First Case of Right Malrotated Kidney Transplantation.

Vascular anatomy may widely vary in malrotated kidneys, depending on the degree of rotation. Polar arteries and venules are often accompanied by structural and positional anomalies of the kidney that can make donor nephrectomy more complicated. Detailed evaluation of the donor before surgery is very important for both surgeon and patient. In particular, vascular anatomy should be evaluated in detail by modern imaging methods in donor nephrectomy. Herein we share our experience with right malrotated kidney open donor nephrectomy.

Anatomic Diversity Encountered During Laparoscopic Hand-Assisted Transperitoneal Donor Nephrectomy: A Case Report of Complete Caval Duplication.

INTRODUCTION: Laparoscopic donor nephrectomy is widely used to retrieve a kidney for transplantation. Preoperative evaluation of the donor is of crucial importance to the recipient. In particular, vascular anatomy should be assessed with the help of modern imaging modalities. We present a hand-assisted laparoscopic nephrectomy of a kidney donor with a complete duplex vena cava. CASE REPORT: A 40-year-old male patient was admitted to our clinic as a kidney donor for his 20-year-old son. After the preliminary tests, further imaging with the use of computerized tomographic angiography showed a complete duplex vena cava. He had no morbidities or previous surgeries. A hand-assisted transperitoneal laparoscopic left nephrectomy was performed as the kidney removal technique commonly used in our center. There was minimal blood loss, and the warm ischemia time was 66 minutes. Operation time was 265 minutes. After transplantation had been performed, graft functions were good with normal urine output. Blood sample tests were in normal ranges. The live donor was discharged on the 7th day after the procedure without any complications. CONCLUSIONS: Although renal vascular anomalies are rarely seen, they have a significant impact on the outcomes of the renal transplantation. Knowing the vascular anatomy minimizes the complications risk and increases the success rate. Laparoscopic live-donor nephrectomy can be performed safely, even in patients with vascular anomalies.

Hospital admissions for anaphylaxis in Istanbul, Turkey.

BACKGROUND: There are very limited data characterizing the epidemiology of anaphylaxis from low- and middle-income country settings. We aimed to estimate the frequency of anaphylaxis admissions to hospitals in Istanbul. METHODS: We obtained data from all 45 hospitals in Istanbul over a 12-month period and used ICD-10 codes to extract data on those admitted with a recorded primary diagnosis of anaphylaxis. Because of concerns about possible under-coding, we undertook an additional analysis to identify patients admitted with two or more clinical codes for symptoms and/or signs suggestive of, but not coded as having, anaphylaxis. RESULTS: A total of 114 cases (79 people with anaphylaxis codes and 35 with symptoms and signs suggestive of anaphylaxis) were identified, giving an overall estimate of 1.95 cases per 100 000 person-years. CONCLUSION: The novel two-stage identification approach employed suggests significant under-recording of anaphylaxis in those admitted to hospitals in Istanbul.

Virtual bronchoscopy as a dynamic modality in the diagnosis and treatment of suspected foreign body aspiration.

AIM: Rigid bronchoscopy (RB) is an invasive procedure and has its own risks. The place of virtual bronchoscopy (VB) in the treatment of patients with a clinical and radiological suspicion of foreign body aspiration was evaluated to see whether its usage can prevent rigid bronchoscopy. PATIENTS AND METHODS: The study was performed between December 2005 and May 2007 in 60 patients (35 M and 25 F) aged between 4 months and 7 years with clinical and radiographical suspicion of foreign body aspiration. Patients with radio-opaque foreign body aspiration were excluded from the study and treated directly by RB. VB was performed using 16 detector multislice computerized tomography (MDCT). If VB or clinical follow-up supported the diagnosis of foreign body, RB was performed for diagnosis and treatment. The results of RB were compared with the results of VB. RESULTS: All patients underwent VB. In 40 patients there was a suspicion of foreign body with VB. Two patients improved without RB: one had spontaneous discharge of the foreign body with coughing, and one experienced spontaneous clinical improvement. The remaining 38 patients underwent RB and a foreign body was found in the reported localization in 33. No foreign body was found with RB in 5 patients showing foreign body in VB. But we found bronchial vegetations in 2, obstructing mucus plug in 2 and external bronchial compression by neuroenteric cyst in one. In 20 patients there was no suspicion of foreign body with VB. Of these, 7 patients with presenting symptoms for more than one month underwent RB, but no foreign body was found. The 13 remaining patients were followed up clinically with improvement of symptoms. CONCLUSION: MDCT devices still require further investigation when used in pediatric surgical pathologies. Reconstructed images of VB can reveal images close to the real anatomy. In patients with a suspicion of foreign body ingestion, initial VB may help to determine the presence and exact localization of the foreign body and if negative, may reduce the number of unnecessary rigid bronchoscopies. None of the patients with negative VB had foreign bodies. Positive VB may help to shorten the operative time by providing information about the localization and size of the foreign body.

