Bulent Alici

High Levels of Cadmium and Lead in Seminal Fluid and Blood of Smoking Men are Associated with High Oxidative Stress and Damage in Infertile Subjects

We measured the levels of malondialdehyde (MDA), protein carbonyls, glutathione S-transferase (GST) and reducte glutathione (GSH) in seminal plasma and spermatozoa from 95 subjects including 50 infertile patients to evaluate the association between oxidative stress and damage and the components of the anti-oxidant defenses in seminal plasma and spermatozoa of infertile subjects and concentrations of cadmium (Cd) and lead (Pb) in the blood and seminal plasma because of tobacco smoke exposure. The reactive oxygen species (ROS) in spermatozoa were also evaluated by luminol (5-amino-2,3-dihydro-1,4-phthalazinedione)-enhanced chemiluminescence assay. The sperm count, motility, and morphology in the smokers infertile group were found to be lower than those in the fertile male group and nonsmokers infertile group (p < 0.001). Concentrations of Cd, Pb, MDA, protein carbonyls, and ROS levels in the smokers infertile group were significantly higher than those in the fertile male and nonsmokers infertile male groups (p < 0.001). However, GSH levels and GST activities were decreased in the smokers infertile male group than those in the fertile male and nonsmokers infertile male groups (p < 0.001). The results indicate that smoking could affect semen quality and oxidative lipid and protein damage in human spermatozoa. From Pearson correlation analysis, positive correlations were demonstrated between the seminal plasma Cd and seminal plasma protein carbonyls and between seminal plasma Pb and spermatozoa ROS levels in smokers of the subfertile group, while there was a significant positive correlation between blood Cd and ROS levels in smokers of the fertile group. There was also a significant negative correlation of the Cd level of the blood and GSH levels of the sperm and seminal plasma. These findings suggest that cigarette smoking enhances the levels of Cd and Pb in seminal plasma and blood and the extent of oxidative damage associated with a decrease in components of the anti-oxidant defenses in the sperm of infertile males.

Impact of Cu and Fe concentrations on oxidative damage in male infertility

Oxidative stress in the reproductive system is thought to have an effect on the fertilizing ability of sperm. The purpose of this study was to assess the interaction of iron (Fe) and copper (Cu) ions in suspected subfertile and fertile male groups and to find out the relationships of the semen parameters (sperm count, motility, and abnormal morphology), glutathione, malondialdehyde, and reactive oxygen species with these variables. Semen and blood obtained from 60 subfertile men and from 40 fertile volunteers were examined. The sperm count and motility in the subfertile male group were found lower than those in fertile male group (p<0.001). Cu levels in serum and seminal plasma in the subfertile male group were significantly higher than those in the fertile male group (p<0.001 and p<0.05, respectively). There was also a significant increase in the Fe level of seminal plasma in the subfertile male group (p<0.001). However, there was no significant difference in the Fe level of serum in the subfertile male group. In conclusion, these findings suggest that Cu and Fe might be mediators of the effects of oxidative damage and play an essential role in spermatogenesis and male infertility; the determination of Fe and Cu levels in serum and seminal plasma during infertility investigation is recommended.

Apoptosis in the erectile tissues of diabetic and healthy rats.

Objective To compare the frequency of apoptosis in the erectile tissue of chronic diabetic and healthy rats.

Incision and Venous Patch Graft in the Surgical Treatment of Penile Curvature in Peyronie’s Disease

