Comparison of serum concentration of Ca, P, Mg, and Fe between hemifacial spasm patients and healthy controls; prospective randomized controlled study.

PURPOSE: In this study, we aimed to measure the serum vitamin D level in hemifacial spasmic (HFS) patients and show the role of HFS in the pathogenesis and place in etiology. MATERIALS AND METHODS: This study included 43 prospective newly diagnosed HFS patients and 43 healthy volunteers in the neurology clinic. The serum (Ca, P, Mg, Fe) concentration of 4 essential elements was measured with a biochemical device. The groups were correlated in terms of four essential element concentrations. The severity of the disease was measured using Lee's Quality of Life Scale and correlated with the concentration of four trace elements. The results were compared using the independent t-test and Mann-Whitney U-test. RESULTS: Concentration of serum Ca, P, and Mg in the HFS patients was found to be lower in the control group which was statistically significant (P < 0.05). There was no statistically difference between the groups in terms of Fe concentration (P > 0.05). There was no significant correlation between trace element concentration and severity of illness and daily life quality in the patient group. CONCLUSION: These results show us the role of HFS in the pathogenesis of these four trace elements and the importance of its location in etiology. We think that changes in the concentration of trace elements in HFS can lead to demyelinization, which may lead to spasm.

The role of electrophysiological examination in the diagnosis of carpal tunnel syndrome: Analysis of 2516 patients.

OBJECTIVE: The aim of the present study was to assess the correlation between patient history, physical examination, and electrophysiological method of assessment in patients with clinical suspicion of carpal tunnel syndrome (CTS). PATIENTS AND METHODS: Results of electrophysiological examinations performed from 2009 to 2016 on 3151 hands of 2516 patients who had symptoms that clinically suggested CTS were examined retrospectively. Patients were assessed in terms of age, gender, direction of nerve compression, and presence and degree of CTS as determined electrophysiologically. Kolmogorov-Smirnov test, Levene's test, and Chi-square test were used for statistical analyses. Level of significance was accepted as P < 0.05. RESULTS: : Of the 2516 patients, 1838 (73.1%) were female and 678 (26.9%) were male. Average age was 48.60 ± 14.83 years, and 1858 (73.8%) of the patients had complaints in only 1 hand, whereas 658 (26.2%) had complaints in bilateral hands. CTS was detected in 1383 patients (54.9%; female/male: 1019/364) and average age was 52.16 ± 13.84 years. No statistically significant association was found between CTS and gender. Nerve compression was found in 1 hand of 71.5% (1328) of females and 28.5% (530) of males, and this result was found to be statistically significant. No significant association was found between degree and direction of nerve compression. CONCLUSION: Only 54.9% of the patients with clinical suspicion were found to have CTS. Given complexity of the hand and a large number of potential pathologies, electrophysiological examination is necessary for definitive diagnosis to avoid unnecessary surgical interventions.

Disseminated BCG infectious disease and hyperferritinemia in a patient with a novel NEMO mutation

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Proximal protection with hybrid stent, a safer combination for carotid artery stenting against carotid endarterectomy?

AIM: Carotid revascularization is an established theurapeutic modality in preventing stroke and death among patients with severe carotid stenosis. Although carotid endarterectomy remains as the primary option, carotid stenting is accepted as an alternative for patients with high risk for carotid endarterectomy. Recently published reports have better results with proximal protection devices when compared with distal protection devices. These studies have revealed less microembolic signals and less periprocedural new ischemic lesions on diffusion weighted magnetic resonance imaging. Stent choice may be also important for these procedures as open cell stent design has advantage of better flexibility whereas closed cell systems have an advantage of better scaffolding. Hybrid stents which are composed of open cells in the proximal and distal part and closed cells in the middle may carry both advantages. The aim of this study is to demonstrate whether combination of proximal protection devices with hybrid stents can be a safe alternative for carotid stenting in terms of periprocedural and 30-day outcomes. METHODS: Here we retrospectively evaluated 68 symptomatic carotid stenosis patients undergoing carotid stenting with hybrid stent (Cristallo Ideale®, Invatec s.r.l., Medtronic, Italy) and proximal protection device (MO.MA®, Invatec s.r.l., Medtronic, Italy). RESULTS: Our results showed only 1 minor stroke in the periprocedural period and during the first 30-day after stenting, with no death or myocardial infarction. CONCLUSION: Although our case number is not large, we propose that carotid stenting may be safer with utilization of proximal protection system and hybrid type carotid stents.

