Abdominal Stab Wounds in Children: an 18-Year Experience

Objective: Evaluation of the diagnosis, management, and the role of selective treatment in children with abdominal stab wounds. Patients and Methods: 59 children (56 male and three female) were included in the study. The patients' median age was 11.8 years (range, 5–14 years). Time between injury and admission was about 3 h. Laparotomy was performed in 44 patients (74%). Solid organ injury was detected in 32 of these patients (73%) and could not be observed in twelve (27%). 15 patients (26%) were treated conservatively, and only one (6.6%) underwent laparotomy during the follow-up. The stomach was the most frequently injured organ (ten patients), followed by the intestines (nine patients). Types of surgical treatment were as follows: primary suture in 28 patients, resection-anastomosis in three, and osteotomy in two. Results: Some prognostic factors such as presence of abdominal organ evisceration and pneumoperitoneum were not significantly correlated with intraabdominal organ injury, whereas some other risk factors such as acute abdomen on admission (p < 0.002) or abdominal clinical and hemodynamic findings (p < 0.001) showed significant correlation with intraabdominal organ injury. The relative risk (odds ratio) of developing an intraabdominal organ injury was > 2 for patients with signs of an acute abdomen on admission. Postoperative complications were observed in five patients with organ injuries. None of our patients died. Conclusions: Conservative treatment can be safely performed in most children with abdominal stab injuries. Signs of major internal hemorrhage or generalized peritonitis are an absolute indication for emergency operation for abdominal stab wounds. Peritoneal penetrations, free air on the abdominal X-ray, and omental or intestinal evisceration are poor indicators of significant organ injuries, and patients presenting these signs shold be closely followed up for developing acute abdominal symptoms. Received: November 2, 2001; revision accepted: February 15, 2002     

Diabetes education: a chance to improve well-being of Turkish people with type 2 diabetes

To examine the influence of diabetes education on well-being, 255 patients with type 2 diabetes were recruited according to whether they attended a diabetes education program (n=126) or not (n=129). In patients who had participated in the program, the mean anxiety score was significantly lower, whereas positive well-being and general well-being scores were significantly higher than for patients who had not participated. Factors related to lower well-being included: being female, taking insulin, not attending a diabetes education program and having HbA(1c) level greater than 8%. The odds of having better well-being were two-fold higher in patients participating the diabetes education program compared with those who had not. Diabetes education has a crucial role in improving the well-being of patients with type 2 diabetes. All patients with diabetes should be encouraged to attend a diabetes education program.     

Ginkgo biloba extract ameliorates ischemia reperfusion-induced renal injury in rats.

There is increasing evidence to suggest that reactive oxygen metabolites (ROMs) play a role in the pathogenesis of ischemia/reperfusion injury (I/R) in the kidney. This study was designed to determine the possible protective effect of Ginkgo biloba extract (EGb) on renal ischemia/reperfusion (I/R) injury. Wistar albino rats were unilaterally nephrectomized, and 15 days later they were subjected to 45 min of renal pedicle occlusion followed by 6 h of reperfusion. Ginkgo biloba extract (EGb) (50 mg kg(-1) day(-1)) or saline was administered twice, 15 min prior to ischemia and immediately before the reperfusion period. At the end of the treatment period, all rats were decapitated. Kidney samples were taken for histological examination or determination of the renal malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity and collagen content. Production of reactive oxidants was monitored by chemiluminescence (CL) assay. Creatinine and urea concentrations in blood were measured for the evaluation of renal function. Tumor necrosis factor-alpha (TNF-alpha) and lactate dehydrogenase (LDH) were also assayed in serum samples. Ischemia/reperfusion caused a significant decrease in GSH level, which was accompanied with significant increases in MDA level, MPO activity and collagen content of kidney tissues. Similarly, serum BUN and creatinine levels, as well as LDH and TNF-alpha, were elevated in the I/R group as compared to control group. On the other hand, EGb treatment reversed all these biochemical indices, as well as histopathological alterations, which were induced by I/R. The findings imply that ROMs play a causal role in I/R-induced renal injury and EGb exerts renoprotective effects probably by the radical scavenging and antioxidant activities.     

