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Aims: The aim of the study was to use Response Surface Methodology (RSM) to find optimal experimental design for wastewater treatments from office paper recycling. In this way, interactive effects of treatment factors were evaluated, including microwave power (MW) and durations with centrifuge time while turbidity of wastewater was chosen as the dependent output variable or an optimal response. Methodology: The RSM approach was utilized for optimization of the process parameters and identifying the optimal conditions for the removal of turbidity in paper recycling wastewater. In this regard, a three-factor RSM were selected, using MW irradiation power (Watts), durations (seconds) and centrifuge time (min). Statistical analysis of variance (ANOVA) was carried out to identify the adequacy of the developed model. In this case, specially prepared office papers (one-side laser printed) were subjected to standard paper recycling procedure for obtaining wastewater at laboratory conditions. The experimentally derived RSM model was validated using range of statistical parameters. Conclusions: The study revealed that under the RSM optimized conditions, a marked reduction in the turbidity of wastewater was observed for both groups studied. The R2, R2(adj) and R2(pred) values were indicates, the developed model was significant which revealed a well agreement between the experimental data and proposed model. In this approach, the R2=99.710% and lack-of-fit value were found to be 0.111 (p>0.05), which shows the model and the data consisted to each other. The lowest turbidity value was found with 150.000 Watts and 60.000 seconds in MW conditions with 15.000 minutes of centrifugation time, experimentally. With employing these variables, the turbidity value of 6.65 NTU was determined. However, the highest turbidity value of 18.013 NTU was found with MW power of 200.00 Watts with 40.000 seconds of durations and 1.591 minute of centrifugation time. It is important to note that with using optimized parameters, the turbidity value of 1.43 NTU was calculated while 1.47 NTU was found with experimentally.

Resumen Introduccion y objetivos Comparar, en terminos de eficacia y seguridad, los resultados del tratamiento endoscopico del reflujo vesicoureteral (RVU) en dos cohortes diferentes de RVU primario tratadas con Dexell y Vantris. Pacientes El estudio incluyo 128 unidades de reflujo renal (URR) en 87 pacientes con RVU primario (64 mujeres, 23 hombres). Se excluyeron los pacientes con RVU secundario y disfuncion vesical e intestinal severa. Un total de 22 ninos mayores ya continentes, con disfuncion vesico-intestinal leve, fueron sometidos a entrenamiento vesico-intestinal previo a la implantacion. Todos los procedimientos se realizaron en presencia de orina esteril mediante la tecnica convencional de inyeccion transuretral subureteral. Resultados No hubo diferencias estadisticamente significativas entre los dos grupos en cuanto a media de edad, sexo, lateralidad de la URR, captacion de 99mTc-DMSA y grado de reflujo. Las tasas de resolucion global con base en el numero de URR con hasta tres tratamientos endoscopicos fueron del 80% (56/70) en el grupo Dexell y del 94,8% (55/58) en el grupo Vantris (p = 0,012). No se observaron recidivas ni obstrucciones de la union vesicoureteral en el postoperatorio en ningun grupo. Conclusiones Dexell y Vantris proporcionaron un tratamiento endoscopico eficaz y seguro en el seguimiento a corto y medio plazo del RVU primario en ninos. Se requieren mas estudios para evaluar la eficacia de estas sustancias, cuyo efecto de volumen depende del tamano de sus particulas, en la resolucion segura del RVU.

Introduction and Objectives We aimed to point out the ureteral access facility and obstruction removal efficiency of mini-URS in the use of proximal ureteral stone management in children under five-year-old. Patients We retrospectively reviewed the data of 26 children who underwent mini-URS-LL for obstructive stones in proximal ureter between January 2016 and August 2018. The effectiveness of the mini-URS-LL was assessed based on the feasibility, reliability, and success of the technique. Results Mean age was 3 ± 1.3 years, and 11 (42.3%) patients were ≤2 years old, remaining 15 (57.7%) were aged 3−5 years. Mean stone size was 9.11 ± 3.02 mm. A stone-free status was obtained at the end of 31 ureteroscopic procedure in 24 (92.3%) patients. The mean age was found significantly higher in patients who had the procedure without pre-stenting than the others who did (P = .027). No perioperative complication was experienced. Conclusion In preschool-age children, laser lithotripsy with mini-URS may be a safe technique in the hands with advanced endo-urological skills but it has low efficacy with higher rates of prestenting causing additional anesthesia sessions.

