Süleyman Ataus

Relation between bladder cancer and protein oxidation.

DNA, protein oxidation and lipid peroxidation possess a major impact in carcinogenesis. Also, inflammatory and oxidative events have remarkable importance in bladder cancer. Thus, in this study total protein, protein carbonyl, nitrotyrosine, thiol residues, non-protein thiols, lipid peroxidation, and also, because of their relations to the above parameters, iron and iron binding levels have been investigated in patients with bladder cancer and in control group. Statistical evaluation of the results demonstrated significantly lower plasma protein levels in the patients with bladder cancer, as compared to the healthy control group. Serumiron levels in patients with invasive bladdercancer were found to be significantly lowerwhen compared with non-invasive group. Proteincarbonyl groups were remarkably higher inbladder cancer patients than in healthycontrols. Patients with bladder cancer weredemonstrated to have significantly lower levelsof total thiol groups and protein-bound thiolgroups as compared to healthy controls.Protein-bound thiol groups in patients withinvasive bladder cancer revealed a moresignificant decline, than in non-invasivegroup.

Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature.

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the review of the literature, we reported two cases of XPN with psoas muscle abscesses caused by Staphylococciaereus in one of the patient and Serratia mascerentes in the other. Both of the patients had renal calculus. We performed nephrectomy with psoas abscess drainage and started appropriate antibiotics, but one of the patients died of septic shock. Other patient is free of symptoms at the end of 5 years follow-up.

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.

Complications of the Mainz Pouch II (Sigma Rectum Pouch)

Objective: The complications of the sigma rectum pouch were analyzed. Methods: A total of 60 patients who underwent a construction of the Mainz pouch II was analyzed retrospectively. Data on early complications was available for all patients, while long–term follow–up data was available for 50 patients. Results: Perioperative mortality was nil. Early complications were encountered in 2 (3.3%) patients. Oral alkalizing supplementation therapy was required in 30 (60%) of the patients; 3 (6%) patients needed hospitalization for severe acidosis and hypokalemia. Hydronephrosis developed in 5 (5%) of 98 renoureteral units anastomosed. Acute pyelonephritis was observed in 3 (8%) patients. All of the patients were continent except for 1 female patient who had had previous radiotherapy to the pelvis. The mean voiding frequency during the day and night was 5.1±1.1 and 1.9±0.7, respectively. The psychological state and general health of 2 patients became progressively worse until they died of probable malnutrition and metabolic abnormalities. Mechanical bowel obstruction developed in 1 patient 2 years after surgery. Conclusion: The complication rate of the Mainz pouch II appears to be acceptable with a median follow–up of 31 months. Patient selection and cooperation are of paramount importance for a successful outcome.

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.

Transitional cell carcinoma of the bladder in patients under 40 years of age

There are conflicting reports about the natural history and prognosis of bladder tumours in patients under 40 years of age. A review of 156 patients younger than 40 treated at our Department between 1960 and 1991 with transitional cell carcinoma of the bladder revealed that 89.1% had superficial (Ta/T1) disease and the remaining 10.9% presented with invasive disease. Slightly more than half of the patients with superficial disease had multiple tumours. The follow-up of 97 patients over a period of 12–372 months revealed that there was a recurrence rate of 10.3% and 38.4% for Ta and T1 tumours, respectively (p<0.01). Further analysis comparing patients under 30 to those between 30 and 40 years revealed recurrence rates of 7.5% and 22%, respectively (p<0.05). Progression rates for Ta and T1 tumours are 3.5% and 19.3% (p<0.05). In the invasive disease group 8 patients were lost for follow-up, 2 died of the disease and the remaining 7 are alive, with a mean follow-up of 3.6 years.We conclude that while transitional cell carcinoma of the bladder in patients under 30 behave less aggressively, the behaviour of the disease in patients 30 to 40 years old is similar to the older age group and should be monitored closely, especially when risk factors for recurrence and progression are present.

Transition zone biopsy and prediction of extraprostatic extension at radical prostatectomy

Background: There is limited data in the literature that suggests that transition zone (TZ) biopsy might be useful for the prediction of extraprostatic extension (EPE) in clinically localized prostate cancer. We studied the role of TZ biopsy in the prediction of EPE.