US, CT and MRI findings in a case of diffuse lymphangiomatosis and cystic hygroma.

Lymphangiomatosis is a rare disease with multifocal lymphatic proliferation that typically occurs during childhood and involves multiple parenchymal organs including the lung, liver, spleen, bone, and skin. Lymphangiomatosis may occur synchronously or metachronously with cystic hygroma of the neck. We present US, CT, and MRI findings of cystic hygroma of the neck associated with generalized lymphangiomatosis affecting bones and spleen in a 2-year-old girl.

Non-operative management of isolated solid organ injuries due to blunt abdominal trauma in children: a fifteen-year experience.

The purpose of this study was to evaluate essential prerequisites for a selective non-operative approach in children with solid organ injuries due to blunt abdominal trauma, and to determine the predictive value of two different trauma scoring systems: the Injury Severity Score (ISS) and the Paediatric Trauma Score (PTS). A retrospective review of children who were admitted with blunt abdominal solid organ injuries to a paediatric trauma centre between January 1986 and September 2001 was performed. Hepatic, splenic, and renal injuries were graded, based on the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (ranged from grade I to IV). The patients were treated non-operatively or operatively and the two groups were compared for variables such as age, blood transfusion, ISS, PTS, length of hospitalisation, morbidity and mortality rate. Two hundred and five patients (147 boys and 58 girls) entered in this study. Median age was 7 years (1 - 15 yrs). The most common cause of trauma was falls (50%). Abdominal organ injuries were present in all patients with the spleen as the most commonly injured organ (111 patients). Fifty-one patients (32%) had additional extra-abdominal organ injuries. Thirty-five (17%) patients were treated operatively, while 170 (83%) were treated non-operatively. Post-traumatic complications developed in 10 patients treated operatively versus 4 patients treated non-operatively. Four patients died due to multiple organ failure (2 non-operative, 2 operative). When compared to the non-operative group, higher transfusion requirements (p < 0.05), a higher ISS (p < 0.01), lower PTS values (p = 0.0001), a longer hospitalisation period (p = 0.0001), and a higher complication rate (p < 0.05) were observed in the operative group. In addition, the non-operative treatment approach was more common in the last five years compared to the previous ten years (p = 0.002). In conclusion, the appropriate non-operative management of injured children reduces the risks of blood transfusion and decreases the length of hospital stay compared with a surgical approach. The use of physiological parameters and radiological findings may be sufficient criteria for observing haemodynamically stable patients with isolated abdominal organ injuries, and thus intensive care unit costs may be avoided. In addition, a careful and close follow-up is essential in injured patients with a low PTS or high ISS.

Management of anorectal injuries in children: an eighteen-year experience.

