Barış Altay

Women with low libido: correlation of decreased androgen levels with female sexual function index

The aim of the present study was to investigate a possible correlation between decreased androgen levels and female sexual function index (FSFI) in women with low libido and compare these findings with normal age-matched subjects. In total, 20 premenopausal women with low libido (mean age 36.7; range 24–51 y) and 20 postmenopausal women with low libido (mean age 54; 45–70 y), and 20 premenopausal healthy women (mean age 32.2; range 21–51 y) and 20 postmenopausal healthy women (mean age 53.5; range 48–60 y) as controls were enrolled in the current study. Women with low libido had symptoms for at least 6 months and were in stable relationships. All premenopausal patients had regular menstrual cycles and all postmenopausal patients and controls were on estrogen replacement therapy. None of the patients were taking birth control pills, corticosteroids or had a history of chronic medical illnesses. All completed the FSFI and Becks Depression Inventory (BDI) questionnaires. Hormones measured included: cortisol; T3, T4 and TSH; estradiol; total and free testosterone; dehydroepiandrosterone sulfate (DHEA-S); sex hormone binding globulin (SHBG). We performed statistical analysis by parametric and nonparametric comparisons and correlations, as appropriate. We found significant differences between the women with low libido and the controls in total testosterone, free testosterone and DHEA-S levels and full-scale FSFI score for both pre- and postmenopausal women (P<0.05). In addition, decreased total testosterone, free testosterone and DHEA-S levels positively correlated with full-scale FSFI score and FSFI-desire, FSFI-arousal, FSFI-lubrication and FSFI-orgasm scores (P<0.05). Our data suggest that women with low libido have lower androgen levels compared to age-matched normal control groups and their decreased androgen levels correlate positively with female sexual function index domains.

Streptozotocin-induced diabetic effects on spermatogenesis with proliferative cell nuclear antigen immunostaining of adult rat testis

OBJECTIVE To examine the histopathological effects of diabetes on spermatogenesis and to detect the proliferation of germ cells with proliferative cell nuclear antigen (PCNA). DESIGN Controlled experimental study. SETTING The animal laboratory of the Experimental Surgery Center of Ege University, Izmir, Turkey. ANIMAL(S) Ten nondiabetic (control) and 20 diabetic adult male albino rats. INTERVENTION(S) The rats were IP injected with 40 mg/kg streptozotocin for 5 days to create a diabetic condition that was confirmed by testing blood glucose levels 5-7 days after the first injection. MAIN OUTCOME MEASURE(S) Mean testicular diameter, mean semniferous tubuli diameter (MSTD), and PCNA index. RESULT(S) Six weeks after the streptozotocin injection, both the mean testicular and the seminiferous tubuli diameters were significantly decreased in diabetic rats compared with the control group. CONCLUSION(S) The effects of diabetes on spermatogenesis can be clearly detected as a decrease in testicular diameter, MSTD, and PCNA index.

Central and peripheral motor conduction to cremasteric muscle

The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to the cremaster reflex with no reference to central and peripheral nerve conduction to the muscle, probably for technical reasons.Twenty‐six normal adult male volunteers were studied by transcranial magnetic cortical stimulation (TMS) and stimulation of thoracolumbar roots. The genitofemoral nerve (GFN) was stimulated electrically at the anterior superior iliac spine and a needle electrode was inserted into the CM for conduction studies. The motor latency to the CM from the cortical TMS ranged from 20 to 33 ms among the subjects (25.8 ± 2.9 ms, mean ± SD). Magnetic stimulation of the lumbar roots produced a motor response of the CM within 9.6 ± 1.9 ms (range, 6–15). The central motor conduction time to the CM was 16.5 ± 2.8 ms (range, 10–21). Stimulation of the GFN produced a compound muscle action potential with a mean value of 6.4 ± 1.8 (range, 4–10) ms in 23 of the 26 cases. Thus, central motor nerve fibers to the CM motor neurons exist, and there may be a representation area for the CM in the cerebral cortex. The GFN motor conduction time to the CM may have clinical utility, such as in the evaluation of the groin pain due to surgical procedures in the lower abdomen. Muscle Nerve, 2005

Electrophysiological evaluation of the genitofemoral nerve in patients with inguinal hernia

Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal hernia operations, but the integrity of the nerves in this region, including the genitofemoral nerve (GFN), has not been investigated. We studied GFN motor conduction time to the cremasteric muscle (CM), the CM electromyogram (EMG), and the CM reflex in 30 patients with unilateral inguinal hernia who underwent herniorrhaphy and in 26 similar patients who had no surgical intervention. Among the 30 patients undergoing herniorrhaphy, 14 (47%) showed motor involvement of the GFN, whereas 6 of the 26 (23%) patients not treated surgically had involvement of the GFN. These findings indicate that subclinical motor involvement of the GFN can be demonstrated by electrophysiological methods and is common after inguinal herniorrhaphy. Based on patient complaints, the herniated mass may also be responsible for motor involvement of the GFN in some patients before surgery. Muscle Nerve, 2005

