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Öğe Initial Oxygenation Response to Inhaled Nitric Oxide Predicts Improved Outcome in Congenital Diaphragmatic Hernia(Springer International Publishing, 2014) Tiryaki S.; Ozcan C.; Erdener A.Conclusion: Inhaled nitric oxide therapy seems to increase survival in PH due to CDH. No predictive parameters to orient patient selection could be identified; however, the early response seemed to predict the overall outcome. Good results in our series were attributed to routine use of sildenafil and dopamine, along with the nitric oxide inhalation.Background: Pulmonary hypertension (PH) is the most important complication of congenital diaphragmatic hernia (CDH) and still has a high mortality rate. The aim of this study was to evaluate the effectiveness of inhaled nitric oxide therapy in PH due to CDH.Methods: Hospital records of children who had undergone inhaled nitric oxide therapy for PH due to CDH between June 2009 and December 2011 were reviewed.Results: Twenty-nine patients had a diagnosis of CDH at the time of study, and eight of these patients underwent nitric oxide therapy because of failure of conventional ventilation techniques, which was successful in five of these patients. Patients who had a good overall outcome of nitric oxide therapy experienced rapid improvement (pretreatment, mean PaO2 = 44.8 mmHg; after the first hour of therapy, mean PaO2 = 96.8 mmHg), whereas patients with no response did not have a similar course (pretreatment, PaO2 = 37 mmHg; after the first hour, PaO2 = 54.6 mmHg). © 2014, The Author(s).Öğe The maximum anteroposterior diameter of renal pelvis changes by hydration in cases of ureteropelvic junction obstruction(2013) Alkan M.; Tiryaki S.; Özbek S.S.; Avanoglu A.; Ulman I.Objective: The aim of this study is to investigate the degree of variation of hydronephrosis by hydration in patients with ureteropelvic junction obstruction (UPJO). Material and Methods: Patients with antenatally diagnosed UPJO who admitted in a three months period were evaluated in terms of variation in sonographic findings for hydronephrosis. Serial renal ultrasounds were carried out before and after hydration considering parameters for hydronephrosis. Parameters evaluated on each ultrasound included degree of hydronephrosis, maximum anteroposterior diameter of the renal pelvis (mAPD) and anteroposterior pelvic diameter at hilum (hAPD), renal parenchymal thickness, dimensions of both kidneys, grade of hydronephrosis and the volume of the bladder. Results: Eleven children with unilateral hydronephrosis due to UPJO were evaluated. There were 10 males and 1 female at a mean age of 10.3 (3-30) months. The mean value of mAPD before hydration was 19.3±4.3 and increased to 21.3±4.6 mm (9.6% increase) after hydration showing a statistically significant difference (p=0.006). The corresponding measurements for hAPD before and after hydration were 14.5±3.6 mm and 14.6±3.4 mm respectively (p=0.846). Parenchymal thickness before and after hydration were 7.2±0.53 and 6.9±0.44 respectively which also showed no statistical significance (p=0.335). Hydration was found to have no significant effect on the parameters examined of contralateral kidney. Conclusion: The commonly used ultrasonographic parameters in the follow-up examination of hydronephrotic kidneys are prone to hydration effects. Among these parameters hAPD seems to be less affected. Copyright © 2013 by Türkiye Klinikleri.Öğe Nonneuropathic Neuropathic Bladder - Is it Really Nonneuropathic?(Lippincott Williams and Wilkins, 2019) Tiryaki S.; Eraslan C.; Soyer T.; Calli C.; Ulman I.; Avanoglu A.Purpose: Hinman syndrome is a rare disease with urodynamic findings and a clinical course resembling neuropathic bladder, without a neuropathic etiology. Diffusion tensor imaging is a special technique of magnetic resonance imaging that has recently been used to evaluate the peripheral nerves but has been demonstrated to be applicable for evaluation of the lumbosacral plexus. We examined the lumbosacral plexus using diffusion tensor imaging, which has not previously been reported in patients with Hinman syndrome. Materials and Methods: The study included 12 patients who fulfilled criteria for Hinman syndrome, with severe bladder dysfunction on urodynamics, renal scarring on scintigraphy and no pathological findings on magnetic resonance imaging. The 12 subjects serving as controls required pelvic or spinal magnetic resonance imaging for reasons other than spinal abnormalities. Evaluation was performed with a 3.0 Tesla magnetic resonance imaging system and 16-channel body coil. Tractography was done to examine the lumbosacral plexus. Fractional anisotropy and mean diffusivity were computed and compared between groups for the right and left plexuses. Results: Mean fractional anisotropy was 0.24 and 0.35 for the right plexus in patients and controls, respectively, and 0.24 and 0.36 for the left plexus. Mean diffusivity was 1.39 for the right and left plexuses in patients, and 1.28 for the right and left plexuses in controls (p <0.001 for all). Conclusions: Our study focusing on the lumbosacral plexus as a possible origin of neuropathy revealed abnormal findings in patients with Hinman syndrome resembling nerve injury series. This is the first known study to provide data showing that Hinman syndrome may have a neuropathic etiology. © 2019 by American Urological Association Education and Research, Inc.