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GİRİŞ veAMAÇ: Konjenital diyafragma hernisi (KDH) yüksek mortalite ve uzun dönemmorbiditeler ile ilişkili nadir bir anomalidir. Bu çalışmanın amacı ünitemizdeKDH tanısı ile takip edilen hastaların demografik, klinik özelliklerini,uygulanan tedavi ve sonuçlarını tanımlamaktır.YÖNTEM ve GEREÇLER: : Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi yenidoğanyoğun bakım ünitesinde KDH tanısı ile tedavi gören hastalar retrospektif olaraktaranmıştır. Ocak 2007 ile Aralık 2016 arasında ünitemizde tedavi gören hastalarınmedikal kayıtları incelenmiştir. Hastaların demografik ve doğum özellikleri,pulmoner hipertansiyon durumları, karaciğer ve mide herniasyonları, ekkonjenital anomalileri, mekanik ventilasyon şekilleri değerlendirilmiştir.BULGULAR: : Çalışma periyodu boyunca KDH nedeniyle tedavi gören 40 hastaçalışmaya alınmıştır. Tüm hastalar içinde ölüm oranı %67.5 (27/40) olarakgerçekleşmiştir. Düşük doğum ağırlığı, düşük gestasyonel hafta, düşük APGARskorları ve başlangıçta yüksek oksijen ihtiyacı mortalite ile ilişkilibulunmuştur. Opere edilen hastalar içinde yaşama oranı %61 (13/21) idi. Yaşayanhastaların ortalama hastanede kalış süreleri 23 (14–35) idi. Taburculuk sonrasıkomorbid durumlar kronik gastrointestinal, pulmoner sorunlar ve büyüme geriliğiolarak saptandı.TARTIŞMA ve SONUÇ: KDH halen yüksek mortalite ve morbiditeye sahiptir. Prenataltanı alan hastaların uygun merkezlerde doğması başarılı müdahale şanslarınıartıracaktır. Congenital Diaphragmatic Hernia:Ten-Year Single Center ResultsINTRODUCTION:Congenital diaphragmatic hernia (CDH) is a rare abnormality with high mortalityand long-term comorbid conditions. Our aim, in this paper, was to describedemographics and birth characteristics, treatment, and outcomes of consecutivepatients with CDH treated at our institution.METHODS: The present study represents a retrospective cohort study of neonateswith CDH who were treated at Uludag University Medical Faculty, Neonatalintensive care unit, Bursa. We identified the medical records of all patientswith CDH who were admitted for treatment to our neonatal intensive care unitfrom January 2007 to December 2016. We reviewed the medical, surgical records,demographics and birth characteristics. We also recorded presence of pulmonaryhypertension, whether or not the liver and, stomach also herniated into the thorax,other associated congenital malformations, and type of mechanical ventilation.RESULTS: Forty patients were included in this study. The overall mortality was67.5% (27/40). Survival for those who had surgical correction of CDH was 61%(13/21). Low birth weight, low gestational age, low APGAR scores and, highoxygen need at baseline was found to be associated with mortality, in patientswith CDH. Among survivors, the median duration of hospitalization was 23(14–35) days. Chronic gastrointestinal, pulmonary disorders and, failure tothrive were the most comorbid conditions after discharge.DISCUSSION AND CONCLUSION: KDH still has high mortality and morbidity. Thebirth of patients with prenatal diagnosis at appropriate centers will increasetheir chances of successful intervention.

In this study our experience in surgical management of 5 patients with choanal atresia are presented Four patients were operated in the neonatal period while only one patient was operated at the age of 14 years Three patients had membraneous type atresia while the other 2 patients had osseous type atresia All of the patients were repaired using transanal drillout method Soft stends were fashioned from silastic endotracheal tube and used for 6 weeks postoperatively One patient with Charge association died because of intracranial hemorrhage Of the five patients two developed postoperative stenosis requiring further dilatation There was no complication in the remaining two patients in the postoperative follow up period Key words: Choanal Atresia Transnasal Drillout, Bu çalışmada koanal atrezili 5 hastadaki tedavi sonuçlanınız sunulmuştur Hastalarımızın 4 ü yenidoğan döneminde tedavi edilirken bir hastamız 14 yaşında tedavi edilmiştir Üç hastada membranöz tipte 2 hastada osseöz tipte atrezi saptanmıştır Tüm hastalar transnazal dril yöntemi ile tedavi edilmiş ve 6 hafta süre ile yumuşak silastik endotrakeal tüp stend olarak kullanılmıştır Charge sendromlu bir hasta intrakranial kanama nedeniyle kaybedilmiştir Beş hastanın ikisinde dilatasyonlara yanıt alınan stenoz gelişmiştir İki hastanın postoperatif takiplerinde sorunla karşılaşılmamıştır Anahtar kelimeler: Koanal Atrezi Transnazal Dril Uygulaması

