Kaan Sönmez

Gazi University, Engüri, Ankara, Turkey

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Publications (73)69.43 Total impact

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    ABSTRACT: Introduction: Short bowel syndrome (SBS) is a clinical condition resulting from the loss of absorptive surface area following resection of 50% or more small bowel. Morphological and functional changes called "intestinal adaptation" occur in the residual intestine. Melatonin exists in the gastrointestinal tract and has effect on mitotic activity. Therefore, we hypothesized that melatonin may have beneficial effects on intestinal adaptation. Materials and methods: A total of 32 male Wistar albino male rats were divided into four groups. In group I (sham-S), small bowel was transected and reanastomosed. In group II (SBS-control), 75% small bowel resection and anastomosis were performed. In group III (SBS-vehicle), after 75% small bowel resection and anastomosis, 2 mL of 5% ethanol in saline was given intraperitoneally once a day. In group IV (SBS-melatonin), after 75% small bowel resection and anastomosis, 300 µg/kg melatonin was given intraperitoneally once a day. After 15 days, small bowels were removed and divided into two segments as jejunum and ileum. Each segment was weight and measured. Histological examination was performed in all samples. Bowel and mucosal weights and DNA/protein ratio were calculated. Apoptotic cells were also identified. Results: The bowel length measurements were statistically longer in group IV. Mucosal and bowel weights were the highest in group IV. The villus height, crypt depth, and the number of mitotic figures were the highest in the jejunum of group IV. Melatonin also gave rise to a significant increase in DNA/protein ratios in group IV. Conclusion: According to this study, melatonin significantly enhanced intestinal adaptation.
    No preview · Article · Apr 2013 · European Journal of Pediatric Surgery
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    ABSTRACT: Vascular access device fragment embolization is a relatively rare but potentially serious complication. The purpose of this study was to report our experience with endovascular retrieval of embolized vascular access device fragments by interventional radiological means. Ten patients with a vascular access device fragment embolism were treated between 2004 and 2010. Attempted retrieval from the vascular bed was performed for five port catheter fragments, two temporary catheter fragments and three guide wires. The demographic data, underlying disease of the patients, type of inserted catheters, interval between implantation and discovery of embolism, interval between discovery of embolization and retrieval and localization and length of the embolized fragments were identified from the patient charts. In nine of the ten patients (90%), radiologic intervention retrieval of the embolized vascular access device fragments was successful. The reasons for intravascular fragment embolism consisted of rupture at the connection site of the chamber or the external hub and the intravascular catheter (n=4), pinchoff syndrome (n=3), operator inexperience (n=3). Embolized catheter fragments or guide wires were retrieved under fluoroscopy by a gooseneck snare. The postprocedural course was uneventful. The radiological retrieval of embolized vascular access device fragments is the preferred method, and it has a high success rate. Considering the potential for devastating complications, patients should be referred to interventional radiology, and the embolized catheters should be retrieved using interventional endovascular techniques.
    Preview · Article · Feb 2011 · Diagnostic and interventional radiology (Ankara, Turkey)
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    ABSTRACT: The management of giant omphalocele (GO) presents a major challenge to pediatric surgeons. Current treatment modalities may result in wound infection, fascial separation, and abdominal domain loss. We report a GO infant who required a delayed closure and was managed using sterile incision drape and polypropylene mesh. A 3080 g full-term female infant was born with a GO. The skin was dissected from the fascia circumferentially without opening the amniotic sac and the peritoneum. Subsequently, two polypropylene meshes of 10 x 10 cm in diameter were sutured to each other. Inner surface of the mesh silo was covered with sterile incision drape. This texture was sutured to the fascial margin. Then, the skin was sutured to the mesh and the silo was closed from the side and above. On the 4th day the reduction was started using thick sutures without anesthesia. This procedure was repeated on every 3rd day. When it came closer to the skin margins, constriction was performed using right angle clamps, each time placed 2 cm proximally to the previous sutures in a circular manner. Silo was removed easily and the skin, subcutaneous layers, and fascia were then approximated on the 42nd day. The postoperative course was uneventful and the infant was well with left inguinal hernia repaired in the 3rd month. The method we used can be performed at bedside and without the application of anesthesia, but should be tried on more patients to determine its effect.
    Full-text · Article · Aug 2010 · World Journal of Pediatrics
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    ABSTRACT: Blind-ending bifid ureter is an extremely rare congenital anomaly. The authors report on a 13-year-old boy who presented with a previous diagnosis of right duplicated ureter and who had undergone a bilateral ureteroneocystostomy for vesicoureteral reflux in another clinic. The revision showed right blind-ending bifid ureter. The embryology, clinic and treatment of this anomaly is discussed.
