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Öğe Accidental ingestion of concentrated white vinegar in Hatay children in Turkey(Sciendo, 2023) Atici, Ahmet; Micoogullari, Lina; Ugur, Bahar; Celikkaya, Mehmet Emin; Akcora, BulentWhite vinegar which contains high concentrations (similar to 85 %) of acetic acid is a staple ingredient used in food preparation in many Mediterranean cuisines but in small amounts. Being corrosive, it can cause ulcerative injury to the oropharynx and oesophagus and upset the stomach with resulting nausea and vomiting. This study presents 11 cases of paediatric patients (five boys and six girls, aged between 11 and 89 months) with oesophageal strictures who drank white vinegar by accident. They all received endoscopic oesophageal dilation (with a bougie) ranging from one to 28 per patient, depending on the severity of the injury. Follow-up showed uneventful healing in eight patients, who at the time of the telephone call were able to swallow solids and liquids normally. Two patients who could not be reached by telephone were found healthy by consulting the national database (e-Nabiz). Unfortunately, one patient, who was discharged without any symptoms after the first dilation, suffered massive gastrointestinal bleeding 24 hours after the dilation and died. The loss of this patient shows that ingesting white vinegar can be very dangerous in children, especially if parents delay seeking medical help. We believe that controlling the production and sales of highly concentrated white vinegar and selling it in child-proof containers can help to prevent accidental ingestions by children and tragic outcomes such as the one reported here.Öğe A common public health problem: corrosive ingestion in children(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2018) Celikkaya, Mehmet Emin; Atici, Ahmet; El, Cigdem; Akcora, BulentObjective: Corrosive substances are both histologically and functionally damaging agents when contacted with the mucosa. Corrosive substance ingestion is still one of the most important and frequent home accidents because of the reasons such as the storage of corrosives in food containers, colored packages, and places where children can reach easily. Methods: The medical records of 125 patients who were followed up because of intake of corrosive substances between 2014 and 2017 were retrospectively reviewed. Patients were evaluated according to age, gender, type of corrosive substance ingested and type of treatment. Results: Of 125 cases 63 were girls (50.4%), 62 were males (49.6%). The median age of the cases was 4.1 years. Among the corrosive substances, most frequently laundry bleach (48%; n=61), vinegar (17%; n=21), drain opener (12.8%; n=16), washing liquid (9%; n=11), olive sweetener (caustic) (n=3; 2.4%), lime dissolver (n=4; 3.2%), salicylic acid (n=3; 2.4%), oil solvent (n=2; 1.6%), wart drug (n=2; 1.6%), and acetonide (n=2; 1.6%) were ingested in respective number of patients. Esophagoscopy was performed only in patients with symptoms. Conclusion: Prevention of the intake of corrosives is much simpler and more economical when compared with long and expensive treatment processes. It is necessary that everyone who cares about children must be carefull. Corrosive substances must kept in sealed packages even in locked cabinets. Also, packages containing corrosive substances should not contain interesting colors and designs for children.Öğe Comparative results after transabdominal Duhamel and Boley procedures in Hirschsprung disease(Logos Medical Publishing, 2019) Çelikkaya, Mehmet Emin; Atici, Ahmet; El, Çi?dem; Urfali, Senem; Akçora, BülentObjective: Hirschsprung Disease (HD) is a neurocristopathy resulting from the migration failure of neural crest cells during intestinal development. It results in aganglionic colon and causes a functional constipation in children. We aimed to compare functional outcomes such as voluntary bowel movements, encopresis and constipation in patients with HD following Boley and Duhamel procedures. Method: Patients who underwent pull through procedures using Boley or Duhamel methods were included in the study. All patients underwent a three-stage operation (opening of the ostomy, definitive operation and closure of the ostomy). Krickenbeck criteria were used to evaluate postoperative functional outcomes including voluntary bowel movements, soiling and constipation. Results: Twenty-seven patients were male and 12 were female. 