Yasemin Dere Günal

The effect of colchicine and low-dose methotrexate on intestinal ischemia/reperfusion injury in an experimental model

AIM Intestinal ischemia/reperfusion (I/R) injury is a serious clinical condition. Colchicine and low-dose methotrexate have anti-inflammatory features. An experimental model was conducted to investigate the effect of colchicine and methotrexate on intestinal I/R injury. METHODS Twenty-four rats were included. Only laparotomy was done in control group (CG, n=6). In experimental groups, superior mesenteric artery was occluded. After 1h ischemia, reperfusion (1h) was started by de-occlusion. 30min before reperfusion, saline in sham group (SG, n:6), colchicine (1mg/kg) in colchicine group (CNG, n:6), and methotrexate (0.1mg/kg) in methotrexate group (MTXG, n:6) were infused intraperitoneally. Small intestines were harvested for evaluation of intestinal mucosal injury (Chiu score) and oxidative stress markers (nitric oxide: NO, malondialdehyde: MDA, superoxide dismutase: SOD). RESULTS Biochemically, MDA levels were significantly low in CG compared to SG, CNG, and MTXG (p<0.05). NO levels were significantly low and SOD levels were significantly high in CG compared to MTXG (p<0.05). Histopathologically, Chiu score was significantly low in CG compared to SG, CNG, and MTXG (p<0.05), and significantly high in MTXG compared to SG and CNG (p<0.05). CONCLUSION The present experimental model caused I/R injury in rat intestines. Contrary to literature, it was found that methotrexate worsens and colchicine does not attenuate intestinal I/R injury.

Results of Multichannel Intraluminal Impedance pH Metry in Symptomathic Children with Normal pH Metry Findings

AIM A retrospective study was performed to evaluate the results of multichannel intraluminal impedance (MII) pH metry in symptomatic children with normal pH monitoring (PM) findings. PATIENTS AND METHODS Children who have reflux index (RI) less than 4% in PM and recurrent symptoms were included. All children underwent MII. Children who received antireflux treatment with normal PM findings were excluded from the study. MII results were evaluated for RI, content of reflux (acid, weak acid, and alkaline) number and type of impedance events, esophageal bolus clearance time and proximal extent of reflux (PER). RESULTS Eight patients (age range: 5-13 years) were included to the study. The male female ratio was 5:3. The recurrent symptoms were related with gastrointestinal (n = 5) and upper respiratory system (n = 3). One of the patients was operated for esophageal atresia and one was followed for corrosive esophageal disease. Four of the patients had RI higher than 4% in MII. Patients with normal RI in MII, had weak acid reflux (n: 1), alkaline reflux (n = 1) and no reflux (n = 2). When number of impedance events evaluated, four patients had abnormal reflux episodes (70 or more reflux episodes). Impedance event recordings were correlated in 75% of PM findings. The content of impedance events were mixed and gas in nature. Prolonged esophageal clearance time and PER were detected in patients with chest pain and operated esophageal atresia. CONCLUSION MII can be considered as a superior diagnostic tool to detect weak acid and alkaline reflux in patients who had recurrent symptoms with normal PM studies. MII also provides information about bolus clearance time and extent of reflux.

Investigation of the effects of enteral hormones on the pyloric muscle in newborn rats

PURPOSE To investigate the effects of enteral hormones on pyloric muscle in order to clarify the etiopathogenesis of hypertrophic pyloric stenosis (HPS). METHODS Forty-two newborn Wistar-Albino rats were included. No intervention was done in the control group (CG, n=6). In the sham group (SG, n=6) 1ml saline (0.9% NaCl solution), in the Nw-nitro-l-arginine methyl ester hydrochloride (L-NAME) group (LNG, n=6) 100mg/kg/d L-NAME, in the somatostatin group (STG, n=6) 7mcg/kg/d ST, in the cholecystokinin group (CCKG, n=6) 3mcg/kg/d CCK, in the substance P group (SPG, n=6) 5ml/kg/d SP, and in the prostaglandin-E1 group (PGE1G, n=6) a cumulative dose of 360mcg/kg PGE1 was given intraperitoneally for 14days. On the 21st day, histopathological examination and muscle thickness measurements were done. Results were evaluated statistically. RESULTS Total and circular pyloric muscle thicknesses were significantly increased in the LNG compared to the CG and SG (p<0.05). Circular pyloric muscle thickness was not increased in the STG, CCKG and SPG compared to the CG and SG (p>0.05). In the PGE1G, muscle thickness was significantly decreased in the pylorus and increased in the antrum compared to the CG and SG (p<0.05). CONCLUSION Nitric oxide synthase (NOS) inhibition with L-NAME seems to be a causative factor in HPS by increasing pyloric muscle thickness. PGE predominantly affects antral gastric muscle and has no profound effect on pyloric muscle.

Caudate lobe of the liver as the only content of the umbilical cord hernia

Umbilical cord hernia (UCH) is the least common of abdominal wall defects, wherein there exists an amniotic sac only containing intestinal loops protruding through a defect with a diameter less than 4 cm (Klein 2012). A 2600 gram female newborn was referred. Her physical examination revealed an umbilical cord hernia with a diameter of 3.5 cm. There was no associated anomaly. Bowel ischemia was suspected because of purple color and urgent surgical repair was planned (Fig. 1a). When the sac was opened, there was no bowel in it. Instead, caudate lobe of the liver was the only content of the sac (Fig. 1b). The liver was dissected free from the sac and repositioned into the abdomen. She fed orally on postoperative second day, and was discharged on the sixth day uneventfully. The well-known facts about UCH are that it is the least common of abdominal wall defects, its diameter is less than 4 cm, a membrane covers it, the only content is midgut, and it is able to be repaired primarily (Haas et al. 2011; Klein 2012). When bowel ischemia is suspected because of dark purple color of the sac, the management should be done immediately. We did so in the present case; however, we were faced with an unusual content – “caudate lobe of the liver”. There are very few reports revealing liver content of UCH in the literature. It has been reported that the accessory lobe of the liver or gallbladder has been in the sac (Festen et al. 1988; Elmasalme et al. 1995). Nearly the whole liver appearing in the UCH has also been reported very rarely (Zameer et al. 2012). The present case is the first report of UCH including only the caudate lobe of the liver besides these cases. This unusual and rare content should be kept in mind in cases with umbilical cord hernia that is dark in color to avoid causing fatal liver damage. DISCLOSURE

A rare cause of acute abdominal pain in children: Isolated tubal torsion; a case series

Isolated tubal torsion -a rare cause of acute abdomen in children-is usually difficult to diagnose because of non-specific findings. Surgical salphingectomy is required in delayed diagnosis in most cases. Three sexual inactive adolescents diagnosed in isolated tubal torsion (ITT) were discussed for its diagnostic features and surgical management. Laboratory tests and radiological studies including ultrasonography (US), color doppler ultrasound were performed in all patients after evaluation for acute lower abdominal pain in emergency department and they underwent surgical intervention with laparotomy (n:2) and laparoscopy (n:1). One of the patients in this study had salpingectomy. Detorsion of the fallopian tube and cyst excision were performed in the remaining two patients who also had paratubal cysts. There was no recurrence in these patients during the follow-up for 3 and 2 years. The isolated tubal torsion should be kept in mind and early surgical management is essential in order to preserve fallopian tube because of its importance in fertility.

HİDROSEFALİLİ BİR HASTADA VENTRİKÜLOPERİTONEAL ŞANT KATETERİNİN DİSTAL UCUNUN İNGUİNAL HERNİ KESESİNE MİGRASYONU

Literaturde ventrikuloperitoneal (VP) sant kataterinin intestinal perforasyon, inguinal herni, peritonit gibi abdominal komplikasyonlara neden olabilecegi bildirilmistir. Hidrosefali nedeniyle VP sant takilmis 2 aylik erkek hastanin klinik takibinde, sant ameliyatindan otuz gun sonra sol kasiginda sislik saptandi. Yapilan abdominal ultrasonografi ve direkt grafi tetkiklerinde hastanin sol skrotumu icerisinde VP sant kateterinin distal ucunun izlenmesi uzerine hasta Cocuk Cerrahisi Bolumu tarafindan degerlendirildi. Hastaya sol inguinoskrotal herni tanisi koyularak ameliyat edildi. Kateter ucu karin icerisine redukte edilerek yuksek ligasyon ile inguinal herni onarimi yapildi. Hastanin ameliyat sonrasi uc aylik takibi sonunda nuks ve/veya komplikasyon izlenmedi. Sonuc olarak VP sant takilan hastalarda inguinoskrotal komplikasyonlar akilda tutulmalidir. VP sant ameliyati sonrasi kasik bolgesindeki sislikler inguinal herni acisindan degerlendirilmeli ve erken tani ve tedavi icin aile bilgilendirilmelidir.

Does penile tourniquet application alter bacterial adhesion to rat urethral cells: an in vitro study

PURPOSE To investigate the effects of penile tourniquet (PT) application on bacterial adhesion to urothelium. METHODS Fifty-six rats were allocated into control group (CG), sham group (SG), PT group (PTG). No intervention was applied in CG. A 5mm-length urethral repair was performed in SG and PTG. In PTG, a 10-min duration of PT was applied during the procedure and the tissue oxygenation monitor was used to adjust the same degree of ischemia in all subjects. Samples were examined for wound healing parameters and tissue levels of inflammatory markers, eNOS, e-selectin, and ICAM-1antibodies. The adhesion of Escherichia coli to urothelium was investigated with in vitro adhesion assay. RESULTS Inflammation was higher and wound healing was worse in SG than CG and in PTG in comparison to CG and SG (p<0.05). The endothelial damage, as shown by eNOS expression, was significantly higher in PTG compared to CG and SG (p<0.05). The staining with ICAM-1 and e-selectin antibodies, showing increased inflammatory response to bacterial adhesion, was significantly higher in PTG compared to CG and SG (p<0.05). In vitro urethral cell proliferation was achieved only in CG and SG revealing significantly increased adhesion in SG compared to CG (p<0.05). The PT application caused endothelial corruption and prevented cell proliferation in cell culture. CONCLUSION The PT application does not improve wound healing and increases bacterial adhesion molecules in penile tissue. The in vitro assays showed that PT causes severe endothelial damage and inhibits endothelial cell proliferation.

Evaluation of intraabdominal hypertension and genitofemoral nerve motor conduction.

BACKGROUND/AIM The aim of this study was to electrophysiologically evaluate the effect of increased intraabdominal pressure (IAP) on genitofemoral nerve (GFN) motor conduction. MATERIALS AND METHODS Seven Wistar albino rats were included. After anesthetization, latency and duration of GFN conduction was recorded with a needle-probe at rest. IAP was increased to 15 mmHg by insufflating atmospheric air with a percutaneous intraperitoneal needle. At 30 min of IAP, GFN motor conduction was recorded. Abdominal pressure was then increased to 20 mmHg. At 60 min, GFN motor conduction was recorded again. The consecutive recordings of latency and duration of GFN conduction (rest, 30 min, 60 min) were evaluated statistically. RESULTS There was a significant difference between latencies at rest (1.90 ± 0.22 ms), at 30 min (2.3 ± 0.36 ms), and at 60 min (2.74 ± 0.57 ms) (Friedman test, P = 0.001). The latency was significantly increased at 60 min compared to rest (post hoc Tukey test, P = 0.003). No similar difference was detected between the recordings at 30 and 60 min. The duration of GFN motor conduction showed no difference between consecutive recordings (P = 0.067). CONCLUSION Both increased and prolonged IAP causes prolonged latency of GFN conduction, probably due to a compression effect on GFN. Neuropraxial consequences of increased IAP are thought to be related to the compression effect of peripheral nerves.