Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item The Separation of The Epididymis and The Abnormal Attachment of The Gubernaculum Cause Undescendence in The Rat Testes(2014) Acer, Tugba; Hicsonmez, Akgun; https://orcid.org/0000-0001-5391-9094; 25217829; E-4455-2019Epididymal anomalies are common in cryptorchid patients. This led us to consider that anomalies of the epididymis, to which the gubernaculum is attached, or abnormal attachment of the cranial end of the gubernaculum, could lead to cryptorchidism. Twenty-eight male Sprague-Dawley rats were divided into two groups: In Group 1 rats (n = 14), the epididymis was isolated from the testis, and in Group 2 rats (n = 14), the gubernaculum was isolated from the epididymis and re-attached to the tail of the epididymis. In both groups, the non-operated testes were used as the control. In Group 1, cryptorchidism rates were 1/14 in the control testes and 8/14 in the operated testes (p < 0.01). In Group 2, cryptorchidism rates were 0/13 in the control testes and 6/13 in the operated testes (p < 0.01). Cryptorchidism was seen when the epididymis was loosely or non-connected to the testis and the gubernaculum was attached solely to the epididymis (mimicking anomalies of ductal fusion) and when the gubernaculum was attached to the tail of the epididymis (mimicking anomalies of ductal suspension). Therefore epididymal anomalies and abnormal attachment of the gubernaculum may play a role in the undescendence of the testes in the rats.Item Aspiration of An Interesting Foreign Body: Myiasis(2015) Ince, Emine; Oguzkurt, Pelin; Gezer, Hasan Ozkan; Aliskan, Hikmet Eda; Hicsonmez, Akgun; 0000-0001-9060-3195; 27735804; AAE-2282-2021; J-3197-2013Myiasis is a rare condition caused by the invasion of tissues by the larvae of flies. Many cases of myiasis involving various human organs have been reported. Tracheopulmonary or intratracheal myiasis is a very unusual and aberrant form of the disease in humans. We present a case of respiratory myiasis after aspiration of larvae by a healthy 8-month-old girl, which cannot be found in the English literature.Item Solid Variant of Aneurysmal Bone Cyst of The Rib Presenting As A Left Intrathoracic Mass Without Radiological Bone Destruction(2014) Gezer, Hasan Ozkan; Oguzkurt, Pelin; Temiz, Abdulkerim; Demir, Senay; Hicsonmez, Akgun; https://orcid.org/0000-0002-4635-2613; https://orcid.org/0000-0001-8789-6003; https://orcid.org/0000-0002-4209-9075; 25341605; J-3197-2013; A-4719-2018; AAK-9310-2021An aneurysmal bone cyst (ABC) is a benign but often rapidly expanding osteolytic multi-cystic osseous lesion that occurs as a primary, secondary, intra-osseous, extra-osseous, solid, or conventional lesion. A 15-year-old boy presented with a left-sided intrathoracic mass displacing the lung without bone destruction. The mass was totally resected without rib resection, and the pathological diagnosis was ABC. The clinical manifestations, etiology, management, and pathology are discussed, with a brief discussion regarding the difficulty in the preoperative differential diagnosis.Item 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-4455-2019Background/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.Item Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience(2018) Acer Demir, Tugba; Ekenci, Berk Yasin; Ozer, Dogancan; Turanoglu, Mehmet Ali; Haberal, Kadem Cem; Bilgin, Elif Bengisu; Hicsonmez, Akgun; 0000-0001-5391-9094; 0000-0002-5939-4548; 29032240; E-4455-2019; GPG-1911-2022OBJECTIVE To elucidate epidemiological data and hydrocele progression, we reviewed pediatric patients diagnosed with hydroceles in our institution retrospectively. MATERIALS AND METHODS We reviewed data from 355 pediatric patients with hydroceles. Questionnaires regarding age at diagnosis, time of delivery, presence of hydroceles in the father and brothers, age at recovery, age at surgery, cause of hydrocele (if present), type of hydrocele, associated pathologies, treatments, and posthydrocelectomy complications were completed by reviewing patients' medical records and interviewing their families. RESULTS Patients with congenital hydroceles were more frequently born prematurely (32.5%) than were patients with noncongenital hydroceles (15.9%; P=.001). Fathers of 10 patients (3.7%) and brothers of 21 patients (7.7%) also had hydroceles. Hydroceles were