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1.
Ren Fail ; 37(10): 354-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26375508

RESUMO

BACKGROUND: This is the first study performed to evaluate the effects of intravesical hyaluronic acid (IHA) instillation on diminishing the frequency of recurrent urinary tract infections (UTIs) in children. METHODS: Fifteen children (10 girls, 5 boys) with recurrent UTIs were divided into two groups as either complicated (group 1) (with accompanying disorders including vesicoureteral reflux or neurogenic bladder) or uncomplicated patients (group 2). After administration of weekly four sessions of IHA therapy the patients were followed-up monthly for 2 years and classified as responsive (complete/partial) or unresponsive to treatment. RESULTS: 53.3% of the patients with recurrent UTIs were complicated. In group 1 (n = 8), complete and partial response rates were 62.5% (n = 5) and 25% (n = 2), respectively. There was no response in 12.5% (n = 1) of the cases in group 1. In group 2 (n = 7), complete and partial response rates were 71.4% (n = 5) and 14.3% (n = 1), respectively. In this group, 14.3% (n = 1) of the patients were found to be unresponsive to IHA treatment. No side effects were observed in any of the patients. CONCLUSIONS: IHA administration is considered as an effective treatment modality which significantly reduces the prevalence of or even provides complete recovery from recurrent UTIs in childhood. Therefore, it is believed that this approach can be used as a promising alternative to widespread use of antibiotics in this patient group.


Assuntos
Ácido Hialurônico/administração & dosagem , Infecções Urinárias/tratamento farmacológico , Administração Intravesical , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Recidiva , Estudos Retrospectivos
2.
Turk J Gastroenterol ; 26(2): 186-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25835120

RESUMO

Rarity of Superior Mesenteric Artery Syndrome (SMAS) and necessity of invasive tests to verify the diagnosis leads to patients receiving symptom-oriented drugs for a long period without any definite diagnosis. Diagnostic tests such as barium series, abdominal CT scan, abdominal angiography or magnetic resonance arteriography are used in patients with suspected SMAS. In pediatric patients, a non-invasive SMAS diagnosis may be considered easily with abdominal ultrasound performed by experienced hands. Megabulbus is used as a radiological term; however, reviewing the literature an endoscopic definition for megabulbus was not found. We decided to mention severely dilated pyloric ring and bulb as megabulbus. Megabulbus might be an indicator for SMAS. This is the first case of SMAS in adult and pediatric age groups presenting with megabulbus.


Assuntos
Endoscopia , Dilatação Gástrica/diagnóstico , Síndrome da Artéria Mesentérica Superior/complicações , Síndrome da Artéria Mesentérica Superior/diagnóstico , Tomografia Computadorizada por Raios X , Dor Abdominal/etiologia , Adolescente , Dilatação Gástrica/diagnóstico por imagem , Dilatação Gástrica/etiologia , Humanos , Masculino , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem , Síndrome da Artéria Mesentérica Superior/patologia , Ultrassonografia , Vômito/etiologia
3.
J Pediatr Hematol Oncol ; 36(5): e328-32, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24608073

RESUMO

Fibrolamellar variant of hepatocellular carcinoma (FLHCC) does not have a favorable prognosis than conventional HCC, and there is no difference regarding the response to chemotherapy and the degree of surgical resectability. FLHCC commonly recurs after complete surgical resection, and there is a high rate of lymph node metastases. Herein, we report a 12-year-old girl with metastatic FLHCC with multiple recurrences aggressively treated with surgery, chemotherapy, and antiangiogenic agents. She is in complete remission after 4 years and 2 months after the diagnosis of metastatic FLHCC. The standard treatment of FLHCC is excision of the primary tumor and its metastases. Chemotherapy for FLHCC is controversial, and it has been suggested that cytoreductive chemotherapy was ineffective and adjuvant chemotherapy did not improve survival. Our patient with multiple recurrences was successfully treated with surgery, first-line chemotherapy with cisplatin and doxorubicin, second-line chemotherapy with 5-fluorouracil/interferon-α combination, and adjuvant antiangiogenic agents like cyclophosphamide and thalidomide. As FLHCC patients have no underlying liver disease, they can tolerate higher doses of chemotherapy compared with conventional HCC patients. We support the use of repeated aggressive surgery with adjuvant chemotherapy and antiangiogenic therapy, which provided complete remission in our patient with metastatic and recurrent FLHCC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/terapia , Carcinoma Hepatocelular/secundário , Criança , Cisplatino/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Hepatectomia , Humanos , Interferon-alfa/administração & dosagem , Neoplasias Hepáticas/patologia , Metástase Linfática , Recidiva Local de Neoplasia/patologia , Prognóstico , Indução de Remissão , Talidomida/administração & dosagem
4.
Eur J Pediatr Surg ; 24(2): 150-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23589080

