High ligation to treat pain in varicocele

Purpose: There are limited data about the effectiveness of surgery in patients withpainful varicocele. We report a retrospectivestudy done for the follow up on all varicocelehigh ligations performed for pain to evaluatethe effectiveness of the operations.Materials and methods: The patients who were all physically active workers and who underwent high inguinal ligation of varicocelefor pain from January 1995 to January 2000,were invited for interviews. Their charts werereviewed to document patient age, grade andlocation of varicocele, duration and quality ofpain, response to conservative treatment. Allpatients who could be contacted were interviewed for resolution of pain and complications, their physical examinations were made.Results: 87 of 140 (62.1%) patients wereavailable for the follow up. Median patient agewas 26 (15 to 34) years old. The varicocele wason the left side in 82 patients and bilateralin 5. The pain was dull in 42, throbbing in 25,sharp in 6 and as a pulling sensation in 14.The longest conservative therapy given in theliterature failed in all patients. Varicocelegrades were as follows: Grade I in 17, Grade IIin 34 and Grade III in 36 patients. Highinguinal ligation was used in all patients. 72(82.8%) patients reported complete resolution, 8 (9.2%) patients reported partial response, 7(8%) patients had persistant pain.Conclusions: High inguinal ligation iseffective in the treatment of painfulvaricocele in highly selected patients.Prospective randomized studies are neededcomparing surgical and conservativetreatments.     

The relation between tooth loss and bone mass in postmenopausal osteoporotic women in Turkey: a multicenter study

 The purpose of this study was to investigate the associations of tooth loss with skeletal bone mass, years since menopause, educational level, current smoking status, dietary calcium intake, and number of pregnancies in postmenopausal osteoporotic women in Turkey. The study population consisted of 1171 postmenopausal women aged 40–86 years (mean age, 61.19 ± 7.28 years). A detailed history was obtained from all women, including relevant lifestyle parameters, risk factors, and measurements of weight and height. Women were separated into three groups according to the number of teeth remaining as group 1 (edentulous, 457 women), group 2 (10 or fewer teeth, 232 women), and group 3 (more than 10 teeth remaining, 482 women). There was no significant difference among the three groups in mean age and menopausal age (P < 0.05). Body mass index of group 1 was significantly higher than that of group 2 (P < 0.01). Educational level was significantly different between three groups: groups 1 and 2 (P < 0.001), groups 1 and 3 (P < 0.0001), and groups 2 and 3 (P < 0.001). Educational level was lowest in group 1 and highest in group 3. Despite a low ratio of cigarette smoking in general, a smoking habit was most prevalent in group 3 and least in group 2. The ratio of women receiving adequate calcium was significantly lower in group 1 than in other groups (P < 0.001); mean calcium intake was similar in all groups. The number of pregnancies was significantly higher in group 1 than in other groups (P < 0.001). Lumbar bone mineral density (BMD) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001). Although no significant difference was found between groups 1 and 3, femoral neck BMD of group 2 was less than in others, and differences between groups 1 and 2 and between groups 2 and 3 (P < 0.001) were significant. Lumbar bone mineral content (BMC) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001), and lumbar BMC in group 2 was significantly higher than in group 3 (P < 0.05). Femoral neck BMC in group 1 was significantly higher than in groups 2 and 3 (P < 0.001). In conclusion, lumbar BMD and BMC in the edentulous group were significantly lower, whereas femoral neck BMD and BMC were significantly higher in edentulous group compared with the others. Our findings indicated that improvement in lifestyle factors and nutritional strategies for the treatment and prevention of osteoporosis may have additional benefit in reducing tooth loss. Received: February 18, 2002 / Accepted: June 21, 2002 Offprint requests to: A. Gur     

Direct Formation of Nanospheres from Amphiphilic β-Cyclodextrin Inclusion Complexes

