Safety of ESWL in elderly: Evaluation of independent predictors and comorbidity on stone‐free rate and complications

Aim: Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side‐effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients. Methods: A retrospective study was carried out on patients aged over 65 years who underwent shock wave lithotripsy at our Department from 2009 to 2011, with a Siemens Lithostar electromagnetic shockwave lithotripter. A total of 231 patients (157 males, 74 females) out of 1694 (13.6%) were studied. The patients were divided into two groups (group 1 = 65–70; group 2 >70). The effect of age and other possible predicting factors (sex, stone localization and stone size) were investigated. Concomitant diseases and related complications were also evaluated. Results: An overall stone‐free rate (SFR) of 82.2% was found. The influence of sex on SFR was non‐significant. There was no significant difference when comparing SFR between the age groups. When patients were divided into those with renal and ureteral stones, the SFR were 94.4% and 67.6% (P < 0.01), respectively. The SFR of the stone size groups, ≤10 mm and >10 mm were 80% and 84.4%, respectively. Comorbidity was present in 148 patients. Complications were noted in 56 of 231 patients. Of 56 patients, 43 had minor complications and 13 major complications. Conclusion: ESWL seems to be an effective first‐line treatment choice for urinary stones in elderly patients with careful patient selection and personalized preparation. Geriatr Gerontol Int 2012; 12: 413–417.     

An unresolved discussion: presence of premature ejaculation and erectile dysfunction in lumbar disc hernia

Purpose

Premature ejaculation (PE) and erectile dysfunction (ED) are both frequent diseases with several questions about the aetiological factors for these disorders. Lumbar disc herniation (LDH), which can cause both neurological and physiological impairments, may be a causative reason. We prospectively tried to evaluate the presence of PE and ED in patients with LDH and identify the effect of both surgical and physical therapy treatments for LDH on PE and ED.

Methods

A total of 50 patients with LDH and a corresponding control group without LDH at an age of 18–50 years were included in the study. Both PE and ED were evaluated with premature ejaculation diagnostic tool (PEDT) and International Index of Erectile Function. Mean intravaginal ejaculatory latency time (IELT) was calculated at their 5 consecutive intercourse. Physical therapy or microdiscectomy was performed according to indication. After 6 months of follow-up, patients in treatment group were re-evaluated for PE and ED.

Results

Mean age of study and control group was 34.1 ± 3.3 and 34.2 ± 4.0 years, respectively (p = 0.979). In LDH group, IELT was <1 min in 12 (24 %), 1–2 (16 %) min in 8, 2–3 min in 7 (14 %), 3–4 min in 7 (14 %) and 4 or more minutes in 16 (32 %) patients. These numbers were 11 (22 %), 8 (16 %), 5 (10 %), 9 (18 %) and 17 (34 %) in control group, respectively. Mean PEDT score of patients who had IELT < 1 min was 11.9 ± 2.1 and 10.7 ± 2.1 in study and control group, whereas it decreased to 1.0 ± 2.8 and 0.5 ± 1.8 as IELT increased over 4 min, respectively. There were 11 (22 %) patients with ED in LDH group, whereas there were only 2 (4 %) in control group (p = 0.017). Twenty patients with LDH underwent surgery while 30 had been taken into physical therapy. After 6 months, patients with PE significantly decreased in both surgery and physical therapy group (p = 0.025 and p = 0.046). Patients with ED also decreased after treatment, but the numbers were so limited for statistical evaluation.

Conclusion

Although ED was more frequent in patients with LDH, PE was similar in both study and control groups, but the treatment of LDH had positive effects on PE and ED.     

The effect of collagen,Interleukin-l α and glicosaminoglycan on the neovascularization of central nervous system

Abstract

Neovascularization, the development of a new microvasculature, has an important role in physiological and pathological processes. The vascular changes in the brain can be easily detected because the proliferation of endothelial cells in its vascular structure is quite small, and so constitutes a good model for neovascularization studies. In the present investigation, to induce intracerebral neovascularization, we implanted collagen, Interleukin-l alpha (IL-lα) and glicosaminoglycan into the brain ofpigs, in order to test the hypothesis that IL-l α, collagen and glicosaminoglycan play a pivotal. role in the process of neovascularization. Both pure collagen and collagen combined with IL-l a induced neovascularization according to light-electron microscopic findings and values of enzymes' activities. In particular, collagen combined with IL-lα synergically affected the increase of neovascularization. However, glicosarrinoglycan did not affect it significantly. Although the results of this study provided us with some interesting data indicating the beneficial effects of collagen combined with IL-1α on neovascularization, further studies should be done to study the short term effect of these biochemical substances. [Neural Res 1998; 20: 513-525]     

c-KIT expression in columnar cell lesions of the breast accompanied by benign and malignant breast diseases

