Determination of the thickness of the safe enamel for laminate veneer preparation and orthodontic stripping by CBCT.

AIM: The purpose of this study is to determine the thickness and limitation of the safe enamel for laminate veneers and orthodontic stripping applications. Enamel thickness (ET) was determined in detail for each tooth and also it was examined whether there was a relationship between the mesiodistal crown width of the teeth and the thickness of the enamel and whether there was a sexual dimorphism. SUBJECTS AND METHODS: CBCT records of 101 subjects (mean age: 20.88 ± 2.48 years) were examined. ET was measured both mesial and distal region of maxillary and mandibular incisors, canines, and premolars in different levels as cervical, middle, and incisal (occlusal) 1/3. Paired t-test, student t-test, Mann-Whitney U-test and Pearson correlation coefficients a simple linear regression analysis used for statistical analysis. RESULTS: ET of mandibular first premolars and canines was thicker at right side. Mesial enamel of maxillary first premolars, canines, lateral incisors and mandibular premolars and canines were significantly thicker than distal enamel. The mesial enamel of mandibular first premolars was significantly thicker in females. Also, males' maxillary laterals were significantly larger. All premolars had a correlation between mesio-distal crown widths and ET. CONCLUSIONS: Mesial and distal ET was unique for each one tooth at different levels. The relationship between ET and crown dimensions of all premolar teeth was also determined.

Treatment of ureteral calculi with semirigid ureteroscopy: where should we stop?

OBJECTIVES: To evaluate the efficacy of semirigid ureteroscopy in the management of ureteral stones located in different parts of the ureter. METHODS: 1,503 patients were treated with semirigid ureteroscopy. All ureteral stones were either removed only by a basket catheter or disintegrated by pneumatic lithotripsy. Success rates, auxiliary procedures, complication rates and operation time were comparatively evaluated according to stone location. RESULTS: Overall, mean stone size and age were 12.1 +/- 3.7 mm and 43.2 +/- 9.72 years, respectively. While 1,416 patients (94.2%) were completely stone-free, the procedure was unsuccessful in 87 cases (5.8%). The success rate was relatively low in the proximal ureter (71.7%) when compared with the mid (94.8%) and distal ureter (98.9%) (p = 0.021). Mean operation time was 25.4 +/- 11.7 min. Longer duration of operation and higher complication rate were found in proximal ureteral calculi. Stone migration to the kidney and hematuria were the main reasons of failure in the proximal ureter and ureteral stenting was needed for 56.4% of patients with upper ureteral stone. CONCLUSIONS: Semirigid ureteroscopy can be the treatment of choice in lower and midureteral stones. However, it is an invasive and less successful treatment modality for proximal ureteral stones with relatively high complication rates.

Ureteroscopic management of ureteral calculi in children.

PURPOSE: To evaluate the efficacy and safety of rigid ureteroscopy for the treatment ureteral calculi in children. PATIENTS AND METHODS: Between January 2002 and January 2006, 16 boys and 25 girls with an average age of 9.5 years (range 3-15 years) were treated with a 95F rigid ureteroscope for stones 4 to 10 mm (mean 5.6 mm) in 46 renoureteral units (RUUs), and the results were evaluated. The stones were located in the upper ureter in 4 RUUs, the middle ureter in 15, and the lower ureter in 27. Dilatation of a tight ureteral orifice was necessary in 17 cases (36.9%). RESULTS: On examination during ureteroscopy, all calculi were well fragmented, and in 33 patients (94%), stone fragments were removed directly. Stones were fragmented with pneumatic lithotripsy in 23 RUUs and removed by forceps with or without fragmentation in the remaining 23. Whereas the treatment was successful in 36 children (87.8%), it was unsuccessful in 5 (12.2%) secondary to bleeding and mucosal injury in 3 children (7%; 1 middle- and 2 upper-ureteral stones) and severe ureteral stenosis with kinking in 2 (4.8%; 1 middle- and 1 upper-ureteral stone) children. In two other cases, although the fragments in the upper portion of the ureter could be reached with the ureteroscope, the stones migrated into the renal collecting system during pneumatic lithotripsy and were treated successfully with subsequent SWL (4.8%). At the end of the procedure, a 4.8F Double-J stent was left in place in 9 cases. There were no serious complications, and the children were not specifically evaluated for postoperative vesicoureteral reflux. Follow-up ranged from 1 to 36 months with an average duration of 22.4 months. CONCLUSION: With the aid of the experience gained in the adult population and careful instrumentation, we believe that, in skilled hands, rigid ureteroscopy can be applied in a safe and efficient manner for stones located in different portions of the pediatric ureter.

Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up.

