The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study.

The aim of this study was to determine the independent risk factors, morbidity, and mortality of central nervous system (CNS) infections caused by Listeria monocytogenes. We retrospectively evaluated 100 episodes of neuroinvasive listeriosis in a multinational study in 21 tertiary care hospitals of Turkey, France, and Italy from 1990 to 2014. The mean age of the patients was 57 years (range, 19-92 years), and 64% were males. The all-cause immunosuppression rate was 54 % (54/100). Forty-nine (49 %) patients were referred to a hospital because of the classical triad of symptoms (fever, nuchal rigidity, and altered level of consciousness). Rhombencephalitis was detected radiologically in 9 (9 %) cases. Twenty-seven (64 %) of the patients who had cranial magnetic resonance imaging (MRI) performed had findings of meningeal and parenchymal involvement. The mean delay in the initiation of specific treatment was 6.8 ± 7 days. Empiric treatment was appropriate in 52 (52 %) patients. The mortality rate was 25 %, while neurologic sequelae occurred in 13 % of the patients. In the multivariate analysis, delay in treatment [odds ratio (OR), 1.07 [95 % confidence interval (CI), 1.01-1.16]] and seizures (OR, 3.41 [95 % CI, 1.05-11.09]) were significantly associated with mortality. Independent risk factors for neurologic sequelae were delay in treatment (OR, 1.07 [95 % CI, 1.006-1.367]) and presence of bacteremia (OR, 45.2 [95 % CI, 2.73-748.1]). Delay in the initiation of treatment of neuroinvasive listeriosis was a poor risk factor for unfavorable outcomes. Bacteremia was one of the independent risk factors for morbidity, while the presence of seizures predicted worse prognosis. Moreover, the addition of aminoglycosides to ampicillin monotherapy did not improve patients' prognosis.

When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study.

OBJECTIVE: In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. METHODS: Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into 2 groups according to the "patient-based approach" criteria we adopted in our clinic. Group 1 in whom the contralateral teste was fixed in the same surgical act and group 2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. RESULTS: A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% Group 1 vs. 5.3% Group 2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. CONCLUSION: There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.

Spreading-splashing transition of nanofluid droplets on a smooth flat surface.

HYPOTHESIS: Even a small fraction of nanoparticles in fluids affects the splashing behavior of a droplet upon impact on a smooth surface. EXPERIMENTS: Nanofluid drop impact onto a smooth sapphire substrate is experimentally investigated over wide ranges of Reynolds (102

Caudal analgesia for prostate biopsy.

BACKGROUND: Although various local anesthesia techniques have been suggested to decrease pain and discomfort during a transrectal ultrasound (TRUS)-guided prostate biopsy, the best method has not yet been defined. The present prospective, double-blind, randomized study aims to investigate the clinical efficacy of 'walking' caudal block compared with an intrarectal lidocaine gel for this procedure. METHODS: One hundred patients were randomly assigned to two groups. In the lidocaine gel group, 10 ml of gel containing 2% lidocaine was given intrarectally. In the caudal group, 20 ml 0.1% bupivacaine with 75 microg fentanyl was injected. Pain scores, anal sphincter tone and patient satisfaction were evaluated. RESULTS: The pain scores were significantly lower in the caudal group at all stages. Verbal rating scores (scale 1-4) during probe insertion, probe maneuver and biopsies were 1 (0-2), 1 (0-2) and 1 (0-2) vs. 3 (0-5), 2 (1-3) and 4 (2-6), respectively (P value <0.0001 at all stages). The anal sphincter was more relaxed in the caudal group than in the gel group (P value <0.0001 in all categories). Highly satisfied patients were more frequently encountered in the caudal group, 34 (68%) vs. 8 (16%), P<0.0001, and unsatisfied patients were more frequently found in the gel group 1 (2%) vs. 12 (24%); P<0.001. All patients were able to walk without any assistance immediately after the procedures. CONCLUSION: 'Walking' caudal analgesia is an efficacious method for relieving the pain during TRUS-guided prostate biopsies in ambulatory practice.

Possible impact of inflammatory status on C-telopeptide pyridinoline cross-links of type I collagen and osteocalcin levels around oral implants with peri-implantitis: a controlled clinical trial.

