MR imaging and electrophysiological evaluation in carpal tunnel syndrome

The objective of this study was to compare the MRI findings of wrists in patients diagnosed with CTS with those of the healthy controls, and to evaluate the correlation between the MRI differences and the electrophysiological findings in the patient group. This study involved 55 wrists, 30 of which were clinically and electrophysiologically diagnosed with CTS and 25 healthy controls. These 55 wrists were evaluated electrophysiologically, and in terms of median nerve diameter, ratio of median nerve diameter at psiform bone level to distal radio-ulnar joint level, the flexor retinaculum bulging ratio and the median nerve intensity by MRI. When the patient group, which were clinically and electrophysiologically diagnosed with CTS, and the healthy control group were compared, a significant difference (p < 0.001) was observed between the two in terms of median nerve diameters (at psiform bone level: 8.47 +/- 1.41mm and 2.91 +/- 1.01 mm, distal radio-ulnar joint level: 4.04 +/- 1.06 mm and 2.42 +/- 0.95 mm), ratio of median nerve diameter at psiform bone level to distal radio-ulnar joint level (2.17 +/- 0.54 and 1.25 +/- 0.12), their flexor retinaculum bulging ratios (26.21 +/- 5.98% and 7.27 +/- 4.53%) and their median nerve intensities. In the patient group, no significant correlation between MRI and the electrophysiological findings was found (p > 0.05). According to the data obtained from the study, we believe that the MRI examination of structural changes that occur in the carpal tunnel, neighboring structures and the median nerve would be useful in the diagnosis of CTS, especially in cases with suspected clinical and electrophysiological diagnosis.     

Impact of p53 and Ki-67 in predicting recurrence and progression of superficial (pTa and pT1) urothelial cell carcinomas of urinary bladder

In predicting the aggressive behavior of bladder tumors, the histopathological characteristics of grade and invasive stage are of principal importance. However, for predicting tumor recurrence and progression, these are sufficient only to a limited extent, particularly in the case of superficial (pTa and pT1) urothelial cell carcinomas. New prognostic factors are therefore needed to avoid either insufficient or excessive treatment. In this retrospective study, we investigated the prognostic value of the p53 and Ki-67 immunoreactivity indices. The present study included 118 superficial urinary bladder tumors consisting of 58 recurrent and 60 non-recurrent cases. Twenty of the recurrent tumors progressed into a higher grade and/or invasive stage. Paraffin immunohistochemical analysis was carried out using anti-p53 and anti-Ki-67 antibodies on the initial tumor tissues. We concluded that there is a highly significant relationship between the p53 and Ki-67 immunoreactivities and the histological grade and pathological stage of the tumors (P < 0.0001). We observed a significant relationship between the presence of recurrence and progression and the p53 immunoreactivity index (P < 0.01 and P = 0.017, respectively) and Ki-67 immunoreactivity index (P < 0.0001 and P = 0.046, respectively). Positivity for p53 and Ki-67 can demonstrate the risk of recurrence (p53: sensitivity = 76%, specificity = 58%; Ki-67: sensitivity = 86%, specificity = 48%) and progression (p53: sensitivity = 80%, specificity = 46%; Ki-67: sensitivity = 85%, specificity = 36%; ). We believe that both of these immunohistochemical markers can be considered valuable in addition to classical histopathological prognostic parameters for predicting recurrence and progression risks.     

Analysis of premature ejaculation in hemodialysis patients using the International Index of Erectile Function

OBJECTIVE: We have conducted the following study to determine the prevalence of premature ejaculation in male hemodialysis patients and its impact on sexual quality of life. METHODS: This study was performed in hemodialysis facilities. Patients were asked to complete the International Index of Erectile Function (IIEF) questionnaire and also to report their ejaculation status. 98 male hemodialysis patients with normal potency were included in the study. The IIEF domain scores were determined, and the overall and relationship satisfaction rates were calculated for the patients with and without premature ejaculation separately. RESULTS: The mean age was 45.9 (range 30-69) years and the duration of hemodialysis was 37.8 (range 7-84) months. Premature ejaculation was determined in 31 (31.6%) patients. Patients with premature ejaculation experienced significantly lower overall satisfaction scores. Items of satisfaction with overall sexual life and sexual relationship with partner were responded to with a score of 'moderately satisfied' or 'very satisfied' in 47 and 53% of patients with premature ejaculation and 84 and 86% of patients without premature ejaculation, respectively. CONCLUSIONS: Premature ejaculation is a prevalent disorder in hemodialysis patients and seems to affect the satisfaction rate and sexual quality of life of these patients.     