12 patients underwent Boley and 27 patients Duhamel procedure. In the majority of patients, the pathology was in the rectosigmoid region (n:28, 71.79%). The rates of voluntary bowel movement were 83.33% in the Boley and 85.18% in the Duhamel group. There was no statistically significant difference between the two groups (p<0.05). No significant difference was found between the two groups in terms of the frequency and degree of soiling (Duhamel 22.21%, and Boley 16.66%, p>0.05). In the Duhamel group, constipation was more frequent than Boley group (p<0.05). Conclusion: Each technique has advantages and disadvantages compared to each other. In the majority of cases no serious complication is encountered, regardless of which technique is chosen for definitive surgery. It is recommended that the surgeon should continue to use the technique it is accustomed to and does well. © 2019 Turkey Association of Pediatric Surgery.Öğe Corrigendum to “The Efficacy of Shear-Wave Elastography-Performed Simultaneously with Doppler Sonography-For Differentiating Between Testicular Torsion and Epididymo-Orchitis” [J Pediatr Surg 54/8 (2019) 1644–1649](S0022346818308145)(10.1016/j.jpedsurg.2018.12.005)(W.B. Saunders, 2019) Atici, Ahmet; Kayali, Alperen; Çelikkaya, Mehmet E.; Akçora, BülentThe publisher regrets that the author names and corresponding author were not shown for the article. © 2019 Elsevier Inc.Öğe The efficacy of shear-wave elastography - performed simultaneously with Doppler sonography - for differentiating between testicular torsion and epididymo-orchitis(W B Saunders Co-Elsevier Inc, 2019) Atici, Ahmet; Kayali, Alperen; Celikkaya, Mehmet Emin; Akcora, Bulent[Abstract Not Available]Öğe The histopathological effect of tissue adhesive on urethra wound healing process: An experimental animal study(Elsevier Sci Ltd, 2020) Atici, Ahmet; Secinti, Ilke Evrim; Celikkaya, Mehmet Emin; Akcora, BulentIntroduction and Objective: The present study aimed to determine the histopathological effect of Tisseel tissue adhesive on the urethral wound healing process after urethroplasty in a rat model. Study design A total of 24 animals were randomly allocated into three groups: Group 1; control group (n = 6); Group 2; suture-closure group (n = 9); and Group 3; suture + adhesive group (n = 9). In group 2, an incision 4 mm long was made on the ventral skin of the penis along the midline from the glans penis, to open the dartos muscle, corpus spongiosum, and urethra. Next, initially, the urethra alone, and then the layers up to the skin were covered in layers with 8/0 vicryl interrupted sutures. Group 3 underwent the same procedures as group 2, but after the urethra was repaired 0.1 cc of Tisseel tissue adhesive was applied over the urethra. Penile tissue samples were obtained 21 days later, and tissue samples were sent for histopathological analysis. Results Urethral epithelial thickness and connective tissue thickness in group 3 were higher than in group 1 and group 2. Fibrosis in group 3 was higher than in group 2. The difference in inflammation between group 3 and group 2 was not significant. There was no significant difference in microvessel density between group 2 and group 3. Discussion Both increased fibrosis and connective tissue thickness were noted in group 3 compared to group 2 and group 1. These increases may have been caused by the hemostatic effect of the Tisseel adhesive and its triggering of fibroblast growth factors. The epithelial thickness increased significantly in group 3 and group 2 compared to group 1. This increase in tissue thickness without an increased number of epithelial cells can be explained by the development of oedema. Conclusion The present study suggests that while Tisseel tissue adhesive increases connective tissue thickness and fibrosis, it does not demonstrate a prolonged inflammation or increased neovascularization in the urethral wound at 3 weeks after surgery. The data obtained in our study does not support the use of Tisseel in urethroplasty surgery. The results obtained in this study demonstrate a significantly higher formation of fibrosis (scar tissue), which underlines the importance of new studies to identify new treatments for urethral wound healing after urethra trauma or surgery. [GRAPHICS] .