Comparison of Transrectal Ultrasonography-Guided Prostate Biopsies Analgesia's; Rectal Lidocaine Gel Versus Sandwich Anesthesia (Transurethral Plus Transrectal Lidocaine Gel Administration): A Double-Blind, Randomized, Controlled and Prospective Study

Objectives

We aimed to evaluate the effectiveness of the additive transurethral anesthetic agent to transrectal anesthetic agent.

Methods

Transrectal ultrasound-guided 12 core prostate biopsy planned, 237 patients included in our study. The patients randomly divided into two groups. Group 1 (n=113): Only transrectal 2% lidocaine, Group 2 (n=124): Transrectal + Transurethral(Sandwiches) lidocaine gel given to the patients 10 min before the procedure as anesthesia. Immediately after the biopsy, the patient questioned about the level of pain he felt during the needle entry. The evaluation measured by the VAS score. Immediately after biopsy satisfaction rate with the procedure and if rebiopsy was required, acceptance was scored between 1 and 4. The two groups compared statistically.

Results

The mean VAS score of Group 1 and Group 2 was 4.88±1.89 and 3.77±1.83, respectively. The pain level of Group 2 was lower than Group 1' pain level. The difference between the two groups was considered statistically significant (p<0.001). The patient satisfaction rates of Group 1 and Group 2 found to be 2.45±0.71 and 2.78±0.66, and the acceptance rate of rebiopsy was 2.81±0.69 and 3.02±0.51, respectively. The patient satisfaction rate and acceptance rate of the rebiopsy of Group 2 were higher than Group 1. Patient satisfaction level (p<0.001) and rebiopsy acceptance rate (p=0.014) between the two groups found to be statistically significant.

Conclusion

In the TRUS-guided prostate biopsies, sandwich anesthesia is a cheap, convenient, tolerable, and effective method.

Foreign Body Implanted Into the Penis During Traffic Accident

Although there are some reports describing foreign body implantation into the penis by intentional manipulation, no records about patients got aware of it many years after traffic accidents. A 29-year-old male patient had been severely injured in a traffic accident 13 years ago. Following a coma state for several months, he had no any symptom for a long time. Four years later, he got aware of the inconvenience on the ventral side of his penis during erection. His partner had also complained of pain during coitus. When he was admitted to our clinic, there was a semi-mobile, fibrous dense 2x2 cm knob on the ventral side of the penis consisting of a coronal sulcus. Under local anesthesia, we got out of a piece of glass. He was discharged after enough follow-up periods without complication. The interesting point of this case was not the clinical condition of the patient; it was that no one could consider a coma patient would have a complaint of penis injury several years later. This case showed us, one more time, how important the complete physical examination was.

Morphometric features of the thyroid gland: a cadaveric study of Turkish people

BACKGROUND

Although racial and ethnic variations in the morphology of anatomical structures are defined well, the size, shape, and weight of the thyroid gland have not previously been reported in Turkish people. This study provides data about the morphometric features of the thyroid gland, thyroid lobes, and pyramidal lobe, and highlights some anatomical variations in people from the Marmara region in Turkey.

MATERIAL AND METHODS

The material for the present study consisted of thyroid glands obtained from 75 male and 15 female adult cadavers aged between 18 and 80 years. A dissection was carried out and the thyroid glands were exposed. The glands were weighed and measured according to the various age groups of the patients.

RESULTS

A pyramidal lobe was found to be present in 57.8% of the cadavers (52/90). During midline dissection of the neck 2 males out of 90 cadavers, giving an incidence of 2.22%, did not show an isthmus. The mean thyroid weight was 26.11 ± 8.14 g. In males it was 26.93 ± 7.96 g while in females it was 21.93 ± 7.98 g.

CONCLUSIONS

This is the first reported morphometric study on cadaveric thyroid glands from Turkey and it highlights individual and ethnic/racial variations. In order to perform safe and effective surgery and for the accurate diagnosis of thyroid disorders, knowledge of normal anatomy and the variations of the thyroid gland are essential.

Black esophagus: a rare autopsy case

The black esophagus is a rare entity of an acute esophageal necrosis described at endoscopy and typical histological properties of a diffuse mucosal necrosis. The presented case was a 17-year-old girl; admitted to the hospital with an abdominal distantion and vomiting, who died soon after admittance. The case was investigated by local prosecutor, as the cause of the death was unknown; a forensic autopsy was mandated and later performed in our department. During autopsy on macroscopic examination an acute esophageal necrosis with black colored esophageal mucosa was detected. In this case report, we aimed to explain the autopsy findings, clinical presentation, histological appearance, risk factors and pathogenesis of the disease from the medico legal point of view (Tab. 1, Fig. 1, Ref. 5).

Allergic myocardial infarction due to hydatid cyst: an autopsy case

Hydatid disease is a parasitic tapeworm infestation. Anaphylactic reactions as a result of cyst perforation generally occur after trauma during a spread of cystic fluid in the intravascular space, which may also initiate anaphylaxis. The reported case was a 17-year-old boy who was admitted to the hospital emergency department with a sudden onset of nausea, vomiting and fainting, resulting in death. The cause of his sudden death was unknown. Autopsy macroscopically revealed hydatid cysts in the liver. In the histopathological examination, hydatid cyst was recognized by scolices and also an inflammatory infiltration composed mainly of mast cells in the myocardium was detected. Sudden death in this case was attributed to allergic myocardial infarction due to intravascular spread of the hydatid cyst content (Fig. 2, Ref. 10).

Blast injury: lessons learned from an autopsy

Blast injury is becoming more common in the non-military population but it is still rare to see such injuries and deaths unrelated to terrorist acts. The exact mechanisms involved in blast injuries are unclear. Civilian physicians and surgeons need to have a basic understanding of the patho-mechanics and physiological effects of blast injuries. We report a case where a 31-year-old male accidentally detonated a diesel storage tank. His autopsy findings provide useful information for those who investigate explosive-related deaths.