Browsing by Author "Melek, Mehmet"

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Acute Appendicitis in Two Children With Henoch-Schonlein Purpura
(Maney Publishing, 2012) Bilici, Salim; Akgun, Cihangir; Melek, Mehmet; Peker, Erdal; Akbayram, Sinan; Bulut, Gulay; Dogan, Murat
In Henoch-Schonlein purpura (HSP), involvement of the ileum and ascending colon with vasculitis can mimic appendicitis and cause unnecessary appendicectomy. A 13-year-old boy presented with signs of HSP and abdominal pain. He was treated with prednisolone (2 mg/kg/day) for 10 days, but there was no improvement. At laparotomy he had acute suppurative appendicitis. A 12-year-old girl presented with HSP associated with abdominal pain and bloody diarrhoea and at laparotomy was also found to have suppurative appendicitis. Both patients had vasculitic areas in the ileum. In HSP, although suppurative appendicitis is rare, it should always be considered and appropriate investigations, including ultrasonography, undertaken.
Anal Protrusion Caused by a Ventriculoperitoneal Shunt
(2016) Gulsen, İsmail; Ağengin, Kemal; Melek, Mehmet; Sösuncu, Enver; Şimşek, Metin; Kıymaz, Nejmi
Hidrosefalinin tedavisinde ventriküloperitoneal şant en yaygın kulanılan cerrahi yöntemdir. Ventrikküloperitoneal şantın peritoneal kateterinin bağırsağı perfore edip anal yoldan protrüze olması nadir bir komplikasyondur. Eğer erken tanı konulmazsa, kateter yoluyla taşınan gastrointestinal floradan dolayı şiddetli ventrikülit ve en sonunda sepsis gelişebilir. Bu olguda Hidrosefali tedavisi için ventriküloperitoneal şant takılan 3,5 yaşındaki kız çocuğun 40 ay sonra şantın peritoneal kateterinin kolonu perfore ederek anüsten dışarı çıktığı bir olgu sunulmuştur
Autologous Blood Pleurodesis: a Good Choice in Patients With Persistent Air Leak
(Wolters Kluwer Medknow Publications, 2009) Cobanoglu, Ufuk; Melek, Mehmet; Edirne, Yesim
Aim: The study compares the efficiency, side effects and complications of autologous blood pleurodesis with talcum powder and tetracycline. Materials and Methods: This prospective study evaluated 50 patients with persistent air leak resulting from primary and secssondary spontaneous pneumothorax between February 2004 and March 2009. The patients inclussded 32 (64.0) males and 18 (36.0) females with a median age of 39 years (range 14-69 years). All cases had persistent air leak of more than seven days. Pleurodesis was performed using autologous blood in 20 (40.0) patients, talc powder in 19 (38.0) patients and tetracycline in 11 (22.0) patients through a chest tube. Air leak cessation times after pleurodesis, side effects and pulmonary function tests (PFT) in the first and third months were measured. Results: Recurrent primary spontaneous pneumothorax was the cause of persistent air leak in all cases. Air leaks were expiratory only in 54.0 of cases. We obtained a success rate of 75.0 using autologous blood, 84.2 using talc powder and 63.6 using tetracycline. Mean air leak termination interval was significantly (P < 0.001) shorter in patients treated with autologous blood in comparison to talc powder and tetracycline. We observed a significant (P < 0.05) decline in PFT in patients treated with talc powder compared with tetracycline and autologous blood. Vital capacity, FVC and FEV1 were significantly lower in patients treated with tetracycline compared with autologous blood. Conclusion: This study shows that autologous blood pleurodesis compared to talc powder and tetracycline is related with shorter leak cessation time and less pulmonary function decline in patients with persistent air leak. We think further randomized clinical trials of pleurodesis as treatment could increase its use in thorax surgery by demonstrating the safety and the efficacy of this procedure.
