Two-level ACDF with a zero-profile stand-alone spacer compared to conventional plating: a prospective randomized single-center study.

PURPOSE: Stand-alone zero-profile devices have already proven safety, and a reduced dysphagia rate was assumed. So far, no level-one evidence is available to prove the proposed advantages of zero-profile implants in multilevel procedures. The aim of this RCT was to compare the clinical and radiological outcome of a zero-profile spacer versus cage + plate in two-level ACDF. METHODS: Consecutive patients with contiguous two-level cDD were randomly assigned either to the interventional group (zero-profile device) or to the control group (cage + plate). Primary endpoint of the study was the prevalence of dysphagia at 24 months. Disability, progress of adjacent segment degeneration, fusion status and loss of correction were analyzed as secondary outcome measure. Primary outcome parameter was statistically analyzed by Chi-square test. RESULTS: Forty-one patients met inclusion criteria and were randomly assigned to the interventional and the control group. Dysphagia was frequent in either group at 3 months FU favoring interventional group (p = 0.078). At final FU, less patients of the interventional group complained about dysphagia, but the difference was not significant. No relevant differences at final FU were recorded for NPDI, loss of correction and adjacent-level degeneration. Fusion rate was slightly lower in the interventional group. DISCUSSION: Two-level ACDF either by a stand-alone zero-profile spacer or cage + plate is safe. Using a zero-profile cage dysphagia was infrequent at 24 months, but the value did not reach statistical significance in comparison with the cage + plate. Hence, this randomized trial was not able to prove the proposed clinical superiority for dysphagia rates for zero-profile anchored spacer in two-level cDD.

The surgical technique and initial outcomes of Anatolian neobladder: a novel technique of ileal neobladder after radical cystectomy.

BACKGROUND: We describe a detailed novel step-by-step approach for creation of an ileal neobladder and compare the outcomes with standart neobladder. METHODS: Between August 2009 and January 2016, 36 consecutive patients with bladder cancer underwent radical cystectomy and orthotopic urinary diversion with an ileal neobladder. A novel technique of ileal neobladder construction, called the Anatolian neobladder, was designed by a single surgeon (ZT). Demographics and clinical data were collected. Perioperative, oncologic, and functional outcomes were reported. Complications were graded as early or late. These outcomes were compared with patients who underwent standard neobladder during this period in our center. RESULTS: The operation was technically successful in all cases. Early postoperative complications occurred in 33.3% of the patients. Daytime continence was achieved successfully in 83.3% of the patients. No patient had severe metabolic acidosis. Six patients (16.6%) died during follow-up, five due to metastatic bladder cancer and one due to a cardiac problem. There was no any statistically significant difference between novel technique and standard neobladder for oncological and functional outcomes. CONCLUSIONS: The Anatolian ileal neobladder is as feasible and safe as standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy.

Urologic health condition of spinal cord-injured patients living in Turkey.

OBJECTIVES: To determine the urologic health condition of spinal cord-injured (SCI) patients living in Turkey, and to analyze the relationship between the prevalence of urologic health condition parameters and the patient's characteristics. METHODS: Telephone call survey was conducted with a structured questionnaire among all members of Turkish Society of Spinal Cord Injured Patients. RESULTS: Data were obtained from 300 patients. Mean age was 42 years with a male/female ratio of 2.3, while the most common cause of injury was transport (35.3%). Although 70% were aware of potential kidney and bladder problems after injury >60% of the patients were not under regular urologic follow-up. Secondary health problems experienced as being most important was urination problems (50%). Of the patients 72.7% (83% in females vs 68% in males) had urinary incontinence (UI) during last 3 months, and 64.3% used clean intermittent catheterization (CIC) (68% in males vs. 56% in females), while 73%, 57% and 26% of incontinent patients used diaper/pad, medication and condom catheter, respectively, and the use of CIC decreased with time. Surgical procedures on urinary tract were performed in 22.6% of the patients; stone surgeries were the most frequent ones. CONCLUSION: This study demonstrated that the UI rate was high among SCI patients, and more common in females with fairly good proportion of patients using incontinence medication. Main bladder management method was CIC and more prevalent in males, although the use of CIC decreased with time. Urinary stone surgery was the leading surgical procedure.

