A comparison of central corneal thickness measured using noncontact methods and ultrasonic pachymetry

Aim

The aim of this study is to compare central corneal thickness (CCT) measurements in healthy eyes using ultrasonic pachymetry (UP) with values obtained using anterior segment spectral domain optical coherence tomography (SD-OCT), the Scheimpflug camera system, and noncontact specular microscopy.

Material and Methods

One hundred and twenty-five eyes of 117 healthy individuals (56 women, 61 men) were included. All patients underwent consecutive CCT measurement with UP, the Scheimpflug camera, anterior segment SD-OCT, and specular microscopy. The four devices could be read. Measurements from the four devices were classified in pairs and compared using the paired t-test. Relations between the devices were analyzed using the Pearson test. An alpha error level of P < 0.05 was regarded as statistically significant.

Results

The mean age of the healthy individuals included in the study was 34.75 ± 14.55 years (20-76). Mean CCT values were 541.21 ± 29.24 μm with UP, 539.26 ± 29.27 μm with the Scheimpflug camera system, 532.21 ± 29.53 μm with SD-OCT, and 534.45 ± 29.20 μm with specular microscopy. The differences in measurements at the paired t-test were statistically significant (P < 0.001 for all). However, measurements using the four devices exhibited significant mutual correlation (P < 0.001 for all).

Conclusions

CCT can be measured using different devices. Noncontact methods have now begun replacing UP, regarded as the gold standard. Although CCT values obtained from different devices were correlated, the difference between these measurements was statistically significant. Therefore, the same device should be used for measurement in the diagnosis and follow-up of diseases such as corneal ectasia and glaucoma where corneal thickness is important.

Evaluation of choroidal thickness before and after strabismus surgery in paediatric patients by spectral-domain optical coherence tomography

Aim

This study aimed to determine the effects of strabismus surgery on choroidal thickness in paediatric patients with Spectral Domain-Optical Coherence Tomography (SD-OCT).

Material and Methods

Sixty eyes of 60 children with esotropia were included. The mean age was 9.5 ± 3.1 years. The choroidal thickness was measured using SD-OCT, which was performed before the surgery and 1 week, 1 month and 3 months postoperatively. At the same time, the patients' visual acuity was evaluated.

Results

There were no statistically significant differences between the preoperative and postoperative values in terms of the visual acuity (P > 0.05). When compared to the preoperative values, decreases were found in the choroidal thicknesses in all of the areas measured during the first week evaluation (P < 0.05). In the postoperative first month, significant decreases were also found in the choroidal thicknesses in all the areas measured (P < 0.05); however, in the postoperative third month, there were no changes in any of the areas (P > 0.05).

Conclusions

We observed that there was a significant decrease in the choroidal thickness during the early postoperative period and no significant change in the late postoperative period in paediatric patients of double horizontal muscle surgery. Moreover, these early changes in the choroid in paediatric patients show that it does not cause a functional loss.

Evaluation of neurodegenerative and inflammatory processes in temporomandibular joint disorders using optical coherence tomography

INTRODUCTION

Temporomandibular joint disorders (TMD) is a process with systemic effects rather than local effects. The purpose of this study is to examine the retinal layer structure using optical coherence tomography (OCT) method in order to detect possible degenerative and inflammatory process in patients with TMD.

MATERIAL AND METHODS

Thirty-five healthy controls and 34TMD patients were evaluated bilaterally in this study. The retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and choroidal thickness were analyzed using OCT.

RESULTS

When TMD patients were compared with healthy controls, GCL and IPL volumes and RNFL thickness decreased; while choroidal thickness increased. In the unilateral TMD patients, there was no statistically significant difference in GCL, IPL, RNFL and choroidal thickness between the affected and the unaffected regions.

DISCUSSION

OCT findings showed GCL and IPL volumes and RNFL thickness were decreased while choroidal thickness was increased in TMD patients. These findings suggest that TMD may cause neurodegeneration and inflammation.

Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer

Background and Aim

There are conflicting results of studies on accuracy of positron emission tomography (PET)/computed tomography (CT) for axillary staging. The aim of this study is to determine the factors affecting the efficacy of 18F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT in detecting axillary metastases in invasive breast cancer.

Materials and Methods

Data of 232 patients with invasive breast cancer who underwent ¹⁸F-FDG PET/CT examination before surgery between January 2013 and September 2017 were reviewed retrospectively. Histopathological examination of axillary lymph nodes (ALNs) was used as a reference to assess the efficacy of ¹⁸F-FDG PET/CT in detecting axillary metastases.

Results

While 134 (57.8%) patients had axillary metastases as detected in ¹⁸F-FDG PET/CT scans, histopathologically axillary metastases were detected in 164 (70.7%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of ¹⁸F-FDG PET/CT in detection of axillary metastasis were 72.56%, 77.94%, 88.8%, 54%, and 74.1%, respectively. The false-negative and false-positive rates were 27.4% and 22%, respectively. In univariate analysis, patients' age, estrogen receptor positivity, higher ALN SUVmax, greater tumor size, and lymph node size determined by ¹⁸F-FDG PET/CT were all significantly associated with accuracy of ¹⁸F-FDG PET/CT for axillary metastasis. In multivariate analysis, tumor size determined by ¹⁸F-FDG PET/CT and ALN SUVmax were independent variables associated with axillary metastasis. The accuracy of ¹⁸F-FDG PET/CT for axillary metastasis was higher in patients with a larger tumor (≥19.5 mm) and a higher ALN SUVmax (≥3.2).

Conclusion

¹⁸F-FDG PET/CT should not be routinely used for axillary staging, especially in patients with small tumors. It cannot eliminiate the necessity of sentinel lymph node biopsy. When it is used, both visual information and optimal cut-off value of axillary node SUVmax should be taken into consideration.

Combination therapy with selective serotonin reuptake inhibitors and phosphodiesterase-5 inhibitors in the treatment of premature ejaculation

We aimed to evaluate the effectiveness of paroxetine and tadalafil combination in the treatment of premature ejaculation (PE). A total of 150 primary (lifelong)PE patients were randomly distributed into three groups of 50 patients each. Group 1 received 20 mg paroxetine every day for 1 month, Group 2 received 20 mg tadalafil on demand 2 h before intercourse, and Group 3 received paroxetine and tadalafil on demand 2 h before intercourse. Intravaginal ejaculatory latency times (IELT) scores were evaluated at baseline, at the end of the first month of therapy and 1 month after discontinuation of the treatment, while International Index of Erectile Function (IIEF) questionnaire scores were evaluated both prior to and after the treatment. At the end of the first month of therapy, IELT scores were compared with the basal values and statistically significant changes were detected (60.6 ± 30.2-117.3 ± 67.3, 68.5 ± 21.4-110.2 ± 37.3, 71.56 ± 40.23-175.2 ± 60.2)(P < 0.01). IELT scores after discontinuation of treatment were found to be close to the baseline IELT scores (P > 0.05). IIEF scores were evaluated both prior to and after the treatment, and no statistically significant difference was detected (P > 0.05). It is concluded that utilisation of selective serotonin reuptake inhibitors (SSRI) and phosphodiesterase-5 inhibitors (PDE5i) combination before intercourse seems to provide significantly longer ejaculatory latency times as compared with SSRI alone for a long time in patients with PE.

Oncologic results, functional outcomes, and complication rates of transperitoneal robotic assisted radical prostatectomy: single centre's experience

BACKGROUND

We report the operative details and short term oncologic and functional outcome of the first 334 Robotic-assisted radical prostatectomy experiences for organ confined prostate cancer

METHODS

From August 2009 to December 2012, details of 334 consecutive patients were retrospectively analyzed. The analyzed parameters included: preoperative, per-operative characteristics, postoperative minor and major complications, positive surgical margin continence, potency, and biochemical progression at the follow-up period.