Öğe Propranolol as the first-line therapy for infantile hemangiomas: Preliminary results of two centers(2012) Celik A.; Tiryaki S.; Musayev A.; Kismali E.; Levent E.; Ergun O.Aim: Despite a mostly self-limiting course, infantile hemangiomas can cause severe functional and/or cosmetic problems. The aim of this study was to determine the efficiency of propranolol treatment on infantile hemangiomas. Methods: Sixty-seven infantile hemangioma patients were included in propranolol protocol in two institutions from 2009 to 2011. Participants included 36 boys and 31 girls. An associate protocol with radiology and pediatric cardiology was constructed for appropriate patient selection. Patients received a dose of 2 mg/kg/day, and all were admitted for the first 24 hours of therapy. Results: Sixty-seven patients were included in the study. Mean age at the initiation of therapy was 7 months (1 to 24 months), and eleven patients were older than 12 months of age when propranolol was started. All patients showed improvement with varying responses. No side effects were detected during the treatment. Conclusion: Previously defined treatments for hemangiomas were efficient, yet had a limited usage because of side effects. Propranolol, with a high efficacy (not as total involution but stabilization and regression) and feasibility deserves to be the first line therapy for infantile hemangiomas even after the proliferation phase. Copyright © 2012 Journal of Drugs in Dermatology.Öğe Telemedicine practices in the pediatric urology department; [Pediatrik üroloji biriminde teletıp uygulamaları](Logos Medical Publishing, 2023) Yücel Ö.B.; Tekin A.; Avcı D.; Tiryaki S.; Bağcı U.; Ulman İ.Objectives: In this study, we aimed to assess the perspective of the patients and the parents regarding their satisfaction with the televisits in our center. Patients and methods: Between November 2019 and December 2021, a total of 247 participants (155 males, 92 girls, median age 76.9 months; range, 4.9 to 518.6 months) who met the inclusion criteria were analyzed. A questionnaire which was prepared to evaluate parents' satisfaction with telemedicine, was sent to parents of the children who were evaluated with televisits. Results: There was no statistically significant difference between the groups in terms of the satisfaction and simplicity scores according to the diagnosis (p=0.099 and p=0.243, respectively). Also, 77% of parents in our study found televisits similar to face-to-face (in-person) visits. Conclusion: Our study results show that patient satisfaction with televisit is high in terms of ease of use, shortened travel time and reduced cost. In addition, televisit provides parents with a positive opportunity to take time off from work. The majority of our participants reported that they desired to continue televisit after the end of the pandemic. © All authors, 2023.Öğe Utilizing the Ex-Vivo Bovine Model in Retrograde Intrarenal Surgery Training(Elsevier Inc., 2024) Teki?n A.; Tiryaki S.; Yagmur I.; Yücel Ö.B.; Bilge O.; Onen A.; Ulman I.Objective: To present an ex-vivo bovine model for retrograde intrarenal surgery (RIRS) training. Materials and Methods: The model was specifically developed for a pre-congress course organized as part of the National Pediatric Urology Congress. The course involved a 2-day online theoretical segment followed by hands-on training. Bovine kidneys were chosen for their anatomical resemblance to human kidneys. The kidneys were sourced from a local slaughterhouse, ensuring the intactness of the pelvis, ureters, and perirenal fat. A Modified Larssen solution was used for tissue preservation. The tissue was positioned within a cardboard box, with specific preparation techniques to ensure realism. During the hands-on training, participants utilized a flexible ureterorenoscope for practice. After the course, participants completed an 18-question survey assessing the model and training experience. Results: Twenty-four participants completed the training and survey. Four out of 8 procured kidneys were suitable. The model's cost was 18 euros. Around 87.5% of participants reported increased RIRS confidence. Those with prior course experience rated the model's anatomical resemblance higher (P = .016). No significant difference was observed in feedback on the model's durability or tactile feedback based on prior experience (P >.05). Conclusion: The ex-vivo bovine model provides a promising alternative for RIRS training. While further studies are needed to validate its widespread application, initial feedback suggests it offers a balance between cost-effectiveness and realistic training experience. © 2024 Elsevier Inc.