Ali Faik Yilmaz

Incidence of Acute Prostatitis Caused by Extended-spectrum β-Lactamase-producing Escherichia coli After Transrectal Prostate Biopsy

OBJECTIVES To study the clinical and bacteriologic picture of acute prostatitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli after transrectal ultrasound-guided prostate biopsy. METHODS The retrospective data from 1339 patients who had undergone transrectal ultrasound-guided biopsy from November 2003 to June 2008 were reviewed. An automatic biopsy gun with an 18-gauge needle was used to obtain 10-core biopsies for first biopsies and > or =12-core for repeat biopsies. These patients had received 500 mg ciprofloxacin orally twice daily for 5 days, beginning 24 hours before biopsy. All biopsies were performed as outpatient procedures. RESULTS Of the 1339 patients, 28 (2.1%) had acute bacterial prostatitis detected after transrectal ultrasound-guided prostate biopsy. Acute prostatitis occurred after the first biopsy in 15 patients (1.3%) and after repeat biopsy in 13 (6.8%). The patients had developed infective symptoms a mean of 3 days after transrectal ultrasound-guided prostate biopsy. Of the 28 patients, 17 (61%) had positive urine and/or blood cultures, including E. coli in 14. Of the 14 patients, 6 had acute prostatitis caused by ESBL-producing E. coli. Bacteria isolated from urine were tested for drug susceptibility to a wide range of antibiotics. All patients with ESBL-producing E. coli were treated with imipenem. The bacteria detected in these urine cultures were resistant to ciprofloxacin, ceftriaxone, sulbactam/ampicillin, and cefazolin. Imipenem and piperacillin-tazobactam were the most active agents against ESBL-producing E. coli. ESBL-producing isolates had a significant reduction in activity for most antimicrobial agents, including fluoroquinolones and amikacin. CONCLUSIONS The prompt initiation of effective antimicrobial treatment is essential in patients with ESBL-producing E. coli, and empirical decisions must be determined by knowledge of the local distribution of pathogens and their susceptibility.

Vitamin D receptor gene polymorphisms in patients with urolithiasis

Urolithiasis is a multifactorial disease, the onset and severity of which is influenced by both genetic and environmental factors. This study represents an investigation of the role of vitamin D receptor (VDR) gene polymorphisms (ApaI, BsmI, and TaqI) and combined genotypes in urolithiasis in a Turkish population. We studied 110 patients with urinary stones and 150 control subjects. The polymorphic regions were amplified using polymerase chain reaction, followed by digestion with restriction enzymes BsmI, ApaI, and TaqI, and analyzed electrophoretically. Genotype and allele frequencies were calculated, and the association with urolithiasis, family history, and recurrence of stone was investigated. Our data provide no evidence for an association between urolithiasis and VDR ApaI, BsmI, and TaqI genotypes. We also analyzed the effects of VDR ApaI, BsmI, and TaqI genotypes in combination; the “GTT” VDR haplotype, constructed from three adjacent restriction fragment length polymorphisms was overrepresented among the urolithiasis patients. However, no significant differences between heterozygous carriers (OR 1.302; 95% CI 0.527–3.215) and homozygous carriers (OR 3.39; 95% CI 0.719–15.985) were observed in our study population. A significant association was found only between the ApaI polymorphism and family history (P=0.017; χ2=5.657). Our data indicate that the VDR ApaI, BsmI, and TaqI polymorphisms do not confer a significant risk for urolithiasis.

p53 and bcl-2 overexpression as associated risk factors in patients 40 years old or less with transitional cell carcinoma of the bladder.