RESUMO

INTRODUCTION: Short bowel syndrome (SBS) is a clinical condition resulting from the loss of absorptive surface area following resection of 50% or more small bowel. Morphological and functional changes called "intestinal adaptation" occur in the residual intestine. Melatonin exists in the gastrointestinal tract and has effect on mitotic activity. Therefore, we hypothesized that melatonin may have beneficial effects on intestinal adaptation. MATERIALS AND METHODS: A total of 32 male Wistar albino male rats were divided into four groups. In group I (sham-S), small bowel was transected and reanastomosed. In group II (SBS-control), 75% small bowel resection and anastomosis were performed. In group III (SBS-vehicle), after 75% small bowel resection and anastomosis, 2 mL of 5% ethanol in saline was given intraperitoneally once a day. In group IV (SBS-melatonin), after 75% small bowel resection and anastomosis, 300 µg/kg melatonin was given intraperitoneally once a day. After 15 days, small bowels were removed and divided into two segments as jejunum and ileum. Each segment was weight and measured. Histological examination was performed in all samples. Bowel and mucosal weights and DNA/protein ratio were calculated. Apoptotic cells were also identified. RESULTS: The bowel length measurements were statistically longer in group IV. Mucosal and bowel weights were the highest in group IV. The villus height, crypt depth, and the number of mitotic figures were the highest in the jejunum of group IV. Melatonin also gave rise to a significant increase in DNA/protein ratios in group IV. CONCLUSION: According to this study, melatonin significantly enhanced intestinal adaptation.


Assuntos
Íleo/fisiopatologia , Jejuno/fisiopatologia , Melatonina/fisiologia , Síndrome do Intestino Curto/fisiopatologia , Adaptação Fisiológica , Animais , Apoptose , DNA/metabolismo , Modelos Animais de Doenças , Íleo/patologia , Mucosa Intestinal/patologia , Jejuno/patologia , Masculino , Melatonina/administração & dosagem , Tamanho do Órgão , Proteínas/metabolismo , Distribuição Aleatória , Ratos Wistar , Síndrome do Intestino Curto/patologia , Redução de Peso
5.
J Paediatr Child Health ; 50(2): 107-11, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24134432

RESUMO

AIM: The aim of this study was to investigate quality of life (QoL) and anxiety level in Turkish children with anorectal malformation as well as the anxiety level of their mothers and the support group effects on anxiety. METHODS: A total of 87 children and their parents were included. They were grouped according to children's age: <8 years (group 1), 8-12 years (group 2) and >12 years (group 3). The anxiety of all mothers and of children in group 3 was assessed by Spielberger's State-Trait Anxiety Index-2. The QoL of children in groups 2 and 3 was evaluated with the Ped-QL 4.0 test by self-report and proxy report. The QoL results in groups 2 and 3 were compared with age-matched controls. RESULTS: Mothers in groups 1 and 3 were more anxious than were those in group 2. Adolescents in group 3 had poorer QoL compared with controls by self- and proxy reports. A significant difference was observed in QoL between the children who did and those who did not soil. The anxiety level was significantly lower in parents who attended more than one meeting. CONCLUSIONS: High anxiety and poor QoL levels in adolescence may have been related to the growing importance of body image. The higher anxiety levels of mothers in group 1 could be explained by an encounter with a baby who was different from the imagined baby and the newness of illness. QoL may have been perceived as being worse than what it was for psychological reasons.


