Aydin Yagmurlu

Preventive effect of pentoxifylline on renal scarring in rat model of pyelonephritis

OBJECTIVES To evaluate the efficiency of pentoxifylline (PTX), a methyl xanthine derivative, in preventing renal scar formation after the induction of pyelonephritis in an experimental rat model with delayed antimicrobial therapy. METHODS An inoculum of 1 x 10(9) colony-forming units/0.1 mL of the K-12 strain of Escherichia coli, which has both type 1 and P pili, was injected directly into both renal parenchyma of Wistar rats (n = 40). Group 1 (control) received isotonic saline instead of bacterial solution (n = 10). Four equal groups were then formed: group 2 was not treated and group 3 was treated only with ciprofloxacin for 5 days, starting 3 days after bacterial inoculation; in group 4, 50 mg/kg of PTX, and in group 5, PTX (50 mg/kg) and ciprofloxacin (15 mg/kg) together were administered intraperitoneally for 5 days, starting 3 days after bacterial inoculation. Six weeks after bacterial inoculation, all the rats were killed, and both kidneys were examined histopathologically for renal scarring. RESULTS Delayed treatment with antibiotics had no effect on scarring compared with the untreated controls. However, the addition of PTX to the delayed antibiotic therapy significantly inhibited renal scarring compared with the untreated or antibiotic-only groups (P <0.05). CONCLUSIONS These results suggest that PTX is effective in preventing renal scar formation in pyelonephritis when the initiation of antimicrobial treatment is delayed in this rat model of pyelonephritis.

Caspofungin treatment in two infants with persistent fungaemia due to Candida lipolytica

Candida lipolytica has infrequently been identified as a cause of infection and is associated mostly with vascular catheter-related fungaemia. Patients reported in the literature have been successfully treated with catheter removal or amphotericin B treatment. We report 2 infants with C. lipolytica fungaemia unresponsive to catheter removal and amphotericin B therapy and treated successfully with the addition of caspofungin to amphotericin B.

Post-traumatic intrasplenic pseudoaneurysms with delayed rupture: color Doppler sonographic and CT findings.

Post‐traumatic intrasplenic pseudoaneurysms are very rare in children. Since pseudoaneurysms may expand a splenic hematoma and cause delayed splenic rupture, early diagnosis and treatment are crucial. In this report, we describe the case of a 12‐year‐old boy with a delayed splenic rupture caused by a splenic hematoma containing 2 pseudoaneurysms. Abdominal sonography showed free intraperitoneal fluid and a mildly enlarged spleen with a large heterogeneous area occupying the upper half of the organ. Two anechoic lesions (15 and 4 mm) were seen inside the hematoma near the splenic hilum. Color Doppler sonography demonstrated turbulent arterial flow within the lesions, suggesting pseudoaneurysms. On CT, the lesions enhanced simultaneously with the splenic artery in the arterial phase of contrast enhancement. CT also showed an intrasplenic arterial branch leading to the larger of the 2 pseudoaneurysms.

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

The effect of electromagnetic field on undescended testis after orchiopexy

Undescended testis is a common problem leading to infertility. After orchiopexy some studies support the necessity of hormonal therapy. Electromagnetic field stimulation on living tissues increase cell proliferation, protein and DNA synthesis.Sixteen prepubertal rats was objected to the fixation of left testes to the anterior abdominal wall for 30 days, right testes were removed. Another group of sixteen rats objected only to the right orchiectomy and a manipulation simulating study group without fixation. After orchiopexy, animals were divided into two groups. Both groups had eight rats. Electromagnetic field (EMF) stimulation group had the stimulation for two hours every day for ten days, while the second group did not. The sham group also divided into two groups. The first one applied EMF and name as Group CEM, the second one was sham. Weight of removed testes were measured and fixed in 10% formaldehyde for histopathological evaluation. At the creating of undescended testis and right orchiectomies a blood sample was obtained for testosterone level of prepubertal rats. After finishing EMF stimulation the rats were mated with females for 17 days. After fertility study a blood sample was obtained for testosterone assay and body weight were measured and fixed in formaline for histopathologic evaluation. All the rats were killed with overdose ether anesthesia and number of fetuses were recorded. Histopathological evaluation was based on Johnsen criteria and seminiferous tubule diameter measurements.We conclude that EMF stimulation resulted in Leydig cell proliferation, increase in testosterone level, testis weight, but decrease in germ cell population.

