Epimorphin expression in a rat model of pulmonary hypoplasia associated with congenital diaphragmatic hernia.

PURPOSE: The pathogenesis of pulmonary hypoplasia associated with congenital diaphragmatic hernia (CDH) remains unclear. Interactions between the epithelium and surrounding mesenchyme play an important role in normal lung morphogenesis. Epimorphin, a stromal protein, plays a role in epithelial morphogenesis and lung branching, both of which are involved in pulmonary hypoplasia. In this study, we aimed to examine the relationship between epimorphin and pulmonary hypoplasia associated with CDH in an animal model. METHODS: Time-pregnant rats were exposed to nitrofen or vehicle on gestational day 9 (D9). Fetuses were harvested on D16 and D20, and were divided into control, hypoplastic lungs with CDH (CDH+), and hypoplastic lungs without CDH (CDH-). Both lungs of each fetus were removed and subjected to morphometric and molecular biologic analyses. Lung-to-body weight ratios were calculated. Pulmonary RNA was extracted, and relative mRNA level of epimorphin was determined by quantitative real-time PCR (qRT-PCR). Protein expression of epimorphin was investigated by Western blotting. RESULTS: In groups D16 and D20, lung-to-body weight ratios in subgroups CDH+ were significantly lower than those of controls and CDH-. The relative mRNA expression levels of epimorphin were significantly increased in both lungs in subgroup CDH+ compared with controls and CDH- on D16. Pulmonary epimorphin gene expression levels were significantly decreased in CDH+ group on D20 compared to controls. Western blotting confirmed the qRT-PCR results showing decreased pulmonary epimorphin protein expression in CDH+ hypoplastic lungs compared to controls on D20. CONCLUSION: Our study shows that there is an association between the epimorphin expression and pulmonary hypoplasia associated with CDH. Although the cause-effect relationship is far from being established, epimorphin-related mechanisms have a more critical role in early (D16) developmental stage.

A rare outcome of iron deficiency and pica: Rapunzel syndrome in a 5-year-old child iron deficiency and pica.

Bezoar is defined as the accumulation of organic or nonbiological substances inside the gastrointestinal system. Trichobezoars are the most frequently detected ones and are mostly present in patients with neuropsychiatric disorders. The continuance of the trichobezoar tail-shaped extension over the duodenum and jejunum is described in Rapunzel syndrome. Both conditions are rarely reported in children. The present case submitted here is related to a 5-year-old girl referred with an abdominal mass and anemia, diagnosed with Rapunzel syndrome and developing trichobezoar due to iron deficiency and pica.

Turkish pediatric surgical nurses' knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns' pain relief.

Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to describe Turkish pediatric surgical nurses' knowledge and use of pain assessment and nonpharmacologic and environmental methods in relieving newborn's pain in hospital. The sample consisted of 111 pediatric surgical nurses employed in pediatric surgical unit in 15 university hospitals located in Turkey. A questionnaire was used to measure the nurses' knowledge and use of pain assessment, nonpharmacologic, and environmental methods. Data were analyzed with the use of descriptive statistics. Of the nurses that participated in the study, 83.8% were between the ages of 20 and 35 years, 54.1% had a bachelor degree, and 75.7% had a nursing experience ≤10 years. 50.5% stated that physiologic and behavioral indicators used in the assessment of pain in infants. The most commonly used nonpharmacologic methods were giving nonnutritive sucking, skin-to-skin contact, and holding. The most commonly used environmental methods were avoiding talking loudly close to the baby, minimal holding, care when opening and closing of the incubator, avoiding making noise when using wardrobe, drawers, trash, or nearby devices, such as radio and television, avoiding sharp fragrances, such as alcohol, perfume, near the baby, and reducing light sources. Although Turkish pediatric surgical nurses used some of the nonpharmacological and environmental methods in infant's pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.

Does massive proximal small bowel resection influence prostaglandin E2 synthesis in the stomach and ileum during adaptive process in rats?

