Ultrasound-guided hydrostatic enema reduction of intussusception and confirmation with single abdominal radiograph in children.

PURPOSE: To detect false-positive reduction results after ultrasound (US)-guided hydrostatic intussusception reduction, we have incorporated water-soluble contrast material to the enema fluid and confirmed the reduction with a single abdominal radiograph. We present the results of the combined imaging method for the reduction of intussusception in children. MATERIALS AND METHODS: The records of the patients who were treated for intussusception were analyzed retrospectively. Patients were divided into two groups: a US-guided reduction group and a US-guided reduction plus radiographic control group. The patient characteristics, symptoms, treatment methods, outcomes, and complications and follow-up were analyzed. RESULTS: A total of 164 intussusception episodes were treated in 153 patients. Hydrostatic reduction of intussusception was performed in 59 patients in the US-guided group and in 94 patients in the US-guided plus radiographic control group. Recurrence rate in the US-guided group was 15.7%, vs 3.5% in the US-guided plus radiography group (P = .029). In the US-guided plus radiographic control group, 5 (5.3%) false positive reductions under US guidance were determined by abdominal radiography. CONCLUSION: In order to decrease false positive reduction rate and early recurrence, US-guided intussusception reduction can be performed with saline plus water-soluble contrast material and confirmation of reduction obtained with a single direct abdominal radiograph.

The role of water-soluble meconium subfraction and lipid-soluble meconium subfraction on the superior mesenteric artery vasoconstriction in chick embryos.

OBJECTIVE: Intraamniotic meconium has been responsible for intestinal damage in gastroschisis and meconium-dependent intestinal ischemia has been proposed to induce additional intestinal damage in gastroschisis. This study is aimed to determine the effects of lipid and water-soluble meconium subfractions on the contractility of the superior mesenteric artery (SMA). MATERIALS AND METHODS: The study was conducted on 18-day fertilized chick embryos (Gallus Domesticus). Meconium is fractioned into water and lipid-soluble components. Only one SMA tissue was prepared from each embryo and suspended in the organ bath. Isometric contraction responses (ICR) were created in SMA tissues by one hour of incubation in Krebs-Henseleit solution for each group. Groups consisted of control, meconium, water-soluble meconium subfraction and lipid-soluble meconium subfraction. ICR of the SMA specimens were evaluated with a transducer-amplifier system on a computer. The data were expressed (mean±1SD) as milliNewton (mN). RESULTS: The ICR of the meconium, water-soluble meconium subfraction and lipid-soluble meconium subfraction groups were significantly high when compared to the control group (p<0.01). The meconium and water-soluble meconium subfraction created more contraction response than the lipid-soluble meconium subfraction (p<0.01). The ICR of the meconium group was not different from the ICR of the water-soluble meconium subfraction group (p>0.05). CONCLUSION: Water-soluble meconium subfraction has a profound vasoconstrictor effect on the SMA compared to the lipid-soluble meconium subfraction.

The intestinal damage induced by lipid soluble meconium subfraction is profound compared to the intestinal damage induced by water soluble meconium subfraction.

BACKGROUND: It is unclear which substances in meconium are responsible for intestinal damage in gastroschisis. An experimental study was designed to investigate the effects of the lipid or water soluble subfractions of meconium on the intestines of gastroschisis in a chick model. METHODS: Meconium was pooled, homogenated, rota-evaporated dry and diluted. Meconium subfractions were obtained from water soluble and lipid soluble extracts of the meconium. Five days old fertilized chick embryos were used and divided into 5 groups: control, sham, water soluble meconium subfraction, lipid soluble meconium subfraction and whole meconium. All embryos were extirpated on the 18days and the intestines were harvested for histopathological examination. Serosal thickness was measured under light microscopy. RESULTS: Serosal thickness of the meconium (36.36±2.8µm), the water soluble meconium (14.15±0.93µm) and the lipid soluble meconium (23.88±1.69µm) subfractions groups were significantly increased compared with the control (7.47±0.68µm) and the sham (7.48±0.71µm) groups (p<0.001). Serosal thickness of the lipid soluble meconium subfraction group was significantly increased compared with the water soluble meconium subfraction group (p<0.001). Serosal thickness of the meconium group was significantly increased compared to both the water and the lipid soluble meconium subfraction groups (p<0.001). CONCLUSION: Lipid soluble meconium subfraction induces more intestinal damage compared to water soluble meconium subfraction.