The aim of this study was to compare the clinical results of plasmakinetic resection of the prostate (PRP) with standard transurethral resection (TUR) of the prostate (TURP). A total of 240 patients (mean age 63.5; age range 52-90 years), with symptomatic benign prostatic hyperplasia were randomized into two groups and treated with two different techniques (TURP and PRP). We evaluated pre-operative, per-operative and post-operative (first and 12th months) findings of all patients. The mean catheterization time was 3 and 4.5 days in the PRP and standard TURP groups, respectively (P<0.001). We observed the improvements in maximum flow rates in PRP group were significantly higher than TURP group (P<0.001). TUR of the prostate using plasmakinetic energy seems to be a promising treatment alternative to conventional TURP. It has the advantages of low intraoperative and post-operative complications, short convalescence, excellent intraoperative hemostasis, absence of fluid absorption and TUR syndrome.

Renal tubular injury induced by hyperoxaluria: evaluation of apoptotic changes.

In order to evaluate the injurious effect of hyperoxaluria on renal tubular epithelium, as judged by apoptotic changes in the renal parenchyma, we performed an experimental study in 20 rabbits. In the experimental group animals (n = 10) severe hyperoxaluria was induced by continuous ethylene glycol (EG; 0.75%). Histologic alterations, including crystal formation, together with apoptotic changes were evaluated after 7 and 28 days. Control group animals (n = 10) received normal distilled drinking water. Following 7- and 28-day periods, tissue sections obtained from kidneys were examined histopathologically under light microscopy for the presence and the degree of crystal deposition in the tubular lumen. Apoptotic changes in renal tubular cells were examined using the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP in situ nick and labeling (TUNEL) method during the same follow-up period. Crystal deposition was evident in the tubular lumen of tissue sections obtained during the 7-day examination period. During the 28-day examination period, however, these findings were found to be either limited or to have disappeared. In relation to apoptotic changes, the percentage of positive nuclei stained using the TUNEL method was from 11 to 20% in the experimental group and 5.6% in the control group. Our findings indicate that both calcium oxalate (CaOx) crystals and hyperoxaluria itself may be injurious to renal tubular cells, as indicated by apoptotic changes. These changes may be responsible for the pathologic course of urolithiasis.

Unilateral testicular torsion: evaluation of bcl-2, p-53 and PCNA expression in contralateral testes.

OBJECTIVES AND METHODS: The present study aims to evaluate the histologic as well as apoptotic changes indicated by PCNA, p-53 and bcl-2 expression in the contralateral testes after a period of unilateral testicular torsion of 4 h. RESULTS: Regarding the histologic changes, while some significant alterations such as complete or incomplete spermatocytic arrest as well as sertoli cell only formation have to some extent been noted after the detorsion procedure, reasonably better preserved histology could be demonstrated following the orchiectomy procedure both in the early and late follow-up. Thus, the orchiectomy procedure was found to be limiting enough on the severity of the histologic changes in the contralateral testes after a certain period of time following the torsion procedure. On the other hand, however, in relation to the apoptotic events indicated by the three markers, while PCNA activity was found to be significantly different depending on the procedure performed (detorsion or orchiectomy), p-53 and bcl-2 positivity did not exhibit any difference in this aspect. Increased PCNA activity (especially after the detorsion procedure) together with marked positivity of p-53 both in the early and late follow-up indicated the increased cell turnover in the contralateral testes, which in turn may be accepted as a sign of increased apoptosis in these testes. In addition to these findings, bcl-2 expression has been found to be consistently negative in all specimens evaluated both in the early and late follow-up. CONCLUSION: Taking into account the strong inhibitory effect of bcl-2 during apoptotic events, these findings again support the likelihood of increased apoptosis in the contralateral testes.

Evaluation of human leukocyte antigen expression in patients with prostate cancer.

OBJECTIVE: The aim of this prospective study was to evaluate the possible relationship between human major histocompatibility antigens [human leukocyte antigen (HLA)] and prostatic adenocarcinoma. MATERIAL AND METHODS: This clinical study was performed in 30 patients with histologically proven prostatic adenocarcinoma and 102 healthy men. HLA A, B and DR groups were evaluated in all patients. RESULTS: Of the HLAs examined, A2, A10, A28, A14, DR6, DR7 and DR9 were found to be accumulated significantly in patients with prostatic cancer in comparison with the healthy subjects. Apart from HLA A2 and DR7, the relative risk has been found to be over 2 in patients demonstrating these antigens. CONCLUSIONS: Although there was a statistically significant difference with respect to HLA accumulation between patients with prostate cancer and healthy subjects, larger series of patients including other parameters are needed.

Unilateral testicular torsion: protective effect of verapamil on contralateral testicular histology.

In this experimental study, it was our aim to reduce the effects of ischemic insults to the contralateral testicle after unilateral testicular torsion. The protective effect of a calcium channel blocking agent (verapamil) on the histology and the tubular diameter of contralateral testicle was evaluated. Following a definite period of unilateral testicular torsion (i.e., 4 h), the protective effect of this specific medication was evaluated both after detorsion and orchiectomy procedures. The results of our study demonstrated the protective effect of verapamil on both parameters, especially in animals undergoing orchiectomy. The majority of the specimens demonstrated normal histologic findings together with preserved tubular structures after a 1-week period under verapamil medication.

Epitheloid sarcoma of the penis.

We report a case representing the clinical as well as histopathologic features of epitheloid sarcoma. Both a clinical review and the results of definitive treatment together with the follow-up data are presented.

