Audiovestibular disturbance in patients with systemic lupus erythematosus.

OBJECTIVE: The aim of this study was to evaluate the audiovestibular disturbance in patients with systemic lupus erythematosus (SLE). STUDY DESIGN AND SETTING: Twenty-eight patients with SLE and 28 healthy control subjects were included. Pure-tone audiometry, impedance audiometry, and electronystagmography (ENG) were used for baseline evaluation. Laboratory tests were carried out. Cranial and brain stem magnetic resonance imagings (MRI) were undertaken. RESULTS: Nineteen (67%) patients reported audiovestibular symptoms. Sensorineural hearing loss was found in 6 (21%) patients. Abnormal results on ENG were significantly higher (50%) (P < 0.01). Abnormal laboratory data were available from 26 patients (P < 0.05). MRI did not show any pathosis. CONCLUSION: The audiovestibular disturbances in SLE are more prevalent than previously recognized. Although no cause and effect relationship can be established by this type of study, it appears that a relationship exists. SIGNIFICANCE: Audiologic research should be directed toward routine, pure tone audiometry, and ENG assessment for patients with SLE to enable crucial treatment.     

Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA

BackgroundThe external obturator footprint in the trochanteric fossa has been suggested as a potential landmark for stem depth in direct anterior THA. Its upper border can be visualized during surgical exposure of the femur. A recent study reported that the height of the tendon has little variability (6.4 ± 1.4 mm) as measured on CT scans and that the trochanteric fossa is consistently visible on conventional pelvic radiographs. However, it is unclear where exactly the footprint of this tendon should be templated during preoperative planning so that it can be useful intraoperatively.Questions/purposesIn this study, we sought: (1) to provide instructions on exactly where to template the external obturator footprint on a preoperative planning radiograph, and (2) to confirm the small variability in height of the external obturator footprint found on CT scans in a cadaver study.MethodsTwo-dimensional (2-D) and three-dimensional (3-D) imaging was used to map the anatomy of the external obturator footprint. This dual approach was chosen because of their complementarity; conventional 2-D radiographs translate to clinical practice but 3-D navigation-based digitalization combined with CT allows for a better understanding of the cortical lines that comprise the outline of the trochanteric fossa. In 12 (four males, mean age 80 years, range 69 to 88) formalin-treated cadaveric lower extremities including the pelvis, the external obturator tendon was dissected, and the top and bottom end of its footprint marked with two small needles, and calibrated radiographs were taken. For another five (three males, mean age 75.7 years, range 61 to 91) fresh-frozen cadaveric lower extremities, including femoral reflective marker frames, CT scans were obtained and the exact location of the external obturator footprint was recorded using 3-D navigation-based digitalization. Qualitative analysis of both imaging modalities was used to develop instructions on where the external obturator footprint should be templated on a preoperative planning radiograph. Quantitative analysis of the dimensions of the external obturator footprint was performed.ResultsThe lowest point of the external obturator footprint was consistently found (± 1 mm) at the intersection of the vertical line comprised of the lateral wall of the trochanteric fossa and the oblique line formed by the intertrochanteric crest and therefore allows templating of this structure on the preoperative planning radiograph. The median (range) height of the footprint measured 6.4 mm and demonstrated small variability (4.7 to 7.6).ConclusionsWe suggest templating a 6.4-mm circle with its bottom on the intersection described above.Clinical RelevanceThe distance between the templated shoulder of the stem and the top of the circle can be used intraoperatively for guidance. Discrepancy should lead to re-evaluation of stem depth and leg length. Future work will investigate the usability, validity, and reliability of the proposed methodology in daily clinical practice.     

Laparoscopic Radical Prostatectomy Alone or With Laparoscopic Herniorrhaphy

Background and Objectives:

Prostate cancer and inguinal hernia are common health issues in men aged more than 50 years. Recently, more data are accumulating that laparoscopic radical prostatectomy (LRP) and laparoscopic inguinal hernia repair (LIHR) can be performed in the same operation. The purpose of this study was to compare patients who underwent simultaneous extraperitoneal LRP (E-LRP) and LIHR with control patients who underwent only E-LRP in a matched-pairs design.

Methods:

Medical records of 215 patients were evaluated, and 20 patients who underwent E-LRP+LIHR were compared with 40 patients who underwent only E-LRP in a matched-pairs analysis. Preoperative clinical parameters (age, body mass index, prostate-specific antigen, clinical stage, Gleason score of the prostate biopsy, and prostate volume) and operative data (operation time, duration of catheterization, length of hospital stay, estimated blood loss, time to perform the anastomosis and its quality, and the percentage of patients with bilateral lymphadenectomy) were evaluated, as well as postoperative parameters (pathological stage, Gleason score, specimen weight, follow-up duration, biochemical recurrence, complication rates, and duration of postoperative analgesic treatment).

Results:

No statistically significant differences were found in the preoperative and operative parameters between the 2 study groups. Pathological parameters and the follow-up period and complication rates were similar between the 2 groups.

Conclusion:

Performing LIHR and E-LRP during the same operation is safe and feasible in the treatment of patients with prostate cancer and inguinal hernia.     

The effect of Ramadan fasting on kidney function in patients with chronic kidney disease

International Urology and Nephrology - Because of the increase in globalization, clinicians all over the world are confronted the questions about safety of Ramadan fasting. However, there is no...     

Permanent first molar extraction in adolescents and young adults and its effect on the development of third molar

Objectives

The aim of the present study was to determine the prevalence of permanent first molar (P1M) extraction among Turkish adolescents and young adult subpopulation, and to investigate the effects of P1M extraction on development of the third molars (3Ms) in the same quadrant.

