Omer Bayrak

Is single-dose fosfomycin trometamol a good alternative for asymptomatic bacteriuria in the second trimesterof pregnancy?

Untreated asymptomatic bacteriuria has been associated with acute pyelonephritis, which may have a role in many maternal and fetal complications. Acute pyelonephritis in pregnancy is related to anemia, septicemia, transient renal dysfunction, and pulmonary insufficiency. A randomized study was conducted to assess the clinical and microbiological efficacy of a single dose of fosfomycin trometamol for the treatment of asymptomatic bacteriuria in the second trimester of pregnancy compared with a 5-day regimen of cefuroxime axetyl. Forty-four women received fosfomycin trometamol and 40 women received cefuroxime axetyl. There were no statistically significant differences between both groups regarding the mean age and mean duration of pregnancy. Therapeutic success was achieved in 93.2% of the patients treated with fosfomycin trometamol vs 95% of those treated with cefuroxime axetyl. A single dose of fosfomycin trometamol is a safe and effective alternative in the treatment of asymptomatic urinary tract infections in the second trimester of pregnancy.

An insidious risk factor for cardiovascular disease: Benign prostatic hyperplasia

Patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTSs) have a considerably higher prevalence of cardiovascular disease (CVD) than the general population in old age. Many hypotheses have been created to explain traditional clinical risk factors of CVD, including age, male gender, cigarette smoking, inheritance, high blood pressure (BP), obesity, elevated fasting plasma glucose, diabetes mellitus, dyslipidemia, decreased physical activity and metabolic syndrome; or nontraditional risk factors such as oxidative stress, inflammation, vascular calcification, malnutrition, homocysteine and genetic variation. Although these risk factors are important in CVD pathophysiology and clinical presentation, there is still no single theory sufficient to provide an adequate explanation for all the properties of CVD. We speculate that by causing nocturia-induced sleep disturbances, BP variability, increased sympathetic activity, non-dipping BP variations; BPH may be an insidious risk factor for CVD. Benign prostate hyperplasia may be related to increased BP, coronary ischemic hearth disease or other cardiovascular pathologic conditions. This attention on BPH may produce a new approach to the diagnosis and treatment of CVD. Although the underlying mechanisms are still exactly unclear, further prospective randomized controlled studies are needed to identify if patients with BPH/LUTS is higher risk for CVD.

The effect of dietary ginger (Zingiber officinals Rosc) on renal ischemia/reperfusion injury in rat kidneys.

Oxidative stress has been considered as one of the possible mechanisms of ischemia/ reperfusion (I/R) injury in the kidney. The aim of this study was to analyze the possible protective effect of dietary ginger (Zingiber officinals Rosc), a free radical scavenger, on renal I/R injury in rats. The protective effect of ginger against the damage inflicted by reactive oxygen species (ROS) during renal I/R was investigated in Wistar albino rats using histopathological and biochemical parameters. Thirty rats were randomly divided into five experimental groups (i.e., control, sham-operated, ginger, I/R, and I/R + ginger groups, n = 6 each). The ginger and I/R + ginger groups were fed on the test diet containing 5% ginger. The rats were subjected to bilateral renal ischemia followed by reperfusion in I/R and I/R + ginger groups. At the end of the reperfusion period, rats were sacrificed, and kidney function tests, serum and tissue oxidants and antioxidants, and renal morphology were evaluated. Serum urea, creatinine, and cystatin C (CYC) levels were significantly elevated in the ischemia group, but these levels remained unchanged in the ginger + I/R group compared to the I/R group. Reduction of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzyme activity was significantly improved by the treatment with ginger compared to I/R group. Administration of ginger resulted in significant reduction levels of tissue malondialdehyde (MDA), NO, protein carbonyl contents (PCC) in the ginger + I/R group compared with the I/R group. Ginger supplementation in the diet before I/R injury resulted in higher total antioxidant capacity (TAC) and lower total oxidant status (TOS) levels than I/R group. The ginger supplemented diet prior to I/R process demonstrated marked reduction of the histological features of renal injury. The findings imply that ROS play a causal role in I/R-induced renal injury, and ginger exerts renoprotective effects probably by the radical scavenging and antioxidant activities.

Platelet Parameters in Children with Upper Urinary Tract Infection: Is There a Specific Response?

