Pancreatic transplantation in the rat. Long-term study following different methods of management of exocrine drainage.

A major problem in pancreas transplantation is the management of exocrine drainage. Isotransplantation has been performed in streptozotocin-induced diabetic rats using a microsurgical technique, and four methods of exocrine drainage have been compared over a nine-month period. The duct system was ligated, left open to drain into the peritoneal cavity, or obliterated with latex or with Ethibloc I occlusion gel. Biochemical follow-up included determinations of serum glucose concentration, intravenous and oral glucose tolerance tests (GTTs), and insulin assays. Histological studies were performed at 1 and 9 months posttransplant. All animals became normoglycemic after the operation. Although 25 out of 28 remained normoglycemic throughout the period of study, oral GTTs performed at six months indicated impaired endocrine function in some of the ligated, freely draining, and Ethibloc I-obliterated animals. Latex-obliterated grafts showed normal oral GTTs up to 9 months postoperatively. Intravenous GTTs showed impairment of endocrine function in all groups, but this was least evident in the latex-obliterated rats. These changes were supported by the peak serum insulin levels during the GTTs. Histologically, long-term ligated, freely draining, and Ethibloc I-obliterated pancreas grafts showed similar degrees of exocrine degeneration, fibrosis, and disruption of islets of Langerhans. In contrast, long term latex-obliterated pancreas grafts demonstrated minimal exocrine tissue and intact islets.

Amputation rate in 147 Turkish patients with diabetic foot: the Hacettepe University Hospital experience.

To determine the lower extremity amputation rate and the risk factors for amputation, we analysed the medical records of 147 Turkish diabetic patients who have been referred to the clinic with diabetic foot. Eleven patients (7.5%) had type 1, and 136 patients (92.5%) had type 2 diabetes mellitus. Fifty-four patients (36.7%) have undergone amputation due to diabetic foot. Femoropopliteal by-pass has been performed in 4 patients in the non-amputees group who did not have gangrene. None of the patients in the amputees group has undergone a revascularisation procedure. Considering all lower-extremity amputations in the group studied, 25.9% were transphalangial amputations, 3.7% were transmetatarsal amputations, 7.4% were Syme type amputations, 51.9% were below-knee amputations, and 11.1% were above-knee amputations. In a logistic regression model, age, gender, duration of diabetes, smoking history, hypertension, retinopathy, nephropathy, and peripheral neuropathy were insignificant factors in determining the risk of amputation. In contrast, presence of peripheral vascular disease (odds ratio 4.0, 95% CI 1.17-13.4; p = 0.03), osteomyelitis (odds ratio 3.73, 95% CI 1.08-12.6; p = 0.04) and gangrene (odds ratio 30.8, 95% CI 7.39-121.5; p < 0.0001) were found to be the significant predictors of amputation. The mortality rate due to amputation during hospital stay was 13.2%. These data suggest that lower extremity amputation is a frequently encountered outcome of the hospitalized patients in Turkish diabetic population with diabetic foot which mainly occur due to peripheral vascular disease, osteomyelitis and gangrene. Lack of adequate vascularisation procedures might have contributed to a high percentage of major amputations in the group studied. Population-based studies should be undertaken in order to determine the status of lower extremity amputation as a whole in Turkish diabetic population.

A comparison of two nonsteroidal antiinflammatory drugs (diflunisal versus dipyrone) in the treatment of moderate to severe cancer pain: a randomized crossover study.

The efficacy of diflunisal in cancer pain was evaluated and compared with dipyrone. Diflunisal was given at the dosage of 500 mg perorally twice a day, and dipyrone was given at the dosage of 500 mg perorally three times a day. Duration of each treatment was 7 days; after a 12-hour wash-out period, patients were given the other drug for another 7 days. A total of 50 patients were enrolled in the study. Pain intensity was assessed by 10-point visual analog scale (VAS). Patients who had a VAS score higher than 5 were included. A total of 47 patients were evaluable. Initial VAS score was a mean of 8.57+/-1.33. Diflunisal reduced the pain score by a mean of 4.65+/-3.10, whereas dipyrone reduced the pain score by a mean of 3.25 < or = 2.85 (p < 0.001). Patients were also analyzed in three subgroups according to the presence of nonmetastatic, metastatic, and bone metastatic diseases. In each of these subgroups, diflunisal reduced the pain score more than dipyrone; however, the difference was statistically significant only in patients who had bone metastasis. Adverse reactions were rare and acceptable with both drugs. Diflusinal is superior to dipyrone at this dosage and schedule in the treatment of moderate to severe cancer pain.