    No preview · Article · Feb 2010 · Acta chirurgica Belgica
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    ABSTRACT: Necrotizing enterocolitis (NEe) and fokal intestinal perforation (FIP) are two relatively common diseases that require neonatal surgical therapy. NEC affects 7% to 8% of extremely low birt weight infants and >30% of those with NEC require surgical intervensions. FIP appears to be a distinct clinical entity that occurs in 3% of very low birth weight infants. These two diseases are often confused and incorrectly treated. Although it is possible that isolated perforation is merely a focal form of NEC, clear differences in the natural history and pathologic findings in these two disorders contradict this hypothesis. Bowel with isolated perforation shows a local area with full thickness necrosis and acute inflammation, whereas bowel with NEC shows edema, various degrees of inflammation, coagulation necrosis, bacterial invasion, and often areas of submucosal or subserosal gas. Indeed, both diseases likely result from similar factors that affect the perfusion, impairment of the facters that ensure immunologic defense and resistance to rupture of the bowel wall. In recent years, peritoneal drainage treatment is applied for intestinal perforation in extremely low birth weight babies. In this review we make the differential diagnosis of these two disorders and focus on peritoneal drainage to determine its indicatiens.
    Preview · Article · Jan 2010 · Turkiye Klinikleri Journal of Medical Sciences
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    ABSTRACT: Bladder calculi are a common late complication of bladder augmentation with a reported incidence of 10% to 50%, but scrotal calculi are rare. Here we report a patient with augmented bladder who was operated for huge bladder calculi and multiple scrotal calculi, considered to develop due to bladder neck repair. The patient with prior reconstruction for extrophy-epispadias complex in the newborn period underwent sigmoid augmentation and Mitrofanoff stoma formation in the age of nine. At the age of 17, he was admitted to the hospital for macroscopic hematuria, presence of stones in the scrotum, and urine coming out of his scrotum. On physical examination, multiple scrotal stones and a scrotal fistula with a stone in its outer opening were noticed. The patient was operated for bladder and scrotal calculi. The stones, six of which were over 4 cm, were removed. Bladder calculi is a common complication after augmentation cyctoplasty, however with irregular follow up and treatment, scrotal stone formation may occur as a rare complication.
    No preview · Article · Jan 2010 · Turkiye Klinikleri Journal of Medical Sciences
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    ABSTRACT: Endoscopic treatment of vesicoureteral reflux (VUR) by subureteral injection of biocompatible polymers is an established treatment option for reflux. Dextranomer/hyaluronic acid copolymer(Dx/HA) has gained wide popularity for treating VUR. We decided to investigate the antibacterial activity of Dx/HA and its interaction with antibiotics in in-vitro conditions. Materials and Methods: Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Proteus mirabilis suspensions were inoculated into Mueller-Hinton agar media and 30 micro liter of Dx/HA was inoculated in 5 mm diameter pits and the plates were incubated at 37 degree C for 24 hours. At the end of the incubation period, inhibition zones around the discs were measured. Expansion of the inhibition zones towards the pits which contained Dx/HA was considered as synergism. Dx/HA was inoculated into pits made in Mueller-Hinton agar medium without antibiotic discs but containing suspensions of bacteria. These media were incubated under the same circumstances and same measurements were done. All experimental procedures were performed twice. Increase in bacterial zone diameters for >= 5 mm was inoculated was regarded as significant for each agent. Results: Dx/HA caused no difference in bacterial growth either with or without antibiotic discs as determined by inhibition zones in the culture media. Conclusion : Dx/HA will not contribute to UTI if it is used for the treatment of VUR in cases either with or without infection.
    No preview · Article · Jan 2010
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    ABSTRACT: Splenic hamartoma is a rarely diagnosed tumor in children. Most patients with splenic hamartomas are asymptomatic and a few have clinical findings. Most frequently reported symptoms include pancytopenia, anemia, and thrombocytopenia. Less commonly, fever, malaise, and weight loss have been reported. In the last decades, most of the splenic hamartomas were found incidentally during laparatomy or autopsy. The use of modern radiologic imaging techniques such as sonography, computed tomography, radionuclide scintigraphy, and magnetic resonance imaging showed that splenic hamartoma was not as uncommon as it was thought previously. We presented a 28-month-old girl who had a history of frequent infections, fever and anemia. On the physical examination, she had a palpable mass in the left upper quadrant of her abdomen. The sonography and computed tomography revealed that she had a mass of 5 x 4 + 4 cm in the lower pole of her spleen first thought to be a splenic hamartoma. We excised the splenic mass by partial splenectomy. The histopathological findings were compatible with splenic hamartoma. The reported patient is the third case of symptomatic splenic hamartoma in the English treated with partial splenectomy. Despite numerous imaging modalities available, it is difficult to base the a definitive diagnosis of splenic hamartoma solely on imaging. It is often necessary to obtain a tissue diagnosis to eliminate the possibility of malignancy. Spleen has important hematologic and immunologic functions especially in children, therefore, spleen-preserving surgery is an acceptable and desirable principle in the treatment of benign splenic lesions.
