The evaluation of renal parenchymal scarring using static renal scintigraphy after percutaneous nephrolithotomy operations.

OBJECTIVE: To analyze whether operative techniques and other variables related to patient and renal stone characteristics affect potential renal parenchymal damage. MATERIALS AND METHODS: The study population comprised 64 patients who underwent percutaneous nephrolithotomy operations (PCNL). Data of the operated renal units, renal stone burden, route and number of entries, dilation techniques, duration of surgery, preoperative and postoperative glomerular filtration rate (GFR) and relative dimercaptosuccinic acid (DMSA) uptakes, as well as the changes in hemoglobin values, were recorded and analyzed for all patients. RESULTS: The mean age of the patients was 44 years. In 11 (17.1%) cases, renal cortical defects in the 3rd month were detected on DMSA scintigraphy. When the patients with and without renal cortical defect were compared regarding their preoperative and postoperative GFR values, no statistically significant difference was noticed between the groups (P > 0.05). Similarly, when postoperative relative DMSA uptakes were compared with preoperative relative DMSA uptakes of the same kidneys, no statistical significance was seen. When preoperative relative DMSA uptake values between groups with and without renal scarring were compared, no statistically significant difference was observed (P > 0.05). CONCLUSION: We did not observe any significant difference in scintigraphic parameters and GFR values. Hence, in the current trial, significant loss in renal function after PCNL operations was not observed. Thus, PCNL operations should be regarded as safe, but still, the risk of loss of kidney function should always be considered.

Evaluation of panoramic radiographs taken from 1,056 Turkish children.

OBJECTIVE: Panoramic radiographs (PRs) play an important role in the diagnosis and treatment planning of a wide range of dental and maxillofacial diseases and conditions. To examine and to determine the status of oral lesions, dental anomalies and pathologies in panoramic radiographs, which were taken at the department of pediatric dentistry, Dental School, Marmara University, Istanbul, Turkey. MATERIALS AND METHODS: This retrospective study consists of 1,056 randomly selected PRs of children aged from 4 to 12 years old, conducted at the department of pediatric dentistry at Dental School, Marmara University, between 5 th December 2011 and 17 th January 2012. The following information was obtained from the patients' records and PRs: Gender, age, presence or absence of oral lesions, dental anomalies and pathologies such as mesiodentes, supernumerary teeth, odontoma, radicular cyst, impacted tooth, and fusion. RESULTS: One thousand and fifty-six PRs from 520 girls and 536 boys were observed. The mean and standard deviation age of the patients was 8.43 ± 2.17. Among 1,056 patients, 457 (43.28%) of them had oral lesions, discovered by the PRs. The age of these 457 patients was ranged from 4 to 12 years. There were 37 (3.50%) mesiodentes, 9 (0.85%) supernumerary teeth, 4 (0.38%) odontoma, 12 (1.14%) radicular cyst, 16 (1.52%) impacted tooth, and 20 (1.89%) fusion. CONCLUSIONS: Oral lesions with a rate of 43.28% could be detected relatively at early age, as presented in the present study. Early treatment of these lesions, dental anomalies, and pathologies could avoid maxillofacial deformity and other complications.

Positive correlation of serum parathormone and prostate specific antigen levels in prostate cancer.

OBJECTIVES: Clinical and experimental observations reveal the exact role of vitamin D in prostate cancer. Yet, a complete understanding of the issue necessitates the evaluation of the exquisite mechanisms that involve full actors of the calcium homeostasis in relation. BACKGROUND: Besides the role of vitamin D, parathyroid hormone (PTH) is now understood to be a mitogen for prostate cancer cells, and calcium has already been known for such role. The interplay between renin-angiotensin-aldosterone system effector hormones and calcium homeostasis attracts attention in recent studies. METHODS: Twenty five patients with prostate cancer (median age 66 (62-67) years) who had presented at the Urology Outpatient Clinic were prospectively included in the study. Also, 30 volunteer controls (median age 63 (60-70) years) were enrolled for comparison. Serum total PSA, intact PTH, calcium, aldosterone and 25-hydroxy vitamin D levels were detected in a selected group of patients with prostate cancer. RESULTS: The vitamin D levels were lower in PCa patients in line with some of the previous studies, supporting the role of vitamin D in prostate cancer. We also observed a positive correlation between PTH and PSA both in PCa patients and the controls. CONCLUSION: Our findings indicate that like age and race, PSA is associated with PTH. The role of PTH, as a master of calcium homeostasis, seems to be neglected in prostate carcinogenesis, concerning a very few number of studies pertaining to the subject in the literature (Tab. 2, Fig. 2, Ref. 19).

