Relation between Cajal Cell Density and Radiological and Scintigraphic Outcomes in Patients with Ureteropelvic Junction Obstruction.

INTRODUCTION: In this study, we aimed to investigate the correlation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters in ureteropelvic junction obstruction (UPJO). METHODS: The study group consisted of 41 renal units (38 consecutive patients; 13 female and 25 male) surgically treated for UPJO. UPJ specimens from patients were immuno-stained with CD117 (c-kit) antibody for interstitial Cajal cells (ICCs). The relation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters was evaluated. RESULTS: The mean age of the patients was 8.52 ± 8.86 (0-35) years. The density of Cajal cells was defined in 2 groups for convenient analysis as 0-5 cells (low) in 19 (46.3%) patients and >5 cells (moderate-high) in 22 (53.6%). There was significant difference between the preoperative and postoperative anteroposterior diameters of the related kidneys in both Cajal groups (p = 0.001-low, p = 0.000-moderate-high) independent of Cajal cell density. Regression in hydronephrosis postoperatively was determined in both Cajal groups (77.8%-low, 64.7%-moderate-high); however, there was no difference between them (p = 0.39). Preoperative T1/2 was significantly longer in the low Cajal group (p = 0.02). Postoperative T1/2 decreased in both low (p = 0.000) and moderate-high (p = 0.001) Cajal groups, but no difference was found between them (p = 0.24). There was significant improvement in the kidney differential function after surgery in the low Cajal density group (p = 0.015) while there was no correlation between the scintigraphic success or improvement and Cajal cell density (p = 0.51). DISCUSSION/CONCLUSION: ICC deficiency/density could not be shown as a predictive factor for the determination of success rate of pyeloplasty. Despite the lack of any evidence for the degree of deficiency as an indicator for the severity of obstruction and prediction of surgical success, further studies are needed for confirmation.

Utility of 18-fluorodeoxyglucose positron emission tomography in children with relapsed/refractory leukemia.

OBJECTIVE: Few data are available on the clinical significance of 18-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) results in patients with leukemia. We investigated the utility of FDG-PET/CT at the time of relapsed/refractory disease in pediatric patients with leukemia. METHODS: Medical records of 28 children with suspected leukemia progression or recurrence during/after chemotherapy or allogeneic stem cell transplantation (allo-SCT) were retrospectively reviewed to determine the utility of FDG-PET/CT. RESULTS: Twenty-two of the 28 patients have documented abnormal imaging findings during clinical follow-up, while six had were interpreted as not demonstrating signal consistent with active leukemia. Of the 22 patients with abnormal FDG-PET/CT studies 14 were found to have FDG-PET/CT reported as consistent with active leukemia and increased leukemia blasts on bone marrow biopsy. Regarding the eight patients without positive FDG-PET/CT and proven leukemia relapse, four had discordant findings on FDG-PET/CT and biopsy, and four had FDG-PET/CT reported as infection. Mean maximum standardized uptake values (SUVmax) were significantly higher among patients whose FDG-PET/CT findings were positive for leukemia as opposed to infectious disease (p < .05). Mean SUVmax was also significantly higher among patients with multifocal lesions on FDG-PET/CT than among those with diffuse lesions (p < .05). CONCLUSIONS: The findings suggest that FDG-PET/CT may be a complementary imaging modality that could be combined with bone marrow examination to improve detection of subtle leukemic infiltration in children with suspected leukemia progression or recurrence after chemotherapy or allo-SCT.

Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center.