Detection of progression level of peri-implantitis may help in the prevention of oral implant failure. C-telopeptide pyridinoline crosslinks of Type I collagen (ICTP) and osteocalcin (OC) are specific markers of bone turnover and bone degradation. Determination of the ICTP and OC levels in the peri-implant sulcus fluid (PISF) may predict the metabolic and/or inflammatory changes in the peri-implant bone. The aim of this clinical study was to evaluate ICTP and OC levels in the PISF for oral implants with and without peri-implant bone destruction and correlate these levels with the traditional clinical peri-implant parameters (probing depth, plaque index, gingival index and gingival bleeding time index) and radiographic bone level measurements. Fifteen patients with 30 peri-implant sites with bone destruction (radiographic bone loss) and health were included. Clinical parameters were measured and PISF was collected from the sites. Peri-implant sulcus fluid ICTP and OC levels were detected by radioimmunoassay technique from PISF samples. All clinical parameters demonstrated a significant increase in peri-implantitis sites compared with healthy sites. The PISF volume of the peri-implantitis sites was also significantly higher than of the healthy peri-implant sites. Although not statistically significant, a trend of increase was demonstrated in ICTP PISF samples sampled from peri-implantitis sites compared with healthy sites. A significant increase was noticed for OC PISF level in peri-implantitis sites compared with healthy ones. As well as peri-implant clinical measurements, volumetric changes at PISF may be counted as an important clinical parameter to distinguish the bone destruction sites from healthy sites around oral implants.

The effect of maternal nutrition level during the periconception period on fetal muscle development and plasma hormone concentrations in sheep.

The effect of maternal nutrition level during the periconception period on the muscle development of fetus and maternal-fetal plasma hormone concentrations in sheep were examined. Estrus was synchronized in 55 Karayaka ewes and were either fed ad libitum (well-fed, WF, n=23) or 0.5×maintenance (under-fed, UF, n=32) 6 days before and 7 days after mating. Non-pregnant ewes (WF, n=13; UF, n=24) and ewes carrying twins (WF, n=1) and female (WF, n=1; UF, n=3) fetuses were removed from the experiment. The singleton male fetuses from well-fed (n=8) and under-fed (n=5) ewes were collected on day 90 of gestation and placental characteristics, fetal BWs and dimensions, fetal organs and muscles weights were recorded. Maternal (on day 7 after mating) and fetal (on day 90 of pregnancy) blood samples were collected to analyze plasma hormone concentrations. Placental characteristics, BW and dimensions, organs and muscles weights of fetuses were not affected by maternal feed intake during the periconception period. Maternal nutrition level did not affect fiber numbers and the muscle cross-sectional area of the fetal longissimus dorsi (LD), semitendinosus (ST) muscles, but the cross-sectional area of the secondary fibers in the fetal LD and ST muscles from the UF ewes were higher than those from the WF ewes (P<0.05). Also, the ratio of secondary to primary fibers in the ST muscle were tended to be lower in the fetuses from the UF ewes (P=0.07). Maternal nutrition level during the periconception period did not cause any significant changes in fetal plasma insulin and maternal and fetal plasma IGF-I, cortisol, progesterone, free T3 and T4 concentrations. However, maternal cortisol concentrations were lower while insulin concentrations were higher in the WF ewes than those in the UF ewes (P<0.05). These results indicate that the reduced maternal feed intake during the periconception period may alter muscle fiber diameter without affecting fiber types, fetal weights and organ developments and plasma hormone concentrations in the fetus.

Kinetic properties of human placental glucose-6-phosphate dehydrogenase.

