Impact of physician assistance on the reliability of the International Index of Erectile Function.

The aim of this study was to analyse the impact of assistance on the comprehensibility and reliability of the Turkish version of International Index of Erectile Function (IIEF). In this study, 458 patients were asked to complete the IIEF questionnaire by themselves during their first visit and then once again during their second visit with the assistance of a physician. The impact of physician assistance was evaluated by comparing the first and second questionnaires. The data were analysed using statistical package software (spss). A t test, Cronbach's alpha analysis, test-retest correlation (Pearson) and comparison of two rates between two independent groups test were used to analyse the impact of physician assistance. A P value <0.05 was considered to be significant. The proportions of the patients who completed the questionnaires were 70.9% and 100% at the first and second visit respectively. Physician assistance significantly increased the number of patients who completed the questionnaire among patients ≥ 60 years old (P = 0.0009) and in patients with low levels of education (P = 0.0001). The Cronbach's alpha coefficients were 0.782 and 0.917 for the first and second questionnaires respectively. A high degree of internal consistency was observed for the 'physician-assisted' questionnaire (P < 0.001), and relatively less internal consistency was found for the 'self-administered' questionnaire (P < 0.05) A relatively weaker correlation was found between the first and second questionnaires in primary school graduates (r = 0.391, P < 0.05) and in patients ≥ 60 years old (r = 0.433, P < 0.05). There was a significant difference between the 'self-administered' and 'physician-assisted' IIEF scores in patients ≥ 60 years old (P < 0.0001) and primary school graduates (P < 0.0001). Physician assistance increased the comprehensibility and reliability of the IIEF questionnaire, especially in elderly patients and in patients with low education levels.

Central corneal thickness and intraocular pressure relationship in eyes with and without previous LASIK: comparison of Goldmann applanation tonometer with pneumatonometer.

PURPOSE: To investigate central corneal thickness (CCT) and intraocular pressure (IOP) relationship in eyes with and without previous corneal laser refractive surgery and to compare the estimates of two different tonometers-Goldmann applanation and pneumatonometer. METHODS: The study population included 234 glaucoma suspects who were referred to the glaucoma clinic with cup/disc ratios greater than 0.4, asymmetric cupping, and/or IOP greater than 22 mmHg during routine eye examination. Of those, 84 had previous myopic laser-assisted in situ keratomileusis (LASIK) (Group 1) while 150 of them did not (Group 2). CCT was measured by using optical coherence tomography (OCT) and IOP with both Goldmann applanation tonometer (GAT) and pneumatonometer (PT). In both groups, the difference between IOP estimates of two different tonometers and the relationship between CCT and IOP were analyzed. RESULTS: In eyes with previous LASIK, GAT measured IOP significantly lower than PT (mean difference of 3.8+/-1.9 mmHg, p<0.0001). In eyes with virgin corneas, IOP estimates of GAT or PT were not different from each other (19.9+/-2.8 versus 19.9+/-2.2 mmHg, respectively, p=0.81). In both groups, there was a significant positive correlation between CCT and IOP estimates of GAT(R=0.29, p=0.007 in eyes with LASIK and R=0.38, p<0.0001 in those without), while no similar relationship was present between CCT with those of PT (R=0.03, p=0.76 in eyes with LASIK and R=0.03, p=0.69 in those without). CONCLUSIONS: In eyes with previous LASIK, GAT measured IOP significantly lower than PT. Because IOP estimates of PT were found to be independent from CCT in all of the study eyes, this device was considered to be a more reliable method of IOP estimation than GAT in eyes with and without previous LASIK.

Is leptin associated with diabetic retinopathy?

