MicroRNA Levels in Exhaled Breath Condensate of Patients with Esophageal Atresia.

MicroRNAs (miRNAs) are noncoding RNAs that play an important role in the regulation of inflammation and have not been evaluated in exhaled breath condensates (EBC) of patients with esophageal atresia and tracheoesophageal fistula (EA-TEF). It is aimed to evaluate the levels of miRNA-21 and miRNA-24 in EBC of patients with EA-TEF. Patients who received surgery for EA-TEF (EA) were assessed for age, sex, types of anomaly, surgical treatments, and respiratory problems. A 500-1000 mL of EBC was obtained from each participant with EcoScreen. The levels of miRNA-21 and miRNA-24 in the EBC were analyzed by real-time polymerase chain reaction and compared between the EA group and the control group consisting of healthy children with no history of respiratory problems (n = 17). The levels of miRNAs in relation to respiratory problems and gastroesophageal reflux (GER) were also assessed. A total of 19 patients were enrolled in the EA group with a mean age of 7.8 ± 3.2 years and a male-to-female ratio of 10:9 EA cases had significantly lower levels of miRNA-21 (P < 0.05) compared to that in control group. The miRNA-24 levels did not differ between groups (P > 0.05). EA patients with positive pH testing for GER (n = 6) and fundoplication (n = 6) had higher levels of miRNA-21 than those with normal pH testing and without fundoplication, respectively (n = 13, P < 0.05). The levels of miRNA-21 and miRNA-24 did not differ between patients with and without proton pump inhibitor treatment (P > 0.05). The lower levels of miRNA-21 in the EBC of EA patients suggest a hyperreactive airway problem, which may be associated with GER and its surgical treatment.

Rare gallbladder parasitosis mimicking cholelithiasis: Dicrocoelium dendriticum.

Cholelithiasis is increasingly diagnosed in childhood and infancy. Biliary parasites are the rarest cause of cholelithiasis in all age groups. We present a twelve-year-old girl with non-hemolytic gallbladder stone and discuss the clinical features and differential diagnosis of Dicrocoelium dendriticum (DD) invasion that causes and/or mimics cholelithiasis in children.

Electrophysiological evaluation of cremasteric reflex in experimental testicular torsion.

AIM: The aim of the study was the electrophysiological evaluation of the cremasteric reflex after experimental testicular torsion. MATERIAL AND METHODS: Ten male Wistar rats were enrolled into the study. Genitofemoral nerve (GFN) motor conduction and cremasteric reflex (CR) responses were evaluated electrophysiologically after being subjected to anesthesia with intramuscular ketamin hydrochloride. Testicular torsion was performed by rotating the right testicle 720 degrees in a clockwise direction from a midscrotal incision. Electrophysiological evaluations were repeated in the early (30 minutes) and late (90 minutes) periods of testicular torsion. Subsequently, detorsion of the testicles was performed and electrophysiological recordings were completed after 60 minutes of detorsion. The CR was also evaluated clinically before each electrophysiological evaluation. The latency and duration of GFN motor conduction and CR responses was compared for base, early torsion, late torsion and detorsion recordings. Friedman's test for repeated measurements was used for statistical analysis. RESULTS: The CR, which was detected clinically before torsion and after detorsion, was not detected during torsion. When base, early torsion, late torsion and detorsion recordings were compared, there was no statistical difference with respect to both latency and duration of GFN motor conduction and CR responses (p > 0.05). CONCLUSION: Although CR was not detected clinically during testicular torsion, the electrophysiological parameters of the reflex did not differ in the early and late periods of torsion in rats. The GFN motor conduction parameters also showed no differences. In conclusion, the absence of the CR after testicular torsion could not be confirmed by electrophysiological studies.

The use of pH monitoring and esophageal manometry in the evaluation of results of surgical therapy for gastroesophageal reflux disease.