Bir Periton Diyalizi Komplikasyonu Olarak Over Arteri Yaralanması: Olgu Sunumu
(2009) Beger, Burhan; Edirne, Yeşim; Çetin, Mecnun; Melek, Mehmet
Periton diyalizi tedavisindeki hastalar, başta peritonit olmak üzere, kateter çıkış yeri infeksiyonu, kateter disfonksiyonu, yetersiz klirens ve yetersiz ultrafiltrasyon gibi birçok komplikasyon ile karşı karşıyadırlar. Periton diyalizi yapılan hastalarda hemoperitoneum benign bir komplikasyon olarak tariflenmekle birlikte olguların % 20 gibi bir kısmında hayatı tehdit eden şiddette görülmesi nedeniyle dikkat edilmesi gereken önemli bir komplikasyondur. Çeşitli serilerde periton diyalizi sırasında oluşan intraperitoneal kanama komplikasyonu bildirilmekle birlikte kanamanın spesifik bir odağından bahsedilmemektedir. Bu çalışmada periton diyaliz kateterinin takılmasını takiben dördüncü günde gelişen over arteri yaralanmasına bağlı intraabdominal hemoraji sonucu exitus olan iki aylık kız bebek olgu sunulmaktadır. Özellikle sert malzemeden yapılmış periton diyaliz kateterlerinin kanama komplikasyonuna etkisi oldukça fazladır ve bu tür kateterlerin stabilizasyonu hayati önem taşır.
Borchardt Triade: a Symptom of Acute Gastric Volvulus
(derman Medical Publ, 2014) Bilici, Salim; Goksu, Mehmet; Melek, Mehmet; Sayir, Fuat; Simsek, Metin
Gastric volvulus, especially cases with an acute onset, may result strangulation, perforation, peritonitis, shock and death. The disease is rarely seen in children, but early diagnosis and treatment is essential due to its life-threatening potential. In patients with acute gastric volvulus, the clinical Borchardt triade may be observed, which is characterized by acute severe pain and distension in the upper abdomen or lower thoracic region, retching and the inability to pass a nasogastric tube. In this article, We aimed to emphasize the Borchardt's triad by presenting a pediatric case who was diagnosed with Borchardt's triad and who had acute mesenteric axial gastric volvulus which diaphragmatic hernia and mobile (wandering) spleen were accompanied.
Catalase and Carbonic Anhydrase Enzyme Activities, and Some Mineral-Heavy Metal Concentrations in Newborns With Congenital Malformations
(Ortadogu Ad Pres & Publ Co, 2011) Melek, Mehmet; Demir, Halit; Kirimi, Ercan; Meral, Ismail; Keskin, Siddik
Objective: The aim of this study is to evaluate the factors such as antioxidant condition and mineral-heavy metal level association that may play a role in development of congenital malformations. Material and Methods: Fifteen healthy neonates as control group and 15 neonates with various congenital malformations were included study. Erythrocyte cataly (CAT) which is an antioxidant enzyme, erythrocyte carbonic anydrase (CA) enzyme activities which play a important role in acid-base balance, serum copper (Cu), lead (Pb), zinc (Zn), cadmium (Cd), iron (Fe), manganese (Mn) and magnesium (Mg) were measured from venous blood samples of each subject. Results: Erythrocyte CAT enzyme activity, serum Zn and Fe levels were statistically significantly decreased (P<0.05) in the study group while serum Cu and Cd levels were statistically significantly high (P<0.05)in the study group when compared to the control group. A negative correlation between erythrocyte CA activity and serum Pb levels was found in the study group. In the control group, negative correlations were found between erythrocyte CAT activity and serum Pb levels; serum Mg and Cu levels; and serum Cd and Mn levels. In addition, in the control group a positive correlation between serum Zn and Cu levels; erythrocyte CA activity and serum Mn levels was found. Conclusion: Our results suggest that erythrocyte CAT enzyme activity and serum Cu, Zn, Fe and Cd levels may play a role in pathogenesis of congenital malformations. The oxidative stress that rise as a result of an imbalance between prooxidant and antioxidant reactions seems to be associated with congenital malformations. Further studies are needed to confirm the association of antioxidant condition and mineral-heavy metal levels in the pathogenesis of congenital malformations.
