Factors affecting survival in patients undergoing percutaneous transhepatic biliary drainage for malignant biliary obstruction.

OBJECTIVE: The general approach to malignant biliary obstruction (MBO) is to provide drainage in all patients with jaundice. However, the procedure is often palliative, and its contribution to survival is debated. This study aimed to investigate prognostic factors in patients undergoing percutaneous transhepatic biliary drainage (PTBD) for MBO. PATIENTS AND METHODS: All laboratory values were divided into two groups based on median values: low and high. Chi-square analysis was performed for dichotomous data. The time from the PTBD procedure to the date of death or last follow-up was considered overall survival (OS). Univariate and multivariate analyses were calculated using the Cox regression model. RESULTS: A total of 152 patients were included in the study, of whom 84 (55.3%) were male. The median OS was 71 ± 12.6 days (95% CI: 46.3-95.7). The 1, 3, 6, and 12-month OS rates were 74.3%, 45.2%, 29.2%, and 13%, respectively. In the multivariate analysis, comorbidity (p=0.029), Eastern cooperative oncology group performance status (ECOG PS) (p=0.007), pre-PTBD albumin (p=0.025), post-PTBD aspartate aminotransferase (p=0.025), chemo naive (p<0.001), and post-PTBD chemotherapy (CT) (p=0.01) were found to be independent prognostic factors. CONCLUSIONS: In patients with poor prognosis MBO, the decision for PTBD should be made multidisciplinarily, taking into consideration ECOG PS, comorbidities, albumin levels, and prior CT status.

The hidden cochlear implant.

OBJECTIVE: The hidden cochlear implant concept has two data transmission methods: Bluetooth low energy and transtympanic optical data transfer systems. This study aimed to present the hidden cochlear implant and compare the test results with the existing fully implanted cochlear implant. METHOD: The Bluetooth low energy module was implanted into the implant bed. For the transtympanic optical data transfer tests, a receiver was passed through the posterior tympanotomy, and the transmitter was placed in the ear canal. RESULTS: The Bluetooth low energy module range was 5.2-17.5 m. Transtympanic optical data transfer reached a rate of 1 Mbit/s and had 99.22 per cent accuracy. Despite various obstacles, the accuracy of the transtympanic optical data transfer was more than 99 per cent with a 250 Kbit/s rate. The average power consumption was 310 mW for the implanted Bluetooth low energy module and 41 mW for the transtympanic optical data transfer receiver. CONCLUSION: Bluetooth low energy is suitable to be used transcutaneously. Transtympanic optical data transfer is an effective and promising technology. Hidden use cochlear implants aim to have the aesthetics of a fully implantable cochlear implant with higher reliability and a magnet-free design with smart device integration.

The success of dorsal onlay buccal mucosal graft urethroplasty in challenging urethral stricture cases after multiple failed urethrotomies.

Background: Urethroplasty is the gold standard treatment procedure for male patients with urethral stricture and is becoming increasingly popular among urologists worldwide. Procedure success rates have risen with increased experience. Aims: Here we aimed to examine the results of urethroplasty in challenging cases of urethral stricture and its effect on sexual function. Patients and Methods: Data were collected retrospectively from the patients who had undergone urethroplasty after multiple failed direct vision internal urethrotomy (DVIUs) from 2017 to 2020. All patients were monitored for a minimum of 12 months. Outcomes of urethroplasty were analyzed according to stricture location, length, and the number of prior DVIUs. Penile length and sensation, erectile, and ejaculatory function of the patients were evaluated pre- and postoperatively. Results: The patient cohort consisted of 36 males with a mean age of 63 ± 3.2 years. The most prevalent stricture etiology was iatrogenic (83%). Patients who underwent three or more DVIUs before urethroplasty and stricture length >4 cm were included in the analysis. Accordingly, the overall success rate was 83% (30/36). When the success rate and the IIEF5 scores were assessed separately, there was no significant relationship between the number of DVIUs (P > 0.05). Similarly, no significant relationship was also found with the stricture length (P > 0.05). Conclusion: Appropriate and correctly applied surgical technique does not impair sexual activity, even in patients with severe urethral stricture, regardless of the length or location of the stricture and the number of prior endoscopic procedures.

