Effects of comorbidities associated with COVID-19 cases in Intensive Care Unit on mortality and disease progression.

OBJECTIVE: The patient's age, gender and the presence of certain concomitant diseases have been reported to play a part in the course and progression of COVID-19 in the literature. In this study, we aimed to compare the comorbidities causing mortality in critically ill Intensive Care Unit (ICU)-patients diagnosed with COVID-19. PATIENTS AND METHODS: The data as regards the COVID-19 cases followed up in the ICU were retrospectively reviewed. 408 COVID-19 patients with positive PCR test were included in the study. In addition, a subgroup analysis was performed in patients treated with invasive mechanical ventilation. While the primary aim of this study was to evaluate the difference in survival rates due to comorbidities in critical COVID-19 patients, we also aimed to assess the comorbidities in severely intubated COVID-19 patients in terms of mortality. RESULTS: A statistically significant increase in mortality was observed in patients with underlying hematologic malignancy and chronic renal failure (p=0.027, 0.047). Body mass index value in the mortal group was significantly higher in both the general study group and subgroup analysis (p=0.004, 0.001). CONCLUSIONS: Advanced age and comorbidities such as chronic renal failure and hematologic malignancy in COVID-19 patients are associated with poor survival prognosis in critically ill COVID-19 patients.

Urinary CXCL9 and CXCL10 Levels and Acute Renal Graft Rejection.

BACKGROUND: Monitoring of chemokines, CXCL9 and CXCL10, in serum may present a non-invasive detection method for rejection. OBJECTIVE: To investigate the relationship between urinary levels of CXCL9 and CXCL10 and graft function following renal transplantation. METHODS: 75 living-related donor renal transplant recipients were studied. Urinary levels of chemokines were collected pre-operatively, on post-operative 1st day, 7th day, 1st month, 3rd month, and at the time of rejection. Chemokines levels were assayed using and enzyme-linked immunosorbent assay. RESULTS: Clinical variables were monitored. 10 (15%) patients had biopsy-proven rejection during the follow-up period. The urinary CXCL9 level in those with rejection was significantly higher than that in those with non-rejection group at the 1st day (p<0.001), 7th day (p<0.001), and at the time of rejection (p=0.002). The urinary CXCL10 level was also significantly higher in those with rejection compared with non-rejection group at 1st day (p<0.001), 7th day (p<0.001), and at the time of rejection (p=0.001). Serum creatinine level was strongly correlated with the urinary CXCL9 and CXCL10 levels at the time of rejection (r=0.615, p=0.002; and r=0.519, p=0.022, respectively). Among those with T cell-mediated rejections the mean urinary CXCL10 level increased to as high as 258.12 ng/mL. CONCLUSION: Urinary CXCL9 and CXCL10 levels might have a predictive value for T cell-mediated rejection in early post-transplantation period. Measurement of urinary CXCL9 and CXCL10 levels could provide an additional tool for the diagnosis of rejection.

[Results of laparoscopic ureterolithotomy depending on the type of laparoscopic approach and location of the stone].

AIM: To investigate the results of laparoscopic management of patients with ureterolithiasis, depending on the type of laparoscopic approach and location of the stone. MATERIALS AND METHODS: This study is a retrospective analysis of 30 ureterolithiasis patients who underwent laparoscopic ureterolithotomy from 2010 to 2015. Patients were divided into four subgroups depending on the type of laparoscopic approach - transperitoneal (n=17) and retroperitoneal (n=13) and on location of stones - upper ureteral stone (n=20) and mid ureteral stone (n=10). The patients comprised 23 (76.7%) men and 7 (23.3%) women aged from 18 to 68 years (mean age 46.2+/-2.3 years). 15 patients had stones in the right and 15 in left ureters. The groups were comparable by sex, age, the severity of hydronephrosis, body mass index, duration of urolithiasis, comorbidities and previous surgeries (p>0.05). RESULTS: There were no deaths, conversion to open surgery or intraoperative complications. The only statistically significant difference between transperitoneal and retroperitoneal approaches was the absence of postoperative complications (p<0.05). The duration of drainage and hospital stay was significantly shorter in patients with mid ureteral stone than in patients with upper ureteral stone (p<0.05). CONCLUSION: Surgical management of patients with ureterolithiasis of various locations using laparoscopic ureterolithotomy by different approaches showed positive results of in all cases thus indicating high clinical effectiveness of this method.

[THE RESULTS OF LAPAROSCOPIC PARTIAL NEPHRECTOMY DEPENDING ON THE TYPE OF ACCESS AND THE TUMOUR SIZE].

