Enhancing esophageal repair with bioactive bilayer mesh containing FGF.

We aimed to prepare a bioactive and biodegradable bilayer mesh formed by fibroblast growth factor (FGF) loaded gelatin film layer, and poly ε-caprolactone (PCL) film layer, and to investigate its treatment efficacy on esophageal anastomosis. It is envisaged that the bioactive mesh in in vivo model would improve tissue healing in rats. The full thickness semicircular defects of 0.5 × 0.5 cm2 were created in anterior walls of abdominal esophagus. The control group had abdominal esophagus isolated with distal esophageal blunt dissection, and sham group had primary anastomosis. In the test groups, the defects were covered with bilayer polymeric meshes containing FGF (5 µg/2 cm2), or not. All rats were sacrificed for histopathology investigation after 7 or 28 days of operation. The groups are coded as FGF(-)-7th day, FGF(+)-7th day, and FGF(+)-28th day, based on their content and operation day. Highest burst pressures were obtained for FGF(+)-7th day, and FGF(+)-28th day groups (p < 0.005) and decreased inflammation grades were observed. Submucosal and muscular collagen deposition scores were markedly increased in these groups compared to sham and FGF(-)-7th day groups having no FGF (p = 0.002, p = 0.001, respectively). It was proved that FGF loaded bioactive bilayer mesh provided effective repair, reinforcement and tissue healing of esophageal defects.

Comparative analysis of epidemiological and clinical characteristics of appendicitis among children and adults.

BACKGROUND: This study aimed to investigate whether there are some differences between pediatric and adult patients with appendicitis. METHODS: We retrospectively reviewed the records of 279 pediatric and 275 adult patients with respect to demographics, past medical history, duration of symptoms, laboratory and radiological findings, operation notes, pathological reports, length of hospital stay and post-operative outcomes. RESULTS: No significant differences were found with respect to gender, rates of perforation and negative appendectomy, laboratory findings, and overall outcomes between children and adults. However, our study suggests that the diagnosis is more difficult in children, the most preferred radiologic diagnostic methods are abdominal ultrasound and plain X-ray in children vs. computed tomography in adults, air-fluid levels and right-sided scoliosis are more commonly detected on X-ray in children, appendiceal perforation is more common at both extreme of ages, the appendix is perforated earlier and length of hospital stay is longer in children, and misdiagnosis at first admission in children and advanced age in adults were the risk factors associated with the complications. CONCLUSION: The present study found some important differences between childhood and adulthood appendicitis. If these differences are considered when evaluating the patients, more desired outcomes can be achieved for both clinicians and patients.

Bladder exstrophy with exstrophic rectal duplication in an infant: An extremely rare case.

Exstrophic rectal duplication and its association with bladder exstrophy and anorectal malformation is an extremely rare clinical entity. This is a report of the second case of an exstrophic rectal duplication associated with bladder exstrophy in English literature. However, it is the first case, where all these anomalies were accompanied by an anorectal malformation.

Diagnostic value of serum pentraxin 3 level in children with acute appendicitis.

BACKGROUND: Appendicitis is one of the most common surgical emergencies. Early diagnosis of appendicitis is important in children because any delay in treatment substantially leads to complicated appendicitis. In this study, we aimed to test the diagnostic value of pentraxin 3 (PTX3) level in children with acute appendicitis and to investigate whether there is a relationship between the progression of the disease and PTX3 level. METHODS: This prospective study included 70 children. They were divided into three groups as follows: group 1 (appendicitis; n=37), group 2 (abdominal pain; n=25), group 3 (control; n=8). Demographic data, medical history, the time from the onset of symptoms to blood sampling, operative and pathological findings of the patients were noted, and white blood cell (WBC), C-reactive protein (CRP) and PTX3 values were measured. RESULTS: The mean WBC, CRP and PTX3 values were found to be significantly increased in the appendicitis group (p<0.001). PTX3 has the highest diagnostic value (AUC=0.828), specificity (88%) and positive predictive value (90%) in the appendicitis group. WBC values did not show a significant correlation with the time periods (p=0.999). The mean CRP level of the appendicitis group in 24-48 hours was found to be higher than in 0-24 hours, but this was marginally significant (p=0.068). On the other hand, PTX3 value was significantly correlated with the time periods (p<0.05). CONCLUSION: This study showed that PTX3 is a valuable inflammatory biomarker in the diagnosis of acute appendicitis and also documented that PTX3 is useful for predicting the progression of the disease.

