Riza Rizalar

Effects of estradiol and progesterone on the synthesis of collagen in corrosive esophageal burns in rats

The effects of sex hormones on the synthesis of collagen were investigated in rats with alkali-induced corrosive esophageal burns. In 75 rats, a standard esophageal burn was produced as described by Gehanno. The animals were then grouped as follows: controls (group A), animals with pure esophageal burns (group B), and animals with esophageal burns treated with estradiol and progesterone (group C). All animals were killed on the 28th day of the experiment. Hydroxyproline levels were determined, and histopathologic evaluation was performed for each group. The hydroxyproline levels were significantly lower in the rats treated with estradiol and progesterone. Histopathologically, collagen deposition in the submucosa and tunica muscularis was lower in the estradiol/progesterone group than in the group with pure esophageal burns. Based on the results, the authors believe that estradiol and progesterone inhibited new collagen synthesis, and therefore, alkali-induced esophageal stricture formation.

Minimally invasive management of children with caustic ingestion: less pain for patients

PurposeManagement of caustic ingestion in children is still controversial. In this study, we evaluate a minimally invasive management consisting of flexible endoscopy, balloon dilatation and intralesional steroid injection in children, with a history of caustic ingestion.MethodsBetween April 2002 and January 2009, 350 (206 males and 144 females) children with a history of caustic ingestion were admitted. Enteral feeding was discontinued for 24xa0h. Parenteral feeding was started in patients with inadequate oral intake. No patient underwent an early esophagoscopy or gastrostomy. A contrast study of upper gastrointestinal tract was performed in all patients with persistent dysphagia within 3xa0weeks after injury. In case of an esophageal stricture, a dilatation program was initiated. For this purpose, a flexible esophagoscopy was performed. A guidewire was placed through the narrowed segment into the stomach and a balloon dilatator was inserted with the assistance of the guidewire. Balloon dilatations were performed every 1–3xa0weeks. In intractable strictures, triamcinolone acetonide (TAC) was injected into the narrowed segment via flexible endoscopy.ResultsSeventeen patients (8 males, 9 females, median 3xa0years old) required esophageal dilatation. All of the patients completed dilatation program with complete relief of symptoms. None of the patients required any stent application nor esophageal replacement or gastrostomy. Ten patients underwent intralesional TAC injection. No patient had an esophageal perforation or any other complication related to dilatation. In all patients, the symptoms have been alleviated completely and no further dilatation was necessary after a median of five dilatation sessions (1–19 dilatations).ConclusionMinimally invasive management of caustic ingestion consisting of flexible endoscopy, guidewire-assisted esophageal balloon dilatation and intralesional TAC injection without any gastrostomy or esophageal stent/placement is effective and leads to relief of dysphagia in almost all patients. This method of dilatation is also safe and iatrogenic esophageal perforation is very unlikely.

Effects of omeprazole and gentamicin on the biochemical and histopathological alterations of the hypoxia/ reoxygenation induced intestinal injury in newborn rats

We utilized a newborn rat model of hypoxia/reoxygenation (H/R) that resembles human necrotizing enterocolitis (NEC) to investigate the effects of omeprazole and/or gentamicin on the formation of free oxygen radicals (FOR) and bowel histopathology. For H/R, 1-day-old rats were placed into a chamber of 100% CO2 for 5xa0min, then they were reoxygenized for the next 5xa0min. The rats (n=70) were divided into seven groups: group 1 (control), group 2 (H/R), group 3 (omeprazole), group 4 (H/R+omeprazole), group 5 (gentamicin), group 6 (H/R+gentamicin), group 7 (H/R+omeprazole+gentamicin). Gentamicin and/or omeprazole were given orally for 3xa0days, then all animals were killed; bowel specimens were harvested. Histopathologic injury scores (HIS) and malonyldialdehyde (MDA) and XO/(XO+XDH) rates (XO; xanthine oxidase, XDH; xanthine dehydrogenase) were measured, which reflect the FOR levels. In group 2, the HIS was significantly higher than groups 4 and 6. The mean MDA values in groups 1–7 were as follows: 54.16, 104.2, 56.85, 63.43, 62.31, 76.85, 79.13, respectively. The mean XO/(XO+XDH) levels were 0.306, 0.461, 0.286, 0.335, 0.323, 0.410, 0.375 from groups 1 –7, respectively. Group 2 rats had significantly more MDA and XO/(XO+XDH) rates versus other groups (P<001). Histopathologic injury and biochemical results were significantly more severe in group 2 than in groups 4 and 6 (P<001). There was no difference between groups 1 and 4 according to XO/(XO+XDH) rates. In newborn rats, H/R produces FOR, which cause serious intestinal damage. Omeprazole and/or gentamicin reduce biochemical and histopathologic bowel damage. This effect was more obvious in omeprazole treated rats. We think omeprazole may open new insights into the treatment of H/R related bowel injuries like NEC.

