Spinal cord injury resulting from gunshot wounds: a comparative study with non-gunshot causes.

STUDY DESIGN: Retrospective, comparative 7-year study. OBJECTIVES: To identify the clinical characteristics of patients with spinal cord injury (SCI) resulting from gunshot wound (GSW). SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS: The study included 1043 consecutive patients with SCI who were divided into two groups according to etiology: patients with gunshot-induced spinal cord injury (GSWSCI) constituted the study group, and randomly selected patients with non-gunshot-induced spinal cord injury (NGSWSCI) who were matched for gender and for week of admission constituted the control group. The demographic and clinical characteristics of the patients were recorded, compared and analyzed. RESULTS: The study group included 102 patients (mean age: 26.93±9.11 years). The vast majority of the patients were aged 16-30 years (68.6%) and 90.2% were male. The majority of the lesions were at the thoracic level (58.8%) and a complete injury (60.8%). Surgical stabilization of the spine was performed in 50 patients (49%). The most prevalent associated injury was intra-abdominal injury followed by chest injury. Compared with the NGSWSCI group, the GSWSCI patients were more likely to have a complete lesion (60.8% vs 45.1%, P=0.025), had a lower rate of surgical stabilization (49 vs 88.2%, P=0.0001) and had a higher rate of associated injuries (54.9% vs 25.5%, P=0.0001). Compared with the civilian GSWSCI group, the military GSWSCI patients had a higher rate of surgical stabilization and associated injuries (60% vs 40%, P=0.049, 68.9% vs 43.9%, P=0.012, respectively). CONCLUSION: The results revealed that GSWSCI and military GSWSCI patients may have different demographic and clinical features compared with NGSWSCI and civilian GSWSCI patients, respectively.

Ultrasound findings of the urinary tract in patients with spinal cord injury: a study of 1005 cases.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To document urinary tract abnormalities (UTAs) in patients with spinal cord injury (SCI) and to assess demographic and clinical features associated with UTA detected via ultrasound (US). SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS: The medical and radiological records of all patients with SCI were screened. Variables in each patient with SCI, including age at the time of the US examination, gender, etiology, level and severity of SCI, time since injury, bladder management methods and findings of urinary tract US, were reviewed and analyzed. RESULTS: Data were obtained from 1005 patients during the 6-year study period (2008-2013). The mean age was 35.67 ± 14.79 years and the male-female ratio was 2.84:1. Trabeculated bladder (TB) was observed in 35.1% of the patients, bladder calculi in 6%, renal calculi in 6%, hydronephrosis in 5.5% and renal atrophy in 1.2%. Bladder calculi, renal calculi and renal atrophy were observed in patients with TB at higher rates than in those without TB (P = 0.001, 0.036 and 0.004, respectively). The association of TB with hydronephrosis was very close to significance level (P = 0.052). CONCLUSION: A large number of SCI patients had UTAs including TB, renal and bladder calculi, hydronephrosis and renal atrophy. The time since injury, level and severity of SCI and bladder management method may influence development of UTA. In addition, TB may be a helpful parameter for predicting UTA in SCI patients.

Demographic and clinical characteristics of patients with traumatic cervical spinal cord injury: a Turkish hospital-based study.

STUDY DESIGN: Retrospective study. OBJECTIVES: To determine the demographic and clinical characteristics of patients with cervical spinal cord injury (CSCI) admitted to a single Center. SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS: The medical records of all patients with spinal cord injury admitted from January 2009 to December 2013 were screened. Variables of each patient with cervical injury (CSCI), such as age at the time of injury, gender, etiology, degree and level of neurological impairment, associated injuries, surgical stabilization and length of rehabilitation stay (LOS), were analyzed. RESULTS: In all, there were 804 patients with traumatic spinal cord injury (SCI) during the 5-year study period, of which 562 (69.9%) were paraplegic and the remaining 242 (30.1%) had a CSCI (C1-C8) and were included in the study. Among the CSCI patients, 80.6% were male (male:female ratio is 4.15:1), mean age at the time of injury was 32.58±14.71 years (range: 4-79 years), the largest age group was 16-30 years (n=117, 48.3%), followed by 31-45 years (n=70, 28.9%). Motor vehicle accident (MVA) was the most common cause of injury (49.2%), followed by falls (21.5%) and diving accidents (18.2%). Low CSCI (C5-8; 61.2%) and incomplete injury (55%) occured more often than high CSCI (C1-4) and complete injury. In total, 202 (83.5%) patients underwent surgical stabilization. Thirty-seven (15.3%) had associated injuries. CONCLUSION: The present findings show that most of the CSCI patients were aged 16-30 years. In addition, based on the frequency of the causes of injuries we think that prevention efforts should mainly focus on MVA, falls and diving accidents.

