The effect of whole gut irrigation on contractile responses of guinea pig gallbladder, ileum, and tissue cholecystokinin levels.

AIM: An experimental study was performed to evaluate the effect of whole gut irrigation (WGI) solutions on contractile responses of the gallbladder and ileum and also on tissue cholecystokinin (CCK) levels. MATERIALS AND METHODS: Thirty guinea pigs were enrolled into five groups including control group (CG) and WGI group (saline physiologic [SP], Ringer lactated [RL], polyethylene glycol [PEG], and dibasic sodium phosphate [DNP]). After median laparotomy, the distal esophagus was ligated and SP, PEG, RL, and DNP infusions (2 mL/kg/min) were performed via gastric catheter until rectal discharge became clear in WGI groups. Ileum and gallbladder samples were obtained for in vitro and biochemical studies without irrigation in CG and after irrigation with different WGI solutions. Isolated ileum and gallbladder preparations were suspended in organ baths for contractile responses of carbachol and CCK. Also, biochemical analysis of tissue CCK levels was performed in ileum and gallbladder samples. RESULTS: In PEG group, gallbladder and ileum CCK levels were significantly higher than CG (p < 0.05). Also, DNP irrigation caused increased CCK levels in gallbladder samples (p < 0.05). In lower carbachol concentrations, PEG group showed increased contraction responses in gallbladder samples when compared with controls (p < 0.05). However, ileal responses to carbachol did not show any significant difference between groups, contraction responses to CCK was decreased in PEG group when compared with CG (p < 0.05). CONCLUSION: Among WGI solutions, PEG caused the highest CCK levels in gallbladder and ileum samples. Different WGI solutions affected the contractile responses of gallbladder and ileum smooth muscles divergently. Increased levels of CCK in PEG group support the decreased contractile responses in ileum. Therefore, our results confirm that the effect of WGI on gallbladder and ileum contractility may be CCK related.

The impact of Pediatric Trauma Score on burden of trauma in emergency room care.

Traumatic injuries are the leading cause of mortality and morbidity during childhood. A retrospective study was performed to evaluate the impact of Pediatric Trauma Score (PTS) on burden of trauma in emergency care. Children admitted to the emergency room were retrospectively evaluated for age, sex, mechanism of injury, physical examination findings, and PTS. The cost of trauma was obtained by medical records. A total of 146 patients (male/female: 93/53) were enrolled. The median age was 6 (interquartile range: 3-9.25). Mechanism of injury was falls (74%), motor vehicle crashes (9.6%), non-vehicular accidents (7.5%), struck by/against (6.2%), and cuts and gunshots (2.1%). The median PTS was 10. In the evaluation of trauma burden, radiologic investigations accounted for 41%, consultations for 23.5%, laboratory investigations for 15.6%, emergency surgical interventions for 12.1%, and medical interventions for 6.8% of total trauma cost in emergency care. PTS showed no impact on burden of trauma in emergency care (p > 0.05). Total trauma cost was increased 2.1-fold in male patients, 2.6-fold in head injuries and 4.4-fold in abdominal injuries (p < 0.05). Pediatric Trauma Score had no effect on the burden of pediatric trauma in emergency care. The total cost of trauma was primarily affected by head injury and abdominal trauma. Higher costs may be related with routine radiological investigations in head and abdominal injuries.

Physicians' attitudes and perception of pediatric trauma cost.

Pediatric trauma is the leading cause of mortality and morbidity in children. A questionnaire was applied to evaluate physicians' attitudes and perception of pediatric trauma cost. Physicians working in the field of pediatric trauma (namely those who work in emergency services, pediatrics and pediatric surgery departments; who are consulted regarding pediatric traumas; and those for whom pediatric trauma patients constitute the majority of their patient spectrum) were enrolled in the survey. A questionnaire was administered to elicit the demographic data, features of pediatric trauma in their practice, self-perception of pediatric trauma knowledge, estimation of trauma severity, parameters used for pediatric trauma diagnosis, and perception of pediatric trauma score (PTS) and trauma cost. A total of 103 physicians responded to the questionnaire (median age: 30.8 +/- 5.6 years; range: 24-56). Of the 103 respondents, 49 were males (47.6%) and 54 were females (52.4%). Physicians responding to the questionnaire were specialists in Pediatrics (32.9%), Pediatric Surgeons (5.9%), Emergency Medicine Specialists (2.9%), and residents (47.6%) in those three disciplines in University Hospitals, Public Hospitals and Research Hospitals. Physicians reported falls (58.1%) as the most common cause of trauma, and noted head injuries with an incidence of 49.9% in their trauma practice. Physicians' self-perception of their pediatric trauma knowledge was questioned in three categories as: overall, diagnosis and treatment of trauma. They reported that their knowledge of pediatric trauma overall and regarding diagnosis and treatment was "efficient" at rates of 87.4%, 83.6% and 74.8%, respectively. However, while 76.7% of physicians perform radiological evaluations in all trauma patients, only 56.3% of them use laboratory tests routinely in diagnosis. Participants reported that cost of trauma was mostly affected by severity of trauma (49.5%) and least affected by the patient's sex (64.1%). They also believed that radiologic evaluations (66%) accounted for the largest portion of trauma cost and the cost of consultations (44.7%) for the smallest portion. In conclusion, we suggest that although most physicians were aware of cost factor in trauma, they did not consider trauma costs in diagnosis and management.