Objectives: Transitional cell carcinoma (TCC) of the bladder in younger patients has historically a favourable prognosis. bcl-2 and p53 genes are implicated in cell cycle regulation with roles on programmed cell death. Presence of nuclear accumulation of p53 and cytoplasmic accumulation of bcl-2 were proposed to confer a growth advantage to tumour cells. In this study, we investigated the roles of p53 and bcl-2 as prognostic factors in TCC of bladder in patients younger than 40 years. Patients and Methods: From 1986 to 1998, 25 patients younger than 40 years were treated for TCC of bladder in our hospital. Of the tumour specimens, 24 were adequate for evaluating p53 and bcl-2 oncoproteins (group I). As a control (group II), we randomly selected 30 patients older than 50 years treated for bladder cancer in this period. Two oncoproteins were detected by immunohistochemical analysis in paired tumour tissue specimens in both groups. Retrospectively obtained clinical follow-up data were available, with a mean follow-up of 44 and 25.5 months in groups I and II, respectively. Relations between tumour recurrences and progression with positivity of bcl-2 and p53 were investigated. Results: Expression of bcl-2 was observed in 13 (54.1%) and 11 (36.7%) and nuclear p53 accumulation in 9 (37.5%) and 17 (56.7%) of groups I and II, respectively. In the presence of p53 expression, tumours showed significantly more progression in group I (55 vs. 6.7%) and group II (41.1 vs. 0%). Recurrence rates were not significantly different in tumours with and without nuclear p53 overexpression in both groups. Also, recurrence and progression rates were not significantly different in tumours with and without cytoplasmic bcl-2 overexpression in both groups. Grade (G) and stage appeared as important prognostic factors in both groups since 60% of GIII tumours showed progression in group I, but none of GI and GII tumours. Similarly, 75% of T3 tumours progressed, while these rates were 25 and 25% for T1–T2 tumours in group I. In group II, 31.2, 25 and 0% of GIII, GII and GI tumours progressed, while 50, 41.6 and 0% of T3, T2 and T1 tumours progressed, respectively. Conclusions: Nuclear p53 expression in TCC appears to be associated with a poorer prognosis in both younger and older patients. Although cytoplasmic bcl-2 overexpression is found in the majority of tumours in the younger group, it is not associated with tumour progression and recurrence.

Experimental Unilateral Spermatic Cord Torsion: The Effect of Polypolymerase Enzyme Inhibitor on Histopathological and Biochemical Changes in the Early and Late Periods in the Ipsilateral and Contralateral Testicles

OBJECTIVES We wanted to show early and late biochemical, histopathological, and apoptotic changes caused by unilateral spermatic cord torsion in ipsilateral and contralateral testicles and the effect of the poly (adenosine triphosphate-ribose) polymerase (PARP) inhibitor, nicotinamide, on these changes in early and late periods. MATERIALS AND METHODS Forty-seven Wistar albino rats were divided into 2 major groups as early and late periods. Subsequently, each group was divided into subgroups as control, sham, torsion-detorsion (TD), TD treated with saline (TDS), and TD treated with nicotinamide (TDN). Left testicles were subjected to spermatic cord torsion for 4 hours. Thirty-minutes before detorsion, 0.2 mL saline or 10 mg/kg nicotinamide was administered intraperitoneally to the TDS and TDN groups, respectively. Bilateral orchidectomy was performed by the end of the fourth hour in early and 2 months after TD in late groups and the animals were sacrificed. Apoptosis, Johnsen Tubular Biopsy Score, and seminiferous tubule diameter (STD) were used to evaluate histopathological changes. Ischemia-reperfusion injury-related changes were assessed by levels of malondialdehyde (MDA) and total and free glutathione in serum. RESULTS There were no significant differences between groups in terms of serum MDA and total and free glutathione levels. Rats given nicotinamide had a higher number of spermatogonia in seminiferous tubules in early and late periods when compared with the untreated group (P <.05). In early and late groups, mean STD of contralateral and ipsilateral testicles were higher in rats given nicotinamide when compared with untreated groups. No significance was observed in terms of STD between early and late groups. Late groups treated with nicotinamide had less apoptosis when compared with untreated groups (P <.05). CONCLUSIONS Nicotinamide may successfully decrease ischemia-reperfusion injury in early and late periods in both testicles.

