Application of the full consistency method (FUCOM) - Cosine similarity framework in 5G infrastructure investment planning: An approach for telecommunication quality improvements.

In the rapidly evolving telecommunications landscape, the shift towards advanced communication technologies marks a critical milestone. This transition promises to revolutionize connectivity by enabling seamless data downloads, high-quality video streaming, and instant access to applications. However, adapting to these advanced technologies poses significant challenges for infrastructure expansion, requiring innovative investment and deployment strategies. These strategies aim not only to enhance service quality but also to ensure extensive network coverage. To address the need for systematic planning in infrastructure investment, this paper presents a novel methodology that combines the Full Consistency Method (FUCOM) with cosine similarity analysis. This integrated approach effectively prioritizes service areas for the deployment of 5G technology, emphasizing the importance of detailed planning in mobile strategy development. By leveraging FUCOM to determine the weights of various criteria and employing cosine similarity analysis to rank service areas, the methodology facilitates efficient resource allocation and service quality enhancements. Empirical validation using real data from a Turkish telecommunications company confirmed the effectiveness of the proposed algorithm. The results indicate that this integrated approach can significantly advance the telecommunications industry by providing essential insights for companies seeking to improve service quality amidst the transition to 5G and beyond. The successful implementation of the proposed algorithm demonstrates its effectiveness in addressing the challenges faced by telecommunications companies and underscores the importance of a data-driven approach in strategic decision-making and resource allocation. Furthermore, the findings suggest that the integrated FUCOM and cosine similarity analysis approach can offer a valuable tool for telecommunications companies worldwide, offering a systematic method for prioritizing infrastructure investments and enhancing network performance.

Erectile dysfunction in patients with major burn injury: The significance of follow-up.

BACKGROUND: There were few prospective studies investigating the relationship between the burn injury and erectile dysfunction (ED). The aim of this study was to prospectively explore the alteration in erectile functions regarding major burn. METHODS: This study was conducted as a prospective survey in patients with major burn injury. The study group consisted of burn cases with at least 20% of body surface area affected according to the Wallace Rule of Nines. Initially International Index of ED-5 (IIEF-5) was administered to the patients in the burn unit, and it was repeated in the 2rd and 6th months. Burn types, the severity of burns, age of patients, and alteration in IIEF-5 scores were compared. RESULTS: The study included 63 male patients. The median age of the patients was 35 (20-73) years, and the median burn percent-age was 22 (20-60). The rate of ED was markedly increased during follow-up as 8%, 39.7%, and 25.4% at baseline, 3rd, and 6th month evaluation, respectively. The median initial IIEF-5 score of the patients was 23 (5-25). Subgroup analysis revealed that IIEF-5 score of patients with electrical and flame burn significantly decreased at 3rd month compared with the baseline values. The median IIEF-5 score of patients with electrical burn increased at 6th month compared with 3rd month (p=0.042). Binary logistic regression analysis showed that age and service period, and IIEF-5 Score at 3rd month and burn grade were all statistically significantly associated with the normal erectile function (IIEF-5>=18), at 3rd month and 6th month, respectively. CONCLUSION: The current trial demonstrated that IIEF-5 scores of patients with major burn can show significant impairment in long term, and it seems a time-dependent process. This is the first prospective trial showing that IIEF can be utilized to monitor erectile function of burn patients in a longer follow-up program.

Investigation of the causes of BCG refractory in patients treated with intracavitary BCG as secondary treatment in superficial bladder tumors with transurethral resection.

