Comparison of Anastomosis Safety in Colonic Dissections Using Scalpel, Scissors and Cautery in Rats: Experimental Study

Objective:Postoperative anastomotic leakage is still an issue in modern surgery. Re-hospitalization due to postoperative anastomosis leakage prolongs hospital stay and re-operations increase the cost. There is still no consent on how to dissect the intestines. The objective of the present study is to analyze the safety of colonic anastomoses after dissections using scalpel, scissors and cautery in rats.Method:There were 4 groups of 32 Wistar Hannover adult rodents. Each group consisted of 8 animals: group 1: sham, group 2: scalpel, group 3: scissors, group 4: cautery. Anastomosis was done over a single layer. Bursting pressure (BP) was measured at day 7. Tissue and blood samples were taken for the evaluation of biochemical and histopathological parameters.Results:Statistically significant disparity was seen among the sham, scalpel, scissors and cautery groups regarding the mean BP average, mean hydroxyproline levels and fibrosis distributions.Conclusion:Cautery is the best choice for hemostasis; however, when considering tissue healing, scalpel and the scissors were found to be safest alternatives

Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey

Objectives: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. Methods: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). Results: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p < 0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p = 0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p = 0.008). Conclusions: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials

Influence of air pollution on hematological parameters in children

Bu çalışmaya; Bursa ilinde hava kirliliğinin en yoğun olduğu Küçükbalıklı bölgesinde bulunan 6 ay-6 yaş çocuklar ve hava kirliliğinin az yoğunlukta olduğu Çekirge bölgesinde bulunan aynı yaş grubu çocuklar alındı. Çalışmada hava kirliliğinin hematolojik parametreler üzerine olan etkisi araştırıldı. Çalışma grubunda Küçükbalıklı bölgesinde bulunan 236 çocuk vardı, kontrol grubunda ise Çekirge bölgesinde bulunan 80 çocuk vardı. Sağlık ocaklarına aynı ekip tarafından gidilerek, çocukların fizik muayeneleri yapıldı. Tüm çocuklardan tam kan sayımı, SeDE, SDBK, TS, ferritin düzeyleri çalışıldı. Periferik yayma ve retikülositleri değerlendirildi. Ailelerin sosyo-demografık özellikleri yönünden fark yoktu (p > 0.05). Çalışma grubundaki 6 ay-6 yaş çocukların hemoglobin, ferritin, serum demir düzeyleri kontrol grubuna göre anlamlı düşük bulundu (p 0.05). Sonuç olarak, hava kirliliği ile yoğun karşılaşan çocuklarda demir eksikliği anemisi yüksek oranda bulundu. Bu duruma, kirli havada bulunan çeşitli toksik maddelerin özellik de kurşunun yol açabileceği düşünüldü. İnsan sağlığı yönünden olumsuz etkileri olan hava kirliliğinin önlenmesi için acil girişimde bulunulması gerektiği sonucuna varıldı

Management of thoracic empyema in children

The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim Of this Study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. A series of 25 consecutive children who had loculated pleural empyemas that did not respond to tube thoracostomy and antibiotics is presented. Their ages ranged from I to 12 years (mean 4.22). There were 19 boys and 6 girls, and all epyemas were postpneumonic. The fibrinolytic agent used was urokinase in 17 and streptokinase in 8. The mean duration of fibrinolytic treatment was 4.3 days (range 2 to 8) and the mean duration of chest-tube drainage was 8.9 days (range 7 to 13). In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multi-loculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases