Is paracetamol responsible for fatal acute liver failure in pediatric patients after hip dysplasia surgery?

OBJECTIVE: It is well known that local complications, such as avascular necrosis and arthrosis can develop after surgery for developmental dysplasia of the hip (DDH). Thus far, systemic complications that may develop in such cases have not been identified in the literature. This study is the first case series to evaluate acute liver failure (ALF) development after DDH surgery in pediatric patients. PATIENTS AND METHODS: Six patients, five female and one male, who underwent DDH surgery were selected for this study. Perioperative fasting time, laboratory values, treatments, histopathological evaluations, and prognoses after ALF in these patients were evaluated retrospectively. RESULTS: All the patients were administered paracetamol and sevoflurane in therapeutic doses. The patients were referred postoperatively to our pediatric emergency department after 5 ± 1.67 days (range = 3-7 days) on average. The average perioperative fasting time was 9.3 ± 0.82 hours (range = 8-10 hours). Due to the very high aminotransferases and use of paracetamol, intravenous N-acetylcysteine was administered alongside supportive treatments to all the patients. After liver transplantation, two of three patients with grade 3 encephalopathy, died in the early postoperative period. Histopathological evaluations of the three patients' explants were compatible with toxic hepatitis due to paracetamol. CONCLUSIONS: Paracetamol is a commonly used analgesic after pediatric surgery. The therapeutic dose of paracetamol remains uncertain in children who have been fasting for a long time and have been exposed to hepatotoxic drugs due to previous surgery. In conclusion, caution should be exercised in the use of paracetamol in children with DDH who will undergo surgery, and careful perioperative clinical and laboratory monitoring for ALF is essential.

Is there any relationship between clinical parameters and histopathologic features of gallbladder specimens obtained from living liver donors?

OBJECTIVE: To investigate whether there is any relationship between the clinical parameters and the histopathological features of the gallbladder (GB) specimens obtained from living liver donors (LLDs). METHODS: The demographic (age, sex, height, weight, and BMI), clinical (liver graft type, liver graft weight, and GB volume), microbiological (bile culture), and histopathological (width, length, wall thickness, and microscopic properties of the GB specimen) data of 169 LLDs, who underwent living donor hepatectomy between October 2015 and October 2017, were prospectively recorded and retrospectively analyzed. The LLDs were compared with respect to sex (male vs. female) and the histopathological features of the GB (normal structure vs. chronic cholecystitis vs. cholesterolosis/polyps/cholelithiasis). RESULTS: There were no significant differences between both sexes with respect to age, graft type, and some features of GB (volume, wall thickness, width, length, and bile culture). On one hand, there were significant differences between both sexes with regard to height (P < 0.001), weight (P < 0.001), BMI (P < 0.001), histopathological findings (P = 0.003), and graft size (P = 0.003). Comparison with regard to GB's histopathological features revealed no significant differences between the three groups with respect to age, weight, and some features of GB (volume, length, width, and bile culture). On the other hand, the three groups were significantly different in terms of sex (P = 0.003), height (P = 0.008), BMI (P = 0.002), and wall thickness (P = 0.044). Bile culture proliferation occurred in none of the patients except for one patient. CONCLUSION: This study is the first to assess GB's volume, dimensions, and bile culture in healthy individuals such as LLDs.

Acute toxic hepatitis induced by a herbal medicine : Anchusa Boraginaceae.