Histological changes of liver glycogen storage in mice (Mus musculus) caused by high-protein diets.

High Protein diets (HP) have been popular for people who want to lose weight since the 1960s. Even though these diets do not harm healthy people in the short term, there is insufficient data to support their safe use and efficiency over a long period. Because of the fact that the proteins in these diets are mainly from animal sources, it induces a higher intake of total fat, saturated fat and cholesterol. It is proven that high protein diets cause both physical and pathological abnormalities in the body. However, there exist very few studies about the effects of high protein nutrition on liver glycogen storage. For this study 40 Swiss albino mice consisting of two groups were used. The first group was fed with 25% High Protein; the other was fed with standard meal. The two groups were fed with respect to their diets for 30 days. At the end of 15th, 20th, 25th and 30th days 5 from each group were killed with cervical dislocation. The livers were removed after perfusion then fixated. The routine paraffin pursuit was applied before cutting into 5 micrometer sections and staining with H-E, PAS and silver. There were major differences in weight loss between the first and the fifteenth days. Glycogen storage was significantly reduced in HP (15) stained with PAS. Hydropic degeneration and regenerative activity was observed in H-E and silver stained HP group. As a result for the high protein diet group, weight loss at the 15th day and a significant decrement in glycogen storage at the 30th day was observed.

Interferon alpha-2b may impair testicular histology including spermatogenesis in a rat model.

Interferon-alpha has been used in various diseases at the reproductive ages. However, the effect of interferon-alpha on testicular histology has not been studied in literature. The aim of this study was to investigate the effects of interferon alpha-2B on testicular histology including spermatogenesis in a rat model. Seventeen adult male Wistar albino rats were divided into 3 groups: Six rats received 7.500 units (5 MIU/m2) of interferon alpha-2B (Intron), considered clinical treatment dose range. Six rats received 30.000 units (20 MIU/m2) of interferon alpha-2B (Intron), considered high treatment dose. Five rats served as a control group receiving 0.5 mL of saline injection. All injections were done intraperitoneally 3 times weekly for 3 weeks under inhalation anesthesia. All rats underwent bilateral orchiectomy 30 days after the experiment. Histological examination included the mean seminiferous tubular diameter (STD), germinal epithelial cell thickness (GECT), and testicular biopsy score (TBS). The mean STD was significantly lower in the low-dose interferon and high-dose interferon groups than in the control group (p = 0.008 and p = 0.004, respectively). The mean GECT was significantly lower in the low-dose interferon and high-dose interferon groups than in the control group (p = 0.008 and p = 0.004, respectively). The mean TBS was significantly lower in the low-dose interferon group (p = 0.05) and the high-dose interferon group (p = 0.01) than in the control group. The decreases in the mean values of the STD, GECT and TBS were not related to the interferon dose. Interferon alpha-2B may impair testicular histology even in clinical widely used treatment dose. Therefore, men at the reproductive ages should be fully informed for the use of interferon-alpha in the treatment of various diseases.

Is routine urinary tract investigation necessary for children with monosymptomatic primary nocturnal enuresis?

OBJECTIVES: To investigate in a prospective study the role of bladder function and to compare the results of urinary tract ultrasonography and urinalysis in children with and without primary nocturnal enuresis because, although this is a common problem in children, the etiology and mechanisms of the disorder have not been elucidated. METHODS: The study included 106 children with monosymptomatic primary nocturnal enuresis and a control group of 57 children with no history of voiding dysfunction, aged 5 to 19 years. All children underwent urinalysis, bladder and upper urinary tract ultrasonography, and uroflowmetry. The bladder capacity, bladder wall thickness, and postvoid residual volume were measured using ultrasonography. The findings were compared between the enuresis and control groups according to age: 5 to 9 years, 10 to 14 years, and 15 to 19 years. RESULTS: The mean age was 9.6 +/- 3.1 years in the nocturnal enuresis group and 9.4 +/- 3.3 years in the control group (P = 0.727). The mean number of defecations per week was significantly lower statistically in the enuresis group than in the control group in the age categories of 5 to 9 years and 10 to 14 years (P = 0.038 and P = 0.018, respectively), and the mean number of urinations per day was significantly higher statistically in the enuresis group than in the control group in the age groups of 5 to 9 years and 10 to 14 years (P = 0.002 and P = 0.001, respectively). The bladder capacity, bladder wall thickness, postvoid residual volume, uroflowmetry maximal flow rate, and average flow rate were not significantly different statistically between the children with primary nocturnal enuresis and the control group in the three age brackets. Urinary infection was detected in 2 children (1.88%) in the nocturnal enuresis group and none of the children in the control group (P = 0.547). Upper urinary tract abnormalities detected by ultrasonography were seen in 3 children (2.83%) in the nocturnal enuresis group and 1 child (1.75%) in the control group, revealing no statistical significance (P = 0.671). CONCLUSIONS: Our findings show that the ultrasonographic and uroflowmetry findings on bladder function and the upper urinary system and the incidence of urinary infection are similar in children with and without nocturnal enuresis. Obtaining a voiding and elimination diary in conjunction with a good history may be beneficial in children with monosymptomatic primary nocturnal enuresis. In addition, routine urinalysis may be unnecessary in the evaluation of children with monosymptomatic primary nocturnal enuresis after obtaining a careful and complete history of the voiding dysfunction.