Successful treatment of hepatic and mesh Aspergillosis in a neonate with giant omphalocele.

Aspergillosis is a rare and life-threatening fungal infection in immunocompetent children, particularly in infants. We present a case of invasive Aspergillosis (IA) that developed hepatic and mesh infection due to Aspergillus flavus following the rupture of a giant omphalocele. A male baby was born at 37 weeks of gestation with a giant omphalocele. No other congenital abnormalities were found. In the pediatric surgery operation room, the amniotic membrane seemed to be ruptured in some parts, which had been repaired within a few hours of birth. No further intervention to reduce the volume of visceral organs could be performed due to the tiny abdominal cavity. Postoperatively piperacillin-tazobactam and fluconazole were empirically initiated. Abdominal defects had been covered with polypropylene polylactic acid synthetic Mesh on postnatal day 11 to protect the organs and prevent abdominal infections. Fungal hepatic lesions were observed during surgery, and black necrotic lesions were also observed on the mesh on day 12. On the 16th postnatal day, Aspergillus flavus grew in the wound, graft, hepatic biopsy cultures. Serum galactomannan (GM) assay test was positive (GM:2.9), and voriconazole was initiated. All necrotic lesions resolved with liposomal amphotericin B (L-AmB) and voriconazole treatment, and antifungal therapy was discontinued after 134 days. Eye examination for the retinopathy didn't show any abnormalities. The patient was discharged with full recovery on day 155. In conclusion, IA is a rare and life-threatening infection in the neonatal period. To the best of our knowledge, this is the first case of hepatic and mesh infection caused by Aspergillus flavus that was successfully treated with voriconazole and l-AmB.

Hacettepe cartilage slicer: a novel cartilage slicer and its performance test results.

OBJECTIVE: This study investigated the performance of a cartilage slicer device referred to as the 'Hacettepe cartilage slicer'. METHODS: Forty-one cartilage pieces were harvested from eight fresh frozen human ears and measured in thickness with a digital micrometer. These pieces were randomly sliced using four different thickness settings and two different types of blades. The thicknesses of the slices and remaining pieces were measured also. Scanning electron microscopy was utilised to determine the surface smoothness of the slices. RESULTS: Thickness results showed a proportional increase with the increasing thickness setting, with a ±0.1 mm margin of error. The measurements showed that over 95 per cent of the slices' structural integrity was preserved. Although both blades provided satisfactory results, scanning electron microscopy revealed that the slices cut with a single bevel blade had superior surface smoothness. CONCLUSION: To our knowledge, the current study is the first to evaluate the performance of a cartilage slicer device. Based on the thickness results, the Hacettepe cartilage slicer fulfilled its design goals: to consistently produce slices at the intended thickness with a ±0.1 mm tolerance, and to preserve over 95.3 per cent of cartilage thickness thereby ensuring undamaged, strong cartilage slices.

Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients.

