Comparison between dorsal onlay and one-sided dorsolateral onlay buccal mucosal graft urethroplasty in long anterior urethral strictures.

OBJECTIVE: To compare dorsal onlay (conventional Barbagli) and one-sided dorsolateral onlay (Kulkarni technique) buccal mucosa substitution urethroplasty techniques for the treatment of long anterior urethral strictures. METHODS: Demographic data, treatment outcomes and success rates of patients who underwent either conventional Barbagli or Kulkarni urethroplasty for the treatment of an anterior urethral stricture longer than 8 cm between January 2010 and March 2019 in our center were retrospectively reviewed. RESULTS: Demographic parameters of patients who underwent the conventional Barbagli (n = 37) or Kulkarni procedure (n = 31) did not differ. The mean surgical duration and hospital stay were shorter for patients treated with the Kulkarni technique (179.5 ± 30.0 and 3.5 ± 1.2 vs 195.5 ± 28.9 min and 4.4 ± 1.8 days; P = 0.037, P = 0.002). Mean intraoperative blood loss and perioperative complication rates were signficantly lower in patients who underwent the Kulkarni technique than those who underwent the conventional Barbagli technique (164.3 ± 62.9 vs 202.4 ± 78.1 mL; P = 0.033 and 16.1% vs 37.8%; P = 0.046). The mean follow-up time period was 59.8 ± 24.7 and 63.5 ± 26.8 months for Kulkarni and conventional Barbagli techniques, respectively. Success rates based these follow-up time periods were 27 (87.1%) and 26 (70.3%) for the Kulkarni and conventional Barbagli techniques, respectively. CONCLUSION: The Kulkarni technique should be more preferred for the treatment of long anterior urethral strictures over the conventional Barbagli technique based on surgical outcomes and success rates.

Dorsal onlay buccal mucosal graft urethroplasty in the treatment of urethral strictures - does the stricture length affect success?

BACKGROUND: Treatment of urethral strictures can be challenging, but, with appropriate preoperative evaluation and surgical planning it is possible to achieve successful results. OBJECTIVES: To analyze if the stricture length affects the success with dorsal onlay buccal mucosal graft urethroplasty technique. MATERIAL AND METHODS: Between January 2004 and June 2010 a total of 40 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤7 cm, and >7 cm), and localization of the stricture were assessed as the factors affecting success rate. RESULTS: The clinical outcome was defined as a failure when any operative instrumentation including dilatation was needed or the urine flow rate was less than 14 mL per second at the sixth month, postoperatively. The mean follow-up period was 43.44 months. Of 40 patients, 28 (70%) were successful and 12 (30%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p=0.26 and p=0.41). The statistical difference was significant for the localization and length of the stricture by means of success (p=0.002 and p=0.025). CONCLUSIONS: Our results show that the stricture length and localization are the most important variables for desirable success. Even though surgical techniques are constantly evolving, long strictures stay as a problem for urologists. Studies with larger number of patients with long urethral strictures may support our findings, and may prove the efficiency of these surgical techniques.

Quantum molecular resonance-assisted phonomicrosurgery: preliminary experience.

The objective of this study was to evaluate the use of quantum molecular resonance (QMR) energy in phonomicrosurgery. Quantum molecular resonance energy (QMRE) is an innovative technology that provides low temperature cutting and coagulation of tissues and causes minimal tissue damage during the procedure. Because of these features, this technology may offer new possibilities in phonomicrosurgery. Twelve patients with vocal fold polyps underwent QMR-assisted phonomicrosurgery. The patients were evaluated before and after surgery at 1 and 3 months postoperatively by using the voice handicap index, laryngeal stroboscopy rating, acoustic voice analysis, and perceptual voice evaluation. The subjects were also evaluated by a patient self-assessment questionnaire at 3 months postoperatively. All parameters significantly improved after QMR-assisted phonomicrosurgery (P < .05). All of the patients also subjectively improved by self-rating. These results suggest that QMRE is a safe and potentially promising treatment in phonomicrosurgery. Yet, further studies should be conducted to confirm these results.

Alpha adrenergic receptors in renal pelvis and calyces: can rat models be used?

