The effects of the nitric oxide donor molsidomine prevent in warm ischemia-reperfusion injury of the rat renal — A functional and histophatological study

Aim of this experimental study is to verify the protective effect of molsidomine on the renal function and structural modifications in the ischemia-reperfusion rat kidney. Sixty-eight male Sprague-Dawley rats, which were right nephrectomized and occluded left renal artery for 60 minutes were used. Group I (n = 10) Sham-Operated animals, which only underwent right nephrectomy. Group II (n = 20) Untreated ischemic rats, which underwent left renal ischemia by occlusion of the renal artery for 60 minutes before blood flow was restored. Group III (n = 18) Molsidomine treated ischemic rats, Group IV (n = 20) L-NAME (N^G-nitro-L-arginine methyl ester) treated ischemic rats. Serum creatinine and blood urea nitrogen (BUN) were measured daily and biopsies were obtained from the remaining left kidneys. At seventh day, 55% and50% of the rats remained alive at the G-II and G-IV respectively. Molsidomine treated rats (G-III) were alive and healthy at day 7. The serum creatinine and BUN levels were significantly higher in G-II and G-IV when compared with the sham-operated group (G-I). G-III rats showed a rapid return to the normal serum creatinine and BUN values on postoperative days 1, 2, 3 and 4. The obtained values in G-III were significantly lower in comparison to the values of G-II and G-IV. The most severe damage (grade3 to 4) was determined in the kidneys of rats from GII or GIV. The degree of renal tubular damage in GIII was evaluated as grade 1 or 2 tubular damage according to Jablonkski's scale. Our findings suggested that the administration of molsidomine may vanquish the pernicious effects of warm ischemia on kidney structure and function. This revised version was published online in June 2006 with corrections to the Cover Date.     

Quantitative evaluation of interstitial fibrosis with Sirius Red in IgA nephritis

Objective: Tubulointerstitial fibrosis is one of the strongest independent predictive factors in determining the prognosis in IgA nephritis. Recently, software-based quantitative measurement of interstitial fibrosis with Sirius Red staining has entered the practice. The objective of this study was to investigate the prognostic value of measurement of interstitial nephritis with this method in IgA nephritis. Method: Forty-three patients diagnosed with IgA nephritis with renal biopsy between the years 2005 and 2009 were included in this retrospective observational study. The diagnostic biopsies of 37 patients were examined. Basal data included age, gender, creatinine level, glomerular filtration rate (GFR), presence of proteinuria, hypertension, glomerulosclerosis, mesangial proliferation, and interstitial fibrosis and fibrosis index calculated by the measurement of computed images of Sirius Red positive areas. Final visit included evaluation of development of end-stage renal disease (ESRD), and GFR (whether?=?60?mL/min or <60?mL/min). Results: Numbers of patients with hypertension (75% vs. 34.5%; p?=?0.050), ESRD development (62.5% vs. 20.7%, p?=?0.035), GFR?<60?mL/min (87.5% vs. 31%; p?=?0.007) were greater; and basal GFR (34.25?±?25.29 vs. 64.14?±?35.34; p?=?0.048) was lower in high-intensity interstitial fibrosis group (>1000?μm2) compared to low-intensity interstitial fibrosis group (≤1000?μm²). Conclusion: Quantitative analysis of computed imaging of areas of Sirius Red positive tubulointerstitial fibrosis might serve as an effective novel method to determine the prognosis in IgA nephritis.     

The impact of pretreatment with bolus dose of enteral glutamine on acute lung injury induced by oleic acid in rats

Purpose

Both parenteral and enteral glutamine have shown beneficial effects in sepsis and ischemia/reperfusion-induced acute lung injury (ALI). Oleic acid (OA) has been used to induce ALI in experimental studies. In this study, we investigated the effects of pretreatment of a bolus dose of enteral glutamine on ALI induced by OA in rats.

Methods

Twenty-eight adult female Sprague–Dawley rats weighing 240–300 g were divided into four groups, 7 in each. Group I and group II received normal saline for 30 days, group III and group IV received glutamine at a dose of 1 g/kg for 10 days by gavage, and in group II and group IV 100 mg/kg OA was administered i.v. Histopathological examination of the lung was performed with light and electron microscopy. Levels of protein carbonyl, malondialdehyde, superoxide dismutase, catalase, and glutathione peroxidase levels were measured in tissue samples. Levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and total tissue oxidant status and total tissue antioxidant status were measured in serum samples.

Results

Light microscopy showed that the total lung injury score of group IV was significantly lower than group II. Change in thickness of the fused basal lamina was not significantly different in groups II and IV under electron microscopy. TNF-α, IL-6, and IL-10 serum levels were higher in group II when compared to group I and significantly attenuated in group IV.