BACKGROUND AND AIM: Herbal treatments are becoming increasingly popular in many countries. Anchusa Boraginaceae (also called Tort plant and beef tongue) is commonly used as a herbal medicine in Elazig region as diuretic and in the treatment of ulcers, and it is stated that this has no adverse effect. We report a case of acute hepatitis associated with long time use of high doses of Anchusa Boraginaceae. CASE: A 43-year-old male patient is drinking water of Anchusa Boraginaceae that is boiling for 14 days to dissolve the stones in the gallbladder. He had no medical history and did not take any other drugs or toxins. Two weeks later ; he admitted with developed tea colored like urine and yellowing of the body. Three weeks later; he was referred to the our department from the epicenter. Blood tests showed aspartate aminotransferase : 37 U/L, alanine aminotransferase : 66 U/L, gama glutamyl transferase : 23 U/L, total bilirubin : 16.9 mg/dL, direct bilirubin : 12 mg/dL, and INR : 1.3 Viral and autoimmune hepatitis were eliminated. Upper abdominal ultrasound was normal. After the herbal medicine was stopped on admission, the patient's laboratory tests didn't recover. Then; the support treatment was performed. The clinical and the laboratory values returned to normal after 2 months after the acute episode. CONCLUSIONS: The consumption of herbal medicines containing Anchusa Boraginaceae can induce toxic hepatitis. Recovery can be complete after discontinuation. This case report highlights the risk and lytic effect on gallstone associated with Anchusa Boraginaceae.

Beneficial effects of aminoguanidine on radiotherapy-induced kidney and testis injury.

This experimental study was designed to investigate both protective and therapeutic effects of aminoguanidine (AG), on radiotherapy (RT)-induced oxidative stress in kidney and testis. Forty rats were divided into five groups equally as follows: (i) control, (ii) RT, (iii) AG, (iv) AG+RT and (v) RT+AG group. Histopathological findings and biochemical evaluations, including tissue malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), glutathione (GSH), total oxidant status (TOS), total antioxidant capacity, oxidative stress index (OSI), blood urea nitrogen (BUN), serum creatinine (Cr) and testosterone levels, were determined. MDA, TOS and OSI were significantly higher in RT-treated groups, whereas SOD, CAT, GPX and GSH were significantly lower in these groups when compared with the control rats in the kidney and testis tissue. AG treatment significantly decreased MDA, TOS and OSI levels and increased SOD, CAT, GPX and GSH levels, when compared to the RT-treated groups in both kidney and testis tissue. BUN and Cr levels did not change among the groups, whereas testosterone levels were found as reduced in the RT-treated rats. AG treatment significantly augmented these hazardous effects of RT on testis tissue. According to our results, AG has beneficial effects against RT-induced kidney and testis injury.

Preventive and early therapeutic effects of ß-glucan on the bleomycin-induced lung fibrosis in rats.

OBJECTIVE: The ß-glucans are long-chain polymers of glucose, which comprise the fungal cell wall, stimulate cells of the innate immune system, enhance disturbed epithelization, and have antioxidant effects. Oxidative stress has been implicated in the pathogenesis of bleomycin-induced lung fibrosis and various antioxidant agents have been studied for prevention and treatment of the disease. In this experimental animal study, we assessed effects of ß-glucan, extracted from barley, on the bleomycin-induced lung fibrosis, and evaluated differences of starting before and after bleomycin instillation. MATERIALS AND METHODS: Male Spraque-Dawley rats were given a single dose of bleomycin in pulmonary fibrosis groups. First dose of ß-glucan and NAC was given three days before the bleomycin injection, and at one of the other group ß-glucan was started 12 hours after bleomycin and continued until 14th day. Fibrotic changes in lung were estimated by using Aschoft's criteria and measuring lung hydroxyproline content. RESULTS: Bleomycin induced severe pulmonary fibrosis with marked increase in hydroxyproline content of lung tissue and typical lung fibrosis, which was prevented by ß-glucan. Hydroxyproline level was significantly higher in bleomycin treated rats than the other groups, and its level was decreased in the therapeutic groups, especially in the ß-glucan post-bleomycin group fibrosis score, hydroxyproline and MDA levels returned to the control levels. On the other hand, reduced glutathione level elevated in the same group. CONCLUSIONS: The data suggest that ß-glucans have protective and early therapeutic effects against bleomycin-induced lung fibrosis in rats.

Effects of pinealectomy and exogenous melatonin on the brains, testes, duodena and stomachs of rats.