OBJECTIVE: This study aimed to investigate the efficacy of resective surgery in children with focal lesional epilepsy by evaluating the predictive value of pre- and postsurgical factors in terms of seizure freedom. METHODS: This study included 61 children aged between 2 and 18years who were admitted to the pediatric video-EEG unit for presurgical workup. Each patient was evaluated with a detailed history, video-EEG, neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom. All the possible factors including history, etiology, presurgical evaluation, surgical procedures, and postsurgical results were analyzed for their predictive value for postoperative seizure freedom. RESULTS: Of the 61 patients, 75% were diagnosed as having temporal lobe epilepsy (TLE), and 25% were diagnosed with extra-TLE. Two years after the surgery, 78.6% were seizure-free, of which 89% had TLE, and 50% had extra-TLE (p<0.05). Patients were more likely to have a favorable outcome for seizure freedom if they had rare seizure frequency, focal EEG findings, and focal seizures; had a temporal epileptogenic zone; or had TLE and hippocampal sclerosis. On the other hand, patients were more likely to have unfavorable results for seizure freedom if they had younger age of seizure onset, frequent seizures before the surgery, a frontal or multilobar epileptogenic zone, secondarily generalized seizures, extra-TLE with frontal lobe surgery, or focal cortical dysplasia. SIGNIFICANCE: Resective surgery is one of the most effective treatment methods in children with intractable epilepsy. A history of young age of seizure onset, frequent seizures before surgery, secondarily generalized seizures, a multilobar epileptogenic zone, frontal lobe surgery, and focal cortical dysplasia (FCD) are the most important predictive factors indicating that a patient would continue having seizures after surgery. On the other hand, focal seizure semiologies, temporal lobe localization, and hippocampal sclerosis indicate that a patient would have better results in terms of seizure freedom.

Unexpected Uptake by the Gallbladder in Post-Ablative I-131 Scan.

A 47-year-old woman was diagnosed as papillary thyroid carcinoma. I-131 ablation therapy was applied following total thyroidectomy, and the whole-body scan revealed a focus of increased uptake in the right upper quadrant. Lateral view images of the uptake site showed that the focus was located near the right liver lobe. The patient was referred to radiology department for correlative abdominal Computed Tomography (CT) and Ultrasonography (US) to rule out a possible liver metastasis. CT images detected a gallstone in the corresponding area, which was verified by US. These methods did not reveal any metastatic disease in the liver or in other abdominal organs. This is the first published case report documents a rare false-positive finding of I-131 scan that was associated with an asymptomatic gallstone, and emphasizes the importance of correlative imaging in gallbladder related I-131 uptake.

Surgical outcome in patients with MRI-negative, PET-positive temporal lobe epilepsy.

PURPOSE: The purpose of this study was to determine the long-term surgical outcomes of magnetic resonance imaging (MRI)-negative, fluorodeoxyglucose positron emission tomography (FDG-PET)-positive patients with temporal lobe epilepsy (TLE) and compare them with those of patients with mesial temporal sclerosis (MTS). METHODS: One hundred forty-one patients with TLE who underwent anterior temporal lobectomy were included in the study. The surgical outcomes of 24 patients with unilateral temporal hypometabolism on FDG-PET without an epileptogenic lesion on MRI were compared with that of patients with unilateral temporal hypometabolism on FDG-PET with MTS on MRI (n=117). The outcomes were compared using Engel's classification at 2 years after surgery. Clinical characteristics, unilateral interictal epileptiform discharges (IEDs), histopathological data and operation side were considered as probable prognostic factors. RESULTS: Class I surgical outcomes were similar in MRI-negative patients and the patients with MTS on MRI (seizure-free rate at postoperative 2 years was 79.2% and 82% in the MRI-negative and MTS groups, respectively). In univariate analysis, history of febrile convulsions, presence of unilateral IEDs and left temporal localization were found to be significantly associated with seizure free outcome. Multivariate analysis revealed that independent predictors of a good outcome were history of febrile convulsions and presence of unilateral IEDs. CONCLUSION: Our results suggest that epilepsy surgery outcomes of MRI-negative, PET positive patients are similar to those of patients with MTS. This finding may aid in the selection of best candidates for epilepsy surgery.

Ictal body turning in focal epilepsy.

