Estado actual de la formación urológica y diferencias entre instituciones / Current status of urological training and differences between institutions

Objetivos La formación adecuada de los residentes de urología es importante para garantizar no solo una atención de alta calidad a los pacientes, sino también un futuro promisorio para nuestra especialidad. Nuestro objetivo es investigar la formación de los residentes desde el punto de vista de la cualificación y la estandarización, y evaluar de forma exhaustiva la formación quirúrgica, la producción de publicaciones, las condiciones de trabajo, los planes de futuro y la satisfacción global. Métodos Se realizó una encuesta a los jefes de residentes/recién graduados en Turquía para identificar las diferencias entre instituciones y las deficiencias en la formación de los residentes de urología. Se contactó telefónicamente a un total de 155 jefes de residentes/especialistas recién graduados para completar la encuesta. Resultados La tasa de respuesta a la encuesta fue del 96,1%. Los encuestados presentaron un nivel alto de competencias en endourología (97,3%), similar al de Canadá y los países europeos. Sin embargo, manifestaron una falta de competencias en laparoscopia (28,9%) y urología funcional (26,2%). Además, ninguno había realizado un procedimiento robótico como primer cirujano. El 75,2% de los encuestados no tenía ninguna publicación como primer autor, y el 10,1% no tenía presentaciones de resúmenes como primer autor. No hubo diferencias significativas entre los distintos tipos de instituciones con o sin certificación. Hubo un índice de satisfacción del 87,2% entre los participantes. Conclusiones Se ha observado que no se ha conseguido una formación cualificada y estandarizada, y que aún no se evidencian los efectos positivos de la certificación. Se debe modernizar la formación en todos los aspectos, y no existe un plan de estudios estandarizado que aborde la investigación académica (AU)

Objectives Appropriate training of urology residents is important to secure not only high-quality patient care, but also the bright future of our specialty. We aimed to investigate residency training from the perspective of qualification and standardization and to evaluate surgical education, publication output, working conditions, future plans, and overall satisfaction, in a comprehensive way. Methods We conducted a survey of urology chief residents/recent graduates in Turkey to identify differences between institutions and deficiencies in urology resident training. A total of 155 chief residents/recently graduated specialists were contacted by phone and a survey was completed. Results The survey response rate was 96.1%. Respondents had high proficiency in endourology (97.3%), similar to Canada and European countries. However, they reported a lack of proficiency in laparoscopy (28.9%) and functional urology (26.2%). Also, no one had completed a robotic procedure as first surgeon. A total of 75.2% respondents had no first author publication, and 10.1% had no first author abstract presentation. There was no significant difference between institution types with or without certification. There was a satisfaction rate of 87.2% among participants. Conclusions It was observed that qualified and standardized training could has not been achieved and the positive effects of certification have not been seen yet. There is a lack of modernization in all aspects of education, and there is no standardized curriculum addressing academic research. Therefore, there is a risk that future urologists will have insufficient skills. We hope this study serves as a guide for modernization and standardization in urology training (AU)

Buckwheat conservation as hay or silage: agronomic evaluation, nutritive value, conservation quality, and intake by lactating dairy goats.

Buckwheat was conserved either as silage at two dry matter (DM) levels attained with (wilted silage (WS), 313 g/kg) and without wilting (direct cut silage (DS), 171 g/kg) or as hay (856 g/kg) and was included in the isonitrogenous and isocaloric total mixed ration (TMR) of four groups of six Saanen goats each at the rate of 200 g/kg DM. Ensiling buckwheat at low DM led to a poorly fermented silage with higher ammonia-N and butyric acid contents and extensive growth of enterobacteria and mold-yeast than WS. The DM recovery of DS was lower than that of WS. The total phenol (TP) content of buckwheat was also preserved more efficiently in hay than in DS. The nutritive value of hay was higher than that of the silages because hay had less fiber contents but more non-fiber carbohydrates and total digestible nutrients. The decrease in nutritive value in buckwheat silages, in particular for DS, increased the nutrient intensity in the concentrated feed. The DM intake of goats fed DS TMR tended to be lower (P=0.09) than that of the goats fed WS TMR in the first week of the experiment, but the goats quickly adapted to the poorly fermented silage and did not reduce their overall DM intake. The DS, WS, and hay TMRs did not affect fat corrected milk yield but increased the milk TPs compared to a TMR with legume-grass hay. It was concluded that buckwheat hay and silages are well accepted by dairy goats, but the DM content of buckwheat at ensiling may require over 330 g/kg for producing well-fermented silages.

