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Öğe Advantages of early intervention with arterial embolization for intra-abdominal solid organ injuries in children(2019) Demircan, Mehmet; Gürünlüoğlu, Kubilay; Gözükara Bağ, Harika; Sığırcı, Ahmet; Saraç, Kaya; Kutlu, Ramazan; Yıldırım, İsmail OkanAbstract: PURPOSE Active bleeding due to abdominal trauma is an important cause of mortality in childhood. The aim of this study is to demonstrate the advantages of early percutaneous transcatheter arterial embolization (PTAE) procedures in children with intra-abdominal hemorrhage due to blunt trauma. METHODS Children with blunt abdominal trauma were retrospectively included. Two groups were identified for inclusion: patients with early embolization (EE group, n=10) and patients with late embolization (LE group, n=11). Both groups were investigated retrospectively and statistically analyzed with regard to lengths of stay in the intensive care unit and in the hospital, first enteral feeding after trauma, blood transfusion requirements, and cost. RESULTS The duration of stay in the intensive care unit was greater in the LE group than in the EE group (4 days vs. 2 days, respectively). The duration of hospital stay was greater in the LE group than in the EE group (14 days vs. 6 days, respectively). Blood transfusion requirements (15 cc/kg of RBC packs) were greater in the LE group than in the EE group (3 vs. 1, respectively). The total hospital cost was higher in the LE group than in the EE group (4502 USD vs. 1371.5 USD, respectively). The time before starting enteral feeding after first admission was higher in the LE group than in the EE group (4 days vs. 1 day, respectively). CONCLUSION Early embolization with PTAE results in shorter intensive care and hospitalization stays, earlier enteral feeding, and lower hospital costs for pediatric patients with intra-abdominal hemorrhage due to blunt trauma.Öğe Clear cell sarcoma of the kidney in a newborn(Turgut Özal Tıp Merkezi Dergisi, 2016) Gürünlüoğlu, Kubilay; Uğuralp, Sema; Akpolat, Nusret; Sığırcı, Ahmet; Özgen, ÜnsalAbstract In the present article, we present the case of a 37-month-old male newborn, who was delivered by normal birth with no history of routine examinations during pregnancy, with an abdominal mass observed after the birth, and was eventually diagnosed with clear cell sarcoma of the kidney in the histopathology examination after the mass was dissected by surgery. We report the observed symptoms as well as related cases found in the literature related to childhood and newborn age clear cell sarcoma of the kidney. We also put forward clinical observance, stages, management and outcomes of clear cell sarcoma of the kidney during newborn. Our study underlines that clear cell sarcoma should be kept in mind during differential diagnosis although it is rarely observed in newborns. Keywords: Clear cell sarcoma; Kidney; Newborn; Children.Öğe Clear cell sarcoma of the kidney in a newborn(Turgut Özal Tıp Merkezi Dergisi, 2016) Gürünlüoğlu, Kubilay; Uğuralp, Sema; Akpolat, Nusret; Sığırcı, Ahmet; Özgen, ÜnsalAbstract In the present article, we present the case of a 37-month-old male newborn, who was delivered by normal birth with no history of routine examinations during pregnancy, with an abdominal mass observed after the birth, and was eventually diagnosed with clear cell sarcoma of the kidney in the histopathology examination after the mass was dissected by surgery. We report the observed symptoms as well as related cases found in the literature related to childhood and newborn age clear cell sarcoma of the kidney. We also put forward clinical observance, stages, management and outcomes of clear cell sarcoma of the kidney during newborn. Our study underlines that clear cell sarcoma should be kept in mind during differential diagnosis although it is rarely observed in newborns. Keywords: Clear cell sarcoma; Kidney; Newborn; ChildrenÖğe Comparison of routine laboratory tests in acute appendicitis and intussusception in childhood(2019) Gürünlüoğlu, Kubilay; Taşcı, Aytaç; Gözükara Bağ, Harika; Demircan, MehmetAbstract: Aim: Acute appendicitis and idiopathic intussusception are two major causes of acute abdomen in childhood. In this study, we investigated the clinical, laboratory and radiological findings of these two surgical emergencies during the first presentation. Material and Methods: In this study, we retrospectively reviewed the records of pediatric patients with acute appendicitis and idiopathic intussusception between 2015-2018. Patients were