Despite the explanations of many lateralization findings, body turning in focal epilepsy has been rarely investigated. One of the aims of this study was to evaluate the role of ictal body turning in the lateralization of focal epilepsies. The records of 263 patients with focal epilepsy (temporal lobe epilepsy (TLE), n=178; extratemporal lobe epilepsy (ETLE), n=85) who underwent prolonged video-EEG monitoring during presurgical epilepsy evaluation were reviewed. Preoperative findings (TLE, n=16; ETLE, n=6) and postoperative outcomes (TLE, n=7) of patients with focal epilepsy with ictal body turning were assessed. For the evaluation of ictal body turning, two definitions were proposed. Nonversive body turning (NVBT) was used to denote at least a 90° nonforced (without tonic or clonic component) rotation of the upper (shoulder) and lower (hip) parts of the body around the body axis for a minimum of 3s. Versive body turning (VBT) was used to denote at least a 90° forced (with tonic or clonic component) rotation of the upper (shoulder) and lower (hip) parts of the body around the body axis for a minimum of 3s. Nonversive body turning was observed in 6% (n=11) of patients with TLE and 2% (n=2) of patients with ETLE. For VBT, these ratios were 5% (n=8) and 7% (n=6) for patients with TLE and ETLE, respectively. Nonversive body turning was frequently oriented to the same side as the epileptogenic zone (EZ) in TLE and ETLE seizures (76% and 80%, respectively). If the amount of NVBT was greater than 180°, then it was 80% to the same side in TLE seizures. Versive body turning was observed in 86% of the TLE seizures, and 55% of the ETLE seizures were found to be contralateral to the EZ. When present with head turning, NVBT ipsilateral to the EZ and VBT contralateral to the EZ were more valuable for lateralization. In TLE seizures, a significant correlation was found between the head turning and body turning onsets and durations. Our study demonstrated that ictal body turning is a rarely observed but reliable lateralization finding in TLE and ETLE seizures, which also probably has the same pathophysiological mechanism as head turning in TLE seizures.

18F-FDG PET/CT findings of radiotherapy-related myocardial changes in patients with thoracic malignancies.

OBJECTIVE: The purpose of this study was to investigate myocardial findings of F-fluorodeoxyglucose PET/computed tomography (F-FDG PET/CT) after thoracic radiotherapy. METHODS: F-Fluorodeoxyglucose PET/CT examination was performed in 38 patients at least 4 months after radiotherapy. Patients with known cardiac diseases, high cardiovascular risk factors, or diabetes mellitus were excluded. RESULTS: On visual analysis, 28 patients were seen to have regional myocardial F-FDG uptake (74%), five patients were seen to have diffuse myocardial F-FDG uptake (13%), and five patients were seen to have no significant myocardial F-FDG uptake (13%). Regions of interest were drawn on irradiated and nonirradiated segments of the myocardium. The standardized uptake value measurements of the 28 patients with regional myocardial F-FDG uptake revealed significantly higher values in the irradiated segments in comparison with nonirradiated segments (P<0.001). CONCLUSION: Annular or focal increased F-FDG uptake in irradiated myocardial segments may be observed after thoracic radiotherapy. These myocardial uptake regions were not consistent with the vascular territory of coronary arteries, and the patients had no prior myocardial infarction or coronary artery disease. The patients with a history of thoracic radiotherapy, who showed increased F-FDG uptake on PET/CT, especially in the basal myocardium, should be followed up cautiously for the early diagnosis of cardiac events.

Value of semiquantitative analysis for clinical reporting of 123I-2-ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl)nortropane SPECT studies.

