Roles of beta2-adrenergic receptor gene polymorphisms in a Turkish population with obstructive sleep apnea syndrome or obesity.

We determined the distribution of the Arg16Gly and Gln27Glu polymorphisms of the beta-2 adrenergic receptor gene (ADRB2) in patients with obstructive sleep apnea syndrome as well as a control group in Northeastern Turkey. A total of 52 patients diagnosed with obstructive sleep apnea in a sleep laboratory and 78 control subjects were examined. Peripheral blood samples were taken from patients diagnosed with obstructive sleep apnea by polysomnography. DNA was extracted from blood samples and amplified using polymerase chain reaction. Amplification products were digested with restriction enzymes to investigate gene polymorphisms. Restriction products were extracted from agarose gel electrophoresis and polymorphisms were analyzed using gel images. The Arg16Gly polymorphism was observed in 18 of 52 patients and in 23 of 78 controls. The Gln27Glu polymorphism was observed in 21 of 52 patients and in 28 of 78 controls. In conclusion, there was no correlation among polymorphic frequencies between patient and control groups. Based on the results, these polymorphisms do not contribute to the clinical diagnosis of this syndrome. However, the distribution of Arg16Gly vs Gln27Glu polymorphisms may contribute to obesity in patients with a body mass index greater than 30 (P < 0.05). Different results may be obtained if the parameters of obstructive sleep apnea disease are changed.

Novel clues for ultrasonographic diagnosis of reflux in pregnant women: a pilot study.

The aim of the present study was to define some novel radiological clues that may aid in the ultrasonographic diagnosis of gastroesophageal reflux in pregnant women. A total of 84 pregnant women, consisting of 42 reflux patients and 42 controls were included in the study. Reflux and control groups were compared in terms of age and our novel ultrasonographic landmarks related to oesophageal structure. While the two groups did not differ in terms of age, they were significantly different from each other with respect to: single layer, single wall oesophageal thickness; double layer, double wall oesophageal thickness; oesophageal hiatal diameter; perioesophageal fat pad thickness; hypoechogenic single wall muscularis mucosa and lamina propria thickness. Owing to our newly defined radiological clues, ultrasonography may have a 'greater than expected' role in the diagnosis of gastroesophageal reflux in pregnant women. However, further studies must be performed to document the actual diagnostic potential of these radiological tips.

Endovenous 1470 nm laser treatment of the saphenous vein: early report of pain assessment.

AIM: The aim of the paper was to evaluate the rate of postoperative pain by using endovenous laser ablation with wave-length of 1470 nm for incompetent saphenous veins in our single center experience. METHODS: A non-randomized prospective trial was performed. Patients with symptomatic varicose small saphenous vein and great saphenous vein were considered suitable for endovenous laser ablation. The VenaCure EVLT™ (Angiodynamics, Queensbury, NY) generator was used to provide laser energy (1470 nm emission wavelength). Pain was assessed on the 7th days, 1st months, 3rd months, and 6th months using a visual analog scale rating of 0 cm (no pain) to 10 cm (worst imaginable pain). RESULTS: Of the 30 patients who eventually underwent endovenous laser ablation, 14 underwent bilateral treatment. Totally, 44 treated legs were scored. When questioned by using a visual analog scale pain score of 0-10, patients, on average, graded their pain 3.86 ± 1.04 at admission, 2.83 ± 0.91 at 1 week, 1.46 ± 0.63 at 1 month, 0.63 ± 0.49 at 3 months, and 0.07 ± 0.25 at 6 months. No major complication occurred, and there was no deep venous thrombosis or pulmonary embolism nor skin ulceration. CONCLUSION: Endovenous laser ablation for chronic venous insufficiency with a 1470-nm diode laser appears to be effective and safe. The procedure is simple to perform, well accepted by patients and relatively atraumatic.

Post-contrast FLAIR imaging in a patient with posterior reversible encephalopathy syndrome (PRES).

