Siirt Ulu Cami Minaresi

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180-W XPS GreenLight laser vaporization for benign prostate hyperplasia: 12-month safety and efficacy results for glands larger than 80 ml

WOS: 000348297900042PubMed ID: 25274195The purpose of the current study was to evaluate the efficacy and safety of laser prostatectomy by using the latest 180-W XPS GreenLight laser with the new MoXy fiber in the surgical treatment of glands larger than 80 mL in a prospective study. From December 2011 to May 2013, 68 consecutive patients with a mean age of 71.1 +/- 9.8 years (range 49 to 85) underwent 180-W XPS laser prostatectomy at our institution. The baseline characteristics, perioperative data, and complications were recorded. Evaluation of outcomes was assessed at 3, 6, and 12 months postoperatively comparing subjective (International Prostate Symptom Score [IPSS], International Index of Erectile Function-5 [IIEF-5]) and objective (Maximal flow rate [Q(max)], postvoid residual urine [PVR], transrectal ultrasound [TRUS] volume) parameters to the preoperative data. Mean preoperative prostate volume was 104.3 +/- 29.7 mL (range 81 to 185). Mean operation time was 65.5 +/- 29.6 min (range 38 to 124), with a mean energy delivery of 398 +/- 169 kJ (range 39 to 523). The catheterization time was 20.8 +/- 1.9 h (range 6 to 92) and the hospital stay was 27.3 +/- 8.7 h (range 12 to 80). No major intraoperative complications were observed. Improvement in IPSS, Q(max), and PVR was statistically significant (p < 0.001) at 3, 6, and 12 months. Urethral strictures were observed in two patients (2.9 %). No patients required reintervention due to residual adenoma. The average volume reduction was 40.5 % at 12 months. Photoselective vaporization of the prostate (PVP) using the new 180-W XPS GreenLight laser system seems to be a safe and effective procedure and could play an important role in the surgical treatment of symptomatic benign prostatic hyperplasia (BPH) patients with larger prostate volumes

Üreter taşı hastalarında postüreteroskopik lezyon skalası ile emilen irrigasyon sıvısı arasında bağlantı var mı?

Objective: Post-Ureteroscopic Lesion Scale (PULS) is used to classify ureteral wall injury that occurs during ureteroscopy. In this study we presented the preliminary results of absorbed irrigation fluid volumes according to PULS grades. Material and Methods: Forty-four patients to whom 7F semirigid ureteoscopy was performed due to ureteral stone were included in the study. All patients received general anesthesia. Izotonic containing 1% ethanol was used as irrigation fluid. Ethanol concentration in venous blood was commenced to be measured at the start of irrigation use and was carried on at 15-minute intervals including the post-operative period in the recovery room. Absorbed fluid volume was calculated by using blood ethanol concentrations. Irrigation time, stone size and PULS grade were recorded. Results: Mean operation time was found to be 44.2 ± 19.9 minutes. Mean stone size was measured to be 12.7± 6 mm and mean irrigation fluid amount used was 1371±1262 ml. PULS grade of 0 was seen in 26 patients and that of 1 or more was seen in 18 patients. No patient had a PULS grade of 3 or 4. Mean absorbed fluid volume was measured to be 58 ± 50,6 ml. No significant correlation was found between PULS grade and mean absorbed fluid volume. Conclusion: Fluid absorption during URS is not correlated with the PULS grade. Semirigid URS is a safe treatment option for ureteral stone disease in terms of the level of irrigation fluid being absorbed.Amaç: Üreteroskopi esnasında üreter duvarında oluşan hasarı sınıflandırmak için Post-Üreteroskopik Lezyon Skalası (PULS) kullanılmaktadır. Bu çalışmada PULS derecelerine göre absorbe edilen irrigasyon sıvı hacimlerinin ön sonuçlarını sunduk. Gereç ve Yöntemler: Bu çalışmaya üreter taşı nedeniyle 7 F semirijid üreteroskopi uygulanan 44 hasta dahil edildi. Tüm hastalara genel anestezi uygulandı. %1 etanol içeren izotonik irrigasyon sıvısı olarak kullanıldı. Venöz kan etanol konsantrasyonları irrigasyon kullanılmaya başlaması ile ölçülmeye başlandı, operasyon sonrası derlenme odasını kapsayacak şekilde 15 dakika arayla periyodik ölçüldü. Absorbe edilen sıvı hacmi kan etanol konsantrasyonları kullanılarak hesaplandı. İrrigasyon süresi, taş boyutu, PULS derecesi kaydedildi.Bulgular: Ortalama operasyon süresi 44.2 ± 19.9 dakika olarak saptandı. Ortalama taş hacmi 12.7± 6 mm ve ortalama kullanılan irrigasyon sıvı miktarı 1371±1262 mL olarak ölçüldü. Hastaların 26’sınde PULS derecesi 0 iken 18’inde 1 veya üzerindeydi üzerindeydi. Hiçbir hastada PULS derecesi 3 veya 4 olmadı. Ortalama absorbe edilen sıvı hacmi 58 ± 50,6 mL olarak hesaplandı. PULS derecesi ile ortalama absorbe edilen sıvı miktarı arasında istatistiksel anlamlı fark saptanmadı.Sonuç: URS esnasında oluşan PULS derecesi 1-2 olan veya düşük dereceli submukozal üreter lezyonlarıyla sıvı emilimi korele bulunmamıştır. Semirijid URS, üreter taşı hastalığı tedavisinde irrigasyon sıvısının emilimi açısından güvenli bir yöntemdir

