Effects of resveratrol on ileal smooth muscle reactivity in polymicrobial sepsis model.

OBJECTIVE: To determine the effects of resveratrol on the ileal smooth muscle reactivity in polymicrobial sepsis. MATERIAL AND METHODS: Polimicrobial sepsis was induced by the cecal ligation and perforation (CLP) procedure. Sprague Dawley rats were divided into three groups. Rats in resveratrol group received resveratrol after CLP (100 mg/kg, i.p.). Rats received saline immediately after CLP in the sepsis group. Control group rats underwent sham operation. The rats were sacrificed and the ileum was excised 24 h after the operation. Contractile and relaxant responses in isolated smooth muscle strips (SMS) were determined using an in vitro muscle technique. TNFα and IL-6 levels were measured in blood samples. RESULTS: Contractile responses to carbachol and KCl and relaxant responses to transmural electrical field stimulation (EFS) were significantly decreased in the sepsis group compared with control and resveratrol groups. No significant changes were observed for smooth muscle reactivity in the resveratrol and control groups. Sodium nitroprusside (SNP) or papaverine-induced relaxations were similar in the all groups. Resveratrol treatment supressed increased TNFα and IL-6 levels in blood seen in sepsis group. CONCLUSION: Ileal smooth muscle reactivity was improved after resveratrol treatment in rats with sepsis. The results of the present study indicate that the beneficial effects of resveratrol might be, at least in part, attributed to its effects on non-adrenergic non-cholinergic pathway and/or anti-inflammatory and antioxidant activity.

The advantages of cyanoacrylate wound closure in circumcision.

PURPOSE: To compare 2-octyl-cyanoacrylate (2-octyl-CA) glue with polyglytone 6211 sutures in circumcision wound closure on the basis of operative time, safeness, postoperative pain and cosmesis. PATIENTS AND METHODS: The boys who would undergo circumcision in 18-month period (n = 137) were grouped into two. In Group 1 (n = 64), 6/0 polyglytone 6211 sutures, and in Group 2 (n = 73), 2-octyl-CA glue were used for wound closure. Durations of anesthesia, surgical procedures and postoperative pain, and pain scores on the 2nd and 48th postoperative hours were determined. A classification system was constructed to evaluate cosmesis, intraoperative and postoperative bleeding. Quantitative differences were assessed by Mann-Whitney U and Student's t tests, and qualitative analyses were performed by χ (2) test. p was considered as significant at less than 0.05. RESULTS: The pain scores of the groups were comparable. Durations of anesthesia, surgical procedures and postoperative pain were significantly shorter (p < 0.05); and cosmesis, intraoperative and postoperative bleeding status were significantly better in Group 2 (p < 0.05). CONCLUSION: 2-Octyl-CA seems to be a good alternative to the conventional suturing technique in circumcision wound closure with shorter operation time, ease of appliance, improved safeness, better cosmesis and shorter duration of postoperative pain.

Preliminary results of propranolol treatment for patients with infantile hemangioma.

Propranolol, a non-selective beta-blocker, has recently been introduced as a treatment for infantile hemangiomas. In this study, we evaluated the effect of propranolol in 12 infants with hemangioma. Twelve infants (9 girls) with a median age of 4.5 months were included in the study. All of the patients in the study group received short-term (1-9 weeks, median: 4 weeks) systemic corticosteroids as a first-line therapy. All patients received propranolol 2 mg/kg/day, divided into three doses. They were treated in an inpatient setting for the first 72 hours of the treatment. Vital signs, blood pressure and blood glucose were monitored. Propranolol treatment was given for 4-9 months (median: 5 months). In the study group, regression rate of the mean dimension of the lesion was 38% +/- 15 (range 15%-50, median 45%) at the 2nd month of therapy. Over 9 months, which was the maximum follow-up period, the regression rate of the mean dimension of the lesion was 55% +/- 31 (range 20%-80, median 50%). One patient had transient bradycardia, which improved spontaneously. No other side effect was observed in the study population. Propranolol appears to be an effective drug for infantile hemangiomas with good clinical tolerance. We suggest that propranolol is the preferable drug as the first-line therapy for infantile hemangiomas.

