Spontaneous intestinal perforation after oral ibuprofen treatment of patent ductus arteriosus in two very-low-birthweight infants

AIM: To discuss intestinal side effects of ibuprofen in the treatment of patent ductus arteriosus, after having observed two cases of spontaneous intestinal perforation following ibuprofen treatment. METHODS: Clinical and laboratory records of two preterm infants, who developed intestinal perforation after ibuprofen administration, were evaluated. RESULTS: Gestational ages of infants were 29 wk (male) and 30 wk (female). Both infants developed intestinal perforations without signs of necrotizing enterocolitis. The perforations cured with Penrose drainage alone. CONCLUSION: Although ibuprofen is a reasonable treatment alternative to indomethacin, randomized controlled trials, which address potential adverse effects including spontaneous intestinal perforation, are needed.     

Bilirubin is cytotoxic to rat oligodendrocytes in vitro

High levels of unconjugated bilirubin can be neurotoxic and gliotoxic. However, the effect of bilirubin on oligodendrocyte viability has never been investigated. In the present study, we searched the possible toxic effect of bilirubin on differentiated rat oligodendrocytes. Bilirubin was added to oligodendrocyte cultures at different concentrations varied between 10 and 100 microM, and cultures were incubated for different times (24, 48 and 72 h). Cell viability was evaluated by trypan blue exclusion. The results showed that bilirubin decreased oligodendroglial cell viability in a concentration and time-dependent manner. Bilirubin induced apoptotic cell death as revealed by TUNEL staining and poly(ADP-ribose) polymerase cleavage. We found that bilirubin induced inducible nitric oxide synthase (NOS) mRNA expression in rat oligodendrocytes. Bilirubin also increased oligodendroglial nitrite production in a concentration-dependent manner and NOS inhibitor partly blocked bilirubin-induced cytotoxicity. These results suggest that bilirubin induces cytotoxicity, at least partly, via the induction of nitric oxide production in oligodendrocytes.     

Erythropoietin protects against necrotizing enterocolitis of newborn rats by the inhibiting nitric oxide formation

BACKGROUND: Necrotizing enterocolitis (NEC) is an important neonatal disease with a high mortality rate; erythropoietin (Epo) is a hematopoietic growth factor. Functional Epo receptors are in the fetal and postnatal small bowel and their ligands are available for binding. Excessive nitric oxide (NO) production by an isoform of NO synthase inducible by inflammatory stimuli leads to changes in vascular permeability and tissue injury. The aim of this study was to investigate NO formation in an experimental model of NEC and the possible role of NO in the protection Epo provides against NEC. METHODS: Twenty-four Wistar albino rat pups were divided into three groups: group 1 = control; group 2 = hypoxia-reoxygenation and saline; group 3 = hypoxia-reoxygenation and recombinant human EPO (rhEpo) pretreatment. rhEpo was given 750 U/kg/week by intraperitoneal injection 3 times a week for 2 weeks. On the 15th day, hypoxia was induced by placing the pups in a 100% CO(2) chamber for 5 min. After the hypoxia period the pups were reoxygenated for 10 min with 100% O(2) and returned to their mothers. All pups were killed 4 h after the hypoxia-reoxygenation period was over. The abdomen was opened and representative samples of injured areas were taken for histopathologic examination. Then nitrite levels were determined in the intestine by Griess Reagent. RESULTS: On histopathological examination, injury scores in group-2 animals were found to be significantly higher than in group-3 animals (p = 0.001). Significantly increased intestinal nitrite levels were found in group-2 rats compared to the rats of groups 1 and 3 (p = 0.001 and p = 0.001, respectively). There was a positive correlation between the histological findings and the intestinal nitrite levels in group-2 and -3 animals (r = 0.94, p = 0.001; r = 0.99, p = 0.001, respectively). CONCLUSION: The present study demonstrates that the Epo-pretreated group had decreased levels of NO and limited mucosal necrosis in intestinal tissue samples. We believe that these results deserve further experimental studies in order to elucidate the possible effector mechanisms involved in the inhibitory relationship between Epo, NO and NEC.     