Effect of terazosin on the lipid profile in patients with symptomatic benign prostatic hyperplasia.

INTRODUCTION: To determine the changes in plasma lipid levels in symptomatic benign prostatic hyperplasia (BPH) patients receiving terazosin treatment. MATERIALS AND METHODS: The study included 99 patients with BPH aged 44-74 years. The patients were divided into 3 groups: in group 1 (n = 25) with baseline total cholesterol levels of >220 mg/dl, terazosin 5 mg/day was used; in group 2 (n = 56) with basal total cholesterol levels of < 220 mg/dl, terazosin 5 mg/day was used, and group 3 (n = 18) did not use terazosin and was defined as the control group. Plasma levels of total cholesterol, low-density lipoprotein, high-density lipoprotein and triglyceride were recorded, and the high-density lipoprotein to total cholesterol ratio was calculated at the beginning of the study and after 12 weeks. RESULTS: The total cholesterol level decreased from the baseline level by 10.88% after 12 weeks (p < 0.05) in group 1. The decrease was observed in 22 of 25 patients (88%). In group 1, the mean plasma total cholesterol level decreased significantly (p < 0.05), but the decrease was not significant in group 2 and no change was observed in group 3. The mean plasma low-density lipoprotein level decreased significantly in group 1 (p < 0.05), but no change was observed in the other 2 groups. The mean plasma high-density lipoprotein level increased in group 1, whereas no change was observed in the other 2 groups. The mean plasma triglyceride level decreased significantly in groups 1 and 2 (p < 0.05), but no change was observed in group 3. The high-density lipoprotein to total cholesterol ratio increased significantly in group 1, but no change was observed in the other 2 groups. CONCLUSION: We suggest that terazosin may be a reasonable choice because of the beneficial effect on the lipid profile in older symptomatic BPH patients with a higher ratio of dyslipidemia.

The assessment of constipation in monosymptomatic primary nocturnal enuresis.

OBJECTIVES: Nocturnal enuresis and constipation are common pediatric problems. The aim of this study was to assess the incidence of constipation in children with or without monosymptomatic primary nocturnal enuresis. METHODS: The study included 5350 children, ages 5-19 years, who were surveyed to detect the incidence of nocturnal enuresis. Of those surveyed, 679 (12.7%) had primary nocturnal enuresis. All children were questioned by mail with a standard form that addressed their micturition and defecation habits. The children those who had primary nocturnal enuresis were invited to the Pediatric Urology Section of the University Hospital. Of those 679 children, 125 kept that invitation. All 125 of those children underwent an abdominal ultrasound. Also, these children had serum creatinine levels drawn and plain abdominal films taken. RESULTS: Constipation, defined as less than 3 bowel movements per week, was seen in 48 of 679 children with nocturnal enuresis (7.06%). Of those 4671 children without nocturnal enuresis, only 68 (1.45%) had constipation. The difference in constipation between the two groups was statistically significant (z = -9.251; p = 0.000). Of note, 10 of the 125 children (8%), evaluated at the hospital, had constipation. None of the children had an abnormal neurologic examination. Finally, faecal loading was detected on the plain films of 8 of the 125 children evaluated, 7 of who had constipation. The sensitivity of grading plain films for faecal loading to denote constipation in this population was 87.5%. CONCLUSIONS: Children with primary nocturnal enuresis should be thoroughly assessed for coexisting constipation.