Mean platelet volume and red cell distribution width as potential new biomarkers in children with gastroesophageal reflux disease.

The aim of this study was to calculate the corrected rate of reflux in children with gastroesophageal reflux (GER)-like complaints by 24-hour pH monitoring and esophagogastroduodenoscopy (EGD), and to determine the utility of mean platelet volume (MPV) and red cell distribution width (RDW) as diagnostic biomarkers of GER disease (GERD) in children. The subjects in this prospective study were 109 children, 6 to 18 years old. Of them, 74 subjects were with GER symptoms and 35 healthy controls. The subjects were divided into three groups: those who underwent 24-hour pH monitoring (Group 1), those who underwent EGD together with pH monitoring (Group 2), and the healthy controls (Group 3). The results of pH monitoring and EGD and hematological parameters with controls were compared between Groups 1 and 2. In Groups 1 and 2, the overall rate of reflux was 40%, of esophagitis was 27.8%, and of Helicobacter pylori infection was 31.2%. The MPV and RDW cut-offs in subjects with reflux were ≤ 8.97 (sensitivity 89%, specificity 89%) and ≤ 12.78 (sensitivity 80%, specificity 97%), with an area under the Receiver Operating Characteristic (ROC) curve ± standard error (AUC ± SE) = 0.917 ± 0.027 (P < 0.001) and AUC ± SE = 0.866 ± 0.036 (P < 0.001), respectively. The endoscopic procedures are not practical due to being invasive and expensive. However, hemogram is a simple test which can be performed in an outpatient clinic. MPV and RDW calculated in hemogram could be easy, cost-effective, and high sensitive new biomarkers that can be used in children with GERD.

Effect of P/E-selectin blockage on antisperm antibody development and histopathological alterations in experimental orchitis.

AIM: This study aimed to evaluate the effect of P/E-selectin blockage on antisperm antibody (ASA) development and histopathological alterations in experimental orchitis. MATERIALS AND METHODS: Thirty-six Wistar albino-type male rats weighing 100-150 g were included in the study. Rats were allocated into six groups (n = 6) including control (CG), sham (SG), orchitis (OG), antimicrobial treatment (AG), P/E-selectin blockage (PESG), and both antimicrobial and P/E-selectin treatment (TG) groups. In CG, serum samples were taken from the tail vein prior to the procedure and followed by extraction of both testes. In SG, 1 ml of saline solution was injected in testicular parenchyma. OG was obtained by injecting 0.1 ml 106 cfu/ml Escherichia coli (0:6 strain) and 1 ml saline solution into the right testes. AG received ciprofloxacin (50 mg/kg/day) twice a day through gastrogavage 24 hours after generating orchitis. In PESG, P/E-selectin antibody (100 µg) was administered intravenously via the tail vein 24 hours after the induction of orchitis. Finally, both ciprofloxacin and P/E-selectin antibody were administered in TG 24 hours after the induction of orchitis for 14 days. At the end of treatment, 1 ml of serum sample was obtained to evaluate the ASA, P-selectin and E-selectin levels. In order to evaluate spermatogenesis (Johnsen score) and testicular injury (Cosentino score), both testes were extracted at the end of the 14th day. RESULTS: In orchitis-induced groups (OG, ATG, PSEG, TG), ASA levels were significantly increased at the 14th day when compared to SG (p < 0.05). In TG, ASA levels were decreased when compared to AG. However, similar alteration in ASA levels was not detected in PSEG (p > 0.05). In OG and AG, P-selectin levels were decreased at the 14th day when compared to levels observed on 0 day (p < 0.05). E-selectin levels on 0 day showed that each group had higher levels of E-selectin when compared to CG (p > 0.05). There was no significant difference regarding E-selectin when compared to CG (p > 0.05). No significant differences regarding E-selectin levels were detected on the 0th and 14th days between AG and CG (p > 0.05). When the Cosentino and Johnsen scores were compared among groups, TG and PSEG has decreased scores of Cosentino than OG on the right testicle (p < 0.05). In contrast, an increased Johnsen score was detected in TG and PSEG when compared to OG (p < 0/05). No significant difference was detected for both Cosentino and Johnsen scores on the left testicle (p > 0.05). There was no difference with regard to the right and left testicular injury in TG. In P/E-blocked groups, decreased histopathological alterations were observed in the contralateral testis. CONCLUSION: P/E-selectin blockage may reduce ASA production after orchitis when combined with antimicrobial treatment. P/E-selectin blockage not only has a protective effect on blood-testis barrier but also decreases the histopathological alterations in both the affected and contralateral testis. Histopathological parameters of spermatogenesis may also be prevented by P/E-selectin blockage in experimental orchitis.

