Urology Education and Urology Practice: Trend Topics and the Needs

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Urology education starts with medical faculty and it is a life-long education. The first rule to be a successful urologist is to like urology as a medical branch and to stay updated. Today urology education differs in European and Non-European countries as they have their own core education programmes. Education in European countries is almost similar as national societies prefer to use educational programme of European Board of Urology. Urology education must be standart in all countries because incidence and prevalance rates are similar for especially urooncologic diseases. Patients also deserve to have standart urological care. Unfortunately, after the urology education urologist do not have chance to have enough instruments and technologic devices in most of the hospitals to show their capabilities and their personal attributes. For this reason, quality of urological treatment and care decrease by time related with the personal motivation of urologists. In most of the European and Non-European countries, only university and research hospitals have standart devices to catch technologic standart care. For example, laparoscopic devices are missing in most of the peripheral hospitals and robot is only found in some big reference centers. This condition cause to be under the technologic and guideline standarts for the treatment of urologic diseases. 

Also in most of the countries, urologists pay less attention to some of the subbranches of urology and as a result there is lack of subspecialists in these subbranches such as pediatric urology, andrology and female urology. Diseases of these branches are unfortunately the ones that urologists ignore and avoid to have detailed knowledge. This negative condition causes the decrease in standart care of the diseases that these subbranches cover. There are official educational programmes or rotations in most of the countries related these subbranches and this must motivate junior urologists to have tendency to these branhes from the beginning. It is also important for senior urologists to motivate junior urologists for these branches. Trend topics of urology are always the urooncologic and endourologic diseases and interventions. Mainly most of the urologists likely to be involved in these subbranches to catch the trends and nearly all the urologists unfortunately define theirselves as endourologists even the ones that only perform cystoscopy. 

Technologic improvements for these branches are charming the urologists. Apart from these problems, urologists are lack of enough academic background because daily practice is taking most of the time and excessive work load causes tiredness. Most of the urologists are willing to deal with academic works but it is impossible for some reasons. This problem will lead bigger ones in the following time and there will not be enough academic urologists in the nearest future according to many studies. These basic problems must be solved as soon as possible at least the main ones. Urologists must have enough facilities, enough time to deal with academic work and enough time for theirselves. Solution of these main problems will also affect the quality of patient care and the mood of urologists. Better mood will result in better work and better careers.

A Complex Clinical Case with Retroperitoneal Fibrosis

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Retroperitoneal fibrosis (RP) is an inflammatory tissue reaction characterized with fibrosis in the the retroperitoneum.There are different diagnostic radiologic studies used for the diagnosis of RP. The disease is also called ‘Ormond disease. In this study, we aimed to present the patient that was admitted to our clinic with bilateral hidronephrosis and diagnosed as retroperitoneal fibrosis, the surgical treatment of disease and persistent clinical situation.

54 year-old male patient admitted to emergency service with bilateral flank pain, nausea and vomiting. According to ultrasonography there was bilateral hydronephrosis. Creatine level increased and the patient was consulted to our clinic. Creatinine level was 6.2mg/dl and there was oliguria. Ultrasonography revealed right pelvicalyceal grade 3 hydronephrosis, and left pelvicalyceal grade 1 hydronephrosis. Computerised tomography was normal. Magnetic resonance revealed hypointense soft tissue formation compatible with retroperitoneal fibrosis that was in midline of abdomen and started form truncus choliacus and extended to iliac bifurcation level and through paraaortic and left pararenal space. Bilateral double J catheterization and steroid treatment was given.

In early postoperative period, creatinine level decreased to 2.1 mg/dl. In the following period, bilateral uretherolysis operation was performedin another clinic due to the increased creatinin levels and persistent bilateral hydronephrosis according to ultrasonography. On postoperative 6th month, patient admitted to our clinic again with bilateral flank pain and ultrasonography revealed right grade 3 hydronephrosis and left grade 1 hydronephrosis. After that we performed bilateral uretheral double J catheterization. But due to the persistent right hydronephrosis nephrostomy catheter was inserted On postoperative 3rd month Escherichia Coli was detected in urine culture and appropriate antibiotherapy was given. After treatment rightnephrostomy and left DJ catheter was removed and right metalic DJ catheterization was performed. On postoperative 3rd month creatinine level was 1.4 mg/dl. There wasn’t any urinary tract infection periodic dj catheter exchange operations planned for the patient. 

Health Tip: Sleep Better

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Poor rest expands your danger of medical issues, for example, cardiovascular illness, hypertension, diabetes, gloom and stoutness, the U.S. National Institute on Aging says. 

Poor rest additionally has been connected to memory issues and expanded danger of falls, the office includes. 

You should go for no less than seven hours of value rest every night. The establishment offers these recommendations for showing signs of improvement rest: 

Go to informal lodging up in the meantime every day, even on the ends of the week or while on an excursion. 

Abstain from utilizing PDAs, PCs and TVs in your room. 

Discover approaches to unwind before bed. 

Try not to eat enormous suppers, or drink caffeine or liquor late in the day. 

