2017.3394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819863PMC
December 2017

A Novel Mutation of AMHR2 In Two Siblings with Persistent Müllerian Duct Syndrome.

Sex Dev 2017 13;11(5-6):289-292. Epub 2018 Jan 13.

Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Persistent müllerian duct syndrome (PMDS) is characterized by the presence of müllerian duct derivatives in otherwise phenotypically normal males. It is caused in approximately 85% of the cases by mutations in the AMH gene or its type II receptor (AMHR2). We report on 2 brothers with normal external genitalia but high serum AMH levels. Sequence analysis of the AMHR2 gene in the 2 siblings revealed a novel homozygous missense mutation in exon 10 (p.V458L, c.1372G>T). PMDS is a rare condition, but it has to be considered in differential diagnosis of cryptorchidism with normal male genitalia.
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http://dx.doi.org/10.1159/000485882DOI Listing
October 2018

Pudendal Nerve Block Versus Penile Nerve Block in Children Undergoing Circumcision.

Urol J 2018 05 3;15(3):109-115. Epub 2018 May 3.

Cerrahpasa Medical Faculty, Department of Anesthesiology and Reanimation, Istanbul, TURKEY.

Purpose: Penile nerve block is the most popular nerve block for the circumcision in pediatric patients. This study aimed to compare the analgesic efficiency of penile nerve block and the pudendal nerve block on postoperative pain and additional analgesic requirements in children undergoing circumcision.

Material And Methods: This prospective randomized double-blind study enrolled 85 children, aged 1 to10 years, undergoing circumcision. The patients were randomly divided into two groups either receiving dorsal penile block group (PNB-Group) or pudendal nerve block (PDB-Group). In the PNB-Group, 0.3 ml/kg 0.25 % bupivacaine was used; and, in the PDB-Group, 0.3 ml/kg bupivacaine was applied with nerve stimulator at a concentration of 0.25%. In the postoperative period, the modified CHEOPS pain scale scoring and additional analgesic demand were evaluated at the 5th and 30th minutes and at the 1st and 2nd hours. The subsequent pain evaluations were made by the parents at home, at the postoperative 6th, 12th, 18th and 24th hours.

Results: Seven patients were excluded from the study, and seventy eight patients were evaluated for analysis. Patients in PDB-Group had significantly lower postoperative pain intensity and lower mCHEOPS scores (3.83 ± 0.98) when compared to the PNB-Group (6.47 ± 0.91) (P < .01) at all measurement times and none of patients in PDB-Group had additional analgesic requirements up to 24 hours. Patients in the PNB-Group had significantly more analgesic requirements at all measurements times except at the 1st, 2nd, 24th hours. 3.8%, 30.8%, 46.2% and 59% of the patients in the PNB group needed additional analgesia respectively at 5th, 6th, 12th and 18th hours.

Conclusion: Pudendal nerve block provided additional analgesic free period and had better analgesic efficiency compared to the penile nerve block lasting until 24 hours after operation.
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http://dx.doi.org/10.22037/uj.v0i0.4292DOI Listing
May 2018

Which treatment modality for pediatric pilonidal sinus: Primary repair or secondary healing?

Asian J Surg 2018 Sep 15;41(5):506-510. Epub 2017 Oct 15.

Istanbul University, Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Turkey.

Objective: To evaluate the outcome and characteristics of patients who were operated for sacrococcygeal pilonidal sinus (SPS) treatment using primary repair or secondary healing technique.

Methods: Forty-seven patients (female: 25, male: 22) diagnosed with pilonidal sinus operated between 2009 and 2015 were retrospectively analyzed. The cases were evaluated for age, gender, body mass index (BMI), surgical technique, hospital stay, recovery time and recurrence. Mainly two types of surgical techniques were applied: primary repair and secondary healing.