Anorectal injuries (ARI) are rare in childhood and yet occur due to sexual abuse and firearm injuries in developed countries. The labeling of ARI remains controversial in spite of a number of divergent reports over the past decade. We evaluated the surgical indications for primary repair of ARI without stoma, and also the potential risk factors affecting morbidity and mortality in children with ARI. Between 1983 and 2001, 41 children were diagnosed as ARI in our institution due to blunt or penetrating trauma. There were 17 male and 24 female patients. Causes of anorectal injury were blunt injuries in the majority of cases (56 %). Vagina and extremity fractures were the organs most frequently associated with ARI. There was isolated ARI in 49 % of cases. Intraperitoneal organ injury was found in 3 patients (7 %). The distribution of injury location according to the classification of ARI in our children was as follows: 10 % in G I, 32 % in G II, 51 % in G III, and 10 % in G V. Primary repair without colostomy was performed in 51 % of cases. Primary repair and diversion of faecal stream by loop colostomy was required in 20 (49 %) patients. Postoperative septic complications occurred in 29 % of cases. Some potential risk factors such as trauma mechanism and associated organ injury were not significantly correlated to postoperative septic complications, while other risk factors such as mode of treatment, time of operative intervention and contamination were significantly related to postoperative septic complications (p < 0.05). The sensitivity of trauma scoring systems for the estimation of postoperative complication occurrence was significant for ISS (p < 0.05) and ARI score (p < 0.05). The relative risk of developing a postoperative septic complication was higher than 2 for patients with ARI grade III, ISS > 15, primary repair + colostomy group, and time of operative intervention > 8 hours. A child in the colostomy + primary repair group died on the first postoperative day from rapidly progressing septicaemia and multiple organ failure (2.4 %). The management of ARI can be carried out by primary repair procedure without colostomy in the majority of cases if the needed selectivity is established.

Retroperitoneal lipoblastoma involving the right common iliac artery and vein.

A case of benign lipoblastoma of the retroperitoneum in a 12-month-old boy, presenting as a huge abdominal mass and right lower extremity swelling, was reported. Surgery revealed involvement of the right common iliac artery and vein by lipoblastoma, requiring the sacrifice of both vessels for complete removal of the tumour. Vascular continuity of both vessels was re-established by a saphenous vein graft interposition. Involvement of a great artery by benign lipoblastoma has not been reported before.

Influence of the platelet-activating factor receptor antagonist BB-882 on intra-abdominal adhesion formation in rats.

Postoperative intra-abdominal adhesion formation is a major clinical problem. We aimed to examine the preventive effect of treatment with the platelet-activating factor (PAF) antagonist (lexipafant, BB-882) on experimentally induced intra-abdominal adhesion formation in rats. Twenty male Sprague-Dawley rats weighing 250 and 290 g were studied. Generation of adhesions in rats by brushing a 1-cm(2) area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intra-abdominal administration of saline and 5 mg/kg in a volume of 0.2 ml PAF receptor antagonist BB-882. After 45 days, formation of adhesions was graded and histological evaluation was processed. The severity of adhesions was significantly less in the BB-882 group than in the control group (p < 0.001, p < 0.05). The average adhesion scores in the control and BB-882 groups were 3.2 +/- 0.6 and 0.6 +/- 0.6, respectively, and the difference between both groups was found to be significant (p < 0.0001). The number of polymorphonuclear leukocytes and fibrotic areas was significantly decreased in the BB-882 group when compared to the control group (p < 0.001, p < 0.002). In conclusion, this study confirms the efficacy of BB-882 in the prevention of postoperative intra-abdominal adhesions in a rat model.

Epidemiology and control of nosocomial infections in paediatric surgery.

The purpose of this study was to determine the epidemiology and control of hospital-acquired infections (HAI) in paediatric surgery. We reviewed 2844 hospitalized children in a paediatric surgical clinic between January 1997 and December 2000. The diagnosis of HAI was made based on criteria proposed by Centers for Disease Control and Prevention (CDC). The incidence, type of micro-organisms and infections, age, sex, risk factors, and the economic aspects were recorded. The mortality, duration of hospitalization and economic aspects of patients were compared with 78 control patients matured for age, sex and primary illness and free of HAI. There were 78 children with HAI, the overall incidence was 2.74% (4.99% in 1997, 3.89% in 1998, 1.33% in 1999, 1.44% in 2000). The most frequent infections were surgical wound (28 patients) and urinary tract (25 patients). The most frequent risk factors were urethral catheterization (10.26%), trauma (9.25%), and parenteral nutrition (8.70%). Mean hospitalization was 16 days (range 4-28 days) in patients with infection compared with nine days (range 2-22 days) in control group. Eight patients died in the infection group, while two died in the control group. HAI caused a significant increase in mortality, prolonged hospitalization and increased costs (P < 0.05, P < 0.001, P < 0.001, respectively).

