Serum adenosine deaminase, catalase, and carbonic anhydrase activities in patients with renal cell carcinoma.

OBJECTIVES: To determine whether serum levels of adenosine deaminase (AD), catalase (CAT), and carbonic anhydrase (CA) enzymes may be useful biomarkers in the diagnosis of renal tumors and may lead to early diagnosis of renal tumors. MATERIAL AND METHODS: The study included 33 patients with renal cell carcinoma (RCC) and 31 healthy controls. The activity of serum AD, CA, and CAT was determined and analyzed using the Giusti spectrophotometric method, H2O2 substrate, and C02 hydration, respectively. RESULTS: Serum AD and CA activity were significantly higher in patients with RCC than in controls. However, serum CAT activity was significantly lower in patients with RCC than in controls. CONCLUSION: These markers might be potentially important as an additional biochemical tool for diagnosing RCC. We believe multidisciplinary studies are needed to plan patients' preoperative and postoperative treatment and to create follow-up protocols.

Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic.

OBJECTIVE: The objective is to compare the analgesic effects of diclofenac, acetaminophen, and acupuncture in urolithiasis-driven renal colic pain relief. METHODS: Renal colic patients were divided randomly into 3 groups. Patients in group I (n = 40) were treated with intravenous acetaminophen, those in group II (n = 41) with acupuncture, and those in group III (n = 40) with a 75-mg intramuscular injection diclofenac sodium. Visual analogue scale (VAS) and verbal rating scale (VRS) were used to assess pain intensity after 10, 30, 60, and 120 minutes. RESULTS: No significant differences in baseline VAS or VRS were found with regard to age or sex. After 10 minutes, all 3 groups experienced a significant decrease in VAS and VRS scores, with the most drastic decrease occurring in group II. After 30 minutes, there was a significantly higher decrease in group III than in group I (P = .001). After 60 minutes, mean VAS scores of groups I and III (P = .753) were similar. The mean VAS score of group III was lower than that of group II (P = .013). After 120 minutes, the difference in the VAS scores was (P = .000) between groups I and II and between groups II and III. Yet, the VAS evaluation made after 120 minutes revealed statistically similar outcomes for groups I and III (P = .488). The statistical findings for VRS evaluations made after 10, 30, 60, and 120 were similar to those for VAS. CONCLUSIONS: In renal colic patients with a possible nonsteroidal anti-inflammatory drug and acetaminophen side effect risk, acupuncture emerges as an alternative treatment modality.

Benign prostatic hyperplasia and prostate cancer differentiation via platelet to lymphocyte ratio.

BACKGROUND: The aim of the current study is to evaluate NLR and PLR inflammation markers in PCa and BPH. METHODS: Clinical and pathological data such as age, prostate volume, PSA, NLR, and PLR levels of 201 patients were retrospectively reviewed. Pathological sample results of these patients were categorized either as benign or malign. The benign group consisted of chronic prostatitis and BPH and the malign group of PCa. The PSA levels were divided into three categories as PSA: 0-4 ng/ml, PSA: 4-10 ng/ml, and 10 ng/ml and above. RESULTS: In the benign category, the mean PLR values for PSA: 0-4 ng/ml is 131.8 ± 31.2, for PSA: 4-10 ng/ml 124.7 ± 83.9 and 10 ng/ml and above 124 ± 53 in chronic prostatitis group and in the BPH group for PSA: 4-10 ng/ml 120.3 ± 45.1, for PSA: 4-10 ng/ml 126 ± 54.2, and 10 ng/ml and above 191.4 ± 176.1. In the malign category, the mean PLR values of PCa patients is for PSA: 0-4 ng/ml 122.8 ± 43.8, for PSA: 4-10 ng/ml 123 ± 43.8, and above 10 ng/ml 179.1 ± 94. Related to the variables of age, NLR, and mean prostate volume, there were no statistically significant differences. Statistically significant differences were observed in the mean PLR values only if the PSA level was 10 ng/ml and above (p: 0.044) in the BPH and PCa groups. The correlation of the PCa Gleason score and PSA, NLR and PLR parameters in the malign category revealed no statistically significant differences (P > 0.05). CONCLUSION: Effective malign and benign differentiation of prostate pathologies based on noninvasive inflammation biomarkers such NLR and PLR necessitate clinical studies with larger patient series.