The effects of melatonin on the antioxidant systems in experimental spinal injury

Melatonin has been recently shown by various in-vivo and in-vitro studies to exert potent neutralising effects on hydroxyl radicals, stimulate glutathione peroxidase (GSH-Px) activity, and protect catalase (CAT) from the destructive activity of hydroxyl radicals in neural tissue. We aimed to investigate the possible effects of pharmacological dose of melatonin on some of the antioxidant defence systems in an in-vivo study of experimental spinal injury. Seven groups of adult male Sprague Dawley rats were used in the following scheme: Group I: Naive (n = 6), Group II: Lesion (n = 8), Group III: Melatonin (n = 5), Group IV: Melatonin + Lesion (n = 8), Group V: Placebo + Lesion (n = 5), Group VI: Sham operation (n = 5), and Group VII: Placebo (n = 5). Experimental spinal injury was induced at level T7-T8 by 5 sec compression of the total cord with an aneurysm clip on anaesthetised and laminectomized animals. The total 10 mg/kg dose of melatonin (Sigma) dissolved in alcohol-water was administered i.p. four times in 2.5 mg/kg doses, at 20 min pre-, at the time of and at 1 h and 2h post-compression. At 24 +/- 2h post-injury, the rats were euthanized and the lesioned segments of cord were dissected and homogenised with special care taken to distribute equal amount of injured tissue in each sample for analysis of reduced glutathione (GSH), oxidised glutathione (GSSG), superoxide dismutase (SOD), and CAT activity. Compression injury decreased GSH/GSSG ratio significantly (p < .0001). Melatonin, by itself, significantly decreased GSSG content (p < .05) and increased CAT activity (p < .05) in the na?ve rats. Melatonin treatment decreased GSSG activity, thus elevating GSH/GSSG ratio, and also increased SOD and CAT activity without reaching statistical significance in the lesioned animals. In conclusion, pharmacological dose of systemically applied melatonin seemed to support some features of the antioxidant defence systems in our hands.     

Microembolic signals in patients undergoing coronary artery bypass grafting. Effect of aortic atherosclerosis

The aim of this prospective study was to determine whether aortic atherosclerotic plaques are associated with increased frequency of microembolic signals and stroke in patients who undergo coronary artery bypass grafting. A total of 69 such patients were monitored by transcranial Doppler ultrasonography for 30 minutes before and after surgery. To our knowledge, this study is the 1st in which in vivo pathologic analysis of aortic plaques was systematically performed-and microembolic signals monitored-before and after open-heart surgery. Plaques were assessed by transesophageal echocardiography and by biopsy of materials taken during surgery. The frequency of microembolic signals was evaluated with regard to the occurrence of postoperative stroke. In the preoperative phase, only 10 of 48 patients with aortic plaques had microembolic signals, and the mean count of microembolic signals was 3.2 +/- 1.2 per hour. At the conclusion of 24 postoperative hours, 29 patients (42%) displayed such signals (mean count, 9.8 +/- 3.1/h). Seven of the 48 patients (15%) with aortic atherosclerosis had cerebral ischemic events, but none of those with normal aorta (21 patients) experienced stroke during the postoperative phase. During postoperative monitoring, patients with stroke had higher microembolic-signal counts than did those with normal aorta (174 +/- 3.3/h vs 5.9 +/- 3.1/h; P <0.05). Our findings suggest that microembolic signals can be a marker of severe aortic atherosclerosis and that monitoring these signals should enable the application of appropriate surgical methods to coronary artery bypass patients who are at higher risk of stroke.     

Is gastric aspiration needed for newborn management in delivery room?

Aim

Gastric aspiration is still applied in many centres during delivery room management of the newborn without any supporting evidence. We aimed to determine whether gastric aspiration affects vital signs, oxygenation, nutrition and short-term prognosis of the newborn.

