Twenty-four-hour Variations in the Effect of Nitrodilators in Rat Aorta: Lack of Influence of the Endothelium

Time-dependent variations of the vasodilator effects of sodium nitroprusside and glyceryl trinitrate on isolated smooth muscle have been studied on rings of rat thoracic aorta, both endothelium-intact and endothelium-denuded. For most of the concentrations of sodium nitroprusside used the induced relaxations were significantly dependent on the time the tissues were obtained. However, significant temporal differences were obtained for glyceryl trinitrate-induced relaxations at lower concentrations only for both endothelium-intact and endothelium-denuded preparations. EC50 values of sodium nitroprusside and glyceryl trinitrate (i.e. the concentrations inducing half the maximum response) were also significantly different and they had quite similar rhythmic features both in endothelium-intact and in endothelium-denuded preparations. These results clearly show that the in-vitro sensitivity of rat thoracic aorta to nitrodilator agents varies over a 24-h period and thus depends on when the animals were killed; the presence of endothelium does not change the rhythm of nitrodilator activity. These variations might be a result of circadian rhythm in the guanylate cyclase-cGMP system which mediates responses to nitrodilator agents.     

Confetti‐like macular atrophy: A new entity?

Anetoderma, is characterized by herniated atrophic macules clinically and by decreased to absent dermal elastic fibers histopathologically. Atrophoderma is characterized by depressed, atrophic, pigmented patches clinically and by thickened and homogenized dermal collagen bundles with absence of elastolysis histopathologically. Atrophoderma elastolyticum discretum describes lesions that are reminiscent of atrophoderma clinically but they are compatible with anetoderma histopathologically. A 34-year-old female patient presented with diffuse, hypopigmented, atrophic, shiny macules on the upper limbs and upper trunk. Histopathological examination revealed an atrophic epidermis with disorganized, hyalinized and coarse collagen bundles in the middle and lower dermis. Elastic fiber loss and fragmentation were detected in the upper dermis. The other patient was a 42-year-old female patient. She applied with diffuse, hypopigmented, shiny, atrophic macules on the upper limbs and upper trunk. Histopathological examination revealed findings that were similar to those of the first case but there was near complete loss of elastic fibers throughout the whole thickness of dermis. Our cases did not show depressed or herniated atrophic macules clinically but the macules were at the same level with the surrounding healthy skin. Histopathological findings in these cases showed the histopathological features of both atrophoderma and anetoderma. These two cases are interesting because they may represent a clinicopathological entity which has not been described before.     

Bilateral disruption of corpus cavernosum with complete urethral rupture

Penile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow-up.     

Prediction of Head‐Up Tilt Test Result: Is it Possible?

Background: The determination of early, accurate, predictive criteria for a positive result would permit a reduction in the duration of the head‐up tilt testing (HUTT). Previous studies propounded that existence of early sympathetic overreactivity (rapid and sustained increase in heart rate) during HUTT predicts positive result. However, the exact value of this variable is unknown. We analyzed the early heart rate (HR) responses to HUTT and evaluated their ability to predict HUTT result. Methods: Consecutive patients referred to the syncope unit of our center for recurrent unexplained syncope were studied. Results: We studied 189 consecutive patients and 67 (35%) patients had a negative HUTT; 122 (65%) patients had a positive HUTT. The early HR increase was defined as the maximum HR during the first 10 minutes of tilting minus the resting HR before tilting. The receiver–operator curves (ROCs) show the overall performance of the HR changes for predicting the HUTT result. For all variables, area under the ROC curve (AUC) was nearly equivalent to 0.50 and early HR increase was not a predictor of the negative result of HUTT (AUC = 0.546). Also there was no any significant correlation between the magnitude of early HR increase and patient age (r =?0.03, P = 0.76). Conclusions: The results suggest that the early increase in HR during the first 10 minutes of the HUTT may not be a useful parameter for predicting the test result. Many factors, such as late exaggeration in sympathetic activity during HUTT and age‐dependent reduction in baroreflex sensitivity, may attenuate the predictive value of early HR increase. (PACE 2010; 33:153–158)     

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor.     

Wound approximation with tissue glue in circumcision

BACKGROUND: To assess the feasibility of using tissue glue in the approximation of circumcision wounds in children. PATIENTS AND METHODS: A prospective randomized trial was carried out on 30 boys (age, 1-10 years) admitted to the Kahramanamaras Sutcuimam University Medical Faculty, Turkey. The results of wound approximation in circumcision with cyanoacrylate tissue glue and suturing with interrupted 5/0 plain catgut were compared. The operations were carried out by the same surgeon using an identical technique. The wounds were assessed 1 day, 3 days, 1 week and 1 month postoperatively. RESULTS: There was no difference between the two groups in the rates of wound inflammation, infection, bleeding and dehiscence, although cosmetic appearance was better in the tissue glue group. The operation time was also shorter in this group. CONCLUSION: Using tissue glue for wound approximation in circumcision is a feasible alternative.     

