Diagnostic value of penile color doppler ultrasonography in patients with veno-occlusive erectile dysfunction.

BACKGROUND: The method used in the first assessment of patients with veno-occlusive erectile dysfunction (ED) is penile color doppler ultrasonography (PCDU). However, cavernosography performed following intracavernosal pharmacostimulation is accepted as a more precise method for showing venous leakage. AIMS: The objectives of this study were to compare results obtained from patients undergoing PCDU, and those undergoing cavernosography, and to investigate the diagnostic value of PCDU in the diagnosis. METHODS: A total of 133 patients who presented at the urology clinic due to ED have veno-occlusive dysfunction (VOD) detected as a result of PCDU and underwent cavernosography for further assessment when scheduled for penile embolization. The results obtained were retrospectively evaluated. RESULTS: The mean age of 133 patients with VOD identified as a result of PCDU was 48.7 ± 11.2 years. In cavernosography performed after PCDU, venous leakage was detected in 127 patients (95.49%), while no leakage was found in six patients (4.51%). Bilateral venous leakage was found in 91.34% (n:116), right venous leakage in 5.51% (n:7), and left venous leakage in 3.15% (n:4) of the patients with venous leakage. CONCLUSION: Evaluating the cavernosography results, PCDU alone is often sufficient to diagnose veno-occlusive ED. Cavernosography is a more invasive diagnostic method compared to PCDU that is adequate in cases where venous surgery or embolization is not considered, and cavernosography is not recommended in these patients.

Effects of mandatory salt iodization on breast milk, urinary iodine concentrations, and thyroid hormones: is iodine deficiency still a continuing problem?

PURPOSE: To investigate whether mandatory use of iodized salt in Turkey, since 1999 has sufficient effects on pregnant women and their newborns' urinary iodine concentrations (UIC), maternal and newborns' thyroid function tests and breast milk iodine concentrations (BMIC). METHODS: This cross-sectional analytical-type study was conducted in an obstetrics and gynecology hospital in Konya, Turkey. One hundred and seven pregnant women and their 107 full-term newborns were included into the study. Levels of pregnant women and their newborns' UIC, thyroid-stimulated hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin (Tg), and BMIC were studied. RESULTS: Of 107 women with term pregnancy, mean TSH value and hypothyroidism frequency were found as 2.34 ± 1.33 mIU/L and 18.7%, respectively. Cord blood TSH level was found higher (≥ 10 mIU/L) in five newborns. Accordingly, the incidence of transient congenital hypothyroidism was 4.7% (5/107). Tg levels were observed to be higher in 50.5% of newborns and 22.4% of pregnant women. Frequency of iodized salt use in pregnancies was detected as 96.3% in general population, 97.5% in urban, and 92.9% in rural areas. Of pregnancies and newborns, 57.9 and 53.3% were found to have deficient urinary iodine, respectively, and BMIC deficiency was detected as 52.0%. There was a significant positive correlation between pregnant women's UIC, and newborns' UIC and BMIC. CONCLUSIONS: Despite the effective struggle with iodine deficiency and salt iodination control program in Konya, we concluded that iodine deficiency still persists as a significant problem in pregnancies.

Restless legs syndrome and quality of life in chronic hemodialysis patients.

CONTEXT: Restless legs syndrome (RLS) is a sensorimotor disorder that often has a profound impact on sleep and one of the most troublesome conditions experienced in hemodialysis patients. Aims: The aim of study was to search frequency of RLS and effects of RLS on quality of life (QoL) in chronic hemodialysis patients. SETTINGS AND DESIGN: Chronic hemodialysis patients of classical hemodialysis units were chosen. Length of the study was approximately 1 year. SUBJECTS AND METHODS: Two hundred and thirty-seven patients were investigated. RLS was diagnosed using to international the RLS questionnaire. The International RLS (IRLS) rating scale was used to calculate RLS severity. QoL was assessed using the World Health Organization QoL brief version (WHOQOL-BREF) instrument. STATISTICAL ANALYSIS USED: Student's t-test, Chi-square test or Fisher's exact test, Bonferroni correction for multiple comparisons, and Pearson or Spearman correlation analysis were used. Significance level was P < 0.05. Results: The overall prevalence of RLS according to the four essential criteria was 18.6% (n = 44). According to IRLS, 22.7% of the patients with RLS were mild (n = 10), 63.6% were moderate (n = 28), and 13.7% were severe (n = 6). The parameters of QoL were compared in RLS-positive and negative patients. There was no significant difference in psychological health (P = 0.971), social relationships (P = 0.462), and environment (P = 0.483) between two groups. Only the physical health scores were higher in without RLS than patients with RLS (P = 0.027). CONCLUSIONS: This study revealed that the frequency of RLS among chronic hemodialysis patients is 18.6% and RLS leads to physical life quality disturbances.

