European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorectal malformations.

The ARM-Net (anorectal malformation network) consortium held a consensus meeting in which the classification of ARM and preoperative workup were evaluated with the aim of improving monitoring of treatment and outcome. The Krickenbeck classification of ARM and preoperative workup suggested by Levitt and Peña, used as a template, were discussed, and a collaborative consensus was achieved. The Krickenbeck classification is appropriate in describing ARM for clinical use. The preoperative workup was slightly modified. In males with a visible fistula, no cross-table lateral X-ray is needed and an anoplasty or (mini-) posterior sagittal anorectoplasty can directly be performed. In females with a small vestibular fistula (Hegar size 5 mm, and in the meantime, gentle painless dilatations can be performed. In both male and female perineal fistula and either a low birth weight (<2,000 g) or severe associated congenital anomalies, prolonged preoperative painless dilatations might be indicated to decrease perioperative morbidity caused by general anesthesia. The Krickenbeck classification is appropriate in describing ARM for clinical use. Some minor modifications to the preoperative workup by Levitt and Peña have been introduced in order to refine terminology and establish a comprehensive preoperative workup

Diagnostic value of plain abdominal radiographs in acute appendicitis in children

Objective: The plain film of the abdomen (PAX) is still utilised in the diagnosis of acute appendicitis (Aap). Aim of this study was to evaluate the value of PAX in the diagnosis of Aap in children, since it continues to be a controversial subject. Design: A retrospective study. Setting: Department of Paediatric Surgery, Gazi University Medical School. Patients The histopathological diagnoses and PAX of 213 children (mean age 9-6 years) operated for acute right-lower quadrant pain were evaluated retrospectively. There were 181 patients with Aap and 32 with normal appendix. Methods: The rate of detection of overall thirteen roentgenographic criteria defined in various reports in medical literature as indicating appendicitis were noted and compared with histopathological diagnoses. The PAX which revealed one or more of these signs in combination was considered to be positive for Aap. Data was analysed statistically and sensitivity, specificity and positive and negative predictive values of PAX in the diagnosis of Aap were determined. Results: Roentgenographic sign(s) were detected in 170 (79%) cases, 18 without Aap. The most frequent were lumbar scoliosis with left-sided convexity (50%) and small intestinal air-fluid levels (32%). In 39 cases, 25 with Aap, no sign(s) was detected. In all of the perforated cases, at least one of the determined criteria was seen. The percentage of roentgenographic signs found in cases with and without appendicitis was different significantly (

Diagnostic value of plain abdominal radiographs in acute appendicitis in children

Objective: The plain film of the abdomen (PAX) is still utilised in the diagnosis of acute appendicitis (Aap). Aim of this study was to evaluate the value of PAX in the diagnosis of Aap in children, since it continues to be a controversial subject. Design: A retrospective study. Setting: Department of Paediatric Surgery, Gazi University Medical School. Patients The histopathological diagnoses and PAX of 213 children (mean age 9-6 years) operated for acute right-lower quadrant pain were evaluated retrospectively. There were 181 patients with Aap and 32 with normal appendix. Methods: The rate of detection of overall thirteen roentgenographic criteria defined in various reports in medical literature as indicating appendicitis were noted and compared with histopathological diagnoses. The PAX which revealed one or more of these signs in combination was considered to be positive for Aap. Data was analysed statistically and sensitivity, specificity and positive and negative predictive values of PAX in the diagnosis of Aap were determined. Results: Roentgenographic sign(s) were detected in 170 (79%) cases, 18 without Aap. The most frequent were lumbar scoliosis with left-sided convexity (50%) and small intestinal air-fluid levels (32%). In 39 cases, 25 with Aap, no sign(s) was detected. In all of the perforated cases, at least one of the determined criteria was seen. The percentage of roentgenographic signs found in cases with and without appendicitis was different significantly (

