Outcomes of Pediatric Fistulising Perianal Crohn’s Disease

Background: Perianal disease is reported more widely in pediatric Crohn patients than in the past, and has been stated as an independent modifier of the disease behavior. In this study, we aimed to analyze the clinical characteristics and outcomes of fistulising perianal Crohn’s disease (fpCD) in the pediatric age group.Methods: A total number of 149 children with an established diagnosis of inflammatory bowel disease who have been diagnosed before 18 years of age and followed in our tertiary center were revised. Clinical, endoscopic, laboratory, and radiologic data of 50 patients with CD, who had at least 18 months follow-up data, were compiled.Results: Of 50 patients, 26 (52%) were diagnosed as fpCD (38% at onset). More than half of the patients without any notable external orifices around the perianal area were diagnosed as fpCD by an magnetic resonance imaging (MRI). Pediatric fpCD patients had a higher disease activity score and platelet count, lower serum albumin level, and a higher rate of granuloma in the biopsy samples, compared with non-fistulising patients. A considerably high rate of surgical interventions (i.e., seton placement 46% and abscess drainage 15%) was performed in combination with infliximab.Conclusion: Fistulising perianal Crohn’s disease seems to be more common than previously reported in the pediatric age group. A severe course of the disease might serve as a warning for the development of fpCD. A careful physical examination and use of perianal MRI with a high index of suspicion may increase the likelihood of fistula detection, hence may change the treatment strategy.     

A long-standing incomprehensible matter of obstetrics: meconium-stained amniotic fluid,a new approach to reason

Objective

We sought to determine whether meconium-stained amniotic fluid is based on chronic hypoxia or not? In case of chronic hypoxia, higher red blood cell (Rbc) count and/or total hemoglobin levels (Hgb) and/or higher fetal hemoglobin (HbF) and/or lower adult hemoglobin (HbA) levels were expected when compared with controls.

Design

Case–control study.

Setting

Obstetric unit of a tertiary ministry of health hospital.

Sample

Fifty singleton pregnancies with meconium-stained amniotic fluid and 50 singleton pregnancies with clear amniotic fluid at all stages of labor.

Methods

Umbilical cord blood samples were collected for determination of total blood parameters and hemoglobin electrophoresis.

Main outcome measures

Red blood cell count, total hemoglobin, fetal and adult hemoglobin contents (HbF and HbA).

Results

Red blood cell count, total hemoglobin, fetal hemoglobin (HbF) and adult hemoglobin (HbA) contents were not different between meconium stained and clear amniotic fluid groups.

Conclusion

These results suggest that meconium passage may not be associated with chronic fetal hypoxia as demonstrated by similar red blood cell count, total hemoglobin values and fetal hemoglobin (HbF) and adult hemoglobin (HbA) contents.

     

Abdominal computed tomography findings of malignant tumors in patients with solid organ transplants

AIMS: Incidence of malignancy in solid organ transplant recipients is higher compared to the general population. The aim of this study was to characterize distribution and appearance of abdominal malignant tumors detected with spiral computed tomography (CT) examination in patients with solid organ transplantation. MATERIALS AND METHODS: Between July 1994 and April 2006, 198 patients underwent liver transplantation and 568 patients underwent renal transplantation in our center. The abdominal CT studies were reviewed to determine the presence or absence of abdominal malignancy. All abdominal CT examinations were performed prior to immunomodulation or chemotherapy. RESULTS: Eleven renal and one liver transplantation patient developed an abdominal malignancy. Among 11 renal transplantation patients eight were diagnosed as abdominal Kaposi's sarcoma (KS) and three as posttransplantation lymphoproliferative disorder (PTLD) upon spiral CT examination. In two patients the transplanted organ itself had malignant tumors: one patient had PTLD with Burkitt lymphoma in the transplanted liver and the other a renal cell carcinoma in the transplanted kidney. Abdominal PTLD and KS showed imaging findings and the site of organ involvement somewhat different from nontransplant patients. The most common pathologies in KS were liver lesions (n=6) and lymphadenopathy (n=6). But in abdominal PTLD, the spleen (n=3) was the most involved organ. CONCLUSIONS: The early diagnosis of abdominal malignancies after solid organ transplantation is crucial for the patient's prognosis, especially under immunosuppression. The abdominal spiral CT examination was an effective modality to depict a malignancy among patients with solid organ transplantation.     

Thyroid incidentalomas: prediction of malignancy and management

The treatment strategy of an incidentally detected thyroid nodule is controversial. The aim of this study was to establish management criteria for thyroid incidentalomas by defining and formulating the risk factors predicting thyroid malignancy. A prospective database containing 815 consecutive patients who underwent a thyroidectomy for nodular thyroid disease, between January 1992 and May 2003, was studied. Multivariate analyses demonstrated that the independent clinical predictors of malignancy were a fixed nodule and cervical lymphadenopathy on palpation, a euthyroid patient, and a patient age <23 years or >45 years; and independent nodule features significantly associated with malignancy were punctuate calcifications, irregular nodule margin, solid appearance on ultrasonography, and solitary nodule in an euthyroid patient. Using the regression coefficients of four independent ultrasound (US) features, a malignancy risk score of a nodule was calculated as follows. Depending on the score of a thyroid nodule, a simple follow-up, a US-guided fine needle aspiration biopsy or a thyroidectomy, may be offered for management.     

