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Volume : 45 Issue : 1 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 45 (1)
Volume: 45  Issue: 1 - 2014
CASE REPORT
1.Bilateral Congenital Diaphragmatic Hernia: A Rare Case Report
Elif Ağaçayak, Mehmet Özer, Abdulkadir Turgut, Ali Özler, Senem Yaman Tunç
Pages 1 - 5
Konjenital diyafragma hernisi nedeni bilinmeyen, oldukça nadir görülen bir doğumsal anomalidir. Diğer anomaliler ile ilişkisi ve farklı klinik desenleri ile çeşitli nedenleri olabileceğini düşündürmektedir. Konjenital diyafragma hernisi 2.500 canlı doğumda 1 görülür. Olguların% 85’inde defekt [1] sol taraflıdır. Konjenital diyafragma hernisi vakalarının çoğu sporadiktir. Ailesel konjenital diyafragma hernisi, tüm vakaların sadece % 2‘ sini [2] oluşturur, oldukça nadirdir. Bu konjenital anomali hemen hemen her zaman doğum öncesi ultrasonografik muayene ile tanınabilir. Tedavisi ile sonuçlar herninin derecesine göre değişkenlik gösterir. Bilateral konjenital diyafragma hernisi kötü prognozile, nadir bir doğumsal anomalidir. Biz sağ taraflı konjenital diyafragma hernisi operasyon sırasında keşfedilen bilateral konjenital diyafragma hernisi olgusu sunulmuştur. Diyafragmatik defekt onarıldı ve bir prolen örgü abdominal kompartman sendromu önlemek için karın yara yerleştirildi. Hasta yine de ameliyat sonrası ciddi pulmoner hipertansiyon nedeniyle öldü. Öncelikle olgu sınırlı sayıda olup bilateral konjenital
diyafragma hernisi, son derece nadirdir. CDH hasta bakımı yenidoğan ve cerrahlar için çok zordur. Olgumuzu sunmamızın amacı özellikle bilateral konjenital diyafragma hernisi olan hastaların tedavi ve sonuçlarını değerlendirmektir.
Congenital diaphragmatic hernia is a relatively rare birth defect with unknown etiology. Its association with other anomalies and distinct clinical patterns suggest that several causes may be involved. Congenital diaphragmatic hernia occurs in 1 in 2500 live births. In 85% of cases the defect is left-sided [ 1]. Most cases of congenital diaphragmatic herniaare sporadic and familial congenital diaphragmatic herniais rare, comprising only 2% of congenital diaphragmatic herniacases[2]. This congenital anomaly can almost always be recognized with prenatal ultrasound screening. There is a high degree of variability in both treatment and outcomes. Bilateral congenital diaphragmatic hernia is a rare birth defect, with grim prognosis. We describe a case of bilateral congenital diaphragmatic hernia discovered while repartitioning right sided congenital diaphragmatic hernia. The diaphragmatic defect was repaired and a prolene mesh was placed on the abdominal wound to avoid abdominal compartment syndrome. The patient nonetheless died post operatively due to severe pulmonary hypertension. Bilateral congenital diaphragmatic hernia, priorly identified through a limited number of case reports, is extremely rare. The
care of congenital diaphragmatic hernia patients is very difficult for neonatologists and surgeons. Our report particularly the management and outcome of patients with bilateral congenital diaphragmatic hernia.

ORIGINAL RESEARCH
2.İstanbul’da Bir Referans Hastanesinin Üçüncü Basamak Yoğun Bakım Ünitesinde İzlenen Çok Düşük Doğum Ağırlıklı Yenidoğanların Klinik Seyri
Özge Serçe, Derya Benzer, Tuğba Gürsoy, Fahri Ovalı, Güner Karatekin
Pages 5 - 10
INTRODUCTION: The outcome of preterm neonates’ varies in different hospitals in developing countries. Due to monitoring the effectiveness of current practice, every hospital should evaluate their own surveillance of up-todate outcome of the infants. The aim of this study is to establish the morbidity and mortality of very low birth weight (VLBW) infants admitted to a referral hospital in Istanbul, Turkey and to analyze risk factors associated with poor outcome.
METHODS: The files of the neonates (≤ 32 gestational weeks, ≤ 1500 g birth weight) who were born and hospitalized in Neonatology unit between January 1, 2010- 2011 at Zeynep Kamil Maternity and Childrens’ Training and Research Hospital were investigated retrospectively. Risk factors were analyzed using logistic regression models.
RESULTS: Of all, 154/370 (41.6%) infants died. The main reasons of mortality were respiratory distress syndrome (RDS) (39.2%), congenital anomalies (14.4%), pulmonary hemorrhage (13.7%), and sepsis (12.4%). In the infants who survived the incidence of retinopathy of
prematurity was 49.6%; of RDS, 44.7%; of bronchopulmonary dysplasia, 29.7%; of patent ductus arteriosus, 21.8%; of intraventricular hemorrhage, 18.6%; of necrotizing enterocolitis, 13%. Lower birth weight, resuscitation at delivery room, RDS, acute renal failure, and umbilical venous catheterization were negatively; cesarean delivery and physiological weight loss were positively correlated with mortality
DISCUSSION AND CONCLUSION: Even with modern perinatal care, deaths of VLBW infants are still common in our hospital in which high risk pregnancies or without follow up pregnancies admitted. Lower birth weight was the significant risk factor for death and short-term disability

