Assessment of antioxidant system status before and after operation in neonates with congenital heart disease.

Background/Aim: Oxidative stress is considered to have a significant role in the development of cardiovascular diseases (CVDs) as well as many other diseases. Therefore, the purpose of the study is to evaluate the antioxidant system status at pre- and post-operative period in newborns with congenital heart disease (CHD) requiring operation. Materials and Methods: Fifty CHD patients participated in this research. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and thiobarbituric acid reactive substances (TBARS) levels were studied in blood samples. RACHS-1 score, blood lactate levels, and hypoxic events were also recorded. Comparisons of antioxidant system parameters were conducted at pre- and post-operative periods and also between exitus and discharged groups. Results: GPx activity and TBARS levels were significantly higher in the pre-operative period than post-operative period though the other antioxidant enzymes were not altered. In pre-operative period, GPx activity was low in addition to rarer hypoxic events in the discharged group. Also, a negative correlation was found between SOD and GPx activities in pre-operative period. Conclusion: The results provide fundamental data showing the lowered GPx activity and TBARS levels considered as sensitive oxidative biomarkers after the operation. It was assumed that antioxidant system parameters might show changes after the operation, and GPx is prominent for resistance to hypoxic conditions. Post-operative reduction of GPx and TBARS levels is significant for evaluating the antioxidant system alterations after the operation. However, further investigations follow long-term duration for post-operative monitoring to estimate how antioxidant system status changes to improve the treatment of the health condition.

Acute ureterolithiasis: incidence of secondary signs on unenhanced helical CT and influence on patient management.

AIM: The purpose of this study was to determine the incidence of secondary signs associated with ureteral stones on unenhanced helical computed tomography (CT) of patients with acute renal colic, and to correlate these with patient management and outcome. MATERIALS AND METHODS: One hundred and ten patients with ureterolithiasis were evaluated prospectively for the secondary signs of obstruction on unenhanced helical CT. Our attention was focused primarily on the presence or absence of seven secondary signs on unenhanced helical CT, including hydronephrosis, unilateral renal enlargement, perinephric oedema, unilateral absence of the white pyramid, hydroureter, periureteral oedema and lateroconal fascial thickening. RESULTS: Of the 110 patients, 91 (82.7%) had hydroureter, 88 (80%) had hydronephrosis, 65 (59%) had periureteric oedema and 63 (57.2%) had unilateral renal enlargement. Ninety stones passed spontaneously and 21 required intervention. CONCLUSION: Secondary signs of urinary tract obstruction are useful and supportive findings in interpretation of the CT examination. In our experience, the most reliable signs indicating ureteral obstruction are hydroureter, hydronephrosis, periureteral oedema and unilateral renal enlargement, respectively. In addition, stones larger than 6 mm, located within the proximal two thirds of the ureter, and seen associated with five or more the secondary signs of obstruction, are more likely to require endoscopic removal and/or lithotripsy.

Fournier's gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application.

OBJECTIVES: Fournier's gangrene (FG) is an abrupt, rapidly progressive, gangrenous infection of the external genitalia, perineum or abdominal wall and is a real urologic emergency. In this study, the risk factors of FG and the effects of enzymatic debridements on wound healing were investigated. PATIENTS AND METHODS: We reviewed the records of 34 patients with FG to investigate the possible correlation between clinical outcome and infection focus, patient age, number of types of bacteria cultured, delay until presentation, predisposing diseases or accompanying conditions such as diabetes, neurologic deficit, chronic alcoholism and renal failure. Broad-spectrum triple antimicrobial therapy, aggressive and frequent surgical debridement, and if necessary urinary and colonic diversions were performed to control the infection. The effects of enzymatic debridements with topical lyophilized collagenase applications on the wound healing after the control of active infection were evaluated. RESULTS: The average age of the patients was 55 years. The sources of infections were urogenital in 12 (35.3%), anorectal in 10 (29.4%), dermal in 10 (29.4%) and undetermined in 2 (5.8%) of the patients. The average presentation time was 4.4 days and the number of isolated bacteria was 3.05 per case. The number of isolated bacteria and surgical debridements, the duration of hospital stay and the rate of mortality in patients with anorectal foci were higher than those of the patients with urogenital or dermal foci (p < 0.05). Diabetes, uremia and advanced age did not significantly affect the number of surgical debridements, the duration of hospital stay and control of active infection. Mortality was increased in chronic alcoholism, a finding of undetermined significance. Enzymatic debridements decreased the duration of hospital stay (p < 0.05). Five patients (14.7%) died despite prompt medical and surgical preventive measures. CONCLUSION: Chronic alcoholism, anorectal infection foci, neurological deficit and delayed presentation were found as risk factors in FG. Diabetes and advanced age did not affect the progression of disease in our cases. Enzymatic debridements decrease the number of surgical debridements and the duration of hospital stay.