The Density of Interstitial Cells of Cajal Is Diminished in Choledochal Cysts.

BACKGROUND AND AIMS: Interstitial cells of Cajal (ICC) have been shown to be present in the extrahepatic biliary tract of animals and humans. However, ICC distribution in choledochal cysts (CC) has not been investigated. A study was conducted to investigate the distribution of ICC in the extrahepatic biliary tract, including CC, in pediatric human specimens. METHOD: The specimens were divided into two main groups as gallbladders and common bile ducts. Gallbladders were obtained from the cholelithiasis, CC operations and autopsies. Common bile ducts were obtained from autopsies. Tissues were stained using c-kit immunohistochemical staining. ICC were assessed semi-quantitatively by applying morphological criteria and were counted as the number of cells/0.24 mm(2) in each area under light microscopy. RESULTS: A total of 35 gallbladders and 14 CC were obtained from operations. Ten gallbladders plus common bile ducts were obtained from autopsies. The mean numbers of ICC in the gallbladders of cholelithiasis and the gallbladders of CC were 12.2 ± 4.9 and 5.3 ± 1.2, respectively (p = 0.003). The mean numbers of ICC in the common bile ducts and CC were 9.8 ± 2.9 and 3.4 ± 1.4, respectively (p = 0.001). CONCLUSION: The scarcity of ICC in the extrahepatic biliary tract may be responsible for the etiopathogenesis of the CC.

Effect of Meconium on the Contractility of the Superior Mesenteric Artery: A Clue to Intestinal Damage in Gastroschisis.

INTRODUCTION: Intestinal damage has been shown to occur when intra-amniotic meconium concentration exceeds threshold level. However, the mechanism of the meconium-induced intestinal damage is still unclear. Intestinal ischemia can cause intestinal damage in gastroschisis. This study was aimed to determine the effects of intra-amniotic meconium on the contractility of superior mesenteric artery (SMA). MATERIALS AND METHODS: Eighteen-day-old fertilized chick embryos (Gallus Domesticus) were extirpated and intestines were harvested. The SMA specimens were prepared as 4 mm segments in the organ bath with Krebs-Henseleit buffer. The isometric contraction responses of the SMA specimens were evaluated with norepinephrine, different meconium concentrations, and clear amniotic fluid. Maximum isometric contractions responses (MICR) of the SMA specimens were recorded with an amplifier system on a computer. RESULTS: In the norepinephrine group, MICR was found as 2.92 ± 0.57 mN. While MICR of the 1/100 meconium group (highest meconium concentration) was found as 1.56 ± 0.40 mN, MICR of the clear amniotic fluid group was 0.41 ± 0.07 mN. The MICR of the norepinephrine group was significantly increased compared with the 1/100 meconium and clear amniotic fluid groups. MICR of the 1/100 meconium group was also found to be significantly increased compared with clear amniotic fluid group. No statistically significant difference was found among the meconium subgroups. CONCLUSION: Intra-amniotic meconium in fetuses with gastroschisis might cause ischemic intestinal damage by reducing the intestinal blood flow. Further studies are needed to show the outcomes of the vasoactive effect of meconium on the SMA blood flow.

Complex fetal ovarian cysts cause problems even after regression.

