The incidence and most common levels of thoracic degenerative disc pathologies.

OBJECTIVES: In this study, we aimed to describe and characterize the incidence of thoracic degenerative disc pathologies, bulging/herniation, and the most common affected levels. PATIENTS AND METHODS: Between January 2008 and May 2012, a total of 195 patients (109 females, 86 males; mean age 43.5 years; range, 15 to 74 years) who were admitted with the complaint of dorsalgia and underwent magnetic resonance imaging (MRI) of the thoracic vertebral column were included in the study. Data including MRI findings, endplate and disc degeneration, disc height loss, bulging, and disc herniation were retrospectively analyzed. RESULTS: Of 3,348 patients, 195 patients had disc bulging/herniation. When 12 levels in 195 cases were taken into consideration, disc pathologies were found in 412 (18%) levels among the total of 2,340 intervertebral disc levels. Bulging was present in 11% (244/2,340) of the levels. Disc herniation was present in 7% (168/2,340) of the levels. The most commonly affected site was T7-8, followed by T8-9 and T11-12. CONCLUSION: Thoracic disc pathologies are still a significant diagnostic challenge. Our study results show that the incidence of these pathologies is higher than expected.

Effects of Caspase 9 Gene Polymorphism in Patients with Prostate Cancer.

BACKGROUND: Prostate cancer is one of the most common solid tumors and the second leading cause of the death due to malignancy in men. Caspase 9 (CASP9) is a member of the intrinsic pathway and plays a central role in the apoptosis. PATIENTS AND METHODS: Genotyping of the CASP9 (rs1052576) polymorphism were performed using real-time polymerase chain reaction for blood samples of prostate cancer patients (n=69) and controls (n=76). RESULTS: There were no significant differences between the groups in the frequency of CASP9 genotypes (χ2=1.363; p=0.506). Patients with CASP9 (rs1052576) CT genotype were 12.8 fold higher in pathological stage of pT2a compared to any other stages of cancer (OR=0.078, 95% CI= 0.009-0.062; p=0.004). Also TT genotype carriers were 11.3 times lower in pathological stage of pT2a (OR=11.33, 95% CI=2.39-53.748; p=0.000). C allele carriers were 11.36 fold higher in pathological stage of pT2a compared to any other stages of cancer (OR=0.088, 95% CI=0.019-0.418; p=0.002). CONCLUSION: CASP9 (rs1052576) C allele was decreasing the risk for pathological stage of patients with prostate cancer and also CT genotype had positive impact on pathological stage of patients with prostate cancer. CASP9 (rs1052576) TT genotype was seemed to be associated with higher risk of pathological stage. Those results implicated that CASP9 variations could be associated with severity of prostate cancer.

Systemic endothelial function measured by flow-mediated dilation is impaired in patients with urolithiasis.

Some in vitro and animal studies have shown endothelial dysfunction in hyperoxaluria models indicating its role in pathogenesis of urolithiasis and relation to CVD. The aim of this study was to investigate endothelial function in patients with urolithiasis in relation to urinary stone risk factors and metabolic parameters. A total of 120 subjects without any known CVD (60 with urolithiasis and 60 healthy subjects) were included into study. Fasting blood and 24-h urine samples were collected to study metabolic parameters (glucose and lipids) and urine stone risk factors (oxalate, citrate, uric acid, and calcium, pH). Endothelial function was assessed as flow-mediated dilation (FMD) at the brachial artery. Age, sex, and body mass index were similar in patients and controls. Of urine stone risk factors, oxalate and citrate were higher in patients than controls. Fasting blood glucose, total LDL cholesterol, and triglyceride were higher, and HDL cholesterol was lower in patients than controls. Although within normal limits systolic blood pressure was higher in patient group, patients with urolithiasis had a lower %FMD than controls. Percent FMD was negatively correlated with urinary oxalate/creatinine ratio (p = 0.019, r = -0.315), calcium/creatinine ratio (p = 0.0001, r = -0.505) age (p < 0.001, r = -0.694), BMI (p < 0.001, r = -0.838), total cholesterol (p < 0.001, r = -0.559), and triglyceride (p < 0.001, r = -0.529). Urine oxalate/creatinine ratio was positively correlated with age (p = 0.01, r = 0.327) and calcium/creatinine ratio with BMI (p = 0.001, r = 0.410). This is the first study demonstrating endothelial dysfunction in human subjects with urolithiasis. This indicates a possible predictive role of urolithiasis in future development of cardiovascular diseases.

The Daily Resistive Index measurement useful tool in the estimation of the optimal time interval between two Shock Wave Lithotripsy sessions.