BACKGROUND: The aim of this study was to determine the dimensional characteristics and variations in the origin of vertebral arteries (VA). MATERIALS AND METHODS: We retrospectively reviewed angiographic studies in 254 patients (133 males, 121 females) for the evaluation of diameter differences in VA. We examined different criteria from the literature (difference of ≥ 0.3 mm, ≥ 0.8 mm, ≥ 1 mm between the widths of two VA and diameter ratio more than 1.4) to find out the dominant VA, rate of co-dominance and hypoplasia. The differences among groups were analysed using the c2 and Kruskal-Wallis test. Also concordance analysis test was used to determine correspondence between the tests. We also noticed the variations in the origin of VA. RESULTS: The average diameter of VA in 254 patients was 3.21 ± 0.7 mm on the right, and 3.16 ± 0.7 mm on the left. The average diameter difference was found 0.88 ± 0.7 mm. The rate of hypoplasia was found 7.1% on the right and 9.4% on the left. Among 254 patients according to the criterion of any diameter difference; right side was found wider in 126 (49.6%) patients and left side was found wider in 120 (47.2%) patients. The criterion of 0.3 mm or greater difference showed right VA dominance in 107 (42.1%) patients, left VA dominance in 99 (39%) patients. Co-dominance was mainly observed when we used the criteria of 0.8 mm and 1 mm or greater difference and diameter ratio more than 1.4. We found out harmony of two criterion of difference of ≥ 0.8 mm and ≥ 1 mm (concordance analysis test, 76.1%). There was no statistically significant relation between age, gender and any dominance criteria (p > 0.05). The majority of VA showed classical origin arising from both subclavian arteries with a rate of 94.9%. CONCLUSIONS: The most striking result we have found is the dominance of the right VA in diameter by using all different criteria unlike with previous reports in the literature.

Incidence and prognosis of intraabdominal hypertension and abdominal compartment syndrome in children.

PURPOSE: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high mortality rates in children (40-60%). However, literature lacks comprehensive series in childhood. In this study, we aimed to determine the incidences of IAH and ACS, to identify high risk disorders for the development of IAH/ACS and to decrease ACS-associated mortality by early diagnosis and timely intervention. METHODS: A prospective study was performed between December 2009 and October 2010 in our institution. IAH was defined by a sustained or repeated pathological elevation in IAP≥12mmHg without a new organ failure. ACS was identified as a sustained IAP>15mmHg with a new organ dysfunction/failure. After recognition of IAH or ACS, patients underwent prompt decompressive interventions as medical or surgical procedures. RESULTS: 150 patients were enrolled to the study (86 M, 64 F). The incidences of IAH and ACS were 9% and 4%, respectively. High risk disorders were trauma, ileus, necrotizing enterocolitis, abdominal wall defects, diaphragmatic hernia and septic shock with massive fluid resuscitation. 14 patients with IAH were treated and mean IAP was decreased from 13.9±1.9mmHg to 9.2±2.1mmHg (p<0.001). None of them progressed to ACS. Six patients with ACS underwent decompressive laparotomy. Mean IAP decreased significantly from 20±3mmHg to 9±1.4mmHg (p=0.001). Vital signs like mean urine output, abdominal perfusion pressure (APP) and respiratory rate were significantly improved after surgery (p<0.05). ACS-associated mortality rate was determined as 16%. CONCLUSIONS: IAH or ACS was occurred in nearly one tenth of patients admitted to neonatal and pediatric intensive care units. High clinical suspect must be drawn on to recognize and treat these clinical complications more efficiently. Regular and frequent IAP measurement in high risk disorders is essential for early diagnosis. Lower mortality rates can be achieved by early recognition and timely intervention in children.

A case of a rare aortic arch variation: the avian form.

Variations in the branching pattern of the aortic arch are multiple. The avian form is an extremely rare anatomical variation with only a few reported cases in the literature. Herein we report a case of avian variation with two branches arising from the aortic arch: a bicarotid trunk and a common origin for bilateral subclavian arteries.

N-acetyl cysteine attenuates diazinon exposure-induced oxidative stress in rat testis.

The aim of this study was to investigate the gonadotoxic effects of diazinon and its mechanism of action with special reference to its possible reactive oxygen species generating potential in rat testis and the protective effect of N-Acetyl Cysteine (NAC) on the exposure of diazinon. The vehicle was given orally to the control group and NAC, diazinon, combination of NAC and diazinon were given to three treatment groups for 4 weeks. Testis lipid peroxidation levels were higher in diazinon group than in control although lipid peroxidation levels were lower in diazinon + NAC group than in diazinon group. The reduced glutathione (GSH) levels were lower in diazinon group than in control and NAC group although its levels were higher in diazinon + NAC group than in diazinon group. Vitamin C, Vitamin E and ß-carotene concentrations were also lower in diazinon group than in control and NAC groups. Vitamin E and ß-carotene concentrations were higher in diazinon + NAC group than diazinon group. Glutathione peroxidase activity and vitamin A concentrations in the testis did not show any difference between the four groups. In conclusion, we observed that NAC treatment modulated diazinon-induced oxidative injury in the rat testis. These findings suggest that NAC supplementation can be useful in testis oxidative injury caused by the organophosphate insecticides.

