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    Experience with renal gunshot injuries in a rural setting
    (Elsevier Science Inc, 1999) Ersay, A; Akgün, Y
    Objectives. To investigate the high nephrectomy rate in patients with gunshot injury at Dicle University Medical School Research Hospital and to determine the factors that affect our nephrectomy decision. Methods. During a 4-year period, 71 patients were hospitalized for renal injuries at our hospital. Renal gunshot injuries (RGIs) were noted in 45 kidneys of 42 patients (59.1%). Twenty-five patients underwent nephrectomy (55.5%). Twenty kidneys were reconstructed (44.4%). The hospital records were reviewed retrospectively. In these two groups of patients, the following clinical data were entered into a computer data base and compared: presence and type of hematuria, type and degree of renal injury, hemodynamic status, results of imaging studies, surgical technique, type of weapon, reason for nephrectomy, associated organ injury, injury severity score, complications, and mortality. Results. The patients who underwent renal repair and those who underwent nephrectomy had a mean injury severity score of 33.6 +/- 7.5 and 42.0 +/- 9.9, respectively (P < 0.001). The main grade of injury was 4.4 +/- 0.8 in nephrectomy patients and 2.8 +/- 0.9 in the patients for whom renal salvage was possible (P < 0.05). Patients who required nephrectomy, as a group, appeared to have a higher rate of high-velocity bullet injury (HVBI) (76%) (P < 0.05) and higher numbers of associated abdominal injury (P < 0.05). Conclusions. HVBI makes extensive tissue debridement imperative and reconstruction difficult. We believe that in RGIs caused by a high-velocity bullet, nephrectomy is more likely to be required. Hemodynamic instability was the major reason for our intraoperative nephrectomy decision. HVBI should be accepted as a subcategory of RGI.
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    Intravesical oxybutynin application: Ultrastructural effects on bladder epithelium.
    (Mbr Press Inc, 1999) Ersay, A; Ketani, MA; Nergiz, Y; Demirtas, OC; Akkus, M; Otludil, B
    Intravesically applied oxybutynin, rapidly absorbs into the bloodstream, additional to profound local effect. Currently morphologic effects of oxybutynin on local bladder tissue relatively well established at light microscopic level, but not ultrastructural level. Thirty New Zealand White female rabbits were catheterized daily and intravesical instillation were performed with whether 1mg/kg oxybutynin solution or saline for 30 days. The local effects of the drug on bladder epithelium at electron microscopic level were examined comparing with saline administration. Urinary tract infection (UTI) incidence were similar in both saline and oxybutynin groups (9 vs. 10 of 15 animals respectively) (p>0.05). Interestingly, in 4 of 5 animals that received oxybutynin and never had UTI during the study, separation of zonula occludens intercellular junction was determinated by Jeol electron microscope. This observation can explain rapid absorption of oxybutynin through the bladder into the blood stream. Oxybutynin can damage bladder surface epithelium at ultrastructural level. This effect may lead to increase absorption of it, but not result in higher incidence of bacterial infection.
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    Quantitative residual cortical activity measurement: Appropriate test for diagnosis of renal artery stenosis?
    (Karger, 1999) Gezici, A; Ersay, A; Antevska, E; Heidental, GK; Schreij, G; Demirtas, OC
    Objectives: To evaluate the diagnostic validity of quantitative measurement of residual cortical activity (RCA) in renal artery stenosis (RAS). Methods: In 45 patients with a high clinical likelihood of renovascular hypertension (RVH) and unimpaired renal function, dynamic imaging was performed after an intravenous bolus injection of 148 MBq Tc-99m MAG3 for both baseline renoscintigraphy and captopril renography following oral application of 50 mg captopril. RCA was measured according to the Sfa-kianakis method: RCA = cortical counts at 20 min/counts at peak x 100%. An increase in RCA of greater than or equal to 5% from baseline was considered indicative of RAS. After renography, all patients underwent selective transfemoral angiography with the digital subtraction technique. A luminal reduction of greater than or equal to 50% was considered as proof of RAS. Results: The number of kidneys that had a change of 15% in RCA values was 12 (27.2%) in normal kidneys, 7 (58.3%) in the patients with bilateral RAS, 14(82.3%) in the patients with unilateral RAS, and 21 (72.4%) in overall kidneys with RAS. The positive test ratio in pathologic groups was significantly higher than normal (p < 0.05). The sensitivity and specificity of the RCA test were 72.4 and 72.7%, respectively; the positive and negative predictive values were 63.6 and 80%, respectively. Conclusion: Quantitative measurements of RCA can be used as a diagnostic parameter of renal artery stenosis and may contribute of the diagnostic accuracy of visual interpretation and other renographic diagnostic criteria.