Gastrointestinal Injuries in Blunt Abdominal Traumas.

AIM: To discuss the efficiency of RTS (Revised TraumaScore), ISS (Injury Severity Score), and factors that affect mortality and morbidity in gastrointestinal injuries due to blunt trauma.Method and methods: Patients with gastrointestinal injuries due to blunt trauma operated within the last six years have been studied retrospectively in terms of demographics,injury mechanism and localization, additional injuries, RTS and ISS, operative technique, morbidity, mortality and duration of hospitalization. FINDINGS: Of the eighteen cases, cause of injury was a traffic accident for 11 (61.1%), fall from height for 5 (27%) and physical attack for 2 (11%). Among the eighteen patients,there were 21 gastrointestinal injuries (11 intestinal, 6 colon,3 duodenum, 1 stomach). 10 (55.6%) had additional intraabdominal injuries while the number for extra-abdominal injuries were 12 (66.7%). Primary suture (10), segmentary resection (9) and pyloric exclusion (2) were the operations performed for the twenty-one gastrointestinal injuries.Although statistically not significant, 13(72.2%) patients with additional injuries compared with 5 (27.8%) patients with isolated gastrointestinal injuries, were found to have lower RTS (7.087/7.841), higher ISS (19.4/12.2), longer duration of hospitalization (11.5/8.4 day) as well as higher morbidity (7/1) and mortality (2/0) rates. Comparing the RTS (7.059/7.490) of patients who have and have not developed morbidity revealed no significant difference.However, ISS (23.9/12.2) was significantly higher in patients who have developed morbidity (p=0.003). RTS (6.085 7.445) and ISS (39.5/14.6) of patients who have survived were significantly different than patients who have not(p=0.037 and p=0.023, respectively) CONCLUSION: Additional injuries in patients with gastrointestinal injury due blunt abdominal traumas increases, although not significantly, morbidity, mortality and duration of hospitalization even when operated early. High ISS is significantly related to the risk of both morbidity and mortality while low RTS is significantly related only to the mortality risk.

Primary angiosarcoma of the breast: Diagnosis with computer-assisted MRI-guided radio-guided occult lesion localization (ROLL) technique.

Primary angiosarcoma of the breast is a rare type of breast cancer that represents approximately 0.04% of all primary breast tumors. We report herein a case of primary breast angiosarcoma that was only visible on magnetic resonance imaging (MRI) examination. The patient presented with a palpable right breast lump that was not visible either on ultrasonography and mammography. MRI showed a lesion of the right breast that presented washout kinetics. MRI-guided biopsy allowed histopathological examination of the tumor that was further confirmed as primary angiosarcoma. Subsequently, MRI guided ROLL (radio-guided occult lesion localization) technique was used for localizing the lesion prior to surgery.

Anatomical comparison and evaluation of human proximal femurs modeling via different devices and FEM analysis.