Oligodendroglioma arising in a mature cystic ovarian teratoma in a child.

In childhood mature cystic teratomas are the most common type of ovarian germ cell tumors. Tumors of neuroepithelial origin are extremely rare in mature teratomas. To the authors' knowledge, this is the first case report oligodendroglioma arising in a mature cystic ovarian teratoma in children. A 13-year-old girl presented with a history of pelvic pain for 2 months. An ultrasound examination showed a monolateral multicystic, calcific ovarian mass, measuring approximately 6 x 5 cm, arising in the left over and adnexia, suggesting a teratoma. An exploratorative laparotomy and ooferectomy were performed. On histopatological examination, various samples from cystic areas had mature tissues from all 3 germ cell layers, including skin, bone, bronchial structures, and cerebellum. Sections from solid areas showed uniform population of monotonous, rounded cells with indistinct cytoplasm and having perinuclear halo (fried-egg appearance) on a fibrillary, neuropilic background. Microcalcifications as calcospherites were noted in the stroma. Based on the typical morphological features, the cased was diagnosed as mature cystic teratoma with low-grade oligodendroglioma. To the authors' knowledge, there are a few reports in the literature of an oligodendroglioma arising in an ovarian teratoma in adults and this presented patient is the first case in childhood.

LigaSure compared with ligatures and endoclips in experimental appendectomy: how safe is it?

PURPOSE: The present study aims to compare strength, healing, and inflammation of appendiceal stumps closed by LigaSure Precise (Valleylab, Boulder, CO, USA) device, ligatures using polyglactin 910 (Vicryl, Ethicon, Edinburgh, UK) and endoclips (Ligaclip ERCA, Ethicon, OH, USA), and operation time (OT) in experimental appendectomy. METHODS: Forty-eight Sprague-Dawley rats were divided into two (Group A and B). Each group was further subdivided into three subgroups (AS, AC, AL, BS, BC, BL) containing eight rats. Appendectomy was performed and stump was closed by ligatures in S, by endoclips in C and by LigaSure in L subgroups. OT was recorded. In Group A, cecum bursting pressures (BP) were determined instantly after the operation. In Group B, BP, histological evaluations, and measurements of collagen contents estimated by the tissue hydroxyproline (HPL) level were made on the seventh postoperative day. Statistical analyses were performed with Kruskal-Wallis test and Mann-Whitney U test. P value was considered significant at less than 0.05. RESULTS: BPs of subgroups were comparable on postoperative immediate period and day 7. HPLs and OTs were significantly better in L subgroups. BL had the least inflammation. CONCLUSION: Better healing, less inflammation, shorter OT, and equal strength achieved with LigaSure device comparing with polyglactin 910 ties and endoclips in experimental appendectomy is encouraging.

Childhood non-Hodgkin's lymphoma arising as a complication early in the course of Crohn's disease.

The neoplastic change in patients with Crohn's disease is usually seen in the form of adenocarcinoma. Primary gastrointestinal lymphoma complicating chronic inflammatory bowel diseases is thought to be uncommon. This report describes a case of gastrointestinal lymphoma in a 12-year-old boy with Crohn's disease of one-year duration that initially manifested as an abdominal mass. Although Crohn's disease may present as a palpable abdominal mass, changing symptomatology should always warrant consideration of developing lymphoma complicating inflammatory bowel diseases. It is our hope that this case report gives the clinician an insight into the possibility of lymphoma development, even in the early course of the disease, and stresses the importance of obtaining a reliable histological diagnosis whenever possible.

A case report: gastric adenocarcinoma in childhood.

Primary gastric adenocarcinoma is extremely rare in children, and accounts for 0.05% of all gastrointestinal malignancies during childhood. The initial symptoms of epigastric pain, feeling of fullness, belching, and loss of appetite are non-specific and misleading. Nausea, vomiting and weight loss may accompany, which also complicate reaching a prompt diagnosis. In the presented case, a 15-year-old girl admitted with ascites, pleural effusion, right supra-clavicular lymphadenopathy, and back pain. No primary focus of a malignancy was accomplished in radiological evaluation, and the diagnosis of gastric carcinoma was achieved with upper gastrointestinal system endoscopy. We point out the importance of upper gastrointestinal system endoscopy in patients with ascites and uncertain diagnosis of the primary focus of malignancy.