Effects of intracavernous calcium channel blockers in dogs

Intracavernous injection of smooth muscle relaxing agents can induce penile erection. In this experimental study, we compared the effects of intracavernously injected calcium channel blockers (CCBs) and papaverine in dogs, and investigated their clinical applicabilities.We administered 30 mg papaverine, 10 mg nifedipine, 10 mg nitrendipine and 2.5 mg verapamil to 10 adult male dogs intracavernously, each at different times. Intracavernous pressure values, systemic arterial pressure values and heart rate values were recorded for 45 minutes after the intracavernous injections. We used the paired Studentt-test for statistical analysis.Papaverine induced full erection in all of the 10 dogs. Nifedipine induced full erection in 4, nitrendipine in 5, and verapamil in 6 of the 10 dogs. Nifedipine and nitrendipine caused significant decreases in blood pressure and increases in heart rate.In conclusion, the effects of intracavernous CCBs are not superior to those of papaverine. We cannot recommend nifedipine and nitrendipine for intracavernous injection, but verapamil may be included in intracavernous pharmacotherapeutic combinations.

Renal hydatid cyst treatment: Retroperitoneoscopic “closed cyst” pericystectomy

Cystic hydatid disease is an endemic disease caused by the larval form of Echinococcus spp. Isolated renal involvement is extremely rare. The treatment methods for renal hydatid disease require some form of intervention, ranging from traditional open techniques to laparoscopic techniques. Herein, we present a large hydatid cyst in the lower pole of the left kidney in a 43‐year‐old male patient who was treated by the “closed cyst” method via the retroperitoneal laparoscopic approach to prevent soiling of the peritoneal cavity. To our knowledge, this is the first case of a renal hydatid cyst treated by preserving the renal parenchyma by pericystectomy via the retroperitoneoscopic laparoscopic approach in an adult patient. No complications occurred during the perioperative and postoperative periods. After 9 months of follow up, the patient was asymptomatic with no evidence of clinical recurrence. Retroperitoneoscopic laparoscopic closed cyst pericystectomy can be an alternative minimally invasive treatment technique for the treatment of renal hydatid disease.

ApaL1 urokinase and Taq1 vitamin D receptor gene polymorphisms in first-stone formers, recurrent stone formers, and controls in a Caucasian population

AbstractThe purpose of this study was to determine differences in genotype distribution and allele frequency of urokinase and vitamin D receptor (VDR) single nucleotide polymorphisms (SNPs) between first-stone formers, recurrent stone formers, and controls in a Caucasian population. A total of 86 first-stone formers, 78 recurrent stone formers, and 167 controls were included. Urokinase and VDR SNPs were tested by gene amplification followed by ApaL1 and Taq1 endonuclease digestion, respectively. Baseline variables, genotype, and allele frequencies were compared between the three groups, using descriptive statistics. Adjusted odds ratios were calculated to estimate the risk for recurrent urolithiasis associated with genotypes. We found that differences in the distribution of ApaL1 SNP and Taq1 SNP genotypes were statistically different between recurrent stone formers and first-stone formers, and between recurrent stone formers and controls. Allele frequency analysis showed that the T allele for ApaL1 SNP and the C allele for Taq1 SNP were significantly associated with recurrent urolithiasis. For Taq1 SNP, logistic regression analysis showed that the C/C genotype was associated with a more than threefold higher risk for recurrent urolithiasis. We conclude that ApaL1 and Taq1 SNPs of the urokinase and VDR genes are associated with recurrent urolithiasis in a Caucasian population.