The treatment of acute myocardial infarction due to the occlusion of the left main coronary disease

Acute myocardial infarction (AMI) due to the occlusion of the left main coronary artery (LMCA) is a rare but serious condition in the era of percutaneus coronary intervention (PCI). Even more rare is AMI involved with both LMCA and its branches like trifurcartion or bifurcation: this is challenging for interventional cardiologists, because it involves the extension of the myocardium complicated by cardiogenic shock and its technical difficulties. Trifurcating coronary artery disease is a complex atherosclerotic process involving the origin of one or more of three side branches arising from a left main coronary vessel or trunk, with or without the involvement of LMCA itself. There is no classification or standardized methodology to treat LMCA disease in elective percutaneous intervention procedures. Furthermore, acute myocardial infarction presenting with left main coronary artery trifurcation lesion seems to be more troublesome, especially in young patients. Few series of PCI on significant lesions of the left main trifurcations have been described. Herein, we describe a patient who successfully underwent PCI and was supported by post intravascular ultrasound sonography and multislice computed angiography (MSCA), and after an uneventful follow-up with MSCA is now on the ninth month. (Cardiol J 2011; 18, 1: 77-82

Blood transfusion improves renal oxygenation and renal function in sepsis-induced acute kidney injury in rats

Background: The effects of blood transfusion on renal microcirculation during sepsis are unknown. This study aimed to investigate the effect of blood transfusion on renal microvascular oxygenation and renal function during sepsis-induced acute kidney injury. Methods: Twenty-seven Wistar albino rats were randomized into four groups: a sham group (n = 6), a lipopolysaccharide (LPS) group (n = 7), a LPS group that received fluid resuscitation (n = 7), and a LPS group that received blood transfusion (n = 7). The mean arterial blood pressure, renal blood flow, and renal microvascular oxygenation within the kidney cortex were recorded. Acute kidney injury was assessed using the serum creatinine levels, metabolic cost, and histopathological lesions. Nitrosative stress (expression of endothelial (eNOS) and inducible nitric oxide synthase (iNOS)) within the kidney was assessed by immunohistochemistry. Hemoglobin levels, pH, serum lactate levels, and liver enzymes were measured. Results: Fluid resuscitation and blood transfusion both significantly improved the mean arterial pressure and renal blood flow after LPS infusion. Renal microvascular oxygenation, serum creatinine levels, and tubular damage significantly improved in the LPS group that received blood transfusion compared to the group that received fluids. Moreover, the renal expression of eNOS was markedly suppressed under endotoxin challenge. Blood transfusion, but not fluid resuscitation, was able to restore the renal expression of eNOS. However, there were no significant differences in lactic acidosis or liver function between the two groups. Conclusions: Blood transfusion significantly improved renal function in endotoxemic rats. The specific beneficial effect of blood transfusion on the kidney could have been mediated in part by the improvements in r

Quantification of Three-Dimensional Cell-Mediated Collagen Remodeling Using Graph Theory

Background: Cell cooperation is a critical event during tissue development. We present the first precise metrics to quantify the interaction between mesenchymal stem cells (MSCs) and extra cellular matrix (ECM). In particular, we describe cooperative collagen alignment process with respect to the spatio-temporal organization and function of mesenchymal stem cells in three dimensions. Methodology/Principal Findings: We defined two precise metrics: Collagen Alignment Index and Cell Dissatisfaction Level, for quantitatively tracking type I collagen and fibrillogenesis remodeling by mesenchymal stem cells over time. Computation of these metrics was based on graph theory and vector calculus. The cells and their three dimensional type I collagen microenvironment were modeled by three dimensional cell-graphs and collagen fiber organization was calculated from gradient vectors. With the enhancement of mesenchymal stem cell differentiation, acceleration through different phases was quantitatively demonstrated. The phases were clustered in a statistically significant manner based on collagen organization, with late phases of remodeling by untreated cells clustering strongly with early phases of remodeling by differentiating cells. The experiments were repeated three times to conclude that the metrics could successfully identify critical phases of collagen remodeling that were dependent upon cooperativity within the cell population. Conclusions/Significance: Definition of early metrics that are able to predict long-term functionality by linking engineere