Effects of metabolic syndrome on early mortality and morbidity in coronary artery bypass graft patients.

Metabolic syndrome is a well-known cardiovascular risk factor closely related to increased insulin resistance. This study assessed the effects of metabolic syndrome on early post-operative mortality and morbidity in 100 coronary artery bypass graft (CABG) patients: 50 patients with and 50 without metabolic syndrome. A total of 17 patients were excluded from the analysis as they did not attend follow-up, leaving 51 males (61.4%) and 32 (38.6%) females of mean +/- SD age 60.02 +/- 9.76 years for analysis. Diabetes, hypertension and a high body mass index were significantly more common in patients with metabolic syndrome. A statistically significant relationship was found between metabolic syndrome and surgical wound infection. Non-significant positive correlations were found between metabolic syndrome and post-operative atrial fibrillation, surgical revision due to haemorrhage, ventricular tachycardia and ventricular fibrillation, and prolonged intubation. In conclusion, metabolic syndrome did not affect mortality, but did increase the risk of post-operative surgical wound infection.

Subjective image quality of digitally filtered radiographs acquired by the Dürr Vistascan system compared with conventional radiographs.

OBJECTIVES: To compare the different digital filters implemented in the Dürr Vistascan system with conventional film and to analyze the filter specificity to anatomic structures. STUDY DESIGN: Ten panoramic image pairs and 10 periapical image pairs (1 digital and 1 conventional) were obtained from 20 patients conventionally and digitally. The display quality of different anatomic image structures was rated subjectively on a 5-point scale. The responses were evaluated using ANOVA and Tukey-Kramer post hoc tests. The intraobserver reliability was evaluated by Cohen's kappa statistics. RESULTS: The display quality of anatomic structures was rated higher by using Caries 1 or 2 filters for periapical and Periodontal 1 or 2 filters for panoramic images, whereas nonfiltered and Noise Reduction-filtered images received the lowest scorings compared to all other digital image modalities (P < or = .0097). The superiority of conventional radiographs to the digital ones was statistically significant (P < or = .0039 and P < or = .0152 respectively). CONCLUSIONS: Depending on the diagnostic task, digital images of the Vistascan system should be filtered before examination. Perfect conventional radiographs still remain the gold standard for image quality.

[Left main coronary artery stent application: early and late period results]. / Sol ana koroner artere stent uygulamalari: erken-geç dönem sonuçlari.

OBJECTIVES: Percutaneous coronary intervention of left main coronary artery (LMCA) in the setting of acute myocardial infarction or in patients with cardiac and non-cardiac diseases that increase mortality rate after coronary artery bypass surgery has been proposed as "last resort option" and these patients can be managed safely with intracoronary stenting. In this study, we evaluated the short- and long-term follow-up outcomes of patients with left main coronary lesions underwent stent implantation in our clinic. METHOD: A total of 15 patients (12 M, 3 F; mean age 58 +/- 13 years) with left main coronary stenosis considered at high risk for surgical treatment or patients with acute myocardial infarction with LMCA stenosis were enrolled into the study and treated by stenting. Eight patients were treated for unstable angina (53%), 2 had stable angina (13%) and 5 had acute myocardial infarction (33%). Three patients had "protected" and 12 patients "unprotected" LMCA stenosis. An intraaortic balloon pump was used in 6 (40%) and pacemaker in 4 (26.6%) patients. RESULTS: In the study group the short and long-term mortality rate was 4 (26.6%). Among 13 survived cases, signs of left ventricular failure developed in 2 patients (15.3%). Restenosis rate on control coronary angiography was revealed in 28.8% of cases. CONCLUSION: Utilization of elective stenting in patients at high surgical risk with protected and unprotected LMCA lesions and percutaneous coronary intervention in patients with acute myocardial infarction and left main coronary artery lesions could be appraised as an alternative to surgical treatment approaches.