Assuntos
Ansiedade , Mães/psicologia , Psicologia da Criança , Qualidade de Vida , Adolescente , Malformações Anorretais , Anus Imperfurado/psicologia , Criança , Pré-Escolar , Incontinência Fecal/etiologia , Incontinência Fecal/psicologia , Feminino , Humanos , Lactente , Masculino
6.
Pediatr Int ; 55(4): e86-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23910814

RESUMO

Rectal duplication (RD) cysts are rare congenital anomalies that can be diagnosed with the presence of another opening in the perineum. They seldom accompany anorectal malformations (ARM). Two cases of RD accompanying ARM at opposite ends of the phenotypic spectrum, are described. A 3-month-old baby and a 2-year-old girl with ARM were scheduled for posterior sagittal anorectoplasty. The infant had an orifice at the anal dimple and the other had an orifice at the vestibulum posterior to the rectovestibular fistula. The infant presented with no other anomalies whereas the older one presented with an unusual coexistence of caudal duplication and caudal regression syndromes. Perioperatively both orifices were found to be related to retrorectal cysts, and were excised. Clinicians should always be alert when dealing with complex malformations. Because these malformations have variable anatomical and clinical presentations, they can represent a diagnostic and therapeutic challenge.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos de Cirurgia Plástica/métodos , Fístula Retal/cirurgia , Reto/anormalidades , Pré-Escolar , Colostomia , Feminino , Seguimentos , Humanos , Recém-Nascido , Fístula Retal/diagnóstico , Reto/cirurgia
7.
S Afr J Surg ; 50(2): 37-9, 2012 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-22622100

RESUMO

AIM: The aim of this study was to present our experience in patients with intussusception (IN). MATERIALS AND METHODS: One hundred and five cases of IN treated between 1991 and 2007 were analysed. Age, gender, symptoms, signs, diagnostic and treatment methods, types of IN including leading point, and postoperative complications were evaluated. RESULTS: The mean age of the patients was 2.5 years (range 1 month - 15 years). Fifty-nine per cent (62/105) were under 1 year of age, and of these 28% were receiving therapy for upper respiratory tract infection. The most common symptom was colicky abdominal pain. Rectal bleeding was present in all patients under 2 years of age. In 23 children (21.9%) leading points were detected. Thirty per cent of the patients were older than 4 years, and 76.6% of these had leading points. Ultrasonography demonstrated the invaginated segment in 93 patients. Hydrostatic reduction was attempted in 71.4% (75) of the patients and was successful in 48% (36), 70% of whom were under 1 year of age. Of the patients with unsuccessful hydrostatic reduction, 11 required intestinal resection and primary anastomosis and 35 manual reduction. Twenty-four patients were diagnosed by means of ultrasonography and were operated on immediately. Ten of these patients had signs of peritonitis on admission and were treated by resection-primary anastomosis. CONCLUSION: In patients with IN under 2 years of age, hydrostatic or pneumatic reduction may be successful. Considering the high incidence of leading points in older children, one should not persist with reduction but should rather design a treatment plan accordingly, i.e. laparotomy with manual reduction or resection.


Assuntos
Intussuscepção/cirurgia , Laparotomia/métodos , Adolescente , Sulfato de Bário/uso terapêutico , Criança , Pré-Escolar , Meios de Contraste/uso terapêutico , Diagnóstico Diferencial , Enema , Feminino , Humanos , Incidência , Lactente , Intussuscepção/diagnóstico por imagem , Intussuscepção/epidemiologia , Masculino , Peritonite/diagnóstico por imagem , Peritonite/epidemiologia , Peritonite/cirurgia , Complicações Pós-Operatórias , Recidiva , Resultado do Tratamento , Turquia/epidemiologia , Ultrassonografia
8.
Pediatr Surg Int ; 27(10): 1075-8, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21789666