Peripheral mononuclear leukocyte DNA damage, plasma prolidase activity, and oxidative status in patients with benign prostatic hyperplasia.

OBJECTIVES: Prolidase plays a major role in collagen turnover, matrix remodeling, and cell growth. Benign prostatic hyperplasia (BPH) may be associated with an increased extracellular matrix deposition. Therefore, the present study was designed to investigate the plasma prolidase activity, oxidative status, and peripheral mononuclear leukocyte DNA damage in patients with BPH. PATIENTS AND METHODS: Twenty-six male patients with BPH and 24 healthy male subjects were included in this study. Blood samples were collected from antecubital vein after an overnight fasting period, and the plasma was separated. Plasma prolidase activity, total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) were determined. The peripheral lymphocyte oxidative DNA damage was determined using an alkaline single cell gel electrophoresis assay (comet assay). RESULTS: The plasma prolidase activity, TOS levels, OSI values, and peripheral mononuclear leukocyte DNA damage were significantly higher (P < 0.001), while the TAC levels were significantly lower (P < 0.001) in patients with BPH than controls. In BPH patients, the prolidase activity was significantly associated with TAC levels (r = -0.366, P < 0.05), TOS levels (r = 0.573, P < 0.001), and OSI (r = 0.618, P < 0.001) and peripheral mononuclear leukocyte DNA damage (r = 0.461, P < 0.001). CONCLUSIONS: Our results showed that BPH might be associated with an increased oxidative stress, and also an increased plasma prolidase activity. Increased prolidase activity might play an important role in the etiopathogenesis and/or progression of BPH.

Tissue damage in kidney, adrenal glands and diaphragm following extracorporeal shock wave lithotripsy.

This study was designed to investigate whether exposure to short-term extracorporeal shock wave lithotripsy (ESWL) produces histologic changes or induces apoptosis in the kidney, adrenal glands or diaphragm muscle in rats. The effect of shock waves on the kidney of male Wistar rats (n = 12) was investigated in an experimental setting using a special ESWL device. Animals were killed at 72 h after the last ESWL, and the tissues were stained with an in situ Cell Death Detection Kit, Fluorescein. Microscopic examination was performed by fluorescent microscopy. Apoptotic cell deaths in the renal tissue were not observed in the control group under fluorescent microscopy. In the ESWL group, local apoptotic changes were observed in the kidney in the area where the shock wave was focused. The apoptotic cell deaths observed in the adrenal gland of the control group were similar to those observed in the ESWL groups, and apoptosis was occasionally observed around the capsular structure. Apoptotic cell deaths in the diaphragm muscle were infrequently observed in the control group. Apoptosis in the ESWL group was limited to the mesothelial cells. This study demonstrated that serious kidney, adrenal gland and diaphragm muscles damage occurred following ESWL, which necessitated the removal of the organ in the rat model. It is recognized that the ESWL complications related to the kidney, adrenal gland and diaphragm muscles are rare and may be managed conservatively.

Conservative approach in the treatment of renal trauma in children.