Congenital vulvar teratoma in a newborn.

The most common site of teratomas in neonates is in the sacrococcygeal region. Herein the authors describe a congenital teratoma, and to their knowledge it is the first reported case of vulvar site in a newborn. Tumor was removed on the fourth day of life, and she was completely normal 18 months after the operation. Because of possible malignancy or recurrence, complete surgical excision of the tumor and careful follow-up is the treatment of choice. J Pediatr Surg 36:620-621.

Pentoxifylline inhibits overflow and reduces intestinal reperfusion injury.

The aim of this study was to determine the effects of pentoxifylline (Ptx) in reperfusion injury of the small bowel as a leukocyte stabilizer, free radical scavenger, and microcirculatory regulator. Ninety-six male Sprague-Dawley rats were used to determine the biochemical, histopathologic and blood flow changes of the reperfused small intestines after 30 minutes of a warm ischemic insult. Animals were divided into six groups: Sham (S), sham plus Ptx (SP), ischemia (I), ischemia plus Ptx (IP), reperfusion (R), and reperfusion plus Ptx (RP). Pentoxifylline was administered intraperitoneally at a dose of 50 mg/kg 15 minutes before ischemia. The superior mesenteric artery (SMA) was occluded distal to the right colic artery and collateral arcades were ligated as described by Megison. Sixty of the 96 rats (n = 10) were used to determine histopathologic changes, malondialdehyde (MDA), and myeloperoxidase (MPO) levels in tissue. Mucosal lesions were graded on a scale from 0 to 5 as described by Chiu. MDA and MPO levels of the intestinal mucosa were assayed to reflect the free radical formation and neutrophil sequestration, respectively. Thirty-six rats (n = 6) were used to measure blood flow changes of the intestine using 133Xe clearance technique. All data were presented as the mean values plus or minus the standard error of the means (means +/- sem). Although in the R group, mucosal injury score, blood flow, MPO, and MDA levels were higher significantly from the other groups (P < .05), in the RP group blood flow, MPO, and MDA levels were significantly decreased to the basal values (P < .05). Mucosal injury score of the RP group were lower than the reperfusion group but higher than the normal (P < .05). The authors conclude that pentoxifylline pretreatment before reperfusion stabilizes blood flow, decreases MPO and MDA levels to the normal, and attenuates but not completely prevents mucosal damage.

Treatment of chronic hepatitis C infection with interferon alpha-2a in a Turkish population.

Recombinant interferon (IFN) alpha has been shown to normalize the aminotransferase levels in approximately half of patients with chronic hepatitis C virus (HCV) infection. Twenty four patients with chronic HCV infection were treated with IFN alpha-2a subcutaneously, three times a week for 6 months. All patients responded to IFN therapy with a decrease of alanine aminotransferase (ALT) level. Thirteen out of 24 cases (54.2%) had normal ALT levels at the end of the sixth month of therapy. However, four of these complete responders (30.8%) relapsed during the 12 month follow-up. Relapse was high in the partial responder group (45.5%). Overall relapse rate was 37.5% at 6 months. HCV genotype II, which is associated with a low response rate to IFN was prevalent (85-87%) in our patient population. This study shows that interferon therapy can be effective in reducing transaminase levels in patients with chronic hepatitis C in a population with a high prevalence of HCV type II. The relapse rate after discontinuation of treatment, however, remains a problem.

The split notochord syndrome with dorsal enteric fistula, meningomyelocele and imperforate anus.

A male infant was referred to our department because of lumbosacral meningomyelocele, dorsal enteric fistula and imperforate anus. The mother had received a parenteral drug containing estradiol benzoate and progesterone for inducing abortion in the first trimester. She also used an anal pomade containing triamcinolone and lidocaine-HCl during the pregnancy for hemorrhoids. Sigmoid end colostomy was performed after meningomyelocele repair. On abdominal exploration a wandering spleen was detected but no other anomalies. Two months later, an abdominoperineal pullthrough was performed, and the patient was discharged well after three weeks. Our case is the sixth that had split notochord syndrome associated with dorsal enteric fistula and imperforate anus. Additionally, penoscrotal transposition and wandering spleen were present in this case. To our knowledge, these associated anomalies have been extremely rare.

Comparison of preputial sac and urine cultures in healthy children.

