The relationship between protein convertase subtilisin kexin type-9 levels and extent of coronary artery disease in patients with non-ST-elevation myocardial infarction.

BACKGROUND: Cardiovascular disease is one of the leading causes of death worldwide. According to the results of various studies, protein convertase subtilisin kexin type-9 (PCSK9) was determined as a novel risk factor for stable coronary artery disease. Few studies have investigated the relationship between PCSK9 levels and the severity of coronary artery disease in patients with acute coronary syndrome; thus, we herein aimed to investigate this relationship in patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent coronary angiography. PATIENTS AND METHODS: Herein, 168 patients with NSTEMI were prospectively enrolled, and severity of atherosclerotic lesions was determined using SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX), Gensini and Jeopardy scores. Plasma PCSK9 levels, lipid parameters and C-reactive protein levels were measured after a 12-h fasting period. The relationship of PCSK9 levels and clinical and laboratory parameters of patients with their SYNTAX, Gensini and Jeopardy scores was investigated. RESULTS: Pearson correlation analysis showed a strong positive correlation between PCSK9 and the three scores (P < 0.001, r > 0.5 for all). In ROC analysis, a mid-high SYNTAX score of at least 25 was predicted with a sensitivity of 81% and a specificity of 63% when the PCSK9 level was higher than 52.8 ng/ml (area under a curve 0.76, P < 0.001). Multivariate linear regression analysis revealed that PCSK9, low-density lipoprotein cholesterol and creatinine levels were independent predictors of a high SYNTAX score. CONCLUSION: Taken together, high PCSK9 levels may be a risk factor for adverse events in patients with NSTEMI. Aggressive lipid-lowering therapies may benefit this group of patients.

Revision shoulder arthroplasty with a reverse shoulder prosthesis : Use of structural allograft for glenoid bone loss.

INTRODUCTION: Revision shoulder arthroplasty presents many unique and complex challenges when glenoid bone loss is involved. A distorted and medialized anatomy prevents the proper mechanics of the reverse prosthesis with regard to deltoid tension and ultimate function. This paper highlights one surgeon's experience using structural allograft for glenoid bone loss. PATIENTS AND METHODS: In all, 20 patients for a total of 24 surgeries with a medialized glenoid and/or substantial glenoid bone loss of grade IIB or higher were evaluated in this retrospective study. The allograft surgeries were performed as a one-stage procedure except for three patients. Recombinant human bone morphogenetic protein-2 (BMP2) was added to supplement incorporation in all cases. Four patients had two separate allograft procedures. Eight of the allograft procedure were femoral shaft, eleven of the allografts were femoral neck/head, and five of the allograft procedures were from proximal humerus. A graft was considered a success if they had at least 12 months of clinical and radiographic follow-up without subsequent removal of the graft or radiographic failure. Patients with less than 12 months of follow-up were included if the graft was removed or had early failure. RESULTS: All femoral shaft allografts except one failed, and during revision surgery it was often noted that the graft was cracked where the peripheral screws had been drilled. In nine patients the graft was still in place at last follow-up, seven of these were femoral neck/head allografts. Five grafts were removed secondary to infection. Average follow-up was 24 months (range 5-45 months). CONCLUSIONS: Femoral neck allografts are an option in patients with substantial bone loss. The authors do not recommend use of femoral shaft allografts.

Regular exercise alleviates renovascular hypertension-induced cardiac/endothelial dysfunction and oxidative injury in rats.