Comparison of the body compositions in obese and nonobese individuals: Can learning body compositions motivate losing weight?

BACKGROUND: Obesity is one of the leading preventable causes of death worldwide. OBJECTIVE: To compare body compositions in obese and nonobese individuals. METHODS: This cross-sectional study constituted of 428 individuals. Body compositions were determined using the Tanita. RESULTS: Of all the participants, 300 (70.1%) were female. The prevalence of overweight and obesity was 30.8% and 47.7%, respectively. Having low educational level, female gender, not working, being married, and nonsmoker significantly increased more in obese than nonobese (P < 0.001). Total body water, visceral fat accumulation, body mass index, resting metabolic rate, fat-free mass, bone mass, and muscle mass were significantly higher in obese when compared to those with nonobese (P < 0.001). Thirteen percent of the participants were thinking of changing their diet and lifestyle to lose weight at the beginning. After learning their body compositions, the rate increased to 60% who decided to modify their lifestyle and asked for help to lose weight. This behavior change was significant in especially the overweighted participants (P = 0.025). CONCLUSION: The changes in body composition are associated with obesity and increased risk for certain cancers, cardiovascular disease, type 2 diabetes mellitus. Learning the health risks can motivate losing weight. Multicentered studies can be illuminating different cultural factors about obesity.

Evaluation of depression and quality of life in patients with obstructive sleep apnea syndrome.

BACKGROUND: Sleep fragmentation, repetitive hypoxemia during sleep, excessive sleepiness during the day, lack of concentration, memory loss, depression, decreased libido, and impotence are the characteristics of obstructive sleep apnea syndrome (OSAS) that may impair quality of life (QOL). This study aimed to investigate the QOL and factors that may affect QOL in people with different OSAS severity and without sleep apnea. METHODS: This was an analytical cross-sectional study. Polysomnography was performed on 200 people. Those detected as having nonapnea and mild-moderate-severe OSAS were administered the Epworth sleepiness scale, Beck Depression Inventory, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale. RESULTS: According to the apnea-hypopnea index, 36 people (18.0%) were in the nonapnea-hypopnea group, 28 (14.0%) in the mild OSAS group, 63 (31.5%) in the moderate OSAS group, and 73 people (36.5%) were in the severe OSAS group. Depression was present in 31 people (15.5%) who participated in the study. The nonapnea-hypopnea group comprised 12.9% of those with depression, mild OSAS group comprised 16.1%, moderate OSAS group comprised 22.6%, and severe OSAS group had 48.4% of the depressed subjects. Beck depression scores showed a significant positive correlation with the Epworth scale (t< 90% SaO2) (r = 0.285, P< 0.001 and r = 0.283, P< 0.001, respectively). The mean scores of WHOQOL-BREF subgroups' physical health (P < 0.001), psychological health (P < 0.001), social relations (P < 0.001), and the environmental area (P < 0.001) in those with depression were statistically significantly lower than those without depression. QOL was significantly associated with the presence of OSAS (P = 0.008). CONCLUSION: Decreased deep sleep duration, increased arousal index, and a high ratio of sleep duration with oxygen saturation below 90% to the duration of the entire sleep period increase daytime sleepiness and depressive symptoms in those with OSAS; thus, disrupting general health and QOL.

Multidrug-Resistant Bacterial Sepsis and Inferior Vena Cava Thrombosis in Liver Transplant Recipients Used Synthetic Vascular Graft: Three Fatal Cases.

