İlknur Kılıç

The role of elevated liver transaminase levels in children with blunt abdominal trauma

The role of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels on intra-abdominal injury in children has not been adequately studied. In this report, the accuracy of these tests in predicting the degree and extend of intra-abdominal and hepatic injury in children with blunt abdominal trauma was investigated.Eighty-seven haemodynamically stable children with multiple trauma were prospectively evaluated. The SGOT and SGPT of patients with and without abdominal trauma (Groups I and II) were compared. Patients with and without radiologically verified intra-abdominal injury were further compared (Groups Ib and Ia). There was significant difference in SGOT and SGPT levels of Groups I and II. SGOT and SGPT levels were 333.6+/-283.8 and, 197.5+/-192.5 U/l, respectively in Group Ib; but 84.2+/-55.9, 43+/-29.8 U/l in Group Ia (P<0.001). In all patients with radiologically detected intra-abdominal pathology SGOT and SGPT levels were above 110.5 and 63.5 U/l, respectively. In patients with hepatic injury SGOT level was above 500 U/l and, SGPT level was above 300 U/l. Statistically significant positive correlation was found between radiologically detected intra-abdominal pathology and increased SGOT (above 110.5 U/l) and SGPT (above 63.5 U/l) levels (P<0.05). These data indicated that the SGOT and SGPT levels were significantly higher in patients with intra-abdominal injury even in the absence of hepatic injury. We suggest that liver function tests may be used as screening tests in children with blunt abdominal trauma in addition to physical abdominal examination. A sudden rise up to 110.5 U/l in SGOT and 63.5 U/l in SGPT indicate an intra-abdominal injury and severe hepatic injury should be suspected with higher levels of SGOT and SGPT.

Effects of different corticosteroids on the brain weight and hippocampal neuronal loss in rats.

Equivalent antiinflammatory doses of steroids including betamethasone, methylprednisolone and dexamethasone were administered in the neonatal period in a rat model. In situ cell death in hippocampus quantified by Terminal Deoxynucleated Transferase Nick-End Labeling and on ratio of brain to body weight was investigated. Apoptotic index (AI) was significantly higher in methylprednisolone, and high dose dexamethasone groups than the other groups. AI in Cornu ammonis 1 (CA1) and Cornu ammonis 3 (CA3) subregions of high dose dexamethasone group was the highest among the five groups tested. AI in CA3 subregions of methylprednisolone group was also significantly higher than the control, betamethasone and low dose dexamethasone groups. AI in CA1 subregion were not different among control, betamethasone, methylprednisolone and low dose dexamethasone groups. In addition, high dose dexamethasone resulted significant decrease in the ratio of brain weight to body weight in comparison to all other groups tested. In conclusion, betamethasone and low dose dexamethasone may be better alternative treatments among agents tested in this study for chronic lung disease (CLD).

Role of Nitric Oxide in Hypoxia-Induced Changes in Newborn Rats

In order to investigate the role of nitric oxide (NO) in hypoxic tissue damage in newborns, we studied the effects of systemic administration of an inhibitor of NO synthase, NG-nitro-L-arginine (L-NNA), and the precursor for the synthesis of NO, L-arginine (L-ARG), on the biochemical and histological changes in brain, heart, lung, liver, kidney, intestine, and skeletal muscle tissues. Four groups of 1-day-old Wistar rat pups were used: control, hypoxic, L-ARG, and L-NNA groups. L-ARG 100 mg/kg or L-NNA 2 mg/kg was administered as a bolus intraperitoneally 1.5 h before hypoxia. Hypoxia increased lipid peroxidation in all tissues except muscle; this increase was prevented by L-NNA and L-ARG in brain, heart, lung, kidney, and liver tissues. L-NNA in intestine and L-ARG in muscle tissue increased lipid peroxidation. The tissue-associated myeloperoxidase activity was decreased in the liver by L-NNA and L-ARG. Histopathological changes in intestines were villous epithelial separation and hyperemia in hypoxic and L-NNA groups which were not observed in control and L-ARG groups. In lungs, pulmonary hemorrhage was observed only in the hypoxic group. These data suggest that NO acts both as a destructive and a protective agent in the pathogenesis of hypoxia-reoxygenation injuries.