Aim - retrospective comparative analysis of results of laparoscopic partial nephrectomy (LPN) depending on the type of access and the size of the tumor. The study included 170 patients undergoing LPN during the period from 2010 to 2015 years. Among the patients was 108 males (63.5%) and 62 women (36.5%) ranging in age from 17 to 80 years (average age 56,6±0.9 years). Depending on the type of access and the size of the tumor patients divided into 4 subgroups-154 patients who performed transperitoneal LRP, 16 patients undergoing retroperitoneal partial nephrectomy, 117 patients with tumor less than 4 cm and 53 patients with tumor more than 4 cm. There were no fatalities in 170 patients undergoing LRN, 3 (1.8±1.0%) patients had conversion, two of which involved open partial nephrectomy and one case involved radical nephrectomy. The duration of the surgery ranged 50-250 min (115.4±2.3 min on average), while time of insufflation ranged 40-240 min (103.8±2.2 min on average). Average intraoperative blood loss constituted 120.6±6.3 ml (15-400 ml), average time of warm ischemia was 22.01±0.83 min. Different intraoperative complications were observed in 4 patients (2.4%), in the postoperative period in 25 patients (14.7±2.7%). Patients spent 2-16 days (average 4.11±0.16 days) in the hospital after surgery. LRP can perform as transperitoneal а retroperitoneal approaches. The large size of kidney tumour, are not a contraindication for laparoscopic organ-preserving surgery and can successfully performed in experienced hands and specialized centres.

[Laparoscopic radical nephrectomy].

OBJECTIVE: Evaluation of retrospective results of treatment of patients with kidney cancer, who have undergone a laparoscopic or a retroperitoneoscopic radical nephrectomy. MATERIALS AND METHODS: We have conducted a retrospective analysis of 185 patients with kidney tumour, who have undergone a laparoscopic or a retroperitoneoscopic radical nephrectomy during 2010-2015. Amongst the participants there were 116 men (62.7%) and 69 women (37.3%) aged 29-86 (average age of 58.1 years). 150 patients (81.1%) have performed radical nephrectomy by transperitoneal access, while 30 patients (16.2%) experienced identical process through retroperitoneal access. 5 cases (2.7%) hybrid technique was utilized. 97 patients performed nephrectomy on the right side, 88 patients on the left side. 178 patients (96.2%) had a single kidney tumours, while 7 (3.8%) had multiple tumours ranging between 2-8. 15 patients, who experienced a laparoscopic radical nephrectomy, had a thrombus in kidney vein (level 1 under Mayo classification). 1 patient had a thrombus in vena cava (level 2). RESULTS: Only one of the patients suffered a fatal outcome. 12 patients (6.5%) had a conversion. The duration of operation ranged between 50-215 minutes (average of 104.3 minutes), time of insufflation ranged between 36-205 minutes (average of 96.2 minutes). Average intraoperative blood loss constituted 147.8 ml. Patients spent 2-18 days (average 4.1 days) in the hospital after the surgery. CONCLUSION: There is an obvious advantage to utilizing a laparoscopic or a retroperitoneoscopic intervention in order to treat kidney cancer. The process constitutes minimal invasiveness, low death rates, minimal intraoperative blood loss and fast rehabilitation of the patients. 72% of patients who have who have experienced surgical intervention, such as radical nephrectomy, spent only 3-4 days in the hospital.

Effect of Donor Nephrectomy Technique on Recipient Lymphatic Drainage.

AIM: We sought to evaluate the postoperative recipient lymphatic drainage depending on open donor nephrectomy (ODN) or laparoscopic (LDN) techniques. METHOD: Between March 2012 and August 2014, 58 patients underwent renal transplantation from living-related donors. Thirty donors underwent ODN (group 1), and 28 LDN (group 2). Operations were performed by the same surgeons. Both cranial and caudal drainage catheters for lymphatic leakage were placed preoperatively and all the recipients received tacrolimus, mycophenolate mofetil, and steroid as immunosuppressive regimen. None of the patients had coagulation abnormalities. RESULTS: All grafts were functioning during the early postoperative period and diuresis was ensured. No difference was observed on early postoperative period regarding to acute rejection (P = .329) or infection (P = .546). No difference was seen concerning mycophenolate mofetil and mycophenolate sodium regimens among the 2 groups (P = .227). In groups 1 and 2, the cranial drainage catheters were not taken out until postoperative days 5.5 ± 2.5 (range, 0-11) and 6.4 ± 3.8 (range, 0-14) and the caudal catheters stayed in place until days 8.8 ± 3.5 (range, 1-16) and 9.9 ± 5.9 (range, 3-22), respectively. No difference was found when comparing the cranial (P = .308) and caudal (P = .426) drainage periods. However, during clinical acute rejection episodes the cranial drainage period was longer in group 1 (P = .003). Three patients developed lymphoceles, 1 requiring drainage, in group 2. CONCLUSIONS: There seems to be no difference in recipient lymphatic drainage by donor nephrectomy technique. A laparoscopic procedure may be advantageous owing to shorter lymphatic drainage during clinical acute rejection episodes.

