The first serological detection of West Nile virus infection among residents living in northern Turkey.

BACKGROUND & OBJECTIVES: West Nile virus (WNV) is transmitted by a mosquito-borne virus whose natural reservoir is birds. Humans and horses are considered accidental hosts. Even if the vast majority of WNV infections in humans have asymptomatic or mild disease settings, serious neurological disorders with lethal outcomes can also be observed in around 1% of the cases. We aimed to serologically investigate the presence of WNV in humans living in Black sea of Turkey, and to obtain epidemiological data that will contribute to the implementation of public health policies to control and prevent potentially other life-threatening arboviral infections. METHODS: In the current study, a total of 416 human sera were collected from native patients of Samsun and its boroughs attending Samsun Training and Research Hospital; these sera were tested for WNV with pooling method, using anti-IgM and IgG ELISA commercial kits. All pools that were found positive for both IgM and IgG were individually retested for the detection of positive WNV sera. After that, all positive samples were tested using real-time PCR to detect the presence of WNV-RNA particles. RESULTS: Total seropositivity rates of WNV in terms of IgM and IgG were found as 0.96% and 0.72%, respectively. No presence of WNV-RNA could be detected in positive samples. INTERPRETATION & CONCLUSION: According to the data, further studies should be conducted to better understand the epidemiological dynamics of WNV in Turkey. It is recommended that other antigenically related flaviviruses which can give cross-reaction with WNV should also be investigated.

Pulmonary-specific quality of life and dyspnea among patients hospitalized for coronavirus disease 2019: Evaluation of patient groups 1, 3 and 6 months after discharge.

BACKGROUND: Shortand long-term lung damage after coronavirus disease 2019 (COVID-19) has been emphasized in many studies, but pulmonary-specific health-related quality of life (HRQOL) has been examined only in a limited capacity. OBJECTIVES: In this study, we aimed to assess pulmonary-specific HRQOL and dyspnea among patients hospitalized for COVID-19 by applying the St George's Respiratory Questionnaire (SGRQ) to patient groups 1, 3 and 6 months following discharge (groups T1, T3 and T6). MATERIAL AND METHODS: This cross-sectional study was conducted between April 2020 and December 2020 at a tertiary hospital in Turkey. A total of 345 patients with a definite diagnosis of COVID-19 were included in our research. RESULTS: Total SGRQ score was significantly lower in the T6 group than in the T1 group (p < 0.001). The SGRQ-Symptom score was similar in the T3 and T6 groups, while the T1 group had significantly higher values (p < 0.001). The SGRQ-Activity score was significantly lower in the T6 group than in the T1 and T3 groups (p = 0.001), while the SGRQ-Impact score was significantly higher in the T6 group compared to the other 2 groups (p < 0.001). When the patients were analyzed statistically in terms of dyspnea, the difference between the baseline and 6-month results was found to be statistically significant (p < 0.001). CONCLUSIONS: Although long-term consequences are still not fully known, the SGRQ scores and dyspnea outcomes of our patients show that pulmonary-specific HRQOL and dyspnea remain at a similar level from discharge until the 6th month after discharge. Studies with extended and longitudinal follow-up are required.

Derangements of vaginal and cervical canal microbiota determined with real-time PCR in women with recurrent miscarriages.

