Cüneyt Turan

The effect of vitamin E on ipsilateral and contralateral testis following unilateral testicular torsion in rats.

An experimental study was conducted to investigate the role of lipid peroxidation in ipsilateral and contralateral testicular reperfusion injury following unilateral testicular torsion (TT) and the effect of vitamin E in the management of this injury. Fifty adult male Sprague-Dawley rats were divided into five equal groups. Bilateral orchiectomy was performed immediately in group 1, and 3 h after unilateral TT in group 2. In group 3, both testes were harvested 3 h after a sham operation. In groups 4 and 5, unilateral TT, detorsion after 3 h and bilateral orchiectomy after 6 h were performed. Vitamin E was given before detorsion in group 4 and after detorsion in group 5. The levels of malondialdehyde (MDA) were meas-ured as an index of lipid peroxidation in all testes. There were no significant differences between right and left testes within groups or between right or left testicular MDA values in different groups. The results suggest that lipid peroxidation does not play an important role in ipsilateral and contralateral testicular injury following unilateral TT and that vitamin E given before or after detorsion of testes is not useful in preventing testicular reperfusion injury.

Corrosive injuries of the esophagus in newborns

Abstract To evaluate the morbidity and mortality of corrosive esophageal injuries (CEI) in the neonatal period, the records of 184 children hospitalized following caustic ingestion over a 10-year period from January 1987 to November 1997 were reviewed. Eight (4.3%) were newborns (5 boys and 3 girls). The mean age of the newborns was 12 days (range 1–28). The ingested caustic materials were benzalkonium chloride in six patients and trichloroacetic acid in two. Oropharyngeal examination and esophagoscopy were performed for diagnosis. Hyperemia and fibrin plaques were present in the oropharynx in all patients. The management consisted of endotracheal intubation, antibiotics, corticosteroids, and total parenteral nutrition. Pneumonia and sepsis developed in three patients and one died of sepsis. Stenosis developed in two patients, who were treated three times with antegrade dilatations. The morbidity was 62.5% (five patients) and the mortality was 12.5% (one) in newborns with CEI. These results indicate that ingestion of a caustic substance results in high morbidity and mortality in newborns. Parents and nurses should be warned about this risk.

Malformation of the epididymis in undescended testis

Abstract During a 6-year period, 312 boys (mean age 4.7 years) underwent orchidopexy for cryptorchidism. A total of 388 epididymides were examined and the configurations were recorded as a prospective trial. This study consists of 166 ectopic testes and 222 undescended testes. The observed configurations of epididymides in the ectopic testes were: type 1a in 99 cases (59.6%), type 1b in 35 (21.1%), type 2 in 24 (14.5%), type 3 in 7 (4.2%), and type 4 in 1 (0.6%). There were no patients in the study with type 5 and 6 anomalies. The configurations of epididymides in the undescended testes were: type 1a in 105 (47.3%), type 1b in 63 (28.4%), type 2 in 26 (11.7%), type 3 in 13 (5.9%), type 4 in 5 (2.3%), type 5 in 7 (3.2%), and type 6 in 3 (1.4%).The data revealed that the incidence of epididymal abnormalities in undescended testes (41%) was higher than that in the ectopic testes (25.9%) (P < 0.05).

The evaluation of technetium 99m-citrate scintigraphy in children with suspected appendicitis

PURPOSE The authors evaluated the use of technetium (Tc) 99m-citrate scan in 30 children whose diagnoses of appendicitis were unclear. METHODS There were 17 boys and 13 girls (mean age 10.6 years). Nineteen of 30 patients had appendicitis confirmed at laparotomy and through histological examination, and 11 patients had other causes of acute abdominal pain. RESULTS Children included in this study were similar with respect to age, duration of symptoms, temperature, white blood cell count, and the incidence of right lower quadrant tenderness. Sixteen children had positive scan for acute appendicitis, but 1 of them had false-positive. Fourteen children had negative scan, but 4 of them had false-negative. The calculated values were 78.9% (15 of 19), 90.9% (10 of 11), 83.3% (25 of 30), 93.7% (15 of 16), and 71.4% (10 of 14) for sensitivity, specificity, accuracy, positive prediction, and negative prediction, respectively, in this study. CONCLUSION The authors suggest the use of 99mTc-citrate scan in children when the diagnosis of appendicitis using other methods is unclear.

