Intracavernosal adrenalin injection in priapism.

Prolonged erection is a rare problem in urology but it must be treated effectively. The most common etiological factor is intracavernosal vasoactive agent injection for diagnosis or treatment of erectile dysfunction. The aim of this study was to evaluate the efficacy of intracavernosal adrenalin injection alone in the treatment of priapism. Nineteen patients with prolonged erection were evaluated. Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1/100 000) was injected in each cavernosal body. In the patients who did not respond to the first injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the first injection. Repeated adrenalin injections (2-5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. There was no significant difference in blood pressure and heart rate during the monitoring of the patients when compared to the initial values. No standard treatment method has yet been described for prolonged erection. Repeated aspirations and irrigations for treatment of prolonged erection are problematical applications both for patients and urologist. Intracavernosal adrenalin injection alone can be used with high efficacy and safety for the treatment of prolonged erection especially in patients with a short duration of erection.

Patient-controlled sedation and analgesia during SWL.

Sixty unpremedicated outpatients undergoing elective extracorporeal shockwave lithotripsy (SWL) using a Dornier MPL 9000 lithotripter were randomly assigned to receive either propofol-alfentanil (PA group; N = 30) or midazolam-alfentanil (MA group; N = 30) by a patient-controlled analgesia (PCA) device for sedation and analgesia. Although pain intensity scores were lower after 20 minutes and sedation was more pronounced in the MA group, both drug regimens produced satisfactory sedation and analgesia and allowed the maximum number of shockwaves to be given. Alfentanil consumption was less in the MA group (P < 0.05). Both groups were hemodynamically stable. The patients in the MA group had slower ventilation rates, lower oxygen saturation, and higher end-tidal carbon dioxide levels. Use of MA was associated with more episodes of oxygen desaturation to < 90% (30% vs. 11%; P < 0.05). One patient in the PA group and three patients in the MA group developed bradypnea (< 10 breaths/min). Patient satisfaction was very high with the two sedative-analgesic techniques. Propofol and midazolam, when given in combination with alfentanil using a PCA pump, may provide safe, effective analgesia and sedation during lithotripsy. Patient-controlled sedation and analgesia may provide optimal conditions for SWL of urinary tract stones and is a useful alternative to other forms of anesthesia and analgesia.

Comparison of tear function tests and impression cytology with the ocular findings in acne rosacea.

PURPOSE: The aim of this study was to determine the correlation between tear function tests and impression cytology results and the clinical findings in ocular rosacea. METHODS: Patients with a histopathologic and clinical diagnosis of acne rosacea were studied. Ocular examination consisted of best-corrected visual acuity measurement, slitlamp examination, tear break-up time (BUT), basal Schirmer test, and rose Bengal staining. Impression cytology was done two days later. Ocular findings and symptoms were checked and scored. Age-matched controls were assessed using the same parameters. RESULTS: The most frequent symptoms were itching (80%), redness (68%), burning (64%), and photophobia (60%). The most frequent clinical findings were meibomitis (92%), telangiectasis (88%), blepharitis (84%), superficial punctate keratopathy (72%), and hyperemia (60%). Mean tear BUT was 9.6+/-3.1 (SD) seconds (range 5-17 seconds). Mean Schirmer test measured 11.4+/-1.6 mm (SD) (range 8-15 mm). Mean rose Bengal staining scored 1.8+/-0.1. Mean tear BUT, Schirmer test and rose Bengal staining scores were lower in the rosacea group than the control group (p<0.003, p=0.04, p< or =0.038, respectively). Staining was pathologic in 18 patients (36%) and the highest staining score was 4. No significant difference was found between the stages of the nasal and temporal conjunctival impression cytologies in each eye, and there was no relationship between impression cytology stages and rose Bengal scores (p>0.05). A significant relation was observed between the stages of impression cytology and the severity of meibomitis (Fisher's test, chi2=9.625, p=0.001). The Schirmer test gave lower results in patients with severe blepharitis (Mann-Whitney U Test, U=180.5, p=0.034). CONCLUSIONS: Early diagnosis prevents serious ocular complications and chronic dry eye in rosacea. We suggest that in addition to tear function tests, rose Bengal staining and impression cytology can be successfully used in the early diagnosis of dry eye and in monitoring medical treatment in ocular rosacea. Meibomian glands play an important role in the pathogenesis of the ocular disease.

