Anti-sperm Antibody Positivity in Men with Varicocele: A Systematic Review and Meta-Analysis.

PURPOSE: Despite the significant role of varicocele in the pathogenesis of male infertility, its association with anti-sperm antibodies (ASA) remains controversial. This systematic review and meta-analysis (SRMA) aims to investigate the frequency of ASA positivity in men with varicocele. MATERIALS AND METHODS: This SRMA is conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology guidelines. We investigated the frequency of ASA positivity in ejaculates or serum of men with varicocele as compared to men without varicocele (controls). A literature search was performed using the Scopus and PubMed databases following the Population Exposure Comparison Outcome, Study Design model. Data extracted from eligible studies were meta-analyzed and expressed as odds ratios (ORs) and confidence intervals (CIs). RESULTS: Out of 151 abstracts identified during the initial screening, 6 articles met the inclusion criteria and were included in the meta-analysis. Using mixed antiglobulin reaction (MAR) assay, 61 out of the 153 (39.8%) patients with varicocele tested positive for ASA in their ejaculates as compared to 22 out of the 129 control subjects (17%, OR=4.34 [95% CI: 1.09-17.28]; p=0.04). Using direct or indirect immunobead test, 30 out of 60 cases diagnosed with varicocele (50%) had shown ASA positivity in their ejaculates as compared to 16 out of 104 controls (15.4%, OR=3.57 [95% CI: 0.81-15.68]; p=0.09). Using enzyme-linked immunosorbent assay (ELISA), out of 89 varicocele patients, 33 (37.1%) tested positive for serum ASA as compared to 9 out of 57 participants in the control group (15.8%, OR=7.87 [95% CI: 2.39-25.89]; p<0.01). CONCLUSIONS: This SRMA indicates that ASA positivity is significantly higher among men with varicocele when tested by direct method (MAR) or indirect method (ELISA). This data suggests an immunological pathology in infertile men with varicocele and may have implications for the management of these patients.

Is preoperative pulmonary rehabilitation effective in the postoperative period after lung resection?

Objective: Investigating the effects of the preoperative short term intensive pulmonary rehabilitation program applied for patients who have undergone lung resection by thoracotomy, on lung functions, complication rates and length of hospital stay during the postoperative period. Methods: A prospective randomized trial of sixty patients were enrolled who would undergo pulmonary resection by thoracotomy and were randomly divided in two groups. Intensive pulmonary rehabilitation was performed on these patients in the study group 3 hours a day throughout 7 days during the preoperative period. Groups were compared with respect to their spirometric pulmonary functions, respiratory parameters, blood gas parameters, complication rates and length of hospital stay. Results: Total incidence rate of complications in the patients from the control group significantly increased(p=0,028). When patients who underwent lobectomy and wedge resection were observed, length of hospital stay of those in the control group was seen to be statistically higher in comparison with the study group(p<0,05). Conclusion: We consider that it will be very beneficial to perform a short term and intensive pulmonary rehabilitation program on every patient possible who is planned to undergo thoracotomy and lobectomy or wedge resection treatment.

Risk factors associated with survival in surgically treated large cell neuroendocrine carcinoma of the lung.

Introduction: Pulmonary large cell neuroendocrine carcinomas (LCNEC) are one of the rare malignant neoplasms of the lung. A standard management model for LCNEC has not yet been established and the poor prognostic factors and treatment modalities are still uncertain. Aim: LCNEC are fairly rare and have a poor prognosis. Determination of the risk factors associated with survival can contribute to its management. Material and methods: In this retrospective study, we analyzed the data of 42 patients. We obtained the data about the age, gender, smoking history, symptoms, tumor size, tumor location, pathological type, TNM stage, treatments, surgical modality, length of hospital stay, postoperative complications, disease-free survival and total survival from the hospital electronic files of the patients. Then we analyzed the relationship between these data and survival. Results: 40 (95.24%) were male, and the mean age was 64.26 ±8.62. 12 (28.57%) patients were in stage I, 14 (33.3%) were in stage II, 15 (35.71%) were in stage III and only 1 (2.38%) patient was in stage IV. 15 (35.71%) had sublobar resection (wedge resection (n = 13) + segmentectomy (n = 2), 24 (57.14%) had lobectomy and 3 (7.14%) had pneumonectomy. The mean overall survival (OS) time was 34.86 ±30.11 months. 1-year, 3-year and 5-year survival rates of the patients were 73.80%, 47.61% and 19.04%, respectively. T stage (HR = 8.956, 95% CI: 1.521-11.034, p = 0.005) N stage (HR = 5.984, 95% CI: 1.127-7.982, p = 0.028) were independent risk factors for OS. Conclusions: The overall survival in LCNEC was poor and the tumor size and the nodal stage were independent risk factors for overall survival.

