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    Histologic Changes in Eustachian Tube Mucosa of Rats After Exposure to Gastric Reflux
    (WILEY, 2008) Yazici, Zahide Mine; Sari, Murat; Uneri, Cuneyd; Midi, Ahmet; Tugtepe, Halil
    Objective: Reflux is thought to be a risk factor for middle ear disease, but the mechanism underlying this relationship is unclear. In this study, we evaluated the effects of reflux on the eustachian tube (ET) mucosa. Materials and Methods: Twenty-two healthy 150 to 220 g Wistar rats with normal middle ears were used. The animals were divided into three groups according to exposure time: 1-, 3-, and 12-week exposures. Four rats were used as a control group. An experimental model of gastroesophageal reflux was induced under general anthesia. After exposure, the animals were sacrificed, and cross sections of the ETs were prepared. The histologic changes in the ET mucosa were observed under a light microscope. Results: The density of goblet cells, numbers of lymphocytes, polymorphonuclear leukocytes, and eosinophils, subepithelial edema, subepithelial vasodilatation, subepithelial gland formation, and intraepithelial gland formation were compared among the groups; The goblet cell density and numbers of lymphocytes and polymorphonuclear leukocytes were significantly higher in the three exposure groups compared with the control group. Conclusion: Nasopharyngeal exposure to experimental reflux alters the ET mucosa histopathology, which suggests that gastroesophageal reflux has a role in ET dysfunction.
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    Positional installation of contrast (PIC) and Redo-PIC cystography for diagnosis of occult vesicoureteral reflux
    (TURKISH J PEDIATRICS, 2018) Karadeniz-Cerit, Kivilcim; Thomas, David Terence; Ergun, Raziye; Yildiz, Nurdan; Alpay, Harika; Inanir, Sabahat; Dagli, E. Tolga; Tugtepe, Halil
    To evaluate the value of Positional Installation of Contrast (PIC) and Redo-PIC cystography in patients with febrile recurrent urinary tract infection (f-UTI) where voiding cystourethrogram (VCUG) was negative. Patients with recurrent f-UTI with no reflux on VCUG referred to the outpatient clinic of Pediatric Urology, between June 2011 and June 2016 were included in the study. A PIC cystography was performed in all patients. When reflux was found, subureteric injection was performed. Urinary cultures were used for follow-up. Patients that continued having f-UTI, received redo-PIC cystography. PIC cystography was performed on 42 patients. The average age of patients was 8.0 +/- 3.6 years. Vesicoureteral reflux (VUR) was detected in 41 patients. Average follow-up time after PIC cystography was 44.6 months. Thirty-three patients (80.5%) were free of f-UTI after PIC cystography and concurrent subureteric injection. Eight patients continued to have recurrent f-UTI. Six of these patients underwent redo-PIC cystography and PIC-VUR was demonstrated in all patients. After an average follow up of 30.9 months, no f-UTI was seen in these patients. The success rate of 80.5% (33/41) after 1st PIC cystography and subureteric injection increased to 95.1% (39/41) after redo-PIC cystography in six patients. Patients with recurrent f-UTIs without VUR on VCUG are an important challenge. PIC cystography is an important tool in demonstrating occult VUR in these patients. We advise that PIC cystography is performed in all patients with recurrent f-UTI with negative VCUG and redo-PIC cystography in patients who continue to have f-UTI after 1st PIC cystography and subureteric injection.
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    Somatosensory evoked potentials as a screening tool for diagnosis of spinal pathologies in children with treatment refractory overactive bladder
    (SPRINGER, 2017) Thomas, David Terence; Yener, Sevim; Kalyoncu, Aybegum; Uluc, Kayihan; Bayri, Yasar; Dagcinar, Adnan; Dagli, Tolga; Tugtepe, Halil
    Purpose To evaluate the usefulness of somatosensory evoked potential as a screening tool for spinal pathologies in patients with treatment refractory overactive bladder. Methods This prospective study was performed between January 2011 and January 2014. Children > 5 years old with treatment refractory overactive bladder were enrolled after exclusion of anatomical and neurological causes of incontinence. All patients underwent urodynamic studies, spinal MRI, and somatosensory evoked potential (SEP). Sensitivity, specificity, PPV, and NPV were calculated for SEP. Results Thirty-one children (average age 8.3 +/- 2.9 years) were included in the study. SEP was abnormal in 13 (41.9%), and MRI was abnormal in 8 (25.8%) patients. SEP was found to have a sensitivity of 87.5%, a specificity of 73.9%, positive predictive value of 53.85%, and negative predictive value (NPV) of 94.4%. Conclusion In patients with treatment refractory OAB, SEP is an important tool for the screening of tethered cord/spinal pathologies. Our results suggest that a child with a normal SEP study in this group of patients may not require further investigation with MRI.