Evaluation of omental inflammatory response with P-/E-selectin levels and histopathologic findings in experimental model.

AIM: The omentum plays a crucial role in abdominal defense mechanism by adhering to sites of inflammation and absorbing bacteria and debris from the peritoneal cavity. An experimental study was conducted to evaluate the inflammatory response of omentum in different abdominal events with omental P-/E-selectin levels and histopathologic findings. MATERIALS AND METHODS: Thirty Wistar rats were placed into 5 groups (n = 6), including a control group (CG), sham group (SG), bladder perforation (BP) group, splenic laceration (SL) group, and cecal ligation and puncture (CLP) group. Omental samples were obtained in CG after median laparotomy. In accordance with described models, BP, SL, and CLP were performed in experimental groups. Twenty-four hours after the first laparotomy, localization of the omental pad was noted, and omental samples were obtained for biochemical analysis of levels and histopathologic findings (no. of vessels in sections, polymorphic nuclear leukocytes [PMLs], lymphocytes). The mean P-/E-selectin levels and histopathologic findings of inflammation were compared between groups. RESULTS: Although omentum was adhered to the cecum in all subjects after CLP, similar findings were not detected in other groups. P-selectin and E-selectin levels and number of PML were significantly increased in the CLP group when compared with other groups (P < .05). The number of vessels in sections was significantly increased in CLP group when compared with SG and BP groups (P < .05), and the BP group had a decreased number of vessels than CG (P < .05). The number of PML was significantly increased in SG and SL and BP groups with respect to CG (P < .05). CONCLUSION: Among different experimental intraabdominal catastrophes, only CLP caused an inflammatory response and increased levels of adhesion molecules in the omentum. These findings suggest that the nature of the inflammation is the main determining factor for the omental function in intraabdominal events.

Protective effect of intraperitoneal ozone application in experimental ovarian ischemia/reperfusion injury.

AIM: The current accepted management of ovarian torsion is ovary-sparing surgery. Ozone therapy is used to reduce ischemia/reperfusion (I/R) injury in several situations. An experimental study was designed to evaluate effect of ozone application in ovarian I/R injury. MATERIALS AND METHODS: Three groups (n = 6) and 18 rats were included in the study. After anesthesia, right ovaries were fixed and removed at the end of 2 hours in sham group (SG). In torsion group (TG), right ovaries underwent 720° torsion in a counterclockwise direction. Ovaries were removed after 2 hours torsion and 2 hours reperfusion. In ozone group (OG), torsion was created by the same technique, and 95% oxygen plus 5% ozone gas mixture was given intraperitoneally (25 µg/mL, 0.5 mg/kg) 10 minutes before reperfusion. After 2 hours reperfusion, ovaries were removed. Histopathologic examination of ovarian and periovarian sections was performed for the presence of congestion (C), hemorrhage, interstitial edema (IE), and polymorphonuclear neutrophilic infiltrations. Tissue samples were analyzed for malondialdehyde, nitric oxide (NO), and total sulphidryl (t-SH) values. Results were compared between 3 groups. RESULTS: At histopathologic examination, the TG have elevation in terms of ovarian C, polymorphonuclear neutrophilic infiltration, and periovarian IE when compared with SG (P < ,05). In OG, ovarian C and periovarian IE were reduced according to TG, whereas the increase was observed only in ovarian C compared with SG (P < .05). At biochemical evaluation of oxidative stress markers in SG and TG, there was no difference between them (P < .05). Malondialdehyde levels were significantly lower in OG than TG, whereas NO and t-SH values were higher (P < .05). Malondialdehyde levels were decreased in OG compared with SG (P < .05). However, no difference was observed in NO and t-SH levels (P > .05). CONCLUSION: Intraperitoneal application of ozone creates a positive impact on histologic and biochemical markers on I/R injury owing to ovarian torsion. The ozone application can be developed to support efforts to protect ovary in ovarian torsion.

