Özlem Türksoy

Protective value of a folkloric medicinal plant extract against mortality and hemorrhage in a life-threatening renal trauma model.

OBJECTIVES To compare the efficacy of a folkloric medicinal plant extract (Ankaferd Blood Stopper [ABS]) with that of oxidized cellulose (Surgicel) in a life-threatening renal injury model. ABS is a mixture of 5 plants that has historically been used in Turkish traditional medicine. It has been approved by the Ministry of Health to manage external hemorrhage and dental surgery bleeding in Turkey. METHODS Twenty-two Wistar albino rats underwent partial nephrectomy after intravenous heparin anticoagulation (2000 U/kg). The cut surface received 1 of 3 therapies, namely no treatment, Surgicel (Johnson & Johnson, New Brunswick, NJ) or ABS (Trend Teknoloji Iaç AS, Istanbul, Turkey). Blood pressure was continually monitored. Survival time, total blood loss, and mean arterial pressure were recorded for 60 minute or until death. Rats that were alive (mean arterial pressure>or=20 mm Hg) at the end of 60 minutes were sacrificed with blood withdrawal with the help of catheters. RESULTS All animals that received no treatment died within 60 minutes of follow-up. One of 7 in the Surgicel group, and 5 of 7 animals in the ABS group, survived. Mean survival times for the Surgicel and ABS groups were 42.7 and 53.4 minutes, respectively. Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (P<.05). There were no significant differences between the ABS and the Surgicel groups in survival (P=.128). CONCLUSIONS ABS is as effective as Surgicel in achieving hemostasis and lengthening survival time following partial nephrectomy in an experimental rat model.

Impact of COPD exacerbation on cerebral blood flow

We aimed to investigate the impact of chronic obstructive pulmonary disease (COPD) exacerbation on cerebral blood flow (CBF). In 21 COPD patients - in both exacerbation and stable phases -Doppler ultrasonographies of internal carotid artery (ICA) and vertebral artery (VA) were performed. There were significant differences in total, anterior and posterior CBF, ICA and VA flow volumes in exacerbated COPD compared to stable COPD. Total CBF was correlated with cross-sectional areas of left and right ICA, whereas independent predictor of total CBF was cross-sectional area of right ICA. Increased CBF might indicate cerebral autoregulation-mediated vasodilatation to overcome COPD exacerbation induced hypoxia.

Comparison of the analgesic effects of dexketoprofen and diclofenac during shockwave lithotripsy: a randomized, double-blind clinical trial.

BACKGROUND AND PURPOSE This prospective, randomized, and double-blind clinical study aimed to assess the analgesic efficacy of single-dose intramuscular (IM) injection of dexketoprofen (group DE) compared with single-dose IM injection of diclofenac (group DI) in patients who were undergoing shockwave lithotripsy (SWL). PATIENTS AND METHODS A total of 70 men with single renal or ureteral stones were randomly separated into two groups. The 40 men in group DI received 75 mg IM diclofenac sodium and 30 men in Group DE received 50 mg IM dexketoprofen trometamol 30 minutes before SWL. A 10-point visual analog scale was used to evaluate pain. RESULTS The age, body mass index, and mean stone burden were comparable between the two groups (P > 0.05). The mean visual analog scale score for group DE was statistically lower compared with the score for group DI (P = 0.02). In 34 (85%) of the 40 men in group DI, the SWL procedure was performed with no, minor, or tolerable pain. In group DE, however, 28 (93.3%) of 30 patients evaluated the pain severity as no, minor, or tolerable (p = 0.01). No major/minor adverse effects were observed in group DI, whereas in one patient in group DE, dyspepsia after injection was noticed (P = 0.423). CONCLUSIONS The severity of SWL-related pain was significantly better tolerated with dexketoprofen trometamol. During an SWL procedure, the analgesic efficacy of dexketoprofen was greater than that of diclofenac sodium. Although statistically insignificant, a little increased risk for gastric irritation was noticed with dexketoprofen.