We herein present a case of delayed enhancement of CSF on fluidattenuated inversion recovery (FLAIR) imaging in a patient with posterior reversible encephalopathy syndrome (PRES). In our case despite the settled clinical setting of PRES initial MR scan was negative and on repeated FLAIR imaging increased CSF signal intensity was more conspicuous than subtle cortical involvement.

Evaluation of normal appearing white matter in multiple sclerosis: comparison of diffusion magnetic resonance, magnetization transfer imaging and multivoxel magnetic resonance spectroscopy findings with expanded disability status scale.

PURPOSE: The aim of this study was to determine diffusion magnetic resonance imaging (MRI), magnetization transfer (MT) imaging and multivoxel MR spectroscopy findings in plaques, periplaque white matter and normal appearing white matter (NAWM) regions in multiple sclerosis (MS) and to correlate the findings with the expanded disability status scale (EDSS). METHODS: A total of 30 patients with MS and 30 healthy control subjects were studied and apparent diffusion coefficient (ADC) values, MT ratio (MTR), N-acetyl-aspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr) ratios were measured in plaques, periplaques and NAWM regions and compared with the control subjects. RESULTS: The MTR and NAA/Cr ratio were decreased more in plaques than periplaques and NAWM, in contrast ADC values and Cho/Cr ratios were highest in plaques and higher in periplaques than in NAWM. Decreased MTR and NAA/Cr in NAWM demonstrated moderate inverse correlations (r = - 0.604, p < 0.001 and r = - 0.494, p < 0.001, respectively) while Cho/Cr ratios and ADC of NAWM demonstrated weak linear correlations (r = 0.370, p = 0.004, r = 0.297, p = 0.021 respectively) with EDSS. CONCLUSIONS: The MS, MTR and MR spectroscopy findings were found to be useful for detecting subtle abnormalities in NAWM. Although ADC values were significantly altered in plaque and periplaque regions a significance difference was not found in NAWM.

Intracranial hemorrhage in Kimura's disease: coincidence or consequence?

OBJECTIVE: To report an unusual case of Kimura's disease associated with intracranial hemorrhage, the first such report in the literature. CASE REPORT: A 38-year-old man presented with chronic neurological disorders and a 10-year history of left cervical soft tissue swellings. Magnetic resonance imaging (MRI) of the cranium showed a subacute/chronic hematoma in the left occipitotemporal lobe and a chronic infarct in the right parietal lobe. Cervical computed tomography (CT) and MRI showed multiple masses on the left side of the neck and parotid gland. Histopathologic examination revealed lymphocyte and eosinophil infiltration, proliferation of hyalinated blood vessels, and interstitial fibrosis. Steroid therapy (2 mg/kg per day) was started and the lesions regressed partially. The masses and some enlarged regional lymph nodes were resected. CONCLUSIONS: Intracranial hemorrhage can either be a coincidental finding or complication of Kimura's disease. MRI and CT are effective modalities in radiologic diagnosis of this condition.

Effects of sildenafil on ocular perfusion demonstrated by color Doppler ultrasonography.

The aim of this study was to investigate the effects of sildenafil on ocular hemodynamics by color Doppler ultrasonography (CDU). In all, 38 patients with erectile dysfunction diagnosed by International Index of Erectile Function (IIEF) and Sexual Health Inventory of Men (SHIM) scores were included into the study. After taking 100 mg of oral sildenafil citrate, all patients underwent CDU examination of central retinal artery at 60 and 75 min and CDU examination of cavernosal artery at 20, 60 and 75 min. All of the side effects during and after the test were also recorded. The mean cavernous artery peak systolic flow velocity increased significantly after sildenafil. However, no significant change was determined in central retinal artery flow parameters including peak systolic flow velocity, end-diastolic flow velocity, resistive index, pulsatility index, volume and diameter. Five patients experienced ocular side effects. No significant change was observed in retinal artery CDU measurements of patients having ocular side effects. Sildenafil has no effect on ocular hemodynamics on the basis of CDU. Ocular side effects may be the result of other changes in retinal photoreceptors rather than the ocular circulation.

Sexual dysfunction in male patients on hemodialysis: assessment with the International Index of Erectile Function (IIEF).