The effect of acute ligation of the rabbit appendix on antioxidant enzymes

The role of oxygen free radicals (OFR) in the pathogenesis of many diseases is known. This experimental study was planned to investigate the role of OFR in acute abdominal inflammation. In this study, 20 adult rabbits were used. They were divided into two groups with 10 rabbits in each. In the study group, blood samples were taken from peripheral and mesenteric veins and then their appendices were ligated; after 24 h, blood samples were taken again and the appendices were resected. The same procedures were carried out in the control group, except for ligation of the appendices. Superoxide dismutase, catalase and glutathione peroxidase (GPX) activities were measured in all blood samples. The activities of catalase and GPX were increased postoperatively in peripheral and mesenteric blood samples in the experimental group. The catalase activity was increased in the control group. These results suggest that OFR increased sufficiently to activate the enzymatic defense system in acute appendicitis.

Effectiveness of lycopene on experimental testicular torsion.

AIM We aimed to demonstrate the long term effectiveness of lycopene, a precursor of vitamin A, on the testes for ischemia-reperfusion injury. MATERIALS AND METHODS Seventy male Wistar albino rats were used for this experiment. The rats were divided into seven groups. Group 1 served as the control group; group 2 was sham-operated; group 3 received 20mg/kg/day lycopene (intraperitoneally); in group 4, the right testes of rats were kept torted for 2hours and then were detorted and the animals lived for three days; in group 5, the right testes of rats were kept torted for 2hours and then were detorted and the animals lived for ten days; in group 6, the right testes of the rats were kept torted for 2hours and then detorted and the animals received 20mg/kg/day lycopene (intraperitoneally) for three days; in group 7, the right testes of the rats were kept torted for 2hours and then were detorted and the animals received 20mg/kg/day lycopene (intraperitoneally) for ten days. Lycopene was used intraperitoneally. Some of the testes tissues were used for biochemical analyses and the other tissues were used for histological procedures. The Johnsens score was used for seminiferous tubule deterioration. The TUNEL method was utilized to show apoptosis of testicular tissue. Testosterone levels were measured from blood samples and SOD, MDA, TNF-α, IL-1β and IL-6 measurements were recorded from tissue samples. The results were analyzed statistically. RESULTS In groups 1, 2 and 3 there was normal testicular structure. Rats in groups 4 and 5 had damaged testicular tissues. In groups 6 and 7, in which we used lycopene, the testes were not better than those in groups 4 and 5. The MSTD and JTBS values were better in group 6, but not in group 7 among the torsion groups. As a result, MDA, SOD, TNF-α and IL-1β were increased and serum testosterone and IL-6 levels were decreased in groups 4 and 5 compared to group 1. There was no improvement in the groups treated with lycopene for therapeutic purposes. CONCLUSION It was shown that lycopene, as an antioxidant agent, is not effective for testicular torsion in the long term. This study can be considered as a preliminary study showing the need for further researches using different antioxidant agents to determine their long term effects in ischemia-reperfusion injuries in an appropriate experimental design.

A Case of Child Physical Abuse With a Rolling Pin Insertion, Resulting in Bladder and Rectal Perforation.

Visceral injuries are not uncommon in nonaccidental trauma and often require emergent operative intervention. However, sometimes it can be difficult to assess the extent of injury. In this report, we present a case of child physical abuse resulting in bladder and rectal perforations, which was initially referred to our hospital as acute abdomen with intraperitoneal free fluid on ultrasonography. An exploratory laparotomy revealed the perforations and surgical repair was performed. The patient was evaluated by the Hospital Child Protective team and it was revealed that bladder and rectum perforations were due to insertion of rolling pin into the rectum by the stepmother. The child was discharged home uneventfully with a temporary colostomy. We believe that this is the first reported case in the English literature of inflicted perforation of the rectum and bladder through insertion of a rolling pin.