The importance of physical activity in the management of renovascular diseases is well-known, but lacks evidence of underlying mechanisms. The purpose of the study was to elucidate the protective/therapeutic effects of regular exercise on experimental renovascular hypertension (RVH)-induced oxidative stress and cardiac dysfunction. Wistar albino rats underwent a RVH surgery (2K1C, Goldblatt). Three weeks later half of the rats started swimming exercise for 9 weeks (n = 15), while the sedentary RVH group (n = 15) had no exercise during that period. Sham-operated control rats (n = 10), had the similar surgical procedures but the left renal artery was left unclipped. Body weights were monitored, and blood pressures were measured weekly using tail-cuff. Echocardiographic evaluation was performed on the 3(rd) week and on the 12(th) week of the experiment before the rats were decapitated. Heart and thoracic aorta were removed and serum was collected, while aortic samples were put in a 10% formaldehyde solution for immunochemistry. Cardiac tissue samples obtained from each animal were used for the determination of tissue myeloperoxidase (MPO) and catalase (CAT) activities, malondialdehyde (MDA), and glutathione (GSH) levels. In the sedentary RVH group, aortic contractile response (contraction/relaxation in isolated organ bath), left ventricular diastolic and systolic dimensions, and immunohistochemical staining of aortic inducible nitric oxide synthase (iNOS) were increased, while ejection fraction and aortic endothelial nitric oxide synthase (eNOS) staining were decreased. RVH in the sedentary rats resulted in increased pro-inflammatory cytokines (TNF-α, IL-2, IL-6), lipid peroxidation (malondialdehyde) and neutrophil infiltration (myeloperoxidase activity) along with reductions in antioxidant glutathione and catalase levels in the cardiac tissue. Exercise after RVH increased the immunohistochemical staining of aortic eNOS, decreased iNOS staining and reversed the alterations in echocardiographic and oxidative parameters. Regular exercise commenced after RVH surgery alleviated renovascular hypertension-induced oxidative injury, by modulating oxidant-antioxidant balance via the involvement of the endothelial NO system.

Four Separate Hepatic Vein Reconstructions in Living-Donor Right-Lobe Liver Transplantation: Case Report.

Living-donor liver transplantation (LDLT) with the use of a partial liver graft was established as an option to overcome the donor pool shortage, especially in developing countries. When right-lobe grafts are used for LDLT, appropriate venous drainage of the anterior segment is critical for maximizing the graft capacity. Here, we report a successful LDLT case using a right-lobe graft with 4 hepatic veins that were anastomosed separately to obtain adequate blood flow through the vena cava.

Functional assessment of reattached macula in nine cases with excellent Snellen acuities.

PURPOSE: To compare the macular functions of patients with excellent visual acuity after retinal detachment (RD) surgery, with the healthy fellow eye. METHODS: Of 214 patients, nine patients, who were successfully operated because of unilateral RD involving the macula and achieved excellent visual acuity, were analysed. The fellow eyes of the patients were taken as the control group. The macular functions were evaluated with visual acuity, contrast sensitivity, colour vision, visual field, and pattern VEP in operated and nonoperated eyes. RESULTS: There was no significant difference in visual acuity, contrast sensitivity, colour vision, and VEP outcomes between operated and nonoperated eyes. However, it was seen that the mean deviation in the visual field was significantly higher in the operated eyes (5.8+/-1.8 dB) when compared with the undetached fellow eyes (3.1+/-1.8 dB), (t=12.5; P=0.013). CONCLUSION: Even though the visual acuity, colour vision, contrast sensitivity, and VEP results returned to normal after a successful RD surgery, we found that the mean deviation measured by the visual field, which reflects the retinal sensitivity, was still significantly low after nearly 5 years follow-up.

A healthy birth after intracytoplasmic sperm injection by using immotile testicular spermatozoa in a case with totally immotile ejaculated spermatozoa before and after Percoll gradients.

Total asthenozoospermia is a severe problem, as only a micromanipulation technique can assist the couple, and even then fertilization and pregnancy rates are very low. The first healthy birth, achieved by using testicular immotile spermatozoa in a case with total asthenozoospermia before and after Percoll gradient preparation, is reported.

Fertility with testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermic men.

