2021 Cilt 19 Sayı 2

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

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Clinical characteristics and treatment outcomes of patients with malignant extracranial germ cell tumors: A 20-year single-center experience
(Galenos Yayıncılık, 2021-04-02) Küpesiz, Funda Tayfun; Tüysüz, Gülen; Akınel, Ayşe Nur; Tekneci, Ayşegül; Sivrice, Ayşe Çiğdem; Melikoğlu, Mustafa; Pestereli, Hadice Elif; Küpesiz, Osman Alphan; Güler, Elif
Introduction: Germ cell tumors account for 2–3% of all pediatric tumors. The aim of this study was to evaluate the clinical features and treatment outcomes of pediatric patients treated and followed up for extragonadal MGCTs in our center. Materials and Methods: A total of 41 patients diagnosed with MGCTs in the pediatric oncology department of Akdeniz University between June 1999 and June 2019 were evaluated retrospectively. Results: Twenty-nine (71%) of the patients were girls and female dominance (p<0.001). The median age was 3.22 (0–18) years. The most patients in the ≤ 5year age group (p<0.001). Nineteen (44%) of the tumors were gonadal and 22 (54%) were extragonadal. The most common histolology of MGCTs were yolk sac tumor (36%), mixed GCTs (29%), immature teratoma (20%), and dysgerminoma (15%). Twenty-five (61%) patients presented with advanced stage disease and 37 patients (90%) were treated with chemotherapy. The patients with stage I testicular and stage I ovarian germ cell tumors underwent complete tumor resection followed by a watch-and-wait approach with alpha fetoprotein monitoring without chemotherapy. Of six patients with relapse/refractory disease, two patients survived. Two patients who underwent autologous stem cell transplantation showed complete response but later died due to infection. The median follow-up period of the patients was 34.9 (4–190.6) months and the 10-year overall and disease-free survival rates were 77.1±6.8% 77.1±6.8%. Two relapsed refractory patients who underwent autologous transplantation survived at a mean of 33.21 months. Conclusions: The clinical features and treatment outcomes of the patients in our study were consistent with the literature. The fact that most of our patients were symptomatic at presentation and had advanced stage disease when diagnosed highlights the importance of detailed evaluation and examination. Although good outcomes are achieved in patients with early stage disease, new treatment approaches are needed for patients with advanced and relapsing disease
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.
Evaluation of 36 patients with rare factor deficiency
(Galenos Yayıncılık, 2021-06-01) Üzel, Veysiye Hülya; Yılmaz, Kamil; Öncel, Kahraman; Tekin, Suat; Söker, Murat
Introduction: Rare factor deficiencies are predominantly autosomal recessively inherited disorders with a frequency of approximately 1: 500000 to 1: 2000000 in the general population. They account for 3-5% of all inherited coagulation disorders. In this study, we aimed to evaluate the demographic features and clinical findings of 36 patients who were followed up and treated with the diagnosis of rare factor deficiency. Materials and Methods: A total of 36 patients aged between 0-16 years diagnosed with rare coagulation deficiencies were evaluated in terms of demographic, physical examination, clinical follow-up, and laboratory findings at the Dicle University Pediatric Hematology Unit. Ethics committee approval was obtained from Dicle University for the study on 16.03.2018 with decision no 115. Results: Rare factor deficiencies were diagnosed in 36 (35 %) of 103 patients who were followed up with coagulation disorders. Hemophilia a, hemophilia b, and von Willebrand disease constituted 67 of our patients. Familial consanguinity was present in 75, 6 %, and positive family history was found at 16.6% of the patients. 11 (32.4%) of our patients were diagnosed under the age of one year. Most of our patients diagnosed with factor X deficiency (38.8%). The most common symptoms were mucocutaneous bleeding (50%). Intracranial hemorrhage was detected in 7 (%19,5) patients. Conclusions: Early diagnosis and treatment are very important in the case of rare factor deficiency since severe bleeding complications such as intracranial hemorrhage may develop. Rare factor deficiencies are seen more frequently in places where consanguineous marriage is more common than the general population. Families should be informed about this issue, and family screening should be done early.
Exclusive breastfeeding duration, breastfeeding continuation and associated factors among Turkish mothers: A baby-friendly hospital study from Konya, Turkey
(Galenos Yayıncılık, 2021-04-25) Alp, Esma Keleş
