The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature

INTRODUCTION

Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression.

PRESENTATION OF CASE

Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest.

DISCUSSION

PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery.

CONCLUSION

In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.     

Investigation of the Factors Affecting Allograft Kidney Functions: Results of 10 Years

IntroductionSignificant improvements in patient and graft survival and reductions in the frequency of acute rejection were obtained in the early period after renal transplantation, but this success was not sufficiently reflected in the long term. Allograft kidney losses in the long term remain a significant problem. In this study, we investigated the specific causes of graft losses in patients who had a good clinical course in the first year but developed graft loss in the long term.MethodsA total of 118 patients who underwent kidney transplantation in 2005 and 2006 in the Organ Transplantation Center of Ege University Medical Faculty Hospital were evaluated. The inclusion criteria were to be older than 18 years and have a serum creatinine value of <2 mg/dL at the 12th month after transplantation.ResultsSixty-one percent of the recipients were male, and the mean age at the time of transplantation was 34 ± 11 years (18 to 61). We observed 29 graft losses during the mean follow-up period of 129 ± 35 months (27 to 162). Three of the graft losses were death by functional graft. Of the 26 patients with graft loss, 16 had chronic rejection, and 8 had recurrent glomerulonephritis. The relationship between nonimmune causes and graft loss was not detected.ConclusionsIn conclusion, nonimmune factors may not be as important as we think in relatively young and healthier recipients. Chronic rejection and recurrent glomerulonephritis are the main causes of long-term graft loss of patients with good graft function at the end of the first year. Improvement of long-term survival will be possible with the prevention and effective treatment of these 2 problems.     

An adult female epispadias without exstrophy was presented with urinary incontinence: a case report

A 39-year-old woman with three children presented with primary severe urinary incontinence. Epispadias without exstrophy was determined in physical examination. The single-stage procedure including vulvoplasty and modified Young-Dees-Leadbetter bladder neck repair was performed to obtain sufficient cosmetic outcome and continence. Excellent functional and cosmetic results were obtained.     

Effect of long-term application of epinephrine on rat skin vasculature: experimental study

As a potent vasoconstrictor, epinephrine is used ubiquitously in plastic surgery. It is typically delivered subcutaneously in very low concentrations over a brief time interval. We are aware of no reports describing the long-term release of epinephrine as an independent agent to the soft tissues for the purpose of causing prolonged local vasoconstriction. This study was designed to address two goals: first, to investigate the effect of long-term local release of epinephrine from a drug delivery system on rat abdominal skin vasculature; secondly, to evaluate the pharmacological properties of this drug delivery system (DDS). Thirty male Sprague-Dawley rats, weighing 300-400 g, were included in the study. Animals were subdivided into two groups of 15 each. Group A (control group) and Group B (experimental group) were treated with saline and epinephrine-loaded microspheres (msps), respectively. The manufacturing process and formulation studies of the DDS are described. In vivo assays revealed a 7-day sustained release of epinephrine. After 7 days, neither residual nor supraphysiologic release of epinephrine was shown with high-performance liquid chromatography (HPLC). Histological studies with hematoxylin-eosin and periodic acid Schiff revealed a statistically significant increase in number of vessels as well as their diameter and wall thickness (P <0.05). Epinephrine release via this msp/DDS predictably induces local vasoconstriction over a time sequence known to be optimally associated with hypoxia and promotion of vascular augmentation. This model can be valuable in sustaining hemostasis during long-lasting (more than a few hours) surgical procedures by its long-acting vasoconstructive effect. The system's ability to intentionally cause vascular augmentation also bodes great potential in flap and graft surgery.     

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.     

Risk factors for amputation in patients with diabetic foot infection: a prospective study

There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. In this study, we aimed to evaluate the independent risk factors for osteomyelitis, amputation and major amputation in patients with DFI using standard scoring procedures. We prospectively studied 379 patients with DFI. The variables were analysed using logistic analysis. A total of 126 cases (33·2%) underwent amputation. The odds ratios in the amputation model were 3·09 for osteomyelitis (P < 0·001), 4·90 for arterial stenosis (AS) (P < 0·001), 3·67 for the history of DFI (P = 0·001), 2·47 for ulcer duration >60 days (P = 0·001), 3·10 for ulcer depth > 15 mm (P < 0·001) and 10·28 for fungal DFI (P = 0·015). In this study, the unusual result of well‐known literature was fungal DFI as an independent risk factor for amputation in patients with DFI.     

