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    The effects of acetylsalicylic acid, interferon-?, and vitamin E on prevention of parenteral nutrition-associate cholestasis
    (Lippincott Williams & Wilkins, 1999) Demircan, M; Uguralp, S; Mutus, M; Gurer, EI; Atik, E; Turhan, F; Gursoy, MH
    Background: Cholestasis is one of the major complications of parenteral nutrition. The purpose of this experimental study was to detect the effects of acetylsalicylic acid (ASA), vitamin E (Vit E), and interferon-alpha (IFN-alpha) on prevention of parenteral nutrition-associated cholestasis. Methods: Ten experimental groups, each consisting of 10 4-week-old Wistar albino rats, were formed: control 10- and 20-day groups (C-10 and C-20), parenteral nutrition-only 10- and 20-day groups (T-10 and T-20), ASA-supplemented parenteral nutrition 10- and 20-day groups (TA(10) and TA(20)), Vit E-supplemented parenteral nutrition 10- and 20-day groups (TE10 and TE20), and IFN-alpha-supplemented 10- and 20-day groups (TF10 and TF20). Acetylsalicylic acid, Vit E, and IFN-alpha were administered in the parenteral nutrition solution through an intraperitoneal route. At the end of the study, serum total bile acids, serum aspartate and alanine aminotransferases, and alkaline phosphatase were measured biochemically. In addition, the histopathologic findings of cholestasis were evaluated by using a morphologic portal inflammation index. Results: Although the difference in the serum levels of transferases and alkaline phosphatase was not significant among all groups (p > 0.05), it was significant in total bile acid levels (p 0.05). There was also a significant correlation between the histopathologic changes of the liver and serum total bile acid concentrations (p < 0.05). Portal inflammation in varying degrees was seen in all experimental groups, but not in the control groups. Serum total bile acid concentrations in parenteral nutrition groups receiving ASA were significantly lower than those in the parenteral nutrition-only group (p < 0.01). Although Vit E-supplemented parenteral nutrition was effective in preventing the development of cholestasis in the 10-day group (p < 0.05), it was not effective in the 20-day group when compared with incidence of cholestasis in the parenteral nutrition-only group (p > 0.05). Conversely, IFN-alpha-supplemented parenteral nutrition had no effect on cholestasis in the 10-day group (p > 0.05) but lowered cholestasis in the 20-day group when compared with incidence the parenteral nutrition-only group (p < 0.05). Conclusion: Our results indicate that acetylsalicylic acid may be beneficial in preventing, and alpha-interferon in treating, parenteral nutrition-associated cholestasis.
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    Intraoperative laparoscopy by a flexible scope: Is a a good alternative to routine bilateral exploration in childhood hernias?
    (Monduzzi Editore, 1997) Gursoy, MH; Gurel, M; Koltuksuz, U; Uguralp, S; Aydinc, M
    Negative contralateral explorations go on raising the question on whether the contralateral exploration is still necessary or not. To iind out whether the contralateral processus vaginalis was patent or not, we performed intraoperative non-puncture laparoscopy by a flexible scope. We inserted the flexible scope through the open hernia sac and tried to see the opening of the contralateral processus vaginalis. The study involved a total of 20 children, 16 boys and 4 girls. The symptomatic side was explored and laparoscopy was performed through the opened hernial sac. We found a contralateral processus vaginalis in 6 children, 4 boys and 2 girls, by flexible scopy. We confirmed the results by exploring the opposite groin. There was 1 false-positive result in a girl. Intraoperative non-puncture laparoscopy by a flexible scope through the hernial opening is an uncomplicated, reliable and precise method. it may represent a very satisfactory alternative to routine bilateral inguinal exploration and also by its enhanced mobility, it may be much more beneficial than the recently developed technique of scoping children with a rigid laparoscope.