OBJECTIVE: Our aim was to evaluate the role of a conservative approach in the treatment of renal trauma in the pediatric age group. MATERIALS AND METHODS: A total of 31 pediatric patients with renal trauma (male = 25, female = 6) in whom we used a conservative approach in our clinic between the years 2002 and 2010 were included in the study. Patients were assessed according to the type of trauma, type of treatment, findings of radiological imaging, concomitant other organ injuries and complications occurring during follow-up. RESULTS: Surgery was required in just 4 of 31 pediatric patients who were treated with the conservative approach. Of the patients who underwent surgery, only one child needed nephrectomy. No complications were detected in the clinical and radiological follow-up of the patients who received the conservative approach. CONCLUSIONS: The main objective in the treatment of renal trauma occurring in childhood is to protect the kidneys. If the hemodynamic findings are stable, a conservative approach should be the first preferred method of treatment in every grade of renal trauma that can occur in childhood.

Plasma human neutrophil proteins-1, -2, and -3 levels in patients with bladder cancer.

OBJECTIVES: Human neutrophil proteins-1, -2, and -3 (HNPs -1, -2, and -3) are expressed in several tumor types. However, the role of HNPs 1-3 in human bladder cancer has not yet been determined. We investigated the association between the plasma levels of HNPs 1-3 and clinicopathological parameters in bladder cancer patients. DESIGN AND METHODS: The plasma levels of HNPs 1-3 were measured in 60 patients with bladder cancer and in 58 healthy controls. The plasma levels of HNPs 1-3 were determined by a solid-phase enzyme-linked immunosorbent assay (ELISA). Plasma samples were obtained before surgery. Plasma samples were permitted to clot and were then stored at -80 °C until use. RESULTS: The levels of the HNPs increased from grade 1 to 4 tumors and this difference was statistically significant (p < 0.001). Additionally, plasma HNP levels were significantly higher in patients with metastatic bladder cancer and in patients with lymphovascular involvement, metastasis of the lymph nodes, and increased tumor burden (p < 0.001). CONCLUSIONS: The preoperative plasma levels of HNPs 1-3 paralleled the progression and pathological stages of the malignancies. This study suggests that HNPs 1-3 promote tumor invasion and are potential indicators of disease progression in patients with bladder cancer.

Complete duplication of the bladder and urethra in the coronal plane: case report with review of the literature.

Complete duplication of the bladder and urethra without other congenital anomalies is a very rare congenital anomaly. We report the case of an 8-year-old boy with complete duplication of the bladder and urethra in the coronal plane, without any other associated congenital anomalies and without complaint associated with the urinary tract.

Serum prolidase activity, oxidative stress, and nitric oxide levels in patients with bladder cancer.

OBJECTIVES: Prolidase is a member of the matrix metalloproteinase family. It plays a major role in collagen turnover, matrix remodeling and cell growth. Nitric oxide (NO) regulates many processes such as collagen synthesis and matrix remodeling. Thus, NO may augment angiogenesis, tumor invasion, and metastasis. The aim of this study was to investigate total antioxidant status (TAS), malondialdehyde (MDA) and NO levels in patients with bladder cancer and to determine their relationship with prolidase activity. DESIGN AND METHODS: Thirty-five patients with bladder cancer and 32 controls were enrolled. Serum TAS, MDA, prolidase activity and NO levels were determined. RESULTS: Serum prolidase activity, NO levels and MDA levels were significantly higher in bladder cancer than controls (all, P < 0.05), while TAS levels were significantly lower (P < 0.05). CONCLUSIONS: Our results show that increased prolidase seems to be associated with increased NO levels and oxidative stress along with decreased antioxidant levels in bladder cancer.

Effects of shock waves on oxidative stress and some trace element levels of rat liver and diaphragm muscles.