Chromosome line and characterization of nine Turkish alfalfa (Medicago sativa L.) lines were investigated using karyological techniques in this study. Root tips were obtained from germinated alfalfa seeds in petri dishes at room temperature (25°C) for visualizing somatic chromosomes. The chromosome numbers of nine alfalfa lines were determined as 2n=4x=32. The karyotype formula of 2n=32= 30m+ 2sm (30 median + 2 submedian) were noted for Line 1, 2and 3. Whereas, Line 4, 6, 8, 9 showed the karyotype formula of 2n=32=32m (32 median). The karyotype formula of Line 5 and 7 were 2n=32=28m+4sm (28 median + 4 submedian). Satellite chromosome pairs were observed from Line 5. The results of the karyotype asymmetry index analysis showed that intrachromosomal asymmetry is higher than interchromosomal asymmetry in the karyotypes of alfalfa lines.

Children with constitutional mismatch repair deficiency syndrome (CMMRDS) are prone to different types of cancers. A 16-year-old girl who was misdiagnosed with neurofibromatosis Type-I (NF-I) for 1 years had experienced glioblastoma and colonic adenocarcinoma. After operation, chemotherapy and radiotherapy were started for adenocarcinoma. Genetic analysis from the patient, effected brother, and mother showed heterozygote (c.479 + 36A> G) mutation in the intron 4 region of NF-1 gene. Initially, it was thought that this genetic variant was causative. Furthermore, next generation sequencing showed that the index patient and his brother have homozygote (c.1444 C>T) mutations in the MSH6 gene which are associated with CMMRDS both died because of colonic adenocarcinoma, and T cell non-Hodgkin lymphoma, respectively. Patients with CMMRDS may resemble NF-I. The physicians must not be confused with the previous diagnosis. Increased awareness of CMMRDS, and prompt evaluation for an underlying genetic background is advised if there are unexpected cancer in patients with NF-I.

Background: Mungbean [Vigna radiata (L.) Wilczek] is known as one of the important crop of the Vigna group. In order to determine morphological traits of mungbean, multivariate analysis will provide important advantages in the selection phase of future breeding programs. Multivariate statistical analysis was used to determine and classify these traits. Multivariate analysis, that includes principal component analysis (PCA) and cluster analysis (CA), is considered the best tool for selecting promising genotypes in the future breeding programs. Methods: Eighteen landraces and two species were used to classify morphological traits in this study. Nine different morphological traits were observed during the research period. These are; days to 50% flowering (DFT), plant height (PH), branches per plant (BPP), clusters per plant (CPP), number of pods per cluster (PPC), seed yield per plot (SYPP), biomass yield per plot (BYPP), harvest index (HI), 1000 seed weight (SW). Result: Principal component analysis (PCA) revealed a high level of variation among the genotypes. Therefore, high variability was observed in DFT (36-59 day), PH (39-76 cm), BPP (3-7), CPP (4-21), SYPP (231-824 g), BYPP (3300-10300 g), HI (6.77-11.25%) and 1000 SW (19.95-50.50 g). According to cluster analysis, landraces with the least genetic diversity distance between them in terms of morphological traits examined were determined as 2 and 3.

To the Editor Sodium-glucose co-transporter 2 (SGLT2) inhibitor therapy is a specific mode of anti-diabetic strategy that significantly improves cardiovascular outcomes.1 The recently published article by Joshi et al 1 has focused on beneficial effects of SGLT2 inhibitors in the setting of heart failure (HF). We fully agree that complex cellular mechanisms, beyond diuresis,1 seem to underlie pleitrophic actions of these agents. More specifically, it also seems likely that SGLT2 inhibitors might potentiate favourable effects of certain metabolic agents including cellular anti-ischaemics (and vice versa) in patients with diabetes with cardiovascular disease. Accordingly, combination of SGLT2 inhibitors with cellular anti-ischaemic regimens might have important implications in these …

In clinical practice, cardiac myxomas constitute the majority of benign cardiac neoplasms, and might potentially present with a variety of embolic, obstructive as well as constitutional symptoms. On the other hand, these neoplasms might be potentially associated with the evolution of takotsubo cardiomyopathy (TTC) that is universally considered as a transient form of acute myocardial dysfunction. Accordingly, the present paper primarily aims to focus on potential mechanisms and associated clinical implications of TTC evolution in the setting of cardiac myxomas.

