Ozone therapy prevents renal inflammation and fibrosis in a rat model of acute pyelonephritis.

INTRODUCTION: Not only bacterial characteristics but also oxidative/nitrosative stress could play a significant role in renal parenchymal inflammatory processes in acute pyelonephritis (APN). This study was conducted to evaluate the effect of ozone therapy (OT), as an immunomodulator and antioxidant, on the renal function, morphology and biochemical parameters of oxidative stress in an experimental model of APN in rats. MATERIALS AND METHODS: Forty rats were divided equally into five groups as control, APN, APN + Antibiotic, APN + OT, and APN + Antibiotic + OT. APN was induced by 0.1 ml of freshly prepared Escherichia coli (ATCC 25922) solution containing 10(10) colony-forming unit/ml into the kidney. A control group was administered 0.1 ml of 0.9 % NaCl solution. Treatment was begun 72 h after bacterial inoculation. Control and APN groups were given 0.9% NaCl solution, APN + Antibiotic and APN + OT were given either antibiotic (ciprofloxacine 150 mg/kg intramuscular/twice daily) or OT. APN + Antibiotic + OT group was given both antibiotic and OT for five consecutive days. At the end of the seventh day, animals were killed via decapitation and trunk blood was collected. Both kidneys were harvested and one half of each kidney were immediately stored for antioxidant enzyme activity, tissue lipid peroxidation and protein carbonyl content. The remainder was fixed for histopathologic examination. RESULTS: E. coli-induced APN increased the renal glomerular and tubular dysfunction, oxidative stress parameters and antioxidant enzyme activities. Either antibiotherapy or OT markedly ameliorated renal dysfunction, the antioxidant status of the kidneys and histopathological injuries subjected to E. coli-induced APN. Interestingly, the combination of antibiotherapy and OT was much more effective than either of the treatment modalities alone. CONCLUSION: The combination of antibiotherapy and OT markedly ameliorated renal dysfunction and improved antioxidant status and histopathologic modalities in rats subjected to E. coli-induced APN than either antibiotherapy or OT treatment alone. Therefore, OT may be considered as an adjuvant therapy to classical antibiotherapy to prevent renal inflammation and fibrosis in APN.

Erdosteine and ebselen as useful agents in intestinal ischemia/reperfusion injury.

BACKGROUND: Reactive oxygen and nitrogen species generated during reperfusion of the tissue are characteristic of ischemia/reperfusion (I/R) injury. The purpose of the present study was to investigate whether erdosteine and ebselen, molecules with antioxidant properties and peroxynitrite scavenging capability, respectively, can reduce oxidative stress and histological damage in the rat small bowel subjected to mesenteric I/R injury. MATERIALS AND METHODS: Forty Sprague-Dawley rats were divided into five groups equally: sham, I/R, I/R plus erdosteine, I/R plus ebselen, and I/R plus erdosteine and ebselen. Intestinal ischemia for 45 min and reperfusion for 3 d were carried out. Ileal specimens were obtained to determine the tissue levels of malondialdehide (MDA), protein carbonyl content (PCC), superoxide dismutase (SOD), glutathione peroxidase (GPx), nitrite/nitrate (NO(x)) level and histological changes. RESULTS: Intestinal I/R resulted in increased tissue MDA, PCC, and NO(x) levels and decreased SOD and GPx activities. Both erdosteine and ebselen alone significantly decreased MDA, PCC, and NO(x) levels and increased antioxidant enzymes activities, but all values were different from control. These changes almost returned to control values in the group treated with erdostein and ebselen. Histopathologically, the intestinal injury in rats treated with erdosteine and ebselen as well as combination were less than I/R group. CONCLUSIONS: Both erdosteine and ebselen were able to attenuate I/R injury of the intestine via inhibition of lipid peroxidation and protein oxidation, maintenance of antioxidant, and free radical scavenger properties. Nevertheless, combination treatment showed more promising results, suggesting that scavenging peroxynitrite nearby antioxidant activity is important in preventing intestinal I/R injury.

Appendicitis within an umbilical hernia sac: previously unreported complication in children.

Umbilical hernia is one of the most common congenital pathologies of the anterior abdominal wall in children. Umbilical hernia in children has a high tendency for spontaneous closure. Surgical treatment is performed only for rarely occurring complications. Appendicitis within an umbilical hernia sac is a previously unreported complication for umbilical hernias. We report here the first case in the current English language literature.

Inflammatory Myofibroblastic Tumor Invading the Left Atrium: Report of a Rare Case.

Inflammatory myofibroblastic tumors (IMTs) of the lung are rare solid tumors and usually affect children and young adults. We describe an unusual form of an IMT of the left lower lobe invading the left atrium. A 9-year-old male patient with recurrent cough was referred for an evaluation of left-lung pneumonia. Transthoracic needle biopsy was performed, and the histopathological examination showed mixed inflammatory cells. Accordingly, an IMT was considered. Left lower lobectomy was performed. A portion of the tumor invading the left atrium was resected together with the intact atrial wall. The postoperative period was uneventful, and the patient was discharged on the sixth postoperative day.