OBJECTIVE: In advanced stages of diabetic retinopathy, new blood vessels are formed based on undefined mechanisms. Recently, leptin was shown to possess an angiogenic action in vitro and to induce neovascularization in vivo. The aim of the present study was to investigate the relationship between plasma leptin levels and the severity of diabetic retinopathy. RESEARCH DESIGN AND METHODS: There were 70 patients with type 2 diabetes (age 47.9 +/- 9.7 years, BMI 26.4 +/- 3.3 kg/m2) who were seen in a retina outpatient clinic recruited and assigned to subgroups according to the stage of their diabetic retinopathy. There were 66 healthy volunteer subjects matched with the diabetic patients for age, BMI, and sex who served as control subjects (age 46.0 +/- 8.8 years, BMI 27.1 +/- 2.3 kg/m2). Fasting plasma leptin levels were measured. RESULTS: Plasma leptin level of the diabetic patients was not significantly different from the control subjects. In patients with proliferative diabetic retinopathy (n = 17), the mean plasma level of leptin (16.1 +/- 9.2 ng/ml) was significantly higher than that in patients with nonproliferative retinopathy (n = 20) (11.5 +/- 3.5 ng/ml, P = 0.039) or patients without retinopathy (n = 33) (5.8 +/- 3.7 ng/ml, P = 0.001). The mean leptin level in patients with nonproliferative diabetic retinopathy was also significantly higher than that in patients without retinopathy (P = 0.002). CONCLUSIONS: Our results show that the more advanced the diabetic retinopathy, the higher the plasma leptin levels, even after adjusting the leptin levels for BMI. The presence of such a positive correlation need not imply a causal relationship. Nevertheless, previously observed leptin-induced promotion of angiogenesis and neovascularization lends support to the possibility that leptin may play a role in the progression of human diabetic retinopathy to a proliferative phase. This possibility deserves further investigation.

Influence of scan radius correction for ocular magnification and relationship between scan radius with retinal nerve fiber layer thickness measured by optical coherence tomography.

PURPOSE: To investigate how optical coherence tomography (OCT) modifies the preset scan parameters to correct the errors resulting from ocular magnification, the influence of examiner's final correction of those already modified parameters on retinal nerve fiber layer (RNFL) thickness measurements, the induced change on RNFL thickness measurements and RNFL estimated integrals (RNFL(estimated integrals)) by adjusting the actual scan radius during RNFL examinations performed by OCT. METHODS: Thirty-five healthy patients underwent an RNFL examination by OCT four times using different scan radii. The first scan was performed with the preset circular scan diameter of 3.46 mm; the actual scan diameter was different, however, because it was modified by the OCT instrument. The second, third, and fourth scans were generated after readjusting the already modified scan diameter by the examiner to 3.46, 3.20, and 3.60 mm. The relationship of axial length and refractive error with the actual scan radius (with ocular magnification calculated by OCT), with the influence of the examiner's final correction on RNFL thickness measurements, with the relationship between scan radius with RNFL thickness measurements, and with RNFL(estimated integrals) were investigated. RESULTS: The actual scan diameter was found to be primarily determined by axial length (R = 0.97, P < 0.0001), but the influence of refractive error was small (R = -0.26, P = 0.067). Final correction of the actual scan radius by the examiner had a significant influence on RNFL thickness measurements (P = 0.025). RNFL thickness measurements obtained without correction of the actual scan radius for magnification were found to be inversely correlated with axial length (R = -0.54, P = 0.001), whereas no similar relationship was found when RNFL thickness measurements were obtained with correction (R = 0.21, P = 0.11). A reciprocal relationship between 1/scan radius with RNFL thickness measurements (they tended to be thinner as scan radii were increased) was found (R = 0.41, P = 0.169), but RNFL(estimated integrals) areas were found to be independent of the scan radius (P = 0.521). CONCLUSION: To increase the accuracy of RNFL thickness measurements, it will be appropriate for the examiner to manually correct the actual scan parameters to the desired or preset ones after their automatic modification performed by the OCT instrument. Keeping the actual scan radius constant for repeated exams is also recommended because RNFL thickness measurements were found to depend on scan size. Alternatively, RNFL(estimated integrals) could be used because they were found to be independent of the scan size.

Pigmented congenital vitreous cyst.

PURPOSE: To describe the clinical findings in a case with a typical pigmented congenital vitreous cyst and to discuss its differential diagnosis. METHODS/CASE REPORT: A 24-year-old woman complaining of floaters and blurring of vision during eye movements in the right eye was examined. RESULTS: A diagnosis of congenital vitreous cyst was made after detailed vitreoretinal examination, B-scan ultrasonography (eye and abdomen), computerized tomography of brain, chest radiogram, serologic tests for Echinococcosis and Cysticercosis in the serum, and complete blood count for eosinophilia. Clinical presentation and the patient's complaints remained unchanged during 3 years of follow-up. CONCLUSIONS: Congenital vitreous cysts are benign lesions. Differential diagnosis from acquired cysts requires careful clinical examination and appropriate laboratory tests.

Urinary tuberculosis in a two-year-old boy.

The authors describe a case of genitourinary tuberculosis hitherto unobserved in early childhood.

Staging error in the bladder tumor: the correlation between stage of TUR and cystectomy.