Esophageal, tracheal and pulmonary parenchymal alterations in experimental esophageal atresia and tracheoesophageal fistula. A histological and morphometric study.

Pulmonary complications are among the most important causes of morbidity and mortality in neonates with esophageal atresia and tracheofistula. We aimed to investigate the possible causes of respiratory complications encountered in esophageal atresia (EA) and tracheoesophageal fistula (TEF) in an experimental model. Sprague-Dawley fetal rats treated with adriamycin were used for the experiment. Time mated pregnant rats were given 1.75 mg/kg of adriamicyn intraperitoneally on days 6-9 of gestation. The fetuses were sacrificed on day 21, weighed, and dissected under the surgical microscope. The animals were divided into four groups: (1) control group; (2) saline-injected group; (3) adriamycin-induced EA group, and (4) adriamycin administered but without development of EA. The lungs, esophagus, and trachea were excised and underwent histological examination. The mucosa of distal esophagus was thickened (p < 0.05); the submucosa was thinner (p < 0.05); and the muscular layer was thickened (p < 0.05) in fetuses with EA and TEF. In adriamycin-treated rats, in which EA and TEF developed, tracheal cartilage was loosened and formed into a D or C shape. The cartilage was fragmented into several segments on transverse sections in most fetuses. Alveolar septa were thin in lungs of fetus with EA and TEF (p < 0.05), without any fibrosis or evidence of parenchymal abnormality microscopically. Our findings suggest that respiratory complications may contribute to structural lesions in the trachea and particularly in the distal esophagus but not in the pulmonary parenchyma itself.

Experimental study on effects of deferoxamine mesilate in ameliorating cisplatin-induced nephrotoxicity.

PURPOSE: Cisplatin (CCDP), an indispensable agent of several chemotherapy protocols, has serious dose limiting side effects, including nephrotoxicity. In this experimental study, we used deferoxamine mesilate (DFO), an iron chelating agent, to ameliorate cisplatin-induced nephrotoxicity. MATERIALS AND METHODS: Sixty adult male bulb-c mice were divided in 6 equal groups. Group 1 received distilled water, group 2 received 100 mg/kg DFO, group 3 received 0.9 mg/kg CCDP, group 4 received 100 mg/kg DFO one hour before 0.9 mg/kg CCDP, group 5 received 1.8 mg/kg CCDP, and group 6 received 200 mg/kg DFO one hour before 1.8 mg/kg CCDP transperitoneally for 10 days. The next day, blood and urine samples were obtained, and all the animals were sacrificed, the kidneys and testes were removed, and histopathologic and biochemical analyses were performed. RESULTS: Low-dose and high-dose CCDP treated mice had significantly more extensive proximal tubular degeneration (p < 0.001) when compared to control animals. Moreover, these changes were significantly less extensive in the mice taking DFO than mice taking CCDP. DFO showed no effect on cisplatin induced testicular histopathology. The cisplatin administration significantly increased the serum urea and plasma creatinin concentrations, and DFO administration prior to CCDP significantly decreased serum urea and plasma creatinin concentrations. CONCLUSION: Our findings suggest that DFO administration may be safe and useful for ameliorating cisplatin-induced nephrotoxicity.

Indications and results of surgery in patients with Crohn's disease with onset under 10 years of age: a series of 18 patients.

