İrfan Kırıştıoğlu

Interferon-gamma expression by intraepithelial lymphocytes results in a loss of epithelial barrier function in a mouse model of total parenteral nutrition

ObjectiveTo determine the etiology of the loss of epithelial barrier function observed with the administration of total parenteral nutrition (TPN) in a mouse model. Summary Background DataRemoval of enteral nutrition with the administration of TPN is associated with a loss of intestinal epithelial barrier function. The etiology of this barrier loss is not clear. Because intraepithelial lymphocytes (IELs) produce a number of cytokines that may alter epithelial permeability, the authors investigated IEL cytokine expression in a mouse model of TPN. MethodsAdult C57BL/6 mice received TPN or enteral diet for 7 days. IELs were subsequently harvested and the mRNA expression of cytokines was measured. Epithelial barrier function was assessed in vitro with 51Cr-EDTA in Ussing chambers and was expressed as the permeability coefficient (Papp). ResultsIEL mRNA expression of interferon-gamma (IFN-&ggr;) rose from 0.14 ± 0.07 in the control (enterally fed) group to 0.44 ± 0.11 attomoles/&mgr;L in the TPN group (P < .05). Transforming growth factor-&bgr;1 declined slightly but not significantly, from 0.75 ± 0.35 to 0.55 ± 0.18 attomoles/&mgr;L in the control and TPN groups, respectively. Epithelial barrier function declined significantly with TPN compared to controls. To assess the relevance of IFN-&ggr; changes, permeability in IFN-&ggr; knockout mice was studied. Barrier function was significantly higher in IFN-&ggr; knockout mice on TPN compared to C57BL/6 mice that received TPN. ConclusionsIEL cytokine expression changes significantly with TPN administration. The partial correction with IFN-&ggr; knockout mice suggests that an upregulation of IFN-&ggr; expression is one mechanism responsible for the loss of the epithelial barrier associated with TPN.

Total Parenteral Nutrition-Associated Changes in Mouse Intestinal Intraepithelial Lymphocytes

Intraepithelial lymphocytes (IEL) play a major role in mucosal defense mechanisms against intraluminal foreign antigens. To address the role luminal nutrients have on the phenotype and function of the IEL, we administered total parenteral nutrition (TPN) to mice, with the absence of enteral intake. We hypothesized that administration of TPN would result in changes in the phenotype and function of the IEL. For this, we utilized a mouse model of TPN. A significant decline in the CD4+ IEL population occurred with TPN. Additionally, the CD8+,CD44+ IEL subset showed a 65% decline (P < 0.05), and the CD4+,CD44+ subset declined by 55% with TPN (P < 0.05). The CD8αβ+ population (a marker of thymic-dependence) also declined by 92% (P < 0.01) with TPN. IEL in the TPN group showed a significantly lower degree of in vitro proliferation. In conclusion, the IEL showed significant phenotypic changes with TPN including the loss of the thymic-derived population. Functionally, the IEL showed a significant decline in proliferation. Such changes demonstrate the important role luminal nutrients have on IEL phenotype and function.

Hepatic P-glycoprotein changes with total parenteral nutrition administration

BACKGROUND The mechanism(s) responsible for the development of parenteral nutrition-associated liver disease (PNALD) is unknown. Recently, a number of bile canalicular transport proteins have been identified that transport bile components out of hepatocytes. One group of these genes, multidrug resistance 1 (mdr1) and mdr2, encode P-glycoproteins. Mice lacking mdr2 expression develop liver disease that appears similar to PNALD. This study investigated the alteration in the expression of these transport proteins during the administration of total parenteral nutrition (TPN). METHODS Mice received either physiologic saline and standard chow or TPN. Mice were sacrificed on day 7, and hepatic DNA and RNA content, mRNA expression, and levels of mdr1 and mdr2 proteins were measured. RESULTS TPN administration led to a significant (p < .05) decline in mdr2 mRNA expression and an increase in mdr1 mRNA expression. Mdr2 protein expression declined by 66% in the TPN-treated group, and mdr1 protein expression significantly increased by 58%. Histology and biochemical parameters showed no evidence of liver injury. Serum bile acid levels were elevated in the TPN group, suggesting the development of early cholestasis. CONCLUSIONS The decline in mdr2 and rise in mdr1 mRNA and protein expression with TPN administration occurred before the development of liver injury but during an early state of cholestasis. This suggests that alterations in mdr gene expression may be a causative factor in the development of PNALD.