The aim of the present study was to examine subpreputial bacteriology and to compare it with the urine cultures of healthy male children. Seventy-two male children were divided into two groups as A and B according to age. In both groups preputial sac and urine cultures were taken simultaneously. Gram (+) enteric cocci were the most common isolated pathogens from the preputial sac in group B. Enterobacter, E. coli and staphylococci species were isolated from the urine cultures of three patients in group B. We could not find any difference between the preputial sac swabs of group A and B patients, but the isolation rate of urine cultures of group A patients was significantly higher than group B (p < 0.05). The findings of the present study support a potential role of the prepuce acting as a reservoir of faecal bacteria in the pathogenesis of UTI in male infants, especially in the first year of life. Improved penile hygiene after the first year of life does not alter the subpreputial bacteriology, but significantly decreases the contamination of urine.

Ectopic adrenocortical nodules along the spermatic cord of children.

OBJECTIVE: Nodules of ectopic adrenal cortex are found incidentally during inguinal operations. These rests have some clinical significance as they may undergo marked hyperplasia in conditions associated with excessive ACTH production, and occasionally may give rise to neoplasms. In the present study, it is aimed to evaluate the ectopic remnants of adrenal tissue encountered during the inguinal operations in children. PATIENTS AND METHODS: Four hundred and fifty-two inguinal operations were performed on 397 children (325 male/72 female; mean age 2.7 years), during a period of 36 months. Nodules resembling ectopic adrenal tissue from eleven patients (2.7%) were removed and the histopathological examination was performed using hematoxylin-eosin staining. RESULTS: Ectopic adrenal cortical tissues were found in eight male patients (2%), located within the distal end of the spermatic cord. Macroscopically, the nodules were round to oval in shape, 1 to 5 mm in diameter, and bright yellow to orange in colour. Microscopically, they had three layers of adrenal cortex surrounded by a fibrous capsule and none contained any medulla. Hyperplasia or neoplastic changes were not detected, and no fetal cortex was identified. CONCLUSIONS: It is important for surgeons to be conscious of the possibility that a nodule along the spermatic cord may be the ectopic adrenal cortical tissue. As they are associated with hyperplasia and neoplastic change, removal of ectopic adrenal cortical tissue is warranted whenever it is encountered, but a routine search for them is not mandatory.

Splenectomy reduces remote organ damage after intestinal ischaemia-reperfusion injury.

PURPOSE: In this study, we aimed to reduce mononuclear phagocytic system (MFS) cells with splenectomy and investigate its preventive effects on lung, liver, and kidney ultrastructure and free radical generation after intestinal ischaemia-reperfusion (IIR). METHOD: Forty adult male albino Wistar rats were randomly divided into four groups as sham laparatomy (SL), splenectomy + sham laparatomy (SSL), intestinal ischaemia-reperfusion (IIR), and splenectomy + intestinal ischaemia-reperfusion (SIIR). One hour of mesenteric ischaemia and four hours of reperfusion were applied. Splenectomy was performed just before reperfusing the intestine. Serum levels of malonedialdehyde (MDA) was measured, and tissue samples obtained from the lung, liver, and kidneys were fixed in 2.5% glutaraldehyde for electron microscopy. RESULTS: Lung, liver, and kidney ultrastructures were normal in both groups of SL and SSL. In the IIR group, type 2 pneumocytes showed lamellar body degeneration, dilation of smooth endoplasmic reticulum, and thickening of the basal lamina. Hepatocytes showed dilation of the rough endoplasmic reticulum, mitochondrial degeneration, and cytoplasmic lipid droplets. The glomerular basement membrane was thickened and the endothelial cells showed discontinuity. The foot processes of the podocytes and microvilli of the proximal tubule cells had also disappeared in the kidney. Splenectomy attenuated these ultrastructural changes in the SIIR group. In the IIR group, serum MDA level was significantly increased to 171.7 +/- 6.7 nmol/ml (p < 0.05). Splenectomy significantly reduced serum MDA level to 87.8 +/- 2.5 nmol/ml in the SIIR group (p < 0.05). CONCLUSIONS: Splenectomy attenuated degenerative findings encountered in lung, liver, and kidney ultrastructure after IIR. Splenectomy also significantly decreased serum levels of MDA. The possible role of splenectomy is to reduce the MFS cells, which play an important role in the remote organ injury after intestinal reperfusion damage.

The correlation between nitric oxide and vascular endothelial growth factor in spinal cord injury.