Exploring the relationship between the severity of oligozoospermia and the frequencies of sperm chromosome aneuploidies.

The study was aimed to investigate the association between the degree of oligozoospermia and sperm chromosome aneuploidy frequencies in male infertility and to determine whether chromosomal profiles of sperm nuclei would be used for a supportive test before additive reproduction technics. The meiotic segregation profiles of chromosomes X, Y, 13, 18 and 21 were compared by fluorescent in-situ hybridisation (FISH) on the spermatozoa of 30 normally karyotyped oligozoospermic (10 mild, 11 moderate, nine severe) cases without Y-microdeletions, and 10 normozoospermic cases. The results showed significantly higher frequencies of chromosomes 13, 18, 21 disomies (P < 0.001) in the group of patients with moderate and severe oligozoospermia compared with the disomy frequencies of normozoospermic group. The statistically significant differences were also determined in disomy frequencies of sex chromosomes (XY, XX and YY) in between oligozoospermic and normozoospermic groups (P < 0.001, P < 0.001, P < 0.040, respectively). Because oligozoospermic patients are the ones consulted the most for assisted reproductive techniques, identification of sperm aneuploidy rates in men could be considered as an appropriate supportive test before the reproductive implementations. Furthermore, the patients should be counselled with respect to genetic screening results for the potential risk of aneuploid embryo and pre-implantation genetic diagnosis or prenatal diagnosis.

The comparison of efficacy of single intraarticular steroid injection versus the combination of genicular nerve block and intraarticular steroid injection in patients with knee osteoarthritis: a randomised study.

OBJECTIVES: The aim of this study is to evaluate the efficacy of genicular nerve block (GNB) and intraarticular corticosteroid injection (IACSI) in patients with knee osteoarthritis (OA). METHODS: Forty patients with Kellgren-Lawrence grade 2-4 knee OA were included for the study. Patients were divided into two groups randomly as IACS and IACS + GNB groups. All patients were evaluated with ultrasound for cartilage thickness, patellar tendon thickness, quadriceps tendon thickness and quadriceps muscle cross-sectional area (QMA). Pain intensity of the patients was evaluated with visual analogue scale and the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Functional status of the patients was evaluated with Western Ontario and Mc Master Universities Osteoarthritis Index. Quality of life of the patients was assessed with Nottingham Health Profile (NHP). All assessments were measured and compared at baseline, 1st month and 3rd month after treatment. RESULTS: All evaluation parameters were significantly improved in IACSI and IACSI + GNB groups. However, the improvement was better in IACSI + GNB group compared to those in IACSI group in terms of all evaluation parameters except QMA (0.10 ± 0.18 and 0.11 ± 0.22, respectively) and NHP scores in 1st month evaluation (- 3.11 ± 6.99 and - 3.54 ± 1.74, respectively). CONCLUSIONS: When combined with IACSI, GNB yields better analgesic effect and improves function in patients with knee OA compared to only IACSI.

The short- and long-term effectiveness of transcatheter arterial embolization in patients with intractable hematuria.

PURPOSE: Selective transarterial embolization (TAE) of the internal iliac artery is a well-known alternative technique to control intractable bladder hemorrhage (IBH). We explored the short- and long-term effectiveness of, and clinical outcomes after, TAE in patients with IBH. MATERIALS AND METHODS: In this retrospective study, we reviewed the hospital records of 18 IBH patients non-responsive to conservative medications who underwent TAE between January 2003 and May 2014. The early- and long-term effectiveness of TAE was investigated in the context of hematuria control, complications, mortality, requirement for blood transfusions, and hematocrit level. RESULTS: Sixteen of the 18 patients underwent endovascular treatment; the technical success rate was 88%. TAE allowed complete remission in 16 patients (100% clinical success). On follow-up, mean hematocrit (P=0.003) and hemoglobin (P=0.005) levels significantly improved. Thirteen of the 16 patients (81%) required no further emergency admission after TAE during a mean follow-up period of 18.1months (range, 3-105months). CONCLUSION: TAE is a feasible, effective, and safe technique in both the short- and long-term for the treatment of IBH.