Objectives: To assess the efficacy of incision and venous patch grafting method in the surgical treatment of the curvature in Peyronie’s disease. Methods: Fifty–eight patients with Peyronie’s disease underwent incision of the tunica albuginea with Peyronie’s plaque(s) and venous patch grafting between 1994 and 1999. Segment(s) of lower saphenous vein in 48, deep dorsal vein in 7, and upper saphenous veins were used in 3 cases as venous patch(es). Assessment of the potency status, curvature, and vascular structure were performed pre–operatively with detailed history, counselling, autophotography, and color Doppler ultrasonography. Realistic expectations from the surgery was discussed with the patients in advance. Postoperative evaluation was performed at least twice, in the 6th week and the 3rd month. The third evaluation was done in 12–36 months by telephone. Results: Fifty of the patients (86%) achieved straight erections after the surgery. Five patients (9%) had improvement in their penile curvature that enabled them to perform sexual intercourse easily. In 3 of our patient (5%) recurrence of the curvature was observed. Penile shortening of 0.5–1.5 cm was observed in 13 of the cases (22.4%). Fifty–four cases (93%) reported no change in their quality of erections. Conclusion: Incision of the tunica albuginea and venous patch grafting technique is a very satisfactory surgical method in the treatment of the curvature in Peyronie’s disease.

An unusual presentation of a foreign body in the urinary bladder : A migrant intrauterine device

A 35-year-old woman, who had had an intrauterine device inserted 7 years earlier, presented with dysuria, pollakiuria, suprapubic pain and urethral irritation. The intrauterine device was found in the bladder with stone formation and was removed by endoscopy.

Superficial dorsal penile vein thrombosis (penile Mondor's disease)

In our center between 1992 and 1994 penile Mondors disease (superficial dorsal penile vein thrombosis) was diagnosed in 5 patients aged 20–39 years. In all patients the thromboses were noted 24–48 hours after a prolonged sexual act with or without an intercourse. The main symptom was a cord-like thickening of the superficial veins, which were painless or slightly painful. Doppler examination of the superficial dorsal vein revealed obstruction of the vessels. In 2 patients the retroglandular plexus was also involved. Patients were treated with anti-inflammatory medications (Tenoxicam or Ibuprofen). The resolution of the thrombosis occurred uneventfully within 4–6 weeks. No recurrence or erectile dysfunction was noted in any of the patients. Penile Mondors disease is a benign pathology of the superficial dorsal penile vein and should be taken into account in the differential diagnosis of penile pathologies.

Protective effect of decorin on acute ischaemia-reperfusion injury in the rat kidney.

Introduction Transforming growth factor-β1 (TGF-β1) has a crucial role in collagen synthesis and fibrosis. TGF-β1 can be antagonized and/or reduced by the action of certain agents. We propose to identify the role of decorin in treatment of tubular and interstitial fibrosis and in the inhibition of TGF-β1 in an acute ischaemic kidney. Material and methods We grouped 34 female Sprague Dawley type rats into 3 groups as 9 sham, 9 ischaemia-reperfusion (I/R) and 16 I/R + decorin respectively. The rats in the I/R + decorin group had decorin administered intraperitoneally at the dose of 0.1 mg/kg for 9 days after reperfusion. After 9 days, all the rats in the 3 groups were unilaterally nephrectomized. The TGF-β1 level was measured immunohistochemically in the nephrectomized material. Results The TGF-β1 level was lower in the I/R + decorin group. Evaluation of apoptotic activity level by caspase staining showed a statistically significant difference between the 3 groups. The number of caspase stained cells was lower in the I/R + decorin group. The amount of collagen in interstitial tissue was higher in the I/R group than in the I/R + decorin group, but this difference was not statistically significant. Conclusions We found that the TGF-β1 level – the so-called initiator of fibrotic activity – and apoptotic activity were low in the I/R + decorin group. Additional studies must be performed to understand the role of decorin in inhibition of TGF-β1 and to assess decorin’s routine use in acute renal ischaemia.

Association of Pb, Cd, and Se Concentrations and Oxidative Damage-Related Markers in Different Grades of Prostate Carcinoma