Background: It is known that chemotherapeutic agents cause myocardial cell damage leading to left ventricular dysfunction and heart failure. Fragmented QRS is an indication of fibrosis developing as a result of myocardial cell damage. The aim of this study is to assess whether there is a relationship between the chemotherapeutic treatment and the development of the fragmented QRS complex in electrocardiography (ECG). Patients and Methods: Among 130 patients who were diagnosed with non-Hodgkin lymphoma and received an R-CHOP treatment regimen, the potential emergence of fragmented QRS on ECG as well as the changes in the left ventricular ejection fraction (LVEF) (on transthoracic echocardiography) in response to various chemotherapeutic regimens were sought. Results: New development of a fragmented QRS pattern was observed in 53 of the 130 patients (40.8%). These patients were found to have lower LVEF values along with higher numbers of chemotherapy courses and cumulative doses. In the logistic regression analysis, age (OR = 1.042; 95% CI 1.009–1.076; p = 0.012) and number of courses (OR = 1.848; 95% CI 1.409–2.423; p < 0.001) were found to be the most important predictors of fragmented QRS development. In subjects with a fragmented QRS pattern, there was a significant difference between the initial and repeat LVEF values (p < 0.001). Importantly the emergence of a fragmentation pattern occurred much earlier compared to the drop in LVEF values (10.62 ± 4.04 vs. 15.24 ± 7.49 months). Conclusion: Development of a fragmented QRS pattern in response to cancer therapy emerges as a new parameter potentially predictive of chemotherapy-induced cardiotoxicity.

Introduction and objectives To compare the results in terms of efficacy and safety of the endoscopic management for vesicoureteral reflux (VUR) in two different standardized primary VUR cohorts treated with Dexell and Vantris. Patients 128 refluxing renal units (RRU) in 87 patients with primary VUR (64 females, 23 males). Patients with secondary VUR and severe bladder and bowel dysfunction were excluded. A total of 22 continent children with mild bladder-bowel dysfunction underwent bladder-bowel training before the implantation. All procedures were performed in the presence of sterile urine using a conventional subureteral transurethral injection technique. Results There were no statistically significant differences between groups in terms of mean age, sex, RRU side, 99mTc-DMSA uptake, and reflux grade. The overall resolution rates based on the number of RRUs for up to three endoscopic treatments were 80% (56/70) in Dexell group and 94.8% (55/58) in Vantris group (P = .012). No postoperative recurrences or vesicoureteral junction obstructions were seen in any group. Conclusions Dexell and Vantris provided an effective and safe endoscopic VUR treatment in the early and mid-term follow up of children with primary VUR. The effectiveness of these substances, which can produce different mass effects with different particle sizes, in safe VUR resolution, needs further investigations.

Altay D, Ozcan A, Unal E, Deniz K, Ozkan KU, Patiroglu T, Arslan D. A rare cause of vomiting in an adolescent: gastric Burkitt`s lymphoma. Turk J Pediatr 2019; 61: 431-435. Burkitt`s lymphoma, which is the most commonly diagnosed pediatric gastrointestinal tumor, usually affects the intestinal tract. However, the diagnosis of gastric Burkitt`s lymphoma in childhood is extremely rare. Here, we have reported the case of an adolescent male patient with vomiting and weight loss symptoms who was diagnosed with Burkitt`s lymphoma of the pyloric antrum. The patient responded very well to chemotherapy and he did not develop tumor lysis syndrome. Based on this case report, gastric Burkitt`s lymphoma might be included in the differential diagnoses of pediatric patients who experience vomiting that results in significant weight loss.

