Hospital cost analysis of management of patients with renal colic in the emergency department

Acute severe colicky pain in the flank region is termed as renal colic (RC), which is commonly diagnosed and treated in the emergency department (ED). The present study is designed to investigate the hospital costs of patients with RC admitted to the ED and factors affecting the figures. Retrospective analysis includes all patients diagnosed with RC following physical examination and X-ray, ultrasound, computed tomography together with laboratory investigations in the university-based ED between February 2007 and February 2009. The study included 574 patients eligible for the predefined criteria. Mean total hospital cost in patients admitted to the ED due to RC was calculated to be 55.77 Euro. The greatest contribution to the total cost was made by radiological investigations in the ED (40.5%) followed by treatment costs (19.7%). Size and location of the stone and stay times in the ED were the independent variables affecting the costs. The costs were higher as the stones were bigger and as they were more distal in the ureter. Renal stones were associated with the lowest hospital costs. Radiological investigations are the greatest contributors in the ED costs in patients with RC. Effective measures need to be undertaken to reduce resultant costs. Preventive measures as well as diagnostic and therapeutic procedures should be standardized in the ED in accordance with technological advances and also cost-effectiveness when appropriate.     

Ultrastructural evaluation of pulsed radiofrequency and conventional radiofrequency lesions in rat sciatic nerve

BackgroundPRF treatment has recently been described as minimally neurodestructive alternative to radiofrequency heat lesions. Patients with some pain syndromes in whom the pain could not be controlled by alternative techniques may be treated using PRF. In the present study, our main goal was to evaluate and compare the ultrastructure of peripheral nerve tissue that was heated by PRF, CRF with 42°C, and CRF with 70°C.MethodsForty-five male rats were divided into 5 groups. In PRF group and CRF with 42°C group, the sciatic nerve was heated at a temperature of 42°C for 120 seconds. As a positive control, some rat sciatic nerves were treated with CRF lesions at 70°C. The rats were kept alive for 21 days and then killed. Tissue was evaluated with transmission electron microscope, and grading was done to the groups.ResultsThe unmyelinated nerve fibers were ultrastructurally normal in all groups. The results of myelinated axons indicated that PRF group had better grades, and CRF with 70°C group had the worst grade. Especially, comparison of the group of PRF and CRF with 42°C revealed significant difference. In PRF group, none of the myelinated axons showed severe degeneration findings, and most of the damaged myelinated axons showed only separation in myelin configuration.ConclusionsPRF treatment may cause separation in myelinated axons. However, it seems that all changes were reversible. The present study supports the hypothesis that pulsed RF treatment does not rely on thermal injury of neurologic tissue to achieve its effect.     

Comparison of collagen biomatrix and omentum effectiveness on peripheral nerve regeneration

Despite the presence of various nerve coaptation materials and techniques, achievement of the functional nerve regeneration is still inadequate. This study was aimed to compare the effectiveness of conduit composed of collagen biomatrix and omentum graft on peripheral nerve regeneration. Thirty-five male Wistar rats were divided into four groups. In the control group, the right sciatic nerve was skeletonized from the sciatic notch till the point of bifurcation. In the primary epineural repair group, the nerve was transected 1 cm proximal to the bifurcation with a sharp pair of micro scissors and then repaired with four epineural sutures. In the collagen biomatrix group, the epineural repaired nerve was wrapped with collagen biomatrix. In the collagen group, the epineural repaired nerve was wrapped with the nonpediculated omentum. Assessment of the nerve regeneration was based on functional (Walking Track Analysis, Electrophysiological Measurements), histological, and morphometric criteria. Light and electron microscopic examinations showed that collagen-biomatrix-wrapped specimens have the best regeneration. The electrophysiological study confirmed the recovery of electrical activity in the regenerated axons.     

Ectopic Growth Hormone-Releasing Hormone Secretion by a Neuroendocrine Tumor Causing Acromegaly: Long-Term Follow-Up Results

Ectopic secretion of growth hormone-releasing-hormone (GHRH) is a rare cause of acromegaly—representing less than 1% of patients. A 25-year-old woman was admitted to the hospital with acromegaly and a 6 × 6 cm infrahepatic mass. Sellar magnetic resonance imaging indicated diffuse pituitary enlargement consistent with hyperplasia. The infrahepatic mass was resected, and the histopathological diagnosis was a well-differentiated invasive neuroendocrine carcinoma of the duodenum with metastases to local lymph nodes. The tumor cells contained cytoplasmic immunoreactivity for GHRH. Because increased IGF-1 concentrations persisted after the operation, the patient was treated with octreotide long-acting repeatable (LAR) injections of 20 mg/month. Growth hormone and IGF-1 levels normalized. After 6 years of surveillance, a left paraaortic mass was detected by uptake of indium¹¹¹ octreotide. Surgical exploration revealed metastatic neuroendocrine carcinoma in a 2.5-cm lymph node. Postoperatively, the IGF-1 concentration was mildly elevated. Octreotide LAR therapy is being continued at 10 mg/month. This case suggests that octreotide treatment may have a beneficial effect on disease course and can be maintained for as long as 7 years in a patient with acromegaly due to a GHRH-secreting neuroendocrine carcinoma.     

Case report: seizures in a child caused by a large venous angioma

Cerebral venous angioma is a congenital anomaly of the medullary vein, the vessel that drains into the transparenchymal venous stem. This lesion is also referred to as a developmental venous anomaly. A few reports in the literature have documented developmental venous anomaly-related epilepsy, neurologic deficits, and intracranial hemorrhage. A 3-year-old boy was referred to our hospital after he sustained an afebrile, tonic-clonic, focal seizure of 15 minutes' duration that affected his right arm, leg, and eyebrow. Cerebral digital subtraction angiography showed a bilateral, large periventricular developmental venous anomaly. This report describes the clinical and radiologic findings for this large venous angioma that caused seizures in a child.     

Elevated CK-MB mass and plasma brain-type natriuretic peptide concentrations following convulsive seizures in children and adolescents: Possible evidence of subtle cardiac dysfunction

Purpose:   To evaluate the presence of myocardial injury during convulsive seizures in children and adolescents by determining serum concentrations of cardiac troponin I (cTnI), creatine kinase-MB mass (CK-MB mass), and plasma brain-type natriuretic peptide (BNP).
Methods:   Thirty-one children (20 boys; mean age, 6.6 ± 5.34 years) with convulsive seizures and 50 healthy children were enrolled. Serum cTnI, CK-MB mass, and plasma BNP concentrations were analyzed 12 h after the seizure and repeated 7 days thereafter in the patient group and obtained one time in the control group.
Results:   The difference between serum concentrations of cTnI obtained 12 h and 7 days after the seizure was not statistically significant. cTnI levels 12 h postictal and those in control subjects also were not significantly different. CK-MB mass and BNP at the 12th h were higher than those obtained on the 7th day (p  <  0 . 05 and p  <  0 . 001, respectively). Children with seizures had increased levels of CK-MB mass and BNP 12 h after seizure than control subjects (p  <  0 . 05 and p  <  0 . 001, respectively). The results of electrocardiography (ECG) recordings, which were obtained up to 30 min after seizure activity, were completely normal in patients with seizure.
Conclusion:   Normal cTnI levels are not indicative of overt myocardial necrosis in patients with seizures. However, markedly elevated BNP concentrations together with elevated CK-MB mass levels do suggest subtle cardiac dysfunction in patients with seizure, and further large-scale studies are warranted.