Akin Soner Amasyali

Increased preoperative levels of plasma fibrinogen and D dimer in patients with renal cell carcinoma is associated with poor survival and adverse tumor characteristics

BACKGROUND AND OBJECTIVEnThe relationship between renal cell carcinoma (RCC) and coagulation/fibrinolysis system has been described in several studies. The aim of this study was to investigate the role of 4 different coagulation/fibrinolysis factors on the prediction of histopathologic and survival prognosis in patients with RCC.nnnPATIENTS AND METHODSnData from 128 patients who underwent surgical intervention between March 2006 and January 2011 for RCC were evaluated in this prospective study. Blood samples were collected from all patients on the morning of the operation to measure the plasma fibrinogen, D-dimer, coagulation factor VII, and antithrombin 3 levels. The relationships of these factors in the demographic, clinical, and histopathologic outcomes were analyzed using the Student t, Mann-Whitney U, Kruskal-Wallis, and one-way analysis of variance tests. Receiver operating curve analyses were performed to determine the optimal cutoff level for fibrinogen and d dimer, both of which had a strong relation with the clinical and histopathologic parameters. Disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) were assessed using the Kaplan-Meier method. Multivariate Cox regression analyses (forward stepwise logistic regression) were performed to examine the independent prognostic values on survival outcomes.nnnRESULTSnIncreased plasma fibrinogen and d-dimer levels were associated with tumor size (P = 0.004 and 0.106), nuclear grade (P<0.001 and<0.001), TNM category (P<0.001 and 0.029), and metastasis (P<0.001 and 0.032). Both increased plasma fibrinogen and d-dimer levels predicted decreased DFS (P = 0.027 and 0.04), CSS (P = 0.007 and 0.043), and OS (P = 0.014 and 0.001) rates based on Kaplan-Meier analyses. Furthermore, multivariate analyses demonstrated that fibrinogen independently predicted poor DFS (hazard ratio [HR] = 2.52; 95% CI: 1.04-6.31; P = 0.029) and CSS (HR = 3.89; 95% CI: 1.13-13.40; P = 0.032), whereas d dimer had negative independent prognostic value on OS (HR = 4.01; 95% CI: 1.54-10.50; P = 0.005).nnnCONCLUSIONSnIncreased plasma fibrinogen levels accurately predict poor histopathologic and survival outcomes and may be an effective independent prognostic factor in patients with RCC. Moreover, d dimer may serve as a copredictive factor in conjunction with fibrinogen.

Genetic variants of MnSOD and GPX1 and susceptibility to bladder cancer in a Turkish population.

This study was conducted to investigate the association of genetic polymorphisms in the MnSOD and GPX1 genes with the risk and invasiveness of bladder cancer in a Turkish population. This prospectively designed study enrolled 157 patients with bladder cancer (mean age 63.2xa0±xa010.86xa0years) and 224 healthy controls (mean age 61.7xa0±xa08.39xa0years). Genotyping of the MnSOD Ala-9Val and GPX1 Pro198Leu polymorphisms was carried out by PCR–RFLP. No significant difference was found in MnSOD genotype distributions between the controls and the bladder cancer patients. However, the Leu/Leu genotype of GPX1 was associated with a significantly higher risk of bladder cancer than the Pro/Pro genotype. When stratified according to tumor stage, the Leu/Leu genotype of GPX1 was more frequently observed in bladder cancer patients with high-stage tumors than those with low-stage tumors. Additionally, patients carrying both Ala/Ala of MnSOD and Leu/Leu of GPX1 had the highest risk of developing bladder cancer. In conclusion, the present study indicates that the GPX1 Pro198Leu polymorphism may be associated with the risk and development of invasive bladder cancer. In addition, the combination of the MnSOD Ala/Ala and GPX1 Leu/Leu genotypes may have a synergistic effect on disease risk.

Nitric oxide synthase (eNOS4a/b) gene polymorphism is associated with tumor recurrence and progression in superficial bladder cancer cases.

PURPOSEnWe investigated the relationship between the distribution of the eNOS4a/b polymorphism and the clinical features of superficial bladder cancer.nnnMATERIALS AND METHODSnThis study included 201 healthy controls with a mean ± SD age of 62.35 ± 7.96 years and 123 patients with a mean age of 64.03 ± 11.00 years diagnosed with histopathologically confirmed superficial bladder cancer. The eNOS4a/b polymorphism genotype (aa, bb or ab) was identified by polymerase chain reaction. Blood glutathione and plasma malondialdehyde levels were measured by spectrophotometry as an indicator of oxidative stress. We estimated total plasma levels of nitric oxide metabolites using a colorimetric assay kit.nnnRESULTSnThere were no significant differences in age or body mass index between patients and controls. Malondialdehyde and nitric oxide metabolite levels were statistically significantly increased (p = 0.000 and 0.024, respectively) and glutathione levels were decreased (p = 0.000) in patients with superficial bladder cancer. The bb genotype of the eNOS4a/b polymorphism is the most frequent one in the Turkish population and the aa genotype was significantly more common in patients with superficial bladder cancer (p = 0.000). Also, the aa plus ab genotype was significantly more common in patients with high grade tumors (p = 0.013) and in those with more progression to muscle invasive disease (p = 0.000). This genotype was also a significant independent risk factor for recurrence after adjusting for smoking status, stage, grade and the presence of carcinoma in situ on logistic regression analyses (OR 3.095, 95% CI 1.21-7.86, p = 0.018).nnnCONCLUSIONSnThe current study suggests that a genotype containing the a allele of the eNOS4a/b polymorphism may be a risk factor for bladder cancer. Additionally, patients harboring the aa plus ab genotype are more likely to experience tumor recurrence and progression.