Exercise every day, except not just before sleep time. 

Maintain a strategic distance from rests of over 30 minutes.

Art of Salvaging: Bicuspidization and Bone Grafting with Platelet Rich Fibrin in Mandibular Left First Molar – A Case Report

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The increased desire of patients to salvage and maintain their dentition has forced conservative and regenerative dentistry to conserve the teeth in the mouth which are planned to be removed. Thus periodontally compromised teeth with severe vertical bone loss and furcation invasion may well be retained of their roots. In this case report bicuspidization of the left first mandibular molar with bone graft and Platelet Rich Fibrin (PRF) membrane and subsequent prosthetic treatments are presented.

The treatment and management of mandibular molar teeth exhibiting furcation invasions (FI) may involve restorative dentistry, endodontics and periodontics, so that the teeth are retained in whole or in part. Such teeth can be useful as independent units of mastication or as abutments in simple fixed bridges. Thus tooth separation and resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth. The furcation defects vary from a subtle loss of attachment in the buccal furcation area, forming a shallow pocket, to advanced pathology with deep pockets > 10 mm, advanced bone loss and clinical exposure of the furcation. In the mandibular molars, grade III defects are managed by tunnelling procedures, hemisection and bicuspidisation along with open flap debridement. 

The ultimate goal of periodontal therapy is to regenerate the lost periodontal tissues caused by periodontitis. Various controlled clinical trials have demonstrated that some of the available grafting procedures may result in periodontal regeneration in intrabony defects, but complete and predictable reconstruction of periodontal tissues is still difficult to obtain. The reason is that periodontium, once damaged has a limited capacity for regeneration. The most positive outcome of periodontal regeneration procedures in intrabony defect has been achieved with a combination of bone graft and guided tissue regeneration REVIEW OF LITERATURE Bisection or bicuspidization is the separation of mesial and distal roots of mandibular molars along with their coronal portion, where both segments are then retained individually.

Endodontic therapy is performed initially, and during the open flap debridement procedure, the bicuspidization is done and the tooth is restored with a post-endodontic restoration, keeping in mind that the restoration allows for optimal plaque control in the space between the separated roots. A 31-year-old male presented with the complaint of pain of left mandibular first molar with slight mobility. On examination, the tooth was sensitive to percussion. On probing the area, there was a 9-mm-deep periodontal pocket around the mesial aspect of the furcation area. 

A Case of Adult Double-Chambered Right Ventricle Causing Severe Right Ventricular Outflow Tract Obstruction: A Perioperative Perspective

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Double-chambered right ventricle (DCRV) is a rare, congenital heart disease often caused by anomalous muscle bands that can obstruct or even divide the right ventricle into high and low pressure chambers leading to progressive right ventricular outflow (RVOT) obstruction. It is seen in only 0.5-2% of all congenital heart diseases and associated with VSD in 75-90% of cases. DCRV is typically diagnosed and treated during childhood, with rare diagnoses made in adulthood. There does not appear to be a genetic component. It can be difficult to diagnose, especially in the adult patient, due to limitations in modern imaging of the right ventricle. We report a case of a 63-year-old female who returned to the United States for the first time since diagnosis of ventricular septal defect (VSD) at age three. Her symptoms of dyspnea on exertion and fatigue were attributed to right ventricular hypertrophy with obstruction. The patient was scheduled for VSD closure and myomectomy of RVOT utilizing cardiopulmonary bypass (CPB). 

The severe nature of her disease required careful planning of her perioperative management to maintain stable hemodynamics and prevent cardiovascular collapse. Intra-operatively the patient was found to have a myocardial morphology consistent with DCRV. Successful selection and timing of anesthetics, invasive monitoring, vasopressors, and inotropes facilitated an uneventful hospital course. Dis charge occurred on post-operative day four without adverse sequelae. While previous reports have focused on the surgical findings and procedures, very few case reports in the literature have concentrated on the anesthetic management of this complicated congenital condition. This is the only known case that did not require a significant fluid load following induction and initiation of positive pressure ventilation. With careful planning it was even possible to remove autologous blood to minimize transfusion requirements. This report will aid the perioperative team in recognition of characteristic findings in DCRV and offer insight into perioperative management. 

The patient is a 63-year-old female with a known history of uncorrected, congenital VSD who returned to the United States for evaluation of increasing shortness of breath during light activity. Her parents, both missionaries in Tanzania, brought the patient to the U.S. at age three for evaluation of a mur-mur noted at birth. At the time, it was deemed unnecessary to intervene, and the patient experienced a largely unrestricted life in Africa completing missionary work herself. Over the last few years the patient noted a few episodes of atypical non-exertional chest pain as well as progressive exertional dyspnea. The patient’s medical history included only known congenital VSD and right ventricular hypertrophy. She had not undergone prior surgeries. She did not use tobacco, alcohol or illicit drugs and her family history includes heart failure and stroke. The patient underwent extensive cardiac evaluation upon returning to the United States including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), cardiac magnetic resonance imaging (MRI), right and left heart catheterization with ventriculography, as well as electrocardiogram (ECG). The patient was noted to have severe narrowing of the RVOT (Figure 1) with severely increased velocity of 5.45 m/sec and severe pressure gradient of 119 mm Hg across the tract.