Impact of passive smoking on uterine, umbilical, and fetal middle cerebral artery blood flows

PurposeThe aim of this study was to evaluate the influence of passive maternal smoking on blood flow velocities in arteries of the fetal-placental-maternal circulation.Materials and methodsA total of 79 pregnant women in their third trimester, including 33 passive smokers, 23 active smokers, and 23 nonsmoking controls, were enrolled in the study. Fetal biophysical indices were evaluated with B-mode scanning, whereas blood flow waveforms of uterine, umbilical, and fetal middle cerebral (MCA) arteries were analyzed with Doppler ultrasonography.ResultsThere were significant differences among active smokers vs. passive smokers vs. controls with regard to the presence of a uterine artery diastolic notch (39.1% vs. 18.2% vs. 4.3%; P = 0.012); ratio of peak systolic/end-diastolic velocity of fetal MCA [3.73 ± 1.27 vs. 4.26 ± 1.20 vs. 5.00 ± 2.15, analysis of variance (ANOVA) P = 0.026]; resistance index of fetal MCA (0.74 ± 0.08 vs. 0.75 ± 0.07 vs. 0.80 ± 0.09; ANOVA P = 0.014); ratio of fetal MCA/umbilical artery resistance index (1.27 ± 0.20 vs. 1.24 ± 0.14 vs. 1.39 ± 0.21; ANOVA P = 0.011); and ratio of fetal MCA/umbilical artery pulsatility index (1.56 ± 0.44 vs. 1.63 ± 0.43 vs. 1.97 ± 0.54; ANOVA P = 0.046).ConclusionEffects of passive maternal smoking on the fetal-placental-maternal unit were comparable to those with active maternal smoking as determined by the means of increased resistance in the maternal vasculature and adaptive changes of cerebroplacental circulation for maintaining fetal cerebral circulation.

Pain Perception During Shock Wave Lithotripsy: Does It Correlate With Patient and Stone Characteristics?

Background: To investigate the correlation of various clinical parameters [number of shock wave lithotripsy (SWL) sessions, body mass index, patient age, gender, and stone characteristics] with pain perception during the SWL procedure. Methods: A total of 88 patients who underwent 165 SWL sessions for renal or ureteral stones in our institution were included in the study. The degree of pain perception during the procedure was evaluated with a 10‐point visual analog scale. Results: A significant p value was reached when the cut‐off value for stone burden was taken as 100 mm2. Mean pain scores during the SWL procedures were affected by gender and the number of SWL sessions. However, they were not affected by laterality, patient age, body mass index, and location of stones. Conclusion: Our results suggest that patient comfort is better during the first SWL session than in the following sessions for renal or ureteral stones with a stone burden of less than 100 mm2. In addition, severity of pain during SWL treatment may be better tolerated in males than in females.

The importance of preoperative radiological assessment in intersex patients

[1]. They performed laparoscopy in 14 patients among 80 intersex patients, in order to observe gonadal structures, obtain biopsy if necessary and remove them in selected cases. Out of these 14 patients, five cases with androgen insensitivity syndrome (AIS) underwent laparoscopic gonadectomy with subsequent estrogen replacement following gonadal biopsies. As authors emphasized, the procedure is minimally invasive with low morbidity, shorter postoperative recovery period and less formation of cutaneous scars. It also provides magnified and easy access to the pelvic and peritoneal cavity. However, precise radiological evaluation has to be accomplished for the establishment of additional congenital anomalies related with other organ systems, mainly the urinary system in intersex patients. Since the Mullerian ducts develop in association with the Wolffian ducts and derivatives, the clinician must expect renal abnormalities if maldevelopment or absence of Mullerian structures were noticed. For this purpose, use of magnetic resonance imaging (MRI) technique has some advantages over other imaging modalities. Particularly, good contrast resolution and soft tissue visualization allow exact localization of undescended testes or immature gonadal structures. It was reported that in up to 86% of cases with AIS or true hermaphroditism, gonadal structures were localized accurately with MRI [2]. We recently diagnosed a case of complete ASI with solitary pelvic kidney [3]. She was a 16-year-old female who was admitted initially with the chief complaint of amenorrhea. It was seen that her kidney was localized in bony pelvis between the dome of the bladder and sacrum on left side. In addition, gonadal structures were clearly demonstrated in pelvic sections of MRI. So, coexistence of other congenital anomalies in patients with intersex disorders must be kept in mind. Although detailed evaluation is sometimes regarded as unnecessary and time consuming, it gives the precise localization of pelvic organs to the surgeon, preoperatively. In conclusion, during surgical treatment of these patients, especially with minimally invasive techniques like laparoscopy, preoperative assessment with MRI allows the surgical anatomy to be handled easily. In addition, possible intraoperative injuries to other organ systems could be prevented, especially when experience in laparoscopic procedures is not excessive. Certainly, this is not the case for Dr. Chertin and associates, as they successfully operated more than 80 intersex patients, including 14 cases which were laparoscopically managed without any complication.

