CT-Based Determination of Ureteral Stone Volume: A Predictor of Spontaneous Passage.

INTRODUCTION AND OBJECTIVES: Which ureteral stone can pass spontaneously? It is hard to answer this question exactly. The size and location of the stone are the most important predictors. However, there is still a considerable gray zone that needs to be clarified. We try to identify the role of stone volume (SV) in the prediction of spontaneous passage (SP). MATERIALS AND METHODS: Seventy-eight patients with a solitary ureteral stone were retrospectively evaluated. Ureter SV measurements were taken in three planes and were calculated using the following formula: V = (X) × (Y) × (Z) × 0.52. SVs, and the longest diameters (LDs) were compared between patients who passed stones spontaneously and those who needed intervention. RESULTS: The SVs and LDs were significantly lower in patients who passed stones spontaneously than in patients who required intervention (41.2 ± 35.5 vs 128.1 ± 91.1 mm(3), p = 0.001; 5.7 ± 1.8 vs 7.4 ± 1.7 mm, p = 0.001). The optimum cutoff values were 7.0 mm and 52.6 mm(3) for the LD and SV, respectively. For those stones of ≤7 mm, the volumes of the stones that could and could not pass did not differ significantly. However, the volume of the stones >7.0 mm that could pass was significantly higher than of those that could not. SP was 30.6% for stones >7 mm; however, when we removed the stones >52.6 mm(3), SP increased to 75% for stones higher than 7 mm (p = 0.001). CONCLUSIONS: To classify ureteral stones using only one parameter such as stone diameter may lead to heterogeneity within the group. SV may be used in addition to size to determine a more definite homogeneous group to predict SP more precisely.

The Role of Extra-Anatomic Bypass in the Surgical Treatment of Acute Abdominal Aortic Occlusion.

BACKGROUND: Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures. METHODS: Eighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis. RESULTS: In all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of 21.2±9.4 months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up. CONCLUSION: To conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.

Alterations of thyroid volume and nodular size during and after pregnancy in a severe iodine-deficient area.

OBJECTIVE: The effects of pregnancy on thyroid nodules were investigated in a few number of studies. We aimed to evaluate the prevalence of thyroid nodules, the changes in size, volume and number of nodules during pregnancy and after delivery in pregnant women. DESIGN AND METHODS: This prospective study was performed in a severe iodine-deficient area and included 83 pregnant women (mean age 30·4 ± 5·5 years). We evaluated thyroid hormone levels, ultrasound examination of thyroid and urine iodine concentration (UIE) at each trimester and at 3-month post-partum period (PP). All patients with thyroid nodules >1 cm underwent fine-needle aspiration biopsy (FNAB) after the last visit at the PP. RESULTS: Twenty-six women had thyroid nodules on thyroid ultrasonography at the first trimester. The volume of single/dominant nodule showed enlargement during pregnancy and remained at the PP; however, it was not significant (first trimester: 0·83 ± 0·8 ml; second trimester: 0·92 ± 1 ml; third trimester: 0·99 ± 1·2 ml; PP: 0·92 ± 1·2 ml). The maximum diameter of single/dominant nodule in the third trimester of pregnancy (12·6 ± 5·4 mm) was greater than the first trimester (11·9 ± 4·8 mm) (P = 0·002). The number of nodules did not change during pregnancy. The mean TV increased during pregnancy and remained 3 months after delivery (P < 0·001), and the maximum value of TV was reached in the third trimester (14·2 ± 7·9 ml). FNAB results revealed a 6·6% prevalence of malignancy among the nodules. CONCLUSIONS: Thyroid nodules were present in 30·1% of pregnant women. While size of the single/dominant thyroid nodule increased significantly during pregnancy, the number of nodules did not change.

Testosterone- and cortisol-secreting adrenocortical oncocytoma: an unusual cause of hirsutism.

