Robotic surgery for malignant and large adrenal masses: A doable and safe option

Background

Laparoscopic adrenalectomy is currently considered the gold standard method for adrenal surgery. Open surgery is the most frequent technique preferred amongst surgeons who are faced with tumours of larger sizes or challenging lesions. Despite the increasing interest in laparoscopy, most centres still utilise open surgery for challenging adrenal cases.

Patients

and Methods

We retrospectively evaluated our successive 30 robotic adrenalectomies performed in the past 10 years and assigned the patients into 'difficult' and 'easy' groups. Patients with malignant tumours or tumour size of over 8 cm were assigned to the 'difficult group' and others to the 'easy group'. Groups were evaluated according to the demographic features of the patients, side of the operation, the body mass index (BMI) and laparotomy history. The duration of anaesthesia, amount of bleeding during surgery and the hospitalisation periods were also evaluated.

Results

There is no statistically significant difference between the two groups considering age, gender, BMI value, operation side, presence or absence of a laparotomy history, the amount of bleeding during the operation and hospitalisation duration (P > 0.05). The anaesthesia duration was found to be higher in the 'difficult' patient group (P < 0.05).

Conclusion

Our results present robust evidence to support the idea that robotic adrenalectomy is not only a doable but also a safe option for malignant and large adrenal masses.

Use of relative motion splint in extensor mechanism repairs: a retrospective case series

This case series determines the clinical outcomes of relative motion extensor splints (RMES) in extensor mechanism repairs. Nine patients who underwent extensor tendon repair, juncturae tendinum or sagittal band repair were included. A forearm-based volar blocking wrist splint was applied after surgery. The RMES was configured at the initial hand therapy appointment. Total active motion (TAM) at 4 and 8 weeks after surgery and return to work were assessed. There were 7 males and 2 females with a mean age of 28 (16-53 years). The mean TAM of the uninjured digits was 270° (245°-290°). The mean TAM of the injured digits was 209° (125°-275°) at week 4 and 245° (185°-290°) at week 8. The mean return to work time was 25 days. None of the patients had tendon ruptures and required secondary procedures. In our study, active movement with RMES was allowed immediately after surgery. The RMES program supported safer and earlier recovery of motion. All patients were able to perform activities of daily living while wearing the splint.

Immunoexpression of p38 Mitogen-Activated Proteinkinase in Patients with Aggressive and Chronic Periodontitis

The influence of p38 mitogen-activated proteinkinase (MAPK) expression in the development and progression of periodontal disease is currently under investigation. The aim of the present study is to investigate whether the p38 MAPK expression in gingival tissues correlates with IL-1β levels in gingival crevicular fluid (GCF). Twenty patients with generalized aggressive periodontitis (GAgP), 15 patients with generalized chronic periodontitis (GCP) and 10 healthy subjects (H) were enrolled in the study. Clinical data, gingival tissue biopsies and GCF samples were collected. The expression of p38 was investigated by immunohistochemistry. The levels of IL-1β in GCF were measured using ELISA. Mean clinical parameters and GCF volumes were statistically higher in patients with GAgP and GCP compared to H subjects. Higher levels of IL-1β were found in both periodontitis groups. The p38 expression was significantly increased in inflamed gingival tissues. There were no statistically significant differences in levels of IL-1β and p38 expression between subjects with GAgP and GCP. Our data support the hypothesis that MAPK signaling pathway is an additional player in the pathogenesis of periodontitis. This is the first report to evaluate the involvement of p38 MAPK in patients with GAgP and GCP which might be, in part, considered of value in understanding disease mechanisms.

Femoral pseudoaneurysm in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: incidence, clinical course and risk factors

AIM

Various peripheral vascular complications may be observed after cardiac catheterization. However, no data are available about femoral pseudoaneurysm (FPA) after urgent primary percutaneous coronary intervention (PCI). We sought to determine the in-hospital incidence, clinical course and predictors of FPA in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI.

METHODS

Two thousand six hundred consecutive STEMI patients (mean age: 56.5 ± 11.7 years; 2158 men) undergoing primary PCI were retrospectively enrolled into this study. Patients were evaluated with Doppler ultrasonography following PCI and categorized into two groups according to whether FPA developed or not. All the parameters were compared between FPA and non-FPA groups.

RESULTS

The incidence of FPA after primary PCI was determined to be 2.3%. The mean age was higher in the FPA group compared to the non-FPA group (mean age: 60.6 ± 11.6 vs. 56.5 ± 11.8, respectively, P=0.007). Furthermore, the FPA developing group experienced prolonged hospitalizations compared to the non-FPA group, but no differences in in-hospital or long term mortality were noticed. In the multivariate analysis of this study, female gender and age (>75 years), after primary PCI, were found to be independent predictors of FPA.

CONCLUSION

High incidence of FPA was noticed in STEMI patients undergoing primary PCI, which prolonged in-hospital stay. Extra care must be given, especially to women and those who are >75 years of age, for this complication.