Giriş ve Amaç: Konjenital diyafragma hernisi (KDH) yüksek mortalite ve uzun dönem morbiditeler ile ilişkili nadir bir anomalidir. Bu çalışmanın amacı ünitemizde KDH tanısı ile takip edilen hastaların demografik, klinik özelliklerini, uygulanan tedavi ve sonuçlarını tanımlamaktır. Yöntem ve Gereçler: Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi yenidoğan yoğun bakım ünitesinde KDH tanısı ile tedavi gören hastalar retrospektif olarak taranmıştır. Ocak 2007 ile Aralık 2016 arasında ünitemizde tedavi gören hastaların medikal kayıtları incelenmiştir. Hastaların demografik ve doğum özellikleri, pulmoner hipertansiyon durumları, karaciğer ve mide herniasyonları, ek konjenital anomalileri, mekanik ventilasyon şekilleri değerlendirilmiştir. Bulgular: Çalışma periyodu boyunca KDH nedeniyle tedavi gören 40 hasta çalışmaya alınmıştır. Tüm hastalar içinde ölüm oranı %67.5 (27/40) olarak gerçekleşmiştir. Düşük doğum ağırlığı, düşük gestasyonel hafta, düşük APGAR skorları ve başlangıçta yüksek oksijen ihtiyacı mortalite ile ilişkili bulunmuştur. Opere edilen hastalar içinde yaşama oranı %61 (13/21) idi. Yaşayan hastaların ortalama hastanede kalış süreleri 23 (14–35) idi. Taburculuk sonrası komorbid durumlar kronik gastrointestinal, pulmoner sorunlar ve büyüme geriliği olarak saptandı. Tartışma ve Sonuç: KDH halen yüksek mortalite ve morbiditeye sahiptir. Prenatal tanı alan hastaların uygun merkezlerde doğması başarılı müdahale şanslarını artıracaktır. Introduction: Congenital diaphragmatic hernia (CDH) is a rare abnormality with high mortality and long-term comorbid conditions. Our aim, in this paper, was to describe demographics and birth characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution. Methods: The present study represents a retrospective cohort study of neonates with CDH who were treated at Uludag University Medical Faculty, Neonatal intensive care unit, Bursa. We identified the medical records of all patients with CDH who were admitted for treatment to our neonatal intensive care unit from January 2007 to December 2016. We reviewed the medical, surgical records, demographics and birth characteristics. We also recorded presence of pulmonary hypertension, whether or not the liver and, stomach also herniated into the thorax, other associated congenital malformations, and type of mechanical ventilation. Results: Forty patients were included in this study. The overall mortality was 67.5% (27/40). Survival for those who had surgical correction of CDH was 61% (13/21). Low birth weight, low gestational age, low APGAR scores and, high oxygen need at baseline was found to be associated with mortality, in patients with CDH. Among survivors, the median duration of hospitalization was 23 (14–35) days. Chronic gastrointestinal, pulmonary disorders and, failure to thrive were the most comorbid conditions after discharge. Dıscussıon And Conclusıon: KDH still has high mortality and morbidity. The birth of patients with prenatal diagnosis at appropriate centers will increase their chances of successful intervention.

Congenital short oesophagus and with intrathoracic development of the stomach is a rare developmental anomaly of the gastrointestinal system. Knowledge regarding its aetiology and management is limited. We report a case in which, in addition to short oesophagus and intrathoracic stomach, an encephalocele was identified during the antenatal period. After the postpartum examination, encephalocele, split notochord malformation, midline localized liver and congenital short oesophagus were confirmed. The report of this case adds to the body of knowledge on this rare condition.

Aim: Clinical features and outcome of 36 patients with necrotizing pneumonia (NP) as well as 36 children with parapneumonic effusions (PPE) and 36 with severe control pneumonia (CP) were investigated. The mean age of the patients in the NP, PPE and CP groups were similar (3.8+/-3.3 (mean+/-SD), 4.2+/-3.0 and 4.2+/-3.0 y, respectively (p>0.05)). The duration of symptoms at presentation were 11.9+/-8.5, 9.2+/-7.2 and 6+/-3.6 d, respectively (p0.05).

In the Department of Pediatric Surgery, Uludag University Medical Faculty in Bursa, during the last 11 years, the Peter G. Jones technique for the surgical correction of muscular torticollis in older children has been introduced. Twenty children between 4 and 13 years of age were treated for muscular torticollis. They were followed up from 3 months to 10 years after surgery. All patients had a middle-third open transection of the sternocleidomastoid muscle. Preoperative and postoperative assessment by a rigid scoring system showed that all patients improved in terms of function as well as cosmesis. Children younger than 10 years showed the most improvement, with 90% excellent and good results. Late middle-third open transection of the sternomastoid in muscular torticollis may give acceptable results.