We aimed, in this study, to determine the distribution of α-1 AR subtypes in rat and human pelvis and calyces, and to evaluate, by comparing these two species, the possibility of rats to be used as models for humans. Twenty patients with renal carcinoma were included into the study. The patients underwent radical nephrectomy for renal cell carcinoma (RCC). After nephrectomy, specimens were evaluated and excisional biopsies from healthy pelvis and calyces tissues were performed. When pathology confirmed the non-invasion of RCC, specimen was included into the study. A total of 7 adult Wistar Albino (250-300 g) female rats were used in this study. Specimens included renal pelvis and calyces. All specimens were evaluated under light microscope histopathologically. The concentrations of the receptor densities did not differ between the two groups. With the demonstration of the α receptors in rat kidneys and calyces, many receptor-based studies concerning both humans and rats can take place. Novel medication targeting these subtypes -in this matter α1A and α1D for renal pelvis and calyces- may be helpful for expulsive therapy and/or pain relief. With the demonstration of similar receptor densities between human and rat tissues, rat model may be useful for α-receptor trials for renal pelvis and calyces.

Alpha adrenergic receptors in renal pelvis and calyces: can rat models be used?

We aimed, in this study, to determine the distribution of α-1 AR subtypes in rat and human pelvis and calyces, and to evaluate, by comparing these two species, the possibility of rats to be used as models for humans. Twenty patients with renal carcinoma were included into the study. The patients underwent radical nephrectomy for renal cell carcinoma (RCC). After nephrectomy, specimens were evaluated and excisional biopsies from healthy pelvis and calyces tissues were performed. When pathology confirmed the non-invasion of RCC, specimen was included into the study. A total of 7 adult Wistar Albino (250-300 g) female rats were used in this study. Specimens included renal pelvis and calyces. All specimens were evaluated under light microscope histopathologically. The concentrations of the receptor densities did not differ between the two groups. With the demonstration of the α receptors in rat kidneys and calyces, many receptor-based studies concerning both humans and rats can take place. Novel medication targeting these subtypes -in this matter α1A and α1D for renal pelvis and calyces- may be helpful for expulsive therapy and/or pain relief. With the demonstration of similar receptor densities between human and rat tissues, rat model may be useful for α-receptor trials for renal pelvis and calyces.

Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6.

INTRODUCTION: The discrepancy between prostate biopsy and prostatectomy Gleason scores is common. We investigate the predictive value of prostate biopsy features for predicting Gleason score (GS) upgrading in patients with biopsy Gleason scores ≤6 who underwent radical retropubic prostatectomy (RRP). Our aim was to determine predictors of GS upgrading and to offer guidance to clinicians in determining the therapeutic option. METHODS: We performed a retrospective study of patients who underwent RRP for clinically localized prostate cancer at 2 major centres between January 2007 and March 2013. All patients with either abnormal digital examination or elevated prostate-specific antigen at screening underwent transrectal ultrasound-guided prostate biopsy. Variables were evaluated among the patients with and without GS upgrading. Our study limitations include its retrospective design, the fact that all subjects were Turkish and the fact that we had a small sample size. RESULTS: In total, 321 men had GS ≤6 on prostate biopsy. Of these, 190 (59.2%) had GS≤6 concordance and 131 (40.8%) had GS upgrading from ≤6 on biopsy to 7 or higher at the time of the prostatectomy. Independent predictors of pathological upgrading were prostate volume <40 cc (p < 0.001), maximum percent of cancer in any core (p = 0.011), and >1 core positive for cancer (p < 0.001). CONCLUSIONS: When obtaining an extended-core biopsy scheme, patients with small prostates (≤40 cc), greater than 1 core positive for cancer, and an increased burden of cancer are associated with increased risk of GS upgrading. Patients with GS ≤6 on biopsy with these pathological parameters should be carefully counselled on treatment decisions.

A comparison of histopathological results of conventional surgery and transoral radiofrequency ablation in early stage laryngeal carcinoma.