The Effectiveness of Active External Warming of Patient Concurrently With Ice Application on the Incision Site on Post-Thoracotomy Pain and Analgesic Consumption.

The aim of study is to investigate the effects of active external warming of patient concurrently with application of ice to incision site on thoracotomy pain and analgesic consumption. The research is a quasi-experimental design with control and study groups. The study was conducted in 2018 and 2019. A total of 70 patients were included in the study: 35 in the control group and 35 in the study group. The mean verbal pain scale values were significantly lower in the intervention group (2.85 point) than in the control group (4.57 point; p < .001). Opioid consumption rate was high in control group patients (77.1% tramadol 30 mg; 45.7% morphine sulfate 5 mg) In contrast, the rate of opioid consumption was lower in patients in the intervention group (40% tramadol 30 mg; 17% morphine sulfate 5 mg). Active external warming and ice application on the incision area, could reduce the intensity of thoracotomy pain.

Risk factors for mediastinitis and mortality in pneumomediastinum.

Introduction: Pneumomediastinum (PM) is a self-limiting disease with a good prognosis. Mediastinitis is a rare but potentially fatal complication of PM. Identification of risk factors for mediastinitis is essential for better management. Methods: This is a single-center, retrospective study conducted in a university hospital. Adult patients with PM between January 2016 and June 2020 were involved in the study. The data about age, gender, symptoms, signs, treatment, development of mediastinitis, hospital stay, and mortality were investigated. Results: In total, 79 patients with PM were analyzed. The most common symptom was dyspnea(58;73.4%) and the most common sign was subcutaneous emphysema (48;60.7%). Thirty(37.9%) of them were iatrogenic PM (IPM), while 22 (27.9%) were spontaneous PM (SPM) and27 (34.2%) were traumatic PM (TPM). Mediastinitis developed in 17 (12 from IPM, 4 from TPM,1 from SPM) patients, and 11 (58.8%) of these patients died. The incidence of mediastinitis in the IPM group was significantly higher than in the TPM and SPM group (respectively, P = 0,03,P = 0,01). There was no significant difference between the age, gender, symptoms, and signs of those with or without mediastinitis. Mortality was lower in TPM and SPM than IPM (respectively,P = 0,05, P = 0,03), and hematological malignancy was remarkably common in patients who died from mediastinitis in the TPM and SPM group. Conclusion: Mediastinitis and mortality were significantly higher in IPM, while hematological malignancy was remarkably prevalent in patients deceased from mediastinitis in TPM and SPM.

What are the independent prognostic factors in patients undergoing esophagectomy for esophageal cancer?

Background: This study aims to investigate the prognostic factors affecting survival in patients undergoing surgical treatment for esophageal cancer. Methods: A total of 50 patients (33 males, 17 females; mean age: 57.8±11.8 years; range, 28 to 80 years) who underwent esophagectomy for esophageal cancer in our clinic between January 2008 and March 2018 were retrospectively analyzed. Prognostic factors affecting survival were investigated. Data including age, sex, tumor size, histological and macroscopic type, tumor stage, T and N categories, the total number of resected lymph nodes and metastatic lymph node ratio, differentiation degree, vascular and perineural invasion, proximal surgical margin distance, adjuvant therapy, and the presence of postoperative complications were recorded. Results: The patients after radical surgery with a tumor size of <3 cm, macroscopic type non-ulcerative-infiltrative squamous cell carcinoma pathology, Stage 1 disease, pT1-2, pN0, well-differentiated groups, no perineural invasion, a metastatic lymph node ratio of <0.2, proximal surgery margin length of 5 to 10 cm, and no postoperative complications had higher five-year survival rates. However, when the effects of these factors on overall survival were examined independently, none of them had a statistically significant effect (p>0.05). The main factors affecting the prognosis were Stage ≥2 disease, postoperative complications, and proximal surgical margin less than 5 cm. Conclusion: Our study results suggest that Stage 1 disease, a proximal surgical margin length of more than 5 cm, and the absence of complications are associated with longer survival times and these patients are greatly benefited from surgical treatment.

Pulmonary aspergilloma management: 5 years of experience from a tertiary hospital.