Unusual clinical presentations of brucellosis

Sir, We read the article by Dr. Hatipoglu et al. with interest (Scand J Infect Dis 2004; 36:694 /7). The authors reported 11 cases with atypical presentations of brucellosis among 240 patients with systemic brucellosis. They observed 10 patients with neurobrucellosis, peritonitis, pericarditis, pancytopenia, uveitis and 1 patient with epididymo-orchitis. We have experienced a similar case with brucella epididymo-orchitis. A 58-y-old male patient was admitted to emergency service with complaints of fever, headache, fatigue for 3 months and right scrotal swelling and mass lesion for 15 d. Brucella tube agglutination titer was 1/1280 and scrotal examination revealed minimally tender and very swollen right hemiscrotum. On scrotal ultrasonographic examination (GE Logic-9), multiple hypoechoic solid nodular lesions, some of which were necrotic-cystic centrally in the testis parenchyma, were noticed. The right epididymis was multiloculated and cystic in nature with thickening of the wall. The patient was hospitalized with a presumptive diagnosis of brucellosis and right epididymo-orchitis. Antibiotic treatment with streptomycin (1 g/d i.m.) for 3 weeks and tetracycline (2 /100 mg/d p.o.) for 6 weeks was given. At the follow-up examination 6 weeks later, all the symptoms had resolved and scrotal ultrasonography was normal. Unfortunately, no bacteria were isolated from blood and urine cultures. Amin et al. reported the use of polymerase chain reaction (PCR) for detection of Brucella melitensis in semen [1]. In addition, Vandercam et al. have isolated Brucella melitensis from human sperm [2]. However, no semen samples were obtained from our patient. Finally, we would like to mention that accurate diagnosis with appropriate antibiotics prevents excessive medication and unnecessary surgical inguinal exploration for the testis involved in cases of epididymo-orchitis caused by infectious agents such as Brucella. We thank Dr. Hatipoglu and her associates for this interesting and insightful article.

RE: 3 T magnetic resonance diffusion tensor imaging and fibre tracking in cervical myelopathy.

would introduce an unnecessary cumbersomeness to the rhythm of written reports and speech. I am interested to note that the author of the commentary article is French, so I have experimented with pronunciation. When pronouncing the word “retrolapse” in a French accent it does flow nicely; try it. However, pronounced in either a British or American English accent it does not. This difference is an example of the relative fluidity of spoken French, a very attractive language to speak and listen to, but the lingua franca (pun intended) of medicine is English. The attempt to change the language for change’s sake flies in the face of the fact that there is no problem that needs to be fixed, and certainly no problem that necessitates the introduction of the novel but lumpen and unnecessary word “retrolapse”.

376 LOW-POWER HOLMIUM: YAG LASER URETHROTOMY FOR URETHRAL STRICTURE DISEASE: COMPARISON OF OUTCOMES WITH THE COLD-KNIFE TECHNIQUE

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Discriminative Role of CT in Exudative and Transudative Pleural Effusions

36 Copyright a 2011, Else doi:10.1016/j.kjms.2011.06.013 Abstract In this prospective randomized clinical trial, we aimed to evaluate the safety and efficacy of endourethrotomy with holmium:yttrium-aluminium-garnet (HO:YAG) laser and compare the outcomes with the conventional cold-knife urethrotomy. Fifty-one male patients with single, iatrogenic, annular strictures of the urethra were randomly divided into two groups; 21 patients who underwent direct-vision endoscopic urethrotomy with Ho:YAG laser (15 W; 1,200 e1,400 mJ; 8e12 Hz) at 12 o’clock position (laser group) and 30 patients who underwent directvision endoscopic urethrotomy with cold-knife incision at 12 o’clock position (cold-knife group). The results obtained were analyzed and compared at 3 months, 6 months, 9 months, and 12months postoperatively by clinical evaluation, uroflowmetry, and retrograde urethrographies. Variables were compared among groups using Fisher’s exact and Mann Whitney U tests. There were no differences between two groups in terms of patient age, preoperative Qmax value, stricture location, and length. Operative time was shorter in laser group (16.4 8.04 minutes) when compared with cold-knife group (23.8 5.47 minutes) (p< 0.001). Recurrence-free rate at 3 months was similar between two groups (pZ 0.122). However, recurrence-free rates at 6 months, 9 months, and 12 months were significantly higher in laser group when compared with cold-knife group (p values were 0.045, 0.027, and 0.04, respectively). No intraor postoperative complications were encountered. Use of Ho:YAG laser in the management of urethral stricture disease is a safe and effective method. In addition, it provides shorter operative time and lower recurrence rate when compared with the conventional technique. Copyright a 2011, Elsevier Taiwan LLC. All rights reserved.