UNLABELLED: Clinical (123)I-2-ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl)nortropane ((123)I-FP-CIT) SPECT studies are commonly performed and reported using visual evaluation of tracer binding, an inherently subjective method. Increased objectivity can potentially be obtained using semiquantitative analysis. In this study, we assessed whether semiquantitative analysis of (123)I-FP-CIT tracer binding created more reproducible clinical reporting. A secondary aim was to determine in what form semiquantitative data should be provided to the reporter. METHODS: Fifty-four patients referred for the assessment of nigrostriatal dopaminergic degeneration were scanned using SPECT/CT, followed by semiquantitative analysis calculating striatal binding ratios (SBRs) and caudate-to-putamen ratios (CPRs). Normal reference values were obtained using 131 healthy controls enrolled on a multicenter initiative backed by the European Association of Nuclear Medicine. A purely quantitative evaluation was first performed, with each striatum scored as normal or abnormal according to reference values. Three experienced nuclear medicine physicians then scored each striatum as normal or abnormal, also indicating cases perceived as difficult, using visual evaluation, visual evaluation in combination with SBR data, and visual evaluation in combination with SBR and CPR data. Intra- and interobserver agreement and agreement between observers and the purely quantitative evaluation were assessed using κ-statistics. The agreement between scan interpretation and clinical diagnosis was assessed for patients with a postscan clinical diagnosis available (n = 35). RESULTS: The physicians showed consistent reporting, with a good intraobserver agreement obtained for the visual interpretation (mean κ ± SD, 0.95 ± 0.029). Although visual interpretation of tracer binding gave good interobserver agreement (0.80 ± 0.045), this was improved as SBRs (0.86 ± 0.070) and CPRs (0.95 ± 0.040) were provided. The number of striata perceived as difficult to interpret decreased as semiquantitative data were provided (30 for the visual interpretation; 0 as SBR and CPR values were given). The agreement between physicians' interpretations and the purely quantitative evaluation showed that readers used the semiquantitative data to different extents, with a more experienced reader relying less on the semiquantitative data. Good agreement between scan interpretation and clinical diagnosis was seen. CONCLUSION: A combined approach of visual assessment and semiquantitative analysis of tracer binding created more reproducible clinical reporting of (123)I-FP-CIT SPECT studies. Physicians should have access to both SBR and CPR data to minimize interobserver variability.

The effect of diabetes mellitus on α1-adrenergic receptor subtypes in the bladder of rats.

OBJECTIVE: To detect the possible alterations on density or sensitivity of α1-adrenergic subtypes in diabetic bladder by reverse transcriptase-polymerase chain reaction technology and in vitro studies. METHODS: Experimental diabetes was induced by administration of streptozotocin with a single injection through the tail vein. Rats were divided into control and diabetic groups. Contractile responses of bladder strips from each group were obtained for postassium chloride, adenosine triphosphate, and electrical field stimulation (0.5-32 Hz) in organ bath. Electrical field stimulation responses of strips were evaluated in the presence of PPADS (nonselective P2 antagonist), atropine (cholinergic antagonist), 5 MU (α-1a-adrenergic antagonist), BMY-7378 (α-1d-adrenergic antagonist), and finally CED (α-1b-adrenergic antagonist). mRNA expression of α1-adrenergic subtypes was determined for each group. RESULTS: The difference between contractile responses related to electrical field stimulation with incubation with PPADS, atropine, 5 MU, BMY-7378, and CED, respectively, was not significant in the control and diabetic groups (P > .05). The electrical field stimulation responses of strips at 0.5-2 Hz without incubation were significantly different between the control and diabetic groups (P < .05). The contractile responses of strips with PPADS + atropine + 5 MU and BMY-7378 incubations in the diabetic group were significantly lower than in the control group in all doses (P < .05), The mRNA expression of α-1a-adrenergic in the diabetic group was significantly lower than in the control group (P < .05). No change was found in the expression of mRNA of α-1b-adrenergic. CONCLUSION: These results support the probability of changes in presynaptic and autonomic receptor sensitivity. We believe that α-1a-adrenergic and α-1d-adrenergic subtypes should be kept in mind in the treatment of diabetic cystopathy.

Early post-transplantation positron emission tomography in patients with Hodgkin lymphoma is an independent prognostic factor with an impact on overall survival.

