Mustafa Resorlu

Evaluation of Platelet Distribution Width and Mean Platelet Volume in Patients With Carotid Artery Stenosis

Platelets contribute to the pathogenesis of atherosclerosis. Platelet activation has been linked with increased mean platelet volume (MPV) and platelet distribution width (PDW). We investigated the association between PDW, MPW, and the degree of carotid artery stenosis (CS). Patients (n = 229) were divided into 3 groups according to the North American Symptomatic Carotid Endarterectomy Trial criteria. Demographic and clinical features were collected retrospectively. Correlation analysis showed a positive association between PDW and the degree of CS. However, there was no significant correlation between CS and MPV. Moreover, we observed that PDW and low-density lipoprotein cholesterol were independent predictors of the degree of CS. This study showed that PDW, not MPV, is related to the degree of CS. Platelet distribution width could be a useful biomarker for CS. Whether targeting PDW will be of clinical benefit remains to be established.

Retrograde intrarenal surgery in pediatric patients.

Urinary tract stone disease is seen at a level of 1%-2% in childhood (< 18 years). In recent years, however, there has been a marked increased in pediatric stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to todays advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques.

Prognostic Significance of Hydronephrosis in Bladder Cancer Treated by Radical Cystectomy

Objectives: Hydronephrosis is a common finding in patients with bladder cancer. This study aims at an analysis of the association between hydronephrosis, pathologic characteristics of bladder cancer and cancer-specific survival rate after radical cystectomy. Methods: Clinical data of 241 patients who underwent radical cystectomy between 1990 and 2007 for invasive bladder cancer were analyzed retrospectively. The significance of the relation between the clinical and pathological findings were determined by the χ2 test. The Kaplan-Meier test was used for the estimation of disease-specific survival obtained according to hydronephrosis, and the differences were examined by the log-rank test. Multivariate analysis was performed by the Cox regression model. Results: Of 241 patients, 39 (16.2%) had unilateral and 13 (5.4%) bilateral hydronephrosis. Five-year cancer-specific survival rates were reported as 63.4% in non-hydronephrotic and 11.57% in hydronephrotic patients (log-rank test, p < 0.001). The presence of hydronephrosis was associated with advanced pT stage, higher tumor grade and lymph node metastases (p < 0.001, p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that hydronephrosis is an important factor directly affecting cancer-specific survival (0.0264). Conclusions: The presence of hydronephrosis prior to radical cystectomy is a significant prognostic parameter, associated with poor cancer-specific survival and advanced disease stage.

Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging.

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.

The Usage of 2 and 3-Dimensionel Ultrasound in Prenatal Diagnosis of Sacrococcygeal Teratoma: Report of a Case

DOI: 10.4328/JCAM.2055 Received: 17.09.2013 Accepted: 01.10.2013 Printed: 01.10.2013 J Clin Anal Med 2013;4(suppl 2): 123-5 Corresponding Author: Ahmet Uysal, Çanakkale Onsekiz Mart Üniversitesi, Kadın Hastalıkları ve Doğum ABD, Çanakkale, Türkiye. T.: +905332635540 E-Mail: drahmetuysal@hotmail.com Özet Sakrokoksigeal teratom 1:40.000 canlı doğum prevalansı ile tüm fetal tümörlerin yarısını oluşturmaktadır. Sıklıkla benign davranışlı olmasına rağmen, kalp yetmezliği ve hidropsa neden olması mortalite ve morbidite oranını yükseltmektedir. Kötü prognoza neden olan faktörler kitlenin solid komponentinin fazla olması ve 30 haftadan önce hidrops gelişmesidir. Prenatal dönemde B mod, renkli Doppler ultrasonografi ve üç boyutlu ultrasonografi (3B US) ile lezyonun karakterizasyonu yapılabilmektedir. 27 yaşında G2P1 gebeye yapılan obstetrik ultrasonografik değerlendirmede, biometrik ölçümlere göre 18. haftalık kız fetusta, sakrokoksigeal bölgede, 22x23 mm boyutlarında, düzgün sınırlı, heterojen ekojen içyapıda kitlesel lezyon saptandı. Ailenin gebeliğin devamını istemi ile gebelik terme kadar yakın takip edildi. Tümörün ani hızlı büyümesi nedeniyle, fetal hidrops veya plasentomegali gibi komplikasyonlar gelişmemişken gebeliğin 36. haftasında sezaryen ile komplikasyonsuz olarak doğum gerçekleştirildi. Operasyon sonucu histopatolojik değerlendirmede sakrokoksigeal bölgedeki kitlesel lezyon immatür teratom olarak raporlandı.

