Person: KIYAN, GÜRSU
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KIYAN
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GÜRSU
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Publication Metadata only Outcome of Very Low and Low Birth Weight Infants with Esophageal Atresia: Results of the Turkish Esophageal Atresia Registry(GEORG THIEME VERLAG KG, 2021) KIYAN, GÜRSU; Oztan, Mustafa O.; Soyer, Tutku; Oztorun, Can, I; Firinci, Binali; Durakbasa, Cigdem U.; Dokumcu, Zafer; Gollu, Gulnur; Akkoyun, Ibrahim; Demirel, Dilek; Karaman, Ayse; Ciftci, Ilhan; Ilhan, Huseyin; Parlak, Ayse; Ozden, Onder; Comert, Hatice S. Y.; Oral, Akgun; Tekant, Gonca; Kiyan, Gursu; Erginel, Basak; Guvenc, Unal; Erdem, Ali Onur; Erturk, Nazile; Yildiz, AbdullahIntroduction 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.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 Open Access Laparoscopic approach for removing a coin trapped in Meckel's diverticulum(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2017) KIYAN, GÜRSU; Karadeniz, Kivilcim; Kalyoncu, Aybegm; Erbarut, Ipek; Kiyan, Gursu; Dagli, Tolga EmrullahForeign body ingestion is a common problem in children. Most of these foreign bodies spontaneously pass through the gastrointestinal tract. When there is a persistent foreign body in the abdomen, it is impossible to make a diagnosis without exploration. We herein present the case of a child who was admitted to our hospital with a coin trapped in Meckel's diverticulum and our laparoscopic approach in this case. The diagnosis of Meckel's diverticulum should be considered when there is a prolonged lodgment of a foreign body in the right lower quadrant, and the laparoscopic approach is the preferred choice in these cases.Publication Open Access An unusual case of childhood sarcoidosis(SOC ARGENTINA PEDIATRIA, 2013-10-01) KARADAĞ, BÜLENT TANER; Gokdemir, Yasemin; Ersu, Refika; Karadag, Bulent; Karakoc, Fazilet; Kiyan, Gursu; Kaya, Handan; Kasapcopur, Ozgur; Erdem, Ela; Dagli, ElifSarcoidosis is a systemic granulomatous disease of unknown etiology that may affect many systems, mainly lungs. Most of the patients present at stages I and II lung involvement. Pulmonary infiltrates without hilar lymphadenopathy (state III) rarely occurs. Extrapulmonary organ involvement is common in pediatric sarcoidosis. The aim of this report is to present an unusual case of childhood sarcoidosis with stage III lung involvement without any extrapulmonary organ involvement. A 7-year-old girl presented with the complaints of malaise, fatigue, weight loss and dyspnea. There was patchy, bilateral ground glass view at high resolution computer tomography. Video assisted thoracoscopic lung biopsy was performed and histopathological examination showed nonnecrotising epitheloid-cell granulomas with giant cells. She did not have any hilar or extrapulmonary organ involvement and pulmonary sarcoidosis at stage III was diagnosed. Sarcoidosis should be considered in the differential diagnosis of children with interstitial lung disease.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.Publication Metadata only Effects of hyperbaric oxygen therapy on caustic esophageal injury in rats(W B SAUNDERS CO-ELSEVIER INC, 2004) KIYAN, GÜRSU; Kiyan, G; Aktas, S; Ozel, K; Isbilen, E; Kotiloglu, E; Dagli, TEBackground/Purpose: Caustic esophageal burn is a serious problem in pediatric surgery. Even though many clinical and experimental studies had been performed, the complication rate could not be reduced to a satisfying level. In this study, the authors evaluated the effects of hyperbaric oxygen (HBO) therapy in caustic esophageal burn in-rats. Methods: Rats were divided into 4 groups, and caustic burn at the distal esophagus was created by applying 50% NaOH for 3 minutes in all groups. The first and third groups did not receive HBO therapy. HBO therapy was applied to the second group for 2 days and to the fourth group for 28 days. To evaluate the effects of short-term HBO therapy, the first 2 groups were compared for ulceration, inflammation, and submucosal vascular thrombosis after 2 days. The third and fourth groups were compared for the long-term effects of HBO therapy. Rats in these groups were killed after 28 days and compared for the collagen content, weight, and mortality rate. Results: In the second group, which received 2 days of HBO therapy, ulcer depth and vascular thrombosis were significantly lower than these in the first