Effect of sildenafil on platelet function and platelet cGMP of patients with erectile dysfunction.

To investigate the effect of sildenafil on platelet function and cyclic guanosine monophosphate (cGMP) levels in patients with erectile dysfunction, we evaluated the association between erectile function and platelet responses after administration of 100 mg sildenafil. Erectile responses were monitored after 8 daily doses of the drug. Adenosine diphosphate (ADP) and collagen-induced platelet aggregation and simultaneous adenosine triphosphate (ATP) release and cGMP levels were determined before and after sildenafil therapy. Basal levels for platelet aggregation, ATP release and cGMP were compared with age-matched controls. There was no difference among basal levels of platelet responses between patients and controls, except for ADP-induced platelet aggregation (P = 0.04). It was significantly higher in the patient group. Analysis of the responses to sildenafil revealed that for the patients who showed a positive erectile response, there was a significant increase in platelet cGMP (P = 0.028) and a decrease in ADP-induced platelet aggregation (P = 0.04). However, for those who showed a negative or poor erectile response, there was no change in platelet cGMP levels and platelet functions. Sildenafil did not affect collagen-induced platelet responses although cGMP levels of the responders increased. It is concluded that sildenafil increases platelet cGMP in the patients with positive erectile response. Therefore, it has been speculated that platelet cGMP may be used as an index for erectile response.

Effect of aging on quality of nocturnal erections: evaluation with NPTR testing.

Nocturnal penile tumescence and rigidity testing (NPTR) has traditionally been performed to distinguish psychogenic from organic impotence. However, considerable lack of uniformly accepted normative data for NPTR readings makes the reproducibility of the method questionable. In this study, we try to evaluate the impact of aging as independent criteria for quality of erectile episodes. A total of 455 patients (ages 20-71 y) whose initial complaints were erectile dysfunction underwent two nights NPTR measurement with Rigiscan device. After analyzing the data, 353 men out of 455 were regarded as having normal NPTR recordings. The number of normal erectile episodes (erectile episode of penile tip rigidity greater than 60% more than 10 min duration), RAU Tip, RAU Base, TAU Tip, TAU Base, Average event rigidity of Tip (%), Average event rigidity of Base (%) and Duration of erectile episodes > or =60% minute were re-evaluated with regard to five age groups (group I: <30 y; group II: 30-39 y; group III: 40-49 y; group IV: 50-59 y; group V: > or =60 y). The mean values of erectile episodes in the age groups were as follows: group I, 2.46; group II, 2.28; group III, 2.40; group IV, 1.58; group V, 1.27. When we analyzed the groups between themselves, we observed statistically significant difference after the age of 50 y. The mean erectile episodes in patients younger than 50 y were 2.37 (s.d.: 1.50), whereas 1.49 (s.d.: 1.15) in patients older than 50 y (P<0.001). We also observed statistically significant difference at all of the above-mentioned NPTR parameters with regard to age. The results of our study showed that aging negatively influence quality of nocturnal erections especially after 50 y and we suggest that age needs to be taken into account in the diagnostic interpretation of NPTR testing.

Craniofacial growth and skeletal maturation: a mixed longitudinal study.

The purpose of this study was to investigate the relationship between craniofacial growth and skeletal maturation. The material consisted of the cephalometric and hand-wrist film pairs of 35 males and 43 females (78 subjects) whose development was followed for a period of 4 to 7 years. The subjects were grouped according to their skeletal maturation. Their mean ages were: Group I 10.27, Group II 11.55, and Group III 14.79 years, respectively, at the beginning of the observation period. Intra- and inter-group differences were examined through paired t-tests, and Pearson correlation analysis was used to detect the relationship between craniofacial growth and skeletal maturation (percentage growth potential). The results show that the middle cranial base (T-W) maintained its stability in all pubertal growth periods. However, posterior cranial base length (T-Ba) increases significantly (P < 0.001) throughout the same period. There were similar increases in the vertical dimensions of the face and alveolar height throughout pubertal growth. Despite the intensified increases in both the sagittal and vertical directions, facial characteristics were constant in the sagittal direction. The skeletal development (percentage growth potential) has clearly been effective in the vertical facial development commencing in Group I and reaching its maximum level in Group II. However Cd-Go was the exception.

Hazards of orthodontics appliances and the oropharynx.