BACKGROUND: Non-muscle invasive bladder cancers (NMIBC) tend to recur and progress over time. Bacillus Calmette-Guerin (BCG) is an effective therapy for the treatment of NMIBC in that it reduces both recurrence and progression rates. The present study investigates the causes of BCG failure, with emphasis on those attributable to application errors by the practitioner and/or patient. METHODS: The demographic and histopathological characteristics of 115 patients who underwent TUR-B for primary bladder tumors and who underwent intracavitary BCG in the postoperative period in the Urology Clinic of the Izmir Katip Çelebi University Atatürk Training and Research Hospital between January 2014 and January 2019, were analyzed retrospectively. BCG-refractory patients were compared with non-BCG refractory patients after BCG administration. RESULTS: The extent of the tumor, and the involvement of the tumor in the bladder trigone and/or the bladder neck were found to increase significantly the likelihood of BCG refractory. When the micturition times of both groups were compared after instillation, the differences between the groups were found to be statistically significant. In the BCG-refractory patient group, the micturition time after instillation was shorter due to the tumor involvement in the trigone/bladder neck. CONCLUSION: Some modifiable factors originating from the patient and the tumoral characteristics were found to have an effect on BCG failure. It was further determined that the time until micturition after BCG administration is an important parameter to be considered in the prevention of application deficiencies. We believe these factors should be subjected to careful consideration during patient selection and follow-up.

A novel surgical technique for extraperitoneal radical prostatectomy with using 3 trocars: Results after 154 cases. / Una novedosa técnica para la prostatectomía radical extraperitoneal con 3 trocares: resultados después de 154 casos.

OBJECTIVES: Recently laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical option for prostate cancer (PCa) treatment in the lack of robot. To eliminate numbers of trocars and to modify surgical technique can make the LRP procedure easier. We aimed to introduce our novel approach on LRP by using just only 3 trocars and to compare conventional extraperitoneal LRP (eLRP) with 3 trocars eLRP. METHODS: Of the 223 PCa patients undergone eLRP were divided into 2 groups as Group 1 (n=69) consisted of conventional eLRP, Group 2 (n=154) consisted of consecutive 3 trocars eLRP. Demographic, operative, postoperative, and short-term follow-up data including functional results were analysed. RESULTS: Mean follow-up was 10.9±5.1 months. Preoperative and demographic parameters were comparable between the groups. Mean operative time, intraoperative used carbon dioxide (CO2) gas, and hospital stay were significantly shorter in Group 2 (for all parameters p<0.001). Haemoglobin decrease was also less in Group 2 without statistical significance. Oncologic and functional results were similar. There was no major complication in Group 2. CONCLUSIONS: According to our results 3 trocars eLRP can be performed safely and effectively in experienced hands. Haemorrhage, operative time, CO2 usage, and hospital stay could be shortened with our novel approach.

OBJETIVOS:  Recientemente, la prostatectomía radical laparoscópica (PRL) es una opción mínimamente invasiva para el tratamiento del cáncer de próstata (CaP) cuando no existe la robótica. Eliminar el numero de trocares y modificar la técnica quirúrgica, puede hacer la PRL un procedimiento fácil. Nuestro objetivo es introducir nuestra nueva técnica para la PRL utilizando solo 3 trocares y compararla con la PRL tradicional. MÉTODOS: De los 223 pacientes con cáncer de próstata que recibieron una PRL extraperitoneal se dividieron en 2 grupos: Grupo 1 (n=69) consistió en la PRL convencional; Grupo 2 (n=154) PRL con 3 trocares. Datos demográficos, quirúrgicos, postoperatorios, seguimiento y resultados funcionales fueron analizados. RESULTADOS: La mediana de seguimiento fue de 10,9±5,1meses. Las variables preoperatorias y demográficas fueron comparables entre ambos grupos. El tiempo medio de cirugía, el uso intraoperatorio de CO2 y la estancia hospitalaria fueron menores en el Grupo 2 (para todos los parámetros pde hemoglobina fue menor también en el grupo 2 sin significación estadística. Los resultados funcionales y oncológicos fueron similares. No hubo complicaciones mayores en el Grupo 2. CONCLUSIONES: De acuerdo con nuestros resultados la PRL extraperitoneal con 3 trocares se puede realizar de forma segura y efectiva en manos expertas. El sangrado intraoperatorio, tiempo quirúrgico y el uso de CO2 se pueden acortar con el uso de esta técnica.