Background and objectives: Cranial magnetic resonance imaging findings of patients considered to be cryptogenic stroke may be useful in determining the clinical and prognostic significance of arrhythmias, such as atrial premature beats and atrial run attacks, that are frequently encountered in rhythm Holter analysis. This study was conducted to investigate the relationship between short atrial runs and frequent premature atrial contractions detected in Holter monitors and infarct distributions in cranial magnetic resonance imaging of patients diagnosed with cryptogenic stroke. Materials and Methods: We enrolled the patients with acute ischemic stroke whose etiology were undetermined. We divided the patients in two groups according to diffusion-weighted magnetic resonance imaging as single or multiple vascular territory acute infarcts. The demographic, clinical, laboratory, echocardiographic, and rhythm Holter analyses were compared. Results: The study investigated 106 patients diagnosed with cryptogenic stroke. Acute cerebral infarctions were detected in 31% of the investigated patients in multiple territories and in 69% in a single territory. In multivariate logistic regression analysis, the total premature atrial contraction count (OR = 1.002, 95% CI: 1.001&ndash, 1.004, p = 0.001) and short atrial run count (OR = 1.086, 95% CI: 1.021&ndash, 1.155, p = 0.008) were found as independent variables that could distinguish between infarctions in a single or in multiple vascular territories. Conclusions: Rhythm Holter monitoring of patients with infarcts detected in multiple vascular territories showed significantly higher premature atrial contractions and short atrial run attacks. More effort should be devoted to the identification of cardioembolic etiology in cryptogenic stroke patients with concurrent acute infarcts in the multiple vascular territories of the brain.

Introduction:Myocardialinjury after percutaneous coronary intervention (PCI) is seen frequently.Ischemia/reperfusion injury, side branch occlusion and distal embolization ofatherothrombotic debris are the main causes of myocardial injury. Remoteischemic preconditioning (RIPC) is a promising technique for protection fromischemia/reperfusion injury, but sufficient data of long-term clinical outcomesis not available. In this study we planned to investigate the effect of onecycle of RIPC on major cardiovascular events one year after elective PCI.Patientsand Methods: 102 patients, undergoing elective PCI, with normalbaseline cTroponin-I (cTn-I) values, were randomized equally into two groups.Five minutes of ischemic preconditioning was applied before the intervention tothe preconditioning group, by inflating blood pressure cuff up-to 200 mmHg onnon-dominant arm. After 1 year, the clinical outcomes of these patients(angina, heart failure, death, myocardial infarction, repeat revascularization)were questioned.Results: From a total of 102patients, 90 could be reached after an year. The mean duration of follow-up was432 vs. 423.5 days (p= 0.793). Post-PCI 16th hour cTn-I was insignificantlylower in the preconditioning arm (0.079 μg/L vs. 0.069 μg/L, p= 0.074). Theincidence of cTn-I elevation 5 fold above the URL (> 0.115 μg/L) was lowerin the preconditioning group; however, it was also insignificant (24.4% vs.13.3%, p= 0.301). Death, MI or repeat revascularization rates did not differbetween the groups., Giriş: Perkütan koroner girişim sonrası miyokart hasarı sıklıklagörülmektedir. Miyokart hasarı iskemi/reperfüzyon hasarına, yan dal tıkanmasınave aterotrombotik debrisi distal embolizasyonuna bağlı gelişmektedir. Uzaktaniskemik ön koşullanma iskemi reperfüzyon hasarından korunmada ümit vericiteknikledendir ancak uzun dönem sonuçları ile ilgili yeterli veri henüzbulunmamaktadır. Biz bu çalışmadaperkütan koroner girişim öncesi uygulanan tek sefer uzaktan önkoşullanmanın bir yıl sonunda majör kardiyovasküler olaylar üzerine etkisiniaraştırmayı planladık.Hastalar ve Yöntem: Elektif perkütan koroner girişimplanlanan 102 hasta çalışmaya alındı ve hastalar iki gruba randomize edildi. Önkoşullanma grubundaki hastalara girişimden önce, kan basıncı manşonu 5 dakikaboyunca 200 mmHg’da şişirilerek ön koşullanma uygulandı. İşlem öncesi vesonrası cTroponin-I değerlerine bakıldı. Birinci yıl sonunda hastaların klinikdurumları sorgulandı (angina, kalp yetersizliği, ölüm, miyokart infarktüsü,tekrar revaskülarizasyon).Bulgular: Yüz iki hastanın 90’ına ulaşılabildi. Ortalama takipsüresi 432 vs. 423.5 gün (p= 0.793). Ön koşullanma grubunda koroner girişimsonrası 16. saat cTroponin-I değeri kontrol grubuna göre daha düşük bulunduancak istatistiksel anlamlılık saptanmadı (0.079 μg/L vs. 0.069 μg/L, p=0.074). cTroponin-I beş kat arttığı hasta oranı da ön koşullanma grubunda dahaazdı ancak bu fark da istatistiksel olarak anlamlı saptanmadı (24.4% vs. 13.3%,p= 0.301). Ölüm, miyokart infarktüsü ve tekrar revaskülarizasyon açısındangruplar arasında fark saptanmadı.Sonuç: Tek sefer uzaktan iskemikön koşullanmanın elektif perkütan koroner girişim sonrası majör kardiyovaskülerolaylar üzerine etkisi saptanmamıştır.

