Browsing by Author "Parlak, Ayşe"

Now showing 1 - 9 of 9

Cross-sectional imaging and laparoscopic findings of diaphragmatic mesothelial cysts
(W.B. Saunders, 2019-10-30) Sansar, Serpil; Özçakır, Esra; Kaya, Mete; Kandemirli, Sedat Giray; Parlak, Ayşe; Bilgin, Cem; Gürpınar, Arif Nuri; Yazıcı, Zeynep; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; 0000-0001-7686-2561; AAH-6766-2021; HHS-7433-2022; AAI-2303-2021; A-1409-2017; ITP-4695-2023; 22834938400; 57202853581; 57200617643; 7004350616; 6701668723
AIM: To present cross-sectional imaging, surgical findings, and follow-up results of diaphragmatic mesothelial cysts. MATERIALS AND METHODS: Radiological findings for location, size, shape, and internal structure of cysts were reviewed retrospectively. For patients that underwent surgery, surgical reports and laparoscopy images were reviewed. In conservatively managed patients, changes in size and imaging findings of the cyst were assessed during follow-up visits. RESULTS: A total of 13 paediatric cases with an imaging and/or pathological diagnosis of diaphragmatic mesothelial cyst were identified. In all cases, the cystic lesions were located between the diaphragm and the posterolateral aspect of the right lobe of the liver. Eleven lesions (84.6%) had a bi-lobulate shape. Eight of these cases underwent laparoscopic cyst aspiration/unroofing. The postoperative course was uneventful and there were no cases of recurrence. The remaining five cases were managed conservatively with follow-up available in four cases. In three cases (75%), there was reduction in the size of the cysts with a mean volume reduction of 55%. CONCLUSION: Diaphragmatic mesothelial cysts are congenital cystic lesions that are usually detected incidentally. A common pitfall is incorrect interpretation of the lesion as a hepatic cyst. Conservative management with imaging follow-up can be adopted in asymptomatic cases with typical imaging findings.
Double purse -string suturing: An easy plication technique in thoracoscopic repair of diaphragmatic eventration
(W B Saunders Co-elsevier Inc, 2020-05-01) Parlak, Ayşe; PARLAK, AYŞE; Gürpınar, Arif Nuri; GÜRPINAR, ARİF NURİ; Doğruyol, Hasan; Bursa Uludağ Üniversitesi/Tıp Fakültesi; 0000-0001-7686-2561; AAH-6766-2021; AAI-3658-2021
Objective: The aim of this study was to describe a new double purse-string suturing plication method that was developed to minimize difficulties experienced in thoracoscopic plication in pediatric patients.Methods: We retrospectively analyzed the data of patients that underwent diaphragmatic eventration repair with new technique developed in our clinic. In this technique, we perform diaphragm plication with continuous double layer purse-string suturing. A third suturing may be necessary in case of wide eventrations. Thoracic drainage catheter is inserted into the thorax on a routine basis.Results: Thoracoscopic plication was performed using the double purse-string suturing technique on 16 cases that presented with diaphragmatic eventration between April 2012 and December 2018. The patients' mean age was 2.2 years (6 months-17 years). The main causes of admission were recurrent respiratory system infections (n: 14), respiratory distress with effort (n: 4), ventilator dependence (n: 1), and gastrointestinal complaints such as nutritional problems (n: 1). Diaphragmatic eventration was incidentally detected in 1 patient. No complications were observed during the postoperative period, except for 1 patient that developed pneumothorax. The mean duration of hospital stay was 4.9 days (2-7 days), except for 1 patient who had ventilator dependence and congenital myopathy. The mean descending distance of the diaphragm was 2.3 intercostal spaces at postoperative first month. The clinical outcomes were satisfactory and all patients experienced symptom improvements.Conclusions: Diaphragm plication with double purse-string suturing method enables symmetrical stretching of the diaphragmatic muscles. Therefore, the diaphragmatic surface and costophrenic sinium are protected and remain functional. The advantages of this new double purse-string suturing method are easy application and durability. We believe that this method can become a preferred thoracoscopic plication technique for treatment of diaphragmatic eventration.