Does washing the biopsy needle with povidone-iodine have an effect on infection rates after transrectal prostate needle biopsy?

PURPOSE: To determine the effect of washing the biopsy needle with povidone-iodine solution on infection rates after transrectal ultrasonography-guided prostate biopsy. PATIENTS AND METHODS: 180 patients with transrectal prostate biopsy were included. Infection was excluded with midstream urine culture before biopsy, and patients were divided into two groups. In group 1 (n = 84), the needle was washed with povidone-iodine after each material reception during biopsy, and in group 2 (n = 96), it was not. At day 3 and 2 weeks after the biopsy, patients were checked. On day 3, midstream urine was cultured and patients were checked for fever, hematuria, rectal hemorrhagia, hematospermia and urinary retention. Also, the effect of rectal preparation on infection rate was evaluated. RESULTS: There was no significant difference between the patients' ages, PSA levels and prostate volumes. In total, 11 patients (6.1%; 4 from group 1 and 7 from group 2) developed infectious complications. There was no statistically significant difference between the groups. Fever, asymptomatic bacteriuria and urinary system infection rates were also not statistically different between the groups. The most frequent complication was hematuria with 83 cases (46.1%), but they did not need hospitalization and no patient had acute urinary obstruction. CONCLUSIONS: Washing the biopsy needle with povidone-iodine did not have an effect on the infection rates. Antibiotic prophylaxis and cleaning the biopsy equipment is adequate for low infection rates.

Retrospective study of systemic immune-inflammation index in muscle invasive bladder cancer: initial results of single centre.

PURPOSES: We aimed to evaluate the prognostic value of the preoperative systemic immune-inflammation index (SII) in patients who underwent radical cystectomy due to muscle invasive bladder cancer (MIBC). METHODS: We researched our cystectomy database between April 2006 and December 2018. Demographic data, operation and postoperative data were recorded. There were 191 MIBC patients who underwent radical cystectomy. After detailed analyses, preoperative SII was calculated by the formula as "(neutrophil) × (platelet)/(lymphocyte)". Cancer-specific survival (CSS) and overall survival (OS) were examined. The prognostic value of SII was analysed with univariate and multivariate Cox proportional hazards regression models. Receiver operating characteristic (ROC) was used to determine the optimum SII. Significant P was P < 0.05. RESULTS: The mean follow-up was 37 ± 6.7 months. The mean age of patients was 62.1 ± 9 years. The optimal cutoff value of SII was determined as 843 in ROC curve (area under the curve: 0.9; P < 0.001). The CSS and OS were significantly poor in patients with higher SII level (respectively; P < 0.001, P = 0.04). Gender, lymph node involvement, pathologic stage, grade and SII were statistically significant in multivariate Cox proportional hazards regression model for CSS. CONCLUSIONS: Preoperative elevated SII could be an independent prognostic factor in MIBC patients who underwent radical cystectomy. If SII > 843, CSS might be poor. Our results should be confirmed with randomised-controlled prospectively designed future studies with large cohorts.

Impact of increased aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio in prognosis of testicular cancer.