Renal cell carcinoma in a giant renal cyst. A case report and review of the literature.

A case of renal carcinoma in a giant solitary renal cyst is reported. Ultrasonography and CT showed an apparently benign left renal cyst except for wall irregularity. Cytological examination and fat analysis of the cyst content were negative but the fluid was haemorrhagic in nature. Frozen section of the cyst wall revealed malignancy and further histopathologic examination indicated renal cell carcinoma.

Eosinophilic cystitis induced by mitomycin-C.

Eosinophilic cystitis is an unusual form of cystitis which is characterized by irritative voiding symptoms and haematuria. In the report herein two adult cases of eosinophilic cystitis treated with intravesical Mitomycin-C instillations for prophylaxis of bladder carcinoma are presented and the literature is reviewed.

[The antifungal effects of tioconazole aerosol form]. / Tiokonazol'un aerosol tipindeki ilaç seklinin antifungal etkinliginin arastirilmasi.

In this study antifungal effects of tioconazole which is prepared in aerosol forms were investigated. For this purpose, the formulations which have and have not active material were sprayed on petri dishes inoculated with Candida albicans and Aspergillus niger. Because of non growth in dishes with formulations containing active material, formulations with active material were sprayed on to the pregrowth Candida albicans and Aspergillus niger in order to detect if the effect is fungicide or not. At the end of application time, the samples taken from these dishes were inoculated by the direct way. The lack of growth had confirmed the realization of the formulations with fungicide effects.

Leydig cell tumor of the testis: comparison of histopathological and immunohistochemical features of three azoospermic cases and one malignant case.

Leydig cell tumors of the testis are rare, mostly presenting as a testicular mass or as endocrinological symptoms. Here, three patients who were admitted for investigation of primary infertility and one patient presenting with a testicular mass are reported. The histological features were reviewed and an immunohistochemical study was done using a panel of antibodies against cytokeratin, vimentin, inhibin A, S-100, Ki-67, follicle-stimulating hormone, luteinizing hormone, prolactin, p53, bcl-2, and c-erbB2. The latter case (lost during follow up of metastatic disease) demonstrated massive tumor necrosis, extension through the tunica albuginea, and a high mitotic activity and MIB-1 score. Only this malignant case was bcl-2 positive. Of the two oncogenic markers studied, none of the cases were positive for c-erb2, while p53 was positive in more than 50% of cells in the malignant case and in one case of infertility with a large tumor, hemorrhage, focal necrosis and atypical cytological features. We recommend the evaluation of infertile men for Leydig cell tumors, and we believe that a panel of antibodies, including Ki-67, p53 and bcl-2, used for immunohistochemical analysis could be of diagnostic value in the identification of malignant and borderline cases of Leydig cell tumor.

Anti-bacterial activity of the fluid contents of spermatoceles and epididymal cysts.

OBJECTIVE: To show that the fluids obtained from spermatoceles and epididymal cysts are not infected, even though they may be present for long periods, and that these fluids have bactericidal activity. MATERIALS AND METHODS: Sixteen patients, 13 with a spermatocele and three with an epididymal cyst, were included in the study. Protein, glucose, chloride, inorganic phosphorus, calcium and magnesium contents were measured and cultures of the fluids were carried out. Bactericidal activity against the Escherichia coli NTCC 10418 clone was tested in different dilutions. RESULTS: Biochemical analysis showed that the protein, glucose and ionic content of the fluids was lower than that of serum, except for chloride. Microbiological cultures were negative for all samples. A significant bactericidal effect was obtained with 1/1 dilution and no reproduction was seen with this dilution. CONCLUSION: These findings indicate that the fluids within spermatoceles and epididymal cysts do not become infected under normal circumstances.

The role of ESWL in the treatment of calculi with anomalous kidneys.