OBJECTIVE: : To monitor the impact of Shock Wave Lithotripsy (SWL) on the renal resisive index (RI) and to investigate the potential of the RI measurement for the estimation of the optimal duration between 2 SWL sessions. MATERIAL AND METHODS: Thirty patients with single pelvis renalis stone were included. Participitants were grouped according to their age as group 1 (<40 years, mean age 36.2+/-3.9 years) and group 2 (>/=40 years, mean age 55.4+/-6.5 years). RI measurement was performed in of all patients prior to SWL. After SWL, RI was monitored daily until RI returned to their pre-SWL values. RESULTS: The mean stone size was 2 8.97+/-3.62 in group 1 and 10.08+/-4.67 mm in group 2 (p=0.077). Following SWL, the RI value of both goups increased and the higher RI value was measured at the 24th hour as compared with their pre-SWL values (p<0.001). In day 2 RI of the groups declined, but the differences were still statistically different from their pre-SWL RI values (p<0.001). However, on the third day, RI of group 1 was close to their pre-SWL level (p=0.143). But, in group 2, RI value returned to their pre-SWL limits on day 4 (p=0.229). CONCLUSIONS: RI measurement gives important data regarding SWL related acute renal trauma and should be used as an US marker for recovery after SWL.

Intrarenal Surgery vs Percutaneous Nephrolithotomy in the Management of Lower Pole Stones Greater than 2 cm.

PURPOSE: To compare the efficacy of RIRS and PNL in lower pole stones ≥ 2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients' preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. RESULTS: There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. CONCLUSIONS: RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients.

Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients.

Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n = 56) and 4-day diet group (n = 45). Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring <6 mm and ≥6 mm. We graded the residual fluid, tagging quality for solid stool, and fluid per bowel segment. We performed a questionnaire to assess patient compliance. Results. 604 bowel segments were evaluated. There was no significant difference between 2-day and 4-day diet groups with respect to residual solid stool, residual fluid, tagging quality for stool, and fluid observed in fecal tag CT colonography (P > 0.05). The prevalence of moderate discomfort was significantly higher in 4-day group (P < 0.001). Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients.

Intrarenal Surgery vs Percutaneous Nephrolithotomy in the Management of Lower Pole Stones Greater than 2 cm

Purpose To compare the efficacy of RIRS and PNL in lower pole stones ≥2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients’ preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. Results There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. Conclusions RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients. .

Does early PET/CT assesment of response to chemotherapy predicts survival in patients with advanced stage non-small-cell lung cancer?

The aim of this study is to determine the prognostic role and the timing of metabolic response to chemotherapy, based on F-fluorodeoxyglucose positron emission tomography (F-FDG-PET), in patients with metastatic non-small-cell lung cancer (NSCLC). The study included 55 patients with metastatic NSCLC that were analyzed in terms of prognostic factors and survival. F-FDG-PET/CT findings were evaluated in patients separated into 3 groups, before and after 1st, 2nd, 3rd cycle of the first line chemotherapy. Metabolic response was assessed according to PET Response Criteria in Solid Tumors (PERCIST 1.0). Among the 55 patients, 34 (62%) died, and 21 (38%) remained alive during a mean follow-up of 13.5 months. Median overall survival (OS) was 11.69 months (range 2-26.80 months) and median progression-free survival (PFS) was 6.27 months (range 1.37-20.43 months). Univariate analysis showed that the only favorable prognostic factor for OS in all the patients was the achievement of metabolic response. Metabolic response according to PERCIST, and weight lose ≤ 5% were also independent favorable prognostic factors predictive of survival in all patients based on multivariet analysis (metabolic response: P=0.002, OR; 1.90, 95% CI 1.26-2.89, and weight lose ≤5%: P=0.022, OR; 2.24, 95% CI 1.12-4.47). Median OS in all patients with partial response (PR)-according to the PERCIST 1.0- was significantly longer than in those with progressive disease (PD) (16.36 months vs 8.14 months, P=0.008). Median OS in the patients with PR was significantly longer than in those with PD based on PET/CT performed after 2nd and 3rd cycles of chemotherapy (18.35 months vs 7.54 months, P=0.012 and 18.04 months vs 7.43 months, P<0.001, respectively), whereas, median OS did not differ significantly between patients with PR and those with PD based on PET/CT performed after the 1st cycle of chemotherapy (8.01 months vs 5.08 months, P=0.290). Metabolic response according to PERCIST and weight loss are independent factors predictive of OS. PET/CT performed after second cycle of chemotherapy may be the earliest predictor of treatment response in patients with advanced stage NSCLC.

The efficacy of diffusion weighted imaging for detection of acute pancreatitis and comparison of subgroups according to Balthazar classification.