Split notochord syndrome with prolapsed congenital colostomy

A case of split notochord syndrome associated with a prolapsed colostomylike dorsal enteric opening, a foreshortened colon, imperforate anus, and meningocele is presented. The surgical management of this disorder is discussed and available literature is reviewed. The patient was successfully treated with a combined, single-stage surgical correction.

Surgical correction of muscular torticollis in older children with Peter G. Jones technique

In the Department of Pediatric Surgery, Uludağ University Medical Faculty in Bursa, during the last 11 years, the Peter G. Jones technique for the surgical correction of muscular torticollis in older children has been introduced. Twenty children between 4 and 13 years of age were treated for muscular torticollis. They were followed up from 3 months to 10 years after surgery. All patients had a middle-third open transection of the sternocleidomastoid muscle. Preoperative and postoperative assessment by a rigid scoring system showed that all patients improved in terms of function as well as cosmesis. Children younger than 10 years showed the most improvement, with 90% excellent and good results. Late middle-third open transection of the sternomastoid in muscular torticollis may give acceptable results.

Complete Penile Duplication with Structurally Normal Penises: A Case Report

Background: Diphallia is a very rare anomaly and seen once in every 5.5 million live births. True diphallia with normal penile structures is extremely rare. Surgical management for patients with complete penile duplication without any penile or urethral pathology is challenging. Case Report: A 4-year-old boy presented with diphallia. Initial physical examination revealed first physical examination revealed complete penile duplication, urine flow from both penises, meconium flow from right urethra, and anal atresia. Further evaluations showed double colon and rectum, double bladder, and large recto-vesical fistula. Two cavernous bodies and one spongious body were detected in each penile body. Surgical treatment plan consisted of right total penectomy and end-to-side urethra-urethrostomy. No postoperative complications and no voiding dysfunction were detected during the 18 months follow-up. Conclusion: Penile duplication is a rare anomaly, which presents differently in each patient. Because of this, the treatment should be individualized and end-to-side urethra-urethrostomy may be an alternative to removing posterior urethra. This approach eliminates the risk of damaging prostate gland and sphincter.

Çocuklarda Özofagus Yabancı Cisimleri

Foreign bodies of the esophagus are common problems in children and there are various methods to manage esophageal foreign bodies We retrospectively reviewed our cases in respect to the time of admittance after ingestion the presenting symptoms the site and type of the foreign body and the management undertaken From 1991 to 1998 134 esophageal foreign bodies were managed in our institution There were 77 boys and 57 girls 56 7 n:76 of the children were less than 3 years old 91 8 n:123 of foreign bodies were opaque and 8 2 n:1 1 were nonopaque 98 of opaque foreign bodies were coins 106 of foreign bodies were located at the proximal third 14 at the middle third and 14 at the distal third of the esophagus Duration of ingestion was less than 12 hours in 64 9 n: 87 of the patients and the longest duration was three months Complications were observed in two patients 84 8 n:127 of foreign bodies were managed with McGill pliers extraction n: 85 with foley balloon extraction n: 16 with endoscopic extraction n:25 with fogarty cathater extraction n:1 under general anesteshesia and with magnetic exraction n:3 Four of the foreign bodies were pushed into the stomach We believe that removal of the esophageal foreign bodies in children must be performed in the operation theatre McGill pliers and foley balloon catheter are suitable for removal of proximal third esophageal foreign bodies and endoscopy for removal of middle or distal third esophageai foreign bodies If the removal of the foreign bodies is impossible advancement into the stomach is suitable Key words: Esophagus Foreign Bodies Children