In non-obstructive azoospermia spermatozoa can usually only be isolated from the testicles, and thus the most promising treatment model is testicular sperm extraction (TESE). Hormone concentrations, testicular volume determinations and testicular biopsy results are not uniform enough to select potential candidates for successful TESE and intracytoplasmic sperm injection (ICSI) approaches in advance. The aim of this study was to assess the efficacy of using ICSI with testicular spermatozoa in cases of non-obstructive azoospermia and to compare the inclusion criteria and sperm existence in the testicles in sperm obtainable and non-obtainable groups. All men showed either complete or incomplete (n = 14) maturation arrest in spermatogenesis, severe hypospermatogenesis (n = 10) or Sertoli cell-only syndrome (n = 5) in their testicular biopsies. Only 14 out of a total of 29 men provided enough spermatozoa for the ICSI procedure, while no spermatozoa were found in the testicular samples of the remaining 15 men. Out of 123 oocytes obtained from 14 females, 101 were injected with the husbands' testicular sperm cells. Total fertilization failure was observed in three cases. Of 39 oocytes fertilized, 38 cleaved. The fertilization and cleavage rates were 38.6 and 97.4% respectively. The pregnancy rate was 20.7% per initiated cycle. In the group from whom spermatozoa were obtainable, the pregnancy rate was 42.9% per initiated cycle and 54.5% per embryo transfer. A total of six pregnancies were achieved, of which two were twins and four were singletons. One singleton pregnancy resulted in abortion in the first trimester. There was no statistical difference concerning the serum follicle stimulating hormone concentration, testicular volume and biopsy results in groups in which spermatozoa were obtainable or not. In conclusion, although the association of TESE with ICSI obtained pregnancies for some patients with non-obstructive azoospermia, further studies are needed to determine the inclusion criteria for successful TESE.

Predictive value of a new scoring system for the outcome of primary in situ experimental extracorporeal shock wave lithotripsy of upper ureteral calculi.

The results of primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi were analyzed retrospectively in 491 eligible patients. The treatment was successful in 371 patients (76%). Degree of obstruction, stone size, localization of stone, history of previous ipsilateral surgery, and body mass index were found to be factors that can influence the outcome of treatment. A scoring system based on these factors has been developed to select the appropriate group of patients for primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi.

Partial bladder reconstruction with pedicled rectus and gracilis muscle flaps: an experimental study in dogs.

OBJECTIVE: To investigate the functional, anatomical and histopathological results of partial bladder reconstruction with skeletal muscle flaps. MATERIALS AND METHODS: Partial bladder reconstruction with gracilis or rectus muscle flaps was performed in 10 mongrel dogs. Bladder compliance and uninhibited contractions were investigated in five female dogs. Pre-operative and post-operative cystograms were performed in four female dogs. The dogs were killed 8-12 weeks after the operation. Bladders and muscle flaps were grossly examined and removed for histopathological examination. RESULTS: There was no extravasation on post-operative cystography. Bladder compliance was normal and uninhibited contractions were not present. Severe contracture and atrophy of the muscle flaps were observed in all dogs at necropsy. Bladder volumes were not changed significantly (P > 0.05). Histopathological examination revealed severe mesenchymal metaplasia in all of the flaps. CONCLUSION: Partial reconstruction of the bladder with skeletal muscle flaps did not result in extravasation and bladder function was not altered. However, bladder volume could not be increased because of contracture and atrophy of the flaps.

Trial with bacillus Calmette-Guérin and epirubicin combination in the prophylaxis of superficial bladder cancer.