The aim of the present study was to investigate the prognostic role of pre- and/or early post-autologous stem cell transplantation (ASCT) (18)F-flourodeoxyglucose (FDG) positron emission tomography (PET) in patients with relapsed/refractory Hodgkin lymphoma. Forty-three consecutive patients were enrolled in this study. FDG-PET/CT was performed following salvage chemotherapy within 6 weeks of undergoing ASCT and at the first month after ASCT. FDG-PET positivity was found in 26 patients before ASCT and in 13 patients after ASCT. The patients who had negative PET scan before or after ASCT had significantly better outcomes in terms of overall survival (OS) and progression-free survival (PFS). Pre- and post-ASCT FDG-PET positivity was found to be independently associated with PFS while post-ASCT FDG-PET was an independent factor with an impact on OS in multivariate analysis. (18)F-flourodeoxyglucose positron emission tomography imaging may be useful in predicting prognosis after ASCT. Furthermore, effective treatment options including allogeneic stem cell transplantation might be considered in patients with positive FDG-PET scan after salvage chemotherapy and ASCT.

Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma.

PURPOSE: We assessed the role of the maximum standardized uptake value (SUV(max)) of bone marrow and the extramedullary lesion with the highest SUV(max) in positron emission tomography/computed tomography (PET/CT) of newly diagnosed multiple myeloma (MM) patients in predicting overall survival (OS). METHODS: A total of 61 newly diagnosed patients (55 MM and 6 plasmacytoma) were enrolled in the study [37 men and 24 women with a median age of 57 years (range 28-80 years)]. The SUV(max) of bone marrow and the extramedullary lesion in PET/CT was correlated with the levels of ß(2)-microglobulin, C-reactive protein (CRP), albumin, creatinine, per cent of bone marrow plasma cells, serum free light chain (FLC) ratio, International Staging System (ISS) score and Durie-Salmon stage. RESULTS: The extramedullary lesion with the highest SUV(max) showed significant correlation with bone marrow fluorodeoxyglucose (FDG) uptake (p = 0.027) and near significant correlation with ISS (p = 0.048). Bone marrow SUV(max) correlated significantly with the per cent of bone marrow plasma cell count (p = 0.024), CRP (p = 0.012) and ISS (p = 0.013). In stage III MM the mean values of SUV(max) in extramedullary lesions were significantly higher than stages I and II (6.23 ± 6.32 vs 2.85 ± 3.44, p = 0.023). The serum FLC ratio did not show any correlation with SUV(max) of lesions and bone marrow (p > 0.05). Forty-four MM patients with FDG-positive lesions in PET/CT showed inferior 5-year estimated survival (61.73%) when compared to 11 patients without FDG-positive lesions, all of whom were alive (p = 0.01). In multivariate analysis an extramedullary lesion with the highest SUV(max) was the only independent predictor of OS (p = 0.03). CONCLUSION: PET/CT allows identification of high-risk myeloma patients, and extramedullary lesions with the highest SUV(max) independently predict inferior OS.

Comparison of diagnostic performances of three different software packages in detecting coronary artery disease.

PURPOSE: Quantification of myocardial perfusion scintigraphy is frequently performed to assist physicians in detecting coronary artery disease (CAD). Software packages provide automated quantification of perfusion data. We aimed to compare the three commonly used software packages, Emory Cardiac Toolbox (ECT v2 and ECT v3), 4D-MSPECT (4DM v2 and 4DM v4) and Quantitative Perfusion SPECT (QPS v3 and QPS v4). METHODS: We selected 283 patients who had a myocardial perfusion scintigraphy with (201)Tl followed by coronary angiography within 3 months. Summed stress score (SSS), summed difference score (SDS), total stress defect extent (TDE) and regional stress defect extent values were obtained from programs. A ≥70% stenosis in coronary arteries and their major branches was considered positive for CAD. A subgroup of patients was used to form an institutional normal database for QPS and 4DM. Receiver-operating characteristic (ROC) analysis to detect CAD was performed. RESULTS: Mean SSS ± SD (vendor) for ECT v3, QPS v4 and 4DM v4 were 9.2 ± 7.1, 10.1 ± 6.8 and 5.5 ± 6.1, respectively. Area under the curve (AUC) values of SSS ROC analysis were 0.738 ± 0.031 for QPS v3, 0.755 ± 0.030 for QPS v4, 0.758 ± 0.030 for ECT v2, 0.778 ± 0.029 for ECT v3 and 0.771 ± 0.030 for 4DM v4. The AUC values for TDE were 0.755 ± 0.030 for QPS v4, 0.769 ± 0.030 for ECT v3 and 0.775 ± 0.029 for 4DM v4. The differences were not significant for both SSS and TDE. Differences of AUC between regional stress defect extent values of programs and AUC of SSS between institutional and vendor normal databases were not significant. CONCLUSION: The diagnostic performances of programs to detect CAD are similar. However, there are differences in the magnitudes of the quantitative values produced by the programs.

