Laparoscopic Decortication of Hilar Renal Cysts Using LigaSure

Background and Objectives:

In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts.

Methods:

Seventeen patients underwent laparoscopic decortication of hilar renal cysts with the LigaSure system. Our study included only symptomatic, Bosniak type 1, simple and symptomatic renal cysts. The operative route, transperitoneal or retroperitoneal, was planned according to the location confirmed by computed tomography. The patients'' symptoms were preoperatively and postoperatively evaluated by the Wong-Baker visual pain scale. Operative measures and radiologic outcomes were prospectively evaluated.

Results:

The mean age of the patients was 56.4 years, and the mean follow-up period was 12.5 months. Preoperative computed tomography showed only a single cyst in 15 patients (88.2%) and showed two separate cysts in 2 cases (11.8%). The cysts were located in the perihilar region close to the vascular structure in all patients. A transperitoneal approach was used in 9 patients, and a retroperitoneal approach was used in 8 patients. The mean operative time and hospitalization time were 56.4 minutes and 1.2 days, respectively. Minor complications were observed in 3 patients. Symptomatic and radiologic success rates of 94.2% and 100%, respectively, were achieved.

Conclusion:

Laparoscopic decortication of symptomatic hilar renal cysts—first reported in the literature in this study—using the LigaSure sealing system is feasible, effective, and safe, even if the cyst is located in the perihilar area.     

Right ventricular myocardial performance index and exercise capacity in athletes

Right ventricular function is important for exercise capacity in athletes. The aim of this study was to investigate the effects of habitual exercise training on right ventricular global function. Fifty-two male athletes (25 runners, 27 wrestlers) and 43 age-matched sedentary male subjects were studied. All subjects in the study underwent an echocardiography examination and cardiopulmonary exercise test. Maximal oxygen consumption, right ventricular cavity diameters, and diastolic parameters were higher in the athletes than in controls. However, the right ventricular myocardial performance index was lower in athletes compared with controls. Therefore, the right ventricular myocardial performance index showed a negative correlation with maximal oxygen consumption (r = −0.61; P < 0.001). The right ventricular myocardial performance index may reflect changes in right ventricular function and exercise capacity in athletes.     

A case report of doxycycline induced esophageal and gastric ulcer.

It is well-established that various drugs can induce esophageal and gastric mucosal injury. Generally neither motility disorder nor an anatomical stricture is found in such cases and the cause of mucosal injury is usually found to be inadequate fluid intake with medicine or consumption just prior to bedtime. Athough there are some case reports of doxycycline induced esophageal mucosal injury, doxycycline induced gastric ulcer has been reported only once in the literature. In this case report, a 33 year old female patient who had been prescribed doxycycline for pelvic inflammatory disease is presented. She was admitted with retrosternal and epigastric pain and odynophagia, which had begun after taking the second oral dose of the drug. Endoscopic examination showed ulcers in the mid esophagus and fundus of the stomach. Histologic findings supported a drug induced etiology in these ulcers. This is only the second case in the literature where gastric ulcer has been caused by doxycycline.     

A rare coronary artery anomaly: anomalous right coronary artery arising from the left anterior descending artery

Anomalous right coronary artery is a rare entity with an incidence of 0.26%. The anomalous origin usually arises from the left sinus valsalva. An anomalous right coronary artery arising from the left anterior descending artery is rare. It is usually known as a benign entity but may have clinical importance due to its course between the aorta and pulmonary artery which may cause myocardial ischemia or sudden cardiac death. Here we present an anomalous coronary artery arising from the left anterior descending artery detected by coronary artery angiogram and confirmed by multislice computed tomography thereafter. 40% retrospective electrocardiographic gating is performed and volume-rendered 3 D and axial MIP (maximum intensity projection) images were reconstructed on a Vitrea post- processing Workstation. The images demonstrated the anomalous origin of the right coronary artery arising from the proximal portion of left anterior descending artery after the first septal perforator and coursing.     

Prevalence and risk factors of depression among community dwelling elderly

Depression in the elderly is associated with increased morbidity and mortality. The purpose of this study was to determine the prevalence and risk factors of depression among community-dwelling older population in an urban setting in Turkey. This cross-sectional study was conducted among 482 elderly individuals 65 years and over in an urban area. Cluster sampling method was used for sample size. Depression in the elderly had been diagnosed by a clinical interview and Geriatric Depression Scale. Data were collected by door-to-door survey. Chi square test was used for statistical analysis. P value, which was calculated by the results of chi square test and coefficient of phi (φ), below 0.05 was included in the analysis of logistic regression. Depression was significantly associated with female gender, being single or divorced, lower educational status, low income, unemployment, and lack of health insurance. However, logistic regression analysis revealed higher depression rates in the elderly with chronic obstructive pulmonary disease, psychiatric disease, cerebrovascular disease, low income and being dependent. Depression is common among community-dwelling older people in an urban area of Izmir, Turkey. Older adults living in community should be cautiously screened to prevent or manage depression.