Intrascrotal extratesticular neurofibroma as a possible cause of failed descent in ipsilateral testis.

Intrascrotal extratesticular neurofibromas (IEN) often originate from genitofemoral nerve (GFN) and present as a paratesticular mass. Synchronous presence of IEN and undescended testis has not been reported previously. A 12-year-old boy with neurocutaneous syndrome and congenital giant melanocytic nevi along with IEN and ipsilateral undescended testis is presented, to discuss the underlying pathophysiology of failed testicular descent in the presence of IEN.

The impact of Pediatric Trauma Score on burden of trauma in emergency room care.

Traumatic injuries are the leading cause of mortality and morbidity during childhood. A retrospective study was performed to evaluate the impact of Pediatric Trauma Score (PTS) on burden of trauma in emergency care. Children admitted to the emergency room were retrospectively evaluated for age, sex, mechanism of injury, physical examination findings, and PTS. The cost of trauma was obtained by medical records. A total of 146 patients (male/female: 93/53) were enrolled. The median age was 6 (interquartile range: 3-9.25). Mechanism of injury was falls (74%), motor vehicle crashes (9.6%), non-vehicular accidents (7.5%), struck by/against (6.2%), and cuts and gunshots (2.1%). The median PTS was 10. In the evaluation of trauma burden, radiologic investigations accounted for 41%, consultations for 23.5%, laboratory investigations for 15.6%, emergency surgical interventions for 12.1%, and medical interventions for 6.8% of total trauma cost in emergency care. PTS showed no impact on burden of trauma in emergency care (p > 0.05). Total trauma cost was increased 2.1-fold in male patients, 2.6-fold in head injuries and 4.4-fold in abdominal injuries (p < 0.05). Pediatric Trauma Score had no effect on the burden of pediatric trauma in emergency care. The total cost of trauma was primarily affected by head injury and abdominal trauma. Higher costs may be related with routine radiological investigations in head and abdominal injuries.

Electrophysiologic evaluation of genitofemoral nerve in children with inguinal hernia repair.

AIM: Genitofemoral nerve (GFN) injury may occur because of chronic pressure of hernia sac or surgical intervention. A prospective study was performed to evaluate GFN electrophysiologically in children with inguinal hernia repair. METHODS: Children with inguinal hernia were evaluated for GFN electrophysiologically before and after (3-6 months postoperatively) inguinal hernia repair. Bilateral GFN motor response latencies and durations were investigated electrophysiologically by surface electrodes. Wilcoxon signed ranked test was used for statistical analysis, and P values lower than .05 was considered to be significant. RESULTS: Eleven patients with a mean age of 4.45 +/- 2.16 were enrolled in the study. Mean latency of patients was 2.37 +/- 0.89 milliseconds preoperatively and 3.14 +/- 1.02 milliseconds postoperatively. Latency of GFN was found prolonged after hernia repair (P = .008). Duration of GFN motor response was 9.94 +/- 1.49 milliseconds and 11.18 +/- 2.44 milliseconds, respectively, in preoperative and postoperative recordings. There was no significant difference detected in mean durations (P > .05). CONCLUSION: Latency of GFN may prolong after inguinal hernia repair. Prolongation of GFN latency may be the result of surgical injury during hernia repair and consequently also related with chronic groin pain.