Balanced vaginal microbiota and, as a continuum, cervical canal microbiota help prevent reproductive disorders, including recurrent miscarriage (RM). In a significant proportion of couples with RM, routine diagnostic workup cannot find any manageable cause, leading to a requirement for new diagnostic tools. In the present study, we determined the quantitative composition of the microbiota of the vagina and cervical canal, assessed by real-time polymerase chain reaction, in women with RM. It also evaluated their derangements related to the pathogenesis of RM, and thus the suitability of this test as a diagnostic tool for managing RM. Vaginal and cervical canal specimens of 25 women with RM and 25 healthy volunteers were collected. The test results revealed information about the total vaginal bacterial biomass by measuring the abundance of Lactobacillus spp.; other bacteria; and pathogens, including Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma (urealyticum + parvum), and Candida spp. Overall, the findings of this study implied the abundance of Lactobacillus spp. decreased in women with RM with an increase in the abundance of other microorganisms in accordance with the reduction in the abundance of Lactobacillus spp. due to aerobic vaginitis and bacterial vaginosis. Vaginal and cervical canal microbiota need to be considered during the diagnostic workup of women with RM.IMPACT STATEMENTWhat is already known on this subject? Recurrent miscarriage (RM) is a well-known reproductive disorder. Its diagnostic workup is not successful in determining the underlying problem in many cases. Hence, novel diagnostic tools based on real-time polymerase chain reaction (PCR) are needed for evaluating reproductive microbiota, which are considerably reliable, to satisfy the expectations of women with RM.What do the results of this study add? Overall, the decrease in the abundance of Lactobacillus spp. was found to be related to RM, and the patterns of the presence of other microorganisms were in accordance with the reduction in the abundance of Lactobacillus spp. These findings suggested an important role of vaginal and cervical canal microbiota in the pathogenesis of RM.What are the implications of these findings for clinical practice and/or further research? Additional research is warranted to elucidate the functional impact of altered components of the microbiota of vaginal and cervical canals on the physiology of the local cervical canal and its participation in the microbiota of the endometrial cavity, especially regarding unsuccessful pregnancies as a result of the disturbed physiology of the local endometrial microenvironment. However, possible applications of real-time PCR-based tests for the screening of subclinical infections in clinical practice require the performance of further investigations in patients with RM.

Assessment of vaginal and endometrial microbiota by real-time PCR in women with unexplained infertility.

AIM: Microbiota of the reproductive tract may be associated with unexplained infertility in women. We aimed to determine the derangements of vaginal and endometrial microbiota related to unexplained infertility by real-time polymerase chain reaction (real-time PCR) microbiota analyses of vaginal and endometrial samples of the unexplained infertility patients and fertile women. MATERIALS AND METHODS: Twenty-six women with unexplained infertility and 26 age-matched fertile women were included. Vaginal and endometrial samples were obtained in the mid-menstrual cycle for analysis by quantitative real-time PCR method. RESULTS: The proportion of lactobacilli-impaired microbiota was significantly higher in the vaginal samples of unexplained infertility patients (76.9% vs. 26.9%; p < 0.001). Those with impaired lactobacilli microbiota of vaginal samples had an increased risk of 9.048 times for infertility than those with normal lactobacilli microbiota. In addition, the mean lactobacilli/total bacterial mass (TBM) ratio in the vaginal samples was significantly lower in the unexplained infertility patients (38.2% vs.76.3%; p = 0.001). CONCLUSION: The present study results supported the role of vaginal and endometrial microbiota derangements in unexplained infertility. Many time-consuming and invasive methods are currently used in the diagnosis of infertility. Our study showed that the quantitative determination of lactobacilli/TBM ratio in vaginal specimens, a less invasive and easily obtainable method, could be used as a diagnostic test during the workup of couples with unexplained infertility.

Distribution and antifungal susceptibility of candida species isolated from blood cultures.

OBJECTIVE: To determine the distribution of samples exhibiting candida growth among the blood cultures, and the antifungal susceptibility. METHODS: The retrospective study was conducted at Samsun Training and Research Hospital, Samsun, Turkey, and comprised data of immunosuppressed patients with sepsis from January to December 2018. Yeast growth was typed by means of colony morphology, germ tube formation and the VITEK 2 system. The susceptibility was determined using the same automated system. Resistant strains were also tested using the dilution method. Data was analysed using SPSS 25. RESULTS: Of the 50 patients, 31(62%) were males and 19(38%) were females. The overall mean age was 60.84±22.05 years. Of the total samples, 31(62%) were received from intensive care units, 14(28%) from the palliative care unit, and 5(10%) from inpatients. The most common isolate was candida albicans 26(52%), while candida parapsiosis was the most common among non-albicans species 13(26%). Resistance to antifungals was observed in 13(26%) isolates; 5(10) to fluconazole, 4(8%) to voriconazole, 2(4%) each to flucytosine and amphotericin B. The findings obtained through both the dilution method and the automated system were consistent. CONCLUSIONS: The resistance to antifungal drugs varied among different candida species.

Ecchymosis and Coldness in Peripheral Varicose Vein Patients: Observations From VEIN-TURKEY Study.

The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, P = .002, respectively), and ecchymosis (16.6%, 2.7%, P < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis (r = 0.18, P < .001) and coldness (r = 0.35, P < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction.

Venous leg symptoms in patients with varicocele: A multicenter assessment study (VEIN-TURKEY study).