Method

A total of 310 eligible healthy term newborns, identified from a total of 1300 live births, were randomly allocated to receive either gastric aspiration or standard care. During the first 20 min, SpO₂, heart rate, cyanosis and retraction scores were recorded once in a min; and blood pressure, respiration rate and neuroadaptive capacity were recorded once in every 5 min. Information about nutrition and vomiting behaviours of the babies were taken from the mothers of the neonates on the postnatal 1st day at bedside and by a telephone call on the 7th day.

Results

No difference was determined between the groups in terms of 1st to 5th min Apgar scores, attainment duration of SpO₂ to 85%, 92% and 95%, mean heart rate and respiration rate. Retraction frequency and mean systolic blood pressure of the 5th-min values were found to be significantly higher in the gastric aspiration group. There was no difference between the groups regarding breastfeeding starting time and vomiting frequency.

Conclusion

No positive effect of gastric aspiration in delivery room management of the newborn was observed. Conversely, the negative effects of gastric aspiration in neonates were observed with respect to physiological parameters. Our data suggest that gastric aspiration is not useful and may even be harmful in delivery room management of the healthy term newborns.     

Therapeutic plasma exchange in non-hematooncological disorders in pediatrics: A single center experience

The use of therapeutic plasma exchange in the pediatric age group is mostly based on retrospective, single-center experiences. The decision to implement apheresis in pediatric patients is usually adopted from the results of studies on adult patients. In order to expand the limited data on pediatric TPE in general and non-hematooncological disorders in particular, we retrospectively evaluated TPE experience in pediatric patients who underwent the procedure for reasons other than hematooncological disorders. A total of 160 sessions in 34 patients (21 females and 13 males) with a median age of 7 (1–17) were analyzed. Most of the patients had sepsis and organ failure (12 patients, 35 procedures). In only one patient (2.9%) with methyl malonic aciduria (MMA) and sepsis, the procedure was terminated due to a grade 3 allergic reaction. Among the study cohort, 4 patients passed away. No patient died due to complications of TPE. The relatively low discontinuation rate and the lack of procedure-related mortality indicate that TPE is generally well tolerated in the pediatric age group similar to the adult population. However, since there are very limited evidence-based data on TPE use, especially in the pediatric age group, retrospective case series may also be helpful for clinicians in the decision-making process.     

Evaluation of flow characteristics of the left internal thoracic artery graft: perioperative color Doppler ultrasonography versus intraoperative free-bleeding technique

From October 2000 through April 2001, we prospectively evaluated the flow characteristics of the left internal thoracic artery (LITA) graft in a homogenous group of 44 men with isolated severe proximal left anterior descending coronary artery stenosis who underwent elective coronary artery bypass grafting with cardiopulmonary bypass. We performed transthoracic color Doppler ultrasonography preoperatively and repeated this examination in each patient between the 5th and 7th postoperative days, obtaining cross-sectional area, total flow volume, diastolic velocity, systolic velocity, mean velocity, pulsatility index, and resistance index. These results were compared with those of the intraoperative free-bleeding technique. Good-quality Doppler images of the LITA were easily obtained with a combined supraclavicular-parasternal approach. After surgery, systolic flow velocity, pulsatility index, and resistance index decreased significantly, but diastolic flow velocity and mean flow velocity increased significantly. The intraoperative flow volume obtained by the free-bleeding technique (32.42 +/- 12.33 mL/min) was significantly less than both pre- and postoperative ultrasonographic values (42.22 +/- 10.77 mL/min and 45.36 +/- 19.52 mL/min, respectively). No significant difference was found when changes in LITA values were compared between patients with (n=19) and without (n=25) normal anterior wall motion. We conclude that color Doppler ultrasonography is a reliable noninvasive technique for preoperative evaluation of the LITA as a graft and for postoperative long-term follow-up of graft function. However the intraoperative free-bleeding technique is not reliable for flow-volume measurement due to anesthesia-related hemodynamic changes and vasospasm. Color Doppler can prevent useless LITA harvesting and decrease the need for postoperative LITA angiography.