Long-term effects of microsurgical varicocelectomy on pain and sperm parameters in clinical varicocele patients with scrotal pain complaints.

We aimed to investigate the long-term effects of microsurgical varicocelectomy on pain improvement and sperm parameters in patients with varicocele-related pain. A total of 72 patients who had undergone microsurgical subinguinal varicocelectomy because of varicocele with scrotal pain between 2004 and 2009 were included in the study. The patients were grouped according to the presence or absence of pain following surgical treatment. The patients expressing a decrease in frequency and severity of pain or minimal fullness sense were included in the pain-positive group. The mean follow-up period was 54.4 ± 18.06 months. There was left-sided varicocele in 80.3% of patients, while 19.7% had bilateral varicocele. In our study, complete success rate (Visual Analog Scale: 0-1) was found to be 79.2% (57/72), while failure (complete and partial failure) rate was 20.8% (15/72), and a significant difference was found (P < 0.05). Microsurgical subinguinal varicocelectomy is a reliable approach for clinically varicocele patients with scrotal pain complaints. Regardless of the type of pain, varicocelectomy significantly decreases pain. The success of the treatment is not related to the degree of varicocele.

Success of Malone's antegrade continence enema (MACE) from the patients' perspective.

PURPOSE: Fecal incontinence (FI) is a devastating problem for children. The failure of optimal medical treatment may require further interventions such as appendicocutaneostomy. We report on a patients' perspective of the success of a Malone procedure for FI. PATIENTS AND METHODS: The records of 32 patients who had undergone ACE procedure in the past 9 years were reviewed. Patients and families were contacted, and telephone inquiries were conducted to assess the overall success of the operation. The questionnaire covered the concerns of patients/families about the stoma, functional results and changes in the patients' quality of life (QOL). RESULTS: The indications for ACE stomas were meningomyelocele in 17 patients, anorectal malformation in 8, Hirschsprung/NID in 3, spinal tumor in 3 and traumatic spinal injury in one. 7 laparoscopic and 25 conventional operations were performed. The vermiform appendix was used in 27 of the patients and a cecal flap was used in 5. The most frequent complication was stenosis of the stoma orifice observed in 14 patients. 8 patients responded to dilatations while 6 patients required minor surgical revision. There were 2 perforations during catheterization, and they required surgical repair of the conduit. 5 patients had mild leakage from the stoma; all 5 were open ACE procedures, and required revision. 25 patients could be reached by phone. 5 of these children stopped using the stoma due to previous perforation in 2 patients and stricture in 1. The remaining 2 stopped using their stomas because "they did not like the idea of it". 16 patients are completely clean. 3 patients have occasional soiling. Only one patient was not satisfied with using the ACE stoma and stated that it did not sufficiently improve her condition. 8 patients complained about the duration of the enema (longer than 1 h); however, 5 of them refuse to use the stoma every day. All patients but one perceived a significant improvement in their QOL. Mean QOL scores before and after the procedure were 5.8 (2-9) and 11.5 (5-14), respectively. CONCLUSIONS: ACE stomas provide a satisfactory improvement in patients' quality of life. Stoma-related complications are not uncommon. The most common problems are strictures, followed by stoma leakage.

A single centre experience in circumcision of haemophilia patients: Izmir protocol.