Purpose. The aim of this work was to develop and characterize a highly loaded nanoparticulate system based on amphiphilic -cyclodextrins (CDs) to facilitate the parenteral administration of poorly soluble antifungal model drugs bifonazole and clotrimazole. Methods. Inclusion complexes were characterized with spectroscopic techniques. Particle size distribution of nanospheres were determined by photon correlation spectroscopy (PCS). Nanospheres were assessed for hemolytic activity. Entrapped and released drug quantities were determined and minimum inhibitory concentration (MIC) values of drugs, amphiphilic -CDs, and drug loaded nanospheres were evaluated. Results. 1:1 inclusion complexes of model drugs with amphiphilic -CDs gave nanospheres <300 nm (polydispersity index < 0.15) by nanoprecipitation technique without using surfactants. By direct preparation from preformed inclusion complexes, loading was increased 2- to 8-fold depending on CD type and loading technique. Conventionally loaded CD nanospheres displayed immediate release whereas preloaded and highly loaded nanospheres liberated model drugs over a period of 1 h reducing the initial burst effect. MIC values of bifonazole and clotrimazole were lowered significantly when associated to amphiphilic -CD nanospheres. Conclusion. Amphiphilic -CDs form nonsurfactant, highly loaded nanospheres with lower hemolytic activity than that of natural CDs directly from inclusion complexes. They enhanced solubility and subsequently therapeutic efficacy of the model drugs.     

Reliability of the disk damage likelihood scale

PURPOSE: To report the reliability of the glaucoma disk damage likelihood scale (DDLS) in comparison to the Armaly cup/disk ratio by determining the interobserver and intraobserver agreement for optic disk stereo photographs and the interobserver agreement for in vivo patient measurements of the optic disk. DESIGN: Observational case series. METHODS: Optic disk photographs: 48 stereo pairs of optic nerve photographs were selected from patients with a spectrum of glaucomatous visual field loss. Two masked observers graded the optic disk photographs three times according to the DDLS and Armaly cup/disk ratio. Interobserver and intraobserver agreements were calculated using the test-retest method. Patient measurements: three observers performed in vivo patient measurements on 34 eyes of glaucoma clinic patients and made a single determination of the DDLS stage and Armaly cup/disk ratio, based on the indirect biomicroscopic examination. Level of interobserver agreement was tabulated. RESULTS: Optic disk photographs: interobserver and intraobserver agreement for the vertical DDLS measurement was greater than for two determinations (clinical impression and measured) of the vertical Armaly cup/disk ratio (interobserver: 85% vs 68% and 74%, respectively; intraobserver grader 1: 97% vs 89% and 80%, grader 2: 99% vs 95% and 89%, respectively). In vivo patient measurements: the interobserver agreement for the DDLS and Armaly cup/disk ratio was similar (70.1% vs 67.6%, respectively). CONCLUSIONS: For the stereo optic disk photographs, the inter- and intra-observer agreement for the DDLS is greater than the Armaly cup/disk ratio. For the in vivo patient measurements, the level of agreement for the DDLS and the Armaly cup/disk ratio is similar.     

Comparison of antiallergic drugs in an experimental model of ocular anaphylaxis

PURPOSE: To compare the efficacy of antiallergic drugs in an experimental ocular anaphylaxis model. MATERIALS AND METHODS: Fifty-two rats were divided into 8 groups. Dithiothreitol and ovalbumin (OVA) were applied to both eyes of previously OVA-inoculated rats in groups 1-5 and 7. In groups 1-5, antiallergic efficacy of the drugs (lodoxamide, sodium cromoglycate, levacobastine, cimetidine, and diclofenac sodium) instilled on the right eyes were compared with the buffer instilled on the left eyes, measuring the amount of extravasated Evans blue (EB) dye by spectrophotometric analysis. Group 6 served as a control of EB dye extravasations in nonimmunized eyes. Histopathologic examinations for anaphylaxis and controls were done in groups 7 and 8. RESULTS: Only levacobastine and lodoxamide decreased vascular permeability at a significant ratio (46%, p < 0.01 and 31%, p < 0.05, respectively). CONCLUSION: Levacobastine and lodoxamide but none of the three other drugs mentioned above were found to be effective in decreasing vascular permeability.     

