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Introduction: We retrospectively assessed our experience with ureteroscopy (URS) for ureteric calculi in prepubertal children. Patients and Methods: The records of all children who underwent URS at our institution for ureteral calculi between September 2007 and July 2009 were retrospectively reviewed. Patient demographics, stone location and size, pre- and postoperative stenting, intraoperative active dilatation, stone-free rates and complications were noted. Results: A total of 26 patients (20 males and 6 females; mean age 59.9 months) underwent 30 URS procedures with rigid ureteroscopes for 31 ureteral calculi. The mean size of ureteral stones was 8.6 mm. A total of 18 URS procedures were performed without any active ureteral dilatation, and 8 patients underwent 12 passive dilatations of initially inaccessible ureters. Stents remained in place for 2–4 weeks. The stone-free rate was 84.6% for all patients and all procedures. Postoperatively, 12 patients (46%) had stent placement for 2–5 days because of stone burden, edema of the ureteral orifice and hematuria. Conclusions: URS treatment of ureteral stones without active dilatation can be performed safely and effectively in prepubertal children. Passive ureteral dilatation might be necessary in some cases to enable ureteral access.

The aim of this study was to assess the feasibility of endovenous laser ablation of incompetent perforator veins in a patient with incompetency of the small saphenous vein and multiple perforator veins. Two different methods were used to ablate seven perforator veins with a laser giving 50-60 J/cm energy. Total occlusion was observed in six perforators, and partial ablation in one perforator, at 1-month follow-up. To our knowledge, endovenous laser ablation of incompetent perforator veins is easy and a good therapeutic method.

To determine the distribution of atherosclerotic peripheral artery disease (PAD) and associated risk factors in patients who have undergone pelvic and lower-limb angiography.Records of 626 consecutive patients (88 women, 538 men; mean age, 62 years; age range, 31-85 y) with PAD were retrospectively reviewed. Severity of limb ischemia was staged according to Rutherford classification of PAD. The arterial system was divided into three segments including aortoiliac, femoropopliteal, and crural segments. PAD was defined as a greater than 50% stenosis or occlusion of any segment. Univariate and multivariate analyses were used to determine associations between segmental arterial disease and patient demographics, medical history, and angiographic findings.Of the 626 patients, 400 (64%) had multisegmental disease, the most common form of which was combined femoropopliteal and crural disease (25%). A significant association was found between severity of limb ischemia and distribution of PAD. Intermittent claudication was significantly associated with aortoiliac disease (odds ratio, 2.15; P.001), whereas critical limb ischemia was associated with crural disease (odds ratio, 2.5; P = .001) on multivariate analysis. Significant associations were found between smoking and aortoiliac, femoropopliteal, and multisegment disease; between diabetes mellitus and crural disease; and between age and femoropopliteal and multisegment disease.PAD was multisegmental in most of the patients in this study group. Different clinical risk factors predict the involvement of different arterial segments. Severity of limb ischemia was significantly associated with the distribution of PAD.

Objectives Tensile distracting forces caused by elements such as a muscle pull can cause widening of scars in the tissue during the wound healing process. The aim of the present study was to investigate whether induced immobilization of the urethral muscle using botulinum toxin-A (BTX-A) enhances wound healing and also reduces the amount of scar formation in an experimentally induced urethral injury in a male rat model. Methods Prepubertal male albino rats were divided into 2 groups: 20 rats in the BTX-A group received BTX-A injection treatment during surgery and 10 rats in the control group received 0.9% saline solution injection. The penile skin was incised circumferentially and degloved. To make the urethral injury at a location approximately 15 mm proximal to the external meatus, the urethra was cut transversally with scissors, from the 2-o'clock to the 10-o'clock position and then sutured by a single suture at the 6-o'clock position. To evaluate chronic inflammation and fibrosis, the rats were killed, and the injured portions of the urethras were harvested for histopathologic examination after a follow-up period of 21 days. Results On histopathologic evaluation, the control group rats had a more severe fibrotic change in the urethral tissue compared with the BTX-A injected rats, which showed a mild fibrotic change. The mean ± SD and median fibrosis score was 2.4 ± 0.5 and 2 in the control group and 1.5 ± 0.5 and 1 in the BTX-A group, respectively ( P P Conclusions The results of our study have shown that BTX-A prevented increases in collagen content during urethral wound healing.

Objective To retrospectively evaluate technical success and long-term outcome of endovascular treatment in patients with iliofemoral deep vein thrombosis (DVT) due to iliac vein compression syndrome (IVCS). Materials and methods Between March 2003 and September 2006, 36 consecutive patients (26 women [72%], 10 men, mean age 50 ± 18 years) with acute or chronic iliofemoral deep vein thrombosis due to iliac vein compression syndrome were evaluated for outcome of endovascular treatment. Stent patency was estimated by using the Kaplan–Meier method. Results Technical success was achieved in 34 of 36 patients (94%). Six patients with acute or subacute thrombosis had chronic occlusion of the left common iliac vein. Rethrombosis of the stents was observed in four patients. Primary and secondary patency rates were 85 and 94% at 1 year, and 80 and 82% at 4 years. Resolution of symptoms was achieved in 17 of 20 patients (85%) with acute and subacute DVT, and 4 of 16 patients (25%) with chronic DVT. Major complication was seen in one patient (3%). Conclusion Intimal changes in the left common iliac vein are mostly chronic in nature even in patients with acute DVT secondary to IVCS. Endovascular treatment with stent placement has a high technical success rate and good long-term patency in the treatment of acute and chronic DVT due to IVCS. Symptomatic improvement seems to be better in patients with acute than chronic DVT due to IVCS.