Introduction: Pulmonary aspergilloma (PA) is a chronic lung infection. Lobectomy is the recommended surgical modality. However, recent studies have suggested that wedge resection may be better than lobectomy. Aim: We compared short-term complications and mortality according to surgical methods in pulmonary aspergilloma. Material and methods: In this study, we analyzed the patients diagnosed with PA in the period 2015-2019 at a tertiary hospital. We obtained the data about the age, gender, smoking history, symptoms, radiological findings, operation technique, complications, length of hospital stay, and mortality from the electronic patient files. Then we compared short-term complications and mortality according to surgical methods in PA. Results: Of a total of 27 PA patients, 22 (81.5%) were male, with a mean age of 48.1 ±15.6 years. The most common symptom was dyspnea (48.1%). Nineteen (70.0%) of the patients had wedge resection and 6 (22.3%) of the patients had a lobectomy. Prolonged air leak and empyema were the most common postoperative complications. Prolonged air leak was significantly more common in lobectomy than in wedge resection (p = 0.046). There was no significant difference in other complications, hospital stay length, intensive care unit stay length or mortality between lobectomy and wedge resection. Conclusions: Wedge resection can be safely performed in aspergilloma. Prolonged air leak was less common in wedge resection than in lobectomy.

Anxiety and depression as possible criteria in the treatment of bronchiectasis.

BACKGROUND: The aim of this study was to investigate the effect of bronchiectasis operation on anxiety and depression. METHODS: Between August 2014 and March 2019, a total of 167 patients with bronchiectasis (107 males, 60 females; mean age: 43.5±13.9 years; range, 18 to 84 years) who received medical (n=70) and surgical (n=97) treatment were retrospectively analyzed. Data including patients" characteristics, operation indication, operation type, and bronchiectasis localization were obtained from the electronic patient files. The patients were reached via phone calls and evaluated whether the operation provided a significant symptomatic improvement and whether the symptoms disappeared. The number of exacerbations/hospitalizations associated with bronchiectasis within the last year was also questioned. The anxiety and depression status of the patients in both groups was assessed by the Hospital Anxiety and Depression Scale. RESULTS: Eleven (15%) patients in the medical group and 10 (10%) patients in the surgical group had an anxiety score above 7. Twenty-one (30%) patients in the medical group and 10 (10%) patients in the surgical group had a depression score above 7. Both the anxiety and depression scores were significantly lower in the surgical group than the medical group (p<0.001). Annual exacerbation and annual hospitalization rates were also significantly lower in the surgical group (p<0.001). CONCLUSION: Our study results suggest that patients with bronchiectasis treated medically rather than surgically are more prone to be anxious and depressive. The benefits of surgical treatment in patients with bronchiectasis is not limited to improving symptoms and decreasing the frequency of exacerbations/hospitalizations. We believe that surgical treatment also reduces anxiety and depression and improve the quality of life. While making a surgical decision, the anxiety/depression status of bronchiectasis patients should be considered.

Mediastinal hibernoma: An uncommon tumor.

Hibernoma is a rare tumor originating from fetal brown fat. Mediastinum is a very rare localization for the hibernoma. In this article, we present the clinical and radiological findings of a 46-year-old male patient with pleuritic chest pain.

Self-mode-locking semiconductor disk laser.

The development of mode-locked semiconductor disk lasers received striking attention in the last 14 years and there is still a vast potential of such pulsed lasers to be explored and exploited. While for more than one decade pulsed operation was strongly linked to the employment of a saturable absorber, self-mode-locking emerged recently as an effective and novel technique in this field - giving prospect to a reduced complexity and improved cost-efficiency of such lasers. In this work, we highlight recent achievements regarding self-mode-locked semiconductor devices. It is worth to note, that although nonlinear effects in the active medium are expected to give rise to self-mode-locking, this has to be investigated with care in future experiments. However, there is a controversy whether results presented with respect to self-mode-locking truly show mode-locking. Such concerns are addressed in this work and we provide a clear evidence of mode-locking in a saturable-absorber-free device. By using a BBO crystal outside the cavity, green light originating from second-harmonic generation using the out-coupled laser beam is demonstrated. In addition, long-time-span pulse trains as well as radiofrequency-spectra measurements are presented for our sub-ps pulses at 500 MHz repetition rate which indicate the stable pulse operation of our device. Furthermore, a long-time-span autocorrelation trace is introduced which clearly shows absence of a pedestal or double pulses. Eventually, a beam-profile measurement reveals the excellent beam quality of our device with an M-square factor of less than 1.1 for both axes, showing that self-mode-locking can be achieved for the fundamental transverse mode.

[Molecular characterization of beta-lactamase-associated resistance in Acinetobacter baumannii strains isolated from clinical samples]. / Klinik örneklerden izole edilen Acinetobacter baumannii suslarinda beta-laktamaz kaynakli direncin moleküler karakterizasyonu.