Synthetic vascular grafts are commonly used in liver transplantation. Thrombosis is a possible complication of using expanded polytetrafluoroethylene (e-PTFE) grafts. Herein, we report on 3 cases of liver recipients who died of intermittent sepsis episodes emerged concurrently with the thrombosis in synthetic vascular grafts and inferior vena cava (IVC) vein. Right lobe liver transplantation from living donors was performed for 3 patients by using e-PTFE grafts between the liver and IVC. Although heparin had been administered, thrombosis was developed in vascular graft and IVC extending to the right atrium; it was developed within 1-4 months of transplantations. All 3 patients suffered from recurrent sepsis episodes (4, 5, and 6 attacks for each patient) by different multidrug-resistant bacterial species. Treatment attempts including thrombolytic and antimicrobial drugs made, and surgical, endoscopic and radiological interventions could not resolve the clinical situation. The patients died of septic complications. We concluded that severe recurrent sepsis attacks may develop in liver transplant recipients when IVC and synthetic vascular graft were thrombosed. Removing the e-PTFE graft may be benefit for the treatment.

Endoscopic treatment of biliary complications after living donor liver transplantation in a high volume transplant center in Turkey; a single-center experience.

BACKGROUND AND AIM: Biliary complications are an important cause of mortality and morbidity after living donor liver transplantation (LDLT). We present our endoscopic treatment results after LDLT as a single center with high volume. METHODS: Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) after LDLT between 2005 and 2015 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including need for percutaneous and surgical interventions. RESULTS: ERCP was performed in 446 (39.2%) patients with duct-to-duct anastomosis of 1136 LDLT patients. The most common biliary complication was stricture ± stone (70.6%, 315/446). Stricture and leak occurred in 60 (13.4%) patients. Only biliary leak was found in 40 (8.9%) patients. Our endoscopic treatment success rate in patients with biliary stricture after LDLT was 65.1%. Overall endoscopic success rates in our patients were 55.0% in patients with both leak and stricture, and only leak. In all, our percutaneous transhepatic biliary interventions (PTBI) and ERCP success rate was 90.6% in patients with biliary complications after LDLT. CONCLUSIONS: Endoscopic treatments are highly effective for biliary complications after LDLT. Effective use of percutaneous interventions in collaboration with endoscopic treatments significantly reduces the need for surgical treatment.

Telescopic Biliary Reconstruction in Patients Undergoing Liver Transplantation With 1-Year Follow-up.

BACKGROUND: Biliary complications are important during liver transplantation because of their effect on recipient and graft survival, incidence, and the long treatment period. These complications are associated with 50% morbidity and 30% mortality rates in recent studies. One of the most important reasons for biliary anastomosis complications is arterial ischemia. We present the results of our telescopic biliary anastomosis technique performed on the mucosa of the main biliary duct. PATIENTS AND METHODS: Fifty-six cases of telescopic biliary reconstruction were performed in 203 patients during 2015. Fifty cases and 52 patients who underwent standard reconstruction were chosen and compared. All patients had been scanned retrospectively. Statistical analyses were conducted with χ2 and Mann-Whitney U tests for the complications that occurred during the first 3 months. A P value <.05 was considered significant. RESULTS: No clinical or demographic differences were detected between the groups. About 90% of both groups were living donor liver transplantation cases. Five (10%) anastomotic leaks occurred in telescopic reconstruction group (n = 50), and 13 (25%) occurred in the standard reconstruction group (n = 52; P < .05). CONCLUSION: The arterial blood supply is better if the biliary anastomosis is made on the mucosal side of the main biliary duct. Early period anastomotic leaks may decrease significantly.

The frequency of smoking, quitting and socio-demographic characteristics of physicians of a medical faculty.