Chest Radiography Diagnosis of Pulmonary Contusion Is Associated With Increased Morbidity and Mortality
(Springer india, 2010) Cobanoglu, Ufuk; Melek, Mehmet; Edirne, Yesim
Background: The aim of this study is to compare morbidity and mortality rates of patients with Chest Radiography (CXR) proven pulmonary contusion and normal CXR but pulmonary contusion on contrast Computed Tomography (CT). Methods: Cases were divided into two groups according to diagnosing method: CXR-proven (CXR-group) and CT-only diagnosed pulmonary contusion group (CT-group). Groups were compared for Injury Severity Score (ISS), Length Of Stay in Hospital (LOSH), length of stay in Intensive Care Unit (ICU), Arterial Blood Gas (ABG) changes, andmorbidity and mortality rates. Results: Mean LOSH and LOSI were significantly longer (23.09 +/- 4.01 and 13.42 +/- 3.47) in CXR group than in the CT group (10.97 +/- 3.27 and 3.59 +/- 1.54). Mean ISS score was significantly higher in the CXR group (38.63 +/- 9.37) than in the CT group (22.74 +/- 18.00). Mean ABG results were significantly poorer in the CXR group than in the CT group. The percentage of the cases requiring mechanic ventilation was 54.5% in the CXR group. Morbidity and mortality rates were 45.4% and 27.7% in the CXR group and 10.8% and 4.3% in the CT group, respectively. Conclusion: Diagnosis of pulmonary contusion by CXR is associated with higher morbidity and mortality rates.
Chest Traumas Due To Bicycle Accident in Childhood
(derman Medical Publ, 2011) Cobanoglu, Ufuk; Melek, Mehmet; Sayir, Fuat; Mergan, Duygu
Aim Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Trauma is the second most common cause of mortality in children aged 1-4 years and leading cause of death in children older than 4 years. Thoracic injury is the second most leading cause of death in traumatized children. Multisystemic injury is found in more than 50% of children with thoracic injuries most of which are secondary to blunt traumas. We planned this study to evaluate thorax trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers. Material and Methods A retrospective evaluation was performed in 17 pediatric patients admitted to the Department of Thoracic Surgery during 2006-2010 with a diagnosis of chest trauma due to bicycle driving. For every patient, a pediatric trauma score (PTS) was calculated. Descriptive statistics were performed for PTS. Results Eleven (64.70%) cases were injured due to the tricycle accidents and six cases 6 (35.29%) were injured due to the two-wheeled bicycle accidents. The most frequent thoracic pathologies included pulmonary contusion (41.2%) and chest wall contusion (29.41%). Extrathoracic injuries were seen in 35.29%, the extremities (17.64%) and abdomino pelvic (11.76%) being the most commonly involved. Treatment consisted of symptomatic treatment in 12 patients (70.58%), tube thoracostomy in 2 patients (11.76%), and thoracotomy in 1 patient (5.9%). The morbidity was seen in 3 patients (17.64%). The mortality rate was 5.9% (n:1). The mean PTS of the cases who had additional system injuries were significantly worse than the cases who had isolated chest traumas. Conclusions The pediatric thorax has a greater cartilage content and incomplete ossification of the ribs. Due to the pliability of the pediatric rib cage and mediastinal mobility, significant intrathoracic injury may exist in the absence of external signs of trauma. Pulmonary contusion and pneumothorax are frequently present without rib fractures. Pulmonary contusion, pneumothorax, and rib fractures are the most common injuries. In order to prevent bicycle accidents; bicycle drivers should have specific education, helmet use must become widespread and special traffic regulations have to be settled. Increasing the education level if family will contribute to the prevention of childhood trauma.