Association between genetic variants in glutathione peroxidase 1 (GPx1) gene, GPx activity and the risk of prostate cancer.

AIM: The aim of this study was to investigate the association between GPx1 Pro198Leu polymorphism with the development and progression of prostate cancer (PCa) and evaluate whether smoking status and advanced age could modify this association. METHODS: A total of 134 PCa patients and 159 healthy control subjects with serum prostate specific antigen (PSA) levels <4 ng/mL and normal digital rectal examination (DRE) findings were enrolled in this prospectively designed study. PCA patients were classified as low (T1 or T2 and N0M0 stages) and high stage disease (T3 or T4 and N0M0 or N1 or M1 stages). GPx1 Pro198Leu polymorphism was determined using polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP). Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Compared to the carriers of Pro/Pro genotype, subjects with the variant genotypes (Pro/Leu or Leu/Leu) had significantly higher risk of PCa. The Leu/Leu genotype was correlated with lower GPx activity among both controls and PCa patients. With respect to tumor stage, Leu/Leu genotype was more frequent in patients with high stage disease than those of low stage disease. In stratified analyses, although the variant Leu/Leu genotype was significantly associated with increased risk of PCa in older age, smoking did not alter this association. CONCLUSION: The present data provide evidence that GPx1 Pro198Leu polymorphism may be associated with the development and progression of PCa and older ages may influence the association.between GPx1 Pro198Leu polymorphism and PCa.

The most commonly altered type of Peyronie's disease deformity under oral colchicine treatment is lateral curvature that mostly shifts to the dorsal side.

The aim of the present study was to evaluate changes in clinical characteristics of Peyronie's disease (PD) patients under oral colchicine treatment in comparison with the initial clinical evaluation with a special emphasis on patients with altered deformity after treatment. A total of 118 patients under oral treatment with colchicine for at least 3 months in the acute phase of PD were retrospectively evaluated with combined infection and stimulation test. PD patients were followed up in four groups according to the clinical course of the deformity: improved, remained unchanged, deteriorated deformities or altered localisation of the deformity. Among 116 patients who completed the treatment, penile curvatures improved in 27.6% (n = 32), remained unchanged in 39.7% (n = 46) and deteriorated in 12.1% (n = 14) of the patients after a follow-up of 8.6 ± 3.2 (6-17) months, while localisation of the deformities changed in 20.7% (n = 24) of the patients. In this group, the initial side of the deformities were lateral, ventral, ventrolateral in 41.6% (n = 10), 29.1% (n = 7) and 8.3% (n = 2) of the patients and of hourglass and notching type (n = 4, 16.6%) respectively. Six (60%) patients with lateral, five (71.4%) with ventral curvatures completed their follow-up period with dorsal curvatures. In conclusion, lateral curvature is the most commonly altered deformity that mostly shifts to the dorsal sise of the penis after colchicine therapy.

Microscopic venous invasion is associated with disease free and cancer free survival in renal cell carcinoma.

AIM: The aim of this study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC). METHODS: The present study included 220 patients with non-metastatic RCC who underwent radical nephrectomy (RN). MVI was defined by the presence of a cancer cell in blood vessels based on microscopic examination of hematoxylin-eosin stained specimens. The impact of MVI on disease progression and survival after 37 (6-190) months of median follow-up and its correlation with known clinicopathological features were studied. Survival analyses using Kaplan-Meier and log-rank models for univariate comparisons and Cox proportional hazards model for multivariate analyses were performed. RESULTS: MVI was found in 68 patients (30.8%), and of these, 26 (38.2%) developed a tumor recurrence and 16 (23.5%) died of cancer progression, whereas only 18 (11.8%) of the remaining 152 patients without MVI presented with disease-recurrence and 8 (5.3%) died of cancer. In the multivariate analysis, MVI (P=0.014) Fuhrman's grade (P=0.028), and sarcomatoid differentiation (SD) (P=0.01) were the factors predicted a decreased disease-free survival (DFS). Meanwhile, MVI (P=0.04) and SD (P=0.029) were also found to be predictor of cancer specific survival (CSS) with necrosis (P=0.037) in multivariate analysis. CONCLUSION: The present study showed that MVI is associated with the vast majority of the adverse pathological features related with RCC. Furthermore, it was found to be an independent clinical prognostic factor for DFS and CSS.

Multiple variations of the abdominal aorta in a single cadaver.

