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Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux
(Brazilian Soc Urol, 2018) Tekin, Ali; Yagmur, Ismail; Tiryaki, Sibel; Dokumcu, Zafer; Ulman, Ibrahim; Avanoglu, Ali
Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new went.
Clostridial collagenase aggravates the systemic inflammatory response in rats with partial-thickness burns
(Elsevier Sci Ltd, 2008) Dokumcu, Zafer; Ergun, Orkan; Celik, Handan Ak; Aydemir, Sohret; Sezak, Murat; Ozok, Geylani; Celik, Ahmet
Aim: Clostridial collagenase A (CCA) has been shown effective in degrading collagen in eschar tissue and promoting healing in partial-thickness burns. As there are also reports of fever, leukocytosis, increased C-reactive protein (CRP) levels and septic complications during treatment with CCA, we aimed to determine in rats whether CCA aggravates the systemic inflammatory response. Methods: Rats with partial-thickness burns were randomly divided into groups with either no dressing (ND), povidone-iodine dressing (PID) or CCA dressing (CCAD). Body weights and temperatures, blood leukocyte counts, and serum levels of CRP, interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha), were measured at 0, 3, and 24 h and days 3 and 7 from burn. Wounds were cultured on days 1, 3 and 7 and burn depth was evaluated on day 1. Results: Body weights for all groups were significantly lower after burn, with highest loss (25.5%) in the CCAD group. At 3 h a significant drop in rectal temperature was noted in all groups. The CCAD group had higher rectal temperature levels than the PID group on days 3 and 7 (p < 0.05). Changes in serum levels of CRP, IL-1 beta, IL-6 and TNF-alpha were not significant in the ND and PID groups; the CCAD group showed a significant rise in serum levels of CRP on day 1, of IL-6 on day 3 and of TNF-alpha on day 7. Wound infection was more common in CCAD group and increased on days 3 and 7, but this was insignificant. Conclusion: CCA aggravated the systemic inflammatory response in rats with partial-thickness burns, which is accompanied by a higher risk of infection. (C) 2008 Elsevier Ltd and ISBI. All rights reserved.
The effect of azygos vein preservation on postoperative complications after esophageal atresia repair: Results from the Turkish Esophageal Atresia Registry
(W B Saunders Co-Elsevier Inc, 2021) Soyer, Tutku; Oztorun, Can Ihsan; Firinci, Binali; Durakbasa, Cigdem Ulukaya; Bahadir, Gulnur Gollu; Karaman, Ayse; Dokumcu, Zafer
Aim: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. Methods: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fis-tula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. Results: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p < 0.05). The rates of primary anastomosis and ten-sioned anastomosis were similar in both groups (p > 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the re-quirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) Conclusion: The data in the TEAR demonstrated that preserving the AV during EA repair led to no sig-nificant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory com-plications. (c) 2020 Elsevier Inc. All rights reserved.
The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry
(Wiley, 2022) Comert, Hatice Sonay Yalcin; Guney, Dogus; Durakbasa, Cigdem Ulukaya; Dokumcu, Zafer; Soyer, Tutku; Firinci, Binali; Ciftci, Ilhan
ObjectivesPostoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. Study DesignAmong the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. ResultsAmong 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. ConclusionWe demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.