Chest Traumas Due To Fall in Childhood
(derman Medical Publ, 2011) Cobanoglu, Ufuk; Melek, Mehmet
Aim Falls are the most common reason for childhood traumas. The aim of this study is to investigate the causes, types, monthly frequencies and results of injuries due to fall of children in our region and to recommend some precautions for preventing these injuries. Material and Methods A retrospective evaluation was performed in 47 pediatric patients admitted to the Department of Thoracic Surgery during 2006-2009 with a diagnosis of chest trauma due to fall. For every patient, a pediatric trauma score (PTS) was calculated. Descriptive statistics were performed for PTS and the duration of hospital stay. Results The mean PTS of the cases who had additional system injuries were significantly worse than the cases who had isolated chest traumas. Similarly, the length of hospital stay was also much longer in the cases with associated system injuries. Conclusions Injuries occur mostly in summer season. It may be due to the fact that the children do not go to the school and usually spend their times outside in this period. The children and their parents should be educated about the prevention of these accidents. Additionally, the accident and injury rates may also be reduced by constructing safer games and sports grounds with robust infrastructure.
Çocukluk Çağında Nadir Bir Barsak Obstrüksiyonu Nedeni: Poliüretan Köpük Yutma
(2016) Kızılyıldız, Baran Serdar; Beger, Burhan; Karaman, Kamuran; Melek, Mehmet
Yabancı cisim yutulması çocukluk çağında morbidite ve mortaliteye neden olan önemli bir sorundur. Yutulan yabancı cisimlerin %60'ının midede, %20'sinin özefagusta, %11'inin barsaklarda, %9'unun orofarinkste olduğu bildirilmiştir. Yutulan bu cisimlerin çoğu gastrointestinal sistemi kesintisiz olarak geçmektedir. Olguların %10-20'si endoskopik olarak, %1-14'ü ise cerrahi olarak çıkarılmaktadır. Bu çalışmada poliüretan köpük yutma sonucu gelişen ve ileal obstrüksiyon nedeniyle laparotomi uygulanan 8 yaşındaki bir olgu sunuldu.
Comparison of the Methods of Fibrinolysis by Tube Thoracostomy and Thoracoscopic Decortication in Children With Stage Ii and Iii Empyema: a Prospective Randomized Study
(Pagepress Publ, 2011) Cobanoglu, Ufuk; Sayir, Fuat; Bilici, Salim; Melek, Mehmet
Today, in spite of the developments in imaging methods and antibiotherapy childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options. We excluded from the study cases with: i) thoracoscopic intervention and fibrinolytic agent were contraindicated; ii) immunosup pression or additional infection focus; iii) concomitant diseases, those with bronchopleural fistula diagnosed radiologically, and Stage I cases. This gave a total of 54 cases: 23 (42.6%) in stage II, and 31 (574%) cases in stage III. These patients were randomized into two groups of 27 cases each for debridement or fibrinolytic agent application by video-assisted thoracoscopic decortication (VATS). The continuity of symptoms after the operation, duration of thoracic tube in situ, and the length of hospital stay, in the VATS group were of significantly, shorter duration than in the streptokinase applications (P=0.0001). In 19 of 27 cases (70.37%) in which fibrinolytic treatment was applied and in 21 cases of 27 (77.77%) in which VATS was applied, the lung was fully expanded and the procedure was considered successful. There was no significant difference with respect to success rates between the two groups (P-0.533). The complication rate in our cases was 12.96% and no mortality was observed. Similar success rates in thoracoscopic drainage and enzymatic debridement, and the low cost of enzymatic drainage both served to highlight intrapleural streptokinase treatment as a reliable method in reducing the need for surgery in complicated empyema.