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia.

OBJECTIVES: Transurethral resection of the prostate (TURP) can cause elevation of total serum prostate-specific antigen (PSA). However, the effect of these procedures on free PSA and percent free PSA is still unknown. The aim of this study was to investigate the effect of TURP on serum total PSA, free PSA, and free/total (f/t) PSA ratio in patients with benign prostatic hyperplasia (BPH) and to determine the reliability of f/t PSA ratio after such interventions. METHODS: Fifty-three patients with BPH who underwent TURP because of severe bladder outlet obstruction symptoms were included in this study. All patients underwent digital rectal examination and transrectal ultrasound (TRUS), and routine hematologic (complete blood count) and serum biochemical tests, urine analysis, and a peak urinary flow test were performed. Serum total PSA and free PSA levels were determined 1 hour before and 24 hours after TURP by using enzyme immunometric assay. Preoperative and postoperative free and total PSA and f/t PSA ratio were statistically compared. RESULTS: Although postoperative total PSA and free PSA increased significantly compared with preoperative values (P <0.001 and P = 0.024, respectively), the difference between preoperative and postoperative f/t PSA ratios was not statistically significant (P = 0.103). CONCLUSIONS: Finding no significant change in f/t PSA ratio, although there is a significant increase in the serum levels of total and free PSA, suggests to us that f/t PSA ratio may be a more reliable parameter in the early period after such interventions as TURP.

Effect of postnecrotic and alcoholic hepatic cirrhosis on development of benign prostatic hyperplasia.

BACKGROUND: The object of this study was to investigate the effects of hepatic cirrhosis on the development of benign prostatic hyperplasia and consequent effects on prostatic volume, serum prostate-specific antigen (PSA), and prostatism symptoms. METHODS: Sixty patients with postnecrotic cirrhosis and alcoholic cirrhosis at age 40 and over, and 20 voluntary subjects in the same age group with normal hepatic functions, were evaluated with prostatic volume calculation by transrectal ultrasound, symptom scoring according to American Urology Association (AUA) criteria, measurement of serum prostate-specific antigen (PSA), serum total testosterone (TT), free testosterone (FT), estradiol (E2), and calculation of E2/FT ratios, and the results were analyzed statistically by the Mann-Whitney U-test. RESULTS: Serum FT and TT levels were significantly lower in the hepatic cirrhosis group compared to the control group (P = 0.0000 and P = 0000, respectively). Though mean serum E2 level was a little higher in cirrhotic patients compared to controls, the difference was not significant; however, the higher E2/FT ratio in the cirrhotic group was statistically significant (P = 0.27 and P = 0.0002, respectively). In the cirrhotic group, the decrease in FT and TT levels was greater, as the disease advanced. While E2 and E2/FT ratio increase, correlate with poor prognosis, no statistically significant differences were found. Mean prostatic volume, serum PSA level, and total symptom score were significantly higher in the control group, compared to the cirrhotic group (P = 0.0001, P = 0.0006, and P = 0.002, respectively). Prostatic volume decreased parallel to severity of disease in cirrhotic patients. CONCLUSIONS: The main reason for the decrease in mean prostatic volume in cirrhotic patients compared to subjects in the same age group with normal hepatic functions was the decrease in serum FT and TT levels, and the secondary cause was the increase in E2/FT ratio, indicating estrogenic predominance.

Relationship between prostate specific antigen density, microvessel density and prostatic volume in benign prostatic hyperplasia and advanced prostatic carcinoma.

The aim of this study was to investigate the relationship between prostate specific antigen density and prostate volume with microvessel density in patients with benign prostatic hyperplasia and advanced prostatic carcinoma. Sixty-eight patients with benign prostatic hyperplasia and 11 patients with advanced prostatic carcinoma participated in the study. The paraffin blocks of all patients were stained with CD34 by the standard immunohistochemical technique and microvessel density, prostate specific antigen density and prostatic volume were determined. In patients with benign prostatic hyperplasia the mean microvessel density, mean prostate specific antigen density and mean prostatic volume were 74+/-89+/-22.73, 0.12+/-0.10 and 59.97+/-27.0 ml, respectively. There was no correlation between prostate specific antigen density and mean prostatic volume or microvessel density (r = 0.079 and -0.095, respectively). In patients with advanced prostatic carcinoma the mean microvessel density, mean prostate specific antigen density and mean prostatic volume were 147.90+/-47.55, 0.63+/-0.41 and 54.00+/-22.42 ml, respectively. In this group, while there was a good correlation between prostate specific antigen density and microvessel density (r = 0.785), no significant correlation was found between prostatic volume and microvessel density (r = -0.07). There was significant statistical difference in patients with advanced prostatic carcinoma compared to patients with benign prostatic hyperplasia in terms of mean microvessel density (p<0.0001). The findings that there was no correlation between prostatic volume and MVD either in benign prostatic hyperplasia or in prostatic carcinoma suggest that microvessel development is not correlated with prostatic volume but may be correlated with morphology.

Comparative early results of transurethral electroresection and transurethral electrovaporization in benign prostatic hyperplasia.

OBJECTIVE: To compare the results of conventional transurethral electroresection of the prostate (TURP) and transurethral electrovaporization (TUEP) in patients with symptomatic benign prostatic hyperplasia. PATIENTS AND METHODS: The study comprised 46 patients with moderate or severe symptoms of prostatism and a maximal flow rate of < 15 mL/s. Pre-operatively, all patients underwent a digital rectal examination and the determination of prostatic volume by ultrasonography, and a symptom score, the maximal flow rate, post-void residual urine, routine biochemical variables and serum prostate specific antigen were measured. The haematocrit and blood Na+ levels were also determined pre-operatively and again 24 h after the operation. Patients were divided randomly into two groups: the first underwent a conventional TURP and the second TUEP using 240-300 W of cutting current. Three months after operation, all the variables were remeasured and the values compared with those before treatment and between the groups. RESULTS: The improvements in symptom score, maximum flow rate and residual urine were slightly better after TURP than after TUEP but the differences between treatments were not statistically significantly different. However, TUEP used slightly less irrigant solution, allowed earlier removal of the urethral catheter, required no blood transfusions and was easier to perform. CONCLUSION: Although the improvements in the objective variables 3 months after TUEP were almost the same as after TURP, there were advantages in using less resources: further studies with more patients and a longer follow-up are required to determine the efficacy and safety of this procedure.

A urodynamic evaluation of patients with renal, upper and lower ureteric stones.

OBJECTIVE: To investigate the urodynamic variables of the patients with renal, upper and lower ureteric stones and compare the results according to the location of the stone. PATIENTS AND METHODS: Pre-operatively, 49 patients with kidney, upper and lower ureteric stones were evaluated to determine bladder capacity, compliance and urine volume at first sensation. Patients with urinary tract infection, neurogenic pathology and bladder outlet obstruction were excluded. The patients were divided into two groups; 20 patients with kidney and upper ureteric stones and 29 patients with lower ureteric stones. RESULTS: The mean bladder compliance, bladder capacity and volume at first sensation were all significantly lower in patients with lower ureteric stones (P = 0.026, P = 0.005 and P = 0.042, respectively). These patients also had more prominent irritative symptoms, urgency and frequency. However, the mean values of bladder capacity, compliance and volume at first sensation were within normal limits in both groups. CONCLUSION: Lower ureteric stones cause more irritative bladder symptoms than do renal and upper ureteric stones and lower ureteric stones should be considered as a possible cause of sensory urgency.

Urodynamic parameters in preoperative evaluation of patients with bladder tumours.

Urodynamic evaluation was done in 28 patients with various staged bladder tumours. In 12 patients with superficial bladder tumours all urodynamic parameters were in normal range. Thirteen patients of 16 with invasive bladder tumours had low capacity of bladder and 5 of them also had involuntary contractions. In this study we suggest that urodynamic parameters in patients with bladder tumour became significantly abnormal when the first tumour invasion is seen at the muscular layer of the bladder (p < 0.05); so compliance significantly decreased and the other pathological conditions were followed (p < 0.05).

Primary retroperitoneal liposarcoma: a case report and review of the literature.

We report a case of a 43 years old woman with a retroperitoneal liposarcoma located in the left iliac fossa. The condition was discovered because of the association of left flank pain, abdominal distention and persistent urinary infection with symptoms of vesical irritation. The diagnosis was suggested by intravenous pyelography (IVP), abdominal and pelvic ultrasonography (USG) and computed tomography (CT). Treatment was exclusively surgical. During a six-month follow-up, no recurrence was observed.