RESULTS

The classical extrafascial, interfascial, intrafascial and fascia sparing radical prostatectomy were performed in 31, 41, 200, and 62 cases, respectively. The mean operation time was 213.8±90.1minutes, and the mean estimated blood loss was 116.1±58.9cc during operation. A nerve-sparing procedure was performed bilaterally in 198 (59.3%) cases and unilaterally in 126 (37.7%) cases. The catheter was removed on postoperative day 9, 1±1.9. Surgical margin was positive in 36 (10.7%) patients. The overall, pT2, pT3a and pT3b PSM rates were 8 (2.4%), 12 (3.6%), 16 (4.8%) respectively and PSM and BCR rates were not statistically different among four approach (P>.05). At the follow-up period, the continence rates were 74.4%, 80.4%, 80.5%, and 96.7% (P<.001), and previously potent patients' potency rates were 64.3%, 66.6%, 68.1%, and 74.5% (P>.05), in classic extrafascial, interfascial, intrafascial, and fascia sparing intrafascial prostatectomy, respectively.

CONCLUSION

RARP is a safe and feasible technique in treatment of localized prostate cancer. Fascia sparing approach has better continence rate. This results need to be supported by new prospective, randomized studies.

Abdominal wall haemorrhage after robotic-assisted radical prostatectomy: is it a complication of robotic surgery?

OBJECTIVE

Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but hemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP.

PATIENTS AND METHODS

From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused hemodynamic instability after surgery were enrolled.

RESULTS

A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114 min. The mean estimated blood loss was 110 ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treatment without surgical exploration.

CONCLUSIONS

Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery.

Predictive value of umbilical artery Doppler for adverse perinatal outcome in patients with HELLP syndrome

OBJECTIVE

In this study, we aimed to evaluate in a prospective design the importance of pathologic umbilical artery (UA) Doppler findings as a predictive marker for neonatal outcome in patients with HELLP syndrome.

PATIENTS AND METHODS

A total of 45 pregnant women at 24-42 weeks of gestation with a diagnosis of HELLP syndrome were included. The study group consisted of 20 patients with abnormal UA Doppler results, and the remaining 25 HELLP syndrome patients with normal UA Doppler results were assigned to the control group. All patients were followed up until delivery, and the neonatal characteristics were compared.

RESULTS

Baseline characteristics of the groups were similar. In the study group, gestational week at delivery and infant birth weight were significantly lower (p < 0.05). The rates of significant neonatal morbidity, neonatal mortality, and neonatal intensive care unit (NICU) admission were significantly higher in study group patients (p < 0.05).

CONCLUSIONS

UA Doppler abnormalities can be considered predictive of poor neonatal prognosis in patients with HELLP syndrome, as they were significantly related with higher rates of neonatal mortality and significant morbidity.

Investigation of inflicted injury in a young girl reveals mild haemophilia A and Turner's syndrome

A 2-year-old girl presented to casualty with a right knee effusion after apparently minor trauma. Inflicted injury was suspected and full forensic coagulation studies were performed which revealed a mild deficiency of factor VIII. Screening of the exons and intron/exon boundaries of F8 gene indicated that the child appeared to be homozygous for the missense mutation c.5123G>A (p.Arg1708His) in exon 14 of the F8 gene. This mutation has been reported to be associated with mild haemophilia A. The possibility of hemizygosity had been masked by the test kit employed but referral to the genetics service and subsequent array CGH resulted in a diagnosis of Turner syndrome.

Treatment of pilonidal sinus by phenol application and factors affecting the recurrence

BACKGROUND

Phenol injection, a less invasive method, has become more popular for the treatment of sinus pilonidalis. Recurrence rates after the use of phenol have been reported to be less than those after other surgical methods.

