Mehmet Emin Ozyalvacli

Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1 bladder cancer.

INTRODUCTION We investigated the value of the preoperative neutrophil-lymphocyte ratio (NLR) in predicting recurrence and progression of high-grade pT1 non-muscle-invasive tumour in patients with bladder cancer during a 5-year follow-up period. METHODS We retrospectively reviewed data of 1100 patients with bladder cancer; these patients underwent transurethral resection and were monitored at multiple centres from 2008 to 2013. In total, 166 consecutive and newly diagnosed patients with high-grade pT1 tumours were included in this study. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. RESULTS Of the 166 patients, 152 were male. The patients were evaluated as two separate groups in terms of recurrence and progression. The mean follow-up period was 24.2 months (interquartile range 13.8-36.6 months). A statistically significant difference was found between recurrence and tumour size (p = 0.001), number of tumours (p < 0.001), NLR (p < 0.001), and smoking (p = 0.007). No statistically significant correlation was found between NLR and progression. According to receiver operating characteristic (ROC) analysis, the optimum cut-off value for the NLR was ≥2.43 (74% sensitivity, 60% specificity, p < 0.001; area under the curve [AUC] 0.687, 95% confidence interval [CI] 0.607-0.767). Multivariate logistic regression analysis determined that the following factors were independent predictors of recurrence in patients with high-grade pT1 non-muscle-invasive bladder cancer: tumour number (OR 5.32, 95% CI 2.10-12.90), NLR of ≥2.43 (OR 2.587; 95% CI 1.156-5.789), and smoking (OR 4.17, 95% CI 1.31-13.21). CONCLUSION A high preoperative NLR may play an important role in predicting recurrence of superficial transitional cell type high-grade pT1 bladder tumours. Prospective studies are required to validate the role of NLR as a prognostic marker in high-grade pT1 bladder tumours.

Expression of NOS isoforms in internal spermatic veins of infertile men with varicocele

Although varicocele is a relatively common entity encountered in the evaluation of infertile men, the exact pathophysiology still remains unclear. Recently, as previously widely investigated in various parts of human circulatory system, nitric oxide synthase (NOS) and its product, nitric oxide (NO) have been thought to play a role in the development of varicocele and thus male infertility. In this study, we determined the concentration of NO metabolite and the expression of NOS isoforms in the internal spermatic (ISV) and superficial branch of inferior epigastric veins of infertile men with varicocele. The study included 60 infertile men with clinically unilateral or bilateral varicocele. Expression of inducible and endothelial NOS (iNOS and eNOS) isoforms were investigated in tissue arrays of internal spermatic and superficial branch of inferior epigastric veins with immunohistochemistry. NO metabolite (nitrite) levels were measured using the calorimetric method. A significantly higher expression of eNOS was observed in the varicose veins (mean score: 2.25 and 1.55, respectively; p = 0.0001). However, statistically, there was no significant difference for expression of iNOS between varicose and control veins (p = 0.094). The nitrite concentration and NOS expression were not found to be correlated with clinical variables (varicocele grade, maximum varicose vein diameter, and sperm concentration, motility, and morphology) (p > 0.05). As a result, the significantly higher expression of eNOS in ISV may be responsible for the development of varicocele, although this finding is not accompanied by an increase in NO concentration. Still, the pattern of the relationship between varicocele and increased eNOS expression warrants further investigation.

Protective Effects of N-Acetylcysteine on Experimentally Undescended Testis

PURPOSE We evaluated the efficacy of N-acetylcysteine for testicular damage induced by undescended testes in rats. MATERIALS AND METHODS Flutamide was injected in the abdomen of pregnant rats daily from days 14 to 20 of gestation. Male offspring with cryptorchidism were randomly divided into 2 groups. Healthy male rats without undescended testes comprised the control group (group 1). Group 2 (undescended testes without N-acetylcysteine) received no treatment. Group 3 (undescended testes plus N-acetylcysteine) received intraperitoneal N-acetylcysteine daily. At 70 days after experiment initiation the testes were removed for histopathological and biochemical analysis. RESULTS Mean malonyl dialdehyde values were lowest in group 1 and highest in group 2. In group 3 malonyl dialdehyde levels were significantly lower than in group 2 (p <0.001). Conversely, mean glutathione peroxidase was highest in group 1 and lowest in group 2. Glutathione peroxidase levels in group 3 were significantly higher than in group 2 (p <0.001). Histopathological differences between groups 1 and 3 in the modified Johnsen score were not significant (p = 0.041). However, the differences between these groups and group 2 were significant (p <0.001). The median apoptotic cell count did not differ between groups 1 and 3 but it was significantly higher in group 2 than in the other groups (p = 0.03 and <0.001, respectively). CONCLUSIONS N-acetylcysteine may alleviate undescended testis induced damage to testes through its antioxidant effects. The underlying mechanism of these effects merits further investigation. Long-term studies are also needed as well as comparative animal and human studies.