STUDY DESIGN: Prospective, randomized, placebo-controlled, experimental study. OBJECTIVES: The issue of whether nitric oxide (NO) production is beneficial or deleterious on ischemic injuries of the central nervous system still remains doubtful. Vascular endothelial growth factor (VEGF) is known to induce the release of NO from endothelial cells. However, the effect of NO on VEGF synthesis is not clear. We aimed to determine the effects of L-arginine and NG-nitro-L-arginine methyl ester (L-NAME) on VEGF synthesis and free radicals in a rat model of spinal cord ischemia-reperfusion (IR) injury. SETTING: Surgical Research Laboratory of a Medical School. MATERIAL AND METHODS: Twenty-eight Wistar rats were divided into four groups as follows (n=7): Sham, IR injury, L-arginine, and L-NAME. Infrarenal abdominal aorta was occluded to induce spinal cord ischemia. L-Arginine (100 mg/kg) and L-NAME (10 mg/kg) were given before aortic occlusion. Biochemical assays of malondialdehyde (MDA), NO and VEGF were carried out in spinal cord specimens. RESULTS: L-Arginine treatment significantly increased MDA and NO, but decreased VEGF levels in spinal cord. However, nonselective inhibition of NOS with L-NAME significantly decreased MDA and NO, but increased VEGF levels. Besides, the positive linear correlation between MDA and NO, and negative linear correlations between MDA, NO and VEGF levels have also been demonstrated. CONCLUSION: Nonselective inhibition of NO synthase activity with L-NAME attenuated free radical formation and increased VEGF level when compared with NO precursor L-arginine in a rat model of spinal cord ischemia. We suggest that inhibition of NO synthase, as well as induction of VEGF, may be a therapeutic option in spinal cord IR injury.

Interferon-induced vitiligo in a patient with chronic viral hepatitis C infection.

Vitiligo is an autoimmune disease characterized by depigmentation of the skin due to destruction of melanocytes. Interferons have been used for the treatment of chronic hepatitis C and some malignancies. We report interferon alpha-2a-induced vitiligo in a male patient with chronic active hepatitis C. All skin lesions disappeared completely without requiring therapy after discontinuation of interferon. This case suggests that vitiligo may be developed during interferon therapy as a side effect.

Ischemia, whether from ligation or torsion, causes ultrastructural changes on the contralateral testis.

OBJECTIVE: Unilateral testicular torsion results with a decrease in contralateral testicular blood flow caused by a reflexive sympathetic response. The aim of this study was to investigate whether twisting of the spermatic cord, or testicular ischemia without twisting, activates this reflex mechanism and causes ultrastructural changes in the contralateral side. MATERIALS AND METHODS: Thirty adult male albino Wistar rats were randomly allocated into three groups of sham, torsion, and ligation. Right testes were twisted 720 degrees counterclockwise in the torsion group. Right spermatic cords were ligated permanently with a silk suture including the vas deferens in the ligation group. After 24 h of testicular ischemia, contralateral left testes were removed for electron microscopic evaluation. RESULTS: Contralateral testes showed similar ultrastructural changes in the torsion and ligation groups. The fibrous tunica propria enveloping the seminiferous tubule was thickened due to increased collagen fibers. The basal lamina was continuous but thickened and showed several foldings. The gap between basal lamina and the germ cells was increased because of collagen fibers. Leydig cells showed mitochondrial degeneration with the loss of its cristae. Leydig cells lost their contact with its neighborhood cells in some areas, and these gaps were filled with collagen fibers. Germ cells showed dilated cisternae of smooth endoplasmic reticulum, cytoplasmic electron-dense bodies and clear regions. CONCLUSIONS: Similar electron microscopic findings observed in the torsion and ligation groups indicate that testicular ischemia rather than twisting of the spermatic cord is responsible for the ultrastructural changes in the contralateral side.

Free insulin-like growth factor-1 and unilateral complete ureteral obstruction in the rat.