Scleral perforation complicating titanium mesh plaque in orbital blowout fracture

A 27-year-old man who underwent a previous reconstruction surgery for left orbital blowout fracture and recent revision surgery for left cicatricial ectropion was admitted to the ophthalmology outpatient clinic with a 20-mm irregular conjunctival and scleral incision in the left eye at the 6-o'clock position. The scleral and conjunctival incisions were repaired, and during the operation, the anterior end of the titanium mesh plate was visible at the inferior orbital rim. The plastic surgery team removed the irritating end of the plate. Obvious adherence of periocular tissues onto the titanium implant and fibrovascular ingrowth through the implant were seen during this operation. The possible mechanism for the misdirection of the anterior end of the implant might be explained by iatrogenic rotation during the revision of the cicatricial ectropion. To the best of our knowledge, this is the first reported case demonstrating scleral incision caused by an orbital titanium implant.     

Frequency of insulin-dependent diabetes mellitus in Turkish adult-onset diabetic population

The frequency of insulin-dependent diabetes mellitus in the Turkish adult-onset diabetic population has not been assessed previously. In the present study, we retrospectively evaluated the medical records of 801 Turkish patients with adult-onset (30 years) diabetes to determine the frequency of cases diagnosed as insulin-dependent diabetes. Fifty-two (6.5%) patients met our criteria of adultonset insulin-dependent diabetes mellitus. At disease onset, 20 patients presented with ketoacidosis (38.5%), while 32 patients (61.5%) were non-ketotic. In the insulin-dependent diabetic group, islet cell antibodies were positive in 10 out of 16 (62.5%) patients studied. In contrast, none of the 16 patients had positive reactions with respect to insulin autoantibodies. Twelve out of 20 patients (60%) had glucagon-stimulated C-peptide levels above 0.6 nmol/l, suggesting a sufficient insulin secretory reserve. In view of these observations, we conclude that insulin-dependent diabetes mellitus is not rare among patients with adult-onset diabetes in the Turkish population. In a majority of cases, the disease onset is non-ketotic. Beta-cell function is relatively preserved, and insulin autoantibodies do not develop at diagnosis. In contrast, islet cell antibodies are frequently present at the onset of clinical insulin-dependent diabetes, possibly indicating continuing beta-cell destruction.     

Evaluation of biochemical variables in patients with trigeminal neuralgia

The aim of this study was to evaluate the calcium, sodium, potassium, serum iron, vitamin B12, and albumin concentrations, and alkaline phosphatase (ALP) activity, in samples of serum from patients with primary trigeminal neuralgia (TN), and investigate the associations between them. Results from 73 patients who had been diagnosed with primary TN between December 2015 and 2017 were compared with those of 70 healthy subjects. Calcium (p = 0.013), iron (p = 0.004), and albumin (p = 0.001) concentrations in the primary TN group were significantly lower than those in the control group, whereas the ALP activity was significantly higher in the TN group than in the control group (p = 0.007). However, there was no significant difference in the sodium, potassium, or vitamin B12 concentrations. Biochemical variables have a role in the pathogenesis and treatment of primary TN, but there are few studies that characterise the relations between the condition and the biochemical changes. Further studies are therefore necessary to gain more information.     

Peripheral vein contrast echocardiography in atrial septal defect

This study was carried out on 233 children suspected clinically of having atrial septal defect with the aim of investigating the diagnostic capability of peripheral venous contrast echocardiography. The transfer of contrast material from the right atrium into the left atrium was evaluated as "positive contrast", while noncontrast blood, passing from the left atrium into the right atrium was termed "negative contrast". Positive contrasts were quantitated in four grades. A significant negative contrast effect was graded 3- or 4-. Three positive, 4+ and/or 3-, 4- contrast effects were considered definite evidence of an atrial septal defect. Among the cases with the above findings 92 underwent surgical closure of atrial septal defect. The procedure was successful in all patients operated; the size of the defect was large. This result demonstrates that the method applied is a safe and reliable one. However, in a group of cases without the above echocardiographic findings the presence of an atrial septal defect was detected by cardiac catheterization and angiocardiography. Therefore, we can conclude that the method applied is not a sensitive, but a specific one, for definite detection of atrial septal defect.