Sağ akciğer agenezisi; izole veya kalp, iskelet ve üriner sistem gibi sistemlere ait anomalilerle birlikte görülebilen nadir bir anomalidir. Olgu 1, Dört aylık bir kız çocuğu olup solunum sıkıntısı nedeniyle getirilmişti. Hastada sağ el başparmakta sindaktili ve polidaktili, sağda mandibuler hipoplazisi ile dismorfik düşük kulak vardı. Akciğer grafisi ve toraks bilgisayarlı tomografisi (BT) sağ pulmoner agenezi ile uyumluydu ve 7. torakal seviyede kelebek vertebra vardı. Toraks BT anjiografide; aort, sol pulmoner arter ve sağ atriyum basılarına bağlı sol ana bronşta ve özofagusda daralma saptandı. Bronkoskopide karina düzeyinde basıya bağlı darlık görüldü ve sağ ana bronş izlenmedi. Batın ultrasonografisinde sağ böbrek yerleşim anomalisi (pelvik ektopi) ve renal sintigrafide iki böbrek arasında füzyonla uyumlu görünüm vardı. Bu bulgularla hastada, sağ pulmoner ageneziye; ipsilateral radyal ray anomalisi, renal anomali, vertebral anomali ve hemifasyal mikrozominin eşlik ettiği tespit edildi. Olgu 2, On beş yaşında erkek çocuk olup, 2 aylıkken hışıltı atağı sonrası akciğer grafisi, toraks BT ve bronkoskopi ile pulmoner agenezi tanısı almıştı. Hastanın son bir yılda belirginleşen egzersizle çabuk yorulma dışında şikayeti yoktu. Fizik muayenesinde; açıklığı sağa bakan hafif skolyozu vardı, sağ hemitoraksta solunum sesleri azalmıştı, kalp sesleri sağda duyuluyordu. Akciğer grafisi ve toraks BT sağ akciğer agenezisi ile uyumluydu. Ekokardiyografide anomali yoktu, batın ultrasonografisi normaldi. Unilateral akciğer agenezilerinde; eşlik eden kardiyovasküler anomaliler, toraks içi yapılardaki distorsiyonlar ve tekrarlayan enfeksiyonlar, morbidite ve mortaliteyi etkileyen başlıca faktörlerdir. Burada izole ve multipl anomalilerle birlikte iki sağ akciğer agenezili olgu sunulmuştur. Right lung agenesis is a rare anomaly that can be isolated or accompanied by system anomalies such as cardiac, skeletal or urinary systems. Case 1, a four-month-old girl, was brought because of respiratory distress. Patient had polydactyly, syndactyly of right thumb, right mandibular hypoplasia and low-set dysmorphic ears. Lung x-ray and thorax computerized tomography (CT) were consistent with right pulmonary agenesis and butterfly vertebra was evident in the 7th thoracic level. Thoracic CT angiography revealed narrowing of the left main bronchus and esophagus due to compression of aorta, left pulmonary artery and right atrium. In bronchoscopy, narrowing due to compression at the carina level was seen and right main bronchus was not seen. In abdominal ultrasonography, right kidney placement anomaly (pelvic ectopia) was present and renal scintigraphy revealed fusion in both kidneys. With these findings, it was found that right pulmonary agenesis was accompanied by ipsilateral radial ray anomaly, renal anomaly, vertebral anomaly and hemifacial microsomia. Case 2, a fifteen-year-old male patient, was diagnosed as pulmonary agenesis via chest x-ray, pulmonary CT and bronchoscopy after a wheezing episode when he was 2 months old. Patient had no complaint except for exhaustion that is aggravated by exercise during last year. In physical examination, he had a mild scoliosis toward right, respiratory sounds were diminished on right hemithorax and heart sounds were heard on right side. Chest x-ray and thoracic CT were consistent with right lung agenesis. No abnormality was found in echocardiography and abdominal ultrasonography was normal. Accompanied cardiovascular anomalies, distortions of intrathoracic structures and recurrent infections are main factors that affect mortality and morbidity. Here, two cases with right lung agenesis, isolated and accompanied by multiple anomalies, were presented.

Koroziv madde içimi çocuk yaş grubunda sıkça rastlanan, önlenebilir bir travmadır. Travmanın uzun dönemde en önemli morbidite ve mortalite sebebi özofagus striktürüdür. Çalışmamızın amacı, extractum cepae?nin özofagus hasarı sonrası iyileşme döneminde olası striktürlerin önlenmesindeki etkinliğinin araştırılmasıdır. Çalışmada deney modeli olarak, Gehanno ve Guedon tarafından tarif edilen yöntem, 30 adet Wistar albino sıçan üzerinde uygulandı. Özofagus hasarı %10 NaOH ve %1 monoetanolamin karışımının %80?lik çözeltisi ile oluşturuldu. Denekler; kontrol (n:10), tedavi (n:10) ve sham (n:10) olarak 3 gruba ayrıldı. Sham grubunda koroziv özofagus hasarı oluşturulmadı. Kontrol grubundaki deneklere koroziv madde uygulanması sonrası tedavi verilmezken, tedavi grubuna hazırlanan extractum cepae suspansiyon oral olarak verildi. Sonuçlar, histopatolojik veriler ve deneklerin canlı ağırlık artışları ile değerlendirildi.Gruplar çalışma sonunda canlı ağırlık artışı yönünden karşılaştırıldığında tedavi grubundaki ağırlık artışının, kontrol grubuna göre anlamlı düzeyde daha fazla olduğu saptandı. Histopatolojik değerlendirmede; submukozal ödem, submukozal kollajen birikimi, muskularis mukoza hasarı, muskuler atrofi, intramuskuler kollajen birikimi ve mononükleer iltihabi hücre infiltrasyonu parametreleri kullanıldı. Gruplar arasında; submukozal ödem, submukozal kollajen birikimi, muskularis mukoza hasarı ve muskuler atrofi açısından anlamlı fark saptandı.Extractum cepae, özofagus yanığı sonrasında deneklerin canlı ağırlık artışının sağlanmasında ve yanık bölgesinde oluşacak olan aşırı kollajen birikimini önlemede etkilidir. Extractum cepae, tedavideki etkinliği, düşük yan etki, düşük maliyet ve kullanım kolaylığı nedeniyle, koroziv özofagus yanığındaki tedavi basamaklarında birinci seçenek olmaya adaydır.Anahtar Kelimeler: Koroziv özofajit, extractum cepae, çocuk Corrosive esophageal burns are preventable trauma, frequently encountered in childhood. The most important cause of morbidity and mortality in long-term follow up in this trauma is esophageal stricture. We aimed to evaluate the effectiveness of extractum cepae on prevention of esophageal strictures during healing after corrosive substance intake.In this study, the corrosive esophagus experimental model that defined by Gehanno and Guedon et al was used with 30 wistar albino rats. Esophageal injury created by 80% solution of 10% NaOH and 1% monoethanolamine. The subjects divided three groups; control (n:10), treatment group (n:10) and sham group. (n:10) The sham group was not injured by corrosive. Extractum cepae suspension was given with nutrients daily for treatment group for 21 days. In control group, was not. The results were evaluated with histopathologic data and the subjects' body weight increases.The groups were compared in terms of weight gain at the end of the study, the treatment groups weight gain were significantly higher than the control group. Histopathologic evaluation was performed for submucosal edema, submucosal collagen deposition, muscularis mucosa injury, muscular atrophy, intramuscular collagen deposition and mononuclear cell infiltration. There was significant difference in submucosal edema, submucosal collagen deposition, muscularis mucosa injury and muscular atrophy between control and treatment groups.The extractum cepae is effective on weight gain of subjects' body and prevent collagen deposition in injuried area. The extractum cepae is a candidate of first step treatment of corrosive esophageal injury because of it?s success on therapy, low side effects, low costs and ease of use. Key words: Corrosive esophagitis, extractum cepae, child 58