In order to examine the presentation and course of Crohn's disease (CD) with an onset of CD before the age of 10 and to assess indications and effects of surgery, a retrospective study was performed in 18 children. One hundred and twenty-two children with CD have been followed over the last 22 years in our institution. Thirty of them had the first onset of disease before 10 years of age. Eighteen out of these 30 underwent intestinal resection (IR). The mean age at the onset of CD was 6.4 years and the average duration of follow-up was 11.1 years. Most common symptoms were abdominal pain (72 %), diarrhoea (72 %), and growth retardation (50 %). Colon and ileum were the most frequently involved areas. Most of the children (94.5 %) received extensive medical and or nutritional treatment before surgery. We performed 26 IRs and 14 other operations in 18 patients. Indications for IR were chronic intestinal obstruction (13 cases) and chronic intestinal disability (13 cases). Improvements in the general clinical state were obtained in 17 cases out of 18. IR is beneficial for chronically ill children with ineffective medical therapy. A disease-free interval after surgery may provide an important time for improved growth and pubertal development and a return to nearly normal life for a long time.

Effects of the nitric oxide donor molsidomine on the early stages of liver damage in rats with bile duct ligation: a biochemical and immunohistochemical approach.

This study aimed to evaluate the effects of the nitric oxide donor molsidomine on the early stages of liver damage and biochemical changes in rats with bile duct ligation (BDL). Forty prepubertal male Sprague-Dawley rats weighing 125-140 g were studied. Group 1 rats (sham-control, n = 10) were not subjected to any surgical manipulation. Group 2 rats (BDL/untreated, n = 10) were subjected to BDL but no drug was administered. Group 3 rats (BDL/L-NAME, n = 10) received a daily dose of N(G)-nitro-L-arginine methyl ester (L-NAME) intraperitoneally for 7 days after BDL. Group 4 rats (BDL/molsidomine, n = 10) received a daily dose of molsidomine by gastric tube for 7 days after BDL. After 1 week, biochemical and histological evaluations were performed and the liver hydroxyproline content was measured. Serum bilirubin and liver enzymes were significantly increased in the BDL/untreated, BDL/L-NAME and BDL/molsidomine groups in comparison with the sham-control group 1 week after BDL. However, the liver enzymes were significantly decreased in the BDL/molsidomine group in comparison with the BDL/untreated and BDL/L-NAME groups. In the BDL/L-NAME group, proliferation of portal and periportal biliary ductules with disorganization of the hepatocyte plates, dilated portal spaces and areas of polymorphonuclear leukocyte infiltration, fibrosis and hepatocyte necrosis were observed. In the BDL/molsidomine group, polymorphonuclear leukocyte infiltration, hepatocyte necrosis and fibrosis were rarely seen. The hydroxyproline content in the liver was increased 1 week after obstruction in the BDL/untreated and BDL/L-NAME groups when compared to BDL/molsidomine group. Collagen type-IV expression was not observed in the BDL/molsidomine group in contrast to the BDL/untreated and BDL/L-NAME groups. In conclusion, during 1 week of treatment, the nitric oxide donor molsidomine improved hepatic fibrosis in the hepatic parenchyma and did not affect serum bilirubin values, but positively affected the serum aspartate aminotransferase and alanine aminotransferase values.

Blunt renal trauma in children with previously undiagnosed pre-existing renal lesions and guidelines for effective initial management of kidney injury.