OBJECTIVES: Because tumor stage is very important in determining therapy, accurate staging of bladder cancer must be estimated. For this aim, we examined the stage of TUR and compared it with the stage of cystectomy. MATERIALS AND METHODS: From 1992 to 1999, operations were performed on 127 patients with local invasive bladder cancer. Eight cases (74 male, 6 female) underwent complete TUR of the tumor and then radical cystectomy. There was no residual macroscopic tumor after TUR in the bladder. The pathological staging of TUR and cystectomy were estimated and compared in these 80 cases. All pathologies were evaluated by the same pathology center. RESULTS: There was correlation in only 20 patients (25%; 15 were T1, 5 were T2) while there was global error and discordance in 60 patients (75%). All of these 60 cases were overstaging in cystectomy specimens and downstaging was not found in any case. Fifty per cent of 10 T1 tumors were T1, while 50% were T3a; 21.4% of T2 tumors were T2, 35.7% were T3a and 42.8% were T3b. CONCLUSIONS: The staging error of TUR in the bladder tumor may cause severe mistakes on deciding about radical surgery. However, although there was no understaging, which is more risky for false cystectomy indication, urologists must be careful about overstage/understage in the staging of TUR.

Ileal orthotopic neobladder in women: the first experiences from Turkey and our modifications.

UNLABELLED: The lower urinary tract reconstruction with an ileal neobladder in woman is not very often but has been recently introduced centers. We report 8 female patients with ileal orthotopic neobladders after cystectomy. PATIENTS AND METHODS: Between 1995 to 1999, 7 female patients with organ confined invasive bladder cancer and 1 female patient with severely contracted bladder secondary to tuberculosis were operated. While standard radical cystectomy was done in 7 patients with bladder cancer, only simple cystectomy was performed in patient with contracted bladder. Detubularized ileal W-neobladder with antirefluxive ureteroileal reimplantation were used as a procedure and reservoirs are connected to the proximal urethra in all patients. Cystoscopy and biopsy was done routinely in the bladder neck and there were no tumour and CIS in any patient. RESULTS: The mean age was 65.4 years (53-70) and the mean postoperative follow-up time was 31.8 months (6-48). There was no perioperative or early postoperative (first one month) mortality. Early postoperative complications included acute renal failure in I patient (12.5%), deep vein thrombosis in 1 patient (12.5%) and leakage from the pouch in 2 patients (25%). In one patient (12.5%), ileo-pouchal fistula was seen in sixth month and reoperated. Although there was not hypercontinence. one patient (12.5%) had totally incontinence. All other patients had normal micturition and no residual urine. Urethral recurrence was not seen in this postoperative follow-up period but pelvic recurrence and then distant metastases were found in one case (12.5%). CONCLUSIONS: The results of ileal orthotopic neobladder after radical or simple cystectomy in appropriate female patients are satisfactory. But certainly, we need the more experiences and studies about this subject.

Fracture of the penis.

Fracture of the penis is a rare condition. The fracture is easy to recognize but treatment remains controversial. Between December 1991 and January 1997, eleven patients underwent emergency operation on the first day after penile fracture. Our operative plan consisted of immediate exploration, identification, debridement and primary repair of the tear in the tunica albuginea. The patients' mean age was 27 years (range 21-38 yrs.). Penile fracture was due to sexual manoeuvres in 8, manipulation in 2 and fall onto erect penis in one of 11 patients. The mean hospitalization time was 2.2 days (range 1 to 3 days). There was no significant early postoperative complication except wound infection in one patient. In the first postoperative month, there was a residual fibrosis due to nonabsorbable sutures in one patient and mild pain during coitus in the other one. All patients had full erection and no patient needed additional treatment. To avoid serious complications and preserve penile functions immediate surgical intervention is recommended.

Immature germ cells in semen and their correlations with other semen parameters.

PURPOSE: The significance of the presence of leukocytes and immature germ cells in semen and other parameters of semen is currently a subject of controversy. MATERIALS AND METHODS: Semen from 572 subfertile patients was analyzed according to WHO criteria and leukocytes as well as immature germ cells were assessed by identifying the round cells in semen by peroxidase staining. Microbiological investigation was carried out in cases with leukocyte counts of >1,000,000/ml. RESULTS: It was found that as the concentration of spermatozoa decreased the rate of immature germ cells increased and this increase was accompanied by a decrease in motility and in the number of spermatozoa with normal morphology. As the sperm count increased, motility, number of spermatozoa with normal morphology and of immature germ cells also increased whereas an increase in sperm motility was accompanied by an increase in the percentage of spermatozoa with normal morphology. Microbiological investigations were negative in patients with semen leukocyte counts of >l,000,000/ml. CONCLUSIONS: Although it is possible to establish that the leukocyte and immature germ cell counts correlate with other parameters of semen, these correlations are not statistically significant. The most significant finding is that as the number of sperms decreases, the ratio of immature germ cells to total germ cells increases. While assessing immature germ cells instead of giving special attention to the number of immature germ cells in semen, the ratio of immature germ cells to total germ cells should be considered. The increase of leukocyte count in the semen of oligospermic patients may not always mean leukospermia.