3.Otuz Dört Hafta Altı Tekil, İkiz ve Üçüz Gebelik Sonuçlarının Karşılaştırılması
Sevilay Topçuoğlu, Dilek Yavuzcan Öztürk, Tuğba Gürsoy, Güner Karatekin, H. Fahri Ovalı
Pages 15 - 20
INTRODUCTION: We aimed to compare the perinatal characteristics, neonatal morbidity and mortality of singletons, twins and triplets born before 34 weeks of gestation and admitted to our neonatal intensive care unit.
METHODS: Singleton and multiple-birth infants born before 34 weeks of gestation and admitted to our unit between January 2012 and January 2013 were compared in terms of demographic features, natal and neonatal problems. Data were collected from medical records.
RESULTS: Five Hundred Forty-Four infants were enrolled to the study. Among these, 435 (80%) there were singletons, 92 (17%) twins and 17 (3%) triplets. There was no difference between groups according to maternalage, chorio amnionitis, oligohydramniosis, and diabetes.
While all triplet pregnancies had antenatal care, only 43.2% of twin pregnancies and 32.2% of singletons had antenatal care (p<0.0001). As expected, antenatal steroid administration rate was higher in triplets (p<0.01). Although there was no difference between incidence of major morbidities, durations of parenteralnutrition and hospitalization were longer in singleton infants. Mortality
was 21.2 % in singletons, 21.3% in twins. All triplet infants were discharged without any complication.
DISCUSSION AND CONCLUSION: There was no adverses hortterm outcome in multiple-birth infants, comparing with singletons. More over, it was found that neonatal outcome was better in multiple-birth group who had higher antenatal care rate.

4.Gastroözefageal Reflü Şüpheli̇ Çocuklarda pH metre Sonuçlarının Değerlendi̇ri̇lmesi
Cengiz Gül, Ayşenur Cerrah Celayir, Ceyhan Şahin, Gökmen Kurt
Pages 20 - 25
INTRODUCTION: 24 hours pH meter analysis in patient with suspected gastroesophageal reflux has a significant recognition as a method to date. It is planned to determine pH meters analysis of the results correlated with clinical findings in patients with susected gastroesophageal reflux.
METHODS: Between January 2006 and January 2008 in patients with suspected gastroesophageal reflux investigement of the pH meter was made whit in the 24 hours period with a double-channel catheter, and all pH meter records were analyzed and evaluated.
RESULTS: pH meter analysis was made of the 109 patents, 70 males and 39 females. The mean ages was 22 months, ranged between 14 days and 120 months. 14 patients with operated for esophageal atresia with fistula, 59 patients with frequent lung infections, 7 pateints who underwent surgery for left diaphragmatic hernia undervent pH meter investigements. 31 cases with gastroesophageal reflux
were detected in 13 females and 18 males. 13 of 31 cases were with frequent lung infections, 5 of its were intermittent vomiting, 9 of its were with had operated esophageal atresia with fistula, 3 of its were with neurological deficit,1 of the pateint was operated for diaphragmatic hernia. As a results of pH meter; gastroesophageal refluxes were determined in 9 of 14 patients with esophageal atresia with fistula (%64), and 13 of 59 patients with frequent lung infections (%22), and only 1 of 7 patients who underwent
surgery for left diaphragmatic hernia (%14). Intensity and duration of reflux which detected by pH meter were required surgery in 8 cases of 31 patients. A parent of a 6 years old girl which had vomiting didn’t accept surgery. Antireflux surgery procedures were performed in 7 patients, 5 of these patients had undergone previous surgery because of esophageal atresia, among
the other two cases had vomiting.
DISCUSSION AND CONCLUSION: As a results of pH meters, indication for reflux surgery was placed in a small group of patients in our series. Although it seems to be noninvasive investigements especially in patients with frequent upper respiratory tract infections; while making a decision for doing of the pH meter should be more selective due to unconfortable of catheterisation.

REVIEW ARTICLE
5.Akut Skrotum; Çocuk Üroloji̇si̇ni̇n Önemli̇ Bi̇r Aci̇l Durumu
Şefik Çaman, Inanç Cici, Ahmet Koray Pelin, Ayşenur Cerrah Celayir
Pages 25 - 30
Acute scrotum may be seen at any age in boys, especially increases in newborns and adolescenses. The differential diagnosis should be done with inguinal canal pathologies like inflamatory conditions and mass in acute scrotum. A delayed or wrong diagnosis may lead to
irreversible damage and ischemic necrosis of the testicle especially due to torsion of the spermatic cord. Due to the potential testicular loss, torsion of spermatic cord must be considered at differential diagnosis of acute scrotum.The purpose ofthis article is to attract attention, in order
toreduce the loss of testes inpatients withacutescrotum, especially in spermatic cord torsionand testicularischemic necrosis with early surgicalintervention.