BACKGROUND: Breuckmann optical scanning, Metris laser scanning and CT are general devices used for modeling hard or soft tissues in the biomedical field. Whereas the CT device is able to model internal and external structures of hard tissues, Breuckmann and Metris devices can only model the exterior portions of tissues. In this study, a human proximal femur was modeled using these devices, and the matching accuracy thereof is presented. METHODS: The human proximal femur was modeled by scanning with Breuckmann optical scanning, Metris laser scanning and CT devices. The 3D/3D registration method was performed in two ways: coordinate to coordinate based, and 2D contour based matching. Matching accuracies of the three models were developed with statistical deviation and local deviation. To determine the significance value between the deviations obtained, one way ANOVA, and for intragroup comparisons Tukey and Thamhane tests were used. After statistical analysis, stresses on the models were evaluated using ANSYS software taking boundary conditions on human standing position into consideration. RESULTS: In this study, the value of the 2D contour based accuracy deviation of the femur head zone between CT and Metris models was obtained as 0.4 ± 0.2 mm while it was 0.3 ± 0.1 mm between CT and Breuckmann. The highest matching deviation obtained as a result of the ANOVA test among these three models was found in the femur trochanter region (0.0142 ± 0.0164 mm), the lowest value was found in the femur head region (0.0070 ± 0.0132 mm). The stress of the CT-Breuckmann pair was found close to each other in stress analysis. CONCLUSION: The deviation values obtained by matching models created by three different methods showed statistically significant results (P < 0.05). Values obtained from the CT-Breuckmann model were lower than those obtained from CT-Metris. In order to lower deviation values, applications such as increasing the resolution of images, using stronger algorithms, meshing methods and enhancing surface form should be implemented.

Fuzzy regression modeling for tool performance prediction and degradation detection.

In this paper, the viability of using Fuzzy-Rule-Based Regression Modeling (FRM) algorithm for tool performance and degradation detection is investigated. The FRM is developed based on a multi-layered fuzzy-rule-based hybrid system with Multiple Regression Models (MRM) embedded into a fuzzy logic inference engine that employs Self Organizing Maps (SOM) for clustering. The FRM converts a complex nonlinear problem to a simplified linear format in order to further increase the accuracy in prediction and rate of convergence. The efficacy of the proposed FRM is tested through a case study - namely to predict the remaining useful life of a ball nose milling cutter during a dry machining process of hardened tool steel with a hardness of 52-54 HRc. A comparative study is further made between four predictive models using the same set of experimental data. It is shown that the FRM is superior as compared with conventional MRM, Back Propagation Neural Networks (BPNN) and Radial Basis Function Networks (RBFN) in terms of prediction accuracy and learning speed.

(2S,12Z)-2-Acetoxy-12-heptadecene: major sex pheromone component of pistachio twig borer, Kermania pistaciella.

The sex pheromone of the pistachio twig borer, Kermania pistaciella (Lepidoptera: Oinophilidae), one of the most important insect pests of pistachio, Pistacia vera, in Turkey and Iran, was identified. In gas chromatographic-electroantennographic detection (GC-EAD) and GC-mass spectrometric analyses of pheromone gland extracts of female K. pistaciella from Turkey, (2S,12Z)-2-acetoxy-12-heptadecene was identified as the major candidate pheromone component. In field experiments in Turkey, lures containing synthetic (2S,12Z)-2-acetoxy-12-heptadecene attracted large numbers of male moths. Its attractiveness was significantly reduced by the presence of the R-enantiomer or of either enantiomer of the corresponding alcohol. (2S,12Z)-2-Acetoxy-12-heptadecene is the first pheromone component identified in the Oinophilidae and the first secondary acetate pheromone component identified in the Lepidoptera.

First description of the disease by Conidiobolus osmodes on Tipula paludosa larvae with the report of a natural epizootic.

A new fungal pathogen of Tipula paludosa (Tipulidae: Diptera) larvae, Conidiobolus osmodes (Ancylistaceae: Entomophthorales), was found during a survey of tipulid larval pathogens in Northumbria and Cumbria in England in 1997-1999. The fungus caused an epizootic in a population at Close House during autumn 1999 and spring 2000 with prevalence rising fourfold reaching about 40% in April 2000. The disease development was presented and the fungus was described from naturally infected larvae and artificial cultures.