Acinetobacter baumannii is an important cause of nosocomial infections that particularly increase the mortality and the morbidity at the intensive care units of the hospitals. The aims of this study were to evaluate the resistance genes, antibiotic susceptibility and the clonal relations among Acinetobacter strains isolated from clinical samples and to determine the resistance mechanisms related to these bacteria in our hospital. A total of 201 A.baumannii strains isolated from different clinical samples (35.3% from tracheal aspirate, 27.3% from blood, 18.4% from abscess material, 19% from other samples) of 160 inpatients evaluated at the Ibni Sina Hospital Central Bacteriology Laboratory, Ankara University School of Medicine, Turkey from April 2010 to December 2011, were included in the study. Identification of the isolates and their susceptibility testing against amikacin, ciprofloxacin, tetracycline, sulbactam/ampicillin, trimethoprim/sulfametoxazole (SXT), ceftazidime, gentamicin, imipenem, levofloxacin, meropenem, piperacillin/tazobactam, cefoperazone/sulbactam, cefepime and colistin were performed by the automated systems, namely Vitek 2 (bioMérieux, France) and BD Phoenix (Becton Dickinson, USA). The molecular mechanisms of beta-lactamase resistance and the presence of integrons were analyzed by polymerase chain reaction (PCR). Moreover, since blaPER-1 gene is of high frequency in Turkey, it was also investigated in the isolates. Pulsed-field gel electrophoresis (PFGE) was performed to examine the clonal relations between isolates. Our results indicated that multidrug resistance rate of A.baumannii was 94.5% (190/201), while 94% (189/201) of the isolates were susceptible to colistin thus making it the most potent antimicrobial agent, followed by amikacin and SXT with a susceptibility rate of 32%. Twelve colistin-resistant isolates were further investigated with the E-test method (AB Biodisk, Sweden) and found to be colistin-resistant. While the results were negative for the genes responsible from metallo-beta-lactamase production, positive results were obtained for blaOXA genes at various rates (OXA-51 100%; OXA-23 91.5%; OXA-58 7%; OXA-24 2%). PFGE results revealed four different main clones (29 isolates in genotype A, 23 in genotype B, 18 in genotype C and 7 in genotype D) in the study population. No common epidemic isolate was detected. Class 1 integrons which take part in the transfer of resistance genes were detected in 112 (55.7%) isolates. There was no statistically significant difference between the genotype distributions of class 1 integron positive strains (p> 0.05). The relationship between the presence of integron in multidrug resistant isolates and resistance to tetracyclin, SXT, imipenem, meropenem, cefoperazone/sulbactam and cefepime were found to be statistically significant (p< 0.05). Of the isolates 42 (21%) were positive for blaPER- 1 gene and all were resistant to ceftazidime. This study indicated that blaOXA genes found together with blaOXA-51 genes play an important role in carbapenem resistance of A.baumannii strains. Moreover, multidrug resistance is still an important problem in infections caused by A.baumannii and integrons play a role in the transfer of the resistance genes. In conclusion, multidrug resistant A.baumannii strains were common in our hospital and our epidemiologic data would be helpful for further investigations and in therapeutical approaches.

The sealing effect of a fibrin tissue patch on the esophageal perforation area in primary repair.

BACKGROUND: The aim of this study was to investigate the efficacy of the fibrin tissue patch and to analyze its use in patients with esophageal perforation. METHODS: We studied 28 patients who were diagnosed with esophageal perforation between January 1990 and January 2006 at Akdeniz University Hospital. Sixteen (57.14%) were male. The average age was 59 +/- 9 years. We performed surgery and primary repair reinforcement even if the diagnosis of esophageal perforation was late. RESULTS: Twenty-three (82.14%) perforations were the result of endoscopic instruments; spontaneous perforations occurred in three (10.71%) patients. Postoperative complication (Heller myotomy) caused perforation in one patient (3.57%) and blunt trauma in one patient (3.57%). Three (10.71%) patients had cervical perforation, and 25 (89.29%) patients had thoracic esophageal perforation. Twelve (42.86%) patients underwent emergency surgery (within the first 24 h). Ten (35.71%) patients underwent surgery within 48 h, and the remaining 6 (21.43%) underwent surgery after 48 h. Nine (32.14%) patients had primary repair, 7 (25%) had reinforcement of the primary repair with fibrin tissue patch, 7 (25%) had esophagectomy and gastric pull-up, and 2 (7.14%) had drainage and placement of metallic stents. In four patients of the nine who had primary repair, fistula complication was detected, whereas in only one of the seven who had reinforcement of the primary repair with fibrin tissue patch was a fistula detected. Three patients (10.71%), two of whom had Boerhaave's syndrome, died. CONCLUSIONS: Surgical primary repair with fibrin tissue patch is the most successful treatment option in the management of esophageal perforation.