OBJECTIVE: The aim of this study is to evaluate chronic venous disease symptoms by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in varicocele patients. MATERIAL AND METHODS: The study was designed as a prospective, case controlled study and conducted in four hospitals from Turkey. A total of 600 patients who admitted to urology outpatient clinic were enrolled to the study. After the exclusion of 44 patients who do not match the inclusion criteria, the remaining 556 patients were examined for the presence and grade of varicocele and subsequently examined clinically for the presence of chronic venous disease findings. Finally, patients were asked to answer the VEINES-Sym questionnaire consisting of 10 items. All patients' demographic parameters, cardiovascular risk factors, other co-morbid diseases and drug usage were noted. RESULTS: Patients were classified into two groups: varicocele (+) group ( n = 269) and varicocele (-) group ( n = 287). VEINES-Sym scores of varicocele patients were lower compared to patients without varicocele (41.41 ± 5.21, 43.19 ± 3.22, respectively, p < 0.001). Grades of varicocele significantly but inversely correlated with VEINES-Sym score ( r = 0, -206, p = 0.001). Logistic regression analysis revealed that presence of varicocele irrespective of grading significantly and independently associated with the presence of aching (odds ratio: 2.054, 95% confidence interval: 1.265-3.338, p = 0.004) and throbbing (odds ratio: 2.586, 95% confidence interval: 1.353-4.943, p = 0.004). CONCLUSION: Varicocele patients have lower VEINES-Sym scores compared to patients without varicocele and this finding is inversely correlated with the degree of the varicocele. This association supports the hypothesis that there may be a systemic vessel wall abnormality in venous disease patients. Patients with symptoms related to vascular dilatation in any territory may deserve to be assessed systematically with the support of further clinical studies.

Comparative Results of Transurethral Incision with Transurethral Resection of The Prostate in Renal Transplant Recipients with Benign Prostate Hyperplasia.

PURPOSE: The aim of this study is to compare the results of transurethral incision of the prostate (TUIP) and transurethral resection of the prostate (TURP) for the surgical treatment of benign prostate hyperplasia (BPH) in patients with renal transplantation. MATERIALS AND METHODS: Between April 2009 and May 2016, BPH patients with renal transplants whose prostate volumes were less than 30 cm3 were treated surgically. Forty-seven patients received TURP and 32 received TUIP. The patients' age, duration of dialysis, duration between transplant and TURP/TUIP, preoperative and postoperative serum creatinine (SCr), International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and postvoidresidual volume (PVR) were recorded. At 1-,6- and 12-month follow-up, early and long-term complications were assessed. Results were evaluated retrospectively. RESULTS: In both groups, SCr, PVR and IPSS decreased significantly after the operation, while Qmax increased significantly (P < .001). There was no difference between the two groups in terms of increase in Qmax and decrease in IPSS, SCr and PVR (P = .89, P = .27, P = .08, and P = .27). Among postoperative complications, urinary tract infection (UTIs) and retrograde ejaculation (RE) rates were higher in the TURP group than the TUIP group (12.7% versus 6.2% and 68.1% versus 25%,respectively), whereas urethral strictures were more prevalent in the TUIP group (12.5% versus 6.3%). CONCLUSION: For the treatment of BPH in renal transplant patients with a prostate volume less than 30 cm3, bothTUIP and TURP are safe and effective.

[Brucellosis as a cause of hemophagocytic syndrome]. / Hemofagositik sendrom sebebi olarak bruselloz.

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of excessive inflammation and tissue destruction due to abnormal immune activation and inflammation. HLH can occur primarily due to genetic etiology, or secondarily associated with malignancies, autoimmmune diseases or infections. There are a number of reports that revealed the relationship of hemophagocytosis with brucellosis. In this report, we described a brucellosis-related HLH case. A 73-year-old male who work as farmer was admitted to our hospital with the complaints of fever continuing for 10 days, loss of appetite and back pain. Physical examination revealed right upper quadrant tenderness and hepatomegaly. Since the patient exhibited five of the diagnostic criteria for HLH (fever, hepatosplenomegaly, bicytopenia, hypertriglyceridemia and high ferritin level), he was diagnosed as secondary HLH. PCR, microscopic agglutination and indirect fluorescent antibody tests gave negative results for the diagnosis of Crimean-Congo hemorrhagic fever, leptospirosis and Q fever, respectively. On the other hand, Rose Bengal test for brucellosis was positive, while standard tube agglutination test (STA) was negative. The patient's serum yielded a very high positive (1/1280) result when Coombs' test was performed in terms of the possibility of blocking antibodies or prozone phenomenon. Additionally, B.melitensis was isolated from his blood culture on the sixth day. The patient was treated with doxycycline and rifampicin, and on the 10th day of antibiotic therapy the patient was discharged and recommended to complete his treatment up to 6 weeks. In conclusion, in patients with secondary HLH symptoms especially in the endemic areas, brucellosis should be considered as a predisposing infection.