The purpose of this study was to compare the technical success and complication rates of ultrasonography-guided central venous catheterization between adult and pediatric patients which have not been reported previously. In a 4-year period, 859 ultrasonography-guided central vein catheterizations in 688 adult patients and 247 catheterizations in 156 pediatric patients were retrospectively evaluated. Mean age was 56.3 years (range, 18 to 95 years) for adults and 3.3 years (range, 0.1 to 16.3 years) for children. The preferred catheterization site was internal jugular vein in 97% of adults and 85% of children. The technical success rate, mean number of punctures, and rate of single wall puncture were 99.4%, 1.04 (range, 1-3), and 83% for adults and 90.3%, 1.25 (range, 1-5), and 49% for children, respectively. All the differences were statistically significant (p0.05). Complication rates were 2.3% and 2.4% for adults and children, respectively (p0.05). Major complications such as pneumothorax and hemothorax were not seen in any group. In conclusion, ultrasonography-guided central venous catheterization has a high technical success rate, lower puncture attempt rate, and higher single wall puncture rate in adults compared to children. Complication rates are comparable in the two groups.

Phlegmasia cerulea dolens is an uncommon but potentially life-threatening complication of acute deep vein thrombosis. It is an emergency and delay in treatment may cause death or loss of the patient's limb. Surgical thrombectomy is the recommended treatment in venous gangrene. Catheter-directed intrathrombus thrombolysis has been reported as successful, but it may require a lengthy infusion. Manual aspiration thrombectomy may clear the entire thrombus with no need for thrombolytic administration and provide rapid and effective treatment for patients with phlegmasia cerulea dolens with impending venous gangrene.

We report two newborns with female external genitalia and bilateral inguinal swelling who were diagnosed with 17 beta-hydroxysteroid dehydrogenase type 3 deficiency, a rare cause of 46,XY disorder of sexual development. The first case had normal clitoral size and vaginal and urethral openings, palpable gonads in the inguinal region, low testosterone, and low levels of basal and GNRH-stimulated gonadotropin. The second case had similar external genitalia, low testosterone but borderline basal and normal stimulated gonadotropin levels. Low testosterone/androstenedione ratios (0.22 and 0.24, respectively; normal, >0.8) after human chorionic gonadotropin stimulation indicated 17 beta-hydroxysteroid dehydrogenase type 3 deficiency. HSD17B3 sequencing revealed a homozygous novel mutation (c.464A>C, p.H155P) in exon 6 in the first case and homozygous c.239G>A (p.R80Q) in exon 3 in the second.

Two varieties of fiddleneck (Phacelia tanacetifolia Benth.) plant were determined for visualizing somatic chromosomes. The 4-5 days old root tips were pre-treated in 6% α-monobromonaphtalane in +4 °C for 7.5 h, then fixed in glacial acetic acid for 30 min and transferred to 70% ethanol for long storage. When the root tips were analyzed, they were hydrolyzed with 1 N HCl for 13 min at room temperature (25 °C). After hydrolyzing, root tips were stained with 2% aceto orcein in darkness for 2.5 h. The squash method for preparation was used for chromosomal investigations. The chromosome length (C), relative length (RL), the long arm (L) and short arm (S) lengths, arm ratio (AR; L/S) and centromeric index (S/C) were calculated for caryologic parameters. The ideograms and detailed chromosome morphology measurements of the species were performed by the use of MicroMeasure 3.3. According to results, fiddleneck (Phacelia tanacetifolia Benth.) has 2n = 22 chromosomes and the karyotype formulas of two varieties of fiddleneck were 16 median and 6 submedian (16 m + 6 sm).

Background: Constipation is one of the most common problems in childhood. In idiopathic constipation it is not possible to identify primary cause in every case. Child behavioral problems and disturbances in parent–child relationships have been cited as causes of constipation. Constipation is a source of anxiety to the child and to the family. The purpose of the present study was to evaluate psychological characteristics of constipated children and their parents. Methods: Thirty-two otherwise healthy children with idiopathic constipation over 4 years old were prospectively evaluated between January 2002 and June 2003. The Child Behavior Checklist (CBCL) and Symptom Checklist-90 revised (SCL-90-R) were used to assess the psychological profiles of the children and the parents, respectively. Thirty children with inguinal hernia who had no constipation or other problems, and their parents were asked to complete the checklists as controls. The scores of the constipation group were compared statistically with those of the control group. Results: In the constipation group there were 19 boys and 13 girls with a mean age of 7.3 years (4–14 years). All the patients responded to medical treatment. Constipated children and their parents were not found to have more behavior problems than the control group (P > 0.05). Conclusions: Children with idiopathic constipation and their parents do not show significant behavioral and emotional problems. Their psychological profiles are not different from the general population.

Background: To assess the feasibility of using tissue glue in the approximation of circumcision wounds in children. Patients and methods: A prospective randomized trial was carried out on 30 boys (age, 1–10 years) admitted to the Kahramanamaras Sutcuimam University Medical Faculty, Turkey. The results of wound approximation in circumcision with cyanoacrylate tissue glue and suturing with interrupted 5/0 plain catgut were compared. The operations were carried out by the same surgeon using an identical technique. The wounds were assessed 1 day, 3 days, 1 week and 1 month postoperatively. Results: There was no difference between the two groups in the rates of wound inflammation, infection, bleeding and dehiscence, although cosmetic appearance was better in the tissue glue group. The operation time was also shorter in this group. Conclusion: Using tissue glue for wound approximation in circumcision is a feasible alternative.

Background: Nicotine is known to be associated with adverse effects in infants and children. It is concentrated in breast milk and is absorbed by the infant. The aim of this study was to investigate the effects on breast-fed rat pups of maternal nicotine exposure during lactation. Methods: In the experimental group (n = 6), nicotine was given to lactating dams (2 mg/kg/day) after delivery and continued for 10 days during lactation. Control animals (n = 4) received saline for the same duration. The suckling rats were weighed and killed on postnatal day 10, and samples were taken from the lung, liver, kidney, spleen and small intestine for histopathological examination. Superoxide dismutase (SOD), catalase (CAT) activities and malondialdehyde (MDA) levels were measured in the liver of the dam and the offspring. Results: Histopathological changes in the liver of the nicotine-exposed group showed portal inflammatory infiltrate, ballooning degeneration of hepatocytes, and focal necrosis in the parenchyma. Thickening of alveolar walls because of interstitial inflammation was noted in the lungs. Histopathological examination of kidney, spleen and small intestine tissue did not reveal any abnormality. In the experimental group, SOD and CAT activities were significantly decreased (p Conclusion: These results indicate that maternal nicotine exposure induces oxidative stress and causes detrimental histopathological changes in the lung and liver of lactating offspring.