Öğe Innocent Children in the Syrian Civil War(Georg Thieme Verlag Kg, 2020) Celikkaya, Mehmet Emin; Atici, Ahmet; Cigdem, E. L.; Akcora, BulentIntroduction Our aim is to present the clinical and surgical characteristics of the children affected by the Syrian civil war. Materials and Methods Medical records were reviewed retrospectively for Syrian war victims between the ages of 0 and 18 who were brought to the emergency department of the Education and Research Hospital between March 2011 and March 2019. Each patient was evaluated with respect to demographic data (gender, age), type of injury, history of operations in Syria, injured organ(s), accompanying traumas and the mortality and trauma score. Results The majority of our study population of 147 patients were male (108/147, 73.46%), and 39 of the total were girls (26.53%). The mean age of the patients was 9 (7.5 +/- 4). The mean age of the girls was 8.5 (range: 7 months to 16 years), and the mean age of the boys was 9.2 (4 months to 17 years). Seventeen patients who had abdominal surgery in Syria were operated on again after clinical and radiological observations. A total of 83 patients were operated on in Turkey. For 66 of those patients, the operation in Turkey was their first surgery on their war injuries. Seventeen patients were operated on in Syria but needed surgery again in Turkey. Conclusion War affects not only the battlefield, but also the neighboring countries in many aspects such as medical, social, and economic. Hollow organ injuries are the most common intraabdominal pathologies. Delayed intervention is associated with increase mortality and morbidity.Öğe Liver trauma in children with Syrian Civil War: How should treatment management?(Ondokuz Mayis Universitesi, 2022) ÇelıKkaya, Mehmet Emin; Atici, Ahmet; Korkmaz, İnan; El, Çiğdem; Akçora, BülentPatients with liver injuries should be considered multidisciplinary cases, and the decision to operate should be made according to each patient’s clinical and hemodynamic stability. In this study, we aimed to describe treatment management approaches and appropriate operation times for children with liver injuries resulting from the Syrian Civil War. A total 32 patients who were admitted to a pediatric surgery clinic between 2010 and 2020 with liver injuries resulting from Syrian Civil War were examined retrospectively. Patients were evaluated according to age, gender, type of injury, accompanying trauma, treatment modality, and mortality. A total of 21 patients were injured with shrapnel, while 11 patients suffered from blast effect injury. The mean pediatric trauma score of the patients was 5.2, while the mean pediatric trauma score of the six patients who died was 3.11. Liver suturing was performed in four patients due to bleeding. A segmentectomy was performed in one patient with active bleeding in segment 7. This bleeding was stopped by ligating the branches of the hepatic artery. Two patients who were operated on in Syria and to whom packing was applied due to uncontrolled bleeding were referred to Turkey. One patient with inferior vena cava injury died due to excessive blood loss and instability at the time of admission, and six patients died due to accompanying head trauma and/or multiple body trauma. The main purpose in emergency operations is to stop bleeding. Rarely, however, suturing or even segment resection in the bleeding area may be required. © 2022 Ondokuz Mayis Universitesi. All rights reserved.Öğe Oxidative stress responses of virtual reality use in refugee children undergoing elective surgery: A randomized controlled trial(Elsevier Science Inc, 2024) Demir, Emel; Duzguner, Vesile; Atici, Ahmet; Yengil, ErhanBackground: With the Virtual Reality (VR) technique, 3D movies can be made for refugee children for pre-operative stress. The study aims to reveal the oxidative responses of the VR technique in pre-operative anxiety in elective surgery in children aged 5-12 years. Methods: The Study was designed according to the CONSORT checklist with a randomized controlled parallel de-sign. The whole sample (n = 23), VR experimental group (n = 12), and control group (n = 11) were determined according to the total count method prospectively in 6 months. Oxidative stress parameters (Cortisol, Malondialdehyde, Nitric oxide, Glutathione) were measured in blood samples from the first hospitalization (beginning) and before the intervention (pre-operative) in