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Mekanik Litotriptör: Göz Ardı Edilen Bir Teknolojiye Modern Bir Yaklaşım
No full textAmaç: Mesane taşları, üriner sistem taş hastalıklarının önemli bir alt grubunu oluşturur ve özellikle benign prostat hiperplazisi olan bireylerde ve üriner disfonksiyon yaşayan nörolojik hastalarda, 60 yaşın üzerindeki erkeklerde sıkça görülür. Teknolojik ilerlemeler, mesane taşlarının tedavisinde transüretral sistolitotripsi, ekstrakorporeal şok dalga litotripsi (ESWL), perkütan sistolitotripsi ve açık sistolitotomi gibi çeşitli yöntemlerin geliştirilmesine olanak sağlamıştır. Mekanik litotriptörler, uzun bir geçmişe sahip olmalarına rağmen, lazer litotripsi gibi yeni teknolojilerin lehine günümüzde daha az tercih edilmektedir. Bu çalışma, mesane taşlarının tedavisinde mekanik litotriptörlerin etkinliğini ve güvenliğini değerlendirmektedir. Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2020 ile Ocak 2023 tarihleri arasında Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi’nde mesane taşı nedeniyle ameliyat edilen 194 hasta dahil edilmiştir. Dahil edilme kriterleri, endoskopik girişim tercih edilen 18 yaşından büyük erkek hastalar ile preoperatif ve postoperatif verilerine ulaşılabilen hastaları kapsamaktadır. Açık cerrahi yöntem uygulanan ve eksik verileri olan hastalar çalışmaya dahil edilmemiştir. Cerrahi yöntemler olarak 30 Watt Holmium Lazer ile litotripsi ve Mauermayer’s Stone punch litotriptörü ile litolapaksi işlemleri uygulanmıştır. Demografik veriler, operasyon süreleri, kullanılan cerrahi ekipmanlar, taş boyutu, postoperatif komplikasyon ve sistolitotripsi sonrası yapılan ek tedaviler retrospektif olarak değerlendirilmiştir. Veriler SPSS 24.0 paket programı kullanılarak analiz edilmiştir. Bulgular: Mekanik litotripsi grubunda (n=140) yaş ortalaması 65,44±14,74 yıl, lazer litotripsi grubunda (n=54) ise 67,91±14,58 yıl idi (p=0,297). Mekanik grubunda 117 hasta spinal anestezi, 23 hasta genel anestezi ile, lazer grubunda ise 44 hasta spinal ve 10 hasta genel anestezi ile opere edildi (p=0,728). Ek cerrahi girişimler her iki grupta da gereksinim duyulmuş olup, anlamlı fark bulunmamıştır (p=0,360). Litotripsi süresi mekanik grupta 52,29±28,86 dk, lazer grubunda ise 62,69±22,83 dk idi (p=0,01). Taş boyutlarında gruplar arasında anlamlı fark saptanmamıştır. Komplikasyon oranları benzer olup, mekanik grupta 133 hasta, lazer grubunda ise 52 hasta komplikasyonsuz olarak kaydedilmiştir (p=0,809). Sonuç: Mekanik litotripsi, lazer litotripsi ile karşılaştırıldığında daha kısa cerrahi süre ve benzer komplikasyon oranları sunmaktadır. Mekanik litotriptörler, cerrahi deneyime sahip merkezlerde mesane taşlarının tedavisinde etkin ve güvenilir bir seçenek olarak kalmaya devam etmektedir. Bu çalışma, mekanik litotriptörlerin güvenliği ve etkinliği konusunda mevcut literatüre katkıda bulunmaktadır.Objective: Bladder stones represent a significant part of urinary stone diseases, predominantly affecting men over 60, especially those with benign prostatic hyperplasia and neurological disorders with urinary dysfunction. Technological advancements have led to various treatment modalities for bladder stones, including transurethral cystolithotripsy, extracorporeal shock wave lithotripsy (ESWL), percutaneous cystolithotripsy, and open cystolithotomy. Mechanical lithotriptors, despite their long history and efficacy, have become less prominent in favor of newer technologies like laser lithotripsy. This study evaluates the effectiveness and safety of mechanical lithotriptors in the treatment of bladder stones. Material and Methods: This retrospective study included 194 patients who underwent surgery for bladder stones at Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital between January 2020 and January 2023. Inclusion criteria were male patients over 18 years undergoing endoscopic intervention with available preoperative and postoperative data. Patients who underwent open surgery or had incomplete data were excluded. Surgical methods included lithotripsy using a 30 Watt Holmium Laser and litholapaxy using Mauermayer’s Stone punch lithotriptor. Data on demographics, surgery duration, surgical equipment used, stone size, postoperative complications, and additional treatments were recorded and analyzed using SPSS 24.0. Results: The mechanical lithotripsy group (n=140) had an average age of 65.44±14.74 years, while the laser lithotripsy group (n=54) had an average age of 67.91±14.58 years (p=0.297). In the mechanical group, 117 patients had spinal anesthesia and 23 had general anesthesia, compared to 44 spinal and 10 general anesthesia in the laser group (p=0.728). Additional surgical interventions were required in both groups with no significant difference (p=0.360). The average lithotripsy time was significantly shorter in the mechanical group (52.29±28.86 minutes) compared to the laser group (62.69±22.83 minutes) (p=0.01). No significant differences were found in stone size between groups. Complication rates were comparable, with 133 complication-free cases in the mechanical group and 52 in the laser group (p=0.809). Conclusions: Mechanical lithotripsy offers a shorter surgery duration with comparable complication rates to laser lithotripsy. Despite being underutilized, mechanical lithotriptors continue to be a viable and effective option for treating bladder stones, particularly in centers with surgical expertise. The findings of this study support the safety and efficacy of mechanical lithotriptors in clinical practice, contributing to the existing literature on bladder stone treatment options
SAĞLIK, ÇEVRE, KENTLEŞME VE GELİR ARASINDAKİ İLİŞKİLERİN YENİ SANAYİLEŞMİŞ ÜLKELER ÖZELİNDE İRDELENMESİ: CS-ARDL MODELİ AMPİRİK KANITLARI
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Regenerative Endodontic Treatment of a Necrotic Mature Tooth and a Previously Treated Tooth with Periapical Lesions: Report of Two Cases
No full textDoes Imagery Ability Affect Pelvic Floor Muscle Function?