Results: Mean age of the patients was 15.6 (±1.2) years. Excision and primary repair was performed in 36, excision and secondary healing was in 11. There was no statistically significant difference between the groups regarding length of hospital stay and duration of postoperative pain (p > 0.05). There was a statistically significant difference between groups regarding recovery time (p < 0.05). Recurrence was detected in a total of 11 (23.4%) patients.

Conclusion: We did not find any significant difference concerning length of hospitalization, duration of postoperative pain and recurrence rate. However we determined that the primary repair group recovery time is significantly shorter compared to our secondary healing group. Therefore we recommended primary repair in the treatment of primary repair PS in children.
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http://dx.doi.org/10.1016/j.asjsur.2017.08.006DOI Listing
September 2018

Transversus Abdominis Plane (TAP) block for postoperative analgesia in neonates and young infants: retrospective analysis of a case series. TAP blocks in neonates and young infants.

Minerva Anestesiol 2017 03 11;83(3):282 - 287. Epub 2016 Nov 11.

Department of Anesthesia and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey -

Background: The effectiveness of the TAP block in children has been well characterized in literature. However, there are only few reports about TAP block in the neonates and low birth weight groups. This is a retrospective observational analysis of ultrasound - assisted TAP blocks in neonates and young infants. The aim of this study to analyze retrospectively the analgesic effectiveness of TAP block in neonates and infants undergoing abdominal and inguinal surgeries.

Methods: Thirty-four cases of neonates and infants with (whom) applied TAP block were retrospectively analyzed. The TAP block was performed postoperatively in supraumbilical surgeries and preoperatively in infraumbilical surgeries. The TAP block was applied with 0.8 ml/kg-1 of 0.25% bupivacaine in unilateral approach and 1.6 mlkg-1 of 0.125% bupivacaine in bilateral approach. The CRIES Pain Scale was used for postoperative pain measurement of neonates.

Results: The patient's age ranged from 2 to 88 day-old with a mean (SD) of 36.2(24.2). Eleven of them were premature babies. The weight ranged from 1.6 to 5.8 with a mean (SD) of 3.7kg (1.1). Twenty-nine patients were extubated at the end of the surgery and the other patients within 12 hours. 67.7% infants required no additional postoperative analgesic in 24 hours and none of them required narcotic analgesics.

Conclusions: Our conclusion is that the use of TAP blocks results in low analgesic requirements and a low incidence of postoperative intubation and mechanical ventilation in neonates and infants. It should be considered in this age group of child for postoperative analgesia.
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http://dx.doi.org/10.23736/S0375-9393.16.11420-8DOI Listing
March 2017

Testis sparing surgery for Leydig cell pathologies in children.

J Pediatr Urol 2017 Feb 11;13(1):51.e1-51.e4. Epub 2016 Oct 11.

Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Objective: The aim was to analyze testis-sparing surgical procedures in boys with Leydig cell pathologies.

Study Design: The hospital records of four boys with Leydig cell hyperplasia who underwent testis-sparing surgery for testicular masses between 2000 and 2012 were analyzed retrospectively. Tumor markers were evaluated and all boys underwent scrotal ultrasonography preoperatively. The hormonal profile was also analyzed for symptoms of precocious puberty. The testis was delivered through a high transverse inguinal incision and the tumor was excised by enucleation. After confirming the benign nature of the tumor with frozen-section examination, the testis was reinserted and fixed into the scrotum with absorbable sutures. All cases were followed-up with physical examination, scrotal ultrasonography, and measurement of β-human chorionic gonadotropin (HCG), α-fetoprotein, and hormone levels.

Results: The mean age of the patients was 9.4 years (1.5-15 years). Testicular mass and scrotal asymmetry were detected in all cases. Ultrasonography was the main initial diagnostic modality for detecting testicular masses (Table). β-HCG and α-fetoprotein levels were normal. Three cases had Leydig cell hyperplasia and one patient was diagnosed to have a Leydig cell tumor. Signs of precocious puberty were detected in the four patients. The mean follow-up period was 4.8 years (2-8 years). Neither recurrence nor testicular atrophy developed in the follow-up. Findings of precocious puberty continued in one patient with Leydig cell hyperplasia, in whom a 2-mm contralateral metachronous lesion was detected and enucleated successfully.