RESUMO

PURPOSE: Ostomy is an important step in the treatment of patients with anorectal malformation (ARM). Sometimes this basic surgical procedure may cause a devastating complication. METHODS: The medical reports of the patients with ARM who had ostomy in the past were inspected. How many of them were operated in this center or sent from others, the type of ARM, what type of ostomy performed and which place of the bowel used and the complication type and rate related to ostomy and ostomy closure were evaluated. RESULTS: Nearly, 157 of 230 patients with ARM had ostomy during twenty-two years were evaluated. The prevelent type of ostomy was loop (50.3%) and then separated (36.9%), end (7%), double barrel (4.4%) and window (1.2%). The ostomies were located in the tranverse colon (53.5%), descending colon (24.2%), sigmoid colon (17.8), pouch colon (2.5%) and ileum (1.9). Total complication rate was found to be 15.2% (24/157) (window 100%, double barrel 42.8%, separated 15.5%, loop 11.3%, end 9%). The main complication of loop ostomies was prolapse whereas wound problems, stenosis, intestinal obstruction or perforation were serious problems of separated ostomies. Complication rate in the descending colon and tranverse colon was found to be 7.1 and 28%, respectively (p = 0.001). Any difference for complication rate between loop and separated ostomies was not found. Eighteen of separated ostomies had mucous fistula and six of them (33%) were complicated, this rate was higher than those without mucous fistula (p = 0.012). Two babies with separated ostomy were lost due to surgical complications (1.2%). Complication rate after ostomy closure was 10.7% [wound infection (4.4%), intestinal obstruction (1.7%)]. CONCLUSION: According to this study, ostomy performed in the descending colon carries greater risks for complication regardless of its type. Nevertheless, separated ostomy with mucous fistula should be performed by experienced hands.


Assuntos
Anus Imperfurado/cirurgia , Enterostomia/métodos , Complicações Pós-Operatórias , Malformações Anorretais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Turquia
10.
Pediatr Surg Int ; 26(3): 287-92, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19921213

RESUMO

AIM: Spermatic cord torsion is a surgical emergency that requires early intervention to protect the effected testicle. The literature review about this ischemic reperfusion (I/R) injury reveals not only ipsilateral, but also contralateral testicular and epididymal injuries in a broad fashion. However, there is no data about vas deferens injury related with this surgical emergency. The aim of the study is to evaluate the morphological changes of the vas deferens due to testicular I/R injury. MATERIALS AND METHODS: Eighteen Wistar-Albino rats were allocated to three groups. Bilateral vasa deferentia of control group (Gr C, n = 6) were harvested without any surgical intervention. The torsion group was subjected to 2 h torsion and 2 h detorsion of the left testicle (Gr T, n = 6) and the third group underwent sham operations (Gr S, n = 6). Bilateral vasa deferentia of Gr T and S were harvested after surgery. The either side of the vas deferens was divided into three equal segments and these regions (adjacent to urinary bladder, medial and adjacent to testicle) were evaluated histopathologically. RESULTS: The electron microscopic evaluation of bilateral vasa deferentia of Gr T revealed different degrees of degeneration on either side. The region adjacent to testicle of the contralateral vas deferens was the most effected segment when compared with the other segments. CONCLUSION: In the light of these findings, it can be said that testicular I/R injury effects not only testis and epididymis, but also the adjacent vas deferens. This effect seems to be bilateral, like the testis and epididymis injury. Moreover, it mostly seems to depend on the apoptotic processes.


Assuntos
Torção do Cordão Espermático/patologia , Torção do Cordão Espermático/cirurgia , Ducto Deferente/patologia , Ducto Deferente/cirurgia , Animais , Modelos Animais de Doenças , Masculino , Distribuição Aleatória , Ratos , Ratos Wistar
11.
Pediatr Rep ; 2(2): e18, 2010 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-21589831

RESUMO

In this study, colonic manometry studies of the patients with repaired anorectal malformations (ARM) were compared with those of patients with severe colonic dismotility due to chronic constipation (CC) and acute pseudo-obstruction (PSO). The patients with repaired ARM were accepted as group #1 (n=10). The patients with CC and acute PSO composed group #2 (n=10). Eight-channel water perfused catheter was inserted into the colon under sedation. Colonic activity was recorded in three phases including fasting, after meal and after bisacodyl installation. The results were assessed by Pearson χ(2) test, P<.05 was considered statistically significant. Mean age was 9.6 and 12.1 in groups #1 and #2, respectively. Ninety-five per cent of all patients had propagated contractions (PCs) and 20% and 40% of the patients in group #1 had PCs during fasting and after meal, respectively. These contractions were seen 30% and 70% of the patients in group #2, but no statistical difference was found between the groups. PCs after bisacodyl were observed 90% and 40% of the patients in groups #1 and #2, respectively, and this difference was statistically significant (P=.019). In this study, the prominent difference between the groups was found in response to intraluminal stimulation. This finding may indicate that the colon of the patients with ARM has more capacity to develop PCs by peripheral stimuli and more regular enteric nervous integrity.

