The ability of emergency physicians to diagnose and score acute pancreatitis on computed tomography.

PURPOSE: The aim of this study is to determine the ability of emergency physicians' (EP) interpreting contrast-enhanced computed tomographies (CECTs) performed in patients diagnosed or suspected acute pancreatitis (AP), using the modified computed tomography severity index (MCTSI) scoring system. METHODS: This study was conducted in Training and Research Hospital's Emergency Department. From January 1, 2013 to April 30, 2016, patients whom performed CECT within 24 h of admission with diagnosis or suspicion of AP were reviewed retrospectively. One hundred eighteen patients were included in the study. Three-third-year EPs received education about CECT interpretation and MCTSI criteria. Each EP interpreted CECTs in a blinded manner. The EPs' performance of determining the CECTs with or without AP and scoring the CECTs with CTSI scoring system was investigated. RESULTS: The agreement (weighted kappa) between the EPs and the radiologists for determining CECTs positive for AP was 0.932 (p < 0.001), 0.864 (p < 0.001) and 0.949 (p < 0.001) for EP1, EP2 and EP3, respectively. The agreement for MCTSI scores was 0.649 (p < 0.001), 0.588 (p < 0.001) and 0.734 (p < 0.001). These values showed a significant relationship between the EPs and radiologists. CONCLUSIONS: EPs can diagnose the AP on CECTs and score CECTs with MCTSI scoring system correctly.

Can ischemia-modified albumin be used as an objective biomarker for renal ischemic damage? An experimental study with Wistar albino rats.

INTRODUCTION: This study sought to evaluate the correlation of ischemia-modified albumin (IMA) with time-dependent renal ischemic injury. METHODS: We established 5 groups of 8 Wistar albino rats as follows: sham, 10 minutes of renal ischemia, 20 minutes of renal ischemia, 30 minutes of renal ischemia, and 40 minutes of renal ischemia. Renal ischemia was established by occlusion of the right renal pedicle. Blood samples were obtained after exploration of the renal pedicle in the sham group and after thoracotomy and directly from the cardiac chambers at the end of the ischemic period in the other groups. The ischemic kidneys were removed for histopathological evaluation, and the rats were killed. RESULTS: There were significant differences among the IMA levels of the 5 groups (P = .0013). Pathological examination showed that renal ischemic injury corresponded to the duration of ischemia. In the group analysis, the pathological evaluation scores were significantly different among the groups (P < .001). CONCLUSIONS: This study shows that IMA levels can be used as a nonselective biomarker for renal ischemic injury. However, further studies are needed to support our findings.

Outpatient follow-up'' or ''Active clinical observation'' in patients with nonspecific abdominal pain in the Emergency Department. A randomized clinical trial.

AIM: The aim of this study was to determine whether it is safe and cost-effective to discharge nonspecific abdominal pain (NSAP) patients from the Emergency Department (ED) and re-evaluate diagnosis later. METHODS: Patients aged between 18 and 65 years were enrolled into the study. They had been admitted to the ED for acute abdominal pain with an indefinitive diagnosis after clinical examination and base-line investigations. The patients were randomly assigned into two groups: 1) active clinical observation (ACO), comprising those admitted to the ED observation room; 2) outpatient group (OG), comprising those discharged and asked to return for re-evaluation at 8-12 hours intervals over the following three days. Each patient was examined by an ED physician and a consultant general surgeon. Demographics, blood tests, morbidity and mortality, number of operations, together with 6-month follow-up results were noted. Finally, a patient satisfaction questionnaire was administered. RESULTS: A total of 105 patients were enrolled into the study; 50 were randomized to the ACO group and 55 to the OG. There were no statistically significant differences in demographics and blood parameters between the two groups. Overall agreement of ED diagnosis with final diagnosis was 91.4%. Total morbidity was 10% in the ACO group and 7.2% in the OG. There were no statistically differences in morbidities and usage of diagnostic imaging modalities between the two groups (P>0.05). No deaths occurred in either group during the study period. The patients in the ACO group were more keen on returning for re-evaluation and willing to recommend our hospital services to other people (P< or =0.05). CONCLUSION: Outpatient evaluation of patients with an ED diagnosis of NSAP may be an option, seems to be safe, is not accompanied by an increased incidence of complications and is efficient if patients are selected properly.