Gastroözofageal reflü hastalığı tanısında impedans tekniği ile tespit edilmeyen reflü ataklarında 'pH-ONLY olayları' fenomeni ve impedans ile phmetre tekniği arasında özofagusun asit etkisinde kalış sürelerinin karşılaştırılması
(Uludağ Üniversitesi, 2015) Parlak, Ayşe; Doğruyol, Hasan; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.
Gastroözofageal reflü hastalığı (GÖRH) tanısında uzun yıllar altın standart olarak kabul edilen intraözofageal pH monitörizasyonu (pHmetre) incelemelerinde bazı yetersizlikler göze çarpmaktadır. Bu durum özellikle zayıf asit reflülerde ön plana çıkmaktadır. Tekniğin bu kısıtlılığı impedans kullanılarak giderilmeye çalışılmıştır. Fakat bu kombinasyonda da pHmetreye göre üstünlükleri detaylı bir şekilde incelenmemiştir. İmpedansın standardı oluşturulamamıştır. Bu konuda yapılan yayınlar kısıtlıdır. Semptomatik infantlarda ve çocuklarda yapılan çalışmalarda %9-80 oranında impedansda görülmediği halde pHmetrede ortaya çıkan reflü epizotlarına rastlanmıştır. 'pH-only olayları' adı altında toplanan ve incelenen bu durum impedansın aydınlanması gereken problemlerindendir. Biz çalışmamızda impedansda tespit ettiğimiz pH-only olaylarının nedenlerini açıklamaya çalıştık ve her iki teknikte özofagusun asit etkisinde kalma süresini karşılaştırdık. Metod: Şubat 2014 – Ağustos 2014 tarihleri arasında gastroözofageal reflü (GÖR) şüphesi nedeniyle impedans tekniği yapılması planlanan 0-17 yaş aralığındaki 50 hastanın impedans kayıtlarının otomatik analizi incelendi. pH-only reflü olaylarının nedenleri; impedans ölçüm kriterlerini karşılayamayan olaylar, impedans kriterlerini karşılayan ancak reflü işareti olmayan olaylar, artefakt, hava nedeniyle pozitif defleksiyon ve impedans kanallarında değişiklik olmayan olaylar şeklinde sınıflandırıldı. İmpedans kanallarında değişiklik olmayan olaylar da 3 gruba ayrıldı: 1.Çalışma boyunca düşük impedans 2.Asit reflüden sonraki 30 saniye içerisindeki olaylar 3.Açıklanamayan olaylar. İmpedans ve pHmetredeki asit etkisinde kalış süresinin karşılaştırılması için impedans ve pHmetrede eş zamanlı saptanan reflülerin volüm ve kimyasal klirens süreleri bulunarak çeşitli hesaplamalar yapıldı. Bulgular: pHmetrede saptanan asit reflülerin %56.1'i impedansda saptanmadı. İmpedansda saptanmayan bu pH-only reflü olaylarının nedenleri %10 impedans ölçüm kriterlerini karşılamada yetersizlik , %8 impedans kriterlerini karşıladığı halde reflü işareti olmayan pH 4'ün altında olduğu olaylar, %0 Artefakt, %14 hava nedeniyle impedans kanallarında pozitif defleksiyon, %68 impedans kanallarında her hangi bir değişiklik olmayan olaylardan dolayıydı. İmpedans kanallarında her hangi bir değişiklik olmayan olaylar çalışma boyunca düşük impedans olan n:437(%25), önceki asit reflü olayından sonraki 30 saniye içerisinde pH 4'ün altına düştüğü n:342 (%20) , açıklanamayan n:400(%23) olay vardı. pH-only reflüler dışlanarak impedans ile eş zamanlı pHmetrede saptanan reflülerin süresi ve sayısı karşılaştırıldığında anlamlı şekilde farklı sonuçlar elde edildi(p<0,001). pHmetrede asit reflü süresi impedansa göre bariz şekilde fazla idi. Sonuç: pHmetre ile asit reflü olarak kabul edilen olayların yarısından fazlası impedansda asit reflü olarak tespit edilmedi. Buna sebep olan nedenler halen net değildir. İmpedans otomatik analizinin kısıtlamaları göz önüne alınarak tek başına değil de pHmetre ile değerlendirilmesi ve manuel analizin vakit, deneyim gerektirmesine rağmen doğru karar verebilmek için şart olduğu kesindir.