OBJECTIVES: This study aims to compare histopathological results of conventional surgery and transoral radiofrequency ablation in patients with early stage laryngeal carcinoma. PATIENTS AND METHODS: Between January 2006 and May 2010, 36 patients (34 males, 2 females; mean age 61.6 years; range 43 to 77 years) who underwent partial laryngectomy in our clinic were retrospectively analyzed. All patients were randomized to partial laryngectomy with radiofrequency ablation or conventional surgery. Hoarseness due to early stage T1 and selected T2N0 vocal cord lesions was an indication for surgery. Of 20 patients receiving conventional surgery, 14 underwent partial laryngectomy, while six patients underwent cordectomy for the excision of tumors. Tumors were excised by transoral radiofrequency ablation in 16 patients. RESULTS: We observed thermal artifacts in four patients undergoing conventional surgery and in 13 patients undergoing transoral radiofrequency ablation. There was also hemorrhage in 16 patients undergoing conventional surgery and in seven patients undergoing transoral radiofrequency ablation. Histopathological examination revealed that the surgical margins were safe in 10 patients after radiofrequency ablation. The specimens obtained from six patients showed thermal artifacts which complicated histopathological examination. Sixteen (80%) of 20 conventional surgery patients and nine (56%) of 16 radiofrequency ablation patients had safe surgical margins. CONCLUSION: In radiofrequency ablation, the surgical zone must be larger than in conventional surgery due to the high risk of tissue damage and complicated histopathological examination.

A good alternative to indwelling catheter owing to benign prostate hyperplasia in elderly: Memotherm prostatic stent.

OBJECTIVE: To evaluate the long-term results of using Memotherm (Angiomed Gmbh & Co.) prostatic stents in the treatment of bladder outlet obstruction from benign prostatic hyperplasia (BPH) in patients with high anesthetic risk for surgery. METHODS: A total of 29 patients with BPH, who were ruled unfit for surgery, underwent a prostatic stenting procedure between 1998 and 2005 at our hospital, with a mean age of 75 years (range, 65-87) and a mean symptomatic period of 62.5 months (range, 7-180). All patients had previous failed medical treatment for severe lower urinary tract symptoms and evaluated as high risk for anesthesia. Mean follow-up period was 6.8 years (range, 60-125 months). Preprocedural, first year, and fifth year postprocedural values for peak flow rates, residual urine volumes, Turkish symptom scores, and quality of life index scores were compared and evaluated. RESULTS: Memotherm prostatic stent placement was successful in treating 25 patients with BPH (86%) at high risk for surgery who had prostate-related urinary obstruction. For the remaining 4 patients (13.8%), stent migration into the bladder prompted removal of the stents. Marked improvement in residual urine volume, Turkish symptom score, quality of life index scores, and peak flow rates were observed 1 and 5 years after the procedure. CONCLUSION: The results of our study suggest that placement of Memotherm prostatic stents is an effective treatment option in elderly patients with BPH at high anesthetic risk. And by this way, the possible unwanted results of continuous catherization and patient discomfort might be prevented.

Glomus tumor of the proximal trachea: a case report.

Glomus tumors are uncommon benign neoplasms, which rarely occur in the trachea, usually originating from the posterior wall of the distal portion. Most of tracheal glomus tumors are located in the lower two thirds of the trachea. In this article, we present a 50-year-old male patient with a glomus tumor located on the upper third of the posterior wall of the trachea. A transoral endoscopic laser excision was performed. No finding suggesting tumoral regrowth at 36 months following surgery was found, as assessed by laryngoscopy and imaging studies.

A benign teratoma presenting as an obstruction of the nasal cavity: a case report.

INTRODUCTION: Teratoma refers to a neoplasm that recapitulates all three germ layers. Teratomas may be histologically mature and oncologically benign. Teratomas may also be histologically immature while being oncologically benign, or they may harbor malignant components and have the potential to exhibit an aggressive biological behavior. Teratomas of the head and neck are extremely rare and usually present in the neonatal period. As a general rule, pediatric teratomas of the head and neck tend to be oncologically benign, whereas adult teratomas tend to be histologically and oncologically malignant. Most of these teratomas are found in the cervical region and nasopharynx. Calcification within the mass is often evident. CASE PRESENTATION: A 27-year-old Caucasian man complaining of a nasal obstruction was admitted to our clinic in January 2006. A transnasal endoscopic examination revealed a mass arising from the nasal septum which was completely removed using an endoscopic approach. Histologically, it was determined to be a benign teratoma. CONCLUSION: Herein, we present a rare case, along with a review of the related literature, in order to emphasize that a benign teratoma of the nasal septum should not be ignored.