Diagnostic Dilemma in Hydatid Cysts: Tumor-Mimicking Hydatid Cysts
(Aves, 2015) Cobanoglu, Ufuk; Asker, Selvi; Mergan, Duygu; Sayir, Fuat; Bilici, Salim; Melek, Mehmet
OBJECTIVES: Hydatid cysts are sometimes confused with different pathologies, and problems arise in their diagnosis and treatment. In this study, cases that are followed up with a diagnosis of lung malignancy and that are detected to have hydatid cysts were retrospectively examined. MATERIAL AND METHODS: Seven patients with hydatid cysts whose clinical and radiological features were consistent with lung malignancy were retrospectively examined between 2010 and 2014 regarding sex, age, symptoms, diagnostic methods, surgical procedures performed, and postoperative complications. In the diagnosis of the patients, radiological diagnostic methods such as chest radiography, thoracic computed tomography (TCT), and positron emission tomography+computed tomography (PET-CT) as well as invasive diagnostic methods such as bronchoscopy, fine-needle aspiration biopsy, thoracentesis, and video-assisted thoracoscopic surgery were used. RESULTS: The average diameter of the lesions was determined as 4.14 +/- 1.57 cm in TCT. Maximum standardized uptake value (SUV max) was measured as 8.77 +/- 3.41 (5.4-15.1) in the PET-CT analysis. Bronchoscopy, fine-needle aspiration biopsy, and thoracentesis yielded no results. Definitive diagnosis was established by performing thoracotomy and video-assisted thoracoscopic surgery. CONCLUSION: Pulmonary hydatid cysts can appear as malignant diseases such as lung cancer as well as infectious pathologies such as tuberculosis or benign pathologies. Radiologically, it should be kept in mind that pulmonary hydatid cysts can mimic many pulmonary pathologies, particularly malignancies. Necessary examinations towards its differential diagnosis must be performed in the preoperative period.
Diaphragmatic Herniation Diagnosed at a Late Stage: an Evaluation of Eight Cases
(Baycinar Medical Publ-baycinar Tibbi Yayincilik, 2012) Sayir, Fuat; Cobanoglu, Ufuk; Bilici, Salim; Melek, Mehmet; Mergan, Duygu
Background: In this study, we aimed to analyze patients with diaphragmatic hernias who had specific clinical features and interesting clinical, radiologic presentations, and had operated following late diagnosis. Methods: A total of eight diaphragmatic hernia cases, of whom three were adults and five were children (4 males, 4 females; mean age 12.4 +/- 24 years; range 9 months to 28 years), who were diagnosed in the late period and who were operated on in our clinic between January 2006 and August 2010 were evaluated retrospectively. In all patients, primary repair of the diaphragm was performed following laparotomy and thoracotomy. Results: The children were diagnosed following the neonatal period. Three patients were diagnosed in adulthood. Five patients had right-sided congenital Morgagni hernias, one patient had a hiatal hernia, and two patients had left-sided Bochdalek hernia. All patients were discharged between the 5th and 19th postoperative days. The average duration of hospital stay was 9.8 days (range 7 to 23 days). The follow-up time were between six months and two years, and no significant respiratory and gastrointestinal complaints were recorded. No morbidity was detected in three cases with Morgagni hernia. Conclusion: Congenital diaphragmatic hernias are pathologies which are seen in the neonatal period, and the diagnosis of these hernias can be difficult after this period. Mortality and morbidity rates are low in cases who are followed and treated in clinics by dedicated thoracic surgeon.