Small intestinal lactoferrin and calprotectin levels in different stages of necrotizing enterocolitis in a rat model.

PURPOSE: Necrotizing enterocolitis (NEC) is a severe disease of mostly premature infants with high morbidity and mortality rates. There is no reliable biomarker for detecting newborns at risk for NEC development. We aimed to investigate small intestinal lactoferrin (LF) and calprotectin (CAL) levels as predictors and indicators of disease severity in an experimental newborn rat model. MATERIALS AND METHODS: Newborn pups were randomly divided into two groups, NEC and control. The NEC group pups were decapitated on the second, third and fourth days of the experiment for an assessment of the different stages of NEC. In the study group, hypoxia-reoxygenation model used to induce NEC. As biochemical parameters, small intestinal LF and CAL levels were measured with an enzyme-linked immunosorbent assay technique and intestinal injury scoring was evaluated as a pathologic parameter. RESULTS: Small intestinal levels of both LF and CAL increased in the second and the third day groups, but began to decrease by the fourth day. The first, second and third day levels of LF and CAL were higher than controls. The intestinal injury scores of all NEC groups were significantly higher than the control group. CONCLUSION: Small intestinal lactoferrin and calprotectin were good markers for demonstrating NEC. However, instead of spot testing, monitoring the levels of these markers may be more informative.

The efficacy of mesenchymal stem cell transplantation in caustic esophagus injury: an experimental study.

Introduction. Ingestion of corrosive substances may lead to stricture formation in esophagus as a late complication. Full thickness injury seems to exterminate tissue stem cells of esophagus. Mesenchymal stem cells (MSCs) can differentiate into specific cell lineages and have the capacity of homing in sites of injury. Aim and Methods. We aimed to investigate the efficacy of MSC transplantation, on prevention of esophageal damage and stricture formation after caustic esophagus injury in rats. 54 rats were allocated into four groups; 4 rats were sacrificed for MSC production. Group 1, untreated controls (n: 10). Group 2, membrane labeled MSCs-treated rats (n: 20). Group 3, biodistribution of fluorodeoxyglucose labeled MSCs via positron emission tomography (PET) imaging (n: 10). Group 4, sham operated (n: 10). Standard caustic esophageal burns were created and MSCs were transplanted 24 hours after. All rats were sacrificed at the 21st days. Results. PET scan images revealed the homing behavior of MSCs to the injury site. The histopathology damage score was not significantly different from controls. However, we demonstrated Dil labeled epithelial and muscle cells which were originating from transplanted MSCs. Conclusion. MSC transplantation after caustic esophageal injury may be a helpful treatment modality; however, probably repeated infusions are needed.

Mercaptoethylguanidine attenuates caustic esophageal injury in rats: a role for scavenging of peroxynitrite.

INTRODUCTION: After ingestion of caustic material, tissue damage is caused by reactive oxygen species and reactive nitrogen species such as peroxynitrite. Mercaptoethylguanidine (MEG) is a well-known scavenger of peroxynitrite. This study was designed to determine whether MEG has a beneficial effect on caustic esophageal injury. MATERIALS AND METHODS: Forty-five rats were allocated into 3 groups: sham-operated, untreated, and treated groups. Caustic esophageal burn was created by instilling 15% NaOH in the distal esophagus. The rats were left untreated or treated with 10 mg/kg per day MEG intraperitoneally for 5 days. All rats were killed at 28 days. Efficacy of the treatment was assessed both histopathologically and biochemically. RESULTS: Of 15 rats, 6 (40%) died in the untreated group, and only 1 (7%) rat died in the treated group. The stenosis index (SI) and the histopathologic damage score were significantly lower in the MEG treatment group than the untreated group, which showed a correlation with tissue hydroxyproline level. In the untreated group, tissue oxidative stress parameters (malondialdehyde and protein carbonyl content) were significantly higher; and antioxidant enzyme activities (superoxide dismutase and glutathione peroxidase) were significantly lower. Administration of MEG ameliorated oxidative stress parameters and antioxidant enzyme activities. Urinary nitrate and nitrite levels increased in the treated and untreated groups in the first 3 days, suggesting increased nitrosative stress; but at the fourth day, nitrate and nitrite level reached control values in the treated group. CONCLUSION: Peroxynitrites play an important role in the healing process of caustic esophagitis. As a peroxynitrites scavenger, MEG potentially might be a useful adjuvant agent in the treatment of esophageal caustic burn by modulating the antioxidant defense mechanism.

Pediatric abdominal masses: diagnostic accuracy of diffusion weighted MRI.