The Efficacy of Intralesional Steroid Injection in the Treatment of Corrosive Esophageal Strictures in Children
(Lippincott Williams & Wilkins, 2016) Divarci, Emre; Celtik, Ulgen; Dokumcu, Zafer; Ozcan, Coskun; Erdener, Ata
Purpose of the Study: Esophageal dilatation can be insufficient in the treatment of severe corrosive esophageal strictures. In this study, we aimed to present the efficacy of intralesional steroid injection as an adjunct to dilatation therapy. Materials and Methods: Retrospective analysis of children who underwent intralesional steroid injection between 2004 and 2014 was performed. Patients' age, type of corrosive substance, length of stricture, number of injection and dilatation sessions and complications were reviewed. The success was evaluated by the comparison of number, frequency, and requirement of dilatation therapy before and after injection. Results: Intralesional steroid injection was performed to 32 children with a mean age of 3.6 +/- 2.5 years. The types of corrosive agents were alkali (24) or acid (8). Mean number of injection sessions was 2.5 +/- 1.1(1 to 6). Mean number of dilatation sessions was decreased from 10 +/- 8.8 to 5.4 +/- 4.6 after injection (P= 0.003). Mean frequency of dilatations was extended from 3.6 +/- 0.9 weeks to 8.7 +/- 3.9 weeks (P= 0.000). Dilatation treatment was successfully terminated in 25 of 27 children with short-segment strictures after injection (92%). Whereas all of the children with long-segment strictures could not resolved and finally required esophageal replacement (5 patients). One patient had transient cushingoid phenotype as a complication. There was not seen any major complication-like perforation. The mean follow-up period was 6 +/- 3 years. Conclusions: Intralesional steroid injection is an effective adjunct to dilatation in most of the children with short-segment strictures. It should be performed as a safe and efficient treatment option in patients with short-segment corrosive esophageal strictures resistant to dilatation therapy.
Examining the Potential of Advanced Robotic-Assisted Thoracic Surgery in Pediatric Cases
(Galenos Publ House, 2024) Celtik, Ulgen; Sahutoglu, Cengiz; Dokumcu, Zafer; Ozcan, Coskun; Erdener, Ata
Aim: Robotic-assisted surgery has demonstrated safety and feasibility in numerous pediatric cases. Nevertheless, there is a scarcity of literature regarding advanced pediatric thoracic robotic surgery (APTRS). The objective of this study was to present our experiences with APTRS in 31 Materials and Methods: From October, 2020 to December, 2023, a total of 31 APTRS procedures were conducted at our institution. A retrospective analysis was carried out, encompassing demographics, indications for surgery, console time, complication rates, length of hospital stay, and Results: Twenty-one patients (M/F: 13/17) underwent robotic-assisted surgery, with procedures including thoracic mass excision in 17 cases, esophageal surgery in 8 cases, and various other pathologies in 5 patients. The average age at the time of surgery was 8.4 +/- 5.2 years (10 months-17 years), and the average weight was 29.6 +/- 18.4 kg (10-65 kg). The mean console time was 165.6 +/- 124.8 minutes, with no instances of conversion. The median length of hospital stay was 3.5 days (1-30 days). Postoperative complications occurred in eight patients (25.8%). Conclusion: Our experience in pediatric robotic thoracic surgery reinforces its suitability even for complex cases. Robotic thoracic surgery appears to offer benefits, particularly in posterior mediastinal mass excision and esophagectomy for corrosive esophageal strictures, when compared to thoracoscopy.
Factors Affecting Same-Day Discharge Following Laparoscopic Cholecystectomy in Children
(Galenos Yayincilik, 2017) Dokumcu, Zafer; Divarci, Emre; Tiryaki, Sibel; Celik, Ahmet; Ozok, Geylani; Ergun, Orkan
Aim: Laparoscopic cholecystectomy (LC) as day surgery is widely performed on adults; however, experience in pediatric LC in an out-patient setting is limited. We aimed to review our experience and investigate related factors. Materials and Methods: Medical records of patients who underwent elective LC from June 2005 to July 2016 were retrospectively reviewed. Patients were grouped according to the duration of hospital stay, and patient characteristics and outcome were compared. T-test and chi-square were used for statistical analysis. Results: A hundred and sixty-seven patients with a mean age of 10.4 years were enrolled. There was no conversion to open surgery, with only one postoperative complication in a patient with consumption coagulopathy. Same-day discharge (SDD), overnight stay (ONS) and prolonged stay (PS) groups were constituted of 50, 92, 25 patients respectively. All groups had similar preoperative characteristics and median postoperative pain scores. Previous history of cholecystitis and underlying hematological diseases were more common in the PS group (p<0.05). Duration of anesthesia was shortest in SDD, longest in PS groups (p<0.006). Perioperative minor complications were more common in the PS group than the SDD group (p=0.03). Mean time for oral feeding was 3.2, 5.4 and 14.8 hours for SDD, ONS and PS groups respectively (p<0.009). There was no readmission. Conclusion: LC may safely be performed as day surgery in children without comorbidities. Shorter duration of anesthesia and early oral feeding seem to play a key role in SDD in these cases.
