Can sensitivity of voided urinary cytology or bladder wash cytology be improved by the use of different urinary portions?

OBJECTIVE: To improve sensitivity by using different portions of voided urine cytology (VUC) and bladder wash material cytology (BWC). MATERIALS AND METHODS: 52 patients with biopsy-proven superficial transitional cell carcinoma (TCC) of the bladder were studied. Voided urine specimens were divided into a first stream, mid-stream and terminal stream. Bladder wash material was also divided into a first portion, mid-portion and last portion. All portions were investigated for cytology abnormalities. RESULTS: Sensitivity for the detection of malignant cells was 34.6, 38.5 and 38.5% for the first, mid- and terminal stream of VUC and 34.6, 38.5 and 34.6% for the first, mid- and last portion of BWC, respectively. The sensitivity of VUC was 20-25% for grade I, 30-40% for grade II, and 50-75% for grade III tumors, respectively. The sensitivity of BWC was 25% for grade I, 35-45% for grade II, and 33-50% for grade III tumors, respectively. There was no statistical significant difference for sensitivities between either grades (p = 0.06) or portions or streams (p = 0.3) of VUC and BWC. CONCLUSIONS: In this small group of patients, we did not find any significant difference, but we found highest sensitivity in grade III tumors with the terminal portion of the voided urine when compared to other portions of VUC. Therefore, we believe that further study in a large series is necessary to investigate this approach of differentiated BWC and especially VUC.     

Fatal occupational injuries among workers in Kocaeli, Turkey, 1990-1999

The authors evaluated occupational accidents in Kocaeli, Turkey, using epidemiologic criteria. Data were derived from the registries of the service on Occupational Injuries and Diseases of the Social Insurance Institution's District Authority in Kocaeli. The analysis was based on data from 387 deaths. The rates of occupational injuries and mortality and fatalities from them were 5.1%, 30.6 per 100,000 workers, and 6.0%, respectively, compared with 2.8%, 35.2 per 100.000 workers, and 12.7% in Turkey. Sectors with the highest rates of fatal occupational injuries were construction (30.2%), transportation (13.2%), basic metal industry (9.0%), manufacturing of metal products (5.9%), and heating with electricity, gas, and steam (5.9%). 38.2% of these workers were 25-34 years old. Nearly all were male, most were married, and three fourths had children. Of all deaths due to occupational injuries, 121 (31.3%) were caused by traffic injuries, 93 (24.1%) by falling from high places, and 43 (11.1%) by electrocution; 89% occurred at workplaces, 42% of the workplaces were small, and 45.9% of the deceased workers had been working there for less than three months. Although the situation was better than that in the rest of Turkey in terms of epidemiologic criteria, the death rates, as in other developing countries, are higher than those in the world in general.     

Chromosome 1p36 and 22qter deletions in paraffin block sections of intracranial meningiomas

Meningiomas are the most frequent benign tumors of the intracranial cavity. The classification and underlying pathogenetic mechanisms have been reported to be investigated by both pathological and genetic methods. In this study, we aimed to detect Ip36 and 22qter deletions by fluorescence in situ hybridization (FISH) in archival materials of 50 intracranial meningioma patients. The clinical material consisted of paraffin-embedded tissue sections from 50 patients who were surgically treated and had histopathologic diagnosis of an intracranial meningioma. We observed Ip36 deletion in 23/50 (46%) and 22qter deletion in 33/50 (66%) patients. In addition, we observed 22qter deletion in 26/36 (72.2%) patients with meningothelial meningioma. This finding implies that 22qter deletion might play an important role in the pathogenesis of meningothelial meningioma. On the other hand, no alterations were documented in the frequency of these chromosomal alterations according to the grade of meningiomas, suggesting that malignant progression of these tumors depends on other, more relevant, genetic changes.     