DiGeorge Syndrome (DGS) is a congenital disorder that affects the thymus, parathyroid glands, and heart and brain. Thymus involvement in DGS may vary between absence/hypoplasia of thymus to various forms of reduced T cell function. TBX1 deficiency causes a number of distinct vascular and heart defects, suggesting multiple roles in cardiovascular development, specifically, formation and growth of the pharyngeal arch arteries, growth and septation of the outflow tract of the heart, interventricular septation, and conal alignment. Here the authors describe a case of DGS presenting with severe combined immunodeficiency, esophageal atresia, and tracheoesophageal fistula (TEF). DGS is an important differential diagnosis in TEF.

Koroziv maddelerin içimi çocuk yaş grubunda sıkça rastlanan, önlenebilir bir travmadır. Travmanın uzun dönemde en önemli morbidite ve mortalite sebebi özofagus striktürüdür. Çalışmamızda özofagus hasarı sonrası iyileşme aşamasında olası striktürlerin önlenmesi amaçlanmıştır.Çalışmada deney modeli olarak Şentürk ve ark. tarafından tanımlanan koroziv özofagus modeli 30 adet Wistar albino sıçan üzerinde uygulandı. Özofagus hasarı %10 NaOH, %1 monoetanolamin karışımının %70'lik çözeltisi ile oluşturuldu. Koroziv madde uygulanan denekler 3 gruba ayrıldı. Ayrıca hasar oluşturulmayan 6 denekle sham grubu oluşturuldu. Kontrol grubundaki deneklere koroziv madde uygulanması sonrası tedavi verilmezken oral tedavi grubuna extractum cepae, heparin ve allantoin (CHA) karışımından oluşan contractubex® jel oral olarak verildi. Kateterle tedavi grubuna jel kateterle özofagus lümenine verildi. Sham grubundaki denekler günde 1 kez feeding sonda ile kateterize edildi. Sonuçlar histopatolojik veriler ve deneklerin canlı ağırlık artışları ile değerlendirildi.Gruplar çalışma sonunda canlı ağırlık artışı yönünden karşılatırıldığında tedavi gruplarının ağırlık artışının kontrol grubuna göre anlamlı düzeyde arttığı saptandı (P

Giriş: Lobektomi kazanılmış ve konjenital nedenlerle uygulanan ve çoğunlukla minimum akciğer doku kaybının hedef alındığı ancak kalan akciğer dokusunun fonksiyon ve gelişiminin devamı açısından uygulanması zorunlu olan bir operasyondur. Kliniğimizde lobektomi yapılmış olan olgular retrospektif olarak lobektomi endikasyonları ve postoperatif takipleri açısından değerlendirilmiştir. Gereç ve Yöntem: Kliniğimizin kayıtları taranarak lobektomi uygulanan olgular etyolojik yönden ve postoperatif takipleri açısından retrospektif olarak değerlendirilmiştir. Pnömonektomi ve segmentektomi uygulanan olgular değerlendirilmeye alınmamıştır. Temel olarak etyolojik faktörler konjenital ve kazanılmış olarak iki grupta ele alınmıştır. Bulgular: Toplam 27 olgu çalışmaya dahil edilmiştir. Bu olguların 16’sı erkek ve 11’i kızdı. Yaş aralığı 2 gün ile 17 yaş arasında değişmekteydi. Bu olgulardan konjenital nedenlerle opere edilen olgu sayısı 14 ve bunların ortalama operasyon yaşı 3 aydı. Kazanılmış nedenlerle opere edilen 13 olgunun yaşları 2,5 ila 17 arasında ve ortalama operasyon yaşı 6 idi. Konjenital malformasyonların 4’ü konjenital kistik adenoid malformasyon, 3’ü pulmoner sekestrasyon ve 7’si konjenital lober amfizemli olguydu. Kazanılmış nedenlerden dolayı lobektomi uygulanan olgulardan 12'si postpnömonik nedenlerle, 1'i ise travmatik bronş rüptürü nedeniyle opere edilmişti. Konjenital nedenlerle opere edilmiş olguların tamamında şifa elde edilirken kazanılmış nedenlerden lobektomi yapılmış Kartegener sendromu ve tüberküloz tanılı 2 olgunun takibine enfeksiyon ekibiyle birlikte devam edilmektedir. Diğer olgularda şifa sağlanmıştır. Sonuç: Lobektomi özellikle konjenital nedenlerle yapıldığında sonuçları daha iyidir. Kazanılmış nedenler nedeniyle opere edilen olguların postoperatif takipleri daha uzun zaman almakta ve sonuçlar primer hastalığa bağlı olarak değişmektedir. Introduction: Lobectomy is a compulsory operation performed due to congenital or acquired reasons in which, minimum lung tissue loss and the prevention of residual lung function is targeted. Patients who had lobectomy in our clinic were retrospectively evaluated for indications of their lobectomies and postoperative follow up. Materials and Method: Our clinic records were retrospectively investigated for lobectomy operations and with their etiologies. The pneumonectomy and segmented lobectomy operations were excluded from this study. Principally, etiologic factors were divided in 2 groups; congenital and acquired deformities. Results: Twenty seven patients (16 males and 11 females) were included and their ages ranged from 2 days to 17 years. The number of patients with congenital disease was 14 and their mean age for operation was 3 months. The number of patients who had acquired etiology was 13 and their mean age for operation was 6 years. The congenital causes were lobar emphysema (n:7), congenital cystic adenomatoid malformation (n:4) and pulmonary sequestration (n:3). The acquired causes were post pneumonic deformities (n:12) and traumatic bronchus rupture (n:1). While patients who were operated due to congenital reasons were completely cured, the follow up of 2 patients with acquired reasons (one with Kartagener’s syndrome and one with tuberculosis) is still continuing in assistance with pediatric infectious disease team. Conclusion: The results of lobectomy are better for congenital causes. The patients having acquired causes for lobectomy need longer follow-up times and their results vary depending on primary disease.