In vitro activity of Brucella melitensis isolates to various antimicrobials in Turkey.

BACKGROUND: Brucellosis is a systemic infectious disease caused by Brucella bacteria. A successful treatment requires antibiotics that can penetrate into the cell at high concentrations. The aim of this study was to assess the biotype and in vitro activity of 80 Brucella isolates obtained from blood against various antimicrobials for human brucellosis in Turkey. METHODS: Identification of the types of the species designated Brucella species was made using the polymerase chain reaction (PCR), with type-specific primers. Serotyping was performed using mono-specific A and M antisera. The minimum inhibitory concentrations (MICs) of antibiotics known to have good intracellular penetration (doxycycline, rifampicin, ofloxacin, levofloxacin, moxifloxacin, clarithromycin, and azithromycin) were determined by the agar dilution method. RESULTS: All of the 80 Brucella isolates were determined to be Brucella melitensis: 75 B. melitensis biotype 3 (93.7%) and 5 B. melitensis biotype 1 (6.3%). Doxycycline was the most effective among the tested antibiotics against Brucella species (MIC(50)-MIC(90), 0.25-0.5 µg/ml), and it was followed by levofloxacin (MIC(50)-MIC(90), 0.5-1 µg/ml), moxifloxacin (MIC(50)-MIC(90), 1-1 µg/ml), ofloxacin (MIC(50)-MIC(90), 1-1 µg/ml), rifampicin (MIC(50)-MIC(90), 2-4 µg/ml), azithromycin (MIC(50)-MIC(90), 4-8 µg/ml), and clarithromycin (MIC(50)-MIC(90), 8-32 µg/ml), respectively. CONCLUSIONS: The in vitro activity of doxycycline and rifampicin, which are used in the classic treatment of brucellosis, was found to be very good. Quinolones were found to have in vitro activity against Brucella isolates. Among the macrolides, azithromycin had a higher level of activity compared with clarithromycin. A combination of quinolones and azithromycin could be an alternative to doxycycline and rifampicin in the treatment of brucellosis.

Effects of micronised purified flavonoid fraction on pain, semen analysis and scrotal color Doppler parameters in patients with painful varicocele; results of a randomized placebo-controlled study.

AIM: Aim of this study is to evaluate the effects of micronised purified flavonoid fraction (Daflon(®)) on pain, semen analysis and color Doppler parameters in patients with painful varicocele. MATERIALS AND METHODS: Forty varicocele patients whom have normal sperm concentration (>20 million/ml) were involved in the study. The patients were divided into two groups such as Daflon (n = 20) and placebo (n = 20) group. Pain score, semen analyses and Doppler sonography were performed in all patients before and after the treatment. RESULTS: In the first group, mean pain scores at 1, 3, 6 and 12 months were 1.80 ± 1.32, 1.15 ± 0.93, 1.05 ± 0.95 and 0.95 ± 0.89, respectively, all were significantly lower (P < 0.001 for each) than baseline (5.25 ± 1.07). While semen volume, total sperm count, sperm concentration and morphology were not changed significantly, the motility of sperm increased significantly (P = 0.015) due to decrease in grade 1 sperms at the 6th month in the first group. Reflux time of left spermatic vein during the Valsalva maneuver decreased significantly (P < 0.001). CONCLUSIONS: Results of this study suggest the safety and efficacy of Daflon in the treatment of varicocele-associated pain. However, these results of the present study must be confirmed by randomized placebo-controlled studies by using different drug doses and durations before making any recommendation for the use of Daflon.

Lipid peroxidation and antioxidant enzyme activities in cancerous bladder tissue and their relation with bacterial infection: a controlled clinical study.