Seguridad y eficacia de la cirugía retrógrada intrarrenal en pacientes de diferentes grupos de edad

OBJECTIVES To assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. PATIENTS AND METHODS We performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analysed both as a continuous and categorical variable and patients were categorized into three age groups; aged ≤ 15 years at surgery (group i, n=51), 16 - 60 years (group Ii, n=726) and>60 years (group iii, n=170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. RESULTS The stone-free rate was 78.4% in group i, 77.5% in group ii, and 81.1% in group iii (P=.587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group i, 5.6% group ii, and 7.6% in group iii. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group ii and 2 patients (1.1%) in group iii. A 48-year-old man died from septic shock 5 days after the surgery. CONCLUSIONS RIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor.

Re: Imaging the urologic patient: the utility of intravenous pyelogram in the CT scan era

We read with great interest the recent article by Hale et al. [1] on the comparative study of intravenous urography (IVU) and computerized tomography (CT). They concluded that IVU has a limited clinical role on the evaluation of the urologic patient, and thus, its use should be strictly limited to highly select cases. We congratulate the authors for their work and thank them for bringing this important topic to our attention; however, we feel that some issues described in their paper need further discussion. We know that noncontrast CT is the most accurate imaging method for identifying urinary stones, and it has become the standard test for diagnosis of acute flank pain [2]. It offers the advantages over IVU of avoiding contrast allergy or nephrotoxicity and has ability to determine the other causes for abdominal pain. However, most of the patients with a history of flank pain return with similar symptoms and need to undergo repetitive CT examinations. Furthermore, current EAU guidelines recommend a contrast study (enhanced CT or IVU) if stone removal is planned, because the anatomy of the renal collecting system needs to be assessed prior to stone surgery or shock wave lithotripsy [2]. But use of repeated CT or IVU would increase the risk of cancer development. Epidemiological trials have reported an association between doses of radiation administered in CT and an increased risk of malignancy [3]. Recently, published studies also reported a theoretic increased risk of fatal cancer in pediatric and adult population as a result of single CT scan, based on data from similar levels of exposure to radiation during the atomic bombings of Nagasaki and Hiroshima [4, 5]. It was underlined that a single abdomen CT in infants would cause in one CT-related death per 550 scans [6]. Therefore, we believe that combination of ultrasonography and abdominal radiography may be considered in the evaluation of acute flank pain especially in children and patients with known urinary stone disease. Noncontrast CT may be reserved for those patients with suspected urolithiasis but negative findings on plain radiography and ultrasonography.

Do Hypertension, diabetes mellitus and obesity increase the risk of severity of nephrolithiasis?

Objective: In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension (HT), diabetes mellitus (DM) and body mass index (BMI). Methods: A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. Results: Of the 121 patients with kidney stones 30 (24.7%) had HT, while 66 (14.5%) of the 453 patients without stones had HT (p=0.007). BMI values of those with and without stones were 27.2 ± 4.93 kg/m2 and 25.29 ± 4.12 kg/m2, respectively (p<0.001). Twenty-five (20.6%) of the patients with stones diagnosed by ultrasound had DM, while 49 (10.8%) of those without stones had DM (p=0.004). When comparing patients with and without kidney stones, logistic regression analysis revealed that DM (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.17 to 3.63, p=0.013) and BMI (OR 1.08, CI 1.03 to 1.13, p=0.003) were independently associated with presence of stones. No significant relationship was found between the same variables and cumulative stone diameter (CSD) and stone surface area (SA) evaluated for stone burden. Conclusions: While diabetes mellitus, Hypertension and increased Body Mass Index may add to the possibility of stone formation, they did not affect stone burden.

Retrograde Intrarenal Surgery in Cross-fused Ectopic Kidney

Cross-fused renal ectopia is a rare congenital anomaly in which both kidneys are fused and located on the same side. We report a case of right-to-left cross-fused renal ectopia and nephrolithiasis, in whom retrograde intrarenal surgery was used to treat the stone disease. To our knowledge, this is the first case of retrograde intrarenal surgery of a crossed-fused ectopic kidney.

Accuracy of Unenhanced Computerized Tomography Interpretation by Urologists in Patients with Acute Flank Pain

Purpose: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. Materials and Methods: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. Results: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. Conclusion: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.