Can Human Recombinant Epidermal Growth Factor Improve Ischemia and Induce Healing of Anastomosis in an Experimental Study in a Rabbit Model?

Purpose: Anastomotic leaks following intestinal operations may cause devastating effects on patients. Ischemia may also occur at the intestinal walls in the presence of strangulations. In this study, we examined the effects of human recombinant (Hr)-epidermal growth factor (EGF) given at a single intramural dose into the intestinal walls and daily intraperitoneal cavity on ischemia and the healing process of anastomosis. Materials and Methods: Sixteen male New Zeland white rabbits were randomly divided into four groups (n = 4 in each group). In Group 1, two different segments of ileum were identified and, then, transected and the free ends were sutured each other. In the other groups, ischemia was induced by ligating the mesenteric vascular arcade. After the ischemic induction, Group 2 received intramural injections of %0.9 saline, Group 3 received intramural injections of a single dose of EGF, and Group 4 received intramural and intraperitoneal injections of EGF. Bursting pressures and tissue hydroxyproline levels were analyzed. Necrosis, fibroblastic activity, collagen deposition and neovascularization were also studied. Results: The mean levels of bursting pressures in Group 4 (148.6 ± 25.3 mmHg) were higher than Group 2 (70 ± 21.5 mmHg) (p = 0.001). The mean level of bursting pressures was not statistically significant between Group 1 (170.1 ± 35 mmHg) and Group 4 (p = 0.073). Hydroxyproline levels in Group 2 were lower than Groups 3 and 4. There was a statistically significant difference in the mucosal ischemia, mucosal healing and degree of adhesion, but not in the mural anastomotic healing among the groups. Conclusions: Intramural injection with daily intraperitoneal administration of low-dose EGF enhances the bursting pressure and collagen accumulation in ischemic anastomosis, improving many histological variables associated with ischemic intestinal anastomosis.     

Combination of fillet and triangular flaps for the web reconstruction in pollicization: a case report

Thumb hypoplasia represents a major disability requiring sophisticated reconstructive procedures. One of the basic criteria of the pollicization to construct a functional thumb is scar free web reconstruction. In this article, a technique to avoid excessive scarring in the first web space reconstruction by filleting out the hypoplasic thumb combining with a triangular flap is presented. A 5-year-old girl was presented. She had a Back-Gramcko type IV thumb hypoplasia. A triangular flap was planned on radial border of the long finger. Floating thumb was filleted out with preservation of the neurovascular bundle and transferred to the first web space while cooperating with triangular flap. Patient was followed up for 18 months. No early or late major complication was seen. Flap healed without any necrosis. The ratio of active motion in pollicized finger was measured 60% after cerebral reorientation. A satisfactory grip and pinch were seen in pollicized finger. Patient as well as her parents was satisfied with the results. Filleting out the floating thumb and combining with a triangular flap harvested by a V-Y flap design is a good option to avoid excessive scarring in reconstruction of the first web space in pollicization. It is strongly recommended that floating thumb should be preserved for future pollicization, and any attempt to amputate it in early years of life should be postponed till the time of definitive surgery.     

Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction

Purpose

This study aims to analyse the short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction surgery.

Methods

Clinical outcomes of 19 patients who had partial medial meniscectomy and anterior cruciate ligament reconstruction during the same surgery (Group 1) were compared with the outcomes of 25 patients who had also reconstruction but did not have any meniscal lesion (Group 2). Median follow-up time was 29 months (range 12–67 months) in Group 1 and 27 months (range 12–70 months) in Group 2. Feeling of apprehension in sports activities, International Knee Documentation Committee (IKDC) score, KT-2000 Arthrometer^® measurements and post-operative time to return to sports activity were the criteria for data analysis.

Results

Eight patients (42 %) in Group 1 and 5 patients (20 %) in Group 2 stated feeling of apprehension in sports activities. IKDC score improved to A in 11 patients (58 %) from Group 1, and 18 patients (72 %) from Group 2. Mean anterior translation according to KT-2000 arthrometer measurements was 5.2 ± 1.3 mm in Group 1, and 4.6 ± 1.3 mm in Group 2. Post-operative time to return to sports activity was 8.5 ± 3.0 months in Group 1, and 6.5 ± 2.2 months in Group 2.

Conclusion

Partial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. This study may be a reference for long-term clinical trials and also future investigations of new methods in the treatment of similar cases.

Level of evidence

IV.