Training and practice of cytotechnologists: a discussion forum focused on Europe.

OBJECTIVES: To discuss the role and training of cytotechnologists (CTs) in Europe, to identify areas of good practice and to provide an informed opinion to those providing guidelines for training and practice in Europe. METHODS: All members of the Editorial Advisory Board of Cytopathology were invited to take part in a 'discussion forum' for which six topics were circulated in advance concerning the roles of CTs with regard to: (1) pre-screening slides; (2) 'signing out' reports; (3) carrying out ancillary techniques; (4) supervising laboratory staff; (5) taking part in rapid on-site evaluation (ROSE) of fine needle aspirates (FNAs); and (6) whether CTs were trained specifically in cytopathology or in general histopathology. Notes of the meeting were circulated by email and a final report was agreed by 22 participants from 17 predominantly European countries. RESULTS: Training for CTs throughout Europe was variable, especially for non-gynaecological cytology, which was inconsistent with the range of activities required. The participants recommended graduate entry, preliminary training in general laboratory technology, and subsequent training to take account of the probability and, in some centres, the reality of primary cervical cancer screening changing from cytology to human papillomavirus (HPV) testing. They further recommended that CTs should perform HPV tests and take part in ROSE for FNAs, and they supported the European Federation of Cytology Societies developing guidelines for training and practice. CONCLUSION: With CT training added to a university-based education in laboratory or biomedical science, a career in cytotechnology should be an attractive option involving a diverse range of laboratory and clinically based activities.

Relation of protein oxidation parameters and disease activity in patients with Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a chronic inflammatory vasculitis characterized by endothelial dysfunction, elevated reactive oxygen species (ROS), and neutrophil hyperfunction production including acute attacks and remission periods. Ischemia modified albumin (IMA), advanced oxidation protein products (AOPP), prooxidants-antioxidants balance (PAB), and ferric reducing antioxidant power (FRAP) were evaluated in regard to their role in the pathogenesis of BD as well as their relation to clinical presentation, uveitis attacks and remission periods, and healthy volunteers. METHODS: The study included 28 BD cases and 27 healthy volunteers as the control group. Blood samples were taken twice from each patient; first during an attack and second about three months after an attack, during remission period. RESULTS: AOPP, IMA and PAB levels were significantly increased in active periods of patients with BD compared with healthy control and remission periods of patients with BD (p < 0.0001, p < 0.0001, p < 0.0001, respectively). FRABP levels were found to be lower in active periods of patients with than healthy controls and remission periods of patients with BD (p < 0.001, p < 0.05, respectively). The AOPP levels were negatively correlated with the levels of FRAB in patients (r = -0.468, p = 0.012; r = -0.394, p = 0.038, respectively). The PAB levels were positively correlated with the levels of CRP in patients (r = -0.606, p = 0.001). CONCLUSIONS: Our results show that these parameters play a major role in the inflammatory reactions observed in BD. Increased levels of IMA and PAB are likely to be a result of inflammation-induced oxidative stress and hence its potential significance as a new marker of oxidative stress in BD.

The relationship between ischemia modified albumin and oxidative stress parameters in patients with cardiac syndrome X.