Intussusception in adult and pediatric patients: Two different entities

PurposeIntussusception is one of the most common abdominal emergencies in pediatrics, but adult intussusception is an uncommon entity and most surgeons have only limited experience in treating this disease. The purpose of this study was to highlight the differences between pediatric and adult intussusception.MethodsThe records of 40 patients during 14 years were reviewed retrospectively. The symptoms, diagnosis, sites of intussusception, associated pathologies, and treatment methods of each patient were analyzed.ResultsA total of 31 pediatric and 9 adult patients were included in the study. In the pediatric group, bloody stool and vomiting were the most common symptoms whereas adult patients commonly presented with abdominal pain. The physical examination was diagnostic in a remarkable proportion of the pediatric patients but the diagnosis was suggested based on imaging techniques in the adults, and preoperative diagnosis was more successful in the pediatric group. Intussusception was more often associated with an underlying pathology in adults and no adult patient underwent nonoperative reduction, whereas pediatric patients were managed either with hydrostatic reduction or surgery.ConclusionsAlthough intussusceptions occur at all ages, there are major differences in the clinical presentation, diagnostic approach, and management between pediatric and adult populations. Intussusception is remarkably different in these two age groups and it must be approached from a different clinical perspective.

An unconditioned bone marrow transplantation in a child with purine nucleoside phosphorylase deficiency and its unique complication

Abstract:  Purine nucleoside phosphorylase deficiency is a rare immunodeficiency syndrome characterized by recurrent infections, neurological dysfunction, and autoimmunity. Early diagnosis and hematopoietic stem cell transplantation may reverse the dismal prognosis in PNP deficiency. This report presents a new PNP deficiency case successfully transplanted without a conditioning regimen from an HLA‐identical family donor, who developed a complication of disseminated BCG infection.

Gadolinium-enhanced three-dimensional MR angiography in jugular phlebectasia and aneurysm.

True jugular vein aneurysms and phlebectasias are very rare abnormalities, which are usually discovered in children. Though their ultrasonographic features have been well described, magnetic resonance angiographic appearance of these lesions has not been reported in the radiology literature. We describe gadolinium-enhanced MR angiographic findings in two patients with internal jugular vein phlebectasia and one patient with anterior jugular vein aneurysm. The jugular venous system and its abnormalities were successfully depicted in the coronal plane, much like the images of coronal angiography.

Clinical characteristics of recessive and dominant congenital hyperinsulinism due to mutation(s) in the ABCC8/KCNJ11 genes encoding the ATP-sensitive potasium channel in the pancreatic beta cell

Abstract Background: Recessive mutations in ABCC8/KCNJ11 of β-cell KATP channel generally cause severe medically unresponsive hyperinsulinemic hypoglycemia (HH). Rarer dominant mutations in these genes have been described that mostly cause milder, medically responsive congenital hyperinsulinism. Rarer dominant mutations in these genes have been described that mostly cause milder, medically responsive congenital hyperinsulinism. To date the phenotype of patients with dominant mutations seems to be different from those with recessive mutations as the majority of patients are responsive to diazoxide therapy. Controversy exists on whether these dominant ABCC8 or KCNJ11 genes mutations predispose to diabetes mellitus in adulthood or not. Subjects: We report the clinical and genetic characteristics of five patients with neonatal HH, three had recessively inherited KATP channel mutations and two with a dominantly acting mutation. As a result of failure to medical therapy, patients with recessive KATP channel mutations underwent a near total pancreatectomy. Two siblings with a novel dominant mutation showed good response to medical treatment. Although the HH remitted in early infancy, they became diabetic at the prepubertal age. Their mother, maternal aunt and maternal grandfather had the same mutation without any medical history of neonatal HH. Conclusion: The clinical presentation of our two patients with a dominant ABCC8 mutation was milder than that of patients with the resessive form of the disease as they responded well to medical management.

Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients

SUMMARY:  Encapsulating peritoneal sclerosis (EPS) is a serious complication of chronic peritoneal dialysis (CPD). In contrast to the adult population, there are few studies regarding EPS in paediatric CPD patients, and the majority of reported patients are from Japan. The aim of the present report is to define the incidence of EPS in our paediatric CPD patients and to describe the clinical and laboratory characteristics. A total of 104 paediatric patients were followed from November 1989 to November 2003 and two were diagnosed as EPS (1.9%). The dialysis periods of these patients were 45 and 53 months with 6 and 8 peritonitis episodes, respectively. Clinical signs of EPS developed 7 and 14 days after the removal of the dialysis catheter, and CPD was replaced by haemodialysis because of persistent peritonitis. One patient was well after surgical management but died 6 months later. The second patient who was treated with prednisolone remained well at 16 months. In conclusion, EPS is a rare but important complication of CPD. We recommend that all patients on CPD who develop ultrafiltration failure be evaluated radiologically for the occurence of EPS. Management should be tailored to the individual patient.