Tıp Fakültesi / Faculty of Medicine

Permanent URI for this collectionhttps://hdl.handle.net/11727/1403

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2015 - 20193

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Author: search.filters.author.Hicsonmez, AkgunSubject: search.filters.subject.Children

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    Bloody Nipple Discharge As A Benign, Self-Limiting Disorder in Young Children: A Systematic Review Including Two Related Case Reports
    (2015) Acer, Tugba; Derbent, Murat; Hicsonmez, Akgun; 0000-0001-5391-9094; 26410727; E-4455-2019
    Background/purpose: Bloody nipple discharge (BND) is rare, distressing for parents, and presents a challenge for physicians. Methods: We used PubMed to search for cases of BND that were diagnosed before adolescence and added data from two of our cases. Results: The analyzed cohort comprised 46 patients (28 boys and 18 girls; mean [SD] age, 12.5 +/- 13.3 months; range, 20 days to 4 years). The mean time for spontaneous resolution was 2.8 +/- 2.4 months (range, 1 week to 8 months) after onset of BND without any intervention. The diagnosis was mammary ductal ectasia (MDE) in 15 patients, gynecomastia with MDE in two patients, hemorrhagic cysts in two patients, and gynecomastia alone in one patient. The majority (89.3%) of patients <1 year old were managed conservatively, but half of them aged >1 year (50.0%) underwent surgery. Surgery was performed more often in patients in whom a mass had been identified. Conclusions: Age and findings at physical examination affect selection of treatment, but not sex. We found no reported cases of malignancy. Symptoms in children who are managed conservatively resolve within 10 months. Children with BND should be conservatively managed to avoid the risk of developing breast deformities before adolescence. (c) 2015 Elsevier Inc. All rights reserved.
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    Meckel Diverticulum in Children: Evaluation of Macroscopic Appearance for Guidance in Subsequent Surgery
    (2016) Gezer, Hasan Ozkan; Temiz, Abdulkerim; Ince, Emine; Ezer, Semire Serin; Hasbay, Bermal; Hicsonmez, Akgun; 0000-0002-4635-2613; 0000-0001-8789-6003; 0000-0002-9597-3264; 26435520; J-3197-2013; A-4719-2018; AAJ-9529-2021
    Background: The treatment of incidentally encountered asymptomatic Meckel diverticulum(MD) is controversial. We evaluated whether the macroscopic appearance correlates with clinical features, histopathological findings, future complications, and management decisions. Methods: Patients who underwent MD resection at a single institution from 2000 to 2012 were retrospectively analyzed in terms of age, sex, clinical features, laboratory data, perioperative findings (diverticulum length, diameter, depth, thickening, and height-to diameter ratio [HDR]), pathology, and postoperative follow-up. Results: Fifty children were enrolled. Sixteen percent of the resected MDs were found incidentally. Of 42 complicated MDs, 17 (40%) were long (HDR >= 2), 14 (33%) were thickened, and 29 (70%) exhibited base widening. Histopathologically, ectopic mucosa was found in 32 (64%) of all MDs and in 5 (62%) of incidentally removed MDs. There was no statistical difference between the macroscopic appearance and clinical signs, sex, or presence of ectopic tissue based on palpation. Conclusion: The macroscopic appearance of MD does not indicate the presence or absence of HGM and cannot be used to guide subsequent surgery. Additionally, 40% of symptomatic patients in our study had life-threatening complications requiring prompt fluid resuscitation. We consider that incidentally detected MD should be removed regardless of its macroscopic appearance. (C) 2016 Elsevier Inc. All rights reserved.
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    Boix-Ochoa (Partial Fundoplication) Treats Reflux, Even in Neurologically Impaired Patients. Can it Take the Title of "Gold Standard" from Total Fundoplication?
    (2019) Gezer, Hasan Ozkan; Ezer, Semire Serin; Temiz, Abdulkerim; Ince, Emine; Hicsonmez, Akgun; 0000-0002-4635-2613; 30887292; J-3197-2013
    Background In 4-5% of cases of gastroesophageal reflux disease (GERD), surgical treatment is required. The aim of the study was to evaluate the success of Boix-Ochoa antireflux surgery, which is considered more physiologic with a higher failure rate (need for reoperation) than Nissen fundoplication, which is believed to be the gold standard operation. Method In the 13 years from 2005 to 2018, the medical records of all children who underwent Boix-Ochoa in a single institution by pediatric surgeons were reviewed retrospectively. Results A total of 133 fundoplications were performed, of which patients were divided into four groups: neurologically impaired, structurally impaired, neurologically and structurally impaired, and neurologically and structurally normal; there were 64, 8, 34, and 27 patients in each group, respectively. Structural impairments included hiatal hernia and esophagus atresia, having previously had a gastrostomy and esophageal stenosis. The most common short-term complication was distal esophageal stenosis (13%), which caused vomiting and dysphagia, and was treated by dilatations. There were six (4.5%) recurrences of GER, one in the neurologically and structurally impaired group with a hiatal hernia and five in the structurally impaired group (three esophagus atresias, two caustic esophageal strictures). The mean follow-up period was 5.27 +/- 3.43 years. Neurological impairment did not affect the success rate. Conclusion Although there has not any literature demonstrating significant benefits of one procedure, we detected with this largest study in the pediatric literature about Boix-Ochoa fundoplication (more physiologic and easily performed) that it was successful (95%) in protecting reflux even in neurologically impaired patients (98%). We consider Boix-Ochoa (partial fundoplication) to be an alternative method to Nissen (complete fundoplication), and it can be done safely with a high success rate.