OBJECTIVES: To record pre-existing renal lesions (PERL) found incidentally during evaluation for blunt renal trauma in children, determine their importance, suggest guidelines for the effective initial management of children with significant renal trauma and to evaluate the role of temporary percutaneous nephrostomy tube drainage (TPND) in these patients. PATIENTS AND METHODS: We reviewed 338 children who were hospitalized with blunt abdominal trauma between 1992 and 2000. Thirty-one patients had significant renal injury, 17 before 1997 (reviewed retrospectively) and the others reviewed and followed prospectively. RESULTS: Eleven of the 31 children had a PERL, which had been undiagnosed before the injury. The mean (range) follow-up was 52 (15-104) months. There were 22 boys and nine girls (mean age 9.1 years, range 2-13). The mean age was lower in patients with a PERL than in children with isolated renal injury. The most common cause of blunt renal injuries was a fall (45%) followed by motor vehicle accidents. Renal stones were present in five children, pelvi-ureteric junction obstruction in four, megaureter in one and a renal cyst in one. The mean injury severity scores were 12 in the children with a PERL and 14 in patients without. TPND was used in seven (22%) children; four were associated with a PERL. The mean grade of injury score for the kidney was higher in patients with a PERL and in children who underwent TPND than in patients who previously had a normal kidney and in children who did not undergo TPND. Early surgical intervention was required in three children; all were associated with a PERL. Of the 13 children who underwent surgery 11 had previous disease. CONCLUSIONS: The frequency of PERL is high (36%) in children with blunt renal trauma. PERL can predispose minor trauma to cause kidney injury even with no evidence of hydronephrosis. When a minor trauma results in renal injury, it is important to seek a PERL. In selected patients, TPND may decrease the length of hospital stay and improve the outcome of the injured kidney, thereby decreasing the need for further surgery in those with isolated renal injury; however, it appears not to decrease the need for later operations in children with a PERL.

The protective effects of captopril and nitric oxide on solitary kidney after chronic partial ureteric obstruction.

OBJECTIVE: To determine whether vasodilator agents (captopril and nitric oxide) change the morphological and functional effects of chronic partial ureteric obstruction in solitary kidney tissue in unilaterally nephrectomized rats. MATERIALS AND METHODS: Each of 50 prepubertal Wistar albino rats underwent right nephrectomy and were then assigned to one of five groups. Rats in group 1 underwent a sham operation (control) and in the other groups the ureter of the remaining kidney was partially obstructed by surgery. In group 2, no drug treatments were given; in groups 3, 4 and 5 captopril, L-arginine methyl ester (L-Arg) or NG- nitro-L-arginine-methyl ester, respectively, were given for 3 weeks. In all rats, diuretic scintigraphy was used to measure kidney perfusion, glomerular filtration rate (GFR) and concentration. Blood urea nitrogen (BUN), serum creatinine levels, kidney parenchymal weight and pelvic volume were measured and the kidneys evaluated histopathologically. RESULTS: Renal perfusion was significantly greater in both group 3 and 4 than in group 2. The GFR was 18% greater in group 3 and 22.3% greater in group 4 than in group 2. The GFR was decreased by 67% in group 5 compared with the control group. The mean parenchymal weight, mean pelvic volume, BUN and serum creatinine in the four groups with a partially obstructed ureter were significantly different from the control group. There also were significant differences between group 2 and groups 3--5, and between group 2 and group 3. Histological damage was severe in all four groups with partial ureteric obstruction, but in the drug-treated groups, medullary fibrosis was less frequent. CONCLUSION: After 3 weeks of treatment, captopril and L-Arg both improved kidney perfusion, GFR, BUN and serum creatinine levels, but were less effective in preventing parenchymal atrophy and changes in pelvic volume.

Interaction of nitric oxide and cell adhesion molecules after 24 hours of complete ureteric obstruction in the rats on a solitary kidney.

