Arzu Demirtola

STOBADINE PROTECTS RAT KIDNEY AGAINST ISCHAEMIA/REPERFUSION INJURY

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. Iscahemia–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.

Sequential cytokine levels in the diagnosis of appendicitis

Objective. To determine the diagnostic value of sequential white blood cell count (WBC), tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) in patients with abdominal pain. Material and methods. Tests were determined at hospital admission and 6 h later in 105 children. Patients who were non‐operatively followed and had a normal histopathology were classified as the non‐appendicitis (NA) group. Patients with symptoms consistent with appendicitis were classified as the appendicitis group (A). Data were analyzed as positive/negative predictive value, sensitivity, specificity and accuracy rate (AR). The global power of the variables in discriminating the patients between the two groups and advanced/simple appendicitis was assessed from the area under the receiver operating characteristic (ROC). Results. Initial measurements showed WBC to be a valuable diagnostic tool in acute appendicitis (AR = 74 %), whereas IL‐6 and TNF‐α were found not to be valuable. The second measurements revealed higher values, and IL‐6 reached its highest AR (89 %). When initial values were evaluated in combination, the highest AR of 73 % was observed with TNF‐α + WBC. The highest AR (90 %) was seen with IL‐6 + TNF‐α in the second measurements. ROC analysis showed WBC to be the most valuable parameter of the three. The area under the curve (AUC) was 0.750 for the initial measurement and 0.779 for the repeat measurement of WBC (p = 0.001). The most useful diagnostic parameter in discriminating between the simple and the advanced cases was IL‐6 as assessed with the ROC curve (p<0.01). Conclusions. WBC elevation in patients with suspected acute appendicitis is an important parameter supporting the diagnosis at initial admission, whereas IL‐6 is a more valuable tool in diagnosing advanced appendicitis.

Effects of Varicocele on Electrical Field Stimulation-Induced Biphasic Twitch Responses in the Ipsilateral and Contralateral Rat Vasa Deferentia

Aim: Although little is known about the mechanisms, varicocele is considered as one of the factors leading to male infertility. Since reduced motility of the vas deferens was shown to contribute to male infertility, in this study we aimed to investigate the effect of varicocele on electrical field stimulation (EFS)-induced biphasic contractions of the vas deferens in order to evaluate the effect of varicocele on the motility of the vas deferens. Material and Methods: A total of 26 Sprague-Dawley rats (200–250 g) were assigned randomly into two groups: sham (n = 10) and varicocele (n = 16). Varicocele was produced by partial obstruction of the left renal vein. Four weeks after the surgical procedure, vasa deferentia were harvested and EFS-induced responses were recorded from the strips prepared from ipsilateral and contralateral sides via Grass isometric force displacement transducers. Exogenous α-β methyl ATP was applied at the concentration of 10–5M to the vasa deferentia strips, and exogenous noradrenalin was applied cumulatively at the concentrations between 10–7 and 10–4M. At the end of each experiment, 80 mM KCl was applied to induce contractions. All contractions were expressed as the percentage of the 80 mM KCl-induced contractions. Results: Varicocele significantly inhibited both phases of EFS-induced biphasic contractions in the ipsilateral side, whereas in the contralateral site it did not produce any change. However, there was no change in exogenously applied α-β methyl ATP, noradrenalin and KCl-evoked contractions of the vasa deferentia obtained from both sides. Conclusions: These results suggest that varicocele affects the ipsilateral vas deferens motility by reducing neurotransmitter release.

Negative appendectomy experience in children

BackgroundThe aim of this study was to discuss the findings of our patients who had negative appendectomy.Patients and methodsHospital records of negative appendectomy for abdominal pain patients were evaluated retrospectively.ResultsNegative exploration for acute appendicitis (AP) was done in 149 patients. The most frequent complaints were abdominal pain, vomiting and fever. The commonly established diagnoses after negative exploration were gastroenteritis and urinary infections. However, the frequent pathologies observed during the operation were mesenteric lymphadenitis and Meckel’s diverticulum. All patients with systemic disease such as Henoch-Schonlein’s purpura operated for AP had it diagnosed during the postoperative course. Interestingly, two different types of worms were found in the lumen of the appendices.ConclusionDespite new techniques, 100% correct diagnosis of AP is still a challenging problem. Furthermore, appendicitis is a deadly disease if not treated properly. Therefore, it is best to perform exploration without undue delay in cases with suspicious AP.

A novel technique for vas deferens transection repairs.

The purpose of this study is to describe a technique, that is as successful as microsurgery in terms of patency rates and histopathologic assessments, and can be performed even by untrained hands in microsurgery, for repairing vas deferens injuries that can be percieved during inguinal herniorrhaphy. Thirty male Wistar–Albino rats were randomly allocated to five groups. In control group, the vas deferens was harvested without any surgical intervention (Group 1) and in sham group the vas was harvested after a limited dissection (Group 2). Three suture approximation technique was carried out in Group 3, and a novel vasovasostomy technique was carried out by using a hypodermal needle in Groups 4 and 5, with polypropylene and polyglactin 910 (rapid vicryl®), respectively. Results were evaluated in terms of operative time, patency and flow rates, inflammation and sperm granuloma. The mean operative times for hypodermal needle assisted approximation of Groups 4 and 5 were found significantly less than Group 3. The compared results of the groups in terms of patency, flow rate, inflammation and spermatic granuloma indicated Group 4 to be superior to the other groups. We have found the hypodermal needle assisted approximation technique to be easier, less time consuming and cost effective. With these promising results, this modus operandi can be described as an appropriate technique for vas deferens transection repairs.

An innocent perioperative position, an unexpected postoperative complication: bilateral foot drop

SIR—A 14-year-old boy child with a fracture of the middle third of his left femur was treated with a closed intramedullary fixation. Some hours later signs consistent with an anterior compartment syndrome of the thigh including severe local pain and a tense quadriceps muscle developed. The pressure in the anterior compartment being greater than 45 mmHg, a lateral fasciotomy was performed. Two days later loss of fixation was noted. As a consequence external fixators were inserted. One week later signs consistent with osteomyelitis including fever, thigh pain and pathologically increased inflammatory parameters were noted. Hence the child was treated with antimicrobials. Five weeks later the external fixators and the intramedullary nails were surgically removed in a ‘latexfree environment’ and the fasciotomy wound opened and washed with a solutions containing polyhexanide, a chlorhexidine polymer. Within minutes blood pressure fell to 50/20 mmHg, heart rate increased to 180 bÆmin and a generalized urticarial rash and wheeze were noted. The child was treated with intravenous adrenaline, antihistamines and methylprednisolone and recovered fully. The incidence of anaphylaxis during anesthesia varies between 1 : 10 000 and 1 : 20 000 (1). Neuromuscular blocking agents and natural rubber latex are the most frequent causes (1). In this patient operated in a ‘latex-free environment’ careful analysis of the anesthetic record strongly suggests that anaphylaxis was caused by polyhexanide, confirming the recent assumption that antimicrobials are a further important cause of intraoperative anaphylaxis (1). The use of chlorhexidine and its polymer polyhexanide is thought to be safe. The present case report should remind the potential risk of chlorhexidine and of its polymer polyhexanide also in childhood (2–4). Alessandra Ferrarini md Marco Baggi md Rudolph Flückiger md Mario G. Bianchetti md Ospedale della Beata Vergine, Mendrisio, Switzerland (email: mario.bianchetti@pediatrician.ch)