ORIGINAL RESEARCH
6.Salin İnfüzyon Sonografisi ile Ön Tanı Konulan Hastaların Histeroskopik Tanılarının Karşılaştırılması
Ahmet Zeki Nessar, Hakan Nazik, Hakan Aytan, Murat Api
Pages 30 - 35
INTRODUCTION: We aimed to compare hysteroscopic diagnosis of patients who were diagnosed preoperatively with the salin infusion sonography and to discuss the efficiency and accuracy of hysteroscopy.
METHODS: Ninety-five patients who underwent hysteroscopy procedure in Dept of Gyn&Ob, Adana Numune Teaching and Research Hospital, between October 2011 to December 2012, included in this study. Preoperative sonohysterography was performed
in all patients who scheduled for hysteroscopy with different indications. Patients underwent to hysteroscopy procedure after the sonohysterographic diagnoses recorded. Afterwards the diagnostic values of these two commonly used methods compared with histological diagnosis that considered the gold standard.
RESULTS: In condition of histological diagnosis was considered the gold standard we found that: diagnostic sensitivity and specifity of sonohysterography, respectively: polyp 90.62% and 90.48%, myoma 84.21% and 100%. Diagnostic sensitivity and specifity of histerography, respectively: polyp 96.78% and 90.48%, myoma 84.21% and 100%.
DISCUSSION AND CONCLUSION: Saline infusion sonography satisfied us about the focal lesions but in our routine practice hysterescopic
approach is gone to widespreading and essential tool for the diagnosis and treatment of endometrial cavity lesions.

7.Gebeli̇kte Anemi̇ni̇n Değerlendi̇ri̇lmesi̇nde Hemoglobi̇n Renk Skalasının Kullanımının Etkinliği
Zübeyde Ekşi, Hediye Arslan Özkan
Pages 35 - 40
INTRODUCTION: This descriptive and prospective study has been conducted in order to determine the effectiveness of a screening test developed by the World Health Organization (WHO Haemoglobin Colour Scale) for the purpose of detecting anemia cases during pregnancy.
METHODS: The study group included 428 pregnant women who applied to Zeynep Kamil Gynecologic and Pediatric Diseases Education and Research Hospital, Outpatient Obstetrics Service for their pregnancy follow-up and found to have no risks associated with their pregnancies. In the study, obstetrical and demographical data of the patients were collected, followed by the determination of haemoglobin values using Haemoglobin Colour Scale (HCS). Haemoglobin values as measured by an automated device in the department were used as a reference.
RESULTS: Based on the findings of this study, the average age of the pregnant women in 28% of whom anemia (hb<11g/dl) was detected was 26.01±5.06 years. HCS was identified to have a sensitivity of 81.67%, selectivity of 92.8% and accuracy of 89.72% for the hb<11g/dl
level. In case of levels hb<10g/dl HCS sensitivity, selectivity and accuracy were determined as 69.05%, 95.8% and 95.52%, respectively.
DISCUSSION AND CONCLUSION: As a result, we concluded that HCS is an easy-to-use and rapid method which may be applied by midwives, nurses and other health-care professionals during anemia screenings and house visits where there is a lack laboratory facilities.

REVIEW ARTICLE
8.Obez ve Morbi̇d Obez Gebelerde Obstetri̇k Anestezi
Yunus Oktay Atalay, Sadık Şahin, Mustafa Eroğlu
Pages 40 - 45
Obesity is a major public health problem all over the world increasing day by day. The prevalence of encounter with this patient group is increasing in our anesthesia practice. When we think that obesity brings some of problems with it, it is obvious that these problems
may be more frequent and severe health problems in an obese pregnant woman. Obesity increases maternal and fetal complications in pregnancy.Cesarean section, diabetes, hypertension and pre-eclampsia, postpartum infection, the risk of tthromboembolism are just a few of these problems.Knowing the physiologic changes in obesity and pregnancy and also their relaitons with the morbidity will all help in planning of the anesthetic approach.

CASE REPORT
9.Konjenital Mezoblastik Nefroma: Olgu Sunumu
Mesut Polat, Resul Arısoy, Emre Erdoğdu, A. Doğukan Angın, Ahmet Semih Tuğrul, Nermin Koç
Pages 45 - 50
We reported a case of 27 year old gravida 3, parity 1, abortion 1 referred to our clinic with the diagnosis of preterm labour and polihydramniosis at 34. gestational week. The ultrasonografic examination of the patient, with no antenatal follow up before, revealed a fetal biometry of 33 weeks and polyhydramniosis. A 63x66 mm solid mass with reguler border which involves the whole right kidney was determined with ultrasonografic examination of the fetus. Blood flow of the mass was also demonstrated with colour-doppler ultrasound. There was no additional pathology in the other systems and left kidney. The patient was counselled with pediatric nephrology
and pediatric surgery departments. Cesarean section was performed with the endication of preterm rupture of membranes and previous history of cesarean section. 2600 gr male baby was delivered. 70x73mm solid mass was confirmed with neonatal examination of the fetus
and nephrectomy was performed on 16th day by pediatric surgery. Pathological examination of the specimen demonstrated congenital mesoblastic nephroma.

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