In this study we determine the sexual problems and the prevalence of erectile dysfunction (ED) in male hemodialysis patients by means of the International Index of Erectile Function (IIEF). A total of 187 male patients were included in the study. All of the patients who underwent hemodialysis were asked to complete the IIEF questionnaire. The IIEF domain scores were calculated and erectile dysfunction grading was determined on erectile function domain. Patients were also asked to report whether they had disclosed their sexual problems to physicians or not.The mean age was 49.3+/-13.2 y and the duration of hemodialysis was 38.1+/-8.4 months. By means of the IIEF, the prevalence of erectile dysfunction of any degree was 80.7%. The prevalence of any ED for the patients <50 y and >or=50 y was 74.5% and 86.6%, respectively. The prevalence and the severity of ED was significantly higher in patients >or=50 y. The frequency of intercourse attempts during the last four weeks was 1-2 in 130 (69.5%) of patients. Only 1% of patients disclosed their erectile problems and sought medical assistance prior to our study.Erectile dysfunction is highly prevalent in hemodialysis patients. The prevalence and the severity of ED increased with age. Evaluations for ED should be included in routine assessment of hemodialysis patients.

Efficacy and safety of sildenafil for treating erectile dysfunction in patients on dialysis.

OBJECTIVE: To assess the efficacy of sildenafil for erectile dysfunction (ED) in patients on haemodialysis (HD) or peritoneal dialysis (PD), as men with end-stage renal disease (ESRD) often have sexual dysfunction (up to 82% among those on chronic dialysis). PATIENTS AND METHODS: Forty-one patients with ED and in ESRD participated in an open-label prospective study. Thirty patients on HD and 11 on PD were asked to complete the International Index of Erectile Function (IIEF) and Fugl-Meyer life-satisfaction scale before and after sildenafil treatment. A total score in the erectile function domain of < or = 25 was accepted as indicating ED. All patients were started on a 25-mg dose, which was increased to 50 mg if there was no response after two trials. In addition, the overall efficacy question was used to evaluate satisfaction, and patients reported any side-effects during treatment. RESULTS: The erectile function and intercourse satisfaction domains improved significantly in both groups (P < 0.01). After sildenafil treatment, two-thirds of those on HD (20/30) and nine of the 11 on PD recovered their erectile function. The pretreatment scores on the IIEF and four domains (except sexual desire) of those responding were significantly higher than in those not responding (P < 0.05). The satisfaction rate on the overall efficacy question was 80% and 82% for the HD and PD groups, respectively. At least one side-effect was seen in 17 patients (43%); one had severe hypotension in the PD group. Overall, mild headache (seven patients, 18%) and flushing (12, 30%) were reported most often. CONCLUSIONS: Sildenafil is a safe and satisfactory drug for improving erectile function in patients with ESRD. Patients were satisfied whether treated by HD or PD. Pretreatment scores on the IIEF may be useful for predicting the success of treatment.

Recovery period of the bladder after exposure to soluble virulence factor produced by Escherichia coli.

OBJECTIVES: This study was designed to determine the time interval required for the recovery of the bladder after exposure to soluble virulence factor (SVF) in an animal model. In addition, we aimed to determine the changes in the epithelium during the recovery period. METHODS: A total of 46 male New Zealand rabbits were used in this study. Sterile human urine was infected with Escherichia coli type O6 to obtain supernatant, which would contain SVF, but no bacteria. Rabbits were assigned to one of three groups comprising the supernatant urine group (SUG) and controls, respectively. Sterile human urine and supernatant urine were instilled to controls and SUG, respectively. Bacterial inoculation with E. coli was performed 1, 24 and 72 h after initial instillation. Histopathologic and microbiologic analyses were performed on these animals. RESULTS: In SUG bacterial colonization was significantly higher than in controls 1 and 24 h after exposure to supernatant. Histopathologic analysis confirmed this finding. Histologic changes were most pronounced 1 hour after instillation of supernatant. A moderate degree of recovery was noted at 24 h, and complete recovery was seen at 72 h. CONCLUSION: Bacterial growth is potentiated by SVF-induced impaired bladder mucosa until the repairing process has been completed. During this time interval, SVF enables the colonization and growth of E. coli and other bacterium species that may result in sustained bacterial presence and recurrent infection.

