Arzu Şencan

Effects of intrinsic denervation on intestinal morphology in rats with short-bowel syndrome.

Abstract When benzalkonium chloride solution (BACs) is locally applied, to the serosal surface of the intestine, it causes intrinsic denervation (ID) of the myenteric plexus (MP), changes intestinal morphology, and slows intestinal passage by prolonging small-bowel transit time. These effects of ID suggest that chemically-induced bowel denervation may be useful in the treatment of short-bowel syndrome (SBS). How ID affects intestinal morphology in rats with SBS has not previously been investigated. A 75%–80% mid-small-bowel resection was performed in 20 rats with mean body weight 247 ± 30 g. The proximal and distal 2 cm of the resected bowel were examined histologically. After intestinal continuity was maintained by end-to-end anastomosis, a 2-cm jejunal segment was marked with silk sutures to form the test segment. BACs 0.1% was applied to 10 of the 20 test segments according to the modified Fox method, resulting in MP destruction (G1). Saline solution was applied to the other 10 test segments to form the control group (G2). Three months later, the rats were killed and the jejunal, ileal, and test segments were evaluated morphologically. Results were expressed as mean ± standard deviation. The Wilcoxon parametric test was performed to compare the groups during the operation and after death, while the Mann–Whitney U-test was used to compare the data in G1 and G2. No intestinal obstruction was observed in either group. In G1, the body weight increased by 19.1% and the total small-intestinal lengthening was 62.2% (P < 0.05). In the test segment of G1, 75% of the ganglia in the MP were destroyed and villus height, crypt depth, intestinal muscle thickness, number of enterocytes, and villus density increased compared to G2. In the ileal segments of G1, there was an increase of 28.8% in intestinal diameter, 14% in muscle thickness, and 15% in villus density (P < 0.05). No change was observed in the untreated jejunal segments of G1 and G2. Thus, ID of the MP after segmental BACs application of the jejunal level: (1) does not cause intestinal obstruction after 3 months; (2) the increase in bowel diameter in the test and ileal segments increases the absorptive surface of the mucosa; (3) the morphologic changes in the test and ileal segments verify an increase in intestinal adaptation; and (4) BACs application in rats with SBS is an easy procedure with no morbidity or mortality, and can be used to increase intestinal adaptation in rats with SBS.

Late ureteral obstruction after endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer.

OBJECTIVE To investigate the incidence and presentation of ureteral obstruction after endoscopic injection of polyacrylate polyalcohol copolymer (PPC) for the treatment of vesicoureteral reflux, and to analyze its possible causes, together with histopathologic assessment. PATIENTS AND METHODS The data of 189 patients who underwent endoscopic injection of PPC between May 2011 and December 2013 were retrospectively reviewed. After the injection, patients were followed up by urinalysis and ultrasonography monthly for 3 months. Control voiding cystouretrography was performed in the third postoperative month. Patients were then followed up by ultrasound every 3 months. If a new-onset hydroureteronephrosis (HUN) was observed, control ultrasound was performed monthly to follow the change in the degree of HUN. If a moderate or severe HUN was observed, technetium-99m mercaptoacetyltriglycine or dimercaptosuccinic acid scintigraphy was performed. For patients who needed open surgery, Cohen ureteroneocystostomy was performed. The distal 1 cm of the ureters was resected and examined histopathologically. RESULTS One hundred eighty-nine patients with 268 refluxing ureters underwent endoscopic injection of PPC. Ureteral obstruction was observed in 3 ureters (1.1%), in 3 female patients of whom the degrees of reflux were grade 4, 5, and 5, respectively. Obstruction showed late onset in all 3 patients. Manifestations of obstruction included pain in 2 patients and recurrent febrile urinary tract infection with loss of function in scintigraphy in 1. All 3 patients underwent open ureteroneocystostomy. CONCLUSION PPC may cause ureteral obstruction several months or even years after injection. Patients who undergo endoscopic treatment of PPC need long-term follow-up, despite reflux showing complete resolution.

A new variation of urethral duplication.

Urethral duplication is a rare congenital anomaly. This case study intends to define a new anatomic variation of an accessory urethra. The case is a 5-year-old boy who presented with dorsal chordee requiring operative intervention. At surgery, an accessory urethra on the dorsum of the penis was detected. It was observed that the distal part of the accessory urethra had no external opening and the proximal part had no connection with the native urethra. The accessory urethra was completely excised without complication. To our knowledge, this type of accessory urethra is the first reported case in the English literature.