BACKGROUND/PURPOSE: Surgery is indicated for the treatment of gastroesophageal reflux disease (GERD) when medical treatment fails or complications are encountered in children. However, it has not been fully established how the results after surgery can be evaluated. A prospective study was performed to evaluate the results of surgical therapy for GERD by pH monitoring (PM) and esophageal manometry (EM) in children. METHODS: Patients who were candidates for anti-reflux surgery between 2003 and 2004 were evaluated for symptoms, growth and results of PM and EM both in the pre- and postoperative periods. RESULTS: Thirteen patients were included (mean age = 6.65 +/- 3.28 years, male/female ratio = 10/3). Most frequently occurring symptoms were recurrent respiratory infections (RRI) (n = 11) and vomiting (n = 8). Nissen fundoplication was performed because of unresponsiveness to treatment (n = 10), RRI (n = 9), failure to thrive (n = 7) and esophagitis (n = 2) after medical treatment (2 - 36 months). Symptoms were resolved in 83.9 % of patients and were not changed in 16.1 % following surgery. Weight percentiles had significantly improved (pre: 12.38, post: 25.4, p < 0.05) during a short follow-up period (1 - 4 months). Mean reflux index (pre: 24.73 +/- 21.07 %, post: 0.93 %, min: 0 - max: 3.6, p < 0.05), reflux time (pre: 368 +/- 313 min, post: 17.1 +/- 15.9 min, p < 0.05), number of episodes (pre: 344.7 +/- 343.6, post: 19.53 +/- 11.13, p < 0.05) and number of reflux episodes longer than 5 minutes (pre: 4.3, min: 0 - max: 58, post: 0.61, min: 0 - max: 3, p < 0.05) were found to be reduced after surgery by PM. Lower esophageal sphincter pressure (pre: 55 +/- 27 cmH (2)O, post: 64.46 +/- 30.85 cmH (2)O), contraction amplitude (pre: 141.92 +/- 69.11 cmH (2)O, post: 130.69 +/- 45 cmH (2)O) and contraction velocity (pre: 1.94 cm/s, min: 0.1 - max: 7.5, post: 4.29 cm/s, min: 0.2 - max: 10) did not differ postoperatively (p > 0.05). However, contraction times were decreased postoperatively (pre: 73.6 +/- 52.9 s, post: 27.67 +/- 20.1 s, p < 0.05) and were found to be correlated with reflux time and the number of reflux episodes longer than 5 minutes. CONCLUSION: Nissen fundoplication is effective for the treatment of GERD. It supports the anti-reflux mechanism without affecting esophageal motility except for contraction times. The decrease in contraction time after surgery can be explained by the decreases in reflux time and in the number of reflux episodes longer than 5 minutes. PM and EM confirmed the clinical improvement and can be used for the evaluation of results of NF.

The effect of penile urethral fat graft application on urethral angiogenesis.

BACKGROUND: Autologous fat grafts are rich in adipose-derived stem cells, providing optimal soft-tissue replacement and significant quantities of angiogenic growth factor. Although fat grafts (FG) are used in several clinical conditions, the use of FG in urethral repairs and the effects of FG to urethral repairs have not yet been reported. OBJECTIVE: An experimental study was performed to evaluate the effect of FG on urethral angiogenesis and tissue growth factor (GF) levels. STUDY DESIGN: Sixteen Wistar albino, adult, male rats were allocated into two groups: the control group (CG) (n = 8) and the experiment group (EG) (n = 8). After anesthetization of all rats, 3-mm vertical incisions were made on the urethras, and then sutured with interrupted 5/0 vicryl sutures. The operations were performed under a stereo dissecting microscope under magnification (×20). In the CG, no additional procedure was performed. In the EG after the same surgical procedure, 1 mm(3) FG was removed from the inguinal region by sharp dissection with a knife. The grafts were trimmed to 1 × 1 mm dimensions on millimeter paper. The FGs were placed on the repaired urethras. The skin was then closed. Samples from urethral and penile skin were taken 21 days after surgery in both groups. Density and intensity of staining with vascular-endothelial GF (VEGF), VEGF-receptor, and endothelial-GF receptor (EGFR) in the endothelial and mesenchymal cells of the penile urethral vessels were immunohistochemically evaluated. Data obtained from immunohistochemical evaluations were analyzed with SPSS 15.0. The P-values lower than 0.05 were considered as significant. RESULTS: Density of VEGF staining was significantly decreased in the vascular endothelium of the EG compared to the CG (P < 0.05). Density of the EGFR staining was significantly decreased in the vascular endothelium of the EG compared to the CG (P < 0.05) (Table). Intensity of VEGF, VEGF-R and EGFR staining was not significantly different between the two groups. There were no significant differences between groups regarding to VEGFR staining and mesenchymal examination. DISCUSSION: Decreased density was found in the VEGF staining in the vascular endothelium. This could be explained by the day that the tissues were harvested or because autologous fat grafts might cause decreased growth factor levels, which is contrary to the literature data. CONCLUSION: Fat grafting has an immunohistochemical effect on the growth factor levels that are related to angiogenesis after urethral repair. It is difficult to make a firm conclusion about the role of fat grafting on urethral healing. Therefore, future studies are needed to see if FG can be used as an alternative to other procedures in order to avoid complications.

Transient hypertrophic pyloric stenosis due to prostoglandin infusion.

