Percutaneous cholecystostomy in the management of acute cholecystitis-comparative analysis of before and after the COVID 19 pandemic.

BACKGROUND: Percutaneous cholecystostomy (PC) is a minimally invasive temporary treatment for patients with acute cholecys-titis (AC) who are at high risk for surgery. The aim of this study was to compare the characteristics of patients with AC treated with PC before and during the coronavirus disease 2019 (COVID 19) pandemic. METHODS: The data of patients who underwent PC with the diagnosis of AC between 2019 and 2021 were analyzed by scanning the hospital registry system. During the COVID 19 pandemic period of March 11, 2020, to March 11, 2021, 110 patients with AC were treated with PC. In the pre-pandemic period of March 2019 to March 2020, 99 patients who underwent PC were added to the study as a control group. The data of the 209 patients included in the study were recorded, and descriptive statistical analysis was performed. The patient characteristics of the two groups were compared. RESULTS: Evaluation was made of 209 patients who were diagnosed with AC between March 2019 and March 2021 and could not be operated on due to the high risk of surgery. The average age of the patients was 63.84 years (21-97) in the pandemic period and 68.43 years (31-100) in the pre-pandemic period. The rate of female patients was 45.5% in the pandemic group and 44.5% in the pre-pandemic group. The mean procedure-discharge time was 3.85 days in the pandemic period and 3.34 days pre-pandemic. The American Society of Anesthesiologists physical status classification (PS) was determined to be 1 or 2 in 56.4% of the pandemic group patients and 3 or 4 in 78.8% of the pre-pandemic group. There was no comorbidity accompanying AC in 45 (40.9%) patients in the pandemic period, and at least one comorbid condition accompanying AC was detected in 77 (77.8%) patients in the pre-pandemic period. The severity grading for AC was 2 (moderate) in 97.3% of the patients in the pandemic group and 3 (severe) in 26.3% of the patients in the pre-pandemic group. Of the 110 patients in the pandemic period, 14 were Covid 19 positive or suspected. PC-related mortality was not observed in either group. CONCLUSION: PC is an effective and safe treatment method that reduced the operating room and intensive care burden during the exacerbation of the COVID 19 pandemic. Therefore, it seems like a logical option to expand the PC indications at times when the number of COVID 19 patients increases.

Can pre-procedural MRI signal intensity ratio predict the success of uterine artery embolization in treatment of myomas?

Background/aim: Magnetic resonance (MR) images, signal intensity ratios calculated using region of interests (ROI) in T2W images by proportioning the dominant myoma to iliac muscle can aid patient selection and, thus, in achieving better outcomes with the uterine artery embolization (UAE) procedure. The present study investigates the association between the success of UAE treatment with signal intensity (SI) ratio of the dominant myoma to the iliac muscle in MR imaging performed prior to the procedure. Materials and methods: This is a retrospective study and included 30 patients who admitted to our clinic between February 2017 and July 2019 due to symptoms associated with myoma and who underwent MR imaging before and after UAE treatment. All patients, MR images obtained before UAE treatment and at the 12th month after the procedure were evaluated. In MRI, SI values were calculated by proportioning the dominant myoma to the iliac muscle using circular ROI in T1 weighted (W), T2W, and post-contrast T1W images. In the present study, 50% or more volumetric regression of the myoma with infarction of fibroids (loss of enhancement) at the 12-month follow-up MRI after the procedure was considered a successful procedure. Results: Myoma volumes calculated in MR images showed significant differences between the MRI performed before UAE procedure and the MRI performed at the 12th month after the procedure (p < 0.0001). SI ratio calculated from pre-procedure T2W MR images was found to be a significant determinant of 50% or more volumetric regression in the myoma after UAE procedure (p = 0.017), T1W, post-contrast T1W images were not statistically significant (p = 0.211). Conclusion: Our results indicate that SI ratio of the dominant myoma to the iliac muscle calculated using ROI in T2W images of MR studies performed before UAE procedure can predict the success of the procedure.

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

PURPOSE: We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. MATERIALS AND METHODS: The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. RESULTS: In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5-20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6-20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). CONCLUSIONS: Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

ABSTRACT Purpose We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. Materials and Methods The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. Results In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5–20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6–20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). Conclusions Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Bilateral Leydig cell tumor of the testis: a case report.

Leydig cell tumors are rare testicular tumors of the male gonadal interstitium. Although uncommon, Leydig cell testicular neoplasms are the most common sex cord-stromal tumors and comprise 1-3% of all testicular neoplasms. This tumor is always benign in children and approximately 90% are benign in adults. In most cases, patients present with an incidental finding of a testicular mass on scrotal ultrasonography during evaluation of hydroceles or varicoceles or during diagnostic workup for infertility. Leydig cell tumors have been primarily managed with radical inguinal orchiectomy. However, conservative management with testis-sparing surgery in younger adults and children were reported in the literature. Here we report a case of bilateral Leydig cell tumor of the testis treated with radical orchiectomy who presented with the complaint of infertilityand no disease recurrence in followup for 9 months. The patient is currently disease-free and under androgen supplemantation for androgen insufficiency. We recommend complete exam and diagnostic workup in patients with infertility and azoospermia.

Oral vitamin C and E combination modulates blood lipid peroxidation and antioxidant vitamin levels in maximal exercising basketball players.

Oxidative stress occurs during maximal exercise, perhaps as a result of increased consumption of oxygen. Vitamins C and E can overcome the effects of antioxidants in exercise. We investigated the effects of supplementation with a combination of vitamin C and E (VCE) on blood lipid peroxidation (LP) and antioxidant levels following maximal training in basketball players.Blood samples were taken from 14 players (group A) and divided into two subgroups namely maximal training (group B) and maximal training plus VCE groups (group C). Group B maximally exercised for 35 days. VCE was supplemented to group C for 35 days and blood samples were taken from group B and C. Plasma and hemolyzed erythrocyte samples were obtained from the players.Erythrocyte glutathione peroxidase (GSH-Px) activity and plasma vitamin E concentration were lower in group B than in group A, whereas plasma and erythrocyte LP levels were higher in group B than in group A. Plasma vitamin A, vitamin E, erythrocyte GSH-Px, and reduced glutathione (GSH) values were higher in group C than in groups A and B although LP levels in plasma and erythrocytes were lower in group C than in group A and B. beta-Carotene values did not change in the three groups.In conclusion, VCE supplementation in maximal exercising basketball players may strengthen the antioxidant defense system by decreasing reactive oxygen species (ROS).