No full textHypothesis / aims of studyThe aim of this study was to investigate the relationship between kinesthetic and visual imagery ability and pelvic floor muscle (PFM) activity in healthy women.Study design, materials and methodsThis research was planned as a cross-sectional study. The study involved fifteen women aged 20 to 25 years. The socio-demographic characteristics of the participants was collected. PFM activity was assessed using the Neurotrac® Myoplus 2 Pro, a surface electromyography biofeedback device. After the participants understood the method for contracting the PFM, superficial electrodes were placed to the skin to the PFM and transversus abdominis muscle. Kinesthetic imagery and visual imagery ability were assessed with the Movement Imagery Questionnaire-3 (MIQ-3) and the Vividness of Visual Imagery Questionnaire (VVIQ), respectively. Spearman correlation analysis was used to evaluate the correlation between the parameters. Significance level in statistical analysis was accepted as 0.05.ResultsThe mean age and mean body mass index of the participants were 21.8±1.21 years and 23.9±3.72 kg/m2, respectively. It was found that mean the VVIQ was 62.8±7.18. The mean internal visual sub-parameter of HIA-3 was 5.8±0.65, the mean external visual sub-parameter was 5.60±1.08, and the mean kinesthetic sub-parameter was 5.60±0.97. The mean maximum voluntary contraction (MVC) of PFM in rapid (phasic), tonic and endurance contractions were found 49.7±10.6, 38.8±9.0 and 39.0±7.29, respectively. No correlation was found between the MIQ-3 and VVIQ and PFM phasic, tonic, and endurance contractions.Interpretation of resultsOur study found that the participants had relatively excellent levels of kinesthetic and visual imagery, as well as phasic, tonic, and endurance contractions of the PFM. However, we observed no relationship between imagery ability and PFM activity.Concluding messageGiven that the contraction of the PFM could not be easily observable, it is essential to investigate its correlation with the imagery ability in terms of improving rehabilitation programs. Future studies with larger numbers of participants may elucidate the relationship between kinesthetic and visual imagery ability and PFM activity.</p
Effect of Conditioner on GIC-Dentin Bond After Thermal Cycling
No full textAim: The study aimed to evaluate the effect of different surface conditioning protocols on the bond strength of high-viscosity glass ionomer cement to primary dentin under various thermocycling conditions.Materials and Methods: The study protocol was approved by the institutional ethics committee (Approval No.2024/05-34). A total of 108 extracted primary teeth meeting the inclusion criteria were used. Specimens were randomly assigned to four groups according to the number of thermocycles (control, 1000, 5000, 10,000). Each group was further divided into three subgroups based on the surface conditioning protocol: no conditioning, conditioning with the liquid of glass ionomer cement, and conditioning with polyacrylic acid. Bond strength was measured using a shear bond test. Data were analyzed using the Shapiro-Wilk test, robust ANOVA test, and Bonferroni test (p<0.05).Results: It was observed that the bond strength significantly decreased statistically in thermal cycling processes, regardless of surface conditioning protocols (p<0.001). Surface conditioning protocols, independent of thermocycling, did not have a statistically significant effect on bond strength (p=0.941). No significant interaction effect was observed between thermocycling and surface conditioning on bond strength (p=0.617). There was no significant correlation between fracture types and the study groups (p=0.999).Conclusion: Surface conditioning with polyacrylic acid did not improve the bond strength of high-viscosity glass ionomer cement to primary dentin, while thermocycling had a detrimental effect. These findings highlight the need for alternative conditioning strategies to enhance long-term performance.Keywords: Glass ionomer, Shear bond strength, Primary tooth</p