Extrahepatic biliary obstruction caused by small-cell lung cancer: a case report.

The pancreas is a rare site of metastasis from small-cell lung cancer (SCLC). We present the case of a pancreatic metastasis of small-cell lung cancer associated with jaundice, in which, initially, the case was evaluated as a primary pancreatic carcinoma and pancreaticoduodenectomy was performed. We also review the reported cases of pancreatic metastases from SCLC.

Tear nitrite and nitrate levels as nitric oxide end products in patients with Behçet's disease and non-Behçet's uveitis.

To evaluate the role of nitric oxide (NO) in ocular inflammation, tear nitrite and nitrates (NN) as NO end products were determined in 11 patients with Behçet's disease (BD) and in 11 with non-Behçet's uveitis (NBU) during the active and remission stages and in 12 healthy controls. Median (with the range) NN levels were 82.29 (59. 60-98.25) micromol/l in the active and 98.25 (52.88-246.92) micromol/l in the remission stage of BD; 88.17 (25.99-116.73) micromol/l in the active and 83.00 (31.04-250.28) micromol/l in the remission stage of NBU and 109.17 (88.17-158.74) micromol/l in the controls. The NN levels in the active stage of BD and NBU were significantly decreased when compared to the controls (p < 0.05; Kruskal-Wallis test). Decreased NN levels at the activation stage may be caused by the rapid transformation of the NO to peroxynitrites, which are highly oxidizing and cytotoxic substances.

HHV-8 is not a cofactor in the pathogenesis of environmentally induced malignant pleural mesothelioma.

After the recognition of human herpes virus 8 (HHV-8) in Kaposi's sarcoma lesions, this new virus has been shown to be associated with various types of malignancy. One of them, body cavity-based lymphoma, is a high grade B-cell lymphoma arising from the body cavities. Similarly, mesothelioma is a tumour that originates from the serosal linings of the pleural, pericardial and peritoneal cavities. One of the striking characteristics of mesothelioma cells is the secretion of interleukin-6 (IL-6). Also, it is known that HHV-8 upregulates the levels of IL-6, and this virally originated IL-6 is a well-established growth factor for HHV-8-associated lesions. Therefore, it was hypothesized that HHV-8 may have a role in the pathogenesis of malignant mesothelioma. Twenty-nine pleural biopsy specimens from environmentally induced malignant mesothelioma patients were investigated for the presence of HHV-8 deoxyribonucleic acid (DNA) using the polymerase chain reaction (PCR). Control pleural samples were collected from 15 biopsy specimens from patients with tuberculosis. From all samples, a segment of the beta-globulin gene was amplified in order to make sure that the DNA was extracted properly and did not contain any inhibitors. The specificity of the PCR amplification was confirmed by means of restriction enzyme analysis using Providencia stuartii I. PCR did not reveal HHV-8 DNA in any of the mesothelioma patients or in the control group. It was possible to amplify a segment of the human beta-globulin gene from all the samples of the patient and control groups. HHV-8 DNA was amplified in the control sample, which was a tissue biopsy specimen from a Kaposi's sarcoma lesion, and it was confirmed that the amplified DNA belonged to HHV-8 by restriction enzyme analysis. Malignant mesothelioma continues to be a public health problem in rural parts of Anatolia, Turkey. The major causal factor of the disease is exposure to asbestos and fibrous zeolite (erionite). It seems that there must be some aetiological factors other than exposure to these minerals as not all patients exposed to asbestos develop the disease and the disease is not always associated with any known exposure. From the present study, it was concluded that human herpes virus 8 does not seem to be associated with environmentally induced malignant mesothelioma in Turkey. Other possible causal factors of malignant mesothelioma should be sought.

Primary composite tumour with bipartite differentiation of the esophagus.

