Alim Koşar

Ochratoxin A in human serum samples collected in Isparta-Turkey from healthy individuals and individuals suffering from different urinary disorders

Ochratoxin A (OA) is a nephrotoxic fungal metabolite (mycotoxin) occurring in foodstuffs. The compound is causally associated with mycotoxin porcine nephropathy, a disease comparable with a human kidney disease called endemic nephropathy. In this paper OA levels in the human serum samples collected from healthy individuals and individuals suffering from different urinary disorders in Isparta-Turkey are presented. OA was measured in serum samples of 40 healthy people and a total of 93 patients with different kinds of urinary disorders. Four different kinds of urinary disorders were represented: chronic renal failure treated by hemodialysis (35), chronic renal failure treated by peritoneal dialysis (28), patients with bladder cancer (15), patients with renal stones (15). Analysis of OA in human blood samples was performed using an analytical method based on the measurement of fluorescence spectra. The mean concentration of OA in the healthy group was 0.4 +/- 0.28 ng/ml. The highest mean concentration was found in the group of patients treated by hemodialysis, 2.1+/- 1.2 ng/ml. The mean concentrations of the toxin in all patients groups were higher compared to the control group. Also, a significant difference was found between the mean concentrations of the groups of patients treated by dialysis (hemodialysis or peritoneal dialysis) and of the patients with renal stones or bladder cancer, only with the exception of the difference between peritoneal dialysis and renal stones group. No other significant differences were found when comparing the two groups. The findings indicate that OA may have a role in the human urinary pathology considered herein. A higher level of OA in dialysis groups compared to the control, renal stones and bladder cancer groups could probably be explained by the reduced glomerular filtration rate of these patients.

Influence of Experimental Spermatic Cord Torsion on the Contralateral Testis in Rats

To evaluate the degree of ischemia formation in the contralateral testicle following unilateral testicular torsion, free oxygen radical formation after detorsion or an orchiectomy procedure in terms of superoxide dismutase (SOD) and catalase activities was detected in adult male Wistar rats. Animals were divided into 4 groups and following 2 and 6 h of unilateral torsion, the orchiectomy or detorsion procedures were performed and free radical scavenger enzyme activities (SOD, catalase) were measured in the contralateral testes after 24 h, 1 week and 1 month. Evaluation of our results revealed no meaningful ischemia formation in the contralateral testes of rats undergoing 2 h of unilateral testicular torsion. However, animals undergoing 6 h of unilateral testicular torsion demonstrated a statistically significant alteration with respect to enzyme concentrations. Alterations in the contralateral testes were more prominent in animals that had undergone the detorsion procedure following 6 h of testicular torsion. Our results indicate that preservation of twisted testes through a detorsion procedure could cause further deterioration by way of reperfusion injury, indicating the importance of removal of the damaged testicle to minimize long-term histopathologic alterations in the contralateral testes.

Evaluation of Ischemia after ESWL: Detection of Free Oxygen Radical Scavenger Enzymes in Renal Parenchyma Subjected to High-Energy Shock Waves

To evaluate the degree of ischemic formation at the tissue level after high-energy shock wave (HESW) application in a time- and dose-dependent manner, an experimental study in rabbits was performed. Following varying numbers of HESWs (1,000-2,000-3,000 shock waves) under fluoroscopic localization, treated kidneys were removed, by assessing tissue concentrations of two different free-radical scavenger enzymes (superoxide dismutase and catalase) the degree of formation of free oxygen radicals (i.e. ischemia) was evaluated. Evaluation of our results showed a statistically significant (p < 0.05) decrease in tissue scavenger enzyme levels (i.e. formation of free oxygen radicals) after 24 h following HESW application. However, results obtained 7 days after ESWL demonstrated disappearance of ischemia with normalization of tissue enzyme levels (p > 0.05).

Cytogenetic abnormalities detected in patients with non-obstructive azoospermia and severe oligozoospermia.

PurposeTo find the frequency and types of major chromosomal abnormalities with nonobstructive azoospermia and severe oligozoospermia to give appropriate genetic counseling before assisted reproduction techniques in Isparta (South of Turkey), and to investigate the general characteristics in this infertile male population.Methods and patientsA total of 115 infertile males (92 were azoospermic, 23 severe oligospermic) were studied for the cytogenetic evaluation prior to use of assisted reproduction techniques. Also, 60 fertile males as a control group were studied. Karyotyping was performed on peripheral blood lymphocytes according to the standard methods. Levels of luteinising hormone, follicle-stimulating hormone (FSH), testosterone and prolactin were obtained and a testicular sonography examination was conducted.ResultsThe total prevalence of chromosomal abnormalities was found to be 4.3% (5/115), including 4 patients with Klinefelter’s Syndrome and 1 patient with gonadal dysygenesis (46XX). All of them were azoospermic males, corresponding to a frequency of 5.4% (5/92 patients). Oligozoospermic males and control males had no chromosomal abnormalities. There was a significant difference in serum FSH, LH, mean testicular volume and smoking when comparing patients (both azoospermic and oligozoospermic) and control groups (p < 0.05). Also, there was a significant difference in serum FSH, LH and mean testicular volume when compared with azoospermic and oligozoospermic patients (p < 0.05)ConclusionsThe occurrence of chromosomal abnormalities among infertile males strongly suggests the need for routine genetic testing and counseling prior to the employment of assisted reproduction techniques.