Columnar cell lesions (CCLs) of the breast are reported with increasing frequency. However, the significance of these lesions and the treatment approach to these lesions are still unknown. The aim of the present study was to evaluate c-KIT expression in CCLs accompanying benign and malignant breast diseases. A total of 65 patients (18 benign breast diseases, 8 ductal carcinomas in situ (DCI), and 39 invasive carcinomas) were included in the study. c-KIT was strongly expressed in normal breast epithelium (staining intensity; SI: 3 +/- 0.0), whereas a heterogeneous and cytoplasmic staining pattern was observed in CCLs accompanying both benign and malignant diseases. c-KIT expression was decreased, with increasing atypia in CCLs (SI in CCLs with/without atypia; 1.45 +/- 0.52/no case, 1.25 +/- 0.50/1.38 +/- 0.52, 0.77 +/- 0.73/1.21 +/- 0.42 accompanying benign breast disease, DCI and invasive carcinoma, respectively). c-KIT expression was detected in 10.4% of invasive carcinomas. No significant association between c-KIT expression and the histologic grade and nodal status of tumor was noted. As there is a reduction in c-KIT expression with malignant transformation of breast epithelium, c-KIT is believed to play a role in breast carcinogenesis. Furthermore, similar c-KIT expression patterns in CCLs accompanying malignant breast diseases suggest that at least some CCLs could reflect a premalignant status of breast carcinoma. However, the significance of c-KIT expression in CCLs and its relationship to breast carcinogenesis should be evaluated in follow up studies investigating larger series.     

Prevalence study of signs and symptoms of temporomandibular disorders in a Turkish population

AIM: The aim of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in a population of 792 Turkish adults ranging in age from 15- to 72-years-old. METHODS AND MATERIALS: Subjects were examined objectively and subjectively for signs and symptoms of TMD through the distribution of frequency of the data obtained from a questionnaire and a physical examination using a similar methodology of previous studies. RESULTS: This study determined the prevalence of signs and symptoms of TMDs in subjects from male and female subgroups in a Turkish adult population. Both signs and symptoms of TMDs were generally more prevalent in females than in males. CONCLUSION: The prevalence of signs and symptoms were generally greater than in previous studies of other populations.     

Quilting Prevents Seroma Formation Following Breast Cancer Surgery: Closing the Dead Space by Quilting Prevents Seroma Following Axillary Lymph Node Dissection and Mastectomy

Background

Seroma is a frequent problem after mastectomy (ME) and axillary lymph node dissection (ALND). Seroma is associated with pain, discomfort, impaired mobilisation and repeated aspirations, often resulting in a surgical site infection (SSI). It has already been demonstrated that minimizing dead space through fixation of the skin flaps to the underlying muscles (quilting) lowers the incidence of seroma. The aim of this study was to evaluate the effect of quilting on the incidence of seroma, and SSI.

Methods

Two consecutive groups with a total of 176 patients following ME and/or ALND were retrospectively compared. Endpoints were the incidence of seroma, and number and volume of aspirations and SSIs. Analysed risk factors were age, ME, lymph node dissection, neoadjuvant therapy, body mass index (BMI) and hypertension.

Results

The quilted group (n = 89) scored significantly better on all endpoints compared with the conventional group (n = 87). The incidence of seroma decreased from 80.5 % to 22.5 % (p < 0.01), the mean number of aspirations from 4.86 to 2.40 (p = 0.015), the volume of aspirations from 1660 ml to 611 ml (p = 0.05) and the SSIs from 31.0 % to 11.2 % (p < 0.01). Increasing age and lymph node dissection were found to be risk factors for seroma; quilting was a protective factor.

Conclusion

Quilting is an effective method for preventing seroma and its complications.