This study was designed to investigate whether the short-term extracorporeal shockwave lithotripsy (ESWL) exposure to kidney produces an oxidative stress and a change in some trace element levels in liver and diaphragm muscles of rats. Twelve male Wistar albino rats were divided randomly into two groups, each consisting of six rats. The animals in the first group did not receive any treatment and served as control group. The right-side kidneys of animals in group 2 were treated with two-thousand 18 kV shock waves while anesthetized with 50 mg kg(-1) ketamine. The localization of the right kidney was achieved after contrast medium injection through a tail vein under fluoroscopy control. The animals were killed 72 h after the ESWL treatment, and liver and diaphragm muscles were harvested for the determination of tissue oxidative stress and trace element levels. Although the malondialdehyde level increased, superoxide dismutase and glutathione peroxidase enzyme activities decreased in the livers and diaphragm muscles of ESWL-treated rats. Although glutathione level increased in liver, it decreased in diaphragm muscles of ESWL-treated animals. Fe, Mg and Mn levels decreased, and Cu and Pb levels increased in the livers of ESWL-treated animals. Fe and Cu levels increased, and Mg, Pb, Mn and Zn levels decreased in the diaphragm muscles of ESWL-treated animals. It also causes a decrease or increase in many mineral levels in liver and diaphragm muscles, which is an undesirable condition for the normal physiological function of tissues.

Haptoglobin levels in Turkish patients with bladder cancer and its association with clinicopathological features.

Although alteration in the haptoglobin phenotype has been reported in patients with bladder cancer, serum haptoglobin levels have not been evaluated. We hypothesized that serum haptoglobin can be used as a biomarker. The aim of this study was to evaluate the expression of haptoglobin in bladder cancer and to determine the relationship with clinicopathological features. A total of 68 serum specimens obtained before surgery were used to investigate haptoglobin expression using the sandwich ELISA technique. Serum haptoglobin levels were higher in the patients with bladder cancer compared to healthy controls (p<0.0001). Additionally, the levels of haptoglobin protein increased with increasing tumor grades (p<0.001) and were significantly higher in patients with metastatic disease and the presence of lymphovascular involvement, lymph node metastases and increasing tumor burden (p<0.0001). This study suggests that elevated haptoglobin levels are associated with a higher stage, grade, and extent of distant metastasis and larger tumor size. Haptoglobin may therefore provide a useful diagnostic and treatment biomarker for patients with bladder cancer.

Effects of shock waves on oxidative stress, antioxidant enzyme and element levels in kidney of rats.

The aim of this study was to investigate the effect of extracorporeal shock wave lithotripsy (ESWL) on kidney oxidative stress and trace element levels of adult rats. Twelve male Wistar albino rats were divided equally into two groups. First group was used as control. The right-side kidneys of animals in second group were treated with 2,000 18-kV shock waves under anesthesia. Localization of the right kidney was achieved following contrast medium injection through a tail vein under flouroscopy control. The animals were sacrificed 72 h after the ESWL treatment, and the kidneys were taken. Malondialdehyde level was higher in the ESWL group than in the control. Reduced glutathione levels, superoxide dismutase, and glutathione peroxidase activities were lower in the ESWL group than those of the control. Fe, Cu, Pb, Mn, Cd, and Ni levels were lower in the ESWL group than in the control, although Mg level was higher in the ESWL group than in the control. In conclusion, the result of the present study indicated that ESWL treatment produced oxidative stress in the kidney and caused impairments on the antioxidant and trace element levels in the kidneys of rats.

Serum trace element levels in patients with bladder cancer.

Trace elements are essential components of biological structures, but they can be toxic at concentrations beyond those necessary for their biological functions. In the present study, groups of 35 patients with bladder cancer and 34 healthy volunteer controls were measured for trace elements using a furnace atomic absorption spectrophotometer. Serum levels of Cd, Ni and Co were increased (p<0.05) and Mn and Zn were decreased (p<0.05) in patients with bladder cancer. In the present study, a relationship was seen between the level of trace elements and the occurrence of bladder cancer, suggesting that an increase in the serum level of Cd, Ni, Co and a decrease in the levels of Zn and Mn might be important causes of bladder cancer occurrence; however, defining such a cause-and-effect relationship needs several prospective studies to be done, which seems necessary with regard to the high prevalence of this cancer.

Comparison of cystoscopy with diffusion-weighted magnetic resonance images used in the diagnosis and follow-up of patients with bladder tumors.