BACKGROUND/AIMS: The aim of this study was to measure the apparent diffusion coefficient (ADC) values detected by diffusion-weighted imaging (DWI) in acute pancreatitis and compare them with computerized tomography (CT) findings in acute pancreatitis subgrouped by the Balthazar classification. MATERIALS AND METHODS: The study population included 50 patients diagnosed with clinical pancreatitis who were evaluated with both multidetector CT and magnetic resonance imaging (MRI) within 24 h of clinical presentation. We calculated pancreatic ADC values obtained from DWI (b=0 and b=1000 mm2/sn). These values were compared with their normal counterparts (n=24). The patients with acute pancreatitis were subgrouped according to the Balthazar classification. The mean ADC values were calculated in each subgroup, and they were compared with control ADC values. RESULTS: The mean pancreatic ADC values in acute pancreatitis (1.19×10(-3) mm2/sn ±0.32) was significantly lower than in the normal group (1.78×10(-3) mm2/sn ±0.29) (p<0.001). In the subgroup analysis, ADC values in each group were significantly lower than in the control group (p<0.001). In addition, as severity of pancreatitis increased according to the Balthazar classification, lower ADC values were noted. CONCLUSION: DWI with MRI and ADC values are helpful in the diagnosis of all subgroups of acute pancreatitis. Due to the lack of CT findings in grade A patients, DWI may be helpful in the diagnosis in this group as well.

The measurement of the prostatic resistive index is a reliable ultrasonographic tool to stratify symptoms of patients with benign prosthatic hyperplasia.

AIMS: To evaluate the correlation between lower urinary tract symptoms (LUTS) and the resistive index (RI) of the transitional (TZ) and peripheral zone (PZ) of the prostate and to assess the impact of alpha blocker (AB) treatment on RI changes. MATERIAL AND METHODS: TZ-RI and PZ-RI values of 60 patients with LUTS were calculated by using transrectal ultrasound (TRUS). Correlations between the severity of LUTS and RI values were established. Then, AB was given to moderately and severe symptomatic patients with LUTS. One month after AB usage, TRUS was applied to assess the impact of AB on the TZ-RI, PZ-RI and the international prostate symptom score (IPSS). RESULTS: Participants were divided into 3 groups as mild (n=14), moderate (n=25) and severe symptomatic (n=21) patients. Mean TZ-RI and PZ-RI were statistically different between the three groups (p<0.01). TZ-RI and PZ-RI were correlated with the severity of LUTS (r=0.757, p<0.01 and r=0.699, p<0.01 respectively). A decrease in symptom severity and RI values in moderate and severe symptomatic groups were significant after AB treatment. CONCLUSIONS: TZ-RI and PZ-RI values can reflect the severity of LUTS and the AB treatment decreases the TZ-RI and the PZ-RI. Measuring the RI of the prostate by TRUS can be a useful tool to stratify LUTS's severity.

Impact of transobturator tape procedure on female and their partner sexual function: it improves sexual function of couples.

AIM: To assess the impact of transobturator tape (TOT) procedure on female sexual function as well as their male partners. MATERIALS AND METHODS: Sexually active 28 women and their partners included for the study. Before TOT operation, the patients completed incontinence impact questionnaire (IIQ-7) and urogenital distress inventory (UDI-6) to assess the effect of surgery on incontinence. Also the women and their partners completed a self-administered questionnaire evaluating the female sexual function index (FSFI) and international index of erectile function (IIEF-5), respectively. Three months after TOT surgery, the women were asked to complete IIQ-7 and UDI-6 questionnaires to measure the success of TOT procedure. Also, FSFI and IIEF forms were completed by the women and their partners to assess TOT-related sexual life change. RESULTS: After TOT procedure, the mean value of IIQ-7 and UDI-6 questionnaires was lower than the mean scores that measured before treatment (p < 0.001). The mean values of FSFI scores before and 3 months after the operation were 23.15 ± 8.21 vs. 30.01 ± 9.13, respectively (p < 0.001). The mean values of IIEF before and 3 months after the operation were 50.14 ± 5.21 vs. 60.96 ± 10.03, respectively (p < 0.001). CONCLUSION: According to our results, both women and their partners' sexual life improved after TOT surgery for incontinence.

Multifoci Bone Tuberculosis and Lymphadenitis in Mediastinum Mimics Malignancy on FDG-PET/CT: A Case Report.

UNLABELLED: Positron Emission Tomography with 2-deoxy-[F-18]-fluoro-D-glucose (FDG-PET) has become a reliable diagnostic tool in clinical practice similar to Magnetic Resonance (MR) imaging and Computed Tomography (CT). FDG-PET has especially been used to differentiate malignant from benign lesions, and for staging and follow- up malignant tumors. However, FDG-PET has some pitfalls in cancer screening and FDG tracer accumulates at sites of infection and inflammation. Bone tuberculosis may be confused with malignant tumors of bone and its metastases, and can accumulate focally increased FDG in active period. We present a 60-year-old woman with lytic bone lesions and mediastinal hypermetabolic foci, initially suspected to be malignant by means of FDG-PET and the other imaging modalities; however, bone biopsy confirmed the diagnosis of bone tuberculosis. CONFLICT OF INTEREST: None declared.