Intrapleural streptokinase treatment in children with empyema.

Our aim was to compare intrapleural streptokinase (SK) treatment and simple tube drainage in the treatment of children with complicated parapneumonic pleural effusion. A retrospective review of medical records included patient demographics, clinical presentation, biochemical and microbial studies of pleural effusion, radiographic evaluation of chest tube drainage, use of fibrinolytic agents and type of surgical intervention. During the 2.5-year period (1999-2002), 53 children (29 M, 24 F) with complicated parapneumonic effusions or empyema were identified. Closed tube drainage and antibiotic treatment were administered to patients with a diagnosis of complicated parapneumonic effusion (n = 24) until October 2000; after that time point, intrapleural streptokinase was added to this regimen (n = 29). The median age at the time of presentation was 2.5 years (range: 5 months-14.6 years). There were no significant differences in terms of clinical outcomes between the two groups. The average length of hospital stay was 19.1 +/- 5.5 and 21.9 +/- 11.2 days for the drainage and streptokinase groups, respectively; the time to afebrile state after admission was 5.8 +/- 4.1 and 7.6 +/- 7.5 days. The percentage of patients who eventually required surgical intervention was 8.3% for the drainage group and 20.6% for the streptokinase group. In conclusion, in the treatment of complicated parapneumonic effusions or empyema, the adjunctive treatment with intrapleural SK does not significantly reduce durations of fever, chest tube drainage and hospital stay, and the need for surgery, regardless of the stage of the disease, compared to simple closed tube drainage.

Totally implantable central venous access devices in children with hemato-oncologic malignancies: evaluation of complications and comparison of incidence of febrile episodes with similar patients without central venous access devices.

The incidence of mechanical and infectious complications of totally implantable central venous access devices (TIDs) must be related to underlying disease, intensity of the chemotherapy, and frequency of manipulations. Records of the patients hospitalized from January 2002 to May 2005 were evaluated. Patients with TIDs were matched with patients without TIDs having the same malignancy and the same anti-neoplastic chemotherapy. Catheter-related complications were documented and corresponding phases of the chemotherapy in matched pairs were compared with regard to infections. TIDs were inserted in 31 patients with a median age of 4.3 years (22 acute leukemia, 1 NHL, and 8 solid tumors). Total number of catheter days was 5268, with a median catheter life of 174 days (range 9-493 days). Nine catheters (29%) were removed due to mechanical and infectious complications. There was 13 catheter-related infections with a rate of 2.46/1000 catheter days. Total number of mechanical complications was 5 and overall rate of complications was 3.41/1000 catheter days. The rate of febrile episodes was 54 and 41 in the TID and no TID group, respectively (p: .11). Duration of neutropenia was 9.6 and 7.4 days and duration of fever per febrile attack was 5.6 and 4.4 days in the TID and no TID group, respectively (p: .047 and .56). Although most of the patients in this study had hematological malignancy and required frequent manipulation, the results were similar to those in developed countries. TIDs are essential for management of chemotherapy in pediatric malignancies with acceptable complications.

Laparoscopic evaluation in incarcerated groin hernia following spontaneous reduction.

The authors report their initial experience of diagnostic laparoscopy in a baby presenting with small bowel obstruction secondary to strangulated groin hernia. Laparoscopy was accomplished through ipsilateral hernia sac to determine the viability of the incarcerated bowel segment under general anesthesia, following spontaneous reduction under general anesthesia. Diagnostic laparoscopy showed edematous intestinal segments but no sign of necrotic bowel or indirect findings of intestinal perforation. Diagnostic laparotomies may be useful in selected cases preventing an unnecessary laparotomies.

Effects of chronic ethanol consumption on rat upper gastrointestinal system: functional and histologic findings.