The aim of this study is to investigate the effect of zinc aspartate (ZA) pretreatment on ischemia-reperfusion (I/R) injury and blood and tissue antioxidant enzyme activity early after unilateral testicular torsion-detorsion (T/D).Forty prepubertal male Sprague-Dawley rats (weight 160 to 220 g) were divided into 4 groups each containing 10 rats. Surgery was conducted under intraperitoneal 1-shot ketamine (50 mg/kg) anesthesia. The scrotum was entered through a midline incision. Rotating the left testis 720 degrees in a clockwise direction was the model of the testicular torsion. Group 1 was for the basal values. Group 2 had 4 hours T/D. Group 3 also had 4 hours T/D and pretreated with 50 mg/kg intraperitoneal ZA injection half an hour before detorsion. Group 4 was designed as a sham group. In the Group 2 and Group 3, the tunica vaginalis was opened, and left testicles were rotated clockwise 720 degrees and maintained in this torsion position by fixing with a silk suture to the scrotal wall. The scrotum was closed and 4 hours later reentered for testicular detorsion. After spermatic cord detorsion, the scrotum was closed. At the end of 4 hours detorsion period, bilateral orchiectomies were performed, and 5-mL intracardiac blood samples were taken. Blood and tissue superoxide dismutase (SOD), catalase (CAT) activities, and malondialdehyde (MDA) levels were measured, and histopathologic examination was performed.Group 2 and group 3 had decreased blood SOD and CAT activities and elevated MDA levels indicating I/R injury. The 2 groups were also different from each other for these parameters reflecting the beneficial effect of ZA pretreatment (P.05). The decreased ipsilateral tissue SOD and CAT activities in group 2 were different from the other groups including group 3 (P.05). Ipsilateral tissue MDA levels of both group 2 and group 3 were elevated. Group 2 had higher values than group 3 (P.05). In addition, specimens from group 2 had a significantly greater histologic injury than group 3 (P.05). These findings were also supporting the beneficial effect of ZA pretreatment. All measurements of contralateral tests were similar to the basal values for all groups (P.05).ZA pretreatment reduces I/R injury by its antioxidant effects after unilateral testicular T/D and affects the antioxidant enzyme systems.

Introduction: The aim of this study was to evaluate contralateral testicular damage (CTD) following unilateral blunt testicular trauma (BTT) and testicular capsule laceration (TCL) by the serum inhibin B level which is an accepted marker of spermatogenesis. Methods: Fifty peripubertal male Wistar albino rats were divided into 5 groups each containing 10 rats. Group 1 was the control group. Group 2 was the BTT group in which the right testicle was placed on a firm surface and a metal rod weighing 215 g was dropped onto the testicle from a height of 5.5 cm. Group 3 was the TCL group in which right testicular tunica albuginea was lacerated using the needle of 4/0 silk suture. Group 4 had right orchiectomy initially. Group 5 was the sham group. In all groups, 3-ml blood samples were taken and bilateral orchiectomies were performed 6 weeks after initial manipulations. Results: Groups 2 and 3 had decreased inhibin B levels (p < 0.001), although the orchiectomy group had normal levels. Histological analyses showed lower Johnsen scores for both trauma groups in the ipsilateral and contralateral testes (p < 0.05). Conclusions: Serum inhibin B levels decrease following unilateral testicular trauma reflecting CTD.

A 50-year-old man, presented with sudden onset of right leg coldness, numbness and pain for 1.5 months. It was found that the right superficial femoral artery was thrombosed, which ended at the mid-thigh level and a continued as the popliteal artery in magnetic resonance angiography. Persistence of the sciatic artery is extremely rare vascular anomaly. It is prone to undergo early atherosclerotic changes, occlusive embolism, and aneurysm formation. In this article we report a patient with acute artery occlusion developed in popliteal and crural arteries in a patient with persistent sciatic artery which was successfully treated through surgical and endovascular intervention., Elli yaşında erkek hasta, 1.5 aydır sağ bacakta ani başlayan soğukluk, hissizlik ve ağrı şikayetiyle başvurdu. Manyetik rezonans anjijyografide sağ süperfisyel femoral arterin orta uyluk seviyesinde sonlanarak popliteal arter olarak devam ettiği ve tromboze olduğu saptandı. Persistan siyatik arter çok nadir görülen vasküler bir anomalidir. Erken aterosklerotik değişiklikler, emboli ve anevrizma oluşumunda yatkınlığa neden olur. Biz bu çalışmada, popliteal ve krural arterlerinde akut arteriyel oklüzyon gelişen persistan siyatik arterli bir hastada, cerrahi ve endovasküler girişim ile başarılı bir şekilde tedavisini sunduk.