Prostate cancer is known to be affected by the heavy metal levels and oxidative damage of the body, yet there are very few studies which look into the way it occurs. The aim of this study was to determine whether blood and tissue lead (Pb), cadmium (Cd), and selenium (Se) levels are associated with oxidative damage in the context of prostate cancer progression and development. Seventy-nine patients comprising 25 patients with benign prostatic hypertrophy (BPH), 23 patients with malignant prostatic carcinoma (malign Ca), 16 patients with low-grade prostatic intraepithelial neoplasia (LGPIN), and 15 patients with high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosed on the basis of their clinical profile, transrectal ultrasonography, and histopathology were included in this study. Cd and Pb levels in whole blood were found to be increased in patients with HGPIN compared with the BPH group; also, the levels of Cd in whole blood and tissue were found to be increasing in patients with malign Ca, unlike BPH patients. Moreover, the levels of malondialdehyde (MDA) in plasma and tissue were significantly increased in malign Ca, LGPIN, and HGPIN than those in BPH. However, the levels of tissue Pb were found to be decreasing in BPH, unlike the malign Ca and HGPIN patients, and the levels of tissue protein carbonyls in malign Ca were significantly lower than those in HGPIN. The levels of tissue reduced glutathione (GSH) in malign Ca were significantly lower than those in BPH. Additionally, the levels of Se in serum and tissue in LGPIN were significantly lower than those in BPH. The serum Se levels in HGPIN were also significantly lower than those in BPH and malign Ca groups. Furthermore, the concentrations of serum Se in LGPIN were significantly lower than those in malign Ca. From the Pearson correlation analysis, there were significant positive correlations between tissue Cd and MDA levels in malign Ca, LGPIN, and HGPIN and between the tissue Pb and tissue MDA and protein carbonyl levels in malign Ca. Blood Pb and tissue Pb were also significantly positively correlated with plasma MDA and protein carbonyl levels in malign Ca. In addition, blood Pb was significantly positively correlated with tissue MDA and protein carbonyl levels in malign Ca, and a significant positive correlation was also found between blood Cd and plasma protein carbonyls and tissue MDA in LGPIN. We observed that altered prooxidant–antioxidant balance and heavy metal levels may lead to an increase in oxidative damage and may consequently play an important role in prostate carcinogenesis. These findings indicate that changes in the levels of Pb, Cd, Se, MDA, protein carbonyls, and GSH in the blood and/or tissue are related to the prostatic carcinoma development and progression, although triggering one of the mentioned changes is unknown; therefore, further study is required to determine the exact steps of the process and clarify the roles of different substances in order to obtain a more detailed explanation of the phenomenon.

The Relationship between Diabetes mellitus, Impotence and Veno-Occlusive Dysfunction in Peyronie’s Disease Patients

Peyronie’s disease is an ill-defined condition that often leads to severe penile deformity and sometimes erectile dysfunction. Penile Doppler studies indicate veno-occlusive dysfunction as the principal cause of poor rigidity in Peyronie’s disease patients. Diabetes mellitus is also a known cause of impotence and its prevalence tended to be higher in patients with Peyronie’s disease. We evaluated 143 patients with Peyronie’s disease, also 92 impotent men (37 diabetic, 55 nondiabetic) as control group. Penile vascular studies were performed on each group. Diabetes mellitus was also investigated in patients with Peyronie’s disease. Veno-occlusive dysfunction was found as the main cause of impotence in both groups (81.1% in diabetic, 89% in nondiabetic control group and 88.8% in Peyronie’s disease patients). In our study group the prevalence of diabetes mellitus tended to be higher than in the control population but it did not alter the ratio of veno-occlusive dysfunction and impotence in Peyronie’s disease patients. We believe there is a close relationship between diabetes mellitus and Peyronie’s disease, considering our high incidence. We also conclude that diabetes mellitus is not the main cause of impotence in patients with Peyronie’s disease.

The Value of Serum Prostate Specific Antigen and other Parameters in Detecting Bone Metastases in Prostate Cancer

The cut-off value of serum prostate-specific antigen (PSA) level in prediction of bone metastases and the correlation of serum PSA with the clinical stage, grade, score and the rate of bone metastases have been investigated in cases of prostate cancer (PCa).The study population consisted of 160 patients with histologically proven PCa between April, 1993 and August, 1996. The negative predictive value and the sensitivity were the highest (94%) in patients with a serum PSA value less than 10 ng/ml.We claim that in patients with PSA values less than 10 ng/ml whole body bone scan is not necessary.