Fiberoptic endoscopic evaluation of swallowing (FEES) study: the first report in children to evaluate the oropharyngeal dysphagia after esophageal atresia repair
(Springer, 2022) Celtik, Ulgen; Eyigor, Sibel; Divarci, Emre; Sezgin, Baha; Dokumcu, Zafer; Ozcan, Coskun; Ozturk, Kerem
Background The aim of this study was to evaluate the swallowing problems by fiberoptic endoscopic evaluation of swallowing (FEES) study in both short- and long-gap patients after esophageal atresia (EA) repair. Methods Hospital records of patients who had undergone surgery for EA were reviewed retrospectively. Patients were divided into two groups as short-gap (SG) group (n:16) and long-gap (LG) group (n:10) to compare the swallowing problems. FEES study was performed, and the results were discussed in detail. Results There were twenty-six (16 M/10 F) patients with a mean age at evaluation was 7.52 -/+ 3.68 years. Mean follow-up period was 75.35 -/+ 44.48 months. In FEES study, pharyngeal phase abnormalities were detected in 10 patients (38.4%). Pharyngeal phase abnormalities were detected significantly higher in LG group (p:0.015). Laryngeal penetration/aspiration was seen in four patients on FEES study (15.3%). All of them was in LG group (40%). Laryngeal penetration/aspiration was seen significantly higher in LG group (p:0.014). Conclusion This is the first study to conduct FEES study in children after esophageal atresia repair to evaluate their swallowing conditions. Even though our sample is small, swallowing problems are more common than expected in the cases of LG when compared to SG.
Innovative minimally invasive gastric pull-up techniques in children: SILS and robot-assisted gastric pull-up
(Springer, 2024) Dokumcu, Zafer; Celtik, Ulgen; Hasan, Samir; Ozcan, Coskun; Erdener, Ata
Aim This study aims to explore the rationality, feasibility, safety, and effectiveness of single-incision laparoscopic gastric pull-up (SILS-GPU) and robot-assisted gastric pull-up (R-GPU) methods. Methods Hospital records of patients who underwent gastric pull-up with either SILS-GPU or R-GPU between May2016 and January 2024 were reviewed. Demographics, diagnosis, surgical techniques, and postoperative outcomes were evaluated. Results Out of the total 12 patients (eight persistent corrosive esophageal stricture-PCES, four long gap esophageal atresia-LGEA), seven underwent SILS-GPU, while the remaining five underwent R-GPU. The choice of conduit route was based on the primary pathology (PCES/EA) and the presence of posterior mediastinal fibrosis and/or tracheomalacia. The posterior mediastinum was preferred in seven, intrathoracic in three, and retrosternal in two patients. Transhiatal esophagectomy was performed in seven patients, while transthoracic esophagectomy was performed in three. There were no instances of mortality or intraoperative complications related to the preferred technique. All patients except one with Down syndrome were able to feed orally. Conclusion SILS-GPU and R-GPU are demonstrated to be safe and effective in the pediatric population, with relatively lower complication rates in children.
Integration of radiology and clinical score in pediatric appendicitis
(Wiley, 2018) Aydin, Derya; Turan, Caner; Yurtseven, Ali; Bayindir, Petek; Toker, Bade; Dokumcu, Zafer; Sezak, Murat; Saz, Eylem Ulas
BackgroundThe efficacy of ultrasonography (US) and abdominal X-ray in combination with Pediatric Appendicitis Score (PAS) is complicated in the diagnosis of acute appendicitis. Abdominal X-ray is as useful as US with clinical assessment when evaluated by experienced pediatric radiologist in acute appendicitis. The aim of this study was to determine the value of US and abdominal X-ray for appendicitis in children when combined with clinical assessment based on PAS, and to establish a practical pathway for acute appendicitis in childhood. MethodsA prospective, observational cohort study was conducted at an urban, academic pediatric emergency department. Patients were classified at low (PAS 1-4), intermediate (PAS 5-7), or high (PAS 8-10) risk for appendicitis. Low-risk patients were discharged with telephone follow-up in 10days; those at intermediate risk underwent X-ray and US. High-risk patients received immediate surgical consultation. Patients were grouped on histopathology as having either proven acute appendicitis or no appendicitis. ResultsA total of 288 children were analyzed. Surgery was performed in 134 patients (46.5%), and 128 (95.5%) had positive histopathology. Mean PAS in the patients with and without appendicitis was 7.091.42 and 4.97 +/- 2.29, respectively (P=0.00). The rate of missed cases was 6/288 (2%), and the negative appendectomy rate was 6/134 (4.4%). When the score cut-off was set at 6, the sensitivity and specificity of PAS was 86.7% and 63.1%, respectively. The diagnostic performance of daytime US had a sensitivity of 91.1% and specificity of 71.1%. Also, positive US or PAS >6 or both, had sensitivity and specificity 96.7% and 59.9%, respectively. ConclusionUS or abdominal X-ray in children with possible appendicitis should be integrated with PAS to determine the next steps in management. In the case of discordance between the clinical findings and radiology, prolonged observation or further imaging are recommended.