Purpose: Imaging studies can show metastasis in testicular cancer (TCa); however, a test for risk of metastasis in TCa has not been described. The ratio of aspartate aminotransferase to alanine aminotransferase, also called the De Ritis ratio (DRR), is used for many other malignancies. We aimed to evaluate the association between preoperatively assessed DRR and prognosis in patients with TCa. Materials and Methods: One hundred twenty-eight patients with TCa were enrolled in a retrospective study between March 2007 and January 2017. Clinical, biochemical, and pathological data were recorded. Univariate and multivariate logistic regression analyses were used. The prognostic value of DRR and the threshold value were assessed by use of receiver operating characteristic curves. Significance was defined as p<0.05. Results: Mean follow-up was 37±9.7 months. There were 45 and 73 TCa patients with and without lymph node metastasis, respectively. Lung metastases and other solid organ metastases occurred in 14 and 4 patients, respectively. The optimal DRR threshold was 1.30 for both retroperitoneal lymph node involvement and metastasis. DRR was determined as an independent prognostic factor for retroperitoneal lymph node involvement and organ metastasis in univariate and multivariate analyses (p<0.001, p=0.006 and p=0.002, p=0.047, respectively). Conclusions: A preoperative DRR greater than 1.30 may be an independent risk factor for retroperitoneal lymph node involvement and organ metastases in patients with TCa.

Is the brain biopsy obligatory or not for the diagnosis of Schilder's disease? Review of the literature.

BACKGROUND: Schilder's myelinoclastic diffuse sclerosis (Schilder's disease) is a rare demyelinating disorder. Clinical features and neuroimaging findings of this disease might mimic an intra-cranial mass lesion including an abscess or a tumour. CASE REPORT: Clinical and radiological findings of two children with the diagnosis of Shilder's disease are reported, and the role of brain biopsy as a diagnostic tool is discussed.

Nonconvulsive status epilepticus during childhood: clinical and electroencephalographic features.

Nonconvulsive status epilepticus (NCSE) is a medical emergency, which is diagnosed most frequently with the routine use of EEG in the pediatric emergency and intensive care units. Data from eight patients, ranging from 2.8-15 years old (median 8.7 years), treated with the diagnosis of NCSE were evaluated on clinical basis. The patients attended the hospital with acute confusional state ranging from sudden onset of verbal cooperation insufficiency to aimless-meaningless behavior and confusion without any motor component of seizure. While five of the cases were diagnosed and followed up with epilepsy, the other three had no history of epilepsy. No reason was detected that could cause acute encephalopathy. EEG examinations during acute confusional state showed partial or generalized continuous electrographic seizure activity lasting at least 30 minutes without clinical seizure activity. After administration of intravenous antiepileptic medication, the confusional states of the patients recovered, and the EEG examinations showed normal baseline activity with significantly diminished discharges or complete normal waveform. Nonconvulsive status epilepticus should be considered in all children admitted to the hospital with acute unexplained encephalopathy, whether they have a history of epilepsy or not. Emergent EEG examination should be a routine part of evaluation in these children for the diagnosis and treatment of NCSE.

Sperm motility changes after coincubation with various uropathogenic microorganisms: an in vitro experimental study.

OBJECTIVE: We investigated the relationship between semen motility and various uropathogenic microorganisms. MATERIALS AND METHODS: Semen specimens from healthy donors were divided into portions and incubated with uropathogenic microorganisms in concentrations varying from 2 x 10 to 2 x 10(7) microorganisms/ml(-1). Uninfected suspensions of spermatozoa served as controls. In all samples, sperm motility was examined at the second, fourth, and sixth hours after incubation in order to assess motility as a function of time. Enterobacter aerogenes, Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli were used as bacterial agents. Besides these bacterial strains, Candida albicans was also used. RESULTS AND CONCLUSIONS: Observed negative impact on sperm motility was not correlated with microorganism concentration. However, until a certain concentration threshold, this impact was prominent. Regardless of the microorganism, this deleterious effect could not be confirmed in specimens coincubated with lower microorganism concentration. No or poor correlation was found between motility and bacteria concentration except with E. aerogenes at the second hour. The data indicates that sperm function impairment is not related to direct sperm and bacteria interaction. Instead, bacterial concentration enough to change the environment or to consume high energy might result in motility loss.

Can tumor recurrence be reduced with plasma-kinetic vaporization of the area around the tumor in nonmuscle invasive bladder cancer?