An open-source framework of neural networks for diagnosis of coronary artery disease from myocardial perfusion SPECT.

BACKGROUND: The purpose of this study is to develop and analyze an open-source artificial intelligence program built on artificial neural networks that can participate in and support the decision making of nuclear medicine physicians in detecting coronary artery disease from myocardial perfusion SPECT (MPS). METHODS AND RESULTS: Two hundred and forty-three patients, who had MPS and coronary angiography within three months, were selected to train neural networks. Six nuclear medicine residents, one experienced nuclear medicine physician, and neural networks evaluated images of 65 patients for presence of coronary artery stenosis. Area under the curve (AUC) of receiver operating characteristics analysis for networks and expert was .74 and .84, respectively. The AUC of the other physicians ranged from .67 to .80. There were no significant differences between expert, neural networks, and standard quantitative values, summed stress score and total stress defect extent. CONCLUSIONS: The open-source neural networks developed in this study may provide a framework for further testing, development, and integration of artificial intelligence into nuclear cardiology environment.

Characterization of tailor-made copolymers of oligo(ethylene glycol) methyl ether methacrylate and N,N-dimethylaminoethyl methacrylate as nonviral gene transfer agents: influence of macromolecular structure on gene vector particle properties and transfection efficiency.

Oligo(ethylene glycol) methyl ether methacrylates (OEGMA) of various chain lengths (i.e., 9, 23, or 45 EG units) and N,N-dimethylaminoethyl methacrylate (DMAEMA) were copolymerized by atom transfer radical polymerization (ATRP), yielding well-defined P(DMAEMA-co-OEGMA) copolymers with increasing OEGMA molar fractions (F(OEGMA)) but a comparable degree of polymerization (DP approximately 120). Increase of both F(OEGMA) and OEGMA chain lengths correlated inversely with gene vector size, morphology, and zeta potential. P(DMAEMA-co-OEGMA) copolymers prevented gene vector aggregation at high plasmid DNA (pDNA) concentrations in isotonic solution and did not induce cytotoxicity even at high concentrations. Transfection efficiency of the most efficient P(DMAEMA-co-OEGMA) copolymers was found to be >10-fold lower compared with branched polyethylenimine (PEI) 25 kDa. Although OEGMA copolymerization largely reduced gene vector binding with the cell surface, cellular internalization of the bound complexes was less affected. These observations suggest that inefficient endolysosomal escape limits transfection efficiency of P(DMAEMA-co-OEGMA) copolymer gene vectors. Despite this observation, optimized p(DMAEMA-co-OEGMA) gene vectors remained stable under conditions for in vivo application leading to 7-fold greater gene expression in the lungs compared with PEI. Tailor-made P(DMAEMA-co-OEGMA) copolymers are promising nonviral gene transfer agents that fulfill the requirements for successful in vivo gene delivery.

[Differences in cerebral blood flow following risperidone treatment in children with autistic disorder]. / Otistik bozuklugu olan cocuklarda risperidon tedavisinin beyin kan akimi ile degerlendirilmesi]