A new method for the evaluation of erectile dysfunction: sildenafil plus Doppler ultrasonography.

PURPOSE: Of the various methods of hemodynamic studies performed to evaluate erectile dysfunction penile color Doppler ultrasound is currently considered the best. However, intracavernous injection is invasive and has adverse effects, such as prolonged erection. We evaluated whether sildenafil may be used as a substitute for intracavernous agents when assessing impotence on color Doppler ultrasound. MATERIALS AND METHODS: A total of 42 patients with erectile dysfunction underwent color Doppler ultrasound before and after intracavernous injection of 60 mg. papaverine with genital and audiovisual sexual stimulation. Peak flow and end diastolic velocity were measured in the recorded waveforms obtained 0, 1, 5, 10 and 20 minutes after injection. The patients also underwent color Doppler ultrasound after a 50 mg. oral dose of sildenafil with genital and audiovisual sexual stimulation not before 3 days after the papaverine study. The same parameters were measured at 30, 45, 60, 75 and 90 minutes, and compared with the values obtained after papaverine injection. RESULTS: Mean peak flow velocity significantly increased after oral sildenafil starting at 30 minutes and achieving a maximum value at 60 minutes. There were no significant differences in the 2 methods in mean peak velocity 1, 5, 10 and 20 minutes after papaverine injection, and 30, 45, 60, 75 and 90 minutes after oral sildenafil administration. Penile color Doppler ultrasound with intracavernous papaverine injection is accepted as the gold standard but color Doppler ultrasound with sildenafil has 90% sensitivity and 100% selectivity for demonstrating arterial insufficiency. Due to prolonged erection 5 patients (11.9%) in the papaverine group required pharmacological detumescence by intracavernous injection. No adverse effects of sildenafil were observed. CONCLUSIONS: Sildenafil administration achieved increased peak flow velocity comparable to that after intracavernous papaverine injection. With no prolonged erection sildenafil emerges as a safer alternative compared to more invasive intracavernous injection.

Concealed penis: rare complication of circumcision.

A man presented with a concealed penis which developed after circumcision. In addition to anatomic variations in penile skin attachment and obesity, circumcision is an iatrogenic cause in the etiology of a concealed penis. Although it is a frequent and simple operation, it may lead to uncommon complications due to a lack of experience and poor technique.

Renal cell carcinoma with gallbladder metastasis.

The nature of polypoid masses within the gallbladder is difficult to define preoperatively. Tumors larger than 1 cm in size are strongly related to malignancy, but they are not always primary tumors of the gallbladder. We present a patient who underwent radical surgery for renal cell carcinoma and the preoperative finding of a polypoid mass within the gallbladder turned out to be a metastatic lesion.

Significance of serum laminin P1 values in patients with transitional cell carcinoma of the bladder.

OBJECTIVES: The goal of this study was to investigate the relation between serum laminin P1 expression and the grade, stage, size, and multiplicity of the tumors to elucidate the potential role of laminin as a diagnostic and prognostic factor in transitional cell carcinoma (TCC) of the bladder. METHODS: Serum concentration of laminin P1 was measured by radioimmunoassay in 38 patients with TCC of the bladder and compared with the serum laminin P1 values obtained from 34 healthy control subjects. Patients were grouped according to their tumor stage, grade, size, and multiplicity to compare the serum laminin P1 values. RESULTS: The mean serum laminin P1 level in the patient group was statistically higher than the controls (P = 1.3 x 10(-8); with the destruction of basement membrane (stages pT1 or greater), a significant increase in the serum value was observed (P = 0.00023). Laminin level was found to be positively related to the tumor size and number; however, no correlation was observed with the grade. In tumors invading the lamina propria and beyond, the sensitivity of laminin P1 was 78.9% and specificity was 97.1%. The positive and negative predictive values of laminin P1 were 93.7% and 89.5%, respectively. The patients whose serum laminin P1 levels were above the upper limit of normal (1.6863 U/mL) were found to have a higher recurrence rate (72%) than the patients who had lower serum values in the control cystoscopies performed 3 months after the first admission (P < 0.01). CONCLUSIONS: Serum laminin P1 seems to be a valuable adjunctive marker to predict tumor invasion and recurrence. This warrants further research.