    No preview · Article · Dec 2009 · Turkiye Klinikleri Journal of Medical Sciences
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    ABSTRACT: A newborn female infant delivered after a normal pregnancy was found to have a large sacrococcygeal mass. Imaging and laboratory studies suggested this was a sacrococcygeal teratoma. On the 16th day of age, the tumor was completely removed. Histopathologic examination of the tumor showed malignant Triton tumor (MTT). Thus, we describe a female newborn without a family history of neurofibromatosis with an MTT that mimics a sacrococcygeal teratoma. To our knowledge, this is the first report of a sacrococcygeal MTT detected in a neonate.
    No preview · Article · Nov 2009 · Journal of Pediatric Surgery
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    ABSTRACT: Heterotopic gastric mucosa (HGM) occurrence outside of Meckel's diverticulum and intestinal duplication is a very rare pathology of the gut. Herein we report a complicating recurrence of unusual localization HGM in the small intestine. A 13-year-old boy presented with abdominal pain and melena. He had a medical history of prior surgery due to ectopic gastric mucosa, complicated with perforation and bleeding. In the differential diagnosis, Tc99m pertechenate scintigraphy demonstrated ectopic gastric mucosa in the midgut. In laparatomy, approximately 90 cm of the small bowel including the abnormal segment was resected and the patient did well. Gastric heterotopia of the small intestine is a rare pathology. These lesions can be confused with other disorders of the intestine (intussusseption, infectious diarrhea, inflammatory bowel disease, etc). Total resection cures the condition. However, it should be kept in mind that microscopic residuals can cause relapses.
    No preview · Article · Oct 2009 · Turkiye Klinikleri Journal of Medical Sciences
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    ABSTRACT: Foreign body ingestion is a common problem in children. The most commonly ingested objects are coins, toy parts, bones, pins, and disc batteries. The radiolucency of the pull-tabs or stay-tabs of Cola cans constitutes another difficulty. In cases with ingested Cola can stay-tabs, as was in our patient, diagnosis should be confirmed at least by oesophagogram to avoid potential complications.
    No preview · Article · Oct 2009 · Hong Kong Journal of Emergency Medicine
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    ABSTRACT: Gastric volvulus (GV) occurs when the stomach abnormally rotates around one of its axes and is a rare upper gastrointestinal obstruction. We present an unusual case of intrathoracic GV associated with delayed manifestation of congenital diaphragmatic hernia. A 16-month-old female infant presented with a history of projectile non-bilious vomiting for 2 days and mild hematemesis for the last day. Physical examination showed epigastric fullness and pain with abdominal palpation. Complaints of the patient disappeared on the 2nd day after hospital admission. On the 6th day non-bilious vomiting started again and an epigastric mass was palpable. Contrast study of the stomach after oral barium administration showed the mesenteroaxial volvulus of the stomach. At laparotomy, the association of non-necrotic intrathoracic GV with intrathoracic spleen was confirmed. Moreover, the diaphragm presented a giant posterolateral hernia of the left dome. Diaphragmatic repair was performed in addition to gastropexy and splenopexy. The postoperative course was uneventful and the child was discharged on the 5th post-operative day. On follow up after one month, clinical examination and plain abdominal X-ray were normal. GV is a clinical emergency which can be life-threatening for children. Upper gastrointestinal study and CT scan with contrast meal are helpful in the diagnosis of the lesion. We emphasize prompt surgical therapy to avoid gastric necrosis.