Evaluation of Caustic Subtance Taking in Childhood
(2011) Beger, Burhan; Melek, Mehmet
Giriş ve Amaç: Koroziv madde alımına bağlı özofagus yanıkları yüksek morbidite ve mortalite oranları nedeniyle çocukluk çağının önemli bir sağlık problemidir. Koroziv özofajitin tedavisi yıllar içinde gelişme gösterse de üzerinde fikir birliği oluşmuş bir tedavi seçeneği yoktur. Bu çalışma ile çocukluk çağındaki koroziv madde alımlarına ait bilimsel verileri ortaya koymayı ve önlenebilir özellikte olduğuna vurgu yapılan bu tip kazalara karşı gerekli toplumsal duyarlılığın sağlanmasına katkı sunmayı amaçladık.Materyal-Metod: Biz bu çalışmada Yüzüncü Yıl Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Kliniğimize Haziran 2005 - Aralık 2010 tarihleri arasında koroziv madde alımı nedeni ile başvuran ve yatarak takip ve tedavisi yapılan 0-15 yaş aralığındaki 158 çocuk hastayı yaş, cinsiyet, sosyal ve demografik açıdan gözden geçirdik.Bulgular: Hastaların 97'si erkek (%61,4) ve 61'i kız (%38,6) idi. Olguların yaş ortalaması 4,07±2,7 olarak saptandı. Koroziv madde alımı en fazla (%58) 0-3 yaş gurubunda ve ikinci sıklıkta (%26) 3-6 yaş gurubunda görüldü. Her yaşta en sık içilen koroziv madde çamaşır suyu olarak saptandı. Olguların %36,1'inde içilen koroziv madde miktarı bilinmemekteydi. Koroziv maddenin içildiği kap sorgulandığında (%47.5) ile en kalabalık grubu koroziv maddeyi çay bardağından içen olguların oluşturduğu tespit edildi. %39,2' sinin koroziv maddeyi kendi kabından içtiği tespit edildi. Bu tip kazaların %89'unun ev içinde gerçekleştiği saptandı. Olguların %52,7'sinin koroziv maddeyi susuzluğunu gidermek için; %1' inin intihar amaçlı içtiği tespit edildi. Olguların %96,1'i koroziv maddeyi kendi içtiği saptandı. Olguların %73,2'si hasta yakının şüphesi ile hastaneye getirildiler. Olguların %89,8'ine hastaneye getilmeden önce bir ilk müdahale yapıldığı saptandı. Olguların %86,7 sinin ilk 24 saatte hastaneye başvurdukları tespit edildi. %72'sinde ilk fizik muayene normal olarak saptandı. Akut dönem olarak değerlendirdiğimiz ilk 3 gün boyunca oral alımını kestiğimiz olgulara intravenöz mayi verildi. Olgularımızın tümüne proflaktik amaçla antibiyotik tedavisi başlandı. Belirgin semptomları olan ve özofagoskobide pozitif bulgular saptanan 26 olguda tedaviye steroid de eklendi. 26 hastaya özofagoskopi yapıldı. Yedi hastada mukozal ödem ve hiperemi 1 hastada yüzeyel ülserler saptandı. Ortalama hastanede kalış süresi 73,82 ± 25,77 saat olarak gerçekleşti. Olguların %82,3'ü (n:130) semptomlarının gerileyip kaybolmasını takiben poliklinik kontrolümüze devam etmek üzere ve 21. günde de özofagografi çekilmesi planlanarak şifa ile taburcu edildi. 28 olgu ise hastanede tedavinin herhangi bir aşamasında tedaviyi reddederek kliniği terk etmek suretiyle takipten çıktı. Özofagografi sonucu ile polikliniğimize başvuran 61 olgunun 3'ünde değişik derecelerde striktür tespit edildi. Olguların %83,5'inin (n:132) il merkezinde yaşadığı saptandı. %76'sının kendine ait bir evde oturduğu saptandı. Olguların %83'ünün aynı hanede 5 kişiden fazla insanın barındığı kalabalık ailelerden geldiği tespit edildi. %35 (n:54) olguda anne-baba akrabalığı olduğu tespit edildi. Annelerin % 45,6'sı babaların %14'ü okur yazar değildi. Annelerin %95'i babaların %8,9'u çalışmamaktadır. Ailelerin %87,5'inin 1000 Tl' nin altında bir gelirle yaşadığı saptandı.