Haemophiliacs and their families consider that circumcision is a very important step to become a member of society and it is a social obligation for men in Turkey. Although bleeding risk is high, almost all haemophiliacs would like to be circumcised in Turkish society. The aim of this study was to evaluate our experience in circumcision of haemophilia patients and define efficacy, safety and complication rates of our protocol, called 'Izmir protocol'. In this study, we retrospectively reviewed medical records of 50 patients with haemophilia who underwent circumcision at our hospital according to Izmir protocol between 1996 and 2009. Oral tranexamic acid and fibrin glue were used in all children. One hour before the operation, first dose of factor concentrate was given. After reaching a plasma factor level of around 90-100%, the prepuce was incised circumferentially and excised using Gomco clamp or open technique under general anaesthesia. Intermittent injections of factor concentrate were given every 12 for 48 h. While the first two doses were given at higher amount to achieve or continue plasma factor level at 90-100%, in the last three doses, the aim was to maintain the plasma factor level at 50-60%. Forty-eight hours after the circumcision, patients were discharged. Three patients (6%) showed bleeding complication and all were resolved easily. All had at least one excuse from the protocol (Lower doses of factor concentrates was used in 2, tranexamic acid was not used in 2). Izmir protocol is safe, cheap and easy to carry out.

The efficacy of external neuromyogenic stimulation on neuromuscular anorectal incontinence.

AIM: This study reports on the preliminary results of external neuromyogenic electrostimulation (ENS) for the treatment of anorectal continence problems. PATIENTS AND METHODS: A total of seventeen patients with anorectal malformations (n=11), Hirschsprung's disease (n=5) or pelvi-perineal trauma (n=1) were included in the study. All patients were evaluated using clinical, radiological, and manometric methods prior to ENS. The Holschneider Continence Scale and the Quality of Life (QOL) Score were used for clinical assessment. The ENS stimulator is a two-channel ambulatory device providing a pulse current. ENS was performed by parents in a home setting twice daily for 6 weeks using skin electrodes attached to the sides of the anus. Three of the 11 preset programs were used (lack of sensitivity, pelvic floor work out and building up endurance). Clinical and manometric variables were reevaluated following completion of the 6-week program. RESULTS: Mean age was 9.7 years (range 5-22 years). The Holschneider Continence Score increased from a mean value of 5.3+/-3.2 to 12.4+/-1.7 (p=0.002) and mean QOL scores increased from 5.6+/-2.3 to 11.6+/-1.8 (p=0.01) following ENS. Mean anal canal resting pressures prior to ENS were 20.3+/-6 cmH (2)O and increased to 28.7+/-14.1 cmH (2)O after 6 weeks (p>0.05). Maximum voluntary squeeze pressures before and after ENS were 56.1+/-16.7 cmH (2)O and 100.7+/-16.9 cmH (2)O respectively (p=0.001). CONCLUSION: Preliminary results for ENS have shown that patients achieved higher maximum voluntary squeeze pressures, and showed a marked improvement in their continence and QOL scores. Given the advantage of ambulatory use in a home setting, the ENS seems promising in terms of achieving improved anorectal continence in selected patients.

Removal of volatile organic compounds by natural materials during composting of poultry litter.

The objective of this study was to reduce volatile organic compounds (VOCs) produced during composting of poultry litter. The natural zeolite, expanded perlite, pumice and expanded vermiculite as the natural materials were used for the reducing of VOCs. Composting was performed in a laboratory scale in-vessel composting plant. Poultry litter was composted for 100 d with volumetric ratio of natural materials:poultry litter of 1:10. The VOCs were tested using the FT-IR method by VOCs analyzer. Studies showed that VOCs generation was the greatest in the control treatment without any natural materials. The natural materials significantly reduced VOCs. At the end of the processes, removal efficiency was 79.73% for NZ treatment, 54.59% for EP treatment, 88.22% for P treatment and 61.53% for EV treatment. Potential of removal for VOCs on poultry litter matrix using natural materials was in order of: P>NZ>EV>EP.

Visualization of the normal appendix in children by non-contrast MDCT.