Objective. Oncocytomas of the adrenal cortex are usually benign and nonfunctional. They are rarely seen as the cause of hirsutism. Therefore, we aimed to report a case of adrenocortical oncocytoma presenting with hirsutism. Methods. We report a testosterone- and cortisol-secreting adrenal oncocytoma in a 23-year-old female patient presenting with hirsutism. Results. The patient had the complaint of hirsutism for the last year. Laboratory tests revealed total testosterone level of 4.2 ng/mL, free testosterone of >100 pg/mL, and DHEAS level of 574 µg/dL. There was no suppression in cortisol levels with 2 mg dexamethasone suppression test (5.4 µg/dL). Adrenal MRI revealed a 27 × 25 mm isointense solid mass lesion in the left adrenal gland and the patient underwent laparoscopic left adrenalectomy. Pathological examination confirmed the diagnosis of benign adrenocortical oncoyctoma. Conclusion. This well-characterized case describes a testosterone- and cortisol-secreting adrenocortical oncocytoma as a possible cause of hirsutism. To our knowledge, this is the second report in the literature. Adrenal oncocytomas should always be considered in the differential diagnosis of hirsutism.

Low-density lipoprotein subfraction, carotid artery intima-media thickness, nitric oxide, and tumor necrosis factor alpha are associated with newly diagnosed ischemic stroke.

OBJECTIVES: Small dense (sd) low-density lipoprotein (LDL), tumor necrosis factor (TNF) alpha (α), and nitric oxide (NO) have recently emerged as important stroke risk factors. The aim of the study was to investigate the effects of increased levels of small LDL particle size, TNF-α and NO on the developed ischemic stroke and increased carotid artery intima-media thickness (CIMT). MATERIALS AND METHODS: A total of 29 women and 25 men (a total of 54 ischemic stroke patients) and a similar age group of 50 controls (29 females and 21 males) were included in the study. CIMT, C-reactive protein (CRP), TNF-α, NO, and lipid subfraction test of the two groups were measured. RESULTS: The mean LDL particle size was smaller in patients with stroke than in the controls (26.8 ± 0.31 nm vs. 27.0 ± 0.31 nm, P = 0.003). sd-LDL, TNF-α, NO, CRP, right CIMT, and left CIMT were higher in patients with stroke than in the controls (respectively; 8.2 ± 7.8 mg/dL vs. 3.3 ± 3.5 mg/dL, P < 0.001;75.6 ± 25.0 pg/mL vs. 65.4 ± 9.1 pg/mL, P = 0.009;76.4 ± 53.3 mmol/L vs. 41.5 ± 27.0 mmol/L, P < 0.001;1.9 ± 2.6 mm vs. 0.4 ± 0.3 mm P < 0.001;0.97 ± 0.38 mm vs. 0.83 ± 0.15 mm, P = 0.007;1.04 ± 0.44 mm vs. 0.87 ± 0.19 mm, P = 0.010). CONCLUSION: These results show that sd-LDL is independently associated with the incidence of stroke and may be a risk factor in the development of stroke. In addition, TNF-α, NO, right CIMT, and left CIMT may be a risk factor in the development of ischemic stroke.

Increased bladder wall thickness in diabetic and nondiabetic women with overactive bladder.

PURPOSE: Bladder wall thickness has been reported to be associated with overactive bladder (OAB) in women. Diabetic women have an increased risk for OAB syndrome and may have an increased risk for bladder wall thickness. METHODS: A total of 235 female patients aged 40 to 75 years were categorized into four groups. The first group consisted of women free of urgency or urge urinary incontinence. The second group included nondiabetic women with idiopathic OAB. The third group consisted of women with diabetes and clinical OAB, and women with diabetes but without OAB constituted the fourth group. Bladder wall thickness at the anterior wall was measured by ultrasound by the suprapubic approach with bladder filling over 250 mL. RESULTS: The diabetic (third group) and nondiabetic (second group) women with OAB had significantly greater bladder wall thickness at the anterior bladder wall than did the controls. However, the difference was not significant between the diabetic (third group) and the nondiabetic (second group) women with OAB. Women with diabetes but without OAB (fourth group) had greater bladder wall thickness than did the controls but this difference was not significant. Additionally, the difference in bladder wall thickness between diabetic women with (third group) and without (fourth group) OAB was not significant. CONCLUSIONS: This is the first study to show that bladder wall thickness is increased in diabetic women with and without OAB. Additionally, nondiabetic women with OAB had increased bladder wall thickness. Further studies may provide additional information for diabetic and nondiabetic women with OAB, in whom the etiopathogenesis of the disease may be similar.