It is well known that antioxidants and reactive oxygen species play an important role in carcinogenesis. In this study, we attempted to evaluate antioxidant enzyme activities and lipid peroxidation levels in cancerous bladder tissue and to determine their relationship with bacterial infection. Bacterial culture was made from all urine samples using Blood and Eosin Methylene Blue agars for checking the presence of bacterial infections. We measured thiobarbituric acid reactive substances (TBARs) and activities of xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), and catalase (CAT) in cancerous tissues of 25 bladder cancer patients, in noncancerous adjacent bladder tissues of 13 out of these 25 patients, and in control bladder tissues of 15 patients with a non-neoplastic genitourinary disease. TBARs levels increased and XO, SOD, GSH-PX, and CAT activities decreased significantly in cancerous bladder tissues. TBARS, XO, and SOD levels were not significantly different between noncancerous adjacent tissue and control bladder tissue. Statistically significantly lower GSH-PX and higher CAT activities were observed in noncancerous adjacent bladder tissue compared with cancerous tissue. GSH-PX level of tumor tissue was correlated significantly with tumor grade (r=-0.425, P=0.034). Results suggested that pathway activity of free radicals were accelerated in the cancerous human bladder tissues via increased TBARs levels and decreased enzyme activities of XO, SOD, GSH-PX, and CAT, which implicated a severe exposure of cancerous tissues to oxidative stress.

Prospective evaluation of the alterations in the morphology and vascular resistance of the renal parenchyma with color Doppler ultrasonography after percutaneous nephrolithotomy.

PURPOSE: To evaluate the kidneys with color Doppler ultrasonography (CDUS) to determine whether percutaneous nephrolithotomy (PNL) causes renal parenchymal damage. PATIENTS AND METHODS: In 24 patients who underwent unilateral PNL with single renal pole access, cortical thickness, echogenicity, and resistive index (RI) were measured in each pole of the operated and contralateral kidney separately before and at postoperative day (POD) 1, and at 3, 6, and 12 months after PNL. RESULTS: The mean age of the patients was 36.67 +/- 14.68 years. The serum creatinine level increased significantly immediately after PNL but diminished to the preoperative level at POD 1. Changes in serum blood urea nitrogen and electrolyte levels were insignificant. Mean cortical thickness increased significantly in the access pole and contralateral kidney and insignificantly in the nonaffected pole. No statistically significant change was recorded in parenchymal echogenicitiy. Statistically significant differences in cortical thickness between the access pole and the contralateral kidney and between the nonaffected pole and the contralateral kidney disappeared 3 months later. Differences in mean cortical thickness between the access pole and the nonaffected pole were insignificant at all examination periods. Echogenicity was greater in the access pole and the nonaffected pole than in the contralateral kidney only at POD 1. No significant difference was noted in the echogenicity between the access pole and the nonaffected pole. Mean RIs were lower than the universally accepted pathologic RI level (0.70) at all periods. There was no statistically significant difference between the mean RI values of the access pole, nonaffected pole, and contralateral kidney. CONCLUSION: PNL does not cause obvious renal dysfunction and significant parenchymal scarring, which is indicated by the decrease in cortical thickness and increases in cortical echogenicity and intrarenal RI.

Cardiovascular evaluation of young patients with varicocele.

OBJECTIVE: To evaluate cardiovascular risk factors and demographic parameters in patients with varicocele. DESIGN: Although some pathophysiologic hypotheses have been suggested to explain the etiology of varicocele, the exact mechanism underlying varicocele is not yet known. The coexistence of arterial and venous system pathologic conditions has been reported recently, including varicosities of the coronary venous system and leg veins. Cardiovascular risk factors have not been evaluated previously in patients with varicocele. In addition to the presence of cardiovascular risk factors and demographic parameters, we assessed the prevalence of peripheral varicose veins in patients with and without varicocele. PATIENT(S): Study groups consisted of 52 patients with varicocele and 100 patients without varicocele younger than 50 years old. RESULT(S): There were no statistically significant differences between the two groups with respect to presence of hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, body mass index, age, and height. The weight and presence of peripheral varicose veins in the patients with varicocele were significantly higher than in those without varicocele. It was found that presence of peripheral varicose veins was independently and positively associated with varicocele. CONCLUSION(S): We have demonstrated that varicocele is not associated with cardiovascular risk factors or demographic parameters. However, the presence of peripheral varicose veins is positively associated with varicocele, suggesting a possible common pathologic step.