Conclusion

Pretreatment with a bolus dose of enteral glutamine minimized the extent of ALI induced by OA in rats.     

Suture anchor tenodesis in repair of distal Achilles tendon injuries

Background

Distal Achilles tendon avulsions are in the form of either bony and nonbony avulsion of Achilles tendon from its calcaneal insertion.

Methods

Four patients with distal Achilles tendon avulsions or ruptures which were treated with tendon to bone repair using suture anchors are presented here. Operated leg was immobilized in above-knee cast for 4 weeks while the patient walked non-weight-bearing. Then, cast was changed to below knee, and full weight-bearing was allowed. Patients underwent gait analysis minimum at first postoperative year.

Results

Mean American Orthopedics Foot Ankle Society ankle/hindfoot score of patients at last visit was 88.75 (range 85–100), and Achilles tendon total rupture score was 77.75 (range 58–87). Mean passive dorsiflexion of injured ankles (14° ± 5°) was lower than uninjured ankles (23° ± 9°). All the kinematic parameters of gait analysis were comparable to the uninjured side. Maximum plantar flexion power of injured ankle was 1.40 W/kg, and this was significantly lower than the contralateral side value 2.38 W/kg; (P = 0.0143).

Conclusions

There were no visually altered gait or problems in daily life. Suture anchor tenodesis technique of distal Achilles tendon avulsions was successful in achieving durable osteotendinous repairs.     

Lower eyelid reconstruction in a paediatric face: a one-stage aesthetic approach using the versatile temporoparietal fascia flap

There are many different lower eyelid reconstruction techniques defined in the literature. Almost all of the published techniques have been described on elderly patients and use upper eyelid, periorbital or facial tissues as donor sites. However, in case of a paediatric patient or a young adult who has a crease-free and scarless face, camouflage of the facial donor-site scar is usually impossible. In order to avoid possible facial donor-site scars and upper eyelid deformities, a technique which uses the temporoparietal fascia (TPF) flap as the framework of a new eyelid was used for the reconstruction of an adolescent patient's postoncologic defect. The inner side of the flap was covered with nasal septal chondromucosal graft and the external side was covered with a retroauricular full-thickness skin graft. Eighteen months of unproblematic follow-up of this overlooked usage of the versatile TPF flap indicates that our technique has proved successful in terms of good functional and cosmetic outcome that is obtained at one stage.     

Effects of desflurane and isoflurane on hepatic and renal functions and coagulation profile during donor hepatectomy

We compared the effect of two inhalation anesthetics desflurane and isoflurane on postoperative hepatic and renal functions as well as coagulation profiles in living donors undergoing right hepatectomy. This study was performed on 80 patients who were randomly allocated to group D (desflurane, n = 40) or group I (isoflurane, n = 40) after Faculty Ethics Committee approval. After induction, isoflurane or desflurane was used with air/oxygen for anesthetic maintenance. The isoflurane or desflurane concentration was set at one minimum alveolar concentration (MAC). Remifentanil was infused for analgesia as well as cisatracurium. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalized ratio (INR), albumin, total bilirubin, blood urea nitrogen, creatinine, platelet count, and hemoglobin levels were analyzed preoperatively at end of the operation, and on postoperative days (PODs) 1, 2, 3, 5, 7, and 30. Both AST and ALT differed significantly and continually except on POD 30. AST showed significant elevations from the end of the operation to POD 2 and ALT, from the end of the operation to POD 5 in group I compared with group D. INR was significantly higher from the end of the operation to POD 3 in group I and to POD 2 in group D. At the end of the operation as well as on POD 1 and POD 2, INR was significantly increased in group I compared with group D. Albumin level was significantly lower at the end of the operation in both groups, but it was not different. No patient developed hepatic or renal failure. Our study showed better postoperative hepatic tests and INR using desflurane than isoflurane at equivalent doses of 1 MAC in living donors undergoing right hepatectomy.     

High ligation to treat pain in varicocele

Purpose: There are limited data about the effectiveness of surgery in patients withpainful varicocele. We report a retrospectivestudy done for the follow up on all varicocelehigh ligations performed for pain to evaluatethe effectiveness of the operations.Materials and methods: The patients who were all physically active workers and who underwent high inguinal ligation of varicocelefor pain from January 1995 to January 2000,were invited for interviews. Their charts werereviewed to document patient age, grade andlocation of varicocele, duration and quality ofpain, response to conservative treatment. Allpatients who could be contacted were interviewed for resolution of pain and complications, their physical examinations were made.Results: 87 of 140 (62.1%) patients wereavailable for the follow up. Median patient agewas 26 (15 to 34) years old. The varicocele wason the left side in 82 patients and bilateralin 5. The pain was dull in 42, throbbing in 25,sharp in 6 and as a pulling sensation in 14.The longest conservative therapy given in theliterature failed in all patients. Varicocelegrades were as follows: Grade I in 17, Grade IIin 34 and Grade III in 36 patients. Highinguinal ligation was used in all patients. 72(82.8%) patients reported complete resolution, 8 (9.2%) patients reported partial response, 7(8%) patients had persistant pain.Conclusions: High inguinal ligation iseffective in the treatment of painfulvaricocele in highly selected patients.Prospective randomized studies are neededcomparing surgical and conservativetreatments.     