Giriş: Çocukluk çağında ampiyem tedavisi sonrası uzun süreli izlemde akciğer fonksiyonlarının değerlendirilmesi ile ilgili çalışmalar az sayıdadır. Bu çalışmada ampiyemli çocuklarda antibiyotik (AB) veya antibiyotik + tüp torakostomi (TT) veya AB+TT+fibrinolitik (FT) tedavileri sonrası geç dönem solunum fonksiyon testleri sonuçlarının araştırılması amaçlandı. Gereç ve Yöntem: Ampiyem nedeniyle 1-13 yaşlarında tedavi edilmiş 45 olgu çalışmaya alındı. Hastaların yaş, cinsiyet, başlangıç ve izlem süresince saptanan klinik bulguları, radyoloji ve laboratuvar sonuçları, uygulanan tedaviler (AB veya AB+TT veya AB+TT+FT) incelendi. İzlem süreleri sonunda solunum fonksiyon testleri yapı larak değerlendirildi. Bulgular: Olguların ortalama yaşları ilk başvuruda 6,3±3,3 yaş (1-13 yaş), izlem süresi sonunda ortalama 9,3±3,4 yaş (4-17 yaş), ortalama izlem süreleri 30,4±13,5 ay (6-54 ay) olarak bulundu. İlk başvurularında ampiyemli olguların 14’ü (%31,1) akut eksudatif evre (Evre 1), 19’u (%42,2) fibropürülan evre (Evre 2) ve 12’si (%26,7) kronik organize evre (Evre 3) olarak sınışandırılmıştı. Yirmi bir (%46,7) olgu AB, 8 (%17,8) olgu AB+TT ve 16 (%35,5) olgu da AB+TT+FT tedavisi almıştı. İzlem süresinde akciğer grafilerinde 3. ayda 15 (%33,3), 6. ayda 3 (%6,6) olguda patolojik bulgu bulundu, 12. ayda tamamı normaldi. Yirmibeş olguya solunum fonksiyon testleri yapılabildi. Bu olguların ortalama izlem süreleri 32,7±11,9 ay idi. Yirmibeş olgunun 3’ünde (%12) minimal restriktif bulgular saptandı, bu 3 olgunun izlem süreleri daha kısa idi (8,3±3,3 ay). Solunum fonksiyon testleri yapılan 25 olgudan 6’sı (%24) Evre 1, 12’si (%48) Evre 2, 7’si (%28) Evre 3 ampiyem olarak sınışandırılmıştı ve 12 olgu (%48) AB, 4 olgu (%16) AB+TT, 9 olgu (%36) AB+TT+FT tedavisi almıştı. Evrelere ve tedavi yöntemlerine göre olguların VC, FVC, FEV1/FVC, FEV1, FEF25-75% ve PEF değerleri ortalamaları karşılaştırıldığında gruplar arasında istatistiksel anlamlı farklılıklar bulunmadı (p>0,05). Sonuç: Çocuklarda ampiyem tedavisi sonrası izlem süresinde 3.- 6. aylar arasında akciğer grafilerinde belirgin düzelmenin gözlendiği ve geç dönemde solunum fonksiyon testlerinin genel olarak normal sınırlar içinde olduğu belirlendi. Sonuçlarımız çocuklarda ampiyem tedavisi sonrası uzun dönemde akciğer fonksiyonlarında belirgin bir bozulma gelişmediğini düşündürmektedir. Introduction: Studies on lung functions at the long term follow-up of pleural empyema treatment in children are limited. The aim of this study was to evaluate the long term pulmonary function test results in childhood empyema cases treated with antibiotic (AB) or AB+tube thoracostomy (TT) or AB+TT+fibrinolytics (FT). Materials and Method: In this study, 45 cases (1 to 13 years old) treated for empyema were included. The age, gender, clinical characteristics, radiological findings and laboratory results at baseline and during the follow-up periods and the treatment modalities (AB or AB+TT or AB+TT+FT) were evaluated. Pulmonary function tests were performed at the end of the follow-up periods. Results: The mean ages at baseline and at the end of follow-up period of 30.4±13.5 (6-54) months were 6.3±3.3 (1-13) years and 9.3±3.4 (4-17) years, respectively. Stages of the disease at admission was acute exudative (stage 1) in 14 (31.1%) cases, fibrinopurulent (stage 2) in 19 (42.2%) and chronic organizing (stage 3) in 12 (26.7%). Twenty one cases (46.7%) were treated with AB, 8 (17.8%) with AB+TT and 16 (35.5%) with AB+TT+FT. Chest roentgenograms showed abnormal findings in 15 cases (33.3%) at the 3rd month, in 3 cases (6.6%) at the 6th month and none at the 12th month. Pulmonary function tests were available in 25 children. The mean follow-up period of these cases was 32.7±11.9 months after the empyema treatment. Three cases (12%) with a shorter mean follow-up (8.3±3.3 months) had minimal restrictive patterns. Six of 25 (24%) cases having pulmonary function tests were classified as stage 1, 12 (48%) as stage 2, and 7 (28%) as stage 3 empyema at admission. Of 25 cases having pulmonary function tests, 12 (48%) were treated with AB, 4 (16%) with AB+TT and 9 (36%) with AB+TT+FT. Mean VC, FVC, FEV1/FVC, FEV1, FEF25-75% and PEF values did not significantly differ according to stages and treatment modalities (p>0.05). Conclusion: It was seen that after the treatment of empyema, remarkable improvements were seen in chest roentgenographic findings between 3rd and 6th months and in general, pulmonary function tests revealed normal results in long term. Our results suggest that lung functions are not significantly compromised at long term after empyema treatment.