Intra-uterine bupivacaine and levobupivacaine

Aim:  The study aimed to compare the effect of intrauterine bupivacaine and levobupivacaine with placebo in reducing the post-procedure discomfort owing to pain caused by suction endometrial sampling.
Methods:  This study was conducted on randomly selected 45 women with abnormal uterine bleeding and who had undergone outpatient hysteroscopy and endometrial biopsy under sedation with propofol 0.5 mg/kg. The study was performed using 5 mL of bupivacaine 0.5% (Group B, n  = 15) or levobupivacaine 0.5% (Group L, n  = 15) or placebo solution (Group C, n  = 15) intrauterine via a catheter over a 5 min period after suction endometrial sampling. The number of patients with visual analogue scale >3, total postoperative analgesic requirements, satisfaction of patients and adverse events were measured. Nonparametric and parametric data were analysed using Kruskal–Wallis and one-way anova tests respectively.
Results:  Women in Groups L and B had statistically significantly less pain than the women in Group C ( P  = 0.03). When compared with placebo, five ml of bupivacaine 0.5% and levobupivacaine 0.5% respectively were recorded to decrease the incidence of postoperative analgesic consumption from 41 to 35% ( P  = 0.01). The satisfaction score of the patients in Group L was significantly higher than that of the patients in Group C ( P  = 0.03).
Conclusion:  Intrauterine levobupivacaine or bupivacaine is effective in decreasing the pain associated with the endometrial biopsy and curettage under propofol sedation.     

Proliferative activity, angiogenesis and nuclear morphometry in renal cell carcinoma

BACKGROUND: Prognostic parameters other than tumor stage and grade are essential for renal cell carcinoma (RCC) patients. This study was undertaken to determine the usefulness of cellular proliferation, angiogenesis and nuclear morphometry in predicting the biological aggressiveness of RCC. METHODS: Surgical specimens of 70 patients with RCC were investigated by conventional histology, Ki-67 immunostaining and stereological assessment of angiogenesis and mean nuclear volume. RESULTS: There was no difference in disease-specific survival with respect to sex, age and histopathological type (except sarcomatoid and other types). The survival was significantly lower and the chance of metastases was higher in the group with higher proliferative activity (P=0.007). There was no relation between angiogenesis, mean nuclear volume, stage and survival. There was a significant relation between both Fuhrman and WHO grades, tumor stage and survival. Histopathological type, grade, angiogenesis and mean nuclear volume failed to predict recurrences and/or metastases. In multivariate analysis, only TNM stage and proliferative activity were found to be independent prognostic factors. CONCLUSIONS: In addition to tumor grade and stage, proliferative activity of a given RCC may have the potential to identify patients with an impaired prognosis.     

Does previous open or percutaneous renal stone surgery affect retrograde intrarenal surgery outcomes?

Background/aim Open or percutaneous renal stone surgery can have an adverse effect on the collecting system of the kidney. We evaluated retrograde intrarenal surgery outcomes in patients with ≤30 mm renal stones who had open or percutaneous renal stone surgery history.Materials and methods A total of 707 patients who underwent retrograde intrarenal surgery treatment were included in this study. Fifty-six patients had open or percutaneous renal stone surgery history (Group 1) and the remaining did not (Group 2, n = 651). The groups were compared in terms of age, stone size, stone-free rates, and complications.Results The mean age of the patients was 51.16 ± 14.8 and 45.95 ± 14.6 years in Groups 1 and 2, respectively (p = 0.008). The mean stone size was 14.97 ± 6.1 mm and 16.47 ± 6.9 mm in Groups 1 and 2, respectively (p = 0.107). The stone-free rates were 71.4% and 84.1% in Group 1 and 2 respectively and it was significantly higher in Group 2 (p = 0.013). The overall rate of postoperative complications was higher in Group 1 (p = 0.019), but there was no difference between the two groups in terms of Clavien 1–2 and 3–4a complication rates.Conclusion Our results showed that having a history of open or percutaneous renal stone surgery has a negative effect on the success and complication rates in retrograde intrarenal surgery. Therefore, patients should be well informed before this operation.     

Intrarenal arterial stenosis in a patient with thromboangiitis obliterans

Thromboangiitis obliterans (TAO) or Buerger's disease is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries of the extremities. Exception of the peripheral arteries of the extremities in TAO is very rare. Reported herein is the first case of intrarenal branch involvement of the renal artery due to TAO.