The right-sided aortic arch in children with esophageal atresia and tracheo-esophageal fistula: a repair through the right thoracotomy.

PurposeThe management of the esophageal atresia and tracheo-esophageal fistula (EA/TEF) with right-sided aortic arch (RAA) is controversial. The preoperative diagnostic techniques may fail to show RAA associated with EA/TEF. Surgeon may need to make a decision to change the side of thoracotomy. The aim of the current study was to evaluate the possibility of preoperative diagnosis of RAA and the primary anastomosis through right chest.MethodsA retrospective review was performed in EA/TEF patients between February 2001 and 2008. A total of 79 patients (35 female, 44 male) with EA/TEF were reviewed. Eleven (13%) patients (5 female, 6 male) had an RAA. Echocardiography was performed in 10 of 11 patients with RAA. The chest was accessed through the right side in all patients.ResultsThe incidence of RAA was found to be higher in our study than previous studies (13%). Right thoracotomy was performed successfully in all patients. Three patients died due to multiple congenital anomalies and 1 patient due to bleeding postoperatively. Five of 10 had normal echocardiography findings. Only one patient with RAA has been successfully diagnosed by preoperative echocardiographic examination. Seven patients had no complication after operation. Their follow-up was uneventful.ConclusionPreoperative recognition of RAA with echocardiography is unlikely in patients with EA/TEF but the presence of RAA does not decrease the success rate of EA/TEF repair through the right thoracotomy.

Protective effects of vitamin E and omeprazole on the hypoxia/reoxygenation induced intestinal injury in newborn rats

Evaluation of prophylactic effects of omeprazole and/or vitamin E on the formation of free oxygen radicals (FOR) and bowel histopathology in the newborn rat model of hypoxia/reoxygenation (H/R) that resembles human necrotizing enterocolitis (NEC). Eighty newborn rats were randomly divided into eight groups. H/R was done using airtight chamber. Rats were exposed to 100% CO2 for 15xa0min followed by a reoxygenation for the next 15xa0min with 100% O2. Group 1 (nxa0=xa010) was the control group. Group 2 (nxa0=xa010) rats received vitamin E. In Group 3 (nxa0=xa010) omeprazole was administrated. Group 4 (nxa0=xa010) rats received omeprazole and vitamin E. Group 5 (nxa0=xa010) rats were subjected to H/R two times for 2xa0days and one time for 3xa0days. Group 6 (nxa0=xa010) received vitamin E in addition to H/R for 5xa0days and in Group 7 (nxa0=xa010) omeprazole in addition to H/R for 5xa0days. In Group 8 (nxa0=xa010), vitamin E and omeprazole and H/R were applied for 5xa0days. Rats were killed at the end of the each process and bowel specimens were harvested for histopathological and biochemical investigations. We administrated vitamin E intramuscularly 300xa0unit/kg per day and omeprazole orally 20xa0mg/kg per day. Malondialdehyde (MDA), xanthine oxidase (XO), xanthine dehydogenase (XDH) and XO/(XOxa0+xa0XDH) were measured. Vitamin E and/or omeprazole treated rats had significantly less XO% levels than H/R only group (0.36, 0.38 and 0.57, respectively). Similarly, the MDA levels were significantly lower in vitamin E and/or omeprazole received rats than H/R only rats (88.8, 97.9 and 122.6, respectively). All rats treated with omeprazole and/or vitamin E had better biochemical and histopathological levels compared to H/R rats (pxa0<xa00.05). Histopathological results show that Group 5 (H/R only) had significantly more intestinal damage when compared with Group 6 (vitamin Exa0+xa0H/R), Group 7 (omeprazolexa0+xa0R/H) and Group 8 (vitamin Exa0+xa0omeprazolexa0+xa0H/R) (pxa0<xa00.001). Grade 2 and 3 intestinal damages were only in Group 5 and there were no statistical difference between in Groups 6, 7 and 8 (pxa0>xa00.001). Omeprazole and/or vitamin E may protect the biochemical and histopathological intestinal damage of H/R injury in rats. These drugs may be beneficial in the prophylaxis of NEC in humans as well.

