The Role of Partial Nephrectomy without Arterial Embolization in Giant Renal Angiomyolipoma

Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4–8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients

Acute appendicitis coexisting with acute pyelonephritis causing diagnostic dilemma: a case report

Background Acute appendicitis and acute pyelonephritis are the most common diseases admitted to emergency departments. Both conditions have common symptoms such as flank pain, abdominal pain, and fever. Patients' history, physical examination, laboratory evaluation, and imaging methods are used to differentiate these two conditions. Diverticulitis, colitis, gynecological pathologies, and ureteral stones that mimic acute appendicitis should be kept in mind as differential diagnoses. Cases of pyelonephritis mimicking acute appendicitis have been reported in the literature, but there has not been a reported case in which acute appendicitis occurs during management of acute pyelonephritis. In this article, a case report which can cause such a diagnostic dilemma has been presented. Case presentation A 42-year-old female patient presented with clinical features suggestive of acute appendicitis that developed after a diagnosis of acute pyelonephritis. She underwent laparoscopic appendectomy on account of acute appendicitis during medical treatment for acute pyelonephritis. Physical examination showed only right costovertebral tenderness without any rebound tenderness at McBurney's point at the first admission, but during treatment rebound tenderness at McBurney's point was also detected. The Alvarado score of the patient was 5 at the first admission and 7 when acute appendicitis was diagnosed. The patient fully recovered and was discharged after both diseases were completely treated. Conclusions As seen in this case, it should be remembered that both diseases can be seen together which causes a diagnostic dilemma. If clinical or biochemical progression is detected in a patient under treatment, imaging methods should be repeated and additional ones with higher resolutions should be used

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

Background: Implant choice for fixation of intertrochanteric fractures remains controversial despite being one of the most commonly performed operations. Although use of sliding hip screws is still considered a gold standard in treatment of these fractures, there is a wide tendency in using cephalomedullary nails because of their biomechanical superiority over sliding hip screws. This trial was initiated in order to compare the biomechanical properties of two different cephalomedullary nails, aPFN and the PROFIN under axial loading, based on the questions that can a single lag screw with an antirotator blade render better rotational stability? Is there a difference between one lag screw or two lag screws with respect to superior migration or cut-out of the screws? And do different nail designs cause different types of failure and what are the pros and cons of classical and new designs from the view point of biomechanical aspects?Methods: Ten pairs of third generation synthetic bone models simulating unstable intertrochanteric fracture were used for biomechanical testing.Results: No posterior displacement of screws was recorded in both groups suggesting rotational unstability.  There was not a significant difference between forces values loaded at the time of failure.Conclusions: Although there was no statistically significant difference between compressive strengths at the time of failure, aPFN may provide equal rigid fixation with less possible cut-out which may have an important consequences in real clinical applications

Factors Affecting the Outcome in Traumatic Subarachnoid Hemorrhage

Objective: To define risk factors affecting the outcome in traumatic subarachnoid hemorrhage.Material and Methods: Forty-four patients with traumatic subarachnoid hemorrhage were evaluated retrospectively. They were divided into three groups according to their age: elderly (≥65 years), adult (16- 64 years), and children (<16 years). The clinical picture on admission was evaluated using the Glasgow Coma Scale. The patients were also divided into three groups according to their coma grading on admission: mild injury (Glasgow Coma Scale score 13-15), moderate injury (8-12), and severe injury (3-7). The amount of subarachnoid blood shown in computerized tomography was evaluated according to the Fisher index, and additional tomography findings were recorded. At last follow-up, presence of headache and neurological deficits as well as return to work or school were investigated, and the last clinical picture was evaluated with the Glasgow Outcome Scale.Results: There were 11 children, 23 adults and 10 elderly patients. Twelve patients died between 1-49 days after trauma; the others were followed for a mean of 14.6 months (from 10 to 30 months). In the children group, Glasgow Coma Scale score was significantly higher (p=0.004), subarachnoid blood amount was significantly lesser, and Glasgow Outcome Scale score was significantly better compared to the other groups. For all groups, higher trauma severity on admission was associated with higher Fisher index (p=0.016). Most important factors affecting clinical results were severity of head injury on admission (p=0.0001), Fisher index (p=0.003), and presence of additional findings on computerized tomography (p=0.0001).Conclusion: Traumatic subarachnoid hemorrhage usually has a good clinical outcome in children; however, in elderly patients, the outcome is worse, and there are usually additional intracranial traumatic lesions. Most important factors affecting outcome are blood amount on first computerized tomography, head trauma severity, and presence of additional intracranial traumatic lesions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A rare complication of lumbar disk surgery: Ureteral avulsion

A 49-year-old woman was admitted to our clinic with high fever, left lumbar pain and a mass at the flank following spinal surgery for disk disease. Complete left ureteral avulsion with urinoma formation was detected and she was treated with ureteroureterostomy. As in this case shows that the possibility of ureteral injury to the ureter during surgery for a disk hernia should be familiar to all neurosurgeons, orthopedic surgeons and urologists. When the diagnosis is made during early postoperative period, good results with preservation of the kidney can be achieved

Management of renal abscess formation after embolization due to renal angiomyolipomas in two cases

Current management strategies of renal angiomyolipomas (AMLs) include observation, embolization and partial or total nephrectomy. Selective arterial embolization is an effective and safe treatment of large angiomyolipomas with low complication rates. Percutaneous drainage was the recommended treatment for renal abscess formation following the embolization. Herein we describe two cases which we performed percutaneous drainage of the liquefaction of entire tumors after embolization. Open surgery was needed for one of the patients who showed recurrence after percutaneous drainage and alcohol irrigation of the cavity, whereas percutaneous drainage was the sufficient treatment for the other patient as recommended

What Do Productivity Shocks Tell Us About The Saving-Investment Relationship?

This study is a contribution to the empirical literature on the significance of productivity shocks in explaining a high saving-investment correlation, using data from a panel of 21 OECD countries over the period 1970-2003. The study looks at the distributional properties of the productivity shocks in order to test if productivity shocks can relate saving to investment. To this end, we divide the countries into three groups with respect to the distributional characteristics of productivity shocks in each country with an application of the Fuzzy-c-means (FCM) clustering technique. The results provide some support for the productivity shock argument, indicating that the saving retention coefficients are greater for the countries subject to large productivity shocks in magnitude.WoSScopu

What Do Productivity Shocks Tell Us About the Saving-Investment Relationship?

This study is a contribution to the empirical literature on the significance of productivity shocks in explaining a high saving-investment correlation, using data from a panel of 21 OECD countries over the period 1970-2003. The study looks at the distributional properties of the productivity shocks in order to test if productivity shocks can relate saving to investment. To this end, we divide the countries into three groups with respect to the distributional characteristics of productivity shocks in each country with an application of the Fuzzy-c-means (FCM) clustering technique. The results provide some support for the productivity shock argument, indicating that the saving retention coefficients are greater for the countries subject to large productivity shocks in magnitude.Productivity Shocks, Kolmogorov-Smirnov Statistics, International Capital Mobility, Fuzzy Clustering, Feldstein-Horioka Puzzle