group (P = .022 and P = .020, respectively). The fourth group, which received 4 weeks of HBO therapy, had a significantly reduced mortality rate, weight loss, and collagen score and hydroxyproline level if compared with the third group (P = .035; P = .016; P = .028; and P = .033, respectively). Conclusions: These results indicate that HBO therapy is useful in caustic esophageal burn both in short-term and longterm use. (C) 2004 Elsevier Inc. All rights reserved.Publication Metadata only Long-term respiratory outcomes of post-op congenital lung malformations(WILEY, 2021) KARADAĞ, BÜLENT TANER; Dincel, Alican; Yilmaz Yegit, Cansu; Ergenekon, Almala Pinar; Erdem Eralp, Ela; Gokdemir, Yasemin; Kiyan, Gursu; Karadag, BulentBackground Congenital lung malformations (CLM) are rare disorders and surgical intervention is the definitive treatment. Our aim is to evaluate the long-term lung function of patients with CLM after surgery compared to healthy children. Methods Sixteen children with CLM (M/F: 9/7) and 30 age-matched, healthy controls (M/F: 13/17) were included in the study. Demographic data were recorded and both groups were compared by spirometry and the nitrogen-based Lung Clearance Index (LCI). Results Mean +/- SD age of the patients was 12.0 +/- 5.4 years. The mean forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow between 25% and 75% of force expiration (FEF25-75) predicted was, 86.68 +/- 16.65, 88.00 +/- 14.58, 97.44 +/- 9.89, and 79.00 +/- 26.41, respectively in the patient group. Patients with CLM had significantly lower values in FEV1, FVC, FEF25-75 than healthy controls (P = 0.002, P 0.007, P 0.045). While the mean LCI2,5% value in patients' group was 8.33 +/- 1.52, it was 7.28 +/- 0.80 in healthy controls (P = 0.023). Strong inverse correlation between LCI and FEV1, FEV1/FVC was detected in the patient group (P = 0.023; r: -0.581, P 0.017; r: -0.606 respectively). Conclusion This study revealed that, in long-term follow-up, patients who had surgery because of CLM have impairment in the pulmonary function compared to healthy children and LCI may be more accurate in detecting airway diseases early than spirometry.Publication Metadata only Effects of Stamm gastrostomy on gastric emptying rate in rats(KARGER, 2004) YEGEN, BERRAK; Tugtepe, H; Iskit, HS; Bozkurt, S; Kiyan, G; Yegen, BC; Dagli, TEAim: Although frequency of gastroesophageal reflux (GER) increases after gastrostomy, the role of gastric emptying in GER has not been evaluated. In this study, we examined the effects of Stamm gastrostomy on gastric emptying rate in rats and whether Stamm gastrostomy induces GER or not. Methods: Sprague-Dawley rats were divided into three groups. Stamm gastrostomy was done in the first group (SG). Sham operation was carried out in group 2 and the 3rd group served as control. Gastric emptying was assessed using both liquid and solid meals in each group at postoperative 14th day. For solid meal emptying, after fasting of 16 h, the rats were fed for 3 h and gastric emptying rate was measured at the fifth hour. Methylcellulose was used for emptying of liquids and it was given after the animals were fasted for 16 h and gastric emptying rate was measured 30 min later. Histological evaluation for GER was performed in all groups. Results: GER was observed pathophysiologically in 5 of the 7 rats in SG group. Gastric emptying rates of liquid and solid meals were found to be similar in control, SG or sham groups. Conclusion: Surgical gastrostomy does not affect the gastric emptying of solid and liquid meals in rats. Other mechanisms should be considered in the development of GER observed following gastrostomy. Copyright (C) 2004 S. Karger AG, Basel.Publication Metadata only Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study(WILEY, 2021) ERGENEKON, ALMALA PINAR; Atag, Emine; Unal, Fusun; Yazan, Hakan; Girit, Saniye; Uyan, Zeynep Seda; Ergenekon, Almala Pinar; Yayla, Esra; Mertturk, Edanur; Telhan, Leyla; Meral, Ozge; Kucuk, Hanife Busra; Gunduz, Mehmet; Gokdemir, Yasemin; Eralp, Ela Erdem; Kiyan, Gursu; Cakir, Erkan; Ersu, Refika; Karakoc, Fazilet; Oktem, SedatIntroduction Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population. Methods Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed. Results One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease. Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. Conclusion Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications.