ABSTRACT: The present study aimed to characterize the changes in macromolecular composition and structure in ileal tissue induced by postoperative prolonged starvation (PS), human breast milk feeding (HM) and commercial formula feeding (CF) for 48 and 72 h (h). Forty-two Wistar albino rats underwent an ileal transection and primary anastomosis and were then divided into six subgroups. Two groups of seven rats were food-deprived for 48 and 72 h with free access to water only in metabolic cages (48 h PS, 72 h PS). Then, two groups of seven rats received early enteral trophic nutrition (EEN) either using HM, and CF at 48 h post-operation (48 h HM, 48 h CF). The other two groups of seven rats received the same trophic enteral nutrition at 72 h post-operation (72 h HM, 72 h CF). An additional seven rats were fed normal rat chow (control), after which the ileal tissues were harvested and freeze-dried overnight. Then sample spectra were recorded by Fourier transform infrared (FTIR) spectroscopy. PS at 48 and 72 h resulted in an increase in the concentration of lipids and a decrease in the concentration of proteins. CF and HM trophic feeding induced a decrease in membrane fluidity and an increase in lipid order. Ileal tissues showed similar compositional and structural changes in lipids and proteins in the PS and CF groups after 48 and 72 h. A marked decrease in nucleic acid concentration was seen in CF at 48 h compared to HM. The human milk feeding groups did not induce any significant alterations and showed compositional and structural data similar to the controls. In conclusion, EEN application seems to be safer when introduced at 48 h rather than 72 h and time of this nutrition is crucial to maintain ileum structure and therefore immunity and well-being. HM-induced trophic nutrition is seen to protect the ileal tissue from significant alterations within lipid and protein compositions, whereas CF caused notable changes. HM is absolutely the best nutritional source for gut health in this animal model.

ABSTRACT: Fourier transform infrared spectroscopy (FTIR), allows us to monitor changes simultaneously in the structure and properties of biomolecules such as DNA, RNA, proteins, carbohydrates, lipids in biological tissues and cells. In the present study, FTIR spectroscopy was used to characterize the prolonged starvation (PS) and commercial formula (CF) induced changes in the macromolecular composition, concentration and structure of ileal tissue at molecular level. Twenty-one Wistar albino rats (100-180 grams) were food-deprived for 48 hours with free access to water only in metabolic cages. These rats were equally divided into three subgroups (7 rats each) regarding the feeding regiment as fasting, commercial formula (CF) and rat chow fed. Long-term starvation and commercial formula feeding lead to some changes in the lipid and protein content. This study demonstrates that FTIR spectroscopy is a useful tool in rapidly investigating the structural and conformational alterations induced by trophic early enteral feeding in ileum tissue.

ABSTRACT:

Objective: We report the results of a multicenter prospective trial of early enteral trophic feeding in a group of 56 neonates who required abdominal surgery for a variety of congenital anomalies.

Methods: In this clinical study, 33 neonates were fed in the early postoperative period (early enteral nutrition [EEN] group), and the remaining 23 (control [C] group) were fasted until resolution of postoperative ileus. Patients in the EEN group (Kocaeli feeding protocol) received 3 to 5 mL of breast milk every hour through a nasogastric feeding tube, starting a mean of 12 h (8 to 20 h) after surgery. The nasogastric tube was clamped for 40 min after each infusion and then opened for drainage. Groups were further divided into two subgroups according to whether an intestinal anastomosis or laparotomy was performed. The change in daily gastric drainage, time to first stool, day of toleration to full oral feeding, and length of hospital stay were compared. Blood bilirubin levels, white blood cell count, and C-reactive protein levels were monitored.

Results: The time to first stool and day of toleration to full oral feeding occurred significantly sooner, whereas nasogastric tube drainage duration and hospital stay were significantly shorter in the EEN-anastomosis group than in the C-anastomosis group. Time to first stool occurred significantly sooner in the EEN-laparotomy group than in the C-laparotomy group, although other parameters did not differ. Neither anastomotic leakage nor dehiscence was observed in any group. There were two cases of wound infection and two of exitus among patients in the C group.

Conclusion: Postoperative, early intragastric, small-volume breast milk feeding is well tolerated by newborns. It is a reliable and feasible approach in neonates even in the presence of an intestinal anastomosis after abdominal surgery.

ABSTRACT: Complete excision of diffuse abdominal lymphangiomatosis in the newborn is next to impossible. A 3-day-old female infant was found to have diffuse abdominal lymphangiomatosis predominantly in the left mesocolon and retroperitoneum. Initial management was by marsupialization, which was complicated by chylous ascites requiring periodic paracentesis and nutritional support. At the age of 45 days, left hemicolectomy and partial excision of the retroperitoneal cysts were performed together with intracystic injection of OK-432 into the residual cysts. The patient's progress after the second operation was satisfactory. Initial marsupialization followed by delayed partial resection together with injection of OK-432 into the residual cysts is an effective method of managing diffuse abdominal lymphangiomatosis in the newborn.

ABSTRACT: The clinical picture of venous or arterial thrombosis in the presence of circulating antiphospholipid antibodies is referred to as the antiphospholipid syndrome. A 5-month-old baby girl who was quite healthy so far was referred to our clinic with irritability, vomiting, and abdominal distension for 30 hours. Surgical exploration exposed a gangrenous ileal segment about 15 cm long. The postoperative period was unremarkable. Investigation to identify the risk factors for mesenteric thrombosis found anticardiolipin antibodies (isotype Ig G) and decreased protein C level. Protein S and antithrombin III were within normal levels. Hb electrophoresis results showed no HbS, and neither Factor V Leiden nor prothrombin 20210 mutations were detected. Eight months postoperatively, anticardiolipin antibodies were found within normal levels. Lupus anticoagulant, ds DNA, and ss DNA were negative. Direct coombs test and protein C, C3, and C4 were also within normal levels. She had no thrombotic episode in the 24 months postoperatively, although no anticoagulant medication was administered. To the authors' knowledge this case is the first report of segmental intestinal infarction in transient antiphospholipid syndrome in the pediatric population.

ABSTRACT:

Objective: Proper antibiotic treatment and adequate pleural drainage is essential in successful management of pleural effusions. In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading ineffective chest tube drainage. Intrapleural fibrinolytic agents are employed to avoid thoracotomy in such complicated pleural effusions. Our study reviews the results of streptokinase treatment in children with pleural effusion.

Methods: Thirty-two patients with parapneumonic pleural effusions were admitted to our hospital. The patients beyond the exudative stage were divided into two groups according to the initial radiological findings and biochemical parameters of pleural fluid. Intrapleural streptokinase treatment was started in an average of 2 days following initial chest tube placement in both Group I (14 patients) in fibrino-purulent phase with pleural effusion and fluid volume estimated to be larger than one-third of the involved lung and Group II (18 patients) with additional findings in radiological examination regarding the presence of air-fluid levels, multiple loculations, necrotic debris and pleural thickening. The effectiveness of therapy was assessed by monitoring the volume of the fluid, the level of LDH, glucose, pH and by radiological imaging, pre- and post-instillation.

Results: There was statistically significant difference between two groups according to date of admission (6.8 vs 10.4 days), mean of total pleural fluid drainage before (106.9 vs 309.7 ml) and after (258.9 vs 511.2 ml) SK treatment, mean of total number of instillations (2.1 vs 3.6) required and total length of hospital stay (16.6 vs 22.4 days). There was a significant difference regarding pleural chemical analysis. Finally, surgical intervention was necessary in six intractable cases, all of which initially presented a significant small amount of pleural drainage in volume when compared to rest of the patients. The overall success rate of our treatment was calculated as 96% for G-I and 72.2% for G-II cases.

Conclusions: Intrapleural streptokinase is an effective and safe adjunct in facilitating drainage in early and late stage II empyemas. A tendency of decreased rate of drainage besides persisting fever and respiratory symptoms, despite fibrinolytic treatment may be a clue for early surgical intervention.

ABSTRACT:

Background: Laparoscopic surgery is a good alternative to the open technique for treating hernias in female paediatric patients. The laparoscopically inverted and sutured hernia sac forms a nodule, the long-term fate of which has not been previously studied radiologically.

Objective: To describe the early and delayed US changes after laparoscopic inversion and suturing of paediatric female inguinal hernias.

Materials and methods: Twenty girls (age 1.5 months to 12 years; median 4.6 years) who underwent laparoscopic inguinal hernia repair were prospectively evaluated with US the day before and the day after the procedure. Delayed scans were obtained at 1, 6 and 12 months.