Laparoscopic repair of morgagni hernia in children
(Mary Ann Liebert, Inc, 2022-02-11) Parlak, Ayşe; PARLAK, AYŞE; Gürpinar, Arif Nuri; GÜRPINAR, ARİF NURİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0001-7686-2561; AAI-3658-2021; AAH-6766-2021
Background: This study aims to review laparoscopic repair techniques of Morgagni hernias at a tertiary referral center.Methods: This retrospective study includes pediatric patients who underwent laparoscopic repair of Morgagni hernia between March 2004 and March 2021. The patients' demographics, presenting symptoms, operative approach, and postoperative outcomes were recorded.Results: Fourteen patients underwent laparoscopic repair of Morgagni hernia. The mean age at the time of operation was 24.7 months. Defect closing techniques were intracorporeal knot tying (n: 2), extracorporeal knot tying, and subcutaneous knot placement (n: 10), combination with intracorporeal continuous suturing and several extracorporeal intermittent sutures (n: 2). Different approaches were used during removal of the needle from the insertion point in the extracorporeal knot tying: intracorporeally, using a laparoscopic needle holder (n: 6), with an 18-gauge injector tip (n: 1), and extracorporeally with suture passer forceps (n: 3). In the intracorporeal knot tying technique, the mean operation time was 127 minutes (range 90-180 minutes). In the extracorporeal knot tying technique, the mean operation time was 75 minutes (range 30-180 minutes). The mean operation time in the technique that used suture passer forceps for removing the needle from the same point of insertion was 40 minutes. There was no intraoperative complication.Conclusions: In the laparoscopic repair of Morgagni hernia, full-thickness anterior abdominal wall repair with interrupted sutures that are tied extracorporeally in the subcutaneous tissue by separated minor skin incisions is the easy approach. Using suture passer forceps during removal of the needle facilitates this technique and shortens the operation time.
Non-invasive evaluation of botulinum-A toxin treatment efficacy in children with refractory overactive bladder
(Springer, 2018-06-28) Uçar, Murat; Akgül, Ahsen Karagözlü; Yücel, Cem; Parlak, Ayşe; Kılıç, Nizamettin; Balkan, Emin; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı/Çocuk Ürolojisi Bilim Dalı.; 0000-0001-7686-2561; AAH-6766-2021; AAI-3656-2021; AAI-2145-2021; 57202853581; 7005266570; 7004109012
We aimed to evaluate the efficacy and safety of intravesical onabotulinum toxin A (onaBoNTA) injections for the treatment of children diagnosed with refractory overactive bladder (OAB) by using non-invasive methods. A total of 31 pediatric patients with a mean age of 10.2 years received intravesical onaBoNTA injection at the dose of 10 U/kg (max: 200 U). Twenty-one patients who failed to respond to the first injection, received second injection 6 months after the first one. The patients were retrospectively evaluated after the 1st and the 2nd injections by means of standardized questionnaire forms and voiding diary records. In the 6-month follow-up, 10 patients (32.2%) were determined to have full response after the first injection. The number of patients with partial response and no response were found to be 15 (48.4%) and 6 (19.4%), respectively. The mean value of Dysfunctional Voiding and Incontinence Symptom Score (DVISS) of the patients with full response was 8.5 before the injection, which decreased to 1 at 6-month follow-up and to 0.5 at 12-month follow-up (p < 0.001). Twenty-one patients without full response after the first injection received a second injection 6 months after the first one. Full response was achieved in 9 (42.9%) of the 21 patients who had a second injection, but only partial response was achieved in 9 (42.9%). Three (14.3%) of the remaining patients did not respond to the second injection either. 1-year follow-up evaluations revealed that the rates of the full response, partial response, and no response were 61.3, 29, and 9.7%, respectively. Based on our results, onaBoNTA therapy is an effective and reliable second-line off-label therapy in the management of patients with non-neurogenic OAB that is refractory to medical therapy. Asking the patients/guardians to fill out a standardized questionnaire form before and after the therapy enables easy and non-invasive assessment of the response to the therapy.