Comparison of Gleason scores from sextant prostate biopsies and radical prostatectomy specimens

Objectives: We compared the Gleason scores obtained from sextant prostate biopsy and radical prostatectomy (RP) specimens in patients with localized prostate cancer. Patients and Methods: Sixty-one patients having a clinical diagnosis of localized prostate cancer underwent needle biopsy under transrectal ultrasonography (TRUS) and RP. Grading and staging were assigned based on Gleason scores and the TNM system, respectively. Results: Mean patient age was 65.5 ± 13.43 years and mean PSA level was 14.69 ± 3.95. Mean Gleason score for prostate biopsy and RP specimen were 5.85 ± 0.7 and 6.34 ± 1.44, respectively. With respect to clinical stage, there were 20 patients in stage 1 and 41 patients in stage 2 prostate cancer. Comparing the Gleason scores, the biopsy score was lower in 26 (42.26%) and higher than RP specimens in 7 (11.84%) cases, and there was agreement between the biopsy and RP specimens in 28 (45.9%) patients. The difference between the two Gleason scores was ± 1 for 18 patients (29.5%) and ± 2 or more for 17 patients (27.86%). Conclusion: In our study, high Gleason score biopsies with elevated PSA level (>10 ng/ml) were risk factors for extraprostatic extension, and we demonstrated that Gleason scores were significantly correlated with seminal vesicle and lymph node invasion (p < 0.05). The Gleason scores of biopsy and RP specimens agreed with 45.9% of TRUS-guided sextant prostate biopsies, and this ratio was 91.1% in moderately differentiated tumors

Determination of nitric oxide synthase activity and apoptosis of germ cells in different obstruction models.

We aimed to determine the changes of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) immunoreactivity and apoptosis after proximal and distal obstruction models on ipsilateral and contralateral testicular tissues. Male albino Wistar rats were randomly divided into three groups (n=30): a control group which underwent sham operations (n=10), a unilateral vasal ligation (n=10) and a unilateral epididymal ligation group (n=10). iNOS and eNOS distribution and apoptosis were studied in both ipsilateral and contralateral testes using quantitative immunohistochemistry. Nitric oxide synthase activity was significantly affected in ipsilateral and contralateral testes cells after vasal and epididymal ligation. eNOS immunoreactivity increased markedly after ipsilateral vasal ligation (ILVL). Degeneration-related changes were also associated with changes in apoptotic rate. Analysis using the terminal dUTP nick end-labeling TUNEL method revealed that apoptotic cell numbers significantly increased after ILVL. p53 and bcl-2 immunoreactivity increased in both experimental groups compared with the sham-operated group. Changes in iNOS and eNOS immunolocalisation were strongly associated with cell damage, because germ cell degeneration was more prominent in the ILVL group. Altered p53 immunolocalisation was also associated with cell degeneration, and a rise in bcl-2 immunoreactivity might be considered to reflect a protective mechanism in the testis. These cellular changes could enlighten understanding of the interaction between testicular functioning and damage.

Morphology and Innervation of the Human Cremaster Muscle in Relation to its Function

The electromyographic properties of the cremaster muscle (CM) are quite different from other skeletal muscles. It shows excessive spontaneous discharges, and the motor unit shape and firing frequency of the CM muscle differ from that of limb muscles. In this study, CM of six adult cadavers and six orchiectomy specimens were used to reveal the detailed histology of the muscle and provide an anatomophysiological explanation for these unusual electromyographic properties. Routine histochemical stains revealed the CM was composed of several distinct bundles of smooth and striated muscle fibers within connective tissue. The smooth muscle fibers that were more profuse than previously known and were not arranged in layers, but widely dispersed between striated muscle fibers. Bielschowsky silver staining technique, anti‐neurofilament and anti‐synaptophysin immunostaining showed the presence of multiple motor end‐plates observed as a series of small dots or lines running along the striated muscle fibers and several nerve endings on a single muscle fiber. Myosin immunostaining confirmed the CM is a slow‐twitch muscle, and α‐actin smooth muscle immunostaining confirmed the presence of a large number of smooth muscle fibers. There were also small multipolar neurons forming nerve plexuses between smooth muscle fibers. Anti‐GFAP immunostaining confirmed the presence of glial cells similar to astrocytes. In conclusion, the findings of this detailed anatomical study showed the CM, widely known as a striated muscle, contains a large number of smooth muscle fibers, and the spontaneous electromyographic discharges are due to the presence of multiple motor end‐plates and dense innervation. Anat Rec,291:790‐796, 2008.