Purpose: To investigate the effect on recurrence of vaporization of the tumor surroundings and suspicious areas with a plasma-kinetic (PK) system after transurethral resection (TUR) of nonmuscle invasive bladder cancer. Materials and Methods: The study included 121 patients with a primary superficial bladder tumor who were randomized as those who underwent TUR with the PK system (Group 1, n=62) and those who underwent TUR with the monopolar system (Group 2, n=59). The vaporization procedure was performed by suppressing the cutting option of the PK system for a period, which would accumulate energy sufficient to make swelling-waves on the mucosa very close to the area of the loop to be vaporized. Results: A total of 121 patients who met the study criteria were included for evaluation. Recurrence was determined in 21 patients in Group 1 (33.87%) and in 29 patients in Group 2 (49.15%) (p=0.088). Recurrence was close to the old resection site in 6 of 21 patients in Group 1, and in 13 patients in Group 2 (p=0.028); the difference was statistically significant. No statistically significant difference was determined between the two groups with respect to age, gender, number of tumor foci, rate or range of additional treatments applied, cigarette smoking rate, repeat TUR rate and rate of tumor en- countered in repeat TUR, T-stage, and tumor grade. Conclusions: The effect of vaporization on recurrence by the PK system may seem similar to the effect of standard TUR, the recurrence- lowering effect surrounding nonmuscle invasive bladder cancers is better.

The prognostic significance of preoperatively assessed AST/ALT (De Ritis) ratio on survival in patients underwent radical cystectomy.

PURPOSES: We aimed to evaluate prognostic significance of preoperatively assessed aspartate aminotransaminase (AST)/alanine aminotransferase (ALT) (De Ritis) ratio on survival in bladder cancer (BC) patients underwent radical cystectomy (RC). METHODS: We, respectively, analysed clinical and pathological data of 153 patients who underwent RC for BC between February 2006 and December 2016 at a tertiary level hospital. The potential prognostic value of De Ritis ratio was assessed by using ROC curve analysis. The effect of the De Ritis ratio was analysed by the Kaplan-Meier method and Cox regression hazard models for patients' disease-specific survival (DSS) and overall survival (OAS). RESULTS: We had 149 BC patients, in total. Mean age was 61.65 ± 9.13 years. One hundred and thirty-nine (93.3%) of the patients were men. According to ROC analysis, optimal threshold of De Ritis ratio for DSS was 1.30. In Kaplan-Meier analyses, the high De Ritis ratio group showed worse progression in DSS and OAS (all parameters, p < 0.001). On Cox regression models of clinical and pathological parameters to predict DSS, De Ritis ratio (HR 5.79, 95% CI 2.25-15.13), pathological T stage (HR 15.89, 95% CI 3.92-64.33, in all p < 0.001); and to predict OAS, De Ritis ratio (HR 2.61, 95% CI 1.49-4.56; p < 0.001), pathological T stage (HR 5.42, 95% CI 2.63-11.64; p < 0.001) and age (HR 1.05, 95% CI 1.02-1.08; p = 0.001) were determined as independent prognostic factors. CONCLUSIONS: Preoperative elevated De Ritis ratio could be an independent prognostic factor in BC patients underwent RC. Our results should be confirmed by large and properly designed prospective, randomized trials.

Combined bladder, urethral and uterine rupture after a normal, spontaneous vaginal delivery at home: a case report.

BACKGROUND: Uterine rupture and associated injury to the maternal bladder and urethra have been rarely reported. All those cases were associated with a scarred uterus or augmentation of labor. We report a case of simultaneous bladder, urethral and uterine rupture in an unscarred uterus following delivery at home. CASE: A 22-year-old woman was referred from a peripheral hospital to the emergency unit of the Medical Faculty, Yüzüncü Yil University, after delivering at home. On vaginal examination, the bladder neck and proximal one third of the urethra were ruptured. Intraoperatively it appeared that the posterior wall of the bladder and bladder base had ruptured and separated from the level of the interureteric ridge. An extensive rupture of the lower uterine segment to the left sidewall of the uterus was seen. CONCLUSION: To prevent these complications, uneducated, traditional birth attendants should be replaced by at least midwives, and the rate of unsupervised home delivery should be reduced.