Can the levels of nitric oxide in the urine, serum and tumor tissue be putative markers for bladder cancer?

AIM: To determine nitric oxide (NO) levels in serum, urine, tumor tissue and non-malignant adjacent tissue in bladder cancer patients compared with those in patients with a non-neoplastic genitourinary disease and to evaluate postoperative serum and urine NO change. METHODS: Samples was collected in 20 cancer and 41 control patients. Griess reagent was used for NO measurements. RESULTS: Mean age in the cancer and control groups was 64.2 +/- 9.9 and 63.7 +/- 8.9 years, respectively. Preoperatively, urinary infection incidence was not statistically different between groups. There were no significant differences in serum, urine and tissue NO levels in patients with and without infection in both groups. Hematuria was found to not affect urine NO level in the cancer group. Urine NO level was significantly higher than in controls preoperatively, decreased significantly following operation and remained stable after the third month. High serum NO values decreased at the early postoperative period; however, they re-increased in the long-term. No significant differences were observed in the third month in serum and urine NO levels between the patients with (no. 6) and without (no. 14) residual or relapsing tumor. No statistical difference was observed between NO levels in non-malignant adjacent and control tissues. However, tumor tissue NO level was significantly higher than those in the other two. There were no statistical differences in the first and third month serum and urine NO levels between patients who underwent bacillus Calmette-Guérin instillation therapy postoperatively and the patients who took chemotherapy or no further treatment. CONCLUSIONS: Both local and generalized host defense mechanisms seem to function in bladder cancer patients. Although further evaluation with a longer observation period and larger numbers of patients is necessary, results suggest that serum and urine NO levels are not putative and useful markers for bladder cancer.

Paradoxically developed optochiasmatic tuberculoma and tuberculous lymphadenitis: a case report with 18-month follow up by MRI.

We report the first case ofextracranial tuberculous lymphadenitis which paradoxically developed during treatment of intracranial tuberculoma. Our patient, a 15-year-old girl who initially presented with meningitis and intracranial tuberculomas, developed extracranial tuberculomas during treatment for central nervous system tuberculosis. She was followed clinically with cerebrospinal fluid (CSF) studies and magnetic resonance imaging (MRI) at three monthly intervals. Within 18 months of specific antituberculous treatment, the patient had fully recovered. The course and response to therapy are discussed in light of the current literature.

Combined branched-DNA and conventional HBV PCR assays for detection of serum HBV-DNA in hepatitis B e antigen-positive chronic hepatitis B patients.

BACKGROUND/AIMS: Monitoring of HBV replication level is very useful for the management of patients with chronic HBV. However, the use of the correct tools to quantify HBV-DNA levels in serum and monitor the replication of HBV is of paramount importance in terms of diagnosis, and antiviral treatment of patients with chronic HBV infection. The aim of this study was to combine the bDNA assay and HBV PCR to improve detection of viremia the patients with HBeAg-positive chronic hepatitis B infection. METHODOLOGY: In this study, 67 HBeAg-positive chronic hepatitis B patients were analyzed to determine viremia level using bDNA and HBV PCR assays. RESULTS: Sixty-four patients with HBeAg-positive chronic hepatitis B showed positivity by conventional HBV PCR, whereas 56 subjects with HBeAg-positive chronic hepatitis B showed HBV-DNA levels by bDNA. CONCLUSIONS: The results indicated that it is reasonable to use the bDNA assay to determine HBV replicative activity first, and use conventional HBV-PCR for HBeAg-positive chronic hepatitis B patient samples that are negative in bDNA assay.

Long-term effects of percutaneous nephrolithotomy on renal morphology and arterial vascular resistance as evaluated by color Doppler ultrasonography: preliminary report.