Objective To assess recurrence of saphenous veins and their tributaries following endovenous laser ablation (EVLA) and define primary or secondary ablation ratios as a result of misinterpretation, new incompetency formation, and re-canalization. Methods The EVLA procedure was applied for vein insufficiency to 50 symptomatic patients (range, 22–78 years; mean age 45 ± 14 years; gender, 18 [36%] men, and 32 [64%] women). Before and after the procedure, a total of 80 legs were prospectively evaluated for recanalization of the great and small saphenous vein, anterolateral, posteromedial, intersaphenous thigh, and the calf veins by Doppler ultrasonography. EVLA was performed on the saphenous veins along with their tributaries, and was defined as the primary ablation. EVLA and alcohol ablation after the first procedure was defined as the secondary ablation. We evaluated the veins according to re-canalization and secondary ablation, and also measured the primary and secondary ablation ratios. Results Seventy-three (97.0%) VSM and 39 (95.0%) VSP were treated with primary ablation and 2(3.0%) VSM and 2 (5.0%) VSP were treated with secondary ablation because of newly developed incompetency. In addition, 15 (71.0%) saphenous tributaries were treated with primary and 6 (29.0%) with secondary ablation. After primary or secondary ablation, 9 (12.0%) misinterpretation or new incompetency formation was found during a one-year follow-up. Seven (9.0%) VSM were re-canalized at the mean length of 46 ± 15 cm (range 32–65 cm) in one year. The laser energy in the re-canalized VSM was 78 ± 25 joules/cm (range 61–83) and all were retreated with laser or foam sclerotherapy. Conclusions VSM re-canalization and new vessel incompetency formation are reasons for secondary ablation, which is not a rare condition. Follow-up examinations and anatomical mapping are crucial for detecting new vessel formation or miss-interpretation after sclerotherapy or EVLA treatment.

OBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography. MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA. RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors. CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH.

Background/Purpose To evaluate the success rate of open ureteroneocystostomy (UNC) after failed endoscopic treatment of vesicoureteral reflux (VUR) in children and to discuss the reasons for failure under the light of histopathological findings. Methods The clinical data of 371 patients who underwent endoscopic injection for VUR at our institution for the treatment of VUR between January 2008 and January 2014 were reviewed. Patients who were submitted to open ureteral reimplantation following failed endoscopic injection were included in the study. Results Among 371 patients, 34 (49 ureters) were submitted to open UNC (9.1%). There were 22 female and 12 male patients. Three different injection materials were used; dextranomer/hyaluronic acid in 29, carbon-coated beans in 7 and polyacrylate polyalchohol copolymer in 13. Histological study revealed that the injected material was identified in 34 ureters as malpositioned. Control VCUG 6 months after UNC showed complete resolution in 46 of 47 ureters (97.87%). Conclusions Previous endoscopic injection, although causing difficulty in dissection to some degree, does not alter the success rate of UNC. According to the histopathological findings, the cause of failure of injection seems to be attributable to incorrect plane of injection or leakage of the agent after injection.

Objective To evaluate the effectiveness of 4.5F ultrathin semirigid ureteroscope (ultrathin-URS) in the management of ureteral stones in prepubertal children without active or passive ureteral dilatation. Materials and Methods Records of 36 children undergoing ureteroscopy with ultrathin-URS were retrospectively reviewed in 2 different centers for ureteral calculi between November 2011 and December 2013. Stones were fragmented with holmium:yttrium-aluminum-garnet laser and pneumatic lithotripter. Patients' demographics, stone location and size, active dilatation, passive dilatation, postoperative stenting, stone-free rates, and complications were noted. Results Patients consisted of 21 girls and 15 boys with a mean age of 5.33 ± 3 years. Stones were located in the distal, mid, and proximal ureter in 26, 5, and 5 patients, respectively. All ureteroscopies were performed with no active or passive dilatation. Ultrathin-URS was able to provide a stone-free status in the first procedure except 1 patient whose stone was too proximal. Postoperative ureteral stents (post-stenting) had initially been placed in 16 procedures at the end of the procedure to maintain the ureteral passage. However, after increasing occupational experience and learning that ureteral traumas were minimal with ultrathin-URS, no postoperative stent was used in the following procedures. As to complications, only 3 patients had mild hematuria, and 1 patient had febrile urinary tract infection, and 1 stone migration. No ureteral perforation, obstruction and avulsion were encountered. Conclusion In ureteral stone management, ultrathin-URS along with either holmium:yttrium-aluminum-garnet laser or pneumatic lithotripter can be safely and effectively used with a minimal morbidity as a first-line treatment in prepubertal children without active or passive ureteral dilatation and postoperative stenting.