An Analysis of a New Diagnostic Test for Children with Acute Appendicitis: Plasma Leptin Level

Aim: In the diagnosis of acute appendicitis, the most frequently-applied laboratory tests are blood leukocyte level (WBC) and serum C-reactive protein (CRP). In recent years, it has been thought that the leptin hormone level, which has been proven to be raised in acute inflammation, could be used diagnostically in patients with acute appendicitis. In this study, we aimed to determine the relationship between WBC, CRP, and leptin levels with inflammation in acute appendicitis and to define the role of leptin in the mechanism underlying loss of appetite, which is the most frequently observed symptom. Materials and method: The study comprised 40 patients diagnosed with acute appendicitis (AA) in the Pediatric Surgery Department and a control group of 20 age-matched patients. Blood samples were taken from all subjects in both groups and the levels of WBC, CRP and leptin were measured. Body mass index was calculated and all findings were compared. Results: In the AA group, the median leptin value was measured as 1.24 ng/ml preoperatively, 1.37 ng/ml perioperatively, and 0.81 ng/ml 2 days postoperatively. The leptin value in the control group was 1.90 ng/ml. No statistically significant difference was found between the two groups with respect to the preoperative and perioperative leptin values (p>0.05). The postoperative 2nd day leptin values of the AA group were statistically significantly lower than those of the control group (p<0.05). Conclusions: In cases of suspected acute appendicitis, leptin can be a useful diagnostic parameter since its levels increase during the early stages of inflammation.

Comparison of the hemostatic effects of oxidized cellulose and calcium alginate in an experimental animal model of hepatic parenchymal bleeding

Background: Despite all recent developments, bleeding is still one of the main causes of increasing morbidity and mortality following both trauma and elective hepatic surgery. The main goal of treatment is stop the bleeding immediately. In this study, the hemostatic and histopathological effects of Ankaferd blood stopper (ABS), oxidized cellulose (OC), and calcium alginate (CA) were compared in an experimental liver injury. Materials and Methods: Forty Wistar albino rats were randomly divided into four groups of ten animals each, receiving 0.9% NaCl, CA, OC, or ABS following liver resection. After 5 days, the samples from the resection site were acquired for histopathological evaluation. The efficacy of the agents was assessed using the hematocrit level and histopathological examination. Statistical analyses were applied. Results: The amount of bleeding was lowest in ABS-treated rats, followed by those treated with OC, CA, and NaCl, respectively. The difference among the groups was statistically significant (P < 0.001). ABS-treated rats also had significantly less necrosis than those receiving OC; other differences in this regard were not significant. Inflammatory status was significantly different between OC- and CA-treated rats (P < 0.05) but not among the other groups (P > 0.05). No significant difference was determined between the groups regarding granulation (P > 0.05). Conclusion : ABS reduced the volume of bleeding in liver surgery and partial liver resection. The hemostatic effect of CA was limited.

Management and treatment of liver injury in children.

BACKGROUND We aimed to assess the causes of trauma that result in liver injury and additional solid organ injuries, management types and results of management in children referred to our clinic for liver injuries. METHODS The records of 52 patients who were managed for liver injuries due to blunt abdominal trauma between January 2005-2010 were reviewed retrospectively. RESULTS The patients were 1-17 (8.3±5.4) years old; 32 (62%) were male and 20 (38%) were female. Causes of injuries included pedestrian traffic accidents (19, 37%), falls from height (15, 29%), passenger traffic accidents (8, 15%), bicycle accidents (8, 15%), and objects falling on the body (2, 4%). Isolated liver injury was present in 32 patients (62%), while 20 patients (38%) had other organ injuries. Liver injuries were grade I in 6 patients (12%), grade II in 14 (28%), grade III in 22 (43%), grade IV in 9 (17%), and grade V in 1 (2%). Forty-five patients (87%) were managed conservatively in this series of liver injury, whereas seven patients (13%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were significantly lower in surgically managed patients. CONCLUSION As a result, conservative management should be preferred in patients with liver injuries who are hemodynamically stable. Conservative management has some advantages, including shorter duration of stay in hospital, less need for blood transfusion and lower morbidity and mortality rates.