RESUMEN
AIM: To investigate histopathological changes in ureteropelvic junction obstruction (UPJO) from an etiological perspective. PATIENTS AND METHODS: Medical records of patients with UPJO were reviewed and pathological specimens collected. Nephrectomy materials from forensic autopsies were taken as controls. Specimens were assessed with light microscopy. Fibronectin, type 4 collagen, laminin, Bax and Bcl-2 expression for apoptosis, together with interstitial cells of Cajal determination with c-kit were determined immunohistochemically. Staining scores were evaluated semiquantitatively. Results were evaluated using Mann-Whitney U-test. RESULTS: Control group comprised 14 children (median age, 3.5 years; 6 months-17 years). Study group comprised 22 children with UPJO (median age, 9 months; 1 month-10 years). Light microscopy revealed non-specific inflammation, epithelial proliferation and atrophy with fibrosis in the smooth muscle of the UPJ in all patients. Fibronectin, type 4 collagen and laminin were found to be significantly increased in UPJO at the intrafascicular space of smooth muscle and the matrix of stroma. Bcl-2 expression was increased in UPJO. c-Kit was unable to stain interstitial cells of Cajal, but staining for mast cells was significant. CONCLUSIONS: High expression of fibronectin, laminin and type 4 collagen may indicate a relation to the pathogenesis of UPJO. Defective kidney morphogenesis, during branching and tubulogenesis of ureteric bud, may be responsible for this congenital pathology.
Asunto(s)
Apoptosis , Proteínas de la Matriz Extracelular/metabolismo , Proteínas Proto-Oncogénicas c-kit/metabolismo , Obstrucción Ureteral/metabolismo , Adolescente , Niño , Preescolar , Colágeno Tipo IV/metabolismo , Femenino , Fibronectinas/metabolismo , Humanos , Hidronefrosis/etiología , Hidronefrosis/metabolismo , Inmunohistoquímica , Lactante , Células Intersticiales de Cajal/patología , Pelvis Renal/patología , Laminina/metabolismo , Masculino , Músculo Liso/metabolismo , Músculo Liso/patología , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/patología , Proteína X Asociada a bcl-2/metabolismoRESUMEN
BACKGROUND/AIMS: Prevention of renal scarring is the main therapeutic goal in children with spina bifida. We aimed to determine factors affecting renal scar development in these patients. MATERIALS AND METHODS: Records of 312 children admitted between 1994 and 2005 with spina bifida were reviewed. Age on admission, gender, presence of previous febrile urinary tract infections (UTIs), vesicoureteral reflux (VUR), and initial urodynamic findings were noted. Patients were grouped regarding presence/absence of renal scars on DMSA scans. Chi2 and Student's t tests were used for statistical evaluation. RESULTS: Seventy-two patients had renal scars on admission. Mean age was 4.62 +/- 4.59 years for patients without renal scars and 6.35 +/- 4.9 years for patients with scars. Male/female ratio was 1:1 in the scarless group and 1:2 in the group with scars. Previous febrile UTI was present in 11 of 240 scarless patients in contrast to 7 out of 72 patients in the scar group (p > 0.05). VUR was present in only 16.3% of cases without scars, whereas 36.1% of patients in the scar group had VUR. Detrusor overactivity and detrusor sphincter dyssynergia were observed in 67.1% of scarred patients, whereas this figure was 42.4% in the scarless group. The comparison of age on admission, gender, detrusor overactivity, and detrusor sphincter dyssynergia revealed significant differences between patients with and without renal scars. CONCLUSIONS: Late referral, female gender, overactive detrusor, and detrusor sphincter dyssynergia have detrimental effects on renal parenchymal function in spina bifida patients. Patient selection for aggressive treatment using these features may prevent renal parenchymal deterioration.