Materials and methods

A retrospective study including 2,925 panoramic radiographs (PRs) taken from patients (aged 13–20 years) who were examined to identify cases of had at least one maxillary or mandibular P1Ms extracted was performed. Additionally, 294 PRs with the maxillary or mandibular unilateral loss of a P1M were used to assess the developmental grades of the 3Ms. Statistical analyses were performed by means of parametric tests after performing a Shapiro–Wilks normality test to the data.

Result

A total of 945 patients (32.3 %) presented with at least one P1M extraction with no gender difference (P?=?0.297). There were more cases of mandibular P1Ms extracted (784 patients, 1,066 teeth) than maxillary P1Ms extracted (441 patients, 549 teeth) (P?<?0.001). The development of the 3Ms on the extraction side, in the both maxilla and mandible, was significantly accelerated when compared with the contralateral teeth (P?=?0.000, P?=?0.000, respectively). No statistically significant differences were found in the differences in the developmental of the 3Ms between the maxilla and mandible (P?=?0.718).

Conclusions

High prevalence of P1Ms extraction among Turkish adolescents and young adults shows a need for targeted dental actions, including prevention and treatment. The development of the 3Ms on the extraction side, in the both maxilla and mandible, was significantly accelerated.

Clinical relevance

To date, no information about prevalence of P1Ms extraction among Turkish adolescents and young adults is documented. In addition, the present study has a larger population and complementary information about 3Ms development than previous studies.     

Left Thyroid Lobe Hemiagenesis with Hyperthyroidism: Report of a Case

Thyroidal hemiagenesis resulting from the failure of development of one thyroidal bud to develop accounts for fewer than 0.1% of thyroidal disorders necessitating surgery. This rare congenital anomaly usually occurs on the left side. Any nonfunctional lobe detected by scintigraphy needs to be evaluated further by ultrasonography, because thyroid hemiagenesis is associated with varying degrees of morbidity when it coexists with other anomalies requiring surgical intervention. We report the case of a 38-year-old woman with preoperatively diagnosed thyroidal hemiagenesis, who underwent surgery in our clinic. We review the literature in relation to this case, and discuss the problems and complications associated with this unusual congenital anomaly.     

Target volume uncertainty and a method to visualize its effect on the target dose prescription

PURPOSE: To consider the uncertainty in the construction of target boundaries for optimization, and to demonstrate how the principles of mathematical programming can be applied to determine and display the effect on the tumor dose of making small changes to the target boundary. METHODS: The effect on the achievable target dose of making successive small shifts to the target boundary within its range of uncertainty was found by constructing a mixed-integer linear program that automated the placement of the beam angles using the initial target volume. RESULTS: The method was demonstrated using contours taken from a nasopharynx case, with dose limits placed on surrounding structures. In the illustrated case, enlarging the target anteriorly to provide greater assurance of disease coverage did not force a sacrifice in the minimum or mean tumor doses. However, enlarging the margin posteriorly, near a critical structure, dramatically changed the minimum, mean, and maximum tumor doses. CONCLUSION: Tradeoffs between the position of the target boundary and the minimum target dose can be developed using mixed-integer programming, and the results projected as a guide to contouring and plan selection.     

Consistent reconstruction of 4D fetal heart ultrasound images to cope with fetal motion

Purpose

4D ultrasound imaging of the fetal heart relies on reconstructions from B-mode images. In the presence of fetal motion, current approaches suffer from artifacts, which are unrecoverable for single sweeps.

Methods

We propose to use many sweeps and exploit the resulting redundancy to automatically recover from motion by reconstructing a 4D image which is consistent in phase, space, and time. An interactive visualization framework to view animated ultrasound slices from 4D reconstructions on arbitrary planes was developed using a magnetically tracked mock probe.

Results

We first quantified the performance of 10 4D reconstruction formulations on simulated data. Reconstructions of 14 in vivo sequences by a baseline, the current state-of-the-art, and the proposed approach were then visually ranked with respect to temporal quality on orthogonal views. Rankings from 5 observers showed that the proposed 4D reconstruction approach significantly improves temporal image quality in comparison with the baseline. The 4D reconstructions of the baseline and the proposed methods were then inspected interactively for accessibility to clinically important views and rated for their clinical usefulness by an ultrasound specialist in obstetrics and gynecology. The reconstructions by the proposed method were rated as ‘very useful’ in 71% and were statistically significantly more useful than the baseline reconstructions.

Conclusions

Multi-sweep fetal heart ultrasound acquisitions in combination with consistent 4D image reconstruction improves quality as well as clinical usefulness of the resulting 4D images in the presence of fetal motion.

     

Corneal biomechanical properties in eyes with no previous surgery, with previous penetrating keratoplasty and with deep anterior lamellar keratoplasty

Purpose

To compare the biomechanical properties of the cornea in eyes with no previous surgery, with keratoconus with previous penetrating keratoplasty (PK) and with keratoconus with previous deep anterior lamellar keratoplasty (DALK) using the Reichert Ocular Response Analyzer (ORA).

Methods

One hundred twenty eyes of 120 patients were included in this prospective comparative study. Forty eyes were with no previous ocular surgery (group 1), 40 eyes were with previous PK for keratoconus (group 2), and 40 eyes were with previous DALK for keratoconus (group 3). Corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured with ORA.

Results

The CH and CRF values in group 2 were significantly lower than in group 1 and group 3 (p = 0.001). The CH and CRF values were similar in group 1 and group 3. There was no statistically significant difference between group 1 and 3.

Conclusion

Although the post-PK keratoconus cornea has weaker biomechanical properties, post-DALK keratoconus cornea is similar to normal cornea. A cornea weakened by keratoconus can be strengthened with lamellar keratoplasty.