Eosinophil cationic protein: A new diagnostic biomarker in coronary slow flow phenomenon

AIM

This study has investigated the role of eosinophil cationic protein (ECP), released by eosinophils, in the coronary slow flow phenomenon.

METHODS

This study included sixty patients with coronary slow flow (CSF) and sixty patients with normal coronary flow. The coronary flow rate was evaluated with TIMI frame count (TFC). ECP level, blood count and biochemical parameters were assessed.

RESULTS

The ECP levels (18.9±7.5 vs 13.1±6.4 ng/ml, p<0.001) and eosinophil counts (0.25±0.14 vs 0.18±0.09 10³/mm³, p=0.001) were higher in the CSF group. Multivariable regression analysis showed that ECP level and eosinophil counts were independent predictors the presence of CSF (p=0.003 and p=0.006). There was a weak but important correlation among the ECP level, eosinophil count and mean TFC (p=0.001, p=0.003, respectively). The ROC analysis showed a cut off value of 14.05 ng/ml for ECP level to diagnose CSF with 73.3 % sensitivity and 66.7 % specificity, and area under the ROC curve was 0.745 (95% CI: 0.657-0.833, p<0.001).

CONCLUSION

ECP levels were increased in CSF patients and this increasing correlated with coronary artery flow rates. The ECP level was independent predictor for the presence of SCF and it may be use as suitable diagnostic biomarker for CSF (Tab. 3, Fig. 3, Ref. 30).

Does arterial stiffness increase in patients with early surgical menopause?

Introduction

Surgical early menopause is early menopause due to medical reasons rather than the natural aging process. Pulse wave velocity (PWV) and augmentation index (AIx) are simple and non-invasive parameters for assessment of arterial stiffness. The aim of this study investigated the arterial stiffness in the surgical early menopause patients.

Method

We included 40 patient early surgical menopause and 40 control group patients with clinically and demographically similar characteristics. Oscillometric measurement method with Mobil-O-Graph 24h-ABPM NG® arteriography was used to measure the arterial stiffness and cardiovascular hemodynamic parameters.

Results

Of the 40 patients who underwent surgical early menopause, 27 (67.5%) had malignancy, 11 (27.5%) with myoma and 2 (5%) with bleeding. There were no differences in baseline demographic, laboratory, echocardiographic parameters and coronary artery disease risk factors.In terms of arterial stiffness parameters, PWV were significantly higher in the early surgical menopause group than in the control group (6.5±0.8; 5.6±1.2 p&lt;0.001), but there was no statistically significant difference in Alx (28.3±10.9; 27.4±9.0 p=0.69).Also, there was no statistically significant difference in terms of cardiac hemodynamic parameters and central aortic pressures.

Conclusion

When arterial stiffness is noninvasively evaluated by oscillometric method, it is significantly increased in surgical early menopause patients independent of other risk factors.

Funding Acknowledgement

Type of funding source: None

Efficacy of varicocelectomy in primary infertile patients with isolated teratozoospermia. A retrospective analysis

The present study assessed the results of varicocelectomy in patients with isolated teratozoospermia. Sixty-two infertile men with isolated teratozoospermia were evaluated retrospectively. There were significant improvements between preoperative and postoperative mean percentages of spermatozoa with normal morphology (1.15 ± 1.1% versus 2.3 ± 1.8%, p < .001) and spermatozoa with head abnormalities (92.9 ± 4.5% versus 88.6 ± 7.4%, p < .001). Nineteen (31%) patients had children through natural conception, 4 (6%) patients had children with assisted reproductive techniques and 39 (63%) patients had got no children within a mean follow-up period of 31.3 months. In patients who had children with natural conception, significant improvements were detected in postoperative mean percentages of spermatozoa with normal morphology (p < .001), head abnormalities (p < .001), neck/midpiece abnormalities (p = .003) and tail abnormalities (p = .007). When semen parameters of men who had children via natural conception was compared with the men with no children, we found that the percentage of spermatozoa with normal morphology was significantly higher (p = .008) and percentage of spermaztozoa with head anomalies was significantly lower (p = .019) in men who had children via natural conception. We believe that varicocelectomy is a beneficial surgical method for the treatment of isolated teratozoospermia and better postoperative rates of spermatozoa having normal morphology and head abnormalities are related with natural conception.