WOS: 000356531400022 PubMed: 25990260 The purpose of this study was to compare the effectiveness of 1470- and 980-nm lasers with regard to power output, complications, recanalization rates, and treatment response. We prospectively evaluated the effectiveness of endovenous laser ablation (EVLA) in a total of 152 great and small saphenous veins from 96 patients. Lasers were randomly used based on the availability of the units. Patients were clinically evaluated for Clinical Etiologic Anatomic Pathophysiologic (CEAP) stage and examined with Doppler ultrasound. Treatment response was determined anatomically by occlusion of the vein and clinically by the change in the venous clinical severity score (VCSS). Seventy-eight of the saphenous veins underwent EVLA with a 980-nm laser and 74 underwent EVLA with a 1470-nm laser. Treatment response was (68) 87.2 % in the 980-nm group and (74) 100 % in the 1470-nm group (p = 0.004). The median VCSS decreased from 4 to 2 in the 980-nm group (p < 0.001) and from 8 to 2 (p < 0.001) in the 1470-nm group. At 1-year follow-up, seven veins treated with 980 nm and two veins treated with 1470 nm were recanalized (p = 0.16); the average linear endovenous energy density (LEED) was 83.9 (r, 55-100) J/cm and 58.5 (r, 45-115) J/cm, respectively (p < 0.001). Postoperative minor complications occurred in 23 (29.4 %) limbs in the 980-nm group and in 19 (25.6 %) limbs of the 1470-nm group (p = 0.73). EVLA with the 1470-nm laser have less energy deposition for occlusion and better treatment response.

Objective To investigate the incidence and presentation of ureteral obstruction after endoscopic injection of polyacrylate polyalcohol copolymer (PPC) for the treatment of vesicoureteral reflux, and to analyze its possible causes, together with histopathologic assessment. Patients and Methods The data of 189 patients who underwent endoscopic injection of PPC between May 2011 and December 2013 were retrospectively reviewed. After the injection, patients were followed up by urinalysis and ultrasonography monthly for 3 months. Control voiding cystouretrography was performed in the third postoperative month. Patients were then followed up by ultrasound every 3 months. If a new-onset hydroureteronephrosis (HUN) was observed, control ultrasound was performed monthly to follow the change in the degree of HUN. If a moderate or severe HUN was observed, technetium-99m mercaptoacetyltriglycine or dimercaptosuccinic acid scintigraphy was performed. For patients who needed open surgery, Cohen ureteroneocystostomy was performed. The distal 1 cm of the ureters was resected and examined histopathologically. Results One hundred eighty-nine patients with 268 refluxing ureters underwent endoscopic injection of PPC. Ureteral obstruction was observed in 3 ureters (1.1%), in 3 female patients of whom the degrees of reflux were grade 4, 5, and 5, respectively. Obstruction showed late onset in all 3 patients. Manifestations of obstruction included pain in 2 patients and recurrent febrile urinary tract infection with loss of function in scintigraphy in 1. All 3 patients underwent open ureteroneocystostomy. Conclusion PPC may cause ureteral obstruction several months or even years after injection. Patients who undergo endoscopic treatment of PPC need long-term follow-up, despite reflux showing complete resolution.

We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed successfully into the duodenum with a saline flush. No complications were encountered. Use of a peripheral cutting balloon for dilatation of the papilla seems to be safe and effective because it has the advantage of controlled incision and dilatation of the target at low pressures.

Superior vena cava (SVC) syndrome is obstruction of blood flow through the SVC and is characterized by facial and neck swelling and distended veins over the chest. It is a medical emergency and most often manifests in patients with a malignant disease process within the thorax. Lung cancer and lymphoma account for more than 90% of cases of SVC syndrome [1]. The most common underlying malignancy is carcinoma of the lung, in part because of the proximity to the heart and its common prevalence [2]. Lung cancer is the most common primary tumor, and adenocarcinoma the most frequent cell type of cardiac metastases [3]. Breast cancers, melanoma, and lymphoma are also likely noncardiac tumors that involve the pericardium [4].

[Arch Clin Exp Surg 2015; 4(3.000): 176-177]

We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.

The purpose of this study was to present our experience with guiding catheters in manual aspiration thrombectomy of occluded infra-aortic bypass grafts. This material was designed as a guiding catheter but was also used for thrombus aspiration. Six consecutive patients (all male; mean age, 61.0±5.7 years; range, 54-68 years) who underwent manual aspiration thrombectomy at the discretion of the operator for infra-aortic bypass graft thrombosis between 2002 and 2010 were retrospectively reviewed. The angiographic success described as either stenosis or residual thrombus less than 30% was 67%. Primary patency was 50%, and secondary patency was 66.7%. Additional stents were needed in four lesions of three patients. Manual aspiration thrombectomy is intended to remove both soft acute blood clots and hard organized embolic and thrombotic obstructions. Manual aspiration thrombectomy appears to be a safe and effective method for treating delayed graft thrombosis. This method provides an alternative to surgical thrombectomy, especially for patients who are not good candidates for the surgery.

Recent studies have demonstrated a role for calcium channel blocking agents in the treatment of persistent hyperinsulinemic hypoglycemia of newborns. We report a newborn infant with persistent hyperinsulinemic hypoglycemia whom we successfully treated with oral nifedipine alone after surgical therapies. A 4-day-old male infant was referred with intractable hypoglycemia and seziures. Normoglycaemia could be maintained only by the intravenous infusion of glucose at a rate of 20 mg/kg per minute. Persistent hyperinsulinemic hypoglycemia of newborn was diagnosed from an inappropriately raised plasma insulin concentration (44 mU/L) at the time of hypoglycemia. Medical treatments led to only a mild reduction in the intravenous glucose requirement; an 85-90% pancreatectomy was performed and histological "diffuse nesidioblastosis" was confirmed. However, despite all the medical treatments after the first pancreatectomy, the hyperinsulinemic hypoglycemia persisted and a second 95% pancreatectomy was performed. After the second pancreatectomy, persistent hyperinsulinemic hypoglycemia was treated with somatostatin and diazoxide, but led to no reduction in the intravenous glucose requirement. We report the case of an infant who had persistent hypoglycemia after two subtotal pancreatic resections but subsequently became normoglycemic on treatment with nifedipine (2 mg/kg per day). The patient was discharged home on oral nifedipine. Calcium channel blocking agents cuold be used with efficacy and safety in recurrent persistent hyperinsulinemic hypoglycemia.

Objective Arteriovenous fistula (AVF) in patients undergoing hemodialysis (HD) may cause coronary left internal mammary artery (IMA) steal. This phenomenon was demonstrated by few prospective studies with limited number of patients and case reports. We aimed to demonstrate with a relatively larger patient population that the AVF may cause ipsilateral IMA steal. Methods We included 22 prospective patients undergoing HD who had left IMA to left anterior descending artery graft and left upper limb AVF. Right IMA was taken as control. Flows were assessed by using color Doppler ultrasonography. Results The mean age was 57.8 ± 9 years. Statistically nonsignificant increases in AVF flow and decreases in left IMA flow were observed during HD compared with pre-HD. Moreover, fistula localization did not affect median left IMA flows (for peak systolic velocity [PSV] 43.7 versus 70 cm/s, respectively; p = 0.7, and for end diastolic velocity [EDV] 3.4 versus 6.5 cm/s, respectively; p = 0.7). We have not detected significant difference in left IMA flows during HD (median values of PSV 58.4 versus 68.4 cm/s, respectively; p = 0.1, and EDV 6.4 versus 4.4 cm/s, respectively; p = 0.08). Only three patients experienced dialysis-induced reduction of ipsilateral IMA flow that was accompanied by evidence of hypokinesia of the anterior left ventricular wall without clinical angina. Conclusions Hemodynamically affected left IMA flow by ipsilateral upper extremity AVF may cause steal phenomenon. Hemodynamic differences between left and right IMAs in patients undergoing HD via left wrist and brachial fistulae are limited.

To compare the success and complication rates of ultrasound-guided or palpation-guided punctures of the common femoral artery in a prospective randomized study.Percutaneous femoral arterial access is sometimes difficult to perform and is the source of complications. It has not been established whether ultrasound-guided puncture of the common femoral artery is the standard practice for angiography.Two hundred and eight patients were randomized into two groups. One had ultrasound-guided puncture and the other had palpation-guided puncture of the common femoral artery. The technical success, first pass success rate, total number of attempts required for access, time to sheath insertion, pain during puncture, and access-related complication were compared.Technical success tended to be higher and the complication rates tended to be lower in the ultrasound-guided group but the difference did not reach statistical significance (P = 0.052 and P = 0.052). The first pass success rate was higher, total number of attempts required for access and time to sheath insertion were lower in the ultrasound-guided group. Atheromatous plaques on the common femoral artery, iliac artery obstructive lesion, previous ipsilateral puncture of the common femoral artery, obesity, and blood pressure during puncture did not change the outcome.Ultrasound guidance improves secondary outcomes of the common femoral artery puncture when compared to palpation-guided puncture. Technical success and complication rates seem lower in the presence of ultrasound guidance but larger study populations are needed to verify the result.

PURPOSE We aimed to assess the degree of improvement in chronic venous disease-related symptoms after endovenous laser ablation (EVLA) for saphenous vein insufficiency. MATERIALS AND METHODS The study was conducted as a single-center, single-arm prospective cohort study. The series was comprised of 55 limbs of 38 patients (24 [63%] females, 14 [37%] males; mean age, 45 ± 14 years; range, 22-78 years). All patients were clinically evaluated for limb pain, fatigue, heaviness, itchiness, night cramps, burning sensation, swelling, varices, and the presence of venous ulcers. Post-procedure changes in each symptom were categorized as full recovery, improvement, no change, or worsened. RESULTS Clinical improvement in one or more symptoms was observed in 96% of the limbs, and full recovery from each symptom ranged from 36% to 80%. The best clinical response was observed in night cramps, with full recovery in 80% of the limbs, while the least responsive was pain, with full recovery in 36%. Overall 25% of limbs showed full recovery from all symptoms. The venous clinical severity score was significantly decreased from a median of 5 (range, 1-21) before treatment to a median of 3 (range, 0-12) after treatment (P < 0.001). A significant association was found between full recovery from pain and older age (P = 0.016) and combined ablation of both saphenous veins (P = 0.010), and between full recovery from burning sensation and the presence of new incompetent perforator veins (P = 0.048) on multivariate analysis. CONCLUSION EVLA effectively improves clinical symptoms in patients with chronic venous disease. The degree of symptomatic improvement varies for each symptom.

Patients with advanced cancer may present with obstructive jaundice. Biliary stenting is the treatment of choice. However, which patients benefit most is not well-defined, yet. Our aim was to delineate the clinical factors affecting prognosis. Charts of 140 patients with advanced cancer who underwent biliary stenting were retrospectively analyzed. Their median age was 63.5 years. Of these patients, 73 (52.1 %) were male, 32 (22.9 %) had ECOG PS 1 and 81 (57.9 %) had PS 2. The most frequent cancer types were cholangiocellular cancer (64, 45.7 %) and pancreatic cancer (36, 25.7 %). Median overall survival (OS) was 141 (95 % CI, 100.7-185.3) days. Female patients lived longer (161.0 vs. 124.0 days) (p = 0.036). Those patients with colorectal cancer lived the longest (667.0 days), followed by cholangiocellular (211.0 days), and gastric cancers (106.0 days) (p = 0.004). The distribution of primary diagnosis differed significantly between sexes: cholangiocellular cancer was present in 22 (30.1 %) out of 73 men and 42(62.7 %) out of 67 women (chi-square p

To evaluate the results of stent placement for obstructive atherosclerotic aortic disease with or without involvement of the common iliac artery.Forty patients had self-expanding stents primarily or after balloon dilatation in the abdominal aorta between January 2005 and May 2011. All patients had trouble walking. Follow-up examinations were performed with clinical visits; these included color Doppler ultrasonography and computed tomographic angiography.Technical, clinical, and hemodynamic success was achieved in all patients. None of the patients underwent reintervention during the follow-up period, which ranged from 3 months to 6 years (median 24 months). Nine complications occurred in six patients. Of the nine complications, four were distal thromboembolisms, which were successfully treated with catheter-directed thrombolysis or anticoagulation therapy.Endovascular treatment of the obstructive aortic disease using self-expanding stents was safe and effective, with high technical success and long-term patency. Thromboembolic complications were high even though direct stenting was considered protective for thromboembolism formation. Particularly for infrarenal aortic stenosis, it can be recommended as the first-line treatment option for patients with obstructive atherosclerotic aortic disease.