[Demographic and clinical features of coronary artery patients in the district of Antalya and comparison of them with Turkey's averages]. / Antalya bölgesindeki koroner arter hastalarinin demografik ve klinik özellikleri ve bu özelliklerinin Türkiye ortalamalari ile karsilastirilmasi.

OBJECTIVES: Many studies have proved high plasma cholesterol and triglyceride levels as determinant major risk factors for coronary artery disease. It is also well known that coronary artery disease incidence and related mortality and morbidity is low in communities applying Mediterranean diet. Turkey, having a high incidence of coronary artery disease, is unique because of the diversity of eating habits in different regions of the country. The inhabitants of Antalya region of interest in our study, are generally kept Mediterranean diet. We thought to determine the clinical and demographic features of the coronary artery disease patients living in the district of Antalya, and to find out if they correlate with Turkey's averages when compared. We also searched for the preventive effect of Mediterranean diet, if there was any. METHODS: 516 patients, who were admitted to the department of cardiology, were investigated in terms of age, sex, smoking habits, hypertension, hyperlipidemia, diabetes, family history, angina class, usage of aspirin and nitrates. RESULTS: The results revealed that clinical and demographical features of the coronary artery disease in the district of Antalya were similar with turkey's averages and that the benefits brought by the preventive effects of Mediterranean diet, might have been comprised by smoking.

Simultaneous operation for coexisting lung and liver hydatid cysts: a treatment modality.

BACKGROUND/AIMS: Hydatid disease is very common in our region. Whether or not coexisting cysts of lung and liver should be operated on simultaneously is a challenging question. METHODOLOGY: Of 127 patients operated on for hydatid cysts of the lung between 1990 and 1995, 23 (18%) had coexisting hydatid cysts of the right lung and liver. There were 12 male and 11 female patients with an average age of 34 years. RESULTS: All patients had simultaneous operations for both organs via right thoracotomy with an incision in the diaphragm (phrenotomy). In the lung, cystotomy and capitonnage were performed in 21 patients and wedge resection in 2; in the liver, cystotomy and capitonnage were performed in all 23 patients. No hospital mortality occurred. CONCLUSION: Coexisting hydatid cysts of the right lung and liver should be surgically treated simultaneously.

Late results of combined percutaneous balloon valvuloplasty of mitral and tricuspid valves.

Although combined mitral and tricuspid stenosis are rarely seen in patients with rheumatic heart disease, when both exist together, combined percutaneous balloon valvuloplasty can be an alternative to surgical treatment in suitable cases. We present the immediate and late follow up results of 12 patients with rheumatic tricuspid and mitral stenosis treated with combined percutaneous balloon valvuloplasty. Twelve patients (11 female, 91.7%; 1 male, 8.3%) with a mean age of 35.3 +/- 6.4 years were enrolled in the study. The patients were followed up for 38.8 +/- 12.6 months. The mitral valve area increased from 1.2 +/- 0.2 cm2 to 2.3 +/- 0.2 cm2 (P < 0.01) and on follow up the mitral valve area did not differ significantly (2.2 +/- 0.2 cm2; P > 0.05). The tricuspid valve area increased from 1.6 +/- 0.3 cm2 to 3.2 +/- 0.2 cm2 (P < 0.01) and on follow up the tricuspid valve area did not differ significantly (3.1 +/- 0.2 cm2; P > 0.05). Two patients (16.6%) had tricuspid restenosis and tricuspid re-valvuloplasty. One other patient (8.3%) was referred to surgery 14 months after the procedure secondary to severe tricuspid regurgitation. In conclusion, this study demonstrates a sustained benefit on late follow up after combined percutaneous balloon valvuloplasty of mitral and tricuspid valves and confirms the efficacy and safety of the procedure as an alternative to surgery in selected cases of combined mitral and tricuspid stenosis.