The relationship of neutrophil to lymphocyte ratio with testicular cancer

Purpose:

To assess the relationship between testicular germ cell tumors (TGCT) and neutrophil to lymphocyte ratio (NLR) and to determine whether this ratio can be used as a serum tumor marker.

Material and Methods:

Sixty-one patients with testicular germ cell tumors were included into the study. Patients were grouped as localized and non-localized. Histologically patients were categorized as seminoma and nonseminomatous germ cell tumors. Complete blood cell count was measured the day before surgery and at the postoperative 1st month. Preoperative and postoperative mean NLR values were compared.

Results:

Thirty-six patients (59%) had seminomas and 25 patients (41%) had nonseminomatous testicular cancer. Forty-five patients (73.8%) had localized and 16 patients (26.2%) had non-localized testicular cancer. There was a statistically significant difference between preoperative and postoperative mean NLR of the localized patients (p=0.001) but no such difference was detected for non-localized patients (p=0.576). Nineteen patients with localized seminomas had normal preoperative serum tumor markers. There was a significant difference between preoperative and postoperative mean NLR in this group of patients (p=0.010). Twenty-six patients with localized tumors had preoperative increased serum tumor markers which normalized after orchiectomy. Mean NLR of these patients significantly decreased from 3.10±2.13 to 1.62±0.59 postoperatively (p=0.010).

Conclusions:

NLR appears to be a useful marker for TGCT. It is successful in predicting localized and non-localized disease in early postoperative period.

Influence of blood contamination during multimode adhesive application on the microtensile bond strength to dentin

OBJECTIVES

The present study evaluated the effects of blood contamination performed at different steps of bonding on the microtensile bond strength (μTBS) of multimode adhesives to dentin when using the self-etch approach.

MATERIALS AND METHODS

Seventy-five molars were randomly assigned to three adhesive groups comprising 25 specimens each: two multimode adhesives [Single Bond Universal (SBU) and All-Bond Universal (ABU)] and a conventional one-step self-etch adhesive [Clearfil S3 Bond Plus (CSBP)]. Each group was subdivided as follows: (1) uncontaminated (control): bonding application/light curing as a positive control; (2) contamination-1 (cont-1): bonding application/light curing/blood contamination/dry as a negative control; (3) contamination-2 (cont-2): bonding application/light curing/blood contamination/rinse/dry; (4) contamination-3 (cont-3): bonding application/blood contamination/dry/bonding re-application/light curing; and (5) contamination-4 (cont-4): bonding application/blood contamination/rinse/dry/bonding re-application/light curing. Dentin specimens were prepared for μTBS testing after the composite resin application. Data were analyzed with two-way ANOVA and post-hoc tests (α = 0.05).

RESULTS

μTBS values were similar in cont-3 groups, and ABU/cont-4 and corresponding control groups, but were significantly lower in the other groups than in their control groups (P < 0.05). Cont-1 groups showed the lowest μTBS values (P < 0.05).

CONCLUSIONS

Neither decontamination method prevented the decrease in μTBS when contamination occurred after light curing. Drying the blood contaminants and reapplying the adhesive may regain the dentin adhesion when contamination occurs before light curing. Alternatively, rinsing and drying contaminants followed by adhesive re-application may be effective depending on adhesive type.

The force required to fracture endodontically roots restored with various materials as intra-orifice barriers

OBJECTIVE

To evaluate the effect of various materials as intra-orifice barriers on the force required fracture roots.

MATERIALS AND METHODS

One hundred-thirty five mandibular premolars were decoronated and prepared up to size #40. The root canals were filled and randomly divided into two control and seven experimental groups (n = 15), as follows: Positive control group (the intra-orifice barrier cavity was not prepared), negative control group (the intra-orifice barrier cavity was prepared, but not filled), filling using glass ionomer cement, nano-hybrid composite resin, short fiber-reinforced composite, bulk-fill flowable composite, MTA Angelus, Micro Mega MTA or Biodentine. A fracture strength test was performed, and the data were analyzed using one-way ANOVA and Tukey's post hoc tests.