The purpose of the present study was to determine the effect of chronic alcohol consumption on reactivity of esophageal tunica muscularis mucosae (TMM) and lower esophageal sphincter (LES) smooth muscle. Six male rats in alcohol-fed group received ethanol (7.2% v/v) in a modified liquid diet for 4 weeks. Two control groups were used; six rats in the standard diet-fed group received rat chow and water for 4 weeks. Six rats in sucrose-fed group were given sucrose and received a liquid diet. The smooth muscle reactivity of TMM and LES strips from ethanol-fed and control animals was evaluated in organ chambers. Also histologic study was undertaken to show effects of chronic alcohol consumption. Maximum contractile responses of TMM to KCl and carbachol were decreased in the ethanol-fed group compared to the control groups. Relaxant responses to serotonin were decreased in the ethanol-fed group compared to the control groups. In TMM, isoproterenol- and papaverine-induced relaxant responses were similar in the ethanol-fed and control groups. In LES smooth muscle, relaxant responses to papaverine or isoproterenol were similar in the control groups and the ethanol-fed group. There was no change in agonist potency among the groups. The relaxation response elicited by nicotine and sodium nitroprusside (SNP) or contractile response elicited by carbachol and 80 mM KCl was decreased with maximum responses and pD(2) values, in the ethanol-fed group compared to that of the control groups in LES. Decreased nNOS immunoreactivity in myenteric plexus was found in alcohol-exposed group compared to control groups. Our findings suggest that chronic alcohol consumption impairs relaxant and contractile responses of both TMM and LES smooth muscle and it may contribute to gastroesophageal reflux commonly seen after alcohol binges.

Passive smoke exposure is associated with perioperative adverse effects in children.

STUDY OBJECTIVE: To evaluate the frequency of respiratory adverse events during general anesthesia in children passively exposed to cigarette smoke (PSE). DESIGN: Prospective, double blinded, observational study. SETTING: Operating room and recovery room of a university hospital. MEASUREMENTS: Data were collected from 385 children who underwent elective surgery during general anesthesia from June to November, 2008. PSE was identified by using the child's caregivers' information. Respiratory adverse events were recorded during anesthesia and post-anesthesia. MAIN RESULTS: Technique of anesthesia induction and management, distribution of patients' age, gender, surgical procedures, and perioperative analgesic methods were similar in the PSE and non-PSE groups. Respiratory adverse events were reported in 58 patients (15.1%): 50 patients (21.4%) were in the PSE and 8 patients (5.3%) were in the non-PSE group (P = 0.00). The frequency of laryngospasm during anesthesia (P = 0.03) and hypersecretions in the recovery room (P = 0.00) were significantly increased in the PSE group. CONCLUSIONS: Children who are exposed to environmental tobacco smoke and who undergo general anesthesia seem to have an increased risk of respiratory complications in the recovery period rather than during anesthesia.

Surgical experience in a baby with congenital broncho-biliary fistula.

Congenital tracheobiliary and bronchobiliary fistulae are rare malformations in which patent communications exist between the respiratory system and biliary tract, respectively. We present a newborn who was admitted with respiratory distress and bilious tracheal discharge. Investigation revealed a bronchobiliary fistula originating from the left main bronchus, as well as biliary atresia. Excision of the bronchobiliary fistula was successful and the connection between biliary tract and gastrointestinal system was established by performance of a Roux-en-Y cholecysto-jejunostomy. Diagnostic tools, differential diagnosis, and surgical correction strategies are discussed.

Alterations in the mechanical properties of bladder smooth muscle in hydrocephalus rat model.

OBJECTIVES: It is now well established that hydrocephalus is associated with impaired bladder function. The aim of this study was to determine the effects of hydrocephalus on bladder smooth muscle (BSM) reactivity in the rat model. MATERIALS AND METHODS: Hydrocephalus was induced in 7-day-old rats by injection of kaolin into the cisterna magna (AH group). Control group rats underwent a sham operation. After 10 days, rats were decapitated. Each bladder was excised and BSM strips placed in an organ bath where contractile and relaxant responses were studied. RESULTS: Contractile response of BSM to KCl decreased in the AH group. Increased response to muscarinic agonist carbachol was observed in the AH group. The relaxant response to adrenergic agonist isoprenaline was significantly decreased in the AH group, whereas non-receptor-dependent agonist papaverine was unchanged in 2 groups. CONCLUSION: Bladder smooth muscle reactivity is affected by the formation of hydrocephalus essentially by both receptor-dependent and non-receptor-dependent mechanisms. This pathway may be a novel target for the pharmacologic treatment of bladder dysfunction secondary to hydrocephalus.

