Comparison of direct radionuclide cystography and voiding direct cystography in the detection of vesicoureteral reflux

Purpose: The aim of this study is to compare the results of direct radionuclide cystography (DRNC) and voiding cystourethrography (VCUG) in a group of children with a high suspicion of vesicoureteral reflux (VUR).Methods: For this purpose, 25 children were studied with both VCUG and DRNC. Among 50 ureter units able to be compared 39 ureter units did not show any VUR on either study. Eleven ureter units (10 children) had VUR either on one study or on both (VCUG and DRNC). In the children who had VUR on either study, a dimercaptosuccinic acid scintigraphy (DMSA) was performed to determine their cortical function.Results: We identified the following four patterns: 1) Five ureter units (five children) read positive on DRNC who were negative on VCUG and four of these children had positive findings on DMSA; 2) Four ureter units (four children) read positive on VCUG who were negative on DRNC, and two of them had positive findings on DMSA; 3) Two ureters (one child) read positive in both studies and also had abnormal DMSA findings; 4) Thirtynine ureter units read as negative on both studies.Conclusion: Although the results of these two methods did not show a significant difference, DRNC offers a high sensitivity in the younger age group whereas VCUG seems to be more sensitive in the older age group. DRNC also offers continuous recording during the study, ease of assessment and lower radiation dose to the gonads, which makes it a preferable method for the initial diagnosis and follow-up of VUR.     

Evaluation of Cardiac Functions of Patients with Benign Joint Hypermobility Syndrome

We sought to investigate whether echocardiography with tissue Doppler imaging identifies myocardial dysfunction in children with benign joint hypermobility syndrome (BJHS). This cross-sectional study enrolled 75 children with BJHS and 70 healthy children. We performed detailed echocardiography in individuals with BJHS without inherited connective tissue disorders. Any congenital or acquired cardiac disease was excluded by clinical and echocardiographic examination. Both groups were similar in terms of age, sex, and body mass index. The diameter of the aortic annulus and sinus valsalva were wider in patients with BJHS. There was no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the two groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Deceleration time of early mitral inflow was prolonged in patients with BJHS. Mitral and tricuspid annulus Ea velocity were significantly lower in children with BJHS. Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in patients with BJHS than in the control group. The E/Ea ratio was greater in patients with BJHS than in the control group. Isovolumic relaxation time and right-ventricular (RV) and left-ventricular (LV) myocardial performance indices (MPIs) were greater in patients with BJHS. This study showed the diastolic dysfunction in patients with BJHS. In addition, we detected increased LV and RV MPI. We believe that BJHS may affect proteins of the myocardial cytoskeleton and extracellular matrix.     

Diagnosis and treatment of ejaculatory duct obstruction in male infertility

OBJECTIVE: To discuss the diagnosis and treatment of ejaculatory duct obstruction in male infertility. PATIENTS AND METHODS: Twenty-four males were treated for ejaculatory duct obstruction between 1994 and 1998 in our clinic. Patients' age varied between 20 and 40 (mean=29). Ejaculatory duct obstruction was considered in patients with low to normal ejaculate volume, azoospermia or oligospermia, decreased motility, normal serum gonadotropin and testosterone levels, absent or low fructose in the ejaculate and evidence of obstruction on transrectal ultrasonography. The definitive diagnosis was made by the absence of efflux of methylene blue injected through the vas during cytoscopy. All the patients were subjected to transurethral resection of ejaculatory ducts and spermograms before and 3 months after resection were compared. RESULTS: Before transurethral resection mean sperm count was 1.66x10(6)/ml compared to 25.4x10(6)/ml postoperatively. The difference was statistically significant (p=0.001). After the operation, 58.3% of the cases had improvement in sperm motility, and 62.5% had increased ejaculate volume. No significant complications occurred, and in only 1 (4.17%) patient, there was persistent hematuria. After a mean follow-up period of 9 (6-18) months, 6 (25%) pregnancies were noted. CONCLUSION: Although transurethral resection is an effective method for the treatment of ejaculatory duct obstruction, the pregnancy rate is low, which could be related to the hazardous effects of urinary reflux into ejaculatory ducts or functional abnormalities of seminal vesicles.     