A standardized scoring system in the prediction of success and complications of percutaneous nephrolithotomy: guy´s Stone scoring system / Utilización de un sistema de puntuación estandarizado en la predicción del éxito y complicaciones de la nefrolitectomía percutanea: escala stone del Guy`s

OBJECTIVES: In this study, our aim was to determine the role of Guy's stone scoring system (GSS) in the prediction of percutaneous nephrolithotomy (PNL) success and its ability to foresee potential complications in consideration of Clavien grading system (CGS). Material and Methodos: The data of 244 patients who underwent PNL between January 2009 and May 2014 were retrospectively examined. Renal stones were evaluated using GSS with the aid of the patients' preoperative radiological evaluations and their postoperative complications were assessed with CGS. Arch. Esp. Urol. 2015; 68 (9): 710-717 Keywords: Guy's Stone score. Percutaneous nephrolithotomy. Modified Clavien grading system. Stone-free rate. RESULTS: Mean age of the patients (men, n=166; 68% and women, n=78; 32%) was 46.50±13.12 years (range, 16-80yrs). Clinically significant residual stones were not detected in 195 (79.9%) patients, while they were found in 49 (20.1%) patients. Guy's stone scores of 1, 2, 3 and 4 points were estimated in 21.3, 37.7, 29.9, and 11.1% of the cases, respectively. Based on modified Clavien complication grading system, complications were categorized as Clavien grade 1, 2 and 3 in 81.9, 17.2, and 0.8% of the cases, respectively. Clavien Grade 4 and 5 complications were not encountered. A statistically significant correlation was found between Guy's Stone scores and Clavien grades (p < 0.05)- A statiscally and highly significant difference was detected between Guy's Stone scores of the cases with respect to residual stones (p = 0.001; p < 0.01). CONCLUSIONS: Our study findings have revealed that GSS is a successful and easily applicable method for the prediction of success and likelihood of complications of PN

OBJETIVOS: En este estudio nuestro objetivo era determinar el papel de la escala de puntuación STONE de Guy`s (GSS) en la predicción del éxito de la nefrolitotomía percutánea (NLP) y su capacidad de preveer potenciales complicaciones considerando el sistema de gradación de Clavien. MATERIAL Y MÉTODOS: Los datos de 244 pacientes sometidos a NLP entre enero del 2009 y mayo del 2014 fueron evaluados retrospectivamente. Las litiasis renales fueron evaluadas utilizando el GSS con la ayuda de las pruebas radiológicas preoperatorias y las complicaciones postoperatorias se evaluaron con la escala de Clavien. RESULTADOS: La edad media de los pacientes (varones n=166, 68%; y mujeres n=78, 32%) fue 46.50±13.12 años (rango, 16-80 años). En 195 pacientes (79.9%) no se detectaron litiasis residuales clínicamente significativas, mientras que en 49 pacientes (20.1%) sí se encontraron. Con la escala STONE de Guy`s se estimaron puntuaciones de 1,2,3 y 4 puntos en 21.3%, 37.7%, 29.9% y 11.1% de los casos respectivamente. En base a la escala de complicaciones de Clavien modificada las complicaciones fueron categorizadas como Clavien grados 1,2 y 3 en 81.9%, 17.2% y 0.8% de los casos respectivamente. No se encontraron complicaciones de Grado 4 y 5 de Clavien. Se encontró una correlación estadísticamente significativa entre las puntuaciones de la escala STONE de Guy`s y los grados de Clavien (p < 0.02). Se detectó una diferencia estadística y altamente significativa entre las puntuaciones del STONE de Guy`s de los casos con respecto a las de las litiasis residuales (p = 0.001; p < 0.01). CONCLUSIONES: Los hallazgos de nuestro estudio han revelado que la escala Stone de Guy`s es un método exitoso y fácilmente aplicable para la predicción del éxito y la probabilidad de complicaciones de la NLP