Asunto(s)
Cicatriz/etiología , Enfermedades Renales/etiología , Disrafia Espinal/complicaciones , Niño , Preescolar , Cicatriz/prevención & control , Femenino , Humanos , Lactante , Enfermedades Renales/fisiopatología , Enfermedades Renales/prevención & control , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores Sexuales , Infecciones Urinarias/etiología , Urodinámica , Reflujo Vesicoureteral/etiologíaRESUMEN
BACKGROUND/PURPOSE: Recent reports have focused on detorsion after ovarian torsion in the literature. The aim of the study was to investigate late term changes in both ovaries after delayed detorsion following ovarian torsion in rats. MATERIALS: Female, prepubertal, Wistar albino rats were divided into four groups (n = 6/group). The left ovaries were used for the study and the right ovaries were kept as the control. The groups were constituted as follows: Group 1: left ovarian fixation, bilateral oophorectomy 48 hours later; Group 2: left ovarian torsion and fixation, bilateral oophorectomy 48 hours later; Group 3: detorsion 48 hours after torsion and bilateral oophorectomy after another 48 hours; Group 4: detorsion 48 hours after torsion and bilateral oophorectomy after 21 days. The total injury score (TIS) was compiled histologically in a double-blind fashion. Congestion, edema, bleeding and polymorphonuclear lymphocyte infiltration were assessed for TIS. RESULTS: The TIS was found to be 8 points in Group 1; 38 in Group 2; 28 in Group 3 and 12 in Group 4, respectively. The TIS was based on results from the left ovaries in Group 1, whereas 31 points were attributable to the left ovaries and 7 to the right ovaries in Group 2. In Groups 3 and 4, TIS points were the same in both study and control ovaries. The difference between the left ovaries of Groups 1 and 2 and the left ovaries of Groups 2 and 4 was statistically significant (p < 0.05). CONCLUSION: Viable ovarian tissue can be detected even after 48 hours of torsion, which is a relatively long period of ischemia. Tissue injury decreases significantly after detorsion during late recovery. In view of previous case reports in the literature and the present findings, detorsion is recommended in children with ovarian torsion regardless of the ischemic period and/or macroscopic appearance.
Asunto(s)
Infarto/cirugía , Enfermedades del Ovario/cirugía , Ovario/irrigación sanguínea , Animales , Femenino , Necrosis , Enfermedades del Ovario/patología , Ovario/patología , Ratas , Ratas Wistar , Flujo Sanguíneo Regional , Anomalía TorsionalRESUMEN
BACKGROUND: The aim of this study was to evaluate the effect of absorbable fibrin-collagen patch (FCP) during early colonic anastomotic healing in rats. METHODS: Prepubertal Wistar albino rats were randomly divided into 6 groups of 6 rats each. Colon was transected and then anastomosed with sutures (Group A), sutures+FCP (TachoComb; Nycomed, Austria) (Group AT) or only FCP (Group T). Rats were sacrificed either 3 or 7 days after the anastomosis. Anastomoses were evaluated for perianastomotic adhesion formation, bursting pressures and histological features. RESULTS: Perianastomotic adhesion formation was significant in Groups AT and T. Bursting pressures were in higher group AT than in Group A on postoperative day 3 and lower on day 7 (p < 0.05). Histological examinations revealed an increase in inflammatory cells in Group T on day 3 and decreased wound healing in Group AT when compared to Group A on day 7 (p < 0.05). CONCLUSIONS: In the early period of anastomotic healing, FCP supports anastomotic integrity. However, it also causes an inflammatory reaction which may increase the time necessary for healing process. Thus, the use of this biomaterial should be preferred in only selective clinical cases with a careful follow-up.
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Materiales Biocompatibles , Colon/cirugía , Prótesis e Implantes , Cicatrización de Heridas , Anastomosis Quirúrgica , Animales , Colágeno , Fibrina , Presión , Ratas , Ratas Wistar , SuturasRESUMEN
Congenital umbilical disorders are frequently seen in the pediatric population and are mostly classified as retained umbilical cord structures or failure of umbilical ring closure. Vitelline duct anomalies, urachal anomalies and umbilical herniations comprise the main group of these congenital problems. Here we report a new presentation of vesicoumbilical patency in a 20-day-old male baby. A brief review of the literature concerning the classification of patent urachus to explain the possible mechanism of the anomaly is given.
Asunto(s)
Uraco/anomalías , Hernia Umbilical/etiología , Humanos , Recién Nacido , Masculino , Uraco/patología , Conducto Vitelino/anomalíasRESUMEN
Endothelins ( ETs ) are potent vasoconstrictors derived from vascular endothelium. They have primary roles in many pathophysiologic states including ischemia/reperfusion (I/R) injury. The relationships between nitric oxide (NO) and ETs are still under investigation. In this study on rats we want to focus on the interaction of NO and ET especially in I/R injury. For this purpose ET-1 and PD-156252, a nonselective ET receptor blocker, were given in a mesenteric I/R model and reactive oxygen species were detected directly using chemiluminescence of the ileal tissue. ET administrations to sham and I/R groups caused significant increases in NO concentrations whereas, in terms of peroxynitrite, which is a highly reactive group of free radicals, its increasing effects were seen only in I/R groups. This suggests that in I/R where superoxide levels increase together with NO, the conversion to peroxynitrite is likely and this effect is augmented with ET administration. On the other hand PD administration decreases superoxide and thereby peroxynitrite levels and this study shows that the effect of PD-156252 is established through this mode of action. These data suggest therapeutic approaches that may be beneficial in the treatment of I/R injury.