Numerous variations of the abdominal aorta were observed during a routine dissection of the abdominal region in a 60-year-old male cadaver in the Department of Anatomy, Meram Faculty of Medicine, Selcuk University, Turkey. In the present case, a common inferior phrenic trunk arose from the abdominal aorta and then divided into two branches. The left gastric artery arose from the front of the abdominal aorta, with an accessory right hepatic artery arising from the superior mesenteric artery. Although the single right renal artery originated from the abdominal aorta, double left renal arteries were found to originate from the abdominal aorta. Knowledge of these variations could help surgeons to identify and protect the abdominal aorta during surgery.

TGF-beta1 neutralizing antibodies decrease the fibrotic effects of ischemic priapism.

The objective of this study was to evaluate the possible role of transforming growth factor beta 1 (TGF-beta1) antibodies (ab) for the prevention of fibrotic effects of priapism in a rat model. In total, 30 adult Sprague-Dawley rats were divided into five groups. Priapism with 6 h (group 1), priapism with 6 h+ab (group 2), priapism with 24 h (group 3), priapism with 24 h+ab (group 4) and control (group 5). Priapism was induced with a vacuum erection device and a rubber band was placed at the base of the erect penis. At 1 h after the initiation of priapism, TGF-beta1 antibodies were given intracavernosaly. All rats underwent electrical stimulation of the cavernous nerve after 8 weeks. Intracavernous and systemic blood pressures were measured during the procedure. Rats in group 1 showed significantly higher (intracavernosal pressure (ICP) pressures to cavernous nerve stimulation and had higher ICP/BP ratios when compared to other groups. Similarly, histopathologic examination revealed less fibrosis in group 2, compared with the other groups. Consequently, TGF-beta1 antibodies antagonise the fibrotic effects of TGF-beta1, especially in cases with duration of priapism less than 6 h.

Incidentally diagnosed Peyronie's disease in men presenting with erectile dysfunction.

The aim of this study was to analyze characteristics of patients with Peyronie's disease (PD) diagnosed during a standard evaluation for erectile dysfunction (ED) and compare them with patients presenting with the classical complaints of PD. During a 10-y period, a total of 448 patients were evaluated at our two outpatient clinics, directed by the same author (AK). They were divided into two groups: group I consisted of patients, who presented with only ED and were unaware of their penile deformity, and group II consisted of patients with the classical features of the disease. The clinical characteristics, penile deformities, erectile status and the presence of comorbidities were determined in the two groups. Of 448 Peyronie's patients, 16% (n=71) were detected during diagnostic work-up for ED. In this group of patients, ED was the presenting symptom for a mean period of 31.3+/-9.7 months. The mean age of men was 57.54+/-8.75 and 52.21+/-10.27 y in groups I and II, respectively (P=0.0001). The mean degree of deformity was 31.5+/-12.66 degrees in group I and 41.16+/-19.14 degrees in group II (P=0.0001). In group I (n=71), 69% (n=49) of the patients had a poor erectile response to the combined injection and stimulation (CIS) test. Also, in this group, the mean degrees of deformity in CIS-positive and -negative patients were 27.05+/-12.50 and 33.80+/-12.03 degrees , respectively (P=0.033). Diabetes mellitus (40%) was the leading comorbidity in group I, while at least one comorbidity was observed in 73% of the cases (P=0.001). A remarkable percent of Peyronie's patients (16%) were detected during a standard evaluation for ED. This study analyzed, for the first time, the frequency and the characteristics of incidentally diagnosed Peyronie's patients who presented with only ED. Our data indicate that one should always consider the possibility of PD in older patients with diabetes, presenting with only ED.

Does sexual dysfunction correlate with deterioration of somatic sensory system in diabetic women?

To evaluate genital and extragenital somatic sensory system in diabetic women using biothesiometry and investigate the relation with sexual dysfunction. A total of 30 diabetic women and 20 normal sexually active women as a control group were evaluated with a detailed medical and sexual history including Index of Female Sexual Function (IFSF) questionnaire. Somatic sensory system of all women enrolled to the study was assessed by biothesiometry and threshold sensory values of nine genital sites and 14 extragenital sites were analyzed. The IFSF score in diabetic women was 23.6 while it was 38.3 in the control group (&<0.0005). For each genital as well as extragenital sites, the mean biothesiometric values were significantly higher in diabetics. The sensation of introitus vagina, labium minora and clitoris were found to be the most deteriorated genital sites in diabetic women. The difference between diabetic women with or without female sexual dysfunction (FSD) was not significant for biothesiometric values. Our data indicate that, somatic sensory system is affected by diabetes however sexual dysfunction does not always manifest.