Colon perforation during percutaneous nephrolithotomy and fistula closure with Spongostan following conservative therapy.

Percutaneous nephrolithotomy (PCNL) is the first-line treatment for kidney stones. Colon perforation is a rare, but dangerous, complication. Colonic perforation might be very serious if it is not found early. After an unsuccessful extracorporeal shockwave lithotripsy, a 45-year-old female underwent a left-sided PCNL for two 1-cm kidney stones in the left kidney upper pole calyx. During dilatation, a colon perforation was suspected. The procedure was finished by inserting a 14Fr re-entry catheter into the colon. On postoperative day 5, a fluoroscopy was performed by injecting contrast dye through the re-entry catheter, which showed a fistula formation between skin and colon. The catheter was removed completely. A 16Fr external drainage catheter was inserted over the guide-wire through the fistula tract. The fistula was closed by introducing prepared absorbable hemostatic gelatin powder (Spongostan) particles into the fistula tract through the catheter. Fistula tracks can be closed early by injecting absorbable Spongostan particles into the colonic fistula tract, thereby reducing inpatient time and increasing patient comfort.

Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the primary surgical intervention in kidney stone management. Even though it is performed quite often, the complication rates are also high. Arteriovenous fistulas following extended hemorrhages after PCNL are one of the most serious complications of this operation. Our main objective was to review the data of patients who required angiography and embolization. METHODS: In total, we included 1405 patients who underwent PCNL between 2007 and 2014. All patient data were retrospectively reviewed. All patients went under PCNL using fluoroscopy. Following informed consent, all hemorrhagic patients underwent angiography in the interventional radiology department and embolization was performed in patients with a hemorrhage focus point. RESULTS: A total of 147 patients (10.4%) required transfusion for post-PCNL hemorrhages. Of them, 14 (0.99%) underwent angiography and embolization (9 [64.2%] were male and 5 [35.8%] were female, with a mean age of 39.4 ± 10.2). The remaining 133 patients were conservatively managed (81 [60.9%] males and 52 [39.1%] females, with a mean age of 42.3 ± 12.4). When the predicting factors for angiography and embolization were reviewed, renal abnormalities and the mean size of stones were significant in both univariate and multivariate analysis (p < 0.001). CONCLUSION: Patients with extended and intermittent hematuria should be monitored closely for hemodynamics; if there is an ongoing necessity for transfusion, angiography should be considered.

[Investigation of prevalance and risk factors for hospital-acquired urinary tract infections in patients with severe burn injury]. / Ciddi yanik travmasi olan hastalarda hastane kaynakli idrar yolu enfeksiyonu sikligi ve risk faktörlerinin arastirilmasi.

BACKGROUND: This study aimed to investigate the prevalence and risk factors for hospital-acquired urinary tract infections in patients with severe burn injuries. METHODS: In this study, patients treated due to their burn injuries of greater than 20% between August 2009 and April 2012 in Bozyaka Training and Research Hospital Burn Center were assessed retrospectively. Sixty nine patients (30 [43.5%] males, 39 [56.5%] females; mean age 40.1±16.7 years) were included into the study. RESULTS: DM, duration of the catheter and catheter care showed a statistically significant correlation with hospital-acquired urinary tract infections (p<0.005). DISCUSSION: A large number of hospital-acquired urinary tract infections are associated with urinary catheterization. In addition, removing urinary catheter within the shortest time possible is another issue to be considered for the prevention of these infections. If the catheter has to remain for a longer time, regular catheter care is recommended.

Sibling Death after Being Thrown from Window by Brother with Autism: Defenestration, an Emerging High-Risk Behavior.