SİVAS 4 EYLÜL BARAJI İÇME SUYUNDAKİ MANGANIN LABORATUAR VE TESİS ÖLÇEKLİ GİDERİM VERİMLERİNİN KARŞILAŞTIRILMASI

Potable and service water demand of the city Sivas is being supplied partly with the underground water and partly with the stored water within the active basin of the Sivas 4 Eylül Dam. Released discharge which is supplied from the Sivas 4 Eylül Dam is at first step treated at the Water Treatment Plant of the Sivas Municipality and then directed to the water reservoirs and the city main water network. It has been observed that manganese concentration within the potable water supplied from the Sivas 4 Eylül Dam has been increasing during the autumn months (October 2010). Within the scope of this study, appropriate coagulant selection and its optimum dosage determination has been targetted for manganese disposal within the potable water by trying different coagulants via Jar test at laboratory medium. Most appropriate coagulant and its optimum dosage which was determined as a conclusion from the Jar test carried out at laboratory has been applicated at the Water Treatment Plant of the Sivas Municipality. (KMnO4); permanganet of potassium as coagulant, (FeCl3); ferric [Iron (III)] chloride and Anionic Polyelectrolyte as coagulant ancillary chemical has been used. As a conclusion of the test it was determined that manganese disposal efficiency had been 94.7% in case only KMnO4 was used. It was found out that manganese disposal efficiency had been 96.3% in case KMnO4 together with FeCl3 and anionic polyelectrolyte were used. When the optimum conditions of the laboratory mediumwhere high manganese disposal efficiencies are observed were applicated in the facility ; it has been seen that manganese disposal efficiency was 53.4% when appropriate coagulant and its optimum dosage basing the laboratory tests were applicated at site. As a conclusion it has been determined that higher dosages than the ones obtained from laboratory tests were required to be applicated at practice in case a high level manganese disposal at water treatment plant facilities was desired.Sivas kenti, içme ve kullanma suyu ihtiyacının bir kısmını yer altı sularından bir kısmını ise yüzey sularından karşılamaktadır. Sivas 4 Eylül Barajı’ndan temin edilmiş olan yüzey suyu, Sivas Belediyesi İçme  Suyu  Arıtma  Tesisi’nde  arıtılmakta  ve şehir şebekesine  verilmektedir.  4  Eylül Barajı’ndan temin edilmiş olan içme suyundaki mangan konsantrasyonu, sonbahar aylarında (Ekim 2010) artış göstermiştir. Bu çalışmada; içme suyundaki manganı gidermek için laboratuar ortamında yapılan Jar testi çalışmasıyla farklı koagülantlar kullanılarak optimum dozaj ve uygun koagülant seçimi amaçlanmıştır. Jar testi çalışması sonucunda laboratuarda belirlenen en uygun koagülantlar ve optimum dozajlar, içme suyu arıtma tesisinde uygulanmıştır. Koagülant olarak potasyum permanganat (KMnO4), Demir  (III)  Klorür  (FeCl3)  ve  koagülant  yardımcı  kimyasalı  olarak  da  Anyonik  Polielektrolit kullanılmıştır. Deney sonucunda yalnızca KMnO4 kullanılmasıyla mangan giderim veriminin %94,7 olduğu  tespit  edilmiştir.  KMnO4  ile  birlikte  FeCl3  ve  anyonik  polieletrolit  birlikte  kullanıldığında mangan  giderim  verimi  %96,3  olarak  bulunmuştur.  Mangan  giderme  veriminin  yüksek  olduğu laboratuar ortamındaki optimum koşullar tesiste uygulandığında; laboratuar ölçekli elde edilen uygun koagülant ve optimum dozajın saha ölçeğinde uygulanmasıyla mangan giderim veriminin %53,4 olduğu görülmüştür.  Sonuç  olarak;  yüksek  oranlarda  mangan  giderimi  sağlamak  için  içme  suyu  arıtma tesisinde, laboratuar ölçeğinde elde edilen dozajlardan daha yüksek dozajlara gereksinim duyulduğu tespit edilmiştir.

Fournier's Gangrene: Conventional Dressings versus Dressings with Dakin's Solution

Purpose. Fournier's gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. Methods. Data from 14 patients with Fournier's gangrene were retrospectively collected (2005–2011). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (povidone iodine) dressings (group I, n = 6) or dressings with dakin's solution (sodium hypochloride) (group II, n = 8). Results. The mean age of the patients was 68.2 ± 7.8 (55–75) years in group I and 66.9 ± 10.2 (51–79) years in group II. Length of hospital stay was 13 ± 3.5 (7–16) days in group I and 8.9 ± 3.0 (4–12) days in group II (P < 0.05). The number and rate of mortality was 1/6 (16.7%) in group I, and 1/8 (12.5%) in group II. Conclusions. The hospitalization time can be reduced with the use of dakin's solution for the dressings in the treatment of FG. Also, dressings with dakin's solution seems to have favorable effects on morbidity and mortality. Consequently dakin's solution may alter the treatment of this disastrous disease by reducing cost, morbidity and mortality