OBJECTIVE: To evaluate the efficacy of Extracorporeal shock wave lithotripsy (ESWL) in renal anomalies. MATERIAL AND METHODS: From 1991 to May 1995. 53 patients with calculi in anomalous kidneys presented to our clinic for treatment with ESWL. Average patient age was 39 years, a range of 6-66 years. These patients (32 male and 21 female) underwent ESWL treatments. ESWL was performed in 27 patients with urolithiasis in duplex system, 18 with horse-shoe kidneys, 4 with unilateral renal agenesis, 2 with pelvic ectopic kidneys, 1 with sigmoid kidney and 1 with L-shaped kidney. RESULTS: Among patients who completed ESWL the rate free of stones was 60.4% and the rate of clinically insignificant residual fragments was 30.2%. No sign of stone disintegration was observed in 2 patients. They underwent open surgery. The shock waves per therapy varied between 811 and 18,101. Double-J stents were placed in 13 patients. CONCLUSION: Most patients with calculi in anomalous kidneys can be managed primarily with ESWL.

Doxazosin: a new cytotoxic agent for prostate cancer?

OBJECTIVE: To determine the sensitivity of drug-resistant prostate cancer cell lines to doxazosin-mediated cell death, and the effects of combining doxazosin and chemotherapeutic agents on these cell lines. Materials and methods The cytotoxic effect of doxazosin was initially evaluated in the prostate carcinoma cell lines DU145 and PC-3. Doxazosin was combined either with adriamycin, etoposide or paclitaxel after its cytotoxic effects were detected in these cell lines. The tetrazolium dye (MTT) assay and trypan blue dye-exclusion tests were used to determine drug-mediated cytotoxicity. Experiments were performed at least three times and representative data are presented. RESULTS: Both cell lines were sensitive to doxazosin-mediated cytotoxicity and the maximum cytotoxicity was achieved after 72 h. While cell death increased with increasing concentrations of doxazosin, 60 micromol/L doxazosin killed more than half of the cells in these cell lines. The combination of doxazosin with both adriamycin and etoposide resulted in significant synergistic cytotoxic activity at subtoxic concentrations of the drugs. Interestingly, the combination of doxazosin and paclitaxel resulted in antagonistic activity. CONCLUSION: Doxazosin-mediated cytotoxicity in the drug-resistant human prostate carcinoma cell lines was confirmed. Combinations of doxazosin with either adriamycin and etoposide, but not paclitaxel, had synergistic cytotoxic activity in these tumour cell lines. These results suggest that doxazosin could be a new cytotoxic agent, either used alone or combined, in the treatment of prostate cancer.

Results of extracorporeal shock wave lithotripsy in the pediatric age group.

OBJECTIVE: In this study we aimed to show the efficacy of extracorporeal shock wave lithotripsy (ESWL) for urinary stone disease in the pediatric age group and to evaluate the complications encountered after the treatment. METHODS: 67 children with 109 stones underwent ESWL, using a Dornier MPL 9000 lithotriptor. Styrofoam boards were used to protect the lungs. KUB and chest radiographs were taken on the day after treatment. If stone-free status was achieved, the patient was followed with ultrasonography and urine analysis every 6 months for 2 years. If fragments < 4 mm were present, follow-up was repeated every 3 months. RESULTS: Stone size ranged from 0.5 to 3.5 cm. 71 renoureteral units underwent a total of 129 ESWL sessions. Retreatment was required in 28 patients. The mean number of sessions per unit was 1.8. A stone-free status was achieved in 60 renoureteral units. The overall success rate was 88.6%. The composition of the stone was mixed calcium oxalate and phosphate in the majority of the patients. Auxiliary procedures used were push-back, ureteroscopic stone removal, and open surgery. Hematuria, colics and fever over 38 degrees C were the complications encountered after the treatment. CONCLUSIONS: ESWL is the first-line treatment for renal and upper ureteral calculi. However, larger stones which will require several ESWL sessions and consecutively increased number of shock waves are best treated with percutaneous nephrolithotomy plus ESWL. Patients with congenital anomalies necessitating surgical reconstruction are the best candidates for operation.