Percutaneous US-guided needle biopsies of solid renal masses

Our objective was to examine the variables affecting diagnostic yield and complications in percutaneous ultrasonography-guided needle biopsies of solid renal masses. Percutaneous ultrasonography-guided needle biopsy of solid renal masses was performed in 172 patients with either large size (18G) cutting needles or small size (20G) aspiration needles. Retrospectively, 120 patients with diagnosis by percutaneous biopsy and follow-up data were included in this series. Age, gender, side, locations in kidneys, necrosis, calcification, maximum size, needle groups due to needle size and type (either 18G cutting needles or 20G aspiration needles), and needle pass were selected as variables. Their role was investigated in diagnostic yield. Two needle groups were divided and compared for diagnostic yield and safety. Also, change in treatment was evaluated. The mean maximum size of the masses was 8.8±4.9 cm. The only predictor affecting accuracy was side of kidney (p=0.002). Among patients, 15 (12.5%) and 105 (87.5%) had benign and malignant solid masses, respectively. Small and large needle groups did not differ in accuracy, 80.3% vs. 87.1% (p=1.000). Technical success was detected as 100%. No major complications neither tumor seeding was seen. Percutaneous ultrasonography-guided needle biopsy of solid renal masses is effective and safe method with large size cutting needles and small aspiration needles. Change in clinical management was significant at 63.3% rate. Diagnostic yield was low in left kidney relating to right kidney, 69.4 vs. 93.1, while upper lobe location did not lead to significant false result. Repeat biopsies can be taken under CT guidance after nondiagnostic diagnosis in solid tumors of left kidney. All the needles including large cutting type were found safe.     

Risk factors for amputation in patients with diabetic foot infection: a prospective study

There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. In this study, we aimed to evaluate the independent risk factors for osteomyelitis, amputation and major amputation in patients with DFI using standard scoring procedures. We prospectively studied 379 patients with DFI. The variables were analysed using logistic analysis. A total of 126 cases (33·2%) underwent amputation. The odds ratios in the amputation model were 3·09 for osteomyelitis (P < 0·001), 4·90 for arterial stenosis (AS) (P < 0·001), 3·67 for the history of DFI (P = 0·001), 2·47 for ulcer duration >60 days (P = 0·001), 3·10 for ulcer depth > 15 mm (P < 0·001) and 10·28 for fungal DFI (P = 0·015). In this study, the unusual result of well‐known literature was fungal DFI as an independent risk factor for amputation in patients with DFI.     

Metalloproteinases and Their Inhibitors in Patients with Inguinal Hernia

Aim

The aim of this prospective study is to investigate if there is a relationship between inguinal hernia, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs).

Materials and methods

This case control study was performed on patients admitted to the general surgery department of Erzincan University Hospital. Four groups were created: control, indirect hernia, direct hernia, and bilateral hernia. All groups were comprised of 11 patients. Serum and tissue levels of MMP-1, MMP-2, MMP-9, MMP-13, TIMP-1, TIMP-2, TIMP-3, and hydroxyproline were evaluated.

Results

MMPs values were significantly high at hernia groups, especially at bilateral hernia group (p < 0.05), whereas TIMPs values were significantly low at bilateral hernia group (p < 0.05). MMPs values were increasing at hernia groups in an order as control, indirect, direct, and bilateral. TIMPs values were decreasing at hernia groups in an order as control, indirect, direct, and bilateral.

Conclusion

Increased levels of MMP-1-2-9-13 and decreased levels of TIMP-1-2-3 may have played role in the formation of inguinal hernia. Hernia is not only a local defect, but a reflection of systemic disease. This is even more significant for bilateral hernias.

     

CD4 T cells, lymphopenia, and IL-7 in a multistep pathway to autoimmunity

There are many inhibitory mechanisms that function at the cellular and molecular levels to maintain tolerance. Despite this, self-reactive clones escape regulatory mechanisms and cause autoimmunity in certain circumstances. We hypothesized that the same mechanisms that permit T cells to expand during homeostatic proliferation may inadvertently promote autoimmunity under certain conditions. One major homeostatic cytokine is IL-7, and studies have linked it or its receptor to the development of multiple sclerosis and other autoimmune diseases. We show in a model of beta-islet cell self-reactivity that the transfer of activated autoreactive CD4 T cells can prime and expand endogenous autoreactive CD8 T cells in a CD28- and CD40-dependent manner through the licensing of dendritic cells. Despite this, mice do not develop diabetes. However, the provision of exogenous IL-7 or the physiological production of IL-7 associated with lymphopenia was able to profoundly promote the expansion of self-reactive clones even in the presence of regulatory T cells. Autoimmune diabetes rapidly ensued with CD4 help and the subsequent activation of CD8 T cells, which contributed to disease progression. With the advent of many biologicals targeting TNFalpha, IL-6, and IL-1 and their effective use in the treatment of autoimmune diseases, we propose that IL-7 and its receptor may be promising targets for biological agents in the treatment of autoimmunity.     