PURPOSE: Fetal ovarian cysts' size and nature are considered as the most important factors for determining the treatment modality. When to perform an intervention and to which fetal ovarian cysts has not been clarified yet. We herein present our experience with fetal ovarian cysts. Materials and METHODS: The hospital records of 38 ovarian cysts (27 simple and 11 complex) were evaluated retrospectively. The prenatal and postnatal outcomes of the cysts were investigated. RESULTS: Prenatally at the 37 fetuses, 38 fetal ovarian cysts were evaluated retrospectively. There were 27 simple and 11 complex fetal ovarian cysts followed by prenatally and postnatally. None of the simple fetal ovarian cysts underwent in utero torsion. Postnatally, 23 simple ovarian cysts were regressed within 3 months. Four patients with simple ovarian cysts larger than 4 cm were operated. During follow-up period, seven complex ovarian cysts regressed, one complex ovarian cyst complicated with intestinal obstruction underwent surgery, and three complex ovarian cysts did not regress and they were operated. Three out of seven complex ovarian cysts that were initially regressed presented with intestinal obstruction and oophorectomy plus adhesiolysis were performed. Surgical treatment was required in 7 out of 11 (64%) complex ovarian cysts. CONCLUSION: Complex ovarian cysts lead to problems even after regression in the postnatal period and require operative intervention sooner or later.

Pectus carinatum: the effects of orthotic bracing on pulmonary function and gradual compression on patient compliance.

OBJECTIVES: The treatment of pectus carinatum (PC) deformity has been considered to be operative. Some authors have shown that postoperative pulmonary function is worsened. They have suggested that compromised chest wall expansion secondary to surgery leads to compromised pulmonary function. Several authors have advocated an orthotic brace for the treatment of PC. Pulmonary functions after orthotic brace treatment have not been investigated. METHODS: Between April 2006 and October 2012, 61 patients presented with PC. Orthotic braces allowing gradual compression were prepared according to the anthropometric measurements of individual patients. The brace belt was tightened gradually. The brace was worn 6 h a day during the first week and the bracing time was prolonged for an additional hour per week till 16 h per day has been reached. Pre- and post-treatment echocardiography, pulmonary function tests and thorax computed tomography (CT) were obtained. The pectus severity index (Haller index) and the angle of sternal rotation were measured using CT. Satisfaction from bracing was evaluated by parents or patients at the end of the treatment. RESULTS: While the mean pretreatment Haller index was 1.96 ± 0.24, the mean post-treatment index was 2.26 ± 0.32. The angle of rotation was improved by 47.5%. Forced vital capacity and forced expiratory volume in 1 second were correlated with the predicted values for age. There was no statistically significant difference between pre- and post-treatment values. No skin breakdown or bruising was encountered. The overall average satisfaction score was 3.92 ± 0.27. CONCLUSIONS: We conclude that pulmonary function tests are not affected after brace treatment and gradual progression of bracing increases the patient's compliance.

Cholecystectomy conducted with single-port incisionless-intracorporeal conventional equipment-endoscopic surgery.

PURPOSE: As the interest in minimal invasive surgery has turned to single-site access surgery, single-incision laparoscopic surgery (SILS) is becoming popular. Recently limited numbers of pediatric SILS series have been published. SILS needs nonconventional three-lumen ports and articulated working instruments. However, it is possible to perform single-port laparoscopic cholecystectomy using a single conventional port and conventional working instruments. We herein present our preliminary experience with cholecystectomy conducted with single-port incisionless-intracorporeal conventional equipment-endoscopic surgery. SUBJECTS AND METHODS: During December 2009-October 2012, 27 patients (12 boys, 15 girls) underwent single-port incisionless-intracorporeal conventional equipment-endoscopic cholecystectomy. A 10-mm 0° scope with a parallel eye piece and an integrated 6-mm working channel is inserted through an 11-mm "conventional umbilical port." Conventional working instruments were introduced through the integrated working channel. The fundus of the gallbladder is hung with a transabdominal sling suture. The infundibulum is retracted laterally to expose the triangle of Calot with a second transabdominal sling suture. Then the cystic duct and the artery are dissected and clipped separately. The gallbladder is dissected from the liver bed with monopolar cautery and extracted through the umbilicus. RESULTS: The patients were 5-17 years of age (mean, 10.7±4.6 years). Cholecystectomy was performed through a single port in 23 patients. A second port insertion was necessary in 4 patients. No preoperative or postoperative complications were encountered. Mean operating time was 74.3±13 minutes. CONCLUSIONS: Single-port incisionless-intracorporeal conventional equipment-endoscopic cholecystectomy is feasible in pediatric patients with reasonable operating times. It is a safe, cheap, and highly minimal invasive procedure with excellent cosmetic results.

