The laparoscopic stylet

A new instrument, laparoscopic stylet, developed for the laparoscopic extraction of the ureteral and renal pelvis calculi is described. The laparoscopic stylet is made of chromium nickel as a modification of the classical stylet. Until now, this instrument has been used in 11 retroperitoneoscopic ureterolithotomy operation and found to be quite useful for the mobilisation and extraction of the calculi from the ureters, suggesting its probable use also in the laparoscopic pyelolithotomy procedures.

The outcome of tuberculosis in patients on chronic hemodialysis

AIM

In patients on regular hemodialysis, the incidence of tuberculosis is high.

MATERIAL

We present 18 (6.08%) tuberculosis patients among 296 patients on regular hemodialysis between 1980 and 1996.

RESULTS

Pulmonary tuberculosis was seen in 11 (61%) patients, 7 (38%) of whom presented with pleural effusion. Tuberculosis was extrapulmonary in 7 (38%) patients. There were 4 (22.2%) patients with tuberculous lymphadenitis, 2 (11.1%) with tuberculous peritonitis, 1 (5.5%) with urinary tuberculosis. Intermittent fever, malasia and dyspnea were the most common symptoms. The mean duration on hemodialysis before diagnosis of tuberculosis were 22.22+/-7.19 months and the mean duration of symptoms prior to treatment were 34.16+/-3.36 days. Tuberculosis was diagnosed in 10 (55.5%) patients within the first 4 months of dialysis and in 8 (44.4%) between the 1st and the 8th year of hemodialysis treatment. Our patients were treated with isoniazid, rifampicin, morfazinamid and ethambutol. Four patients died within the first 4 months of the antituberculosis therapy, in all of whom tuberculosis was diagnosed within the 4 months of dialysis. In patients who died, duration of symptoms ranged from 30 days to 60 days, mean 42 days. Overall mortality was 22.2% and correlated with the duration of symptoms prior to initiation of antituberculosis and hemodialysis therapy. Fourteen patients (77.7%) who survived longer than one year were clinically cured.

CONCLUSION

Our results suggest that the mortality of tuberculosis is high in patients in the early phase of maintenance dialysis and delay in the disease treatment of tuberculosis. Because of their generally poor state of nutrition, and depressed cellular immunity, the mortality is high in patients in the early stage of maintenance hemodialysis. Therefore, if the diagnosis is delayed, mortality is higher. Tuberculosis should be considered strongly and treated promptly if suspected.

Prevalence of chronic bronchitis and associated risk factors in a rural area of Kayseri, Central Anatolia, Turkey

This population-based cross-sectional survey was carried out to determine the prevalence of chronic bronchitis and associated risk factors in a rural area of Kayseri, Central Anatolia, Turkey. Subjects (1,023) aged 20-83 yrs (81.8% of eligible subjects) were interviewed using a modified version of the adult questionnaire compiled by the European Community Respiratory Health Survey. Subjects with "presence of cough and phlegm on most days during at least three months per year for at least the two previous years" were classified as having chronic bronchitis. According to the criteria used, 138 (13.5%) were classified as having chronic bronchitis. The prevalence was higher in males (17.8%) than females (10.0%). There was no overall significant association between chronic bronchitis and age in males, but, in females, the difference between age groups was important. There was no association between chronic bronchitis and family income, although the prevalence was highest in the low-income group. Subjects who reported childhood respiratory illnesses had a 1.7-fold increased risk of chronic bronchitis compared to those without such a history. The prevalence was much higher among people exposed to biomass fuel combustion and among smokers and exsmokers than among nonsmokers. In multivariate analyses, a significant increase in the prevalence of chronic bronchitis was seen in males, those who had received poor schooling, those reporting childhood respiratory illnesses, and those exposed to biomass fuel combustion and according to smoking habit.

Low dose (1 microg) adrenocorticotropin stimulation test in the evaluation of hypothalamo-pituitary-adrenal axis in patients with active pulmonary tuberculosis