Bellini duct (collecting duct) carcinoma of the kidney.

Bellini duct (collecting duct) carcinoma of the kidney is a rare entity often misinterpreted as renal or transitional cell carcinoma on histologic examination. Immunohistochemical identification of specific antigens is needed for the differential diagnoses. We describe a case of Bellini duct carcinoma that arose from the collecting ducts of Bellini and was treated with aggressive surgery and interferon-based immunochemotherapy.

Sequential bilateral germ cell tumours of the testis.

Bilateral germ cell tumours of the testis are rare but a rise in their incidence is expected since with the new therapeutic possibilities a significant improvement in prognosis has been achieved even in patients with advanced metastatic spread. Of the 210 patients treated for malignant germ cell tumours at our Department, six (2.9%) developed a contralateral testicular tumour. All patients had metachronous tumours and the second tumours occurred after an interval ranging between 1 and 22 years. The epidemiology, histology, diagnosis, therapy and prognosis are discussed, and the significance of regular self-examination of the remaining testis in patients with testicular tumour is emphasized.

Postchemotherapeutic surgery for metastatic testicular germ cell tumors: results of extended primary chemotherapy and limited surgery.

OBJECTIVE: Postchemotherapy surgery has become an increasingly important treatment for residual masses in germ cell tumors of the testis. However, it is still a challenge to find the optimal combination of chemotherapy and surgery for better survival and cure rates with lowest morbidity. This study evaluated the effectiveness of extended chemotherapy followed by surgery resecting only the residual masses. METHODS: After an extended course (one or two additional courses after there is no decrease in tumor size and/or after the normalization of tumor markers) of combination chemotherapies with cisplatin-based regimens, 32 patients underwent surgery for metastatic germ cell tumors of the testis. Complete excision of radiologically determined residual masses and macroscopically suspicious neighboring nodes was performed rather than a conventional retroperitoneal lymph node dissection. RESULTS: Histopathologic examination of the resected specimens revealed teratoma in 17 (55%), fibrosis and/or necrosis in 9 (26.5%), and active residual tumor in 8 (23.5%) of the patients. The patients with residual tumor have been treated with additional chemotherapy. In the follow-up (mean, 28.5 months) 4 patients have relapsed, and 1 died. None of the patients with residual teratomas have shown relapse. Only 1 of the 32 patients has had retrograde ejaculation. CONCLUSIONS: A more conservative approach, such as excision of the residual masses after an extended course of chemotherapy, has given excellent results both in the outcome of the patients in the follow-up and in the rate of retrograde ejaculation. We therefore suggest that this approach would be a good alternative to nerve-sparing surgery following chemotherapy.

Are obstructing ureteral stones more difficult to treat with extracorporeal electromagnetic shock wave lithotripsy?

In situ extracorporeal shock wave lithotripsy (ESL) has increasingly become accepted for the treatment of ureteral stones. However, treatment success is negatively affected by stone impaction or associated urinary obstruction. In order to assess the impact of obstruction on the outcome of in situ ESL, we reviewed the results in 503 patients treated in this way. The presence and severity of urinary obstruction was defined prior to ESL, being classified as no or mild obstruction (Group I) and moderate or severe obstruction (Group II). The stone-free rate in the nonobstructed group was 90%, whereas it was 85% in the obstructed group (P > 0.005). While all of our patients were treated on an outpatient basis, two patients in Group I and four patients in Group II required hospitalization with the diagnosis of pyelonephritis. All six patients were treated successfully with appropriate measures. No other serious complication occurred that required hospitalization. We conclude that urinary obstruction does not affect stone disintegration or passage and suggest that in situ ESL should be the treatment of choice in ureteral stones.