Intracellular localization of beta-catenin expression plays a possible prognostic role on the outcome of hepatoblastoma patients
(Springer, 2020) Celtik, Ulgen; Dokumcu, Zafer; Divarci, Emre; Guler, Ezgi; Ataseven, Eda; Nart, Deniz; Ergun, Orkan
Purpose Wnt/Beta-catenin pathway plays an essential role in liver development and regeneration. Abnormal activation in this pathway leads to development of hepatoblastoma (HB). Although its importance has invoked attention, its prognostic role is debatable. We aimed to evaluate the significance of intracellular localization of beta-catenin (BC) expression in the outcome of hepatoblastoma patients. Methods Medical records of HB patients between 2004 and 2018 were reviewed. Patients were grouped according to intracellular localization of BC expression by immunohistochemistry as being cytoplasmic or nuclear. Demographics, radiological images, PRETEXT classifications, vascular involvement, risk groups, chemotherapy responses, and survival rates were analyzed and compared between groups. Results There were 41 patients. Thirteen patients were excluded for unavailability of records in four, negative/unclear BC expressions in seven. Cytoplasmic expression of BC was observed in 17 patients whereas 13 patients displayed nuclear expression. Demographics were similar in both groups. Cytoplasmic BC expression was associated with poor chemotherapy response (p = 0.001) and increased vascular involvement (p = 0.0162) requiring more extensive surgeries (p = 0.039). Conclusion Although the numbers are limited in our series, the intracellular localization of BC expression has been found to be a promising determining factor for hepatoblastoma prognosis. With larger patient series, more reliable results can be achieved.
Intraoperative Parathyroid Hormone Monitoring Corroborates the Success of Parathyroidectomy in Children
(Galenos Yayincilik, 2014) Celik, Ahmet; Divarci, Emre; Dokumcu, Zafer; Ergun, Orkan; Ozen, Samim; Goksen, Damla; Darcan, Sukran; Ertan, Yesim
Objective: To assess the efficacy of intraoperative parathyroid hormone (PTH) monitoring in evaluating the outcome of parathyroidectomy in pediatric patients. Methods: Intraoperative PTH monitoring during parathyroidectomy was performed in five children (3M, 2F); three had parathyroid adenomas (single gland disease) and two had primary hyperplasia. One patient had undergone two previous surgical interventions to remove the parathyroid glands, but the PTH levels had remained high with persistence of symptoms. Immunoradiometric analysis was used for PTH measurements. Preoperative PTH values were obtained to monitor the baseline levels. Serum samples were collected 20 minutes after removal of the adenoma/parathyroid gland(s) and PTH levels were compared with preoperative values. Specimens were also confirmed by frozen sectional examination. Results: Mean age of the patients was 11 years (range: 3 months-16 years). Mean preoperative PTH values were 633.3+/-579 pg/mL (range: 143-1300 pg/mL). Intraoperative values decreased to 18.7+/-5.5 pg/mL (range: 8-27 pg/mL) following removal of the gland(s). Normal calcium levels were achieved with adequate management following surgery. One patient (with multiple surgeries and found to have an ectopic parathyroid gland) had hungry bone syndrome after the operation and was treated successfully. There were no major complications. All patients maintained normal calcium/phosphorus levels in the follow-up period, ranging from 2 to 5 years. Conclusion: An ectopic parathyroid gland or another undetected adenoma can be overlooked during surgery. Owing to the short life of the hormone, intraoperative PTH monitoring to determine PTH clearance proved to be a feasible marker for adequacy and safety of surgery and "cure".