Discussion: Testis-sparing surgery with its potential long-term psychological, cosmetic, and functional advantages should be used in pediatric patients in whom a benign Leydig cell pathology is confirmed histopathologically.

Conclusion: This intervention with good long-term results can easily be applied through a proper dissection plane in the testicle. Since testicular Leydig cell tumors in childhood have small rates of recurrence, this choice of treatment is efficient in patients with salvageable testicular tissues and normal levels of tumor markers.
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http://dx.doi.org/10.1016/j.jpurol.2016.08.024DOI Listing
February 2017

A rare case with encephalopathy.

Turk Pediatri Ars 2016 Sep 1;51(3):169-172. Epub 2016 Sep 1.

Division of Pediatric Intensive Care, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.

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http://dx.doi.org/10.5152/TurkPediatriArs.2016.3460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047368PMC
September 2016

A review of intussusception cases involving failed pneumatic reduction and re-intussusception.

Ulus Travma Acil Cerrahi Derg 2016 May;22(3):259-64

Department of Pediatric Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul-Turkey.

Background: The aim of the present study was to evaluate cases in which intussusception was unsuccessfully treated with pneumatic reduction (PR), and intussusception recurred following PR.

Methods: The medical records of 401 patients who presented with intussusception between 2003 and 2014 were retrospectively analyzed. Included were 61 patients, 20 of whom underwent unsuccessful PR (Group 1), and 41 of whom experienced intussusception recurrence following PR (Group 2). Treatment and outcome were summarized.

Results: In Group 1 (mean age: 14.2 months; range: 2.5 months-6 years) surgery was indicated due to PR failure in 15 patients, and perforation occurred during PR in 5. In these 5 patients, age was under 1 year (range 6-9 months) and mean time to presentation was 3 days (range 2-4). During laparotomy, pathologies were noted: mesenteric lymphadenopathy (LAP) and/or Peyer's patch hyperplasia was observed in 15 cases, Meckel's diverticulum in 5 cases. In Group 2 (mean age: 20 months; range: 3 months-6 years), intussusception developed after successful PR in 41 patients, most frequently within the first 24 hours (21.51%). Of the 41 patients, recurrent intussusception (RI) was treated with PR in 36, and laparotomy in 5. Operative findings were mesenteric LAP in 4 and polyp in 1.

Conclusion: PR is effective for the treatment of intussusception and recurrences. Delayed presentation reduces the success rate. In the event of failure, a lead point is usually encountered at laparotomy.
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http://dx.doi.org/10.5505/tjtes.2016.79851DOI Listing
May 2016

Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery: A Randomized Controlled Trial.

Reg Anesth Pain Med 2016 Sep-Oct;41(5):610-5

From the Departments of *Anesthesiology and Intensive Care, and †Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Background And Objectives: Postoperative pain management after hypospadias surgery is often challenging. Caudal block is used for analgesia but has limitations. This study compares the analgesic efficiency of pudendal block with that of caudal block in pediatric patients undergoing hypospadias repair surgery.

Methods: This prospective, double-blind, randomized, controlled study enrolled 84 patients receiving pudendal block or caudal block before hypospadias surgery. In the pudendal group, the pudendal nerve was identified using a nerve stimulator, and the block consisted of 0.25% bupivacaine 0.5 mL/kg. In the caudal group, the caudal block used 0.2% bupivacaine 1 mL/kg. Our primary outcome was pain intensity within 24 hours postoperatively. The trial was registered at ClinicalTrials.gov (number: NCT02390388).

Results: For the primary outcome, patients in the pudendal group had lower postoperative pain intensity when compared with the caudal group (P < 0.001). Three patients in the pudendal group and all of the patients in the caudal group needed additional analgesia within 24 hours after the surgery (P < 0.001). The family satisfaction rate was significantly higher in the pudendal group (P < 0.001).