Intra-amniotic administration of urinary trypsin inhibitor preserves intestinal contractility in meconium induced intestinal damage in chick embryos with gastroschisis.

BACKGROUND: Intestinal damage causes intestinal dysmotility in gastroschisis. Urinary trypsin inhibitor (UTI) has been shown to prevent intestinal damage in chick embryos with gastroschisis. The effect of intra-amniotic administration of UTI on intestinal motility in gastroschisis has not been investigated. METHODS: Five-day-old fertilized chick embryos were used. Gastroschisis was created through the amniotic cavity without opening the allantoic cavity. There were six groups; control, gastroschisis only, gastroschisis plus meconium and three treatment groups. In the treatment groups, 100 IU/mL, 200 IU/mL and 400 IU/mL UTI were instilled into the amniotic cavity of the gastroschisis plus meconium embryos, respectively. Serosal thickness of the intestines in each group was measured histopathologically. The contractions of the intestines were evaluated by in vitro organ bath technique and the responses were expressed as maximal contraction induced by acetylcholine. RESULTS: The serosal thickness was significantly increased in the gastroschisis plus meconium, 100 IU/mL, 200 IU/mL UTI groups compared to control and gastroschisis only groups. The serosal thickness of the 400 IU/mL UTI group was similar to control and gastroschisis only groups. Contractility of the intestines was diminished in the gastroschisis plus meconium, 100 IU/mL and 200 IU/mL UTI groups. There was no significant difference regarding contractility among control, gastroschisis only and 400 IU/mL UTI groups. CONCLUSION: Intra-amniotic administration of UTI preserves intestinal contractility in chick embryos with gastroschisis. However, preservation of intestinal dysmotility by using UTI in the human gastroschisis cases needs further experimental and clinical trials.

Altered expression of interstitial cells of Cajal in primary obstructive megaureter.

OBJECTIVE: A marked decrease in the density of interstitial cells of Cajal (ICC) has been shown in patients with ureteropelvic junction obstruction. ICC may also play a role in primary obstructive megaureter (POM). An immunohistochemical study was conducted to investigate the density of ICC in ureterovesical junction (UVJ) segments resected from patients with POM and from control autopsy specimens. MATERIALS AND METHODS: Resected UVJ segments from 11 patients operated for POM comprised the study group. Control UVJs were obtained from autopsy specimens of 7 children who died from causes other than urogenital pathology. The UVJs including the narrowest parts were studied using immunohistochemical staining for C-kit positive cells. RESULTS: The number of ICC was significantly lower in the UVJs of the POM compared to the control group. The UVJs of the POM group had 1.75 ± 1.14 ICC (mean ± 1SD), whereas the control group had 5.76 ± 2.99 ICC (mean ± 1SD). CONCLUSION: The number of ICC was decreased in the UVJs of the patients with POM compared to the normal control group. As dilation of the ureter during fetal life is a common condition and ureteral dilation is often self limiting, we hypothesize that ureteral peristalsis is a maturational event including the maturational development of ICC.

Laparoscopic ureteroureterostomy in children with a duplex collecting system plus obstructed ureteral ectopia.

One of the complex upper urinary tract anomalies is a duplicated collecting system. In cases with a functioning upper moiety, ureteroureterostomy (UU) is the preferred operation to redirect the urine to the normal collecting system. Although open UU is a well-described operation, experience with laparoscopic repair pediatric patients is scarce. We describe the successful application of laparoscopic UU in 2 children and suggest that laparoscopic UU for the duplicated collecting system is a promising minimally invasive procedure.

Appendectomy conducted with Single Port Incisionless-Intracorporeal Conventional Equipment-Endoscopic Surgery.

In "single conventional port" intracorporeal laparoscopic appendectomy, the appendix is suspended with a transabdominal SLING suture, which replaces the second working instrument (grasper). Thus, the second port is not required. We had modified the SLING suture to SWING suture and renamed our technique as Single Port Incisionless-Intracorporeal Conventional Equipment-Endoscopic Surgery. We herein present our experience with appendectomy conducted by the Single Port Incisionless-Intracorporeal Conventional Equipment-Endoscopic Surgery using the homemade grasper: the SWING suture.