associated with inguinal hernias on the same side (12.2%), cryptorchidism (7.5%), varicoceles (6.0%), and testis torsion (0.5%). Among patients aged >1 year (n=185), 27 did not undergo operations and healed spontaneously at an average of 5.30 +/- 3.36 months. For children aged >1 year who did not undergo surgery, the rate of spontaneous recovery within 6 months was 77.8% and that within 1 year was 96.3%. CONCLUSION Until strong evidence of hydrocele-induced testicular damage in children arises, we recommend following up congenital hydroceles until at least 1 year and preferably 2 years of age. We recommend following up noncongenital hydroceles for at least 6 months and preferably 1 year if there is no associated pathology indicating the need for earlier surgery such as an inguinal hernia, cryptorchidism, tense hydrocele, testis torsion, or testis mass. (c) 2017 Elsevier Inc.Item Choledochal Cysts in Children: Intrahepatic Ductal Dilatation Does Not Indicate True Intrahepatic Biliary Duct Disease(2016) Gezer, Hasan Ozkan; Oguzkurt, Pelin; Ince, Emine; Ezer, Semire Serin; Temiz, Abdulkerim; Hicsonmez, Akgun; https://orcid.org/0000-0002-9597-3264; https://orcid.org/0000-0001-8789-6003; 26620959; J-3197-2013; A-4719-2018Background/Aims: Choledochal cysts (CCs) are rare abnormalities of the biliary tract. Presenting our clinical experience with CCs herein, we aimed to identify if intrahepatic ductal dilatation indicates true intrahepatic biliary duct disease. Materials and Methods: We retrospectively reviewed all cases of CCs in children diagnosed at a single center (Baskent University Faculty of Medicine, Department of Pediatric Surgery) institution from 2005 to 2015. Results: Of 18 patients with CCs, 7 were males (39%). The age range was 3 months to 17 years (mean age, 6.2 +/- 3.8 years). Intrahepatic bile duct dilatation was detected in 13 (72%) patients by preoperative scanning. Type I, II, III, and IVA cysts were diagnosed in 13, 1, 1, and 3 patients, respectively. In all patients, total cyst excision and Roux-en-Y hepaticoenterostomy were performed. Conclusion: In this study, most intrahepatic ductal dilatations seen on preoperative imaging were thought to be caused by a distal obstruction, not true intrahepatic biliary duct disease. This study supports the hypothesis that preoperatively distinguishing between type I and type IVA CCs is not necessary; it does not affect the initial treatment. We consider that complete cyst excision with Roux-en-Y hepaticojejunostomy is safe and should be performed soon after diagnosis, irrespective of symptom severity to avoid future complications.Item 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-9529-2021Background: 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.Item Intestinal Malrotation Needs Immediate Consideration and Investigation(2016) Ezer, Semire Serin; Oguzkurt, Pelin; Temiz, Abdulkerim; Ince, Emine; Gezer, Hasan Ozkan; Demir, Senay; Hicsonmez, Akgun; 0000-0002-4209-9075; 0000-0001-8789-6003; 0000-0002-4635-2613; 0000-0002-9597-3264; 27353636; AAK-9310-2021; J-3197-2013; AAJ-9529-2021; A-4719-2018BackgroundThe aim of this study was to evaluate clinical presentation, diagnostic studies, and volvulus rate and to describe the unusual clinical clues of intestinal malrotation. MethodsA retrospective descriptive review was carried out of all patients diagnosed with intestinal malrotation between 2002 and 2014. Patients were divided into two groups: infants (1year, n=16; group 1); and children (>1year, n=12; group 2). Patient demographics, clinical history, symptoms, physical examination, diagnostic work-up, operative findings and early outcome were evaluated. ResultsBilious vomiting was the cardinal complaint in both groups. Unusual symptoms such as respiratory insufficiency, dehydration, afebrile convulsion, and lethargy were prominent symptoms in six patients in group 1, whereas history of frequent hospitalization due to recurrent abdominal pain and feeding intolerance were prominent in six patients in group 2. Midgut volvulus was identified in 15 patients, four of whom were in group 2. Standard Ladd's procedure was done in addition to correction of volvulus. ConclusionMalrotation with or without midgut volvulus is not a rare condition and should be kept in mind for any age group. Specific signs of diagnosis are not easily identified. In