Patient tolerance and complication rates of transperineal prostate biopsy with coaxial technique under local anesthesia: initial experience of a single institution.

OBJECTIVE: Due to infectious complications of transrectal prostate biopsy (TRBx), the transperineal prostate biopsy (TPBx) technique is gaining popularity and is the first-line method in many institutions. We share our experience of the first 100 patients with TPBx, performed using the coaxial needle technique under local anesthesia. PATIENTS AND METHODS: We retrospectively reviewed the records of the first 100 patients who had undergone TPBx between December 2022 and September 2023. Complication rates, cancer detection rates, patient tolerance, and pain response to the TPBx under local anesthesia at different steps of the procedure were collected. RESULTS: The mean age, total prostate-specific antigen (PSA), prostate volume, and PSA density were 64.5±7.5 years, 8.82±12 ng/mL, 58.4±26.4 mL, and 0.17±0.18 ng/mL2. Prostate cancer (PCa) was detected at histopathological evaluation in 51 patients. The mean positive core number and percentage of cancer involvement per core in patients who have PCa were 5.4±3.2 and 68.5±29.1, respectively. The mean pain score during the entire procedure was 2.85±1.48. When the steps are evaluated separately, the mean pain score during the probe placement step, local anesthetic, and sampling steps were 3.35±1.65, 2.54±1.45, and 0.9±0.82, respectively. CONCLUSIONS: Transperineal prostate biopsy with coaxial needle technique under local anesthesia is a well-tolerated procedure with feasible complication rates and patient discomfort.

Diffusion restriction associated with bevacizumab treatment in recurrent glial tumors, evaluation of survival with ADC measurement analysis.

OBJECTIVE: Recurrent glial tumors treated with bevacizumab often develop diffusion restriction. In this study, we investigated the diffusion restriction pattern after bevacizumab treatment along with the relationship between apparent diffusion coefficient (ADC) values of regions with diffusion restriction and survival period as there are conflicting results on this relationship. PATIENTS AND METHODS: We retrospectively identified 24 patients treated with bevacizumab for recurrent glial tumor who had low ADC values after the onset of the treatment. Magnetic resonance imaging (MRI) findings were analyzed for the presence of restricted diffusion, time to onset, location, duration of restriction, and persistence of restriction after cessation of bevacizumab treatment. A retrospective study was performed to investigate the relationship between ADC values obtained at first post-bevacizumab scan and survival periods. RESULTS: Diffusion restriction appeared 2 to 6 months after the onset of bevacizumab therapy and persisted up to 24 months while on bevacizumab. The restricted diffusion persisted up to 6 months after cessation of bevacizumab. Our results showed that there is a negative correlation between ADC values and progression free survival as well as overall survival. Patients having diffusion restriction areas with lower ADC values after the initiation of bevacizumab treatment, are found to have increased overall and progression free survival (p<0.05). CONCLUSIONS: In patients with recurrent glial tumor treated with bevacizumab, diffusion restriction can be observed and the ADC values obtained from these areas at first post-bevacizumab MRI scan correlate with progression free and overall survival with the worst survival seen in patients with higher ADC values which therefore can be considered as an imaging marker that can predict the prognosis.

Advanced oxidation protein product levels as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

We aimed to determine whether advanced oxidation protein product (AOPP) levels can serve as a marker of oxidative stress in paediatric patients with chronic tonsillitis. Thirty children with chronic tonsillitis and 30 healthy children (control group) were recruited from the Otorhinolaryngology (ORL) and Paediatric Surgery departments, respectively, of Dumlupinar University Hospital. In the patient group, blood samples were collected before tonsillectomy, and tonsil tissue was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the serum and tonsil tissue were measured by the spectrophotometric method. Serum AOPP levels were significantly higher in the patient group (13.1 ± 3.3 ng/ml) than in the control group (11.6 ± 2.3 ng/ml; P < 0.05). In addition, the mean AOPP level (41.9 ± 13.5 ng/mg protein) in the tonsil tissue in the patient group was significantly higher than the mean serum AOPP levels in the control and patient groups (P < 0.05). AOPP levels are elevated in the tonsil tissue and serum of patients with chronic tonsillitis compared to the serum AOPP levels in healthy controls. AOPPs may represent a novel class of pro-inflammatory molecules that are involved in oxidative stress in chronic tonsillitis. AOPPs may be used as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

The importance of antenatal diagnosis of congenital duodenal obstruction.