The kinetic properties of placental glucose-6-phosphate dehydrogenase were studied, since this enzyme is expected to be an important component of the placental protection system. In this capacity it is also very important for the health of the fetus. The placental enzyme obeyed "Rapid Equilibrium Ordered Bi Bi" sequential kinetics with K(m) values of 40+/-8 microM for glucose-6-phosphate and 20+/-10 microM for NADP. Glucose-6-phosphate, 2-deoxyglucose-6-phosphate and galactose-6-phosphate were used with catalytic efficiencies (k(cat)/K(m)) of 7.4 x 10(6), 4.89 x 10(4) and 1.57 x 10(4) M(-1).s(-1), respectively. The K(m)app values for galactose-6-phosphate and for 2-deoxyglucose-6-phosphate were 10+/-2 and 0.87+/-0.06 mM. With galactose-6-phosphate as substrate, the same K(m) value for NADP as glucose-6-phosphate was obtained and it was independent of galactose-6-phosphate concentration. On the other hand, when 2-deoxyglucose-6-phosphate used as substrate, the K(m) for NADP decreased from 30+/-6 to 10+/-2 microM as the substrate concentration was increased from 0.3 to 1.5 mM. Deamino-NADP, but not NAD, was a coenzyme for placental glucose-6-phosphate dehydrogenase. The catalytic efficiencies of NADP and deamino-NADP (glucose-6-phosphate as substrate) were 1.48 x 10(7) and 4.80 x 10(6) M(-1)s(-1), respectively. With both coenzymes, a hyperbolic saturation and an inhibition above 300 microM coenzyme concentration, was observed. Human placental glucose-6-phosphate dehydrogenase was inhibited competitively by 2,3-diphosphoglycerate (K(i)=15+/-3 mM) and NADPH (K(i)=17.1+/-3.2 microM). The small dissociation constant for the G6PD:NADPH complex pointed to tight enzyme:NADPH binding and the important role of NADPH in the regulation of the pentose phosphate pathway.

New sample preparation method for the capillary electrophoretic determination of adenylate energy charge in human erythrocytes.

The first step in the separation of adenine nucleotides from different types of tissues or cells is deproteinization. Several sample preparation methods successfully used for a number of tissues or cells failed to work with erythrocytes. Use of strong acids or bases for deproteinization resulted in a low yield due to the hydrolysis of adenine nucleotides. Moreover, the neutralization of these acids or bases increased the ionic strength, resulting in broad and overlapping peaks. In neutral salt precipitation methods, saturated salts caused clogging of the capillaries. A new deproteinization procedure method was developed. The samples were deproteinized by heating of erythrocytes in boiling distilled water at 95 degrees C for 5 min. The denatured proteins were removed by centrifugation and membrane filtration. The adenine nucleotides were then separated using a polyacrylamide coated capillary. Depending on the type, diameter, length of the capillary and the voltage applied, an average of 16.50 min was sufficient for the separation of adenine nucleotides. All adenine nucleotides were clearly resolved and gave very sharp peaks. The amount of each adenine nucleotide was calculated from the areas under the peaks and AEC values were calculated using the integrator software. The AEC value of 0.91+/-0.04 (n=10) obtained for healthy persons was in good agreement with the literature value of 0.85-0.95. These reported method for sample preparation and capillary electrophoresis is simple, fast and inexpensive compared to the previously reported sample preparation, HPLC and enzymatic methods for the determination of AEC.

Clinical management of hydatid disease of the urinary tract.

This study reviews urinary hydatid disease in seven males and three females (mean age, 32.1 +/- 17.7 years; range, 7-67 years). Cysts were located in the kidney in six cases (one also involved the liver), the paravesical and retrovesical region in two cases (one coexisted with a bladder tumour), the adrenal gland (one case) and in the right parapelvic region (one case). Investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), abdominal ultrasonography, intravenous urography and computed tomography (CT). All patients underwent surgery and were followed for an average of 5.6 years. Lumbar or abdominal pain was the most common symptom. Eosinophilia was seen in five patients (50%), IHA positivity occurred in four patients (40%) and the Casoni skin test was positive in four patients (40%). Abdominal CT was the most useful diagnostic method of radiological investigation (100%). No complications or recurrences were seen on follow-up. Urinary hydatid disease is uncommon and is likely to cause considerable diagnostic difficulties, and should therefore be considered in the differential diagnosis of space-occupying lesions of the urinary tract.

Estradiol and nitric oxide in men over 50 years of age.

We measured the circulatory levels of nitric oxide and estradiol in men over 50 years with estrogenisation findings. We investigated relation between nitric oxide, which is the principal signal for relaxation of vascular smooth muscle cells, and estradiol levels in serum in men over 50 years with estrogenisation. This study included 14 men with (group 1) and 20 without estrogenisation findings (group 2). Mean nitric oxide and estradiol levels were found to be significantly lower in group 2 than group 1. Group 2 had lower levels sex-hormone binding globin and higher both systolic and diastolic blood pressure values than group 1. There was a significant correlation between nitric oxide and estradiol in esrogenisation group.

