Percutaneous cholecystostomy in the management of acute cholecystitis-comparative analysis of before and after the COVID 19 pandemic.

BACKGROUND: Percutaneous cholecystostomy (PC) is a minimally invasive temporary treatment for patients with acute cholecys-titis (AC) who are at high risk for surgery. The aim of this study was to compare the characteristics of patients with AC treated with PC before and during the coronavirus disease 2019 (COVID 19) pandemic. METHODS: The data of patients who underwent PC with the diagnosis of AC between 2019 and 2021 were analyzed by scanning the hospital registry system. During the COVID 19 pandemic period of March 11, 2020, to March 11, 2021, 110 patients with AC were treated with PC. In the pre-pandemic period of March 2019 to March 2020, 99 patients who underwent PC were added to the study as a control group. The data of the 209 patients included in the study were recorded, and descriptive statistical analysis was performed. The patient characteristics of the two groups were compared. RESULTS: Evaluation was made of 209 patients who were diagnosed with AC between March 2019 and March 2021 and could not be operated on due to the high risk of surgery. The average age of the patients was 63.84 years (21-97) in the pandemic period and 68.43 years (31-100) in the pre-pandemic period. The rate of female patients was 45.5% in the pandemic group and 44.5% in the pre-pandemic group. The mean procedure-discharge time was 3.85 days in the pandemic period and 3.34 days pre-pandemic. The American Society of Anesthesiologists physical status classification (PS) was determined to be 1 or 2 in 56.4% of the pandemic group patients and 3 or 4 in 78.8% of the pre-pandemic group. There was no comorbidity accompanying AC in 45 (40.9%) patients in the pandemic period, and at least one comorbid condition accompanying AC was detected in 77 (77.8%) patients in the pre-pandemic period. The severity grading for AC was 2 (moderate) in 97.3% of the patients in the pandemic group and 3 (severe) in 26.3% of the patients in the pre-pandemic group. Of the 110 patients in the pandemic period, 14 were Covid 19 positive or suspected. PC-related mortality was not observed in either group. CONCLUSION: PC is an effective and safe treatment method that reduced the operating room and intensive care burden during the exacerbation of the COVID 19 pandemic. Therefore, it seems like a logical option to expand the PC indications at times when the number of COVID 19 patients increases.

Combination of temporary bridging device (Comaneci) and permanent stenting in the treatment of unruptured wide neck bifurcation aneurysms.

The double stent-assisted techniques for the treatment of wide neck bifurcation aneurysms (WNBAs) may be more complicating than single stent-assisted or balloon-assisted coiling. The Comaneci device (Rapid Medical, Yokneam, Israel) is a new temporary bridging device developed for covering the aneurysm neck during coiling. This new design enabled us to treat unruptured WNBAs with the use of single stent-assisted coiling instead of double stent in eight patients. At the 1-year angiographic follow-up, there was no filling in any aneurysm. There was no mortality or morbidity cases related to the procedure. In this study, we are reporting our experience of using single stent-assisted coiling combined with a Comaneci device in the treatment of unruptured WNBAs.

Can pre-procedural MRI signal intensity ratio predict the success of uterine artery embolization in treatment of myomas?

Background/aim: Magnetic resonance (MR) images, signal intensity ratios calculated using region of interests (ROI) in T2W images by proportioning the dominant myoma to iliac muscle can aid patient selection and, thus, in achieving better outcomes with the uterine artery embolization (UAE) procedure. The present study investigates the association between the success of UAE treatment with signal intensity (SI) ratio of the dominant myoma to the iliac muscle in MR imaging performed prior to the procedure. Materials and methods: This is a retrospective study and included 30 patients who admitted to our clinic between February 2017 and July 2019 due to symptoms associated with myoma and who underwent MR imaging before and after UAE treatment. All patients, MR images obtained before UAE treatment and at the 12th month after the procedure were evaluated. In MRI, SI values were calculated by proportioning the dominant myoma to the iliac muscle using circular ROI in T1 weighted (W), T2W, and post-contrast T1W images. In the present study, 50% or more volumetric regression of the myoma with infarction of fibroids (loss of enhancement) at the 12-month follow-up MRI after the procedure was considered a successful procedure. Results: Myoma volumes calculated in MR images showed significant differences between the MRI performed before UAE procedure and the MRI performed at the 12th month after the procedure (p < 0.0001). SI ratio calculated from pre-procedure T2W MR images was found to be a significant determinant of 50% or more volumetric regression in the myoma after UAE procedure (p = 0.017), T1W, post-contrast T1W images were not statistically significant (p = 0.211). Conclusion: Our results indicate that SI ratio of the dominant myoma to the iliac muscle calculated using ROI in T2W images of MR studies performed before UAE procedure can predict the success of the procedure.

Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise.