METHODS

In this study, we applied 80% phenol to 143 patients with sinus pilonidalis. Patients were reevaluated at 1, 3, 6, 12 and 24 months after the phenolization procedure to search for any recurrences. Age, sex, skin color, occupation, hair distribution, complaints, macroscopic characteristics of the lesion, pouch volume, microbiological yield, complications of phenol injection, healing time, and recurrences were determined.

RESULTS

The mean follow-up period was 24 months and the recurrence rate was 8.3% (12 of 143 patients). Volume of the sinus tract and number of sinus orifices were determined to be the factors significantly affecting recurrences (p<0.05).

CONCLUSIONS

Injection of 80% phenol is an ideal approach for the conservative treatment of sinus pilonidalis. This study confirms that this is an effective and costless method with low recurrence rates.

Diagnostic features and treatment modalities in solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome (SRUS) is a traumatic lesion of the anterior or circular rectal wall caused by straining due to functional disorders of defecation. Defecography, transrectal ultrasonography or anorectal manometry are suitable procedures that may be used to detect the causative disorder and should, therefore, be performed in patients with solitary rectal ulcer syndrome. Histopathological features of SRUS are characteristic and pathognomonic, nevertheless the endoscopic and clinical presentations may be confusing. The lesions may mimic other rectal pathologies and lead to wrong diagnosis. We retrospectively evaluated 34 patients with SRUS who had various treatments. Rectosigmoidoscopy, defecography, transrectal ultrasonography and anorectal manometry were performed for evaluation of cases. The operative management was rectopexy in 26 patients, rectal mucosectomy in 4 patients, segmental colonic resection in 2 patients, local excision in 1 patient and colostomy in 1 patient. Total regression and healing of the ulcer occurred in 32 of 34 patients. Partial regression of symptoms in 2 patients, who underwent rectopexy and rectal mucosectomy, occurred, but we could not get complete healing.

The relationship of the heel pad compressibility and plantar pressure distribution

Loss of heel pad elasticity has been suggested as one of the possible explanations of heel pain. This study aimed to determine the effect of heel pad thickness and its compressibility to heel pressure distribution, in 47 (94 feet) normal subjects and 59 (94 feet) patients with heel pain, using radiological measurements and EMED-SF (Novel, Munich) plantar pressure distribution measurement system. Both heels of the patients and control group were radiographed with and without weight bearing. The ratio of the heel pad thickness in loading to unloading position was defined as "the heel pad compressibility index." The plantar peak pressure of the heel was measured at heel strike phase of the gait cycle. The compressibility index for control and patient groups were found to be 0.60 and 0.69, respectively. The peak pressure under the heel pad was recorded to be 28.4 N/cm2 for patients and 31.7 N/cm2 for control group. No significant difference was found for heel pad compressibility index and heel pad pressures between patient and control groups (p > 0.05). This study revealed that there is no relationship between heel pad compressibility and pressure distribution of the heel pad both in control and patient group. We feel the flexibility of the heel pad does not have any influence on heel pain syndromes.

Changes in regional cerebral blood flow demonstrated by single photon emission computed tomography in depressive disorders: comparison of unipolar vs. bipolar subtypes

Single photon emission tomography (SPECT) with 99mTc-HMPAO was used to compare regional cerebral blood flow (rCBF) in patients with unipolar and bipolar depression. The study group consisted of 10 unipolar depressed patients and seven bipolar depressed patients who met the DSM-III-R criteria for major depressive disorder (MDD). Nine physically and mentally healthy volunteers served as control subjects. SPECT images were obtained in the patients at two time points: (1) during the major depressive episode before patients had received medication; and (2) at the beginning of the remitted state while patients were receiving antidepressant medication. During the depressive episode, unmedicated unipolar depressed patients showed relatively increased left frontal rCBF compared both with the control subjects and the bipolar patients (P < 0.05). No significant differences in rCBF emerged between the bipolar patients and the control subjects. The data suggest that unipolar depressed patients, unlike bipolar patients, have relatively increased rCBF in the left frontal lobes during the depressive episode, but these differences tend to disappear during the period of remission.