    Preview · Article · Sep 2009 · World Journal of Pediatrics
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    ABSTRACT: Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Although many agents have been tried experimentally to treat strictures, few have gained clinical application. The aim of this study was to investigate the influence of mitomycin C (MMC), which inhibits fibroblastic proliferation in treating delayed caustic esophageal strictures. Forty-two rats were allocated into 3 groups. Caustic esophageal burns were created as described by Gehanno. Group A was instilled only with saline. Group B was injured with 10% NaOH and left untreated. Group C was injured and received topical MMC at 0.04% concentration in the fourth week. At 56 days, stenosis index (SI), collagen deposition, and hydroxyproline content (HP) were determined in distal esophageal segments. Statistical analyses were performed. The mean SI in group B was significantly higher than others (SI: 1.15 +/- 0.37 d/lum, P < .05). Collagen accumulation was highest in group B, followed by groups C and A, respectively. Collagen deposition in group C was statistically lower than group B (P < .018). The mean HP in group B was statistically higher than others (5.07 +/- 1.30 microg/mg tissue, P < .05), and similar between groups A and C (1.20 +/- 0.20, 1.91+/- 0.79, respectively, P = .73). In the current study, MMC treatment ameliorated caustic esophageal stricture as reflected in the significantly lower SI. We conclude that MMC application is effective in the treatment of caustic esophageal strictures.
    No preview · Article · Feb 2009 · Surgery
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    ABSTRACT: Aim: Recently, colonic manometry (CM) studies have been used increasingly in order to get more information about colonic motility. No CM study has not been reported from Turkey before, so, in this study we aimed to share the preliminary results of our department. Material and Method: An eight-channel catheter was inserted into the colon via colonoscope under general anesthesia. At least eight hours colonic activities were recorded continuously. During the study, mainly, fasting and post-prandial periods and post-enema response were recorded. Results: The first case was a 17 years old girl at and had severe constipation with megarectosigmoid. Although peristaltic activity was recorded proximal to the sigmoid, there was no peristaltism in dilated rectum and sigmoid, and later this part was removed. The second case was an 11 years old boy with soiling and megarectum unresponsive to any treatment since infancy. After CM, irritable bowel syndrome with constipation was identified and tegaserod was administered. The third case was an 8 years old boy with repaired anorectal malformation and permenant transverse colostomy. After evaluation of unused distal part of the colon, closure of the colostomy was advised to the parents. The fourth case was a six years old boy with difficulty of defecation since infancy and increasing narcolepsy. Abnormal propulsive activities were determined in his CM study and he was taken to the follow-up. The fifth case was a 5 years old boy with lymphoma and gradually increasing obstruction of the colon. There was not any propulsive activity during the CM study. This patient was thought as having paraneoplastic syndrome. The last case was a 17 years old girl with repaired cloacal malformation and transverse colostomy. Motility of distal colon was evaluated prior to colostomy closure and contractions like propagating spastic motor complex were observed. Conclusion: CM, in spite of its invasiveness, is a very useful study, especially in selected cases whose colonic motility cannot been evaluated by the other methods.
    No preview · Article · Jan 2009 · Cocuk Cerrahisi Dergisi
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    ABSTRACT: Objective: Inguinal hernias require early elective repairs when diagnosed within the first six months of life. In this period, the risk of incarceration increases as the age decreases. The aim of the study was to evaluate perioperative findings and postoperative complications of the inguinal hernias in the newborn period. Material and Methods: The 95 newborns (73 male, 22 female), who were operated for inguinal hernias in our clinic between 1991 and 2005 were retrospectively assessed. Results: The age at diagnosis for male and female patients was 27 days and 28 days, respectively. Inguinal hernia repair was performed unilaterally in 72 patients (75.8%) and bilaterally in 23 patients (24.2%). High ligation was the surgical approach for all patients (right 60, left 12, bilaterally 23, and total 118). 80 patients were operated electively (84.2%) and 15 patients had emergent operation due to incarceration (15.8%). The incarcerated tissues were small or large bowels in 10 patients and ovary in 3 patients. Spontaneous reduction due to general anesthesia ensued in 2 patients. Postoperative early complication was wound infection in 4 patients (26.7%) and postoperative late complication was testicular atrophy in 1 patient (9.1%) in the incarcerated group. Thirteen patients of the electively operated group had sliding hernias. Sliding organ was appendix in 2 patients, ovary in 6 patients, ovary and uterine tubes in 4 patients and round ligament in 1 patient. Postoperative early complication was wound infection in 2 patients (1.7%) and postoperative late complication was testicular atrophy in 1 patient (1.2%) in the electively operated group. Neither recurrence nor mortality was seen. Conclusion: Newborn inguinal hernias require early elective repairs because of the high incarceration risks they comprise. Incarceration of newborn hernias not only challenges the surgical practice but also increases the postoperative morbidity.