The efficacy and side effects of the prophylactic intravesical bacillus Calmette-Guérin and epirubicin combination therapy were evaluated in 14 patients who underwent transurethral resection for Ta-T1 superficial bladder cancer. Therapy was started 7-10 days after the operation and maintained weekly for 6 weeks and then monthly for 6 months unless withdrawal due to side effects. Instillation of 50 mg epirubicin (Farmorubicin, Farmitalia Carlo Erba) diluted in 50 ml saline was followed by 80 mg of the Connaught strain bacillus Calmette-Guérin (ImmuCyst, Pasteur Mérieux) in 50 ml saline and the duration of instillation was 2 h for each drug. All the patients experienced moderate to severe cystitis and fever. Side effects necessitated discontinuation of the therapy in 5 patients (35.7%). Therapy was delayed in 7 patients (50%) for reasons related or unrelated to the side effects. Of the 9 patients who completed the course, 8 (89%) had no tumor recurrence 10-16 months (mean 14 months) after therapy. Results obtained revealed that this treatment schedule cannot be tolerated by a considerable number of the patients. Mainly the side effects of the combination are emphasized in this report. The therapeutic efficacy of such a combination has yet to be determined and further clinical studies are warranted.

Results of deep prostatic hyperthermia applied with Thermex II in 525 benign prostatic hyperplasias.

Deep prostatic hyperthermia (DPH) with radiofrequency waves has been found to be of considerable beneficial value in benign prostatic hyperplasia. This study was performed on 525 patients. Madsen's criteria were used for symptom scoring. All the treatments were performed at 44.5 degrees C. Mean follow-up was 18 months. DPH is well tolerated and no severe complications were noted. Statistically meaningful changes of improvement were seen in mean flow rate and residual volume in 51% of the patients.

An alternative technique for ureterocolonic anastomosis: ten years of experience.

We present an alternative technique of ureterocolonic anastomosis which has been standardized at our Department since 1981. Early and late postoperative complications of 82 patients who underwent ureterosigmoidostomy are reviewed. Urinary leakage was observed in 3 patients (3.7%) in the early postoperative period. Late complication rate in 38 patients, whose data concerning postoperative course could be obtained, was found to be 15.8%. Mean follow-up was 38.5 +/- 10.2 months. Long-term results were comparable with those in the literature and it has been proved to be a simple and satisfactory technique of ureterocolonic anastomosis.

Raveron versus placebo in the conservative treatment of benign prostatic hyperplasia (BPH).

Thirty patients with BPH were randomized into two groups to receive Raveron and placebo for 6 weeks. The subjective and objective signs associated with BPH were evaluated before and after treatment. There was no significant difference between the effects of Raveron and placebo.

Percutaneous renal cyst aspiration and treatment with alcohol.

Twenty-two simple renal cysts of 16 patients were aspirated under guidance of ultrasound, with a 20-gauge needle with stylet. Sixteen of those cysts were treated with 96% alcohol. All cysts that were not treated with alcohol recurred within 10 weeks. Treatment with alcohol revealed no recurrences in 3 months follow-up for 12 patients and 6 months follow-up for 4 patients. No major complications were encountered.

Ultrasonic lithotripsy of bladder stones.

In the second half of 1985, 15 patients with 25 bladder stones were treated with Lutzeyer's Ultrasonic Lithotriptor. Of the patients 13 underwent additional operations, mostly transurethral resection of the prostate. The average duration of lithotripsy was 30.5 minutes. Some difficulties were experienced especially when drilling hard stones and as a complication late urethral bleeding occurred in one patient.

Vesicovaginal fistula repair: a simple suprapubic transvesical approach.

Simple suprapubic closure operations were performed for complicated vesicovaginal fistulas in 23 patients. Fistulas with previous unsuccessful attempts (13 patients), fistulas located above the interureteric ridge (5 patients) and fistulas including the ureteral orifice (5 patients) were considered as good candidates for suprapubic approach. There have been 3 failures and, thus, the initial success rate is 86.9 per cent.

The advantages of bilateral simultaneous stone removal from the upper urinary tract.

An anterior transperitoneal approach was used to remove the stones from both kidneys and/or ureters simultaneously in 18 patients. The morbidity of this type of surgery in our study was very low and there were no surgical difficulties in exposing the intrarenal structures. Furthermore, especially in secondary cases, this approach was easier and more time-saving than the classical flank approach. We recommend its use at least in selected groups of patients in whom peritoneal gross contamination is not expected.