OBJECTIVES: To determine the effect of unilateral ureteral obstruction on renal free insulin-like growth factor-1 (IGF-1) content in the kidneys and the possible role of free IGF-1 in compensatory growth in the nonobstructed kidney in an experimental model. METHODS: The content of free IGF-1 and total protein in the obstructed and nonobstructed kidneys were measured 7 days after unilateral ureteral obstruction. The weights of the kidneys were also determined. The results were compared with those of the sham-operated animals. RESULTS: The mean renal free IGF-1 level of the obstructed kidneys was significantly lower than the mean renal free IGF-1 level of the sham-operated kidneys (P = 0.03), and the mean renal free IGF-1 level of the nonobstructed kidneys was significantly higher than the mean renal free IGF-1 level of the sham-operated kidneys (P <0.0001). The serum free IGF-1 levels in the two groups were not different. The mean weight of the obstructed and nonobstructed kidneys was significantly higher than those of the sham-operated kidneys (1.49 +/- 0.09 and 1.03 +/- 0.03 versus 0.88 +/- 0.02 g, P <0.0001 and P = 0.006, respectively). The obstructed kidneys had significantly lower mean protein content than the nonobstructed kidneys and had significantly higher mean protein content than the sham-operated kidneys (P <0.0001 and P = 0.0004, respectively). CONCLUSIONS: Our results reveal that compensatory renal growth is driven by a rise in the free IGF-1 concentration after unilateral ureteral obstruction.

Pentoxifylline reduces biochemical markers of ischemia-reperfusion induced spinal cord injury in rabbits.

STUDY DESIGN: Occlusion of the infrarenal abdominal aorta with administration of pentoxifylline was applied to adult rabbits, followed by removal of aortic clamp and reperfusion. Tissue levels of cytokines, lipid peroxides, and antioxidant enzymes were assayed and compared within groups. OBJECTIVES: To examine the effect of pentoxifylline (PTX) on cytokine levels, lipid peroxidation, and antioxidant enzymes in a rabbit model of spinal cord ischemia-reperfusion injury induced by aortic occlusion. SETTING: Isparta, Turkey. METHODS: Rabbits were randomly allocated into four groups of sham laparotomy (SHAM), sham laparotomy with PTX administration (SHAM+PTX), aortic occlusion and reperfusion (AOR), aortic occlusion and reperfusion with PTX administration (AOR+PTX). An intravenous bolus of 50 mg/kg PTX was given just before aortic cross clamping. An atraumatic microvascular clamp was then placed on the abdominal aorta immediately distal to the left renal artery for 30 min. PTX was infused at a rate of 0.5 mg/kg/min during the aortic occlusion. Animals were subjected to 120 min of reperfusion after removal of the aortic clamp. All animals were sacrificed at the end of reperfusion. The lumbosacral segments of spinal cords were quickly harvested and stored at -78 degrees C for biochemical assays of IL-6, TNF-alpha, MDA, SOD, and CAT levels. Differences among groups were analyzed by one-way analysis of variance followed by a post hoc Tukey's honestly significant difference test. RESULTS: No differences in mean levels of IL-6, TNF-alpha, MDA, SOD, and CAT were noted between SHAM and SHAM+PTX groups (P>0.05). There was a significant increase in all biochemical parameters in the AOR group (P<0.05). Administration of PTX significantly attenuated the levels of all biochemical parameters in the AOR+PTX group (P<0.05). CONCLUSION: PTX pretreatment attenuated ischemia-reperfusion induced spinal cord injury in a rabbit model, in terms of biochemical parameters of ischemia and reperfusion.

Pentoxifylline attenuates reperfusion injury in testicular torsion.

OBJECTIVES: An experimental study was designed to evaluate the effects of pentoxifylline (Ptx) on lipid peroxidation, and histopathology in both testes after unilateral testicular torsion and detorsion. MATERIALS AND METHODS: Forty adult male albino Wistar rats were randomly divided into 4 groups of sham operation, sham operation with Ptx, torsion and detorsion, torsion and detorsion with Ptx. After intraperitoneal administration of Ptx at a dose of 50 mg/kg 15 min before torsion; right testes of the rats underwent 30 min of torsion and 30 min of detorsion. Malondialdehyde (MDA) levels were assayed and histopathological changes were evaluated in both testes of all groups. RESULTS: Unilateral testicular torsion and detorsion caused an increase in the MDA levels of both testes. Histopathological evaluation showed interstitial hemorrhage on the ipsilateral side. Pentoxifylline decreased MDA levels on both side, and attenuated interstitial injury on the ipsilateral side. CONCLUSIONS: The results of this study suggest that pentoxifylline treatment attenuates reperfusion damage on both side, possibly with its effects on blood flow and neutrophils. However, further studies are necessary to evaluate the effects of pentoxifylline on testicular torsion.

Renal transplantation in the rat--a new simple, non-suture technique.

Renal transplantation in the rat can be performed by a simple technique utilising cuff anastomosis. This method is quick and reliable, and the results compare well with those achieved by standard microsurgical techniques.