Rosuvastatin protects tissue perfusion in the experimental testicular torsion model.

Recently, anti-inflammatory and tissue protective effects of statins have been shown independent from its anti-hyperlipidemic effect. It has been shown that one of the statins, rosuvastatin, may reduce ischemia/reperfusion (I/R)-induced tissue injury in the brain, intestines, and heart. We planned an experimental study to evaluate the effect of rosuvastatin on I/R injury encountered after the detorsion of the testicular torsion. Rats were divided into three groups. In group 1, testis basal blood flow (basal value) was measured with LASER Doppler flowmeter (LDF). Testis was relocated into the scrotum without torsion. Two and 3 h after the basal measurement, testis was brought out from the same incision, and the second (second value) and third (third value) testicular blood flow measurements were done, respectively. In group 2, after the measurement of basal value testicular torsion was created. Second and third value measurements were obtained with LDF at the end of the 2 h of testicular torsion just before the detorsion and 1 h after detorsion. In group 3, same procedures in torsion/detorsion group were repeated in this group, but 10 mg/kg rosuvastatin was injected intraperitoneally 30 min before detorsion. Second values in groups 2 and 3 were significantly lower than group 1. Third values were significantly low in group 2 compared to groups 1 and 3. Regarding the third measurement, there was no significant difference between the groups 1 and 3. Tissue injury is closely related with condition of microvascular perfusion after I/R. Rosuvastatin can protect tissue perfusion in the experimental testicular torsion model.

Stromal-predominant mesenchymal hamartoma of the liver with elevated serum alpha-fetoprotein level.

Mesenchymal hamartoma of the liver (MHL) is an uncommon, benign, tumor-like lesion and is usually diagnosed in the first 2 years of life. Its pathogenesis remains unclear. Treatment of choice is radical excision. The authors report a case of solid stromal predominant MHL in a 12-month-old male infant who also had an elevated serum alpha-fetoprotein level. He also had hypospadias, which might represent a spectrum of developmental anomalies. It usually presents as an asymptomatic mass, however, as in the reported case, it may cause several complications due to the compression of surrounding structures. He was successfully treated with total excision of the pedunculated large tumor without any complication.

Amniotic fluid ferritin as a marker of intestinal damage in gastroschisis: a time course experimental study.

BACKGROUND/PURPOSE: Intestinal damage (ID) is closely related to morbidity and mortality in gastroschisis. This study was performed to determine the intraamniotic substances that may correlate ID and also to verify their time course levels that would be useful for determining when ID starts in gastroschisis. METHODS: In this study, 13-day-old fertilized chick eggs were used. The amnioallantoic membrane was perforated to create amnioallantoic cavity in all embryos. Gastroschisis was created in gastroschisis group to simulate human gastroschisis. Amnioallantoic fluid samples were collected from the embryos on the 13th to 19th gestational days, and the intestines of each group were harvested for evaluation. Amnioallantoic levels of interleukin-8, ferritin, alkaline phosphatase, and amylase were measured. Serosal thickness of the intestines in each group was evaluated. RESULTS: Increasing amnioallantoic fluid levels of interleukin-8, alkaline phosphatase, and amylase were found in both groups. In contrast to control group, ferritin levels, as a sign of inflammation, were found increased only in gastroschisis group. Histopathologic examination of intestines in the gastroschisis group showed a significant increase in the serosal thickness especially after the 16th day. CONCLUSION: Increases in amnioallantoic fluid levels of ferritin show promise as a marker for determining ID encountered in gastroschisis but warrant further investigation.

The effect of dilated ganglionic segment on anorectal and urinary functions during 1-stage transanal endorectal pull through for Hirschsprung's disease.