The effect of agmatine on the vascular reactivity in streptozotocin-diabetic rats.

AIM: We investigated the vascular effects of agmatine (decarboxylated arginine=AGM), an endogenous ligand for alpha(2)-adrenoceptors and imidazoline receptors, present in endothelium and smooth muscle, using the diabetic rat aortae. MATERIALS AND METHODS: Studies were performed in control group (0.2 ml i.p. saline, n=10), streptozotocin (STZ)-diabetic control group (60 mg kg(-1) STZ i.p., n=10), agmatine (AGM)-control group (5 mg kg(-1)day(-1) i.p. AGM for 1 month, n=10), citrate-control group (0.2 ml 0.01 M, n=10), insulin-treated diabetic group ((3 U kg(-1) NPH+1 U kg(-1) regular insulin) twice per day, for 1 month, n=10) and AGM-treated diabetic group (5 mg kg(-1)day(-1) i.p. for 1 month, n=10). All values are expressed as means+/-S.E.M. Statistical analysis of the data was performed using ANOVA followed by Tukey multiple comparisons test. RESULTS: One-month AGM-treatment significantly decreased the blood glucose levels of diabetic rats (502+/-44 mg dl(-1) to 343+/-31 mg dl(-1), P<0.001). Fast, slow and total components of responses to noradrenaline in all the experimental groups were not significantly affected by AGM-treatment. AGM reversed the decreased responses of acetylcholine (pD(2) and Inh.%, P<0.001 and P<0.05) in diabetic rats although it did not affect the responses of sodium nitroprusside in all groups. The contraction values of KCl in all groups were not affected by AGM-treatment. CONCLUSION: AGM-treatment could improve the increased blood glucose level, reverse the endothelial dysfunction and normalize the endothelium-dependent relaxation responses in STZ-diabetic rats.

Bombesin improves burn-induced intestinal injury in the rat.

This study was designed to determine the effect of exogenous bombesin (10 microg/kg/day, subcutaneously, three times a day) on intestinal hypomotility and neutrophil infiltration in the early and late phases of burn injury (partial-thickness, second-degree burn of the skin). In acute (2 h after burn injury) or chronic (3 days after) burn groups, intestinal transit was delayed, which was reversed by bombesin treatment. In the acute burn group, but not in the chronic group, increased MPO activity was also reduced by bombesin treatment. The results demonstrate that bombesin ameliorates the intestinal inflammation due to burn injury, involving a neutrophil-dependent mechanism.

The delays in intestinal motility and neutrophil infiltration following burn injury in rats involve endogenous endothelins.

This study was carried out to investigate the role of endogenous endothelins in intestinal motility following bum injury by using a nonselective endothelin-1 (ET-1) antagonist and to evaluate the ET-1-mediated reactive oxygen metabolite formation and neutrophil infiltration following burn injury. In 2 h and 3 day postburn groups, transit indices were significantly decreased as compared to corresponding sham groups. Transit index was not significantly changed by PD156252 pretreatment in the 2 h postburn group, whereas the delay in transit was abolished in the ET-antagonist treated 3 day postbum group. In the 2 h postburn group, tissue-associated myeloperoxidase (MPO) activity value was found to be increased compared to corresponding sham group, while PD156252 pretreatment partially reversed this effect. Although MPO activity levels were not significantly different between 3 day postburn and corresponding sham groups, MPO levels showed a significant increase in ET antagonist-treated group as compared to the corresponding burn group. In the early phase of the burn, there was no significant difference in protein oxidation levels among the groups. In the 3 day postburn group, protein oxidation levels in ET-antagonist-treated group showed an increase compared to its corresponding burn group. In conclusion, the results demonstrate that endogenous endothelins have an important role in the systemic response to burn injury, as observed by a delay in intestinal motility and an infiltration of neutrophils. Although the results of the animal studies are not readily applicable to burned patients, the present study may suggest that the burned patient's condition should be carefully evaluated to secure a proper and early enteral feeding.