Alterations of Cajal cells in patients with small bowel atresia

PURPOSEnInterstitial cells of Cajal (ICC) are regarded as the pacemaker cells of the gastrointestinal tract. There are some well-designed studies investigating the structure and function of ICC subsequent to experimentally induced intestinal obstructions. However, it remains unclear whether reduction of number of ICC primarily leads to mechanical obstruction of the bowel such as seen in intestinal atresia. We aimed to investigate the number of ICC in proximal and distal parts of the atresias of patients with small bowel atresia.nnnPATIENTS AND METHODSnTwenty-one patients (13 male and 8 female; median age, 3 days; median gestation age, 38 weeks) with jejunal or ileal atresia underwent primary repair between 2001 and 2009. The demographic data were reviewed. The specimen of the distal and proximal parts of the atretic segments was investigated according to presence and number of ICC in the myenteric plexus using immunohistochemical methods. The jejunum segments of 14 newborns who died from causes other than bowel disease were examined as a control. Scoring and count systems were developed for the evaluation of ICC. A continuous layer of CD-117 immunoreactive Cajal cells around the myenteric plexus was scored as 3, whereas discontinuous and diminished Cajal cells were scored as 2. Few and sparse Cajal cells around the myenteric ganglia and in the muscle layer were scored as 1. If there was no Cajal cell at all, it was scored as zero. In addition, the number of ICC per field was counted. The scores and the numbers of ICC per field were compared in patients with small bowel atresia and control group.nnnRESULTSnAll patients but one survived. One patient was lost because of congenital cardiac anomalies. The median score of control subjects was 3 (range, 1-3). Both the proximal and distal segments of the atretic bowel had a median score of 1 in patients with atresia. Twenty patients score of proximal (95%) and 19 patients score of distal bowel segment (90%) had an ICC score of 2 or less. Only 1 control subject (7%) had an ICC score of less than 2. Results were statistically significant in controls and patients. The mean number of ICC in the control group was 5.36 +/- 2.36; in distal segments of patients with atresia, it was 1.03 +/- 1.4; and in proximal segments, it was 0.82 +/- 1.56. The difference between the control group and the patients was statistically significant (P < .05).nnnCONCLUSIONnWe demonstrated a remarkable decrease of ICC in small bowel wall of patients with intestinal atresia; but we could not show whether the reduction of ICC is a primary event, which also participates in the pathogenesis of intestinal atresia, or whether the mechanical obstruction caused by any unknown etiology (eg, ischemia) leads to decrease in number of ICC.

Biochemical and histopathologic effects of omeprazole and vitamin E in rats with corrosive esophageal burns