BACKGROUND: The objective of this study was to evaluate the serum levels of ischemia modified albumin and oxidative stress parameters in patients with cardiac syndrome X. METHODS: A total of 61 patients, composed of 32 consecutive patients (24 female, 8 male, average age: 47.63 +/- 9.49 years) diagnosed with cardiac syndrome X by coronary angiography (initially performed following the identification of ischemia by exercise stress test or myocardial perfusion scintigraphy) and a control group of 29 consecutive patients (15 female, 14 male, average age: 49.59 +/- 11.68 years) with similar features without cardiac syndrome X were included in the study. The levels of the ischemia modified albumin (IMA), ferric reducing antioxidant power (FRAP), prooxidant-antioxidant balance (PAB), and advanced protein oxidation products (AOPP) were determined by colorimetric methods. RESULTS: Patients have significantly higher PAB, AOPP, and IMA levels in the patient group than in the control group (p < 0.01, p < 0.001, and p < 0.02, respectively). Also, serum triglyceride (p < 0.005) and hs-CRP (p < 0.0001) levels were significantly higher in the patient group (p < 0.01, p < 0.001, and p < 0.02, respectively). We found that there was a significant correlation between hs-CRP, plasma PAB (r: 0.258; p < 0.05), AOPP (r: 0.459; p < 0.001), and triglyceride levels (r: 0.404; p < 0.01). Plasma AOPP levels were also significantly positive correlated with triglyceride levels (r: 0.463; p < 0.001). In addition, during the correlation analysis performed on the patient group, a positive correlation was observed between the levels of IMA with the levels of plasma PAB and plasma AOPP (r: 0,994; p < 0.01 and r: 0.857; p < 0.05, respectively) In a multiple linear regression analysis, AOPP levels were significantly related with hs-CRP and triglyceride (R2: 0.380, p < 0.0001 and p < 0.05). Simple linear regression analysis was performed between plasma PAB (as dependent variable) and hs-CRP levels. Plasma PAB levels were related with hs-CRP (R2: 0.258, p < 0.05). Using the receiver-operator characteristic (ROC) curve, the best cut-off values for predicting cardiac syndrome X of PAD, AOPP, IMA, and hs-CRP levels were 88.1 arbitrary units, 68.5 kloramin T micromol/L, 7.17 U/mL, and 1.09 mg/dL, respectively. CONCLUSIONS: Based on the results of our study, the increase in oxidative stress during cardiac syndrome X appears to be related to elevated levels of IMA. Treatment modalities that decrease oxidative stress might be beneficial for the treatment of cardiac syndrome X.

Multinational study of oestrogen and progesterone receptor immunocytochemistry on breast carcinoma fine needle aspirates.

OBJECTIVES: To collect data on the variability of immunocytochemical (ICC) procedures used to detect oestrogen/progesterone receptors (ER/PR) on cytological material; to test the reproducibility of results; and to identify the crucial points in the ICC procedures that affect the result. METHODS: Ten laboratories from eight countries participated in a two-part study. In the first part, one of the participants (the coordinator) prepared and distributed cytospins from a fine needle aspirate of a primary breast carcinoma. Laboratories performed ICC staining for ER/PR according to their own methods on the test slides and in-house positive controls. Slides were returned to the coordinator together with information on the preparation of positive control slides and the ICC methodology used. In the second part, obligatory methods of fixation and antigen retrieval were specified. Evaluation of results included grading the number of positive cells, staining intensity, background staining, cytoplasmic staining, sample condition and cellularity. Participants evaluated their own results, which were subsequently evaluated by the coordinator. RESULTS: There was great variability in the preparation of slides for in-house controls and ICC methodology. The outcome of ICC staining of in-house control slides was excellent in two laboratories, adequate in three, sub-optimal in four and inadequate in one. Only six obtained a positive reaction on the test slides and not all were of a high quality. Results of the second run were greatly improved in terms of cellularity of in-house positive control slides, and scores for the percentage of stained cells and staining intensity of control and test slides. Cytospins and monolayer (ThinPrep(®)) preparations were superior to direct smears; methods of fixation and antigen retrieval were the key points in the staining process. CONCLUSIONS: Our experience points to the need for guidelines for hormonal receptor determination and external quality control on cytological material, in order for cytological methods to be used in routine clinical practice with a suitable degree of confidence.

Retrospective evaluation of the efficacy of daily paroxetine/tadalafil combination in patients with premature ejaculation and erectile dysfunction.

OBJECTIVE: Premature ejaculation (PE) and erectile dysfunction (ED) are sexual dysfunction diseases affecting males. The phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil are used to treat ED whereas selective serotonin reuptake inhibitors (SSRIs) are preferred for PE. Most of the patients with ED also suffer from PE simultaneously. The combined drug therapies are commonly preferred as they favor elevated intra-vaginal ejaculation latency time (IELT) scores and improved sexual function. The study aimed to evaluate the efficacy and safety of daily paroxetine and tadalafil combination therapy in patients with PE and ED. PATIENTS AND METHODS: A total of 81 PE patients with ED were enrolled in the study. Patients were treated with daily paroxetine 20 mg and tadalafil 5 mg for 4 weeks. Pre- and post-treatment IELT, premature ejaculation profile (PEP), and International Index of Erectile Function-Erectile Function (IIEF-EF) scores of the patients were analyzed. RESULTS: The mean IELT and PEP index scores, and mean IIEF-EF values improved after combination therapy (p<0.001 for each). When lifelong and acquired PE+ED patients were compared, significant improvements were observed in IELT, PEP, and IIEF-EF scores in both groups (p<0.001). CONCLUSIONS: Even though the treatment methods are different, combined therapies to treat simultaneous PE and ED presence are effective compared to monotherapies. However, there is still no definitive treatment that can cure all subtypes of PE or ED.