Pulmonary actinomycosis is rarely reported in pediatric age. An 11-year-old girl with history of two-month back pain was admitted to our hospital. On physical examination respiratory sounds were diminished on the left upper lung. Chest radiograph revealed a mass in the left upper lobe. Computed tomography showed solitary lesion (5.6 x 4.5 cm in size) in the left upper lobe. We could not rule out the possibility of malignant thoracic tumor. The patient underwent surgery. Histological examination of the resected tissue revealed, numerous sulfur granules, characteristic of Actinomyces, surrounded by purulent exudates, which are consistent with actinomycosis. She was treated with penicillin G. The patient responded well to penicillin therapy and the lesions regressed completely. She remained well throughout the three-year follow-up.

The aim of the study is to evaluate the indications, safety, and efficacy of endoscopy guided balloon dilatation (EGBD) in the treatment of strictures of the oesophagus in children. Between 1998 and 2002, 12 infants and children with oesophageal strictures were treated with EGBD in our institute. Median age was 4.1 years (range, 2 months-11 years). Of 12 patients, four had oesophageal strictures, following repair of oesophageal atresia; six had short-segment caustic strictures; and two had anastomotic strictures after oesophageal replacement (colon, 1; stomach, 1). All patients had previously failed to respond to conventional bouginage (mean, 6 sessions; range 2-14). All patients underwent contrast studies before EGBD. EGBD was performed using flexible endoscopy and fluoroscopic screening under general anaesthesia. The mean number of EGBD procedures per patient was six (range 4-10). The functional results were complete in ten and temporary in two patients. There has been no morbidity or mortality. EGBD is safe and effective for treating oesophageal anastomotic and short-segment caustic strictures.

The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim Of this Study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. A series of 25 consecutive children who had loculated pleural empyemas that did not respond to tube thoracostomy and antibiotics is presented. Their ages ranged from I to 12 years (mean 4.22). There were 19 boys and 6 girls, and all epyemas were postpneumonic. The fibrinolytic agent used was urokinase in 17 and streptokinase in 8. The mean duration of fibrinolytic treatment was 4.3 days (range 2 to 8) and the mean duration of chest-tube drainage was 8.9 days (range 7 to 13). In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multi-loculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases.

Rabdomyosarcoma of the biliary tree is one of the rare causes of biliary tract obstruction in childhood. Nevertheless it is the most common cause of obstructive jaundice due to neoplastic biliary obstruction. We present a two-year-old child with obstructive jaundice secondary to an embryonal rhabdomyosarcoma of the biliary tree. She underwent surgery and, after total excision of the mass, a hepaticojejunostomy and Roux-en-Y anastomosis were performed. She was referred to the Pediatric Oncology Group for follow-up. Rhabdomyosarcoma of the bilary tree, although rare, must be considered in the etiology of obstructive jaundice in children.

SummaryIngestion of safety pins (SP) is relatively uncommon in infants. To attach an amulet with SP on the clothes of a baby is widely-accepted as a tradition in Turkey with the result that ingestion of open SP is more common here. 15 patients were admitted during a 3 year period after having swallowed an open safety pin; eight were males in the age range 7–12 months. All of the patients were asymptomatic. The sites of the foreign bodies were; the oesophagus (four), stomach (four), duodenum (three), small bowel (three), and rectum (one). Extraction by means of flexible gastroscopy was successful in 10 patients (90.6 %) while one (9.4 %) required a laparotomy. The remaining four patients discharged the foreign body via the rectum without any complication. Endoscopic extraction of open safety pins with the flexible endoscope is usually successful in infants.

The role of sigmoidoscopic examination in the diagnosis, evaluation, and treatment of minor lower gastrointestinal bleeding was investigated. A hundred patients with minor rectal bleeding were examined by rigid sigmoidoscopy under general anaesthesia between January 1989 and July 1996. Patients who had bleeding secondary to infections, anal fissure, or haemorrhoids were excluded from study. Patients were reviewed retrospectively according to their diagnosis and endoscopic and histopathological findings. Twenty nine of these patients were girls and 71 boys; their ages ranged between 8 month and 14 years (mean 7.2 years). Endoscopic pathological findings were established in 60 patients; 32 had rectal polyps, 16 non-specific proctitis, four solitary rectal ulcers, three internal haemorrhoids, two ulcerative colitis, two Hirschsprung's enterocolitis, and one haemangioma. It is concluded that sigmoidoscopic examination should be performed for the diagnosis, prognosis, and choice of treatment in patients with minor rectal bleeding and the diagnosis should be confirmed histopathologically.