Adrenocortical function in patients with active pulmonary tuberculosis is a debate of matter. Previous studies related to adrenocortical function in patients with active pulmonary tuberculosis demonstrated a high rate of suboptimal cortisol response to standard dose ACTH (250 microg) stimulation test. The aim of this study was to assess the hypothalamo-pituitary-adrenal (HPA) axis in low dose (1 microg) and standard dose ACTH (250 microg) stimulation tests in the patients with active pulmonary tuberculosis. Twenty-seven patients and 21 healthy subjects were included in the study. Cortisol levels were measured before, 30 and 60 min after ACTH (1 microg or 250 microg iv) injection. Cortisol responses to 1 microg ACTH at 30 and 60 min were significantly higher in the patient group than in the control group (p<0.05). Peak cortisol levels were significantly higher in the patient group than in the control group after both 1 microg and 250 microg ACTH administration (p<0.05). Cortisol responses to 250 microg ACTH at 30 and (at 30 and 60) 60 min were significantly higher in the patient group than in the control group (p<0.05). Peak cortisol levels obtained after 250 microg ACTH and after 1 microg ACTH were similar in the patient group (p>0.05). This study shows that 1 microg ACTH iv gives an equivalent peak cortisol value to 250 microg ACTH in patients with activated HPA axis. The cortisol levels obtained at 08:00, 11:00, 17:00 and 24:00 h were significantly higher in the patients than in the controls. This study clearly shows that HPA axis is activated in active pulmonary tuberculosis rather than underactivated.

Posterior mediastinal goiter

A patient with chronic cough and recent dysphagia was found to have a retrotracheal mass extending into the mediastinum on chest radiography. A computed tomographic scan confirmed a retrotracheal posterosuperior mediastinal lesion which was believed to have a neurogenic origin. A thyroid 131I scan revealed no uptake of tracer in the chest and results of thyroid function tests were normal. A large retrotracheal colloidal nodular goiter was excised through a right thoracotomy. The diagnostic approach and the safety of surgical access by thoracotomy for thyroid lesions in this unusual site are discussed.

The first case of periureteric hibernoma. Case report

Hibernoma is a rare type of soft tissue neoplasm originating from brown fat tissue. The present case is the first periureteric hibernoma concentrically surrounding the ureter with a concomitant renal pelvis stone.

Management of undeflatable Foley catheter balloons in women

The inability to deflate a self-retaining balloon catheter is a rare problem but may be encountered by physicians. Many techniques have been described to solve the problem, some of which may be dangerous. The technique must not disturb the patient or create any additional morbidity. Those methods commonly used are the instillation of ether, liquid paraffin, chloroform or mineral oil through the inflation channel the use of a fine wire to burst the balloon or to recanalize the obstructed inflation channel; bursting or deflating the balloon through suprapubic, transvaginal or urethral routes: and the overinflation technique. The techniques which might be most appropriate for women are explained in a stepwise manner. First the catheter is cut in the proximal segment of the valve. If this is not successful, a ureteric catheter stylet is advanced through the inflation channel until it touches the balloon. If this is still unsuccessful, the balloon is deflated through the drainage channel using the technique proposed by Davies and Thomas. As a second choice, an intravenous cannula with its inner needle drawn back is advanced through the urethra next to the catheter; towards the balloon which, is then punctured with the inner needle. If these steps are followed, the patient will have no additional discomfort and no trauma to the surrounding tissues, and there will be no need for cystoscopy or any other expensive intervention.

Changes in the size of adrenal glands in acute pulmonary tuberculosis with therapy

Adrenal glands may be involved during both acute and chronic tuberculosis. They are enlarged in acute pulmonary tuberculosis. We aimed to investigate the changes in adrenal size in acute pulmonary tuberculosis before and after therapy in a prospective study. Eleven hospitalized patients with newly diagnosed sputum positive pulmonary tuberculosis were studied. Basal cortisol levels were measured in the patients before and after the therapy. Cortisol levels were also measured 30 and 60 min after Synacthen (250 micrograms i.v.) injection in the patients before the therapy. The size of the adrenal glands was measured by computerized tomography. The maximum width perpendicular to the long axis of the body of the gland, maximum width of the medial and lateral limbs and the length of the adrenals were measured. All measurements were done before and after the eight-month anti-tuberculosis therapy. All 11 patients had an intact adrenal cortisol reserve. Both the width and length of the right and left adrenal glands were significantly greater before the therapy than after the therapy. We conclude that adrenal enlargement demonstrated by computerized tomography in acute pulmonary tuberculosis is reduced after appropriate therapy.

A comparison of various methods to burst Foley catheter balloons and the risk of free-fragment formation

OBJECTIVE

To compare the efficiencies of bursting balloons and the risks of forming free fragments after rupture using needles, the stylet of a ureteric catheter, instillation with ether or overinflation.