Outcome of very low and low birth weight infants with esophageal atresia: Results of the Turkish esophageal atresia registry
(Georg Thieme Verlag, 2021-06-01) Öztan, Mustafa O.; Soyer, Tutku; Öztorun, Can, I; Fırıncı, Binali; Durakbaşa, Çiğdem U.; Dökümcü, Zafer; Göllü, Gülnur; Akkoyun, İbrahim; Demirel, Dilek; Karaman, Ayşe; Çiftci, İlhan; İlhan, Hüseyin; Parlak, Ayşe; Özden, Önder; Cömert, Hatice S. Y.; Oral, Akgün; Tekant, Gonca; Kıyan, Gürsu; Erginel, Başak; Güvenç, Ünal; Erdem, Ali Onur; Ertürk, Nazile; Yıldız, Abdullah; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; AAH-6766-2021
Introduction The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the outcome of very low birth weight (VLBW) and low BW (LWB) infants with esophageal atresia (EA).Materials and Methods The data registered by 24 centers between 2014 and 2018 were evaluated for demographic features, prenatal findings, associated anomalies, surgical treatment, and outcome. Patients were enrolled in three groups according to their BWs (VLBW <1,500g), LWB=1,500-2,500g), and normal BW (NBW; >2,500g).Results Among the 389 cases, there were 37 patients (9.5%) in the VLBW group, 165 patients (42.4%) in the LBW group, and 187 patients (48.1%) in the NBW group. Prenatal diagnosis rates were similar among the three groups (29.7, 34.5, and 24.6%, respectively). The standard primary anastomosis was achieved at a significantly higher rate in NWB cases than in the other groups ( p <0.05). In patients with tracheoesophageal fistula (TEF), patients of the NBW group had significantly higher rates of full oral feedings, when compared with VLBW and LBW cases ( p <0.05). At the end of the first year, when we evaluate all patients, the number of cases with fistula recanalization and esophageal anastomotic strictures (AS) requiring esophageal dilatation was similar among the groups. The weight and height measurements at 6 months and 1 year of age of the survivors were similar in all the groups. The overall mortality rate was significantly higher in the VLBW and LBW groups, when compared with the NBW patients, even in patients with tension-free anastomosis ( p <0.05). The incidence of the associated anomalies was 90.6% in cases with mortality, which was significantly higher than in survivors (59.6%; p <0.05). According to Spitz's classification, the survival rate was 87.1% in class I, 55.3% in class II, and 16.7% in class III. The most common causes of mortality were associated with cardiovascular diseases, pneumonia, and sepsis.Conclusion The national data of TEAR demonstrates that the developmental and feeding parameters are better in NBW patients. Although VLBW patients have higher risk of developing fistula canalization than the LBW and NBW groups, long-term complications, such as anastomotic strictures, weight, and height values, after 1 year are similar in both groups. According to our results, associated anomalies and LBWs are still significant risk factors for mortality in cases with EA.
Reason for inconsistency between ph monitoring and impedance in detecting acid gastroesophageal reflux: PH-only events
(Galenos Publ House, 2021-08-01) Parlak, Ayşe; Doğruyol, Hasan; PARLAK, AYŞE; Doğruyol, Hasan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı; 0000-0001-7686-2561; AAH-6766-2021; ETC-9949-2022
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 (Mil) 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 Mil 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 MIL The reason of this situation has been not clear. For the correct decision, it is important to evaluate Mil recordings together with pH meter results rather than evaluating automatic analysis alone.
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; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim 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.
The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry
(Wiley, 2022-11-25) Comert, Hatice Sonay Yalcin; Guney, Dogus; Durakbasa, Cigdem Ulukaya; Dokumcu, Zafer; Soyer, Tutku; Firinci, Binali; Ciftci, Ilhan; Oztan, Mustafa Onur; Demirel, Berat Dilek; Parlak, Ayşe; Gollu, Gulnur; Karaman, Ayse; Akkoyun, Ibrahim; Gul, Cengiz; Ilhan, Huseyin; Oral, Akgun; Ozcan, Rahsan; Ozen, Onder; Kiyan, Gursu; Erdem, Ali Onur; Ozaydin, Seyithan; Uzunlu, Osman; Yildiz, Abdullah; Erginel, Basak; Erturk, Nazile; Bilici, Salim; Samsum, Hakan; Ozen, Mehmet Ali; Ozcakir, Esra; Aydin, Emrah; Mert, Mehmet; Topbas, Murat; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; AAH-6766-2021
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.