Course and prognosis of spinal epidural abscess. Report of five cases

Five patients suffering from spinal epidural abscess associated with neurologic deficit are reported. Four patients underwent a decompressive procedure for abscess drainage, and one patient was medically treated. One of the patients showed a neurologic deterioration at the early postoperative period. The long-term follow-up showed a good outcome in all patients. It is concluded that epidural abscess associated with progressive neurologic deficit requires immediate decompression and administration of antibiotic. Postoperative neurological deterioration may be seen despite proper and immediate decompression and in such a case neurologic improvement is observed in the late postoperative period.     

Corpus callosum in schizophrenia with deficit and non-deficit syndrome: a statistical shape analysis

BackgroundThe corpus callosum (CC) is the most targeted region in the cerebrum that integrates cognitive data between homologous areas in the right and left hemispheres.AimsOur study used statistical analysis to determine whether there was a correlation between shape changes in the CC in patients with schizophrenia (SZ) (deficit syndrome (DS) and non-deficit syndrome (NDS)) and healthy control (HC) subjects.MethodsThis study consisted of 27 HC subjects and 50 schizophrenic patients (20 with DS and 30 with NDS). 3 patients with DS and 4 patients with NDS were excluded. Three-dimensional, sagittal, T1-spoiled, gradient-echo imaging was used. Standard anatomical landmarks were selected and marked on each image using specific software.ResultsAs to comparing the Procrustes mean shapes of the CC, statistically significant differences were observed between HC and SZ (DS+NDS) (p=0.017, James’s F_j=73.732), HC and DS (p<0.001, James’s F_j=140.843), HC and NDS (p=0.006, James’s F_j=89.178) and also DS and NDS (p<0.001, James’s F_j=152.967). Shape variability in the form of CC was 0.131, 0.085, 0.082 and 0.086 in the HC, SZ (DS+NDS), DS and NDS groups, respectively.ConclusionsThis study reveals callosal shape variations in patients with SZ and their DS and NDS subgroups that take into account the CC’s topographic distribution.     

Differential correlates of prolonged grief and depression after bereavement in a population-based sample

Bereavement can lead to prolonged grief disorder (PGD) as well as episodes of major depression. Studies on the prevalence of PGD and its differences from postbereavement depression have not been conclusive. This study compared the correlates of depression and prolonged grief (PG) symptoms in a population-based random sample (N = 535) using the Beck Depression Inventory, Inventory of Complicated Grief–Revised, Anxiety Sensitivity Index (ASI), and Adult Separation Anxiety Questionnaire (ASAQ). Correlates of PG and depressive symptoms were examined using linear regression in 328 bereaved respondents. The prevalence of probable PGD based on PGD-2009 criteria was 3.0% among bereaved respondents and 1.9% in the total sample. PG was related to bereavement-related features including sex of the deceased, β = − .110, p = .026; time since loss, β = − .179, p = .001; the number of lifetime losses experienced, β = .157, p = .016; and perceived closeness with the deceased, β = .214, p < .001. Only lower income of the bereaved predicted depression, β = − .139, p = .018. In women, but not in men, the loss of a male family member (i.e., brother or son) was a significant predictor of PG symptoms, β = − .180, p = .006. The results confirm the qualitative distinction between depression and PG in a nonclinical sample and show that PG is mainly related to the intrinsic and extrinsic characteristics of the deceased or of death, whereas depression relates only to the characteristics of the bereaved person.     

Unroofing and Curettage for the Treatment of Acute and Chronic Pilonidal Disease

Background  

Various surgical techniques are available in the management of pilonidal sinus, but controversy concerning the optimal surgical approach persists. The present study analyzes the outcome of unroofing and curettage as the primary intervention for acute and chronic pilonidal disease.     

Polysplenia syndrome accompanied with situs inversus totalis and annular pancreas in an elderly patient

Polysplenia syndrome (PS) is rarely encountered in elderly. It is characterized by multiple spleens associated with various cardiac and gastrointestinal abnormalities including partial or complete agenesis of dorsal pancreas. Situs inversus totalis (SIT) is a rare congenital anomaly with mirror image of viscera combined with dextrocardia. Occurrence of SIT and PS in the same patient is exceedingly rare. We present the first case of adult PS with SIT accompanied with annular pancreas.