Pleiotropic effects of pitavastatin: a pilot study using the saphenous vein endothelial cell model of endothelial injury and prevention of atherosclerosis.

OBJECTIVE: Cardiovascular diseases are responsible for the majority of deaths on a global scale. Atherosclerosis is the main risk factor for cardiovascular disorders and represents a complex phenomenon associated with endothelial dysfunction and inflammation. Statins, especially atorvastatin (ATV) and pitavastatin (PTV), are common agents used to control ongoing atherosclerotic events in the body to minimize cardiovascular disease-based deaths. MATERIALS AND METHODS: The present study aimed at comparing the efficacy of ATV and PTV in a cell line model of inflammation. Human saphenous vein cells were treated with TNF-alpha to mimic atherosclerotic conditions, and the cells were divided into 7 groups, including control, DMSO, TNF-alpha (10 ng/mL-6 hours), ATV (50 µM/24 hours), PTV (2 µM/24 hours), ATV (50 µM/24 hours)+TNF-alpha (10 ng/mL-6 hours) and PTV (2 µM/24 hours)+TNF-alpha (10 ng/mL-6 hours). The expression levels of 20 proinflammatory cytokines and chemokines were investigated in these groups using a human atherosclerosis antibody array. RESULTS: Possible pathway interactions were determined by STRING and PANTHER analyses. Comparison with the effect of ATV indicated that PTV reduced the levels of 4 proinflammatory cytokines: CCL11, CSF2, CCL20, and TGFB1 (p<0.05). CONCLUSIONS: Pleiotropic effects of pitavastatin against cardiovascular diseases appeared to be better; however, additional studies are required to compare statins and to identify new drugs that maintain broader protection from the risks of cardiovascular diseases.

Cervical cancer screening in Mediterranean countries: implications for the future.

Prompted by feedback from the 34th European Congress of Cytology (ECC), the practice of including a special symposium in the programme was continued in the 35th ECC in Lisbon (2009) by arranging a satellite symposium entitled 'Cervical Cancer Screening in the Mediterranean Countries'. Because of the importance to the future of this discipline, it was felt appropriate to summarize the highlights of this symposium here. Cervical cancer prevention strategies in the countries participating in the symposium (Portugal, Spain, Italy, Croatia, Greece and Turkey) appear to be highly variable. As yet, none of these countries can demonstrate a fully implemented national screening programme, but all are in different phases of designing and/or setting up such a programme, which is important. At present, the time-honoured concept of cervical cancer prevention by Pap smear screening is under review, because prophylactic human papillomavirus (HPV) vaccines demonstrate a potential to prevent the vast majority (albeit not all) of cases of cervical cancer in the foreseeable future. Cervical cancer screening is still needed in this emerging era of HPV vaccination, but clearly the existing screening strategies must be modified to provide a cost-effective combination of vaccination and screening. If the currently evaluated new screening strategies, such as HPV testing followed by cytology triage, become a reality, there is the likelihood that the Pap test will have only a secondary role, subordinate to HPV testing. Supporters of this scenario claim that Pap test performance will deteriorate in vaccinated populations. Reduced positive predictive value (PPV), due to lower disease prevalence, is inevitable, however, and this would also affect HPV tests. Any decline in sensitivity and specificity depends on human performance, and as such is avoidable by taking appropriate preventive measures. As clinical cytologists, we should focus attention on minimizing the risk to the Pap test of falling sensitivity because of unfamiliarity with abnormal cells, and also of reduced specificity if the fear of missing significant disease leads to overcalling of benign abnormalities.

Survey of medical training in cytopathology carried out by the journal Cytopathology.

