Treatment of renal stones with flexible ureteroscopy in preschool age children

The aim of the study is to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in preschool age (<7 years) children. From September 2005 to May 2013, a total of 65 children (31 boys and 34 girls) with 72 renal stones were treated using RIRS. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. In the presence of residual calculi >4 mm, a second-stage RIRS was performed. The pre-operative, operative and post-operative data of the patients were retrospectively analyzed. A total of 65 patients with a mean age of 4.31 ± 1.99 years (6 months–7 years) were included in the present study. The mean stone size was 14.66 ± 6.12 mm (7–30 mm). The mean operative time was 46.47 ± 18.27 min. In 5 (7.69 %) patients, the initial procedure failed to reach the renal collecting system and ended with the insertion of a pigtail stent. The stone-free rates were 83.07 and 92.3 % after the first and second procedures, respectively. Complications were observed in 18 (27.7 %) patients and classified according to the Clavien system. Post-operative hematuria (Clavien I) occurred in 6 (9.2 %) patients, post-operative urinary tract infection with fever (Clavien II) was observed in 10 (15.4 %) patients, and ureteral wall injury (Clavien III) was noted in 2 (3 %) patients. RIRS is an effective and safe procedure that can be used to manage renal stones in preschool age children.     

A scale-development study: Exploration of intensive-care nurses’ attitudes towards futile treatments

The study was conducted to determine the validity and reliability of the tool used to assess nurses’ attitudes towards futility, and to explore intensive-care nurses’ attitudes towards futility. Principal components analysis revealed that 18item scale was made up of four subdimensions that assess Identifying(beliefs), Decision-Making, Ethical Principles and Law, and Dilemma and Responsibilities related to futile treatments. The internal consistency of the scale was in the acceptable range, with a total Cronbach’s alpha value of 0.72. Overall the results of study suggest that scale can be used as a valid and reliable assessment tool to assess nurses’ attitudes towards futility.     

Pulse wave analysis of the aortic pressure waveform in patients with vasovagal syncope

Vascular reflex mechanisms contribute to vasovagal syncope. However, the alterations in central haemodynamics in patients with vasovagal syncope are unknown. 30 consecutive patients (36.5 ± 15 years, 14 females) with recurrent vasovagal syncope (VVS) and a positive tilt table test were compared to 39 age- and sex-matched controls (36.9 ± 16 years, 15 females) with a negative tilt table result and no history of syncope. Central aortic pressure parameters including augmentation index and central pulse pressure as markers of aortic stiffness were generated non-invasively by applanation tonometry of the radial artery and use of a validated mathematical transfer function. No difference in aortic augmentation index was observed between groups. (VVS 9 ± 2.6 vs. Control 11 ± 2.4, p = 0.8). However, in patients with vasovagal syncope the aortic pressure waveform significantly differed from healthy controls. A prolonged time to the peak of aortic pressure wave (aortic T2) was observed in patients with vasovagal syncope (226 ± 24 vs. 208 ± 21 ms, p = 0.001). Furthermore time to the first shoulder of the aortic pressure wave (aortic T1) was slightly shorter compared to healthy controls, but did not reach statistical significance (106 ± 22 vs. 110 ± 12 ms, p = 0.33). Patients with vasovagal syncope have an altered aortic pressure waveform at rest, but no signs of elevated aortic stiffness. The underlying mechanisms for these findings may potentially result from a complex imbalance of the autonomic nervous system with a continuous deregulation of the sympathetic and parasympathetic reflex arcs.     

Typhoid fever as a rare cause of hepatic, splenic, and bone marrow granulomas

During the course of typhoid fever, the usual histologic finding of the liver is "nonspecific reactive hepatitis." Hepatic granuloma (HG) is a rare complication of typhoid fever. We present two cases of typhoid fever with HG and review the relevant literature. Case 1 (a 53-year-old female) was found to have both hepatic and splenic granulomas. This is the first case of typhoid fever with splenic granulomas in the English language literature. Case 2 (a 66-year-old male) developed granulomas in the bone marrow in addition to HG. It should be considered that typhoid fever may lead to granulomas in several organs.     