Apendektomi sonrası yara problemleri halen en önemli morbidite sebebi olmayı sürdürmektedir. Perforeapendsitli çocuklarda yara kapatılması konusunda tartışmalar devam etmektedir. Eksplorasyon esnasında apendiksin perlore olduğu takdirde yaranın kontamine olduğu ve atılan her dikişin enfeksiyon olasılığı arttıracağı kabul edilir. Bu çalışmanın amacı çocukluk çağı perfore apandisitlerde uyguladığımız primer yara kapatılması PYK ve geç primer yara kapatılması GPYK yöntemlerinin karın içi yara yeri ile ilgili komplikasyonlar ve hastanede kalış süresi açısından karşılaştırılmıştır. 1988-1997 yılları arasındaki kliniğimizde tedavi edilen 110 perfore apandisit olgunun kayıtları değerlendirilmiştir. PYK grubundaki % 16.2 komplikasyon gelişirken GPYK grubunda 5 17. Komplikasyonu görülmüştür p/0.05 Batın duvarı ile ilgili komplikasyonların incelenmesinde PYK grubunda % 6.9 GPYK grubundaki % 13.4 0.05 PYK grubundaki hastaların ortalaması HKS 6.9 gün iken GPYK Grubundaki hastalarda bu süre 9.1- 4.7 gün olarak saptanmıştır 0.05 Bizim serimizdeki perfore apendisitli olgularda PYK yöntemi Gpyk yöntemine göre daha az komplikasyona sebebiyet veren ve hastanede kalış süresini kısaltan bir yöntem olarak bulunmuştur. Wound related problems remain the most common source of morbidity of appendectomy. There still remains controversy cancelling road closure in children with perforated appendicitis. If the appendix found to be formatted the operative wound immediately becomes contaminated and consequently. To suture it closed is to im site injection. Thill's undertaken to compare the complication rates and length of hospital stay in the paediatric population lolling primm wod closure (PWC and delayed primary wound closure (DPWC) in peljorared appendicitis. We studied the clinical course of children consecutively admitted with appendicitis in clinic jiom 1988 to 1997 The total complication rates in PWC and DPWC groups were 16.2% and 17.9% per the (p> 0.05). Tlıe wound related complication rates in PWC and DPWC groups were 6.9% and 13.4% especie (p< 0.05). Mean length of hospital stays in PWC and DPWC groups were 6.9:t3.5 and 9.1 4.7 days respectively (p< 0.05). We concluded that, PWC is more advantageous than DPWC in complication rate and shortens hospital stay in children with perforated appendicitis.

Summary. Fifteen patients with cases of metallic foreign bodies in the oesophagus and stomach were referred for fluoroscopic removal by a magnet coupled to an orogastric tube. Removal was successful in all 15 cases. No fluoroscopic removal by a magnet coupled to an complications occurred and no patients required hospital admission, endoscopic or surgical intervention, or general anaesthesia. The authors conclude that orogastric magnet removal is a minimally invasive and well-tolerated method and an alternative to endoscopic or surgical removal.

A total of 24 neonates and infants, aged from 2 days to 10 months, received treatment with intravenous fluconazole for microbiologically documented or presumed fungal infection. The mean fluconazole dosage was 6 mg/kg/day (range 2 –16 mg/kg/day) and the mean duration of therapy was 25 days (range 5–72 days). Efficacy was evaluated in neonates with proven fungal infections, as documented by the presence of pathogen at baseline. A positive clinical response was achieved in 23 of the 24 clinically evaluable patients (96%); eradication of the fungal organism was also achieved in 23 of the 24 evaluable patients (96%). Adverse events occurred in two patients (8%) but therapy was not discontinued in either patient. The present results confirm the efficacy and safety of fluconazole in the treatment of neonates and infants with severe fungal infections.

Growth and development were monitored for up to 42 months in nine neonates to whom ciprofloxacin, a fluoroquinolone, was given in the neonatal period at a dosage of 20 mg/kg/day. Ciprofloxacin was used only as a 'life-saving' therapy in cases of sepsis produced by bacterial agents resistant to other antibiotics. Two other groups of nine neonates, matched by birth weight and gestational age, were studied as controls: one group with sepsis, which was effectively treated with cefotaxime and a group of healthy neonates. No statistically significant differences in growth and development between the groups were found during follow-up for 42 months. No osteoarticular problems or joint deformities were observed in the ciprofloxacin group. Ciprofloxacin appears to provide a therapeutic option as a 'life-saving' therapy for newborns with sepsis produced by multiply resistant organisms.

7 yaşındaki bir kız çocuğunda biseps femoris adalesine yerleşmiş hidatik kisl olgusunu; nadir lokalizasyonu, ekstremite yumuşak doku kitlelerinin ayırıcı tanısında düşünülmesi gerektiğini vurgulamak ve preoperatif tanının tedaviyi planlama ve anaflaksiden korunma önemini belirtmek amacıyla yayınlamayı uygun bulduk. We have presented a case of hydatid disease in M. biceps femoris in a seven-year-old girl to emphasize its rare localization, to express the importance of the diagnosis in planning of the treatment and preservation of the anaphylaxis.