Antioxidant enzyme activities and lipid peroxides in the plasma of patients with benign prostatic hyperplasia or prostate cancer are not predictive.

In this study, lipid peroxide and total sulfhydryl contents and activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) were investigated in the plasma of patients with benign prostatic hyperplasia (BPH) and prostate cancer. No significant change was found in lipid peroxidation or antioxidant systems in the plasma of patients with BPH and prostate cancer. The results indicate that evaluation of the prooxidant-antioxidant balance in the plasma of BPH and prostate cancer patients cannot be used as a marker to discriminate between these diseases.

Clinical significance of nuclear p53 protein accumulation in bladder cancer.

OBJECTIVES: To investigate the correlation of nuclear p53 accumulation with disease outcome in a cohort of patients with transitional cell carcinoma of the bladder. METHODS: A total of 90 patients (11 female, 79 male) with transitional cell carcinoma of the bladder were included in this study. Tumour samples from the primary tumour were analysed by immunohistochemistry for nuclear accumulation of p53 protein. Outcome of each patient was recorded and investigated for a possible relation with p53 status. RESULTS: Nuclear p53 deposition was determined in 22 specimens. The nuclear p53 deposition was seen in less than 20% of the nuclei examined in 13 and more than 20% in 9 cases. No stromal staining was observed. Nuclear p53 deposition was present in 15.2% (7/46) of grade 2 tumours, and 34% (15/44) of grade 3 tumours (p=0.037). Stage distribution revealed 15.5% (5/33) positivity in stage pTa, 25.8% (8/31) in pT1 and 34% (9/26) in stage pT2-3 tumours. Tumours with p53 nuclear accumulation had a higher rate of recurrence and progression and shorter survival. CONCLUSION: Results of the current study indicate p53 as an important factor in determination of biological behaviour of bladder cancer.

Prognostic significance of p53 protein accumulation in stage pT1 transitional cell carcinoma of the bladder.

OBJECTIVE: Mutations in the tumour suppressor gene p53 results in the production of a mutant type, dysfunctional p53 protein which can readily be detected in the cell nucleus by immunohistochemical staining. This study aims to investigate the association of nuclear p53 protein accumulation with the clinical outcome of stage pT1 transitional cell carcinoma of the bladder which is renowned for high rates of recurrence and progression. METHODS: TUR samples of the tumours from fifty-two patients with primary stage T1 bladder cancer were analyzed immunohistochemically using the standard avidin-biotin peroxidase method for nuclear p53 accumulation. Status of p53 immunostaining was correlated with tumour recurrence, disease progression and three-year survival of each patient. RESULTS: The rate of tumour recurrence in pT1 bladder cancer was 36% in patients with tumours stained negatively for p53 protein and 78% in patients with tumours stained positively for p53 protein. Disease progression was seen in 15% of p53 (-) patients and in 56% of p53 (+) patients. CONCLUSIONS: In stage pT1 bladder tumours p53 nuclear accumulation indicates higher rates of tumour recurrence and disease progression. Accordingly, in patients who have pT1 bladder tumours with nuclear p53 accumulation, institution of more aggressive therapy should be considered and early radical therapeutic modalities should be offered to these patients.

Nuclear accumulation of mutant p53 protein: a possible predictor of failure of intravesical therapy in bladder cancer.

OBJECTIVE: To investigate the expression and importance of the nuclear accumulation of p53 in superficial transitional cell carcinoma (TCC) of the bladder and its role as a predictor of response to treatment. PATIENTS AND METHODS: Tumour samples from 30 patients (two women and 28 men, mean age 60.1 years, range 44-75) with pTa/pT1 tumours were assessed immunohistochemically using the Pab1801 monoclonal antibody and standard avidin-biotin peroxidase staining for p53 protein. RESULTS: Tumours from six patients (20%) showed nuclear accumulation of p53; five of these patients failed intravesical therapy with bacille Calmette-Guèrin (BCG) and progressed to muscle invasive and/or metastatic disease, in contrast to six of 24 patients with no detectable nuclear oncoprotein. CONCLUSIONS: The nuclear accumulation of p53 appears to be a prognostic indicator of tumour unresponsive to intravesical treatment, even with the most potent agent (BCG). Therefore, early radical treatment modalities must be seriously considered in this group of patients.