Sympathetic skin response recorded from the genital region in normal and diabetic women

AIM OF THE STUDY An electrophysiological technique assessing the sympathetic skin activity related to sudomotor function from the genital skin has been described previously in normal adult man. The problems of the genitourinary tracts and the sexual disorders are difficult to analyse in women. In this paper, a method for recording the genital sympathetic skin responses (g-SSR) has been described in normal women and the objective changes were demonstrated in female patients with diabetes mellitus. MATERIAL AND METHOD Our study comprised 20 healthy adult women (mean age 42.5 years) and 20 diabetic women (mean age 52.8 years). We examined both left hand sympathetic skin responses (SSR) and genital region SSR by electrophysiological methods. Superficial Ag-AgCl electrodes were placed on perineum in front of the anal sphincter and 1-1.5 cm lateral to right labia majora for recording after the stimulation of the right median nerve. All g-SSRs from both recording sites were analysed, latency and amplitudes were compared in normal subjects and patients. RESULTS It has been clearly demonstrated that the g-SSR is easily obtained from all normal female subjects in labia majora-perineum montage. In seven of 20 diabetic patients g-SSR could not be elicited. Mean amplitude was significantly reduced in diabetic group according to normal subjects (P < 0.05). CONCLUSION It was concluded that the method described in this study is easily applied and objectively evaluated for the female patients with genitourinary and sexual problems.

The best management of superficial bladder tumours: Comparing TUR alone versus TUR combined with intravesical chemotherapy modalities?

To compare retrospectively the recurrence rates of TUR alone versus different intravesical chemotherapy modalities in superficial bladder cancer cases, 187 patients with stage Ta and T1 bladder tumours were treated with transurethral resection followed by adjuvant intravesical chemotherapy with mitomycin, BCG or epirubicin or by transurethral resection alone. All patients in this study had historically proven transurethrally resectable primary, category Ta and T1 transitional cell carcinoma (TCC) of the bladder. Group I included transurethral resection alone, and the other groups included intravesical mitomycin-C(Group II), BCG (Group III) and epirubicin (Group IV) therapies after transurethral resection. 146 male and 41 female patients (78% male and 22% female patients) in this study were diagnosed as primary TCC bladder tumours. Only 52 of them were stage Ta and 135 of them were stage T1 bladder tumours. Examining the histological grade of the bladder tumours, 88 (47%) of the patients had grade I, 53 (28%) had grade IIa, 30 (16%) had grade IIb and remaining 16 (9%) had grade III bladder cancers. The recurrence rates were 25% for Group I, 23.8% for Group II, 26.2% for Group III and 22.7% for Group IV. These values were given with disregarding the grade and volume of the bladder tumours. For solitary, less than 3 cm low grade tumours (grade I, IIa) recurrence rates were 16% for Group I, 15.4% for Group II, 17.8% for Group III, 17.2% for Group IV (p> 0.05). As a result of this retrospective study, for patients with low grade, stage Ta and T1 tumours TUR alone may be the best treatment modality. Although intravesical chemotherapy is effective in decreasing short-term incidences of tumour recurrence, it has not decreased long-term incidences of tumour recurrence. The high cost and adverse side effects of intravesical chemotherapy should also be taken into consideration in superficial, single, low grade tumours of bladder.

From a Molecular Biological Viewpoint, Does Endothelin Type A Receptor Antagonist Therapy Reduce Diabetes-induced Testicular Damage in Rats?

OBJECTIVES To evaluate the therapeutic effects of a selective endothelin type A receptor antagonist (ERA-A) on testis of streptozotocin (STZ)-induced diabetic rats. METHODS Eighty rats were analyzed in 4 groups: healthy controls, diabetic rats, diabetic rats treated with ERA-A, and healthy rats treated with ERA-A. Diabetes was induced in 40 rats by a single intraperitoneal injection of STZ and followed for 2 months. A total of 20 diabetic and 20 healthy rats were also intravenously treated with ERA-A at days 7 and 15. The remaining untreated healthy rats served as controls. Blood glucose levels of ≥ 250 mg/dL were considered to indicate diabetes and were measured at the end of the second month. Formalin-fixed paraffin-embedded testis tissue sections were analyzed after staining with hematoxylin and eosin or specific antibodies for apoptotic markers. mRNA expressions of genes involved in the apoptotic pathway or spermatogenesis were evaluated by real-time reverse transcription-polymerase chain reaction. RESULTS Major therapeutic effects of ERA-A could be achieved for damages caused by oxidative stress. Although a decrease in apoptotic cell death could be detected, no statistically meaningful results could be obtained for the duration of spermatogenesis. CONCLUSIONS ERA-A could prevent germ cell death by apoptosis and testicular damage in diabetic rats.