INTRODUCTION: The aim of this study was to compare the outcome of operated newborns that had an antenatal diagnosis of congenital duodenal obstruction (CDO) with those who had a late diagnosis in the postpartum period. MATERIALS AND METHODS: The newborns that were operated with the diagnosis of CDO in our department were retrospectively recorded. The patients were grouped according to the time of diagnosis; the ones who had an antenatal diagnosis were assigned to group 1, while the ones that had a diagnosis in the postpartum period were assigned to group 2. The groups were compared in terms of their pregnancy weeks at the time of birth, birth weight, additional congenital anomalies, the type of obstruction, the procedures that are applied, the day of operation, the time for oral feeding tolerance, the duration of hospital stay, and pre- and post-operative complications. RESULTS: Fifteen patients with a diagnosis of CDO were operated on in our department between 2009 and 2014. Eight patients were male and seven patients were female. There were nine patients in group 1 and six patients in group 2. The diagnosis was confirmed in group 1 on the first day of the postpartum period. In the subanalysis, five patients had type 1 CDO and four had type 3 CDO in group 1, while five patients had type 1 CDO and one had type 3 CDO in group 2. There was not any complication in group 1 in the pre-operative period, but two patients had aspiration pneumonia and one had dehydration in group 2 pre-operatively. The mean operation day in the postpartum period was 2.34 (±0.5) days in group 1 and 7.17 (±2.04) in group 2. The time for the patient to tolerate oral feeding in the post-operative period was 11.33 (±1.80) in group 1 and 14.83 (±2.48) in group 2. The duration of hospital stay in group 1 was 20.67 (±9.81) days and 24.66 (±4.50) days in group 2. In the post-operative period, chylous ascites occured in a patient in group 1 and the post-operative period was complicated with ileus in one patient in group 2. No mortalities happened in both groups. CONCLUSION: The prenatal diagnosis of CDO affects the pre-operative complication rate, the time for the operation in the postpartum period, the duration to start post-operative oral feeding, and the duration of hospital stay, but does not affect the mortality or the morbidity.

Circadian reactivity rhythm of rat gastric mucosa to restraint-cold stress and indomethacin: temporal variation in the protective effect of iloprost.

In this study, the time-dependent ulcerogenic effects of restraint-cold stress and indomethacin on the gastric mucosa and the temporal variation in the protective effect of iloprost, a synthetic stable analog of prostacyclin, were investigated in rats synchronized to 12h light and 12h darkness, lights on at 08:00. The severity of gastric ulceration produced by either stress or indomethacin showed marked circadian variation; it was greatest at 11 HALO (hours after lights on) for restraint-cold stress and at 23 HALO for indomethacin. The severity of the induced ulcerogenesis was least at 7 HALO for both stimuli. The protective effect of iloprost against restraint-cold stress was most prominent at 15 HALO and 19 HALO with an approximately 80% protection score. On the other hand, pretreatment with iloprost reduced the indomethacin-induced mucosal injury only at 23 HALO. The circadian variation in the effect of iloprost and in the rhythmic modalities of these two experimental ulcer models are indicative of differences in their underlying mechanisms. In experimental models of ulceration, the circadian time of application of the ulcerogenic stimulus must be considered as an important experimental factor. Moreover, the protective effectiveness of antiulcer drugs can express time-dependent differences and must also be taken into account in investigative research.

Temporal variation in the interaction between calcium channel blockers and morphine-induced analgesia.

Circadian variations in the interaction between calcium channel blockers and morphine-induced analgesia were determined by the mouse hot-plate test. Calcium channel blockers diltiazem, verapamil, or nicardipine alone did not display any significant analgesic effect, but all of them potentiated morphine-induced analgesia when injected 30 min prior to morphine at most of the injection times. In terms of percent absolute potentiation, they produced more potentiation during the light period than darkness. Their potentiating effects decreased abruptly during darkness, and around the midtime of the dark period no significant potentiation of morphine-induced analgesia was observed. It is concluded that these fluctuations in the magnitude of interaction between calcium channel blockers and morphine must be taken into consideration particularly in studies dealing with the role of calcium in analgesia.

Brief group therapy with offspring of holocaust survivors: leaders' reactions.

The authors, themselves children of Holocaust survivors, discuss their reactions and experiences in leading nine short-term awareness groups designed for this population. They evaluate their role as leaders, and examine countertransference, personal motivation, and the establishment of goals within the group context. Preparation for therapists leading short-term homogeneous groups of which they are not members is also explored.