Is Temperature Monitoring Necessary in Pediatric Circumcision?
(Aves, 2022) Sahutoglu, Cengiz; Bor, Canan; Dokumcu, Zafer; Balcioglu, Taner
Objective: Perioperative hypothermia occurs in the pediatric age group in the perioperative period at a high rate. In this study, it is aimed to reveal the incidence of perioperative hypothermia and the risk factors that play a role in its development in pediatric circumcision cases that have a brief operation duration. Materials and Methods: This prospective observational cohort study included 100 children who underwent circumcision under general anesthesia. All patients were heated with a passive heater and hypothermia was interpreted as a drop in body temperature below <36 degrees C. The patients were divided into 2 groups: group 1 (patients with body temperature <36 degrees C) and group 2 (>= 36 degrees C). Demographic data, the American Society of Anesthesiologists' Classification of Physical Health Score, premedication method, operation time, fluid amount, preoperative and postoperative temperature of patients as tympanic were recorded. Results: The average age of the patients was 70 +/- 40 months (median: 84) and 93% were ASA I. In 71% of patients, a decrease in body temperature and hypothermia developed in 39% compared to baseline. The duration of operation was longer in the group with hypothermia (30 min [15-70] vs. 25 min [15-60], P <.001). Only the duration of operation was determined as the independent risk factor associated with hypothermia (odds ratio: 1.103 [1.017-1.197], P =.018). Conclusion: In this study, it was found that high rates of hypothermia developed even in minor operations such as pediatric circumcision. The risk of hypothermia increases with the prolongation of surgery.
Laparoscopic adrenalectomy in children: A 25-case series and review of the literature
(W B Saunders Co-Elsevier Inc, 2018) Dokumcu, Zafer; Divarci, Emre; Ertan, Yesim; Celik, Ahmet
Background: Laparoscopic adrenalectomy (LA) is the gold standard and is widely performed in adults, but its use in children is relatively new. We aim to present our experience in twenty-five children with diverse adrenal pathologies and to discuss an extensive review of pediatric LA in English literature. Methods: Medical records of children with adrenal tumors admitted to a tertiary center and treated with LA were reviewed. Characteristics and outcome of patients were compared with results of a systematic Pubmed/Medline literature review. Results: Transperitoneal LAs were performed for 12 malignant and 14 benign adrenal masses (size range: 2-8 cm) in 25 children (median age: 63 months). Fourteen lesions were on the right side, and there was one bilateral case. There were no conversion and no complication within 36 months of follow-up. A literature review revealed 437 pediatric LAs with left side predomination (51.4%). The indication was a malignant lesion in 60.2% of the cases (sizes range: 1-10 cm). The transperitoneal route was preferred in 94.2% of the procedures. Conversion and complication rates were 7.5% and 3.1%, respectively. Conclusion: LA should be preferred in selected children with adrenal pathologies. The transperitoneal route seems to be the standard approach for pediatric surgeons. Preoperative planning and surgical expertise are the keys to success. (C) 2017 Elsevier Inc. All rights reserved.
Living With My Baby With Congenital Anomaly: A Qualitative Case Report
(Sage Publications Inc, 2022) Ozlu, Nazife Gamze Ozer; Vural, Fatma; Dokumcu, Zafer
This case report was made to understand the emotions, thoughts, and experiences of the mother, who was lying in the long-term neonatal intensive care unit. An individual in-depth interview was conducted once with the mother of the infant with the diaphragm hernia. The interview recorded and lasted approximately 30 min. The data were analyzed by inductive method and themes and codes were created. The mother of the infant with a diaphragmatic hernia was 31 years old, married with 2 children, and employed full-time. The infant was diagnosed antenatally at 37 weeks old, weighed 3.000 g, and was male. As a result of the interview, 3 main themes were identified: Facing the disease, Experiences in intensive care, and Change in family life. The results show that having an infant with congenital anomaly affects the life of all family members and shows the problems experienced strikingly.