Bu çalışma, 6-9 Kasım 1991 tarihleri arasında Antalya[Türkiye]'da düzenlenen Xl. Ulusal Çocuk Cerrahisi Kongresinde bildiri olarak sunulmuştur. Kliniğimizde 1988-1993 tarihleri arasında eş senelikperiyolla 115 intraabdominal hemoraji vakası belirli bir protokol dahilinde takip edilmiştir. Bu çalışmada konservatif tedavi kriterleri ve sonuçları sunulmuştur. İntraabdominal hemoraji tespit edilen vaka arın resüsitasyon sonucu stabil olan 84 'üne (% 73) konservatif tedavi, instabil olan 31'ine (% 27) cerrahi tedavi uygulanmıştır. Klinik gözleme alınan stabil hastalardan 8 'inde klinik kötüleşme ortaya çıkması üzerine laparatomiye karar verilmiştir. Bu şekilde laparatomiye karar verilen toplam 39 hastadan 30 'u şifa ile taburcu olmuş, 9 'u ise ex olmuştur. Bu 9 hastanın 8 'i ilk resüsitasyonda instabil olup da doğrudan laparatomiye karar verilen grupta, 1 'i ise başlangıçta stabil olup da konservatif olarak takip edilen gruptaydı. Buna göre konservatif gruptaki 84 hastadan 74'ü (% 66) şifa ile 7'si (% 7) operasyon sonucu şifa ile taburcu edilmiş ve 1 'i (%0.8) kaybedilmiştir. We followed up 115 intraabdominal cases under a certain protocol for a period of five years between 1988-1993 in our institution. In this study, criterion and results of conservative management were presented. Patients with intraabdominal haemorrhage were resuscitated: 84 stabil patients (73 %) were treated conservatively while 31 instabil patients (27 %) operatively. 8 of the stable patients who were observed clinically, were operated on because of clinical deterioration. 30 of the 39 patients were instabil after resuscitation and direct It underwent the operation, while 1 of them was stabil in the beginning and in the conservative group. 74 of 84 patients (66 %) in the conservative group recovered, 7 (7 %) recovered by surgery while 1 (0.8 %) died.

Bu çalışma, 14-18 Haziran 1993 tarihleri arasında İstanbul[Türkiye]'de düzenlenen XXX. Türk Pediatri ve ll. Ulusal Neonatoloji Kongresinde poster olarak sunulmuştur. Hepatik hemanjioendotelyoma (HHE) nadir karaciğer tümörlerindendir. Bu yazıda konjenital hepatik hemanjioendotelyoma bir yenidoğanda, doğum travmasına bağlı olarak gelişen intraabdominal hemoraji (İAH) olgusu literatür eşliğinde sunuldu. Hepatic hemangioendothelioma is a rare tumoral mass of the liver. We present a newborn with congenital hepatic hemangioendothelioma causing to intra abdominal haemorrhage due to birth trauma.

The study was performed in 20 Wistar rats.(~)Approximately 4 mm perforations were created in the left colon of ten rats to which fibrin glue was applied (Group D). The control group had the same injury without any therapeutic or surgical measures (Group K). Of the 20 rats in both groups none died during the postoperative period, All animals sacrificed on the 11th postoperative day. All ten rats of Group D displayed inflammatory foreign body reactions. The control group showed no such reaction.

3. Ulusal Perinatoloji Kongresinde sunuldu. 1 - 5.3.1992, Bursa Sacrococcygeal teratoma 1/35.000 doğumda bir görülen yenidoğan döneminin en sık rastlanan solid tümörüdür. Prenatal dönemde ultrasonla yanlış tanı konan (ikiz gebelik) ve doğum esnasında sacrococcygeal teratomu saptanan olgu sunuldu ve ilgili literatür gözden geçirildi. Sacrococcygeal teratoma (SCT) is the most common solid tumor of the newborn with a reported incidence of 1 in 35.000 live births. We present a case prenatally misdiagnosed (as twin pregnancy) by ultrasound and diagnosed to be sacrococcygeal teratoma during vaginal delivery. The canceming literature reviewed.

Les auteurs rapportent l'observation d'une fillette de 1 jour atteinte du syndrome typique d'Aicardi: agenesie du corps calleux, anomalies oculaires, spasticite infantile et hemangiome du palais. La masse intrabuccale entrainant une occlusion incomplete de l'oro-pharynx et de la partie a droite du naso-pharynx fut partiellement excisee sous anesthesie generale. D'apres la consultation du medline, il s'agit du premier cas de syndrome d'Aicardi associe a un hemangiome palatin.

A patient, 5 years of age, presented with a swelling on the right side of the neck. Ultrasonography and computed tomography confirmed a diagnosis of phlebectasia of the right internal jugular vein (IJV). The patient underwent operation and the dilated IJV was excised. Dilatation of the IJV with a Valsalva maneuver suggested a mechanical obstruction in the neck or mediastinum. However, the exact cause is still unknown. Finally, we found the patient to have a thinning of the wall but no other associated abnormality.

Les duplications kystiques ileales a l'interieur d'omphalocele geante sont tres rares et seulement tres peu de cas ont ete decrits dans la litterature anglaise. Nous rapportons un cas d'omphalocele geante avec une duplication kystique ileale, diagnostiquee a la fois en prenatal par echographie et au moment de la correction chirurgicale apres la naissance. Ce cas illustre les problemes diagnostiques et therapeutiques susceptibles de survenir pendant la grossesse et la periode neonatale.

Tracheobronchial foreign bodies can usually be extracted by skillful application of endoscopic techniques. The authors report on experience in the treatment of an infant in whom a plastic object was extracted by an open surgical approach. The authors discussed clinical presentation and treatment options in the treatment of this patient who had a plastic pencil top lodged in the lung. In highly selected cases, an open surgical procedure entails less risk than endoscopic extraction.

Summary. Two patients were admitted after having inhaled a pin; both were females aged between 8-9 years. Aspiration into the right bronchial tree, which was not attained by a foreign-body forceps, occurred in both patients. The pins were successfully retrieved by use of the magnetic extractor using a rigid bronchoscope under direct visual control.

A foreign body in the esophagus of a four-day-old male baby is presented. Since self-introduction of a foreign body is impossible at this age, the accident was considered to be the result of a form of neglect.