Conclusions: For the pudendal group, the pain scores for the first 24 hours after the surgery were significantly lower and the duration of analgesia was longer.
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http://dx.doi.org/10.1097/AAP.0000000000000447DOI Listing
March 2017

Ultrasound-Guided Thoracic Paravertebral Block Experience in a Child.

Turk J Anaesthesiol Reanim 2016 Feb 1;44(1):57-8. Epub 2016 Feb 1.

Department of Pediatric Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.

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http://dx.doi.org/10.5152/TJAR.2016.32448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894122PMC
February 2016

Presentation of H-Type Tracheoesophageal Fistula in Two Adolescents: Delayed Diagnosis.

Pediatr Neonatol 2017 04 29;58(2):187-188. Epub 2016 Apr 29.

Department of Pediatric Infectious Diseases, Clinical Immunology and Allergy, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.pedneo.2015.10.016DOI Listing
April 2017

Emergency bronchoscopy for foreign-body aspiration in a child with type I mucopolysaccharidosis: a challenging airway management experience.

J Anesth 2016 08 4;30(4):696-8. Epub 2016 May 4.

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey.

The mucopolysaccharidosis (MPS) is a rare lysosomal storage disease. Glycosaminoglycans (GAG) accumulate in musculoskeletal system, connective tissues. Enlarged tongue, short immobile neck, and limited mobility of the cervical spine and temporomandibular joints render the airway management potentially risky. MPS children have high anesthetic risks, especially in airway management of emergency situations. The foreign-body aspiration requiring intervention with rigid bronchoscopy is an urgent and risky clinical situation. We present our experience with a challenging airway management with a three-year-old child with MPS who needed emergency bronchoscopy due to peanut aspiration.
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http://dx.doi.org/10.1007/s00540-016-2180-7DOI Listing
August 2016

[Duodenum perforations in children: case series].

Ulus Travma Acil Cerrahi Derg 2016 Jan;22(1):109-13

Department of Pediatric Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

To analyse patients those admitted to our clinic due to perforation in duodenum. Fourteen patients those have been admitted to our center with perforation in duodenum between 1990 - 2014 analysed retrospectively. Ten patients (8M, 6F) those have been admitted to our clinic between 1990 - 2014 have a mean age of 6.2 years (25 days - 16 years). Two of cases admitted directly to our clinic and the rest referred from another hospitals. Mean time for appliance to our clinic was 3.2 days (1day - 1 week). Ulcer in duodenum was the cause of perforation in 10 cases while in 3 the cause was trauma and in 1 case was surgical complication of infantly persistant hyperinsulinism (IPHH). The case with hyperbilluribinemia after near total pancreatectomy due to IPHH had been explored and perforation in deuedenum diagnosed. Resection in first two parts of duodenum and pylor, choledochojejunostomy, gastrojejunostomy and jejunojejunostomy was performed. Primary repair was performed in the remaining patients. In one case with primary repair gastrostomy was performed, while in 9 cases omentoplasty were performed. In the follow-up 12 cases has no problems and doing well. Two patients died. Perforation in duedenum is a rare entity that pediatric surgeons should encounter and keep in mind. Primary repair (duodenoraphy ± omentoplasty) is safe and reliable surgical treatment modality.
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http://dx.doi.org/10.5505/tjtes.2016.69947DOI Listing
January 2016

Results of a Two-stage Technique for Treatment of Proximal Hypospadias with Severe Curvature: Creation of a Urethral Plate Using a Vascularized Preputial Island Flap.

Urol J 2016 Apr 16;13(2):2629-34. Epub 2016 Apr 16.

Department of Pediatric Surgery, Division of Pediatric Urology, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, 34098, Turkey.

Purpose: To present the results of a two-stage technique used for the treatment of proximal hypospadias with severe curvature.