MATERIALS AND METHODS

Two hundred 18 F 'silkolatex' Foley balloon catheters were divided into four groups of 50. Each balloon was inflated with 30 mL of distilled water, the catheters immersed in urine collected from healthy volunteers and maintained at 37 degrees C for 48 h. Attempts were made to burst the balloons with a needle (group 1), by overinflation (group 2), by ether instillation (group 3) and using the stylet of 7 F ureteric catheter through the inflation channel (group 4).

RESULTS

The ratio of the burst to deflated balloons and the formation of free fragments were 100% and 0% in the group 1, 94% and 83% in the group 2, 100% and 100% in group 3 and 16% and 0% in the group 4, respectively.

CONCLUSION

Bursting the catheter balloons using a needle seems to be the most appropriate method, being efficient and having little risk of forming free fragments.

[Evaluation of 18 epididymo-orchitis cases]

Eighteen patients with epididymo-orchitis were reviewed clinically, microbiologically and serologically. While there were positive urine culture in 5 patients before treatment, only one of them had positive culture in the epididymal aspirate. The epididymo-orchitis in two patients was the complications of the brucellosis. Ofloxacin or doxycycline was used in the treatment of 16 patients for 2-3 weeks and all, except one patient were recovered completely. The cases secondary to the brucellosis were treated with rifampicin plus doxycycline combination for 6 weeks. After treatment, no positive urine cultures were noted in all patients. As a result the epididymal aspiration to clarify etiological agent is not necessarily needed and empirical treatment may be generally curative.

Urethrocutaneous fistula due to a coil of hair

Strangulation of the penis by a coil of hair is often an unrecognized clinical entity with severe potential complications. In this report, a five-year-old boy with urethrocutaneous fistula caused by the wrapping of a single strand of hair around the penis is presented.

Seminal parameters of ejaculates collected successively with sixty minute interval in infertile men: effect of combination of prazosin and terbutaline on these parameters

Out of 37 infertile men, 33 who were able to give two ejaculates by masturbation successively with a sixty minute interval, were studied. There was no significant change in sperm density in the second ejaculation whereas seminal volume decreased (P less than 0.01) and sperm motility increased (P less than 0.05) significantly. After a seven-day treatment with combination of prazosin (alpha 1-blocker) and terbutaline (beta 2-stimulator), the same successive ejaculates were obtained from only 27 of these patients. In this case sperm density and motility changed insignificantly, whereas seminal volume again decreased (P less than 0.01) significantly. The changes in seminal parameters were not significant between the pre- and post-treatment second ones. In a short-term study there are not any alterations to observe. The favourable results with a long-term treatment, published by Japanese authors, require a confirmation by further studies.

The effects of caffeine and theophylline on the triple adenosine triphosphatase enzyme activities of spermatozoa from males with oligoasthenospermia

The triple ATPase activities of washed spermatozoa of oligoasthenospermic men (but not of normals) were enhanced by the addition of caffeine and theophylline, which are known to have a stimulating effect on sperm motility. The biochemical mechanism of action of caffeine and theophylline on sperm homeostasis is discussed.

The effect of spermine, spermidine and kallikrein on the triple adenosine triphosphatase enzyme activity of spermatozoa in males with oligoasthenozoospermia

Unknown factors in the seminal plasma of normal semen that affect the motility of spermatozoa have a positive effect on adenosine triphosphatase (ATPase) enzyme activity. In an attempt to produce such an effect, spermine, spermidine and kallikrein were added to the incubation media in which spermatozoal ATPase enzyme activity was determined. These seminal substances increased the triple ATPase enzyme activity of spermatozoa from oligoasthenozoospermic men. We propose that the ATPase enzyme activity of spermatozoa may indicate sperm motility as a biochemical test.

Effect of testicular torsion on the contralateral testis and prevention of this effect by prednisolone

This study was instituted to evaluate the effect of unilateral testicular torsion on contralateral testicular histology and the prevention of this effect by prednisolone. Fifty Swiss albino rats were equally divided into 5 groups. In group 1, it was observed that, due to torsion, the mean seminiferous tubular diameter and percentage of spermatogenetic activity of the contralateral testes were reduced and an inflammatory reaction was also noted. In group 2, detorsion increased the above-mentioned damage, and in group 3, orchiectomy failed to prevent it. In group 4, it was seen that prednisolone slightly increased the mean percentage of spermatogenetic activity and produced proliferation of the Leydig cells in the intact testicle. In group 5, when prednisolone was injected just after torsion, no damage to the contralateral testes appeared. It has been thought that damage to the contralateral testes may arise from an autoimmune mechanism and prednisolone appeared to be very helpful in preventing damage by immunologic suppression.