Occasionally orthodontic appliances or parts of orthodontic appliances have caused problems with either the airway or the gastrointestinal tract. The type of appliances that have caused problems and their clinical management are discussed. A case is described in which an upper removable appliance with inadequate retention became lodged in a patient's pharynx lacerating the palatine tonsils. Suggestions are made to try and avoid the problems that were encountered in this case and others reported in the literature in patients undergoing orthodontic treatment.

Effect of varicocelectomy on seminal plasma transferrin values: a comparative clinical trial.

The possible effects of varicocele and of the varicocelectomy procedure on Sertoli cell function were investigated. Transferrin concentrations in seminal plasma in men with varicocele before and 3 months after the operation were evaluated. Concentrations were measured in 10 normozoospermic fertile men as a control group and 32 oligozoospermic men with varicocele. Also, sperm analysis before and 3 months after the operation was performed. The mean transferrin level in seminal plasma was 108.4 +/- 17.5 micrograms ml-1 in normoozoospermic men and 58.1 +/- 14.4 micrograms ml-1 in patients with varicocele before the operation (P < 0.0001). Mean sperm concentration, motility and normal morphology ratio showed significant improvement 3 months after the operation (P < 0.0001). Although the mean transferrin level increased slightly (to 60.8 +/- 16.2 micrograms ml-1; P = 0.2), there was a statistically significant correlation between the change in transferrin concentration and the change in sperm concentration after the operation (r = 0.56, P = 0.0008). These results showed that elevated transferrin secretion after the treatment seems to be associated with an increase in sperm concentration after varicocelectomy. The finding of improvements in seminal parameters after the operation but insignificant changes in seminal transferrin levels indicates that varicocelectomy results in a greater improvement in sperm quality than in Sertoli cell function.

Effect of microsurgical subinguinal varicocele ligation to treat pain.

OBJECTIVES: The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy. We report our results with microsurgical subinguinal varicocele ligation to treat pain. METHODS: From 1996 to 1999, a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele. The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound. Patients described pain with testicular discomfort as scrotal heaviness or a dull ache. While waiting for the operation (range 3 to 5 weeks), all the patients underwent a preoperative trial of conservative management for pain. RESULTS: Of 119 men, 82 (69 %) were available for follow-up 3 months postoperatively. Of those 82 patients, 72 (88%) reported complete resolution of pain, 4 patients (5%) partial resolution, 5 patients (6%) no change, and 1 patient (1%) epididymal discomfort that resolved with conservative measures. Of the 9 patients with partial or no change, 2 patients had reflux recurrence as seen on color Doppler ultrasound. CONCLUSIONS: Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients.

The effects of functional treatment on the sagittal position of the mandibular condyle.

The aim of the current study was to evaluate the effects of functional treatment appliances, a U-Bugel type I activator and a conventional activator, on the mandibular condyle considering the sagittal direction. Alterations in the growth direction and quantity of the condyle effects the ramal inclination and, consequently, the whole mandible. This situation is important when considering treatment prognosis and stability. The material consisted of pre- and post-treatment lateral cephalograms and hand-wrist films of 49 individuals having skeletal and dental Class II/div.1 malocclusions. Although the elimination of overjet and correction of Class II/div.1 anomalies was achieved, statistically significant changes were not observed in the sagittal direction of the mandibular condyle.

Craniofacial characteristics of Klippel-Feil syndrome in an eight year old female.

A female eight year, one month old patient with Klippel-Feil syndrome has been introduced. General appearance of the patient was characterized by short neck with limited head movements, craniofacial asymmetry, low posterior hairline and a short stature. Cephalometric analysis revealed a Class I dentoskeletal pattern with an excessive mandibular plane angle and fused cervical vertebrae. Panoramic radiogram showed congenitally missing lower second premolars and right central incisor.

Transmurally absorbed intravesical chemotherapy with dimethylsulfoxide in an animal model.