A patient presenting with concha bullosa in another concha bullosa: a case report.

INTRODUCTION: Anatomic variations of the paranasal sinuses are very common. The paranasal sinus anatomy should be carefully examined prior to performing endoscopic sinus surgery in terms of both existent pathologies and anatomic variations. The anatomy of the paranasal sinuses and its variations have gained importance, along with advances in coronal paranasal sinus computed tomography and extensive use of endoscopic sinus surgery. CASE PRESENTATION: A 53-year-old Caucasian woman was admitted to our clinic with complaints of nasal breathing difficulties and headache persisting for a long time. Another concha bullosa was detected in the middle concha bullosa on preoperative paranasal computed tomography examination. It is known that the paranasal sinuses have a number of anatomical variations. CONCLUSION: Herein we report a rare case, along with a review of the literature, to emphasize that a concha bullosa inside another concha bullosa should not be ignored.

[Evaluation of operation success in patients with nasal septal deviation with quality of life scale and objective methods]. / Nazal septum deviyasyonlu hastalarda ameliyat basarisinin yasam kalitesi ölçegi ve objektif yöntemler ile degerlendirilmesi.

OBJECTIVES: In this study we aimed to evaluate the quality of life during, before and after septoplasty in patients who were diagnosed with nasal septal deviation and also to demonstrate the role and importance of acoustic rhinometry and rhinomanometry methods in objectively demonstrating surgical success. PATIENTS AND METHODS: This study was carried out in 44 patients undergoing septoplasty surgery. Patients' preoperative complaints were evaluated by Nasal Obstruction Symptom Evaluation (NOSE) scale. The pre- and post-decongestion acoustic rhinometry and rhinomanometry data of the patients were recorded simultaneously. One month after Cottle's septoplasty performed as the septal surgery method, patients were re-evaluated by NOSE scale, acoustic rhinometry and rhinomanometry and the findings were compared with the preoperative data. RESULTS: Compared to the patients' preoperative values, a significant decrease in NOSE scores (p<0.05); a significant increase in the minimal cross-sectional area (MCA1, MCA2) and volume values measured by acoustic rhinometry (p<0.05) and a significant decrease in the nasal resistance values measured by rhinomanometry (p<0.05) were observed. No significant relationship was found between the change in patients' pre- and postoperative NOSE score values and the change in their acoustic rhinometry and rhinomanometry data (p>005). CONCLUSION: Nowadays, evidence-based medical practices are increasingly gaining importance and acoustic rhinometry and rhinomanometry are methods that can be used in objective evaluation of operation success.

[Incidental thyroid carcinoma found during surgery for laryngeal carcinoma: a case report]. / Larenks karsinomu nedeniyle boyun diseksiyonu yapilan olgularda rastlantisal tiroid karsinomu: Olgu sunumu.

At the histopathologic examination of neck dissection specimens of the patients who underwent surgical treatment with the diagnosis of laryngeal cancer, thyroid cancer metastases may also be detected in addition to laryngeal cancer metastases. Were retrospectively reviewed the files of 74 patients who were diagnosed with laryngeal cancer and underwent total or partial laryngectomy and neck dissection in our clinic between January 2008 and July 2010. Thyroid papillary carcinoma was found in neck dissection specimen of two patients who underwent partial laryngectomy and neck dissection. Total thyroidectomy was performed to complete the treatment. No recurrence or metastasis was found during the postoperative follow-up for an average of 9.5 months (range 5 to 14 months). Although it is a rare condition, the possibility of coexisting thyroid carcinoma in laryngeal cancer patients and the possible need for completion surgery when required should always be kept in mind.