BACKGROUND/PURPOSE: During a 1-stage transanal endorectal pull through (OS-TERP) for Hirschsprung's disease (HD), dilated ganglionic segment (DGS) may pose a problem during coloanal anastomosis. Apart from the anorectal problems occurring after the HD operations, lower urinary tract problems may also be encountered. The anorectal and lower urinary tract system functions of the patients that underwent OS-TERP in the presence of DGS were evaluated. METHOD: From 2000 to 2005, 15 patients (14 boys and 1 girl) underwent OS-TERP for HD. During the presence of DGS, the coloanal anastomosis of the DGS was completed without any tapering or excision. Hospital and digital video records of all the patients who underwent OS-TERP were evaluated, and the operation time, complications, and follow-up periods of the patients were compared. Standard urodynamic studies were performed after at least 6 months. Bladder capacity; mean bladder capacity ratio; maximum filling pressure; the number of contractions during the filling phase; intraabdominal, intravesical, and detrusor pressures; residual urinary volume; and electromyography activities of the pelvic floor muscles were evaluated. RESULTS: Six patients had ganglionic segment of normal caliber, whereas 9 patients had DGS. Duration of the operation was significantly longer in the DGS group. One patient in DGS group experienced a single episode of enterocolitis in the postoperative period. Transient urinary retention occurred in another patient in DGS group. In ganglionic segment of normal caliber group, one patient experienced 2 episodes of enterocolitis in the postoperative period. Urodynamic study of the 7 patients in the DGS group had postvoiding urine volume of less than 20 mL. The detrusor activities of all the patients were found to be normal. None of the patients had developed urinary tract problems during the follow-up period. CONCLUSION: With the coloanal anastomosis technique, we have described that narrowing the DGS to anal caliber step by step without any excision or tapering enables DGS to fit to the anus easily. Although further clinical studies with larger sample sizes are necessary, present study may imply that OS-TERP performed in the presence of a DGS may not increase morbidity and affect anorectal functions. The normal urodynamic study results obtained in this study may imply that OS-TERP procedure may be performed safely in the presence of DGS.

Single-port laparoscopic appendectomy conducted intracorporeally with the aid of a transabdominal sling suture.

BACKGROUND/PURPOSE: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute and perforated appendicitis. Since it was first described, LA has been modified various times. We present the results of a new technique of LA conducted through a single port without exteriorizing the appendix to perform the operation. MATERIALS AND METHODS: Single-port LA was attempted in 38 patients (23 boys, 15 girls). Under general anesthesia, an 11-mm port with two 5-mm working channels or an 11-mm port through which a 10-mm scope (0 degrees) with a parallel eyepiece and a 6-mm working channel was inserted through the umbilicus. The appendix was grasped and dissected from the surrounding tissues with a single dissector or grasper. With a percutaneously inserted suture from the right lower quadrant into the peritoneal cavity, the appendix was pulled toward the abdominal wall after passing the suture through the mesoappendix. After mesenteric dissection with hook cautery, the base of the appendix was ligated with 2-0 polyglactin with a fisherman knot. The appendix was withdrawn into the trocar and extracted from the abdomen together with the trocar. RESULTS: Laparoscopic appendectomy was completed in 35 patients through a single port. A second port insertion was required in 3 patients. No peroperative and postoperative complications were encountered. Average duration of the procedure was 38 +/- 5.6 minutes. CONCLUSION: This unique method further improves the minimal invasiveness of LA because a single port is used. Single-port intracorporeal appendectomy procedure is a safe, highly minimal invasive procedure with excellent cosmetic results.

Laparoscopic excision of a giant ovarian cyst after ultrasound-guided drainage.

The laparoscopic approach to giant ovarian cysts in pediatric population may be difficult regarding the risk of cyst rupture and limited working space. We herein report a 16-year-old adolescent girl that presented with a giant ovarian cyst. To reduce the limitations of the laparoscopy, we performed laparoscopy after draining the cyst under ultrasonographic guidance. Under local anesthesia, a nephrostomy catheter was placed into the cyst by the Seldinger technique. During laparoscopy, abdominal cavity was explored by the scope and then the nephrostomy catheter was removed. Laparoscopic procedure was completed easily. No pre- and postoperative complications were encountered and the patient was discharged on the second postoperative day. The pathologic examination of the cyst revealed as follicular cyst. Laparoscopic excision of giant ovarian cysts after ultrasound-guided drainage seems to be safe and applicable treatment modality in children.