Although complete blood count is routinely ordered in most upper urinary tract infections (UTI), and information regarding the patients platelet indices is made available without added cost, the relationship between platelet count and mean platelet volume (MPV) and specific platelet responses to different infectious agents has not been extensively characterized in UTI. The objectives of this study were to examine platelet counts and platelet indices in children with culture-proven upper UTI to determine if there are organism-specific platelet responses. A retrospective analysis of data from all pediatric urine samples processed at Fatih University Medical School microbiology laboratory was undertaken for a period of two years (January 1, 2005, to December 31, 2006). Of the 200 patients with positive urine cultures, 146 (73%) were infected with gram-negative bacteria and 54 (27%) grew gram-positive bacteria. The platelet count during the episode of upper UTI and the incidence of thrombocytosis was significantly higher with the gram-positive infections than with the gram-negative infections or controls (p < 0.05). A statistically significant higher MPV was detected in the subjects with upper UTI (p < 0.05). Also, our data showed a statistically significant increase in MPV with gram-positive infections compared with the other groups (p < 0.05). In conclusion, based on the importance of the hemostatic component in the pathophysiology of infections, our findings of platelet count and MPV and predictivity of the type of the organism would suggest the usefulness of the routine measurements in children with upper UTI.

The Evaluation of Clitoral Blood Flow and Sexual Function in Elite Female Athletes

INTRODUCTION Clitoral blood flow measurements using clitoral color Doppler ultrasound have been performed with increasing frequency either in order to assessment of female sexual function/dysfunction. The trials to evaluate the sexual function in healthy subjects, especially in the subgroup of female elite athletes, are limited. AIM The aim of the study was to evaluate whether elite female athletes and sedentary healthy females differ in their clitoral blood flow and sexual function as an expression of their physical fitness status. METHODS Twenty-five female elite athletes (Group I) and healthy female subjects (Group II) were enrolled as volunteers in the study. All women were instructed to complete the Female Sexual Function Index (FSFI) questionnaire. Each subject underwent high definition color Doppler ultrasonography to measure the clitoral blood flow parameters. Main Outcome Measures. The effect of physical activity on clitoral blood flow and sexual life in women. RESULTS Mean age, mean age of menarche, mean marriage age, and body mass index were similar for both groups. In Group I, the mean peak systolic velocity and end-diastolic velocity were higher than those of Group II, whereas the mean RI was similar for both groups. There were statistically significant differences for total FSFI score and all domain scores, except desire domain, between both groups. CONCLUSION In elite female athletes as compared with sedentary healthy females, better clitoral blood flow and better sexual function were demonstrated. Therefore it seems superior physical fitness correlates with better sexual function.

Urethral adenocarcinoma mimicking urethral caruncle

Urethral caruncles are considered as benign tumors. They need to be treated surgically; specimens should carefully be evaluated for the presence of any malignancy. We are presenting a 57-year-old female patient with a urethral lesion that looks like caruncle, but histopathologic examination of the excised lesion was reported as urethral adenocarcinoma.

Circadian rhythm of blood pressure in patients with benign prostatic hyperplasia

Objective. Nocturia, a common and bothersome symptom of benign prostatic hyperplasia (BPH), may cause sleep disturbances. Patients with nocturia may have difficulty returning to their normal sleep after repeated episodes of waking and voiding. Therefore, nocturia may have an impact on the circadian rhythm of blood pressure (BP). The association between nocturia and the circadian rhythm of BP was investigated in this study. Material and methods. A total of 100 male patients who had been diagnosed with BPH and 53 healthy male subjects were included in the study. Nocturnal urinary frequency was assessed by means of a questionnaire and recorded in both groups. Ambulatory BP monitoring was performed in all patients over a 24-h period. Results. Patient characteristics and laboratory parameters were similar in both groups. Seventy-five patients (75%) in the BPH group and 20 subjects (37.7%) in the control group were non-dippers, i.e. they did not have a normal nocturnal fall in BP, and this difference was statistically significant (p=0.001). Eighty-nine patients in the BPH group and 13 in the control group had nocturia. Seventy-one patients (79.8%) with nocturia were non-dippers and the difference compared to the patients without nocturia in the BPH group was significant (p=0.003), whereas four patients with nocturia (30.8%) were non-dippers in the control group. Conclusions. Our findings indicate that non-dipping was more prevalent in elderly men with BPH and nocturia. BPH and nocturia may be etiological factors in the pathogenesis of non-dipping, which is an indicator of early cardiovascular disease. Further studies must focus on this relationship and, especially, on whether treatment of nocturia and BPH helps to treat non-dipping or not.