Spontaneous Renal Parenchymal Hematoma Associated With Clopidogrel in a Patient With Diabetic Nephropathy

Spontaneous retroperitoneal hematoma (SRH) is a very rare clinical picture that may emerge without a trauma or an underlying pathology and also may be fatal. SRH caused by clopidogrel treatment is a rare condition in the literature. In this case, we aimed to emphasize the phenomenon of hematoma caused by spontaneous renal parenchymal laceration after clopidogrel treatment in a patient who was on hemodialysis replacement treatment for diabetic nephropathy. The 65-year-old man presented to the emergency service with sudden onset of right flank pain, abdominal pain, and nausea that woke him up at night. The rectal touch was natural, and no macroscopic hematuria was identified. The patient did not have a history of trauma. Vital signs were in the normal range. He had been diagnosed with coronary artery disease 6 years ago and started on acetyl salicylic acid treatment; however, his treatment was switched to clopidogrel 75 mg once daily after he had had stomach bleeding 3 months ago. His hemoglobin level was 9.5 g/dL. The platelet count (171 k/μL), prothrombin time (14 s), and activated thromboplastin time (79%) were in the normal range. CT angiography demonstrated secondary active contrast extravasation from the higher and lower poles of the kidney and retroperitoneal hematoma that was secondary to the laceration in the axial images obtained in the arterial phase (A) and venous phase (B, C) and in the coronal reformat images (D). Clopidogrel was discontinued because it was thought that the hemorrhage might be associated with clopidogrel. On day 15, the patient had a significant reduction in hematoma, as demonstrated by a control CT (Figure 1). There are a limited number of cases that report SRH caused by the use of anticoagulants and antithrombotic therapy in the literature. Reported cases with SRH secondary to clopidogrel treatment often present with additional anticoagulant use and concomitant diseases. Furthermore, the origin of the SRH in such cases is often vascular and develops as a result of an excessive bleeding disorder. In a study that evaluated the incidence, severity, and predictors of hematoma in patients who received clopidogrel treatment over the past 1 year, started after a percutaneous coronary intervention, 49 (5.6%) patients were identified with major hematoma, whereas retroperitoneal hematoma was reported in neither the clopidogrel nor the placebo group. Interestingly, in our case, the origin of the bleeding was the renal laceration. No evidence of any trauma or renal tumor was identified in our patient as a cause of renal laceration. Even though we were unable to identify the etiology of renal laceration precisely, it was considered that the condition was triggered by the clopidogrel-associated bleeding diathesis developed in the background of underlying diabetic chronic renal failure. In harmony with our hypothesis, the Naranjo probability scale indicated a probable relationship between clopidogrel and retroperitoneal bleeding. In conclusion, SRH is one of the diagnoses that should definitely be ruled out when there are additional factors that increase the risk of bleeding, such as diabetes mellitus, chronic renal failure, and the use of antiaggregants, in patients who develop a complaint of acute flank pain or abdominal pain under clopidogrel treatment.

Relationship between Prostate Size and Positive Surgical Margin in the Open Radical Prostatectomy Surgery

Methodology: In our study, a number of 450 patients who had undergone radical prostatectomy surgery at 2 centers within the last 5 years was evaluated. Age, total PSA, number of positive cores for prostate cancer, Gleason score, transfusion amount and prostate volume were all evaluated in the study. Evaluated all these parameters, 170 consecutive patients of whom data were available were included in the study

The combination of furosemide and intravenous hydration does not affect the success of shock wave lithotripsy in renal stone treatment: a prospective randomised single blinded trial

Objectives To investigate the effect of furosemide given before shock wave lithotripsy (SWL) in patients with renal stones. Methods Two-hundred patients with renal stones measuring 6–20 mm in diameter were prospectively included in this study. The treatment group (n=100 patients) received 40 mg furosemide 30 min before SWL plus 1000 mL 0.9% sodium chloride, infused during the procedure. Standard SWL alone was used for the control group (n=100 patients). The effectiveness of SWL was compared between the two groups. Results No statistically significant difference was found between the groups in age, stone size, Hounsfield units, urinary pH, stone density, average number of sessions, average number of pulses or mean energy used. The stone-free rate was 69% in the control group and 71% in the treatment group (p=0.758). Conclusions Although it is an easy and safe application, no positive effects of furosemide and hydration were found.