12.
Turk J Pediatr ; 51(4): 336-43, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19950840

RESUMO

The objective of this article was to review the case series' profile followed up by the Gazi University Multidisciplinary Team for Child Protection and to describe the challenges in our child protection system. The cases referred to this team between February 2001 and January 2007 were analyzed. In addition to the clinical management, challenges encountered during follow-up due to gaps in the child protection system were reviewed. A total of 139 patients were referred to the team during the study period. Mean age for physical abuse, sexual abuse, and neglect were 8.9 +/- 6.2, 10.8 +/- 4.2, and 5.1 +/- 5.5 years, respectively. Sexual abuse was significantly less common while neglect was significantly more common in the 0-5 years of age group. In addition to the gaps within each link of the child protection system (medical, legal and social services) in Turkey, interagency collaboration seems to be inadequate. Hospital-based multidisciplinary teams can start such a collaboration.


Assuntos
Proteção da Criança , Adolescente , Criança , Maus-Tratos Infantis/prevenção & controle , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Turquia
13.
Ren Fail ; 31(10): 971-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20030534

RESUMO

Many pharmacological agents were investigated for the prevention of renal ischemic reperfusion (IR) injury as well as the phosphodiesterase (PDE) inhibitors. The aim of the study was to examine the possible renoprotective effect of enoximone as a member of this family on IR injury. Thirty-six Wistar-Albino rats were allocated to six groups. Sham (S) and control groups (E1, E2) only received 0.09% NaCl, 5 mg/kg and 10 mg/kg enoximone via caudal caval vein, respectively. In ischemia (I) and treatment groups (IE1, IE2), the rats were subjected to bilateral renal artery occlusion and were given 0.09% NaCl, 5 mg/kg and 10 mg/kg enoximone in the same route, respectively. Bilateral kidneys were removed at the sixth hour of laparotomy for histopathological and biochemical analysis, such as superoxide dismutase, myeloperoxidase, malonyldialdehyde, and nitric oxide end products. Blood samples were taken in order to evaluate renal function tests. The data were analyzed by using one-way analysis of variance, and p < .05 was considered to be statistically significant. The worst results were achieved in ischemia group (p < .05). Treatments groups showed nearly similar findings with this group (p < .05). There was no significant difference between control and sham groups. In this study, we found that apart from the other members of the PDE inhibitors' family, enoximone did not contribute to the attenuation of IR injury of kidney.


Assuntos
Enoximona/uso terapêutico , Nefropatias/prevenção & controle , Inibidores de Fosfodiesterase/uso terapêutico , Traumatismo por Reperfusão/prevenção & controle , Animais , Enoximona/farmacologia , Masculino , Inibidores da Fosfodiesterase 3 , Inibidores de Fosfodiesterase/farmacologia , Ratos , Ratos Wistar
14.
Exp Toxicol Pathol ; 61(5): 519-27, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19631517

RESUMO

Ovarian torsion is a surgical emergency affecting not only the ipsilateral ovary but also contralateral ovary. Although the conventional treatment is salpingo-oophorectomy, recent studies advocate detorsion. We hypothesized that iloprost, an analogue of prostacyclin with cytoprotective properties, may prevent the harmful effects of ischaemia-reperfusion injury in bilateral ovaries after unilateral ovarian torsion-detorsion in rat. In this study, 24 female Wistar-albino female rats were divided into four groups. Ovarian torsion was produced by applying vascular clamps to right ovaries. In Group I, bilateral oophorectomy was performed. In group II, bilateral oophorectomy was performed after a unilateral torsion period of 4h. In group III, bilateral ovaries were removed, following unilateral torsion-detorsion periods each lasted for 4h. Saline was injected i.p. 30 min before detorsion. In group IV, same experimental protocol, which was conducted in group III, was repeated. Iloprost was injected i.p. 30 min before detorsion instead of saline in group IV. Tissue levels of malondialdehyde (MDA) and nitric oxide (NO), which are the indicators for oxidative stress were determined and histopathological evaluation was performed in bilateral ovaries in all groups. The MDA and NO levels for ipsilateral ovaries of four groups were compared and no significant difference was found (p>0.05). The same comparison were done for the contralateral sides and no difference was seen either (p>0.05). In histological examination, iloprost produced improvement in I/R-induced alterations in ipsilateral and contralateral ovaries. In conclusion, these results showed that iloprost has beneficial effect on the histological appearances in both the ipsilateral and contralateral rat ovaries after unilateral torsion-detorsion.