RESULTS

Nano-hybrid composite, short fiber-reinforced composite, bulk-fill flow able composite, and glass ionomer cement increased the force required fracture the roots compared to the positive and negative control groups (P < 0.05). While MTA groups did not increase the force required fracture the roots compared to the control groups, Biodentine increased significantly.

CONCLUSIONS

Within the limitations of the present study, the use of nano-hybrid composite, short fiber-reinforced composite, bulk-fill flowable composite, and glass ionomer cement as an intra-orifice barrier may be useful in reinforcing roots. MTA placement (MTA Angelus or Micro Mega MTA) did not significantly increase the fracture resistance of endodontically treated roots compared to the control groups, however Biodentine did.

Effectiveness of laser-assisted irrigation and passive ultrasonic irrigation techniques on smear layer removal in middle and apical thirds

The purpose of this study was to investigate the evaluation of laser-assisted irrigation (LAI) on the removal of the smear layer as compared to passive ultrasonic irrigation (PUI). Forty-eight single-rooted, upper-central incisor teeth were selected and prepared with ProTaper rotary instruments up to size #40 (F4) at the working lengths. Specimens were divided into four groups, as follows: (a) PUI with 5 mL of 2.5% NaOCl for 60 s; (b) PUI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s; (c) LAI with 5 mL of 2.5% NaOCl for 60 s; and (d) LAI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s. In the PUI groups, the ultrasonically activated file was inserted 1 mm short of the working length, but in the LAI groups, the fiber tip was applied into the pulp chamber. LAI in the pulp chamber with the combination of 17% EDTA and 2.5% NaOCl removed more of the smear layer than the other groups (p < 0.018). LAI in the pulp chamber with the combination of 2.5% NaOCl and 17% EDTA better removed the smear layer than LAI applied similarly but without EDTA or PUI with the same NaOCl and EDTA combinations using an ultrasonically activated file inserted 1 mm short of the working length.

Endoscopic guided additional access for staghorn calculi

BACKGROUND AND PURPOSE

Flexible nephroscopy is an important technique in the management of staghorn renal calculi to reach peripheral calices. In this study, we present our experience with flexible nephroscopy and fluoroscopy-guided additional access creation for staghorn renal calculi.

PATIENTS AND METHODS

We conducted a retrospective analysis of patients with staghorn renal calculi who were treated with multiple percutaneous renal tracts created with the guidance of flexible nephroscopy and fluoroscopy. Additional tracts were performed with combined flexible nephroscopy and fluoroscopy guidance. Flexible nephroscopy was used to help target the calix and ensure the safety of access.

RESULTS

Additional percutaneous renal access was achieved using combined flexible nephroscopy and fluoroscopy guidance in 26 patients with complete staghorn (n=21) and partial staghorn (n=5) kidney stones. The cumulative stone size was 59.3 mm. The mean procedure times, fluoroscopy times, and hospitalization times were 91.5 minutes, 3.4 minutes, and 2.7 days, respectively. The postoperative hematocrit drop was 4.96±3.8. Upper and lower calices were the most common primary access tracts in 11 and 15 patients, respectively. Stone-free status was achieved in 22 (84.6%) patients with a mean 2.1±0.3 tract number. Postoperative complications were observed in six (23.1%) patients.

CONCLUSIONS

In the requirement of additional access for staghorn renal calculi, use of flexible nephroscopy with fluoroscopy increases the safety of the procedure by confirmation of precise renal access.

Laparoscopic decortication of hilar renal cysts using LigaSure

Background and Objectives:

In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts.

Methods:

Seventeen patients underwent laparoscopic decortication of hilar renal cysts with the LigaSure system. Our study included only symptomatic, Bosniak type 1, simple and symptomatic renal cysts. The operative route, transperitoneal or retroperitoneal, was planned according to the location confirmed by computed tomography. The patients' symptoms were preoperatively and postoperatively evaluated by the Wong-Baker visual pain scale. Operative measures and radiologic outcomes were prospectively evaluated.