BACKGROUND: The purpose of the present study was to investigate the hypothesis that dimethylsulfoxide (DMSO) enhances the absorbtion of the intravesical chemotherapeutics. METHODS: Fifty male Wistar rats received 1.5 mg N-methyl-N-nitrosourea (MNU) intravesically every other week (weeks 0, 2, 4, 6 and 8) for a total of five doses. After week 14, rats underwent intravesical installation of either epirubicin (1 mg) or epirubicin + DMSO (50%) every other week (weeks 14, 16, 18, 20 and 22). The absorbtion of epirubicin was estimated histologically by observing its fluorescence in the bladder. RESULTS: We observed papiller and/or hyperplastic formations in rat bladders (10/50 rats) due to installation of MNU. Epirubicin fluorescence was observed in the entire bladder wall of normal or hyperplastic regions in rats that were given DMSO prior to epirubicin. However, epirubicin was observed only in normal-appearing mucosa or in superficial layers of hyperplastic regions. CONCLUSIONS: The concomittant addition of DMSO with intravesical epirubicin enhances the absorbtion of epirubicin to the entire bladder wall. In this way, epirubicin cytotoxicity and antitumor activity can be potentiated. This can be useful for both the treatment of superficial bladder cancer (especially in local recurrence and progression) and invasive bladder cancer (especially in regional chemotherapy).

Significance of serum FSH levels and testicular morphology in infertile males.

OBJECTIVES: To determine the relationship between plasma levels of FSH and testicular spermatogenic patterns. METHODS: Testicular biopsies were obtained from 99 infertile men. Biopsies were performed either in order to distinguish the type of azoospermia (obstructive/non-obstructive) or because of severely subnormal semen variables. Serum FSH was measured by immunoassay (normal range is less than 7 mIU/ml). RESULTS: Statistically significant difference was detected between patients with Sertoli cell only syndrome and normal spermatogenesis, hypospermatogenesis and maturation arrest (p<0.01, p<0.01, p<0.05, respectively). No statistically significant differences were found between normal spermatogenesis, hypospermatogenesis and maturation arrest. CONCLUSION: Our study revealed that elevation of serum FSH correlates only with the appearance of Sertoli cell only syndrome. We think that azoospermic or severely oligoasthenoteratozoospermic patients with highly elevated plasma FSH levels (three times the normal) could be excluded from separate testicular biopsy, because these patients are not suitable for conventional treatments. If he is willing to undergo an IVF program the sperm will often be present, no matter what the testicular histology is to be used for assisted reproductive techniques, particularly ICSI.

Effect of laser prostatectomy on the serum prostate-specific antigen concentration: results of a prospective study.

OBJECTIVE: To assess the effect of the laser prostatectomy (LP) procedure on the serum prostate-specific antigen (PSA) levels. PATIENT AND METHODS: The serum PSA level was determined in 41 patients with benign prostatic hyperplasia 1 day before and 1, 3, 7, 15, 30, and 90 days after LP. All patients underwent preoperative evaluation with routine blood tests, serum PSA level, IPSS symptom questionnaire, intravenous pyelography, uroflowmetry, postvoid residual urine measurements, and transrectal ultrasonography (TRUS). IPSS symptom questionnaire, uroflowmetry, postvoid residual urine measurements, and TRUS were repeated 3 months after LP. RESULTS: PSA levels showed a statistically significant increase 24 h after LP, then a slow decrease and by 1 month the PSA levels had returned to their initial levels. A statistically significant positive correlation was found between the PSA level 24 h after LP and the amount of energy applied to the prostate during operation (r 0.87, p < 0.0001). After 30 and 90 days the mean PSA values were under the preprostatectomy concentration. The mean PSA values at 30 and 90 days were statistically significantly lower than those measured before treatment (p < 0.05). There was a statistically significant positive correlation between the reduction in PSA and the reduction in prostate weight 3 months after LP. CONCLUSION: This study showed that LP produced a variable rise in PSA, with a peak rise in PSA occurring 24 h after the procedure. In some patients, the serum PSA returned to baseline by 15 days. But, after 15 days the mean PSA level was still greater than the preprocedure value. Therefore, we recommend that blood should not be sampled for PSA for at least 30 days after LP. The mean PSA levels 30 and 90 days after treatment were lower compared with the preoperative levels. This low level of PSA can probably indicate a reduction in prostate volume following LP.

Third molar impaction in extraction cases treated with the Begg technique.

The aim of this study was to investigate the differences between two groups of patients with either erupted or impacted mandibular third molars before and after orthodontic treatment. All patients were treated with Begg appliances following extraction of the four first premolars. The erupted group consisted of 14 subjects and the impacted group 13 subjects. Lateral cephalometric films, peri-apical radiographs, orthopantomographs and orthodontic casts of each subject were taken before and after treatment. Thirteen measurements were carried out on the lateral cephalometric radiographs. The results revealed slightly more vertical growth and a smaller mandibular arc angle in the erupted group at pre-treatment, and also a more upright lower third molar position and slightly greater distance between the distal point of the lower second molars and the centre of ramus (Xi) in the same group. In the course of treatment, mandibular third molars seemed less likely to erupt when the condyle grew vertically. The lesser resorption on the anterior border of the ramus might have played a part in this finding. In addition, a greater mesial inclination of the mandibular third molars might be an indication of the tendency for these teeth to be impacted in the present study.

Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types.

Extracorporeal shockwave lithotripsy (SWL) currently is accepted as the preferred treatment for most renal and upper ureteral calculi. However, little is known about the infection risks of SWL. In this study, the incidence and severity of urinary tract infection in 117 patients with renal calculi undergoing SWL were evaluated and the stone characteristics of those with and without infection were compared. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was noted in six patients within 24 hours after SWL. No bacteriuria was noted 2 weeks later. Of these patients, three were symptomatic (including dysuria, burning, and fever >38 degrees C). No patient was hospitalized. We found no significant correlation between the occurrence of bacteriuria and the number or size of the stones (P > 0.05), nor was there any correlation between bacteriuria and the stone-free rate or the location of the calculi (P > 0.05). However, there was a significantly higher risk of urinary tract infection in patients with struvite stones than in those with other types of stones (17.3% v 2.1%). In patients with infection stones, prophylactic antimicrobial chemotherapy is necessary even if bacteriuria is not present before SWL.

Effects of transurethral prostate resection and transurethral laser prostatectomy on plasma hormone levels.

OBJECTIVE: The short and long-term effects of two common transurethral procedures (TURP and TULP, transurethral prostatic resection and laser prostatectomy, respectively) on plasma hormone levels in patients with benign prostatic hyperplasia (BPH) have been evaluated. PATIENTS AND METHODS: Totally 57 patients with histologically proven BPH (age range 54-81 years, mean 62.5 years) were included into the study program. Of these 57 patients, 44 underwent TURP and 13 underwent TULP for treatment of their bladder outlet obstructions. 20 patients with bladder cancer undergoing transurethral resection (n = 15) and those undergoing transurethral laser ablation (n = 5) constituted the control group. Plasma luteinizing hormone (LH), prolactin (PRL), follicle-stimulating hormone (FSH), adrenocorticotrophic hormone (ACTH), cortisol, aldosterone, dihydroepiandrosterone sulfate (DHEA-S) and testosterone levels were assessed in all patients before and after 3 weeks and 3 months following the aforementioned procedures. Comparative evaluation of the results with respect to the effect of different procedures have been made between study and control groups. RESULTS: Preoperatively, we were not able to demonstrate any significant difference with respect to all but plasma prolactin levels (p < 0.05) between the study and control groups. Prolactin levels were found to be significantly higher in BPH patients. In BPH patients undergoing TURP, while LH levels were significantly higher during the 3 weeks' evaluation (p < 0.001) no significant difference could be shown during the 3 months' examination (p > 0.05). Again, prolactin levels did significantly decline (p < 0.05) in patients undergoing TURP during the 3 weeks' follow-up evaluation, no difference was present 3 months postprocedure. On the other hand, in patients undergoing TULP, while we were not able to show any significant difference with respect to plasma prolactin levels (p > 0.05) pre- and postoperatively, plasma LH levels were significantly increased during the 3-month evaluation (p < 0.05). CONCLUSIONS: Alterations in the plasma levels of LH and prolactin following prostatectomy during follow-up evaluation, led the physicians to consider possible effects of some factors released from resected prostate gland. Behavior of prolactin and LH after TURP and laser ablation is quite different in our study. It may be related to the higher amount of residual prostate tissue after TULP. On the other hand, normalization of hormone levels 3 months following TURP, led us to think about the activation of some factors responsible for hormonal regulation which in turn institutes a new hormonal balance.

Evaluation of basal membrane antibody (immunoglobulin G) formation after high-energy shockwave application in rats.

To evaluate the immune pathologic effects of high-energy shockwave (HESW) application on glomerular and tubular basal membrane antibody (IgG) formation, an experimental study on rats has been performed. Following application of different numbers of shockwaves (100-200-500), the presence of antibody was examined with the direct immunofluorescent technique 2 weeks and 3 months postprocedure. Whereas specimens examined after 2 weeks showed antibody formation in only one animal (500 HESWs), being located in the tubular tissues, all treated kidneys demonstrated various degrees of antibody formation in both tubular and glomerular tissues after 3 months. Antibody formation had a close relation to the number of HESWs applied and the time of examination after shockwave application. Apart from the well-defined functional and morphologic side effects of shockwave therapy, the possibility of immunologic alterations after this form of therapy has to be evaluated thoroughly in both clinical and experimental studies.