BACKGROUND: The aim of this study was to determine the epidemiology of smoking among physicians and to describe their socio-demographic characteristics. SUBJECTS AND METHODS: All professors, associate professors, assistant professors, lecturers and research assistants working for the Faculty of Medicine of Meram, University of Selçuk, were included in the study. Of the 500 subjects, 363 (72.6%) completed the anonymous questionnaire of the survey satisfactorily. The smoking status, age at smoking initiation, daily cigarette consumption and association between current smoking and socio-demographic variables, family characteristics and body mass index were examined. The SPSS software was used to tabulate the data. The chi-square test was used for statistical analysis. RESULTS: The mean age was 34.2 +/- 9.1 years. The rate of ever-smokers was 28.7% (n = 104). The rates of smoking in females and males were 13.4% (n = 15) and 35.6% (n = 89), respectively (p = 0.000). The rate of ex-smokers was 9.9% (n = 36). The rate of never-smokers was 61.4% (n = 223). The mean age at starting smoking was 21.7 +/- 4.9 years. The quit ratio was 25.7% (36/140) [23.3% (27/116) for men and 37.5% (9/24) for women]. Fagerstrom score was averaged 2.8 +/- 2.7 among all smokers. The rate of smoking in the families (p = 0.003) and among close friends (p = 0.000) of the smoker-group was higher than in non-smokers. CONCLUSION: In Turkey, prevalence of tobacco smoking is high among physicians though lower than the general community. This may compromise their role in tobacco control unless they quit smoking.

Retained Foreign Body in Transplanted Liver.

Liver transplantation is a technically complex and long surgical procedure. A large quantity of various materials such as catheters, sutures, needles and clips are frequently used during the procedure. These materials may enter in the liver from the vascular or biliary orifices inadvertently. A 50-year-old patient who had hepatic failure due to HBV underwent a deceased-donor liver transplantation. The deceased donor was a 75-year-old HbsAg(+) man. The recipient had subfebrile fever and leukocytosis post-operatively. A control computed tomography revealed a cuneiform ischemic area, and a foreign body inside the right anterior portal vein branch proximal to this ischemic region. A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery. Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation. Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver. As far as we know, such a complication of liver transplantation has never been described previously.

Effects of misoprostol on bone loss in ovariectomized rats.

This study was performed to investigate whether misoprostol (prostaglandin E1 analogue) (Cytotec, Searle, England) is effective for restoration of bone loss. Four-month-old parous female Sprague-Dawley rats (n = 30) were subjected either to bilateral ovariectomy (OVX, 24 rats) or to sham surgery (sham, 6 rats). The OVX rats were divided into four groups 60 days after the surgery. Six of them were killed, and dual-energy X-ray absorption (Norland xr-36, Norland Corporation, Fort Atkinson, WI, USA) measurements were performed, called pretreatment OVX group. The remaining groups (each had 6 rats) treated orally with 0 (control), 100, 200 micrograms/kg/day misoprostol for 60 days. All rats were killed 60 days after having treatment, and bone loss of the lumbar spine was measured by dual-energy X-ray absorption. The bone mineral density was decreased by 25.4% in control group and 23.6% in pretreatment group compared to sham group, but restored by 86% and 96% in groups treated with 100 and 200 micrograms/kg/day misoprostol, respectively. These results suggest that misoprostol restores bone loss in the lumbar spine of OVX rats in a dose-dependent manner.

Dural cavernous hemangioma originating from superior petrosal sinus.

Cavernous angiomas of the dura are rare and have been described in the literature particularly in the middle cranial fossa. We present a case of cavernous hemangioma of the middle cranial fossa arising from the superior petrosal sinus. In our review of the literature, this is the 2(nd) report describing a cavernous hemangioma in such a location.

Effects of caffeic acid phenethyl ester and epidermal growth factor on the development of caustic esophageal stricture in rats.