Children diagnosed with autistic spectrum disorders (ASD) may have serious behavioral problems such as aggression, self-injury, and violence. However, the literature on ASD either overrules any correlation between aggression and ASD or maintains the fact that the efforts to link them have so far been inconclusive. Although severe forms of violence are extremely rare in children with autism, there are a few cases reported in the literature with significant harm to siblings. We hereby report an 8-year-old boy with ASD who caused the death of his sibling by throwing her out of the window. Shared similarities of all defenestration cases indicate a pattern of high-risk behavior threatening the survival of minors. We recommend precautions against this high-risk behavior in children with ASD.

Diagnostic value of cytokeratin-18 as a tumor marker in bladder cancer.

OBJECTIVES: The aim of the study was to compare serum levels of cytokeratin-18 of patients with bladder cancer with those of the healthy controls, and to investigate the relation between cytokeratin level and the tumor stage. DESIGN AND METHODS: Serum cytokeratin-18 levels of 38 patients with bladder cancer and of 25 healthy people were determined. Tumor stage was T(1) in 12 patients, T(2) in 9 patients, T(3) in 10 patients and T(4) in 7 patients. The serum cytokeratin-18 levels in these cases were analyzed with respect to the stage of the tumor. RESULTS: Cytokeratin-18 level in the patient group was found to be significantly higher than that of the control group (p < 0.010) when the groups were totally compared. However, when the levels in patients with different tumor stages were compared with that of the controls, the difference was not significant in patients with stage 1 and 2 tumors (p > 0.05). Regarding the cut off value as 4.0 ng/mL, sensitivity and specificity for serum cytokeratin-18 were found to be 53% and 72% respectively. When sensitivity was calculated with respect to tumor stages, it was 8% for T(1,) 33% for T(2,) 90% for T(3) and 100% for T(4.) On the other hand, considering higher stage (T(3) and T(4)) tumors only, the sensitivity was calculated as 94%, but the sensitivity for lower stage (T(1) and T(2)) tumors was 19%. CONCLUSIONS: It is clear that serum cytokeratin-18 level increases in patients with bladder cancer. However, it can only be useful as a tumor marker in the diagnosis of T(3) and higher staged tumors. This study indicated that cytokeratin-18 does not have any diagnostic value in lower stage bladder cancers.

Cerebral infarcts in full term neonates.

Cerebral infarcts are an important cause of neonatal convulsions. We report the etiologic factors, and clinical and neuroradiologic findings of four full term neonates who presented with neonatal convulsions and had cerebral infarct. In our patients the risk factors for the cerebral infarct were perinatal asphyxia, sepsis, dehydration and catheter application. All had convulsions as the initial sign of infarct and had cranial imaging which revealed the definitive diagnosis. The patients underwent an extensive evaluation for hereditary causes of cerebral infarct that included anticoagulant factors (Proteins C and S, antithrombin III, antiphospholipid antibodies), factor V Leiden and prothrombin gene mutations, blood and urine amino acid and urine organic acid levels. The results were found to be within normal limits. In conclusion, neonatal convulsions can be the first sign of cerebral infarct. For this reason it seems preferable to include cranial imaging by computed tomography or magnetic resonance imaging (MRI) in the work-up of cases with unexplained neonatal convulsions.

A case of tuberous sclerosis presenting with dysrhythmia in the first day of life.

Cardiac rhabdomyoma (CR) is the most common primary cardiac tumor in childhood. Although CRs are asymptomatic in many cases, they may cause arrhythmia, heart failure and fetal hydrops. Babies with arrhythmia in the neonatal period must be investigated for structural heart disease including CR. Cardiac rhabdomyoma may either present as an isolated tumor or may be related with tuberous sclerosis. Arrhythmia due to CR may be the initial sign of tuberous sclerosis. We report a case of tuberous sclerosis presenting with ventricular premature beats and second-degree atrioventricular block in the first day of life who was found to have multiple CR during echocardiographic examination.