Comparative investigation of the fetus and adult joint ligament in the knee and elbow with structural levels / Investigación comparativa del ligamento conjunto de rodilla y codo con niveles estructurales en fetos y adultos

The aim of this study was to examine and compare fetal and adult knee and elbow joint ligaments and determine histologically how these ligaments change over time. In addition, the images of fetal and adult joint ligaments were examined with magnetic resonance imaging (MRI). This study was conducted on 10 male fetus ranging from ages 14 to 17.5 weeks, two adult male cadavers obtained from Gazi University Faculty of Medicine Department of Anatomy and MR images of the knee and elbow regions of 10 male adults obtained from Atatürk Educational and Research Hospital between 2009 and 2011. In the present study, the sections taken from knee and elbow of ten 14­17.5 week old fetuses and the ligaments of tissue taken from the knee and elbow of two male cadavers using the same method of dissection were monitored. After monitoring tissue, microtome sections taken from paraffin-embedded structures were stained using the Masson-Trichrom and Orcein-Picroindigocarmine staining method. These sections were examined under a microscope and photographed. The images of 17 week old fetuses and the knee and elbow of the adults were obtained with MRI. The differences detected between adult and fetus ligaments consisted of fibroblast density and collagen thickness, density and waves. Although the fetus ligaments were not seen sufficiently with 1.5 Tesla (T) MR, they were seen very clearly with 3 T MR. Structural differences between adult and fetal ligaments revealed in histological and MRI images.

El objetivo del estudio fue examinar y comparar los ligamentos de la articulación de la rodilla y del codo en fetos y adultos y determinar histológicamente como estos ligamentos cambian con el tiempo. Además, las imágenes de los ligamentos de las articulaciones fetales y adultas se examinaron con imágenes de resonancia magnética (IRM). Fueron utilizados 10 fetos masculinos entre 14 y 17,5 semanas, y dos cadáveres adultos masculinos obtenidos del Departamento de Anatomía, Facultad de Medicina de la Universidad Gazi junto con las IRM de las regiones de la rodilla y del codo de 10 hombres adultos obtenidos de Atatürk Educativa y del Hospital de Investigación entre los años 2009 y 2011. Para las secciones de rodilla y codo de los diez fetos y de los cadáveres masculinos se utilizó el mismo método de disección. Después de procesar los tejidos e incluirlos en parafina, se obtuvieron cortes en micrótomo los cuales fueron posteriormente teñidos con Tricrómico de Masson y Orceína-picro-índigo Carmín. Las secciones fueron fotografiadas y examinadas bajo microscopio. Se obtuvieron IRM del codo y de la rodilla de los fetos y adultos. Las diferencias encontradas entre los ligamentos de adultos y fetos estaban en relación a la densidad de fibroblastos y espesor de colágeno. Aunque no fue posible observar los ligamentos fetales con 1,5 Tesla (T) MR, se observaron claramente con 3 T MR. Las diferencias estructurales entre los ligamentos fetales y adultos se observan tanto a nivel histológico y de resonancia magnética.

Serum cystatin C and serum creatinine levels in type 2 diabetes mellitus.

Background: Diabetes mellitus is a metabolic disorder resulting from deficient insulin secretion, inefficient insulin action or both leading to chronic hyperglycemia. Diabetic complications result from the toxic effects of chronic hyperglycemia combined with other metabolic derangements. Diabetic nephropathy eventually leads to loss of kidney function, which is the most common cause of End stage renal disease. Measurement of GFR is an important parameter in assessing kidney function for which Creatinine is currently being used despite its inherent fallacies. Cystatin C is an alternative marker with some advantages. Aims and objectives: To measure the serum cystatin C levels in type 2 diabetes mellitus patients. To compare serum cystatin C levels with serum creatinine levels in type 2 diabetes mellitus patients. Methods: The study was carried out in 30 type-2 diabetic patients and 30 non-diabetic controls, in the age group of 35 to 75 years. Both the groups were age and gender matched. Serum cystatin C levels and serum creatinine levels were measured in both the groups. Serum creatinine was estimated by Jaffe's kinetic method, while the estimation of serum cystatin C was done by Immunoturbidimetric method. Results: Serum creatinine as well as serum cystatin C levels were significantly elevated in the study group as compared to non-diabetic controls. There was a strong positive correlation of serum cystatin C with serum creatinine. Conclusion: Serum cystatin C can be used as an alternative to serum creatinine in determining GFR in type 2 diabetes mellitus.

Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy

Since its introduction, there have been many refinements in the technique and implementation of robotic-assisted radical prostatectomy [RARP]. However, it is unclear whether operative outcomes are influenced by surgical case order. We evaluated the effect of case order on perioperative outcomes for RARP within a large health maintenance organization. We conducted a retrospective review of RARP cases performed at our institution from September 2008 to December 2010 using a single robotic platform. Case order was determined from surgical schedules each day and surgeries were grouped into 1[st], 2[nd] and 3[rd] round cases. Fourth round cases [n = 1] were excluded from analysis. We compared clinicopathological variables including operative time, estimated blood loss [EBL], surgical margin rates and complication rates between groups. Of the 1018 RARP cases in this cohort, 476 [47%] were performed as 1[st] round cases, 398 [39%] 2[nd] round cases and 144 [14%] 3[rd] round cases by a total of 18 surgeons. Mean operative time was shorter as cases were performed later in the day [213 min vs. 209 min vs. 180 min, P < 0.0001] and similarly, EBL also decreased with surgical order [136 mL vs. 134 mL vs. 103 mL, P = 0.01]. Transfusion rates, surgical margin rates and complication rates did not significantly differ between groups. Patients undergoing RARP later in the day were much more likely to have a hospital stay of 2 or more days than earlier cases [10% vs. 11% vs. 32%, P = 0.01]. Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3[rd] round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs

Endoscopic removal of a proximal urethral stent using a holmium laser: case report and literature review

Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser. The literature on various management options and outcomes for urethral stent removal is reviewed. Endoscopic removal of proximal urethral stents is feasible and safe and should be considered as the primary treatment option in patients requiring stent extraction