The rate of non-typhoid Salmonella infections has increased remarkably in recent years. Endovascular system infection is one of the most serious forms of extraintestinal Salmonella infection. The abdominal aorta is frequently involved, while bone and joint involvement are rarely seen. We present a rare case of successful endovascular treatment of a left iliac artery rupture and pseudoaneurysm both occurring due to the direct invasion of lumbar spondylodiscitis caused by Salmonella typhimurium.

Objectives To compare the success and complication rates of ultrasound-guided or palpation-guided punctures of the common femoral artery in a prospective randomized study. Background 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. Materials and Methods 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. Results 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. Conclusions 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. © 2013 Wiley Periodicals, Inc.

The severe ischemia or necrosis of the glans penis is a rarely seen complication after circumcision. We report the case of a 7-year-old boy with severe glans penis ischemia occurring 24 hours after circumcision with local anesthesia (0.1% xylocaine containing ephedrine). His hemogram and levels of proteins C and S and fibrinogen were normal, but the D-dimer level was higher than normal (2.57 mg/L; normal level 0–0.5 mg/L). Normal blood flow was indicated on color Doppler ultrasonography. The severe ischemia in the glans penis was successfully treated with subcutaneous injection of enoxaparin (low-molecular-weight heparin) for 5 days, and the appearance of the glans was close to normal on the fifth day. The patient did not require any surgical intervention and was discharged without sequelae. As a result, we consider that ischemia of the glans penis may initially be managed with enoxaparin, especially in cases in which the D-dimer level is higher than normal.

To determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 ± 5 years; range 42–67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliac recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4–25) before the procedure to 20 (range 1–25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.

Breast swelling is caused by many etiological factors, but should alert central vein occlusion in hemodialysis patients when the permanent vascular access is in the same arm. The swelling of the breast is caused by venous hypertension in the venous plexus draining the breast. Endovascular treatment relieves venous hypertension and related clinical signs. Additional diagnostic workup or invasive interventions such as a biopsy should be avoided in such patients, as diagnosis is straightforward with the presence of a functioning arteriovenous fistula in the same arm.

Our purpose was to report the outcome of endovascular treatment with manual aspiration thrombectomy as the first-line thromboablative method for phlegmasia cerulea dolens.Between October 2006 and May 2010, seven consecutive patients (5 women, 2 men; age range, 31-80 years) with the diagnosis of phlegmasia cerulea dolens secondary to acute iliofemoral deep venous thrombosis had endovascular treatment with manual aspiration thrombectomy. Catheter-directed thrombolysis and stent placement were used as adjunctive procedures. Phlegmasia was left-sided in five and right-sided in two patients.All patients had associated great saphenous vein thrombosis in addition to iliofemoral deep vein thrombosis (DVT). Aspiration thrombectomy completely removed the thrombus from the popliteal vein to the inferior vena cava (IVC) in all cases. Three patients with May-Thurner syndrome had stent placement in the left common iliac vein. Two patients had early recurrences. Repeated aspiration thrombectomy was unsuccessful in one patient. There were no complications related to the procedure. One patient who had been successfully treated died of sepsis and another patient who had unsuccessful repeated interventions had below-the-knee amputation. Overall, the clinical success and survival rates of patients in this study were 86%. On follow-up, three patients with successful treatment were asymptomatic with no deep venous insufficiency. One of these patients died during the 4-month follow-up period. Two patients had mild ankle swelling with deep venous insufficiency.Manual aspiration thrombectomy with adjunctive use of catheter-directed thrombolysis and stent placement is an effective endovascular treatment method with high clinical success and survival rates for phlegmasia cerulean dolens.