The role of cigarette smoking in prostatic enlargement.

OBJECTIVE: To investigate the association between cigarette smoking and sex hormone concentrations in men with benign prostatic hyperplasia (BPH) and thus provide some understanding of the underlying mechanism of the effects of cigarette smoking on prostatic enlargement. PATIENTS AND METHODS: The association between cigarette smoking and prostatic volume was investigated in 68 men with BPH (mean age 59 years, range 52-74) by assessing changes in serum levels of oestradiol, testosterone, dihydroepiandrosterone (DHEA) and dihydroepiandrosterone sulphate (DHEA-S). Possible enzymatic mechanisms in the prostate gland that might be affected by cigarette smoking were assessed. RESULTS: The mean prostate volume was greater in non-smokers than smokers. Current cigarette smokers had significantly higher mean serum oestradiol levels than did the non-smokers (33.8 and 26.7 pg/mL, respectively, P < 0.01). Cigarette smoking was inversely but not significantly related to testosterone level. These differences persisted after adjusting for body mass index. There was no significant difference in serum DHEA and DHEA-S levels between smokers and non-smokers. There was a weak correlation between the degree of prostatic enlargement, the presence of obstructive symptoms and urinary flow rates. CONCLUSION: These results indicate that cigarette smoking may affect the size of the enlarging prostate, but through indirect effects of smoking on factors provoking the development of BPH.

Immunohistochemical determination of p53 protein in prostatic cancer and prostatic intraepithelial neoplasms.

A role of genetic alterations in the p53 tumor suppressor gene has been implicated in many types of human malignancies. In this study, we examined the prevalence of immunohistochemically detectable p53 accumulation in prostatic tissues obtained from patients with prostatic adenocarcinoma, benign prostate hyperplasia and prostatic intraepithelial neoplasms. Six of 36 (16.7%) cancer cases and 2 of 11 (18.2%) cases of high-grade prostatic intraepithelial neoplasms showed p53 expression while no nuclear staining was observed in normal and hyperplastic prostatic tissues. Correlation of p53 expression with cancer stage, Gleason score and serum prostate-specific antigen level demonstrated that there was no statistically significant relationship between p53 expression and these clinicopathological parameters. Also, no significant association between p53 expression and prognosis was observed.

Carcinosarcoma of the prostate. A case report and a possible evidence on the role of hormonal therapy.

A case of prostatic carcinosarcoma is presented with histopathologic and immunohistochemical characteristics. A 70-year-old man presented with a history of anti-androgen (cyproterone acetate) therapy for prostatic adenocarcinoma. Diffuse and strong staining for progesterone receptor was observed in the carcinosarcoma specimen although it was completely negative in the previous adenocarcinoma specimen. It may be speculated that hormonal therapy might have facilitated the selection of a progesterone-dependent subclone of tumor cells with the ability of mesenchymal differentiation and that genetic instability due to p53 inactivation might have played a role in this process.

A 49-year-old woman with non-complicated exstrophy of the bladder.

We report a 49-year-old woman with exstrophy of the bladder. Our living case constitutes a rare example of bladder exstrophy cases, who lived about 50 years without any severe complication or intervention.

Serum neuron specific enolase: can it be a tumour marker for renal cell carcinoma?

Neuron specific enolase (NSE) is an isoenzyme of the glycolytic enzyme enolase. It is not only a marker for all types of neurons but also for all neuroendocrine or paraneuronal cells and various malignant tumours, even of non-neuroendocrine types. We had studied serum NSE in 25 consecutive patients with renal cell carcinoma (RCC). The study included 10 stage I, 3 stage II, 3 stage III-B and 9 stage IV-B patients. Both pretreatment and posttreatment levels were evaluated. Regardless of stage, overall we observed elevated levels of NSE in 80% (20/25) at diagnosis. After the appropriate treatment, according to the stage, there had been a statistically significant (p < 0.05) decrease in the serum levels in all stage I, II and III-B patients. The posttreatment values were not available for stage IV-B patients because they did not come for follow-up. The preliminary results of our study revealed that serum NSE may be considered as a useful marker in the evaluation and surveillance of RCC.