Second branchial anomalies in children

Aim: The aim of this study was to evaluate the data of our patients who had been treated for second branchial anomalies in the last 10 years. Here we report our clinical experience in second branchial anomalies with a review of the literature. Patients and Methods: We evaluated retrospectively the data of 14 patients, who had been operated on between 1994 and 2004 for second branchial anomalies, in relation to age, sex, complaint at application, diagnostic test, surgical procedures and histopathologic findings. Results: The mean age of the patients ( 8 female, 6 male) was 5.3 years ( range = 1.5 - 16). The anomalies were usually located on the left side of the neck (n = 6). There were only 3 cases with bilateral anomalies. The majority of the lesions were sinuses (93%). The most frequent clinical feature was the presence of persistent discharge from an external ( cutaneous) orifice. All lesions were excised by performing a second step ladder incision. Eight of the lesions were removed under the guidance of 3/0 polypropylene suture. No postoperative complication or recurrence was observed during the follow-up period. Conclusions: Second branchial arches anomalies are the most common branchial anomalies. Sinuses are more frequently encountered in children. Definitive treatment for these lesions is surgical excision. A polypropylene suture can be inserted into the tract as a guide to prevent incomplete excision. Copyright (C) 2005 S. Karger AG, Basel

Effects of amrinone on bilateral renal ischemia/reperfusion injury

Renal ischemia/reperfusion injury could arise as a consequence of clinical conditions such as renal transplantation. shock, cardiac arrest. hemorrhage and renal artery surgery. In this experimental study. we aimed to determine he preventive effects of amrinone on bilateral renal ischemia/reperfusion injury in rats. A total of 60 Wistar-albino rats were divided into six groups (n = 10). Midline laparotomies were made under ketamine anesthesia. In the sham. amrinonel and amrinone2 without ischemia (AWI1 and AW12) groups saline, 5 and 10 mg/kg of amrinone was infused, respectively. In the ischemia, ischemia plus amrinonel (IPA1) and ischemia plus amrinone2 (IPA2) groups, saline and 5 and 10 mg/kg of amrinone was infused. respectively. at the beginning of reperfusion. subsequent to 45 min of bilateral renal artery occlusion. Following 6 h of reperfusion. blood was drawn to study serum BUN and creatinine and a bilateral nephrectomy was done to determine tissue malonyldialdehyde (MDA) and myeloperoxidase (MPO) levels. The results were analyzed by Mann-Whitney U-test. The parameters Studied were statistically higher in the ischemia group compared with the other groups (P 0.05, for each comparison). The treatment groups IPA1 and IPA2 had statistically similar results compared with the sham group. showing the preventive effect of amrinone on renal I/R injury at the given doses. We conclude that amrinone prevented experimental renal ischemia/reperfusion injury in rats. independently of the administered doses. This preventive effect of the agent could depend on its effect of regulating the microcirculation. in decreasing intracellular calcium and in preventing neutrophil activation. We propose that this preventive effect of amrinone - which has gained clinical application especially in cases of cardiac insufficiency - could also be exploited in clinical conditions related with renal ischemia, reperfusion

Effect of bilirubin in ischemia/reperfusion injury on rat small intestine

Purpose: The aim of this study was to determine the effects of bilirubin in experimental small intestinal ischemia/reperfusion (I/R) injury in rats. Methods, Thirty rats were divided into 5 groups (n = 6). In group S, saline and in group B, bilirubin, 20 mg/kg were infused via the jugular vein without an additional procedure. In groups S-IR, saline, B-1-IR and B-2-IR, 10 and 20 mg/kg/h of bilirubin were infused for 2 hours, respectively. In these groups, an I/R procedure was done after infusions by occluding the superior mesenteric artery for 45 minutes followed by 1 hour of reperfusion. After reperfusion, the small intestines were resected for histopathologic and malondialdehyde (MDA) assessments. Mucosal lesions were scored between 0 and 5. Malondialdehyde levels and histopathologic grades were analyzed statistically. Results: Mucosal injury was severe in S-IR (grade 4 to 5), mild in B-1-IR (grade 0 to 3) and none in B-2-IR group (grade 0). Grades of group S-IR were higher than those of B-1-IR and B-2-IR statistically (P < .05). Tissue MDA levels of the S-IR group were significantly higher than those of B-1-IR and B-2-IR groups (U = 36, P < .05). Bilirubin levels correlated inversely with MDA levels (r = -0.94). Conclusions: Bilirubin effectively prevents intestinal I/R injury in rat. This observation is consistent with the hypotheses regarding bilirubin as an antioxidant, having a role in the body defense. Copyright (C) 2001 by WB. Saunders Company