OBJECTIVE: We studied the proportion of normal appendices, identified on non-contrast MDCT scans of the abdomen and pelvis in children with possible renal stones. MATERIALS AND METHODS: A total of 105 patients were included in the study, comprising 40 girls (38%) and 65 (62%) boys, with a mean age of 7.3 years. Non-enhanced abdominal computed tomographies were evaluated retrospectively, and the visualization, location, contents, diameter of the appendix, and the amount of abdominal fat were recorded. RESULTS: The appendix was clearly distinguished in 72 patients (68.5%). The difference in appendix visualization rates between patients with low and medium amounts of abdominal fat was statistically significant (p < 0.001). Visualization increased with age. The greatest external diameter was between 2.8 and 10 mm, with a mean of 5 +/- 1.34 mm. CONCLUSION: MDCT without contrast will be more useful when used in patients of 6 years old and over, for visualization of the appendix. A better visualization of retrocaecal appendix by MDCT provides a greater advantage over US. Prospective comparative studies will determine the role of this method in the diagnosis of acute appendicitis in pediatric patients.

Bronchial to coronary artery fistulas: an important sign of silent coronary artery disease and potential complication during bronchial artery embolization.

Coronary artery fistulas are rare and usually asymptomatic congenital anomalies generally diagnosed incidentally during coronary angiographies. Herein, we present a case of bronchial to coronary artery fistula which was diagnosed incidentally during bronchial artery embolization. Embolization was performed successfully without complication, and an underlying important coronary artery stenosis was subsequently found by coronary computed tomography angiography.

A comparison of efficacy between two natural exogenous surfactant preparations in premature infants with respiratory distress syndrome.

The mortality and various morbidity rates have been substantially reduced by means of exogenous surfactant replacement, the cornerstone in the treatment of respiratory distress syndrome (RDS) in premature infants. The objective of this study is to compare two natural surfactant preparations (Alveofact(R), Survanta(R)) in terms of effectiveness and side-effects. A total of 50 infants with RDS were given surfactant due to RDS were taken into the scope of this study. Survanta(R) and Alveofact(R) were administered to randomized infants with RDS and the results obtained during clinical observations were compared. Second hour mean FiO (2), MAP and a/APO (2) values showed changes in favour of Alveofact(R) (n = 25) group compared to the Survanta(R) (n = 25) group (p < 0.05 for each parameter). However, this difference disappeared in the 6 (th) hour. No statistical difference was established between the two groups with regard to sideeffects (pneumothorax, sepsis, intraventricular hemorrhage, bronchopulmonary dysplasia), duration of mechanical ventilation in survivors, duration of hospitalization in survivors and mortality before the 28 (th) day. It was concluded that results obtained with different surfactant preparations having dissimilar compositions were not different in terms of final impacts and side-effects.

Prophylactic antibiotic use in pediatric burn units.

Prophylactic antibiotic use in childhood burns is controversial. The efficiency of antibiotic prophylaxis in 77 pediatric burn patients was evaluated. Forty-seven patients received prophylactic antibiotics (Group AP), while 30 patients received no prophylaxis (Group NP). Age, wound depth, day of admission, mechanism of burn injury, type of dressings were similar for both groups (p > 0.05). Wound infection rates were 21.3 % in Group AP and 16.7 % in Group NP (p > 0.05). S. aureus, Enterobacter spp., P. aeruginosa, and E. coli were the most common microorganisms. Patients with wound colonization and infection had a larger burned total body surface area (BTBSA) in both groups (p < 0.01). Eight patients had clinical sepsis. All but one of the septic patients were from Group AP. Associated infections of the upper and lower respiratory tract (16), urinary tract (7), and otitis media (2) were more common in Group AP. One patient died from sepsis in Group AP. Hospital stays were longer in Group AP (21.7 +/- 16.4 vs. 13.5 +/- 10 days; p < 0.05). Antibiotic prophylaxis in childhood burns does not reduce the rate of wound infection. Age, wound depth and BTBSA are not critical variables for prophylaxis. Reinforcing the use of culture-specific antibiotics for more beneficial and cost-effective results in the treatment of childhood burns is recommended.