Long-term outcome and efficiency of symptom-selective approach to assess gastroesophageal reflux prior to gastrostomy in neurologically impaired children
(Springer, 2021) Ulman, Hilmican; Dokumcu, Zafer; Elekberova, Vusale; Celtik, Ulgen; Divarci, Emre; Ozcan, Coskun; Erdener, Ata
Purpose To evaluate the necessity of preoperative screening for gastroesophageal reflux (GER) prior to gastrostomy in neurologically impaired children. Methods Medical records of neurologically impaired children, who have undergone laparoscopic gastrostomy between January, 2004 and June, 2018, were retrospectively reviewed. Before the year of 2014, all patients who required gastrostomy had been routinely screened for GER pre-operatively, but after the year of 2014, only the ones with GER-related symptoms were tested. The characteristics and outcomes of Routine Screening (RS) and Selective Screening (SS) periods were compared. Results There were 55 and 54 patients in the RS and SS periods, respectively. Demographics, primary pathologies, and mean follow-up durations (> 2 years) were similar. The rate of GER screening was significantly lower in the SS period (29.6% vs. 63.6%). The rate of Laparoscopic Nissen Fundoplication (LNF) combined with gastrostomy was significantly lower in the SS period (14.8% vs. 38.2%). During follow-up, the rates of new-onset GER symptoms (13% vs. 11.7%) and LNF requirement later on (6.5% vs. 8.8%) were statistically similar between the two periods. Conclusion Routine screening for GER is not necessary prior to gastrostomy in neurologically impaired children. Symptom-selective screening algorithm is safe and efficient in the long term.
Long-term surgical outcomes in pediatric ovarian neoplasms: 20-year single-center experience
(Springer, 2022) Kurtmen, Bade Toker; Dokumcu, Zafer; Divarci, Emre; Ergun, Orkan; Ozok, Geylani; Celik, Ahmet
Purpose The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON. Methods A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence. Results Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7 years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1 years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group. Conclusion The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue.
Management of Childhood Thyroid Nodules: Surgical and Endocrinological Findings in a Large Group of Cases
(Galenos Yayincilik, 2017) Divarci, Emre; Celtik, Ulgen; Dokumcu, Zafer; Ergun, Orkan; Ozok, Geylani; Ozen, Samim; Simsek, Damla Goksen; Darcan, Sukran; Cetingul, Nazan; Oral, Aylin; Ertan, Yesim; Demirag, Bengu; Celik, Ahmet
Objective: The management of childhood thyroid nodules is still a big challenge for clinicians. In this study, we aimed to present our surgical and endocrinological experience in more than one hundred pediatric cases. Methods: A retrospective analysis of patients admitted with a thyroid nodule between 2006 and 2014 was performed. Detailed ultrasonography and fine-needle aspiration biopsy (FNAB) were the cornerstones of the diagnostic approach. Results: One hundred-three children (72 female, 31 male) with a mean age of 13.1 +/- 3.6 years (3-18 years) were admitted to our center. Management strategy was surgery in 58 patients and follow-up in 45 patients. Mean nodule size was 17 +/- 12.7 mm (2-45 mm). The diagnoses were listed as benign solitary nodule (48 patients), thyroid carcinoma (26 patients), multinodular goiter (23 patients), Hashimoto thyroiditis (4 patients), and Graves' disease (2 patients). Surgical procedures were nodulectomy/lobectomy (32 patients), total thyroidectomy (TT) (13 patients), or TT+ neck dissection (13 patients). The rate of malignancy was 25% in the total group and 44% in the surgery group. The malignancy rate was higher in patients younger than 12 years compared to older children (41% vs. 17%, p = 0.040). Metastasis was seen in 38% of the malignant nodules. Postoperative complications were transient hypocalcemia (8%), permanent hypocalcemia (1.7%), and unilateral vocal cord paralysis (1.7%). Recurrence or mortality was not encountered in the 5.4 +/- 1.2-year follow-up period. Conclusion: Thyroid nodule in a child requires an aggressive diagnostic approach due to increased risk of malignancy and metastasis. Intraoperative frozen section examination must be done as a useful adjunct to determine the surgical strategy. Incidence of complications is small in thyroid surgery when performed by experienced surgeons.