Results:

The mean age of the patients was 56.4 years, and the mean follow-up period was 12.5 months. Preoperative computed tomography showed only a single cyst in 15 patients (88.2%) and showed two separate cysts in 2 cases (11.8%). The cysts were located in the perihilar region close to the vascular structure in all patients. A transperitoneal approach was used in 9 patients, and a retroperitoneal approach was used in 8 patients. The mean operative time and hospitalization time were 56.4 minutes and 1.2 days, respectively. Minor complications were observed in 3 patients. Symptomatic and radiologic success rates of 94.2% and 100%, respectively, were achieved.

Conclusion:

Laparoscopic decortication of symptomatic hilar renal cysts—first reported in the literature in this study—using the LigaSure sealing system is feasible, effective, and safe, even if the cyst is located in the perihilar area.

Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy

The micro-percutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that is performed through a 4.8 Fr all-seeing needle. We aimed to measure the intrarenal pelvic pressure (IPP) during microperc and compare it with the levels of conventional PNL. A total of 20 patients with 1- to 3-cm renal calculi resistant to shock wave lithotripsy were treated either with microperc (Group-1, n: 10) or conventional PNL (Group-2, n: 10) by the same surgical team. The IPP was measured during different stages (entrance into the collecting system, stone fragmentation, and before termination) of the procedures by an urodynamic machine using the 6 Fr ureteral catheter. All the variables were statistically compared between the two groups. The demographic values of the patients were similar. The operation time and duration of hospitalization were significantly prolonged in conventional PNL group (p = 0.034, p = 0.01, respectively). The mean drop in hematocrit levels was significantly lower in microperc group (3.5 ± 1.5 vs. 1.8 ± 0.8; p = 0.004). The IPP was significantly higher in microperc group during all steps of the procedure. The highest level of the IPP was measured as 30.3 ± 3.9 and 20.1 ± 3.1 mmHg in Group 1 and Group 2, respectively (p < 0.0001). However, the complication and success rates were found comparable. In conclusion, we demonstrate that the level of IPP is significantly increased during microperc compared to conventional PNL. Microperc should be used cautiously in cases with impaired drainage of the collecting system.

The all-seeing needle instead of the Veress needle in pediatric urologic laparoscopy

PURPOSE

To investigate the feasibility of the all-seeing needle for safe entry and creation of pneumoperitoneum in pediatric urologic laparoscopy.

PATIENTS AND METHODS

A total of 14 children underwent various transperitoneal urologic laparoscopic procedures. The all-seeing needle, which is 4.85F in diameter, was used for safe entry into the abdominal cavity at the site of the umblicus in all cases. The microoptic was integrated with the light system and connected via a zoom ocular enabling direct visualization of the layers between the skin and the peritoneal cavity. Once the intraperitoneal access was obtained, CO2 pneumoperitoneum was created from one port of the three-way connector attached to the proximal part of the needle. Then the laparoscopic trocars were placed under vision of the microoptical system.

RESULTS

Mean age of the children was 4.5 ± 2.9 years. In all children, the all-seeing needle was safely introduced into the abdominal cavity under direct vision. Then, CO2 pneumoperitoneum was succesfully performed. The mean time for optical puncture was calculated as 1.1 ± 0.8 minutes. No complication was encountered during the introduction of the needle, creation of the pneumoperitoneum, and placement of the trocars.

CONCLUSIONS

The all-seeing needle appears to be beneficial in safe entry and for creating pneumoperitoneum in laparoscopic pediatric urology cases. It eliminates the disadvantages of the Veress needle, which is blunt insertion, and may possibly prevent complications.

Comparison of flexible and rigid cystoscopy-assisted ureteral catheter insertion before percutaneous nephrolithotomy: a prospective randomized trial

BACKGROUND AND PURPOSE

To compare the advantages of flexible and rigid cystoscopy-assisted ureteral catheter placement before prone percutaneous nephrolithotomy (PCNL).