Early effects of extracorporeal shock-wave lithotripsy exposure on testicular sperm morphology

OBJECTIVE: To investigate the effects of extracorporeal shock-wave lithotripsy (ESWL) applied to the pelvic region on testicular histology and spermatogenesis. MATERIAL AND METHODS: ESWL (2000 shock waves over a 20-min period at 18 kV) was applied to 12 adult New Zealand male rabbits. The rabbits were divided into three equal groups: those in Group 1 were sacrificed 1 h after the intervention, those in Group 2 were sacrificed on the 3rd day and those in Group 3 were sacrificed on the 7th day. Both testicles were removed for histopathological examination to investigate the effects of ESWL. Transmission electron microscopy (TEM) was used to detect ultrastructural changes. Epididymal and testicular touch-print preparations were stained with SperMac stain in order to evaluate the morphology of the spermatozoa. RESULTS: There were no significant differences between the groups in terms of sperm morphology (p = 0.386). TEM revealed only huge vacuolation of Sertoli cells and diffuse edema in the mitochondria of Sertoli cells. CONCLUSION: No detrimental effect of ESWL on sperm morphology was detected in this study. We conclude that shock waves do not cause severe permanent effects but only transient disorders in testes.     

Wavelet entropy analysis of event-related potentials indicates modality-independent theta dominance

Sensory/cognitive stimulation elicits multiple electroencephalogram (EEG)-oscillations that may be partly or fully overlapping over the time axis. To evaluate co-existent multi-frequency oscillations, EEG responses to unimodal (auditory or visual) and bimodal (combined auditory and visual) stimuli were analyzed by applying a new method called wavelet entropy (WE). The method is based on the wavelet transform (WT) and quantifies entropy of short segments of the event-related brain potentials (ERPs). For each modality, a significant transient decrease of WE emerged in the post-stimulus EEG epoch indicating a highly-ordered state in the ERP. WE minimum was always determined by a prominent dominance of theta (4-8 Hz) ERP components over other frequency bands. Event-related 'transition to order' was most pronounced and stable at anterior electrodes, and after bimodal stimulation. Being consistently observed across different modalities, a transient theta-dominated state may reflect a processing stage that is obligatory for stimulus evaluation, during which interfering activations from other frequency networks are minimized.     

Color Doppler tissue imaging in assessing the elastic properties of the aorta and in predicting coronary artery disease

We hypothesized that the change in aortic elastic properties could directly be shown with color Doppler tissue imaging (CDTI), that these findings could be related to aortic stiffness and distensibility and that, through these, coronary artery disease (CAD) could be predicted. One hundred and twenty six patients (group I: 83 with CAD, mean age 54+/-10 years, 18 female, 65 male; group II: 43 without CAD, mean age 53+/-10 years, 27 female, 16 male) having been evaluated for coronary artery disease by angiography were examined by echocardiography. Arterial pressure was measured immediately before echocardiographic evaluation. Internal aortic systolic and diastolic diameters by M-mode echocardiography and aortic upper wall tissue velocities (Aortic S, E, A, m/sec) by CDTI were measured 3 cm above the aortic valve. Lateral mitral annulus tissue velocities (Annulus S, E, A, m/sec) were also recorded. Aortic distensibility (cm2 x dynes(-1)) and aortic stiffness index were calculated using formulas. In the statistical analyses, CAD risk factors and left ventricular ejection fraction were used for adjustment. Aortic stiffness (2.79+/-3.49 vs 1.62+/-1.31, P=0.03), distensibility (1.55+/-1.46 vs 2.37+/-3.08, P=0.04), and aortic S velocity (0.057+/-0.016 vs 0.064+/-0.015, P=0.02) differed significantly between groups I and II. After adjustment, while aortic stiffness and S velocity were still statistically different (P=0.04; P=0.03 respectively), the significance of the difference in aortic distensibility disappeared (P=0.051). Aortic stiffness and aortic S velocity (0.06 m/sec<) were important CAD determinants (Odds ratio=1.4 P=0.03; Odds ratio=3.6 P=0.01, respectively), but aortic distensibility was not. Aortic stiffness was correlated only with aortic S velocity (r=-0.28, P=0.01), and aortic distensibility had a significantly positive correlation with aortic S velocity (r=0.20, P=0.02). The interobserver and intraobserver correlation coefficients for aortic S velocities were 0.65 and 0.71, respectively (P<0.05). Elastic properties of the aorta can directly be assessed by reproducibly measuring the movements in the upper wall of the aorta by CDTI. Reduced aortic S velocity is associated with increased aortic stiffness. Increased aortic stiffness and reduced aortic S velocity are important predictors of CAD.     