It is unclear whether massive small bowel resection (SBR) affects prostaglandin E2 synthesis in the gastrointestinal tracts. Thus the aim of this study was to investigate possible changes over tissue levels of prostaglandin E2 in the stomach and ileum after massive proximal SBR. Female Swiss-Albino rats underwent control operation (groups 1, 3, 5) or an 80% SBR (groups 2, 4, 6). The specimens were obtained during relaparotomy at 3 days in groups 1 and 2, at 9 days in groups 3 and 4, at 15 days in groups 5 and 6. Group 2 vs. groups 1 and 6, group 4 vs. groups 3 and 6 had significant increase in the levels of gastric acid (P < 0.01, P < 0.05, respectively). Gastric prostaglandin E2 levels markedly increased in group 2 compared to group 1 (P < 0.01). Ileal prostaglandin E2 levels showed to be significantly higher in group 6 when compared with groups 2, 4, and 5 (P < 0.05). Gastric acidity increased at 3 and 9 days, decreased thereafter at 15 days following massive proximal SBR. While resected rats had increased levels of gastric prostaglandin E2 at 3 days, ileal prostaglandin E2 was markedly elevated at 15 days. Therefore, we conclude that prostaglandin E2 may have a possible role in regulating intestinal adaptation at the end of the adaptive process, and contribute to cytoprotective barrier function in the ileum and stomach at early and late periods of the intestinal adaptation, respectively.

A rare case of esophageal atresia with gastric outlet obstruction.

Although the combination of gastric outlet obstruction and esophageal atresia is rarely seen in neonates, it has been well described. We report the case of a 5-day-old newborn with esophageal atresia and tracheoesophageal fistula associated with complete gastric outlet obstruction due to a mucous plug. As the patient had intense gastric distention, severe respiratory distress requiring ventilatory therapy and complete pyloric obstruction in radiograms, emergency gastrostomy was performed before definitive operation. Definitive treatment consisted of tracheoesophageal fistula ligation and primary esophageal anastomosis. Exploratory laparotomy during the same session revealed a normal pyloric canal, completely obstructed by a firm mucous plug. The plug was removed by pylorotomy, and a pyloroplasty was performed to ease gastric evacuation. Postoperative feeding problems suggested gastric dysmotility as the possible cause for the mucous plug obstruction.

Omentum pediculed musculo-peritoneal flap (OPMP) for growing intestinal neomucosa in a rat model.

BACKGROUND/PURPOSE: To construct a musculo-peritoneal flap adequately vascularised through attached omentum and to evaluate whether this flap is functional for growing new intestinal mucosa. METHODS: 24 rats underwent two surgical procedures. 1) A musculo-peritoneal flap was prepared, omentum was fixed onto the muscular side and a silicon graft was placed on the peritoneal side. 2) After one month the so constructed OPMP flap was mobilised and attached to the jejunum. Animals were harvested at 2, 4 and 8 months for macroscopic and microscopic evaluation. RESULTS: One rat died at 7 months due to intestinal volvulus. In the remainder the circumference of the patched intestine significantly increased compared to that of normal intestine (p<0.001). The flaps were markedly contracted in the 4 month rats (p<0.01). All flaps were completely covered by neomucosa except in the 2 month rats. Crypt depth and crypt density of the neomucosa was significantly lower in 2 month rats compared to other groups (p<0.05). Similarly neomucosal villous height was markedly low in the 2 month rats (p<0.01). CONCLUSIONS: To date, we have found no reports of small bowel patching using this technique. In this context, use of OPMP flap is likely to be useful for increasing intestinal surface area.

Delayed-interval delivery of triplet pregnancy following preterm labor. A case report.

Patients with multiple pregnancies have an increased risk of preterm labor and delivery with the associated high prenatal morbidity and mortality. Obviously, as the number of multifetal pregnancies increases (due primarily to the use of assisted reproductive treatments), a rise in the unexpected birth of one or more siblings at premature or previable stages is observed. In multiple pregnancies with imminent preterm birth, delayed delivery may offer survival chances and a favorable outcome for the remaining fetus(es). Herein, we report on the prolongation of a triplet pregnancy and survival of fetuses B and C after loss of fetus A at 21 weeks' gestation.