PATIENTS AND METHODS

From March to September 2012, a total of 80 patients with kidney stones underwent PCNL by the same surgical team. The patients were randomly assigned into one of the groups according to the technique used for ureteral catheter insertion: Flexible cystoscopy (group 1, n=40) or rigid cystoscopy (group 2, n=40). Patient demographics and operation-related factors were compared. The preparation period included positioning, cystoscopy-assisted stent insertion, and patient repositioning for PCNL. In addition, discomfort scores of the operating room (OR) staff were measured.

RESULTS

The demographic values of the groups in terms of patient sex, age, body mass index, and stone size were comparable. While the mean preparation period was calculated as 9.9±2.3 minutes in the flexible cystoscopy group, it was significantly longer (19.7±2.9 minutes) in the rigid cystoscopy group (P<0.0001). In addition, the discomfort score of the OR staff was found to be significantly higher in the rigid cystoscopy group (1.1±0.9 vs 2.05±0.68, P<0.0001). The rest of the operative and postoperative parameters were similar.

CONCLUSIONS

The insertion of a ureteral catheter with a flexible cystoscope before prone PCNL shortens the preparation period and minimizes the discomfort of OR staff related to patient positioning and transfer.

Is the Percutaneous Nephrolithotomy Procedure Complicated in Patients with Anterior Caliceal Stones?

<b><i>Objectives:</i></b> It was the aim of this study to evaluate and compare the outcomes of percutaneous nephrolithotomy (PNL) for the treatment of posterior and anterior caliceal stones. <b><i>Patients and Methods:</i></b> We performed a retrospective analysis of 86 patients with isolated caliceal stones who underwent PNL between 2011 and 2012. The patients were classified into two groups according to the localization of the stone, either in the anterior (group 1, n = 41) or posterior (group 2, n = 45) calyx, on axial plane computed tomography. <b><i>Results:</i></b> The mean age, male/female ratio and stone size and location were similar in both groups. Fluoroscopy, operation time and duration of hospitalization were also similar between groups. Patients in group 1 had a greater postoperative hemoglobin drop than patients in group 2. Blood transfusion was required for 5 patients in group 1 and for 4 patients in group 2. In addition, open conversion was required for 2 patients in group 1 during the early postoperative period because of extensive bleeding. Hemodynamics were stabilized with angioembolization in 2 patients with prolonged hematuria in group 1. The overall success and complication rates were similar in both groups. <b><i>Conclusion:</i></b> Although the postoperative hemoglobin drop did not significantly differ between groups, hemorrhaging was more severe in patients with anterior caliceal stones than in those with posterior caliceal stones.

Laparoscopic-assisted "microperc" of a stone in a pelvic kidney of a 3-year-old girl

Treatment of kidney stones in pelvic ectopic kidneys of children is a challenging procedure for urologists. Herein we report a case of laparoscopy-assisted "microperc" in a 3-year-old girl with a stone in her pelvic ectopic kidney. This micro-optical system is helpful in confirming the percutaneous access and provides the possibility of fragmenting the stone without the necessity of dilating the tract.

Micropercutaneous nephrolithotomy in the treatment of moderate-size renal calculi

PURPOSE

We present our initial experience with microperc in patients with moderate-size renal calculi.

PATIENTS AND METHODS

A retrospective analysis of 30 patients (male 14, female 16) with moderate-size (1-3 cm) kidney stones who underwent microperc between August 2011 and July 2012 was performed. The demographic values, perioperative and postoperative measures including age, stone size and location, body mass index, operative and fluoroscopy time, hemoglobin decrease, success and complication rates were prospectively recorded into a patient entry system.

RESULTS

The average stone size was 17.9±5.0 mm (10-30 mm). The mean age of the patients was 41.5±18.2 years (range 3-69 years). The duration of the operation was calculated as 63.5±36.8 minutes (range 20-200 min). Mean fluoroscopic screening time was 150.5±90.4 seconds (range 45-360 seconds). The patients were discharged after a mean hospitalization period of 35.5±18.6 hours (range 14-96 hours). An overall success rate of 93% (including 10% of insignificant residual fragment rate) was achieved. In the follow-up, residual stone fragments were detected in two (7%) patients. Conversion to miniperc was necessitated in three (10%) patients. The mean hemoglobin drop was found to be 1.1±0.8 mg/dL (range 0-2.8 mg/dL). Complications were observed in five (13.3%) patients.