We aimed to show whether the administration of exogenous L-Arg would alter the morphological, functional changes and interaction of nitric oxide and cell adhesion molecules such as tenascin and lectin after release of twenty-four hours complete ureteric obstruction in the solitary rat kidney tissue. Forty prepubertal Wistar-Albino rats were separated into 4 groups, each containing 10 rats. In the group 1 (Sham-control, n = 10), right nefrectomy was performed; the left ureter was visualized but not ligated. In the remaining 30 rats, the abdomen was opened and undergone right nephrectomy and the left ureter was completely obstructed. After 24 hours, thirty rats were divided as group 2, 3, and 4, each containing 10 rats. In-group 2, no drug treatments were given. In-group 3 L-Arg (L-arginine methyl ester) was infused immediately after abolishing ureteric obstruction. In-group 4 L-NAME was give separately during L-Arg administration during 30 minutes immediately after abolishing ureteric obstruction. Than, the animals were prepared for functional and histopathological studies. BUN value was decreased significantly in L-Arg group when compared with untreatment and L-NAME groups (p < 0.05, p < 0.001 respectively). Creatinine values were decreased in L-Arg group when compared with untreatment group (p < 0.002). Urine flow and urinary Na value was increased significantly in L-Arg group when compared to other obstruction groups (p < 0.001, p < 0.001). The increase in the number of macrophages in Untreated and L-NAME group were significant (p < 0.001, p < 0.001) when compared to L-Arg group. Immunohistochemical study showed that tenascin and lectin expression was severe in tubulus basal membrane of untreated and L-NAME treated rats. In L-Arg group, tenascin and lectin expression was moderate in tubulus membrane. Our results suggest that the administration of exogenous L-Arg protect the functional and degenerative effects of acute complete obstruction in the solitary kidney tissue of the rats. Nitric oxide cause these positive effects by decreasing preglomerular vascular resistance, regulation of neutrophil function and preventing the expression of cell adhesion molecules such as tenascin and lectin.

The effects of the nitric oxide donor molsidomine prevent in warm ischemia-reperfusion injury of the rat renal--a functional and histophatological study.

Aim of this experimental study is to verify the protective effect of molsidomine on the renal function and structural modifications in the ischemia-reperfusion rat kidney. Sixty-eight male Sprague-Dawley rats, which were right nephrectomized and occluded left renal artery for 60 minutes were used. Group I (n = 10) Sham-Operated animals, which only underwent right nephrectomy. Group II (n = 20) Untreated ischemic rats, which underwent left renal ischemia by occlusion of the renal artery for 60 minutes before blood flow was restored. Group III (n = 18) Molsidomine treated ischemic rats, Group IV (n = 20) L-NAME (N(G)-nitro-L-arginine methyl ester) treated ischemic rats. Serum creatinine and blood urea nitrogen (BUN) were measured daily and biopsies were obtained from the remaining left kidneys. At seventh day, 55% and 50% of the rats remained alive at the G-II and G-IV respectively. Molsidomine treated rats (G-III) were alive and healthy at day 7. The serum creatinine and BUN levels were significantly higher in G-II and G-IV when compared with the sham-operated group (G-I). G-III rats showed a rapid return to the normal serum creatinine and BUN values on postoperative days 1, 2, 3 and 4. The obtained values in G-II were significantly lower in comparison to the values of G-II and G-IV. The most severe damage (grade 3 to 4) was determined in the kidneys of rats from GII or GIV. The degree of renal tubular damage in GIII was evaluated as grade 1 or 2 tubular damage according to Jablonkski's scale. Our findings suggested that the administration of molsidomine may vanquish the pernicious effects of warm ischemia on kidney structure and function.

Urogenital injuries in childhood: a strong association of bladder trauma to bowel injuries.

We analysed the inter-relationships of the cause and the type of trauma, the presence of pelvic fracture, the associated intraabdominal organ injuries, and the morbidity and mortality rates in 154 patients presenting and being treated for UGT between 1983 and 1997. The cause of injury was blunt in 77% of cases and penetrating in 13%. The most frequently injured organs were kidney followed by urethra and bladder. Bowels, liver and spleen were the most frequently associated injured organs. Moreover, bladder injuries were strongly associated with bowel injuries (p < 0.0001). Hemodynamically normal 49 children with minor or major kidney injuries were managed conservatively. Hemodynamically non-stable 11 patients were explored. The majority of urogenital injuries can be managed conservatively even when associated with intraabdominal organ injuries. Solid genitourinary organ injuries may accompany more frequently to intraperitoneal solid organ injury. Whereas, non-solid genitourinary organ injuries may more frequently associated with injuries of intraperitoneal hollow viscus.

Characteristics of penetrating abdominal firearm injuries in children.

Penetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children < or = 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8; 41 children had an ISS value of > or = 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value > or = 16 were hospitalized significantly longer than those with < or = 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.