BACKGROUND: It is generally agreed that physiological levels of melatonin, a hormone secreted by the pineal gland, are important in protecting against oxidative stress-induced tissue damage. AIM: We investigated the effects that pinealectomy and the administration of exogenous melatonin have on the brains, testes, duodena and stomachs of rats. MATERIALS AND METHODS: Pinealectomized (Px) and sham-operated (non-Px) rats were used. We evaluated structural changes, and catalase (CAT), reduced glutathione (GSH), super oxide dismutase (SOD) and malondialdehyde (MDA) levels. The rats were divided into the following five groups (eight rats in each group): sham (non-Px), Px+ vehicle, Px+ melatonin (10 mg/kg given daily intraperitoneally for a week), melatonin and ethyl alcohol. RESULTS: The antioxidant levels in the tissue of Px rats were significantly lower than in those of the sham group. Administering melatonin significantly increased antioxidant levels (p < 0.05). The Px rats also showed a significant increase in MDA levels when compared to the sham group, and administering melatonin to the Px rats significantly reduced their MDA levels (p < 0.05). The severity of caspase-3 staining was lower in the Px+ melatonin group than in the Px+vehicle group. CONCLUSIONS: These findings suggest that significantly more oxidative and structural changes occur in rats' brains, spinal cords and testes after pinealectomy, but that this can be diminished by melatonin treatment. However, Px does not have important effects on the duodenum and stomach.

A rare cause of ankle pain: concomitant intravenous lobular capillary haemangioma and arteriovenous fistula.

Intravenous lobular capillary haemangioma (ILCH), also called intravenous pyogenic granuloma, is a rare benign lesion. These lesions are frequently showed themselves in the veins of the neck and upper extremities of young women. Clinical features are not specific. Ultrasonography can be used for diagnosis and showing additional pathologies such as arteriovenous fistula. The treatment is surgical excision. Correct pathologic diagnosis is required for differential diagnosis. We report an ILCH case presented to the Emergency Department with the complaints of pain and swelling in the ankle, originated from an arteriovenous fistula in vena saphena magna.

Effects of iloprost on bleomycin-induced pulmonary fibrosis in rats compared with methyl-prednisolone.

OBJECTIVE: Prostacyclin (PGI2) has been shown to inhibit the expression of pro-inflammatory and pro-fibrotic mediators in pulmonary fibrosis. In this study, we aimed to test the preventive effects of intraperitoneally administered iloprost, a stable PGI2 analog, on bleomycin-induced pulmonary fibrosis in rats and to compare the effects of iloprost with the effects of methyl-prednisolone, a traditional therapy. METHODS: Rats were randomly allocated into four groups: 1. Saline alone (n=6); 2. Bleomycin+placebo (n=7); 3. Bleomycin+methyl-prednisolone (n=7); 4. Bleomycin+iloprost (n=7). Fibrotic changes in the lungs were demonstrated by analyzing the cellular composition of bronchoalveolar lavage fluid, histological evaluation and lung hydroxyproline content. RESULTS: Fibrosis was made in the lungs of rats by bleomycin experimentally. Fibrosis scores in the methyl-prednisolone and the iloprost groups were significantly lower than in the placebo group (p<0.05). Furthermore, the score of the iloprost group was significantly lower than the score of the methyl-prednisolone group. The hydroxyproline content was significantly less in the methyl-prednisolone and the iloprost groups (p<0.05). In the placebo group, the neutrophil percentage in bronchoalveolar lavage was significantly higher than in the other groups, whereas the macrophage percentage in placebo group was significantly lower (p<0.05). CONCLUSION: Iloprost has protective effect on the pulmonary fibrosis induced by bleomycin and it may be more effective in decreasing fibrotic changes than methyl-prednisolone.

Therapeutic effects of ivabradine on hemodynamic parameters and cardiotoxicity induced by doxorubicin treatment in rat.