Diagnosis and Surgical Treatment of Morgagni Hernia: Report of Three Cases

Morgagni hernia is a rare congenital disorder, which is usually asymptomatic, but may cause respiratory or gastrointestinal symptoms. We reviewed the clinical findings of three patients with a Morgagni hernia, diagnosed and treated in our department between 1997 and 2000. The Morgagni hernia caused various symptoms in all three patients and surgery was performed via posterolateral thoracotomy in two, and via laparatomy in one. The hernial defect was closed by primary suturing in two patients and by synthetic mesh in one. All three patients had an uneventful postoperative recovery. We believe that the transthoracic approach is an effective way of repairing Morgagni hernia. Received: October 19, 2001 / Accepted: July 2, 2002 RID="*" ID="*" Reprint requests to: I.C. Kurkcuoglu, Ataturk Universitesi Tip Fakultesi, Gogus Cerrahisi ABD, 25240 Erzurum, Turkey     

Risk factors for breast cancer-related upper extremity lymphedema: Is immediate autologous breast reconstruction one of them?

Breast cancer related upper extremity lymphedema (BCRL) reduces the quality of life of those who have had surgery for breast cancer. The aim of this study is to evaluate the risk factors for BCRL and determine whether immediate autologous tissue breast reconstruction is one of them. A case control study was conducted comparing patients with BCRL (n=97) to surgically treated breast cancer patients without BCRL (control, n=126). The groups were matched for age, type of breast surgery and radiation therapy. Postoperative upper extremity infection, body mass index (BMI), occupation (level of hand-use), and immediate autologous tissue breast reconstruction were investigated as a risk factor of BCRL. Mastectomy was performed on 47.6 % (n=60) and 37.2% (n=36) of patients in the control and the BCRL groups, respectively. Eight patients (13.3%) had immediate autologous tissue breast reconstruction in the control mastectomy group. Six of 36 BCRL patients (16.7%) underwent mastectomy with immediate autologous tissue breast reconstruction. There was no significant difference between groups with respect to incidence or method of immediate reconstruction (p=0.65). Patient occupation (level of hand use) was found to be positively correlated to development of BCRL (p=0.0001). Upper extremity infection rate was 22.7% in the BCRL group and 4.0% in the controls (p=0.0001). The mean BMI in the control and BCRL groups 26.8 kg/m² and 29.1kg/m², respectively (p=0.003). In conclusion, in this study characteristics positively associated with development of BCRL included occupation, infection, and increased BMI. Immediate reconstruction of the breast was not found as a risk factor for BCRL. However larger studies are needed, to further evaluate the effect of breast reconstruction on BCRL.     

A neurosurgical view of anatomical evaluation of anterior C1–C2 for safer transoral odontoidectomy

An anatomical study for evaluation of anterior C1–C2. To provide essential anatomic data for safer transoral odontoidectomy. The surface dimensions of the atlas vertebra and the transoral approach for odontoidectomy have been described in detail. Anterior arcus of C1 must be drilled out to reach odontoid process for transoral odontoidectomy. The thickness of anterior ring of C1 has not been studied before. Sixty, dried adult atlas and 60 axis vertebrae and ten cadaveric craniocervical specimens were measured for the following: (1) bony drilling depth (BDD), the distance from the anterior wall of anterior ring of C1 to anterior wall of odontoid; (2) minimum drilling diameter (MDD), distance of minimum C1 anterior ring removal for odontoid resection on horizontal plane; (3) maximum bony drilling diameter (MBDD), distance of maximum C1 anterior ring removal for odontoid resection on horizontal plane. Lateral border of this diameter is limited by medial borders of the lateral mass; (4) the widest odontoid diameters (WOD) on coronal sections were measured. On 60 atlas and axis vertebrae, the BDD was 7.0 ± 1.2 mm on dry bones, the distance between the medial borders of the lateral mass (MBDD) was 16.1 ± 1.5 mm, and the WOD on coronal sections (WOD) was 9.8 ± 0.8 mm. On cadavers, the distance between the two edges of C1 anterior ring removal for odontoid resection (MDD) was 10.8 ± 1.1 mm and the WOD on coronal sections (WOD) was 10.1 ± 1.4 mm. An odontoid surgery through transoral approach is safe and feasible. A quantitative understanding of the anterior anatomy of C-1 and C-2 is necessary when considering transoral odontoid resection. In this study the authors define safe zones for anterior atlas and axis.