Central corneal thickness and intraocular pressure relationship in eyes with and without previous lasik - Comparison of Goldmann applanation tonometer with pneumatonometer.

PURPOSE: To investigate central corneal thickness (CCT) and intraocular pressure (IOP) relationship in eyes with and without previous corneal laser refractive surgery and to compare the estimates of two different tonometersGoldmann applanation and pneumatonometer. METHODS: The study population included 234 glaucoma suspects who were referred to the glaucoma clinic with cup/disc ratios greater than 0.4, asymmetric cupping, and/or IOP greater than 22 mmHg during routine eye examination. Of those, 84 had previous myopic laser-assisted in situ keratomileusis (LASIK) (Group 1) while 150 of them did not (Group 2). CCT was measured by using optical coherence tomography (OCT) and IOP with both Goldmann applanation tonometer (GAT) and pneumatonometer (PT). In both groups, the difference between IOP estimates of two different tonometers and the relationship between CCT and IOP were analyzed. RESULTS: In eyes with previous LASIK, GAT measured IOP significantly lower than PT (mean difference of 3.81.9 mmHg, p<0.0001). In eyes with virgin corneas, IOP estimates of GAT or PT were not different from each other (19.92.8 versus 19.92.2 mmHg, respectively, p=0.81). In both groups, there was a significant positive correlation between CCT and IOP estimates of GAT (R=0.29, p=0.007 in eyes with LASIK and R=0.38, p<0.0001 in those without), while no similar relationship was present between CCT with those of PT (R=0.03, p=0.76 in eyes with LASIK and R=0.03, p=0.69 in those without). CONCLUSIONS: In eyes with previous LASIK, GAT measured IOP significantly lower than PT. Because IOP estimates of PT were found to be independent from CCT in all of the study eyes, this device was considered to be a more reliable method of IOP estimation than GAT in eyes with and without previous LASIK. (Eur J Ophthalmol 2005; 15: 81-8).

Color doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele.

OBJECTIVE: The standardization of diagnostic criteria for varicocele has not yet been established. This causes difficulty in evaluating both the incidence and clinical studies. Our aim was to establish diagnostic criteria for varicocele in Doppler procedures. METHODS: The characteristics of blood flow in the internal spermatic vein were investigated with color Doppler ultrasonography (CDU) and venous flow spectral analysis in 100 infertile men without clinical varicocele (group I), 100 infertile men with clinical left varicocele (group II), and 50 fertile men without clinical varicocele served as controls (group III). RESULTS: Three types of flow pattern were found in the spectral analysis of venous flow. If the venous flow was directed to the heart and did not change direction with an intra-abdominal pressure increase, it was classified as type I; venous flow directed to the heart, but changing direction with an intra-abdominal pressure increase, was classified as type II, and blood flow directed to the testicles and augmenting with an intra-abdominal pressure increase, was classified as type III. In group I, flow patterns were 39, 56 and 5% on the left side and 55, 42 and 3% on the right side for types I, II and III, respectively. In group II, flow patterns were 0, 35 and 65% on the left side and 61, 38 and 1% on the right side for type I, II and III patterns, respectively. In group III, the figures were 44, 54 and 2% for the left and 54, 46 and 0% for the right. Type II and III flow patterns were seen more frequently than type I in patients with clinical left varicocele (p<0.001). Whereas type I and II flow patterns were more common than type III in subjects without clinical varicocele (p<0.05). A type II flow pattern during normal breathing was seen at a lower rate in the control group than in the other groups (p<0.05). CONCLUSION: Spectral analysis of Doppler waves should be used in combination with CDU for the diagnosis of varicocele. Varicocele should not only be diagnosed with a type II flow pattern which occurs during valsalva. For the diagnosis of varicocele, the main criterion must be a type III pattern flow, as well as a type II pattern during normal breathing.