PURPOSE: To retrospectively identify apparent diffusion coefficient (ADC) values of pediatric abdominal mass lesions, to determine whether measured ADC of the lesions and signal intensity on diffusion-weighted (DW) images allow discrimination between benign and malignant mass lesions. MATERIALS AND METHODS: Approval for this retrospective study was obtained from the institutional review board. Children with abdominal mass lesions, who were examined by DW magnetic resonance imaging (MRI) were included in this study. DW MR images were obtained in the axial plane by using a non breath-hold single-shot spin-echo sequence on a 1.5-T MR scanner. ADCs were calculated for each lesion. ADC values were compared with Mann-Whitney U test. Receiver operating characteristic curve analysis was performed to determine cut-off values for ADC. The results of visual assessment on b800 images and ADC map images were compared with chi-square test. RESULTS: Thirty-one abdominal mass lesions (16 benign, 15 malignant) in 26 patients (15 girls, 11 boys, ranging from 2 days to 17 years with 6.9 years mean) underwent MRI. Benign lesions had significantly higher ADC values than malignant ones (P < .001). The mean ADCs of malignant lesions were 0.84 +/- 1.7x10(-3) mm2/s, while the mean ADCs of the benign ones were 2.28 +/- 1.00x10(-3) mm2/s. With respect to cutoff values of ADC: 1.11x10(-3) mm2/s, sensitivity and negative predictive values were 100%, specificity was 78.6% and positive predictive value was 83.3%. For b800 and ADC map images, there were statistically significant differences on visual assessment. All malignant lesions had variable degrees of high signal intensity whereas eight of the 16 benign ones had low signal intensities on b800 images (P < .001). On ADC map images, all malignant lesions were hypointense and most of the benign ones (n=11, 68.7%) were hyperintense (P < .001). CONCLUSION: DW imaging can be used for reliable discrimination of benign and malignant pediatric abdominal mass lesions based on considerable differences in the ADC values and signal intensity changes.

Henoch-Schönlein purpura presenting with symptoms mimicking balanoposthitis.

Henoch-Schönlein purpura is a leukocytoclastic vasculitis, characterized with palpable purpuric rush and collection of immunglobuline A (Ig A) around small vessels. Onset of purpuric rush at gluteus and lower extremities is the main symptom of the disease, however it presents with a wide variety of signs and symptoms. Here, we present a two-year-old boy who had presented with penile swelling and color change. Then, purpuric rush was occurred and it was seen spontenous resolution on second day without treatment.

Congenital pouch colon: is it really a rare pathology?

Congenital pouch colon is a condition of a shortened and pouch-like dilated colon and it is usually associated with an anorectal malformation. The pathogenesis and embryology of congenital pouch colon are not well understood, but dietary, environmental factors and familial inheritance may be contributing factors in this pathology. Most of the cases in the literature have been reported from India. This increased regional incidence may be attributed to the lack of awareness of this pathology or its mislabeling rather than regional distribution. Congenital pouch colon is classified into four types based on the length of the abnormal colon. A variable dilatation of the rectum and sigmoid is always present in anorectal malformation. However, there is no clear definition of a limit for the dilatation of the rectum and sigmoid observed in anorectal malformation. Furthermore, many surgeons do not routinely take a biopsy from a dilated rectum or sigmoid during a colostomy procedure in anorectal malformation cases. For these reasons, type IV congenital pouch colon can be easily underdiagnosed. Surgical treatment options in type IV congenital pouch colon include resection of the affected sites of the colon or excisional tapering coloplasty. In the undiagnosed cases, congenital pouch colon results in severe constipation and overflow incontinence. We herein report two additional new cases of type IV congenital pouch colon.

Increasing tendency in caustic esophageal burns and long-term polytetrafluorethylene stenting in severe cases: 10 years experience.

In recent years, lye products have come into common household use in Turkey. Unfortunately, we have noted more cases of serious corrosive esophagitis owing to accidental caustic agent ingestion. The aims of this study were to (1) evaluate our experience with these cases and (2) investigate the effects of long-term intraesophageal polytetrafluorethylene stenting on esophageal remodeling and its impact upon the need for esophageal replacement. Between 1997 and 2006, 68 patients (44 males and 22 females) with accidental caustic agent ingestion were admitted to our department, the only tertiary care referral center for the Turkish Army. Once stabilized, esophagoscopy was performed for injury grading (grades 0, 1, 2a, 3b, 3a, or 3b) as described by Millar and Cywes (Pediatric Surgery. 1998;969-979). Esophagogram was performed 3 weeks after injury to assess healing. At presentation, the injury grade for 24, 31, 11, and 1 cases were 0 or 1, 2a, 2b, and 3a, respectively. One case had gastric outlet obstruction. All cases of grade 0 or 1 injuries had a normal esophagogram at 3 weeks postinjury. For the remaining 44 patients, several treatment modalities have been applied, including antegrade and retrograde dilatations in 31 grade 2a patients, intraluminal stenting in 11 grade 2b patients, esophageal reconstruction in 1 grade 3a patient, and gastroenterostomy in 1. Of the 11 patients with esophageal stenting, 8 patients have resumed a normal diet after 9 to 14 months of stenting. Mean follow up duration is 3.5 years (1-6 years) after stent removal. In the remaining 3 cases, treatment is still ongoing. Esophagitis and esophageal structuring because of caustic agent ingestion is a major public health problem in Turkey. Our small uncontrolled pilot series suggests that intraluminal polytetrafluorethylene stenting may be an effective treatment method to reduce the need for major surgical reconstruction of recalcitrant esophageal strictures.