Assuntos
Iloprosta/farmacologia , Doenças Ovarianas/tratamento farmacológico , Estresse Oxidativo/efeitos dos fármacos , Inibidores da Agregação Plaquetária/farmacologia , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Modelos Animais de Doenças , Feminino , Doenças Ovarianas/patologia , Ovário/efeitos dos fármacos , Ovário/lesões , Ovário/patologia , Ratos , Ratos Wistar , Traumatismo por Reperfusão/patologia
15.
Child Abuse Negl ; 33(4): 247-55, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19328549

RESUMO

OBJECTIVES: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS: A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS: Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS: A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS: Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.


Assuntos
Maus-Tratos Infantis/prevenção & controle , Proteção da Criança , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Criança , Maus-Tratos Infantis/classificação , Maus-Tratos Infantis/estatística & dados numéricos , Pré-Escolar , Educação/organização & administração , Humanos , Cooperação Internacional , Iowa , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Turquia , Universidades
16.
J Pediatr Surg ; 43(10): 1839-43, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18926217

RESUMO

BACKGROUND/PURPOSE: In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. METHODS: Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature. RESULTS: Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF). CONCLUSIONS: In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.


Assuntos
Canal Anal/anormalidades , Motilidade Gastrointestinal , Reto/anormalidades , Anormalidades Múltiplas/epidemiologia , Adolescente , Adulto , Canal Anal/fisiopatologia , Canal Anal/cirurgia , Criança , Pré-Escolar , Consenso , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Defecação , Diarreia/epidemiologia , Diarreia/etiologia , Diarreia/fisiopatologia , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Megacolo/epidemiologia , Megacolo/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Guias de Prática Clínica como Assunto , Fístula Retal/complicações , Fístula Retal/epidemiologia , Reto/fisiopatologia , Reto/cirurgia , Índice de Gravidade de Doença , Volição , Adulto Jovem
17.
J Pediatr Surg ; 42(10): E13-6, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17923182

RESUMO

Congenital pouch colon associated with anorectal malformation is an unusual anomaly reported most frequently in Asian countries. Pediatric surgeons must be familiar with this anomaly and the pre- and postoperative problems of these patients. The aim of this report is to bring attention to congenital pouch colon associated with anorectal malformation by discussing experiences with 2 patients.


Assuntos
Anormalidades Múltiplas/patologia , Colo/anormalidades , Anormalidades Múltiplas/cirurgia , Canal Anal/anormalidades , Canal Anal/cirurgia , Anus Imperfurado/complicações , Apêndice/anormalidades , Colo/cirurgia , Colostomia , Incontinência Fecal/etiologia , Feminino , Humanos , Recém-Nascido , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Fístula Retovaginal/complicações , Fístula Retovaginal/congênito , Fístula Retovaginal/cirurgia , Reto/anormalidades , Reto/cirurgia , Incontinência Urinária/etiologia , Vagina/anormalidades , Vagina/cirurgia
19.
Clin Exp Pharmacol Physiol ; 34(3): 210-6, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17250641