Quantifying the expression of VEGF using qRT-PCR, evaluation of MVD and their correlation with clinicopathological factors in laryngeal squamous cell carcinoma.

OBJECTIVES: In this study we quantified the expression of vascular endothelial growth factor (VEGF) using quantitative real-time polymerase chain reaction in laryngeal squamous cell carcinoma (LSCC) tissues and evaluated the correlation between the level of VEGF and microvessel density (MVD), and clinicopathological factors. PATIENTS AND METHODS: Twenty-seven patients with LSCC undergoing total or partial laryngectomy at the Ear, Nose, and Throat and Head and Neck Surgery Department of the Izmir Tepecik Training and Research Hospital between September 2006 and July 2008. There was no VEGF expression in two patients that were excluded from the study. Twenty-five patients (24 males, 1 female; mean age 61 years; range 43 to 82 years) were included in this study, but MVD levels of 10 patients could not be determined. RESULTS: As defined by the 2003 American Joint Committee on Cancer (AJCC) TNM classification, seven patients (28%) were stage 1, six patients (24%) were stage 2, four patients (16%) were stage 3, and eight patients (32%) were stage 4. Thirteen patients (52%) had well-differentiated (G1) tumors, and twelve had moderately differentiated tumors. Among the 15 patients for whom the MVD was determined, the median value was 48, with a (range 13-78; vessels / 3.76 mm2). Among the 25 patients for whom the VEGF level was determined, the median value was 0.035 vessels / 3.76 mm2 (range 0.010-0.127). CONCLUSION: We could not find a statistical correlation between clinicopathological factors and either VEGF or MVD. Our study demonstrates that VEGF is expressed by LSCC.

Prognostic factors in metastatic prostate cancer.

OBJECTIVE: Aim of this study is to determine the prognostic value of age, serum alkaline phosphatase, pretreatment PSA level, Gleason score, and number of bone metastasis focuses. PATIENTS AND METHODS: One hundred fifty-one patients who had been followed in our clinic between years 1989 and 2006 were investigated retrospectively. RESULTS: As a result of this study, it has been detected that serum alkaline phosphatase, Gleason score, and intensity of bone metastasis are important and statistically significant prognostic factors, and affects time to progression and life time. But pretreatment PSA level, and age have been detected not to be effective in predicting time to progression and life time. CONCLUSION: Metastatic prostate cancer provides a wide spectrum for risk of death from the disease, and clinicians have long sought methods to predict the outcome accurately in individual patients. In our study, we found that high serum alkaline phosphatase, high Gleason score, and intense bone metastasis (>6) has negative impact on progression and survival.

[Combined treatment supported by piracetam and/or acyclovir in idiopathic sudden sensorineural hearing loss: experience with 81 cases]. / Ani isitme kayiplarinda pirasetam ve/veya asiklovir eklenerek yapilan kombine tedavi: 81 olguluk deneyim.

OBJECTIVES: To investigate the efficiency of piracetam and acyclovir in treating sudden hearing loss. PATIENTS AND METHODS: Eightyone patients (44 males, 37 females; mean age 40.4 year; range 18 to 72 years) who had treatment between January 2002 and December 2006 with diagnosis of idiopathic sudden hearing loss were evaluated retrospectively. These patients were divided into four groups according to the treatment they received. The patients who had combined treatment constituted the first group; those who had combined treatment and piracetam the second; those who had combined treatment and acyclovir the third; those who had combined treatment, acyclovir, and piracetam the fourth group. RESULTS: For the four treatment groups, in the pre-and post-treatment (10th day) evaluation of the treatment efficiency made by calculation of the hearing thresholds in 250-8000 Hz frequencies, no significant difference between the groups was determined (p>0.05). CONCLUSION: No additional benefit was obtained with acyclovir and piracetam in treatment.

Extraordinary pathologic entities within the concha bullosa.