the experimental and control groups. Findings: MDA, NO, and cortisol levels (p < 0.05), which indicate the stress level, are high in all groups. In pre-operative measurements, oxidative parameters were lower in the VR experimental group than in the control group. At the same time, the anti-stress antioxidant factor Glutathione was higher in the VR experimental group in pre-operative measurements.Discussion: The application of 3D film as a VR technique reduces stress parameters in pre-operative stress, and its antioxidant system activating effect has been determined.Application to practice: It can be applied to refugee child groups for pre-operative stress by shooting 3D movies in different languages.(c) 2023 Published by Elsevier Inc.Öğe Pediatric esophageal perforation due to firearm injuries during the Syrian war and a new suture technique(Elsevier, 2018) Atici, Ahmet; Celikkaya, Mehmet Emin; El, Cigdem; Akcora, BulentThe incidence of esophageal perforation (EP) due to firearm injury (FAI) is markedly low compared with that occurring in other organs. The most frequently reported cause of EP is iatrogenic injuries. The incidence of EP due to penetrating injuries, such as FAI, is very rare and highly destructive. Here we report cases of EP due to FAI in childhood during the Syrian war and elucidate a new suture technique.Öğe Pyloric perforation due to stress disorders in an adolescent girl(Elsevier Science Bv, 2018) Atici, Ahmet; Celikkaya, Mehmet Emin; El, Cigdem; Akcora, BulentGastroduodenal perforation is a serious emergency condition. The predominance of duodenal perforation in pediatric age group shifts towards gastric perforation at later ages. However, due to thick muscle tissue pyloric perforation is seen very rarely in all age groups [3]. A 14-year-old female patient with abdominal pain lasting for one day admitted to our pediatric emergency room. During the physical examination, generalized abdominal tenderness and muscular defense were observed in all quadrants of the abdomen. Laparotomy was performed with an upper abdominal median incision. A large amount of serous, non-biliary fluid was observed in the abdomen. A perforation area of nearly 3 mm was identified on the anterior of the pylorus. Primary repair with omentopexy of the pyloric perforation was performed. On postoperative day 7, the patient was discharged without any complication. Pyloric perforation should be considered in the differential diagnosis of patients presented with epigastric pain.Öğe A rare cause of vestibular mass: Urethral prolapse in a nine-year-old girl(Logos Medical Publishing, 2020) Atici, Ahmet; Ekinci, Halime; Çelikkaya, Mehmet Emin; Akçora, BülentUrethral prolapse is a very rare disease characterized by circular protrusion of the distal urethral mucosa along the external mea. A 9-year-old girl admitted to the pediatric surgery clinic with the complaint of painless spotting vaginal bleeding. Physical examination revealed that, a round, reddish edematous, 2x2 cm fragile mass in the vestibulum prolapsed from the external mea. Patient was discharged on the first postoperative day uneventfully. In this paper, we aimed to present a 9-year-old girl who was admitted for urethral prolapse and treated surgically. © Logos Medical Publishing. All rights reserved.Öğe Secondary blast injury: radiological characteristics of shrapnel injuries in children(Springer Heidelberg, 2023) Korkmaz, Inan; Celikkaya, Mehmet Emin; Atici, AhmetPurposeThe aim of this study is to examine the radiological images of child victims suffering from secondary blast injuries, to reveal organ-based injury patterns and their interrelationships, and to record mortality rates that may develop due to injured systems.MethodsA total of 65 patients with secondary blast injury due to bomb explosion were included in the study. Injury findings due to shrapnel in radiologic images of the patients were examined. Injured systems and types of injuries were recorded.ResultsThe most common injuries were intra-abdominal injuries (63%) and fractures (58.5%). Lung injury was observed in 4 (9.8%) of 41 patients with intra-abdominal injury, while 37 (90.2%) did not, and this was statistically significant (p = 0.003). The most common intra-abdominal organ injury was a small bowel injury in 23 (35.4%) patients. The coexistence of small bowel injury and large bowel injury was present in 8 