BACKGROUND/PURPOSE: An experimental study was performed to modify the healing response in caustic esophageal burns to prevent stricture development. Two different agents with different modes of actions, caffeic acid phenethyl ester (CAPE) and epidermal growth factor (EGF), were studied. CAPE has antiinflammatory, immunomodulatory, antioxidant, and antimitotic properties. EGF has known properties in supporting wound healing and in protecting esophagus from injuries. METHODS: The model described by Gehanno and its modification by Liu was used to create standard esophageal burns with 50% NaOH. The study was performed with 76 rats in 4 main groups (sham, CAPE, EGF, and control) and 2 subgroups in each for 5 and 28 days of observation. Efficacy of treatment was assessed in 28-day subgroups by measuring weight gain, contrast esophagograms on day 27, histologic evaluation by measuring stenosis index (wall thickness/lumen diameter), and collagen deposition, and biochemically by determining tissue hydroxy proline (OHP) content. RESULTS: In the end of the study, increase rates of mean body weights of the animals in the 28-day subgroups were as follows: sham, 30%; CAPE, 23%; EGF, 22%; and control, 14%. Although all the animals in subgroups significantly gained weight, the mean weight gain was significantly low in controls when compared with sham, CAPE, and EGF groups (P <.05). Contrast esophagograms on day 27 showed no stenosis in the sham, mild stenosis in CAPE and EGF, and severe stenosis with proximal dilatation in controls. Stenosis indices of the subgroups were as follows: sham, 0.29; CAPE, 0.41; EGF, 0.41; control, 0.84. Index was significantly higher in controls (P <.05). Collagen accumulation scores in the esophageal wall were as follows: Sham, 0.0; CAPE, 0.87; EGF, 0.30; control, 2.70. Scores also were significantly higher in controls (P <.05). Tissue (OHP) levels were as follows (mg/g dry tissue): Sham, 1.48; CAPE, 1.53; EGF, 1.90; control, 4.01. Production of OHP was significantly higher in controls. CONCLUSIONS: The results of the parameters in the study indicate that administration of CAPE and EGF has beneficial effects in the prevention of caustic esophageal strictures. Those effects of CAPE may occur through its antiinflammatory, immunomodulatory, and antioxidant properties, and EGF may occur through its induced proliferative properties on the esophagus.

Ectopic thymic tissue: a cause of emphysema in infants.

Ectopic thymic tissue can present a diagnostic dilemma when it is located in the posterior mediastinum. The diagnosis can be made by awareness of it and by use of computed tomography (CT) and magnetic resonance imaging (MRI). Rarely, ectopic thymus are reported to cause airway obstruction. In infants ectopic thymic tissue should also be considered in the differential diagnosis of secondary pneumonias and emphysema especially located in the upper lung zones.

Fistulisation of pyogenic liver abscess into the portal vein and bile ducts.

We report pyogenic liver abscess complicated by fistulisation into the portal vein and bile ducts in a 58-year-old diabetic woman, who was admitted to the hospital with fever, chills and rigors. Abdominal ultrasonography and computed tomography demonstrated a 7-cm multiloculated abscess in segment III, close to the left branch of the portal vein. The abscess was drained under fluoroscopic guidance in a single pass. Pus was aspirated, and diluted water-soluble contrast was injected into the cavity. Early films revealed filling of the cavity. Later, the contrast appeared in the bile ducts and left branch of the portal vein. Radiological intervention was discontinued. Immediate surgery, including left lateral segmentectomy, was performed. The preoperative course was uneventful, except for superficial surgical site infection. We opine that a hepato-venous fistula is an indication for surgical intervention, and that early resection of the fistula can prevent severe septic complications.

Biliary complications in 106 consecutive duct-to-duct biliary reconstruction in right-lobe living donor liver transplantation performed in 1 year in a single center: a new surgical technique.

OBJECTIVE: Biliary complications remain a major source of morbidity after living donor liver transplantation (LDLT). Of 109 consecutive right lobe (RL)-LDLTs performed in 1 year in our institution, we present the biliary complications among 106 patients who underwent a new duct-to-duct anastomosis technique known as University of Inonu. METHODS: Of 153 liver transplantations performed in 1 year from January to December of 2008, 128 were LDLTs including 109 RL-LDLTs. The others were left or left lateral grafts. All RL-LDLT patients were adults, all of whom except three included a duct-to-duct anastomosis. RESULTS: All, but three, biliary reconstructions were completed with a surgical technique, so called UI, in which 6-0 prolene sutures were used. Nine bile leaks were seen in 106 recipients (8.49%) performed in a duct-to-duct fashion in a time period of 1 to 4 weeks. Seventeen patients (16.03%) posed bile duct stricture (BDS). Five patients had both. Although endoscopic stent placement and percutaneous balloon dilatation, 4 patients continued to suffer from BDS on whom a permanent access hepatico-jejunostomy (PAHJ) procedures were performed. CONCLUSION: We recommend a duct-to-duct biliary reconstruction because of its de facto advantages over other types of anastomosis provided the native duct is not diseased. After almost 2 years, the bile tract complication rate was 22.64%.

