Omer Yilmaz

CYP1A1 (Ile462Val), CYP1B1 (Ala119Ser and Val432Leu), GSTM1 (null), and GSTT1 (null) polymorphisms and bladder cancer risk in a Turkish population.

We aimed to investigate bladder cancer risk with reference to polymorphic variants of cytochrome p450 (CYP) 1A1, CYP1B1, glutathione S-transferase (GST) M1, and GSTT1 genes in a case control study. Polymorphisms were examined in 114 bladder cancer patients and 114 age and sex-matched cancer-free subjects. Genotypes were determined using allele specific PCR for CYP1A1 and CYP1B1 genes, and by multiplex PCR and melting curve analysis for GSTM1 and GSTT1 genes. Our results revealed a statistically significant increased bladder cancer risk for GSTT1 null genotype carriers with an odds ratio of 3.06 (95% confidence interval=1.39-6.74, p=0.006). Differences of CYP1A1, CYP1B1 and GSTM1 genotype frequencies were not statistically significant between patients and controls. However, the specific combination of GSTM1 null, GSTT1 null, and CYP1B1 codon 119 risk allele carriers and specific combination of GSTM1 present, GSTT1 null, and CYP1B1 432 risk allele carriers exhibited increased cancer risk in the combined analysis. We did not observe any association between different genotype groups and prognostic tumor characteristics of bladder cancer. Our results indicate that inherited absence of GSTT1 gene may be associated with bladder cancer susceptibility, and specific combinations of GSTM1, GSTT1 and CYP1B1 gene polymorphisms may modify bladder cancer risk in the Turkish population, without any association being observed for CYP1A1 gene polymorphism and bladder cancer risk.

Evaluation of the Impact of Shock Wave Lithotripsy on Kidneys Using a New Marker: How Do Neutrophil Gelatinese-associated Lypocalin Values Change After Shock Wave Lithotripsy?

OBJECTIVE To determine possible acute kidney injury with new marker neutrophil gelatinase-associated lipocalin (NGAL) in urine and to show the relationship between changes of this marker and conventional markers in patients undergoing shock wave lithotripsy (SWL). METHODS In patients with kidney stones, serum urea, creatinine, urine microalbumin, and NGAL levels were determined before SWL and at the first, second, and seventh days after SWL. In addition, patients who had undergone SWL were evaluated with Technetium-99m (Tc99m)-dimercaptosuccinic acid (DMSA) and Tc99m-diethylenetriaminepenta acetate renal scintigraphy 1 week before and 3 months after SWL. RESULTS AND LIMITATIONS Forty patients were included in the study. All patients had a single stone in the kidney with an average size of 9.25 mm (range 5-15). No statistical change was found in the levels of average serum urea and creatinine levels, urine microglobulin, and NGAL levels, which were measured before SWL and after SWL. No significant difference was identified in urine NGAL and microalbumin levels of the groups, which were separated by shock wave number and shock energy amount on the first, second, and seventh days after SWL. In the high-energy SWL group, 3 patients had a statistical decrease in their differential kidney function measured with Tc99m difference between differential function rates of the kidney before and after SWL (DMSA) after 3 months after SWL. CONCLUSION Our study found that, using both new and conventional parameters in the acute stage and 3 months later, SWL treatment does not cause acute kidney damage.

Isolated cerebellar damage caused by carbon monoxide intoxication

An unconscious 5-year-old girl with convulsions was admitted to emergency department. Her blood carboxyhaemoglobin level was 7.3%. CO intoxication was presumed and she was referred to our department for a brain MRI. In addition to conventional sequences, diffusion-weighted imaging (DWI) was also performed. Whereas there was no pathological signal change on supratentorial images, symmetrical lesions in the grey matter were observed in both cerebellar hemispheres. MRI showed hypointensities on T1weighted image (figure 1A), hyperintensities both …

Cross-Sectional Analysis of Penile Length in Males 13 to 15 Years Old According to Pubertal Development Stages

PURPOSE Genital development is affected by pubertal process to a great extent, and puberty is a complex phenomenon that is influenced by multiple factors resulting in individual differences. We studied penile length and its relationship to pubertal stage in boys 13 to 15 years old. MATERIALS AND METHODS Healthy boys who were candidates for military high school were evaluated between June and July 2011. Age, residence and body mass index were recorded. Stretched penile length was measured. Pubic hair was assessed according to Tanner and Marshall staging. Genital puberty stage was defined by measurement of testicular volume with Prader orchidometer. Relationship of penile length to age, residence, pubertal stages and body mass index was evaluated statistically. RESULTS A total of 1,539 boys were included in the study. Mean ages and number of patients according to genital stage were as follows. Mean age was 14 years for genital stage 1 (5 patients), 13.9 years (range 13 to 15) for stage 2 (194), 14.07 years (13 to 15) for stage 3 (965) and 14.11 years (13 to 15) for stage 4 (375). Linear regression analysis revealed a significant effect of body mass index, genital stage and pubic hair stage on penile length (p <0.001) but no significant effect of age or residence. Mean penile length was significantly different among different age groups and among pubertal stages. However, mean penile lengths of different age groups within the same pubertal stage were similar. CONCLUSIONS Penile length during puberty should be evaluated individually according to the current pubertal stage. Our study offers a reliable reference table of penile length for pubertal age group.