CONCLUSIONS

Our initial results provide that microperc is a feasible, safe, and efficacious treatment modality for moderate-size kidney stones as well as small ones with its minimally invasive nature. Technical refinements are needed to achieve better results and overcome the limitations of technique.

The role of microperc in the treatment of symptomatic lower pole renal calculi

BACKGROUND AND PURPOSE

The treatment of symptomatic lower pole (LP) calculi poses a challenge because of lower clearance rates. We present our experience with microperc in the treatment of LP renal calculi.

PATIENTS AND METHODS

We retrospectively evaluated the symptomatic patients with LP renal calculi who underwent microperc between August 2011 and June 2012 from two referral hospitals. Patients were included only in cases of failure after shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) and according to patient preference. The percutaneous renal access was performed using the 4.8F "all-seeing needle" with C-arm fluoroscopy or ultrasonographic guidance with the patient in the prone position. Stone disintegration was established using a 200 μm holmium:yttrium-aluminum-garnet laser fiber.

RESULTS

A total of 21 patients (mean age 37.3 ± 20.1 years) with LP stone underwent microperc. The mean body mass index was 28.6 ± 6.0 kg/m(2), and the mean stone size was 17.8 ± 5.9 (9-29) mm. The duration of surgery and fluoroscopic screening was 62.8 ± 25.2 minutes and 150.5 ± 92.8 seconds, respectively. The patients were discharged after a mean 37.5 ± 14.4 hours of hospitalization time. The mean hemoglobin drop was 0.8 ± 0.6 (0.1-2.3) g/dL. Conversion to miniperc was necessitated in one patient with loss of vision. Stone-free status was achieved in 18 (85.7%) patients. Clinically insignificant residual fragments were observed in only one (4.8%). The procedure failed in two (9.5%) patients. A total of two minor complications (renal colic necessitating stent insertion and urinary tract infection) were observed postoperatively, none severe.

CONCLUSION

Microperc is a feasible and efficient treatment modality for symptomatic LP calculi. Our results provide that microperc might take a part in case of SWL and RIRS failures or as an alternative to percutaneous nephrolithotomy or RIRS in the management of symptomatic LP calculi.

Correlation between the resistive index values of renal and orbital arteries

BACKGROUND

Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage.

AIMS

The purpose of this study is to evaluate the association between RI values of orbital and intrarenal arteries by means of Doppler ultrasonography (US).

METHODS

We evaluated 103 diabetic patients. As a control group, 30 subjects were examined. The patients were divided into two groups. Group 1 consisted of patients with urinary albumin excretion (UAE) <300 mg/day and estimated glomerular filtration rate (eGFR) levels >90 ml/min (n = 50); Group 2 had a UAE >300 mg/day and/or eGFR levels between 89 and 60 ml/min (n = 53). The association between RI values obtained with Doppler US of the ophthalmic artery, central retinal artery, posterior ciliary artery and intrarenal arteries were calculated.

RESULTS

Both orbital and intrarenal arterial RI values in Group 1 and Group 2 were higher than the control group (p = 0.001); furthermore, values were higher in Group 2 than in Group 1 (p = 0.0004/0.029/0.036, p = 0.016, respectively). A positive correlation was found between orbital and intrarenal arterial RI values in Group 2 (r = 0.475, 0.285, 0.363, p < 0.01, respectively).

CONCLUSION

Both orbital and renal arterial RI values were shown to be higher than the control group. Further, a trend towards higher RI values was observed with renal disease. RI may be useful as one of the markers for early diagnosis and follow-up of diabetic nephropathy and retinopathy.

Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis

PURPOSE

The aim of our study was to evaluate the outcomes of retrograde intrarenal surgery (RIRS) in elderly patients with stones of moderate size.

PATIENTS AND METHODS

Between September 2008 and June 2011, a total of 28 patients over 65 years of age with single renal stones that measured 1.5 to 3 cm were treated with RIRS. The outcomes of these patients were compared with those of the patients who underwent percutaneous nephrolithotomy (PCNL) using matched-pair analysis (1:1 scenario). The matching parameters were the size and location of the stone as well as age, sex, body mass index, degree of hydronephrosis, presence of previous shockwave lithotripsy, and open surgery. SPSS version 16 was used for statistical analysis.