RESUMO

1. Ischaemia-reperfusion (I/R) injury, one of the main causes of acute renal failure, still needs satisfactory treatment for routine clinical application. Stobadine, a novel synthetic pyridoindole anti-oxidant, has the ability to reduce tissue injury induced by mechanisms involving reactive oxygen species during I/R. The aim of the present study was to determine the effects of stobadine on renal I/R injury. 2. Forty male Wistar rats were randomly divided into four groups as follows: sham, I/R, stobadine treated and I/R + stobadine treated. Stobadine (2 mg/kg, i.v.) was given intravenously to two groups of rats. The stobadine-treated group was treated with stobadine following sham operation before the abdominal wall was closed, whereas the I/R + stobadine group received stobadine at the beginning of reperfusion. Renal I/R was achieved by occluding the renal arteries bilaterally for 40 min, followed by 6 h reperfusion. Immediately thereafter, blood was drawn and tissue samples were harvested to assess: (i) serum levels of blood urea nitrogen and creatinine; (ii) serum and/or tissue levels of malondialdehyde (MDA), glutathione (GSH), glucose 6-phosphate dehydrogenase (G-6PD), 6-phosphogluconate dehydrogenase (6-PGD), glutathione reductase (GR) and glutathione peroxidase (GPx); (iii) renal morphology; and (iv) immunohistochemical staining for P-selectin. 3. Stobadine was able to significantly attenuate the renal dysfunction as a result of renal I/R injury. Ischaemia-reperfusion resulted in a significant increase in serum and kidney MDA levels and a decrease in serum and kidney GSH. Stobadine treatment at the beginning of reperfusion attenuated both the increased MDA levels and decreased GSH secondary to I/R injury. In addition, the decreased G-6PD activity observed after I/R was significantly attenuated by stobadine treatment. Stobadine did not alter 6-PGD activity after I/R. Neither GR nor GPx activity was significantly changed in the I/R alone or the I/R + stobadine groups compared with the sham group. In addition, stobadine decreased the morphological deterioration and high P-selectin immunoreactivity secondary to renal I/R injury. 4. A pyridoindole anti-oxidant, stobadine exerts a renal protective effect in renal I/R injury, which is probably due to its radical-scavenging and anti-oxidant activities.


Assuntos
Carbolinas/uso terapêutico , Nefropatias/prevenção & controle , Traumatismo por Reperfusão/prevenção & controle , Animais , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Glucosefosfato Desidrogenase/metabolismo , Glutationa/metabolismo , Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Imuno-Histoquímica , Injeções Intravenosas , Rim/efeitos dos fármacos , Rim/enzimologia , Nefropatias/etiologia , Nefropatias/patologia , Masculino , Malondialdeído/metabolismo , Via de Pentose Fosfato/efeitos dos fármacos , Fosfogluconato Desidrogenase/metabolismo , Ratos , Ratos Wistar , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia
20.
Urol Int ; 77(3): 264-8, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17033216

RESUMO

AIM: The most important goal in the treatment of cryptorchidism is to preserve the potential for fertility. This experimental study was performed to investigate the effect of propylthiouracil (PTU) on the undescended testes (UTs) of newborn rats. MATERIALS AND METHODS: The experimental cryptorchidism model in newborn male rats consisted of 4 groups. The groups A (control) and B (PTU) underwent no surgical intervention, whereas in groups C (UT only) and D (treatment) UTs were produced by dissecting and suturing the future right scrotal area. In groups D and B, 0.1% (w/v) PTU was added to the drinking water of mother rats between 2 and 24 days. At the end of the 90th day rat body weights, testicular weights, Johnsen tubular biopsy scores (JTBSs), seminiferous tubule diameters (STDs), testosterone, and thyroid hormone levels were measured. Mann-Whitney U test was used for statistical analysis. RESULTS: Mean testicular weight was similar between groups A, B and D, and statistically lowest in group C. Mean body weight was statistically higher in groups A and C compared with groups B and D. Mean testosterone levels showed no statistical difference between the groups. Mean JTBSs were statistically higher in groups A and B compared with groups C and D. The value in treatment group D was statistically higher compared to group C (p<0.05). Mean STDs were statistically lowest in group C compared to other groups (p<0.05). No difference was found between groups A, B, and D (p>0.05). Both the mean free triiodothyronine and free thyroxine values between groups A and C and between groups B and D were similar. The values in groups A and C were statistically higher than those of groups B and D (p<0.05). CONCLUSION: PTU-induced transient hypothyroidism in the newborn rat UT model shows protective effects on testicular growth parameters.


Assuntos
Antimetabólitos/uso terapêutico , Criptorquidismo/tratamento farmacológico , Propiltiouracila/uso terapêutico , Animais , Animais Recém-Nascidos , Biópsia , Criptorquidismo/sangue , Criptorquidismo/patologia , Modelos Animais de Doenças , Seguimentos , Masculino , Ratos , Ratos Wistar , Testosterona/sangue , Resultado do Tratamento
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