Person: KIYAN, GÜRSU
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KIYAN
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GÜRSU
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Publication Metadata only Early pulmonary involvement in Niemann-Pick type B disease: Lung lavage is not useful(WILEY, 2005) KARADAĞ, BÜLENT TANER; Uyan, ZS; Karadag, B; Ersu, R; Kiyan, G; Kotiloglu, E; Sirvanci, S; Ercan, F; Dagli, T; Karakoc, F; Dagli, ENiemann-Pick disease (NPD) is a rare, autosomal-recessively inherited lipid storage disease which is characterized by intracellular deposition of sphingomyelin in various body tissues. The disease is heterogeneous and classified into six groups. Pulmonary parenchymal involvement may be a feature of several subtypes of NPD, including type B. Progressive pulmonary involvement in NPD type B is a major cause of morbidity and mortality It is usually diagnosed at older ages. Only a few cases with early pulmonary involvement have been reported. In this report, a patient with NPD type B, hospitalized with the diagnosis of pneumonia at age 3 months, is presented. Following treatment for pneumonia, she continued to have persistent respiratory symptoms and became oxygen-dependent. High-resolution computed tomography of the chest revealed diffuse interstitial changes. During follow-up, the patient developed hepatosplenomegaly. Lung, liver, and bone marrow biopsies showed characteristic findings for NPD. Biochemical studies also confirmed the diagnosis, and the sphingomyelinase enzyme level of the patient was low. Unilateral lung lavage was performed in order to decrease lipid storage as a treatment modality However, there was no clinical or radiological improvement. The patient died at age 15 months due to progressive respiratory failure. Pulmonary involvement is a rare entity in early childhood in patients with NPD type B, but should be considered in the differential diagnosis of persistent interstitial lung disease. It may cause progressive respiratory failure, but the treatment options remain limited.Publication Metadata only Epididymitis in infants with anorectal malformation(2003) KIYAN, GÜRSU; Kiyan, Gürsu; Dagli, Tolga E.; Iskit, Serdar H.; Tugtepe, HalilOBJECTIVE: To document the characteristics of epididymitis in boys with anorectal malformations. METHODS: Sixty-six boys with anorectal malformation were treated between January 1990 and January 2000, in our center. Four of these boys experienced epididymitis attacks. The first three patients had rectourinary fistula and the fourth had a low type anorectal malforation without a rectourinary fistula. RESULTS: Patients were followed up for seven to nine years and epididymitis did not recur after the definitive operation in the first three patients. The fourth patient had four other episodes of epididymitis postoperatively and no reason for these episodes could be found during the further urological evaluation. Two patients had urinary tract infection and one patient had urinary tract contamination during their episodes of epididymitis. CONCLUSION: The cause of the epididymitis can be anorectal malformation with rectourethral fistula itself or another urogenital anomaly that is associated with anorectal malformation. There is a relationship between urinary tract infection and epididymitis in these patients.Publication Metadata only Double intussusception in an infant(W B SAUNDERS CO, 2002) KIYAN, GÜRSU; Kiyan, G; Tugtepe, H; Iskit, SH; Dagli, TEIntussusception is a common surgical disorder in infancy. Double intussusception (DI), however, is an extremely rare form of this pathology. The authors report a case of idiopathic DI in an 8-month-old girl, which is the third case of idiopathic DI in childhood in the English-language literature. Copyright 2002, Elsevier Science (USA). All rights reserved.Publication Metadata only Esophageal balloon dilation in children: prospective analysis of hemodynamic changes and complications during general anesthesia(ELSEVIER SCIENCE INC, 2007) KIYAN, GÜRSU; Gercek, Arzu; Dogan, Varlik; Dagli, Tolga; Ay, Binnaz; Kiyan, Gursu; Gogus, YilmazStudy Objective: To investigate hemodynamic changes and complications in children during balloon dilation of esophageal strictures. Design: Prospective, controlled study. Setting: University teaching hospital. Patients: 5 ASA physical status I and II pediatric patients with benign esophageal stricture related to ingestion of caustic substances. Interventions: Anesthesia was induced with intravenous propofol two mg/kg and cisatracurium 0.2 mg/kg and maintained with 66% nitrous oxide and one minimum alveolar concentration of sevoflurane in oxygen. In each session, balloon size was increased until the stricture was opened. Measurements and Results: A total of 18 sessions and 99 dilations