the case of unusual clinical presentation, diagnosis may be delayed and can result in catastrophic consequences if intestinal perfusion occurs. Although midgut volvulus is seen most frequently in infants, risk and complication rate are high beyond 1year of age as well, and can manifest as failure to thrive, food intolerance, and abdominal pain needing recurrent hospitalization. Diagnostic suspicion and interdisciplinary coordination are essential for timely diagnosis and surgical treatment.Item The Effect of Intraperitoneal N-Acetylcysteine on Postoperative Adhesions in Rat Models(2017) Asian, Gizem Inal; Otgun, Ibrahim; Acer, Tugba; Tepeoglu, Merih; Hicsonmez, Akgun; https://orcid.org/0000-0002-9894-8005; 28874629; AAK-5222-2021ATM: In this study, we researched the effect of local administration of N-acetylcysteine (NAC) on postoperative intra-abdominal adhesion formation in the rat models. METHODS: 20 female Wistar Albino rats which were 5-7 months old are used for the study. The rats were divided into two equal groups. Group one was administered saline solution (n=10) while group two was administered NAC (n=10) after caecal abrasion. They were dissected on postoperative tenth day and were examined macroscopically and microscopically for the adhesion formation. Intraperitoneal adhesion formation was scored blinded with Evans model. The most adherent bowel section was excised for histopathologic examination. Mann Whitney U test were used for statistical analysis. RESULTS: In Group one, all rats have had adhesions. None of the rats in Group two had either severe inflammatory cell reaction or dense interstitial fibrosis. Macroscopic adhesion formation and microscopic inflammatory cell reaction and interstitial fibrosis formation after surgery were less at the group two (NAC applied) (p<0.05, p<0.05, p<0.05). CONCLUSION: We believe that the intraperitoneal single dose usage of NAC may be promising for decreasing the postoperative intraabdominal adhesions.Item Management of Traumatic Bile Duct Injuries in Children(2018) Temiz, Abdulkerim; Ezer, Semire Serin; Gedikoglu, Murat; Serin, Ender; Ince, Emine; Gezer, Hasan Ozkan; Canan, Mehmet Oguz; Hicsonmez, Akgun; https://orcid.org/0000-0001-8789-6003; https://orcid.org/0000-0002-9597-3264; https://orcid.org/0000-0002-0138-6107; https://orcid.org/0000-0002-4635-2613; https://orcid.org/0000-0003-0614-4497; 29948144; A-4719-2018; AAJ-9529-2021; AAM-7281-2021; J-3197-2013; AAI-9386-2021Pediatric experience with biliary tract injuries (BTI) is limited and mostly consists of case presentations. The purpose of this study is to evaluate clinical and radiological findings of possible BTI, treatment strategies, and results. The records of nine patients with the diagnosis of BTI between July 2009 and November 2017 were reviewed retrospectively. There were seven boys and two girls (mean 8.05 +/- 4.39 years). The mechanisms were motor vehicle occupant, fall, crush and gunshot wound. Hepatic laceration routes that extended into the porta hepatis and contracted the gall bladder were demonstrated on computerized tomography (CT). Bile duct injury was diagnosed with bile leakage from the thoracic tube (n = 2), from the abdominal drain (n = 2) and by paracentesis (n = 5). Extrahepatic (n = 8) and intrahepatic (n = 1) bile duct injuries were diagnosed by cholangiography. Endoscopic retrograde cholangiography, sphincterotomy, and stent placement were successfully completed in five patients. Peritoneal drainage stopped after 3-17 days of procedure in four patients. The fifth patient was operated with the diagnosis of cystic duct avulsion. Cholecystectomies, primary repair of laceration, cystic duct ligation, and Roux-en-Y hepatoportoenterostomy were performed in the remaining four patients. All patients presented with clinically normal findings, normal liver functions, and normal ultrasonographic findings in the follow-up period. The presentation of the parenchymal injury extending to the porta hepatis with contracted gall bladder on CT and diffuse homogenous abdominal fluid should be considered as signs of BTI. We suggest a multi-disciplinary approach for the diagnosis and treatment of BTIs. Surgery may be indicated according to the patient's clinical condition, radiological findings and failure of non-operative treatment.
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