RESULTS

Stone-free rates after a single procedure were achieved in 82.1% of patients for the RIRS and 92.8% of patients for the PCNL group. The second flexible ureterorenoscopy procedure was performed for five patients in the RIRS group. Finally, stone-free rates during the third month of the follow-up period were 92.8% in the RIRS group and 96.4% in the PCNL group. The mean operative time per patient was 64.5 ± 20.9 minutes in the RIRS group after a total of 33 procedures, while it was 40.7 ± 10.7 minutes in the PCNL groups (P<0.0001). The overall complication rates for the RIRS and PCNL groups were 7.1% and 10.7%, respectively. Blood transfusions were needed in two patients in the PCNL group. Hospitalization time was significantly shorter in the RIRS group (26.5 ± 10.6 h per patient vs 60.0 ± 28.8 h; P<0.0001). In both groups, stones were most frequently composed of calcium oxalate (68.4% in the RIRS group and 77.7% in the PCNL group).

CONCLUSION

RIRS has a low complication rate and represents a safe and effective treatment alternative in selected geriatric patients with kidney stones of moderate size.

Variables that influence operative time during percutaneous nephrolithotomy: an analysis of 1897 cases

BACKGROUND AND PURPOSE

Operative time is an important perioperative factor and is related to postoperative complications and procedural cost-effectiveness. There are few studies, however, investigating factors that affect operative time during percutaneous nephrolithotomy (PCNL). In this study, patient and kidney stone-related factors that influence operative time were analyzed.

MATERIALS AND METHODS

Clinical records from 1897 patients with renal calculi who underwent PCNL were retrospectively reviewed, and these patients were divided into two groups based on their median operative time (group 1: ≤60 min; group 2: >60 min). Multivariate analyses as well as univariate analyses including chi-square, Fisher exact and Mann Whitney U tests were used to investigate the effects of independent variables on operative time, including patient and kidney stone-related factors such as age, sex, body mass index, history of ipsilateral open surgery, shockwave lithotripsy, presence of hydronephrosis, stone burden, stone type and opacity, and surgical experience.

RESULTS

The mean operative time was 64.9±27.6 minutes (range 10-220 min). Univariate analyses determined that a history of open surgery, presence of hydronephrosis, stone type and size, and surgical experience correlated with operative time (P<0.05 for all). Multivariate analyses revealed that presence of hydronephrosis (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.17-1.78, P=0.002), stone type (OR: 2.12, 95% CI: 1.69-2.70, P<0.0001), stone burden (OR: 2.44, 95% CI: 1.85-3.12, P<0.0001), and surgical experience (OR: 0.56, 95% CI: 0.46-0.70, P<0.0001) were significant independent factors in influencing operative time.

CONCLUSIONS

Presence of hydronephrosis, renal stone size and type significantly affect the operative time during PCNL. The duration of the operation was also observed to decrease with increased surgical experience.

Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience

PURPOSE

To investigate variables that affect bleeding during percutaneous nephrolithotomy (PCNL), focusing on the experience of a single surgeon.

PATIENTS AND METHODS

The records of 649 PCNL procedures that were performed by the same surgeon were reviewed retrospectively. The effect of surgical experience; patient and stone-related factors, including age, sex, hypertension, and diabetes, serum creatinine level, history of ipsilateral renal procedures, stone surface area and type, degree of hydronephrosis, preoperative hemoglobin level; operative factors, such as the calix of puncture, number of accesses, operative time; and intraoperative complications, such as pelvicaliceal system perforation on bleeding (described as decrease in hemoglobin level and need for blood transfusion), were investigated. For statistical assessment, univariate analyses and multivariate stepwise regression analyses were used.