Primary renal lymphoma associated with hepatitis C virus infection

Hepatitis C virus (HCV) infection may cause hepatic and extra-hepatic manifestations. A causative association between HCV and non-Hodgkin’s lymphoma (NHL) has been reported in many clinical and epidemiological studies [1]. Renal involvement is a common finding in advanced NHL and the frequency is ranging from 37 – 47% [2]. However, primary renal lymphoma (PRL) is a rarely seen malignancy and, to our knowledge, there is no data about the relationship between HCV infection and PRL in the literature. Herein, we report a case of PRL possibly secondary to HCV infection for the first time. Biopsy of kidney revealed large B-cell malign lymphoma infiltration. A 68 year-old woman was admitted with 2-months history of bilaterally severe flank pain and dysuria. Her medical history was unremarkable. Her vital functions were normal. On physical examination, there were no peripheral edemas, lymphadenopathy or hepatosplenomegaly. Laboratory investigation showed anemia, high erythrocyte sedimentation rate, hypoalbuminemia and impairment in renal and liver functions. Laboratory values are shown in Table I. Creatinin clearance was 11 ml min and urine protein level was 472 mg per day. Abdominal ultrasound revealed bilaterally enlarged kidneys (right kidney 145656 mm and left 140664 mm), increased bilaterally renal parenchymal thickening and echogenicity. Computerized tomography of abdomen and thorax, confirmed the presence of bilaterally enlarged kidneys and no lymphadenopathy was seen in the retroperitoneum and thorax. The liver and spleen viewed as normal. Among viral hepatitis markers, anti-HCV was positive as well as HCV RNA positive with 850 000 copies. With the suspicious diagnosis of glomerulonephritis, we made additional measurements. Serum complements C3 and C4 levels, ANA, anti-ds-DNA, anti-glomerular basal membrane, pANCA and c-ANCA antibodies titers were all within normal range. Also protein electrophoresis was normal and cryglobulin was negative. An ultrasound guided percutaneous true-cut biopsy of left kidney revealed large B-cell malign lymphoma infiltration. Hematoxylin and eosin section of these materials revealed neoplastic lymphoma cells with increased nuclearcytoplasmic ratio, prominent nucleoli and mitotic figures (Figure 1). In immunohistochemical stain, lymphoma cells were positive for leucocyte common antigen CD-45 and B-lymphocyte marker CD-20, but negative for T-lymphocyte marker CD-3 (Figure 2). Bone marrow aspiration and biopsy showed no malignant cells. The gallium-67 scan showed no evidence of systemic neoplastic infiltration except bilaterally renal involvement. On follow-up, renal and liver dysfunctions were progressively worsened and she died 10 days after admission. Primary renal lymphoma is a very rare disease. Most of the cases are seen in middle age and there is a slight male preponderance; however it has also been reported in childhood [3]. It may be difficult to clinically and radiologically distinguish from other renal diseases such as simple cyst, abscess, angiomyolipoma, pyelonephritis and other neoplasms. Because PRL is a systemic and very mortal disease,

Double-J stent placement with grasping forceps through ureteroscope working channel: a novel technique

To report a new technique for the retrograde placement of a double-J stent with grasping forceps through the ureteroscope working channel. Materials and methods: In our technique, the ureteroscope is advanced to the renal pelvis or proximal location of the obstruction in the ureteral lumen; a double-J stent is then introduced into the ureteroscope working channel. The double-J stent is pushed forward until its proximal tip is seen; then the clamp over the distal tip of the pusher is opened and the guide-wire and pusher are removed from the channel, respectively. The grasping forceps is inserted into the working channel until it is touching the stent; the ureteroscope is removed from the ureter by pulling it over the stent and grasping forceps. Thus, the stent is placed in the ureteral lumen. Results: This technique was successful in 17 patients: 16 retrograde ureteroscopies for stone extraction and 1 retrograde ureteroscopy with ureteropelvic junction obstruction. No complications occurred during follow-up. Conclusion: Our simple technique may be safely used to place double-J stent in cases of ureteral obstruction. It may reduce procedure time and it avoids the potential complications of blind catheter placement.

Standard percutaneous nephrolithotomy on a pelvic kidney without any ancillary modalities

We are presenting a patient with two calculi in a right pelvic kidney managed by percutaneous nephrolithotomy with an access just above the iliac crest in the prone position.