Is Muscle-Sparing Thoracotomy Advantageous
(Ekin Tibbi Yayincilik Ltd Sti-ekin Medical Publ, 2011) Cobanoglu, Ufuk; Hiz, Ozcan; Melek, Mehmet; Edirne, Yesim
Background: The aim of this study was to compare muscle-sparing thoracotomy for the latissimus dorsi and the serratus anterior muscles (MST-L), and muscle-sparing thoracotomy for serratus anterior muscle (MST-S) with each other and with standard posterolateral thoracotomy (SPLT) in terms of advantages and disadvantages. Methods: Sixty patients (18 females, 42 males; mean age 42.6 +/- 16.6 years; range 15 to 72 years) in whom thoracotomy was indicated were randomly grouped into three categories. The groups were compared in terms of the effects of thoracotomy on shoulder range of motion, muscle strength, pulmonary function, postoperative pain, and duration of hospitalization. Results: Shoulder range of motion and serratus anterior muscle strength in the SPLT group were significantly lower than in the other groups. The latissimus dorsi muscle strength in the MST-L group was significantly better than that of the other groups. The parameters of pulmonary function on days 3 and 7 in the MST-L group were significantly better than those of the other groups. The duration of hospitalization in the MST-L group was significantly shorter than that of the other groups. Conclusion: The improvement of pulmonary function occurs earlier in thoracotomies that spare the chest wall muscles, and postoperative complications due to detachment are decreased. Although there is a better field of view in SPILT and MST-S than that of MST-L, considering the other advantages of MST-L, we recommend initiating with MST-L in all thoracotomies, except in emergency cases.
Isolated Hemothorax Following Thoracic Trauma: Analysis of 57 Cases
(derman Medical Publ, 2012) Cobanoglu, Ufuk; Melek, Mehmet; Kara, Volkan; Mergan, Duygu
Aim: The aim of this study was to review cases with isolated hemothorax after thoracic trauma, to assess the diagnostic and treatment methods, and to discuss the determining factors of morbidity and mortality. Material and Method: A total of 57 patients were examined retrospectively. All patients underwent tube thoracostomy and underwater seal as the initial treatment approach. Emergency thoracotomy was performed on cases with continuing drainage from the chest tube, expanding hemothorax on the posteroanterior (PA) chest x-ray, and with hemodynamic instability. Result: Hemothorax occurred as a result of penetrating trauma in 31 (54.38%) and due to blunt trauma in 26 (45.61%) cases. Of the cases, 49 (85.96%) underwent tube thoracostomy drainage. All the 8 cases (14.03%) that underwent emergency thoracotomy had penetrating trauma. Mortality occurred in one patient (1.75%) who had penetrating trauma and who underwent emergency thoracotomy. The morbidity rate in patients with blunt trauma was significantly higher than those with penetrating trauma (p<0.0001). Discussion: Accurate diagnosis and appropriate surgical intervention in cases with traumatic hemothorax is essential for reducing the morbidity and mortality. Chest tube insertion and underwater seal application should be the initial treatment modality and successful in most cases. Emergency thoracotomy is life-saving in indicated patients. The need for thoracotomy is higher in isolated hemothorax due to penetrating chest trauma.
Landmine Associated Injuries in Children in Turkey
(Elsevier Sci Ltd, 2009) Can, Muhammet; Yildirimcan, Humeyra; Ozkalipci, Onder; Melek, Mehmet; Edirne, Yesim; Bicer, Umit; Uner, Huseyin Bulent
This study aims to examine trends of injuries due to landmines and unexploded ordnance (UXO) and to determine problems during and after the treatment of children and adolescent victims in Turkey. Data from the records of 23 children injured from landmines and UXO were analyzed from April 2001 to October 2008. Cases consist of 21 (91.3%) males and two (8.7%) females with a mean age of 12.8 years. Cause of injury was landmine explosion in 20 (87.0%) and UXO in three (13.0%) cases. Injuries in upper and lower extremities were determined in eight (34.8%) children. Hand amputation was the result in 10 (43.5%) children where in two cases a leg, in one case an eye, in one case a hand and arm, in two cases a hand and leg, in one case an eye and a leg and in three cases a hand and eye were lost. One case of death was recorded from UXO with an autopsy performed. Contaminated areas in our region should be cleared according to international contracts to prevent injuries in children, centers providing rehabilitation services should be established and policies regarding social support for child victims should be ascertained. (c) 2009 Published by Elsevier Ltd and Faculty of Forensic and Legal Medicine.