Giant spontaneous urinoma draining from the scrotal wall

An 18-year-old male presented elsewhere with right abdominal pain and swelling, right scrotal pain and fluid discharge from a scrotal wound. On physical examination the patient appeared unhealthy and the right abdomen was asymmetrically swollen with a firm nontender mass .A3c m. vertical incision was noted on the right scrotum as well as abundant discharge of clear fluid from this wound. Abdominal discomfort and pain recurred 1 month later. A week later the right abdomen was enlarged, and the right scrotum became red, tender and swollen. The scrotum was incised elsewhere and the diagnosis was right scrotal abscess. The purulent discharge changed within days and large quantities of clear fluid began to drain from the scrotal incision. Simultaneously daily urine output decreased and abdominal swelling increased. The patient was referred to our institution. Laboratory evaluation demonstrated a creatinine of 8.43 mg./dl. (normal 0.5 to 1.4), urea 251 mg./dl. (normal 10 to 50), erythrocyte sedimentation rate 110 mm. per hour and leukocyte count 18,400/mm.3 Urine output was about 100 cc/24 hours and urinalysis showed pyuria. Computerized tomography (CT) revealed an atrophic left kidney and right hydronephrosis with stones in the right kidney and ureter. An immense cystic mass probably originating from the right kidney occupied the right retroperitoneum and extended into the right scrotum through the inguinal canal (fig. 1). The differential diagnosis at this time was tuberculosis, hydatid disease, hydrocele en bisac and spontaneous urinoma. Serological evaluation for tuberculosis and hydatid disease was negative. Radiopaque material was avoided due to high serum creatinine. The mass was punctured under ultrasound guidance, and cytological and biochemical studies were performed. The creatinine level of the fluid was 39.5 mg./dl., which was 5-fold that of the simultaneous serum level. Thus, the diagnosis of spontaneous urinoma was confirmed. A double pigtail ureteral catheter was inserted on the right side. General condition improved within days, daily urine output increased, and blood urea and creatinine returned to normal. Drainage from the scrotal incision ceased and abdominal swelling disappeared 4 days after catheter insertion. Excretory urography on day 10 postoperatively showed a bifid pelvis and normal right kidney function, the double pigtail catheter in situ, and lower caliceal and mid ureteral stones. The urinoma was followed by CT. Complete resolution of the urinoma was noted on CT 4 months postoperatively (fig. 2). Stones were treated with extracorporeal shock wave lithotripsy followed by catheter removal. The patient was well and without complaints at 5-month followup.

Intermediate-Risk Group in Patients with Transitional Cell Carcinoma of the Bladder: Prediction of High-Risk Patients in This Heterogeneous Group

Objective: To determine whether recurrence at first follow-up cystoscopy predicts future recurrence in patients with an intermediate risk of superficial bladder cancer. Methods: In total, 304 patients were classified as low (n = 60), intermediate (n = 177) or high risk (n = 67) based on the primary pathological/clinical findings, as previously described in literature. The intermediate-risk group was further divided into 2 subgroups based on recurrence at the first follow-up cystoscopy: A (recurrence negative) and B (recurrence positive). Results: The mean recurrence rates of low-, intermediate- and high-risk patients were 1.76, 6.41 and 9.49, respectively (p < 0.05). Similarly, the difference in the recurrence rates between subgroups A (4.37) and B (9.12) was found to be statistically significant (p = 0.00). Additionally, while the difference between the low-risk group and subgroup A was statistically significant (p = 0.008), there was no significance between subgroup B and the high-risk group (p = 0.892). In the multivariate analysis, the most significant prognostic parameter for recurrence was the outcome of the first follow-up cystoscopy, followed by tumor multiplicity and grade. Conclusions: Patients showing recurrence at first follow-up cystoscopy in the intermediate-risk group should be classified as high-risk patients and treated accordingly.

Serum levels of growth factors in patients with urinary bladder cancer

Abstract Background: Altered signalling of human epidermal growth factor receptor-2 (HER-2/neu), insulin-like growth factor 1 (IGF-1) and epidermal growth factor (EGF) have been shown to play important role in tumor development and progression in various cancers. Their serum levels may be reliable indicator for diagnosis and progression of cancer. Objective: To examine the serum levels of soluble HER-2/neu (sHER-2/neu), IGF1 and EGF in patients with urinary bladder cancer (UBC). Material and methods: Serum levels of sHER-2/neu, IGF1 and EGF were measured by enzyme-linked immune assay in newly diagnosed, untreated patients with UBC. Results: In the patient group, sHER-2/neu level was found to be increased, IGF1 level was found to be decreased in comparison to those in the control group. Although serum level of sHER-2/neu was lower in the patients with Ta stage than that in the patients with T1 and T2 stages, this difference was not at a statistically significant level. Conclusion: Serum level of sHER-2/neu is increased in patients with UBC. Despite the lack of a significant association between sHER-2/neu level and pathological pT stage, sHER-2/neu may be a promising marker for UBC but IGF-1 and EGF have not such a potential.