2021 Cilt 19 Sayı 2

Permanent URI for this collectionhttps://hdl.handle.net/11452/24568

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Browsing by Department "Çocuk Cerrahisi Ana Bilim Dalı"

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    Diagnostic discordance-based inferences regarding imaging modalities in children with a preliminary diagnosis of choledochal cyst: Clinical experience and review of literature
    (Galenos Yayıncılık, 2021-04-25) Özçakır, Esra; Kaya, Mete; Tıp Fakültesi; Çocuk Cerrahisi Ana Bilim Dalı; 0000-0002-0773-7430; 0000-0002-8877-5737
    Introduction: Definitive diagnosis is essential for the medical and surgical management of pediatric patients with a preliminary diagnosis of a choledochal cyst. Our study aimed to investigate the roles of Magnetic Resonance Cholangiopancreatography (MRCP), Intraoperative Cholangiography (IOC) in differential and definitive diagnosis of choledochal cyst by comparing their results with the intraoperative gross pathological appearance. Materials and Methods: The medical records of seven pediatric patients preliminary diagnosed with choledochal cyst between May 2014 and January 2021 in our clinic, were retrospectively reviewed. We investigated the clinical characteristics, the MRCP and IOC results, and compared their results with the intraoperative gross pathological findings of patients with preliminarily diagnosed choledochal cyst. We evaluated the outcomes involving the preliminary diagnosis and subtype of choledochal cyst with MRCP preoperatively and with IOC and gross pathological findings intraoperatively. Results: Six patients had undergone a laparotomy and IOC procedure, and their results were: in three, the MRCP and IOC results were consistent, both revealing a Type-I choledochal cyst; in another patient, MRCP revealed a Type IV choledochal cyst, whereas IOC showed a Type-I choledochal cyst; one patient reported having a Type-II choledochal cyst in MRCP turned out to have a duodenal duplication cyst intraoperatively; the sixth operated patient had an MRCP result of Type-I choledochal cyst, but the IOC was consistent with biliary atresia and severe hydropic bile stasis. The last child was a non-operated patient whose MRCP revealed a Type-I choledochal cyst whereas contrast-enhanced liver magnetic resonance showed a simple liver cyst. Conclusions: Even though MRCP is valuable regarding choledochal cyst’s differential diagnosis, we should confirm its diagnosis by IOC and intraoperative gross pathological view because other pathologies might appear similar to choledochal cyst in MRCP.
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    Reason for inconsistency between ph monitoring and impedance in detecting acid gastroesophageal reflux: Ph-only events
    (Galenos Yayıncılık, 2021-06-20) Parlak, Ayşe; Doğruyol, Hasan; Tıp Fakültesi; Çocuk Cerrahisi Ana Bilim Dalı; 0000-0001-7686-2561; 0000-0002-8642-5899
    Introduction: Acid reflux events detected by pH and not identified by impedance are called ‘pH only events’. We aimed to explain the incidence and the possible reasons of ‘pH– only events’. Materials and Methods: The automated multichannel intraluminal impedance (MII) analysis in 50 cases was investigated. Changes in impedance channels during pH-only acid reflux events were examined and grouped. 1. Events that fail to meet the impedance measurement criteria 2. Events with no change in impedance channels 3. Events that meet the impedance criteria, but do not have signs of reflux 4. Artifact 5. Positive deflection due to air. Results: The number of acid reflux events detected in the MII records was 1475, the number of acid reflux events detected in the pH meter was 3093, and the number of pH-only acid reflux events was 1736. 56.1% of the acid reflux events were detected by pH meter not identified by MII. The most common reasons for this were events no changes in impedance channels (68%) and other reasons such as positive deflection due to air (14%), and events that could not meet impedance measurement criteria (10%). 8% of pH-only events that met MII criteria, but were not accepted as reflux by MII. Conclusions: There was more than half of acid reflux events detected by pH meter but not identified by MII. The reason of this situation has been not clear. For the correct decision, it is important to evaluate MII recordings together with pH meter results rather than evaluating automatic analysis alone.