Prostaglandin E1 (PGE1) is widely used in ductus-dependant congenital heart disease to maintain the patency of ductus. Hypertrophic pyloric stenosis (HPS) due to gastric mucosal proliferation is a rare complication of prolonged PGE infusion. A male newborn who developed HPS during PGE1 infusion is presented to discuss the clinical features and treatment modalities of PGE-related transient HPS. The boy was 2500 g and born at 35 weeks of gestation from a 23-year-old mother. He was admitted to neonatal intensive care with breathing difficulty and cyanosis. His echocardiography revealed pulmonary atresia, ventricular septal defect and major aorta-pulmonary collateral (MAPCA). PGE infusion with a dose of 0.05 mcg kg⁻¹ was initiated. At the 8th day of infusion, he developed non-billous vomiting. Ultrasonographic evaluation revealed 1.9 cm length of pyloric channel and 0.5 cm of wall thickness on 11th day and diagnosed as HPS. On 42th postnatal day, he underwent MAPCA closure, right modified Blalock-Taussi shunt and repair of pulmonary artery bifurcation with bovine patch. PGE infusion was stopped and enteral nutrition was started on 8th postoperative day. Control ultrasonography on 12th postoperative day revealed normal pyloric channel length (0.9 cm) and wall thickness (0.3 cm). Prolonged use of PGE infusion in neonates with congenital heart disease may cause transient HPS. The clinical and radiological features of HPS relieves after stopping PGE infusion. It should be kept in mind that HPS due to PGE infusion can be transient and pyloromyotomy should be kept for patients with persistent findings.

Evaluation of contralateral kidney, liver and lung after extracorporeal shock wave lithotripsy in rabbits.

An experimental study was carried out to evaluate the effects of extracorporeal shock wave lithotripsy (ESWL) on contralateral kidney, liver and lung by histopathological and biochemical methods. Twelve New Zealand rabbits were allocated to two groups (n = 6). Tissues of control group (CG, n = 6) were harvested without any intervention. In ESWL group (EG), right kidneys were exposed to 3,000 shock waves at 14 kV energy using electro-hydraulic type ESWL device three times every other day. Both kidneys, liver, and right lobe of lung tissues in EG were harvested on seventh day. Kidneys were examined histopathologically for presence of glomerular and tubular injury, interstitial edema, congestion, inflammation and fibrosis. Livers were examined for hepatocyte vacuolization, congestion, portal inflammation and fibrosis. Lung tissues were examined for loss of normal structure, emphysema, interstitial congestion-edema, prominent alveolar septal vessels, interstitial inflammation, intra-alveolar hemorrhage, intraluminal hemorrhage, peribronchial edema, congestion, inflammation in bronchial wall and epithelial desquamation. Biochemical analysis of tissue samples was performed for oxidative injury markers. Histopathological evaluations revealed that tubular injury was found in both shocked and contralateral kidneys (p < 0.05). EG showed higher grades of portal fibrosis in liver and higher grades of peribronchial congestion in lung when compared to CG (p < 0.05). Biochemical evaluations of both kidneys showed that malondialdehyde levels were higher in EG than in CG (p < 0.05). ESWL causes histopathologic alterations both in shocked and contralateral kidneys. Extrarenal tissues such as liver and lung can be affected by shock waves histopathologically and oxidative injury of contralateral kidney may occur acutely after ESWL.

Effect of penile tourniquet on growth factors in rat penile tissue.

AIM: This study aimed to evaluate the effect of penile tourniquet application on growth factors in rat penile tissues. MATERIALS AND METHODS: Forty Wistar male rats were included in the study. Rats were divided into 4 groups. After anesthetization, perimeatal penile skin and the corpus cavernosum were sampled in the control group (CG). A Mathieu-like flap was designed without a penile tourniquet (PT) to serve as a sham group (SG). In the PT groups, a Mathieu-like flap was created and a 5 mm diameter rubber circular band was applied at the base of the penis. The PT was applied for 10 min in the PT-10 group and for 30 min in the PT-30 group. Penile tissue was sampled 24 h after PT application in the SG and PT groups. Tissues obtained were examined in three sections: the subepithelial vascular plexus (SVP), the corpus cavernosum (CC) and the smooth muscle-like mesenchymal cells in the corpus cavernosum (MC). Acute inflammation was evaluated with hematoxylin-eosin staining. The effect of PT on vascular endothelial growth factor (VEGF), VEGF receptor (VEGFR) and transforming growth factor beta receptor (TGF beta-R) levels was evaluated. RESULTS: Higher grades of acute inflammation were encountered in the PT-10 and PT-30 groups compared to the CG and SG (p<0.005). However, mean grades of acute inflammation did not show a statistical difference between the PT-10 and PT-30 groups (p>0.05). When the levels of growth factors were compared between the CG and PT-10 group, the PT-10 group showed increased levels of VEGF and TGF beta-R. In the PT-30 group, both VEGF and VEGFR levels were found to be decreased. When acute inflammation grades of tissues were correlated with VEGF and TGF beta-R, higher acute inflammation grades correlated with decreased VEGF and increased TGF beta-R levels (Spearman's correlation, p<0.005). Although alterations in VEGF and TGF beta-R levels were detected in the SVP and CC of penile tissues, altered VEGFR levels were only detected in the MC sections. CONCLUSION: PT caused higher grades of acute inflammation which correlated with decreased VEGF levels and increased TGF beta-R levels. Decreased VEGF levels after PT may alter the angiogenesis phase of wound healing and cause poor angiogenesis in penile skin flaps. Increased levels of TGF beta-R can be considered as an acute inflammatory response to PT. These results confirmed that prolonged PT application may result in altered growth factors in penile tissue and may reduce the success rate of repair.