Distal vaginal agenesis in monozygotic twins: case report.

Distal vaginal agenesis is one of the rarest congenital malformations of female genital tract. We describe successfully operated teenaged monozygotic twins by combined abdominal and perineal approach. The imaging studies and surgical experience were presented.

The effect of N-methyl-D-aspartate receptor antagonist (memantine) on esophageal and gastric smooth muscle: functional investigation in a rat hydrocephalus model.

OBJECT: The purpose of this study was to investigate the effect of N-methyl-d-aspartate (NMDA) receptor antagonist on esophageal and gastric smooth muscle reactivity in a rat hydrocephalus model. MATERIAL AND METHODS: Hydrocephalus was induced in rats by injection of kaolin into the cisterna magna. Two weeks after the procedure, memantine (20 mg/kg per day, 2 weeks) was given to rats with hydrocephalus in the memantine group (MG). The rest of the rats with hydrocephalus received serum physiologic (hydrocephalus group, HG). The control group (nonhydrocephalic rats, CG) was sham operated. The fourth group consisted of nonhydrocephalic rats with treated memantine (memantine control group, MC). Contractile (KCl, carbachol) and relaxant (isoprenaline, papaverine) esophageal and gastric smooth muscle reactivity were determined by in vitro muscle technique. RESULTS: No significant difference was found in the KCl (nonreceptor-mediated)-induced esophageal smooth muscle reactivity among the groups. Carbachol (receptor-mediated)-induced smooth muscle reactivity significantly decreased in HG compared to other groups. The isoprenaline (receptor-mediated)-induced smooth muscle reactivity significantly decreased in HG compared to other groups. No significant difference was found in smooth muscle reactivity to papaverine (nonreceptor-mediated) among the groups. Gastric smooth muscle reactivity to KCl significantly increased in HG compared to other groups. Also, KCl-induced smooth muscle reactivity significantly increased in MG compared to CG and MC. Carbachol-induced smooth muscle reactivity significantly decreased in HG compared to MG, CG, and MC. No significant difference was observed in isoprenaline- and papaverine-induced smooth muscle reactivity among the groups. CONCLUSION: Our findings suggest that memantine may influence esophageal and gastric smooth muscle reactivity in hydrocephalus.

Bronchogenic cyst of the right hemidiaphragm mimicking a hydatid cyst of the liver: report of the first pediatric case.

Bronchogenic cyst (BC), which develops from abnormal budding of the tracheal diverticulum or ventral foregut, is a congenital bronchopulmonary malformation. Localization of the BC varies depending on the level of the abnormal budding. Thoracic or abdominal-sited diaphragmatic lesions are the rarest presentations of the BC. We present a case of BC that originated from the diaphragm and mimicking hydatid cyst of the liver in a 19-month-old girl. Diagnosis of a diaphragmatic lesion was confirmed during laparotomy and complete resection was successful.

The effect of hydrocephalus on lower esophageal sphincter smooth muscle reactivity: experimental study.

PURPOSE: The aim of this study was to assess the pharmacophysiological significance of the enteric nervous system for the mechanical responses of lower esophageal sphincter (LES) in infantile rats with kaolin-induced hydrocephalus. MATERIAL AND METHODS: Hydrocephalus was created in 7-day-old rats by injection of kaolin into the cisterna magna. After 10 days, rats were decapitated. Contractile (KCl, carbachol) and relaxant (isoprenaline, papaverine) responses were determined by using in vitro muscle technique in isolated LES smooth muscle strips. RESULTS: The receptor-mediated contractile and relaxant response to carbachol and isoprenaline in the LES smooth muscle was impaired in rats with hydrocephalus. There was no significant difference in the KCl and papaverine response in hydrocephalic and sham operated rats. CONCLUSION: Our findings suggest that hydrocephalus may impair receptor-mediated contractile and relaxant activity of LES smooth muscle leading to gastroesophageal reflux.