This report of the Editorial Advisory Board of Cytopathology gives the results of a survey of medical practitioners in cytopathology, which aimed to find out their views on the current situation in undergraduate and postgraduate training in their institutions and countries. The results show that training in cytopathology and histopathology are largely carried out at postgraduate level and tend to be organized nationally rather than locally. Histopathology was regarded as essential for training in cytopathology by 89.5% of respondents and was mandatory according to 83.1%. Mandatory cytopathology sections of histopathology were reported by 67.3% and specific examinations in cytopathology by 55.4%. The main deficiencies in training were due to its variability; there were insufficient numbers of pathologists interested in cytology and a consequent lack of training to a high level of competence. Pathologists without specific training in cytopathology signed out cytology reports according to 54.7% of responses, more often in centres where training was 3-6 months or less duration. Although 92.2% of respondents thought that specialist cytology should not be reported by pathologists without experience in general cytopathology, that practice was reported by 30.9%, more often in centres with small workloads. The survey report recommends that 6-12 months should be dedicated to cytopathology during histopathology training, with optional additional training for those wanting to carry out independent practice in cytopathology. Formal accreditation should be mandatory for independent practice in cytopathology. When necessary, temporary placements to centres of good practice should be available for trainees intending to practise independently in cytopathology. There should be adequate numbers of pathologists trained in cytopathology to a high level of competence; some of their time could be released by training cytotechnologists and trainee pathologists to prescreen cytology slides and assess adequacy of fine-needle aspiration samples when immediate diagnosis was not required. The survey demonstrated a clear need for European and international guidelines for training in cytopathology.

Intermediate-risk group in patients with transitional cell carcinoma of the bladder: prediction of high-risk patients in this heterogeneous group.

OBJECTIVE: To determine whether recurrence at first follow-up cystoscopy predicts future recurrence in patients with an intermediate risk of superficial bladder cancer. METHODS: In total, 304 patients were classified as low (n = 60), intermediate (n = 177) or high risk (n = 67) based on the primary pathological/clinical findings, as previously described in literature. The intermediate-risk group was further divided into 2 subgroups based on recurrence at the first follow-up cystoscopy: A (recurrence negative) and B (recurrence positive). RESULTS: The mean recurrence rates of low-, intermediate- and high-risk patients were 1.76, 6.41 and 9.49, respectively (p < 0.05). Similarly, the difference in the recurrence rates between subgroups A (4.37) and B (9.12) was found to be statistically significant (p = 0.00). Additionally, while the difference between the low-risk group and subgroup A was statistically significant (p = 0.008), there was no significance between subgroup B and the high-risk group (p = 0.892). In the multivariate analysis, the most significant prognostic parameter for recurrence was the outcome of the first follow-up cystoscopy, followed by tumor multiplicity and grade. CONCLUSIONS: Patients showing recurrence at first follow-up cystoscopy in the intermediate-risk group should be classified as high-risk patients and treated accordingly.

The role of breast FNAC in diagnosis and clinical management: a survey of current practice.

Most participating countries have now adopted a triple assessment approach, i.e. clinical,imaging and pathology, to breast diagnosis, with FNAC as the first-line pathological investigation in both screening and symptomatic populations, with the exception of microcalcifications. Pathologists specialized in cytopathology are best qualified to collect and interpret FNAC samples, but this is not always possible or practical. Radiologists involved in breast imaging should ensure that they have the necessary skills to carry out FNAC under all forms of image guidance. Best results are achieved by a combination of both techniques, as shown in the image-guided FNAC in the presence of the cytopathologist. The majority of European countries use similar reporting systems for breast FNAC (C1-C5), in keeping with European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, although some still prefer descriptive reporting only. When triple assessment is concordant, final treatment may proceed on the basis of FNAC, without a tissue biopsy. ER and PR assessment can be done safely on FNAC material. However, not all institutions may have expertise in doing this. HER-2 protein expression on direct cytological preparations is insufficiently reliable for clinical use, although its use for FISH is possible, if expertise is available. The majority of participants practise a degree of one-stop diagnosis with a cytopathologist present in the out-patient clinic. Formal recognition of the importance of the time spent outside the laboratory, both for cytopathologist and cytotechnologist, is necessary in order to ensure appropriate resourcing. The use of core biopsy (CB) has increased, although not always for evidence-based reasons. CB and FNAC are not mutually exclusive. FNAC should be used in diagnosis of benign, symptomatic lesions and CB in microcalcifications, suspicious FNAC findings and malignancies where radiology cannot guarantee stromal invasion.