PURPOSE: The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70-99%) stenosis of a major intracranial artery with Enterprise stent. METHODS: This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70-99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. RESULTS: A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6-72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. CONCLUSION: In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

PURPOSE: We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. MATERIALS AND METHODS: The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. RESULTS: In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5-20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6-20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). CONCLUSIONS: Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

ABSTRACT Purpose We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. Materials and Methods The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. Results In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5–20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6–20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). Conclusions Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Ultrasonographic measurement of femoral cartilage thickness in acromegalic patients.

Joint involvement is one of the most frequent clinical complications of acromegaly. The aim of this study was to evaluate the femoral cartilage thicknesses of acromegalic patients using ultrasound (US). Sixty-two patients diagnosed with acromegaly (30 F, 32 M) were included. Patients' demographic and clinical characteristics were recorded. The thickness of the femoral articular cartilage was measured using a 6- to 18-MHz linear probe. Measurements were performed bilaterally from three points (medial condyle, intercondylar area, and lateral condyle). Of the patients, 14 (22.5 %) reported pain in the knee joints. A significantly higher femoral articular cartilage thickness was determined in the patients compared with the controls (all parameters, p < 0.001). US measurements results from all points were consistent, but these values were not correlated with levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Analysis of acromegaly patients as active (n = 37) or inactive (n = 25) revealed no significance with respect to femoral cartilage thickness. Acromegalic patients seem to have thicker femoral articular cartilages irrespective of disease activity state.

Bilateral Leydig cell tumor of the testis: a case report.

Leydig cell tumors are rare testicular tumors of the male gonadal interstitium. Although uncommon, Leydig cell testicular neoplasms are the most common sex cord-stromal tumors and comprise 1-3% of all testicular neoplasms. This tumor is always benign in children and approximately 90% are benign in adults. In most cases, patients present with an incidental finding of a testicular mass on scrotal ultrasonography during evaluation of hydroceles or varicoceles or during diagnostic workup for infertility. Leydig cell tumors have been primarily managed with radical inguinal orchiectomy. However, conservative management with testis-sparing surgery in younger adults and children were reported in the literature. Here we report a case of bilateral Leydig cell tumor of the testis treated with radical orchiectomy who presented with the complaint of infertilityand no disease recurrence in followup for 9 months. The patient is currently disease-free and under androgen supplemantation for androgen insufficiency. We recommend complete exam and diagnostic workup in patients with infertility and azoospermia.

Oral vitamin C and E combination modulates blood lipid peroxidation and antioxidant vitamin levels in maximal exercising basketball players.

Oxidative stress occurs during maximal exercise, perhaps as a result of increased consumption of oxygen. Vitamins C and E can overcome the effects of antioxidants in exercise. We investigated the effects of supplementation with a combination of vitamin C and E (VCE) on blood lipid peroxidation (LP) and antioxidant levels following maximal training in basketball players.Blood samples were taken from 14 players (group A) and divided into two subgroups namely maximal training (group B) and maximal training plus VCE groups (group C). Group B maximally exercised for 35 days. VCE was supplemented to group C for 35 days and blood samples were taken from group B and C. Plasma and hemolyzed erythrocyte samples were obtained from the players.Erythrocyte glutathione peroxidase (GSH-Px) activity and plasma vitamin E concentration were lower in group B than in group A, whereas plasma and erythrocyte LP levels were higher in group B than in group A. Plasma vitamin A, vitamin E, erythrocyte GSH-Px, and reduced glutathione (GSH) values were higher in group C than in groups A and B although LP levels in plasma and erythrocytes were lower in group C than in group A and B. beta-Carotene values did not change in the three groups.In conclusion, VCE supplementation in maximal exercising basketball players may strengthen the antioxidant defense system by decreasing reactive oxygen species (ROS).

An intensive combined training program modulates physical, physiological, biomotoric, and technical parameters in women basketball players.

The purpose of this study was the investigation of the effects of an intensive combined training program based on the pretest scores of a university women's basketball team on their physical, physiological, biomotoric, and technical features. Twenty-four university volunteers were equally divided into two groups: an experiment group (intensive combined training group) and a control (technical training) group. The 10-week intensive combined training program was performed on the experiment group according to their pretest outcomes. Before and at the end of each period of training, which was scheduled four times a week, the physical, physiological, biomotoric, and technical performance of each subject were determined. With respect to the pre- and posttest measurements, the basketball group showed significant differences (p < 0.05) in girth measurements (shoulder, waist, hip, arm, thigh, and calf), in skinfold measurements (percent body fat), in physiological measurements (vital capacity and forced vital capacity), in biomotoric tests (right-left hand grip, dynamic and countermovement jump, sit-up, push-up, 1500-m endurance), and in technique tests (free and inside shooting). It can be concluded that a 10-week intensive combined training program performed on university women basketball players had a significant effect on improving their physical, physiological, biomotoric, and technical features. It proved to be highly recommendable for female basketball players who are preparing for short-term tournaments; the basketball group in this study won a championship.