Purpose: To evaluate the pathological correlation and prognostic significance of tissue stiffness measured by shear wave elastography (SWE) in bladder cancer. Materials and Methods: Patients with microscopic or macroscopic hematuria diagnosed with bladder tumors were included. SWE measurements were performed using a Samsung Medison RS80A Prestige ultrasonography device, with ten valid measurements taken for each tumor. Tumor specimens were collected via transurethral resection (transurethral resection of the bladder tumor) for histopathological analysis. Microvessel density (MVD) was assessed by immunohistochemical staining with anti-CD34 antibody using the hot-spot method. Correlations between tissue stiffness, MVD and tumor stage and grade were analyzed, and receiver operating characteristic (ROC) analysis determined the optimal SWE cutoff for differentiating tumor characteristics. Results: A total of 65 bladder urothelial carcinoma patients were included in the study (43 high-grade, 22 low-grade). SWE and MVD were significantly higher in the high-grade group (p=0.001, p=0.002, respectively). ROC analysis showed SWE could differentiate tumor grades (area under ROC curve=0.837, p<0.001), with a cut-off of 4.25 kPa (74% sensitivity, 86% specificity). Stiffness was also higher in recurrence (p=0.007). A strong positive correlation between SWE and MVD was found (rho=0.767, p<0.001).SWE may be a reliable, non-invasive tool for assessing tumor grade and recurrence risk. Conclusions SWE may be a reliable, non-invasive preoperative marker for bladder cancer, aiding in tumor characterization and clinical decision-making.

OBJECTIVES: Mucosal free grafts may be successfully applied in many surgical interventions. This study aims at investigating the feasibility of palatal mucosa graft in sub-glottic field in an animal model. METHODS: This randomized prospective controlled study was conducted with an animal model. Sub-glottic inflammation was created in 15 adult rabbits in each group and sub-glottic stenosis surgery was applied thereafter. The rabbits in group 1 (control group) underwent segmental resection, partial cricoidectomy, and trachea-thyroid cartilage anastomosis; the rabbits in group 2 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free buccal mucosa graft; and the rabbits in group 3 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free palatal mucosa graft. Re-stenosis was evaluated after 42 days. RESULTS: The percentages of stenosis were 27%±20%, 40%±20%, and 34%±23% for group 1, 2, and 3, respectively and the difference was not statistically significant (P=0.29). Intensive and tight fibrosis was observed in 2 rabbits (13%) in group 1, in 5 rabbits (33%) in group 2, and in 3 rabbits (20%) in group 3. There was not a statistically significant difference between groups (P=0.41). Excessive inflammation was observed in 3 rabbits (20%) in group 1, in 7 rabbits (47%) in group 2, and 3 rabbits (20%) in group 3. There was no a statistically significant difference between groups although inflammation rate was higher in the rabbits which underwent buccal mucosa graft (P=0.18). CONCLUSION: The surgical treatments applied with free mucosa graft reduced anastomosis tension through enabling anastomosis to the distal of cricoid instead of thyroid cartilage. Free palatal mucosa grafts may be used in sub-glottic field, one of the most challenging fields of trachea surgery, due to ease of application and rapid vascularization.
Adult ; Autografts ; Cartilage ; Constriction, Pathologic* ; Fibrosis ; Humans ; Inflammation ; Models, Animal ; Mouth Mucosa ; Mucous Membrane* ; Prospective Studies ; Rabbits ; Thyroid Cartilage ; Trachea ; Tracheal Stenosis ; Transplants* ; Wound Healing

BACKGROUND: Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures. METHODS: Eighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis. RESULTS: In all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of 21.2+/-9.4 months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up. CONCLUSION: To conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.
Amputation ; Aorta, Abdominal ; Critical Care ; Emergencies ; Follow-Up Studies ; Humans ; Mortality ; Pathology ; Postoperative Period ; Retrospective Studies ; Tertiary Care Centers ; Transplants ; Ultrasonography, Doppler