Burn-associated bloodstream infections in pediatric burn patients: Time distribution of etiologic agents

BACKGROUND Infections are the leading cause of morbidity and mortality in patients with burns in burn units. Bloodstream infections (BSIs) in patients with burns may result from burn wound infection, use of invasive devices such as central venous catheters, and translocation of the gastrointestinal flora. OBJECTIVE In this study, we investigated the distribution and antimicrobial drug resistance of causative pathogens in children with burns and the durational changes of microorganisms in the distribution of BSIs in children. METHODS This study was conducted at the Pediatric Burn Unit (PBU) of Dr. Behçet Uz Children Research and Training Hospital during the period of November 2008-April 2015. The study subjects were all the patients admitted to the PBU, in whom microorganisms were isolated at least from one of the cultures, including blood and catheter cultures. RESULTS Gram-positive bacteria were the most common causative agents of BSI in patients with burns (66.4%), followed by gram-negative bacteria (22.1%) and fungi (11.5%). The median duration of development of BSIs caused by gram-positive bacteria from the time of burn was 5 days (ranging from 2 to 54 days of burn), which was significantly shorter than that of BSIs caused by gram-negative bacteria (12 days) and fungal pathogens (13 days). CONCLUSION The etiologic agents of BSIs in children may differ from those in adults. Gram-negative drug-resistant bacteria such as multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were important agents of BSI in patients with burns, especially in the long term; however, gram-positive bacteria should also be considered while deciding the antimicrobial therapy, especially in the early periods of burn.

Open ureteroneocystostomy after failed endoscopic injection with three different bulking agents for the treatment of vesicoureteral reflux

BACKGROUND/PURPOSE To evaluate the success rate of open ureteroneocystostomy (UNC) after failed endoscopic treatment of vesicoureteral reflux (VUR) in children and to discuss the reasons for failure under the light of histopathological findings. METHODS The clinical data of 371 patients who underwent endoscopic injection for VUR at our institution for the treatment of VUR between January 2008 and January 2014 were reviewed. Patients who were submitted to open ureteral reimplantation following failed endoscopic injection were included in the study. RESULTS Among 371 patients, 34 (49 ureters) were submitted to open UNC (9.1%). There were 22 female and 12 male patients. Three different injection materials were used; dextranomer/hyaluronic acid in 29, carbon-coated beans in 7 and polyacrylate polyalchohol copolymer in 13. Histological study revealed that the injected material was identified in 34 ureters as malpositioned. Control VCUG 6 months after UNC showed complete resolution in 46 of 47 ureters (97.87%). CONCLUSIONS Previous endoscopic injection, although causing difficulty in dissection to some degree, does not alter the success rate of UNC. According to the histopathological findings, the cause of failure of injection seems to be attributable to incorrect plane of injection or leakage of the agent after injection.

Early Results of Endoscopic Treatment of Vesicoureteral Reflux with Polyacrylate Polyalcohol Copolymer

Objective: To evaluate the early results of endoscopic treatment of vesicoureteral reflux (VUR) in children using polyacrylate polyalcohol copolymer (PPC). Patients and Methods: We retrospectively reviewed 45 patients treated with subureteric injection of PPC in our clinic. The results of voiding cystouretrography performed on the 3rd postoperative month and the results of 1-year follow-up were evaluated. Results: A total of 45 patients (57 ureters) underwent injection of PPC. The mean age of the patients was 6.5 years. There were 6 (10.5%) grade 1, 7 (12.2%) grade 2, 26 (45.6%) grade 3, 16 (28%) grade 4, and 2 (3.5%) grade 5 VUR. There were 11 overactive bladders, 2 duplex collecting systems, and 4 posterior urethral valves among the patients. Voiding cystouretrography postoperatively at the 3rd month showed that VUR had disappeared in 82.5% (47/57) of the ureters, downgraded to grade 2 and 3 in 7% (4/57), persisted in 5.2% (3/57) and upgraded in 5.2% (3/57). The success rate at the end of the first year was 98.1%. The procedure was free of complications such as fever, dysuria, lumbar pain or obstruction in all patients. No patient showed VUR recurrence at the end of the first year. Conclusions: The short-term results of our patients suggested that PPC can be safely and successfully used in the endoscopic treatment of VUR in children. However, further prospective, controlled trials showing the long-term results of the patients are needed.

Esophageal Button Battery Ingestion in Children

BACKGROUND Button battery lodged in the esophagus carries a high risk of morbidity and mortality. The purpose of this study was to present cases of patients with esophageal button battery ingestion treated at our clinic and to emphasize the importance of early diagnosis and treatment. METHODS Records of patients admitted to our hospital for foreign body ingestion between January 2010 and May 2015 were retrospectively reviewed. Cases with button battery lodged in the esophagus were included in the study. Patient data regarding age, sex, length of time after ingestion until admission, presenting clinical symptoms, type and localization of the battery, management, and prognosis were analyzed. RESULTS Among 1891 foreign body ingestions, 71 were localized in the esophagus, and 8 of those (11.2%) were cases of button battery ingestion. Mean age was 1.7 years. Admission was within 6 hours of ingestion in 5 cases, after 24 hours had elapsed in 2, and 1 month after ingestion in 1 case. All patients but 1 knew the history of ingestion. Prompt endoscopic removal was performed for all patients. Three patients developed esophageal stricture, which responded to dilatation. CONCLUSION Early recognition and timely endoscopic removal is mandatory in esophageal button battery ingestion. It should be suspected in the differential diagnosis of patients with persistent respiratory and gastrointestinal symptoms.