Successful treatment of Buerger's Disease with intramedullary K-wire: the results of the first 11 extremities.

OBJECTIVE: This study describes a new technique for treatment of Buerger's disease, developed to stimulate angiogenesis, using a Kirschner wire placed in the medullary canal of the tibia. The aim of the study was to evaluate clinical and radiological effects of this technique in patients where medical and surgical therapy had failed. MATERIAL AND METHODS: Eleven extremities (six patients) with Buerger's disease were treated with the intramedullary Kirschner wire technique. Inclusion criteria were chronic critical ischemia, Rutherford Grade II or III, with major arterial occlusion shown by Doppler examination and angiography; failure to respond to non-surgical and surgical treatment; and the need for strong analgesics. RESULTS: The mean follow-up time was 19 months (range, 13-25 months). Satisfactory remission in each patient was obtained within 6 weeks of intervention. A significant improvement in clinical manifestations including reduced rest pain and increased claudication distance was observed. Foot ulcers completely healed after Kirschner wire intervention. CONCLUSION: Despite short-term follow-up and small patient series, the intramedullary Kirschner wire technique can be expected to achieve relief of pain and a decrease in major amputations in patients with Buerger's disease in whom medical and surgical therapy had failed. However, comparative studies with longer follow-up should be done to confirm the benefits of this new treatment.

The relationship between traumatic tympanic membrane perforations and pneumatization of the mastoid.

We evaluated the possible relationship between tympanic membrane perforations resulting from blast trauma or slap and pneumatization of the mastoid cells. A total of 25 male patients with tympanic membrane perforations resulting from blast injury (n = 7), slap (n = 17), and football hit (n = 1) and 20 healthy male volunteers without any ear problem had temporal bone computed tomographic scans in the axial plane, parallel to the infraorbitomeatal line, with 2 mm slice thickness and 2-mm intervals using bone algorithm with a ProSpeed Spiral tomography machine. The area of air cells in each slice was measured using trace and area measurement functions of the tomography machine, and by multiplying the resulting area by slice thickness, the volume of each slice was calculated. For each ear, the total of volumes of air cells was calculated by adding the volumes of each slice containing air cells. The calculated volumes of mastoid cells were evaluated by comparing microscopic findings. Both patient and control groups consisted of males, and their ages ranged from 17 to 32 (mean 24.5) years. Microscopic examinations revealed that perforations were frequently located in the lower quadrants and that most of them were less than 3 mm. There were no pars flaccida and marginal perforations. Ossicular chain destruction was noted neither in temporal bone tomographic nor during intraoperative examinations. The mean (+/- SD) volumes of right and left ear mastoid air cells in patient and control groups were 6.92 +/- 2.45 vs. 7.00 +/- 2.59 cm(3) and 9.04 +/- 4.55 vs. 8.95 +/- 4.53 cm(3), respectively, and the differences were not statistically significant. It was found that the level of mastoid pneumatization has no statistically significant effect on tympanic membrane pathologies due to blast or other injuries.

Ruptured intracranial aneurysm associated with isolated aortic arch interruption.

Interruption of the aortic arch is a very rare congenital defect consisting of discontinuity between the ascending and descending aorta. Few patients survive to adulthood, due to effective collateral arterial flow to the descending aorta. An intracranial aneurysm is reported in only one patient with aortic arch interruption. We report a 16-year-old boy with an isolated aortic arch interruption and a ruptured anterior communicating artery aneurysm.

Spinal pneumorrhachis.

The term pneumorrhachis refers to the presence of air in the spinal canal. There are only a few previously reported cases in the literature. A case of air within the cervical and lumbar subarachnoid spaces, and a second case of air within the cervical subarachnoid space due to traumatic pneumocephalus are presented in this study.