Determination of the site of metabolism of total, free, and complexed prostate-specific antigen.

OBJECTIVES: To determine the site of metabolism of total prostate-specific antigen (tPSA), free PSA (fPSA), and complexed PSA (cPSA). METHODS: A total of 20 male patients, 50 years old or older, having a clinical indication for left and right heart catheterization were enrolled in this study. Selective blood samples were obtained from the infrarenal, infrahepatic, and suprahepatic inferior vena cava, renal vein, hepatic vein, superior vena cava, pulmonary artery, and femoral artery. cPSA concentration was accepted as the difference between tPSA and fPSA concentrations. RESULTS: We found that tPSA and fPSA concentrations in the infrarenal inferior vena cava were significantly higher than in the systemic artery. There was no significant difference between the systemic artery and the infrarenal inferior vena cava for cPSA concentration. Although fPSA concentration decreased significantly across the renal circulation, the decreases in cPSA and tPSA concentrations were statistically insignificant. In the hepatic circulation, we found that tPSA, fPSA, and cPSA concentrations were significantly decreased. No decrease in tPSA, fPSA, and cPSA concentrations were noted across the pulmonary circulation. CONCLUSIONS: Our results indicate that fPSA and tPSA are released into serum from the prostate but the prostate may not have a significant role in complex formation of PSA. In addition, the liver has a significant role in the elimination of tPSA, fPSA, and cPSA. By contrast, the kidneys have a significant role only in the elimination of fPSA. We also found that the lungs did not have a significant role in the elimination of tPSA, fPSA, or cPSA.

Sustained ventricular tachycardia in cardiac hemochromatosis treated with amiodarone.

Cardiac hemochromatosis can cause heart failure and cardiac arrhythmias. Among these arrhythmias, ventricular tachycardia may be resistant to treatment. A case of cardiac hemochromatosis complicated with ventricular tachycardia that did not respond to intravenous lidocaine, procainamide or propafenone, nor to DC cardioversion, was successfully treated with amiodarone. Amiodarone, a class III antiarrhythmic drug, may be highly effective in similar cases.

Comparative clinical and angiographic analysis of the initial efficacy and long-term follow-up of Wiktor stent implantation with conventional balloon angioplasty.

This study was retrospectively designed to examine if the Wiktor stent, a balloon-expandable tantalum coil stent, provides a more favorable procedural and long-term clinical and angiographic outcome than does conventional coronary balloon angioplasty (POBA). From April 1995 to April 1996, we implanted 56 Wiktor stents in 46 lesions (LAD: 23, RCA: 16, CX: 7) in 42 patients (average age 53 +/- 10 years). Coronary lesions from the stent group were matched with similar lesions of another 42 POBA patients whose characteristics were identical to the Wiktor group. Revascularization indications in the Wiktor and POBA groups, respectively, were recent myocardial infarction (RMI) (45%, 40%), unstable (31%, 39%) and stable (24%, 21%) angina pectoris. 7% of the stents and 17% of the POBA balloons were less than 3 mm in diameter (p > 0.05). Procedural success was significantly greater in the Wiktor group than in the POBA group (100% vs. 92%, p < 0.05). Neither major cardiac event (death, CABG, acute myocardial infarction) nor (sub)acute occlusion was encountered in the Wiktor group during the hospitalization period and 1 month follow-up. There was 1 urgent CABG and 4 subacute occlusions in the POBA group. Control angiography at 8 months was performed in patients of both groups, of whom some were symptomatic at long-term follow-up or completely event free for 8 months. Angiographic restenosis (> 50% diameter stenosis) occurred in 25% of the Wiktor patients and in 43% of those in the POBA group (p < 0.05). For an 18 month clinical follow-up, 91% of the patients in the Wiktor group were asymptomatic and without ischemia in radionuclide imaging (RI), whereas 79% of the POBA patients were angina-free and 74% were without ischemia in the RI study. In conclusion, Wiktor stent implantation, with no major cardiac event or subacute occlusion, provides a more favorable procedural and long-term clinical and angiographic outcome than does conventional POBA.