OBJECTIVE: To retrospectively analyze the extraordinary pathologic entities inside the concha bullosa (CB). METHODS: Surgical interventions were performed on 136 patients (234 CB) at the Department of Ear, Nose, and Throat, and Head and Neck Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey between January 2002 and December 2007. Radiological and histopathological findings of these cases were reviewed retrospectively. RESULTS: In 203 (86.8%) of the 234 cases, only a pneumatized cavity was observed. The cavity was filled with purulent secretion in 13 (5.6%) cases. A bony septum, pyocele, polyp, ossifying fibroma, fungus ball, and cholesteatoma were the other extraordinary pathologies associated with CB. CONCLUSION: Although most of the CB cases have pneumatized cavity, it should be kept in mind that some extraordinary pathologies can be associated with CB.

Comparison of three different chemotherapy regimens containing epirubicin in hormone-refractory prostate cancer patients.

We compared three different chemotherapy regimens containing epirubicin in hormone-refractory prostate cancer (HRPC) patients. Sixty-nine patients with HRPC were randomized into three groups. The first group (22 patients) received 30 mg/m2/week i.v. epirubicin for 8 weeks. The second group (24 patients) received 30 mg/m2/week i.v. epirubicin for 8 weeks followed by monthly maintenance therapy for 4-6 months. The third group (23 patients) received oral estramustine phosphate (EMP) at a dose of 840 mg/day together with weekly and monthly maintenance epirubicin. The response rates, mean survival times, and toxicity were determined. Within the first 3 months, pain and performance scores were improved by at least one degree in all the groups. One patient in group two and three patients in group three had complete response. Partial response rates were 23% in group 1, 25% in group 2, and 17% in group 3. Stable disease rates were 41% in group 1, 33% in group 2, and 26% in group 3. The progression rates within the first 3 months were 36% in group 1, 38% in group 2, and 44% in group 3. None of the patients developed complications that were significant enough to terminate the treatment. Two patients in group 3 died of cardiotoxicity. The mean survival times were 10.1, 15.8, and 16.1 months in groups 1, 2, and 3, respectively. It was determined that weekly and maintenance epirubicin treatment protocol, and estramustine treatment protocol in addition to this treatment, was only meaningfully more effective against weekly epirubicin treatment in the statistical sense (0.01 < p < 0.05). However, due to the complications of EMP, which influence the quality of life, we believe that this was usable only when measures were adopted against these effects.

Effects of the integrin-linked kinase inhibitor QLT0267 on squamous cell carcinoma of the head and neck.

OBJECTIVE: To study the expression of integrin-linked kinase (ILK) in human squamous cell carcinoma of the head and neck (SCCHN) tumor specimens and cell lines and the efficacy of the novel small molecule QLT0267. DESIGN: Immunohistochemical analysis of 17 SCCHN tumor tissue specimens and 3 normal tongue tissue specimens for ILK expression and in vitro analysis of the effectiveness of QLT0267 on SCCHN cells. SETTING: Academic medical center. MAIN OUTCOME MEASURES: Expression levels of ILK in SCCHN tumor specimens and cell lines and the efficacy of QLT0267 in inhibiting cell growth and inducing apoptosis in SCCHN cell lines. RESULTS: Most SCCHN tumor specimens stained for ILK, whereas none of the 3 normal tongue tissue specimens stained for ILK. Integrin-linked kinase was expressed in all 6 SCCHN cell lines tested. In 4 pairs of normal and SCCHN tumor specimens, ILK expression and activity were higher in most tumor samples tested. A kinase assay showed that QLT0267 inhibited the ILK activity of 2 SCCHN cell lines (TU167 and MDA1986). Modified tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, DNA fragmentation ladder, and TUNEL (terminal deoxynucleotidyl transferase-mediated biotin-deoxyuridine triphosphate nick-end()labeling) assays showed that QLT0267 inhibited cell growth and induced apoptosis in these 2 cell lines. A dose-dependent decrease in Akt phosphorylation was observed for these 2 cell lines on treatment with QLT0267. CONCLUSIONS: Integrin-linked kinase is overexpressed in SCCHN tumor specimens. Targeting ILK with the small-molecule ILK inhibitor QLT0267 inhibits cell growth and induces apoptosis in SCCHN cell lines by reducing ILK activity and Akt phosphorylation. Integrin-linked kinase may be an attractive target for molecular therapy with which to enhance treatment of SCCHN.