The effects of caspofungin and voriconazole in an experimental fungal infection of the ear due to Aspergillus

The purpose of the study was to evaluate the effectiveness of caspofungin and voriconazole in the treatment of experimental Aspergillus otits media in an experimental rabbit model. A total of 30 New Zealand white rabbits were divided into four treatment groups and one control group. The rabbits were immunosuppressed by cyclophosphamide and triamcinolone acetonide. The right ear of each rabbit was infected by an injection of the inoculum of 0.1 ml (8.6 × 103 CFU/0.1 ml) of Aspergillus fumigatus into the middle ear cavity. At 72 h after the inoculation, amphotericin B 1 mg/kg per day (n = 6), itraconazole 10 mg/kg per day (n = 6), voriconazole 10 mg/kg per day (n = 6) and caspofungin 5 mg/kg per day (n = 6) were injected to each treatment group. No antifungal drug was administered to the control group (n = 6). Clinical and histopathological examination scores and microbiological analysis of middle ear mucosa were compared.There was statistically significant difference in the clinical scores, histopathological scores, and mean CFU/g between the treatment and control groups (P < 0.05). There was no statistically significant difference among the treatment groups in the clinical and histopathological scores, whereas there was statistically significant difference in the mean CFU/g (P < 0.05). The mean CFU/g of amphotericin B and caspofungin groups were similar and both were lower than the itraconazole and voriconazole groups. Also, the mean CFU/g of voriconazole group was lower than the itraconazole group (P < 0.05). Caspofungin and voriconazole were demonstrated at least as effective as amphotericin B and itraconazole. We suggest that caspofungin and voriconazole may be considered for the treatment of fungal infection of the ear.     

Postoperative Necrotizing Enterocolitis Following Incarcerated Inguinal Hernia Repair: Report of a Case

The postoperative development of necrotizing enterocolitis (NEC) following major surgery in neonates has often been described. We report herein the case of an older infant in whom postoperative NEC developed following emergency repair of an incarcerated inguinal hernia. Received: March 8, 2000 / Accepted: November 20, 2000     

Synthesis and antifungal activities of some aryl(benzofuran-2-yl)ketoximes

In this study, some aryl(benzofuran-2-yl)ketoximes and their ethers and esters were synthesised. The structure elucidation of the compounds was performed by IR, 1H NMR and mass spectroscopic data and elemental analyses results. Antifungal activities of the compounds were examined and notable activity was obtained.     

The effect of adrenalectomy on leptin levels and some metabolic parameters in rats with diet-induced obesity

Recently, there has been many investigations on the relationship between leptin and obesity, which is the main health problem in developed countries. In some reports, it has been claimed that the adrenalectomy has lead to weight loss and thus prevented obesity induced in rodents in various ways. It has also been accepted that diet-induced obesity in animals is very similar to obesity in humans beings. In this study, obesity has been developed with high-calorie diet given for 8 weeks in Sprague-Dawley rats. Then, it has been investigated how leptin and some metabolic parameters change in blood samples obtained from rats 15 d after adrenalectomy. Leptin levels was determined with Radio Immun Assay (RIA, Linco Research Co) method. Our study showed that, there were statistically significant increases in leptin (p<0.001), glucose (p<0.05), triglyceride (p<0.01) levels in diet-induced obese rats (n=19) when compared with the findings of control rats, lean ones (n=16), (Tables 3, 4). Adrenalectomy led to decreased serum leptin (p<0.001) and triglyceride (p<0.01) levels both in the obese and lean rats (Table 5). As a conclusion, it could be claimed that the decrease in leptin levels may be attributed to reduced adipose tissue due to adrenalectomy. On the other hand, the decreases in glucose and triglyceride levels might be the consequence of reduced lipogenesis and impaired gluconeogenesis with the effect of adrenalectomy. It was concluded that adrenalectomy might prevent obesity by affecting leptin and intermediate metabolism.     

Effect of topically applied charged particles on healing of colonic anastomoses

HYPOTHESIS: Various forms of electrical stimulation can improve wound healing in different tissues, but their application to gastrointestinal tract healing has not been investigated. We assumed that positively charged diethylaminoethyl cross-linked dextran bead (diethylaminoethyl Sephadex [DEAE-S]) particles would have a beneficial effect on the healing of colonic anastomoses. DESIGN: Experimental animal study. SETTING: Animal research laboratory of a university hospital. ANIMALS: Forty female Wistar albino rats. INTERVENTIONS: Right colonic transection and anastomosis was performed in 5 animal groups. The control group received no treatment; the placebo group, methylcellulose gel; and the DEAE-S group, DEAE-S in methyl cellulose gel applied topically around the anastomoses. The fecal peritonitis (FP) group underwent cecal ligation and perforation simultaneously with the anastomosis to cause FP; the FP + DEAE-S group also received DEAE-S applied around the anastomoses. MAIN OUTCOME MEASURES: After the completion of postoperative day 4, all rats were killed. Anastomotic bursting pressures and hydroxyproline concentrations in perianastomotic tissue were measured and compared. RESULTS: Mean bursting pressures were 115.1 mm Hg in the control group, 113.6 mm Hg in the placebo group, 159.4 mm Hg in the DEAE-S group, 62.8 mm Hg in the FP group, and 121.1 mm Hg in the FP + DEAE-S group (P =.001, 1-way analysis of variance [ANOVA]). The differences between the control vs DEAE-S groups, placebo vs DEAE-S groups, and FP vs FP + DEAE-S groups were significant (P<.05, t test). Mean hydroxyproline concentrations were 5.2 microg/mg in the control group, 4.9 microg/mg in the placebo group, 5.6 microg/mg in the DEAE-S group, 4.5 microg/mg in the FP group, and 5.4 microg/mg in the FP + DEAE-S group (P =.09, 1-way ANOVA). The difference between the FP and FP + DEAE-S groups was significant (P =.04, t test). CONCLUSIONS: A positively charged particle, DEAE-S, improves healing of colonic anastomoses in healthy rats and in rats with FP. This inexpensive, nontoxic material is easily applied and deserves further evaluation in gastrointestinal tract healing.