The aim of the study reported here was to evaluate the biochemical and histopathologic effects of omeprazole and vitamin E in rats with corrosive esophageal burns. A total of 144 Wistar Albino rats were divided into 12 experimental groups (12 rats per group) and used in an animal study. Group I rats were given a laparotomy and received no treatment (control group), while groups II, III and IV received a laparotomy and were treated with omeprazole, vitamin E or omeprazole/vitamin E, respectively. Groups V-XII rats received a laparotomy and were given a caustic acid burn through acid instillation (1 ml caustic 10% sulphuric acid; groups V–VIII) or alkali instillation (corrosive 10% sodium hydroxide solution; groups IX–XII) into the isolated esophageal segment via a 22-Fr cannula for 2 min. Each group of rats subjected to caustic burn received either no treatment (groups V and IX) or were treated with omeprazole, vitamin E or omeprazole/vitamin E, respectively (remaining six groups). Omeprazole (20xa0mg/kg) or vitamin E (10xa0mg/kg) was administered to the rats intraperitoneally or intramuscularly, respectively. Seventy-two rats (50% of each group, nxa0=xa06) were killed immediately after the experimental treatment (acute phase). The remaining rats were kept under standard conditions for 21xa0days (late phase) before being killed. The distal esophageal segments were harvested from all animal and used in histopathologic and biochemical analyses. Compared to the controls (no caustic burn), rats receiving only the acid or alkali installation (and no subsequent treatment) had the highest mean malondialdehyde (16.9 and 15.8 μmol MDA/g protein, respectively) and hydroxyproline (5.9 and 5.7; mg HP/g wet tissue) levels of all groups. In comparison, rats treated with acidxa0+xa0omeprazole and/or vitamin E had relatively lower MDA (12.9 and 11.6 μmol/g protein, respectively) and HP levels (4.3 and 4.08 mg/g wet tissue, respectively). Similarly, rats treated with alkalixa0+xa0omeprazole and/or vitamin E had low levels of MDA (13.9 and 11.7 μmol/g protein, respectively) and HP (4.3 and 4.4 mg/g wet tissue, respectively). The glutathione (GSH) levels of acid-only- or alkali-only-treated rats were lower than those found in omeprazole- and/or vitamin E-treated rats. Based on these results, we conclude that vitamin E and omeprazole affect the biochemical and histopathologic parameters in rats receiving corrosive esophageal burn from acid and alkali. The effect of both substances was slightly greater in the acid-treated groups.

Bilateral adrenal cystic neuroblastoma with superior vena cava syndrome and massive intracystic haemorrhage

Bilateral cystic adrenal tumours are a rare presentation of neuroblastoma. Intratumoural haemorrhage is a frequent finding in neuroblastoma, but is rarely symptomatic. We present an 11-month-old girl with predominantly cystic bilateral neuroblastomas and distant lymph-node metastasis. Massive intracystic haemorrhage and superior vena cava (SVC) syndrome were ominous prognostic factors, leading to death. Large tumours with intracystic haemorrhage might require a conservative approach.

Two cases of fetus in fetu

Fetus in fetu (FIF) is a rare cause of abdominal mass in children. One of the malformed monozygotic diamniotic twins is located in the body of other twin. It is differentiated from teratoma by the presence of vertebral organization with limb buds and other organ systems. Diagnosis is based on radiologic findings. Surgical excision is the treatment of choice, leading to the complete removal of the mass. To our knowledge, less than 200 cases have been described in the literature. Herein, we report 2 cases of FIF, a newborn who was diagnosed antenatally and a three-and-half-year- old boy diagnosed with mediastinal FIF after admission for recurrent respiratory tract infections.

Antiadhesive effects of mitomycin C and streptopeptidase A in rats with intraperitoneal adhesions

Intraabdominal adhesion formation is a frequent problem after major abdominal surgery. For many years, there have been various attempts to decrease adhesions by using systemic and local drugs and mechanical barriers. In this study we aimed to evaluate the antifibrinolytic antiadhesive effects of mitomycin C (MMC) and streptopeptidase A (SA) against intraabdominal adhesions. Forty-eight rats were divided into six groups, each with eight rats. Group 1 (sham group) rats were laparotomized by transverse incision only. In Group 2 (laparotomy and talcum powder), 2xa0ml talcum powder was scattered equally onto the intestinal surface after laparotomy. Group 3 (SA only), 2xa0g SA was introduced onto the intestinal surface. Group 4 (talcum powder and SA), 2xa0ml talcum powder was scattered onto the intestinal surface and then 2xa0g SA was applied on the same area. Group 5 (MMC only), 2xa0ml MMC was introduced onto the intestinal surface. Group 6 (talcum powder and MMC), 2xa0ml talcum powder was scattered onto intestinal surface and then MMC was applied onto same area. We assessed adhesion grades macroscopically, as well as, hydroxproline levels biochemically. Macroscopicaly, the number of rats with moderate or severe adhesions was significantly higher in the control group than all other groups (Pxa0<xa00.05). SA and MMC groups had only mild adhesions. No intraabdominal problem was detected in rats with SA or MMC. Hydroxyproline (HP) levels were significantly higher in control group than all other groups (Pxa0<xa00.05). There was no statistical significance between the rats with SA and MMC (Pxa0>xa00.05) according to the HP measurements. MMC and SA may have potential antiadhesive effects. Both substances could be beneficial against adhesion formation after laparotomies.