OBJECTIVE: Functional changes in the brains of autistic children due to risperidone treatment and theirs relationship to the symptom clusters are yet unknown. In this autistic disorder case series we aimed to comparatively evaluate the clinical findings before and after risperidone treatment, and regional cerebral blood flow (rCBF) findings with 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain SPECT. METHOD: Eleven autistic patients (age range: 6-7 years; 4 girls, 7 boys) received risperidone therapy (1.5-2.5 mg d(-1)) and were followed-up for 3 months. All the patients underwent neurologic examinations, psychometric examinations, and SPECT imaging, both at the start of risperidone treatment and 3 months after the treatment started. Clinical observations, and the observations of parents and teachers were recorded. These results were compared with cerebral perfusion indices obtained from SPECT data. RESULTS: After 3 months of treatment changes in rCBF were observed in various regions and to varying degrees. We observed relationships between clinical symptoms and pre-therapy rCBF findings, and between clinical improvement and rCBF changes. CONCLUSION: Findings in the present case series are the first to demonstrate a relationship between clinical improvement and regional perfusion patterns after risperidone treatment. We think that these findings may contribute to the understanding of the neurofunctional mechanisms and hypothetical models of autism.

Tissue reactions of suture materials (polyglactine 910, chromed catgut and polydioxanone) on rat bladder wall and their role in bladder stone formation.

Suture materials are widely used in urological surgery especially in regions that are in contact with urine. In this study, we aimed to compare polyglactine 910, chromed catgut and polydioxanone sutures according to stone formation and inflammation, congestion and foreign body reaction that occur on bladder mucosa. Cystotomy procedure was performed, in three groups of Wistar female rats, with 4/0 polyglactine 910, 4/0 chromed catgut and 4/0 polydioxanone sutures. All groups were divided into two sub-groups with 4 and 8-week follow up periods. Rats were treated with 20 mg kg(-1) day(-1) Ofloxacin (i.p.) daily until the seventh post-operative day. Urinary pH, leucocyte esterase and nitrite levels were determined. All rats were killed at the end of the follow-up period and stone formation on sutures and degrees of tissue reactions (inflammation, congestion and foreign body reaction) on bladder mucosa were compared. Tissue reactions were evaluated by the same pathologist (S. K.). Chi-square and Student's t test were used in statistical analysis (p<0.05). There was no significant difference between the mean weights of the groups. Leucocyte esterase and nitrite were negative in urine analyses. There was no significant difference between urinary pH levels of the groups with 4 and 8 weeks follow-up (p>0.05). Although the difference between the degrees of congestion in groups was not statistically significant (p>0.05), there were statistically significant differences between the degrees of inflammation and foreign body reaction in groups. Although the duration of urinary contact of suture is the main factor in stone formation on suture material, tissue reaction on mucosa and the physical structure of suture also affect this formation. We observed lower degrees of inflammation and foreign body reaction with 4/0 polydioxanone and no stone formation. We believe that polydioxanone may be useful and reliable in urological surgery due to these properties.

Testicular microlithiasis in patients with scrotal symptoms and its relationship to testicular tumors.

OBJECTIVES: To evaluate in a prospective study the coexistence of testicular microlithiasis with various scrotal pathologies and the relationship with testicular tumors in symptomatic patients presenting with various scrotal complaints. METHODS: A total of 197 male patients of reproductive age who applied to our clinic between December 2004 and June 2005 with various scrotal complaints were included in the study. Patient complaints were of pain, swelling, smallness of the testes, and infertility. Patients were evaluated according to their medical history, scrotal ultrasonograms, tumor markers, and hormone profiles after physical examination. Independent t test and Fisher's exact test were used for statistical analysis. RESULTS: The mean (+/-SD) age of the 197 patients was 28.3 +/- 8.5 years. Pathologic findings were testicular tumors (1.8%), cryptorchidism (3.5%), varicoceles (75%), hydroceles (9.8%), epididymal cysts (9%), and atrophic testes (0.9%). Testicular tumors were found in 4 patients, and testicular microlithiasis was observed in 3 (75%) of these patients. Testicular microlithiasis ratios were determined as 25% in cryptorchidism, 6.5% in varicocele, 23% in hydrocele, 10% in epididymal cyst, and 50% in atrophic testes. The rate of testicular microlithiasis was significantly higher in patients with testicular tumors. The mean follow-up of patients was 19.5 months (range, 16 to 23 months), during which no new cancer case was detected. CONCLUSIONS: Testicular microlithiasis was more frequently observed in patients presenting with mass lesions and testicular tumors. Our findings suggest that symptomatic patients should be warned and kept aware of this issue, particularly if they have risk factors for testicular cancer.