Evaluation of silicosis in ceramic workers

This study is aimed to evaluate the incidence of silicosis and the relation of it with personal and work-related factors among workers exposed to silica in ceramic factory. Workers were evaluated by respiratory symptoms, physical examination, pulmonary function and radiological findings. Occupational and Enviromental Pulmonary Disease Evaluation Questionnaire of the Turkish Thoracic Society Enviromental and Occupational Pulmonary Diseases Working Group was used. 365 of 626 workers had exposure to silica and the rest 261 were concerned as control group. There was no difference between mean age, duration of work and smoking pack year among the groups (p> 0.05). Cough and sputum rates were higher in silicosis group FEV1 and FVC values were lower in silica group but this was not statistically significant. When the two subgroups of silica group (the workers in high dust concentration and the ones in low concentration) were compared, the high concentrated group had significantly more sputum but the other symptoms and pulmonary functional parameters were not different significantly. 24 workers had parenchymal densities adjusted with pneumoconiosis. The workers with the pneumoconistic finding, had a higher mean age and longer duration of work. As a conclusion, ceramic industry has risk for silicosis. And the risk increase by time and age.     

Treatment in patients with low traumatic pneumothorax ratio

Thoracostomy tube placement (TT) is currently one of the most important treatment modalities used in traumatic pneumothorax patients. In patients with low pneumothorax ratio (percentage), both follow-up without surgery and employing intervention when indicated may be appropriate choice. We presented the outcome of patients with low traumatic pneumothorax ratio treated by follow up without surgical intervention in our clinic. During the period from January 2000 until January 2002, 108 patients who were treated and followed with low percentage traumatic pneumothorax in Ankara Numune Hospital Thoracic Surgery Clinic were allocated into three groups due to blunt trauma of the thorax, penetrating-cutting instrument injury and gunshot injury. All patients were admitted to the clinic with the purpose of observation without surgical intervention and chest roentgenograms were taken at the sixth and twelfth hours and daily thereafter. TT was performed for 46 (43%) patients whose pneumothorax ratio increased during the observation period. TT was more frequent in patients with 20% percentage pneumothorax (69%) as well as with two or more fractured ribs (69%). Follow-up without surgical intervention may one of the appropriate modes of treatment in patients who have minimal traumatic pneumothorax.     

Development of microsatellite markers for the critically endangered frog Telmatobufo bullocki and cross-species amplification in two related species

Fifteen microsatellite markers were developed for Telmatobufo bullocki, a critically endangered frog species from Chile. Genetic diversity that was assessed in 29 individuals from one location showed 3–19 alleles per locus. These markers were then tested for cross-species amplification in two related and similarly threatened species. The markers will be used in genetic studies aiding the management and conservation of T. bullocki.     

Effect of Topical Tetracycline on Seroma Formation in the Lichtenstein Technique: A Prospective Randomized Study

We sought to investigate whether application of topical tetracycline has a limiting effect on seroma formation in patients undergoing hernia repair using a polypropylene mesh. This study was conducted in 96 patients undergoing an elective groin hernia repair. Patients were randomized and divided into 2 groups. After the graft was placed, and before external oblique muscle aponeurosis was closed, 5 mL tetracycline was administered on the graft in the tetracycline group (tetra group, n = 50), and 5 mL isotonic saline was administered in the control group (n = 46) without putting in a drain. Seroma checks via surface ultrasonography were done. Seroma amounts measured on the first day were significantly higher in the tetra group (P = 0.04). There were no significant differences regarding seroma measurements on the seventh day or in the first and second months. Topical tetracycline application has no limiting effect on seroma formation after a groin hernia operation.Key words: Lichtenstein technique, Polypropylene mesh, Topical tetracycline, Seroma, UltrasonographyHernia operations are among the most frequently performed surgical operations. Graft use to repair the defect is commonplace because graft use decreases recurrence rate, and defect closure in large abdominal hernias is easier with a mesh.¹ The most commonly used and least expensive mesh is the polypropylene mesh. This mesh causes a foreign-body reaction where it is placed, which leads to seroma formation.² Repeat aspirations of seromas cause infection, and recurrence is seen on follow-up, especially in large hernias.² While drain use is not recommended in groin hernias, drain use in other abdominal-wall hernias is left to the physician''s discretion. The biggest problem with drain use is transport of the infection by an ascending route.³Tetracycline is an antibiotic, the solution form of which is topically used for pleurodesis in chest surgery.⁴ Some researchers also report successful topical use of its solution in seroma treatment, taking advantage of its sclerosing effect in cases with breast carcinoma.^5,6 Tetracycline has demonstrated increased growth factor–like activity in mesothelial cells exposed to tetracycline leading to fibroblast proliferation.⁷ This study sought to investigate whether tetracycline has a reducing effect on seroma development in cases undergoing elective groin hernia repair using a polypropylene mesh.