Prevalence and correlates of female sexual dysfunction among Turkish pregnant women.

OBJECTIVEnThe aim of the present study was to determine the prevalence and associated factors of female sexual dysfunction together with the concerns of women about sexuality during pregnancy.nnnMATERIAL AND METHODSnA total of 207 healthy, sexually active pregnant women were enrolled in the study. Demographic data of all participants were noted and sexual functions were evaluated by Female Sexual Function Index (FSFI). Each FSFI domain score was calculated and mean scores were noted. Concerns of women about sexuality were also investigated.nnnRESULTSnMean age of participant women was 27.0±5.9 (range 15-44) years. Prevalence of sexual dysfunction was found to be 87% in study population. Mean FSFI score was 18.6±1.21. The rate of sexual dysfunction was higher in the first (87%) and third (92.6%) trimesters when compared to the second (80.6%) trimester (p=0.243). Among demographic variables, education levels of partners and preconceptional sexual dysfunction were found to be significantly related to FSD. The most common concerns of women about sexual relationship have been reported as the fear of having pain (35%), risk of abortion (21.3%) and religious factors (10%).nnnCONCLUSIONnPrevalence of sexual dysfunction is relatively high among pregnant women. Educational levels and preconceptional sexual functions were found to have an impact on this high rate. Accurate counseling of partners about sexuality during pregnancy may help to reduce misbeliefs, concerns and, thereby, decrease this high rate of female sexual dysfunction.

Clinical and Radiological Characteristics of Patients Operated in the First Year of Life Due to Ureteropelvic Junction Obstruction: Significance of Renal Pelvis Diameter

OBJECTIVESnTo analyze the data of our series of patients either operated in the first year of life or managed conservatively because of prenatally detected ureteropelvic junction obstruction, with particular consideration for the significance of renal pelvis diameter.nnnMETHODSnA total of 56 patients with prenatal ultrasonographic findings suggestive of ureteropelvic junction obstruction were enrolled in this study. Operated group and control group consisted of 35 and 21 patients, respectively. We compared postnatal imaging findings of patients managed either conservatively or operatively. The diagnostic accuracy of imaging studies in confirming the diagnosis of obstruction and determining the need for surgery was analyzed.nnnRESULTSnIf relative function of the involved side being <40% was accepted as the gold standard, renal pelvis diameter was found to be a statistically significant predictor of surgical intervention based on the results of receiver operating characteristic curve analysis. The critical diameter was found to be 22 mm, at which sensitivity and specificity of identifying surgical candidates were calculated to be 78.9% and 50%, respectively. In addition, if we consider that having undergone a pyeloplasty procedure is the most accurate definition of ureteropelvic junction obstruction, the critical pelvis diameter was found to be 19 mm. Renal pelvic dilation >19 mm defines obstruction that may necessitate surgical treatment with a sensitivity of 93.9% and specificity of 71.4%.nnnCONCLUSIONSnRenal pelvis diameter may indicate the need for surgical intervention or further assessment to define clinical significance more accurately.

Role of Contrast Enhancement and Corrected Attenuation Values of Renal Tumors in Predicting Renal Cell Carcinoma (RCC) Subtypes: Protocol for a Triphasic Multi-Slice Computed Tomography (CT) Procedure

Summary Background To distinguish RCC subtypes based on contrast enhancement features of CT images. Material/Methods In total, 59 lesions from 57 patients were included. All patients underwent multi-slice CT imaging with a triphasic protocol, which included non-contrast, corticomedullary, nephrographic and urographic phases. Contrast enhancement features of renal masses were evaluated in terms of CT attenuation values (AV) and differences in contrast density; the aorta or renal parenchyma were evaluated based on corrected or relative values. Results Clear cell RCC (ccRCC) showed more intense contrast enhancement than other RCC subtypes. When differentiating ccRCC from other RCC subtypes, a cut-off AV of 86–89 HU, aorta-based corrected AV of 89–95 HU and renal parenchyma-based corrected AV of 87–95 HU showed a diagnostic accuracy of 81–86%, 86–88% and 74–78%, respectively, in the corticomedullary phase. Furthermore, a cutoff of 2.42–2.72 for the relative contrast enhancement ratio, a cutoff of 2.59–2.74 for the aorta-based corrected relative contrast enhancement ratio and a cutoff of 2.63–2.76 for the renal parenchyma-based attenuation ratio showed a diagnostic accuracy of 83–88%, 88–90% and 81%, respectively. Conclusions The most reliable parameters for differentiating ccRCC from other RCC subtypes are aorta-based corrected AV and aorta-based corrected relative contrast enhancement values in the corticomedullary phase.

1840 THE EFFECT OF COMBINED FUROSEMIDE AND INTRAVENOUS HYDRATION TO ESWL SUCCESS ON RENAL STONES

session (82.6%) (p 0.004). After correcting for stone size and location, fluoroscopy time (p 0.001), fragmentation rate (p 0.002), and stonefree rate (p 0.04) maintained their significance. When comparing the top 3 RTs performing 100 SWL sessions, RTs B and C had significantly higher fluoroscopy time compared with RT A [OR (95%CI): 1.84(1.382.45); p 0.001 and 2.67 (2.003.57); p 0.001], respectively. After correcting for stone size and location, RT B had significantly lower fragmentation rate when compared with RT A [OR (95%CI): 0.21(0.05-0.86), p 0.03]. However, there were no significant differences among the top 3 RTs in terms of stone-free rates. CONCLUSIONS: RTs significantly differ in fluoroscopy usage in addition to stone fragmentation and stone-free rates.