in 5 children performed over a one-year period were included in the study. In 8 of 18 sessions, esophageal stricture was located in the middle one third of the esophagus; and in the others, in the upper one third. Four cases experienced bleeding; two cases, inability to ventilate due to obstruction of the endotracheal tube tip by the inflated balloon; and two cases, postextubation bronchospasm. In 95 of the 99 dilations, while the balloon was inflated, heart rate was faster and blood pressure increased significantly. Conclusion: Anesthesiologists should keep in mind the possibility of hemodynamic instability and possible endotracheal tube tip obstruction by the inflated balloon and safeguard the airway against bleeding, secretions, and radio-opaque fluid during esophageal balloon dilation. (c) 2007 Elsevier Inc. All tights reserved.Publication Metadata only Testicular biopsy during orchidopexy procedure: Does it have an adverse effect on fertility?(KARGER, 2005) KIYAN, GÜRSU; Iskit, SH; Tugtepe, H; Tugay, M; Kiyan, G; Kotiloglu, E; Dagli, TEIntroduction: The aim of this study is to evaluate the effect of the gonadal biopsy procedure on fertility and histology of the experimentally created undescended testis. Materials and Methods: Thirty Wistar- Albino rat litters were divided into three groups. In the first two groups, undescended testes were obtained by dividing the right gubernaculum in the first 48 h and the third group constituted the sham group. When the rats were 30 days old, orchidopexy was performed in the first group (O), whereas orchidopexy and testicular biopsy were performed in the second group (OB). After the fertility study all rats were sacrificed at week 11 and testicular weights, mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores ( MTBS) were measured. Results: One testis in the O group and three testes in the OB group were atrophied and these rats were excluded from the study. Testicular weights, MSTD and MTBS values of the operated side in the O and OB groups were lower than those in the sham group. There was a statistically significant cant difference between the MSTD values of the ipsilateral testes in the OB group and sham group ( p < 0.05). MTBS values of the ipsilateral testes in the O and OB groups were <8. There was no difference in all parameters in the contralateral testes between all groups (p > 0.05). All the evaluated rats were fertile. While there was no difference in number of fetuses and fertility scores between the O and OB group, however, the differences were significant between each of these groups and the sham group (p < 0.05) Conclusion: Testicular biopsy in the unilateral undescended testis model results in limited histological changes without affecting the fertility.Publication Metadata only The roles of free oxygen radicals, nitric oxide, and endothelin in caustic injury of rat esophagus(W B SAUNDERS CO-ELSEVIER INC, 2004) DAĞLI, EMRULLAH TOLGA; Ozel, SK; Dagli, TE; Yuksel, M; Kiyan, G; Kotiloglu, EPurpose: The authors aimed to find out the roles of free oxygen radicals, nitric oxide (NO), and endothelin (ET) in caustic injury of rat esophagus. Methods: Forty-five Wistar albino rats were used to form 6 groups. The study groups are summarized as 1, sham (S; n = 7); 2, sham + L-arginine (SA; n 7); 3, sham + L-NAME (SN; n = 7); 4, injury (I; n = 8); 5, injury + L-arginine (IA; n = 8); 6, injury + L-NAME (IN; n = 8). Normal saline in the sham groups and 50% NaOH in the caustic injury groups were administered to the distal esophagus. Free oxygen radicals and NO were detected by chemiluminescence from tissue samples, and they were correlated with histologic examinations. Tissue ET was measured also with immunohistochemistry. Results: The injury was verified histologically. Free oxygen radical levels were found to be increased as well as NO and ET with the caustic injury (P < .05). L-arginine caused a histologic increase in the injury that was close to statistical significance (P = .08). L-NAME showed no significant effect. Conclusions: Free radicals, NO, and ET increase in the early phase of caustic esophageal injury. Understanding their early interactions during the caustic injury may help in future therapeutic strategies. (C) 2004 Elsevier Inc. All rights reserved.Publication Metadata only Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula(SPRINGER-VERLAG, 2003) KIYAN, GÜRSU; Kiyan, G; Dagli, TE; Tugtepe, H; Kodalli, NCongenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children.Publication Metadata only Foreign body aspiration in children: The value of diagnostic criteria(ELSEVIER IRELAND LTD, 2009) KIYAN, GÜRSU; Kiyan, Gursu; Gomen, Basar; Tugtepe, Halil; Karakoc, Fazilet; Dagli, Elif; Dagli, Tolga E.Objective: Foreign body aspiration (FBA) is a serious problem in