How to Protect Against Heart Disease

                                                            

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Coronary illness is a main source of death in the United States, yet there are various things you can do to ensure yourself, a cardiologist says. "Coronary illness slaughters countless Americans every year, except a significant number of these conditions are preventable," said specialist Dr. David Slotwiner, head of the division of cardiology at NewYork-Presbyterian Queens. "Exercise, an adjusted eating regimen and maintaining a strategic distance from high-hazard exercises like smoking are a portion of the most ideal approaches to keep your heart sound," he said in a healing facility news discharge. 

Slotwiner's cardiology group offered the accompanying tips on anticipating coronary illness, for February, which is Heart Health Month. Eat a lot of entire, plant-based sustenances, for example, natural products, vegetables, nuts and seeds. Cut down on refined or prepared sustenances, for example, white bread, wafers and treats, and also sugary refreshments, for example, pop and natural product juice. Stay away from trans fats, which are found in bundled heated merchandise, nibble nourishments, margarine and singed quick sustenances. Trans fats can expand your danger of coronary illness or stroke. 

Try not to smoke. Presentation to tobacco smoke adds to around 34,000 untimely coronary illness passings a year, as per the American Heart Association. Get enough rest - seven to eight hours every night. On the off chance that you have rest apnea, get it treated. The condition is connected to heart musicality issues and coronary illness. Have your circulatory strain checked each time you get a physical. Get general exercise (no less than 30 minutes every day, five days seven days) and control your worry through solid techniques, for example, contemplation, yoga, exercise or investing energy with loved ones. Deal with your teeth and gums. Individuals with gum infection frequently have a similar hazard factors for coronary illness.

Abolition of Ventricular Tachycardia by Revascularization: When Blood Flow is All You Need to Terminate a Recurrent Ischemic Ventricular Arrhythmia

                           http://www.mathewsopenaccess.com/cardiology-Vol-1-Iss-2.html

Active vascular events such as spasm, plaque rupture or thrombosis in the setting of acute coronary syndromes precipitate fatal arrhythmias due to acute ischemia. Lethal ventricular tachycardia (VT) in the setting of ischemic heart disease (IHD) results either from acute ischemia or from chronic scar. Ischemia produces several intra, and extra-cellular changes in ionic concentration and acid-base balance. In this context, the surviving Purkinje fibers exhibit several electrophysiological changes, namely, abbreviated action potentials of reduced amplitude, and depolarized membrane potentials, and reduced conduction velocity. These biochemical and electrophysiological disturbances act in accordance with a number of probable genetic predispositions. 

The resultant ischemia-induced VT may be suppressed by revascularization of the occluded vessel ameliorating the ischemic tissue. Sustained VT in the peri-infarction period may develop due to transient arrhythmogenic phenomena in ischemic and infarcting tissue such as the following: abnormal automaticity, triggered activity, and re-entrant circuits created by heterogeneous conduction and repolarization. Combining different diagnostic techniques, a relation between myocardial ischemia and induction of ventricular arrhythmias can be demonstrated in patients with IHD. Coronary revascularization must be the main goal and may constitute definitive therapy in certain patients with ischemic ventricular arrhythmias. This pure anti-ischemic therapeutic strategy seems to be justified in certain cases of patients with preserved left ventricular function, demonstrable reversible ischemia and non-inducible VT pre and post revascularization. In all other instances an additional treatment with antiarrhythmic drugs and an implantable cardioverter defibrillator is paramount.

Ischemic heart disease (IHD) is the most common cause of sudden cardiac death (SCD) resulting from fatal ventricular arrhythmias, and some of these events occur in persons without any history of cardiac disease. Sustained ventricular tachycardia (VT) and, in particular, ventricular fibrillation (VF), are the immediate causes of cardiac arrest in the majority of the estimated 350,000 cases of SCD that occur annually in the USA. A major cause of SCD is acute myocardial infarction (AMI). Cardiac arrest secondary to AMI induced-VF occurs commonly without warning. Because spontaneous conversion of VF to non-lethal rhythms is rare, out-of hospital VF progresses to death within minutes in more than 95% of the victims. AMI induced-VF leads to SCD as the first manifestation of a preexisting coronary artery disease in about 80,000 people per year. Polymorphic VT in patients with a normal QT interval during sinus rhythm is most frequently seen in the context of acute ischemia. In addition, it may be also seen with other cardiac diseases such as cardiomyopathy, heart failure, and even in the absence of overt cardiac disease, namely, idiopathic polymorphic VT, catecholaminergic VT. Since the electrophysiological changes and ventricular arrhythmias induced by ischemia could be transient and temporary if the ischemic episode subsides, the suppression of ventricular arrhythmias and the ischemia-induced electrophysiological changes by coronary revascularization is the focus of this manuscript.