Concealed penis: rare complication of circumcision

A man presented with a concealed penis which developed after circumcision. In addition to anatomic variations in penile skin attachment and obesity, circumcision is an iatrogenic cause in the etiology of a concealed penis. Although it is a frequent and simple operation, it may lead to uncommon complications due to a lack of experience and poor technique.     

The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications

Introduction: Artificial liver support systems represent a potential useful option for the treatment of liver failure. The outcomes of patients treated with the fractionated plasma separation and adsorption (FPSA) system are presented. Patients and methods: FPSA was performed 85 times for 27 patients (median 3 treatments/patient) with liver failure [85.2% acute liver failure (ALF) and 14.8% acute‐on‐chronic liver failure] using the Prometheus 4008H (Fresenius Medical Care) unit. Citrate was used for anticoagulation. A variety of clinical and biochemical parameters were assessed. Comparisons between pretreatment and post‐treatment data were performed using paired t‐test. Results: The 85 sessions had a mean duration of 6 h. There were significant decreases in total bilirubin (13.18 ± 9.46 mg/dL vs. 9.76 ± 7.05 mg/dL; P < 0.0001), ammonia (167.6 ± 75 mg/dL vs. 120 ± 43.8 mg/dL; P < 0.0001), blood urea nitrogen (BUN; 12.55 ± 13.03 mg/dL vs. 8.18 ± 8.15 mg/dL; P < 0.0001), creatinine (0.54 ± 0.47 mg/dL vs. 0.46 ± 0.37 mg/dL; P = 0.0022) levels, and in pH (7.48 ± 0.05 vs. 7.44 ± 0.08; P = 0.0045). Four patients (14.8%) received liver transplantation after the treatments; in nine patients, transplantation was not necessary anymore (33%); the remaining 14 patients did not receive a transplantation because they were either not appropriate candidates or no organ was available. Overall survival was 48.1% (4 transplanted and 9 treated patients). No hematological complications related to FPSA were observed. Conclusions: FPSA system is a safe and effective detoxification method for patients with liver dysfunction, including ALF. The system is useful as a symptomatic treatment before liver transplantation; in up to 1/3 of the cases, it can even be used as a sole method of treatment. J. Clin. Apheresis 25:195–201, 2010. © 2010 Wiley‐Liss, Inc.     

Intraabdominal hematoma following orchiectomy: a potential pitfall in using CT for staging of testicular cancer

Internal bleeding in patients undergoing orchiectomy for a malignant testicular tumor can cause a dissecting hematoma in the retroperitoneum. This mass may have the clinical appearance of an iliac fossa mass and may simulate metastasis on computed tomography (CT). This condition was seen in four of 486 orchiectomy patients who underwent postoperative staging with CT. One patient is described in detail.     

Detection of extended spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae.

The presence of extended spectrum beta-lactamases (ESbetaLs) in 129 Escherichia coli and 128 Klebsiella pneumoniae strains was determined with the E test. beta-lactamases were detected in 66 (51.2%) of E.coli and 107 (83.6%) of K. pneumoniae by the nitrocefin disk method. Putative ESbetaL production was observed in 15.5% of E. coli and 55.5% of K. pneumoniae with the E test. Among the putative ESbetaL-producer strains 11 were found to be susceptible to ceftizoxime, 6 to ceftazidime, 2 to ceftriaxone, cefotaxime and aztreonam, and one to cefoperazone according to the disk diffusion test. All putative ESbetaL-producers were resistant to cefodizime, thus it may be a good indicator of the presence of mainly TEM-type ESbetaL. The E test was also found to be practicable for the detection of ESbetaLs in clinical laboratory. Further studies are needed to clarify whether ESbetaL can be identified reliably in species that, in addition to plasmid mediated ESbetaL production, chromosomally encoded AmpC beta-lactamases and other class A ESbetaLs by disk diffusion test.