Design, synthesis, and aqueous aggregation behavior of nonionic single and multiple thermoresponsive polymers.

Nonionic water-soluble poly(acrylamide)s and poly(acrylate)s were synthesized by RAFT and ATRP methods. Similar to the synthesized poly(N-isopropylacrylamide) and poly(N-acryloylpyrrolidine), aqueous solutions of statistical acrylate copolymers bearing two different oligo(ethylene oxide) side chains showed a sharp clouding transition upon heating beyond characteristic temperatures. The temperature of the cloud point can be easily fine tuned by the copolymer composition. As for poly(N-isopropylacrylamide) and poly(N-acryloylpyrrolidine), the cloud-point temperatures of these statistical copolymers are rather insensitive to changes in the molar mass or the NaCl content of the solutions. Also, ternary triblock copolymers containing one permanently hydrophilic block and two different thermoresponsive blocks were synthesized, varying the block sequence systematically. Their aggregation in aqueous solution was followed by turbidimetry and dynamic light scattering. Depending on the heating process and the triblock sequence, micellar aggregates of 40 to 600 nm size were found. The thermally induced aggregation behavior depends sensitively on the block sequence but is also subject to major kinetic effects. For certain block sequences, a thermally induced two-step association is observed when heating beyond the first and second cloud points of the thermoresponsive blocks. However, the thermal-transition temperatures of the block polymers can differ from the thermal-transition temperatures of the individual homopolymers. This may be caused by end-group effects but also by mutual interactions of the different blocks in solution, as physical mixtures of the homopolymers exhibit deviations from a purely additive thermal behavior.

Fate of bulk autografts in uncemented total hip arthroplasty. Evaluation by bone scintigraphy.

OBJECTIVE: To review short term results of uncemented cup implantation and the fate of bulk femoral head autografts in patients with acetabular bone deficiency due to dysplasia of the hip. We used bone scintigraphy to assess the viability of the grafts. METHODS: We treated 19 hip joints of 17 patients with osteoarthritis due to developmental dysplasia of the hip with uncemented total hip arthroplasty between 1997-2003 in the Department of Orthopedics and Traumatology, Gazi University, Ankara, Turkey. The average age was 49.1 (31-72 years), and the average follow up period was 36 months. We used femoral head autografts to reconstruct superolateral segmental deficiencies of the acetabuli. We evaluated the patients clinically and radiologically to assess acetabular loosening, and we used three-phase bone scintigraphy to evaluate the viability of the autograft. RESULTS: There was no acetabular component revision throughout the follow up period. There was no radiological evidence of graft resorption or graft displacement in any of the patients. In bone scintigraphy, we observed hyperemia in the blood pool phase, and the osteoblastic activity of the bone graft was at the level of the neighboring iliac bone. CONCLUSION: The application of a non-cemented acetabular component with femoral autograft in superolateral acetabulum deficiency increases the stability of the implant and increases the bone stock. It is not easy to evaluate the viability of the graft by the use of radiological methods. Bone scintigraphy gives sufficient information about the viability of the graft as a non-invasive method.

Point by point comparison of two thermosensitive polymers exhibiting a similar LCST: is the age of poly(NIPAM) over?

The present Communication compares the thermosensitivity in dilute aqueous solutions of well-defined copolymers composed of 95% of 2-(2-methoxyethoxy)ethyl methacrylate (MEO2MA) and 5% of oligo(ethylene glycol) methacrylate (OEGMA, Mn = 475 g.mol-1) and poly(N-isopropylacrylamide) (PNIPAM) samples having similar degrees of polymerization and chain-ends. The thermoresponsive behavior of P(MEO2MA-co-OEGMA) was found to be overall comparable, and in some cases, superior to PNIPAM. Hence, P(MEO2MA-co-OEGMA) copolymers can be considered as ideal structures, which combine both the properties of poly(ethylene glycol) and PNIPAM in a single macromolecule.