Materials And Methods: The medical records of children with proximal hypospadias and severe curvature were retrospectively analyzed. A 2-stage procedure was performed in 30 children. In the first stage, the release of chordee was performed, and a well-vascularized preputial island flap was created. The vascularized island flap was brought anteriorly and sutured over the ventral surface of the glans and degloved penile shaft. The second stage was performed 6-8 months later. A neourethra was reconstructed by the tubularization of the preputial-urethral plate utilizing the principles of Duplay technique. All surgical procedures were performed between 2005 and 2011.

Results: The mean age of the patients was 4.4 years (1-17 years). The mean duration of urethral catheterization was 6 days after the first stage and 10 days following the second stage. The flaps were viable in all of the children. There was no residual chordee. Following the second stage (n = 30), complications developed in 11 children (36%), namely, a fistula in 7, a pinpoint fistula in 3, and a diverticulum formation in 1. The cosmetic outcome was satisfactory. Uroflowmetry measurements were evaluated, and only one patient had a diverticulum formation at the late follow-up.

Conclusion: Vascularized preputial island flap is an alternative to free grafts for the reconstruction of the urethra. The main advantage of this flap technique is the creation of a thick, healthy and well-vascularized urethral plate. The advantages of this technique include better aesthetic appearance, an acceptable complication rate, and a very low rate of diverticula formation.
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April 2016

Ultrasound-Guided Percutaneous Nephrostomy Performed on Neonates and Infants Using a "14-4" (Trocar and Cannula) Technique.

Cardiovasc Intervent Radiol 2015 Dec 6;38(6):1617-20. Epub 2015 Jun 6.

Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, KMPasa, Fatih, Istanbul, 34098, Turkey.

Purpose: Percutaneous nephrostomy (PCN) catheters are placed under combined ultrasound and fluoroscopic guidance in the interventional radiology suite and present unique challenges in neonates and infants. The purpose of this study was to demonstrate feasibility of PCN using a "14-4" (trocar and cannula) technique on neonates and infants.

Materials And Methods: Between September 2009 and June 2014, data for 27 kidneys from consecutive 22 neonates or infants who underwent PCN catheter placement using the "14-4" technique were retrospectively analyzed. The median age at the time of placement of the PCN catheters was 11 days (range 5-300 days). There were 18 males and 4 females. All procedures were performed in the interventional radiology suite but without using fluoroscopy.

Results: Unilateral PCN was performed on 17 out of 22 patients, while bilateral drainage was performed on five patients. The technical success rate was 100%. The median duration of PCN catheter was 75 days (range 10-138 days). Minor macroscopic hematuria not requiring blood transfusion was present in two of the patients in which the hematuria lasted in 2 days.

Conclusion: Placement of PCN catheters using a "14-4" technique with ultrasound as the sole imaging modality is a technically feasible and desirable option for neonates or infants. The technique obviates the need for ionizing radiation and potentially could be performed in the ultrasound room or even at the bedside.
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http://dx.doi.org/10.1007/s00270-015-1144-xDOI Listing
December 2015

Effectiveness of extracorporeal shock wave lithotripsy on intrahepatic biliary calculi developing after choledochal cyst surgery: A case report.

Turk J Gastroenterol 2015 May;26(3):274-6

Department of Pediatric Surgery, İstanbul University, Istanbul University Cerrahpaşa Medical Faculty, İstanbul, Turkey.

The development of intra- and extrahepatic bile duct stones has been reported as one of the most serious complications after choledochal cyst excision with biliary-enteric reconstruction through Roux-en-Y hepaticojejunostomy (HJ). Here, we report our experience with extracorporeal shock wave lithotripsy (ESWL) in a case of giant intrahepatic stones developing after choledochal cyst surgery. ESWL is an excellent therapeutic modality for large intrahepatic biliary calculi, and after dilating the HJ anastomosis percutaneously, it can be offered as first-line therapy to these patients.
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http://dx.doi.org/10.5152/tjg.2015.0045DOI Listing
May 2015

An unusual cause of recurrent chylothorax: gorham syndrome.