An algorithm to predict risk of type 2 diabetes in Turkish adults: contribution of C-reactive protein

BACKGROUND AND AIM

An algorithm for predicting Type 2 diabetes (DM) risk in a population with prevalent metabolic syndrome (MetS) is needed since ethnicity influences the pathogenesis of DM.

MATERIAL AND METHODS

The 8- yr risk of DM was estimated in 2261 middle-aged Turkish adults free of DM at baseline who were followed for over 7.6 yr. DM newly developed in 212 subjects. Cox proportional hazard regression and 15 variables were used to predict DM. Discrimination was assessed with area under receiver operating characteristics curve (AROC).

RESULTS

In multivariable analysis, height, family income brackets, systolic blood pressure, smoking status, alcohol usage, and HDL-cholesterol levels were not predictive in either sex. In addition to sex, family history of DM, fasting glucose, and waist circumference were predictors, in men, age and non-HDL-cholesterol, while in women physical inactivity and serum C-reactive protein were so. AROC of the final model was 0.783 in men, 0.772 in women (p<0.001 each). An algorithm using the stated 7 variables was developed separately for each sex. Men and women in the top quintile of risk score were, respectively, 20 and 50 times and significantly more likely to develop DM than those in the bottom quintile. The predictive value of the algorithm was validated in 2 split samples.

CONCLUSIONS

A marker of low grade inflammation provides useful predictive ability beyond other simple predictors in a female population with MetS prevailing. The derived simple algorithm may be useful in estimating the 8-yr risk of DM among middle-aged Turkish men and women.

Serum apolipoprotein C-III in high-density lipoprotein: a key diabetogenic risk factor in Turks

AIMS

We studied determinants of serum apolipoprotein C-III (apoC-III) and whether levels of apoC-III or its fractions predict metabolic syndrome (MetS), Type 2 diabetes and coronary heart disease (CHD).

METHODS

The predictive value of apoC-III, measured by immunoturbimetric immunoassay in 802 tracked individuals of a Turkish general population in determining cardiometabolic risk was assessed over 4.4 +/- 1.2 years' follow-up. Patients with MetS, Type 2 diabetes and CHD at baseline were excluded.

RESULTS

Total apoC-III, as well as both fractions, was significantly, linearly and inversely related to smoking status, positively to alcohol usage and to levels of complement C3. Mid and high tertiles of total or non-high density lipoprotein (HDL) apoC-III predicted significantly and independently incident MetS; they predicted CHD with risk ratios of 1.6 [95% confidence intervals (CI) 1.02-2.5], for 1 sd increment, after adjustments that included HDL cholesterol and body mass index (BMI). The highest tertile of HDL apoC-III was a major independent predictor of new-onset diabetes with a 2.5-fold risk ratio for 1 sd increment (95% CI 1.5-4.0) in combined sexes, after adjustment for waist circumference, HDL cholesterol and other confounders and was a better predictor than waist girth.

CONCLUSIONS

Serum total apoC-III or its fractions are linearly and inversely associated with smoking, positively with alcohol usage and serum complement C3. The presumably dysfunctional HDL apoC-III is a stronger predictor of Type 2 diabetes than waist girth in Turks. Non-HDL apoC-III predicts strongly the development of MetS as well as incident CHD, independent of HDL cholesterol, BMI and non-lipid factors. The atherogenicity of apoC-III and dysfunctionality of HDL apoC-III carry huge public health implications in Turks.

Three dimensional monitoring of urban development by means of ortho-rectified aerial photographs and high-resolution satellite images

Nowadays, cities are developing and changing rapidly due to the increases in the population and immigration. Rapid changing brings obligation to control the cities by planning. The satellite images and the aerial photographs enable us to track the urban development and provide the opportunity to get the current data about urban. With the help of these images, cities may have interrogated dynamic structures. This study is composed of three steps. In the first step, orthophoto images have been generated in order to track urban developments by using the aerial photographs and the satellite images. In this step, the panchromatic (PAN), the multi spectral (MS) and the pan-sharpened image of IKONOS satellite have been used as input satellite data and the accuracy of orthophoto images has been investigated in detail, in terms of digital elevation model (DEM), control points, input images and their properties. In the second step, a 3D city model with database has been generated with the help of orthophoto images and the vector layouts. And in the last step, up to date urban information obtained from 3D city model. This study shows that it is possible to detect the unlicensed buildings and the areas which are going to be nationalized and it also shows that it is easy to document the existing alterations in the cities with the help of current development plans and orthophoto images. And since accessing updated data is very essential to control development and monitor the temporal alterations in urban areas, in this study it is proven that the orthophoto images generated by using aerial photos and satellite images are very reliable to use in obtaining topographical information, in change detection and in city planning. When digital orthophoto images used with GIS, they provide quick decision control mechanisms and quick data collection. Besides, they help to find efficient solutions in a short time in the planning applications.