Evolution of endoscopic management of ectopic ureterocele: a new approach

PURPOSE: We report the evolution of endoscopic treatment of ectopic ureteroceles from the unroofing technique to a novel approach using concomitant ureterocele double puncture and intraureterocele fulguration. We also compare the results of different endoscopic modalities at a single center. MATERIALS AND METHODS: We reviewed the records of 46 children with ectopic ureteroceles who were treated endoscopically between 1995 and 2005. The patients were divided into 2 main groups. Group 1 included 17 patients who underwent common endoscopic treatments, including ureterocele incision (4 patients), single ureterocele puncture (4), and single puncture with insertion of a Double-J stent (9). Group 2 included 29 children who underwent ureterocele double puncture and fulguration of the anterior and posterior walls of the collapsed ureterocele after insertion of a Double-J stent into both punctured sites. We also managed concomitant vesicoureteral reflux by endoscopic injection of tricalcium phosphate ceramic into the subureteral region. RESULTS: Total success rates in group 1 were 0%, 25% and 33% in patients who underwent ureterocele incision, single ureterocele puncture and single puncture with insertion of a stent, respectively. Total success rate in group 2 was 90% (p<0.05). New onset vesicoureteral reflux developed in 8 patients (47%) in group 1, of which 6 were in ureterocele moieties, and in 8 patients (28%) in group 2, with none in a ureterocele moiety (p<0.01). A total of 13 patients (76%) in group 1 required open surgical intervention, compared to 3 (10%) in group 2 (p<0.05). CONCLUSIONS: This new endoscopic approach is highly effective in the treatment of children with ectopic ureteroceles.     

Infantile bladder rupture during voiding cystourethrography

Bladder rupture is rare during infancy and most of reported cases had urethral obstruction or neurogenic bladder. We report two cases of infantile bladder rupture during voiding cystourethrography (VCUG). This report reinforces the criteria for proper VCUG imaging procedure. Consideration of expected bladder volume for body weight, and close monitoring of bladder pressure and injection speed could prevent such complications.     

Role of endogenous cannabinoids in ischemia/reperfusion injury following testicular torsion in rats

Objectives:   The role of endogenous cannabinoids in ischemia/reperfusion induced germ cell apoptosis in rats was investigated.
Methods:   Baseline group was for basal normal values. The Sham operated group served as a control group. The torsion/detorsion (T/D) group underwent torsion (1 h) and detorsion; AN1, AN2, and AN3 groups received anandamide (10 mg/kg) 30 min before torsion, 30 min after torsion, and just after detorsion, respectively. In the AM251 group, AM251 (0.5 mg/kg) was injected 45 min before torsion and in the AN/AM group, AM251 and anandamide were injected 45 and 30 min before torsion, respectively. Lipid peroxidation, antioxidant enzymes, and germ cell apoptosis was determined.
Results:   Malondialdehyde (MDA) levels in the T/D group were significantly higher than the control group. Moreover, MDA values in the AN1, AN2, and AN3 groups were significantly lower than T/D. There were significant decreases in catalase and superoxide dismutase activities in the T/D group versus the control group. These values in the AN1, AN2, and AN3 groups were significantly higher than T/D. It was also shown that MDA levels in the AN/AM group were significantly higher than the AN1 group. In the AN/AM group, catalase and superoxide dismutase activities were significantly lower versus the AN1 group. The mean germ cell apoptosis scores in all animals with testicular T/D were significantly higher than the control group. There was no difference between the apoptotic indices in the AN1, AN2, AN3, and T/D groups. Apoptosis scores in AM251 and AN/AM were significantly higher compared with the T/D and AN1 groups.
Conclusions:   Although anandamide increased antioxidant markers, it failed to reduce germ cell apoptosis. AM251 worsened the antioxidant defense system, which is reflected as higher germ cell apoptosis.     

CT Perfusion in Acute Lacunar Stroke: Detection Capabilities Based on Infarct Location

BACKGROUND AND PURPOSE:Recent studies demonstrated superiority of CTP to NCCT/CTA at detecting lacunar infarcts. This study aimed to assess CTP''s capability to identify lacunae in different intracranial regions.MATERIALS AND METHODS:Over 5.5 years, 1085 CTP examinations were retrospectively reviewed in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. Patients had infarcts ≤2 cm or no acute infarct on DWI; patients with concomitant infarcts >2 cm on DWI were excluded. CTP postprocessing was automated by a delay-corrected algorithm. Three blinded reviewers were given patient NIHSS scores and symptoms; infarcts were recorded based on NCCT/CTA, CTP (CBF, CBV, MTT, and TTP), and DWI.RESULTS:One hundred thirteen patients met inclusion criteria (53.1% female). On DWI, lacunar infarcts were present in 37 of 113 (32.7%), and absent in 76 of 113 (67.3%). On CTP, lacunar infarcts typically appeared as abnormalities larger than infarct size on DWI. Interobserver κ for CTP ranged from 0.38 (CBF) (P < .0001) to 0.66 (TTP) (P < .0001); interobserver κ for DWI was 0.88 (P < 0.0001). In all intracranial regions, sensitivity of CTP ranged from 18.9% (CBV) to 48.7% (TTP); specificity ranged from 97.4% (CBF and TTP) to 98.7% (CBV and MTT). CTP''s sensitivity was highest in the subcortical white matter with or without cortical involvement (21.7%–65.2%) followed by periventricular white matter (12.5%–37.5%); sensitivity in the thalami or basal ganglia was 0%.CONCLUSIONS:CTP has low sensitivity and high specificity in identifying lacunar infarcts. Sensitivity is highest in the subcortical white matter with or without cortical involvement, but limited in the basal ganglia and thalami.

Lacunar infarcts are ischemic insults that predominantly result from the occlusion of single perforating arteries.¹ Typically, lacunae occur within the thalami, basal ganglia, brain stem, corona radiata, or internal capsule.^2–4 Although lacunar infarcts predominantly occur secondary to small vessel disease, other etiologies such as cardiac emboli and vasculitis also have been described.⁵ Lacunar strokes are a common cause of morbidity and account for up to 25% of all ischemic strokes.^6,7 Classically, symptoms of lacunar infarcts include pure sensory syndrome, pure motor hemiparesis, sensorimotor stroke, ataxic hemiparesis, or dysarthria-clumsy hand syndrome.^2,8 Thrombolytic therapy has been shown to be effective in the treatment of acute lacunar stroke, making the timely and accurate diagnosis of lacunar infarcts of utmost importance.⁹NCCT is less sensitive than DWI in the detection of lacunar strokes, with reported sensitivities ranging from 0%–35% for NCCT and 75%–95% for DWI.^10–13 Nevertheless, because CT remains more accessible than MR imaging in emergency settings, its optimization in the diagnosis of stroke continues to be vital.¹⁴ Recently, CTP has been shown to be superior to NCCT and CTA in assessing for lacunar infarcts.^4,15 However, neither of the recent studies directly compared CTP with NCCT/CTA in the detection of lacunae: Rudilosso et al¹⁵ assessed the use of CTP in patients with clinical lacunar syndrome, and Das et al⁴ investigated the use of CTP as part of a multimodal approach in the setting of lacunar infarction, noting only that 61% of patients had an abnormality on CTP concordant with infarction on DWI. Furthermore, neither study investigated CTP''s capability to detect lacunae within specific regions of the brain.The purpose of this study was to compare the diagnostic performance of CTP with NCCT/CTA in the identification of acute lacunar infarcts and evaluate the diagnostic capabilities of CTP in the detection of lacunar strokes within different areas of the brain.