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    Clinico-epidemiological Study of Caustic Substance Ingestion Accidents in Children in Anatolia: The DROOL Score as a New Prognostic Tool
    (Acta Medical Belgica, 2012) Uygun, I.; Aydogdu, B.; Okur, M. H.; Arayici, Y.; Celik, Y.; Ozturk, H.; Otcu, S.
    Background : To examine the clinico-epidemiological details of paediatric caustic substance ingestion (CSI) accidents in Turkey. To present the new DROOL Score (DS), which the authors developed based on the severity and duration of initial signs and symptoms (ISSs) to predict oesophageal stricture (OS) without endoscopy, and to present our management protocol based on immediate feeding, early detection, and oesophageal balloon dilatation (OBD) of OS with no barium study. Methods : We prospectively reviewed the records of 202 children admitted with a history of CSI within 48 hours. Patient, parent, caustic substance, and accident characteristics were noted in detail. Patients were fed as soon as they could swallow saliva. Diagnoses of OS were made earlier via timely endoscopy (mean, 10-14 days after CSI) for patients with persistent dysphagia and OBD was started earlier. ISSs and DSs were analyzed. OS treatment results were compared between early (10-14 days) and late (>= 21 days) dilatation patients who were referred for OBD by other hospitals. Results : In total, 144 (71%) incidents occurred within the parents' home and 44 (22%) occurred at another individual's home. The caustic substances were frequently sold in non-original containers (68.8%). Most patients' parents had low incomes and were poorly educated. Ninety-six children had no ISSs, whereas 106 patients had ISSs. Seventeen symptomatic patients had persistent dysphagia after 10-14 days. Timely endoscopy was performed within 10-14 days for these patients only, and OS was diagnosed and successfully treated. DSs were significantly lower in patients with OS than those without (p < 0.001). A DS <= 4 was a significant predictor of OS (100% sensitivity, 96% specificity, 85% positive and 100% negative predictive values). Results were significantly more satisfactory in early (n = 17) than in late (n = 6) dilatation patients. Conclusions : Paediatric CSI accidents might decrease if caustic substances were sold in the original child-proof containers. OS can be highly predicted by a simple DS instead of endoscopic grading, and can be diagnosed earlier (10-14 days) via endoscopy only in patients with persistent dysphagia, instead of a late barium study (>= 21 days). OBD can then also be started earlier in these patients.
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    Fluid resuscitation in the treatment of uncontrolled hemorrhagic shock
    (Springer Wien, 2008) Yagmur, Y.; Ozturk, H.; Orak, M.; Tas, A.; Guneli, E.
    Background: We evaluated the effect of continuous fluid resuscitation on the hemodynamic response and survival following massive splenic injury (MSI) in rats. Methods: Uncontrolled hemorrhagic shock was produced in 70 rats by sharp transaction. The animals were randomized into 7 groups: group 1 (n = 10), sham-operated; group 2 (n = 10), MSI was untreated and splenectomy was performed after 45 min; group 3 (n = 10), MSI treated after 15 min with 7.5 ml/kg/h of 7.5% NaCl (HTS-7.5) and splenectomy after 45 min; group 4 (n = 10), MSI treated with 35 mL/kg/h Ringers lactate (RL) solution (RL-35) and splenectomy; group 5 (n = 10), MSI treated with 70 mL/kg/h RL (RL-70) and splenectomy, group 6 (n=10), NISI treated with 35mL/kg/h of 0.9% NaCl (NaCl-35) and splenectomy; and group 7 (n=10), MSI treated with 70mL/kg/h of 0.9% NaCl (NaCl-70) and splenectomy. Results: Small and high volume ringer lactate (RL-35, RL-70) infusion increased MAP, pulse rate, and hematocrit level compared to untreated group (p<0.001); however, best response was inquired by RL-35. TBL with RL-35 (22% of blood volume) was less than RL-70 and other groups (p<0.01). High rate of early mortality (33.4% at 30min) with HTS infusion was noticed. TBL was moderately increased in NaCl-70 (32% of blood volume) compared to NaCl-35 (30% of blood volume). Survival time was better with RL-35 and RL-70 at 60 min and 120min, respectively, compared to other groups (p < 0.05). Conclusions: In conclusion, continuous infusion of HTS, RL-70, NaCl-35 and NaCl-70 following massive splenic injury in uncontrolled hemorrhagic shock resulted in a significant increase in intra-abdominal bleeding compared to lower dose RL-35 and greatest survival time was noticed with RL-35 and RL-70 at 60 and 120 min, respectively.
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    N-Acetylcysteine Prevents Deleterious Effects of Ischemia/Reperfusion Injury on Healing of Colonic Anastomosis in Rats
    (Karger, 2009) Kabali, B.; Girgin, S.; Gedik, E.; Ozturk, H.; Kale, E.; Buyukbayram, H.
    This study was designed to determine the effects of intraperitoneally or orally administered N-acetylcysteine (NAC) on wound healing following resection and anastomosis of a colon segment with ischemia/reperfusion injury. Forty female Spraque-Dawley rats were randomly allocated to one of four groups containing 10 rats each: (1) normal resection plus anastomosis; (2) ischemia/reperfusion plus resection plus anastomosis; (3) ischemia/reperfusion plus resection plus anastomosis plus intraperitoneal NAC; (4) ischemia/reperfusion plus resection plus anastomosis plus oral NAC. Group comparison showed that the anastomosis bursting pressure was significantly higher in group 3 than in the other groups. The mean tissue hydroxyproline concentration in the anastomotic tissue was significantly lower in group 2 than in the other groups. The collagen deposition was significantly increased on day 7 in groups 3 and 4 compared to the other groups. In conclusion, this study demonstrates that NAC significantly prevents the effects of reperfusion injury on colonic anastomoses in a rat model. Copyright (C) 2009 S. Karger AG, Basel