PURPOSE: To compare diffusion-weighted magnetic resonance imaging (DW-MRI) with cystoscopy in the diagnosis and follow-up of patients with bladder tumor and to investigate any histopathological correlation. MATERIALS AND METHODS: Totally 59 patients, between 31-85 years (mean age 60∓13) referred to our clinic due to a hematuria complaint were enrolled and evaluated by upper urinary system pathology and then DW-MRI (average 7 days) and cystoscopy. Apparent diffusion coefficients (ADCs) of images were calculated. RESULTS: While a mass in bladder was determined with cystoscopy in 43 out of 59 patients,the mass was not determined in 16 of the patients (n=34 malign, n=9 benign). While a mass was determined in 40 out of 59 patients with DW-MRI,the mass was not determined in 19 of the patients(n=40 malign, n=19 benign). Regarding ADC values, mean ADC values of 34 patients who were diagnosed with a bladder tumor (1.05∓0.22x10(-3) mm2/s), were significantly lower than the mean ADC values obtained from the normal bladder wall (1.830∓0.18x10(-3) mm2/s) whereas a statistically significant difference was found (p<0.001). ADC values in 9 patients with a benign lesion (1.73∓0.12x10(-3) mm2/s), were not found statistically different from the mean ADC values obtained from the normal bladder wall (1.78∓0.2x10(-3) mm2/s) (p>0.05). A significant difference was determined between ADC values of benign lesions and the ADC values of malign lesions (p<0.001). CONCLUSIONS: According to cystoscopy, values of DW-MRI's related with sensitivity, specificity and accuracy were found, respectively 90%, 93% and 91%. As the DW-MRI is a non-invasive and a rapid technique, and does not contain ionized radiation and because it is accepted as an important marker of tumor cellularity, it may be used as an alternative in future diagnosis and follow-up of bladder tumors.

Ectopic intrauterine device in the bladder of a pregnant woman.

Background. Uterine perforation and transvesical migration of an intrauterine device are rare complications. Case. A 28-year-old woman who had an intrauterine device was admitted to our outpatient clinic with complaints of amenorrhea lasting 5 weeks and pelvic pain lasting a year. Transvaginal ultrasonography revealed embedding of the intrauterine device in the bladder. The misplaced device was removed by laparotomy. Conclusion. The followup of intrauterine device localization with transvaginal ultrasonography is essential for early detection of possible serious complications.

Renal involvement in Brucella infection.

OBJECTIVES: To examine our patients with brucellosis and renal involvement. Although brucellae have been recovered from the urine of patients with brucellosis, renal involvement is uncommon. METHODS: The data from 15 patients (8 males and 7 females, mean age 43 +/- 18.9 years, range 16 to 80), who had been admitted to our hospital with the diagnosis of brucellosis with renal involvement from 1998 to 2006, were retrospectively evaluated. RESULTS: In almost all cases, urinalysis revealed hematuria and variable amounts of proteinuria; some of the patients had pyuria. Of the 15 patients, 14 had renal failure. The etiology of renal failure was prerenal azotemia in 1, acute tubular necrosis because of nonsteroidal anti-inflammatory drug use in 1, anuric tubulointerstitial nephritis due to rifampin use in 1, nephritis accompanied by brucellar endocarditis in 3, brucellar endocarditis and tubulointerstitial nephritis-associated vasculitis in 1, brucellar membranoproliferative glomerulonephritis in 1, and brucellar tubulointerstitial nephritis clinically in 6 patients. Hemodialysis was required in 5 patients. Chronic renal failure developed in 1 patient, 2 patients were lost to follow-up, and renal function completely recovered in 11 patients. Two patients underwent renal biopsy and membranoproliferative glomerulonephritis with intraglomerular infiltration of histiocytes was identified in 1 patient and chronic tubulointerstitial nephritis associated with vasculitis and immune complex nephritis features was identified in the other. CONCLUSIONS: In areas endemic for brucellosis, this infection can be associated with hematuria, proteinuria, and renal failure. In addition, many diverse etiologies can play a role in the renal involvement associated with Brucella infection.