PURPOSE The purpose of this study was to evaluate the outcomes of ultrasound-guided femoral artery access for total percutaneous endovascular repair of abdominal and thoracic aortic aneurysms. MATERIALS AND METHODS Total percutaneous aneurysm repair of the abdominal and thoracic aorta was performed in 52 consecutive patients (46 males, 6 females; mean age, 64.6±16 years; age range, 24-93 years) in a total of 85 access arteries. Of the aortic aneurysms repaired, 33 were abdominal, and 19 were thoracic. Ultrasound- guided puncture of the access artery was performed in all patients. The access artery was closed with a Prostar XL device at the end of the procedure. RESULTS The outer diameter of the vascular sheaths or the stent graft system ranged from 14 F to 27 F. All but one patient achieved successful closure of the arterial puncture with the closure device. One patient required surgical cutdown because of device failure. Two patients required long-duration manual compression. Technical success was achieved in 49 patients (94%). Forty-five patients (87%) were discharged on the first postoperative day. There were no complications of the access arteries one day or one month postoperatively, as determined by ultrasonography and computed tomography examinations, respectively. The mean diameters of the access arteries prior to and one month after the procedure were unchanged, as demonstrated by computed tomography. CONCLUSION Ultrasound-guided puncture of the common femoral artery for percutaneous closure of the access site has a high technical success rate and a very low complication rate. The addition of ultrasound guidance decreases the difficulty of the procedure and helps to avoid some of its complications.

Purpose To evaluate the immediate and long-term outcomes of percutaneous manual aspiration thrombectomy with provisional stent placement in treating acute and subacute iliofemoral deep venous thrombosis (DVT). Materials and methods One hundred and thirty-nine consecutive patients (75 women; mean age, 51 years) with acute (n=110) or subacute (n=29) iliofemoral DVT underwent endovascular treatment (total of 148 limbs). All patients were treated with percutaneous manual aspiration thrombectomy by using large-bore guiding catheters with adjunctive catheter-directed thrombolysis and stent placement, if needed. Venography was used to grade thrombus removal. Results Thrombus removal was less than 50% in five limbs (3.4%), between 50% and 95% in 45 limbs (30.4%), and more than 95% in 98 limbs (66.2%). At least one stent was placed in 99 limbs. Recurrent thrombosis occurred in 27 patients, mostly during the first few months after the procedure. Rethromboses were more frequent among postpartum patients. One patient had a major pulmonary embolism. No major hemorrhage or procedure-related deaths occurred. Conclusion Manual aspiration thrombectomy is a safe, rapid, and effective treatment option for acute and subacute iliofemoral DVT. Hence, catheter-directed thrombolysis may not be required in a majority of patients.

Purpose This study retrospectively evaluated ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of postcatheterization femoral and brachial artery pseudoaneurysms. Materials and methods Fifty-five patients with postcatheterization femoral artery (n = 53) or brachial artery (n = 2) pseudoaneurysms were treated using US-guided human thrombin (500 IU/mL) injection. Pseudoaneurysm size, thrombin dose, therapy outcome, and complications were documented. Follow-up color Doppler US was performed 7 and 30 days after treatment. Short-duration supplemental compression was applied to six patients at the first week follow-up examination after a reinjection of thrombin had failed. Results Mean pseudoaneurysm volume was 20.3 ± 18.7 cm(3). The mean injected thrombin dose was 478 ± 238 IU. Thirty-eight (69.1%) of the 55 pseudoaneurysms were thrombosed with a single injection, and 11 of 17 pseudoaneurysms were thrombosed after a second injection. All (100%) of the 41 pseudoaneurysms that were diagnosed within the first two weeks of postcatheterization were successfully treated. The overall primary success rate was 89.1% (49 of 55 pseudoaneurysms). Supplemental compression promoted thrombosis in four of the six patients who had treatment failure with thrombin injection. The secondary success rate was 96.4% (53 of 55 pseudoaneurysms). There were no complications. Conclusion US-guided thrombin injection was most successful within the first two weeks, and the supplemental compression might aid in the closure of partially thrombosed pseudoaneurysms.

The aim of this study was to report technical details, procedure-related complications, and results of endovascular treatment in chronic iliac artery occlusion. Between 2001 and 2008, endovascular treatments of 127 chronic iliac artery occlusions in 118 patients (8 women and 110 men; mean age, 59 years) were retrospectively reviewed. The study was based on Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery Standards). All occlusions were treated with stent placement with or without preliminary balloon angioplasty. Kaplan–Meier estimators were used to determine patency rates. Univariate and multivariate analyses were performed to determine variables affecting successful recanalization, major complications, early stent thrombosis (≤30 days), and primary and secondary patency rates. Initial technical success was achieved in 117 (92%) procedures. Successful recanalization was obtained by antegrade approach in 69 of 77 (90%) procedures and by retrograde approach in 52 of 105 (50%) procedures (p < 0.001). Complications were encountered in 28 (24%) patients [minor in 7 patients (6%) and major in 22 patients (19%)]. One death occurred in the operative period secondary to iliac artery rupture. Early stent thrombosis was seen in eight (7%) patients. Presence of critical limb ischemia (p = 0.03), subintimal recanalization (p = 0.03), and major complication (p = 0.02) were the independent predictors of early stent thrombosis on multivariate analysis. Primary and secondary patency rates at 5 years were 63 and 93%, respectively. Presence of critical limb ischemia, TASC type C iliac lesions, combined occlusions of both common and external iliac arteries, and major complications were associated with decreased patency rates on univariate analysis, whereas these factors were not independent predictors of stent patency on multivariate analysis. In conclusion, endovascular treatment of iliac artery occlusion has a high technical success rate with favorable long-term patency rate. Success of recanalization increases with use of the antegrade approach and with the presence of a stump of artery before the occlusion.