Late Recognized Nail Aspiration in a Child: Case Report
(Turkish Assoc Trauma Emergency Surgery, 2011) Cobanoglu, Ufuk; Can, Muhammed; Birincioglu, Ismail; Edirne, Yesim; Melek, Mehmet
Foreign body (FB) aspiration is common in children aged 0-3 years. Our case, a 2.5-year-old girl, presented with sudden onset of cough, fever and sputum; she had been treated twice for acute bronchitis four months ago. Resisting complaints led to an esophagoscopic examination in our Chest Surgery Clinic after a chest X-ray suggested FB in the esophagus, but no FB could be detected. A lateral chest X-ray revealed a FB with its sharp end targeting the trachea and its round end to the right hemithorax. Removal of the FB with forceps was not possible during rigid bronchoscopy. The FB was removed by thoracotomy and bronchotomy under general anesthesia. The removed FB was a nail measuring 6 cm in length. This case report should serve to stress the diversity of FB aspirations in childhood, the role of parental neglect, and that physicians should be aware of the possibility of FB in children with persistent cough.
Megacystis-Microcolon Hypoperistalsis Syndrome: a Case Report
(Hindawi Ltd, 2009) Melek, Mehmet; Edirne, Yesim; Beger, Burhan; Cetin, Mecnun
Megacystis Microcolon Intestinal Hypoperistalsis Syndrom (MMIHS) is a quite rare congenital and fatal disease which was firstly defined by Berdon and his colleagues. It appears through a widely enlarged bladder and microcolon and its cause is unknown (Berdon et al., 1976; Carmelo et al., 2005; Makhija et al., 1999; Loening-Baucke and Kimura 1999; Redman et al., 1984; Hsu et al., 2003; Yigit et al., 1996; Srikanth et al., 1993). The disease is found in females three or four times more than in males (Srikanth et al., 1993; Sen et al., 1993; Hirato et al., 2003). Most of the cases die within the early months of their lives (Yigit et al., 1996; Srikanth et al., 1993; Sen et al., 1993; Hirato et al., 2003). We present the case of a female newborn with antenatal ultrasound revealing intestinal mass and bilateral hydroureteronephrosis. The case was admitted for intestinal obstruction after birth. Copyright (C) 2009 Mehmet Melek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A New Technique in Primary Repair of Congenital Esophageal Atresia Preventing Anastomotic Stricture Formation and Describing the Opening Condition of Blind Pouch: Plus ("+") Incision
(Hindawi Ltd, 2011) Melek, Mehmet; Cobanoglu, Ufuk
Anastomotic strictures are common and important problems following repair procedures of esophageal atresia. We hereby defined an anastomosis technique that could efficiently prevent this complication in 11 patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF). The proximal end of the atretic esophagus was opened with a plus ("+")-shaped incision providing sufficient anastomosis width. Longitudinal incisions of 2 mm length were made on the anterior and posterior parts of the distal end according to the patients. The two ends were anastomosed with a primary suture at a single plain. We performed this technique on 11 patients, and in the 4-year follow-up period no dilatation proved necessary in any of our patients due to anastomotic strictures or symptomatic dysphagia. This technique that we have described provides a large zigzag anastomosis line and in this way minimizes the incidence of stricture formation. Furthermore, this technique, which we believe to have provided a new opinion on the topic of how to open the proximal end of an atretic esophagus, is quite easy and effective.