Management of Bladder Cancer After Renal Transplantation.

OBJECTIVES: In renal transplant recipients, the risk of developing bladder cancer and rate of diagnosis of advanced staged bladder cancer are generally higher than the general population. Also, it is more challenging to treat renal transplant recipients than the regular patient population. We aimed to evaluate the efficacy and safety of radical cystectomy (RC) and urinary diversion with ileal conduit in renal transplant recipients. METHODS: We identified 2 patients with prior history of renal transplantation who underwent RC and ileal conduit urinary diversion for bladder cancer. Preoperative clinical and demographic data were presented and outcomes were assessed. RESULTS: The RC and ileal conduit urinary diversion were performed in the first patient 56 months after renal transplantation and in the second patient 64 months after renal transplantation. Clinical staging was high-grade T2 transitional cell cancer of the bladder for patient 1 and T2 with pure squamous cell cancer of the bladder for patient 2. No perioperative or postoperative complication and no graft dysfunction occurred in either patient. CONCLUSION: Our experience demonstrated that RC with ileal conduit reconstruction in renal transplant recipients is safe and feasible.

Bilateral Occipital Arteries of Internal Carotid Origin: Report of a Case and Review of the Literature.

The present report describes a patient with bilateral occipital arteries of internal carotid origin, which is an extremely rare variation, and left vertebral artery ostial stenosis diagnosed by selective catheterization and digital subtraction angiography.

Mammographic and Ultrasonographic Findings of Different Breast Adenosis Lesions.

Aim: To describe imaging features of different breast adenosis lesions. Materials and methods: Mammographic and ultrasonographic findings of patients with different types of adenosis were reviewed retrospectively Tissue samples were obtained either with US-guided core needle biopsy or localization with needle-wire system and surgical excision. Results: Forty-three adenosis lesions were diagnosed in 41 patients: 27 sclerosing adenosis, 13 blunt duct adenosis and 3 microglandular adenosis. Most frequent abnormal findings of sclerosing adenosis were masses with non-circumscribed margins and focal acoustic shadowing without mass configuration (54%) on ultrasonography. Mammography was normal in 54% of sclerosing adenosis, the most common abnormality was architectural distortion (21%). In blunt duct adenosis, usually circumscribed masses (46%) were detected on ultrasonography, clustered punctate microcalcifications (23%) and circumscribed masses (23%) were observed on mammography. All microglandular adenosis lesions were non-circumscribed masses. Premalignant components were detected only with surgical excisional biopsy in three patients that showed suspicious radiological findings and benign pathological result on core biopsy. Conclusion: The adenosis lesions have no pathognomonic characteristics on mammography and ultrasound. Total excision may be considered when suspicious radiological findings are present although core needle biopsy results are benign.

Extracorporeal shockwave lithotripsy in the pediatric population.

BACKGROUND: Shockwave lithotripsy (SWL) is being used increasingly as a therapeutic modality for childhood urolithiasis. We reported our experience and results of SWL in the pediatric population. METHODS: The 59 renal units (RU) of 54 patients were retrospectively reviewed. The mean patient age was 10+/-3.5 years. All patients were treated with the Lithostar lithotripter in outpatient settings. Those with positive culture results were treated under appropriate antibiotic coverage. Seven patients were treated under general anesthesia and the rest under sedoanalgesia. Shielding of the lung fields or gonads was not used. For the upper pole stones, protection of the lungs was accomplished by elevating the upper half of the body with supportive pillows, thus moving the kidney away from the lung fields. Six RUs were catheterized via double-pigtail ureteral catheters or by percutaneous nephrostomy tube prior to treatment. The average stone load was 1.8+/-2.5 cm2. RESULTS: Patients were treated with an average of 2.5 sessions. A total of 1000 to 2500 shockwaves were delivered between 14.5 and 17.8 kV. Routine spasmolytic treatment was not initiated. The stone-free rate was 64%, and clinically insignificant residual fragments (CIRF) were present in 29% of RUs; thus, the success rate was 93%. Fever that necessitated hospitalization occurred in one patient. No other complications were seen except skin bruising and early hematuria. CONCLUSION: Shockwave lithotripsy is a safe and effective treatment modality for childhood stones of appropriate size and radiologic characteristics.