Comparison of consequent small bowel anastomoses after transient ischemia: An experimental study in rats

Background/Purpose: The role of ischemia/reperfusion (I/R) damage on intestinal anastomotic healing remains to be precisely determined. The objective of this study was to investigate healing of small bowel anastomoses performed at different times after transient ischemia

Neovascularization of the testicle through spermatic vessels by omental pedicle flap: A new experimental model

The aim of this experimental study in rats was to consider the supplementary role of an omental pedicle flap on the neovascularization of the testicles through the spermatic vessels, for which a Fowler-Stephens procedure had been planned, To compare results, 12 animals had only the spermatic vessels ligated, without an additional procedure (Fowler-Stephens procedure [FS group]), and 12 others had omentopexy of the spermatic vessels of the left testes, with ligation of the vessels 4 weeks later (Fowler-Stephens procedure plus omentopexy [FSO group]). In the sham group (n = 8), only omentopexy of the left spermatic vessels was performed. Six rats served as controls. In each rat, both testes were evaluated by color Doppler ultrasonography to assess capsular and intratesticular blood flow, followed by orchiectomy to determine testicular weights, testicular biopsy scores, and mean seminiferous tubule diameters. Data were analyzed statistically. According to the color Doppler ultrasonography, the testicular blood flow in the FSO group was better than that of the FS group, but was less sufficient than that of the sham and control groups. The testicular weights and biopsy scores for the FSO group were statistically greater than those of the FS group, and less than those of the sham and control groups. There was no significant difference in the mean seminiferous tubule diameters of the FSO and FS groups. The contralateral testes of the four groups did not differ significantly for any parameter. In light of the data available, it is suggested that the omental pedicle flap neovascularizes the testicle through spermatic vessels. Given the high incidence of testicular atrophy associated with Fowler-Stephens orchiopexies, it might be beneficial to perform laparoscopic orchiopexy of testicles neovascularized with omental pedicle flaps as the first-stage procedure. (C) 1995 by W.B. Saunders Compan

The effect of taurine on renal ischemia/reperfusion injury

Ischemia-reperfusion (I/R) injury is one of the most common causes of renal dysfunction. Taurine is an endogenous antioxidant and a membrane-stabilizing, intracellular, free beta-amino acid. It has been demonstrated to have protective effects against I/R injuries to tissues other than kidney. The aim of this study was to determine whether taurine has a beneficial role in renal I/R injury. Forty Wistar-Albino rats were allocated into four groups as follows: sham, taurine, I/R, and I/R + taurine. Taurine 7.5 mg/kg was given intra-peritoneally to rats in the groups taurine and I/R + taurine. Renal I/R was achieved by occluding the renal arteries bilaterally for 40 min, followed by 6 h of reperfusion. Immediately thereafter, blood was drawn and tissue samples were harvested to measure 1) serum levels of BUN and creatinine; 2) serum and/or tissue levels of malondialdehyde (MDA), glutathione (GSH), glucose 6-phosphate dehydrogenase (G-6PD), 6-phosphogluconate dehydrogenase (6-PGD) and glutathione reductase (GSH-red); 3) renal morphology; and 4) immunohistochemical staining for P-selectin. Taurine administration reduced I/R-induced increases in serum BUN and creatinine, and serum and tissue MDA levels (p < 0.05). Additionally, taurine lessened the reductions in serum and tissue glutathione levels secondary to I/R (p < 0.05). Taurine also attenuated histopathologic evidence of renal injury, and reduced I/R-induced P-selectin immunoreactivity (p < 0.05). Overall, then, taurine administration appears to reduce the injurious effects of I/R on kidney