Non-alcoholic fatty liver disease is associated with benign prostate hyperplasia in men and with overactive bladder in women.

OBJECTIVE: Metabolic syndrome plays a significant role in the development of benign prostate hyperplasia (BPH) and overactive bladder (OAB). Non-alcoholic fatty liver disease (NAFLD) is accepted as the hepatic component of metabolic syndrome. This study investigated the association of NAFLD with BPH and OAB. MATERIAL AND METHODS: In total, 702 men with BPH and 529 women with and without OAB were recruited into the study in a cross-sectional risk factor analysis. All male and female patients were separated into two groups, with or without NAFLD. An overnight fasting blood profile was obtained and whole abdominal ultrasound was performed by a blinded radiologist in each patient to measure hepatic steatosis. RESULTS: NAFLD was diagnosed in 387 (55.8%) of 702 men with BPH. Statistically significantly higher prostate volumes were found in men with NAFLD in comparison to without (p = 0.018). The female population included 207 women with NAFLD and 322 women without. OAB was found in 75.8% and 52.4% of women with and without NAFLD (p = 0.022). CONCLUSIONS: NAFLD is associated with BPH in men and with OAB in women. These findings confirm the hypothesis that BPH is an aspect of the metabolic syndrome and support the hypothesis that OAB is an aspect of the metabolic syndrome.

Testis sparing surgery in a case of small unilateral testicular cancer.

A 22-year-old male presented at our institution with an incidentally ultrasound-detected testicular tumor. Magnetic resonance imaging showed a contrast-enhanced right intratesticular mass over 1 cm in size. The patient underwent testis sparing surgery. Pathologic examination revealed seminoma. A follow-up nine months later showed no residual tumor, a normal contour of the testis and no evidence of atrophy. Testis sparing surgery is an option for patients with small unilateral testicular tumors even in the presence of a healthy contralateral testis.

Direct venous spinal reabsorption of cerebrospinal fluid: a new concept with serial magnetic resonance cisternography in rabbits.

OBJECT: For nearly 100 years it has been believed that the main reabsorption of CSF occurs in arachnoid projections into the superior sagittal sinus, but a significant number of experiments and cases conflict with this hypothesis. According to recently published studies, CSF is permanently produced and absorbed in the whole CSF system. Clusters of arachnoidal villi, which are speculated to have a role in the reabsorption of CSF, have recently been revealed in the dorsal root of the spinal nerves. Huge absorptive surface areas of microvessels have been suggested to serve a putative role in reabsorption. The authors' aim was to observe direct venous connections between the subarachnoid space and the perispinal veins. METHODS: Eleven adult (6 months old) New Zealand white male rabbits weighing approximately 3.0 kg each were used in this experiment. After obtaining precontrast MR cisternography images, subarachnoid access was gained percutaneously via a cisternal approach by using a 20-gauge intravenous indwelling cannula. One rabbit died as a result of brainstem trauma during percutaneous cannulation before contrast administration, but contrast agent was still injected to see the possible MR imaging results of spinal CSF reabsorption after death. Magnetic resonance imaging was performed at 15, 60, 120, and 180 minutes after the administration of contrast agent. After intramuscular injections of anesthetic, 2 rabbits died 120 and 150 minutes after contrast injection, but the MR imaging study at 180 minutes after contrast injection was still performed. RESULTS: Direct connections between the subarachnoid space and the perispinal veins were observed in all rabbits during serial MR cisternography. The enhancement power was not affected by the amount of injected contrast agent or by cervical or lumbar penetration but was increased at higher contrast concentrations or upon seizure (physical activity). CONCLUSIONS: Extracranial reabsorption of CSF has been finally proved with direct radiological confirmation of spinal venous reabsorption of CSF using serial MR cisternography. The authors believe that this study can help to develop a more accurate model of CSF dynamics, which will allow understanding of many CSF-related diseases, as well as the development of new strategies for treatment.