children. While bronchoscopy should be performed in all patients with aspiration; patients without aspiration should be carefully excluded to avoid an unnecessary bronchoscopy. In this study we analyzed the details of our series, complication rates and compared the diagnostic findings between patients with an aspirated FB and those without. We also calculated the sensitivities, specificities, positive predictive values and negative predictive values of clinical history, symptoms, physical examination findings and radiological findings in patients with suspected FBA (sFBA). Finally, we evaluated the validity of our bronchoscopy indications in these patients. Methods: We reviewed the data of 207 patients who underwent rigid bronchoscopy for sFBA. We used clinical history, symptoms, physical examination and radiological findings as diagnostic findings. Complication rates in addition to these four diagnostic criteria constitute our indications for performing a rigid bronchoscopy. Results: After excluding 15 patients with radiopaque FB or previous fiberoptic bronchoscopy, 138 of 192 patients had an aspirated foreign body. The sensitivity and specificity of clinical history, symptoms, physical examination findings and radiological findings were 90.5% and 24.1%, 97.8% and 7.4%, 96.4% and 46.3, and 71.7% and 74.1% respectively. There was only one major complication which caused moderate neurological sequelae. There was no mortality and no thoracotomy or tracheotomy requirement in this group. Conclusions: While symptoms, physical examination findings and clinical history had high sensitivities, radiological findings had the highest specificity. Low specificities of clinical history, symptoms and physical examination findings were due to our expanded bronchoscopy indication, which aimed to include all patients with foreign body aspiration. Our low complication rate facilitated the expansion of bronchoscopy indications, even for patients with slight clinical suspicion. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Publication Metadata only Contradictory supranormal function in hydronephrotic kidneys: Fact or artifact on pediatric MAG-3 renal scans?(LIPPINCOTT WILLIAMS & WILKINS, 2005) KIYAN, GÜRSU; Inanir, S; Biyikli, N; Noshari, O; Caliskan, B; Tugtepe, H; Erdil, TY; Akpinar, I; Kiyan, G; Alpay, HObjectives: Contradictory supranormal renal function (SRF) in unilateral hydronephrosis is a debatable subject resulting from the methodology of nuclear renography or the characteristics of the patient. In this study, we aimed to investigate the frequency and comparison of SRF with MAG-3 scans by 8 different technical analyses in pediatric hydronephrosis. Methods: We reviewed Tc-99m MAG-3 scans in 82 children with unilateral hydronephrosis (52 male, 30 female, mean age: 47.7 +/- 64.5 months). Of 82, 34 also had Tc-99m DMSA scans. Data were reprocessed with 4 different regions of background activity (subrenal, perirenal C-type, perirenal ring, and lateral) at 2 different time intervals (1-2 and 2-3 minute), and 8 different estimates of MAG-3 differential renal function (DRF) were obtained in 67 patients. SRF was defined as DRY greater than 55% in the hydronephrotic kidney. Results: The routine processing protocol showed only 3 renal units with SRF, and all were on the right side (3.6%). After reprocessing, a total of 10 dilated kidneys had SRF in I or more of DRF estimates (5.2% of all estimations). These cases were significantly younger (8.1 +/- 6.7 vs. 42.5 +/- 52.5, P < 0.05) and had a larger renal area ratio (1.25 +/- .24 vs. 1.07 +/- .2 1, P < 0.05). There was no SRF with DMSA. In comparison between MAG-3 and DMSA DRY in 20 children who underwent both tests within 3 months, the best correlation was obtained when C-type correction was used for both agents at 2 time intervals (r: .86 and .84 for early and late time intervals, P < 0.00001, respectively). Conclusions: SRF in unilateral hydronephrosis is, at least, in part, technical in origin in this particular pediatric patient population with tubular immaturity (ie, physiological high background activity) and asymmetric kidney size.Publication Metadata only An unusual case of chylothorax complicating childhood tuberculosis(WILEY, 2008) KARADAĞ, BÜLENT TANER; Cakir, Erkan; Gocmen, Basar; Uyan, Zeynep Seda; Oktem, Sedat; Kiyan, Gursu; Karakoc, Fazilet; Ersu, Refika; Karadag, Bulent; Dagli, Tolga; Dagli, ElifEndobronchial tuberculosis (EBTB) and chylothorax are rare clinical disorders. The concurrence of these two disorders as manifestations of childhood pulmonary tuberculosis has not been reported. We report a 4-month-old boy presenting with chylothorax as the initial presentation of tuberculosis that has been successfully treated with octreotide, antituberculosis drugs and steroid therapy.