Preoperative Nutritional Risk Assessment in Predicting Postoperative Outcome in Patients Undergoing Major Surgery

Introduction Although a variety of nutritional indices have been found to be valuable in predicting patient outcome when used alone, there is no consensus on the best method for assessing the nutritional status of hospitalized patients. Therefore, the aim of this study was to assess the nutritional status of a cohort of patients who underwent major elective surgery using the Nutritional Risk Index (NRI), Maastricht Index (MI), Subjective Global Assessment (SGA), and Mini Nutritional Assessment (MNA) to determine the best possible nutrition screening system in surgical practice. Methods The study population consisted of 460 patients who underwent major elective surgery between December 1999 and March 2002. Each patient had a complete set of the three nutritional assessment techniques (NRI, MI, SGA); in addition, the MNA was performed in patients older than 59 years of age. One of the coauthors who was unaware of the nutritional assessments assessed the patients for postoperative morbidity and mortality. Complications were classified as major or minor and as infectious or noninfectious. To assess the predictive value of the assessment techniques, likelihood ratios were calculated for the various strata of each method. The odds ratio and receiver operating characteristic (ROC) curves were also calculated to describe and compare the diagnostic value of each of the four nutrition indices. Results Twenty patients died during the study period. No complications occurred in 329 of the 460 patients; 42 patients suffered from two or more complications. The frequency of malnutrition was found to be 58.3%, 63.5%, and 67.4% as assessed by the SGA, NRI, and MI, respectively. Morbidity rates, especially severe infectious and noninfectious complications, were significantly higher in malnourished patients in all nutritional indices. The likelihood ratio was well correlated with the risk categories of every nutritional index. The area under the ROC curves revealed that each scoring system proved to be significantly powerful in predicting the morbidity (infectious and noninfectious severe morbidity) and mortality. However, no differences were detected among the nutritional indices in 460 patients. The odds ratio for morbidity between the well nourished and malnourished patients was 3.09 [95% confidence interval (CI), 1.96–4.88], 3.47 (95% CI, 2.12–5.68), 2.30 (95% CI, 1.43–3.71), and 2.81 (95% CI, 0.79–9.95) for the SGA, NRI, MI, and MNA, respectively. All indices except the MNA were significantly predictive for morbidity. The odds ratios were not statistically different among the indices. Conclusions Our findings revealed that all nutritional assessment techniques can be safely applied to the clinical setting with no significant difference in predictive value. We therefore strongly recommend the use of any of these techniques to improve the outcome of surgical care. Meanwhile, further investigations are needed, and much effort must be given to find the best method for assessing nutritional status. This work was presented at a conference of the European Society for Clinical Nutrition and Metabolism (ESPEN), August 31 to September 4, 2002, Glasgow, UK.     

The Efficacy of Tc99m Dimercaptosuccinic Acid (Tc-DMSA) Scintigraphy and Ultrasonography in Detecting Renal Scars in Children with Primary Vesicoureteral Reflux (VUR)

Introduction: Pyelonephritis-induced renal scarring in children is a major predisposing factor for proteinuria, hypertension, and ultimate renal failure. The aim of this study was to investigate and compare the efficacy of Tc99m dimercaptosuccinic acid (Tc-DMSA) renal scintigraphy and renal ultrasonography (USG) in detecting renal scars in children with primary vesicoureteral reflux (VUR). Materials and methods: Tc-DMSA scan and USG studies were done in 62 children who were admitted to our clinic between 1997 and 2003 because of documented urinary tract infection (UTI) and diagnosed with primary VUR. Renal scarring detection rates of Tc-DMSA scan and USG were compared according to reflux grades. Results: In the whole group, renal scars were detected by Tc-DMSA scan and USG in 55% and 38% of refluxing units, respectively. Detection rates of Tc-DMSA and USG according to reflux grades were as follows: 47% and 29 % in low-grade VUR (grades 1 and 2), 46 % and 25% in mid-grade VUR (grade 3), 76% and 65% in high-grade VUR (grades 4 and 5), respectively. Conclusion: USG was found to be an inappropriate study in the detection of renal parenchymal scars, irrespective of the reflux grade. In this study, Tc-DMSA scan detected scars in 35% of kidneys reported to be normal on USG.