Prospective Evaluation of Ipsilateral and Contralateral Renal Blood Flow During Retrograde Intrarenal Surgery.

OBJECTIVES: To evaluate the changes of peak systolic velocity(PSV), end-diastolic velocity(EDV), and resistive index(RI) of renal and arcuate arteries at the ipsilateral and contralateral kidneys during the retrograde intrarenal surgery. METHODS: The patients who had RIRS for the treatment of renal stones were prospectively included in the study. An experienced radiologist performed doppler ultrasonography of the ipsilateral and contralateral kidney before the surgery just after the anesthesia and at the end of the surgery before stenting. The PSV, EDV, and RI of renal and arcuate arteries at the ipsilateral and contralateral kidneys were measured. RESULTS: A total of 53 patients were included in the study. The postoperative mean PSV, EDV, and RI of renal arteries at the ipsilateral and contralateral arteries were similar to preoperative values. The mean PSV and RI of the arcuate arteries at the ipsilateral kidney significantly increased postoperatively (P = 0.032, P = 0.012) The postoperative mean PSV, EDV, and RI of arcuate arteries did not change significantly during the surgery. The age, gender, and flexible ureteroscopy time did not affect the change of renal and arcuate arterial PSV, EDV, and RI at the ipsilateral and contralateral kidneys. CONCLUSION: The elevation of intrarenal pressure during RIRS did not change the blood flow at the major arteries of the ipsilateral and contralateral kidneys. On the other hand, there was a significant increase at the RI of the arcuate arteries in the ipsilateral kidney which was proposed to be related to the vasoconstriction of minor vasculature of the kidney.

Vagus nerve assessment via ultrasonography in irritable bowel syndrome. Are there any changes of dimension in the vagus nerve?

BACKGROUND/AIM: Irritable bowel syndrome (IBS) is the functional gastrointestinal disorder which has closely relationship with Central Nervous System (CNS). VN is the major connector between CNS and Enteric Nervous System (ENS). The aim of this study was to investigate the possible changes of dimension of Vagus Nerve (VN) with Vagus ultrasonography (VU) in IBS. MATERIAL AND METHODS: A total 119 patients which is consisted of 66 IBS patients appropriated with Rome IV criterias and 53 patients of control group were enrolled to the study. All patients were underwent to colonoscopy for role-out the organic pathologies, such as polyposis, inflammatory bowel syndromes, diverticulosis and colon cancer. Right Vagus (RV) and left Vagus (LV) nerve areas and diameters were calculated with VU. RESULTS: There were no statistical difference of RV (p=0.445) and LV (p=0.944) diameter between two groups. There were also no statistical difference of RV (p=0.549) and LV (p=0.874) areas between IBS and control groups. CONCLUSION: VU clearly depicted that there is no changes of dimension in VN areas and diameters in the IBS. This might show that VN is only a transporter of abnormal neuronal stimulations according to IBS pathophisiology.

Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions?

PURPOSE: In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods. METHODS: From July 2015 to December 2016, a total of 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed. RESULTS: After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015). CONCLUSION: BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.

Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures

ABSTRACT Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.

Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures.

Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.

Can ultrasonography-guided aspiration and steroid injection treat reflux venous blood flow around symptomatic Baker's cysts? Our short-term experience.

OBJECTIVE: The aim of the current study was to investigate the efficacy of ultrasonography-guided aspiration treatment with concomitant steroid injection on relieving reflux blood flow in veins located next to symptomatic Baker's cyst. METHODS: All patients were examined by ultrasonography at administration and 1 month follow-up after intervention. Puncture and aspiration of the cyst, as well as injection of 1 ml dexamethasone were performed by the same radiologist. Compression on popliteal vein and vena saphena parva and the degrees of reflux before and after treatment were recorded. RESULTS: Twenty-six patients were included in the study. An overall reduction of the cyst's size was observed in all patients of the study group. Reduction of the cyst size is more evident during the 1st week, which was observed by a slight enlargement during the 1st and the 3rd months controls. CONCLUSION: Ultrasonography-guided puncture, aspiration and steroid injection seems to yield promising outcomes in terms of relieving venous reflux flow around simple Baker's cysts.

Diagnostic significance of periesophageal fat pad in ultrasonography for sliding hiatal hernias: sonographic fat pad sign.

The aim of the present study was to investigate the diagnostic significance of visualization of periesophageal fat pad in ultrasonography or computed tomography for sliding hiatal hernias. Forty-six controls and 21 esophageal hiatal hernia patients were compared in terms of sonographic and tomographic esophageal diameters. We suggest that absence of periesophageal fat pad sign in ultrasonography or computerized tomography is a noteworthy finding that calls for further investigation for the diagnosis of sliding hiatal hernias.