The aim of this study was to investigate the possible effects of ivabradine against doxorubicin (DOX)-induced cardiotoxicity in rats using hemodynamic parameters (electrocardiogram, heart rate (HR), and blood pressure), biochemical markers of oxidative stress, lactate dehydrogenase, aspartate transaminase, creatine kinase-MB, and histopathological analyses both in serum and tissue specimens. A total of 28 female rats were randomly assigned to 4 groups: (a) control (n = 6 rats), (b) DOX group (n = 7 rats), (c) DOX + ivabradine-treated group (n = 8 rats), and (d) ivabradine group (n = 7 rats). When the means of the four groups were compared, there was only a significant difference in the level of HR (p < 0.05). DOX treatment caused more HR elevation when compared to the control group, whereas ivabradine application after DOX treatment significantly reduced HR levels. Cardiomyocytes were revealed as normal histology in the light of both hematoxylin and eosin staining and immunostaining methods (caspase-3 and bcl-2) in all groups. The present study reported the therapeutic effects of ivabradine against DOX-induced cardiotoxicity accompanied by the hemodynamic and biochemical parameters.

Effects of electromagnetic radiation produced by 3G mobile phones on rat brains: magnetic resonance spectroscopy, biochemical, and histopathological evaluation.

OBJECTIVE: The effects of electromagnetic radiation (EMR) produced by a third-generation (3G) mobile phone (MP) on rat brain tissues were investigated in terms of magnetic resonance spectroscopy (MRS), biochemistry, and histopathological evaluations. METHODS: The rats were randomly assigned to two groups: Group 1 is composed of 3G-EMR-exposed rats (n = 9) and Group 2 is the control group (n = 9). The first group was subjected to EMR for 20 days. The control group was not exposed to EMR. Choline (Cho), creatinin (Cr), and N-acetylaspartate (NAA) levels were evaluated by MRS. Catalase (CAT) and glutathione peroxidase (GSH-Px) enzyme activities were measured by spectrophotometric method. Histopathological analyses were carried out to evaluate apoptosis in the brain tissues of both groups. RESULTS: In MRS, NAA/Cr, Cho/Cr, and NAA/Cho ratios were not significantly different between Groups 1 and 2. Neither the oxidative stress parameters, CAT and GSH-Px, nor the number of apoptotic cells were significantly different between Groups 1 and 2. CONCLUSIONS: Usage of short-term 3G MP does not seem to have a harmful effect on rat brain tissue.

The incidence of non-proliferative and precancerous lesions of reduction mammoplasty: evaluation of 273 cases.

BACKGROUND: Reduction mammoplasty (RM) is one of the most commonly performed plastic surgery procedures to treat symptomatic macromasty or to correct asymmetry. Occult breast carcinomas were rarely defined in RM specimens. There are few studies aiming to define the incidence of non-proliferative and precancerous lesions. MATERIAL AND METHODS: We evaluated the pathological findings of the RM specimens that have been submitted to our Center for the last 6 years (2005-2011). RESULTS: A total of 273 cases with bilateral RM were enrolled to the study. Of them, 229 cases had pathological changes. Eight cases (2.9%) had atypical ductal/lobular hyperplasia. One case (0.3%) had lobular carcinoma in situ; however, no invasive breast carcinoma was detected. Other pathological findings included fibrocystic changes, fibrosis, adenosis, fibroadenoma (without complex features), mastitis and duct ectasia. CONCLUSIONS: Pathological examination of the RM specimens is quite important to define the lesions precancerous of breast carcinoma. Unknown occult breast lesions could be identified and early interventions may be taken into account.

Primer malignant melanoma of kidney: a case report.

We report a case of malignant melanoma of the kidney presenting as a primary tumor. This tumor was found incidentally in a 67-year-old man. This is a rare primer malign melanoma case of the kidney in 67-year old man, with no history of melanoma, presenting with an asymptomatic solitary renal mass. The patient underwent a right radical nephrectomy, We discuss the probability that this tumor is renal in origin and directly linked to the origin of malignant melanoma.