identified according to inclusion criteria. Results: Physical examination findings were positive in all patients with acute appendicitis and idiopathic intussusception. White Blood Cell (WBC) [15.55] and C-Reaktif Protein (CRP) [3.75] were high in the laboratory test in patients with acute appendicitis. In patients with idiopathic intussusception, lactate dehydrogenase (LDH) [302] and CRP [0.6] were high and Ultrasound findings were positive. In addition, WBC [10,1 (5,07)] was normal in patients with idiopathic intussusception. Conclusion: While WBC, CRP, physical examination is valuable in the diagnosis of acute appendicitis, physical examination, CRP, LDH and USG are valuable in the diagnosis of intussusception. In an Idiopathic intussusception patient, WBC may be normal at first admission.Öğe The effects of hydrostatic reduction and operative manual reduction on the success of intussusception reduction(2018) Gürünlüoğlu, Kubilay; Taşcı, Aytaç; Gözükara Bağ, Harika; Sığırcı, Ahmet; Demircan, MehmetAbstract: Aim: Intussusception is the most common cause of bowel obstruction in children aged 3 months to 6 years. Ultrasonically guided Hydrostatic reduction (UGHR) and operative manual reduction (OMR) are among the treatment methods. The aim of this study is to compare the effects of UGHR and OMR techniques on successful reduction in children with intussusception. Material and Methods: This study was performed retrospectively between January 2015 and May 2018. The data of intussusception child patients were reviewed. A total of 63 patients’ records were reached. A total of 31 UGHR procedures and 32 OMR procedures were recorded. Demographic data, recurrence, reduction success of UGHR and OMR patients were calculated and evaluated statistically. Results: No significant difference was found in terms of demographic information. There was no recurrence in both groups. While rate of successful reduction of patient with UGHR is 77.4%, OMR’s success is 87.5%. There was no statistically significant difference in terms of reduction success. It was determined that what was important in the reduction success was the first application time. Conclusions: When we evaluated our results, we found that the factor affecting the reduction success in a patient with intussusception was not the method of reduction. We found that the most important factor affecting reduction success was the time between onset of symptoms and initiation of reduction. If this is less than 24 hours, we have found that the reduction success is very good.Öğe The effects of total parenteral nutrition on telomerase expression in rabbit(2018) Gürünlüoğlu, Kubilay; Bayrakci, Ercan; Kocabıyık, Alper; Gökçe, Hasan; Taşkapan, Mehmet Çağatay; Taşcı, Aytaç; Aksungur, Zeynep; Arslan, Ahmet Kadir; Demircan, MehmetAbstract: Aim: Total parenteral nutrition (TPN) is a technique which is use to give vitally mandatory substances in to the venous compartments whenever the gastrointestinal system cannot be used by the patients. Telomerase catalyzes DNA synthesis, which is necessary to maintain telomere length and stabilize the genome to allow continued cell proliferation. In this study, we explored the effects of TPN administration on telomerase reverse transcriptase (TERT) expression in various tissue and serum telomerase level. Material and Methods: In this study a number of 42 same-aged albino, equal number of male and female, new zealand rabbits were use, divided in to three groups. Group 1 rabbits received TPN for 10 days via a central venous catheter. Group 2 received 50 mL/ kg/day physiological saline via a central venous catheter. Group 3 served as the control group. The rabbits were sacrificed after 10 days, and serum telomerase levels were measured by enzyme-linked immunosorbent assay. TERT expression in gonadal, liver, jejunum, and skin tissues were determined immunohistochemically. Blood samples were obtained before and after TPN and saline administration in the TPN and serum saline groups, respectively, and at the end of the experiment in the control group. Results: Telomerase expression in liver, gonads and serum level of TPN group was significantly higher than control and serum saline groups. Conclusion: TPN may be a positive effect in liver and gonadal telomer kinetic. However, we think that TPN increases DNA damage throughout the body.