APSP J Case Rep 2014 May 21;5(2):23. Epub 2014 May 21.

Department of Pediatric Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey;

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090821PMC
May 2014

The impact of share wave elastography in differentiation of hepatic hemangioma from malignant liver tumors in pediatric population.

Eur J Radiol 2014 Sep 13;83(9):1691-7. Epub 2014 Jun 13.

Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, 34300, Kocamustafapasa, Istanbul, Turkey. Electronic address:

Objective: In children it is crucial to differentiate malignant liver tumors from the most common benign tumor, hepatic hemangiomas since the treatment strategies are quite different. We aimed to evaluate the efficiency of shear wave elastography (SWE) technique in differentiation of malignant hepatic tumors and hepatic hemangiomas.

Methods: Twenty patients with hepatic tumor were included in our study. Two radiologists performed SWE for 13 patients with malignant hepatic tumors including hepatoblastoma (n=7), hepatocellular carcinoma (n=3), metastasis (n=2), embryonal sarcoma (n=1) and 7 patients with hepatic hemangioma. All of our patients were between the age of 1 and 192 months (mean age: 56.88 months). Receiver operating characteristic analysis was achieved to evaluate the diagnostic accuracy of SWE and to determine the optimal cut-off value in differentiation hepatic hemangioma from malignant hepatic tumors.

Results: The mean SWE values (in kPa) for the first observer were 46.94 (13.8-145) and 22.38 (6.6-49.6) and those for the second observer were 57.91 (11-237) and 23.87 (6.4-57.5), respectively for malignant hepatic tumors and hepatic hemangiomas. The SWE values of malignant hepatic tumors were significantly higher than those of hepatic hemangioma (p=0.02). The inter-observer agreement was almost perfect (0.81). The area under the receiver operating characteristic curve of SWE for differentiating the hepatic hemangioma from malignant hepatic tumors was 0.77 with a sensitivity of 72.7% and a specificity of 66.7% at a cutoff value of 23.62 with 95% confidence interval.

Conclusion: Shear wave elastography can be helpful in differentiation of malignant hepatic tumors and hepatic hemangioma.
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http://dx.doi.org/10.1016/j.ejrad.2014.06.002DOI Listing
September 2014

Successful management of hepatic mucormycosis in an acute lymphoblastic leukaemia patient: a case report and review of the literature.

Mycoses 2014 Aug 18;57(8):513-8. Epub 2014 Mar 18.

Pediatric Hematology Oncology Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

We present a case of hepatic mucormycosis in a 9-year-old boy with acute lymphoblastic leukaemia. Despite long-term use of combined liposomal amphotericin B and posaconazole therapy, the lesion persisted and could only be treated by surgical excision. After surgery, antifungal treatment was continued with posaconazole. On follow-up, the patient had two episodes of ascending cholangitis which were responsive to intravenous antibiotics. He is doing well at the moment in remission for 2.5 years. Mucormycosis was long regarded as a fatal infection with poor prognosis. With early medical and surgical management, survival rates increase. Isolated hepatic mucormycosis is rare and only seven cases were reported in the literature up to now. We wanted to emphasise the role of early surgery in patients with hepatic mucormycosis in view of the literature.
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http://dx.doi.org/10.1111/myc.12184DOI Listing
August 2014

Subserosal leiomyoma of uterus mimicking an ovarian tumor in adolescent patient.

Jpn J Radiol 2014 Jan 17;32(1):48-52. Epub 2013 Nov 17.

Division of Pediatrics, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, 34098, Turkey,

Uterine leiomyomas are the most common gynecological tumors in adult women. These benign tumors are rarely seen in the adolescent population: there are only a few cases that have been reported so far in this age group. In this case report, we present a giant uterine leiomyoma that mimicked an ovarian tumor in a 15-year-old girl.
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http://dx.doi.org/10.1007/s11604-013-0263-zDOI Listing
January 2014