Emergent stenting after uncomplicated ureteroscopy: evaluation of 23 patients.

OBJECTIVES: To evaluate the causes of emergent stent placement during the postoperative early period after uncomplicated ureteroscopy in 23 patients. METHODS: Of 276 uncomplicated ureteroscopy procedures performed for the management of ureteral calculi, double-J stent placement was necessary on an emergent basis in 23 patients because of intolerable colic pain and extreme patient discomfort. All stents were inserted within 24 hours after the procedure. RESULTS: Of the 23 patients requiring emergent stent placement, 14 were men and 9 were women. The stones had been located in the lower ureter in 11, mid-ureter in 6, and upper ureter in 6 patients. All patients had undergone an uncomplicated procedure with no complication evident either during or immediately after ureteroscopic stone management. The intraoperative findings for the 23 patients revealed extensive edema formation, unrecognized small stones embedded in the edematous ureteral wall, unpassed small fragments gathered at the orifice, obstructing blood clots, and kinking of the ureter. A retrospective evaluation of the operative CD recordings and radiographic findings clearly showed that a longer operative time, repeated access, management of a large stone, impacted calculi with ureteral wall edema, a mildly narrowed ureteral segment, ignored caliceal small calculi, and a recent history of urinary tract infection contributed to the need for postoperative intervention. CONCLUSIONS: Ureteral catheterization, at least in the form of overnight stent placement, might prevent the formation of transient ureteral obstruction, with resultant postoperative patient discomfort and colic pain evident in selected cases.

The evaluation of saphenofemoral insufficiency in primary adult varicocele.

The aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele. A total of 70 patients with the primary diagnosis of varicocele were included into the study. A total of 30 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by palpation and observation of each spermatic cord in standing position before and during a valsalva maneuver. Additionally, scrotal Doppler and lower extremity venous Doppler ultrasonography were performed. Patients who were with spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for saphenofemoral junction insufficiency. Thirty-six (51.35%) patients had insufficiency in saphenofemoral junction in the study group (6 [8.5%] bilateral, 30 [42.85%] unilateral) whereas 8 (26.6%) had insufficiency in the control group (2 [6.6%] bilateral, 6 [20%] unilateral insufficiency). The patients with primary varicocele had a statistically significant (P = .02) higher rate of venous insufficiency in their saphenofemoral junctions when compared with the control group. In the present study, the rate of saphenofemoral insufficiency has been found to be statistically higher in patients with primary varicocele compared with healthy men. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from saphenofemoral junction insufficiency.

Diagnostic value of renal parenchymal density difference on unenhanced helical computed tomography scan in acutely obstructing ureteral stone disease.

OBJECTIVES: To evaluate the diagnostic value of the renal parenchymal density difference, detected using unenhanced helical computed tomography, as a secondary sign of acute obstruction due to a ureteral stone. METHODS: Fifty-five patients with acute flank pain, in whom a ureteral stone was detected on the symptomatic side using unenhanced helical computed tomography, and 22 control subjects with no urinary stone disease were included in this prospective study. Computed tomography was performed, starting from the upper poles of the kidneys down to the base of the urinary bladder. The renal parenchymal density was measured in the upper, middle, and lower portions of each kidney, and a mean value was calculated. The difference between the mean values of the two kidneys was used to predict the presence of an acutely obstructing ureteral stone. RESULTS: In 49 patients with a ureteral stone (89.1%), the difference between the parenchymal densities of the obstructed and nonobstructed kidneys was 5 Hounsfield units (HU) or greater and was lower on the obstructed side. In the remaining 6 patients (10.9%), the density difference was less than 5 HU but was still lower on the obstructed side. All subjects in the control group had a density difference of less than 5 HU. A renal parenchymal density difference of 5.0 HU or greater had 89.1% sensitivity, 100% specificity, 100% positive predictive value, 85.7% negative predictive value, and 93.4% accuracy in predicting the presence of an acute obstructing ureteral stone. CONCLUSIONS: These data suggest that the renal parenchymal density difference may be a valuable secondary sign of acute obstructing ureteral stone disease.

Transient partial amnesia complicating cardiac and peripheral arteriography with nonionic contrast medium.

The aim of this study was to present a case of disruption of the blood-brain barrier during the coronary and lower extremity angiographies with radiological and clinical findings. This condition was secondary to intraarterial use of a nonionic, monomeric contrast medium. A total of 450 cc contrast media was used. Computed tomography examination showed contrast enhancement of the right occipital and frontoparietal cortical regions, which returned to normal one day after. The patient also fully recovered from the neurological symptoms within 24 h. We discussed the possible mechanism for blood-brain barrier disruption in this case.