RESULTS

A 92.3% success rate was achieved after one session PCNL. The overall blood transfusion rate was 10.8%. The number of accesses, stone type, diabetes, preoperative hemoglobin level, and operative time were the most important factors for blood transfusion requirement. In the receiver operating characteristic curve, the best cutoff point of operative time was 58 minutes for the blood transfusion requirement. Multivariate stepwise regression analyses showed that there was an association between diabetes, operative time, number of accesses, and stone type with the decrease in hemoglobin levels. No correlation between surgical experience and decrease in hemoglobin level as well as blood transfusion necessity was found.

CONCLUSIONS

Depending on the results achieved by a single surgeon, multiple access tracts, staghorn calculi, presence of diabetes, and prolonged operative time, but not surgical experience, significantly increased blood loss during PCNL.

Rare mechanical complication of myocardial infarction: isolated right ventricle free wall rupture

Rupture of the left ventricular free wall is a dramatic complication of acute myocardial infarction (MI) and occurs in about ten percent of patients with fatal acute MI. However, there are limited reports about right ventricular free wall rupture due to MI. In this case report, a patient with isolated right ventricular rupture following MI that was visualised with real-time transthoracic echocardiography is discussed for the first time in the literature.

Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children

OBJECTIVES

Management of ureteral stones in children represents a challenging problem. In this study, we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (ESWL) in 192 children with ureteric stones.

METHODS

Between 1990 and 2003, 192 children (<or= 14 years old) with ureteric calculi were treated with the Siemens Lithostar Plus (Siemens Medical Systems, Iselin, NJ). There were 39 stones in the proximal ureter, 19 in the mid-ureter and 134 in the distal ureter.

RESULTS

Mean patient age was 7.3+/-4.1 years (6 months-14 years). There were 122 boys (64.2%) and 70 girls (35.8%). All procedures were performed on an outpatient basis with intravenous sedation in 73 cases (38.1%), general anesthesia in 68 cases (35.7%) and no anesthesia in 51 cases (26.2%). A maximum of 3500 shocks and 18 kV per session were used. A 94% success rate was achieved in proximal (n: 39) and mid-ureteral stones (n: 19). Stone free rates for distal ureteral calculi were 90.6% for stones less than 1 cm in diameter (n: 94) and 91.7% for stones between 1 and 2 cm (n: 26). Overall re-treatment and efficacy quotient rates for proximal ureteral stones were 45.1% and 68.9%, 62.5% and 61.5% for mid-ureteral calculi, and 49.6% and 60.0% for distal ureteral stones.

CONCLUSION

Our results indicate that ESWL with highly satisfactory stone free rates ranging between 90 and 100% and negligible complications can be considered as a first line treatment for ureteric stones in the pediatric age group.

The Effects of Transcranial Electrical Stimulation on Anaesthesia and Analgesia in Rats

In this study, we determined the effects of transcranial electrical stimulation (TCES) on the anaesthetic requirements of thiopental and the analgesic requirements of remifentanil, in rats. The experiments were performed on 120 albino male Wistar rats, which were randomly allocated to four groups (n=30). (Thiopental, Thiopental+TCES, Thiopental+Remifentanil, and Thiopental+Remifentanil+TCES). Animals were anaesthetized with thiopental, and 15 min later, remifentanil was injected to rats in the Remifentanil groups. TCES was started in the stimulated groups 20 min after thiopental administration. Rats were stimulated 5 times for this experiment. The times for recovery, herein called Cognition Recovery Time and Motion Recovery Time were measured. Cognition Recovery and Motion Recovery Times were not affected by the stimulation. Analgesia was assessed using the wet tail-flick latency (TFL). In the Thiopental group, the analgesia level returned to control values on the 35th min. In the Thiopental+Remifentanil group, the analgesia level returned to control values on the 50th min. In the Thiopental+ TCES group, the analgesia level reached the peak value on the 65th min. In the Thiopental+Remifentanil+TCES group, the analgesia level reached the peak value on the 35th min and analgesia remained high during the 90 min after cessation of the stimulation. The analgesic potency for the Thiopental+Remifentanil+TCES group was increased by 30-40% when compared with the prior TFL values, 160% when compared with the control group, and 50-75% when compared with Thiopental+TCES group on the 35th min (P<0.001). In conclusion, TCES markedly decreases the anaesthetic and analgesic requirements for thiopental and remifentanil in rats.