Extracorporeal shockwave lithotripsy for stones in abnormal urinary tracts: analysis of results and comparison with normal urinary tracts.

PURPOSE: We reviewed our experience with SWL for stones in abnormal urinary tracts and compared the results with those in normal urinary tracts. PATIENTS AND METHODS: The study group was composed of 2566 renal units (RU) treated on the Siemens Lithostar lithotripter at our SWL unit whose treatment and follow-up at 10 to 12 weeks were completed. Sixty-eight RUs (2.7%) belonged to 52 patients who had congenital upper urinary tract abnormalities. Logistic regression analysis was performed to analyze the impact of age, stone size, location, and the type of abnormality on the outcome of the SWL in the abnormal RU. The student t-, chi-square, and Fisher's exact tests were used for the comparison of stone load, number of treatment sessions, catheter placement, and success rates of the patients with normal and abnormal RU. Results of long-term follow-up for available patients (38 RU; 56%) were also evaluated. RESULTS: Age, stone load, stone location, and the type of abnormality did not have a statistically significant impact on the outcome of SWL for abnormal RU. The average stone load was 2.1 +/- 2.8 cm2 in the abnormal and 1.4 +/- 1.3 cm2 in the normal RU. Thus, the stone load was significantly higher in the abnormal RU (P < 0.05). In the abnormal group, 56% of the RU became stone free, 37% had nonobstructive and noninfectious clinically insignificant residual fragments < or = 4 mm (CIRF), and SWL failed in 7%. In the normal group, 78% of the RU became stone-free, 18.5% had CIRF, and SWL failed in 4%. There was no significant difference in the success rates in the groups if success was defined as stone free and CIRF together (P > 0.05). However, there was significant a difference when stone-free, CIRF, and failure rates were evaluated separately (P < 0.05). Recurrence, regrowth, and retreatment rates in abnormal RU were 50%, 37%, and 34%, respectively. CONCLUSIONS: Although the fragmentation rates were similar, clearance of the fragments was hampered in abnormal urinary tracts. Thus, especially for large stones, other endourologic treatment options should be considered. High recurrence and regrowth rates warrant careful monitoring and consideration for medical treatment during follow-up.

Apical leakage of a new glass ionomer root canal sealer.

A new glass ionomer root canal sealer (Ketac-Endo) has been developed. The purpose of this study was to compare the apical leakage of Ketac-Endo and AH26 using two different filling techniques and a controlled vacuum procedure. Sixty-four extracted human maxillary anterior teeth were instrumented and divided into four groups of 15 roots each. The groups were obturated as follows: group 1, a single cone technique and Ketac-Endo; group 2, a lateral condensation technique and Ketac-Endo; group 3, a single cone technique and AH26; and group 4, a lateral condensation technique and AH26. After storage in 100% humidity at 37 degrees C for 1 wk, the root surfaces were coated with two layers of nail polish and sticky wax. All specimens were immersed in a vacuum flask containing 2% methylene blue dye solution. The air was evacuated with a vacuum pump. The roots were sectioned longitudinally, and the linear extent of dye penetration was measured. Statistical analysis revealed that there were no significant differences between any of the groups.

Preliminary report on the application of pulsed CO2 laser radiation on root canals with AgCl fibers: a scanning and transmission electron microscopic study.

Fifteen maxillary central incisors were treated in vitro with pulsed CO2 laser radiation (wavelength:9.6-microns pulse duration:135-microseconds pulse energy:60 mJ energy density:12 J/cm2) delivered by an AgCl fiber into the root canal. Preliminary results show opening of dentin tubules as well as fused areas of hydroxyapatite in the root canal after laser treatment. Temperature measurement at the root surface showed that 40 degrees C was not exceeded. These preliminary results show the ability of this laser system to open dentin tubules and to fuse hydroxyapatite but further development in fiber technology is necessary to achieve predictable results.