SOMATIC ANGIOTENSIN CONVERTING ENZYME IN VARICOCELE

The ACE is found as two isozymes in the body. A somatic isozyme found in blood and several other tissues, and a testis-specific isozyme found only in developing spermatids and mature sperm. In this study, we investigated the ACE activity in left spermatic vein blood samples of infertile patients with varicocele and its correlation to spermatologic parameters. The somatic ACE activities were determined in the peripheral and left spermatic vein blood samples from 31 infertile patients who underwent variococelectomy, and 11 fertile control subjects underwent left inguinal herniorraphy. The somatic ACE activity was measured by kinetic spectrophotometric assay. Semen analyses were performed according to WHO guidelines. The mean somatic ACE activities of peripheral and left spermatic veins of the varicocele group were 60.3 ± 23.0 and 60.2 ± 23.2 U/L, respectively. In control group, peripheral and left spermatic vein ACE activities were found as 56.8 ± 17.1 and 56.5 ± 15.5 U/L, respectively. There was no significant difference between the ACE activity in peripheral and left spermatic vein blood sample from the varicocele and control group. There was no statistically significant correlation between the spermatologic parameters and ACE activities in the spermatic and peripheral vein in both of varicocele and control groups. As a result, it may be suggested that the somatic ACE has no causative role in pathophysiology of varicocele and varicocele related infertility.

Erişkin Enürezis Nokturnada İmipramin Ve Dezmopresin (Ddavp) İle Uzun Süreli Tedavi Sonuçlarının Karşılaştırılması

The Comparison of Imipramine and Desmopressin (DDAVP) Long-Term Therapy Results in Adult Enuresis Nocturna The long-term therapy results of Imipramine and Desmopressin were compared in 35 adult patients with monosymptomatic enuresis nocturna. Randomly selected 17 patients were treated with 1 mg/kg oral Imipramine and 18 with 20 pg intranasal Desmopressin nightly for three months. Dose titration was done for Desmopressin monthly. Complete improvoment rates in the Desmopressin group were 55%, 61% and 72% after the first, the second and the third months respectively, whereas in the Imipramine group these were found 23%, 40% and 47 %, respectively. The difference between the improvement rates of two groups were not statistically significant (p>0.05). Three months after the end of therapy, complete improvement rates were 30% and 28% for Desmopressin and Imipramine respectively. Relaps rates were 61% in the Desmopressin group and 30% in the Imipramine group (p 0.05). Tedavi kesildikten 3 ay sonra tam iyilesme oranlan dezmopressin icin %30 ve imipramin icin %28 bulundu. Rolaps oranlan ise dezmopressin icin %61 ve imipramin icin %30 idi (p<0.05). Ilaclara bagli ciddi yan etki saptanmadi. Rolaps orani dezmopressin grubunda yuksek olmasina ragmen eriskin enurezis nokturnanin uzun sureli tedavisinde iki ilac arasinda fark bulunamadi.

Üreteroneosistostomi: 26 Olgunun Gözden Geçirilmesi

SUMMARY URETERONEOCYSTOSTOMY: REVIEW OF 26 CASES The results of 39 ureteroneocystostomy operations were performed in 26 cases between April 1979 and April 1989 at the Department of Urology, Ondokuz Mayis University, Faculty of Medicine determined retrospective i y . Indications for ureteroneocystostomy were vesicoureteral reflux in 17 patients, stenosis at ureterovesical junction in 8 patients, and distal ureteral traumatisation in 1 patient. Operations were performed bilaterally in 11 of the patients with reflux and 2 of the patients with obstruction. The operative techniques were Politano-Leadfoetter in 22 units, Cohen in 12 units and Lich-Gregoir in 5 units. The success rate of the operations were 92.8 %. OZET Ondokuz Mayis universitesi Tip Fakultesi Hastanesi uroloji Klini¬ginde Nisan 1979- ile Mart 1989- tarihleri arasinda vezikoureteral reflu, obstruksiyon ve distal ureter yaralanmasi nedeniyle 26 olgu icin yapilan 39 ureteroneosistostomi girisimlerine ait so¬nuclar degerlendirildi. Ureteroneosistostomi indikasyonu 17 olgu icin vezikoureteral reflu, 8 olgu icin ureterovezikal birlesim yeri obstruksiyon ve bir olgu icin, ise distal ureter yaralanmasiydi. Reflulu olgularin 11* inde, obstruksiyonlu olgularin 2sinde iki tarafli girisim yapildi. Politano - Leadbetter yontemi 22, Cohen yontemi 12 ve Lich-Gregoir yontemi 5 birimde uygulandi. Girisimlerin basarisi % 92.8 olarak belirlendi.