Risk Factors for the Formation of a Steinstrasse after Shock Wave Lithotripsy

Introduction: We studied the various stone, renal, and therapy factors that could affect steinstrasse formation after shock wave lithotripsy (SWL) to define their predictive value. Patients and Methods: Between May 1999 and September 2002, 563 patients were treated with a Stonelight V3 lithotriptor. A steinstrasse was recorded in 46 patients. All patient data, stone and renal characteristics, and data of SWL were reviewed. Statistical analyses of patients, stones, and therapy characteristics in correlation with the incidence of steinstrasse formation were performed to assign factors that had a significant impact on the formation of this complication. Results: The overall incidence of a steinstrasse was 8.17%. The steinstrasse was in the pelvic ureter in 84.3% of the cases, in the iliac ureter in 7.84% of them, and in pelvic and iliac ureter in 7.84% of the patients. The incidence of a steinstrasse significantly correlated with stone size and site. The incidence rates of a steinstrasse in renal stones <1 cm, 1–2 cm, and >2 cm were 4.46, 15.87, and 24.3% respectively. The incidence rates of this complication in ureteral stones <1 cm and 1–2 cm were 3.37 and 9.52%, respectively. The incidence rates of a steinstrasse in stones located in upper calices, middle calices, lower calices, and renal pelvis were 6.12, 10.52, 6.36, and 19.32%, respectively. Conclusions: Stone size and site are the significant factors predicting the formation of a steinstrasse. If a patient has a high probability of steinstrasse formation, close follow-up with early intervention or prophylactic pre-SWL ureteral stenting is indicated.

Analysis of the trace element contents of inner nucleus and outer crust parts of urinary calculi.

In this study, the lead, cadmium, nickel, and aluminum concentrations were analyzed in inner nucleus and outer crust parts of various kinds of urinary calculi, and the results obtained were statistically compared. Significant differences were found among the element concentrations in the different stone groups. In general, higher element concentrations were found in the nuclei as compared with the crust parts. In addition, some significant intra- and intercorrelations were established among the elements analyzed. The results suggest that some trace elements, including lead, cadmium, nickel, and aluminum, together with other factors may have as yet no clarified functions in the stone precipitation process in the urinary tract.

Urethral coitus and urinary incontinence in a case of Mayer–Rokitansky syndrome: an alternative surgical procedure

A patient with vaginal agenesis presented with complaints of urethral damage due to urethral coitus. We performed a urethrospincteric reconstruction and formation of a new vagina using the bladder flap and the urethra which was used for coitus, respectively. To the best of our knowledge, this is the first report of this procedure.

Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder.

Background: We describe a new operative technique for the surgical treatment of bladder cancer.

The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation

Background and objectives: The aim of ourstudy was to compare the three differentregional anaesthesia methods in patients whounderwent transurethral resection of theprostate (TURP) and to determine the idealanaesthesia method for TURP operation.Methods: Totally 77 ASA II–III patientswere preloaded with 500 ml 0.9% NaCl solutionbefore regional anaesthesia. In group E (n:27)epidural anaesthesia were achieved by applying75 mg bupivacaine heavy + 50 µg fentanyl inthe L3–L4 intervertebral space. In group SP(n:28) 15 mg bupivacaine heavy + 50 µgfentanyl were used for spinal anaesthesia(L3–L4 intervertebral space) while in group SA(n:30) 10 mg bupivacaine heavy + 50 µgfentanyl were used with saddle blockade.Systolic arterial pressure (SAP), heart rate(HR), peripheral oxygen saturation (SpO2),serum sodium measurement was recorded beforeand after hydration and during operation. Themotor block and sensory level have beenmeasured.Results: Intraoperative SAP values were morestable than the other groups in group SA. Thedecrease in HR values were significant 15minutes after prehydration in three groups(p < 0.05). SpO2 values of the groups werestable during the operation. The time to reachthe maximum block was very short in patients inGroup SA (p < 0.0001). There was astatistically significant difference betweenthe groups in terms of motor block values(p < 0.0001). No fully paralysed sample wasseen in Group SA even though there was asufficient surgical anaesthesia.Conclusions: Saddle block has someadvantages compared to spinal and epiduralanaesthesia methods such as achieving adequateanaesthesia, stable haemodynami, the lowerdegree of motor blockage and no full blockagein patients. Saddle block is an the mostoptimal anaesthesia method for TURP operation.

Long-term effects of microsurgical varicocelectomy on pain and sperm parameters in clinical varicocele patients with scrotal pain complaints

We aimed to investigate the long‐term effects of microsurgical varicocelectomy on pain improvement and sperm parameters in patients with varicocele‐related pain. A total of 72 patients who had undergone microsurgical subinguinal varicocelectomy because of varicocele with scrotal pain between 2004 and 2009 were included in the study. The patients were grouped according to the presence or absence of pain following surgical treatment. The patients expressing a decrease in frequency and severity of pain or minimal fullness sense were included in the pain‐positive group. The mean follow‐up period was 54.4 ± 18.06 months. There was left‐sided varicocele in 80.3% of patients, while 19.7% had bilateral varicocele. In our study, complete success rate (Visual Analog Scale: 0–1) was found to be 79.2% (57/72), while failure (complete and partial failure) rate was 20.8% (15/72), and a significant difference was found (P < 0.05). Microsurgical subinguinal varicocelectomy is a reliable approach for clinically varicocele patients with scrotal pain complaints. Regardless of the type of pain, varicocelectomy significantly decreases pain. The success of the treatment is not related to the degree of varicocele.