The etiology of tracheal mucosal injury in proximal esophageal atresia plus distal tracheoesophageal fistula: an animal study.

Tracheal mucosal damage has been reported in autopsy specimens of cases with proximal esophageal atresia and distal tracheoesophageal fistula (EA-TEF) (Gross classification type C). Such changes have not been reported for isolated EA (Gross classification type A). Our hypothesis is that passage of amniotic fluid (AF) through fistula via larynx and trachea may damage tracheal mucosa. An experimental study was conducted to investigate this hypothesis in the Adriamycin-induced EA-TEF model. In the first stage of the study, we tested whether the fetuses with EA-TEF associated with pyloric atresia cannot swallow AF whereas the fetuses EA-TEF without intestinal atresia can swallow AF. Carbon solution was injected into the AF for this purpose. In the second stage of study, at the 21st day of their gestation, fetuses were extirpated and dissected under microscope. In both stages, fetuses were divided into four groups as control, fetuses without tracheoesophageal abnormalities, fetuses with EA-TEF only, fetuses with pyloric atresia associated with EA-TEF. Lungs and tracheas of the all fetuses were removed for histopathological examination. While carbon particles were present in the trachea, stomachs of the fetuses without tracheoesophageal anomalies, with EA-TEF only and control fetuses, carbon particles were absent in both trachea and stomachs of the fetuses with pyloric atresia associated with EA-TEF. Histopatological examination of the tracheal mucosa showed damage throughout the trachea in the fetuses with EA-TEF only group. Tracheal mucosa was found to be normal in other groups. Bronchial mucosa and lung tissues were found to be normal in all groups. Amniotic fluid swallowed through the TEF causes histopathological changes in the tracheal mucosa of the fetuses with EA-TEF only group. These findings may also contribute to the development of new fetal treatment modalities.

Urinary trypsin inhibitor present in fetal urine prevents intraamniotic meconium-induced intestinal damage in gastroschisis.

BACKGROUND/PURPOSE: Contact with amniotic fluid causes intestinal damage in gastroschisis, and intraamniotic meconium has been shown to be responsible. Meconium has been shown to contain a significant amount of IL-8, which may be the responsible cytokine for harmful effects of meconium. Neonatal urine contains high amount of urinary trypsin inhibitor (UTI) compared with adult human urine. Urinary trypsin inhibitor has been shown to exert inhibitory effects on IL-8. Therefore, far from being destructive, presence of fetal urine in the amniotic fluid might be beneficial because human urine contains UTI. An experimental study has been performed to investigate whether presence of intraamniotic human urine (consequently UTI) besides meconium is beneficial on intestines of chick embryo with gastroschisis. METHODS: Five-day-old fertilized chick eggs were used. Gastroschisis was created through amniotic cavity without opening the allantoic cavity. Sterile urine and meconium were obtained from newborn humans. Study was conducted in 2 stages. In the first stage, gastroschisis was created, and meconium suspensions at minimal harmful meconium concentration were prepared using natural and denatured human neonatal urine and instilled into the amniotic cavity. In the second stage of study, various concentrations of UTI plus meconium suspension at minimal harmful meconium concentration was instilled into the amniotic cavity. RESULTS: Serosal thickening, inflammation, and focal fibrin deposits were observed in intestines of the groups with meconium and meconium in denatured urine. Histopathologic features of intestines of the group with meconium in natural urine did not differ from the intestines of the control group. Histopathologic examination of intestines of groups with meconium and meconium plus 50 U/mL UTI showed serosal thickening, inflammation, focal fibrin, and collagen deposits. Histopathologic features of intestines of the groups with 1:400 intraamniotic meconium plus 100 and 200 U/mL UTI did not differ from the intestines of control group. CONCLUSION: Urinary trypsin inhibitor 100 U/mL prevented the intestinal damage via inhibiting IL-8, which is contained by 1:400 concentration of meconium. Therefore, besides the existence of threshold level of meconium, the existence of UTI, which is capable of inhibiting IL-8 contained by threshold level of meconium, may be a factor in the occurrence of intestinal damage in gastroschisis.