Results: The laparoscopic procedure involved inversion and suturing of the hernia sac, which resulted in a nodule that plugged the internal inguinal ring and resembled a rosebud laparoscopically. US detected the 'rosebud' in all cases on the first postoperative day. Initially appearing as a rounded or ovoid mass with a slightly hypoechoic texture, the 'rosebud' became progressively smaller, more hypoechoic and more lobulated on follow-up. It disappeared in all but two cases at 6 months and in all cases at 1 year. There was no US evidence of recurrence.

Conclusions: The 'rosebud' formed by this laparoscopic procedure displays typical US features and temporal changes.

ÖZET: Akciğer kist hidatik tedavisinde cerrahi yaklaşım halen ilk seçenek olarak kabul edilmektedir. Günümüzde video-endoskopi alanındaki gelişmeler sonucu çocuk yaş grubu akciğer kist hidatiği tedavisinde, torakoskopik girişimler güvenli ve nisbeten kolay bir yaklaşım olarak uygulanabilmektedir. Bu çalışmada, birisi komplike olmuş ve akciğer absesi ön tanısıyla girişim yapılmış olan iki olguya ait farklı iki torakoskopik yaklaşım bildirilmektedir.

ÖZET:

GİRİŞ ve AMAÇ: Komplike parapnömonik effüzyonlu olguların tedavisinde, tüp torakostomi ile her zaman etkili bir drenaj sağlanamayabilir. Bu nedenle komplike plevral effüzyon tedavisinde fibrinolitik ajanların kullanımı önerilmektedir. Çalışmada, komplike plevral effüzyonlu olgular fibrinolitik ajan olarak streptokinaz uygulandı ve bu tedavinin etkisinin değerlendirilmesi amaçlandı.

YÖNTEM ve GEREÇLER: Ocak 2001-Aralık 2002 tarihleri arasında, pnömoniye bağlı plevral effüzyonlu 22 olgu başvurdu. Tüm olgulara ikili antibiyotik tedavisi verildi. Eksudatif evredekiüç olgu sadece torasentez ve/veya tüp torakoskopi ile, komplike effüzyon evresindeki 19 olgu tüp torakoskopi ve intraplevral streptokinaz uygulanarak tedavi edildi. Streptokinaz uygulanan ve uygulanmayan olgularda başvuru sırasında mevcut şikâyetlerinin süresi, tüp kalış ve hastanedeki yatış süresi tespit edildi. Streptokinaz uygulanan olgularda tedavi öncesi ve sonrası plevral sıvının toplam drenaj miktarı ve biyokimyasal parametrelerin değişiklikleri değerlendirildi. BULGULAR: Yaş ortalaması 3.95 yaş (6 ay-10y) olan on dört kız, sekiz erkek toplam 22 plevral effüzyonlu olgunun 21’ine göğüs tüpü takıldı. Bu olgulardan 19’una tüp takıldıktan ortalama iki gün sonra intraplevral streptokinaz uygulandı. Drene olan plevral sıvı miktarı ve USG bulgularının sonuçlarına göre ortalama 2.8 kez (1-4) doz tekrarı yapıldı. Şikâyetlerin başlangıcı ile başvuru arasında geçen süre SK uygulanmayan olgularda 5.32 gün, uygulanan olgularda 9.78 gündü. SK uygulanan olguların plevral sıvı analizlerinde, tedavi sonrası drene olan sıvı miktarında artış ve biyokimyasal analizlerinde (Glukoz, pH ve LDH) belirgin değişiklik kaydedildi. SK uygulanan olgularda ortalama tüp süresi 9.51±5.82 (3-30) günken yatış süresi 25.2±12.36 (14-45) gün olarak tespit edildi. Bronkoplevral fistülü olan dört olgu takip sırasında kendiliğinden düzeldi. İki olguda tedaviye bağlı yeterli düzelme olmadığından cerrahi girişim uygulandı. SK uygulamasına bağlı % 89.4 oranında başarı tespit edildi.

TARTIŞMA ve SONUÇ: Çocuk ampiyem olgularının tedavisinde intraplevral streptokinaz uygulamasının etkili ve güvenilir bir drenaj sağladığını düşünmekteyiz.

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