The protective effect of erythropoietin infusion on testicular torsion/detorsion: an experimental study.

INTRODUCTION: The aim of the present study was to evaluate the effects of erythropoietin (EPO) on the histopathology of testes after unilateral testicular torsion and detorsion. MATERIALS AND METHODS: Twenty-five male Sprague-Dawley rats weighing 120 g were used in this study. The rats were randomly divided into three groups, a sham group consisting of five rats and the other two groups consisting of ten rats. In group 1 (sham group), right orchiectomy with no additional intervention was performed. In group 2 (T/D group), torsion was created by rotating the testis 720 degrees in a clockwise direction for 4 h. After a 4-h torsion period, the right testis was detorted and replaced into the scrotum for 4 h. After the torsion, 0.5 cc 0.9% NaCl solution was injected once and three times in a week (total 12 doses). In group 3 (T/D + erythropoietin; EPO group), the same surgical procedure was done as in group 1, but EPO 1,000 IU/kg was injected just before the detorsion and three times in a week. At the end of each procedure, bilateral orchiectomies were performed for the histopathological examinations in all groups. RESULTS: We examined the testes weight, vascularization of the region between the seminiferous tubules, percentage of necrotic seminipherous tubules, and maturation of spermatogenesis in terms of necrosis, sertoli cells, maturation arrest of spermatogenesis, hypospermatogenesis, and normal spermatogenesis of torsioned testis tissues with and without EPO treatment. Extremely significant differences in testicular weight were observed in group 1 compared to groups 2 and 3 (P < 0.001). CONCLUSION: Administration of EPO significantly influenced the rescue of testicular function by preserving the intact seminiferous tubular morphology, lowering the percentage of necrotic seminipherous tubules, and significantly reducing histological damage (P < 0.05).

True hermaphroditism presenting as an inguinal hernia.

A 21-year-old patient with cryptorchidism was found to have a left inguinal mass on physical examination. The patient was operated with a diagnosis of bilateral cryptorchidism and left inguinal hernia. Besides bilateral inguinal undescended testicles, female genital organs like fallopian tubes, uterus and ovary were found on the exploration.

True hermaphroditism presenting as an inguinal hernia

A 21-year-old patient with cryptorchidism was found to have a left inguinal mass on physical examination. The patient was operated with a diagnosis of bilateral cryptorchidism and left inguinal hernia. Besides bilateral inguinal undescended testicles, female genital organs like fallopian tubes, uterus and ovary were found on the exploration.

Severe complications of circumcision: an analysis of 48 cases.

OBJECTIVE: Circumcision is still the most commonly performed surgery in Islamic and Jewish societies. We report the findings of 48 cases referred for serious complications after circumcision that needed secondary surgical interventions. The aim of this study is to emphasize the important problem of circumcision complications. PATIENTS AND METHODS: The 48 cases (mean age 14 years, range 5 months-24 years) with complications of circumcision were reviewed retrospectively. Circumcisions were performed at various medical centers or during religious ceremonies in environments other than health facilities. RESULTS: The most commonly observed complication was preputio-glandular fusion, seen in 25 cases (52%). The other complications were: meatal stenosis in 11 (23%), urethral fistula in five (10.4%), partial glandular amputation in four (8%) and opening distal urethra in three (6%). Adhesion freeing and revision were performed in all cases of preputio-glandular fusion, patients with meatal stenosis underwent meatotomy, urethral fistulae were repaired by simple closure, partial glans amputations were patched with buccal mucosa, and patients with complete open distal urethra were repaired by Mathieu (one patient) and tubularized incised plate urethroplasty techniques. CONCLUSION: Circumcision may be associated with many serious complications. To prevent these complications, the operation should be performed by educated and experienced personnel.