Primary small cell carcinoma of the esophagus is a rare tumour. A primary composite tumour of the esophagus is even rarer and only four cases had been reported in the literature up to August 1998. The definitive histogenesis of this tumour remains controversial in spite of the additional information provided by electron microscopy and immunohistochemistry. In the presented case, histologically, the tumour tissue was composed of two malignant components: approximately 50% of a moderately differentiated squamous cell carcinoma, and approximately 50% of a small cell carcinoma. A lot of morphological transition zones were observed between the squamous cell carcinoma components and the small cell carcinoma components in some areas in the squamous cell carcinoma component. Histochemically and immunohistochemically, the small cell carcinoma cells demonstrated argyrophil granules, and Cytokeratin and Chromogranin A reactivity, but the squamous cell carcinoma cells demonstrated only Cytokeratin reactivity. Negative reactivity for argentaffin granules, neuron-specific enolase and S-100 were observed in both the small cell carcinoma and the squamous cell carcinoma components. Histological, histochemical and immunohistochemical findings suggest that a primary composite tumour of the esophagus may be derived from a totipotent primitive cell in the basal region of the squamous mucosa of the esophagus. The patient received chemotherapy preoperatively but died one month after the initial diagnosis.

Dynamic fuzzy neural networks-a novel approach to function approximation.

In this paper, an architecture of dynamic fuzzy neural networks (D-FNN) implementing Takagi-Sugeno-Kang (TSK) fuzzy systems based on extended radial basis function (RBF) neural networks is proposed. A novel learning algorithm based on D-FNN is also presented. The salient characteristics of the algorithm are: 1) hierarchical on-line self-organizing learning is used; 2) neurons can be recruited or deleted dynamically according to their significance to the system's performance; and 3) fast learning speed can be achieved. Simulation studies and comprehensive comparisons with some other learning algorithms demonstrate that a more compact structure with higher performance can be achieved by the proposed approach.

Surgical treatment of hydatid cyst of the lung: review of 30 cases.

Hydatid cyst disease is still a problem in Turkey, especially in the east Anatolian region, as well as in many other places in the world. A retrospective review was made of the surgical treatment of 30 patients with pulmonary hydatid cysts during the last 3 yrs. Nineteen patients were male and 11 female with an average age of 23.5 yrs (range 4-44 yrs). Cystotomy and capitonnage were performed in 28 of the 30 cases (93.4%). The transdiaphragmatic route or simultaneous laparotomy was preferred when the liver was involved. Albendazole was used in four patients with multiple hydatid cyst due to probable recurrence in the postoperative period. Cough and chest pain were the prominent symptoms in the majority of cases. A single lobe was affected in 22 patients. Unilateral multiple foci were present in four patients and bilateral multiple foci in four. Six patients had concomitant liver cysts. Morbidity was low and no mortality was seen. No recurrences were seen on control chest radiographs during the last 2-yr follow-up. In the treatment of hydatid cyst of the lung, conservative surgical methods such as cystotomy and capitonnage still remain the treatment of choice. Medical treatment could be used for prophylactic purposes and in some instances, but the percutaneous aspiration method should not be performed.

Evaluation of trauma care in a developing country highlighted by a major aircraft accident.

The aim of this study was to evaluate the day-to-day trauma care in a developing country highlighted by a major accident. In this accident, early management was not carried out according to triage principles. Scene mortality and in-hospital mortality were 72% (n = 55) and 14% (n = 3), respectively. Overall mortality rate was 76%. Five survivors were minor wounded. Three laparotomies, one thoracotomy and three tube thoracostomies were performed in the acute phase. Skeletal injuries, mainly rib fractures (43.3%) and haemothorax (10.8%), were the most frequent pathologies seen. One liver laceration, one splenic rupture, one intraabdominal bleeding due to rupture of mesenteric vessels, two major cranial traumas and an abruptio placenta were the other pathologies. The missed injury rate in this accident was 16% (n = 6). It is concluded that the missed injuries in this incident reflect the inadequacy of trauma care in the rural area of the developing country.