Postshockwave Lithotripsy Outcome Evaluation in Ureteral Stones: Comparison Between Noncontrast Computed Tomography and Plain Abdominal Radiography

BACKGROUND AND PURPOSE There are no definite data indicating which modality to use to assess the efficacy of shockwave lithotripsy (SWL). Usually, plain abdominal radiography (PAR) is recommended in percutaneous nephrolithotomy (PCNL) afterward and in the follow-up of asymptomatic stones, whereas noncontrast CT (NCCT) is recommended in cases of residual fragments. We compared the efficacies of PAR and NCCT in terms of assessing the outcome of SWL treatment for radiopaque ureteral stones. PATIENTS AND METHODS Those patients with renal colic and a radiopaque ureteral stone of 5 to 20 mm that was detected on PAR were included in the study; body mass index (BMI) values were calculated and recorded. Patients whose PAR revealed opacities suspicious for ureteral stones were evaluated with NCCT at 3-mm slices. Stone status was assessed with PAR and NCCT on post-SWL day 3. Detection of no stone, a residual fragment of ≤ 4 mm, and a residual fragment of >4 mm was defined as success, clinically insignificant residual fragments, and failure, respectively. RESULTS On post-SWL day 3, both PAR and NCCT revealed stones in 31 patients, and no stones were seen in either modality in 29 patients. NCCT revealed stones whereas PAR had negative results for stones in two patients. These patients had upper ureteral stones of 7.5 mm (6-9 mm) before SWL. Mean stone size on NCCT after SWL was 2.5 mm (1-4 mm). Mean BMI of these two patients was 27.72, and mean BMI of the patients with upper ureteral stones that were revealed by both PAR and NCCT was 27.68; these two values were statistically similar. CONCLUSION PAR is capable of detecting clinically significant residual fragments, and patients can be followed up with PAR alone after SWL treatment for radiopaque ureteral stones. This approach both decreases the cost and prevents excessive radiation exposure.

Abdominal pain due to rectus abdominis muscle haematoma associated with anticoagulant therapy

Dear Editor, Rectus abdominis haematoma is rare and occurs as a result of trauma or an underlying bleeding disorder; and few cases are described while using anticoagulant treatment (Table 1). Acute haematoma formation may present with sudden abdominal pain and may mimic any urgent abdominal pathology. A 56-year-old woman was admitted with left-sided abdominal pain and coughing for 2 weeks. She had chronic obstructive pulmonary disease (COPD) for 10 years. She had had a left lower limb deep venous thrombosis 6 months previously and had been on warfarin treatment since then. She had discontinued warfarin after developing abdominal pain. Abdominal examination revealed a mass in the left lower quadrant. Laboratory findings including a full blood count, INR and biochemical tests were normal. Ultrasonography showed a 12 ¥ 5 cm mass that on abdominal MRI was shown to be a haematoma in the left rectus abdominis sheath (Fig. 1). On the third day of hospitalization, there was sudden onset of right lower limb pain and swelling. A deep vein thrombosis was diagnosed by Doppler ultrasound. Aspirin plus low-molecular weight heparin (LMWH) were initiated and she was assessed for a possible underlying hypercoagulation disorder. Free protein S deficiency (47%, N: 54–123%) and increased factor VIII were found. Other thrombophilic factors including antithrombin III, protein C, factor V Leiden, prothrombin G20210A mutation, antiphospholipid antibodies, methylene tetrahydrofolate reductase (MTHFR) mutation and homocysteine were negative. Her symptoms including pain and swelling of the right leg gradually improved and the haematoma diminished in size. The patient was discharged on LMWH, and at follow up at 1 month was free of any symptoms. Rectus muscle haematoma is an uncommon cause of abdominal pain and may be misdiagnosed clinically. Clinically as a cause of abdominal pain it is misdiagnosed. The bleeding into the rectus sheath results from damage to the epigastric arteries or their branches, or from a direct tear of the rectus muscle. The immediate causes of the rupture may be external trauma to the abdominal wall, iatrogenic trauma from surgery, or excessively vigorous contractions of the rectus muscle including Valsalva manoeuvres with severe coughing, vomiting or straining at the stool. Predisposing factors for rectus muscle haematoma include coughing, vomiting, age, obesity, anticoagulant use and chronic liver disease. In the present case, chronic coughing due to COPD and warfarin use were implicated. When the history and physical examination findings raise suspicion for rectus muscle haematoma as a cause of acute abdominal pain, ultrasonography, CT scanning and MRI are useful to confirm the diagnosis. Conservative treatment is appropriate for patients who are haemodynamically stable, and have a small, non-expanding haematoma in which symptoms are mild and the diagnosis is certain. This conservative treatment should include rest, analgesia, haematoma compression, ice packs and consideration of any predisposing conditions. The haemodynamically unstable patient will require more aggressive therapy with intravenous fluid

The Influence of Bhcg Treatment on Testicular Apoptosis in Experimental Cryptorchidism Model in Rats

Abstract Purpose We sought to find out how testicular apoptosis is influenced by BHCG treatment in an experimental cryptorchidism model. Material and Methods Three main groups of 22 day-old healthy male Sprague-Dawley rats were formed (Sham-operated (SO), experimental cryptorchidism (EC), hormone treated EC groups (HT)). Each main group was also divided into early and late orchidectomy groups. HT group received 50 IU/kg BHCG daily for 7 days starting on first postoperative day. Eight and 30 days after EC surgery, all rats underwent left orchidectomy to reveal early and late changes in the testes. Apoptosis index (AI) was defined as the mean number of apoptotic cells per tubule. All groups were compared to each other, while each group was evaluated in terms of the differences between early and late periods. Results Study was carried out with 60 rats in 6 groups totally. AI was significantly greater in EC and HT groups than SO group in both early and late periods. AI in HT group was smaller than EC group; the difference was statistically significant in late period while it was not so in early period. AI was found to be significantly decreased with time in all 3 groups. Conclusions Testicular apoptosis was found to be increased in experimental cryptorchidism. In HT group, AI was smaller than that of EC. For this reason, we suggest that hormone treatment in EC may have an effect that prevents or decreases apoptosis in EC model.