Use of an Innsbruck sensorimotor activator and regulator (ISMAR) in the treatment of oral motor dysfunctions: a single case report

Many patients with cerebral palsy have difficulties during the oral preparatory phase and also during the food transport phase (swallowing), and oral-sensorimotor therapy is practised with these individuals. With oral-sensorimotor therapies, the functioning of the lips, cheeks, tongue and pharyngeal structures, and the interplay between these structures, can be improved. An Innsbruck sensorimotor activator and regulator (ISMAR) is one of the appliances used for oral-motor therapy. The purpose of this study is to describe the appliance and report a patient using ISMAR.     

Transcorneal stimulation of trigeminal nerve afferents to increase cerebral blood flow in rats with cerebral vasospasm: a noninvasive method to activate the trigeminovascular reflex

OBJECT: The goal of this study was to investigate whether stimulation of trigeminal afferents in the cornea could enhance cerebral blood flow (CBF) in rats after they have been subjected to experimental subarachnoid hemorrhage (SAH). Cerebral vasospasm following SAH may compromise CBF and increase the risks of morbidity and mortality. Currently, there is no effective treatment for SAH-induced vasospasm. Direct stimulation of the trigeminal nerve has been shown to dilate constricted cerebral arteries after SAH; however, a noninvasive method to activate this nerve would be preferable for human applications. The authors hypothesized that stimulation of free nerve endings of trigeminal sensory fibers in the face might be as effective as direct stimulation of the trigeminal nerve. METHODS: Autologous blood obtained from the tail artery was injected into the cisterna magna of 10 rats. Forty-eight and 96 hours later (five rats each) trigeminal afferents were stimulated selectively by applying transcorneal biphasic pulses (1 msec, 3 mA, and 30 Hz), and CBF enhancements were detected using laser Doppler flowmetry in the territory of the middle cerebral artery. Stimulation-induced changes in cerebrovascular parameters were compared with similar parameters in sham-operated controls (six rats). Development of vasospasm was histologically verified in every rat with SAH. Corneal stimulation caused an increase in CBF and blood pressure and a net decrease in cerebrovascular resistance. There were no significant differences between groups for these changes. CONCLUSIONS: Data from the present study demonstrate that transcorneal stimulation of trigeminal nerve endings induces vasodilation and a robust increase in CBF. The vasodilatory response of cerebral vessels to trigeminal activation is retained after SAH-induced vasospasm.     

Ionized calcium level predicts in-hospital mortality of severe sepsis patients: A retrospective cross-sectional study

Objective: To evaluate the effect of serum ionized calcium levels on the prognosis of severe sepsis patients. Methods: This retrospective cross-sectional study included sepsis patients who were hospitalized in an intensive care unit between January 2011 and December 2014. The demographic and baseline data of the patients who died and survived were compared. The cutoff value of ionized calcium for in-hospital mortality was determined by the receiver operating characteristics curve (ROC). In-hospital mortalities and the survival rates were compared between patients with different ionized calcium levels. Besides, the risk factor of in-hospital mortality was determined. Results: This study included 145 patients with 113 patients who died in the hospital. The patients who died had significantly lower ionized calcium levels (U=2.25, P=0.034). A cut-off value of 0.93 mmol/L of ionized calcium was determined by the ROC curve. The patients with ionized calcium>0.93 mmol/L showed a significantly lower morality (χ2=9.90, P=0.002) and higher survival rate than with ≤0.93 mmol/L (log rank=6.20, P=0.010). Multivariate Cox regression revealed that ionized calcium ≤0.93 mmol/L was a risk factor of in-hospital mortality. Conclusions: Ionized calcium level≤0.93 mmol/L was an independent predictor of in-hospital mortality of severe sepsis.