Introduction: Identifying and understanding the factors on exclusive breastfeeding duration and continuation at the community level in a clinician’s setting is vital for designing interventions to improve. The objective of this study was to evaluate the factors associated with exclusive breastfeeding time and total continued breastfeeding period among mothers in the middle region of Turkey. Materials and Methods: A questionnaire form including; information about women’s and children’s socio-demographic characteristics and breastfeeding habits was used. Results: A total of 1041 mothers were included in the study. Exclusive breastfeeding time and total continued breastfeeding period were found as 5.45±1.98/month and 17.56±8.17/month, respectively. On the other hand, most of the mothers (74.9%) exclusively breastfed their children more than 6 months while only 35% of mothers continued breastfeeding over 24 months. Current study showed that types of first prelacteal feeds, maternity age (30-40 years of age), socioeconomic status, single child birth and doctor/nurse as the source of knowledge about benefits of breastfeeding were strongly associated with the exclusive breastfeeding time of ≥6 months. In addition, young mothers (20-30 years of age), primiparous, breast milk as the first prelacteal feed, lower educational level, low socioeconomic status, nuclear type of family status and doctor/nurse as the source of knowledge about benefits of breastfeeding were found to be strongly associated with total continued breastfeeding period of ≥24 months. Conclusions: Certain factors can be associated with exclusive breastfeeding duration and breastfeeding continuation. So, community-based proposals should be prepared by working on the determined factors to improve breastfeeding duration.
Knowledge levels of vocational high school students about substance addiction and sexually transmitted diseases
(Galenos Yayıncılık, 2021-03-24) Börekçi, Gülay; Uysal, Derya Akdeniz; Özel, Arzu; Aksu, Döne; Yılmaz, Mualla; Sarı, Ayşe Yüksel; Aşkan, Fahri Aşkan; Yiğit, Ümit; Tekgül, Nilüfer; Coşkun, Adnan Batuhan; Özdemir, Özcan; Emül, Tuba Güner; Uzel, Asiye; Değirmenci, Filiz; Yiğit, Rana; Taşdelen, Bahar
Introduction: This study was carried out to determine the knowledge levels of vocational high school students about substance addiction and sexually transmitted diseases (STDs). Materials and Methods: 20691 students from 22 vocational high schools were included in this study, and it was conducted with a total of 1929 students selected with stratified sampling. The data obtained in this study was collected using a questionnaire form. Results: The mean age of the students was 16.58±1.17, of which 54.1% were male, and 57.4% were high school 9-10th grade. It was determined that most of the students (95.9%) lived with their families and 25.2% of them came with migration. 95.5% of the students stated that they had information about the health hazards of cigarettes, alcohol and other substances. While 60.9% of students stated knowing HIV/AIDS, 55.7% hepatitis B and 45.2% hepatitis C from STDs, 70.1% stated not knowing genital wart, 76.3% gonorrhea, 76.7% syphilis, 86.7% chlamydia, and 87.6% trichomonas. More than half of students stated knowing that STDs have symptoms like vaginal discharge odor (56%), inguinal pain (52.8%), itch (52.1%), and wart and blister (54.3%) in sexual organs. It was determined that more than half of the students do not know complications of STDs, and 41.5% of students stated that condom usage in every intercourse was necessary. 68.8% of the students did not receive any education about STD. Conclusions: It was determined that the vocational high school students did not have enough information about STD and substance abuse and peer-based education were planned for the students
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.
Retrospective evaluation of neonatal morbidities of full-term and early term newborns
(Galenos Yayıncılık, 2021-05-13) Yarcı, Erbu; Uraş, Nurdan
Introduction: Newborns having a gestational age between 37 to 416/7 weeks are defined as term newborn. The aim of the study was to investigate the rates and causes of hospitalization, and the differences in neonatal morbidities between early-term and full-term infants as a single-center experience in our hospital. Materials and Methods: This retrospective study was carried out in a tertiary neonatal intensive care unit between January 2013 and December 2014. Maternal characteristics and comorbidities; neonatal characteristics, length of hospital stay, and neonatal morbidities were recorded. Primary outcome measure was need for neonatal intensive care unit (NICU) admission. Results: Maternal comorbidities, ceserean delivery, low birth weight, SGA and multiple gestations were found to be higher in early-term infants and earlyterm infants were at higher risk for respiratory morbidities, respiratory support requirement, hypoglycemia and intravenous antibiotic therapy. After multivariate logistic regression analyses, only higher risk for respiratory morbidity persisted (OR:1.28 [1.02-1.59]; p=0.02). In contrast to that, full-term infants was found to be at higher risk for hypernatremia compared to early-term infants. Conclusions: Early term birth is associated with a higher neonatal morbidity and NICU admissions, and gestational age is known to be the most important determinant of this situation. With advanced maternal care and better understanding of the factors causing early term birth will lead to prevention and successfull management of this risk group.

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