Two cases of retrovesical haematoma following prostatic biopsy.

Prostatic biopsy is a definitive diagnostic method that should be used whenever a prostatic malignancy is suspected. Anatomically it can be done from the transrectal or perineal route. In two methods transrectal ultrasonography can be used as a helper tool. In this paper we present two cases of pelvic haematoma following prostatic biopsy that occasionally cause complications.

Adriamycin absorption after Nd:YAG laser coagulation compared to electrosurgical resection of the bladder wall.

The toxicity of intravesical drugs used for the treatment of bladder cancer is increased by systemic absorption. Therefore, treatment is often delayed several weeks after transurethral resection until sufficient healing occurs. Since a neodymium:YAG laser causes tissue injury by thermal coagulation, we investigated differences in bladder permeability after laser treatment compared to TUR. Comparable 2.5 cm in diameter areas of tissue injury were created in the bladder of mongrel dogs either by Nd:YAG laser coagulation or transurethral electrocautery resection (TUR). Subsequently, 30 mg. of adriamycin were instilled intravesically. A control group consisted of animals receiving adriamycin alone. Blood was taken at 10, 30, 60, and 120 minutes after instillation and the serum concentration of adriamycin measured quantitatively by high performance liquid chromatography (HPLC) with fluorescence detection. The maximum serum ADM concentration during 120 minutes for the control group was 28.0 +/- 12.9 ng/ml compared to 38.9 +/- 4.8 for the laser group and 102.9 +/- 29.9 for TUR. The area under the curve was 35.1 +/- 10.2 ng x hours/ml for control, 43.5 +/- 3.9 for laser and 127.7 +/- 49.9 for TUR. Using a two-tailed Student's t test, the difference between the TUR and the laser group was significant (p less than 0.01). There was no difference between laser and control. These results suggest that laser treatment has minimal effect on the absorption of drugs from the bladder. The clinical practice of delaying intravesical therapy after TUR is verified but a similar policy may not be necessary after laser treatment.

Definition and treatment of chordee without hypospadias: a report of 5 cases.

The controversies in chordee without hypospadias are mostly focussed on the definition and treatment of type I and type IV chordee. In this respect we believe that surgical exploration is necessary to make a precise classification leading to the most appropriate therapy. We present 5 cases, 3 of which had type I chordee, 1 had type II and 1 had type III. In the 2 cases with type I chordee, type IV chordee coexisted. Although all the patients have had satisfactory cosmetic results, 3 of them should be reevaluated after puberty since they are prepubertal yet.

Sacral agenesis with imperforate anus and its late complication: neuropathic bladder.

The authors report a rare case of imperforate anus as a congenital anomaly. Early diagnosis and close follow up are emphasized, in order to prevent the development of complications which may last for a lifetime.

Long-term follow-up results of the MAGPI (meatal advancement and glanuloplasty) operations in distal hypospadias.

Between 1985 and 1989, 54 boys underwent a MAGPI procedure. Excellent cosmetic and functional results were achieved in 94% of our cases in the early period. In order to assess the long-term results of this procedure, 41 boys attended long-term re-evaluation between 6 and 40 (mean 29) months postoperatively. MAGPI was a very satisfactory procedure for micturition function. We observed in 22% of cases partial and in 15% complete regression. On the long term, excellent cosmetic results were achieved in all glanular cases but in only 65% of coronal and 15% of subcoronal cases. We believe that the MAGPI procedure is not a suitable operation for subcoronal hypospadias.

Malignant Leydig cell tumour of the testis: a case report and review of the literature.

A rare case of malignant Leydig cell tumour of the testis is presented. There was no standard therapy regimen. Leydig cell carcinoma is relatively refractory to radiotherapy and chemotherapy. So a retroperitoneal node dissection should be performed before or after chemotherapy for staging and also for therapeutic reasons.