PURPOSE: To report the immediate and midterm results of manual aspiration thrombectomy as the first thrombus removal method in the treatment of acute or early chronic arterial thromboembolism in the lower extremity. MATERIALS AND METHODS: Retrospective review of 40 limbs in 37 nonconsecutive patients between March 2006 and March 2008 (21 female [57%], 16 male; mean age, 67 +/- 10 years; age range, 42-84 years) who had percutaneous aspiration thrombectomy for lower limb arterial thromboembolism. Twenty-nine legs had acute ( < 14 days) and 11 legs had early chronic (15-60 days) thromboembolism. Clinical categories of limb ischemia were stage I in 12 limbs, stage IIa in 17 limbs, and stage IIb in 11 limbs. RESULTS: Technical success was achieved in 35 limbs (88%). Complete thrombus removal was achieved in 26 of 29 limbs (90%) with acute occlusions and 4 of 11 limbs (36%) with early chronic occlusions (P < 0.05, chi(2) test). Amputation-free survival rate was 100% at one month, 93% at one year, and 93% at two years with Kaplan-Meier survival analysis. Freedom from symptoms of claudication or critical limb ischemia was achieved in 31 of 39 limbs (80%) at one month and 25 of 35 limbs (71%) at one year. There were three major complications and ten minor complications. CONCLUSION: Percutaneous aspiration thrombectomy is a rapid and effective way of removing thrombus in thromboembolic occlusions of the limb arteries below the inguinal ligament. It can be used in patients with acute limb ischemia (Rutherford clinical category IIb).

The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

Background It has been demonstrated that brief episodes of sublethal ischemia-reperfusion, so-called ischemic preconditioning, provide powerful tissue protection in different tissues such as heart, brain, skeletal muscle, lung, liver, intestine, kidney, retina, and endothelial cells. Although a recent study has claimed that there are no protective effects of ischemic preconditioning in rat testis, the protective effects of ischemic preconditioning on testicular tissue have not been investigated adequately. The present study was thus planned to investigate whether ischemic preconditioning has a protective effect on testicular tissue. Methods Rats were divided into seven groups that each contained seven rats. In group 1 (control group), only unilateral testicular ischemia was performed by creating a testicular torsion by a 720 degree clockwise rotation for 180 min. In group 2, group 3, group 4, group 5, group 6, and group 7, unilateral testicular ischemia was performed for 180 min following different periods of ischemic preconditioning. The ischemic preconditioning periods were as follows: 10 minutes of ischemia with 10 minutes of reperfusion in group 2; 20 minutes of ischemia with 10 minutes of reperfusion in group 3; 30 minutes of ischemia with 10 minutes of reperfusion in group 4; multiple preconditioning periods were used (3 × 10 min early phase transient ischemia with 10 min reperfusion in all episodes) in group 5; multiple preconditioning periods were used (5, 10, and 15 min early phase transient ischemia with 10 min reperfusion in all episodes) in group 6; and, multiple preconditioning periods were used (10, 20, and 30 min early phase transient ischemia with 10 min reperfusion in all episodes) in group 7. After the ischemic protocols were carried out, animals were sacrificed by cervical dislocation and testicular tissue samples were taken for biochemical measurements (protein, malondialdehyde, nitric oxide) and histological examination. Results Although decreased tissue malondialdehyde levels were detected in the groups of 2, 3, 4, and 5 compared to group 1, significant decreases were observed in only group 2 and group 5 (p < .05). Nitric oxide levels were numerically decreased in all groups compared to the control group but was statistically significant only in group 5 (p < .05). Histopathological examination demonstrated that all groups subjected to ischemic preconditioning had less tissue damage than group 1 (p < .05). Conclusion These results suggest that ischemic preconditioning provides tissue protection in testicular tissue.

To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD).To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age+/-S.D.: 61.5+/-11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis (or =60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement).Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n=60) had significant (or =60%) renal artery stenosis. Only age and hypertension (blood pressure systolic140 mmHg or diastolic90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5+/-8.9 years compared with 61+/-11.2 years for patients without RAS (p0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p=0.01).Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

To retrospectively evaluate compression of the left common iliac vein as demonstrated at computed tomography (CT) in patients with iliofemoral deep vein thrombosis due to iliac vein compression syndrome (IVCS) and compare compression ratios with those of asymptomatic subjects.Between March 2003 and June 2007, compression of the left common iliac vein by the right common iliac artery, as demonstrated with CT, in 34 patients (25 women and nine men; mean age, 51 years; age range, 21-79 years) with IVCS was retrospectively evaluated. Compression ratios were compared with those of 34 age- and sex-matched asymptomatic subjects. A t test was used to compare the compression ratios.The percentages of compression of the left common iliac vein were 45%-100% (mean, 74% +/- 17) for patients with IVCS and 0%-68% (mean, 28% +/- 20) for control subjects (P.05). Of the 34 patients with IVCS, 11 (32%) had less than 70% compression and 23 (68%) had at least 70% compression.There was considerable overlap between the degree of compression in patients with IVCS and control subjects. Compression of the left common iliac vein was significantly more prominent in patients with lower extremity deep vein thrombosis due to IVCS when compared with control subjects. Compression in excess of 70% as demonstrated at CT can be helpful for identifying possible underlying IVCS in patients with a left lower extremity deep vein thrombosis.