Hydatid disease of the urinary tract: review of the management of 9 cases.

The aim of this study is to review 9 cases with urinary tract hydatid disease in terms of symptoms, findings, laboratory tests, radiological findings and treatment modalities. There were 7 males and 2 females with a mean age of 33.6 years (range from 7 to 67 years). In 6 patients hydatid cyst was located in the kidney (1 involved the liver), in 2 the cysts were in the paravesical and retrovesical region (1 coexisted bladder tumor) and 1 the cyst was located adrenal gland. The investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), transabdominal ultrasonography (TAUS), intravenous urography (IVU) and computed tomography (CT). All patients underwent various surgical procedures and were followed-up for an average of 3 years (range: 1 month to 5 years) period in terms of complications and recurrence rates. The most common symptom was lumbar or abdominal pain. Eosinophilia was seen in 4 patients (44.4%), IHA positivity in 3 patients (33.3%) and Casoni skin test were positive in 3 patients (33.3%). The most diagnostic method of radiological investigations was abdominal pelvic CT (100%). After surgical treatment, in mean a 3 year (range: 1 month to 5 years) follow-up period, no complication and recurrence were seen. Hydatid disease of the urinary tract is relatively uncommon and is likely to cause considerable diagnostic difficulties for clinicians and radiologists: therefore, it should be born in mind in the differential diagnosis of space-occupying lesions of the urinary tract.

Transitional cell carcinoma of the bladder in patients under 40 years of age.

A review of our records between 1993 and 1998 identified 25 patients with transitional cell carcinoma of the bladder who were less than 40 years old, 22 males and 3 females. The youngest patient was 19 years old. At the time of diagnosis 16 patients had superficial (Ta/T1) and 9 had invasive disease. Twenty-four patients were followed up for a period of 3-71 months (mean: 19.2 months). The recurrence rate for patients with superficial disease was 12.5%, and the progression rate for patients with invasive disease was 77.7%. We concluded that the patients under 30 years of age presented with lower grade and lower stage disease than those over 30. Transitional cell carcinoma of the bladder in young adults has a natural history similar to that seen in older patients. Accordingly, all patients, regardless of age, should be treated as aggressively as necessary on the basis of the stage and the grade of the tumour.

Squamous metaplasia of the bladder: findings in 14 patients and review of the literature.

We have documented the data of squamous metaplasia of the bladder in 14 patients who had undergone cystoscopies for different reasons. In two biopsies, there were marked keratinization and cellular atypia. One of these two subjects was diagnosed as squamous carcinoma of the prostate and transitional cell carcinoma of the bladder. The lesions of 8 female patients were on the trigone and evaluated as normal anatomical variants due to hormonal changes. Three of them were remarkable because of recurrent urinary infections. Apart from the two male patients with squamous cell carcinoma of the prostate the two male patients with current squamous metaplasia have been following up. In this study, we have also reviewed the relationship between squamous metaplasia, infection and malignancy.

Iatrogenic injuries to ureter, bladder and urethra during abdominal and pelvic operations.

Abdominal and pelvic operations at Departments of Obstetrics and Gynaecology, and General Surgery play an important role in ureteral, bladder and rarely urethral injuries. Fifty-nine patients with iatrogenic ureteral, bladder and urethral injuries were treated at the Department of Urology, Atatürk University Research Hospital, between 1985 and 1995. These injuries were urinary vaginal fistulas in 43 patients (vesicovaginal 33, ureterovaginal 7, urethrovaginal 2 and vesicovaginal plus urethrovaginal 1), ureteric ligation in 9, bladder laceration in 7. These injuries were treated by different methods. All patients were followed up by intravenous urography (IVU) and urine culture three months later. It must be borne in mind that iatrogenic urinary tract injuries are not rare. Bladder and ureteral catheterization must be performed to prevent these complications.

Effects of doxazosin in men with benign prostatic hyperplasia: urodynamic assessment.