Regional variations in small intestinal submucosa evoke differences in inflammation with subsequent impact on tissue regeneration in the rat bladder augmentation model

OBJECTIVE

To examine the histological differences in the inflammatory response and regenerative outcomes of distal vs proximal porcine small intestinal submucosa (SIS) grafts in the rat bladder, as SIS from distal small intestine yields reliable and reproducible bladder regeneration, while SIS from proximal portions of small intestine does not provide similar results.

MATERIALS AND METHODS

In all, 30 Sprague‐Dawley rats underwent hemi‐cystectomy followed by anastomosis of a bladder patch of SIS prepared from either distal or proximal small intestine. After bladder harvest, immunohistochemistry was used to quantify mast cells, eosinophils, macrophages, and neutrophils (PMNs). Total cell count per unit area was compared across the time course in univariate and logistic regression modelling.

RESULTS

There were more eosinophils and mast cells in proximal SIS grafts, while there were more macrophages and PMNs in distal SIS grafts (all P < 0.05). Trichrome analysis showed increased collagen deposition in proximal SIS grafts and little smooth muscle regeneration. There was also significant graft contracture in proximal SIS grafts compared with distal SIS grafts (P < 0.05).

CONCLUSIONS

We conclude that the location of SIS origin may evoke different inflammatory responses, which results in altered bladder tissue regeneration.     

Is D2-40 a useful marker for distinguishing malignant mesothelioma from pulmonary adenocarcinoma and benign mesothelial proliferations?

Since pulmonary adenocarcinomas, malignant mesotheliomas (MM), and sometimes benign mesothelial proliferations show a great histomorphological resemblance to each other, an immunohistochemical panel is usually necessary for differential diagnosis. D2-40 is an available monoclonal antibody, which is already in use as a lymphatic endothelial marker. It has also been suggested to be useful in identifying the mesothelial differentiation. The aim of this study is to compare D2-40 immunostaining in MM, pulmonary adenocarcinoma, and benign mesothelial proliferations. In this retrospective study, D2-40 immunostaining was investigated in 37 cases of MM, 36 cases of pulmonary adenocarcinoma, and 31 cases of benign mesothelial proliferation. The diagnosis of MM had previously been confirmed by a panel including calretinin, CK5/6, and CEA. Predominantly membranous immunoreactivity was observed in 51% of MMs and in 55% of benign mesothelial proliferations. All the 36 pulmonary adenocarcinomas were negative. These results were statistically significant (p<0.001). We believe that D2-40 may be helpful in the differential diagnosis of MM from pleural involvement of pulmonary adenocarcinoma.     

The efficacy of technetium-99m ciprofloxacin (Infecton) imaging in suspected orthopaedic infection: a comparison with sequential bone/gallium imaging

Technetium-99m ciprofloxacin (Infecton) has recently become established as a new radiopharmaceutical for the imaging of infection. This study was performed to determine the value of Infecton imaging in demonstrating orthopaedic infection and to compare the results with bone/gallium imaging. Twenty-two patients (12 female, 10 male; mean age 51.7+/-16.8 years) with suspected orthopaedic infective conditions were included in the study. The patients underwent three scintigraphic studies in the following sequence: 740 MBq 99mTc-methylene diphosphonate (MDP) three-phase bone scintigraphy; at least 2 days later, 370 MBq Infecton scan at 1-4 h; and finally, 185 MBq gallium-67 scintigraphy. 67Ga imaging could not be performed on four patients. All images were blindly interpreted by two independent observers. The final diagnosis was made by consensus when the readings were different. Interpretation of the early and late Infecton images was made separately, with visual findings being classified according to a four-grade scale (0, +, ++, +++). Images graded 0 and +, and also those regions which showed a decrease in uptake grade on late images as compared with early images, were classified as negative for infection; grades ++ and +++ were classified as positive. Bone/gallium images were considered positive when the images were spatially incongruent or when gallium uptake was more intense than that of 99mTc-MDP. The diagnosis was confirmed by intraoperative microbiological or histological findings, or by the presence of gross purulence. The sensitivity of Infecton imaging was found to be 85%, the specificity 92% and the accuracy 88%, as compared to figures of 78%, 100% and 90%, respectively, for bone/gallium imaging. Although the two modalities showed a similar clinical yield, the easy availability of Infecton and the short investigation time make Infecton imaging the better option for the detection of orthopaedic infection.