    No preview · Article · Jan 2009 · Turkiye Klinikleri Journal of Medical Sciences
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    ABSTRACT: In this study we aimed to investigate the effects of different suture materials on wound healing and infection in subcutaneous closure techniques. Twenty-nine rats were randomly allocated to 5 groups. All subjects received 2-cm vertical dermal and subdermal incisions on their backs under sterile and proper surgical conditions. The subdermal cuts were then closed with vicryl (polyglycolic acid), biosyn (monofilament glycomer), prolene (polypropylene) and tissue adhesive (2-octylcyanoacrylate). After 10 days, all sutured areas were examined for seroma, haematoma formation and cosmetic outcome. The incisional lines were excised with 1-cm-wide skin strips and tissue hydroxyproline levels were determined. The specimens obtained were evaluated for the presence of giant cells, mononuclear cells, fibrosis and neutrophils. No differences in tissue hydroxyproline levels were found between any of the suture materials used. Fibrotic process and inflammatory cell infiltration were more prominent in the biosyn and prolene groups than in other groups. Foreign body giant cells were observed in the biosyn group. Vicryl and tissue adhesive should be preferred in subcutaneous closure techniques.
    No preview · Article · Jan 2009 · B-ENT
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    ABSTRACT: Isolated premature thelarche is a common disorder characterized by breast development, usually younger than 2 years, with no other signs of puberty. Although it is usually associated with adrenal or ovarian disorders, hypothyroidism, and use of exogenous hormones or drugs, it may also be associated with long-term use of herbal medicine. Thus, long-term use of preparations such as Foeniculum vulgare, which is used to eliminate gas and regulate intestinal function in children, may cause premature thelarche, and thus, the use of such preparations should be limited.
    Full-text · Article · Dec 2008 · Journal of Pediatric Surgery
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    ABSTRACT: Ureteral injuries represent less than 1% of all traumatic genitourinary injuries. The rarity of traumatic ureteral injury is at least in part because the ureters are relatively well protected in the retroperitoneum. Ureteral injuries after blunt trauma are not common, and bilateral disruption of the ureteropelvic junction (UPJ) has only been previously reported in just one child. This is the first documented case of operative ureteral repair of bilateral complete UPJ disruption with double J ureteral stents in a child.
    No preview · Article · Nov 2008 · Journal of Pediatric Surgery
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    ABSTRACT: Castleman disease is a rare lymphoproliferative disorder of unclear etiology. It usually presents as localized enlarged lymph nodes in children. Surgical excision is curative in localized form. Clinical findings of malabsorption are rarely reported in the literature. Herein, we describe a 14-year-old girl who presented with anemia, failure to thrive, osteoporosis, zinc, and vitamin deficiency. She was diagnosed as localized mesenteric mixed type of Castleman disease. Her clinical findings improved after surgical excision of the mass.
    No preview · Article · Sep 2008 · Journal of Pediatric Hematology/Oncology
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    ABSTRACT: Many factors and mechanisms have been proposed as causes for intussusception (IN); however, the etiology remains unclear. Inflammatory mediators such as tumor necrosis factor (TNF) and interleukin-6 (IL-6), which are elevated during infectious diseases, can significantly affect gastrointestinal motility. Motility changes caused by these agents might contribute to the development of IN. The aim of this experimental study was to determine the preventive effects of indomethacin on lipopolysaccharide (LPS)-induced IN in mice and to investigate the role of TNF and IL-6 on intussusception. Seventy-eight mice were divided into five groups. In the Control group (n=6), no procedure was done. In the Sham group (n=6), 1 ml saline, in the Indomethacin group (n=6), 10 mg/kg of indomethacin, in the LPS group (n=30), 12 mg/kg of LPS was administered intraperitoneally (IP). In the Treatment group (n=30), 10 mg/kg of indomethacin was administered IP following 12 mg/kg of LPS. All animals were laparotomized 6 hours following IP injections. The existence of IN was noted and blood specimens were obtained. TNFalpha and IL-6 plasma level measurements were performed by standard ELISA for mice. The results were compared using the Mann-Whitney U test and one-way ANOVA test. A value of p<0.05 was considered significant. Five mice (1 in the control, 2 in the LPS, 2 in the Treatment group) were excluded from the study. IN was observed in 6 (20%) mice in the LPS group, whereas it was not found in any mice in the Treatment group. Mean TNFalpha and IL-6 levels were statistically higher in the LPS group (394.72+/-403.79; 195.18+/-218.37 pg/ml, respectively) compared to all other groups, including the Treatment group (p<0.05 for each comparison). Within the LPS group of mice, the levels were higher in animals with IN compared to the mice without IN. Increased TNFalpha and IL-6 levels induced by LPS correlated well with the occurrence of IN, and a decrease in these levels via cyclooxygenase (COX) inhibition by indomethacin prevented IN from forming in this experimental model.
    No preview · Article · Apr 2008 · European Journal of Pediatric Surgery