Ugur Yilmaz

Effect of combined treatment with melatonin and methylprednisolone on neurological recovery after experimental spinal cord injury

Spinal cord injury (SCI) results in the loss of function below the lesion. Secondary injury following the primary impact includes a number of biochemical and cellular alterations leading to tissue necrosis and cell death. Methylprednisolone (MP), by reducing edema and protecting the cell membrane against peroxidation, is the only pharmacological agent with a proven clinically beneficial effect on SCI. Melatonin, known as a free radical scavenger, has been shown to have an effect on lipid peroxidation following experimental SCI. The purpose of this study was to examine the effect of MP and melatonin on neurological, ultrastructural, and electrophysiological recovery. Female albino rats weighing 200–250 g were randomized into five groups of 18 rats each and six rats for the control group. Weight-drop trauma was performed for each group and a 30-mg/kg single dose of MP for rats in group 1, a 10-mg/kg single dose of melatonin for rats in group 2, and MP and melatonin in the same doses for rats in group 3 were administered immediately after trauma. The rats in group 4 were the vehicle group (treated with ethanol) and group 5 was the trauma group. The motor and somatosensory evoked potentials were recorded at the 4th hour, the 24th hour, and on the 10th day of the study for six rats in each group. Posttraumatic neurological recovery was recorded for 10 days using “motor function score” and inclined plane test. After electrophysiological study the rats were terminated for an analysis of lipid peroxidation level of the injured site of the spinal cord. Electron microscopic studies were performed to determine the effects of melatonin, MP, and the combined treatment with MP and melatonin on axons, neurons, myelin, nucleus, and intracytoplasmic edema. The groups treated with MP, melatonin, and a combination of both had significantly enhanced electrophysiological, biochemical, and neurological recovery and also showed better ultrastructural findings than the trauma and vehicle groups. Although combined treatment was significantly more effective on lipid peroxidation than melatonin or MP treatments alone, at the 10th day, neurobehavioral, electrophysiological, and ultrastructural recovery were at the same level. In conclusion, MP, melatonin, and MP and melatonin combined treatment modalities improved functional recovery at the same level. Future studies involving different doses of melatonin and different dose combinations with MP could promise better results since each drug has a different antioxidative mechanism of action.

Auditory event-related potentials in patients with premature ejaculation.

OBJECTIVES To investigate in a descriptive manner the P300 component of the event-related potential (ERP), which is related to aspects of cognitive processing, in patients with premature ejaculation (PE) to determine whether there is a cognitive alteration in this condition. Recent studies with short latency evoked potentials such as cortical somatosensory evoked potentials have indicated that afferent sensory inputs from the genital area to the nervous system are increased in PE. However, the cortical neural process of ejaculation has remained poorly understood. METHODS We performed ERPs in 20 patients with PE and in 20 age-matched healthy subjects. ERPs were evoked by an auditory oddball paradigm consisting of 150 tone bursts (80% 1 kHz; 20% 2 kHz). The latencies of the N200 and the P300 waves and the amplitude of the P300 wave were measured. RESULTS The mean latencies of the N200 and P300 waves were significantly longer in the patients with PE than in the controls (P <0.04 and <0.03, respectively). No significant difference was found in the P300 amplitude between the controls and patients (P >0.05). CONCLUSIONS These data indicate that the greater cortical representation of sensory stimuli from the genital areas that has been shown with somatosensory evoked potential studies might be related to a cognitive/neurobehavioral dysfunction. The dysfunction involves an increased time to evaluate and categorize the stimuli in the central nervous system, with no change in the quality of cognition and neural disinhibition by the prefrontal cortex to early sensory processing in subcortical or primary cortical regions, which are cognitive neural processes underlying ERP generation.

Primary renal carcinoid natural history of the disease for ten years: case report

BackgroundPrimary renal carcinoid is extremely rare and there are few reports on the natural history of the disease.Case presentationA 68-year-old male with a right renal mass who lost to follow-up for ten years has been presented. His only complaint was a mild flank pain. Upon admission to the hospital for his renal mass, he underwent a right radical nephrectomy and pathological examination revealed the diagnosis of primary renal carcinoid.ConclusionsIn light of the presented case, primary renal carcinoma may have a prolonged natural history with no distant metastasis and any change in the quality of life of the patient.