patients (34.8%), and it was statistically significant (p = 0.019). A total of 14 (21.5%) of the patients died. There was no significant relationship between mortality and gender (p = 319). Brain damage was present in 10 (71.4%) of the 14 (21.5%) patients who died, which was statistically significant (p < 0.001).ConclusionOur results showed that the most common injuries were intra-abdominal injuries, damage to different organs could occur at the same time, and deaths were especially associated with brain injuries. For this reason, it should not be forgotten that CT scans will have an important place in the triage of the patient, especially in victims with shrapnel at the abdominal and cranial levels in radiography examinations.Öğe A significant cause of constipation and growth retardation: hirschsprung's disease(Bayrakol Medical Publisher, 2019) El, Cigdem; Celikkaya, Mehmet Emin; Atici, Ahmet; Akcora, BulentAim: In this study we aimed to draw attention to HD which may lead to mortal complications if early diagnosis and treatment are not provided for infants with gastrointestinal symptoms. Material and Method: In Mustafa Kemal University, Faculty of Medicine, Department of Pediatrics between September 2016 and March 2018 the data of the patients who were diagnosed with Hirschsprung's disease were retrospectively analyzed. In this study age, gender, percentile values of growth and development (height, weight, head circumference), neurodevelopment stages (ability to tonic neck reflex, ability to sit supported and unsupported ability to sit), first meconium time, the most common complaints and physical examination findings were examined. Results: The mean age of the 19 patients was 7.42 months (48 days-40 months). Sixteen (%84) of the patients were male and 3 (%16) of the patients were female. Growth and development values were detected in 8 of the patients in the range of 10-25, 6 of the patients in the 3-10 percentile range and 5 of the patients were under the 3rd percentile. The first meconium excretion time of the patients was an average of 3 days (49 hours-5 days). Discussion: It should be kept in mind that organic causes such as HD should be considered in children with history of delayed meconium passage in the anamnesis and if complaints have been present before the age of one year and in whom growth retardation is detected in theft examinations. In this way, late diagnosis, complications, unnecessary and costly tests and treatments can be prevented in the HD.Öğe Sirenomelia/mermaid syndrome without imperforate anus in a premature infant(Elsevier Science Bv, 2018) Atici, Ahmet; Celikkaya, Mehmet Emin; Arslan, Selda; El, Cigdem; Akcora, Bulent[Abstract Not Available]Öğe Successful Treatment of Major Abdominal Trauma in a 9-year-old Male due to Bomb Explosion(Editura Celsius, 2020) Atici, Ahmet; Ozkan, Mustafa; Celikkaya, Mehmet Emin; Akcora, BulentThe present case report describes a pediatric patient that sustained and survived major abdominal trauma due to an open-air explosion during the Syrian civil war. A 9-year-old male patient was brought to our hospital's paediatric emergency department after a bomb explosion that occurred 8 hours prior to presentation. The patient had a severe flap-like skin defect that extended from the below the umbilicus to the right femur. The defect was embedded with multiple stones, plastic, and soil fragments of varying size. Debridement of the anterior abdominal wall was performed, followed by exploratory laparotomy. Multiple sites of perforation of the small bowel were resected, and anastomosis was performed. Vacuum-assisted closure (VAC) was applied to the large wound area. The VAC dressing was changed every 3 days. Granulation tissue developed post-operatively after 26 days and the defect was repaired using skin grafts harvested from the patient's left leg. The patient was considered fully recovered and was discharged 34 clays post-surgery. The presented case shows that despite the severity of the patient's major abdominal injuries, rapid wound debridement, exploratory laparotomy, VAC therapy and a multidisciplinary approach are crucial in preventing death and achieving a full recovery.Öğe TRAUMA OF THE LIVER IN CHILDREN WITH FIREARM INJURIES DUE TO WAR: WHEN IT SHOULD BE OPERATED?(Bmj Publishing Group, 2019) Celikkaya, Mehmet; Atici, Ahmet; El, Cigdem; Akcora, Bulent[Abstract Not Available]