Limitation of shockwave-induced enhanced crystal deposition in traumatized tissue by verapamil in rabbit model.

OBJECTIVE: To evaluate the possible protective effect of verapamil (a calcium channel blocking agent) against the traumatizing effects of high-energy shockwaves (HESW) and new stone formation, as indicated by crystal deposition in the renal parenchyma, an experimental study was performed in rabbits. METHODS: A total of 65 rabbits were included. During severe hyperoxaluria induced by continuous ethylene glycol (EG) (0.75%) administration, animals in the first group (N = 15) received EG only, and animals in the second group underwent administration of 500 to 1500 shockwaves, animals in the third group (N = 15) received verapamil (0.1 mg/kg) for 3 days prior to HESW application, a control group (N = 15) received various numbers (500 to 1500) of shockwaves alone. Sham-treated animals (N = 5) constituted the last group in our study. Three months after shockwave application, tissue sections obtained from treated and untreated kidneys were evaluated histopathologically under light microscopy and transmission electron microscopy (TEM) for the presence and degree of crystal deposition in the cortical parenchymal region subjected to HESW. RESULTS: Whereas crystal deposition was evident in the intercellular region and intratubular parts of the parenchyma in animals receiving EG and HESW, especially in those receiving relatively higher numbers of shockwaves), animals receiving verapamil demonstrated limited or no crystal formation. No significant crystal deposition could be noted in specimens from animals undergoing either EG or SWL alone, and sham-treated animals demonstrated no significant alteration, as expected. CONCLUSION: Using this model, the traumatic effects of HESW could be evaluated as a factor in new stone formation after SWL. Verapamil has been found to be protective against crystal deposition.

The place of diuretic enhanced Doppler sonography in distinguishing between obstructive and non-obstructive hydronephrosis in children.

OBJECTIVE: In an attempt to differentiate obstructive from non-obstructive dilation of the renal collecting system in children, a prospective clinical study was carried out. MATERIAL AND METHODS: During duplex Doppler sonography examination in 23 children resistive index (RI) and pulsatility index (PI) and RI ratio values before and after intraverous furasemide administration were compared with the findings obtained with diuretic renogram examination (t(1/2)). RESULTS: Evaluation of the results demonstrated that diuresis RI and PI determination may aid differentiation of severely obstructed renal units from those with slight (equivocal) or no obstruction. CONCLUSION: Kidneys with severe UPJ obstruction tended to have more elevated RI and PI values than the non-obstructed or equivocally obstructed ones. Again, determination of RIR values for each kidney showed the same elevation in severely obstructed kidneys, while non-obstructive or indeterminately obstructed ones demonstrated statistically insignificant changes.

Xanthogranulomatous pyelonephritis: report of four cases.

We report 4 patients with xanthogranulomatous pyelonephritis (diagnosed and treated between 1992 and 1996), aged 16 to 55 years (mean age 37 years). All had urolithiasis, pyonephrosis and nonfunctioning kidneys prior to surgical intervention, and underwent total nephrectomy. Clinical, laboratory and radiologic findings are discussed in the light of the cases reported in the literature.

Sacral agenesis in siblings.

Sacral agenesis is a rare congenital abnormality of the lower vertebral column which is frequently associated with neurological, orthopedic as well as urological malformations. With regard to the incidence of the anomaly, although approximately 200 cases have been reported previously, the occurrence of sacral agenesis in siblings has only rarely been found. To date only two pairs of siblings have been reported. Herein we present 2 siblings with partial sacral agenesis and emphasize the need for a careful family investigation, early diagnosis and appropriate treatment.

Hydatid disease of the kidney: evaluation and features of diagnostic procedures.

We discuss 8 patients with hydatid cystic disease of the kidney. Diagnostic procedures included eosinophil count, Casoni's skin test, Ghedini-Weinberg complement fixation test, abdominal x-ray, excretory urogram, ultrasonography and computerized tomography. The combined findings of these different modalities aid greatly in establishing the correct diagnosis.

Ultrasound examination of scrotal masses.

The technique of renal time ultrasound of the scrotum is described. The examination was performed in 50 patients and 15 normal males at the Sahinbey Hospital. Given the clinical diagnosis ultrasound proved reliable in almost all cases. In this study ultrasonography of the scrotum has been found to be the most useful method demonstrating testicular diseases.

Hydatid disease of the kidney.

OBJECTIVE: To define the clinical manifestations of echinococcal involvement of the urinary tract and to propose guidelines for treatment. PATIENTS AND METHODS: A positive diagnosis of hydatid disease was made in seven patients and in all of these the cyst was located in the kidney only. The patients included four males and three females whose ages ranged from 6 to 56 years (mean 33.3). RESULTS: Surgical treatment involved total nephrectomy in six patients and partial nephrectomy in one patient. There was no operative or post-operative mortality and all patients were cured of the disease. CONCLUSION: Despite its rarity, hydatid disease should be considered in the differential diagnosis of space-occupying lesions of the urinary tract.