Sympathetic skin responses in Type‐1 diabetic children: Relationship to urodynamic findings

AIMS Cystopathy is an important problem in diabetes mellitus (DM) when diabetes is not well-controlled. In most cases of diabetic csytopathy, autonomic involvement is responsible, which develops insidiously over a long time. We investigated the hand and genital sympathetic skin responses (SSRs) and its relation to urodynamic abnormalities in this group of patients. METHODS We performed hand and genital SSRs in 24 children with Type-1 DM, whose hemoglobin A1C values were above normal limits. We also recruited 19 healthy children for SSRs measurements. Cystometry was performed in 24 children with Type-1 DM. Based on cystometry findings, these children were classified into two groups as normal (n:6) and abnormal (n:18). The amplitude and latency of hand and genital SSRs of 24 children with Type-1 DM and 19 healthy children were compared. RESULTS Hand and genital SSRs were obtained from all of the diabetic and healthy children. The mean genital SSRs amplitude in diabetic children was significantly lower than the controls. There was no difference in the mean values of all investigated parameters between the normal group and controls. When compared to the controls, there was prolonged latency and decreased amplitude of genital SSRs and decreased hand SSRs amplitude in abnormal group. CONCLUSIONS SSR is a non-invasive test for the evaluation of autonomic sympathetic involvement. Our study revealed differences in genital SSR before the manifestations of cystopathy. Children with abnormal urodynamic findings had changes in both hand and genital SSRs. These findings suggest that SSR tests may have a place in the evaluation of diabetic cystopathy in the early asymptomatic period.

Bilateral disruption of corpus cavernosum with complete urethral rupture

Abstract Penile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow‐up.

Role of penile electrodermal activity in the evaluation of autonomic innervation of corpus cavernosum

Electrodiagnostic tests measuring the activities of cavernous smooth muscle and sudomotor structures of penile skin are used in order to evaluate autonomic innervation of the penis. Owing to closeness of these tissues, the interference of sympathetic activity during recording is a possibility. In this study, we investigated this possibility in 10 patients whose cavernosal tissues were destroyed during penile prosthesis implantation by comparing the pre- and postoperative penile skin electrodermal activities. Penile electrodermal activities were recorded with surface electrodes before and after the operation. All of the patients had spontaneous and evoked penile electrodermal activity (EDA). The mean amplitude of evoked EDA decreased from 2159±700 to 1413±515 μV following penile prosthesis surgery (P=0.017). The decrease in the amplitude of penile-evoked EDA following penile prosthesis implantation suggests the contribution of cavernous smooth muscle activity to the sudomotor responses prior to operation. Although corpus cavernosum sympathetic activity contributes to the penile skin recordings, these recordings are mostly the result of penile skin sudomotor sympathetic activity. Therefore, surface potentials recorded from penile skin should not be used for the evaluation of autonomic innervation of corpus cavernosum.

Evrim Bougie: A new instrument in the management of urethral strictures

BackgroundIn this study a new instrument and technique is described for the endoscopic treatment of complete posterior urethral strictures, which may result in serious complications and sometimes require troublesome treatments.MethodsThree patients with complete posterior urethral obstruction were treated endoscopically with the guidance of a new instrument: Evrim Bougie. Evrim Bougie looks like a Guyon Bougie, has a curved end, which facilitates getting into the bladder through the cystostomy tract and with a built in channel of 1.5 mm in diameter for a sliding needle exiting at its tip. Having confirmed fluoroscopically and endoscopically that the sliding needle had passed across the strictured segment, the strictured segment was incised with internal urethrotomy, distal to the strictured segment, and urethral continuity was accomplished. At the end of the operation a Foley urethral catheter was easily placed into the bladder per urethra. Patients were instructed in self-catheterization after removal of the urethral catheter. All patients achieved normal voiding at postoperative 7th month follow-up evaluation.ConclusionInternal urethrotomy could be performed under the guidance of the sliding needle of Evrim Bougie advanced from above the posterior urethral strictures, which to our knowledge was described for the first time in the English literature. We also believe that there may be other possible indications of Evrim Bougie for different procedures in urethral surgery.

Single session endoscopic management of intrinsic ureteropelvic junction obstruction and concomitant renal stone disease in a child: a case report.

BackgroundPercutaneous nephrolithotomy is a well known therapeutic modality for stone diseases of childhood. Antegrade and retrograde endopyelotomies are also well defined options of treatment for secondary ureteropelvic junction obstruction. Yet there are few reports regarding endoscopic therapy of intrinsic ureteropelvic junction obstruction. To our knowledge, there exist only a few reports of endosurgical treatment of children with stone disease and with concomitant intrinsic ureteropelvic junction obstruction, in the literature.Case presentationWe present the endoscopic management of stone disease and concomitant intrinsic ureteropelvic junction obstruction of a child in one session.ConclusionPercutaneous nephrolithotomy and antegrade endopyelotomy is combined safely with successful outcome in a child.

Case report: Percutaneous nephrolithotomy for an ectopic kidney with stone disease

Ali Güneş1, Murat Uğraş2, Uğur Yilmaz1, Aliseydi Bozkurt2 & Tayfun Gürpinar3 1Assistant Professor, Department of Urology, Turgut Özal Medical Center, İnönü University Medical Faculty, Malatya, Turkey; 2Resident in Urology, Turgut Özal Mdeical Center, İnönü University Medical Faculty, Malatya, Turkey; 3Associate Professor, Department of Urology, Maltepe University School of Medicine, İstanbul, Turkey