Effects of Intra-Articular Vitamin E and Corticosteroid Injection in Experimental Hemarthrosis in Rabbits

The effects of intra-articular injections of vitamin E and corticosteroid were investigated in skeletally mature New Zealand white rabbits in which experimental hemarthrosis was induced for 14 days. The rabbits were divided into three groups composed of eight rabbits each: the first group comprised of animals with hemarthrosis, the second group animals with hemarthrosis and intra-articular injections of 20 mg vitamin E, and the third group animals with hemarthrosis and intra-articular injections of 10 mg of triamcinolone acetonide (TCA). Proteoglycan levels in the joint cartilage of the hemarthrosis group were found to be increased significantly compared with the controls (P < .01), whereas in the vitamin E-injected group they were significantly decreased (P < .05). In the TCA-injected group, proteoglycan levels were not found to be significantly different from those in the hemarthrosis group (P > .05). Histopathological evaluation showed that the cartilage structure in the joint of the control limbs was identical to that in the vitamin E- and TCA-injected limbs. In the hemarthrosis group, in comparison with the controls, the joint surface was roughened and fibrillated. In the superficial areas of the cartilage tissue, chondrocytes were decreased in number. These findings suggest that in this model, vitamin E and TCA may be helpful in preventing the joint cartilage changes seen in hemarthrosis.

Laparoscopy offers diagnosis and treatment in abdominal stab injuries.

Purpose To assess the role of laparoscopy in the diagnosis and treatment of abdominal stab injuries (ASI). Methods Patients who underwent laparoscopic procedures due to ASI were included in the study. Hemodynamic instability, injuries to the posterior trunk, concomitant severe cranial injuries, and prior abdominal operations were considered as contraindication for laparoscopy. Results From January 1997 to March 2006, 88 patients underwent laparoscopic management of ASI. In 45 patients (51.1%), there was no intra-abdominal pathology requiring surgical intervention (nontherapeutic laparoscopy) and 5 patients in this group had no peritoneal penetration (negative laparoscopy). In another 25 patients (28.4%), laparoscopic treatment was performed (therapeutic laparoscopy), including bleeding control in liver, colonic, gastric, and diaphragmatic repairs and intra-abdominal bleeding control. Laparotomy was avoided in a total of 70 (79.5%) patients. In 18 patients (20.5%), laparoscopy was converted to laparotomy. There was no mortality, and except one missed small bowel injury nor perioperative morbidity in patients undergoing laparoscopy. In the laparotomy group, major complications were seen in 7 patients. Conclusions Laparoscopy is safe and efficient in the management of ASI and should be more frequently considered as a therapeutic tool.

Effect of maternal NG‐nitro‐l‐arginine administration on fetal growth and hypoxia‐induced changes in newborn rats

Background :u2002Nitric oxide (NO) inhibition with NG‐nitro‐l‐arginine methyl ester (l‐NAME) in the last trimester of pregnancy caused intrauterine growth retardation and hind‐limb disruptions in rats. In the present study, the effect of maternal NO inhibition with NG‐nitro‐l‐arginine (l‐NNA) on hypoxic newborn rats was investigated.

Effects of neonatal dexamethasone or methylprednisolone on rat growth and neurodevelopment

Background: Clinical studies have demonstrated that premature infants receiving long‐term dexamethasone therapy have reduced linear growth, decreased weight gain, and smaller head circumferences. The purpose of the present study was to investigate the effects of the same equivalent doses for anti‐inflammatory potency of neonatal dexamethasone and methylprednisolone on rat growth and neurodevelopment.

Acute conjunctivitis caused by Actinobacillus ureae

The genus Actinobacillus , which previously belonged to the genus Pasteurella , is a commensal organism in the human upper respiratory tract and various mammals. Although the most common infections have been closely related to skull trauma or neurosurgery, it has rarely been isolated from human clinical samples including sputum, synovia, cerebrospinal fl uid and bone aspiration materials. 1 – 4 Despite culture being relatively simple, primary pathogens of pediatric conjunctivitis such as genus Haemophilus and genus Pasteurella may cause confusion on bacterial identifi cation. 1,5 We report the fi rst case, in the Medline-based literature, of Actinobacillus ureae conjunctivitis in a child.