We evaluated the long-term effects of percutaneous nephrolithotomy (PNL) on renal morphology and vascular resistance. Parenchyma thickness, echogenicity and resistive index (RI) of upper, middle and lower poles of operated and contralateral kidneys of 41 patients with 82 renal units who underwent unilateral PNL with single pole access between 2000 and 2002 were examined separately by color Doppler ultrasonography. Mean patient age and duration between PNL and evaluation time were 38.29+/-11.53 years and 46.44+/-10.9 months, respectively. In operated kidney, mean RI, parenchyma thickness and echogenicity of the access pole were not statistically different than those of the adjacent two poles (0.608+/-0.053 vs. 0.608+/-0.052 for RI, P=0.895; 11.46+/-2.58 vs. 11.41+/-2.68 mm for parenchyma thickness, P=0.838; 0.049+/-0.31 vs. 0.073+/-0.33 for parenchyma echogenicity, P=0.160, respectively). Although mean RI and parenchyma thickness of access pole were statistically significantly different than the mean values of contralateral kidney (0.562+/-0.032 and 14.31+/-1.37 mm, respectively), no statistical difference was found between mean parenchyma echogenicities of both of them (echogenicity of contralateral kidney was 0, P=0.317). No significant difference was found between the average echogenicities of the three poles of the operated and contralateral kidneys (0.063+/-0.32 vs. 0, P=0.080). In 14 patients RI decreased from 0.694+/-0.058 to 0.602+/-0.056 in operated kidney (P=0.001) and from 0.604+/-0.06 to 0.559+/-0.031 in contralateral kidney (P=0.018) following PNL. It seems that PNL does not cause renal scarring, renal parenchymal loss or increase in renal vascular resistance in the long term. However, prospective studies must be performed for more definitive conclusions.

Increased prevalence of varicocele in patients with coronary artery ectasia.

BACKGROUND: Coronary artery ectasia (CAE) is defined as localized or diffuse non-obstructive lesions of the epicardial coronary arteries with a luminal dilation exceeding the 1.5-fold of normal adjacent segment or vessel diameter. Varicocele is the dilatation of the pampiniform plexus. Recently increased prevalence of peripheral varicose veins has been shown in patients with CAE. In this study we aimed to assess the prevalence of varicocele, which is dilatation of another venous system, in patients with CAE. MATERIALS AND METHODS: Thirty-five male consecutive patients with coronary artery ectasia in combination with or without coronary artery disease (CAD) and 63 male, age-matched patients with coronary artery disease were included in the study. All patients were evaluated for the presence of varicocele. RESULTS: Twenty-one patients with CAE were found to have varicocele (62% of group I patients). In patients with CAD, 24 patients (38%) were found to have varicocele. The difference between the two groups in respect to presence of varicocele was statistically significant (P=0.02; odds ratio=1.57; 95% confidence interval 1.05- 2.3). CONCLUSION: We have shown that patients with coronary artery ectasia have an increased prevalence of varicocele compared to those with coronary artery disease. The mechanism underlying coronary artery ectasia might further increase the prevalence of varicocele in susceptible patients.

Color Doppler sonography examination of partially obstructed kidneys associated with ureteropelvic junction stone before and after percutaneous nephrolithotripsy: preliminary report.

AIM: To evaluate resistive index (RI) changes before and after unilateral percutaneous nephrolithotripsy in chronic partially obstructed kidneys due to ureteropelvic junction (UPJ) stones. METHODS: Intrarenal RI of obstructed and contralateral normal kidneys of 18 patients were recorded immediately before the operations and at postoperative days 1, 7 and 30. Postoperative RI measurements were compared with baseline values for all patients without grouping and separately for different groups according to the preoperative RI value of the obstructed kidney. RESULTS: Mean age and symptom duration were 27.5 years and 43.8 weeks, respectively. Preoperatively and at all postoperative controls, kidney diameters and renal parenchyma thicknesses were normal in all patients. Mean RI of obstructed kidneys decreased from 0.68 to 0.63 for all patients (P=0.032), from 0.64 to 0.63 for those with preoperative RI<0.70 (P=0.850) and from 0.73 to 0.62 for those with preoperative RI>or=0.70 (P=0.001). In patients with preoperative RI>or=0.70 in obstructed kidney, significant RI decreases were recorded at postoperative day 7 and RI differences between obstructed and contralateral kidneys disappeared after then. No difference was present pre- and postoperatively between the mean RI of obstructed and contralateral kidneys of the patients with RI<0.70. Mean RI of contralateral kidneys were normal preoperatively and showed no significant change postoperatively. CONCLUSIONS: Preoperative RI levels may indirectly reflect the presence of functionally significant obstruction in chronic obstructed kidneys related to UPJ stones. Patients with RI>or=0.70 may have a good indication for a surgical approach. Normalization of high RI occurs rapidly after percutaneous nephrolithotripsy.