Multicenter Survey of Endoscopic Treatment of Vesicoureteral Reflux Using Polyacrylate-Polyalcohol Bulking Copolymer (Vantris)
(Elsevier Science Inc, 2014) Kocherov, Stanislav; Ulman, Ibrahim; Nikolaev, Sergey; Corbetta, Juan Pablo; Rudin, Yuriy; Slavkovic, Andjelka; Dokumcu, Zafer; Avanoglu, Ali; Menovshchikova, Ludmila; Kovarskiy, Semen; Skliarova, Tatiana; Weller, Santiago; Bortagaray, Juan I.; Lopez, Juan C.; Duran, Victor; Burek, Carol; Sager, Cristian; Dmitriy, Maruhnenko; Garmanova, Tatiana; Djamal, Aliev; Jovanovic, Zorica; Vacic, Nikola; Abu Arafeh, Wael; Chertin, Boris
OBJECTIVE To evaluate an outcome of endoscopic correction of vesicoureteral reflux (VUR) using Vantris (Promedon, Cordoba, Argentina) in terms of its effectiveness and morbidity in a multicenter study. MATERIALS AND METHODS From 2009 to 2013, 611 patients (210 boys and 401 girls) with a mean age of 3.56 years (range, 1 month-18 years) were treated at 7 centers worldwide endoscopically with Vantris injection. VUR was unilateral in 413 and bilateral in 198 patients comprising 809 renal refluxing units (RRUs). Of these, primary VUR was present in 674 RRUs (83.3%) and 135 (16.7%) were complex cases. Reflux was grades I-V in 24 (2.96%), 123 (15.2%), 451 (55.8%), 158 (19.5%), and 53 (6.6%) RRUs respectively. The follow-up continued from 6 to 54 months. RESULTS Reflux resolved in 759 RRUs (93.8%) after first Vantris injection, in 26 (3.1%) after second, and in 6 (0.7%) after third injection, respectively. VUR improved to grade I after 1 or 2 injections in 5 ureters (0.6%), which needed no further treatment. Thirteen ureters (1.6%) failed endoscopic correction and required ureteral reimplantation. Vesicoureteral junction obstruction requiring ureteral reimplantation developed in 6 ureters (0.7%) and in 4 (0.5%) required stent insertion. Twenty-three patients (3.8%) suffered afebrile urinary tract infection. Seven (1.2%) developed febrile urinary tract infection. None of the studied patients demonstrated VUR recurrence on voiding cystourethrography. CONCLUSION The results of this multicenter survey confirm that endoscopic subureteral Vantris injection is a simple, safe, and effective outpatient procedure for treating all grades of VUR. (C) 2014 Elsevier Inc.
Necrotizing Liver Granuloma/Abscess and Constrictive Aspergillosis Pericarditis with Central Nervous System Involvement: Different Remarkable Phenotypes in Different Chronic Granulomatous Disease Genotypes
(Hindawi Ltd, 2017) Akarcan, Sanem Eren; Karaca, Neslihan; Aksu, Guzide; Bozkaya, Halil; Ayik, Mehmet Fatih; Sahan, Yasemin Ozdemir; Kilinc, Mehmet Arda; Dokumcu, Zafer; Eraslan, Cenk; Divarci, Emre; Alper, Hudaver; Kutukculer, Necil
Chronic granulomatous disease (CGD) is a primary immune deficiency causing predisposition to infections with specific microorganisms, Aspergillus species and Staphylococcus aureus being the most common ones. A 16-year-old boy with a mutation in CYBB gene coding gp91 phox protein (X-linked disease) developed a liver abscess due to Staphylococcus aureus. In addition to medical therapy, surgical treatment was necessary for the management of the disease. A 30-month-old girl with an autosomal recessive form of chronic granulomatous disease (CYBA genemutation affecting p22(phox) protein) had invasive aspergillosis causing pericarditis, pulmonary abscess, and central nervous system involvement. The devastating course of disease regardless of the mutation emphasizes the importance of early diagnosis and intervention of hematopoietic stem cell transplantation as soon as possible in children with CGD.

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