Öğe Intussusception due to appendicitis(Turgut Özal Tıp Merkezi Dergisi, 2016) Gürünlüoğlu, Kubilay; Zeliha Kaya; Gürünlüoğlu, Semra CaferoğluAbstract Intussusception is an important childhood disease. It is usually accompanied by abdominal pain and throwing up complaints caused by a lead-point in the intestines and intestinal obstruction symptoms and requires emergency surgical operation. Acute appendicitis is a serious condition that most frequently requires emergency surgical operations during childhood. The condition is usually accompanied with abdominal pain, abdominal sensitivity along with vomiting, abdominal muscular defense and rebound symptoms. Frequently the pathogen is fecalith in the appendicitis. In the present study, a intussusception case caused by the lead-point role of a sudden acute appendicitis induced by fecalith in an 8 years old young female with abdominal pain and vomiting symptoms is presented. A literature review was conducted and the fact that appendicitis could cause intussusception as well as intussusception could cause appendicitis is identified and discussed. Keywords: Acute Appendicitis; Intussusception; Childhood.Öğe Kolon Perforasyonu ve Ventrikülo-Peritoneal Şantın Anüsten Protrüzyonu: İki Olgu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2006) Ceran, Canan; Karadağ, Özen; Gürünlüoğlu, Kubilay; Önal, ÇağatayHidrosefalik çocukların tedavisinde beyin omurilik sıvısı akımını düzeltmek için en sık uygulanan yöntem ventrikülo-peritoneal şant vasıtasıyla beyin omurilik sıvısının periton içine akıtılmasıdır. Basit ama komplikasyon oranı yüksek bir yöntem olan ventrikülo-peritoneal şant uygulaması sonrası şant kateterinin anüsten çıktığı iki olguyu sunarak; bu komplikasyonun muhtemel oluş mekanizmalarını ve tedavisini tartışmayı amaçladık.Öğe Pancreas divisum, pancreaticolithiasis and extraordinary ductal variation in a 14-year-old girl(Zeynep Kamil Tıp Bülteni, 2005) Demirbilek, Savaş; Gürünlüoğlu, Kubilay; Yıldırım, Bülent; Akın, Melih; İrşi, Cesim; Aksoy, Rauf Tuğrul; Altınok, TayfunÖz: Pankreas divizyum dorsal ve ventral pankreatik kanalların birleşmemesi sonucu ortaya çıkan pankreasın embriyolojik bir anomalisidir. Çalışmada çok nadir görülen pankreatik kanal anomalisi olan çocuk olgu sunulmuştur. Sunulan olguda dorsal pankreatik kanal ana kanal olup, ventral kanal ikincil kanal olarak dorsal kanalla birleşmektedir. Ana papilla sadece koledok ile devam etmektedir. Kız olgu pankreas divizyununun nadir bir komplikasyonu olan pankreas taşları ile de komplike olmuştur. Olgu birden fazla denenen minör papilla sfinkterotomisine cevap vermemiş ve bu nedenle de açık cerrahi tedavi planlanmıştır. Olguya genişletilmiş uzunlamasına pankreatikojejunostomi (Frey operasyonu) uygulanmış ve cerrahi sonrası son bir yıldır olgunun hiçbir yakınması olmamıştır.Öğe Total parenteral nütrisyon uygulamasının vasküler endotel üzerinde hasar yapıcı etkisinin deneysel olarak araştırılması(İnönü Üniversitesi, 2007) Gürünlüoğlu, KubilayTotal parenteral nütrisyon (TPN) gastrointestinal sistemin kullanılamadı ı durumlarda hayati fonksiyonların devamı için gerekli olan su, protein, karbonhidrat, lipid, elektrolit, vitamin ve eser element gibi substratların periferik veya santral venöz kompartmana verildi i bir tekniktir. TPN'un yaygın kullanımı ile konjenital ve akkiz hastalıklarda uygulanan cerrahi i lemler sonucunda mortalite önemli ölçüde azalmı tır. Di er taraftan TPN uygulaması sırasında geli en komplikasyonlar önemli bir mortalite nedeni olarak ortaya çıkmı tır. Hepatobilier disfonksiyon ve sepsis, üzerinde en fazla durulan ve pek çok ara tırma yapılan en önemli komplikasyonlardır. TPN uygulaması sırasında geli en sepsisin etyopatogenezi hala tam olarak aydınlatılamamı tır. Bu konuda yapılan ara tırmalarda solüsyonların verildi i kateterler ve verilen solüsyon veya emülsiyonların sepsis geli iminden sorumlu tutulmu tur. Sorumlu tutulan di er bir neden de TPN uygulaması sırasında geli en vasküler endotel hücrelerindeki hasardır. Biz yaptı ımız bu deneysel çalı mada TPN uygulaması sırasında geli en sepsiste anahtar rolü oynadı ı için vasküler endotel hücre hasarını ara tırmayı planladık. Çalı mada toplam 50 adet tav an 5 gruba ayrıldı. Her grupta 10 tav an vardı. lk 4 gruba internal juguler ven yoluyla ?cut-down? yöntemiyle santral venöz kateter takıldı. Birinci gruptaki 10 tav ana 10 gün süresince lipidli TPN verilirken, ikinci gruba 10 gün süresince lipidsiz TPN verildi. Üçüncü gruba sadece serum fizyolojik verildi. Dördüncü gruba ise herhangi bir tedavi verilmeksizin, santral kateter ile 10 gün takip edildi. Be inci grup ise kontrol grubunu olu turdu. On günlük deney süresinin sonunda tüm tav anlardan karaci er, böbrek ve vena kava inferior doku örnekleri alındı ve tav anlar sakrifiye edildi. 