Objective To prospectively evaluate the technical success and immediate complication rates of temporary central catheter placement in a homogenous patient population with disorders of hemostasis. Materials and methods One hundred and thirty three temporary central vein catheters inserted under ultrasound guidance in 119 patients with bleeding disorders were analyzed over a 4-year period. Patients were males ( n =51; 43%) and females ( n =68; 57%) with a mean age of 56.6 years (age range 18–95 years). A catheter was inserted in IJV in 129 (97%) procedures, subclavian vein in 2 (1.5%) procedures and femoral vein in 2 (1,5%) procedures. Thirty-three (24.8%) procedures were performed on bedside. Of 119 patients, 106 (89%) had only one catheter placement and the rest had had more than one catheter placement (range 1–3). Results Technical success was achieved in all patients (100%). Average number of puncture was 1.01 (range 1–2). One hundred and nineteen insertions (89.5%) were single-wall punctures, whereas 14 insertions were double-wall punctures. Eight (6%) minor complications occurred including oozing of blood around the catheter in five (3.8%) procedures, small hematoma in two (1.5%) procedure and both in one patient. There was no inadvertent arterial puncture or major complications like hemothorax or pneumothorax in any patients. Conclusion US-guided placement of central vein catheters in patients with disorder of hemostasis is safe with high technical success and low complication rates. US guidance for central venous catheterization should be the preferred method in this group of patients, if available in the hospital setting.

Background: This study was conducted to determine the prevalence of diurnal enuresis (DE) and its association with background variables among children aged 5–15 years living in Sivas and Kahramanmaraş, Turkey. Methods: The parents of 1,760 children voluntarily completed a questionnaire consisting of 42 items under supervision of a researcher. Results: Overall, the reported prevalence of DE was 4.2%, with a tendency to decrease with increasing age and with no difference between genders. Smoking during pregnancy, delayed initiation and dealing with the child by punishment in toilet training, urination frequency, urgency, soiling, arousal difficulty, urinary infection history, lower school performance, poor social adaptation, wetting history in the family, were all significantly prevalent among diurnal enuretics (p < 0.05). Socioeconomic or sociodemographic factors based on families and stressful life events were not associated with DE (p > 0.05). 63.9% of all parents reported some level of concern about the wetting problem and 51.7% of the diurnal enuretics had previously visited a physician. Conclusions: The prevalence of DE in our sample is not too different from the prevalence rates reported previously from Turkey and other countries. This type of enuresis seems to be more associated with an organic neurological or urological disorder than is nocturnal enuresis.

A wide spectrum of anomalies can be associated with Pierre Robin sequence. This report presents a 3-day-old infant with micrognathia, U-shaped cleft palate, low-set right ear with microtia, glossoptosis, esophageal atresia, and right congenital radioulnar synostosis. The association of congenital radioulnar synostosis and esophageal atresia with Pierre Robin sequence has not been previously described.

Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isn't done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed.

Patients with ventriculoperitoneal (VP) shunts may have multiple complications. Migration of the peritoneal catheter into some anatomical or congenitally open cavities can cause inguinal or genitourinary manifestations such as hernia, hydrocele or acute scrotum, and these are common in male infants. We report a very rare complication of VP shunt encountered in a female infant, manifesting as hydrocele of the canal of Nuck, the female counterpart of hydrocele of the spermatic cord. It is emphasized that VP shunts may also cause clinical inguinal manifestations in female infants, and groin or external genital organ swelling in these patients may be an important sign of shunt malfunction.

SCT treatment in newborns consists of surgery and selective chemotherapy. Few reports document urological sequelae using this approach. This review focuses on the urological and neurourological findings following SCT treatment in the newborn period.We reviewed the records of all infants with SCT resected in early infancy who underwent urodynamic evaluation for bladder dysfunction between 1986 and 2004. The radiological, neurological and urodynamic findings, and postoperative incontinence management were analyzed.We analyzed UDS of 14 patients who presented with urinary infection or incomplete bladder emptying after SCT resection. At the time of UDS an abnormal neurological examination was noted in 5 patients (36%). Detrusor overactivity was seen in 8 patients, underactivity in 2 and normal activity in 4. Abnormal urethral sphincter EMG potentials were observed in 7 of 13 patients (54%). Five of 13 patients (38%) had sphincter dyssynergia during voiding. Consequently, CIC was needed in 11 of the 14 patients (79%) to empty the bladder, of whom 5 also required anticholinergics to improve detrusor compliance and dryness. Only 3 patients voided spontaneously with normal bladder and sphincter function, of whom 2 were toilet trained. Hydronephrosis was seen in 6 patients and reflux was noted in 7 (including 5 of 6 with hydronephrosis). Antireflux surgery was performed in 6 patients, all of whom had up to grade 4 reflux due to recurrent urinary tract infection. One girl with grade 2 reflux had spontaneous resolution.SCT and its treatment can produce neurourological dysfunction of the lower urinary tract with high grade reflux, and abnormal bladder and urethral function. Complete assessment, including urodynamic studies, is imperative preoperatively and postoperatively. Constant vigilance is required to maintain as near normal bladder function as possible and to prevent upper urinary tract injury.

This experimental study was instituted to evaluate whether or not there is an effect of zinc aspartate administration on injured testes. Sixty prepubertal male Sprague-Dawley rats (weighing 180-240 g) were divided into six equal groups each containing ten rats. Group I was the control group. Rats in group II and group III which were blunt testicular trauma groups were subjected to right blunt testicular trauma to rupture the tunica albuginea. Just after this, animals in group III were given 30 mg/kg zinc aspartate intraperitoneally, and this treatment was continued for 30 days at a dose of 10 mg/kg per day. Animals in group IV and group V which were thermal injury groups were subjected to right thermal testicular injury with injection of boiling normal saline. After that, animals in group V were also treated with zinc aspartate as described in group III. Group VI was used as a sham group. After 30 days, both testes were removed and examined. Damage in ipsilateral testes was evaluated with histological scoring methods. Contralateral testes were evaluated with measurement of tubular diameter and percentage of spermatogenesis histologically. Ipsilateral testes from non-treated groups had much greater histological injury than treated groups ( p0.05). Additionally, contralateral testes had no evidence of injury. As a consequence, after acute testicular injury that takes form in a variety of ways, immediate administration of zinc aspartate and its continuation for some period may prevent the progression of the injury and improves the healing process.