OBJECTIVE: In this study, a randomized and placebo controlled trial, we aimed to study the effectiveness and safety of doxazosin based upon urodynamic parameters, especially pressure/flow studies, in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 57 men (29 doxazosin, 28 placebo) 48-82 years of age with BPH were enrolled. Yet, 8 of 29 in the doxazosin group and 10 of 28 in the placebo group were excluded due to side effects of doxazosin and intolerability of urodynamic assessment of free uroflow, postvoiding residual urine volume (PVR) and pressure/flow studies. RESULTS: There were improvements in all urodynamic parameters (Free Qmax: 30.4% and 28%, PVR: 14 ml and 12 ml, invasive Qmax: 29.3% and 26.2%, Pdet at Qmax: -32.7% and -30%, Pdet-max: -29% and -27.7% at end of the 1st and 6th months whereas placebo effects were worsening in all urodynamic parameters. CONCLUSIONS: We suggest that doxazosin is an important treatment option for patients with BPH, and efficacy of doxazosin should be evaluated with objective, quantitative urodynamic studies not with subjective symptom scores. But additional costs and invasiveness of urodynamic studies restrict their common usefulness.

¿Cuándo se debe realizar la fijación testicular contralateral en pacientes pospuberales con torsión testicular? Estudio comparativo / When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study

Objetivo En este estudio nos propusimos averiguar cuál es el momento óptimo para realizar la fijación testicular contralateral evaluando nuestros resultados de diez años en pacientes pospuberales con torsión testicular bajo un enfoque centrado en el paciente. Métodos Los pacientes pospuberales con diagnóstico de torsión testicular en un hospital terciario entre enero de 2012 y septiembre de 2022 se dividieron en dos grupos según los criterios del «enfoque centrado en el paciente» que adoptamos en nuestro centro. En el grupo1 se fijó el testículo contralateral en el mismo acto quirúrgico y en el grupo2 la fijación se realizó de forma diferida. Ambos grupos fueron examinados retrospectivamente, analizados estadísticamente y comparados. Resultados Un total de 41 pacientes se incluyeron en el estudio. En 19 (46,3%) de ellos se realizó fijación en el mismo acto, y en 22 (53,7%) se efectuó la fijación testicular contralateral de forma electiva. Se observó dehiscencia precoz de la herida en un paciente de cada grupo (4,5% grupo1 frente al 5,3% grupo2). En el periodo postoperatorio no se detectó atrofia ni torsión testicular contralateral en ningún grupo del estudio durante el seguimiento de 1año. Conclusión No existe ningún algoritmo para determinar el momento óptimo en que debe realizarse la fijación testicular contralateral en pacientes pospuberales con torsión testicular. Mediante enfoques centrados en el paciente, en los que se da prioridad a las características clínicas del paciente para determinar cuándo realizar la fijación testicular contralateral, se pueden obtener resultados que demuestran su eficacia y su seguridad (AU)

Objective In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. Methods Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into two groups according to the «patient-based approach» criteria we adopted in our clinic. Group1 in whom the contralateral teste was fixed in the same surgical act and group2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. Results A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% group1 vs. 5.3% group2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. Conclusion There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results (AU)

Antiapoptotic effects of dehydroepiandrosterone on testicular torsion/detorsion in rats.

In the present study, we aimed to evaluate the effects of dehydroepiandrosterone (DHEA) on apoptosis of testicular germ cells after repair of testicular torsion in rats. Twenty-four adult male Sprague-Dawley rats were randomly divided into four groups, with six rats in each group: sham operation, torsion/detorsion (T/D), T/D + vehicle, and T/D + DHEA. Three hours before detorsion, 50 mg kg(-1) DHEA was given intraperitoneally to T/D + DHEA group. In all groups, bilateral orchiectomies were performed and both testicles were histologically examined, with apoptosis detected using the in situ DNA fragmentation [terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)] system, with morphological damage detected using a four-level grading scale in each specimen. The testes of the sham group showed a normal histology. In T/D and T/D + vehicle groups, apoptotic spermatogonia and spermatocyte number were significantly higher than in the sham group (P < 0.01 for all). The T/D + DHEA group showed a reduction in apoptotic spermatocyte and spermatogonia number in seminiferous epithelia compared with T/D group (P < 0.01 for both). Apoptotic cell number of contralateral testes did not reveal any significant differences among these groups (P > 0.05). Specimens from T/D and T/D + vehicle had a significantly greater histological injury than sham and T/D + DHEA groups in the ipsilateral testes (P < 0.01 for both). Therefore, the results suggest that DHEA may be a protective agent for preventing apoptosis caused by testicular torsion.