58 Alınan doku örneklerinde vasküler endotelial hücre hasarının göstergesi olan VCAM- 1 ekspresyonu immünohistokimyasal yöntemlerle incelenerek histopatolojik de erlendirme yapıldı. statistiksel olarak kar ıla tırma ANOVA testi ve LSD testi ile yapıldı. Tüm sonuçlar de erlendirildi inde TPN uygulamasının, karaci er ve böbrekteki küçük çaplı venlerin ve vena kava inferiorun endotel hücrelerinde hasara neden oldu u ve bu hasarın TPN'nin içeri inden kaynaklandığını ve solüsyonlardaki lipidin bu hasarı istatistiksel olarak anlamlı olmasada azalttığını saptadık. Sonuç olarak, TPN uygulaması sırasında geli en sepsis komplikasyonunda anahtar rol oynayan vasküler endotelyal hücre hasarının TPN içeri indeki solüsyonlardan kaynaklandı ını ve bu hasarın parenteral lipidler ile azaltılabileceğini düşünmekteyiz.Öğe What the twenty-year series in children with disorders of sex development tells us?(2022) Macit, Bengü; Akıncı, Ayşehan; Demircan, Mehmet; Gürünlüoğlu, Kubilay; Sığırcı, AhmetAim: Although Disorders of sex development (DSD) are not a common pathology, they are destructive for individuals, families and society and require serious effort for the health personnel who treat and follow these patients. This study aims to evaluate the clinical, laboratory, genetic and radiological findings of our twenty-year series with DSD patients and to reveal remarkable issues. Materials and Methods: This retrospective study and DSD patients who were detected were divided into three groups according to the Chicago classification. In this study, there were a total of 92 patients with DSD in the hospital records from 1999 to 2019 and all the data obtained were evaluated descriptive statistical. The distributions of the qualitative data were expressed by count and percentage in frequency tables. Results: The mean presentation age of 92 patients with DSD was 9.45 ± 6.81. These patients were admitted due to suspicious genitalia. Twenty-five out of all patients (27.1%) had sex chromosome DSD patients. The mean presentation age of these patients was 15 ± 0.83 years. We examined the etiologies of thirty-four 46 XY DSD patients. Totally 12 patients had androgen-insensitive syndrome. In our study we found thirty-three, 46 XX karyotypes DSD patients. Twenty seven out of the patients in the same group were found to have congenital adrenal hyperplasia (CAH). Conclusion: The differences in DSD patients maybe are not noticed by both the family and the doctors they first consult. DSD patients may be diagnosed late and genetic analy- sis may be delayed because the first admission to these patients is delayed. These patients maybe are raised in different genders until they are diagnosed by their specialists. The delay in the diagnosis of the patient may also affect the content of the surgical procedure performed. DSD should be considered in every child who presents with suspicious genital anomalies.Öğe When is free air a sign of complication on abdominal plain radiography after laparotomy in pediatric patients?(2018) Sığırcı, Ahmet; Demircan, Mehmet; Gözükara Bağ, Harika; Gürünlüoğlu, Kubilay; Taşçı, AytaçAbstract: Aim: Postoperative free air in the abdomen may not be harmful for the patient, it may be innocent, but it may also be an important indicator or marker of an operation-related complication. In this study we aimed to find out retrospectively when post-operative free air in the abdomen disappears in pediatric patients undergone laparotomy. Material and Methods: From January 2009 to April 2018, records of all pediatric patients under 17 years of age undergoing laparotomy were reviewed. The data of 1570 patients who underwent laparotomy were obtained. Among these patients, 101 patients who complained of vomiting on the first postoperative day were identified. On the first postoperative day, 101 patients with vomiting complaints were found to have abdominal plain radiographs (APR). Among these patients, those who were re-operated were identified. Both groups were statistically analyzed in terms of the disappearance time of free air and demographic information in the APR film. Results: The free air in the group of re-laparotomy continued to be seen for a longer time. We found that free air was lost in APR in 28.7% of patients in 1 day, 60.3% in 2 days, 7.9% in 3 days and 2.9% in 4 days. Conclusion: In our study, we found that free air continued to be seen in APR for 2 days after laparotomy in children. We claim that surgical intervention should be considered as a primary consideration if free air is present in the APR after 3rd postoperative day.
